myNeedle Guide 3D Workflow with myNeedle Laser Video - Clinical Usage

Hello, my name is Matthias, my I am associate professor here in the University Hospital in Arlington and I'd like to introduce you the new City interventional suite with laser guidance. So let's first see how we start the interventional workflow from the control room and it all starts with the patient registration where we get the information directly from the patient worklist from the radiological information system by clicking the accent button we start the application, and besides the icons, we have a dedicated interventional protocol folder, and in this case we choose the abdominal protocol. Inside the examination room, we already mounted the mobile tablet and the icontrol joystick to position the patient for the top program procedure. Once we captured the localizer, we were able to plan the first ice viral acquisition, which we then will use for planning purposes. And it is absolutely mandatory to use the same breathing command which you plan to use throughout the entire intervention. My recommendation is to use expiration breathhold commands. The acquired data set is then automatically reconstructed in thin slices and transferred to the interventional workflow in the upper row you see a 2D display and in the lower row a 3D MPR setting. The radiologist is then free to select the display office choice. For access planning. We evaluate the region for the pathologic lesion. In this case, let's say a metastasis to the liver to plan the needle path, I would recommend to take the crosshair in the middle of the lesion. And take the pink line to angulate on the left and right side. In the meantime my view goes on the right pink plane to evaluate the anterior access possibilities. We see that the easy and short access path from the left side in this case is obstructed by a large vessel, even if angulation in two planes is performed. So we have to switch to a much longer access path from the right side, and we select the target and entry point by two clicks. Once we define one or even more of these little paths, we start the progress needle workflow in the upper left corner. The patient is then moved out of the gantry by clicking the move button and once in position the laser guidance turns on. The disinfection process can directly be started because the skin entrance point is already projected on the patient by the lasers in green. This helps to speed up the process and assures that the skin is already dry. When we put the patient in steroid. In the meantime, we prepare the sterile table, put our lead aprons if we want to stay inside the room, and our sterile aprons and sterile gloves as well. In order to operate the scanner from inside the room, we put dedicated sterile covers on the tablet. And mounted on the tablet holder or on the gantry. To turn on and off the radiation, there are two options. First is the classic foot switch and 2nd, which I prefer is to use the remote control, which I also wrap in steroid. This assures that I have the full access to the radiation from everywhere inside the room. After we put a sterile cover to the patient skin, the laser projection does not only help me to cover the patient in sterile, but also to take the local anesthesia needle and point the tip directly on the middle of the crosshair projection in green on the patient skin. I would always recommend to take the offsite at hand to the gantry to not cover parts of the projection. I then adapt the steerage, inject a few milliliters of local anesthesia and readapt the plane of the needle once you see the crosshair on the stamp of the needle, you know that you're in the perfect position. And now we're ready for the first image control. I'm able to change the acquisition mode on the tablet from spiral to sequential or even fluorel mode and adapt this deposition to the actual position of the needle. In this case, a sequential scan is enough to cover the area of the needle and allows me for 3D evaluation. The image evaluation and angulation on the needle path can then be done by my tech from outside the room or by myself on the tablet interface. Once I am confident with the position of the anesthesia needle. I can turn on and off the laser guidance whenever I like during the entire intervention and get the patient out of the gantry and into position. After a short incision with a scalpel, I can then remove the local anesthesia needle and start the insertion of the coaxial needle. The process is the same like with the anesthesia needle that I point the tip towards the crosshair on the skin and then double angulate the path by the laser guidance in green. The combination of laser guidance and needle path which is displayed on the large monitor gives me a full comfort of information about how to position the needle. Another sequential scan confirms the correct angulation of the needle with a high precision, referred to the planned path. And also gives me information about the missing distance and depth. Several other functionalities are available on the tablet interface as well, like in this example to turn on and off the overlay. The large in room monitor display, which is roof mounted, helps to find adjust the needle position in the sequential approach. The comfortable shuttle mode helps to quickly move the patient in and out the isocenter. Once the coaxial needle is in position, I remove the trocar and insert the biopsy system to take a probe from the lesion. Once the quality of the probe was considered as fine, the coaxial needle can be removed and as sterile patch is put on the incision. After re movement of all sterile material, a control scan is regularly performed as I spiral to check for complications like bleeding or organ lesions. In this case, the air accumulation in the lesion provides us additional information about the correct position of the probe sampling. Motion rather occurs regularly in the case of abdominal biopsies, so it's mandatory to be safe that the current needle position fits to the lesion, but the drawback is that in the last image, without contrast injection, we often know more see the lesion, so fusion is a nice tool to come over this problem. You can switch to the first image and the last image. Fluently and also get some overlay images to see the lesion and the needle, and that's exactly what it's about. Taking biopsies from lesions and not somewhere else.

*8/18/1988 12345678 512 15/07/1954 55 10 0.50 1,02 0.67 2,57 2.57 myNeedle Guide 3D Workflow with myNeedle Laser Video Clinical Usage PD Dr. Associate Professor at the University Hospital Erlangen PD Dr. med. habil. Matthias May althineers Healthineers Start the myNeedle Cuide 3D Workflow from the Control Room SIEMENS . Scheduler Patient Registration Patient Patients (1 result(s), 9:11:00 AM) Doe, John Medical Information Exam Information Scheduled, Today Date and Time Doe Admitting Diagnosis First Name John Requested Procedure Title Description Alerts Accession No Middle Name Medical Alerts Patient ID 12345678 Comments Allergies Age 32 Year(s) Sex Weight ft in Institution U.S. Institution Name ZMPT ZMPT Referring Physician |Safety relevant information needs to be validated and confirmed * Mandatory information Save Cancel Delete Local Data Prior Studies Exam Scan Last Name Doe Last Name Register a Patient Procedure Suffix Date of Birth 8/18/1988 [M/d/yyyy] Date of Birth EN OEN 7/16/2021, 09:59 Date of Birth 8/18/1988 * 8/18/1988 (32) 12345678 Starting Application ... ECG Demo Protocol Protocol Selection Protocol Parameters Browse Protocols Physiological Signal Reconstruction Close Search Adult Child Trauma Intervention Select protocol OK Add Replace Select an Intervention Protocol Protocol: Thorax Intervention 3D [factory] -Indications: biopsy, abscess in the thorax wiwo CM Topogram InterventionSequenceAdultAbdomen, i-Spiral Thorax InterventionFluoroAdultAbdomen2d Protocol: Abdomen Intervention 3D [factory] -Indications: biopsy, abscess in the abdomen, w/wo CM -Scan modes: InterventionSpiralAdultAbdomen, i-Spiral Abdomen Protocol: Spine Pain Therapy 3D [factory] -Indications: periradicular therapy, nerve root block, facet joint injection, arthrogram in the spine region, wiwo CM i-Spiral Spine -Scan modes: InterventionSpiralAdultSpineSn, Apply protocol Confirm myNeedle Laser RTP Overlay None Confirm or skip Step Tablet View SIEMENS In Audio Control German Back GO Test Table Movement Sn 100 Visuals Ready to load Topogram Position the Patient Head First - Supine Prepare and Perform a Topo Scan Topogram Loaded Delay Time Plan an i-Spiral Acquisition Perform an i-Spiral Acquisition myNeedle Guide UI Plan the Needle Path Add a Needle Path Start Progress Needle Activate the myNeedle Laser Button and Position the Table Prepare a Sterile Intervention He TENS Heolthineers Position the Needle Using the Laser Guidance System (32 cm) Perform an i-Sequence Scan (24 cm) (24 cm) 1,02 Release Radiation via Remote Control SSDE Needle (24 cm) 1,03 MPR Evaluate Control Scan Images and Needle Path Angulation < 2 (24 cm) 1.03 Activate myNeedle Laser via the Tablet Remove Anesthesia Needle and Insert Coaxial Needle Align Needle Position with Perform a Control Scan i-Sequence Abdomen Scan Exam Time Press START Switch to In-Plane View / Needle- Oriented View to Check the Needle Position < 3 Adjust the Needle Position Repeat the i-Sequence Scan (24 cm) 1.02 Perform a Biopsu with myExam Companion Remove the Coaxial Needle Examination Monitor View Recon Ranges Perform an i-Spiral Scan TA Check the Lesion Synchronization of Guided and Actual Needle Path 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 Manual shall be used as your main reference, in particular for relevant safety information like warnings and cautions. Please 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. C Siemens Healthcare GmbH 2021