ARTIS飞龙系统操作之6-路径图

欢迎您来参加ARTIS pheno血管机系统的在线操作培训。 这个培训会向您介绍操作系统所需的工作流程。 您将特别学习到以下内容： 患者登记 患者摆位 选择检查协议及调整参数 将系统移动至工作位 进行常规采集   路径图是一种特殊的操作模式，用来支持放置导丝及支架。 在准备路径图的过程中，一幅透视图像与另一幅图像相减影创建一幅减影的蒙片像。这幅蒙片反转并且叠加在后续的透视图像上。当蒙片包含了一根充盈造影剂的血管时，结果就是一根反转的（白色）血管覆盖在实时减影透视图像上。 路径图有三种变种： 经典路径图：蒙片在透视期间产生 DSA路径图（CLEARmap）：用一个先前采集的DSA序列作为蒙片 附加路径图：使用一项特殊技术，蒙片用采集剂量来改善图像质量。 请注意：路径图期间实时部分显示路径图像，而且参考部分显示参考图或者实时原始图像。可以在系统控制台上的检查任务卡里面选择设置。   学习关于经典及附加路径图 学习关于经典及附加路径图 Slide NumberText BlocksCalloutsAudio ScriptImage File1在经典路径图里面所有成像都是用透视，包括蒙片的创建。   要启动路径图，从检查室触摸屏或者控制室的系统控制台选择路径图功能。 从触摸屏选择：RDMP and Overlay> Roadmap 从系统控制台选择图标： 检查任务卡>路径图图标  In classic Roadmap all imaging is done with fluoroscopy, including the creation of the mask image. To start Roadmap, select Roadmap from either the touchscreen in the exam room or from the system console in the control room. From the touchscreen select roadmap and overlay and Roadmap. From the system console select the Examination task card and then the Roadmap icon. 2您选择了路径图功能后就准备好开始成像，踩下踏板上的透视脚闸。 在路径图第一期相，图像显示为原始图像。 第一期相有两个阶段：期相一（a）及期相一（b） 第一期相（a）期间会出现剂量调节 第一期相（b）期间图像被平均化为减影创建一幅蒙片 保持踩住透视脚踏板，会自动过渡到第二期相。After you have selected Roadmap and you are ready to start imaging, press on the fluoroscopy pedal on the footswitch. In Phase one of Roadmap, the images are displayed native. Phase one has two stages; Phase one A and Phase one B. During Phase one A, the dose regulation is occurring. During Phase one B, the images are being averaged to create a mask for subtraction. Keep your foot pressed on the fluoroscopy pedal, the transition to Phase two will occur automatically. 3当进入第二期相时显示为减影图像。第二期相开始时大屏幕的信息区显示注射器符号。   当您看到注射符号时，开始注射造影剂。   一直保持踩住透视脚闸直到感兴趣血管充盈造影剂。   当血管充盈时您可以松开透视脚闸。   在这个期相停止X线后，实时部分显示一幅末帧保存图像（LIH）。 最大不透明化在这个期相生效。什么是最大不透明化？通常造影剂不会均匀一致地充盈血管，不如说是造影剂团“旅行”经过血管。最大不透明化功能结合了充盈期所有图像成为一幅图像来显示造影剂获取的路径。When Phase two is entered the images are displayed subtracted. At the beginning of Phase two an injection symbol appears in the Info area on the Large Display. When you see the injection symbol, start injecting contrast. Keep your foot pressed on the fluoroscopy pedal until the vessels of interest have been filled with contrast. When the vessels have been filled, you can release the fluoroscopy foot pedal. After X-ray stop in this phase, the Live segment shows a last image hold. Maximum opacification is effective in this phase. 4您通过释放透视开始路径图第三期相。   在这个期相图像显示为减影模式并且蒙片是充盈造影剂血管的最大不透明化图像。   血管反转显示（白色）并且覆盖在实时减影图像上。   每一次释放透视时路径图都会停留在第三期相。   要退出路径图可以在触摸屏上选择路径图按钮或者在系统控制台上检查标签里选择路径图图标。You start Phase three of Roadmap by releasing fluoroscopy. During this phase the images appear subtracted and the mask image is the maximum opacification image of the contrast filled vessel. The vessel appears inverted (white) and overlaid on the live subtracted image. Roadmap will stay in Phase three with every new release of fluoroscopy. To exit Roadmap, select Roadmap on the touchscreen or select the Roadmap icon in the Examination tab on the system console. 5附加路径图是一种特殊的路径图技术，用来获得比透视更高的图像质量。   创建血管图像使用的是采集剂量（一期及二期），而三期及四期使用的是透视剂量。所有期相一直使用的是透视脚闸。   附加路径图的工作流程与经典路径图基本相似。附加路径图工作流程的主要区别是当激活路径图时，您需要一个选择一个特定的检查设置。   某些检查在路径图模式配置有一个DSA协议作为可选择采集程序。选择的DSA协议作为可选择采集用来创建蒙片。   请与您的西门子医疗教育代表核对选择哪个检查设置可以实现附加路径图。Additional Roadmap is a special Roadmap technique used for higher image quality than fluoroscopy. Acquisition dose is used for the vessel map creation (Phase one and Phase two) and fluoroscopy dose is used in Phase three and Phase four. The fluoroscopy pedal is used for all phases. The workflow for additional Roadmap is basically the same as with Classic Roadmap. The main difference in the Additional Roadmap workflow, is that you need a specific exam set selected when Roadmap is activated. Certain exam sets have a DSA protocol configured as an alternative acquisition in Roadmap mode. The DSA protocol selected as the alternative acquisition will be used for the mask creation. Please check with your Siemens Healthineers education representative which exam set to select for Additional Roadmap. 学习关于DSA路径图 学习关于DSA路径图 Slide NumberText BlocksCalloutsAudio ScriptImage File1DSA路径图可以使用任何一个以前采集的DSA参考图像或者一个以前采集的DSA序列自动生成的最大不透明化图像作为蒙片。其他所有图像都是在透视下创建的。   首先您需要创建一个DSA序列。   如果血管显示清晰并且您愿意使用这个图像做路径图，用导航控制模块上的按键保存一张参考图。   如果您正在使用一个设置了最大不透明化的DSA协议，激活DSA路径图后会自动生成DSA参考图像。请与您的西门子医疗教育代表核对哪一个协议可以用来使用这个功能。In DSA Roadmap either a previously acquired DSA reference image or the automatically generated Maximum opacification image of a previously acquired DSA scene can be used as the mask. All other images are created with fluoroscopy. First you need to create a DSA scene. If the vessels are clearly demonstrated and you would like to use the image for Roadmap, save a reference image using the key on the Pilot control module. Hint: If you are using a DSA protocol that has Maximum Opacification configured, the DSA reference image will be automatically generated after activation of DSA Roadmap. Please check with your Siemens Healthineers education representative which protocol can be used to utilize this function. 2一旦您的DSA图像保存为一张参考图像，您可以启动路径图。   在触摸屏上选择：RDMP and Overlay > Roadmap > DSA RDMP Ref1 或者 DSA RDMP Ref2（依据DSA图像保存在哪一个参考部分）   请注意：在以下情况下，不能实现DSA路径图： 如果保存参考图像后移动系统，这包括C臂及床的移动 如果图像放大率发生改变 提示：您同样可以从控制室的系统控制台选择DSA路径图，选择：检查任务卡> DSA 或者DSA 2 图标Once your DSA image is stored as a reference image, you can start Roadmap. On the touchscreen select: Roadmap and Overlay, Roadmap, DSA Roadmap, Ref one or DSA Roadmap Ref two (depending on the reference segment on which your DSA image is stored). Please note that in the following circumstances, DSA Roadmap will not be possible: If the system has moved since the reference image was taken, this includes C-arm and table movement. If there are changes to image zoom. 3路径图开始前核对以下内容： 原始图像采集后系统没有发生过移动。 保存参考图像后患者没有发生过移动 参考1或者参考2 部分有一张DSA减影参考图像 您已经选择的DSA路径图协议与保存参考图的参考部分相匹配 当您准备好启动路径图，踩下脚闸上的透视踏板。   路径图启动第一期相并且会显示原始图像（非减影）。   第一期相期间，系统会调整剂量且之后创建一幅蒙片。保持踩住脚闸上的踏板直到显示减影图像。Before starting Roadmap check the following: No system movements have occurred since the original acquisition was acquired. The patient has not moved since the reference image was stored. There is a DSA subtracted reference image on either the Reference one or Reference two segment. You have selected the DSA Roadmap protocol that matches the reference segment on which the reference image is stored. When you are ready to start Roadmap, press the fluoroscopy pedal on the footswitch. Roadmap will start in Phase one and the images will appear in native display (without subtraction). During phase one, the system is regulating the dose and then creating a mask image. Keep the foot pedal on the footswitch pressed until the subtracted image is displayed.4当您看到减影图像，保持踩住脚闸上的透视踏板。   因为已经从DSA参考图创建蒙片，所以您无需注射任何造影剂。   下一步松开透视脚闸，路径图自动转换到第三期相并且图像显示为反转的DSA图像覆盖在实时减影图像上面。   您可以根据需要松开和激活透视脚闸。路径图会一直持续激活直到您从触摸屏上取消路径图。When you see the subtracted image keep the fluoroscopy foot pedal on the footswitch pressed. Because the mask was already created from the DSA reference image, you do not need to inject any contrast media. With the next release of the fluoroscopy foot pedal, Roadmap automatically switches to Phase three and the images appear with the inverted DSA image overlayed on the live subtracted image. You can release and activate the fluoroscopy footswitch as required. Roadmap will remain active until you disable Roadmap on the touchscreen. 学习关于路径图模式下的操作 学习关于路径图模式下的操作 Slide NumberText BlocksCalloutsAudio ScriptImage File1由于患者移动，减影图像可能不精准一致，如果发生了这种情况，路径图期间图像可以进行调整（当没有释放x射线时）。   您可以用手动和自动像素移位功能调整图像。 屏幕菜单：DSA 菜单>  Auto Pixelshift 或者Manual Pixelshift 您可以使用导航控制模块上的调节旋钮来调整图像。   在控制室系统控制台上： 后处理任务卡> DSA子任务卡，点击图标Pixel shift 提示：要回到应用像素移位前的原始设置，在触摸屏上选择DSA菜单>像素移位复原Due to patient movement, subtracted images may not coincide exactly. If this occurs, the images can be adjusted during roadmap (when no x-ray is being released). You can adjust the images using manual and automatic methods of pixel shift. On the onscreen menu select the DSA Menu, auto pixel shift or manual pixel shift. You use the jog wheel on the Pilot control module to adjust the images. In the control room on the post processing task card select the DSA sub task card and click on the Pixel shift icon.2在检查室里面可以改变解剖背景或者血管或导管的对比度。 可以提供选择的由系统控制台上的设置决定： 采集>设置解剖背景/设置血管/导管对比 当选择了设置血管/导管对比度：从触摸屏上可以选择VC/CC 当选择了设置解剖背景：从触摸屏及屏幕菜单上可以选择解剖背景。 In the exam room it is possible to change either the Anatomical Background or the vessel or catheter contrast. The available selection depends on the setting on the system console; acquisition, set anatomical background, set vessel or catheter contrast. When set vessel catheter contrast is selected; vessel contrast, catheter contrast can be selected on the touchscreen. When set anatomical background is selected; anatomical background can be select on the touchscreen and on the onscreen menu.3在一个减影序列里面，通常是看不到解剖背景的。然而在某些情况下，显现解剖背景是有益的，特别是使用解剖标记的时候。   解剖背景可以设置在0%和100%之间。 0%是减影。100%时显示为原始图像。 要调整解剖背景： 屏幕菜单：DSA菜单>解剖背景Anatomical Background 触摸屏: RDMP &Overlay > Roadmap > Anatomical Background 您使用导航控制模块上的调节旋钮来调整解剖背景。   在控制室里面的系统控制台上： 后处理任务卡>DSA子任务卡，点击调整解剖背景图标 提示：如果选择了VC/CC，触摸屏及屏幕菜单不会提供选择解剖背景。In a subtracted scene, the anatomical background is normally not visible. In some cases however, it can be beneficial to visualize the anatomical background, particularly when using anatomical landmarks. The anatomical background can be set between zero percent and one hundred percent. At zero percent, the display is subtracted. At one hundred percent, the images appear in native display. To adjust the anatomical background; on the onscreen menu select the DSA Menu, anatomical background. On the touchscreen, select roadmap and overlay, roadmap and anatomical background. You use the jog wheel on the pilot control module to adjust the anatomical background. In the control room on the post processing task card, DSA sub task card click on the adjust anatomical background icon. 4路径图期间您可能需要显现导管或导丝更多的细节。路径图协议里面定义了血管对比度及导管对比度的初始值。路径图期间可以调整血管及导管对比度。 触摸屏：路径图及叠加>路径图>VC/CC对比度（RDMP &Overlay > Roadmap > VC/CC Contrast） 您使用导航控制模块上的调节旋钮调整血管及导管的对比度。   在系统控制台上，后处理任务卡主菜单选择 Image（图像）> Change Vessel / Catheter Contrast（改变血管/导管对比度） 使用上下箭头来调整数值提示：如果选择了解剖背景，触摸屏上将不提供VC/CC选项During roadmap you may need to visualize the catheter or the vessel in greater detail. The initial values for vessel contrast and catheter contrast are defined in the roadmap protocol. The vessel and catheter contrast can be adjusted during roadmap. On the touchscreen select, roadmap and overlay, roadmap vessel contrast and catheter contrast. You use the jog wheel on the Pilot control module to adjust the vessel and catheter contrast. On the system console, on the post processing task card, in the main menu select, image, change vessel, catheter contrast. Use the up and down arrows to adjust the values.5做路径图时，有可能发生运动伪影。   如果出现了运动伪影，您可以用ResetRoadmap功能重置路径图并且创建一幅新的蒙片。 触摸屏：RDMP &Overlay > Roadmap > Reset Roadmap（路径图及叠加>路径图>重置路径图） 在控制室里面的系统控制台上： 检查任务卡>路径图对话框，点击重置路径图图标 可以将脚闸上的一个踏板配置为重置路径图功能。请与您的西门子医疗服务代表确认。When performing Roadmap, it is possible for motion artifact to occur. If this occurs, you can reset Roadmap and create a new Mask image using the Reset Roadmap function. On the system console in the control room, select the Examination task card, Roadmap Dialog and click on the reset roadmap icon. Hint: It is possible that your footswitch is configured with a Reset roadmap foot pedal. Please confirm with your Siemens Healthineers service representative.6在一些检查过程中，比如栓塞过程中可能会放置包括弹簧圈、许多栓塞剂等器械，使得要看清导丝很困难。 在这些情况下，可以在路径图期间激活功能Show Progress。   当激活这些功能时末帧透视保存图像用来替换蒙片。结果是之前放置的栓塞剂被减掉，生成一个减影的路径图视图。 触摸屏：RDMP & Overlay > Roadmap > Show Progress（路径图及叠加>路径图>显示进展） 在控制室里面的系统控制台上： 检查任务卡>路径图对话框，点击Show Progress（显示进展）图标 During certain procedures such as, embolization procedures involving coiling, many embolization agents may be deployed, making visualization of guide wires difficult. For such cases, Show progress can be activated during roadmap. When activated, the last image hold (LIH) is used to replace the mask image. As a result, the previously deployed embolization agents are subtracted, resulting in a subtracted Roadmap view. On the touchscreen, select roadmap and overlay, roadmap, show Progress. On the system console in the control room click on the show progress icon in the roadmap dialog. 7路径图期间，您可能需要看到感兴趣区的更多细节。可以使用路径图模式中的 “放大及移动”功能。 屏幕菜单：DSA  > Zoom by Factor 2 触摸屏：RDMP &Overlay > Roadmap > Zoom by Factor 2（路径图及叠加>路径图>放大两倍） 这个功能应该在需要但不需要持久使用时激活。   如果您决定需要长时间增强显示细节，可以使用其他功能，比如，扩大放大率并且重新采集蒙片，或者另选一个有更大实时部分的大屏幕布局。During Roadmap, you may need to visualize an area of interest in greater detail. It is possible to 'Zoom and pan' in Roadmap mode. You can activate 'Zoom and pan' from the Onscreen menu, select, the DSA menu, Zoom by factor two. This function should only be utilized as required and it is not intended for prolonged use. If you determine that you require detail enhancement for a longer period of time, use other functions, for example, enlarge the zoom stage and re-acquire the mask, or choose a different layout with a larger live segment on the large display. 8路径图期间两个系统位置可以存储两个路径图蒙片，举例来说，一个左前斜和一个右前斜的C臂位置。您可以在两个位置间来回切换，执行路径图时无需重新采集一幅路径图蒙片。   在一个系统位置选择路径图并且执行路径图 移动C臂到另一个位置并且执行路径图   在第二个系统位置执行路径图后，在触摸屏路径图的菜单里面会提供Previous Mask（先前蒙片）功能   在触摸屏上选择“Previous Mask”将系统移动至之前的蒙片位置 选择：Drive to Position（驱动到位置） 按住触摸屏上的“Hold to drive”（保持驱动） 系统移动到之前路径图蒙片的位置。提示：只有已经激活两个系统位置的路径图时，触摸屏上才可以提供选择先前的路径图。During Roadmap two Roadmap mask images may be stored for two system positions, for example, an LAO and an RAO C-arm position. You can move back and forth between the two positions, performing Roadmap at each position without reacquiring a Roadmap mask. Select Roadmap and perform Roadmap in one system position. Move the C-arm to another C-arm position and perform Roadmap. After Roadmap is performed in the second system position previous mask is available on the touchscreen in the roadmap menu. To move the system to the previous Roadmap position, select previous mask on the touchscreen. Select, drive to position. Press Hold to Drive on the touchscreen. The system moves to the position for the previous Roadmap mask 请注意此学习资料只用于培训目的！ 为了正确使用软件及硬件，请始终使用西门子医疗发布的操作手册。本资料仅作为培训资料使用，绝不能替代操作手册。本培训中使用的任何材料将不定期更新，也不一定反映培训时可用的最新软件和硬件版本。 用户操作手册应该作为你的主要参考资料，特别是与安全信息如警告及提醒相关内容。 注意：这份资料提供的某些功能是选配件，您的系统上可能没有配置。 这份资料中描述的功能能或者部分机能可能还没有面向用户发布，也尚未在每个国家进行商业销售。由于监管要求，上述功能或其部分在任何特定国家的未来可用性都不能得到保证。请联系您当地西门子医疗销售代表获取最新信息。 未经书面授权，不得复制、传播或分发本培训或其内容。违法者将承担损害赔偿责任。 保留一切权利，包括授予专利权或者对实用新型、外观设计进行登记所产生的权利。 Copyright © Siemens Healthcare GmbH   欢迎您来学习ARTIS  pheno操作系统路径图相关知识。 在此您可以详细了解经典路径图，附加路径图及DSA路径图的相关原理及操作方法。