MAMMOMAT Revelation (VC20) – Basic Quick Guide for 2D & 3D

MAMMOMAT Revelation (VC20) – Basic Quick Guide for 2D & 3D 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 Job Aid | Mammomat Revelation – Basic System Operation 2D & 3D Effective Date: 22/01/2021 | HOOD05162003148254 Introduction 3 System hardware overview 4 Key hardware features 6 Acquisition workstation 10 Icons 17 Tomosynthesis (option) terms 18 Detector calibrations 19 Exercise: 2D examination 22 Exercise: re-enter a patient 23 Exercise: tomosynthesis (option) examination 24 Insight BD (option) 25 TiCEM (option) 27 Exercise: TiCEM (option) examination 32 Restricted Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2021 SIEMENS Master Template Effective Date: 5 Mar 2020 | HOOD05162003074494 Job Aid Effective Date: 22 JAN 2021 | HOOD05162003148254 Healthineers Page 2 of 34 Job Aid | Mammomat Revelation – Basic System Operation 2D & 3D Effective Date: 22/01/2021 | HOOD05162003148254 Introduction You may have already gained an overview of the MAMMOMAT Revelation hardware components and user interface while working through the provided online training courses on PEPconnect. To help you to prepare for the initial training, you can use this quick guide 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 that are provided after each chapter so that they can be answered and clarified by a certified education specialist during the handover training. Note: Tomosynthesis, TiCEM and Insight BD are optional features that need dedicated licenses. You will find detailed information about the features and their workflows in the corresponding operator manuals. Training overview Upon completion of this workbook, you will be able to: • Identify the key hardware features of the MAMMOMAT Revelation • Identify the key features on 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 Revelation, 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: 22 JAN 2021 | HOOD05162003148254 Healthineers Restricted Page 3 of 34 Job Aid | Mammomat Revelation – Basic System Operation 2D & 3D Effective Date: 22/01/2021 | HOOD05162003148254 System hardware overview (1) (2) (9) (3) (4)- ( 2) (5) (6) (7). (8) (10) (1) Swivel arm with X-ray tube unit and collimator (integrated) (2) Swivel-arm operation keys (on both sides) to adjust the height and angle of the swivel arm and to turn on the field light (3) Compression emergency unlocking device (4) Compression/decompression control knobs (on both sides) (5) Compression unit (6) Object table (7) Patient support hand rest behind compression unit (8) Stand display, digital (9) Emergency STOP button (10) Foot switches (2 switches; figure shows one foot switch) Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2021 SIEMENS Master Template Effective Date: 5 Mar 2020 | HOOD05162003074494 Job Aid Effective Date: 22 JAN 2021 | HOOD05162003148254 Healthineers Restricted Page 4 of 34 Job Aid | Mammomat Revelation – Basic System Operation 2D & 3D Effective Date: 22/01/2021 | HOOD05162003148254 Notes Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2021 SIEMENS Master Template Effective Date: 5 Mar 2020 | HOOD05162003074494 Job Aid Effective Date: 22 JAN 2021 | HOOD05162003148254 Healthineers Restricted Page 5 of 34 Job Aid | Mammomat Revelation – Basic System Operation 2D & 3D Effective Date: 22/01/2021 | HOOD05162003148254 Key hardware features Overview This section will discuss key hardware features of the MAMMOMAT Revelation. Swivel arm (1) (4) (2) (5) (3) (6) (1) Raise swivel arm (height adjustment) (2) Turn swivel arm counterclockwise (angle adjustment) (3) Lower swivel arm (height adjustment) (4) Turn swivel arm clockwise (angle adjustment) (5) Single-touch button Press the single-touch button briefly: automatic movement to the preset angle position for the next projection view - during movement → movement stop. - Press the single-touch button slightly longer: transfer angle position to the opposite side - The single-touch functionality needs to be activated by rotating the swivel arm once from +90° to -90° angle once a day and after each system restart. (6) Collimator light (switched ON automatically when the foot switch compression is activated) Compression plate Mounting the compression plate: • Insert the guide of the compression plate into the receiver on the compression unit. • The compression plate automatically locks in position. Removing the compression plate: • Press the release button on the compression plate receiver and pull the compression plate out. Various compression plates are available for this system. The plates vary according to function, flexibility and size – the availability of your plates depends on the clinical procedures and your order. Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2021 SIEMENS Master Template Effective Date: 5 Mar 2020 | HOOD05162003074494 Job Aid Effective Date: 22 JAN 2021 | HOOD05162003148254 Healthineers Restricted Page 6 of 34 Job Aid | Mammomat Revelation – Basic System Operation 2D & 3D Effective Date: 22/01/2021 | HOOD05162003148254 Emergency stop buttons Emergency stop buttons are located on both sides of the system and on the Control Box. STOP 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. Stand display The stand display is located at the base of the X-ray stand. From here you can view the projection angle, the breast compression thickness and the compression force. (1) (2) (3) 0 219 O mm N ( P ) - ( 5 ) Fletcher Mae + (4) (1) Projection angle Current angle of the swing arm in [°] (2) Thickness of the compressed object in [mm] (3) Compression force (F), expressed in N (Newtons) (when OPCOMP is used and the optimum compression is achieved, the force indicator flashes) (4) Patient name (5) Blocked movements: As soon as the N (P) is displayed, the table movements are blocked. Compression/decompression OPCOMP The “optimized compression” (OPCOMP®) function determines the correct compression force to be exerted on the breast based on individual features of the breast. This provides optimal comfort for the patient as well as 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. • Is regarded as a recommendation but all patients may not be able to tolerate it. If breast is not taut, additional compression may be given. Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2021 SIEMENS Master Template Effective Date: 5 Mar 2020 | HOOD05162003074494 Job Aid Effective Date: 22 JAN 2021 | HOOD05162003148254 Healthineers Restricted Page 7 of 34 Job Aid | Mammomat Revelation – Basic System Operation 2D & 3D Effective Date: 22/01/2021 | HOOD05162003148254 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. 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 In the event of a power failure or if motor-driven decompression is not possible (not working), release the patient as follows: Emergency compression release (1) (1) LK (3) (2) (2) 1 Forcefully press the emergency release button (1) with one hand, and keep the button pressed. 2 Place the other hand under the compression plate (2) and press it upward. The patient can be removed from the compression plate. 3 First remove the hand from the emergency release button, and then remove the hand from the compression plate. Make sure the compression plate does not fall on the detector. Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2021 SIEMENS Master Template Effective Date: 5 Mar 2020 | HOOD05162003074494 Job Aid Effective Date: 22 JAN 2021 | HOOD05162003148254 Healthineers Restricted Page 8 of 34 Job Aid | Mammomat Revelation – Basic System Operation 2D & 3D Effective Date: 22/01/2021 | HOOD05162003148254 If the emergency release button is blocked, proceed as follows: (1) (1) (2) 1 Forcefully press the emergency release button (1) with one hand, and press against the compression holder (3) with the other. The emergency release button is released. 2 Keep the emergency release button pressed. 3 At the same time, place your hand under the compression plate (2) and press it upward. The patient can be removed from the compression plate. 4 First remove the hand from the emergency release button, and then remove the hand from the compression plate. Make sure the compression plate does not fall on the detector. ....................................... 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: 22 JAN 2021 | HOOD05162003148254 Healthineers Restricted Page 9 of 34 Job Aid | Mammomat Revelation – Basic System Operation 2D & 3D Effective Date: 22/01/2021 | HOOD05162003148254 Acquisition workstation Overview This section will discuss the design and function of the acquisition workstation and application program. (1) (3) (1) Operating console (option) with radiation shield (option) (4) (5) (2) Workstation with CD-R/DVD-R drive (6). (3) TFT monitor (4) Control Box (7) (5) Mouse (6) Keyboard (on keyboard shelf) (7) Operating console (hydraulic continuous height adjustment possible) (2) Examinations using the MAMMOMAT Revelation system are controlled at the Acquisition Workstation. Notes Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2021 SIEMENS Master Template Effective Date: 5 Mar 2020 | HOOD05162003074494 Job Aid Effective Date: 22 JAN 2021 | HOOD05162003148254 Healthineers Restricted Page 10 of 34 Job Aid | Mammomat Revelation – Basic System Operation 2D & 3D Effective Date: 22/01/2021 | HOOD05162003148254 Control Box ST OP (2) ( L ) O (5) (3) (6) (M-) (4) (1) Emergency stop All system movements and X-ray radiation are stopped. (2) Not used (3) Raise compression plate (decompression) Press and hold the button → decompression starts (4) Start radiation (Exposure button) The button lights up yellow during irradiation (radiation display). Button flashes green if action is required, e.g. compression. Button lights up solid green if the system is ready for exposure. (5) System OFF (6) System ON When the system is ready for operation, the button lights up green. Switching the system on (startup) The MAMMOMAT Revelation 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. • Complete the +90° to -90° “single touch” activation. Switching the system off (shutdown) • Go to the top menu bar and click on Options, then select End Session and choose Shutdown System. • Confirm by clicking YES. • The system will automatically shut down to standby mode. • Once the system has begun the countdown, press the System OFF button (6) on the Control Box and the system will shut down completely. The MAMMOMAT Revelation 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. Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2021 SIEMENS Master Template Effective Date: 5 Mar 2020 | HOOD05162003074494 Job Aid Effective Date: 22 JAN 2021 | HOOD05162003148254 Healthineers Restricted Page 11 of 34 Job Aid | Mammomat Revelation – Basic System Operation 2D & 3D Effective Date: 22/01/2021 | HOOD05162003148254 Application program (1) Examination Viewing| Open patient (2) Operato (3) (1) Menu bar Procedure: (2) Task cards PV sequence: Filming (3) Control area with subtask cards @ Auto Filming (4) Image area d Auto Expose Acquisition Post processing (5) Image tab card Close patient Procedure (4) (6) Generator control field Images (5) (7) Status bar ..... Decomp Adv (6) (7) Examination task cards (2) The examination task card is subdivided into the following areas: 1. Menu bar 2. Control area 3. Image area 4. Generator control field 5. Status bar 6. Information bar Generator control field (6) OPDOSE - 50-59 mm 29 kV - + +WIRh 0000. 50 mm Adv. (1) (2) (3) (4) (5) (6) (7) (8) (9) (1) Display and selection of exposure mode (manual, AEC, OPDOSE) (2) Display and selection of compression thickness range (OPDOSE only) (3) Display and selection of +/- kV (4) Display and selection of +/- mAs (only manual) (5) Display and selection of anode/filter combination (6) Overview of current detailed parameter settings in Advanced dialog box (7) Display of currently set focus (small focus or large focus) (8) Display of current compression thickness value if compression is over 30N (9) Button to call up Advanced dialog box to change detailed parameters Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2021 SIEMENS Master Template Effective Date: 5 Mar 2020 | HOOD05162003074494 Job Aid Effective Date: 22 JAN 2021 | HOOD05162003148254 Healthineers Restricted Page 12 of 34 Job Aid | Mammomat Revelation – Basic System Operation 2D & 3D Effective Date: 22/01/2021 | HOOD05162003148254 Exposure parameters 27 kV 30.6 mAs W/Rh 0.6 mGy 0 deg 20 mm 46 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) Exposure parameters (kV, mAs, anode/filter combination, dose value) (2) Angle of rotation of the swivel arm (3) Compression parameters (thickness, compression force) Patient browser Patient Browser Patient Transfer Edit View Worklist Filter Sort Private Applications Options Help X XI AB Bilater ar Local job status Network job status AB_Test 21 Tool R - TICEM 111111 / DONE /com///11 / DONE Local Database_ AB_Test.21.Re/Enter Bilateral Mammogram [16] Radiation Dose Structured Report 111111 / DONE /com/ / /11 / DONE /com///11 / DIS/LOC Scheduler AB_Test 21_Tools Re-ente [15] INSIGHT 3D R-CC 2D+, Diagnosis worklist //p//11 / DONE /com///11 / DIS/LOC DVD AB_Test.20.View.Images.I [14] INSIGHT 2D R-CC 2D+, Diagnosis //// / DONE /com///11 / DIS/LOC AB_Test 10 Perform.Exa [13] TOMO R-CC 2D+, Empire_D, Diagnosis Scheduler 111111 / DONE /com///11 / DIS/LOC AB_Test.9.Marple, Mary [12] T_PR R-CC 2D+, Diagnosis 1111/5/ / OPEN /com///11 / DIS/LOC Marple, Mary [11] T_PR_raw R-CC 2D+, Diagnosis ///// / DONE /com///11 / DIS/LOC AB_Test. 8 Mag [10] T_PR R-LM 2D+, Diagnosis /// / DONE /com///11 / DIS/LOC Linnen, Angelina [9] T_PR_raw R-LM 2D+, Diagnosis //// / DONE /com///11 / DIS/LOC AB_Test 6 Operation time [8] MAMMOGRAM, Diagnosis 000000000 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. Click on Scheduler. 2. Click on Worklist, then select Update Worklist a. (if worklist is not scheduled to update automatically). 3. Click on the folder with the patient’s name. 4. Click on Patient, Register. 5. Verify the patient information and insert your initials in the operator box. 6. Click on Exam. Registering a patient manually 1. Click on the Register Patient icon or on the menu bar→ Patient → Register. 2. Enter the required data. 3. Click the Exam button. Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2021 SIEMENS Master Template Effective Date: 5 Mar 2020 | HOOD05162003074494 Job Aid Effective Date: 22 JAN 2021 | HOOD05162003148254 Healthineers Restricted Page 13 of 34 Job Aid | Mammomat Revelation – Basic System Operation 2D & 3D Effective Date: 22/01/2021 | HOOD05162003148254 Re-enter exam The examinations carried out 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 Click the Re-enter button in the toolbar at the top of the patient browser. The selected study is loaded in the Examination task card. ?4 ? Job status Here you can check all current transfer jobs performed on the local PC and in the network. Patient procedures – good to know Test your knowledge and familiarize yourself with the following topics: Activate a projection view • Double-clicking on a projection view icon (Images subtask card) Images activates the respective projection view (white icon) independently of the pre-defined order. C CC cc mlo • The double-clicked projection view becomes C Disable exposure the first/next projection view to be acquired. mlo Deactivate a projection view • When a projection view is activated, you cannot modify it. Right-click on the projection view to Disable exposure in order to be able to Modify, Add or Insert a projection view. R-CC Image Attributes To locate technical, clinical and patient factors: Images • Right-clicking on the image icon (Images subtask card) opens the dropdown menu. Image Attributes ... Repeat • Select Image Attributes to display the details. Reject + Repeat ... Correct ... Repeat Reprocess .. Reject InBD Values • Right-click on the image icon Transfer and select Repeat from the dropdown menu. • Select a reason for the repetition. • An additional image is provided as the last projection view and can be acquired. • Both images will be sent to the reading workstation and to the archive. Reject and Repeat To reject and repeat an image: • Right-click and select Reject and Repeat from the dropdown menu. • The selected image will be rejected. • An additional image is provided as the last projection view and can be acquired. Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2021 SIEMENS Master Template Effective Date: 5 Mar 2020 | HOOD05162003074494 Job Aid Effective Date: 22 JAN 2021 | HOOD05162003148254 Healthineers Restricted Page 14 of 34 Job Aid | Mammomat Revelation – Basic System Operation 2D & 3D Effective Date: 22/01/2021 | HOOD05162003148254 Reprocessing a 2D image Reprocess a 2D image with another IPPG (image processing parameter group) to get a different image impression: • Right-click on the affected image in the Images subtask card. • Confirm that the IP set name is correct. Select a new IPPG that is desired. • Click on OK and confirm the changes. • Wait until reprocessing is finished. • Note that this image is sent to the archive if you close the examination. Transferring an image (manually) Images • Right-click on the image you wish to transfer. • Note the white arrow as the image is transferring. ( cc Modify Modify / Add / Insert / Delete Add Projection views can be added or inserted on the Images subtask card. Insert mlo Delete • Right-click on the projection view you want to modify or delete. • Select Modify or Delete in the displayed popup menu. • 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. • Right-click on the projection view in front of which you want to insert an additional projection view and select Insert in the displayed popup menu. • Right-click on the projection view and select Delete to delete this projection view. Reconstructing a tomosynthesis scan (tomosynthesis license active) To select a different reconstruction parameter group (RPG): • Right-click on the affected image in the Images subtask card. • Choose the new RPG desired. • Click OK. • Delete any unwanted reconstructions prior to closing. Select/deselect Insight 2D or Insight 3D (tomosynthesis license active) • Navigate to the Acquisition subtask card. • Check or uncheck the boxes accordingly. Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2021 SIEMENS Master Template Effective Date: 5 Mar 2020 | HOOD05162003074494 Job Aid Effective Date: 22 JAN 2021 | HOOD05162003148254 Healthineers Restricted Page 15 of 34 Job Aid | Mammomat Revelation – Basic System Operation 2D & 3D Effective Date: 22/01/2021 | HOOD05162003148254 Notes Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2021 SIEMENS Master Template Effective Date: 5 Mar 2020 | HOOD05162003074494 Job Aid Effective Date: 22 JAN 2021 | HOOD05162003148254 Healthineers Restricted Page 16 of 34 Job Aid | Mammomat Revelation – Basic System Operation 2D & 3D Effective Date: 22/01/2021 | HOOD05162003148254 Icons Icon Definition Icon Definition Projection view according to default, expo- Image finally acquired sure scheduled mlo Projection view changed, exposure sched- Exposure interrupted uled O mlo* O Projection view according to default, magni- Image rejected fication exposure scheduled mlo ) Projection view changed, magnification Image released for repetition exposure scheduled mlo* Projection view selected for exposure, wait- Repeated image finally acquired ing for system to be ready for exposure mlo Repeat/reject image Image released for rejection/repetition Cc Projection view according to default, Projection view selected for exposure, sys- Implant exposure scheduled tem is ready xccm mlo Projection view according to default, Spot Projection view acquired, image transmis- Del exposure scheduled sion runs Projection view according to default, Prime Projection view acquired, image processing Mode* exposure scheduled IP ongoing xccm Projection view according to default, 2D Radiation is released Tomo Implant* exposure scheduled CAUTION: X-ray radiation! Projection view according to default, Prime Projection view selected for exposure, sys- and Tomo* exposure scheduled tem is ready. Im cc NOTE: Some prerequisites have not been ful- filled (e.g ., magnification exposure without magnification table), exposure is possible. Projection view according to default, Tomo Projection view selected for exposure, sys- Implant* exposure scheduled tem is not ready. V Im mlo NOTE: Some prerequisites have not been ful- Filled (e.g ., compression plate not installed), exposure not possible. 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: 22 JAN 2021 | HOOD05162003148254 Healthineers Restricted Page 17 of 34 Job Aid | Mammomat Revelation – Basic System Operation 2D & 3D Effective Date: 22/01/2021 | HOOD05162003148254 Icon Definition Icon Definition Projection view according to default, 2D Problem with the MAMMOMAT (e.g ., no con- Tomo* exposure scheduled nection), exposure not possible. Imo mlo Projection according to default, specimen Projection according to default, InSpect exposure scheduled View exposure scheduled spec InSpect Projection view according to default, Image transferred individually during exami- TiCEM* exposure scheduled nation cc * optional 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. Empire technology Unique, multiple algorithms, providing superior image quality in both contrast and detail. First view First exposure during tomo scan where the swivel arm is at an angle of 0º.When using 2D + Tomo the first image is the 2D image. 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. Insight 3D 3D 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 If the processing of projections is activated, projections acquired during a tomo scan are processed with OpView 2D image processing for better visualization. Per default the processing is deactivated. These images are saved as DICOM MG for presentation. When using 2D + Tomo the first image of the stored projections series is the 2D image. Raw projections Single image taken during the tomo scan. 25 projections are acquired during the sweep of 50º, every other degree one projection. The projections are 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 Stack of images parallel to the detector surface reconstructed from projections with the purpose of 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. Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2021 SIEMENS Master Template Effective Date: 5 Mar 2020 | HOOD05162003074494 Job Aid Effective Date: 22 JAN 2021 | HOOD05162003148254 Healthineers Restricted Page 18 of 34 Job Aid | Mammomat Revelation – Basic System Operation 2D & 3D Effective Date: 22/01/2021 | HOOD05162003148254 Detector calibrations The detector settings can be changed by external influences (e.g. temperature fluctuations, humidity, vibrations). For this reason, a regular calibration of the detector is required. Calibrations should be performed every 3 months or when there is a difference between the detector and calibration temperatures of +/- 7°C. The MAMMOMAT Revelation offers three types of calibrations to ensure optimal detector settings. System preparation: • Rotate swivel arm to 0°. • Remove face shield, compression plate, 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 system warm-up time of 10 minutes and the preparation of the system, you can start the calibration procedure. • Go the menu bar and select Patient > Detector Calibration • 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 CONTACT 2019-08-02 3 1970-01-01 31.4'C 0.0'C (3) (2) MAGNIFICATION MAGNIFICATION 2019-08-02 (2) 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 next required step (2) Area with 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 has to be performed) • Click on the type of calibration you want to perform. • Read upcoming messages carefully and confirm or react. • When you click on Start Calibration, the Calibration subtask pops up and the projection view is automatically activated. Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2021 SIEMENS Master Template Effective Date: 5 Mar 2020 | HOOD05162003074494 Job Aid Effective Date: 22 JAN 2021 | HOOD05162003148254 Healthineers Restricted Page 19 of 34 Job Aid | Mammomat Revelation – Basic System Operation 2D & 3D Effective Date: 22/01/2021 | HOOD05162003148254 • The text on the subtask card guides you step by step through the procedure. • Acquire an image and continue if the image is suitable for calibration. or Open patient • Click Repeat if the exposure is not suitable. Calibration • The calibration image will be rejected CONTACT and a new exposure added. Acquire an image, • The number of accepted and rejected exposures is counted evaluate the quality in the Calibration subtask card. and select accept/reject • Once you have acquired all the calibration images, you get a message telling you the calibration was performed successfully Continue Repeat in the appropriate calibration type. Number of: Acquired images: O Accepted images: 0 Rejected images: Wait 10 minutes after calibration is completed before embarking on the patient examination. Help H. Post processing Close patient Exercises Please perform the following calibrations based on this description and note your observations: 1. Contact calibration 2. Magnification calibration 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: 22 JAN 2021 | HOOD05162003148254 Healthineers Restricted Page 20 of 34 Job Aid | Mammomat Revelation – Basic System Operation 2D & 3D Effective Date: 22/01/2021 | HOOD05162003148254 Image DICOM information – what you see >>Standard 2D image Patient’s name Insight 20.07.24-11:38:31-S-D- Accession number Patient’s date of birth Projection view L-CC 121 Study date and acquisition time 2048 L-CC Scale 111% o.p. Breast Density per Image Vfg: 43.7 Vb: 1199.2 InsightTest AF Vbd: 3.6% 20.07.24-11:38:31-STD-1.3.12.2. 7/24/1964 DGI: a 8/3/2020 L-CC 12:18:17 PM 2848 Scale 111% o.p. Breast Density per Image Vfg: 43.7 Vb: 1199.2 Vbd: 3.6% kV: 29 mÁs: 108.0 mAs Exposure parameters Angle: 0.0 KV: Focus: large Magn. factor: 1.000 mAs: 108.0 mAs Comp. Force: 68 N Thickness: 58 mm Gantry angle Anode/Filter: W/Rh Angle: 0.0 Entrance Dose: 4.6 mGy Glandular Dose: 1.25 mGy Focus: large Operator: Institution: Hospital Magn. factor: Station: MAMMOPC StreetNo Street //SBCDK-XC7J ... Breast compression thickness Comp. Force: 68 N Thickness: 58 mm Anode/Filter: W/Rh in mm Dose per breast Entrance Dose: 4.6 mGy .25 mGy Glandular Dose: 1.25 mGy Institution: Operator: Station: MAMMOPC StreetNo Street //SBCDK-XC7J ... Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2021 SIEMENS Master Template Effective Date: 5 Mar 2020 | HOOD05162003074494 Job Aid Effective Date: 22 JAN 2021 | HOOD05162003148254 Healthineers Restricted Page 21 of 34 Job Aid | Mammomat Revelation – Basic System Operation 2D & 3D Effective Date: 22/01/2021 | HOOD05162003148254 >>Tomosynthesis image (option) 46 L-CC TOMO Projection view Insight Test AF 20.07.24-11:38:31-STD-1.3.12.2. Empire *7/24/1964 8/372020 10:21:00 AM 1802 2104 46 L-CC TOMO Empire Tomo reconstruction Scale 140% o.p. Breast Density per Image parameter group Vfg: 39.7 Vb: 588.1 Vbd: 16.7% DGI: b Comp. Force: 58 N Slice Height: 51 mm of 51 mm Slice T Thickness: Anode/Filter: W/Rh Entrance Dose: 5.6 mGy Glandular Dose: 1.63 mGy T30.0 TAS Angle: 0.0 Comp .. Force: 58 N Slice Height: 51 mm of 51 mm Slice Thickness: 1 mm Anode/Filter: W/Rh Entrance Dose: 5,6 mGy Glandular Dose: 1.63 mGV Operator: Cumulative dose per Institution: Hospital Station: MAMMOPC StreetNo Street //SBCDK-XC7J. tomo scan Exercise: 2D examination Perform the following procedures by using a mammography phantom or similar ones. 1. Activate the single touch functionality. Open patient 2. Register a patient manually or load the data from the scheduler. 3. Click on Exam to start the examination. 4. Fill in the Operator name in the Open Patient tab card. Operator: 5. Select the required Procedure, e.g. Bilateral Mammo. 6. Change the PV sequence to RCC, RMLO, LMLO, LCC or depending on your use. Procedure: 7. Position the phantom. Bilateral Mammog 8. Open the Acquisition tab card and verify the parameters. PV sequence: 9. Compress the phantom and activate the first projection view R-CC, L-CC, R-M (if necessary). Display Markers: 10. Take the first exposure (Control Box) Except mag/spot 11. Check the details shown in the displayed image. Auto Filming 12. Insert an exaggerated RCC after the RCC. Auto Expose Acquisition 13. Take the next exposure. Post processing 14. Repeat the XCC taken. Close patient 15. Take the remaining exposures. 16. The image “LCC” label is marked incorrectly. Use the correct function to change it to LXCC. 17. Verify whether the images are marked correctly. 18. End the examination and go to the Close Patient tab card. 19. Skip EndExam Transfer Rules is not enabled. 20. Open Scheduler is enabled. 21. Close the patient. 22. You are now back in the patient browser and can check the patient data. Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2021 SIEMENS Master Template Effective Date: 5 Mar 2020 | HOOD05162003074494 Job Aid Effective Date: 22 JAN 2021 | HOOD05162003148254 Healthineers Restricted Page 22 of 34 Job Aid | Mammomat Revelation – Basic System Operation 2D & 3D Effective Date: 22/01/2021 | HOOD05162003148254 Notes Exercise: re-enter a patient 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. 4. Check the new laterality. 5. Add an RML image. 6. Position the phantom. 7. Compress the phantom and activate the first projection view (if necessary). 8. Take the first exposure (Control Box). 9. End the examination and go to the Close Patient tab card. 10. Skip EndExam Transfer Rules is not enabled. 11. Open Scheduler is enabled. 12. Close the patient. 13. Manually send/archive images from the patient browser to the desired destination. 14. Then check the network job status. Notes Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2021 SIEMENS Master Template Effective Date: 5 Mar 2020 | HOOD05162003074494 Job Aid Effective Date: 22 JAN 2021 | HOOD05162003148254 Healthineers Restricted Page 23 of 34 Job Aid | Mammomat Revelation – Basic System Operation 2D & 3D Effective Date: 22/01/2021 | HOOD05162003148254 Exercise: tomosynthesis (option) examination Open patient 1. Register a patient manually or load a patient from the scheduler. Acquisition 2. Click on Exam to start the examination. Acquisition mode: Tomo 3. Fill in the Operator name in the Open Patient tab card. 4. Select a tomosynthesis procedure. RPG: Empire 5. Enable Insight 2D on the Acquisition tab card. INBD n.a 6. Enable Skip InExam Transfer. 7. Position the phantom. 8. Check the parameters for tomo: Acquisition mode and RPG (Empire). Insight 2D 9. Compress the phantom and activate the first tomo projection view Insight 3D (if necessary). Skip InExam Transfer 10. Take the first exposure (Control Box). 11. Keep the exposure button pressed until the 25 projections are acquired. Tomo Post processing 12. Image processing starts immediately after exposure. Close patient 13. The Tomo tab card pops up. 14. Familiarize yourself with the details. Move the mouse over each button to get information on each function. 15. Click on the Slices button and scroll through using the slider or dog-ear. 16. Check the details shown in the displayed slices. Open patient 17. Click on the Insight 2D button and check the image details as well. Acquisition Tomo 18. Position and take the next exposure. 1 Reconstr. available 19. Take the remaining exposures. TOMO L-CC, Emj 20. Add an additional 2D image. 21. Position and take the exposure. 22. Verify whether the image is marked correctly. O DO 23. End the examination and go to the Close Patient tab card. 24. Skip EndExam Transfer Rules is not enabled. 20 auto 25. Open Scheduler is enabled. 26. Close the patient. Reconstruct ... Delete Reconstruction Post processing Close patient Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2021 SIEMENS Master Template Effective Date: 5 Mar 2020 | HOOD05162003074494 Job Aid Effective Date: 22 JAN 2021 | HOOD05162003148254 Healthineers Restricted Page 24 of 34 Job Aid | Mammomat Revelation – Basic System Operation 2D & 3D Effective Date: 22/01/2021 | HOOD05162003148254 Notes 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 the dense tissue areas. It is also considered to be 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 breast density category is made visually by medical professionals. The calculation of the breast density can be performed per breast, per side or per woman. This setup is performed in the service configuration by your Education Specialist. Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2021 SIEMENS Master Template Effective Date: 5 Mar 2020 | HOOD05162003074494 Job Aid Effective Date: 22 JAN 2021 | HOOD05162003148254 Healthineers Restricted Page 25 of 34 Job Aid | Mammomat Revelation – Basic System Operation 2D & 3D Effective Date: 22/01/2021 | HOOD05162003148254 In this example, you can see how the information is shown up 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 as well as in tomosynthesis acquisition mode. Values displayed in the dialog window Insight BD X Patient Name: Sita_065529 Sita_GWCVVC Patient ID: 237876 Density grade for Study date: Patient n.a 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 ... ... 5.2 % 4.2 % 3.3 % 3.9 % Result per view b a a a ------ Result per side Average (or highest*) 4.7 % Right Left 3.6 % of all views of that breast breast breast Result per woman 4.2 % b or Based on values per side a Highest density Average of volumetric grade index of breast density both sides [a-d] per side [%] Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2021 SIEMENS Master Template Effective Date: 5 Mar 2020 | HOOD05162003074494 Job Aid Effective Date: 22 JAN 2021 | HOOD05162003148254 Healthineers Restricted Page 26 of 34 Job Aid | Mammomat Revelation – Basic System Operation 2D & 3D Effective Date: 22/01/2021 | HOOD05162003148254 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 plate as well as for the Spot Plus plate. 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: Push the implant out of the image area, if possible. Otherwise reject the images from the calculation manually. Insight BD values are not reliable when a foreign object (e.g. implant, guidance wire, pacemaker, clip) appears inside the breast. In these cases, reject the images from the calculation 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 very 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 compared to the visual rating of breast density. In this case, consider visual evaluation instead. 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. Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2021 SIEMENS Master Template Effective Date: 5 Mar 2020 | HOOD05162003074494 Job Aid Effective Date: 22 JAN 2021 | HOOD05162003148254 Healthineers Restricted Page 27 of 34 Job Aid | Mammomat Revelation – Basic System Operation 2D & 3D Effective Date: 22/01/2021 | HOOD05162003148254 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, which are used to process the low energy view. It is recommended to use the same parameter as for standard 2D image processing to secure the same image impression. DPPG Dual Processing Parameter Groups, which are used to process the recombined image. Insight CEM This is the combined image of the low and high energy image. Depending on the weighting factor, the image impression can change. Twin View Display mode for TiCEM to display the low and the recombined image next to each other at the same time. Image DICOM information – what you see >>TiCEM image er Examination Edit View Image Tools Scroll Options Help WID DO.000033 Examination |Viewing WID DO 000033 12/2017 17.06.13-13:32:45- test 1:37:18PM 6/13/1984 W 2400 Open patient BDD Twin View Acquisition TICEM Post processing Close patient R-CC LE R-CC Insight CEM Filming Skip Auto- Transfer Rules Low energy Insight CEM Contrast: N.A. Vol n.a. Contrast: N.A. Conc. n.a. Vot n.a. Conc: n.a. Flow: n.a. Delay time Flow: n.a. Time inj: 00:25 min:sec kV: 30 since injection Time inj: 00:25 min:sec KV: n.a. mAs: 115.0 mAs Angle: 0.0 mAs: n.a. Angle: 0.0 115 0 MAS Focus: large Focus: large oCus lange Magn. factor: 1.000 Comp. Force: 74 N Magn. factor: 1.000 ww. factor, 1 000 omp Force: 74 N Comp. Force: 74 N Thickness: 62 mm Thickness: 62 mm hode filter WE trance Dose 5.4 Anode Filter: W.Rh Anode Filter: W/Rh - WTI Mandujar Dose. per ator Oporst Street Cly District Zation Street Ch OPDOSE- 41-50 mm 49 kV - + + 50 mm Adv. Compression plates For a TiCEM examination, the following plates (in cm) can be used: • SoftComp compression plates (12x24, 18x24, 20x26) • Flexible compression plates (18x24, 24x30) • Compression plates with high/low edge (18x24, 24x30) • Shifting paddle with high/low edge (18x24) Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2021 SIEMENS Master Template Effective Date: 5 Mar 2020 | HOOD05162003074494 Job Aid Effective Date: 22 JAN 2021 | HOOD05162003148254 Healthineers Restricted Page 28 of 34 Job Aid | Mammomat Revelation – Basic System Operation 2D & 3D Effective Date: 22/01/2021 | HOOD05162003148254 Before starting the examination, the following has to be considered with regard to 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 weight. • Prepare everything that is needed for the cannulation and perform it (responsible person for cannulation and for patient observation). • Ensure that everything needed is available in case of allergic reactions or other emergencies (emergency trolley). Power injector and cannulation preparation • Power injector → training to be given beforehand by the injector provider • Pre-heating cabinet (to warm up the contrast agent prior to 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 INA. lodine (Default Contrast Agent Test • Prepare the AWS→ register a patient, Concentration 350.00 ng/ml adapt the PV sequence (start with the “pathology” side Volume 120.00 Flow rate or according to your defined procedure sequence). 3.00 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. Contrast Conditions • Prepare the MAMMOMAT: face-shield, 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 00 min:sec Flow rate 3.00 ml/s Reset time OK Cancel Notes Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2021 SIEMENS Master Template Effective Date: 5 Mar 2020 | HOOD05162003074494 Job Aid Effective Date: 22 JAN 2021 | HOOD05162003148254 Healthineers Restricted Page 29 of 34 Job Aid | Mammomat Revelation – Basic System Operation 2D & 3D Effective Date: 22/01/2021 | HOOD05162003148254 Software overview Images • Icon for TiCEM →” Dual Energy “ with laterality and a syringe symbol Note: Only CC and MLO projection views are selectable. CC mlo 8 8 mlo Acquisition tab card Open patient Acquisition Acquisition mode: TiCEM PPG FO_Gen1 Selection of IPPG for the Low energy image DPPG CEM_A Selection of DPPG for the Insight CEM image box 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 Delay time 59:00 min:sec Post processing Close patient Flow rate 3.00 m/s Reset time OK Cance TiCEM tab card 04:19 The Delay time will be displayed e.g. 04:19 means 04:19 Open patient min after injection. Acquisition TiCEM Recombine Opens the window to recombine the InsightCEM image: Backgroundfactor, IPPG and DPPG 04:19 X Sand glass: Exposure start Please keep the exposure button pressed to acquire the dual energy images: 0% Recombine Sand glass: in work X Please keep the exposure button pressed to acquire the dual energy images: 50% Sand glass: Exposure finish DDD Please release the X-ray button after finished exposure. Please keep the exposure button pressed to acquire the dual energy images: 100% Click the TiCEM Low button: >The 2D LE image is displayed (normal 2D MG image). Click the Insight CEM button: Post processing - The 2D combined image is displyed (HE-LE) Close patient Click the TiCEM Twin View button on the TiCEM subtask card. - The disply 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: 22 JAN 2021 | HOOD05162003148254 Healthineers Restricted Page 30 of 34 Job Aid | Mammomat Revelation – Basic System Operation 2D & 3D Effective Date: 22/01/2021 | HOOD05162003148254 TiCEM workflow steps Once all preparations have been made, you can start the examination following these steps: 1. Patient has 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. 90 sec. (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 finished. 8. The first and second images are acquired. 9. Make sure the breast is decompressed, automatically or manually, immediately after exposure. 10. Directly position the next PV. 11. Acquire the next TiCEM exposures (do not waste time). 12. Display and process the TiCEM examination images. 13. 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: 22 JAN 2021 | HOOD05162003148254 Healthineers Restricted Page 31 of 34 Job Aid | Mammomat Revelation – Basic System Operation 2D & 3D Effective Date: 22/01/2021 | HOOD05162003148254 Exercise: TiCEM (option) examination Perform the following procedures using a suitable phantom (e.g. eggplant) 1. Activate the single touch functionality. 2. Register a patient. Open patient 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. Procedure: 7. When the contrast medium is completely injected, TiCEM click OK and the timer starts immediately. PV sequence: 8. Detach the power injector from the patient (leave the needle in!). L-MLO CEM, L-CC 9. Position the patient for the first projection view. Display Markers: 10. After approx. 90 sec. acquire the first images Except mag/spot Auto Filming (LE / HE images → keep 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 tab card. Use the appropriate icons to display LE/ CEM and TwinView images. 15. Click on 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 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: 22 JAN 2021 | HOOD05162003148254 Healthineers Restricted Page 32 of 34 Job Aid | Mammomat Revelation – Basic System Operation 2D & 3D Effective Date: 22/01/2021 | HOOD05162003148254 Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2021 SIEMENS Master Template Effective Date: 5 Mar 2020 | HOOD05162003074494 Job Aid Effective Date: 22 JAN 2021 | HOOD05162003148254 Healthineers Restricted Page 33 of 34 Job Aid | Mammomat Revelation – Basic System Operation 2D & 3D Effective Date: 22/01/2021 | HOOD05162003148254 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: 22 JAN 2021 | HOOD05162003148254 Healthineers Restricted Page 34 of 34