MEDIX VOL.

61

Clinical Experience Using the Open Bore

Multislice CT System Supria (16 slice CT)
Hiroki Kadoya Yukiko Kitagawa

MEDIX VOL. 61 P.8 〜 P.11

 Clinical Experience Using the Open Bore
Multislice CT System Supria（16 slice CT）
Hiroki Kadoya Yukiko Kitagawa

Kitagawa Hospital, Kouyuukai Medical Corporation（Hirado City, Nagasaki Prefecture）

Clinical experience using the Supria ※1 multislice（16 slice）CT system, manufactured by Hitachi Medical Corporation,
introduced at our institution in March, 2014 is reported below. Supria enables smooth and efficient operations and settings
to meet various scanning and patient positioning needs with its wide-open 750mm gantry bore and full data retention at the
maximum FOV（500mmφ）
. Also, this CT system is capable of low exposure scanning, applying iterative reconstruction
technology as a standard function. Furthermore, it realizes both the fast speed and wide range acquisition of thin slice vol-
ume data for short-time and high-resolution imaging.

Key Words:  Supria, FOV, Open Bore Gantry, Intelli IP

1. Introduction
Our hospital, which opened in Hirado, Nagasaki, in 1954, system, manufactured by Hitachi Medical Corporation
currently has 52 beds. It has specialized departments in （Fig. 1）
.
internal medicine, surgery, pediatrics, gastrointestinal Here, we report on our experiences using this CT sys-
medicine, cardiovascular medicine, proctology, radiology, tem and present actual clinical images.
and rehabilitation.
As time had come to renew our CT system（Multislice
CT ROBUSTO, Hitachi Medical Corporation）
, we decided
to install a new system.
In Hirado, Nagaski, the proportion of 65 years old or
older is relatively high at 33.2％1）. Our hospital also has a
geriatric health services facility in addition to a pediatrics
department. Therefore, in selecting the device, we mainly
considered the convenience of scan positioning, a reduced
rate of rescanning for patients in a hunched position, and
dose-reduction technology. Space and power requirements
comparable to those of a conventional CT system addition-
ally emerged as selection criteria, and therefore the deci-
sion was made in March 2014 to install the Supria ※1 CT Fig. 1: Supria

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 Figure 3 shows the results for the rate of noise reduction
2. Outline of the installed system
measured using the water phantom. In the case of scan-
Supria has a minimum scan time of 0.75s/rot and is ning conditions that assumed a pediatric brain scan, we
equipped with a 5MHU X-ray tube. It has a large gantry confirmed that the noise-reduction effect increased by
bore of 750mm. Regardless of the field of view（hereinaf- 7.7％ on average for each increment in Intelli IP level.
ter referred to as FOV）which is set when planning the
scan conditions, the system constantly retains all data at
Table 1: Scanning conditions for Clinical case 1
the maximum FOV（500mm）
.
kV mA Scan time Scan type
Given the frequent scanning of the elderly at our hospi-
120 240 1.0 Normal
tal, we judged that the system would contribute to reduc-
ing the rescanning rate. Furthermore, with regard to the Slice thickness Collimation Tilt Kernel

scanning of children, we judged that use of the system 5 0.625×16 11° F19
would help to reduce their fear of examination.
The system has a footswitch, which can control the
movement of patient table based on the preset positions.
This ensures safety by freeing up both hands of the opera-
tor while also enabling smooth positioning of the patient.
The system is also equipped with a Breath guide－a useful
function for elderly patients that allows breath-holding
instructions to be displayed with characters. This function
is implemented by miniature monitors, placed at 3 sites
within the gantry. As for functions related to dose reduc-
tion, the system is equipped with“IntelliEC ※2 ”
, which Fig. 2: Brain image of a child: 6-year old boy
forms an elliptical model of the human body for each
patient to control the tube current, and“Intelli IP※3 ”
, an
4.5
image processing technique that applies iterative recon-
struction which repeats the calculations to reduce the 4.0

noise both in projection space and image space. 3.5

100mAs
We intend to reduce radiation exposure by utilizing 3.0 200mAs
240mAs
SD value

these functions not only when scanning children but dur- 2.5 250mAs
300mAs
ing all examinations. 2.0
350mAs
1.5 400mAs

3. Presentation of clinical images
（1）Clinical case 1 Brain image of a child: 6-year old boy
Scanning was performed with the protocol shown in
Table 1. For scanning unsedated children, the scan time
must be shortened. Although we considered performing a
non-helical scan by increasing the rotation speed to 0.75s/
rot since Supria installed here could generate outputs of
up to 400mA, we employed the scan conditions in Table 1
in consideration of the tradeoff with the view rate.
The brain image of a child generally shows less contrast
than that of an adult. However, the contrast obtained in
this case（Fig. 2）is likely to be sufficient for making clini-
cal diagnoses.
In addition, we consider that by jointly using Intelli IP,
it improves the image characteristics such as graininess,
and this leads to obtaining the images which are easy to
diagnose. For Intelli IP, the operator can select from
among seven levels（Level 1 to Level 7）
. We confirmed
how noise varied at each level by using a water phantom.
1.0
0.5
0.0
FBP Level 1 Level 2 Level 3 Level 4 Level 5 Level 6 Level 7
Intelli IP level
Fig. 3: Noise reduction effect of Intelli IP using a water
phantom
Figure 4 shows images in which Intelli IP was applied
to pediatric brain scans. The scanning conditions are iden-
tical to those indicated in Table 1. We studied whether
images with better visibility could be obtained owing to
the noise-reduction effect by increasing the level of Intelli
IP, even with actual clinical images. As a result of per-
forming SD measurements for each case at the epiphysis
level, it was confirmed that SD reduction effect is similar
to that of the phantom experiment. However, when the
level is increased excessively, our impression is that the
images become unsuitable for diagnostic use. In the case

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 of the current pediatric brain scan conditions, we infer
that Level 2 or Level 3 is approximately the appropriate
level.
Table 2. Because Supria constantly retains all data at the
maximum FOV（500mm）
, it can restore the lost portion
only by recalculation and can re-center the image（Fig.
5b）
. When scanning is performed with a fixed tube cur-
rent, this reduces radiation exposure by approximately
69mGy per rotation compared to when rescanning is per-
formed.

Table 2: Scanning conditions for Clinical case 2

kV mA Scan time Scan type
120 350 1.0 Normal
Slice thickness Collimation Tilt Kernel
FBP Level 1 5 0.625×16 9° F12

Level 2 Level 3 a: Image loss

example

Level 4 Level 5 b: Re-calculation

example

Fig. 5: Brain image of patient with a hunched condition:

86-year old male

（3）Clinical case 3 Adult lung image（arms lowered）

Level 6 Level 7
Fig. 4: Example of Intelli IP applied to the brain of a
child: 9-year old boy
（2）Clinical case 2 Brain image of patient with a hunched
condition: 86-year old male
In scanning patients who are hunched, image loss may
occur when the patient deviates from the FOV set at the
time of scanning. Figure 5a shows an image in which a
defect occurred under the scanning conditions shown in
:
92-year old female
At our hospital, scanning with the arms lifted is difficult
in some cases（e.g., with elderly patients）
. Figure 6 shows
an image of the lungs（arms lowered）scanned under the
conditions shown in Table 3. The image suggests that arti-
facts such as those that arise from the upper forelimb
bone are reduced to a degree that is unproblematic for
diagnosis. This is presumably due to the effect of the
CORE technique for the newly installed 3D image recon-
struction algorithm, in addition to the effects of ADNR
（Automatic Data Noise Reduction）
, an artifact suppres-
sion software program that had also been installed in the
previous system.

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 Table 3: Scanning conditions for Clinical case 3
kV mA Scan time Scan type
120 200mA 0.75 Volume
Slice thickness Collimation Beam pitch Kernel
5 1.25×16 1.06 F22/F32
Fig. 6: Adult lung image（arms lowered）: 92-year old female
（4）Clinical case 4 Adult lung image（patient with diffi-
culty assuming a dorsal position）
: 86-year old male
When scanning elderly patients, we sometimes encoun-
ter those that have difficulty assuming the dorsal position,
similar to cases of scanning with the arms lowered.
Figure 7 shows an image obtained by scanning in the
dorsal position.
For Supria installed here, which has a large gantry bore
of 750mm, the positioning of patients that need to be
scanned in an irregular position is relatively easy. In addi-
tion, our impression is that artifacts occur infrequently
even during scanning in an irregular position.
Fig. 7: Adult lung image（patient with difficulty assum-
ing the dorsal position）: 86-year old male
4. Future challenges
At our hospital, we consider it necessary to implement
further dose-reduction measures, particularly when scan-
ning children.
As has already been reported, when viewed in terms of
image SD values, a maximum dose-reduction effect of
approximately 80％ can be expected by using Intelli IP 2）.
However, increasing the level of Intelli IP appears to
change the visual quality. Specifically, image blurring
tends to intensify in accordance with the level of Intelli IP,
as shown in Fig. 4. This suggests that when considering
the compatibility between dose reduction and image qual-
ity, the proper level of Intelli IP and scanning conditions
should be continuously explored and established in accor-
dance with conditions such as age, sex, and scanned area of
the patient.
Although here we primarily investigated dose reduc-
tion in children, it will be important to continue investiga-
tions on optimizing scanning conditions（including Intelli
IP）so that radiation exposure can also be reduced during
other CT examinations.
5. Summary
Supria, manufactured by Hitachi Medical Corporation
and installed in our hospital, has a high degree of freedom
with regard to scan positioning during examination due to
its large gantry bore and constant retention of data within
the maximum FOV. In addition, because examinations
with a reduced dose are possible, we confirmed that the
system fits well with the classes of patient and regional
characteristics of our hospital and has high clinical utility.
High-resolution images can also be obtained even as the
breath holding time is shortened. This allows high-resolu-
tion images and low-dose examinations to be achieved
simultaneously－a feat that was difficult to achieve with
the previous system.
We suggest that this system can contribute to improv-
ing the quality of examinations（e.g., image quality）and
providing further benefits for patients.
※1 Supria, ※2 IntelliEC, and ※3 Intelli IP are registered trade-
marks of Hitachi Medical Corporation.
References
1） 2010 Population Census, Statistical Tables According
to Prefecture, City, District, Town, and Village.（in
Japanese）
2） K. Uchiyama et al.: Background Introduction and
Usage Experience of MDCT Supria from Hitachi
Medical Corporation. Radfan, Vol.11, No.15: 32-35,
2013.（in Japanese）
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