Equipment

Siemens (and Syngovia) Computer

• Turning off: Make sure you turn off XWP first, then turn off the Siemens Artis Q (otherwise XWP will not be turned off properly/hard shutdown). Turning on the Artis (silver computer) will also turn on the whole x-ray system + the injector in Lab 4!
• Turning on: No specific order. The tube/whole system will turn on when you turn on the computer.

Control Module

Table

• Hold both tilt buttons to re-zero back to 0 tilt
• Hold down the orientation button to change. Make sure this matches where the console is! (Otherwise, the machine will not move as expected)

Tube

Auto/Preset Movements

• Hold and push joystick forward to get a list of presets. Push to 'scroll' through them
• Select the desired position by clicking either side button
• Hold and push forward (no need side buttons) to move into position
• Will appear on assist screen as moving into target position and when movement completed

Manual Movements

• To move the whole C-arm unit back/forward and angle, push down whilst pressing the side buttons.
• To tilt the C-arm into cranial/caudal and RAO/LAO, just push down.
• Back of the joystick has up and down buttons to change SID (be careful of hitting pt!).
• Reset filter/collimators by pressing down.
• Magnification button on bottom right (start with 25 prior to engaging then drop to 20 once beginning to acquire in artery).
• Final clean: Rotate whole C-arm to lateral to clean bottom easier.

Screening (Fluoroscopy and Acquisitions)

Fluoroscopy (left/blue background)

• Depending on cardiologist, may go down to 4p/s or 6p/s (lower p/s means the imaging will be less smooth, but save dose).
• Ensure the bottom RDMP buttons are NOT selected (or else the reference image will overlay live image and look strange).
• Default: stay on lowest setting (FL -).

Acquisitions (right/purple background)

• May increase to VHH 2 or Coro BMI+ for the spiderview in large pts > 100kgs (going through dense area and at a steep angle).
• Select the C-arm button to automatically display the reference image based on the tube position (only works with limited ~5 reference images so try not to save too many rubbish references!).
• When dose is getting high: reduce by suggesting dr to use less angle, collimating in, reducing OID or reducing frame rates.

Sony Screen

• Ensure correct pt and cardiologist is selected (otherwise select unknown top right corner)
• Click finish once case is done
• May be used to record the case e.g. for trial TAVI cases (so make sure the correct pt/dr is selected)
• The sony screen is the ultimate control panel for the screens, cameras (3 in each room which you can angle to where you want) and other external devices (e.g. TOE/US)
• ✨Sony 1: Can put ANYTHING you want on this screen as long as it is connected to the system or automatically exists in the system (e.g. want to make Haemo bigger - set Haemo as Sony 1 and choose the larger sony layout!). SyngoWP appears as Siemens Review.

Siemens Troubleshooting

Check the bottom of the Artis Assist screen for any errors to do with the table/tube. If at anytime you are unsure, ask the supervisor for help! (Call 12243 or ask someone to help you find them)

Table Not Moving

• Re-zero tilt (even 0.1 degrees tilt which will appear as 0 on the screen will affect table movement).
• Ensure lock is not selected on the touch screen.
• Check bedside and our emergency brakes are not on.

Tube Not Moving

• Monitor sensors activated on roof railings - guardrail activated
• Tube sensors activated/pressing on something.
• 'Collision with pt': hold down preset position buttons 1 and 2 and manually move the tube out - make sure someone in the room is checking tube is actually not hitting anything ❗

Reset

• While holding preset buttons 1 and 2, press emergency button.
• Wait a few seconds before releasing the emergency button.



Restart!

• Absolute final resort.
• Put table/tube in safe position first.
• Let cardiologist know the table/tube will not be able to be moved for the next 10-15 minutes during restart.

Main monitor not working

• Don't panic
• Use the Sony Nucleus to see what they are doing via the Left CR and Right CR screens
• Use the tube/table control modules to reference, fluorosave etc.

Incorrect pt details/examination

• Only correct once finished (otherwise half will be correct and half will be wrong; very hard to fix!)
• Let a supervisor know and they will contact PACS

Not opening patient before beginning screening

• Only correct once finished (otherwise half will be correct and half will be wrong; very hard to fix)
• DO NOT close the pt after finishing
• On Syngo WP screen, enter the details of the patient, accession number (e.g. VHH25), check the vertical tabs to ensure all necessary info is added.
• Double-check details are correct
• Send 1 image/run to Intellispace. If it is in the correct folder, then send the rest.
• For the dose report, go back to the Artis screen and enter the pt height/weight.
• Send to the Syngo WP screen and drop into the correct pt folder. No PSD will be recorded.

Accidentally adding EMR radiation dose and protocol

• Cannot be deleted unfortuantely, it is what it is.
• Add a note stating 'Radiation not required' at the top and sign
• Mark as 'in error'

Pedal runs out of battery/stops working

• Start charging pedal again
• We can screen for the doctors using the pedal outside the room. If STENTBOOST is needed (our pedal does not have a configured setting for STENTBOOST), can change the acquisition setting on the screen (just like changing to BMI+ setting) and use the acquisition pedal - make sure to screen for slightly longer!

Artis out of storage space

• Go to browser > local database and delete an old studies folder by right clicking.
• May happen with long TAVI cases in which many runs are fluorostored and using higher frame rates.

Canon Alphenix Sky (Lab 7)

• Mostly set up for PPMs - controls on left side.
• Table and tube can only be moved from inside the room! Either using buttons on the back of the C-arm or the control modules.
• When starting an examination, make sure to also start the dose calculation screen for PSD - check correct weight range is selected as well!
• Switch between screens using ALT + space
• Don't finish/close pt until you record the doses!

Our Controls

• Hold both tilt buttons to re-zero back to 0 tilt.
• Hold down the orientation button to change. Make sure this matches where the console is! (Otherwise, the machine will not move as expected.)

Inside room controls

• Same as ours with added:
  • "Mechanical Operation Section" which controls table and tube
  • "Playback/Operation Section" which enables auto-positions + changing orientation as below!
  • To change orientation follow the steps in order below

Canon Troubleshooting

• Emergency stop button accidentally pressed: all movement is stopped EXCEPT longitudinal and lateral movement.
• To reset Hardware errors (H-errors)
  1. Press the Emergency Stop Button
  2. Wait for 5 seconds
  3. Press the Power Reset Button located near the table base. All mechanical functions will be reset.

Contrast Injector

• The injector is typically controlled by the nurses who are already leaded-up in the room.
• Only in Lab 4 is the injector screen outside and we have to set up the parameters. Otherwise, if you know the injector will definitely be used (e.g. before a TAVI case) feel free to set it up! (Just ask the nurses - "hey are you happy for me to set up the injector for the next case?")
  Screen set up:
• First select protocol, still checking with cardiologist what rate, volume, and PSI they want (ask exact numbers, not just 'protocol/preset' as each radiologist has their preference).
• For arteries, PSI will never exceed 300 (risk of perforation).
• Ensure ISI is on if injecting and acquiring automatically and not by hand-injection (usually auto/ISI ON!)
• Check for error stating need to re-wind syringe to remove air - make sure to let nurses inside know!



Make sure to end case on the screen once completed (will reset volume used/injected to start fresh for new pt and also make it easier to remove the syringe when cleaning).

Injector set up:
• There are 2 types of syringes, one with a blue cap and one with an orange cap. For both, make sure you keep the cap sterile (put back in container) to put back on after filling with contrast.
• Match up the arrow on the front of the holder with the syringe opening to insert it securely
• Purge air out (press middle button to unlock and then up and down arrows) so you can fill it with contrast
• TAVIs: Fill with 1 small and 1 big bottle ~140ml
• Put the sterile cap back on!

General troubleshooting

*REMINDER* It's okay to ask for help :) Asking stupid questions is easier than making stupid mistakes. And when you do make a mistake, be kind to yourself and learn from it.

Incorrect pt details/examination

• Only correct once finished (otherwise half will be correct and half will be wrong; very hard to fix!)
• Let a supervisor know and they will contact PACS

Accidentally adding EMR radiation dose and protocol

• Cannot be deleted unfortuantely, it is what it is 🫠
• Add a note stating 'No radiation used' at the top and sign

Computers suddenly turning off

• Check RCD buttons are not accidentally being pressed! (May happen when consultant is sitting on the side with chair hitting buttons on the wall!)



• Hard restart; PC on/off button is on the backside of the monitors at the top.

Our monitor malfunctions/everything appearing small on the screen

• Let the team know our screens are malfunctioning
• HARD restart (soft restart wasted time and doesn't appear to do anything)
• Otherwise continue with case, try to use the CR screens to follow along and reference/store/filter.