09_FT_05_User manual rev1.7.24

["alien X \/ alien e 51 User manual Revision: 1.7.24 - 25.02.2021 1. 2. 3. Moreover, compared to the other pages, three more buttons are present on the top tool-bar, those are: User button: opens the \u201cuser login\u201d. 51 | P a g i n a","alien X \/ alien e 52 User manual Revision: 1.7.24 - 25.02.2021 Text label button: is used to switch between text mode and icon mode. In the first case, the button consists of a brief description of the functionality, in the second of a graphical representation of it. Switch off button: used to switch off the software. When the trolley is disconnected from the arc the following disconnect icon appears at the top right. In case of disconnection the exam will be closed. When the panel is disconnected but the trolley is connected to the C-arm, the following icon appears. Similarly, in the event of disconnection, the current exam will be closed. 10.2.1.1 WORK LIST The DICOM work list can be either downloaded from a remote PACS server or loaded from a local file, where such a file has been created locally as a copy of the last work list downloaded remotely. Therefore, when no Internet connection is available, selecting the \u201cRemote\u201d tab, the work list can be downloaded locally (pressing the button synchronize button) and when needed, selecting the tab \u201cLocal\u201d, the work list can be loaded from the file saved locally. Moreover, the research on the remote server may be filtered using some patient information, such as Surname, Name, Sex, Birth date, ID of the patient, or using exams data, such as date start, date end, Station AET, and modality. By default, the dates are set to the current one. In order to exploit the Work list function, the system should be properly configured for the connection to the srever. This configuration should be performed by technical assistance. 10.2.1.2 EXAM DATA As soon as the work list has been loaded from a local or remote database, the selection of the proper patient information within the list will automatically fill out the exam data. To be noted that all the fields marked with a yellow asterisk (*) are mandatory. Moreover, if any incorrect entry may occur the \u201cX\u201d button allows to clear all the fields. THE \\\"X\\\" BUTTON DO NOT DELETE THE PATIENT FROM THE MEMORY BUT SIMPLY CLEARS THE PATIENT DATA FIELDS. If all the mandatory fields have been completed and the anatomical program has been selected then the exam can be regularly initialized clicking on the flag button. However, in case of emergency, in order to speed up the access to the image acquisition system in case of emergency procedure, the exam can be initialized by simply pressing at the emergency button. 52 | P a g i n a","alien X \/ alien e 53 User manual Revision: 1.7.24 - 25.02.2021 10.2.1.3 EXAM PROCEDURE The exam procedure can be selected from the list of available anatomical optimized programs. As explained below, each of them is identified by a suitable icon and is coupled with a pre-set of default acquisition and setup parameters. However, all the system parameters might be changed through the proper function in the GUI. CARDIOLOGY programs: Two are the cardiology programs available, Electrophysiology, and Hemodynamic. Both offers optimization procedures, such as pacemaker placement, coronary angiography, catherization and spider position. GASTROENTEROLOGY program: it involves subprograms such as PCR, endoscopy. NEUROLOGY program: it involves pre-set configurations for neurosurgery procedure on-spine. ORTHOPEDIC program: it involves an optimized procedure for each body district. UROLOGY program: it includes default optimized configurations for kidney and urinary tract. VASCULAR program: for each region of the vascular system a proper optimized procedure is made available. It may include also optional programs such as DSA and Roadmap. PEDIATRIC program: it enables functions for pediatric purposes, i.e. additional filters and dose reductions. In pediatric procedures or if necessary, the grid can be removed manually, without the use of tools or instruments. 10.2.2 DATABASE PAGE This page is committed to the management of the exams archive. The database page can be seen as divided into three sub-panels. The \u201cExams selection\u201d sub-panel contains the fields from which to filter the research within database: local, imported, external or from the PACS server. Those are mainly, the patient data and the exam info. 53 | P a g i n a","alien X \/ alien e 54 User manual Revision: 1.7.24 - 25.02.2021 The \\\"Exam List\\\" sub-panel shows the exams selected and loaded from the system database. While the \u201cRuns view\u201d sub-panel visualizes the list of runs present in the selected exams. 54 | P a g i n a","alien X \/ alien e 55 User manual Revision: 1.7.24 - 25.02.2021 10.2.2.1 EXAMS SELECTION The exams can be loaded from four different units. The source can be specified selecting one of the following tabs at the top of the Exams selection sub-panel: which identifies the local archive. which identifies the imported archive. It includes the data previously downloaded from the PACS server by means of the \u201cQuery-Retrieve\u201d tab. it allows to upload the exam from an external unit, such a hard-drive. It is an optional function therefore it may be not present in the software GUI. Using the buttons on the side, the external unit can be accessed or removed. If the external unit contains local exams, obtained with the same instrumentation, they are loaded into the corresponding subpage, after setting the filtering data with the corresponding button. Exams obtained with other devices can be loaded only if in DICOM format from USB or CD To select \/ deselect all exams, hide them and load them the corresponding buttons are shown on the side. \u201cQ\/R\u201d: The DICOM Query\/Retrieve function is used to download data coming from a configured PACS server. As previously mentioned, before sending a query command to the external database, some filtering information may be added in order to speed up the searching process. Query command: Therefore, once the filtering data have been set, a query command can be send. The \\\"Query results\\\" panel will be displayed on the right side of the page, showing all the studies in the database compatible with the data entered. Being the query\/retrieve mechanism based on the hierarchic structure of each individual SOP instance in the DICOM standard, the data retrieved will be structured as follows: Studies \u2192 Series \u2192 Images As a result of the first query the software GUI will show all the available Studies in the PACS server. \\\"retrieval \/ download of studies\\\" button: the user will be able to retrieve\/download the whole available studies for each patient, or send another query command, pressing the \\\"query command\\\" button. 55 | P a g i n a","alien X \/ alien e 56 User manual Revision: 1.7.24 - 25.02.2021 The result of the second query will be a list of all the available Series (for the selected Study) which again can be further queried , or retrieved\/downloaded locally. Similarly, the result of a second query will be a list of all the Images with the same Series which can finally be selected and retrieved\/downloaded individually or as a whole. During the operations mentioned above the following sub-panels will be visible: In order to simplify and optimize the research, the exams can be filtered by means of one or more patient info (Surname, Name, Patient ID, Acc. Number, etc) or through the exams data, such as specialty, department, operator or doctor. If any incorrect entry occurs all the fields can be cleared selecting the \u201cX\u201d button. To be noted that each Study\/Series\/Image may be individually selected selecting the left column corresponding to the proper line and the appropriate key. It is also possible to select\/deselect all the exams the exams using the appropriate keys. The results can be deleted using this button. 56 | P a g i n a","alien X \/ alien e 57 User manual Revision: 1.7.24 - 25.02.2021 As shown in the figure above, a selected exam can be exported on a USB unit selecting the proper tab. In addition, depending on the user access level it may be possible to modify the patient data from the equivalent tab. When the latter function is available, the following panel will open: To be noted that some or all the exams appearing in the sub-panel can be hidden pressing on this button. 10.2.2.2 EXAMS VIEW The Exams view sub-panel visualizes the list of exams previously loaded form the database. As in the previous case, from such a list an exam may be selected individually or altogether through appropriate buttons. For any selected exam, as shown in the figure below, the images, information and dose statistics can be visualized, exported and printed. The \\\"Dose Report\\\" button allows the view, and eventually print, the dose level report of the exam highlighted on a new page. The \u201cStatistics\u201d tab, will visualize a new page containing a copious amount of data about the patient and the exam which may be printed as well. From this sub-panel also, a Radiation Dose Structured Reports (RSDR) may be exported on a USB device or to a PACS storing service. Similarly, a Dose level report or a DICOM file may be exported to a PACS storage system One or more dose level reports can be directly printed pressing this button. 57 | P a g i n a","alien X \/ alien e 58 User manual Revision: 1.7.24 - 25.02.2021 In addition, the image may be exported on a USB unit as a Raw or TIFF format and after on CD. Lastly, the exam list can be unloaded pressing the \u201cUnload\u201d button. To be noted that the \u201cdelete\u201d button will be enabled only if the access level is appropriate. 10.2.2.3 RUNS VIEW The images included in the selected exams are visualized as a list in the current panel, as depicted in the figure below. As for the previews paragraphs, the selected run is indicated by a check sign on the left column. In addition, the operator can check exclusively the runs marked as important (\u25b2) pressing the proper button. In order to visualize the appropriate image in the monitor page, select the desired run and then select the row. As soon as the row is highlighted in yellow, which means that it has been selected, the image will be visible. As shown in the figure above, for each run other than its Id, its acquisition time, its program and sub- program, the acquisition mode, Dose Level and Recording Mode are shown: Each run may be exported as a DICOM format to an external USB device connected to one of the USB port available, CD\/DVD or PACS storage system. In addition, an image can be converted or not (Raw format) to TIFF format and loaded on a USB device or CD. Each of these procedures is completed by selecting (\u2713) near the line of interest and clicking the button for the desired export. During the procedure the software returns feedback to the user and confirms the success \/ failure of the procedure. 58 | P a g i n a","alien X \/ alien e 59 User manual 10.2.3 VIEWERS PAGE Revision: 1.7.24 - 25.02.2021 1 The viewer page is committed to the visualization of the images that are acquired during the exam or present in the system database. As shown in the figure above, this page is made up by two viewers monitors and for each one of this monitor it is possible to switch among six different pages or panels, navigating through the tool-bars (1) at the top page. Each tab of the tool-bars will open a different panel among those listed below: Panel acquire: visualizes the panel which includes the main acquisition settings, such as the selection f body district, acquisition mode, AEC etc. Panel play\/preview: visualizes the panel which includes the controls for the digital video player. Panel analyse: visualizes the panel which includes the control and functions for the image analyses. Panel preview: visualizes the panel that includes all the previews of the current run. Panel information: visualizes the panel that reports all the information about the current exam, run and frame. 59 | P a g i n a","alien X \/ alien e 60 User manual Revision: 1.7.24 - 25.02.2021 Panel C-arm: visualizes the panel that includes all the information about the C-arm and the buttons for its control. To be noted that only the C-arm panel is available at the time that no examination is open or loaded. Monitor panel: displays the image corresponding to the icon represented, as explained below. To configure the type of monitor to be displayed, the user can use the buttons in the left and right corners, respectively. The user can select the monitor of interest from the list of monitors shown, as shown in the following example: To be noted that the icons may differ from those shown above depending on the types of configured and active monitors. Namely, both monitors can be configured as: Real-time monitor: visualizes live images as they are acquired. Where the number at the bottom right corner refers to the left (1) or right (2) monitor. Dvp monitor: visualizes recorded images previously loaded from the database and selected from the list of runs. In the case of subtracted images or roadmaps the number at the bottom right differentiates the image reproduction modes. Monitor of the last image acquired: it automatically updates and displays the last image acquired during the exam. This monitor is only available for the left monitor. Fixed reference monitor: shows a fixed image, which is maintained as a fixed reference image. This monitor is only available for the left monitor. Monitor with DICOM image: shows an image in DICOM format previously imported into the system via USB and \/ or CD device. Monitor with 3D DICOM image: shows an image in DICOM format previously imported into the system via USB and \/ or CD device. This type of display is possible if the 3D image reconstruction (also MRI) is possible from the DICOM study. From both panels, the displayed images can be: 60 | P a g i n a","alien X \/ alien e 61 User manual Revision: 1.7.24 - 25.02.2021 set as a reference and transferred on the right monitor, through the \u201cTransfer Image\u201d button. To be noted that the reference image will always be moved to the right monitor since it is the only one equipped with the reference image functionality. Saved on an external support, through the \u201cExport\u201d button. If one or more individual frames have been marked (\u25b2), at the click on the button the following message will appear allowing you to choose the format and export target between DICOM PACS, DICOM USB, DICOM CD and PNG format. If no frame is selected as imported, the images are automatically saved in PNG format without any message appearing. Printed on the local configured thermal printer, if present, pressing the \u201cPrint\u201d button. It is possible to adjust the opening\/closing the collimator directly on the image: selecting the button and touching the image the blade will be positioned at the indicated point. To adjust the position, simply slide your finger on the touchscreen ETS15 to the desired position: the blade will follow the finger movement until it is released. The button automatically deselects on release. In order to continue moving the collimator in this way it is necessary to re-select it. This button is visible only with the monitor in real-time. Select an image analysis tool. By default it is set to the gestural mode of scrolling between frames and run. When the gesture mode is active, it is possible hold down any point in the image to display of instructions on how to use gestures, as shown in the following image: 61 | P a g i n a","alien X \/ alien e 62 User manual Revision: 1.7.24 - 25.02.2021 To select the desired analysis tool press this button. Will appear the following popup message: Each analysis tool with the corresponding icon is also briefly described. The selected instrument will become the current one only after confirmation. When a tool different by the default tool is selected, the selection button will change color and show the icon of the current tool. The available tools, besides the gesture mode, are the following: Manual movement of the frame Image rotation Pointer tool to view a red laser when a point is pressed on the image. 62 | P a g i n a","alien X \/ alien e 63 User manual Revision: 1.7.24 - 25.02.2021 Drawing tool Text annotation Measuring tool Stenosis tool Redraw the ROIN of the processed image The last four tools, if selected, cause the opening of the Analysis Panel, where there are additional features. Please refer to the chapter Panel Analyze (10.2.3.4) for further explanations. 10.2.3.1 GENERAL INFO 12 3 4 56 7 The figure above illustrates the bottom section of the viewer page which is always visualized, independently from the active panel in the two monitor pages. It gives information about: 1. the space left in the working and storing database, 2. the effective exposition time, total time and dosimetry 3. Information about the material used as a filter and its thickness (3), the anode and housing temperatures as they approach their limits 63 | P a g i n a","alien X \/ alien e 64 User manual Revision: 1.7.24 - 25.02.2021 4. The acquisition and exposure levels such as kV, mA, pulse length and frame-rate. The \u201cx-ray\u201d symbol indicates the system status: it turns blue when the exposure is disabled, the interlock is active, or the detector is not ready; it is green when the exposure is enabled, yellow if under exposure and red if there is any exposure error, generator error or of any other kind. 5. Among the general information, the sub-panel shows when: the AEC mode is enabled, which Dose Level is used, if the \u201cHard Metal\u201d function is applied, which kind of recording mode is active. The software also shows the following icon if the offsets with which the panel is working are in the range of +\/-3 \u00b0 compared to the measured temperature, otherwise in the place of \u2713 will be shown the following !, in yellow. 6. It also visualizes the acquisition modes and commands configured on the pedal Below are listed all the icons representing the control actions that can be associated to the pedal: Change mode x-rays command 0 64 | P a g i n a","alien X \/ alien e 65 User manual Revision: 1.7.24 - 25.02.2021 Change mode x-rays command 1 Fov up: increase the Fov dimensions Fov down : decrease the Fov dimensions Fov change: switch FOV Dose up: increase the Dose level Dose down: decrease the dose level Dose change: change dose level Save last run Fix image Re-mask Voice control Saving the last run may take a few seconds. A popup is shown during this operation (below on the left) and at the end (below on the right). Voice control, when activated by pedal, allows the following commands: \u2022 \\\"show run #\\\": shows the desired run \u2022 \\\"mark run #\\\": marks the desired run \u2022 \\\"play\\\": reproduces the current run \u2022 \\\"stop\\\": stops the current run \u2022 \\\"fov in\\\": closes the collimator of a step \u2022 \\\"fov out\\\": opens the collimator of a step \u2022 \\\"next\\\": shows the next run \u2022 \\\"reference\\\": sets the current run as a fix image. 7. Lastly, the sub-panel indicates the FOV dimensions (6), in mm, and the c-arm angular positions (6), in degrees. 65 | P a g i n a","alien X \/ alien e 66 User manual Revision: 1.7.24 - 25.02.2021 This icon appears instead if it is recommended to use the high dose program. 10.2.3.2 PANEL ACQUIRE By default, when an exam is open the monitor \u201c2\u201d will show the acquire panel so that the user will be able to modify the default acquisition settings, while the monitor \u201c1\u201d shows the live image. First of all, the user will need to select the proper body district from the \u201cProgram Selection\u201d sub-panel (1) by selecting on the desired body area. Moreover, for each body district a proper sub-program may be loaded from the \u201cPrograms Selection Menu\u201d below (2). To be noted that the available body districts and associated sub- program depends on the anatomical program previously selected while opening the exam. Using the \u201cPatient Orientation\u201d drop-down menu it is possible to select the patient's position between prone, semi-prone, supine, standing, kneeling, frog, sitting and right or left lateral decubitus. On the basis of the selected district, it is possible to choose the current laterality. Subsequently, the operator can modify the default settings for the analytical sub-program in use as well as the functions associated to each pedal (identified as Xrays Cmds). 66 | P a g i n a","alien X \/ alien e 67 User manual Revision: 1.7.24 - 25.02.2021 12 In particular, for what concerns the pedal commands, knowing that the left pedal is referred as number 0 and the right one as number 1, the buttons in the section \\\"Cfg Cmds\\\" (1) allows to configure the control action associated to each pedal button choosing from the list previously explained. In addition, the operator can select from the \u201cX-rays\u201d command menu (2) the acquisition mode associated to each pedal button, choosing among the followings: Scopy Scopy SS Scopy HQ Scopy HQ SS Scopy HQ DSA Scopy HQ DSA CO2 Scopy DSA Roadmap Graphy DR The available image acquisition modalities depend on the main program selected. The recording modality can be specified individually for the \u201cScopy\u201d and for the Scopy \u201cHQ\u201d selecting the proper one among the following list: Record only last image Record all frames Save the last run 67 | P a g i n a","alien X \/ alien e 68 User manual Revision: 1.7.24 - 25.02.2021 Furthermore, the operator can modify the Dose Level, selecting the desired one among \u201cHigh\u201d, \u201cNormal\u201d and \u201cLow\u201d dose level, from the \u201cDose Control\u201d sub-panel. In addition, for acquisition modality present for the sub-program chosen, it is possible to vary the \u201cNoise\u201d and the frame-rate, as shown below. For each one of those values, two buttons are available in order to decrease (-) or increase (+) the quantity. The default settings may be restored pressing on the \u201cDefaults\u201d button. Additional options are the automatic exposure control mode (AEC), which can be disabled\/enabled, as well as the Hard metal function. When the \u201cRoadmap DSA Scopy\u201d is enabled (depending on the sub-program previously selected) also the subtraction mask may be changed using the button. Lastly, among the acquisition settings, from the \u201cAnatomic Filters\u201d sub-panel, the operator can vary the filters quantity used for the image processing. In particular, those filters are: Gray compression level Median filter Contrast level Edge level Latitude level Windowing If the \u201cDSA \u201cacquisition modality is enabled a further sub-panel \u201cDSA Filters\u201d will be displayed, allowing to adjust: Brightness level 68 | P a g i n a","alien X \/ alien e 69 User manual Revision: 1.7.24 - 25.02.2021 Contrast level Land marking: It allows to regulate the percentage of anatomic view below the Road-map view. DSA noise correction factor: check the image opacity For each one, the left button is used to decrease the filter value, while the right one to increase it. In order to restore the default values, press the \u201cDefaults\u201d button. 10.2.3.3 PANEL PLAY\/PREVIEW The following description of the play \/ preview panel refers to the images reproduced if a DICOM image is not shown in the monitor of the side panel. 1 23 This page provides all controls for the review and navigation of the acquired exam runs. Through the \u201cOptions\u201d sub-panel (1) the user can enable the auto-play function for the \u201cScopy\u201d or \u201cScopy HQ\u201d. Therefore, the run will be played automatically for the selected acquisition modality as soon as it is selected. The Runs Tools sub-panel (2) provides: the button that allows to view all the runs of the exam (as a sequence) or only the selected run filtered by the user; the control buttons that allows to navigate through the exam runs and select eventually the previous run (\u2190) or the next one (\u2192). The \u201cPlay Tools\u201d sub-panel buttons (3) provides the possibility to play, slide through the different frames using the sliding bar. 69 | P a g i n a","alien X \/ alien e 70 User manual Revision: 1.7.24 - 25.02.2021 Finally set up the reproduction speed of the run. Where 100% means the same speed of the original acquisition frame-rate. The secondary panel \\\"Image Tools\\\", as well as the secondary panel \\\"Review tools\\\", includes command buttons to: navigate within the frames selecting the previous (\u2190) or next frame (\u2192), to mark the frame as important using (\u25b2). This button instead allows you to deselect all the frames marked as important (\u25b2). It is even possible to select the first or the last frame. This button allows to view useful tools in the secondary panel below: 12 3 The secondary panels \u201cCfg Views Left\u201d and \u201cCfg Views Right\u201d (1) show and allow the choice of the reproduction mode in the case of subtracted images and roadmaps. It corresponds to the same functionality of the display panel as selecting the DVP Monitor. The button matches are as follows: 70 | P a g i n a","alien X \/ alien e 71 User manual Revision: 1.7.24 - 25.02.2021 The DVP1 monitor shows the subtracted image. The DVP2 monitor shows the trace of the subtracted image. The DVP3 monitor shows the anatomical image. The buttons on the secondary panel (2) respectively allow to recalculate the mask, set the entire stack or the image as a trace for the roadmap. The pixel shift panel (3) allows to move \/ reset the image with respect to the mask. This button allows to view the \\\"Anatomic filters\\\" and \/ or \\\"DSA Filters\\\" secondary panel visible if the one shown above is visible. This new panel provides controls for the filters to be applied during image processing Finally, the preview panel contains a preview list of all the runs in the current exam on the right side sub- panel (). From it the user can directly select the run and mark them as important. The navigation buttons allows to navigate through the pages if the runs occupy more than one page. The list then can also be filtered by the runs selected or marked. If instead a DICOM image is shown, this panel will be divided into a Settings section (1), several sub-panels that allow scrolling between the different instances, series and, in the case of DICOM multiframes, video playing (2) and a section with zoom and measurement tools (3). 71 | P a g i n a","alien X \/ alien e 72 User manual Revision: 1.7.24 - 25.02.2021 1 2 3 The setting sub-panel (1) allows the adjustment of the DICOM image by acting on the WindowLevel e WindowCenter parameters, by default set to the values read by the selected series or by the instances. This button allows to set these parameters between the different instances and series that are part of the same study. If a study contains more series or instances, the start \/ stop buttons of the overview (1), which allows automatic scrolling between the different images, and the manual scroll buttons (2) will be enabled in the Runs Tools sub-panel. 1 2 In the case of DICOM multiframes, the subpanels containing the reproduction and scrolling tools between frames allow the following functions: \u2022 manual scrolling between frames (1), \u2022 selection of the first or last frame (2), \u2022 setting the playback speed (3), \u2022 start \/ stop video playback (4). 72 | P a g i n a","alien X \/ alien e 73 User manual Revision: 1.7.24 - 25.02.2021 1 3 2 4 These buttons show, in the Tools subpanel, which of the interaction modes with the DICOM image is set and its selection. If the Panoramic interaction mode is enabled (in the top),it is possible to move image by touching it . If the Measures interaction mode is enabled, it is possible to add measures or modify existing ones. The zoom buttons allow to increase, decrease or reset the zoom of the image. The reset button also allows you to return to the default image position. Using this button it is possible to make the zoom parameters and image position permanent between the different instances and the different series. If the Measure interaction mode is enabled, you can add measures using the appropriate button. Pressing the button adds a measurement object (as shown in the following figure), containing information on the length of the measurement, color and with the possibility of hiding \/ showing the measurement or deleting it. It is possible to create the measurement by touching the image and dragging a finger on it. It is possible to modify the image only if the relative interaction mode is enabled and the desired measurement is selected. 73 | P a g i n a","alien X \/ alien e 74 User manual Revision: 1.7.24 - 25.02.2021 10.2.3.4 PANEL ANALYZE 1 2 3 The \\\"Stopwatch\\\" panel (1) acts as a stopwatch with the respective \\\"stop\\\", \\\"play\\\" and \\\"reset\\\" buttons. The stopwatch is also visible on the doctor monitor, when it has a different value than the \\\"reset\\\" status For what concerns the \u201cView tools\u201d sub-panel (2), the user can zoom in (+) or out (- ) or restore the image dimensions through this button. These buttons allow to mirror the image horizontally and vertically, or to swap blacks and whites. Furthermore, the sub-panel provides control buttons to rotate clockwise or counterclockwise the image, as well as restore the default orientation. Further functionality of the selected instruments are displayed here: It provides also, the tools to draw on the image by pushing the following button, which will enable and open the \u201cDraw \u201csub-panel, as shown in figure below: 74 | P a g i n a","alien X \/ alien e 75 User manual Revision: 1.7.24 - 25.02.2021 From it, it is possible to choose between the writing or deleting tools and tract widths. It is possible to select the desired color by pressing the button. Finally, the drawing may be hide or deleted. The text box, through which the user enter text on the image. Selecting a point on the image displays the following window: which requires the user to enter an annotation. Press \\\"OK\\\" to save the text on the image. Each annotation can be deleted by pressing the button in the \\\"Overlay Tools\\\" panel: Measure tool 75 | P a g i n a","alien X \/ alien e 76 User manual Revision: 1.7.24 - 25.02.2021 When pressing the \u201cMeasurement\u201d button the following control buttons will be shown: Each measurement refers to a known reference measurement, with which the measurement system is previously calibrated. To calibrate the measurement it is necessary to acquire the image of an object with a known size (for example a radio-opaque disk) placed in the field of vision according to a suitable inclination, thus arranging the known dimension in a direction orthogonal to the beam. Next, add on the image containing the known object in millimeters (mm), a measurement indication: select the icon and click on the start and end point of the note dimension on the object. Press the button that opens the following window: and enter the actual measurement. Any other measurement made will be scaled using the known size. Note that the measurements on the image are not affected by the zoom on the image. In order to add a measurement indication on the image, such as a distance or length measure, the user will need to select the button and then select on the image the measurement starting point and final point (both are identified by a red dot when marked), as a consequence a segment indicating the measure (mm) will appear. Similarly, an angular measurement can be added selecting, where in this case three points need to be identified in order for the measurement to appear on the image. In addition, the measure indication can be moved on the image pressing the button and then moving the start\/end point along the image or deleted through the proper button. Lastly, all the measurements can be deleted or hidden through the proper buttons. The measurement limits of the system are given by the pixel size of the panel used (for example, if the panel has a pixel size of 0.2 mm, the accuracy will be 0.2 mm), then refer to the panel technical sheet. 76 | P a g i n a","alien X \/ alien e 77 User manual Revision: 1.7.24 - 25.02.2021 It is necessary to recalibrate the measurement system, and then repeat the calibration procedure with a known object (see above) every time the patient or the C-arm is moved. Stenosis Tool The viewfinder icon should be selected first in order to be able to draw on the image the reference dimension (as for the measurements, click on the image to select the starting point and then click again to select the last point). As soon as the reference green segment has been draw, mark the start and end point on the image and a segment will appear showing the dimension in percentage with respect to the reference, as shown in the figure below: As for the functions explained previously in this paragraph, the segment can be moved and deleted (as well as the reference) through the proper buttons. Image reprocessing based on the selected ROIN Through the central button it is possible to restore the considered ROIN to the whole one, while through the arrows it is possible to resize it as desired. In this way, the image considered will be reworked at runtime. 77 | P a g i n a","alien X \/ alien e 78 User manual Revision: 1.7.24 - 25.02.2021 10.2.3.5 PANEL PREVIEW The \u201cPreview\u201d panel displays all the runs of the current exam as a preview list so that the user can easily identify and select the proper one. As shown in the figure above, the list is disposed in the form of a grid and its dimensions can be adjusted choosing among the following buttons. From left to right, the icons show that the grid dimensions (number of previews per row\/column) can vary from lower to larger dimensions. If the number of previews exceeds the maximum number for a single page, the up and down arrows should be used to change them. In addition, the previews list can be filtered so that it shows only the runs marked as important (\u25b2), checked (\u2713) or marked as single frame \u201cfluoroscopy\u201d, using the proper buttons. Indeed, as previously explained in this section, the buttons shown below may be used to select one single run as important or select\/deselect all the runs together (from right to left) Sam holds for the check sign. 78 | P a g i n a","alien X \/ alien e 79 User manual Revision: 1.7.24 - 25.02.2021 10.2.3.6 PANEL INFORMATION The panel visualizes all the information about the selected exam, run and frame, dividing them into three sub-panels (exam info, run info and frame info). All the information is referred to the image displayed in the opposite viewer. As shown in the figure above, the patient details and exams info are listed among the \u201cExam Info\u201d, while anatomical program and sub-program is displayed in the \u201cRun Info\u201d, together with data about the options used (such as metal function). Lastly, the \u201cFrame Info\u201d contains data about the exposure and dose levels while acquiring the frames. 79 | P a g i n a","alien X \/ alien e 80 User manual 10.2.3.7 PANEL C-ARM Revision: 1.7.24 - 25.02.2021 1 2 3 4 The \u201cC-arm \u201cpanel provides the control buttons to move the C-arm along the principal directions, eventually store the positions in memory in order to facilitate the c-arm positioning later on, and finally move the C-arm in the Angle Positions. The \u201cJogs\u201d sub-panel (1) contains the buttons to control the C-arm movement along the vertical direction: along the vertical direction along the orbital direction circumferential direction horizontal direction. In addition, it allows to brake\/unbrake the horizontal carriage, in order to move the C-arm in horizontal direction manually; in this case the automatic movements are blocked. 80 | P a g i n a","alien X \/ alien e 81 User manual Revision: 1.7.24 - 25.02.2021 The buttons allows to rotate the C-arm in any direction up to the 0\u00b0 position, into circumferential direction (green) or orbital direction (blue). Whenever, the button is pressed, all the movements are slower. To be noted that if the \u201cradar\u201d button is enabled, meaning that the anti-collision system is active, all the movements which will inevitably lead to a collision will be disabled (impossible to control). The secondary panel \u201cCollimator\u201d (2), provides the command button to be used to control the horizontal opening of the collimation blades vertical openings of the collimation blades. and command button to decrease or increase the FOV (field of view). This panel also provides other command button like: the laser centering tool, the field illumination lamp the exposure time reset, the enabling\/disabling of the anti-collision system and DFF movement The \u201cMems\u201d sub-panel (3) allows to store four C-arm positions described as a combination of the circumferential, orbital and SID movement. Therefore, in order to memorize the position, first position the C-arm at the proper location, using the control buttons previously described, and then press the button associated to the proper memory key (M1, M2, M3, M4). As a consequence, the description below will be updated showing the new memorized position, as shown below: Thus, C-arm will automatically move towards the memorized \u201cM#\u201d position whenever the \u201cM#\u201d button is pressed. To be noted that such a movement is semi-automatic, meaning that the C-arm will automatically 81 | P a g i n a","alien X \/ alien e 82 User manual Revision: 1.7.24 - 25.02.2021 stop as soon as the target position is reached but in order to do so the user must keep the button pressed for the while procedure. The secondary panel \\\"Isocentrism\\\" (4) allows to activate this feature for circumferential movements. The following buttons allow you to move the isocenter in a vertical direction respectively upwards and downwards. 10.2.4 SYSTEM CONTROL PAGE 1 23 The \u201cSystem Control Page\u201d provides all the information about the C-arm positioning and x-rays settings. Those information are indeed updated constantly and shown in the central section (2) of the page, as shown in the figure above. As previously mentioned, the \u201cx-rays\u201d symbol shows weather the x-rays emission is active(yellow) or not (blue). In addition to the general information, this page provides two main sub-panels which are equipped with buttons for the control of the C-arm, the collimation system and other additional system services. Starting from the left sub-panel (1), here is a list describing each control button and their related control commands: from which it is possible to access the list of positions with which to define the position of the unit with respect to the patient and thus allowing the movement of the arc in pre-memorized projections. 82 | P a g i n a","alien X \/ alien e 83 User manual Revision: 1.7.24 - 25.02.2021 Based on the figure shown above, the C-shaped bow is positioned relative to the patient in position; indefinite, at the patient's head, at the patient's feet, on the left and right side (on the other side downwards). X-rays collimator control commands : the user can choose the filtering component along with its thickness selecting the proper one from the \u201cSelection Menu\u201d, as shown below: It provides the control buttons for the opening and closing movement of the collimator along the horizontal direction vertical direction for the widening and narrowing of the field of view (FOV), for the rotation of the blades and their movement along the radial direction Service function control commands: from it can be enabled: 83 | P a g i n a","alien X \/ alien e 84 User manual Revision: 1.7.24 - 25.02.2021 The centering laser il laser di centraggio, The C-arm light Trolley image display lift, table movimentation, reset the collimator to a max opening button to release orbital movement brake. Note that this automatic brake release precludes the possibility of automatic motor movement, therefore the icons relating to the orbital movement will be switched off as soon as the brake is deactivated and reactivated otherwise. anchor the movement of the C-arm to the bed. In case of connection with the CT70T Evolution device, it is possible to obtain the vertical movement of the table with the buttons above described. The contemporary movement can be controlled only by the C-arm control system. The activation of movements performed through console of the table does not generate C-arm movement. Xrays commands configuration: 84 | P a g i n a","alien X \/ alien e 85 User manual Revision: 1.7.24 - 25.02.2021 From the right sub-panel (3) instead, the following control buttons are provided: which opens a further sub-panel containing seven saved \u201cprojection\u201d c-arm configurations. Therefore, selecting the proper one, the C-arm will reach the memorized positions so that the resulting projection matches the required one. 85 | P a g i n a","alien X \/ alien e 86 User manual Revision: 1.7.24 - 25.02.2021 Similarly, to the above command, this control button will open a further sub-panel showing the four (M1, M2, M3, M4) c-arm positions saved. As shown in the figure below, for each one the fly software saves the rotation angle, the orbital angle and the sid position: which provides all the control buttons that allow to move the c-arm to known angular positions along the circumferential and orbital direction, as shown below: 86 | P a g i n a","alien X \/ alien e 87 User manual Revision: 1.7.24 - 25.02.2021 which shows the commands that control the continuous rotation of the arc along the orbital and circumferential direction, and the monitor vertical movement as well. If the system is equipped with the DFF (Dynamic Field to Focal), the panel also include the button to modify the sid up or down. Unlike the previous commands, those here mentioned enable the \u201cjog\u201d movement, meaning that the c-arm will move according to the specific requirement as long as the button is pressed, and will stop only if the user releases the button or the c-arm reaches the limit or sees an obstacle in the way. which opens the sub-panel containing the general settings. In particular, from it the user will be able to enable\/disable the automatic exposure control, select the required dose level among the three available (low, normal, high), select the recording system for \u201cScopy\u201d and \u201cScopy HQ\u201d. 87 | P a g i n a","alien X \/ alien e 88 User manual Revision: 1.7.24 - 25.02.2021 which opens the \u201cdose regulation\u201d sub-panel. From it the user will be able to adjust manually the dose parameter as well as the frame rate, according to selected acquisition mode. To be noted that the manual configuration will be available only when the automatic exposure control is disabled, otherwise the software will not use the required exposure level set. If the pulsed exposure modality is active, the selection of the length of the pulse will be not available. 88 | P a g i n a","alien X \/ alien e 89 User manual Revision: 1.7.24 - 25.02.2021 10.2.5 SYSTEM SETTING PAGE The System Settings page allows the configuration of the system, including the network, the monitors and the channels associated with them. Depending on the access level some settings are not configurable. In particular, this page is divided into 3 sub-pages which can be accessed through the corresponding buttons. The required access levels are, from left to right, \\\"Operator\\\", \\\"Administrator\\\" and \\\"Assistance\\\" respectively. Obviously, each page that is accessible to users with less privileges, as an operator, is accessible to users with greater privileges, such as administrator or assistance. The following chapter will deal with the \\\"Operator\\\" account, while the \\\"Administrator\\\" and \\\"Assistance\\\" will only be described in the Technical Manual. 10.2.5.1 SYSTEM SETTINGS PAGE - OPERATOR As shown in the figure above, from the \u201cOperator\u201d account page, the user may configure all the basic (1) system functionalities such as: \u2022 connect the external database \u2022 choose the desired language among the listed ones \u2022 enable\/disable the mouse pointer and keyboard auto-hide \u2022 enable more printed pages 89 | P a g i n a","alien X \/ alien e 90 User manual Revision: 1.7.24 - 25.02.2021 \u2022 take a screen-shot \u2022 if the anti-collision system is disabled from the system control page, the button for completely disabling the proximity sensor, allows to have no restrictions on the possible movements of the machine \u2022 configure the screens and monitor in which the FlyWiki tool is shown. \u2022 configure the network, enabling either the wired or wireless Internet connection In addition, this page provides the DICOM services configuration buttons. In particular, enable the MPPS (Modality Performed Procedure Step Service) In addition, the operator can select the desired server for the 3 modes of store \/ work list and Query \/ retrieve and subsequently verify the operation of the connection through the \\\"ping\\\" and \\\"c-echo\\\" buttons. 10.2.6 SYSTEM MONITOR PAGE 10.2.6.1 FLYWIKI FlyWiki is a visible help tool, if the license is enabled, which allows the search and display of content useful to the user regarding the use of the machine such as procedures and features. Through the search bar (1) it is possible to search for the desired content using keywords. If the search bar is left empty, pressing the search button (2) will display all the available contents. The FAQs show the most commonly used content (3). 1 23 Each content shows a title and a short description. When a content is selected, images are shown to explain the procedure or functionality. If there are several images, these buttons allow scrolling between these images If there are several images, these buttons allow scrolling between these images By pressing the return button, it is possible return to the search page and stop playing the video. 90 | P a g i n a","alien X \/ alien e 91 User manual Revision: 1.7.24 - 25.02.2021 10.2.6.2 ERROR MONITORING If a hardware or software error is revealed, the icon of the System Control page will start to blink indicating the error event. Icon stop blinking only after the user opens this page and deletes the errors listed using the \\\"clear\\\" button at the bottom of the page. A description of the error may be evaluated pushing the icon and getting access to the system control page, where the erro is usually reported by code and description in red color. The error list may be deleted acting on the \\\"clear\\\" button at the end of the page. Example: An error popup will be also displayed to a brief period. 91 | P a g i n a","alien X \/ alien e 92 User manual Revision: 1.7.24 - 25.02.2021 10.2.6.3 LOG MONITORING The events occurring in the fly software are regularly recorded as messages or logs which can be visualized in the System Monitor page, selecting the \u201cLogs\u201d tab. Those messages are commonly used to understand and track down the activity of the system and eventually diagnose a problem. As shown in the figure above, the \u201cLogs\u201d page provides two lateral bars each one composed by several tabs representing a specific module (left bar) or function (right bar) of the software. Therefore, selecting the proper one the user will visualize the messages coming from that module\/function. To be noted that irregular behavior of the software will be displayed in yellow, while errors will be shown in red. The latter will be finally shown in the page opened from the \u201cErrors\u201d tab. 92 | P a g i n a","alien X \/ alien e 93 User manual Revision: 1.7.24 - 25.02.2021 11 PROCEDURES This chapter is meant to identify and describe the main procedure of the fly software. 11.1 SOFTWARE START-UP The fly software starts-up automatically at the unit start-up. Indeed, pushing the power-on button at the rear of the trolley, turns on the computer which gives the boot command to the fly software. The software start-up procedure ends as soon as the GUI is \u201con-line\u201d., meaning as soon as the anatomical programs key are enabled, and the emergency button is shown, as described in the figure below: The software immediately requires a system login and automatically asks for it, showing the following login window: It is mandatory, for the user to login in order to access any sensible data within the system database. Therefore, it is always recommended to login, except if an emergency procedure is required. In the latter case, select \u201cCANCEL\u201d and open the exam as \u201cemergency\u201d as soon as the GUI is \u201con-line\u201d. In order to login into the system enter a valid \u201cuser-name\u201d and \u201cpassword\u201d, which should have been provided by the system administrator and proceed with the exam configuration. If no \u201cuser-name\u201d nor \u201cpassword\u201d have been provided, please contact the system administrator or eventually the assistance. 11.2 OPEN AN EXAM In order to open an exam, the software requires either to fill in the patient exam data, or to open the exam as an emergency procedure. To open an exam as a regular procedure, the user must complete all the mandatory fields in the exam data section, which involves, patient: 93 | P a g i n a","alien X \/ alien e 94 User manual Revision: 1.7.24 - 25.02.2021 \u2022 surname and name \u2022 ID and acceptance number \u2022 Sex and birth date All that mandatory information is marked with an asterisk. Further information, which are not mandatory to open a regular procedure are: the department, doctor and operator name and the study ID. In order to fill in the exam patient data the user can download the patient info from the remote work list, from the local work list, or inserting each data singularly. In the latter case, select the rectangular area next to each singular mandatory field and type in the data using the keyboard that will appear. To move from one field to the one immediately below, use the \u201ctab\u201d key of the keyboard: As soon as all the mandatory information have been given, the \u201copen procedure\u201d button will turn into a flag, as shown in the figure below: Therefore, select the proper anatomical program among those available and open the exam using the key. 94 | P a g i n a","alien X \/ alien e 95 User manual Revision: 1.7.24 - 25.02.2021 11.2.1 LOAD EXAM DATA FROM A REMOTE WORK LIST This paragraph assumes that all the remote work list connection has been correctly configured and checked. Before retrieving the data from the remote work list make sure that all the filters are consistent with the requirements. As default, those filters are set to the configured AET station name and modality, and to the current date. Download the work list from the remote server by pressing the key. As a result, the table will fill up with the patient data, as shown below: Select the patient data, by clicking the proper row. In this way, the exam data will automatically fill up. In order to delete all the patient data and select another patient from the work list, first clear all the data inserted using the key, confirm the choice and subsequently click the proper row. To be noted that if no connection was correctly established by the system the following window will be shown: If such a case occurs, please check the Internet connection or contact the assistance for the work list configuration. 11.2.2 LOAD EXAM DATA FROM A LOCAL WORK LIST If no Internet connection is available but the work list has been previously downloaded from the server, select the local work list and the load key. As a result, the local work list table will fill in. Again, select the proper patient and the exam data will automatically fill in. 95 | P a g i n a","alien X \/ alien e 96 User manual Revision: 1.7.24 - 25.02.2021 11.3 IMAGE ACQUISITION At this point the unit is ready to acquire images. However, the emission will still be inhibited if the emission interlock key is locked. Therefore, check that the interlock is unlocked. Whenever the exam is opened, the software automatically opens the viewers pages on the touch screens ETS15, which displays the viewer \u201cLive\u201d on the left side and the \u201cPanel acquire\u201d with all the acquisition settings, on the right side. The doctor monitors, instead, will display the 2 configured default viewers. From the \u201cPanel acquire\u201d the user should setup the: \u2022 desired body strict, selecting the correct body part and choosing among the available programs from the program list (which usually only contains a default program). if no body part has been selected and the emergency program is available, the software starts from the latter. desired recording mode among \u201clast frame\u201d only, meaning that only the last frame of each run will be saved, or \u201call frames\u201d, which produce a multi frame run. desired dose control: if low, medium, or high level dose. desired field of view: which is the viewing area of the detector. It can reduce or increased by a fixed percentage depending on what is the minimum and how many steps were configured. Or It can be adjusted moving the horizontal or vertical blades. Desired x-ray commands configured for each pedal: selecting the desired acquisition mode from the lists, as follows: 96 | P a g i n a","alien X \/ alien e 97 User manual Revision: 1.7.24 - 25.02.2021 the available acquisition modes depend on the anatomical program previously selected when opening the exam. Desired x-ray commands configured for each pedal button: selecting the desired one from the command lists, as follows: check the acquisition settings: increasing or decreasing the noise level, the frame rate for each available acquisition mode. First choose the acquisition mode from the acquisition mode list and then adjust its settings: As default the software automatically set the AEC as active. Therefore, the software is ready to start the acquisition as soon as the pedal is pressed, and automatically regulates the exposure parameters in order to meet the program settings configured. Once the x-ray commands have been correctly selected from the list, start the acquisition by pressing one of the two available pedals. The real-time image will immediately appear on the viewers touch screens ETS15 and doctor monitors, together with the exposure parameters computed by the software during the automatic exposure control (AEC). The system also constantly monitors the anode and housing temperatures and displays all the relevant information in the lower sub-panel on the touch screens ETS15 as well as on the doctor monitors: In order to change the projection, move the C-arm, following the instruction listed above. If the body district has to be changed the user should newly setup the acquisition settings starting from the top of the dotted list above described. 11.4 LOAD EXAM FROM DATABASE An exam might be loaded from local, extern or imported database. For a detailed description of how to use the Q\/R command please refer to the appropriate paragraph. In order to load an exam, follow the instructions described below: 97 | P a g i n a","alien X \/ alien e 98 User manual Revision: 1.7.24 - 25.02.2021 1. select the unit from which to retrieve the exams, choosing between local, imported or extern (optional \u2013 therefore not necessarily present). 2. insert patient information in order to speed up the searching process. Eventually delete all the patient information inserted and re-search results, if you entered wrong information, using the button. 3. press the query key and select the right exam\/s from the list resulting in the \u201cQuery results\u201d. To select the exam, click on the first column of the row corresponding to the desired exam\/s and it will be marked as checked (\u2713). To select\/unselect all use the buttons on the sides. 4. once at least one exam has been selected, the software will enable the import button. Therefore, click it in order to load it 5. at the end of the loading process, all the exams loaded are shown in the \u201cExams\u201d list. Therefore, select the desired exam by clicking anywhere on the proper row. The selection is represented as an highlighted row. 6. choose the desired run among the ones shown in the \u201cRun\u201d list. In this way the selected ones will be shown in the DVP viewers. 7. In order to unload an exam check (\u2713) the right row and use the unload key. 98 | P a g i n a","alien X \/ alien e 99 User manual Revision: 1.7.24 - 25.02.2021 8. If another exam is needed to be loaded, start again from point 1. 11.5 IMPORT EXAM To import Raw images from USB device it is possible: 1. Select the external unit from which to retrieve the exam. 2. Select local images to upload images in Raw format (only if exported from other Eurocolumbus machines). 3. Insert the USB device so that the desired images are accessible through the search button. 4. Select the desired exam and import it with the appropriate import button. 5. Then select the unit containing the imported exams, choose the exam just imported and load it using the appropriate button. 6. The imported series will be visible. Just select one to view it. 99 | P a g i n a","alien X \/ alien e 100 User manual Revision: 1.7.24 - 25.02.2021 The steps to import DICOM images are: 1. Select the external drive from which to recover the images. 2. Select to obtain DICOM images from a USB device. 3. Select the desired exam. Using the appropriate button it is possible to access the contents of the folder. 4. Using the same button in the DICOMDIR folder, you can access the DICOM images. To import the images, select them and press the import button. 5. Then select the unit containing the imported exams, choose the exam just imported and load it using the appropriate button. 6. The selection of the desired series allows its display. 100 | P a g i n a"]