AXIOM 08-2008 Cardiology and Angiography

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The Magazine for Interventional Angiography and Cardiology,
Phone: +49 9131 84-0 Radiography and Fluoroscopy
www.siemens.com/healthcare
08
www.siemens.com/healthcare-magazine Issue Number 8/October 2008
Order No. A91AX-50801-13C1-7600 | Printed in Germany | CC AX 50801 ZS 090825. | © 09.2008, Siemens AG
Issue Number 8/October 2008

On account of certain regional limitations of Global Business Unit In USA:
sales rights and service availability, we cannot Siemens AG Siemens Medical Solutions U.S.A., Inc.
guarantee that all products included in this Medical Solutions 51 Valley Stream Parkway New Trends
brochure are available through the Siemens
sales organization worldwide. Availability and
Angiography, Fluoroscopic and
Radiographic Systems
Malvern, PA 19355-1406
USA
in Surgery
packaging may vary by country and are subject Siemensstr. 1 Phone: +1-888-826-9702
to change without prior notice. Some/All of DE-91301 Forchheim www.siemens.com/healthcare
Cardiovascular Surgery
the features and products described herein may Germany opens up for New
not be available in the United States. Phone: +49 9191 18-0 Treatment Methods
Page 14
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
Local Contact Information Efficiency
individual cases. in the EP
In Asia
Siemens reserves the right to modify the design, Siemens Medical Solutions syngo DynaCT Cardiac
packaging, specifications and options described Asia Pacific Headquarters enhances Ablation
herein without prior notice. The Siemens Center
Please contact your local Siemens sales 60 MacPherson Road
Therapy
representative for the most current information. Singapore 348615 Page 26
Phone: +65 9622-2026
Note: Any technical data contained in this
document may vary within defined tolerances. AXIOM
Original images always lose a certain amount
of detail when reproduced.
In Canada Luminos TF
Siemens Canada Limited
Medical Solutions Pediatric Imaging
2185 Derry Road West in Fluoroscopy
Mississauga ON L5N 7A6
Canada
Page 36
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In Latin America Large Volume Imaging
08
Siemens S.A., Medical Solutions
with Artis zeego

Avenida de Pte. Julio A. Roca No
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Phone: +54 11 4340 8400
www.siemens.com/healthcare More anatomical coverage with Large Volume syngo DynaCT
Imprint
Editorial
AXIOM Innovations Imprint

© 2008 by Siemens AG, Berlin and Munich, All Rights Reserved
“Keeping our customers Publisher

Siemens AG
Lee Benson, MD
Cardiac Diagnostic and Interventional
Unit, Hospital for Sick Children,
Harald Sandmayr, MD
Radiography Department
Landeskrankenhaus Steyr
at the cutting edge of Medical Solutions

Angiography, Fluoroscopic
and Radiographic Systems
Toronto, Canada
Joris Ector, MD, Stijn De Buck, MSc ,PhD

Steyr, Austria
Prof. Martin Skalej, MD,
technology and enabling

Siemensstr. 1, Hein Heidbuchel, MD, PhD Oliver Beuing, MD,
91301 Forchheim, Germany Department of Cardiology, Anja Lenz, MD
University Hospital Gasthuisberg Leuven, University of Magdeburg,
Responsible for contents Leuven, Belgium Magdeburg Germany
them to do more with

Norbert Gaus, PhD
Erik Fosse, MD Prof. Wolfgang Steinbrich, MD
Chief editor The Interventional Centre, Christian Kluth
Sabine Wich Rikshospitalet, University of Oslo, University Hospital Basel
their systems and appli- sabine.wich@siemens.com
Editorial board
Monika Böhmer
Oslo, Norway
John P. Harris, MD
Charles E. Winn, MD
Basel, Switzerland
Warren Swee, MD, MPH

Department of Radiology
cations is one of our Klaudia Dorsch

Vera Jünnemann
Oliver Meissner, MD, PhD
North Colorado Medical Center,
Greeley, CO, USA
University of Virginia Health System
Charlottesville, VA, USA
most important goals.”

Nadine Meru, PhD David Lacey, MD Prof. Wolfram Voelker, MD
Andrea Müller Iowa Methodist Medical Center University Clinic Wuerzburg
Prof. Georg Nollert, MD Des Moines, IA, USA Wuerzburg, Germany
Roland Papenfuß
Siegfried Prell Jaime Lavados, MD Production
Dr. Norbert Gaus, CEO of the Angiographic, Susanne Seah Eduardo Bravo, MD Michael Brumme
Radiographic and Fluoroscopic Division (AX) Dirk Sunderbrink Neurosurgery Institute Santiago, Siemens Healthcare
at Siemens Healthcare Santiago, Chile
Contributors to this issue Layout and editorial staff
Alfonso Aguilera, Erik Busch, Knut Imhof, Luis Ramos, MD, Satzwerker – Jäger & Tuppi
Michaela Kandolf, Andra Kirchner, X-ray Department Nuremberg/Karlsruhe, Germany
Barbara Reber, Antonio Ribeiro, Markus University Hospital Puerta
Rossmeier, Gerald Sandridge de Hierro Majadahonda, Printer
Madrid, Spain. Farbendruck Hofmann
All at Siemens AG Healthcare Sector Gewerbestraße 5
90579 Langenzenn, Germany
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2 AXIOM Innovations · October 2008 · www.siemens.com/healthcare-magazine AXIOM Innovations · October 2008 · www.siemens.com/healthcare-magazine 49
Editorial
Dear Reader,
Dr.-Ing. Norbert Gaus
President AX Division
To be ahead of the game, you have to the high risks involved. Also, after a cal experiences in interventional imag-
spot upcoming trends early enough to minimally invasive procedure patients ing and X-ray await you in this edition
act on them. This goes without saying do not need to stay in intensive care as of AXIOM Innovations.
both for you, our customers, and for us long as they do after normal surgery.
at Siemens Healthcare. So the Artis zee family for interven- I hope you enjoy reading this issue.
At Siemens, we like to keep you on the tional imaging is finding its way into I can tell you I did.
forefront of technology so you can zee the OR. But that is not all you can read
more and therefore do more. about in this edition of AXIOM Inno-
One fast growing trend is minimally vations. Recently, Siemens acquired a
invasive surgery performed in so-called new company and further extended
hybrid rooms, where high-end imaging our product portfolio. Together with Dr. Norbert Gaus
and surgery come together. Surgeons the technology and the products of
have already recognized this and are CAS Innovations, we are now able to
active in bringing minimally invasive offer electro-magnetic needle guid-
procedures with interventional imaging ance. Now it is possible to precisely
to their operating rooms. This combina- place electrodes or biopsy devices and
tion enables procedures that give hope guide them to the region of interest
to a lot of very sick patients who could very accurately and without radiation.
not undergo surgery before because of These and many more topics, e.g clini-
AXIOM Innovations · October 2008 · www.siemens.com/healthcare-magazine 3

Content
14 22
Content New Treatment Possibilities
for Cardiac Surgery
Electromagnetic Needle Guidance
Cover Story 2 Editorial

8 Artis zeego in the OR
Physicians at Oslo’s Rikshospitalet are
achieving new levels of flexibility, ef- 6 News
ficiency and 3D imaging quality in a
wide range of clinical environments,
from cardiology, body and neuroint-
erventional radiology suites to high- 8 Cover Story
end imaging in the OR.
Artis zeego in the OR
14 Special
Surgery Opens up for New
Treatment Methods
Cover
Percutaneos Nephrostomy
for an Obstructed Ectopic 49 Imprint
Pelvic Kidney
Courtesy of Warren Swee,
MD, MPH
4 AXIOM Innovations · October 2008 · www.siemens.com/healthcare-magazine

Content
26 38
Improved Efficiency Pediatric Imaging
in the EP Lab with AXIOM Luminos TF
Surgery Cardiology Customer Care.Life

8 Robotic Technology 26 Improved Efficiency in the EP Lab 40 Virus Protection
with Human Benefits University Hospital Gasthuisberg, in How the University Hospital in Basel
Artis zeego in the OR Leuven, Belgium experiences work- protects its systems
flow benefits with syngo DynaCT
Cardiac
14 Surgery Opens up 44 Learning With and From
to New Treatment Methods the Experts
New trends in cardiac sugery 32 Taking Care of Children Hands-on training for
Combined imaging interventional cardiology
in pediatric cardiology
Angiography
46 Light and Sound Concept
20 Percutaneos Nephrostomy for an 34 Hypoplastic Left Heart Syndrome Artificial light enviroments
Obstructed Ectopic Pelvic Kidney Clinical case create more patient comfort
Clinical case
Fluoroscopy 47 Upcoming Congresses &

22 Radiofrequency Ablation Workshops
of a Large Vertebral Metastasis 36 AXIOM Luminos TF
Clinical case Digital radiography in pediatric fluo-
roscopy expedites clinical outcomes
24 State-of-the-Art Imaging
Technology in South America- 38 Therapeutic Relief of Sigmoidal
Neurosurgery Institute of Santiago Volvulus under Fluoroscopy
in Chile installs first biplane system Clinical case
with high-end 3D imaging

News
First Ysio installation at Clinical results with

Landeskrankenhaus Steyr, syngo iGuide – Endoleak
Austria Repair on an Abdominal
Aortic Aneurysm
The first Ysio, a fully auto- The new syngo iGuide application is available with the
mated digital radiography new Artis zee systems for interventional radiology and
solution, was installed on provides live and integrated needle guidance.
May 20th, 2008 in Landes-
krankenhaus Steyr, Austria.
Needle path planning Bulls eye view
This hospital, along with
another center in Enns,
has 800 beds and a staff
of 1,890. The radiology
Landeskrankenhaus Steyr, Austria
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- Progression view Planned needle path on
live fluoro
ment has acquired over 5,000 images with Ysio and they are
highly satisfied with their new digital radiography solution.
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.
Ysio room – Prim. Dr. Harald Sandmayr (extreme right) and his staff

News
Get Your Free DVD of this Year’s

ECR Hands-on Workshop Sessions
Computed Tomography (CT) and intensive overview of the main fields

Magnetic Resonance Imaging (MR). of interest for syngo DynaCT for neuro-
Clinical presentations by leading experts radiology.
were followed by demonstrations of The ECR hands-on workshops have now
clinical cases during which participants been compiled into a DVD that contains
were guided through the processing both the clinical presentations and the
tools available for the syngo Multi- step-by-step hands-on demonstrations.
Modality Workplace platform. These recordings offer over twelve hours
Sitting at one of the sixteen worksta- of learning material and provide an easy
tions, radiologists and technologists way to get started or improve your skills
from over fifty countries had the oppor- on the state-of-the-art evaluations tech-
tunity to discover the capabilities of niques that greatly enhance the diagnos-
syngo software. The angiography ses- tic capabilities of AX, MR and CT.
sions focused on the usage of syngo
At this year’s European Congress of Radi- DynaCT. Dr. Waggershauser from the Please feel free to order your free copy
ology (ECR) in Vienna, more than three University Hospital Munich explained of the ECR HOW DVD via:
hundred customers participated in the the benefits of syngo DynaCT for
hands-on workshops organized by the abdominal procedures while Prof. Dr. www.siemens.com/ecr-how-dvd
Siemens Healthcare Divisions Angiogra- Dörfler and Dr. Engelhorn from the
phy, Fluoroscopy and Radiography (AX), University Hospital in Erlangen gave an DVD not available in the U.S.
A True Icon in Fluoroscopy –

3,000th AXIOM Iconos Delivered to Spain
The AXIOM Iconos systems are one of ing cardiology, pediatrics, obstetrics,
the most successful fluoroscopy plat- vascular surgery, geriatrics.
forms worldwide. There are installa- This site is a reference hospital in Spain
tions in almost every country. And hos- in various clinical fields: it is widely
pitals use it every day in their clinical recognized for its broad program of
routine. In recent years the system organ and tissue transplants as well as
proved to be a real workhorse. Due to for the complexity of its clinical assis-
its flexibility and the individual custom- tance cases. The facility purchased two
ization options, the remote-controlled AXIOM Iconos R200 systems to offer
system meets virtually all the require- its patients improved comfort during
ments of its users without compromise. examinations and provide the physi-
This spring the 3,000 th system world- cians greater ease of use, excellent im-
wide was installed. age quality and diagnostic confidence.
The 3,000 th system went to the newly The digital AXIOM Iconos models can
built University Hospital Puerta de NEU be easily integrated into the hospital’s
Hierro Majadahonda in Madrid, Spain. RIS and PACS systems to store patient
With over 800 beds, the new hospital data and the clinical studies done on
covers the northwest area of Madrid Luis Ramos, MD, Head of X-ray department, the systems. This is enabled by the
in front of AXIOM Iconos R200
and offers clinical services to the public FLUOROSPOT Compact digital imaging
in many different clinical fields includ- system.

Cover Story Titel

Artis zeego in the OR Cover Story
Artis zeego
Robotic Technology
with Human Benefits
With the introduction of the Artis zeego, the first
multi-axis C-arm system based on robotic tech-
nology from Siemens Healthcare, physicians at
Oslo’s Rikshospitalet are achieving new levels of
flexibility, efficiency 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
The Interventional Center Rikshospitalet anywhere in a sphere around the pa-

in Oslo, Norway is a cutting-edge imag- tient. The movement of Artis zeego can
ing department that is widely known also be coordinated with the operating
for being at the forefront of medical table. The coordination between the
technology and methodology. As part table and the C-arm means that the
of a partnership with Siemens, the Cen- physician is allowed to operate at an
ter recently installed the Artis zeego, optimal position. The advanced imag-
the newest generation of flexible inter- ing capabilities of Artis zeego give the
ventional imaging systems. The robotic physician visual support beyond earlier
technology built into the Artis zeego technologies, and its software also
makes it possible to position the C-arm helps physicians choose the optimal
exactly according for the view required, approach, says Erik Fosse, M.D., head of

Cover Story Artis zeego in the OR
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
Highlights of Artis zeego
Unique positioning flexibility
Frame rates from 0.5f/s to

7.5 f/s native, optional up to
30 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

team making critical decisions with very

narrow margins.”
Hol also points to the benefits of the “When we plan an operation
new C-arm in planning surgical pro-
cedures. “When we plan an operation
in the limited space of an OR,
in the limited space of an OR, the
increased flexibility with Artis zeego
the increased flexibility with
means that we don’t have to restrict Artis zeego means that we don’t
ourselves to avoid problems with the
C-arm,” he says. “Instead, we can make have to restrict ourselves to
the plan with a full focus on the patient
and the best procedure for the opera-
avoid problems with the C-arm.”
tion at hand.” Per Kristian Hol, MD, Manager of Radiology Research at the Interventional Center,
Rikshospitalet, Oslo, Norway
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 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.
“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 With the C-arm stored away, there is always enough space for the anesthesia equipment and free
even further by designing and building access to the head of the patient.
a new lighting system,” says Fosse. “We

Cover Story Artis zeego in the OR
have bought an LED system designed hitting the lamps.” full support of the C-arm wherever they
for follow-spots in the theater. This al- The lighting system is not yet complete- need to move around the patient.
lows us to place the operating lamps at ly finished; the software still has to be “Surgeons have been striving for many
a greater distance, thus giving ourselves further developed. But when the project years to get better access to the patient
and the C-arm a better chance to move is finished, the surgeons will finally be when operating,” says Fosse. “With Artis
without blocking the light, and avoiding able to get both good lighting and the zeego and the new lighting system, we

“Surgeons have
been striving for
will really have come a long way expertise and technology are scattered,
towards the optimal solution.” you always are at risk of losing precious many years to get
time if something needs to be adjusted.
The Artis zeego decreases that risk.”
better access to
Artis zeego: A Versatile Tool The Artis zeego C-arm offers better sup- the patient when
port for physicians across any clinical
Artis zeego could be considered the environment, from body and neuroint- operating. With
ultimate technological answer to the erventional radiology suites to ORs and
development of new procedures and hybrid rooms. The adjustable isocenter Artis zeego and
new working environments like the
hybrid room. When hospitals bring radi-
enables off-center rotational angiogra-
phy for all parts of the body. 3D imaging
the new lighting
ology and cardiology together with the
surgeons, the flexibility and imaging ca-
techniques include Siemens technolo-
gies like syngo DynaCT, syngo iPilot and
system, we will
pacities of the Artis zeego provides the syngo iGuide. really have come a
optimal support for the team at work. syngo iPilot enables faster and more
“The new technologies help us to create precise catheter navigation through 3D long way towards
better hybrid rooms,” says Fosse. “Well-
functioning hybrid rooms mean we can
roadmapping that superimposes 3D re-
constructions onto live 2D fluoroscopy
the optimal
save lives, and allow us to always
choose the least invasive procedures.
images, 2D roadmaps or digital subtrac-
tion angiography (DSA). The application
solution.”
This means less risk for the patient and provides real-time updates of C-arm and
Erik Fosse, MD, Head of the Interventional
shorter hospitalization as well as huge table movements, as well as changes in Center, Rikshospitalet, Oslo, Norway
cost savings for society.” zoom and source-to-image distance.
Radiologists and cardiologists have been syngo iGuide is designed to bring nee-
performing more and more advanced dle procedures back into the interven-
interventions, and even though they tional suite, allowing them to be execut-
perform them well, this means greater ed faster and with greater confidence.
risks if the planned procedure needs to All in all, the Artis zeego C-arm has re-
be changed for any reason. moved numerous obstacles for the doc-
Hol is equally positive about working in tors at Rikshospitalet in their pursuit of
the hybrid room, and agrees that the the ideal environment for invasive pro-
new technologies such as Artis zeego cedures. It’s a happy combination of ad-
mean new ways to improve procedures. vanced technology that benefits physi-
“By combining knowledge and technolo- cians and patients alike.
gies from radiology, cardiology and sur-
gery, we may even develop new tailor- Nils Lindstrand is a freelance business, medical
made procedures and techniques,” he and technology writer based in Stockholm,
Sweden.
says. “It is also a major improvement
that the advanced imaging systems can
give you immediate confirmation that Contact
the procedure was performed correctly georg.nollert@siemens.com
and gave the expected results. When

Kategorie Titel
Surgery
Opens up to
New Treatment
Methods
Recent developments in cardiac
surgery have led to new therapies
integrating surgical procedures
with skin incisions and interventions,
e.g. transcatheter 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
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.
Basics of the hybrid room If a fixed C-arm system is being consid- tween pediatric cardiology and pediatric
ered, 45 m2 space is the lower limit. cardiac surgery, currently the strongest
There is no doubt that an interdisciplin- Lead shielding (2-3 mm) will need to be driver for hybrid therapies is transcathe-
ary team of surgeons, interventionalists, built into existing rooms. In some coun- ter replacement of the stenotic aortic
anesthesiologists, and other associated tries, special training for the use of valve.
specialists should plan and run such a X-ray devices may be required.
facility. Centers in close proximity to in- In general, all members of the team
tervention rooms and ORs probably have need access to all important informa- Trends in pediatric cardiac
better prerequisites than hospitals with tion. Therefore, multiple moveable and surgery
the classic separation that placed inter- flexible booms need to be installed in
ventional rooms in the internal medicine the operating room. If there are two Surgery remains the treatment of choice
building and operating theaters in the booms to be installed, a boom on every for most congenital cardiac malforma-
surgery building. In this situation, it is side of the OR table serves the operations. But interventional cardiology ap-
recommended to install the hybrid room tive team. Collision of the ceiling- proaches are increasingly being used in
in the surgical wing, where all OR equip- mounted displays with operating lights simple and even complex lesions. The
ment and personnel (e.g. heart-lung or other ceiling-mounted equipment percutaneous approach can be challeng-
machine and perfusionists), anesthesia should be avoided. A dedicated ceiling ing due to low patient weight or poor
and surgical intensive care are readily plan with all ceiling-mounted compo- vascular access. The passage of large
available. Reasonable proximity of the nents including air conditioning should catheters through the heart in small in-
hybrid room to other imaging systems be drawn to ensure the function and fants may result in rhythm disturbances
like computed tomography scanning or usability of all devices. and hemodynamic compromise. Diffi-
magnetic resonance imaging should cult and complex anatomy such as in
also be taken into consideration. double-outlet right ventricle or transpo-
A hybrid OR should be larger than a New therapies have emerged sition of the great arteries, or acute
standard OR and the basic principle for turns or kinks in the pulmonary arteries
planning is “the larger the better”, be- Pediatric hybrid operations, hybrid coro- in tetralogy of Fallot patients can make
cause not only the imaging equipment nary revascularization, transcatheter percutaneous procedures challenging if
needs sufficient space. Staff calcula- valve replacement and repair, or stent- not impossible. Surgery also has its limi-
tions have shown that in hybrid proce- graft placement in the thoracic aorta tations, when it comes to operative clo-
dures up to 18 people need to be in the are new developments that are ideally sure of multiple apical muscular ventric-
hybrid room. Experts recommend 70 m2 performed in a hybrid operating room. ular septal defects, adequate and lasting
for new ORs being built. Additional Although hybrid therapies were first de- relief of peripheral pulmonic stenosis, or
space for a control room is mandatory. veloped in a close collaboration be- management of a previously implanted

New Trends in Surgery Special
1 2 3 4
1 CoreValve 2 Edwards Sapien protheses 3 Transapical technique 4 Transfermoral technique
stenotic stent. Furthermore, in some tion of the aorta, which reduces the creased transfusions. Six-month angio-
complex malformations, the presence of chance of potentially fatal emboli, and graphic vessel patency and major
multiple ventricular septal defects in- the low surgical trauma by using mini- adverse cardiac events were similar in
creases the mortality risk, because they mally invasive techniques. Hybrid revas- the hybrid and off-pump coronary
are difficult to access by surgery. Com- cularization is currently performed only artery bypass groups. These clinical ad-
bining interventions and surgery into a in a few centers worldwide. One reason vantages will probably lead to a spread
single therapeutic procedure reduces is the real challenge regarding logistics, of hybrid revascularization techniques
complexity, cardiopulmonary bypass because an interventional and surgical when hybrid rooms become more com-
time, risk, and improved outcomes. team have to work together, and the en- monly available.
vironment in which to perform this
therapy – a hybrid room – is scarce. But
New possibilities for heart in the end, a higher number of repeat Trends in transcatheter
patients interventions compared with off-pump valve therapy
coronary artery bypass grafting was
Surgical and percutaneous coronary ar- seen, because the stented vessels had a Transcatheter valve therapies are cur-
tery interventional revascularization are higher occurrence of restenoses. How- rently developed for the most common
traditionally considered isolated op- ever, with the advent of drug-eluting valve diseases: mitral valve regurgita-
tions. A simultaneous hybrid approach stents, the reintervention rate de- tion, aortic stenosis, and – in children –
may allow an opportunity to match the creased. A recent feasibility study from pulmonary valve disease. For repair of
best strategy for a particular anatomic the University of Maryland evaluated 13 mitral regurgitation, more than 30 de-
lesion. Revascularization of the left an- patients with multi-vessel coronary ar- vices are currently under investigation
terior descending artery with the left in- tery disease who underwent left inter- and await market approval. Experimen-
ternal mammary artery is by far the best nal mammary artery-to-LAD minimally tally, prostheses for mitral und tricuspid
treatment option in terms of long-term invasive direct coronary bypass per- valve replacement are under develop-
results. Integrating this therapy with formed through a lateral thoracotomy, ment and certainly will be available
percutaneous coronary angioplasty of- followed by stenting of non-LAD le- within the next several years.
fers multi-vessel revascularization sions, in a fluoroscopy-equipped operat- Aortic stenosis is the most frequent ac-
through a mini-thoracotomy. Particular- ing room. These patients had a more quired heart valve lesion in developed
ly in high risk patients, morbidity and than 40% decreased length of stay and countries. Conventional aortic valve
mortality decreases compared to con- a more than 90% decrease in intubation replacement for aortic stenosis is based
ventional surgery. Reasons are the times. Despite aggressive anticoagula- upon standardized guidelines with ex-
avoidance of cardiopulmonary and its tion and confirmed platelet inhibition, cellent outcomes particularly in younger
bypass-related morbidity, no manipula- the patients had less blood loss and de- patients at relatively low risk. Advanced

Special New Trends in Surgery
5 6
5 AXIOM Artis U, the room-mobile system 6 Artis zee floor-mounted system

for small ORs. brings high-end imaging to the OR.
age and severe co-morbidities lead to an nary artery ostia, and a wide mesh transapical valve implantations using
increased surgical risk. Cardiologists are allowing for unobstructed coronary an oversizing technique were published
reluctant to refer these patients to sur- flow. The Edwards Sapien prosthesis in summer 2006. When both tech-
gery, because they are considered to be has a 14 – 16 mm balloon-expandable niques are compared, stroke risk was
‘too sick’, although conservative treat- straight-tube steel stent, mimicking a demonstrated to be lower with the
ment of aortic stenosis carries a fatal standard stented bioprosthetic valve. It transapical approach, which could be
prognosis. Low-risk, minimally invasive is strictly deployed within the aortic an- related to less aortic manipulation. A
techniques are needed to treat these nulus and sits in a subcoronary position second important complication of TAVR
very high-risk patients. in vivo. With regard to the leaflet cusps, is the high incidence of AV block, which
the CoreValve device is constructed is obviously valve-dependent and re-
of porcine pericardium, whereas the ported to be higher with the CoreValve.
Transcatheter aortic valve Edwards Sapien device utilizes bovine ATS, JenaValve, Sorin, and Ventor,
replacement (TAVR) pericardium. Three generations of the among other companies, are currently
CoreValve device have been implanted, conducting experimental evaluations
In 2002, Cribier reported the first the 24F, 21F, and now the 18F prosthe- and are on the verge of clinical implan-
human transcatheter aortic valve re- ses. Two inflow diameters, 26 and tations. Further systems for TAVR includ-
placement (TAVR) using a transfemoral, 29 mm, are available, allowing for suffi- ing the Lotus, AorTx, the Direct Flow
antegrade, transseptal approach. cient oversizing. With the Edwards Sapi- Medical valve and the PercValve are un-
Subsequently two valves were intro- en valve, diameters of 23 and 26 mm der development and further systems
duced to the market, i.e., the CoreValve are offered. A 29 mm prosthesis is un- will follow.
and the Edwards Sapien prostheses der development. Current sheath diam- For TAVR, valve positioning remains the
(Fig. 1 and 2)1 . eters for transfemoral implantation are most critical part of implantation with
Both valves have some similar funda- 22F and 24F, with smaller versions on the risk of coronary artery obstruction
mental design features, including xeno- the horizon. Implantations have been and the risk of paravalvular leak. Exact
genic pericardial valve cusps and a performed using both the transfemoral positioning, optimal imaging during im-
compressible stent suspending these and the transapical route with each de- plantation and an experienced team
cusps allowing for transcatheter deliv- vice. Up to now, more than 1,000 pa- performing the procedure are critical.
ery. There are, however, significant tients have received a CoreValve or an TAVR requires some specific equipment.
differences. The CoreValve prosthesis Edwards Sapien prosthesis. In parallel A hybrid operative theater is the ideal
has an approximately 50 mm long self- with the development of the transfem- setting for TAVR and is recommended by
expanding nitinol stent, with a tubular oral technique (Fig. 3), the direct, the European Association for Cardio-
‘hour glass’ shape that can deploy in the antegrade, transapical technique was Thoracic Surgery. The hybrid OR offers
aortic root, above the level of the coro- explored (Fig. 4). The first successful the sterile environment with emergency

New Trends in Surgery Special
7 8
7 Flexibility and whole body coverage is provided by the 8 Flexible park positions, variable iso-center and new 3D
Artis zee ceiling-mounted solution. imaging capabilities are possible only with Artis zeego.
back-up measures and the angiographic ventional surgery with cardiopulmonary its flexible patient access, outstanding
imaging technology needed in the cath- to the less invasive catheter techniques. 3D imaging capabilities and its variable
eterization laboratory. Excellent imag- iso-center make Artis zeego an ideal
ing capabilities are the most important A whole new spectrum system for imaging in the OR.
criterion for exact valve positioning and of therapies
thus optimal patient outcome. The over- References
all setting of a hybrid operative theater The hybrid operating room facilitates a 1. Walther T, Chu MW, Mohr FW. Transcatheter
is of specific value most importantly whole new spectrum of cardiac surgical aortic valve implantation: time to expand?Curr
Opin Cardiol. 2008 Mar;23(2):111-6.
when emergency cardiopulmonary by- therapies and will therefore become an
pass or conversions to conventional sur- essential resource of every cardiac cen- 2. Vahanian A, Alfieri OR, Al-Attar N, Antunes
gery are required. This life-saving effect ter. The trend towards hybrid tech- MJ, Bax J, Cormier B, Cribier A, De Jaegere P,
Fournial G, Kappetein AP, Kovac J, Ludgate S,
has certainly been demonstrated in niques is more a revolution than an evo- Maisano F, Moat N, Mohr FW, Nataf P, Pierard L,
some of the current studies. In addition lution. Stanford University is already Pomar JL, Schofer J, Tornos P, Tuzcu M, van
to the environment, a dedicated team of including catheter techniques into train- Hout B, von Segesser LK, Walther T. Transcathe-
ter valve implantation for patients with aortic
cardiologists, cardiac surgeons, anes- ing of cardiovascular surgeons. Within stenosis: a position statement from the Europe-
thetists, scrub nurses, and technicians only two years the majority of all Ger- an Association of Cardio-Thoracic Surgery
are necessary for successful TAVR. In man heart centers started planning a (EACTS) and the European Society of Cardiology
(ESC), in collaboration with the European Asso-
some centers the same integrated team hybrid OR. Cardiac surgeons around the ciation of Percutaneous Cardiovascular Inter-
performs both transfemoral and world emphasize that cardiac surgery is ventions (EAPCI). Eur J Cardiothorac Surg. 2008
transapical approaches. moving rapidly towards the hybrid pro- Jul;34(1):1-8.
TAVR is not a mature method yet; expe- cedure and that the change is now, not 3. Reicher B, Poston RS, Mehra MR, Joshi A,
rience with it is limited and long-term in 5 years. Odonkor P, Kon Z, Reyes PA, Zimrin DA. Simulta-
neous “hybrid” percutaneous coronary interven-
results lacking. The clinical value has to Siemens Healthcare has recognized tion and minimally invasive surgical bypass
be proven in a randomized, controlled these trends in surgery and offers a grafting: feasibility, safety, and clinical out-
trial. Without the results of such a com- complete portfolio of high-end angiog- comes. Am Heart J. 2008 Apr;155(4):661-7
parison, the excellent long-term results raphy systems for imaging in an OR en- 4. Bacha EA, Marshall AC, McElhinney DB, del
of conventional aortic valve replace- vironment. From a semi-mobile system Nido PJ. Expanding the hybrid concept in con-
genital heart surgery. Semin Thorac Cardiovasc
ment make this therapy the gold stan- for smaller ORs to the flagship of inno- Surg Pediatr Card Surg Annu. 2007:146-50.
dard. Patients with an acceptable risk vation Artis zeego, the new angiogra- Review.
profile should therefore continue to un- phy system based on robotic technology,
dergo the standard therapy. However, Siemens delivers floor- and ceiling-
Contact
in the long run, valve therapy – for all mounted systems dedicated to surgery
georg.nollert@siemens.com
valves - will certainly change from con- procedures. Especially Artis zeego with

Angiography Large Volume syngo DynaCT
Percutaneos Nephrostomy for an Obstructed

Ectopic Pelvic Kidney in an Obese Patient
Supported by Artis zeego
and Large Volume syngo DynaCT
Division of Angiography and Interventional Radiology, Department of Radiology
University of Virginia Health System, Charlottesville, VA, USA
Patient history
46-year-old morbidly obese female
presented with high fevers, chills and
lower abdominal pain. Her condition
rapidly worsened to include lethargy
and hypotension.
Diagnosis
Pyelonephritis 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.
Treatment
Multiple Large volume syngo DynaCT
acquisitions with Artis zeego were per-
Dr. Warren Swee and the new Artis zeego multi-axis system at UVA
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- Comments Acknowledgements
dow for percutaneous access requiring Following nephrostomy tube placement I would like to thank Zachary Ryan, R.T.
passage through the psoas muscle to a and medical management, there was (R) for his assistance in image acquisi-
depth of 20 cm. After access was ob- complete resolution of the patient’s uro- tion.
tained, fluoroscopy was used to position sepsis.
Contact
a 10 French nephrostomy tube within
gerald.sandridge@siemens.com
the renal pelvis.

Large Volume syngo DynaCT Angiography
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.
1A 1B 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.
2A 2B
3A 3B

Angiography Electromagnetic Needle Guidance
Radiofrequency Ablation
of a Large Vertebral Metastasis
Using iGuide CAPPA
Electromagnetic Needle Guidance
Prof. 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 2 a+b The electromagnetic tracking shows progression
demonstrates large metastasis with intraspinal growth of the needle into the soft tissue mass.
and extension to the lungs, the aortic arch, the trachea
and the esophagus.
Patient history
68-year-old female with known renal nal and paravertebral infiltration quency ablation and subsequent radia-
cell carcinoma first diagnosed in 1996 and slight compression of the myelon tion therapy was planned. For radio-
with worsening pain in the upper (Fig 1). The lesion extends to the frequency ablation, first imaging with
thoracic spine. Patient showed discrete trachea and the aortic arch ventrally syngo DynaCT was performed.
paresis of the left arm, but no other and the lungs laterally. No other spinal The electromagnetic tracking system
neurologic deficit. metastases were detected. iGuide CAPPA, which superimposes the
puncture needle on the syngo DynaCT
Pre-treatment Imaging Treatment data set, was used for precise place-
MRI of the spine revealed a large metas- The patient was considered inoperable ment (Fig. 2 a + b). Then the electrodes
tasis with destruction of the second concerning tumor resection and verte- were introduced through the puncture
thoracic vertebra and extensive intraspi- bral body replacement. Thus radiofre- needle. The final position achieved

Electromagnetic Needle Guidance Angiography
2b 3
3 Documentation of the final position of the

electrodes with syngo DynaCT. The image was
reconstructed at a syngo X Workplace.
Comments
according to the electromagnetic track- The electromagnetic tracking system in ther imaging is necessary during the
ing system was confirmed by another combination with syngo DynaCT allows intervention. X-ray exposure to the
syngo DynaCT run (Fig. 3) and the abla- precise placement of electrodes or bi- examiners is reduced when compared
tion was conducted with a total energy opsy devices even in regions that are to interventions performed under CT-
of 40 kJ. The patient tolerated the inter- difficult to evaluate with fluoroscopy or fluoroscopy guidance. If wanted, a
vention without any complication, pain where critical anatomic structures not control scan can be performed to docu-
improved immediately after the proce- visible with fluoroscopy alone must be ment the final position.
dure. avoided. The tracking system provides
excellent depiction of the progression
Contact
of the needles and anatomic detail is
vera.juennemann@siemens.com
provided by syngo DynaCT. Also no fur-

Angiography Imaging Technology in South America
State-of-the-Art Imaging Technology

Raises 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 first public hospital in South America with new
high-end medical imaging equipment.
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
President of Chile, Michelle Bachelet, and the team of the Neuroradiology Department
system is equipped with the syngo
at the Neurosurgery Institute in Santiago, Chile
DynaCT application to create cross-sec- Source: Presidency of the Republic of Chile
tional images during an angiography
procedure, which had helped us reach a
fast and reliable treatment decision in tute confirms that the application is a “For us AXIOM Artis dBA is special in
121 procedures performed between great imaging tool and has fast acquisi- two ways”, says Dr. Bravo. “The two
June 2007 and January 2008. The insti- tion and processing times. C-arms allow us to acquire two views

Imaging Technology in South America Angiography
“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
during a neuroradiological intervention, Improved patient care institute hosted a workshop with 37
so we can see the same pathology in Latin American neuro-interventionalists
two different planes, which provides us Among advanced imaging capabilities, focusing on syngo DynaCT and how its
with a 3D view of millimetrical struc- AXIOM Artis dBA brings other advantag- soft tissue imaging capabilities can dis-
tures for greater safety in our work and es to the facility. Dr. Bravo is very satis- play details that no other angiography
minor risk for the patient.” fied with the new system, mainly be- system on the market can offer. These
The other great benefit is that it enables cause it is the first in a public hospital in details range from hemorrhages in the
the physician to see complications in South America and because of the fi- brain to stent visualization. Many live
the treatment of patients in the same nancial benefits. “Working with the bi- cases were discussed with the partici-
room without moving the patient to an- plane system reduces the expenses for pating radiologists who also confirmed
other imaging modality. “Without mov- contrast agent and speeds up the proce- the high clinical value of syngo DynaCT.
ing the patient, it is possible to see any dure because it is not necessary to
kind of complication during treatment change C-arm positioning during the
in a very user-friendly way”, affirmed procedures,” he explains.
Contact
Bravo. At the end of February 2008, the same
antonio.carlos@siemens.com
1 2 3 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.

Cardiology Efficiency in EP
Improved Efficiency in the EP Lab

with syngo DynaCT Cardiac
By Joris Ector, M.D., Stijn De Buck, M.Sc., Ph.D., Hein Heidbuchel, M.D., Ph.D
Department of Cardiology, University Hospital Gasthuisberg, Leuven, Belgium
At the University Hospital Gast- Image integration for ablation ed with 3D mapping systems. The Uni-
huisberg in Leuven, Belgium syngo of atrial fibrillation versity Hospital Gasthuisberg pioneered
DynaCT Cardiac has become a useful integration of 3D models with real-time
application during ablation therapy. Pre-procedural imaging and three-di- biplane fluoroscopic imaging to guide
The team in the cardiology depart- mensional (3D) reconstruction of the catheter navigation and ablation.2 Image
ment describes their experiences left atrium and pulmonary veins is per- integration is usually based on cardiac
with the system and how it contrib- formed in the majority of centers before CT or MRI images that are acquired prior
utes to an efficient workflow and atrial fibrillation (AF) ablation proce- to the procedure, and reconstructed
excellent results. dures.1 Detailed anatomical information into a 3D model for treatment planning.
can help achieve a more effective and One drawback of this approach is the
successful ablation and may prevent possibility of changes in the left atrial
procedure-related complications. Pa- geometry between imaging and the
tient-specific 3D models can be integrat- ablation procedure due to differences in

Efficiency in EP Cardiology
cardiac loading conditions, resulting in per second during a single 5-second ro-
1A Ungated syngo DynaCT Cardiac
inaccurate image integration during the tation and were automatically trans-
acquisition (after ATP)
procedure. Moreover, an additional am- ferred to the Siemens Workplace for 3D
bulatory hospital visit or earlier hospital- reconstruction to axial images and fur- 1B 2D Slice Reconstruction
ization is often required for the patient ther 3D processing (Fig. 1 A-C). Whereas
1c 3D Volume Rendering
to acquire the images necessary for 3D contrast administration for left atrial
syngo DynaCT Cardiac: (LA: left atrium, LV: left
reconstruction. This leads to extra logis- syngo DynaCT Cardiac examinations is ventricle, RIPV: right inferior pulmonary vein,
tical overhead. conventionally performed in the pulmo- LSPV: left superior pulmonary vein, RSPV: right
syngo DynaCT Cardiac now offers the nary artery, we developed a new ap- superior pulmonary vein, ap: anterior papillary
possibility of CT-like imaging of the left proach in which diluted contrast agent muscle, pp: posterior papillary muscle, LAA: left
atrial appendage)
atrium and pulmonary veins during the is directly injected into the left atrium.
ablation procedure. At the beginning of To obtain optimal contrast filling and to
1A
2008, we evaluated a new workflow in reduce cardiac motion artifacts, contrast
which syngo DynaCT Cardiac images injection and syngo DynaCT Cardiac ac-
were acquired during AF ablation proce- quisition were performed after adminis-
dures and reconstructed into a 3D mod- tration of adenosine-triphosphate (ATP)
el for integration with biplane fluoro- to induce transient ventricular asystole
scopic imaging. Catheter navigation and (Fig. 2 A) or during rapid right ventricu-
ablation were guided solely by syngo lar pacing to reduce cardiac output and
DynaCT Cardiac-based 3D-fluoroscopy cardiac motion (Fig. 3 A-B). This ap-
integration, without the use of a 3D proach resulted in high quality 3D re-
mapping system. Our goal was to devel- constructions of the left atrium and pul-
1B
op a workflow resulting in high quality monary veins, using only a limited dose
3D reconstructions of the left atrial of ionizing radiation and contrast agent.
anatomy with the lowest possible pa- Given the excellent quality of syngo
tient radiation exposure, eliminating the DynaCT Cardiac, pre-procedural imaging
need for additional pre-procedural im- with Cardiac CT or MRI is no longer con-
aging and improving image integration sidered necessary for clinical use in our
accuracy. center.
Imaging the left atrium with a syngo DynaCT Cardiac for 3D

single C-arm rotation image integration 1C
syngo DynaCT Cardiac offers the possi- In our opinion, one of the most impor-
bility for both ungated image acquisi- tant advantages of syngo DynaCT
tion with a single 5-second C-arm rota- Cardiac lies in the new possibilities for
tion over 200°, and an ECG-gated image 3D image integration. AF ablation pro-
acquisition using 4 sequential 5-second cedures are performed in our center
rotations with retrospective ECG gating. under general anesthesia. As a result, no
To reduce patient radiation dose, we patient movements occur and patient
opted for the ungated acquisition proto- position is identical during syngo DynaCT
col. Images are acquired at 60 frames Cardiac acquisition and fluoroscopic im-

2A 2B
3A
2A syngo DynaCT Cardiac, ungated acquisition after ATP

Coronary Sinus Catheter
2B Cardiac CT image
Comparison 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.
3B
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)
4A 4B
Coronary Sinus Catheter
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 5C
5B 5D
5 A+B RAO view visualized with LARCA (Leuven Augmented Reality for Catheter Ablation) software
5 C+D LAO view visualized with LARCA software

Biplane 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)

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- University Hospitals
ment is already performed in our re- Leuven, Campus
search setting using in-house developed
Gasthuisberg
software (Leuven Augmented Reality for
Catheter Ablation, LARCA, Fig.5). It may With 1,894 patient beds
be available in later versions of systems and 8,447 employees, the
using syngo DynaCT Cardiac, further in- University Hospital Leuven
creasing the value of 3D-fluoroscopy in- is Belgium’s largest medi-
tegration. Moreover, 3D overlay provides cal institution. Recently,
direct image integration with electro- the Medical Imaging Cen-
anatomical mapping systems, obviating ter was identified as a new
the need for registration with 3D geom- interdisciplinary research
etries acquired with a roving catheter center, with a central
and thereby reducing the duration of the position in the University
procedure. Hospital Gasthuisberg. The
center is a joint initiative
References of the University of Leuven
1. Calkins H, Brugada J, Packer DL et al. HRS/ (faculties of medicine
EHRA/ECAS expert Consensus Statement on and engineering) and the
catheter and surgical ablation of atrial fibrilla-
University Hospitals Leu-
tion: recommendations for personnel, policy,
procedures and follow-up. A report of the Heart ven. Over 80 engineers,
Rhythm Society (HRS) Task Force on catheter physicians and physicists
and surgical ablation of atrial fibrillation. Heart from ESAT/PSI, Radiology,
Rhythm 2007; 4(6):816-861. Nuclear Medicine, Cardiol-
2. Ector J, De Buck S, Huybrechts W et al. Bi- ogy and Radiotherapy are
plane three-dimensional augmented fluorosco- working closely together
py as single navigation tool for ablation of atrial
on innovative imaging
fibrillation : accuracy and clinical value. Heart
Rhythm 2008;In Press. applications.
Contact
erik.busch@siemens.com

“Given the excellent image quality with

syngo DynaCT Cardiac, pre-procedural
imaging with cardiac CT or MRI
is no longer considered necessary 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

Cardiology Pediatric Cardiac Surgery
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.
MR table integration with angiographic tabletop

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 workflow
and avoids two procedures”
Lee N. Benson, MD, The Hospital for Sick Children, Toronto, Canada
Taking Care of Children

Pediatric cardiology has always been a special field 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.
Unlike other medical disciplines there tion, treatment plans have evolved that With this system combination, workflow
has been a long and productive relation- utilize the unique attributes of what at is streamlined, all anatomical data is
ship between the pediatric cardiologist first may seem like competitive special- available prior to the surgery and the
and cardiovascular surgeon, together ties, but have come together, as Taussig complete treatment can be done under
focusing on improving the lives of chil- did with Blalock, to develop new tech- the same anesthetic. The MIYABI con-
dren with congenital heart lesions. This niques and management strategies. The cept offers flexibility for system usage,
cooperative spirit found its origins, case presented on the following pages as both systems can be operated sepa-
when in November 1944, Dr. Alfred Bla- is one such contemporary example, that rately as well. But when used together,
lock, encouraged by Dr. Helen Taussig, of management of the newborn with they become a very powerful high-per-
performed the first arterial shunt, set- hypoplastic left heart syndrome. The formance interventional system. The
ting the stage for a revolution in cardiac treatment algorithm was bilateral pul- availability of two imaging technologies
care. That spirit continues today in very monary artery banding and placement during interventional procedures and
specialized centers dealing with con- of a ductal stent in a hybrid surgical an- the convenient way to move the patient
genital heart disorders like The Hospital giography suite, with prior cardiac MR from one system to the other quickly
for Sick Children in Toronto, Canada. imaging, and transfer on Siemens Miya- and easily supports an optimized treat-
With the development of percutaneous bi system from the MRI scanner to the ment and gives seriously ill children
techniques for cardiovascular interven- hybrid room for angiography. new hope.

Cardiology Pediatric Cardiac Surgery
Hypoplastic Left Heart Syndrome

Combined Imaging –
Angiography and MRI
Lee N. Benson, M.D.
The Hospital for Sick Children, Toronto, Canada
Patient history
3-day-old baby boy, weight 2.5 kg. a hybrid procedure. Because of the child’s stent into the arterial duct through the
size it was determined that the hybrid main pulmonary artery was successfully
Diagnosis procedure would be a better option. performed.
Hypoplastic left heart syndrome.
Treatment Comments
Therapy planning The child was anesthetized and under- The child recovered well, was extubated
At three days of life, after consultation went a pre-procedural MRI to define the on day three following the procedure
with the family, the management deci- anatomy. (Fig. 3) Following the MRI, and returned home on day seven.
sion was to follow single ventricle pallia- the child was moved into the angiogra-
tion towards an eventual Fontan proce- phy suite while under the same anes-
dure. The first stage of palliation was thetic. A bilateral pulmonary artery Contact
either a standard Norwood operation or banding procedure and insertion of a dirk.sunderbrink@siemens.com
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 2 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.
3 4
4 Banded pulmonary arter-
ies, Patent Ductus Arterious
injection.
5 Opened stent in PDA.
6 Angiogram of ductal stent

in position.
5 6
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

Fluoroscopy Pediatric Imaging
Pediatric Fluoroscopy
with Digital Radiography
Expedites Clinical Outcomes
AXIOM Luminos TF, the proven system for fluoroscopy,
has many features to ease workflow and facilitate system
handling. Together with the mobile digital flat detector it
becomes even more versatile, producing excellent results
in pediatric care.
Tailored for optimal Fast diagnosis same patient folder and displayed in the
patient care by the patient’s side order of acquisition.
The open design of AXIOM Luminos TF Digital radiographic exposures in addi-

facilitates easy and comfortable access tion to fluoroscopy can be acquired di- Brilliant image quality
to the patient. The large distance be- rectly in the fluoroscopic suite with the and lowest dose levels
tween the tabletop and digital imaging integrated mobile Flat Detector (mFD).
tower as well as a wide tabletop make The light -weight, mobile and easy-to- With convenient and efficient system
user perform patient repositioning more handle mFD is quickly positioned in the handling and the outstanding image
conveniently. Bucky tray or used for free exposures. quality at low dose levels, pediatric ex-
All operator controls are within easy The acquired images are available in aminations can be performed with radi-
reach during the procedure, allowing seconds and eliminate time-consuming ation exposure levels that are as low as
the operator to select organ programs examination steps such as cassette reasonably achievable while maintain-
and control radiographic parameters di- handling, allowing the operator to re- ing diagnostic image quality. Equipped
rectly in the examination room. main in the examination room. with the comprehensive radiation re-
Diagnosis from the entire procedure can duction program CARE, AXIOM Luminos
be accomplished faster. All acquired im- TF with mFD can reduce the skin en-
ages, whether fluoroscopy scenes or ra- trance dose by a factor of eleven in pe-
diographic images are located in the diatric fluoroscopy*.
*Data on file. Results may vary.
With mFD
Patient
Exposure Repositioning Exposure
positioning
Images available Images available

within seconds within seconds
With CR cassettes
Patient Insert Exchange Reposition Remove Scan Read out Images available
Exposure Exposure
positioning cassette cassette Patient cassette cassette cassette for review
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.

Pediatric Imaging Fluoroscopy
“Overhead radiographs acquired with

the mobile flat detector are not only
of outstanding image quality but also
significantly enhance the procedure
workflow. 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 3 Convenient and efficient system handling
flexibility and efficiency. for a smooth procedure.
2 3

Fluoroscopy Pediatric Imaging
Therapeutic Relief of Sigmoidal Volvulus

Under Fluoroscopy
Supported by AXIOM Luminos TF
with mobile Flat Detector (mFD)
John P. Harris, M.D., Charles E. Winn, M.D.
North Colorado Medical Center, Greeley, CO, USA
Dr. John Harris and his team at the AXIOM Luminos TF. North Colorado Medical Center, Greeley, CO, USA.
Patient history
A 13-year-old female presented to the 1
1 Delayed radiograph
emergency department with sudden
taken 10 min. after
nausea, vomiting and abdominal pain. the therapeutic relief
No history of surgery or injury given. started.
Diagnosis
The 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.

Pediatric Imaging Fluoroscopy
Treatment
2 The treatment initially began in the
2 Gastrografin enema
SIMMs position where the patient is lay-
validating the volvulus
ing on the left side with the right knee
at the rectosigmoid
junction. 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
3 Delayed radiograph approx. 20 min. after procedure started showing contrast left and the transverse colon. The co-
passing into the descending and transverse colon. lon was of more normal caliber. The
following delayed images indicated fur-
3
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.
Comments
With 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.
Contact
kelly.obrien@siemens.com
barbara.reber@siemens.com

Customer Care.Life Virus Protection
Virus Protection
at the University Hospital Basel,
Switzerland
The 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

configured 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
In the University Hospital Basel, on a Providing operating security the hospital’s internal operating net-
daily basis, about ten thousand patient for the systems work. The systems are increasingly
images – corresponding to a volume of threatened by viruses stemming from
18 gigabytes – are processed and regis- Given the high level of system utiliza- data exchange, for example through
tered in the network of the radiological tion, equipment reliability is crucial. And USB devices and network-connected lap-
image storage system. Currently, the security considerations play an increas- tops or from files downloaded from
entire quantity of stored image data ingly important role in providing this the Internet. For the University Hospital
amounts to about 32 terabytes, which is reliability. On the one hand, networked Basel, the safety and protection of medi-
equivalent to the contents of over 5,000 communications and the exchange of cal technical systems with their enor-
kilometers of file shelves. data worldwide brings the risk of con- mous volumes of data have top priority.
tamination by malicious software, such Professor Wolfgang Steinbrich, MD,
as viruses, worms, and Trojan horses. Director of the Institute for Diagnostic
On the other hand, the systems need to Radiology, explains: “Today our capacity
be protected from risks resulting from is configured in such a way that the de-

Virus Protection Customer Care.Life
“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
vices always have to be functioning. through Siemens Virus Protection. The tomer is even aware of the virus on-site
That’s why in addition to system quality, service consists of virus detection and and before the virus can cause any dam-
operational security is our most impor- elimination as well as prevention. age. Professor Steinbrich values this as-
tant goal.” Through the installation of a virus scan- pect in particular: “It’s our responsibility
To achieve this, the University Hospital ner and connection of the systems to to safeguard and protect our image
Basel installed full-scale protection Siemens Remote Service (SRS), remote data. Due to new technologies, new
against malicious attacks – the first hos- updates with relevant hotfixes are im- dangers have arisen that we must elimi-
pital in Switzerland to take this step. To ported proactively to protect the sys- nate. I was very positively impressed by
protect against viruses, worms, and Tro- tems against attacks from every type of Siemens’ proactive approach with Virus
jan horses, most imaging systems from known virus. Should a virus infection Protection. That’s why I strongly sup-
Siemens are equipped with Siemens nevertheless occur, the Siemens experts ported this solution.”
Virus Protection. can frequently detect this very early – The director of Medical and Operational
The University Hospital currently has 27 thanks to remote monitoring via SRS – Technology, Christian Kluth, attaches
Siemens modalities that are secured and take suitable action before the cus- special importance to ensuring that all

Customer Care.Life Virus Protection
Siemens Virus Protection continuous-

ly monitors the large-scale equip- “Just one insecure site would be one
ment operated at the University Hos-
pital Basel. This includes systems
too many. Only the installation of
used in various areas, such as an- Virus Protection in all equipment
giography, computed tomography,
magnetic resonance tomography, offers the protection we prefer to
and medical imaging stations. The
solution includes proactive virus pro- help ensure the operating reliability
tection as well as virus detection and
virus elimination. Virus Protection is
of our machines and systems.”
one of the innovative service offer-
Christian Kluth, Director of Medical and Operational Technology,
ings made possible by Siemens Re-
University Hospital Basel, Switzerland
mote Service (SRS), the infrastructure
for long-distance data transmission.
The benefits at a glance
Reliable protection against

software attacks
Expert problem resolution
Reduced technical and IT costs
Smoothly running clinical routines
Higher system availability
Improved efficiency
Increased planning security
large-scale equipment in the University cal diagnostic equipment has become cludes: “Although the different networks
Hospital Basel is equipped with virus highly developed – from the original are physically decoupled, they are con-
protection. As he says, a complete solu- precision mechanical systems with ana- nected through the exchange of infor-
tion of this kind is a highly feasible ap- log electronics to computer-controlled mation. In order to prevent the misuse
proach for providing comprehensive instruments with complex software for of personal data at the interfaces and to
protection against virus attacks: “Just digital imaging. Second, the stand-alone avert threats, for example, from Trojan
one insecure site would be one too workstation systems of former times are horses or viruses, comprehensive inno-
many. Only the installation of Virus Pro- today interconnected and networked vative protection systems are required –
tection in all equipment offers the pro- with the image viewing units of image such as Siemens Virus Protection.”
tection that we prefer to help ensure storage networks. In addition, a high-
the operating reliability of our machines performance link to the radiological in-
and systems.” formation system and to the hospital- Contact
Professor Steinbrich attributes the dan- wide network of the clinical information birgit.munz@siemens.com
www.siemens.com/virus-protection
gers to two principal causes: “First, clini- system is planned.” Steinbrich con-

How can I improve ablation
therapy?
With syngo DynaCT Cardiac 3D images of the left atrium can be

created directly in the EP lab to help guide the ablation catheter.
The Artis zee imaging system with syngo® DynaCT Cardiac is able to create CT-like 3D images of the beating heart within
seconds during the procedure – directly in the EP lab. With a single click of the mouse, the left atrium is segmented. The result
can be merged with electroanatomical maps and overlain on the live fluoroscopic image, providing anatomical information to
support treatment decisions. Visit our website and zee the future. www.siemens.com/artis-zee +49 69 797 6420
Answers for life.
AX-Z1089-2-7600
Customer Care.Life Learning with and from the Experts
Learning With
and From the Experts
Siemens offers intensive hands-on training for interventional
cardiology using state-of-the-art simulation technologies
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
The 3-level CME accredited diagnostic ac procedures from basic diagnostics to Clinic in Wuerzburg, Germany. His opin-
and interventional cardiology course led complex interventional procedures. In a ion is also reflected by the participants.
by Prof. Wolfram Voelker and his team, simulated cath lab environment, partici- For Dr. Hannes Lafenthaler from Austria
offers attendees a unique opportunity pants can broaden knowledge in the the course was a great inspiration. He
to get extensive hands-on experience techniques of coronary angiography had also attended other Siemens hands-
using cutting edge simulation technolo- and interventional techniques, includ- on workshops before and liked the bal-
gies. The practical training course, initi- ing three-dimensional imaging to quan- ance between theory and hands-on
ated and organized by Siemens Health- tify and visualize coronary artery lesions training. “The intensive practical train-
care is widely recognized as one of the with more accuracy. Besides the use of ing on the simulators and the individual
most successful methods to learn and the imaging system and catheter ad- mentoring by experienced cardiologists
master new techniques for catheter- vancing techniques, the learning objec- in a real cath lab environment enabled
based procedures. Over the last three tives vary from the right selection and me to greatly improve my skill set. After
years, our simulation-based training has handling of catheter materials to com- this instruction, I now pay special atten-
offered cardiologists the chance to en- plication management in the cath lab tion on how to keep the radiation expo-
hance their skills in interventional cardi- during an intervention. In small groups, sure in the cath lab at a minimum,” he

Learning with and from the Experts Customer Care.Life
“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
“My expectations of this course were

more than fulfilled. 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
explained. Also Dr. Sabine Bleiziffer’s taught me effectively about catheters

expectations of the course were more and guidewire selection and the neces-
than fulfilled and she appreciated the sary maneuvering of catheter through
use of various simulation systems. “Es- coronary vessels. To me it was very im- Available hands-on courses
pecially the lesson about measurements portant to learn about radiation reduc- (English and in German)
for coronary arteries greatly increased tion in the cath lab. Less dose is not
my knowledge and will be productive in only beneficial for the patient, but also
my daily routine. I also appreciated the crucial for me as a physician.” Level 1 Introduction in Diagnostic
limited group size and being supported Coronary Angiography
by an experienced cardiologist which Level 2 Introduction in
extraordinarily increased the learning Interventional Cardiology
curve.” Dr. Ibrahima Bara Diop from CHU Further information Level 3 Complex cases in
Fann in Senegal confirmed: “I signifi- and registration: Interventional Cardiology
cantly improved my skill set in coronary axiom.educate.med@siemens.com
angioplasty. The hands-on sessions

New Light and Sound Concept
Siemens Presents
New Light and SoundConcept*
Many patients are anxious or even especially in children. Interventional should remain out of view. To work
scared prior to a catheterization proce- treatment becomes faster and more effectively in this light environment,
dure and need to be calmed down with effective when the patient is calmer and Siemens offers the TRAXON ™ Nano
sedatives. Various studies revealed that more at ease. Liner, a white light for clinical use to
sound and light effects in the room can For these reasons, Siemens created a provide adequate table lighting during
help take away that fear and anxiety, new light and sound concept which can the procedure. And with the BOSE ™
be individually designed for the custom- sound system connected to an iPod®
ers’ needs. It creates a soothing light Touch, the whole sound and light
Components of the light
environment consisting of various ele- environment can be operated with a
and sound concept ments the customer can choose from. syngo-like user interface.
Skylight LED tubes on the wall can create a For the light and sound installation dif-
LED Wall lightening warm light with different soft and fluid ferent themes like landscapes or special
French Window – colors that can also be coordinated with images for children are also available.
music. A skylight with a customized im-
artificial door/window
age can be tailored to any room size,
TRAXON Nano Liner * Siemens light and sound concept is currently only
even with a ceiling-mounted system, to available in Europe.
for patient table lighting
create the impression of a large and airy
BOSE Sound System
room. Another highlight is the artificial
with iPod Touch connection Contact
French door which is ideal to simulate
markus.rossmeier@siemens.com
daylight or to cover up objects that

Congresses & Workshops
Upcoming Congresses
& Workshops 2008 / 2009
We always would like to give you the the latest technological advances. You below you will find information on vari-
opportunity to get in “touch” with the will have the chance to experience our ous events where we offer you the op-
real system and learn more about sys- technology at international congresses, portunity to meet AX.
tem handling to keep you in step with 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 Cardiovascular Oct. 12 – 17, 2008 www.tctconference.com
Therapeutics
ISHAHD Beijing, China International Symposium on Hybrid Oct. 18 – 20, 2008 www.hybridheartbeijing.org
Approach to Heart Diseases 2008
JFR Paris, France Journées Francaise de Radiologie Oct. 24 – 28, 2008 www.jfrexpo.com
AOCR Seoul, South Korea 12th Asian Oceanian Congress of Oct. 24 – 28, 2008 www.aocr2008.org
Radiology
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 Rome, Italy 13 International Symposium

th
Dec. 2 – 5, 2008 www.aimgroup.it/2008/pacing
Electrophysiology
APCC Taipei, Taiwan 16th Asian Pacific Congress of Dec. 13 – 16, 2008 www.apcc2008.org
Cardiology
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 Society Jan. 26 – 28, 2009 www.sts.org
of Thoracic Surgeons
Arabhealth Dubai, Exhibition and Congress Jan. 26 – 29, 2009 www.arabhealthonline.com

United Arab Emirates
CCT Kobe, Japan Complex Catheter Therapeutics Jan. 29 – 31, 2009 http://cct.gr.jp
DGHTG Innsbruck, Austria 38th Jahrestagung der dt. Gesellschaft Feb. 15 – 18, 2009 www.dgthg.de
für Thorax-, Herz- und Gefäßchirugie
ECR Vienna, Austria European Congress of Radiology Mar. 6 – 10, 2009 www.ecr.org
SIR San Diego, CA, USA Annual Scientific Meeting Mar. 7 – 12, 2009 www.sirmeeting.org
CIT 2009 Beijing, China China Interventional Therapeutics Mar. 18 – 22, 2009 www.citmd.com
2009
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

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AXIOM Innovations
Radiography and Fluoroscopy
Issue No. 8 | October 2008
New Trends
in Surgery
Cardio-vascular surgery
opens up for new treat-
ment methods
Page 14
Efficiency
in the EP
syngo DynaCT Cardiac
enhances ablation therapy
Page 26
AXIOM
Luminos TF
Pediatric imaging
in fluoroscopy
Page 36
Virus protection
at the University Hospital
Basel, Switzerland
Page 40
Large Volume Imaging
08
with Artis zeego
More anatomical coverage with Large Volume syngo DynaCT
AXIOM Innovations MAGNETOM Flash SOMATOM Sessions Perspectives

Everything from the worlds Everything from the world Everything from the world Everything from the world
of interventional radiology, of magnetic resonance of computed tomography. of clinical diagnostics. This
cardiology, fluoroscopy, imaging. The magazine With its innovations, clini- semi-annual publication
and radiography. This presents case reports, cal applications, and vision, pro-vides clinical labs with
semi-annual magazine is technology, product news, this semiannual magazine diagnostic trends, technical
primarily designed for phy- and how-to’s. It is primarily is primarily designed for innovations, and case stud-
sicians, physicists, re- designed for physicians, physicians, physicists, re- ies. It is primarily designed
searchers, and technical physicists, and technical searchers, and technical for laboratorians, clinicians
personnel. personnel. personnel. and technical personnel.
For current and older issues and to order the magazines, please visit www.siemens.com/healthcare-magazine

Imprint
Editorial
AXIOM Innovations Imprint

© 2008 by Siemens AG, Berlin and Munich, All Rights Reserved
“Keeping our customers Publisher

Siemens AG
Lee Benson, MD
Cardiac Diagnostic and Interventional
Unit, Hospital for Sick Children,
Harald Sandmayr, MD
Radiography Department
Landeskrankenhaus Steyr
at the cutting edge of Medical Solutions

Angiography, Fluoroscopic
and Radiographic Systems
Toronto, Canada
Joris Ector, MD, Stijn De Buck, MSc ,PhD

Steyr, Austria
Prof. Martin Skalej, MD,
technology and enabling

Siemensstr. 1, Hein Heidbuchel, MD, PhD Oliver Beuing, MD,
91301 Forchheim, Germany Department of Cardiology, Anja Lenz, MD
University Hospital Gasthuisberg Leuven, University of Magdeburg,
Responsible for contents Leuven, Belgium Magdeburg Germany
them to do more with

Norbert Gaus, PhD
Erik Fosse, MD Prof. Wolfgang Steinbrich, MD
Chief editor The Interventional Centre, Christian Kluth
Sabine Wich Rikshospitalet, University of Oslo, University Hospital Basel
their systems and appli- sabine.wich@siemens.com
Editorial board
Monika Böhmer
Oslo, Norway
John P. Harris, MD
Charles E. Winn, MD
Basel, Switzerland

Department of Radiology
cations is one of our Klaudia Dorsch

Vera Jünnemann
Oliver Meissner, MD, PhD
North Colorado Medical Center,
Greeley, CO, USA
University of Virginia Health System
Charlottesville, VA, USA
most important goals.”

Nadine Meru, PhD David Lacey, MD Prof. Wolfram Voelker, MD
Andrea Müller Iowa Methodist Medical Center University Clinic Wuerzburg
Prof. Georg Nollert, MD Des Moines, IA, USA Wuerzburg, Germany
Roland Papenfuß
Siegfried Prell Jaime Lavados, MD Production
Dr. Norbert Gaus, CEO of the Angiographic, Susanne Seah Eduardo Bravo, MD Michael Brumme
Radiographic and Fluoroscopic Division (AX) Dirk Sunderbrink Neurosurgery Institute Santiago, Siemens Healthcare
at Siemens Healthcare Santiago, Chile
Contributors to this issue Layout and editorial staff
Alfonso Aguilera, Erik Busch, Knut Imhof, Luis Ramos, MD, Satzwerker – Jäger & Tuppi
Michaela Kandolf, Andra Kirchner, X-ray Department Nuremberg/Karlsruhe, Germany
Barbara Reber, Antonio Ribeiro, Markus University Hospital Puerta
Rossmeier, Gerald Sandridge de Hierro Majadahonda, Printer
Madrid, Spain. Farbendruck Hofmann
All at Siemens AG Healthcare Sector Gewerbestraße 5
90579 Langenzenn, Germany
AXIOM Innovations on the net:

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We remind our readers that, when printed, X-ray
films never disclose all the information content Partial reproduction in printed form of individual Manuscripts submitted without prior agreement as
of the original. Artifacts in X-ray, CT, MR and contributions is permitted, provided the custo- well as suggestions, proposals and information are
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pical features and are generally distinguishable and title of the contribution as well as date and submitted to the editorial board for review.
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Issue Number 8/October 2008

In Latin America Large Volume Imaging

with Artis zeego

AXIOM Innovations Imprint

“Keeping our customers Publisher

at the cutting edge of Medical Solutions

Joris Ector, MD, Stijn De Buck, MSc ,PhD

Prof. Martin Skalej, MD,

technology and enabling

them to do more with

their systems and appli- sabine.wich@siemens.com

Warren Swee, MD, MPH

cations is one of our Klaudia Dorsch

most important goals.”

AXIOM Innovations on the net:

AXIOM Innovations · October 2008 · www.siemens.com/healthcare-magazine 3

Cover Story 2 Editorial

Artis zeego in the OR

Surgery Opens up for New

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

Surgery Cardiology Customer Care.Life

Fluoroscopy 47 Upcoming Congresses &

AXIOM Innovations · October 2008 · www.siemens.com/healthcare-magazine 5

First Ysio installation at Clinical results with

Dr. Lacey at Iowa Methodist Medical Center, USA, is one

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Get Your Free DVD of this Year’s

Computed Tomography (CT) and intensive overview of the main fields

A True Icon in Fluoroscopy –

AXIOM Innovations · October 2008 · www.siemens.com/healthcare-magazine 7

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

The Interventional Center Rikshospitalet anywhere in a sphere around the pa-

AXIOM Innovations · October 2008 · www.siemens.com/healthcare-magazine 9

the Interventional Center at Rikshospi-

Highlights of Artis zeego

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Frame rates from 0.5f/s to

Large Volume syngo DynaCT

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team making critical decisions with very

Siemens Healthcare has been working

a new lighting system,” says Fosse. “We

AXIOM Innovations · October 2008 · www.siemens.com/healthcare-magazine 11

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

AXIOM Innovations · October 2008 · www.siemens.com/healthcare-magazine 13

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

AXIOM Innovations · October 2008 · www.siemens.com/healthcare-magazine 15

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

1 CoreValve 2 Edwards Sapien protheses 3 Transapical technique 4 Transfermoral technique

AXIOM Innovations · October 2008 · www.siemens.com/healthcare-magazine 17

5 AXIOM Artis U, the room-mobile system 6 Artis zee floor-mounted system

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

AXIOM Innovations · October 2008 · www.siemens.com/healthcare-magazine 19

Percutaneos Nephrostomy for an Obstructed

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

3 A+B Axial and sagittal MIP recon-

AXIOM Innovations · October 2008 · www.siemens.com/healthcare-magazine 21