Artis zee System Overview

Welcome to the ARTIS Zee System Overview online training. This module will introduce you to the system components when working in the exam room and the control room. Additionally, important safety and maintenance information will be explained. In this training you will learn about the following system components: • Equipment in the control room • C-arm and table in the exam room • System control modules • Exam room display The safety information in this module introduces you to the locations on the system where there is a possible danger of collision during system movements and how you can stop system movements in case of an emergency. You will also learn about the integrated system safety mechanisms and radiation protection.  Please note that this module should not be seen as a replacement to the safety information outlined in the Operator Manual.  Guidance is available in the form of pictogram labels and system messages shown on the displays in the control and exam room. You will find a comprehensive list of the pictograms in your Operator Manual.   Important pictograms Important pictograms Base ImageHotspotsText BlocksImage FileDanger of crushing.Danger of crushing.This pictogram indicates that special instructions can be found in the accompanying documents. Please read the Operator Manual and other accompanying documents.Footswitch.Class 1M Laser Take care that no persons look directly into the light beam.Accessory load (example)CPR positionCPR position.Emergency stop.Maximum weight load. Learn about system messages Learn about system messages Slide NumberText BlocksCalloutsAudio ScriptImage File1Types of messages: Feedback message: A feedback message is displayed in the exam room on the data display / Assist screen and provides you with information about the system status, for example: Automatic run: Position reached.  Instruction message: An instruction message is displayed in the exam room on the data display / Assist screen and advises you about an action that you need to perform, for example: Automatic run: Move the table lift up.     Error message: An error message is displayed in both the exam and control room and provides you with information about problems with system components and system functions. Many error messages provide you with guidance to fix the problem, for example: Footswitch at table out of order.Enter your script here.2Messages in the Exam Room In the exam room messages appear on the message bar in the  Assist Screen. There are two lines of messages: The stand/table message line The system status message line Enter your script here.3Messages in the Control room In the control room, messages appear in the status area at the bottom right corner of the system console and at the bottom of the image. In the status area the messages appear as text lines and icons: Two lines of text appear and a line of icons Enter your script here. ARTIS Zee has many integrated safety mechanisms, there is always a possibility of collision with objects. You must pay attention when activating system movements to ensure that no collision will occur, which may cause system damage or worse, patient and personal injury. Take special care at points on the stand/C-arm and table where movement occurs. In some cases, it is better to block all system movements, for example: During patient transfer When cleaning the system ​Anytime the system is not in use   Take care at these points on the C-arm and table Take care at these points on the C-arm and table Slide NumberText BlocksCalloutsAudio ScriptImage File1Stand and C-arm: There is a risk of collision and crushing at the following points on the stand and C-arm: At all joints during rotations and movements On the rails of the FD slide for FD lift Enter your script here.2Table: There is a risk of crushing at these points on the table: Between the tabletop and the table frame Between the tabletop and the table column There is a risk of collision at these points on the table: On the outer edges of the table On the accessory rails Enter your script here. Learn how to block system movements Learn how to block system movements Slide NumberText BlocksCalloutsAudio ScriptImage File1Blocking system movements from exam room: To block the system movements from the exam room: Select: the Block movement key on the Touch scree control (TSC) When the Background colour is blue the movements are not blocked When the Background colour is white the movements are blocked Enter your script here.2Blocking system movements from control room: To block system movements from the control room: - Select the icon in the Examination task card on the System consoleEnter your script here. ARTIS systems are equipped with emergency stop buttons and emergency shutdown buttons. In order to interrupt movements and x-ray release in emergency situations, you should press one of the emergency stop buttons. The emergency shutdown button should only be used in extreme situations as it will result in full system interruption and is an uncontrolled process which could result in data loss. Emergency stop buttons are on the front sides of the Table and Stand/C-arm control module(TCM/SCM). When the emergency stop button is pressed the following system functions are interrupted: System movements are stopped immediately Fluoroscopy and acquisition are stopped If the injector is controlled by the system, injections are also stopped ​Fluoroscopy and acquisition can be released again without cancelling the emergency stop, but system movements will only be possible after cancelling the emergency stop. To cancel the emergency stop, pull on the button. ARTIS systems are equipped with the following safety mechanisms to help prevent unintentional movements and collisions: Emergency stop buttons, when activated, immediately stop system movements and interrupt x-ray release Dead man's grip (DMG) ensures that system movement occurs only when the operating element is activated correctly The collision avoidance computation calculates possible collisions between the stand/C-arm and patient table Acoustic signals are activated when the system is driven into a zone of possible collisions Speed reduction of system movements when the system is in a range of an upcoming collision The Collision sensors stop movements when a collision is detected Collision sensors are integrated in the flat panel detector (FD), collimator, in the covers of the C-arm and stand, and a sensor is detecting the lift up of the tabletop plate (Siemens Multi-tilt table only). Learn about the collision avoidance computation Learn about the collision avoidance computation Slide NumberText BlocksCalloutsAudio ScriptImage File1 ARTIS systems know the system geometry to avoid possible collisions during system movements, this is called collision avoidance computation. The shape of the patient table is virtually extended by a patient and the user defined head holder or head clamp. This sphere helps to avoid collisions, especially when the patient is draped and most parts of the system under the table are invisible. During movement, if the C-arm comes too close to system components or the 'virtual patient' the speed of movements is reduced and an audible sound will be heard. Please note: The system movements will not be stopped; you still need to take care that no collision will occur. Other extensions to the table, for example IV stands and so on, are not part of the collision avoidance computation. ARTIS systems know the system geometry to avoid possible collisions during system movements, this is called collision avoidance computation. The shape of the patient table is virtually extended by a patient and the user defined head holder or head clamp. This sphere helps to avoid collisions, especially when the patient is draped and most parts of the system under the table are invisible. During movement, if the C-arm comes too close to system components or the 'virtual patient' the speed of movements is reduced and an audible sound will be heard. Please note: The system movements will not be stopped; you still need to take care that no collision will occur. Other extensions to the table, for example IV stands and so on, are not part of the collision avoidance computation..2 The following room and system components are included in the calculation of the collision computer: Patient table Stands Floor Walls Please note: In the case of an unknown tabletop, the system movements are slow.   Enter your script here.3 IMPORTANT: Not all components of the exam room are considered in the collision avoidance calculation. Smaller, moveable components and any external components are not included: Arm boards, armrests and the patient's extremities Mobile equipment such as anesthesia carts, trolley, Ultra Sound machines, procedure tables, rolling IV stands, chairs or other such furniture Control console trolley Accessory rails and attached items for example, IV bottle holder, instrument tray, control modules, injector head, lower body radiation protection, patient monitoring devices and the Sensis Vibe signal input box Ceiling suspensions with displays or other equipment Ceiling mounted devices such as lamps and radiation protection shields Enter your script here.4 For some tabletops it is possible to attach individual head holders. Each head holder has a different shape and will need to be calculated by the collision avoidance. To ensure that the head holder is calculated by the collision computer correctly, the correct head holder must be selected in the configuration. CAUTION: There is a high risk of collision and damage if the incorrect head holder is selected. CalloutsExample of a Head Holder collision zone (view from top)Example of a Head Holder collision zone (lateral view)Enter your script here.5 You must activate the correct Head Holder before each examination. If the correct Head Holder is not selected, a default Head Holder will be assigned, with a large safety zone. This will cause a reduction in the speed of system movements in the area of the Head Holder. To select the Head Holder: On the system console, Examination task card select: Acquisition > Head Holder Click on the head holder that is used and select OK Note: Above Head Holder selection is optional  Enter your script here. Learn about Dead Man's Switch Learn about Dead Man's Switch To avoid accidental radiation release it is recommended to activate Block radiation whenever radiation is not required. This is particularly important during patient transfer and when cleaning the system. Block radiation can be activated from the control or the exam room. When enabled, radiation release from the footswitch or hand switch is blocked and a message will appear on the Assist Display and on the system console. Please note: Block radiation will not interrupt radiation. You cannot use Block radiation in an emergency situation to stop x-ray during release. In this case, you will need to press the emergency stop button. Learn how to block radiation Learn how to block radiation Slide NumberText BlocksCalloutsAudio ScriptImage File1Blocking radiation from exam room: To block radiation from exam room: ​​Select the Block radiation icon on the Touch screen control When the Background is white, radiation is blocked When the Background is blue, radiation can be released ​Please note: Block radiation and Block movement are automatically activated when driving into the Patient Transfer or Parking Position.Enter your script here.2Blocking radiation from control room / system console: To block radiation from control room: Select the Block radiation icon on the Examination task card ​When the Background is white, radiation is blocked When the Background is blue, radiation can be released ​Please note: Block radiation and Block movement are automatically activated when driving into the Patient Transfer or Parking Position. Enter your script here. The ARTIS table is designed to allow for CPR with a compression pressure of up to 600 N (60 kg).  In the case that CPR is required, the tabletop must not be tilted and the tabletop must be positioned so that the patient's thorax is positioned over the table column. This will ensure the greatest possible stability. Note: The maximum patient weight must not be exceeded. The following equipment is located in the control room: A 19" TFT color display  As an option: An additional display for reference image display or the 30" Artis cockpit A system keyboard and mouse On Box (power control) The control room is where system start-up and shut down occurs, along with many other important tasks related to image and patient documentation. Some examples of tasks performed in the control room include: Patient registration, pre-procedure planning, parallel processing, image review and post processing and procedure  Learn about On Box Learn about On Box Base ImageHotspotsText BlocksImage File RESET button Power-on pushbutton and indicator CD/DVD drive USB port for image export. Only USB memory sticks can be used. The use of hard drives is not permitted. Microphone and headphone jacks Learn about the control room displays Learn about the control room displays Tab TitleTextStandard display As standard, the ARTIS Zee is installed with a 19" (48 cm) TFT color display for medical viewing of DICOM gray scale images.  The display will start automatically during system start-up.  In the case that the monitor is not switched on, a power on switch is located on the underside of the display.   Artis Cockpit An option is Artis Cockpit. The Artis Cockpit consolidates a number of systems to one console. You can operate multiple computers and applications from one monitor with a single mouse and keyboard. Up to nine system inputs can be displayed on the Artis cockpit, such as: ARTIS, PACS or Sensis. Learn about system start-up and shut-down Learn about system start-up and shut-down Slide NumberText BlocksCalloutsAudio ScriptImage File1System Startup: To start the system press and hold the power-on button on the CPC for approximately 0.5 seconds. note: Workplace (eg.Sensis, Syngo wrokplace) must be switched on separately! Enter your script here.2System Shutdown from system console: When turning the system off, it is important to always use the proper sequence of steps. System Shutdown is done with the system console. Select: Options > End Session The End session window will appear Select: Shutdown System The Log Off in the End-Session menu will stop and restart syngo and the application.  you might want to use this if e.g. the mouse pointer does not react any more. it does not reset the imaging system!   Shutdown time approx: 2 1/2 min Please note:  Never use the main power off switch to shut down the system! Workplace (eg.Sensis, Syngo wrokplace) must be switched on separately! Enter your script here. The ARTIS zee system is comprised of the following components: Stand C-arm Detector Collimator The stand and C-arm can be moved manually or via pre-programmed system positions using the Stand control module.  The Flat panel detector (FD) comes with different shapes for dedicated application, (as20 square shaped for Cardio) or (as40 rectangular shaped for Vascular / Radiology), detector can be rotated to landscape or portrait orientation depending on the area of interest. During rotation of the detector and swiveling of the C-arm, the Multispace feature ensures alignment of the FD and collimation to the tabletop. This straight view feature ensures upright imaging of the anatomy. Learn about the C-arm and detector Learn about the C-arm and detector Tab TitleTextSID and patient coverage Detector as20   Detectro as40 Learn about the detector membrane keys Learn about the detector membrane keys Base ImageHotspotsText BlocksImage FileC-arm orbital movement (RAO/LAO angulations)Longitudinal tabletop movement with stepping table Longitudinal C-arm movement with Artis zee multi-purpose/Artis zee ceilingC-arm rotation (cran/caud angulations)FD rotation (setting portrait/landscape)FD lifting and lowering - setting the SIDFD lifting and lowering - setting the SID Scatter radiation grid Scatter radiation grid Checklist TitleChecklist TypeChecklist ContentWhen to remove the grid?HTML The scatter grid is intended to filter scatter that is created by the patient and other objects, out of the image to improve image quality. As in pediatrics the dose awareness is high and the scatter, created by small patients is low, the grid can be removed. To reduce patient entrance dose, while maintaining image quality, the 'Air Gap Method' can be used for pediatric patients less than 20 kg. The 'Airgap method' involves the following workflow: Remove the grid Increase the SID Increase the field of view (reduce zoom stage) In ARTIS systems, all default pediatric programs are designed for this workflow. Please note: To ensure optimal image quality, the grid should remain inserted for all other cases. Ensure the C-arm is not rotatedHTML To minimize the risk of the grid falling, the c-arm should be either in the 'zero', anterior-posterior (AP) position or close to the AP position when removing or inserting the grid ​ Please note: Handle the grid with special care. If the grid is dropped or not handled properly, the grid could be damaged. Grid damage cannot always be seen externally, it is possible for internal damage to occur that can impair image quality .Press the button on the front of the FDHTML The grid slides out of its holder Once the grid is removed, place the grid in a safe place Insert the grid from the backHTML When inserting the grid, pay attention to correct orientation. The arrows on the grid must point toward the detector and the label must point toward the patient. Note:  For biplane systems, the grids are labelled for plane A Please check the label before inserting the grids. Insert the grid till the mechanical stopHTML Pay attention to correct locking: an audible engagement sound should be heard When Scatter grid is required ?HTMLThe scatter grid is intended to filter scatter that is created by the patient and other objects, out of the image to improve image quality. X-ray Indication Lamp X-ray Indication Lamp In your ARTIS Zee Multi-tilt table, there are four possible tabletops: narrow, wide, neuro or long. Before positioning the patient on the table, pay attention to the table weight limit. It is important that you consider not only the patient weight, but also the weight of the accessories on the rails and the weight needed in the event that cardio-pulmonary resuscitation (CPR) is required.  At the base of the table and on the tabletop you will find a sticker indicating the weight limit for your table top. Learn about the weight limits Learn about the weight limits Tab TitleTextWeight limit The permissible patient weight with which you can load your tabletop is stated on  the label on the tabletop and on the table column (on the support arm with  Artis zee multi-purpose) and in the technical data. It is important that the load is distributed uniformly over the tabletop. Otherwise  there is a risk of material deformation and system malfunction. The patient weight  includes any parts permanently or loosely connected with the patient, such as  equipment, prostheses, implants, plaster casts. Example of incorrect use with uneven weight distribution: A patient with a maximum weight sitting at the end of a fully extended tabletop.   Weight limit labels Accessories weight also to be considered Accessory rail adjustment Learn about Multi-tilt table Learn how to use the Multi-tilt table Tab TitleTextTable Top Floating Movement Table Height Adjustment Rotate the table with the TCM Trendelenberg / Reverse Trendelenberg Table control module (TCM) is used to perform table movements. You may have one of two variations of the table control module: TCM-M/S panning knob with floated tabletop (with or without servo-assisted) TCM-J with joystick for motorized table movements. The keys on the table control module control the following important functions: Perform table tilt (Trendelenberg/Reverse Trendelenberg) Select lateral table tilt (Cradle Movement) Unlock/Lock for table rotation Set Isocenter Unlock/Lock lateral tabletop movement Set the orientation of the control modules Please note: When using the TCM-S, if the table is not tilted, the movements are servo-assisted. If the table is tilted, the tabletop is moved with a constant speed. Icons of table Control module Icons of table Control module Base ImageHotspotsText BlocksImage FileSet isocenterPerform table top movement.Unlock table rotation –LED lights while function active(table rotation is unlocked). –LED not lights while function is inactive(table rotation is locked)  Lock lateral tabletop movement – LED lights while function active.Select lateral table tilt – LED lights while function active.Orientation of the control module. The Orientation key causes movements to be made in the same direction as the joystick of the respective control console is deflected. The illuminated LED indicates the selected orientation. You can change the orientation of the control console by pressing the key for more than  3sec.Lift table up/Lower table downPerform table tiltEmergency stop button. Multi functional Table movements Multi functional Table movements Tab TitleTextTable Top Floating Movement Table Height Adjustment Table Top Rotation movement Trendelenberg / Reverse Trendelenberg Operation of system movements and imaging functions are handled through the control modules. There are four parts to the control modules:    1.The Table control module (TCM) for table movements    2.The Stand control module (SCM) for system movements and image review    3.The Collimator control module (CCM) for collimator and filter placement and adjustment    4.The Touchscreen Control(TSC) with Mouse joystick for operating imaging system The control modules can be mounted on the accessory rails at the tableside or on a trolley. On the table there are accessory rails either side of the table or at the table foot end. The control modules are designed so that they fit directly on the lower-body x-ray protection shield. This makes it easier to operate the system while maintaining the optimal x-ray protection.     ​ Learn about the control modules Learn about the control modules Base ImageHotspotsText BlocksImage FileCollimator control module (CCM) provides the controls for collimator and filter positioning.Table control module (TCM) provides the controls for table movements.  There are two variations of the table control module: TCM-S: Table control module with panning knob TCM-J: Table control module with joystick Please note: The TCM-S cannot be used on the control trolley or in the control roomThe Stand control module (SCM) is the main control module for system movements.The touchscreen provides access to many system functions, for example: Change x-ray parameters Image review Select Roadmap parameters Large Display layout selection Select Store fluoro, Radiation disable/enable, Care positiion. Using Task cards(Settings, Exam, Image, Quant, Physio, 3D/4D(inspace), Etc. Mouse joystick: The joystick can be deflected to the left/right/up/down and in any diagonal direction.    (1) Joystick function without button pressed    (2) Joystick function with a button pressed    (3) Possible directions of joystick deflection Different functions can be assigned to the buttons depending on the currently selected function. note: A bright background indicates that the function is currently active. A dark background indicates that the function is not active. mouse joystick which has three buttons:    (1) Left mouse joystick button: Select button    (2) Middle mouse joystick button: Store Ref button    (3) Right mouse joystick button: Close button   Explanation of color Explanation of color The control buttons are color coded to indicate direct operations or pre-selection of functions. If one of the blue button is pressed, the system will react directly. The gray buttons will pre-select a function and an additional movement of one of the joysticks is required to get a reaction of the system. Orientation of Control module Orientation of Control module Control Modules Orientation (Left side/Right side/Foot side)TitleTextTCM orientation R(Right)Tab TitleTextTab 1 TCM orientation L(left)Tab TitleTextTab 1 TCM Orientation F(Foot)Tab TitleTextTab 1 SCM Orientation L(Left)Tab TitleTextTab 1 SCM Orientation R(Right)Tab TitleTextTab 1 SCM Orientation F(Foot)Tab TitleTextTab 1 Consist of:   • Dead man’s switch for releasing movements   • Selection Buttons on each side with the same function:   • FD Lifting button   • System position button   • Programmed position button   • Store position button   • Orientation selection button   • zero stop button ​ •  Select direct positions I, II, III With the multifunction joystick the stand and C-arm positions can be adjusted by  deflecting the joystick in the required direction. The movement direction depends on the console orientation key.   Learn Stand Control Module Learn Stand Control Module Tab TitleTextStand Control moduleDead Man's GripOption selection buttonFD lift buttonsSystem position buttonProgrammed position buttonStore position buttonOrientation buttonZero Stop buttonDirect position I, II, IIIAssist monitor Learn about direct position store button Learn about direct position store button Sample IntroTitleTextStoring Direct position stepsTab TitleTextTab 1Storing Direct positionTab TitleTextTab 1Moving to Stored Direct positionTab TitleTextTab 1 Learn about Programmed position button Learn about Programmed position button Sample IntroTitleTextStoring Programmed position stepsTab TitleTextTab 1Storing Programmed positionTab TitleTextTab 1Moving to Programmed positionTab TitleTextTab 1 Learn about system position store button Learn about system position store button Tab TitleTextSystem position simple stepsSystem positions Head to LeftSystem position step by stepSystem positions To reduce scatter radiation and improve image quality, use the Collimator control module (CCM) to adjust the collimator and filter positions. The componenets of the CCM include: Two joysticks for filter placements One joystick for collimator placement Collimator reset button Home button for collimator & filters Keys to select filter type (Wegde filter or Finger filter) Detector magnification functions Detector Rotation functions You can perform collimation on the live fluoroscopy image or with CAREprofile on the last image hold (LIH). CAREprofile allows for collimation without radiation by placing graphical collimation lines on the LIH image. To active CAREprofile, activate the filter or collimation joystick when fluoroscopy is not active. The graphics appear on the last image hold and you can collimate and place filters on the image using the joysticks. When you press the fluoroscopy pedal again the image is collimated and filters are in place. Detector Magnification Detector Magnification Collimation / Shutter usage Collimation / Shutter usage Detector Rotation (Landscape Portrait) Detector Rotation (Landscape Portrait) Tab TitleTextDetector Orientation Landscape to PortraitDetector Orientation Portrait to Landscape Learn Collimator Control components Learn Collimator Control components Sample IntroTitleTextCCM OverviewTab TitleTextTab 1Filter JoysticksTab TitleTextTab 1Collimation JoystickTab TitleTextTab 1Filter selection (Wedge)Tab TitleTextTab 1Filter selection (Finger)Tab TitleTextTab 1Open Collimator leavesTab TitleTextTab 1Reset Collimator leavesTab TitleTextTab 1Detector Collimator rotationTab TitleTextTab 1Plane selection (A-Plane / B-Plane)Tab TitleTextTab 1Detector Zoom formatTab TitleTextTab 1CARE PositioningTab TitleTextTab 1 Touchscreen Control(TSC) with Mouse joystick for operating imaging system The touchscreen control (TSC) has a touch-sensitive liquid-crystal display. It can  display graphics and texts like a conventional computer screen and at the same  time allow you to enter data by pressing the buttons on the touchscreen, a bit like  a membrane keyboard. Basically the functions on the touchscreen control are performed in the same way  as with the mouse on the system console. Mouse Joystick Selected functions of the imaging system can be operated with the mouse joystick  and touchscreen in the examination room. Note: Please enable Adobe Flash player to view the below simulation ​ Explore/Simulate Touchscreen Control Console Explore/Simulate Touchscreen Control Console Click on the button/Tabs on the above picture to explore the options    click Help Button and select any button to know the functions                                        Upon completion of this course you will be able to: •Identify the main components of the control and exam room   •Perform C-arm and table movements using the control modules   •Recognize the components of the control modules​   •Apply collimation and filters using the control module   •Understand important safety considerations   The following equipment is in the exam room:   •Multi-axis stand, C-arm, x-ray tube and detector   •Siemens Multi-tilt table   •Exam room display   •Control modules •Footswitch for radiation release Standard footswitch  There are two single plane versions with 4 pedal functions and a biplane version  with 8 pedal functions. The functions of the pedals can be configured by Siemens  Service to your preference   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, in particular for relevant safety information like warnings and cautions. Note: Some functions shown in this material are optional and might not be part of your system. Certain products, product related claims or functionalities (hereinafter collectively “Functionality”) may not (yet) be commercially available in your country. Due to regulatory requirements, the future availability of said Functionalities in any specific country is not guaranteed. Please contact your local Siemens Healthineers sales representative for the most current information. The reproduction, transmission or distribution of this training or its contents is not permitted without express written authority. Offenders will be liable for damages. All names and data of patients, parameters and configuration dependent designations are fictional and examples only. All rights, including rights created by patent grant or registration of a utility model or design, are reserved. Copyright © Siemens Healthcare GmbH 2019