www.siemens.

com/healthcare

Cios Alpha
Operator Manual

Answers for life.

Manufacturer’s notes:

This product is provided with a CE marking in accordance with the

regulations stated in Annex II of Directive 93/42/EEC of June 14th, 1993
concerning medical devices, as well as directive 2011/65/EU of June 8,
2011 regarding the restricted use of certain hazardous substances in
electrical and electronic equipment.

The CE marking applies only to medical devices which have been placed
on the market according to the above-mentioned EC Directive.

Unauthorized changes to this product invalidate this declaration.

Original language: English

Siemens Healthcare Headquarters Legal Manufacturer

Siemens Healthcare GmbH Siemens AG
Henkestr. 127 Wittelsbacherplatz 2
91052 Erlangen 80333 München
Germany Germany
Phone: +49 9131 84-0
siemens.com/healthcare

Print No. XPR2-400.620.30.01.02 | © Siemens Healthcare GmbH, 2015

www.siemens.com/healthcare
Cios Alpha
Operator Manual
 Legend

Indicates a hint
Is used to provide information on how to avoid operating errors or information emphasizing
important details

Indicates the solution of a problem

Is used to provide troubleshooting information or answers to frequently asked questions

Indicates a list item

Indicates a prerequisite
Is used for a condition that has to be fulfilled before starting a particular operation

Indicates a one-step operation

Indicates steps within operating sequences

Italic Is used for references and for table or figure titles

Is used to identify a link to related information as well as previous or next steps

Bold Is used to identify window titles, menu items, function names, buttons, and keys, for example,
the Save button

Blue Is used to emphasize particularly important sections of the text

UI text Is used for on-screen output of the system including code-related elements or commands

User text Is used to identify inputs you need to provide

Menu > Menu Item Is used for the navigation to a certain submenu entry

CAUTION
&$87,21
Used with the safety alert symbol, indicates a hazardous situation which, if not avoided, could
result in minor or moderate injury or material damage.
CAUTION consists of the following elements:
◾ Information about the nature of a hazardous situation

◾ Consequences of not avoiding a hazardous situation

◾ Methods of avoiding a hazardous situation

WARNING
:$51,1*
Indicates a hazardous situation which, if not avoided, could result in death or serious injury.
WARNING consists of the following elements:
◾ Information about the nature of a hazardous situation

◾ Consequences of not avoiding a hazardous situation

◾ Methods of avoiding a hazardous situation

4 Operator Manual
Print No. XPR2-400.620.30.01.02
 Table of contents

1 Introduction 7
1.1 Use of the Product 8
1.2 Information about this Operator Manual 10
1.3 Do you have any notes on this Operator Manual? 10

2 Safety 13
2.1 General Safety Information 15
2.2 Personal Safety 25
2.3 Equipment Safety 44

3 System Description 51
3.1 Device Description 53
3.2 System Operation 65
3.3 Emergency Situations 92

4 Examination 97
4.1 Safety information 99
4.2 Preparing the system 101
4.3 Patient registration 105
4.4 Defining the examination settings 115
4.5 Acquiring images 124
4.6 Ending the examination 133
4.7 Performing special examinations 135

5 Postprocessing 143
5.1 Patient data 145
5.2 2D image processing 154
5.3 Subtraction processing 178

6 Documentation 187
6.1 Filming/Printing 188
6.2 Exporting 191
6.3 Checking the data transfer 201
6.4 Reports 203

7 Configuration 207
7.1 User Settings 209
7.2 Examination settings (PEX Editor) 221

8 Maintenance 235
8.1 Functional and safety checks 236
8.2 Service via network connection 241
8.3 Cleaning and Disinfection 246
8.4 Protection classes/Protection measures 248
8.5 Active ingredient classes 248

9 Technical Specifications 249

9.1 Curves and diagrams 251

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 Table of contents

9.2 Notes on electromagnetic compatibility (EMC) 268

9.3 Original equipment manufacturer 272
9.4 System data 273
9.5 List of Standards 282
9.6 Labels 283

10 Options 291
10.1 System accessories 292

6 Operator Manual
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 Introduction 1

1 Introduction
1.1 Use of the Product 8
1.1.1 Intended use 8
Body region 8
1.1.2 Patient group 8
1.1.3 Contraindications 8
1.1.4 Physical functionality 8
1.1.5 User profile 8
Training 9
1.1.6 Conditions of use 9
Maintenance, cleaning and disinfection, service 9
1.1.7 Essential performance characteristics 9
1.1.8 Frequently-used operating functions 9
1.1.9 Operating functions regarding safety 9
1.2 Information about this Operator Manual 10
1.2.1 Names and parameters 10
1.2.2 Values 10
1.2.3 Layout conventions 10
1.3 Do you have any notes on this Operator Manual? 10

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 1 Introduction

1.1 Use of the Product

We welcome you as a user of the powerful Cios Alpha, the multifunctional C-
arm system from Siemens.

1.1.1 Intended use

The Cios Alpha mobile radiography system was developed for clinical
applications such as vascular, cardiac, traumatological, orthopedic, neurological,
endoscopic, urologic, and pain therapy procedures, as well as cholangiography
and pediatric examinations. It supports medical examinations through digital
imaging.
Body region
The systems are suitable for a large variety of clinical visualizations such as
◾ Visualization of bones
◾ Visualization of vessels, soft tissues
◾ Visualization of implants
◾ Visualization of surgical instruments

1.1.2 Patient group

In principle, the Cios Alpha can be used for examining all types of patients
without restriction. When using this system, the relevant applicable country-
specific requirements must be complied with.

1.1.3 Contraindications
Prior to the examination, it must be confirmed by a physician that an
examination is permissible and checked whether increased precautions are
necessary.

1.1.4 Physical functionality

The Cios Alpha X-ray system is a compact and powerful mobile X-ray system
with flat detector and digital image processing.
The system is equipped with a footswitch and a hand switch for the release of
radiation.
The following modes of operation are available in Cios Alpha for the broad
scope of applications: Single image radiography (Single Image), fluoroscopy
(Fluoro), subtraction (Sub), and roadmap (Road).

1.1.5 User profile

The system can be used properly only by suitably qualified medical personnel.
This requires operating personnel to be familiar with the Operator Manual. This
manual must be studied in detail prior to starting up the system. Special
attention must be given to the following sections:
◾ General Safety Information
◾ Personal safety

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 Introduction 1

◾ Equipment safety
◾ Maintenance
It is the responsibility of the system operator to ensure that operating personnel
are professionally and properly instructed.
As the manufacturer of the system, SIEMENS is not responsible for any impact
on its safety, reliability and performance if it is not used in accordance with the
Operator Manual.

 Please also read the supplements and addenda to the Operator Manual
necessitated by technical developments.

Training
It is recommended that operating personnel undergo application training prior
to using the system. This training can be conducted by Siemens employees.

1.1.6 Conditions of use

The digital Cios Alpha X-ray system is a mobile system that is designed for use in
the ER, OR, and in radiology and endoscopy departments of hospitals, clinics,
and outpatient practices. The applicable country-specific requirements must be
observed when using the system.
The system is suited for operation on hospital networks (IEC 60601-1 Chap.
14.13 IT security statement). For more information, see the technical
documentation.
Maintenance, cleaning and disinfection, service
See ( Page 235 Maintenance).

1.1.7 Essential performance characteristics

See ( Page 249 Technical Specifications).

1.1.8 Frequently-used operating functions

◾ System On/Off
◾ Patient registration
◾ Selecting the operating mode
◾ Acquiring X-ray images
◾ Processing X-ray images (Postprocessing/Adding comments)
◾ Saving/archiving studies locally or to a PACS

1.1.9 Operating functions regarding safety

◾ Emergency stop function (Emergency stop button)
◾ Radiation protection (Collimator function)
◾ Moving the C-arm

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 1 Introduction

1.2 Information about this Operator Manual

1.2.1 Names and parameters

All names and data on patients and equipment that are used as examples in this
Operator Manual are entirely fictional.
Any resemblance to names of real persons and institutions is entirely
coincidental.
All parameters and images shown in this Operator Manual are examples. Only
the parameters displayed by your system are definite.

1.2.2 Values
All numbers specified are typical values unless specific tolerances are indicated.

1.2.3 Layout conventions

The Operator Manual has several registers. A detailed table of contents listing all
chapters contained in the manual is provided at the beginning.
Certain sections of text are marked with symbols to help you quickly identify the
information content of the text.
See ( Page 4 Legend).

1.3 Do you have any notes on this Operator Manual?

Your opinion matters a lot to us!
We make every effort to continuously improve our product documentation.
Therefore, we would like to offer you the opportunity to give us your direct
feedback concerning your requests, suggestions and criticism with respect to
this Operator Manual.
◾ For feedback by fax, please use the following fax number:
+49 9131/84-2378
◾ If you prefer notification by e-mail, please send your feedback to:
[email protected]
When contacting us please refer to the entire print number shown in the
footer of this page.
Thank you very much for supporting us in our efforts to improve our products.

10 Operator Manual
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 Introduction 1

My notes

Optional information

Name

Hospital

City/Country

E-mail

Telephone/Fax

Number of fax pages

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 Safety 2

2 Safety
2.1 General Safety Information 15
2.1.1 Laws and regulations 15
2.1.2 Range of application 15
2.1.3 Using the system 15
2.1.4 Software 16
2.1.5 Potential equalization 16
2.1.6 Electromagnetic compatibility 17
2.1.7 Use in connection with high frequency 17
2.1.8 Maintenance and inspection 17
Wear and tear 17
Image quality 18
Calibration 18
Performing maintenance 18
2.1.9 Malfunctions 18
Error messages at the C-arm system 18
System messages on the monitor 19
Handling error messages 20
2.1.10 Malfunction of electrical systems 21
System failure 21
Switching to emergency power supply 22
Disconnecting the power plug 22
2.1.11 EMERGENCY STOP 22
Press the EMERGENCY STOP button 22
Unlocking the EMERGENCY STOP button 23
2.1.12 Fire protection 23
2.1.13 Explosion protection 24
2.1.14 Overload protection 24
2.2 Personal Safety 25
2.2.1 Open heart and skull examinations 25
2.2.2 Crushing hazards on the C-arm system 25
2.2.3 Mechanical damage 27
2.2.4 Radiation protection 27
For the patient 27
For the operating personnel 27
For patients and operating personnel 27
Deterministic radiation effect 28
Location and size of the relevant operating areas 29
Radiation interruption for all operating modes 43
2.3 Equipment Safety 44
2.3.1 Mechanical safety 44
2.3.2 Positioning the C-arm 44
Brakes 44
Transport 44
2.3.3 Installation, repair 45
2.3.4 Original accessories 45
2.3.5 Combination with other systems 46

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2.3.6 Attachment of dedicated options 46

General safety requirements 46
Attenuation equivalent 46
Weight counterbalance 47
Image quality 47
Electrical safety 47
Electromagnetic compatibility 47
Attaching navigation systems 47
Additional safety information 49
2.3.7 Disposal 49

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 Safety 2

2.1 General Safety Information

2.1.1 Laws and regulations

If legally binding regulations govern the installation and/or operation of the
system, it is the responsibility of the installer and/or the operator to observe
these regulations.
Regulations required by law and the radiation protection regulations must be
observed in all countries. Deviating from this Operator Manual, values may be
set according to country-specific regulations.
The product bears a CE mark in accordance with the provisions of Directive
93/42/EEC dated June 14, 1993 on medical devices as well as Directive
2011/65/EU dated June 8 2011 on the restricted use of certain hazardous
substances in electrical and electronic devices.
Data related to individual persons are subject to data protection. Please comply
with the applicable legal regulations.
Legally required tests must be performed at the specified intervals. These tests
include, for example,
◾ Constancy test according to the X-ray ordinance (§16 RöV) in the Federal
Republic of Germany.
◾ Tests based on DHHS guidelines (Department of Health and Human Services)
where applicable.

2.1.2 Range of application

This Operator Manual is valid for the following product:
◾ Cios Alpha

2.1.3 Using the system

 CAUTION

Improper use of the system beyond its intended use.

Risk to the patient and user!
◆ The system may only be used as defined by its intended use for clinical
applications.

 CAUTION

System operation by untrained users.

Risk of improper operation due to misinterpretation of image
information.
◆ Only persons with the required knowledge and expertise who have
undergone the appropriate user training may work with the system.

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 2 Safety

 CAUTION

Occurrence of audible signals.

Hazards possible, for example due to crushing risks, extended
radiation release, and high dose rate.
◆ Please note that continued system operation may lead to one of these
hazards.
◆ Use the system with extreme caution to avoid these hazards.

2.1.4 Software
The system and user software used in this product is protected by copyright. The
current software version is displayed on screen during system start-up.

 CAUTION

Use of unreleased or altered software or hardware components.

Risk of malfunction that could endanger the patient or product.
◆ Only use Siemens-authorized software and hardware components.
◆ Only perform repairs, or have them performed by an authorized third
party, after having received our express written approval.

 CAUTION

Unauthorized or incorrect alterations/changes of the software or

connection of the system to a network.
Risk of unauthorized access.
◆ Make sure that all necessary precautions are taken with regard to the
applicable security level if a functionality is added or the configuration
of the condition on delivery is changed.

 CAUTION

Unauthorized changes or interventions in the imaging system.

No or improper function of the imaging system.
◆ Do not perform any changes or interventions of any type on the imaging
system without the written consent of Siemens Healthcare (supplier).
This includes replacing hardware or installing and running additional
software.

2.1.5 Potential equalization

Products for which equipotential bonding is required may only be operated in
medical facilities where supplementary equipotential bonding has been
installed and tested according to DIN VDE 0107/10.94 section 4 for Germany or
the relevant country-specific regulations.

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 Safety 2

2.1.6 Electromagnetic compatibility

This medical device complies with the requirements of the applicable standard
on electromagnetic compatibility (EMC). See ( Page 268 Notes on
electromagnetic compatibility (EMC))
Please be advised that other mobile electronic devices, e.g. cellular telephones,
exceeding the established emissions limits in the EMC standard may disrupt the
functions of your medical device.

 CAUTION

Interference.
Impact on the patient's electronic life-sustaining systems.
◆ In case of unusual system behavior (performance characteristics),
additional measures (adjustment, repositioning) may be required.

2.1.7 Use in connection with high frequency

The following regulations for use must be observed:
◾ IEC/TR 1289-1/07.94/
High frequency surgical equipment - Part 1: Operation
◾ IEC/TR 1289-2/08.94/
High frequency surgical equipment - Part 2: Maintenance

2.1.8 Maintenance and inspection

Before using the equipment for examination, the user must ascertain that all
safety-relevant devices function properly and that the system is ready for
operation.
Wear and tear
The system is subject to mechanical and electrical wear and tear. In the interest
of the safety of patients, operating personnel and third persons, maintenance
and safety checks must be carried out every 24 months to maintain the
operational safety and reliability of the product.

 CAUTION

Wear and tear.

Risk of injury to the patient, operating personnel, and other persons.
Permanent damage to the system.
◆ Follow the maintenance guidelines to maintain the safety and
functionality of the system.

 Please observe the relevant information in ( Page 235 Maintenance).

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Image quality
Maintenance should include checking the image quality. Maintenance at regular
intervals is recommended to always ensure best image quality.

To ensure optimal image quality, have the following functions checked in

 particular as part of regular maintenance:

Pixel shift, image rotation, noise reduction, edge enhancement,
subtraction, roadmapping, intraframe noise filter.

Calibration
Maintenance should include checking the flat detector calibration.

 CAUTION

Geometric calibration adjusted incorrectly.

Risk of incorrect evaluation.
◆ Perform calibrations on a regular basis.

Performing maintenance
Maintenance work should be performed by trained technical personnel only. If
you do not have a maintenance contract, please contact Siemens Customer
Service.
If national laws or regulations specify more frequent inspection and/or
maintenance, these must be observed.

2.1.9 Malfunctions
In the event of malfunctions of the Cios Alpha system, please call Siemens
Customer Service.
Error messages at the C-arm system
When a malfunction is detected, the Cios Alpha system is disabled. The problem
is shown as an error on all control units.

18 Operator Manual
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 Safety 2

A message window with additional explanations is also displayed on the left

monitor ( Page 19 System messages on the monitor).
System messages on the monitor
On the left monitor (upper left), three different types of system messages can
appear. The type of message is identified by a corresponding symbol (top left).

Error message:

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Warning:

Information:

Handling error messages

✓ An error message window is displayed.

Acknowledging error messages 1 Please read the error messages carefully. Use the scroll bars to display error
messages outside the area currently displayed.
2 Acknowledge the error message by clicking OK or pressing the footswitch or
hand switch.

 If you cannot continue with the normal examination mode, contact

Siemens Customer Service.

Repeatedly occurring errors If errors occur repeatedly, switch off the Cios Alpha and notify Customer Service.
Save the log file with the logged system activities beforehand:
1 Right-click this icon on the lower left of the left monitor.
2 In the dialog box, select the storage destination (USB and/or local storage for
analysis via remote diagnostics) and confirm with OK.
3 Additionally, write down the following information:
Error number and time when error occurred.
Operating mode selected.
Was radiation activated when the error occurred?
Is the error related to an operating process?

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 Safety 2

4 In the case of a malfunction or failure of the radiation indicator, please notify

Siemens Customer Service.

2.1.10 Malfunction of electrical systems

In case of risks for patients and operators (e.g. if there is no live image on the
monitor and the radiation indicator is on despite this) or in case of risks for the
device, you must disconnect the power plug immediately. Cios Alpha is
completely shut down and disconnected from line power. This
◾ switches off radiation
◾ aborts the current system program
◾ aborts and cancels current operating sequences
◾ deletes all image information not saved to a hard disk

 CAUTION

Technical error.
Unintentional radiation release.
◆ If the unintentional radiation release cannot be ended with the
EMERGENCY STOP button, press the off switch to shut down the entire
system.

Only after the cause of the hazard has been clearly identified and remedied may
the system be reconnected to the power supply. In all other cases, e.g. system
malfunction, contact Siemens Customer Service immediately.

 CAUTION

Failure of LED indicators on the control panel.

Treatment not possible.
◆ Perform the daily function check of the LED indicators before beginning
treatment.
◆ If an LED indicator fails, contact Siemens Customer Service.

System failure
The user must have a replacement unit available if a system failure could
predictably cause a critical situation resulting in patient injury during a medical
examination.

 CAUTION

System component failure during cardiac/vascular procedure.

Risk of injury to the patient!
◆ Prepare a reserve system during cardiac/vascular applications.

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 2 Safety

 CAUTION

Due to the complexity of the system or if the line voltage is outside of the
designated specification, the loss of X-ray imaging or other system
functions during an examination cannot be entirely excluded.
Imaging is delayed or not possible at all, resulting in suboptimal
treatment.
◆ For this reason, establishing emergency procedures for such cases
should be considered.

Switching to emergency power supply

In the event of a power interruption of longer than 10 ms, the Cios Alpha
switches off. In this case the Cios Alpha must be switched on again after the
system has switched over to the emergency power supply.
Disconnecting the power plug
After the power plug is disconnected, the uninterruptible power supply (UPS)
supplies voltage to the imaging system and the left-hand monitor until the Cios
Alpha switches off completely.

 CAUTION

Unsuitable devices connected to the UPS.

Risk of electrical shock or damage to the system.
◆ Do not attach additional devices to the UPS sockets.

2.1.11 EMERGENCY STOP

Press the EMERGENCY STOP button
Immediately press the red EMERGENCY STOP button (arrow) on the C-arm
system control unit at the first sign of a dangerous situation resulting from
motorized movement.
◾ Motorized vertical lift and motorized orbital and angular movements are
disabled immediately.
◾ The electromechanical brakes are locked.
◾ Active radiation is terminated.
◾ All other system functions remain unaffected by this.

 CAUTION

Manual or motorized movements.

Risk of crushing and collision for persons and objects in the vicinity of
moving parts.
◆ Check the EMERGENCY STOP function a daily basis.

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 Safety 2

 CAUTION

Position of EMERGENCY STOP button not known.

In an emergency, the EMERGENCY STOP button will not be actuated in
a timely manner.
◆ Make sure you know where the EMERGENCY STOP buttons are located.
EMERGENCY STOP buttons are in the following locations (see the
figure).

Emergency Stop button


If during an examination an error occurs and radiation cannot be
interrupted by releasing the trigger switch, press the EMERGENCY STOP
button on the chassis of the C-arm system.

Unlocking the EMERGENCY STOP button

Unlock the button only after the danger has clearly been eliminated.
◆ To unlock the button, gently turn it clockwise so that it pops back out.

2.1.12 Fire protection

 CAUTION

Fire in or near the system.

Injury to patient and personnel, and damage to device. Risk of gas
poisoning due to burning plastic.
◆ In case of fire switch off the system.
◆ Be aware of and inform patients of escape routes.
◆ Be aware of where fire extinguishers are located and know how to use
them.

Please inform our Customer Service prior to starting up the Cios Alpha again if
repair work has to be performed due to the fire.

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2.1.13 Explosion protection

 CAUTION

The system is not designed for operation in areas where there is an

explosion hazard. The system does not meet the requirements for AP/APG
classification.
Explosion hazard!
◆ The system may not be used in locations where explosive atmospheres
may occur.

2.1.14 Overload protection

Prolonged continuous radiation at maximum tube load is possible in fluoroscopy
mode. However, this can cause the X-ray tube assembly and C-arm to heat up.
For this reason, the X-ray tube assembly and C-arm have a thermal monitor. If
the X-ray tube assembly is too warm, there may be a reduction in pulse rate if
necessary in all operating modes beginning with the next scene. If the C-arm
temperature rises to ≥ 40 °C, the following message is displayed:

When Yes is selected, the C-arm temperature can rise to 48 °C. This extends
system availability. There is no impact on function until 48 °C is reached.

When No is selected, the maximum permitted temperature for the C-arm (41 °C)
is not increased. This causes the device to reach maximum temperature sooner
and reduce the frame rate sooner.

 CAUTION

Defect in the radiation generation cooling system.

Risk of burns!
◆ Before beginning the examination, perform the daily function and safety
checks.

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 Safety 2

 CAUTION

Under extreme operating conditions (continuous operation), the X-ray

tube can become very hot.
Risk of burns!
◆ Avoid touching the X-ray tube housing.

A constant X-ray tube load can lead to temperature-related cutoff of the

radiation. Please make sure that the system has cooled down before
performing critical interventional applications. We also recommend keeping

 a second system ready for continuous radiation lasting longer than 30

minutes.
In the rare event image display is delayed due to high system utilization,
radiation is automatically turned off. To continue treatment, radiation
release has to be actuated again.

 If the Radiography mode is misused on purpose by the operator for real-

time imaging, the image display delay may be longer than in Radioscopy.

2.2 Personal Safety

2.2.1 Open heart and skull examinations

If an approved system is used alone or with other equipment for open heart or
open skull examinations, a conductive connection must be made between the
system and a potential equalization point, e.g. the tabletop.
( Page 67 Establishing the equipotential bonding connection)
Only then can the patient be connected to the system.

2.2.2 Crushing hazards on the C-arm system

Correct handling of the C-arm system requires that operating personnel and
patients use only the handles provided for this purpose. Where this is not
possible, monitor the points of potential crush injury between movable system
parts and their guide openings.

 CAUTION

The distance between the patient or other persons and the system is too
small.
Risk of crushing!
◆ Use the system only if the patient and other persons can be observed
during movements.

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 CAUTION

The points marked on the figure indicate hazardous locations around the
system.
Risk of injury to the patient and personnel due to crushing or collision.
◆ Be careful around the hazardous locations indicated.

 CAUTION

The distance between the handles and other components is too small.
Risk of crushing!
◆ Be careful around the hazardous locations indicated.

 CAUTION

Movements of the C-arm during patient positioning.

Crushing hazard for the patient!
◆ Be careful around the hazardous locations indicated.

Hazardous locations during C-arm movements

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 Safety 2

2.2.3 Mechanical damage

To avoid injury to the patient, operating personnel or third parties, mechanical
damage to the system must be repaired by authorized service personnel.

2.2.4 Radiation protection

The unit is intended for procedures that may involve high skin doses when it is
used as intended (mainly due to the long examination times), which presents a
risk of radiation injury.
Therefore observe the following important notes in order to keep the dose
absorbed by the patient as low as possible.
For the patient
◾ Keep the radiation field as small as possible without reducing the active
measuring field.
◾ If possible, ensure the best possible protection of the patient during
fluoroscopy and acquisitions in the vicinity of his or her reproductive organs
(use gonadal shields, ovarian shields and lead rubber covers).
◾ Remove all radiopaque parts from the fluoroscopy field or field of view, if
possible.
◾ Set the voltage of the X-ray tube as high as necessary (note the image
quality, however).
For the operating personnel
◾ Wear protective clothing in the control area during an examination:
Depending on the application involved, the use of lead vests, lead jackets, X-
ray protection goggles, sternum protection and protective gloves is
recommended.
For patients and operating personnel
◾ Keep the fluoroscopic time as short as possible.
◾ Set the tube-skin distance as high as can be justified for the respective
examination.

 CAUTION

Because of a technical error the acquisition is not stopped or there is an

unintended release of radiation.
Risk of unnecessary radiation exposure!
◆ In the event of unwanted radiation, press the nearest EMERGENCY STOP
button.

 CAUTION

Failure of radiation indicator.

Danger of unintended radiation!
◆ If a radiation indicator fails contact Siemens Customer Service.

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 CAUTION

Additional objects in the beam path.

Risk of unnecessary radiation exposure!
◆ Note that additional objects in the beam path increase scatter radiation.

Please be aware that certain materials in the X-ray beam (e.g. parts of an


operating table) may impair the X-ray image due to imaging of contours
and inclusions in these materials. In certain rare cases, this may lead to
incorrect diagnosis. This material may also result in higher radiation
exposure.

Cios Alpha contains no patient positioning aids. Therefore, undertable

 radiation protection options are not included in the scope of supply. For
example, overhanging lead rubber mats can be used to protect against
scattered radiation underneath the patient table.

Deterministic radiation effect

As per IEC 60601-1-3, 5.2.4.5 (A.2), deterministic radiation injury is possible if a
radiation dose delivered to an organ or tissue exceeds a value of 1 to 3 grays.
With typical applications and proper use of the C-arm, there is no reason to
expect such radiation injuries. It is assumed that the maximum fluoroscopic
time will not exceed 20 minutes, depending on the application, and that the
point of skin penetration will be 30 cm (50 cm maximum) away from the
detector input.
Example: An accumulated fluoroscopic time of 20 minutes and a skin
penetration dose of 20 mGy/min yields a dose of 400 mGy.
In the medical disciplines of vascular and cardiac surgery in particular, several
applications require a significantly higher radiation time of up to 60 minutes.
Example: When treating an abdominal aortic aneurysm (AAA) with the
Endovascular Aortic Repair (EVAR) procedure, the administered radiation dose
can exceed 1 Gy. The average radiation dose when using this method is usually
less than 500 mGy.
For procedures with a longer than expected radiation time, we recommend
varying the beam direction (oblique beam through orbital and/or angular
rotation) during the course of the procedure. In addition, the system reports the
beam duration that has already been applied (regardless of applied dose).
The skin penetration dose for various operating modes and under standard
operating conditions can be estimated using the "Dosimetric information" table
( Page 257 Dosimetric information).

When changing the distance from the skin penetration point to the focus,

 please note that the skin dose decreases with the inverse square of the
distance to the focus. This means that when the distance to the focus is
halved, the skin penetration dose rate quadruples.

28 Operator Manual
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 Safety 2

 CAUTION

Remaining in hazardous area.

Danger of inadvertent radiation!
◆ During radiation release, make sure you are in a location subject to as
little radiation as possible.

Location and size of the relevant operating areas

All examination types may be performed in the illustrated operating areas of the
X-ray system.

X-ray tube assembly at the bottom

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Maximum scatter radiation in Scatter radiation in the main operating area according to EN 60601-1-3
operating area

Height above the Measurement A1 Measurement A2 Measurement B1 Measurement B2

floor [cm] [mGy/h] [mGy/h] [mGy/h] [mGy/h]

10 1.70 1.76 0.02 0.83

20 1.87 1.85 0.03 0.84

30 2.23 1.95 0.04 0.89

40 2.30 2.58 0.07 0.93

50 2.67 2.95 0.08 0.96

60 3.56 4.29 0.04 1.00

70 4.55 5.33 0.04 1.07

80 5.06 6.27 0.07 1.08

90 5.54 7.12 0.15 1.05

100 5.72 7.70 0.19 0.99

110 5.66 7.50 0.18 0.89

120 5.28 5.42 0.15 0.78

130 4.26 4.13 0.14 0.71

140 3.24 2.98 0.14 0.70

150 2.09 1.60 0.14 0.64

160 1.06 0.99 0.12 0.57

170 0.52 0.68 0.11 0.47

180 0.38 0.50 0.11 0.40

190 0.31 0.37 0.11 0.32

200 0.28 0.30 0.11 0.25

Tolerance of air kerma measurements ± 5%

◾ Measurement A1: Operating area A1
Fluoroscopy 125 kV, 20 mA, 13.3 ms, 15 p/s, 18 cm x 18 cm; C-arm vertical,
X-ray tube assembly at the bottom, with scattered radiation grid
◾ Measurement A2: Operating area A2
Fluoroscopy 125 kV, 20 mA, 13.3 ms, 15 p/s, 18 cm x 18 cm; C-arm vertical,
X-ray tube assembly at the bottom, with scattered radiation grid
◾ Measurement B1: Operating area B1
Fluoroscopy 125 kV, 20 mA, 13.3 ms, 15 p/s, 18 cm x 18 cm; C-arm vertical,
X-ray tube assembly at the bottom, with scattered radiation grid

30 Operator Manual
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 Safety 2

◾ Measurement B2: Operating area B2

Fluoroscopy 125 kV, 20 mA, 13.3 ms, 15 p/s, 18 cm x 18 cm; C-arm vertical,
X-ray tube assembly at the bottom, with scattered radiation grid

(1) Measurement A
(2) Measurement B

Measurement A
◾ Measurement A1
Fluoroscopy 125 kV, 20 mA, 13.3 ms, 15 p/s, 18 cm x 18 cm
◾ Measurement A2
Fluoroscopy 125 kV, 20 mA, 13.3 ms, 15 p/s, 18 cm x 18 cm
Measurement B
◾ Measurement B1
Fluoroscopy 125 kV, 20 mA, 13.3 ms, 15 p/s, 18 cm x 18 cm
◾ Measurement B2
Fluoroscopy 125 kV, 20 mA, 13.3 ms, 15 p/s, 18 cm x 18 cm

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X-ray tube assembly at the top

Maximum scatter radiation in Scatter radiation in the main operating area according to EN 60601-1-3
operating area

Height above the Measurement A1 Measurement A2 Measurement B1 Measurement B2

floor [cm] [mGy/h] [mGy/h] [mGy/h] [mGy/h]

10 0.48 0.59 0.02 0.48

20 0.57 0.84 0.02 0.54

30 1.19 1.26 0.02 0.60

40 2.18 1.45 0.03 0.67

32 Operator Manual
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Height above the Measurement A1 Measurement A2 Measurement B1 Measurement B2

floor [cm] [mGy/h] [mGy/h] [mGy/h] [mGy/h]

50 3.03 4.20 0.03 0.72

60 3.38 5.82 0.03 0.73

70 4.27 7.47 0.03 0.78

80 5.12 9.34 0.04 0.89

90 5.52 9.05 0.08 0.97

100 5.52 8.16 0.15 1.03

110 4.53 7.06 0.20 1.04

120 4.16 6.06 0.20 1.02

130 3.33 4.82 0.20 0.98

140 2.54 3.65 0.21 0.90

150 2.28 3.01 0.22 0.87

160 2.04 2.40 0.23 0.81

170 1.65 1.95 0.24 0.76

180 1.52 1.58 0.23 0.71

190 1.26 1.39 0.23 0.66

200 1.08 1.16 0.23 0.61

Tolerance of air kerma measurements ± 5%

◾ Measurement A1: Operating area A1
Fluoroscopy 125 kV, 20 mA, 13.3 ms, 15 p/s, 18 cm x 18 cm; C-arm vertical,
X-ray tube assembly at the top, with scattered radiation grid
◾ Measurement A2: Operating area A2
Fluoroscopy 125 kV, 20 mA, 13.3 ms, 15 p/s, 18 cm x 18 cm; C-arm vertical,
X-ray tube assembly at the top, with scattered radiation grid
◾ Measurement B1: Operating area B1
Fluoroscopy 125 kV, 20 mA, 13.3 ms, 15 p/s, 18 cm x 18 cm; C-arm vertical,
X-ray tube assembly at the top, with scattered radiation grid
◾ Measurement B2: Operating area B2
Fluoroscopy 125 kV, 20 mA, 13.3 ms, 15 p/s, 18 cm x 18 cm; C-arm vertical,
X-ray tube assembly at the top, with scattered radiation grid

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(1) Measurement A
(2) Measurement B

Measurement A
◾ Measurement A1
Fluoroscopy 125 kV, 20 mA, 13.3 ms, 15 p/s, 18 cm x 18 cm
◾ Measurement A2
Fluoroscopy 125 kV, 20 mA, 13.3 ms, 15 p/s, 18 cm x 18 cm
Measurement B
◾ Measurement B1
Fluoroscopy 125 kV, 20 mA, 13.3 ms, 15 p/s, 18 cm x 18 cm
◾ Measurement B2
Fluoroscopy 125 kV, 20 mA, 13.3 ms, 15 p/s, 18 cm x 18 cm

34 Operator Manual
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Detector, lateral 42°

Maximum scatter radiation in Scatter radiation in the main operating area according to EN 60601-1-3
operating area

Height above the Measurement A1 Measurement A2 Measurement B1 Measurement B2

floor [cm] [mGy/h] [mGy/h] [mGy/h] [mGy/h]

10 0.74 1.03 0.02 0.46

20 0.77 1.11 0.02 0.50

30 0.87 1.39 0.02 0.53

40 0.97 1.76 0.04 0.56

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Height above the Measurement A1 Measurement A2 Measurement B1 Measurement B2

floor [cm] [mGy/h] [mGy/h] [mGy/h] [mGy/h]

50 1.09 2.28 0.08 0.57

60 1.22 2.99 0.07 0.58

70 1.33 4.01 0.03 0.62

80 1.41 5.38 0.02 0.70

90 1.52 6.99 0.03 0.78

100 1.60 8.53 0.03 0.85

110 1.68 9.15 0.03 0.87

120 1.79 8.26 0.03 0.85

130 1.81 6.58 0.03 0.78

140 1.75 4.90 0.04 0.70

150 1.53 3.63 0.04 0.62

160 1.55 2.72 0.10 0.55

170 1.48 2.10 0.14 0.52

180 1.22 1.61 0.13 0.50

190 1.04 1.30 0.13 0.48

200 0.89 1.04 0.12 0.43

Tolerance of the air kerma measurements ± 5%

◾ Measurement A1: Operating area A1
Fluoroscopy 125 kV, 20 mA, 13.3 ms, 15 p/s, 18 cm x 18 cm; C-arm lateral
42°, X-ray tube assembly at lateral 42° position, with scattered radiation grid
◾ Measurement A2: Operating area A2
Fluoroscopy 125 kV, 20 mA, 13.3 ms, 15 p/s, 18 cm x 18 cm; C-arm lateral
42°, X-ray tube assembly at lateral 42° position, with scattered radiation grid
◾ Measurement B1: Operating area B1
Fluoroscopy 125 kV, 20 mA, 13.3 ms, 15 p/s, 18 cm x 18 cm; C-arm lateral
42°, X-ray tube assembly at lateral 42° position, with scattered radiation grid
◾ Measurement B2: Operating area B2
Fluoroscopy 125 kV, 20 mA, 13.3 ms, 15 p/s, 18 cm x 18 cm; C-arm lateral
42°, X-ray tube assembly at lateral 42° position, with scattered radiation grid

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(1) Measurement A
(2) Measurement B

Measurement A
◾ Measurement A1
Fluoroscopy 125 kV, 20 mA, 13.3 ms, 15 p/s, 18 cm x 18 cm
◾ Measurement A2
Fluoroscopy 125 kV, 20 mA, 13.3 ms, 15 p/s, 18 cm x 18 cm
Measurement B
◾ Measurement B1
Fluoroscopy 125 kV, 20 mA, 13.3 ms, 15 p/s, 18 cm x 18 cm
◾ Measurement B2
Fluoroscopy 125 kV, 20 mA, 13.3 ms, 15 p/s, 18 cm x 18 cm

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X-ray tube assembly lateral 45°

Maximum scatter radiation in Scatter radiation in the main operating area according to EN 60601-1-3
operating area

Height above the Measurement A1 Measurement A2 Measurement B1 Measurement B2

floor [cm] [mGy/h] [mGy/h] [mGy/h] [mGy/h]

10 0.96 1.16 0.02 0.52

20 0.98 1.28 0.02 0.54

30 1.10 1.57 0.03 0.59

40 1.28 1.97 0.04 0.63

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 Safety 2

Height above the Measurement A1 Measurement A2 Measurement B1 Measurement B2

floor [cm] [mGy/h] [mGy/h] [mGy/h] [mGy/h]

50 1.53 2.63 0.05 0.63

60 1.77 3.94 0.07 0.70

70 2.64 6.32 0.09 0.77

80 2.30 8.83 0.12 0.84

90 1.95 9.95 0.15 0.90

100 2.01 10.68 0.14 0.88

110 1.84 10.89 0.14 0.79

120 1.74 10.08 0.13 0.66

130 1.66 8.04 0.13 0.59

140 1.54 5.51 0.12 0.54

150 1.35 3.45 0.12 0.47

160 1.15 2.17 0.12 0.41

170 0.97 1.66 0.11 0.36

180 0.82 1.30 0.11 0.31

190 0.53 1.04 0.09 0.27

200 0.37 0.82 0.05 0.25

Tolerance of air kerma measurements ± 5%

◾ Measurement A1: Operating area A1
Fluoroscopy 125 kV, 20 mA, 13.3 ms, 15 p/s, 18 cm x 18 cm; C-arm vertical,
X-ray tube assembly at lateral 45° position, with scattered radiation grid
◾ Measurement A2: Operating area A2
Fluoroscopy 125 kV, 20 mA, 13.3 ms, 15 p/s, 18 cm x 18 cm; C-arm vertical,
X-ray tube assembly at lateral 45° position, with scattered radiation grid
◾ Measurement B1: Operating area B1
Fluoroscopy 125 kV, 20 mA, 13.3 ms, 15 p/s, 18 cm x 18 cm; C-arm vertical,
X-ray tube assembly at lateral 45° position, with scattered radiation grid
◾ Measurement B2: Operating area B2
Fluoroscopy 125 kV, 20 mA, 13.3 ms, 15 p/s, 18 cm x 18 cm; C-arm vertical,
X-ray tube assembly at lateral 45° position, with scattered radiation grid

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(1) Measurement A
(2) Measurement B

Measurement A
◾ Measurement A1
Fluoroscopy 125 kV, 20 mA, 13.3 ms, 15 p/s, 18 cm x 18 cm
◾ Measurement A2
Fluoroscopy 125 kV, 20 mA, 13.3 ms, 15 p/s, 18 cm x 18 cm
Measurement B
◾ Measurement B1
Fluoroscopy 125 kV, 20 mA, 13.3 ms, 15 p/s, 18 cm x 18 cm
◾ Measurement B2
Fluoroscopy 125 kV, 20 mA, 13.3 ms, 15 p/s, 18 cm x 18 cm

40 Operator Manual
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 Safety 2

X-ray tube assembly horizontal

Maximum scatter radiation in Scatter radiation in the main operating area according to EN 60601-1-3
operating area

Height above the Measurement A1 Measurement A2 Measurement B1 Measurement B2

floor [cm] [mGy/h] [mGy/h] [mGy/h] [mGy/h]

10 1.20 1.63 0.05 1.15

20 1.26 1.86 0.05 1.17

30 1.45 2.39 0.10 1.23

40 1.64 3.17 0.17 1.25

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 2 Safety

Height above the Measurement A1 Measurement A2 Measurement B1 Measurement B2

floor [cm] [mGy/h] [mGy/h] [mGy/h] [mGy/h]

50 1.85 4.18 0.27 1.30

60 2.05 5.52 0.23 1.34

70 2.17 7.38 0.18 1.35

80 2.70 9.85 0.24 1.33

90 3.16 12.69 0.33 1.28

100 2.57 13.33 0.35 1.20

110 1.14 11.71 0.34 1.15

120 0.56 9.75 0.34 1.08

130 0.48 4.89 0.33 0.98

140 0.41 2.14 0.31 0.86

150 0.36 1.18 0.28 0.73

160 0.27 0.79 0.26 0.63

170 0.18 0.57 0.22 0.52

180 0.12 0.44 0.18 0.44

190 0.09 0.37 0.11 0.38

200 0.06 0.30 0.07 0.32

Tolerance of air kerma measurements ± 5%

◾ Measurement A1: Operating area A1
Fluoroscopy 125 kV, 20 mA, 13.3 ms, 15 p/s, 18 cm x 18 cm; C-arm
horizontal, detector at lateral 90° position, with scattered radiation grid
◾ Measurement A2: Operating area A2
Fluoroscopy 125 kV, 20 mA, 13.3 ms, 15 p/s, 18 cm x 18 cm; C-arm
horizontal, detector at lateral 90° position, with scattered radiation grid
◾ Measurement B1: Operating area B1
Fluoroscopy 125 kV, 20 mA, 13.3 ms, 15 p/s, 18 cm x 18 cm; C-arm
horizontal, detector at lateral 90° position, with scattered radiation grid
◾ Measurement B2: Operating area B2
Fluoroscopy 125 kV, 20 mA, 13.3 ms, 15 p/s, 18 cm x 18 cm; C-arm
horizontal, detector at lateral 90° position, with scattered radiation grid

42 Operator Manual
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 Safety 2

(1) Measurement A
(2) Measurement B

Measurement A
◾ Measurement A1
Fluoroscopy 125 kV, 20 mA, 13.3 ms, 15 p/s, 18 cm x 18 cm
◾ Measurement A2
Fluoroscopy 125 kV, 20 mA, 13.3 ms, 15 p/s, 18 cm x 18 cm
Measurement B
◾ Measurement B1
Fluoroscopy 125 kV, 20 mA, 13.3 ms, 15 p/s, 18 cm x 18 cm
◾ Measurement B2
Fluoroscopy 125 kV, 20 mA, 13.3 ms, 15 p/s, 18 cm x 18 cm
Radiation interruption for all operating modes
The hand switches and footswitches are designed as pushbutton switches.
Radiation is interrupted in fluoroscopy when releasing the corresponding
operating element or, in other operating modes, after acquiring the stored
image.

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2.3 Equipment Safety

2.3.1 Mechanical safety

 CAUTION

System component error.

An error on one system component can reduce the safety of the entire
system.
◆ Terminate system operation.
◆ Contact Siemens Customer Service.

 CAUTION

Image intensifier housing or detector cover damaged.

Toxic contamination!
◆ If the image intensifier housing or the detector is damaged, do not
continue using it.
◆ Contact Siemens Customer Service.

 CAUTION

Spindle nut broken or worn.

Risk of crushing!
◆ Vertical lift is blocked if the mechanical safeguard was triggered.
Contact Siemens Customer Service to replace the mechanical safeguard.

2.3.2 Positioning the C-arm

In case of improper handling of the , the mobility of the C-arm may lead to
collisions of the detector and the single tank with the patient and the patient
table.
Brakes
Make sure the brakes are applied after adjusting the C-arm position.
Transport
When moving or transporting the C-arm system please take special care that the
system parts do not collide with an obstacle. This could also result in accidental
radiation release or an impairment of image quality under certain
circumstances.

44 Operator Manual
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 Safety 2

 CAUTION

Transport damage.
Risk of injury!
◆ If repairs are not done by a professional, injuries to the user, patient or
third parties and consequential product damage cannot be ruled out.

2.3.3 Installation, repair

Modifications of or additions to the product must be made in accordance with
the legal regulations and generally accepted engineering standards.
As the manufacturer, Siemens cannot accept responsibility for the safety
features and for the reliability and performance of the equipment if:
◾ The product is used in a manner other than that specified in the Operator
Manual
◾ Installation, upgrades, readjustments, modifications or repairs are performed
by personnel not contracted and authorized by Siemens
◾ Components affecting safe operation of the product are not replaced by
original spare parts in the event of a malfunction
◾ The electrical wiring in the room containing the system does not meet the
specifications of DIN VDE 0107 or the corresponding local regulations
If desired, we will provide the technical documentation for the product.
However, this does not imply authorization to undertake repairs.
We cannot be held responsible for repairs made without our express written
approval.
When any work is performed on the product, we recommend that you obtain a
certificate indicating the nature and scope of the work performed. The
certificate should include any changes in rated parameters or operating ranges
as well as the date, the name of the company and a signature.

2.3.4 Original accessories

For safety reasons, only approved original accessories or non-Siemens
accessories approved by Siemens Healthcare GmbH, may be used for this
product.
The operator is liable for any risks associated with the use of accessories not-
approved by Siemens.

 CAUTION

Inappropriate accessories.
The use of accessories that do not comply with the safety
requirements of this equipment can reduce the safety of the entire
system.
◆ Use only original Siemens accessories or accessories approved by
Siemens.

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2.3.5 Combination with other systems

To ensure the required safety, only products/components expressly approved by
Siemens Healthcare GmbH may be used in combination with this system.

 Please note that changes to the system may be carried out only with the
express authorization of Siemens Healthcare GmbH.

 Additional components placed into the beam path (e.g. positioning aids)
will attenuate radiation and can degrade image quality.

2.3.6 Attachment of dedicated options

The attachment of certain (dedicated) options is permitted only if the following
conditions are met:
General safety requirements
The use of accessories that do not comply with the relevant safety requirements
of this system can result in a reduced safety level of the combined system.
When choosing accessories, the following aspects must be considered in
particular:
◾ Use of accessories close to the patient.
◾ Proof that the accessories have been safety tested according to the applicable
IEC 60601-1 guideline and/or the IEC 60601-1-1 harmonized national
standard.

 CAUTION

Changing the overall center of gravity.

Risk of crushing!
◆ Only products/components approved by Siemens may be installed.

Attenuation equivalent
According to IEC 60601-1-3, inadequate attenuation of the X-ray beam by
materials between the patient and image receptor must be avoided.
Documented proof by the manufacturer is recommended.
Remove any auxiliary devices located in the beam path for calibration or
adjustment of the dedicated options before operating the .

Image quality can be impaired by placing materials directly in front of the

 image intensifier/detector, or the applied dose is increased by the automatic

adjustment. Additional objects in the beam path may result in increased
scattered radiation.

46 Operator Manual
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 Safety 2

Weight counterbalance

 CAUTION

Changing the weight distribution

Risk of crushing!
◆ Adding weight to the image intensifier/detector or single tank side
means a loss in counterweight and can result in unintended movement
of the C-arm.

Users must be alerted to the loss of counterbalance by a warning label. The

responsibility for affixing the corresponding warning label lies with the
company that attaches the dedicated option to the C-arm.
Image quality
The attachment of a dedicated option must not affect image quality
(impairment of the follow-up).
After maintenance or service work, the correct function of the non-Siemens
system on the detector must be tested.
Electrical safety
EN 60601-1, Section 3, “Protection against electric shock hazard” must be
complied with.
Electromagnetic compatibility
EN 60601-1-2 must be observed in order to comply with the limit values for
electromagnetic compatibility.
Attaching navigation systems

 CAUTION

Additional weight after installing components for navigation.

Risk of injury!
◆ Note that the C-arm is no longer balanced after additional components
are attached. It can move on its own after brakes are released.

 CAUTION

Heavy weight of external navigation components.

Risk of injury!
◆ Note that stability in accordance with DIN EN/UL standards is guaranteed
only if the external system on the image intensifier/detector (2D
navigation) does not exceed the calculated maximum weight.

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 CAUTION

Overloading the C-arm.

Risk of injury!
◆ Note that the braking action is guaranteed only if the external system on
the image intensifier/detector (2D navigation) does not exceed the
calculated maximum weight.

 CAUTION

Sharp edges.
Risk of injury!
◆ Be careful of any sharp edges on the externally attached navigation
system.

 CAUTION

Incorrectly attached navigation system.

Risk of injury!
◆ Before navigation-assisted operation, the user must ensure sufficient
accuracy of the navigation system.

 CAUTION

Insufficient navigation accuracy due to contaminated or defective detector

interface.
Risk of injury!
◆ Prior to using the navigation system check the required cleanliness and
functionality.

 CAUTION

Use of insufficiently electrically-protected external navigation components.

Risk of injury!
◆ Use only accessories corresponding to the CE Declaration of Conformity.

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 Safety 2

Additional safety information

◾ To avoid thermal overloading of components and short circuits, EN 60601-1
Section 7 and, if appropriate, UL 60601-1 must be complied with.
◾ Connecting external loads to the power supply of the C-arm system is not
permitted.
◾ We recommend that users in the EU have the relevant manufacturer of the
accessory operated by you confirm the CE Declaration of Conformity
according to Appendix II, MDD (Directive 93/42/EEC dated June 14, 1993),
Directive 2011/65/EU dated June 8, 2011 on the restricted use of certain
hazardous substances in electrical and electronic devices, and the Declaration
of Compatibility according to Article 12, MDD. In countries outside the EU the
relevant national regulations must be observed.


The product liability and warranty are restricted or expire if the above listed
conditions and limit values are not complied with when attaching
accessories.

 For non-Siemens options we generally accept no liability.

2.3.7 Disposal
◾ If you want to remove the product from service, take into consideration that
public legal directives may contain special regulations regarding disposal of
this equipment. In order to ensure that these legal regulations are complied
with and to avoid potential environmental hazards which may be caused by
the disposal of your system, please consult Siemens Customer Service.
◾ Batteries and packaging material must be disposed of in an environmentally
safe manner according to national regulations.
◾ The sterile single-use covers must be disposed of in accordance with national
regulations or the rules of the hospital.
◾ For further information about the disposal of the product, please refer to our
service documents.

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50 Operator Manual
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 System Description 3

3 System Description
3.1 Device Description 53
3.1.1 System overview 53
Options 53
3.1.2 C-arm system 55
Flat detector with grid 56
Single tank 56
3.1.3 Monitor trolley 57
UPS display field 58
3.1.4 Control elements 58
Control unit on the C-arm system 59
Control panel on the monitor trolley 60
Hand switch 61
Footswitch 61
3.1.5 Operating modes 62
Fluoroscopy 62
Single image 63
Subtraction/Roadmap (optional) 63
3.1.6 Description of image processing 64
3.1.7 Image display 64
3.2 System Operation 65
3.2.1 Start-up 65
Connecting the C-arm system with the monitor
trolley 65
Connecting the footswitch 66
Establishing the equipotential bonding connection 67
Establish the power line connection 67
Switching on the Cios Alpha 67
Functions during system start-up 68
3.2.2 Move C-arm 69
Operating the brakes 70
Lifting and lowering the C-arm 71
Moving the C-arm horizontally 73
Swivelling the C-arm 74
Angulating the C-arm 74
Orbital movement of the C-arm 75
3.2.3 Control panel 76
Exposure parameters 77
Task cards 78
Control elements 79
Submenus 80
Keyboard mode 81
3.2.4 Operating the hand switch 82
Radiation release 82
Image storage 82
Storage 83
3.2.5 Operating the footswitch 83
Radiation release 83
Image storage 83

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3.2.6 Switching off 84

Switching off the system completely 84
Switching off the C-arm system only 85
Disconnecting Cios Alpha from line power 85
Reactivating the system 86
3.2.7 Transporting the C-arm system 86
Preparing the C-arm system 86
C-arm system travel mode 87
Braking the C-arm system 88
C-arm system park position 88
3.2.8 Transporting the monitor trolley 89
Preparing the monitor trolley 89
Moving the monitor trolley 90
Locking the monitor trolley 90
Setting the direction of the monitor trolley 90
Monitor trolley park position 91
Park position of the monitors with height-adjustable
monitor column (optional) 91
3.3 Emergency Situations 92
3.3.1 Function of the Emergency Stop button 92
Overriding the brakes 93
3.3.2 Behavior in case of power failure 93
Restarting 93
3.3.3 Restarting the Cios Alpha 94
3.3.4 Restart via reset 94
Resetting 95
3.3.5 Procedure for cardiopulmonary resuscitation (CPR) 95

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3.1 Device Description

3.1.1 System overview

The Cios Alpha consists of a C-arm system and a monitor trolley.

(1) C-arm system with flat detector (20 cm x 20 cm or 30 cm x 30 cm

depending on the configuration) and dual-focus rotating anode X-ray tube
with generator
(2) Monitor trolley with touch screen, mouse, USB port, two rotatable TFT
displays, DVD drive, and memory for 150,000 images

Options
The following options are available for the Cios Alpha:

Monitor trolley ◾ Height-adjustable and foldable (Park position) monitors

◾ 2 TFT Premium high-brightness color displays (alternative to standard TFT
high-brightness color displays)
◾ DVI video splitter (Monitors A and B)
◾ Video manager
◾ Wireless network connection (WLAN)
◾ Sony UP-D898MD thermal printer
Economical, light-weight, compact printer for A6 b/w printing on thermal
paper
◾ SONY UP-971AD, UP-991AD thermal printer
Economical, light-weight printer for A4 b/w printing on thermal paper
(UP-971AD, UP-991AD) and transparent film (UP-991AD)

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◾ Audio package
◾ DVD recorder

C-arm ◾ 30x30 detector, 20x20 detector

◾ Single tank with 25 kW, 25 kW ESU, 12 kW
◾ Active cooling (for 12 kW version)
◾ Motorization package (Orbital/angular)
◾ Position memory
◾ Interface for injection pump triggering
◾ Integrated detector laser light localizer
◾ Single-tank laser light localizer
◾ Dose measurement chamber for dose area product/air kerma (valid for IEC
60601-1:2005 only)

Control elements ◾ Motorization package control module

◾ Remote control unit
◾ Additional holder for remote control unit
◾ Multifunctional footswitch (with extended functionality)

Applications ◾ Vascular Software

◾ Vascular Software Premium
◾ Digital subtraction angiography (according to DIN 6868-150, with up to 7.5
P/s (without ESU) and 30 P/s (with ESU)
◾ Stenosis quantification
◾ Radiation lock code
◾ 2D measuring function (for measuring angles and distances)
◾ DICOM Worklist
◾ DICOM Send
◾ DICOM Print
◾ DICOM Query/Retrieve
◾ HIPAA (Health Insurance Portability and Accountability Act)

Interfaces ◾ DVI video splitter (Monitors A and B)

◾ Video manager
◾ Injector interface
◾ NaviLink 2D (integrated digital navigation interface for lossless transfer of 2D
image data to a navigation system)

Accessories ◾ Grounding cable

◾ DHHS spacer
◾ Sterile covers for the detector, single tank, and C-arm
◾ Sterile cover for the remote control unit

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◾ Non-sterile cover for (Standard/multifunctional) footswitch

◾ Clamp

3.1.2 C-arm system

(1) C-arm
(2) Control unit
(3) Horizontal support arm
(4) Handles on both sides with a holder for the hand switch, as well as a
steering handle (center) for moving/transporting and braking the C-arm
system
(5) Lifting column
(6) Cios Alpha Electronics unit
(7) Footswitch (standard)
(8) Flat detector with grid
(9) Handles for manual movement/positioning of the C-arm
(10) Single tank with X-ray tube unit and integrated collimator
(11) Wheels with cable deflectors

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Flat detector with grid

Compared with the classic image intensifier, the flat detector has a much higher
dynamic range. This enables an expansion of the application range, for
example, to soft tissue imaging.
The grid attached to the flat detector further increases image quality.

(1) Handle for manual movement/positioning of the C-arm

(2) Flat detector
(3) Removable grid
(4) Brake keypad on the detector housing

Single tank

(1) Exit window for optional laser light localizer

(2) Integrated collimator system

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3.1.3 Monitor trolley

(1) Radiation display

(2) Monitors can be rotated by 180°
(optional: folding monitors)
(3) Control panel
(4) Handles: for neat cable storage
(5) Drawer for storage of CDs/DVDs, Quick Guide, etc.
(6) DVD R/W drive
(7) Wheels with cable deflectors
(8) Monitor column
(optional: height adjustable)
(9) Storage for mouse, MP3 player;
Cios Alpha on/off switch, connections for USB, mouse
(10) Connection for WLAN, LAN, Reset key
(11) Shelf for printer
(12) UPS window (Charge state)
(13) Central locking brake

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UPS display field

(1) UPS window

The UPS display field on the front of the monitor trolley shows the charge state
of the batteries and the operating status.
(1) LED “Green”: Input voltage (line power operation)
(2) LED “Yellow”: Battery operation
(3) LED “Red”: Alarm, malfunction
(4) Bar display of utilization ratio
(5) Bar display of battery charge status


When the red LED is lit, the Cios Alpha is no longer protected against power
outages by the UPS. The power plug may not be pulled until the imaging
system is shut down. If this is the case, notify Siemens Service.

3.1.4 Control elements

The following graphic is an overview of the Cios Alpha control elements. Some
of the control elements presented here are available as options.

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(1) Control unit on the C-arm

(2) Hand switch
(3) Control panel on the monitor trolley
(4) Optional: Remote control unit with cable
(5) Standard footswitch
(optional: multifunctional footswitch)

 Use only your fingers to operate the control units. Do not use hard or sharp
objects.

Control unit on the C-arm system

The control unit for performing your examinations is located on the C-arm
system.

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(1) Power supply (green LED)

(2) Radiation indicator
(3) EMERGENCY STOP
(4) Vertical movement of the C-arm
(5) Releasing/locking the C-arm brakes
(6) Control panel
(7) Control module for the motorization package (optional)

The control panel on the C-arm control unit offers the same functions and
shows the same user interface as the control panel on the monitor trolley.

 The control panel is not an imaging device as prescribed in DIN 6868-157.

Any images displayed are not suitable for diagnostic purposes.

Control panel on the monitor trolley

The monitor trolley control panel is used to operate applications for preparing
(e.g. entering patient data) and evaluating examinations. The control panel is
integrated flush into the cover plate of the monitor trolley.

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(1) Control panel on the monitor trolley

 The control panel is not an imaging device as prescribed in DIN 6868-157.

Any images displayed are not suitable for diagnostic purposes.

There is also a mouse, which is used as usual to execute functions on the left
monitor.
Hand switch

(1) Yellow button for radiation release

(2) Holder for hand switch
(3) Key for saving images

Footswitch
The footswitch pedals assignment can be configured.

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Configuration for foot pedal assignment

(1) Radiation release in preselected operating mode (standard setting)

Exception: Single image when fluoroscopy operating mode is preselected
(2) Radiation release for fluoroscopy (Standard setting)

 In addition, the image saving function can be allocated to a pedal if desired.

(Standard footswitch only).

3.1.5 Operating modes

The following presents the operating modes of the Cios Alpha, their properties,
and assigned system settings.
Fluoroscopy
For Fluoroscopy operating mode, you can choose between several examination
sets with different characteristic curves for fluoroscopy to determine the
radiation parameters for fluoroscopy. Every application allows you to choose
between different optimized programs.
The pulse duration is generally between 5 and 14 milliseconds. According to the
level of noise reduction, many different fluoroscopic images can be integrated.
The standard setting of the Cios Alpha after startup is established in the
configured standard application, and in general is Fluoroscopy
( Page 221 Examination settings (PEX Editor)).

System settings Exposure factors and system control units, including the way in which the
automatic setting is controlled:
◾ 1 k2 matrix (1.5 k2 matrix for 30 cm x 30 cm detector);
◾ Frame rate usually 0.5 to 30 frames/s;
◾ Image integration (as a function of the k factor set), i.e., a number of k
exposures are integrated into one image by sliding averaging; the k factor can
be selected between k = 1 (“OFF” setting) and k = 16 (32 for LIH) and can be
assigned to an examination set and stored.

Typical clinical procedure Fracture reposition of the distal upper extremity (e.g. distal forearm fracture) in
the plaster room of an emergency outpatient clinic where, under fluoroscopy,
the fracture elements are reduced by extension, fixed temporarily in the best
possible position and then fixed permanently by applying a plaster cast.

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Single image
The Single image operating mode provides an electronic instant image of the
patient on the monitor. It is recommended for final exposures. The exposure
time depends on the pulse width set.

System settings Exposure factors and system control units, including the way in which the
automatic setting is controlled:
◾ 1 k2 matrix (1.5 k2 matrix for 30 cm x 30 cm detector);
◾ X-ray pulse with a width of 5 ms up to a maximum of approx. 1400 ms.

Typical clinical procedure Final follow-up exposure of a fracture reposition of the distal upper extremity
(see above).
Subtraction/Roadmap (optional)
The subtraction memory option allows you to perform a digital subtraction
angiography and simultaneously display the unsubtracted angiogram on the
second monitor. Subtraction technique allows hemodynamic display as well as
display of the maximum vascular filling and Roadmap. The Roadmapping
features can also be used for other procedures.

System settings Exposure factors and system control units, including the way in which the
automatic setting is controlled:
◾ 1 k2 matrix (1.5 k2 matrix for 30 cm x 30 cm detector);
◾ Acquisition rate is freely selectable, usually 4 to 15 frames/s;
◾ Image integration (as a function of the k factor set), i.e. a number of k
exposures are integrated into one image; the k factor can be set between k =
1 and k = 16 (32 for LIH) by an authorized technician.

Typical clinical procedure ◾ Display of an arterial vessel for localizing vascular stenoses with injection of a
contrast agent to enable the contrast-enhanced display of the vascular filling
(subtraction of the native image (mask) from the contrast-enhanced image).
◾ Alternative to native display, subsequent inversion of the displayed image
allows you to display a catheter introduced into the vessel path using the
Roadmap function.

 For information on performing an examination with Subtraction or

Roadmap, refer to ( Page 135 Performing special examinations).

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3.1.6 Description of image processing

All image processing of the modality is executed by the "Imaging chain"
component, which is part of the image system software. The imaging chain is
divided into hardware and software modules. It is responsible for correct
parameterization of the hardware modules (e.g. the flat detector or the image
intensifier group). From there, the raw image data from the image converter is
transferred via exclusive image transfer interfaces to the PC hardware using
streaming technology. On the PC, the image data is then analyzed and
processed in real time, and an initial adjustment of the brightness and contrast
is performed. Finally, the image data is transferred to the image system
software where it is stored. At the same time, the image data is processed for
optimum medical evaluation for the application in question (including local
filtering, subtraction, brightness and contrast processing, geometric operations,
"Peak opacification") and displayed without delay on one or more monitors. The
export for the preview, on touch displays for example, is done in the same way
(if supported by the system).
If a DICOM report is needed, the image data can be reimported into the process.
All required processing steps are then performed again and the image data re-
exported to the imaging system software. From there they are sent to a
(DICOM) archive along with the patient data.
Note that the exported images are not transmitted as raw data, but include all
of the applied processing steps. The original condition cannot be restored
(please do not use these images for primary diagnosis!).

3.1.7 Image display

The imaging system uses two monitors for image display.
◾ The left monitor is used to display live images as well as preoperative and
postoperative images.
◾ The right monitor is used to display the reference images.
Reference images may be:
◾ preoperative images, incl. images of other modalities (e.g. CT, MR)
◾ images of current examinations
◾ images from previous examinations

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(1) Control area with function displays

(2) Image area

3.2 System Operation

3.2.1 Start-up

 Ensure that plugs and connectors are clean and dry.

Do not use damaged cables.

Connecting the C-arm system with the monitor trolley

The C-arm system is connected to the monitor trolley with a cable.

 CAUTION

Tripping over cable.

Risk of falling.
◆ When routing cables, make sure they run on the floor properly and
without loops.

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1 Plug the central plug into the socket on the left side of the C-arm system,
when viewed from the C-arm. The switch must always be in the vertical
position.

The monitor trolley may only be connected to the corresponding C-arm

system. If the monitor trolley is connected to the wrong C-arm system, an

 error message is displayed indicating that the C-arm and monitor trolley are
not a suitable pairing. Upon acknowledging the message, the text "Incorrect
C-arm" indicating the status is displayed at the lower left of the imaging
system monitor.

2 Turn the central plug switch to the right until it audibly clicks into place.
The monitor trolley is connected to the C-arm system.
Connecting the footswitch
For the release of radiation with the footswitch, it must be connected to the C-
arm system.

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◆ Plug the footswitch cable into the socket labeled with the footswitch symbol
on the front of the C-arm system.
Establishing the equipotential bonding connection
The Cios Alpha can be connected to a protective ground terminal via the
equipotential bonding connector on the C-arm system. This will ensure that the
Cios Alpha has the same electrical potential as other units connected to the
same protective ground terminal.
When performing cardiac examinations or examinations of the open skull, an
additional grounding cable according to DIN 57107/VDE107 must be routed in
rooms of Application Group 2.

◆ Clamp the equipotential bonding cable to the socket indicated by the symbol
on the C-arm system front connection panel (arrow) and to an equipotential
bonding point in the vicinity of the patient.
Equipotential bonding is established.
Establish the power line connection
The Cios Alpha operates using a line power connection cable from the monitor
trolley to a properly grounded socket.

 CAUTION

Cable damage.
Risk of electrical shock!
◆ Check the power cable. Do not use the device if the power cable is
damaged.

1 Plug the monitor trolley power plug into the appropriate socket.
The line power connection is established.
2 Position the unit so that it is easy to disconnect from the line power.
Switching on the Cios Alpha
◆ Press the right ON button on the monitor trolley.

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 The button that can be used to make a change is always illuminated. Thus,
when the system is shut off, the ON button is illuminated.

Functions during system start-up

The Cios Alpha is switched on.
The system automatically runs a self-test.
On the control panel, all LEDs light for approx. 2 seconds as a function test and
then switch off automatically.

 Check whether all LEDs light correctly. If not, notify Siemens Customer
Service as there could be a malfunction.

An audible signal sounds while the system starts up.

 If an audible signal does not sound, notify Siemens Customer Service; there
is a possibility that audible signals will not play back correctly.

An automatic self-test is performed for the C-arm control unit buttons.


Do not press any keys (such as the lift key) during booting; otherwise, an
error message will be displayed indicating that a key was pressed during
booting, and therefore the self-test of the keys did not function.

If error messages are displayed during the self-test, a new self-test is performed
automatically. The self-test can be performed up to four times.
A failed self-test is indicated on the affected control panel by continuous
flashing of all LED fields. Use of the buttons is not possible in this state; the
affected control panel is then shut down automatically. In this case, Siemens
Customer Service must be notified.

Radiation stand-by

On the left monitor, radiation stand-by is indicated by a symbol in the status bar
(lower left). On the control panel, radiation stand-by is indicated by a green
horizontal bar in the exposure parameters area (top left).
This icon appears on the monitor if radiation release is blocked. On the control
panel, the horizontal bar is grey. You need to enter the password to unlock the
radiation release ( Page 103 Unlocking/locking radiation release).
Radiation cannot be released if the monitor trolley is operated separately. On
the control panel, the horizontal bar is white.

 Essentially, the system is not ready for radiation unless a patient is

registered.

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If the C-arm system is connected to a monitor trolley that is already

 switched on, it normally becomes available after 120 s. It is then in the

same operating state as it was prior to being disconnected from the monitor
trolley.

Flat detector calibration message If amessage is displayed on the monitor indicating that flat detector calibration
is due:
1 Perform detector calibration.
2 Confirm it to continue start up.
All images acquired with an uncalibrated system are tagged "without valid
calibration".

Presettings The following functions are set when the Cios Alpha is started:
◾ Operating mode: the preset operating mode in the application configured as
Standard ( Page 221 Examination settings (PEX Editor))
◾ Image mirroring: switched off if it is not switched on in the application
configured as Standard ( Page 221 Examination settings (PEX Editor))
◾ Number of images (fluoro): the default value in the application configured as
Standard ( Page 221 Examination settings (PEX Editor))
◾ Automatic dose rate control (ADR): Activated
◾ Zoom level: 0, if it is not switched on in the application configured as
Standard Standard ( Page 227 Editing applications)
◾ Collimators: Full format

3.2.2 Move C-arm

The horizontal movement, swivel movement, angulation and orbital movement
of the C-arm are performed manually. Use the handles on the C-arm or the
image intensifier/flat detector.
Additionally, the C-arm can be adjusted in height by motor control. Motorized
angulation and orbital movements are possible only with the motorization
package.

 WARNING

Manual or motorized movements.

Risk of crushing and collision for persons and objects in the vicinity of
moving parts.
◆ During manual and motorized movements of the device, make sure you
take into account any persons or objects in the way of movement, and
control the movement to avoid collisions.
◆ Make sure that everyone is outside the hazardous zone.

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 CAUTION

Uncontrolled C-arm movements.

Risk of injury and crushing!
◆ Make sure the C-arm cable does not get caught in the horizontal support
arm.

 CAUTION

Activation of system movements without visual contact.

Risk of crushing!
◆ Use the system only if the patient and other persons can be observed
during movements.

 CAUTION

C-arm rotation.
Risk of crushing!
◆ Pay particular attention to crushing risks between moving system parts
and the corresponding guide openings.

 CAUTION

Movement due to unintended actuation of operating elements.

Risk of collision, risk of injury to the patient or operator, risk of
damage to the device parts.
◆ Press the closest EMERGENCY STOP button if device movements do not
stop.

 Please note that the scale on the C-arm is intended for orientation only, not
for measurement.

Operating the brakes

The Cios Alpha is equipped with electromechanical brakes that you can control
with the C-arm system control unit, the remote control, and the brake keypad
on the flat detector.

 CAUTION

Brake failure.
Risk of crushing!
◆ Before beginning the examination, perform the daily function and safety
checks.

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The buttons for releasing and locking the brakes for different directions of
movement are marked with different colors. A graduated scale in the same
colors for the corresponding directions of movement is located on the housing.

Releasing the brake Before moving the C-arm, the brake for the relevant direction of movement
must be released.
◆ Press the button for the brake for the desired direction of movement.
The “brake released” indicator (open lock) lights up orange. The
corresponding brake is released.
You can move the C-arm.

Engaging the brake ◆ Press the button for the brake again.
The “brake released” indicator goes out. The corresponding brake is locked.
You can no longer move the C-arm in this direction.

 Engage the corresponding electromagnetic brakes after moving the C-arm.

Lifting and lowering the C-arm

You can lift and lower the C-arm by motor control using the arrow buttons on
the C-arm system control unit.

The lifting column can be lowered from position 1 (highest level) to

intermediate position 2, down to position 3 (lowest level).

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(1) Position 1 = highest level

(2) Position 2 = intermediate position
(3) Position 3 = lowest level

Lifting the C-arm

◆ Press the Up button on the C-arm system control unit.

The lifting column moves upwards.

Lowering the C-arm The lifting column can be lowered to position 3.

1 Press the Down button on the C-arm system control unit.

The lifting column then moves to the intermediate position (2) and
automatically stops there.
2 Press the Down button on the C-arm system control unit again.
The lifting column is lowered further.
An audible signal sounds.

 Make sure there is nothing in the hazard zone (under the C-arm or travel
frame) when lowering the C-arm; crushing hazard!

Lifting movement failure If the lifting column cannot be moved the EMERGENCY STOP button is pressed
and must be unlocked.

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1 Turn the knob clockwise until it pops back out.

2 If the lifting column can still no longer be moved in any direction, then please
contact Siemens Customer Service.
Moving the C-arm horizontally
You can move the support arm horizontally by up to 20 cm.

1 Press the button marked in green for the horizontal movement brake.
The brake is released.
The “brake released” indicator lights up orange.
2 Move the support arm to the desired position while observing the green
scale.
3 Press the button for the brake again.
The brake is locked.
The “brake released” indicator goes out.

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Swivelling the C-arm

You can move the C-arm in the horizontal plane ± 12° about the lifting column.

1 Press the button marked in orange for the horizontal swivel brake.
The brake is released.
The “brake released” indicator lights up orange.
2 Swivel the C-arm to the required position.
3 Press the button for the brake again.
The brake is locked.
The “brake released” indicator goes out.
Angulating the C-arm
You can rotate the C-arm in the vertical plane ± 225° about the horizontal
support arm.

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(1) Mechanical brakes

(2) Control panel
(3) Control module for the motorization package (optional)

1 Press the button marked in yellow for the angulation (1) brake.
The brake is released.
The “brake released” indicator lights up orange.
2 Rotate the C-arm to the required angulated position while observing the
yellow scale on the support arm joint.
3 Press the button for the brake again.
The brake is locked.
The “brake released” indicator goes out.
Using the optional control module for the motorization package (3), these C-
arm movements can be motorized. Refer to the description in
( Page 300 Control module for the motorization package (optional)).
Orbital movement of the C-arm
Starting from the basic position (0°), you can swivel the C-arm by up to +96.5°
or up to -51.5° (148° in total).

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(1) Mechanical brakes

(2) Control panel
(3) Control module for the motorization package (optional)

1 Press the button marked in blue for the orbital movement (1) brake.
The brake is released.
The “brake released” indicator lights up orange.
2 Swivel the C-arm to the required orbital position while observing the blue
scale.
3 Press the button for the brake again.
The brake is locked.
The “brake released” indicator goes out.
Using the optional control module for the motorization package (3), these C-
arm movements can be motorized. Refer to the description in
( Page 300 Control module for the motorization package (optional)).

3.2.3 Control panel

The control panels on the C-arm control unit, monitor trolley, and (optional)
remote control unit are identical in terms of function and display.
Press the corresponding symbol button to operate the function.

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(1) Displays and operating elements for the exposure parameters

(2) Task cards with operating elements for the current work step
(3) Close pat. button
(4) Button to manually select keyboard mode

Exposure parameters
The left section of the control panel contains the operating and display
elements for image acquisition. This area remains the same regardless of the
task card selected.

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(1) Radiation stand-by indicator

Green: ready, white: not ready, e.g., C-arm system not connected or
patient not registered, grayed: Radiation release blocked (password entry
required)
(2) Display elements and position memory
Current C-arm angles (for optional motorized operation and position
memory), cumulative dose and radiation time, kV, mAs/mA, pre-indication
of FD-grid status
(3) Exposure preparation
Collimator setting, laser light localizer, reset warning signal (radiation time)
(4) Operating mode selection
Fluoroscopy (Fluoro), Single image, Subtraction (Sub), Roadmap (Road)
(5) Setting of radiation parameters
Dose, Metal correction, Automatic dose control (ADR), zoom, noise filtering
and motion detection, pulse frequency

Task cards
The task cards provide you access to all required operating elements in the
current work step.
In the PROCESSING work step you are provided with operating elements for
image postprocessing.

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(1) Basic operating elements for image display

(2) Operating elements for special applications (subtraction, roadmap)
(3) Operating elements for image postprocessing and -evaluation
(4) Area for displaying submenus ( Page 80 Submenus)
(5) Image and information area

Changing task cards

◆ Press the tab of the required task card.

Control elements
You perform individual function and set the required parameters using the task
card operating elements.


When you press a button and a dashed line appears, this means the
requested function is being processed by the system. No additional
operating steps are possible during this time for safety reasons.

Function value display: For some functions, the current set value is displayed
in the operating element (example: Pulse rate 15 p/s).

Function inactive: Many functions can only be executed when specific

conditions are met (for example, Hold reference only when the image display is
on the right monitor. Functions that currently cannot be executed appear as
inactive.

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Performing the function

◆ Press the button for the required function.

 For some functions the button can be pressed and held to continue
performing the function (such as moving the collimator).

Activating/deactivating functions For functions that can be switched on or off, the button with the light
background indicates the active state.
1 Press the button in deactivated state to switch on the function.

2 Press the button in activated state to switch off the function.

Submenus
For functions requiring further input or additional settings, corresponding
operating elements are available in a submenu.

Opening the submenu

1 Press the button for the required function.

The function is activated.
A submenu with function-specific operating elements is shown in the upper
section of the task card.

2 Change the settings using the operating elements shown.

Close the submenu

◆ Press the Close button.

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– or –
Press the button for the required function again.

Select a different submenu.

Keyboard mode
Keyboard mode is used to enter text and numbers.

(1) Text field

(2) Keyboard
(3) Symbol button bar for opening functions

Opening keyboard mode The system switches automatically to keyboard mode when functions requiring
text input are opened (such as for patient registration). Keyboard mode can be
opened manually when necessary (e.g., for service purposes).
◆ Press this button on the control panel (lower right).
A virtual keyboard appears on the control panel instead of the task cards.

Entering text ◆ Press the corresponding character buttons like a computer keyboard.
The entered characters are shown in the input screen on the monitor and in
the white text field of the virtual keyboard.
For upper case letters and to enter special characters, press the Shift button
and then the corresponding character.
To enter special characters briefly press in sequence: Ctrl + Alt or Shift + Ctrl
+ Alt

Ending keyboard mode Keyboard mode ends automatically when the corresponding input screen on the
monitor is closed. Depending on the function that is open, this can be done with
the Enter button (such as comment text) or by opening the next work step
(such as examination after patient registration).

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◆ To terminate keyboard mode manually, press the Close button.

The task card previously shown is displayed again.

3.2.4 Operating the hand switch

The hand switch is used to remotely control radiation release and image
storage.
The hand switch can be inserted into the holder provided on the C-arm system.

(1) Radiation release key

(2) Image storage key

Radiation release
The hand switch is used to release radiation in the preselected operating mode.
◆ Press the yellow radiation release key on the hand switch and hold it down
while radiation is released.
The current radiation parameters are shown on the control units.
The currently generated image is displayed on the left monitor.
Image storage

During radiation

◆ Press this key on the hand switch.

The image currently generated and displayed is saved.

After radiation

◆ Press this key on the hand switch.

Holding the key for < 2 seconds: Saves the image last recorded (LIH).
Holding the key for > 2 seconds: Saves the scene last recorded (LSH).

 The images are transferred from the left monitor to the right monitor and
then stored in the local database.

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Storage
When not in use, the hand switch can be kept in one of the holders on either
side of the C-arm system.

3.2.5 Operating the footswitch

The footswitch is used if both hands need to be free during the exposure.

 The footswitch is also suitable for applications where fluids may land on the
floor.

 For operation of the multifunctional footswitch (optional) see

( Page 295 Multifunctional footswitch (optional)).

Radiation release
In the default setting, the pedals of the footswitch are allocated as follows:
◾ The right pedal is always used to activate Fluoroscopy (Fluoro).
◾ The left pedal is used to activate the preselected operating mode.
Exception: If the Fluoroscopy (Fluoro) operating mode is preselected, the
left pedal is allocated the Single image operating mode.

 The left/right functionality of the two pedals can be reversed by Siemens

Customer Service upon request.

Pedal allocation:
The current pedal allocation is shown on the monitor trolley left screen.

If the footswitch is defective or not connected, the symbol for the hand switch is
displayed instead.

Releasing radiation

◆ Keep the left or right foot pedal pressed during radiation release.
The current radiation parameters are shown on the control units.
Image storage
One of the pedals can be configured with the "Save" function by Siemens
Customer Service. In this case, in the default setting the pedals of the footswitch
are allocated as follows:
◾ The right pedal is used to activate the preselected operating mode.
◾ The left pedal is used to activate image storage.

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Saving during radiation

◆ Press the "Save" pedal on the footswitch.

The image currently generated and displayed is saved in the local database.

Saving after radiation

◆ Press the "Save" pedal on the footswitch.

Holding the pedal for < 2 seconds: Saves the image last recorded (LIH).
Holding the pedal for > 2 seconds: Saves the scene last recorded (LSH).

 The images are transferred from the left monitor to the right monitor and
then stored in the local database.

3.2.6 Switching off

Before disconnecting the Cios Alpha from line power, you must shut it down.
During the shutdown procedure the imaging system is shut down before the
system is switched off.
The shutdown procedure for the imaging system is complete when the stand-by
indicator in the left monitor goes out.

 CAUTION

Loss of image data.

Risk of unnecessary radiation exposure!
◆ Do not shut down the system while radiation is being released.

If you still need the monitor trolley (for postprocessing), you can disconnect the
C-arm system while switched on. In this case, only the C-arm system is shut
down.
Switching off the system completely

Ending active processes 1 Close the current patient with the corresponding button on the control panel.
2 Make sure data were not written to CD/DVD.
If necessary, wait for CD/DVD write processes to be completed.
3 If there is a disk in the CD/DVD, take it out of the drive.


Open network export jobs are retained during shutdown and are continued
when the system is switched back on. Storage jobs for removable devices as
well as print jobs are stopped and deleted.

Switching off

◆ Press the OFF button on the monitor trolley.

The C-arm system is immediately switched off.
The imaging system switches off after the computer is shut down.

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 The button that can be used to make a change is always illuminated. Thus,
when the system is switched on, the OFF button is illuminated.

Switching off the C-arm system only

◆ Turn the central plug lever on the C-arm system to the left to unlock it.
Unplug the connector.
The C-arm system is immediately switched off.
As long as a C-arm system is not connected, the acquisition functions on the
imaging system are not available.
Disconnecting Cios Alpha from line power
Please note that after finishing an examination, the Cios Alpha must be shut
down properly before it is disconnected from the power supply.
1 Switch off the Cios Alpha and wait for it to shut down.
2 Disconnect the monitor trolley power plug from the power outlet.
When the power plug is pulled, the UPS switches to battery mode (yellow LED
illuminates).

 Pull on the plug, not on the cable!

Releasing the connection cable 1 Turn the central plug lever on the C-arm system to the left to unlock it.
Unplug the connector.
2 If attached, disconnect the equipotential bonding connection from the C-arm
system.

Removing the remote control unit ◆ See ( Page 299 Removing the remote control unit and holder).

Rolling up the footswitch cable The footswitch is placed in the holder provided for storage and during transport.

◆ Roll up the footswitch cable (1) onto the cleat provided and place the
footswitch into its holder (2).

 When attaching the footswitch, please be careful not to kink the cable.

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Reactivating the system

If the imaging system cannot be shut down properly after pressing the OFF
button or if it no longer reacts to input, you must reactivate the Cios Alpha
system as follows:

1 Press the RESET button on the right side of the monitor trolley.
All running processes are terminated and the Cios Alpha is shut down.
2 Switch the Cios Alpha on again and let it boot up completely.
Now you can either continue using the Cios Alpha or shut it down.

 If the Cios Alpha is not fully operational despite the reset, please notify
Siemens Customer Service.

3.2.7 Transporting the C-arm system

The C-arm system is equipped with 4 wheels for easy steering in any direction.
The C-arm system can be locked in place with the steering/brake lever.
When transporting the C-arm system in the transport position, the floor
inclination must not exceed 10°.
Preparing the C-arm system
Prior to transport, the C-arm system must be set to the transport position.
1 Release all brakes of the C-arm.
2 Set the C-arm to the transport position shown in the drawing.
Angulation 0°/Orbital position 0°.
3 Move the lifting column to its lowest position.
4 Move the horizontal support arm all the way back.

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C-arm system travel mode

(1) Brake engaged (indicator red)

(2) Brake released (indicator green)

1 Release the brake using the unlock button.

Steering lever shown in the position for forward travel

2 Turn the steering lever in the required direction.


The steering lever can be locked into 3 different positions. One is for
movement straight ahead, the others for transverse travel to the right or
left.

3 Move the C-arm system by hand.

If the steering lever is in a transverse position, the C-arm system moves
parallel to the lever position.

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 Avoid transporting the C-arm system on inclined surfaces > 5° or it may slip
or tip over.

 CAUTION

Weight of the device.

Risk of crushing!
◆ Fast braking can be impacted by the weight of the device. Pay
attention to your speed as well as the floor covering, slope, and
uneven areas.

 When transporting the C-arm system make sure there are no obstructions
on the floor.

Braking the C-arm system

To securely brake the C-arm system, particularly on tilted or uneven planes and
surfaces, proceed as follows:
◆ Keep the unlocking button pressed and lift the steering lever.
The red indicator appears.

The C-arm system brakes are now locked. However, even with the brake
applied, C-arm movements are still possible.
C-arm system park position

 CAUTION

Insufficient braking force.

Risk of crushing!
◆ When parking the C-arm system on an inclined surface, lock the brakes
on the C-arm system and turn the wheels perpendicular to the slope.

1 Lock the brakes on the C-arm system.

The red indicator appears (brakes locked).

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2 Set the steering lever to lock position for transverse travel to the right or left,
so that the wheels are braked in transverse position.

3.2.8 Transporting the monitor trolley

When transporting the monitor trolley in the transport position, the floor
inclination must not exceed 10°.
Preparing the monitor trolley
Prior to transport, the rolled-up power cable and the connection cable for the C-
arm system should be placed on the handles of the monitor trolley.

 CAUTION

Increased tipping effect.

Risk of crushing!
◆ Only products/components approved by Siemens may be installed.

◆ Hang the rolled-up cables on the handles of the monitor trolley.

 Avoid transporting the monitor trolley on inclined surfaces > 5° or it may

slip or tip over.

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Moving the monitor trolley

◆ Release the central brake on the front of the monitor trolley (see arrow) to
start moving it.

 When the monitor trolley is moved, care must be taken that it does not
collide with catheters or anesthesia tubes.

Locking the monitor trolley

◆ To lock the monitor trolley, push the center brake down with your foot until it
stops/engages.

 CAUTION

Brake failure.
Risk of crushing!
◆ Before beginning the examination, perform the daily function and
safety checks.

Setting the direction of the monitor trolley

◆ Push the center brake upwards with your foot until it stops/engages.
This locks the front right wheel into a fixed position when moving the
monitor trolley, and thereby sets the direction of movement.

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The monitor trolley then can be pushed in the direction of the set front
wheel.
Monitor trolley park position

 CAUTION

Insufficient braking force.

Risk of crushing!
◆ When parking the monitor trolley on an inclined surface, face the front
toward the incline and lock the brakes.
◆ Make sure the monitor trolley is not parked on a wet floor or other
places where the adhesion of the wheels is greatly reduced.

On inclined surfaces with an angle of > 5°:

1 Make sure that the brakes are locked.
2 Make sure that the front of the monitor trolley faces forward in the direction
of the incline.

Park position of the monitors with height-adjustable monitor column

(optional)
The monitor trolley holds two rotatable monitors. Using the corresponding
option, these can be height-adjusted and folded up for transport.

(1) Height-adjustable monitors

(2) Toggle switch for height-adjustment of the monitors

The height of the monitors can be adjusted with the black toggle switch.
1 Press the arrow symbol for Down on the toggle switch.
Motors move the monitors down; they can only be lowered to a specific end
position.

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 CAUTION

Motorized movements.
Risk of crushing!
◆ Do not stand in the travel range of the monitor or place objects on the
trolley housing.

2 Prior to transport fold the monitors together to prevent colliding with

obstructions.

 CAUTION

Folding the monitors.

Risk of crushing!
◆ Be careful when folding in the monitors - your hands could get
caught.

3.3 Emergency Situations

 Keep a replacement unit ready for critical applications in an emergency.

Refer to ( Page 21 System failure).

3.3.1 Function of the Emergency Stop button

A red EMERGENCY STOP button is located on the C-arm system control unit and
the (optional) remote control.

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The EMERGENCY STOP button stops the following processes immediately in a

hazardous situation:
◾ motorized C-arm movements
◾ released electromechanical brakes (will be locked)
◾ active radiation

When the EMERGENCY STOP button is activated (pressed), a red lock

 symbol flashes on the active emergency stop button. The lock symbol lights
constantly on the other emergency stop components as long as the
emergency stop button is active in at least one location.


If the EMERGENCY STOP button has been activated (pressed), radiation can
still be released manually and the brakes can be actuated manually.
Motorized movements are not possible, however.

◆ Unlock the EMERGENCY STOP button by turning it to the right only when the
hazardous situation has been eliminated.
Overriding the brakes
In case of emergency (patient recovery during power failure), the C-arm can be
moved in the direction desired without releasing the brakes when enough
strength is applied.

3.3.2 Behavior in case of power failure

In the case of a power failure, the unit is switched off. In order to prevent data/
image loss, an uninterruptible power supply (UPS) which carries out a controlled
shutdown of the imaging system is installed in the monitor trolley. The images
from the last examination are saved if the auto save function is switched on
(Auto save must be on for interventional applications).
The following are not saved:
◾ Collimator position
◾ Set dose
◾ Image orientation
◾ Position memory
◾ Zoom
If there is one, a hospital emergency power supply cuts in if the line power
supply fails. However, this usually occurs with interruption and can take some
time.
The system can be restarted as soon as the mains power supply is available or
the emergency power unit is functioning.
Restarting
1 Press the ON button on the monitor trolley to restart the system.
2 Wait until the unit has fully rebooted.
3 Pay attention to error messages.
When the power-up process has been completed (after approx. 4 minutes),
the Cios Alpha is fully operational again.

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4 Reselect the last patient in order to continue his or her treatment.

5 Perform the procedure, dose and collimator settings required in order to
continue the application.
The positioning of the C-arm remains intact when the system is switched off.
Nevertheless, please check the current position and correct it if necessary.

3.3.3 Restarting the Cios Alpha

The Cios Alpha must be restarted following certain error messages.
The following settings are reset to their default values by a restart:
◾ Collimator position
◾ Set dose
◾ Image orientation
◾ Position memory
◾ Zoom
1 Switch the system off by pressing the OFF button on the monitor trolley.
2 Wait until the computer has shut down.

3 Press the ON button on the monitor trolley to restart the unit.

4 Pay attention to the error messages displayed.
5 Reselect the last patient in order to continue his or her treatment.
6 Perform the procedure, dose and collimator settings required in order to
continue the application.
The positioning of the C-arm remains intact when the system is switched off.
Nevertheless, please check the current position and correct it if necessary.

 CAUTION

Restarting the imaging system is not possible.

Treating patients no longer possible!
◆ Restart the system as presented in the following reset procedure.

3.3.4 Restart via reset

If the computer fails to shut down or no longer reacts to inputs, a system reset
may be necessary.
The following information will be lost following a reset:
◾ Collimator position
◾ Set dose
◾ Image orientation
◾ Position memory
◾ Zoom

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Resetting

1 Use a pin or a pointed object to actuate the reset button on the monitor
trolley (the system will not automatically boot up afterwards).
2 After the system switches off, press the ON button to switch the unit on.
Wait until the system has rebooted.
3 Reselect the last patient in order to continue his or her treatment.
4 Perform the procedure, dose and collimator settings required in order to
continue the application.
The positioning of the C-arm remains intact when the system is switched off.
Nevertheless, please check the current position and correct it if necessary.

3.3.5 Procedure for cardiopulmonary resuscitation (CPR)

If cardiopulmonary resuscitation (CPR) becomes necessary, the Cios Alpha must
be removed from the treatment table to ensure free access to the patient.
1 Move the C-arm into a position where it can be removed from the table
without causing a collision.
2 Release the brakes and move the C-arm to the required position either via
motor drive or manually. Reapply the brake to prevent unwanted movements
of the C-arm.
3 In the case of a power failure, the C-arm can be moved by applying excess
pressure to override the brakes.
4 If necessary, remove the remote control unit from the patient table and
fasten it to the monitor trolley.
5 Then release the brake lever and move the Cios Alpha out of the treatment
area.
6 At the same time, watch out for the cables leading to the monitor trolley, the
remote control unit and the footswitch.
7 Release the brake of the monitor trolley, if necessary, and remove it from the
treatment area.

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4 Examination
4.1 Safety information 99
4.1.1 Prior to the examination 99
Examination settings 99
Audible warnings 99
Software failure 99
Storage capacity 99
Reference images from previous examinations 99
4.1.2 During the examination 100
Patient position 100
Image orientation 100
Data conformity 100
Detector temperature 100
4.2 Preparing the system 101
4.2.1 Removing/inserting the flat detector grid 101
Removing the flat detector grid 101
Inserting the flat detector grid 102
4.2.2 Protection against contamination and the penetration of
fluids 102
4.2.3 Positioning the C-arm 102
Using the laser light localizer 102
Aligning the C-arm 103
4.2.4 Unlocking/locking radiation release 103
Unlocking radiation release 103
Locking radiation release 104
4.2.5 Selecting the application 104
Setting the application and application group 105
4.3 Patient registration 105
4.3.1 Emergency registration 107
Emergency registration on the control panel 107
Emergency registration on the monitor 107
Emergency registration with the hand switch or
footswitch 107
Provisional patient data 108
4.3.2 Registering a new patient 108
Opening patient registration 108
Data Entry Dialog window 108
Entering data 110
Completing registration 110
4.3.3 Registering previous patients 111
Opening the Patient list 111
Checking/correcting patient data 112
Completing registration 112
Resuming a commenced study (e.g., intravenous
pyelography IVP) 112
4.3.4 Registering patients from the worklist 113
Updating the worklist 113
Opening the worklist 114
Checking/correcting patient data 114
Completing registration 115
Deleting a patient entry 115

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4.4 Defining the examination settings 115

4.4.1 Changing the fluoroscopy parameters 116
Selecting the operating mode 116
Setting collimators 117
Selecting the dose rate level 118
Switching on metal correction 119
Selecting the motion/noise filter 119
Selecting the input format (Detector zoom/
magnification) 120
Setting the pulse rate 121
Setting the X-ray parameters manually 121
4.4.2 Setting the image parameters 123
Selecting the image orientation 123
Standard image orientation 123
Rotating/flipping images 123
4.5 Acquiring images 124
4.5.1 Releasing radiation 125
Displaying fluoroscopy images 125
Switching on enlarged preview image (blow-up) 126
Confirming a warning signal 127
Temperature monitoring 127
Radiation information 128
4.5.2 Saving and displaying images 128
Storing images (during radiation) 129
Storing images (after radiation) 129
Saving and reviewing a scene 129
Changing the image display 130
Recording video 131
4.5.3 Using reference images 131
Transferring Images 131
Scrolling through images 132
Holding the reference image 132
Loading images from an external video source 132
4.6 Ending the examination 133
4.6.1 Closing the patient 133
4.6.2 Examining the next patient 134
Another patient registered 134
4.7 Performing special examinations 135
4.7.1 Digital subtraction angiography (Sub) 135
Progression 135
Performing subtraction angiography 135
4.7.2 Roadmap (Road) 136
Fill image available 136
Generating a new fill image 137
Using the fill image from subtraction angiography 137
Manually selecting the fill image 138
Positioning the catheter (phase C) 138
4.7.3 Using graphics overlays 139
Live graph overlay menu 139
Drawing lines 139
Deleting points 140
Postprocessing lines 140
Deleting everything 140
4.7.4 Pediatric use 140

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4.1 Safety information

4.1.1 Prior to the examination

Examination settings
Before starting surgery, please make sure that all the set parameters as well as
examination settings in all operation modes are correct.
Audible warnings
Audible warnings over the loudspeakers indicate possible hazards, such as
crushing hazards, longer radiation release or high dose rate.

 CAUTION

An audible signal sounds when below the safety standard.

Risk of crushing!
◆ Check for proper loudspeaker function before beginning the
examination. Note when booting the system whether an audible signal
is heard.

Software failure

 CAUTION

Software crash.
Working with the imaging system is no longer possible.
◆ Restart the system.

Storage capacity
The hard disc fill level is displayed in the status bar of the left monitor. A
warning signal is displayed before the final capacity of the hard disk is reached.
This icon, for instance, indicates that about 25 percent of the disk space has
been used.
This icon, for instance, indicates that the available disk space has reached a
critical level.

 Please make sure that there is sufficient storage capacity before you start
the examination. In addition, please observe the relevant system messages.

Reference images from previous examinations

 CAUTION

Risk that the network connection may not be available continuously.

Reference images not available during intervention.
◆ Before beginning the intervention, the user should load the required
images from the network archive.

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4.1.2 During the examination

 CAUTION

C-arm movement during surgery.

Risk of injury!
◆ Due to the maneuverability of the C-arm, collisions with other surgical
devices are possible if the device is not used as intended and in
accordance with the instructions in this manual.

 CAUTION

Instruments falling into the gap between the control unit and its housing.
Risk of short circuit, electric shock, and/or fire!
◆ Make sure no instruments, conductive material, or fluids penetrate into
the openings/joints between the control unit and its housing.

Patient position
Prior to the release of radiation, it is necessary to check whether the patient is
positioned correctly.
Image orientation
Ensure correct image orientation (accurate to side) on the monitor/on the
hardcopy.
Data conformity
Correct orientation of image and patient data must be checked before storage.
Before terminating an examination and beginning work on the next patient, the
patient data should be verified.
The registered patient should be deselected at the end of the examination.
( Page 133 Closing the patient)
Detector temperature

 CAUTION

Detector temperature is not within recommended range.

Risk of limited image quality in the resulting X-ray images. Risk of X-
ray radiation exposure without any diagnostic value!
◆ Regularly check the temperature icon on the display.

Exceeding the critical temperature threshold of 54 °C is indicated by a system

message. In this case it is recommended to shut down the system immediately
to allow it to cool.

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4.2 Preparing the system

 CAUTION

Brake failure.
Crushing hazard from automatic movements!
◆ Before beginning the examination, perform the daily function and safety
checks.

4.2.1 Removing/inserting the flat detector grid

Removing the flat detector grid reduces the radiation dose (as well as image
quality), e.g., for a pediatric examination.

 CAUTION

Changing the grid.

Crushing hazard between the detector housing parts.
◆ Note the hazardous zones/locations between the detector housing parts.

 CAUTION

Incorrect grid status: inserted, removed.

Radiation unsuitable for imaging results in unnecessary radiation
exposure!
◆ Select the application according to your clinical procedure.
◆ Make sure that the current grid status meets your image requirements.
The imaging system indicates whether a grid has been inserted or
removed.
◆ If necessary, insert or remove the grid manually.

Removing the flat detector grid

1 Open the grid cover by pulling it down.

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2 Carefully pull the flat detector grid from its holder.

3 Put the flat detector grid in a safe place.
4 Check that the icon for “Flat detector grid inserted” has a line through it.
This indicator appears on the left monitor and the control panels in the
exposure parameter area.

Inserting the flat detector grid

Once the pediatric examination is completed, you must reinstall the flat
detector grid in order to ensure optimum image quality during standard
examinations.
1 Install the flat detector grid in the reverse order of its removal.
2 Check that the icon for “Flat detector grid inserted” does not have a line
through it.
This indicator appears on the left monitor and the control panels in the
exposure parameter area.

4.2.2 Protection against contamination and the penetration of

fluids
If a significant amount of fluid is expected during an examination, there is a risk
of fluids penetrating into the system. It is recommend to cover the relevant
areas appropriately.
The C-arm can be covered completely or partially with a sterile disposable sheet
to protect it against contamination ( Page 301 Sterile cover on the C-arm).

 CAUTION

Fluid penetration and contamination.

Damage to the flat detector
◆ Make sure that the detector is always covered by a disposable cover
during the examination.

4.2.3 Positioning the C-arm

Using the laser light localizer
Depending on the configuration of your Cios Alpha you can use the laser light
localizer as a positioning aid.

Switching on

◆ Press this button on the control panel.

Depending on the system configuration, all laser light localizers on the C-arm
system switch on.
The target crosshairs are displayed on the left monitor as long as the laser
light localizer is switched on.

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Switching off

◆ Press the activated button on the control panel.

 All activated laser light localizers are switched off automatically after 5
minutes.

Aligning the C-arm

 CAUTION

Collision with other systems.

Risk of injury!
◆ Due to the maneuverability of the C-arm, collisions with other systems
are possible if the device is not used as intended and in accordance with
the instructions in this manual.

1 Align the C-arm system to the table and patient.

2 Release the relevant brake and move the C-arm to the required exposure
position ( Page 69 Move C-arm).
3 Lock all brakes again.

4.2.4 Unlocking/locking radiation release

Your system has a lock-out option for radiation release to prevent unintentional
release of radiation, e.g., by accidentally pressing the footswitch.
The radiation lock can be optionally secured with a password so only authorized
persons can set the exposure parameters and release radiation.

 You can set and change the password for locking radiation release in the
configuration ( Page 221 Password for radiation release).

Unlocking radiation release

1 Press this button on the PREPARATION task card.
Without password protection on the radiation lock, exposure parameters can
be set and radiation released.
With radiation lock password protection, the password entry dialog is
displayed.

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2 Enter the correct password (default setting: 0000).

Exposure parameter setting and radiation release are released.
– or –
Press this button if you want to keep the lock in place.
The dialog box closes without changes.

 If you mistype your password, you can delete your entry with the Del
button.

Locking radiation release

1 Press this button on the PREPARATION task card.
Without password protection on the radiation lock, exposure parameter
setting and radiation release are locked.
With password protection, the password entry dialog is displayed.
2 Enter the correct password.
Exposure parameter setting and radiation release are locked.
– or –
Press this button if you do not want to lock radiation release.
The dialog box closes without changes.

4.2.5 Selecting the application

The applications contain individual sets of examination settings tailored to
various medical application areas (such as General, Breast, Ortho).
The available applications are divided into application groups, for example,
according to hospital-specific requirements.

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 CAUTION

The image orientation is reset.

Risk of an incorrect decision during surgery!
◆ Be aware that the image orientation is reset when changing the
application group or application. All previous settings are lost.

 For further information about applications and application groups, as well

as their configuration, see ( Page 221 Examination settings (PEX Editor)).

Setting the application and application group

The application groups and applications are available in selection lists on the
PREPARATION task card.

1 Press the arrow button to open the Application group or Application

selection lists.

2 Use the arrow buttons to scroll up and down in the selection lists.
3 Click the desired entry.
The exposure parameters including the operating mode are preset according
to the selected application.

4.3 Patient registration

Before you can examine a patient with your system, you must register the
patient.
Registration means that you give your system all the information about a
patient that it requires for an examination.

 Do not press the key combination Ctrl + Alt + Del.

 CAUTION

Risk of mistaking patients.

The wrong patient is being treated.
◆ The user must ensure the correct patient is being treated before he or
she is registered on the system.

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 CAUTION

Patient ID already exists.

Misinterpretation of data of the examined patient if the selection is
based solely on the patient ID.
◆ Always use four-way identification [patient name, sex, date of birth,
patient ID].
◆ Avoid mixing up patient data by using four-way identification. Selecting
patient data based on the patient ID alone is insufficient. Ensure the
proper display of parameters in the Worklist and in the Patient list.

Depending on how registrations are organized in your hospital and how much
time you have for registration, you can choose between different patient
registration procedures.
◾ Emergency registration
If a patient is admitted who is in an extremely critical condition and must
therefore be examined and treated immediately, select emergency
registration. The patient is registered with provisional data as an emergency
patient. This reduces the time before you can begin the examination to a
minimum.
◾ Registration for the examination
However, if you want to register a patient for an examination, you first enter
the patient's data or select it from the database and then examine the
patient.
◾ Preregistration
If you want to prepare the system to examine a patient at a later point in
time, then you can preregister the patient.
For example, in the morning you can enter the data of all the patients to be
examined during the day. When you want to begin an examination, simply
select the relevant data and edit them, if necessary. This saves time during
the examination.
◾ HIS/RIS query
If your system is connected to a HIS/RIS system (hospital and radiology
information system), the patient can be registered for the examination
though one of these systems.

 CAUTION

HIS/RIS configuration not harmonized.

Communication not possible.
◆ Within the HIS/RIS do not use the "Only Patient ID" configuration
because the patient is identified in the imaging system based on four
pieces of data (patient name, ID, sex, date of birth).

 Patient registration is also possible on the monitor trolley when the C-arm
system is disconnected.

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4.3.1 Emergency registration

An emergency registration is performed if a patient must be examined and
treated immediately, without any time to waste entering the patient’s data.
Emergency registration on the control panel
Emergency registration can be performed on the control panel at any time,
regardless of the processing step you find yourself in.

PREPARATION task card

1 Change to the PREPARATION task card if necessary.

2 Press the "Emergency patient" button.

The PROCESSING task card is displayed on the control panel.
You can now start with the examination.

Keyboard mode If you are in a processing step requiring text entry, keyboard mode is set on the
control panel.
◆ Press this button in the symbol button bar.
The patient is registered as an emergency patient.
Keyboard mode ends.

Another patient registered If you perform emergency registration while another patient is registered, a
corresponding dialog box is displayed.
1 Select the desired options to conclude the examination ( Page 133 Closing
the patient).
2 Press OK to close the currently registered patient.
Emergency registration on the monitor
When you are editing patient data the Data Entry Dialog window is displayed
on the monitor. You can start emergency registration in that window with a
click of the mouse.
◆ Click this button in the Data Entry Dialog window.
The patient is registered as an emergency patient.
The dialog window on the monitor closes.
Emergency registration with the hand switch or footswitch
Outside a running examination, you can perform emergency registration by
activating the hand switch or footswitch.
1 Make sure that there is not a patient registered for an examination.
2 On the hand switch, press the radiation release key once.

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– or –
On the footswitch, press the radiation release pedal once.
The patient is registered as an emergency patient.

Provisional patient data

During emergency registration, missing patient data are supplemented
automatically. An emergency patient is registered with the following data:

Data type Entry

Last name Emergency

First name Emergency if the patient ID has

already been entered
sequential number if the patient ID
has not already been entered

Date of birth Today's date

Sex Unknown

Patient ID E_sequential number

 Make sure to correct the provisional patient data when the opportunity
becomes available ( Page 148 Correcting data).

4.3.2 Registering a new patient

If a patient has never been examined in your hospital or practice before, no data
about this patient will be stored on your system. Therefore all the required data
for this patient must be entered before an examination.
Opening patient registration
Open patient registration on the control panel in the PREPARATION task card.
1 Change to the PREPARATION task card if necessary.

2 Press this button.

The control panel switches to keyboard mode.
The Data Entry Dialog window opens on the left monitor.
Data Entry Dialog window
The mandatory fields for registration and preregistration are highlighted in bold.
Which fields are displayed and which are mandatory can be configured
( Page 211 Patient registration).

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PATIENT area Name, Patient ID, Age, and Sex of the patient are always mandatory entry fields.
This information uniquely identifies the patient in your databases.
Special notes:
◾ Patient ID
You can have a unique patient ID generated as long as no internal rules have
been set for the format.
◾ Date of Birth
Four digits must be entered for the year of birth.
If the date of birth is unknown, the patient's age is used to calculate a date of
birth from today's date.
◾ Age
If the date of birth has been entered, the patient's age is calculated from
today's date and entered.

STUDY area In this area, data from the HIS/RIS system (optional), if connected, are entered
automatically. The data are used especially to uniquely identify the study
created for the examination.

INSTITUTION area This area contains information regarding the examining facility and personnel.
The information can be helpful if the examination images are passed on to a
different organization for reporting.
Special notes:
◾ Institute Name
The institute name entered during configuration is entered here as the
default.

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Application area This area shows the applications available for selection, divided into different
application groups ( Page 104 Selecting the application).
Entering data
The cursor is in the input field for the patient's name.

Making entries 1 Enter text and numbers using the keyboard in the control panel.
The characters entered are shown on the monitor and in the text field on the
control panel.

2 Use the mouse to select entries from the selection list.

Changing fields

◆ Use the Tab button (hold down the Shift button to go backwards) to switch
to the required field.

Generate a patient ID

◆ Press this button in the symbol button bar on the control panel.
– or –

Click the icon in the Data Entry Dialog window.

A new patient ID is generated based on the current date and time.

Correcting the entry

1 On the control panel press the arrow button of the text field to move the
cursor character-by-character.

2 Press this button to delete the character in front of the cursor.

– or –

Mark the incorrect characters with the arrow buttons while holding the Shift
button, and overwrite with the keyboard.

Deleting all entries

◆ Press this button in the symbol button bar on the control panel.
All entries in the Data Entry Dialog window are deleted.

Completing registration
Once you have at a minimum completed the mandatory fields in the Data Entry
Dialog window, you can register the patient for the ensuing examination or
preregister him or her for examination later on.

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Examining the patient

◆ Press this button in the symbol button bar on the control panel.
– or –

Click this button in the Data Entry Dialog window.

The Data Entry Dialog window closes.
The PROCESSING task card is displayed on the control panel.
You can start examining the patient.

Preregistering patients During preregistration the patient and entered data are stored locally. You can
then access the patient data again when you start the examination
( Page 113 Registering patients from the worklist).
◆ Press this button in the symbol button bar on the control panel.
– or –

Click this button in the Data Entry Dialog window.

The patient is included in the Worklist.
The Data Entry Dialog window closes.
The PREPARATION task card is displayed on the control panel.

4.3.3 Registering previous patients

A patient who has already been examined in your hospital or practice is known
to your system.
For the current patient registration you apply the saved information in the Data
Entry Dialog window.
Opening the Patient list
You open the Patient list on the control panel in the PREPARATION task card.
1 Change to the PREPARATION task card if necessary.

2 Press this button.

The control panel switches to keyboard mode.
The Patient list opens on the left monitor.

Patient not found If the patient you want is not displayed, a database filter may be on or the
patient has been deleted.

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1 Set the filter criteria accordingly or switch off the filter. See
( Page 147 Filtering data)
2 If necessary, import the patient data from the archive. See
( Page 151 Importing data)
Checking/correcting patient data

Opening data

1 Use the arrow buttons or mouse to select the required patient.

2 Press this button in the symbol button bar on the control panel.
The data of the selected patient are transferred to the Data Entry Dialog
window.

Editing data ◆ Check that the information in the Data Entry Dialog window is correct and
add any missing data ( Page 110 Entering data).

Wrong patient If you have selected the wrong patient:

◆ Press this button in the symbol button bar on the control panel.
All changes in the Data Entry Dialog window are discarded.
The Patient list is displayed again.
Completing registration

Examining the patient

◆ Press this button on the control panel or click the button on the screen.
The Data Entry Dialog window closes.
The PROCESSING task card is displayed on the control panel.
You can start examining the patient.

Preregistering patients

◆ Press this button on the control panel or click the button on the screen.
The patient is included in the Worklist.
The Data Entry Dialog window closes.
The PREPARATION task card is displayed on the control panel.
Resuming a commenced study (e.g., intravenous pyelography IVP)
If you cancelled a study with Close, you can continue this study later. Just select
the study, load the data into the Data Entry Dialog window, and then start the
examination. All newly generated images are saved in the existing study as a
new series. Please note that this is only possible if you have already acquired
images in the commenced study. An empty study cannot be used for
registration.
1 Open the Patient list.
2 Select the corresponding study.

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3 Transfer the data to the Data Entry Dialog window.

4 Register the patient for examination.

The PROCESSING task card is displayed on the control panel.
You may resume your study.

4.3.4 Registering patients from the worklist

The Worklist contains patients that were preregistered manually in your system
and automatically via the HIS/RIS connection.
Updating the worklist
The Worklist is updated via the HIS/RIS system at regular intervals, and when
the Worklist is opened. You can also initiate the update manually, for example,
when you want to continue working without HIS/RIS connection.
◆ Press this button on the PREPARATION task card on the control panel.
The Manage Tool opens on the left monitor.

Worklist complete

◆ Click this button in the Patient subtask card.

The Manage Tool closes.
The Worklist opens on the left monitor and is updated with the examinations
planned for your system.

Filtering the worklist If you are looking for a specific patient you can enter his name or you can query
the HIS/RIS for specific entries only.
1 Click this button in the Patient subtask card.
The Get Worklist Dialog window opens.

2 Enter the data you know as search criteria.

Possible placeholders: * stands for one or more random characters, ? stands
for one random character.
Modality: The modality planned for the patient.

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Not only today's worklist: Query for all scheduled appointments.

3 Click this button.
The Manage Tool closes.
The Worklist opens on the left monitor and updates. In addition to the
patients preregistered manually, only those HIS/RIS entries that meet the
search criteria are displayed.
Opening the worklist
You open the Worklist on the control panel in the PREPARATION task card,
unless it is already displayed due to a manual update.
1 Change to the PREPARATION task card if necessary.

2 Press this button.

The control panel switches to keyboard mode.
The Worklist opens on the left monitor.

Checking/correcting patient data

Opening data

1 Use the arrow buttons or mouse to select the required patient in the
Worklist.

2 Press this button in the symbol button bar on the control panel.
The data of the selected patient are transferred to the Data Entry Dialog
window.

Editing data 1 Check that the information in the Data Entry Dialog window is correct and
add any missing data ( Page 110 Entering data).
2 Press this button on the control panel or click the button on the screen to
confirm changes.
The Worklist is displayed again.

 For reasons of data consistency, some information in HIS/RIS entries cannot

be changed, such as the personal data of the patient.

Wrong patient If you have selected the wrong patient:

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◆ Press this button in the symbol button bar on the control panel.
All changes in the Data Entry Dialog window are discarded.
The Worklist is displayed again.
Completing registration
◆ Use the arrow buttons or mouse to select the required patient in the
Worklist, if necessary.

Examining the patient

◆ Press this button on the control panel to examine the patient.

The Worklist closes.
The PROCESSING task card is displayed on the control panel.
You can start examining the patient.
– or –
Double-click the patient with the mouse.
Deleting a patient entry
As soon as the examination of a patient in the Worklist ends, the data saved in
the study is moved automatically to the Patient list.
If an examination for a patient is cancelled, you can manually delete the entry
so that the Worklist remains clear.
1 Use the arrow buttons or mouse to select the required patient in the
Worklist, if necessary.

2 Press this button on the control panel to remove the patient in question from
the Worklist.

4.4 Defining the examination settings

The standard exposure parameters are already set by default for the
examination, depending on the Application you have selected
( Page 104 Selecting the application).
If these settings are appropriate for your examination, you can start the image
acquisition immediately on the Cios Alpha ( Page 124 Acquiring images).
The Application currently selected together with the patient data are displayed
in the left monitor on the upper left.

 Make sure that the patient’s name on the monitor matches the patient to be
examined.

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4.4.1 Changing the fluoroscopy parameters

On the control units, you set the exposure parameters in the left area of the
control panel. Settings may be changed prior to each radiation release.

 CAUTION

Incorrect exposure parameters.

Risk of unnecessary radiation exposure due to incorrect exposure
parameters.
◆ Ensure the exposure parameters are correct. Pay attention to the
exposure index (EXI).

Selecting the operating mode

The operating mode currently set is indicated by the button highlighted white.
The current operating mode is deselected when switching to another mode.

The operating modes can also be selected via the corresponding button on

 the multifunctional footswitch (optional), if used. You can then release

radiation again right away. ( Page 295 Multifunctional footswitch
(optional))

Fluoroscopy

◆ Press this button.

Fluoroscopy mode is selected.
The button is highlighted white.


Upon switching on the Cios Alpha, the operating mode configured as the
standard application, usually Fluoroscopy, is selected automatically by
default ( Page 221 Examination settings (PEX Editor)).

Single image Single image operating mode enables an electronic instant image with the best
image quality. It is recommended for final exposures.
On activation of single image a short radiation pulse is released.


Please note that a Fluoro exposure with > 2fps has to be made before a
single exposure in order to set the exposure parameters (kV/mA) and
thereby achieve good image quality.


When acquiring single images, remember to keep the radiation release
button pressed (on the hand switch or footswitch) until the radiation
indicator goes out.

◆ Press this button.

Single image operating mode is selected.
The button is highlighted white.

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In order to ensure sufficient image quality, images are completely acquired

 after the start of acquisition, even if no more radiation is released.

After complete image acquisition, radiation is automatically switched off,
even if the radiation release button remains pressed.

Subtraction (Sub) The subtraction technique enables an isolated display of the vascular system
after injection of the contrast agent by means of background subtraction
( Page 135 Digital subtraction angiography (Sub)).
◆ Press this button.
Subtraction operating mode is selected.
The button is highlighted white.

Roadmap The Roadmap technique enables the user to position a catheter precisely in a
blood vessel under fluoroscopy. ( Page 136 Roadmap (Road))
◆ Press this button.
The Roadmap mode is selected.
The button is highlighted white.


Please note that a Fluoro exposure with > 2fps has to be made before
exposures using subtraction or roadmap technique in order to set the
exposure parameters (kV/mA) and thereby achieve good image quality.

Setting collimators
The Cios Alpha uses the following collimators to collimate the X-ray beam:
◾ Rectangular collimator
The rectangular collimator provides radiation protection for the patient and
all persons participating in the examination.
◾ Slot collimator
The slot collimator is used primarily for collimation of the extremities.

 CAUTION

Wrong collimator setting.

Dose not as required!
◆ The collimators need to be set so that at least one edge of the leaves is
visible in the fluoroscopy image. This must be checked daily.

Digital collimator function: The areas outside the collimated areas are
automatically blackened if so configured for the selected application.
( Page 227 Editing applications)

Collimation menu

◆ Press this button.

The Collimation menu opens.

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The current collimation setting is displayed on the left monitor and in the
image area of the control panel.
When you release radiation, the collimators are in the position shown in the
image.


When you open/close the rectangular collimator or move the slot collimator
without radiation, you can see the position of the collimator on the LIH
image displayed with lines superimposed.

Opening/closing the rectangular When switching on the Cios Alpha, the rectangular collimator automatically
collimator opens to full format. Smaller collimation produces less scatter radiation and
therefore better image contrast.
◆ Press one of these buttons.
The rectangular collimator opens/closes.

Opening/closing the slot collimator Collimation enhances image contrast and reduces scatter radiation. Direct
radiation that passes the soft tissue laterally is reduced to such an extent, that
differences in brightness do not disturb when images are viewed on the
monitor.
The position of the left and right slot collimator blades can be changed jointly
(symmetric) and individually (asymmetric).
1 Press one of these buttons.
The slot collimator opens/closes symmetrically.

2 Press one of these buttons for the left or right slot collimator side.
The corresponding blades extend/retract on one side.

Rotating the slot collimator By rotating the slot collimator, the collimated field can be quickly oriented to
the direction of the anatomy under examination (e.g. the extremities).
◆ Press one of these buttons.
The slot collimator rotates to the left/right.

Resetting the collimators

◆ Press this button.

The collimators are reset to full format.

Selecting the dose rate level

You can choose between three dose levels (deviating from the current user
program).
The dose level currently set is displayed at the Dose button of the control panels
and at the left monitor.

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 When selecting different dose levels, please note that additional specific
parameter settings, such as k factor and pulse rate, change automatically.

Dose menu

◆ Press this button.

The Dose menu appears.
The current setting is highlighted white.

Selecting the dose level

◆ Select the required dose with the buttons.

Dose levels of low, medium, and high may be set.

If the maximum skin dose is exceeded at the highest dose level, the
corresponding button is called "High level" and marked with a warning


symbol. The button and the display on the monitor are marked with a
warning symbol.

Switching on metal correction

Metal correction is designed for examinations with metal parts in the
measurement range (e.g., larger, non-standard implants). When activated, the
contrast and brightness settings are adjusted accordingly and the automatic
dose rate control is improved.
◆ Press this button.
The button is highlighted white.

Selecting the motion/noise filter

By using noise filters with motion detection, you take into account the influence
of movements when filtering noise. Image integration depends on the preset k
factor (depending on the operating mode up to max. k = 16), which is adapted
according to the selected motion/noise filter.


k factor: a number of k exposures are integrated into one image; the k
factor can be selected between k = 1 and k = 16 and can be assigned to an
examination set and stored (IEC 60601-2-7:1998 29.1.103 d).

Motion noise filter menu

◆ Press this button.

The Motion Noise filter menu is displayed.
The current settings are highlighted white.

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Motion detection Motion detection is used to establish whether the maximum number of images
(for still objects) or a lower number of images (for moving objects) should be
used for image integration.
◆ Press one of these buttons.
Off: Image integration is independent of movements in the image with
preconfigured k-factor.
On: Image integration takes place only if movements are detected in the
image.

Cardiac filter The Cardiac button is used for examinations requiring particularly high
temporal resolution. It reduces the k factor to a minimum to reduce blurring. It
may however also increase noise.
◆ Press this button.
No image integration occurs. In this way rapidly occurring processes (e.g.
beating heart) can be best shown.

Averaging live image By fine adjusting the averaging, you take into account the motion frequency of
the object to be examined. An integration factor is applied to the k value that
results for the selected motion detection.
◆ Press a button in the Noise filter live image area.
Low: A low integration factor is selected (for recording fast-moving objects;
default: 0.7).
Medium: No change in the k value (integration factor = 1).
High: A higher integration factor is selected (for very slow movements;
default: 1.4).

Noise filter LIH A separate setting for image integration is available for the LIH (Last Image
Hold) image. The values to be set and the functionality is the same as for Noise
filter live image.
◆ Press a button in the Noise filter LIH area.
Possible settings: Low, Medium, High.

Selecting the input format (Detector zoom/magnification)

Three different zoom levels are available. This sets the input format for the
subsequent image acquisition. The input format is the size of the detector area
that is exposed and then fills the screen when displayed on the monitor.

Zoom level Mag 0 Mag 1 Mag 2

Input format (20 cm x 20 20 cm x 20 cm (full format) 15 cm x 15 cm 10 cm x 10 cm

cm detector)

Input format (30 cm x 30 30 cm x 30 cm (full format) 20 cm x 20 cm 15 cm x 15 cm

cm detector)

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Magnification menu

◆ Press this button.

The Magnification menu opens.
The current input format level is displayed on the left monitor and in the
image area of the control panel.

Select the zoom level

◆ Select the required zoom level with the keys.

The input format display is updated accordingly.

Setting the pulse rate

Depending on the configuration level, you can select from among up to 9
different pulse rates during the examination. The respective set value is
displayed on the control panel using the Pulse rate button.

Pulse rate menu

◆ Press this button.

The Pulse rate menu opens.
The current setting is highlighted white.

Selecting the pulse rate

◆ Select the pulse rate required with the corresponding button.

The pulse rate changes accordingly.

Setting the X-ray parameters manually

You can change the default X-ray parameters manually with the +/- buttons for
kV/mA or kV/mAs (for single image operating mode).
Automatic dose rate control: Using automatic dose rate control (ADR), the
kV/mA values or kV/mAs values are regulated so that the mean value of the
image gray values is kept constant largely independently of the object thickness
and position. This ensures optimal image quality for on-screen evaluation.
The current automatic dose rate control status can be read on the control panel
using the Tech lock button.

(1) ADR activated (kV/mA are automatically regulated)

(2) ADR locked (kV/mA remain constant for the current values)

Activating Tech lock Stop When metallic objects (e.g. intermedullary nails) are introduced into the beam
path or when examining objects of varying density (e.g. hip prosthesis) under
fluoroscopy, it is recommended that you set the kV just established with the
Tech lock button at the start of fluoroscopy.

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 The automatic dose rate control (ADR) must remain activated during
interventional procedures.

1 Press this button.

The Tech lock menu opens.

2 Press this button.

The stop function is activated and the Stop button is highlighted white.
Automatic dose control is disabled.
The +/- buttons for kV/mA or kV/mAs are enabled.

Do not switch between Fluoroscopy and Single Image operating modes

 while Tech lock Stop is active, because with Tech lock Stop the image
brightness cannot be adjusted to the different dose levels in the two
operating modes.

Changing the X-ray parameters Activating Tech lock Stop enables you to manually set kV/mA or kV/mAs.
manually
The set values are displayed on the control panel.

(1) Display of kV/mA (mAs) and pulse width in the Tech lock menu
(2) Display of kV/mA (mAs) in the exposure parameter area

◆ Press the +/- buttons.

The values for kV/mA or kV/mAs increase or decrease.
Pressing the button for an extended period continually increases or decreases
the corresponding X-ray parameter.
Once the upper or lower limit of the setting range is reached, an audible tone
is emitted. Pressing the button again has the same effect.

 The mA values assigned to the kV values result from the fluoroscopy curves
( Page 251 Curves and diagrams).

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4.4.2 Setting the image parameters

On the control units, you set the image parameters in the PROCESSING task
card in the right area of the control panel. Changing the settings impacts the
image currently displayed (if applicable) and any images acquired thereafter.
Selecting the image orientation
It may be necessary to rotate and/or flip the image so that it appears in the
required orientation on the monitor.

 Object display on the monitor depends upon the C-arm system position
relative to the patient.

 CAUTION

Inverted image orientation.

Risk of an incorrect decision during surgery.
◆ The operator must apply due diligence; identifying each side is
recommended.

 CAUTION

Inverted image orientation.

Incorrect intervention decision!
◆ It is recommended to mark the patient position using lead letters.

Standard image orientation

(1) Left side of patient

(2) Right side of patient

Rotating/flipping images
The current image rotation and -flip settings are displayed in the image area of
the control panel.

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 The rotation angle ranges from 0° to 359°.

Rotation Flip menu

◆ Press this button.

The Rotate Flip menu appears.

Selecting the image rotation

◆ Use these buttons to set the angle of rotation in 90° increments.

– or –

Press this button.

The angle of rotation is reset to 0°.

Selecting image flip

◆ Press one of these buttons.

Vertical/horizontal image flip is activated.

4.5 Acquiring images

All further steps of the examination are performed at the C-arm system. For
detailed information on operating the C-arm, hand switch, and footswitch, see
( Page 51 System Description).
The registered patient's last name, first name and date of birth appear in the
upper control area of the left monitor.
◆ Prior to releasing radiation, make sure that the registered patient and actual
patient are the same.

 CAUTION

Inverted image orientation.

Risk of an incorrect decision during surgery.
◆ Prior to releasing radiation, the user must ensure the correct patient
position with respect to the X-ray beam.

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4.5.1 Releasing radiation

◆ Release radiation with the hand switch or footswitch.
The current fluoro image is displayed on the left (live) monitor.
Complete image integration as a function of the set k factor (up to max. k =
16, depending on the operating mode) is ensured even for very short
exposures ("toe tapping").


k factor: a number of k exposures are integrated into one image; the k
factor can be selected between k = 2 and k = 16 and can be assigned to an
examination set and stored (IEC 60601-2-7:1998 29.1.103 d).

 CAUTION

Defective imaging system hardware.

Risk of X-ray radiation exposure without a saved image!
◆ If no image appears, immediately stop the radiation and switch off the
tube assembly.

 CAUTION

Because of a technical error the acquisition is not stopped or there is an

unintended release of radiation.
Risk of unnecessary radiation exposure!
◆ Press the OFF button on the monitor trolley, even if the EMERGENCY
STOP button has already been pressed. Radiation terminates
immediately, even if the sound of the rotating anode can still be heard.

Displaying fluoroscopy images

In the image area the fluoroscopic images are displayed during and after
exposure. Additional information may be shown as image text, depending on
the configuration ( Page 216 Image display and print properties).

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(1) Information on kV and mA

(2) Window value and LUT information

Live images As soon as the exposure (i.e. radiation) starts, the current fluoroscopic images
(live images) are displayed on the left monitor and the control panels.

Last Image Hold (LIH) The last image hold (LIH) is displayed as soon as the exposure has ended.

Switching on enlarged preview image (blow-up)

You can always enlarge (blow up) the displayed image using the control panel.
1 Tap the image area.
The displayed image is enlarged across the entire task card range.
Buttons to change the image display appear on the right side.

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(1) Blow-up area

(2) Image display functions
2 Press the Close button to reset the control panels to normal display.

Confirming a warning signal

After 5 minutes of uninterrupted fluoroscopy time, a warning signal sounds.
However, this can be reset on the control panels. After 10 minutes of
uninterrupted fluoroscopy time, radiation is terminated. However, it can be
released again.

 These settings are country-specific and can be changed by Siemens

Customer Service in accordance with the applicable regulations.

◆ Press the reset button (alarm icon flashes).

The audible warning signal is deactivated.
The fluoro timer is reset.
Temperature monitoring
If the system is used intensively over an extended period, the X-ray tube and
single tank can become very hot.

Single-tank temperature

The current thermal capacity of the single tank is shown by an 11-segment bar
display on the left monitor:

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The length of the bar indicates the relative temperature load of the X-ray
system.

X-ray tube temperature The X-ray tube temperature status is displayed on the left monitor as follows:

If the temperature is normal, a green tube symbol appears on the color monitor,
and a solid symbol appears on the b/w monitor.

If the tube is heated, an orange tube symbol appears on the color monitor, and
a flashing symbol appears on the b/w monitor.

If the tube temperature is critical, a red tube symbol with an exclamation point
appears on the color monitor, and a solid tube symbol with exclamation point
appears on the b/w monitor.
To prevent overheating, the pulse rate for a very hot tube is limited to 10
images per second. Working with the reduced frame rate is nevertheless
possible without any further restrictions.
Radiation information
The radiation data are shown on the control panels and on the left monitor. The
information is updated with every release of radiation.
Here, the entire fluoroscopic time since the start of the examination of a patient
is displayed.

The cumulative dose area product for the current patient is displayed if the
optional dose measurement chamber is installed.
As an alternative: Display of the air kerma value and cumulative air kerma
value. These data appear on the left monitor.

The reference location for determining the air kerma values with the
optional dose measurement chamber is 30 cm in front of the detector
input. The reason for this convention is that in typical applications the

 object to be examined is located approximately 30 cm in front of the flat

detector.
Depending on country-specific regulations, you can have Siemens Customer
Service change the display so that it indicates the air kerma and cumulative
air kerma value instead of the dose area product.

4.5.2 Saving and displaying images

In Fluoroscopy, Subtraction, and Roadmap operating modes, images can be
saved manually during the examination. Images that you want to print out later
have to be saved during the examination. Images printed directly during the
examination are saved automatically.

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If the application used is configured such that all images are saved
automatically, manual saving is not necessary and therefore not possible.


Saving images/scenes with the footswitch is also possible when the pedal
allocation is configured accordingly.
Images/scenes can always be saved via the corresponding button on the
multifunctional footswitch (optional). See ( Page 295 Multifunctional
footswitch (optional)).

Storing images (during radiation)

◆ Press this button on the control panel.
– or –

Press this button on the hand switch.

The current image (or the subtraction image in Sub/Roadmap mode) is stored
in the local database. All images saved in the course of an examination are
stored as a series.
The saved fluoro image is displayed on the right (reference) monitor. This
does not occur if a second video source is displayed on the right (reference)
monitor (refer to ( Page 132 Loading images from an external video
source)).
Storing images (after radiation)
◆ Press this button on the control panel.
– or –

Press this key on the hand switch (press and hold < 2 seconds).
The displayed image (LIH) is stored in the local database.
The LIH is displayed on the right (reference) monitor.

 Holding the key for > 2 seconds: Saves the scene last recorded (LSH).

Saving and reviewing a scene

In the fluoroscopy, subtraction and Roadmap operating modes, scenes can be
saved and reviewed (Last Scene Hold) during the examination.

Saving the scene

◆ Press this button on the control panel.

– or –

Press this key on the hand switch (press and hold > 2 seconds).
The current scene (LSH) will be stored in the local database. In case of a
restricted review range, images are saved from the starting point to the end
point.
The LSH is displayed on the right (reference) monitor.

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 Holding the key for < 2 seconds: Saves the image last recorded (LIH).

Reviewing a scene

1 Press this button.

The Cine replay menu appears.

2 Press the activated Pause button to start (replay speed matches the storage
rate).
During replay the Pause button changes to a Start button.
3 Replay at half/normal/double speed.

4 Previous/next single image.

5 Play previous/next available scene.

6 Establish starting point and end point for replay.

The corresponding image number is displayed in the respective button.

7 Switches automatic cine replay on/off.

 If Autoreplay is configured in the application used, cine replay is started

automatically at the end of the exposure.

Changing the image display

There are tools available on the control panels for subsequent optimization of
the image display. For detailed information see ( Page 154 2D image
processing).
1 Edge enhancement and spatial noise filter (4 levels each).

2 Brightness/Contrast, image inversion.

3 Zoom/pan image/set shutter.

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4 Rotate/flip an image.

 CAUTION

Processing images by changing the image display.

Loss of image quality by artifacts.
◆ Use care when changing the image display settings.

Recording video
Parallel to the display on the left monitor, you can save images and scenes to
DVD as video. The resulting DVD is suitable for use with a DVD player.

Starting recording 1 Insert an empty CD into the DVD drive.

Supported formats: DVD-R, DVD+R
After inserting a DVD when a recorder license is available, the monitor
queries whether the DVD should be used for recording.
2 Change to the EXTERNAL task card.

3 Press this button.

Ending the recording

1 Change to the EXTERNAL task card if necessary.

2 Press this button.

3 After the write process, remove the DVD from the drive.

4.5.3 Using reference images

In addition to the live images on the left monitor, selected images, e.g. images
used for comparisons, can be displayed on the right monitor.
Transferring Images

Automatic During saving, an image or scene is transferred automatically to the right

monitor:
1 Save the image manually with the Store button (during/after radiation)
The displayed image/LIH is saved and transferred.
– or –
Save the image automatically ("Automatic save" is active)
The LIH is saved and transferred after radiation ends.
2 Save the scene manually with the Store cine button
The LSH is saved and transferred.

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– or –
Save the scene automatically ("Automatic save" is active)
The LSH is saved and transferred after radiation ends.

Manual Using the Transfer A to B function you can transfer an image to the right
monitor during or after radiation, without saving it simultaneously.
◆ Press this button.
The displayed image is transferred.

 Please remember that the transferred image has not been saved, and will
be lost permanently if overwritten by another image.

Scrolling through images

If the "Automatic save" function is active or you have saved several times,
images in addition to the displayed image are available on the right monitor.
1 Scroll to previous image/to previous scene.

2 Scroll to next image/to next scene.

Holding the reference image

The Hold reference function allows you to select a particular image to
permanently display as the reference image on the right monitor.
1 Press this button.
The display on the right monitor is “frozen”.
The transfer of additional images and scrolling to other images is disabled on
the right monitor.
2 Press the button again to cancel Hold reference.

Hold reference is automatically turned on for the first image transferred to

 the right monitor.

Hold reference is cancelled automatically when switching to image
overview display ( Page 155 Displaying the image overview).

Loading images from an external video source

If suitable video sources are connected to your system (such as endoscope or
microscope), you can display the recorded images on the right monitor for
reference.

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Selecting the video source

1 Change to the EXTERNAL task card.

2 Press this button.

The video inputs of your system are checked according to the connecting
video sources.
3 Keep the button pressed until the required video source is reached.

Displaying images

◆ Press this button.

The image recorded from the video source is displayed on the left monitor if
radiation is not being released.
The image is saved to the local database as "CAP image" under the current
study of the registered patient.

4.6 Ending the examination

After you have completed your exposures, the last acquired image is displayed
on the left monitor. Now you finish the examination of the current patient.
If you want to examine the next patient immediately afterwards, you can
register that patient straight away. In this case the examination of the current
patient is automatically finished.

4.6.1 Closing the patient

Closing the patient ends the current examination. The patient data and images
saved in a study in the local database are moved to the Patient list.
1 Press this button on the bottom right of the control panel.
The Close menu appears.

2 Select the desired options.

Print rad. summary: Prints the radiation report on the default printer.

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Export rad. summary: Sends the radiation report to the default address for
export.
Send MPPS: Sends the documentation to the HIS/RIS or a network address
established for this purpose.
3 Press this button.
The examination is concluded. The patient data and images are cleared from
the monitors.
– or –
Press this button to continue the examination with the registered patient.

4.6.2 Examining the next patient

1 Change to the PREPARATION task card if necessary.

2 Register the next patient for examination ( Page 105 Patient registration).

Another patient registered

If another patient is still registered the New patient menu is displayed.

1 Select the desired options to conclude the examination ( Page 133 Closing
the patient).
2 Press OK to close the currently registered patient.

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The new patient is registered for examination.

4.7 Performing special examinations

The following optional operating modes require special procedures deviating
from the standard examination:
◾ Subtraction angiography (Sub)
◾ Roadmap (Road)
◾ Using live graphic overlays
◾ Pediatric applications

 After incorrect operation, it may be necessary for the user to repeat certain
procedures, e.g. administering of contrast agent.

4.7.1 Digital subtraction angiography (Sub)

Cios Alpha provides the Digital Subtraction Angiography mode and fulfills the
German standard DIN 6868-150.
During the examination, images without contrast agent (mask) are continuously
subtracted from images with contrast agent and displayed on the monitor.
Depending on the contrast agent flow, they display the relevant vascular
segment without superimposition in real time.
Progression
Subtraction angiography is divided into three phases:
◾ Phase A
Time until the mask is completed (permanently defined)
◾ Phase B1
Time from the "inject" display on the monitor until the contrast agent has
reached the examination region
◾ Phase B2
Time of the actual exposure of the examination region
Performing subtraction angiography
✓ The patient to be examined has been registered.
1 Select an application with the suffix “_DSA”.
Please note that DSA is performed only if applications with suffix “_DSA” are
selected.
2 Press this button.
Subtraction operating mode is selected.

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Phase A

◆ Release radiation with the hand switch or with the assigned footswitch.
During the generation of the mask the native image is displayed on both
monitors.

Phase B 1 Keep the exposure release button pressed.

2 Inject the contrast agent as soon as the syringe symbol appears on the screen
and control panel.
The corresponding subtraction image is displayed on the control panel and
left monitor.
In the native image on the right monitor you can see the continuous filling of
the blood vessel with contrast agent.

Keep the radiation release button pressed until the vessel is filled with


contrast agent.
Depending on the setting of the Landmark function, a certain percentage
of anatomical background is displayed in the subtraction images
( Page 229 Parameter for fluoroscopy and exposure).

Fill image ◆ Let go of the radiation release button.

After radiation has been switched off the maximum fill image is calculated
and displayed on the left monitor.
The vessels are highlighted in the native image on the right monitor.

 The mask (phase A), subtraction series (phase B) and the fill image are
saved automatically.

4.7.2 Roadmap (Road)

In the first step of the Roadmap examination, the fill image is created as a mask
from a normal subtraction (phase A and phase B).
In the second step, the display of the vessel into which the catheter is to be
positioned is superimposed by current fluoroscopic images (phase C).
Fill image available
You can use the existing fill image if you have already performed a subtraction
angiography during the current examination ( Page 137 Using the fill image
from subtraction angiography).
The availability of the fill image is shown on the Road button and on the
footswitch icon on the monitor. In that case, the first step of the Roadmap
examination is not required.

 A previously created fill image can also be used if you have switched to a
different operating mode (such as single image).

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Generating a new fill image

If there is no suitable fill image (e.g. from a previous subtraction angiography),
you have to generate a new one.
✓ The patient to be examined has been registered.
1 Make the necessary settings for the examination. ( Page 115 Defining the
examination settings)
2 Press this button.
The Roadmap mode is selected.

Phase A

◆ Release radiation with the hand switch or with the assigned footswitch.
During the generation of the mask the native image is displayed on both
monitors.

Phase B 1 Keep the exposure release button pressed.

2 Inject the contrast agent as soon as the syringe symbol appears on the
screen.
In the native image on the right monitor you can see the continuous filling of
the blood vessel with contrast agent.
The corresponding subtraction image is displayed on the left monitor.

 Keep the radiation release button pressed until the vessel is filled with
contrast agent.

Fill image 1 Let go of the radiation release button.

Radiation is stopped.
The fill image is calculated and displayed.
2 Start positioning the catheter ( Page 138 Positioning the catheter (phase
C)).
Using the fill image from subtraction angiography
✓ Subtraction angiography (Subtraction operating mode) was performed at
some point during the current examination.
1 Press this button.
The Roadmap mode is selected.
2 Start positioning the catheter ( Page 138 Positioning the catheter (phase
C)).

 If you press the Sub button, the existing fill image is discarded. You will
then have to regenerate the fill image.

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Manually selecting the fill image

✓ A subtraction data set (subtraction or Roadmap operating mode) was
generated in the current examination.

Fill image with another mask To calculate a new fill image you have to determine a suitable subtraction mask
that can be used.
1 Press this button.
The Select mask menu opens.

2 Move the slider to the left/right to select another mask image.

Pressing the arrow repeatedly takes you incrementally from image to image.
The fill image is recalculated automatically.

Fill image from image selection To calculate a new fill image you have to determine a suitable selection of
subtraction images that can be evaluated.
1 Press this button.
The Fill image menu opens.

2 Display the subtraction series images, and use the buttons to set the first/last
image you select as the new start point/end point.
The Fill image menu displays the images numbers for the start point and end
point of the limited series range.
A new fill image is calculated and displayed based on the image selection.
3 Press this button to apply the fill image.
The Fill image menu closes.

Selecting a different fill image If multiple fill images have been calculated you can select the most suitable
image for phase C.
1 Press this button.
The Fill image menu opens.

2 If necessary, repeatedly press one of the buttons to select the fill image
required.

Positioning the catheter (phase C)

If the vessels are easily discernible, position the catheter in the fill image under
fluoroscopy.
1 Release radiation with the hand switch or with the assigned footswitch.
2 Position the guidewire or the catheter under fluoroscopic control.
The right monitor shows the fluoro image (native).
The left monitor shows the subtracted Roadmap image with catheter.

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 You can repeat fluoroscopy as often as needed while you insert the
catheter.

4.7.3 Using graphics overlays

The lines drawn in an ongoing examination can be transferred to the
subsequent live images. Such graphic overlays are used, for example, in
orthopedics, traumatology as well as in subtraction and roadmap examinations.
For example, lines can be drawn into fill images to support the treatment of
abdominal aortic aneurysms.

 WARNING

An annotated image with graphic overlay lines is displayed. Following

system and/or table or patient movements and/or image modifications,
subsequent images may not match the overlay line displayed due to
projective changes.
Incorrect interpretation of the display and resulting incorrect decision
during operation!
◆ The graphic overlay line is displayed until the user actively turns it off.
This is done independently of any changes (for example, movements,
operating mode changes, image modifications). The user must ensure
that the displayed overlay line matches the current, underlying image
(for example, display of anatomical structures via the label function
and/or use of contrast agent).

Live graph overlay menu

1 Display the required image.
2 Press this button.
The Live graph overlay menu is displayed.

Drawing lines
You draw the lines as a polygon where each change in direction creates a vertex
in the image.
1 Press this button to set the starting point and vertices at the respective mouse
pointer positions.

2 Press this button at the required end point.

The new line is shown as a dotted line in the image.


If a graphic overlay was already used in the previous image, the
corresponding lines are displayed as continuous. The old overlay is replaced
by the newly drawn in lines in the following images.

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Deleting points
If a point has been placed incorrectly, it can be deleted immediately after being
drawn as long as the end point has not been set.
◆ Press this button.
The last point set is deleted from the image.
Pressing the button again deletes the previous point.
You can continue drawing the line.
Postprocessing lines
Postprocessing via the Live graph overlay menu is possible only for newly
drawn lines (dotted). A previously used overlay (solid lines) can be post-
processed using the Measure Annotate menu see ( Page 168 Evaluating
images).
1 Move the mouse pointer to the line or a point to select the given graphic
object.

2 Press this button.

Now you can move (arrow buttons) or delete (Delete selected button) the
selected point or the complete line.
Deleting everything
◆ Press this button.
The newly drawn graphic overlay (dotted lines) is deleted.

4.7.4 Pediatric use

The Cios Alpha may be used for pediatric purposes.
We suggest using the available special applications for pediatric use in the
application database delivered with the system. There are individual pediatric
applications for each application group of the default application database.
These default pediatric applications may be used for basis of the examination
for all pediatric patients (in general for children up to the age of 14 years).
It is recommended to remove the anti-scatter grid for all pediatric patients up to
the age of 7 years as well as all medical applications that are restricted to
extremities.
For pediatric patients older than 7 years an anti-scatter grid is recommended
otherwise image quality may be compromised.
If depending on patient stature the kV increases above 100 kV it is suggested to
switch to the corresponding adult program (otherwise image quality may be
compromised).
Depending on the medical requirements of your respective examination,
consider other dose saving measures. For example, reduce the frame rate and
radiation time as much as possible.

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Following these suggestions will lead to a minimalized dose for the patient.
For an orientation of dose savings please see the following table with a
comparison between pediatric and standard protocols:
Object: 10 cm PMMA directly located on the FD cover (without anti-scatter grid
for pediatric programs)

Fluoro Sub

Application (Group) Standard - Dose rate Pediatrics - Dose rate Standard - Dose rate Pediatrics - Dose rate
(mGy/min) (mGy/min) (mGy/min) (mGy/min)

Card. 1.4 0.2 1.6 0.4

Gastro 1.4 0.2 1.5 0.2

General 0.8 0.2 1.1 0.2

Ortho 0.8 0.2 1.1 0.2

Uro 0.8 0.2 1.1 0.2

Vascular 0.8 0.2 1.0 0.2

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5 Postprocessing
5.1 Patient data 145
5.1.1 When to use the Patient list 145
5.1.2 External data 145
5.1.3 Searching for and selecting patient data 145
Flag 146
Opening the Patient list 147
Sorting data 147
Filtering data 147
Selecting data 148
5.1.4 Correcting data 148
Opening the correction dialog 148
Data Entry Dialog window 149
Editing data 149
5.1.5 Deleting data 150
Deleting data manually 150
Protecting data from deletion 150
5.1.6 Importing data 151
Import dialog 151
Opening the import dialog 152
Data from removable devices 152
Data in the network 153
5.2 2D image processing 154
5.2.1 Loading and displaying images 154
Loading images 155
Displaying the image overview 155
Changing the display mode 156
Scrolling 157
Displaying full screen image 157
Reviewing a scene 158
5.2.2 Selecting images 159
Single selection 159
Multiselection 159
5.2.3 Deleting individual images/series 161
5.2.4 Changing the image display 162
Selecting images for processing 162
Windowing images 162
Inverting images 163
Using image filters 164
Rotating/flipping images 165
Zooming and panning images 165
Setting digital shutters 166
Resetting the image display 167
5.2.5 Evaluating images 168
Selecting images for evaluation 168
Displaying the evaluation functions 168
General work steps 169
Calibration 170
Measuring the distance 171
Measuring an angle 172
Annotating images 172
Setting the side identification 173

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5.2.6 Evaluation in enhanced mouse mode 173

Activating enhanced mouse mode 174
Turning off enhanced mouse mode 174
General work steps 174
Calibration 175
Measuring the distance 175
Measuring an angle 175
Annotating images 176
5.2.7 Saving images 177
Saving a single image 177
Saving multiple images 177
5.3 Subtraction processing 178
5.3.1 Postprocessing functions 178
5.3.2 Loading and displaying images 178
Loading images 178
Changing the monitor layout 179
Displaying images 179
5.3.3 Changing the image display 179
Windowing images 179
Including anatomical background (Landmark) 180
Making the image and mask coincide exactly (Pixel
shift) 180
5.3.4 Evaluating subtraction images 182
Stenosis quantification 182

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5.1 Patient data

All acquisitions (images, series) prepared as part of an examination are saved in
a study on the hard drive of the imaging system (local database). You can access
these data quickly and easily using the Patient list.

5.1.1 When to use the Patient list

◾ To examine a patient who has already been examined once before with your
system and whose data are still saved in the local database
( Page 111 Registering previous patients)
◾ To view the images of a patient from earlier examinations in order to
compare them with current results
◾ To postprocess or add comments to images after an examination
◾ To correct incorrect information on a patient stored in your system
◾ To print a patient's images for documentation purposes
◾ To archive patient data and images or to send them to another location in
your hospital via the network

5.1.2 External data

To view or process data from an external storage medium or other network
node, they first have to be imported.

5.1.3 Searching for and selecting patient data

The studies of patients examined previously that are saved to the local database
are displayed in the Patient list.

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(1) Table heading

(2) Study entries (List of patients and their studies)
(3) Preview images of the selected study

Flag
An abbreviation in the Flag column indicates the study status:

Flag Meaning

A/a All/some images were sent to the archive and the

receipt was confirmed (as long as the archive works
with DICOM Storage Commitment)

C Study is closed (no further acquisition possible)

D/d All/some images were transferred to or from CD/DVD

P/p All/some images were printed

R/r All/some images read in via network

S/s All/some images were sent and the receipt was con-
firmed (if the recipient works with DICOM Storage Com-
mitment)

# Study is protected against deletion

* Study was received from HIS/RIS

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Opening the Patient list

You open the Patient list on the control panel in the PREPARATION task card.
1 Change to the PREPARATION task card if necessary.

2 Press this button.

The control panel switches to keyboard mode.
The Patient list opens on the left monitor.
Sorting data
You can sort list entries according to the displayed columns.
1 Click the table header for the respective column.
The list is sorted in alphanumerically ascending order based on this column.
Studies with the same entry in the sorting column are further sorted by the
date and time of the examination.
2 Click the table header of the same column again.
The sorting sequence is reversed.
Filtering data
It is possible to only display studies that meet specific criteria by using database
filters. The Flags of the individual studies are evaluated in this case
( Page 145 Searching for and selecting patient data).

Activating a filter

1 Press this button in the symbol button bar on the control panel.
The Database Filter window appears on the left monitor.

2 Activate the required check boxes.

show: only display studies with the selected flag
hide: hide all studies with the selected flag
3 Confirm with OK to apply the filter.

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
You can specifically delimit the list display by combining multiple filter
criteria. Example: Printed show together with Archived hide shows the
studies that have been printed but not yet archived.

Deactivating the filter

1 Press this button in the symbol button bar on the control panel.
The Database Filter window appears on the left monitor.

2 Click this button.

All data (unfiltered) are displayed in the Patient list.

Selecting data

Searching by the first letter 1 Using the keyboard in the control panel, press the first letter of the required
patient.
The first name with a suitable patient name is selected in the Patient list.
2 Press this same letter button again, to select the next list entry for a patient
with this first letter.

Direct selection

◆ Use the arrow buttons on the control panel to select the required study.
– or –
Click the list entry with the mouse.

Multi study mode If Multi study mode is configured for patient lists, selecting one study in turn
selects all studies for the patient.

5.1.4 Correcting data

Every now and then it is necessary to correct patient data for an examination.
This is the case particularly with emergency patients that are saved to the local
database with provisional data.

 Patient data in studies you have already exported or sent via the network
cannot be changed in the local database.

Opening the correction dialog

Patient and examination data are corrected in the Data Entry Dialog window.

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1 Select the study entry to be corrected in the Patient list.

2 Press this button in the symbol button bar on the control panel.
The data of the selected patient are transferred to the Data Entry Dialog
window.
Data Entry Dialog window
Patient and examination data of the selected study saved in the local database
are entered in the Data Entry Dialog window.

Editing data
Which fields are displayed and therefore can be corrected depends on the
configuration settings ( Page 211 Patient registration).

Changing fields

◆ Use the Tab button (hold down the Shift button to go backwards) or click the
mouse to switch to the required field.

Correcting the entry

1 On the control panel press the arrow button of the text field to move the
cursor character-by-character.

2 Press this button to delete the character in front of the cursor.

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– or –
Mark the incorrect characters with the arrow buttons while holding the Shift
button, and overwrite with the keyboard.

Saving changes

◆ Press this button on the control panel or click the button on the screen to
confirm changes.
The Data Entry Dialog window closes.
The Patient list is updated based on the changes.

5.1.5 Deleting data

You should delete archived images you no longer need from the local database
on a regular basis. This ensures sufficient storage capacity on your system.
You can delete data as follows:
◾ Automatic deletion
Depending on the configuration settings, images are deleted once they reach
a specific status ( Page 220 Deleting images automatically)
◾ Manual deletion
You can individually select studies and delete regardless of data status
Deleting data manually
1 Select the entry to be deleted in the Patient list.
2 Make sure that the selected study has been archived correctly.

3 Press this button in the symbol button bar on the control panel.
The selected study and all its images are deleted.

 In Multi study mode, all of the selected patient's studies are selected and
deleted.


During image postprocessing, you can delete individual images or series of
a study using the image overview ( Page 161 Deleting individual images/
series).

Protecting data from deletion

You can protect images on the local database against unintentional manual
deletion and automatic deletion.

Setting deletion protection

1 In the Patient list select the entry you want to protect against deletion.

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2 Press this button in the symbol button bar on the control panel.

 In Multi study mode, all of the selected patient's studies are selected and
protected.

Removing deletion protection

1 Select the deletion-protected entry in the Patient list.

2 Press this button in the symbol button bar on the control panel.

5.1.6 Importing data

If the required patient data and images are on removable devices or other
network nodes, import them to the local database. The data are then available
in the Patient list.
Import dialog

(1) Data source selection

(2) Display thumbnails (CD/DVD and USB storage media only)
(3) Disk space required on the hard drive (CD/DVD and USB storage media
only)
(4) Button bar
Import: Starts data import
Status: Displays the data transfer status
Close: Closes the dialog window

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Opening the import dialog

◆ Click this button on the left monitor (lower left).
The Import from... dialog window is displayed.

Data from removable devices

Image data on a data medium in DICOM format can be read in as long as an
appropriate drive is installed and configured.

Displaying saved data 1 Have the required data medium on hand.

Insert the CD/DVD into the drive.
Connect the USB memory to the USB socket.
2 Select the applicable data medium as the data source in the Import from...
dialog window.
The studies saved on the data medium are listed.
If activated, thumbnails are displayed for the currently selected study.
Example: Displaying the content of a CD/DVD

Importing data 1 Click the required study with the mouse.

Press and hold the Ctrl button to select multiple entries.
2 Click this button in the Import from... dialog window.
The data are read in.

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Data in the network

You can access image data on other workstations or a long-term archive using
“Query & Retrieve”.

Opening “Query & Retrieve” ◆ In the Import from... dialog window select the DICOM node entry as the
data source.
The Query for retrieve dialog window is displayed.

(1) Input fields for search criteria (search screen)

(2) Network node selection (data source)
(3) List of search results

Starting a search 1 As search criteria enter the known patient data and further search details, if
necessary.
2 Select the network node where you want to search for the data.
3 Click this button.
The patients and studies found are listed in the results area.

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(1) Details on the study currently selected in the results list

(2) List of found patients and studies
(3) Currently selected study

Displaying series If you only require a selection of images from a specific study, then display the
series contained in the study.
1 Select the corresponding study in the results list.
2 Click this button.
All series of the selected study are listed in the results area.


Use this button to display the list of found patients and studies again.

Importing data 1 Select the required data (studies or series) in the results list with the mouse.
Press and hold the Ctrl button to select multiple entries.
2 Click this button in the Import from... dialog window.
The data are read in.

5.2 2D image processing

As part of postprocessing, you view the results of an examination and evaluate
them using 2D processing functions. You can also compare the image material
from various examinations of a patient (such as the current examination and a
previous examination).

5.2.1 Loading and displaying images

During an examination in progress you can only edit images of the registered
patient. Outside of an examination, you can load the images of any patient for
processing.

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Loading images
In the Patient list you have access to the images of prior examinations stored
on the local database. Select one or more studies of the required patient here
( Page 145 Searching for and selecting patient data).
With an examination in progress, all saved images are already loaded. If needed,
you can load additional images from prior examinations of the registered
patient.

 If the required images are no longer in the local database, then first import
the data from the external source ( Page 151 Importing data).

1 Change to the PREPARATION task card if necessary.

2 Open the Patient list.

3 Search for the patient, sorting and filtering the list as necessary.
4 Select the required study or studies.
5 Press this button in the symbol button bar on the control panel.
The selected images are loaded and displayed on the monitors.
The PROCESSING task card is displayed on the control panel.
– or –
Double-click the patient with the mouse.
Displaying the image overview
In the image overview display, the monitor layout changes specifically for 2D-
postprocessing. You have direct access to all loaded images and you can select
them for processing either individually or in any combination.

Activating the overview If a patient is not registered the images are displayed in the image overview
after loading. With an examination in progress, you may need to switch from
the live image display to the image overview display.
◆ Press this button on the control panel.
– or –

On the left monitor click the 4x4 layout button (lower left).
The Overview menu is displayed on the control panel.

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(1) Selection buttons for Series/Images

(2) Full image display
(3) Multi-selection of Series/Images
(4) Display mode (Stack/Stripe)

Monitor layout The following views are set on the monitors by default:
◾ Left monitor
– 4x4 layout with all loaded images, sorted by exposure time
– Stack display
– 1st series selected (1st image segment is highlighted)
◾ Right monitor
– 1x1 display of the (selected) 1st series

Switching off the overview The image overview can only be switched off during an examination in
progress.
◆ Press this button again.
The live image display is activated.
– or –
On the left monitor click the activated 4x4 layout button (lower left).

 The system switches to live image display automatically during radiation

release.

Changing the display mode

You can select from among the following displays of loaded images on the left
monitor:
◾ Stack display: One series per image segment
◾ Image stripe display: One image from the selected series per image segment

Selecting stack display Stack display is suitable as an overview of loaded studies and for direct
comparison of images from several series.

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◆ Press this button in the Overview menu.

Selecting image stripe display Image stripe display is suitable for viewing a selected series in detail (image by
image).
◆ Press this button in the Overview menu.

In stack display, image segments that contain a scene are identified by an

icon at the bottom right. Double-clicking the scene switches to image stripe

 display.

Scrolling
In the Overview menu you establish which image should be displayed on the
right monitor.

Changing image/series

1 Select the suitable display mode:

Image stripe display if you want to show a different image in the current
series.
Stack display if you want to display a different series.
2 Scroll in the image overview until the number of the required image or series
is displayed.

3 Press the selection button for the required image or series.

The selected image is displayed on the right monitor.
– or –
In the left monitor click the applicable image segment with the mouse.

Next/Previous series If you want to show images of another series in image stripe display, you can
scroll through the series without switching to stack display.
◆ Press one of the buttons repeatedly if necessary.

Displaying full screen image

Basically, the image selected in the overview is displayed as a full image on the
right monitor. However, if the Hold reference function is active the monitor
display remains unchanged. In this case use the Full image function to display
the required image in full size on the left monitor.

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Activating full image

◆ Press this button in the Overview menu.

 Using the Next/Previous series buttons you can switch to other series in full
image view.

Switching off full image

◆ Press this button again.

The image overview on the left monitor switches into the most recent display
mode (stripe or stack).

Outside of an ongoing examination (no patient registered), you can turn

full image view on and off using the activated 4x4 layout button (lower left

 of screen).

Reviewing a scene
After an examination, you can start movie mode to check the quality of the
scenes you acquired.
A scene is usually reviewed on the right monitor. If Hold reference is active, the
review takes place on the left monitor. The system switches automatically to
1x1 layout.

Cine replay menu 1 Show the required scene.

2 Press this button.

The Cine replay menu appears.

Starting the review If the automatic review of scenes (Auto replay) is switched off, the review
process is paused.
1 Press the activated Pause button to review the scene.
The replay speed varies with the number of saved images.
During review the Pause button changes to a Play button.
2 Press this button to change the review speed.
Replay at half/normal/double speed.

Limiting the playback range 1 Switch to the required image, for example using the slider or by stopping the
review process at the appropriate location.
2 Press one of the buttons to set the starting point or end point for playback.
The corresponding image number is displayed in the respective button.

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 By pressing the starting point and end point buttons again you can reset the
original playback range.

Scrolling image by image

1 Press this button to stop the review process.

2 Press the button to go backward/forward by a single image.

Different scene

◆ Press the button for the previous/next available scene.

5.2.2 Selecting images

You have to select images before you edit them. Single and multiple selections
are possible.
◆ Select the suitable display mode in the Overview menu:
Image stripe display if you want to select multiple images in the current
series.
Stack display if you want to select one or more series.
Single selection
◆ Press the selection button for the required image or series in the Overview
menu.
– or –
In the left monitor click the applicable image segment with the mouse.

 If the left monitor has been changed to full image mode, the image
displayed there is selected.

Multiselection
Multiselection enables you to select images from one or more series
individually. Images of a multiselection are marked on both monitors by a white
dot.
1 Press this button in the Overview menu.
The menu extension for multiselection is shown.
The number of images currently selected is displayed.

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2 Pressing the button again toggles to single selection.

Individual images/series

◆ Press the selection buttons for the required image or series in sequence.
– or –

Switch into keyboard mode, hold down the Ctrl button, and click the desired
images/series on the left monitor.

Sequential images/series

1 Press this button.

2 Select the first required image/series.

3 Select the last required image/series.

All images/series in between are selected as well.
– or –
Click the first desired image/series in the left monitor.
4 Switch into keyboard mode, hold down the Shift button, and click the last
desired image/series.

Supplementing the selection

1 Switch the display mode if necessary.

2 Select additional images/series using multiselection.
The newly selected images are added to the multiselection previously
defined.

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– or –
Press this button to add the image or series selected in the image overview to
the multiple selection.

All images/series

◆ Press this button.

Image stripe display: All images in the series are selected.
Stack display: All loaded images are selected.

Deselecting images

◆ Deselect the selected images/series individually using the corresponding

selection buttons in the image segments.
– or –

Press this button for the images or series to be deselected.

Press this button to deselect all images.

5.2.3 Deleting individual images/series

While the Patient list is used to delete complete studies ( Page 150 Deleting
data), you can use the image overview to select individual images or series for
deletion.
1 In this case switch into stack display.

2 Switch into keyboard mode and press Alt + d.

A message box is displayed on the left monitor.

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3 Click the images/series to be deleted in the image overview.

The selected images are marked with an X.
4 Click OK to delete the selected images.

5.2.4 Changing the image display

In the loaded images you can adapt the window values (contrast and
brightness), display enlarged sections, and center regions of interest in the
middle of the image. You can also rotate, flip or invert images for certain
diagnostic problems.

 Image manipulation capabilities are limited for images imported from other
modalities and images from external video sources (CAP images).

 CAUTION

Incorrect or extreme image processing parameters.

Risk of limited image quality in the resulting X-ray images. Risk of
incorrect decision during intervention or artifacts.
◆ Apply image processing parameters carefully, such as edge
enhancement and windowing, and always check them carefully.
◆ Always check the image quality before reaching an interventional
decision.

Selecting images for processing

Changes in image display affect all images of an individual series. The image
functions cannot be applied to multiple series at the same time.
◆ Display an image of the required series (single selection).
Windowing images
Using the windowing settings, you establish a grayscale range in which the
image is displayed. This enables you to highlight the region of interest and the
relevant tissue type.
During windowing you optimize image brightness (shifting the windowing
center along the grayscale) and image contrast (change of window width).
The set window values are shown at the bottom right in the image.

(1) WW: Window width – Contrast

(2) WC: Window center – Brightness

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Brightness Contrast menu

◆ Press this button.

The Brightness Contrast menu is displayed.

Changing window values 1 Move the slider to the left/right to make infinitely variable adjustments in
brightness (1) and contrast (2).

2 Click the left/right arrow to change the window values in small increments.


The controllers set numerical brightness values. Whether the image
impression turns out brighter or darker depends on which display is
selected (bone black or white).

Windowing using the mouse 1 Place the mouse pointer in the required image on the left monitor.
2 Move the mouse with the center mouse button pressed:
(1) Brightness - (Center +)
(2) Brightness + (Center -)
(3) Contrast - (Width +)
(4) Contrast + (Width -)

Fixed window value settings (LUTs) Using window value settings, you can select three predefined settings for the
window values using LUTs (look up tables). The values can be configured
specifically for an application ( Page 227 Editing applications).
◆ Press the button for the required preset.

Default The Default setting assigns the window values from auto contrast.

◆ Press this button.

Brightness and contrast are reset to the default.

Inverting images
When an image is inverted, bright areas in grayscale images are displayed dark
and dark areas are displayed bright. You use this function to toggle the bone
display between white and black, for example.

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1 Open the Brightness Contrast menu.

2 Press this button.

Image inversion is switched on.

Using image filters

You can improve the appearance of blurred images using appropriate filters. The
following filters can be used individually or in combination:
◾ Edge filter
◾ Spatial noise filter
◾ Edge-preserving noise reduction (optional)

Image enhancement menu

◆ Press this button.

The Image enhancement menu opens.

Selecting the edge filter Edge enhancement is an adaptive filter that highlights all existing structures
(edges) in the image. For very noisy images, setting edge enhancement to its
lowest level or switching it off entirely is recommended.
◆ Press one of these buttons.
The higher the filter setting, the more structures are enhanced and the less
they are smoothed.
– or –
Press this button.
Edges are not enhanced.

Selecting the spatial noise filter

◆ Press one of these buttons.

The higher the filter setting, the more the image is smoothed, which will
reduce its sharpness.
– or –
Press this button.
There will be no spatial noise filtering.

Selecting edge-preserving noise It is suitable, for example, for low-dose abdominal applications (large objects)
reduction (optional) and applications with low k factor (such as cardiac applications). It is not
suitable for the extremities or for applications with high dose and/or high k
factors.
◆ Press one of these buttons (recommendation: start with Low and increase
incrementally as needed).
The higher the filter setting, the more blurring is removed.

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Large differences in gray values are not averaged so that the edges remain
unaffected.
– or –
Press this button.
There is no edge-preserving noise reduction.

Rotating/flipping images
The rotate and flip functions allow you to easily compare images of series that
were acquired in a different orientation.

Rotation Flip menu

◆ Press this button.

The Rotate Flip menu appears.

Selecting the image rotation

◆ Press one of these buttons.

With each short press of the button, image rotation increases 1° in the
corresponding direction.
Pressing the button for an extended period continually increases or decreases
the angle of rotation.
– or –
Use these buttons to set the angle of rotation in 90° increments.

Rotate using the mouse 1 Place the mouse pointer on the edge of the required image on the left
monitor.
2 Drag the mouse pointer in the required direction of rotation.

No image rotation

◆ Press this button.

The angle of rotation is reset to 0°.

Selecting image flip

◆ Press one of these buttons.

Vertical/horizontal image flip is activated.

Zooming and panning images

You can zoom in on sections of images that you are particularly interested in
(zooming). The zoomed image can be panned so that the relevant section is in
the center of the image (panning).

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Zoom Pan Shutter menu

◆ Press this button.

The Zoom Pan Shutter menu appears.

Zooming the image

1 Move the slider up/down for infinitely variable zoom in/zoom out of the
image.
Upper limit: Zoom factor 4x
Lower limit: Zoom factor 1x
2 Click the up/down arrow to change the image size in small increments.

Panning the image After zooming, if the relevant image area is outside the image segment, pan it
accordingly.
◆ Press the arrow button for the direction in which the image content to be
displayed is located.
Vertical arrow buttons: Pan up/down
Horizontal arrow buttons: Pan left/right
Diagonal arrow buttons: Combined horizontal and vertical pan

 Image panning is possible only with a zoom factor > 1x.

Resetting Zoom/Pan

◆ Press this button.

The original image display is restored.

Setting digital shutters

You can hide irrelevant areas of the image. To do that, you place appropriate
shutters over the image. Image areas covered by shutters appear black.
1 Open the Zoom Pan Shutter menu.

2 Press this button.

The menu extension for shutter definition is shown.

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Adding shutters You can slide a total of 4 rectangular shutters into the image starting at the
edges. First activate them individually or jointly using the appropriate buttons,
and then fit them into place.
1 Press one of these buttons for the shutters you want to set.
Upper shutter
Right shutter
Left shutter
Lower shutter
2 Press this button to slide the activated shutters toward the center of the
image.

3 Press this button to slide the activated shutters toward the edges of the
image.

Hiding the shutters

◆ Press this button.

The full image area displayed again.

Resetting the image display

If adjusting the image parameters did not produce the desired results, you can
reset the processing steps of the current session. All images are then returned to
their original state.
◾ During an examination in progress: Status after image acquisition or after
saving
◾ Outside an examination: Status after loading or after saving

 After resetting, all changes in the image display are irrevocably lost.

1 Press this button.

A confirmation dialog box is displayed.

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2 Press Yes to reset the images.

– or –

Press No to close the dialog box without changes.

5.2.5 Evaluating images

Using graphical evaluation functions you can measure distances, lengths, and
angles of relevant structures, as well as add annotations. The left monitor
switches automatically to 1x1 layout. When the evaluation is finished the
original monitor layout is restored.

 Measurements are not possible for images imported from other modalities
and images from external video sources (CAP images).

Selecting images for evaluation

Graphical evaluations can only be performed on a single image at a time.
◆ Display the required image (single selection).
Displaying the evaluation functions
The evaluation functions are available on every control panel in the Measure
Annotate menu. If you are working on the monitor trolley, you can switch to
enhanced mouse mode and open the evaluation functions from the screen
menu ( Page 173 Evaluation in enhanced mouse mode).

Measure Annotate menu

◆ Press this button.

The Measure Annotate menu appears.

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General work steps

During graphical evaluation you use graphic objects (such as lines and text
fields) that you draw in the image on the left monitor. The graphic objects are
saved in the image automatically.
The following presents the basic steps you will use with graphic objects
regardless of the evaluation function.

Moving the mouse pointer Use the mouse pointer to set the position in the image where you want
processing of graphic objects to take place (such as insert, select).
◆ Use the arrow buttons to move the mouse pointer in the image.
Vertical arrow buttons: Move up/down
Horizontal arrow buttons: Move left/right
Diagonal arrow buttons: Combined horizontal and vertical movement
– or –
Move the mouse pointer with the mouse.

Selecting You must select an existing graphic object to process it.

◆ Move the mouse pointer with the arrow buttons or the mouse to the graphic
object.
Highlighting of the reference points (vertices, center point) indicates that the
graphic object is selected.

Panning 1 Select the graphic object.

2 Press this button.

The graphic object is linked to the mouse pointer.
3 Move the graphic object to the required position with the arrow buttons or
mouse.
4 Press this button.
The link between the graphic object and the mouse pointer is removed.

Deleting (individual) 1 Select the graphic object.

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2 Press this button.

The selected graphic object is deleted.

Deleting (all)

◆ Press this button.

All graphic objects in the image are deleted.

Calibration
If you perform evaluations with distance measurements, you must calibrate the
image.

 CAUTION

Misinterpretation of results.
Incorrect interventional decision!
◆ During length calibration or when measuring or interpreting distances in
images, note that the acquired images represent two-dimensional
projections of real objects.

Depending on the system, the calibration error is +/- 0.2 mm. Under real
conditions, an error of at least +/- 1 mm must be assumed even if you

 proceed carefully (with a sufficiently large and visible calibration object,

pixel-accurate marking of the end points and the calibration object and
measured object in the same plane). The error is largely determined by the
position of the measured object in relation to the image itensifier/detector.

Calibration object For increased accuracy it is recommended to use a calibration object that is as
large as possible, but still can be displayed completely. The edges of the
calibration object must be clearly recognizable and its dimensions must be
known.

 CAUTION

Risk of entering the incorrect calibration. Incorrect calibration display.

Incorrect measurement of graphic objects. Incorrect interventional
decision!
◆ The user must carefully enter the known length of the calibration object.
The calibration object must be perpendicular to the X-ray beam.

 Please note that the calibrating accuracy decreases if the calibration object
is not located in the same plane as the measured object.

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Performing calibration

1 Draw a distance line along the calibration object.

Be careful to mark the starting and end points with as close to pixel accuracy
as possible in order to achieve optimal measuring accuracy (the line to be
calibrated has to be selected/marked).
2 Then press this button.
The control panel switches to keyboard mode.

3 Enter the distance (in mm) and confirm with Enter.

A length scale is displayed in the image and is applied to the remaining
images of the series.
Distances already drawn in are updated.
Measuring the distance
Using a distance line, you can measure the distance between two points in an
image. Proceed carefully when setting the starting and end points in order to be
as accurate as possible.

Distance drawing mode

◆ Press this button to activate the Distance drawing mode.

Setting the starting point

◆ Use the arrow buttons to move the mouse pointer to the starting point of the
line and press this button.
– or –
Click the starting point with the left mouse button.
The starting point of the line is set.
The button changes to Set last point.

Setting the last point

◆ Use the arrow buttons to move the mouse pointer to the last point of the line
and press this button.
– or –
Click the last point with the left mouse button.
The distance line is set.
The length (in mm) and the sequential number of the graphic object are
displayed at the end point of the line.

The inaccuracy of a length measurement is at least +/- 0.2 mm even under

 ideal conditions (with an optimally performed calibration and the measured

object lying directly on the detector). Inaccuracy > +/- 1 mm must be
assumed under real conditions.

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Deleting points If the starting point or end point has been placed incorrectly, it can be deleted
immediately after being drawn.
◆ Press this button.
The last point set is deleted from the image.
Pressing the button again deletes the starting point if available.
You can continue drawing the line.
Measuring an angle
You can define an angle by two lines, the legs of the angle that you draw on the
image. Proceed carefully when setting the starting and end points in order to
obtain as high an accuracy as possible.

Angle drawing mode

◆ Press this button to activate the Angle drawing mode.

Drawing an angle

1 Draw the first line in the image by setting the starting point and end point
( Page 171 Measuring the distance).
The first leg of the angle is set.
2 Draw the next line in the image by setting the starting point and end point
( Page 171 Measuring the distance).
The angle is set.
The drawn angle (in °) and the sequential number of the graphic object are
displayed at the end points of the legs.
Either an inner or outer angle is indicated depending on the starting point
and end point of the second leg.

The accuracy of the angle measurement largely depends on how carefully


the user proceeds. In normal cases, the inaccuracy of the angle
measurement must be assumed to be +/- 1°. The accuracy can be improved
by increasing the distances between the starting and end points of the legs
drawn in.

Annotating images
You can annotate interesting or anomalous areas in the image accordingly.

Text drawing mode

1 Press this button to activate the Text drawing mode.

2 Move the mouse pointer to the required position for the annotation with the
arrow buttons or mouse.

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Entering text

1 Press this button.

The control panel switches to keyboard mode.

2 Enter the text and confirm with Enter.

The text is inserted at the position of the mouse pointer.

Inserting predefined text Frequently used texts can simply be selected from a template once they have
been created as such ( Page 176 Annotating images).
◆ Select the required text from the selection list.
The text is inserted at the position of the mouse pointer.

Changing text 1 Select the graphic object with the text.

2 Press this button to change the text using the keyboard.

– or –

Select a new text from the selection list.

Setting the side identification

By identifying the side of the patient you avoid a mistake in image orientation.
The side identification is applied automatically to the remaining images of the
series.
◆ Switch on the Text drawing mode, if required.

Adding side identification 1 Move the mouse pointer to the required position for the identification (such
as the edge of the image) with the arrow buttons or mouse.
2 Press the button for the correct patient side.
The selected identification L or R is inserted at the position of the mouse
pointer.

Changing the side identification

◆ Press the button for the correct patient side.

The original side identification is deleted.
The selected identification L or R is inserted at the position of the mouse
pointer.

5.2.6 Evaluation in enhanced mouse mode

When you evaluate images on the monitor trolley you can perform all
evaluation functions directly on the left screen with the mouse. You only use
the control panel to enter text.

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Activating enhanced mouse mode

1 Click this button on the left monitor (lower left).
The buttons for evaluation with the mouse are displayed (upper left).

2 Click the button for the required function.

Enhanced mouse mode is activated.
The control panel switches to keyboard mode.
Turning off enhanced mouse mode
◆ Click the button of the activated function.
– or –
End keyboard mode.

General work steps

During graphical evaluation you use graphic objects (such as lines and text
fields) that you draw in the image on the left monitor. The graphic objects are
saved in the image automatically.
The following presents the basic steps you will use with graphic objects
regardless of the evaluation function.

Selecting You must select an existing graphic object to process it.

1 Click this button.

The "Selection" function is activated.
2 Click the graphic object.
Highlighting of the reference points (vertices, center point) indicates that the
graphic object is selected.

Panning 1 Select the graphic object.

2 Press the mouse button and drag & drop the center point to the required
position.

Changing dimensions 1 Select the graphic object.

2 Press the mouse button and drag & drop the vertices in the required
direction.

Deleting (all)

◆ Click this button on the left monitor.

All graphic objects in the image are deleted.

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Deleting (individual) 1 Select the graphic object.

2 Press this button on the control panel.

The selected graphic object is deleted.

Calibration
1 Draw a distance line along the calibration object and select it
( Page 175 Measuring the distance).
Be careful to mark the starting and end points with as close to pixel accuracy
as possible in order to achieve optimal measuring accuracy.
2 Then click this button.
The Calibrate dialog box is displayed.

3 Enter the distance (in mm).

4 Click OK.
A length scale is displayed in the image and is applied to the remaining
images of the series.
Distances already drawn in are updated.
Measuring the distance
Using a distance line, you can measure the distance between two points in an
image. Proceed carefully when setting the starting and end points in order to
obtain as high an accuracy as possible.
1 Click this button.
2 Click the starting point of the line.
3 Click the desired end point.
The distance line is set.
The length (in mm) and the sequential number of the graphic object are
displayed at the end point of the line.

The inaccuracy of a length measurement is at least +/- 0.2 mm even under

 ideal conditions (with an optimally performed calibration and the measured

object lying directly on the detector). An inaccuracy > +/- 1 mm must be
assumed under real conditions.

Measuring an angle
You can define an angle by two lines, the legs of the angle that you draw on the
image. Proceed carefully when setting the starting and end points in order to
obtain as high an accuracy as possible.

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1 Click this button.

2 Draw the first line in the image by setting the starting point and end point.
The first leg of the angle is set.
3 Draw the next line in the image by setting the starting point and end point.
The angle is set.
The drawn angle (in °) and the sequential number of the graphic object are
displayed at the end points of the legs.
Either an inner or outer angle is indicated depending on the starting point
and end point of the second leg.

The accuracy of the angle measurement largely depends on how carefully


the user proceeds. In normal cases, the inaccuracy of the angle
measurement must be assumed to be +/- 1°. The accuracy can be improved
by increasing the distances between the starting and end points of the legs
drawn in.

Annotating images
In addition to to side identification annotating interesting or anomalous areas in
an image, you can add image comments. Comments always appear centered at
the bottom edge of the image and are transferred automatically to all images of
the series.
◆ Click this button.
The input dialog box for text and comments is displayed.

Setting the side identification By identifying the side of the patient you avoid a mistake in image orientation.
The side identification is applied automatically to the remaining images of the
series.
1 Select the appropriate patient side in the text and comments dialog box.
2 Using the mouse, click the appropriate location in the image (e.g. at the edge
of the image).
The selected identification L or R is inserted at the position of the mouse
pointer.

Inserting annotations 1 Select the annotation from the Text selection list.
– or –
Click the text field of the Text selection list and overwrite the displayed text
with the keyboard.
2 Click the required position in the image.

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Adding a comment ◆ Select the text from the Comment selection list.
– or –
Click the text field of the Comment selection list and overwrite the displayed
text with the keyboard.

 To delete a comment from the images, use the Backspace button to delete
it from the text field of the Comment selection list.

Creating predefined texts You can save frequently used texts and comments as templates and select them
from the list as needed.
1 Enter the text in the text field of the corresponding selection list.
2 Click this button.
The text is added to the list as a new entry.
Up to 20 entries each can be created in the Text and Comment selection
lists.

Deleting predefined texts 1 Select the entry you no longer require from the corresponding selection list.

2 Click this button.

The text is deleted from the list.

5.2.7 Saving images

After completing postprocessing of a prior examination, all changes in the
image are saved when you close the patient. If you want to save intermediate
states, manually save the images in the required processing phase. The images
are saved as copies of the original in the corresponding study.

 To save images while an examination is in progress see ( Page 128 Saving

and displaying images).

Saving a single image

✓ Multiple images are not selected ( Page 159 Multiselection).
1 Display the required image (single selection).
2 Press this button.

Saving multiple images

With the appropriate image selection you can save a portion or all images of one
or more series, as well as segments of series.

Images/series 1 Select the required images/series in multiselection

( Page 159 Multiselection).
2 Press this button.

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Partial scene 1 Show the scene.

2 Open the Cine replay menu.

3 Limit the replay range of the scene to the relevant section.

4 Press this button.

The images are saved from the starting point to the end point as a new scene.

5.3 Subtraction processing

When subtraction is performed, two X-ray exposures are acquired of the region
of interest, one without contrast agent and one with contrast agent. Afterwards
both exposures are subtracted.
In the subtraction image, areas with the same attenuation and areas with a
(slightly) different attenuation, e.g. vessels with contrast agent, can be
discerned clearly.

5.3.1 Postprocessing functions

The following functions are available to postprocess subtraction images during
or after an examination:
◾ Anatomical background
◾ Pixel shift
◾ Stenosis quantification

5.3.2 Loading and displaying images

Native images from examinations acquired in Subtraction or Roadmap operating
mode (optional) are stored in the local database together with the subtraction
images. Both image types can be displayed simultaneously on both monitors.
Loading images
With an examination in progress, the images required for subtraction processing
are already loaded and saved. For subsequent processing, load the subtraction
data from the local database.
1 Select the subtraction study of the required patient in the Patient list.

2 Press this button in the symbol button bar on the control panel.
The selected images are loaded and displayed on the monitors.
The PROCESSING task card is displayed on the control panel.

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Changing the monitor layout

After loading the images, 2-channel display is activated with both monitors in
1x1 layout. The left screen shows the subtraction images, the right screen the
corresponding native images. This setting can be switched if necessary.
1 Press this button.
The Sub / Native menu appears.
2 Select the required monitor layout.
2-channel display (only for full image display on the left monitor).
Simultaneous display of the subtraction image (left monitor) and
corresponding native image (right monitor).

1-channel display – native images. Only native images are shown on both
monitors. Applies particularly when the image overview is activated on the
left monitor.
1-channel display – subtraction images. Only subtraction images are shown
on both monitors. Applies particularly when the image overview is activated
on the left monitor.

Displaying images
After switching the monitor to 1-channel display, use the image overview
display to show the required images.
1 Switch on image overview if necessary.
2 Use the functions for image display in the same manner as for standard
examinations (without subtraction).
◾ Changing the display mode ( Page 156 Changing the display mode)
◾ Scrolling ( Page 157 Scrolling)
In stack display the maximum fill image (Peak OP image) of the respective
series is displayed.
◾ Reviewing a scene ( Page 158 Reviewing a scene)
In 2-channel display, the subtraction scene plays on the left monitor, the
corresponding native scene simultaneously on the right monitor.

5.3.3 Changing the image display

As with standard examinations (without subtraction) you can window, zoom/
pan, rotate, and flip subtraction and native images ( Page 162 Changing the
image display).
The following presents special functions for use exclusively with subtraction
data sets.
Windowing images
The change in windowing settings always refers to an image type. In 2-channel
display you select whether you want to window subtraction images or native
images.
1 Open the Brightness Contrast menu.

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2 Press the button for the required image type.

3 Change the window value settings using the functions in the Brightness
Contrast menu.
– or –
Press the button for automatic window value assignment.
If available, window values are adjusted based on the maximum fill image.

Including anatomical background (Landmark)

Normally the anatomical surroundings of vessels of interest are not visible in
images that are displayed subtracted. By adding the mask image, the
surrounding tissue can be highlighted more or less.
1 Press this button.
The Pixel shift Landmark menu appears.

2 Set the degree of inclusion with the slide control.

0%: Fully subtracted (without anatomical background)
100%: Native display
Making the image and mask coincide exactly (Pixel shift)
During acquisition of the subtraction series, the patient or the C-arm system
may have moved. The images that are to be subtracted may not be congruent.
The anatomical background, especially in the area of image contrasts, is
therefore not canceled out.
Through a suitable shift of the mask by a few pixels, you eliminate the
displacement of fill the image and mask.

Pixel shift Landmark menu 1 Display the required subtraction series (single selection).

2 Press this button.

The Pixel shift Landmark menu appears.
The subtraction series is shown in image stripe display on the left monitor.
The currently selected image of the subtraction series is shown on the right
monitor.

Selecting the image ◆ Use the slider to display the first image with poor coverage on the right
monitor.

Automatic pixel shift Mark an area of obvious displacement in the subtraction image. The pixel shift
needed for alignment is calculated automatically.

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1 Press this button to switch from manual pixel shift to auto pixel shift, if
necessary.
In the preview image on the right monitor, a rectangle indicates the mouse
position in the center of the image.
2 Move the rectangle to the position in the image where misalignment is most
evident.
3 Press this button.
A new fill image based on the altered pixel shift settings is calculated and
displayed on the right monitor.
4 Press this button to apply the pixel shift to the current and subsequent
images.

Manual pixel shift Shift the mask manually until the best impression of the subtraction image is
achieved.
1 Press this button to switch from auto pixel shift to manual pixel shift, if
necessary.

2 Move the mask with the arrow buttons until you get optimum coverage.

3 Press this button.

A new fill image based on the altered pixel shift settings is calculated and
displayed on the right monitor.
4 Press this button to apply the pixel shift to the current and subsequent
images.

You can use manual and auto pixel shift multiple times one after the other

 or in combination as soon as the previously changed pixel shift is accepted.

The image shift with pixel shift is used in forward direction for subtraction
scenes; that is, for subsequent images, not backward for previous images.

Undoing pixel shift Accept pixel shift applies the changed pixel shift to the affected images and
saves it. In the event of an error, you can cancel the last step or all steps.
◆ Press this button to cancel the last change in the pixel shift.
– or –

Press this button to restore the state prior to opening the Pixel shift
Landmark menu.

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5.3.4 Evaluating subtraction images

The following presents special evaluation functions for subtraction data sets.
Stenosis quantification
In stenosis quantification, the reduction of vascular diameter is determined
through a stenosis identified in the image.

Stenosis measurements should preferably be done using subtracted images.

 The edge position has to be checked in native display or with anatomical

background. If necessary, the vascular edges have to be corrected
manually.

Opening stenosis quantification 1 Display the desired fill image (single selection).

2 Click this button on the left monitor (lower left).

The control panel switches to keyboard mode.
The Stenosis Quantification dialog box is displayed.

Defining the vascular course You identify the vascular course by drawing the center line of the vessel as a
polygon. With each change of direction, you set a vertex in the image. The
center line of the vessel should include the section with the pathological
(stenotic area) and normal vascular diameter (reference area).
1 You set the starting point and vertices with a single click of the mouse.
A line is drawn connecting the points.
2 Set the end point with a double click of the mouse.
A vascular contour is determined and drawn in the image.
Stenosis calculation
After drawing the vascular contour, the "stenosis diameter" (white line) and
"reference diameter" (gray line) are determined automatically, and each is
displayed as a bar cursor.

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The degree of stenosis relative to the reference area is output in %:

◾ %D: (D = diameter) deviation of the diameter on line "Stenosis diameter" as
a percentage relative to the diameter on the line "Reference diameter" (1-
Dsten/Dref)*100%
◾ %A: (A = area) deviation of the calculated area of the circle as a percentage
(¼*π*D2) on the "Stenosis diameter" line, relative to the calculated area of
the circle on the "Reference diameter" line (1-Asten/Aref)*100%
◾ %G: (G = gray level) deviation of the gray level on the "Stenosis diameter"
line as a percentage relative to the gray level on the "Reference diameter"
line (1-Gsten/Gref)*100%
Please note:
◾ Values are limited to ± 100%
◾ Negative values are an indication that the lines for stenosis diameter and
reference diameter are incorrectly assigned.

In addition to the imprecision caused by the parallax effect, limits to


measurement precision are set that trace back to internal rounding errors.
This additional imprecision generally does not exceed 10% for area
measurements, 5% for diameter measurements, and 1% when measuring
grayscale proportions.

With non-circular stenoses, the stenosis may only be recognizable by the gray
level ratio:

Example: Vessel Possible display Result of steno-

cross-section in X-ray image sis quantifica-
(schematic) (schematic) tion

Vessel circular No stenosis

(no stenosis) found for diame-
ter, area, gray
level

Non-circular Stenosis only

stenosis found for gray
level

Moving the stenosis/reference cursor The positions of the stenosis and reference cursors can be changed individually.
The stenosis is then recalculated automatically.

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1 Drag the slider to the desired position or click the arrow buttons.
– or –

Press these buttons on the control panel to move the stenosis cursor.

2 Press these buttons on the control panel to move the reference cursor.

Correcting contour lines You change the course of the contour line by manually redrawing the vascular
edge in the section to be corrected. The stenosis is then recalculated
automatically after the correction.
1 Mark the starting point of the vascular contour to be corrected with a click of
the mouse.
If the mouse pointer is located over a valid vascular position, it takes the
shape of a cross.
2 Mark the end point of the vascular contour to be corrected by double clicking.
The vascular contour between these points is changed.

Moving the stenosis text block After the stenosis is drawn in the image, you can move the text block to another
position, for example, if it is covering an important detail.
◆ Click the text block; drag the text block to the new position, and click again at
the new position.
A number indicates the stenosis cursor to which the text block belongs.

Confirming stenosis quantification ◆ Click OK in the Stenosis Quantification dialog box.

 If necessary you can evaluate additional stenoses in the image in the same
manner.

Deleting stenosis calculation 1 Click the stenosis to be deleted.

(individual)
The stenosis is marked by small squares.
2 Click this button in the Stenosis Quantification dialog box.
The selected stenosis graphic with evaluation is deleted.
Other stenosis graphics are retained.

Saving the stenosis image

◆ Click this button in the Stenosis Quantification dialog box.

The stenosis graphics are “burned into” the image.
The image is stored as a new image and is assigned to the study.

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The results of the stenosis quantification tool highly depends on the image
content. So the results are influenced by the body anatomy (thickness and
vessel form and routing), the projection (angle, distance to focus, etc.), the

 achieved image contrast (dose), the contrast medium and many other
factors.
The displayed values from the stenosis tool always need to be checked for
plausibility. This can be achieved by Subtraction images from a different
projection angle and additional indicators like (EEG, ECC).

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6 Documentation
6.1 Filming/Printing 188
6.1.1 Selecting images 188
Single image 188
Multiselection 188
6.1.2 Printing using default settings 189
Starting printing 189
6.1.3 Printing with changed settings 189
Input dialog box for print settings 190
Changing print settings 190
Displaying a print preview 191
Starting printing 191
6.2 Exporting 191
6.2.1 Export procedures 192
Standard export 192
Changing the export settings 192
Automatic export 192
6.2.2 Export destinations 192
Removable device 192
Other workstation 193
Archive 193
6.2.3 Overview of transfer capabilities 193
6.2.4 Selecting images 194
Images from an examination in progress or
postprocessing 195
Complete studies 195
6.2.5 Preparing the removable devices 196
Working with data media 196
Drives 196
Inserting a CD/DVD 196
Connecting the USB storage medium 196
6.2.6 Exporting using default settings 196
Starting export 196
6.2.7 Exporting with changed settings 197
"Export to" dialog box 197
Changing the export settings 198
Starting export 200
Establishing default settings 200
6.3 Checking the data transfer 201
6.3.1 Indicators in the status bar 201
6.3.2 Viewing and processing jobs 201
Job status list 201
Influencing job performance 202
6.4 Reports 203
6.4.1 Selecting a study 203
6.4.2 Radiation Summary Report 204
Opening the report 204
Exporting the report 204
Printing a report 205

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6.1 Filming/Printing
You can expose the images of a study on film or print them on paper for
documentation and reporting.

 Make sure the printer is switched on before you send images to print.


Filming and printing are the same process except that they use different
output devices. If the term "filming" or "printing" is used alone in the
following, the description applies equally for the other process.

Standard printing
You can print the displayed image or a selection of multiple images simply by
pressing a button. The print job is processed with standard settings (simplified
print procedure).
Changing print settings
If you want to check or change settings prior to printing, use the "enhanced
print procedure". You can display a print preview and adapt the print layout, for
example. In a second step, you forward the print job to the required printer.

6.1.1 Selecting images

Before you start a print job, you have to select the images.
You have access to the currently loaded images through the PROCESSING task
card on the control panel. Single and multiple image selections are possible
( Page 159 Selecting images).
◆ Select the suitable display mode in the Overview menu:
Image stripe display if you want to select multiple images in the current
series.
Stack display if you want to select one or more series.
Single image
◆ Select the required image or series in the Overview menu.

 If the left monitor has been changed to full image mode, the image
displayed there is selected.

Multiselection
◆ Press this button in each case to add the image or series selected in the image
overview to the multiple selection.

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– or –
Switch on multiselection in the Overview menu.

Select the images or series.

Images of a multiselection are marked on both monitors by a white dot.

 The Multiple Selection menu has to be open/active during printing;

otherwise, only the currently marked image/scene is printed.

6.1.2 Printing using default settings

The following default settings are used with the simplified print procedure:
◾ Page size and layout (page partitioning) according to the configuration
settings for the Default Printer ( Page 215 DICOM Properties - Printing).
◾ Handling of subtraction images and image text display as in the last print job.
These settings can be changed in the enhanced print procedure
( Page 190 Changing print settings).
Starting printing
◆ Press this button.
The print job is started.
In the Patient list the selected images are marked as "printing" ("p" flag).
When the print job is complete the images are marked as "printed" ("P" flag).


After printing, the images are released for automatic deletion if necessary.
Depending on the hard disc fill level, the images are deleted on the
specified date ( Page 220 Deleting images automatically).

The "printed" flag is set as soon as the images are successfully transferred to

 the printer driver. Not all printers (e.g., paper printers) can solve printing
problems themselves. The image printout may be lost! Verify that the
printouts are available before you delete images.

6.1.3 Printing with changed settings

In the enhanced print procedure you can change the following settings:
◾ Printer selection
◾ Layout settings
◾ Image text display
◾ Handling subtraction images
◾ Number of copies

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Input dialog box for print settings

(1) Print settings

(2) Buttons for print, print preview, and print status

◆ Click this button on the left monitor (lower left).

The input dialog box for print settings is displayed on the monitor.

Changing print settings

The input dialog box for print settings initially contains the settings used for the
last print session.

 Changes to the settings for subtraction images and image text display are
used as new default settings for standard printing.

Printer The Printer selection list contains the paper and DICOM printers configured in
the system.
◆ Select the required printer.

Layout settings Individual print layouts under an individual name are created in the
configuration for each printer ( Page 218 Print Layout task card).
◆ Select the layout settings in the selection list.
Name: Stored print layouts for the selected printer
Size: Available page sizes for the selected printer
Layout: Available page partitions for the selected printer

Image text display The scope of image text information is defined in the configuration for each
print layout ( Page 218 Image text settings).
1 Select the Anonymous option is you want to avoid assigning printed images
to a patient.
"Anonymous" appears in the hardcopy instead of the patient name. The
remaining demographic data are hidden.

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2 Select the Hide Text option if all image text is to be hidden in the hardcopy.

Subtraction images Subtraction images are usually printed in native display.

◆ If needed, select the subtracted display for printing.

Number of copies

◆ Define the number of copies.

Up to 9 copies per print job are possible.
Displaying a print preview
In the print preview you can see how the images will look later on the exposed
film or paper hardcopy. You can also change the position of individual images
where necessary.
1 Click this button in the input dialog box for print settings.
The images appear on the left monitor in the selected print layout.
2 Use the mouse wheel to display the individual pages of the print job.
3 Use the mouse's drag and drop function to arrange the images in the selected
page layout.
Starting printing
◆ Click this button in the input dialog box for print settings.
The print job is started.
In the Patient list the selected images are marked as "printing" ("p" flag).
When the print job is complete the images are marked as "printed" ("P" flag).


After printing, the images are released for automatic deletion if necessary.
Depending on the hard disk fill level, the images are deleted on the
specified date ( Page 220 Deleting images automatically).

The "printed" flag is set as soon as the images are successfully transferred to

 the printer driver. Not all printers (e.g., paper printers) can solve printing
problems themselves. The image printout may be lost! Verify that the
printouts are available before you delete images.

Print status You can track and influence job processing for print jobs on DICOM printers.

◆ Click this button in the input dialog box for print settings.
The Job status list opens ( Page 201 Job status list).

6.2 Exporting
After an examination or postprocessing, the saved images are stored on the
hard drive (local database).

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This section explains how to save images and patient data from the local
database, send them within the network, and save them to data media.

6.2.1 Export procedures

Standard export
During an examination or postprocessing, you can export the displayed image
or a selection of multiple images simply by pressing a button. The export job is
processed using default settings (simplified export procedure).
Changing the export settings
If you want to check or change settings prior to export, use the "enhanced
export procedure". You can then change the export destination and data format.
Automatic export
Depending on the configuration setting, at the end of the examination acquired
images are sent automatically to a default address ( Page 215 DICOM
Properties - Sending).
The address and export settings used are the same as for default export.

6.2.2 Export destinations

Depending on the job setting, you select one of the following export
destinations in the enhanced export procedure.
Removable device
You write data to removable devices to save it short term or pass it on.
The following media types are supported for saving data:
◾ DVD-R (minus R), DVD+R
◾ CD
◾ USB storage media (external hard drives, sticks)
The accidental use of other media, e.g., DVD-RW, can result in an error message
or impair functionality.

 CAUTION

Risk that CD/DVD-R media used for exporting can become damaged or be
unreadable on other CD/DVD drives.
Data loss or apparent data loss.
◆ Use removable devices as transfer media only. Only data media
approved by Siemens may be used.

 In general, do not use storage media that require their own power supply.
In addition, do not use USB storage media containing an autorun.inf file.

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As a rule, you cannot release radiation during the CD/DVD write process. In
exceptional cases (emergencies), you can release radiation in fluoroscopy
operating mode. However, radiation may be disrupted.

 Moreover, the export process of subtracted images to CD/DVD is interrupted

during radiation release and other processing-intensive procedures (e.g.,
play LSH). In those cases images are stored as raw data.
You are therefore urgently advised to start write processes outside of
examination hours (e.g. at the end of the office day).

Other workstation
If your system is connected to a network, you can send patient and examination
data to other workstations via the network. The data can be processed or used
for diagnosis there.
Archive
To archive, you send the selected patient and examination data to a DICOM
network node that has been established as an archive. You can import archived
data back to your local database whenever you need them.

 CAUTION

Use of the imaging system hard drive as a long-term archive.

Loss of image data.
◆ Do not use the imaging system hard drive as a long-term archive. Follow
the local regulations regarding the archiving of X-ray images, while
taking into account the use of DICOM archive nodes.

 CAUTION

Loss of image data.

Risk of unnecessary radiation exposure!
◆ The hard disk of the imaging system is not suitable for long-term
archiving of patient and image data. There are statutory requirements
governing the archiving period, data availability, and data security (data
integrity), as well as recommendations concerning fire protection or
water damage for the archiving of image data. The operator of the
archive is responsible for observing these regulations.
◆ Because of advances in technical development and statutory
requirements, the storage of image data and access to it cannot be
realized with a single storage and media technology alone. Therefore,
the migration of data may be necessary under the responsibility of the
operator of the digital archive.

6.2.3 Overview of transfer capabilities

The figure below shows the data backup and transfer options available to you.

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(1) Export to DICOM network nodes (Archive or other workstation)

(2) Export to removable devices (CD/DVD, USB drive)
(3) Import from DICOM network nodes (Query & Retrieve) ( Page 153 Data in
the network)
(4) Importing from removable devices ( Page 152 Data from removable
devices)


Please remember that not all transfer options may be available on your
system. The devices and network nodes available depend on the individual
configuration of your system and the options installed.

6.2.4 Selecting images

Before you start an export job, you have to select the images.

You can only export objects that are stored in the local database. If data are

 to be transferred from one data medium to another, they must first be

imported.
Exporting data from other modalities is not possible however.

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Images from an examination in progress or postprocessing

You have access to the currently loaded images through the PROCESSING task
card on the control panel. Single and multiple image selections are possible
( Page 159 Selecting images).
◆ Select the suitable display mode in the Overview menu:
Image stripe display if you want to select multiple images in the current
series.
Stack display if you want to select one or more series.

Single image

◆ Select the required image or series in the Overview menu.

 If the left monitor has been changed to full image mode, the image
displayed there is selected.

Multiselection

1 Switch on multiselection in the Overview menu.

2 Select the images or series.

Images of a multiselection are marked on both monitors by a white dot.
– or –

Press this button to add the image or series selected in the image overview to
the multiple selection.

 The Multiple Selection menu has to be open/active during export;

otherwise, only the currently marked image/scene is exported.

Complete studies
To save or archive complete studies, select the data sets in the Patient list
( Page 145 Searching for and selecting patient data).
1 Change to the PREPARATION task card if necessary.

2 Open the Patient list.

3 Search for the patient, sorting and filtering the list as necessary.
4 Select the required study or studies.

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6.2.5 Preparing the removable devices

Depending on the routine you use, one or several drives and connections for
external data media will be established for your system.
Working with data media
Follow the instructions of the manufacturer for handling and storage of CD/
DVDs.
Drives
Your system comes with a CD/DVD writer for data storage.
Inserting a CD/DVD
CDs/DVDs can be written to on one side only.
◆ Place the CD/DVD into the drive with the label facing upwards.

 Never shut down the Cios Alpha or disconnect the monitor trolley from the
C-arm system while data is being written to CD/DVD.

Connecting the USB storage medium

 CAUTION

Risk of connecting/disconnecting USB devices during the exposure.

Such behavior can lead to system instability. This can also impact
other processes, such as exposure jobs in progress. Loss of data,
interference in exposure process.
◆ Do not insert or disconnect USB devices during exposure or other critical
processes.

 CAUTION

Risk of disconnecting USB devices during ongoing data transfer.

Loss of data and damage to the data medium possible.
◆ Do not disconnect the USB device during active data transfer (such as
export).
◆ Use removable devices as transfer media only. Removable devices are
not permitted for archiving purposes.

◆ Connect the USB plug into the USB jack.

6.2.6 Exporting using default settings

During the simplified export procedure, the settings established as defaults are
used. The default settings can be changed in the enhanced export procedure
( Page 198 Changing the export settings).
Starting export
On the control panel there is an export button whose appearance depends on
the default export destination set.

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◆ Press this appropriate key.

The export job is started.
After successful completion of the export job to a network node, the selected
images are marked as sent ("S" flag) or archived ("A" flag) in the Patient list.


After exporting, the images are released for automatic deletion if necessary.
Depending on the hard disc fill level, the images are deleted on the
specified date ( Page 220 Deleting images automatically).

The "sent" or "archived" flag is set as soon as the images are successfully
transferred to the network nodes. Even when the addressee works with

 Storage Commitment, the flags only identify the receipt and storage of the
data on the recipient's hard drive. A misinterpretation of the flags can result
in a loss of data during the prescribed storage period. For this reason,
follow the regulatory requirements regarding the archiving procedure.


Note that the exported images are not transmitted as raw data, but
including all of the applied processing steps. They cannot be restored to
their original state. Do not use these images for the primary diagnosis!

6.2.7 Exporting with changed settings

In the enhanced export procedure you can change the following settings:
◾ Export destination selection
◾ Data format
◾ Image properties
◾ Handling subtraction images
◾ Saving with a DICOM Viewer
"Export to" dialog box
◆ Click this button on the left monitor (lower left).
The Export to... dialog box appears on the monitor.

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(1) Export settings

(2) Storage capacity or removable devices
(3) Buttons for export, export status, and close
Changing the export settings
In the Export to... dialog box you can first enter settings that will be used as the
defaults.

Export destination ◆ Select the required destination medium from the Target Type selection list.
DICOM node: Another workstation, archive, PACS
CD/DVD: Inserted CD or DVD
USB device: Connected USB data medium

 When DVD recording is active, export to DVD is not possible.

Export address When selecting "DICOM node" you have to enter a network address configured
in the system as the destination.
◆ Select the network node from the Target selection list.

Data format The systems and applications in which the exported data can be opened and
processed depend on the data format.
◆ Select the data format in the Export Format selection list.
Private: Format that is only readable by FLC imaging systems
DICOM: Standardized file format in medical imaging

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TIFF: PC graphics format

AVI: PC video format

 When "DICOM node" is selected as the export destination, only the DICOM
format can be used.

Image properties Depending on the data format, prior to export images can be prepared
differently in terms of graphics and text embedding as well as file size.

 When Private is selected as the data format, the data is exported only in its
original state.

◆ Select the image properties in the Export images as area.

Processed: Changes in the image display compared to the original are used
(such as window values, image rotation/flip, zoom, pan, edge filter, set black
function) and evaluation graphics are "burned" into the image.
Anonymized: "Anonymous" appears in the image instead of the patient
name. The remaining demographic data are hidden.
Downsized: The files are made smaller by reducing the image resolution 50%
and the bit depth to 8 bits/pixel.

 To save the image brightness and contrast, select Processed.

Subtraction images You can export images of a specific image type or multiple image types from
subtraction series.
◆ Select the image types in the Export subtracted images as area.
Subtracted: Images in subtracted display
Native: Native images without mask and without Peak OP image

Radiation Summary Report Two different file formats are possible if the radiation summary report is
exported in DICOM format.
◆ Select the file format in the Export Dose Report as area.
DICOM dose report: Structured Report (DICOM SR)
DICOM SC image: Image with "burned in" text

DICOM Viewer When exporting to a removable device, a DICOM Viewer is saved to the CD/DVD
or USB medium together with the image data. This allows for viewing the
exported images on any computer. The DICOM Viewer starts directly from the
data medium (automatically after inserting/connecting). No installation of files
takes place on the computer in question.
◆ Deselect this option if you do not want to save the DICOM Viewer.

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Scope of data

◆ Specify the scope of the images to be exported.

Selected: all selected images (especially individually selected images)
Marked: all marked images (with white dot)
All: all images in the study

Checking disk space If a removable device is indicated as the export destination, the current storage
capacity and required disk space are displayed.
1 Use the display to check where there is sufficient space available on the
medium.
2 Change the data medium if necessary before starting the export.

Starting export
◆ Click this button in the Export to... dialog box.
The export job is started.
After successful completion of the export job to a network node, the selected
images are marked as sent (“S” flag) or archived (“A” flag) in the Patient list.


After exporting, the images are released for automatic deletion if necessary.
Depending on the hard disk fill level, the images are deleted on the
specified date ( Page 220 Deleting images automatically).

The "sent" or "archived" flag is set as soon as the images are successfully
transferred to the network nodes. Even when the addressee works with

 Storage Commitment, the flags only identify the receipt and storage of the
data on the recipient's hard drive. A misinterpretation of the flags can result
in a loss of data during the prescribed storage period. For this reason,
follow the regulatory requirements regarding the archiving procedure.

Export status You can track and influence job processing for all export jobs.

◆ Click this button in the Export to... dialog box.

The Job status list opens ( Page 201 Job status list).
Establishing default settings
Export jobs using the simplified procedure (standard export), automatic export,
and sending the radiation summary report at the end of the examination, are all
performed using default settings.
1 Select the required export settings in the Export to... dialog box.
2 Select the Set as Default option.

3 Click this button.

Changed default settings are stored.

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6.3 Checking the data transfer

All jobs for importing, exporting, and printing/filming data are performed in the
background.
The processing of jobs can be viewed in the status bar, enabling you to react in
case of error.

6.3.1 Indicators in the status bar

The corresponding icon is displayed in the status bar on the left monitor (lower
left) for data transfers in progress. The icons indicate the action being
performed and whether an error has occurred.

Action Not active Active Error

Write to CD/DVD No icon No icon

Read from CD/DVD No icon No icon

Write to USB device No icon No icon

Read from USB device No icon No icon

Export to DICOM network node (send- No icon

ing)

Import from DICOM network nodes No icon No icon

(receiving)

Printing/filming to DICOM printer No icon

6.3.2 Viewing and processing jobs

In the Job status list you can learn about the following jobs running in the
background – sorted by transfer type:
◾ Printing/filming to DICOM printer (DICOM Film)
◾ Export to DICOM network node (DICOM Send)
◾ Import from DICOM network nodes (DICOM Retrieve)
◾ Write to CD/DVD
◾ Read from CD/DVD
◾ Write to USB storage medium
◾ Read from USB storage medium
Job status list
Several methods are available for opening the Job status list:
◆ Click the Status button in the Import from, Export to dialog box, or the print
settings dialog.

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– or –
Click the icon for the applicable data transfer on the left monitor.
The Job status list is displayed. The task card for the applicable data transfer
is displayed.

(1) Tabs for selecting the transfer type

(2) Details and status of the transfer jobs
(3) Area to show the course of job processing
(4) Buttons for deleting the list or selection and to close
Influencing job performance
The work steps available in the list depend on the transfer type and the status of
a job.

Selecting jobs Some actions are limited to the transfer jobs selected in the list.
◆ Click the required jobs in the list (press and hold Ctrl for multiple selection).

Restarting DICOM Send Failed export jobs to DICOM network nodes can be repeated with the same
settings or redirected to a new address.
◆ Click Send.
The selected jobs are restarted with the original destination address.
– or –
Click Redirect.
The selected jobs are diverted to the DICOM network node currently set in the
Export to... dialog box.

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Aborting jobs ◆ Click Abort.

All transfer jobs are cancelled and the start of other planned jobs in the list is
prevented.

 A data transfer in progress for which there are additional images (such as a
print job with multiple images on a page) is not cancelled.

Clearing lists ◆ Click Clear List.

All jobs that have ended or for which data transfer preparation has been
completed are hidden.
– or –
Click Clear selected.
Of the selected jobs in the list, all that have ended or for which data transfer
preparation has been completed are hidden.

6.4 Reports
Certain examination data are saved in the form of structured reports. Cios Alpha
offers the following types of reports:
◾ Radiation Summary Report
Use: The reports serve to document examination and treatment data. They are
mostly generated automatically. Depending on the type of report you can read,
edit/supplement, print, and export them.
Prerequisite: The examination of a registered patient is the prerequisite for a
report to exist.
Formats: Reports are saved in two different formats. This allows them to be
opened in different applications.
◾ Secondary Captures (DICOM SC)
Allows loading into a viewer, for example; PACS compatible.
◾ Structured Report (DICOM Dose)
Data format that is compatible with other DICOM systems; reports must be
exported to these systems in DICOM-SR format.

6.4.1 Selecting a study

One radiation summary report is created in the local database for each study.
◆ Select an image or series of the required study in the PROCESSING task card
on the control panel.
– or –

In the Patient list select the study if the applicable data have not been
loaded.

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6.4.2 Radiation Summary Report

The radiation summary report contains the cumulated values for the number of
exposures, duration, and dose over the course of an examination. The
generation of this report is a fully automated process.

(1) Patient and examination data, cumulative radiation data

(2) Detailed information on the acquired series and images
(3) Buttons for scrolling in the report, exporting, and printing the report, as
well as closing the dialog box

Opening the report

✓ A study or a series/image is selected.
◆ Click this button on the left monitor (lower left).
The radiation summary report is displayed on the monitor.

Exporting the report

The default settings established in the Export to... dialog box are used when
exporting the report. This is particularly true of the file format when DICOM
format is set.

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◆ Click this button.

The report is exported to the default address.
Printing a report
When you send the report directly to the default printer, the settings established
for standard printing are used. To use other printer settings or a different
printer, open the print preview first.

Standard printing

1 Select the Print on filmsheet option, if necessary.

2 Click this button.

The report is printed on the default printer.

Changing print settings

1 Select the Print on filmsheet option.

2 Click this button.

The report is opened in print preview. Make the necessary print settings and
start the print job here ( Page 190 Changing print settings).

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7 Configuration
7.1 User Settings 209
7.1.1 Opening/closing a configuration window 209
7.1.2 Site Info 209
Institution Name 210
Institutional Department Name 210
Hospital Address 210
Patient Demographic Data 210
Display Dose Unit in 210
Daylight saving time 211
7.1.3 Patient registration 211
Name-display format 211
7.1.4 DICOM Properties 212
DICOM Properties - General 213
DICOM Properties - Protocol codes 214
DICOM Properties - Sending 215
DICOM Properties - Printing 215
7.1.5 Examination properties 216
Nominal Power Shot 216
7.1.6 Image display and print properties 216
Display Layout task card 217
Print Layout task card 218
Image text settings 218
7.1.7 Deleting images automatically 220
Auto delete 220
7.1.8 Password for radiation release 221
7.2 Examination settings (PEX Editor) 221
7.2.1 Introduction 221
PEX Editor 222
PEX database 222
Online/offline 222
Data categories 222
Names 222
Storage capacity 223
Access control 223
Access modes 223
Import/Export 223
Automatic backup 223
7.2.2 Starting the PEX Editor 223
PEX Editor layout 225
General work steps in the PEX Editor 225
7.2.3 Editing application groups 226
Assigning applications to application groups 227
Removing applications from an application group 227
Establishing the default application group 227
7.2.4 Editing applications 227
Configure triplets for applications 228
Defining other parameters 228
7.2.5 Parameter for fluoroscopy and exposure 229
Parameter 229
7.2.6 Defining parameter sets 230

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7.2.7 PEX service functions 231

Configuration parameters 231
Changing the PEX Editor password 231
Backing up and restoring the PEX database 232

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7.1 User Settings

7.1.1 Opening/closing a configuration window

1 Change to the PREPARATION task card on the control panel if necessary.

2 Press this button.

The control panel switches to keyboard mode.
Manage Tool is displayed on the monitor.
3 Click this icon on the Settings subtask card in the Manage Tool.
The menu for defining user settings is displayed.

4 Double-click the required settings icon to open the respective settings

windows.
5 Change the settings as required. See following pages.
6 Click Apply to accept the changes.
7 Click OK to confirm the changes and close the settings window.
8 Click Cancel to reject your changes and close the settings window.
9 Press this button again to exit the Manage Tool.

7.1.2 Site Info

In the Site Info dialog box you establish site-specific settings, such as the name
and address of your facility.

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Institution Name
◆ Enter the name of your hospital or practice (64 characters maximum).

 A change of the Institution Name will have no effect on already acquired

images.

Institutional Department Name

◆ Enter the name of your department or ward (64 characters maximum).
Hospital Address
◆ Enter the address of your hospital or practice.
Patient Demographic Data
◆ Select the patient data to display on the monitor in addition to the patient
name:
Accession No.
Request ID
Patient ID
Date of birth
Display Dose Unit in
◆ Select the unit (cGy cm2 or μGy m2) to be used for the dose display.

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Daylight saving time

◆ Select Automatic activation.
When Automatic activation is selected, the system automatically switches to
daylight saving time.

7.1.3 Patient registration

In the Patient Registration Input Fields dialog box you establish what
information can be entered during patient registration.
Entries can only be made with the mouse.

◆ Activate or deactivate the respective entries.

Visible: Entry will be shown in the Data Entry Dialog window.
Mandatory: Entry must be completed in the Data Entry Dialog window.
(Entry will be shown in the Data Entry Dialog window in bold letters).
Name-display format
Sets the parts of the patient name to be displayed:
1 Click Change.

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2 Select the parts of the patient name that should be displayed (maximum
five).
3 Click the corresponding check box if a comma should be placed between the
parts of the name.

4 Click OK.
The patient name composition that has been established is displayed.
This composition will be used when displaying patient names in images and
on hardcopies/filmsheets.

7.1.4 DICOM Properties

In the DICOM Properties dialog box you establish the settings for DICOM
functions, such as saving, sending, and printing of images.

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DICOM Properties - General

Storage Commitment Waiting time: The time the imaging system waits for storage commitment after
a study/images have been sent to an archive server.
Number of retries: If the archive server is not available, the imaging system
performs the selected number of retries.
If a DICOM node for which storage commitment is configured does not send a
confirmation within the configured waiting time/number of retries, neither the
S (sent) or A (archived) flag is set.

Worklist query RIS Timer: You can set the update interval (in minutes) for receiving worklist
data from the HIS/RIS (hospital/radiology information system) by specifying the
update interval (in minutes).
Possible settings: Update: 0 - 1440 minutes (24 hours), 0 = no update
Modalities to query: Selection of modality/modalities to use for worklist
queries.
Any modality with a two-letter name can be entered for the worklist query
(Other).

Detailed dose information in MPPS Send exposure dose sequence: The exposure dose sequence is documented in
the performance documentation (MPPS).
Extended dose info.: The dose area product and the name of the application
are listed for every exposure.
The MPPS settings can only be changed in the Service Settings and not in this
dialog box.

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DICOM Properties - Protocol codes

For MPPS Close, you can define protocol codes.

Adding a new protocol code 1 Enter the code: Code Value, Code Meaning, Code Designator, Code
Version.
2 Then click Insert.
A new Protocol Code is created.

Deleting a protocol code ◆ Select the entry to be deleted from the Protocol Code list and then click
Remove.

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DICOM Properties - Sending

Images for autosending ◆ Select which images are to be sent automatically:

Off: No images will be sent automatically.
All: All acquired images will be sent automatically.
Marked: Only marked images will be sent automatically.
DICOM Properties - Printing

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Default Printer ◾ Target: Select one of the configured printers

◾ Layout: Select one of the currently defined DICOM layouts
(Specification: First layout of the default printer)

7.1.5 Examination properties

Activate special performance tests to check your X-ray system in the
Examination Properties dialog box.

Nominal Power Shot

Enable Nominal Power Shot: For VA (Veteran's Health Administration)
hospitals in the United States it is required to check the nominal power of an X-
ray exposure at 100 kV for 100 ms in accordance with the IEC. When this
function is active, the generator creates an exposure with the nominal power
when triggering a single image exposure. The function is deactivated again
automatically after triggering an exposure.
To activate the function, proceed as follows:
◾ The check mark for Enable Nominal Power Shot has to be set in the user
settings.
◾ A patient has to be registered.
◾ A new application has to be selected (regardless of which).
– The Nominal Power Shot is active one time. (Single image and 100 kV are
displayed at this time).

7.1.6 Image display and print properties

In the Image Display and Print Properties dialog box you establish the
information to be displayed in the images when shown on the monitor and in
the hardcopy.

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Display Layout task card

Image layout Display image text: Show the selected text elements in the image on the
monitor.

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Print Layout task card

Image layout ◾ Name: Print layout name

◾ Type: Type of print layout (Paper, DICOM)
◾ Size: Size of the paper/filmsheet in inches
◾ Layout: Page partitioning
◾ Enlarge patient name: Print the patient name larger than the other text
Image text settings

Top left Patient information:

◾ Patient name: Patient’s last name, first name
◾ Patient ID: Patient’s identification number
◾ Date of birth: Patient's date of birth
◾ Ward: Ward of examination
◾ Request ID
◾ Accession No.

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Bottom left Exposure information:

◾ Dose area product: Dose area product
◾ kV: Exposure kV
◾ mA / mAs: Exposure mA/mAs
◾ Dose value / Sensitivity class: Dose value or sensitivity
◾ II/FD image size: Input format/zoom level
◾ Image no.: Image number
◾ Application: Application program name

Bottom center ◾ Comment: Image comment

Top right System information:

◾ Institution name: ( Page 209 Site Info)
◾ System Type: Product name
◾ Software Version: Product version
◾ Physician 1 / Physician 2: Examining physicians
◾ Date of exposure: Date acquired
◾ Time of exposure: Examination date and time

Bottom right Image information:

◾ Matrix size: Image matrix
◾ Image type: Image type
◾ Mask Number: Number of the mask image
◾ LUT level: Name of the look-up table (LUT)
◾ Edge level: Edge enhancement module name
◾ Window values: Window values
– WW: Window width
– WC: Window center
◾ Window values for subtracted images:
– WC: Window contrast
– WB: Window brightness
◾ Pixel shift values: Pixel shift values X: .../Y: ...

Labeling

Label "left/right": Select text for laterality labels, depending on regional

practice.

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◾ L/R:
Display L (English: Left or German: Links) for left label
Display R (English: Right or German: Rechts) for right label
◾ G/D:
Display G (French: Gauche) for left label
Display D (French: Droite) for right label
◾ SIN/DX:
Display SIN (Latin: sinister) for left label
Display DX (Latin: dexter) for right label

7.1.7 Deleting images automatically

In the Image Delete dialog box you establish the rules for automatic deletion of
images in the local database.

Auto delete
Enable auto delete: Activate the automatic image deletion function.
If enabled, you can define the rules for automatic deletion.
◾ Hard disc fill level: Hard disc fill level (depending on the “memory extension”
license key) for activation of automatic deletion (60% to 90%)
◾ Deletion size: Amount of hard disk volume to be deleted (10% to 40%)
◾ Activation time: Activation time for automatic deletion (hh:mm:ss)
◾ Activation date: Activation day for automatic deletion (Daily/Weekly with
selection item for day)

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◾ Conditions: Condition(s) for automatic deletion of images (any combination

of the following conditions):
– Images sent: Delete all images that have been sent to a DICOM node (with
or without confirmation of receipt).
– Images filmed: Delete all printed/filmed images.
– Images stored on CD/DVD: Delete all images stored on CD/DVD.
At least one condition has to be set to activate the automatic delete function.
◾ User confirmation: Obtain user confirmation before starting automatic
deletion (show confirmation dialog box).

 If the password for the Recycle Bin is set, the configuration dialog for auto
delete is also protected with the same password.

7.1.8 Password for radiation release

In the Radiation Release Passcode dialog box you change the password
required for radiation release.

1 Enter the old password.

2 Enter a new password (four-digit number).
3 Repeat entry of the new password.
4 Click OK.

7.2 Examination settings (PEX Editor)

7.2.1 Introduction
The Cios Alpha system provides a series of applications and acquisition program
triplets for standard examinations.
The applications are divided into application groups and saved in a database.
The fluoroscopy and acquisition parameters are established in the applications.
All Fluoro, ROAD, DR (Single image), and SUB acquisition programs are
available as versions with low, medium, and high dose.

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Operating mode Fluoro ROAD SUB DR

Low x x x x

Medium x x x x

High x x x x

An application comprises three acquisition program triplets each (low, medium,

high) for each operating mode (fluoro, single image, subtraction, roadmap).
PEX Editor
The Programs and Exams Editor, PEX Editor for short, is a tool for viewing and
editing application groups, applications, and acquisition program triplets. You
can also define parameter sets that can be used with the acquisition programs.

 The PEX Editor may be used by authorized persons only.

PEX database
The PEX Editor administers a database, the PEX database, containing the
definitions of the application groups, applications, and acquisition program
triplets, as well as the parameter sets.
Online/offline
The PEX Editor runs on the Cios Alpha.
Offline editing of the PEX database is also supported. A special version of the
PEX Editor runs on a separate Windows PC without the main application.
Data categories
The PEX database supports the storage of the following data types:
◾ User data
Your specific applications and application groups.
◾ Siemens data
– Standard applications, application groups, parameter sets, and program
triplets. These entries are marked with (d) = default.
– IQAP applications, application groups, and parameter sets. These entries
are marked with (i) = IQAP.
– Calibration applications, application groups, and parameter sets. These
entries are marked with (c) = calibration.
– Service programs for maintenance. These entries are marked with (m) =
maintenance.
Names
The names of the applications, application groups, parameter sets, and program
triplets depend on the language set for the user interface:

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◾ The names of Siemens elements depend on the language set for the user
interface. In other words, every element has a different name in each
configurable language, but the parameters are the same in each language.
◾ User specific applications and application groups do not depend on the set
language. In other words, there is only one name for all configurable
languages.
Storage capacity
The following number of programs can be stored in the database:
◾ Up to 44 activated application groups, i.e., up to 44 application groups that
can be selected on the control panel
◾ Up to 3000 applications
◾ Up to 44 applications per application group
◾ Up to 30 application program triplets per application
Access control
To open the PEX Editor you are asked to enter a password or to select the
viewing mode. The customer mode password is site-specific. It can be set up
and edited. In service mode, the customer mode password can be reset without
knowledge of the current password.
Access modes
There are three modes for accessing the data:
◾ In Customer mode, you have access rights for user data and also for viewing
the standard applications and application groups. Access to IQAP, calibration,
and service data is not possible.
◾ In IQ expert mode, Siemens image quality experts have access to view and
edit all data.
◾ In Viewing mode, you can see all data sets, but you cannot modify them.
Import/Export
You can import a PEX database into the PEX Editor via any local or external drive
e.g. local hard drive, a CD/DVD drive, or a USB storage medium. Each import
replaces the current database and cannot be undone.
Depending on licensing, several applications/acquisition programs may be
inactive after the transfer. Inactive applications/acquisition programs cannot be
selected.
Automatic backup
Backups of the PEX database are done automatically. The automatic backup runs
in the background after each editing session when the PEX Editor is closed.
Up to ten backups are kept in a folder on the hard drive.
A database stored via automatic backup can be restored with the import
function.

7.2.2 Starting the PEX Editor

1 Change to the PREPARATION task card on the control panel if necessary.

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2 Press this button.

Manage Tool is displayed on the monitor.

3 Click this icon on the Settings subtask card in the Manage Tool.
The password dialog box for the PEX Editor is displayed.

 The factory-set password for customer mode is: customer.

4 Select Customer mode.

5 Enter the correct password.
6 Click Ok or press Enter.
The PEX Editor is opened for editing.
– or –
Click Ok for Viewing only.
The PEX Editor is opened for viewing only.

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PEX Editor layout

Example

The PEX Editor includes the following task cards:

◾ Application Group: Add or remove applications from application groups.
◾ Application: Establish acquisition program selection and properties within an
application.
◾ Triplets: Establish acquisition program triplets for Fluoro, SUB/ROAD, and DR
operating modes.
◾ Param. Module: Define and edit parameter sets referenced in the acquisition
programs.
◾ Configuration: Define and edit system configuration data, e.g. language
configuration, generator type. Functions for backup/restore of the PEX
database are also located here.
General work steps in the PEX Editor
◆ Check/modify the parameters.
( Page 226 Editing application groups)
( Page 227 Editing applications)
( Page 229 Parameter for fluoroscopy and exposure)

Adopting changed parameters ◆ Click Store.

Creating a new application group/ 1 Enter a new designation for Application Group Name or Application Name
application or a new acquisition or Triplet Name.
program triplet
2 Click Store as new.

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Deleting an application group/ 1 Select the element.

application or an acquisition program
2 Click Delete.
triplet
A confirmation dialog box appears.
3 Click Yes to delete the element.

 A triplet used in an application cannot be deleted.

Siemens standard triplets can only be deleted in IQ expert mode.

Rejecting changed parameters

1 Click Close.
– or –
Click the Close icon.
A confirmation dialog box appears.
2 Click Ok to reject changes.

7.2.3 Editing application groups

Example

The Application Group task card displays all available applications and
application groups. You define application groups and assign applications to the
application groups here.
◾ The applications are listed in the Application List.
◾ The application groups and all assigned applications are listed in the
Application Group List.
( Page 225 General work steps in the PEX Editor)

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 The Application Group Name comprises a maximum 15 Unicode

characters.

Assigning applications to application groups

1 Mark an application in the Application List.
2 Mark an application group in the Application Group List.
3 Click Insert Application.
– or –
Drag an application from the Application List to an application group in the
Application Group List.
The application is assigned to the application group under the position
marked in the Application Group List.

 The same application can be assigned to multiple application groups.

Removing applications from an application group

1 Mark the application in the Application Group List.
2 Click Remove Application.
Establishing the default application group
◆ Mark the application in the Application Group List and then click Set as
default.

7.2.4 Editing applications

Example

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The Application task card shows the assigned acquisition program triplets for
the Fluoro, SUB, ROAD, and DR operating modes, as well as additional
parameters. You can configure the applications and establish the application-
specific parameters here.
( Page 225 General work steps in the PEX Editor)

 The Application Name comprises a maximum 15 Unicode characters.

Configure triplets for applications

1 Select a triplet for each operating mode.
2 Activate the Auto Window to switch to automatic window value assignment
for SUB/ROAD.
The brightness and contrast settings of the currently available Peak OP image
are used when reviewing the subtraction scene or for subsequent subtraction
exposures.
3 For automatic saving activate the Auto-store option field and enter the
Storage Rate and Max scene length.
The maximum scene length is set in seconds.
The percentage save frequency (save rate) corresponds to the proportion of
images to be saved from the live scene; e.g., at a 25% save rate, every 4th
image is saved.
4 Activate Autoreplay if scenes should replay automatically.
5 For SUB/ROAD establish the Number of frames for mask, i.e., the number of
images used to calculate the mask.
Defining other parameters
1 Select an entry in the Name Module of Contrast Automatic list to establish
the brightness and contrast.
2 Select a multiplication factor for Toggle function EE.
The user can toggle the edge enhancement between low, default, and high
on the control panel. The default value is set in the triplet. The values for low
and high are calculated by a factor.
A factor of 1 means the edge enhancement is medium.
A factor of 0 means the edge enhancement is off.
3 Select a multiplication factor for Toggle function MD.
The user can toggle the motion detection (k factor) between low, default,
and high on the control panel. The default value is set in the triplet. The
values for low and high are calculated by a factor.
A factor of 1 means the motion detection is medium.
4 Select a Center Shift and a Width Factor for LUT Preset 3.
The values for center shift and width factor can be set for automatic contrast
regulation. Correction values for center/width and brightness/contrast of the
third LUT can be set.

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5 Activate Set Black if the image area outside the collimated area should be
blackened (digital collimation).
6 Define the input values for Rotation in degrees (0 - 359), Flip (vertical and⁄or
horizontal flip) and Magnification (Level 0, 1, 2).
7 Establish the measurement field with the Measurement parameter.

7.2.5 Parameter for fluoroscopy and exposure

Example

The Triplets task card enables triplets and parameters to be established for all
operating modes on the corresponding cards.
◾ Fluoro card: Parameters for unsubtracted fluoroscopy
◾ SUB/ROAD card: Parameters for subtracted fluoroscopy
◾ DR card: Parameters for unsubtracted single image acquisitions
( Page 225 General work steps in the PEX Editor)
Parameter
Triplet Name: Name of the fluoroscopy or acquisition program triplet (max. 63
characters).
◾ Number of Images: Number of images from which the LIH (last image hold)
is calculated.
◾ Number of Images IDL: Number of pulses used to calculate the individual
images in Fluoro and SUB/ROAD modes.
◾ Number of Pulses: Number of pulses to obtain a specific overall dose for a
single image acquisition.
Examples: A factor of 1 corresponds to a single acquisition. With a factor of 8,
the image is calculated from 8 acquisitions. Possible values: 1, 2, 4, 8, 16, 32
Landmark: Basic setting for anatomical background in subtracted images.
Possible values: 0 - 100%

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Parameter modules Noise Time Filter, Noise Spatial Filter, Spatial Frequency
Response: Three parameter sets can be selected for each dose level. The
parameter sets are defined by experts. ( Page 230 Defining parameter sets)
◾ Default: Establish the default parameter set: Low or Medium. High cannot
be selected as the default.

7.2.6 Defining parameter sets

Example

Parameter sets can be defined and edited on the Param. Module task card.
These can then be referenced in application and/or triplet definitions.

 Parameter sets may be changed in expert mode only; changed parameter

sets cannot be saved in customer mode.

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7.2.7 PEX service functions

Configuration parameters

◾ Units for: Unit to be used (cm or inches) for the Collimator Size
◾ Password: ( Page 231 Changing the PEX Editor password)
◾ Database Export/Import: ( Page 232 Backing up and restoring the PEX
database)
◾ Restore/Import Database Selection: Database selection for export/import
◾ Pex Versions: Displays the PEX Editor version
Changing the PEX Editor password
1 Click the Configuration card.
2 Click Change Password.
The password change dialog is displayed.

3 Enter your old password.

4 Enter your new password.
5 Re-enter your new password.
6 Click Ok.

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Backing up and restoring the PEX database

It is possible to import or export the PEX database via a local or external drive
(e.g. local hard drive, CD/DVD drive, USB memory stick).

 This process should only be perform by an expert or specialist.

◆ Click the Configuration card.

Exporting the PEX database 1 If necessary, have the required external data medium on hand.
Insert a blank CD/DVD into the drive.
Connect the USB memory to the USB socket.
2 Click Backup / Export.
A list of all writable devices connected to the PC in use (system or user PC
with offline PEX Editor) that can be used for export/backup is displayed.

3 Select the destination drive.

4 Click Go to start export.
The PEX database is copied to the destination drive in a predefined folder
(e.g. D:\PEX_backup\). The name of the database copy is the original name
extended by creation date and time.
A message window indicates that the backup is complete.
5 Click OK.

 The number of backups on the local drive (C: and D: drives) is limited to 10.

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Importing a PEX database By importing you replace the old system database. If an error occurs during
transfer, the old database remains valid.

 After correct import the old database is permanently deleted.

1 If necessary have the required external data medium to which the new
database will be stored on hand.
Insert the CD/ DVD into the drive.
Connect the USB memory to the USB socket.
2 Select the database you want to replace.
Customer DB, Service DB, or Both for both databases.
3 Click Restore / Import.
A list of all readable devices connected to the PC in use (system or user PC
with offline PEX Editor) that can be used for import/restore is displayed.

4 Select the source device.

A list of all restorable databases is shown.
When copying from the local hard drive you have to select one of the two
backup folders (manual, automatic backup) to get the list of restorable
databases.
5 Select the new database or databases.
6 Activate Assure data consistency if the data are to be checked for errors.
7 Click Go to start the import.

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8 Maintenance
8.1 Functional and safety checks 236
8.1.1 Daily checks 236
Prior to the examination 236
Checking the EMERGENCY STOP function for motor-
driven system movements 236
8.1.2 Monthly checks 236
Functional check of the dose rate control 236
8.1.3 Checks prior to special examinations (e.g. of the open
heart and skull) 237
8.1.4 Calibration 237
Detector calibration 237
Calibrating the dose measurement chamber 238
8.1.5 Maintenance plan for checking the system 238
8.1.6 Maintenance intervals 239
General information on maintenance intervals 239
Batteries 239
8.1.7 Dose and consistency test 240
Preparation 240
Dose measurement 240
Calculation 241
8.2 Service via network connection 241
8.2.1 Remote Service 241
Software updates via remote access 241
Setting access rights 241
8.2.2 Application support 243
Enabling remote access 243
Rejecting remote access 243
Entering the session number 244
8.2.3 Transmitting error messages 244
Transmitting to the factory 245
Saving to a USB drive 245
8.2.4 Updating virus protection 245
Behavior during virus attack 246
8.3 Cleaning and Disinfection 246
8.3.1 Cleaning the system parts 247
8.3.2 Cleaning the screen surfaces/TFT displays 247
8.3.3 Disinfection 247
8.4 Protection classes/Protection measures 248
8.5 Active ingredient classes 248

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8.1 Functional and safety checks

To ensure that the Cios Alpha is ready for operation and all safety features are
functioning properly, you must perform regular functional and safety checks.

8.1.1 Daily checks

Prior to the examination
1 Check the power plug. If the power plug is damaged, the Cios Alpha must not
be used.
2 Check the power cable. If the power cable is damaged, the Cios Alpha must
not be used.
3 Check the function of the locking brakes of the C-arm system and the monitor
trolley as well as the steering of the C-arm system.
4 Check the C-arm counterbalance after releasing the brakes.
5 Check the loudspeakers for proper functioning. An audible signal must sound
while the system starts up.
6 Check that all radiation indicators are functioning properly.
7 Inspect the flat detector unit housing and the single tank for mechanical
damage.
8 Check that the flat detector grid and the knurled screw are fastened properly.
Checking the EMERGENCY STOP function for motor-driven system
movements
1 Switch the Cios Alpha on.
2 Move the lifting column and press the EMERGENCY STOP button at the same
time.
The lifting movement is stopped.
A message is displayed on the monitor indicating that EMERGENCY STOP has
been actuated.
3 Release the EMERGENCY STOP button.
4 Press one of the buttons for moving the lifting column.
The lifting movement is enabled again.

8.1.2 Monthly checks

Functional check of the dose rate control
You can check the function of the dose rate control without an object using the
simple procedure described below. A kV value of ≤ 45 kV must stabilize:
1 Open the rectangular and slot collimators to maximum aperture.
2 Press the Tech lock button and select Stop.
3 Select 125 kV with the +/- buttons.
4 Press the Tech lock button again and select Auto.
The stop function is canceled; automatic dose rate control is switched on
again.

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5 Release radiation in fluoroscopy mode.

The tube voltage is reduced to a value ≤ 45 kV.
The monitor image is not overexposed.

8.1.3 Checks prior to special examinations (e.g. of the open heart

and skull)
◆ Make sure that there is an additional conductive connection between the C-
arm system and a point of potential equalization, e.g. the patient table.

8.1.4 Calibration
Detector calibration
The detector calibration shall be done in regular intervals.

 CAUTION

Incorrect calibration parameters. Reduced image quality.

Risk of unnecessary radiation exposure due to incorrect calibration
parameters!
◆ Calibrate the system after 24 months to preserve image quality.

 CAUTION

Operator error.
Risk of unnecessary radiation exposure!
◆ Follow the calibration procedure instructions.

 To ensure optimum image quality, we recommend performing detector

calibration at shorter intervals than specified above.

Additionally the imaging system will remind the user to recalibrate the detector
in factory-defined intervals.
The detector calibration needs to be done also in case there are new defective
pixels visible in the x-ray image. These defective pixels will be displayed e.g. as
white dots in the image. In such a case perform the detector calibration as soon
as possible.
It will be always possible to work with the system even if the detector
calibration warning was confirmed without starting the detector calibration
immediately.
1 In the PREPARATION subtask card, press the Data system button on the
monitor trolley control panel.
Manage Tool is displayed on the monitor.

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2 Click the Service subtask card on the monitor.

3 Click Service login. Alternatively, on the control panel press the Service
login button on the lower right.
The Service login screen appears.

4 Enter the following password: admin2 and confirm with OK.

The Tune Up field appears.
5 Click the Tune Up field.
The Tune Up screen opens.
Under User Password (1) you can enter a separate password or continue
with FD Calibration (2).
6 Click FD Calibration (2).
The FD Calibration screen opens.
7 Follow the menu instructions.

 Radiation has to be released during the calibration procedure.

Calibrating the dose measurement chamber

The dose measurement chamber is calibrated on a regular basis as part of the
maintenance contract (every 5 years at the latest). If you do not have a
maintenance contract, Siemens Customer Service or the manufacturer can
calibrate the dose measuring chamber.

8.1.5 Maintenance plan for checking the system

The tests and inspections required by national laws or regulations, such as DHHS
regulations or RöV (constancy tests), are not part of the activities listed in this
maintenance plan.
If national laws or regulations specify more frequent checking and/or
maintenance, these must be observed.
Maintenance work should be performed by trained technical personnel only. To
keep the system in an optimum condition, we recommend that you conclude a
maintenance contract. If you have any questions relating to maintenance/
maintenance contract please contact our Siemens Customer Service.

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 Please observe the relevant information in ( Page 17 Maintenance and

inspection).

8.1.6 Maintenance intervals

General information on maintenance intervals
Regular maintenance takes place in 24-month intervals. It contains numerous
maintenance steps that have to be performed:

Procedures to be performed Function Interval

External visual inspection Damage, total system 24 months

Mechanical safety Covers, cable guards, C-arm, C-arm 24 months

movements, scattered radiation grid/
grid holder, brakes. C-arm system and
monitor trolley wheels, lifting column,
emergency stop button, warning
labels, identification labels, monitors,
options (if present, e.g. motorized
movements, laser light localizers)

Electrical safety Cable and plug, network connection 24 months

socket, fluoroscopy indicator, acoustic
warning signal, radiation release
switch, radiation indicator, options (if
present, e.g. dose area product and/or
air kerma measuring device), total sys-
tem image quality, checks in accord-
ance with IEC 62353

Maintenance System ventilation, cleaning of system 24 months

Operating value inspection Output and assess Event Log 24 months

Functional inspection Control functions, monitor indicators 24 months

of beam path opening/slot collimator
positions, options

Upkeep Housing 24 months

The stated functions are minimum requirements.

Batteries
Battery replacement intervals (UPS and PC)

Procedures to be performed Function Interval

Operating value inspection UPS lead gel batteries First replacement after 42 months,
subsequently every 48 months
PC bios battery

The stated functions are minimum requirements

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8.1.7 Dose and consistency test

Carry out dose area product testing after performing the following procedure:
Preparation
1 Open the collimator completely (full format).
2 Select the "Fluoroscopy" operating mode.
3 Center the lead ruler on the flat detector.
4 Release radiation, setting the rectangular collimator to approx. 15 cm edge
length.
5 Keep the field size (shown on the lead ruler) constant.

 The rectangular collimator may no longer be adjusted.

6 Remove the lead ruler.

7 Center the dose measurement device on the flat detector (see (1) in graphic).

(1) Dose measurement device

Dose measurement
1 Release radiation for a short period and then actuate the Teck lock button
and set 70 kV.
2 Record the dose area product - value "A" (µGycm2) - shown on the monitor.
3 Set the measured dose area product to "0" on the measuring device.
4 Release radiation for approx. 10 s and record the measured dose (cGy).
5 Record the dose area product - value "B" - shown on the monitor.
6 Subtract value "A" from value "B".

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Calculation
Measured dose area product = measured dose (cGy) x 225 cm2
◆ Compare the measured value with the dose area product displayed on the
monitor.


With a correct adjustment, the displayed and calculated values agree within
a maximum deviation of +/- 25%. If the deviation exceeds this percentage,
please inform service.

8.2 Service via network connection

The Cios Alpha must be connected to a network (DSL ≥ 1 Mbit/s) to enable
remote access service measures.

8.2.1 Remote Service

If the rights are granted accordingly, Siemens Customer Service can access the
Cios Alpha for maintenance and installation activities via an active network
connection.
Software updates via remote access

 CAUTION

Software installation interferes with system functions.

Interruption of patient examination and loss of patient data.
◆ Do not start the installation while working with patients.

 CAUTION

Failure installing the update package.

A failed software installation means that the system is in an undefined
state.
◆ Stop using the system and notify the UPTIME Service Center.

 CAUTION

No restart after service session.

Changes to the service environment may not go into effect without a
system restart.
◆ Restart the system after a service session.

Setting access rights

In the Remote Service window you grant service personnel access rights so that
they can perform maintenance in a remote session.

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 The patient must be closed; otherwise, there could be problems accessing

the control panels.

1 In the PREPARATION subtask card, press the Data system button on the
monitor trolley control panel.
Manage Tool is displayed on the monitor.
2 Click the Settings subtask card on the monitor.

3 Double-click the Telephone icon.

The Remote Service window appears.

4 Click one of the following options to define the type of access:

Full access: Service receives full access rights to your system.
Limited access: Service receives limited access, that is, they can see error
messages and reset passwords.
No access (default setting): Service does not receive access to your system.
5 Click the Accept silent installation of virus pattern check box if you want
the virus scanner to be updated regularly.

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6 Click OK to apply all settings and exit the window.

7 Press this button again to exit the Manage Tool.

8.2.2 Application support

If you require online support for your system, you can grant access to the Cios
Alpha as follows:
1 Right-click the i icon (1) on the monitor.
The Headquarter Support Applications screen opens:

2 Click Remote assistance.

The Remote Desktop Assistance window opens.

Enabling remote access

◆ To enable remote access to the system click I agree.
The dialog window for entering the session number opens.
Rejecting remote access
◆ To reject remote access to the system click I do not agree.
The request is canceled.

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Entering the session number

1 Enter the session number provided to you by Service.

2 Click Login.

3 Click OK to accept the request to take over your system remotely.

The requesting technician receives the right to control the user interface.
4 Click Viewing Only, to deactivate remote system control if it is currently
active.
System control by the moderator or other participant is cancelled. System
control is returned to you.
5 Click Disconnect to disconnect the established connection.
The remote support connection icon disappears.
6 Click Cancel to close the window.

8.2.3 Transmitting error messages

You can transmit error messages directly to the factory or save them to a USB
drive.

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Transmitting to the factory

1 Click the i icon.
The Headquarter Support Applications screen opens.
2 Under Send to factory mark the appropriate check box.
3 You can also enter a comment by marking the appropriate check box and
entering text.
4 Confirm with OK.
The message and/or log files are sent.


If the system is not currently connected to the network, the files are placed
in a transfer folder on the system. The files are sent the next time a network
connection is established.

Saving to a USB drive

1 Insert the USB drive into a free USB slot on the monitor trolley.
2 Click the corresponding box and confirm with OK.
The log files will be saved to the USB drive.

8.2.4 Updating virus protection

A virus scanner is part of the software installed on your system.

 CAUTION

New viruses not detected.

System malfunction as the result of a virus attack.
◆ Acknowledge the virus pattern file and scan engine updates during
booting. Only available with remote handling of updates.
◆ Otherwise, contact Siemens Customer Service.

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 The Cios Alpha should be operated only in a virus-protected hospital

network.

Behavior during virus attack

A message window is displayed if a virus is detected.

 In this case, you must contact Siemens Customer Service.

Do not try to correct the problem yourself.

8.3 Cleaning and Disinfection

Before cleaning or disinfecting the Cios Alpha, the system must be disconnected
from the power supply and switched off.

 CAUTION

Inadvertent actuation of the foot pedal.

Risk of radiation!
◆ Switch off the system before cleaning.

Before each examination, clean all parts that could come into contact with the
patient or bodily fluids to prevent contamination of the Cios Alpha. Also make
sure that any dust deposits on the housing of the image intensifier/flat detector,
the single tank, and the C-arm are removed prior to every treatment. Please
follow the cleaning instructions as described below.

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 Maintenance 8

 CAUTION

Improper cleaning.
Risk of infection!
◆ After dealing with patients with highly infectious diseases, clean the
unit wheels, in addition to regular cleaning.

8.3.1 Cleaning the system parts

1 Clean the system parts with a damp cloth.
2 For moistening, use water or a lukewarm, diluted aqueous solution consisting
of water and a household cleaning agent.

 Cleaning agents and disinfectants containing chlorine derivatives can

discolor cables, but will not negatively impact system functions.

Never immerse system parts (excepting the footswitch) in liquid or

 autoclave system parts!

Observe the respective protection and active ingredient classes in this
regard.

8.3.2 Cleaning the screen surfaces/TFT displays

The screen surfaces can be cleaned at any time.
1 Clean the monitor screen with a cotton cloth dampened with water.
2 Immediately dry off the monitor screen with a soft cotton cloth.
3 Wipe off contrast agent spots as soon as possible.

8.3.3 Disinfection
For the disinfection of surfaces we recommend liquid solutions of common
surface disinfectants based on aldehyde and/or amphoteric surfactants, e.g.
Tensodur 103, Kohrsolin, Cidex.
Certain substituted phenol-based or chlorine-splitting disinfectants can corrode
materials and are therefore not recommended.

 CAUTION

Use of unsuitable cleaning agents.

Risk of contamination.
◆ Only use the recommended cleaning agents and disinfectants.

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 CAUTION

Use of abrasive cleaning agents, liquids, or sprays.

Risk of electrical shock or damage to the system.
◆ Only use the recommended cleaning agents and disinfectants.
◆ Do not allow any cleaning fluids to enter the openings of the system
(e.g. air openings, gap between covers).
◆ Follow the cleaning and disinfection instructions.

◆ Please also observe the instructions for use of the disinfectant.

Some substances contained in disinfectants are known to be hazardous to

 health. The concentration of such substances in the air must not exceed the
legally defined limit. We recommend that you follow the manufacturers’
usage instructions for these products (active ingredient classes).

8.4 Protection classes/Protection measures

System components Protection class Protection measures

X-ray tube assembly (Single-tank) IPX0 - No protection protect with sterile cover

Flat detector IPX0 - No protection protect with sterile cover

C-arm IPX0 - No protection protect with sterile cover

Remote control unit (optional) IP65 dust tight, protected against protect with sterile cover, separate
water jets from chassis before cleaning

Standard footswitch IPX8 protected against immersion protect with sterile cover, separate
beyond 1 m from chassis before cleaning

Multifunctional footswitch IPX8 protected against immersion protect with cover, separate from
beyond 1 m chassis before cleaning

Hand switch IP54 dust protected, protected against separate from chassis before cleaning
splashing of water

8.5 Active ingredient classes

The following active ingredient classes may be used to clean and disinfect the
Cios Alpha.

Active ingredient class Aldehydes, alkylamines, quaternary com-

pounds, guanidine derivatives, peroxide com-
pounds, organic acids, chlorine derivatives,
alcohol, benzene, common household dish-
washing liquids, detergents

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 Technical Specifications 9

9 Technical Specifications
9.1 Curves and diagrams 251
9.1.1 Heating curve without cooling 251
9.1.2 Heating curve with cooling 251
9.1.3 Small focus (0.3) emission curves 252
9.1.4 Large focus (0.5) emission curves 253
9.1.5 Fluoro curves 253
Systems with 25 kW generator 253
Systems with 12 kW generator 255
9.1.6 Dose rate at the flat detector input 256
Dose rate value deviation 257
Setting the dose rate value 257
9.1.7 Dosimetric information 257
Air kerma strength 257
Dosimetric information in accordance to IEC
60601-2-43:2010 265
9.2 Notes on electromagnetic compatibility (EMC) 268
9.2.1 Guidelines and manufacturer's declaration –
Electromagnetic emissions 268
9.2.2 Guidelines and manufacturer's declaration –
Electromagnetic interference immunity 269
9.2.3 Guidelines and manufacturer's declaration –
Electromagnetic interference immunity 269
9.2.4 Recommended separation distances between portable
and mobile RF telecommunications equipment and the
system 271
9.3 Original equipment manufacturer 272
9.3.1 Introduction 272
9.3.2 For Open Source Software (OSS) only 272
9.4 System data 273
9.4.1 Entire system 273
General data 273
Weight 273
Classification 274
Current/voltage values 274
9.4.2 Generation of radiation 274
X-ray generator 274
X-ray tube assembly (Single-tank) 275
9.4.3 Image receptor 276
Flat detector 276
Scattered radiation grid on flat detector 278
9.4.4 Unit components 278
C-arm 278
Collimator system 279
Imaging chain 279
Monitors 279

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9.4.5 Equipment options 280

Dose measuring chamber (DAP meter) 280
Automatic dose rate control (ADR) 280
Detector laser light localizer (optional) 281
Single-tank laser light localizer (optional) 281
HD video manager 281
DVI video splitter 281
SCALANCE W 721 WLAN access point 281
9.5 List of Standards 282
9.6 Labels 283
9.6.1 C-arm system 283
1. C-arm travel frame 284
2. Base system (Chassis) 285
3. Horizontal support arm 286
4. Control unit for C-arm system 286
5. Control module for the motorization package 287
6. Inside of C-arm 287
9.6.2 Monitor trolley 289

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9.1 Curves and diagrams

9.1.1 Heating curve without cooling

Heat storage capacity single tank SMB30 without cooling, Undertable/Overtable:

(1) yellow curve: cooling curve

(2) light blue curve: 100 W, Overtable
(3) dark blue curve: 100 W, Undertable
(4) light green curve: 300 W, Overtable
(5) dark green curve: 300 W, Undertable
(6) pink curve: 600 W, Overtable
(7) red curve: 600 W, Undertable

9.1.2 Heating curve with cooling

Heat storage capacity single tank SMB30 with cooling, Undertable/Overtable:

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(1) yellow curve: cooling curve

(2) light blue curve: 100 W, Overtable
(3) dark blue curve: 100 W, Undertable
(4) light green curve: 300 W, Overtable
(5) dark green curve: 300 W, Undertable
(6) pink curve: 600 W, Overtable
(7) red curve: 600 W, Undertable

9.1.3 Small focus (0.3) emission curves

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9.1.4 Large focus (0.5) emission curves

9.1.5 Fluoro curves

The following fluoro curve properties are available in the system for clinical use.
The following base values apply for all systems and fluoro curves:
◾ Minimum kV = 40
◾ Maximum kV = 125

 The currents (mA) shown in the following tables indicate effective values.

Systems with 25 kW generator

Characteristic curves for fluoroscopy The maximum average power for normal fluoroscopy characteristic curves is
600 W. Characteristic curves with the HL add-on have a maximum average
power of 1000 W (limited to 30 s radiation), and curves with the HL ESU add-on
have a maximum average power of 3000 W (limited to 30 s radiation).

Example for the same object at 15 fps1)

Characteristic Min mA (pulse) Max mA (pulse) kV ∅ mA (calcula- ∅ power (W)

Curve ted)

FL-CARD HP 3.0 59.5 80 4.0 320

FL-CARD HP HL 10.0 168.0 80 4.0 320

FL-CARD HP HL 10.0 200.0 80 4.0 320

ESU*

FL-CARD 3.0 42.2 80 4.0 320

1) with the same image receptor dose

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Example for the same object at 15 fps1)

Characteristic Min mA (pulse) Max mA (pulse) kV ∅ mA (calcula- ∅ power (W)

Curve ted)

FL-CARD HL 10.0 84.0 80 4.0 320

FL-CARD HL ESU* 10.0 84.0 80 4.0 320

FL-HC HP 3.0 67.0 69 8.0 552

FL-HC HP HL 10.0 224.0 66 9.5 627

FL-HC HP HL ESU* 10.0 250.0 63 12.0 756

FL-HC 3.0 53.1 71 6.6 469

FL-HC HL 10.0 100.0 66 9.5 627

FL-HC HL ESU* 10.0 100.0 63 12.0 756

FL-IOD HP 3.0 67.0 67 9.0 603

FL-IOD HP HL 10.0 211.5 66 9.5 627

FL-IOD HP HL 10.0 237.0 66 9.5 627

ESU*

FL-IOD 3.0 50.1 66 8.9 590

FL-IOD HL 10.0 100.0 66 9.5 627

FL-IOD HL ESU* 10.0 100.0 66 9.5 627

FL-LD HP 3.0 56.0 92 2.3 212

FL-LD 3.0 37.6 92 2.3 212

FL-S HP 3.0 67.0 86 2.8 241

FL-S HP HL 10.0 211.5 78 4.5 351

FL-S HP HL ESU* 10.0 250.0 71 7.2 512

FL-S 3.0 42.0 86 2.9 249

FL-S HL 10.0 100.0 78 4.5 351

FL-S HL ESU* 10.0 100.0 71 7.2 512

* only available on systems with the ESU option

1) with the same image receptor dose

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Characteristic curves for single image

Example for the same object2)

Characteristic Curve Min mA (pulse) Max mA (pulse) kV mAs

DR-CARD HP 10.0 250.0 80 0.265

DR-CARD 10.0 100.0 80 0.265

DR-HC HP 10.0 250.0 67 0.594

DR-HC 10.0 100.0 67 0.600

DR-IOD HP 10.0 250.0 66 0.630

DR-IOD 10.0 100.0 66 0.630

DR-LD HP 10.0 250.0 83 0.223

DR-LD 10.0 100.0 83 0.223

DR-S HP 10.0 250.0 64 0.749

DR-S 10.0 100.0 64 0.750

Systems with 12 kW generator

Characteristic curves for fluoroscopy The maximum average power for normal fluoroscopy characteristic curves is
600 W. Characteristic curves with the HL add-on have a maximum average
power of 1000 W (limited to 30 s radiation).

Example for the same object at 15 fps3)

Characteristic curve Min mA (pulse) Max mA kV ∅ mA (calcula- ∅ power (W)

(pulse) ted)

FL-CARD HP 3.0 59.5 80 4.0 320

FL-CARD HP HL 10.0 119.0 80 4.0 320

FL-CARD 3.0 42.2 80 4.0 320

FL-CARD HL 10.0 84.0 80 4.0 320

FL-HC HP 3.0 67.0 69 8.0 552

FL-HC HP HL 10.0 119.0 66 9.5 627

FL-HC 3.0 53.1 71 6.6 469

FL-HC HL 10.0 100.0 66 9.5 627

FL-IOD HP 3.0 67.0 67 9.0 603

FL-IOD HP HL 10.0 119.0 66 9.5 627

2) with the same image receptor dose

3) with the same image receptor dose

Cios Alpha 255

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 9 Technical Specifications

Example for the same object at 15 fps3)

Characteristic curve Min mA (pulse) Max mA kV ∅ mA (calcula- ∅ power (W)

(pulse) ted)

FL-IOD 3.0 50.1 66 8.9 590

FL-IOD HL 10.0 100.0 66 9.5 627

FL-LD HP 3.0 56.0 92 2.3 212

FL-LD 3.0 37.6 92 2.3 212

FL-S HP 3.0 67.0 86 2.8 241

FL-S HP HL 10.0 119.0 78 4.5 351

FL-S 3.0 42.0 86 2.9 249

FL-S HL 10.0 100.0 78 4.5 351

Characteristic curves for single image

Example for the same object4)

Characteristic curve Min mA (pulse) Max mA (pulse) kV mAs

DR-CARD HP 10.0 120.0 80 0.265

DR-CARD 10.0 100.0 80 0.265

DR-HC HP 10.0 120.0 67 0.594

DR-HC 10.0 100.0 67 0.600

DR-IOD HP 10.0 120.0 66 0.630

DR-IOD 10.0 100.0 66 0.630

DR-LD HP 10.0 120.0 83 0.223

DR-LD 10.0 100.0 83 0.223

DR-S HP 10.0 120.0 64 0.749

DR-S 10.0 100.0 64 0.750

9.1.6 Dose rate at the flat detector input

The dose rate is set at the factory; it is measured behind the scattered radiation
grid at the flat detector input. Refer to the acceptance protocol §16 RöV for the
system-specific dose values (Federal Republic of Germany only).
The dose rate is set in the kV range between 70 and 80 kV using a technical
phantom.

3) with the same image receptor dose

4) with the same image receptor dose

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Dose rate value deviation

Depending on the examined object, different fluoroscopy data (kV, mA) arise.
Because flat detector sensitivity depends on beam quality (kV), the same gray
values in the image may correspond to different dose rate values at the detector
input.
When examining a patient in fluoroscopy mode, additional scattered radiation
values are produced in comparison to the phantom values, affecting the dose
rate at the flat detector input.
Setting the dose rate value
If desired, the preferred position for the dose rate can be reprogrammed.

9.1.7 Dosimetric information

Air kerma strength
The skin dose values were measured at a distance of 30 cm (patient entry
reference point) from the image receptor input with a 20 cm PMMA phantom
(equivalent to a typical patient) in accordance with IEC 60601-2-43:2010,
203.5.2.4.5.101.

Radioscopy, Detector size 20x20

Program5) Dose level Voltage Current Pulse width Pulse rate Dose rate dis-
play
with anti-scatter grid [kV] [mA] [ms] [1/s]
[mGy/min]
Magnify 0

Intervention, Card. Interv. low 80 18.0 5.0 15 4.0

medium 80 24.0 5.0 30 10.2

high 80 38.0 5.0 30 16.0

Intervention, Gastro low 83 14.0 5.0 15 3.4

Interv.
medium 88 16.0 5.0 30 9.1

high 89 20.0 5.0 30 12.0

Intervention, Vasc. Interv. low 63 64.0 5.0 7.5 3.7

medium 65 67.0 5.0 15 9.1

high 64 154.0 5.0 15 16.6

Intervention, Vasc. Interv. low 80 19.0 5.0 7.5 2.0

AAA
medium 80 25.0 5.0 15 5.3

high 80 38.0 5.0 15 7.9

5) Only valid as delivered from factory. Technical changes reserved.

Cios Alpha 257

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 9 Technical Specifications

Program5) Dose level Voltage Current Pulse width Pulse rate Dose rate dis-
play
with anti-scatter grid [kV] [mA] [ms] [1/s]
[mGy/min]
Magnify 0

Card, Card Standard low 80 16.0 5.0 30 7.5

medium 80 24.0 5.0 30 10.7

high 80 30.0 6.0 30 15.6

Gastro, Gastro Standard low 83 10.0 5.0 30 5.7

medium 86 14.0 5.0 30 7.4

high 90 20.0 5.0 30 11.0

Vascular, Vasc Standard low 64 38.0 5.9 15 5.2

medium 65 52.0 6.8 15 9.0

high 68 49.0 9.3 15 13.1

Urology, Uro Standard low 64 38.0 5.9 15 5.2

medium 65 52.0 6.8 15 9.0

high 68 49.0 9.3 15 13.1

Ortho/Trauma, Ortho low 64 38.0 5.9 15 5.2

Standard
medium 65 52.0 6.8 15 9.0

high 68 49.0 9.3 15 13.1

General Standard low 64 38.0 5.6 15 5.2

medium 65 52.0 6.8 15 9.0

high 68 49.0 9.3 15 13.1

General Adipose low 64 54.0 5.0 15 5.1

medium 65 67.0 5.2 15 9.0

high 62 148.0 5.0 15 15.4

General Extremity low 66 50.0 8,9 15 11.1

medium 66 49.0 11.9 15 16.0

high 76 43.0 11.9 15 18.5

General Standard HL low 80 16.0 5.0 15 3.3

medium 80 32.0 5.0 15 6.4

high 80 72.0 5.0 15 15.3

5) Only valid as delivered from factory. Technical changes reserved.

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 Technical Specifications 9

Program5) Dose level Voltage Current Pulse width Pulse rate Dose rate dis-
play
with anti-scatter grid [kV] [mA] [ms] [1/s]
[mGy/min]
Magnify 0

Intervention, Vasc. Interv. high dose 125 94.0 5.0 30 100.0

with ESU6)

General Pediatrics low 75 6.9 5.0 15 1.3

w/o anti-scatter grid medium 79 7.3 5.0 15 1.7

high 81 9.0 5.0 15 2.3

Radioscopy, Detector size 30x30

Program7) Dose level Voltage Current Pulse width Pulse rate Dose rate dis-
play
with anti-scatter grid [kV] [mA] [ms] [1/s]
[mGy/min]
Magnify 0

Intervention, Card. Interv. low 80 12.0 5.0 15 2.4

medium 80 17.0 5.0 30 7.0

high 79 25.0 5.0 30 9.8

Intervention, Gastro low 82 10.0 5.0 15 2.4

Interv.
medium 84 12.0 5.0 30 6.0

high 87 15.0 5.0 30 8.0

Intervention, Vasc. Interv. low 63 49.0 5.0 7.5 2.5

medium 65 54.0 5.0 15 6.0

high 61 114.0 5.0 15 10.5

Intervention, Vasc. Interv. low 80 12.0 5.0 7.5 1.2

AAA
medium 80 17.0 5.0 15 3.6

high 79 25.0 5.0 15 4.7

Card, Card Standard low 80 11.0 5.0 30 4.9

medium 80 15.0 5.0 30 6.6

high 80 22.0 6.0 30 9.6

5) Only valid as delivered from factory. Technical changes reserved.

6) Highest deliverable air kerma rate.
7) Only valid as delivered from factory. Technical changes reserved.

Cios Alpha 259

Print No. XPR2-400.620.30.01.02
 9 Technical Specifications

Program7) Dose level Voltage Current Pulse width Pulse rate Dose rate dis-
play
with anti-scatter grid [kV] [mA] [ms] [1/s]
[mGy/min]
Magnify 0

Gastro, Gastro Standard low 83 10.0 5.0 30 4.8

medium 84 12.0 5.0 30 6.2

high 87 15.0 5.0 30 8.0

Vascular, Vasc Standard low 63 43.0 5.0 15 4.2

medium 65 53.0 5.4 15 6.4

high 67 52.0 7.1 15 8.3

Urology, Uro Standard low 63 43.0 5.0 15 4.2

medium 65 53.0 5.4 15 6.1

high 67 52.0 7.1 15 8.3

Ortho/Trauma, Ortho low 63 43.0 5.0 15 4.2

Standard
medium 65 53.0 5.4 15 6.3

high 67 52.0 7.1 15 8.3

General Standard low 63 43.0 5.0 15 4.2

medium 65 53.0 5.4 15 6.2

high 67 52.0 7.1 15 8.3

General Adipose low 64 46.0 5.0 15 5.0

medium 65 54.0 5.0 15 6.0

high 61 124.0 5.0 15 11.3

General Extremity low 66 50.0 7.1 15 7.9

medium 66 50.0 10.0 15 11.2

high 71 41.0 11.9 15 15.3

General Standard HL low 80 11.0 5.0 15 2.4

medium 80 20.0 5.0 15 4.0

high 80 55.0 5.0 15 10.6

Intervention, Vasc. Interv. high dose 125 94.0 5.0 30 100.0

with ESU8)

7) Only valid as delivered from factory. Technical changes reserved.

8) Highest deliverable air kerma rate.

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Program7) Dose level Voltage Current Pulse width Pulse rate Dose rate dis-
play
with anti-scatter grid [kV] [mA] [ms] [1/s]
[mGy/min]
Magnify 0

General Pediatrics low 69 6.2 5.0 15 0.9

w/o anti-scatter grid medium 73 6.7 5.0 15 1.1

high 77 7.1 5.0 15 1.4

Other pulse rates and zoom factors Dose values for other pulse rates and zoom factors may be roughly estimated
with the aid of the following scaling factors:

Pulse rate Scaling Factors for Air Kerma/Air

Kerma Rate9)
[1/s]
related to 15 p/s

0.5 0.03

1 0.07

2 0.13

3 0.2

5 0.33

7.5 0.50

10 0.67

15 1.00

30 2.00

Scaling Factors for Air Kerma/Air Kerma Rate10)

Zoom Steps 20x20 Detector 30x30 Detector

[Magnify]

0 1 1

1 1.33 1.5

2 2 2

7) Only valid as delivered from factory. Technical changes reserved.

9) Only valid as delivered from factory. Technical changes reserved.
10) Only valid as delivered from factory. Technical changes reserved.

Cios Alpha 261

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 9 Technical Specifications

Radiography, Detector size 20x20

Program11) Dose level Voltage Charge Dose

with anti-scatter grid, [kV] [mAs] [mGy]
Magnify 0

Intervention, Card. Interv. low 80 1.8 < 0.1

medium 80 5.3 0.2

high 80 10.6 0.4

Intervention, Gastro low 89 1.0 < 0.1

Interv.
medium 94 2.4 0.1

high 98 4.3 0.2

Intervention, Vasc. Interv. low 73 3.1 0.1

medium 77 7.3 0.3

high 80 12.5 0.6

Intervention, Vasc. Interv. low 80 1.9 < 0.1

AAA
medium 80 5.6 0.2

high 80 11.2 0.5

Card, Card Standard low 80 1.8 < 0.1

medium 80 5.3 0.3

high 80 10.6 0.5

Gastro, Gastro Standard low 89 0.9 < 0.1

medium 94 2.2 0.1

high 98 3.8 0.2

Vascular, Vasc Standard low 73 3.1 0.1

medium 77 7.3 0.3

high 80 12.6 0.6

Urology, Uro Standard low 73 3.1 0.1

medium 77 7.3 0.3

high 80 12.6 0.6

11) Only valid as delivered from factory. Technical changes reserved.

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Program11) Dose level Voltage Charge Dose

with anti-scatter grid, [kV] [mAs] [mGy]
Magnify 0

Ortho/Trauma, Ortho low 73 3.1 0.1

Standard
medium 77 7.3 0.3

high 80 12.6 0.6

General Standard low 73 3.1 0.1

medium 77 7.3 0.3

high 80 12.6 0.6

General Adipose low 73 3.1 0.1

medium 77 7.3 0.3

high 80 12.5 0.6

General Extremity low 66 5.3 0.1

medium 77 12.8 0.5

high 93 10.3 0.6

General Standard HL low 80 1.6 < 0.1

medium 80 4.7 0.2

high 80 9.4 0.4

Intervention, Vasc. high dose 125 7.9 0.9

Interv.12)

General Pediatrics low 85 0.4 < 0.1

w/o anti-scatter grid medium 89 0.9 < 0.1

high 91 1.5 < 0.1

Radiography, Detector size 30x30

Program13) Dose level Voltage Charge Dose

with anti-scatter grid, [kV] [mAs] [mGy]
Magnify 0

Intervention, Card. Interv. low 80 1.2 < 0.1

medium 80 3.5 0.2

high 80 7.1 0.3

11) Only valid as delivered from factory. Technical changes reserved.

12) Highest deliverable air kerma rate.
13) Only valid as delivered from factory. Technical changes reserved.

Cios Alpha 263

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 9 Technical Specifications

Program13) Dose level Voltage Charge Dose

with anti-scatter grid, [kV] [mAs] [mGy]
Magnify 0

Intervention, Gastro low 87 0.7 < 0.1

Interv.
medium 92 1.8 0.1

high 96 3.1 0.2

Intervention, Vasc. Interv. low 72 2.1 < 0.1

medium 76 5.3 0.2

high 78 9.1 0.3

Intervention, Vasc. Interv. low 80 1.2 < 0.1

AAA
medium 80 3.8 0.2

high 80 7.5 0.3

Card, Card Standard low 80 1.1 < 0.1

medium 80 3.5 0.2

high 80 6.7 0.3

Gastro, Gastro Standard low 88 0.7 < 0.1

medium 92 1.8 0.1

high 96 3.1 0.1

Vascular, Vasc Standard low 73 2.1 < 0.1

medium 77 5.3 0.2

high 80 9.0 0.4

Urology, Uro Standard low 73 2.1 < 0.1

medium 77 5.3 0.2

high 80 9.0 0.4

Ortho/Trauma, Ortho low 73 2.1 < 0.1

Standard
medium 77 5.3 0.2

high 80 9.0 0.4

General Standard low 73 2.1 < 0.1

medium 77 5.3 0.2

high 80 9.0 0.4

13) Only valid as delivered from factory. Technical changes reserved.

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Program13) Dose level Voltage Charge Dose

with anti-scatter grid, [kV] [mAs] [mGy]
Magnify 0

General Adipose low 72 2.1 < 0.1

medium 76 5.3 0.2

high 78 9.1 0.4

General Extremity low 66 4.2 0.1

medium 71 13.9 0.4

high 88 11.1 0.6

General Standard HL low 80 1.3 < 0.1

medium 80 3.6 0.1

high 80 7.1 0.3

Intervention, Vasc. high dose 125 7.9 0.9

Interv.14)

General Pediatrics low 83 0.3 < 0.1

w/o anti-scatter grid medium 87 0.7 < 0.1

high 90 1.2 < 0.1

Dosimetric information in accordance to IEC 60601-2-43:2010

Measuring conditions ◾ Specifications for interventional systems acc. to EN/IEC 60601-2-43

◾ Reference air kerma strength and ranges of air kerma strength according to
EN/IEC 60601-2-43

Isokerma curves All following curves were recorded as follows:

beam projection horizontal and vertical (tube unit above)
◾ SID of 109.7 cm
◾ 25 cm x 25 cm x 25 cm PMMA Phantom centered/aligned central beam axis
◾ Entrance Surface of the Phantom is at the PATIENT ENTRANCE REFERENCE
POINT
◾ Radiation field size 10 cm x 10 cm at entrance of PMMA Phantom
◾ Isokerma curves 100 cm and 150 cm above the floor
◾ Scattered radiation of isokerma curves in μGy/(Gy cm²) at 125 kV/20 mA and
15 pulses/s according to IEC 60601-2-43:2010
The values in μGy/(μGy m²) according to IEC 60601-2-43:2000 can be calculated
by a factor of 0.01.

13) Only valid as delivered from factory. Technical changes reserved.

14) Highest deliverable air kerma rate.

Cios Alpha 265

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Cios Alpha, 100 cm above floor,

horizontal, Gy/(Gy cm2)

Cios Alpha, 100 cm above floor,

vertical, Gy/(Gy cm2)

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Cios Alpha, 150 cm above floor,

horizontal, Gy/(Gy cm2)

Cios Alpha, 150 cm above floor,

vertical, Gy/(Gy cm2)

Cios Alpha 267

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 9 Technical Specifications

9.2 Notes on electromagnetic compatibility (EMC)

Medical electrical equipment is subject to special precautions regarding EMC.
These systems must be installed and put into service according to the EMC
information provided in the accompanying documents.
Portable and mobile RF communications equipment can affect medical electrical
equipment.

Permanently connected equipment or system cabling that cannot be

 removed by the user is not listed. This cabling is part of the system and was
considered in all EMC measurements. Without this cabling the equipment or
system would not function.

The use of accessories, transducers and cables other than those specified,


with the exception of transducers and cables sold by the manufacturer of
the equipment or system as replacement parts for internal components,
may result in increased emission or decreased immunity of the equipment
or system.

9.2.1 Guidelines and manufacturer's declaration – Electromagnetic

emissions
The system is intended for use in the electromagnetic environment as specified
below. The customer or the user of the system should ensure that it is operated
in such an environment.

Emissions test Compliance Electromagnetic environment –

Guidelines

RF emissions Group 1 The system uses RF energy exclusively

for its internal function. Therefore, its
according to CISPR 11
RF emissions are very low and not
likely to cause any interference in
nearby electronic equipment.

RF emissions Class A The system is not suitable for use in

domestic establishments and estab-
according to CISPR 11
lishments directly connected to a pub-
lic power supply network that supplies
buildings used for domestic purposes.

Harmonic emissions Not applicable The system is a professionally used

unit with a total rated power of more
according to IEC 61000-3-2
than 1 kW. There are no limit values
for this rated power.

Emission of voltage fluctuations/flicker Complies

according to IEC 61000-3-3


The use of this device or system can cause RF interference or interfere with
the operation of nearby equipment. In such cases employ suitable remedies
such as shielding or rearranging the equipment.

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The device or system should not be operated next to or on/under other

 devices. If adjacent or stacked use is necessary, the equipment or system

should be observed to verify normal operation in the configuration in which
it will be used.

9.2.2 Guidelines and manufacturer's declaration – Electromagnetic

interference immunity
The system is intended for use in the electromagnetic environment as specified
below. The customer or the user of the system should ensure that it is operated
in such an environment.

Interference immunity IEC 60601 - test level Compliance level Electromagnetic environment –
tests Guidelines

Electrostatic discharge ± 6 kV contact dis- ± 6 kV contact dis- Floors should be made of wood, con-
(ESD) charge charge crete or ceramic tiles. If the floor is cov-
ered with synthetic materials, the rela-
IEC 61000-4-2 ± 8 kV air discharge ± 8 kV air discharge
tive humidity must be at least 30%.

Electrical fast transient/ ± 2 kV for power supply ± 2 kV for power supply The line power quality should corre-
bursts lines lines spond to that of a typical commercial or
hospital environment.
according to IEC ± 1 kV for input/output ± 1 kV for input/output
61000-4-4 lines lines

Surges ± 1 kV differential-mode ± 1 kV differential-mode The line power quality should corre-

voltage voltage spond to that of a typical commercial or
according to IEC
hospital environment.
61000-4-5 ± 2 kV common-mode ± 2 kV common-mode
voltage voltage

Voltage dips, short < 5% UT * (> 95% dip in < 5% UT * (> 95% dip in The line power quality should corre-
interruptions and fluc- UT) for 0.5 cycles UT) for 0.5 cycles spond to that of a typical commercial or
tuations of the power hospital environment. If the user of the
supply voltage 40% UT (60% dip in UT) 40% UT (60% dip in UT) system requires continued operation
for 5 cycles for 5 cycles during power mains interruptions, it is
according to IEC
70% UT (30% dip in UT) 70% UT (30% dip in UT) recommended that the system be pow-
61000-4-11
for 25 cycles for 25 cycles ered from an uninterruptible power sup-
ply.
< 5% UT (> 95% dip in < 5% UT (> 95% dip in
UT) for 5 s UT) for 5 s

Magnetic field at supply 3 A/m 3 A/m Power frequency magnetic fields should
frequency (50/60 Hz) be at levels characteristic of a typical
location in a commercial or hospital
according to IEC
environment.
61000-4-8

* Remark: UT is the AC line power voltage before application of the test level.

9.2.3 Guidelines and manufacturer's declaration – Electromagnetic

interference immunity
The system is intended for use in the electromagnetic environment as specified
below. The customer or the user of the system should ensure that it is operated
in such an environment.

Cios Alpha 269

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 9 Technical Specifications

Interference immunity IEC 60601 - test level Compliance level Electromagnetic environment –
tests Guidelines

Portable and mobile RF telecommunica-

tions equipment should be used no
closer to any part of the system (includ-
ing cables) than the recommended sep-
aration distance calculated from the
equation applicable to the frequency of
the transmitter.

Recommended separation distance

Conducted RF distur- 3 Vrms 10 Vrms

bances
150 kHz to 80 MHz
according to IEC
61000-4-6

Radiated RF disturban- 3 V/m 10 V/m for 80 MHz to 800 MHz

ces
80 MHz to 2.5 GHz
according to IEC
61000-4-3

for 800 MHz to 2.5 GHz

Where P is the maximum output power

rating of the transmitter in watts (W)
according to the transmitter manufac-
turer and d is the recommended separa-
tion distance in meters (m).
Field strengths from fixed RF transmit-
ters, as determined by electromagnetic
site surveya, should be less than the
compliance level in each frequency
range.b
Interference may occur in the vicinity of
equipment marked with the following
symbol:

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 Technical Specifications 9

Interference immunity IEC 60601 - test level Compliance level Electromagnetic environment –
tests Guidelines

Remark 1: At 80 MHz and 800 MHz, the safe distance for the higher frequency range applies.

Remark 2: These guidelines may not apply in all situations. Electromagnetic propagation is affected by absorption and
reflection from buildings, objects and people.

a Field strengths from fixed transmitters, such as base stations for radio (cellular/cordless) telephones and land mobile
radios, amateur radio, AM and FM radio broadcast and TV broadcast cannot be predicted theoretically with accuracy. To
be able to assess the electromagnetic environment with regard to the stationary transmitters, an electromagnetic site
study should be considered. If the measured field strength in the location in which the device or system is used exceeds
the applicable RF compliance level above, the device or system should be observed to verify normal operation. Should
unusual performance features be observed, additional measures (such as change in orientation or change of site of the
system) may be necessary.

b Above the frequency range of 150 kHz to 80 MHz the field strength should be less than 3 V/m.

9.2.4 Recommended separation distances between portable and

mobile RF telecommunications equipment and the system
The system is intended for use in an electromagnetic environment in which
radiated RF disturbances are controlled. The customer or the operator of the
system can contribute to avoiding electromagnetic interference. For this
purpose he should comply with the minimum distance stated below (depending
on the maximum output nominal power of the communication devices)
between portable and mobile RF telecommunication devices (transmitters) and
the system.

Rated maximum output Safe distance according to frequency of transmitter [m]

power of transmitter [W]

150 kHz to 80 MHz 80 MHz to 800 MHz 800 MHz to 2.5 GHz

0.01 0.12 0.12 0.23

0.1 0.38 0.38 0.73

1 1.2 1.2 2.3

10 3.8 3.8 7.3

100 12 12 23

For transmitters rated at a maximum output power not listed in the table above, the recommended separation distance d
in meters (m) can be estimated using the equation applicable to the frequency of the transmitter, where P is the maxi-
mum output power rating of the transmitter in watts (W) according to the transmitter manufacturer.

Remark 1: At 80 MHz and 800 MHz, the safe distance for the higher frequency range applies.

Remark 2: These guidelines may not apply in all situations. Electromagnetic propagation is affected by absorption and
reflection from buildings, objects and people.

Cios Alpha 271

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 9 Technical Specifications

9.3 Original equipment manufacturer

Original Equipment Manufacturer (OEM), Open Source Software (OSS) from
third-party providers in Siemens Healthcare products.

9.3.1 Introduction
The product can contain OEM and OS software licensed and developed by third-
party providers (depending on the system configuration and options).
These OEM and/or OS files are protected by copyright. Your right to use OEM
and/or OS software beyond the mere execution of the Siemens program is
governed by the relevant terms of the OEM and/or OS software license.
Complying with these licensing conditions authorizes you to use the OEM
and/or OS software as provided in the respective license. In case of conflicts
between the licensing conditions of Siemens and the OEM and/or OS software
license conditions, the OEM and/or OS software conditions govern the OEM
and/or OS portions of the software.
The OEM and/or OS software licenses (license conditions) are available on the
CDs/DVDs (open source/legal concept) delivered together with the system.

9.3.2 For Open Source Software (OSS) only

Open source software is licensed free of charge (meaning that exercising the
licensing rights is free of charge, while fees may be charged to recover the costs
borne by SIEMENS). If programs contained in this product are licensed under
GNU General Public License (GPL), GNU Lesser General Public License (LGPL), or
another open source license that requires source code, the corresponding code
is delivered together with the device on CD/DVD.
Warranty regarding the further use of software from third-party providers:
SIEMENS makes no warranty regarding the OEM and/or OS software programs
in this device, when such programs are used in a manner other than the
program execution intended by SIEMENS. The licenses mentioned previously
define the warranty, if any, from the authors or licensors of the OEM and/or OS
software. SIEMENS specifically disclaims any warranties for defects caused by
altering any OEM and/or OS software program or the product’s configuration. If
the OEM and/or OS software violates the intellectual property of a third party,
you have no warranty claim against SIEMENS.
Technical support is available only for software that has not been modified.

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9.4 System data

9.4.1 Entire system

General data

Power requirements 100 V, 110 V, 120 V, 127 V, 200 V, 220 V, 230 V, 240 V ± 10%; 50/60 Hz (± 1
Hz)
An on-site 16 A/characteristic C overcurrent release (trip breaker) is recommen-
ded by DIN VDE 0100-710 for supply network voltages of 230 V/240 V.
Country-specific requirements apply for the fuse values to be used for other
supply network voltages.

Unit fuse protection (internal) 100 V to 127 V 20 A slow-blow fuse

200 V to 240 V 15 A slow-blow fuse

Nominal rating 20 A to 127 V∼, 15 A from 200 V∼ corresponds to the nominal value of the
slow-blow fuse in the power input of the product

Internal line impedance Ri max. 0.3 Ohm for 100 - 127 V∼

Ri max. 0.8 Ohm for 200 - 240 V∼

Power consumption (for 230 V) Typically 2.4 kVA (625 W standby power consumption)

Continuous 8.8 A

Short term 9.8 A

Ambient conditions for operation Temperature range: +15 °C to +35 °C

Rel. humidity: 35% to 75%, non-condensing
Barometric pressure: 700 hPa to 1060 hPa

Ambient conditions for transport and Temperature range: -20 °C to +37.5 °C

storage
Rel. humidity: 10% to 95%, non-condensing
Barometric pressure: 700 hPa to 1060 hPa

For ambient conditions that fall within the specified values, no waiting time


is required for radiation operation.
For ambient conditions that fall outside the specified values, a waiting time
of one to twelve hours must be factored in for radiation operation,
depending on the location of the system.

Weight

Monitor trolley (including 2 230 kg

monitors, UPS)

C-arm system Cios Alpha 12 kW Cios Alpha 25 kW Cios Alpha 25 kW ESU

without accessories 352 kg 360 kg 374 kg

Cios Alpha 273

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 9 Technical Specifications

Additional weight for moto- 13 kg

rization

Classification

Protection against electric shock Class 1, no applied part according to IEC 60601-1

Protection against ingress of fluids IPX0 (not protected) according to IEC 60529

Operating mode Pulsed and continuous radioscopy

Current/voltage values

Voltage (V AC) Long-term current consumption (A) Short-term current consumption (A)

100 20 22
110 19 21
120 17 19
127 16 18
200 11 12
220 10 11
230 10 11
240 9 10

9.4.2 Generation of radiation

X-ray generator


The values in the table provide the technical thresholds of X-ray generation.
Whether these threshold values can be reached during clinical operation
depends on the set configuration values.

High-frequency generator 12 kW 25 kW 25 kW ESU

Rated power (IEC 601) 12 kW (100 kV, 20 mA, 100 25 kW (100 kV, 50 mA, 100 25 kW ESU (100 kV, 50 mA,
ms) ms) 100 ms)

Single image pulse power 12 kW (100 kV, 120 mA, 25 kW (100 kV, 250 mA, 25 kW (100 kV, 250 mA,
(max) 100 ms) 100 ms) 100 ms)

Average power in series 1000 W (125 kV, 53 mA, 5 1000 W (125 kV, 53 mA, 5 3000 W (125 kV, 126 mA,
operation (max) ms, 30 P/s) ms, 30 P/s) 6.3 ms, 30 P/s) (max current
ESU; high dose)

Inverter control frequency 18 kHz to 50 kHz 18 kHz to 50 kHz 18 kHz to 50 kHz

kV range 40 kV to 125 kV 40 kV to 125 kV 40 kV to 125 kV

Single image 10 mA - 120 mA 10 mA - 250 mA 10 mA - 250 mA

0.05 mAs - 12 mAs 0.05 mAs - 25 mAs 0.05 mAs - 25 mAs

5 ms ~ 160 ms 5 ms ~ 160 ms 5 ms ~ 160 ms

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 Technical Specifications 9

Fluoroscopy 3 mA - 119 mA 3 mA - 224 mA 3 mA - 224 mA

Pulse rate 0.5 p/s up to 30 p/s 0.5 p/s up to 30 p/s 0.5 p/s up to 30 p/s

Pulse width 5 ms - 14 ms 5 ms - 14 ms 5 ms - 14 ms

Single tank heat storage 1,900,000 J 1,900,000 J 1,900,000 J

capacity
2,565,000 HU 2,565,000 HU 2,565,000 HU

Data according to IEC 60601-2-54:

12 kW 25 kW 25 kW ESU

Radiography

Rated tube voltage 125 kV with Imax = 94 mA 125 kV with Imax = 188 mA 125 kV with Imax = 188 mA

Highest X-ray tube current 120 mA with Vmax = 100 250 mA with Vmax = 99 kV 250 mA with Vmax = 100
kV kV

Radioscopy

Rated tube voltage 125 kV with Imax = 94 mA 125 kV with Imax = 106 mA 125 kV with Imax = 126 mA

Highest X-ray tube current 119 mA with Vmax = 99 kV 224 mA with Vmax = 62 kV 250 mA with Vmax = 64 kV

Highest power (nominal 100 kV, 120 mA, 100 ms 100 kV, 250 mA, 100 ms
power)

Smallest value for current- 0.05 mAs

time product

Data according to IEC Tube voltage (kV): ± 5%

60601-1-3:
Tube current (mA): ± 15% (minimum ± 0.1 mA)
Precision of the loading
Current-time product (mAs): ± 10% (minimum ± 0.2 mAs)
parameters
Pulse duration (ms): ± 10% (minimum ± 1 ms)

X-ray tube assembly (Single-tank)

The X-ray tube assembly and image receptor are geometrically aligned such that
the emitted radiation cone (radiation axis) is always perpendicular to the plane
of the detector.

Model Single tank with dual-focus rotating anode tube

Nominal focus value 0.3/0.5

Tube rated voltage (IEC 613) 150 kV

Single tank rated voltage 125 kV

Anode heat storage capacity (IEC 613) 270,000 J (365,000 HU)

Anode heat dissipation 70,000 J/min (91,000 HU/min)

Optical anode angle 10°

Inherent filtration (IEC 601) 3.0 mm Al with 75 kVp/0.1 mm Cu

Cios Alpha 275

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 9 Technical Specifications

Continuous heat dissipation 100 W without cooling, 300 W with cooling

(values apply for single tank alone without system environment)

Anode drive frequency max. 180 Hz

9.4.3 Image receptor

Flat detector
Cios Alpha utilizes Varian PaxScan detectors. The solid state detector converts
the X-rays to visible photons by a scintillator. The visible photons are absorbed
by pin photodiodes and converted to electron-hole pairs, which collect on the
capacitance of the photodiodes. The pin photodiodes are discharged when the
pixel`s TFT is turned ON. The charge is collected by an integrating amplifier and
converted to a voltage. The signal voltage has a programmable gain applied,
depending upon operating conditions. The output voltage is converted to digital
data by an analog-to digital converter.
The following table shows the typical performance test data of the two detector
sizes used with the Cios Alpha conducted with the Varian PaxScan solid state
detector used with the Cios Alpha.

Detector Pax Scan 3030X Pax Scan 2020X

Unit Min Typical Max Min Typical Max

Technology

Scintillator CsI CsI

Geometry

Pixel pitch μm 194 194

Active area mm (V x 298 x 298 199 x 199

H)

Active area Pixels (V x 1536 x 1024 x

(total)15) H) 1536 1024

Used bin- 1x1, 2x2 1x116)

ning

Dose characteristics

Voltage kVp 40 150 40 150

range

Saturation µGy 4.4 8.2

dose (flu-
oro)

Saturation µGy 29 29
dose (sin-
gle image)

15) The useable pixel matrix is reduced on each side by up to 10 pixels relative to the values stated here
16) Although the 2020X is capable of 2x2 binning as well, this mode is currently not used by Siemens

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Detector Pax Scan 3030X Pax Scan 2020X

Unit Min Typical Max Min Typical Max

Noise nGy/ 3.5/2x2 3.5/2x2 17)

equivalent binning
dose

Dynamic dB 94 96 94 96
range 18)

Image quality performance19)

Sensitivity LSB/nGy 30 36 17 20
(low-dose
fluoro)

Electronic nGy/ 0.75/2x2 1.5/1x1

noise (low- binning
dose flu-
oro)

Residual % in 1st 5 5
Lag image

DQE @ 40nGy, RQA5

(30x30 cm2, 2x2)

at 0.05 % 72 77 n/a
lp/mm

at 1.0 % 43 n/a
lp/mm

at 1.29 % 25 n/a
lp/mm
(Nyquist)

DQE @ 80 nGy, RQA5

(20x20 cm2, 1x1)

at 0.05 % 72 77 72 77
lp/mm

at 1.0 % 55 55
lp/mm

at 2.0 % 30 30
lp/mm

at 2.58 % 14 14
lp/mm
(Nyquist)

MTF (1x1 binning)

17) Although the 2020X is capable of 2x2 binning as well, this mode is currently not used by Siemens
18) Typical dynamic range is defined as 2 x log10 (typical LSB dynamic range) dB, where typical LSB dynamic range = 50000
19) DQE measured according to standard IEC 62220-1

Cios Alpha 277

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 9 Technical Specifications

Detector Pax Scan 3030X Pax Scan 2020X

Unit Min Typical Max Min Typical Max

at 1.0 % 52 55 52 55
lp/mm

at 2.0 % 25 25
lp/mm

at 2.58 % 16 16
lp/mm
(Nyquist)

Main functionalities

Max frame fps/binning 15/1x1 30/2x2 30/1x1

rate for full
field of
view20)

Max frame fps/binning 30/1x1 n/a

rate for
limited
field of
view21)

Scattered radiation grid on flat detector

Varian PaxScan 2020X Pb 17 / 70 fo 115

Varian PaxScan 3030X Pb 17 / 70 fo 115

9.4.4 Unit components

C-arm

Orbital movement 148° (-51.5° to +96.5°)

Motorized orbital movement 141° (-48° to +93°)

(optional)
10°/s

Angulation ± 225°

Motorized angulation (optional) ± 220°

10°/s

Horizontal movement 20 cm (7.9")

Immersion depth 73 cm (28.7")

Swivel range ± 12°

Vertical movement 45 cm (17.7"), motorized

20) Full field of view = 30x30 cm2 for 3030X, 20x20 cm2 for 2020X
21) Limited field of view = 20x20 cm2 for 3030X, n/a for 2020X

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SID 110 cm (43.3")

Single tank image receptor distance 85 cm (33.5")

Collimator system

Rectangular collimator For concentric, radiation-free collimation

Slot collimator For symmetric and asymmetric radiation-free collimation, unlimited rotation

Imaging chain

Flat detector 2020X 1024 (H) x 1024 (V) @ up to 30 fps

Flat detector 3030X 1536 (H) x 1536 (V) @ up to 5 fps

1024 (H) x 1024 (V) @ up to 30 fps

768 (H) x 768 (V) @ up to 30 fps

Imaging System Features, e.g. digital image rotation ± 360°

Monitors

TFT high-brightness color display

Screen diagonal 19" (48 cm)

Image display 1280 x 1024 (pixels)

Brightness (DICOM calibrated) 400 cd/m2

Maximum brightness, typical 650 cd/m2

Horizontal/vertical viewing angle 178°/178°

Contrast ratio, typical 900 : 1

Backlight LED technology

TFT Premium high-brightness color

display (optional)

Anti-reflexion coated cover, high-con-

trast

Protective collision cover

Monitor Interface Input: 1 x DisplayPort

Screen diagonal 19" (48 cm)

Image display 1280 x 1024 (pixels)

Brightness (DICOM calibrated) 400 cd/m2

Maximum brightness, typical 1000 cd/m2

Cios Alpha 279

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Horizontal/vertical viewing angle 170° / 170°

Contrast ratio, typical 1000 : 1

Response time, typical 25 ms

Ambient light sensor

Backlight White LED technology

Monitor columns

Flex display column (Standard) Display positioning with rotation angle -30° to 210°; defined lock-in positions at
0º and 180º

Flex Plus display column (optional) Display positioning with rotation angle -30° to 210°; defined lock-in positions at
0º, 90º and 180º, motorized height adjustment; fold function to protect the dis-
plays in park position and during transport

9.4.5 Equipment options

Dose measuring chamber (DAP meter)

Technology Semiconductor chamber

Active area Rectangle - 60 mm x 60 mm

DAP resolution 0.01 μGym2 equivalent to 0.01 cGycm2

Maximum measurable DAP 3000.00 μGym2 equivalent to 3000.00 cGycm2

Reproducibility < 1% under constant pressure and temperature

Energy range 40 - 150 kV ± 6%

Attenuation equivalent (Inherent fil- < 0.30 mm Al equivalent

tration)

Dose rate linearity Better than ± 2% for dose area product rate ≥ 1 μGym²/s, otherwise better than
± 5%

Measuring readiness 20 seconds after power on

Work environment Temperature range: +10 °C to +70 °C

Rel. humidity: 15% to 75% (without condensation)
Barometric pressure: 700 hPa to 1060 hPa

Precision of the dose measuring cham- < 25% (deviation between displayed and measured dose area product)
ber (DAP meter)

Automatic dose rate control (ADR)

Precision of automatic dose rate con- ± 25% (value depends on measurement setup)
trol (ADR)

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Detector laser light localizer (optional)

Laser class Class 1 (IEC 60825-1:2007)

Laser type Semiconductor laser (laser diode)

Wave length 650 nm

Color Red

Effective power ≤ 3 mW

Single-tank laser light localizer (optional)

Laser class Class 1 (IEC 60825-1:2007)

Laser type Semiconductor laser (laser diode)

Wave length 650 nm

Color Red

Max. power ≤ 3 mW

HD video manager

Outputs DVI (2x)

Inputs DVI-I (analog or digital) (2x), RGB, YPrPb, Y, S-Video (2x), Composite,
SD/HD-SDI (2x), VGA; offers 150 preprogrammable timing settings with up to
1080p
(1920 x 1080, 50/60 Hz, interlaced/progressive) including PAL and NTSC

DVI video splitter

Outputs DVI (2x)

Conditions for use The displays or monitors used must be compatible with the SXGA standard
1280 x 1024 at 60 Hz

No galvanic separation, therefore the connected monitors must comply with

IEC 60601-1-1

SCALANCE W 721 WLAN access point

Data transfer

Ethernet transfer rate BASE-T max. 100 MBit/s

Wireless transfer rate max. 150 Mb/s

Radiated power typically: 100 mW, max. 200 mW

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Supported wireless standards IEEE 802.11a

IEEE 802.11b
IEEE 802.11e
IEEE 802.11g
IEEE 802.11h
IEEE 802.11i
IEEE 802.11n

Supported standards for power supply IEEE 802.3at Type 1 (802.3af) and 802.3at Type 2 (power supply via Ethernet)

9.5 List of Standards

Siemens hereby certifies that the Cios Alpha is compliant with the following
recognized consensus standards covering electrical and mechanical safety:

Standard organization Reference number and date Title of Standard

IEC 60601-1 3rd Medical Electrical Equipment - Part 1:

General Requirements for Safety,
2005

IEC 60601-1-1:2000 Medical electrical equipment - Part

1-1: General requirements for safety -
Collateral standard: Safety require-
ments for medical electrical systems

IEC 60601-1-2 3rd 2007 Medical Electrical Equipment - Part

1-2: General requirements for basic
safety and essential performance -
Collateral Standard: Electromagnetic
Compatibility - Requirements and
Tests

IEC 60601-1-3: 3rd 2008 Medical electrical equipment - Part

1-3: General requirements for basic
safety and essential performance -
Collateral Standard: Radiation protec-
tion in diagnostic X-ray equipment

IEC 62366: 2007 Medical devices - Application of usabil-

ity engineering to medical devices

ISO 14971: 2012 Medical devices - Application of risk

management to medical devices

IEC 62304 Ed. 1.0 2006 Medical device software - Software life
cycle processes

IEC 60601-2-7 (1998) Medical electrical equipment - Part

2-7: Particular requirements for the
safety of high-voltage generators of
diagnostic X-ray generators

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IEC 60601-2-28 Edition 2.0 2010-03 Medical electrical equipment - Part

2-28: Particular requirements for the
basic safety and essential performance
of X-ray tube assemblies for medical
diagnosis

IEC 60601-2-32: 1994 Medical electrical equipment - Part 2:

Particular requirements for the safety
of associated equipment of X-ray
equipment

IEC 60601-2-54 2009 Medical electrical equipment - Part

2-54: Particular requirements for the
basic safety and essential performance
of X-ray equipment for radiography
and radioscopy

IEC/PAS 61910-1 2007 IEC PAS 61910-1 First Edition

2007-07, Medical electrical equipment
- Radiation dose documentation - Part
1: Equipment for Radiography and
Radioscopy

NEMA PS 3.1 - 3.20 (2011) Digital Imaging and Communications

in Medicine (DICOM) Set

IEC 60825-1:2007 Safety of laser products - Part 1: Equip-

ment classification, and requirements

IEC IEC 60601-2-43 - Ed. 2.0 2010-03 Medical electrical equipment - Part
2-43: Particular requirements for the
safety and essential performance of X-
ray equipment for interventional pro-
cedures

9.6 Labels

This section provides information on the position of system labels. The

 numbers and parameters on the labels are examples only. A real system
label may contain other numbers and parameters (such as the serial
number).

9.6.1 C-arm system

The labels shown below are attached permanently to the following sub-
assemblies.

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(1) C-arm travel frame

(2) Base system (chassis)
(3) Horizontal support arm
(4) C-arm system control unit
(5) Control module for motorization package
(6) Inside of C-arm

1. C-arm travel frame

(1) Manufacturer's system identification label, weight label

General (country-specific)

(2) Identification label (for Brazil only)

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(3) Warning label (for China only)

(4) Environmental label: for China only

(5) Hazardous substances label: for China only

2. Base system (Chassis)

General information

(1) Warning label read Operator Manual, transport park position, basic system

Hand switch

(2) Hand switch identification label

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Standard footswitch

(3) Standard footswitch identification label

Multifunctional footswitch

(4) Multifunctional footswitch identification label

3. Horizontal support arm

(1) Weight label

(2) Warning label X-ray radiation (Canada only)

(3) X-ray control area warning label (for Germany and Austria only)

4. Control unit for C-arm system

(1) Manufacturer's identification label

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(2) Protection class label

5. Control module for the motorization package

(1) Manufacturer's identification label

6. Inside of C-arm
(*) various labels

X-ray tube unit

(1) Supplemental label

(2) Single tank identification label

(3) Approval-related label

(4) X-ray tube identification label

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Flat detector

(1) Supplemental label

(2) Identification label

(3) Flat detector identification label

Collimator

(1) Supplemental label

(2) Manufacturer's identification label for collimator

(3) Approval label

Dose measurement chamber

(optional)

(1) Supplemental label

(2) Identification label

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(3) Approval label

Single-tank laser light localizer

(optional)

(1) Supplemental label

(2, 3) Manufacturer's identification label, approval label

9.6.2 Monitor trolley

(1) Manufacturer's identification label

(2) Manufacturer's identification label for monitors

(3) Monitor identification label

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(4) Warning label

(5) Supplemental label country-specific connection data

(6) Warning label read Operator Manual, watch inclines

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10 Options
10.1 System accessories 292
10.1.1 Spacer 293
10.1.2 Grounding cable (optional) 293
10.1.3 Wireless WLAN network connection (optional) 293
Activating WLAN 294
Operation via Ethernet cable 294
10.1.4 Multifunctional footswitch (optional) 295
Selecting the operating mode 295
Releasing radiation 295
Storing images (during radiation) 296
Storing images (after radiation) 296
Storage for transport 296
10.1.5 Remote control unit (optional) 296
Attaching the remote control unit 297
Connecting the remote control unit 298
Removing the remote control unit and holder 299
Storing the remote control unit 299
10.1.6 Control module for the motorization package (optional) 300
Saving positions 300
10.1.7 Position memory for non-motorized units 301
Saving a position 301
Moving to the target position 301
Deleting the position memory 301
10.1.8 Sterile cover on the C-arm 301
Applying the sterile cover 302
10.1.9 Sterile cover for the remote control unit 304
10.1.10 Detector laser light localizer (optional) 304
10.1.11 Single-tank laser light localizer (optional) 304
Protection measures 304
10.1.12 Dose measuring chamber (DAP meter) 304
10.1.13 Active cooling 305
10.1.14 Energy storage unit (ESU) 305
Reduction of acquisition kV for the same image
receptor dose 305
Increased image receptor dose with the same kV 305
10.1.15 NaviLink 2D 305
10.1.16 Connection for contrast agent injector 305
Description of interfaces 306
Connecting the interface housing to Cios Alpha 306
10.1.17 Video manager 307
10.1.18 DVI video splitter 307
10.1.19 "EMotion" sound system 308

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10.1 System accessories

Anyone who connects additional equipment to the medical device is

considered to be configuring the system and is therefore responsible for
ensuring that the current system configuration complies with the relevant
standards (e.g. system standard IEC/EN 60601-1-1 and/or other applicable

 standards). In case of questions please speak with your local contact

person.
If one of the listed accessory parts requires special operating conditions
(e.g. temperature, air pressure, humidity), appropriate attention will be
drawn to such in the description. Please follow the Operator Manual
provided by the manufacturer.

The following accessories have been approved for use with the Cios Alpha:

Accessories Part number Manufacturer

Sterile cover set (C-arm, 14436405 and Microtec

flat detector, single 14436366
tank)

Sterile cover for flat 14436404 and Microtec

detector 14436369

Sterile cover for single 14436368 Microtec

tank

Sterile cover for remote 14436370 Microtec

control unit

Metal bracket for C-arm 14436403 Pscherer

Grounding cable 14402243 Nicolay Services GmbH

Spacer 14436408 Techno Blech GmbH

Wireless network con- 14436364 Siemens Healthcare

nection WLAN GmbH

Multifunctional foot- 14436357 Steute

switch

Remote control unit 14436358 Penta

Holder for remote con- 14436360 Siemens Healthcare

trol unit GmbH

Integrated laser light 14436342 Siemens Healthcare

localizer for flat detec- GmbH
tor

Single-tank laser light 14436343 Siemens Healthcare

localizer GmbH

Non-sterile cover for 14436371 Microtec

footswitch

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Accessories Part number Manufacturer

Non-sterile cover for 14436372 Microtec

multifunctional foot-
switch

10.1.1 Spacer
The distance between the source and tube assembly cover (shortest possible
source-skin distance) is ≥ 200 mm with the standard system (according to IEC
601-1-3).
Country-specific regulations may require a larger source-skin distance (≥ 300
mm according to DHHS 21 CFR). This is achieved by attaching an additional
spacer to the C-arm system.

◆ If this source-skin distance is too large for special examinations, the spacer
can be removed by taking off the screws.
The spacer must be reattached after this type of examination to ensure the
reduction in skin dose resulting from a greater source-skin distance.

10.1.2 Grounding cable (optional)

An optional grounding cable is available for equipotential bonding in
accordance with DIN 57107/VDE 0107 for rooms of Application Group 2E
(cardiac catheterization).

10.1.3 Wireless WLAN network connection (optional)

The WLAN option enables a wireless connection between the Cios Alpha and a
(hospital) network. The dedicated WLAN unit is integrated into the monitor
trolley housing and is completely set up. Its On/Off switch is found on the side
of the monitor trolley.

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(1) WLAN On/Off switch

Activating WLAN
◆ To activate WLAN, use the switch on the side of the monitor trolley.
The WLAN switch illuminates.

 Once the WLAN unit is switched on, it takes less than a minute for the
WLAN connection to be functional.

 CAUTION

Interference.
Effect on persons with implants.
◆ Maintain a minimum distance in accordance with IEC 60601-1-2. If
this is not possible, switch off the WLAN client.

The coexistence of wireless sources operated in the same environment may

 affect the quality of data transfer.

The transmission speed is reduced if additional WLAN clients are operated
simultaneously in the same environment.

 For reasons of data security, it is recommended to encrypt the data in the

WLAN according to WPA or WPA2.


In case the wireless connection is interrupted, impaired or overloaded, it is
recommended to keep an Ethernet cable on hand, provided there are
connection options nearby.


If WLAN is activated, no devices sensitive to high frequencies should be
placed on top of the unit. Otherwise, damage to such devices or
impairment to WLAN functionality could result.

Operation via Ethernet cable

When operating the Cios Alpha via Ethernet cable, the WLAN at the monitor
trolley needs to be deactivated prior to switching on the system.

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 Simultaneous operation via Ethernet cable and WLAN is not possible and
should be avoided by all means.

After inadvertent simultaneous operation or after a change between both

options, the system must be switched off and on again.

10.1.4 Multifunctional footswitch (optional)

Selecting the operating mode

The MODE (operating mode) button of the multifunctional footswitch allows
you to select one of the operating modes: Single image, fluoro, SUB, Roadmap
or a video source (depending on the configuration level).
◆ If necessary, press this button on the multifunctional footswitch several
times.
The selected operating mode is indicated in the Examination task card and
on the control panel of the C-arm system.
The set video source alters the image content of the right-hand monitor on
the monitor trolley.
A confirmation sound acknowledges successful operating mode/video source
switchover. You can then release radiation again right away.
Releasing radiation
The left pedal is always used to activate fluoroscopy (CFC) (Preferred setting).
The right pedal is used to activate the currently selected operating mode.
Exception: If Fluoroscopy (CFC) mode is selected, the right pedal is assigned the
single image operating mode.

 The functionality of the pedals can optionally be changed.

◆ Keep the foot pedal pressed during radiation release.

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Storing images (during radiation)

◆ Press the save button on the multifunctional footswitch during radiation.
The image currently generated and displayed is saved in the local database.

Storing images (after radiation)

◆ Press the save button on the multifunctional footswitch.
Holding the key for < 2 seconds: saves the image last recorded (LIH).
Holding the key for > 2 seconds: saves the scene last recorded (LSH).

 The Cios Alpha transfers images from monitor A to monitor B and then
stores them in the local database.

Storage for transport

To transport the multifunctional footswitch properly, proceed as follows:
1 Wrap the multifunctional footswitch cable around the bracket.

2 Insert the multifunctional footswitch and wrapped cable into the holder
provided on the front of the C-arm system.

10.1.5 Remote control unit (optional)

The remote control unit allows the C-arm system to be operated in the OR
directly from the patient table. It is used in the same way as the control unit on
the C-arm system.

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 CAUTION

The surfaces of the remote control unit become hot.

Risk of burns!
◆ Make sure that the patient does not touch the remote control unit for
more than 10 minutes or that after 10 minutes can no longer come in
contact with it.
◆ As a rule, contact between the patient and the remote control unit
should be avoided.

(1) Integrated EMERGENCY STOP button

(2) Displays and buttons of the remote control unit
(3) Control panel
(4) Control module for the motorization package (optional)

Attaching the remote control unit

 CAUTION

Remote control unit falls down.

Risk of injury/crushing!
◆ It is recommended to keep the remote control unit in the holder
provided. If a holder is not available, place the remote control unit on
the instrument table.

Attach the remote control unit to the patient table railing as follows:
1 Attach the holder to the table railing (1) and tighten the holder screw (2).

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2 Place the patient sterile cover over the holder.

3 If necessary, pack the remote control unit in the sterile cover and place it on
the magnetic holding plate.

 CAUTION

Remote control unit covered by unsuitable covers.

Overheating of the remote control unit!
◆ Only use the sterile covers specified!

Connecting the remote control unit

(1) Round socket for connecting the remote control unit

◆ Plug the connector of the remote control unit into the round socket on the C-
arm system, which is located next to the central plug.
The remote control unit is ready for operation and can be used in parallel
with the control panel on the C-arm system.

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 The remote control unit can also be connected to other C-arm systems. In
this case a message is displayed that you have to confirm.

Removing the remote control unit and holder

1 Unplug the connector of the remote control unit from the round socket on
the C-arm system.
2 Remove the remote control unit from the magnet by slightly tilting it to the
side.

3 Remove the holder by first turning the screw (1) and then removing the
holder upward (2).

Storing the remote control unit

 CAUTION

Improper positioning of the remote control unit.

Risk of contamination.
◆ Do not place the remote control unit on the patient.

To store the remote control unit, proceed as follows:

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1 Remove the remote control unit together with the holding plate from the
table railing and wrap the cable around the back.

2 Attach the remote control unit together with the holding plate to the monitor
trolley railing (see figures 1 and 2).

10.1.6 Control module for the motorization package (optional)

The control module for the motorization package can be attached to the C-arm
control unit and to the remote control unit. It offers the user more efficient C-
arm movements.
(1) Position memory
(2) Motorized C-arm movements

Saving positions
A maximum of two position memories can be used.
1 To save a position, move to the required C-arm position.
2 Then press the Save button.
The “Save position” buttons 1 and 2 both flash.
3 Select by pressing one of the two “Save position” buttons.
4 The “Save position” button then illuminates continuously to indicate that the
position was saved successfully.
5 To move to the saved position, press and hold the button until the position is
reached.

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10.1.7 Position memory for non-motorized units

You can save an orbital and an angular position in the position memory. After
intermediate changes of acquisition position, this enables you to move the C-
arm back to the original position.
Saving a position
1 Perform angular and orbital C-arm movement to a target position you want to
save.
2 Press this button on the control unit.
The current orbital and angular positions are saved.

Moving to the target position

◆ Move the C-Arm toward the target position.
The required direction of movement and progress toward reaching the target
is indicated by corresponding icons on the control panel, see the following
example illustration:

Icon Meaning

Deviation from target position > 5°

Deviation from target position < 5°

Deviation from target position < 1°

Target position reached precisely

On the left monitor, an arrow of the same color shows the deviation and the
required direction of movement during the examination.

Deleting the position memory

◆ Press the button in the activated state.
The position memory is deleted.

10.1.8 Sterile cover on the C-arm

To protect it against contamination, the C-arm including the flat detector and X-
ray tube assembly are completely covered with a three-piece sterile disposable
cover of transparent polythene sheet.

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C-arm completely covered

 CAUTION

Improper attachment of the sterile cover on the C-arm.

Risk of infection!
◆ Follow the instructions for handling the sterile covers.

 Always use sterile covers during interventions to protect the flat panel
detector against the ingress of liquids!

Applying the sterile cover

Follow these instructions to wrap the C-arm in the sterile cover:
1 Move the metal bracket into the transparent disposable cover.

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2 Tension the metal bracket with the disposable cover in the C-arm.

3 Pull the plastic cover over the single tank.

The plastic cover is fixed in place with an elastic cord.

4 Pull the other plastic cover over the flat detector.

5 Secure the plastic cover over the handle in the locations provided.

The C-arm is now covered completely.

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10.1.9 Sterile cover for the remote control unit

◆ Insert the remote control unit in the tube-like plastic sack and close it
carefully.

10.1.10 Detector laser light localizer (optional)

To project the target crosshairs, two Class 1 lasers are used whose exit windows
are arranged in the detector cover.

10.1.11 Single-tank laser light localizer (optional)

To project the target crosshairs, two Class 1 lasers are used whose exit windows
are arranged in the single tank cover.
Protection measures
Brief exposure to a class 1 laser is safe for the eye.
The aversion response and the blinking reflex will usually protect the eye.
In Germany, the operator is responsible for ensuring that the user has been
instructed in the use of the laser. Outside Germany, the relevant laws and
regulations regarding the use of Class 1 lasers must be complied with.

10.1.12 Dose measuring chamber (DAP meter)

If available, this option is integrated in the single tank of the Cios Alpha. The
DAP meter determines the dose area product (DAP) and air kerma values
( Page 240 Dose and consistency test). The cumulative patient data are
displayed on the monitor trolley during the examination ( Page 128 Radiation
information).

Dose measuring chamber (DAP meter), integrated in the single tank

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10.1.13 Active cooling

For a Cios system with a 12 kW generator, an additional active cooling system is
available as an option. The active cooling system integrated in the single tank
and C-arm ensures longer availability of the tube assembly during extensive
fluoro times, e.g. during complex OR procedures.

10.1.14 Energy storage unit (ESU)

For a system with a 25 kW generator, the “Energy Storage Unit” (ESU) function is
available as an option.
On the control panels, an ESU discharge status indicator is located at the top of
the exposure parameters area displaying the discharge in steps of 20%. It takes
about one minute for the ESU to recharge completely. Releasing radiation is
possible before the 100% charging level is reached.
There are two supplemental applications compared to the normal 25 kW
version.
Reduction of acquisition kV for the same image receptor dose
This is recommended for example for obese patients when the power limit (mA)
has already been reached with normal fluoroscopy parameters. The reduction in
kV usually means a significant improvement in contrast.
Increased image receptor dose with the same kV
Improves the contrast-to-noise ratio for optimum display of the smallest
structures.

If the highest selectable dose level per organ program selection is

associated with particularly high power, the corresponding button is called


High level and marked with a warning symbol. The maximum duration of a
fluoro scene is limited to 30 s.

10.1.15 NaviLink 2D
If the NaviLink 2D option is available in the system and communication
between the navigation system and the C-arm is activated, you can see a
NaviLink 2D icon in the status bar (bottom left) of the left monitor.
The navigation system sends a message to the C-arm system signaling readiness
for receiving images. The C-arm system receives the message, identifies the
sending navigation system and responds. The communication connection
between the two systems is activated and the NaviLink 2D icon displays. As
soon as the communication connection is terminated, the NaviLink 2D icon
disappears again.

10.1.16 Connection for contrast agent injector

A connection (unidirectional trigger output) for a contrast agent injector is
possible as an option.

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The use of a contrast agent injector can result in an improved image quality
during subtraction angiography, since the stable flow rate of the contrast agent
ensures homogeneous contrast enhancement during the entire examination.
This can also reduce the patient's exposure to contrast agent and radiation.

 Refer to the operator manual from the respective manufacturer for the
operation and start-up of the released contrast agent injector.

Description of interfaces
Cios Alpha provides a signal at this interface that displays the duration of
radiation when there is an "armed" signal. The signal can be used for example to
connect external radiation lamps of a contrast agent injector.
Cios Alpha waits for the injector's “armed” signal and then sends a 'rad on' (inject
signal) when radiation is released. Signal transmission is wired or wireless,
corresponding to the interface. Through a defined delay before the start of
injection (can be set on the injector), an optimum start of the contrast agent
administration can be achieved after creating the mask image.

 CAUTION

Radiation release without taking the contrast agent injector status into
account.
Risk of unnecessary radiation exposure.
◆ Therefore, make sure that the injector is ready to administer contrast
agent before releasing radiation.

Connecting the interface housing to Cios Alpha

1 Attach the contrast agent injector interface electronics housing to the Cios
Alpha electronics unit using the attachment kit provided.

2 Insert the interface electronic housing connector into the corresponding Cios
Alpha electronics unit socket.

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 A system-specific connection cable is used for wired systems to connect the

injector.

10.1.17 Video manager

Cios Alpha has an additional HD video manager option for emitting video
signals, e.g. on external monitors, or for feeding in video signals for display on
the reference monitor (monitor B), e.g. for endoscopy images.
The video signal feed interfaces are located on the back of the monitor trolley
(see left graphic).
To establish the connection to an external monitor, proceed as follows.

1 Insert and secure the receiver module (1) in the DVI interface of your external
monitor.
2 Using a CAT cable (2), connect the receiver to the respective socket A (live
monitor) or socket B (reference monitor) on the monitor trolley.
3 Insert the 5 V connector of the power supply (3) into the receiver.
4 Plug the corresponding power plug into the power outlet.
The connection to the external monitor is now operational.

10.1.18 DVI video splitter

Cios Alpha has an additional DVI video splitter option available for outputting
image signals to an external live monitor (monitor A) and an external reference
monitor (monitor B) via the DVI connection.

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◆ To connect an external monitor, insert the DVI connection cable into the
respective interface for monitor A or B on the monitor trolley.

10.1.19 "EMotion" sound system

The EMotion integrated sound system is available as an option for Cios Alpha,
with an interface for operating external (MP3) audio equipment via Aux-in jack
(Aux input) including amplifiers with digital sound processor (DSP) and 2-way
stereo loudspeaker systems for high quality sound.

 Do not connect a device with its own power cord to the Aux input, use
battery-operated devices only.

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