Alluramonoplaneinstructionforuseeng PDF

a n g i og r ap hy
INTEGRIS
Allura
Monoplane
INTEGRIS SYSTENS INSTRUCTIONS FOR USE
Release 1
English
9896 001 33152
INTEGRIS Allura
Monoplane
INSTRUCTIONS FOR USE
Release 1
English
9896 001 33152
Philips Medical Systems
Instructions for Use
Philips Medical Sytsems Nederland reserves

the right to make changes to both this
Instructions for Use and to the product(s) it
describes. Equipment specifications are subject
to alteration without notice. Nothing
contained within this Instructions for Use is
intended as an offer, warranty, promise or
contractual condition, and must not be taken
as such. All changes will be in compliance with
regulations governing manufacture of medical
equipment.
Printed in the Netherlands.
Document number
9896 001 33152
© Copyright Philips Medical Systems

Nederland 2000
No part of this publication may be reproduced,

transmitted, transcribed, stored in a retrieval
system or translated into any human or
computer language in any form by any means
without the consent of the copyright holder.
Unauthorized copying of this publication may

not only infringe copyright but also reduce the
ability of Philips Medical Systems Nederland
to provide accurate and up-to-date information
to users and operators alike.
9896 001 33152

4 I N T E G R I S A l l u r a M on o p la n e Release 1
Contents
Contents
1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-1
1.1 About the INTEGRIS Allura Monoplane systems . . . . . . . . .1-1

1.2 About this manual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-1
1.3 Intended use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-3
1.4 Contra-indications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-3
1.5 Compatibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-3
1.6 Compliance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-4
1.7 Training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-4
1.8 Other manuals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-5
2 Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-1
2.1 Important safety directions . . . . . . . . . . . . . . . . . . . . . . . . . .2-1

2.2 Emergency procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-2
2.3 Electrical safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-3
2.4 Mechanical safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-3
2.5 Explosion safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-4
2.6 Fire safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-4
2.7 Mobile telephones & similar equipment . . . . . . . . . . . . . . . .2-4
2.8 Radiation safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-5
3 Installation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-1
4 System overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-1
4.1 General layout . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-1

4.2 Configuration and options . . . . . . . . . . . . . . . . . . . . . . . . . .4-1
4.2.1 Geometry segment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-1
4.2.2 Patient support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-3
4.2.3 Geometry control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-4
4.2.4 Acquisition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-5
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4.2.5 Digital acquisition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-10

4.2.6 Viewing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-16
4.2.7 External communication . . . . . . . . . . . . . . . . . . . . . . . . . . .4-17
4.3 Controls and indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-21
4.3.1 Acquisition console . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-21

4.3.2 Viewing console, TAM and viewpad . . . . . . . . . . . . . . . . . .4-26
4.3.3 Viewing functions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-35
4.3.4 Monitors and room facilities . . . . . . . . . . . . . . . . . . . . . . . .4-50
4.3.5 Connection box and tableside operation modules . . . . . . . .4-57
4.3.6 Tabletop Shifting Device / Speed control hand switch . . . .4-66
4.3.7 Foot switches, hand switch and stand switches . . . . . . . . . .4-67
4.3.8 HCU controls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-69
4.3.9 Storage media. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-69
4.3.10200X Ultrasound scanner . . . . . . . . . . . . . . . . . . . . . . . . . .4-71
4.4 Overview of control, status and report pages . . . . . . . . . . . .4-74
4.4.1 Viewing console text display . . . . . . . . . . . . . . . . . . . . . . . .4-74
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Contents
4.5 Overview of acquisition and viewing displays . . . . . . . . . . .4-87

4.5.1 Acquisition console . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-87
4.5.2 Monitors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-88
4.5.3 Hard copy layout . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-92
4.5.4 Ultrasound image display . . . . . . . . . . . . . . . . . . . . . . . . . .4-93
4.6 Accessories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-94
5 Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-1
5.0 Basic procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-1

5.0.1 Preparing the system for diagnostic imaging . . . . . . . . . . . . .5-3
5.0.2 Patient and examination data . . . . . . . . . . . . . . . . . . . . . . .5-11
5.0.3 Making images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-15
5.0.4 Viewing images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-17
5.0.5 Post-processing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-21
5.0.6 Archiving . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-22
5.0.7 Transporting the system . . . . . . . . . . . . . . . . . . . . . . . . . . .5-24
5.1 Preparing the system for diagnostic imaging . . . . . . . . . . . .5-25
5.1.1 Setting the geometry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-27
5.1.2 Application settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-29
5.1.3 X-ray filters and accessories . . . . . . . . . . . . . . . . . . . . . . . . .5-35
5.1.4 XB and colour monitors . . . . . . . . . . . . . . . . . . . . . . . . . . .5-49
5.1.5 200X ultrasound scanner . . . . . . . . . . . . . . . . . . . . . . . . . . .5-50
5.1.6 APR handling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-54
5.1.7 Automatic Position Control (APC) . . . . . . . . . . . . . . . . . . .5-61
5.2 Patient and examination data . . . . . . . . . . . . . . . . . . . . . . .5-64
5.2.1 Importing patient data from the RIS interface . . . . . . . . . . .5-64
5.2.2 Modifying examination data . . . . . . . . . . . . . . . . . . . . . . . .5-67
5.2.3 Deleting an examination . . . . . . . . . . . . . . . . . . . . . . . . . . .5-67
5.2.4 Modifying the time and date . . . . . . . . . . . . . . . . . . . . . . . .5-68
5.2.5 Physician page . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-69
5.3 Making images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-71
5.3.1 Trace Subtract Fluoroscopy (TSF) . . . . . . . . . . . . . . . . . . .5-72
5.3.2 Parallel fluoroscopy and dual fluoroscopy modes . . . . . . . . .5-73
5.3.3 Bolus chase . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-74
5.3.4 Rotational angiography . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-83
5.3.5 Ultrasound . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-88
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5.4 Viewing images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-91
5.4.1 Viewing during acquisition . . . . . . . . . . . . . . . . . . . . . . . . .5-91
5.4.2 Ultrasound . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-91
5.5 Post-processing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-93
5.5.1 Text & annotations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-93

5.5.2 Clinical programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-94
5.5.3 Calibration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-95
5.5.4 Vessel diameter analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-97
5.5.5 Automated Vessel Analysis (AVA) . . . . . . . . . . . . . . . . . . .5-105
5.5.7 Centerline wall motion . . . . . . . . . . . . . . . . . . . . . . . . . . .5-153
5.5.8 Regional wall motion . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-156
5.5.9 Slager wall motion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-158
5.5.10Automated coronary analysis . . . . . . . . . . . . . . . . . . . . . . .5-160
5.6 Archiving . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-187
5.6.1 Flagging images, runs and/or examinations . . . . . . . . . . . .5-188
5.6.2 Transfer to the image archive (external (DICOM) station) 5-190
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Contents
5.6.3 Export patient data to the RIS interface . . . . . . . . . . . . . . .5-192

5.6.4 Selecting another destination . . . . . . . . . . . . . . . . . . . . . . .5-194
5.6.5 Transferring images to/from an Optical Disk Recorder
(ODR) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-195
5.6.6 Recording on a Video Cassette Recorder (VCR) . . . . . . . .5-198
5.6.7 Printing reports . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-199
5.6.8 Image transfer function . . . . . . . . . . . . . . . . . . . . . . . . . . .5-202
5.7 Transporting the system . . . . . . . . . . . . . . . . . . . . . . . . . .5-205
6 System and error messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-1
6.1 Error handling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-1

6.1.1 Acquisition console . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-1
6.1.2 Viewing console . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-5
7 Maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-1
7.0 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-1

7.1 Planned maintenance programme . . . . . . . . . . . . . . . . . . . . .7-1
7.2 User routine checks programme . . . . . . . . . . . . . . . . . . . . . .7-2
7.3 Cleaning and disinfection . . . . . . . . . . . . . . . . . . . . . . . . . . .7-4
7.3.1 Cleaning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-4
7.3.2 Disinfection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-4
8 Product disposal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-1
8.0 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8-1

8.1 Passing the INTEGRIS Allura Monoplane on to another user 8-1
8.2 Final disposal of the INTEGRIS Allura Monoplane system . .8-2
8.3 Fitting, removing and disposing of batteries . . . . . . . . . . . . .8-2
8.3.1 Battery replacement for remote control . . . . . . . . . . . . . . . . .8-2
9 Technical data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-1
9.1 Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9-1

9.1.1 Environmental requirements . . . . . . . . . . . . . . . . . . . . . . . . .9-1
9.1.2 Mains . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9-1
9.1.3 X-ray generator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9-1
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9.1.4 X-ray tubes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9-1

9.1.5 Examination light . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9-2
9.1.6 Ceiling suspended radiation shield . . . . . . . . . . . . . . . . . . . .9-2
9.1.7 Accessory bracket for ceiling suspended radiation shield . . . .9-2
9.1.8 Wedge filters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9-2

9.1.9 Additional filtering . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9-2
9.1.10Imaging chain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9-5
9.1.11XB monitor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9-5
9.1.12Colour monitor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9-6
9.1.13Beam carriers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9-6
9.1.14Angio DIAGNOST 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9-7
9.1.15Contrast medium power injectors . . . . . . . . . . . . . . . . . . . . .9-7
9.1.16Storage media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9-8
9.1.17Network data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9-8
9.2 Stray radiation data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9-9
9.2.1 Measuring results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9-9
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Contents
10 Appendices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-1
10.0 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-1

10.1 Standards and regulations . . . . . . . . . . . . . . . . . . . . . . . . . .10-1
10.1.1Measurement of technical parameters . . . . . . . . . . . . . . . . .10-1
10.2 Application guidelines . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-3
10.2.1Digital lower peripheral angiography . . . . . . . . . . . . . . . . . .10-3
10.2.2Rotational angiography . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-4
10.2.3Mask averaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-5
10.2.4Ultrasound . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-5
10.2.5Type B symbol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-8
10.3 Wedge filters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-10
10.3.1Manual-only wedge control (Vascular APR) . . . . . . . . . . .10-10
10.3.2Automatic/manual wedge control (Cardiac APR) . . . . . . .10-11
10.4 Stand and table movements . . . . . . . . . . . . . . . . . . . . . . . .10-14
10.4.1Safety devices for the stand and table movements . . . . . . .10-14
10.4.2Stand movements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-15
10.4.3Table movements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-24
10.4.4Angio DIAGNOST 5 with SyncraTilt option . . . . . . . . . .10-26
11 Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-1
11.1 Definitions and terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11-1

11.2 Abbreviations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11-9
11.3 Legend . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11-11
12 Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I-1
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1 Introduction
1.1 About the INTEGRIS Allura

Monoplane systems
The INTEGRIS Allura Monoplane is a dedicated monoplane X-ray system
for vascular diagnostic and interventional procedures. The system is
equipped with a CCD imaging chain for digital imaging and a ceiling
suspended C-arm stand with PentaView 38 cm (15 inch) or 4-fields 30 cm
(12 inch) Image Intensifier (II).
Through a wide range of options, the system can be fully customized to suit a
variety of applications including peripheral, abdominal, and cerebral
diagnostic and interventional angiography, neuro applications, cardiac
applications and non-vascular interventions.
The system is based on an integrated concept with Local Area Network
(LAN) and fibre optic interfaces for communication between the main
segments.
The imaging modalities include:
• digital processed fluoroscopy
• digital acquisition, viewing, processing and archiving
The INTEGRIS Allura Monoplane provides full body coverage.
1.2 About this manual

‘Instructions For Use’ identification
In order to identify this ‘Instructions For Use’, with the system for which it is
intended to be used, a label has been placed on the title page and indicates
the following:
• project number
• shop/COS number
• customer order number
• project destination.
9896 001 33152
The following illustration is an example of such a label (shown approximately

actual size), note that each system delivered will have its own unique
numbers:
An identical label is placed on the Aquisition console, the label is always

positioned in the same place. If the Aquisition console is placed on a table,
the label is on the rear side. If the Aquisition console is wall mounted, the
label is on the top side.
INTEGRIS Allura Monoplane Release 1 Introduction 1-1

1.2 About this manual
Before using this ‘Instructions For Use’ with your system, ensure that the
identification labels both show the same information.
This manual is intended to assist users and operators in the safe and effective
operation of the equipment described. The ‘user’ is considered to be the body
with authority over the equipment; ‘operators’ are those persons who actually
handle the equipment. Before attempting to operate the equipment, you
must read, note and strictly observe all DANGER notices and safety
markings on the INTEGRIS Allura Monoplane.
Before attempting to operate the equipment, you must read this manual
thoroughly, paying particular attention to all WARNINGS, Cautions and
Notes incorporated in it. You must pay special attention to all the
information given and procedures described in the SAFETY section.
This symbol, used throughout the manual, indicates a WARNING.
WA R N I N G S are directions which if not followed could cause fatal or serious injury to an operator,
patient or any other person, or could lead to a misdiagnosis.
CAUTIONS are directions which if not followed could cause damage to the equipment described in
this Manual and/or any other equipment or goods, and/or cause environmental
pollution.
N OT E S are intended to highlight unusual points as an aid to the operator.
This Manual describes the system in its full configuration with all options
and accessories fitted. Not every function described may be available on your
system.
This English language version of the Manual was originally drafted, approved
and supplied by Philips Medical Systems under the product part code
indicated on page 4.
Section 4 ‘System overview’ gives a complete description of the system,

paying special attention to all controls, indicators and display layouts. The
controls and indicators are sequentially numbered in the text and the
numbers may therefore appear out of sequence in the illustrations. The
Legend gives an overview of the location of all controls and indicators and
can be folded out for easy reference.
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Section 5 ‘Operation’ gives information about all actions that have to be

performed before the system can be used for examinations. Procedures for
operating the equipment are also given in Section 5 under the headings
‘Making images’, ‘Viewing images’ ‘Post processing’ and ‘Archiving’. These
sections describe specific actions and the sequence in which they must be
performed, with references to the ‘Legend’ for locations, and to the ‘System
overview’ for detailed descriptions of the functions concerned.
1- 2 Introduction INTEGRIS Allura Monoplane Release 1

Intended use 1.3
1.3 Intended use

The Philips INTEGRIS Allura Monoplane is intended to be installed, used
and operated only in accordance with the safety procedures and operating
instructions given in this Manual and for the purposes for which it was
designed. The purposes for which the equipment is intended are given below.
However, nothing stated in this Manual reduces users’ and operators’
responsibilities for sound clinical judgment and best clinical procedure.
The Philips INTEGRIS Allura Monoplane system is intended for

interventional and diagnostic vascular, cardio vascular and neurovascular
procedures, non-vascular interventions and non-vascular diagnostics.
Installation, use and operation of this equipment is subject to the law in the
jurisdiction(s) in which the equipment is being used. Both users and
operators must only install, use and operate the equipment in such ways as
do not conflict with applicable laws, or regulations which have the force of
law.
Uses of the equipment for purposes other than those intended and expressly
stated by the manufacturer, as well as incorrect use or operation, may relieve
the manufacturer (or his agent) from all or some responsibility for resultant
non-compliance, damage or injury.
CAUTION In the United States, Federal law restricts this device to sale, distribution, and use by or
on the order of a physician.
1.4 Contra-indications
X-rays are potentially hazardous. Special precautions must be taken and/or
caution must be exercised in the following cases:
• Special consideration must be given to the protection of the embryo or
fetus during radiological examination or treatment of women known to be
pregnant.
• Sensitive body organs (e.g., lens of eye, gonads) must be shielded whenever
they are likely to be exposed to the working beam.
• Acute skin burns (patients).
• Acute hair loss (patients).
• Chronic radiation injury (staff).
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1.5 Compatibility
Equipment described in this manual should not be used in combination with

other equipment or components unless such other equipment or
components are expressly recognized as compatible by Philips Medical
Systems. A list of such equipment and components is available on request
from the contact address given in the paragraph on ‘Compliance’.

1.6 Compliance
Changes and/or additions to the equipment should only be carried out by

Philips Medical Systems or by third parties expressly authorized by Philips
Medical Systems to do so. Such changes and/or additions must comply with
all applicable laws and regulations that have the force of law within the
jurisdiction(s) concerned, and with best engineering practice.
Changes and/or additions to the equipment that are carried out by persons
without the appropriate training and/or using unapproved spare parts may
lead to the Philips Medical Systems warranty being voided. As with all
complex technical equipment, maintenance by persons not appropriately
qualified and/or using unapproved spare parts carries serious risks of damage
to equipment and personal injury.
1.6 Compliance
The Philips INTEGRIS Allura Monoplane complies with relevant
international and national standards and laws. Information on compliance
can be obtained from your local Philips Medical Systems representative or
from:

Dept. Corporate Technology
P.O. box 10.000
5680 DA Best, The Netherlands
Fax: +31 40 27 62205
The Philips INTEGRIS Allura Monoplane complies with relevant

international and national law and standards on EMC (electromagnetic
compatibility) for this type of equipment when used as intended. Such laws
and standards define both the permissible electromagnetic emission levels
from equipment and its required immunity to electromagnetic interference
from external sources.
1.7 Training
Operators of the Philips INTEGRIS Allura Monoplane must have received
adequate training in its safe and effective use before attempting to operate the
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equipment described in this Manual. Training requirements for this type of

device will vary from country to country. It is for users to make sure that
operators receive adequate training in accordance with local laws or
regulations which have the force of law.
If you require further information about training in the use of this

equipment, please contact your local Philips Medical Systems representative.
Alternatively, contact:

Other manuals 1.8

P.O. box 10.000
Fax: +31 40 27 62205
1.8 Other manuals

This Manual describes the INTEGRIS Allura Monoplane. However, certain
other pieces of equipment may be used with the system, and each will have
its own Manual.
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1.8 Other manuals
9896 001 33152


2 Safety
2.1 Important safety directions

Philips Medical Systems products are all designed to meet stringent safety
standards. However, all medical electrical equipment requires proper
installation, operation and maintenance, particularly with regard to human
safety.
It is vital that you read, note, and where applicable strictly observe all
DANGER notices and safety markings on the INTEGRIS Allura
Monoplane.
It is vital that you follow strictly all safety directions under the heading
SAFETY and all WARNINGS and CAUTIONS throughout this Manual, to
help ensure the safety of both patients and operators.
In particular, you must read, understand and know the ‘Emergency

procedures’ described in this SAFETY section before attempting to use the
equipment for any patient examination.
You should also note the following information given in the Introduction
section of this Manual:
• 1.3 Intended Use
• 1.4 Contra-indications
• 1.7 Training
Only qualified and authorized personnel may operate this equipment. In this
context, qualified means those legally permitted to operate this type of
medical electrical equipment in the jurisdiction(s) in which the equipment is
being used, and authorized means those authorized by the user of the
equipment.
Personnel operating the equipment and personnel in the examination room

must observe all laws and regulations which have the force of law within the
jurisdiction(s) concerned. If you are in any doubt about the laws and
regulations which apply to the operation of this equipment, do not use it.
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WA R N I N G S Maintenance & faults

• Do not use the INTEGRIS Allura Monoplane for any application until you are sure
that the User Routine Checks Program has been satisfactorily completed, and that
the Planned Maintenance Program is up to date.
• If any part of the equipment or system is known (or suspected) to be defective or

wrongly-adjusted, DO NOT USE the system until a repair has been made.
Operation of the equipment or system with defective or wrongly-adjusted
components could expose the operator or the patient to radiation or other safety
hazards. This could result in serious or fatal injury, or to clinical misdiagnosis/
incorrect treatment.
INTEGRIS Allura Monoplane Release 1 Safety 2-1

2.2 Emergency procedures
You can find information about the ‘User Routine Checks Program’ and the
‘Planned Maintenance Program’ in the ‘Maintenance’ section of this Manual.
Safety awareness
• Do not use the INTEGRIS Allura Monoplane for any application until you have
read, understood and learnt all the safety information, safety procedures and
emergency procedures contained in this SAFETY section. Operation of the
INTEGRIS Allura Monoplane without a proper awareness of how to use it safely
could lead to serious or fatal injury. It could also lead to clinical misdiagnosis/
incorrect treatment.
Adequate training
• Do not use the INTEGRIS Allura Monoplane for any application until you have
received adequate and proper training in its safe and effective operation. If you are
unsure of your ability to operate this equipment safely and effectively DO NOT
USE IT. Operation of this equipment without proper and adequate training could
lead to serious of fatal injury. It could also lead to clinical misdiagnosis/incorrect
treatment.
For information about training, please refer to ‘Training’ in the

‘Introduction’ section of this Manual.
Safety devices
• Never attempt to remove, modify, override or frustrate any safety device on the
equipment. Interfering with safety devices could lead to serious or fatal injury.
Intended use & compatibility

• Do not use the INTEGRIS Allura Monoplane for any purpose other than those for
which it is intended.
• Do not use the INTEGRIS Allura Monoplane with any products other than those
which Philips Medical Systems recognizes as compatible. Operation of the
INTEGRIS Allura Monoplane for unintended purposes, or with incompatible
equipment, could lead to serious or fatal injury. It could also lead to clinical
misdiagnosis/incorrect treatment.
Intended use of the INTEGRIS Allura Monoplane is described under the

heading ‘Intended use’ in the ‘Introduction’ section of this Manual.
Compatibility is discussed under the heading ‘Compatibility’ in the
‘Introduction’ section of this Manual.
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2.2 Emergency procedures

WA R N I N G S • In the event of a system movement emergency, press emergency power off [130] or
[160] to block all movements except manual L-arm rotation and longitudinal
movement and tabletop float.
2- 2 Safety INTEGRIS Allura Monoplane Release 1

Electrical safety 2.3
• In the event of a clinical emergency involving a patient, do not press emergency

power off [130] or [160]. Move the image intensifier and/or the tabletop, and/or
rotate or park the stand to provide clear, all-round access to the patient. During
such an emergency, with power on, the image intensifier can also be moved upwards
manually by applying the required threshold force (approximately 60 N).
• To ensure free all-round access to the patient, do not switch off the X-ray system
using a local mains power switch.
2.3 Electrical safety
WA R N I N G Do not remove covers or cables from this equipment unless expressly instructed to do
so in this Manual. High electrical voltages are present within this equipment. Removing
covers or cables could lead to serious or fatal injury.
Covers or cables should only be removed by qualified and authorized service

personnel. In this context, qualified means those legally permitted to work
on this type of medical electrical equipment in the jurisdiction(s) in which
the equipment is being used, and authorized means those authorized by the
user of the equipment.
Only use this equipment in rooms or areas that comply with all applicable
laws (or regulations having the force of law) concerning electrical safety for
this type of equipment. Always electrically isolate this equipment from the
mains electrical supply before cleaning, disinfecting or sterilizing it.
Equipotential ground connection

An equipotential ground (earth) connection point is provided. This
equipment may only be used in areas meeting local standards for electrical
safety in rooms used for medical purposes, such as the US National Electrical
Code. IEC 601 also gives guidance on equipotential ground (earth)
connection points.
2.4 Mechanical safety

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WA R N I N G Do not remove covers from this equipment unless expressly instructed to do so in this
Manual. Moving parts are present within this equipment. Removing covers could lead
to serious or fatal injury.
Covers should only be removed by qualified and authorized service

personnel. In this context, qualified means those legally permitted to work
on this type of medical electrical equipment in the jurisdiction(s) in which
the equipment is being used, and authorized means those authorized by the
user of the equipment.

2.5 Explosion safety
2.5 Explosion safety

This equipment must not be used in the presence of explosive gases or
vapours, such as certain anesthetic gases. Use of electrical equipment in an
environment for which it was not designed can lead to fire or explosion.
WA R N I N G Flammable or potentially explosive disinfecting sprays must not be used since the
resultant vapor could ignite, causing fatal or serious injury and/or damage to
equipment.
2.6 Fire safety

Use of electrical equipment in an environment for which it was not designed
can lead to fire or explosion. Fire regulations for the type of medical area
being used should be fully applied, observed and enforced. Fire extinguishers
should be provided for both electrical and non-electrical fires. All operators
of this medical electrical equipment should be fully aware of and trained in
the use of fire extinguishers and other fire-fighting equipment, and in local
fire procedures.
WA R N I N G Only use extinguishers on electrical or chemical fires which are specifically labeled for
those purposes. Using water or other liquids on an electrical fire can lead to fatal or
serious injury.
If it is safe to do so, attempt to isolate the equipment from electrical and

other supplies before attempting to fight a fire. This will reduce the risk of
electric shocks.
2.7 Mobile telephones & similar equipment

Philips INTEGRIS Allura Monoplane medical equipment complies with the
requirements of the applicable EMC standards. Other electronic equipment
that exceeds EMC radiation standards, such as certain mobile telephones,
may affect the operation of this equipment.
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WA R N I N G Do not allow any portable radio devices (such as mobile telephones) into the
examination room - whether switched on or off. Such devices could exceed EMC
radiation standards and, under certain conditions, interfere with the proper
functioning of the system. This could, in extreme cases, lead to fatal or serious injury.
CAUTION In the United States Federal law restricts this device to sale, distribution, and use by or
on the order of a physician.

Radiation safety 2.8
2.8 Radiation safety

Operators are strongly urged to acquaint themselves with the current
recommendations of the International Commission on Radiological
Protection, and in the United States, with those of the US National Council
for Radiological Protection.
• ICRP, Pergamon Press, Oxford, New York, Beijing, Frankfurt, São Paulo,
Sydney, Tokyo, Toronto
• NCRP, Suite 800, 7910 Woodmont Avenue, Bethesda, Maryland 20814,
USA
Full use must be made of all the equipment’s radiation protection features
and of all radiation protection devices, accessories, systems and procedures
available to you as the operator.
WA R N I N G Never attempt to remove, modify, override or frustrate any safety device on the
equipment. Interfering with safety devices could lead to serious or fatal injury.
Use only the prescribed dose necessary to perform a particular examination

or treatment.
Radiation guidelines
Always apply the following rules when using radiation equipment:

• never radiate unless absolutely necessary
• radiate for as short a time as possible
• when possible, use automatic dose rate control
• stay as far away from the radiated object as possible
• always wear an apron
• use badges to monitor the radiation received
• collimate as much as possible
• keep the focal spot to skin (object) distance as large as possible
• remove all unnecessary obscuring objects from the primary beam
(including the operator’s hands)
• for extra operator safety, keep the X-ray source under the table.
Filtration and leakage radiation

The minimum inherent filtration (at 100 kV) of the X-ray tube/collimator is
2.5 mm Al.
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Additional filters are (see also section 9 ‘Technical data’):
Type number Type Filter Filter Filtration

(12NC) in mm Al-eq.
(at 100 kV)
9896 010 22051 Vasc 1 0.1 mm Cu + 1.0 mm Al 3.7

2 0.4 mm Cu + 1.0 mm Al 9.0
3 0.9 mm Cu + 1.0 mm Al 17.6
9896 010 22061 Cardio 1 0.1 mm Cu + 1.0 mm Al 3.7

2 0.4 mm Cu + 1.0 mm Al 9.0
3 0.9 mm Cu + 1.0 mm Al 17.6

2.8 Radiation safety
Leakage radiation
The leakage radiation for the X-ray tube/collimator assembly is less than 100
mR/hr (0.87 mGry/hr) measured at a distance of 1 meter in any direction of
the source when operated at the leakage technique factors 125 kV, 12mA.
N OT E For information on stray radiation refer to section 9, Technical Data.
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3 Installation
Not Applicable.
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INTEGRIS Allura Monoplane Release 1 Installation 3-1

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3- 2 Installation INTEGRIS Allura Monoplane Release 1

4 System overview
4.1 General layout
L-arm
Examination and
reference monitors
C-arm stand
Display unit
Acquisition console
Viewing monitor
Viewing console
36280010
INTEGRIS Allura Monoplane system
4.2 Configuration and options
4.2.1 Geometry segment
L-arm
Image
intensifier
C-arm
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X-ray tube
36280020
The geometry segment provides total body coverage and offers a wide range
of projections for PA and AP imaging for all vascular and neuro applications.
The INTEGRIS Allura C-arm stand with 38 cm (15 inch) or 30 cm (12
inch) Image Intensifier (II) is attached to a ceiling suspended L-arm. The L-
arm is suspended from a ceiling rail which runs parallel to the longitudinal
axis of the table.
INTEGRIS Allura Monoplane Release 1 System overview 4-1

The L-arm can be rotated and/or moved longitudinally, either manually or

under motor control, to allow a three-sided patient approach. C-arm stand
rotation, angulation and II lift are motorized
The X-ray field is always aligned with the Image Intensifier entrance screen
and the reference axis is always perpendicular to the Image Intensifier
entrance plane.
C-arm stand movements
Rotation:
• from 90° LAO (+rotation) to 90° RAO (-rotation) (stand in its side
position perpendicular to the table)
• from 120° LAO (+rotation) to 185° RAO (-rotation) (stand in its head
position parallel to the table)
• variable rotation speed via tableside operation module up to 25°/sec.
Cranial/caudal angulation:
• from 90° cranial (+angulation) to 90° caudal (-angulation) (max = 90°)
(stand in its head position parallel to the table)
• from 120° cranial (+angulation) to 185° caudal (-angulation) (stand in its
side position perpendicular to the table)
• variable angulation speed via tableside operation module up to 18°/sec.
N OT E The full angulation capability is limited by the table position and patient position.
Rotational angiography:
position perpendicular to the table (rolling movement)) at a speed of up to
30°/sec
• from 120° LAO (+rotation) to 185° RAO (+rotation) (stand in its head
position parallel to the table (propeller movement)) at a speed of up to
55°/sec.
Image intensifier movements:

• motorized focus/II screen distance (SID) from 89.5 to 119.5 cm (35.2 to
47 inch)
• motor-driven II movement speed:
- 10 cm/sec (3.9 inch/sec) towards the patient
- 15 cm/sec (5.9 inch/sec) away from the patient.
Image intensifier modes:
• 38 cm II: 38/31/25/20/17 cm (15/13/11/8/6 inch)
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• 30 cm II: 30/22/17/12 cm (12/9/6/4.5 inch).
L-arm movements
• longitudinal movement (parking movement) of 260 cm (102.3 inch)
• motorized longitudinal movement speed of 15 cm/sec (5.9 inch/sec)
• rotation movement over 180° (2 x 90°)

• motorized rotation speed of 12°/sec.
N OT E The maximum speeds are set in the APR’s (by Service) and cannot be changed by the
physician.
4- 2 System overview INTEGRIS Allura Monoplane Release 1

Configuration and options 4.2
Options
Short L-arm
The short L-arm allows the C-arm to be installed in rooms with a lower than
normal ceiling height. By using the short L-arm, the minimum ceiling height
is reduced from 290 cm (114.2 inch) to 270 cm (106.3 inch).
4.2.2 Patient support

‘Angio Diagnost 5’ (AD5) patient support provided with a flat carbon fibre
tabletop:
• metal-free overhang of 125 cm (49.2 inch)
• floating tabletop movement of 100 cm (39.4 inch) in the longitudinal
direction and 2 x 18 cm (2 x 7.1 inch) in the transverse direction
• maximum patient weight: 200 kg (440 lb)
• motorized height adjustment from 76 to 104 cm (29.9 to 40.9 inch).
• separate operating modules for geometry and imaging functions can be
attached to either side of the table
• the set of patient accessories (supplied with the system) includes:
- 5 rail accessory clamps
- head fixing aids
- 2 tabletop accessory clamps
- 4 restriction straps
- wedge shaped mattress
- 2 arm supports
- 1 cerebral filter
- translucent catheterization arm support
- peripheral filter
- drip stand
- cable guides.
N OT E All accessories except the cerebral filter are mounted on the table.
Options
Catheterization arm support

Height adjustable, for brachial catheterization and digital imaging. The
support is made of X-ray transparent material with the exception of the
fixing clamp and pivots.
Pivot for table base

For angiographic and interventional procedures on the upper peripherals. It
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improves table access for patient transfer.

The pivot option provides:
• pivoting of the table base around its vertical axis
• pivot range from -90° to +90° with locked positions on 0, -13°/

+13°(facilitating arm-angiography) and -90°/+90°
• pivot device with graduated scale, mounted on the universal floor plate of
the table.
Ratchet compressor
The option comprises:
• 3 cotton compression belts 23 cm (9.1 inch) wide
• a ratchet winding mechanism on one side for symmetrical compression.

SyncraTilt
SyncraTilt enhances the accuracy and efficiency of gravity-oriented
procedures. SyncraTilt is ideal for interventional, myelography,
phlebography and head down procedures because it provides more precise
imaging of contrast medium, blood, or objects in the body. With SyncraTilt,
the isocenter is automatically located at the isocenter of rotation and
angulation of the stand. If the longitudinal position of the stand changes, the
tilt isocenter is changed to match the new stand position, ensuring that the
region of interest (ROI) is always centered.
As the table tilts, the X-ray beam automatically compensates for the
movement. When the tilt option is installed:
• manual tabletop float is only transversal
• longitudinal tabletop movement is motorized only.
The table floats even when tilted and the ROI can be tracked by panning the
tabletop. When combined with the Bolus Chase option, SyncraTilt allows
phlebography to be performed with a head-up tilted patient.
The option provides:
• maximum tilt range: -28° head down tilt (HDT) to +20° head up tilt
(HUT). For isocentric tilt, the tilt range depends on the distance between
the isocenter of the stand and the table base
• an automatic safety system with manual override
• a panning range in tilted plane equal to the standard tabletop
specifications (longitudinal movement of 100 cm (39.4 inch), lateral
movement of 36 cm (14.2 inch)).
Accessories:
• foot support
• shoulder support (not with neuro tabletop)
• ankle support
• chin support (cushion)
• 4 handgrips.
4.2.3 Geometry control

The geometry control console attached to the patient support can be used for
the following functions:
• C-arm rotation/angulation
• L-arm rotation and longitudinal movement (park)
• tabletop panning movement
• table height movement
• store and recall of two projections, including the SID.
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• image intensifier movement (Source Image Distance (SID))

• table tilt (if installed)
• stop.
Options
Pan handle
An extension of the control facility for floating movements of the tabletop,
the pan handle is used to assist tabletop positioning at the tableside in parallel
with the standard geometry Tableside Operation module (TSO). It can be
attached anywhere to the tabletop and accessory rails without decreasing the
floating range. The pan handle is connected to the table-base connection box

in a master-slave configuration with the geometry TSO module. The

connection offers a free choice of master and slave assignment. Any action at
the master module immediately deactivates the slave module.
Second geometry module

An extension of the control facility for geometry movements, the second
geometry module is used to assist operation of the stand and table in parallel
with the standard module at table side. Both modules are identical and have
the same functionality. They are connected to the table-base connection box
in a master-slave configuration. The connection offers a free choice of master
and slave assignment. Any action at the master module immediately
deactivates the slave module.
SyncraTrak Automatic Position Control (APC)

The automatic position controller has three operating modes. The stand
rotation angle, angulation angle and wedge filter position are stored in all
three modes:
• scratch mode: in this mode two projections can immediately be stored and
recalled at any time during the examination
• sequencer mode: stand positions of one or more Service-installed
sequences can be recalled. A total of 100 positions can be stored to be
divided into a maximum 10 sequences
• reference mode: a reference image driven mode, in which the stand
position corresponding to the displayed reference images can be recalled.
This enables accurate comparison of pre-intervention (reference) and post
intervention (live) images.
The option includes a controller and APC module. The projections are
indicated on the display unit.
4.2.4 Acquisition
General
• 100 kW X-ray power pack generator
• integrated generator/examination console
• X-ray depth collimator, including two independent semi-transparent
wedged filters with automatic and manual positioning
• CCD based imaging chain with a high performance state of the art CCD
camera with a digital output.
The chains include:
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• pentaview 38 cm (15 inch) II or 4-fields 30 cm (12 inch) II

• digital scanning automatically matched to the C-arm position to maintain
upright patient orientation on monitor
• intercom for communication with the control room.
XB Monitors and Room Facilities
Infrared receiver
The infrared receiver, for communication with the viewpad(s), is integrated
into the monitor suspension and positioned just above the monitors.

Monitor ceiling suspension

The monitor ceiling suspension provides flexible positioning of the monitors
over a large range of up to 360 cm (141.7-inch) in longitudinal direction and
300 cm (118.1-inch) in lateral direction. Depending on the system
configuration the suspension accommodates 1, 2, 3, 4 or 6 monitors, one or
two near-monitor displays (display units) and the ultrasound scanner 200X.
Near-monitor display (display unit)

The near-monitor display (display unit) provides information to the operator
in the examination room. Status information on stand rotation and
angulation, system messages, X-ray tube load status (traffic lights), the
selected fluoroscopy mode, the selected II fields and dose rate are displayed.
There is also an intercom for communication with the control room.
XB monitors
Two sizes of XB monitors are specified with the system:
• a 21-inch monitor, with a concave front, used in the examination room
and mounted in the monitor ceiling suspension
• a 17-inch monitor used for viewing in the control room.
The XB Progressive Display (PD) monitors with CyberScreen technology are

for display of all live and reference images, featuring:
• extra bright images, high contrast and high resolution TripleGun
monochrome CRT
• non-interlaced progressive display at 76 full images (frames) per second for
a sharp, high resolution display of the finest details, eliminating both line
and field flicker
• ambient light dependent contrast and brightness control and black level
stabilization for constant brightness
• user programmable and standard reference settings
• on-screen display
• daisy chain capability providing single control for multiple monitors
• concave model for optimal viewing of the assembled live image monitor
with (optional) monitors, as for example. reference image and dual
fluoroscopy.
X-ray ON indicator lamp

The monitor suspension is provided with an X-ray ON indicator lamp.
X-ray tubes
The system is equipped with either an MRM or MRC X-ray tube:
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MRM-GS 04 10
• MRM 04 10 Maximus ROTALIX Metal tube with grid switch and 0.4/
1.0 mm nominal focal spot values, maximal 25 and 85 kW short time load
• grid switching in pulsed fluoroscopy mode
• anode heat storage capacity: 1.4 MHU

• continuous heat dissipation: 1.5 kW
• ROT GS-2502 tube housing for oil cooled X-ray tube with thermal safety
switch.

MRC-GS 03-10
• MRC-GS 200 03 10 Maximus ROTALIX Ceramic tube with grid switch
and 0.3/1.0 mm nominal focal spot values, maximal 20 and 100 kW short
time load
• ROT-GS 1004 tube housing for oil cooled X-ray tube with thermal safety
switch.
MRC-GS 04-07
• MRC-GS 200 04 07 Maximus ROTALIX Ceramic tube with grid switch
and 0.4/0.7 mm nominal focal spot values, maximal 30 and 67 kW short
time load
• ROT-GS 1004 tube housing for oil cooled X-ray tube with thermal safety
switch.
N OT E Both MRM and MRC X-ray tubes offer additional beam filtration capabilities. See
section 9 ‘Technical data’ for additional information.
CAUTIONS In case a defective spectrabeam is detected, the user is warned that there might be a
higher dose rate than usual during fluoroscopy. The following messages will then be
displayed:
• On the frontal display unit: ‘Warning’
• On the acquisition console: ‘Spectral filter defect Call Service’.
In case a defective grid switch is detected, the user is warned that there might be a
higher dose rate than usual during fluoroscopy. The following message will then be
displayed:
• On the acquisition console: ‘Failing gridswitch Call Service’.
X-ray tube housing

302.5
380
36280160
9896 001 33152
The C-arm of the INTEGRIS Allura Monoplane system is normally

supplied with an X-ray tube housing which offers a minimum source (X-ray
tube focus) to skin distance of 302.5 mm (11.9 inch). However, legal
regulations in some countries require that the minimum source to skin

distance is 380 mm (14.9 inch), in such cases the X-ray tube housing for
these systems will be fitted with a spacer in order to meet the legal
regulations.

Beam limitation
The system has been provided with a beam limiting device (shutters) to limit
the extent of the X-ray field. The extent of the X-ray field is automatically
limited to just outside the edges of the maximum image reception area as
displayed on the monitor. The size of the actual maximum image reception
area is dependent on the selected II field size. The extent of the X-ray field
can be manually limited with rectangular X-ray shutters.
Fluoroscopy
There are three programmable fluoroscopy modes (3 (High), 2 (Normal) and
1 (Low)).
The configuration of these modes is dependent on whether or not the system
is configured for the following functions:
• dynamic pulsed fluoroscopy
• MRC-GS X-ray tube with SpectraBeam.
The high, normal and low fluoroscopy modes differ with regard to image
quality, dose rate and image processing (dose level, pulsed/continuous
fluoroscopy, beam filtration, noise reduction, adaptive contour enhancement
and harmonization). The modes can be selected from the imaging TSO. The
settings are configured by Service.
If the AEP meter option is present, the dose rate is indicated on the display
unit [127]. Dose reduction can be achieved by using Cu filters for X-ray
beam filtration. For filter values, refer to section 9 ‘Technical data’.
Other fluoroscopy features:
• Trace Subtract Fluoroscopy (TSF)
• fluoroscopy image storage and archiving (frame grabbing)
• fluoroscopy stopwatch.
Dynamic pulsed fluoroscopy

Pulse rates [pulses/s] for high, normal and low fluoroscopy modes:
Mains frequency 5122 matrix 10242 matrix
50 HZ 8, 12.5, 25 6, 8, 12.5, 25
60 HZ 7.5, 15, 30 7.5, 15, 30
Options
21 inch colour monitor

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21 inch medical colour monitor for assembling in the monitor ceiling

suspension. The housing is identical to the housing of the 21 inch XB
Progressive Display (PD) monitors, to allow integration with the XB
monitors in the same ceiling suspension.
The colour monitor is used to display colour images and data in the
examination room, for instance provided by, either:
• A hemodynamic acquisition system, or
• INTEGRIS 3D-RA.

Second TSO imaging module

An extension of the control facility for imaging selection, the second TSO
can be used in parallel with the standard module at tableside. Both modules
are identical and have the same functionality. They are connected to the
table-base connection box. The connection offers a free choice of master and
slave assignment. Any action at the master module immediately deactivates
the slave module.
Parallel fluoro vascular

This option provides the parallel fluoroscopy mode, allowing the use of
digitally processed fluoroscopy in parallel with viewing and processing of
previously acquired images of the current and/or previous patient to increase
patient throughput and procedure efficiency. Viewing console functions are
suspended during exposures and enabled again after the exposures are made.
The option also provides a fluoro channel in parallel to the default fluoro
channel, allowing fluoroscopy during image transfer i.e. to a CD-Medical or
remote destination.
Dual fluoro
This is a digital subsystem with additional 21 inch XB monitor allowing:
• digitally processed fluoroscopy in parallel with viewing and processing of
previously acquired images of the current and/or previous patient to
increase patient throughput and procedure efficiency
• digitally processed fluoroscopy in parallel with Trace Subtract Fluoroscopy
(TSF), providing a non-subtracted reference fluoro image for complex
interventions
The option also provides a fluoro channel in parallel to the default fluoro
channel, allowing fluoroscopy during image transfer i.e. to a CD-Medical or
remote destination. Viewing console functions are suspended during
exposures and enabled again after the exposures are made.
Examination light
The monitor suspension is provided with a bracket for mounting the
optional examination light.
Table mounted radiation shield

The table mounted radiation shield offers the physician and staff additional
protection against scattered radiation.
The option allows three main operating modes at the doctor’s and/or nurse’s
side of the table:
• working position with lower and upper shield
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• working position with lower shield only (upper shield folded down)
• parking position (shield folded under the table).
The radiation shield is provided with a special AD5-table clamping device
with clamping knob for mounting it to the table accessory rail. It is

fabricated from 0.5 mm Pb equivalent material and can be swiveled into any
working position.
To achieve optimal protection against scattered radiation use both the lower
and the upper shield. The shield should be set between the radiated object
and the physician. The upper shield can be folded down in situations where
its use would unacceptably limit access to the patient. The shield can remain
fitted to the accessory rail when cleaning the table and during patient

preparation as it can fully be parked under the tabletop. The shield can be
simply converted (by Service) for fitting to the nurse-side of the table. If
necessary, two protection shields can be fitted - one on either side of the
table. The option includes a docking rail which can be mounted to the wall.
Ceiling suspended radiation shield

This option provides a ceiling suspended radiation shield to protect the eyes
and upper body of the physician and staff against scattered radiation.
The ceiling suspended radiation shield comprises:
• a counter balanced two section suspension arm (75/90 cm)
• tiltable lead acrylic shield (40 x 50 cm), lead equivalence 0.5 mm Pb
• lead apron (35 x 50 cm), lead equivalence 0.5 mm Pb.
The lead acrylic shield is provided with two notches to hold a sterile cover
bag, if required.
The two section suspension arm of the radiation shield is attached to the
accessory bracket mounted on the monitor ceiling carriage. This allows free
positioning of the shield.
Optimal radiation protection is achieved when the ceiling suspended
radiation shield is used in combination with the optional table mounted
radiation shield.
4.2.5 Digital acquisition

General
The digital acquisition segment coordinates the parameters for automatic
exposure control ensuring optimal X-ray tube loading.
It uses various different algorithms for different types of examinations/
exposure techniques:
• single shot mode with phototiming
• serial imaging based on image phototiming and kV control
• fast response DSA with automatic test shot and automatic exposure
setting. Algorithms for ECG triggering and variable frame rate are
included
• the acquisition segment includes an integrated (desktop or wall mounted)
generator/examination console as the user interface for selecting and
modifying acquisition protocols, display of acquisition protocols, X-ray
parameters and system status messages
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Storage capacity [images]:

50/60 Hz system (at 10 bits/pixel):
Configuration 5122 matrix 10242 matrix

Basic 57,600 14,400
Basic + Storage extension 115,200 28,800
Basic + Dynamic acquisition 57,600 14,400
Basic + Storage extension + Dynamic acquisition 115,200 28,800
4- 1 0 System overview INTEGRIS Allura Monoplane Release 1

Frame speeds [images/s]:
Image technique DIGITAL VASCULAR (at 10 bits/pixel)

50 Hz system:
Basic 25 6.25
Basic + Storage extension 25 12.5 1)
Basic + Dynamic acquisition 25 6.25
Basic + Storage extension + Dynamic acquisition 25 12.5 1)
60 Hz system:
Basic 30 7.5
Basic + Storage extension 30 15 2)
Basic + Storage extension + Dynamic acquisition 30 15 2)
1)
Or 25 at 8 bits/pixel.
2)
Or 30 at 8 bits/pixel.
Image technique DIGITAL-DYNAMIC (at 8 bits/pixel)

50 Hz system:
Basic 25 6.25
Basic + Storage extension 50 25
Basic + Storage extension + Dynamic acquisition 50 25
60 Hz system:

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Basic 30 7.5

Image technique DIGITAL-DYNAMIC (at 10 bits/pixel):

50 Hz system:
INTEGRIS Allura Monoplane Release 1 System overview 4 -11

Basic 25 6.25
Basic + Storage extension 50 12.5
Basic + Storage extension + Dynamic acquisition 50 12.5
60 Hz system:
Basic 30 7.5
• service configurable disk partition allowing allocation of the available disk

capacity to two different users
• the image processor is designed for video speed image processing.
It includes:
• noise reduction (recursive filtering)
• adaptive contour enhancement with 9 x 9 kernel size
• harmonization.
Maximum patients and runs

The maximum number of patients (examinations) is 100 and the maximum
number of runs is 999. Three runs are pre-set for each examination.
Options
Area Exposure Product (AEP) meter

The area exposure product meter provides patient dose measurement during
examination. Measurements are shown on the near-monitor display (display
unit).
Dynamic acquisition package

For vascular and cardio-vascular dynamic imaging with continuous kV/mA
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control as well as locked kV/mA techniques, allowing, for example, cardiac

applications.
The package increases the maximum frame rate in 512 x 512 acquisition
matrix from 12.5 (15) to 25 (30) frames per second, 50 (60)Hz.
Storage extension
This option comprises two additional digital disks in order to extend the
image storage capacity of the basic system.

Bolus chase plus

For visualization of vessel structures, especially in the lower peripherals, when
the blood flow is difficult to estimate. It solves the problem of cumbersome
step movements, the mismatch between blood flow and selected program,
and lack of real time image information. During acquisition with
uninterrupted real-time image display, the contrast bolus is permanently
followed (chased) by the motorized table scan movement at a speed matched
to the blood flow. For operator convenience bolus chase can be carried out
using either interactive or programmed speed control with a choice of speed
profile curves. Viewing is possible in subtracted and non-subtracted mode.
The required acquisition program is selected from the acquisition console.
Interactive bolus chase

In interactive mode the operator uses a hand-held speed controller to match
the table scan speed to the blood flow during digital acquisition in non-
subtracted mode with real time image display. The frame speed can also be
matched to flow. The bolus run is followed by a mask run which is carried
out with the speed profile and frame speed used for the bolus run. Viewing is
possible in subtracted and non-subtracted mode. If subtracted viewing is not
required, the mask run can be skipped.
Automatic bolus chase

This provides digital acquisition in non-subtracted mode with real time
image display. The table scan movement and frame speed are programmed
but the operator has a choice of speed profile curves. The bolus run is
followed by a mask run performed with the speed profile used for the bolus
run. Viewing is possible in subtracted and non-subtracted mode. If
subtracted viewing is not required, the mask run can be skipped.
Optimal table scan movement is achieved by adjustment for patient height.

Further dose reduction is achieved by appropriate adjustment of the number
of exposures during the scan movement.
• tabletop motor drive and hand-held speed controller
• automatic exposure control.
Dose/Examination report
This is an optional report facility for examination or dose data. The report
can be printed, in A4 format using the standard ASCII character set, on any
standard printer to complete the patient file. The printer is connected to the
acquisition console via a parallel (centronics) interface. The report is printed
at the touch of a button on the acquisition console at the end of the
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examination. The facility is configured (by Service) to print a condensed

dose report or an extended examination report in one of the available
languages (English, French, German or Spanish).
The dose report provides the following information:

• hospital name and city
• examination date and time of patient entry
• patient demographics
• cumulative fluoroscopy time
• cumulative fluoroscopy dose
• cumulative exposure dose
• cumulative total examination dose
• total number of runs

• per run: run number, real start time, kV, mA, mAs, ms (last used value, per
channel).
The examination report gives the following information in addition to that

provided in the dose report:
• per run: number of images, APR used, run speed, angulation/rotation per
channel
• SID, II format used.

• report software package
• standard parallel interface on the Acquisition console. The maximum
cable length is 5 meters (196.9 inches).
Physio display
Extension for acquisition, storage and display of physiological signals.
• acquisition and storage of 8 channels of physio data with images
• display of one user-selected physio channel selected during image review.
Rotational Angiography
Rotational Angiography is an acquisition procedure that gives information
on the 3-dimensional structure of blood vessels through rotation of the C-
arm during image acquisition. One of the system acquisition programs is
used to select the procedure and its specific parameters. The rotational end
and start positions can be selected by the operator and stored using the store/
recall buttons on the geometry module. The procedure is controlled using
the exposure hand or foot switch, or the injector hand switch.
For subtraction rotational angiography, two acquisition runs are made. After
the first (mask) run, the stand automatically returns to its start position,
ready for the second (dye) run. The images are displayed in non-subtracted
mode during acquisition. Subtraction can be carried out during viewing.

• C-arm rolling movement:
- maximum rotation speed of 30°/s
- maximum scan ratio of 180°.
• C-arm propeller movement:
- maximum rotation speed of 55°/s
- maximum scan ratio of 305°.
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Frame speeds [images/s]:
PHOTOTIMED exposure technique:

50 Hz system:
Basic 12.5 12.5
Basic + Storage extension 12.5 12.5
Basic + Dynamic acquisition Not applicable Not applicable

(see note) (see note)

Basic + Storage extension + Dynamic acquisition Not applicable Not applicable

60 Hz system:
Basic 15 15
Basic + Dynamic acquisition Not applicable Not applicable

Basic + Storage extension + Dynamic acquisition Not applicable Not applicable

kV/mA exposure technique (see note):
50 Hz system:
Basic system (see note) Not possible Not possible
Basic + Storage extension Not possible Not possible
Basic + Storage extension + Dynamic acquisition 25 12.5
60 Hz system:
Basic system (see note) Not possible Not possible
Basic + Storage extension Not possible Not possible
N OT E With the ‘Dynamic acquisition’ package option installed, the rotational angiography
APRs use kV/mA exposure techniques, the other rotational angiography APRs use
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phototimed exposure techniques.
200X Ultrasound Scanner

Required for all applications where ultrasound is used to support
interventional procedures. The ultrasound unit is mounted on the monitor

support for safe and convenient access and parking. Ultrasound images are
displayed on the frontal Examination monitor in the examination room and
in the control room. The user interface contains a storage facility for two
probes and a control panel that provides the following functions: power on/
off, time gain control (total gain, far gain and near gain), freeze image,

increase/decrease image depth, biopsy line on/off, reverse image, probe

selection, distance measurement, and toggle display between U.S./X-ray
imaging.
Any two of the following probes can be connected to the scanner: 7.5 MHz
linear array, 3.5/5.0 MHz curved array, 3.5 MHz high-definition curved
array and 5.0/7.5 MHz curved array. Needle guide accessories can be
provided for the 7.5 MHz linear array, the 3.5/5.0 MHz curved array and the
3.5 MHz high-definition curved array probes.
4.2.6 Viewing
The viewing segment comprises:
• desktop viewing console with SyncraTouch control, providing direct access
to multiple viewing/post-processing functions for efficient operation. It
includes:
- alphanumeric keyboard and display for patient administration, a
control panel and a 17 inch XB monitor for permanent image viewing
- clinical application software packages with short response times
(optional)
• tableside viewing in the examination room using an infrared remote
controlled SyncraTouch viewpad (2 viewpads included) or the Tableside
Analysis Module (TAM).
The viewing console provides controls for image selection, processing,

subtraction, photofile/reference, text & annotation, selection for transfer and
other general functions.
Viewpad
Viewpad functionality can be configured to the user’s preference at
installation.
Options
CO2 trace
Software package for stacking images acquired with CO2 injections.
Coronary quantification software package

Functions:
• vessel diameter/stenotic index
• Automated Coronary Analysis (ACA)
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• calibration routines.
Left ventricular quantification software package

For analysis of left ventricular angiograms. Calculates the Ejection Fraction
(EF), ventricular volumes and Wall Motion (WM) parameters.
Functions:
• Automated Left Ventricular Analysis (ALVA)
• manual EF
• regional wall motion
• centerline wall motion
• Slager wall motion
• calibration routines

• recalculate EF
• recalculate ALVA.
Autocalibration
This option avoids the need for manual calibration for objects in the
isocenter when using the quantification software packages.
Parallel viewing
This option allows images to be viewed and processed at the viewing console
while another patient is being examined in the examination room. Parallel
viewing is temporarily suspended during fluoroscopy and/or exposures.
Tableside Analysis Module (TAM)

Provides processing facilities and (optional) quantification software at the
table to further improve procedure efficiency
With the TAM connected to the patient accessory rail via a dedicated holder
the operator can perform post-processing and quantification functions
without leaving the catheterization room.
• a module (TAM) with five push-buttons and a joystick for (configuration
dependent) control of image selection, processing, subtraction, photofile/
reference, text & annotation, selection for transfer and other general
functions
• holder for infrared remote control SyncraTouch viewpad
• holder for module, which can be connected to the table accessory rail.
4.2.7 External communication

Digital output for connection to a digital laser Hard Copy Unit (HCU).
Options
Analog output
For connecting an (analog) PMI 11 RC or PMI 3000 multi-image camera.
Optical Disk Recorder (ODR)

Suitable for erasable 5 1/4 inch optical disks. The maximum disk capacity is;
300 (10242 matrix size) or 1200 (5122 matrix size) X-ray images. Image
transfer is performed in ‘background mode’ meaning that the system remains
available for other functions during transfer.
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Standard line rate video output

Standard 625 lines (50 Hz) or 525 lines (60 Hz) video output board.
Required for connection of standard line rate video peripherals such as a
Video Cassette Recorder (VCR) and/or extra monitor.
High-Speed DICOM Image Interface

Interface for the export of photofile and exposure images, heartbeats or
exposure runs from INTEGRIS Allura cardio-vascular systems to DICOM
compliant destinations with an image server functionality, like radiology or

cardiology Picture Archive and Communication Systems (PACS),

EasyVision Release 4.3 onwards or dedicated INTEGRIS vascular series
option INTEGRIS 3D-RA and Inturis DICOM Recorder.
The following output formats are available:
• DICOM Secondary Capture (SC) for photofile images
• DICOM X-ray Angiographic (XA), unprocessed and uncompressed
images, multiframe XA objects, for cardiac run exposures
• Original images, with all processing specified as private attributes, to be
used with INTEGRIS 3D-RA or EasyVision Release 4.3 onwards.
The High-Speed DICOM Image Interface can be extended with the
following options:
• Cardiac DICOM XA, providing (5122, 8/10 bits matrix size):
- JPEG lossless compression, to allow compressed transfer of cardiac run
exposures
- edge enhancement processing for cardiac run exposures.
• Vascular DICOM XA, providing:
- transfer of uncompressed images and/or runs in DICOM single frame
XA objects with a 10242, 8/10 bits matrix size
- images and/or runs will be exported with the following (if applied)
processing parameters:
• image subtraction
• pixelshift
• landmarking
• edge enhancement.
Inturis DICOM Recorder

Software for recording DICOM images, on a Compact Disc-Recordable
(CD-R), transferred from a modality through the High-Speed DICOM
Image Interface (HSDII). The software package is designed for a standard
Personal Computer (PC) with Windows NTTM operating system. The Inturis
DICOM Recorder can receive examinations from any DICOM compliant
modality that supports the output of the following formats:
• 512 x 512 8 bits DICOM XA Multi-Frame (MF)
• 512 x 512 8 bits DICOM XA Single-Frame (SF)
• 1024 x 1024 10 bits DICOM XA SF
• photofile DICOM Secondary Capture (SC) (any format, no restrictions).
The Inturis DICOM Recorder also allows multi-session and multi-patient
recording. With the current CD-R capacity of 650 MB, e.g. approximately
5000 (5122 matrix size) or 300 (10242 matrix size) images can be recorded on
one disc. Examinations exceeding this limit will be recorded on multiple
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discs.
For safety reasons, this software package runs exclusively on a PC and does
not allow use of other software packages.
The user interface shows all incoming, recorded and temporarily stored cases.
Recording progress and status are shown, as well as the content of the CD-R
loaded in the system. Cases can be recorded by mouse-only operation,
automatically or by free case selection.
• Inturis DICOM Recorder release 1 software, including a license for one
input connection
• 10 CD-Recordables.

This option is compatible with DICOM sources supporting XA MF, XA SF

and SC protocols such as:
• All INTEGRIS (Allura, H/V) series with HSDII (with cardiac and/or
vascular DICOM compressed XA options)
• EasyVision release 4.3 onwards
• INTEGRIS 3D RA.
The Inturis DICOM Recorder can be extended with the input extension
license option to allow multiple connections with compatible systems, as
mentioned above.
DICOM RIS (Radiology Information System) interface

Software package to allow communication of the INTEGRIS Allura system
with a departmental Information System (IS). The interface makes use of the
DICOM Worklist Management (WLM) and Modality Performed Procedure
Step (MPPS) protocols.
If a hospital has an INTEGRIS Allura system and a Cardiology or Radiology
Information System (CIS or RIS), it will be possible to import patient and
examination information from the IS (request) and to report examination
results to the IS in order to:
• eliminate the need for retyping patient information on the INTEGRIS
Allura system
• prevent errors in typing of patient name or identification (ID). This
ensures consistency with the information on the IS, and prevents problems
in archive clusters or for searching for a name in case of later retrieval
• inform the IS about the acquired images and radiation dose.
Upon request from the INTEGRIS Allura system, the complete worklist
with all relevant patient and examination data is imported from the IS to the
INTEGRIS Allura system. For each patient the following information will be
shown on the INTEGRIS Allura system after it has been imported from the
IS:
• patient data:
- patient name
- birth date
- sex
- patient ID
- scheduled physician’s name
- scheduled procedure step start time.
• examination/request information (only displayed in the ‘Information
screen’):
- accession number (a RIS generated number which identifies the order
for the study)
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- requested procedure ID and description

- scheduled procedure step ID, description and start date
- scheduled station (Application Entity (AE)) title
- modality.
N OT E It will at all times be possible to enter manually patient demographics information

within the INTEGRIS Allura in case of an emergency or in case the IS connection is
down. However, patient data received from the IS is automatically protected against
modification and cannot be modified within the INTEGRIS Allura system.
On request of a clinical user, the INTEGRIS Allura system will export the
following information to the IS:
• patient data:

- patient name
- birth date
- sex
- patient ID.
• examination/request information:
- accession number
- requested procedure ID
- performed station title
- performed procedure step ID, status, start/end date and time
- performed physician’s name
- referenced image sequence.
• radiation dose:
- total time of fluoroscopy
- accumulated fluoroscopy dose
- accumulated exposure dose
- total dose
- total number of exposures
- total number of images.
Further detailed information can be found in the INTEGRIS DICOM
Conformance Statement.
The interface requires EasyLink hardware and software if the IS is not
DICOM Work List Management and Modality Performed Procedure Step
compliant.
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Controls and indicators 4.3
4.3 Controls and indicators

This Section describes all the controls, indicators and displays, and their
interrelationships. The numbers refer to the key numbers shown on in-text
illustrations and to the survey of all controls and indicators given in Section
11, ‘Legend’.
4.3.1 Acquisition console

The Acquisition console can be placed on a table or mounted on a wall in the
examination room or control room.
2
80 kv 900 mA 170 ms 00 min
1
3
2 Gycm2
4a 4b
4
4c
4c
A 10
B 8
5
9
33726400
6
7
Acquisition console
[A] Power on and reset.

Pressing this key switches on the generator and all components of the system
33720050
except the Digital Imaging System, which must be switched on separately.

When the system is switched on, an automatic self-check will be performed.
A message ‘System Starting’ is displayed with a walking busy indicator. The
light next to key [A] comes on to indicate that the power is on.
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N OT E To avoid malfunction, do not touch any key during the Switch-On process.
The system is set to the default settings configured during installation.

Pressing Power on when the system is already switched on, resets the system.
After certain errors, the system will reset automatically. Notify Service if
automatic resets occur frequently. After a system reset, most of the
parameters will have the values they had previously.

[B] Power off.

Switch off takes 2 seconds during which time the light next to key [A] will
33720060
flash. The Digital Imaging System must be switched off separately.
[1] Display of generator related parameters

Displays:
• radiation on
• fluoroscopy on (‘eye’ symbol)
• fluoroscopy or exposure parameters: kV, ms, mA or mAs, depending on
the selected imaging technique.
• cumulative patient dose in Gycm2 (4 digits). Every time X-radiation is
stopped, the cumulative patient dose is displayed. The dose rate is updated
every second.
• cumulative fluoroscopy time in intervals of 0.1 minute (4 digits).
[2] Reset fluoroscopy time buzzer

A buzzer sounds and the light next to the key goes on after every 5 minutes
cumulative fluoroscopy time. Pressing this key switches off the buzzer and
light. If this is not done, fluoroscopy is automatically switched off after a
further 5 minutes. The light next to the key remains on and the buzzer will
continue to sound.
N OT E The other audible signals from the acquisition console are an end of exposure
radiation beep (0.1 s), and under/over exposure beep (0.1 s).
[3] X-ray control

When [3] is pressed, X-radiation is inhibited. This avoids accidental
activation of X-radiation. All other user controls remain enabled. The
inhibited status is indicated by an indicator lamp near the key and the
message ‘X-radiation disabled’ displayed on the acquisition console and the
display unit in the examination room. Press the key again to re-enable X-
radiation.
[4] Display and selection keys for acquisition related parameters

The display shows the imaging techniques that can be selected and, after an
imaging technique has been selected, it shows the APRs available for
acquisition together with the main exposure parameters and system and/or
error messages when applicable. Main and sub APRs are available for digital
vascular techniques. The layout and the type of information displayed
depend on the imaging technique activated. For a survey of possible layouts
see Section 4.5, Overview of Acquisition and Viewing Displays.
Screen saver
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If configured, the display switches to a digital clock refreshed every 5

seconds, when nothing changes on the display for a pre-set period of time.
This time can be set by Service to between 1 and 60 minutes. If a soft key
[4a,b,c] is pressed, the screen is restored without performing the key’s
function. If any other key on the Acquisition console is pressed, the screen is
restored and the key’s function is performed.
[4a/b] Select imaging technique or APR (main/sub)

When power is switched on, the default APR for the default imaging
technique is automatically selected. The corresponding boxes are highlighted.
Another main APR can be selected by pressing one of the other keys [4a/b].
The APRs are configurable by Service. If ‘Digital Vascular’ is selected as

imaging technique, the main APR can be selected with [4a] and the sub-APR
with [4b]. The corresponding boxes will flash to indicate that the system is
busy with this function. After some seconds the box will be highlighted,
indicating that the system is ready to carry out this function. During this
period another main APR or sub-APR can be selected. If another APR or
sub-APR was already selected (box highlighted) the highlighting will be
switched off. If the imaging technique page is displayed, after pressing the
imaging technique function key [4c], keys [4a/b] can be used to activate
another imaging technique. When a new imaging technique is selected, the
last APR selected for that imaging technique becomes the current one, and
user adjustments made for that imaging technique become applicable.
[4c] Acquisition function keys

The actions of the six acquisition function keys depend on the installed
configuration and on the selected page displayed.
The following functions can be programmed for the acquisition function
keys.
• imaging technique
• subtraction
• one/two-knob injection
• display stopwatch
• variable frame rate
• print dose/examination report
The system ignores selection of unprogrammed function keys.
Imaging technique.
Depending on the system configuration, the following Imaging Techniques
33720070
can be selected:
• digital vascular:
- lock-in mode
Exposure characteristics are calculated on the basis of on one test shot
with phototiming. kV/mA/ms is locked-in during the run.
• single sequential scan mode:
No integration of frame time periods. Frame rate 25 (30) images/
second.
• integrated sequential scan mode.
A specific number of frame time periods are integrated during one
exposure pulse to construct one image.
- bolus Chase mode:
• phototiming with kV control for frame rate 8 (10) images/second.
• cine technique (automatic kV/mA): frame rate 12.5 (15) images/
second.
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- user-defined subtracted Bolus Chase mode:

• phototiming with kV control for frame rates 8 (10) images/second.
- predefined subtracted Bolus Chase mode:
• phototiming with kV control for frame rates 8 (10) images/ssecond.
- rotational scan mode:

• cine technique (kV/mA automatic): frame rates 12.5 (15) images/
second.
• phototimer technique (kV control): frame rates 12.5 (15) images/
second.
• digital dynamic acquisition:
- digital cine technique, kV/mA control (auto and manual mode (locked
and unlocked)).

• miscellaneous acquisition (monoplane only):

- miscellaneous (stationary) mode, kV/mas and kV/mA/s control.
N OT E If fluoroscopy is active, Miscellaneous acquisition cannot be selected. All other
imaging techniques can be selected during fluoroscopy.
When the related function key is pressed, the APR page belonging to the
selected imaging technique is displayed on the Acquisition console after a few
seconds and the current APR for this technique is automatically selected.
When an imaging technique is reselected, the last-used APR for that
technique, including any user adjustments to its parameters, becomes the
current APR.
When the imaging technique page is displayed, pressing the exposure hand
switch or foot switch will result in:
• display of the current APR page belonging to the current imaging
technique, and
• acquisition.
Subtraction.
Subtracted acquisition using this key is only possible when the digital
33720090
dynamic technique has been selected.Once selected this function remains

enabled and the ‘Subtraction’ box remains highlighted until another imaging
technique or a new patient is selected or a reset is performed. Pressing the key
a second time deselects subtraction.In the digital vascular imaging technique,
subtraction is part of the APR program.
Selection of one- or two-knob acquisition.

Press this key to activate one-knob operation. The exposure is activated with
33720100
the injector hand switch. The contrast medium is injected when the system is
ready and the exposure run is made according to the currently-selected APR.
Note that acquisition can still be activated with the foot switch or hand
switch. If the injector hand switch is pressed during fluoroscopy, contrast
medium will be injected but acquisition will not be activated. Deactivate
one-knob acquisition when two-knob operation is required.
Use the foot switch or hand switch to start exposure and the injector hand
switch for injection. Consult the injector manual for details of how to
program and select injector parameters such as inject delay, flow rate,
volume, pressure etc.
Display stopwatch.
Press the |Display stopwatch| key to select the ‘Stopwatch’ function. The
33720110
corresponding symbol is highlighted on the Acquisition console and the

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stopwatch time is displayed. The ‘Stopwatch’ function is configurable, by

Service, for either the cardiac or vascular mode.
In the cardiac mode, the stopwatch is displayed on the Near Monitor Display
(NMD) unit and Acquisition console. In the vascular mode, the stopwatch is
only displayed in the right corner of the Examination monitor.

The initial display is ‘0’. Depending on the configured stopwatch type
(Service), the stopwatch will behave like a normal stopwatch, up to 9
minutes 59 seconds or each time fluoroscopy is activated the stopwatch
displays the elapsed time in seconds up to a maximum of 9 minutes 59
seconds (i.e. a display of 9:59). The function can be activated before and
during fluoroscopy. Press this key again to deselect the function.

N OT E In the cardiac mode, the stopwatch runs for longer than 10 minutes. When 10 minutes
is reached the stopwatch display returns to ‘0’.
Variable Frame Rate (VFR).

If VFR values are included in the chosen APR for the Digital Vascular
33720130
Imaging Technique it is possible to toggle between two acquisition speeds
during digital acquisition using this key on the Acquisition console (or key
[157] on the Imaging module). This function can be performed more than
once during acquisition. The acquisition speed is displayed on the
Acquisition console. The current acquisition speed is the first acquisition
speed displayed.
Print dose/examination report.

Depending on the installed configuration, pressing this key prints either a
33720140
dose or an examination report. The content of these reports is described in

Section 5.6 ‘Archiving’. A maximum of 500 runs per patient can be stored.
Cumulative time, cumulative dose and the total number of runs will not be
reset. Pressing this function again before printing is complete cancels the
printing process. Printing is performed in the background.
Patient orientation
[5] Legs up.

See [6].
33720150
[6] Nose down (patient prone).

These functions allow the orientation of the image display to match the
33720160
position of the patient on the table and must be set before exposure.
The following conditions are assumed:
• the top of the monitor corresponds to the patient’s head
• the bottom of the monitor corresponds to the patient’s feet
• the right side of the monitor corresponds to the patient’s left
• the left side of the monitor corresponds to the patient’s right.
The default setting is nose up and legs down (keys unlit). Four orientations
are possible:
• ‘Normal’: Patient on back with head at tabletop head
• ‘Legs-up’: Patient on back with feet at tabletop head
• ‘Nose-down’: Patient on stomach with head at tabletop head
• ‘Legs-up’ and ‘nose-down’: Patient on stomach with feet at tabletop head.
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[7] Display information.

Pressing [7] displays detailed information on the current exposure and
33720170
fluoroscopy parameters for the imaging technique selected. Only the

exposure information for the active channel is displayed. Fluoroscopy
information is displayed for both channels. To cancel the function, press [7]
again or press the |Imaging technique| [4c] or |New patient| [4c] key. If
fluoroscopy or exposure is started while this page is displayed, it remains
displayed.
[8] Dial wheel.

Used to decrease or increase a parameter value.
[9] Enter.

Used to confirm a new choice of parameter or a change in parameter value.
[10] Alter APR parameters.

To change APR parameters.
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4.3.2 Viewing console, TAM and viewpad

When digital acquisition or functions on the TAM/Viewpad are initiated in
the examination room, all viewing functions at the viewing console are
(temporarily) disabled. The ‘Viewing mode frozen’ symbol is displayed in the
top right corner of the Viewing monitor, if the system is switched to parallel
viewing mode. The ‘Viewing mode frozen’ symbol will disappear if a viewing
function on the viewing console is activated or if the parallel viewing mode is
disabled (see Section 4.5.2 ‘Monitors’).
For a description of the viewing functions see Section 4.3.3 ‘Viewing

functions’.
Viewing console
Viewing
monitor
Text
display
Viewing
console
Keyboard Mouse
33726410
The viewing console consists of:

• power on/off keys, the power of the viewing subsystem (including the
viewing console) is switched on or off with these keys. Depressing the on
key immediately results in a reset of the viewing subsystem (warm-restart)
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• a monitor for display of images and information related to the

examination selected for viewing
• keys, for selection and processing of images
• a mouse, used for certain review functions
• a keyboard, for selecting the control and status pages (keys [F1] to [F10]),
entering data, and selecting items on the screen with the cursor keys
• a text display and 8 keys for selecting functions on the control and status
pages. These pages are described in Section 4.4
• an intercom unit, for communication between the examination and the
control room.

18
16
17
15
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Text display
[C] Digital imaging system power on.

When the system is switched on, a self-test is performed at the end of which
33720050
a start up page is displayed showing the release implemented and a copyright

statement. The total start-up time is about 5 minutes. To prevent
malfunction, do not touch any key during the Switch-on process. Pressing
[C] when the system is already switched on resets the digital imaging system.
[D] Digital imaging system power off.

Pressing this key switches off power to the digital imaging system. During the
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shut down period (about 10 seconds) the light in [D] flashes and the
Viewing console cannot be switched on. At the end of this period, the digital
imaging system will be switched off.
[15] Function keys

Keys to activate the functions of the control or status page displayed.
[16] Talk.
See [17].
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[17] Listen.
The intercom system consists of a microphone, speaker, volume control and
33724180
headset jackplug, together with two keys for selecting ‘listen’ or ‘talk’. These
two functions are not automatic and must be activated by the operator after
the system has been started up. ‘Talk’ is only active while key [16] is held
down. ‘Listen’ is activated when [17] is pressed. ’Listen’ remains active until
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[17] is pressed again. ‘Talk’ overrides ‘Listen’. An indicator [120] on the

Display unit lights when the intercom is on.
N OT E When a headset is connected (jackplug), both the internal loudspeaker and
microphone are bypassed.
[18] Volume control.

The volume control is situated near the speaker on the back of the console
N OT E A remote intercom with headset is available as an option. The ‘listen’ function can be
selected separately on each intercom. Activating the talk function on one intercom
deselects this function on the other intercom.

Keyboard
20
24
22
23
21
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The keyboard is used to select control and status pages with the function keys
[F1] to [F10], to enter alphanumeric data and to select objects on the screen
with the cursor keys [20].
[20] Cursor keys.

Cursor up, cursor down, cursor left and cursor right. The cursor is visualized
by means of a blinking underline.
[21] Enter.
To confirm a keyboard entry or selection and to move to the next entry field.
[22] Delete.
To delete the previous character/space.
[23] Tab.
Not used.
[24] Function keys.

These keys are used to display one of the Control and Status pages:
• F1 Schedule page: used to enter and select scheduled examinations for
acquisition
• F2 Review page: used to select acquired examinations for viewing
• F3-F5 Function depends on system configuration, function keys [F3 to
F5] can be configured to access the Transfer page, and the Transfer page
can be configured to list all possible archiving systems. The remaining
function keys can be configured to access separate archiving system pages.
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Configuration is carried out by Service. The following configurations are

possible for keyboard function keys [F3 to F5]:
- Report page: enables the user to report a selected examination to a
connected information system
- Export page: lists all examinations flagged for transfer to a configured

export station.
- ODR page: used to control all actions of an optical disk recorder
- Copy page: used to copy photofiles from completed examinations to a
remote HCU
- Transfer page: All, or a selection of, the archiving functions: Report
page, Export page, ODR page and/or copy page.

• F6 System page: to set the date and time, to make a test image and to enter
‘Service mode’
• F7 Physician page: used to enter the physician names and codes with the
related disk partition and station name
• F8 Reserved
• F9 Status page: displays information on the progress of actions started
• F10 Help page: displays an overview of all configured control and status
pages.
An overview of the control and status pages is given in Section 4.4.
Mouse
The mouse is used to interact with the graphic elements (cursor etc.)
displayed on the monitors.
26
25
27
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[25] Accept.
Click [25] to confirm a selected item or position.
[26] Action.
Click [26] to activate a selected function.
[27] Reject.
Click [27] to terminate a function.
Viewing keys
It is possible to assign selected functions to certain keys during installation
(see table at end of section). The installed system may therefore be controlled
by keys at other locations than those described here. Functions not available
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on the console can (if configured) be activated with one of the Menu keys or
with keys on the tableside analysis module or viewpad. In general, the
indicator light between a key and its nameplate or symbol will be on if the
corresponding function is active. If the system is unable to perform a
function, the key indicator flashes until the function key is released. If the
current acquisition examination is the same as the current viewing
examination, the viewing console indicators show the functions activated
with the analysis module or viewpad in the examination room.

85 86 66 55 36 67 80 81 51 95 57 96 53 97
64 41
60 40
52
39 34
91 63
50
38
42
70 43
49
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71 61 33 31 30 32 62 54 48 45 46 47 58
Vascular viewing keys
The relevant viewing functions [32, 33 and 91] are described in section 4.3.3
‘Viewing functions’.
For an overview of the viewing console functions see table at the end of this
section. The viewing functions [30 - 98] are described in section 4.3.3
Tableside Analysis Module (TAM)

The TAM allows image processing and quantitative analysis to be performed
at the tableside for rapid and reliable diagnosis in the examination room. A
Viewpad can be parked on the TAM. The functions of both the TAM and
the Viewpad are only active for the current acquisition patient.
100 101 102 103 104
108
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105 106 107
For an overview of the TAM functions, see the table at the end of this
section. The TAM functions [100 - 104] are described in section 4.3.3
Mouse functions can also be performed with the following keys on the TAM.
[105] Accept.
As [25]. Press to confirm a selected item or position.
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[106] Action.
As [26]. Press to activate a selected function.
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[107] Reject.
As [27]. Press to terminate a function.
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[108] Joystick
This is used to simulate mouse movements (moving the joystick moves the
cursor across the screen at a speed proportional to the displacement of the
joystick from its central position) and for functions with a variable parameter
(speed, contrast etc.), it can be used to increase or decrease the parameter
when the function is activated.
Viewpad
The Viewpad is a remote control device using Infrared Radiation (IR). The
IR transmitter is located on the front end of the Viewpad and, if obstructed,
no signals will be transmitted. The location of the IR receiver is fixed during
installation. A green light on the receiver indicates that the selected
command has been accepted. The Viewpad will function when packed in a
transparent sterile cover. During installation, some key functions can be
configured to user’s preference. The Viewpad is battery powered and the
batteries must be replaced regularly.
CAUTION Remove the batteries when the Viewpad will not be used for a long time.
Identical Viewpads are interchangeable. Therefore, if two identical Viewpads

are used in the same room, they may interfere with each other if used
simultaneously, causing uncontrolled behaviour. And, if several INTEGRIS
systems are in the same room, Viewpad commands for one system may start
actions on another.
WA R N I N G S • Do not use the Viewpad when more than one INTEGRIS system is in use in the same
room.
• Infrared signals from the Viewpad may interfere with other infrared-controlled
equipment in the room. Before using the Viewpad in a procedure, check that there
is no interference with other equipment.
Battery replacement
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For safe operation, the batteries have to be replaced at regular intervals. To

replace the batteries, open the cover on the rear of the Viewpad, remove the
old batteries and place new batteries in the position indicated in the battery
compartment. Battery type: Philips ‘Penlite’ LR03.
N OT E Batteries harm the environment; dispose of the old batteries in an environmentally

sound way.

a b
c d
e
f g
h i
j k
l m
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For an overview of the Viewpad functions, see the tables below. The
corresponding Viewing console functions are described in section 4.3.3
Function overview
Selection
Key number Function Viewing TAM View-

console pad
Viewing TAM Viewpad

console
30/31 d, c View forward/reverse F - F
32/33 Step to next/previous run F C C
34/35 Reserved - - -
36 e Cycle through run S C S
37 Cycle through examination C C C
38/39 Higher/lower speed F - -
40 Run overview S C C
41 f Examination overview S C S
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Processing

console pad
Viewing TAM View-

console pad
45/46 i, h Contrast increase/decrease F C S
48/49 Brightness increase/decrease F C C
51/52 Edge enhancement inc/dec. F C -


console pad
Viewing TAM View-

console pad
54 Select video invert F C C
55 103 Pan & zoom S S -
56* g Center zoom - - S
57 Position shutters S C -
58 Override manual adjustments F C -
Subtraction

console pad
Viewing TAM View-

console pad
60 a Subtraction on/off S C F
61 Move mask F - -
62 b New mask F C F
63 Average mask S - -
64 101 Pixel shift S S -
65 Run subtract C C -
66 104 Landmarking S S -
67 View trace S - -
68 CO2 trace C(o) C(o) -
Photofile/reference

console pad
Viewing TAM View-

console pad
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70 Store image in photofile F C(k) -
71 Delete image from photofile F C(k) -
74/75* j,k Store reference 1/2 - - S
78/79* l,m View reference 1/2 - - S

Text & annotation

console pad
Viewing TAM View-

console pad
85 Add text S - -
86 Annotation S - -
87 Display physiological data C C C
Selection for transfer

console pad
Viewing TAM View-

console pad
90 Flag image C C C
91 Flag run F C C
92 Flag heartbeat C C C
93 Flag examination C C -
94 Examination dump C C C
General

console pad
Viewing TAM View-

console pad
95/96/97 102 Menu 1/2/3 F F -
98 100 Analytical programs C(o) C(o) -
Legend
F Fixed position C(k) Configurable as key, not in menu

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S System default but reconfigurable C(o) Only with option present
C Configurable C(v) Only with vascular option

* Only configurable on Viewpad(s) S(k) As S, but not configurable in menu
- Not possible - -
N OT E Configurable functions (indicated with a ‘C’) can be configured for:

• All keys on the two top rows of the Viewing console, except the Menu keys [95-97];
keys [34, 35] are also configurable)
• All keys of the TAM, except the |Menu Tam| key [102]
• Keys [e-m] of the Viewpad

4.3.3 Viewing functions

Selection
[30] View forward.

See [31].
[31] 33720310 View reverse.

During forward or reverse viewing, the images are displayed in the sequence
33720320
in which they were acquired, or in reverse sequence. The image numbers are
updated. If this function is activated when there is no current viewing run,
the first (last) image of the first run of the current viewing or acquisition
examination (not the photofile run) is displayed. If there is no run other than
the photofile run, the middle image of the photofile is displayed first. Images
are displayed with the current processing parameter settings. The image-
processing functions (contrast, brightness and edge enhancement) applied to
the current image are shown on the Viewing console. When a run boundary
is reached the key must be released and pressed again to go to the next or
previous run. If there is no next or previous run, pressing the key has no
effect.
Fast viewing
When the forward or reverse key is held down for longer than 0.5 s, the next
or previous images are displayed in the sequence in which they were acquired
at a rate of 3 images/s for acquisition speeds < 3 images/s, ECG-triggered
runs and photofile runs, or at the default speed for acquisition speeds > 3
images/s. The default speed is set during installation and can be increased or
decreased with [38] or [39]. If the requested display speed exceeds the
capability of the system, images are skipped. The maximum display speed for
the photofile is the maximum rate at which images can be displayed without
skipping. For VFR runs, the acquisition speed is taken to be the maximum
speed during acquisition of the run.
[32] Step to next run.

See [33].
33720330
[33] Step to previous run.

These functions [32, 33] allow the operator to step quickly through the runs
33720340
of the viewing examination. The middle image of the next/previous run is

9896 001 33152
displayed. If the |Step to next run| [32] or |Step to previous run| [33] key is
pressed during the last/first run, no action is performed. If either key is held
down for more than 0.5 s, stepping is continuous at a rate of 1 step/s until
the key is released, or the start or the end of the examination has been
reached.
N OT E If [32+30] or [33+31] are pressed, the last or first run is displayed immediately,
skipping the runs in between.
The run information (number of images, current image and mask image) is
updated continuously. For a run acquired with subtraction, the system
displays a subtracted image constructed from the mask image selected during

acquisition and the ‘middle’ image of the run. Otherwise the ‘middle’ image
is displayed non-subtracted. For photofile runs the middle image is
displayed.
[34-35] Reserved.
[36] Cycle through run.

33720370
If this function is activated immediately after acquisition, the images of the
current run are displayed one after the other, starting with the first image. All
viewing functions, such as increased contrast, pixel shift etc. are enabled. If
there is no current viewing run, the first exposure run of the current viewing
examination is used as the current viewing run. If there is no exposure run,
the photofile run is used. When the last image has been displayed, the
process is repeated from the first image. This continues until the key is
pressed again or until a set time (configurable by Service) has elapsed. The
currently displayed image will then remain visible on the monitor. The
default cycle speed is set during installation (with possible values of 0.5, 1.5
or 2.0 times the acquisition speed) and can be increased with [38] or
decreased with [39]. For photo and ECG-triggered runs, the display speed is
set at 3 images/s. If the requested display speed exceeds the capability of the
system, images are skipped.
[37] Cycle through examination.

If configured, pressing [37] cycles through all exposure runs in an
33720380
examination (photofiles excluded). The Cycle through examination function

begins with the current image. If there is no current run or if the current run
is the photofile, the function starts with the first image of the first exposure
run. The default cycle speed is the same as for the Cycle through run
function [36] and is set during installation (with possible values of 0.5, 1.5 or
2.0 times the acquisition speed). The cycle speed can be adjusted with
|Higher/lower speed| [38, 39]. For ECG-triggered runs, the display speed is
set at 3 images/s. If the requested display speed exceeds the capability of the
system, images are skipped. Cycle through examination continues until key
[37] is pressed, or an examination has been displayed four times, or a new
run or examination is selected. The last image displayed when the function
stops remains on the monitor(s).
[38] Higher speed.

See [39].
33720390
[39] Lower speed.

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The viewing speed for view forward/reverse [30, 31] and cyclic viewing [36,
33720400
37] of the current run can be modified.

Approximate speed settings [images/s] available:
• 50 Hz: 0.5, 1, 2, 3, 4, 6, 8, 12.5, 25, 50 and 100.
• 60 Hz: 0.5, 1, 2, 3, 4, 6, 7.5, 10, 15, 30, 60 and 120.

If either key is kept pressed for more than 0.5 second, the display speed
increases or decreases at a rate of 2 steps/s until the key is released or the
maximum or minimum speed has been reached. If the requested display
speed exceeds the capability of the system, images are skipped. The
maximum display speed for the photofile is the maximum speed at which
images can be displayed without skipping.

[40] Run overview.

This function can be used to check whether all images of the current run are
33720410
flagged for transfer. Pressing [40] displays 20 images (5 x 4 matrix) of the
current run (16 images for a photofile) at lower resolution with the current
processing parameters for: Contrast, Brightness, Image inversion,
Subtraction and Run subtract. The image sequence and symbols used are as
follows:
a S
Image
c
33723590
20
f g
a: first image displayed

b: previous page indicator
c: flagged image indicator
d: flagged heartbeat indicator
e: flagged run indicator
f: next page indicator
g: last image displayed
No flagging indicators will be shown if Run overview [40] is activated while

the Run subtract function [65] is active. The upper left and lower right

corners show the image number of the first/last image displayed. The
symbols / indicate the existence of a previous/next page. If the number
of images in the run is less than 20 some of the frames will be blank. A
rectangular frame marks the current image. The marker can be moved with
the |View forward| [30] and view reverse [31] keys to select another current
image. If the |View forward| [30] or |View reverse| [31] key is pressed for +
0.5 s, the marker moves at a rate of about 5 images/s. When the marker
reaches the first or last image it stops at that position. Pressing [30, 31] when
the current run marker is at the end or beginning of the overview page,
displays the next or previous overview page , if present. If [30 or 31] is
pressed before an overview page is completed, build-up of the next or
previous overview page will start. The center image of the next or previous
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run can be selected with keys [32, 33]. During run overview, all image
processing functions are disabled. Pressing [40] again, displays the selected
(current) image of the current run at full-screen size. Pressing |Cycle through
run| [36] starts cycling.
N OT E S The time required to build up the overview display depends on the number of disks
installed and the matrix resolution.
[41] Examination overview.

This function can be used to check whether all runs in one examination are
33720430
flagged for transfer.

Pressing [41] displays the center images of 20 runs in the current

examination (with the exception of the photofile run but including the
current run) in a 5 x 4 matrix at lower resolution. The image sequence and
symbols used are as follows:
h S
a
i
c
b
Image
d
33720440
20
g j
a: center image of run 01

b: center image of run 06
c: center image of run 10
d: flagged image indicator
e: flagged heartbeat indicator
f: flagged run indicator
g: next page indicator
h: run number of first run displayed
i: previous page indicator
j: run number of last run displayed

The top left and bottom right corners show the run number of the first/last
run displayed. The symbols / indicate the existence of a previous/next
page. If the number of runs in the examination is less than 20 some of the
frames will be blank. The current run is marked with a rectangular frame.
The marker can be moved with the forward and reverse keys [30, 31] to
select another current run. If the |view forward| [30] or |View reverse| [31]
key is pressed for + 0.5 s, the marker moves at a rate of about 5 images/s.
When the marker reaches the first or last image it stops at that position.
Pressing [30, 31] when the current run marker is at the end or beginning of
the overview page displays the next or previous overview page, if present. If
[30 or 31] is pressed before an overview page is completed, build-up of the
next or previous overview page will start.
For runs containing a selected image for transfer, the center image of that run
is marked accordingly. All image processing functions are disabled during
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examination overview. Pressing [41] again displays the selected (current)

image of the current run at full-screen size. Pressing |Cycle through run| [36]
starts cycling.
N OT E S The time required to build up the overview display depends on the number of disks
installed and on the matrix resolution.
[42] Frontal channel.

Not used.
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[43] Lateral channel.

Not used.
33720450
Processing
During viewing, the operator can change the levels of contrast, brightness
and edge enhancement applied to the displayed images. In the case of a
single-shot image, the new levels are applied to that image only. In the case of
a run, the new levels are applied to all the images in that run, separately for
subtracted and non-subtracted images.
[45] Contrast increase.

See [47].
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[46] Contrast decrease.

See [47].
33720480
[47] Contrast level indicator.

31 levels of contrast can be applied to images during viewing. The level of
contrast is shown on indicator [47] and can be increased or decreased with
[45] or [46] respectively.
[48] Brightness increase.

See [50].
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[49] Brightness decrease.

See [50].
33720500
[50] Brightness level indicator.

31 levels of brightness can be applied to images during viewing. The level of
brightness is shown on indicator [50] and can be increased or decreased with
[48] or [49] respectively.
N OT E The contrast and brightness indicators show the current settings. They each consist of
a bar of 16 LEDs with pairs of adjacent LEDs used to denote intermediate levels.
[51] Edge enhancement increase.

See [53].
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33720510
[52] Edge enhancement decrease.

See [53].
33720520
[53] Edge enhancement level indicator.

0 to 16 levels of edge enhancement can be applied to images during viewing.
The level of edge enhancement is shown on indicator [53] and can be
increased or decreased with [51] or [52] respectively.

N OT E S If a contrast, brightness or edge enhancement control key is held down for longer than
one second, the action is automatically repeated at a rate of 4 steps per second until
the key is released or the maximum or minimum level is reached.
[54] Select video invert.

Pressing [54] displays the image within the circle and also the brightness
33720530
setting with inverted polarity. The area outside the circle, added text,
annotations and electronic shutters remain unchanged. Pressing [54] again
restores the image to its default polarity.
[55] Pan & zoom.

This function allows a part of the image to be zoomed to full screen size.
33720540
Pressing [55] zooms the central part of the image by a factor of 2. The area
zoomed can be changed by holding down |Action| [26] and moving the
mouse. Clicking |Accept| [25] confirms the action, and the zoomed image
remains on the viewing monitor. Clicking |Reject| [27] cancels the action
and restores the original image. The required display area can be changed
with the mouse. It is possible to step through a run with the same zoom
factors.
N OT E Pan & zoom can also be performed with the joystick [108] on the Tableside analysis
module.
[56] Center zoom.

If configured on the viewpad, pressing [g (56)] zooms the central area of the
33720550
currently displayed image by a factor of 2. Pressing [g (56)] again deactivates

the zoom function and the image is displayed unzoomed. The Pan & zoom
function [55, 103] can be used during viewing.
[57] Position shutters.

Mechanical collimation produces black borders around the image. If the
33720010
image polarity is inverted these show up as white margins which may

interfere with perception of image detail. This can be avoided by using the
electronic shutters. These ensure that the images always have dark margins.
One pair of shutters closes and opens horizontally, the other pair vertically.
They are centered on the horizontal and vertical mid-lines of the screen
respectively. The initial position of the shutters is calculated for normal
images. As a result, with zoomed images the electronic shutters may be off
the screen. Pressing [57], closes the electronic shutters by 10% on the
currently displayed image. The pairs of horizontal and vertical shutters can
be moved independently with the mouse or joystick [108]. Pressing |Action|
[26, 106] activates the mouse or joystick. Moving the mouse or joystick
upwards opens the horizontal shutters, moving it downwards closes them.
9896 001 33152
Moving the mouse or joystick to the right opens the vertical shutters, moving
it to the left closes them. The maximum setting for the shutters is 90%
closed. The shutters can be ‘locked’ in the chosen position by pressing
|Accept| [25, 105]. The functions for viewing images or masks in forward or
reverse sequence are still available with the same shutter settings. Pressing
[57] again or |Reject| [27, 107], or selecting another run for viewing
terminates the function.
[58] Override Manual Adjustments (OMA).

All manually adjusted parameters applied to the run return to the setting
33720570
they had when the run was viewed for the first time after acquisition.

Subtraction
[60] Subtraction on/off.

Pressing [60], displays the current image subtracted from the current mask. If
33720580
no mask image has been selected, the first image of the run will be used as the
mask. Pressing [60] again cancels all activated subtraction functions and
redisplays the unsubtracted current image.
[61] Move mask.

33720600 This function is only available when subtraction [60] is on. Pressing [61]
selects the Move mask function. |View forward/reverse| [30, 31] can then be
used to move the mask image. To make the selected image the new mask
image, press new mask [62]. The function is canceled on reaching a
boundary of the current run. Pressing [61] again restores the normal
subtraction mode with the new selected mask.
[62] New mask.

This function is only available when subtraction [60] is on. The image
33720610
currently displayed can be selected as the new mask by pressing [62].
[63] Average mask.

If configured, this function is only available when subtraction [60] is on.
33720620
First select a new mask image and press new mask [62]. Pressing [63] loads a
new (blurred) mask image, which is obtained from the average of a
predefined number of images of the current run. The resulting subtracted
images are displayed on the Viewing monitor(s). If activated, an average
mask indicator () is displayed on the Viewing monitor(s) (bottom right).
The following pre-set number of images may be used to build the average
mask: 1-8, 10, 12, 14 or 16 (dependent on matrix size, see Section 10.2.3
‘Mask averaging’).
When a specific image is selected as new mask [62] (in the current run), the
corresponding average mask image is obtained by averaging the images that
precede the selected mask image. The maximum number of images that can
be used for averaging is given above. If this number is odd, the number used
is equal to the maximum - 1. Press [63] again to terminate the function and
return to the normal subtracted image. The scope of the function is restricted
to the current run. While the function is active, Cycle through run [36] and
View forward/reverse [30, 31] can be used to navigate through the run.
Higher/lower speed [38, 39] can be used to change the cycle speed.
[64] Pixel shift.

9896 001 33152
The Pixel shift function allows correction of motion artifacts in subtracted

33720630
images. It can only be applied to images of the current run if subtraction is

on. Pressing [64] displays a square indicating the degree of pixel shift in the X
and Y directions. The smallest possible shift is 1/8 of a pixel; the maximum
shift is 128 pixels. If a non-shifted image is displayed, the mouse cursor is

displayed at the center of the square. Clicking |Action| [26] and moving the
mouse horizontally or vertically applies the pixel shift in the horizontal or
vertical direction. Images and masks can be viewed in the forward or reverse
direction with the same degree of pixel shift. Click |Accept| [25] to exit the
function. The set degree of pixel shift is applied to all images in the run.

[65] Run subtract.

If configured, the Run subtract function generates subtracted images from
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two different runs (subtracted rotational angiography). The system displays a
subtracted image using the images of the current run (contrast run) and the
images of the next run (mask run) with the same image number as mask
image (contrast(n) – mask(n)). If the next run has an incompatible format
(i.e. matrix size or pixel-depth parameters), the system steps to the next run
(and so on). If no run with a compatible format can be found, the system
selects the contrast run as the mask run. The View forward/reverse [30, 31]
and Cycle through run [36] functions can be used to display other subtracted
images from two runs. When the run subtract function is active, some
functions change as follows:
Display speed
The maximum display speed for dynamic viewing in run subtract mode is at
least 2 images/s.
Status page
Only the contrast run is highlighted on display. When a run is selected in the
Status page, the run subtract function is switched off.
Add text [85]

The item ‘T-RUN’ is removed from the text overlay as soon as |Run subtract|
[65] is activated.
View forward/reverse [30, 31] and higher/lower speed [38, 39]

These functions are used to display the range of subtracted images produced
from the contrast and mask runs (‘Move mask’ not active). As the contrast
and mask runs need not be of equal length and the image pairs need not have
the same image numbers, the ‘View forward/reverse’ function stops as soon
as the first/last image of one of the runs is reached (if the viewing key is held
down). If a run boundary is crossed, the system will step to the next/previous
compatible contrast run.
‘Move mask’ can be used to select a different mask image to be subtracted

from the contrast image (displayed image = contrast (n) - mask (n ± 1)). In
this case, as the run boundary is crossed the system will step to the next/
previous compatible mask run, starting at image number one.
Move mask [61]

Only in monoplane operation, the ‘Move mask’ function allows another
mask run to be selected and subtracted from the contrast run (step run with
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‘Move mask’ active), or another mask image to be selected and subtracted

from the contrast image (view forward/reverse with ‘Move mask’ active).
New mask [62]

The image number of the contrast run will be equal to the image number of
the mask run (‘Move mask’ inactive). If ‘Move mask’ [61] is active, then this
function does not operate.
Step run [32, 33]

This function can be used to change the contrast run. The system will only
step to runs with compatible formats, skipping all runs in between. The
image displayed will be the one with the same image number as the mask
image. If the new contrast run has fewer images than the current image

number of the mask image, both contrast and mask-image numbers are set to
the highest image number in the new contrast run. If no compatible run can
be found in the desired direction, no step run is performed. If ‘Move mask’ is
active, it performs the same function as described above, except this time
only on the mask run. It does not affect the image number in the mask run
to be used as a mask (as this will be set to the same as the contrast image
number).
Cycle through run [36]

With this function, it is possible to cycle through the contrast and mask runs
to view the subtracted image pairs (‘Move mask’ inactive). As the contrast
and mask runs need not be of equal length and the image pairs need not have
the same image numbers, the start of a cycle is defined as the lowest possible
contrast run image number. Cycling starts again as soon as the last image of
either the contrast run or the mask run has been displayed. If the ‘Move
mask’ function is active, the cycle function cycles through the mask run.
Run overview [40]

This function causes an overview of run-subtracted images to be displayed,
according to the specification of the run overview function.
During run subtract, the following functions are disabled:
• subtraction on/off [60]
• flag run/flag heartbeat [91, 92]
• view trace [67].
[66] Landmarking.
A subtracted image may lack necessary anatomical orientation. Landmarking
33728230
(partial subtraction) allows a selectable degree of background anatomy to be

added to the subtracted image. To provide optimal image information and to
maintain vessel detail, the polarity of the landmark is opposite to that of the
vessels. The Landmarking function can only be applied if Subtraction [60] is
on. Pressing [66] displays an initial landmarking mask over the image with a
subtraction factor equal to 75% of the original image. The subtraction factor
can be increased or decreased by clicking |Action| [26] and moving the
mouse up or down. The subtraction factor can be set between 0 and 100%.
Images and masks can be viewed in the forward or reverse direction, with the
same landmark. Clicking |Accept| [25] terminates the function. The set
subtraction factor will be applied to all images in the run.
[67] View trace.

This function allows a series of images, acquired during the flow of contrast
33728220
medium, to be combined in one image, thus revealing the entire flow

9896 001 33152
pattern. The composite image is constructed by setting each pixel equal to

the maximum opacification value of the corresponding pixels in the selected
images. Pressing [67] starts the function. A symbol is displayed to indicate
that the function has been activated. Pressing |View forward| [30] adds the
next image to the composite. Pressing |View reverse| [31] has no effect.
Pressing [67] again terminates the function. The trace image is removed and
the last image added is displayed. The behaviour of the View trace function
depends on the type of injection: Iodine or CO2. The type of injection can be
selected with |CO2 trace| [68] or on one of the Menus [95-97, 102]. Iodine
injection is the default when the system is switched on.

If CO2 injection is selected, the text ‘CO2‘ is added to the trace icon. If
Iodine trace-mode is selected, the resultant image will contain the lowest
pixel values of all processed images. If CO2 trace-mode is selected, the
resultant image will contain the highest pixel values of all the processed
images.
[68] CO2 trace.

33720670
If configured, the behavior of the View trace function depends on the type of
contrast medium: Iodine or CO2. If this function is assigned to the key,
pressing [68] displays a submenu over the image from which the type of
contrast medium can be selected by pointing with the mouse and clicking
|Accept| [25, 105], otherwise one of the Menus [95-97, 102] must be
selected. Iodine injection is the default setting when the system is switched
on.
33723600
Photofile/reference
[70] Store image in photofile.

The currently displayed image, which can be; previously acquired images,
33720690
fluoroscopy images or images from an external video source (e.g. VCR,

ultrasound), can be stored in the photofile by pressing [70]. Any overlays,
such as ROIs, curves, text and annotations, will be stored with the image.
While the action is in progress the light next to [70] will be on. It will go off
to indicate that the action has been completed. If the photofile is full, an
audible signal is given and the message ‘Photofile full’ is displayed. The ‘Store
image in photofile’ function is not permitted if the current examination is
scheduled for transfer.
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[71] Delete image from photofile.

A displayed photofile image can be deleted from the photofile by pressing
33720700
[71] and holding it down for more than 1 s. During this period the light next
to the key will flash. If the key is released during this period, the delete
function is cancelled. When the image has been deleted, the screen is blank.
Deleting photofile images does not usually affect the free image capacity or
free photofile capacity. It only affects the free capacity if the deleted image
was the last image in the photofile. The ‘Delete image from photofile’
function is not permitted if the current examination is scheduled for transfer.
[72-73] Reserved.

[74] Store reference 1.

See [75].
33720710
[75] Store reference 2.
Pressing [j (74), k (75)] on the viewpad ‘grabs’ (stores) an image displayed on
33720720
the examination monitor to the photofile. The stored image is displayed on
the reference monitor with its photofile number and the total number of
photofile images in the lower right corner.
The following functions are available:
• fluoro frame grab (during fluoroscopy)
• external video grab (e.g. ultrasound)
• move acquired image to reference monitor.
During viewing, images can also be stored in the photofile with the ‘Store
image in photofile’ function [70].
[76-77] Reserved.
[78] View reference 1.

See [79].
33720740
[79] View reference 2.

Images stored in the photofile with the ‘Store reference’ function can be
33720750
viewed on the Reference monitor by pressing [l, m] on the Viewpad. The

Viewpad functions ‘View reverse’ and ‘View forward’ [c, d] can be used to
select the image. Pressing [l or m] again deactivates display of the photofile
images and the ‘View reverse’ and ‘View forward’ keys revert to their normal
functions. Only one Reference monitor can be active at any time. The total
number of images in the photofile and the photofile image number are
displayed in the lower right corner of the Reference monitor together with
the ‘View photofile’ symbol.
N OT E Photofile images can also be viewed at the Viewing console by viewing the first run of
the examination, in which case the images will be displayed on the Examination and
Viewing monitors.
[80-81] Reserved.
Text & annotation

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[85] Add text.

Standard text for archiving purposes and the values of T-mask, T-image and
33720780
T-run can be hidden or displayed on the image by pressing [85]. The layout
of the text is the same as that of hard copies (see Section 4.5.3 ‘Hard copy
layout’).
[86] Annotate.
Alphanumeric characters can be added to the image in any position. Pressing
33720790
[86] displays an empty white square on the displayed image. Text can then be
added to the image via the keyboard. Initially, the size of the square is one
character, and it changes as characters are added or deleted, or their size is
changed.

The size of the characters can be increased or decreased before character entry
with:
|>|: 2 x enlarged
|>||>|: 4 x enlarged (keep |Shift| key pressed)
|>||>||>|: 8 x enlarged (keep |Shift| key pressed)
The size of the square changes accordingly. The scale can also be reduced
from large to small with |<|, |<||<| or |<||<||<| before character entry. The
square, including any annotation, can be moved over the image by holding
down |Action| [26] and moving the mouse. Clicking |Reject| [27] erases the
currently entered text and displays a new empty square for input. All
annotations can be erased by clicking |Reject| [27] immediately after starting
the Annotate function before any text is entered.
To accept the currently-entered text and annotation position:
• press |Accept| [25] to display a new text entry square
• press |Enter| [21] to leave the entered text displayed on the image.
The new text will be displayed on other images in the same run selected with
View forward/reverse [30, 31]. If a run boundary is crossed all text will be
removed. The function can be terminated by pressing [86] again.
N OT E S • Use a combination of horizontal and vertical arrows to draw a diagonal arrow.
• Image detail within the square is not shown because the corresponding image data
would be overlaid by the annotation. This must be borne in mind when positioning
the square and before pressing |Accept| [25] or |Enter| [21].
• The image area containing the image number etc. is not available for annotation.
[87] Display physiological data.

When physiological data have been acquired during acquisition, they can be
33720800
displayed together with the rotation and angulation angles on the Viewing
monitor with this function. A maximum of 8 channels of physiological data
can be acquired at the same time. The number of acquisition channels and
the corresponding number of display channels are set during installation. It is
possible to step through all acquired channels by repeatedly pressing the
function key. An extra display channel is reserved for ‘no data acquired’ to
disable the display of physiological data. The timebase of the input signal is
modified so that the complete recorded sequence fits the monitor. ECG
signals are specially processed to preserve the exact location of the R-peaks. A
vertical bar indicates the position of the currently-displayed image in the run.
During viewing this bar moves horizontally across the displayed physiological
data. The function is disabled in overview mode and photofile viewing. The
physiological data are removed when an overview mode is selected or a
photofile image is displayed.
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WA R N I N G A time delay of 10 to 300 ms may occur between the displayed image and the
corresponding displayed ECG signal. This delay is caused by, and is dependent on, the
type of connected Physiology system.
N OT E If no physiological data have been acquired or the physio option is not installed, this
key can be used to display the rotation/angulation angles.
Selection for transfer

[90] Flag image.

If configured, pressing [90] flags the current image for transfer to a
33720810
workstation or local archive connected to the system. Flagging an image that
has already been flagged deselects it. This function can also be activated in
’Run overview’ mode [40]. If the image results from an analytical program, it
must be stored in the photofile and flagged there.
[91] Flag run.

Pressing [91] flags the current run for transfer to a workstation or local
33720820 archive connected to the system. Flagging a run that has already been flagged
deselects it. This function can also be activated in ’Run’ or ’Examination
overview’ mode [40 or 41].
[92] Flag heartbeat.

If configured, pressing [92] flags the heartbeat surrounding the currently-
33720830
displayed image for transfer to a workstation or local archive connected to

the system. The function can also be activated in ’Run overview’ mode [40].
If so, all images displayed within the heartbeat will be flagged. Flagging a
heartbeat that has already been flagged deselects it.
[93] Flag examination.

If configured, this function supports configurations in which both CD-
33720840
Medical and High-Speed DICOM Image Interface are used. Only ’Flag run’
[91] can be used for transfer to CD-Medical and the High-Speed DICOM
Image Interface. If configured, pressing [93] flags all runs (including the
photofile) of the current viewing examination for transfer, if no runs were
flagged before. Pressing [93] for an examination in which run(s) (excluding
the photofile) are already flagged will unflag all runs (including the photofile)
of this examination. If the ’Flag examination’ function is activated, a ‘Flag’
indicator appears on the Viewing console text display and a Flag run
indicator is displayed during ’Run overview’ [40] or ’Examination overview’
[41]. The ’Flag examination’ function is disabled if another examination is
being transferred or an analytical function is busy.
N OT E S • Flagging cannot be carried out on a current examination which is scheduled for
transfer or being transferred.
• If an image, heartbeat, or entire run has been flagged, the run concerned will be
marked with a ‘Flag’ indication on the Status page (F9) [24].
• Automatic Flag run can be configured by Service.
• The Flag examination function [93] also affects the behavior of the Examination
dump function [94].
[94] Examination dump.

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If configured, pressing [94] replays the current examination on the

33720850
examination monitor and on the system output for the VCR. If no runs are
flagged for transfer (|Flag run for transfer| [91]), all runs including the
photofile will be replayed. If runs are flagged, only these are replayed. If
physiological data were acquired with the run, the latest selected channel is
displayed. During system installation, replay can be set to ‘Raw’ or
‘Processed’. If ‘Raw’ is configured, the images are replayed as acquired. If
‘Processed’ is configured, the images are replayed with the latest processing
parameters. The function is terminated when acquisition is activated or at
the end of the replay. During replay, all viewing functions are disabled.
N OT E The disk power supply, tape and other control settings must be switched on before
starting the examination dump.

General
[95] Menu 1.
See [97].
33720860
[96] Menu 2.
See [97].
33720870
[97] Menu 3.
33720880
33720000
Possible configuration for Menu 1.
When one of the menu keys is pressed, the monitor on the viewing console is
cleared and a menu is displayed. If a menu consists of more than 1 page,
‘Previous’ and/or ‘Next’ can be used to display the corresponding page. A
menu item can be selected by moving the cursor with the mouse or joystick
and pressing |Accept| [25 or 105]. After selection, the menu disappears, any
image present is displayed normally, and the selected function starts up. The
items in a menu can be configured during installation.
All viewing functions described in this manual, as well as clinical programs,

9896 001 33152
are configurable as menu items.

N OT E The menu selected from the Tableside analysis module is shown as ‘Menu TAM’.

[98] Analytical programs.

If configured, the following analytical programs can be selected from the
33720900
Viewing console [98], the TAM (if configured)[102] and from the menus
[95-97]:
33720910
• vascular quantification software package
• ventricular quantification software package
coronary quantification software package
33720920
•
• manual quantification software package
33720930
• myocardial quantification software package.
Any software package may consist of a combination of one or more specific
analytical functions. From top to bottom, the symbols shown on the left
33720940
represent the following functions: Automated Coronary Analysis (ACA),

Automated Left Ventricular Analysis (ALVA), Vessel diameter, Calibration,
Centerline wall motion, Regional wall motion and Automated vessel analysis
33720950
(AVA).
For descriptions of the analytical functions, see Section 5.5.2 ‘Clinical
33720960
programs’.
TAM functions
[100] Automated Vessel Analysis.

For descriptions of the analytical functions, see Section 5.5.2 ‘Clinical
33720960
programs’.
[101] Pixel shift.

As [64], the Pixel shift function allows correction of motion artifacts in
33720630
subtracted images. It can only be applied to images of the current run if

subtraction is on. Pressing [101] displays a square indicating the degree of
pixel shift in the X and Y directions. The smallest possible shift is 1/8 of a
pixel; the maximum shift is 128 pixels. If a non-shifted image is displayed,
the joystick cursor is displayed at the center of the square. Pressing |Action|
[106] and moving the joystick [108] horizontally or vertically applies the
pixel shift in the horizontal or vertical direction. Images and masks can be
viewed in the forward or reverse direction with the same degree of pixel shift.
Press |Accept| [105] to exit the function. The set degree of pixel shift will be
applied to all images in the run.
[102] TAM menu.

This is equivalent to the Menu selection function [95-97]. The menu
33720860
displayed is shown as ‘Menu TAM’ to distinguish it from menus that can be

9896 001 33152
activated from the Viewing console [95-97]. Items in the TAM menu can be
configured by Service. All the functions described in this manual, as well as
the clinical programs, can be assigned to this menu.
Pan & zoom.

[103]
Like key [55], this key is used to zoom a part of the image to full screen size.
33720540
Pressing [103] zooms the central part of the image by a factor of 2. The
zoomed region can be changed by pressing action [106] while moving the
joystick [108]. Pressing accept [105] terminates the procedure, leaving the
zoomed image displayed on the Viewing monitor. Pressing reject [107]
terminates the procedure and restores the original image. It is possible to step
through the run with the same zoom factor.

[104] Landmarking.
As [66]. A subtracted image may lack necessary anatomical orientation.
33728230
Landmarking (partial subtraction) allows a selectable degree of background
anatomy to be added to the subtracted image. To provide optimal image
information and to maintain vessel detail, the polarity of the landmark is the
opposite of that of the vessels. The Landmarking is only possible if
subtraction [60] is on. Pressing [104] displays an initial landmarking mask
over the image with a subtraction factor equal to 75% of the original image.
The subtraction factor can be increased or decreased by pressing |Action|
[106] and moving the joystick [108] up or down. The subtraction factor can
be set to any value between 0 and 100% . Images and masks can be viewed in
the forward or reverse direction with the same landmark. Pressing |Accept|
[105] terminates the function. The set subtraction factor will be applied to
all images in the run.
Viewpad functions
For a description of the Viewpad functions, see the descriptions of the
corresponding Viewing console functions in this section. The Viewing
console functions are listed in the tables at the end of Section 4.3.2 ‘Viewing
console, TAM and viewpad’.
4.3.4 Monitors and room facilities

Monitors
Monitor allocation
Exam. Ref.
33728250
Monitor configuration
Parallel viewing option

This option allows images to be viewed and post-processed on the viewing
console, while examining another patient in the examination room.
Restriction
9896 001 33152
• parallel viewing is temporarily suspended during fluoroscopy or exposures.

When only this option is installed, then two monitors are available in the
examination room.
Parallel fluoro option

This option allows images to be viewed and post-processed on the viewing
console, while examining another patient in the examination room. Viewing
and post-processing is only suspended when an acquisition is made.
Restrictions
• parallel viewing is temporarily suspended during exposures
• parallel fluoro is deactivated as soon as the exposure switch is activated

• frame grabbing is not possible with parallel fluoro images

• trace subtract fluoroscopy is not available during parallel fluoro.
Dual fluoro option
• Fluo
• Trace
• Acq • Fluo
• View • LIH
• LIH
33723620
Examination monitor Reference monitor Parallel monitor
This option makes it possible to perform trace subtract fluoroscopy

(displayed on the examination monitor) and normal fluoroscopy (displayed
on the parallel monitor) at the same time. Besides this, it also has the same
functionality as the parallel fluoro option. It allows images to be viewed and
post-processed on the viewing console while another patient is being
examined in the examination room. Viewing and post-processing is
suspended when trace subtract fluoroscopy is performed or a digital
acquisition is made.
Restrictions
• dual fluoro is deactivated as soon as the exposure switch is activated
• parallel fluoro is deactivated as soon as the exposure switch is activated
• viewing at the viewing console is temporarily suspended during exposures
• frame grabbing of images displayed on the parallel monitor is not possible,
it is only possible to grab images displaed on the examination monitor.
Monitor positioning
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36280030
The monitors in the examination room can be manually positioned using

one of the hand grips underneath the monitors or display unit(s). The
maximum longitudinal range is 360 cm (141.7-inch); the maximum lateral

range is 300 cm (118.1-inch). The actual possible range may be restricted
due, for example, to obstructions at the ceiling side. The monitors can be
rotated over 360°. To position the monitors, slowly push or pull them to the
required direction.
General
A typical feature of the XB monitors is the high brightness.

Two sizes of the XB monitors are specified with the system:

• a 21-inch monitor, with a concave front, used in the examination room
and mounted in the monitor ceiling suspension
• a 17-inch monitor, used for viewing in the control room.
Both the 21-inch (Examination and Reference) and 17-inch (Viewing)

monitors have four push buttons on the front cover for contrast and
brightness control and status indicators.
113 115 110
36270050
111 112 114
XB monitor
113 115 110

36270060
111 112 114

Colour monitor (option)
[110] Power on/off and brightness/contrast setting indicator.

• Green: reference setting
• Yellow: user reference setting
• Red: non-reference setting.
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The power supply to the monitors is switched on and off with the system
power.
[111] Sensor for automatic brightness and/or contrast control.

[112] Brightness increase.
[113] Brightness decrease.
[114] Contrast increase.
[115] Contrast decrease.

Reference setting
Brightness and contrast are factory set to a reference level. Pressing [112 +
113] simultaneously activates this reference setting (indicator light [110]
green).
User reference setting

Pressing [114 + 115] simultaneously activates the user reference setting
(indicator light [110] yellow). Briefly pressing one of the brightness and/or
contrast controls changes the setting to a non-reference value (indicator light
[110] red). If the controls are pressed for longer than 0.5 s the setting changes
continuously until the control is released. Pressing [112 + 115]
simultaneously, stores the selected brightness and contrast setting as a new
reference setting, denoted by a yellow light [110]. If the user reference setting
is identical to the reference setting, the indicator light is green [110].
For more information on these settings, refer to Section 5.1.4 ‘XB monitors’.
Daisy chain
For optimal viewing of the monitors it is important that they have identical
settings. The monitors in the examination room are provided with a daisy
chain facilitating a master/slave control for the user settings. Thus, when the
contrast setting on one monitor is altered, the contrast setting on the other
monitors is altered as well. Any of the installed monitors can be used as
master to control the others.
Room facilities
InfraRed (IR) receiver
116
36280040
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[116] Infrared receiver.

Infrared receiver for viewpad signals.

Examination light
a
117
36280050
a. upper handgrip
b. lower handgrip (detachable).
[117] Power on/off and light intensity.

Pressing [117] switches the examination light on/off. Rotating [117] adjusts
the light intensity.
The longitudinal carriage of the monitor suspension is provided with a
bracket for mounting the optional examination light. When positioning the
monitors in longitudinal direction the light will move accordingly. The light
may be moved independently to the required position using either the lower
[b] or upper handgrip [a]. The lower handgrip can either be covered with a
sterile disposable cover, or may be replaced with another, sterilized, handgrip.
The handgrip can be rotated to adjust the required light focus on the work
spot. |Power on/off and light intensity| [117] can be pressed to switch the
light on and off and can be rotated to adjust the light intensity.
CAUTION When positioning the light care should be taken to avoid collision between the light
suspension arm and the X-ray On indicator lamp. Impact could break the lamp cover
causing debris to drop into the working area or sterile region.
X-ray on indicator
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118
36280040
[118] X-ray indicator.

Lights during X-ray preparation and radiation.
Display unit
The display unit is located in the examination room below the monitors. The
display unit displays two title text lines and two information lines. The
information displayed depends on the actual system status.
Indicators:
• stand position (ROT, ANG, SID etc)
• II-format: 2 digits in [cm] or [inch] (depending on system configuration).
• dose rate (if configured): 5 digits in [mGycm2/s] or [cGycm2/s] in the
range of 0 - 99,999
• tube load indicator: green, orange or red light
• fluoroscopy mode indicator: ‘3’ (high), ‘2’ (normal), ‘1’ (low) or ‘4’
(reduced)
• fluoroscopy on/off indication (if Parallel viewing option is present)
• exposure/fluoroscopy ‘Action/warning’ indicator: displays ‘action’ or
‘warning’
• X-rays on indicator
• integral fluoroscopy time (if configured): 4 digits, resolution 0.1 minute
• ‘System starting’ and ‘X-ray disabled’ messages
• FLUORO, FLUORO-VIEW, FLUORO-DUAL.
During system start-up, the message ‘System starting’ is displayed on the

display unit. If X-ray generation is disabled with key [3] on the acquisition
console, the message ‘X-ray disabled’ is displayed on the bottom line.
120 121 123 124 125
33723640
122 126 127
Display unit
[120] Intercom ’listen’ indicator.

On the top left side of the display unit.
[121] X-radiation ON indicator.

The indicator is on when there is a request for X-rays and during radiation.
9896 001 33152
N OT E The X-radiation ON indicator on the Acquisition console display is only switched on

during radiation.
[122] Tube load indicator.

The following three levels can be indicated:

• green light: tube cold
• orange light: tube warm
• red light: tube hot, wait.
Audible tube load indicator

The audible tube load indicator can be set by Service at installation. If set,
during fluoroscopy or exposure a repeating 4-pulse (audible) signal (where
Trepeat = 2 s; tpulse = 125 ms and fpulse = 488 H) is generated by the Display unit
if the Tube load indicator [122] is showing red (Tube hot, wait).
Top line of the display unit

• During the system start-up procedure, the message ‘System starting’ is
displayed.
• During normal operation, the top line displays:
[123] Actual rotation/angulation angles.

This indicates the actual projection angles relative to the patient. The text
line displays ‘ROT’ for the rotation angle and ‘ANG’ for the angulation angle
respectively. The rotation/angulation angles are shown with a prefixed ‘+’ or
‘-’ sign.
[124] Source-image distance/tilt angle indicator.

This indicator shows the table tilt angle when the tabletop is tilted and the
SID when the tabletop is horizontal. To distinguish between the two
readings, the indicator shows either ‘TILT’ or ‘SID cm’ (or ‘SID inches’ ),
together with the value. For HDT the tilt value is shown as negative ‘-’. If the
SID is changed when the table is tilted, the SID will be shown on the display
for approximately 3 s.
[125] II field size.

Displays the II-size used.
N OT E The display can show centimeters or inches (configured during installation).
Bottom line of the display unit

During normal operation, the bottom line displays information concerning
the operating mode:
[126] Fluoroscopy mode/Fluoroscopy level/APC information.

Text displayed for fluoroscopy modes:
‘FLUORO’ (normal fluoroscopy mode), ‘FLUORO-VIEW’ (parallel
fluoroscopy mode) or ‘FLUORO-DUAL’ (dual fluoroscopy mode).
Text displayed for fluoroscopy flavours:
‘1’ (low dose), ‘2’ (normal dose), ‘3’ (high dose) or ‘4’ (reduced).
If the stand is moved to a previously stored position using the Auto Position
Control (APC), indicator [126] shows the geometrical target position.
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[127] Integrated fluoroscopy time/dose rate.

The following items can be displayed in this field:
• patient dose rate: the displayed dose rate in [cGycm2/s] is updated every
second. If fluoroscopy or acquisition is stopped, the cumulative patient
dose is updated and also displayed on the acquisition console and on the
viewing monitor (Status page).
• COLLIS: Collision indicator
• WARNING/ACTION: to indicate that a message is being displayed on
the acquisition console
• Stopwatch time; if activated, the time is displayed as: TIME mm:ss.

4.3.5 Connection box and tableside operation modules

General
Every system is supplied with a set of TableSide Operation (TSO) control
modules. The specification of a TSO depends on the actual system
configuration. The Geometry module is illustrated in the figures below. It
may be mounted on either side of the table.
Pan handle
The Pan handle can be attached to the tabletop or to the patient accessory
rail.
33721030
a b a c
Pan handle attached to accessory rail Pan handle attached to the tabletop
a. Handle to tighten the clamp and lock the pan handle to the rail or table.
b. Clamp to fit the pan handle to the accessory rail.
c. Clamp to fit the pan handle to the tabletop.
Connection box (at back of patient support)
a c
b
a a
e
d
f a
g
h
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33721040
Item Connections
a Earth (ground).
b X-ray hand switch.
c Injector.
d Prepared for local mains connection.

Item Connections
e ECG signal for injector triggering.
f Prepared for connection of physiological measuring.
system.
g X-ray foot switch.
h (see notes) Inlet for: Pan handle, Geometry modules, Imaging

module and TAM.
N OT E S • The two cables for the two TSOs must be run through a grommet at the top-rear of
the table base.
• To provide access to the connectors, the back cover can be opened by pulling it on
the cable inlet side.
TableSide Operation modules (TSOs)
Geometry module
131 142 143 136 130
132 140
36280190
133 144 139 134 145

Monoplane geo vascular module (tilt option)
For more information about bodyguards refer to section 10.4 ‘Stand and
table movements’.
CAUTION If a second, identical geometry module is available, commands given on the module
connected to the upper connector in the connection box have priority over commands
given on the other geometry module.
9896 001 33152
N OT E The geometry functions described below are illustrated in Section 10.4 ‘Stand and
table movements’.
[130] Emergency power off.

STOP If an uncontrolled motorized movement occurs (which is identified as a

33721060
movement emergency situation) pressing switch [130] stops all motorized

movements and releases or blocks all brakes.
The following manual movements remain possible:
• L-arm: rotation and longitudinal movement.
Patient support:
• AD5: transverse and longitudinal brakes are released

• AD5T (tilt): transverse and longitudinal brakes are on.
To reset the geometry system after an ‘emergency power off’ switch the
system off [B] and then on again [A].
N OT E Pressing |Power on and reset| [A], before switching the system off using [B], does not
terminate the emergency power off situation.
[131] Tabletop brakes on/off and logitudinal movements.

33721070 Releases the transverse and the longitudinal brakes to allow the tabletop to be
moved manually.
During installation, this control can be configured to suit the user’s
preference:
• brakes remain released while [131] is held down (preferred condition), or
• press [131] briefly to release brakes, press again to apply brakes.
If the AD5 SyncraTilt option is installed and the tabletop is in a tilt position,
the longitudinal movement is motorized. To activate the motorized
longitudinal movement, press [131] down and then move it in the required
direction. If the geometry module is mounted at the foot end, the behaviour
of [131] is identical to the behaviour at doctor’s side. As the speed of the table
movement depends on the pressure applied to control [131], use gentle force
to ensure a smooth floating movement. The maximum transverse shift of the
AD5 is 2 x 18 cm (2 x 7 inch); the maximum longitudinal shift is 100 cm
(39.4 inch).
N OT E S • This control is a large push button that can be used as a handgrip when moving the
tabletop.
• For releasing and applying the brakes, the optional Pan handle has the same
functionality as this push button but it does not control motor speed.
[132] Longitudinal tabletop brake off.

If the tabletop is in the horizontal position, this can be useful for a
33721080
longitudinal scan under manual control. This switch only operates when
[131] is not activated.
During installation, this control is configured so that either:

• pressing key [132] continuously, releases the longitudinal brake while the
transverse brake is kept on (preferred configuration) or
• pressing key [132] once, releases the longitudinal brake while keeping the
transverse brake on. Pressing key [131] activates the longitudinal brake.
9896 001 33152
If the AD5 SyncraTilt option is installed and the tabletop is in a tilt position,
pressing switch [132] once, keeps the transverse brake on when [131] is used.
Only longitudinal table movements are then possible.
[133] Table height adjustment.

Control knob [133] is used for motorized table height adjustment. To raise
33721090
the table, push the control up (maximum height 104 cm/40.9 inch). To
lower the table, pull the control down (minimum height AD5: 76 cm/29.9
inch). The rotational brakes are released while the table moves up.
N OT E S • If the Pivot option is installed, the height-range of the table is: 78.5 - 106.5 cm (30.9
- 41.9 inch).
• If the Swivel option is installed, the height-range is 83 - 113.5 cm (32.6 - 44.6 inch).

[134] SID adjustment.

Allows the SID to be varied under motor control by moving the II along the
33721100
axis of the X-ray beam.
Joystick up: SID increases (II away from patient).
Joystick down: SID decreases (II towards patient).
The actual SID is displayed on the Display unit [124].
[135] Reserved.
[136] Motor-controlled rotation and angulation.

Joystick up/down: Rotation.
33722650
Joystick right/left: Angulation.

Both movements can be combined.
The speed of the movement depends on the displacement of the joystick, the
33722660
more displacement the faster the movement. The directions of the

movements are relative to the position of the operator. The angles of rotation
and angulation are displayed on the display unit [123].
TSO Angulation Rotation

Position
+ - + -
Doctor side Right Left Up Down
Nurse side Left Right Down Up
Foot end Down Up Right Left
‘Angulation +’ is a clockwise rotation around the angulation axis; ‘Rotation +’

is a clockwise rotation around the rotation axis.
[137-138] Reserved.
N OT E Keys [139] and [140] are only available if the AD5 table is fitted with the ‘SyncraTilt’
option.
[139] Table tilt movement.

The directions of the movements are relative to the position of the operator:
33722680
TSO Position Tabletop head
Up Down
Doctor side Right Left

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Nurse side Left Right
Foot end Not applicable

When the tabletop is moved from a head-down (maximum tilt -28°) to a

head-up (maximum tilt +20°) position, or vice versa, the movement stops
when the tabletop is in the horizontal position. To continue the movement,
release the control knob then push it again in the required direction. The
average speed is 2°/sec. The actual tilt angle is shown on a scale on the table
column and on the Display unit [124]. The SID is normally indicated on the
Display unit if the tabletop is in the horizontal position. If the SID is
changed when the table is in a tilt position the SID will be shown on the

display for approximately 3 s. To avoid an accidental tilt movement, lock the

control knob [139] by pressing it down and turning it 90° counter-clockwise.
To unlock, press the knob down and turn it 90° clockwise.
[140] Movement override.

Pressing this button disables the automatic tilt movement safety system
33722690
which safeguards patient and equipment. If either the |Table tilt movement|
[139] or |Table height adjustment| [133] joystick is then used, an audible
signal warns the operator of the increased collision risk during a tilt or height
adjustment.
[141] Reserved.
[142] Store position 1.

Store the current rotation, angulation and SID settings, the end position for
33720710
Rotational angiography or the table end position for Bolus chase.

Store the current rotation, angulation and SID settings, the start position for
33720720
Rotational angiography or the table start position for Bolus chase.
[144] Recall position 1 or 2.

Pressing the left-hand side of this control sets the rotation, angulation and
33720740
SID to the values stored with |Store position 1| [142] or the pre-defined
rotational angiography end position. Pressing the right-hand side recalls the
values set with |Store position 2| [143] or the pre-defined rotational
33720750
angiography start position. If no positions have been stored, using this

control automatically moves the C-arm to the default 0° positions.
N OT E The indicators next to the keys are on if the settings are stored or after a Recall
request to confirm that the new position has been reached. These indicators flash
when setting the Rotational angiography end and start positions or end and start
positions of the tabletop scan. The indicators only remain on continuously once the
positions have been stored.
[145] Motorized movement of the frontal stand.

The directions of the movements are relative to the position of the operator.
33722710
L-arm rotation and longitudinal movement:
TSO Position Rotation Longitudinal movement
Away Towards Away from Towards

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table base table base
Doctor side Up Down Left Right
Nurse side Up Down Right Left

Foot end Left Right Up Down
Longitudinal movement allows the L-arm to be moved under motor control

from its parking position to its working position and vice versa. There are
automatic stops at the parking, neuro/cardio and lower peripherals position.

N OT E The L-arm can also be moved manually after releasing the brakes by pressing |L-arm
rotation brake release| [190] and/or |Longitudinal movement brake release| [191] on
the L-arm.
Imaging module
150a 151 157
150b
150c 153
33723670
158 155 156
Vascular monoplane imaging module
CAUTION If a second, identical Imaging module is available, commands given on the module that
is connected to the upper connector in the connection box have priority over
commands given on the other Imaging module.
[150] Fluoroscopy mode selection.

During installation, 3 fluoroscopy modes are programmed:
33722730
a: high (fluoroscopy flavour 3)

b: normal (fluoroscopy flavour 2)
c: low (fluoroscopy flavour 1).
The mode selected is shown on the display unit [126]. During fluoroscopy
the mode can be changed but, depending on the parameters set in the
fluoroscopy APRs, the switch over will be smooth or discontinuous. During
a smooth switch over, the image remains visible although a brief disturbance
(change of contrast) may appear. When switch over is discontinous the
radiation is temporarily inhibited.
N OT E To record fluoroscopy images with optimal image quality, use fluoroscopy mode A only.
For image recording, a VCR must be correctly connected to the system and in ‘stand-
by’ status when fluoroscopy mode A is selected.
9896 001 33152
After every 5 minutes cumulative fluoroscopy time, the fluoroscopy time

buzzer will sound. Pressing any of the keys [150a/b/c] switches off the time
buzzer. No matter which key is pressed to switch off the time buzzer, the
system stays in the selected fluoroscopy mode.
After terminating fluoroscopy by releasing [175], the system switches to the

‘Normal’ fluoroscopy mode.
[151] Shutter adjustment.

This control allows the user to adjust the field of view with the rectangular
33722740
(mechanical) X-ray shutters during fluoroscopy. (The circular diaphragm is

automatically adjusted to match the selected field size of the II and the SID).

b
b
33722750
Joystick up: Vertical shutters [a] open.
Joystick down: Vertical shutters [a] close.
Joystick to the right: Horizontal shutters [b] open.
Joystick to the left: Horizontal shutters [b] close.
Pressing the control down resets the shutter positions.
[152] Reserved.
[153] II field size.

This key allows the II field sizes to be selected. Pressing the left side of the key
33722760
selects the next smaller field size. Pressing the right side of the key selects the
next larger field size. The field size selected is shown on the display unit
[125]. The default Image Intensifier mode (small, medium, large or other
33722770
field) at power on, or at new patient selection, can be set by Service at

installation.
[154] Reserved.
[155] Position left wedge filter.

The wedge filter setting can be configured as ‘Manual only’ wedge control
33722800
(Vascular APR) or ‘Automatic/manual’ wedge control (Cardiac APR).

Joystick up: wedge rotates clockwise.
Joystick down: wedge rotates counter-clockwise.
33722810
Joystick left: wedge moves outwards.

Joystick right: wedge moves inwards.
[156] Position right wedge filter.

9896 001 33152
Joystick movements for the right wedge filter are the opposite of the
33728253
movements for the left wedge filter, see [155].

For a more detailed description of the automatic/manual wedge filter
33728254
control, refer to Section 10.3 ‘Wedge filters’.

[157] VFR/Dual/Parallel fluoroscopy.

33723710
Variable frame rate (VFR) is the same function as [4c] on the Acquisition
console. During digital vascular acquisition it is possible to toggle between 2
acquisition speeds if VFR values are included in the chosen APR program.
The function can be performed more than once during acquisition. The
acquisition speed is displayed on the Acquisition console. The current
acquisition speed is the first acquisition speed (V2) displayed. If the parallel

fluoro or dual fluoro option is installed, the VFR key [157] on the imaging
module will serve to toggle between the normal fluoroscopy mode and the
parallel fluoroscopy mode.
Dual fluoroscopy mode

Trace Subtract Fluoroscopy (TSF) eliminates bone structures and is used
extensively in complex interventions. Normally, two problems can arise with
TSF:
1 During multi-stage embolization, the embolization material positioned in
previous stages is no longer visible.
2 Patient movement produces subtraction artefacts which are not desirable
during time-critical moments, e.g. glue injections.
The ‘Dual fluoroscopy’ mode solves these problems by displaying non-
subtracted fluoroscopy alongside the TSF images.
Parallel fluoroscopy mode

This mode saves time during interventions by making it possible to view and
post-process previously acquired images on the viewing console and
examination monitor while fluoroscopy is being performed in the
examination room.
[158] Trace-subtract fluoroscopy (TSF).

If available, TSF can be switched on and off with this key (toggle function).
33722860
TSF is a reference technique for catheter guidance. The movement of

guidewires and catheters can be displayed against an opacified trace image of
the vessel structure. When trace-subtraction is selected, the TSF symbol is
displayed in the upper right corner of the monitor.
Auto Position Control (APC)
162 163 160
161a
161b
161c
164
165
36270040
9896 001 33152
APC module
[160] Emergency power off.

STOP If an uncontrolled motorized movement occurs (which is identified as a
33721060
movement emergency), pressing switch [160] stops all motorized

movements, brakes are released or blocked.
The following manual movements remain possible:
• L-arm: rotation and longitudinal movement.
Patient support:
• AD5: transverse and longitudinal brakes are released
• AD5T (tilt): transverse and longitudinal brakes are locked on.

To reset the geometry system after an emergency power off, switch the system
off [B] and then on again [A].
N OT E Pressing |Power on and reset| [A], before switching the system off using [B], does not
terminate the emergency power off situation.
[161] APC mode selection.

a: Scratch mode.
33722880
b: Sequencer mode.
33722890
c: Reference mode.
When a mode is selected the indicator next to the key switches on and the
33722900
associated positions are displayed on the Display unit.
Scratch mode
Two scratch stand positions can be stored and recalled. When scratch mode
is re-entered the previously stored positions are available provided that the
system function ‘new patient’ has not been activated.

See [163].
33722910

When one of the two buttons is pressed, the current stand position is stored
33722910
as position 1(left button) or 2 (right button).

The current position is defined by the:
• angulation angle
• rotation angle
• SID.
Storing a new position overwrites the previously stored position. Initially, 1 is
set for a position with a rotation and angulation of 0° and a SID of 1.0 m
(39.4 inch). 2 is set for -45° rotation and 0° angulation and a SID of 1.0 m.
Positions can be stored in all APC modes and are displayed on the display
unit.
[164] Select position 1 or 2.

When the left side of the button is pressed, position 1 is recalled and
33722920
displayed on the Display unit. When the right side of the button is pressed,
9896 001 33152
position 2 is recalled and displayed.

[165] Accept and activate.
Acc When the required position is displayed, it can be accepted by keeping [165]
33722940
pressed until the stand stops moving (rotation and angulation). Thereafter,
the II will move to the stored SID unless the movement is stopped by
releasing key [165]. The operator is responsible for avoiding collisions. When
the movement is complete, the other stored position is selected and
displayed.

Sequencer mode
Stand positions from one or more service installed sequences can be recalled.
When only one sequence is available, the user function ‘select position’
becomes immediately active without displaying the sequence identification.
[164] Select sequence.

Pressing the left side of the button selects the previous sequence and pressing
33722920
the right side selects the next sequence. The current sequence is shown on the
display unit.

Acc Pressing this button now accepts and activates the current sequence and
33722940
displays the first position on the display unit.
[164] Select position.

Pressing the left side of the button selects the previous position and pressing
33722920
the right side selects the next position . The current position is displayed on
the display unit. By repeatedly pressing this key, all sequence positions can be
displayed.

Acc When the required position is displayed, it can be accepted by keeping [165]
33722940
releasing key [165]. The operator is responsible for avoiding collisions.
Reference mode
Allows reproduction of the stand position corresponding to the image
displayed on the reference monitor.
[164] Select reference position.

When the left side of the button is pressed, the left displayed reference
33722920
geometry is selected. When the right side of the button is pressed, the right
displayed reference geometry is selected. The selected position is displayed on
the display unit.

When the desired geometry position is displayed, the position can be
33722940
Acc
accepted by keeping [165] pressed until the stand(s) stop(s) moving (rotation
and angulation). Thereafter, the II will move to the stored SID unless the
movement is stopped by releasing key [165]. The operator is responsible for
avoiding collisions.
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4.3.6 Tabletop Shifting Device / Speed control hand

switch
For angiography of the lower peripherals images are acquired as the patient is
moved in one continuous movement at a speed that matches the blood flow
in the peripheral vessels (bolus chasing). This can be achieved automatically
or interactively by the operator.
The table is provided with a motorized Tabletop Shifting Device (TSD)

controlled by an automatic bolus chase program or by the operator using the
TSD speed control (interactive mode).

[170-171] Reserved.
Speed control hand switch
172
33722950
[172] Speed control hand switch.
With interactive mode Bolus Chase the speed control hand switch is
automatically enabled when the end and start positions have been selected. If
a run is interrupted (automatic and interactive mode), the speed control
hand switch can also be used to return to the start position.
The speed control hand switch is used in interactive Bolus Chase mode to
control the scan movement. Pressing [172] starts the tabletop scan
movement. The speed is controlled by the degree to which the button is
pressed. The maximum average speed is about 15 cm/s (5.9 inch/s). As soon
as the tabletop has been moved to its end position, the movement stops and
the speed control must be released. Pressing the speed control again reverses
the scan movement. Acquisition is independent of scan direction. The
system ensures smooth starting and stopping of each movement to avoid
jolting the patient.
4.3.7 Foot switches, hand switch and stand switches

Acquisition foot switch
The acquisition foot switch is connected to the connection box and can be
placed in a convenient position on the floor.
9896 001 33152
179 177
175
33726480

[175] Fluoroscopy.
33728040
Pressing this pedal initiates radiation. Radiation continues until the pedal is
released.
[176] Reserved.
[177] Single-shot exposure/parallel fluoroscopy.

33723010 Depending on the configuration, pedal [177] is configured for either single-
shot acquisition or parallel fluoroscopy.
Single-shot acquisition is only possible with the Digital Vascular (with lock-
33726310
in APR) imaging technique. One knob acquisition is not possible.

If the ‘Parallel fluoroscopy’ option is installed, pressing [177] selects the
parallel fluoroscopy mode. Pressing [177] again, selects the normal
fluoroscopy mode (toggle function). The active fluoroscopy mode is
displayed on the display unit [126].
The parallel fluoroscopy mode saves time during examinations by making it
possible to view and post-process previously acquired images on the viewing
console while fluoroscopy is being performed in the examination room.
[178] Reserved.
[179] Exposure.
33723030
Pressing this pedal initiates preparation of the X-ray tube and exposure.
Releasing the pedal ends the exposure.
Acquisition hand switch

The acquisition hand switch is connected to the Acquisition console.
185
33723050
9896 001 33152
[185] Preparation/exposure.
The two-level pushbutton on this hand switch has two functions:
1 Preparation of the X-ray tube; pressing the small button until it is flush
with the large one initiates preparation of the X-ray tube.

2 Initiating exposure; pressing the two buttons together initiates exposure.
Releasing the button [185] ends the exposure.
L-arm stand switches

Two handgrips are mounted on either side of the L-arm for manual stand
rotation and longitudinal movement.

190
191
36280200
Handgrips on the L-arm (both sides)
[190] L-arm rotation brake release.

Pressing [190] releases the L-arm stand rotation brakes.
33727460
When the brakes are released by pressing and holding down [190], the L-arm
can be moved manually with either of the two handgrips. When the L-arm is
in position, releasing [190] applies the brakes.
[191] Longitudinal movement brake release.

Pressing [191] releases the longitudinal L-arm stand brakes.
33727470
When the brakes are released by pressing and holding down [191], the L-arm
can be moved manually with either of the two handgrips. When the L-arm is
in position, releasing [191] applies the brakes.
N OT E Manual movements override motorized movements.
4.3.8 HCU controls

For operating instructions, refer to the Operator’s Manual supplied with the
camera. If the camera can be controlled manually, it is possible to select and
copy single images. The image copied is that displayed on the viewing
console monitor.
4.3.9 Storage media.

9896 001 33152
The drive accepts both erasable and non-erasable 5.25-inch disks. Optical
disks are mounted in cartridges. Images cannot be stored on a write-
protected disk. Each disk has a storage capacity of 620 Mb, sufficient for
approximately 2 x 150 images (10242) or 2 x 600 images (5122 and 1024 x
512). New disks must be formatted before use (Format function on the
Optical disk page). This takes about 10 minutes. Saving and retrieving
images using an optical disk are background processes. This means that the
system remains available for acquisition and viewing while images are being
saved or retrieved.

33728251
215 216 219 a 218
Optical disk drive
[a] Disk cartridge insertion slot.

Insert the disk cartridge into the slot and and gently push it in until it loads.
[215] Power indicator.

Lights when power to the ODR is switched ON.
[216] LED indications.

LED indications for each condition are as follows:
Drive condition/Mode LED indications
When there is no disk Green (flashing)
When a rewritable disk is loaded Goes out
When a WORM disk is loaded Green (flashing)
BUSY Green (lights)
Heat alarm has occurred Orange (flashing)
[217] Not used.
[218] Eject switch.

Press to eject the cartridge.
[219] Screwdriver hole for manual eject.

To manually eject the cartridge from the drive, insert the supplied
screwdriver into the manual eject screwdriver hole and, while pressing, turn
the screw counterclockwise about 30 times and remove the cartridge.
CAUTION Before performing manual eject, ensure that the power to the ODR is switched OFF.
[225-233] Reserved.
9896 001 33152
Inturis DICOM Recorder (IDR)

For information about the IDR controls and indicators, please refer to the
Inturis DICOM Recorder ‘Instructions for Use’.

4.3.10 200X Ultrasound scanner
b
c
33723860
200X Scanner
Item Part
a Scanner (mounted behind monitors)
b Probe
c Control panel
d Monitors
The ceiling suspension allows the monitors and scanner to be moved

horizontally and vertically and turned for accurate positioning over the image
area.
Control panel
240 241 242 235 G F
243 236
237
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244 239
33723890
245 246 247 238

Scanner control panel
The control panel for the scanner is attached to a movable arm under the
monitors. It can be moved into position for an examination and then stored
back under the monitors after use.

[F] System on.

After switching on, the system is ready for use in 5 seconds (the key light up).
33720050
The indicator lamp above the probe connection on the scanner also comes
on. The examination monitor displays the ultrasound image automatically.
[G] System off.
After switching off the scanner, the examination monitor is switched back to
33720060
normal mode. The indicator lamp above the probe connection on the
scanner goes out.
N OT E The scanner will not start up if it is switched on again immediately after switching off.
To start the scanner, switch it off, wait 10 seconds and then switch it on again.
[235] Probe selection.

33723930
Two probes (single or dual frequency) may be connected to the scanner at the
same time. Press the key repeatedly to select the required probe and
frequency. The selected probe and frequency are displayed in the status field
on the examination monitor. The green light on the 3.5/5.0 MHz and 3.5
MHz high-definition curved array probe indicates the orientation of the scan
plane. In normal operation the position of the green light on the probe
corresponds to the left side of the image on the monitor.
[236] Examination monitor.

33723940
Switches the ultrasound image to the examination monitor. The key lights
when the monitor is displaying ultrasound images. To return to the X-ray
display mode, initiate fluoroscopy [175, 178, 180], acquisition [179, 185] or
select a viewpad function [a-m]. Once the |Examination monitor| key [236]
is pressed it remains illuminated.
N OT E After switching the ultrasound system on, the examination monitor is automatically
selected for ultrasound display.
[237] Grab image.

33723950
Not used.
[238] Distance measurements.

33723960
This key, in conjunction with the joystick [247], is used to measure the
distance (in millimeters) between two points in the image. The procedure is
described in Section 5.3.5 ‘Apply acquisition functions as required’.
[239] Freeze/Unfreeze.
Press [239] once to freeze the current image. Press [239] again to return the
36271210
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monitor to live mode. If the image is frozen, ‘F’ is highlighted in the image
status field.
[240] Biopsy line on/off.
Press [240] once to display a biopsy line (for the selected probe) in a non-
36271220
frozen image. Press [240] again to erase the line.
N OT E Pressing |Biopsy line on/off| [240] when the image is frozen has no immediate effect.
The biopsy line is only displayed after the image has been unfrozen.

[241] Reverse on/off.

Press [241] once to reverse the displayed image. Press [241] again to restore
33723990
the display to normal. The status field indicates the image polarity.
N OT E Pressing |Reverse on/off| [241] when the image is frozen has no immediate effect. The
image is only reversed after the image has been unfrozen.
[242] Depth increase.

33724000
Displays a larger image field (see also [243]).
[243] Depth decrease.

Displays a smaller image field. The depth of the displayed image can be
33724010
changed with keys [242, 243]. The upper and lower limits of the image field
depend on the probe type and frequency. A lower frequency gives a larger
image field.
[244] Near gain control.

Adjusts the gain level in the surface area of the image (see also [246]).
33724020
[245] Far gain control.

Adjusts the gain level in the deeper area of the image (see also [246]).
33724030
[246] Total gain control.

Adjusts overall gain level. In normal situations, the gain control is used to
33724040
give the entire ultrasound image a consistent brightness. The normal setting
is with all of the gain and depth controls set to their center position. For
certain applications, the normal position is not desirable and the brightness
level of the ultrasound image can be adjusted with controls [244 to 246].
N OT E Always try to optimize the image using the scanner’s gain controls; the monitor
controls should not be changed.
[247] Joystick.
The joystick is used to move the on-screen measuring caliper to the desired
measuring positions.
9896 001 33152

4.4 Overview of control, status and report pages
4.4 Overview of control, status and report

pages
4.4.1 Viewing console text display

For an overview of the Control and Status Pages, press key [F10] to display
the Help Page.
PHILIPS INTEGRIS 1997-11-18 Help page
Function Key Page
F1 Schedule page
F2 Review page
F3 1)
F4 1)
F5 1)
F6 System page
F7 Physician page
F8
F9 Status Page
F10 Help page
33725140
• F1 Schedule page: used to enter and select scheduled examinations for
acquisition, also used to perform a query of the work list manager and
enable the display of more information about a scheduled patient record.
• F2 Review page: used to select acquired examinations for viewing and
enable the display of more information about an examination.
• F3-F5 Function (1)) depends on system configuration, function keys [F3
to F5] can be configured to access the Transfer page, and the Transfer page
can be configured to list all possible archiving systems. The remaining
function keys can be configured to access separate archiving system pages.
Configuration is carried out by Service. The following configurations are
possible for keyboard function keys [F3 toF5]:
- Report page: enables the user to report a selected examination to a
connected information system
- Export page: lists all examinations flagged for transfer to a configured
export station.
- ODR page: used to control all actions of an optical disk recorder
- Copy page: used to copy photofiles from completed examinations to a
remote HCU
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- Transfer page: All, or a selection of, the archiving functions: Report

page, Export page, ODR page and/or copy page.
• F6 System page: to set the date and time, to make a test image and to enter
‘Service mode’.
• F7 Physician page: used to enter the physician names and codes with the
related disk partition and workstation address.
• F8 Reserved.
• F9 Status page: displays information on the progress of actions started.
• F10 Help page: displays an overview of all configured control and status
pages.

Overview of control, status and report pages 4.4
Text display
When a page containing examination data is selected, the page with the
current examination is displayed. When no current examination exists, the
first page (if there are several) is displayed. To select other pages, use the
Previous or Next function. The current acquisition examination is displayed
separately on the last line of the last page. The current examination and
active function are highlighted. To select another examination, use the
|Cursor up| or |Cursor down| keys [20, 26] and confirm the selection by
pressing |Enter| [21, 27]. Help and error messages are displayed where
applicable.
Schedule page (F1)
PHILIPS INTEGRIS 1997-11-18 Schedule page
Name Birthdate Sex Patient ID Phys Time Prot
Jones P.H.N 1941-11-18 M CD1234/234 Abel 11:30 Y
Daniel Balavoine 1934-03-23 M 1254.831 J.S.
36120060
Select Add Delete Modify Query More Previous Next
The Schedule page allows an examination schedule to be set up by the

operator before acquisition is started. Up to 50 patients can be selected from
this page for examination in any sequence. The system checks and displays
the status of each examination on the Status page (F9) and the number of
acquired runs and images on the Review page (F2).
For each examination, data can be entered under the headings:
• Name (patient’s name - maximum 26 characters)
• Birthdate (format configured during installation, e.g.: dd-mm-yyyy)
• Sex (Patient’s sex - 1 character)
• Patient ID (maximum 16 characters)
• Physician (maximum 4 characters as entered on Physician page (F7) or as
appropriate)
• Time (Scheduled procedure time - maximum 5 characters).
9896 001 33152
The ‘Prot’ (Protection) field indicates that the patient record is protected
against modification and/or deletion. The displayed protection value can be
one of the following:
• ‘N’: not protected
• ‘M’: protected against modification

• ‘D’: protected against deletion
• ‘Y’: protected against modification and deletion.
N OT E For each protected patient record, the only information which can be changed is the
physician code.
If a patient record originates from a Radiology or Hospital Information

System (RIS or HIS), the ‘Prot’ field contains a ‘Y’.

Entries under ‘Name’ and ‘Birthdate’ are mandatory. All others can be
skipped. When the ‘Sex’ field is skipped, the system automatically enters an
‘M’ in this field. The help and error lines give instructions and error messages
to the operator.
The function line shows the selectable functions, which are (from left to
right):
• Select: select a new patient for acquisition
• Add: enter data for new examinations
• Delete: delete an examination
• Modify: change patient or examination data
• Query: start a query with the connected information system (work list
manager) by displaying the ‘Work List Query Data Entry Screen’
• More: give more information about a patient record by displaying the
‘Information Screen’
• Previous: displays previous schedule page
• Next: displays next schedule page.
Work List Query Data Entry Screen
36120070
The ‘Work List Query Data Entry Screen’ is used to enter data in order to
perform a query of the work list Manager. This screen appears following
selection of the ‘Query’ function on the ‘Schedule page’.
The following data fields are the minimum that must be completed in order
to perform a patient based query:
• Patient Name (maximum 32 characters)
• Accession Number (maximum 16 characters)
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• Req. Procedure ID (requested procedure ID - maximum 16 characters).

The following data fields are the minimum that must be completed in order
to perform a broad query:
• Start date (scheduled procedure start date - maximum 10 characters)

• Modality (maximum 16 characters)
• Station AE Title (scheduled station (Application Entity (AE)) title -
maximum 16 characters).
The only selectable function is:
• Return: to cancel the Work List Query Data Entry Screen and return to
the main Schedule page.

Information screen
36120080
36120080
The ‘Information screen’ is used to display additional information about the
selected scheduled patient record or acquisition examination. This screen
appears following selection of the ‘More’ function on the ‘Schedule page’.
The following functions can be selected from the function line (from left to
right):
• Modify: modify scheduled patient record information (this is only possible
if the examination is not protected)
• Return: to cancel the Information Screen and return to the main Schedule
page.
For unprotected scheduled patient records, the following information can be
modified:
• Patient Birthdate (format configured during installation, e.g.: dd-mm-
yyyy - 10 characters)
• Patient Sex (1 character)
• Accession number (maximum 16 characters)
• Req. Procedure ID (maximum 16 characters)
• Procedure Step ID (maximum 16 characters).
9896 001 33152

Review page (F2)
36120050
The Review page or pages give an overview of all completed examinations
with the number of acquired runs and images. An examination can be
selected from this page for viewing, amendment or deletion.
The ‘Prot’ (Protection) field indicates that the examination is protected
against modification and/or deletion. The displayed protection value can be
one of the following:
• ‘M’: protected against modification
• ‘D’: protected against deletion
• ‘Y’: protected against modification and deletion.
If a examination originates from a Radiology or Hospital Information System
(RIS or HIS), the ‘Prot’ field contains a ‘Y’.
For a completed, unprotected, examination, the following data can be
amended:
• Patient name
• Birth date
• Patient sex
• Patient ID
• Physician code.
right):
• Select: select examination for viewing
• Delete: delete examination
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• Modify: modify examination data

• More: give more information about a patient record by displaying the
‘Information Screen’
• Disk A/B: select disk partition in multidisk systems (if configured)
• Previous: display previous Review page

• Next: display next Review page.

Information screen
36120090
The ‘Information Screen’ is used to display additional information about the
selected scheduled patient record or acquisition examination. This screen
appears following selection of the ‘More’ function on the ‘Schedule page’.
right):
• Modify: modify scheduled patient record information (this is only possible
if the examination is not protected)
• Return: to cancel the Information Screen and return to the main Schedule
page.
For unprotected scheduled patient records, the following information can be
modified:
• Patient Birthdate (format configured during installation, e.g.: dd-mm-
yyyy - 10 characters)
• Patient Sex (1 character)
• Accession number (maximum 16 characters)
• Req. Procedure ID (maximum 16 characters)
• Procedure Step ID (maximum 16 characters).
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Report page
PHILIPS INTEGRIS 1997-11-18 Disk A Report page
Name Birthdate Sex Patient ID Phys Status
Jones P.H.N 1941-11-18 M CD1234/234 Abel Busy
36120020
Report Cancel Disk A/B Previous Next
The Report page or pages give an overview of all completed examinations.

For each examination the patient attributes derived from the scheduled
patient record are shown. The acquisition examination, if present, will be
highlighted (inversed video) and will be the default examination to be
reported. The default examination to be transferred will be the acquisition
examination. If more examinations exist than can fit on one page, then that
page will be shown that contains the current acquisition examination.
For a completed examination, the following data can be amended:
• Patient name
• Birth date
• Patient sex
• Patient ID
• Physician code
• Status.
right):
• Report: send examination report to the connected information system
• Cancel: cancels current transfer
• Previous: display previous report page
• Next: display next report page.
9896 001 33152

Export page
PHILIPS INTEGRIS 1997-11-18 Disk A to Archive Export page
Name Birthdate Sex Patient ID Phys Run Pct Status
Jones P.H.N 1941-11-18 M CD1234/234 Abel 2 Sending
36120010
Save Cancel Disk A/B Previous Next
The Export page or pages display all examinations flagged for transfer,
including, if applicable, an examination with the status ’sending’. If there is
no examination with the status ’sending’ then the pct field is determined. For
each examination the patient attributes derived from the scheduled patient
record are shown. The default examination to be transferred will be the
acquisition examination. If more flagged examinations exist than can fit on
one page, then that page will be shown that contains the current acquisition
examination.
For a completed examination, the following data can be amended:
• Patient name
• Birth date
• Patient sex
• Patient ID
• Physician code
• Run
• Pct (percent)
• Status.
The status can be:
• scheduled: the flagged part of the examination is scheduled for transfer to
the cache buffer
• busy: the flagged part of the examination is being transferred to the cache
buffer
• sending: the flagged part of the examination is being transferred from the
cache buffer to the selected destination
• closing: the examination has been transferred to the selected destination
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and the system is waiting for a storage commitment

• done: the examination has been successfully transferred to the selected
destination and is automatically unprotected for deletion
• aborting: transfer of the examination is being aborted
• aborted: transfer of the examination is aborted

• error: an error has occurred that cannot be resolved by the operator
• warning: an error has occurred that can be resolved by the operator .
right):
• Save: send selected images of the selected examination to the selected
destination

• Cancel: cancels current transfer

• Previous: display previous export page
• Next: display next export page.
ODR page
PHILIPS INTEGRIS 1997-11-18 Disk A to ODR ODR Page
Name Birthdate Sex Patient ID Phys Run Images Status
Jones P.H.N 1941-11-18 M CD1234/234 Abel 11 1023
36120040
Save Cancel Retrieve Format Disk A/B Previous Next
The ODR page allows examinations to be scheduled for saving to and

retrieval from optical disk. The examinations shown are those on the Review
page that are flagged for transfer. While saving or retrieval is in progress, the
ODR page displays the instantaneous number of images still to be saved or
retrieved (counting down to zero). For biplane runs the total number of
images is displayed. The number of runs with flagged items is shown under
‘Run’. The ODR page is only accessible if an optical disk drive is installed
and configured.
The status can be:
• scheduled: saving or retrieval selected
• busy: saving or retrieval in progress
• done: examination successfully saved
• retrieve: examination successfully retrieved
• error: an error has occurred that cannot be resolved by the operator
• warning: an error has occurred that can be resolved by the operator
• aborting/aborted: the save or retrieve process has been canceled.
right):
• Save: save examination to the optical disk
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• Cancel: cancel current transfer

• Retrieve: retrieve examination from the optical disk
• Format: format the optical disk
• Previous: display previous page

• Next: display next page.

Copy page
PHILIPS INTEGRIS 1997-11-18 Disk A Copy page
Jones P.H.N 1941-11-18 M CD1234/234 Abel 1 23 Done
36120030
Copy Cancel Disk A/B Previous Next
The Copy page allows photofiles from completed examinations to be copied

to a remote HCU. While copying is in progress, the page shows the
instantaneous number of runs and images still to be copied (counting down
to zero). The Copy page is only accessible if a remote controlled HCU is
installed.
The status can be:
• Scheduled: copying selected
• Busy: copying in progress
• Done: copying successfully completed
• Error: an error has occurred that cannot be resolved by the operator
• Warning: an error has occurred that can be resolved by the operator
• Cancelled: the copy process has been canceled.
right):
• Copy: copy flagged images of the photofiles to an HCU
• Cancel: cancel current transfer
• Disk A/B: select disk partition in multi-disk systems (if configured)
• Previous: display previous copy page
• Next: display next copy page.
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Transfer page
PHILIPS INTEGRIS 1997-11-18 Transfer page
33725210
REPORT EXPORT ODR COPY
The Transfer Page gives an overview of all accessible archiving systems. The
archiving page is displayed when a system is selected.
If configured, the following can be selected from the function line (from left
to right):
• REPORT: to select the report page
• EXPORT: to select the export page
• ODR: to select the ODR page
• COPY: to select the copy page
System page (F6)
PHILIPS INTEGRIS 1997-11-18 System Page
33725120
Set time Set date Service Test Img IQ Tools

9896 001 33152
The System page is used to set the time and date. Thereafter, the date and
time are maintained by the system. The date and time appear on the header
line of each page and are stored in the file for each examination.
right):
• Set time: the INTEGRIS system time is displayed and can be set (the time
format is hh:mm)
• Set date: the INTEGRIS system date can be set (the format is configurable
during installation)
• Service: gives access to the system for service purposes
• Test img: displays a test image intended for HCU calibration

• IQtools: (for service only) starts the automated image quality

measurement tool (password protected).
Physician page (F7)
PHILIPS INTEGRIS 1997-11-18 Physician Page
Name Code Disk A/B Station name Prot
Dr. Rogers A.C Abel Disk A Dr. Rogers workspot M
36120100
Add Delete Modify Previous Next
The Physician page can contain up to 64 physician codes with the related
disk partitions and network addresses, for use with the Schedule page. A
physician code (max. 4 characters) is an abbreviation of the physician’s name
(max. 26 characters). The code can be used on the Schedule page but the full
name of the physician will appear on films.
right):
• Add: to enter a physician’s name, code, disk partition and network address
• Delete: to delete a physician’s name, code, disk partition and network
address
• Modify: to modify a physician’s name, code, disk partition and network
address.
• Previous: display previous physician page
• Next: display next physician page.
The ‘Prot’ (Protection) field indicates that the physician record is protected
against modification. The displayed protection value can be one of the
following:
• ‘M’: protected against modification.
The disk partition is only available if a disk partition is configured, and a
9896 001 33152
network address is only available if a network is connected.


Status page (F9)
PHILIPS INTEGRIS 1997-11-18 Status page
ACQUISITION EXAMINATION VIEWING EXAMINATION

Jones P.H.N 1941-11-18 Joanne Thomson 1898-03-23
M 1223/234 Abel 1997-11-18 M 1254.831 J.S. 1993-03-23
Busy Run Images
Run Images Photofile 45
Photofile 0 1 Kidney (1024) 21
1 Carotids 115 2 KAT 9
2 Carotids 203 Flag 3 Auto. Bolus Ch. 33
3 Coronary 157 4 Auto. Bolus Ch. 33 Flag
Fluoro dose 30 Gycm 2 Fluoro dose 1 Gycm 2

Exp. dose 780 Gycm 2 Exp. dose 410 Gycm 2
Total dose 705 Gycm 2 Total dose 411 Gycm 2
33725450
Select Modify Previous Next Select Modify Previous Next
The Status page gives information on the status of the current acquisition
and viewing examinations. The status and other relevant information on the
current acquisition examination, as listed in the Schedule page, are displayed
on the left of the page. The status of the current viewing examination, as
listed in the Review page, is displayed on the right hand side, but only when
this examination is not the current acquisition examination. The information
on this page is updated automatically.
Examinations can have the following status:
• Current: currently selected for acquisition
• Examined: acquisition complete
• Scheduled: selected for archiving
• Busy: transfer in progress
• Retrieved: successfully retrieved from ODR disk
• Done: transfer successfully completed
• Error: an error has occurred that cannot be resolved by the operator
• Warning: an error has occurred that can be resolved by the operator
• Cancelled: transfer cancelled.
The ‘Flag’ information field indicates that an image, heartbeat, or complete

run has been flagged. Flag status can be reviewed in ‘Examination overview’
or ‘Run overview’ mode [41, 61] or [40, 62].
right):
• Select: select a new viewing run from the acquisition or viewing
examination
9896 001 33152
• Modify: to modify an APR name

• Previous: display previous page of acquisition runs or viewing runs
• Next: display next page of acquisition runs or viewing runs.

Overview of acquisition and viewing displays 4.5
4.5 Overview of acquisition and viewing

displays

Imaging technique Page
DIGITAL VASCULAR DIGITAL DYNAMIC
36271230
Digital dynamic (alter APR activated)
12.5 FPS Coronary 12.5 Coro Monoplane

DIGITAL DYNAMIC
25 FPS Coronary 25 Coro Monoplane
12.5 FPS LV Lock Exposure parameters 50 Coro Monoplane
25 FPS LV Lock 25 Ped. Monoplane

60 kV
25 FPS Pediatric 50 Ped. Monoplane
500 mA
25 FPS Manual 7 ms
12.5 FPS Calibration
Focus : small
kV :
Available disk time

Available tube time
Cooldown time
36271260
9896 001 33152

4.5 Overview of acquisition and viewing displays
Digital dynamic (info page) + alter APR
FLUOROSCOPY INFO DIGITAL

Normal pulsed Coro Monoplane
Framespeed : 25 fr/s Technique : kV-mA auto
Focus : small Focus : small
Spectral Filter : on Matrix : high res
Film length :8s
Spectral Filter : on
Focus : Small
kV :
Available disk time

Available tube time
Tube warm
36271270
01:23
Digital vascular (display information activated)
Cerebral DIGITAL VASCULAR Cerebral Fr.
Thorax Duration Frame-rate Cerebral Lat.

10 s Delay
Abdomen 4s Manual Cerebral Large
3 /s
Peripheral Neck
10 /s
Total images : 145
Specials 1 Free run/img : 25 / 5000
Intra Venous
kV : 89
T exp : 150 ms
Focus : small
Ecg : 70% single
Tube warm
33723160
4.5.2 Monitors
Examination/Viewing Monitor
General
• if the parallel viewing option is not installed the monitor layout is the
9896 001 33152
same for both the Examination and Viewing monitors.

• if the parallel viewing option is installed:
- when the system is busy with the current acquisition examination: the
monitor layout is the same for both the Examination and the Viewing
monitor.
- when the system is busy with another viewing examination (= parallel
viewing):
• the examination monitor shows viewing and acquisition related
information from the acquisition examination.
• the viewing monitor shows viewing related information from the
viewing examination and the viewing mode frozen icon (e.g. during
acquisition, parallel viewing etc.).

a e
f
c
33724070
d g
Viewing related information
[a] Patient data and examination date (only if the ‘Add text’ function [85] is
activated):
Patient name, patient birth date and sex, registration number and
examination date.
[b] Image area:

live image (fluoroscopy or exposure).
[d] T-mask:
99.999
Additional examination information:
T-image:
(only if the ‘Add text’ function [64] is activated)
33723280
99.999
T-run:
HH:MM:SS
T-mask (99.99): Time between the current mask image and the first image in
the run.
T-image (99.99): Time between the current image and the first image in the
run.
T-run (HH:MM:SS): Time that the run was acquired.
[e] Hospital name and physician name (only if the ‘Add text’ function [85] is
activated):
Hospital name (2 lines); Physician name (1 line).
[f] View trace subtract mode.

Only if ‘View trace’ [67] is activated.
33723210
CO2.
9896 001 33152
Only if ‘CO2 trace’ [68] is selected in view trace subtract mode.

33723220
CO2
Photo.
n1
PHOTO Only for photofile images.
33723300
n2
n1: Total number of images in photofile.
n2: Current photofile image number.
Viewing mode frozen.
Only if the ‘Parallel viewing’ option is installed and the Dual fluoroscopy or
33724220
Parallel viewing mode is active. The symbol is displayed during/after

fluoroscopy in the Parallel viewing mode.

ROT
Geometry angles.
90
33724080
ANG
60
RUN
Image information.
nl
n2
33723310
MASK IMAGE
n3 n4
Run
Not for photofile images. ‘Run’ appears twice in Run-subtract viewing mode.
n1: Current run number.
n2: Total number of images in the run (or pairs of images, for biplane
operation ). Maximum three characters.
Mask
n3: Current mask (pair) number (maximum of three characters).
Image
n4: Current image number (or the image pair number, for biplane operation)
(maximum of three characters).
Acquisition related information
[c] Delay time:

Delay bar in seconds (only for exposures with delay time > 0).

33724075
[f] Last Image Hold (LIH) image.

Only if configured (Service).
33723180
9896 001 33152
Trace image.
Only if Trace subtract fluoroscopy [158] is activated.
33723190
Trace subtract image.

Only if Trace subtract fluoroscopy [158] is activated.
33723200

Stopwatch.
Only if ‘stopwatch’ [4c] is activated.
33723230
M:SS
Time left.
10 seconds left for acquisition before cyclic overwriting of the acquisition
33723240
examination.
Overview related information
[a]
n1
Previous overview page.
Only if ‘overview’ [40, 41] is activated and the previous overview page
33723270
contains images.
n1: image number of the first image displayed.
[g] Next overview page.
Only if ‘overview’ [40, 41] is activated and the next overview page contains
33723320
n1
images.
n1 : image number of the last image displayed.
Reference monitor
33724090
b
Reference related information
[a] Image area:

photofile image or expanded patient name (maximum 26 characters).
View reference.
9896 001 33152
[b]
Displayed if viewpad function is activated.
33724100
n1
Photo.
PHOTO Only for photofile images.
33723300
n2
n1: Total number of images in photofile.
n2: Current photofile image number.

4.5.3 Hard copy layout

The film layout depends on the type of hard copy unit (HCU) control:
• Manual control:
For the frontal/lateral run the film layout is the same as that of the frontal/
lateral Viewing monitor during viewing. For a biplane run the film layout is
the same as that of the frontal Viewing monitor (default). To change the film
layout to that of the lateral viewing monitor (and vice versa) use the channel
select [4c] or frontal/lateral [42/43] controls.
• Remote control:
c
a
33724110
[a] Patient and examination data:
Patient name, patient birth date and sex, registration number and
examination date.
[b] Image area:

Photofile image or expanded patient name (maximum 26 characters).
[c] Hospital name and physician code:

Hospital name (2 lines); Physician code (1 line)
For more information on viewing related information, refer to Section 4.5.2

‘Monitors’.
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4.5.4 Ultrasound image display
Image field
Status
field
Scale
format Results
field
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During acquisition
During acquisition the ultrasound image is displayed on the examination
monitor as follows:
Item Explanation
Status field Frequency (MHz) For selected probe.
F freeze (highlighted)/Unfreeze
R(reversed) Reverse on.
R Reverse off.
Frame rate: Frames/s.
Scale format A scale indicates the displayed depth.
The focus points are marked by arrows.
Image field Displays the ultrasound image.
Results field Displays the numerical results (measurements).

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4.6 Accessories
4.6 Accessories
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Rail accessory clamps Tabletop accessory clamps
33726020
Catheterization arm support Mattress
33726030
Neuro head rest Drip stand
33726040
Height-adjustable arm support Restriction straps

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36270100
Peripheral filters Cerebral filter

33724360
Arm supports Sterile disposable covers

Accessories 4.6
N OT E Sterile disposable covers are not supplied and must be obtained locally.
33726060
Head fixing aids Ratchet compressor
36280060
Table mounted radiation shield Ceiling suspended radiation shield
36280070
Pan handle Examination light
36270110
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Cable guides
For the optional table tilt accessories, see section 10.4.4 ‘Angio DIAGNOST
5 with SyncraTilt option’.

4.6 Accessories
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5 Operation
5.0 Basic procedures

This Section describes the preparation of the system before acquisition can be
started. It is mandatory for the operator to be familiar with the ‘Safety’
procedures described in Section 2, ‘Safety’ and to understand Section 4,
‘System overview’ which describes the functions used in this Section.
WA R N I N G S Safety awareness
Do not start up the INTEGRIS Allura Monoplane system unless you and all other
operators present have read, fully understood and know all the safety information and
emergency procedures given in Section 2, ‘Safety’ of this Manual. Operation of the
INTEGRIS Allura Monoplane system without having read, understood and learnt ALL
the safety information and procedures in Section 2, ‘Safety’ could lead to fatal or
serious injury. It could also result in clinical misdiagnosis/incorrect treatment.
Maintenance & faults

Do not use the INTEGRIS Allura Monoplane system for any medical application unless
you are certain that the ‘user routine checks program’ has been satisfactorily
completed, and that the ‘planned maintenance program’ is up to date. If any part of
the INTEGRIS Allura Monoplane system is known (or suspected) to be defective, do
not use it until a repair has been made. Operation of the INTEGRIS Allura Monoplane
system with defective components may expose the operator or the patient to radiation
or other safety hazards. This, in turn, could lead to fatal or serious injury. It could also
result in clinical misdiagnosis/incorrect treatment.
You can find information about the ‘User routine checks program’ and the
‘Planned maintenance program’ in the ’Maintenance’ section of this manual.
Operator knowledge
Do not operate the INTEGRIS Allura Monoplane system with patients unless you have
a good understanding of its capabilities and functions. Using this equipment without
such an understanding may compromise its effectiveness and/or prejudice the safety of
the patient, yourself and others.
You are strongly recommended to read this manual before using the
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INTEGRIS Allura Monoplane system with patients. You must always

comply with the operating procedures and intended uses described in this
manual.
At installation or during planned maintenance, several parameters that
determine the functioning of the system and the display of images can be
customized by Service to suit user requirements. Some of these parameters
can be overridden by the operator before an examination or during viewing.
INTEGRIS Allura Monoplane Release 1 Operation 5-1

Overview of basic procedures:
Activity Function Sub-function
Preparing the system Switching the system on/off How to switch the system on
for diagnostic imaging
(§ 5.0.1) How to switch the system off
Tableside operation modules How to change the position of

the geometry module
Cable guides How to fit the cable guides
Pan handle How to attach the pan handle to

the accessory rail
How to attach the pan handle to

the tabletop
Fitting sterile covers How to fit sterile covers
How to replace the examination

light lower handgrip
Setting the geometry How to reset the geometry after

an emergency power off
How to set the geometry for

lower peripheral procedures
X-ray filters -
Patient positioning How to place the patient in the

supine position
Use of the injector How to start an acquisition using

contrast medium (one knob)
How to start an acquisition using

contrast medium (two knob)
Patient and Entering examination data How to enter examination data

examination data
Displaying more scheduled patient How to display more scheduled
(§ 5.0.2)
record and examination patient record and examination
information information
Selecting an examination for How to select an examination for

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acquisition acquisition
Making images Fluoroscopy How to perform fluoroscopy

(§ 5.0.3)
Acquisition How to perform acquisition
Single-shot acquisition How to perform single-shot

acquisition
Tube load and dose rate -
Viewing images Viewing after acquisition How to select a viewing

(§ 5.0.4) examination/run
5- 2 Operation INTEGRIS Allura Monoplane Release 1

Basic procedures 5.0
Post-processing How to perform post-processing -

(§ 5.0.5)
Archiving (§ 5.0.6) 1. Storing an image to the How to store images to the

photofile photofile:
• during fluoroscopy/ultrasound
• during acquisition/viewing
How to delete images from the

photofile
2. Transferring photofile images to How to transfer photofile images

the HCU to a remote-controlled HCU
How to cancel the HCU transfer

process
How to transfer photofile images

to a non-remote-controlled
HCU
Transporting the - -
system (§ 5.0.7)
5.0.1 Preparing the system for diagnostic imaging

Switching the system on/off
Basic information for switching the INTEGRIS Allura Monoplane system
on or off.
When the system is switched on, it performs a self-test, after which a Start-up
page is displayed. This page gives information on the release implemented
and a copyright statement. The Schedule page is then displayed. Other pages
can be selected with function keys F2 to F10. An overview of the control and
status pages, and permissible data formats is given in Section 4.4.
Conditions
CAUTIONS • To prevent malfunction, do not touch any key during the Switch-on process.
• Only switch off the X-ray system at a local mains power switch after pressing the
|Power off| [B] and digital imaging system off [D] keys on the acquisition and
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viewing consoles.
How to switch the system on
1 Check that it is safe to switch the system on.

2 Press |Power on and reset| [A] on the acquisition console.

3 Press |Digital imaging system on| [C] on the viewing console.
How to switch the system off
1 Check that it is safe to switch the system off (i.e. no patient on the table).
2 Press |Power off| [B] on the acquisition console.

3 Press |Digital imaging system off| [D] on the viewing console.
WA R N I N G S • Do not use the INTEGRIS Allura Monoplane for any medical application unless you
are certain that the Planned Maintenance Programme is up to date. See Section 7
‘Maintenance’ of these Instructions for use. If any part of the INTEGRIS Allura
Monoplane is known (or suspected) to be defective, DO NOT USE IT until a repair
has been made. Operation of the INTEGRIS Allura Monoplane with defective
components may expose the operator or a patient to radiation or other safety
hazards. This, in turn, could lead to fatal or other serious personal injury. It could
also lead to clinical misdiagnosis.
• Do not operate the INTEGRIS Allura Monoplane with patients unless you have a
good understanding of its capabilities and facilities. Using this equipment without
such an understanding may compromise its effectiveness and/or reduce the safety of
the patient, yourself and others.
Tableside operation module (TSO)

The TSO can be mounted on the doctor side, nurse side or foot end of the
table.
When the TSO is positioned on the doctor side of the table, movement of
the joystick moves the stand logically (i.e. pushing the joystick upwards will
rotate the stand away from the doctor).
To ensure the stand movement remains logical when the TSO is mounted in
one of the other positions, switch [c] (see illustration below) must be set to
the appropriate position:
• left position: Doctor’s side
• center position: Foot end
• right position: Nurse’s side
Conditions
CAUTION Do NOT position the geometry module at the foot end of the table if the (optional) tilt
function is to be used.
How to change the position of the Geometry module
1 To remove the TSO, grip it from the front

with one hand (thumb on top) with the
fingers on the lock-release [a].
a
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2 Pull the lock-release to release the module

and at the same time lift the module
upwards. The module can now be lifted off b

the accessory rail and moved to another
position.
33721010
3 To attach the module to the accessory rail,

place the lock [b] over the accessory rail and
press the module down until the lock
engages.

4 For correct operation, set the location switch

[c] on the underside of the Geometry
Module as appropriate for the new location.
c
33721020
Cable guides
A set of cable guides is supplied with the patient support. The cable guides
are fitted to the patient support accessory rail in order to support the cables
of the Tableside Operation Modules (TSO).
Conditions
When using the cable guides, they should be positioned at intervals along the
accessory rail, ensuring that enough cable guides are used to adequately
support the TSO cables.
How to fit the cable guides

1 Slide the desired number of cable guides
on to the open end of the accessory rail.
Alternatively, the cable guides can be
clipped on to the rail.
2 Position the TSO cables in the lower
36270110
(hook) portion of the cable guides.
Pan handle
The pan handle is used to release the tabletop brakes. Additionally the pan
handle can be used for floating the tabletop.
The pan handle can be configured for two modes of operation, such that:
• when pressed and released, the tabletop brakes are deactivated (table float
activated); when pressed and released a second time, the brakes are
reactivated.
• when pressed and held down, the tabletop brakes are deactivated; releasing
the pan handle reactivates the brakes.
Conditions
No special conditions apply.
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33721030
a b a c
Pan handle attached to accessory rail Pan handle attached to the tabletop

How to attach the pan handle to the accessory rail
1 Fit clamp [b] (not visible) to the accessory rail, positioning the rail inside the
clamp groves.
2 Turn handle [a] to tighten the clamps and lock the pan handle to the rail.
How to attach the pan handle to the tabletop
1 Fit clamp [c] to the tabletop.

2 Turn handle [a] to lock the pan handle to the tabletop.
Fitting sterile covers
WA R N I N G If the foot switch is to be fitted with a sterile cover, it is important to take care that the
cover is not fitted too tightly. This is to ensure that when one pedal is pressed the cover
does not activate another pedal(s).
If using a sterile cover, be sure the original package of the sterile cover is not
damaged and the date is not expired.
In order to create a sterile environment, all system parts in the working area
must have a sterile cover. The exception to this is the examination light lower
handgrip, which can be replaced by a sterilized handgrip.
Sterile disposable covers are not supplied and must be obtained locally.
Conditions
A thin sheet of sterilized plastic is placed over the tabletop, TSOs and pan
handle.
The viewpad(s), radiation shield and image intensifier must be covered
separately with a sterile cover.
How to fit sterile covers

The method of fitting sterile covers is to be determined locally, by the
operator.
How to replace the examination light lower handgrip
1 Depress the handgrip locating button and remove the handgrip from the
examination light.
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36270120
2 Fit a sterilized handgrip, ensuring that the locating button clicks into place.

Setting the geometry
General
The Allura system is equipped with the Bodyguard object sensing system on
critical locations of the X-ray system. The system will protect the patient by
slowing down movement speeds when an object is detected within a certain
safety distance. The detection system does not prevent all collisions, but due
to the reduced movement speeds these collisions will not be harmful if they
occur.
We explicitly state that it is the responsibility of the user to prevent collisions
of the Allura system with any object.
In case of emergency the C-arm stand can be parked, providing complete free
all-round access to the patient. The floating tabletop movements allow the
patient to be removed from the X-ray beam with maximum speed and ease.
WA R N I N G S Emergencies:
• In the event of a system movement emergency (movement of the system without
any user action), press emergency power off [130] or [160] to block all movements
except manual L-arm rotation, longitudinal movement and the tabletop float.
• In the event of a clinical emergency involving a patient, do not press emergency
power off [130] or [160] or switch off the X-ray system using a local mains power-
off switch. Move the image intensifier away (either motor driven or manually, by
firmly pushing it up) and/or the tabletop, and/or rotate or park the stand to provide
clear, all-round access to the patient.
Patient safety:
• When moving the Image Intensifier towards the patient; take care that the Image
Intensifier front plate does not hit small objects.
• If during motorized movements an audible tone (beeping sound) is produced by the
system, this indicates that the bodyguard detection system does not function
properly. For safety reasons the system will automatically switch to a reduced speed
mode. Be aware that in this mode collisions can occur. Call Service.
Conditions
The following procedure describes the conditions required prior to lower
peripheral examinations in general.
How to reset the geometry after an emergency power off
1 Switch the system off by pressing |Power off| [B] on the Acquisition console.
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2 Switch the system on by pressing |Power on and reset| [A] on the Acquisition
console.

How to set the geometry for lower peripheral procedures
36280290
Preferred setting
Preferred procedure
1 Set the table rotation and tilt to 0°.

2 Rotate the C-arm to bring the X-ray tube under the table with 0° rotation
and 0° angulation.
3 Pivot the L-arm perpendicular to the table at +90° or -90°.
4 Place the C-arm in the parking position for convenient transfer of the patient
onto the table.
5 Set the tabletop in the fully retracted position towards the table base.
6 Position the patient in the supine position with the head as close as possible
to the edge of the tabletop (opposite the pedestal) and position the C-arm
with the image intensifier (II) above the bifurcation.
7 Adjust the table and II to optimal height.
8 For further positioning of the ROI use the table movements (horizontal
float) and, if necessary, reposition the patient on the tabletop.
9 Move the II as close as possible to the patient.
Alternative procedure
For reversed bolus chasing the procedure is the same except for procedural
steps 5 and 6:
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5 Position the patient in the supine position with the feet as close as possible to
the edge of the tabletop (opposite the pedestal).
6 Place the tabletop in the fully extended position towards the C-arm such that
the II is above the bifurcation.
X-ray filters
CAUTION Careful positioning of the filters is essential for good image quality, especially in
peripheral procedures. The center filter must be placed as high up as possible between
the patient’s legs. The side filters must be molded to the shape of the legs so that there
are no gaps between the filters and the legs. If necessary, immobilize the patient’s legs
with restriction straps.

A set of long wedge filters is provided. The center filter is placed between the
patient’s legs with the wide part towards the feet and the two side filters are
placed as close as possible to the left and right of the legs respectively. The top
edge of the center filter is provided with marks to facilitate measurements.
Each mark has a diameter of about 5 mm at a distance of about 5 cm (2
inch).
33724540
Patient positioning
33724380
WA R N I N G S If the Pivot option is available:
• When transferring a patient, make sure that the tabletop is fully retracted towards
the foot end and that the tabletop pivot is locked in position.
• The tabletop is held in place in a groove in the locked position and can be moved if
pressure is applied. This may cause unexpected movement during patient transfer
and possible injury to the patient.
• Make sure there are always two people available (one at each side of the patient)
to transfer the patient on/off the table.
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Conditions
Before positioning the patient on the table make sure that:
• the stand is in its parked position or in the P-A projection
• the tabletop is moved all the way towards the foot end (fully retracted).
The tabletop is then freely accessible from both sides allowing transfer of the
patient from a bed to the tabletop. If a Pivot device is available, the table can
be pivoted to increase accessibility. To pivot the tabletop, push it in the
required direction. The tabletop should be pushed at least 1.5 m (59.0 inch)
from the pivot point with the tabletop brakes on.

How to place the patient in the supine position

The following procedure assumes that the geometry module is mounted at
the doctor side of the table.
1 Position the C-arm in the true P-A position.
2 Position the patient on the tabletop and adjust the tabletop to a convenient
working height. For convenience the patient should be placed with his/her
head at the end of the table.
3 Set the system for fluoroscopy with appropriate parameters.
4 Position the tabletop under fluoroscopy so that the region of interest is in the
center of the image.
5 Adjust the height of the tabletop under lateral fluoroscopy until the region of
interest is in the center of the image.
6 Position the C-arm to the angle best suited to the examination.
7 Move the II to the minimum distance from the patient to ensure optimum
image quality and minimum radiation dose.
Use of the injector
36280140
Liebel Flarsheim Medrad
When the programmed X-ray delay (time between injection of contrast

medium and the first exposure) is greater than zero, a bar representing the
delay in seconds appears in the lower left corner of the examination monitor.
This bar shrinks every second until the delay has expired.
Conditions
These condition apply only if two knob aquisition is selected.
The injector is disabled if the acquisition hand switch or foot switch is
activated before the injector hand switch. The injector is disabled until the
X-ray preparation time, plus any programmed (APR) time has expired.
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Injection sequence will start immediately, if the injector hand switch is

activated before the acquisition hand switch or foot switch. No delay in
acquisition initiation , due to X-ray preparation time or any programmed
(APR) time is taken into account.
How to start an acquisition using contrast medium (one knob)
1 Select ‘one-knob acquisition’ [4c] on the acquisition console.

2 Press the injector hand switch [185] to start the acquisition and contrast
injection.
5- 1 0 Operation INTEGRIS Allura Monoplane Release 1

How to start an acquisition using contrast medium (two knob)
1 Select ‘two-knob acquisition’ [4c] on the acquisition console.

2 Press the hand switch [185] or foot switch [179] to start the acquisition.
3 Start and stop the injection manually by pressing and releasing the injector
hand switch.
5.0.2 Patient and examination data

Entering examination data
An examination is scheduled by entering its data at the viewing console on
the Schedule page [F1]. The schedule can be entered and/or modified at any
time. For example, the whole day’s schedule can be entered in the morning,
or entries can be made between examinations.
Data can be entered via the keyboard, pressing |Enter| [21] to confirm, or
skipping entries simply by pressing |Enter|. There is no check on the validity
of entries except the patient’s birth date, i.e. any character can be entered.
Conditions
For correct patient identification at least the following information has to be
entered on the schedule page:
• patient’s name
• birth date
• sex.
How to enter examination data
1 Press F1 [24] to select the schedule page.

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36120060
2 Activate the ‘Add’ function (displayed in the function line).

3 Enter the patient’s name. Enter at least 1 character, not a space.

The cursor will move to the ‘Birth date’ field.
4 Enter the patient’s birth date in accordance with the configured date format
(e.g. ‘yyyy-mm-dd’).
The cursor will move to the ‘Sex’ field.
5 Enter the patient’s sex by using the cursor keys [20] or typing ‘F’ or ‘M’.
The cursor will move to the ‘Patient ID’ field.
INTEGRIS Allura Monoplane Release 1 Operation 5 -11

The patient’s sex and the physician code can be selected from a list, by using
the |Cursor up| or |Cursor down| key [20] when in the appropriate field.
Directions will be given on the help line of the text display when the cursor is
in the selected field. One of the items is a blank line, which can be filled in by
typing a new item and then pressing |Enter| [21].
6 Enter the patient’s ID.
The cursor will move to the ‘Phys’ field.
7 Enter the physician code.
If a defined physician code is entered, the related physician name will be
added to the scheduled patient record attributes. If a non-defined physician
code (no corresponding physician record present) is entered, then instead of
the physician name, the entered physician code will be displayed on the
digital or high line rate hard copy output(s).
8 Enter the scheduled procedure time.
The scheduled procedure time, by default, will be the current system time
and will be filled in automatically, however it can be changed
9 To enter more examinations, activate ‘Add’ again and repeat procedural steps
3 to 7.
Displaying more scheduled patient record and examination

information
The Schedule and Review pages both contain patient and examination
related information. However, for each patient or examination there is more
information available than can be displayed in these pages. It is possible to
display more detailed patient and examination information on an additional
‘Information screen’.
The ‘Information screen’ is displayed by selecting the ‘More’ function on
either the Schedule page or Review page.
Conditions
• When there are no patients on the Schedule page and ‘More’ is selected the
message ‘No patient information’ is displayed on the error line of the
Schedule page.
• When there are no examinations on the Review page and ‘More’ is selected
the message ‘No examination information’ is displayed on the error line of
the Review page.
• It is only possible to modify information of scheduled patients in the
‘Information screen’ that has been entered manually.
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N OT E It is not possible to modify information of scheduled patients in the ‘Information

screen’ that has been retrieved from the RIS, as this information is automatically
protected.
How to display more scheduled patient record and examination information

1 Press F1 or F2 [24].
The Schedule or Review page is displayed.
2 Activate the ‘More’ function [15].
3 Use the |Cursor up/down| keys [20] on the keyboard to select the required
patient/examination.
4 Press |Enter| [21] to confirm the selection.

The Information screen containing additional information from the selected

scheduled patient record or examination is displayed.
36120080
36120080
For manually entered patient information it is possible to modify some of the
fields. The following fields can be modified:
• Patient Name, ID, Birthdate and Sex
• Accession number
• Req. Procedure ID (Requested procedure ID)
• Procedure Step ID.
Fields that are protected against modification will be skipped automatically.
5 Press the |Modify| key.
6 Use the |Cursor up/down| keys [20] on the keyboard to step through the
different fields, making the modifications in each field as required.
7 Pressing |Enter| [21] on the last entry field (Station AE title) will save the
modified information.
8 If the modifications are not required, press the |Modify| key again, or press
|Return|.
All modifications are lost and the Information screen shows the original
values.
9 Press |Return| to cancel the ‘Information Screen’ and return to the Schedule
or Review page.
Selecting an examination for acquisition

At power on, the active acquisition examination is the one that was active
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before the system was turned off. If no current acquisition examination was
present before power down, a new examination (‘No name entered’) is added
and selected as current acquisition examination. Fluoroscopy is now possible.
This temporary examination is removed when a new acquisition examination
is selected if the temporary examination did not contain stored images or

fluoroscopy-doses.
Conditions
• If the Viewing console is not available or is switched off, press |New
patient| [4c] on the Acquisition console.
• If the Viewing console is available, it is not possible to select a new patient
from the Acquisition console.

• If a new acquisition examination is selected and the previously selected

acquisition examination contained no images or fluoroscopy dose, the
previously selected acquisition examination acquires the status
‘Scheduled’.
• If the previously selected acquisition examination did contain either
images or fluoroscopy dose, it acquires the status ‘Examined’.
• If a new acquisition examination is selected and at least one of the
following conditions is met:
- the current acquisition examination contains images
- the CDM and/or export option is installed and configured as present
- the previous current acquisition examination does not have the export
status ‘Done’
- the configuration item ‘Warning on CDM/EXPORT not saved’ is set to
‘Yes’.
Then:
- the text ‘Previous examination not saved’ is displayed on the frontal
Examination and Viewing monitors
- the prompt ‘Previous examination not reported and/or images not
saved, proceed (yes/no) ?’ is displayed on the viewing console (default
answer is ‘No’).
If the operator types in ‘No’, the newly selected examination is NOT selected
as current acquisition examination and remains in the scheduled list. If the
operator types in ‘Yes’, a normal selection of a new current acquisition
examination is executed.
If the ‘Modality’ attribute from the selected scheduled patient record is not
equal to ‘XA’ (default) or has no value, then the operator is prompted with
the message ‘Examination is not scheduled for this modality. Please select
another’.
How to select an examination for acquisition
1 Press F1 [24] to select the Schedule page.

The ‘Select’ mode is automatically activated.

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36120060
2 Use the |Cursor up| and/or |Cursor down| keys [20] to select a scheduled
acquisition examination.
3 Confirm the selection by pressing |Enter| [21].

If configured, the operator is asked to confirm that the selected patient is

actually the patient to be examined. The following message appears, ‘Are you
sure this is the correct patient (Yes/No)?’ (default answer is ‘Yes’). If the
operator types in ‘No’, the selection procedure is stopped.
The name of the patient will be displayed on the Reference monitor until
another action that uses the monitor is performed. The Status page will
appear on the Viewing console text display. The examination time is the time
at which the examination is selected for acquisition.
After selection, the system checks if a photofile of the configured length (set
by Service during installation) can be created without deleting images. If this
is not the case, the prompt ‘No sufficient photofile space, continue (Yes/No)’
is displayed (default answer is ‘Yes’). If ’No’ is entered, the selection
procedure is stopped. Otherwise, the selection procedure continues, creating
a photofile as large as the remaining free storage space allows.
All newly acquired images are added to the disk partition corresponding to
the physician code of the current acquisition examination.
5.0.3 Making images

It is mandatory for the operator to be familiar with the ’Safety’ procedures
described in Section 2 and to understand Section 4, ’System overview’ that
describes the functions used in this section.
Fluoroscopy
Fluoroscopy is generation of images at low dose rates.
Conditions
If an error occurs, fluoroscopy will not start. When the error disappears, the
footswitch has to be released and pressed again.
Low level fluoroscopy is still possible after an emergency power off.
Before performing fluoroscopy, the following functions can be set or
modified:
• patient orientation [5, 6]
• image intensifier field size [153, 154]
• shutter adjustment [151, 152]
• wedge filter [155, 156]
• stopwatch [4c].
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How to perform fluoroscopy
N OT E With only one imaging mode available at any one time and acquisition being
dominant, acquisition will overrule fluoroscopy. This reduces the risk of waste of
contrast (or overdose of contrast and X-ray) in case of inappropriate use of the
footswitch.
1 Position the patient.

2 Select one of the fluoroscopy modes at the imaging module [150].
3 Initiate fluoroscopy with the |Fluoroscopy| foot switch [175].

During fluoroscopy, the fluoroscopy ‘eye’ on the Acquisition console will

flash and the ‘X-ray on’ indicator [121] on the Display unit will be on. The
fluoroscopy parameters (kV, mA) are displayed on the Acquisition console
after pressing |Display information| [7].
4 To stop fluoroscopy release the footswitch.
If configured, the last acquired fluoroscopy image will remain displayed on
the Examination monitor (LIH) until the operator performs another action
requiring this monitor.
A buzzer sounds after 5 minutes’ cumulative fluoroscopy time. To switch the
buzzer off, press |Reset fluoroscopy time buzzer| [2] or |Fluoroscopy mode|
[150 a/b/c]. If this is not done, fluoroscopy will be automatically switched off
after a further 5 minutes.
Acquisition
Digital acquisition of X-ray images. The result will be a series of images.
Conditions
Acquisition is disabled during a change of APR. Pressing the footswitch after
a change of APR directly activates X-ray exposure.
After starting the exposure, all other active system functions are stopped and
the Examination monitor is blanked. A delay bar is displayed in the bottom
left corner of the Examination monitor if a delay time is programmed. After
system preparation, the images are acquired using the selected image
technique and displayed on the Examination monitor. If the acquisition
speed exceeds the display speed at full resolution, the display will be at half
resolution.
How to perform acquisition
N OT E S • If the intention is to use quantative analysis programs using the auto-calibration

factor, it is necessary to work in the isocenter. The isocenter can be found by
adjusting the tabletop position such that the ROI is displayed in the center of both
the frontal and lateral examination/viewing monitors.
• With only one imaging mode available at any one time and acquisition being
dominant, acquisition will overrule fluoroscopy. This reduces the risk of waste of
contrast (or overdose of contrast and X-ray) in case of inappropriate use of the
footswitch.
1 Position the patient.

2 To select the Imaging Technique (APR), press |Image technique| [4c].
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The Imaging technique page is displayed at the acquisition console.

3 To select another APR, press the appropriate soft key [4a,b].
4 To display information on the APR parameters press |Display Information|
[7]. To alter a parameter, press |Alter APR parameters| [10] (see Section
5.1.6. ‘APR handling’.
5 Before performing digital acquisition, the following functions can be set or
modified:
• patient orientation [5, 6]
• II field size [153, 154]
• shutter adjustment [151, 152]
• wedge filter [155, 156]

• subtraction on/off [4c] depending on the selected imaging technique.

• one/two-knob injection [4c]
• stopwatch [4c].
6 Initiate acquisition by pressing the |Exposure| foot switch [179] or hand
switch [185] and keeping it held down.
7 Acquisition will stop when; either the footswitch or hand switch is released,
or the programmed number of images has been acquired.
Single-shot acquisition
Digital acquisition of a single X-ray image.
Acquired images are added to the current patient’s examination file. The
acquired images can be viewed at any time. The Viewpad is most convenient
for this purpose.
Conditions
Single-shot acquisition is only possible for digital vascular procedures with
lock-in APRs and can only be started with the foot switch. One-knob
acquisition and programmed delay time is not possible.
How to perform Single-shot acquisition
1 Refer to procedural steps 1 to 5 of ‘How to perform acquisition’ (previous

procedure).
2 Initiate Single-shot acquisition by pressing the footswitch [177].
Tube load and dose rate
WA R N I N G It is the responsibility of the operator to avoid actions that could increase the tube
load.
Tube load
The tube load is shown by one of the indicators [122] on the display unit:
green, yellow or red. If the red indicator is lit, only low and normal
fluoroscopy modes are possible. The maximum recommended run time or
tube cool-down time is displayed on the acquisition console.
Dose rate
The dose rate is monitored during acquisition and is shown on the display
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unit [127] where it is updated every second. At the end of acquisition, the
accumulated dose is displayed on the Acquisition console and on the Status
page [F9] on the viewing console. If configured, a dose/examination report
can be printed [4c].
5.0.4 Viewing images

Before reading this Section the operator must be familiar with the functions
described in Section 4, ‘System overview’.

This Section refers to a system with factory default viewing functions. If the
viewing functions were reconfigured during system installation (see Section
4.3.2, ‘Viewing console, TAM and viewpad(s)’), it is strongly recommended
to amend the section accordingly.
When acquisition functions are activated by the operator in the examination
room, the patient annotation function [86] and analytical programs [98] are
terminated. Other programs are suspended with their current settings intact
and remain visible on screen in a suspended state. Terminated functions must
be re-activated after exiting the function that was activated in the
examination room.
Viewing after acquisition

If the system is unable to perform a function requested by the operator, the
corresponding indicator will flash until the function key is released. For
example, this will occur if the landmarking function [66] is selected while
subtraction is off.
Viewing can be started from the Review page or by pressing any key that
produces an image.
Conditions
If a function is activated at one user interface (e.g. Viewing console, TAM or
Viewpad), it will remain active until it is deactivated. In addition, the
activated function will only be indicated as active on the user interface from
which it was selected.
If the current acquisition examination is the same as the current viewing
examination, processing indicators on the Viewing console will refer to
functions activated from the Viewpad(s) and TAM.
Parallel viewing allows selection of images (image runs) of a patient other
than the one currently being examined.
Unless otherwise specified, the following rules apply to viewing functions
controlled by the mouse (and by the joystick and related keys on the TAM):
• processing parameters only take on the displayed value after clicking
|Accept| [25] (left mouse button). When a function key is pressed again
before clicking |Action| [26] (middle mouse button), the processing
parameters are reset to the values they had when the function was entered
• when a function is overridden or a run boundary is crossed, the function is
terminated, and the processing parameters remain active as if |Accept| [25]
had been clicked
• modified processing parameters can be reset to their acquisition values by
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clicking |Reject| [27] (right mouse button)

• clicking |Accept| [25] or |Reject| [27] terminates the current function
• panning, pixel shifting, landmarking, moving shutters, drawing lines etc.
can only be carried out by moving the mouse while holding down the
middle mouse button |Action| [26]. Cursors, however, are moved by

simply moving the mouse (without pressing |Action|).
How to select a viewing examination/run
1 Press F2 [24] to select the Review page.

The ‘Select mode’ is automatically activated.

36120050
2 Use ‘Previous’, ‘Next’ and/or ‘Disk A/B’ to select the page containing the
viewing examination.
3 Use the |Cursor up/Cursor down| keys [20] to select the viewing
examination.
The middle image of the first run is displayed on the image monitor. The
Status Page of the selected examination will be displayed.
5 To select a specific run from the Status page, use the |Cursor up/Cursor
down| keys [20].
7 Once a run has been selected, other images from the run can be selected and
processed by using the |View forward/reverse| keys [30/31].
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33726410
Viewing console
The following Viewing console functions can be used for image selection, see
illustration above:
Purpose Available function(s)
To display the images of the run in the sequence in • View forward/reverse [30, 31]
which they were acquired or in reverse sequence:

To step quickly through the runs of the examination • Step to next/previous run [32, 33]
selected:
To cycle through the run: • Cycle through run [36]
To cycle through runs of an examination: • Cycle through examination [37]
To modify the viewing speed for forward, reverse or • Higher/lower speed [38, 39]
cyclic viewing:
To display an overview of 20 images of the current • Run overview [40]

run:
To display an overview of the center images of 20 • Examination overview [41]

runs:
a b
c d
e
f g
h i
j k
l m
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Viewpad
The following viewpad functions can be used for image selection for the
acquisition patient only, see illustration above:
To display the current image subtracted from the Subtraction on/off [a]
current mask:
To make the current image the new mask image: New mask [b]
To display the images of the run in the sequence in View forward/reverse [d, c]
which they were acquired or in reverse sequence:
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To cycle through the run: Cycle through run [e]
To display an overview of the middle images of 20 Examination overview [f]

runs:
To zoom the central area of the the currently Center zoom [g]
displayed image:
To change image contrast: Contrast decrease [h]

Contrast increase [i]
To store an image on display as reference 1 or 2: Store reference 1 [j]

Store reference 2 [k]

To display the reference images 1 or 2: View reference 1 [l]

View reference 2 [m]
5.0.5 Post-processing
Post-processing allows the operator to optimize the quality of the images, i.e.
contrast, brightness and edge enhancement etc.
Conditions
In order to perform post-processing the required run must first be selected.
It is necessary to have good images at the start of the post-processing
procedures in order to achieve optimum quality.
Performing post-processing on one specific image affects the whole run.
How to perform post-processing
1 Press the required post-processing function key on the viewing console.

2 If necessary use the mouse for the ‘Pan and zoom’ [55], ‘Position (electronic)
shutters’ [57], ‘Pixel shift’ [64] or ‘Landmarking’ [66] functions.
The following processing functions can be applied to all images in the
selected run:
To change image contrast: Increase contrast [45]

Decrease contrast [46]
To change image brightness: Increase brightness [48]

Decrease brightness [49]
To change edge enhancement: Increase edge enhancement [51]

Decrease edge enhancement [52]
To change image polarity: Select video invert [54]
To zoom a quarter of the image area by a factor of 2: Pan & zoom [55]
To mask image edges: Position (electronic) shutters [57]
To override applied processing functions and reset the Override manual adjustment [58]
run to its state at acquisitions:
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If the vascular option is installed, the following subtraction functions are

available on the Viewing console and/or Cardio-mix Viewpad:
To display the current image subtracted from the Subtraction on/off [60]
current mask:
To select a new mask image using the View forward/ Move mask [61]
reverse function:
To make the current image the new mask image: New mask [62]

To correct for motion artifacts in subtracted images: Pixel shift [64]
To add background anatomical features to a Landmarking [66]

subtracted image:
To combine in one image all images acquired during View trace [67]
the flow of contrast medium in a single image:
5.0.6 Archiving
Images obtained from the INTEGRIS system can be transferred to a HCU.
For archiving examinations to other archiving systems refer to Section 5.6
‘Archiving’.
1. Storing an image to the photofile

The photofile is used for storing selected images prior to transfer to a HCU.
All images in the photofile will be transferred to the HCU.
Conditions
Before sending images to a HCU the images need to be stored in the
photofile, selection of the images has to be done manually.
How to store images to the photofile

Any fluoroscopy, acquisition or viewing image may be stored as follows:
During fluoroscopy/ultrasound
1 Press |Store reference 1/2| key [j, k] on the viewpad. The image is displayed
on the Reference monitor and stored in the photofile.
During acquisition/viewing
1 Complete the current acquisition examination.
The image(s) can be selected after completing the examination run.
2 If necessary, press the |Add text| key [85] to switch image information on/off.
3 If necessary, press the |Annotate| key [86] to switch text annotation on/off.
4 Use the selection keys [30 - 43] (see Section 4.3.3) on the viewing console to
select the image to be stored.
5 Press the |Store image in photofile key| [70] on the viewing console.
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The image is stored in the photofile.
How to delete images from the photofile
Select the image to be deleted from the photofile.

2 Press and hold the |Delete image from photofile| key [71] on the viewing
console until the viewing monitor is blank.
The following functions can be applied to the photofile:

To store the currently-displayed image in the Store Image in Photofile [70]

photofile:
To delete the currently-displayed image from Delete Image from Photofile [71]
the photofile:
The reference functions are available on the viewpad(s) as standard.
2. Transferring photofile images to the HCU

All photofile images are transferred to the HCU in the background (i.e.
normal operation of the system is possible).
If an HCU error occurs, the error message ‘HCU Error’ is displayed on the
viewing console. Detailed error information is given at the HCU itself. The
error message will remain displayed while the HCU error persists and
examinations have the status ‘Scheduled’ or ‘Busy’.
Conditions
Ensure that:
• the HCU connected to the INTEGRIS system is ready for use
• images required to be transferred to the HCU are stored in the photofile.
How to transfer photofile images to a remote-controlled HCU
1 Press F3, F4 or F5 [24] to select the Copy page.
PHILIPS INTEGRIS 1997-11-18 Disk A Copy page
Jones P.H.N 1941-11-18 M CD1234/234 Abel 1 23 Done
36120030
Copy Cancel Disk A/B Previous Next

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2 Select the ‘Copy’ function.

3 Use the ‘Previous’, ‘Next’ and/or ‘Disk A/B’ functions to select the page
containing the examination to be copied.
4 Select the examination to be copied with the |Cursor up| and |Cursor down|
keys [20].
The following information will be added to each image or to the first image
on each film (configurable by Service during software installation):
• patient name
• birth date

• examination ID
• patient sex
• examination date
• examination time
• physician’s name
• hospital name.
Other examinations can be selected before the transfer process has been
completed. Each examination will start on a new film. The film format is
Service configurable.
How to cancel the HCU transfer process
1 Press F3, F4 or F5 [24] to select the Copy page.

2 Activate the ’Cancel’ function.
3 Select the examination to be cancelled.
4 Press |Enter| [21].
Cancelling is not carried out until processing of the current film is complete.
How to transfer photofile images to a non-remote-controlled HCU

For operating instructions, refer to the Operator’s Manual supplied with the
HCU. The image transferred will be that displayed on the viewing console
monitor (default). Take care not to change anything on the display while
manual hard copying is in progress.
5.0.7 Transporting the system

Not applicable.
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Preparing the system for diagnostic imaging 5.1
5.1 Preparing the system for diagnostic

imaging
This Section describes the extended procedures. Basic information
concerning the following sections is detailed under the corresponding
heading in Section 5.0 ‘Basic procedures’.
Overview of preparation procedures:
Setting the geometry Pivot option How to pivot the table

(§ 5.1.1)
Tilt option How to tilt the table
Application settings Upper peripheral procedures -

(§ 5.1.2)
Cervical myelography with direct -
puncture procedure
Non-vascular interventional -
procedures
Cardiac procedures -
Trauma patients -
Neuro procedures -
Rotational angiography Using C-arm rolling movement
Using C-arm propeller

movement
Thoracic and abdominal -

procedures
X-ray filters and X-ray filters -

accessories (§ 5.1.3)
Cerebral filter How to fit the cerebral filter
How to remove the cerebral

filter
Image intensifier entrance screen How to remove the II entrance

grid screen grid
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How to fit the II entrance screen

grid
Table mounted radiation shield How to mount the radiation

shield to the table
How to deploy the upper shield
how to fold the upper shield

down
How to park the radiation shield

5.1 Preparing the system for diagnostic imaging
X-ray filters and Ceiling suspended radiation shield How to position the ceiling
accessories (§ 5.1.3) suspended radiation shield
(continued)
Ratchet compression band How to attach the compression
band unit to the edge of the table
How to use the compression

band
How to remove the compression

band unit from the edge of the
table
Head supports How to use the head supports
Table accessory clamps Rail accessory clamps
Tabletop accessory clamps
Arm supports How to use the arm supports
Adjustable arm supports How to attach the adjustable arm

support to the table
Catheterization arm support How to use the catheterization

arm support
Table tilt accessories How to attach the footrest
How to fit the ankle straps
How to fit the shoulder supports
How to attach the handgrips
How to position the chin

support
XB and colour Reference setting How to recall the reference

monitors (§ 5.1.4) setting
User reference setting How to recall the user reference

setting
How to store a new user

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reference setting
200X ultrasound Preparing the scanner How to disinfect the probes

scanner (§ 5.1.5)
How to switch the scanner on
Needle guides How to prepare the needle

guides
How to switch the scanner off and -

park the control panel

APR handling (§ 5.1.6) How to change APR parameters -
Selectable frame speeds -
Alter sequence -
Selectable values Digital vascular [frames/s]
Sequence display Lock-in mode
Integrated sequential scan mode
Bolus chase
Rotational angiography
Automatic position Scratch mode How to use the scratch mode

control (§ 5.1.7)
Sequencer mode How to use the sequencer mode
Reference mode How to use the reference mode
5.1.1 Setting the geometry

This section describes the pivot and tilt options for the AD5 patient support
(table).
Pivot option
Pivoting the table around a fixed point (table base).
Conditions
The pivot option must be installed on the AD5 table.
How to pivot the table
1 To pivot the table, push the side of the table in the required direction. It is
advisable to push the head end of the table at least 1.5 m (59.1 inch) from
the pivot point with the tabletop brakes activated.
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36280300
13° pivot position, -90° pivot position and +90° pivot position
SyncraTilt option
The tabletop can be tilted head-down (max. -28°) and head-up (max. +20°)
using the |Table tilt movement| [139] control. The actual tilt angle is shown
on a scale on the table column and is also given on the display unit [124].
The SID is normally indicated [124] when the tabletop is in the horizontal
position.

If the tabletop is in a tilt position, the tabletop can be panned using control
[131]. The transverse movement is manual and longitudinal movement is
motorized. To activate the motorized longitudinal movement, press |Both
tabletop brakes on/off and longitudinal movement| [131] in the required
direction. As the longitudinal panning speed depends on the side-pressure
applied to control [131], use a gentle force to ensure smooth movement.
WA R N I N G S • Although an automatic safeguarding system is fitted, care must be taken to prevent

any collision between the patient and the equipment.
• Care must be taken to prevent anything being trapped between floor and tabletop.
• Ensure there is sufficient free space to allow maximum longitudinal tabletop
panning. The tabletop is not provided with collision sensors to stop longitudinal
movement if a collision occurs.
Various isocentric tilt positions are illustrated below. Isocentric tilting is only
possible if configured (Service).
36280310
Isocentric HDT with P-A projection Isocentric HUT with P-A projection
for patient in supine position or A-P for patient in supine position or A-P
projection for patient in prone position projection for patient in prone position.
36280320
Isocentric HDT, lateral projection Isocentric HUT, lateral projection

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Conditions
The SyncraTilt option must be installed on the AD5 table.
When the tabletop is moved from a head-down (maximum tilt -28°) to a
head-up (maximum tilt +20°) position, or vice versa, the movement stops
when the tabletop is in the horizontal position. To continue the movement,
release |Table tilt movement| knob [139] then push it again in the required
direction.
How to tilt the table
1 Unlock the knob [139] by pressing it down and turning it 90° clockwise.

2 Use the |Table tilt movement| knob [139] to adjust the tilt angle of the table.
3 To avoid an accidental tilt movement, lock the knob [139] by pressing it
down and turning it 90° counter-clockwise.
Pressing the |Movement override| button [140] disables the automatic tilt
movement safety system which safeguards patient and equipment. If either
the |Table tilt movement| [139] or |Table height adjustment| [133] joystick is
then used, an audible signal warns the operator of the increased collision risk
during a tilt or height movement.
5.1.2 Application settings

The procedures mentioned in this section describe the preferred stand
positions related to the examination types.
Upper peripheral procedures
36280560
Preferred settings
N OT E The preferred settings are illustrated for the floor mounted C-arm stand but the same
settings are also used for the ceiling suspended C-arm stand.
Preferred procedure
1 Set table rotation and tilt to 0°.

and 0° angulation.
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3 Pivot the table into a locked position away from the C-arm and retract the
tabletop towards the table base for convenient transfer of the patient onto the
table.
4 Place the patient in the supine position with the head as close as possible to
the edge of the tabletop.
5 Pivot the table to the locked position at +13° for the right arm or -13° for the
left arm.
6 Position the arm on the arm support at an angle of about 35° with the body.
7 Pivot the L-arm to -40° for the right arm or to +40° for the left arm in order
to align the shutters with the arm.

8 Adjust the table to a convenient working height.

9 For further positioning of the region of interest (ROI) use the table
movements (horizontal float).
10 Move the II as close as possible to the object.
11 The full length of the arm can be scanned using the floating movement of
the tabletop.
Other procedures
As above, but with the II under the table.
Cervical myelography with direct puncture procedure

For clinical convenience in direct puncture cervical myelography, the
physician requires access to the head of the patient and the orientation of the
image on the monitor must match the orientation of the puncture needle.
The following settings are therefore recommended.
36280570
Preferred setting
Preferred procedure

2 Rotate the C-arm to bring the X-ray tube under the table.
3 Pivot the L-arm perpendicular to the table at +90°.
4 Pivot the table to a locked position away from the C-arm and retract the
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table.
5 Place the patient in the prone position with the head as close as possible to
6 Move the table back to its 0° position (non-rotated position).

7 Set the C-arm rotation to +90° (II at right side of patient and C-arm under
the table).
8 Adjust the table height so that the ROI is at the isocenter.

9 Set the C-arm angulation to +90° (C-arm lies in horizontal plane and
surrounds the head-end of the table) so that the orientation of the image on
the monitor matches that of the needle to facilitate accurate positioning of
the needle.
10 For further positioning of the ROI use the table movements (horizontal float
and table height).
11 After positioning the needle and injecting the contrast medium, the required
projections can be set for image acquisition.
Non-vascular interventional procedures

Due to the diversity of these types of procedures no preferred settings can be
given as these vary according to the procedure used. The II is usually
positioned above the table but if more space is required above the patient
(e.g. to accommodate use of long needles) the II can be positioned under the
table. The table isocentric tilt facility is very useful in many non-vascular
interventional procedures. Gravity can be used to assist the procedure (e.g.
for draining) by applying an HDT or HUT.
Cardiac procedures
36280330
Preferred settings Other settings
Preferred procedure
1 Set the L-arm rotation to 0° (in line with the table).

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table.
5 Place the patient in the supine position with the head as close as possible to

8 Set the C-arm rotation and angulation for the required projection.
and table height).

Other procedures
As above but with the L-arm rotated to +90° or -90°, so that the C-arm is
perpendicular to the table.
Trauma patients
For procedures that require free access for a trolley to the C-arm stand in
cases of emergency, trauma etc.
Preferred procedure
1 Pivot the table to the +90° or -90° position (see Section 5.1.1 ‘Pivot option’).
Neuro procedures
CAUTION Always use the wedge shaped neuro head rest to position the head at the isocenter
while ensuring a convenient working height.
36280330
Preferred procedure
1 Set the L-arm rotation to 0° (in line with the table).

and 0° angulation.
table.
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to the edge of the tabletop

7 Use the table height and the horizontal float controls to position the region
of interest (ROI) at the isocenter.

8 Adjust the rotations and angulations of the C-arm for the required
projections.

Other procedures
As above but with the L-arm rotated to +90° or -90° so that the C-arm is
perpendicular to the table (see also ‘Rotational angiography’).
Rotational angiography - using C-arm rolling movement
36280340
Preferred procedure

3 Pivot the L-arm perpendicular to the table at +90° or -90°.
table.
to the edge of the tabletop.
7 Move the tabletop longitudinally to bring the ROI in front of the image
intensifier and, if necessary, move the C-arm along the table.
WA R N I N G Make sure that no collision can occur during rotation of the C-arm, as all bodyguards
are switched off during rotational angiography acquisition.
10 Rotate the C-arm to the required end-position of the scan and store this
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position in the Store 1 memory by pressing |Store position 1| [142].

11 Rotate the C-arm to the required start-position of the scan and store this
N OT E Positioning the C-arm in the pre-defined end or start position can be done using the
|Recall position 1 or 2| key [144] on the geometry module.

Other procedures
The procedure described above allows scanning of the ROI in a plane
perpendicular to the object. However, it is also possible to scan in a plane
with a skewed angle to the object. If this is required carry out one of the
following alternative procedures while keeping all other preferred settings
unchanged:
• pivot the L-arm only, so that it makes a skewed angle with the table, or
• keep the L-arm perpendicular to the table but angulate the C-arm, so that
it makes a skewed angle with the L-arm, or
• do both, i.e. pivot the L-arm and angulate the C-arm with respect to the
L-arm.
Rotational angiography - using C-arm propeller movement
36280580
Preferred procedure

3 Move the L-arm parallel to the table at the 0° head position.
table.
7 Move the tabletop longitudinally to bring the ROI in front of the image
intensifier and, if necessary, move the C-arm along the table.
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WA R N I N G Make sure that no collision can occur during rotation of the C-arm, as all bodyguards
are switched off during rotational angiography acquisition.
10 Rotate the C-arm to the required end-position of the scan and store this
11 Rotate the C-arm to the required start-position of the scan and store this

N OT E Positioning the C-arm in the pre-defined end or start position can be done using the
|Recall position 1 or 2| key [144] on the geometry module.
Thoracic and abdominal procedures
36280350
Preferred procedure

3 Move the L-arm perpendicular to the table at +90° or -90°.
table.
8 Adjust the C-arm rotation and angulation for the required projection.
and table height).
Other procedures
As above but with the L-arm in the 0° position in line with the table.
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5.1.3 X-ray filters and accessories

X-ray Filters
Various filters can be placed in the X-ray beam to compensate for large
differences in the absorption of the object.

Different filters are used according to the ROI, the projection and the
imaging technique.
Cerebral filter
The cerebral filter is used for neuro angiographies of the head and avoids
direct radiation on the image intensifier entrance screen, thus improving the
overall image quality.

WA R N I N G Ensure that the filter is securely in position during use.
Conditions
The cerabral filter is only to be used for cerabral angiography examinations.
How to fit the cerebral filter
1 Push the cerebral filter into the rim on the X-ray tube housing.
36270140
How to remove the cerebral filter
1 Remove the cerebral filter by inserting a finger into the filter hole and lifting
the filter out of the rim on the X-ray tube housing.
Image intensifier entrance screen grid

The Image Intensifier (II) entrance screen grid is used to filter out stray
radiation. The II entrance screen grid should be removed prior to procedures
where a low X-ray dose is required, e.g. pediatric studies.
Conditions
There are no special conditions for the following procedures.
How to remove the II entrance screen grid
1 Using a 2 mm Allen key, remove the four

screws and washers that secure the II
entrance screen cover plate to the II
housing.
36270150
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Entrance screen with screws removed
2 Move the lever (a) of the cover plate

towards the centre of the cover plate
and remove the cover plate from the
a
II entrance screen.
36270160

36270170
Cover plate removed
3 Move the lever (b) of the II entrance

screen grid towards the centre of the
II entrance screen grid and remove
the II entrance screen grid from the
II entrance screen.
b
36270180
36270190
Entrance screen grid removed
4 Refit the coverplate to the II

entrance screen by positioning pin
(c) of the coverplate into the
corresponding recess (d) of the II d
entrance screen and then by pulling c
back lever (a) and pushing the cover
plate back into place. Ensure lever (a)
36270200
locates back into its retaining slot.
5 Secure the II entrance screen cover plate to the II housing using the four
screws and washers removed in step 1.
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How to fit the II entrance screen grid
1 Using a 2 mm Allen key, remove the four

screws and washers that secure the II
entrance screen cover plate to the II
housing.
36270150
Entrance screen and cover plate with

screws and washers removed

2 Move the lever (a) of the cover plate

towards the centre of the cover plate
and remove the cover plate from the a
II entrance screen.
36270160
36270190
Cover plate removed
3 Fit the II entrance screen grid to the

f
II entrance screen by positioning pin
(e) of the grid into the corresponding
recess (f) of the II entrance screen e
and then by pulling back lever (b)
and pushing the grid back into place.
Ensure lever (b) locates back into its
36270210
retaining slot.
4 Refit the coverplate to the II

entrance screen by positioning pin
(c) of the coverplate into the
corresponding recess (d) of the II d
entrance screen and then by pulling c
back lever (a) and pushing the cover
plate back into place. Ensure lever (a)
locates back into its retaining slot. 36270200
5 Secure the II entrance screen cover plate to the II housing using the four
screws and washers removed in step 1.
Table mounted radiation shield

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The table mounted radiation shield offers the physician and staff additional
protection against scattered radiation. Maximum protection can be achieved
by using the table mounted radiation shield in conjunction with the ceiling
suspended radiation shield.
WA R N I N G Before using the radiation shield, check that the shielding material is not damaged.
The shield should be free from visible cracks and tears when examined using
fluoroscopy. It is strongly recommended to perform this check on a regular basis (see
Section 7, ‘Maintenance’) and whenever there is a possibility that the shield may have
been damaged.

CAUTION Always remember to remove the radiation shield from the table accessory rail before
tilting the table.
Conditions
How to mount the radiation shield to the table
1 Hold the radiation shield with the right

hand on the clamping knob and the left
hand on the arm of the shield.
33725550
2 Slide the clamping device to the edge of
the table accessory rail.
3 Turn the knob clockwise to clamp the
shield to the table accessory rail.
33725560
The radiation shield can be manually located into one of the following
positions:
• working position with lower and upper shield
• working position with lower shield only (upper part folded down)
• parking position (shield stowed under the table).
36280080
Lower and upper shield, Lower shield only and Parking position
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How to deploy the upper shield
1 Lift the shield upwards.

33725580

2 Keep lifting it up until locking pins (a)

drop into the notches (b).
a
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How to fold the upper shield down
1 Pull the shield upwards to lift the

locking pins (a) out of their locating
notches (b).
2 Fold the upper shield down.
36280090
How to park the radiation shield
1 If the upper shield is deployed, fold it

down.
2 Move the radiation shield backwards
until it is perpendicular to the length
of the table.
36280100
Ceiling suspended radiation shield
The ceiling suspended radiation shield offers the physician and staff
additional protection against scattered radiation. Maximum protection can
be achieved by using the ceiling suspended radiation shield in conjunction
with the table mounted radiation shield.
WA R N I N G Before using the radiation shield, check that the shielding material is not damaged.
9896 001 33152
The shield should be free from visible cracks and tears when examined using
fluoroscopy. It is strongly recommended to perform this check on a regular basis (see
Section 7, ‘Maintenance’) and whenever there is a possibility that the shield may have
been damaged.
CAUTION Always be aware that collisions may occur with the ceiling suspended radiation shield
during positioning of the monitor ceiling carriage and/or during positioning of the
geometry segment. Such collisions must be avoided as this may cause damage to the
equipment.
Conditions
If required, place a sterile bag, from the bottom, over the apron and lead
acrylic shield, secure the bag in the two notches on the lead acrylic shield (a).

How to position the ceiling suspended radiation shield
1 Using the pivot action and up/down movement of the suspension arm,
manually move the shield to the desired position (b).
2 If required, tilt the shield to the desired position (c).
36280110
Optimal protection can be achieved by using the ceiling suspended radiation
shield and the table mounted radiation shield together.
36280150
Ratchet compression band

The ratchet compression band is used to immobilize patients and to decrease
movement artefacts on the images.
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WA R N I N G The ratchet mechanism exerts considerable mechanical force while the strap is being
tightened. Be careful to control the amount of pressure used.
Conditions
How to attach the compression band unit to the edge of the table
1 Position the unit on the edge of the table and tighten the knurled fixing
screws underneath the unit.

How to use the compression band
33724550
a b
1 Push the release lever [a] downwards to release the strap.

2 Pull out the strap, pass it over the patient and under the table, and then pass
the end over the roller.
3 To increase compression, turn the ratchet winder [b] clockwise. To decrease
compression, push the lever downwards and turn the winder counter-
clockwise.
4 When finished, reduce compression as in procedural step 3, then rewind the
strap by turning the winder further counter-clockwise.
How to remove the compression band unit from the edge of the table
1 Slacken the knurled screws and slide the complete attachment from the table.
Head supports
Head supports are used to immobilize the pat ent’s head and for patient
comfort during the examination, this in turn reduces motion artefacts on the
images.
Conditions
A piece of anti-slip foil, cut from the reel supplied and renewed when
necessary, should be placed between the head cup and the table to prevent
the cup from slipping.
How to use the head supports
c
b
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33724560
1 Place the head cup [c] at the head end of the table on a piece of non-slip foil.
2 If the head is to be tilted, place one or both wedges [a, b] under the head cup.
3 Position the patient so that the head lies comfortably in the cup.

Table accessory clamps
33723550
Rail accessory clamps Tabletop accessory clamps
Rail accessory clamps

The rail accessory clamps are attached to the table accessory rail in order to
be able to attach other accessories.
Conditions
When no other accessories are fitted to the clamps, the clamps should be
removed from the rails.
How to fit the rail accessory clamps

1 Slide the clamp(s) on to the accessory rail.
2 Fit an accessory into the clamp(s).
3 Turn the knob so that the clamp and accessory are firmly attached to the
accessory rail.
Tabletop accessory clamp

The tabletop accessory clamps are attached to the table side in order to be
able to attach other accessories.
Conditions
There are no special conditions for the following procedure.
How to fit the tabletop accessory clamps

1 Slide the clamp(s) on to the edge of the tabletop.
2 Secure the clamp(s) by tightening the lever on the clamp underside.
3 Fit an accessory into the clamp(s) and tighten the accessory securing lever.
Arm supports
The arm supports are only used for patient comfort during examination.
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Conditions
There are no special conditions for this procedure.

How to use the arm supports
33724570
a b
1 Slide the long part of the support [a, b] under the patient at forearm level and
place the arm in the channel so formed.
2 Repeat procedural step 1 for the other arm.
Adjustable arm support

The adjustable arm support is used to support the arm during venous Digital
Subtraction Angiography (DSA). The height (adjustable) of the arm support
influences the blood flow.
Conditions
How to attach the adjustable arm support to the table
b
33724580
1 Slide the clamp over the edge of the table to the right of the patient at
shoulder level.
2 Fix the clamp by turning the lever underneath.
3 Set the angle of the support as required by rotating it on the frictional pivot
[b].
4 If the handgrip on the top of the adjustable arm support is not required, it
may be removed after loosening the knurled nut [a], and an end stop
substituted.
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Catheterization arm support

33726320
The catheterization arm support is used for upper peripheral and brachio
cephalic catheterization procedures.

Conditions
The patient must be positioned on the table before sliding the
catheterization arm support under the patient’s shoulder.
How to use the catheterization arm support
1 If applicable, position the stand in accordance with the upper peripheral

procedure (see Section 5.1.2 ‘Application settings’).
2 Slide the catheterization arm support under the patient’s shoulder.
Table tilt accessories

The table tilt accessories are used to prevent the patient from sliding off the
table during table tilt movements.
WA R N I N G All accessories are intended to help secure the patient to the tabletop. When attaching
the accessories, always check correct positioning and fixing of the clamps. This is very
important to prevent the patient sliding off the table during a tilt movement.
Conditions
Accessories required during patient examination should be fitted prior to
patient positioning.
WA R N I N G The ankle straps must always be used in combination with the two handgrips as a
safety backup.
How to attach the footrest

The footrest is attached using the
normal rail accessory clamps.
1 Mount the two clamps on either
side of the tabletop.
Note that there is only one position
in which the footrest can be fitted.
2 Fit the footrest into the clamps and
tighten the clamps. 33724590
The footrest can be used with the patient

prone or supine.
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If necessary, a mattress can be placed

under the footrest.
33724600
Prone position

33724610
Supine position
How to fit the ankle straps

The ankle straps consist of left and right
ankle harnesses, each with an attachment
ring, a belt with buckle, fastener and
attachment ring and a peg with a table
rail clamp.
1 Attach the peg to the foot end of the
33724620
tabletop rail using the rail accessory
clamps.
33724630
2 Place the ring over the peg.
33724640
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3 If necessary, release the fastener and

adjust the length of the belt.
33724650

4 Lock the fastener.

5 Fit the ankle harness to the patient’s
ankles.
6 Finally, secure the patient by connecting
the belt buckle to the harness rings. If
necessary, readjust the length of the belt.
33724660
The straps can be used with the patient
prone or supine.
33724670
Prone position
33724680
Supine position
How to fit the shoulder supports

The shoulder supports are attached to the tabletop using special tabletop
clamps.
Conditions
The following procedure is only valid for a normal (i.e. non-neuro) tabletop.
1 Mount two clamps on the tabletop
without tightening them
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2 Fit the shoulder support into the clamps.

3 Tighten the tabletop clamps.
33724690

The position of the two foam shoulder

supports can be adjusted to suit the
patient.
33724700
The supports can be adjusted to fit a
prone or supine patient.
33724710
Prone position
N OT E The shoulder supports should not be used for examination of the neck region as they
are opaque to X-radiation. For this type of examination, it is better to use the ankle
straps to secure the patient.
33724720
Supine position
How to attach the handgrips

Two short and two long handgrips are
available for patient comfort and safety.
They must be used as safety backups for
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ankle straps. They can be attached to

either side of the tabletop.
Short version
33724730
1 Fit the handgrips into the tabletop

accessory clamps and tighten the clamps
to secure the handgrips.
Long version
1 Fit the handgrips into the rail accessory clamps and tighten the clamps to
secure the handgrips.

How to position the chin support

A foam chin support helps ensure the
comfort of the patient.
1 Ensure the patient is in the prone
position.
2 Place the thick end of the wedge shaped
chin support under the patient’s chin.
33724710
5.1.4 XB and colour monitors
The XB monitors are used to display all live and reference images during
examinations. The XB monitors have a light sensor which detects the
ambient light in the examination room and automatically adapts the
brightness of the monitors.
The colour monitor is used to display colour images and data in the
examination room, for instance provided by, either:
• A hemodynamic acquisition system, or
• INTEGRIS 3D-RA.
Reference setting
The reference setting is the default (factory adjusted) brightness and contrast
setting of the monitor(s). Recalling the reference setting restores the
brightness and contrast settings of all individual monitors in the examination
room to reference setting. The reference setting can be activated on either
monitor (daisy chain).
Conditions
How to recall the reference setting
1 Press |Brightness increase| [112] and |Brightness decrease| [113]

simultaneously.
The following window will be displayed on the monitors:
MODE
REF. SETTING 1
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The reference setting is recalled for all monitors in the examination room.
User reference setting

The user reference setting is the default (user adjusted) brightness and
contrast setting of the monitor(s). Recalling the user reference setting restores
the brightness and contrast setting of all individual monitors in the
examination room to user reference setting. The user reference setting can be
activated on either monitor (daisy chain).
Conditions

N OT E When adjusting the user reference setting, the ambient lighting does not need to be
taken into consideration.
How to recall the user reference setting
1 Press |Contrast increase| [114] and |Contrast decrease| [115] simultaneously.

MODE
USER SETTING
The user reference setting is recalled for all monitors in the examination
room (daisy chain).
How to store a new user reference setting

This function allows a currently active brightness and contrast monitor
setting to be stored as new user reference setting for all monitors (daisy
chain). The (new) user reference setting can be defined on either monitor
and can be recalled for all monitors in the examination room whenever the
user reference function is activated.
1 If necessary, change the brightness and/or contrast level to the desired
reference level by pressing the |Brightness increase/decrease| [112, 113] and/
or |Contrast increase/decrease| [114, 115] keys.
2 Press |Brightness increase| [112] and |Contrast decrease| [115]
simultaneously.
MODE
USER STORE
The new user reference setting is stored for all monitors in the examination
room.
5.1.5 200X ultrasound scanner

The ultrasound scanner is used to produce images, which in addition to X-
ray images provide a different perspective for the operator.
WA R N I N G S • Prepare the probe for sterile conditions as required. The probe is not shipped sterile.
9896 001 33152
• If a probe is dropped on the floor, always have it inspected by a service engineer to

avoid serious injury due to damaged insulation.
• Do not use a probe that is damaged.
• Cracks, breaks or other damage to the probe housing or cable can present an
electrical hazard.
CAUTIONS • Inspect the probe for cracks and other damage before use.
• Avoid pinching or kinking the probe cable.
• Disconnect the probe from the scanner before cleaning or disinfecting it.
• Do not immerse the probe in water.
• Never operate the equipment at an ambient temperature greater than 40 °C.
• Avoid installing the unit near a heater or in direct sunlight.

• To avoid serious damage to the scanner and/or probes only connect or disconnect
the probes when the scanner is switched off (when the indicator lamp above the
probe connection on the scanner is off).
Conditions
The probes must be replaced in the probe-holders (located at the back of the
control panel) or in their original case before moving the monitors and
scanner.
When using probes under sterile conditions wrap the disinfected probe in
protective sterile covers.
Use a protective sterile probe cover or sheath to cover the probe during
patient examinations. To avoid patient-to-patient contamination, dispose of
the probe cover or sheath immediately after each examination.
When using probes in an intraoperative procedure, clean and disinfect the
probe prior to use and between each examination. Disinfection is required
before the first examination and between all subsequent examinations.
Preparing the scanner
How to disinfect the probes
1 Disinfect the probe using CidexTM Activated Dialdehyde solution in

accordance with the manufacturer’s instructions.
2 After disinfecting the probe, rinse it in sterile water.
How to switch the scanner on
1 Move the control panel from the parked position underneath the monitor(s).
2 Check the probe(s) (housing, cable and connector) and the scanner for
damage.
3 Connect each probe to the scanner with cable pointing downward.
4 Check that the connections are secure.
5 Press the |System on| button [F] on the scanner front panel.
After switching on, the system is ready for use when the key lights (after
approximately 5 seconds). The indicator above the probe connection on the
scanner is also lit. The examination monitor displays the ultrasound image
automatically.
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N OT E If the system is switched off immediately after switching on, it cannot be switched on
again immediately. Wait 10 seconds before switching the system on again.
6 Select a probe using the |Probe selection| key [235].

7 After acquiring images (see Section 5.1.5 ), switch off the scanner.
8 Using a sufficient quantity of gel, position the probe on the skin over the area
of interest. If necessary, use the cable hook under the swivel arm and on the
left side of the scanner to keep the probe cables properly aligned.

Needle guides
Needle guides are used to direct the needle to a specific region of interest, as
seen on the monitor.
Conditions
Clean and sterilize the needle guide prior to use and between examinations.
The needle guide is not shipped sterile.
Only use the needle guide when the probe is covered with a sterile sheath.
Handle the needle guides with care. Inspect daily to ensure that they are not
bent or otherwise distorted.
Needle guides must not be used for chorionic villi sampling, percutaneous
umbilical blood sampling, or in vitro fertilization.
WA R N I N G Do not use the needle guide if it is distorted in any way until a service engineer inspects
it.
How to prepare the needle guides
1 Clean the needle guide before each examination to remove all visible tissue
residue, fluid or other material.
2 Scrub the needle guide with water and a mild detergent. Use pipe cleaners to
clean the lumen of the needle guide.
3 Sterilize the needle guide prior to first use and between all subsequent
examinations. There are two ways to sterilize the needle guide:
• steam autoclaving
• soaking the needle guide in CidexTM Activated Dialdehyde Solution in
accordance with the manufacturer’s instructions.
4 After sterilizing the needle guide, rinse it in sterile water.
7.5 MHz linear array probe

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33724740
Fitting the needle guide to the 7.5 MHz linear array probe
5 Slide the needle guide holder (type II) over the probe cover onto the ‘V’
attachment on the probe.
6 Fix the holder to the probe cover by tightening the thumb screw.

7 Slide the needle guide for the required needle size into the needle guide
holder.
8 If necessary, rotate the needle guide to allow the needle to be inserted and
removed.
Other probes

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Attaching the needle guide to the 5.0/7.5 MHz, 3.5/5.0 MHz or 3.5 MHz HD probe
1 If still in place, remove the black rubber ‘O’ ring from around the probe.
2 Slip the needle guide clamp (type I) onto the probe, making sure that the
locating pin engages in the locating hole.
3 Apply contact gel to the probe and insert the probe into the sterile probe
cover provided with the disposable kit.
4 Snap the needle guide holder over the probe cover onto the clamp.
5 Slide the needle guide for the required needle size into the needle guide
holder.
6 Insert the needle into the guide and rotate the guide so that it locks into the
holder.
How to switch the scanner off and park the control panel
CAUTION When positioning the arm of the scanner tray under the monitors make sure that the
probes in the probe tray do not collide with the handles underneath the monitors.
1 Press the |System off| button [G] on the scanner front panel.
The examination monitor re-displays the X-ray image.
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2 Return the probes and scanner to their parked position.


33724940
Control panel in parked position
5.1.6 APR handling

Anatomical Programmed Radiology (APR) are the pre-programmed image
technique settings.
This section describes how to customize APR default parameters.
The altered parameters retain their new values provided the system remains
switched on, no reset is performed, no new patient is selected and the same
APR is used. Selection of another imaging technique will not affect the
values. Selection of another APR within one imaging technique will not
affect APRs belonging to another imaging technique.
Conditions
When the system is switched off and switched on again, a new patient is
selected or another APR within the same imaging technique is selected, the
system will return to the default APR parameters.
How to change APR parameters
1 Press |Alter APR| [10] on the acquisition console.

The indicator near the key will light and a parameter-adjustment window
will appear on the text display.
The first parameter that can be adjusted by the operator will be highlighted
and its value can be changed with the |Dial wheel| [8]. Values for all
parameters can be dialed from a table of values to prevent invalid inputs.
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Selectable values start from the current value.

2 Turn the |Dial wheel| [8]:
• clockwise to select the next higher value from the corresponding table
• counter-clockwise to select the next lower value.
3 To accept the displayed value, press |Enter| [9].

The next adjustable parameter is highlighted.
Press the |Enter| key [9] repeatedly to step through the parameters without
making adjustments. When the last APR parameter in the list has been
adjusted or skipped, the sequence can be repeated, starting from the first
APR parameter.

4 To terminate the procedure, press the |Alter APR parameters| key [10] on the
acquisition console again.
The altered APR parameters will be stored and the indicator will flash for
about 2 seconds.
Overview of user-adjustable parameters
Imaging technique Parameter
Digital-vascular Runtime 1 - Runspeed 1
Alter sequence Runtime 2 - Runspeed 2

Runtime 3 - Runspeed 3
Alter KAT Bolus-chase-kat

Total number of images
Digital dynamic Focal spot

kV (manual only)
Miscellaneous: Focal spot

2-factor technique kV, mAs (see note 1)
3-factor technique kV, mA, ms (see note 2)
N OT E S • For a 2-factor technique, the kV and mAs values can be adjusted. When the kV value
is changed, the new mAs value is checked to ensure that it lies within the limits of
the mAs parameter. Whilst this is taking place, the kV display flashes. If the mAs
value lies outside the limits, the highest possible mAs value is highlighted and the
current value can be altered. The system itself may also decrease the current value
if it lies outside the limits.
• For a 3-factor technique, the kV, ms and mA values can be adjusted. When the kV or
ms value is changed, the new mA value is checked to ensure that it lies within the
limits of the mA parameter. Whilst this is taking place, the kV or ms display
(whichever was changed) flashes. If the mA value lies outside the limits, the highest
possible mA value is highlighted.
Selectable frame speeds

Frame speeds [images/s] can be selected by choosing the correct APR (not via
the |Dial wheel| [8]). For selectable frame speeds, refer to tables in Section
4.2.5 ‘Digital acquisition’.
Alter sequence
The Alter Sequence function allows the speed and runtime of a Digital
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Vascular image acquisition to be changed. It is activated by pressing the |Alter

APR parameters| key [10]. The programmed acquisition sequence displayed
consists of three time/frame rate combinations.
During acquisition the active sequence is highlighted:
Duration Frame-rate
T1 s V1 /s
T2 s V2 /s
T3 s V3 /s

Duration Frame-rate
Total images: N1
Free run/img: N2/N3

N1 is the total number of images acquired in the system. N2/N3 is the free
disk capacity (runs and images). T1 , T2 and T3 are the periods (seconds) in
the sequence and V1, V2 and V3 are the delay or the acquisition speed in the
corresponding period.
The ‘Total images’ figure that is displayed and is calculated from the box
values T1 to V3 can exceed the free image capacity. If so, the user is informed
with a system message on the acquisition console:
‘Total-images: 35’
‘Free run/img: 5/24’
The displayed free capacity ‘N2/N3’ is the number of runs and images which
are free for the currently selected APR.
The total images is calculated as follows:
• complete pre-programmed sequence:
- (T1*V1)+(T2*V2)+(T3*V3)
• manual pre-programmed:
- (a) (T1*V1)+(T3*V2)or
- (b) (T1*V1)++(T3*V3).
If ‘Manual pre-programmed’ the system will use (a) or (b) whichever is

higher, to check if there is sufficient free image capacity. In case the ‘Total
images’ exceed the ‘Free image capacity’ an exposure run cannot be made
unless image capacity is reclaimed (delete examination) or the APR is
reprogrammed.
If ‘Total images’ exceeds 5000 then ‘>5000’ will be displayed at the
acquisition console.
If T1 is highlighted, the value can be:
• increased by turning the Dial wheel [8] clockwise
• decreased by turning the Dial wheel [8] counter-clockwise. Turning the
Dial displays each of the higher or lower values available. When a speed of
0 is selected, the display will show the word ‘Delay’ instead of the figure 0
• accepted by pressing |Enter| [9]. Time/frame rate combinations will be
highlighted in succession and in each case the displayed values can be
accepted or altered.
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The Alter Sequence function can be terminated by pressing the |Alter APR
parameters| key [10] again. The new total number of images is then
calculated and displayed. A programming example is given at the end of this
section.
Selectable values
• T1 0, 1, 2, 3, ..... 19, 20
• T2 Manual, 0, 1, 2, 3, ..... 19, 20
• T3 0, 1, 2, 3, ..... 19, 20 or 0, 1, 2, 3, ......39, 40 if T2 ‘manual’,
• V1, V2, V3 Selectable values of acquisition speeds depend on pre-
programmed APR parameters and the mains supply frequency (50 or 60
Hz).

Digital-vascular [frames/s]:
5122 matrix 10242 matrix
50 Hz 25, 12.5, 8, 6, 4, 3, 2.5, 2, 1, 0.5, 0 25, 12.5, 8, 6, 4, 3, 2.5, 2, 1, 0.5, 0
60 Hz 30, 15, 10, 7.5, 6, 5, 4, 3, 2, 1, 0.5, 0 30, 15, 7.5, 6, 5, 4, 3, 2, 1, 0.5, 0
N OT E S • The values shown are rounded-off and therefore approximate.

• Selection of lower speeds is always possible. Selection of higher speeds is possible up
to a maximum that is dependent on other factors in the selected APR.
Sequence display
The contents of the displayed sequence depend on the APR mode.
The following sequence displays are possible:
• normal sequence
• manual sequence
• ECG sequence
• high-speed sequence
• bolus chase
• rotational scan sequence.
Lock-in mode
Normal sequence
Duration Frame-rate
T1 s V1 /s
T2 s V2 /s
T3 s V3 /s
Total images: N1
Free run/img: N2/N3
Manual sequence
Duration Frame-rate
T1 s V1 /s
T3 s manual
V2 /s
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V3 /s
Total images: N1
Free run/img: N2/N3
The total time of the VFR period is given as T3 sec. The actual acquisition
speed is displayed as:
V2 (frames/s); the alternative acquisition speed as V3 (frames/s).
The entry order is T3 , V2 , V3.
ECG sequence
If ‘ECG’ is programmed during installation, the wait time (T1) and the run
time (T2) can be changed.

Duration Frame-rate
T1 s delay
T2 s ECG
Total images: N1
Free run/img: N2/N3

The maximum number of images that will be acquired is:
• single ECG: 3 x T2
• dual ECG: 6 x T2
This number of images must be available as free capacity in order to perform

acquisition.
High-speed sequence
The speed values 12.5 and 25 (50 Hz) / 15 and 30 (60 Hz) cannot be dialed
or changed by the operator. These values can be programmed during
installation. For these speeds, the sequence display will show:
Duration Frame-rate
T1 s delay
T2 s V2 /s
Total images: N1
Free run/img: N2/N3
T1 and T2 can be changed by dialing. Delay is fixed and V2 is fixed at 12.5

(50 Hz) / 15 (60 Hz) or 25 (50 Hz) / 30 (60 Hz).
Integrated sequential scan mode

Same as lock-in mode normal sequence, ECG and VFR sequence; for ECG
and VFR not all speeds are possible.
Bolus chase
Three APR modes are possible for bolus chase:
• Automatic bolus chase with subtraction (with bolus chase package only);
the system automatically selects the correct run sequence based on the
KAT (Knee Arrival Time). The KAT can be entered using Alter sequence.
• Interactive bolus chase with subtraction (with ‘bolus chase plus’ package
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only); only the normal sequence can be changed using Alter sequence.
• Non-subtracted; available using the Alter sequence function (VFR and
Normal sequence).
K.A.T. 7s
Total images: 37
Recommended injection:
8ml/s 80 ml (10s)
Total images: 21
Free run/img: 932

KAT and total number of images can be altered by pressing enter [9]. The
recommended injection parameters for the KAT specified are displayed. The
operator must also confirm the table start and end positions by moving the
table and using the Geometry module (see Section 4.3.5 Connection box
and tableside operation modules. The table start and end positions specify a
table-travel distance (TTD). The TTD influences the range of values
admissible for the ‘total number of images’. When the Acquisition console
receives a TTD, it calculates the new range for the ‘total number of images’.
If the current total number of images falls outside this range the value of this
parameter is automatically adjusted to the maximum/minimum admissible
value and the display is updated accordingly. This happens when a TTD is
received during alter-APR. The default range (after APR selection) is 9 - 39
images.
For rotational angiography by the cine technique, the sequence block can be
altered as described for the ‘high-speed’ sequence. For rotational angiography
by the phototimer technique the sequence can be altered as described for the
‘normal’ or ‘manual’ sequence. When the operator accepts the altered values
(by pressing the alter-APR key), the new total number of images is calculated
and displayed.

If the sequence display is as follows:
Duration Frame-rate
4s 1 /s
5s 8 /s
7s 3 /s
then dialing and entering ‘manual’ in box T2 generates a new sequence

display:
Duration Frame-rate
4s 1 /s
7s manual
8 /s
3 /s
The operator can successively enter new values for T3 (=7), V2 (=8) and V3
(=3).
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If the sequence display is as follows:
Duration Frame-rate
4s 1 /s
9s manual
6 /s
2 /s

With these acquisition sequence parameters, the system starts exposure (after
the test shot) at 1 frame/s over a period of 4 seconds. The system then
automatically switches to an acquisition rate of 6 frames/s for a maximum

period of 9 seconds. The actual acquisition period is highlighted. During this

9 second period, the operator can switch manually (VFR key) between the
two (6 or 2 frames/s) pre-programmed acquisition rates. In the above
example, the total run time never exceeds 13 seconds. Manual change of the
acquisition rate is possible during the last 9 seconds of the runtime. The total
number of images varies between 22 and 58, and the system displays: ‘Total
images: 58’.
If a ‘manual VFR’ APR program is selected, the sequence display always has
the following layout:
Duration Frame-rate
T1 s V1 /s
T3 s manual
V2 /s
V3 /s
If the ‘Alter sequence’ function is active the user can enter new values for T1,
V1, T2, V2, T3 and V3 successively. If another value is dialled and entered for
T2 (other than ’Manual’) then the sequence display will change into:
Duration Frame-rate
T1 s V1 /s
T2 s V2 /s
T3 s V3 /s
T3 s = 0 initially.
Now the user can dial en enter new values for V2, T3, and V3 successively.
If a ‘Manual VFR’ APR program is selected with the following sequence

parameters:
Duration Frame-rate
4s 1 /s
12s manual
6 /s
3/s
and with the ‘Alter sequence’ the T2 value (‘manual’) is changed to 7 and
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entered than the sequence display will change to:
Duration Frame-rate
4s 1 /s
7s 6 /s
0s 3/s
The user is now able to dial and enter new values for V2, T3, V3, T1, V1 and
T2 successively.

5.1.7 Automatic Position Control (APC)

The APC is used for storing and recalling geometric stand positions. The
exception is table movements.
During acquisition, the APC can be used in the following modes:
• scratch mode: for storing two specific stand positions for recall later,
during the same examination
• sequencer mode: the customer specific stand positions are programmed by
Service, these positions can be recalled at any time
• reference mode: allows reproduction of the stand position corresponding
to the image displayed on the reference monitor.
WA R N I N G Activating a recalled stand position may cause a collision; if necessary stop the recall
function and position the stand manually.
The current position is defined by the:

• angulation angle
• rotation angle
• SID.
Scratch mode
Two scratch mode stand positions can be stored and recalled. When scratch
mode is re-entered the previously stored positions are available provided that
the system function ‘new patient’ has not been activated.
Initially, 1 is set for a position with a rotation and angulation of 0° and a SID
of 1.0 m (39.4 inch). 2 is set for -45° rotation and 0° angulation with a SID
of 1.0 m. Positions can be stored in all APC modes and are displayed on the
display unit.
Conditions
Storing a new position overwrites the previously stored position.
How to use the scratch mode
1 Press |Store position 1| [162] or |Store position 2| [163] on the APC module,
the stand position is stored as position 1 or 2.
2 To recall position 1 or 2 press the |Select position 1 or 2| key [164] on the
APC module.
When the left side of the button is pressed, position 1 is recalled and
displayed on the display unit. When the right side of the button is pressed,
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position 2 is recalled and displayed.

3 Press and hold the |Accept and activate| key [165] to accept the position and
activate stand movement.
Movement is stopped by releasing key [165].

When the required position is displayed, it can be accepted by keeping [165]
releasing key [165]. The operator is responsible for avoiding collisions. When
the movement is complete, the other stored position is selected and
displayed.

Sequencer mode
Stand positions from one or more service installed sequences can be recalled.
Conditions
When only one sequence is available, the user function ‘select position’
becomes immediately active without displaying the sequence identification.
CAUTION The operator is responsible for avoiding collisions.
How to use the sequencer mode
1 Press the |Select sequence| set and position key [164] on the APC module to
choose from different customer specific pre-programmed sequences.
Pressing the left side of the button selects the previous sequence and pressing
the right side selects the next sequence. The current sequence is shown on the
Display unit.
2 Press the |Accept and activate| key [165] to accept and activate the current
sequence and display the first position on the display unit.
3 Press the |Select sequence| set and position key [164] to select the required
position within the programmed sequence.
Pressing the left side of the button selects the previous position and pressing
the right side selects the next position. The current position is displayed on
the display unit. By repeatedly pressing this key, all sequence positions can be
displayed.
Reference mode
Stand positions corresponding to the stored references (left and right) can be
recalled.
Conditions
When the mode is re-entered, the last stored positions are available provided
that the system function ‘New patient’ has not been activated.
How to use the reference mode
1 Use the |View forward/reverse| keys [30, 31] on the viewing console to select
the required image on the examination monitor.
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2 Press the |Store reference 1 or 2| key [74 or 75] to store the image in the
reference file.
The image is displayed on the reference monitor.
3 Press the |Select position| key [164] to select the reference stand position.
When the left side of the button is pressed, the stand position corresponding
to the image on the reference monitor is selected. If a second reference
monitor is present, pressing the right side of the button selects the stand
position corresponding to the image on that monitor. The selected position
is displayed on the display unit.


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5.2 Patient and examination data

Overview of patient and examination procedures:
Importing patient How to use the RIS interface -

data from the RIS
How to query the work list
interface (§ 5.2.1)
manager
Modifying How to modify examination data -

examination data
(§ 5.2.2)
Deleting an How to delete an examination -

examination (§ 5.2.3)
Modifying the time How to set the time and date -

and date (§ 5.2.4)
Physician page How to modify phisician data -

(§ 5.2.5)
How to delete phisician data
How to add new phisician data
5.2.1 Importing patient data from the RIS interface

The RIS interface allows communication of the INTEGRIS system with
a local Information System (IS).
Upon request from the INTEGRIS system, the complete work list with all
relevant patient and examination data is imported from the IS to the
INTEGRIS system. For each patient the following information will be
shown on the INTEGRIS system after it has been imported from the IS:
• patient data:
- patient name
- birth date
- sex
- patient ID
- scheduled physician’s name
- scheduled procedure step start time.
• examination/request information (only displayed in the ‘Information
screen’):
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- accession number
- requested procedure ID and description
- scheduled procedure step ID, description and start date
- scheduled station (Application Entity (AE)) title
- modality.
N OT E It will at all times be possible to enter manually patient demographics information
within the Integris in case of an emergency or in case the IS connection is down.
However, patient data received from the IS is automatically protected against
modification and cannot be modified within the Integris system. Instead, the data must
be modified in the IS itself and re-imported into the Integris system.

Patient and examination data 5.2
Each time the schedule page is selected [F1], the system automatically
performs a query to the Work list Manager (IS) for all the procedures that are
scheduled on this modality for today. The displayed work list is a merge of
the work list received from the information system and any patients which
have been entered manually. The displayed list is sorted by the Scheduled
Procedure Step start date and time.
It is also possible to perform a more specific query of the work list Manager
by selecting the ‘Query’ function, which becomes available once the schedule
page [F1] has been selected, and then entering values for a combination of
DICOM attributes, this is a user defined work list query. This type of query
can be divided into two groups:
• patient based query: query the work list for a particular patient
• broad query: query the work list for e.g. many patients.
The minimum requirement to perform a patient based query is:
• Patient name
• Patient ID
• Accession number
• Req. procedure ID.
The minimum requirement to perform a broad query is:
• Scheduled Procedure Step start date
• Modality
• Station AE title.
Conditions
Patient data must be available in the IS.
If the connection with the IS fails, within 30 seconds the message ‘No
connection with the Information System’ appears on the error line of the
schedule page. Under these circumstances, it is still possible to add a patient
record by hand following selection of the ‘Add’ function on the schedule
page.
When performing a work list Manager query:
• If there are no results on the query, the message ‘No query results’ is
displayed in the error line of the schedule page.
• If the query results exceed the maximum number of entries allowed, the
message ‘Number of results exceeds 50. Please be more specific’ is
displayed.
• If the Information System does not support the ‘Query’ function, the
message ‘This function is not supported by the information system’ is
displayed.
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• When wildcards are used when not allowed, the message ‘Invalid DICOM
attribute value’ is displayed.
How to use the RIS interface

1 Press F1 [24] on the keyboard to display the schedule page.

The scheduled patients list will be automatically updated from the RIS and
displayed.

36120060
patient examination.
How to query the work list manager
1 Press F1 [24] on the keyboard to display the schedule page.

2 Activate the ‘Query’ function [15].
The ‘work list Query Data Entry Screen’ is displayed.
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3 Use the |Cursor up/down| keys [20] on the keyboard, or the |Enter| key [21],
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to step through the different fields. Enter the data in each field as required.
The only field that allows wildcard matching is the patient’s name.
4 Pressing |Enter| [21] on the last entry field (Station AE title) automatically
starts the query toward the work list Manager.
5 If the query is not required, press |Return| to cancel the ‘work list Query
Data Entry Screen’ and return to the main schedule page.
The results of the query are displayed on the schedule page. The schedule
page remains empty while the query is being performed.

5.2.2 Modifying examination data

Examination data can be modified by using the ‘Modify’ function on the
schedule page (F1) or the review page (F2).
Conditions
In the case of a protected examination, it is only possible to modify the
physician code.
An examination that is being saved or copied cannot be modified until the
process has been completed.
If the physician code is modified for an examination in which images have
been acquired, the disk partition will not be changed.
How to modify examination data
1 Press F1 [24] to modify a scheduled examination, or press F2 [24] to modify

the data for an acquired examination.
The Schedule page or Review page respectively will be displayed with the
oldest examination highlighted.
36120060
2 Activate the ‘Modify’ function [15], which will be highlighted.

3 Press |Cursor up| and/or |Cursor down| [20] and, if necessary, |Next| and/or
|Previous| [15] until the examination to be modified is highlighted, then
press |Enter| [21].
4 Use the |Enter| key [21] to highlight the data field to be modified.
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5 Modify the data in the selected field and press |Enter| [21].
6 Proceed through the remaining data fields by pressing |Enter| [21] repeatedly.
To modify more examinations, repeat procedural steps 3 to 6.

5.2.3 Deleting an examination

The ‘Delete’ function allows examinations to be removed.
Conditions
Any examination can be deleted from the Schedule page (F1).

Only the oldest examination and the current examination can be deleted
from the Review page (F2).
If the current viewing examination is deleted, the current acquisition
examination will be set as current viewing examination.
If the current acquisition examination is deleted, the system automatically
selects a ‘No Name Entered’ acquisition examination as current. This text is
automatically removed when a new acquisition examination is selected.
If an examination is protected against manual deletion, the following
warning message is displayed, ‘Exam. protected against manual deletion. Do
you want to proceed (Yes/No)’ (default answer is ‘No’). Answering ‘Yes’ to
this question will result in the deletion of the examination even if it is
protected, this facility has been included for emergency situations.
How to delete an examination
1 Press F1 or F2 [24].
The Schedule or Review page is displayed with the oldest examination
highlighted.
Daniel Balavoine 1934-03-23 M 1254.831 J.S. 36120060
2 Activate the ‘Delete’ function [15], which will be highlighted.

3 Use |Cursor up| and/or |Cursor down| [20] to highlight the examination to be
deleted.
The prompt ‘Delete this examination (Y/N)?’ is displayed.
5 To delete the examination, type: Y, then press |Enter| [21].
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The highlighted examination is deleted, and the message ‘Examination being

deleted’ is displayed. Type: N to cancel the deletion.
To delete more examinations, repeat procedural steps 3 and 4.

5.2.4 Modifying the time and date

This function allows the operator to modify the system time and date using
the system page (F6).

Conditions
On the system page (F6) only the time and date can be modified by the
operator, all other items are configured by Service during installation.
How to set the time and date
1 Press F6 [24] to select the System page.
PHILIPS INTEGRIS 1997-11-18 System Page
33725120
Set time Set date Service Test Img IQ Tools
2 Select ’Set time’ or ’Set date’ [15].

The system will prompt for entry of the new time or date. The time format
is: hh.mm. The date format is configurable during installation.
3 Confirm the settings by pressing |Enter| [21].
5.2.5 Physician page

The physician data can be modified, deleted or new physician data can be
added using the physician page (F7).
The physician page can be used to define the external (DICOM) receiving
station for post processing or archiving purposes, also, the disk partition can
be allocated (cardiac/vascular studies) using the physician page.
Conditions
It is not possible to have identical physician codes.
How to modify physician data

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1 Press F7 [24] to select the physician page.


PHILIPS INTEGRIS 1997-11-18 Physician Page
Name Code Disk A/B Station name Prot
Dr. Rogers A.C Abel Disk A Dr. Rogers workspot M
36120100
Add Delete Modify Previous Next
2 Select ’Modify’ using the corresponding function key [15].

3 Use the |Cursor up| or |Cursor down| keys [20] to highlight the name to be
modified.
5 As required, modify the:
• physician name
• physician code
• disk partition
• export station name (DICOM).
How to delete physician data

2 Select ’Delete’ using the corresponding function key [15].
3 Use the |Cursor up| or |Cursor down| keys [20] to highlight the name to be
deleted.
How to add new physician data

2 Select ’Add’ using the corresponding function key [15].
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3 Type the full name of the physician (max. 26 characters).

5 Type the corresponding physician code (max. 4 characters).

7 Select the disk partition and station name with the |Cursor up| and |Cursor
down| keys [20].

Making images 5.3
5.3 Making images

Overview of making image procedures:
Trace Subtract How to perform TSF -

Fluoroscopy (TSF)
(§ 5.3.1)
Dual fluoroscopy/ How to perform dual fluoroscopy -

parallel viewing
How to activate parallel viewing
(§ 5.3.2)
Bolus chase (§ 5.3.3) Automatic mode General preparation
How to determine the KAT
Bolus chase preparation
How to confirm the end and

start positions of the tabletop
How to make a mask run
How to make a contrast run
How to process images
How to transfer a run for BCR
Interactive mode General preparation
How to confirm the end and

start positions of the tabletop
How to make a contrast run
How to make a mask run (if

required)
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How to process images
How to determine the KAT (if

applicable)
How to determine the injector

parameters (if applicable)

5.3 Making images
Rotational How to perform rotational -

angiography (§ 5.3.4) angiography
Ultrasound (§ 5.3.5) How to decrease/increase scan

depth
How to adjust the gain level
How to reverse the image
How to display a biopsy line
How to freeze the image
How to measure distances
5.3.1 Trace Subtract Fluoroscopy (TSF)

TSF provides an overview of the blood vessels in the region of interest during
fluoroscopy.
33723190
33723200
Trace image symbol Trace subtract image symbol
N OT E For CO2 injections, the colors of the vessels are the opposite of those seen with Iodine
injections since CO2 has minimal opacity whereas Iodine has maximal opacity.
Conditions
TSF can be performed in any fluoroscopy mode.
How to perform TSF
1 Press the |Trace subtract fluoroscopy| key [158] on the imaging module, and
select the injection medium (Iodine or CO2 from one of the menus [95-97
(viewing console) or 102 (TAM, if configured)].
The Trace image symbol appears in the top right corner of the examination
monitor.
2 Initiate fluoroscopy with the foot switch [175].
3 Wait until fluoroscopy is stabilized and subtracted fluoroscopy is
automatically activated.
The image on the monitor turns grey (mask image).
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4 Start the contrast injection.

From now on the maximum opacification of each pixel in the image is
stored. The vessels, therefore, remain white even after the contrast medium
has passed through.

5 Stop fluoroscopy by releasing the foot switch.
The ‘peak’ image remains displayed. The TSF symbol becomes visible.
During each subsequent period of fluoroscopy this ‘peak’ image (the mask)
will be subtracted from the live image. This results in a white trace for the
vessels, on which the position of the catheter is superimposed in black.
6 To deactivate the ‘TSF’ function, press the |Trace-subtract fluoroscopy| key
[158] on the imaging module again.

Making images 5.3
5.3.2 Parallel fluoroscopy and dual fluoroscopy modes

This paragragh describes the two available fluoroscopy modes through the
following options:
• the Parallel Fluoro option provides the parallel fluoroscopy mode
• The Dual Fluoroscopy option provides the parallel fluoroscopy mode and
the dual fluoroscopy mode, and comes with an extra parallel monitor.
The active fluoroscopy mode is displayed on the display unit [126]:
• if the system is in the normal mode, the display unit [126] will display the
text ‘FLUORO’
• if the system is in the parallel fluoroscopy mode, the display unit [126] will
display the text ‘FLUORO VIEW’
• if the system is in the dual fluoroscopy mode, the display unit [126] will
display the text ‘FLUORO DUAL’.
Parallel fluoroscopy mode

This mode allows the use of digitally processed fluoroscopy in the
examination room in parallel with viewing and processing of previously
acquired images of the current and/or previous patient in the control room,
to increase patient throughput and procedur efficiency. When the system is
in the parallel fluoroscopy mode, the viewing console functions are
suspended during exposures and enabled again after the exposures are made.
Dual fluoroscopy mode

The dual fluoroscopy mode allows digitally processed fluoroscopy in parallel
with trace subtract fluoroscopy, providing a non-subtracted reference fluoro
image for complex interventions.
Conditions
If digital exposures are made in the examination room while post-processing
or archiving is being performed at the Operator’s console, the Operator’s
console functions are temporarily frozen.
When the system is in the parallel or dual fluoroscopy mode, the fluoro
images cannot be grabbed, nor can they be recorded on video.
In the parallel fluoroscopy mode, running Quantitative Analysis software
packages will be terminated by exposures.
How to activate parallel fluoroscopy mode

1 Set the system to normal fluoroscopy mode. If the system is in the trace
subtract mode,or dual fluoroscopy mode (if dual fluoro option is installed),
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deselect this mode by pressing the |Trace-subtract fluoroscopy| key [158].

2 Press the |VFR/Dual/parallel fluoroscopy| key [157] on the imaging module
to toggle the system to the parallel fluoroscopy mode.
3 Press the |Fluoroscopy| pedal [175] to initiate fluoroscopy.

In case the parallel fluoro option is installed, the fluoroscopy images are
displayed on the examination monitor.
In case the dual fluoro option is installed, the fluoroscopy images are
displayed on the parallel monitor.

5.3 Making images
4 To deactivate the parallel fluoroscopy mode, press the |VFR/Dual/parallel

fluoroscopy| key [157] again or press one of the |Acquisition| pedals [177,
179]. This returns the system to the normal fluoroscopy mode. Press the
|VFR/Dual/parallel fluoroscopy| key [157] again to set the system in the
parallel fluoroscopy mode again if necessary.
How to activate the dual fluoroscopy mode

1 Set the system to normal fluoroscopy mode. If the system is in the parallel
fluoro mode, deselect this mode by pressing the |VFR/Dual/parallel
fluoroscopy| key [157].
2 Press the |Trace-subtract fluoroscopy| key [158] on the imaging module to set
the system to the dual fluoroscopy mode.
3 Press the |Fluoroscopy| pedal [175] to initiate fluoroscopy. The fluoroscopy
image is displayed on the parallel monitor and the trace subtract fluoroscopy
image is displayed on the examination monitor.
4 To deactivate the dual fluoroscopy mode, press the |Trace-subtract
fluoroscopy| key [158] again or press one of the |Acquisition| pedals [177,
179]. This returns the system to the normal fluoroscopy mode.
N OT E Although not recommended, when the system is in the Dual Fluoroscopy mode, it is
possible to switch to the Parallel Fluoroscopy mode by pressing the |VFR/Dual/parallel
fluoroscopy| key [157]. Pressing this key again will return the system to the Dual
Fluoroscopy mode. The active fluoroscopy mode is displayed on the display unit [126].
5.3.3 Bolus chase

Introduction
For background information on Bolus Chase, refer to Section 10.2,
‘Application guidelines’.
Bolus chasing can be performed with the INTEGRIS Allura Monoplane (38
cm (15 inch) II).
The protocol basically consists of the following steps:

• general preparation
• determination of Knee Arrival Time (KAT)
• bolus chase preparation
• confirmation of end and start positions of the tabletop
• mask run
• contrast run
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• image processing
• transfer run for Bolus Chase Reconstruction (BCR) (if applicable).
The steps will be described in detail for the automatic mode and the
interactive mode.

Making images 5.3
Automatic mode
a b c d c b a d
36280630
Standard Bolus Chase Reversed Bolus Chase
a. Start position.
b. Table travel distance; min 70 cm (27.6 inch), max 100 cm (39.4 inch).
c. End position.
d. Bolus Chase table scan direction.
WA R N I N G Before performing Bolus Chase, carefully check that patient and table will not collide
with any object.
General preparation
1 Position the C-arm perpendicular to the table with the X-ray tube under the
table.
2 Make sure that the table is in the non-rotated and non-tilted position.
3 When using a floor mounted C-arm, press the |Swivel in| key [186] to move
the table into the peripheral position.
4 Position the patient in the supine position with head as close as possible to
the edge of the tabletop (opposite the pedestal).
N OT E If reversed bolus chasing is preferred both the patient and the movement have to be
reversed and step (4) is as follows:
Position the patient in the supine position with feet as close as possible to the edge of
the tabletop (opposite the pedestal).
5 Press the |Tabletop brakes on/off and longitudinal movement| control [131]
on the geometry module to release the tabletop brakes and move the tabletop
transversely to its central position.
Make sure that the femoral heads of the patient are just visible in the lower
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6
corners of the fluoroscopic image with an II input field size of 38 cm (15
inch) and, if not, reposition the C-arm, or reposition the patient on the table.
7 If the Bolus Chase Reconstruction (BCR) with EasyVision is planned after
the examination, position the special ruler for BCR between the legs of the
patient.
8 Position the central peripheral filter carefully between the patient’s legs with
the thin, wide end towards the feet and the thick, narrow end as high up as
possible.
9 Position the two side filters as close as possible to the left and right side of the
legs with the wider part at the feet.

5.3 Making images
These filters must be molded to the shape of the legs to avoid gaps between
the filters and the legs.
10 Immobilize the patient’s legs at knee and ankle using restraint straps.
N OT E The legs must be strapped together with the central filter only, the side filters must be
left free for molding against the legs and to avoid tilting.
For patients with genu varum (O), the knees should be slightly lifted and
supported underneath to enable them to be strapped together closely. For
patients with genu valgum (X), the same procedure is necessary to allow the
ankles to be strapped together closely.
11 Press the |Tabletop brakes on/off and longitudinal movement| key [131] on
the geometry module and move the tabletop to check filter positioning and
patient coverage fluoroscopically.
N OT E For convenience this should be done before the patient is covered with sheets.
The patient should now be prepared for the insertion of the catheter.
Determination of KAT
1 Insert the catheter and make sure that the tip is at L3/L4 level.
2 Press the |Tabletop brakes on/off and longitudinal movement| key [131] on
the geometry module and move the tabletop to bring the knee joint into the
field of view.
3 Select the KAT measure APR [4a/b].
4 Prepare the injector for a small and short test injection (e.g. 8 ml, flow 8 ml/
s, delay and rise time = 0 s).
5 Select One-knob acquisition [4c] on the acquisition console for ‘coupled
injection’.
6 Enable the injector (ready indicator ON).
7 Start an acquisition run using the injector hand switch.
8 Continue the exposures until the front of the bolus has reached the two knee
joints, do not wait for maximum contrast in the knee area; the bolus will not
necessarily arrive at both knee joints simultaneously.
9 Stop the exposures by releasing the injector hand switch.
10 Define the KAT by viewing the run and reading the ‘T-image’ on the image
with the ‘Add text’ function [85] activated.
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The KAT is defined as the time when the front of the bolus just starts to
become visible at the knee joint. If there is a difference between the left and
the right KAT, the operator may, depending on the clinical situation, decide
to use the average value of the two KAT values or the KAT of the leg of most
interest.
If the KAT values differ too much (more than 40%) the chance that the
contrast bolus will be visible in both legs becomes smaller. In those
situations, it may help to increase the injection duration (i.e. increase the
volume setting). Another alternative is to give up the single injection
technique and to use the ‘Multiple position DSA’ method (see section
10.2.1).

Making images 5.3

The sequence block on the acquisition console will display the following:
K.A.T. 7s
Total images: 15
8 ml/s 80 ml (10s)
By default the KAT field is highlighted for editing.

1 Use the |Alter APR parameters| key [10] if the previously measured KAT
value differs from the displayed value (10 seconds in the example).
2 Select the measured KAT value with the |Dial wheel| [8].
3 Press the |Enter| key [9] to move to the next parameter.
The number of images field will be highlighted for editing.
4 If necessary, change the number of images per run with the |Dial wheel| [8]
and press the |Alter APR parameters| key [10] on the acquisition console to
confirm.
Using fewer images reduces the patient dose.
The minimum and maximum numbers of images/run vary according to the
distance travelled by the table: between 9 and 29 for 70 cm and between 12
and 39 for 100 cm.
N OT E S • For a Bolus Chase Reconstruction on an EasyVision workstation the number of
images/run should be set to maximum. This maximum number results in an imaging
distance of about 3 cm. This small distance is needed for good results of the Bolus
Chase Reconstruction algorithm.
• Lower radiation dose to the patient can be achieved by selecting a lower number of
images/run. The minimum number results in an imaging distance of about half the
field of view, providing sufficient overlap of the succesive images. It is clear that the
minimum and maximum number of images/run will vary according to the selected
table scan distance (min = 7-9; max = 29-39).
5 Prepare the injector for the contrast run and set the recommended injector
parameters as displayed on the acquisition console.
N OT E The table speed is automatically adjusted such as to attempt to follow the middle of
the bolus. The duration of injection is a crucial factor therefore. If for some reason
the amount of contrast medium has to be decreased, the flow rate must be decreased
accordingly to maintain the same duration of injection (shown in brackets on the
acquisition console display).
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Entering the end and start positions of the tabletop

Make sure that the tabletop is positioned as high as possible with the II as
close as possible to the patient. With these settings maximal anatomic
coverage is obtained.
1 Select the Automatic Bolus Chase APR [4a/b] on the acquisition console.
The message ‘Move tabletop to end position’ is displayed on the acquisition
console and the message ‘Action’ is displayed on the monitor display.
The indicator near the |Store position 1| key [142] on the geometry module
flashes to indicate that the end position can be entered.

5.3 Making images
2 If necessary, press the |Tabletop brakes on/off and longitudinal movement|

control [131] to release the longitudinal tabletop brakes and move the
tabletop towards its end position. The recommended end position is where
the ankle joints are visible in the center of the TV monitor during
fluoroscopy (see the illustration ‘Patient positioning for bolus chase’ in this
section).
3 Press the |Store position 1| key [142] on the geometry module to store the
end position.
The indicator near [142] should be lit to indicate that the end position is
stored.
From now on the following geometry functions are blocked until another
image technique or APR is selected:
• rotation/angulation
• II movement
• tabletop height
• tilt (if applicable)
• L-arm movements.
Only horizontal tabletop movement is enabled.
If the end position is not more than 70 cm (27.6 inch) away from the
mechanical tabletop start position, the additional message ‘Scan range too
short, change end position’ is displayed on the acquisition console. This
message disappears as soon as the operator has pressed the |Store position 1|
key [142] with the end position more than 70 cm away from the mechanical
tabletop start position. The indicator near the |Store position 2| key [143]
flashes to indicate that the start position can be entered and the message
‘Move tabletop to start position’ appears on the acquisition console.
4 Press the |Tabletop brakes on/off and longitudinal movement| control [131]
on the geometry module to release the longitudinal tabletop brakes and move
the tabletop towards its start position.
The recommended start position is where the femoral heads are visible in the
lower corners and L2 is visible at the upper edge of the fluoroscopic image
(see the illustration ‘Patient positioning for bolus chase’ in this section).
5 Press |Store position 2| [143] to store the start position.
The indicator near [143] should be lit to indicate that the start position is
stored. If the start position is not more than 70 cm away from the end
position, the additional message ‘Scan range too short, change start position’
is displayed on the acquisition console. This message disappears as soon as
the user has pressed the |Store position 2| [143] key with the table-top more
than 70 cm away from the end position. The tabletop will automatically lock
in the start position, all messages are cleared from the acquisition console and
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the indicators near [142] and [143] remain lit.


Making images 5.3
1. Catheter tip
at L3/L4 level
2. Magnification
table high (max)
image intensifier close to object
4. Start position
mid L2 at upper edge of image
femoral heads in lower corners
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3. End position
ankle joints in center of image
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Patient positioning for Bolus Chase

5.3 Making images
Mask run
In the automatic mode the operator is free to select which run (mask or
contrast) will be made first. The advantage of making the contrast run first is
that this unsubtracted first run may itself provide sufficient diagnostic
information to avoid the need for a mask run and further X-ray exposure.
However, if subtracted images are found to be required it is then necessary to
allow sufficient time for the contrast medium to leave the veins before
making the mask run in order to avoid venous over-projection after
subtraction. The advantage of making the mask run first is that there can be
no venous over-projection in the subtracted image, but unnecessary mask
exposures will have been made if the unsubtracted images are subsequently
found to provide sufficient diagnostic information in themselves.
1 Disable the injector (Ready indicator OFF).
2 Make sure that the tabletop is in its start position (indicators near keys [142,
143] are lit). If not, move the table back to its start position using the |TSD
speed control| [172].
3 Press the injector hand switch to start exposures and tabletop travel.
The injector will not start since it has been disabled.
4 Keep the injector hand switch pressed until the tabletop has returned to its
start position.
Contrast run
1 Check that the injector is still in one-knob operation at the acquisition

console, otherwise select one-knob operation [4c] on the acquisition console.
2 Enter the injection parameters and enable the injector (Ready indicator ON).
3 Give appropriate patient instructions.
4 Press the injector hand switch to start injection, tabletop travel and
exposures.
5 Keep the injector hand switch pressed after acquisition has stopped.
The table will automatically move back to its start position and stop.
N OT E Exposures can also be stopped by releasing the injector hand switch before the
selected tabletop end position has been reached. The tabletop then has to be moved
back again to its start position by pressing the hand held |TSD speed control| [172].
6 If necessary, review the run and decide whether a mask run is required (if the
procedure had started with a contrast run).
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Image review
1 Select the first run and then the |Run subtract| key [65] (if applicable) on the
viewing console.
The corresponding images from the two runs will be subtracted one from the
other and displayed dynamically. All viewing and processing functions can be
applied to all the subtracted and non-subtracted images.
Transfer a run for BCR
1 Use the export page (F3 to F5 [24] on the keyboard) to transfer the contrast
run to the EasyVision workstation for BCR. The mask run need not be
transferred as EasyVision provides BCR based on contrast images only.

Making images 5.3
Interactive mode
a b c d c b a d
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Standard Bolus chase Reversed Bolus chase
a. Start position.
b. Table travel distance; min 70 cm (27.6 inch), max 100 cm (39.4 inch).
c. End position (see note below).
d. Bolus Chase table scan direction.
CAUTION Before performing Bolus chasing, check carefully that patient and table will not collide
with any object.
N OT E Defining the end position also sets the end position for the speed control hand switch
[172] movement. Therefore, before defining the end position, be sure that this position
is compatible with the ROI.
General preparation
Same as ‘General preparation’ for ‘Automatic mode’.
Advantages of KAT measurements

Although not essential for interactive operation, it is recommended to
perform the KAT measurement, as described for the automatic mode, after
the general preparation rather than to determine the injector parameters by
guesswork.
The advantages of applying the KAT measurement are:

• optimal efficiency of the contrast medium used (optimal contrast medium
density and no reflux)
• adequate bolus length, which facilitates interactive control of the table
movement during imaging
The KAT and injector parameters (if applicable) must always be determined
after general preparation and before confirmation of the end and start
positions of the tabletop.
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Determination of KAT (if applicable)

See ‘How to determine the KAT’ in ‘Automatic mode’.
Determination of injector parameters from KAT (if applicable)
1 Select the Bolus Chase APR (4a/b) on the acquisition console.

The sequence block on the acquisition console will display the following:
K.A.T. 7s

5.3 Making images
Total images: 15
8 ml/s 80 ml (10s)
By default the KAT field is highlighted for editing. If the previously

measured KAT value differs from the displayed value (10 seconds in the
example).
2 Use the |Alter APR parameters| key [10] and set the measured KAT value
with the |Dial wheel| [8]
3 Press the |Enter| key [9] to move to the next parameter.
4 Press the |Alter APR parameters| key [10] on the acquisition console to
confirm and exit the alter APR mode.
The recommended injection parameters are displayed on the acquisition
console.
5 Set the recommended injector parameters for the interactive mode as
displayed.
Entering the end and start positions of the tabletop
1 Select the Interactive Bolus Chase APR [4a/b] on the acquisition console.
Otherwise the procedure is the same as that described in the ‘Automatic
mode’. A scan range of less than 70 cm (27.6 inch) is possible in interactive
mode.

The sequence block on the acquisition console displays the following:
Duration Frame-rate
10s 2/s
20s 1/s
20s 0,5/s
1 If required, change the run sequence with the |Alter APR parameters| key
[10].
2 Use the |Dial wheel| [8] to change the parameters and press |Enter| [9] to
move to the next parameter.
3 Press the |Alter APR parameters| key [10] on the acquisition console to
confirm and exit the alter APR mode.
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Contrast run
In the interactive mode the first run has to be the contrast run because it is
the real time visualization of the contrast bolus that allows the operator to
adjust the table speed interactively.
1 Select one-knob operation [4c] for coupled injection.

2 Enter the injection parameters and enable the injector (ready indicator ON).
3 Give appropriate patient instructions.
4 Press the injector hand switch to start the exposure series and the injector.

Making images 5.3
5 When the contrast bolus reaches the bottom of the image on the monitor,
start moving the table top and regulate the speed with the hand held |TSD
speed control| [172], such that the contrast bolus remains close to the
bottom of the image.
WA R N I N G Do not wait for maximal opacification, if you miss the peak of the bolus you may not
be able to catch up with it!
During image acquisition, the speed of movement can be changed or motion

can be stopped for short periods using the |TSD speed control| [172].
6 Once all the required images have been obtained, release the hand held |TSD
speed control| [172] and the injector hand switch.
If the injector hand switch is released before the end of the sequence, table
movement and acquisition are stopped.
7 The |TSD speed control| [172] must be used to bring the table back to its
start position.
The message ‘Ready for recorded exposure run’ appears on the acquisition
console to indicate that the system is ready for a mask run.
N OT E If the operator changes parameters in the sequence block after the contrast run and
before a mask run has been made, the results of subtraction are unpredictable because
both runs have to be made with the same parameters. If the parameters have to be
modified, another contrast run must be made before the mask run.
Mask run (if required)
1 Disable the injector (ready indicator OFF).

2 Make sure that the tabletop is in its start position (indicator near key [142] is
lit). If not, press the hand held |TSD speed control| [172] to bring the table
to its start position.
3 Press the injector hand switch or the acquisition hand switch [185] to start
exposures and tabletop travel.
The injector will not start since it has been disabled. The system then
duplicates exactly the speed profile of the contrast run and the run stops at
exactly the same position as in the contrast run. The tabletop automatically
returns to the start position.
Image review
1 Use the |Cursor up/down| keys [20] to select the first run and then press the
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|Run subtract| key [65] (if configured) on the viewing console.

The corresponding images from the two runs will be subtracted one from the
other and displayed dynamically. All viewing and processing functions can be
applied to all the subtracted and non-subtracted images.
5.3.4 Rotational angiography

Rotational angiography is used to acquire a 3-dimensional perception of the
vessel anatomy. For INTEGRIS Allura two different types of rotational
movements are possible:
• C-arm rolling movement:

5.3 Making images
- maximum rotation range from 90° LAO to 90° RAO, at -30°, 0° or

+30° angulation, maximum rotation speed is 30°/s.
• C-arm propeller movement:
- maximum rotation range from 120° LAO to 185° RAO, at 0°
angulation, maximum rotation speed is 55°/s.
Rotational angiography can be performed using either of the following
procedures:
• User defined rotational angiography:
- the start and end positions are defined by the user, within the
constraints of the rotational angiography.
• 3D-reconstruction defined rotational angiography:
- fixed stand positions have been pre-programmed in order to comply
with the 3D-workstation (INTEGRIS 3D-RA) requirements.
Both the C-arm rolling and propeller movements can be used for the
procedures mentioned above.
From the beginning to the end of the rotational angiography, the C-arm
rotates at a maximum speed of 30°/s during the rolling movement or 55°/s
during the propeller movement. This speed is reached within 2 seconds.
Service can program a delay in the APR so that acquisition is not started
before a certain speed is reached. The last 2 seconds of rotation are needed
for the C-arm to slow down, and if the hand (or foot) switch is kept pressed
after rotation is complete, the C-arm will automatically return (at half the
rotation speed) to its start position. If the selected exposure switch is released
before the scan is finished, rotation and image acquisition are automatically
stopped and the system returns to step 3 (see below). The message ‘Confirm
end position’ is then displayed on the acquisition console (see also, Section
10.2.2 ‘Rotational angiography’).
WA R N I N G S • Before performing rotational angiography, check carefully that the C-arm cannot
collide with the patient or any other objects.
• During the actual rotation scan movement the detection system is switched off. For
safety reasons therefore, the user should not allow any patient or table movement.
For safety reasons, after the start and end position of a rotational angiography are
programmed, do not allow any patient or table movement. Because the bodyguard
is switched off, the patient could be harmed during the high speed rotational
angiography movement.
Conditions
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To improve image quality and to make sure that the propeller movement can
be carried out, position the head support directly on the tabletop (i.e. no
mattress in between).
Make sure that the table is in line with the table base at the 0° pivot position.
It may be necessary to reposition the patient on the tabletop in order to

ensure that the ROI can be positioned in the isocenter of the X-ray beam.
How to perform a user defined rotational angiography

Before selection of the |Rotational scan APR| [4a/b] on the acquisition
console, the indicators below the |Store position 1| key [142] and the |Store
position 2| key [143] on the geometry module are both extinguished.
1 Select the |Rotational scan APR| [4a/b] on the acquisition console.

Making images 5.3
The message ‘Confirm end position’ appears on the acquisition console [4],
and the indicator below key [142] starts to flash.
2 Position the L-arm in the desired position, either manually after pressing the
|L-arm rotation brake release| button [190] and |Longitudinal movement
brake release| button [191] or under motor control using the |Motorized
movement of the frontal stand| control [145].
For a C-arm rolling movement: position the L-arm in the side-position (+90°
(nurse side) or -90° (doctor side)).
For a C-arm propeller movement: position the L-arm in the 0° (head)
position.
3 In the case of a propeller movement, ensure that the tabletop height is
adjusted sufficiently so as to enable the C-arm propeller movement.
4 Position the ROI in the isocenter of the X-ray beam.
To do this it may be necessary to use a lateral projection to adjust the height
of the tabletop and a frontal projection to adjust the tabletop position.
5 Move the C-arm to the desired end position using the |Motor-controlled
rotation and angulation| knob [136].
6 In case of a C-arm rolling movement, the C-arm will now be in the user
defined position (angulation/rotation). If either the 0°, -30° or +30°
angulation position is wanted, then the C-arm needs to be repositioned using
the |Motor-controlled rotation and angulation| knob [136]. At -30° and +30°
angulation the movement will stop automatically.
Ensure that the ROI is in the isocenter of the X-ray beam before the end
position is stored as all table movements are blocked after the end position is
stored.
7 Confirm the rotational scan end position by pressing the |Store position 1|
key [142] on the geometry module.
The indicator below key [142] stops flashing and will be extinguished, and
the indicator below key [143] starts to flash. The message ‘Confirm start
position’ is displayed on the acquisition console [4]. From this moment on,
motorized angulation, table movement and SID adjustment are disabled.
8 Move the C-arm to the desired start position using the |Motor-controlled
rotation and angulation| knob [136] and ensure that the ROI is in the
isocenter of the X-ray beam.
9 Confirm the rotational scan start position by pressing the |Store position 2|
The indicator below key [142] will be lit continuously and the indicator
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below key [143] stops flashing and will be lit continuously.

10 Enter the injector parameters and enable the injector. If necessary, couple the
injector using the |Selection of one- or two-knob acquisition| key [4c] on the
11 If required, a mask run can be performed. Press and hold down the
|Preparation/exposure| button [185] on the acquisition hand switch.
This starts acquisition and rotation of the C-arm from the start position to
the end position and back again. This completes the mask run.
12 Start the rotational scan using one or two knob operation:
• One-knob operation, activated key [4c]:

5.3 Making images
1 Press the injector hand switch and keep it pressed until the C-arm has
rotated from the start position to the end position and back again. This
completes the contrast run.
• Two-knob operation, deactivated key [4c]: holding the acquisition hand
switch in one hand and the injector hand switch in the other:
1 Press the |Preparation/exposure| button [185] on the acquisition hand
switch until the small button is flush with the large button and hold the
button in this position, this initiates preparation of the X-ray tube.
2 Press the injector hand switch and keep it pressed, this initiates injection of
contrast media.
switch all the way in to initiate exposure, keep the buttons pressed until
the C-arm has rotated from the start position to the end position and back
again. This completes the contrast run.
During acquisition, the images are displayed in non-subtracted mode.

Subtraction can be carried out during ‘Viewing’. Since the stored rotational
scan start and end positions of the C-arm remain in memory, the rotational
scan can be repeated until an APR is selected.
For safety reasons, the rotational angiography will stop immediately when
the acquisition or injector switch (the latter in the case of a coupled
injection) is released. As a result, the programmed start and end positions will
be lost and the procedure has to be repeated from procedural step 4 onwards.
How to perform a (pre-programmed) 3D-reconstruction defined rotational

angiography
The following procedure is standard for 3D-reconstruction defined
rotational angiography, but can also be performed even if the 3D-RA option
is not available.
The calibration, by Service to allow 3D-reconstruction, has been executed at

the following L-arm positions:
• For a C-arm rolling movement:
- either at the +90° (nurse side) or -90° (doctor side) position, and
- a user-defined longitudinal position.
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The calibrated L-arm side position is indicated on a sticker attached to the

back of the L-arm and a sticker on the ceiling rail depicts the longitudinal
position.
• For a C-arm propeller movement:

- at the 0° (head) position, and
- the pre-programmed longitudinal head position.
Before selection of the |Rotational scan APR| [4a/b] on the acquisition

console, the indicators below the |Store position 1| key [142] and the |Store
position 2| key [143] on the geometry module are both extinguished.
1 Select the |Rotational scan APR| [4a/b] on the acquisition console.

Making images 5.3
The message ‘Confirm end position’ appears on the acquisition console [4],
and the indicator below key [142] on the geometry module starts to flash.
2 For the corresponding rotational angiography scan, use the |Motorized
movement of the frontal stand| control [145] to position the L-arm in the
correct position as calibrated by Service, wait for the ‘click’ sound to make
sure that the stand is in the correct position.
For a C-arm rolling movement: position the L-arm in the side-position
(depending on the calibration, either +90° or -90°) and at the pre-defined
longitudinal position.
For a C-arm propeller movement: position the L-arm in the head-position
(0° rotation) at the pre-programmed longitudinal head position.
Make sure that the L-arm is in the correct 3D-RA calibrated side position,
and also the correct longitudinal position.
3 In case of a propeller movement, ensure that the tabletop height is adjusted
sufficiently so as to enable the C-arm propeller movement.
4 Position the ROI in the isocenter of the X-ray beam.
To do this it may be necessary to use a lateral projection to adjust the height
of the tabletop and a frontal projection to adjust the tabletop position.
5 Move the C-arm to the pre-programmed end position by pressing the left
hand side of the |Recall position 1 or 2| key [144] on the geometry module.
The indicator below key [142] flashes until the C-arm reaches the pre-
programmed end position, the indicator is then lit continuously.
6 In the case of a C-arm rolling movement, the C-arm will now be in the 0°
angulation position. If either the -30° or +30° angulation position is wanted,
then the C-arm needs to be repositioned using the |Motor-controlled
rotation and angulation| knob [136]. At -30° and +30° angulation the
movement will stop automatically.
Ensure that the ROI is in the isocenter of the X-ray beam before the end
position is stored as all table movements (except for the pivot movement) are
blocked after the end position is stored.
7 Confirm the rotational scan end position by pressing the |Store position 1|
The indicator below key [142] is extinguished and the indicator below key
[143] starts to flash. The message ‘Confirm start position’ is displayed on the
acquisition console [4]. From this moment on, motorized angulation, table
movement and SID adjustment are disabled.
8 Move the C-arm to the pre-programmed start position by pressing the right
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hand side of the |Recall position 1 or 2| key [144] on the geometry module.
The indicator below key [143] flashes until the C-arm reaches the pre-
programmed start position, the indicator is then lit continuously.
9 Confirm the rotational scan start position by pressing the |Store position 2|

Both indicators are then lit continuously. This indicates that the
programming of the procedure has been completed successfully.
10 Enter the injector parameters and enable the injector. If necessary, couple the
injector using the |Selection of one- or two-knob acquisition| key [4c] on the

5.3 Making images
12 Start the rotational scan using one or two knob operation:
• One-knob operation, activated key [4c]:
1 Press the injector hand switch and keep it pressed until the C-arm has
rotated from the start position to the end position and back again. This
completes the contrast run.
• Two-knob operation, deactivated key [4c]: holding the acquisition hand
switch in one hand and the injector hand switch in the other:
switch until the small button is flush with the large button and hold the
button in this position, this initiates preparation of the X-ray tube.
2 Press the injector hand switch and keep it pressed, this initiates injection of
contrast media.
switch all the way in to initiate exposure, keep the buttons pressed until
the C-arm has rotated from the start position to the end position and back
again. This completes the contrast run.
During acquisition, the images are displayed in non-subtracted mode.

Subtraction can be carried out during ‘Viewing’. Since the stored rotational
scan start and end positions of the C-arm remain in memory, the rotational
scan can be repeated until an APR is selected.
When the acquisition or injector hand switch (the latter in the case of a
coupled injection) is released before the C-arm has returned to the start
position, the programmed start and end positions will be lost and the
procedure has to be repeated from procedural step 4 onwards.
Following acquisition, the images obtained during the rotational scan can be
exported to a 3D-workstation, see section 5.6 ‘Archiving’.
5.3.5 Ultrasound
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Ultrasound is used to give the operator a different perspective of the same

region of interest compared to X-ray.
Conditions
Prepare the ultrasound system as described in section 5.1.5 ‘200X ultrasound

scanner’. General information about probes and needle guides can be found
in Section 10.
How to decrease/increase scan depth
1 Press the |Depth decrease| [243] or |Depth increase| [242] key on the
ultrasound control panel to display a smaller or larger image field.

Making images 5.3
The depth of the displayed image can be changed real time by using keys
[242 and 243]. The upper and lower limit of these selections depend on the
probe type and frequency. A lower frequency gives a larger image field.
How to adjust the gain level
1 On the ultrasound control panel, press the:

• |Near gain control| key [244] to adjust the gain level in the surface area of
the image.
• |Far gain control| key [245] to adjust the gain level in the deeper area of
the image.
• |Total gain control| key [246] to adjust the overall gain.
The gain control is used to give the entire ultrasound image a consistent
brightness. In the normal setting all the gain and depth controls are set in
their center position. For certain applications, this normal setting is not
desirable and the brightness level of the ultrasound image can be adjusted
using controls [320 to 322].
How to reverse the image
1 Press the |Reverse on/off| key [241] on the ultrasound control panel once to
reverse the displayed image.
Pressing [241] again will return the display to normal. The status field
indicates whether or not the image is reversed.
N OT E Reverse on/off [241] has no immediate effect when the image is frozen. Reversal only
occurs once the image has been unfrozen.
How to display a biopsy line
1 Press the |Biopsy line on/off| key [240] on the ultrasound control panel once
to display a biopsy line (for the selected probe) in a non-frozen image.
Pressing [240] again erases the line.
N OT E Biopsy line on/off [240] has no immediate effect when the image is frozen. The biopsy
line is only displayed once the image has been unfrozen.
How to freeze the image
1 Press the |Freeze/unfreeze| key [239] on the ultrasound control panel once to
freeze the current image.
Pressing [239] again will return the image to the live mode. If the image is
frozen, ‘F’ is highlighted in the image status field.
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How to measure distances

To display and measure the distance between two points in an ultrasound
image.
1 Press the |Distance measurement| key [238]:

• the first caliper cross appears at the top of the ultrasound image
• the result field is displayed in the image
• the ultrasound image is frozen (denoted by the letter ‘F’ in the status field).
2 Move the first caliper cross to the desired position using the |Joystick| [247].

5.3 Making images
3 Press the |Distance measurement| key [238] to fix the position of the first
cross.
The second caliper cross is displayed on the image.
4 Move the second caliper cross to the desired position using the |Joystick|
[247].
5 Press the |Distance measurement| key [238] to fix the position of the second
cross.
The distance (millimeters) is displayed in the result field.
6 Press the |Distance measurement| key [238] again.
The measurement information is erased and the second caliper cross remains
on the screen to allow further measurement.
7 Press the |Freeze/unfreeze| key [239].
The measurement procedure ends and the ultrasound image returns to
normal mode.
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Viewing images 5.4
5.4 Viewing images

Overview of viewing image procedures:
Viewing during - -
acquisition (§ 5.4.1)
Ultrasound (§ 5.4.2) How to store (grab) an ultrasound -

image to the photofile
5.4.1 Viewing during acquisition

The TAM allows image processing and quantitative analysis to be performed
at the tableside for rapid and reliable diagnosis in the examination room. A
Viewpad can be parked on the TAM.
100 101 102 103 104
108
105 106 107 33728255
Tableside analysis module
The following TAM functions can be used for image selection for the
acquisition patient only, see illustrations above:
To zoom the current image: Pan & Zoom [103]. The zoomed area
can be changed with the joystick [108]
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To correct motion artifacts: Pixel shift [101]
To add background anatomical features to a Landmarking [104]

subtracted image:
Analysis functions: Automated Vessel Analysis (AVA) [100]
Other functions: TAM Menu [102]
5.4.2 Ultrasound
The ultrasound images appear on the frontal examination monitor.

5.4 Viewing images
Conditions
To view the ultrasound images after acquisition the images need to be stored
(grabbed) into the photofile.
How to store (grab) an ultrasound image to the photofile
1 Press the |Store reference 1/2| key [j (74), k (75)] on the Viewpad.
The stored ultrasound image is displayed on the reference monitor. Its
photofile number and the total number of photofile images are shown in the
lower right corner of the reference monitor.
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Post-processing 5.5
5.5 Post-processing
This section gives an overview of extended post-processing functions and
describes the quantative analysis programs.
Overview of extended post-processing procedures:
Text & annotations - -

(§ 5.5.1)
Clinical programs User input -

(§ 5.5.2)
Calibration (§ 5.5.3) How to position the ROI in the
isocenter
How to use ‘Auto CF’
Vessel diameter analysis (§ 5.5.4) For sub-fuctions refer to 5.5.4

‘Procedure’
Automated Vessel Analysis (AVA) For sub-fuctions refer to 5.5.5

(§ 5.5.5) ‘Procedure’
Monoplane left ventricular analysis For sub-fuctions refer to 5.5.6

(§ 5.5.6) ‘Procedure’
Centreline wall motion (§ 5.5.7) Standard procedure
Regional wall motion (§ 5.5.8) Standard procedure
Slager wall motion (§ 5.5.9) Standard procedure
Automated Coronary Analysis For sub-fuctions refer to 5.5.10

(ACA) (§ 5.5.10) ‘Procedure’
5.5.1 Text & annotations

The following viewing console functions can be selected to add data to
images. For other post-processing functions refer to section 5.0.5 ‘Post-
processing’.
To add text (patient and examination data) to Add text [85]

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the image:
To add annotation to the image: Annotate [86]
To display the acquired physiological data: Display physiological data [87]

WA R N I N G There may be a time delay of 10 to 300 ms between the displayed image and the
corresponding ECG signal displayed. This is caused by, and depends upon, the type of
physiology system connected.

5.5 Post-processing
5.5.2 Clinical programs

Special clinical programs for quantitative analysis are available as options.
When clinical programs are installed they can be displayed using the Menu 1,
2 or 3 keys [95, 96 or 97] on the viewing console, or the TAM menu key
[102] on the Tableside Analysis module. The program required can be
selected using the left mouse button [25]. The indicator above the menu key
remains on while the function is active. A clinical program can also be
assigned to the clinical program key [98], or to the key on the Tableside
Analysis module [100]. A clinical program is selected by pressing its
corresponding key. The clinical program is applied to the image series
displayed just before the program was activated.
User input
The mouse is used for user input. When the mouse is active the actions of
the three mouse buttons are displayed at the bottom of the screen. By
convention, the three mouse buttons are designated, from left to right, as
|Accept| [25] (left mouse button), |Action| [26] (middle mouse button) and
|Reject| [27] (right mouse button). The |Video invert| [54], |Contrast| [45,
46], |Brightness| [48, 49] and |Edge enhancement| [51, 52] functions can be
used with a clinical program. Images can be selected using the image
selection control keys: |Cycle through run| [36], |Cycle through examination|
[37], |View forward/reverse| [30/31]. When a cursor is visible it can be
moved using the mouse. Where relevant, the image produced by a clinical
program can be stored in the photofile by pressing |Flag image| [90] or |Store
image in photofile| [70] on the Viewing console. Patient information can be
added to this image by pressing |Add text| [85] on the Viewing console. If the
image is stored in the photofile, the added patient information is also stored.
WA R N I N G S • The clinical program software has been thoroughly checked and tested prior to
delivery. The software is designed to produce a mathematical model as described in
the medical literature or medical research. Philips Medical Systems cannot be held
responsible in any way for any inaccuracies of any nature resulting from the use of
this software. If the calibration guidelines are not followed, the absolute
measurements may be inaccurate or unreliable.
• As the accuracy of the clinical programs is based upon the ROI position (being in
the isocenter), do not change the position of the table during the examination.
• When using the CF, make sure that the ROI is in the isocenter. If the ROI is not in
the isocenter, this will result in inaccurate measurements which can lead to a
hazardous situation.
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CAUTION Interrupting a program erases all intermediate results.
N OT E User input for the clinical programs described is via the Viewing console and the
mouse. The Tableside Analysis Module (TAM) in the examination room can be used
instead of the mouse. Press the menu key on the TAM to display the clinical programs
available and use the joystick [108], instead of the mouse, for program selection,
cursor movement or drawing actions. The |Accept| [105], |Action| [106] and |Reject|
[107] keys are located to the right of the joystick [108]. When using the TAM, image
selection can be performed using the image selection keys on the viewpad.

Post-processing 5.5
5.5.3 Calibration
General
Before performing quantative analysis programs, calibration must be carried
out either manually or automated (if autocalibration option is installed).
Manual calibration is done by the operator prior to making measurements,
and can be done in two ways:
• grid calibration, for example see 5.5.5 ‘4. AVA manual calibration
procedure’
• catheter calibration, for example see 5.5.4 ‘1. Vessel diameter standard
procedure’.
Calibration for the automated procedure is periodically performed by
Service. This means that the operator only needs to select the ‘Auto
Calibration Factor (Auto CF)’ and does not need to calibrate the system. The
auto calibration factor is only valid for objects in the isocenter.
If no automated calibration has been performed, or only manual calibration
has been performed, the following screen will be superimposed on the image
displayed on the viewing monitor:
33726290
If no manual calibration has been performed, then the ‘Standard CF-Value’ is

set to ‘none’.
If only auto-calibration has been performed, or both manual and auto-
calibration have been performed, then the following screen will be displayed
on the viewing monitor:
9896 001 33152

5.5 Post-processing
33726300
If no manual calibration has been performed, then the ‘Standard CF-Value’ is
set to ‘none’.
The operator can choose which type of calibration will be used.
Conditions
When using the automated calibration factor, it is important to ensure that
the ROI is in the isocenter. This will ensure that measurements are
performed accurately.
How to position the ROI in the isocenter
1 Position the stand in the AP position..

2 Using the |Tabletop brakes on/off and longitudinal movements| control
[131] on the geometry module, position the ROI in the center of the
fluoroscopy image.
3 Position the stand in the lateral (horizontal) position.
4 Using the |Table height adjustment| control [133] on the geometry module,
position the ROI in the center of the fluoroscopy image.
How to use the ‘Auto CF’
1 Move the tabletop to position the ROI in the isocenter (see procedure
above).
When viewing, the ROI must be displayed in the center of the monitor.
9896 001 33152
2 Acquire images of the ROI within the isocenter.

3 Press the |Menu 1/2/3| keys [95, 96, 97] on the viewing console.
The quantative analysis program menu appears on viewing monitor.
4 Use the mouse to select the quantative analysis program to be performed.

The calibration factor menu appears on the viewing monitor.
5 Retrieve the ‘Auto CF’ by selecting ‘Measurement with Auto CF’ from the
menu displayed on the viewing monitor.
6 Perform the quantative analysis program.

Post-processing 5.5
5.5.4 Vessel diameter analysis

Method and application
The method used to calculate the vessel diameters and percentage
obstruction is based on a set of standard geometrical formulas. Vessel
diameters are measured in repeated projections for comparison and
assessment during PTA procedures. The calibration needed to obtain
dimensions in millimeters should be performed routinely on an object of
known diameter. A discussion on the use and advantages of this type of
method can be found in the reference literature. The standard procedure is
described first, followed by a description of the Special Calibration
Procedure.
References
1 Reiber, J.H.C. et al. Qualitative Coronary Angiography. In ‘Cardiac

Imaging - Principles and Practice’: Marcus H.L. et al (ed.). W.B. Saunders
Co. 1989.
2 Koning, G. et al. Advantages and limitations of two software callipers in
quantitative coronary arteriography. Int. J. of Cardiac Imaging, 7, pp 15-
30, 1991.
3 Reiber, J.H.C. et al. Assessment of dimensions and image quality of
coronary contrast catheters from cine angiograms. Catheterization and
Cardio-vascular Diagnosis, 11, pp 521-531, 1985.
Procedure
1 Vessel diameter standard procedure:

• Selecting the program
• Vessel diameter calibration procedure:
- Step 1 Selecting an image and zoomed area.
- Step 2 Drawing a calibration line
- Step 3 Selecting the size.
• Vessel Diameter Measurement Procedure:
- Step 5 Drawing the first measurement line.
- Step 6 Drawing the second measurement line.
- Step 7 Final display.
2 Vessel diameter special calibration procedure:
• Free Format calibration:
- Step 1 Free format menu.
- Step 2 Entering the size.
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1. Vessel Diameter Standard Procedure

This section describes the standard procedure for manual quantification of
vessel sizes. It comprises both the calibration and measurement procedures.

5.5 Post-processing
Selecting the program
PROGRAM MENU 1
PREVIOUS
NEXT
ACA Short
ACA
Vessel Diameter
Run Overview
33721970
1 Select the correct image series on which to run the Vessel Diameter program.
2 Press one of the three menu keys on the viewing console. The indicator above
the key remains on while the function remains active.
3 If necessary, select Next/Previous screen to access more items.
4 Use the left mouse button [25] to select the ‘Vessel Diameter’ program. A
menu is displayed for selection between calibration and measurement. If no
calibration factor has been determined, calibration is the only item available.
Calibration
Measurement
CF = 0.108 mm/pixel
33721980
5 Click the left mouse button [25] on the selected item to confirm the choice.
9896 001 33152
Vessel Diameter Calibration Procedure

The following steps describe how to calibrate the vessel diameter after
calibration has been selected. The procedure determines the diameter of a
segment of the catheter by manually tracing it. A calibration factor is
obtained by comparing the indicated catheter diameter with its known size.
• For accurate and reliable results, the use of a calibration object of a size
larger than 20 pixels is recommended. If a smaller object is used, the
message ‘Warning: size of diameter smaller than recommended’ will be
displayed.
- Click the left mouse button [25] to continue the program.
- Click the right mouse button [27] to cancel the program.
N OT E The calibration factor is expressed in millimeters/pixel of the display matrix.

Post-processing 5.5
Step 1
Selecting the image and zoomed area.
Image : Select ----
CF = 0.108 mm/pixel
33721990
1 Use the image selection keys on the viewing console to select an image with a
clear view of the catheter. The image is zoomed and the zoom frame can be
positioned as for the normal zoom function.
2 Click the left mouse button [25] to confirm the image selection and zoomed
area. The cursor appears on the screen and can be controlled using the
mouse.
Step 2
Drawing a calibration line.
Diameter : Accept Draw Reject
CF = 0.108 mm/pixel
33722020
9896 001 33152
1 Position the central dot of the cursor on one edge of the catheter. This marks
the start of the calibration distance.
2 Hold down the middle mouse button [26] and drag the cursor to the
opposite edge of the catheter. A line is drawn as the mouse is moved.
3 If necessary, click the right mouse button [27] to reposition the start point of
the line.

5.5 Post-processing
Diameter : Accept Draw Reject
CF = 0.108 mm/pixel
33722030
4 Click the left mouse button [25] to confirm the calibration line.
Step 3
Selecting the size.
A menu now appears over the image, offering French sizes (F4 to F9) and
Free Format (FF).
F4
F5
F6
F7
F8
F9
FF
2.7
CF = 0.108 mm/pixel
33722000
1 Move the arrow to the appropriate box in the F-size range.

2 If a size has been entered or selected previously, it appears in a box at the
bottom of the menu. It can be selected by pointing the arrow at this box.
3 If the size of the catheter used is not shown or another calibration object is
9896 001 33152
used, the Special Calibration Procedure must be performed by selecting the

FF (free format) box.
4 Click the left mouse button [25] to confirm the choice. The calibration
factor is displayed at the bottom of the screen in millimeters per display pixel.
Since calibration has been carried out, the arrow now points to
‘Measurement’ by default.
5- 1 0 0 Operation INTEGRIS Allura Monoplane Release 1

Post-processing 5.5
Calibration
Measurement
CF = 0.108 mm/pixel
33722010
5 Click the left mouse button [25] on ‘Measurement’ to continue with the
measurement procedure.
Vessel Diameter Measurement Procedure
Step 4
Selecting an image and zoomed area.
The following criteria are important for the image selection process:
• the arterial segment should be well filled with contrast medium.
• the obstructed vessel segment should be clearly visible, preferably without
any overlap with other vessels or side branches. The central part of the
image is zoomed automatically and the zoom frame can be positioned
using the mouse.
Diameter 1 : Accept Draw Reject
CF = 0.115 mm/pixel
33722040
9896 001 33152
1 Use the image selection keys on the viewing console to select an image.
area.
Step 5
Drawing the first measurement line.
INTEGRIS Allura Monoplane Release 1 Operation 5-1 0 1

5.5 Post-processing
CF = 0.115 mm/pixel
33722050
The cursor appears on the image.
1 Position the cursor on one edge of the vessel to be measured.
2 Hold down the middle mouse button [26] and drag with the mouse to draw
a line to the opposite edge of the vessel.
3 Click the right mouse button [27] to reposition the starting point of the line
if necessary.
4 Click the left mouse button [25] to confirm the position of the line.
5 The first diameter, D1, (in mm) is displayed at the bottom of the image and
is the reference diameter for the percentage diameter obstruction.
Step 6
Drawing second measurement line.

9896 001 33152
D1 = 2.01 mm
CF = 0.115 mm/pixel
33722060
The cursor appears on the image.

1 Draw a second line with the mouse as described in (1) to (3) of ‘step 5’.
2 Click the left mouse button [25] to confirm the position of the second line.
Step 7
Final display.

Post-processing 5.5
1
2
%D = 60 %
D1 = 2.01 mm
D2 = 0.79 mm
Cf = 0.115 mm/pixel
33722070
The final display also shows the second diameter, D2 (in mm), and the
percentage diameter obstruction (%D). The value of %D is the stenotic
index based on the diameters. The hospital name and the examination date
are displayed at the top of the image. When the light above the menu key
goes out, the program has finished. The results remain on display and can be
stored in the Photofile. Patient information and text can be added.
2. Vessel diameter special calibration procedure
Free Format calibration

This procedure is used if the size of the catheter differs from the F-sizes
shown in the menu, or when other calibration objects are used.
Step 1
Free Format menu.
This step follows on from ‘step 3’ of the Vessel Diameter Standard Procedure,
after FF (Free Format) has been selected. A menu appears for entry of the
catheter diameter in mm (3F = 1 mm).
.
0
1
2
3
4
5
6
8
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9
0
OK
Enter size (mm): 2.660000

CF = 0.115 mm/pixel
33722080
N OT E If a size has been entered or selected previously, it will be displayed in the Enter field,
and can be selected by moving the arrow to the OK box and clicking the left mouse
button [25] to confirm.
Step 2

5.5 Post-processing
Entering the size.
.
0
1
2
3
4
5
6
8
9
0
OK
Enter size (mm): 2
CF = 0.115 mm/pixel
33722090
1 Move the arrow to the first digit of the value to be entered and click the left
mouse button [25]. Any existing Free Format size will be erased and the first
digit selected will be inserted in the Enter field.
2 Enter the next digit as described above. Up to 9 digits and a decimal point
can be entered.
3 The last-entered digit can be removed by clicking the right mouse button
[27]. Digit selection can then be resumed.
.
0
1
2
3
4
5
6
8
9
0
OK
CF = 0.115 mm/pixel
33722100
4 Once the required size (in millimeters) has been entered, move the arrow to
the OK box and click the left mouse button [25] to confirm. The calibration
9896 001 33152
factor is displayed at the bottom of the image. The menu reappears as shown
below.

Post-processing 5.5
Calibration
Measurement
CF = 0.108 mm/pixel
33722010
5 Click the left mouse button [25] to continue with the Vessel Diameter
Measurement Procedure (‘step 4’).
5.5.5 Automated Vessel Analysis (AVA)

The Automated Vessel Analysis program allows objective and reproducible
assessment of the severity of any existing vessel narrowing. Both calibration
and measurement involve three stages. Firstly, a start and an end point are
manually defined and a path line is then automatically detected within the
indicated segment (ref. 1). Secondly, using this path line as a model, catheter
or vessel contours are detected in two passes (ref. 2). And finally, from these
detected contours, either the calibration factor or a number of clinically-
relevant parameters are calculated.
The AVA program can be run on images or an image series displayed in non-
subtracted or subtracted mode with the injected contrast medium displayed
as black or white. The section on the AVA Standard Procedure describes the
standard procedure for catheter calibration and measurement. The section on
the AVA Manual Selection Procedures describes manual procedures for
selecting the obstruction and reference diameters. Free Format AVA
Calibration Procedures describes calibration procedures for free format
selection to suit the size of catheter used and the calibration procedures to be
used with an object of known size are described in the section: AVA Manual
Calibration Procedure. This calibration procedure can be used when the AVA
program is run on an image series in which the catheter is not displayed or
9896 001 33152
when the calibration factor given by AVA Catheter Calibration lacks

sufficient accuracy.
References
1 Van der Zwet, P.M.J. et al. A new approach for the automated definition
of path lines in digitized coronary angiograms. Int. J. Cardiac Imaging, 5,
no. 2-3, 1990. pp. 75-83.
2 Van der Zwet, P.M.J. et al. An on-line system for the quantitative analysis
of coronary arterial segments. Computers in Cardiology, 1990.

5.5 Post-processing
Procedure
1 AVA standard procedure:

• Selecting the program.
• AVA Catheter Calibration:
- Step 1 Selecting an image.
- Step 2 Selecting the segment for calibration.
- Step 3 Automatic detection of contours.
• AVA Measurement:
- Step 6 Selecting the vessel segment.
- Step 7 Confirming or correcting the path line.
- Step 9 Correcting a contour segment.
- Step 10 Automatically defined obstruction and reference sites.
- Step 11 Result page.
- Step 12 Exiting the program.
2 AVA manual selection procedure:
• Redefining the obstruction and/or reference sites:
- Step 1 Redefining the obstruction site.
- Step 2 Redefining the reference site.
- Step 3 Changing the reference site.
- Step 4 Result page.
3 Special AVA calibration procedures:
• Free format calibration:
- Step 1 Free Format menu.
4 AVA Manual calibration procedure:
• Selecting the program:
- Step 2 Drawing the calibration line.
- Step 3 Entering the size of the calibration object.
- Step 4 Selecting the program.
1. AVA standard procedure

This section describes the standard procedure for automated quantification
of vessel segments. It includes both the catheter calibration and measurement
procedures.
9896 001 33152

Post-processing 5.5
PROGRAM MENU 3
PREVIOUS
NEXT
Automated Vessel Analysis
33722110
1 Select the correct image series to which the program is to be applied. The
correct image series must be selected before proceeding.
2 Press one of the three menu keys [95, 96 or 97] to display the menu. The
indicator above key remains on while the function is active.
3 If necessary, select Previous/Next to access more items.
4 Use the left mouse button [25] to select ‘Automated Vessel Analysis’.
The AVA menu is displayed. This contains the items ‘Exit Program’,
‘Catheter Calibration’, ‘Manual Calibration’ or ‘Measurement’. If no
calibration factor has been determined, the ‘Measurement’ item will not
appear.
Exit Program
Catheter Calibration
Manual Calibration
Measurement
CF = 0.127 mm/pix
9896 001 33152
SELECT MENU ITEM

33722120
Accept ----- -----
5 Click the left mouse button [25] to confirm the choice.

AVA catheter calibration

This procedure determines the boundaries of a segment of the catheter using
automated contour detection techniques. By comparing the calculated
average diameter of the catheter segment with its known size, a calibration
factor specific to the current image series is obtained. The accuracy of the
calibration factor depends on the displayed size of the catheter. Accuracy
increases with decreasing image intensifier field size and/or increasing
catheter size.

5.5 Post-processing
To ensure accurate calibration, the following rules should be observed:

• select an image with a clear view of the catheter
• use a straight catheter segment for calibration, not a tapered or curved
segment.
WA R N I N G If these calibration guidelines are not followed, the measurements may be inaccurate
or unreliable.
Step 1
Selecting an image.
33722130
SELECT IMAGE FOR CALIBRATION
Accept ----- Menu
1 If necessary, click the right mouse button [27] to return to the AVA menu.
2 Select an image with a clear view of the catheter and click the left mouse
button [25] to confirm the image selection.
Do not alter the image processing settings (contrast, brightness, etc) once an
image has been selected. The following prompt will appear: ‘Dark vessels on
bright background? Yes — No’.
3 Click the left mouse button [25], if the injected contrast medium or the
catheter is to be displayed as black on white, or click the right mouse button
[27], if the injected contrast medium or the catheter is to be displayed as
white on black.
Step 2
Selecting the segment for calibration.
The catheter segment used for calibration must be straight. It must not be
9896 001 33152
tapered or curved.

Post-processing 5.5
33722140
INDICATE START POINT FOR CALIBRATION
Accept ----- Menu
A cursor appears on the image.

2 Move the central dot of the cursor to the start point of the catheter segment
to be used for calibration.
3 Click the left mouse button [25] to confirm the start point.
33722150
INDICATE END POINT FOR CALIBRATION

Accept ----- New start point
4 Move the center dot of the cursor to the end point of the catheter segment to
be used for calibration.
5 If necessary, click the middle mouse button [26] to select another start point.
6 Click the left mouse button [25] to confirm the end point and selected
9896 001 33152
segment.
Step 3
Automatic detection of contours.
Once the start and end points of the catheter segment have been defined, a
path line between these points will be detected automatically.
The following steps are performed automatically:
• the path line in the catheter segment is defined
• the contour-finding process starts
• the image is zoomed. The twofold magnification (zoom) is not performed
if the segment length exceeds a quarter of the image size

5.5 Post-processing
• the initially-detected contours are displayed along the catheter segment

and the message ‘Final Contour Detection in Progress’ appears. The
initially-detected contours serve as a model for final contour detection.
The final contour-detection procedure is based on the assumption that the
two contours of a non-tapering catheter are parallel.
33722160
DETECTED CONTOURS
Accept Hide New segment
1 After the final contours have been displayed, click the middle mouse button
[26] to hide the detected contours and check their accuracy.
2 Click the left mouse button [25] to confirm the final catheter contours.
3 If necessary, click the right mouse button [27] to select a new segment for
calibration. The program returns to ‘step 2’.
N OT E S If the calibration factor is not sufficiently accurate, the following warning is displayed:
‘Calibration factor accuracy only xx%’ (‘xx’ is the accuracy value).
• click the left mouse button [25] to accept this accuracy and the final catheter
contours.
• click the right mouse button [27] to select a new segment for calibration if the
accuracy is not acceptable. The program returns to ‘step 2’.
• or double click the right mouse button [27] and select Manual Calibration to carry
out calibration using an object of known size (see AVA Manual Calibration
Procedure below).
Step 4
Selecting the size.
A menu is now displayed over the image listing French sizes (F4 to F9) and
Free Format (FF).
9896 001 33152

Post-processing 5.5
F4
F5
F6
F7
F8
F9
FF
1,7
SELECT FRENCH SIZE
33722170
Accept ----- -----
1 Move the arrow to select the desired F-size and click the left mouse button
[25]. For Free Format, see Special AVA Calibration Procedures below.
N OT E If a size has previously been entered or selected, it is displayed in a box at the bottom
of the menu.
Exit Program
Manual Calibration
Measurement
CF = 0.204 mm/pix
SELECT MENU ITEM
33722180
Accept ----- -----
The calibration factor in millimeters per pixel (display pixel) is shown in the
lower right corner of the screen and the AVA menu (‘Exit program’, ‘Catheter
calibration’, ‘Manual calibration’ and ‘Measurement’) is redisplayed. Since
calibration has now been performed, the arrow points to the Measurement
box by default.
2 Use the left mouse button [25] to select an item.
9896 001 33152
AVA Measurement
Step 5
Selecting an image.
1 Use the image selection keys on the viewing console to select an appropriate
image. The following criteria are important for the image selection process:
• the vessel segment should be well filled with contrast medium
• the obstructed vessel segment should be clearly visible, preferably without
any overlap with other vessels or side branches.

5.5 Post-processing
33722190
SELECT IMAGE FOR MEASUREMENT
Accept ----- Menu
2 Use the left mouse button [25] to confirm image selection.

Do not change the image processing settings (contrast, brightness, etc) once
an image has been selected.
The following prompt appears: ‘Dark vessels on bright background? Yes —
No’.
• Click the left mouse button [25] if the injected contrast medium is to be
displayed black on white.
• Click the right mouse button [27] if the injected contrast medium is to be
displayed white on black.
A cursor appears on the image
Step 6
Selecting the vessel segment.
To guarantee reproducible assessment of the morphology of vessel segments,
such segments should be selected in a standardized manner, i.e. from side
branch to side branch. Therefore, it is preferable to position the start point
immediately distal and the end point immediately proximal, to a branch
point.
9896 001 33152
33722200
INDICATE START POINT OF VESSEL SEGMENT

Accept ----- Menu
1 Move the center dot of the cursor to the start point of the vessel segment to
be analyzed.

Post-processing 5.5
33722210
INDICATE END POINT OF VESSEL SEGMENT
4 Move the center dot of the cursor to the end point of the vessel segment to be
analyzed.
5 Click the left mouse button [25] to confirm the end point and the selected
segment.
6 If necessary, click the middle mouse button [26] to select another start point.
Once the start and end points of the vessel segment have been defined, the
message ‘Image Filtering in Progress’ is displayed and a path line between
these points will be detected automatically. The purpose of the image
filtering procedure is to ensure reliable detection of the path line in the
selected segment. If no path line can be found, the message ‘Cannot find
path line’ will be displayed and the program returns to the beginning of ‘step
6’.
Step 7
Confirming or correcting the path line.
9896 001 33152
33722220
PATHLINE
Accept Correct Start Point
The path line must lie entirely inside the selected vessel segment but does not
necessarily have to follow the centerline of the vessel segment precisely.
1 Click the left mouse button [25] to accept the path line and proceed with
‘step 8’.

5.5 Post-processing
2 Click the right mouse button [27] to return to ‘step 6’ and select a new start
point for the vessel segment.
3 If necessary, click the middle mouse button [26] to correct the path line. A
cursor appears on the image.
33722230
INDICATE CORRECTION POINT TO
TO BE
BE INCLUDED IN PATHLINE
Accept ---- Reject
4 To change the path line, place the cursor at the point to be included in the
path line (off the current path line but inside the selected vessel segment) and
click the left mouse button [25] to confirm. A new path line will then be
drawn through this point. If a new path line cannot be found, the previous
path line will be redisplayed with the message ‘Cannot find corrected path
line’. More corrections can be made by repeating the correction procedure
until a satisfactory result has been obtained. 33722240
PATHLINE
Accept Correct Initial pathline
9896 001 33152
5 Click the right mouse button [27] to restore the initial path line and return
to the beginning of ‘step 7’.
6 Or click the left mouse button [25] to confirm the path line.
Step 8
After the path line has been defined, the contour-finding process starts.
• the contour-finding process starts. The message ‘Initial Contour Detection
in Progress’ is displayed

Post-processing 5.5

if the segment length exceeds a quarter of the image size. Final contour
detection in the non-magnified image will have a detrimental effect on the
accuracy of the derived parameters
• the initially-detected contours are displayed along the vessel segment and
the message ‘Final Contour Detection in Progress’ appears. The initially-
detected contours serve as a model for final contour detection.
DETECTED CONTOURS
Accept Hide Correct
33722250
1 Once the final contours have been displayed, press the middle mouse button
[26] to hide the contours and check their accuracy.
2 Click the left mouse button [25] to accept the detected contours and proceed
to ‘step 10’.
3 Click the right mouse button [27] to correct a segment of the detected
contours.
Step 9
Correcting a contour segment.
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INDICATE DISTAL
DISTAL POINT OF ERRONEOUS
ERRONEOUS CONTOUR PART AND ERASE
33722260
----- ----- Erase
1 Position the cursor over the contour, distal to the segment to be corrected
and press the right mouse button [27]. The contour will be erased until this
button is released.

5.5 Post-processing
N OT E Erasure always takes place towards the start point. The cursor must therefore be
placed at the end of the segment to be erased. When the cursor reaches the end of the
contour, it jumps to the start of the remaining part of the contour and erasure
continues from there.
CONTOUR CORRECTION
Accept Draw Erase
33722270
2 Draw the new contour segment by holding down the middle mouse button
[26] and dragging with the mouse.
3 Click the left mouse button [25] to close the contour segment with a straight
line and to confirm the final vessel contours. If the new contour segment
differs significantly from the original, a new contour will be calculated
automatically within a limited region.
DETECTED CONTOURS
Accept Hide Correct
33722280
4 If necessary, repeat the correction procedure until a satisfactory result has

9896 001 33152
been obtained.
5 Click the left mouse button [25] to confirm all corrections made.
Step 10
Automatically defined obstruction and reference sites.

The detected luminal contours are used to calculate reference contours that
are then displayed on the image. From the detected vessel contours, the
diameter of the vessel can be calculated for each point along its centerline.
This defines the diameter function. This function is then used to derive the
reference contours, which represent the best approximation to the original
size of the vessel before disease occurred. The obstruction and reference
diameters are automatically calculated at the site of maximum percentage

Post-processing 5.5
diameter stenosis which is marked on the image by a straight line. The values
of the obstruction and reference diameters in millimeters are displayed in the
top left corner.
Obs : 3.84 mm
Ref : 6.85 mm
OBSTRUCTION AND REFERENCE SITES

Accept Redefine New segment
33722290
1 Click the right mouse button [27] to return to ‘step 6’ and select a new vessel
segment.
2 Click the middle mouse button [26] if the automatically selected obstruction
and reference positions are not appropriate, or if it is necessary to analyze
more than one obstruction in the selected segment, and proceed as described
in the section on AVA Manual Selection Procedures.
3 Click the left mouse button [25] to confirm the automatically-defined
obstruction.
Step 11
Result page.
9896 001 33152
33722300
RESULTS: Continue ----- Store

This page shows the anatomy of the obstruction along with the most relevant
geometrically-derived parameters. The black rectangular box shows the
diameter function for the analyzed vessel segment. Vessel diameter in
millimeters (vertical axis) is plotted against position along the centerline
(horizontal axis) from start to end point. The straight line through the
diameter function is the reference diameter function, defining the estimated
geometry of the vessel before disease occurred, as reconstructed from the
available diameter values. The position of the minimum obstruction

5.5 Post-processing
diameter and the proximal and distal boundaries are indicated by vertical
lines. These positions are also shown on the vessel segment. The areas
between the reconstructed reference contours and the luminal contours
within the obstructed region are shaded; the shaded area is a measure of the
area of the plaque as seen in this particular view. The obstruction and
reference diameters (Obs.D., Ref.D.), the percentage diameter (%D-Sten)
and the percentage area (%A-Sten) stenosis, the calibration factor (CF), the
symmetry index and the obstruction length (Obs. len.) are shown at the
bottom of the image. The percentage area stenosis is based on the
assumption of circular cross-sections at the obstruction and reference
positions. The symmetry index is 1.0 for a completely symmetric plaque area
and 0.0 for a totally eccentric area. The hospital name and the date are shown
at the top of the image.
• Click the right mouse button [27] to store the displayed result in the
photofile.
• To define another obstruction and/or reference site (return to ‘step 10’) or
to select a new vessel segment (return to ‘step 6’), click the left mouse
button [25] followed by the left button again or the right mouse button
respectively.
Step 12
Exiting the program.
1 To return to the AVA menu, click the left mouse button [25] and then the
right mouse button [27] when the result page is displayed.
Exit Program
Manual Calibration
Measurement
CF = 0.204 mm/pix
SELECT MENU ITEM
33722310
Accept ----- -----
2 Select ‘Exit program’ and click the left mouse button [25].
9896 001 33152
N OT E The program can be exited at any time by pressing the active program menu key on the
viewing console.
2. AVA manual selection procedure

Redefining the obstruction and/or reference site

This procedure is used when the automatically selected obstruction and/or
reference sites are not appropriate, or when more than one obstruction must
be analyzed in the selected arterial segment.
Step 1
Redefining the obstruction site.
This step follows on from ‘step 10’ of the AVA Standard Procedure.

Post-processing 5.5
Obs : 3.84 mm
Ref : 6.85 mm
REDEFINE OBSTRUCTION SITE

Accept Move Initial
33722320
1 Hold down the middle mouse button [26] and drag the reference site with
the mouse. The obstruction and reference diameters, displayed in the top left
corner of the image, are automatically updated. The reference value is
determined from the computed reference diameter function.
Obs : 4.41 mm
Ref : 6.89 mm

Accept Move Initial
33722330
2 Click the right mouse button [27] to restore the automatically-calculated

(initial) obstruction site and return to ‘step 10’ of the AVA Standard
Procedure.
3 Or click the left mouse button [25] to confirm the new obstruction location.
Step 2
Redefining the reference site.
9896 001 33152
At this stage it is still possible to restore the previous automatically-calculated

(initial) diameters by clicking the right mouse button [27] and returning to
‘step 10’ of the AVA Standard Procedure.

5.5 Post-processing
Obs : 3.84 mm
Ref : 6.85 mm
REFERENCE SITE
Accept Redefine New segment
33722340
1 Click the left mouse button [25] to accept the automatically-calculated
reference diameter at the user-defined obstruction site and go on to step 4 in
this section.
2 Click the middle mouse button [26] to redefine the reference site.
Step 3
Changing the reference site.
The reference diameter displayed in the top left corner of the image will now
be measured between the actual arterial luminal contours. This is clearly
different from the situation described in ‘step 1’ of this section.
Obs : 4.41 mm
Ref : 4.41 mm
REDEFINE REFERENCE SITE

Accept Move At obstruction
33722350
1 Hold down the middle mouse button [26] and drag reference site with the
9896 001 33152
mouse.

Post-processing 5.5
Obs : 4.41 mm
Ref : 6.43 mm
REDFINE REFERENCE SITE

33722360
reference diameter at the location of the user-defined obstruction site. The
program returns to step 2 of this section.
3 Or click the left mouse button [25] to confirm the new reference diameter.
Step 4
Result page.
A full description of the Result page is given in ‘step 11’ of the AVA Standard
Procedure.
33722370
RESULTS: Continue ----- Store
On the result page the reference diameter will now be indicated by a broad
9896 001 33152
line which is shaded to distinguish it from the obstruction diameter.

Parameters that are directly affected by the manual selection are marked with
an asterisk (*).
• Click the right mouse button [27] to store the result page in the photofile.
• To define another obstruction and/or reference site (return to ‘step 10’ of
section AVA Standard Procedure) double click the left mouse button. To
select a new vessel segment (return to ‘step 6’ of section AVA Standard
Procedure), click the left mouse button [25] followed by the middle
button [26].
To return to the AVA menu, click the left mouse button [25] followed by the
right mouse button [27].

5.5 Post-processing
3. Special AVA calibration procedures
Free Format calibration

These procedures can be used if the size of the catheter differs from the F-
sizes shown in the menu.
Step 1
Free Format menu.
This step follows on from ‘step 4’ of the AVA Standard Procedure. The menu
displayed lists a choice of French sizes or Free Format (FF).
N OT E If a size has been entered or selected previously, it is displayed in a box at the bottom
of the menu. To select this value, point to it with the mouse and click the left mouse
button [25].
F4
F5
F6
F7
F8
F9
FF
F4
SELECT FRENCH SIZE

Accept ----- -----
33722380
1 Move the arrow to ‘FF’ (Free Format) and click the left mouse button [25]. A
menu is displayed for entry of the size in millimeters (3F = 1mm).
Step 2
Entering the size.
.
0
1
2
3
4
5
6
9896 001 33152
7
8
9
OK

Select digit ----- Erase digit

33722390
To select the size last entered or selected (displayed in the ‘Enter’ field):
1 Move the arrow to the bottom box (OK) and click the left mouse button to
confirm.

Post-processing 5.5
To enter a new value:

mouse button [25]. The selected digit is entered in the ‘Enter’ field, erasing
the previous free format size.
3 Move the arrow to the next digit to be entered and click the left mouse
button [25]. Proceed in this way until the required size has been entered. A
maximum of nine digits can be entered, with the decimal point in any
position.
4 If necessary, click the right mouse button [27] to remove the last digit
entered.
.
0
1
2
3
4
5
6
7
8
9
OK
Enter size (mm):

(mm): 1.72
1.72
33722400
5 After the required size (in millimeters) has been entered, move the arrow to
the bottom box (OK) and click the left mouse button [25] to confirm.
The calibration factor in millimeters per pixel (display pixel) is displayed in

the bottom right corner of the screen and the AVA menu (Exit Program,
Catheter Calibration, Manual Calibration and Measurement) is redisplayed.
Since calibration has now been performed, the arrow points to the
Measurement box by default. The arrow can be moved by moving the
mouse.
Exit Program
Manual Calibration
Measurement
9896 001 33152
CF = 0.204 mm/pix
33722410
SELECT MENU ITEM

Accept ----- -----
6 Click the left mouse button [25] to confirm the selection.

5.5 Post-processing
4. AVA manual calibration procedure

This procedure performs a calibration using an object of known size and can
be used when the AVA program is run on an image series in which the
catheter is not displayed. To ensure accurate calibration, the following points
should be observed:
• a calibration object (grid or sphere) measuring at least 4 cm must be used
for accurate calibration
• the geometry of the X-ray stand and table during calibration has to be the
same as that used during the acquisition of the image series on which the
AVA is to be performed. This means that the same image intensifier field
must be chosen and the same geometric enlargement must be applied. In
other words, the grid or sphere has to be in the same position as the vessel
segment to be analyzed was during image acquisition
• the calibration object should be placed in the center of the field of view to
minimize distortion.
1 Select the image series containing the calibration object.

2 Press one of the three menu keys [95, 96 or 97] on the Viewing console.
The indicator above the key remains on while the function remains active.
PROGRAM MENU 3
PREVIOUS
NEXT

33722110
3 Use the mouse to move the arrow to ‘AVA’ and click the left mouse button
[25] to confirm. If necessary, select ‘Next/Previous’ to access more items.
The AVA menu is displayed.
9896 001 33152

Post-processing 5.5
CF = 0.204 mm/pix
SELECT MENU ITEM
33722420
Accept ----- -----
4 Move the arrow to ‘Manual calibration’ and click the left mouse button [25]
to confirm the selection.
Step 1
Selecting the image and zoomed area.
After Manual Calibration has been selected, the image is zoomed
automatically. The image can be panned by moving the mouse.

Accept ----- Menu
33722430
2 Click the right mouse button [27] to return to the AVA menu.
9896 001 33152
area.
Step 2
The cursor displayed on the screen can be controlled using the mouse.

5.5 Post-processing
DRAW CALIBRATION DIAMETER

Accept Draw Erase
33722440
a calibration line of known length.
2 Click the right mouse button [27] to reposition the start point of the line.
3 Click the left mouse button [25] to confirm the calibration line.
N OT E S If the calibration factor is not sufficiently accurate, a warning is displayed: ‘Calibration
factor accuracy only xx%’ (where ‘xx’ is the accuracy value).
- click the left mouse button [25] to accept this accuracy.
- or click the right mouse button [27] to reject the accuracy and return to the AVA
menu. Accuracy can be improved by using a larger object for calibration.
Step 3
Entering the size.
A menu is now displayed over the image allowing entry of any millimeter
value for the size of the calibration object.
.
0
1
2
3
4
5
6
7
8
9
OK

9896 001 33152

33722450
1 Move the arrow to the bottom box (OK) and click the left mouse button
[25] to confirm.

Post-processing 5.5
button [25]. Proceed in this way until the required size has been entered.
A maximum of nine digits can be entered, with the decimal point in any
position.
entered.
Enter size (mm): 60
33722460
CF = 0.207 mm/pix
SELECT MENU ITEM
33722470
Accept ----- -----

9896 001 33152
Calibration is now complete. The calibration factor, CF, is displayed on the

image in millimeters per pixel (display pixel). The AVA menu is redisplayed.
Since calibration has been performed, the arrow points to the Measurement
box by default.
N OT E If the image series containing the calibration object is the same as that on which AVA is
to be performed, select Measurement. Click the left mouse button [25] to confirm the
choice and proceed with ‘step 5’ of ‘AVA Measurement’ in the AVA Standard
Procedure.
Step 4
Selecting the program.

5.5 Post-processing
CF = 0.207 mm/pix
SELECT MENU ITEM
33722480
Accept ----- -----
1 Use the mouse to point the arrow at the Exit Program box and click left
mouse button [25] to confirm.
2 Select the image series on which AVA is to be performed.
3 Press one of the three menu keys [95, 96 or 97]. The indicator above the key
remains on while the function remains active.
PROGRAM MENU 3
PREVIOUS
NEXT

33722110

5 Use the left mouse button [25] to select the item ‘AVA’. After AVA has been
selected, the AVA menu is displayed. Since calibration has now been
performed, the arrow points to the Measurement box by default.
9896 001 33152
6 Select ‘Measurement’ and click the left mouse button [25] to confirm.
7 Go on to ‘step 5’ of ‘AVA Measurement’ in the AVA Standard Procedure.

Post-processing 5.5
5.5.6 Monoplane left ventricular analysis

N OT E Help and error messages are displayed in shadow text on the message line just above
the ECG signal.
CAUTION Interrupting a program erases all intermediate results.

Automated left ventricular analysis is carried out either by the area-length
method, described by Sandler and Dodge (ref. 1), or by Simpson’s rule (ref.
2). The formulas used to calculate left ventricular volume are based on the
findings (ref. 3) of the Laboratory for Clinical and Experimental Image
Processing at the University Hospital of Leiden (the Netherlands). The wall
parameters are derived according to methods described by Brower et al. (ref.
4 and 5). The wall stress (ref. 6) is normalized to an intraventricular pressure
of one. The Body Surface Area is calculated by the Dubois and Dubois
height-weight equation (ref. 7). Automated contour detection begins with an
initial model which is derived from the actual contents of the selected ED-
and ES-images. However, in some cases when a reliable model cannot be
derived, a standard initial model is used. Published results and tests have
shown that this program is suitable for the analysis of 30RAO projections
of left ventricular angiograms. As a rule, 35 to 50 ml of contrast medium is
administered at a rate of about 15 ml/s.
References
1 Sandler, H. and Dodge, H.T., The use of single plane angiocardiograms

for the calculation of left ventricular volume in man. American Heart
Journal, 75, pp. 325-334, 1968.
2 Folland, E.D. and Parisi, A.F., Ventricular volume and function, in:
Textbook of two-dimensional echocardiography, Talano, J.V. and Gardin,
J.M. (eds), Grune & Stratton (New York), p. 165, 1983.
3 Reiber, J.H.C., Viddeleer, A.R., Koning, G. et al., Left ventricular
regression equations from single plane cine and digital X-ray
ventriculograms revisited, International Journal of Cardiac Imaging, 12:
69-78, 1996.
4 Brower, P.W., Meester, G.T., Hugenholtz, P.G., Quantification of
ventricular performance: A computer-based system for the analysis of
angiographic data, Cath. and Cardiovasc. Diagn., 1, pp. 133-155, 1975.
5 Brower, P.W. and Meester, G.T., Quantification of left ventricular function
in patients with coronary disease, in: Clinical and research applications of
engineering principles, University Park Press (Baltimore), chap. 16, 1979.
9896 001 33152
6 McHale, P.A. and Greenfield, J.C., Evaluation of several geometric models

for estimation of left ventricular circumferential wall stress, Circ. Res, 33,
pp. 303-312, 1973.
7 Yang, S.S., Bentivoglio, L.G., et al., From cardiac catheterization data to
hemodynamic parameters, 3rd edition, F.A. Davis Company

(Philadelphia), p. 42, 1988.
8 Koning, G., Brand, M. van den, Zorn, I., et al., Usefulness of digital
angiography in the assessment of left ventricular ejection fraction, Cath.
and Cardiovasc. Diagn., 21, pp. 185-194, 1990.
Procedure
1 Monoplane left ventricular analysis standard procedure:

5.5 Post-processing
• calibration:
- step 1 Selecting the program
- step 2 Selecting an image and zoomed area
- step 3 Drawing a calibration line
- step 4 Selecting free format
- step 5 Selecting the size of the calibration line.
2 Automated left ventricular analysis procedure:
• selecting the program
• defining the ED contour:
- step 1 Selecting an image
- step 2 Defining the valve plane
- step 3 Defining the position of the apex
- step 4 ED contour.
• defining the ES contour:
- step 1 Selecting an image.
- step 2 Defining the valve plane
- step 3 Defining the position of the apex
- step 4 ES contour.
• analysis results:
- step 1 First Result Page.
- step 2 Entering height and weight. Second Result Page.
- Step 3 Entering heart rate. Third Result Page.
- Step 4 Defining the epicard wall. Fourth Result Page.
- Step 5 Result Overview.
3 Fine tuning:
• manual contour correction.
4 ALVA recalculation:
• performing the ALVA recalculation.
5 ALVA properties:
• volume calculation
• BSA input
• text overlay in photofile.
1. Monoplane left ventricular analysis standard procedure
Calibration
N OT E The accuracy with which the calibration is performed has a direct influence on the
reliability of the left ventricular volumes calculated by the automated left ventricular
analysis program. Large deviations from expected volumes are generally due to
inaccurate calibration.
9896 001 33152

• use a calibration object (grid or sphere) measuring at least 4 cm. The use of
contrast catheters for manual calibration is not recommended
• place the calibration object in the center of the field of view to minimize
distortion
• the image intensifier field size must not be greater than 9 inches
• make sure that the geometry of the X-ray stand and table is the same as
that used during the left ventricular exposure, this involves choosing the
same image intensifier field and the same geometric enlargement. In other
words, the calibration object must be in the same position as the heart was
during image acquisition.
Step 1

Post-processing 5.5

First select the image series containing the calibration object.
33725220
1 Press one of the three menu keys [95, 96 or 97] on the Viewing console. The
key remains lit as long as the function is active.
2 Use the left mouse button [25] to select the item ‘Calibration’.
After the calibration program has been selected, the image is zoomed
automatically. The image can be panned using the mouse.
Step 2
Selecting an image and zoomed area.
Image : Select -- -- --
33721120
9896 001 33152
N OT E The ‘message line’ at the bottom of clinical images indicates the current actions of the
mouse buttons. For example, in the above image, the left mouse button is used for the
‘Select’ command and the middle and right buttons have no action.
2 Click the left mouse button to confirm the image selection and zoomed area.
The cursor displayed on the screen can be controlled using the mouse.
Step 3

5.5 Post-processing
Diameter
Diameter :: Accept
Accept Draw
Draw Reject
Reject
33721130
a calibration line of known length.
2 Click the right mouse button [27] to reposition the starting point.
3 Click the left mouse button [25] to confirm the calibration line. A menu is
now displayed over the image listing French sizes (F4 to F9) and free format
(FF).
Step 4
Selecting free format.
33721140
1 Move the arrow to ‘FF’ (free format) and click the left mouse button [25]. A
9896 001 33152
box menu is displayed for entering the size (in millimeters) of the calibration
object line.
N OT E The last item on the menu is the size last entered or selected. When using standard size
objects, this value can be selected directly by pointing to it with the mouse and clicking
the left mouse button.
Step 5
Selecting the size of the calibration line.
confirm.

Post-processing 5.5
Enter (mm) : 2.000000
33721150
button [25]. Proceed in this way until the required size has been entered. A
maximum of nine digits can be entered, with the decimal point in any
position.
entered.
Enter (mm) : 5
33721160
9896 001 33152

5.5 Post-processing
Enter (mm) : 50
33721170
Calibration is now complete. The calibration factor, CF, is displayed on the
image in millimeters per pixel (display pixel).
CF = 0.145 mm/pixel
33721180
2. Automated Left Ventricular Analysis (ALVA) procedure

The ALVA procedure is performed on the image series currently displayed.

First select the image series with which the program is to be used. The correct
image series must be selected before proceeding.
9896 001 33152

Post-processing 5.5
33751190
1 Press one of the three menu keys [95, 96 or 97]. The corresponding indicator
remains on while the function is active.
2 Use the left mouse button [25] to select the item ‘automated left ventricular
analysis (ALVA)’.
Defining the ED contour
Step 1
Selecting an image.
Exit
Measurement with standard CF
Measurement with Auto CF
Standard CF-Value: x.xxx mm/pix

Auto CF-Value : x.xxx mm/pix
ED IMAGE : select ---- quit

33720000
1 Select the end diastolic (ED) image using the image selection keys on the
9896 001 33152
viewing console. Only cardiac cycles free from extrasystolic contractions are
appropriate.
2 Click the left mouse button [25] to confirm selection of the ED image. A

N OT E The ‘message line’ at the bottom of the clinical images indicates the current actions of
the mouse buttons. For example, in the above image, the left mouse button is used for
the ‘Select’ command, the middle button has no action, and the right button is used for
the ‘Quit’ command.
Step 2
Defining the valve plane.

5.5 Post-processing
AORTIC VALVE : Accept Draw Reject
33721210
Define the valve plane in this RAO view as follows:
1 Place the cursor at one end of the aortic valve line.
2 Click the middle mouse button [26] to define this point as one of the end
points of the valve line.
3 Define the other end point of the valve line contour by moving the mouse
while holding [26] down.
4 Click the left mouse button [25] to accept the valve line.
5 If necessary, click the right mouse button [27] to redefine the first end point
of the valve line.
Step 3
Defining the position of the apex.
.
9896 001 33152
APEX : Accept ---- ----

33721220
1 Move the cursor to the apex point and click the left mouse button [25] to
define the position of the apex.

N OT E If the aortic valve line or apex is drawn outside the image area the message ‘Aortic
valve drawn out of image area’ or ‘Apex drawn out of image area’ is displayed.
Step 4
ED contour.

Post-processing 5.5
The automatic contour seeking algorithm starts immediately and the

message “Calculating contour of ventricle” is displayed. A first
approximation of the contour is displayed as an interim result. Once the
process is complete, the cursor is displayed to allow manual correction of the
contour. The procedure for manual correction is described in the section on
‘Automated left ventricular analysis fine tuning’.
CONTOUR : Accept Hide Erase
33721230
1 Press and hold down the middle mouse button [26] to temporarily remove
the contour line from the image and check its accuracy.
2 Click the left mouse button to confirm the ED contour if no correction is
necessary.
Defining the ES contour
Step 1
Selecting an image.
9896 001 33152
ES IMAGE : Select ---- Quit

33721240
1 Use the image selection keys to select the end systolic (ES) image following
the current ED image.
2 Click the left mouse button [25] to confirm this selection.
The cursor is displayed on the image and the valve line and apex can be
defined in the same way as for the ED image (steps 2 and 3). The ES contour
is then calculated. The contour is displayed and the cursor appears in the
center of the image.

5.5 Post-processing
Step 4
ES contour.
CONTOUR : Accept Hide Erase
33721250
1 Press and hold down the middle mouse button [26] to temporarily remove
the contour line from the image and check its accuracy.
2 Click the left mouse button to confirm the ES contour if no correction is
necessary.
The procedure for manual correction is described in the section on
‘Automated left ventricular analysis fine tuning’.
Analysis results
Step 1
First ‘result’ page.
EF : 55% a
EDV : 172.0 ml
ESV : 77.0 ml
SV : 94.9ml
CF : 0.159 mm/px
9896 001 33152
RESULT PAGES : Next Results Store

33725230
First result page
The asterisk [a] denotes that the EF value is based on a non-default (user
defined) correction formula (see Section ‘5. ALVA properties’).

This page shows the ED image, with the longest axes of the ED and ES
contours, and the value of the ejection fraction (EF [%]). The end diastolic
volume (EDV [ml]), end systolic volume (ESV [ml]), stroke volume (SV
[ml]), and calibration factor (CF [mm/pixel]) are also displayed if calibration
has been performed.
To proceed, the message line provides three options:

Post-processing 5.5
• ‘Next’: continues the ALVA procedure and generates the next result page
• ‘Results’: shows the calculated results on the results overview
• ‘Store’: stores the ‘result’ page in the photofile. Depending on the ALVA
configuration (see Section 5 ‘ALVA properties’) the result page will be
stored with or without patient data.
1 If desired, click the right mouse button [27] to store the first ‘result’ page in
the photofile.
2 Click the left mouse button [25] to continue.
ALVA procedure
Required
inputs Back
1st "result"page Results overview
Contour def. Results

START
(ED + ES)
Next Quit
2nd "result"page EXIT

program
Height/weight Results
or BSA
Next
3rd "result"page
Results
Heart rate
Next
4th "result"page
Results
Epicard wall
or next
33725240
Schematic overview of the ALVA procedure
Step 2
9896 001 33152
Entering height and weight.

1 Click the left mouse button [25] to obtain the second ‘result’ page. This
displays the first input query. Either the patient’s height and weight, or the
body surface area (BSA) is requested according to the ALVA configuration
(see ‘5. ALVA properties’).

5.5 Post-processing
Enter Patient Height (m):
33725250
2 Use the mouse to select the patient’s height in meters.

To enter a patient height of 1.80 m:
1 Move the arrow to position ‘1’ and click the left mouse button [25].
2 Repeat step 1 for the decimal point and other digits.
3 Confirm the entry by moving the arrow to ‘OK’ and clicking the left mouse
button [25]. The patient’s weight is now requested.
Enter Patient Weight (kg):

33721280
4 Use the mouse to select the patient’s weight in kg.
Second ‘result’ page.

9896 001 33152

Post-processing 5.5
EF : 55%
SV : 94.9 ml
BSA : 2.00 m2
EDV(I) : 86.0 ml /m2
ESV(I) : 38.5 ml /m2
SV(I) : 47.5 ml /m2
EDV : 172.0 ml
ESV : 77.0 ml
CF : 0.159 mm/px
33725260
Second result page
contours, and the value of the ejection fraction (EF [%]). The end diastolic
volume (EDV [ml]), end systolic volume (ESV [ml]), stroke volume (SV
[ml]), and calibration factor (CF [mm/pixel]) are also displayed. In addition,
the body surface area (BSA [m2]) and the BSA-index volumes EDV(I),
ESV(I), and SV(I) are displayed in ml/m3.
1 If desired, click the right mouse button [27] to store the second ‘result’ page
in the photofile.
Step 3
Entering heart rate.
1 Click the left mouse button [25] to obtain the third ‘result’ page. Before
displaying this page the system requests additional input from the user.
9896 001 33152
Enter Heart Rate (bpm):

33721300
2 Use the mouse to enter the heart rate in beats per minute.
Third ‘result’ page.

5.5 Post-processing
EF : 55%
HR : 70 BMP
C0 : 6.64 1/min
CI : 3.32 1/min
33725270
Third result page
contours, and the value of (1)the ejection fraction (EF [%]). Since calibration
has been performed and the heart rate (HR [bpm]) has been entered, the
cardiac output (CO [l/min]) is displayed.
The cardiac index (CI [1/min.m2]) is also displayed, since the BSA has either
been entered or calculated.
1 If desired, click the right mouse button [27] to store the third ‘result’ page in
the photofile.
Step 4
Defining the epicard wall.
1 Press the left mouse button [25] to obtain the fourth ‘result’ page. Additional
user input is required before this page can be displayed.
9896 001 33152
EPICARD WALL : Accept Hide Erase

33721320
2 Drag with the mouse while holding down the middle mouse button [26] to
define the epicard wall. If necessary, click the right mouse button to redefine
the outline of the epicard wall.

Post-processing 5.5
EPICARD WALL : Accept Draw Erase
33721330
3 Click the left mouse button to confirm the position of the epicard wall.
Fourth ‘result’ page.
EF : 55 %
WT : 9.1 mm
WV : 225 ml
WM : 239 g
WS : 4.90

33725280
Fourth ‘result’ page.
contours, the epicard wall contour, and the value of the ejection fraction (EF
[%]). The calculated wall thickness (WT [mm]), wall volume (WV [ml]),
wall mass (WM [g]), and normalized wall stress (WS) are also displayed.
1 If desired, click the right mouse button [27] to store the fourth ‘result’ page
into the photofile.
2 Click the left or middle mouse button [25 or 26] to obtain the Results
9896 001 33152
overview.
Step 5
Results overview.

5.5 Post-processing
EF : 55 %
EDV : 172.0 ml
ESV : 77.0 ml
SV : 94.9 ml
EDV(I) : 86.0 ml/m2
ESV(I) : 38.5 ml/m2
SV(I) : 47.5 ml/m2
CO : 6.64 1/min
CI : 3.32 1/(min m2)
WT : 9.1 mm
WV : 225 ml University Medical Center
WM : 239 g Dr. Cardiologist
WS : 4.90 18-01-1998
CF : 0.159 mm/px
BSA: 2.00 m2 John Doe
05-01-1951
HR : 70 bpm H123456789
Volume calculation method:
Area Length
Volume correction method:
Vol.= 0.787 Vol.- 3.759
33725290
(user defined) Back Quit Store
Results overview
If all ‘result’ pages have been generated, this page shows the ED image, with
the longest axes of the ED and ES contours, the epicard wall contour
together with all calculated results (from ‘result’ pages 1 to 4). It also
indicates the methods used for volume calculation and volume correction,
and gives the patient data. If results overview is selected after the first, second
or third ‘result’ page, only those results that are currently available are
displayed.
To access other pages:
• click the left mouse button [25] to view the first ‘result’ page
• click the middle mouse button [26] to exit the ALVA program
• click the right mouse button [27] to store the Results overview in the
photofile.
9896 001 33152


Post-processing 5.5
3. Fine tuning
Manual contour correction
Correct Contour : Accept Draw Erase Correct Contour : Accept Draw Erase
33721350
Correct Contour : Accept Draw Erase Correct Contour : Accept Draw Erase
Although an ED contour is illustrated above, the same procedure is used to

correct ED and ES contours. Once a contour has been drawn automatically,
the cursor moves to the center of the image where it can be used to manually
correct the contour (end of step 4).
1 Place the cursor over the last contour point to be corrected.
2 Press and hold down the right mouse button [27] to erase the contour in a
counter-clockwise direction.
3 Release the right mouse button [27] to stop erasing the contour.
4 Press the middle mouse button [26] and drag with the mouse to redraw the
erased section of the contour.
5 Click the left mouse button [25] to close the contour. If the cursor is not
positioned on the contour exactly, it will close automatically. A fine-tuning
procedure is automatically performed on the corrected section.
6 Click the left mouse button [25] to confirm the ED or ES contour and to
9896 001 33152
continue with the automatic procedure.
4. ALVA recalculation
If required, the volumes and other parameters can be recalculated without
redrawing the contours.

The calibration factor used during Automated Left Ventricular Analysis
(ALVA) recalculation is the one that has been used during the ALVA
procedure.

5.5 Post-processing
33725220
Performing the ALVA recalculation
1 Select the correct image series for which the ALVA recalculation is to be
performed. The volumes for this series are then recalculated using the
calibration factor that has been used during the ALVA procedure.
2 Press one of the three menu keys to display the menu. The indicator remains
on while the function is active.
3 Use the left mouse button [25] to select ALVA recalculation. The ALVA
program will begin at the first ‘result’ page, showing the results based on the
contours previously defined.
4 Click the left mouse button [25] to obtain the next ‘result’ page; Additional
user input is required only for those items not previously entered during the
standard ALVA procedure.
• Click the middle mouse button [26] to obtain the results overview or
• Click the right mouse button [27] to store the ‘result’ page in the
photofile.
5. ALVA properties
The operator can use the ALVA properties section to change the
configuration settings used in the ALVA program.
The configuration settings are:
• volume calculation method:
- area length or Simpson
- volume correction formula (= regression equations).
9896 001 33152
• BSA input:
- BSA value or heigth and weight.
• text overlay in photofile.

Post-processing 5.5
33725300
Changing the ALVA properties
2 Use the left mouse button [25] to select ALVA properties. The ALVA
properties main screen is displayed.
ALVA properties main screen.
ALVA PROPERTIES
Exit program
Volume Calculation
BSA input
Text overlay in photofile
Volume calculation method: Area Length

Volume correction formula:
Volume = 0.783 Volume - 3.759 (default)
BSA input method: Height/Weight
Text overlay in photofile: Yes
SELECT MENU ITEM

33725310
Accept ------- -------
ALVA properties main screen
Volume calculation
Select ‘Volume calculation’ to change the method used for volume
9896 001 33152
calculation or the volume correction formula (= regression equations).

1 Move the arrow to item ‘Volume Calculation’ on the ALVA properties main
screen and click with the left mouse button [25]. The volume calculation
page is displayed.

5.5 Post-processing
ALVA PROPERTIES

CHANGE VOLUME CALCULATION METHOD OR FORMULA
33725320
Method Correction formula Menu
The volume calculation page
Returning to the ALVA properties main screen.

Click the right mouse button [27] to return to the ALVA properties main
screen
Changing the method of volume calculation
N OT E Mathematical models are used to calculate the left ventricular volumes. As these
models only approximate the complex shape of the left ventricle (Vmeasured) regression
equations are applied to correct the volumes. These regression equations are based on
data obtained from postmortem casts. The format of the regression equation for the
volume calculation is:
V = (slope value) * Vmeasured + (offset value)
Both the slope and offset values are regression factors. These factors are dependent on
the model used and the projection view during acquisition. The default regression
equations for both the Area length method and the Simpson’s rule method used in the
ALVA program are valid for RAO 30° projections (ref. 3).
1 Click the left mouse button [25] to change the method of volume
calculation.
ALVA PROPERTIES
9896 001 33152

33725330

Area Length Simpson Cancel
• Click the left mouse button [25] to select the Area length method. The
volume calculation page is displayed (Area length method previously
selected).
• Click the right mouse button [27] to cancel. The volume calculation page
is displayed.

Post-processing 5.5
• Click the middle mouse button [26] to select the Simpson method. The
volume calculation page is displayed showing the new method of
calculation to be used.
ALVA PROPERTIES
Volume calculation method: Simpson‘s rule

33725340
Method Correction formula Menu
Volume calculation page showing the new method of calculation
Changing the correction formula
WA R N I N G If regression factors other than the default factors are used, the calculated left
ventricular volumes could be incorrect. It is therefore strongly recommended
to use the program default regression factors only.
If the regression factors are changed, an asterisk “*” is displayed after the EF
value in the ALVA program.
N OT E When a volume calculation method is selected all user defined regression factors are
lost and replaced by the default regression factors.
1 Click the middle mouse button [26] to change the correction formula.
ALVA PROPERTIES
Volume calculation method: Simpson´s rule

9896 001 33152

33725350
VOLUME CORRECTION FORMULA

Defult User defined Cancel
• Click the left mouse button [25] to use the default correction formula
belonging to the selected volume calculation method. The volume
calculation page is displayed.
• Click the right mouse button [27] to cancel. The volume calculation page
is displayed.

5.5 Post-processing
• Click the middle mouse button [26] to change the correction formula
belonging to the selected volume calculation method. A box menu is
displayed for entering the slope value.
ALVA PROPERTIES
.
1
2
3
4
5
6 Volume calculation method: Simpson´s rule
7 Volume correction formula:
8 Volume = 0.737 Volume - 4.649 (default)
9
OK
Slope Value 0.737000
33725360
Enter Slope Value: Insert ------- Remove
The user defined page
2 Move the arrow to the digit or decimal point to be inserted and click the left
mouse button [25].
3 Repeat step 2 to enter the complete slope value. If necessary, click the right
mouse button [27] to delete the last digit entered.
4 Confirm the new slope value by moving the arrow to ‘OK’ and clicking with
the left mouse button [25]. A box menu is displayed for entering the offset
value.
ALVA PROPERTIES
-
.
1
2
3
4
5
6 Volume calculation method: Simpson´s rule
7 Volume correction formula:
8 Volume = 0.813 Volume - 4.649 (user defined)
9
OK
Offset Value -4.649000
33725370
Enter Offset Value: Insert ------- Remove

9896 001 33152
5 Use the mouse to enter the offset value. If the offset value to be entered is a
negative value, first select and enter the ‘minus’ sign and then the digits or
decimal point.
6 Confirm the entry by moving the arrow to ‘OK’ and clicking with the left
mouse button [25].

Post-processing 5.5
ALVA PROPERTIES

New volume correction formula:
Volume = 0.813 Volume - 4.500 (user defined)
CORRECTION FORMULA
33725380
Accept Modify -------
7 If necessary, click the middle mouse button [26] to modify the new
correction formula.
8 Click the left mouse button [25] to accept the new correction formula. The
ALVA properties main screen is displayed showing the updated values.
ALVA PROPERTIES
Exit program
Volume Calculation
BSA input

BSA input method: Height/Weight
SELECT MENU ITEM 33725390
Accept ------- -------
BSA input
The ‘BSA input’ page can be used to select either ‘BSA’ or ‘Height/weight’ as
input for the second ‘result’ page in the ALVA program.
1 Move the arrow to ‘BSA input’ on the ALVA properties main screen and click
with the left mouse button [25]. The BSA input page is displayed.
9896 001 33152

5.5 Post-processing
ALVA PROPERTIES
BSA input method: Heigth/Weight
33725400
SELECT BSA INPUT METHOD IN ALVA
BSA Value Height/Weight Menu
The BSA input page
2 Click the left mouse button [25] to select BSA as input for the ALVA
program or click the middle mouse button [26] to select height/weight as
input for the ALVA program.
3 Click the right mouse button [27] to return to the ALVA properties main
screen.
ALVA PROPERTIES
Exit program
Volume Calculation
BSA input

BSA input method: BSA value
33725410
SELECT MENU ITEM

Accept ------- -------

It is possible to store the individual ‘result’ pages of the ALVA program in the
photofile with or without patient data as text overlay.
1 Move the arrow to ‘Text overlay in photofile’ on the ALVA properties main
9896 001 33152
screen and click with the left mouse button [25]. The ‘Text overlay in
photofile’ page is displayed.

Post-processing 5.5
ALVA PROPERTIES
Text overlay in photo file: Yes
33725420
SELECT TEXT OVERLAY IN PHOTOFILE
Yes No Menu
The ‘text overlay in photofile’ page
2 Click the left mouse button [25] to store the text overlay with the ALVA
‘result’ pages in the photofile or click the middle mouse button [26] to store
no text overlay with the ALVA ‘result’ pages in the photofile.
3 Click the right mouse button [27] to return to the ALVA properties main
screen.
ALVA PROPERTIES
Exit program
Volume Calculation
BSA input

BSA input method: BSA value
Text overlay in photofile: No 33725430
SELECT MENU ITEM

Accept ------- -------
Exit the ALVA properties program

To exit the ALVA properties screen move the arrow to ‘Exit program’ and
click with the left mouse button [25].
9896 001 33152
5.5.7 Centerline wall motion

The method used to calculate the centerline wall motion (CWM) is based on
the contraction model described in the medical literature. The method aims
to describe the displacement between end diastole and end systole of
particular points on the left ventricular wall. The calculations are considered
valid for the same standard RAO projection that is used for the global
ejection fraction calculation. This clinical program uses the left-ventricular
outlines resulting from the left ventricular (EF) analysis programs thus
avoiding additional user interaction and ensuring correct application
conditions.

5.5 Post-processing
Reference
Sheehan, F.H. Advantages and applications of the centerline method for
characterizing regional ventricular function. Circulation, 74, (2), pp. 293-
305, 1986.
Standard procedure
33721110
1 Select the correct image series with which to run the CWM program. The
CWM function uses the information for the image series currently displayed,
so the correct image series must be selected before proceeding.
2 Check that one of the left ventricular (EF) analysis programs has been
applied to the image series.
4 Use the left mouse button [25] to select the centerline wall motion function.
No further user action is required once the CWM program has started.
5 Use the left mouse button [25] to view the next/previous screens.
When the indicator above the menu key goes out, the program has finished.
The results are displayed and can be stored in the Photofile.
The final display shows: 9896 001 33152

Post-processing 5.5
33721550
Top left
The ED image used for left ventricular (EF) analysis with the contours
accepted in the analysis. The centerline is determined between the ED and
the ES contours. 100 equidistant chords perpendicular to this centerline are
calculated. The program ensures that chords do not cross one another. Only
50 chords are displayed.
Top right
This quarter of the display contains a graph of normalized chord lengths
plotted against wall location. The vertical axis represents the chord lengths
normalized to the end diastolic circumference. In other words, the chord
length is expressed as a percentage of the end diastolic circumference. The
horizontal axis represents the locations of the measurement points. The ED
and ES points are matched by the chords. The apex point is indicated on the
horizontal axis. The gray band represents the wall motion parameters for a
normal patient population, collected by the Thorax Center, Erasmus
University and the University Hospital Dijkzigt, Rotterdam, the
Netherlands. The gray band shows the average normal value ± 2 standard
deviations.
Bottom left
This quarter shows the deviations of the local wall motion parameters
compared with the values obtained for the normal patient population. The
gray band indicates the average normal values ± 2 standard deviations (95%
probability). The apex point is indicated on the horizontal axis. If the graph
of wall motion remains within the gray band for the normal population, it
9896 001 33152
matches the normal patient group.
Bottom right
This quarter of the display gives general information.
Line 1: Name of the hospital
Line 2: Examination date

Line 3: Patient’s name
Lines 4 and 5: Patient’s date of birth and the identification code entered with
the patient’s name

5.5 Post-processing
5.5.8 Regional wall motion

The method used to calculate the regional wall motion (RWM) is the most
typical method described in the medical literature. The model aims to
describe the displacement of the left ventricular wall from end diastole to end
systole. The calculations are considered valid for the same standard RAO
projection that is used for the global ejection fraction calculation. This
clinical program uses the left-ventricular outlines produced by the left
ventricular (EF) analysis programs, thus avoiding additional user interaction
and ensuring correct application conditions.
Reference
Wong, W.H., Kirkeeide, R.L. and Gould, K.L.; Computer applications in
angiography; in Cardiac Imaging and Image Processing; Collins, S.M and
Skorton, D.J. (eds); McGraw-Hill Book Company; New York 1986; 232-
233.
Standard procedure
33721110
1 Select the correct image series to be analyzed by the RWM program. The
RWM program uses the information for the image series currently displayed,
9896 001 33152
4 Use the left mouse button [25] to select the regional wall motion function.
No further user action is required once the RWM function has started.
The final display shows:

Post-processing 5.5
33721570
Top left
The ED image used for left ventricular (EF) analysis with the contours
accepted during the analysis. The mathematical center of gravity is
determined for both the ED and ES contours. In each contour, the right
mitral valve point is determined and the wall between the left aortic valve
and the right mitral valve points is then divided into the 5 anatomical wall
segments. These segments are shown for the ED contour only. In the
displays, the segments are numbered in clockwise sequence for reference.
Top right
This quarter of the display contains a graph of radial shortening, plotted
against wall location. The vertical axis represents the percentage displacement
of corresponding ED and ES wall locations with reference to the center of
gravity, in other words, the difference in length between the ED and ES radii
divided by the length of the ED radius. The horizontal axis represents the
locations of the wall points. The ED and ES are matched between their left
aortic valve and right mitral valve points. The dashed line indicates the
divisions between the anatomical segments. The numbers at the bottom are
the segment numbers as shown in the top-left quarter of the display.
Bottom left
This quarter of the display gives the numerical results. First, the EF
percentage calculated by the left ventricular (EF) analysis program is
displayed, representing a volume ratio. The second block shows the average
percentage shortening for each of the 5 anatomical segments. The numbers
are the segment numbers used in the top left quarter of the display and the
9896 001 33152
graph in the top right quarter. The anatomical nomenclature used is

described in the reference cited. In addition to diaphragmatic, the terms
posterolateral and posteroapical are also used in the medical literature.
Bottom right
This quarter of the display gives general information.

Line 1: Name of the hospital
Line 2: Examination date
Line 3: Patient’s name
Lines 4 and 5: Patient’s date of birth and identification code entered with the
patient’s name.

5.5 Post-processing
5.5.9 Slager wall motion

The method used to calculate the Slager wall motion (SWM) is based on a
contraction model described in the medical literature. The model aims to
describe the displacement of set points on the left ventricular wall between
end diastole and end systole. The calculations are considered valid for the
same standard RAO projection that is used for the global ejection fraction
calculation. This clinical program uses the left-ventricular outlines produced
by the left ventricular (EF) analysis programs, thus avoiding additional user
interaction and ensuring correct application conditions.
References
1 Slager, C.J. et al. Left ventricular contour segmentation from anatomical

landmark trajectories and its application to wall motion analysis. Comp. in
Card., pp. 347-350. 1979.
2 Slager, C.J. et al. Quantitative assessment of regional left ventricular
motion using endocardial landmarks. Journal of the American College of
Cardiology, 7, pp. 371-326. 1986.
Standard procedure
PROGRAM MENU 2
PREVIOUS
NEXT
Slager Wall Motion

33721580
1 Select the correct image series to be analyzed by the SWM program. The
SWM program uses the information for the image series currently displayed,
9896 001 33152

4 Use the left mouse button [25] to select Slager wall motion. No further user
action is required once the SWM program has started.
The final display shows:

Post-processing 5.5
33721590
Top
The top half of the display shows a composite graph of CREF values for the
20 segments. CREF values (regional contribution to global EF) are derived
from systolic wall displacement data and left ventricular long-axis shortening.
The individual anterior and posterior CREF values of the patient are
superimposed and connected by straight lines. To compare the quantitative
results with those provided by the usual visual interpretation, the left
ventricular boundary is divided into 5 anatomical regions, denoted
anterobasal, anterolateral, apical, diaphragmatic and posterobasal. The
segments are assigned to these regions and the CREF values for the regions
are plotted as well. The gray band represents the wall motion parameters for a
normal patient population, collected by the Thorax Center, Erasmus
University and the University Hospital Dijkzigt, Rotterdam, the
Netherlands. The gray band shows the average normal value ± 2 standard
deviations.
Bottom left
This shows the ED image chosen for left ventricular (EF) analysis with the
contours accepted during the analysis. Left ventricular segmental wall
motion is computed along 20 straight lines, calculated from a mathematical
expression derived from anatomical landmark trajectories in normal patients.
The 20 lines result from 20 well-defined ED contour points or segments, 10
anterior and 10 posterior. The point or segment numbers are plotted along
the contour. A center of contraction is defined for each pair of 2 opposite ED
contour points.
9896 001 33152
Bottom right
This section of the display shows the ejection fraction as previously
computed from the contours, the name of the hospital, examination date, the
patient’s name and date of birth, and the identification code entered with the
patient’s name

5.5 Post-processing
5.5.10 Automated coronary analysis

The Automated Coronary Analysis (ACA) program allows objective and
reproducible assessment of the severity of any existing coronary narrowing
(Ref.1). Both calibration and measurement are carried out in three stages.
Firstly, a start and an end point are defined manually and a path line is
automatically detected within the segment indicated (Ref.2). Secondly, using
this path line as a model, catheter or arterial contours are detected in two
passes (Ref.3). And finally, from these detected contours, either the
calibration factor or a number of clinically-relevant parameters are calculated.
The ACA Standard Procedure is described first for catheter calibration and
then for measurement. The section on ACA Manual Selection Procedures
describes the manual procedures for selecting the obstruction and reference
diameters. The section on ACA Final Display gives a detailed description of
the final display. The ACA short procedure, which allows measurement with
minimal user interaction, is also described. The section on Free Format ACA
Calibration Procedures describes special calibration procedures, with free
format selection to suit the size of catheter used.
References
1 Reiber, J.H.C. et al. On-line quantification of coronary angiograms with

the DCI system. MedicaMundi, 34, no. 3, 1989. pp. 89-98.
2 Van der Zwet P.M.J. et al. A new approach for the automated definition of
path lines in digitized coronary angiograms. Int. J. Cardiac Imaging, 5, no.
2-3, 1990. pp. 75-83.
3 Van der Zwet, P.M.J. et al. An on-line system for the quantitative analysis
of coronary arterial segments. Computers in Cardiology, 1990.
4 Austen, W.G. et al. A reporting system on patients evaluated for coronary
artery disease. Report of the Ad Hoc Committee for grading of coronary
artery disease. Council on Cardio-vascular Surgery, American Heart
Association. Circulation 51, no. 2, 1975. pp. 7-40.
5 Kirkeeide, R.L. et al. Assessment of coronary stenoses by myocardial
perfusion imaging during pharmocologic coronary vasodilation. VII.
Validation of coronary flow reserve as a single integrated functional
measure of stenosis severity reflecting all its geometric dimensions. JACC
7, no. 1. 1986, pp 103-113.
6 Reiber, J.H.C. et al. Assessment of dimensions and image quality of
coronary contrast catheters from cine angiograms. Catheterization and
Cardio-vascular Diagnosis, 11, 1985, pp. 521-531.
9896 001 33152
Procedure
1 ACA standard procedure:


• ACA catheter calibration:
- Step 2 Selecting the segment for calibration.
• ACA measurement:
- Step 6 Selecting the coronary segment.

Post-processing 5.5
- Step 7 Confirming or correcting the path line.

- Step 9 Correcting a contour.
- Step 10 Automatically defined obstruction and reference site.
- Step 11 Result pages.
2 ACA manual selection procedure:
• redefining the obstruction and/or reference site:
- Step 1 Redefining the obstruction site.
- Step 2 Redefining the reference site.
- Step 3 Changing the reference site.
3 ACA final display:
• first result page
• second result page.
4 ACA Short Procedure.
• aca short catheter calibration
• aca short measurement:
- Step 2 Selecting the coronary segment.
5 Special ACA calibration procedure:
• free format calibration:
- Step 1 Free Format menu.
1. Automated Coronary Analysis (ACA) standard procedure

This section describes the standard procedure for automated quantification
of arterial segments. It includes both the catheter calibration and
measurement procedures.
1 Select the correct image series on which the program is to operate. The
correct image series must be selected before proceeding.
2 Press one of the three menu keys [95, 96 or 97] to display the menu.The
indicator remains on while the function is active.
9896 001 33152

5.5 Post-processing
PROGRAM MENU 1
PREVIOUS
NEXT
ACA Short
ACA
Vessel Diameter
Run Overview
33721600
3 If necessary, select ‘Previous/Next’ to access more items.
4 Use the left mouse button [25] to select ‘ACA’.
The ACA menu is displayed. This contains the following items: ‘Exit
program’, ‘Catheter calibration’ and ‘Measurement’. If no calibration factor
has been determined, the Measurement item will not appear.
Exit Program
Measurement
CF = 0.108 mm/pix
SELECT MENU ITEM
Accept ---- ----
33721610
5 Use left mouse button [25] to confirm the choice.
ACA catheter calibration

This procedure determines the boundaries of a segment of the catheter using
automated contour detection techniques. A calibration factor for the current
9896 001 33152
image series is obtained by comparing the calculated average diameter of the

catheter segment with its known size.
• select an image with a clear view of the catheter
• the catheter segment chosen for calibration may be straight or curved, but
must not taper.
WA R N I N G If these calibration guidelines are not followed, the absolute measurements may be
inaccurate or unreliable.
Step 1

Post-processing 5.5
Selecting an image.

Accept ----- Menu
33721620
1 Select an image with a clear view of the catheter.
2 Click the left mouse button [25] to confirm the image selection.
3 If necessary, click the right mouse button [27] to return to the ACA menu.
Step 2
Selecting the segment for calibration.
The catheter segment used for calibration may be straight or curved, but
must not taper.
INDICATE START POINT FOR CALIBRATION

Accept ---- Menu
33721630
A cursor appears on the image for selecting the catheter segment.

9896 001 33152
1 Move the mouse until the central dot of the cursor is positioned at the start
point of the catheter segment to be used for calibration.

5.5 Post-processing
INDICATE END POINT FOR CALIBRATION

Accept ----- New Start Point
33721640
3 Place the center dot of the cursor at the end point of the catheter segment to
be used for calibration.
4 Click the left mouse button [25] to confirm the end point and selected
segment.
5 If necessary, click the right mouse button [27] to select another start point.
Step 3
After the start and end points of the catheter segment have been selected the
message ‘Image filtering in progress’ is displayed and a path line between
these points will be detected automatically. The purpose of the image
filtering procedure is to ensure reliable detection of a path line in the catheter
segment. If no path line can be found, the message ‘Cannot find path line’
will be displayed and the program returns to the beginning of ‘step 2’.
• the path line in the catheter segment is defined
• the contour-finding process starts
if the segment length exceeds a quarter of the image size
and the message ‘Final Contour Detection in Progress’ appears. The
initially-detected contours serve as a model for final contour detection.
The final contour-detection procedure is based on the assumption that the
two contours of a non-tapering catheter are parallel.
9896 001 33152

Post-processing 5.5
DETECTED CONTOURS
Accept Hide New Segment
33721650
1 Once the final contours are displayed, press the middle mouse button [26] to
hide the detected contours and check their accuracy.
2 Click the left mouse button [25] to confirm the final catheter contours.
3 Click the right mouse button [27] to select a new segment for calibration.
The program returns to ‘step 2’.
Step 4
Selecting the size.
A menu is now displayed over the image listing French sizes (F4 to F9) and
free format (FF).
F4
F5
F6
F7
F8
F9
F9
2.7
SELECT FRENCH SIZE

Accept ----- -----
33721660
1 Move the arrow to select the desired F-size and click the left mouse button
9896 001 33152
[25]. For Free Format, see the description of the Special ACA calibration
procedure.
N OT E If a size has previously been entered or selected, it is displayed in a box at the bottom
of the menu.

5.5 Post-processing
Exit Program
Measurement
CF = 0.108 mm/pix
SELECT MENU ITEM
Accept ---- ----
33721670
The calibration factor in millimeters per pixel (display pixel) is displayed in
the lower right corner and the ACA menu (Exit Program, Catheter
Calibration, Measurement) is redisplayed. Since calibration has now been
performed, the arrow points to the Measurement box by default.
2 Use the left mouse button [25] to select an item.
ACA measurement
Step 5
Selecting an image.
image of the coronary arterial segment to be analyzed.
The following criteria are important for image selection:
• the arterial segment should be well filled with contrast medium
• to avoid motion blur, the image should preferably be selected in the
diastasis or end diastolic phase
• the obstructed coronary segment should be clearly visible, preferably
without any overlap with other vessels or side branches.
9896 001 33152


Accept ----- Menu
33721680
2 Click the left mouse button [25] to confirm image selection. A cursor
appears for selecting the coronary arterial segment to be analyzed.

Post-processing 5.5
Step 6
Selecting the coronary segment.
To guarantee reproducible assessment of the morphology of coronary
segments, such segments should be selected in a standardized manner,
according to the recommendations of the AHA (Ref.4), i.e. from side branch
to side branch. Therefore, it is preferable to position the start point
immediately distal to a branch point and the end point immediately
proximal to a branch point or at the end of the coronary artery. The start
point should always be proximal to the end point, i.e. the direction from start
point to end point is the same as the direction of the coronary blood flow.
The reason for this constraint is that the computation of the stenotic flow
reserve is dependent on direction.

Accept ----- Menu
33721690
1 Place the center dot of the cursor at the start point of the arterial segment to
be analyzed.
9896 001 33152

33721700
4 Place the center dot of the cursor at the end point of the arterial segment to
be analyzed.
5 Click the left mouse button [25] to confirm the end point.

5.5 Post-processing
After the start and end points of the coronary segment have been selected the
message ‘Image filtering in progress’ is displayed and a path line between the
start and end points will be detected automatically. The purpose of the image
filtering procedure is to ensure reliable detection of a path line in the
coronary segment. If the image selected is the same as that used for
calibration, image filtering will not be performed. If no path line can be
found, the message ‘Cannot find path line’ will be displayed and the program
returns to the beginning of ‘step 6’.
Step 7
Confirming or correcting the path line.
The path line must lie entirely inside the selected arterial segment but does
not need to follow the centerline of the arterial segment precisely.
PATHLINE
Accept Correct Startpoint
33721710
1 Click the left mouse button [25] to accept the path line and proceed with
‘step 8’.
2 Click the right mouse button [27] to return to ‘step 6’ and select a new start
point for the arterial segment.
3 If necessary, click the middle mouse button [26] to correct the path line. A
9896 001 33152


Post-processing 5.5
INDICATE CORRECTION POINT TO BE INCLUDED IN PATHLINE

Accept ---- Reject
33721720
4 Position the cursor at the point to be included in the path line (off the path
line but inside the selected arterial segment) and click the left mouse button
[25] to confirm. A new path line will then be drawn through this point. If a
new path line cannot be found, the previous path line will be redisplayed
with the message ‘Cannot find corrected path line’.
PATHLINE
Accept Correct Initial Pathline
33721730
More corrections can be made by repeating the correction procedure until a

satisfactory result has been obtained.
5 Click the right mouse button [27] to restore the initial path line and return
to the beginning of ‘step 7’.
6 Click the left mouse button [25] to accept the path line.
9896 001 33152
Step 8
The contour-finding process starts as soon as the path line has been defined.

detection in the unmagnified image will have a detrimental effect on the

5.5 Post-processing
• the initially-detected contours are displayed along the arterial segment and
the message ‘Final Contour Detection in Progress’ appears.
DETECTED CONTOURS
Accept Hide Correct
33721740
1 Once the final contours have been displayed, press the middle mouse button
[26] to hide the detected contours and check their accuracy in relation to the
actual vessel boundaries.
2 Click the left mouse button [25] to accept the detected contours and
continue with ‘step 12’.
3 To correct a segment of the detected contours, click the right mouse button
[27].
Step 9
Correcting the contours.
INDICATE DISTAL POINT OF ERRONEOUS

CONTOUR PART AND ERASE
9896 001 33152
----- ----- Erase

33721750
1 Position the cursor over the contour, distal to the part to be corrected and
press the right mouse button [27]. The contour will be erased until this
button is released.
N OT E Erasure always takes place towards the start point. The cursor must therefore be
placed at the end of the segment to be erased. When the cursor reaches the end of the
contour, it will jump to the start of the remaining part of the contour and erasure will
continue from there.

Post-processing 5.5
CONTOUR CORRECTION
Accept Draw Erase
33721760
2 Draw the new contour segment by holding down the middle mouse button
[26] and dragging the mouse.
3 Click the left mouse button [25] to close the contour section with a straight
line and to confirm the final arterial contours. If the new contour segment
differs significantly from the original, a new contour will be calculated
automatically within a limited region.
DETECTED CONTOURS
Accept Hide Correct
33721770
4 If necessary, repeat the correction procedure until a satisfactory result has

been obtained.
5 Click the left mouse button [25] to confirm all corrections made.
Step 10
9896 001 33152
Automatically defined obstruction and reference site.

On the basis of the detected luminal contours, reference contours are
calculated and displayed on the image. From the detected arterial contours,
the diameter of the vessel can be calculated for each point along its
centerline. This defines the diameter function. This function is used to derive
reference contours, which represent the best approximation to the original
size of the vessel before disease occurred. The obstruction and reference
diameters are automatically calculated for the point of maximum percentage
diameter stenosis, whose location is indicated by a straight line, and are
displayed in millimeters in the upper left corner.

5.5 Post-processing
OBSTRUCTION AND REFEREENCE SITES

Accept Redefine New Segment
33721780
1 Click the right mouse button [27] to return to ‘step 6’ to select a new vessel
segment.
2 Click the middle mouse button [26] and carry out the ACA Manual
Selection Procedure if the automatically selected obstruction and reference
positions are not appropriate, or if it is necessary to analyze more than one
obstruction in the selected segment.
3 Click the left mouse button [25] to confirm the automatically-defined
obstruction.
Step 11
Result pages.
33721790
RESULTS
RESULTS: Continue Second Page Store Continue Second Page Store
First result page Second result page
• Use the middle mouse button [26] to select the first and second result
pages.
9896 001 33152
• To redefine another obstruction and/or reference site (return to ‘step 10’)
or to select a new vessel segment (return to ‘step 6’), click the left mouse
button [25] and then click the left or middle mouse button respectively. A
full description of the result pages is given in the section ‘ACA final
display’.
Step 12
1 To display the ACA menu, click the left mouse button [25] and then the
right mouse button [27] when the first or second result page is displayed.

Post-processing 5.5
Exit Program
Measurement
CF = 0.107 mm/pix
SELECT MENU ITEM
Accept ---- ----
33721800
2 Select Exit Program and click the left mouse button [25].
N OT E The program can be exited at any time by pressing the active Menu key [95, 96 or 97]
on the Viewing Console.
2. ACA manual selection procedure
Redefining the obstruction and/or reference site

This procedure is used if the automatically selected obstruction and/or
reference sites are not appropriate or to analyze more than one obstruction in
the selected arterial segment.
Proceed from ‘step 10’ of the ACA Standard Procedure.
Step 1
Redefining the obstruction site.
9896 001 33152

Accept Move Initial
33721810
1 Hold down the middle mouse button [26] and drag the obstruction site with
the mouse. The obstruction and reference diameters, displayed in the top
left corner of the image, are updated. The reference value is determined from
the computed reference diameter function.

5.5 Post-processing

Accept Move Initial
33721820
(initial) obstruction site and return to ‘step 10’ of the ACA Standard
Procedure.
3 Or click the left mouse button [25] to confirm the new obstruction site.
Step 2
Redefining the reference site.
At this stage it is still possible to restore the previous automatically-calculated
(initial) diameters by clicking the right mouse button [27] and return to ‘step
10’ of the ACA Standard Procedure.
REFERENCE SITE
Accept Redefine Initial sites
33721830
1 Click the left mouse button [25] to accept the automatically-calculated

9896 001 33152
reference diameter at the user-defined obstruction site and go on to ‘step 4’

below.
2 Click the middle mouse button [26] to redefine the reference site.
Step 3
Changing the reference site.
The reference diameter displayed in the top left corner of the image will now
be measured between the arterial luminal contours. This is clearly different
from the situation described in ‘step 1’ above.

Post-processing 5.5

33721840
1 Hold down the middle mouse button [26] and drag with the mouse to
change the position of the reference site.

Accept move at obstruction
33721850

reference diameter at the user-defined obstruction site. The program returns
to ‘step 2’ of this section.
3 Click the left mouse button [25] to confirm the new reference diameter.
Step 4
Result pages.
9896 001 33152
33721860
RESULTS
RESULTS: Continue Second page Store Continue First page Store

5.5 Post-processing
On the first result page the reference diameter will now be indicated by a
broad line which is shaded to distinguish it from the obstruction diameter.
On the first and second result page the parameters that are directly affected
by the manual selection are marked with an asterisk (*).
• Click the middle mouse button [26] to select the first and second result
page.
• To redefine another obstruction and/or reference site (return to ‘step 10’ of
the ACA Standard Procedure) double click the left mouse button [25]. To
select a new vessel segment (return to ‘step 6’ of the ACA Standard
Procedure) click the left mouse button [25] followed by the middle button
[26].
• To return to the ACA menu, click the left mouse button [25] and then
click the right mouse button [27].
The result pages are described in detail in the section on ACA Final Display.
3. ACA final display
First Result Page
33721790
RESULTS
This page shows the anatomy of the obstruction with the most relevant,
geometrically-derived parameters. The black rectangular box shows the
diameter function for the analyzed coronary segment. The diameter in
millimeters (vertical axis) is plotted against position along the centerline,
from start to end point (horizontal axis). The straight line through the
diameter function is the reference diameter function, defining the estimated
geometry of the vessel before disease occurred, as reconstructed from the
available diameter values.
The position of the minimum obstruction diameter and the proximal and
9896 001 33152
distal boundaries are indicated by vertical lines. These positions are also
shown on the vessel segment. The area between the reconstructed reference
contours and the luminal contours within the obstructed region is shaded;
this area is a measure of the area of the atherosclerotic plaque as seen in this
particular view. The percentage diameter (%D-Sten) and percentage area
(%A-Sten) stenosis, the obstruction and reference diameters (Obs.D.,

Ref.D.), the Stenotic Flow Reserve (SFR) and the calibration factor (CF) are
displayed at the bottom of the image. The percentage area stenosis is based
on the assumption of circular cross-sections at the obstruction and reference
positions. The hospital name and the date are shown at the top of this image.

Post-processing 5.5
Second Result Page
33721870
RESULTS
Continue First Page Store
Top Left
The top-left quadrant shows a graph of the Stenosis Flow Reserve (SFR) for
this lesion.
33721880
Several points should be kept in mind when considering SFR values, SFR
reflects solely the effect of the measured arterial morphology on flow. To
make SFR specific for the measured lesion morphology, other parameters
affecting the coronary flow and coronary flow reserve, e.g. heart rate, aortic
pressure, additional coronary stenoses, are fixed for the determination of
SFR.
9896 001 33152
For example, pressure proximal to the analyzed segment is always taken as

100 mmHg, and the distal myocardial bed is always characterized by a linear
pressure-flow relationship that can increase the flow to 5 times its resting
value if no stenoses were present. SFR values will therefore always lie between
0 and 5 (0 for an occluded segment, and 5 for an unstenosed segment). An

SFR of 1 represents a case where a stenosis limits the maximum flow to no
more than the projected normal resting flow rate through the stenosis.
Coronary pressure (distal to the stenosis) is plotted along the Y axis and
coronary flow (relative to resting flow) along the X axis. The downward
curved line shows the projected fall in coronary pressure as flow through the
lesion is increased by vasodilation of the distal myocardial bed. Coronary

5.5 Post-processing
pressure continues to fall until the distal bed is dilated to its maximum
extent, a condition represented by the slanting straight line (the pressure-flow
relationship for the distal bed at maximum vasodilation). The intersection of
the curve and the straight line is the maximum relative flow through the
lesion, i.e. the SFR (Ref.5).
Bottom left
The bottom-left quadrant gives an overview of all geometrical parameters:
obstruction diameter and circular cross-sectional area, obstruction length,
reference diameter and circular cross-sectional area, percentage diameter and
area stenosis, plaque area and symmetry index (1.0 is completely symmetric
and 0.0 totally eccentric).
33721890
Top right
The top-right quadrant shows some of the underlying numerical data. The
total pressure drop across moderate to severe stenoses is derived from two
sources: frictional losses along the entrance and throat regions of the stenosis,
defined by the Poisseuille resistance; and losses caused by the sudden
expansion of the flow as it emerges from the stenosis exit, defined by the
turbulent resistance. Both resistances can be computed from the geometry of
the obstruction (Ref.5). The normal flow is calculated from the average
cross-section of the vessel and an assumed average flow velocity of 20 cm/s.
The table gives the pressure drop over the stenosis (mmHg) for the various
normalized flow values up to the stenotic flow reserve value. 9896 001 33152

Post-processing 5.5
33721900
Bottom right
The bottom-right quadrant shows the hospital name, the date and the
patient identification.
RESULTS
33721910
Continue First page Store
4. ACA short procedure

This section describes the measurement procedure for the ACA Short
program. The difference between this and the regular ACA program is that
no manual correction procedures are included, which speeds up the
determination.

9896 001 33152
1 Select the correct image series to which the ACA Short program is to be
applied. The correct image series must be selected before proceeding.
2 Press one of the three menu keys to display the menu. The indicator above
the key remains on while the function remains active.

5.5 Post-processing
PROGRAM MENU 1
PREVIOUS
NEXT
ACA Short
ACA
Vessel Diameter
Run Overview
33721920
3 If necessary, select Next/Previous to access more items.
4 Use the left mouse button [25] to select the ACA Short program. The ACA
menu is displayed.
Exit Program
Measurement
CF = 0.108 mm/pix
SELECT MENU ITEM
Accept ---- ----
33721610
The menu contains the items ‘Exit Program’, ‘Catheter Calibration’, or

‘Measurement’. If no calibration factor (either general or specific to the
current run) has been determined, the Measurement item will not appear.
5 Click the left mouse button [25] to confirm the choice.
ACA short catheter calibration

The catheter calibration procedure is identical to that described for the ACA
9896 001 33152
Standard Procedure. See ‘ACA Catheter Calibration’ in the section on the

ACA Standard Procedure.
ACA short measurement

Step 1
Selecting an image.
image of the coronary arterial segment to be analyzed.
The following criteria are important for the image selection process:
• the arterial segment should be well filled with contrast medium

Post-processing 5.5
• to avoid motion blur, the image should preferably be selected in the

diastasis or end diastolic phase
• the obstructed coronary segment should be clearly visible, preferably
without any overlap with other vessels or side branches.

Accept ----- Menu
33721680
2 Click the left mouse button [25] to confirm image selection. A cursor
appears for selecting the coronary arterial segment to be analyzed.
Step 2
Selecting the coronary segment.
To guarantee reproducible assessment of the morphology of coronary
segments, such segments should be selected in a standardized manner,
according to the recommendations of the AHA (Ref.4), i.e. from side branch
to side branch. Therefore, it is preferable to position the start point
immediately distal to a branch point and the end point immediately
proximal to a branch point or at the end of the coronary artery. The start
point should always be proximal to the end point, i.e. the direction from start
point to end point should be the same as the direction of the coronary blood
flow. The reason for this constraint is that the computation of stenotic flow
reserve is dependent on direction.
9896 001 33152

Accept ----- Menu
33721690
1 Move the cursor so that its center dot is at the start point of the arterial
segment to be analyzed.

5.5 Post-processing

33721700
4 Move the cursor so that its center dot is at the end point of the arterial
segment to be analyzed.
5 Click the left mouse button [25] to confirm the end point and the selected
segment.
Step 3
Once the start and end points of the coronary segment have been selected,
the message ‘Image filtering in progress’ is displayed and a path line between
the start and end points will be detected automatically (The purpose of the
image filtering procedure is to ensure reliable detection of a path line in the
coronary segment. If the image is the same as that used for calibration, image
filtering will not be performed). If no path line can be found, the message
‘Cannot find path line’ will be displayed and the program returns to the
beginning of ‘step 3’.
• the image is zoomed.The twofold magnification (zoom) is not performed
detection in the non-magnified image will have a detrimental effect on the
and the message ‘Final Contour Detection in Progress’ appears.
9896 001 33152
As soon as automatic contour detection is complete, the First Result Page is

displayed.
Step 4
Result pages.

Post-processing 5.5
33721790
RESULTS
• Click the middle mouse button [26] to select the first and second result
pages.
• Click the right mouse button [27] to store the result in the photofile.
• To select a new vessel segment (return to ‘step 2’), click the left mouse
button [25] and then click the middle mouse button [26].
The Result Pages are described in detail in the section on ACA Final Display.
Step 5
1 To display the ACA menu, click the left mouse button [25] and then the
right mouse button [27] when the first or second result page is displayed.
Exit Program
Measurement
CF = 0.107 mm/pix
SELECT MENU ITEM
Accept ---- ----
33721800
2 Select ‘Exit program’ and click the left mouse button [25].
9896 001 33152
N OT E The program can be exited at any time by pressing the active Program Menu key on
the Viewing Console.
5. Special ACA calibration procedure

Free format calibration

This procedure can be used if the size of the catheter differs from the F-sizes
included in the menu, or when other calibration objects are used (Ref.6)
Step 1
Free Format menu.

5.5 Post-processing
This step follows on from ‘step 4’ of the ACA Standard Procedure (ACA
Catheter Calibration). A menu appears over the image offering the choice of
French sizes or Free Format (FF).
N OT E If a size has been entered or previously selected, it is displayed in a box at the bottom
of the menu. To select this value, point to it with the mouse and click the left mouse
button [25].
F4
F5
F6
F7
F8
F9
FF
2.7
SELECT FRENCH SIZE

Accept ----- -----
33721930
1 Move the arrow to ‘FF’ (free format) and click left mouse button [25]. A box
menu is displayed for entering the size (diameter in millimeters) of the
calibration object.
Step 2
Entering the size.
.
0
1
2
3
4
5
6
8
9
0
OK

33721940
9896 001 33152
confirm.

Post-processing 5.5
.
0
1
2
3
4
5
6
8
9
0
OK
Enter size (mm): 2
33721950
button [25]. Proceed in this way until the required size has been entered.
A maximum of nine digits can be entered, with the decimal point in any
position.
entered.
.
0
1
2
3
4
5
6
8
9
0
OK

33721960
9896 001 33152
The ACA menu (Exit Program, Catheter Calibration, Measurement) is

redisplayed together with the calibration factor. Since calibration has now
been performed, the arrow points to the Measurement box by default. The
arrow can be moved by moving the mouse.

5.5 Post-processing
Exit Program
Measurement
CF = 0.108 mm/pix
SELECT MENU ITEM
Accept ---- ----
33721670
5 Use left mouse button [25] to confirm the choice.
9896 001 33152


Archiving 5.6
5.6 Archiving
Overview of the (extended) archiving procedures:
Examination finished - -
Primary archiving 1. Flagging images, runs and/or How to select an examination

examinations (§ 5.6.1)
How to flag/unflag:
• the entire examination
• a run
• an image
• a heartbeat
2. Transfer to the image archive How to transfer an examination

(external (DICOM) station) to the external (DICOM) station
(§ 5.6.2)
How to cancel the transfer
3. Export patient data to the RIS How to export patient data

interface (§ 5.6.3)
Secondary archiving Selecting another destination How to select a different station

(§ 5.6.4) name (destination)
Transferring images to/from an How to insert a cartridge

(§ 5.6.5) How to remove a cartridge
How to format a new disk or

erase an erasable disk
How to cancel the formatting

process
How to transfer to ODR
How to cancel transfer to the

ODR
How to retrieve from ODR

9896 001 33152
How to cancel retrieval
Recording on a Video - -
Cassette Recorder
(VCR) (§ 5.6.6)
Printing reports - How to print a dose or

(§ 5.6.7) examination report
How to cancel a print job
Report examples

5.6 Archiving
Image transfer - How to store an image:

function (§ 5.6.8) • during acquisition
• during viewing
How to transfer an image from

photofile to system disk
5.6.1 Flagging images, runs and/or examinations

It is necessary to flag images, runs or examinations before they can be
archived.
The ‘Flag’ information field on the Status page indicates that either an image,
heartbeat or a complete run has been flagged, but does not indicate which
one of them has been flagged. To check whether it is an image, heartbeat or
run that has been flagged, use the ‘Run overview’ or ‘Examination overview’
key [40, 41] on the viewing console.
Conditions
Before transferring images, runs or examinations to an archiving system, they
have to be flagged.
If automatic run flagging is configured (Service), the whole examination will
be flagged. Images, runs or examinations that are not required to be
transferred need, therefore, to be unflagged.
All flagging keys [90 - 94] toggle between on and off.
How to select an examination
1 Press F2 [24] on the keyboard to select the Review page.

The current acquisition and viewing examinations are displayed.
9896 001 33152

36120050
2 If not highlighted, press the function key [15] corresponding to the ‘Select’
function.
The ‘Select’ function is then highlighted.
3 Use the cursor keys [20] to select the examination containing the images to
be flagged.

Archiving 5.6

The examination is selected and displayed under ‘VIEWING
EXAMINATION’ on the Status page.
From now on individual images, runs or the entire examination can be
flagged.
How to flag/unflag the entire examination
1 If configured, press the |Flag examination| key [93] on the viewing console.
The entire examination is flagged for transfer and the ‘Flag’ message appears
next to all runs, including the photofile, on the Status page.
2 To unflag the examination, press the |Flag examination| key [93] on the
viewing console.
The ‘Flag’ message disappears from all runs, including the photofile, on the
Status page.
How to flag/unflag a run
1 Use the cursor keys [20] to select the run for flagging/unflagging.
The run is selected and displayed on the viewing monitor(s).
3 To flag/unflag the run, press the |Flag run| key [91].
After flagging/unflagging, the ‘Flag’ message is displayed at, or cleared from,
the end of the selected run line.
4 To flag/unflag other runs, use the |Step to next/previous run| keys [32, 33]
and repeat procedural step 3.
How to flag/unflag an image
1 Use the |Step to next/previous run| keys [32, 33] to select the run containing
the image to be flagged.
2 Use the |View reverse/forward| keys [31, 30] to select the image to be
flagged/unflagged.
3 To flag/unflag the image, press the |Flag image| key [90].
4 Repeat procedural steps 1 to 3 to flag/unflag other images.
How to flag/unflag a heartbeat
1 Use the |Step to next/previous run| keys [32, 33] to select the run containing
the heartbeat to be flagged.
9896 001 33152
2 Use the |View reverse/forward| keys [31, 30] to select the heartbeat to be
flagged/unflagged.
3 To flag/unflag the heartbeat, press the |Flag heartbeat| key [92].
4 Repeat procedural steps 1 to 3 to flag/unflag other heartbeats.

5.6 Archiving
5.6.2 Transfer to the image archive (external (DICOM)

station)
High-Speed DICOM Image Interface

Ethernet 100 Mbits/s network (via Export page)
or EasyVison
R4.3
onwards
DICOM
DICOM
COMPLIANT
EQUIPMENT
36280170
The INTEGRIS Allura system allows transfer to an external (DICOM)
station using the High-Speed DICOM Image Interface.
An external (DICOM) station can be:
• Picture Archiving and Communication System (PACS)
• (DICOM) viewer
• EasyVision workstation
• (DICOM) image server
• Local archive (to be referred to as ‘Secondary archiving’)
• Other DICOM compliant equipment.
The High-Speed DICOM Image Interface allows entire flagged photofile

and/or examination runs or images to be transferred to an external
(DICOM) station.
The export of images is done in one of the following standards:
• DICOM XA multiframe - for cardiac exposure runs
• DICOM XA single frame - for vascular exposure runs
• proprietary DICOM format (ACR-NEMA 2.0) - for vascular applications
only (for export to EasyVision)
• Photofile images in DICOM secondary capture.
9896 001 33152
Since a local archive (such as IDR, ODR, HCU) has been identified as an
external (DICOM) station, the same explanation is valid for the local
archive.
If the system is configured for automatic run flagging (Service), all current
acquisition examination runs and the photofile are flagged during
acquisition. Instead of using the automatic ‘Flag run’ function [91],
individual images may be flagged using the ‘Flag image’ function [90] (if
configured). If subtracted images are flagged individually, the last selected
mask is also sent.

Archiving 5.6
Storage commitment guarantees the safe storage of image information to the

external (DICOM) station. Storage commitment will only be performed
when an external (DICOM) station is configured to support storage
commitment.
Conditions
Transfer takes place in two stages:

• from the INTEGRIS system to an intermediate buffer, in the foreground.
During the transfer process, the message ‘TRANSFER IN PROGRESS
TO:’ followed by the station name and then ‘SYSTEM LOCKED’ is
displayed on all the monitors, and the ‘Status’ field on the export page will
display ‘Busy’. Normal operation of the acquisition system is not possible
during transfer to the intermediate buffer.
When the transfer to the intermediate buffer is finished, the ‘SYSTEM
LOCKED’ message disappears:
• from the intermediate buffer to an external (DICOM) station, in the
background.
During the transfer process, the ‘Status’ field on the export page will
display ‘Sending’. It is not possible to select or transfer a new examination
until the current examination has been transferred to the external
(DICOM) station.
Once the examination has been successfully transferred to the external
(DICOM) station and no storage commitment was requested, the ‘Status’
field on the export page will display ‘Done’
If the external (DICOM) station supports storage commitment, and this is
configured for this station, then after receiving confirmation that the
exported images are received a storage commitment is requested. While
waiting for the storage commitment the ‘Status’ field on the export page will
display ‘Closing’. During the waiting period the system can be used for every
other function.
The system will investigate, at least every 10 minutes, if an outstanding
storage commitment has been received.
Following receipt of the storage commitment, the delete protection for the
examination is removed and the ‘Status’ field on the export page will display
‘Done’. If a negative commitment is received, the ‘Status’ field on the export
page will display ‘Error’ and the delete protection for the examination is not
removed.
A warning ‘Previous examination not saved’ is displayed on the viewing and
9896 001 33152
examination monitors if a new patient is selected on the INTEGRIS system

before the previous examination has been transferred.
After a power failure, the system will automatically restart the transfer process
if the entire (flagged) examination was stored in the intermediate buffer. If
this was not the case, the transfer process has to be repeated.
If the selected external (DICOM) station is not ready, then the system will
retry every two minutes.
Do not switch off the INTEGRIS system before the transfer process is
complete. The status of the transfer process can be checked by selecting the
Export page (using function keys F3, F4 or F5 [24]).

5.6 Archiving
Do not switch off the external (DICOM) station before the transfer process
is complete.
How to transfer an examination to the external (DICOM) station
1 Press F3, F4 or F5 on the keyboard [24] to select the Export page.

The Export page is displayed, the current examination is highlighted and the
number of flagged runs appears on the list.
PHILIPS INTEGRIS 1997-11-18 Disk A to Archive Export page
Name Birthdate Sex Patient ID Phys Run Pct Status
Jones P.H.N 1941-11-18 M CD1234/234 Abel 2 Sending
36120010
Save Cancel Disk A/B Previous Next
2 If not highlighted, press the function key [15] corresponding to the ‘Save’
function.
3 Use the |Cursor up/down| keys [20] to select an examination for export.
4 Press the |Enter| key [21].
The selected examination is transferred to the external (DICOM) station, via
the intermediate buffer.
During the transfer process, the message ‘TRANSFER IN PROGRESS TO:’
followed by the station name and then ‘SYSTEM LOCKED’ is displayed on
the viewing/examination monitors, and the ‘Status’ field on the export page
will display ‘Busy’ or ‘Sending’.
How to cancel the transfer
1 Press the function key [15] corresponding to the ‘Cancel’ function.

The message line will display ‘Cancel transfer, are you sure y/[n] ?’.
If the operator types: N or presses the |Enter| key [21] the transfer process
continues.
Type: Y to abort the transfer process.
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2
After a few moments, the message ‘TRANSFER ABORTED’ is displayed on
all monitors.
During the cancel operation, the ‘Status’ field on the export page will display
‘Aborting’. If applicable, images are removed from the intermediate buffer.

When the cancel operation is complete, the ‘Status’ field on the export page
will display ‘Aborted’ and all functions are enabled again.
5.6.3 Export patient data to the RIS interface

The RIS interface allows communication of the INTEGRIS system with
a local Information System (IS).

Archiving 5.6
After completing the examination, patient and examination data can be

exported from the INTEGRIS to the IS using the report page. For each
patient the following information will be exported:
• patient data:
- patient name
- birth date
- sex
- patient ID.
• examination/request information:
- accession number
- requested procedure ID
- performed station (Application Entity (AE)) title
- performed procedure step ID, status, start/end date and time
- performed physician’s name
- referenced image sequence.
• radiation dose:
- total time of fluoroscopy
- accumulated fluoroscopy dose
- accumulated exposure dose
- total dose
- total number of exposures
- total number of images
- quantitative analysis results.
Conditions
The Information system (IS) must be able to receive the data to be exported.
If the IS does not accept the ‘Report’ request the message ‘This function is
not supported by the information system’ is displayed on the error message
line of the Report page.
If the connection with the IS fails or another error situation occurs, the
message ‘No connection with the information system’ is displayed on the
error message line of the Report page.
As the data exported to the IS will indicate to which station name images
have been exported last, it is strongly recommended to export patient data to
the IS immediately after the images have been exported to the (long term)
image archive. This will maximize, but not guarantee, consistency between
the IS and the image archive.
During the transfer process, the message ‘TRANSFER IN PROGRESS TO:’
followed by the station name and then ‘SYSTEM LOCKED’ is displayed on
the viewing/examination monitors, and the ‘Status’ field on the Report page
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will display ‘Busy’. Normal operation of the acquisition system is not possible
during transfer to the IS.
How to export patient data

1 Depending on the configuration, press F3, F4 or F5 [24] on the keyboard to

display the Report page.

5.6 Archiving
PHILIPS INTEGRIS 1997-11-18 Disk A Report page
Name Birthdate Sex Patient ID Phys Status
Jones P.H.N 1941-11-18 M CD1234/234 Abel Busy
36120020
Report Cancel Disk A/B Previous Next
2 If not highlighted, press the function key [15] corresponding to the ‘Report’
function.
patient examination to be reported.
4 Press the |Enter| key [21].
The patient examination data is then exported to the IS.
Following successful completion of the transfer, the ‘Status’ field on the
Report page will display ‘Reported’.
5.6.4 Selecting another destination

When more than one external image receiving (DICOM) station is
connected to the INTEGRIS system, each external (DICOM) station is
controlled by a different station name. To address another external
(DICOM) station, a new station name must be assigned to that external
(DICOM) station and programmed into the INTEGRIS system, this is done
by Service (normally during installation).
Also, for each station name a specific (DICOM) format is programmed by
Service. It is even possible to have one or more additional (different)
DICOM formats programmed for the same destination. In that case the
different formats will be distinguished by a different station name.
How to select a different station name (destination)
1 Press F2 [24] on the keyboard to select the Schedule page.

9896 001 33152

Archiving 5.6
36120060
2 If not highlighted, press the function key [15] corresponding to the ‘Modify’
function.
The ‘Modify’ function is then highlighted.
3 Use the |Cursor up/down| keys [20] to select the required examination.
4 Press the |Enter| key [21] to confirm.
5 Move to the physician code (Phys) field by pressing the |Enter| key [21].
6 In the physician code field, use the |Cursor up/down| keys [20] to select the
required physician code, with corresponding external (DICOM) station,
from the list.
7 Press the |Enter| key [21] to confirm.
5.6.5 Transferring images to/from an Optical Disk

Recorder (ODR)
This function allows the transfer of unprocessed images or photofile images
to and from the ODR in the background (i.e. normal operation of the system
is possible during data transfer).
Each side of an optical disk has a capacity for approximately 150 images of
10242 pixels or 600 images of 5122 pixels. The average transfer time for 20
high-resolution (10242) images is less than 5 minutes. An optical disk written
on a release ‘n’ system can only be read by a system of release ‘n’ or higher.
Conditions
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Write protection

5.6 Archiving

33723830
The cartridge has a write-protect switch on each side. To protect one side of a
cartridge, set its switch to the protect position. To protect both sides of the
cartridge, set both switches to the protect position.
When handling ODR cartridges:
• do not remove the disk from the cartridge
• do not touch the disk surface through the optical access door
• use, handle and store in clean office conditions
• do not smoke while handling the optical disk. Smoke particles are a prime
source of disk contamination
• do not eat or drink while handling the optical disk. Liquids spilled on the
cartridge can seriously contaminate the disk surface which may then need
to be reconditioned.
New disks must be formatted before they can be used for image storage.
If no optical disk or a write-protected disk is inserted, the message ‘Please
insert an unprotected optical disk, press enter when done’ will be displayed
on the viewing console.
The system will check to ensure that all flagged items can fit on the optical
disk. If there is insufficient space, the system displays the message
‘Insufficient disk space, save examination on another disk’ on the viewing
console.
9896 001 33152
If the disk inserted was formatted on a system with an earlier release number,
the message ‘Incompatible disk, save examination on another disk’ is
displayed on the viewing console.
How to insert a cartridge
1 To insert a cartridge, slide it into the disk cartridge insertion slot [a] of the
ODR with the side to be read or written upwards.
LED indicator [216] flashes (green) when the drive is empty.
How to remove a cartridge
1 Press the |Eject switch| [218] on the ODR.

Archiving 5.6
The cartridge will be partially ejected from the disk cartridge insertion slot
[a] and can be removed by hand.
N OT E S • Cartridges cannot be ejected during a save, retrieve or erase process.
• The cartridges are mechanically keyed so that they cannot be incorrectly inserted.
• An error message is displayed if an incompatible cartridge is inserted.
How to format a new disk or erase an erasable disk
1 Press F3, F4 or F5 [24] to select the ODR page.
PHILIPS INTEGRIS 1997-11-18 Disk A to ODR ODR Page
Jones P.H.N 1941-11-18 M CD1234/234 Abel 11 1023
36120040
Save Cancel Retrieve Format Disk A/B Previous Next
2 If not already highlighted, press the ‘Format’ key [15] on the viewing console
to select the ‘Format’ function.
If the inserted disk contains examinations, the following prompt is displayed:
‘The optical disk contains examination items: continue format? Y/N’ If the
inserted disk contains data but no examinations, the following prompt is
displayed: ‘The optical disk contains data, but no examination items:
continue format? Y/N’
3 Type: N to terminate the function, or type: Y to continue the format process.
One side of the disk is then formatted.
How to cancel the formatting process
1 Press the ‘Format’ function key [15] again.

If the format or erase function is cancelled the disk cannot be used until it
has been fully formatted.
How to transfer to ODR

9896 001 33152
1 Press F3, F4 or F5 [24] to select the ODR page.

2 If not already highlighted, press the ‘Save’ key [15] on the viewing console to
select the ‘Save’ function.
3 Use the ‘Previous, Next’ and/or ‘Disk A/B’ functions to select the page with
the flagged examinations for transfer.
4 Use the cursor keys [20] to select the examination to be transferred to the
optical disk.

5.6 Archiving
The system will start saving the flagged items of the selected examination to
the optical disk. If desired, more examinations can be scheduled for transfer
to the optical disk.
How to cancel transfer to the ODR

2 Select the examination to be cancelled and press |Enter|.
Transfer of the current image will be completed before the process is
canceled.
How to retrieve from ODR
1 Press F3, F4 or F5 [24] to select the ODR page. Ensure that the correct
optical disk is loaded in the recorder
2 If not already highlighted, press the ‘Retrieve’ key [15] on the viewing
console to select the ‘Retrieve’ function.
If an acquisition examination is in progress the system responds with the
prompt ‘Exposures will be disabled, are you sure’. The reason for this is that
the system will close the current patient and open a new patient to store the
retrieved examination in. After retrieval is complete, a new patient is opened.
3 Type: Y to continue.
The system then checks to ensure that there is a valid optical disk in the disk
drive. If not, it displays the message ‘Please insert correct optical disk, press
enter when done’.
The system now checks the optical disk, reads information and displays the
prompt ‘Please select the examination to be retrieved’.
4 Select the examination to be retrieved with the cursor keys [20] and press
|Enter| [21].
Only one examination can be retrieved at a time. If more examinations need
to be retrieved, repeat from procedural step 2.
Retrieved examinations are stored in the last selected disk partition.
If the system does not have enough storage capacity to retrieve the
examination, it responds with the message ‘Not enough space to retrieve
examination’. Other examinations must be deleted to create space (‘Delete’
function on Review page).
How to cancel retrieval

The partly retrieved examination is stored in the system.
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5.6.6 Recording on a Video Cassette Recorder (VCR)

Refer to the VCR’s Operator’s Manual for operation of the VCR.
Conditions
If a VCR is installed and configured in the APR for the selected imaging
technique, the recorder is automatically started and stopped by the system.
This can be configured for both fluoroscopy and/or exposures. Ensure that
the VCR is in “stand-by” mode before acquisition is started.
Real-time recording during fluoroscopy or acquisition:

Archiving 5.6
• the VCR is automatically started and stopped by the system if ’VCR-ON’

has been set in the APR
In general:
• starting and stopping the recorder should be done manually, between
starting and stopping the ‘Examination dump’ function [94] should be
activated
• the ‘Examination dump’ function [94] (if configured) is used for
recording. This function replays the current acquisition/viewing
examination on the viewing monitor and on the output to the VCR
• if no runs are flagged for transfer (’Flag run’ [91]), all runs including the
photofile are displayed and recorded
• if any run is flagged, only the flagged runs are displayed and recorded
• if physiological data were acquired with the run, the channel(s) last
selected is displayed and recorded
• a blank image is displayed for 1 second between runs
• the function will terminate if the system is used for fluoroscopy or
exposure, or if the current examination is modified or deleted
• all other viewing functions are disabled during transfer
• images recorded on the VCR are displayed on the Examination monitor.
VCR play back is stopped when an acquisition or viewing action is
activated.
5.6.7 Printing reports

A dose or examination report, see illustrations below, can be printed once an
examination is completed but before a new examination is started. Printing
can be started by pressing key [4c] on the acquisition console.
Conditions
All report data is cleared after selection of a new patient.
The local printer (paper) has to be installed and ready for use.
Reports are printed with standard ASCII characters (no special characters are
available).
If an item is not available it is left blank.
The following restrictions apply to the miscellaneous image techniques:
• the generated data is different for 2-knob and 3-knob techniques
• the angulation, rotation and SID values are unknown
• the plane field (PL) is left blank on a monoplane system and for
monoplane image techniques.
9896 001 33152
How to print a dose or examination report
1 Press [4c] on the acquisition console to print the configured (Service) report.
The |Print dose/examination report| symbol on the acquisition console

display is highlighted during printing.
How to cancel a print job

Print jobs can be cancelled (stopped) to avoid problems if the printer is
switched off, inoperable, incorrectly connected, or out of paper.
1 Press [4c] on the acquisition console again.

5.6 Archiving
The |print dose/examination| symbol on the acquisition console is no longer

highlighted.
Report examples
33725800
Example of dose report
9896 001 33152


Archiving 5.6
Explanatory notes for dose reports

Hospital name and city As configured in the system.
Examination data Date and time of the last new-patient selection.
Cumulative fluoroscopy time –
Cumulative fluoroscopy dose Sum of dose values.
Cumulative exposure dose Sum of dose values for 1st tube.
Cumulative total exposure dose Sum of fluoroscopy and exposure dose values.
Total number of runs Since last new-patient selection.
Per run:
• Run number -
• Time Start time of the first exposure (no preparation).
• exposure parameters
- kV Last value for each run.
- mA Last value for each run.
- mAs Last value for each run.
- ms Last value for each run.
Examination report
9896 001 33152
33725810
Example of examination report

5.6 Archiving
Explanatory notes for examination reports

Hospital name and city As configured in the system.
Examination data Date and time of the last new-patient selection.
Cumulative fluoroscopy -
time
Cumulative fluoroscopy Sum of dose values.

dose
Cumulative exposure Sum of dose values for 1st tube.

dose
Cumulative total Sum of fluoroscopy and exposure dose values.

exposure dose
Total number of runs Since last new-patient selection.
Per run:
• Run number –
• Time Start time of the first exposure (no preparation).
• Number of images For digital image techniques only.
• APR name APR name (sub-APR name for vascular purposes, maximum of 20
characters).
• Runspeed The maximum run speed is used for sequential blocks and VFR.
• Exposure parameters
- kV Last value for each run.
- mA Last value for each run.
- mAs Last value for each run.
- ms Last value for each run.
- Angulation/rotation For rotation angio, the last value for each run [degrees].
- Source image distance Last value for each run [cm].
- II format used [cm].
5.6.8 Image transfer function

The ‘Image transfer function’ is used to store images containing an artefact or
images which are of poor quality to the system disk so that they are accessible
to Service for later analysis.
How to store an image during acquisition

9896 001 33152
1 Complete the current acquisition examination.

The image containing the artefact can be selected once the examination is
complete.
2 If necessary, press the |Add text| key [85] to switch text annotation off.
3 Use the |View forward/reverse| keys [30, 31] on the viewing console to select
the relevant image.
4 Press the |Store image in photofile| key [70] on the viewing console.
5 If deactivated, press the |Add text| key [85] to switch text annotation on.

Archiving 5.6
How to store an image during viewing
1 If necessary, press the |Add text| key [85] to switch text annotation off.
2 Press the |Store image in photofile| key [70] on the viewing console.
3 If deactivated, press the |Add text| key [85] to switch text annotation on.
How to transfer an image from photofile to system disk
1 Use the |Cursor| keys [20] to select the photofile.

2 Use the |View forward/reverse| keys [30, 31] to select the image in the
photofile.
3 Press |Menu 3| key (see note) [97, 102] on either the viewing console or the
TAM.
N OT E For most systems the image transfer function is configured on Menu 3. If not, the
image transfer function is configured on Menu 1 or 2 [95 or 96].
33724890
Possible configuration with image transfer on Menu 3.
4 Use the Mouse or Joystick [108] to select the ‘Image transfer’ function and
press the |Accept| key [25 or 105].
The following menu appears on the viewing and examination monitors:
9896 001 33152
33724900
5 Use the Mouse or Joystick [108] to select the file name to which the image
will be transferred and press the |Accept| key [25 or 105].

5.6 Archiving
Storing the selected image takes about 20 seconds. No message appears

during this phase. If no errors occur, the message ‘Frontal view/live monitor,
image stored in file IMAGE_X.VIS’ is displayed on the viewing and
examination monitors. If an error occurs, the message ‘Image not stored,
error number <nr>’ is displayed.
N OT E Selecting a file name replaces the old version. No message or warning will appear!
9896 001 33152


Transporting the system 5.7
5.7 Transporting the system

Not applicable.
9896 001 33152

5.7 Transporting the system
9896 001 33152


6 System and error messages
6.1 Error handling

If a warning or error is detected, a message is displayed on the system message
lines of the acquisition console and an action/warning indication is given on
the display unit [127] to indicate that a message is displayed on the
acquisition console. Messages are displayed at the moment the error occurs
and for as long as the error conditions remain. If more than one error is
detected, the message relating to the error with the highest priority is
displayed. If an action type message is displayed, the system cannot be used.
If a warning type message is displayed, the system can be used with reduced
performance. When for instance the viewing system is switched off, the
system will perform ‘fluoroscopy’ with bypass fluoroscopy (if the option is
present).
N OT E Errors related to the wedge-filters, grid-switch and tube-load counter are not
accompanied by an Action/Warning message on the Display unit.

System and error messages are displayed on two or three lines on the
Acquisition console (in area [4]). The first line displays application and error
messages related to the geometry of the system. The other lines display
application and error messages related to acquisition and viewing. An Action/
Warning indication is given on the Display unit when system or error
messages are displayed. Messages are displayed for as long as the error
condition lasts. If more than one error is detected, the messages relating to
the error of highest priority will be displayed.
For certain errors the system will reset automatically. Contact Service if
automatic resets occur frequently. The following tables show all error and
warning messages valid for the INTEGRIS systems:
Errors
Message Action
9896 001 33152
Acquisition Console not available Call Service
Biplane fluoroscopy not possible Select another fluoro mode
B: Bolus chase not available Call Service

B: Bolus chase SPD controller not ready for use Call Service
B: Frontal display not ready for use Call Service
B: Table movements not ready for use Call Service
Bolus chase speed controller not ready for use Call Service
Bolus chase not available Call Service
INTEGRIS Allura Monoplane Release 1 System and error messages 6-1

6.1 Error handling
Message Action
Bolus chase not ready for use, reduce table tilt
Bolus chase not ready for use, park lateral stand
B: One TSO module not ready for use Call Service
Brake footswitch not ready for use Call Service
B: Table step and scan mv. not ready for use Call Service
B: TSO mod. and brake footsw. not ready for use Call Service
Calibration of frontal collimator required Call Service
Calibration of frontal stand required Call Service
Calibration of lateral collimator required Call Service
Calibration of lateral stand required Call Service
Cine not available
Cine camera not ready Check film
Collimator not available Call Service
Collimator not ready for exposure Call Service
Collimator not ready for fluoroscopy Call Service
Confirm end position
Confirm start position
Current channel not possible, select other channel
Deselect tilt mode for table-top panning
Digital processing not available Please check
Digital processing 2 not available Please check
Digital processing not ready for fluoroscopy
Digital processing 2 not ready for fluoroscopy
Digital processing not ready for exposure
Dose meter not operable Call Service
ECG trigger not available
Emergency brake release operated, operate again

9896 001 33152
Emergency power active Only 3 mA fluoroscopy available
Emergency STOP switch on TSO operated: turn power

off/on
End position not correct, position tabletop correctly
Exposure APR not accepted Call Service
Exposure APR not accepted. Total images = 0
Exposure failed Try again
Exposure not possible during Alter APR
Exposure not possible, select another channel
6- 2 System and error messages INTEGRIS Allura Monoplane Release 1

Error handling 6.1
Message Action
Failing gridswitch Call Service
Failure in digital image link Try again
Fluoroscopy APR not accepted Call Service
Fluoroscopy failed Try again
Foot-/handswitch initial ON Release switch
Frontal collimator not ready for use Call Service
Frontal display not ready for use Call Service
Frontal stand not ready for use, set SID to 1 m Call Service
Geometry not available Call Service
Geometry not ready for exposure
Geometry not ready for fluoroscopy
Geometry: Stepping not ready Please check
Imaging not available Call Service
Imaging not ready for exposure Call Service
Imaging not ready for fluoroscopy Call Service
Lateral collimator not ready for use Call Service
Lateral display not ready for use Call Service
Lateral stand not in park or work position, position

correctly
Lateral stand not ready for use, set SID to 1 m Call Service
Motorized movements not ready for use Call Service
Move table-top to end position
Move table-top to start position
MRC not operable, only fluoroscopy Call Service
No cine film present Load film
No exposure Position II in beam
No fluoroscopy Position II in beam

9896 001 33152
Not enough storage capacity
No tube load counter Call Service
No lateral X-ray, position lateral channel

One TSO module not ready for use Call Service
Over exposure predicted Select a less heavy APR
Position stand correctly for table tilt
Position stand correctly for tabletop tilt
Ready for recorded exposure run
Reduced speed, bodyguard blocks high speed movement

6.1 Error handling
Message Action
Rotational angio not ready for use, park lateral stand
Select acquisition examination
Set stand rot. and ang. to less than 20 degrees
Set tabletop horizontal
Scanrange too short, change end position
Scanrange too short, change start position
Shutters not operable Call Service
Single shot not possible, select appropriate APR
Spectral filter defect Call Service
Stand movement failed Try again
Start position not correct, position table-top correctly
System configuration mismatch Call Service
System hardware error Call Service
System signal bus error Call Service
Table movements not ready for use Call Service
Table step and scan movement not ready for use Call Service
Table step not ready for use, position tabletop correctly
Table stepping not ready for use, park lateral stand
Table stepping not ready for use, position table horizontal
Tabletop movement failed Try again
Testshot failed Try again
Testshot failed: overexposed Select a less heavy APR
Testshot failed: underexposed Select a heavier APR
Tilt control locked
TSO mod. and brake footswitch not ready for use Call Service
Undefined table position Please lock table-top
Undefined table step position Try again

9896 001 33152
Under exposure detected Select a heavier APR
Under exposure predicted Select a heavier APR
Warning: bodyguard faulty or too close at start-up, risk. Increase distance from bodyguard
and restart system. If message

reappears (bodyguard faulty),
movement is at own risk, call
Service
Warning: bodyguard faulty, move at own risk Clean bodyguard
Warning: non standard procedure, re-select APR for std

proc

Error handling 6.1
Message Action
Warning: reduced rotation speed, decrease angulation
Wedge filter defect Call Service
X-ray disabled Press button
X-ray disabled Check door-contacts
X-ray generator not available Call Service
X-ray generator not ready Please wait
X-ray tube heat overload Please wait
10 minutes fluoroscopy limit expired Reset buzzer
Warnings
Message Action
Available tube time Orange light:

Remaining exposure time between 1 and X seconds;
exposure not stopped, fluoroscopy still possible.
Red light:
Reduced fluoroscopy, remaining exposure time 0 s;
exposures possible until heat switch is activated.
Available disk time Warning 10 seconds before first exposure (current patient)
will be overwritten.
Messages
User message
Bolus chase not ready for use, park lateral stand

Bolus chase not ready for use, reduce table tilt
Bolus chase not ready for use, position puck correctly
Scan range too short, change end position

Scan range too short, change start position
Table step not ready for use, position table-top correctly

Table stepping not ready for use, park lateral stand
9896 001 33152
Error message Action
Bolus chase not available Call service

B: Bolus chase not available Call service
Bolus chase speed controller not ready Call service

B: Bolus chase speed controller not ready Call service
6.1.2 Viewing console

Messages displayed on the help and error message lines in the text display of
the Viewing console.
• HCU error

6.1 Error handling
• please insert an unprotected optical disk, press |Enter| [21] when done
• too many images in this examination to fit on optical disk, unflag items
• exposures will be disabled, are you sure
• please insert correct optical disk
• please select the examination to be retrieved
• not enough space to retrieve examination
• net error.
Messages relating to the Image Transfer function
Error number Explanation
19071 Transferred image was zoomed; record the image in the

photofile first.
9896 001 33152


7 Maintenance
7.0 Introduction
To ensure satisfactory operation the Philips INTEGRIS Allura Monoplane
requires periodic planned maintenance and routine user checks. These are
essential to keep the equipment operating safely, effectively and reliably.
Planned maintenance may only be carried out by qualified and authorized
service technicians. In this context, qualified means those qualified to work
on this type of medical electrical equipment in the jurisdiction in which the
equipment is being used, and authorized means those authorized by the user
of the equipment. Philips is able to provide a full planned maintenance and
repair service on either a call basis or a contract basis. Contact your Philips
Service Organization.
7.1 Planned maintenance programme

Planned maintenance tasks may only be carried out by qualified and
authorized service technicians, and are comprehensively described in the
service documentation. A summary of the planned maintenance programme
is given in the table below.
Check Reason Frequency
Earth (ground) Check maximum earth (ground) of whole Yearly

system
Power supplies • Check AC supply voltage Yearly

• Check internally-generated DC voltages Yearly
PCBs and racks Ensure secure fitting and check for dust and Yearly
corrosion
Motorized movements Check electrical and mechanical settings Yearly
Interlocks Check proper functioning Yearly
Bearings Check freedom from dust, grease and oil Yearly

9896 001 33152
Drive chains Check for wear and correct tension Yearly
C-arm To ensure optimum life of equipment check Weekly

that the tracks are free from dust, grease or
other particles
Controls and indicators Check accuracy and functioning of:

• All controls 6 monthly
• All visible/audible indicators 6 monthly
• Table controls/movements 6 monthly
• SIDs 6 monthly
Alignment • Collimator alignment and field limitation 6 monthly

• Beam alignment and centering 6 monthly
INTEGRIS Allura Monoplane Release 1 Maintenance 7-1

7.2 User routine checks programme
Collision detectors Check that applied movement is inhibited and 6 monthly

that an audible alarm is generated
Mechanical • All mechanical stops (limits) 6 monthly

• Brakes and locks 6 monthly
Warning (DHHS) label on Check for presence and readability of 6 monthly

acquisition console warning label
Patient fluoroscopic Check maximum value of patient 6 monthly

entrance exposure rate fluoroscopic entrance exposure rate
Table cleanliness Hygiene and to ensure safe and optimum life Daily or as
of equipment needed
Radiation shield Check for cracks or tears (fluoroscopy) Weekly
Accessories To ensure that applicable accessories are Daily

fastened securely to the table, especially the
footrest.
7.2 User routine checks programme

The user of the equipment must establish a programme of routine user
checks as detailed in the table below. Normally, the user will instruct the
operator to perform these checks. However, it is for the operator of the
equipment to ensure that all checks have been satisfactorily completed before
using the equipment for its intended purpose. Routine user checks may be
carried out by the user.
All accessories Availability and integrity Daily (see note)
All controls Ensure correct functioning Daily (see note)
Brakes and wheels Ensure correct functioning Daily (see note)
All indicators Ensure correct functioning Daily (see note)
Cabling Inspect for kinks and/or cracks Daily (see note)
Inscriptions and labels Check for legibility Weekly

9896 001 33152
N OT E Visual and/or audible checks during routine use. Refer to Service documentation.
How to check the beam limiting device (shutters)

If applicable, the following procedure should be carried out for the lateral
channel as well.
1 Press (frontal) |Shutter adjustment| [151] to reset the shutters.
2 Position the tabletop horizontally and adjust it to maximum height.
3 Position the stand (in the frontal position) with the X-ray beam
perpendicular to the tabletop.
7- 2 Maintenance INTEGRIS Allura Monoplane Release 1

User routine checks programme 7.2
4 Position two lead rulers crosswise on the tabletop and use tape to attach the
rulers.
5 Use joystick (frontal) |SID adjustment| [134] to move the II as close as
possible to the rulers.
6 Press |II field size| [153] to select an appropriate II field size.
7 Initiate fluoroscopy by pressing footswitch [175] or ([178]).
8 Use the |Tabletop brakes on/off and longitudinal movements| knob [131] to
position the center of the intersection of the two lead rulers to the center of
the image.
9 Initiate single-shot acquisition by pressing footswitch [177] and write down
the ruler values (A1 to D1), corresponding to the edges of the image (see
illustration below).
9
10
C1
11
12
13
14
15
8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
16
17
18
A1 B1
19
20
21
22
23
D1
33728247
24
10 Position an adequate size film cassette on top of the rulers.

11 Expose the film by performing fluoroscopy.
The maximum density of the developed film should be 0.9 ± 0.1.
12 Write down the ruler values (A2 to D2) (see illustration below).
9
C2
10
11
12
13
14
15
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7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
16
17
18
A2 B2
19
20
21
22
23
33728248
D2
24
13 Determine the distance [X] between the focal spot and the tabletop by
deducting the II to tabletop distance from the SID [124].
14 For each edge (A to D) calculate the following:

7.3 Cleaning and disinfection
• |Value 2 - Value 1| X/50.

A1 = 7; A2 = 6.8 and X = 85, the formula gives:
|6.8 -7| 85/50 (= 0.2 1.7), which is OK.
If any calculated value is larger than X/50, the beam limiting device is
malfunctioning and Service should be called.

Cleaning and disinfection of the Philips’ INTEGRIS Allura Monoplane will
normally be required in connection with some or all of the intended
applications. Guidelines for each are given below.
WA R N I N G To avoid electric shock, always isolate the equipment from the mains electrical supply
prior to cleaning, desinfecting or sterilizing it.
CAUTION Never allow water or other liquids to leak into the equipment as this may cause short-
circuits or corrosion.
7.3.1 Cleaning
Enameled parts and aluminum surfaces should only be wiped clean with a
damp cloth and mild detergent, and then rubbed down with a dry woolen
cloth. Never use corrosive cleaning agents, solvent or abrasive detergents or
polishes. If you are uncertain of the nature of a cleaning agent, do not use it.
Chrome parts should only be cleaned by rubbing down with a dry woolen
cloth. Do not use abrasive polishes. To preserve the finish, use non-abrasive
wax.
7.3.2 Disinfection
All parts of the equipment, including accessories and connecting cables, can
be disinfected by wiping them with a cloth dampened with disinfectant.
Never use corrosive or solvent disinfectants. If you are in any doubt about the
nature of a disinfecting agent, do not use it.
9896 001 33152
WA R N I N G Flammable or potentially-explosive disinfecting sprays must not be used since the

resultant vapor could ignite causing injury and/or damage to equipment.
CAUTION Disinfecting a medical equipment room by means of sprays is not recommended since
the vapor can penetrate the equipment causing electrical short-circuits or corrosion.
If non-flammable, non-explosive spray disinfectants are to be used, the

equipment must first be switched off and allowed to cool. This prevents
convection currents drawing disinfectant mist into the equipment. Plastic
sheeting must be used to cover the equipment thoroughly, following which
disinfectant spraying can take place. Once all traces of the disinfectant vapor
have dispersed, the plastic sheeting can be removed and the equipment itself
can be disinfected in the recommended way. If a spray has been used, the

Cleaning and disinfection 7.3
operator must be satisfied that all traces of the vapor have dispersed before
switching the equipment on again. Disinfection techniques for both the
equipment and the room must comply with all applicable laws and
regulations which have the force of law within the jurisdiction in which the
equipment is located.
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9896 001 33152


8 Product disposal
8.0 Introduction
Philips Medical Systems is concerned to help protect the natural
environment and to help ensure continued safe and effective use of the
INTEGRIS Allura Monoplane system through proper support, maintenance
and training. Philips equipment is therefore designed and manufactured to
comply with relevant guidelines for environmental protection. As long as the
equipment is properly operated and maintained it presents no risk to the
environment. However, the equipment may contain materials which could
be harmful to the environment if disposed of incorrectly. Use of such
materials is essential for the implementation of certain functions and for
meeting certain statutory and other requirements. This section of the
Manual is directed mainly at the user of the equipment or system, the body
with legal authority over the equipment. Operators are not usually involved
in disposal, except in the case of certain batteries (see paragraph 8.3 below).
8.1 Passing the INTEGRIS Allura

Monoplane on to another user
If the INTEGRIS Allura Monoplane system is to be passed on to another
user who is to use it for its intended purpose, then it should be passed on in
its complete state. In particular, the existing user should make sure that all
the product support documentation - including this Manual - is passed on to
the new user. A new user should be made aware of the support services that
Philips Medical Systems provides for installing, commissioning and
maintaining the equipment or system, and for the comprehensive training of
operators. Existing users must bear in mind that passing on medical electrical
equipment to new users may present serious technical, medical and legal
risks. The original user may remain liable even if the equipment is given
away. Existing users are strongly advised to seek advice from their local
Philips Medical Systems representative before agreeing to pass on any
equipment. Alternatively, contact Philips Medical Systems at the address
given below.
9896 001 33152

P.O. box 10.000

Fax: +31 40 27 62205
Once the equipment has been passed on to a new user, the previous user may
still receive important safety-related information, such as bulletins and field
change orders. In many jurisdictions there is a clear duty on the previous user
to communicate such safety-related information to new users. Previous users
INTEGRIS Allura Monoplane Release 1 Product disposal 8-1

8.2 Final disposal of the INTEGRIS Allura Monoplane system
who are not able or prepared to do this should inform Philips Medical
Systems about the new user, so that Philips Medical Systems can provide the
new user with safety-related information.
8.2 Final disposal of the INTEGRIS Allura

Monoplane system
Final disposal is when the user disposes of the equipment or system in such a
way that it can no longer be used for its intended purposes.
WA R N I N G Do not dispose of the INTEGRIS Allura Monoplane system (or any parts of it) with
industrial or domestic waste. The system may contain materials such as lead, tungsten
or oil, or other hazardous substances that can cause serious environmental pollution. It
is advisable to contact your Philips Service Organization before disposing of the
INTEGRIS Allura Monoplane system.
Philips gives support for:

• recovery of reusable parts
• the recycling of useful materials by competent disposal companies
• safe and effective disposal of equipment.
For advice and information, contact your Philips Service Organization first,
or otherwise Philips Medical Systems at the address below.

P.O. box 10.000
Fax: +31 40 27 62205
8.3 Fitting, removing and disposing of

batteries
8.3.1 Battery replacement for remote control

For safe operation, the batteries must be replaced at regular intervals. To
9896 001 33152
replace the batteries, open the cover on the rear of the remote control,
remove the old batteries and place new batteries in the position indicated in
the battery compartment.
Battery type: Philips ‘PENLITE’ LR03.
N OT E Batteries harm the environment; dispose of the old batteries in an environmentally

sound way.
CAUTION Always remove the batteries if the remote control will not be used for some time.
8- 2 Product disposal INTEGRIS Allura Monoplane Release 1

9 Technical data
9.1 Specifications
9.1.1 Environmental requirements

• Ambient temperature: 10 - 35°C.
• Humidity: 20 - 80%.
9.1.2 Mains
• 380 V ± 10%, 50 and 60 Hz, 3 phase.
• 440 V ± 10%, 50 and 60 Hz, 3 phase.
• 480 V ± 10%, 50 and 60 Hz, 3 phase.
9.1.3 X-ray generator

Microprocessor-controlled 100 kW high-frequency converter generator.
Quartz-controlled thyristor timer with minimum switching time of 1 msec.
• Voltage range: 40 kV to 150 kV.
• Maximum current: 1000 mA at 100 kV, 800 mA at 125 kV and 640 mA
at 150 kV.
• Maximum continuous power: 1.5 kW.
• Nominal power (highest electrical power): 100 kW (1000 mA at 100 kV)
(IEC 601-2-7/1987)
• Reference loading conditions: 125 kV, 12 mA continuous.
9.1.4 X-ray tubes

MRM-GS 04 10
• Grid-switch version for enhanced pulsed fluoroscopy image quality.
• Focal spot: 0.4/1.0.
• Power: 25/85 kW.
• Anode heat storage capacity: 1400 kHu.
• Continuous heat dissipation: 1500 W.
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MRC-GS 200 03 10
• Power: 20/100 kW.

MRC-GS 200 04 07
• Power: 30/67 kW.
INTEGRIS Allura Monoplane Release 1 Technical data 9-1

9.1 Specifications
9.1.5 Examination light

• Light intensity: 30,000 Lux.
• Colour temperature: 4300 °K.
• Colour rendering index Ra: 96.
• Focusable light field size: 14 - 25 cm (5.5 - 9.8 inch).
• Working distance: 70 -140 cm (27.6 - 55.1 inch).
• Light intensity at 30,000 Lux: 114 W/m2.
• Lamp type: halogen 22.8 / 24 V 50 W.
• Mains power: 220/240 V.
9.1.6 Ceiling suspended radiation shield

The ceiling suspended radiation shield comprises:
• 75/90 cm counter balanced two section suspension arm
• 40 x 50 cm tiltable lead acrylic shield, lead equivalence 0.5 mm Pb
• 35 x 50 cm lead apron, lead equivalence 0.5 mm Pb.
The total weight of the radiation shield and arm is 19 kg.
9.1.7 Accessory bracket for ceiling suspended radiation

shield
Accessory bracket for mounting the ceiling suspended radiation shield,
comprising:
• mounting spigot with a 32 mm diameter groove for securing the ceiling
suspended radiation shield.
Mechanical rating: 200 Nm maximum.
9.1.8 Wedge filters

Two independent semi-transparent wedge-shaped filters, with automatic or
manual positioning.
9.1.9 Additional filtering

• Filter 0: No filter.
• Filter 1: 1.0 mm Al + 0.1 mm Cu = 3.3 mm Al equivalent at 100 kV.
9896 001 33152
• Wedge filter: 1 mm brass R019 = 19.8 mm Al equivalent at 100 kV.
N OT E For each of the tables below, the column headed ‘Additional filter (Programmed)’ is
filled in by Service, if the default filter values are changed, during system installation.
Fluoroscopy modes
Fluoroscopy mode Additional filter Additional filter

(Default) (Programmed)
3 0
9- 2 Technical data INTEGRIS Allura Monoplane Release 1

Specifications 9.1
Fluoroscopy mode Additional filter Additional filter

(Default) (Programmed)
2 1, if MRC-GS
1, if MRM-GS
1 1, if MRC-GS
1, if MRM-GS
Digital dynamic APR’s
APR APR name Filter used Additional filter

No. 50 Hz (60 Hz) (Default) (Programmed)
1 12.5 (15) FPS Coronary 0
2 25 (30) FPS Coronary 0
3 12.5 (15) FPS LV Lock 0
4 25 (30) FPS LV Lock 0
5 12.5 (15) FPS Coro intensive 0
6 25 (30) FPS Coro intensive 0
7 - 0
8 - 0
9 25 (30) Pediatry < 4y 1
10 50 (60) Pediatry < 4y 1
11 25 (30) Pediatry > 4y 1
12 12.5 (15) FPS Calibration 2
Digital vascular APR’s

No. (Default) (Programmed)
1 Cerebral 0
2 Neck 0
3 Cerebral fast 0
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4 - 0
5 - 0
6 - 0
7 Lungs 0
8 Lungs (1024) 0
9 Lungs non-subtracted 0
10 Arch 0
11 - 0

9.1 Specifications

No. (Default) (Programmed)
12 - 0
13 Abdomen AP 0
14 Abdomen LAT 0
15 High speed 0
16 Kidney (1024) 0
17 - 0
18 - 0
19 Iliac 0
20 Upper Extr. 0
21 Lower Extr. 0
22 Foot/Hand 1
23 - 0
24 - 0
25 Non-subtracted bolus chase 0
26 Automatic bolus chase 0
27 Interactive bolus chase 0
28 Rot. Scan 0
29 - 0
30 K.A.T 0
31 IV Neck 0
32 IV Arch 0
33 IV Abdomen 0
34 IV Iliac 0
35 IV Upper legs 0
36 IV Lower legs 0
Fluoroscopy APR’s
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APR APR name Filter used (Default) Additional filter

No. (Programmed)
MRM MRC-GS
1 Bypass emergency continuous 0 0
2 Bypass low continuous 0 0
3 Bypass normal continuous 0 0
4 Emergency continuous 0 0
5 Low continuous 0 0

Specifications 9.1
APR APR name Filter used (Default) Additional filter

No. (Programmed)
MRM MRC-GS
6 Normal continuous 0 0
7 Low pulsed 2 2
8 Normal pulsed 1 1
9 Quality pulsed 0 0
10 Low Vasc. 2 2
11 Normal Vasc. 2 2
12 High Vasc. 1 1
9.1.10 Imaging chain

38 (15 inch) system:
• 15 inch penta-mode high-contrast image intensifier:
- Full metal construction
- 38/31/25/20/17 cm (15/13/10/8/6 inch) input screen
- Fibre optic output window
30 (12 inch) system:

• 12 inch 4-fields high-contrast image intensifier:
- Full metal construction
- 30/22/17/12 cm (12/9/6/4.5 inch) input screen
TV chain:
• CCD camera with proprietary digital output
• CCIR: 625/1249 lines for 50 Hz systems
• EIA: 525/1069 lines for 60 Hz systems.
9.1.11 XB monitor
• Mains voltage: 90 - 264 V.
• Mains frequency: 45 - 66 Hz.
• Maximum power consumption: 190 W.
• Weight:
9896 001 33152
- 24 kg (17-inch monitor)
- 33 kg (21-inch monitor).
• Size (width x height x depth):
- 17-inch monitor: 42.6 x 44.6 x 49.5 cm (16.7 x 17.6 x 19.5 inch)
- 21-inch monitor: 49.8 x 40.2 x 49.5 cm (19.6 x 15.8 x 19.5 inch).
Monitor suspension
Maximum load applied on a monitor position: 40 kg.

9.1 Specifications
9.1.12 Colour monitor

• Mains voltage: 90 - 264 V
• Mains frequency: 47 to 63 Hz
• Maximum power consumption: 180 W
• Weight: 35 kg
• Size (width x height x depth):
- 21-inch monitor: 49.8 x 40.2 x 57.1 cm (19,6 x 15,8 x 22,5 inch).
9.1.13 Beam carriers

Ceiling suspended C-arm stand
Rotation:
position perpendicular to the table)
position parallel to the table)
• variable rotation speed via tableside operation module up to 25°/sec.
Angulation:
• from 90° cranial (+angulation) to 90° caudal (-angulation) (max = 90°)
(stand in its head position parallel to the table)
• from 120° cranial (+angulation) to 185° caudal (-angulation) (stand in its
side position perpendicular to the table)
• variable angulation speed via tableside operation module up to 18°/sec.
Rotational angiography:
position perpendicular to the table (rolling movement)) at a speed of up to
30°/sec
position parallel to the table (propeller movement)) at a speed of up to
55°/sec.
Image intensifier movements:

• motorized focus/II screen distance (SID) from 89.5 to 119.5 cm (35.2 to
47 inch)
• motor-driven II movement speed:
- 10 cm/sec (3.9 inch/sec) towards the patient
- 15 cm/sec (5.9 inch/sec) away from the patient.
9896 001 33152
Image intensifier modes:

• 38 cm II: 38/31/25/20/17 cm (15/13/11/8/6 inch)
• 30 cm II: 30/22/17/12 cm (12/9/6/4.5 inch).
L-arm
• longitudinal movement (parking movement) of 260 cm (102.3 inch)
• motorized longitudinal movement speed of 15 cm/sec (5.9 inch/sec)
• rotation movement over 180° (2 x 90°)
• motorized rotation speed of 12°/sec.

Specifications 9.1
Short L-arm (option)

• minimum ceiling height: 270 cm (106.3 inch)
• rotation movement: 2 x 90°.
9.1.14 Angio DIAGNOST 5

Patient support
• Length: 293 cm (115.4 inch)
• Width: 50 cm (19.7 inch)
• Free overhang: 220 cm (86.6 inch)
• Longitudinal float: 100 cm (39.4 inch)
• Transverse float: 36 cm (14.2 inch)
• Height adjustment (without pivot option): 76 to 104 cm (29.9 to 40.9
inch)
• Maximum leveling speed (height adjustment):
- 2 cm/s (0.8 inch/s) for 50 Hz systems
- 2.4 cm/s (0.9 inch/s) for 60 Hz systems
• Maximum patient weight: 200 kg (440 lb)
• Additional force for resuscitation: 600 N
• Including:
- mattress
- infusion stand
- catheterization arm support
- 5 x clamp for accessories
- 2 x hand grip.
Additional features with SyncraTilt option

• Motorized longitudinal movement with tilted tabletop at any speed
between 0 and 15 cm/s (0 and 5.9 inch/s)
• Tilt movement:
- Range: -28° HDT to +20° HUT, average speed 2°/s
• Maximum leveling speed (height adjustment) AD5-tilt: 2 cm/s
• Maximum patient weight: 200 kg (440 lb). Over the tilt range -20° to -28°
longitudinal tabl speed may be reduced for a patient weighing more than
160 kg (352 lb).
• Additional maximum force for resuscitation 600 N.
N OT E S • Under certain circumstances the tilt-center automatically coincides with the iso-
center of stand rotation and angulation.
• Under certain circumstances the stand angulation is synchronized with the tilt
9896 001 33152
movement.
Options
• Pivot for table base:
- Maximum pivot range from -90° to +90° with locked positions at 0°,
-13°/+13°, and -90°/+90°
- Increases table height by 2.5 cm (0.98 inch).
• Bolus chase.
9.1.15 Contrast medium power injectors

• Liebel Flarsheim:

9.1 Specifications
- Illumena.
• MEDRAD
- Mark V ProVis.
9.1.16 Storage media

• Loading system: Front loading
• Interface: Small Computer System Interface (SCSI)
• Power requirements: 100-240 V AC, 50/60 Hz
• Power consumption: 46 W max
• Dimensions:
- length: 247 mm (9.7 inch)
- Height: 58.5 mm (2.3 inch)
- Depth: 275 mm (10.8 inch)
• Weight: 3.5 kg
• Available positioning: Horizontal
• Environmental conditions:
- Operating temperature: +5 °C to +40 °C (+41 °F to +104 °F)
- Operating humidity: 10% to 80% RH (no condensation)
- Storage temperature: -20 °C to +50 °C (-4 °F to +122 °F)
- Storage humidity: 10% to 90% RH (no condensation)
• Access speed: Within 6 seconds
• Save speed:
- Approximately 8 s per 10242 image
• Retrieve speed: Directory display within 5 s
- First image available within 10 s
Thereafter:
• Erase speed:
- Directory display within 5 s
- One side of disk within 10 minutes
• Disk eject time: Within 5 s.
Inturis DICOM Recorder

• Refer to the Inturis DICOM Recorder ‘Instructions for Use’.
9896 001 33152
9.1.17 Network data

Hi-speed DICOM network
• Maximum Ethernet transfer speed (see note): 100 Mbit/s.
• Transfer speed for images (see note): 2 Mbyte/s.
Radiology Information System (RIS) interface

• Maximum Ethernet transfer speed (see note): 10 Mbit/s.
N OT E Transfer speeds mentioned above depend on the local situation (network load and
external station).

Stray radiation data 9.2
9.2 Stray radiation data

12 34545 (')*%+( ",-./!

6
0

0 '

00
#
(*7/--.88&
200
0,5mm
180
1,0mm
160 1,5mm
140
'
120

100
80

60

40
Correct Contour : Accept Draw Erase
9
20

0 2 3
10 10 10
!" #$%&
24

36270020

N OT E As you can see in the illustration, the protective device lowers the dose by at least an
order of magnitude.
The indicated ‘significant zone of occupancy’ is designated to be used for

radiologic examinations according to section 1.3 ‘Intended use’.
9896 001 33152
9.2.1 Measuring results

Dose values as percentage of curve:

9.2 Stray radiation data
kV Filter Reduction (%)
No 0.5 mm lead 1.0 mm lead 1.5 mm lead

protection equivalence equivalence equivalence
110 0 100 100 100 100
1 66 87 85 76
2 38 69 64 53
3 19 49 47 32
90 0 64 33 34 46
1 39 27 24 31
2 19 20 15 17
3 8.5 12 9.0 9.2
70 0 35 6.0 13 22
1 18 4.1 7.2 12
2 7.1 2.4 3.1 4.6
3 2.3 1.3 1.0 1.9
N OT E The dose values are approximately the same for continuous fluoroscopy as for pulsed
fluoroscopy.
9896 001 33152

9- 1 0 Technical data INTEGRIS Allura Monoplane Release 1

10 Appendices
10.0 Introduction
This Section provides the user with additional background and supporting
information.
10.1 Standards and regulations

The Philips INTEGRIS Allura Monoplane complies with all relevant
national and international standards and laws. Information on compliance
with these standards will be issued on request by your Philips Medical
Systems representative, or by:

P.O. box 10.000
Fax: +31 40 27 62205
10.1.1 Measurement of technical parameters

The following measurements are required in order to check compliance of
the technical parameters of the system.
Peak tube voltage during continuous fluoroscopy

Direct kVp measurements should never be made with the HV dividers
normally supplied to field service. The kVp is factory calibrated for FDA
compliance. The kVp must be measured with a digital voltmeter connected
to measuring points EH116:X25 (KVAV) and EH116:X29 (GND). 1 V
equals 20kVp.
Peak tube voltage during radiography, cine fluorography and pulsed

fluoroscopy
9896 001 33152
Direct kVp measurements should never be made with the HV dividers

normally supplied to field service. The kVp is factory calibrated for FDA
compliance. The kVp must be measured with an oscilloscope connected to
measuring points EH116:X25 (KVAV) and EH116:X29 (GND). 1 V equals
20kVp.
Tube current during continuous fluoroscopy

Measured with a digital mA meter connected to measuring points EHX1002
and EHX1003.
INTEGRIS Allura Monoplane Release 1 Appendices 1 0-1

10.1 Standards and regulations
Tube current during radiography and cine fluoroscopy

The peak value of the tube current during the mA-pulse must be measured
with an oscilloscope connected to measuring points EZ126E:X32
(TCUAVLI) and EZ126:X21 (GND). 1 V equals 0.266 A.
Tube current during pulsed fluoroscopy

The peak value of the tube current (Ipeak) during the mA-pulse must be
measured with an oscilloscope connected to measuring points EZ126E:X32
(TCUAVLI) and EZ126:X21 (GND). 1 V equals 0.266 A. The tube current
during pulsed fluoroscopy (Ipulsed fluoro) is calculated from the following
expression:
Ipulsed fluoro = Ipeak x t x f

where: I = electrical current [A], t = exposure time [s] and f = frequency [Hz]
Exposure time
The exposure time must be measured with an oscilloscope connected to
measuring points EH116:X25 (KVAV) and EH116:X29 (GND). 1 V equals
20 kVp. The exposure time is the time for which the measured kV remains
equal to or greater than 75% of its maximum value.
mAs
Measured with a digital mAs meter connected to measuring points
EHX1002 and EHX1003. Indicated values, meter readings and control
settings are accurate to within the following limits:
Parameter Range Accuracy
kV (radiography) 50 - 150 kV for all techniques:

kV (fluorography) 40 - 125 kV ± 5 %, if texp 10 ms and I x t 5 mAs
kV (pulsed fluoro) 40 - 110 kV ± 5 % or ± 1 kV, if texp < 10 ms or I x t < 5 mAs
For radiography and fluorography:

mA (radiography, 10 - 1000mA ± 5 % or ± 1 mA, if texp 10 ms and I x t _ 5 mAs
fluorography) according to ± 5 % or ± 3 mA, if texp < 10 ms or I x t < 5 mAs
tube type.
mA (pulsed fluoro) 30 mA max. Ipeak x (accuracy of texp ) x f + ( accuracy of Ipeakx texp x f )
For all techniques:

exp time (texp) 1 ms - 10 s ± 2 % or ± 1 ms, if texp 10 ms and I x t 5 mAs
(radiography, ± 2 % or ± 1 ms + 35 ms, if 10 mA I < 100 mA
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fluorography, ± 2 % or ± 1 ms + 4 ms, if 100 mA I < 250 mA

pulsed fluoro) ± 2 % or ± 1 ms + 1 ms, if 250 mA I < 500 mA
mAs (radiography) 0.5 - 999 mAs ± 5 % or ± 0.5 mAs, if texp 10 ms and I x t 5 mAs
± 10 % or ± 1.5 mAs, if texp 10 ms or I x t < 5 mAs
kV (continuous 40 - 110 kV ± 5 % or ± 1 kV
fluoroscopy)
mA (continuous 30 mA max. ± 5 % or ± 0.5 mA

fluoroscopy)
N OT E S • Tolerances do not allow for inaccuracies of measurement.

• texp in seconds, f in Hz.
10 - 2 Appendices INTEGRIS Allura Monoplane Release 1

Application guidelines 10.2
10.2 Application guidelines
10.2.1 Digital lower peripheral angiography

Introduction
Digital lower peripheral angiography can be performed using various image
acquisition techniques:
• DSA runs on multiple positions
• DSA or DA (unsubtracted) with stepping
• DSA or DA bolus chasing
DSA runs on multiple positions

This is a safe method which is still used by many physicians. Each DSA run
requires its own injection.
The injection protocol, the acquisition delay time and the acquisition frame
rate can be optimised for each run by using the imaging information from
the previous run.
Bolus tuning is no problem with this method as the acquisition duration of
each run is stopped when the contrast bolus has passed the field of view. The
method offers most diagnostic information overall since inflow, maximum
filling and outflow is visualised.
Even if there is a substantial flow difference between the legs,
uncompromised imaging of both legs is assured by this method.
As about 50% of the current diagnostic angiographic procedures concern the
lower peripheral arteries there was considerable incentive to improve the
existing procedures. Examination time can be minimised by using a single
injection method which uses a moving imaging area from the bifurcation
down to the feet.
DSA or DA with stepping

This is a single injection procedure which is very similar to the old fashioned
Puck stepping method. One of the main disadvantages of this method is that
each step duration is relatively long (1.5 – 2.0 seconds), so that with 6
positions (5 steps) a total duration of 7.5 – 10 seconds is unavailable for
making images.
For patients with a fast blood flow there is thus not sufficient time available
for making images at each position.
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Another disadvantage is that for each step the sudden acceleration and
deceleration of the table movement is very uncomfortable for the patient.
Philips Medical Systems has decided not to implement the stepping method.
DSA or DA with bolus chasing

Bolus chasing is the Philips Medical Systems single injection procedure.
By using short exposure times and limited table speeds the images can be
acquired during the continuous table movement.
Two methods are available to satisfy the wide range of clinical requirements:
• interactive mode
• automatic mode.

The interactive mode gives the physician full control over the table
movement, injection protocol, frame rates and run duration.
With a hand held speed controller the table scan speed can be matched to the
speed of the contrast bolus, displayed in real time on the monitor screen.
The proper speed is achieved if the front of the bolus remains located at the
bottom of the monitor screen at the successive images in the run.
If DSA is required, a second (mask) run must be made without a contrast
injection. During the second run the images are acquired at exactly the same
locations as in the first run, by automatically repeating the recorded table
speed profile and exposure frame rate as used in the first run. With run
subtract the DSA images can be visualized.
The automatic mode applies an automatic table speed profile so that the user
only needs to give the start command.
A range of pre-programmed table speed profiles are available for selection.
Proper selection requires some advance information about the speed of the
blood in the particular patient. Therefore an integral part of the whole
automatic bolus chase procedure is to determine the so called Knee Arrival
Time (KAT) by means of a small test injection above the bifurcation. A very
common KAT value is 6 – 7 seconds, but for various pathological reasons
values between 4 and 20 seconds may be observed.
It is good angiographic practice to adapt the injection rate of the contrast
medium to the expected basal flow rate of the blood at the site of injection.
In this way the best balance is obtained between the chance of reflux and
local dilution at the injection site. So, each KAT program that can be selected
by the user has its own speed profile and optimised injection protocol advice.
In addition, the frame rate is automatically adjusted in such a way that with
the given speed profile the exposures are made at nearly equidistant positions.
Another integral part of the bolus chase procedure is to adapt to various
patients sizes by user selections of start and end positions of the table
movement.
The applied table speed profile in the automatic mode is the result of an
internal automatic optimisation calculation after the user selection of the
KAT value and the begin and end positions.
The optimisation is based on the following assumptions:
• patient positioning is as advised (see section 5.3.3 ‘Bolus chase’)
• catheter tip location is as advised (see section 5.3.3 ‘Bolus chase’)
• injection duration is as advised during KAT selection.
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N OT E Deviations from these advised settings may lead to less optimal results.
10.2.2 Rotational angiography

Rotational Angiography is an acquisition procedure used to obtain

information concerning the 3-dimensional structure of the blood vessels.
The C-arm is rotated during image acquisition. One of the system
acquisition programs is used to select the procedure and its specific
parameters. The rotational end and start positions can be selected and stored
by the operator. The procedure is controlled with the exposure hand or foot
switch or with the injector hand switch. For subtraction rotational
angiography, two acquisition runs are made. After the first (mask) run, the

stand returns automatically to its starting position ready for the second (dye)
run. During acquisition, the images are displayed in non-subtracted mode.
Subtraction can be carried out during viewing. The actual stand position
(‘ROT’ and ‘ANG’ angles) for each image can be displayed on the viewing
monitor when viewing a steady image (i.e. not during a cycle). The operator
can use this information to position the stand in order to have the same view
of an area of particular interest (see also ‘Display physiological data’ [87]).
For more information see Section 5.3.4 ‘Rotational Angiography’.
10.2.3 Mask averaging

The Average Mask function [63] loads a new (blurred) mask obtained from
the average of a predefined number of images. Use of an average mask for
subtraction has two advantages:
• blurring: For an image series containing motion artifacts (e.g. pulmonary
images), the average mask function creates a blurred mask. To avoid
subtraction artefacts, subtracting the blurred mask from the contrast
image results in a reasonable subtracted image providing optimal vessel
contrast amplification.
• image quality: Since image averaging reduces the level of noise, use of the
average mask function reduces the total noise in a subtraction series.
However, the average mask algorithm introduces quantization effects. If

averaging is performed over too many images, these quantization effects
outweigh the improvement in image quality. If the average mask function is
used for blurring effects, the quantization effects are hardly visible.
Recommended use:
To improve image quality it is strongly recommended to create an average
mask from no more than 4 images (10242 matrix) or 16 images (5122
matrix).
10.2.4 Ultrasound
Linear array and curved array technology
Linear array probes

A linear array probe consists of a linear array of transducer elements that emit
short acoustic pulses. The returning echoes are displayed along parallel lines
on the monitor forming a rectangular image of width similar to the physical
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width of the probe.
Curved array probes

The curved transducer array in these probes produces a relatively wide
footprint and a sectorial image with a wide, far field. The large number of
transducer elements makes it possible to focus at four different depths, with
three focal points. The probe automatically selects the optimal focus for the
image depth.

Image resolution
Each picture element is defined by two parameters: the focus setting and the
number of echo-lines per image (frame rate). Optimal image resolution is
achieved by defining each picture element within the image with respect to
the chosen clinical application.
Focus
The focus of an ultrasound image is defined with respect to axial, lateral and
transverse resolution.
Axial resolution
Axial resolution is the minimum separation of two objects along the beam
axis (Z axis) for which two separate echoes can be identified. The axial
resolution is determined by the probe frequency: the higher the frequency of
the probe, the better the axial resolution over a greater depth range. However,
the maximum penetration decreases as the frequency increases.
Lateral resolution
Lateral resolution is the minimum separation of two objects placed at the
same depth (X axis) for which two separate echoes can be identified. The
major determinant of lateral resolving ability is beam width. Beam width
varies with distance from the probe, and is dependent on probe geometry, its
frequency, and focusing characteristics. Increasing the number of focal points
also increases the lateral resolution. As the number of focal points increase,
the frame rate decreases.
Slice thickness
The slice thickness resolution is not directly visible in the image, but it is
substantially related to the spatial resolution. The spatial resolution
corresponds to the smallest distinguishable separation between two reflecting
surfaces. With a linear or curved array probe, fixed focusing is possible only
in the Y direction (thickness of the slice).The form and material of the
acoustic lens control the focus in this direction.
Frame rate
A picture element is also defined by the number of received echo lines per
image (frame rate). The more echo lines received, the better the image that
can be calculated by the Scanner. The frame rate is displayed at the left side
of the screen.
Probes
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33723870
a c/d b
Probes available for scanner
The scanner can be supplied with up to four probes:

a. 7.5 MHz linear array
b. 5.0/7.5 MHz curved array
c. 3.5/5.0 MHz curved array
d. 3.5 MHz High-Definition (HD) curved array

Two probes can be connected to the scanner at one time. Since the Scanner
can handle single-frequency as well as dual-frequency probes, the operator
may choose from four different frequencies (two dual-frequency probes
connected).
Overview of available probes and their intended use
Probe Freq. Application

(MHz)
Abdonem Paediatric Intra- Small Pheripheral

operative objects Vessels
Linear 7.5 • • • • •
array
Curved 5.0/7.5 • • - • •
array
Curved 3.5/5.0 • • - - -
array
HD curved 3.5 • • - - -
array
• = applicable; – = not applicable
Abdominal
For abdominal ultrasound examinations, the depth of the object being
visualized determines which probe is used.
Paediatric
Use the 5.0 MHz curved array [b or c] for abdominal scanning. The 3.5
MHz curved array [c] or 3.5 MHz high-definition curved array [d] may also
be used. The 7.5 MHz linear array [a] or 7.5 MHz curved array [b] gives the
best results when examining superficial objects.
Object depth:
Depth Probe freq. Probe type
(cm) (MHz)
0 - 20 3.5 HD curved array
0 - 20 3.5/5.0 Curved array

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0 - 12 5.0/7.5 Curved array
0-6 7.5 Linear array

Intra-operative
The 7.5 MHz linear array [a] may be used the for intra-operative
visualization of structures in the 0 - 6 cm range. For this technique, the probe
must be covered with a sterile sheath.

Small objects
Use the 7.5 MHz linear array [a] or 7.5 MHz curved array [b] for
visualization of structures in the 0 - 6 cm range.
Peripheral vessels
Use the 7.5 MHz linear array [a] or 7.5 MHz curved array [b] for
visualization of structures in the 0 - 6 cm range.
WA R N I N G S • If a probe is dropped have it checked by a service engineer as damaged insulation

can be dangerous.
• The probes may only be connected or disconnected when the scanner is switched
off. Performing these actions when the scanner is switched on (indicator lamp above
probe connection on) can cause serious damage to the scanner and/or probe.
Needle guides
There are two types of needle guide attachments:
Type I: Needle guide attachment for the 5.0/7.5 MHz and 3.5/5.0 MHz
curved array probes and for the 3.5 MHz high definition curved array probe
(probes [b, c and d]).
Type II: Needle guide attachment for the 7.5 MHz linear array probe (probe
[a]).
33723880
g e f h
Type I needle guide attachment Type II needle guide attachment
e. Type I needle guide holder

f. Type I needle guide
g. Type I needle guide clamp
h. Type II needle guide holder
i. Type II needle guide
N OT E The needle guides should be cleaned and sterilized after each examination.
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WA R N I N G The needle guides are not designed for use with neurological/surgical patients.
10.2.5 Type B symbol

The type B “applied part” symbol can be found on both the patient table
(AD5) and the Image Intensifier (II).

33725440
Type B ‘applied part’ symbol
Definition “applied part”

A part of the equipment which in normal use:
• must come into physical contact with the patient for the equipment to
perform its function, or
• can be brought into contact with the patient, or
• needs to be touched by the patient.
Where normal use is defined as follows:

Operation (including routine inspection and adjustments by the operator
and stand-by) as described in the instructions for use.
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10.3 Wedge filters
10.3 Wedge filters
10.3.1 Manual-only wedge control (Vascular APR)

During fluoroscopy, irradiation of low absorption or radio transparent
regions can cause distracting highlights in the images or saturation of the
video tube. During exposure the presence of highlights in the region of
interest will affect image quality since the exposure parameters will no longer
be optimal. These effects can be suppressed by covering the regions
concerned with wedge filters.
Although, in principal these wedge filters can be used for all examinations
they are particularly useful for the following anatomic regions:
• brain
• neck
• lungs
• peripheral regions.
The controls allow translation and rotation of the semitransparent wedge

filters. The filter algorithms and therefore the controls for the left and right
wedge filters [155, 156] are identical. In the diagrams below the wedge filter
controls are described for the left wedge filter [155]:
Joystick up: wedge rotates clockwise.
Joystick down: wedge rotates counterclockwise.
Joystick left: wedge moves outwards.
Joystick right: wedge moves inwards.
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10 - 1 0 Appendices INTEGRIS Allura Monoplane Release 1

Wedge filters 10.3
max
155
max
155
155
max
155
33722850
10.3.2 Automatic/manual wedge control (Cardiac APR)
The position of the wedge filter is determined according to a curve related to
the stand rotation (LAO (+rotation)/RAO (-rotation) projection). The
default position of the wedge filter depends on the LAO (+rotation)/RAO (-
rotation) projection. If both the RAO (-rotation) and LAO (+rotation)
projections are less than 20°, the default position of the wedge filter is +20%
clockwise over 40% of the radius (these values are valid for a 23 cm (9 inch)
Image Intensifier field and an SID of 1 meter (39.4 inch)) (see illustration).
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100%
60%
+ + +
40% 40%
33722820
LAO/RAO ±20° 20° < LAO 120° 20° < RAO 120°
+rotation/-rotation +rotation -rotation

Automatic wedge filter positions Cardiac APR mode
Wedge filter area increases with increasing LAO (+rotation)/RAO (-rotation)

rotation. The maximum wedge area is 40% for LAO (+rotation) and 60%
for RAO (-rotation).
INTEGRIS Allura Monoplane Release 1 Appendices 10-11

10.3 Wedge filters
N OT E Under conditions where the wedge filter would not be seen, e.g. if either the SID is
greater than 1 meter (39.4 inch) and/or the Image Intensifier field is smaller than 23 cm
(9 inch), the filter is automatically set at ± 45° clockwise over >10% of the radius.
The automatically set wedge filter positions can be manually adjusted. The
figures below show the effects of moving [155] forward, backward, and to the
right respectively; moving the control to the left has the opposite effect to
moving it to the right.
+ +
155
156
+ +
155
156
+ +
max
or
155
156
+ +
33722830
Hysteresis
The algorithm incorporates 10° of hysteresis to ensure filter stability. This
means that when the X-ray tube is rotated within 10°, the position of the
wedge filter remains constant.
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Manual mode
In manual mode, the wedge filter no longer follows the movement of the
stand. Pressing [155] down enters manual mode, the stand position may be
changed, but the wedge filter position does not change. Pressing [155] down
a second time returns the system to automatic mode and the wedge filter
moves to the position fixed by the stand position.

Wedge filters 10.3
155
33723700
156
[155] controls the wedge filter for standard (monoplane) cardiac procedures.
The control allows translation and rotation of the semitransparent wedge
filter. Pressing [155] sets the wedge filter to manual mode. In this mode
[155] controls the wedge filter:
Joystick up: wedge rotates clockwise
Joystick down: wedge rotates counterclockwise
Joystick left: wedge moves out or inwards (depending on wedge filter
position (see illustrations above))
Joystick right: wedge moves in or outwards (depending on wedge filter
position (see illustrations above))
Pressing [155] again, resets the wedge filter to automatic mode (standard
(monoplane) cardiac procedures). Pressing [156] sets the wedge filter to
vascular mode. In the vascular mode [155] controls the left wedge filter and
[156] controls the right wedge filter (see [155, 156]). Pressing [156] again,
resets the wedge filter to automatic mode (standard (monoplane) cardiac
procedures).
N OT E Press [156] to switch from vascular to cardiac mode (automatic/manual mode).
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10.4 Stand and table movements
36280590
Rotation and angulation angles are indicated on the display unit [123].
10.4.1 Safety devices for the stand and table movements
WA R N I N G S • If during motorized movements an audible tone (beeping sound) is produced by the

system, this indicates that the bodyguard detection system does not function
properly. For safety reasons the system will automatically switch to a reduced speed
mode. Be aware that in this mode collisions can occur. Call Service.
• When moving the C-arm or the table, either manually or using the motor drives, the
operator is responsible for the safety of patient, staff and equipment. Collisions
must be avoided in order to prevent serious injury to patient and staff or damage to
the equipment.
The system is provided with several safety devices to help the operator avoid
collisions and carry out the appropriate movements.
N OT E The safety features apply to motorized movements only.
The system is provided with the following safety features:

• dead man’s principle
• bodyguards
• soft collision technology.
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Dead man’s principle

All movement controls must be kept activated by the operator to start and
continue a motorized movement. Releasing the control stops the movement.

A degree of run-out must be taken into account depending on the speed of
movement.
Bodyguards
A bodyguard is not a switch device but a device that senses distance and
controls the maximum permitted speed of the movement. All motorized
movements of the C-arm and table are controlled by the bodyguard system.

Stand and table movements 10.4
The system will protect the patient by slowing down movement speeds when
an object is detected within a certain safety distance. The detection system
does not prevent all collisions, but due to the reduced movement speeds these
collisions will not be harmful if they occur.
N OT E If the bodyguard sensor is covered with a cloth and the cloth becomes wet, it will be
detected as an object and block motorized movement. It is advisable to use plastic
covers rather than a cloth as fluid is not absorbed by plastic and cannot therefore
block the motorized movement.
Soft collision technology

The maximum motor current is calibrated to be just greater than that
required for normal movement. During operation all motor currents are
continuously monitored. If a collision occurs the current will increase until it
attains the calibrated threshold value. The stand will then automatically
back-off from the object by a short reverse movement to clear the collision.
10.4.2 Stand movements

Manual L-arm movements
The C-arm is carried by an L-arm suspended from the ceiling rail running
parallel to the longitudinal axis of the patient table.
Pressing |Longitudinal movement brake release| [191] allows manual
movement of the L-arm along the rail. This is described as ‘longitudinal’
movement of the L-arm.
a b c d
33726750
g1 g2 g3
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Top view of C-arm and table
a. Longitudinal movement of L-arm (260 cm (102.3 inch)).

b. Ceiling rail.
c. Tabletop.
d. Table base.
e. Ceiling carriage.
f. Pivot point.
To assist positioning, a slight resistance will be felt at the following 3

positions along the rail (marked with an arrow):
1 park position [g1]
2 neuro/cardiac position [g2]

3 peripheral position [g3].

Press [190] to release the stand rotation brake allowing manual rotation of
the L-arm around its ceiling pivot point. The L-arm can be pivoted through
an angle of 180°.
+90°
b c d
33726760
-90°
With the stand in the neuro/cardiac position (position [g2]) the L-arm can
be pivoted around the table, when the table is in its fully extended position
and in its mid-lateral position, without collision.
CAUTION Check that there is no risk of collision with the tabletop before pivoting the L-arm.
Short L-arm option

The short L-arm is designed for use in rooms that have a lower ceiling. It
reduces the minimum ceiling height from 290 cm (114.2 inch) to 270 cm
(106.3 inch).
36280600
Standard version Short L-arm version
The L-arm pivot movement is 2 x 90°.

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+90°
33726780
b c d
-90°
The L-arm has three predefined working positions (see illustrations):

• at right angles to the table (+90° and -90°)
• in line with the table (0°).
36280360
+90° position, 0° position and -90° position
Motorized L-arm movements

The rotation and longitudinal (park) movement of the L-arm can be
performed under motor control from the geometry module [145]. The
function includes three automatic stops (at the park, (lower) peripheral and
neuro/cardiac positions).
Using the motor drive makes positioning at the (lower) peripheral or neuro/
cardiac isocenter easy and accurate.
In the case of a motorized rotation of the L-arm, rotation automatically stops
at the predefined working positions. However, if the movement is stopped in
a smart arret area the L-arm will not automatically move to the predefined
position of that area. This allows the stand to be stopped at any wanted
position.
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During an examination the system automatically applies corrections in

perpendicular and parallel stand positions to maintain a logical user interface
and an anatomically-oriented image on the examination monitor.
Motorized L-arm rotation
Move [145] up/down (see note) to rotate the L-arm to one the three
predefined working positions. Pushing [145] up, rotates the L-arm away
from the operator. Pulling [145] down, rotates the L-arm towards the
operator.

N OT E Movements depend on the operator’s position (doctor/nurse side of table). The

illustration below shows the movement when the operator is at the doctor’s side of the
table.
26280380
[145] up/down Rotation movement of the L-arm
36280390
[145] down, L-arm in the -90° position [145] up, L-arm in the +90° position
Motorized L-arm longitudinal movement
Move [145] right/left (see note) to move the L-arm from parking position to
the automatic stop at the neuro/cardiac position. Move [145] further to the
right/left (see note) to move the L-arm to the automatic stop at the (lower)
peripheral position and vice versa.
N OT E Movements depend on the operator’s position (doctor/nurse side of table). The
illustration below shows the movement when the operator is at the doctor’s side of the
table.
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36280400
[145] left/right Longitudinal movement of the L-arm

36280410
[145] left, L-arm in park position [145] right, L-arm in peripheral position
C-arm movements
b
c
36280130
C-arm bodyguards
Bodyguards are fitted to:

• a. the front edge of the II
• b. the housing of the X-ray tube assembly
• c. front side of the C-arm (rolling movement)
• d. the II shift cover.
The C-arm is mounted in a saddle attached to the L-arm in which it can slide
(angulation) up to 90° in both directions.
The saddle is pivoted on the L-arm, allowing a ‘propeller movement’ of 120°
clockwise and 185° counterclockwise as seen from the table. Both C-arm
movements are performed under motorized control.
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WA R N I N G Take care to avoid collisions when moving the C-arm with the motor drive.
Motorized C-arm movements

Motorized movements are controlled by the joysticks [134, 136 and 145] or
by the APC function (see illustrations). Automatic power limitation helps to
ensure safe operation but care must be taken to avoid collisions of any kind.
Provided that the orientation switch on the tableside control module is
correctly set, the functions of the C-arm joysticks are always logically
oriented with respect to the patient, irrespective of the position of the L-arm.

Vascular application
C-arm rotation
36280420
[136] up/down C-arm rotation
36280430
[136] up, +90° (max.) [136] down, -90° (max.)
C-arm angulation
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36280440
[136] left/right C-arm angulation


36280450
[136] left, -55° (max.) (see note) [136] right, +60° (max.) (see note)
N OT E The range of movement is restricted by the table/patient.
Cardiac application
C-arm rotation
36280460
[136] up/down C-arm rotation
36280470
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[136] up, 120° LAO (max.) [136] down, 185° RAO (max.)
C-arm angulation

36280480
[136] left/right C-arm angulation
36280620
[136] left, +50° cranial (max.) (see note) [136] right, +50° caudal (max.) (see note)
N OT E The range of movement is restricted by the table/patient.
Combined movements
36280490
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[136] left/right, up/down C-arm combined movement

36280500
[136] left/up, from basic [136] right/down,[136] up, combined rotation

position, combined combined rotation
rotation and angulation and angulation

36280510
Basic position 2 [136] left/up,[136] down, combined rotation
combined rotation
and angulation
Image intensifier (II) movement (SID adjustment)

The SID of the C-arm can be changed by moving the II along the axis of the
X-ray beam. This is done under motor control using [134]. The SID is
continuously variable from 89.5 to 119.5 cm (35.2 to 47 inch). The SID is
shown on the display unit [124].
WA R N I N G In the event of a clinical emergency involving a patient, do not press emergency power
off [130] or [160] or switch off the X-ray system using a local mains power-off switch.
Move the image intensifier away (either motor driven or manually, by firmly pushing it
up) and/or the tabletop, and/or rotate or park the stand to provide clear, all-round
access to the patient.
Motorized II movements
SID adjustment for C-arm
36280520
[134] up/down SID adjustment

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36280530
[134] up, SID = 119.5 cm (47 inch) [134] down, SID = 89.5 cm (35.2 inch)

10.4.3 Table movements

The tabletop can be moved both longitudinally (max. 100 cm/39.4 inch)
and transversally (± 18 cm/7.1 inch) using [131]. Manual longitudinal
movement only (with lateral movement locked) is possible by pressing
|Longitudinal tabletop brake off| [132]. The table height can be adjusted
under motor control with the |Table height adjustment| control [133]. The
maximum table height is 104 cm (40.9 inch) and the minimum height is 76
cm (29.9 inch). The actual height is shown on a scale on the table column.
Motorized movement
Table height adjustment
36290220
[133] up/down Table height adjustment
33726970
[133] up, tabletop at 104 cm [133] down, tabletop at 76 cm
(40.9 inch)(max.) (29.9 inch)(min.)
N OT E In case the tabletop is moved up or down and moves into the area of a bodyguard
sensor, either on the X-ray tube housing or image intensifier, the table movement is
reduced and finally stopped before a collision would occur.
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Pivot
33723500
AD5 mounted on the pivot
b. Cover plate used by Service to gain access to the friction brake
If the optional Angio DIAGNOST 5 pivot is not installed, an insert is

mounted on the base cover to correct the table height indicator [a]. The pivot
allows rotation of the table base around its vertical axis. The position of the
table can be read from the scale on the base [c] (± 45° with 10° graduations).
The scale does not cover the full rotational range of ± 90° but only that part
of the range most commonly used. The rotation angle is ± 90° from the
normal position. The friction bearing maintains the table at any set angle.
Locks are provided are at the following preferred positions:
• normal use: 0°
• procedures involving the upper peripherals (arms): ± 13°
• procedures requiring free access, e.g. trauma patients: ± 90°.
36280300
-13° pivot position, -90° pivot position and +90° pivot position
The pivot movement must be performed manually. To pivot the tabletop,

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push it in the required direction. It is advisable to push the tabletop at least

150 cm (59.0 inch) from the pivot point with the tabletop brakes activated.
The pivot increases the minimum and maximum table height by about 2.5
cm (1.0 inch).

10.4.4 Angio DIAGNOST 5 with SyncraTilt option
33723520
AD5 with SyncraTilt option.
SyncraTilt is an option for the AD5 patient support used in INTEGRIS

systems. The standard performance of the AD5 table remains unchanged
when tilt movement of the tabletop is added. From the normal horizontal
position, the patient can be tilted in either a head-down or head-up position.
The center of the tilt movement automatically coincides with the isocenter of
rotation and angulation of the X-ray beam. The X-ray beam angulation is
synchronized with the tilt movement to maintain the optimal viewing
projection during the tilt movement. The region of interest can be changed
by panning the tabletop in the tilted plane. In certain situations isocentric tilt
movement is limited by the position of the stand and the height of the table,
further tilt is still possible but the movement will no longer be isocentric.
For safe and easy operation, the unit is fitted with an automatic safety system
which ensures:
• that the minimum distance between the tabletop and the X-ray tube/
collimator housing and/or the II-assembly is never less than that permitted
with the standard table. The movement stops when the minimum distance
is attained. The |Movement override| control [140] then has to be used to
continue the movement and an audible signal warns the operator of the
risk of collision
• the minimum distance between tabletop and floor is 3.8 cm (1.5 inch)
(UL)/12.0 cm (4.7 inch) (NEN).
If the tilt option is installed, three extra functions are available on the
geometry module:
• motorized |Longitudinal movement| [131]
9896 001 33152
• |Table tilt movement| [139]

• |Movement override| [140].
The tilt angle is indicated on the display unit [124] and on the scale (-28° to
+20°) on the table base.

Motorized movement
Table tilt
36290210
[139] left/right Table tilt adjustment at the isocenter of rotation
and angulatuion
36280540
[139] left, -28° HDT (max.) with [139] right, +20° HUT (max.) with
ceiling suspended C-arm in park position ceiling suspended C-arm in park position
Synchronized tilt
36280310
[139] left, synchronized tilt 0° to -28° [139] right, synchronized tilt 0° to +20°
HDT (max) (see note) HUT (max) (see note)
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N OT E Depends on the longitudinal position of the tabletop.
SyncraTilt accessories
Special accessories including a footrest and a set of shoulder straps are
supplied with the tilt option.

c f
d
e
33723540
a. Footrest.
b. Ankle straps.
c. Handgrips - rail version (2 pieces).
d. Handgrips - tabletop version (2 pieces).
e. Shoulder supports (not with neuro tabletop).
f. Chin support.
For more information on the use of these accessories see Section 5

‘Operation’.
9896 001 33152


11 Glossary
11.1 Definitions and terms

Acquisition examination
An acquisition examination has all the capabilities of an examination but in
addition to that it has one or two reference files. An acquisition examination
is automatically created if a scheduled patient record is selected at the
Schedule page.
The examination attributes for that examination are derived from the
selected scheduled patient record and the physician record belonging to that
scheduled patient record.
Acquisition functions (e.g. do fluoroscopy or start exposure) are only possible
when an acquisition examination exists. The acquired exposure runs are only
stored in an acquisition examination. All review functions performed with
the viewpad or the TAM in the examination room operate on the acquisition
examination only.
If an acquisition examination is not present the subsystem will create one
automatically with the patient name: ‘NO NAME ENTERED’.
Anatomically Programmed Radiology (APR)

An APR describes, for each imaging technique, how images will be acquired
and processed. APR items are configured during installation and can be
modified before and during an examination.
N OT E The default APR’s provided are optimized to give the best image quality with regard to
patient load, technical limitations, etc.
Bolus chase
A dynamic digital acquisition technique that allows the flow of contrast
medium to be precisely followed through the lower peripherals in a
continuous movement with just one contrast injection. Bolus chase is
possible in two modes: automatic and interactive, both subtracted and non-
subtracted.
Bolus chase supports a variable table scan movement (70 cm (27.6 inch) up
9896 001 33152
to and including 100 cm (39.4 inch)), which is selected by the operator and
is related to the length of the patient’s legs, and a variable number of
exposures (9 up to and including 39) for patient dose reduction.
Bodyguards
A bodyguard is not a switch device but a device that senses distance and
controls the maximum permitted speed of the movement. All motorized
movements of the C-arm and table are controlled by the bodyguard system.
The system will protect the patient by slowing down movement speeds when
an object is detected within a certain safety distance. The detection system
does not prevent all collisions, but due to the reduced movement speeds these
collisions will not be harmful if they occur.
INTEGRIS Allura Monoplane Release 1 Glossary 1 1-1

N OT E If the bodyguard sensor is covered with a cloth and the cloth becomes wet, it will be
detected as an object and block motorized movement. It is advisable to use plastic
covers rather than a cloth as fluid is not absorbed by plastic and cannot therefore
block the motorized movement.
Disk partition
The image storage capacity of the system can be divided by Service (during
software installation) into disk partitions, giving each partition a part of the
available image storage capacity. So a disk partition can be considered as a
logical disk having the same speed characteristics belonging to the number of
disks in the subsystem.
A maximum of two partitions can be defined. The minimum size of one
partition is limited to 30% of the entire storage capacity.
The partition in which the images of an examination are stored is determined
by the partition code related to a physician code in the examination data.
Doctor and nurse side of table
0 3
33720020
1
Top view of patient table
1 Doctor side.
2 Nurse side.
3 Foot-end.
The doctor side is the right side of the table, which is defined as the right side
of the patient. The patient lies on his/her back on the table with feet pointing
towards the bottom of the table. With this patient orientation, the left side of
the table is the so-called nurse side and the foot end is the side towards which
the patient’s feet are pointing.
Dynamic reference
Each acquisition examination has up to two Dynamic reference files.
Heartbeats that form part of an exposure run are stored in the Dynamic
reference file when the ‘Store reference’ function is used. Storage and recall of
9896 001 33152
Dynamic reference images follow the same principle as for Static reference
images.
Examination
An examination consists of a number of examination attributes such as
patient name, examination ID and examination date, entered by the operator
in an examination schedule, a number of exposure runs, one photofile and
zero or one run report. When an examination has been scheduled for
acquisition, images can be acquired and will be collected in a file for that
examination.
11 - 2 Glossary INTEGRIS Allura Monoplane Release 1

Definitions and terms 11.1
The maximum number of examinations that can be stored in the system is

100.
Examination report
The examination report function prints dose or examination information
concerning the acquisition examination on a printer connected to the
acquisition console. The function provides either a dose or an examination
report (configurable during installation). Since printing is a background
process, the next acquisition examination can be selected as soon as the print
process has been started.
Geometric terms
Geometric term Explanation
Angulation (ANG) Angulation (ANG) Movement around the axis perpendicular to the
patient at an angle to the horizontal plane equal to the rotation angle. So
when the rotation is zero, angulation is a movement around the lateral
axis. Angulation clockwise around the lateral axis is denoted as positive
or plus.
Anterior/Posterior When the patient is in supine position: AP is when the X-ray tube is
(AP), Posterior/ above the patient, PA is when the X-ray tube is under the patient.
Anterior (PA)
Caudal (CAUD) The image intensifier is angulated in the direction of the patient’s feet with
patient in head-to-stand position (i.e. positive angulation).
Cranial (CRAN) The image intensifier is angulated in the direction of the patient’s head
(i.e. negative angulation).
Height Direction perpendicular to the patient in the vertical plane.
Isocenter Point in space around which both the rotation and angulation movements
take place.
Lateral Direction perpendicular to the patient in the horizontal plane.
Left Anterior X-ray beam perpendicular to the longitudinal axis of the patient in supine
Oblique (LAO) head-to-stand position with the image intensifier on the left side of the
patient (i.e. positive rotation).
Longitudinal Direction parallel to the patient.
Rotation (ROT) Movement around the axis parallel to the patient, i.e. around the
longitudinal axis. Clockwise rotation is denoted as positive or plus.
9896 001 33152
Right Anterior X-ray beam perpendicular to the longitudinal axis of the patient in supine
Oblique (RAO) head-to-stand position with the image intensifier on the right side of the
patient (i.e. negative rotation).
Source-Image Distance between the X-ray tube focus and the input screen of the
Distance (SID) imaging device.

Heartbeat
A heartbeat is defined as a sequence of consecutive images of an exposure run
starting at an Rpeak and ending at the next Rpeak of the recorded ECG signal
from that exposure run. If the ECG signal is not recorded, the boundaries of
the heartbeat are -0.5s and +0.5s from the current image. For biplane runs,
the heartbeat is determined from the frontal channel.
Image
The maximum number of images that can be stored in the system is
dependent on the matrix resolution and the number of disks installed. A
typical image attribute is the ‘ flagged for transfer’ attribute. The maximum
number of flagged images per run is 20.
Imaging technique
Selectable imaging techniques: Digital Dynamic, Digital Vascular, etc. The
imaging techniques available in a system depend on the installed options.
Joystick directions
up right
left
down
36280180
Patient orientation
Four orientations are possible:
• ’Normal’: Patient on his/her back with head at tabletop head
• ‘Legs-up’: Patient on his/her back with feet at tabletop head
• ‘Nose-down’: Patient on his/her stomach with head at tabletop head
• ‘Legs-up’ and ‘Nose-down’: Patient on his/her stomach with feet at
tabletop head.
Peripheral run
During a peripheral run with Bolus Chasing the patient (i.e. the tabletop)
9896 001 33152
moves smoothly and continuously in the longitudinal direction to follow the

contrast bolus in the vessels. Several images are obtained with one contrast
injection.
Photofile
Each examination has one photofile. A photofile can have between 1 and a
maximum of 999 photo images in it (depending on the photofile length
configured). The photofile is always regarded as the first run of an
examination.

For the acquisition examination the maximum photofile space will be equal
to the remaining free photo image space of the disk partition the acquisition
examination resides in. At the moment another scheduled patient record is
selected as acquisition examination then the remaining free space of the
photofile of the old acquisition examination will be made equal (if possible)
to the configured photofile length (e.g. 20 photo images).
During review, the user is still able to store images in the photofile until it is
full, then the warning ‘photofile full’ will be given to the user.
The free photofile space of an examination retrieved from ODR is equal (if
possible) to the configured photofile length (e.g. 20 photo images).
The photo images in the photofile will always be flagged for transfer to a
HCU. If ‘Auto run flag for photofile’ is configured ‘ON’ then the photo
images in the photofile will be flagged for transfer to any other connected
device as well (e.g. ODR, Generic archive).
Photo images
Photo images have a fixed matrix size of 1280 x 1024 8 bit pixels (50 Hz).
Only on 60 Hz CCD based imaging systems it will be 1280 x 960 8 bit
pixels.
Photo images are always processed images with burned in graphics, there is
no further image processing possible (e.g. contrast, brightness).
The following functions can be applied to photofile images:
• add text
• annotation
• vessel diameter
• calibration.
Reference files
An acquisition examination can have one or two reference files. A reference
file can have between 1 and 999 reference images in it (depending on the
reference file length configured).
For the acquisition examination the maximum reference file space will be
equal to the remaining photo image space of the disk partition the
acquisition examination resides in.
Reference images
Reference images have a fixed matrix size of 1280 x 1024 8 bit pixels. Only in
60Hz CCD based imaging systems it will be 1280 x 960 8 bit pixels.
Reference images are always processed images with burned in graphics. There
9896 001 33152
is no further image processing (e.g. contrast, brightness) possible.

Typical attributes of a reference image are:
• APC parameters, which can be used to position the stand to the actual
position during acquisition. APC parameters are only valid for reference
images originating from an exposure run image.
Relation photofile and reference file

Images kept in a reference file and images kept in a photo file are there for
different reasons. Reference images are kept in a reference file to support the
doctor during an intervention with reference image(s) on separate
monitor(s). Photo images are kept in a photo file to be able e.g. to make at
later stage a hardcopy of that special image. However, the reference images

are often also that interesting that they have to be archived as well. To achieve
this, reference images are kept in the photofile as well. To avoid unnecessary
copying of images, the actual images will only be saved once. This means that
a reference file is actually a different view of the images in a photo file.
Traditionally in cardio and vascular systems the use of a photofile and
reference files differs. These differences between cardio and vascular systems
were mainly caused by historical reasons. Reference images in vascular
systems were always put in a photofile and were never overwritten. The
length of the reference file and photofile was exactly the same.
Reference (formerly called roadmap) images in cardio systems however were
never put in the photofile, the reference file was a circular image buffer of
limited configurable length (typically 5 images).

Examples 1 and 2 show a possible vascular application.
• The photofile and reference file length were both configured to 4 images.
• In the first example the Reference-1 file is filled with 3 images, which are
stored in the photofile (P1, P3, P6) as well. After e.g. using the Store-
Photo function, P4 in photofile was filled, which led to an automatic
extend of the photofile with another four free places (P5 - P8).
• In the second example the photofile has been extended for a second and
third time.
The length of the reference file is exactly the same as the number of reference
images in it.
9896 001 33152



Grey boxes indicate occupied
Plain boxes indicate free
R1-1 R1-2 R1-3 R1-4

A
P1 P2 P3 P4 P5 P6 P7 P8
C R1-1 R2-1 R1-2 R2-2 R1-3
B R2-1 R2-2 R2-3 R2-4
1 2 3
33725820

Grey boxes indicate occupied
Plain boxes indicate free
R1-1 R1-2 R1-3 R1-4 R1-5 R1-6

A
P1 P2 P3 P4 P5 P6 P7 P8 P9 P10 P11 P12 P13 P14 P15 P16

C R1-1 R2-1 R1-2 R2-2 R1-3 R1-4 R2-3 R1-5 R2-4 R1-6
B R2-1 R2-2 R2-3 R2-4
33725830
A. Reference-1 File
B. Reference-2 File
C. Photofile
* Configured Photofile and Reference File size (4)
1. First extend (4)
2. Second extend (4)
3. Third extend (4)
Images are acquired during rapid rotation of the C-arm around the patient.
9896 001 33152
This type of acquisition run provides information on 3-dimensional

structure.
Exposure run
An exposure run consists of a number of images, up to eight physiological

data streams, a nuber of flaggged heart beats and some run attibutes which
describe the properties of the exposure run. Typical run attributes are: ’spatial
resolution of the images’, ’number of images in the run’, ’acquisition
parameters’ (e.g. APR name, kVp value), ’image processing parameters’, etc.

For image processing parameters different sets will be maintained, one for
image processing during acquisition, one for image processing during review
(this set can be modified by the user), both for subtracted and non-
subtracted display. For biplane runs different sets are maintained for the
frontal and lateral channel.
The maximum number of exposure runs for the system is 999. The
maximum number of heart beats, flagged for transfer, per run is 5.
Indication of free space for exposures

As the free space can be limited both by the number of exposures and by the
number of runs the meaning of the free space indication requires
clarification. A maximum of 14,400 images (of 10242 format) can be stored
in a system fitted with two 9 Gb disks. The system can handle a maximum of
999 runs reduced by twice the maximum number of patients. The maximum
number of patients is 100, independent of the number of disks installed.
“> 5000” displayed.
This means that there is free space for more than 5000 images or for more
than 5 runs (a single shot exposure counts as a run).
When the available free space falls below 5000 there are two possibilities:
• The indicator counts down from 5000 in steps equal to the number of
exposures in the last acquired run and shows the remaining free space for
exposures.
• The indicator counts down from 5000 in steps of 1000 after each acquired
run or single shot exposure. A maximum of 5 runs can be acquired (a
single shot exposure counts as a run).
If the remaining free space becomes too limited, delete an examination.

N OT E Depending on whether the limitation was caused by exposures or by runs, ensure that
the examination deleted creates sufficient free space.
Viewing examination
In order to review an examination (other than the acquisition examination),
the user has to select an examination from the ’done list’ for viewing. The
’done list’ is a list of all finished examinations including the current
acquisition examination. This selected examination will be defined as the
viewing examination.
There can only be one viewing examination at any time. All review functions
performed with the viewing console (if present) operate on the viewing
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examination.
Unless a viewing examination other than the acquisition examination is
explicitly selected, all reviewing functions performed with the viewing
console will be related to the acquisition examination.
Working area
The area around the isocenter of the stand, where digital acquisition is
possible.

Abbreviations 11.2
11.2 Abbreviations
General
Abbr. Explanation Abbr. Explanation
AEP Area exposure product IS Information system
ANG Angulation KAT Knee arrival time
AP Anterior/posterior LAO Left anterior oblique
APC Automatic position control LED Light emitting diode
APR Anatomical programmed LIH Last image hold

radiography
BC Bolus chase MPPS Modality performed procedure

step
CAUD Caudal NMD Near monitor display
CCD Charge coupled device ODR Optical disk recorder
CD-I Compact disk - interactive OMA Override manual adjustments
CD-M Compact disk - medical PA Posterior/anterior
CIS Cardiology information system PACS Picture archiving and

communication system
CRAN Cranial PC Personal computer
CRT Cathode ray tube PD Progressive display
DA Digital angiography PMS Philips medical systems
DCI Digital cardiac imaging RAO Right anterior oblique
DICOM Digital imaging and RIS Radiology information system

communications in medicine
DSA Digital subtraction angiography ROI Region of interest
ECG Electro cardio gram ROT Rotation
EER Entrance exposure rate SID Source to image distance
EMC Electromagnetic compatibility TAM Tableside analysis module
HCU Hard copy unit TSD Tabletop shifting device

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HDT Head down tilt TSF Trace subtract fluoroscopy
HIS Hospital information system TSO Tableside operation module
HUT Head up tilt TTD Tabletop travel distance

ID Identification VCR Video cassette recorder
IDR Inturis DICOM recorder VFR Variable frame rate
II Image intensifier WLM Worklist management
IR infrared radiation (viewpad) XB Extra bright

11.2 Abbreviations
Abbreviations used in the clinical programs
Abbr. Explanation Abbr. Explanation
ACA Automated Coronary Analysis LAO Left Anterior Oblique
ALVA Automated Left Ventricular Analysis Obs.D Obstruction Diameter
AVA Automated Vessel Analysis Obs.len Obstruction length
BSA Body Surface Area %A-sten percentage Area stenosis
CF Calibration Factor %D-sten percentage Diameter stenosis
CI Cardiac Index RAO Right Anterior Oblique
CO Cardiac Output Ref.D Reference Diameter
CREF Regional Contribution to global EF RWM Regional Wall Motion
CWM Centerline Wall Motion SFR Stenosis Flow Reserve
ED End Diastolic SV Stroke Volume
EDV End Diastolic Volume SWM Slager Wall Motion
EF Ejection Fraction WM Wall Mass
ES End Systolic WS Wall Stress
ESV End Systolic Volume WT Wall Thickness
FF Free Format WV Wall Volume
HR Heart Rate
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11 - 1 0 Glossary INTEGRIS Allura Monoplane Release 1

Legend 11.3
Legend
80 kv 900 mA 170 ms 00 min
2
Acquisition Console 1
2 Gycm2 3
A Power on and reset
B Power off
1 Display of generator related parameters 4a 4b
2 Reset fluoroscopy time buzzer
4
3 X-ray control 4c
4c
4 Display and selection keys for acquisition related parameters
4 a/b Select imaging technique or APR (main/sub)
4 c Acquisition function keys A 10
• Image Technique selection • Display stopwatch B 8
33728241
5
• New patient • Variable frame rate (VFR) 6 9
7
• Subtraction • Print dose/examination report
• One- or two knob acquisition
5 Legs up Acquisition console
6 Nose down (patient prone)
7 Display information
8 Dial wheel
9 Enter
10 Alter APR parameters
18
Viewing Console
C
C Digital imaging system power on
D Digital imaging system power off
15 Function keys D
16
Intercom
17
16 Talk 15
17 Listen
33727850
18 Volume control
Keyboard Viewing console text display
20 Cursor keys
21 Enter
22 Delete
23 Tab
24 Function keys
• F1 Schedule Page • F6 System Page
• F2 Review Page • F7 Physician Page
20
• F3 - F5 • F8 Reserved
P h i l i p s M e d i c a l S y s t e m s 9896 001 33152
24
- Report page • F9 Status Page
- Export page • F10 Help Page
- Optical disk (ODR) page
- Copy page 22
- Transfer page 23
21
33727860
Keyboard
INTEGRIS Allura Monoplane

Glossary
Legend 11.3
Mouse Photofile/reference/
25 Accept 70 Store image in photofile
26
26 Action 71 Delete image from photofile
27 Reject 72 Reserved 25
27
73 Reserved
Viewing keys 74 Store reference 1
Selection 75 Store reference 2
30 View forward 76 Reserved
31 View reverse 77 Reserved
32 Step to next run 78 Recall reference 1
33 Step to previous run 79 Recall reference 2
33727870
34 Reserved 80 Reserved
35 Reserved 81 Reserved
36 Cycle through run Mouse
37 Cycle through examination Text & annotation

38 Higher speed 85 Add text
39 Lower speed 86 Annotate
40 Select run overview 87 Display physiological data
85 86 66 55 36 67 80 81 51 95 57 96 53 97
41 Examination overview
42 Not used Selection for transfer
43 Not used 90 Flag image
91 Flag run
64
Processing 92 Flag heartbeat 41
60 40
45 Contrast increase 93 Flag examination 52
46 Contrast decrease 94 Examination dump 39 34
47 Contrast level indicator 91 63
48 Brightness increase General 50
38
42
49 Brightness decrease 95 Menu 1 70 43
50 Brightness level indicator 96 Menu 2
49
51 Edge enhancement increase 97 Menu 3
33728256
52 Edge enhancement decrease 98 Analytical functions
53 Edge enhancement level indicator 71 61 33 31 30 32 62 54 48 45 46 47 58
54 Select video invert Tableside Analysis Module (TAM) Viewing keys
55 Pan & zoom 100 Automated Vessel Analysis (AVA)
56 Center zoom 101 Pixel shift (as [64])
57 Position shutters 102 TAM Menu (as [95-97])
58 Override manual adjustments (OMA) 103 Pan & zoom (as [55]) 100 101 102 103 104
104 Landmarking (as [66])

Subtraction 105 Accept (as [25])
60 Subtraction on/off 106 Action (as [26])
61 Move mask 107 Reject (as [27])

62 New mask 108 Joystick
63 Average mask
64 Pixel shift 108
65 Run subtract
66 Landmarking
67 View trace
68 CO2 trace
33728200
105 106 107
Tableside Analysis module (TAM)

Glossary
Legend 11.3
Viewpad a b
a Subtraction on/off (as [60])
c d
b New mask (as [62])
e
c View reverse (as [31])
d View forward (as [30]) f g
e Cycle through run (as [36]) h i
f Examination overview (as [41]) j k
g Center zoom l m
h Contrast decrease (as [46])
i Contrast increase (as [45])
j Store reference 1 (as [74])
k Store reference 2 (as [75])
33723580
l View reference 1 (as [78]
m View reference 2 (as [79]) Viewpad
Monitors and Room facilities

110 Power on/off and brightness/contrast setting indicator
111 Sensor for automatic brightness and/or contrast control (not used)
112 Brightness increase
113 Brightness decrease
114 Contrast increase
115 Contrast decrease
116 Infrared receiver (not shown)
117 Examination light power on/off (not shown)
118 X-ray indicator (not shown)
113 115 110
36270050
111 112 114
XB monitor
113 115 110
36270060
111 112 114
Colour monitor (option)

Glossary
Legend 11.3
120 121 123 124 125
Display unit
120 Intercom ‘listen’ indicator
121 X-radiation ON indicator
33723640
122 Tube load indicator
123 Actual rotation/angulation angles
124 Source-image distance (SID) / Tilt angle indicator 122 126 127
125 Image intensifier field size

126 Fluoroscopy mode / fluoroscopy level /APC information Display unit
127 Integrated fluoroscopy time/dose rate

Glossary
Legend 11.3
131 142 143 136 130

Geometry Module
130 Emergency power off
131 Tabletop brakes on/off and longitudinal movement
132 Longitudinal tabletop brake off
133 Table height adjustment
134 SID adjustment 132 140
135 Reserved
136 Motor-controlled rotation and angulation
137 Reserved
138 Reserved
139 Table tilt movement
140 Movement override
36280190
133 144 139 134 145
141 Reserved
142 Store position 1
Monoplane geo vascular module (Tilt option)
144 Recall position 1 or 2
145 Motorized movement of the frontal stand
150a 151 157
Imaging Module
150 Fluoroscopy mode selection:
a HIGH
b NORMAL
150b
c LOW
151 Shutter adjustment 150c 153
152 Reserved
153 II field size
154 Reserved
155 Position left wedge filter
33723670
156 Position right wedge filter
157 Variable frame rate (VFR)/Dual/Parallel fluoroscopy 158 155 156
158 Trace-subtract fluoroscopy (TSF)
Vascular monoplane imaging module
Auto Position Control (APC) module
160 Emergency power off
161 APC mode selection
a Scratch mode 162 163 160
b Sequencer mode
c Reference mode
161a
164 Select position 1or 2/ Select sequence / Select position 161b

165 Accept and Activate 164
161c
165
33727960
APC module

Glossary
Legend 11.3
172
TSD speed control
170 Reserved
171 Reserved
172 TSD speed control 179 177
Acquisition foot switch 175

175 Fluoroscopy
33728243
176 Reserved
177 Single-shot exposure/parallel viewing
178 Reserved
TSD speed control Acquisition foot switch
179 Exposure

185 Preparation/Exposure
Hangrips for L-arm stand

190 L-arm rotation brake release
191 Longitudinal movement brakes release
185
33723050
190
191
36280200
Handgrips for L-arm stand

Glossary
Legend 11.3

215 Busy indicator
33723820
215 216 219 a 218
216 Rewrite mode indicator
217 WORM mode indicator Optical disk recorder (ODR)
218 Eject optical disk
219 Manual eject screw
225-233 Reserved
Scanner 200X control panel

F System on
G System off
235 Probe selection
236 Frontal examination monitor
237 Grab image (not used)
238 Distance measurement 240 241 242 235 G F
239 Freeze/unfreeze
240 Biopsy line on/off
241 Reverse on/off
242 Depth increase 243 236
243 Depth decrease
237
244 Near gain control
245 Far gain control 244 239
246 Total gain control
247 Joystick
33728020
245 246 247 238
Scanner 200X control panel


Glossary
P h i l i p s M e d i c a l S y s t e m s 9896 001 33152 Legend 11.3

Glossary
12 Index
Numerics Autocalibration 5-95
200X Ultrasound Scanner 4-15 Automated coronary analysis 5-160
Control panel 4-71 Automated vessel analysis (AVA) 5-105
Preparation 5-50 B
200X ultrasound scanner Basic procedures 5-1
Needle guides 5-52 Acquisition 5-16
Prepare the scanner 5-51 Archiving 5-22
A Cable guides 5-5
Abbreviations 11-9 Entering examination data 5-11
Accessories 4-94 Fitting sterile covers 5-6
Arm supports 4-94 Fluoroscopy 5-15
Cable guides 4-95 Pan handle 5-5
Catheterization arm support 4-94 Patient positioning 5-9
Ceiling suspended radiation shield 4-95 Post-processing 5-21
Cerebral filter 4-94 Selecting an examination 5-13
Drip stand 4-94 Setting the geometry 5-7
Examination light 4-95 Single-shot acquisition 5-17
Head fixing aids 4-95 Switching the system on/off 5-3
Height-adjustable arm support 4-94 Tableside operation module 5-4
Mattress 4-94 Tube load and dose rate 5-17
Neuro head rest 4-94 Use of the injector 5-10
Pan handle 4-95 Viewing after acquisition 5-18
Peripheral filters 4-94 X-ray filters 5-8
Rail accessory clamps 4-94 BodyGuards 10-14, 11-1
Ratchet compressor 4-95 Bolus chase 4-13
Restriction straps 4-94 C
Sterile disposable covers 4-94 Centerline wall motion 5-153
Table mounted radiation shield 4-95 Cleaning 7-4
Tabletop accessory clamps 4-94 Clinical programs 5-94
Acquisition 4-5 CO2 trace 4-16
Fluoroscopy 4-8 Connection box and TSO 4-57
General 4-5 General 4-57
Options 4-8 Control, status and report pages 4-74
XB Monitors and Room Facilities 4-5 Copy page 4-83
X-ray tubes 4-6 Export page 4-81
Acquisition console 4-21 ODR page 4-82
9896 001 33152
Function keys 4-23 Physician page 4-85

Imaging technique Page 4-87 Report page 4-80
Power off 4-22 Review page 4-78
Power on and reset 4-21 Schedule page 4-75
System and error messages 6-1 Status page 4-86

ALVA procedure 5-139 System page 4-84
Analog output 4-17 Transfer page 4-84
Angio DIAGNOST 5 10-26 Controls and indicators 4-21
with SyncraTilt option 10-26 Acquisition console 4-21
Application Display unit 4-55
Guidelines 10-3 Examination light 4-54
Archiving Function overview 4-32
DICOM receiving station 5-190 HCU controls 4-69
Area Exposure Product (AEP) meter 4-12 InfraRed (IR) receiver 4-53
I N T E G R I S A l l u r a M o n o p la n e Release 1 Index I-1

Joystick 4-31 F
Monitors 4-50 Fast viewing 4-35
Mouse 4-29 G
Pan handle 4-57 Geometry 4-4
Patient orientation 4-25 Control 4-4
Storage media 4-69 Geometry segment 4-1
Tableside Analysis Module (TAM) 4-30
H
TableSide Operation modules 4-58
High-Speed DICOM Image Interface 4-17
Tabletop Shifting Device 4-66
Viewing console 4-26 I
Viewing keys 4-29 Imaging technique Page 4-87
Viewpad 4-31 Infrared receiver 4-5
X-ray on indicator 4-54 Inturis DICOM Recorder 4-18, 4-70
Copy page 4-83 L
Coronary quantification software 4-16 L-arm stand 4-68
D L-arm stand switches 4-68
Definitions and terms 11-1 Left Ventricular quantification software 4-16
Digital acquisition 4-10 Legend 11-11
General 4-10 M
Maximum patients and runs 4-12 Maintenance 7-1
Options 4-12 Monitor ceiling suspension 4-6
Disinfection 7-4 Monoplane left ventricular analysis 5-129
Dose/Examination report 4-13 MRC-GS 03-10 4-7
Dynamic pulsed fluoroscopy 4-8 MRC-GS 04-07 4-7
E MRM-GS 04 10 4-6
Examination light 4-9 N
Export page 4-81 Near-monitor display (display unit) 4-6
Extended procedures O
Accessories 5-35 ODR page 4-82
Application settings 5-29 Optical Disk Recorder (ODR) 4-17
APR handling 5-54 P
Archiving 5-187 Pan handle 4-4
Automatic position control 5-61 Parallel viewing 4-9, 4-17
Bolus chase 5-74 Patient support 4-3
Deleting an examination 5-67 Accessories 4-4
Dual fluoroscopy 5-73 Catheterization arm support 4-3
Examination report 5-201 Pivot for table base 4-3
Export patient data 5-192
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Ratchet compressor 4-3

Importing patient data 5-64 SyncraTilt 4-4
Modifying examination data 5-67 Table mounted radiation shield 4-9
Modifying the time and date 5-68 Physician page 4-85
Physician page 5-69
Physio display 4-14

Rotational angiography 5-83 Post-processing 5-93
Setting the geometry 5-27 Product disposal 8-1
Text & annotations 5-93 R
Trace Subtract Fluoroscopy 5-72
Regional wall motion 5-156
Ultrasound 5-88
Report page 4-80
Viewing during acquisition 5-91
Reports 5-199
X-ray filters 5-35
Dose report 5-200
External communication 4-17
Review page 4-78
Options 4-17
Rotational Angiography 4-14
I-2 I n de x I N T E G R I S A l l u r a M on o p la n e Release 1
S TAM functions 4-49
Safety 2-1 Text & annotation 4-45
Electrical safety 2-3 Viewpad functions 4-50
Emergency procedures 2-2 Viewpad
Explosion safety 2-4 Battery replacement 4-31
Fire safety 2-4 W
Important safety directions 2-1 Wedge filters 10-10
Mechanical safety 2-3 X
Mobile telephones etc 2-4 XB Monitors
Screen saver 4-22 Reference setting 5-49
Second geometry module 4-5 User reference setting 5-49
Second TSO imaging module 4-9 XB monitors 4-6
Slager wall motion 5-158 Preparation 5-49
SpectraBeam 4-8 X-ray ON indicator lamp 4-6
Stand movements 10-15
Standard line rate video output 4-17
Status page 4-86
Storage media 4-69
Optical Disk Recorder (ODR) 4-69
Switches 4-67
Acquisition foot switch 4-67
Acquisition hand switch 4-68
SyncraTrak (APC) 4-5
SyncraVision 4-9
System page 4-84
T
Table movements 10-24
Tableside Analysis Module (TAM) 4-17
Tabletop Shifting Device 4-66
Speed control hand switch 4-67
Technical data 9-1
Trace Subtract Fluoroscopy 4-64
Transfer page 4-84
Type B symbol 10-8
U
Ultrasound image 4-93
Display 4-93
V
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Vessel diameter analysis 5-97

Viewing 4-16
Options 4-16
Viewpad 4-16
Viewing console 4-26
System and error messages 6-5
Text display 4-74
Viewing functions 4-35
General 4-48
Photofile/reference 4-44
Processing 4-39
Selection 4-35
Selection for transfer 4-46
Subtraction 4-41
I N T E G R I S A l l u r a M o n o p la n e Release 1 Index I-3

9896 001 33152
I-4 I n de x I N T E G R I S A l l u r a M on o p la n e Release 1
9896 001 33152

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Philips Medical Sytsems Nederland reserves

Printed in the Netherlands.

© Copyright Philips Medical Systems

No part of this publication may be reproduced,

Unauthorized copying of this publication may

9896 001 33152

1.1 About the INTEGRIS Allura Monoplane systems . . . . . . . . .1-1

2.1 Important safety directions . . . . . . . . . . . . . . . . . . . . . . . . . .2-1

4 System overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-1

4.1 General layout . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-1

4.2.5 Digital acquisition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-10

4.3.1 Acquisition console . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-21

I N T E G R I S A l l u r a M o n o p la n e Release 1 Conten ts 0-1

4.5 Overview of acquisition and viewing displays . . . . . . . . . . .4-87

5.0 Basic procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-1

5.5.1 Text & annotations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-93

5.6.3 Export patient data to the RIS interface . . . . . . . . . . . . . . .5-192

6 System and error messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-1

6.1 Error handling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-1

7.0 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-1

8 Product disposal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-1

8.0 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8-1

9 Technical data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-1

9.1 Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9-1

9.1.4 X-ray tubes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9-1

9.1.8 Wedge filters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9-2

I N T E G R I S A l l u r a M o n o p la n e Release 1 Conten ts 0-3

10.0 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-1

11.1 Definitions and terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11-1

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1.1 About the INTEGRIS Allura

The INTEGRIS Allura Monoplane provides full body coverage.

1.2 About this manual

The following illustration is an example of such a label (shown approximately

An identical label is placed on the Aquisition console, the label is always

INTEGRIS Allura Monoplane Release 1 Introduction 1-1

This symbol, used throughout the manual, indicates a WARNING.

N OT E S are intended to highlight unusual points as an aid to the operator.

Section 4 ‘System overview’ gives a complete description of the system,

Section 5 ‘Operation’ gives information about all actions that have to be

1- 2 Introduction INTEGRIS Allura Monoplane Release 1

1.3 Intended use

The Philips INTEGRIS Allura Monoplane system is intended for

Equipment described in this manual should not be used in combination with

INTEGRIS Allura Monoplane Release 1 Introduction 1-3

Changes and/or additions to the equipment should only be carried out by

Philips Medical Systems

The Philips INTEGRIS Allura Monoplane complies with relevant

equipment described in this Manual. Training requirements for this type of

If you require further information about training in the use of this

1- 4 Introduction INTEGRIS Allura Monoplane Release 1

Philips Medical Systems

1.8 Other manuals

INTEGRIS Allura Monoplane Release 1 Introduction 1-5

9896 001 33152

1- 6 Introduction INTEGRIS Allura Monoplane Release 1

2.1 Important safety directions

In particular, you must read, understand and know the ‘Emergency

Personnel operating the equipment and personnel in the examination room

WA R N I N G S Maintenance & faults

• If any part of the equipment or system is known (or suspected) to be defective or

INTEGRIS Allura Monoplane Release 1 Safety 2-1