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Mathias Prokop, MD: Cardiac CT- what comes after the

slice race?
May 16, 2008- 9:10 AM
Stanford Radiology 10th Annual Multidetector CT
Symposium 1
Cardiac CT Cardiac CT – – what comes after the slice race? what comes after the slice race?
A critical analysis of where we stand and what we need A critical analysis of where we stand and what we need
10th Annual International Symposium on Multidetector-Row CT
Las Vegas, May 13 Las Vegas, May 13--16, 2008 16, 2008
Mathias Prokop, MD PD Mathias Prokop, MD PD
University Medical Center Utrecht University Medical Center Utrecht
The Netherlands The Netherlands
Member, advisory board Member, advisory board
Philips Medical Systems Philips Medical Systems
CT Performance
n
c
e
100.0
1000.0
Performance =coverage per second / eff. slice thickness
64-slice
P
e
r
f
o
r
m
a
n
0.1
1.0
10.0
1985 1990 1995 2000 2005
Conventional
Spiral
Dual-slice
4-slice
8-slice
16-slice
2010
The Slice Race
MDCT Scanner Generations
4-slice CT
1998
Fast scans
or
Spiral CT: 6cm in 30s
or
high resolution
for most
organ systems
4 x1 mm 4 x1 mm 25 s scan 25 s scan
16-slice CT
2002
Fast scans +
highresolution high resolution
for all organ
systems
16 x0.75 mm 16 x0.75 mm 8 s scan 8 s scan
16x0.75 mm
13 s scan duration
C i i l f
Faster Scans ?
Scanning may become too fast
Critical for:
•Large aneurysms
•Slow flow
•Peripheral runoff
•Decreased &
inhomogenous contrast
Mathias Prokop, MD: Cardiac CT- what comes after the
slice race?
May 16, 2008- 9:10 AM
Stanford Radiology 10th Annual Multidetector CT
Symposium 2
64-slice CT
2005
Fast scans +
high resolution +
ECG gating ECG gating
for all organ
systems
Gated
thoracoabdominal
CTA
4-slice CT
1998
Coronary CTA
became possible
4 x1 mm 4 x1 mm 40 s scan 40 s scan
became possible
16-slice CT
2002
Fast scans +
highresolution
CoronaryCTA
high resolution
for all organ
systems
16 x0.75 mm 16 x0.75 mm 20s scan 20s scan
CATSCAN Trial - Qualifier
Coronary CTA
became feasible
64-slice CT
2005
LCX
RCA RCA
stent stent
LCX
LAD
Coronary CTA
became practicable
Multi-detector CT
Scanner Generations
1
st
gen. 2
nd
gen. 3
rd
gen. 4
th
gen.
1998 2000-02 2004-05 2006-08
32 rows +z FFS
4 rows 16 rows
64 rows
320 rows
32 rows
+z-FFS
64 rows
+new detector
32 rows +z-FFS
+dual source
128 rows +z-FFS
Beyond the Slice Race
th
4
th
Generation Scanners
Mathias Prokop, MD: Cardiac CT- what comes after the
slice race?
May 16, 2008- 9:10 AM
Stanford Radiology 10th Annual Multidetector CT
Symposium 3
Image quality
• Spatial resolution
• Image noise
Beyond the Slice Race
Important Scanner Features
Image noise
• Artifacts / temporal resolution
Scan speed
Coverage
Radiation dose / prospective triggering
Multi-detector CT
4
th
Generation
Dual source
• Two x-ray tubes
Fast rotation
Siemens
Somatom Definition
Phili iCT
Fast rotation
• Air-bearing gantry
Wide detector
• 8-16 cm
Philips iCT
Toshiba Aquilion One
Philips iCT
New detector / iterative recon.
• Higher resolution / less noise
GE CT750 HD
4
th
Generation Scanners
Siemens
Somatom Definition
Dual source
New tube with z-FFS
Temporal resolution
Dual energy
85 ms 85 ms
4
th
Generation Scanners
Toshiba
Aquilion One
Wider detector (320x0.5mm =16cm)
Cone beam recon +scatter correction
Full organ coverage
Dynamic scanning
Courtesy P. Rogalla, Berlin
4
th
Generation Scanners
Philips
iCT
Wider detector (128x0.625mm =8cm)
Air-bearing gantry (270ms rotation)
New tube with z-flying focal spot
2D scatter grid
Compromise resolution / speed / coverage
4
th
Generation Scanners
GE
CT750 HD
New detector material and design
Iterative image reconstruction
Spatial resolution / noise
Dual energy
Mathias Prokop, MD: Cardiac CT- what comes after the
slice race?
May 16, 2008- 9:10 AM
Stanford Radiology 10th Annual Multidetector CT
Symposium 4
Detector Slices Width
GE CT750 HD 64x0.625 64 4 cm*
4
th
Generation Scanners
Detectors
Philips iCT 128x0.625 256 8 cm
Siemens Definition 32x0.6 64 1.9 cm
AS+ 64x0.6 128 3.8 cm
Toshiba One 320x0.5 320 16 cm
* New detector material
Tubes Rotat. pro. retro.
ms ms ms
GE CT750 HD 1 350 180 50 180
4
th
Generation Scanners
Temporal Resolution
GE CT750 HD 1 350 180 50-180
Philips iCT 1 270 140 40-140
Siemens Definition 2 330 85 40-85
AS+ 1 300 150 50-150
Toshiba One 1 350 180 50-180
width pro. retro.
GE CT750 HD 4 cm 7 6
4
th
Generation Scanners
Number of Heartbeats to Scan the Heart
Philips iCT 8 cm 3 3
Siemens Definition 1.9 cm 8 7
AS+ 3.8 cm 4 4
Toshiba One 16 cm 1 1-3
14cm scan length
Prospective or Retrospective ?
320-slice CT
Retrospective, 2 heartbeats
Heart rate: 58 bpm
Heart rate: 92 bpm
Courtesy of P. Rogalla, Charite, Berlin, Germany
Prospective, 1 heartbeat
Beyond the Slice Race
Functional CT
Morphology
• Coronaries
• Heart +vessels
Beyond the Slice Race
CT Applications
• Standard for all organ
systems
16-slice sufficient
Perfusion
• Myocardium
Motion
• Cardiac function
• J oint motion
• Breathing
• Brain, lung
• Tumors
All other indications profit from 4
th
generation
Mathias Prokop, MD: Cardiac CT- what comes after the
slice race?
May 16, 2008- 9:10 AM
Stanford Radiology 10th Annual Multidetector CT
Symposium 5
CT Perfusion
Vendor Approaches
• Spiral / shuttle mode:
bidirectional table movement
(Siemens / GE)
• Wide detectors
(Philips / Toshiba)
• J og mode - switch between two positions
(Philips)
CT Perfusion
Shuttle Mode
Advantages:
•Larger coverage
•Detector size not limiting
Courtesy of University Erlangen / Erlangen, Germany
g
Disadvantages:
•Patients moves
•Limited temporal
resolution
•Cardiac difficult
CT Perfusion
Stationary Mode
Advantages:
•Patients stable
•High temporal resolution
Courtesy of P. Rogalla, Charite, Berlin
g p
•Cardiac possible
Disadvantages:
•Coverage limited by
detector size
Dual Energy
Vendor Approaches
Dual source
Siemens
Rapid kV switching p g
GE
Split Detector
Philips
Klinikum Dortmund
Dual source technology
140kVp / 80 kVp
Dual Energy
Do we need it ?
Potential Applications:
•Stone differentiation
•Virtual precontrast images
Proven application
p g
•Automated bone removal
•Iodine maps
Myocardial perfusion
Lung perfusion
Tumor enhancement
Low kVp imaging
may be an
alternative
Summaryy
Mathias Prokop, MD: Cardiac CT- what comes after the
slice race?
May 16, 2008- 9:10 AM
Stanford Radiology 10th Annual Multidetector CT
Symposium 6
MDCT Implementation
Summary
4th Generation Scanners
• Mature technology for body imaging (=64-slice)
• Decent technologyfor perfusion Decent technology for perfusion
• Advanced technology for cardiac
• Best cardiac scanners
• Perfusion CT still very radiation intense,
few proven indications