Xper Information Management

Quick Reference Guide – Arterial Trees

Notice of Intended Use
The Xper Information Management /Physiomonitoring and/or Vascular 5 system, Patient Care Console and
Central Station are intended for complete physiologic/hemodynamic monitoring, clinical data acquisition, medical
image/data processing and analytical assessment for cardiac catheterization, invasive radiology and
electrophysiology laboratories. Its users and operators, responsible to interpret the data made available, will be
professional health care providers. The Xper Information Management /Physiomonitoring and/ or Vascular 5
system, Patient Care Console and Central Station provide the ability to transmit patient data files for storage,
analysis and viewing at distributed locations within the clinical facility via intranet or internet, or may function as
a stand-alone device.
The Xper Information Management /Physiomonitoring and/or Vascular 5 system, Patient Care Console and
Central Station are intended for complete physiologic/hemodynamic monitoring, clinical data acquisition, medical
image/data processing and analytical assessment within any healthcare environment. Its users and operators,
responsible to interpret the data made available, will be professional health care providers. Operator-adjustable
alarms (both visual and audible), alert the operator to anomalous occurrences and facilitate timely responses.
The Xper ECG Management System is intended for receiving and storing resting, stress and holter ECG data
from source devices. ECG data is stored, unaltered, in its original format, and made available for review and
procedural report generation purposes. The Xper ECG Management system does not provide interpretive
functions, but does store interpretive statements generated by the source device in an integrated and
expandable database. Its users and operators, responsible to interpret the data made available, will be
professional health care providers. The Xper ECG Management system provides the ability to transmit ECG
data files for storage, analysis and viewing at distributed locations within the clinical facility via intranet or
internet, or may function as a stand-alone device

Contraindications
Use of the Xper Information Management /Physiomonitoring and/or Vascular 5 system is not intended where
unattended patient monitoring is desired or in situations where arrhythmia detection is required.
Use of the Xper Information Management Central Station and Patient Care Console are not intended where
unattended patient monitoring is desired or in situations where arrhythmia detection is required.

Xper Information Management Quick Reference Guide – Arterial Trees is meant as

a quick reference only. For detailed information on any function, and for additional
information and functionality not described in this guide, consult the Xper Information
Management Instructions for Use.

Witt Biomedical Corporation

305 North Drive
Melbourne, FL, USA 32934
Phone: +1.321.253.5693
Toll Free: +1.800.669.1328
Fax: +1.321.253.0372

Rx ONLY: Federal law restricts this device to sale by or on the order of a licensed healthcare practitioner.

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Contents
I Arterial Tree Template Files 4
II Structures 4
III Editing Tree Templates 5
IV Creating New Tree Templates 7
V Using the Templates 7
VI Arterial Tree Tips and Troubleshooting 10

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I Arterial Tree Template Files
Arterial tree template files are proprietary-format flat files that reside on the Xper IM DataCenter and in the
local XIM directory. You may have up to 12 templates:
• S4TREE.CR – Right dominant coronary tree
• S4TREE.CM – Mixed dominant coronary tree
• S4TREE.CL – Left dominant coronary tree
• S4TREE.PEU – Upper peripheral arterial tree
• S4TREE.PEL – Lower peripheral arterial tree
• S4TREE.PEB – Brachial peripheral arterial tree
• S4TREE.PUL – Pulmonary arterial tree
• S4TREE.REN – Renal arterial tree
• S4TREE.HEP – Hepatic arterial tree
• S4TREE.CRA – Cranial arterial tree
• S4TREE.CAR – Carotid arterial tree
• S4TREE.EPS – Cardiac mapping tree

II Structures
Arterial tree structures are items on a tree other than vessels. They are color coded in green. These include
the aortic cusp, the aortic arch, the kidneys, or anything else that you may want to include. Their only
function is orientation, with one exception. A coronary tree must have an aortic cusp in order for Xper IM
to properly identify saphenous vein grafts (SVG).
• To draw a structure, click CUSP STRUCTURE.
• Select the type of structure (Aortic Cusp, Structure 2, or Structure 3). NOTE: if drawing an aortic
cusp for a coronary tree, you must select Aortic Cusp.
• Click once and release, draw the structure, and click again to complete.
• If you are not satisfied with the appearance of the structure, simply click CUSP STRUCTURE and
select the same choice. This will clear the previous structure and allow you to redraw.

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III Editing Tree Templates
Most frequently, you will choose to edit existing templates. To edit a template:
• Open a test case.
• Click HEMODYNAMICS > ARTERIAL TREE > NEW.
• Select the template you wish to edit.
• To add a vessel, click VESSEL ARTERY. This will open a list of artery types specific to the type of
tree you are editing. The list will differ depending on the template. You can also type in a label in
OTHER. Click OK to begin drawing. A prompt will flash at the bottom of the screen.
• Place your cursor at the point of origin of the new vessel, click the left mouse button once, then
release.
• Draw the PATH of the new vessel to the point of termination, then click the left mouse button again.
Do not try to draw the vessel by moving back up to the point of origin (see images below).

Draw the PATH of the artery

• The new vessel will appear on the tree. If you hover over it with the cursor, you will see the label in
the bottom left corner of the screen.
• To reset the ostial, proximal, mid or distal transition points of a vessel, click POSITION.
• Select the position you wish to reset.
• Click on the vessel at the point at which you wish the new position to be set.
• To change the diameter of an existing vessel, click VESSEL SIZE.
• You will be prompted to click on the vessel and use the scrollbar to adjust its size. Scroll up to
increase vessel diameter, or down to decrease the diameter.
NOTE: It is not possible to change the length of a vessel. To do that, you must delete it and redraw.
• To move an artery, click MOVE ARTERY.
• You will be prompted to click on the artery to move.
• Once you have selected the artery, you will be prompted to click on the new ostial position. NOTE:
Depending on the artery placement, it may be better to redraw the vessel (see images below).

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 Depending on the artery placement, it may be better to redraw the vessel

• To change the termination of a vessel, click TERMINATION.

• Select the type of termination: closed, tapered, or open. Closed is the default (see images below).
You would want to select tapered or open if you are going to draw another vessel or segment off the
end. For example, the left main coronary artery would be open, while the right coronary artery might
be tapered so that you could add the PDA.).

Closed Tapered Open

• Click on the vessel.

• To change a label, click ART LABEL. NOTE: Changing the label changes what the user sees in the
bottom right corner when hovering over a vessel (see image below).
• Select a new label from the list, or enter a custom label. Click OK
• Click on the vessel.

Changing the label changes what the user sees in the bottom right corner when hovering over a vessel

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 • To create a note, click NOTE.
• Enter the text in the window. Click OK.
• Click on the template to position the note. NOTE: The note will extend to the right from the point
clicked. Be sure not to place the note over a vessel or structure.
• To move a note, click MOVE NOTE.
• Click on the first letter of the note.
• Click to reposition the note.
• To draw an arrow, click ARROW.
• Click once at the beginning point (the “back end”) of the arrow and release.
• Move in the direction in which you wish the arrow to point.
• Click once at the point you wish the arrow to terminate.
• To delete a vessel, click DELETE.
• Click on the vessel.
• To save the template, click SAVE TMP.
NOTE: Before saving a template, make sure there are no lesions, grafts or collaterals. If there are, they
will become part of the template and will appear each time a user selects that template for a study.

IV Creating New Tree Templates

To create a new template, you must first clear the existing template. You will then use the editing tools (i.e.,
CUSP STRUCTURE, VESSEL ARTERY, etc.) to create the new template:
• In a test case, select the template you want to replace and delete everything in it, including vessels,
notes and arrows. NOTE: You cannot use the DELETE key to remove structures. If the template
contains structures, click CUSP STRUCTURE and select a choice to erase the current structure.
• Use the editing tools to draw the new template. NOTE: If creating a new coronary tree template,
make sure that the designation at the bottom left (Right Dominant, Left Dominant, Mixed Dominant) is
correct. You can change it by clicking the right or left arrow.
• Click SAVE TMP.

V Using the Templates

• To draw a lesion, click inside the vessel or graft at the proximal point of the stenosed area, then
click again at the distal end.
• Select at least one lesion type from either list.
• Adjust the percentage of the stenosis by using the scrollbar. Scroll up to increase, down to decrease.
• To completely occlude a vessel, scroll up to 100%.
• Using VISUALIZED/UNVISUALIZED: These are special “lesion” types that do not create menu
entries. Selecting UNVISUALIZED will occlude the selected section, but will not create a lesion entry
in the menu. Selecting VISUALIZED will “reopen” a section of vessel beyond the distal end of a total
occlusion
• To indicate an intervention, click the type of intervention (PTCA, DCA, ROTA, PTA).

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 • You will be prompted to click to place the note (“Click to position PTCA to 0%). Click in the black
area near, not on, the lesion.
• Use the scrollbar on the right to adjust the percentage of residual stenosis (default is 0%).
• Click into the lesion to place the arrow. This will create an addendum to the tree statement in the
menu, indicating the type of intervention performed and the residual stenosis. NOTE: If you do not
place the arrow correctly, the tree statement will not be amended with the intervention and residual
stenosis.

Click into the lesion to place the arrow

• To indicate a stent placement, click STENT.

• Click near the area of stenosis to place the note.
• Use the scroll bar to adjust the percentage of residual stenosis (default is 0%).
• Click into the lesion to place the arrow (see above).
• Click above the lesion to indicate the beginning of the stented area.
• Click below the lesion to indicate the end of the stented area.

• Bypass grafts: A graft will be labeled LIMA, RIMA or SVG depending on its point of origin. To draw
a LIMA, start the graft to the right outside the aortic cusp. To draw a RIMA, start the graft to the left
outside the aortic cusp. To draw an SVG, start the graft inside the aortic cusp.

• To draw a graft, click GRAFT.

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 • Click at the point of origin and release.
• Draw the path of the graft to the distal anastomosis and click again.
• When drawing a graft, make sure it ends inside a vessel. The menu statement will not read correctly if
the graft/collateral does not connect two vessels.

• To draw a sequential graft, click SEQ GRAFT.

• Draw the first segment as you would a non-sequential graft.
• Click SEQ GRAFT a second time. When drawing the second segment of a sequential graft, click to
start inside the terminating circle of the previous segment (see image below).

• Click at the distal anastomosis of the second segment.

• To draw a Y graft, click Y GRAFT.
• Draw the first segment as you would a non-Y graft.
• Click Y GRAFT again.
• Begin drawing the second segment of the Y graft inside the wall of the first section. Draw the path of
the graft and click at the distal anastomosis.
• To draw a collateral, click COLLATERAL.
• Click in the vessel of origin and release.
• Draw the path of the collateral.
• Click at the termination point. NOTE: When drawing collaterals, always draw in the direction of the
flow.

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VI Arterial Tree Tips and Troubleshooting
• An arterial tree template may contain up to 50 items (structures and vessels).
• If you have a stenosis inside an area of diffuse disease, draw the lesion first, then add the diffused area.
• To display lesion segments, turn on SHOW TREE SEGMENTS on the Hemodynamics configuration
screen.
• If tree statements do not appear in the correct menu, check your menus in the Menu Builder. One
menu should be designated CORONARY, and one menu should be designated PERIPHERAL.

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© 2009 Koninklijke Philips Electronics N.V.
All rights are reserved.

Philips Medical Systems Nederland B.V. reserves the right to make changes in specifications and/or to
discontinue any product at any time without notice or obligation and will not be liable for any consequences
resulting from the use of this publication.
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