Siemens ARCADIS Varic VB 13C Quick Manual
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Siemens ARCADIS Varic VB 13C Quick Manual

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ARCADIS Varic
VB 13C
Quick Guide
C-arm keyboard
mAs
kV
mA
ROAD
SUB
mA
MAP
DR
R
R
top/lateral row of keys
Lift/lower
C-arm
Switch ADR stop
on/off
Reset fluoroscopy
time
bottom row of keys
Operating modes:
- Pulsed
fluoroscopy
- Continuous
fluoroscopy
Power mode
mA
Noise reduction
Open/close
iris diaphragm
Open/close
slot diaphragm
System OFF
Enlarge stored
images
Contrast adjust-
A
B
ment left/right
monitor
Read images from
B
B
memory forward/
backward
min
A B
B
B
A
B
Reduce/increase
kV and mA
Single-tank
laser light localizer
Rotate image
Operating modes:
ROAD
SUB
- Subtraction
MAP
- Roadmap
- Digital
DR
radiography
Enlarge live image
Image reversal
R
R
left/right or
top/bottom
Rotate slot
diaphragm
Radiation indicator
Tube unit tempera-
ture
Edge enhance-
ment
Monitor split
horizontal/vertical
Save image
A B
Print image

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Summary of Contents for Siemens ARCADIS Varic VB 13C

  • Page 1 C-arm keyboard ROAD top/lateral row of keys Lift/lower Reduce/increase C-arm kV and mA Switch ADR stop Single-tank on/off laser light localizer Reset fluoroscopy Rotate image time bottom row of keys Operating modes: Operating modes: ROAD - Pulsed - Subtraction fluoroscopy - Roadmap - Continuous - Digital...
  • Page 2 Monitor trolley symbol keypad Brightness - Brightness + Contrast - Contrast + Scroll study back Scroll study forward Scroll series back Scroll series forward Scroll image back Scroll image forward Switch between Send to node 1 negative and positive image This product is provided with a CE marking in according with the regulations stated in Enter a study...
  • Page 3 Introduction We welcome you as a user of the powerful ARCADIS Varic C-arm system from Siemens. This clearly laid out Quick Guide is intended to guide you through the operation of the sys- tem. The Quick Guide is valid only in conjunction...

  • Page 4: Table Of Contents

    Table of Contents Basics Input devices ........7 syngo user interface ......9 syngo control elements ...... 11 Product overview C-arm system ........13 Monitor trolley ........17 Examination procedure Preparing the system ......19 Patient registration ......21 Preparation in the Examination task card ..........
  • Page 5 Documentation Printing ..........65 Burning CDs ........75 Reports Generating reports ......77 Editing a LithoReport ......79 Printing and exporting a report ... 81 Connectivity Send/Storage Commitment ....87 Get Worklist ........91 MPPS – Modality Performed Procedure Step ........93 Query/Retrieve ........
  • Page 6 Basics This chapter is addressed to syngo begin- ners and users with little computer experi- ence. Functions of the symbol keypad see fold- out cover.

  • Page 7: Basics

    Basics This chapter provides you with basic informa- tion on the input devices of the computer at the monitor trolley and on the syngo user interface. Input devices The mouse (1) Left button Single click: select/mark Double click: load data/program Button kept pressed: drag/move (2) Middle button Button kept pressed: windowing...
  • Page 8 Basics After the ARCADIS Varic system has been switched on, the syngo user interface auto- matically appears on the monitor trolley screens.

  • Page 9: Syngo User Interface

    Basics syngo user interface syngo consists of several stacked task cards. These are assigned to the individual steps of the workflow. Task cards (1) Menu bar Calling up of main menus and submenus (2) Tabs Selection/switching of task cards (3) Stack of subtask cards Selection of processing tools and display functions Switching of subtask card via tab...
  • Page 10 Basics (10)

  • Page 11: Syngo Control Elements

    Basics syngo control elements Control elements on the screen are easiest selected with the mouse. Menus (1) Main menu Opens by pressing left mouse button (2) Popup menu Opens by pressing right mouse button The content depends on the mouse position ("mouse focus") on the screen Input elements (3) Text input field...

  • Page 12: Product Overview

    Product overview As soon as you press the emergency stop button, motorized up and down movement of the C-arm system is disabled. S T O S T O...

  • Page 13: C-Arm System

    Product overview C-arm system C-arm (1) Image intensifier (2) X-ray tube (3) Holder for footswitch (4) Locking brake (5) Hand switch (6) Steering lever (7) Emergency stop button Brakes, steering lever (4) Locking brake ❏ Locking brake released in center position: Move C-arm system (6) Steering lever ❏...
  • Page 14 Product overview 130° ST O P 130° ST O P 190° 190° 20 cm ST O P ST O P 12,5° 12,5°...
  • Page 15 Product overview Moving the C-arm system (1) Vertical travel (motorized) Lift and lower C-arm up to 45 cm (2) Orbital movement Change between a.p. and lateral position ➭ Starting from the a.p. position vertical to - 40° and horizontal to + 90° (130°...
  • Page 16 Product overview Description of keyboard see Basics chap- ter.

  • Page 17: Monitor Trolley

    Product overview Monitor trolley (1) TFT flat screen monitors (2) Keyboard (3) Power on/off switch (4) CD drive (5) Direction locks on the back wheels (6) Brakes on the front wheels...

  • Page 18: Examination Procedure

    Examination procedure If an additional access control mechanism is configured for the system, you have to log in with your name and password.

  • Page 19: Preparing The System

    Examination procedure Preparing the system Connecting, switching on and booting ✧ Connect the monitor trolley connecting cable to the C-arm system (1). ✧ If available, connect the network cable (if the system is connected to an informa- tion system or a navigation system or net- work printer) (2).
  • Page 20 Examination procedure During operation, the window can be opened by pressing the Patient Registration icon button on the monitor trolley.

  • Page 21: Patient Registration

    Examination procedure Patient registration First, the Patient Registration window (1) appears directly. (Here: maximal configuration) ✧ Enter the patient data into this mask (1). At a minimum, the bold fields must be filled out. Using the mouse, click on the Exam (2) ✧...
  • Page 22 Examination procedure To select parameters, use the mouse to click the monitor trolley. If the optional laser light localizer is avail- able, the object should be positioned with the laser light localizer, i.e. without radia- tion, as far as possible for reasons of radia- tion protection.

  • Page 23: Preparation In The Examination Task Card

    Examination procedure Preparation in the Examination task card ✧ Select the medical application area (1). ✧ Select the body region by clicking the VPA (Virtual Patient Anatomy) (2). ✧ Select the required application program (3). ➭ With the application program you simulta- neously select a dose level (reduced, standard, increased).
  • Page 24 Examination procedure Exception: If the continuous fluoroscopy mode is set, pressing the left footswitch releases a single exposure.

  • Page 25: Radiation Release And Dose Display

    Examination procedure Radiation release and dose display Radiation release with the footswitch ✧ Actuate the right footswitch to release continuous fluoroscopy (1). ✧ Actuate the left footswitch to release the set operating mode (2). Radiation release with the hand switch ✧...
  • Page 26 Examination procedure ADR stop is recommended, for example, ❏ Thin objects, e.g. wrist (the movement causes the object to slide out of the central beam, the image is underex- posed) ❏ Metal (high density of the metal leads to strong overexposure) ❏...
  • Page 27 Examination procedure Radiation time and dose display (1) Display of accumulated fluoroscopic time at the C-arm system (2) Display of accumulated fluoroscopic time at the monitor trolley (Examination task card) (3) Display of accumulated dose at the moni- tor trolley (with optional dose measuring chamber) Alternative: Display of air kerma values (preceding item: accumulated air kerma).
  • Page 28 Examination procedure...

  • Page 29: High-Contrast Fluoroscopy (Power Mode)

    Examination procedure High-contrast fluoroscopy (Power Mode) Power Mode is an additional function that can be selected for the fluoroscopy mode. With Power Mode a higher contrast is achieved, but with a higher dose. Select the Power Mode function at the ✧...
  • Page 30 Examination procedure The rotation is performed without radiation and can be observed on the monitor.

  • Page 31: Image Rotation And Reversal

    Examination procedure Image rotation and reversal At the C-arm system Press one of the image rotation buttons ✧ for the required direction of rotation (1). ➭ The angle of rotation in relation to the starting position is shown (2). Press one of the image reversal buttons ✧...
  • Page 32 Examination procedure...

  • Page 33: Collimator Setting

    Examination procedure Collimator setting For radiation protection reason collimators should be inserted. These can be set at the C-arm system. (1) Moves the iris diaphragm into/out of the beam path (2) Rotates the semitransparent diaphragm (3) Moves the semitransparent diaphragm into/out of the beam path The iris diaphragm is a multileaf collimator used for concentric collimation of the radia-...
  • Page 34 Examination procedure (1) (2)

  • Page 35: Changing The Contrast

    Examination procedure Changing the contrast If the image quality is insufficient, a different gray-level curve can be selected at the control panel of the C-arm system during the exami- nation to change the contrast of the image (and all further images). In addition, the edge enhancement of the live images can be changed.
  • Page 36 Examination procedure At the end of radiation, the image last acquired is displayed (LIH, Last Image Hold). If radiation is released again, the LIH image is overwritten.

  • Page 37: Saving Images

    Examination procedure Saving images Single exposure In this operating mode the generated images are automatically saved in the local database of the Patient Browser. Fluoroscopy, pulsed fluoroscopy, subtraction, Roadmap In these operating modes images are stored in the temporary image memory and over- written by new images.
  • Page 38 Examination procedure If Autoloop (option) is configured in the exam set used, review of the scene is started automatically at the end of radia- tion. You can load the scene into the Viewing task card at any time and review it there. If the MPPS option is installed, the Modality Performed Procedure Step window for performance documentation is...

  • Page 39: Fluoro Loop/Lsh (Option)

    Examination procedure Fluoro Loop/LSH (option) In the fluoroscopy, subtraction and Roadmap modes, scenes can be reviewed and stored (Last Scene Hold) during the examination. Reviewing a scene After radiation is ended, the buttons for con- trolling the scene review are displayed. (1) Start (2) Stop (3) Previous frame...

  • Page 40: Subtraction And Roadmap

    Subtraction and Roadmap The Subtraction and Roadmap modes are an option for C-arms used in cardiac and vascular surgery.

  • Page 41: Performing A Subtraction Scene

    Subtraction and Roadmap Performing a subtraction scene Contrast medium injected into the vessels helps to show vessels and changes of/in these vessels (e.g. aneurysms, ruptures). Procedure ✧ Prepare the examination in the Examination task card: (1) Selection of the required application pro- gram (2) Selection of the Subtraction mode ✧...
  • Page 42 Subtraction and Roadmap If auto store is activated in the configura- tion menu, the images of a subtraction scene are automatically saved in the local database. They can then be retrieved for postprocessing at the end of the examina- tion.

  • Page 43: Postprocessing A Subtraction Scene

    Subtraction and Roadmap Postprocessing a subtraction scene ✧ First, load the subtraction scene from the Patient Browser into the Viewing task card. Pixelshift Pixelshift allows you to make the mask and fluoroscopy image coincide. This function is used if the position of the patient has changed in the course of the series in relation to the position of the mask.
  • Page 44 Subtraction and Roadmap...
  • Page 45 Subtraction and Roadmap Auto Pixelshift This function allows automatic pixelshift for a selected region. Click the Auto Pixelshift button (1). ✧ ➭ The mouse pointer changes into a square. ✧ Move the square to the area in the image where the misalignment can clearly be seen.
  • Page 46 Subtraction and Roadmap...
  • Page 47 Subtraction and Roadmap Dual channel function With this function the entire series is dis- played unsubtracted during postprocessing in the Native task card (on the right-hand moni- tor). At the same time, the subtracted display is shown in the Viewing task card (on the left-hand monitor).
  • Page 48 Subtraction and Roadmap (2) (3) (4) (5) (6) (7)
  • Page 49 Subtraction and Roadmap Landmark The Landmark function allows you to subse- quently add an anatomical background for ori- entation purposes (0 to 30 %). ✧ Keeping the left mouse button pressed, drag the bar to the required value (1). Movie mode The replay of the subtraction scene can be repeated in the Viewing task card.
  • Page 50 Subtraction and Roadmap During catheter placement the images are not automatically stored. To manually save images, use the save but- ton on the hand switch or C-arm system. It is not necessary to create a subtraction scene if the Roadmap exam connects to a subtraction angiography.

  • Page 51: Roadmap

    Subtraction and Roadmap Roadmap The Roadmap mode is also used in vascular surgery. This mode is used to place catheters in vessels under fluoroscopy. The examination comprises the following steps: Generation of a subtraction scene ✧ Select the Roadmap operating mode in the Examination task card.

  • Page 52: Postprocessing

    Postprocessing 2D images are postprocessed in the Viewing task card.

  • Page 53: Loading Patient Images Into The Viewing Task Card

    Postprocessing Loading patient images into the Viewing task card Open the Viewing task card. ✧ Open the Patient Browser with the ✧ Call up Patient Browser button on the monitor trolley (1). Load the required series into the Viewing ✧ task card with a double click (2).
  • Page 54 Postprocessing...

  • Page 55: Image Display

    Postprocessing Image display In the View subtask card you can choose between different monitor layouts. (1) Different screen divisions (2) Hiding graphics and patient data in the image area (3) Stripe display: the images are arranged next to each other (4) Stack display: the individual images are arranged one on top of the other...
  • Page 56 Postprocessing...

  • Page 57: Measuring And Annotations

    Postprocessing Measuring and annotations In the Tools subtask card images can be mea- sured and annotations can be added. (1) Diaphragms The subsequent simulation of diaphragms improves the visualization of fine struc- tures that are difficult to see in the image (2) Magnifying glass Individual areas of the loaded image are shown enlarged...
  • Page 58 Postprocessing Distances cannot be measured directly in the images, since the position of the object in the beam path and thus the magnification effect is not clear. A calibration must be performed first before a distance can be clearly determined. calibration object must...
  • Page 59 Postprocessing Calibrating and measuring distances ❏ Calibrating (1st step) Activate the calibration function by click- ✧ ing the corresponding button (1). ➭ A green line appears in the image area which can be lengthened, shortened and positioned as desired with the mouse (2). ✧...
  • Page 60 Postprocessing Edge enhancement (3) means artificially increasing the difference between two gray levels.

  • Page 61: Image Manipulation

    Postprocessing Image manipulation Images can be postprocessed in the Image subtask card. ✧ Prior to postprocessing, activate the required function by clicking the corre- sponding button: (1) Change of contrast The contrast is changed in four defined steps (2) Image rotation Rotation with the left mouse button pressed (3) Edge enhancement...
  • Page 62 Postprocessing Windowing means changing the gray levels in an image and thus the brightness (center of the grayscale) and contrast (width of the grayscale) of the image.
  • Page 63 Postprocessing Windowing ❏ With buttons/softkeys ✧ Select the preset contrast levels by click- → ing the buttons ( Page 61). ❏ With the keyboard of the monitor trolley: ✧ Select the brightness and contrast step by step (1). ❏ With the mouse on the monitor trolley ✧...
  • Page 64 Documentation In radiology the terms "filming" (= printing process), "camera" (= output device) and "exposing" (= printing) are used for the printing of patient images. The syngo user interface uses correspond- ing terms.

  • Page 65: Documentation

    Documentation Printing If the printing function is configured, the Filming task card additionally appears on the right monitor. Here, the images to be printed are collected in film sheets, processed if necessary, and then sent to the printer as a film job. Procedure (1) Copying images to the film sheet: –...
  • Page 66 Documentation...
  • Page 67 Documentation Copying images to the film sheet from the Viewing task card Print jobs can be created in the Viewing task card in parallel with image postprocessing. ✧ Click the patient image to be copied to the film sheet (1). Then click Copy to Film Sheet (2).
  • Page 68 Documentation...
  • Page 69 Documentation Checking the film job and printing from the film preview Click the Film Preview button in the ✧ Patient Browser (1). ➭ A dialog box is opened which shows dif- ferent functions for the film sheet: (2) Dog ears for scrolling through the film sheets (3) Patient name (4) Setting the number of copies of a film job...
  • Page 70 Documentation...
  • Page 71 Documentation Editing the film sheet in the Filming task card Click the Filming task card on the right ✧ monitor (1). ❏ Layout ✧ Select the required film layout in the Layout subtask card (2). ❏ Image display On the Images subtask card, select the ✧...
  • Page 72 Documentation (10)
  • Page 73 Documentation ❏ Camera/printer setting In the Camera subtask card, select a dif- ✧ ferent camera/printer or film size, if nec- essary: (1) Select the camera if several cameras are configured (2) Display of the film job status, e.g. "queued", "printed" etc. (3) Select one of the film formats available in the camera ❏...
  • Page 74 Documentation Only non-rewritable CDs, (CD-Rs), can be used. Rewritable CDs (CD-RWs) are not accepted. The DICOM viewer is started directly from the CD; no files are installed on the com- puter.

  • Page 75: Burning Cds

    Documentation Burning CDs As your system is configured for multi-ses- sion, you can store your data to unrecorded CD-Rs, or CD-Rs that have already been writ- ten to. The new data is added to the old data on the CD-R. ❏...

  • Page 76: Reports

    Reports The prerequisite for both report types is the registration and examination of a patient. In addition, for a LithoReport, the lithotripsy function must be enabled on your system and connected to the imaging system. The radiation summary report is generated automatically based on the present exami- nation data.

  • Page 77: Generating Reports

    Reports Generating reports If the reporting function is enabled on your system, important examination data are auto- matically compiled into a structured report for documentation and treatment purposes. Report types ❏ Radiation summary report contains the accumulated values of the examination for the number of exposures, fluoroscopy time and dose area product ❏...
  • Page 78 Reports A lithotripsy procedure is possible only after a patient has been registered. When you start an ESWL treatment, the LithoReport editor is opened automatically with the new report. In the Viewing task card you can open reports by clicking the rele- vant button on the Reporting subtask card.

  • Page 79: Editing A Lithoreport

    Reports Editing a LithoReport Unlike in the case of the radiation summary report, you can enter or subsequently change part of the LithoReport data yourself. Opening a report ✧ Select the required LithoReport in the Patient Browser and select Reporting > Open Report.
  • Page 80 Reports During an examination the LithoReport edi- tor is automatically in edit mode. To close the LithoReport editor, click OK. With this button in the LithoReport editor you can call up the print pre- view of the report.

  • Page 81: Printing And Exporting A Report

    Reports Completing and changing data To modify data, you need to change into edit mode. This is, however, not possible if the report has already been completed (status “completed”). Click Edit (1). ✧ Make your changes in the Patient/ ✧ Diagnosis, Therapy, Summary, Postprocessing cards.
  • Page 82 Reports Files in pdf format can be read and printed on other computers with the Acrobat Reader freeware program. The program compiles all reports from the local database that meet your specified cri- teria.
  • Page 83 Reports Exporting a report as pdf file The report is saved as a pdf file in the CDR_OFFLINE directory. From there you can write the file to CD. Select the required report in the Patient ✧ Browser and call up Reporting > Export Report to..

  • Page 84: Connectivity

    Connectivity Monitor trolley Monitor trolley...
  • Page 85 Connectivity ARCADIS can optionally be connected to a network. The following two variants are avail- able: DICOM System Basic Send/Receive + Storage Commitment, Print (1) Send/Receive Sending and receiving of patient images (2) Storage Commitment Requesting a confirmation that images have been securely stored after sending (3) Print Printing of patient images on X-ray films...
  • Page 86 Connectivity You can also receive images from another system (CT, MR etc.) or workstation. For this, the images have to be actively sent from this system or workstation to ARCADIS.

  • Page 87: Send/Storage Commitment

    (information system or worksta- tion). Sending to a standard address Press the Send key on the keyboard of ✧ the monitor trolley (4). ➭ The selected patient images are sent to the first "standard" node configured by Siemens Service.
  • Page 88 Connectivity...
  • Page 89 Connectivity Tracking network processes Click the Network Status button (1). ✧ ➭ Current processes in the network are shown (2). Storage Commitment If patient data are sent or archived in an infor- mation system, the Storage Commitment function requests a confirmation from the receiving station that images have been securely stored: (3) Column for error messages...
  • Page 90 Connectivity Get Worklist offers the advantage of a sim- plified workflow: In an information system the OR plan (i.e. which patients are planned for a certain operating room or C-arm) can be prepared the day before and retrieved in the OR. Patients can then be retrieved quickly just before the procedure and the data can be transferred to the Examination task card.

  • Page 91: Get Worklist

    Connectivity Get Worklist The Get Worklist function contains a request for a worklist within an information system. Double-click the Scheduler in the Patient ✧ Browser (1). ➭ A worklist with patients whose data are present in XA format (data format for con- ventional radiography) appears.
  • Page 92 Connectivity...

  • Page 93: Mpps - Modality Performed Procedure Step

    Connectivity MPPS – Modality Performed Procedure Step MPPS (Modality Performed Procedure Step) is a confirmation to an information system that a certain process (in this case the exam- ination of a patient) has been completed. Calling up MPPS after an examination Select Patient >...
  • Page 94 Connectivity The Retrieve function is important above all for preoperative images that are needed for virtually any procedure.

  • Page 95: Query/Retrieve

    Connectivity Query/Retrieve ❏ Query A query to an information system can be started. If the patient is already known to the information system, the existing images are displayed. ❏ Retrieve Images can be imported into the local database and loaded into the Viewing task card.

  • Page 96: Navilink 2D

    NaviLink 2D Communication is implemented either directly between the C-arm and the naviga- tion system or through a hospital network. In the first case, the network cable from the C-arm is connected directly to the naviga- tion system. In the second case it is plugged into the network socket in the OR room.

  • Page 97: Features

    NaviLink 2D Features NaviLink 2D is a newly developed interface that enables the communication of 2D image data between ARCADIS Varic and a naviga- tion system. With the exception of the connection of the C-arm to the navigation system via the net- work cable and the generation of images for navigation, the entire workflow takes place at the navigation system.
  • Page 98 NaviLink 2D Confirmation is required only if the image is to be used for navigation. All other images are only stored in the Patient Browser at the monitor trolley. In general, 2 images are required. All other work steps are performed at the navigation system.
  • Page 99 NaviLink 2D Procedure ✧ Release radiation. The image appears in the References ➭ task card at the monitor trolley. ✧ Check the setting and image quality. If necessary, repeat the exposure. ✧ Confirm the selection of the image at the navigation system by clicking Request image.

  • Page 100: Dismantling

    Dismantling S TO P S TO P To define the switch-on duration yourself, you can perform a full shut-down manually. To do so, select Options > End session in the main menu before turning the system off.

  • Page 101: Transport Position

    Dismantling Transport position The C-arm system should be transported and parked in a zero position. ✧ Move the C-arm into an orbital a.p. posi- tion (1). ✧ Lower the lifting column fully (2). ✧ Move the horizontal carriage to the rear as far as possible (3).

  • Page 102: Cassette Exposure (Option)

    Cassette exposure (option) ARCADIS Varic does not have automatic exposure control for cassette technique. The exposure grid is delivered with the cas- sette holder.

  • Page 103: Components

    Cassette exposure (option) Components Cassette holder The cassette holder may only be attached in one specific position at the image intensifier. The centering pins must lock into the indents on the image intensifier ring. (1) Cassette holder (2) Centering pins on the cassette holder. ➭...
  • Page 104 Cassette exposure (option) Spring (2) and positioning pins (3) must be locked securely to keep the cassette holder in place. An acoustic signal sounds when the sys- tem has stored the positions. To delete the stored positions, you only need to press one of the keys.

  • Page 105: Preparing The Exposure

    Cassette exposure (option) Preparing the exposure Attaching the cassette holder ✧ Attach the cassette holder right (seen from the front) to the image intensifier so that the centering pins lock into the indents in the front ring of the image intensifier (1) on the cassette holder.
  • Page 106 Cassette exposure (option) If a cassette is loaded for the first time after starting the system, only dashes will be displayed in the kV and mAs fields. Before you release radiation, the required kV and mAs values must be set. During the exposure or after ending the exposure, an acoustic warning signal sounds (configurable).

  • Page 107: Exposure

    Cassette exposure (option) Exposure Setting exposure data ✧ Press one of the kV or mAs buttons (1). ➭ 40 kV and 5 mAs are shown on the dis- play as preferred values (2). ✧ Set the required values using the kV and mAs buttons (1).
  • Page 108 Notes...
  • Page 109 Siemens reserves the right to modify the design and specifications contained herein without prior notice. Please contact your local Sales Representa- tive for the most current information. Note: Original images always lose a certain amount of detail when reproduced.
  • Page 110 Siemens AG Wittelsbacherplatz 2 D-80333 München, Germany Contact: Siemens AG, Medical Solutions Special Systems Henkestraße 127 D-91052 Erlangen, Germany  2006 All rights reserved Print No.: SPR2-310.622.01.03.02 Printed in the Federal Republic of Germany Siemens AG 10/06 (English)

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