Philips 722024CA Object Moved User Manual Product Brochure Allura Xper X Ray System FD10 10 Fdee1fe9885c4a7d89f6a77c01514f63

User Manual: Philips 722024CA Product Brochure Philips Allura Xper X-ray system FD10-10 Philips - Allura Xper FD10-10 Biplane X-ray system722024CA

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Making the difference with
Philips Live Image Guidance
in treating congenital heart disease

Key benefits
• Conﬁdently reduce X-ray dose by 50% without
changing your way of working
• Provide more effective, reproducible treatment with
Philips Live Image Guidance
• Enhance precision, predictability, and conﬁdence with
advanced pediatric speciﬁc tools

Making the difference with
Philips Live Image Guidance
As a pediatric cardiologist, your life is committed to
bringing new hope to children. As you struggle to
understand the complexities of a congenital heart
disorder, you need pediatric tools that help you work
precisely and effectively, to give your kids a better chance
of a long and healthy life.
Together we make the difference in the treatment of
congenital heart disease to improve patient outcomes
and save lives. With our Live Image Guidance we aim
to remove barriers to safer, effective and reproducible
treatments, delivering relevant clinical value where it’s
needed most - at the point of patient treatment.
Intuitive, pediatric specific tools, integrated multimodality imaging, and patient information are combined
in an interventional lab or surgical suite. With access
to enhanced live visualization and navigation you can
confidently determine the optimal course of treatment
with greater precision and predictability to help improve
patient outcomes. With AlluraClarity with ClarityIQ

you can confidently reduce X-ray dose by 50% without
changing your way of working, while other Live Image
Guidance tools help minimize contrast-induced
complications to pediatric patients.
Crisp visualizations and fewer contrast-induced
complications
At the same time, you cannot sacrifice critical image
quality or anatomic information that would affect the
optimal course of treatment. Our X-ray images, 3D
and multimodality Live Image Guidance delivers crisp
visualizations of the delicate vasculature of babies and
young children. It also provides live image navigation
through soft tissue anatomy, while reducing the need
for contrast agent. Combined, these pediatric specific
tools offer enhanced precision, predictability,
and confidence.
Together, we open doors to new procedures and
techniques that truly make a difference to the lives of
children and their families.

Contents
A relentless drive towards more effective and safer technologies for children 4
Lower barriers for minimally invasive interventions

X-ray dose reduction and management solutions lower exposure and extend procedural options

Greater insight and confidence in finding and treating the problem

Advanced interventional tools deliver clinical value where it’s needed most: at the point of patient treatment

Better user experience to promote consistency and efficiency 16
Unique Ambient Experience concepts reduce anxiety for children and improve clinical workflow

Increased economic value 22
Service support and education provide a strong return on investment and enhance operational performance

Making the difference with Philips Live Image Guidance | in treating congenital heart disease

A relentless drive towards
more effective and safer
technologies for children
Congenital heart procedures are performed on a relatively
small patient population, but they can have a huge impact
on the lives of children and their families. As a medical
practitioner in this area, you devote many years to training
and developing your skills. At Philips, we have also devoted
many decades developing innovations that will make a
meaningful difference for congenital cardiology procedures.
Our technologies are designed to provide children with
effective, age-appropriate care that helps protect them
from unnecessary contrast medium and dose.

AlluraClarity
The AlluraClarity family of X-ray systems with ClarityIQ
technology sets a new standard by pushing the
boundaries of ALARA (As Low As Reasonably
Achievable) imaging. With AlluraClarity with ClarityIQ
you can confidently reduce X-ray dose by 50% without
changing your way of working.

Dedicated pediatric solutions
Our pediatrics team is made up of professionals who are
profoundly committed to making a difference in the lives of
children. They draw upon Philips rich and varied expertise
across the care spectrum – from adult cardiology and
neurology to CT, MR, critical care informatics, ultrasound,
and other clinical fields – to develop new innovations for
congenital cardiology. Many of these breakthroughs are
based on fundamental technologies we have developed for
other areas. The dramatic dose reduction we have achieved
with our ClarityIQ technology is in part possible due to
the unique capabilities of our MRC X-ray tube.
Dedicate pediatric solutions

Interventional X-ray
Patient critical care informatics
MRI

1900

Introduction
of the
world’s 1st
commercial
X-ray tube

1952

First
commercial
X-ray image
intensifier

1972

First dedicated
neonatal
monitor with
specialized
neonatal ECG
and RESP
algorithms

1979

First Compact
Multiparameter
Neonatal
Monitor

Making the difference with Philips Live Image Guidance | in treating congenital heart disease

1980

DoseWise first integrated
approach to
radiation dose
management
for pediatrics

1988

Dedicated
Pediatric
protocols
on MR

1989

MRC X-ray
tube and
SpectraBeam
copper filtration
system

2000

Microstream
CO2 for
true airway
respiration on
non- intubated
neonatal
patients

2001

SofTone MR
1st 6 channel coil
– combination
of Quad Head
coil and 5
channel Pediatric
mattress

Ultrasound
Ambient Experience
2002

1st dedicated
TEE pediatric
probe (S7-3t)

2004

Introduction
of Allura
Xper biplane
flat detector
system

2005

First Ambient
Experience
installed in a
pediatrics hospital
at Advocate
Lutheran General
Hospital, Illinois,
USA

2006

Dedicated EPX
settings for
pediatrics on
Allura Xper
X-ray system
1st transthoracic
2D and 3D
probe (X7-3)

2007

Introduction
of 3DRA
pediatric
3DRA

2007

Dedicated
8 channel
Pediatric
Cardiac coil

2009

Acoustic
Hood for
noise damping
for Achieva

2010

DoseAwarereal time
dose
feedback for
physicians
and staff

2012

AlluraClarity
X-ray
system with
ClarityIQ
technology
reduces dose
by 50% for
pediatrics

2013

Introduction
of EPIQ 7
ultrasound
system.

Making the difference with Philips Live Image Guidance | in treating congenital heart disease

Lower barriers for minimally
invasive interventions
AlluraClarity – What would you choose for
your kids?
Perhaps nowhere are the low dose benefits of AlluraClarity
more applicable than in pediatrics.Young patients often need
to undergo repeated complex interventional procedures
with an accumulation of dosage. Therefore, it is extremely
important to work with the lowest dose obtainable.
Two cases from the University Children’s Hospital in Zürich,
Switzerland demonstrate the AlluraClarity advantage.
Reduced dose balloon angioplasty – case 1
In the case of an 11-month-old female, suffering from
univentricular heart syndrome, interventional balloondilation of a residual aortic coarctation after Norwood
stage II procedure was indicated. Retrograde balloon
angioplasty of the coarctation was performed and the
gradient eliminated.
As this child may require further intervention in the future,
reducing radiation is of critical importance. The total
cumulative dose area product (DAP) achieved in this clinical
situation was only 1074mGycm2 with a frame rate of 15 fps.
The whole procedure lasted just 60 minutes.
Low dose valve replacement – case 2
In a second case, a 10-year-old boy was suffering from
severe pulmonary graft stenosis and moderate insufficiency.
During the procedure time of 85 minutes a Melody™
valve was placed into this failing graft while exposing the
patient to only 8311mGycm2 with 15 fps. This intervention
replaced a surgical valve replacement to hopefully provide
the patient with enough capacity to stay out of the OR for
the rest of his childhood.
Conclusion and final results
The new AlluraClarity with ClarityIQ technology provides
equivalent image quality at 50% less dose. This provides the
flexibility to use the system in a personalized way for each
procedure and patient.
6

Making the difference with Philips Live Image Guidance | in treating congenital heart disease

Case 1: Coarctation of aorta

LAO 91 Cranial 1, 15 fps
Field of view: 15 cm
Angiography image demonstrating
the coarctation in the aorta (arrow)

LAO 91 Cranial 1, 15 fps,
Field of view: 15 cm
Result after dilation of the
coarctation. The result was
satisfying with an aortic
diameter at the level of the
coarctation of almost 7 mm and
insignificant residual systolic
pressure gradient (2 mmHg).

“Especially for pediatric patients it’s extremely important to
achieve the lowest radiation dosage, conserving at the same
time the best required imaging quality, which is necessary to
perform safe and successful interventional procedures in this
specific patient population.”
Prof. Dr. Oliver Kretschmar, University Children’s Hospital, Zürich, Switzerland
15 fr/s

Patient entrance dose rate (mGy/s)
Patient entrance dose rate (mGy/s)

0.25
0.2

Paediatric cardio fluoro default
15Allura
fr/s Xper
AlluraClarity
Allura Xper

0.2
0.15

AlluraClarity

0.15
0.10
0.10
0.5
0.05
0
0

5
5

7.5

12.5

17.5

Equivalent patient thickness (cm)

7.5

12.5

17.5

20
20

22.5
22.5

25
25

Equivalent patient thickness (cm)

entrance dose (mGy/fr)
Patient entrancePatient
dose (mGy/fr)

0.1
0.09
0.1
0.08
0.09
0.07
0.08
0.06
0.07
0.05
0.06
0.04
0.05
0.03
0.04
0.02
0.03
0.01
0.02
0
0.01 5

Paediatric cardio cine default
15 fr/s
Paediatric cardio cine default
15Allura
fr/s Xper
AlluraClarity
Allura Xper
AlluraClarity

7.5

12.5

0
5

Case 2: Melody™ valve implantation

7.5

12.5

22.5

17.5

22.5

Dose report

Case 1

Case 2

Fluoro time [mm:ss]

14:41

12:46

Acquired exposure runs [N]

Exposure images [N]

3150

1034

Cumulative Frontal Air Kerma [mGy]

Cumulative Lateral Air Kerma [mGy]

2924

780

Cumulative DAP (exposure) [mGycm ]

5387

294

Total Cumulative DAP [mGycm2]

8311

1074

Cumulative DAP (fluoro) [mGycm2]
2

LAO 91 Cranial 0, 15 fps
Field of view: 25 cm
Angiogram demonstrating the
stenosis within the pulmonary
valve. Measurements revealed
a minimal diameter of 12-13mm
measured in the mid 1/3 of the
graft, and a distal diameter of
18-20mm just before the
pulmonary bifurcation.

17.5

Equivalent patient thickness (cm)

LAO 91 Cranial 0, 15 fps
Field of view: 25 cm
A final exposure run was made to
exclude any compression of the left
coronary artery using a selective
injection. The images demonstrate
patent left coronary artery.

Making the difference with Philips Live Image Guidance | in treating congenital heart disease

Take advantage of industry-leading image
quality at a fraction of the X-ray dose,
with ClarityIQ technology
AlluraClarity with ClarityIQ technology
As Philips most powerful interventional X-ray system todate, AlluraClarity delivers relevant clinical value where it’s
needed most – at the point of patient treatment. Clinicians
benefit from high-definition, clear visualization of even the
smallest vessels.

Dramatic results
In a landmark comparative study* conducted at Radboud
University Hospital, Nijmegen, the Netherlands, ClarityIQ
images acquired using 50% less dose were of excellent
diagnostic quality for all patients.
*X
CY607-130009 Clinical study end report ClaritylQ

Complex procedures can be performed with accuracy
and confidence using the new AlluraClarity family of
X-ray systems.

Nijmegen V1.pdf

1. Powerful image processing technology
ClarityIQ technology incorporates powerful state-of-the-art image processing technology, developed by Philips Research,
all working in real-time enabled by the latest computing technology:
• Noise and artefact reduction, also on moving structures and objects;
• Image enhancement and edge sharpening;
• Automatic real-time patient and accidental table motion correction on live images.

Industry leading
image quality

Fraction of the dose

2. Flexible digital imaging pipeline
ClarityIQ technology utilizes a flexible digital imaging pipeline from
tube to display that is tailored for each and every application area
such as Cardio or Neuro. This gives the flexibility to select virtually
unlimited application-specific configurations and obtain superb
images at a fraction of the X-ray dose for every intervention.
3. Clinically fine-tuned parameters across the entire imaging chain
With ClarityIQ technology over 500 system parameters are fine-tuned for each
application area; the result of years of Philips clinical leadership. It is now possible to
filter out more X-ray radiation, use smaller focal spot sizes, shorter pulses, thereby
fully utilising the unique capabilities of the Philips MRC X-ray tube.

Making the difference with Philips Live Image Guidance | in treating congenital heart disease

Greater insight and
confidence in finding and
treating the problem
Enhanced 3D visualization and navigation techniques help
determine the optimal course of treatment with greater
precision. This is critical in pediatrics, as the variety in
patient anatomy and congenital heart defects can be
significant. The ability to capture and reuse 3D data as
a means to reduce the need for additional contrast and
X-ray during a procedure is important.
Three innovative interventional tools in the Allura family
of X-ray systems can help. They may be used alone, or in
a combined multimodality solution. In the skilled hands of
an interventionalist, these tools may assist in:
• Improve confidence/efficacy of the intervention
• Reduce overall radiation exposure
• Reduce contrast dose
• Reduce procedure time

Allura Xper system

Three-dimensional rotational angiography (3D-RA)
3DRA provides fast, high-resolution 3D images of the
cardiac anatomy from any angulation and rotation. It helps
visualize complex vascular anomalies to facilitate decision
making for treatment strategies. Rather than multiple 2D
views, which require multiple contrast injections, a 3DRA
provides a complete 3D overview of the anatomy with a
single injection. The 3D image can be inspected in any view,
even those that cannot be reached with regular
2D projections.

AlluraClarity system

“With ClarityIQ we are able to get
images at corresponding quality but
with at least a 50% reduction of
radiation dose.”
T.J.F. ten Cate, MD, PhD, UMC Radboud, Nijmegen,
The Netherlands

“The images are of the same high
quality as we were used to before.
We are so enthusiastic about the
results that we are now acquiring
images with reduced dose.”

• Treatment decision of aortic coarctation – 3DRA provides
insight into the complex spatial relationship between the
aortic arc and its branching vessels, assisting in the decision
between surgical repair or intervention
3D Roadmap
This tool facilitates complex interventions by providing
live 3D image guidance for navigating vascular structures
anywhere in the body.
Dynamic 3D roadmap overlays real-time 2D fluoroscopy
images and a 3D reconstruction of the vessel tree acquired
with the 3D-RA feature of the AlluraClarity family of X-ray
systems. It improves visualization of anatomical structures
and device navigation and reduces the need for additional
contrast agent during navigation of devices.
MR/CT Roadmap
Imaging from a previously acquired MR or CT scan can be
reused and overlaid by fluoroscopy to guide procedures.
MR/CT Roadmap lets clinicians follow the advance of guide
wires and catheters real-time, thereby reducing X-ray
dose and contrast medium during interventions. Both 3D
Roadmap and MR/CT Roadmap automatically adjusts the 3D
images to gantry changes and any lateral or longitudinal table
movements. For even better visualization, it offers enlarged
full-screen mode and 4x digital zoom.

Examples of congenital cardiology applications where
3D-RA can be useful:
• Diagnosis of the branch pulmonary artery – 3D-RA
facilitates a detailed visualization of the pulmonary
vasculature and the anastomosis that may reveal a
narrowing not seen in 2D
• Planning of Melody valve implantation – 3DRA gives a
better visualization of potential compression of coronary
arteries and the location/distance between the Melody
valve and the coronary arteries

In the study, conducted between September and
November 2012, diagnostic angiography images of the left
coronary artery of 40 patients were monitored. The dose
reduction recorded decreased the likelihood of sporadic
effects of radiation for the cath lab personnel, while
exposing the patient to considerable lower levels as well.

3D-RA

3D-RA reconstruction of the
pulmonary arteries.

Drs. H. Gehlman, Interventional Cardiologist,
Radboud University Hospital
Making the difference with Philips Live Image Guidance | in treating congenital heart disease

Making the difference with Philips Live Image Guidance | in treating congenital heart disease

“DoseAware is one of the most important
new tools available to help reduce
occupational medical radiation exposure
to physicians and staff. It’s a much easier
and practical way to monitor levels than
conventional methods. Creating a better
work environment is not only the right
thing to do but our obligation.”
J. Kiah, MS, RN Lab Manager, Director Cardiac and Vascular
Services, Baptist Cardiac & Vascular Institute, Miami, USA

Pushing the Boundaries of ALARA
Next to AlluraClarity IQ technology, other dose reduction
technologies assist in the management of radiation
exposure. They include:
DoseWise
DoseWise is at the heart of our dose reduction efforts.
It' s a set of techniques, programs, and practices that
ensures optimal mage quality while protecting people in
X-ray environments. It is based on the ALARÁ (As Low As
Reasonably Achievable) principIe. With every new system.
we look at how we can incorpocate better shielding
and improve our X-ray exposure parameters to further
reduce dose. That means before you even put on a lead
æron, Philips has done their utmost to protect you and
your patients from unnecessary dose.
Philips DoseAware* family
Philips DoseAware family offers immediate feedback on
dose to increase radiation awareness and help manage
occupational medical radiation exposure to physicians
and staff. It provides real-time dose feedback in the
examination room to track an individual’s radiation
exposure during each shift, as well as procedure-based data
for deeper insight into staff exposure trends and behavior.
DoseAware Xtend – dedicated room solution
DoseAware Xtend is a dedicated solution for rooms with
Philips FlexVision XL display. Its integration with the Allura
X-ray system allows it to provide detailed feedback on
scattered X-ray dose levels per procedure.

Increases radiation awareness
• Identifies the cumulative amount of X-ray dose received
right after each procedure
• Reminds clinicians to take secondary lead precautions
• Sends weekly or monthly reports automatically on
procedure-based staff dose to help identify individual
exposure trends
• Sends procedural data on X-ray dose in DICOM RDSR
format to PACS or RIS to simplify data analysis
DoseAware – flexible solution for different rooms
DoseAware can be used in any X-ray room to provide
real-time feedback on scattered X-ray exposure so staff
can immediately adjust their working habits to manage
radiation exposure.
Advantages of a real-time dosimeter
• Provide the information necessary to manage individual
X-ray dose exposure
• Show when and where X-ray dose was acquired to allow
for appropriate action
• Check exposure level on the colored display in the
examination room
• Archive, report, and analyze radiation data to maintain
high levels of occupational safety
Smart Beam
With Smart Beam, as the name suggests, the dose is
reduced by taking a more intelligent approach to the
use of X-rays. To this end, the Allura family uses special
SpectraBeam filters in fluoro and exposures to remove
unwanted ‘soft’ radiation, i.e. those X-rays that hit the
patient but do not have enough energy to reach the
image detector.
The soft radiation is replaced by higher energy radiation,
which significantly improves image quality. Alternatively,
it is possible to ‘trade off’ some of this improved quality
to further reduce dose.

*D
oseAware does not replace the thermo-luminescent dosimeter
(TLD) as a legal dosimeter.

Reasonably Achievable) principIe. With every new system,
we look at how we can incorporate better shielding
and improve our X-ray exposure parameters to further
reduce dose. That means before you even put on a lead
æron, Philips has done their utmost to protect you and
your patients from unnecessary dose.

DoseAware – flexible solution for different rooms
DoseAware can be used in any X-ray room to provide
real-time feedback on scattered X-ray exposure so staff
can immediately adjust their working habits to manage
radiation exposure.

Philips DoseAware* family
Philips DoseAware family offers immediate feedback on
dose to increase radiation awareness and help manage
occupational medical radiation exposure to physicians
and staff. It provides real-time dose feedback in the
examination room to track an individual’s radiation
exposure during each shift, as well as procedure-based data
for deeper insight into staff exposure trends and behavior.
DoseAware Xtend – dedicated room solution
DoseAware Xtend is a dedicated solution for rooms with
Philips FlexVision XL display. Its integration with the Allura
X-ray system allows it to provide detailed feedback on
scattered X-ray dose levels per procedure.

Advantages of a real-time dosimeter
• Provide the information necessary to manage individual
X-ray dose exposure
• Show when and where X-ray dose was acquired to allow
for appropriate action
• Check exposure level on the colored display in the
examination room
• Archive, report, and analyze radiation data to maintain
high levels of occupational safety
Smart Beam
With Smart Beam, as the name suggests, the dose is
reduced by taking a more intelligent approach to the
use of X-rays. To this end, the Allura family uses special
SpectraBeam filters in fluoro and exposures to remove
unwanted ‘soft’ radiation, i.e. those X-rays that hit the
patient but do not have enough energy to reach the
image detector.
The soft radiation is replaced by higher energy radiation,
which significantly improves image quality. Alternatively,
it is possible to ‘trade off’ some of this improved quality
to further reduce dose.

*D
oseAware does not replace the thermo-luminescent dosimeter
(TLD) as a legal dosimeter.

Allura Xper system

AlluraClarity system

“With ClarityIQ we are able to get
images at corresponding quality but
with at least a 50% reduction of
radiation dose.”
T.J.F. ten Cate, MD, PhD, UMC Radboud, Nijmegen,
The Netherlands

“The images are of the same high
quality as we were used to before.
We are so enthusiastic about the
results that we are now acquiring
images with reduced dose.”

3D-RA

3D-RA reconstruction of the
pulmonary arteries.

Drs. H. Gehlman, Interventional Cardiologist,
Radboud University Hospital
Making the difference with Philips Live Image Guidance | in treating congenital heart disease

Making the difference with Philips Live Image Guidance | in treating congenital heart disease

3D / MR / CT roadmap

3D-RA: Improved Procedural Planning

Live overlay on 3D/MR/CT roadmap improves visualization
of anatomical structures and device navigation by re-using
preoperative CT or MR angiographic images.

A single rotational scan provides
input for the 3D-RA reconstruction.

3D-RA reconstruction of the aortic arc, allowing
you to plan the optimal treatment.

Making the difference with Philips Live Image Guidance | in treating congenital heart disease

3D Roadmap in AP

3D roadmap in LAO40/Caud27

3D Roadmap: balloon inflation of sidebranch

3D RA of stent after ballooning side branch.

3D Roadmap in AP: overlap at bifurcation, inadequate
for intervention
The ostium of the side branch is not clearly visible in the Allura
3D-RA in AP position because of overlapping vessels.
3D Roadmap in LAO40/Caud27: clear view on bifurcation
The bifurcation is clearly visible in the Allura 3D-RA in
40 LAO/27 Caudal position.
3D Roadmap: balloon inflation of sidebranch
The 3D Roadmap image shows the balloon inflated in the
side branch.
3D RA of stent after ballooning side branch
A post-procedural Allura 3D-RA shows the stent struts open in
the side branch to enable adequate blood flow.

Making the difference with Philips Live Image Guidance | in treating congenital heart disease

“ I have found that the 3D-RA tool
is very beneficial for my pediatric
patients to efficiently manage
radiation dose, contrast dye, and
procedure time.”
Dr. Seong-Ho Kim, Chairman,
Department of Pediatrics

3D-RA and 3D roadmap case study:
Treatment of pulmonary artery stenosis
Catheter based treatment of a complex pulmonary
artery stenosis requires in-depth understanding of the
location and dimension of the stenosis. Using standard
angiograms, requires several X-ray acquisitions to make a
complete evaluation. Dr. Seong-Ho Kim, chairman of the
department of pediatrics at the Sejong General Hospital,
Korea used 3D-RA and 3D roadmap during treatment of
a pediatric patient with a stenotic side branch of the right
pulmonary artery.

Balloon dilatation
The 3D volume was then overlaid on live ﬂuoroscopy,
providing a 3D Roadmap. This Roadmap was used to
navigate the guidewire to the correct position and deploy
the balloon, without the need to use additional contrast.
After dilatation of the side branch, a second 3D-RA was
done to check the dilatation result.
Method and materials used
An Allura 3D-RA acquisition was made on the
AlluraClarity FD10/10 biplane X-ray system. The
acquisition protocol was: a 4 sec, 240 degree (120
LAO/120 RAO) rotational angiogram at 30 frames/sec
using a 25 cm ﬁeld of view. A total contrast volume of
60 cc (2/3 contrast and 1/3 saline) was injected at 12 cc/s
with an injection delay of 1 sec before acquisition. The
contrast was diluted 2/3 contrast to 1/3 saline which
resulted in an actual contrast load of 40 cc.

Patient
A 13 year-old male patient weighing 43 kg was brought to
the cath lab for a pulmonary artery stenosis intervention.
A side branch of the RPA is stenosed, due to a right
pulmonary artery (RPA) stenting procedure in 2013.
This patient was born with a ventricular septal defect
(VSD) and major aorto-pulmonary collateral arteries
(MAPCA). A Rastelli procedure was performed in 2002
to reconstruct the outﬂow from the right ventricle to the
pulmonary arteries (PA). Several procedures followed in
subsequent years: a reconstruction of the RPA, dilatation
and stenting of the left pulmonary artery (LPA), and
dilatation and stenting of the RPA.
Selection of projection angle
Allura 3D-RA was used to provide a better visualization
of the bifurcation, which helped the physician to plan the
treatment strategy and therapeutic approach. This data set
was reconstructed into a 3D volume rendering. The 3D
volume provided a detailed visualization of the pulmonary
vasculature and bifurcation from any angulation and
rotation, allowing the physician to select the projection
which would allow him to precisely treat the lesion of
interest. The AP projection showed overlapping vessels at
the bifurcation which obscured visibility of the ostium of
the side branch of the RPA. The projection was changed to
40 LAO and 27 Caudal, which provided a clear view of the
bifurcation.

Conclusion
The view of the stenosis in the bifurcation of the RPA
was obscured in the AP view. Without using Allura
3D-RA, the physician would have had to acquire several
additional 2D angiograms to get a clear view of the
lesion. The projection angle to navigate the guidewire
to the correct side branch was selected based on the
3D-RA model. Only one 3D-RA was required to get
a detailed visualization of the bifurcation and to select
the precise projection angle for treatment, thereby
saving X-ray dose, contrast medium, and time. After
balloon deployment in the side branch, a second 3D-RA
reconstruction clearly showed the stent struts open
at the side branch enabling adequate blood ﬂow.

Making the difference with Philips Live Image Guidance | in treating congenital heart disease

Intuitively combining live X-ray and echo
guidance for Structural Heart Disease repair
Work with clinical confidence by having access to superb quality images, unique live 3D imaging
capabilities and innovative imaging solutions. This will support you in planning, visualization
and Live Image Guidance of even the most challenging procedures.
EchoNavigator
Increasing numbers of patients with structural heart
disease (SHD) can be treated with catheter-based
techniques. One of the main challenges is visualization;
Live 3D transesophageal echocardiography (TEE) imaging
provides critical insights into soft tissue anatomy, and
function and flow information. At the same time, X-ray is
invaluable for visualizing devices. Both images, however,
are represented separately in a different orientation and
so valuable time is spent mentally aligning them.

Key benefits
• Intuitively combines live 3D TEE echocardiography and
fluoroscopic images. Brings TEE echocardiography and
fluoroscopic images together, in real-time.
• Understand where you are in the 3D space more quickly.
• Anatomical landmarks in Echo are overlaid on X-ray for
guidance of devices.
• Directly controllable at tableside, which facilitates
communication with the echo operator.
• Promotes teamwork within the heart team in the lab.

“ We’re integrating two separate medical
images and bringing them together in a
way that makes performance of these
interventions more straight-forward.”
Professor John Carroll, MD, Interventional Cardiologist,
University of Colorado, Denver
EchoNavigator tackles this issue head-on by intuitively
bringing live 3D TEE and fluoroscopic images together,
in real-time, for a quick understanding of the 3D space.
Images from both modalities are automatically aligned
by tracking the TEE transducer position and orientation
in the X-ray image. As a result, relevant soft tissue anatomy
can by visualized in the X-ray. Markers placed on the
soft tissue structures within the echo image, automatically
appear on the X-ray for context and guidance. This provides
clear targets for catheter navigation. The interventional
operator can directly control the EchoNavigator at tableside,
which facilitates communication with the echo operator.
All of this is designed to simplify navigation, device placement
and promotes communication within the heart team during
structural heart disease procedures.
Training
Our Peer to Peer training programs offer an interactive
program on site with experienced users. These training
programs provide in depth details on how to use the
technology in clinical practice, and provide you with
the confidence to implement these advanced imaging
functionalities in your daily routine and to take your expertise
to the next level. We also provide excellent training of Live 3D
TEE and EchoNavigator to help develop a rapid and thorough
understanding of these breakthrough SHD treatments.

Making the difference with Philips Live Image Guidance | in treating congenital heart disease

“ The beauty of good imaging is that
you don’t have to imagine too much”
Professor J Zamorano, Head of Cardiology,
University Hospital Ramon y Cajal, Madrid
Philips EPIQ 7 ultrasound system

Live 3D TEE of appendage
• Live 3D transesophageal echocardiography allows the viewing
of mitral valves, aortic valves, inter atrial septum, the left atrial
appendage and all chambers of the heart with unique perspectives.
• Philips Live 3D TEE provides real-time 3D and live xPlane views.
These tools provide many beating-heart views that were previously
seen only during cardiac surgery.
• Live 3D TEE features prominently in recent professional society
recommendations regarding echocardiography in trans-catheter
interventions. (EAE/ASE* Recommendations for the Use of
Echocardiography in New Transcatheter Interventions for Valvular
Heart Disease.)

3D zoomed appendage and
pulmonary vein.

* Journal of the American Society of EchocardiographyVolume 24, Issue 9,
September 2011, Pages 937–965EAE/ASE Recommendations for the Use
of Echocardiography in New Transcatheter Interventions for Valvular Heart
Disease • Jose L. Zamorano et al.

A new era in premium cardiovascular ultrasound
The Philips EPIQ 7 ultrasound system incorporates our
most powerful architecture ever applied to ultrasound
imaging – touching all aspects of acoustic acquisition
and processing. Supported by our family of proprietary
xMATRIX transducers and our leading-edge Anatomical
Intelligence, this platform offers you accurate diagnosis,
first-time right, which is faster and easier to perform than
before.You get improved clinical information from each
scan and a higher level of confidence. The EPIQ 7 supports
the live 3D TEE for children above 20kg, as well as the
minimultiplane TEE for infants above 3.5 kg.

EPIQ 7: Designed to reinvent the user experience

Making the difference with Philips Live Image Guidance | in treating congenital heart disease

Better user experience
to promote consistency
and efficiency
Biplane versatility helps reveal hidden pathologies
Congenital heart defects can be hard to predict and
visualize, requiring quite extreme and exotic projections
to visualize each child’s unique anatomy. Achieve the
challenging projection views you require with Philips
Allura’s unique lateral double C-arm. It can make steep
cranial/caudal projections to reveal hidden pathologies or
missing anatomical structures. It allows, for instance, a four
chamber view of the atrial septum. Two views are created
with a single contrast injection. By combining a 20 x 20 cm
lateral with a 30 x 40 cm frontal, you get full flexibility for
imaging infants, young children, and adults without panning
to support a broad range of patients.
The frontal and lateral C-arms can be independently
positioned, allowing full patient access for the heart
team. There is plenty of space at the head side for the
anesthesiologist and echocardiologist without interfering
with the rest of the team. The FD10/10 and FD20/10
biplane systems have a very small footprint to allow
maximal floor clearance.

Hybrid Suite
The interventional and surgical environments are rapidly
evolving as interventional treatment and surgery converge
in hybrid procedures. Interventions are performed for
increasingly complex diseases, while surgical procedures
are becoming less invasive. Patient populations are also
becoming broader as more children with congenital heart
disease survive into adult life. In addition, the availability of
new devices expands the number of treatment options.
With the Hybrid Suite from Philips, a full range of
procedures can be performed in a single room, virtually
without compromise. Several key innovations support
the heart team in carrying out long and often complex
congenital heart procedures with a high degree of
comfort and confidence. Using the unique FlexMove or
FlexMove XL, the ceiling mounted C-arm can be easily
moved as required anywhere around the table – and
then conveniently parked out of the way during open
surgery. This gives the team room to work close to the
patient and frees up the head area so the anesthesiologist/
echocardiologist can work with greater ease.

Biplane imaging

Biplane visualizations can provide a more complete picture of the situation. For instance, on
the frontal plane in this case, the branch of the left pulmonary artery (left image) appears to fill
completely. However, the lateral image (right) shows that only the posterior segment is filling.
18

Making the difference with Philips Live Image Guidance | in treating congenital heart disease

“In the hybrid room you feel completely relaxed.
You know every time you can switch from open
surgery to catheter-based, or from catheterbased to open surgery. So you feel great.”
Prof. Dr. M. Lachat MD, Vascular Surgeon, Zürich University Hospital,
Zürich, Switzerland
MAQUET MAGNUS operating table

MAQUET MAGNUS operating table
The Allura systems are the only biplanes that can be seamlessly
integrated with the best-in-class MAQUET surgical table for
a truly multifunctional room suitable for conventional surgery,
hybrid surgery, or interventions. The two are completely
synchronized and benefit from automatic position control (APC),
bolus chase procedures, and 3D software tools. The table can be
outfitted with a radio translucent tabletop for endovascular and
hybrid procedures, or a modular tabletop for open surgery.
Tabletops can be easily exchanged using the transporter, allowing
smooth transfer of patients between procedures.

Making the difference with Philips Live Image Guidance | in treating congenital heart disease

“Children who are nervous when
they arrive are mesmerized by
the pleasant environment, which
often allows examinations to
be completed more quickly.”
Jojanneke de Leeuw, radiology technician,
Jeroen Bosch Hospital, ‘s-Hertogenbosch, The Netherlands

The Ambient Experience Interventional Suite

For the patient

Personalizing the environment allows the patient to
become a partner in their procedure
20

Making the difference with Philips Live Image Guidance | in treating congenital heart disease

A treatment environment that puts
children at ease
Let’s face it, a child is generally unhappy at being in a
hospital. They can feel apprehensive, nervous and in some
cases plain scared. Especially when they have to undergo
several procedures over a longer period.You want to make
them feel more at ease, but that’s difficult to do when the
surroundings look, sound and smell so different from home.
High patient anxiety can have consequences for the
medical team. This can also have consequences for the
medical team. Clinical staff can become frustrated because
examinations take longer and throughput decreases. It
also affects motivation when efforts to reassure and relax
patients are in vain.
With Ambient Experience we can create a purposefully
designed healthcare environment (including technology,
spatial design and workflow), addressing these issues.You
create the conditions in which children feel more at ease,
clinicians are able to work more effectively and which can
change the community perception.

For the staff

For the patient
Dynamic lighting produces a soft, pleasant effect.
With Ambient Experience children can select a theme
from the touchscreen. Immediately the dynamic Ambient
Lighting produces a warm welcoming atmosphere in the
room. Walls appear to fade away. Thematic video with
sound provide a positive distraction that helps the child
to relax. This calming atmosphere enhances interaction
between the child and staff.
For your staff
Architectural enhancements optimize room design.
In true collaborative fashion, we work with your in-house
team to effectively reduce clutter, recess the cabinetry,
and improve the lighting. Open, stress-free surroundings
provide your staff with an unique interventional
environment. With the support of our global organization,
we help you create a welcoming and effective environment
that will revolutionize the way medical procedures
are performed.
Demonstrating value
The Ambient Experience Interventional Suite can
differentiate you from other healthcare facilities.
This flagship service can enhance the image of your
hospital in the eyes of all stakeholders. It supports better
communication with the patient, and can provide a more
efficient working environment with the potential to
impact staff morale, retention, and recruitment. Ambient
Experience demonstrates your dedication to people
focused healthcare.
Ambient Experience is a purposely designed healthcare
environment. With a refreshingly creative eye, Ambient
Experience integrates technology, spatial design, and
workflow improvements to create a more comfortable,
stress-reducing environment for both patients and staff.

Clinicians benefit from advanced Ambient Experience features
that increase efficiency and improve working comfort
Making the difference with Philips Live Image Guidance | in treating congenital heart disease

Streamlining workflow for complex
congenital procedures
When working to save a child’s life, a medical team
wants to focus fully on what needs to be done. Philips
offers many flexible ways to enhance workflow and help
reduce distractions and clutter in the cath lab or hybrid
environment. These solutions contribute to a wellorganized, smooth running procedure.
Everything you need to see
A pediatric cardiology suite performs a large variety of
procedures, each requiring their own types of images
and information. The FlexVision XL monitor allows for
easy viewing and magnification of any image in the lab –
from X-rays to pre-acquired patient CT and MR scans
– at tableside.
This large, high-definition eight-megapixel LCD screen
layout can be adapted on the fly to physician preferences
and examination requirements – per procedure type or
case. Information from several multi-modality imaging
sources is integrated into one view. This allows the entire
team to understand and share information during each
step of the procedure.
The SuperZoom feature clearly brings small aspects of
anatomy and data into focus without sacrificing resolution.
22

With this feature, the screen can be placed further from
the table, thereby freeing up space.
Zoom in on fluoroscopy images without
increasing dose
Pediatric structures can be small and difficult to visualize.
Our Dual Fluoro option allows you to also magnify
live fluoroscopic images two times without increasing
radiation dose. The zoomed fluoroscopy images are
displayed on the live monitor. This feature can be used
on both frontal and lateral fluoroscopy images.
Physiomonitoring
Philips Xper Flex Cardio, a small hemodynamic system,
seamlessly integrates with the Allura portfolio. It optimizes
workflow and improves the productivity in the lab through
easy exchange of data. Xper Flex Cardio also provides
advanced ECG analysis in the cath lab with ST mapping
and STEMI-CA.
Relevant information at hand
In this flexible, fully integrated environment, Philips
cardiology informatics, tools and real-time information
are all within reach, making it easy to carry out all aspects
of procedures.

Making the difference with Philips Live Image Guidance | in treating congenital heart disease

Managing cardiology information throughout
the care process
Philips CVIS (Cardiovascular Information Management
System) is a unique software solution that enhances
the clinical and financial performance of the cardiology
department. It unifies silos of discrete cardiac information
collected at the point of care into a single powerful
database. This cardiac database is searchable and
actionable to support clinical, qualitative, and business
analysis and reporting needs.
Multi-modality image management
Xcelera cardiology PACS or the enterprise-wide
IntelliSpace PACS solutions can handle image management,

clinical analysis, and reporting. IntelliSpace is a powerful
tool for advanced image review and analysis. It offers
the flexibility to diagnose and collaborate virtually
anywhere. In addition, iSite PACS integrates into existing
infrastructure, enabling all departments to realize a return
on investment at each stage of deployment.
Cath lab workflow solution
Xper IM and Xper Flex Cardio feature intuitive
innovations that create a more efficient workflow in
the cath lab department, including direct access to
acquired images, physiomonitoring, scheduling, inventory
management reporting, and statistics.

Increased economic value
Philips is committed to working closely together with
customers. The purchase of a new interventional suite
and interventional tools demonstrates a long-term
commitment to patients and personnel. We offer a
comprehensive portfolio of service options, training
programs for staff and deliver financing options to help
optimize the economic value across the total life-cycle
of the systems.

As an example, Philips has established Peer-toPeer training programs for physicians interested in
learning about EchoNavigator. Participants visit peers
in the hospital, who are expert in the clinical use of
EchoNavigator, and receive a comprehensive two-day
program combining class room tutorials, hands-on
training. They work closely with these experienced
users during real cases.

RightFit Service agreements
From premium service plans to standard service support,
there is a RightFit Service Agreement to suit every need.
The perfect mix of on-demand support, immediate parts
and service, and comprehensive business solutions helps
hospitals deliver quality patient care.

More knowledgeable personnel have a higher chance
of obtaining accurate results.

Exceptional support is a priority
The Philips global service network is ready to assist when
necessary. Field engineers, remote service technicians, and
front line call-agents support all systems with a worldclass services network. The goal: help customers succeed
in every phase of system ownership, from planning to
start-up, through peak usage and renewal.

Financial options are plenty
Philips Medical Capital makes it surprisingly easy to
arrange financing to address capital budget requirements,
manage increasing patient volume and achieve clinical
superiority. Philips ProPlus combines equipment, service,
and financing in one simple offering to help:

A Remote Services option provides advanced system
troubleshooting that helps lessen downtime even further.
Equipment remains reliable through remote system
diagnoses and fast repair.
Education and training
Regular training is critical to help the medical staff to
better master clinical procedures, get more out of the
equipment, and build professional and clinical skills.
Better-trained staff improves the overall level of service
and operation.

Making the difference with Philips Live Image Guidance | in treating congenital heart disease

Enhances patient care

Appeals to patients and staff

• Stretch capital budget and enhance monthly cash flow
• Lock-in equipment and service costs for up to five years
• Avoid unexpected equipment or maintenance costs
• Simplify financial management and reduce administrative burdens
• Get the equipment necessary to deliver a high level of quality care
• Enhance organization’s reputation and profit potential
Our Live Image Guidance solutions stand at the forefront of
interventional care. For planning, diagnosis, and therapy, they support
the skills of clinical professionals like you.
Making the difference where it really matters.

Making the difference with Philips Live Image Guidance | in treating congenital heart disease

www.philips.com/congenitalheartdisease

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