Somatom Sessions 17

SOMATOM
No 17/December 2005
RSNA-Edition
Nov. 27th –
Dec. 2nd, 2005
www.siemens.com/medical
Sessions
COVER STORY
Dual Source CT Imaging –
A New Era in Computed
Tomography
Page 4
NEWS
CT Clinical Engines – Speed
and Confidence
Page 19
BUINESS
SOMATOM Emotion – “Excel-
lent Price-Performance Ratio“
Page 25
Revenue – Investment
Pays Off
Page 27
CLINICAL OUTCOMES
Oncology – Respiratory Gating
Page 34
Acute Care – Diagnosis and

Surgical Planning in Traumatic
Paraplegia
Page 42
SCIENCE
Increased Speed and Resolu-
tion Make a Difference in
Coronary Artery Imaging
Page 46
CUSTOMER CARE
EDUCATE –
Free CME-Credited CD-Set
Page 49
EDITOR’S LETTER
Deutscher Zukunftspreis/Ansgar Pudenz
Bernd Ohnesorge, PhD,

Vice President
CT Marketing and Sales
Dear Reader,
The number of slices acquired per rotation has doubled every 18 months in the last years,
with Siemens being an innovation leader in both technical concepts and clinical applications.
At RSNA 2003, Siemens set another landmark as the first company to introduce 64-slice CT.
Only two years later, our SOMATOM Sensation 64 is installed in over 500 institutions
world-wide – the largest installed base in this segment.
At Siemens, we continue to challenge the future view on CT technology and clinical applica-
tions. We understand that supplying our users with innovative hardware is not enough. Intro-
ducing our new CT Clinical Engines, we provide perfect clinical CT solutions in neurology, diag-
nostic oncology, cardiovascular and acute care – available across Siemens' CT product line and
based on Siemens' unique syngo platform.
The time has come to explore totally new CT concepts and to move beyond the simple adding
of more detector slices. At RSNA 2005, Siemens moves CT into a new era with the introduction
of the world's first Dual Source CT, the SOMATOM Definition – a breath-taking innovation that
started with a simple scribble and was designed in cooperation with the world's leading clinical
experts. Experience completely new dimensions of CT. Redefine the clinical role of CT in car-
diac imaging and acute care. Explore new clinical frontiers with dual energy scanning. Join us
to reach new levels of excellence in CT.
Now, enjoy reading this 17th issue of the SOMATOM Session magazine. It is the introduction
to another great CT year in – a year in which Siemens will once again set the trend.
Sincerely,
Bernd Ohnesorge, PhD, Vice President CT Marketing and Sales
2 SOMATOM Sessions 17
CONTENT
COVER STORY
4 Dual Source CT Imaging – A New Era in Computed Tomography
12 Dual Source CT Imaging – The Idea behind the Technology
NEWS
19 Speed and Confidence
21 Leader in Customer Care
21 NEW – Advanced Vessel Analysis
22 Proven Leadership
22 Trendsetting Injector Coupling Device
23 Enhanced Workflow
BUSINESS
24 Virus Protection Shields Medical Systems
24 The Easy Way from Sequential to Multislice CT
25 „Excellent Price-Performance Ratio“
26 Reimbursement in the US
27 Investment Pays Off
CLINICAL OUTCOMES
28 Cardiovascular: CT Angiography of Chest, Abdomen, Pelvis and Upper Extremities
with CARE Dose4D and z-Sharp
30 Cardiovascular: Peripheral Runoff
32 Oncology: Computer Assisted Reading - More Speed. Enhanced Confidence
34 Oncology: Respiratory Gated CT-Imaging in Radiation Therapy of Lung Cancer
36 Oncology: Restaging Bronchial Carcinoma after Radiotherapy Treatment
38 Oncology: Making a Difference with PET and CT in Complex Cases
40 Neurology: Bone Subtraction CTA for Vascular Mapping in Head and Neck Imaging
42 Acute Care: 40-Slice CT for Diagnosis and Surgical Planning in Traumatic Paraplegia
SCIENCE
44 Head and Neck Imaging
46 Increased Speed and Resolution Make a Difference in Coronary Artery Imaging
CUSTOMER CARE
48 Customer Event
48 Cardiac CT – Live Case Workshop
48 First High-end Users Meeting
49 Free CME-Credited CD-Set
49 Service: Frequently Asked Questions
50 Service: CT News on the Web
50 Service: Upcoming Events and Courses
51 Imprint
SOMATOM Sessions 17 3
COVER STORY

A New Era in
Computed Tomography
Four prominent medical specialists – from radiology, cardiology

and medical physics – sat down together recently to discuss
a revolutionary innovation in CT technology: dual source CT imaging.
Here is how the experts assessed the new technology.
By Catherine Carrington
Buzz. It’s what fills the air when people take note of an Coronary CTA
exciting new trend, a technological revolution that examination with
83 ms temporal
promises to change the future, an innovation so creative
resolution of
it defines “out of the box” thinking.
a patient with
Buzz. It’s what energized the room when four computed varying heart
tomography (CT) experts gathered in Cleveland, Ohio, to rate of 85-93 bpm
envision the future of imaging, and how it will change during the scan.
with the introduction of a revolutionary new technology:
dual source CT.
The first system worldwide to contain this new technology
is Siemens’ SOMATOM Definition. Overcoming the
convention of thinking in terms of numbers of slices, it is
equipped with two X-ray source/detector systems that
rotate in synchrony, simultaneously capturing image data
in half the time required with conventional technology.
Two X-ray sources, two detectors, a multitude of clinical
possibilities.
At the table were neuroradiologist Michael Modic, M.D.,
chairman of radiology at the Cleveland Clinic Foundation;
radiologist Richard White, M.D., head of the section of
cardiovascular imaging at the Cleveland Clinic Foundation;
cardiologist Gilbert Raff, M.D., director of CT and MRI
research at William Beaumont Hospital, Royal Oak,
Michigan; and medical physicist Cynthia McCollough,
Ph.D., director of the CT Clinical Innovation Center at Mayo
Clinic, Rochester, Minnesota. MIP LAD Diastole MIP LAD Diastole
Courtesy: University Hospital Erlangen
COVER STORY
MICHAEL MODIC, M.D., RICHARD WHITE, M.D., GILBERT RAFF, M.D., CYNTHIA MCCOLLOUGH,
chairman of radiology at the radiologist, head of the cardiologist, director of CT Ph.D., medical physicist,
Cleveland Clinic Foundation section of cardiovascular and MRI research at William director of the CT Clinical
imaging at the Cleveland Beaumont Hospital, Royal Innovation Center, Mayo
Clinic Foundation Oak, Michigan Clinic, Rochester, Minnesota
COVER STORY
Four CT experts from the US gathered in Cleveland to envision the future of imaging, and how it will change with the
introduction of dual source CT.
SOMATOM Sessions: 64-slice CT scanner have been a made it possible for us to do coronary CT angiography. But
remarkable innovation, but we are wondering what we’re still dependent upon picking the right patients. With
challenges still remain. Are there ways in which CT can future CT technology improvements, we need to be able to
become even better? do an examination on any patient.
DR. RAFF: Cardiac CT has extremely high accuracy in finding DR. MODIC: CT is the ideal modality for imaging acute
a lesion and in excluding significant stenosis. However, it stroke. The first decision for us is “blood – no blood,” and
is very important to both, the patient’s management and CT is very good at answering that question. But we also
interventional planning, to discover exactly how severe the need to evaluate the intracranial vessels, including fast and
lesion is – whether it is a 25 percent stenosis or a 75 percent accurate separation of vessels and bone. Moreover, calcified
stenosis. Any move in that direction is key. plaque in the carotid arteries has been a limiting factor in
The second issue is patient preparation. I have an entire applying CT to the evaluation of stroke. We need a tool that
holding area staffed with nurses and equipped with is better able to differentiate tissues.
monitors, all dependent on having to give patients beta DR. MCCOLLOUGH: Radiation dose has become of
blockers to slow the heart rate. We could save a lot of time, increasing concern. With present multislice CT technology,
work and cost if we didn’t need to give patients these beta as temporal resolution improves, the radiation dose goes
blockers. up. It’s a concern that hangs over the technology and makes
DR. WHITE: The leap from 16- to 64-slice technology really everyone worry.
COVER STORY
Cardiac Imaging DR. RAFF: A considerable number of patients can’t take beta
blockers. For example, patients with asthma are not
Dual source CT meets all of these challenges. Consider cardiac candidates for cardiac CT today. And some patients are beta
imaging: Each of the two source/detector systems must travel blocker resistant. If dual source CT means that fewer patients
only 90 degrees to acquire image data, resulting in a doubling are rejected beforehand, and more of the patients we do
of temporal resolution. It provides a temporal resolution of 83 image have diagnostic results, that’s quite important in the
ms – a factor of two better than the 165-ms temporal scheme of things.
resolution of the best single source CT scanners. Together with DR. WHITE: There’s another aspect to consider. Let’s say,
a spatial resolution of less than 0.4 mm, it enables SOMATOM based on the CT study, you’re concerned about athero-
Definition to visualize the smallest anatomical structures with sclerosis and want to determine its functional importance.
exceptional quality – without the compromises associated with Having beta blockers on board may preclude immediately
beta blockers and ECG-gated, multisegment reconstruction. doing a functional assessment with stress testing. That’s a
SOMATOM SESSIONS: How will dual source CT solve some of problem that dual source CT can solve.
the challenges you continue to face in cardiac imaging?
DR. RAFF: Even in patients that we consider ideal today, there
is always cardiac motion and subtle amounts of blurring at the »Better coronary imaging at this
level of the stenosis. The only way we’re going to push coronary
CTA to achieve the quality we need to make key clinical
level is going to revolutionize
decisions is with higher temporal resolution. the treatment of coronary
DR. WHITE: Any opportunity to capture that coronary artery disease, and coronary disease is
as it’s flying by is a major gain. With 83-ms temporal resolution, the most commmon serious
independent of the heart rate, you’re also getting away from
the need for segmented reconstruction approaches.
health problem in
SOMATOM SESSIONS: Let’s talk about multisegment the developed world.«
reconstruction. It’s said to improve temporal resolution and
overcome problems associated with a high heart rate. Are the Gilbert Raff, MD, director of CT and MRI research,
images of consistently high quality? William Beaumont Hospital, Royal Oak, Michigan
DR. WHITE: Multisegmental
reconstruction is not a panacea, and
quite often it’s detrimental rather than
beneficial. You’re averaging data from
multiple cardiac cycles, and that’s not
the most desirable approach.
Multisegment reconstruction should
not be relied upon as the answer to
temporal resolution.
DR. MCCOLLOUGH: If you average
two cardiac cycles and the heart
doesn’t come back to exactly the same
spot on a submillimeter level, you’ve
just blurred out that 1- or 2-mm artery
you’re trying to see.
SOMATOM SESSIONS: High temporal
resolution eliminates the need to give
beta blockers. We have discussed the
operational benefits, but is there also
a clinical benefit?
COVER STORY
Radiation Dose
SOMATOM Definition delivers the lowest possible radiation
exposure in cardiac CT imaging today, despite using two
X-ray sources instead of one. How? Dual source CT images
the heart twice as fast; therefore, Adaptive ECG-pulsingTM
delivers the dose necessary for cardiac imaging in less than
half the time as the most dose-efficient single source CT
scanner. In addition, dual source CT easily acquires images
even at the highest
heart rates, thus allowing for scanning at higher table speed.
Higher table speed results in lower radiation exposure
compared to single-source CT.
SOMATOM SESSIONS: Is dose exposure a big issue in
cardiac CT?
DR. RAFF: Yes, it’s a concern. When the dose gets to be »If you have a strong,
higher than for a coronar y angiogram, there’s a
psychological barrier, and everyone from patients to
premier cardiac program,
government regulators become reluctant. you’ll have to have a dual
DR. MCCOLLOUGH: Radiation dose becomes a very hot- source CT. A health system
button topic because people don’t understand it. If someone like ours should
comes to the emergency room and it’s clearly important to
evaluate them with CT, then the dose risk is negligible in
probably have several.«
comparison to the medical necessity of the exam. But in
those patients that come for rule-out examinations, Michael Modic, M.D., chairman of radiology,
minimizing radiation exposure is very important. Reducing Cleveland Clinic Foundation
the dose in cardiac CT by a factor of two will be an important
prerequisite for further establishing the technique in clinical
practice.
DR. RAFF: I’m concerned about the patient who has CT after
equivocal results on a stress test. They’ve had a nuclear
procedure with radiation, a CT scan with radiation, and they
may go on to cardiac catheterization, with more radiation. SOMATOM Definition has a wide, 78-cm gantry bore, a
Anything we can do along that pathway to minimize 200-cm scan range, and a combined 160-kW of power from
radiation exposure is critically important. two independent X-ray sources. Together, these ensure
SOMATOM SESSIONS: Does radiation dose resonate with excellent image quality and enable scanning at high speed
your patients? Could you draw patients to your center by for pure arterial-phase imaging, even in the heaviest of
emphasizing that dual source CT offers excellent image patients.
quality at half the dose? SOMATOM SESSIONS: How important is it to be able to
DR. MODIC: Absolutely. image obese patients with adequate power and at an
DR. WHITE: Why not put it out there as a mandate? We optimal table speed?
should tell patients: This is one of our core values, to reduce DR. MODIC: Any time you can match dose with body mass,
dose without sacrificing image quality. Lowering dose is the you’re better off. With dual source CT, you’ve got enough
right thing to do for multiple reasons. power to take care of the patient.
DR. RAFF: In obese patients, the deterioration of image
Acute Care quality can be so substantial with conventional CT scanners
A combination of the highest temporal resolution and the that many of these patients have undiagnosable lesions.
highest power available in the industry enables dual source Based on our experience with heavier patients, we don’t
CT to easily image critical and challenging acute care examine cardiac patients with a body mass index over
patients. This includes not only patients who are short of 38 kg/m2.
breath or have a high heart rate, but also obese patients. DR. MCCOLLOUGH: We have successfully done abdominal
COVER STORY
studies on a patient weighing more than 500 pounds, using resolution of 165 ms, there is still going to be motion blur.
a 64-slice scanner. But we have to make compromises. We So I think dual source CT could be a huge benefit for
have to lower the table speed and, therefore, we can’t imaging of pediatric patients without sedation, or for
optimize the exam from a contrast perspective, as we would imaging an injured patient who is in pain and can’t hold
with a regular patient. So if dual source CT allows us to scan still, or a patient who is agitated for some other reason.
obese patients using the dose and the table speed we prefer,
there will be fewer trade-offs. And, in cardiac CT of obese Dual Source CT Allows Dual Energy Imaging
patients, lowering the table speed is not sufficient. You Dual energy imaging – possible only with dual source CT –
simply need more X-rays for those patients. leverages differences in attenuation that depend on the
SOMATOM SESSIONS: Should physicians be concerned types of tissues being scanned, as well as on the energy
about the extra radiation dose to the obese patient? level. Scanning an object with 80 kV results in a different
DR. MCCOLLOUGH: The target organs that you worry about attenuation than scanning an object at 140 kV. This raises
for cancer are buried inside all that tissue, which absorbs a the possibility of direct subtraction of either vessels or bone
lot of the radiation. It turns out that the effective dose, during scanning, as well as characterization of other tissues.
which is an indicator of cancer risk from ionizing radiation, By using two X-ray sources simultaneously at different
only goes up by 10 to 20 percent, even though the scanner energies, SOMATOM Definition can acquire two data sets –
is cranking out double or quadruple the usual dose. with different information – from a single scan. This may
SOMATOM SESSIONS: Are there other types of acute care offer the possibility of going beyond mere visualization of
patients for whom dual source CT could make an important anatomy to differentiation and characterization of tissues.
difference? SOMATOM SESSIONS: What clinical opportunities does
DR. MCCOLLOUGH: We’ve done imaging of non-sedated dual energy scanning offer?
kids for a decade and a half because we’ve had an electron- DR. MCCOLLOUGH: One of the most important challenges
beam CT in our practice. We’ve recently replaced that in cardiovascular CTA is calcium. If a patient has a lot of
scanner with a 64-slice scanner, and we’ve been doing well calcium in the coronaries, you can’t see through that bright
with kids, but we still have to spend a long time in the exam spot to make a good diagnosis. That’s one of the things
room calming them down if they’re agitated. At a temporal we’re hoping dual energy will help us deal with.
COVER STORY
DR. MODIC: The whole issue of calcium isn’t just in the

heart. It could be in the lungs. It could be in peripheral
angiography, even in the hands and feet. We’ll be able to do
bone subtraction, not in postprocessing, but based on the
dual energy source.
SOMATOM SESSIONS: Dr. Modic, you’re a neuroradiologist.
Would it be helpful to you to be able to discriminate bone
and vascular tissue when imaging the brain?
DR. MODIC: Absolutely, especially given the emergence of
CT and CTA in the evaluation of patients with subarachnoid
hemorrhage and acute stroke. The high cervical carotids
and the skull base – those are difficult areas. We’re very
eager to see the quality of the images we can achieve using
dual energy. It’s likely to have a profound effect on the use
of CT in neuroradiology.
DR. WHITE: Dual energy is the big unknown for dual source
CT that’s going to take it into an entirely different dimension.
We don’t know what the prospects are for smarter contrast
agents, for example. We might adjust energies according to
the agent. There are probably opportunities we haven’t even
begun to anticipate.
Financial Justification
SOMATOM SESSIONS: From an operational or economic
standpoint, how would each of you justify investing in a
dual source CT scanner?
DR. MODIC: If you have a strong, premier cardiac program,
you’ll have to have a dual source CT. A health system like
ours should probably have several. If you have the patient
demand, the throughput that you can achieve through these
»Any opportunity to capture devices more than justifies the cost.
DR. MCCOLLOUGH: I can see dual source CT in the
that coronary artery emergency room, taking care of acute care and traumatized
as it’s flying by is a major gain. patients. Also in a big pediatric hospital. These are the places
With 83-ms temporal resolution, where sub-100 milliseconds should be a clear win, and
independent of the heart rate, where it may be worth paying the price differential.
DR. RAFF: For a cardiac program like ours, dual source CT is
you’re also getting away from the an obvious choice. It’s very important for us to be the best.
need for segmented In addition, our emergency room sees six thousand patients
reconstruction approaches.« a year with chest pain, and their average length of stay is
Richard White, M.D., over 24 hours. We’re finishing up a series of studies
head of the section of cardiovascular
imaging, Cleveland Clinic Foundation
COVER STORY
showing a dramatic decrease in length of stay when CT is

used to evaluate chest pain patients. If we could eliminate
beta blockers, we could probably reduce the length of stay
by another two hours. Those are the kind of compelling
numbers that hospital administrators with busy emergency
rooms are going to look at. Also, if a hospital is competing
with other institutions, it will be a distinguishing feature.
Patients will like the convenience.
Evolution or Revolution?
SOMATOM SESSIONS: Many of the advances in CT over the
last several years have been evolutionary. The increasing
number of slices with each new scanner is the most obvious
example. Is dual source CT another evolutionary change, or
is it revolutionary?
DR. MCCOLLOUGH: This scanner jumps off the curve,
because it’s not about the slices, it’s about rotation time.
We went from a half-second to 0.42 seconds to 0.37 seconds
to 0.33 seconds, and the gains were 0.08 and 0.05 and 0.04
seconds. Now we jump off a curve that’s reaching its upper
limit and virtually cut rotation time in half, that’s a big deal.
DR. WHITE: I think it’s both. You can count on it being
evolutionary on day one as we learn how to use it. But then,
the prospects for this technology to set a whole new
direction are amazing, and it will sustain that for quite some
time.
DR. RAFF: We have to consider the potential impact on
cardiology, and, through it, on medicine in general and the
healthcare system. Better coronary imaging at this level is
going to revolutionize the treatment of coronary disease, »Dual source CT could be a
and coronary disease is the most common serious health
problem in the developed world.
huge benefit for imaging of
pediatric patients without
Author: Catherine Carrington is a medical editor in Vallejo, sedation, or for imaging an
California. injured patient who is in pain and
can’t hold still, or a patient
who is agitated
for some other reason.«
Cynthia McCollough, Ph.D.,
director of the CT Clinical
Innovation Center, Mayo Clinic,
Rochester, Minnesota
COVER STORY
COVER STORY
X-ray unit 1
Dual Source
Rotation of
CT Imaging –
X-ray unit
and detector
The Idea behind
X-ray unit 2
the Technology
With the introduction of the Dual
Source CT technology at this year’s RSNA,
Siemens once again demonstrates its
leadership in technology and clinical
applications, moving beyond the simple
Gantry adding of more detector rows – a race
that had dominated CT technology for
the past couple of years.
SOMATOM Definition is the world’s first CT scanner to

Patient table
incorporate this new technology with which Siemens is
once again pushing technical and clinical boundaries to a
higher level by adding a second X-ray source and detector
to the CT system. The results are unprecedented image
quality and detail at lowest patient exposure while ensuring
Detector 1 substantially increased diagnostic speed and confidence.
Detector 2
COVER STORY
Advantages at a Glance
table. What’s more, SOMATOM Definition’s capabilities promote
SOMATOM Definition’s heart rate independent resolution pioneering new clinical opportunities at the highest level.
is 83 milliseconds, permitting scans of virtually every heart
and any heart rate – from acute chest pain evaluation to How Does it Work?
coronary visualization to functional analysis of the heart. The use of two X-ray sources and two detectors at the same
Together with the high spatial resolution of below 0.4 mm, it time result in double the temporal resolution, double speed and
makes the visualization of the smallest anatomical structures twice the power, while even further lowering radiation dose.
possible with exceptional quality.
In combination with a 78-cm large gantry bore and field of Cardiac Imaging
view, 200-cm scan range, and its high generator power, the Optimal cardiac imaging can be best achieved in the diastolic
system allows most accurate scans or acute patients, phase of the heartbeat. The faster the heart rate, the shorter
independent of size or condition. And all this at the lowest this phase becomes. With a single source CT scanner, the
possible dose. Additionally, SOMATOM Definition offers the X-ray source/detector system has to obtain data projections of
widest range of clinical applications, allowing fast and most 180 degrees to take an image within the diastolic phase. With
confident diagnoses to comprehensive reporting in only a Dual Source CT, each of the two source/detector combinations
matter of minutes. Intuitive and computer-assisted reading needs to travel only 90 degrees to acquire an exceptional
tools also assist physicians in early detection, fast evaluation, cardiac image. Based on 0.33 s rotation time, this concept
and precise follow up of malignant diseases, sometimes even provides an unprecedented temporal resolution of 83 ms,
enabling them to review results before the patient is off the independent of the heart rate.
COVER STORY
At a low and stable

heart rate, the time a
single source CT
scanner needs for
imaging is sufficient.
Nevertheless, the
substantially higher
temporal resolution of
Dual Source CT
eliminates residual
motion.
60 bpm single source CT 60 bpm Dual Source CT
At higher or varying
heart rates, the diastolic
phase is too short
for a single source CT
scanner, resulting in
poor image quality.
Dual Source CT, on the
other hand, delivers
sharp and detailed
cardiac images in a
short diastolic phase
and even in the systolic
phase.
COVER STORY
Dual Source CT images

the heart twice as fast
as single source CT
scanners, reducing the
ECG-pulsing window by
more than half.
Heartbeat-controlled
dose modulation
To overcome insufficient
temporal resolution at
high heart rates, single
source CT scanners use
multisegment recon-
struction with high dose
and limited reliability.
Dual Source CT, on the
other hand, maintains
Heartbeat-controlled the lowest dose, inde-
dose modulation pendent of the heart rate.
Dose Reduction
At the same time, SOMATOM Definition offers the lowest reduction of radiation exposure. In other words, the higher
possible radiation exposure in cardiac CT. Thanks to Dual the heart rate, the less time is required for imaging the
Source CT, the CT gantry needs to travel only 90 degrees to heart, and consequently lower dose is needed.
acquire an exceptional cardiac image with unprecedented
temporal resolution of 83 ms, independent of the heart Obese Patients
rate. Monitoring the ECG in real-time, Siemens’ Adaptive Scanning obese patients with single source CT usually results in
ECG-pulsing instantly reacts to any changes of the heart a trade-off between speed and image quality. Dual Source CT
rate. Now that cardiac acquisition is twice as fast, the time overcomes this limitation of restricted power reserves with a
of high exposure during the heart beat, controlled by dose second X-ray source. In other words, it accumulates the power
modulation, can be cut by more than half compared to of the two independent sources, resulting in unprecedented
single source CT scanners. 160 kW, providing sufficient X-ray power reserves for high quality
Instead of using multisegment reconstruction at higher imaging of patients whether tall or small, thin or large – at
heart rates, Dual Source CT’s highest temporal resolution maximum volume coverage speed and fastest rotation time.
allows to acquire cardiac images from single heartbeats, at And, because scan speeds can be increased, the higher power
any heart rate. Using automated table speed adaptation, is used to improve quality, while dose maintains the same as in
SOMATOM Definition increases the pitch with higher heart single source CT. And the large bore of SOMATOM Definition
rates, resulting in a faster table speed and a corresponding makes patient positioning much easier.
COVER STORY
Scan speed
Quality
Power
Dose
SINGLE SOURCE CT WITH LIMITED KW. When imaging obese patients at a high table speed
Insufficient power for high-speed scanning necessary for pure arterial scanning, even a
of obese patients. state-of-the-art, single source CT scanner may not have
sufficient power.
Scan speed
Quality
Power
Dose
DUAL SOURCE CT WITH 160 KW*. Dual Source CT, on the other hand, delivers sharp and
Dual Source CT accumulates the power of two detailed images at any scan speed, because it
seperate sources resulting in unprecedented 160 kW*. accumulates the power of two independent sources.
* Depends on system configuration.
COVER STORY
Using a single source CT scanner, Dual Source CT, on the other hand,
diagnosing the circled area becomes enables physicians to easily
difficult, as insufficient information differentiate tissue types. The lesion
does not allow a differentiation could be identified as a lipid
between different tissue types. degeneration, color-coded in dark
Object
red.
80 kV 140 kV
Attenuation B Attenuation A
Tissue Differentiation
It has always been an aim to collect as much information Energy 1: Energy 2:
as possible for differentiation of tissues. Dual Source CT
assists in opening the door beyond visualization, moving Bone 670 HU Iodine Bone 450 HU Iodine
296 HU 144 HU
into a new world of characterization. Permitting the use of
two sources simultaneously at different energies, SOMATOM
Definition makes it possible to acquire two data sets 80 kV 140 kV
simultaneously from a single scan, running the tubes at two

different kV levels. The result are two data sets with diverse
information, which can allow the user to differentiate,
As X-ray absorption is energy-dependent, changing
characterize, isolate, and distinguish the imaged tissue and the tube's kilo voltage results in a material-specific
material – obtaining specific details about the scanned change of attenuation.
object beyond morphology.
Spectacular research topics lie ahead, waiting to be explored,
as dual energy helps pave the way for a broad spectrum of
potential clinical uses. Possible application fields are: direct
subtraction of either vessels or bone during scanning,
classification of tumors in oncology, characterization of
plaques in vessels and the differentiation of body fluids in
emergency diagnostics.
NEWS
C T CLINIC AL ENGINES
Speed and Confidence

By Louise McKenna, PhD, MBA, Global Product and Marketing Manager CT-Workplaces, and Stefan Wünsch, PhD, Global
Product and Marketing Manager Clinical Solutions, Siemens AG, Medical Solutions, CT Division, Forchheim, Germany
In order to enhance clinical workflow in The Complete Solution for tive, dedicated cardiovascular imaging
the computed tomography (CT) environ- Cardiovascular CT user interface simplifies daily workflow
ment, Siemens’ CT Division is introduc- and ensures highest throughput. The CT
ing a new generation of CT Clinical En- The CT Cardiac Engine offers the com- Cardiac Engine facilitates cardiovascular
gines. “Supplying our customers with plete solution for cardiovascular CT im- diagnosis – from vascular analysis with
hardware dedicated to their needs is not aging. From scan to diagnosis, it covers accurate stenosis measurement to stent
enough,” says Bernd Montag, PhD, Pres- everything to achieve a streamlined car- planning, from cardiac morphology to
ident of the CT Division. “We also want diovascular workflow. State-of-the-art functional analysis, concluding in a
to provide them with applications and ECG-synchronized acquisition, image comprehensive report.
workflow tools that are specifically de- reconstruction techniques and intuitive
signed to enhance image quality and ECG-editing to exclude extra beats be- Full Confidence
workflow efficiency in their particular fore image reconstruction, ensure opti- in Neuro CT
clinical departments.” The CT Clinical En- mal image quality. The lowest possible The CT Neuro Engine delivers the tech-
gines marry the world's most innovative dose for patients is provided with intelli- nology required to perform artifact-free
CT technology with syngo, Siemens’ gent adaptive ECG-pulsing. An innova- imaging with the high spatial and tem-
unique clinical applications solution.
Perfect synergy, designed to reliably se- syngo Circulation as a
cure outstanding clinical outcomes – key component of the CT
the new CT Clinical Engines bring togeth- Cardiac Engine offers
er state-of-the-art CT scanner features physicians the industry’s
such as the industry’s fastest rotation most comprehensive
software for cardiac CT,
speed, lowest possible dose scanning
setting a new benchmark
modes and direct 3D data reconstruction
for improving clinical
with exactly the right syngo solutions. outcomes through inno-
“With our new CT Clinical Engines, we vative software solutions.
take clinical application to the center of
our strategy,” says Bernd Ohnesorge,
PhD, Vice President of CT Marketing and
Sales. “The CT Clinical Engines will pro-
vide our framework to introduce further syngo Neuro DSA CT as
innovations in the rapidly developing part of the CT Neuro
clinical fields of neurology, diagnostic Engine offers tools for
oncology, cardiovascular and acute care fast and easy assessment
of head and neck
that will drive the future of CT.“ They are
images, including direct
designed to enhance speed and diag-
bone subtraction CTA.
nostic confidence by delivering excep-
tional image quality, fast access to im-
age data, and flexible access to intuitive
syngo clinical applications throughout
the radiology environment.
NEWS
poral resolution needed for fast and accu-

rate visualization of complex neurologi-
cal disorders of head, neck, and spine,
as well as injuries and stroke. Siemens’
unique portfolio of syngo automated Siemens CT Division not only takes care of the outer appearance of their existing
software tools for neuro CT will help to SOMATOM Emotion and SOMATOM Sensation product lines – they also introduce
deliver excellent diagnostic outcomes – CT Clinical Engines that offer users the ultimate CT solution in key clinical areas.
with bone subtraction in neuro CT DSA
studies for comprehensive evaluation of
complex vascular structures, with fast ment, every second counts. The CT streamlines the clinical workflow for
brain perfusion for stroke patients and Acute Care Engine delivers the com- cardiac, vascular, musculoskeletal, and
differentiation of brain tumors. plete solution to make fast and confi- stroke evaluation.
dent decisions. By combining state-of-
Faster Diagnosis the-art functions for cardiac, vascular, From Staging to
in Acute Care and neuro CT imaging, and adding inno- Follow-up in Oncology
The Siemens CT Acute Care Engine vative workflow features and high-reso- CT Imaging
offers the complete solution for emer- lution acquisition, the CT Acute Care Siemens’ CT Oncology Engine offers a
gency and trauma imaging with CT. In Engine provides the complete clinical unique combination of the most innova-
acute care, the requirements for CT portfolio for imaging emergency patients tive scanner and syngo solutions for
imaging are very challenging and from head to toe. Using fast direct 3D diagnostic imaging, evaluation, and fol-
diverse – from acute chest pain and reconstruction, images can be reviewed low-up in any diagnostic oncology set-
complex polytrauma to stroke assess- before the patient is off the table. syngo ting. syngo’s intuitive computer-assisted
reading tools, combined with intelligent
The CT Acute Care evaluation, automated follow-up, and
Engine offers a fast one- image guided intervention offer a new
stop diagnostic confi- level of confidence for preventive care,
dence in all emergency staging, follow-up exams, and realtime-
room situations. guided biopsies. Additionally, compre-
hensive tumor perfusion enables a fast
and easy visualization of tumor en-
hancement and aids in differentiating tu-
mors. Fusing images from PET or SPECT
with high resolution CT images helps
not only to better localize tumors, but
also therapy planning. Siemens’ soltions
for interventional CT extend the clinical
spectrum towards differential diagnosis
syngo LungCare CT with
NEV (Nodule Enhanced and treatment.
Viewing) as an element of These first generation CT Clinical Engines
the CT Oncology Engine offer Siemens’ users something very spe-
identifies potential lung cial: a totally unique combination of CT
lesions that were over- technology and syngo, delivering a clin-
looked during the radiolo- ically optimized workflow, designed for
gist’s first read. speed and diagnostic confidence for
every patient, every time. And this is on-
ly the beginning: with a keen eye on the
future, Siemens will continue to set new
trends for the next generation of clinical
CT solutions…
NEWS
Life
Leader in Customer Care

Frost & Sullivan, a global growth con- said Volker Wetekam, President, Global
sulting firm, has conferred Siemens Solutions Division, Siemens Medical
Medical Solutions the “2005 Customer Solutions. “From the moment of pur-
Care Leadership” award. chase, Life surrounds our customers
“Life is the embodiment of Siemens with an array of programs and support, the industry. The recipient must have
Medical Solutions’ dedication to partner- that enable the continuous develop- shown tremendous responsiveness to
ship with health care providers, its inte- ment of their skills, productivity and customer needs and must have continu-
grated service portfolio providing a highly technology, helping them to broaden ally focused on long- and short-term
interactive forum for customer feedback,” their capabilities, increase their prof- customer profitability goals. In addition,
says Siddharth Saha, Industry Manager, itability and take patient care to the next the recipient company must have
Medical Imaging, Frost & Sullivan. level.” demonstrated flexibility in tailoring their
“This award from Frost & Sullivan con- The Frost & Sullivan “Customer Care product offerings to suit customer busi-
firms Siemens’ leadership role in offer- Leadership” award is bestowed upon a nesses.
ing our customers a real lifecycle solu- company that has demonstrated excel-
tion when purchasing our products,” lence in customer care leadership within k www.frost.com
syngo InSpace4D
NEW – Advanced Vessel Analysis

Advanced Vessel Analysis (AVA) is an
optional plug-in for syngo InSpace4DTM.
AVA features a fast and intuitive, guided
workflow for the segmentation of vas-
cular structures, with dedicated algo-
rithms for segmentation of carotids,
aorta, aortic arch, abdominal vessels,
run-off, cardiac vessels and bronchii.
Once the vessels of interest have been
segmented, the user can visualize and
assess stenotic lesions, including calcifi-
cations, applying curved MPR and or-
thogonal views. A wealth of automated
measuring tools allow for accurate
quantification and stent planning. AVA
will be available in syngo 2006A for new
syngo MultiModality workplaces1. To-
gether with syngo InSpace4D advanced
bone removal, AVA provides users with
a comprehensive tool for assessment of
acute vascular conditions plus treat- syngo InSpace4D with Advanced Vessel Anaysis offers a portfolio
ment follow-up. of dedicated algorithms for vascular segmentation.
1
Formerly: LEONARDO
k www.insideinspace.com
NEWS
S O M AT O M S e n s a t i o n
Proven Leadership
With well over 500 installations, the Vice President Sales, Healthcare Practice
SOMATOM Sensation 64 is the world’s North America, Frost & Sullivan.
most widely installed 64-slice computed In recognition of its exceptional image
tomography (CT) system. Its outstanding quality, speed, and ease-of-use, the
capabilities are not only recognized by SOMATOM Sensation 64 was also hon-
physicians, but also by market analysts ored with the gold award in the 2005
and engineering experts. Medical Design of Excellence Awards
Frost & Sullivan has awarded Siemens (MDEA). Judges in the eighth annual
Medical Solutions the “2005 Enabling MDEA competition recognized the sys-
Technology of the Year” award in recogni- tem’s excellent engineering – such as
Bernd Ohnesorge, PhD, Vice tion of being the first company to success- its revolutionary z-SharpTM Technology –
President CT Marketing & Sales fully introduce a 64-slice CT system. identifying it as “a paradigm shift in CT
of Siemens Medical Solutions, “Since the introduction of the SOMATOM scanning technology.” Sponsored by Can-
receives the Frost & Sullivan Sensation 64, healthcare professionals non Communications, publishers of "Eu-
Award from Stephen Mohan, Vice consider it an industry standard in high- ropean Medical Device Manufacturer"
President Sales, Healthcare quality imaging. On the basis of its tech- (EMDM) magazine, the MDEA program
Practice North America, Frost &
nological capability, Siemens has set a honors design and engineering achieve-
Sullivan, at the 6th international
benchmark in the development and ments within the medical industry.
conference on Cardiac CT in
Boston, MA, USA. adoption of high-end technologies in the k www.frost.com;
imaging industry,” said Stephen Mohan, www.devicelink.com/expo/awards02/
C AR E Cont rast C T
Trendsetting Injector Coupling Device

Siemens Computed Tomography (CT) fast contrast enhanced CT scanning. It medicine. The interface is designed to
customers can now profit from a unique speeds up clinical workflow and allows cover future communication tasks be-
synergy of trendsetting scanner tech- efficient and confident monitoring of tween scanner and injector and will
nology, the seamlessly integrated syngo patients during contrast media injection open up new fields of contrast-based ap-
CARE Contrast CT, and contrast media and scan start, even if only one techni- plications. It is currently supported by
injector devices, resulting in the most cian is present. leading injector companies MEDRAD
efficient contrast management on the CARE Contrast CT is the first scanner and MEDTRON. Following this trend,
market. Siemens CARE solutions have interface using a new standard (named additional releases of injectors from oth-
been expanded with the new option CiA425) for injector coupling devices in er companies are expected soon.
CARE Contrast CT, extending the func-
tionality of all Siemens SOMATOM CT CARE Contrast
scanners and optimizing contrast en- CT greatly
hanced CT examinations. speeds up
CARE Contrast CT connects the CT scan- workflow in
ner and the injector, therefore allowing contrast-
enhanced
starting or stopping the scan from one
CT scans.
single entry point. This is a trendsetting
answer to the increasing demands of
NEWS
syngo 2006A
Enhanced Workflow
syngo 2006A, Siemens’ newest work- with enhancements to syngo InSpace ond reader tool for the automated de-
flow software, will be delivered on new 4D, such as bone removal and advanced tection of colon lesions. Together with
syngo MultiModality workplaces1 by the vessel segmentation and analysis func- syngo LungCARE CT with NEV (Nodule
end of January 2006. Continuing the tionalities, users have access to superior Enhanced Viewing), Siemens offers its
‘Think Clinical’ theme, it gives users ac- tools for comprehensive cardiac assess- users an exceptional level of confidence
cess to new features and functionalities ment, fast evaluation of chest pain, for early detection and follow-up exams
designed to enhance workflow and di- complex vascular exams, and fractures. of the colon and lung.
agnostic confidence. In neuro CT, visualization of complex Another new addition to the oncology
cerebro-vascular structures has been portfolio, syngo Body Perfusion CT, en-
Key Clinical Areas hindered by the dense bone at the base ables the user to obtain an accurate pic-
Three key clinical areas have been the of the skull. Siemens’ new syngo Neuro ture of a tumor’s dynamic profile, help-
focus: cardiovascular CT, neuro CT and DSA CT facilitates subtraction of bone ing to optimize treatment decisions. On
CT imaging in oncology and early detec- from contrasted vessels allowing excep- top of the new clinical functionalities,
tion, thus providing key building blocks tional visualization of these vessels. New syngo 2006A provides the user with sig-
for the four new CT Clinical Engines just features in syngo Neuro Perfusion CT in- nificant improvements of workflow per-
introduced at RSNA– namely CT Cardiac clude automatic tissue-at-risk assess- formance. DICOM transfer of up to 21
Engine, CT Neuro Engine, CT Acute Care ment, offering enhanced speed and images per second can be achieved, as
Engine and CT Oncology Engine (see confidence in tumor perfusion and well as loading capacity of up to 3,200
page 19). stroke workflow. images.
syngo Circulation, designed for one- With syngo 2006A, Siemens adds an-
stop, fast, robust morphological and other computer assisted reading tool to
functional cardiac evaluation, makes its its portfolio. syngo Colonography with
debut in syngo 2006A. In combination PEV (Polyp Enhanced Viewing) is a sec- 1
Formerly: LEONARDO
syngo Colonography with PEV (Polyp Enhanced Viewing) The syngo Body Perfusion CT option allows for the
is among the new computer assisted reading tools for quantitative evaluation of dynamic CT data of organs and
early detection available with syngo 2006A. tumors, following the injection of a compact bolus.
BUSINESS
S I E M E N S R E M OTE S E RVI C E
Virus Protection Shields

Medical Systems Siemens Virus Protection handles
virus-related security matters on syngo
based systems.
Regular computers can easily be pro- Siemens Virus Protection is based on
tected against viruses. But regular virus a virus scanner by Trend Micro, Inc., a
protection software cannot be indis- global leader in antivirus and content
criminately used on medical equip- security software and services. It in- usage of various data media and inter-
ment. Without the corresponding vali- cludes regular updates with the latest net connections. “As long as our cus-
dation and testing, a system’s safety and engines and patterns, using a VPN tomers did not optimize their workflow
efficacy may be significantly impacted. (Virtual Private Network) broadband through network connectivity, there
Siemens Virus Protection solves the Siemens Remote Service connection. The was no need for such services,” says
problem. The solution is designed to Virus Protection program has been de- Wolfgang Heimsch, PhD, head of
handle virus-related security matters on veloped, validated and thoroughly test- Siemens Medical Solutions’ Customer
syngo-based systems. It is the first ed in both Germany and the United Service Division. “Now healthcare pro-
on the market to address this issue for States and is now available for Siemens viders are increasingly using networked
medical systems, significantly support- computed tomography systems.* Virus systems, so the market needs a suitable
ing customers in keeping their medical protection for medical systems has be- virus protection solution.”
systems healthy. come a necessity due to the common * depending on software configuration
S O M AT O M S p i r i t
The Easy Way From Sequential

to Multislice CT
To support customers in advancing their accelerates the whole diagnostic
computed tomography (CT) perform- process. Thanks to the SOMATOM Spir-
ance, Siemens’ Life Customer Care Solu- it’s multislice technology, users can re-
tion offers “Elevate”, a program dedicat- construct different slice thicknesses
ed to updating outdated systems with based on one single scan – for example,
new ones – for example SOMATOM AR thin slice, high-contrast images and
sequential scanners from the 1990’s wider slices with soft tissue display at
with the spiral, dual-slice CT SOMATOM low contrast resolution. The SOMATOM
Spirit, a cost-effective system for clinical Spirit offers better resolution in high-
routine. When comparing the two sys- contrast structures, and a better low-
tems, the SOMATOM Spirit offers many contrast detectability in soft tissue.
advantages: Its spiral scan mode and Siemens’ unique UltraFastCeramic
multislice technology broadens the clin- (UFCTM) detector material and dose
ical spectrum. Concurrently, together reduction software lower patient dose
Elevate – Siemens’ managed with its fast scan time, spiral scanning while achieving better image quality.
system upgrade program – brings speeds up data acquisition and thus re- All in all, a lot of reasons why SOMATOM
clinical performance to a higher
duces motion artifacts. With the syngo- AR owners should consider converting
level: from the sequential single-
based, easy-to-operate user interface their system.
slice SOMATOM AR to the new
spiral, multislice SOMATOM Spirit. and an image reconstruction time of k www.siemens.com/
only one second, the SOMATOM Spirit SOMATOMElevate
BUSINESS
Interview
S O M AT O M E m o t i o n
“Excellent Price-Performance Ratio”

Siemens Medical Solutions recently
Johann-C. Steffens,
installed the first SOMATOM Emotion
MD: “The SOMATOM
16-slice computed tomography (CT)
Emotion 16 enables
system at the following locations: in us to achieve low
Germany, at the Israelitische Kranken- image noise and high
haus, Hamburg and Klinikum Nurem- resolution.”
berg Nord; in Belgium, at Clinique du
Sud-Luxembourg/St. Joseph, Arlon;
and in the US, at the Ohio State Uni-
versity, Columbus. SOMATOM Ses-
sions spoke with Johann-C. Steffens,
MD, Head of Radiology of the Israeliti-
sche Krankenhaus.
What are your first experiences with
the 16-slice SOMATOM Emotion? facts are reduced. In addition, run-offs patients from their referrals and also
The amazing fact for me was that the can be performed in better resolution increase the number of referrals. In
new 16-slice SOMATOM Emotion and with a longer range, giving us the addition, the low investment and life-
worked as a reliable scanner from the opportunity to see smaller details. We cycle costs permit radiologists with
very first day, replacing our 6-slice CT achieve very good image quality in limited budgets to purchase a scanner
scanner. Installation took only two abdominal imaging and imaging of with excellent performance. Especial-
days. The syngo user interface of the bony structures. In addition, the im- ly radiological departments in small
16-slice SOMATOM Emotion is so sim- age quality of head scans is outstand- and mid-size hospitals and imaging
ilar to the SOMATOM Emotion with six ing. centers can profit from the excellent
slices that there were no changes in With the 16-slice configuration of price-performance ratio of the SO-
how to operate the system, and no the SOMATOM Emotion, the resolu- MATOM Emotion’s 16-slice configura-
need for additional training. We now tion and the number of slices in- tion.
use the scanner for our daily routine creased. How about patient dose?
as well as for advanced applications Patient dose does not increase. Be- The Israelitische Krankenhaus in
like CT Colonography. cause of the efficient system design, Hamburg is a 205-bed hospital con-
Which clinical advantages and image the effective patient dose is generally sisting of the Medical Clinic and the
quality, compared to a 6-slice CT, very low. For most examinations the Surgery Clinic, plus an interdiscipli-
does the 16-slice configuration of effective patient dose is less than with nary intensive care unit and the De-
the SOMATOM Emotion provide? our former 6-slice system. partment of Anesthesiology. The Radi-
We appreciate the low image noise To which users would you recom- ological Practice of Dr. Steffens, a
and high resolution that the system mend the new configuration of the Cardiological Practice, a Neurological
allows us to achieve. Because of the SOMATOM Emotion? Practice and the cancer research cen-
faster rotation time and the higher I think this scanner provides radiolo- ter, Indivumed, are located on the
number of slices, we can perform sub- gists the opportunity to perform rou- same premises and closely cooperate
millimeter lung examinations in one tine and advanced applications. There- with the hospital.
single breath-hold, so that motion arti- fore it enables them to get more k www.israelitisches-krankenhaus.de
BUSINESS
CARDIAC C T
Reimbursement in the US
New Current Procedural Terminology Category III codes
for Cardiac CT released by AMA to become effective January 1, 2006
clinic and Siemens refererence site, has services and procedures. These codes
worked together with its local Medicare are intended to allow data collection
carrier, Palmetto GBA, to expand its LCD and to substantiate widespread usage a
based upon the recently published criterion the Editorial Panel considers,
64-slice clinical trials (see page 46). As along with clinical effectiveness, before
for coverage by the private sector, car- assigning the new service or procedure
diac CTA reimbursement from private a Category I code. It should be noted
insurance providers (among them Blue that Category III codes are not to be
Cross/Blue Shield, United, Aetna, Kaiser referred to the AMA/Specialty RVS
Permanente and others), is still limited Update Committee (RUC) for valuation.
and mostly dependent upon individual Because no relative value units (RVUs)
contracts between the healthcare pro- are assigned to Category III codes, pay-
Category III codes for Cardiac CT will be vider and their local payers. There is cur- ment is determined by local payers – in
effective January 1, 2006, potentially
rently no reimbursement allowed for Medicare’s case, by local carriers and fis-
leading to Category I coding by 2007.
non-contrast based CT calcium scoring. cal intermediaries who cover the proce-
In general, this procedure is still a con- dure identified by the Category III code,
Currently, computed tomography is sumer directed (or retail) service. not by the Medicare Physician Fee
used by physicians as a diagnostic tool As for coding, in mid-2005, the Ameri- Schedule. It should also be noted that
for many conditions and symptoms. can College of Radiology (ACR) had rec- providers are required to utilize these
Promising new indications are cardiac ommended its members use unlisted new codes when treating their patients.
CT and coronary CT angiography (CTA). CT procedure code for cardiac CTA pro- In 2006, utilization and payment for
While specific procedure codes exist for cedures. Despite this recommendation, cardiac CTA will still need to be driven at
established CT applications, none cur- providers should understand that they the local level by each provider of this
rently exist for the new cardiac appli- still need to obtain approval from local diagnostic tool, through dialogue with
cations. payers for use of this code for cardiac their local payers. Physicians and key car-
The absence of specific codes has not CTA reimbursement. diac CT opinion leaders, including the
prevented some Medicare contractors This situation will change in 2006. At Society of Cardiovascular CT, hope that
from developing Local Coverage Deter- the American Medical Association’s Edi- widespread usage of the new Category
minations, permitting coverage. For ex- torial Panel meeting in June, the Amer- III codes will lead to a successful applica-
ample, since June 2004, Medicare’s lo- ican College of Cardiology (ACC) and tion to secure Category I code as soon as
cal fiscal intermediaries or carriers in the American College of Radiology 2007. Securing a Category I code would
South Carolina, Pennsylvania, New Jer- (ACR) co-sponsored a new coding pro- result in Cardiac CT receiving its own
sey and New York have decided to cover posal specific to cardiac CT and coro- RVU, and would allow the procedure to
cardiac CTA services. As for coding, the nary CTA. The proposal included seven become a truly routine test for non-
Local Carrier Decision Policies (LCD) in temporary new Category III codes and invasive management of Cardiovascular
these states currently specify CTA ex- one “add-on” code. In July 2005, AMA disease.
ams of the chest (with/without contrast, released these temporary new Cate-
plus post-processing) for cardiac CT pro- gory III codes; they will become effec-
cedures. tive January 1, 2006. Category III codes
In a recent development, the South were established by AMA’s Editorial Pan- k www.ama-assn.org/ama/pub/
Carolina Heart Center, a specialty heart el to identify emerging technologies, category/12850.html
NEWSBUSINESS
SECTION
REVENUE
Investment Pays Off

Modern equipment is one of the key sedation was reduced from 4 percent to while enabling “on demand” examina-
factors in providing more efficient and 3.2 percent. “Using modern, multislice tions instead of the long waiting lists com-
higher quality healthcare today. Both clin- equipment dramatically streamlines the mon with the older systems. In spite of
ical community and patients benefit from workflow and increases patient care and higher staffing required to run the
an improved clinical workflow and ad- comfort,” concludes J.A. Marconato, MD SOMATOM Sensation 64, the expenses,
vances in medical diagnosis. In computed at the hospital. He points out, however, as a percentage of the revenue, trend
tomography (CT), scan modes, scan and that this improvement is only possible if down. This is due to higher patient vol-
image reconstruction times, resolution, the entire staff works together as a team ume, and also to a different staffing skill
applications and user interfaces, as well as – from scheduling the examinations to di- mix. Today, more aides are hired for tasks
dose reduction methods, have all devel- agnosing the images: “Today, the limita- that do not require the expertise of a tech-
oped quickly over the past few years. tions are no longer set by the equipment.” nologist to ensure the same patient tran-
Keeping a hospital up-to-date is a finan- sit time and patient care. With this combi-
cially significant task. However, two re- Step by Step nation of measures, the clinic has been
cent analyses show that it pays off. Of course, one expects such savings from able to continuously reduce expenses;
a major upgrade step – even if one new from more than 60 US$ per exam to 45,
A Giant Leap scanner replaces two old ones. But it also despite rising market prices for the scan-
Hospital Moinhos de Vento, Porto Alegre, pays off to be among the early adopters ners. As a result, expenses as a percent-
Brazil, took one giant leap forward when of new CT technology. The Chairman of age of net revenue have decreased from
it replaced two single-slice scanners with the Radiology Department at a huge US over 16 to only 9 percent. In summary, in-
one SOMATOM Sensation Cardiac 16 in hospital compared core data from several creased coverage, speed, resolution, ap-
2004. When comparing the database of a systems, starting with the SOMATOM Plus plications, indications and availability not
six-month period prior to the installation 4, the SOMATOM Volume Zoom and the only increase patient care: When it comes
to a six-month period after the installa- SOMATOM Sensation 16, up to the SO- down to finances, these improvements
tion, they realized that the average time MATOM Sensation 64. One basic result: also decrease spending. A detailed pres-
for scheduling an examination was re- Acquisition and reconstruction times de- entation, now available on CD, was held
duced from 26 to 11 minutes; that the creased dramatically over the years, en- by the clinic's radiology chairman at the
number of examination increased by abling higher patient throughput. The 7th SOMATOM CT User Conference
52 percent; that the average contrast vol- clinic has increased its patient volume 2005 (see page 49).
ume was reduced by 25 percent; and that from less than 20 patients per day with
the number of examinations with patient the SOMATOM Plus 4 to well over 60 – Results may vary. Data on File.
Abdominal CT Scan Total Exam Time Expense Trends
35
Time (Minutes)
18
Percent
Acquisition Payroll & Benefits

30 Patient Transit 16 Medical Supply & Other
25 Recon 14 Direct EquipExpense
12 Total Expense
20
10
15
8
10
6
5
4
0 2
Plus4 Volume Zoom Sensation 16 Sensation 64
0
Plus4 Volume Zoom Sensation 16 Sensation 64
An abdominal scan with the SOMATOM Plus 4
took more than 30 minutes total examination By continuously upgrading their CT equipment,
time – with the SOMATOM Sensation 64, every- the US clinic has been able to increase patient
thing was done in five minutes. throughput while reducing costs.
CLINICAL OUTCOMES Cardiovascular Oncology Neuro Acute Care
Case 1:
CT Angiography of Chest, Abdomen, Pelvis and
Upper Extremities with CARE Dose4D and z-Sharp
By Dominik Fleischmann, MD, Jeffrey C. Hellinger, MD, and Geoffrey D. Rubin, MD, Department of Radiology,
Cardiovascular Imaging Section, Stanford University Medical Center, Stanford, CA, USA
HISTORY
A 34-year-old woman with right arm numbness was referred The imaging goal in this particular case was to identify or
for CTA of the upper extremities as well as the chest, exclude a vascular cause for the patient's recent right arm
abdomen and pelvis. The patient's past medical history was symptoms. Because of the patient's history and the known
significant for a right brachial artery aneurysm – presumably iliac artery aneurysms, the large arteries of the body were
caused by vasculitis – which had been treated with a also imaged. We chose a single CTA acquisition with the
reversed vein graft and secondary interventions over the patient’s arms placed next to her body and a single contrast
past 10 years. The patient also had a history of bilateral iliac medium injection into a left antecubital vein.
artery aneurysms.
Care Dose4D Automated Dose Modulation
Ref mAs: 250, kVp 120 Eff. mAs

Effective mAs (Houndsfield Units)
0 50 100 150 200 250 300
0
73
50
100 245
150
200
93
250
300
Average 180 mAs
350 160
400
450
106
500
550
longitudinal distance in mm
600
252
650
700
750 Image Noise Dose Modulation 158

800 (HU) (eff. mAs)
[ 1 ] Consistently excellent image quality throughout the entire scanning range in vascular territories
within the body and in the upper extremities off-center at an average of 180 effective mAs
NEWS
CLINICAL SECTION
OUTCOMES
[ 2 ] A left vertebral artery origin [ 3 ] Right common iliac artery [ 4 ] Multiple mild focal dilata-
directly off the aortic arch is present. aneurysm and small left internal ili- tions within the right brachial
Otherwise, the supraaortic vessels are ac artery aneurysm. A high-grade artery, a reversed vein graft.
within normal limits. stenosis of the celiac artery, due to The graft is patent with mild
median arcuate ligament impinge- stenosis distally. Several surgical
ment is noted. clips are also noted.
DIAGNOSIS EXAMINATION PROTOCOL

Incidentally noted is a left vertebral artery origin directly off Scanner SOMATOM Sensation
the aortic arch. Otherwise, the supraaortic vessels are within 64-slice configuration
normal limits. The right subclavian and axilary arteries are Scan area From lower neck to finger-tips;
patent. Multiple focal areas of mild dilatation (11 to 14 mm in arms by side of body
diameter) are seen within the right brachial artery reversed Scan length 77.5 mm
Scan time 29 s
vein graft. The graft is patent with mild stenosis distally. The
Scan direction cranio-caudal
radial, ulnar, and interossea arteries are patent.
kV 120 kV
A high-grade stenosis of the celiac artery origin, due to
Effective mAs 180 at 250 Ref mAs
median arcuate ligament impingement, is noted. The thora- Rotation time 0.5 s
co-abdominal aorta and its visceral branches are otherwise Slice collimation 0.6 mm
unremarkable. A 15 mm right common iliac artery aneurysm Slice width 1 mm
and a small, 11 mm left internal iliac artery aneurysm are Pitch 0.7
seen in the pelvis. Reconstruction increment 0.7 mm
CTDI 13.41 mGy
Kernel B25f
COMMENTS
The patient was positioned in supine position with her arms Contrast Omnipaque 350 mg iodine/ml
placed at the sides of her body, to enable coverage of the Volume 25 cc at 5 cc/s, 100 cc at 4 cc/s,
entire chest-abdomen-pelvis and upper extremities vessel ter- followed by 40 cc saline flush
ritories within a single CTA acquisition, and with a single injec- Start delay 5s
tion of contrast medium. Although such positioning may

cause streak artifacts in the shoulder region and excessive
noise within the upper extremities, the use of automated tube
current modulation (CARE Dose4DTM) and high spatial resolu-
tion using z-Sharp Technology resulted in virtually artifact-free
visualization of all clinically relevant vessels at unprecedented
image quality.
Case 2:
Peripheral Runoff
By Jean-Bernard D’Harcour, MD, Cliniques du Sud-Luxembourg,
site St. Joseph, Arlon, Belgium
HISTORY COMMENTS
A 55-year-old patient with previous history of left femoral This case demonstrates the ability of the SOMATOM Emotion
bypass was presented for mild claudication of the right leg. with 16-slice configuration to achieve complete arterial map-
A CTA runoff with the SOMATOM Emotion was performed. ping, thus enabling the physician to plan vascular therapy.
syngo InSpace4D with bone removal allows a quick overview
DIAGNOSIS of the entire vascular tree and permits a reliable analysis of
heavily calcified segments. Complete evaluation should not
CTA shows severe aorto iliac athromatosis and complete take more than 15 minutes.
occlusion of the left iliac axis. Left aorto femoral bypass is
patent. On the left side, a short occlusion of the distal super-
ficial femoral artery (SFA) is disclosed. On the right side,
there is no significant stenosis of the iliac axis but a long
occlusion of the SFA is shown. On both sides, peripheral
arteries are patent.
[ 1 ] VRT showing occlusion of the left iliac artery [ 2 ] VRT of the complete examination
and patency of aorto femoral bypass. Bone removal
was performed with syngo InSpace4D.
CLINICAL OUTCOMES
EXAMINATION PROTOCOL
Scanner SOMATOM Emotion Reconstruction increment 1 mm

16-slice configuration Kernel B20s smooth
Scan area Lower extremity runoff
Scan length 1560 mm
Scan time 25 s Contrast
Scan direction Cranio-caudal Volume 50 cc at 7 cc/s, 100 cc at 5 cc/s,
kV 110 kV followed by 50 cc saline flush
Effective mAs 90 mAs with CARE Dose4D at 5 cc/s
Rotation time 0.6 s Start delay 5s
Slice collimation 16 x 1.2 mm
Slice width 1.5 mm
Pitch 1.5 Postprocessing syngo InSpace4D with bone removal
[ 3 ] MIP image of SFAs shows short occlusion of the [ 4 ] Despite proximal occlusions, distality is
left SFA and long occlusion of the right SFA. clearly depicted on this MIP image. No significant
lesion shown
Computer Assisted Reading – More Speed.

Enhanced Confidence
The use of computer assisted reading tools such as syngo and diagnostic confidence. Two expert centers look at just
Colonography with PEV (Polyp Enhanced Viewing) and how much value second-reader products can add to their
syngo LungCARE CT with NEV (Nodule Enhanced Viewing) clinical workflow.
can significantly enhance clinical workflow, adding speed
Case 3:
Optimizing Clinical Workflow in CT Colonography
Using syngo Colonography PEV
By Anno Graser, MD, and Christoph R. Becker, MD, Department of Clinical Radiology,
University Hospital Munich-Grosshadern, Munich, Germany
At our center, the demand for colorectal cancer screening is reader performance and level of confidence in the detection
growing and the number of CT colonography (CTC) exami- of polyps. The 62-year-old male patient had undergone par-
nations is increasing rapidly. We are constantly looking for tial sigmoidectomy for resection of a stage T2 cancer in
tools that help us to improve speed and enhance confidence 2002. The patient underwent CTC, following incomplete
and offer our patients the highest possible level of care. A colonoscopy.
study performed at our institution to be presented at this There is end-to-side anastomosis of the descending colon
year’s Radiologic Society of North America (RSNA) annual and the remaining sigmoid [Fig. 1] and a 15-mm adenoma-
meeting (Session SSG 10-07, Tuesday, November 29) shows tous polyp in the transverse colon close to the hepatic flex-
that PEV reaches 94% sensitivity in the detection of polyps in ure [Fig. 2]. The PEV algorithm identified several additional
the important 5-9 mm size range. In addition, the study small polyps: one difficult to see hiding between two folds
shows that PEV can be integrated into clinical routine due to [Fig. 3], another had been obscured by a puddle of fluid on
its short running time of 4 minutes per dataset. With PEV the supine scan and can only be seen on prone images where
running in the background, syngo Colonography PEV’s per- there is slightly increased image noise seen as the character-
formance remains unrivalled, delivering excellent perform- istic “cobble stone” pattern of the colonic mucosa which nev-
ance in everyday clinical routine – increasing reader confi- ertheless does not prevent detection of the lesion [Fig. 3]. In
dence and shortening evaluation time. summary, PEV shows an excellent performance in the detec-
The case presented here shows how PEV improves human tion of colonic lesions.
[ 1 ] Anastomosis of the descending [ 2 ] Adenomatous polyp in the trans- [ 3 ] CAD identified several
colon and the remaining sigmoid verse colon close to the hepatic flexure additional small lesions.
CLINICAL OUTCOMES
Case 4:
Improved Workflow for Detection
of Pulmonary Nodules
By Marco Das, MD, Andreas Horst Mahnken, MD, Georg Mühlenbruch, MD, Joachim Ernst Wildberger, MD,
Department of Diagnostic Radiology, Rolf. W Günther, MD, Director, Department of Diagnostic Radiology, and
Thomas Kraus, MD, Department of Occupational Health, RWTH Aachen University, Aachen, Germany
Multidetector-row computed tomography (MDCT) is the

method of choice for detection of pulmonary nodules.
Increased spatial resolution with modern CT scanners facili-
tates the detection of nodules as small as one or two mil-
limeters. Overlooked pulmonary nodules, regardless of size,
may have potentially severe consequences for the patient.
Reasons for missing nodules may be perception errors or
misinterpretation. Double reading during clinical routine has
been suggested to reduce false negative diagnosis. In times
of increased workload and limited human capacity, this
goal is not always practicable. Moreover, quantification of
nodules is problematic due to inter- and intraobserver vari- [ 1 ] 66 year old male patient [ 2 ] The NEV software
who received a low-dose detected the nodule and
ability. Thus, computer algorithms have been developed to
MDCT chest examination for marked it as a potential
aid the radiologist for the detection and quantification of pul-
the detection of pulmonary lesion with a red circle. The
monary nodules. nodules. Initial reading missed mark has to be evaluated
the nodule located centrally by the radiologist to confirm
ENHANCED CONFIDENCE between several surrounding this finding as a true posi-
vessels in the left lower lobe. tive finding.
syngo LungCare CT with NEV facilitates the detection work-
flow and provides easy objective quantification and reporting
of pulmonary nodules. Fig. 1 shows a routine low-dose chest
MDCT examination of a 66-year-old male patient (120 kV, 10
mAs eff., 16 x 0.75 mm collimation, rotation time 0.5 sec,
table feed/rotation 18 mm, 1 mm slice thickness, 0.5 mm
reconstruction). With initial standard reading using Maxi-
mum-Intensity-Projection (MIP technique; 5 mm thick sec-
tion), a pulmonary nodule was not detected, probably
because of its central location closely surrounded by large
vessels. During initial standard reading, the NEV algorithm
runs in the background and marks potential lesion candidates
for reviewing after the initial read. The nodule was detected
and marked by the software automatically [Fig. 2] and was [ 3 ] The software allows a quantitative evaluation of
confirmed by the reading radiologist. With one additional the nodule and gives information about diameters, volume,
mouse-click, quantification of the nodule was performed and CT density values. It also allows a comprehensive view
of the anatomical location between the vessels in this 3D-
[Fig. 3]. After final reporting, the patient underwent CT-guid-
rendered scene of the finding (Volume Of Interest, VOI).
ed, fine-needle aspiration biopsy and small-cell lung cancer
After identifying the nodule as a true positive finding, all
was finally diagnosed during cytopathological work-up. these parameters are stored in the final report.
Case 5:
Respiratory Gated CT-Imaging
in Radiation Therapy of Lung Cancer
By J. Dinkel, MD, A. Jensen, MD, U. Mende, MD, PhD, Department of Radiation Oncology, and J. Debus MD, PhD,
Director, Department of Radiation Oncology, University of Heidelberg, Germany
HISTORY
A 62-year-old female patient under chemotherapy treatment this patient, the breathing frequency was over 12 cycles/min.
for a non-small-cell lung cancer and cerebral metastases CT data was collected in spiral mode, with simultaneous
was examined using the SOMATOM Sensation Open with a acquisition of 24 parallel sections using a 1.2 mm collimation
4D respiratory gated data acquisition protocol in order to and appropriate spiral pitch of 0.1. The respiratory signal
determine the full range of motion of critical internal struc- from the patient was synchronized and simultaneously
tures and the lung cancer during respiration. This method recorded during free-breathing CT data acquisition, using a
was used to achieve a more targeted radiation treatment. chest-belt with a pressure sensor. Virtually correlated 4D
phase volumes (with the time as the fourth dimension) were
DIAGNOSIS reconstructed after the scan to form a model of anatomic
movement. 7 different reconstructions were performed cor-
Respiratory gating supplies information about tumor motion responding to different phases of the breathing cycle.
during the patient's breathing cycle. The introduction of the In these CT scans, a 4 x 3.7 x 3.8 cm lobular mass was clearly
latest generation multislice CT systems with short acquisi- visible in the medial aspect of the left upper lobe extending
tion times permits the evaluation of thoracic structures with to the left hilus. Various nodular calcified lymph nodes as
a temporal resolution of 250 ms. Short acquisition times in well as an enlarged aorticopulmonary lymph node could be
this set-up are achieved by simultaneous acquisition of 24 or seen in the mediastinal region. Additionally, the CT scan
40 transverse sections, half-second scanner rotation, and showed an extrathoracic metastasis in the left adrenal
advanced respiratory-gated reconstruction algorithms. In gland. In our scans, the tumor mobility was about 2.1 mm in
[ 1 ] Nodular calcified lymph node as well as an [ 2 ] Metastasis in the left adrenal gland
enlarged aorticopulmonary lymph node can be seen
in the mediastinal region.
CLINICAL OUTCOMES
3A 3B
[ 3A, 3B ] Two reconstructions corresponding to different phases of the breathing cycle demonstrate the
range of motion of critical internal structures and the lung cancer during respiration.
the x-axis (L-R), 6.2 mm in the y-axis (A-P) and 5.2 mm in the EXAMINATION PROTOCOL
z-axis. The mass, however, did not show a deformation dur-
ing the breathing cycle. Visualization of structure motion is Scanner SOMATOM Sensation Open
possible with dedicated software syngo Inspace4D. Scan area Thorax
Scan length 300 mm
COMMENTS Scan time 51.85 s

Breathing frequency > 12 cycles/min.
New approaches in radiation therapy with the use of more kV 120 kV

Effective mAs 400 mAs
and more conformal dose application in combination with
Rotation time 0.5 s
higher doses per fraction for irradiation treatment need
Slice collimation 1.2 mm
accurate delineation of tumor and critical structures espe- Slice width 1.5 mm
cially in areas where artifacts distorting the geometric shape Pitch 0.1
and location of the organs cannot be tolerated. Motion arti- Reconstruction increment 1 mm
facts usually occur at boundaries of anatomical structures CTDI 35.63 mGy
(both target volumes and organs at risk), resulting in the Kernel B10f
image degradation and the inability to correctly delineate

anatomical structures. This leads to erroneous position, Postprocessing syngo Inspace4D
shape and volume information for target volumes and other
regions affected by motion.
The respiratory gated data acquisition in CT allows the plan-
ning physician to visualize and study the organ and tumor
motion in 3D coordinates and time, contributing to a better
understanding of the target area and potential sparing of
healthy tissue by minimization of treatment volume and
reduction of side effects. Respiratory gating is a promising
new tool to increase the quality of RT planning and patient
treatment.
Case 6:
Restaging Bronchial Carcinoma
after Radiotherapy Treatment
By Jan Capoen, MD, Radiologist, Jan Yperman Ziekenhuis, Ypres, Belgium
HISTORY
A 70-year-old female presented with increasing dyspnea and
[ 1 ] Paramedi-
general detoriation. She was known with an inoperable right
astinal lung-
sided bronchial carcinoma, treated with radiotherapy. A CT
fibrosis and
scan was performed in order to restage this carcinoma and enlarged
to look for any further complications or progression. mediastinal
lymphnodes
DIAGNOSIS AND COMMENTS
The CT scan showed the typical post-radiotherapy changes
on the right side: sharply demarcated paramediastinal fibrotic
pathology. Multiple enlarged lymphnodes were detected:
ipsilateral, contralateral and infracarinal. Confluent hypo-
dense lymphnodes were present paratracheal.
[ 2 ] Inhomoge-
A central tumoral mass caudal in the right hilum encased the
neous enhanc-
inferior right pulmonic vein and abutted the esophagus. The ing tumoral
mass was larger in comparison to the prior CT scans. mass caudal in
Post obstructive lung changes were present in the right mid- the right hilum
dle and lower lobe. Some free plural fluid was present on the and infracarinal
right and left side. lymphnodes
Due to subsecond scanning and high pitch, breathhold was
not an issue. CARE Dose and the 4 mm collimation reduced
the radiation dose significantly. MPR reconstructions, despite
the 4 mm collimation, had additional diagnostic value.
Scanner SOMATOM Spirit Reconstruction increment 2.8 mm
Scan area Thorax CTDIvol. 5.42 mGY
Scan length 288.5 mm DLP 169 mGY
Scan time 17 s Kernel B41s
Scan direction Caudo-cranial
kV 130 kV
Contrast Iomeron 300
Effective mAs 50 mAs (with CARE Dose)
Volume 80 cc
Rotation time 0.8 s
Flow rate 2.6 cc/s
Start delay 25 s
Slice width 5.0 mm
Table feed/rotation 14.4 mm
Pitch 1.8 Postprocessing MPR
CLINICAL OUTCOMES
[ 3 ] Tumoral mass caudal in [ 4 ] Tumoral encasement of [ 5 ] Post obstructive lung changes

the right hilum the inferior pulmonic vein on the right side
[ 6 ] MPR views of the paramediastinal fibrotic changes
Case 7:
Making a Difference with PET and
CT in Complex Cases
The powerful functional imaging in Positron Emission Tomo- PET/CT hybrid-imaging scanners provide seamlessly matched
graphy (PET) became even more powerful with the addition of functional and anatomical images from a single non-invasive
anatomical data from CT. The diagnostic limitations of stand- procedure, enabling accurate tumor diagnosis, whole-body
alone PET and CT procedures are eliminated with combined staging, target definition and treatment planning. The Bio-
PET/CT imaging technology, which has become the gold graph provides complete clinical information regarding the
standard for tumor diagnosis and staging. Siemens Biograph exact location, size and metabolic activity of disease.
Biograph High-Resolution Examination

HISTORY
This 63-year-old female patient with severe scoliosis and his- intra-abdominal lesions [Fig. 3], as well as additional 6 mm
tory of surgically removed gallbladder cancer in 2004 was lesions in the thorax wall [Fig. 4, Fig. 5]. The metastatic and
seen for follow-up in March 2005. In this routine follow-up, some other bone lesions were almost undetectable in the CT
the patient was diagnosed with Non Small Cell Lung Cancer images.
(NSCLC), and a hybrid PET/CT was ordered for staging.
COMMENTS
DIAGNOSIS
PET has a major role in early detection, staging and treatment
In addition to several pulmonary lesions and the NSCLC, the planning of lung cancer and related metastases. FDG PET
PET/CT study, obtained on the Biograph 16 HI-REZ, identified influences patient management decisions, effecting treat-
multiple bone lesions within the spine [Fig. 1, Fig. 2], two ment outcomes and quality of life. Adding co-registered,
detailed anatomical data acquired with a diagnostic CT scan
increases the diagnostic accuracy and provides the reading
and referring physician with the possibility to assess func-
tional and structural changes in one exam.
Using hybrid PET/CT scanning was critical in diagnosing the
additional, unexpected bone metastases and lesions in the
thoracic wall. Some of these bone lesions would have been
difficult to detect using a stand-alone CT. However due to the
patient’s extreme case of scoliosis, an exact correlation of
stand-alone PET data to the corresponding vertebras was only
possible by using co-registered functional (PET) and anatomi-
cal (CT) information provided by the PET/CT hybrid imaging
scan. The HI-REZ PET imaging technology of the Biograph 16,
with its unmatched additional resolution, also played a signifi-
cant role in accurately identifying the smaller lesions in the
[ 1 ] CT Spine image of patient with severe case of scoliosis thorax wall, allowing greater diagnostic confidence to the
interpreting physician.
CLINICAL OUTCOMES
[ 2 ] PET/CT image showing multiple [ 3 ] Fused PET/CT image identifies

bone lesions within the spine two intra-abdominal lesions.
[ 4 ] CT image of the thorax wall [ 5 ] PET/CT image identifies 6 mm

lesions in the thorax wall.
Scanner Biograph 16 Slice width 5.0 mm
FDG 11mCi Table feed/rotation 24 mm
Uptake time 62 min Pitch 1
Beds 7 Reconstruction increment 5.0 mm
Time per bed 3 min
HI-REZ yes
Contrast
Scan area Whole body
Scan direction Cranial-caudal Volume 90 cc
Effective mAs 30 mAs Dual phase CT acquisition of the thorax and
(arterial and portal venous) upper abdomen
Rotation time 0.5 s
Case courtesy of Martina Eschmann, MD, Tuebingen University, Tuebingen, Germany
Case 8:
Bone Subtraction CTA for Vascular Mapping
in Head and Neck Imaging
By Michael Lell, MD and Ulrich Baum, MD, Institute of Radiology, University Erlangen-Nuremberg; Ernst Klotz and
Hendrik Ditt, Physics and Application Development, Siemens AG, Medical Solutions, CT Division, Forchheim; all Germany
Bone subtraction CTA (BSCTA) in neuro CTA proved to be a tissue reaction but without abscess formation. CTA did not
valuable tool for delineation of complex intracranial struc- reveal relevant stenosis of the carotid arteries or the major
tures and cranial aneurysms [Somatom Sessions No. branches.
15/December 2004]. For bone subtraction, a non-enhanced
and contrast enhanced data set has to be acquired. Using COMMENTS
shape and CT value distribution of bony structures in both
data sets, the algorithm automatically matches the volumes To achieve good results, it is of great importance to carefully
using a rigid transformation model. Then the bone removal instruct the patient not to move between the two scans. For
process is performed, which selectively eliminates bone, subtraction purposes, a low dose scan in addition to a regu-
while retaining both soft tissue and contrast-enhanced ves- lar contrast enhanced scan is sufficient to create three-
sels. To determine the optimal contact interface between dimensional, volume-rendered images of the head and neck
vessels and bone, initially a global threshold for the segmen- vasculature, comparable to rotational angiography.
tation of bony structures in the non-enhanced CT images is
used. The threshold is then locally adapted if vessels are in EXAMINATION PROTOCOL
the vicinity of bone to minimize creating artificial luminal
reduction. The resulting bone structures are then selectively Scanner SOMATOM Sensation 64-slice configuration
eliminated from the contrast-enhanced data. Thus “subtrac- Non-enhanced Arterial phase
tion” of soft tissue is avoided. For subtraction purposes, a Scan area C6 zygomatic arch
non-enhanced CT scan in low dose technique is sufficient. Scan length 150 mm
The following case has been evaluated using the new syngo Scan time 3.4 s
Scan direction Caudo-cranial
Neuro DSA CT software.
kV 120 kV
Effective mAs 50 mAs 140 mAs
HISTORY Rotation time 0.33 s
Slice collimation 64 x 0.6 mm
A 63-year-old patient with a history of successfully treated Slice width 0.75 mm
laryngeal carcinoma presented with chronic osteomyelitis of Pitch 0.9
the mandible. A partial resection of the mandible was Reconstruction 0.5 mm
increment
planned and CT was performed to visualize the mandibular
CTDI 7.87 mGy 21.88 mGy
lesion and the external carotid artery and its branches for Kernel H20
microvascular reconstruction.
Contrast
DIAGNOSIS Volume – 50 cc
Flow rate – 5.0 cc/s
CT did not show recurrent tumor or lymph node metastasis. Start delay – individual (test-
bolus or CARE Bolus)
Chronic osteomyelitis of the mandible and a bone fistula
could be detected on the left side, with inflammatory soft
Postprocessing syngo Neuro DSA CT, VRT
CLINICAL OUTCOMES
1A 2A
1B 2B
1C 2C
[ 1A ] Osteolysis of the mandible with [ 2 ] BSCT-Angiogram: frontal view [ 2A ]

cortical destruction [ 1B and 1C ]; Fistula and left carotid artery from a lateral
of the bone in bone [ 1B ] and soft tissue [ 2B ] and medial [ 2C ] view
window [ 1C ]; Inflammation of the soft
tissue along the fistula with skin retraction
Case 9:
40-Slice CT for Diagnosis and Surgical
Planning in Traumatic Paraplegia
By Steffen Günther, MD, and Markus F. Berger, MD, Institute of Diagnostic Radiology,
Swiss Paraplegic Center, Nottwil, Switzerland
HISTORY
A 22-year-old man was brought to our hospital by emergency tive result. Due to the intended straightening of the fracture
transport helicopter (REGA) with incomplete paraplegia sub zone, there was a relatively large bony defect in the body of
L2 (ASIA D) following a motorcycle accident. Prior to admis- L2 and the need for additional anterior intervertebral fusion
sion, the patient had been completely healthy. A vertebral L1/L2 in a second intervention. After both successful opera-
fracture was suspected and CT scanning of the lumbar spine tions the patient showed partial recovery of neural function.
for diagnosis and surgical planning was performed. Following
initial posterior instrumentation, a follow-up examination COMMENTS
was performed to document the operative result and to
assess the need for additional anterior stabilisation. By using 1.0 s rotation and z-Sharp Technology's flying focal
spot, the SOMATOM Sensation scanner with 40 slices allows
DIAGNOSIS us to achieve both extended coverage and the highest reso-
lution in one examination. Vertebral fractures can be
CT scanning revealed a traumatic burst type vertebral body assessed from whole body datasets in multiple planes and
fracture of L2 with loss of spinal stability. Bony compromise of unprecedented detail. Due to the marked reduction of metal
the spinal canal was present. An additional MR scan showed artefacts, imaging of the postoperative spine has dramatical-
traumatic injury to the conus medullaris, as the patient unfor- ly improved. We can now see what was completely invisible
tunately also had a tethered cord. before. The volume rendered images created with the syngo
Follow-up CT after initial treatment by posterior USS-titanium InSpace4D application on the CT workstation are simply stun-
stabilisation from L1 to L3 demonstrated an exellent opera- ning.
[ 1 ] VRT lateral view of the lumbar spine [ 2 ] Axial image showing postoperative
showing fracture of vertebral body L2 follow up after burst type fracture of vertebral
with extension into the posterior column body L2. Note the minimal metal artefacts.
CLINICAL OUTCOMES
Scanner SOMATOM Sensation 40-slice configuration Rotation time 1.0 s 1.0 s
Pre-surgery Post-surgery Slice collimation 0.6 mm 0.6 mm
Scan area Lumbar spine Lumbar spine Slice width 0.75 mm 0.75 mm
Scan length 250 mm 194 mm Pitch 0.45 0.9
Scan time 46 s 18 s Kernel B25s B25s
Scan direction Caudal-cranial Caudal-cranial
kV 120 kV 120 kV
Effective mAs 482 mAs 261 mAs Postprocessing InSpace4D InSpace4D
[ 3 ] VRT images showing postoperative results after posterior-lateral stabilisation;

different views with colour emphasis on the metal implants. Note the virtual absence
of streak artefacts and the excellent delineation of implanted bone chips.
SCIENCE
Multislice CT Angiography
Head and Neck Imaging
By Michael Lell, MD, Institute of Radiology, University Erlangen-Nuremberg; Bernd F. Tomandl, MD, Department of
Neuroradiology, Klinikum Bremen; Axel Barth, Product Manager Applications, Siemens AG, Medical Solutions, CT Division,
Forchheim; Emeka Nkenke, MD, Department of Maxillofacial Surgery, University Erlangen-Nuremberg; all Germany
Patients with carcinoma of the oral cavity that infiltrate bone variety of indications [3–9]. In the following paragraphs, the
require resection of the involved part of the mandible. This protocols and results for CTA used at the author’s institution
resection may be performed in a continuity-preserving or, in will be reviewed.
more advanced cases, continuity-interrupting resection. To
cover larger defects in order to provide fixation of prosthetic Imaging Protocol
dentures and restore the ability to masticate, microvascular Prior to entering the CT suite, an 18-gauge intravenous
grafts are required. Fibula- and radius-grafts are commonly catheter is placed in the right antecubital vein, and all mobile
used. Before reconstructive surgery, detailed information of dentures are removed. The patient is placed in supine posi-
the host region is essential for the surgeon [1]. Tumor recur- tion with the head bedded in a headrest. A biphasic CT scan
rence has to be ruled out, the viability of surrounding bone is performed with a 16-slice or 64-slice spiral CT scanner
has to be assured, and the vascular situation in the host (SOMATOM Sensation 16 or 64). The arterial phase study is
region has to be assessed. Besides course and diameter of used to create 3D angiographic images, the delayed phase
the external carotid artery (ECA) and its branches, it is study for tumor staging. CARE Bolus can be applied to deter-
mandatory to be aware of angiopathies. Nutritive-toxic and mine the individual start delay (TimeDelay) for the arterial
age dependent vessel alterations can be encountered fre- phase. Alternatively, the test-bolus method (10 ml contrast
quently in this patient population. Prior resection or preoper- media, 30 ml NaCl 0.9%) can be used: the test-bolus
ative radiation therapy seriously affects the vascular bed in the sequence is then loaded in the “Dynamic Evaluation” appli-
receiver region. A decision for or against microvascular cation, and contrast enhancement curves of the arterial and
reconstruction has to be made based on the results of the venous system can be analyzed in detail. Time-to-peak plus
angiography. Selective catheter angiography (digital sub- 2s is used as the delay between injection of the full contrast
traction angiography, DSA) is still the gold standard in the bolus and the scan.
diagnosis of the head and neck vasculature. Major drawbacks 100 ml of a non-ionic contrast agent are injected with a power
of DSA for preoperative vascular mapping are the relatively injector at a rate of 4-5 ml/s followed by a saline flush of 30-
high costs and risks of neurological complications. Recently, 50 ml. The scan volume includes the inferior margin of the
multislice spiral computed tomography angiography (CTA) bottom of C6 to the zygomatic arch and the skull base to the
has emerged as an alternative technique to DSA in a large thoracic inlet for the late phase scan. The scanner settings are
[ 1 ] Patient with prior reconstructive surgery 1 2

after tumor resection, scheduled for repeated
surgery because of fracture of the right
reconstructed mandible. DSA: Left carotid
angiogram; patent graft vessel (arrow)
[ 2 ] CTA: Corresponding CTA of the left carotid

artery. Patent graft vessel (arrow)
SCIENCE
[ 3 ] CTA: Recon-
struction of the
given in the examination protocoll. The late phase scan is mandibula (dotted
arrows); graft vessel
performed 60s after the first scan during shallow breathing.
(arrow), fracture
(dotted arrow with
Review of Images round end)
Axial 0.75 mm slices of the arterial phase are reconstructed at
an increment of 0.5 mm with a field of view (FOV) of 180 mm
and a matrix of 512x512, applying a soft tissue kernel. This
data set is transferred to a CT-workstation for 3D volume ren-
dering. A default setting for volume rendering (syngo 3D
platform) is used to limit postprocessing. The analysis of the In a subsequent analysis of patients with prior reconstructive
vessels is done interactively. In selected cases, thin slab-max- surgery and the need of repeated surgery, all patent graft
imum intensity projections (thin-MIP) or multiplanar reforma- vessels could be detected with CTA.
tions (MPR) may be applied.
The late phase scan is used for tumor staging and is routinely Discussion
reconstructed in contiguous 3 mm axial slices and 3 mm For preoperative vascular mapping of head and neck region,
coronal slices (direct 3D reconstruction). In unclear cases, thin CTA is a less invasive and more cost effective alternative to
slice reconstruction may be performed for MPR evaluation. DSA. Tumor staging and vascular mapping can be performed
with a biphasic CT protocol within a single session. No addi-
Results of MSCT-Angiography tional contrast agent injections are necessary, and catheter
In a recently published study [9], we compared the ability of associated risks can be avoided completely. The information
16-slice CTA and selective carotid DSA in the evaluation of the provided by CTA seems to be sufficient for the planning of
ECA and side-branches. For the complete number of vessel microvascular reconstructions. In addition, three-dimen-
branches detected in each of the two different imaging sional image reconstruction uniquely demonstrates anatom-
modalities, a statistically significant difference could not be ical relationships between blood vessels, bones, and soft tis-
found for the two examiners (PCTA = 0.59, PDSA = 0.41). DSA sue. Osseous pathology can be assessed in detail, and virtual
was able to show more vessel segments than CTA, especially preoperative planning as well as computer-aided selection
vessels within narrow bony canals (infraorbital or inferior or preparation of transplant material becomes possible.
alveolar artery), but considering vessels suitable for recon-
structive surgery, no statistically significant difference 1 Ehrenfeld M, Riediger D, Wolburg H, Thron A. Angiographic visualization
and morphology of anastomosed vessels in microsurgical tissue transplan-
between CTA and DSA was found. All CTA studies were diag- tation. Fortschr Kiefer Gesichtschir 1987; 32: 71–74
nostic; no examination had to be repeated. 2 Fleischmann D. Present and future trends in multiple detector-row CT
applications: CT angiography. Eur Radiol 2002; 12 Suppl 2: S11–15
3 Herzog C, Dogan S, Wimmer-Greinecker G, Balzer JO, Mack MG, Vogl TJ. Multi-
CT Examination Protocol detector-row CT: cardiosurgery indications. Eur Radiol 2003; 13 Suppl 5: M82–87
4 Remy-Jardin M, Tillie-Leblond I, Szapiro D, et al. CT angiography of pul-
Arterial phase Delayed phase monary embolism in patients with underlying respiratory disease: impact of
Scanner SOMATOM SOMATOM SOMATOM SOMATOM multislice CT on image quality and negative predictive value. Eur Radiol
Sensation Sensation Sensation 16 Sensation 64 2002; 12: 1971–1978
16-slice 64-slice 16-slice 64-slice 5 Wiesner W, Hauser A, Steinbrich W. Accuracy of multidetector row
configuration configuration configuration configuration
computed tomography for the diagnosis of acute bowel ischemia in a non-
kV 120 120 120 120 selected study population. Eur Radiol 2004
Effective 110 140 150 150
6 Ropers D, Baum U, Pohle K, et al. Detection of coronary artery stenoses
mAs
with thin-slice multi-detector row spiral computed tomography and multi-
Rotation 0.5 s 0.33 s 0.5 s 0.33 s
time planar reconstruction. Circulation 2003; 107: 664–666
Slice 16 x 0.75 mm 64 x 0.6 mm 16 x 0.75 mm 64 x 0.6 mm 7 Catalano C, Napoli A, Fraioli F, Venditti F, Votta V, Passariello R. Multi-
acquisition detector-row CT angiography of the infrarenal aortic and lower extremities
Recon. slice 0.75 mm 0.75 mm 3 mm 3 mm arterial disease. Eur Radiol 2003; 13 Suppl 5: M88–93
thickness
8 Lell M, Wildberger JE, Heuschmid M, et al. CT-angiography of the carotid
Reconstruc- 0.5 mm 0.5 mm 3 mm 3 mm
artery: First results with a novel 16-slice-spiral-CT scanner. Fortschr Röntgen
tion interval
str 2002; 174: 1165–1169
Contrast
9 Lell M, Tomandl BF, Anders K, Baum U, Nkenke E. Computed tomography
Volume 100 cc 100 cc – – angiography versus digital subtraction angiography in vascular mapping for
Flow rate 4 cc/s 5 cc/s – –
planning of microsurgical reconstruction of the mandible. Eur Radiol 2005; 15:
Postprocessing: syngo Neuro DSA CT
1514–1520
SCIENCE
SOMATOM Sensation
Increased Speed and Resolution Make a Difference
in Coronary Artery Imaging
By Stephan Achenbach, MD, Department of Internal Medicine II, University of Erlangen, Germany, President of the Society
of Cardiovascular CT (SCCT)
Non-invasive imaging of the coronary arteries is a “holy

[ 1 ] Istotropic spatial resolution
grail”. Clinically, the need for a non-invasive tool to replace
permits multiplanar reconstruc-
some diagnostic invasive coronary angiograms is obvious, tions of the coronary arteries with-
but the technical challenges to achieve reliable imaging of out losing anatomic detail. Here,
the coronary vessels are tremendous. The coronary arteries a curved multiplanar reconstruc-
are subjected to constant, rapid motion. Along with their tion of a right coronary artery
small dimensions as well as the necessity to achieve high (arrow) is shown. The data set
contrast between the vessel lumen and surrounding struc- was acquired with 64-slice MDCT.
tures, this makes non-invasive coronary imaging an
extremely difficult task.
Around the year 2000, the first multi-detector computed 64-slice CT
tomography (MDCT) systems with rotation times of 500 ms Recently, 64 slice scanners have been introduced. What
were introduced. Dedicated image reconstruction methods advantages have they brought about? Clinically, the
that required less than 360° of data and could correlate improvements that can be attributed to the development of
image reconstruction to the electrocardiogram were devel- 64-slice scanners are very obvious. Increased gantry rotation
oped. With these 4-slice scanners, it could be demonstrated speed (now 330 ms) with higher temporal resolution makes
that non-invasive visualization of the coronary artery lumen it easier to acquire images free of motion artifacts (even
with mechanical CT is possible. However, it was soon recog- though in most cases, lowering the heart rate is still
nized that in many cases both temporal and spatial resolu- advised). The fact that data are acquired in 64 slices within
tion were insufficient and failed to provide diagnostic image each rotation provides for coverage of the complete volume
quality. The next step in the evolution of scanner technology of the heart in 9–12 seconds or less. This has proven to be a
were 16-slice scanners which further increased spatial reso- tremendous clinical advantage – breath holds of that dura-
lution (by providing sub-millimeter collimation) and tempo- tion are truly easy to perform for almost any patient, and the
ral resolution (with rotation times of less than 500 ms). Con- amount of contrast agent needed can be decreased to less
sequently, high diagnostic accuracy for the detection of than 60 ml. An especially important improvement is the fact
coronary artery stenoses was reported by several experi- that the acquired data sets now provide practically isotropic
enced academic sites [1–5]. spatial resolution – the ability to visualize small structures
[ Table 1 ]
Sensitivities and Specificities for the detection of coronary artery

stenoses by 64-slice MDCT in comparison to invasive coronary angiography
Author Publication Number of patients Sensitivity Specificity

Leschka et al [5] Eur Heart J 2005 67 94% 97%
Leber et al [6] JACC 2005 59 87%* 91%*
Raff et al [7] JACC 2005 70 86%+/91%++ 95%+/92%++
*5 of 6 lesions that required revascularization were detected by MDCT
+ ++
Per-segment analysis Per-artery analysis
SCIENCE
within the coronary arteries in the axial imaging plane and in 2A [ 2 ] Stenosis of the left
reformatted images orthogonal to the axial plane is equally
anterior descending coronary
high [Fig. 1]. This brings about a substantial improvement artery visualized by
and facilitation of postprocessing to assess the coronary 64-slice MDCT.
artery lumen in small vessels and at sites with coronary calci-
[ A ] 5 mm maximum inten-
fications (potentially, also coronary stents). The first pub-
sity projection in axial orien-
lished studies that verified 64-slice MDCT against invasive tation shows the lumen
coronary angiography have confirmed the high diagnostic narrowing at the ostium of
accuracy of 64-slice MDCT in detecting coronary artery the left anterior descending
stenoses in patients with various clinical presentations [Fig. coronary artery (large
2, Table] [6–8]. Based on the experience that could be gath- 2B arrow). A small intermediate
ered so far, it can be expected that coronary artery visuali- branch (*) and even the ori-
gin of the sinuatrial nodal
zation by CT will find a clinical role in certain subsets of symp-
artery from the proximal left
tomatic patients who require workup for coronary artery
circumflex coronary artery
disease. High negative predictive values (97%–99%) observed (small arrow) can be appre-
throughout all recent studies [1–8] make applications in the ciated.
context of ruling out coronary stenoses especially promising. [ B ] 3-dimensional recon-
struction of the heart and
Future Developments coronary arteries shows the
What future developments would translate into clinical advan- proximal stenosis of the left
2C
anterior descending coro-
tages for coronary imaging? Clearly, simply adding more slices
nary artery (arrow). The left
will not solve the remaining problems. The only advantage
atrium has been removed to
would be a decreased overall scan time, which, however, is no provide unobstructed view
longer an obstacle of any significance. Further decreasing slice on the left main bifurcation.
collimation would require a parallel, disproportionate increase [ C ] The corresponding inva-
in x-ray tube current and radiation exposure to avoid excessive sive coronary angiogram
image noise. The most desirable improvement would there- confirms the stenosis
fore be an increase in true temporal resolution, as it is possible (arrow).
with the new Dual Source CT technology. This will make image
quality even more stable and predictable and will potentially In summary, the development and clinical introduction of
obviate the need to use medication in order to lower the 64-slice MDCT has substantially enhanced clinical applicabil-
patient’s heart rate in preparation for the scan. Cardiac CT ity, image quality, and accuracy of CT coronary angiography.
scans are even easier to perform. Potentially, higher temporal Isotropic spatial resolution has been found to greatly facili-
resolution might even permit prospective triggering of X-ray tate image evaluation. Further improvements are expected
tube output (instead of retrospective gating of image recon- from increased temporal resolution available with the new
struction) and thus effectively lower radiation exposure. Dual Source CT technology.
1 Kuettner A, Beck T, Drosch T, Kettering K, Heuschmid M, Burgstahler C, 5 Achenbach S, Ropers D, Pohle FK, Raaz D, von Erffa J, Yilmaz A, Muschiol G,
Claussen CD, Kopp AF, Schroeder S. Image quality and diagnostic accuracy Daniel WG. Detection of coronary artery stenoses using multi-detector CT with
of non-invasive coronary imaging with 16-detector slice spiral computed 16x0.75 mm collimation and 375 ms rotation. Eur Heart J 2005; Epub May 27, 2005
tomography with 188 ms temporal resolution. Heart 2005; 91: 938–941 6 Leschka S, Alkadhi H, Plass A, Desbiolles L, Grünenfelder J, Marincek B,
2 Mollet NR, Cademartiri F, Krestin GP, McFadden EP, Arampatzis CA, Serruys Wildermuth S. Accuracy of MSCT coronary angiography with 64-slice tech-
PW, de Feyter PJ. Improved diagnostic accuracy with 16-row multi-slice computed nology: first experience; Eur Heart J 2005; 26: 1482–1487
tomography coronary angiography. J Am Coll Cardiol 2005; 45: 128–132 7 Leber AW, Knez A, von Ziegler F, Becker A, Nikolaou K, Paul S, Winters-
3 Morgan-Hughes GJ, Roobottom CA, Owens PE, Marshall AJ. Highly accurate perger B, Reiser M, Becker CR, Steinbeck G, Boekstegers P. Quantification of
coronary angiography with submillimetre, 16 slice computed tomography. obstructive and nonobstructive coronary lesions by 64-slice computed
Heart 2005; 91: 308–313 tomography. A comparative study with quantitative coronary angiography
4 Hoffmann MHK, Shi H, Schmitz BL, Schmid FT, Lieberknecht M, Schulze and intravascular ultrasound. J Am Coll Cardiol 2005; 46: 147–154
R, Ludwig B, Kroschel U, Jahnke N, Haerer W, Brambs HJ, Aschoff AJ. 8 Raff GJ, Gallagher MJ, O’Neill WW, Goldstein JA. Diagnostic accuracy
Noninvasive coronary angiography with multislice computed tomography. of noninvasive angiography using 64-slice spiral computed tomography.
JAMA 2005; 293: 2471–2478 J Am Coll Cardiol 2005; 46: 552–557
NEWS SECTION
CUSTOMER CARE
S O M AT O M U S E R S M E E T I N G B R A Z I L
Customer Event Brazilian Ricardo Cury, MD, introduced a study

on coronary CTA conducted at Massachusetts
Aiming at partnership and exchange of radiologists, neurologists and cardiolo- General Hospital, Harvard Medical School.
information among magnetic resonance gists, discussed clinical trends, and
(MR), computed tomography (CT) and shared experiences, studies and re- General Hospital, Harvard Medical
molecular imaging (MI) users at MER- searches. The program included discus- School, Boston, MA, USA; Rodofo
COSUR (Argentina, Bolivia, Brazil, Chile, sions on the use of diagnostic imaging Nunez, MD, Anderson Cancer Center
Paraguay and Uruguay), Siemens Medical technologies in neurology; orthopedic; Houston, TX, USA; Henrik Michaelly,
Solutions organized the second regional oncology and screening; cardiovascular MD, California University, Los Angeles,
users meeting in Brazil. 170 Siemens examinations. Among the speakers CA, USA; and Carsten Figge, MD, Bad
users, among them nuclear physicians, were Ricardo Cury, MD, Massachusetts Wildungen, Germany.
WO R KI N G WITH TH E EXPE RTS I N H O N G - KO N G
Cardiac CT – Live Case Workshop

230 cardiologists, radiologists and refer- and consisting of affiliated cardiologists calcified lesions and stents was outstand-
ring physicians from Hong-Kong and the from the center as well as Stefan Achen- ing. Cardiologists, who had never been
neighboring countries participated in the bach, MD, Department of Internal Medi- in touch with cardiac CT before, are
first 64-slice, cardiac Computed Tomogra- cine II, University of Erlangen-Nurem- now convinced of the robustness of the
phy (CT) workshop at Sir Run Run Shaw berg, Germany, evaluated the cases on new technology. Participants from other
Heart Center at St. Teresa’s Hospital. The the spot. Five patients were transferred to SOMATOM Sensation 64-slice sites highly
clinic had installed Hong-Kong's first 64- the cathlab immediately, three to mag- appreciated the teaching aspect and the
slice CT, a SOMATOM Sensation system, netic resonance imaging – both depart- hands-on session on the new CT worksta-
last fall. ments utilizing Siemens state-of-the-art tions featuring syngo Circulation.
Seven cardiac CT examinations were equipment and technology.
broadcast live. A panel board, moderated Participants were impressed by non- k www.sth.org.hk/e/index.html
by the head of the department and super- invasive cardiac CT and the results deliv-
intendent of the hospital, Dr. CM Wong, ered by the system. Image quality from
S O M AT O M U S E R S M E E T I N G I N D I A
First High-end Users Meeting

The first SOMATOM Users Meeting in the Powai Lake. The event was at- Sensation and the magic of z-Sharp
India was held in Mumbai at the pictur- tended by 110 radiologists and comput- Technology at work. Bernd Ohnesorge,
esque Hotel Renaissance overlooking ed tomography (CT) technologists. PhD, Vice President CT Marketing and
Recently, the interest in 64-slice CT in Sales, delivered the keynote address
Konstantin India has increased dramatically and on “30 Years of Siemens CT and
Nikolaou, MD, more than ten Siemens 64-slice scan- Beyond”, and Dr. Nikolaou spoke on
elucidates on ners have been installed in 2005. “Advances in Cardiovascular and Body
the journey International speakers were Konstan- Imaging”. Further highlights were fabu-
from 16 to tin Nikolaou, MD, University Hospital lous displays of coronary imaging tech-
64 slices.
Munich Grosshadern, Germany, and niques. The new syngo Circulation
a delegation from Siemens Medical package for cardiac imaging was met
Solutions, CT Division, Germany. Invi- with great enthusiasm and much posi-
tees witnessed the power of SOMATOM tive comment.
CUSTOMER
NEWS SECTION
CARE
L i f e : E D U C AT E

Siemens Medical Solutions’ Computed Passariello, MD, head of the Department
Tomography (CT) Division has captured of Radiologic Sciences, acted as chair-
the 7th SOMATOM CT Users Conference man of the conference, supported by
2005, held in Rome, Italy, on CD. The Carlo Catalano, MD, Associate Professor
complete package of six CDs is approved at the same department (both Universi-
for AMA PRA Category 1 credit through ty Hospital La Sapienza, Rome, Italy). A CME-credited set of six CDs is
Johns Hopkins University, School of Professor Elliot Fishman, MD, Johns available from the 7th SOMATOM
Medicine, and is ready to order – free of Hopkins Hospital, Baltimore, MD, USA, CT User Conference 2005.
charge. and Professor Yutaka Imai, MD, Tokai
Physicians can benefit from 46 out- University, Tokyo, Japan, were co-chair- an e-mail with your postal address to
standing presentations given by an in- men. med.somatomlife@siemens.com, subject
ternational faculty of leading experts. Customers benefit from Siemens’ clini- “CD set: 7th SOMATOM CT User Confer-
Topics such as “Technology Principles of cal e-learning opportunities – as part of ence 2005”.
Multislice CT”, “Head and Neck CT“, the SOMATOM Educate program within
“Chest CT“, “Cardiac CT“, “Abdominal CT“, “Life“ – and experience the latest clinical
“Vascular CT“, and “New Frontiers in CT” results in the various fields of CT imag-
are covered. Live case demonstrations ing. A preview of the CD is provided
of high-end clinical CT applications in in Siemens’ CT User Lounges at k www.siemens.com/SOMATOMEducate
combination with case interpretations www.siemens.com/SOMATOMWorld. k www.siemens.com/SOMATOMWorld
are included as well. Professor Roberto To obtain a free CD package, please send k www.ctisus.org
SERVICE How can I save a list and/or print a copy of the scan proto-
cols on the system?
Frequently Asked Questions On systems running VA70/VB10 software versions, this can be
accomplished by going to System->Run->List Scan Protocols.
Via the SOMATOM World User Lounges, Siemens applica- Here you can save the list of the protocols (which includes site
tions specialists answer your questions on “how to …” easily specific protocols as well as Siemens default scan protocols)
use Siemens Computed Tomography scanners and applica- onto a floppy disk. Insert floppy into A: drive, and then go to
tions in daily clinical practice. Additionally, SOMATOM Ses- File->Save As, and make sure the 3 _ floppy (A:) drive is select-
sions offers a regular column with frequently asked ques- ed at the dropdown in “Save In” field. Click Save to put a copy of
tions for offline reference. this protocol list to the floppy. Wait until the drive has stopped
activity to remove floppy. You can also print using Print at the
How do I get reference lines on the topogram after the top of the platform if you have a network printer connected to
exam has been closed? system. On systems starting with VA47/VA70, it is necessary to
Open the Patient Browser and double click on the patient's press the <Ctrl> key and the <N> key together to get a second
raw data in the browser to reload the study into the exami- window that has the command dropdowns at the top of it,
nation card. With the topogram in the upper left segment of then accomplish the tasks above. In syngo CT 2006 A/G, this
the examination card, drag and drop the chronicle bar to be function is in the Main Menu of the Scan Protocol Manager
posted onto the topogram in the image segment. Last, (Options->Configuration) under View List. Close the List and
select patient and save image. A new image of the the Scan Protocol Manager, and open the File Browser
topogram with reference lines can be seen in the Patient (Options->File Browser). You will find the html-file in the folder
Browser. H:\SiteData\offline.
CUSTOMER CARE
C T ONLINE
CT News on the Web k www.siemens.com/medicalnews

Siemens Computed Tomography (CT) Division has expanded
k www.siemens.com/DualSource its customer information service, and started the Siemens
This new microsite introduces the latest CT technology – the Medical CT Newsletter. The regular e-newsletter includes a
SOMATOM Definition and its trend-setting Dual Source con- highlight article either on a business, clinical outcomes, sci-
cept. An intro movie and a 3D model lead to explanations of ence or customer care topic, as well as the latest information
the SOMATOM Definition’s technical design and functionali- on upcoming Siemens CT courses, answers to frequently
ty. The system and its clinical outcomes are compared to asked questions plus a section with tricks and tips on “how to
conventional CT technology. Also available are media infor- …” efficiently use Siemens CT scanners and applications in
mation, event reviews and animations. An interactive pre- daily clinical practice. Customers can either subscribe via the
sentation of the SOMATOM Definition and its application above link, or with the postcard attached to the back cover
area enhance the website. of this issue of SOMATOM Sessions.
Upcoming Events & Courses

Title Location Description Date Contact
4th International Garmisch- Scientific talks and lectures Jan.18–21, 2006 www.ct2006.org
Multislice CT Partenkirchen,
Symposium Germany
Arab Health Dubai, UAE Exhibition and Congress Jan. 22–25, 2006 www.arabhealthonline.com
22nd Annual Orlando, USA CME Course Feb.16–19, 2006 www.ctisus.com
Computed Body
Tomography 2006:
The Cutting Edge
ECR Vienna, Austria Congress March 3–7, 2006 www.ecr.org
ACC Atlanta, USA Annual Scientific Session March 11–14, 2006 www.acc.org
and Exposition
The Charleston Course: Charleston, Scientific talks March 20–23, 2006 www.ryalsmeet.com/
Cardiovascular Imaging South Carolina and lectures
Advanced Topics Las Vegas, USA 3D, CT Angiography, and March 24–27, 2006 www.ctisus.com
in CT Scanning Virtual Imaging; CME Course
Advanced Topics Baltimore, USA 3D, CT Angiography, and March 31–April 2, 2006 www.ctisus.com
in CT Scanning Virtual Imaging; CME Course
ITEM Yokohama, Japan Trade fair April 7–9, 2006 www.j-rc.org
Deutsche Gesell- Mannheim, 72. Jahrestagung April 20–22, 2006 www.dgk.org
schaft für Kardiologie Germany
Deutscher Berlin, Germany Kongress und Industrieforum May 24–27, 2006 www.drg.de
Röntgenkongress
Stanford Symposium San Francisco, USA 8th Annual International Sym- June 14–17, 2006 radiologycme.stanford.edu
posium on Multidetector-Row CT
Society of Cardio- Washington, DC, USA 1st Annual Scientific Meeting in co- July 13–16, 2006 www.scct.org
vascular CT operation with the 7th Internatio-
nal Conference on Cardiac CT
Advanced Topics Cruise to the CME Course July 29–Aug. 5, 2006 www.ctisus.com
in Multidetector Mediterranean
CT Scanning
In addition, you can always find the latest CT courses offered by Siemens Medical Solutions at www.siemens.com/SOMATOMEducate.
CUSTOMER CARE
SOMATOM SESSIONS – IMPRINT

© 2005 by Siemens AG, Berlin and Munich, All rights reserved
Publisher M. Das, MD, G. Mühlenbruch, MD,

Siemens AG Department of Diagnostic Radiology, Department of Diagnostic Radiology,
Medical Solutions RWTH University Aachen, Germany RWTH University Aachen, Germany
Computed Tomography Division
Siemensstraße 1 J. Debus, MD, PhD, E. Nkenke, MD,
D-91301 Forchheim Department of Radiation Oncology, Department of Maxillofacial Surgery,
University of Heidelberg, Germany University Erlangen, Germany
Responsible for Contents:
J.-B. D'Harcour, MD, B. F. Tomandl, MD,
Bernd Ohnesorge, PhD
Cliniques du Sud-Luxembourg, Department of Neuroradiology,
site St Joseph, Arlon, Belgium Klinikum Bremen, Germany
Editors
Doris Pischitz, M.A. J. Dinkel, MD, J. E. Wildberger, MD,
(doris.pischitz@siemens.com) Department of Radiation Oncology, Department of Diagnostic Radiology,
Stefan Wünsch, PhD University of Heidelberg, Germany RWTH University Aachen, Germany
(stefan.wuensch@siemens.com)
A. Graser, MD, Cathrine Carrington, medical editor
Editorial Board Department of Clinical Radiology, Tony De Lisa, freelance author
Joachim Buck, PhD University Hospital Grosshadern,
Gumurkh Advani; Jessica Amberg; Axel Barth, Karin
Thomas Flohr, PhD Munich, Germany
Barthel; Dagmar Birk; Joachim Buck, PhD; Chad
Chad DeGraaff
R. W. Günther, MD, DeGraaff; Ana Paula Pieroni De Menezes; Hendrik
André Hartung, MD
Department of Diagnostic Radiology, Ditt; Lars Hofmann, MD; Julia Kern-Stoll; Ernst Klotz;
Julia Kern-Stoll
RWTH University Aachen, Germany Claus Lindemann; Louise McKenna, PhD, MBA;
Matthew Manuel
Praveen Nadkarni; Gitta Schulz; Tobias Seyfarth;
Louise McKenna, PhD, MBA
A. Jensen, MD, Andrea Röder; Katinka van Es; Diane Wurzburger;
Axel Lorz
Department of Radiation Oncology, Claudette Yasell; all Siemens Medical Solutions
Nicole Reyher
University of Heidelberg, Germany
Jens Scharnagl Production
T. Kraus, MD Norbert Moser, Siemens Medical Solutions
Authors of this Issue Department of Occupational Health,
S. Achenbach, MD, Layout
RWTH University Aachen, Germany
Department of Internal Medicine II, independent Medien-Design
University of Erlangen, Germany M. Lell, MD, Widenmayerstrasse 16, D-80538 Munich;
Institute of Radiology, feedback Werbeagentur
University Erlangen, Germany Geisseestraße 63, D-90439 Nuremberg
C. R. Becker, MD,
Department of Clinical Radiology, Printers
A. H. Mahnken, MD,
University Hospital Grosshadern, Farbendruck Hofmann
Department of Diagnostic Radiology,
Munich, Germany Gewerbestraße 5, D-90579 Langenzenn
RWTH University Aachen, Germany
Printed in Germany
U. Baum, MD, U. Mende, MD, PhD,
Institute of Radiology, Department of Radiation Oncology, SOMATOM Sessions is also available on the
University Erlangen, Germany University of Heidelberg, Germany internet: www.siemens.com/SOMATOMWorld
Note in accordance with § 33 Para.1 of the German Federal Data Protection of the drug. The treating physician bears the sole responsibility for the diag-
Law: Despatch is made using an address file which is maintained with the nosis and treatment of patients, including drugs and doses prescribed in
aid of an automated data processing system. connection with such use. The Operating Instructions must always be strict-
SOMATOM Sessions with a total circulation of 35,000 copies is sent free of ly followed when operating the CT System. The sources for the technical
charge to Siemens Computed Tomography customers, qualified physicians data are the corresponding data sheets. Results may vary.
and radiology departments throughout the world. It includes reports in the Partial reproduction in printed form of individual contributions is permitted,
English language on Computed Tomography: diagnostic and therapeutic provided the customary bibliographical data such as author's name and title
methods and their application as well as results and experience gained with of the contribution as well as year, issue number and pages of SOMATOM
corresponding systems and solutions. It introduces from case to case new Sessions are named, but the editors request that two copies be sent to
principles and procedures and discusses their clinical potential. them. The written consent of the authors and publisher is required for the
The statements and views of the authors in the individual contributions do complete reprinting of an article.
not necessarily reflect the opinion of the publisher. We welcome your questions and comments about the editorial content of
The information presented in these articles and case reports is for illustra- SOMATOM Sessions. Manuscripts as well as suggestions, proposals and
tion only and is not intended to be relied upon by the reader for instruction information are always welcome; they are carefully examined and submit-
as to the practice of medicine. Any health care practitioner reading this ted to the editorial board for attention. SOMATOM Sessions is not responsi-
information is reminded that they must use their own learning, training and ble for loss, damage, or any other injury to unsolicited manuscripts or other
expertise in dealing with their individual patients. This material does not materials. We reserve the right to edit for clarity, accuracy, and space.
substitute for that duty and is not intended by Siemens Medical Solutions to Include your name, address, and phone number and send to the editors,
be used for any purpose in that regard. The drugs and doses mentioned address above.
herein are consistent with the approval labeling for uses and/or indications Title page: Image Courtesy of University of Erlangen
S O M ATO M S E S S I O N S S U B S C R I P T I O N
Institution/Hospital CT Scanner type
Function CT Manufacturer
Department CT Scanner age
Title City*
Name* State/Province*
Business Address: Street/P.O. Box* Country*
Zip/Postal Code* E-mail
*obligatory information
I would like to be notified by e-mail about interesting unsubscribe from needed for the mailing of
news from Siemens Computed Tomography. SOMATOM Sessions SOMATOM Sessions.
SOMATOM
No 17/December 2005
RSNA-Edition
Nov. 27th –
Dec. 2nd, 2005
www.siemens.com/medical
Sessions
COVER STORY
A New Era in Computed
Tomography
Page 4
NEWS
CT Clinical Engines – Speed
and Confidence.
Page 19
BUINESS
SOMATOM Emotion – “Excel-
lent Price-Performance Ratio“
Page 25
Revenue – Investment
Pays Off
Page 27
CLINICAL OUTCOMES
Oncology – Respiratory Gating
Page 34
Acute Care – Diagnosis and

Surgical Planning in Traumatic
Paraplegia
Page 42
SCIENCE
Increased Speed and Resolu-
tion Make a Difference in
Coronary Artery Imaging
Page 46
CUSTOMER CARE
EDUCATE –
Page 49
17
SUBSCRIBE NOW!
– and get your free copy of future SOMATOM
Sessions! Interesting information from the world
of computed tomography – gratis to your desk.
Send us this postcard, or subscribe online at
www.siemens.com/SOMATOMWorld
Computed Tomography Division

Marketing/Customer Care
D-91294 Forchheim
Medical Solutions
P.O. Box 1266

Siemens AG
Germany
SOMATOM
Sessions
SOMATOM Sessions
Issue No.17/Dez. 2005
On account of certain regional limitations of sales

rights and service availability, we cannot guarantee
that all products included in this brochure are
available through the Siemens sales organization
worldwide. Availability and packaging may vary
by country and is subject to change without prior
notice. Some/All of the features and products
described herein may not be available in the
United States.
The information in this document contains general

technical descriptions of specifications and options
as well as standard and optional features which do not
always have to be present in individual cases.
Siemens reserves the right to modify the design, pack-

aging, specifications and options described
herein without prior notice. Please contact your local
Siemens sales representative for the most current
information.
Note: Any technical data contained in this document

may vary within defined tolerances. Original images
always lose a certain amount of detail when
reproduced.
Please find fitting accessories:

www.siemens.com/medical-accessories
Siemens AG
Wittelsbacher Platz 2
D-80333 Munich
Germany
Headquarters Contact Address

Siemens AG, Medical Solutions Siemens AG, Medical Solutions
Henkestr. 127, D-91052 Erlangen Computed Tomography
Germany Siemensstr. 1, D-91301 Forchheim © 11.2005 Siemens SOMATOM Sessions
Order No. A91100-M2100-14-1-7600
Telephone: +49 9131 84-0 Germany Printed in Germany
www.siemens.com/medical Telephone: +49 9191 18-0 CC CT 00014 ZS 1105/35.

Somatom Sessions 17

Uploaded by

Document Information

Original Description:

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Somatom Sessions 17

Uploaded by

Copyright:

Available Formats

SOMATOM

Acute Care – Diagnosis and

Bernd Ohnesorge, PhD,

Bernd Ohnesorge, PhD, Vice President CT Marketing and Sales

Dual Source CT Imaging –

Four prominent medical specialists – from radiology, cardiology

DR. MODIC: The whole issue of calcium isn’t just in the

showing a dramatic decrease in length of stay when CT is

SOMATOM Definition is the world’s first CT scanner to

At a low and stable

60 bpm single source CT 60 bpm Dual Source CT

Dual Source CT images

60 bpm single source CT 60 bpm Dual Source CT

100 bpm single source CT 100 bpm Dual Source CT

simultaneously from a single scan, running the tubes at two

Speed and Confidence

poral resolution needed for fast and accu-

Leader in Customer Care

NEW – Advanced Vessel Analysis

Trendsetting Injector Coupling Device

Virus Protection Shields

The Easy Way From Sequential

“Excellent Price-Performance Ratio”

Investment Pays Off

Abdominal CT Scan Total Exam Time Expense Trends

Acquisition Payroll & Benefits

Care Dose4D Automated Dose Modulation

Ref mAs: 250, kVp 120 Eff. mAs

750 Image Noise Dose Modulation 158

DIAGNOSIS EXAMINATION PROTOCOL

tion of contrast medium. Although such positioning may

Scanner SOMATOM Emotion Reconstruction increment 1 mm

Computer Assisted Reading – More Speed.

Multidetector-row computed tomography (MDCT) is the

COMMENTS Scan time 51.85 s

New approaches in radiation therapy with the use of more kV 120 kV

image degradation and the inability to correctly delineate

[ 3 ] Tumoral mass caudal in [ 4 ] Tumoral encasement of [ 5 ] Post obstructive lung changes

[ 6 ] MPR views of the paramediastinal fibrotic changes

Biograph High-Resolution Examination

[ 2 ] PET/CT image showing multiple [ 3 ] Fused PET/CT image identifies

[ 4 ] CT image of the thorax wall [ 5 ] PET/CT image identifies 6 mm

[ 1A ] Osteolysis of the mandible with [ 2 ] BSCT-Angiogram: frontal view [ 2A ]

[ 3 ] VRT images showing postoperative results after posterior-lateral stabilisation;

[ 1 ] Patient with prior reconstructive surgery 1 2

[ 2 ] CTA: Corresponding CTA of the left carotid

Non-invasive imaging of the coronary arteries is a “holy

Sensitivities and Specificities for the detection of coronary artery

Author Publication Number of patients Sensitivity Specificity

Customer Event Brazilian Ricardo Cury, MD, introduced a study

WO R KI N G WITH TH E EXPE RTS I N H O N G - KO N G

Cardiac CT – Live Case Workshop

First High-end Users Meeting

Free CME-Credited CD-Set

CT News on the Web k www.siemens.com/medicalnews

Upcoming Events & Courses

SOMATOM SESSIONS – IMPRINT

Publisher M. Das, MD, G. Mühlenbruch, MD,

Acute Care – Diagnosis and

Computed Tomography Division

P.O. Box 1266

On account of certain regional limitations of sales

The information in this document contains general