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Radionics
Radionics
Radionics
Stereotactic System
Operator’s Manual
TITLE AND PUBLICATION NUMBER
CRW Stereotactic System User’s Guide
15960003 Rev. G (1/2010)
COPYRIGHT INFORMATION
©2010 Integra Radionics, Inc.
All rights reserved.
CAUTION
U.S. Federal law restricts this device to sale by, or on the order of, a physician.
NOTICES
No part of this document may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means — electronic,
mechanical, photocopying, recording, or otherwise — without the expressed, written consent of Integra Radionics. Additional copies of this
document may be ordered from Integra Radionics.
TRADEMARKS
CRW, Luminant, Radionics, NeuroSight, and Integra NeuroSciences are trademarks of Integra LifeSciences Corporation or its subsidiaries
in the United States and/or other countries. MAYFIELD is a registered trademark of SM USA, Inc. and is used by Integra LifeSciences
Corporation under license. The Integra wave logo and StereoCalc are trademarks of Integra LifeSciences Corporation or its subsidiaries.
Clorox is a registered trademark of the Clorox Company. Cidex and Sterrad are registered trademarks of Johnson and Johnson.
i
Collecting CT Scan Rod Position Data ........................................................................................ 50
Index ............................................................................................................................... 71
ii
CHAPTER 1 ABOUT THE CRW® STEREOTACTIC
SYSTEM
For single patient use only. The Disposable Head Ring Screws,
Long and Short (DHRSS5, DHRSL5) are designed as single-use,
disposable products and should not be re-sterilized or reused.
For single patient use only. The Nashhold Biopsy Needle (NBND)
is designed as a single-use, disposable product and should not be
re-sterilized or reused.
For single patient use only. The CRW BiopsyPlus Kit (CRWBP) is
designed as a single-use, disposable product and should not be
re-sterilized or reused.
CRW Arc
System Catalog #
CRWFMA
Localizer Catalog #
QA Component Catalog #
Ear Bar
Support Ear Bar
Bracket
Side View of
Head Ring
Attachment
Thumb Screw
Attachment
Thumb Screws
Note Placing the Head Ring assembly is easier if two people perform the procedure.
3. Finger–tighten the Nylon Thumb Screws on each Support Bracket to secure the Ear Bars.
Caution Overtightening of the Head Ring screws can cause premature failure of the Head Ring
posts and/or the Head Ring screws.
The head ring is now ready for Luminant® localizer attachment. If attaching the BRWLF to the head ring,
proceed to the next page for further assembly instructions.
Note You must attach the Arc Adapter Plate to the UCHRA before you can place the BRWLF on the
UCHRA.
OR
Place Arc base plate on sterile or sterile draped
Phantom Base.
Step 2
A. Remove Arc assembly from sterilization tray.
B. Verify Trunion Rings are fully assembled.
C. Loosen Trunion Ring locking screws.
Step 4.
Step 5
A. Remove Trunion Supports from tray.
B. Verify Trunion Rings are fully assembled with
locking screws and slider bars.
Step 7
Do one of the following:
Lock both Trunion Supports at 50 mm for
easier assembly; or
Set to calculated VERT stereotactic
coordinate.
Step 8
3. Remove Lateral Arc Slide and Guide Block
Holder from the sterilization tray.
4. Remove Lateral Slide Screw and Lock Nut
from the arc.
Step 10
Slide Guide Block Holder onto Lateral Arc Slide.
Step 11
Do one of the following:
Set Guide Block Holder to 0°; or
Set to desired slide angle
Step 13
A. Attach Lateral Arc Slide to main Arc assembly.
B. Place Lateral Arc Slide over top of bridge.
Step 14
The Lateral Arc Slide hooks over the top of the
main Arc assembly
Step 16
A. Place Arc assembly with the Base Plate
B. Loosen all four base screws on the Trunion
Supports.
Step 17
A. Slide Arc assembly onto Base Plate.
B. Typical clinical setup (shown) has the Guide
Block Holder pointing to the Posterior.
Step 19
Note the Guide Block Holder is opposite the
anterior side of the frame (pointing to the
posterior)
Step 20
Fully assembled CRW Arc System.
Setting the Fixed Radial Distance for the Arc System Pointer
Note The CRW Arc has a fixed radial distance of 160 mm from the resting surface on the Guide Block
holder to the target.
Guide Tubes
Guide Tubes fit directly into the Guide Block and have a 6.35 mm outer diameter.
They are specified by GT followed by inner diameter and length in mm. Guide
Tubes with 2.7 I.D. must be used with Reducing Bushing RB27 or with a
compatible length reducing tube. Guide Tubes with 3.2 mm I.D. must be used
with RB32 to guide 3.2 mm O.D. drills. Guide Tube GT46116 is used with 4.6
mm O.D. drills and does not require a Reducing Bushing or a Reducing Tube.
AP scale
adjustment thumb screw
Vertical
Scale
Note Before attaching the CRW Arc to the UCHRA, make sure to assemble
the UCHRA with the Adapter Plate.
1. Fit the three fixation ball feet on the bottom of the Arc Base into the ball sockets of the UCHRA Arc
Adapter, or into the ball sockets of the HRAIM.
2. Secure the cam locks.
1 9
Posterior
(Ignore Posterior rod in Axial Images)
AP Movement
4. Calculate the VERT coordinate:
2 AP Z2
• VERT = Z – 60mm
-
+ -
LAT Movement
Inferior
Note Make sure that the image is not skewed or tilted. Superior
+
1. Use a scanner function to place a grid or set of axes on the 4 5 6
screen. A point of this grid must be at the center (0,0) of
VERT Movement
3 7
LAT–VERT plane. Right LAT
Y2
2. Measure the LAT and VERT distances from the center point 8
VERT
(0,0) of the LAT–VERT plane to the target. The scanner may 2
perform a distance function from (0,0) to the target and Y1
provide x and y ordinates automatically. 1 9
Target
-
+ -
LAT Movement
Note The position of the target is relative to the origin of the Superior
LAT-VERT plane. Movements from patient Left-to-Right or
patient Inferior–to–Superior produce positive numeric 4 5 6
values, while movements from patient Right–to–Left or 3 7
Right
patient Superior–to–Inferior produce negative numeric VERT + VERT +
values. LAT + LAT - 8
2 VERT - VERT -
LAT + LAT -
1 9
-
- AP Movement
+
2 AP - AP +
VERT - VERT -
1
VERT Movement
between rods 7 and 8. Record this as X2. 3
AP X2
3. Calculate X, where X = [X1 + X2]/2. 8
VERT
4. Calculate the LAT coordinate: Anterior
• LAT = X – 60mm 2
X1
Note A positive value is to the patient’s right; 1
a negative value is to the patients’s left. Target
-
- AP Movement
+
AP (Anterior–Posterior) Scales
The AP scales of the Arc Base are ruled in
increments from 0 to 100 mm in both the anterior
and posterior directions. A negative sign (–) is
stamped next to posterior numbers.
Anterior Posterior
11 1
20 0
33 9
Trunion Slide
Thumb Screws
With the Arc trunion rings set along the anterior-posterior axis of
the arc base, the trunion slides will move along the LAT tracks of
the base plate. In this orientation, the A-P target coordinate is set
on the transverse arc coordinate scale, and the LAT target
coordinate is set with the trunion slide.
Lateral Approach
A lateral approach is shown with the Arc System
rotated on the Arc Base.
Standard Approach:
Guide Block
Bottom Lip
Never use the inch setting of the Digital Probe MicroDrive because
all of the CRW Arc System settings are in mm.
2. Position the instrument so that the display reads the desired value.
3. Press the ZERO/ABS button again, and the display will reset to zero. Mea-
sure the next absolute distance.
Note The Digital Probe MicroDrive must be shut off to change from
Absolute measurements. When turned back on, the MicroDrive will
display in Zero mode again.
4. Recalibrate zero by pressing and holding the ORIGIN button until the dis-
play changes to zero.
Anterior Posterior
Note The use of Betadine and other related fluids containing iodine may
stain the surface of the stereotactic system. To minimize
discolorization, wipe off any traces of Betadine and similar solutions
as soon as a possible during or following the surgery.
Because the CRW Arc System is exposed to blood, CSF, Betadine, and other
solutions, it is mandatory to adhere to the following procedures:
Wash the Arc System with distilled, de-ionized water and mild hand cleaner
after surgery to remove all traces of potentially corrosive fluids.
Examine the T-slots on the base of the arc and wipe off any solution residue
with a cloth or Q-tip.
Remove the Guide Block from the Guide Block Holder while still wet. If
either component is exposed to ionic solutions and remains wet, galvanic
action may occur.
Dry the Arc System promptly after washing.
Wrap the arc in Sterile Drapes during storage to protect it from physical dam-
age.
Note Moving parts of the Arc System may be lubricated with a medical
silicone spray lubricant.
Note Use of alcohol may remove the black on the CRW system scales.
Concentration: 725 mg/L 600 mg/L Temperature: 250°F / 121° C 270°F / 132° C
Sterrad®
Parameters: Option 1
System: 100S
BRWLF CT localizer No No No
Index • 71
L steam autoclaving
lateral approach, arc orientation for 59 parameters for 68
localization, CT and MR 1 stereotactic procedures, supported 1
localizer frames sterile devices, list of 12
assembling the BRW and Luminant 23–25 sterile fields, creating 42
Luminant localizer sterilization tray 67
assembling the 25 sterilizing radiosurgery head rings (HRAIM) 68
cleaning the 65 sterilizing, CRW components 68–69
manually calculating targets 45–50 Sterrad sterilization, head ring posts only 68
picture of 10 storing, CRW components 67
scanning the 45
T
M tables, attaching head ring to 41
MicroSlide and MicroDrive, calibration tools 61–62 tap, cleaning 65
MR and CT, CRW support for 1 targets
MR/CT localizer (see Luminant localizer) about AP, LAT and VERT 55
multiple targets, locating 58 calculating Luminant coordinates 45–50
locating multiple 58
N Vernier scales 54–56
NBND needle, using the 36 T-bolt screws 9, 41
temporalis muscles, avoiding the 21
P transphenoidal approaches, arc orientation 60
packing, CRW components 67 transverse arcs, radii of 52
parallel trajactories, setting 58 trunion reticles, visualizing LAT trajectories 63
parts, list of CRW 4–12 trunion ring, setting 57–58
phantom base
assembling the 37–39 U
phantom, qualifying scanners with geometric 64 UCHRA
pins, skull 21 assembling the 13–18
pointer, CRW arc cleaning the 65
picture of 11 UCHRAP (see adapter plates, UCHRAP)
setting the 33 universal compact head ring assembly (see UCHRA)
pointer, setting the CRW arc 33 uses for CRW, approved 1
positioner, head ring 20
posterior fossa approach, arc orientation 60 V
posts, head ring 13–14, 19 Vernier scales 54–56
probe holder
picture of 6 W
warnings
Q anesthetizing gases 3
Quality Assurance (QA) components 10 cleaning with bleach 66
deriving LAT and AP targets 58
R electrosurgical equipment 3
radial distances, measuring 35 ground–referenced electrosurgical device 3
radiosurgery head rings head ring screws, selecting 17, 22
sterilizing 68 Luminant localizer targets 45
reducing bushings and tubes monopolar or bipolar electrode 3
picture of 6 recalibrating the digital probe microdrive 62
reducing bushings and tubes, selecting 36 reviewing sterilization procedures 68
reticles, trunion and AP 63 scan orientations 45
rulers, probe depth 5 setting the digital probe microdrive 62
single use devices 2
S temporalis muscles 14
scales wrenches
AP, LAT and VERT 52 arc system, picture of 5
Vernier 54–56 cleaning head ring and arc system 66
scanning head ring, picture of 8
BRW localizer 50 hex, cautions for using 66
Luminant localizer 45
qualifying with geometric phantom 64
verifying orientations 45
screws, head ring 17
single use devices, warnings about 2
skull pins, placing 21
standard approach, arc orientation 60
72 • Index
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15960003 Rev. G