HEALTHCARE

Imaging Services Service Application Manual

Document No: DD+DIS115.11E

DX-D 600

► Purpose of this Document

This document describes how to:

• Prepare the DX-D 600 Service Application tasks
• Configure the DX-D 600 System
• Train the customer on the DX-D 600 System

► Document History

Edition. Release Changes

Revision Date
1.0 07-2011 Initial release

► Referenced Documents

Document Title
For a list of documents refer to sections 2 and 6.12.

DOCUMENT CONTROL NOTE:

The controlled version of this document is available from the Agfa HealthCare Library. Any printed copy of this document is uncontrolled.

Edition 1, Revision 0
07-2011 printed in Germany Document Node ID: 33453562
so_standard_e_template_v07
Agfa Company Confidential Copyright © 2011 Agfa HealthCare N.V.
DD+DIS115.11E DX-D 600

► Manufacturer
Agfa HealthCare N.V.

Published by
Agfa-Gevaert HealthCare GmbH
Tegernseer Landstraße 161
D - 81539 München
Germany
Copyright © 2011 Agfa HealthCare N.V.
All rights reserved.
Technical modifications reserved.
Agfa and the Agfa rhombus are trademarks of Agfa-Gevaert N.V., Belgium,
or its affiliates.

WARNING:
Improper operation or service activities may cause damage or injuries.

INSTRUCTION:
(1) Read the "Generic Safety Directions" document
(see Agfa HealthCare Library > General Info > Agfa HealthCare > Publications >
Service Manual) prior to attempting any operation, repair or maintenance task on
the equipment.
(2) Strictly observe all safety directions within the "Generic Safety Directions" and on
the product.

IMPORTANT:
The installation and service of the product(s) described herein is to be performed
by qualified personnel who are employed by Agfa HealthCare or one of its affiliates
or who are otherwise authorized by Agfa HealthCare or one of its affiliates to provide
such services.

NOTE:
To verify the latest version of a chapter of the Service Manual refer to the “Checklist for
Completeness” in the Agfa HealthCare Library.

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LIST OF CONTENTS

1 DX-D 600 PRODUCT DESCRIPTION......................................................................................5

1.1 Solution Definition .....................................................................................................................6

1.2 DX-D 600 X-Ray System ..........................................................................................................7

1.2.1 Tubehead Display and Brakes Control Buttons........................................................................8

1.2.2 Collimator ................................................................................................................................10

1.2.3 Table .......................................................................................................................................10

1.2.4 Wall Stand...............................................................................................................................11

1.2.5 X-Ray Tube .............................................................................................................................12

1.2.6 Grid .........................................................................................................................................12

1.2.7 Generator with Touch Screen Console...................................................................................12

2 SAFETY DIRECTIONS...........................................................................................................15
3 TASK OVERVIEW ..................................................................................................................16
4 PREPARATION ACTIVITIES .................................................................................................17
5 SYSTEM TAKEOVER FROM FSE.........................................................................................19
6 CONFIGURING THE NX WORKSTATION ............................................................................20
6.1 Overview of Configuration Steps ............................................................................................20

6.2 Prerequisites ...........................................................................................................................21

6.3 The Default Exam Tree...........................................................................................................21

6.4 Importing the Exam Tree − Local Default or customized........................................................21

6.5 DX-D 600 specific Exam Tree Configuration ..........................................................................22

6.5.1 Configuration of the Exposure Settings ..................................................................................22

6.5.2 Configuration of Modality Settings ..........................................................................................23

6.5.3 Optional Configuration Possibility for free Exposures (CR only) ............................................26

6.5.4 Configuration of the Image Processing...................................................................................27

6.5.5 Configuration of Film Orientation ............................................................................................27

6.6 DR Recovery Procedure Check..............................................................................................28

6.7 Detector Settings ....................................................................................................................29

6.8 Arranging XRG Parameters / User Interface Configuration....................................................30

6.9 Arranging View Image Details / User Interface Configuration ................................................31

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6.10 Compose Exam ......................................................................................................................31

6.11 Activating the Configuration ....................................................................................................32

6.12 Adaptation of default Program Files (optional) .......................................................................32

7 SYSTEM TEST AND SERVICE APPLICATION ACTIVITY ...................................................33

7.1 Overview of DX-D 600-related Acceptance Test Procedures (ATP) and Responsibilities.....33

7.2 NX Workstation Acceptance Test Procedure .........................................................................33

8 CUSTOMER TRAINING .........................................................................................................34

8.1 Training Prerequisites and Preparation ..................................................................................34

8.2 Checklist for Training Sequences ...........................................................................................34

8.2.1 Checklist for X-Ray Unit..........................................................................................................35

8.3 Checklist for Customer Training ”NX Workstation” .................................................................39

8.4 Checklist for Customer Training ”DR Detector Calibration”....................................................44

9 HANDS-ON ASSISTANCE.....................................................................................................45
10 DX-D 600 GLOSSARY ...........................................................................................................46
11 AGFA – DX-D 600 TRAINING AND INSTRUCTION PROTOCOL.........................................47

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1 DX-D 600 Product Description

The DX-D 600 ceiling mounted X-ray System is an X-ray imaging system used in
Hospitals, Clinics and medical practices by radiographers, radiologists and physicists,
to make, process and view static X-ray radiographic images of the skeleton, chest,
abdomen and other body parts on adult, pediatric or neonatal patients.
Applications can be performed with the patient in the sitting, standing or horizontal
position.

The DX-D 600 X-ray unit can be used in the General Radiology:
• Hospitals / Hospital Satellites
• Imaging Centers

Figure 1

Limitations:
The DX-D 600 system is not intended for Mammography applications.

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1.1 Solution Definition

DX-D 600 is an integrated Digital Radiography X-Ray system.

The complete system consists of the following components:

• Ceiling suspension with X-ray tube and automatic collimator
• RAD Table DR with integrated 4343R DR Detector
• RAD Wall Stand DR with integrated 4343R DR Detector
• X-Ray generator
• X-Ray generator control box
• X-Ray tube with automatic collimator
• Dose Area Product Meter (integrated depending of collimator)
• NX workstation

NX
workstation

Figure 2

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Solution Options:
• External Dose Area Product Meter (Vacudap 2004)
• CR unit (DX-G, DX-M or CR-30)
• Hardcopy printer

DX-D 600 System Accessories:

• Compression band
• Hand grips
• Hand grip for wallstand
• Overhead hands support for wallstand
• Table mattress

1.2 DX-D 600 X-Ray System

The DX-D 600 is an integrated Digital Radiography X-Ray system with softconsole.
In the first release (version 1) it is available as Automatic System only.

DX-D 600 Automatic System with:

• Fully motorized with vertical /
horizontal table bucky tracking and
auto-positioning
• Tubehead touch screen with APR and
X-Ray parameters
• NX Integration with soft console
• DR detectors in the table and
wallstand

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1.2.1 Tubehead Display and Brakes Control Buttons

• Control panel with different screens:

o Main display or info screen
(See Figure 5.)
o Position screen
(Position of X-Ray tube)
o RAD screen
(display with selected exposure
technique)
o Programmed Positions (PP)

Figure 3

• Brakes Control Buttons (on left and right

side of display):
o Angle of tube
o Back and front
o Up and down
o Right and left
o Transversal and longitudinal
o Rotation of tube
Figure 4

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Main Display (Info screen)

Figure 5

Main display or Info screen informs about:

• PATIENT INFORMATION and the exposure
• Tube Position:
o SID
o ANG or Angulation
o ROT or Rotation
o TILT or Wall Stand Tilting in case that the Wall Stand is installed with this
option
• Exposure Technique
• Gives access to other areas to adapt:
o Tube position (Position)
o Exposure Technique (RAD)
o Programmed positions (PP)
• Info about movement controls and selected workstation

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1.2.2 Collimator

• Automatic collimator (Ralco 225)

o Motor-driven collimation system
o Three LEDs on the front panel
indicate the mode of the system
operation
o Linear laser to align the collimator
with the image receptor.
o Collimator rotation +/- 90° Figure 6

o With internal DAP

o Additional filtration:
- 1 mm Al + 0.1 mm Cu,
- 1 mm Al + 0.2 mm Cu,
- 2 mm Al

1.2.3 Table

• Maximum patient weight: 300 kg (661 lbs)

• Double touch foot switches
• The Tabletop can be raised, lowered and
four way moved by pressing the
corresponding control pedal.
o Vertical motorized movement
- maximum height of 920 mm (36.22”)
- minimum height of 580 mm (22.83”)
Figure 7
• Discreet light on skirt
• Fixed grid (for version 1)

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1.2.4 Wall Stand

Available as non tilting and manual tilting

wall stand:
• Vertical bucky assembly
• 3 Field AEC chamber
• Optional motorized up / down
movement
• Tilting and rotation of bucky
• Removable grid

Figure 8

Bucky - Rear View

Figure 9

Foot switch to control vertical movement

• Automatic vertical movement
• Controlled by the tube support

Figure 10

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1.2.5 X-Ray Tube

X-Ray Tube Anode angle Tube Focus / Power HeatCapacity

(kilo Heat Units)

Toshiba E7884X 0.6 mm / 20 kW 300 kHU

1.2 mm / 50 kW
Toshiba E7252X 0.6 mm / 27 kW 300 kHU
1.2 mm / 75 kW
12°
Toshiba E7254FX 0.6 mm / 40 kW 400 kHU
1.2 mm / 102 kW
Toshiba E7869X 0.6 mm / 40 kW 600 kHU
1.2 mm / 100 kW

1.2.6 Grid

Anti scatter grid – Table 130 lines/cm ratio 8:1 FFD 1m

Anti scatter grid – Wall 130 lines/cm ratio 8:1 FFD 1.8M, Carbon Cover
and/or
130 lines/cm ratio 8:1 FFD 1.5M, Carbon Cover
(DR only)

1.2.7 Generator with Touch Screen Console

1.2.7.1 Generator

Configurations with 50, 64 and 80 kW are available.

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1.2.7.2 X-Ray Soft Console

• Located on the right-hand side of the NX wide screen Monitor

(See red rectangle below.)
• Provides controls for e.g. position information, SID, angle and rotation of tube
• Generator Controls for adjustment of exposure parameters
• Operational Status Bar to show the device status, DAP display and error
messages

Figure 11

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Figure 12 Figure 13
X-ray generator controls Positioning Control

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2 Safety Directions

WARNING:
Improper operation or service activities may cause damage or injuries.

INSTRUCTION:
(1) Read the "Generic Safety Directions" document
(see Agfa Healthcare Library => General Info => Agfa HealthCare =>
Publications => Service Manual) prior to attempting any operation, repair or
maintenance task on the equipment.
(2) Strictly observe all safety directions within the "Generic Safety Directions" and on
the product.

Please refer to product-specific safety directions available in the different

User Manuals applicable for the DX-D 600 system:

User Manuals are part of the Delivery.

They can also be downloaded from Agfa Healthcare Library.

Available Documentation Path

DX-D 600 User Manual, 0240, Direct Radiography Æ

Document ID 32713780 DR Equipment Æ DX-D 600
Æ User Manual
Getting Started with DX-D 600, 0241,
Document ID 32795423
DX-D 600 X-Ray System User Manual, 0242,
Document ID 32968465
DX-D Software Console User Manual, 0189,
Document ID 32260947
DX-D DR Detector Calibration Key User Manual,
0127, Document ID 32744724

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3 Task Overview

The following table gives an overview of basic Service Application tasks.

Overview Chapter Activity Description Required

Time
4 Preparation Activities Prepare Service Application Tasks 2 hours
after Customer Contract Signature
(organize visit).
5 System Takeover System Takeover of the system from 15 min
Field Service Engineer after installation
6 Configuration Tasks Perform default NX configuration 2 hours
(= system setup)
Configure the APR 2 hours
7 System Test and Service Input from application for the NX 15 min
Application Activity Acceptance Test (fill in the check list)
8 Customer Training, and Radiographer training on Operation
Hands-on Assistance on X-ray system of X-ray 12 hours
system level system

Pre- Prerequisites to keep the timing for the basic application tasks:
requisites
• The FSE has completed the installation. The system is fully operational (PACS,
RIS, Printer, etc.).
• The local default configuration (exam tree, X-ray parameters, GUI) must be
available.
• The customer has to be made aware that only the activities listed above are
included in the standard offering. Additional customization or other application
activities need to be ordered separately.

Restrictions • No adaptation of the default exam tree, X-ray parameters and the
Tubehead display
• No protocol codes configured
• No image quality adaptations including taste settings in Musica²

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4 Preparation Activities

DX-D 600 - Checklist for Preparation Activities

Site: Location: Date:
Goal:
The following list summarizes the activities to prepare the DX-D 600
Service Application tasks.
Topics: Done Reference
Preparation Activities
Identify persons and representatives of the different groups Not
which are involved in the project. applicable

Identify configuration / customization tasks for the solution

together with the customer. Keep in mind the timing for the
basic application. Extra activities need to be ordered
separately by the customer.
Check if a grid shall be used and take it into account for the
exam tree configuration.
Observe if extra application relevant tasks are necessary and
have been ordered.
Estimate the additional effort for adaptations of the default
exam tree, if the customer does not accept the default.
NOTE:
A default exam tree in English is available:
Download path on Agfa Healthcare Library:
Direct Radiography Æ DR Equipment Æ DX-D 600
Æ Software Æ DX-D 600 - Default Examtree

Estimate the additional effort for adaptations of the settings in

the control console of the ceiling suspension, if the customer
does not accept the default.
If applicable, ask the customer for the required Positioner
settings and forward them to the responsible FSE.
Take into account the required time for configuring Protocol
codes. This is not included in the time for Application Services
and should be offered as separate service to the customer.
Analyze the time plan according to application relevant tasks.
Current regulations and guidelines on regional, country and
federal state level have to be filtered with respect to the
relevance for the project.
Check next page Æ

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DX-D 600 - Checklist for Preparation Activities

Topics: Done Reference
Preparation Activities
Analyze the Customer Training Requirements. Not applicable

Define together with the customer when the training should

take place:
• Device training
• Hands-on session with patients
Hand over the filled-in Training and Instruction Protocol to the
Project Manager.
End

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5 System Takeover from FSE

DX-D 600 - Checklist for System Takeover

Site: Location: Date:
Goal:
The following list details the topics to be checked with the Field Service Engineer to
be sure that the technical set-up of the system is complete.
Topics: Done Reference
System Takeover Activities
Check that all components ordered by the customer are Not
present and technically set-up. applicable

Check which kind of detector (e.g. Gadolinium Oxysulfide or

Cesium Iodide) is installed
Check that all (ordered) printers are available and connected
Check the RIS connection
Check that the PACS/Softcopy Reporting Stations are
connected and images can be transferred.
Have the sensitivity settings been communicated? Which
ones?
Medium: ______ μGy
Low and High sensitivity dose values are mathematically
calculated.
Check that the DX-D 600 System User Manuals are available
on site (e.g. on Documentation DVD, which is part of the
delivery).
Get informed about any open issues: e.g. missing
components, unspecified settings, values or results.
Make sure that any open technical issues have been
escalated according to the Agfa service procedures.
End

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6 Configuring the NX Workstation

Required time for a DX-D specific NX configuration:

Approximately 30 minutes if a local and customized Exam Tree is used.
Approximately 4 hours and more have to be estimated only for Exam Tree
configuration and customization if the standard default Exam Tree is used.

6.1 Overview of Configuration Steps

DX-D 600 - Checklist for NX Configuration

Site: Location: Date:
Task Section
Exam Tree Configuration
• Import the local default exam tree for DX-D 600 6.4
or the customized exam tree.
• Perform the DX-D 600 specific configuration of 6.5
the Exam Tree.
• Configure the exposure settings. 6.5.1
• Configure the modality settings. 6.5.2
• Configure free exposures (optional for CR) 6.5.3
• Configure image processing. 6.5.4
• Configure film orientation (optional) 6.5.5
Device Configuration – X-ray device
• Check DR recovery procedure. 6.6
• Check detector settings. 6.7
User Interface Configuration
• Arrange XRG Parameters. 6.8
• Configure EI, TEI, DI in View Image Details. 6.9
• Configure Add Image Pane in Compose Exam. 6.10
Activate settings. 6.11

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6.2 Prerequisites

• NX Workstation is installed.
• XRDI software is installed.
• DR Detector-related software is installed and configured.
• Default DX-D 600 Exam Tree is available.
• Licenses are enabled.

6.3 The Default Exam Tree

IMPORTANT:
The default factory Exam Tree for GenRad that is delivered on each new
NX workstation does not include the modality settings, e.g. the exposure
settings and receptor type.
On the Agfa Healthcare Library the default DX-D 600 Exam Tree is available.
Path: Direct Radiography Æ DR Equipment Æ DX-D 600 Æ Software
It is the responsibility of each country/region to optimize the configuration of
the default DX-D 600 Exam Tree according to local requirements and to re-use this
configuration to avoid unnecessary repetition of work performed on site.

6.4 Importing the Exam Tree − Local Default or customized

To import either the local default exam tree or the customized exam tree,
follow this procedure:

(1) Open the Configuration Tool.

(2) Go to: <Exam Tree Configuration>
(3) Select: <Add Exams> from <Import…>
(4) Go to the directory where either the local default exam tree or the customized
exam tree is stored, e.g.: C:\AGFA\Healthcare\NX\bin\Factory Settings
(5) Open the prepared exam tree from that folder.
(6) Click <OK>.
(7) Select the exams to be included and click <Import>.

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NOTE:
After the import, all exposures are visible in the exam tree, regardless of the device
configuration. However, in the NX GUI the user will only see those exposures that
are relevant.

Example:
If you import an exam tree with CR exposures, but no digitizer is configured, the CR
exposures are visible in the Configuration Tool. In contrast, no CR exposures will be
visible in the NX GUI after activation.

6.5 DX-D 600 specific Exam Tree Configuration

NOTE:
For the procedure of how to configure an exam tree on NX, refer to the
Service Manual and Key User Manual:
Chapter 4, Installation and Configuration Appendices of the NX Service Manual
Chapter 6, Configuring the Examination Tree of the NX Key User Manual

6.5.1 Configuration of the Exposure Settings

It is possible to configure the Auto Rotate (180 °) function on exposure level to prevent
that the customer has to rotate the image manually. This may appear for configurations
like right and left exposures for e.g. hand, wrist and elbow.

(1) Go to: <Exam Tree Configuration>

(2) Select an exposure.

(3) Check the Auto Rotate 180 degree function.

Figure 14

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6.5.2 Configuration of Modality Settings

(1) Go to: <Exam Tree Configuration>

(2) Select an exposure.

(3) In the <Modality Settings> pane go to section <General settings>.
The View with View Name “1” opens. The fields for which a configuration activity
is required are marked with a red rim.

Figure 15

(4) Select the correct modality position, e.g. DR Table or Wallstand.

Figure 16

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(5) Enter the kVp.

Enter the mAs
or
AEC sensitivity, chambers, density.

Figure 17: Example screenshot

NOTE:
The mAs field is case sensitive. When inserting a comma instead of
a point, the comma will be deleted and the value will be completely
wrong, e.g. 2,5 mAs Æ 25 mAs.

(6) Select the appropriate Focus, Grid and, if necessary, the PreFilter.

Figure 18

(7) Configure the <Exposed Area (mm)> (automatic Collimation).

Figure 19

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(8) In the <Modality Settings> pane, section <Positioner settings>,

select from 40 default positions the suited position for the related exposure.
20 positions are linked to Table and the other 20 positions to Wall stand.
If necessary, each position can be adapted with regard to:
• Source Image Distance (SID)
• Detector Angle
• Height
• Tube Angle
• Tube Beta Angle (Rotation of tube)
• Table Bucky Position

Figure 20

(9) Repeat steps (2) to (8) for all exposures.

NOTE:
The default Auto-Position programs can only be adapted via the Service Tool in the
software of the Tubehead display.
See Service Manual “Automatic Ceiling Suspension” on Agfa Healthcare Library
Document ID 33177315 (chapter 5.3.10, Auto-Positions Configuration).

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6.5.3 Optional Configuration Possibility for free Exposures (CR only)

(1) Click on the “+” button to add an additional view.

This is necessary, if two or maximum four views have to be configured on one
cassette (CR free exposures only), e.g. Wrist AP and LAT.

Figure 21: Example screenshot

(2) If necessary, adapt the settings for the other views.

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6.5.4 Configuration of the Image Processing

For instructions on how to configure the NX Image Processing, please refer to

chapter 5, MUSICA2 Image Processing Software, of the NX Service Manual.

6.5.5 Configuration of Film Orientation

On CR systems the film orientation is determined by the cassette orientation.

On DR systems the orientation of the detector is fixed. Therefore, the cassette
orientation is not used for the film orientation.
In the configuration part <Printer Settings> of the exposures a new configuration
option <Film Orientation> is offered:

Figure 22

Automatic:
The Region of Interest (ROI) is automatically detected and acts as reference for the
film orientation (landscape or portrait is automatically chosen).
Landscape:
The film orientation is always set to landscape.
Portrait:
The film orientation is always set to portrait.

NOTE FOR OPTION <FILM ORIENTATION>:

Because of anatomical variation the selected film orientation does not always deliver
the optimal result for the printout.
Inform the user about this behavior and the possibility to correct the film orientation in
the <Editing> pane of the NX user interface.

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NOTE:
The real exposed area determines the closest virtual cassette size which is taken
to be linked to the corresponding film size.
• For more details about the configuration of printer settings refer to the
NX Key User Manual, chapter 6.
• For more details about the printer and printsheet configuration refer to the
NX Key User Manual, chapter 4.

6.6 DR Recovery Procedure Check

If an exposure is no longer linked to a thumbnail, it will arrive on NX as emergency

exposure. The image processing applied to this kind of exposure is defined via
<Exposure Type> as shown below:

(1) Go to: <Device Configuration>

(2) Select <X-ray Device>.

Figure 23

(3) Check if the <Exam Group> and <Exposure Type> are configured.

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6.7 Detector Settings

(1) Go to: <Device Configuration>

(2) Select <X-ray Device>.

(3) Select the X-ray Device model.

(4) Go to: <Detector Settings>

(5) Check the configuration of the DR detector for:

• Serial number
• Modality position (must be Table)
• Patient position

Figure 24

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6.8 Arranging XRG Parameters / User Interface Configuration

(1) Go to: <User Interface Configuration Æ Examination Settings

Æ Configure XRG Parameters>

(2) Open the <XRG Parameters> screen to set the displayed attributes.

Figure 25: Example screenshot

(3) Select a value for <Position>.

(4) Translate the <Label> entry to local language, if necessary.

(5) In <Content> select the XRG Parameter to be displayed.

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6.9 Arranging View Image Details / User Interface Configuration

(1) Go to: <User Interface Configuration Æ Examination Settings

Æ Configure View Image Detail Pane>

Figure 26

(2) Select a value for <Position>.

(3) In Content select EI to be displayed.
(4) Repeat steps 2 – 3 to add TEI and DI.

6.10 Compose Exam

(1) Go to: <User Interface>

(2) In <Examination Settings> select <Configure Add Image Pane>.
(3) Open the tab <Compose Exam>.
(4) Place the exposure thumbnails for all exams and age groups at the preferred
position.

Figure 27

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6.11 Activating the Configuration

Apply the configuration settings. In the Configuration Tool menu select:

<File Æ Activate Configuration>

6.12 Adaptation of default Program Files (optional)

The default positions in the menu <Positioner Settings> can not be modified in
the NX Configuration Tool, but in the Console of the DX-D 600 Tubehead.
The Automatic Position Configuration must be synchronized between the X-ray System
and the NX Workstation.

If an adaptation of the Positioner Settings is requested by the customer:

Ask the customer for these configuration values and forward them before installation
to the responsible Field Service Engineer.

For a detailed description of the procedure refer to:

• DX-D 600 Ceiling Support User Manual, Document ID 33177315,
Intranet Link / Extranet Link
• DX-D 600 System Service Manual, Chapter 2, Installation and Setup -
Synchronization of the automatic Position Configuration between the
X-ray System and NX workstation, Document ID 33249261,
Intranet Link / Extranet Link.

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7 System Test and Service Application Activity

7.1 Overview of DX-D 600-related Acceptance Test Procedures (ATP) and

Responsibilities

The DX-D 600 Service Acceptance Test is performed on two levels:

• System level:
This part covers the entire system.
o DX-D 600 System Acceptance Test (performed by FSE on site)

• Component level:
The main standard components have their own product-specific ATP:
o X-ray Modality Acceptance Test procedure (performed in production)
o NX workstation Acceptance Test procedure
(performed by FSE and CAS on site)
o DR detector (performed by FSE on site)

For more details refer to chapter 11 of the DX-D 600 System Manual.

NOTE:
There is an independent ATP document available for the NX Workstation.

7.2 NX Workstation Acceptance Test Procedure

The NX Acceptance Test Procedure is an independent document which is not part of

the DX-D 600 System ATP. It is available in the NX Service documentation.
The NX ATP provides instructions and checklists to perform the acceptance test of the
NX Workstation at the customer’s site. A print-out of the NX ATP may be used as a
report and be added as supplement to the DX-D 600 ATP document.

IMPORTANT:
It is strongly recommended that the Clinical Application Specialist gets in close
contact with the responsible Field Service Engineer.
The CAS and the FSE should prepare and synchronize their activities in advance to
have everything in place on time.

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8 Customer Training

8.1 Training Prerequisites and Preparation

For a successful training the following assumptions should be met:

• DX-D 600 is fully installed, configured and functional.
• Date of training is defined.
• List of persons to be trained is available.
• The recommended maximum number per training group is 4 participants.
• No interruptions during training and hands-on assistance may occur.

8.2 Checklist for Training Sequences

DX-D 600 - Checklist for Customer Training

Site: Location: Date:

Goal:
After the training the customer should understand the workflow of the DX-D 600
and know how to use the documentation.
Topics: Done Reference
General Topics
• Intended Use 0240 DX-D
600 User
• Available User Manuals Manual
• System Overview
• “Emergency Stop” button(s)
• Safety directions
• Start-up and Switch off Procedure DX-D 600 0240 DX-D
600 User
o Start-up Routine Manual
o Shut-down Routine 0242 DX-D
o Rules for detector warm-up 600 X-ray
System User
o X-ray tube warm-up procedure Manual

• Cleaning and disinfection

• Periodic Maintenance
End

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8.2.1 Checklist for X-Ray Unit

DX-D 600 - Checklist for Customer Training

Site: Location: Date:

Goal:
Training participant knows the different controls of the DX-D 600.
Topics: Done Reference
X-ray Generator Control
• Buttons to switch on and off 0240 DX-D 600
User Manual
• X-Ray Handswitch
o Two stages (Preparation and X-Ray exposure)
Advise the radiographer to verify the exposure settings for
correctness before doing the exposure.
RAD Table
• Table functionality and switches 0242 DX-D
600 X-ray
o Bucky set System User
o Foot switch for table top movements and table vertical Manual
movement
o Emergency Stop button
• Accessories (optional)
o Hand grips
o Compression band
RAD Wall Stand
• Functionality and switches 0242 DX-D
600 X-ray
o Bucky assembly (detector, grid) System User
o Front panel Manual

o Tilting and rotation (lever, locks and indicators)

o Foot switch to control vertical movement
• Vertical Movements
o Manual vertical motion
o Automatic vertical movement
o Auto-tracking
• Accessories (optional)
o Hand grips
o Lateral bar

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DX-D 600 - Checklist for Customer Training

Topics: Done Reference

Grid
• Kind of grid used in table and wallstand 0242 DX-D
600 X-ray
• General rules for using grids, e.g. SID, Range of SID System User
• Grid sensing for table and wallstand Manual

o Relationship to grid status in top pane of soft console

Collimator
• Automatic Collimator 0240 DX-D
600 User
o Collimator Display Manual
o Manual Blade Control
o Automatic Mode Indicator (Green)
o System not ready Indicator (Red)
o Manual Mode Indicator (Yellow)
o Automatic Mode Indicator (Green)
o System not ready Indicator (Red)
o Manual Mode Indicator (Yellow)
o Change of Filter
o Collimator Lamp Control (Led “ON”)
o Retractable Metric Tape
o Laser Pointer Window
o Laser Pointer On/Off Button
o For calibration: Key to unlock the limitation of the
size of the X-ray field.
Make the participants sensitive to switch back to the
automatic mode after finalization of calibration.
Otherwise the pre-configured collimated area is not
communicated from NX.

Tubehead display – Console Control

• Emergency Off Switch
• System Movements
o Buttons for movement

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DX-D 600 - Checklist for Customer Training

Topics: Done Reference

• Touch Panel Screen – General 0242 DX-D
(visible in all Touch Panel Screens) 600 X-ray
System User
o Area for selected workstation, movement controls and Manual
indicators (Auto Center, Auto Tracking, Parking
Position, Detent Skipper)
o Status Indicator
- Ready to make an exposure
- Ceiling suspension in motion
- Ceiling suspension stopped and not centered with
DR detector
- Ceiling suspension not synchronized with generator
- X-ray interlocks unable to make exposures
o Selection area for different screens
(Info, Position, RAD, PP
• Touch Panel Screen – Info
o Area for patient information
o Data area
• Touch Panel Screen – Position
o Manual Position of SID, ANG and ROT Area
o Auto-positions Selection Area
o Activation of changed positions
o Execute the movement with Auto Center function or
Automatic Movement Control Console
• Touch Panel Screen – RAD
o Areas for exposure parameters, AEC, focus
o Modifications are automatically transferred to the
generator
• Touch Panel Screen – PP (Programmed Positions)
o Selection of pre-configured positions.
No parameters can be modified by the operator.
o Activation of changed program
o Execute the movement with Auto Center function or
Automatic Movement Control Console

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DX-D 600 - Checklist for Customer Training

Topics: Done Reference

Tubehead display – Movements and Detents
• Movements and Detents 0242 DX-D
600 X-ray
o Manual Motion System User
o Detent Points Manual

o Automatic Motion
o Auto-center
o Auto-tracking
o Auto-positioning
• Automatic Movements Control Console
o Emergency Stop button
o Auto Center Position
o Parking Position
Software Console
• Top Pane
o Operational Status Bar with:
- Device status (filtering, grid, alignment status, etc.)
- DAP display frame
-%
- Error status bar
• Generator Tab
o Radiographic Parameters
o Focal Spot Indicator
o Automatic Exposure Control
- AEC chamber selection
- Sensitivity
If it is necessary to adapt the cut-off dose, train
not to change the Sensitivity, but to use the
function Density instead.
- Density
- Patient thickness

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DX-D 600 - Checklist for Customer Training

Topics: Done Reference

• Modality Tab 0240 DX-D 600
User Manual
o Automatic positioning selection
o Actual and Target position of the X-ray device for:
- Source Image Distance position*
* Explain the customer that for SID 180 cm the actual value
shown in the Softconsole is 179 cm and the SID shown in the
hardware console 180 cm SID.

o Collimator Blades position

End

8.3 Checklist for Customer Training ”NX Workstation”

Checklist for Customer Training “NX Workstation”

Site: Location: Date:

Goal:
The following list details the topics recommended to be trained and explained to
the training participant. After the training the customer should be able to operate
the NX workstation.
Topics: Done Reference
NX General
Explanation of the NX User Manual NX User
Manual
Intended use and limitations of the system

Basic Workflow
Opening a patient from the RIS NX Key User
Manual
Manually entering patient data

Composing the examination

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Checklist for Customer Training “NX Workstation”

Site: Location: Date:

Selecting and Performing X-Ray Exposures
• DR workflow
• CR workflow

Performing quality control

Editing possibilities
E.g. annotations
“Close and Send” Function

Worklist Window
Different panes: NX User
Manual
• Search pane
• Worklist pane
• Closed Exams pane
• Manual Worklist pane
• Image Overview pane
• Action Buttons

Browsing through the lists

Examination Window
Different panes: NX User
Manual
• Patient pane
• Image Detail pane
• Image Overview pane
• Action buttons

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Checklist for Customer Training “NX Workstation”

Site: Location: Date:

Using Examination:
• Image indicators as modality status, status indication of
DR detector and problem status
• Tools for performing basic QC
(R,L marker, Flip, Rotate)
• Edit patient data
• Edit image data
• Finalizing the exam after the images have been received

Editing Window
Advanced editing possibilities: • NX User
Manual
• Adding annotations to an image and using measurement
tools • NX Service
Manual,
• Rotating or flipping an image, show or hide square chapter 5,
marker "Software
Options −
• Zooming in or out on an image, applying shutters Musica²
Image
• Working with collimation/cropping, collimation/cropping Processing
rules for DR and CR Software“

• Cropping (DR) and Black border (CR)

• Use of window/level
• Adjusting the Musica² image processing parameters and
explaining the impact of taste adjustments on images
Printing images (including Multi Patient Print) NX User
Manual
Action buttons:
Reject, save as new, print sheet, send image, close and send
all

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Checklist for Customer Training “NX Workstation”

Site: Location: Date:

Main Menu
Different panes: NX User
Manual
• Functionality overview pane
• Workspace area
• Image Overview Pane
• Action buttons (individually configurable)
Monitoring and Management
• Queue Management
• Delete Examination
• Lock Examinations
Quality assurance tasks NX User
Manual
• Dose Consistency Reporting
• Repeat Reject Program
• Read and initialize cassettes (optional)
“Import” and “Export” Functions

Training for optional Application Packs

"NX 3.0 Features License": NX User
Manual
• Full Screen Mode
• Configurable UI button to call up 3rd party application
• Forced entry of operator ID
• Mandatory Patient fields
• Multiple DICOM export destinations
• Export of technical or clinical images to hard disk
• Print entire study in one click
NX Full Leg / Full Spine stitching – CR (optional)

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Checklist for Customer Training “NX Workstation”

Site: Location: Date:

Image Quality
Highlight that the basic rules to create an X-ray exposure are Not
still valid and important for the image quality (e.g. collimation applicable
of X-ray beam).
Explain the usage of lead markers.

Explain the dependencies between X-ray dose, signal-to-

noise ratio (SNR) and density.

Point out that modifications in the image processing may

cause image details to get lost (exaggerated MUSICA
settings).
Explain burning/clipping artifacts (exaggerated W/L settings).

Image Quality (continued)

Highlight that the scaling factor of images is independent of Not
real body part size. applicable

Explain the meaning and usage of the “Exposure Index” (EI)

as dose indicator, range of over/under exposure.

Explain the limitation of over/under exposure (dynamic range

of a DR detector versus CR):
E.g. clipping provoked by a too high exposure
End

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8.4 Checklist for Customer Training ”DR Detector Calibration”

Checklist for Customer Training “DR Detector Calibration”

Site: Location: Date:

Goal:
The following list details the topics which are recommended to be trained and
explained to the training participant. After the training the training participant should
be able to calibrate the DR Detector.
Topics: Done Reference
Calibrating the detector
Calibration Frequency DR Detector
Key User
Manual
Calibration Workflow
• Required material
• Preconditions (e.g. warm-up of detector, …)
• Procedure

End

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9 Hands-on Assistance

Checklist for “Hands-on Assistance”

Site: Location: Date:

Goal:
The following list details the topics which are recommended to be done
during hands-on assistance.
Topics: Done
Workflow
Review if the training topics can be applied
in daily routine operation.

Assist in special cases which may appear

in daily routine operation.
Consult the customer in operating the system to avoid
any risk for the patient during the learning phase.

Give the customer guidance in workflow topics.

Preparation for follow-up visit

Applicable if ordered by the customer.

Ask the customer to make a list of all open issues, questions and
other topics he wants to discuss during the follow-up visit.

Ask the customer to collect example images containing

artifacts or other issues that need to be looked at during
the follow-up visit.
End

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10 DX-D 600 Glossary

Term Description

AEC Automatic Exposure Control

APR Anatomical Programmer
ACSS Automatic Cassette Size Sensing
Black Border For CR: Function of MUSICA image processing software: The
black border masks non-relevant image areas, which are outside
the manually collimated image area.
Collimation 1. Collimation at NX, performed by defining a new region of
interest and consecutive re-processing of the image.
2. Collimation at X-Ray device, made by a diaphragm, an X-ray
tube head attachment consisting basically of a sheet of lead with
a hole that determines the size and shape of the primary beam.
Cropping For DR: Region of Interest/Collimated Area is detected with same
algorithm as for Black Border CR images. Non-relevant image
areas are not masked, but cropped.
DAP Dose Area Product (DAP), is a multiplication of the dose and the
area exposed, often expressed in Gy x cm2.

DAP-meter Measurement tool to measure the DAP

DI Deviation Index
EI Exposure Index
Grid Also called anti-scatter-grid. A device constructed of alternating
strips of lead and a radio-transparent medium (such as aluminum
or plastic composites) which are oriented in such a way that most
of the primary radiation will pass through the grid between the
strips while most of the scattered radiation will intersect the lead
strips and be absorbed.
Grid ratio The ratio of the height of the lead grid strips to the distance
between the strips.
TEI Target Exposure Index
XRDI X-ray Device Interface

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11 AGFA – DX-D 600 Training and Instruction Protocol

After filling out this form, hand over a copy of the form to the Agfa project manager.

Site Information
[To be adapted locally:
e.g. name of site, name of contact person, site address

Remove this blue text bloc from final version]

DX-D 600 System Description

X-Ray System CR System

[To be adapted locally: [To be adapted locally:
e.g. ceiling mounted X-ray system, Generator, e.g. digitizer

Remove this blue text bloc from final version] Remove this blue text bloc from final version]

Objective of Training

DX-D 600 can be operated successfully.

Key Aspects
[To be adapted locally, e.g.:
DX-D 600 workflow
Handling instruction of the X-Ray System

Remove this blue text bloc from final version]

Notes
[To be adapted locally:

Remove this blue text bloc from final version]

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AGFA – DX-D 600 Training and Instruction Protocol

Participants List

Date Name, Title Signature

Instruction carried out by: ___________________________________________

Date: ___________________________________________

Signature: ___________________________________________

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