More than 2,000 providers will receive new dose reduction technologies free, ensuring safer IR care.

Siemens is providing its latest dose-reduction applications free of charge to all Artis zee customers.

Kevin M. Baskin, MD, division chief of pediatric interventional radiology at the University of Pittsburgh School of Medicine, recalls the challenges he faced a decade ago, when imaging equipment was pushed to its limits and dose levels were 20 times higher than they are currently.

“The earlier units had very limited capability for managing or measuring dose,” he said. “In order to see small catheters and guidewires, we really had to ramp up the dose for the size of our patients.”

The side effects weren’t pretty. “When you’re doing hours of fluoroscopy, you can have burns or loss of hair,” he said. “That’s a horrible consequence.”

Siemens’ Artis zee family of products has helped make those issues a distant memory for the Children’s Hospital of Pittsburgh, which today boasts a 5-year survival rate of 97% for liver grafts. “Due to its reduced dose, our Artis zee is allowing us to do procedures that we would never have attempted before,” Baskin said.

Addressing the general public sensitivity about radiation, Siemens Healthcare has vowed to equip its partner hospitals, like the Children’s Hospital of Pittsburgh, with a new package of dose-reduction applications.

The company recently announced that its latest Combined Applications to Reduce Exposure (CARE) technologies will be provided, free of charge, to all Artis zee customers. Ultimately, more than 2,000 installed Artis zee systems will be upgraded to the brand-new CARE package.

Dose-Reduction Triggers

Siegfried Schneider, Siemens senior director of product marketing for interventional radiology, notes that customers are facing enormous cost-savings pressure and will encounter even more in the future.

“We think that more and more procedures will be done minimally invasively, as opposed to open surgeries,” he said. “Those procedures are more complex and more time-consuming. What comes with this longer time is more radiation. In order to prepare for that, we have to enable our customers to apply a dose-savings measure.”

Schneider also shared insiders’ insight as to what hospitals and physicians can expect in terms of regulation. He explained that the company has heard from its manufacturer association, which is in regular contact with the Food and Drug Administration, that customers will have to comply with dose reduction, dose monitoring, and dose reporting regulations in the near future.

According to the company, its CARE package reduces radiation and simplifies the monitoring and documentation of dose values. Applications include radiation-free collimation, patient positioning, and pulsed fluoroscopy, resulting in what Siemens says is a 75% reduction in exposure to both the patient and the examiner.

Package Components

“What we have put together is a package of means that will help our customer to reduce the exposure based on the current case and the situation they are facing in their daily work,” Schneider said.

Offering applications that reduce radiation for both patients and clinical staff, the CARE package is designed to simplify the postexamination documentation of dose values. Schneider pointed out that some of the features are not completely new and may have been introduced already in the past. “We are most likely considered the pioneer in dose reduction since our first steps in 1994, when we introduced the CAREvision,” he said. “Our new package enables our customers to reduce the dose even further.”

Here is a rundown of the various components of the package:


The recently unveiled application supports dose monitoring during complex interventional procedures by enabling customers to set threshold levels and therefore minimize skin dose. More specifically, physicians will have the ability to predefine up to three different skin dose thresholds. Upon reaching these values, the system will emit an audible alarm, as well as a pop-up message in the user touch screen. Once the examination is completed, users will have access to structured dose reports that document all patient dose values.

“We are pretty sure that the FDA will soon require that exceeding certain dose levels will have to be reported in a national database,” Schneider said. “This is a precaution to allow our customers to set dose levels even below that so they know where they are during a procedure and can adjust their procedure accordingly.”


Also a brand-new feature, the application works by recording every single dose for every x-ray shot that has been applied. Then, it stores those values in a database in the system, and customers can export this dose report in DICOM. As a result, the monitoring technology can deliver security for audits and helps users comply with government regulations.


Dose rate and dose area product at the Interventional Reference Point are monitored via live display in the examination and control rooms.

Low Dose syngo DynaCT

This technology allows customers to do CT-like imaging with a much lower dose, Schneider said. Low-dose image acquisition protocols allow for 3D imaging for neurology from as low as 0.3 mSv, which Siemens says reduces the dose by up to 72% compared to conventional 3D protocols.

Low Dose Acquisition

Protocols aim to reduce radiation during acquisition, specifically from 240 nGy/f to 80 nGy/f in cardiac interventions and 2.4 uG/f to 0.8 uG/f in radiologic interventions. Customers can enjoy dose savings of up to 67%, according to Siemens.


An automatic variable filterer of the x-ray beam that reduces the amount of low energy dose contrast going through or into the body, minimizing skin dose. No user interaction is necessary, and there is an increase of prefiltering from 0.2 mm to 0.9 mm, reducing dose up to 50%, according to the company.


Customers can adjust their collimators and reduce the dose without using fluoroscopy.


Users can adjust the field of view by panning the table without using fluoroscopy.


Providing low fluoro pulse rates to meet specific targets, the reduction from 30 p/s to 7.5 p/s is said to result in a dose savings of up to 75%.

Schneider said all previously optional CARE features will now be standard so that all customers will receive those features without additional cost. Furthermore, Siemens will upgrade its Artis zee users at no charge. “Of course, this will take time,” he continued, adding that the company has already started upgrades, but it will take some time to get to all 2,000 customers.

Other Developments

In related news, Siemens has issued a “Guide to Low Dose,” a document written for physicians and medical technologists that covers the basics of radiation used for medical purposes. It includes sections on computed tomography, molecular imaging, and angiography, among other specialty areas.

“The guide itself is very comprehensive,” Schneider said. “In the angiography sections, we discuss the dose reduction, dose monitoring, and dose reporting our customers will be forced to comply with.” The guide also describes how to use the system’s various features.

Elaine Sanchez is a contributing writer for Axis Imaging News.

See It at SIR!

Vitrea Enterprise Suite, Version 6.0 from Vital Images

Here is what you can expect from just a few of the vendors that will be exhibiting at the Society of Interventional Radiology show in Chicago on March 26-31, 2011.

ZONARE Medical Systems will exhibit its latest software release for Zone Sonography technology. Rev 4.7 software was created to improve 2D imaging and penetration for use in the interventional radiology suite. Furthermore, it can achieve quicker throughput and ease of use through one-button Auto Optimization and better needle visualization as a result of the company’s new beam steering feature and continual focus throughout the field of view. The battery-operated ZONARE ultra system boasts a small 2′ x 2′ footprint.

Vital Images will showcase its Vitrea Enterprise Suite, Version 6.0. The software release enables in-depth, clinical functionality through a modular architecture that offers optimal performance and thin-client access to applications and imaging data, according to the company. Regardless of the number of simultaneous users or data load on the system, the platform separates rendering, processing, and data storage to deliver quality of service for its customers. Brand-new features in this updated version include Dynamic MR, XA 3D Angio, and Oncology Fusion, allowing users to visualize, quantify, and track tumors using fused CT, MR, PET, and SPECT images. The release also has a new Denoising filter, a multichamber cardiovascular solution, and an enhanced endovascular stent planning application.

Philips Healthcare will focus on its interventional radiology and interventional oncology technologies. Noting that interventional oncology is gaining traction in the medical community, the company offers enhanced features, such as Dynamic 3-D roadmapping. Its functionality allows for live 3-D guidance through tortuous vasculature. Additionally, the XperGuide tool, which offers live 3-D image needle guidance, allows clinicians to bring percutaneous needle procedures into interventional labs.

(Above left) ZONARE will showcase new software for its ultra system. (Above right) GE will be the exclusive US distributor and reseller of Veran’s ig4 navigation system.

GE Healthcare will feature its Innova imaging systems, which work to reduce clinicians’ exposure to radiation without compromising the image quality they need to make confident decisions during interventional procedures. The company will showcase its proprietary Innova flat-panel detector, which it says provides the industry’s highest Detective Quantum Efficiency. The Innova carries dose-reduction features that are controlled from the tableside, like Dynamic Range Management, which helps reduce problems with image blackout and burnout by extracting relevant image information. Furthermore, its system design integrates tableside dose management tools into the procedural workflow. For example, the Automatic Exposure (AutoEx) control system automatically and continuously adapts to optimize image quality while minimizing patient dose.

GE is also announcing it will become the exclusive US distributor and reseller of the ig4 navigation system from Veran Medical Technologies. The company is a provider of proprietary 4D registration capability for precise targeting of lesions. Its multimodality Veran ig4 system assists clinicians in delivering instruments to small targets in difficult-to-access regions of the human body in order to diagnose and treat disease minimally invasively. Particularly, the navigation system employs electromagnetic localization and 4-dimensional registration to display an interventional instrument on a computer monitor with respect to anatomic imaging and treatment planning. Veran’s system is compatible with GE’s Innova imaging systems, which acquire CT-like patient images of the target organ that can be exported to the navigation system in the same imaging suite, during the same interventional procedure. The companies aim to create a comprehensive interventional oncology solution under a single point of contact.

—E. Sanchez