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C M Y CM MY CY CMY K

04

Innovation in Interventionwww.siemens.com/medical

No. 4/March 2007

Contents

Innovation Bulletin

Clinical GalleriesUnderstanding theneeds of healthcareprofessionalsPage 8

Innovation Angiography

AXIOM Artis dBA TwinNew biplane systemfeaturing two largedetectors for extraanatomical coverage2

Innovation Fluoroscopy

AXIOM Luminos dRF*A true 2-in-1 solutionfor fluoroscopy andradiographyPage 36


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I would like to take this opportunity to point out the great importance we

attach to feedback from our customers. Your views, opinions, and

suggestions are extremely valuable in helping us develop trendsetting

solutions. Again, the constant dialogue with specialists on the front lines

of healthcare has led to major innovations.

In this edition, I am particularly pleased to introduce our new Clinical

Galleries concept. We have created a completely new approach to

presenting products and the added value they bring to each aspect of your

clinical workflow – concise, precise, and right to the point. Learn more

about our clinical galleries in this issue of AXIOM Innovation in Intervention

and judge for yourself.

Another innovation I would like to draw your attention to is the new

AXIOM Luminos dRF*, a true 2-in-1 digital imaging solution, which tears

down the wall between fluoroscopy and radiography. With a large

43 cm x 43 cm flat detector and a minimum table height of only 48 cm,

this multi-functional system delivers all the benefits of digital imaging

and sets a new standard in versatility.

Of course, you will also find plenty of case studies and articles to keep you

on the cutting edge of innovations provided by Siemens Medical Solutions.

Enjoy reading AXIOM Innovation in Intervention.

Dear AXIOM reader,

3

Dr.-Ing. Norbert GausPresident AX Division

AXIOM · Issue No. 4/2007

Dr. Norbert Gaus

[email protected] * Pending 510(k) review in the U.S.


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564

syngo® iDentify –Redefining 3D imaging duringintervention with syngo iDentify

Clinical Galleries –Understanding the needs ofhealthcare professionals

A plenitude of benefits –Interview with Roland Gitter, MD

AXIOM Luminos dRF *–Fluoroscopy’s bright future

AX Factory –Innovative products need

innovative manufacturingand logistics

C o n t e n t s

syngo DynaCT –Oncologic experience withhepatic arterial interventionsusing syngo DynaCT

28

6

8

36

14

* Pending 510(k) review in the U.S.


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Innovation Newssyngo iDentify – Redefining 3D imaging during intervention with syngo iDentify

MULTIX Swing going once, going twice, sold!

syngo DynaCT: Results in less than a minute

Innovation BulletinClinical Galleries – Understanding the needs of healthcare professionals

Innovation AngiographyAXIOM Artis dBA Twin – When extra coverage is key

Oncologic experience with hepatic arterial interventions using syngo DynaCT

Clinical Case Report – Myelography

Clinical Case Report – Abdominal vessels

Imaging right at the angio table can be a life-saving feature –

Interview with Saruhan Cekirge, MD

Clinical Case Report – Stenting of carotid bifurcation

Innovation CardiologyAXIOM Sensis XP – Integrating the way You work

A plenitude of benefits – Interview with Roland Gitter, MD

Clinical Case Report – Coarctation of the aorta in low-dose pediatric imaging

Innovation RadiographyAXIOM Aristos VX Plus – Fast, flexible, and cost-efficient

Digital radiography – Experience efficiency with automated system movements

Innovation FluoroscopyAXIOM Luminos dRF* – Fluoroscopy’s bright future

Clinical Case Report – Fluoroscopic assessment of the bariatric surgery patient

Customer CareDose management – Interview with John Benjamin, MD

Advanced skills for advanced technology

Interventional cardiology training on modern simulation systems

Innovative products need innovative manufacturing and logistics

RSNA 2006 – Strengthening professionalism

LINC Course – High interest in the newest endovascular techniques

Popular computer simulation gains gold card travel status

Upcoming events and congresses 2007

About us

5AXIOM · Issue No. 4/2007

Contents

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syngo iDentify

6

Moreover, it allows clear visualization of

a clip, stent, or coil placed in a vessel as

well as soft re-stenosis within a stent and

differentiates calcified plaque from a

vessel. The benefits for the interventional

radiologist are obvious. Stent placement

can be exactly verified and calcified plaque

becomes clearly visible. In line with syngo

applications, syngo iDentify can be displayed

in the examination room and integrated

into the syngo user interface.

Redefining 3D imaging during intervention withsyngo iDentify

3D visualization is a well-established tool in

interventional imaging. Initially, only one

volume data set could be displayed allowing

for the visualization of contrast-filled

vessels, stents, clips, coils, and bone. syngo

iDentify enhances 3D visualization during

interventional procedures by enabling

dual-volume visualization of high-contrast

objects. It provides differentiation between

two 3D objects of high contrast that have

virtually the same contrast density.

On December 7, 2006, the first compact

radiography system, our MULTIX Swing was

sold by Internet auction. After two hours,

the system found a buyer in southern

Germany. This online auction followed

the principle of a Dutch auction or reverse

auction: in this case, the system went to

the first – not the highest – bidder. The

price started at a certain level and dropped

continuously from there. The first buyer to

(virtually) raise his or her hand and set the

price, won the auction. All interested buyers

were able to register online and place a bid

either during or prior to the auction. It was

not even necessary to be online during the

auction. What made this method even more

exciting was the “Buy it now“ option.

MULTIX Swing* going once,going twice, sold!

Any bidder can use it anytime during the

auction to immediately buy the system

at the price displayed. This was our first

attempt to use the Internet as a sales

channel and increase interest among

customers. The project was pioneered in

Germany, but may be available in other

countries in the future. For upcoming

auctions, please visit our website

www.siemens.com/multix-auktion

Simultaneous visualizationof carotid artery and stentenable stent deploymentassessment

The virtual marketplace forMULTIX Swing


* Not available in the U.S.


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Soon after its introduction to the market

in 2004, cross-sectional imaging with

syngo DynaCT is developing towards a

worldwide standard in the interventional

environment.

With more and more clinical staff realizing

the numerous advantages syngo DynaCT

delivers, it has quickly become common

practice to plan interventions on the basis

of syngo DynaCT results.

Successive software development and clinical

experience have led to ongoing progress in

image quality. However, the time required

for reconstruction of the volume data was

largely determined by hardware constraints.

Thanks to further basic development in

computer hardware like the launch of the

Intel® Core™ 2 Duo processor and extensive

research by Siemens engineers, this process

has accelerated noticeably.

The new version of syngo DynaCT requires

less than a minute to reconstruct all syngo

DynaCT protocols – a major improvement

to reconstruction performance, which marks

a new stage of development for syngo

DynaCT. Even better, further improvements

to image quality were implemented in the

new version.

A full year of research and development was

invested in order to profoundly redesign the

entire processing pipeline underlying the

imaging process. The latest technologies

available on the market were extensively

leveraged, e.g., the increasing capabilities

and performance of FPGA chips used on a

syngo DynaCT:Results in less than a minute


dedicated CT-reconstruction CPU reduce the

computational time of particularly expensive

3D reconstruction algorithms by factor of 90.

In-depth performance analysis led to a

focused optimization of algorithms, thereby

ensuring full utilization of the computational

power of the new hardware and software

architecture. “We are confident we can satisfy

the ‘need for speed’ in the modern clinical

environment and enhance the interventional

workflow of our customers,” states

Dr.-Ing. Benno Heigl, manager of 3D

application development at Siemens

Medical Solutions, AX.

The new version of syngo DynaCT with

optimized reconstruction performance was

first presented to the public at the RSNA

2006 and resonated very well among

experts and healthcare professionals.

8 AXIOM · Issue No. 4/2007

Understanding the needsof healthcare professionalsSiemens is breaking new ground incommunication through Clinical Galleries


Our knowledge-driven society is mainly

characterized by an increasing abundance

of information. Ideally, every piece of

information should be focused and prove

immediately beneficial. That’s exactly what

Siemens’ new Clinical Gallery concept offers

to healthcare professionals. It is a completely

new way of presenting products, their features

and the added value they bring to each aspect

of the clinical workflow.

“Following analysis of the clinical workflow, we

strictly focused on the relevant product features

and their clinical benefits to enable an

improved communication. A communication

that has a clinical perspective,” states Kevin

Dand, director of global marketing for

interventional radiology from Siemens Medical

Solutions. “We demonstrate an understanding

of clinical practice and are moving away from

the days of in-depth technical detail, the feature

or the box, towards what really matters:

delivering the tools for an effective clinical

result,“ he further explains. It goes without

saying that an artist’s work is best

presented in a gallery. Our galleries

communicate through a collection of images,

representing clinical benefits enabled by

product features, delivered in line with the

clinicians‘ workflow for the optimum clinical

result. Clinical galleries communicate an

unmatched and tailored solution to modern

clinical needs.

Clinical results, enabled bysystem featuresThe new gallery concept clearly aims to

initiate a dialogue that is closer to the

clinicians‘ world. The dialogue is supported

with images that are appropriate to the

specialists’ expertise. These images are

presented in a logical sequence that matches

clinical workflow and daily routine. Each

image is “enabled” by a system feature that

produces a clinical result or provides well-

defined workflow benefits. “This new

approach enables us to better understand

the specialists’ needs of today and of the

future,“ explains Dand. “It is an exciting

shift whilst improving communication.”

• Parallel Biplane Fluoro

• Parallel Biplane Acquisition

• 2k Imaging

Overview

• syngo Angio Package

• DAZ(Digital Acquisition Zoom)

• High-speed acquisition

• syngo InSpace 3D Viewer

• Automap

ROI Decision

• Roadmap Plus

• Auto pixel shift in roadmap

• syngo iPilot

Guidance

• syngo iDentify

• syngo DynaCT

• Fluoro Loop Biplane

• Parallel Biplane Acquisition

Baseline

• syngo DynaCT

• 2k Imaging

• Flexible pixel shift in DSA

Placement Checkclinical... ...workflow

Overview Neuro GalleryDecision Guidance Placement Check

• syngo Biplane(Quantification)

• syngo InSpace 3D Viewer

• syngo InSpace 3DStenosis Measurement

• syngo Volume analysis

• syngo DynaCT

ROI


The recently published Siemens Neuro

Gallery is the first showcase for the new

concept. It presents relevant neuro features

and the added value they bring in line with

the clinical workflow. Exactly the right

combination of clinical software, workflow,

and system features needed for excellent

neurovascular results in diagnosis and

treatment are presented at a glance –

all in all, a unique and complete solution.

Each reader and observer can individually

benefit from the broad mix of applications

that support the treatment of aneurysms,

AVMs, carotid arteries, spine and stroke work.

A gallery of clinical resultsenabled by a systemSiemens’ Clinical Gallery concept consists of

seven clinically segmented galleries reflecting

the various specialists’ expertise and differing

needs. Focused on clinical demands, each

contains a workflow-based collection of images

that delivers an unprecedented perspective of

medical benefits rather than technical features.

The initial seven galleries are:Fluoroscopy Gallery, Neuro Gallery,Interventional Cardiac Gallery,Electrophysiology Gallery,Body Gallery, Radiography Gallery,Congenital Heart Gallery

Experience this improved

communication by visiting

www.siemens.com/axiom

Contact: [email protected]

A complete picture supportingeffective results


Fluoroscopy Gallery

Neuro Gallery Interventional Cardiac Gallery Electrophysiology Gallery

Body Gallery Radiography Gallery Congenital Heart Gallery

“All physicians

are artists in

their own way.”

Are we speaking the same language?

The Clinical Gallery concept is a new way of presenting our products and the added value they

bring to each aspect of your clinical workflow. We have analyzed your workflow and focused

on the relevant product features and their clinical benefits to enable improved communication.

Images are best presented in galleries. Our Clinical Galleries provide a collection of images,

demonstrating product features that enable you to deliver an optimum clinical result. Clinical

Galleries communicate an unmatched and tailored solution to your clinical needs.


Equipped with two 30 cm x 40 cm flat

detectors, the AXIOM Artis dBA Twin offers

unequalled coverage and flexibility for a vast

application range including neuro, spine and

abdominal as well as pediatric imaging. The

state-of-the-art biplane flat detector system

delivers images with biplane 2k high-detail

resolution, ideally suited for diagnostic and

interventional procedures alike. Thanks to its

ultra-compact rotating detector and collimator

housings, the system grants virtually

unrestricted patient access while also offering

outstanding angulations and unmatched

coverage capabilities.

Almost infinite scopeWith its excellent coverage and image quality,

the AXIOM Artis dBA allows visualization from

the spinal arteries down to the finest brain

distal vessels in both the frontal and lateral

views simultaneously. The system also enables

imaging of the frontal and lateral spine with

optimal coverage, typically from T8 to L5. It

goes without saying that the AXIOM Artis dBA

Twin offers excellent support, particularly for

pediatric applications, where optimal dose

AXIOM Artis dBATwin at a glance:

• Largest biplane

anatomical coverage

available

• Clinical flexibility – from

neurovascular to spine

and abdominal imaging

• Outstanding image

quality, fine detail

resolution, and clear

device visualization

• Enables trendsetting

innovations including

biplane 2k imaging and

syngo DynaCT

• Customized workflow

with programmable

detector positioning and

intelligent collision

protection

When extracoverage is keyAXIOM Artis dBA Twin

reduction capabilities are essential. The system

is also ideal for special imaging procedures, such

as biplane 2k imaging and syngo DynaCT.

Innovative syngo DynaCT supportThe AXIOM Artis dBA Twin supports the latest

trendsetting imaging technique, syngo DynaCT.

This innovative system virtually avoids patient

transfers to a CT by acquiring soft tissue imaging

results in the interventional suite. This yields

better patient management in the interventional

suite and reduces the risk of complications.

Intuitive tableside convenienceOne of the AXIOM Artis dBA Twin’s distinguishing

features is the exceptionally high degree of

operator convenience. The tableside controls

and compact, rotating detectors enable optimal

system positioning and a comfortable patient

experience. Accordingly, the system provides a

high level of utilization while streamlining the

overall clinical workflow.

For more detailed information,

send your questions to:

[email protected]

The power of two


Within the framework of hepatic artery

interventions, Michael Wallace and his

colleagues at the M. D. Anderson Cancer Center

in Houston, Texas, evaluated the advantages

of syngo DynaCT with a Siemens AXIOM

Artis dTA. The following is an abstract of their

conclusions. The abstract was presented at

RSNA 2006.

PurposeTo evaluate syngo DynaCT soft tissue imaging

in the angiography suite and to assess the

impact on hepatic arterial interventions (HI)

in patients with hepatic malignancy.

Method and materialsThe medical and imaging records of patients

who underwent HI as part of the work-up and

treatment of hepatic malignancy from 5/2/05

to 3/23/06 were reviewed. Interventions

included infusion (HAI), radioembolization

(HARE), embolization (HAE), and

chemoembolization (HACE); and syngo

DynaCT imaging in the angiography suite was

obtained [Siemens AXIOM Artis dTA with

Oncologic experiencewith hepatic arterialinterventions usingsyngo DynaCTSeeing more, seeing better – AXIOM Artis dTAin practiceCourtesy of M. J. Wallace, MD; R. Murthy, MD; P. P. Kamat, MD; S. Gupta, MD; K. Ahrar, MD;M. E. Hicks, MD and others

syngo DynaCT software (VB22)] as an adjunct

to conventional DSA. The number of syngo

DynaCT runs per HI was recorded and the

assessment of added value was tabulated

according to one of the following three criteria:

1. No additional information

2. Information without management impact

3. Information with management impact.

The interval between the initial and the last

angiographic run was recorded for all HI and

a two-tailed t-test was used to compare HI

with and without syngo DynaCT.

Resultssyngo DynaCT was used in 86/240 (36%) of

HI on 135 patients, which included 12/72

(16.7%) HAI, 16/38 (42.1%) HARE, 11/36

(30.6%) HAE, and 47/94 (50%) HACE

procedures. The mean number of syngo

DynaCT acquisitions per exam was 1.9 (range

1.1–2.2). Based on criteria 2 and 3, additional

information was demonstrated in 51/86

(59.3%) overall and in 5/12 (41.6%) HAI,

5/16 (31.2%) HARE, 6/11 (54.5%) HAE, and



[email protected]


35/47 (74.5%) HACE interventions. Based

on criterion 3 alone, incremental information

impacted management in 16/86 (18.6%)

overall and in 4/12 (33.3%) HAI, 2/16 (12.5%)

HRE, 1/11 (9.0%) HAE, and 9/47 (19.2%) HACE

interventions. The mean procedure time with

syngo DynaCT was significantly longer for

HAE (16 min; p = .025) and for HACE (19 min;

p = .003) but was not significantly different

for HAI and HARE.

Conclusionsyngo DynaCT provides added information in

more than 50% and impacts management in

19% of HI. With the syngo DynaCT software

version used for this study there is a potential

for a significant increase in procedure times

especially when more than one run per HI is

obtained.

Clinical Relevance/Applicationsyngo DynaCT produces CT- like images during

hepatic artery interventions to provide

additional imaging information beyond DSA

to aid in performing these complex procedures.

[1] syngo DynaCT provides a detailed hepatic vascularanatomic survey and creates a roadmap to achievesubselective catheterization and chemoembolization.syngo DynaCT can also be used to further characterizeindeterminate vessels incompletely visualized on DSA.

[3]Post hepatic artery

chemoembolization:syngo DynaCT enables

the validation of theethiodol accumulationthroughout the entire

target lesion. This waythe homogeneity of the

uptake can easily beassessed.

15

A n g i o g r a p h y1

2

3

[2] Vascular/parenchymal assessment before hepaticartery chemoemblization: syngo DynaCT enables theidentification of occult lesions and corresponding arterialsupplies, allowing selective catheteriazation or therapy.Consequently, pre-therapeutic arterial-parenchymalinformation can be evaluated in correspondence withthe planned target volume. Moreover, the subsequenttherapy is assessed. (Here: entire lesion fed by anticipatedarterial supply).

Reference:Wallace MJ, Murthy R,Karnat PP, Gupta S,Ahrar K, Hicks ME, et al.C-arm CT: oncologicexperience with hepaticarterial interventions(abstr). In: RadiologicalSociety of NorthAmerica scientificassembly and annualmeeting program. OakBrook, Ill: RadiologicalSociety of NorthAmerica, 2006; 249.

ClinicalCaseReport

16

Myelography

syngo DynaCT –Cross-sectional imaging.Setting the trend in intervention.Courtesy of Dr. Jan-Hendrik Buhk,University of Göttingen, Göttingen, Germany

Contrast-enhanced syngo DynaCTof the spinal canal

Patient underwent two lumbar disc

surgeries, segment L4/5 and segment L5/S1,

persisting lumboischialgia. Main symptom:

increase of pain.

Diagnosis:Dural neurocanal of the complete lumbar

spine is normally wide, this is consistent

with the age of patient. In comparison with

the other side, the left spinal root L5 seems

thicker than the right, the remaining ones

are regular. There are no signs of spondylosis

and no suspicious findings in the post

spondylotomy defects. In tomography, there

is a little bit more density in the left spinal

root bag L5, e.g., scar tissue. Essentially,

these findings in post-surgery myelography

are quite regular, but show discreet signs

of adhesion of the left spinal root L5

post surgery.


Patient history:

Comments:The main advantage of syngo DynaCT is

that it can avoid patient transfer to CT after

the myelo procedure. The whole procedure

can now take place in the angio suite,

enabling better patient access throughout

the intervention as well as post-processing

of imaging for both fluoroscopy and cross-

sectional imaging at the same workstation.

Additionally, the new workflow brings

significant patient benefits such as reduced

examination time, no repositioning, and

no waiting time. Myelo syngo DynaCT is

therefore more effective and more efficient

at the same time. Moreover, the spatial

resolution available with syngo DynaCT

enables the precise identification of very

small structures. In this clinical case,

the post-spondylotomy defects and the

excellent contrast of the spinal roots

should be noted.


[2] Sagittal right view.Contrast-enhancedsyngo DynaCT ofthe spinal canal.

[3] Anterior view [4] Sagittal left view

[1] Axial view1

2 3 4

18

Abdominal vessels

syngo DynaCT –Cross-sectional imaging.Setting the trend in intervention.Courtesy of Prof. Frank K. Wacker,Charité, Berlin, Germany

syngo DynaCT sagittal slice

syngo DynaCT provides the ability to acquire,

reconstruct, and visualize cross-sectional images

in the interventional lab.

A medical industry first for Siemens, it started

out as a breakthrough innovation for neuro

applications. Continual development in

collaboration with institutions worldwide

has now made syngo DynaCT available for

applications for the entire body.

Initial applications in neuroradiology imaging

included the visualization of local bleeds,

the ventricular system, and tumors. This has

expanded to abdominal applications, which

include chemoembolizations, RF ablations, stent

placement, vertebroplasties, and punctures.

syngo DynaCT improves patient management

during interventional procedures by enhancing

decision-making with additional cross-sectional

information and virtually avoiding patient

transfer to CT.

Find further information and additional

case studies at our syngo DynaCT website:

www.siemens.com/DynaCT



86-year-old patient with abdominal pain

and elevated lactate levels.

DiagnosisThe CT findings included SMA occlusion, lack

of bowel wall enhancement, and distension

of the right colon with slightly thickened wall.

Based on CTA images, it was unclear if the

celiac trunk was occluded or stenotic. Patient

underwent surgery and ischemic right colon

was resected. Emergency laparotomy revealed

viable small bowel and left colon. Patient was

sent to angiography for diagnostic workup

and possible recanalization and stenting of

the celiac trunk or the mesenteric artery.

syngo DynaCT FindingsContrast-enhanced syngo DynaCT

demonstrates occlusion of the SMA with

calcified plaque at the origin and thrombus

in the first 4 cm of the vessel. High-grade

stenosis of the celiac trunk that comes

off an aneurysmatic portion of the aorta.

Collateral filling of the SMA coming off

the celiac trunk. Pancreatitis of the pancreatic

head clearly visible.

Commentssyngo DynaCT provided comprehensive

diagnosis of occluded SMA and high-grade

stenosis of the celiac trunk prior to angioplasty

and stenting. Instead of performing multiple

conventional DSA runs, syngo DynaCT provided

excellent 3D vessel conspicuity and visualization

of the occluding thrombi/plaque in the

visceral branches.

Patient history [1] syngo DynaCT ofabdominal aorta

[2] syngo DynaCTcollateral filling

of superiormesenteric artery

[3] syngo DynaCTSMA occlusion

1

2

3

Imaging right atthe angio table can bea life-saving featureInterview with Saruhan Cekirge, MD

20

Since its introduction in 2004, syngo

DynaCT has become an integral part

of neuro-interventional procedures

by enabling soft tissue visualization

in the angio lab. Saruhan Cekirge, a

world-renowned interventional

radiologist at Hacettepe University

in Ankara, Turkey, speaks with AXIOM

Innovation in Intervention about

his experiences with syngo DynaCT

and the impact it has had on his

everyday practice.


AXIOM: Dr. Cekirge, would you please tell

us about your practice here in Ankara at

the Hacettepe University Hospital?

Dr. Cekirge: “The neuro-endovascular unit of

the Hacettepe University Hospital has become

one of the few internationally recognized

interventional neuroradiology departments.

Our center is considered a center of

excellence by endovascular companies and

by physicians worldwide. Practitioners from

all over the world, more than 400 physicians

in total during the last four years, visit our


center for training and to witness advanced

neuro-endovascular treatment techniques

for cerebral aneurysms and AVMs.

Regarding a variety of new endovascular

devices, materials and advanced techniques,

workshops are being held for physicians

who are preparing to use these new

approaches. The everyday practice of many

physicians around the world is affected by

the methods we develop and apply, thus we

always have to be aware of our particular

responsibility. The neuro-endovascular team

also travels all around the globe to treat

selected patients in order to proctor

physicians in major university hospitals and

medical centers. During the last five years,

our team members treated more than 300

patients in foreign clinics.

In 2005, the Hacettepe neuro-endovascular

center treated more than 400 cerebral

aneurysms during a total of 1,200 neuro-

interventional procedures. Aside from this

busy everyday practice, we organized 13

international workshops. Ninety-four

interventional neuroradiologists from every

continent attended to acquire cutting-edge

techniques in cerebral aneurysm and AVM

treatment. Our neuro-endovascular center

is currently working with three biplane

neuro-dedicated Siemens angiography

units. The newest one is our AXIOM Artis dBA,

which was installed in May 2006. In 2007,

two additional biplane flat detector

angiography systems will be purchased to

replace our old Neurostar Plus systems.”

AXIOM: You have just recently started

working with the AXIOM Artis dBA

system and syngo DynaCT. What are your

experiences with this technology so far?

Dr. Cekirge: “Our experience with syngo

DynaCT is extremely positive. We believe

this technology to be a milestone

innovation in its field. It has an incredibly

high impact on our daily practice. Formerly,

we had to carry intubated patients to

the CT scanners. But with our new syngo

DynaCT system, we are capable of deciding

whether interventions are necessary

right at the operating table. As a matter

of fact, this advantage can be life-saving.

We are able to view real-time cranial

CT-like images during our intervention

and afterwards. So we can detect adverse

events in the brain parenchyma straight

away, while the patient remains on the

angio table.

The other important feature of syngo

DynaCT is the option to create cross-

sectional images in the angio lab with

intra-arterial contrast injection. These

images are certainly high quality CT-like

angio images, because they deliver

extremely important supplementary

information about the angio-architecture

of atherosclerotic intracranial stenoses,

especially in the bone, and the neck of

complex cerebral aneurysms. Such images

are acquired with IA contrast injections

and their diagnostic quality reaches far

beyond standard 3D images. We use 25%

contrast and just give an additional 5 cc

contrast to create those images.”

AXIOM: What were the decisive factors

for purchasing an AXIOM Artis dBA

system in your specific case?

Dr. Cekirge: “The main reason for

our decision was Siemens’ leadership

in flat detector technology. We already

have two Siemens biplane angio

systems we are completely satisfied

with, and we are also highly pleased

with the maintenance service. So, to us,

buying a Siemens suite again was a

rather logical decision.”

[2] A stent was positionedacross the aneurysm neckfor further coiling withthe guidance of dualreconstruction image

[3] A distal dissecting middlecerebral artery aneurysmoriginating from the inferiortrunk of left MCA

[1] Dual-volume (syngoiDentify) reconstructionimage allowing us tounderstand the neck of therecurrant A-com. aneurysm

1

2

3

As I have already explained, this can be

a life-saving feature.

Furthermore, the ability to fuse 2D–3D and

3D–3D images is an important feature. It

can be performed on a syngo X workstation

for postprocessing using a patient’s MR and

standard CT images. Such image fusion is

highly beneficial, especially in our field of

clinical research.

Finally, I should mention the digital

acquisition zoom fluoroscopy and

roadmapping features. To my knowledge,

these are unique to Siemens systems.

They allow us to zoom in on the lesion

and to see everything in the smallest

detail. We can even see the struts of self-

expandable micro nitinol stents [4+5].”

AXIOM: So, how would you rate the

system altogether?

Dr. Cekirge: “Naturally, no system can be

perfect. There are always opportunities

for further innovation to get as close to

perfection as possible. I would rate the

system nine out of ten.”

AXIOM: Are there any specific challenges

in your particular case mix and, if so, how

does the new AXIOM Artis dBA support

you in your operations?

Dr. Cekirge: “In brief, our everyday challenges

are being able to understand the neck of

complex aneurysms, the angio-architecture

of cerebral AVMs, and the nature and extent

of atherosclerotic plaque in extra- and

intracranial stent lesions. In solving these

problems, syngo DynaCT cross-sectional angio

images with high-quality 3D reconstruction

were a great improvement, so they have

become an indispensable part of our routines.”

AXIOM: At a glance, which features of

your imaging system do you consider

most important?

Dr. Cekirge: “In first place, I have to mention

the high-quality 2D DSA images with 2K

imaging. They enable us to see even the

finest distal vessels. One may think that such

small vessels are negligible, but especially

in treating AVMs, it is of great importance

to visualize them. You have to make sure

that while occluding an AVM you do not

unintentionally occlude fine vessels feeding

other areas of the brain. Second, there are

the superb 3D reconstruction images.

Especially the dual-volume reconstruction

images have a major impact on our daily

work [1+3].

Third, the system provides cross-sectional

angio images directly at the operating table.


[4] A self-expandable stentwas used to perform stent-

coil reconstruction ofthe vessel

[5] DSA image clearlyshowing the struts of nitinol

self-expandable stent

4 5


AXIOM: You have experienced numerous

major innovations in interventional

neuroradiology – stents, remodeling

microballoons, Onyx, catheters and last

but not least, imaging systems. How

would you rate the effect of syngo

DynaCT on the patient management

level you can currently deliver?

Dr. Cekirge: “As I stated before, syngo DynaCT

certainly increased the level of patient care by

delivering indispensable information about

aneurysm morphology and anatomic details

for exact stent or microballoon placement

and assisted treatments as well as about

atherosclerotic plaque extent and morphology

for intracranial stenting.”

AXIOM: Do you see any future challenge

for syngo DynaCT in interventional

neuroradiology?

Dr. Cekirge: “One of the most important

points in my opinion is the development of

reliable perfusion imaging software. This

would notably increase the level of patient

care. Beyond that, additional dedicated angio

software would also be very beneficial for

intracranial stenting.”

AXIOM: If you had to weight the clinical

benefits of cross-sectional imaging and

soft tissue imaging during neuro-

interventional procedures, how would

you prioritize them?

Dr. Cekirge: “In my estimation, standard

cranial syngo DynaCT images to evaluate

the brain parenchyma during and after an

intervention are most important. As a close

second come the CT angio images we get

directly at the angio table to obtain valuable

information about the vessel walls.”

Protocol book for3D applicationswith AXIOM Artis

Providing unforeseen image quality for both 2D and high-contrast

3D imaging, the AXIOM Artis family revolutionized the world

of vascular diagnostics and gained an outstanding reputation

immediately after its introduction in 2001. And there was even

more to come: syngo DynaCT, the peerless tool for acquisition,

reconstruction, and display of cross-sectional soft tissue images,

has taken interventional imaging in the angio lab to a previously

unimagined level.

To support you in your clinical routine and to help you make the best

use of your AXIOM Artis system, we have now compiled an “application

protocol book,” which illustrates the high versatility of our advanced

applications for high and low-contrast imaging. In cooperation with

eight hospitals, 31 example cases have been collected. Thus, the

book, illustrates substantial experience with Siemens 3D applications

and provides practical information on images, contrast injections,

system settings, post-processing as well as users‘ recommendations.

To receive your copy of the book or to obtain further information

on the Siemens AXIOM Artis family, please contact your regional

Siemens representative or order it at www.siemens.com/DynaCT

or contact the authors [email protected] or

[email protected].



[email protected]

[email protected]

syngo DynaCTlow-contrast imagingAlejandro Berenstein, MD; Yasunari Niimi, MD

Joon Song, MD; Danny Hom, RT, Technical Supervisor

Roosevelt Hospital; New York, New York, USAProcedure

Intracranial stent and coils/aneurysm

System/SoftwareversionAXIOM Artis dBA/VB22

Protocol20s 1k DR

”Patient underwent placement ofNeuroform™ stent and then coiling.

Wide neck and difficult location of the

aneurysm made it difficult to assess the

completeness of coiling and patency of

the parent artery. syngo DynaCT with low

dose (15%) contrast injection enabled

us to better visualize the stent and coils,

comparatively to the parent vessel.”

Statement

86

Neuro – with contrast

Acquisition technique

70

kVpSystem dose in μGy/FScan time in secIncrement in degreesNumber of projections

1.2200.4538Reconstruction technique (primary reconstruction)nat

ModeVOISlice matrixKernel

Image characteristics

medium512 x 512bonesmoothContrast medium – injection parameters

33

Quantity% Contrast (dilution with saline)Injection rate

X-ray delayCatheter type/size

15%1.5 cc/s

1.5 s5 French

Viewing and post-processing

yes

VRTMPRMIPSlice thicknessWindow levels

yesyes5 mm-

Injection site

left internal carotid artery

Iodine concentration300 mg/ml

Secondary reconstruction

subfull256 x 256vessel

87

VOISlice matrixKernel

Image characteristics

Mode

auto

Injection duration22 s

Image upper left:Thin MIP, 5 mm slicethickness pre-coilingOther images:MIP post stent andcoil placement

syngo DynaCTlow-contrast imaging

Goetz Benndorf, MD, PhD; Hani Haykal, MD;Richard Klucznik, MD; Charles M. Strother, MDDepartment of Radiology, The Methodist HospitalHouston, Texas, USA

Procedure Intracranial stent/aneurysmSystem/Softwareversion AXIOM Artis dBA/VB30Protocol 20s 1k DR

”To visualize both the vessel and the stent,contrast should not be too high inconcentration, otherwise it willobscure the stent struts.”

Statement

84

Neuro – with contrastAcquisition technique

70kVpSystem dose in μGy/FScan time in secIncrement in degreesNumber of projections

1.2200.4543

Reconstruction technique (primary reconstruction)nat

ModeVOISlice matrixKernelImage characteristics

medium512 x 512bonenormal

Contrast medium – injection parameters40 cc

Quantity% Contrast (dilution with saline)Injection rate


20%2 cc/s

-5 French

Viewing and post-processing

-VRTMPRMIPSlice thicknessWindow levels

-yes1 mm and 4 mmW 3400; C 1400–1700

Injection siteinternal carotid artery

Iodine concentration 300 mg/ml

Secondary reconstruction (see shown images)

manual

VOISlice matrixKernelImage characteristics

512 x 512bonesharp

Neuroform™ stent in curvedvasculature; tip of microcatheterin distal aneurysm visible.

Images shown are obtained viasecondary reconstruction.

85

nat

Mode

Thin MIP, 1 mm slice thickness Thin MIP, 4 mm slice thickness

Injection duration20 s

Thin MIP, 20 mm slice thickness

Images shown are obtained viasecondary reconstruction.

syngo DynaCTlow-contrast imagingGoetz Benndorf, MD, PhD; Hani Haykal, MD;Richard Klucznik, MD; Charles M. Strother, MDDepartment of Radiology, The Methodist HospitalHouston, Texas, USA

Procedure Intracranial AVM

System/Softwareversion AXIOM Artis dBA/VB30

Protocol 20s 1k DR

”AV shunting lesions, such as an AVM,require higher concentration of contrastbecause of the diluting effect: 50 % versus20%; in particular if the lesion is locatedclose to bony structures.”

Statement

82

Neuro – with contrast

Acquisition technique70kVp

System dose in μGy/FScan time in secIncrement in degreesNumber of projections

1.2

20

0.4

543

Reconstruction technique (primary reconstruction)natMode

VOISlice matrixKernelImage characteristics

medium

512 x 512

bone

normal

Contrast medium – injection parameters40 ccQuantity

% Contrast (dilution with saline)Injection rate


50%

2 cc/s

-

5 French

Viewing and post-processing-VRT

MPRMIPSlice thicknessWindow levels

-

yes

20 mm, 40 mm

W 3100; C 1350 (20 mm)W 3500; C 1250 (40 mm)

Injection site internal carotid artery

Iodine concentration 300 mg/ml

Secondary reconstruction (see shown images)

manualVOISlice matrixKernelImage characteristics

512 x 512

bone

sharp

83

natMode

Posterior fossa AVMwith associated aneurysm;Thin MIP, 40 mm slice thickness

Injection duration 20 s

ClinicalCaseReport

24

Stenting of a carotid bifurcationusing syngo DynaCTCourtesy of Saruhan Cekirge, MDHacettepe University,Ankara, Turkey

Dr. Cekirge and his team areperforming an interventionalprecedure on their newAXIOM Artis dBA

Patient history:76-year-old male with transient ischemic attack

(TIA) of right carotid circulation.

Diagnosis:The angiogram showed a high-grade stenosis

at the right carotid bifurcation and an irregular

atherosclerotic lesion in the right petrous internal

carotid artery (ICA) above the stenosis at the

carotid bifurcation.

Treatment/Comments:The lesion at the bifurcation was stented and

the patient was discharged home with no

complication with anti-aggregating treatment.



Probedruck



[1] Irregularatherosclerotic lesionin the right petrous ICAshown with 2Dangiography.

[2] Axial syngo DynaCTangio image perfectlydemonstrating that thelesion in the petrous ICAis calcified and verystenotic.

[3] Good positioning ofthe stent and efficientdilatation of the lesiondemonstrated in poststenting syngo DynaCTangio.

excellent stent positioning and dilatation of

the lesion [3]. A balloon expandable stent

instead of a self-expandable stent was used

for dilatation since the syngo DynaCT before

stenting showed heavily calcified lesion that

could not be dilated efficiently with a self-

expandable stent system.

However, six weeks later he had another

episode of TIA located to the right carotid

circulation. Doppler US on his readmission

showed excellent patency of the stent placed

in carotid bifurcation. We then decided to

take the patient to angio to re-evaluate the

atherosclerotic lesion in petrous ICA that did

not look very stenotic with 2D angio [1].

A syngo DynaCT angio was obtained with

25 cc of 25% contrast injected from the right

ICA. It perfectly showed an eccentric, calcified,

and ulcerative atherosclerotic lesion in the

petrous bone with a high-grade stenosis [2]

that cannot be recognized in 2D angio.

This lesion was the reason for the patient’s

recurrent TIA. A stent was then placed across

the lesion and another syngo DynaCT angio

was obtained after stenting, revealing

1 2 3



[email protected]

[email protected]

AXIOM Sensis XP –Integrating the wayYou workA new generation of cath lab recording systems



DrägerMedicalInfinityMonitoringGateway

* SIB – SignalInput Box

Archive

AXIOMSensis XP – Networking

ReportingWorkplace

Post-processingWorkplace

ReportingWorkplace

ReportingWorkplace

ManagementReporting

MaterialManagement

Sensis Database

FaxE-mail

Database

ASCII

PDF

E-mail

Reports

DICOM

Vitalsigns

HIS / CISHL7

DICOMASCII

InterventionalCath Lab

Electrophysiology Pediatric Cardiology

SIB* SIB* SIB*

In March 2007, Siemens launched a new

generation of the AXIOM Sensis recording

system – AXIOM Sensis XP. Two things make

this new system special – flexibility and

integration.

The first customers clearly state:

AXIOM Sensis XP is “a solution that adapts

to our workflow and preferences.” These

customers are already used to the different

setups and views that could be chosen to

display the recordings on AXIOM Sensis. With

the XP version, customized workflow support

programs for all kinds of hemodynamic

procedures can now be configured. Especially

in pediatrics, this kind of support is very much

appreciated. Like a route planning guide, such

a program can lead the user through a left-

right heart catheter examination step by step,

activity by activity. And even better, users

always have the option to deviate from the

program and adapt to the specific patient

on the table. Users never need to strictly

follow the configured sequence of activities.

This kind of ad-hoc flexibility is unique

to Siemens recording systems. Also, in

electrophysiology, the customers appreciate

the flexibility and ease of use the new

AXIOM Sensis XP provides. Especially the

improved stimulator interface with the ability

to pace on the fly has been very well received.

Every customer using the CARTO® XP mapping

system from Biosense Webster will see the

bidirectional interface to the AXIOM Sensis XP

as an efficiency driver. With this new option,

double entries of patient data are avoided and

the event logs of both systems can also be

synchronized. Thus, every mapping point

localized on the CARTO XP can be matched

with detailed information on intracardial

electrical activation recorded on

AXIOM Sensis XP.

And last but not least, reporting became

more comprehensive with AXIOM Sensis XP.

The report is still automatically generated,

based on all database entries during the

procedure. Additionally the patient’s vital

signs can be imported from the Dräger®

Infinity monitoring gateway. And the 3D

point maps from the CARTO system can be

integrated into the report in the same way

as X-ray images from the AXIOM Artis or

the Congenital Heart Picture. With AXIOM

Sensis XP, Siemens created a sophisticated

solution for a smooth workflow in the

catheterization lab, making the life of

our customers easier.

Workflow support programsfor increased efficiency



[email protected]

A plenitude of benefitsInterview with Roland Gitter, MD

28

Interventional cardiology in pediatrics

is indeed a special subject. Pediatric

anatomy is different from adult anatomy,

and when it comes to radiation, maximum

dose reduction is the crucial point. In the

following interview, Dr. Roland Gitter, head

of the catheterization lab in the pediatrics

department of the National Hospital for

Gynecology and Pediatrics in Linz, Austria,

speaks about interventional cardiology

in pediatrics and elaborates on the

advantages of the new AXIOM Artis dBC

biplane cath lab system.

AXIOM: “Dr. Gitter, especially in pediatrics,

the patient age varies widely. How old

are your patients on average?”

Dr. Gitter: “Our patients can be divided

into three age groups: The largest group

consists of newborns and up to one-year-

olds. Then we have patients between

one and ten years old, and finally there

are adults with congenital heart defects –

former pediatric patients who return for

control examinations on a regular basis.”

AXIOM: “You are working with a biplane

cardiology system, the AXIOM Artis dBC.

Could you tell us about your personal

experiences?”

Dr. Gitter: “In a nutshell, we are delighted

with the system. As our patients are very

small, steep angulations are not a problem.

Image resolution is very good even in zoom

formats, so we see everything we need to

see during examination. One important

advantage is the ability to access the patient

from both sides. Let me give you an example:

We once had a patient who could only be

punctured from the left side. So we simply

reversed the position of every other system

and hence gained perfect access without

any difficulty. Another advantage is that the

patient’s head remains accessible even when

we use both planes. So there is always

enough workspace for the anesthesiologist.”


AXIOM: “The AXIOM Artis dBC is

equipped with two planes. How do you

use these planes in particular?”

Dr. Gitter: “For mere diagnostic purposes,

we mainly use the monoplane version of the

system instead of the biplane one, even to

visualize the beating heart. But in dealing with

complex heart diseases and for interventions,

the use of both planes is indispensable. It

enables us to see the catheter advancement

much better and we save time in our clinical

workflow, which is of course a big advantage

for us as well as for our patients.”

AXIOM: “As we all know, radiation dose

is an absolutely essential issue in

pediatrics. On account of this, do you use

the option of radiation-free patient

positioning (CARE Position)?”

Dr. Gitter: “Yes, of course we do, because

this option is a considerable advantage. The

display is very good and precise. We typically

use this tool to find the region of interest as

quickly and comfortably as possible.”


AXIOM: “Are there any certain conditions

in which you use the 60 frames per

second now possible with the new

imaging platform CLEAR Technology?”

Dr. Gitter: “Especially when dealing with

newborns, we use the 60 frames per second

option, because their hearts are beating

pretty fast – at about 120 beats per minute.

If contrast medium is deployed at all, we

can excellently document the flow of

contrast agent and the distribution in

the body. Furthermore, at a frequency of

60 frames per second, we can get the

diagnosis with the first scene. In comparison

to examinations with 30 frames per second,

we save time and we need less contrast

agent, which definitely is a benefit for our

patients.”

AXIOM: “Alongside the AXIOM Artis dBC,

you also use the AXIOM Sensis recording

system. How do you use this system?”

Dr. Gitter: “AXIOM Sensis is a very useful

and user-friendly tool for the complete

reporting of hemodynamic data including

pulse frequencies. When both the AXIOM

Artis dBC and the AXIOM Sensis are used

together, patient data have to be registered

only once. This saves additional time. I also

like to include the congenital heart picture

to illustrate the disease and therapy to

my referring physicians. The biggest

improvement to my personal workflow is

the integration of the Artis system with

the AXIOM Sensis recording systems. Now I

can finish my procedure reports right after

finishing the case, and all examination data

are automatically incorporated in the report.

So I can spend more time with my patients

and their parents.”

The Landes-Frauen und

Kinderklinik (Provincial

Hospital for Gynecology

and Pediatrics) in Linz,

Austria, is one of the two

specialized hospitals

owned by the Austrian

healthcare provider

gespag. With about 44%

market share in Upper

Austria and more than

9,000 employees, the

company is one of the

biggest healthcare

enterprises in that region.

Apart from the hospital in

Linz, it runs 11 hospitals

at 14 different locations

at present. Eight of the

clinics are general

hospitals, the other two

are specialized facilities.

One of gespag’s main

goals is to provide medical

care in line with the social

and cultural requirements

of the region. The

company cooperates

with various other

medical facilities in

the region and thus

contributes to establishing

comprehensive and safe

treatment opportunities

for its patients.

Landes Frauen-und KinderklinikLinz/Austria



[email protected] or

[email protected]: Werner Leutner

[1A+1B] The biplaneangiogram of the aorticarch shows the stenosisof the aorta during fluoro.The pigtail catheter andthe stenosis showing aminimum of 5.2 mm isclearly visible in both planes.

ClinicalCaseReport


Coarctation of the aorta in low-dosepediatric imagingCourtesy of Roland Gitter, MD and Gerald Tulzer, MD,Department of Pediatric Cardiology, Linz, Austria

Patient history10-year-old male (27 kg) with re-coarctation

of the aorta.

DiagnosisThe coarctation of the aorta had been

surgically treated at the age of one in Zagreb.

Additionally, the patient presented a

small sub-aortic VSD (ventricular septal

defect) and a stenosis of the left vena

brachiocephalica.

1A 1B

Roland Gitter, MD


TreatmentAfter image acquisition and distance

measurement of the stenosis, a 22 mm

CP stent with 14 mm diameter was

inserted within 24 minutes of fluoro.

CommentsThe severe re-coarctation of the aorta could

be clearly diagnosed with the AXIOM Artis dBC.

The Siemens AXIOM Sensis recording solution

supports the peak-to-peak gradient

measurement/calculation of 40 mmHG,

which could be reduced to 8 mmHG after

implanting the 22 mm CP stent.

Regarding the increased risk of dissection, it

was decided not to expand the stent to its

full 14 mm. Over a period of 6 to 12 months

the full length of the stent will be dilated to

14 mm. The sub-aortic VSD is extremely small

and shows no clinical relevance for further

treatment. On the stenosis in the vena

brachiocephalica no clinical indication was

found and an intervention was not performed.

2A 2B 2C

3A 3B 4A

Filling of the 4 cm maxi LD balloonwith a diameter of 14 mm [2A].

After the complete expansionof the balloon a 10 mmdiameter notch at the lowercranial end persists [2C].

[3] Biplane control angiography afterstent implantation [3A+3B] in sameprojection using a multi-purposecatheter. The stent has been placedideally in the stenosis and bloodflow into the left vena subclaviais unimpaired.

[4] Overview image in APposition. The stent shows alight funnel with a medialnotch of 10 mm and adistal expansion of 14 mm.

For more detailed information, send

your questions to:

[email protected]

Fast, flexible andcost-efficientIntroducing the new digital radiography systemAXIOM Aristos VX Plus


The large 43 cm x 43 cm detector of

AXIOM Aristos VX Plus provides extensive

anatomical coverage while the CARE

(Combined Applications to Reduce

Exposure) features minimize radiation

dose for better patient care. Thanks to

a number of CARE features like the high

transparency grid, CAREFILTER (copper

filtration for skin dose reduction) and

optimal exposure settings, up to 50%

dose reduction can be achieved.

Images acquired with AXIOM Aristos VX Plus

are processed with DiamondView, the

intelligent image processing algorithm

which delivers brilliant image contrast for

bones, soft tissues, and even the skin line –

all in a single image.

All in all, AXIOM Aristos VX Plus is a system

that accommodates an extensive range of

radiographic examinations, provides

excellent patient care with low radiation

doses, and delivers excellent image quality

within seconds of acquisition – a key

criterion in a digital flat detector imaging

system.

AXIOM Aristos VX Plus is the newest member

of the trusted AXIOM Aristos family. It was

developed to support imaging centers and

clinics just converting to flat detector

technology or even looking for their second

flat detector digital radiography (DR) system.

The system offers significant benefits such

as an enhanced workflow, reduced radiation

dose, and impressive image quality.

The three key components of AXIOM Aristos

VX Plus are a ceiling-mounted X-ray tube, a

tilting detector stand, and an optional patient

trolley. With these components, an extensive

array of examinations can be performed.

The wide range of vertical movements easily

covers upright examinations from chest to

weight-bearing knees. With the detector

tilted in a horizontal position, extremity

examinations can be easily performed, and

when a mobile trolley is positioned over

the detector, supine examinations are also

conveniently accommodated.

The positioning flexibility of AXIOM Aristos

VX Plus ensures that most standard

radiographic imaging can be acquired with

a single system. To further expand the

spectrum of clinical imaging, the system is

designed for image acquisition of the entire

spine and legs after which the images are

sent to a syngo workplace for dedicated

orthopedic measurements.



[email protected]

Digital radiography –Experience efficiencywith automated systemmovementsEvaluation of an automated digital flat detectorradiography system in a pediatric radiologydepartment


hospital with an annual patient throughput

of 30,000 patients for general radiography.

40% of these imaging examinations are

emergency cases with the patient

throughput remaining at a stable level in

recent years. There are two general

radiography rooms. The AXIOM Aristos FX

system is installed in one of them while the

other room is a conventional radiography

unit with a computerized radiography (CR)

imaging system. The study focused on the

comparative evaluation of the FD system

and the CR system with regard to three

key indicators: patient throughput, changes

of workload within the rooms, and user

satisfaction.

Methods and evaluationThe first part of the study focused on the

comparative evaluation of overall patient

throughput. A total of 193 patients were

evaluated during the study, with 94 patients

examined on the conventional/CR

system and 99 patients examined on the

AXIOM Aristos FX. Of these 193 patients,

There are numerous factors that drive a

radiology department to adopt digital imaging

technology. The use of the Picture Archiving

and Communications System (PACS) and

hospital management’s need to optimize

operating costs for higher efficiency are

only two examples.

With these factors and the impending

obsolescence of the existing conventional

radiography system in some regions, the

radiology department decided on a fully

automated digital flat detector radiography

system, AXIOM Aristos FX. Reasons for this

decision were the preference for a flat detector

(FD) system and one that delivers a high level

of automated system movements. Numerous

independent studies have proven that flat

detector imaging systems improve productivity

and deliver significant dose-saving advantages.

Comparing FD and CR systemsThis study was performed in a pediatric

radiology department of a university

Background information

By Michel Claudon, MD


five categories of examinations were

evaluated; chest, abdomen, pelvis as well

as upper and lower extremities. The

examinations were further divided into

those with a single exposure and those with

two exposures (where frontal and lateral

projections are standard). Throughput and

average examination time of these procedures

were also measured. Additionally, each

examination was broken into three phases

to analyze where the most benefits were

experienced. The phases consisted of:

• Positioning phase: Patient positioning

and placement of detector or CR cassette

for each respective system.

• Execution phase: Execution of the

imaging process including exposure,

access to patient data, CR cassette

processing, and visualization of image

for FD system.

• Acquisition phase: Consisting of archiving

via PACS for the two radiographic systems.

The second focus of the study assessed the

workload distribution of patients to the two

different radiographic rooms over the 1-year

study period. Finally, the 14 users of the

two imaging technologies were surveyed

for their satisfaction with the systems, using

the following criteria:

• User-friendliness of the systems

• Ease of use of the systems

• Image quality

• Speed of examination

Results of comparisonComparative evaluation of the complete

patient treatment time found a 30%

reduction from 403 seconds to 266 seconds

with the FD system compared to the CR

system. The patient treatment time was

defined as the time when the patient

arrived at the waiting room to the time

the acquired image was available on the

internal network. On average, time savings

between 48% and 59% were achieved

for the various examinations from chest to

pelvis, with the greatest time savings for

pelvis examinations. It was also measured

that on average, 51% time savings could be

achieved for single exposure studies and 55

% for double exposure studies. Maximum

time savings were achieved in the execution

phase with up to 83% time savings for a

double exposure study.

For workload distribution, it was observed

that by the end of the study, 84% of patients

were assigned to the AXIOM Aristos FX

room. This is largely due to preference

of the new technology by the users for

its image quality, dose savings of up

to 40%, and reduction in mAs values

while achieving identical image density

and contrast.

Eleven of the 14 users surveyed preferred

the flat detector system on all performance

criteria while three users found the flat

detector and CR systems to be similar for

one criterion each.

Concluding considerationsSome concerns were noted with respect to

a total conversion to a digital department

with only FD systems. As it is a pediatric

department, the large size of the panel could

not always be accommodated in patient

beds and stretchers. Manual handling of

the system and maneuvering of the patient

bed within the examination room required

some effort. Moreover, at the time of the

study, automated and sequential acquisition

of the entire spine and legs was unavailable

on the flat detector system, long CR

cassettes were employed for this imaging

mode. This has since been addressed with

a software upgrade on the system and retro-

fit of the ortho acquisition function and

a new detector housing, which delivers

the same performance as its successor,

AXIOM Aristos FX Plus.



[email protected]

Michel Claudon is

Professor of Radiology

and Chief of

Department at the

Children‘s Hospital of

the University

of Nancy, France.

He previously held

the position of

President at the

European Federation

of the Societies

for Ultrasound in

Medicine and Biology

(EFSUMB). He is

currently President of

the World Federation

for Ultrasound in

Medicine and Biology

(WFUMB).

Prof. Claudon’s fields

of interest include

technical advances

in ultrasound,

uroradiology, and

pediatric radiology.

AXIOM Luminos dRF*:Fluoroscopy’s brightfuture


The world of fluoroscopy is about to

get flatter. Flat detectors have already

displaced film cassettes in mammography

and radiology suites and are gradually

making image intensifiers on C-arm

systems for angiography and cath labs

redundant. Now they stand poised to

enter the fluoroscopy suite as well.

Siemens recently introduced the AXIOM

Luminos dRF fluoroscopy system, built

around a state of-the-art digital flat detector

(FD). The new detector replaces not just the

screen-film cassettes employed for acquiring

static images during fluoroscopic exams, but

also the image intensifiers that have long

been the heart of real-time X-ray imaging.

Compared to current remote-controlled

By Simon Scott, PhD

fluoroscopy systems, the flat-panel

technology provides improved image quality

and smoother workflow. In addition, the

large, square, 43 cm x 43 cm field of view

allows more anatomy to be captured in a

single frame, facilitating examinations and

procedures that were challenging to perform

with the smaller, round field of view of an

image intensifier.

The combination of a fluoroscopy system

equipped with a flat detector offers even more:

With this technology, a wide range of

radiography examinations can be

performed digitally, leading to significant

workflow improvements and thereby to

increased efficiency in your radiology

department.


While the flat detector in the AXIOM

Luminos dRF system provides considerable

image quality and practical advantages for

fluoroscopic imaging, the system’s most

compelling advantage may be the flexibility

to use it for both imaging techniques –

fluoroscopy and radiography. The very

same detector can produce high-quality

fluoroscopy exposures and dynamic

sequences as well as high-quality static

radiography images.

This ability enables the radiologist to perform

both image techniques without compromise.

And it becomes even more important when

one considers the workflow of a fluoroscopic

* Pending 510(k)The information about thisproduct is being providedfor planning purposes.The product is pending510(k) review, and is notyet commercially availablein the U.S.

examination such as a double-contrast barium

enema, where single radiographs need to be

performed. AXIOM Luminos dRF eliminates

the need to pause and set up or reload a film

cassette during the course of the examination.

Since no film processing is required, the

images are immediately available for the

physician for a quick review to ensure that

all relevant medical information is obtained

or whether a retake is needed. However,

because of the wide dynamic range and

linearity of flat detector response, such

retakes due to the overexposure or

underexposure that frequently plague more

finicky systems using film cassettes, would

rarely be needed. The contrast of the digital

images can simply be adjusted through

straightforward postprocessing.

The 2-in-1 solution:Fluoroscopy and radiography


The integration of dynamic and static

acquisitions into a single digital detector also

simplifies image management workflow. The

static images are automatically saved in the

patient folder on the fluoroscopy system,

along with the fluoroscopic sequence. By

contrast, on analog or image intensifier-based

digital systems, the processed film needs to

be digitized, and the resulting digitized

images would have to be merged manually

with the fluoroscopic exam on a PACS system.

The resulting image quality is comparable to

that of any diagnostic, flat detector-based

radiography system, which means that the

system could also be used for general

radiographic examinations, allowing for

maximum utilization of the equipment

and the fluoroscopy suite. This versatility

provides the ability to manage a high

workload and adjust equipment utilization

to a different future break-down of the

clinical application range.

By replacing the imageintensifier with a flat detector, the system can be lowered to 48 cm above the floor, making it easier for the patient to be placed on theexamination table.

This symbiosis of fluoroscopy and

radiography can only be achieved by using

innovative detector technology. The AXIOM

Luminos dRF system employs an indirect-

conversion flat detector based on Cesium

Iodide (CsI) and a 43 cm x 43 cm field of

view. This large field of view represents a

significant advantage for the AXIOM

Luminos dRF’s flat detector over image

intensifiers. It covers nearly 50% more area

than the largest 40 cm diameter image

intensifier previously available. This large,

square field of view makes possible a

number of examinations that were

previously impractical, including urological

examinations that visualize the kidneys and

bladder in a single view and barium-swallow

esophageal exams covering the entire area

from the upper esophagus to the cardia.

With image intensifiers, such studies,

if they are performed at all, may require

two steps during the course of the


To understand the significance of the shift

to flat detectors, it helps to appreciate

something of the long history of fluoroscopy,

arguably the original X-ray imaging modality.

The biggest innovation in the past decade

has been the transition to digital fluoroscopy.

Typically, the output of the image intensifier

is coupled to a video camera for display on a

television monitor and for recording of the

imaging sequence. Traditionally, analog video

cameras and recording devices were

employed, although more recent systems

have employed digital video cameras based

on charge-coupled devices (CCDs), which

allow for digital archiving of the image

sequence. However, all image intensifiers

suffer from pincushion distortions due to

imperfect focusing of the accelerated

electrons on the output screen. Scattering of

output optical light in the glass housing of

the image intensifier also leads to veiling

glare that causes an apparent loss in

brightness at the edge of the intensifier and

a loss in contrast resolution. Neither of these

effects arises in flat detectors, which are

essentially distortion-free and uniform in

response across their fields of view.

Moreover, unlike flat detectors, the image

intensifier lacks the ability to acquire high-

quality radiographic still images. Indeed,

acquiring static, high-quality radiological

images during the course of a fluoroscopic

exam using an image intensifier generally

entails the use of a separate screen-film

cassette.

Flat detectors for X-ray imaging come in two

major varieties: indirect-conversion systems

and direct-conversion systems. All flat-panel

X-ray detectors must ultimately convert a

flux of incident X-rays into a distribution

A paradigm shift : Analog to digitalof electrical charge suitable for digitization

in the readout matrix of the detector. In

direct-conversion systems, often based on

a material known as amorphous selenium,

the X-rays directly produce a cascade of

liberated electrons in the detector material,

and these are collected in an appropriate

electrode prior to readout. In indirect-

conversion systems, the incident X-rays first

get converted into optical photons, which

subsequently impinge on a photodiode at

the base of the detector where they are

converted to electrons and stored until

readout.

The AXIOM Luminos dRF* system employs

an indirect conversion flat-panel detector

based on Cesium Iodide (CsI), which has

been found to have a number of advantages

for fluoroscopic applications over the direct

conversion systems based on amorphous

selenium. CsI absorbs X-rays stronger than

does amorphous selenium in the energy

range employed in fluoroscopy, and it also

has a higher detective quantum efficiency

at these energies, which is essential for

making maximum use of the relatively

few photons that contribute to each

image frame in a fluoroscopic sequence.

Compared to other scintillator choices for

indirect conversion systems, one remarkable

feature of CsI also helps minimize the

degradation in image resolution that usually

occurs when optical photons diffuse while

traveling toward the photodiode: during

their formation, the CsI crystals grow in

long, narrow (5-10 micron) needle-like

shapes, and these act as miniature fiber

optics guiding the shower of optical photons

created by each X-ray down toward the

photodiode with a minimum of spreading.

* Pending 510(k)The information aboutthis product is beingprovidedfor planning purposes.The product ispending 510(k)review, and is notyet commerciallyavailablein the U.S.

exam to inspect all relevant parts of the

anatomy by repositioning the detector-tube

or the tabletop, or even by moving the

patient.

New System Design: Compact,Flexible, and ConvenientThe use of a thin flat detector rather than

a bulky image intensifier in the AXIOM

Luminos dRF* also allows for more flexibility

in table motion, including lowering the table

to 48 cm above the ground rather than the


workflow is improved, resulting in increased

throughput and efficiency for the department.

For certain radiographic exposures of

extremities it is not even necessary to position

the patient on the table. Due to the low table

height, the patient can remain seated in a

wheelchair during an examination of

metatarsals or the ankle. This results not only

in workflow benefits due to simplified

operation, but also in increased comfort for

the patient. The open and compact design of

the table offers the technicians excellent

80 cm achievable previously. This makes it

both easier and faster for immobile or older

patients to be placed on the table, especially

when being transferred from wheelchairs

or stretchers. Both patients and staff in the

fluoroscopy suite thus profit from this newly

achieved table flexibility. What is now more

comfortable for the patient becomes even

more convenient for the staff. Heavy or

immobile patients are easier to handle, work

becomes more ergonomic, and of course,

access to the patient, even from the rear of

the system. Patient transfers from a stretcher

and complex examinations, such as an

endoscopic retrograde cholangiopancreato-

graphy (ERCP), can be performed in an

comfortable manner. The workflow benefits

of digital radiography apply to a broad range

of exposures in upright position. By tilting the

table, swallows in standing position or static

images, for example, from the abdomen or

the vertebral column can be accomplished.

* Pending 510(k)The information about thisproduct is being provided forplanning purposes. Theproduct is pending 510(k)review, and is not yetcommercially availablein the U.S.

• Fully digital 2-in-1 solution for a

future-proof and efficient investment

in the radiology department

• Excellent image quality at a large

coverage of 43 cm x 43 cm provided

by a dynamic flat detector for static

and dynamic imaging

AXIOM Luminos dRFat a glance



[email protected]


Moreover, the images acquired with a flat

detector do not show the intrinsic pincushion

distortion known from image intensifiers,

enabling the physician to conduct

measurements for pre-surgical planning prior

to hip surgery. The indirect-conversion flat-

panel technology, with its high detective

quantum efficiency, makes more efficient

use of the X-rays that penetrate the patient

than image intensifiers allowing for a

reduction in dose both to the patient and

to the physician. Naturally, the AXIOM

Luminos dRF* system can be optionally

equipped with Siemens’ full suite of CARE

(Combined Applications to Reduce Exposure)

applications. These include CAREPROFILE,

which allows radiation-free positioning of

collimators and semi-transparent filters,

as well as CAREPOSITION for quick and

radiation-free positioning of the patient.

Both techniques are supported by the last

image hold (LIH) image. Tremendous dose

savings in fluoroscopy can be attained by

using CAREVISION, which employs pulsed

fluoroscopy using selectable pulse rates

instead of performing continuous

fluoroscopy. The way to a fully digital

radiology department is supported by the

advanced networking capabilities of the

AXIOM Luminos dRF. Starting with an easy

patient registration via the hospital and

radiology information systems (HIS/RIS), the

comprehensive DICOM functionality enables

the acquired data to be sent to various

destinations in the HIS. As a result, the

requirements of clinical data management

are completely met and work procedures

are accelerated. The introduction of flat

detectors to fluoroscopy represents the

latest in a long line of innovations in real-

time X-ray imaging. By incorporating this

technology into the AXIOM Luminos dRF

system, Siemens created a system of rare

versatility that excels in both radiological and

fluoroscopic imaging without compromising

on image quality or ease-of-use.

State-of-the-art fluoroscopic andradiographic examinations on one systemare now a reality with AXIOM Luminos dRF.

Author: Simon Scott is a science writerbased in Chicago. He holds a PhDin Medical Physics.

• Enhanced ease of use

for patients and staff

enabled by a minimum

table height of 48 cm

ClinicalCaseReport


Fluoroscopic assessment of thebariatric surgery patientCourtesy of Myrosia T. Mitchell, MD, and Arunas E. Gasparaitis, MD,Department of Radiology, University of Chicago, Chicago, IL

excluded gastric segment via a G-tube.

Contrast emptied into the duodenum

and progressed antegrade by peristalsis

to the distal Roux-en-Y anastomosis [1A].

Contrast then preferentially flowed into

the alimentary limb, traveling retrograde

towards the gastric pouch [1B]. For the

second stage, barium was administered

orally and augmented with air insufflation

via the G-tube. This opacified a dilated

gastric pouch and stenosis of both the

gastroenteric anastomosis and the

alimentary limb [2A]. At the distal

anastomosis, contrast preferentially

flowed into the biliary limb, with only

a small fraction of the barium flowing

antegrade into the distal small bowel [2B].

Operative FindingsAt surgery the alimentary limb was found to

be excessively short, measuring only 25 cm.

The short limb was excised and a new 110

cm alimentary Roux limb was created, along

with revision of the distal anastomosis. The

patient was discharged tolerating an oral

diet well and with full resolution of her

obstructive symptoms.

DiagnosisFunctional bowel obstruction due to an

excessively short alimentary limb and a

functionally diverting distal Roux-en-Y

anastomosis.

A 52-year-old female underwent Roux-en-Y

gastric bypass surgery at an outside

institution, complicated by severe upper

GI bleeding for which she underwent

an anastomotic revision. She then developed

persistent bilious vomiting, lost a significant

amount of weight, and was unable to eat or

maintain her weight properly.

ImagingUGI exam was performed in two stages.

Initially, barium was injected into the

Patient History

1A

2A

[1A] Contrast injection viaa G-tube opacified theexcluded gastric pouch andthe biliary limb down to thedistal Roux-en-Y anastomosis(arrow).

[1B] Contrast thenpreferentially divertedretrograde into the alimentarylimb (thick arrows), withonly a small amount enteringthe distal small bowel(thin arrow).

[2A] Per oral contrastadministration opacifieda large gastric pouch andthe alimentary limb. Pouchdilatation was due to aproximal anastomoticstenosis (arrow).

[2B] Overhead viewshows the preferentialaccumulation of orallyadministered contrast inthe biliary limb (arrows).At the end of the study,there was still very littlecontrast progression intothe distal small bowel(arrowheads).

1B

2B


and other complications. If distal bowel

pathology is suspected, we may evaluate the

bowel fluoroscopically or by CT exam. CT is

often more helpful in assessing suspected

distal obstructions, while fluoroscopy is

more helpful in assessing suspected

misconstructions and functional pathology.

ReferenceMitchell MT, Pizzitola VJ, Knuttinen M-G,

Robinson T, Gasparaitis AE. Atypical

complications of gastric bypass surgery.

Eur J Radiol 2005; 53:366-73.

The postoperative bowel anatomy in gastric

bypass patients is technically difficult to

evaluate for several reasons. The large

body habitus of these patients limits X-ray

penetration. In addition, these patients often

exceed table weight limitations either for

table movement or even for stationary table

support, limiting the views and positions in

which the anatomy can be assessed. Some

patients are so large that they can only be

imaged in upright position. This decreases

sensitivity for detecting anastomotic leaks

Technical Challenges

A new system was generated in cooperation

with leading medical facilities to serve the

growing demands of bariatric imaging.

AXIOM Luminos TF is Siemens’ state-of-the-

art fluoroscopy system designed for all

patients from pediatrics to bariatrics.

Bariatric imagingAXIOM Luminos TF allows physicians to

assess the anatomy in a variety of views and

positions as it supports up to 600 lbs (272

kg) in the locked horizontal position and

500 lbs (227 kg) with table movements.

The full tilt function from horizontal to

vertical is smooth and steady for excellent

patient care during examinations.

Additionally, patient comfort is enabled by

a spacious 213/4" (55 cm) wide opening

between tabletop and digital image

intensifier. This larger space enables obese

patients to fit easily within the system.


The AXIOM Luminos TF provides remarkable

image quality at very low dose. The

innovative FLUOROSPOT Compact imaging

system supports excellent imaging even for

a sizeable amount of soft tissue which

needs to be x-rayed. It is a high-resolution

digital imaging system which provides

single and serial acquisitions in 10242 matrix

for dynamic review.

Image qualityOur Solution:AXIOM Luminos TF



[email protected]

AXIOM Luminos TF easilysupports patients up to 600

lbs (272 kg) and evenprovides full dynamic table

tilt and movement onpatients weighing up to 500

lbs (227 kg)


213/4" (55 cm) free space –giving patients more spacefor comfort

Moreover, thanks to the low dose levels,

AXIOM Luminos TF suits pediatric demands,

too. It enables full diagnostic image quality

in pediatrics with radiation exposure levels

that are as low as reasonable.

Obesity is one of the major epidemics

worldwide, hence, the demands for

fluoroscopy systems increase. AXIOM

Luminos TF is easy to use and provides

excellent image quality at low radiation

dose with regard to patient care.

Improved patient care

Dose management –a practical trainingprogram to reduceradiation exposure

Interview with John Benjamin, MD


C u s t o m e r


Dr. John D. Benjamin ofthe Morningside Clinic inJohannesburg, South Africa,developed the dosemanagement training CDwith Siemens MedicalSolutions. During his manyyears of working andteaching in the field ofinterventional cardiology,Dr. Benjamin has learnedthe importance of creatingawareness of dose protectionand dose management.

C a r e


measures and to discover his motivation

for creating this training program.

AXIOM: Dr. Benjamin, you have

been an interventional cardiologist

for many years. What prompted your

recent interest in dose management?

Dr. Benjamin: The advent of drug-eluting

stents and other advances in PCI has

resulted in a marked increase in the

number of PCI procedures worldwide.

In addition, the number of complex

lengthy procedures such as chronic total

occlusions and ablations has increased

dramatically, resulting in more radiation

exposure for patients and operators. It

has been my impression that this rapid,

explosive enthusiasm has been somewhat

at the expense of judicious dose management,

and more importantly, there is a distinct

lack of scientific data concerning the long-

term effects of these newer procedures.

AXIOM: How did you learn about

dose management?

Dr. Benjamin: Lectures by radiation

physicists are frequently given at PCI

courses, and there has been an excellent

recent clinical competence statement by

ACCF/AHA/HRS/SCAI which covers the

subject in detail. Siemens has been

very helpful in providing me with data

monitored on their systems.

AXIOM: Having that experience in dose

management, when did you decide to

develop this interactive training?

Dr. Benjamin: I thought it would be

important to share the information with

my colleagues in a clear and meaningful

way and looked for support for my scheme

in 2004. I started the project in 2005 with

Siemens Medical Solutions, because I had

been impressed by the many dose-saving

features on their angiocardiography

systems.

Top: The interactivetraining starts withfundamental informationabout radiation

Bottom: Intuitiveanimations explain theeffects of radiationexposure and illustratemeasures to reduce dosefor both patients and staff

C u s t o m e r

Knowledge of radiation protection in the

catheterization lab for both staff and

patients is becoming more important.

The effects of radiation are intangible

and invisible; they are long-term and

cannot be identified immediately. Dr. John

Benjamin of the Morningside Clinic in

Johannesburg, South Africa, has

developed a training program on dose

management for Siemens Medical

Solutions to increase awareness of dose

reduction measures.

AXIOM Innovation in Intervention had the

pleasure to interview Dr. John Benjamin to

gain insight into radiation reduction


AXIOM: What is your most important

message with regard to dose management?

Dr. Benjamin: There are many important

messages – If I had to choose, I would say a

clear understanding of automatic dose

regulation through the feedback system is

the most important message.

AXIOM: Although you understand how

radiation is generated, you still need to

apply dose in order to perform diagnosis

and treatment?

Dr. Benjamin: Yes, of course, there must be

a dose to have an X-ray. However, you can

decrease the dose quite considerably and

still maintain good image quality.

AXIOM: Could you give us an example?

Dr. Benjamin: Tight collimation, decreasing

the frame rate, the use of fluoroscopy rather

than acquisition, radiation-free collimation

and positioning using the CARE (Combined

Applications to Reduce Exposure) system

features, as well as using RAO projections

as opposed to LAO projections where

possible would be just a few examples.

AXIOM: What are the most important

measures to decrease dose for patients?

Dr. Benjamin: Decreasing the ”beam-on

time” is the key to reducing exposure for

patients. That means putting your foot on

the pedal only when you have to. Additionally,

less-angulated views, the avoidance of

prolonged exposure at the same view, and

the use of CAREPOSITION, the radiation-free

positioning collimation feature, contribute

to dose reduction.

AXIOM: We talked about daily radiation

exposure to medical staff. What can you

recommend to decrease doses for

physicians and medical staff?

Dr. Benjamin: What suits the patient suits

the operator as well. Decreased beam-on

time, increasing distance from source,

adequate upper and lower body protection

as well as less-angulated views are a few

examples. Of course, the ultimate in

distance protection is magnetic navigation.

AXIOM: What are the risks for physicians

and patients when dose management is

disregarded?

Dr. Benjamin: The effects are usually classified

into “deterministic” effects such as local skin

burns and cataracts or “stochastic” effects,

which means the risk of cancer. The latter is

extremely important in pediatrics, as children

are more susceptible to chromosomal

damage.

AXIOM: How does your interactive

training help to avoid that?

Dr. Benjamin: The training provides simple

animated illustrations of X-ray function

and regulation with particular reference

to cardiology positioning and case

management. It provides numerous

graphics, which will enhance the operators’

ability to apply dose-saving measures for

both the operator and the patient.

AXIOM: What is the key target group for

this training?

Dr. Benjamin: The training mainly aims at

physicians and staff in the catheterization

lab or the angiography suite. It also provides

ASRT CE points for continuing education.

AXIOM: How can interested people get

access to the training?

Dr. Benjamin: Siemens Medical Solutions

sends this training CD to all customers

who have recently purchased a new AXIOM

Artis. Other interested customers can send

an email to [email protected]

to receive a copy.

AXIOM: Thank you very much,

Dr. Benjamin.



[email protected]

Dose Management CD

The dose management

E-learning training is available

on CD and provides

ASRT CE credits.

For further information or a

free copy, please contact

[email protected]

C a r e

Advanced skills foradvanced technology

Collaboration between Siemens and AmstelAcademy VU (Free University) Medical Centeron a study program for radiology technicians


C u s t o m e r


C a r e


Literally within a stone’s throw of the VU

Medical Center in Amsterdam is the new and

architecturally eye-catching accommodation

of the Amstel Academy. The hospital’s

medical school prepares students for

professions in hospital healthcare, such

as surgical assistants and anesthesia

assistants, and offers advanced nursing

training and paramedical studies. Students

receive a broad-based education that

constitutes the basis for a specialization in

specific medical imaging disciplines, such as

CT, MRI, angiography, and ultrasonography.

For training radiology technicians, an

advanced “skills lab” was recently set up

jointly with Siemens. “In previous years,

the training course ran increasingly into

practical problems,” relates one of the

teachers, Ingena Visser. “The technological

developments are progressing super-fast and

the options of using diagnostic imaging are

reaching further and further. At a certain

point we noticed that the contents of the

lessons no longer concur with the current

practice in hospitals.”

Skills LabThe skills lab in which students practice

various imaging modalities was based on

conventional imaging techniques using an

old-fashioned combination of film and screen.

Visser: “In the meantime, however, the day-

to-day practice is almost entirely digitalized.

Our training facilities no longer represented

the reality of imaging equipment used in

many Dutch hospitals.” This was a good

reason for the school to invest in a new

building and new facilities. Visser: “We first

made a proper list of the requirements that

a modern skills lab must meet. Following

this inventory, we inevitably arrived at a point

of acquiring a Bucky digital system based

on flat detector technology. An important

requirement in this case is to have a large

number of workstations so that several

students can work independently with

imaging at the same time. We also wanted

to have the option of reconstructing 3D

images from CT or MRI modalities.”

A different approachAnother important requirement was the

functionality of the Bucky system.

“A hospital uses this type of equipment in a

different way from a training school: while

a hospital does not use the whole variety of

functions because of logistic efficiency,

we do want to utilize all the functions. After

all, we want to provide our students with as

many skills as possible: students must be

able to understand the underlying principles

of diagnostic imaging. In this sense, training

demands a completely different approach

from the pure clinical environment.” That

also emerged when the training school,

armed with a package of requirements,

searched for a suitable partner. “We

presented our requirements to various

parties, including Siemens. What struck

us immediately was the fact that from the

start they actively helped us in searching

for a solution. They indicated that they too

regularly ascertained that the information

level of laboratory assistants lags behind

the progress of technological developments.

Therefore, Siemens too was inclined to

cooperate with us on providing the training

program with the best possible structure

according to the most recent insights.”

WorkstationsAccording to Visser, the final choice to work

with Siemens was made foremost because

it became clear that this company was in a

position to adequately meet the technical

requirements. “Siemens supplied a state-of-

the-art Bucky digital system, the AXIOM

Aristos MX, and an accompanying

acquisition station linked to six workstations.

As far as I know, we are the first training

school in the Netherlands that offers its

students this opportunity. What is

AXIOM Aristos MX

C u s t o m e r


special about this system is that it is

completely open: the software is so well

adjusted that we can retrieve images from

the VU Medical Center and subsequently

study and process them here. From a

technical perspective, therefore, we are

completely up-to-date. Furthermore, we

can always count on Siemens’ technical

support both from the Netherlands and

from Germany.

InvolvementAccording to Visser, the decision to select

Siemens gave the company the opportunity

to be involved in the field of training.

“Many of the parties offering their services

can fulfill our technical needs, but Siemens

set themselves apart by helping us plan

our core activity – namely, offering real

training in the area of radiodiagnostics.

Consequently, we agreed that Siemens

would train the staff lecturers of our training

program so they would continuously have

current know-how at their disposal. We can

also count on the expertise of Siemens in

terms of developing new study materials,

especially their open approach with respect

to the options on the equipment. All in all,

you get the sense that both we and Siemens

want to make a solid contribution to the

development of this profession – and the

feeling is welcome and motivating. The

collaboration has run smoothly so far,”

stresses Visser. “For the time being, the

agreement that we have entered is for five

years, including an annual evaluation. This

may not appear to be excessively long, but

relative to the speed of developments in

this discipline, it can be considered a

relatively long period of time. In any case,

from our perspective, we have full

confidence that, thanks to Siemens, our

training program can continue to be optimal

and set up according to the latest insights

in technology.”

“From a technicalperspective, weare completelyup-to-date.”

Ingena Visser,Amstel Academy



[email protected]

C a r e


During the 2006 World Congress of

Cardiology in Barcelona, cardiologists could

perform cardiovascular interventions on

the vascular simulator (Cathi) at the Siemens

booth. This simulation system is used in one

of Siemens’ educational training classes.

In cooperation with Prof. Voelker from the

University of Würzburg, Germany, Siemens

Medical Solutions offers the hands-on

“Introductory Course in Interventional

Cardiology” to train cardiologists who

already have experience in invasive coronary

diagnostics and now want to prepare for

interventions.

Dr. Samo Granda and Dr. Gregor Kompara,

two fellow cardiologists from the General

Hospital in Slovenia, were among the

customers in Barcelona. They noticed that

there was always a big crowd of interested

doctors around the Siemens booth with the

simulation system. After handling the guide-

wire themselves, they were fascinated by

the unique simulation technique. During

the following days, they visited the Siemens

booth several times to do hands-on training

with the cardiovascular simulator.

Both physicians were particularly interested

in the “Introductory Course in Interventional

Cardiology” and thus took part in the

workshop. “It was great how Siemens

presented their educational offerings at the

ESC/WCC in Barcelona. Hence, my colleague,

Dr. Gregor Kompara, and I had spontaneously

decided to take part in the training course,

which took place two weeks later – and it

turned out to be an educational highlight,”

said Dr. Granda.

During the workshop at the Siemens Medical

Solutions training center in Forchheim,

Germany, a lot of attention was paid to the

simulation. “Practice makes perfect” –

this saying goes for physicians as well as for

pilots. And because only constant practice

really makes perfect, airline pilots regularly

have to complete training sessions in a flight

simulator. “Simulator training has been an

integral part of pilot training and pilot careers

for decades. Studies show that repeated

training in the simulator has statistically

increased flight safety by the factor of 45,”

explains Prof. Voelker, assistant medical

director of the Würzburg University Hospital.

Meanwhile, it is not only pilots who have

the chance to practice before doing the

real thing. Thanks to new developments,

physicians can now use simulators to try

various diagnostic and interventional

techniques or learn new procedures and

thus optimize their learning curve.

The hands-on sessions on various simulation

systems took place in very small groups,

which tremendously increased the learning

Interventional cardiologytraining on modernsimulation systems

C u s t o m e r


effect. While the participants were

performing interventions on the simulation

system, there was always an experienced

cardiologist at their side. Besides

Prof. Voelker, a team of four experts in

interventional cardiology from different

schools shared their experience with the

participants. “The teaching passion of the

experienced cardiologists and the very

limited group size enabled me to effectively

interact and gain confidence through

learning by doing,” described Dr. Granda.

and “complication management in the

cardiac cath lab.”

Dr. Granda and Dr. Kompara had the

opportunity to exchange experience with

cardiologists from all over the world.

Participants came from Ireland, Bahrain,

Senegal, Estonia, Bulgaria, and Germany.

Peer-to-peer exchange on an international

level in a mistake-tolerant and relaxed

atmosphere proved very valuable to them.

At the end of the workshop, Dr. Bin Thani

from Bahrain appeared entirely satisfied with

the course concept: “To me, it was absolutely

worthwhile coming from Bahrain to

Forchheim to learn about interventional

cardiology. The skills I obtained here really

helped me to get up to speed in the clinical

environment. In addition to my newly

obtained knowledge, I benefited greatly

from the valuable exchanges among the

international participants.”

At the end of the workshop, the two doctors

from Slovenia were very pleased that they

had so spontaneously decided to travel

to Germany and take part: "The workshop

exceeded my expectations. To me, the

workshop is perfect for beginners in

interventional cardiology,“ said Dr. Granda.

“The workshop greatly increased my

knowledge and skills in performing

interventional procedures very quickly.

Such knowledge augmentation would

not be possible in the clinical routine,”

concluded Dr. Kompara.

Life: Skills, productivity,and technology

The clinical workshop: “Introductory

Course in Interventional Cardiology”

is part of Siemens’ customer care program

“Life,” a series of training courses and

workshops to increase customers’ skills,

productivity, and technology. Continually

enhancing know-how, Siemens Medical

supports users in fully utilizing the

potential of their systems. Based on

the specific needs of the target group,

Siemens Medical offers applications and

clinical training tailored to individual

requirements.

Dr. Kompara further underscored the

particular advantages of the training concept:

“The intensive hands-on sessions with the

simulation systems not only allowed me

to practice in an environment that tolerates

mistakes, but also gave me the opportunity

to discuss the procedures with experienced

cardiologists without any time pressure.”

Beyond the simulation sessions, the two-day

course curriculum included seminars such

as “optimized angiographic settings for

diagnostics and intervention,” “quality

management in the cardiac cath lab,”

“basic principles of radiation reduction,”



[email protected]

Interested cardiologists atthe Siemens booth at theWCC in Barcelona

Dr. Ibrahim Bara Diopfrom CHU Fann, Bahrain,performing an interventionon the cardiac simulationsystem

C a r e


The teams at AX division of Siemens

Medical Solutions don’t simply want

to manufacture and deliver error-free

systems. They really want to understand

how their customers think, work and

what is important to them.

The Supply Chain Management (SCM) at AX

is responsible for the entire process from

incoming order entry to material release,

manufacturing, delivery, and final turn-over

to the customer.

High FlexibilityAX SCM produces 21 different system

types that can be configured in many

different ways. Every system is specifically

customized to customer requirements.

The customer can change the technical

configuration of a system up until two days

before manufacturing starts.

Innovative productsneed innovativemanufacturing andlogistics

At Siemens Medical Solutions, customer-focused processes and highly motivatedteams ensure top performance and highcustomer satisfaction

Since there is usually some room preparation

and construction work to be done at the

hospital before the system can be installed,

the whole process is coordinated by a

project manager of the local Siemens

organization. The project manager regularly

visits the site and is therefore aware of the

local situation. This way, AX starts system

configuration at the last possible moment

and ensures the site is ready for installation

prior to delivery.

To further increase flexibility, the overall

process time has been reduced significantly

in recent years. For example, instead

of using a production line, AX operates

with X-ray isolated production bays. A

system does not move from one workplace

to another as manufacturing is being

completed but remains in the bays during

the entire production and testing period.

C u s t o m e r


C a r e


Should problems occur on one system,

the production line is not blocked for all

other systems in production. In these

bays, AX SCM simulates the same power

supply and IT-environment that exists in

the hospital. That minimizes problems

and installation time at the installation site.

To provide the highest quality, all systems

have to undergo a fully automated

overnight endurance test. This “Clinically

Relevant Simulation Test” (CRST) simulates

the same clinical procedures that are usually

performed in the hospital in one week.

The number of orders processed at one time

differs widely. In August 2006, for example,

AX had by far the highest production

numbers of all time. “We were substantially

exceeding our production capacity right

in the middle of the German vacation

season,“ says Georg Schuldhaus, manager

of the manufacturing department at SCM.

His excitement about this achievement

is evident. “This would not have been

possible without the flexible working

hours and the total commitment of the

production teams,” he continues. “The great

motivation to always get things done,

although it means a lot of extra hours and

canceled vacations in order to finish the

systems our customers are waiting for, is

outstanding.”

Integrated manufacturingThe SCM Process is well-integrated and

connected within the entire AX

organization. For example, SCM works

closely together with product development

in Product Lifecycle Management (PLM).

This assures the SCM influence in all

product development from early-stage

product design to improvements in

existing products. PLM greatly appreciates

the qualified feedback from SCM. They

know about SCM‘s long experience and value

the direct customer feedback SCM usually

receives during installation.

Factory installationsOther central factors to increasing customer

satisfaction as well as employee motivation

are the “Factory Installations.” The same

employees who perform final and

acceptance testing of a system in the

factory start up the system in the hospital.

This ensures that the AX logisticians place

special emphasis on quality because they

are the people facing the customer, should

anything not function as intended. At the

same time, AX can learn in the field and is

able to directly introduce customer needs

and requirements into the manufacturing

process.

AX also emphasizes the fact that all members

of management regularly participates in

factory installations. This really helps to

implement improvements and customer

feedback into SCM processes quickly. It also

increases management awareness of the

difficulties our employees face in the field.

Oskar Schaffner, head of the Installations

Management Team, just came back from

a factory installation of an AXIOM Artis dFC

at the Hospital de Santa Cruz in Caraxide,

Portugal. “It was a great success,“ he says.

“We took out the old system and installed

and turned over the new system in just

ten days. The team was very focused and

worked to deliver an excellent system of

outstanding quality on time.” The customer

was very pleased by the short installation

time, which enabled him to resume patient

care promptly. The excellent image

quality, which was far better than that

of the old system, was another reason

for excitement. “Such customer feedback

is the reward for hard work,” he says.

However, the team still had a one-page list

of improvements to take back home and

C u s t o m e r



[email protected]


he says. Apart from the factory installations,

AX employees regularly visit customers in

hospitals to learn about their workflow

and everyday clinical interventions. They

usually come back freshly motivated and

with big smiles on their faces. ”Maybe

they’ve just seen how the doctor saved

someone’s life with the help of our system,”

states Glanzner.

they really want to work on these now.

“Never be satisfied with the status quo,”

Schaffner continues, “there is always room

for improvement.”

Highly motivated teamsmake it possible

“The general positive atmosphere within

the SCM process is hard to miss. We believe

that the motivation and know-how of our

employees is the basis for everything,”

Rudolf Glanzner, head of the

AX SCM process, points out. They are all

highly qualified and enjoy a continuous and

demanding training plan. “The best

motivation however comes from our customers,”

C a r e

The calm before the storm:The RSNA halls are stillquite empty


RSNA 2006 –Strengtheningprofessionalism

Most of them also visited the Siemens

Medical Solutions booth. The spectrum of

systems and technologies presented there

reached from prevention to diagnostics,

from intervention and treatment to IT

technology. All these different imaging

modalities are connected through IT. The

“Experience Workflow” stations at the booth

showed visitors how modalities can be

combined with intelligent information

technology to streamline work throughout

the different departments of a hospital.

In our “Reading Room,” doctors had the

opportunity to speak to experts about

clinical cases. The Siemens “Destination

Healthcare” center provided additional

The 92nd Scientific Assembly and Annual

Meeting of the Radiological Society of North

America (RSNA) closed its doors on December

1st for another year. Between November 26

and December 1, the McCormick Exhibition

Center in Chicago, IL, USA was open for

“Strengthening Professionalism” in healthcare,

this year’s slogan of the RSNA. During this

time, about 700 technical exhibitors showed

their latest innovations and information to

the professional healthcare community.

Radiologists from all over the world had the

opportunity to join the scientific and

educational program, presentations in all

radiology fields, refresher courses, lectures,

symposia, and the technical exhibition.

C u s t o m e r


information on the recent acquisitions

of the company and the now complete

portfolio from in vitro diagnostics to

therapy.

The Angiography, Fluoroscopy, and

Radiography division of Siemens Medical

Solutions presented three novelties this year:

the AXIOM Artis dBA Twin biplane angio-

graphy system featuring two large detectors

for more anatomical coverage; the new

AXIOM Aristos VX Plus digital X-ray system,

which offers a broad range of applications

and high performance for tight budgets; and

the AXIOM Luminos dRF*, a completely new

approach in fluoroscopy. With this new

system, Siemens can now offer a true 2-in-1

solution for fluoroscopy and radiography.

Featuring a flat detector, the AXIOM Luminos

dRF* is equally suitable for all fluoroscopic

examinations as well as all radiographic

examinations (read more on page 36). But

not only the new systems created a lot of

interest among the visitors; the well-estab-

lished syngo DynaCT also found admirers,

with reconstruction time now under one

minute. The fully automated digital radio-

graphy system AXIOM Aristos FX Plus

was introduced in a pocket-size version to

also fit into smaller examination rooms in

hospitals where space is at a premium.

Once again, the RSNA was a very successful

trade show for the medical industry, and

we at Siemens look forward to sharing with

you at the next RSNA the latest Siemens

innovations that make your work more

comfortable and efficient.



[email protected]

Right: AXIOM Aristos FX Plusshows its abilities

Left: During the RSNA,Siemens had the pleasure ofcongratulating the SwedishMedical Center in Seattle onthe 100th installation ofsyngo DynaCT in the U.S.

C a r e

* Pending 510(k)The information about thisproduct is being providedfor planning purposes.The product is pending510(k) review, and is notyet commercially availablein the U.S.


About 600 experts met at the Marriott

Medical Center in Houston, Texas, in

October 2006 for this year’s LINC course.

The organizers were pleased to announce

a notable growth in the number of

participants, which rose by about 25%.

Approximately 55% of attendees

were interventional neuroradiologists,

followed by about 35% neurosurgeons

and 10% industrial specialists. “These

figures prove the experts’ increasing

interest in new endovascular techniques

and the treatment of cerebrovascular

diseases, which are the core topics of

our event,” states Michael E. Mawad, MD,

Professor at the Houston-based Baylor

College of Medicine and member of

the LINC course planning committee.

High interest in newestendovascular techniquesEndovascular Neuroradiology Workshop andLive Cases Conference (LINC Course) 2006 inHouston, TX, USA

One major goal of the annual LINC course

is to enhance the consistency of surgical

device usage across the globe. In this

context, plenary lectures and panel

discussions were held on the medical,

neurosurgical, and endovascular treatment

of aneurysms, AVMs, stroke, fibrinolysis,

intracranial angioplasty, atherosclerotic

carotid diseases and other subjects were

held during the five-day meeting.

A definite highlight was the live transmission

of endovascular procedures. The audience

was able to interact directly with the

physicians performing the interventions and

discuss the results of the procedures in detail.

Dr. Mawad himself presented various cases

of cross-sectional imaging in the angio suite

using Siemens’ syngo DynaCT.

For more detailed

information,


[email protected]

C u s t o m e r

Michael E. Mawad, MD


Simulators of all kinds are coming closer

and closer to the real deal. They are highly

popular because real situations can be

experienced and procedures can be

practiced. Aircraft pilots, as an example,

spend a large portion of their training in

the flight simulator to prepare for actual

aviation, thus ensuring safer skies. Thankfully

so, as even AX’s 3D simulator is becoming a

frequent flyer and a gold card air miles

collector. Exhibitions and trade shows all over

the world are regular travel destinations for

the simulation computer and user console.

Our 3D simulator is a space-saving and

gainful alternative to installing full-size

systems and performing live demonstrations,

which are usually limited to larger venues

because of their cost and labor intensity.

The new 3D system simulator is far more

practical. It is compact, quick to install, and

fully simulates all system movements on a

plasma screen. All that’s needed to realize a

simulation are the operating elements that

are normally mounted on the patient table,

a fast computer with a fast graphics card,

and the original system control software.

The AX division developed the 3D simulator

for a number of purposes, including training

and AX’s own engineering development and

testing. Real systems with real scenarios are

simulated, providing an enormous value

Popular computersimulation gains goldcard travel status

to both our customers and our own

engineers. The AX development

department also uses the new 3D

simulation technology to simulate system

actions, troubleshoot system errors, and

test new functions. Also interesting are

the opportunities the simulator offers for

product training. System movements

can be easily learned with the simulator

as it provides the touch of the real system.



[email protected]

C a r e

Upcoming events andcongresses 2007

64

C u s t o m e r

We always would like to give you the opportunity to get

in “touch” with the real system and learn more about

system handling to keep you in step with the latest

technological advances. You will have the chance to

experience our technology at international congresses,

trade fairs, and workshops. In the list below you will find

information on various events where we offer you the

opportunity to meet AX.

Websitewww.sirweb.org

www.ecr.org

www.congre.co.jp/jcs71

http://acc07.acc.org/

www.citmd.com

http://en.cmef.com.cn

www.dgk.org

http://www.j-rc.org/news/jrc2007/www.aans.org

www.chinamed.net.cn

www.arabrc.ws

www.heartrhythm2007.org

www.aepc.org

www.drg.de

www.europcronline.com

www.asnr.org/2007/

www.ukrc.org.uk

www.escardio.org/congresses/Europace/Europace07/www.solaci2007.com

www.escardio.org

www.neuroradiologie.de

LocationSeattle, WA,USAVienna,AustriaKobe, Japan

New Orleans,LA, USABeijing, China

Dalian, China

Mannheim,GermanyYokohama,JapanWashingtonDC, USABeijing, China

Dead Sea,JordanDenver, CO,USAWarsaw,PolandBerlin,GermanyBarcelona,SpainChicago, IL,USA

Manchester,UKLisbon,PortugalBuenos Aires,ArgentinaVienna,AustriaMannheim,Germany

Short DescriptionSociety of InterventionalRadiologyEuropean Congressof RadiologyJapanese Circulation Society

American College of Cardiology

China Interventional Therapeutics

China Medical Equipment Fair

Deutsche Gesellschaft fürHerz- und KreislaufforschungInternational Technical Exhibitionof Medical ImagingAnnual Meeting of the AmericanSociety of Neurological Surgeons19th International MedicalInstruments and EquipmentExhibition1st Arab Radiology Conference

Heart Rhythm Society

Association for European PediatricCardiologyDeutscher Röntgenkongress

Paris Course of Revascularization

45th Annual Meeting of theAmerican Society ofNeuroradiologyUK Radiological Congress

European Heart RhythmAssociation13th Congress of Solaci,17th Congress of CACIEuropean Congress of Cardiology

42. JT Deutsche Gesellschaftfür Neuroradiologie

DateMarch 1–6,2007March 9–13,2007March 15–17,2007March 24–27,2007March 31–April 1, 2007April 10–13,2007April 12–14,2007April 13–15,2007April 14–19,2007April 22–24,2007

April 26–29,2007May 9–12,2007May 16–19,2007May 16–19,2007May 22–25,2007June 9–14,2007

June 11–13,2007June 24–27,2007July 4–6,2007Sept. 1–5,2007Aug. 29–Sept. 1,2007

TitleSIR

ECR

JCS

ACC

CIT

CMEF

DGK

ITEM

AANS

ChinaMed

ARC

HRS

AEPC

DRK

PCR

ASNR

UKRC

Europace

Solaci

ESC

DGNR


Aboutus

C a r e


© 2007 by Siemens AG, Berlinand Munich all rights reserved

PublisherSiemens AG, Medical SolutionsAngiography, Fluoroscopic andRadiographic SystemsSiemensstraße 1, D-91301 Forchheim

Responsible for contentsNorbert Gaus, PhD

EditorSabine Wich([email protected])

Editorial boardAndrea BeulckeKevin DandEvgenios DendrinosTaylan ErgenemanMark FlintKai FrölichBenno Heigl, PhDVera JuennemannNadine Meru, PhDAndrea MüllerBeril OnbulakDominique OverkampRoland PapenfussSiegfried PrellEsther Rohm, MDDirk SunderbrinkArne WestphalBernd Weber

Note in accordance with § 33 Para.1 of the Federal Data

Protection Law: Dispatch is made using an address file

which is maintained with the aid of an automated data

processing system.

We remind our readers that, when printed, X-ray films

never disclose all the information content of the original.

Artifacts in X-ray, CT, MR and ultrasound images are

recognizable by their typical features and are generally

ProductionMichael BrummeSiemens Medical Solutions

Layout and editorial stafffeedback communicationGeisseestraße 6390439 NurembergGermany

PrintersFarbendruck HofmannGewerbestraße 590579 LangenzennGermany

Printed in Germany

Kathrin SchindlerSusanne SeahMichael Wiets, PhD

Contributors to this issueJohn Benjamin, MDMorningside Clinic JohannesburgJohannesurg, South Africa

Jan-Hendrik Buhk, MDUniversity of GoettingenGoettingen, Germany

Saruhan Cekrige, MDHacettepe University AnkaraAnkara, Turkey

Michel Claudon, MDCHU de Nancy BraboisVandoeuvre Cedex, France

Roland Gitter, MDLandes Frauen- und Kinderklinik LinzLinz, Austria

Frank Wacker, MDCharite BerlinBerlin, Germany

Michel Mawad, MDSt. Luke’s Episcopal HospitalHouston, Texas, USA

Michael Wallace, MDM. D. Anderson CancerCenter HoustonHouston, TX, USA

distinguishable from existing pathology. As referenced

above, healthcare practitioners are expected to utilize

their own learning, training and expertise in evaluating

images.

Partial reproduction in printed form of individual

contributions is permitted, provided the customary

bibliographical data such as author’s name and title

of the contribution as well as date and pages of

“AXIOM – Innovation in Intervention” are named. The

editors request that two copies be sent to their attention.

The consent of the authors and editors is required for the

complete reprint of an article.

Manuscripts submitted without prior agreement as well

as suggestions, proposals and information are always

welcome; they will be carefully assessed and submitted

to the editorial conference for attention.

First Name/Last Name*

Innovation in Intervention

Siemens AG, Medical Solutions

Angiography, Fluoroscopic

and Radiographic Systems

Marketing Communication

D-91301 Forchheim, Germany

Fax response+49 911 654-4271

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You want the latestinformation from the worldof interventional cardiology,angiography, fluoroscopy,and radiography deliveredto your desk for free? Thensubscribe now to AXIOM –Innovation in Intervention!

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www.siemens.com/AXIOMinnovation

04

Innovation in Interventionwww.siemens.com/medical

No. 4/March 2007

Contents

Innovation Bulletin

Clinical GalleriesUnderstanding theneeds of healthcareprofessionalsPage 8

Innovation Angiography

AXIOM Artis dBA TwinNew biplane systemfeaturing two largedetectors for extraanatomical coveragePage 12

Innovation Fluoroscopy

AXIOM Luminos dRF*A true 2-in-1 solutionfor fluoroscopy andradiographyPage 36


Probedruck


On account of certain regional limitations of sales rights

and service availability, we cannot guarantee that all

products included in this brochure are available through

the Siemens sales organization worldwide. Availability

and packaging may vary by country and is subject to

change without prior notice. Some/All of the features

and products described herein may not be available in

the United States.

The information in this document contains general

technical descriptions of specifications and options as

well as standard and optional features which do not

always have to be present in individual cases.

The information presented in these case studies is for

illustration only and is not intended to be relied upon

by the reader for instruction as to the practice of

medicine. Any healthcare practitioner reading this

information is reminded that they must use their own

learning, training and expertise in dealing with their

individual patients. This material does not substitute

for that duty and is not intended by Siemens Medical

Solutions to be used for any purpose in that regard.

The drugs and doses mentioned herein are consistent

with the approval labeling for uses and/or indications

of the drug. The treating physician bears the sole

responsibility for the diagnosis and treatment of patients,

including drugs and doses prescribed in connection

with such use. The Operating Instructions must always

be strictly followed when operating the AX system.

The source for the technical data is the corresponding

data sheets.

Siemens reserves the right to modify the design,

packaging, specifications and options described herein

without prior notice. Please contact your local Siemens

sales representative for the most current information.

Note: Any technical data contained in this document

may vary within defined tolerances. Original images

always lose a certain amount of detail when reproduced.

Please find fitting accessories:

www.siemens.com/medical-accessories

Siemens AGWittelsbacherplatz 2D-80333 MuenchenGermany

HeadquartersSiemens AG, Medical SolutionsHenkestr. 127, D-91052 ErlangenGermanyTelephone: +49 9131 84-0www.siemens.com/medical

Contact AddressSiemens AG, Medical SolutionsAngiography, Fluoroscopic andRadiographic SystemsSiemensstr. 1, D-91301 ForchheimGermanyTelephone: +49 9191 18-0

© 03.2007, Siemens AG

Order No. A91AX-50701-11C1-7600

Printed in Germany

CC AX 50701 WS 030725.

AXIOM Innovation in InterventionIssue No. 4/March 2007

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