Answers for life.

Smart solutions for routine and advanced cardiac proceduresSiemens’ broad portfolio for interventional cardiology

www.siemens.com/card-angiography

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Interventional cardiology is becoming more challenging. New procedures and devices are continuously introduced, resulting in ever-changing workflows. Both patients and staff are asking for the lowest possible dose during procedures, while clinical outcomes should be consistently improved and costs kept as low as possible.

In an increasingly competitive environment, you need versatile solutions that offer the latest capabilities for you to deliver better, faster, and more effective care – in complex procedures just as in your daily routine. Our dedicated solutions such as CLEARstent Live or IVUSmap help you tackle the toughest challenges in coronary artery disease; whereas syngo® DynaCT Cardiac and syngo Aortic ValveGuide seamlessly fit into your workflow when treating structural heart disease. Stay at the cutting edge of interventional imaging, with Siemens’ comprehensive port folio for interventional cardiology.

Staying on top of interventional cardiology

Not all features shown in this brochure are necessarily standard and available in all countries.

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Welcome to the world of Artis

CARE & CLEAR

• CLEARstent • CLEARstent Live • IVUSmap• syngo IZ3D• Low-dose Acquisition• ACOM.PC

Coronary Artery Disease

Structural Heart Disease

Peripheral vessel disease and vascular procedures

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• syngo InSpace 3D • syngo DynaCT Cardiac • syngo iPilot enhanced • syngo iGuide Toolbox• syngo Aortic ValveGuide• syngo InSpace 3D / 3D Fusion

• Digital Subtraction Angiography (DSA)• Overlay Ref• syngo DynaCT

• Artis family of imaging solutions• Artis Large Display • Artis Cockpit• Sensis

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For diagnosis and treatment of coronary artery disease, you demand crystal-clear images of the moving heart and of challenging cardiac anatomies in any angulation. To spice up the challenge, dose has to be kept to a minimum even during complex procedures.

Our Artis systems deliver images in excellent quality and at low dose, displayed the way you like them best with CLEARchoice. A wide variety of software tools supports the toughest percutaneous coronary interventions. Real-time stent enhancement, for example, allows verification of the stent position even before inflating the balloon ‒ an advantage during procedures where every millimeter matters. Automated co-registration of IVUS and angiography unites their benefits for the first time by localizing information on vessel, lumen, and wall structure within the coronary tree. Find out how these and other smart solutions from Siemens can support you in your routine and advanced procedures for coronary artery diseases.

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Coronary Artery Disease

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Real-time stent enhancement software

With CLEARstent Live, stent enhancement takes place in real time. The software eliminates cardiac movement, allowing you to verify stent position relative to the cardiac anatomy or to stents deployed previously. CLEARstent Live can be operated as an alternative acquisition program and the enhanced images are displayed side-by-side with your current acquisition ‒ without any noticeable lag and while the operator can still move the device. This might come in handy during bifurcational stenting or during long lesion treatments. Besides providing you with more positioning accuracy, CLEARstent Live can help you to speed up the procedures or to lower the amount of contrast agent needed. You need no additional work station for CLEARstent Live and can save results according to the DICOM standard for external review.

CLEARstent LiveCLEARstentStatic stent enhancement software

Optimized for image quality, CLEARstent supports you in precisely assessing and documenting implanted stents after deployment. Depending on the presence of contrast agent, you can generate a high-quality enhanced image of the stent or a view alternating between stent and contrast-filled vessel that is based on a dedicated acquisition or on previously acquired scenes. CLEARstent runs directly on your Artis system, requiring no work station. And as it complies with the DICOM standard, you can save the results to PACS for review using any DICOM viewer.

Visualization of implanted stent

• Optimized image quality for post-deployment analysis and documentation• Use of dedicated acquisition or pre-acquired scenes• No workstation required • PACS compatibility for review using any DICOM viewer

Guided stent implantation during complex bifurcational stenting

• Support of complex procedures• Real-time verification of stent positioning while moving the device• Potential to speed up procedures and to save contrast agent

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Integrated co-registration of IVUS images with angiography

IVUSmap adds detailed information on vessel, lumen, and wall structure to angiography and provides spatial localization for intravascular ultrasound (IVUS*) images within the coronary tree.

Using bookmarks, you can indicate points of interest that will appear on both the IVUS and the angiography image ‒ and can be shown on live fluoroscopy images, a big plus for stent positioning and deployment. Operated via table- side control, an automated workflow guides you through all necessary steps.

IVUSmap syngo IZ3D3D visualization, quantification, and planning

Perform automated 3D reconstruction and analyses of single and bifurcated coronary lesions from two angiography images ‒ with syngo IZ3D. The tool helps to minimize out-of-plane magnification and foreshortening errors by calcu lating the true geometric shape of the vessel in 3D from two 2D X-ray projections.

You can then easily visualize, quantify, and assess the vessel geometry with an interactive rendered view of the coronary artery. Cross-sectional circles support you in identifying the ideal projection plane. Improve clinical outcomes by planning and positioning virtual stents prior to deployment. And as their ends are indicated by markers overlaid onto live fluoro, syngo IZ3D provides reliable image guidance during the implantation.

Combined display of co-registered IVUS and angiopgraphy information

• Combined information of angiography and IVUS imaging• Bookmarks guide stent positioning and deployment• Automated workflow integrated into procedure

3-dimensional model and quantification of coronary lesion

• Interactive 3D view for vessel assessment eliminates foreshortening errors• Virtual stent planning for reliable guidance during intervention• Results are validated to be accurate and reproducible for scientific studies

* Currently available with Volcano

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Low-dose protocols for coronary interventions

Some lighter built patients need much less dose for image acquisition. To meet the needs of these and other dose-sensitive patients, Artis systems provide special low-dose protocols. In fact, you can achieve dose savings of up to 67% compared to standard acquisition values ‒ and still acquire images in excellent quality.

You can quickly and conveniently access the low-dose protocols, as they can be mapped to the alternative acquisition pedal of the footswitch. The scenes are automatically saved to the scene directory and can be used for result review and documentation purposes.

Low-dose Acquisition ACOM.PCCardiac image review and post-processing software

ACOM.PC software turns every standard PC into a professional cardiac review workstation. Image processing and diagnostic tools are tailored to the needs of cardiologists, internal medicine specialists, and cardiac surgeons. Connecting to the Artis system, PACS or standard network storage, ACOM.PC can be completely integrated into your department’s IT landscape and also be used as nearline storage offering high-speed access to image data.

ACOM.PC can be assigned to a separate display in the examination room for the parallel processing-like review of previous studies during ongoing examinations.

Coronary angiography image

• Dedicated low-dose acquisition programs saving up to 67% of dose for children, lighter built adults, and other dose-sensitive patients

• Mapping to alternative acquisition pedal allows for quick and convenient access

• Automatically saved to scene directory for review and documentation purposes

ACOM.PC directory view

• Runs on standard PCs*• Integrates into departmental IT and can be used as nearline storage• Review of previous studies during ongoing examinations

* PC specifications according to ACOM.PC datasheet

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Structural Heart Disease

Treatment options for structural heart disease (SHD) are flourishing at a fast pace with the development of new devices, hardware, and software. These technological innovations can replace surgical pro cedures with per cutaneous interventions, often allowing treatment of previously untreatable patients. This leads to new challenges for physicians and their team – as well as for imaging in terms of workflow or multi-modality integration.

Siemens’ syngo DynaCT Cardiac has revolutionized cardiac imaging, bringing intra-procedural 3D visualizations of the cardiac chambers and vessels of the beating heart into the cath lab. Based on this technology, we also offer software tools that allow fusion of other 3D imaging modalities like CT or MR for transfer of pre-procedural images used for intervention planning into your ongoing procedure. In addition, you can overlay points of interest or whole 3D structures and acquire peri-procedural 3D images for improved guidance during demanding SHD or vascular procedures. Dedicated workflow support tools facilitate procedures like trans-catheter aortic valve replacement (TAVR). Find out how our solutions can support you in the dynamic and fast changing environment of SHD treatment.

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syngo DynaCT CardiacUngated and ECG-gated CT-like imaging of the heart

Create CT-like images of the heart in your cath lab using rotational angiography – with syngo DynaCT Cardiac. The high-quality 3D images support you in analyzing the cardiac anatomy to plan and guide complex SHD procedures.

Fuse 3D volumes acquired with other modalities or mark regions of interest in pre- and intra-procedural 3D images, which can be overlaid onto live 2D images. Here as well, linking the C-arm to a 3D image helps you define the optimal projection angle – without additional contrast media or fluoroscopy.

3-dimensional volume of left atrial appendage

• High-quality 3D volumes for cardiac anatomy assessment, measurements, and procedure planning

• Dedicated acquisition programs for 3D and 4D• Additional tools for procedure planning, overlaying 3D onto 2D,

and fusing 3D volumes from other modalities

syngo InSpace 3DHigh-contrast 3D imaging

Sometimes referred to as 3D-DSA, syngo InSpace 3D generates clear 3D images of high-contrast objects like contrast-filled vessels. In comparison to syngo DynaCT Cardiac, however, you need fewer images and therefore less dose. As a result, syngo InSpace 3D is often used for repairing congenital defects as well as for supporting vascular interventions like aortic aneurysm stenting.

By using Automap to link the C-arm to the 3D image and vice versa, you can identify the optimal projection angles – without needing additional contrast media or fluoroscopy.

3-dimensional volume of aortic isthmus stenosis

• Clear 3D images of high-contrast objects like contrast-filled vessels• Fewer images needed compared to syngo DynaCT Cardiac, reducing patient dose• 3D image can be linked to C-arm to identify optimal projections without

using contrast media or fluoroscopy

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syngo iGuide ToolboxProcedure planning shown on 2D live images

syngo iGuide Toolbox allows you to overlay points of interest from 3D volumes onto 2D live images right on the Artis display. Using the linked cursor feature, you can quickly and easily import the points of interest into the 2D live images ‒ exactly matching the findings in the cross-sectional images of a syngo DynaCT Cardiac acquisition, for example. It takes just a single click to create anatomical outlines of segmented 3D volumes which can be especially helpful for mitral valve repair or for vascular procedures like aortic aneurysm stenting.

The information that is overlaid using syngo iGuide Toolbox is automatically up dated should you change the C-arm angulation, the zoom factor or move the table.

Indication of structures during closure of paravalvular leaks of mitral valve implant

• 2D overlay of points of interest within 3D volumes created before or during a procedure

• One-click generation of anatomical outlines• Changes in C-arm angulation or zoom or table movement

are automatically updated

3-dimensional guidance during LAA occlusion

• Overlay of pre- and intra-procedurally acquired 3D volumes to live fluoroscopy or acquisition

• Image guidance during structural heart interventions like TAVI or LAA occlusion with a potential reduction of contrast media, dose, and examination time

• 3D overlay is compensated for angulation or zoom size changes as well as for table movement

syngo iPilot enhancedOverlay of 3D information to 2D images

Overlay 3D images onto live 2D images – with syngo iPilot enhanced. The 3D images used can be based on syngo DynaCT Cardiac, syngo InSpace 3D or other modality 3D volumes.

syngo iPilot enhanced can support you during the occlusion of the left atrial appendage by acting as a 3D roadmap. It can provide you with crucial information when implanting the closure device to help avoid a cardiac tamponade and save contrast agent. By linking the 3D image to the C-arm, the overlay will automatically be updated if you change the C-arm angulation, the zoom factor or move the table.

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Automatic segmentation of aortic root and indication of relevant structures

• Automatic segmentation of aortic root, indication of anatomical landmarks, and optimal orthogonal view plane in less than 30 seconds

• Automated selection of perpendicular view plane and transfer of angulation data for high precision during valve implantation

• Image guidance by overlaying landmarks and 3D structures onto live fluoroscopy or acquisition

syngo Aortic ValveGuideEnhanced workflow and accuracy for valve positioning

Based on a 5-second syngo DynaCT Cardiac acquisition, syngo Aortic ValveGuide provides you with fast and precise 3D information on the aortic root anatomy – making it an excellent basis for valve implantation planning.

The software automatically segments the aortic root and color-codes landmarks for the coronary ostia or the valve commissures. It indicates the valve cusp points together with a perpendicularity ring, measurement scales, and a center line. syngo Aortic ValveGuide also suggests an ideal implantation view plane, which can be transferred to the C-arm for automated system movements. And in combination with syngo iPilot enhanced, the 3D valve image can be overlaid either in solid or in contour mode.

syngo InSpace 3D / 3D Fusion Multimodality fusion

3D images can be helpful when planning interventions for an SHD treatment or for a vascular procedure. With syngo InSpace 3D/3D Fusion, you can easily and quickly fuse CT, MR or PET•CT images for your ongoing procedure by using high-contrast 3D images or syngo DynaCT datasets. You can transfer and overlay onto live images either • points of interest you marked using syngo iGuide Toolbox or • 3D images using syngo iPilot enhanced.

Registration of a pre-procedural CT volume with an intra-procedural syngo DynaCT volume

• Import 3D images from other modalities and fuse them for use in ongoing procedure

• Use other modality 3D images for procedure planning and image overlay

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DSA image of carotid stenosis

• Image background removal to visualize even the finest vessels• Choose roadmap from dedicated DSA mask or from previous scenes

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Peripheral vessel disease and vascular procedures

Digital Subtraction Angiography (DSA)

Interventional cardiologists are broadening their spectrum beyond the heart to peripheral or renal arteries, carotids, and even intra-cranial vessels. New procedures such as renal denervation blur traditional departmental borders.

A mix of various procedures requires a wide range of physician skills and versatile tools to optimize clinical results. Discover Siemens’ broad portfolio for peripheral vessel disease and vascular procedures.

2D advanced roadmapping

During vascular procedures like carotid stenting, 2D roadmaps provide you with better orientation and help reduce the use of contrast agent.

DSA removes the anatomical background and gives you a clear view of even the finest vessels. It also lets you create images for the advanced roadmap modes, generated either from a dedicated DSA mask/fill run or previously acquired scenes. It can use single maximal opacification images or add several images to a whole vessel tree.

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Overlay Ref

Using reference images as roadmap

During other vascular procedures like renal denervation where the anatomical background is not an issue, you can save the additional dose of DSA and invert any reference image to be overlaid onto the live 2D images.

As the opacity is continuously adjusted, the image is always displayed with an ideal contrast. When treating peripheral vessel disease or vascular cases, an inverted image of a contrast-filled vessel can provide you with the image guidance you need.

Overlay of renal artery image to live fluoroscopy

• Use of inverted reference image, e.g. contrast-filled vessel as 2D roadmap• Saving dose and contrast agent during cases like renal denervation

syngo DynaCTCT-like imaging for vascular procedures

syngo DynaCT was first introduced for interventional radiology procedures. The software has since proven its value in a multitude of applications in peripheral and vascular disease as well.

When stenting abdominal aortic aneurysms, for example, you can use either intra- or pre-procedural 3D imaging to visualize the aneurysm. For image guidance during the implantation of a stent graft, the outline of the aneurysm can then be overlaid to the 2D live images.

After you implant the stent graft, you can use syngo DynaCT to check the success of the intervention or the possible presence of endoleaks that need additional treatment.

syngo DynaCT and syngo iGuide Toolbox used during AAA treatment

• syngo DynaCT can be used to image anatomical structures like AAA• syngo iGuide Toolbox can be used to overlay 3D volume outlines

onto live 2D images• Post-intervention assessment of procedural success and possible

further adjustments

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Welcome to the world of Artis

Artis family of imaging solutions

Offering the right imaging system for all types of interventional cardiology

The Artis family includes three product lines of interventional imaging systems: Artis zee, Artis Q, and Artis Q.zen. All product lines feature the complete port folio for cardiology, including a floor-, ceiling-mounted, or biplane system and even a highly flexible multi-axis system with robotic technology: Artis zeego. The versatile portfolio from Siemens offers the right solution for virtually any need in inter ventional cardiology.

Artis zee

The state-of-the-art system enables improved visu alization of therapeutic devices, as well as a range of advanced 2D and 3D applications that allow you to treat patients with greater speed and precision.

Artis Q

The cutting-edge system provides unparalleled performance with a revolutionary all-new X-ray imaging chain plus new applications for more precise and personalized therapy.

Artis Q.zen

The visionary system combines the Artis Q technology with a groundbreaking new detector based on crystalline silicon that reduces electronic noise and allows imaging at ultra-low-dose levels.

Artis family

of imaging solutions

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Artis Large Display

Seeing the whole picture on one monitor

Seeing more can increase diagnostic and therapeutic confidence. Our Artis Large Display features a full-color 56-inch medical-grade screen that lets you view multiple inputs simultaneously. You can choose between more than 200 layout configurations. In addition, you can select up to 12 different screen combinations with input from up to 24 image sources directly at the table-side. And you can zoom the image of clinical focus up to twice the size of a standard display.

• High definition consolidated display

• Customized views

• Optimal resolution in any window size

• Fast, intuitive handling, tableside control

• Integrated emergency backup

Artis Cockpit

Cleaning up the control room

Stop running from one system to the next – let the Artis Cockpit consolidate all your information in one workplace. The 30-inch medical-grade monitor offers 4 megapixel resolution and high brightness for excellent image display. Up to nine inputs can be simultaneously displayed and controlled, with a choice of four different layouts.

Artis Cockpit offers one single workplace that can be equipped with one or two keyboards and monitors. With so much more efficiency in the control room, you can focus on your procedure and your patient.

• Streamlined setup and workflow

• Control up to nine systems from one workplace and clean up your control room

• Configure the Artis Cockpit to your needs with one or two keyboards and monitors

• Customize layout quickly with drag & drop

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Sensis

The integrated recording and information system

The Sensis amplifier is seamlessly integrated into the Artis table ‒ for free patient access and easy cleaning.

From patient registration to reporting, Sensis is your central point of data handling. Bidirectional communication with your Artis imaging system allows automatic exchange of demographic patient data. In addition, you can quickly obtain dose values and X-ray images for comprehensive reporting. The Artis table-side touchscreen console offers remote control of the main recording functionalities right at your fingertips. Or let your staff control recordings, measurements or vital signs at the Sensis nurse workstation in the examination room. This gives you even more flexibility especially in emergencies, on weekends or during night shifts.

Growing with your cath lab needs

Does a single lab solution suit your needs or do you require your cath lab to be integrated into a multi-lab environment? Do you want a dedicated hemodynamic or a combined hemodynamic and EP solution? With the scalable Sensis, you stay completely flexible right from the start.

• One-stop patient registration and comprehensive reporting

• Seamless amplifier integration

• Flexible handling with table-side control

• Excellent signal quality for hemodynamic and electrophysiology application

• Investment confidence due to scalability

All Artis systems include the CARE & CLEAR packages to complement the imaging chain for optimized post-processing and dose reduction. The CARE package helps reduce radiation for the operator and patient. The CLEAR package offers a comprehensive range of applications to enhance image quality.

Introduced in 1994, our ever growing CARE portfolio (Combined Applications to Reduce Radiation Exposure) continues to reduce radiation dose for patients and clinical staff while maintaining high image quality for diagnostic confidence.

Dose saving

• CAREvision provides variable fluoros-copy frame rates, pulse frequencies can be adapted to clinical needs

• CAREfilter is a specially designed copper prefiltration system that automatically adjusts the filter to the patient’s anatomy

• CAREprofile allows radiation-free collimator and semitransparent filter adjustment using the last image hold (LIH) position as reference

• CAREposition enables radiation-free object positioning, i.e. allows the table or C-arm position to pan without using fluoroscopy

• Low-dose Acquisition, a dedicated acquisition protocol, helps to achieve dose reductions

• Low-dose syngo DynaCT provides 3D images at the lowest possible dose levels

Dose monitoring

• CAREguard allows three threshold values to be defined for the accumu-lated skin dose and signals when a skin dose level is exceeded

• CAREwatch displays the dose area product and dose rate at the interven-tional reference point on the live display in the examination and control rooms

• CAREmonitor shows in real time the accumulated peak skin dose according to the current projection in the form of a fill indicator on the live monitor

Dose reporting

• CAREreport is a DICOM-structured radiation report containing all patient demographic, procedure, and dose information

• CARE Analytics is a stand-alone tool for installation on any PC in the hospital network, allowing evaluation of DICOM dose structured reports

CARE & CLEAR

CARE & CLEAR are standard with all Artis systems

CAREvision

1994

Pulsed Fluoroscopy

CAREfilter

1994

CAREguard

2010Skin dose alert on the touchscreen

2009Acquisition Low Dose

Acquisition

Low-dose Acquisition

CAREreport

2009

Low-dose syngo DynaCT

20090.1 µGy/frame

CARE Analytics

2011Enhanced dose control

Stand-alone PC CARE Analytics

Dose

Time

Other DICOM node (e.g. modality, workstation)

CAREmonitor

2012Enhanced dose reporting

0 2.0Gy

0 2.0Gy

0 > 2.0Gy

CAREprofile

1998 2001

CAREposition

DICOM

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Whereas the MEGALIX Cat Plus X-ray tube introduced unique flat-emitter technology to imaging, the GIGALIX X-ray tube has been designed around it. Compared to the common use of filaments, this technology enhances image quality in challenging situations such as with obese patients or in steep angulations. Its higher spatial resolution helps to better visualize small devices and vessels, resulting in up to 70% better visibility of small devices while at the same time generating equal image quality with up to 60% less dose*.

CLEAR offers a comprehensive range of applications with real-time processing to enhance image quality – without increas-ing the dose. The combination of auto-mated brightness and contrast optimiza-tion, dose-adaptive noise reduction and automated image enhancement algo-rithms ensures optimal images, adjusted to your personal preferenceswith CLEAR-choice. This way, the images are always displayed the way you like them best.

User-specific image quality with CLEARchoice

* Compared to previous X-ray tube technology. Data on file.

Almost 20 years of Siemens innovations to reduce, monitor, and report dose in angiography

Enhanced dose reporting

www.siemens.com/healthcare

Order No. A91AX-11304-20C1-7600 | Printed in Germany | CC AX 1514 08133. | © 08.2013, Siemens AG

On account of certain regional limitations of sales rights and service availability, we cannot guarantee that all products included in this brochure are avail-able through the Siemens sales organization world-wide. Availability and packaging may vary by country and are subject to change without prior notice. Some/All of the features and products described herein may not be available in the United States or other countries.

The information in this document contains general technical descriptions of specifications and options as well as standard and optional features that do not always have to be present in individual cases.

Siemens reserves the right to modify the design, packaging, specifications and options described herein without prior notice. Please contact your local Siemens sales representative for the most current information.

In the interest of complying with legal requirements concerning the environmental compatibility of our products (protection of natural resources and waste conservation), we recycle certain components. Using the same extensive quality assurance measures as for factory-new components, we guarantee the quality of these recycled components.

Note: Any technical data contained in this document may vary within defined tolerances. Original images always lose a certain amount of detail when repro-duced. Caution: Federal law restricts this device to sale by or on the order of a physician.

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Legal Manufacturer Siemens AG Wittelsbacherplatz 2 DE-80333 Muenchen Germany

Global Business Unit Siemens AG Medical SolutionsAngiography & InterventionalX-Ray SystemsSiemensstr. 1DE-91301 ForchheimGermanyPhone: +49 9191 18-0www.siemens.com/healthcare

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