AXIOM 08-2008 cardiology and angiography

The Magazine for Interventional Angiography and Cardiology, Radiography and Fluoroscopy

Issue Number 8/October 2008

AXIOM Innovations

New Trendsin SurgeryCardiovascular Surgery opens up for New Treatment MethodsPage 14

Effi ciencyin the EPsyngo DynaCT Cardiacenhances Ablation TherapyPage 26

AXIOMLuminos TFPediatric Imagingin FluoroscopyPage 36

Virus protectionAt the University Hospital Basel, SwitzerlandPage 40

08

On account of certain regional limitations of sales rights and service availability, we cannot guarantee that all products included in this brochure are available through the Siemens sales organization worldwide. 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.

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.

Note: Any technical data contained in this document may vary within defined tolerances. Original images always lose a certain amount of detail when reproduced.

Global Business UnitSiemens AGMedical SolutionsAngiography, Fluoroscopic and Radiographic SystemsSiemensstr. 1DE-91301 ForchheimGermanyPhone: +49 9191 18-0www.siemens.com/healthcare

Local Contact Information

In AsiaSiemens Medical SolutionsAsia Pacific HeadquartersThe Siemens Center60 MacPherson RoadSingapore 348615Phone: +65 9622-2026www.siemens.com/healthcare

In CanadaSiemens Canada LimitedMedical Solutions2185 Derry Road WestMississauga ON L5N 7A6CanadaPhone: +1 905 819-5800www.siemens.com/healthcare

In Europe/Africa/Middle EastSiemens AG, Medical SolutionsHenkestr. 127,D- 91052 ErlangenGermanyPhone: +49 9131 84-0www.siemens.com/healthcare

In Latin AmericaSiemens S.A., Medical SolutionsAvenida de Pte. Julio A. Roca No 516, Piso 7C1067ABN Buenos AiresArgentinaPhone: +54 11 4340 8400www.siemens.com/healthcare

AX

IOM

In

no

vati

on

sIs

sue

Nu

mb

er

8/O

cto

be

r 2

00

808www.siemens.com/healthcare-magazine

In USA:Siemens Medical Solutions U.S.A., Inc.51 Valley Stream ParkwayMalvern, PA 19355-1406USAPhone: +1-888-826-9702 www.siemens.com/healthcare

Large Volume Imaging with Artis zeegoMore anatomical coverage with Large Volume syngo DynaCT

Order No. A91AX-50801-13C1-7600 | Printed in Germany | CC AX 50801 ZS 090825. | © 09.2008, Siemens AG

Global Siemens Headquarters

Siemens AGWittelsbacherplatz 280333 MuenchenGermany

Global SiemensHealthcare Headquarters

Siemens AGHealthcare SectorHenkestr. 127 91052 ErlangenGermanyPhone: +49 9131 84-0www.siemens.com/healthcare

Legal Manufacturer

Siemens AGWittelsbacherplatz 2DE-80333 MuenchenGermany

Imprint

PublisherSiemens AGMedical SolutionsAngiography, Fluoroscopicand Radiographic SystemsSiemensstr. 1,91301 Forchheim, Germany

Responsible for contentsNorbert Gaus, PhD

Chief editorSabine [email protected]

Editorial boardMonika BöhmerKlaudia DorschVera JünnemannOliver Meissner, MD, PhDNadine Meru, PhDAndrea MüllerProf. Georg Nollert, MDRoland PapenfußSiegfried PrellSusanne SeahDirk Sunderbrink

Contributors to this issueAlfonso Aguilera, Erik Busch, Knut Imhof, Michaela Kandolf, Andra Kirchner, Barbara Reber, Antonio Ribeiro, Markus Rossmeier, Gerald Sandridge

All at Siemens AG Healthcare Sector

Lee Benson, MDCardiac Diagnostic and Interventional Unit, Hospital for Sick Children,Toronto, Canada

Joris Ector, MD, Stijn De Buck, MSc ,PhDHein Heidbuchel, MD, PhDDepartment of Cardiology, University Hospital Gasthuisberg Leuven,Leuven, Belgium

Erik Fosse, MDThe Interventional Centre, Rikshospitalet, University of Oslo,Oslo, Norway

John P. Harris, MDCharles E. Winn, MDNorth Colorado Medical Center,Greeley, CO, USA

David Lacey, MDIowa Methodist Medical CenterDes Moines, IA, USA

Jaime Lavados, MDEduardo Bravo, MDNeurosurgery Institute Santiago,Santiago, Chile

Luis Ramos, MD, X-ray DepartmentUniversity Hospital Puertade Hierro Majadahonda,Madrid, Spain.

Harald Sandmayr, MDRadiography DepartmentLandeskrankenhaus Steyr Steyr, Austria

Prof. Martin Skalej, MD, Oliver Beuing, MD, Anja Lenz, MD University of Magdeburg, Magdeburg Germany

Prof. Wolfgang Steinbrich, MDChristian KluthUniversity Hospital BaselBasel, Switzerland

Warren Swee, MD, MPHDepartment of RadiologyUniversity of Virginia Health SystemCharlottesville, VA, USA

Prof. Wolfram Voelker, MDUniversity Clinic WuerzburgWuerzburg, Germany

ProductionMichael BrummeSiemens Healthcare

Layout and editorial staffSatzwerker – Jäger & TuppiNuremberg/Karlsruhe, Germany

PrinterFarbendruck HofmannGewerbestraße 590579 Langenzenn, Germany

AXIOM Innovations on the net:www.siemens.com/healthcare-magazine

AXIOM Innovations Imprint© 2008 by Siemens AG, Berlin and Munich, All Rights Reserved

Note in accordance with § 33 Para.1 of the Federal Data Protection Law: Dispatch is made using an address file which is maintained with the aid of an automated data processing system. We remind our readers that, when printed, X-ray films never disclose all the information content of the original. Artifacts in X-ray, CT, MR and ultrasound images are recognizable by their ty-pical features and are generally distinguishable

from existing pathology. As referenced above, healthcare practitioners are expected to utilize their own learning, training and expertise in eva-luating images.

Partial reproduction in printed form of individual contributions is permitted, provided the custo-mary bibliographical data such as author’s name and title of the contribution as well as date and

pages of “AXIOM Innovations” are cited. The editors request that two copies be sent to their attention. The consent of the authors and editors is required for the complete reprint of an article.

Manuscripts submitted without prior agreement as well as suggestions, proposals and information are always welcome; they will be carefully assessed and submitted to the editorial board for review.

AXIOM Innovations · October 2008 · www.siemens.com/healthcare-magazine 49

“Keeping our customers at the cutting edge of technology and enabling them to do more with their systems and appli-cations is one of our most important goals.”Dr. Norbert Gaus, CEO of the Angiographic, Radiographic and Fluoroscopic Division (AX)at Siemens Healthcare

2 AXIOM Innovations · October 2008 · www.siemens.com/healthcare-magazine

Editorial


Editorial

Dear Reader,

To be ahead of the game, you have to spot upcoming trends early enough to act on them. This goes without saying both for you, our customers, and for us at Siemens Healthcare.At Siemens, we like to keep you on the forefront of technology so you can zee more and therefore do more. One fast growing trend is minimally invasive surgery performed in so-called hybrid rooms, where high-end imaging and surgery come together. Surgeons have already recognized this and are active in bringing minimally invasive procedures with interventional imaging to their operating rooms. This combina-tion enables procedures that give hope to a lot of very sick patients who could not undergo surgery before because of

the high risks involved. Also, after a minimally invasive procedure patients do not need to stay in intensive care as long as they do after normal surgery. So the Artis zee family for interven-tional imaging is finding its way into the OR. But that is not all you can read about in this edition of AXIOM Inno-vations. Recently, Siemens acquired a new company and further extended our product portfolio. Together with the technology and the products of CAS Innovations, we are now able to offer electro-magnetic needle guid-ance. Now it is possible to precisely place electrodes or biopsy devices and guide them to the region of interest very accurately and without radiation. These and many more topics, e.g clini-

cal experiences in interventional imag-ing and X-ray await you in this edition of AXIOM Innovations.

I hope you enjoy reading this issue. I can tell you I did.

Dr. Norbert Gaus

Dr.-Ing. Norbert GausPresident AX Division


Content

Content

8 Artis zeego in the ORPhysicians at Oslo’s Rikshospitalet are achieving new levels of flexibility, ef-ficiency and 3D imaging quality in a wide range of clinical environments, from cardiology, body and neuroint-erventional radiology suites to high-end imaging in the OR.

Cover Story

22 Electromagnetic Needle Guidance

14 New Treatment Possibilitiesfor Cardiac Surgery

2 Editorial

6 News

8 Cover Story

Artis zeego in the OR

14 Special

Surgery Opens up for New

Treatment Methods

49 Imprint

Cover

Percutaneos Nephrostomy for an Obstructed Ectopic Pelvic Kidney

Courtesy of Warren Swee, MD, MPH


Content

Customer Care.Life

40 Virus ProtectionHow the University Hospital in Basel protects its systems

44 Learning With and Fromthe Experts Hands-on training forinterventional cardiology

46 Light and Sound ConceptArtificial light enviromentscreate more patient comfort

47 Upcoming Congresses &Workshops

Surgery

8 Robotic Technologywith Human BenefitsArtis zeego in the OR

14 Surgery Opens upto New Treatment MethodsNew trends in cardiac sugery

Angiography

20 Percutaneos Nephrostomy for an Obstructed Ectopic Pelvic KidneyClinical case

22 Radiofrequency Ablationof a Large Vertebral Metastasis Clinical case

24 State-of-the-Art ImagingTechnology in South America-Neurosurgery Institute of Santiago in Chile installs first biplane system with high-end 3D imaging

Cardiology

26 Improved Efficiency in the EP LabUniversity Hospital Gasthuisberg, in Leuven, Belgium experiences work-flow benefits with syngo DynaCT Cardiac

32 Taking Care of Children Combined imagingin pediatric cardiology

34 Hypoplastic Left Heart Syndrome Clinical case

Fluoroscopy

36 AXIOM Luminos TFDigital radiography in pediatric fluo-roscopy expedites clinical outcomes

38 Therapeutic Relief of Sigmoidal Volvulus under FluoroscopyClinical case

38 Pediatric Imagingwith AXIOM Luminos TF

26 Improved Efficiencyin the EP Lab


The first Ysio, a fully auto-mated digital radiography solution, was installed on May 20th, 2008 in Landes-krankenhaus Steyr, Austria. This hospital, along with another center in Enns, has 800 beds and a staff of 1,890. The radiology department provides im-

aging services for the two medical centers and performs approximately 39,000 imaging procedures for inpatients and another 70,000 for outpatients annually.The radiological department has a fully automated Ysio equipped with an integrated 43 x 43 cm detector in the wall stand and a 35 x 43 cm wireless mobile detector ( wi-D) in the table that can be used for table Bucky imaging or for free exposures. With this combination of automated tube movements, wireless detector technology and color touchscreen control on the tube, Ysio provides handling flexibility for the department to address their radiographic workload quickly and conveniently.On the first day, they performed their first study, a supine chest examination with the wi-D. Both the image quality and the easy handling of the wi-D were highly appreciated by the department and its users. At print time, the depart-ment has acquired over 5,000 images with Ysio and they are highly satisfied with their new digital radiography solution.

The new syngo iGuide application is available with the new Artis zee systems for interventional radiology and provides live and integrated needle guidance.

Dr. Lacey at Iowa Methodist Medical Center, USA, is one of our first customers to work with syngo iGuide on his new Artis zeego multi-axis system. He is convinced that the application leads to effective needle results, in three easy steps . The intuitive workflow of syngo iGuide makes planning of needle procedures easy and comfort-able for the user. The case above shows a type 2 endo-leak repair using syngo iGuide. The needle path was planned in the syngo DynaCT images and was overlaid on the live fluoro image to provide guidance during needle progression.

First Ysio installation at Landeskrankenhaus Steyr,Austria

Clinical results withsyngo iGuide – Endoleak Repair on an Abdominal Aortic Aneurysm

News

Ysio room – Prim. Dr. Harald Sandmayr (extreme right) and his staff

Landeskrankenhaus Steyr, Austria

Needle path planning

Progression view

Bulls eye view

Planned needle path on live fluoro


News

At this year’s European Congress of Radi-ology (ECR) in Vienna, more than three hundred customers participated in the hands-on workshops organized by the Siemens Healthcare Divisions Angiogra-phy, Fluoroscopy and Radiography (AX),

Computed Tomography (CT) and Magnetic Resonance Imaging (MR).Clinical presentations by leading experts were followed by demonstrations of clinical cases during which participants were guided through the processing tools available for the syngo Multi-Modality Workplace platform. Sitting at one of the sixteen worksta-tions, radiologists and technologists from over fifty countries had the oppor-tunity to discover the capabilities of syngo software. The angiography ses-sions focused on the usage of syngo DynaCT. Dr. Waggershauser from the University Hospital Munich explained the benefits of syngo DynaCT for abdominal procedures while Prof. Dr. Dörfler and Dr. Engelhorn from the University Hospital in Erlangen gave an

intensive overview of the main fields of interest for syngo DynaCT for neuro-radiology. The ECR hands-on workshops have now been compiled into a DVD that contains both the clinical presentations and the step-by-step hands-on demonstrations. These recordings offer over twelve hours of learning material and provide an easy way to get started or improve your skills on the state-of-the-art evaluations tech-niques that greatly enhance the diagnos-tic capabilities of AX, MR and CT.

Please feel free to order your free copy of the ECR HOW DVD via:

Get Your Free DVD of this Year’sECR Hands-on Workshop Sessions

NEU

The AXIOM Iconos systems are one of the most successful fluoroscopy plat-forms worldwide. There are installa-tions in almost every country. And hos-pitals use it every day in their clinical routine. In recent years the system proved to be a real workhorse. Due to its flexibility and the individual custom-ization options, the remote-controlled system meets virtually all the require-ments of its users without compromise. This spring the 3,000th system world-wide was installed.The 3,000th system went to the newly built University Hospital Puerta de Hierro Majadahonda in Madrid, Spain. With over 800 beds, the new hospital covers the northwest area of Madrid and offers clinical services to the public in many different clinical fields includ-

A True Icon in Fluoroscopy –3,000th AXIOM Iconos Delivered to Spain

Luis Ramos, MD, Head of X-ray department,in front of AXIOM Iconos R200

ing cardiology, pediatrics, obstetrics, vascular surgery, geriatrics. This site is a reference hospital in Spain in various clinical fields: it is widely recognized for its broad program of organ and tissue transplants as well as for the complexity of its clinical assis-tance cases. The facility purchased two AXIOM Iconos R200 systems to offer its patients improved comfort during examinations and provide the physi-cians greater ease of use, excellent im-age quality and diagnostic confidence. The digital AXIOM Iconos models can be easily integrated into the hospital’s RIS and PACS systems to store patient data and the clinical studies done on the systems. This is enabled by the FLUOROSPOT Compact digital imaging system.

www.siemens.com/ecr-how-dvd

DVD not available in the U.S.


Cover Story Titel


Artis zeego in the OR Cover Story

The Interventional Center Rikshospitalet in Oslo, Norway is a cutting-edge imag-ing department that is widely known for being at the forefront of medical technology and methodology. As part of a partnership with Siemens, the Cen-ter recently installed the Artis zeego, the newest generation of flexible inter-ventional imaging systems. The robotic technology built into the Artis zeego makes it possible to position the C-arm exactly according for the view required,

anywhere in a sphere around the pa-tient. The movement of Artis zeego can also be coordinated with the operating table. The coordination between the table and the C-arm means that the physician is allowed to operate at an optimal position. The advanced imag-ing capabilities of Artis zeego give the physician visual support beyond earlier technologies, and its software also helps physicians choose the optimal approach, says Erik Fosse, M.D., head of

Artis zeegoRobotic Technologywith Human Benefi tsWith the introduction of the Artis zeego, the fi rst multi-axis C-arm system based on robotic tech-nology from Siemens Healthcare, physicians at Oslo’s Rikshospitalet are achieving new levels of fl exibility, effi ciency and 3D imaging quality in a wide range of clinical environments, from cardi-ology, body and neurointerventional radiology suites to high-end imaging in the OR.

By Nils Lindstrand


Cover Story Artis zeego in the OR

Highlights of Artis zeego

Unique positioning flexibility

Frame rates from 0.5f/s to 7.5 f/s native, optional up to30 f/s

Large Volume syngo DynaCT for visualization of the whole abdomen and thorax.

Portrait syngo DynaCT increases coverage in the z-plane to image the complete thoracic aorta.

Flexible isocenter adepts table height to the surgeon’s needs

Table tracking automatically aligns the C-arm movements to the table position

Multiple park positions away from OR table

the Interventional Center at Rikshospi-talet in Oslo, Norway. The Center has been working with Artis zeego since December 2007, and doctors here are very satisfied with the new features it provides.Per Kristian Hol, M.D., manager of radi-ology research at the Interventional Center, agrees that this new generation of the Siemens C-arm systems, the Artis zee family for interventional imaging, provides enhanced support for critical decisions. “High quality 3D imaging, such as cross-sectional imaging with syngo DynaCT and others, has been sig-nificantly improved and is executed in real time, moreso than ever before,” says Hol. We used to have to wait for the 3D images that provide us with vital information, but Artis zeego has the capacity to create them in seconds. Needless to say this means a lot for a



team making critical decisions with very narrow margins.” Hol also points to the benefits of the new C-arm in planning surgical pro-cedures. “When we plan an operation in the limited space of an OR, the increased flexibility with Artis zeego means that we don’t have to restrict ourselves to avoid problems with the C-arm,” he says. “Instead, we can make the plan with a full focus on the patient and the best procedure for the opera-tion at hand.”

Rikshospitalet: A Leader in Medical R&D

Siemens Healthcare has been working with the doctors and engineers at Rik-shospitalet Intervention Center for many years, taking OR technology to new levels of flexibility and imaging quality. And the new techniques and knowledge that the facility has gained through this partnership also has a ripple effect. The Intervention Center welcomes visiting colleges virtually every week, and has invested in very advanced systems for broadcasting operations to other hospitals and medi-cal universities all over the world.“The Intervention Center at Rikshospita-let is set up to be a department for the development of new procedures and the introduction of new technologies,” says Fosse. “The traditional way of do-ing this has been to just carefully imple-ment them when treating patients. But with healthcare putting increasingly ad-vanced technology into service, becom-ing more industrial if you like, we saw the benefits of setting up a department dedicated to development and working in pretty much the same way as a simi-lar department would do in industry.” What the department is doing with the Artis zeego is therefore a natural pro-cess, including hosting a staff of equal numbers of doctors and engineers.“One of the things we are working on is improving the benefits of Artis zeego even further by designing and building a new lighting system,” says Fosse. “We

“When we plan an operation in the limited space of an OR, the increased fl exibility with Artis zeego means that we don’t have to restrict ourselves to avoid problems with the C-arm.”Per Kristian Hol, MD, Manager of Radiology Research at the Interventional Center,Rikshospitalet, Oslo, Norway

The unique park postions of Artis zeego are extremely helpful to keep the system out of the way when not needed and create sufficient space round the operating table.

With the C-arm stored away, there is always enough space for the anesthesia equipment and free access to the head of the patient.


Cover Story Artis zeego in the OR

have bought an LED system designed for follow-spots in the theater. This al-lows us to place the operating lamps at a greater distance, thus giving ourselves and the C-arm a better chance to move without blocking the light, and avoiding

hitting the lamps.”The lighting system is not yet complete-ly finished; the software still has to be further developed. But when the project is finished, the surgeons will finally be able to get both good lighting and the

full support of the C-arm wherever they need to move around the patient.“Surgeons have been striving for many years to get better access to the patient when operating,” says Fosse. “With Artis zeego and the new lighting system, we



[email protected]

will really have come a long way towards the optimal solution.”

Artis zeego: A Versatile Tool

Artis zeego could be considered the ultimate technological answer to the development of new procedures and new working environments like the hybrid room. When hospitals bring radi-ology and cardiology together with the surgeons, the flexibility and imaging ca-pacities of the Artis zeego provides the optimal support for the team at work.“The new technologies help us to create better hybrid rooms,” says Fosse. “Well-functioning hybrid rooms mean we can save lives, and allow us to always choose the least invasive procedures. This means less risk for the patient and shorter hospitalization as well as huge cost savings for society.”Radiologists and cardiologists have been performing more and more advanced interventions, and even though they perform them well, this means greater risks if the planned procedure needs to be changed for any reason.Hol is equally positive about working in the hybrid room, and agrees that the new technologies such as Artis zeego mean new ways to improve procedures. “By combining knowledge and technolo-gies from radiology, cardiology and sur-gery, we may even develop new tailor-made procedures and techniques,” he says. “It is also a major improvement that the advanced imaging systems can give you immediate confirmation that the procedure was performed correctly and gave the expected results. When

expertise and technology are scattered, you always are at risk of losing precious time if something needs to be adjusted. The Artis zeego decreases that risk.”The Artis zeego C-arm offers better sup-port for physicians across any clinical environment, from body and neuroint-erventional radiology suites to ORs and hybrid rooms. The adjustable isocenter enables off-center rotational angiogra-phy for all parts of the body. 3D imaging techniques include Siemens technolo-gies like syngo DynaCT, syngo iPilot and syngo iGuide.syngo iPilot enables faster and more precise catheter navigation through 3D roadmapping that superimposes 3D re-constructions onto live 2D fluoroscopy images, 2D roadmaps or digital subtrac-tion angiography (DSA). The application provides real-time updates of C-arm and table movements, as well as changes in zoom and source-to-image distance.syngo iGuide is designed to bring nee-dle procedures back into the interven-tional suite, allowing them to be execut-ed faster and with greater confidence. All in all, the Artis zeego C-arm has re-moved numerous obstacles for the doc-tors at Rikshospitalet in their pursuit of the ideal environment for invasive pro-cedures. It’s a happy combination of ad-vanced technology that benefits physi-cians and patients alike.

Nils Lindstrand is a freelance business, medical and technology writer based in Stockholm, Sweden.

“Surgeons have been striving for many years to get better access to the patient when operating. With Artis zeego and the new lighting system, we will really have come a long way towards the optimal solution.”Erik Fosse, MD, Head of the InterventionalCenter, Rikshospitalet, Oslo, Norway


Kategorie Titel

SurgeryOpens up to New Treatment MethodsRecent developments in cardiac surgery have led to new therapies integrating surgical procedures with skin incisions and interventions, e.g. trans catheter techniques with the puncture of a vessel. For these proce-dures, integrated operating rooms are needed. In addition to surgical equip-ment, these hybrid operating rooms need high-end imaging equipment equivalent to the angiography devices used in interventional radiography and cardiology.

By Prof. Dr. Georg Nollert


Titel Kategorie


Special New Trends in Surgery

Basics of the hybrid room

There is no doubt that an interdisciplin-ary team of surgeons, interventionalists, anesthesiologists, and other associated specialists should plan and run such a facility. Centers in close proximity to in-tervention rooms and ORs probably have better prerequisites than hospitals with the classic separation that placed inter-ventional rooms in the internal medicine building and operating theaters in the surgery building. In this situation, it is recommended to install the hybrid room in the surgical wing, where all OR equip-ment and personnel (e.g. heart-lung machine and perfusionists), anesthesia and surgical intensive care are readily available. Reasonable proximity of the hybrid room to other imaging systems like computed tomography scanning or magnetic resonance imaging should also be taken into consideration.A hybrid OR should be larger than a standard OR and the basic principle for planning is “the larger the better”, be-cause not only the imaging equipment needs sufficient space. Staff calcula-tions have shown that in hybrid proce-dures up to 18 people need to be in the hybrid room. Experts recommend 70 m2 for new ORs being built. Additional space for a control room is mandatory.

If a fixed C-arm system is being consid-ered, 45 m2 space is the lower limit. Lead shielding (2-3 mm) will need to be built into existing rooms. In some coun-tries, special training for the use of X-ray devices may be required. In general, all members of the team need access to all important informa-tion. Therefore, multiple moveable and flexible booms need to be installed in the operating room. If there are two booms to be installed, a boom on every side of the OR table serves the opera-tive team. Collision of the ceiling-mounted displays with operating lights or other ceiling-mounted equipment should be avoided. A dedicated ceiling plan with all ceiling-mounted compo-nents including air conditioning should be drawn to ensure the function and usability of all devices.

New therapies have emerged

Pediatric hybrid operations, hybrid coro-nary revascularization, transcatheter valve replacement and repair, or stent-graft placement in the thoracic aorta are new developments that are ideally performed in a hybrid operating room. Although hybrid therapies were first de-veloped in a close collaboration be-

tween pediatric cardiology and pediatric cardiac surgery, currently the strongest driver for hybrid therapies is transcathe-ter replacement of the stenotic aortic valve.

Trends in pediatric cardiac surgery

Surgery remains the treatment of choice for most congenital cardiac malforma-tions. But interventional cardiology ap-proaches are increasingly being used in simple and even complex lesions. The percutaneous approach can be challeng-ing due to low patient weight or poor vascular access. The passage of large catheters through the heart in small in-fants may result in rhythm disturbances and hemodynamic compromise. Diffi-cult and complex anatomy such as in double-outlet right ventricle or transpo-sition of the great arteries, or acute turns or kinks in the pulmonary arteries in tetralogy of Fallot patients can make percutaneous procedures challenging if not impossible. Surgery also has its limi-tations, when it comes to operative clo-sure of multiple apical muscular ventric-ular septal defects, adequate and lasting relief of peripheral pulmonic stenosis, or management of a previously implanted

Imaging devices have been used in operating theaters for a long time. Mobile C-arms, ultrasound, and endoscopy are standard of care for many operations. However, complex transcatheter techniques demand high powered equipment to visualize thin guidewires, quantify small vessel diameters, and evaluate delicate anastomoses. Because of their size and complexity, these integrated endovascular suites or hybrid ORs require special consideration, planning, and design as well as new skills to be learned by the surgical team.


New Trends in Surgery Special

stenotic stent. Furthermore, in some complex malformations, the presence of multiple ventricular septal defects in-creases the mortality risk, because they are difficult to access by surgery. Com-bining interventions and surgery into a single therapeutic procedure reduces complexity, cardiopulmonary bypass time, risk, and improved outcomes.

New possibilities for heart patients

Surgical and percutaneous coronary ar-tery interventional revascularization are traditionally considered isolated op-tions. A simultaneous hybrid approach may allow an opportunity to match the best strategy for a particular anatomic lesion. Revascularization of the left an-terior descending artery with the left in-ternal mammary artery is by far the best treatment option in terms of long-term results. Integrating this therapy with percutaneous coronary angioplasty of-fers multi-vessel revascularization through a mini-thoracotomy. Particular-ly in high risk patients, morbidity and mortality decreases compared to con-ventional surgery. Reasons are the avoidance of cardiopulmonary and its bypass-related morbidity, no manipula-

tion of the aorta, which reduces the chance of potentially fatal emboli, and the low surgical trauma by using mini-mally invasive techniques. Hybrid revas-cularization is currently performed only in a few centers worldwide. One reason is the real challenge regarding logistics, because an interventional and surgical team have to work together, and the en-vironment in which to perform this therapy – a hybrid room – is scarce. But in the end, a higher number of repeat interventions compared with off-pump coronary artery bypass grafting was seen, because the stented vessels had a higher occurrence of restenoses. How-ever, with the advent of drug-eluting stents, the reintervention rate de-creased. A recent feasibility study from the University of Maryland evaluated 13 patients with multi-vessel coronary ar-tery disease who underwent left inter-nal mammary artery-to-LAD minimally invasive direct coronary bypass per-formed through a lateral thoracotomy, followed by stenting of non-LAD le-sions, in a fluoroscopy-equipped operat-ing room. These patients had a more than 40% decreased length of stay and a more than 90% decrease in intubation times. Despite aggressive anticoagula-tion and confirmed platelet inhibition, the patients had less blood loss and de-

creased transfusions. Six-month angio-graphic vessel patency and major adverse cardiac events were similar in the hybrid and off-pump coronary artery bypass groups. These clinical ad-vantages will probably lead to a spread of hybrid revascularization techniques when hybrid rooms become more com-monly available.

Trends in transcathetervalve therapy

Transcatheter valve therapies are cur-rently developed for the most common valve diseases: mitral valve regurgita-tion, aortic stenosis, and – in children – pulmonary valve disease. For repair of mitral regurgitation, more than 30 de-vices are currently under investigation and await market approval. Experimen-tally, prostheses for mitral und tricuspid valve replacement are under develop-ment and certainly will be available within the next several years.Aortic stenosis is the most frequent ac-quired heart valve lesion in developed countries. Conventional aortic valve replacement for aortic stenosis is based upon standardized guidelines with ex-cellent outcomes particularly in younger patients at relatively low risk. Advanced

1 CoreValve

1 2 43

2 Edwards Sapien protheses 3 Transapical technique 4 Transfermoral technique


Special New Trends in Surgery

age and severe co-morbidities lead to an increased surgical risk. Cardiologists are reluctant to refer these patients to sur-gery, because they are considered to be ‘too sick’, although conservative treat-ment of aortic stenosis carries a fatal prognosis. Low-risk, minimally invasive techniques are needed to treat these very high-risk patients.

Transcatheter aortic valve replacement (TAVR)

In 2002, Cribier reported the first human transcatheter aortic valve re-placement (TAVR) using a transfemoral, antegrade, transseptal approach.Subsequently two valves were intro-duced to the market, i.e., the CoreValve and the Edwards Sapien prostheses (Fig. 1 and 2)1 . Both valves have some similar funda-mental design features, including xeno-genic pericardial valve cusps and a compressible stent suspending these cusps allowing for transcatheter deliv-ery. There are, however, significant differences. The CoreValve prosthesis has an approximately 50 mm long self-expanding nitinol stent, with a tubular ‘hour glass’ shape that can deploy in the aortic root, above the level of the coro-

nary artery ostia, and a wide mesh allowing for unobstructed coronary flow. The Edwards Sapien prosthesis has a 14 – 16 mm balloon-expandable straight-tube steel stent, mimicking a standard stented bioprosthetic valve. It is strictly deployed within the aortic an-nulus and sits in a subcoronary position in vivo. With regard to the leaflet cusps, the CoreValve device is constructed of porcine pericardium, whereas the Edwards Sapien device utilizes bovine pericardium. Three generations of the CoreValve device have been implanted, the 24F, 21F, and now the 18F prosthe-ses. Two inflow diameters, 26 and 29 mm, are available, allowing for suffi-cient oversizing. With the Edwards Sapi-en valve, diameters of 23 and 26 mm are offered. A 29 mm prosthesis is un-der development. Current sheath diam-eters for transfemoral implantation are 22F and 24F, with smaller versions on the horizon. Implantations have been performed using both the transfemoral and the transapical route with each de-vice. Up to now, more than 1,000 pa-tients have received a CoreValve or an Edwards Sapien prosthesis. In parallel with the development of the transfem-oral technique (Fig. 3), the direct, antegrade, transapical technique was explored (Fig. 4). The first successful

transapical valve implantations using an oversizing technique were published in summer 2006. When both tech-niques are compared, stroke risk was demonstrated to be lower with the transapical approach, which could be related to less aortic manipulation. A second important complication of TAVR is the high incidence of AV block, which is obviously valve-dependent and re-ported to be higher with the CoreValve.ATS, JenaValve, Sorin, and Ventor, among other companies, are currently conducting experimental evaluations and are on the verge of clinical implan-tations. Further systems for TAVR includ-ing the Lotus, AorTx, the Direct Flow Medical valve and the PercValve are un-der development and further systems will follow. For TAVR, valve positioning remains the most critical part of implantation with the risk of coronary artery obstruction and the risk of paravalvular leak. Exact positioning, optimal imaging during im-plantation and an experienced team performing the procedure are critical. TAVR requires some specific equipment. A hybrid operative theater is the ideal setting for TAVR and is recommended by the European Association for Cardio-Thoracic Surgery. The hybrid OR offers the sterile environment with emergency

5 6

5 AXIOM Artis U, the room-mobile systemfor small ORs.

6 Artis zee floor-mounted systembrings high-end imaging to the OR.


New Trends in Surgery Special

back-up measures and the angiographic imaging technology needed in the cath-eterization laboratory. Excellent imag-ing capabilities are the most important criterion for exact valve positioning and thus optimal patient outcome. The over-all setting of a hybrid operative theater is of specific value most importantly when emergency cardiopulmonary by-pass or conversions to conventional sur-gery are required. This life-saving effect has certainly been demonstrated in some of the current studies. In addition to the environment, a dedicated team of cardiologists, cardiac surgeons, anes-thetists, scrub nurses, and technicians are necessary for successful TAVR. In some centers the same integrated team performs both transfemoral and transapical approaches. TAVR is not a mature method yet; expe-rience with it is limited and long-term results lacking. The clinical value has to be proven in a randomized, controlled trial. Without the results of such a com-parison, the excellent long-term results of conventional aortic valve replace-ment make this therapy the gold stan-dard. Patients with an acceptable risk profile should therefore continue to un-dergo the standard therapy. However, in the long run, valve therapy – for all valves - will certainly change from con-

ventional surgery with cardiopulmonary to the less invasive catheter techniques.

A whole new spectrumof therapies

The hybrid operating room facilitates a whole new spectrum of cardiac surgical therapies and will therefore become an essential resource of every cardiac cen-ter. The trend towards hybrid tech-niques is more a revolution than an evo-lution. Stanford University is already including catheter techniques into train-ing of cardiovascular surgeons. Within only two years the majority of all Ger-man heart centers started planning a hybrid OR. Cardiac surgeons around the world emphasize that cardiac surgery is moving rapidly towards the hybrid pro-cedure and that the change is now, not in 5 years. Siemens Healthcare has recognized these trends in surgery and offers a complete portfolio of high-end angiog-raphy systems for imaging in an OR en-vironment. From a semi-mobile system for smaller ORs to the flagship of inno-vation Artis zeego, the new angiogra-phy system based on robotic technology, Siemens delivers floor- and ceiling-mounted systems dedicated to surgery procedures. Especially Artis zeego with

its flexible patient access, outstanding 3D imaging capabilities and its variable iso-center make Artis zeego an ideal system for imaging in the OR.

References1. Walther T, Chu MW, Mohr FW. Transcatheter aortic valve implantation: time to expand?Curr Opin Cardiol. 2008 Mar;23(2):111-6.

2. Vahanian A, Alfieri OR, Al-Attar N, Antunes MJ, Bax J, Cormier B, Cribier A, De Jaegere P, Fournial G, Kappetein AP, Kovac J, Ludgate S, Maisano F, Moat N, Mohr FW, Nataf P, Pierard L, Pomar JL, Schofer J, Tornos P, Tuzcu M, van Hout B, von Segesser LK, Walther T. Transcathe-ter valve implantation for patients with aortic stenosis: a position statement from the Europe-an Association of Cardio-Thoracic Surgery (EACTS) and the European Society of Cardiology (ESC), in collaboration with the European Asso-ciation of Percutaneous Cardiovascular Inter-ventions (EAPCI). Eur J Cardiothorac Surg. 2008 Jul;34(1):1-8.

3. Reicher B, Poston RS, Mehra MR, Joshi A, Odonkor P, Kon Z, Reyes PA, Zimrin DA. Simulta-neous “hybrid” percutaneous coronary interven-tion and minimally invasive surgical bypass grafting: feasibility, safety, and clinical out-comes. Am Heart J. 2008 Apr;155(4):661-7

4. Bacha EA, Marshall AC, McElhinney DB, del Nido PJ. Expanding the hybrid concept in con-genital heart surgery. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2007:146-50. Review.

[email protected]

7 8

7 Flexibility and whole body coverage is provided by the Artis zee ceiling-mounted solution.

8 Flexible park positions, variable iso-center and new 3D imaging capabilities are possible only with Artis zeego.


Angiography Large Volume syngo DynaCT

Patient history46-year-old morbidly obese female presented with high fevers, chills and lower abdominal pain. Her condition rapidly worsened to include lethargy and hypotension.

DiagnosisPyelonephritis and urosepsis. The etiolo-gy was found to be ureteral obstruction of an ectopic right pelvic kidney on a multidetector CT scan of the abdomen and pelvis. An attempt to treat the obstruction using cystoscopy resulted in inadvertent ureteral perforation with placement of a double J ureteral stent outside of the collecting system. The patient’s condition continued to deterio-rate requiring urgent placement of a percutaneous nephrostomy tube under general anesthesia.

TreatmentMultiple Large volume syngo DynaCT acquisitions with Artis zeego were per-formed to guide a 22-gauge Chiba nee-dle into the posterior calyx of the ecto-pic pelvic kidney. The ectopic position πof the kidney left only a narrow win-dow for percutaneous access requiring passage through the psoas muscle to a depth of 20 cm. After access was ob-tained, fluoroscopy was used to position a 10 French nephrostomy tube within the renal pelvis.

CommentsFollowing nephrostomy tube placement and medical management, there was complete resolution of the patient’s uro-sepsis.

Percutaneos Nephrostomy for an ObstructedEctopic Pelvic Kidney in an Obese PatientSupported by Artis zeegoand Large Volume syngo DynaCTWarren Swee, MD, MPHDivision of Angiography and Interventional Radiology, Department of RadiologyUniversity of Virginia Health System, Charlottesville, VA, USA

[email protected]

Dr. Warren Swee and the new Artis zeego multi-axis system at UVA

AcknowledgementsI would like to thank Zachary Ryan, R.T. (R) for his assistance in image acquisi-tion.


Large Volume syngo DynaCT Angiography

1A

2A

3A

1B

2B

3B

2 A+B Axial and sagittal MIP (maxi-mum intensity projection) recon-structions of a Large Volume syngo DynaCT acquisition to demonstrate successful access to the renal collect-ing system. A previously placed mal-positioned double J ureteral stent is also seen. (*)

3 A+B Axial and sagittal MIP recon-structions of a Large Volume syngo DynaCT acquisition demonstrate suc-cessful placement of a percutaneous nephrostomy tube within the renal pelvis.

1 A+B Axial Large Volume syngo DynaCT images demonstrate a narrow window to access the ectopic pelvic kidney (Kid) between the spine and liver (Lv). Fig 1 shows the first needle pass to be directed laterally toward the liver capsule. Fig 2 shows successful redirection of the needle along the intended course through the psoas muscle (PM). Due to massive percutaneous fat issue, a Large Volume syngo DynaCT acquisition is extremely helpful.

2 a+b The electromagnetic tracking shows progression of the needle into the soft tissue mass.


Angiography Electromagnetic Needle Guidance

Patient history68-year-old female with known renal cell carcinoma first diagnosed in 1996 with worsening pain in the upper thoracic spine. Patient showed discrete paresis of the left arm, but no other neurologic deficit.

Pre-treatment ImagingMRI of the spine revealed a large metas-tasis with destruction of the second thoracic vertebra and extensive intraspi-

nal and paravertebral infiltration and slight compression of the myelon (Fig 1). The lesion extends to the trachea and the aortic arch ventrally and the lungs laterally. No other spinal metastases were detected.

TreatmentThe patient was considered inoperable concerning tumor resection and verte-bral body replacement. Thus radiofre-

quency ablation and subsequent radia-tion therapy was planned. For radio-frequency ablation, first imaging with syngo DynaCT was performed.The electromagnetic tracking system iGuide CAPPA, which superimposes the puncture needle on the syngo DynaCT data set, was used for precise place-ment (Fig. 2 a + b). Then the electrodes were introduced through the puncture needle. The final position achieved

Radiofrequency Ablationof a Large Vertebral MetastasisUsing iGuide CAPPAElectromagnetic Needle GuidanceProf. Martin Skalej, MD, Oliver Beuing, MD, Anja Lenz, MD Department of Neuroradiology, University of Magdeburg, Germany

1 2a

1 T1-weighted image without gadolinium enhancement demonstrates large metastasis with intraspinal growth and extension to the lungs, the aortic arch, the trachea and the esophagus.


Electromagnetic Needle Guidance Angiography

[email protected]

3 Documentation of the final position of the electrodes with syngo DynaCT. The image was reconstructed at a syngo X Workplace.

32b

according to the electromagnetic track-ing system was confirmed by another syngo DynaCT run (Fig. 3) and the abla-tion was conducted with a total energy of 40 kJ. The patient tolerated the inter-vention without any complication, pain improved immediately after the proce-dure.

CommentsThe electromagnetic tracking system in combination with syngo DynaCT allows precise placement of electrodes or bi-opsy devices even in regions that are difficult to evaluate with fluoroscopy or where critical anatomic structures not visible with fluoroscopy alone must be avoided. The tracking system provides excellent depiction of the progression of the needles and anatomic detail is provided by syngo DynaCT. Also no fur-

ther imaging is necessary during the intervention. X-ray exposure to the examiners is reduced when compared to interventions performed under CT-fluoroscopy guidance. If wanted, a control scan can be performed to docu-ment the final position.


Angiography Imaging Technology in South America

In December 2007, the President of Chile, Michelle Bachelet, inaugurated the first AXIOM Artis dBA with syngo DynaCT in South America. The system was installed at Neurosurgery Institute in Santiago. The renowned institute is the most prestigious in Chile and the first in South America with an installed biplane FD Artis angiography system from Siemens.

A great imaging tool

President Bachelet and the Minister of Health, Soledad Barría, had the opportu-nity to see the system in action. Dr. Jaime Lavados, Director of the institute and Dr. Eduardo Bravo, Head of the Neuroradiology Department, presented the various benefits and features of the new AXIOM Artis biplane system. The system is equipped with the syngo DynaCT application to create cross-sec-tional images during an angiography procedure, which had helped us reach a fast and reliable treatment decision in 121 procedures performed between June 2007 and January 2008. The insti-

tute confirms that the application is a great imaging tool and has fast acquisi-tion and processing times.

“For us AXIOM Artis dBA is special in two ways”, says Dr. Bravo. “The two C-arms allow us to acquire two views

State-of-the-Art Imaging TechnologyRaises Healthcare in South America to a New Level High-end 3D imaging with reduced dose and other

innovative medical imaging is important and a mat-ter of fact in highly developed countries like the U.S, Canada, Japan, or the European Union. For South America this is still not the standard equipment for hospitals. With the biplane AXIOM Artis dBA the Neurosurgery Institute of Santiago, Chile, became the fi rst public hospital in South America with new high-end medical imaging equipment.

President of Chile, Michelle Bachelet, and the team of the Neuroradiology Departmentat the Neurosurgery Institute in Santiago, Chile

Source: Presidency of the Republic of Chile


Imaging Technology in South America Angiography

during a neuroradiological intervention, so we can see the same pathology in two different planes, which provides us with a 3D view of millimetrical struc-tures for greater safety in our work and minor risk for the patient.”The other great benefit is that it enables the physician to see complications in the treatment of patients in the same room without moving the patient to an-other imaging modality. “Without mov-ing the patient, it is possible to see any kind of complication during treatment in a very user-friendly way”, affirmed Bravo.

Improved patient care

Among advanced imaging capabilities, AXIOM Artis dBA brings other advantag-es to the facility. Dr. Bravo is very satis-fied with the new system, mainly be-cause it is the first in a public hospital in South America and because of the fi-nancial benefits. “Working with the bi-plane system reduces the expenses for contrast agent and speeds up the proce-dure because it is not necessary to change C-arm positioning during the procedures,” he explains.At the end of February 2008, the same

institute hosted a workshop with 37 Latin American neuro-interventionalists focusing on syngo DynaCT and how its soft tissue imaging capabilities can dis-play details that no other angiography system on the market can offer. These details range from hemorrhages in the brain to stent visualization. Many live cases were discussed with the partici-pating radiologists who also confirmed the high clinical value of syngo DynaCT.

[email protected]

1 Vertebral aneurysm treated with stent and coils. The 6 months control angiography and syngo DynaCT showed stent herniation into the embo-lized aneurysm.

2 Cavernous segment aneurysm treated with a cardiological stent visualized with syngo DynaCT MIP images.

3 Ruptured basilar tip aneurysm treated with stend and coils. The stent was positioned from the basilar artery to the right P1 segment.

1 32

“Working with the biplane system reduces the expenses for contrast agent and speeds up procedures because it is not necessary to change C-arm positioning during the procedures.”Dr. Eduardo Bravo, MD, Head of Neuroradiology Department,Neurosurgery Institute in Santiago, Chile


Cardiology Effi ciency in EP

At the University Hospital Gast-huisberg in Leuven, Belgium syngo DynaCT Cardiac has become a useful application during ablation therapy. The team in the cardiology depart-ment describes their experiences with the system and how it contrib-utes to an effi cient workfl ow and excellent results.

Image integration for ablation of atrial fi brillation

Pre-procedural imaging and three-di-mensional (3D) reconstruction of the left atrium and pulmonary veins is per-formed in the majority of centers before atrial fibrillation (AF) ablation proce-dures.1 Detailed anatomical information can help achieve a more effective and successful ablation and may prevent procedure-related complications. Pa-tient-specific 3D models can be integrat-

Improved Effi ciency in the EP Labwith syngo DynaCT CardiacBy Joris Ector, M.D., Stijn De Buck, M.Sc., Ph.D., Hein Heidbuchel, M.D., Ph.DDepartment of Cardiology, University Hospital Gasthuisberg, Leuven, Belgium

ed with 3D mapping systems. The Uni-versity Hospital Gasthuisberg pioneered integration of 3D models with real-time biplane fluoroscopic imaging to guide catheter navigation and ablation.2 Image integration is usually based on cardiac CT or MRI images that are acquired prior to the procedure, and reconstructed into a 3D model for treatment planning. One drawback of this approach is the possibility of changes in the left atrial geometry between imaging and the ablation procedure due to differences in


Effi ciency in EP Cardiology

cardiac loading conditions, resulting in inaccurate image integration during the procedure. Moreover, an additional am-bulatory hospital visit or earlier hospital-ization is often required for the patient to acquire the images necessary for 3D reconstruction. This leads to extra logis-tical overhead. syngo DynaCT Cardiac now offers the possibility of CT-like imaging of the left atrium and pulmonary veins during the ablation procedure. At the beginning of 2008, we evaluated a new workflow in which syngo DynaCT Cardiac images were acquired during AF ablation proce-dures and reconstructed into a 3D mod-el for integration with biplane fluoro-scopic imaging. Catheter navigation and ablation were guided solely by syngo DynaCT Cardiac-based 3D-fluoroscopy integration, without the use of a 3D mapping system. Our goal was to devel-op a workflow resulting in high quality 3D reconstructions of the left atrial anatomy with the lowest possible pa-tient radiation exposure, eliminating the need for additional pre-procedural im-aging and improving image integration accuracy.

Imaging the left atrium with a single C-arm rotation

syngo DynaCT Cardiac offers the possi-bility for both ungated image acquisi-tion with a single 5-second C-arm rota-tion over 200°, and an ECG-gated image acquisition using 4 sequential 5-second rotations with retrospective ECG gating. To reduce patient radiation dose, we opted for the ungated acquisition proto-col. Images are acquired at 60 frames

per second during a single 5-second ro-tation and were automatically trans-ferred to the Siemens Workplace for 3D reconstruction to axial images and fur-ther 3D processing (Fig. 1 A-C). Whereas contrast administration for left atrial syngo DynaCT Cardiac examinations is conventionally performed in the pulmo-nary artery, we developed a new ap-proach in which diluted contrast agent is directly injected into the left atrium. To obtain optimal contrast filling and to reduce cardiac motion artifacts, contrast injection and syngo DynaCT Cardiac ac-quisition were performed after adminis-tration of adenosine-triphosphate (ATP) to induce transient ventricular asystole (Fig. 2 A) or during rapid right ventricu-lar pacing to reduce cardiac output and cardiac motion (Fig. 3 A-B). This ap-proach resulted in high quality 3D re-constructions of the left atrium and pul-monary veins, using only a limited dose of ionizing radiation and contrast agent. Given the excellent quality of syngo DynaCT Cardiac, pre-procedural imaging with Cardiac CT or MRI is no longer con-sidered necessary for clinical use in our center.

syngo DynaCT Cardiac for 3D image integration

In our opinion, one of the most impor-tant advantages of syngo DynaCT Cardiac lies in the new possibilities for 3D image integration. AF ablation pro-cedures are performed in our center under general anesthesia. As a result, no patient movements occur and patient position is identical during syngo DynaCT Cardiac acquisition and fluoroscopic im-

1A

1B

1C

1A Ungated syngo DynaCT Cardiacacquisition (after ATP)

1B 2D Slice Reconstruction

1c 3D Volume Renderingsyngo DynaCT Cardiac: (LA: left atrium, LV: left ventricle, RIPV: right inferior pulmonary vein, LSPV: left superior pulmonary vein, RSPV: right superior pulmonary vein, ap: anterior papillary muscle, pp: posterior papillary muscle, LAA: left atrial appendage)



2A syngo DynaCT Cardiac, ungated acquisition after ATP

2B Cardiac CT imageComparison of 3D surface models of the left atrium in the same patient, based on ungated syngo DynaCT Cardiac acquisition after administration of ATP and ECG-gated 64-slice cardiac CT. The quality and accuracy of the ungated syngo DynaCT Cardiac-based 3D model is remarkable. (RSPV: right superior pulmonary vein, RIPV: right inferior pulmonary vein, LSPV: left superior pulmonary vein, LAA: left atrial appendage, TS: transseptal sheath)

2A3A

3B

2B

Coronary Sinus Catheter

Coronary Sinus Catheter

4 B4 A

4 A+B Integration of syngo DynaCT Cardiac-based 3D model of the left atrium with fluoroscopy using Siemens syngo iPilot. Left: fluoroscopic image in the right anterior oblique view showing the ablation catheter (Abl) and circumferential mapping catheter (Lasso). Right: after syngo iPilot image integration of the syngo DynaCT Cardiac-based 3D model, the position of the ablation and mapping catheters at the ostium of the left superior pulmonary vein can be accurately determined. (Abl: ablation catheter, Lasso: circumferential mapping catheter, LA: left atrium, RSPV: right supe-rior pulmonary vein, RIPV: right inferior pulmonary vein, LSPV: left superior pulmonary vein, LAA: left atrial appendage)



5A

5B 5D

5C

5 A+B RAO view visualized with LARCA (Leuven Aug mented Reality for Catheter Ablation) software

5 C+D LAO view visualized with LARCA softwareBiplane integration of a syngo DynaCT Cardiac 3D dataset of the left atrium in the right-anterior oblique (RAO) and left-anterior oblique (LAO) imaging planes. A shaded and semi-transparent visualization of the 3D model are shown in the upper and lower panes respectively. Ablation target lines are indicated as yellow dotted circles . The position of the ablation catheter (Abl) and the circumferential mapping catheter (Lasso) can be accurately depicted relative to the ostium of the left inferior pulmonary vein (LIPV), as shown in the semi-transparent LAO view. (TS: transseptal sheaths, Abl: ablation catheter, Lasso: circumferential mapping catheter)



University Hospitals Leuven, CampusGasthuisberg

With 1,894 patient beds and 8,447 employees, the University Hospital Leuven is Belgium’s largest medi-cal institution. Recently, the Medical Imaging Cen-ter was identified as a new interdisciplinary research center, with a central position in the University Hospital Gasthuisberg. The center is a joint initiative of the University of Leuven (faculties of medicine and engineering) and the University Hospitals Leu-ven. Over 80 engineers, physicians and physicists from ESAT/PSI, Radiology, Nuclear Medicine, Cardiol-ogy and Radiotherapy are working closely together on innovative imaging applications.

aging. The location of the reconstructed 3D model relative to the fluoroscopic im-aging geometry is therefore precise and exact. Using the Siemens syngo iPilot function, syngo DynaCT Cardiac-based 3D volumes can be accurately projected as a 3D overlay on fluoroscopic images in the primary imaging plane (Fig. 4). Automatic syngo DynaCT Cardiac inte-gration in a biplane fluoroscopy environ-ment is already performed in our re-search setting using in-house developed software (Leuven Augmented Reality for Catheter Ablation, LARCA, Fig.5). It may be available in later versions of systems using syngo DynaCT Cardiac, further in-creasing the value of 3D-fluoroscopy in-tegration. Moreover, 3D overlay provides direct image integration with electro-anatomical mapping systems, obviating the need for registration with 3D geom-etries acquired with a roving catheter and thereby reducing the duration of the procedure.

References1. Calkins H, Brugada J, Packer DL et al. HRS/EHRA/ECAS expert Consensus Statement on catheter and surgical ablation of atrial fibrilla-tion: recommendations for personnel, policy, procedures and follow-up. A report of the Heart Rhythm Society (HRS) Task Force on catheter and surgical ablation of atrial fibrillation. Heart Rhythm 2007; 4(6):816-861.

2. Ector J, De Buck S, Huybrechts W et al. Bi-plane three-dimensional augmented fluorosco-py as single navigation tool for ablation of atrial fibrillation : accuracy and clinical value. Heart Rhythm 2008;In Press.

[email protected]



“Given the excellent image qual ity with syngo DynaCT Cardiac, pre-procedural

imaging with cardiac CT or MRI is no longer considered nec essary for

clinical use in our center.” Joris Ector, M.D., Department of Cardiology, University Hospital Gasthuisberg, Leuven, Belgium

Left to right: Prof. H. Heidbüchel, MD, J. Ector, MD, PhD, S. de Buck, PhD


With the unique transfer shell system, patient trans-fer from the MRI system to the Artis cardiovascular imaging system is fast, smooth and easy. Specially floor-embedded motorized rails allow the table of the angiography system to be moved conveniently between modalities.

Cardiology Pediatric Cardiac Surgery

MR table integration with angiographic tabletop


Unlike other medical disciplines there has been a long and productive relation-ship between the pediatric cardiologist and cardiovascular surgeon, together focusing on improving the lives of chil-dren with congenital heart lesions. This cooperative spirit found its origins, when in November 1944, Dr. Alfred Bla-lock, encouraged by Dr. Helen Taussig, performed the first arterial shunt, set-ting the stage for a revolution in cardiac care. That spirit continues today in very specialized centers dealing with con-genital heart disorders like The Hospital for Sick Children in Toronto, Canada. With the development of percutaneous techniques for cardiovascular interven-

tion, treatment plans have evolved that utilize the unique attributes of what at first may seem like competitive special-ties, but have come together, as Taussig did with Blalock, to develop new tech-niques and management strategies. The case presented on the following pages is one such contemporary example, that of management of the newborn with hypoplastic left heart syndrome. The treatment algorithm was bilateral pul-monary artery banding and placement of a ductal stent in a hybrid surgical an-giography suite, with prior cardiac MR imaging, and transfer on Siemens Miya-bi system from the MRI scanner to the hybrid room for angiography.

With this system combination, workflow is streamlined, all anatomical data is available prior to the surgery and the complete treatment can be done under the same anesthetic. The MIYABI con-cept offers flexibility for system usage, as both systems can be operated sepa-rately as well. But when used together, they become a very powerful high-per-formance interventional system. The availability of two imaging technologies during interventional procedures and the convenient way to move the patient from one system to the other quickly and easily supports an optimized treat-ment and gives seriously ill children new hope.

Taking Care of ChildrenPediatric cardiology has always been a special fi eld with special requirements. Reduced radiation exposure and state-of-the-art imaging are required to treat complex cases such a hypoplastic left heart syndrome. The MIYABI concept combines MRI and angiography systems from Siemens Healthcare to optimize these procedures.

Pediatric Cardiac Surgery Cardiology

“With the MIYABI concept we were able to get more imaging information during complex procedures under the same anesthetic. This improves workfl ow and avoids two procedures”

Lee N. Benson, MD, The Hospital for Sick Children, Toronto, Canada


Cardiology Pediatric Cardiac Surgery

Patient history3-day-old baby boy, weight 2.5 kg.

DiagnosisHypoplastic left heart syndrome.

Therapy planningAt three days of life, after consultation with the family, the management deci-sion was to follow single ventricle pallia-tion towards an eventual Fontan proce-dure. The first stage of palliation was either a standard Norwood operation or

a hybrid procedure. Because of the child’s size it was determined that the hybrid procedure would be a better option.

TreatmentThe child was anesthetized and under-went a pre-procedural MRI to define the anatomy. (Fig. 3) Following the MRI, the child was moved into the angiogra-phy suite while under the same anes-thetic. A bilateral pulmonary artery banding procedure and insertion of a

stent into the arterial duct through the main pulmonary artery was successfully performed.

CommentsThe child recovered well, was extubated on day three following the procedure and returned home on day seven.

Hypoplastic Left Heart SyndromeCombined Imaging –Angiography and MRILee N. Benson, M.D. The Hospital for Sick Children, Toronto, Canada

[email protected]

Treatment at the biplane AXIOM Artis dBC angiography system with the C-arm in park position for best patient access.


Pediatric Cardiac Surgery Cardiology

1 Placement of sheath into main pulmonary artery for insertion of the stent into the arterial duct.

2 Band (white) around right pulmonary artery.

3 MR image of hypoplastic left heart syndrome before hybrid treatment.

4 Banded pulmonary arter-ies, Patent Ductus Arterious injection.

5 Opened stent in PDA.

6 Angiogram of ductal stent in position.

3

5

1

4

6

2

The Hospital for Sick Children (SickKids), affiliated with the University of Toronto, is Canada's most

research-intensive hospital and the largest center dedicated to improving children's health in the country.

Its mission is to provide the best in family-centered, compassionate care, to lead in scientific and clinical

advancement, and to prepare the next generation of leaders in child health.

www.sickkids.ca


Tailored for optimalpatient care

The open design of AXIOM Luminos TF facilitates easy and comfortable access to the patient. The large distance be-tween the tabletop and digital imaging tower as well as a wide tabletop make user perform patient repositioning more conveniently.All operator controls are within easy reach during the procedure, allowing the operator to select organ programs and control radiographic parameters di-rectly in the examination room.

Fast diagnosisby the patient’s side

Digital radiographic exposures in addi-tion to fluoroscopy can be acquired di-rectly in the fluoroscopic suite with the integrated mobile Flat Detector (mFD). The light -weight, mobile and easy-to-handle mFD is quickly positioned in the Bucky tray or used for free exposures.The acquired images are available in seconds and eliminate time-consuming examination steps such as cassette hand ling, allowing the operator to re-main in the examination room.Diagnosis from the entire procedure can be accomplished faster. All acquired im-ages, whether fluoroscopy scenes or ra-diographic images are located in the

same patient folder and displayed in the order of acquisition.

Brilliant image qualityand lowest dose levels

With convenient and efficient system handling and the outstanding image quality at low dose levels, pediatric ex-aminations can be performed with radi-ation exposure levels that are as low as reasonably achievable while maintain-ing diagnostic image quality. Equipped with the comprehensive radiation re-duction program CARE, AXIOM Luminos TF with mFD can reduce the skin en-trance dose by a factor of eleven in pe-diatric fluoroscopy*.

*Data on file. Results may vary.

Fluoroscopy Pediatric Imaging

Pediatric Fluoroscopywith Digital RadiographyExpedites Clinical Outcomes

AXIOM Luminos TF, the proven system for fl uoroscopy, has many features to ease workfl ow and facilitate system handling. Together with the mobile digital fl at detector it becomes even more versatile, producing excellent results in pediatric care.

Patientpositioning

Patientpositioning

Insertcassette

ExposureExchangecassette

RepositionPatient

ExposureRemovecassette

Scancassette

Read outcassette

Exposure Repositioning Exposure

Images available within seconds

Images available within seconds

With CR cassettes

With mFD

1

1 Compared to CR cassettes, working with the mFD is faster and requires fewer steps. Furthermore there is no need to leave the examination room for cassette processing, thereby increasing quality of patient care.

Images available for review

3 Convenient and efficient system handlingfor a smooth procedure.


Pediatric Imaging Fluoroscopy

“Overhead radiographs acquired with the mobile fl at detector are not only of outstanding image quality but also signifi cantly enhance the procedure workfl ow. Our technologists were able to remain with the patient during the entire examination, greatly improving patient care.”John P Harris, MD, North Colorado Medical Center, Greeley, CO, USA

2 Fully digital imaging with the mobile Flat Detector enhances flexibility and efficiency.

32


Fluoroscopy Pediatric Imaging

Therapeutic Relief of Sigmoidal VolvulusUnder FluoroscopySupported by AXIOM Luminos TFwith mobile Flat Detector (mFD) John P. Harris, M.D., Charles E. Winn, M.D.North Colorado Medical Center, Greeley, CO, USA

Patient historyA 13-year-old female presented to the emergency department with sudden nausea, vomiting and abdominal pain. No history of surgery or injury given.

DiagnosisThe initial X-ray radiograph of the abdo-men showed a large bowel ileus with some mild dilatation. The repeat radio-graph and a subsequent CT scan two hours later confirmed a persistent, progressive air-filled distention to the sigmoid colon and the large bowel.As these findings are very suspicious for a volvulus of the sigmoid colon a gastro-grafin enema was considered for further validation with the possibility of imme-diate therapeutic relief to ensure the blood flow to the intestine.

11 Delayed radiograph taken 10 min. afterthe therapeutic relief started.

Dr. John Harris and his team at the AXIOM Luminos TF. North Colorado Medical Center, Greeley, CO, USA.


Pediatric Imaging Fluoroscopy

TreatmentThe treatment initially began in the SIMMs position where the patient is lay-ing on the left side with the right knee brought up to the chest. The introduc-tion of the contrast agent was conduct-ed under fluoroscopy control. At the junction of the rectosigmoid, a volvulus could be verified. Very slight hydrostat-ic pressure was utilized before draining the contrast back. This procedure was repeated several times under fluorosco-py. Within about 20 minutes of starting this process, contrast was seen to enter the more proximal portion of the sig-moid colon and the patient began feel-ing relieved of symptoms. An additional delayed radiograph showed contrast agent passing into the left and the transverse colon. The co-lon was of more normal caliber. The following delayed images indicated fur-ther evacuation. There was still some dilatation to the sigmoid colon but the patient showed considerable improve-ment in symptoms. The patient was observed in the emer-gency department for an additional two hours and could be released with no residual pain or symptoms. A follow-up with abdominal imaging in three months time was recommended.

CommentsWith the Siemens AXIOM Luminos TF fluoroscopy system and its mobile Flat Detector for digital radiographic imag-ing, the therapeutic relief of the volvu-lus and overhead delayed images could be completed within 23 minutes due to less processing time and well organized workflow. The radiographs acquired with the mobile flat detector were avail-able within seconds and allowed the technologist to remain with the patient at all times. Patient care was perceived to be of higher quality.

3 Delayed radiograph approx. 20 min. after procedure started showing contrastpassing into the descending and transverse colon.

3

[email protected]@siemens.com

22 Gastrografin enema validating the volvulus at the rectosigmoid junction.


Customer Care.Life Virus Protection

In the University Hospital Basel, on a daily basis, about ten thousand patient images – corresponding to a volume of 18 gigabytes – are processed and regis-tered in the network of the radiological image storage system. Currently, the entire quantity of stored image data amounts to about 32 terabytes, which is equivalent to the contents of over 5,000 kilometers of file shelves.

Providing operating security for the systems

Given the high level of system utiliza-tion, equipment reliability is crucial. And security considerations play an increas-ingly important role in providing this reliability. On the one hand, networked communications and the exchange of data worldwide brings the risk of con-tamination by malicious software, such as viruses, worms, and Trojan horses.On the other hand, the systems need to be protected from risks resulting from

the hospital’s internal operating net-work. The systems are increasingly threatened by viruses stemming from data exchange, for example through USB devices and network-connected lap-tops or from files downloaded from the Internet. For the University Hospital Basel, the safety and protection of medi-cal technical systems with their enor-mous volumes of data have top priority. Professor Wolfgang Steinbrich, MD, Director of the Institute for Diagnostic Radiology, explains: “Today our capacity is configured in such a way that the de-

Virus Protectionat the University Hospital Basel, SwitzerlandThe University Hospital in Basel provides a good example of broad-based virus protection for medical technology systems. With Siemens Virus Protection, the hospital proactively protects most Siemens modalities against potential attacks.

“Today our capacity is confi gured in such a way that the devices always have to be functioning. That’s why in addition to system quality, operational security is our most important goal.”Professor Wolfgang Steinbrich, Director of the Institute for Diagnostic Radiology,University Hospital Basel, Switzerland


Virus Protection Customer Care.Life

vices always have to be functioning. That’s why in addition to system quality, operational security is our most impor-tant goal.”To achieve this, the University Hospital Basel installed full-scale protection against malicious attacks – the first hos-pital in Switzerland to take this step. To protect against viruses, worms, and Tro-jan horses, most imaging systems from Siemens are equipped with Siemens Virus Protection.The University Hospital currently has 27 Siemens modalities that are secured

through Siemens Virus Protection. The service consists of virus detection and elimination as well as prevention. Through the installation of a virus scan-ner and connection of the systems to Siemens Remote Service (SRS), remote updates with relevant hotfixes are im-ported proactively to protect the sys-tems against attacks from every type of known virus. Should a virus infection nevertheless occur, the Siemens experts can frequently detect this very early – thanks to remote monitoring via SRS – and take suitable action before the cus-

tomer is even aware of the virus on-site and before the virus can cause any dam-age. Professor Steinbrich values this as-pect in particular: “It’s our responsibility to safeguard and protect our image data. Due to new technologies, new dangers have arisen that we must elimi-nate. I was very positively impressed by Siemens’ proactive approach with Virus Protection. That’s why I strongly sup-ported this solution.”The director of Medical and Operational Technology, Christian Kluth, attaches special importance to ensuring that all

“If I open a network connection to the outside world for the protection of our own network, then it’s important for me to work together with an expert provider. With Siemens we can implement this innovative protection.”Franz Buffon, Director of IT, University Hospital Basel, Switzerland


Customer Care.Life Virus Protection

large-scale equipment in the University Hospital Basel is equipped with virus protection. As he says, a complete solu-tion of this kind is a highly feasible ap-proach for providing comprehensive protection against virus attacks: “Just one insecure site would be one too many. Only the installation of Virus Pro-tection in all equipment offers the pro-tection that we prefer to help ensure the operating reliability of our machines and systems.”Professor Steinbrich attributes the dan-gers to two principal causes: “First, clini-

cal diagnostic equipment has become highly developed – from the original precision mechanical systems with ana-log electronics to computer-controlled instruments with complex software for digital imaging. Second, the stand-alone workstation systems of former times are today interconnected and networked with the image viewing units of image storage networks. In addition, a high-performance link to the radiological in-formation system and to the hospital-wide network of the clinical information system is planned.” Steinbrich con-

cludes: “Although the different networks are physically decoupled, they are con-nected through the exchange of infor-mation. In order to prevent the misuse of personal data at the interfaces and to avert threats, for example, from Trojan horses or viruses, comprehensive inno-vative protection systems are required – such as Siemens Virus Protection.”

[email protected]/virus-protection

Siemens Virus Protection continuous-ly monitors the large-scale equip-ment operated at the University Hos-pital Basel. This includes systems used in various areas, such as an-giography, computed tomography, magnetic resonance tomography, and medical imaging stations. The solution includes proactive virus pro-tection as well as virus detection and virus elimination. Virus Protection is one of the innovative service offer-ings made possible by Siemens Re-mote Service (SRS), the infrastructure for long-distance data transmission.

The benefits at a glance

Reliable protection againstsoftware attacks

Expert problem resolution

Reduced technical and IT costs

Smoothly running clinical routines

Higher system availability

Improved efficiency

Increased planning security

“Just one insecure site would be one too many. Only the installation of Virus Protection in all equipment offers the protection we prefer to help ensure the operating reliability of our machines and systems.”Christian Kluth, Director of Medical and Operational Technology,University Hospital Basel, Switzerland

How can I improve ablationtherapy?

The Artis zee imaging system with syngo® DynaCT Cardiac is able to create CT-like 3D images of the beating heart withinseconds during the procedure – directly in the EP lab. With a single click of the mouse, the left atrium is segmented. The resultcan be merged with electroanatomical maps and overlain on the live fluoroscopic image, providing anatomical information tosupport treatment decisions. Visit our website and zee the future. www.siemens.com/artis-zee +49 69 797 6420

Answers for life.

With syngo DynaCT Cardiac 3D images of the left atrium can be

created directly in the EP lab to help guide the ablation catheter.

AX-Z1089-2-7600


Customer Care.Life Learning with and from the Experts

Learning With and From the ExpertsSiemens offers intensive hands-on training for interventional cardiology using state-of-the-art simulation technologies

The 3-level CME accredited diagnostic and interventional cardiology course led by Prof. Wolfram Voelker and his team, offers attendees a unique opportunity to get extensive hands-on experience using cutting edge simulation technolo-gies. The practical training course, initi-ated and organized by Siemens Health-care is widely recognized as one of the most successful methods to learn and master new techniques for catheter-based procedures. Over the last three years, our simulation-based training has offered cardiologists the chance to en-hance their skills in interventional cardi-

ac procedures from basic diagnostics to complex interventional procedures. In a simulated cath lab environment, partici-pants can broaden knowledge in the techniques of coronary angiography and interventional techniques, includ-ing three-dimensional imaging to quan-tify and visualize coronary artery lesions with more accuracy. Besides the use of the imaging system and catheter ad-vancing techniques, the learning objec-tives vary from the right selection and handling of catheter materials to com-plication management in the cath lab during an intervention. In small groups,

under the expert tuition of Prof. Voelker and his team, the trainees can directly feel and see, in real-time, the conse-quences of their handiwork with cathe-ters, stents and balloons. The simulator also provides feedback on radiation dose during the simulated catheteriza-tion. Participants come from all over the world and have the opportunity to ex-change experience on an international level in a relaxed and mistake-tolerant atmosphere.“In the clinical routine, there is often not enough time for precise teaching in the cath lab. At the center in Forchheim, on the other hand, workshop partici-pants can take their time working through all functions of the radiograph-ic device and simulation models”, says Dr. Wolfram Voelker from the University Clinic in Wuerzburg, Germany. His opin-ion is also reflected by the participants. For Dr. Hannes Lafenthaler from Austria the course was a great inspiration. He had also attended other Siemens hands-on workshops before and liked the bal-ance between theory and hands-on training. “The intensive practical train-ing on the simulators and the individual mentoring by experienced cardiologists in a real cath lab environment enabled me to greatly improve my skill set. After this instruction, I now pay special atten-tion on how to keep the radiation expo-sure in the cath lab at a minimum,” he


Learning with and from the Experts Customer Care.Life

Further informationand registration: [email protected]

Available hands-on courses(English and in German)

Level 1 Introduction in Diagnostic Coronary Angiography

Level 2 Introduction in Interventional Cardiology

Level 3 Complex cases in Interventional Cardiology

“My expectations of this course were more than fulfi lled. We had a lot of

opportunities to train on the various simulation systems, and

being supported by an experienced cardiologist extraordinarily

increased the learning curve.”

Sabine Bleiziffer, MD, Munich, Germany

“At the training center in Forchheim, workshop participants can take their time working through all functions of the radiographic device and simulation models.”

Prof. Wolfram Voelker, MD, Wuerzburg, Germany, Course instructor

explained. Also Dr. Sabine Bleiziffer’s expectations of the course were more than fulfilled and she appreciated the use of various simulation systems. “Es-pecially the lesson about measurements for coronary arteries greatly increased my knowledge and will be productive in my daily routine. I also appreciated the limited group size and being supported by an experienced cardiologist which extraordinarily increased the learning curve.” Dr. Ibrahima Bara Diop from CHU Fann in Senegal confirmed: “I signifi-cantly improved my skill set in coronary angioplasty. The hands-on sessions

taught me effectively about catheters and guidewire selection and the neces-sary maneuvering of catheter through coronary vessels. To me it was very im-portant to learn about radiation reduc-tion in the cath lab. Less dose is not only beneficial for the patient, but also crucial for me as a physician.”


New Light and Sound Concept

Siemens PresentsNew Light and SoundConcept*

[email protected]

Many patients are anxious or even scared prior to a catheterization proce-dure and need to be calmed down with sedatives. Various studies revealed that sound and light effects in the room can help take away that fear and anxiety,

especially in children. Interventional treatment becomes faster and more effective when the patient is calmer and more at ease. For these reasons, Siemens created a new light and sound concept which can be individually designed for the custom-ers’ needs. It creates a soothing light environment consisting of various ele-ments the customer can choose from. LED tubes on the wall can create a warm light with different soft and fluid colors that can also be coordinated with music. A skylight with a customized im-age can be tailored to any room size, even with a ceiling-mounted system, to create the impression of a large and airy room. Another highlight is the artificial French door which is ideal to simulate daylight or to cover up objects that

should remain out of view. To work effectively in this light environment, Siemens offers the TRAXON ™ Nano Liner, a white light for clinical use to provide adequate table lighting during the procedure. And with the BOSE ™ sound system connected to an iPod® Touch, the whole sound and light environment can be operated with a syngo-like user interface. For the light and sound installation dif-ferent themes like landscapes or special images for children are also available.

* Siemens light and sound concept is currently only available in Europe.

Components of the lightand sound concept

Skylight

LED Wall lightening

French Window –

artificial door/window

TRAXON Nano Liner

for patient table lighting

BOSE Sound System

with iPod Touch connection


Congresses & Workshops

Upcoming Congresses& Workshops 2008 / 2009We always would like to give you the opportunity to get in “touch” with the real system and learn more about sys-tem handling to keep you in step with

the latest technological advances. You will have the chance to experience our technology at international congresses, trade fairs, and workshops. In the list

Title Location Short Description Date Contact

Hospeq Beijing, China Trade Fair Oct. 10 – 12, 2008 www.chinahospeq.com

TCT Washington DC, USA Transcatheter CardiovascularTherapeutics

Oct. 12 – 17, 2008 www.tctconference.com

ISHAHD Beijing, China International Symposium on HybridApproach to Heart Diseases 2008

Oct. 18 – 20, 2008 www.hybridheartbeijing.org

JFR Paris, France Journées Francaise de Radiologie Oct. 24 – 28, 2008 www.jfrexpo.com

AOCR Seoul, South Korea 12th Asian Oceanian Congress ofRadiology

Oct. 24 – 28, 2008 www.aocr2008.org

CMEF Suzhou, China Medical Trade Fair Oct. 29 – Nov. 1, 2008 www.cmef.com.cn

AHA New Orleans, LA, USA American Heart Association Nov. 9 – 11, 2008 www.americanheart.org

Medica Düsseldorf, Germany Trade Show Nov. 19 – 22, 2008 www.medica.de

RSNA Chicago, IL, USA 94th Annual Meeting Nov. 30 – Dec. 5, 2008 www.rsna.org

Cardiac Pacing and Electrophysiology

Rome, Italy 13th International Symposium Dec. 2 – 5, 2008 www.aimgroup.it/2008/pacing

APCC Taipei, Taiwan 16th Asian Pacifi c Congress ofCardiology

Dec. 13 – 16, 2008 www.apcc2008.org

IROS Salzburg, Austria Interventional Workshop Jan. 2009 www.irosonline.org

AF Symposium Boston, MA, USA 13th Annual Meeting Jan. 15 – 17, 2009 www.afsymposium.com

STS San Francisco, CA, USA Annual Meeting of the Societyof Thoracic Surgeons

Jan. 26 – 28, 2009 www.sts.org

Arabhealth Dubai,United Arab Emirates

Exhibition and Congress Jan. 26 – 29, 2009 www.arabhealthonline.com

CCT Kobe, Japan Complex Catheter Therapeutics Jan. 29 – 31, 2009 http://cct.gr.jp

DGHTG Innsbruck, Austria 38th Jahrestagung der dt. Gesellschaftfür Thorax-, Herz- und Gefäßchirugie

Feb. 15 – 18, 2009 www.dgthg.de

ECR Vienna, Austria European Congress of Radiology Mar. 6 – 10, 2009 www.ecr.org

SIR San Diego, CA, USA Annual Scientifi c Meeting Mar. 7 – 12, 2009 www.sirmeeting.org

CIT 2009 Beijing, China China Interventional Therapeutics 2009

Mar. 18 – 22, 2009 www.citmd.com

JCS Osaka, Japan Japanese Circulation Society Mar. 20 – 22, 2009 www.j-circ.or.jp

ACC Orlando, FL; USA 58th Annual Meeting Mar. 29 – 31, 2009 www.acc09.acc.org

JRS Yokohama, Japan Japan Radiological Society April 17 – 19, 2009 www.radiology.jp

below you will find information on vari-ous events where we offer you the op-portunity to meet AX.


Subscription

Siemens Healthcare – Customer MagazinesOur customer magazine family offers the latest information and background for every healthcare fi eld. From the hospital director to the radiological assistant – here, you can quickly fi nd information relevant to your needs.

For current and older issues and to order the magazines, please visit www.siemens.com/healthcare-magazine

Medical Solutions

Innovation and trends in healthcare. The magazine, published three times a year, is designed especially for members of hospi-tal management, ad-ministration per-sonnel, and heads of medical departments.

AXIOM Innovations

Everything from the worlds of interventional radiology, cardiology, fluoroscopy, and radiography. This semi-annual magazine is primarily designed for phy-sicians, physicists, re-searchers, and technical personnel.

MAGNETOM Flash

Everything from the world of magnetic resonance imaging. The magazine presents case reports, technology, product news, and how-to’s. It is primarily designed for physicians, physicists, and technical personnel.

SOMATOM Sessions

Everything from the world of computed tomography. With its innovations, clini-cal applications, and vision, this semiannual magazine is primarily designed for physicians, physicists, re-searchers, and technical personnel.

Perspectives

Everything from the world of clinical diagnostics. This semi-annual publication pro-vides clinical labs with diagnostic trends, technical innovations, and case stud-ies. It is primarily designed for laboratorians, clinicians and technical personnel.


Issue No. 8 | October 2008

AXIOM Innovations

New Trends in SurgeryCardio-vascular surgery opens up for new treat-ment methodsPage 14

Efficiency in the EPsyngo DynaCT Cardiac enhances ablation therapyPage 26

AXIOM Luminos TFPediatric imaging in fluoroscopyPage 36

Virus protectionat the University Hospital Basel, SwitzerlandPage 40

08Large Volume Imaging with Artis zeegoMore anatomical coverage with Large Volume syngo DynaCT

NewsOur latest topics such as product news, reference stories, reports, and general interest topics are always available at www.siemens.com/healthcare-news

Imprint

PublisherSiemens AGMedical SolutionsAngiography, Fluoroscopicand Radiographic SystemsSiemensstr. 1,91301 Forchheim, Germany

Responsible for contentsNorbert Gaus, PhD

Chief editorSabine [email protected]

Editorial boardMonika BöhmerKlaudia DorschVera JünnemannOliver Meissner, MD, PhDNadine Meru, PhDAndrea MüllerProf. Georg Nollert, MDRoland PapenfußSiegfried PrellSusanne SeahDirk Sunderbrink

Contributors to this issueAlfonso Aguilera, Erik Busch, Knut Imhof, Michaela Kandolf, Andra Kirchner, Barbara Reber, Antonio Ribeiro, Markus Rossmeier, Gerald Sandridge

All at Siemens AG Healthcare Sector

Lee Benson, MDCardiac Diagnostic and Interventional Unit, Hospital for Sick Children,Toronto, Canada

Joris Ector, MD, Stijn De Buck, MSc ,PhDHein Heidbuchel, MD, PhDDepartment of Cardiology, University Hospital Gasthuisberg Leuven,Leuven, Belgium

Erik Fosse, MDThe Interventional Centre, Rikshospitalet, University of Oslo,Oslo, Norway

John P. Harris, MDCharles E. Winn, MDNorth Colorado Medical Center,Greeley, CO, USA

David Lacey, MDIowa Methodist Medical CenterDes Moines, IA, USA

Jaime Lavados, MDEduardo Bravo, MDNeurosurgery Institute Santiago,Santiago, Chile

Luis Ramos, MD, X-ray DepartmentUniversity Hospital Puertade Hierro Majadahonda,Madrid, Spain.

Harald Sandmayr, MDRadiography DepartmentLandeskrankenhaus Steyr Steyr, Austria

Prof. Martin Skalej, MD, Oliver Beuing, MD, Anja Lenz, MD University of Magdeburg, Magdeburg Germany

Prof. Wolfgang Steinbrich, MDChristian KluthUniversity Hospital BaselBasel, Switzerland

Warren Swee, MD, MPHDepartment of RadiologyUniversity of Virginia Health SystemCharlottesville, VA, USA

Prof. Wolfram Voelker, MDUniversity Clinic WuerzburgWuerzburg, Germany

ProductionMichael BrummeSiemens Healthcare

Layout and editorial staffSatzwerker – Jäger & TuppiNuremberg/Karlsruhe, Germany

PrinterFarbendruck HofmannGewerbestraße 590579 Langenzenn, Germany

AXIOM Innovations on the net:www.siemens.com/healthcare-magazine

AXIOM Innovations Imprint© 2008 by Siemens AG, Berlin and Munich, All Rights Reserved

Note in accordance with § 33 Para.1 of the Federal Data Protection Law: Dispatch is made using an address file which is maintained with the aid of an automated data processing system. We remind our readers that, when printed, X-ray films never disclose all the information content of the original. Artifacts in X-ray, CT, MR and ultrasound images are recognizable by their ty-pical features and are generally distinguishable

from existing pathology. As referenced above, healthcare practitioners are expected to utilize their own learning, training and expertise in eva-luating images.

Partial reproduction in printed form of individual contributions is permitted, provided the custo-mary bibliographical data such as author’s name and title of the contribution as well as date and

pages of “AXIOM Innovations” are cited. The editors request that two copies be sent to their attention. The consent of the authors and editors is required for the complete reprint of an article.

Manuscripts submitted without prior agreement as well as suggestions, proposals and information are always welcome; they will be carefully assessed and submitted to the editorial board for review.


“Keeping our customers at the cutting edge of technology and enabling them to do more with their systems and appli-cations is one of our most important goals.”Dr. Norbert Gaus, CEO of the Angiographic, Radiographic and Fluoroscopic Division (AX)at Siemens Healthcare


Editorial


Issue Number 8/October 2008

AXIOM Innovations

New Trendsin SurgeryCardiovascular Surgery opens up for New Treatment MethodsPage 14

Effi ciencyin the EPsyngo DynaCT Cardiacenhances Ablation TherapyPage 26

AXIOMLuminos TFPediatric Imagingin FluoroscopyPage 36

Virus protectionAt the University Hospital Basel, SwitzerlandPage 40

08

On account of certain regional limitations of sales rights and service availability, we cannot guarantee that all products included in this brochure are available through the Siemens sales organization worldwide. 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.

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.

Note: Any technical data contained in this document may vary within defined tolerances. Original images always lose a certain amount of detail when reproduced.

Global Business UnitSiemens AGMedical SolutionsAngiography, Fluoroscopic and Radiographic SystemsSiemensstr. 1DE-91301 ForchheimGermanyPhone: +49 9191 18-0www.siemens.com/healthcare

Local Contact Information

In AsiaSiemens Medical SolutionsAsia Pacific HeadquartersThe Siemens Center60 MacPherson RoadSingapore 348615Phone: +65 9622-2026www.siemens.com/healthcare

In CanadaSiemens Canada LimitedMedical Solutions2185 Derry Road WestMississauga ON L5N 7A6CanadaPhone: +1 905 819-5800www.siemens.com/healthcare

In Europe/Africa/Middle EastSiemens AG, Medical SolutionsHenkestr. 127,D- 91052 ErlangenGermanyPhone: +49 9131 84-0www.siemens.com/healthcare

In Latin AmericaSiemens S.A., Medical SolutionsAvenida de Pte. Julio A. Roca No 516, Piso 7C1067ABN Buenos AiresArgentinaPhone: +54 11 4340 8400www.siemens.com/healthcare

AX

IOM

In

no

vati

on

sIs

sue

Nu

mb

er

8/O

cto

be

r 2

00

808www.siemens.com/healthcare-magazine

In USA:Siemens Medical Solutions U.S.A., Inc.51 Valley Stream ParkwayMalvern, PA 19355-1406USAPhone: +1-888-826-9702 www.siemens.com/healthcare

Large Volume Imaging with Artis zeegoMore anatomical coverage with Large Volume syngo DynaCT

Order No. A91AX-50801-13C1-7600 | Printed in Germany | CC AX 50801 ZS 090825. | © 09.2008, Siemens AG

Global Siemens Headquarters

Siemens AGWittelsbacherplatz 280333 MuenchenGermany

Global SiemensHealthcare Headquarters

Siemens AGHealthcare SectorHenkestr. 127 91052 ErlangenGermanyPhone: +49 9131 84-0www.siemens.com/healthcare

Legal Manufacturer

Siemens AGWittelsbacherplatz 2DE-80333 MuenchenGermany

Documents

AXIOM 08-2008 cardiology and angiography