SOMATOM Emotion 6: Application Guide

SOMATOM Emotion 6
Application Guide
Routine Protocols
Software Version A70
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The information presented in this application guide
is for illustration only and is not intended to be relied
upon by the reader for instruction as to the practice
of medicine. Any health care practitioner reading this
information is reminded that they must use their own
learning, training and expertise in dealing with their
individual patients.
This material does not substitute for that duty and is
not intended by Siemens Medical Solutions Inc., to
be used for any purpose in that regard. The drugs and
doses mentioned herein were specified to the best
of our knowledge. We assume no responsibility whats-
oever for the accuracy of this information.
Variations may prove necessary for individual patients.
The treating physician bears the sole responsibility
for all of the parameters selected. The pertaining oper-
ating instructions must always be strictly followed
when operating the SOMATOM Emotion 6.
The statutory sources for the technical data are the
corresponding data sheets.
We express our sincere gratitude to the many customers
who contributed valuable input.
Special thanks to Christiane Bredenhoeller, Christoph
Süß, Thomas Flohr and the CT-Application Team for their
valuable assistance.
To improve future versions of this application guide,
we would highly appreciate your questions, suggestions
and comments.
Please contact us:
USC-Hotline:
Tel. no. +49-1803-112244
email ct-application.hotline@med.siemens.de
Editor: Ute Feuerlein
2
Overview
General 8
Children 24
Head 76
Neck 92
Shoulder 102
Thorax 106
Abdomen 134
Pelvis 164
Spine 172
Extremities 182
3
Content
General 8
· Concept 8
· Scan Set Up 9
· Scan and Reconstruction 9
– Slice Collimation and Slice Width 9
– Pitch 11
– Recon Job 11
– Kernels 12
– Image Filter 12
· Effective mAs 14
· Dose Information 15
– CTDIW and CTDIVol 15
– CARE Dose 17
– How Does it Work 17
· Workflow 19
– Auto Load in 3D and
Postprocessing Presets 19
· Contrast Medium IV Injection 20
· How to Create your own Scan Protocols 21
4
Content
Children 24
· Overview 24
· Hints in General 26
– Head kernels 29
– Body kernels 30
· HeadAngio 32
· HeadAngio06s 34
· Head 36
· HeadSeq 37
· Sinus 38
· InnerEar 40
· NeckRoutine 42
· CarotidCTA 44
· CarotidCTA06s 46
· NeonateBody 48
· NeonateBody06s 49
· ThoraxRoutine 50
· ThoraxRoutine06s 52
· ThoraxCombi 54
· ThoraxCombi06s 56
· ThoraxSeqHR 58
· AbdPelRoutine 60
· AbdPelRoutine06s 62
· AbdCTA 64
· AbdCTA06s 66
· Spine 68
· SpineSagittal 70
· Extremity 72
· ExtrHR 74
5
Content
Head 76
· Overview 76
· AngioHead 78
· AngioHead06s 80
· HeadSeq 82
· Head 84
· InnerEarSeq 86
· InnerEar 88
· OrbiSinus 90
Neck 92
· Overview 92
· AngioCarotid 94
· AngioCarotid06s 96
· NeckRoutine 98
· NeckThinSlice 100
Shoulder 102
· Overview 102
· Shoulder 104
Thorax 106
· Overview 106
· LungLowDose 110
· LungLowDose06s 112
· Embolism 114
· Embolism06s 116
· ThoraxCombi 118
· ThoraxCombi06s 120
· ThoraxRoutine 122
· ThoraxRoutine06s 124
· ThoraxFast 126
· ThoraxFast06s 128
· ThoraxHR 130
· ThoraxSeqHR 132
6
Content
Abdomen 134
· Overview 134
· AbdRoutine 140
· AbdRoutine06s 142
· AbdomenCombi 144
· AbdomenCombi06s 146
· AbdMultiPhase 148
· AbdMultiPhase06s 150
· AbdFast 152
· AbdFast06s 154
· AngioFast 156
· AngioFast06s 158
· AngioRoutine 160
· AngioRoutine06s 162
Pelvis 164
· Overview 164
· Hip 168
· PelvisRoutine 170
Spine 172
· Overview 172
· SpineRoutineSeq 176
· SpineObeseSeq 177
· Spine 178
· C-Spine 180
Extremities 182
· Overview 182
· AngioRunOff 186
· AngioRunOff06s 188
· ExtrCombi 190
· ExtrHR 192
7
General
Concept
The scan protocols for adult are defined according

to body regions – Head, Neck, Shoulder, Thorax,
Abdomen, Pelvis, Spine, Extremities.
The pediatric scan protocols are defined under the
folder “Children“.
The protocols for special applications are defined
under “Special“ (please refer to the Application Guide
for Special applications).
The general concept is as follows:
All not specially marked protocols are standard spiral
modes. E. g. “Head” means the spiral mode for the head.
“Fast“: uses 2.0 or 3.0 mm slice collimation and
a higher pitch for fast acquisition for CT Angios or
trauma cases.
“Routine“: uses either 1.0 mm or 2.0 mm slice colli-
mation depending on the region of interest for routine
studies.
“ThinSlice“: uses 1.0 mm slice collimation for thin
slice studies.
“HR“: uses 0.5 mm (optional) or 1.0 mm slice colli-
mation and rotation time of 1.0 s for High-resolution
studies.
“Combi“: uses 1.0 mm as slice collimation and by
default, has 2 reconstruction jobs: one thin slice width
for HiRes or CTA, and one thicker slice width for soft
tissue studies.
“Seq“: stands for Sequence. E. g. “HeadSeq“ means
the sequence mode for the head.
The existence of scan protocols depend on the system
configuration. Protocols with the 0.6 sec. rotation time
are only available on systems configured with the Power
Package, also 0.5 mm slice collimation is available only
on systems with High Resolution option.
8
General
Scan Set Up
Scans can be simply set up by selecting a predefined

examination protocol. To repeat any mode, just click
the chronicle with the right mouse button for “repeat”.
To delete it, select “cut“. Each chronicle is rewriteable
before “load“.
Multiple ranges can be run either automatically with
“auto range“, which is denoted by a bracket connecting
the two ranges, or separately with a “pause” in between.
Scan and Reconstruction
Slice Collimation and Slice Width

Slice collimation is the slice thickness resulting from
the effect of the tube-side collimator and the adaptive
detector array design. In Multislice CT, the Z-coverage
per rotation is given by the product of the number of
active detector slices and the collimation
(e. g. 6 x 1.0 mm).
Slice width is the true thickness of the reconstructed
image.
With the SOMATOM Emotion 6, you select the slice
collimation together with the slice width desired. The
slice width is independent of pitch and algorithm, i. e.
what you select is always what you get. Actually, you
do not need to care about the algorithm any more; the
software does it for you.
9
General
If Metrorecon is not selected you will get routinely

“Real Time” reconstructed images in full image quality.
The Recon icon on the chronicle will be labeled with
“RT”. After the scan the Real Time displayed image series
has to be reconstructed.
The following tables show you the possibilities of image
reconstruction in spiral and sequential scanning.
Slice Collimation and Slice Width for Spiral Mode

0.5 mm 0.63, 0.75, 1, 1.25, 2, 2.5, 3, 4, 5 mm
(optional)
1 mm 1.25, 2, 2.5, 3, 4, 5, 6, 8, 10 mm
2 mm 2.5, 3, 4, 5, 6, 8, 10 mm
3 mm 4, 5, 6, 8, 10 mm
Cardio Spiral Modes
1 mm 1.25, 2, 3 mm
2 mm 2.5, 3, 5 mm
Slice Collimation and Slice Width for Sequence Mode
1.0 mm 1.0, 2.0, 3.0 mm
2.0 mm 2, 4, 6, 12 mm
3.0 mm 3, 6, 9, 18 mm
5.0 mm 5, 10 mm
Perfusion Multiscan Modes
1 mm 1, 2, 3 mm
2 mm 2, 4, 6, 12 mm
3 mm 3, 6, 9, 18 mm
5 mm 5, 10 mm
ECG triggered Modes
1 mm 1.25, 2, 3 mm
2 mm 2.5, 3, 5 mm
HR Spiral Mode
0.5 mm 0.63, 0.75, 1, 1.25, 2, 2.5, 3, 4, 5 mm
(optional)
1 mm 1 mm
HR Sequence Mode
1 mm 1 mm
10
General
Pitch
In single slice CT:
Pitch = table movement per rotation/slice collimation
E. g.: slice collimation = 5 mm,
table moves 5 mm per rotation, then pitch = 1.
With the SOMATOM Emotion 6, in Siemens Multislice
CT, we differentiate between:
Feed/Rotation, the table movement per rotation
Volume Pitch, the table movement per rotation/
single slice collimation
E. g.: single slice collimation = 1.0 mm, table moves
6 mm per rotation, then the Volume Pitch = 6
Pitch Factor, the table movement per rotation/
collimation
E. g.: slice collimation = 6 x 1.0 mm, table moves
6 mm per rotation, then the Pitch Factor = 1
With the SOMATOM Emotion 6, you do not need to
select pitch. Once the scan range, scan time, slice
collimation, and rotation time is defined, the software
will adapt the table feed per rotation accordingly.
The Pitch Factor can be freely adapted from 0.5 – 1.8.
Recon Job
In the Recon card, you can define up to 3 reconstruction
jobs with different parameters either before or after
you acquire the data. When you click on “Recon“, they
will all be done automatically. In case you want to add
another recon job, simply click the little icon on the
chronicle with the right mouse button and select “delete
recon job“ to delete the one which has been completed,
and then one more recon job will be available in the
Recon card. (Note: what you delete is just the job from
the display, not the images that have been reconstructed.
Once reconstructed, these completed recon jobs stay
in the browser, until deleted from the hard drive). You
can also reconstruct images for all scans performed by
not selecting any range in the chronicle, prior to clicking
“Recon”.
11
General
Kernels
There are 5 different types of kernels: “H“ stands for
Head, “B“ stands for Body, “U“ stands for High Reso-
lution, “C“ stands for ChildHead, and “S“ stands for
Special Application, e. g., Osteo CT.
The image sharpness is defined by the numbers –
the higher the number, the sharper the image; the
lower the number, the smoother the image.
A set of 32 kernels is supplied with the Emotion 6 Soft-
ware, consisting of 13 body kernels B10s, B20s, B30s,
B31s, B35s, B40s, B41s, B46s, B50s, B60s, B70s, B80s,
B90s, 12 head kernels H10s, H20s, H21s, H30s, H31s,
H40s, H41s, H50s, H60s, H70s, H80s, H90s, 3 child
head kernels C20s, C30s, C60s, 4 special kernels S30s,
S80s, S90s, U90s.
Note: Do not use different kernels for other body parts
other than what they are designed for.
For further information regarding the kernels, please

refer to the “Hints in General” of the corresponding
body region.
Image Filter
There are 4 different filters available:
PFO: To reduce beam-hardening artifacts in head
images, particularly in the base of the skull, use the
Posterior Fossa Optimization (PFO) filter. It is highly
recommended to use the PFO filter for all soft tissue
reconstruction.
12
General
Reconstruction
with PFO filter.
Reconstruction
without PFO filter.
ASA: The Advanced Smoothing Algorithm (ASA) filter

reduces noise in soft tissue while edges with high con-
trast are preserved.
LCE: The Low-contrast enhancement (LCE) filter
enhances low-contrast detectability. It reduces the
image noise.
HCE: The High-contrast enhancement (HCE) filter
enhances high-contrast detectability. It increases the
image sharpness.
13
General
Effective mAs
In sequential scanning, the dose (Dseq) applied to the

patient is the product of the tube current-time (mAs)
and the CTDIw per mAs:
Dseq = DCTDIw x mAs
In spiral scanning, however, the applied dose (Dspiral)
is influenced by the “classical” mAs (mA x Rot Time) and
in addition by the Pitch Factor. For example, if a Multi-
slice CT scanner is used, the actual dose applied to the
patient in spiral scanning will be decreased when the
Pitch Factor is larger than 1, and increased when the
Pitch Factor is smaller than 1. Therefore, the dose in
spiral scanning has to be corrected by the Pitch Factor:
Dspiral = (DCTDIw x mA x Rot Time)/Pitch Factor
To make it easier for the users, the concept of the
“effective” mAs was introduced with the SOMATOM
Multislice scanners.
The effective mAs takes into account the influence of
pitch on both the image quality and dose:
Effective mAs = mAs/Pitch Factor
To calculate the dose on the SOMATOM Emotion 6,
you simply have to multiply the CTDIW per mAs with
the effective mAs of the scan:
Dspiral = DCTDIw x effective mAs
For spiral scan protocols, the indicated mAs is the effec-
tive mAs per image. The correlation between tube
current mA and effective mAs of spiral scans on a Multi-
slice CT scanner is given by the following formula:
Effective mAs = mA x RotTime/Pitch Factor
Feed/Rot
Pitch Factor =
nrow x Slice collimation
effective mAs
mA = x Pitch Factor
RotTime
where collimated Slice refers to the collimation of one
detector row, and nrow is the number of used detector
rows.
14
General
Dose Information
CTDIW and CTDIVol

The average dose in the scan plane is best described by
the CTDIW for the selected scan parameters. The CTDIW
is measured in the dedicated plastic phantoms – 16 cm
diameter for head and 32 cm diameter for body (as
defined in IEC 60601-2 -44). This dose number gives a
good estimate for the average dose applied in the
scanned volume as long as the patient size is similar to
the size of the respective dose phantoms.
Since the body size can be smaller or larger than
32 cm, the CTDIW value displayed can deviate from the
dose in the scanned volume.
The CTDIW definition and measurement is based on
single axial scan modes. For clinical scanning, i. e. scan-
ning of entire volumes in patients, the average dose
will also depend on the table feed in between axial scans
or the feed per rotation in spiral scanning. The dose,
expressed as the CTDIW, must therefore be corrected by
the pitch-factor of the spiral scan or an axial scan series
to describe the average dose in the scanned volume.
For this purpose the IEC defined the term “CTDIVol“ in
September 2002:
CTDIVol = CTDIW/pitch-factor
This dose number is displayed on the user interface for
the selected scan parameters.
Please note: Up to now the dose display on the
Somaris\5 user interface was labeled “CTDIW“.
This displayed CTDIW was also corrected for the pitch.
15
General
The CTDIVol value does not provide the entire information

of the radiation risk associated with CT examination.
For this purpose, the concept of the “Effective Dose“ was
introduced by ICRP (International Commission on
Radiation Protection). The effective dose is expressed
as a weighted sum of the dose applied not only to the
organs in the scanned range, but also to the rest of the
body. It could be measured in whole body phantoms
(Alderson phantom) or simulated with Monte Carlo
techniques.
The calculation of the effective dose is rather compli-
cated and has to be done by sophisticated programs.
These have to take into account the scan parameters,
the system design of individual scanner, such as x-ray
filtration and gantry geometry, the scan range, the
organs involved in the scanned range and the organs
affected by scattered radiation. For each organ, the
respective dose delivered during the CT scanning has
to be calculated and then multiplied by its radiation
risk factor. Finally the weighted organ dose numbers
are added up to get the effective dose.
The concept of effective dose would allow the com-
parison of radiation risk associated with different CT or
x-ray exams, i. e. different exams associated with the
same effective dose would have the same radiation risk
for the patient. It also allows comparing the applied
x-ray exposure to the natural background radiation,
e. g. 2 – 3 mSv per year in Germany.
16
General
CARE Dose
CARE Dose is a clinical application package that pro-
vides real-time tube current modulation for Spiral and
Sequential Scanning.
CARE Dose reduces patient dose significantly, espe-
cially in the regions of shoulder and pelvis. It decreases
tube load, which extends the capacity for volume scan-
ning with thinner slices, larger volumes or Multi-phase
studies.
It can also improve image quality by increasing mA
thus reducing image noise on the lateral views.
How Does it Work

It reduces the mA for low attenuation views up to 90%
and keeps the nominal higher mA for high attenuation
views, e. g. in the lateral projection (Fig. 4). This is done
“on-the-fly”, i. e. the scanner adapts the mA in real-time,
according to the patient’s attenuation profile (Fig. 5).
17
General
High
attenuation,
high mA
Low attenuation,
low mA
Fig. 4: Example of scanning in the shoulder region.
lateral Object attenuation

a.p. Modulated tube current
1.00
rel. units
0.75
0.50
0.25
time
Fig. 5: Principle of CARE Dose tube current adaptation.
• CARE Dose is pre-selected by default for most standard

protocols. It can be switched on/off in the scan card.
• For the average patients examination, CARE Dose
does not require any manual changes to the scan
protocol. However, the mAs must be adapted manu-
ally for obese and pediatric patients.
• The mean value of the mAs applied will be lower
than what you have selected. Although the average
mA for the entire scan will be lower than selected, we
allow the scanner to apply increased mA levels for
the high attenuation views. This may cause different
results of the tube load controller when switching
on and off CARE Dose.
• The mean value of the effective mAs applied is shown
in the image text.
18
General
Workflow
Auto Load in 3D and Postprocessing Presets

You can activate the “Auto load in 3D” function on the
Examination Card/Auto Tasking and link it to a recon
job. For example, the 2nd recon job with thinner slice
width in some of the examination protocols. If the post-
processing type is chosen from the pull down menu,
the reconstructed images will be loaded automatically
into the 3D Card on the Navigator with the correspond-
ing postprocessing type.
On the 3D Card you have the possibility to create MPR,
MIPthin Range Parallel and Radial protocols which can
be linked to a special series.
For example, if you always do sagittal Multiplanar
Reconstructions for a Spine examination, you load once
a Spine examination into the 3D Card. Select the image
type (MPR, MIPthin), select the orientation and open
the Range Parallel function. Adapt the range settings
(Image thickness, Distance between the images etc.)
and hit the link button. From that point on, you have a
predefined postprocessing protocol, linked to the series
description of a Spine examination.
Exactly the same can be done for VRT presets. In the
main menu, under Type/VRT Definition, you can link
VRT presets with a series description.
19
General
Some of the Scan protocols, primarily for Angio exami-

nations, are already preset in the protocol with Auto load
in 3D. If you prefer not to use this preset, please de-
select the Auto load in 3D and save your scan protocol.
Some of the Scan protocols are preset in the protocol
with links to a postprocessing protocol. If you prefer
not to have this preset, please delete the Range Parallel
preset or overwrite them with your own settings.
Contrast Medium IV Injection*
The administration of a contrast medium depends on

the indication and on the delay times to be used during
the examination. The patient’s weight and circulatory
system condition also play a role. In general, no more
than 3 ml per kg of body weight for adults and 2 ml per
kg of body weight for children should be applied.
As a rule of thumb, the contrast medium injection
should be stopped when the scan (or acquisition)
is finished. Keep this in mind, as you may save contrast
medium on your routine studies since the Multislice
spiral scan can be up to 10 times faster than a 1 second,
single slice spiral scan.
For CTA studies (arterial phase), the principle is to keep
contrast injection for the whole scan. Thus, the total
amount of contrast medium needed should be calcu-
lated with the following formula:
CM = (start delay time + scan time) x flow rate.
CARE Bolus or Test Bolus may be used for optimal
contrast bolus timing. Please refer to the Application
Guide for special protocols.
* For more information regarding the general use

of drugs and doses mentioned in this guide, please
refer to page 2.
20
General
How to Create your own

Scan Protocols
User-specific scan protocols can be saved with the
following basic procedure:
• Register a test patient, patient position must be
Head First – Supine
• Select a scan protocol.
• Set the table position to 0 (either at the gantry panel,
or on the topogram routine card).
• Modify the scan protocol, change parameters, add
new ranges etc.
• Do not load the scan protocol.
• Select Edit/Save Scan Protocol in the main menu.
• Select the organ region and the scan protocol name
in the pop-up dialog. You can either use the same
name to modify the existing scan protocol, or enter
a new name, which will create a new protocol name
and will not alter any of the existing protocols already
stored.
21
General
Tips
– We recommend the use of the default scan protocols
in order to achieve adequate image quality for the
“typical” patient. Using the default scan protocols
minimizes the occurrence of tube cooling delays and
maximizes x-ray tube life.
– It is recommended that you save your own scan
protocol with a new name in order to avoid over-
writing the default scan protocol.
– You may use preceding numbers (e. g. 1_Abdomen)
for user specific scan protocols to make them appear
on top of the list and to distinguish them from the
Siemens defaults.
– Do not use special characters like ”/”, ”.”, ”\” or ”blank”
within scan protocol names.
– Do not rename scan protocol files on Windows NT
level – this will lead to inconsistencies.
– Do not mix head and body scan protocols: e. g. do
not save a head mode in the abdomen directory.
– System/Run offers the tool “Restore Default Scan
Protocols“ which allows you to remove user specific
scan protocols and to restore the Siemens default
settings.
– System/Edit offers save/delete Scan Protocols.
– System/Run also offers the tool “List Scan Protocols“
which generates an HTML table of all available scan
protocols. This list can be printed or saved on Floppy
(“File/Save As…“).
22
General
23
Children
Overview
This folder contains 24 organ specific pediatric proto-

cols with 2 to 5 age or weight dependant subgroups.
For your convenience, the protocols are numbered
according to the body regions, i. e. from Head to Extre-
mities.
The scan protocols for Head and Neck regions are
defined according to age, and the scan protocols for
the other body regions are defined according to body
weight.
As a default, the effective mAs is set to the lowest
category, e. g. less than 6 months in head modes, and
the suggested effective mAs values for the other cate-
gories are written in additional lines in the chronicle.
Whenever possible 80 kV or 110 kV are used instead of
130 kV, either to exploit the significantly higher image
contrast of iodine contrast media at 80 kV or to reach a
lower dose level than possible with 130 kV.
• Head Angio
For head CT Angio studies
• HeadAngio06s
For head CT Angio studies, using a 0.6 sec.
rotation time (optional)
• Head
For routine head spiral studies
• HeadSeq
For routine head sequential studies
• Sinus
For routine sinus spiral studies
• InnerEar
High Resolution mode for inner ear spiral studies
with 6 x 0.5 mm slice collimation (optional)
• NeckRoutine
For routine neck spiral studies
• CarotidCTA
For carotid CT Angio studies
• CarotidCTA06s
For carotid CT Angio studies, using a 0.6 sec.
24
Children
• NeonateBody
Spiral mode for neonate studies
• NeonateBody06s
Spiral mode for neonate studies, using 0.6 sec.
• ThoraxRoutine
For routine chest spiral studies
• ThoraxRoutine06s
For routine chest spiral studies, using 0.6 sec.
• ThoraxCombi
For the combination of thin slice lung and routine
thorax studies
• ThoraxCombi06s
thorax studies, using 0.6 sec. rotation time (optional)
• ThoraxSeqHR
High resolution sequential mode for lung studies
• AbdPelRoutine
For routine abdominal spiral studies
• AbdPelRoutine06s
For routine abdominal spiral studies, using a 0.6 sec.
• AbdCTA
For abdominal CT Angio studies
• AbdCTA06s
For abdominal CT Angio studies, using a 0.6 sec.
• Spine
For routine spine spiral studies
• Spine Sagittal
Thin slice mode for spine spiral studies when
Multi Planar Reformations are necessary
• Extremity
For routine extremity spiral studies
• ExtremityHR
High Resolution mode for extremity spiral studies
with 6 x 0.5 mm slice collimation (optional)
25
Children
Hints in General
1. Topograms: 256 mm lateral topograms are defined

for the head modes, and 512 mm AP topograms are
defined for the body modes. Please keep in mind that
the children’s size can be dramatically different. You
should press the “Hold Measurement“ button when-
ever the range shown on the real time growing topo-
gram is long enough, in order to avoid unnecessary
radiation.
2. Gantry tilt is available for both, sequence and spiral
scanning. However, image artefacts may occur if spirals
are acquired with a tilt angle greater than 8°.
3. For all head studies, it is very important for image

quality purposes to position the patient in the center of
the scan field. Use the lateral laser beam to make sure
that the patient is positioned in the center.
4. Warm surroundings and dimmed lighting are help-

ful to make children more cooperative.
5. Sedation: Although the advent of the Multislice CT

scanner has enabled the user to scan through an area
of interest much faster than ever, sometimes, patient
motion can still lead to severe motion artifacts seen on
the resultant images. This becomes a factor especially
with infants and younger children who are unable to
hold still for the exam. Sedating this population may
be a viable option for your institution. Of course, appro-
priate protocols need to be established at your specific
institution. For instance, the drug of choice for specific
ages/weights of these patients (taking into conside-
ration the total time of the exam), the form of admini-
stration, patient preps, adequate monitoring of the
patient (pre-scan, during the exam and post-scan) etc.
should all be taken into consideration.
26
Children
The proper personnel and equipment must also

be readily available in the event of a problem.
6. Oral and rectal contrast administration: Depending

on the reason for the exam/status of the patient, oral
contrast may or may not be given to these patients.
In general, oral contrast is recommended to opacify
the intestinal tract, as unopacified bowel can have
the appearance of abdominal fluid or mass effect. Oral,
as well as rectal contrast may be required. Usually, a
diluted mixture of iodine and water is used as an oral
agent. Different substances can be added to this mix-
ture to help reduce the bitter taste and make it more
pleasing to the child (apple juice, fruit drink mixes are
just a few of these). Barium may of course be used
in some cases as well. Negative contrast agents such
as water are becoming more popular for delineation
of stomach or bowel wall borders, or when 3D recon-
structions are needed. The user needs to be aware of
all the contraindications of any of the contrast agents
they are using. It is recommended to refer to the spe-
cific vendors recommendations regarding this.
7. I.V. contrast administration: In general, 1 – 2 ml per

kg of body weight should be applied, however, since
the scanning can be completed in just a few seconds,
please keep in mind that the total injection time should
not be longer than the sum of start delay time and the
scan time – do not inject contrast after the scanning is
finished.
It is recommended to use CARE Bolus in order to
achieve optimal contrast enhancement.
Both start delay time and injection rate are exam-/
patient-dependent. I.V. injection with a power injector
is recommended for all scans whenever possible.
Some guidelines to follow with respect to flow rate are
noted in the chart below.
27
Children
Note: these injector guidelines are based on an

antecubital injection site. These guidelines may need
to be adjusted if the site is more peripheral.
Needle Size (gauge) Flow Rate (ml/sec.)
22 1.5
20 2.0 – 3.0
18 3.0 – 5.0
Central lines and ports may need to be hand injected
or power injected at a very low flow rate (1 ml/sec.).
PIC lines and 24 gauge (or smaller) lines are usually
hand injected. All of these protocols should be decided
on by your institution’s appropriate personnel.
8. 80 kV was also used for applications when the

lowest achievable mAs at 110 kV was still higher than
necessary for sufficient noise level (for technical
reasons, generators need to operate at a certain mini-
mum current for stable operation). For applications
such as neonate or airway scanning, the low tube out-
put at 80 kV can be used to further reduce the dose to
the patient.
9. Please observe the recommended mAs settings in

the chronicle.
Note, that these recommendations are valid for the
default tube voltage of the specific protocol.
10. To further optimize MPR image quality we
recommend that you reduce one or more of the follow-
ing: collimation, reconstruction increment, pitch
factor while using a wider slice width for image recon-
struction.
28
Children
Head kernels:
• For head scans of small children, the kernels C20s,
C30s (e. g. for soft tissue studies) and C60s (e. g. for
sinuses) should be chosen instead of the ”adult” head
kernels H20s, H30s and H60s.
• For soft tissue head studies, the standard kernel is
H40s; softer images are obtained with H30s or H20s,
H10s, sharper images with H50s. The kernels H21s,
H31s, H41s yield the same visual sharpness as H20s,
H30s, H40s, but a more agreeable image appearance
and sometimes even better low contrast detectability,
the reason is, as with B31s and B41s, the fine-grained
noise structure.
• For the standard head protocols, we propose H21s,
H31s, H41s.
• High resolution head studies should be performed
with H60s, H70s (e. g. for dental and sinuses) and
H80s, H90s (e. g. inner ear).
29
Children
Body kernels:
• As standard kernels for body tissue studies B30s or
B40s are recommended; softer images are obtained
with B20s or B10s (extremely soft). The kernels B31s
or B41s have about the same visual sharpness as B30s,
respectively, B40s, the image appearance, however,
is more agreeable due to a ”fine-grained” noise struc-
ture; quite often, the low contrast detectability is
improved by using B31s, B41s instead of B30s, B40s.
• The 2 kernels B35s and B46s are especially designed
for cardiac application, in particular, B35s should be
used for Ca-scoring, and B46s for patency of stents.
• For higher sharpness, as is required e. g. in patient
protocols for cervical spine, shoulder, extremities,
thorax, the kernels B50s, B60s, B70s, B80s are avail-
able.
• A special high resolution lung kernel is supplied with
B90s; by using kernel B90s, practically the same
image impression is obtained as with HCE-filtering of
a B40s image.
30
Children
The special kernels are mostly used for ”physical”

measurements with phantoms, e. g. for adjustment
procedures (S80s), for constancy and acceptance
tests (S80s, U90s), or for specification purposes (U90s).
For special patient protocols, S80s and U90s are
chosen, e. g. for osteo (S80s) and for high resolution
bone studies (U90s).
We recommend to use the high resolution specifi-
cation kernel U90s only with ”small” objects, like the
wrist, otherwise artifacts will occur in the images.
31
Children
HeadAngio
Indications:
Spiral mode for head CT angiography, e. g. cerebral
vascular abnormalities, tumors etc.
A range of 6 cm will be covered in 6.9 sec.
HeadCTA
kV 80
Effective mAs *
Slice collimation 1.0 mm
Slice width 1.25 mm
Feed/Rotation 9.0 mm
Rotation time 0.8 sec.
Kernel C30s
Increment 0.8 mm
Image order ca-cr
* The mAs should be adjusted to the age of the child.
Age kV mAs CTDIVol

(mGy)
< 6 years 80 80 6.5
6 years – 12 years 80 120 9.8
32
Children
For the 1st reconstruction the Autoload into MIPthin

Range on the 3D Card is activated. The images will be
automatically loaded into 3D, MIPthin, and a coronal
MIPthin Range will pop up.
Please notice, if you are not satisfied with the Range
preset adapt the parameters to your needs and link
them to the series.
MIPthin: HeadAngio coronal

Image thickness 3
Distance between images 3
Number of images 35
Contrast medium IV injection

Start delay exam dependent
Flow rate dependent upon needle size/Access site
Total amount 1 – 2 ml per kg of body weight
Tips
• Children, who are more than 12 years old should be
scanned with an adult protocol.
33
Children
HeadAngio06s
Indications:
Spiral mode for head CT angiography, e. g. cerebral
vascular abnormalities, tumors etc., using a 0.6 sec.
rotation time.
HeadCTA
kV 80
Effective mAs *
Slice width 1.25 mm
Kernel C30s
Increment 0.8 mm
Image order ca-cr
Age kV mAs CTDIVol

(mGy)
< 6 years 80 80 6.5
6 years – 12 years 80 120 9.8
34
Children

them to the series.
MIPthin: HeadAngio coronal

Image thickness 3
Number of images 35

Tips
35
Children
Head
Indications:
Spiral mode for routine head studies, e. g. tumors,
hydrocephalus, hemorrhaging, abnormalities, etc.
A range of 8.5 cm will be covered in 16.2 sec.
Head
kV 110
Effective mAs *
Slice width 5.0 mm
Kernel C30s
Increment 5.0 mm
Image order ca-cr
Body Weight kV mAs CTDIVol

(mGy)
< 6 months 110 60 11.4
6 months – 3 years 110 170 32.3
3 years – 6 years 110 310 59.0

Tips
• Children, who are more than 6 years old, should
be scanned with an adult protocol as the skull by this
time is fully grown.
• When bone structure is of interest, use kernel C60s
for image reconstruction.
• Posterior Fossa Optimization Filter
Posterior Fossa Optimization (PFO) filter.
36
Children
HeadSeq
Indications:
Sequential mode for routine head studies for
children, e. g. tumors, hydrocephalus, hemorrhaging,
abnormalities, etc.
HeadSeq
kV 110
mAs *
Slice width 6.0 mm
Feed/Scan 12 mm
Kernel C30s
Image order ca-cr
Age kV mAs CTDIVol

(mGy)
< 6 months 110 60 9.8
6 months – 3 years 110 170 27.8
3 years – 6 years 110 310 50.7

Tips
• When bone structure is of interest, use kernel C60s
• Posterior Fossa Optimization Filter
Posterior Fossa Optimization (PFO) filter.
37
Children
Sinus
Indications:
Spiral mode for routine spiral studies of the sinuses
and for the paranasal sinuses when Multi Planar
Reformation (MPR) are intended, e. g. sinusitis, pneu-
matization, polyposis, malformations, tumors etc.
Sinus 2nd reconstr.

kV 110
Effective mAs *
Slice width 3.0 mm 1.25 mm
Kernel C30s C60s
Increment 3.0 mm 0.8 mm
Image order ca-cr
38
Children
Age kV mAs CTDIVol

(mGy)
< 3 years 110 35 6.6
3 years – 6 years 110 50 9.5
For the 2nd reconstruction the Autoload into the MPR

Range on the 3D Card is activated. The images will
be automatically loaded into 3D, MPR, and a coronal
MPRthick Range will pop up. Please notice, if you are
not satisfied with the Range preset adapt the para-
meters to your needs and link them to the series.
MPRthick: Sinus coronal

Image thickness 2
Number of images 30

Tips
• Children, who are more than 6 years old, should be
• The second recon job is defined with kernel C60s
and with an overlap for visualizing bone structures
with MPR.
• If the study is focused on bone structure only, the
mAs can be reduced to 20 for all age groups.
39
Children
InnerEar
Indications:
High Resolution Spiral mode for inner ear studies, e. g.
malformations of the inner ear, inflammatory changes,
pathologies of the mastoid process, tumor processes
of the pyramids, posttraumatic changes, etc.
InnerEar
kV 110
Effective mAs *
Slice width 0.63 mm
Kernel H90s
Increment 0.5 mm
Image order ca-cr
40
Children
Age kV mAs CTDIVole

(mGy)
< 3 years 110 30 5.9
3 years – 6 years 110 50 9.9

Tips
• When soft tissue is of interest, use kernel H30s/H31s
41
Children
NeckRoutine
Indications:
Spiral mode for routine neck studies, e. g. tumors,
lymphoma, abscesses, etc.
Neck
kV 110
Effective mAs *
Slice width 3.0 mm
Kernel B50s
Increment 3.0 mm
Image order ca-cr
Age kV mAs CTDIVol

(mGy)
< 3 years 110 35 2.7
3 years – 6 years 110 50 3.9

Tips
42
Children
43
Children
CarotidCTA
Indications:
CT angiography of the carotid arteries, e. g. carotid
stenosis or occlusion, vascular abnormalities of the
carotids or vertebral arteries, etc.
CTA 2nd reconstr.

kV 80
Effective mAs *
Kernel B41s B31s
Image order ca-cr
Age kV mAs CTDIVol

(mGy)
< 6 years 80 40 1.4
6 years – 12 years 80 60 2.1
44
Children
For the 2nd reconstruction the Autoload into MIPthin

them to the series.
MIPthin: CarotidCTA coronal

Image thickness 3
Number of images 20

Tips
• The first recon job is defined for soft tissue visuali-
zation.
45
Children
CarotidCTA06s
Indications:
CT angiography of the carotid arteries, e. g. carotid
stenosis or occlusion, vascular abnormalities of the
carotids or vertebral arteries, etc., using a 0.6 sec.
rotation time.
CTA 2nd reconstr.

kV 80
Effective mAs *
Kernel B41s B31s
Image order ca-cr
Age kV mAs CTDIVol

(mGy)
< 6 years 80 40 1.4
6 years – 12 years 80 60 2.1
46
Children

them to the series.
MIPthin: CarotidCTA coronal

Image thickness 3
Number of images 20

Tips
• The first recon job is defined for soft tissue visuali-
zation.
47
Children
NeonateBody
Indications:
Spiral mode for routine neonate body studies, e. g.
tumors, abnormalities, malformations, abscesses, etc.
NeonateBody
kV 80
Effective mAs 35
Slice width 5.0 mm
Kernel B41s
Increment 4.0 mm
Image order cr-ca
CTDIVol 1.1 mGy

Tips
• You can modify the slice width for image reconstruc-
tion according to the clinical indications.
48
Children
NeonateBody06s
Indications:
Spiral mode for routine neonate body studies, e. g.
tumors, abnormalities, malformations, abscesses,
etc., using a 0.6 sec. rotation time.
NeonateBody
kV 80
Effective mAs 35
Slice width 5.0 mm
Kernel B41s
Increment 4.0 mm
Image order cr-ca
CTDIVol 1.1 mGy

Tips
• You can modify the slice width for image reconstruc-
tion according to the clinical indications.
49
Children
ThoraxRoutine
Indications:
Spiral mode for routine thorax studies, e. g.
pneumonia, tumors, metastases, lymphoma, vascular
abnormalities etc.
50
Children
Thorax 2nd reconstr.

kV 110
Effective mAs *
Kernel B41s B60s
Image order cr-ca
* The mAs should be adjusted to the body weight
of the child.
Body weight kV mAs CTDIVol

(mGy)
< 15 kg 110 13 1.0
15 – 24 kg 110 17 1.3
25 – 34 kg 110 26 2.0
35 – 44 kg 110 43 3.3
45 – 55 kg 110 60 4.7

Tips
• Children with a body weight of more than 55 kg
should be examined with an adult protocol.
• The first and second recon jobs are defined for
visualization of the mediastinum and the lungs,
respectively.
51
Children
ThoraxRoutine06s
Indications:
Spiral mode for routine thorax studies, e. g.
pneumonia, tumors, metastases, lymphoma, vascular
abnormalities etc., using a 0.6 sec. rotation time.
52
Children

kV 110
Effective mAs *
Kernel B41s B60s
Image order cr-ca

of the child.

(mGy)
< 15 kg 110 13 1.0
15 – 24 kg 110 17 1.3
25 – 34 kg 110 26 2.0
35 – 44 kg 110 43 3.3
45 – 55 kg 110 60 4.7

Tips
• The first and second recon jobs are defined for
visualization of the mediastinum and the lungs,
respectively.
53
Children
ThoraxCombi
Indications:
Combining thin slice lung and routine thorax studies
with one spiral scan. E. g. thorax studies in general and
interstitial changes in the lungs. There are two recon
jobs predefined. The first one, with 3 mm slice thick-
ness, for the mediastinum, the second reconstruction,
with 1.25 mm slice thickness, for the lung.
A range of 15 cm will be covered in 15 sec.
54
Children

kV 110
Effective mAs *
Kernel B41s B60s
Image order cr-ca

of the child.

(mGy)
< 15 kg 110 20
15 – 24 kg 110 26 2.4
25 – 34 kg 110 39 3.5
35 – 44 kg 110 65
45 – 55 kg 110 90 8.2

Tips
• Two recon jobs are predefined for image reconstruc-
tion of routine thorax and thin slice lung.
55
Children
ThoraxCombi06s
Indications:
with one spiral scan. E. g. thorax studies in general
and interstitial changes in the lungs. There are two
recon jobs predefined. The first one, with 3 mm slice
thickness, for the mediastinum, the second recon-
struction, with 1.25 mm slice thickness, for the lung,
using a 0.6 sec. rotation time.
56
Children

kV 110
Effective mAs *
Kernel B41s B60s
Image order cr-ca

of the child.

(mGy)
< 15 kg 110 20
15 – 24 kg 110 26 2.6
25 – 34 kg 110 39 3.5
35 – 44 kg 110 65
45 – 55 kg 110 90 8.2

Tips
• Two recon jobs are predefined for image reconstruc-
tion of routine thorax and thin slice lung.
57
Children
ThoraxSeqHR
Indications:
Sequence mode for High Resolution lung studies, e. g.
interstitial changes of the lung parenchyma, etc.
ThorHR
kV 110
mAs *
Slice width 1.0 mm
Feed/Scan 10.0 mm
Kernel B90s
Image order cr-ca

of the child.

(mGy)
< 35 kg 110 36 0.3
35 – 54 kg 110 120 0.9
Tips
• If you want to acquire the patient at full inspiration
or full expiration, you should practice the breathing
with the patient a few times before beginning the
scan, so that reproducibility may be improved.
58
Children
59
Children
AbdPelRoutine
Indications:
Spiral mode for routine studies in the region
of abdomen and pelvis, e. g. tumors, lymphoma,
abscesses, post-traumatic changes, etc.
Abd
kV 110
Effective mAs *
Slice width 5.0 mm
Kernel B41s
Increment 5.0 mm
Image order cr-ca

of the child.

(mGy)
< 15 kg 110 15 1.2
15 – 24 kg 110 30 2.4
25 – 34 kg 110 50 3.9
35 – 44 kg 110 75 5.8
45 – 55 kg 110 105 8.2

60
Children
Tips
61
Children
AbdPelRoutine06s
Indications:
Spiral mode for routine studies in the region of abdomen
and pelvis, e. g. tumors, lymphoma, abscesses, post-
traumatic changes, etc., using a 0.6 sec. rotation time.
Abd
kV 110
Effective mAs *
Slice width 5.0 mm
Kernel B41s
Increment 5.0 mm
Image order cr-ca

of the child.

(mGy)
< 15 kg 110 15 1.2
15 – 24 kg 110 30 2.4
25 – 34 kg 110 50 3.9
35 – 44 kg 110 75 5.8
45 – 55 kg 110 105 8.2

62
Children
Tips
63
Children
AbdCTA
Indications:
For abdominal CT Angio studies, e. g. vascular
abnormalities, aneurysms, etc.
AbdCTA 2nd reconstr.

kV 80
Effective mAs *
Kernel B41s B31s
Image order cr-ca

of the child.

(mGy)
< 15 kg 80 40 1.4
15 – 24 kg 80 60 2.1
25 – 34 kg 80 80 2.8
35 – 44 kg 80 100 3.5
45 – 54 kg 80 130 4.6

automatically loaded into 3D, MIPthin, and a sagittal
them to the series.
64
Children
MIPthin: AbdCTA sagittal

Image thickness 3
Number of images 60

Tips
• The first recon job is defined for image viewing and
filming.
65
Children
AbdCTA06s
Indications:
For abdominal CT Angio studies, e. g. vascular abnor-
malities, aneurysms, etc., using a 0.6 sec. rotation time.
AbdCTA 2nd reconstr.

kV 80
Effective mAs *
Kernel B41s B31s
Image order cr-ca

of the child.

(mGy)
< 15 kg 80 40 1.4
15 – 24 kg 80 60 2.1
25 – 34 kg 80 80 2.8
35 – 44 kg 80 100 3.5
45 – 54 kg 80 130 4.6

automatically loaded into 3D, MIPthin, and a sagittal
them to the series.
66
Children
MIPthin: AbdCTA sagittal

Image thickness 3
Number of images 60

Tips
• The first recon job is defined for image viewing and
filming.
67
Children
Spine
Indications:
Spiral mode for spine studies, e. g. post-traumatic
changes, tumors, malformations, orthopedic indi-
cations, etc.
Spine 2nd reconstr.

kV 110
Effective mAs *
Kernel B41s B60s
Image order cr-ca

of the child.

(mGy)
< 15 kg 110 22 1.7
15 – 24 kg 110 47 3.7
25 – 34 kg 110 78 6.0
35 – 44 kg 110 110 8.6
45 – 55 kg 110 173 13.5
68
Children

Tips
• If the study is focused on bone structures only,
the mAs can be reduced up to 30% for children with
a body weight of more than 25 kg.
69
Children
SpineSagittal
Indications:
Spiral mode for the spine when Multi Planar Reforma-
tion (MPR) are intended, e. g. post-traumatic changes,
tumors, malformations, CT-myelography, etc.
Spine 2nd reconstr.

kV 110
Effective mAs *
Kernel B41s B60s
Image order cr-ca

of the child.

(mGy)
< 15 kg 110 40 3.5
15 – 24 kg 110 50 4.4
25 – 34 kg 110 60 5.2
35 – 44 kg 110 70 6.1
45 – 55 kg 110 80 7.0

be automatically loaded into 3D, MPR, and a sagittal
MPRthick Range will pop up.
them to the series.
70
Children
MPRthick: Spine sagittal

Image thickness 3
Number of images 20

Tips
71
Children
Extremity
Indications:
Spiral mode for extremity studies, e. g. post-traumatic
changes, tumors, malformations, etc.
Extre 2nd reconstr.

kV 110
Effective mAs *
Kernel B41s B70s
Image order cr-ca

of the child.

(mGy)
< 15 kg 110 15 1.4
15 – 34 kg 110 25 2.3
35 – 54 kg 110 50 4.5

them to the series.
72
Children
MPRthick: Extremity coronal

Image thickness 3
Number of images 20

Tips
73
Children
ExtrHR
Indications:
Spiral mode for High Resolution bone studies, e. g.
tumors, posttraumatic changes, orthopedic indications,
etc.
Two recon jobs are predefined for image reconstruc-
tion of the soft tissue and bone structure.
ExtrHR 2nd reconstr.

kV 110
Effective mAs *
Kernel B41s U90s
Image order cr-ca

of the child.

(mGy)
< 15 kg 110 35 3.3
15 – 34 kg 110 50 4.7
35 – 54 kg 110 80 7.5

them to the series.
74
Children
MPRthick: Extremity coronal

Image thickness 3
Number of images 20
Tips
75
Head
Overview
• AngioHead
For CT Angio studies using 1.0 mm slice collimation
and a 1.25 mm slice thickness
• AngioHead06s
For CT Angio studies using 0.6 sec. rotation time
(optional)
• HeadSeq
Sequence mode for base of the skull and cerebrum
routine studies
• Head
Spiral mode for base of skull and cerebrum routine
studies
• InnerEarSeq
Sequence mode for inner ear High Resolution
studies using 1.0 mm slice collimation and a 1.0 mm
slice thickness
• InnerEar
Spiral mode for inner ear High Resolution studies
using 0.5 mm slice collimation (optional) and a
0.63 mm slice thickness
• OrbiSinus
Spiral mode for orbital and sinus studies
76
Head
Hints in General
• Topogram: Lateral, 256 mm.

• Patient positioning:
Patient lying in supine position, arms resting against
body, secure head well in the head holder, support
lower legs.
• Gantry tilt is available for both, sequence and spiral
scanning. However, image artefacts may occur if
spirals are acquired with a tilt angle greater than 8°.
• For all head studies, it is very important for image
quality to position the patient in the center of the
scan field. Use the lateral laser beam to make sure
that the patient is positioned in the center.
• In general, cerebrum studies with contrast medium,
except CTA and nasopharynx, can be performed
by hand injection. Start the scan after the injection is
completed.
• To further optimize MPR image quality we recommend
that you reduce one or more of the following: colli-
mation, reconstruction increment, pitch factor while
using a wider slice width for image reconstruction.
Head kernels:
• For soft tissue head studies, the standard kernel is
H40s; softer images are obtained with H30s or H20s,
H10s, sharper images with H50s. The kernels H21s,
H31s, H41s yield the same visual sharpness as H20s,
H30s, H40s, but a more agreeable image appearance
and sometimes even better low contrast detectability,
the reason is, as with B31s and B41s, the fine-grained
noise structure. For the standard head protocols, we
propose H21s, H31s, H41s.
• High resolution head studies should be performed
with H60s, H70s (e. g. for dental and sinuses) and
H80s, H90s (e. g. inner ear).
77
Head
AngioHead
Indications:
Spiral mode for cerebral CT Angios, e. g. cerebral
vascular abnormalities, tumors and follow up studies
etc.
Two recon jobs are predefined for postprocessing.
A range of 80 mm will be covered in 12.3 sec.
78
Head
AngioHead 2nd reconstr.

kV 110
Effective mAs 70
Kernel H31s H20s
Image order ca-cr
CTDIVol 13.3 mGy

preset adapt the parameters to your needs and link them
to the series.
MIPthin: AngioHead coronal

Image thickness 3
Number of images 35

Start delay 18 sec.
Flow rate 3.5 ml/sec.
Total amount 75 ml
Use of CARE Bolus with monitoring scans positioned at

the level of the basilar artery or carotid artery. Set the
trigger threshold at 120 HU, or use manual triggering.
79
Head
AngioHead06s
Indications:
Spiral mode for cerebral CT Angios, e. g. cerebral
vascular abnormalities, tumors and follow up studies
A range of 80 mm will be covered in 9.2 sec.
80
Head
AngioHead 2nd reconstr.

kV 110
Effective mAs 70
Kernel H31s H20s
Image order ca-cr
CTDIVol 13.4 mGy

to the series.
MIPthin: AngioHead coronal

Image thickness 3
Number of images 35

Start delay 18 sec.
Total amount 75 ml
Use of CARE Bolus with monitoring scans positioned at

the level of the basilar artery or carotid artery. Set the
trigger threshold at 120 HU, or use manual triggering.
81
Head
HeadSeq
Indications:
Sequence mode for routine head studies, e. g.
stroke, brain tumors, cranial trauma, cerebral atrophy,
hydrocephalus, and inflammation, etc.
Two ranges are predefined. One for the base of the
skull and one for the cerebrum, the scan length for the
entire head is 125 mm.
For both ranges a typical gantry tilt of -20° is predefined.
82
Head
BaseSeq CerebrumSeq
kV 130 130
mAs 260 300
Slice collimation 2.0 mm 3.0 mm
Feed/Scan 12.5 mm 19.0 mm
Rotation time 1.5 sec. 1.5 sec.
Kernel H31s H31s
Image order ca-cr ca-cr
CTDIVol 58.8 mGy 63.2 mGy
PosteriorFossaOptimization Filter
images, use for both ranges the Posterior Fossa
Optimization (PFO) filter.

Start delay 60 sec.
Flow rate 2 ml/sec.
Total amount 50 – 60 ml
83
Head
Head
Indications:
Spiral mode for routine head studies, e. g. stroke,
brain tumors, cranial trauma, cerebral atrophy, hydro-
cephalus, and inflammation, etc.
Two ranges are predefined for the base of the skull
and cerebrum.
A range for the base of 40 mm will be covered in
12.0 sec., a range for the cerebrum of 80 mm will be
covered in 12.0 sec.
84
Head
Base Cerebrum
kV 130 130
Effective mAs 240 300
Slice collimation 1.0 mm 2.0 mm
Feed/Rotation 4.0 mm 8.0 mm
Rotation time 1.0 sec. 1.0 sec.
Kernel H31s H31s
Image order ca-cr ca-cr
CTDIVol 65.9 mGy 70.7 mGy
PosteriorFossaOptimization Filter
images, use for both ranges the Posterior Fossa
Optimization (PFO) filter.

Start delay 60 sec.
Flow rate 2 ml/sec.
85
Head
InnerEarSeq
Indications:
Sequence mode for inner ear High Resolution studies,
e. g. inflammatory changes, tumorous processes
of pyramids, cerebellopontine angle tumors, post-
traumatic changes, etc.
The scan length is 47 mm and a typical gantry tilt of
-20° is predefined.
86
Head
InnerEarSeq
kV 130
mAs 180
Slice width 1.0 mm
Feed/Scan 6.0 mm
Kernel H90s
Image order ca-cr
CTDIVol 49.4 mGy

Start delay 60 sec.
Flow rate 2 ml/sec.
Total amount 60 ml
For image reconstruction of soft tissue, use kernel

H30s/H31s.
87
Head
InnerEar
Indications:
Spiral mode for inner ear High Resolution studies,
e. g. inflammatory changes, tumorous processes
of pyramids, cerebellopontine angle tumors, post-
traumatic changes, etc.
InnerEar
kV 130
Effective mAs 150
Slice width 0.63 mm
Kernel H90s
Increment 0.5 mm
Image order ca-cr
CTDIVol 42.7 mGy

Start delay 60 sec.
Flow rate 2 ml/sec.
Total amount 50 ml

H30s/H31s.
88
Head
89
Head
OrbiSinus
Indications:
Spiral mode for orbital and paranasal sinuses studies,
e. g. sinusitis, mucocele, pneumatization, polyposis,
tumor, corrections etc.
Two recon jobs are predefined for image reconstruction
of the soft tissue and bone structure.
OrbiSinus 2nd reconstr.

kV 130
Effective mAs 60
Kernel H31s H70s
Image order ca-cr
CTDIVol 16.5 mGy
90
Head

them to the series.
MPRthick: Sinus coronal

Image thickness 2
Number of images 30

Start delay 45 sec.
Total amount 75 ml
In this protocol, two recon tasks are predefined for

image reconstruction for both soft issue and bone struc-
ture. If one of them is not required, you can delete it
by clicking the icon of the recon task on the chronicle
with the right mouse button and select “delete recon
job“. You should do this before you start the recon-
struction.
When performing Orbit studies, the patient should
be told to keep his/her eyes closed. This will reduce the
possibility of small streak artifacts from eye movement.
If the study is focused on bone structure only, you can
reduce the mAs to 20.
91
Neck
Overview
• AngioCarotid
For CTA studies
• AngioCarotid06s
For CTA studies, using a rotation time of 0.6 sec.
(optional)
• NeckRoutine
For routine soft tissue spiral studies
• NeckThinSlice
For soft tissue thin slice spiral studies
92
Neck
Hints in General
• Topogram: Lateral, 256 mm, for CTAs AP, 256 mm

Patient lying in supine position, hyperextend neck
slightly, secure head well in head holder.
• Patient respiratory instruction:
do not breathe, do not swallow.
Body kernels:
thorax, lung, the kernels B50s, B60s, B70s, B80s are
available.
• A special high resolution lung kernel is supplied
with B90s; by using kernel B90s, practically the same
a B40s image.
• In case of 3D study only, the mAs value can be
reduced by 50%. Use kernel B10s and at least 50%
overlapping for image reconstruction.
93
Neck
AngioCarotid
Indications:
Noninvasive CT angiography of carotid stenosis
or occlusions, plaques course abnormalities of the
carotids and vertebral arteries, etc.
94
Neck
AngioCarotid 2nd reconstr.

kV 110
Effective mAs 70
Kernel B31s B31s
Image order cr-ca
CTDIVol 6.4 mGy

to the series.
MIPthin: AngioCarotid coronal

Image thickness 3
Number of images 20

Start delay 15 sec.
Flow rate 4 ml/sec.
Total amount 90 ml
CARE Bolus may be used to optimize the bolus timing.

Set the ROI for monitoring scan in the aortic arch
with triggering threshold of 120 HU, or use manual
triggering.
95
Neck
AngioCarotid06s
Indications:
Noninvasive CT angiography of carotid stenosis
or occlusions, plaques course abnormalities of the
carotids and vertebral arteries, etc.
96
Neck
AngioCarotid 2nd reconstr.

kV 110
Effective mAs 70
Kernel B31s B31s
Image order cr-ca
CTDIVol 6.4 mGy

to the series.
MIPthin: AngioCarotid coronal

Image thickness 3
Number of images 20

Start delay 15 sec.
Flow rate 4 ml/sec.
Total amount 90 ml
CARE Bolus may be used to optimize the bolus timing.

Set the ROI for monitoring scan in the aortic arch
with triggering threshold of 120 HU, or use manual
triggering.
97
Neck
NeckRoutine
Indications:
For soft tissue spiral studies in the cervical region.
E. g. tumors, lymphoma, abscesses etc.
A typical range of 20 cm will be covered in 10.5 sec.
98
Neck
Neck
kV 130
Effective mAs 85
Slice width 5.0 mm
Kernel B50s
Increment 5.0 mm
Image order cr-ca
CTDIVol 9.7 mGy

Start delay 45 sec.
Total amount 100 ml
Patient positioning is very important for artifact-free

images. The thoracic girdle should be positioned as far
as possible in the caudal direction. This can be done
using a strap with a permanent loop or Velcro fastener
at its end. The ends of the strap must be attached to
the patients wrists. Then the strap must be wrapped
around the patients feet with his legs extended and
under tension. The entire thoracic girdle is thus pulled
toward the patients feet.
99
Neck
NeckThinSlice
Indications:
Spiral mode using thin slices for soft tissue studies.
E. g. the functional study of the throat.
Two recon jobs are predefined: thinner slice recon-
struction used for post-processing, and thicker slice
reconstruction for soft tissue.
100
Neck
NeckThinSlice 2nd reconstr.

kV 130
Effective mAs 130
Kernel B50s B50s
Image order cr-ca
CTDIVol 17.2 mGy

be automatically loaded into 3D, MPR, and a sagittal
to the series.
MPRthick: NeckThinSlice sagittal

Image thickness 3
Number of images 20

Start delay 45 sec.
Flow rate 3 ml/sec.
Total amount 100 ml
This protocol can also be used in case of suspected

tumor of the hypopharynx and larynx. It is recommen-
ded to acquire the images in E-phonation, and recon-
struct the images with 1 mm slice width and increment
of 0.7 mm for performing MPRs. This would help
differentiate tumor lesions from normal pharyngeal
mucosa.
101
Shoulder
Overview
• Shoulder
Spiral mode for HiRes bone studies and soft tissues
102
Shoulder
Hints in General
• Topogram: AP, 256 mm.

Patient lying in supine position, the uninjured arm
placed above the head, the injured arm placed flat
against his body. If only one side is under investiga-
tion, position this side in the center and support the
other side with a Bocollo pillow (optional).
• If only one side is examined, it is advisable to enter
the side in the comment line on the routine card.
Body kernels:
available.
a B40s image.
103
Shoulder
Shoulder
Indications:
Spiral mode for HiRes bone studies and soft tissues.
E. g. evaluation of joint cavities, masses, trauma,
dislocations, orthopedic indications etc.
A scan range of 15 cm will be covered in 21.8 sec.
104
Shoulder
Shoulder
kV 130
Effective mAs 85
Slice width 3.0 mm
Kernel B60s
Increment 2.0 mm
Image order cr-ca
CTDIVol 9.7 mGy
In case of 3D study, mAs value can be reduced by 50%.

Use raw data to review a target region if necessary.
For image reconstruction of soft tissue use kernel B31s
and a slice width of 5.0 mm.
105
Thorax
Overview
• LungLowDose
Spiral mode with very low dose for special lung
studies, e. g. early visualization of pulmonary nodules
• LungLowDose06s
Spiral mode with very low dose and a rotation time
of 0.6 sec. for special lung studies. E. g. early visuali-
zation of pulmonary nodules (optional)
• Embolism
Spiral mode for Pulmonary Emboli studies
• Embolism06s
Spiral mode for Pulmonary Emboli studies
using a rotation time of 0.6 sec. (optional)
106
Thorax
• ThoraxCombi
thorax studies
• ThoraxCombi06s
thorax studies, using a rotation time of 0.6 sec.
(optional)
• ThoraxRoutine
For routine thorax spiral studies
• ThoraxRoutine06s
For routine thorax spiral studies, using a rotation
time of 0.6 sec. (optional)
• ThoraxFast
Fast spiral mode for long range studies
• ThoraxFast06s
Fast spiral mode for long range studies, using a
rotation time of 0.6 sec. (optional)
• ThoraxHR
Spiral mode for HiRes lung studies
• ThoraxSeqHR
Sequential mode for HiRes lung studies
107
Thorax
Hints in General
• Topogram: AP, 512 mm.

Patient lying in supine position, arms positioned
comfortably above the head in the head-arm rest,
lower legs supported.
• CARE Bolus may be used to optimize the bolus
timing.
Set the ROI for monitoring scan in the aorta at the
level of the diaphragm with triggering threshold of
120 HU, or use manual triggering.
• If the voltage is lowered from 130 kV to 110 kV
substantially higher mAs values have to be used
(at least by a factor of 2).
108
Thorax
Body kernels:
available.
a B40s image.
109
Thorax
LungLowDose
Indications:
Lung studies with low dose setting, e. g. early visuali-
zation of pulmonary nodules.
A typical thorax study in a range of 30 cm will be
110
Thorax
LungLowDose
kV 110
Effective mAs 16
Slice width 5.0 mm
Kernel B50s
Increment 5.0 mm
Image order cr-ca
CTDIVol 1.3 mGy

Start delay 30 sec.
You could repeat the same protocol simply by clicking

the chronicle with the right mouse button for “repeat“.
E. g. when both non-contrast and contrast studies are
required.
For lung cancer staging, this protocol can be combined
with protocol “Neck Routine“.
111
Thorax
LungLowDose06s
Indications:
Lung studies with low dose setting, e. g. early visuali-
zation of pulmonary nodules, using a 0.6 sec. rotation
time.
A typical thorax study in a range of 30 cm will be
112
Thorax
LungLowDose
kV 110
Effective mAs 16
Slice width 5.0 mm
Kernel B50s
Increment 5.0 mm
Image order cr-ca
CTDIVol 1.3 mGy

Start delay 30 sec.

required.
with protocol “Neck Routine“.
113
Thorax
Embolism
Indications:
Spiral mode for Pulmonary Emboli studies.
There are two recon jobs predefined. The first one,
with 3 mm slice thickness, for the mediastinum.
The second reconstruction, with 1.25 mm slice thick-
ness, used for postprocessing.
114
Thorax
Embolism 2nd reconstr.

kV 130
Effective mAs 70
Kernel B41s B41s
Image order cr-ca
CTDIVol 9.2 mGy

to the series.
MIPthin: Embolism coronal

Image thickness 3
Number of images 35

Start delay 12 – 15 sec.*
Flow rate 4 ml/sec.
* CARE Bolus may be used to optimize the bolus timing.
Set the ROI for monitoring scan in the pulmonary

trunc with triggering threshold of 120 HU, or use
manual triggering.
115
Thorax
Embolism06s
Indications:
Spiral mode for Pulmonary Emboli studies using a
rotation time of 0.6 s.
with 3 mm slice thickness, for the mediastinum,
the second reconstruction, with 1.25 mm slice thickness,
used for postprocessing.
116
Thorax
Embolism 2nd reconstr.

kV 130
Effective mAs 70
Kernel B41s B41s
Image order cr-ca
CTDIVol 9.2 mGy

to the series.
MIPthin: Embolism coronal

Image thickness 3
Number of images 35

Flow rate 4 ml/sec.
Set the ROI for monitoring scan in the truncus

pulmonalis with triggering threshold of 120 HU,
or use manual triggering.
117
Thorax
ThoraxCombi
Indications:
with one spiral scan. E. g. thorax studies in general and
interstitial changes in the lungs.
the second reconstruction, with 1.25 mm slice thick-
ness for the lung.
118
Thorax
ThoraxCombi 2nd reconstr.

kV 130
Effective mAs 70
Kernel B41s B70s
Image order cr-ca
CTDIVol 9.2 mGy

to the series.
MIPthin: ThoraxCombi coronal

Image thickness 3
Number of images 60

Start delay 25 sec.
Total amount 80 ml
If you want to reconstruct thin slices in every 2 mm

or 10 mm instead of 0.8 mm as predefined, simply
change the increment before image reconstruction.
119
Thorax
ThoraxCombi06s
Indications:
with one spiral scan. E. g. thorax studies in general
and interstitial changes in the lungs, using a 0.6 sec.
rotation time.
the second reconstruction, with 1 mm slice thickness,
for the lung.
120
Thorax
ThoraxCombi 2nd reconstr.

kV 130
Effective mAs 70
Kernel B41s B70s
Image order cr-ca
CTDIVol 9.2 mGy
For the 2nd reconstruction the Autoload into MPRthin

automatically loaded into 3D, MPRthin, and a coronal
MPRthin Range will pop up.
to the series.
MPRthin: ThoraxCombi coronal

Image thickness 3
Number of images 60

Start delay 25 sec.
Total amount 80 ml
If you want to reconstruct thin slices in every 2 mm

or 10 mm instead of 0.8 mm as predefined, simply
change the increment before image reconstruction.
121
Thorax
ThoraxRoutine
Indications:
Routine spiral studies for the region of thorax, e. g.
screening of tumors, metastases, lymphoma, lymph
nodes, vascular anomalies etc.
122
Thorax
ThoraxRoutine
kV 130
Effective mAs 70
Slice width 5.0 mm
Feed/Rotation 16 mm
Kernel B41s
Increment 5.0 mm
Image order cr-ca
CTDIVol 8.0 mGy

Start delay 25 – 30 sec.
Total amount 80 ml

required.
with protocol “Neck Routine”.
123
Thorax
ThoraxRoutine06s
Indications:
Routine spiral studies for the region of thorax, e. g.
screening of tumors, metastases, lymphoma, lymph
nodes, vascular anomalies etc., using a 0.6 sec.
rotation time.
124
Thorax
ThoraxRoutine
kV 130
Effective mAs 70
Slice width 5.0 mm
Kernel B41s
Increment 5.0 mm
Image order cr-ca
CTDIVol 8.0 mGy

Total amount 80 ml

required.
125
Thorax
ThoraxFast
Indications:
Fast spiral mode for lung studies, e. g. when a patient
has difficulty with breathhold.
A complete thorax scan in a range of 30 cm will be
126
Thorax
ThoraxFast
kV 130
Effective mAs 70
Slice width 6.0 mm
Kernel B41s
Increment 6.0 mm
Image order cr-ca
CTDIVol 7.5 mGy

Total amount 80 ml

required.
127
Thorax
ThoraxFast06s
Indications:
Fast spiral mode for lung studies, e. g. when a patient
has difficulty with breathhold, using a 0.6 sec. rotation
time.
A complete thorax scan in a range of 30 cm will be
covered in 7.9 sec.
128
Thorax
ThoraxFast
kV 130
Effective mAs 70
Slice width 6.0 mm
Kernel B41s
Increment 6.0 mm
Image order cr-ca
CTDIVol 7.5 mGy

Total amount 80 ml

required.
129
Thorax
ThoraxHR
Indications:
Spiral mode for HiRes studies, e.g. interstitial changes
in the lungs. Two recon jobs are predefined: thinner
slice reconstruction used for postprocessing, and thicker
slice reconstruction for soft tissue.
A range of 28 cm for the complete thorax will be
130
Thorax
ThoraxHR 2nd reconstr.

kV 130
Effective mAs 100
Kernel B41s B70s
Image order cr-ca
CTDIVol 13.2 mGy

to the series.
MPRthick: ThoraxHR coronal

Image thickness 2
Number of images 70
With studies of interstitial changes in the lungs, contrast

medium is not necessary.
131
Thorax
ThoraxSeqHR
Indications:
Sequence mode for HiRes lung studies. E. g. interstitial
changes in the lungs.
Images are acquired in 10 mm intervals.
132
Thorax
ThoraxSeqHR
kV 130
mAs 100
Slice width 1.0 mm
Feed/Scan 10.0 mm
Kernel B90s
Image order cr-ca
CTDIVol 1.0 mGy
If you want to reconstruct thin slices every 10

or 20 mm instead of 10 mm as predefined, simply
change the Feed/Scan before loading the mode.
133
Abdomen
Overview
• AbdRoutine
Spiral mode for routine abdominal studies
• AbdRoutine06s
Spiral mode for routine abdominal studies,
• AbdCombi
Spiral mode for the combination of thin slice and
routine abdominal studies
• AbdCombi06s
Spiral mode for the combination of thin slice
and routine abdominal studies, using a rotation time
of 0.6 sec. (optional)
• AbdMultiPhase
Spiral mode for the combination of CTA and two
phases soft tissue studies
134
Abdomen
• AbdMultiPhase06s
For combination of CTA and two phases soft tissue
studies, using a rotation time of 0.6 sec. (optional)
• AbdFast
Fast mode for abdomen studies
• AbdFast06s
Fast mode for abdomen studies, using a rotation
time of 0.6 sec. (optional)
• AngioFast
For long-range CTA studies
• AngioFast06s
For long CTA studies, using a rotation time of 0.6 sec.
(optional)
• AngioRoutine
For CTA routine studies
• AngioRoutine06s
For CTA routine studies, using a rotation time
of 0.6 sec. (optional)
135
Abdomen
Hints in General
• Topogram: AP, 512 or 768 mm.

• Patient respiratory instructions: inspiration.
• Oral administration of contrast medium:
For abdominal studies, it is necessary to delineate
the bowel from other structures such as lymph
nodes, abdominal masses & abscesses. Various types
of bowel opacifying agents can be used:
– Diluted barium suspension (1% – 2%) e. g. EZCAT
– Water soluble agent (2% – 4%) e. g. Gastrografin
– Water alone, as a negative contrast agent.
Timing of the oral contrast administration is important
to ensure its even distribution in the bowel.
Upper abdomen:
Minimum 600 ml of contrast divided into 3 cups
(approximately 200 – 250 ml)
1st cup to drink 30 minutes before exam
2nd cup to drink 15 minutes before exam
3rd cup to drink 5 minutes before exam
Abdomen-Pelvis:
Minimum 1000 ml of contrast divided into 4 cups
1st cup to drink 1 hour before exam
2nd – 4th cups every subsequent 15 minutes
Start exam 5 minutes after the 4th cup is administered.
136
Abdomen
– In general, for abdominal studies such as liver, gall

bladder (query stones), pancreas, gastrointestinal
studies, focal lesion of the kidneys and CTA studies,
it is sufficient to use just water. Water is more effec-
tive than positive oral contrast agent in depicting the
linings of the stomach & intestines in post enhance-
ment studies. In addition, the use of water will not
obscure the blood vessels thus allowing CTA proces-
sing to be performed easily afterwards.
– For patients with bowel obstruction, only water or
water-soluble contrast can be used. Barium suspension
is a contraindication.
• Be careful when examining pheochromocytoma
patients. Administration of an IV CM injection in such
cases may trigger a hypertensive crisis!
For more information regarding the general use
of drugs and doses including specific indications and
contraindications mentioned in this guide, please
refer to page 2.
137
Abdomen
Body kernels:
available.
a B40s image.
138
Abdomen
139
Abdomen
AbdRoutine
Indications:
Spiral mode for all routine studies in the region of
abdomen, e. g. screening, follow-up examinations etc.
A complete abdomen scan in a range of 20 cm will be
140
Abdomen
AbdRoutine
kV 130
Effective mAs 95
Slice width 5.0 mm
Feed/Rotation 15 mm
Kernel B41s
Increment 5.0 mm
Image order cr-ca
CTDIVol 10.8 mGy

Total amount 100 ml

required.
141
Abdomen
AbdRoutine06s
Indications:
Spiral mode for all routine studies in the region of
abdomen, e. g. screening, follow-up examinations
A complete abdomen scan in a range of 20 cm will be
covered in 9.2 sec.
142
Abdomen
AbdRoutine
kV 130
Effective mAs 95
Slice width 5.0 mm
Kernel B41s
Increment 5.0 mm
Image order cr-ca
CTDIVol 10.8 mGy

Total amount 100 ml

required.
143
Abdomen
AbdomenCombi
Indications:
Combination of thin slice and routine abdominal
studies with one spiral scan, e.g. a range of 20 cm for
liver, pancreas or kidneys will be covered in 19.4 sec.
struction used for postprocessing, and thicker slice
144
Abdomen
AbdCombi 2nd reconstr.

kV 130
Effective mAs 120
Kernel B41s B41s
Image order cr-ca
CTDIVol 15.8 mGy
For the 2nd reconstruction the Autoload into the MIPthin

be automatically loaded into 3D, MIPthin, and coronal
to the series.
MIPthin: AbdCombi coronal

Image thickness 3
Number of images 50

Flow rate 4 ml/sec.
Total amount 100 ml
If you want to use this protocol for a two-phase study,

repeat the same protocol as mentioned below, and
chose a start delay time for arterial phase of 20-25 s. In
this case, the thin slice reconstruction can also be used
for postprocessing. But do not administer oral contrast
medium, as this impairs the editing of MIP/SSD/VRT
images. Water could be used instead if necessary.
You can repeat the same protocol simply by clicking
required.
145
Abdomen
AbdomenCombi06s
Indications:
Combination of thin slice and routine abdominal
studies with one spiral scan, using a 0.6 sec.
rotation time. A range of 20 cm for liver, pancreas or
kidneys will be covered in 14.6 sec.
struction used for postprocessing, and thicker slice
146
Abdomen
AbdCombi 2nd reconstr.

kV 130
Effective mAs 130
Kernel B41s B41s
Image order cr-ca
CTDIVol 17.2 mGy
For the 2nd reconstruction the Autoload into the MIPthin

be automatically loaded into 3D, MIPthin, and coronal
to the series.
MIPthin: AbdCombi coronal

Image thickness 3
Number of images 50

Flow rate 4 ml/sec.
Total amount 100 ml
If you want to use this protocol for a two-phase study,

repeat the same protocol as mentioned below, and
chose start delay time for arterial phase as 20-25 s. In
this case, the thin slice reconstruction can also be used
for postprocessing. But do not administer oral contrast
medium, as this impairs the editing of MIP/SSD/VRT
images. Water could be used instead if necessary.
You can repeat the same protocol simply by clicking
required.
147
Abdomen
AbdMultiPhase
Indications:
Combination of CTA and soft tissue studies. E. g.
a range of 20 cm including liver, pancreas and kidney:
arterial phase acquired with 2.0 mm slice collimation
in 15 s, image reconstructed in 2.5 mm for post-
processing, and 5 mm for soft tissue enhancement.
Same range followed with a scan range of 35 cm by
2.0 mm slice collimation acquisition in 25 s for venous
phase, image reconstructed in 5 mm for soft tissue only.
148
Abdomen
Non Arterial Venous

Contrast phase phase
kV 110 110 130
Effective mAs 60 90 95
Slice collimation 2.0 mm 2.0 mm 2.0 mm
Slice width 5.0 mm 5.0 mm/ 5.0 mm
2.5 mm
Feed/Rotation 18.0 mm 12.0 mm 12.0 mm
Rotation time 0.8 sec. 0.8 sec. 0.8 sec.
Kernel B41s B41s/B31s B41s
Increment 5.0 mm 5.0 mm/ 5.0 mm
1.5 mm
Image order cr-ca cr-ca cr-ca
CTDIVol 4.7 mGy 7.0 mGy 10.8 mGy
For the 2nd reconstruction of the Arterial Phase the

Autoload into the MIPthin Range on the 3D Card is acti-
vated. The images will be automatically loaded into
3D, MIPthin, and coronal MIPthin Range will pop up.
to the series.
MIPthin: ArterialPhase coronal

Image thickness 3
Number of images 50

Start delay 20 – 25 sec.* (arterial phase)
50 – 75 sec.* (venous phase)
Flow rate 4 – 5 ml/sec.
Set the ROI for monitoring scan in the abdominal
aorta at the beginning of the scan range with trigger-
ing threshold of 120 HU, or use manual triggering.
Do not administer oral contrast medium, as this

impairs the editing of MIP/SSD/VRT images. Use water
instead if necessary.
149
Abdomen
AbdMultiPhase06s
Indications:
Combination of CTA and soft tissue studies. E. g.
a range of 20 cm including liver, pancreas and kidney:
arterial phase acquired with 2.0 mm slice collimation
in 11.2 s, image reconstructed in 2.5 mm for post-
processing, and 5 mm for soft tissue enhancement.
Same range followed with a scan range of 35 cm by
2.0 mm slice collimation acquisition in 18.7 s for venous
phase, image reconstructed in 5 mm for soft tissue only.
Non Arterial Venous

Contrast phase phase
kV 110 110 130
Effective mAs 60 90 95
Slice collimation 2.0 mm 2.0 mm 2.0 mm
Slice width 5.0 mm 5.0 mm/ 5.0 mm
2.5 mm
Feed/Rotation 18.0 mm 12.0 mm 12.0 mm
Rotation time 0.6 sec. 0.6 sec. 0.6 sec.
Kernel B41s B41s/B31s B41s
Increment 5.0 mm 5.0 mm/ 5.0 mm
1.5 mm
Image order cr-ca cr-ca cr-ca
150
Abdomen
For the 2nd reconstruction of the Arterial Phase the

Autoload into the MIPthin Range on the 3D Card is acti-
vated. The images will be automatically loaded into
3D, MIPthin, and coronal MIPthin Range will pop up.
to the series.
MIPthin: ArterialPhase coronal

Image thickness 3
Number of images 50

Start delay 20 – 25 sec.* (arterial phase)
50 – 75 sec.* (venous phase)
Flow rate 4 – 5 ml/sec.

151
Abdomen
AbdFast
Indications:
Fast spiral mode for abdominal studies, e. g. when a
patient has difficulty with breathhold.
152
Abdomen
AbdFast
kV 130
Effective mAs 95
Slice width 6.0 mm
Kernel B41s
Increment 6.0 mm
Image order cr-ca
CTDIVol 10.1 mGy

required.
For lung cancer staging, this protocol can be com-
bined with protocol “Neck Routine”.

Total amount 80 ml
153
Abdomen
AbdFast06s
Indications:
Fast spiral mode for abdomen studies, using a rotation
time of 0.6 sec., e. g. when a patient has difficulty with
breathhold.
154
Abdomen
AbdFast
kV 130
Effective mAs 95
Slice width 6.0 mm
Kernel B41s
Increment 6.0 mm
Image order cr-ca
CTDIVol 10.1 mGy

required.
For lung cancer staging, this protocol can be com-
bined with protocol “Neck Routine”.

Total amount 80 ml
155
Abdomen
AngioFast
Indications:
Long range CTA studies.
E. g.: a typical study of the whole aorta including its
branchiocephalic trunk and iliac arteries in a range of
30 cm will be covered in 13.1 sec.
156
Abdomen
AngioFast
kV 110
Effective mAs 90
Slice width 3.0 mm
Kernel B31s
Increment 3.0 mm
Image order cr-ca
CTDIVol 7.0 mGy

to the series.
MIPthin: AngioFast coronal

Image thickness 3
Number of images 35

Start delay 20 sec.*
Total amount 120 ml

impairs the editing of MIP/SSD/VRT images.
157
Abdomen
AngioFast06s
Indications:
Long range CTA studies, using a rotation time 0.6 sec.
E. g.: a typical study of the whole aorta including its
branchiocephalic trunk and iliac arteries in a range
of 30 cm will be covered in 9.8 sec.
158
Abdomen
AngioFast
kV 110
Effective mAs 90
Slice width 3.0 mm
Kernel B31s
Increment 3.0 mm
Image order cr-ca
CTDIVol 7.0 mGy

to the series.
MIPthin: AngioFast coronal

Image thickness 3
Number of images 35

Total amount 120 ml

impairs the editing of MIP/SSD/VRT images.
159
Abdomen
AngioRoutine
Indications:
For abdominal CTA studies.
A typical study in a range of 20 cm will be covered in
19.4 sec.
160
Abdomen
AngioRoutine 2nd reconstr.

kV 110
Effective mAs 90
Kernel B31s B31s
Image order cr-ca
CTDIVol 8.2 mGy
For the 2nd reconstruction the Autoload into the

MIPthin Range on the 3D Card is activated. The images
will be automatically loaded into 3D, MIPthin, and
sagittal MIPthin Range will pop up.
to the series.
MIPthin: AngioRoutine sagittal

Image thickness 3
Number of images 60

Flow rate 3.0 – 3.5 ml/sec.


161
Abdomen
AngioRoutine06s
Indications:
For abdominal CTA studies, using a rotation time 0.6 sec.
E. g.: a typical study in a range of 20 cm will be
162
Abdomen
AngioRoutine 2nd reconstr.

kV 110
Effective mAs 90
Kernel B31s B31s
Image order cr-ca
CTDIVol 8.2 mGy
For the 2nd reconstruction the Autoload into the

MIPthin Range on the 3D Card is activated. The images
will be automatically loaded into 3D, MIPthin, and
sagittal MIPthin Range will pop up.
to the series.
MIPthin: AngioRoutine sagittal

Image thickness 3
Number of images 60



163
Pelvis
Overview
• Hip
Spiral mode for HiRes bone and soft tissue studies
of the hip
• PelvisRoutine
Spiral mode for routine pelvis studies
164
Pelvis
Hints in General
• Topogram: AP, 512 mm for pelvis studies and

256 mm for studies of the hip.
• A breathing command is not necessarily required
for the pelvic examination, since respiration does not
negatively influence this region.
• Rectal contrast medium administration:
Rectal contrast media is usually required to delineate
the rectum and sigmoid colon, if lower pelvic mass
or pathology is suspected. In some cases, air may be
substituted for a positive contrast agent. The use of
vaginal tampon may be helpful in adult female patients
with suspected pelvis pathology.
165
Pelvis
Body kernels:
available.
a B40s image.
166
Pelvis
167
Pelvis
Hip
Indications:
Spiral mode for HiRes bone studies and soft tissue
studies of the Hip. E. g. evaluation of joint cavity,
masses, trauma, dysplasia, necrosis of the head of the
hip, congruence evaluations, orthopedic indications
etc.
168
Pelvis
Hip 2nd reconstr.

kV 130
Effective mAs 95
Kernel B41s B70s
Image order cr-ca
CTDIVol 12.5 mGy

to the series.
MPRthick: Hip coronal

Image thickness 3
Number of images 20
In case of 3D study only, mAs can be reduced up to

50%, images should be reconstructed with at least 50%
overlapping and kernel B10s.
If only one side is examined, it is advisable to enter the
side in the comment line on the routine card.
169
Pelvis
PelvisRoutine
Indications:
Spiral mode for routine pelvis studies. E. g. processes
of the prostate, urinary bladder, rectum, gynecological
indications etc.
170
Pelvis
PelvisRoutine
kV 130
Effective mAs 105
Slice width 5.0 mm
Kernel B41s
Increment 5.0 mm
Image order cr-ca
CTDIVol 11.9 mGy

* If the examination performed requires a full urinary

bladder, wait at least 3 minutes following IV admini-
stration of the contrast medium.
171
Spine
Overview
• SpineRoutineSeq
Sequence mode for routine spine studies
• SpineObeseSeq
Sequence mode for studies of obese patients
• Spine
Spiral mode for thoracal/lumbar studies
• C-Spine
Thin slice spiral mode for cervical spine studies
172
Spine
Hints in General
• Topogram: Lateral, 512 mm for thoracic and lumbar

spine and 256 mm for the C-spine.
• Patient positioning for thoracic and lumbar spine
studies:
• Patient positioning for cervical spine studies:
Patient lying in supine position, hyperextend neck
slightly, secure head well in head holder.
Patient respiratory instruction: do not breathe,
do not swallow.
Any possible injuries to the spinal column should be
determined before beginning the examination and
taken into account when repositioning the patient.
• In case of SSD study only, mAs value can be reduced
by 50%. Use kernel B10 and 50% overlapping image
reconstruction.
• For lumbar studies, place a cushion under the
patient’s knee. This will reduce the curve in the spine
and also make the patient more comfortable.
• The CT scan following myelography must be per-
formed within 4-6 hours of the injection, otherwise,
the contrast density in the spinal canal will be too
high to obtain artifact-free images. Also, if possible,
it is a good idea to roll the patient once, or scan in
a prone position. This will prevent the contrast from
pooling posterior to the spinal cord.
• If a prone scan is performed, breathing instructions
are recommended to avoid motion artifact in axial
source and MPR images.
173
Spine
Body kernels:
available.
a B40s image.
174
Spine
175
Spine
SpineRoutineSeq
Indications:
Sequence mode for spine studies, e. g. prolapse,
degenerative changes, trauma, tumors etc.
This protocol contains three ranges:
L3-L4, L4-L5, L5-S1.
The scan length of each range is 2.8 cm
Three different typical gantry tilts are predefined:
for L3-L4: 0°, for L4-L5: +5° and for L5-S1: +15°
SpineRoutineSeq
L3-4 L4-5 L5-S1
kV 130
mAs 280 280 320
Slice width 2.0 mm
Feed/Scan 6.0 mm
Kernel B31s
Cycle time 3.0 sec.
Image order cr-ca
176
Spine
SpineObeseSeq
Indications:
Sequence mode for spine studies of the obese
patients when higher dose are needed, e. g. prolapse,
This protocol contains three ranges:
L3-L4, L4-L5, L5-S1.
The scan length of each range is 2.8 cm
Three different typical gantry tilts are predefined:
for L3-L4: 0°, for L4-L5: +5° and for L5-S1: +15°
SpineObeseSeq
L3-4 L4-5 L5-S1
kV 130
mAs 320 320 370
Slice width 2.0 mm
Feed/Scan 6.0 mm
Kernel B31s
Cycle time 2.5 sec.
Image order cr-ca
177
Spine
Spine
Indications:
Spiral mode for thoracic and lumbar spine studies, e. g.
prolapse, degenerative changes, trauma, tumors etc.
178
Spine
Spine 2nd reconstr.

kV 130
Effective mAs 190
Kernel B31s B60s
Image order cr-ca
CTDIVol 21.6 mGy

to the series.
MPRthick: Spine coronal

Image thickness 3
Number of images 30
179
Spine
C-Spine
Indications:
Spiral mode for cervical spine studies, e. g. prolapse,
180
Spine
C-Spine 2nd reconstr.

kV 130
Effective mAs 150
Kernel B31s B60s
Image order cr-ca
CTDIVol 19.8 mGy

automatically loaded into 3D, MPR, and a sagittal
to the series.
MPRthick: C-Spine sagittal

Image thickness 3
Number of images 20
181
Extremities
Overview
• AngioRunOff
For long range CTA spiral studies
• AngioRunOff06s
For long range CTA spiral studies,
• ExtrCombi
Combination for HiRes bone and soft tissue
spiral studies
• ExtrHR
Spiral mode for bone High Resolution studies using
0.5 mm collimation (optional)
182
Extremities
Hints in General
• Topogram: AP, 128/256 mm for joint studies;

1024/1500 mm for CTA.
Depends on the region of examination.
In general, for bilateral studies, you should always
try to position the patient evenly whenever the
patient can comply.
a) For wrists scan
Patient lying in prone position, hands stretched
above the head and lying flat on a Bocollo pillow
(optional), ankles supported with a pad. Both wrists
should be examined together when necessary.
b) For knee scan:
Patient lying in supine position, feet first, pro-
mote relaxation by placing Bocollo pillows between
knees and feet, bind feet together.
The only exceptions are extremely light patients.
The latter can remove the leg not being examined
from the gantry by bending it 90° at the hip and
the knee and placing the bottom of the same foot
against the gantry casing.
c) For ankle and feet scan:
Patient lying in supine position, feet first.
Bind both ankles together if necessary to assure
the AP position of both feet.
Special positioning is not necessary since the real
time MPR could simulate any view of secondary
reconstruction.
• In case of 3D study only, mAs can be reduced up
to 50%. Use kernel B10s and 50% overlapping image
reconstruction.
183
Extremities
Body kernels:
available.
a B40s image.
• The special kernels are mostly used for ”physical”
measurements with phantoms, e. g. for adjustment
procedures (S80s), for constancy and acceptance
tests (S80s, U90s), or for specification purposes
(U90s).
• For special patient protocols, S80s and U90s are
chosen, e. g. for osteo (S80s) and for high resolution
bone studies (U90s). We recommend to use the high
resolution specification kernel U90s only with ”small”
objects, like the wrist, otherwise artifacts will occur
in the images.
184
Extremities
185
Extremities
AngioRunOff
Indications:
For CTA studies
A range of 80 cm will be done in 31.2 sec.
AngioRunOff
kV 110
Effective mAs 90
Slice width 3.0 mm
Kernel B31s
Increment 1.5 mm
Image order cr-ca
CTDIVol 7.0 mGy
186
Extremities

preset, adapt the parameters to your needs and link them
to the series.
MIPthin: AngioRunOff coronal

Image thickness 3
Number of images 35


If Topo length 1024 mm is not long enough, you can

also choose the Topo length of 1500 mm.
Position the patient as feet first. Bend the feet together
if necessary.
187
Extremities
AngioRunOff06s
Indications:
For CTA studies, using rotation time 0.6 sec.
A range of 80 cm will be done in 23.4 sec.
AngioRunOff
kV 110
Effective mAs 90
Slice width 3.0 mm
Kernel B31s
Increment 1.5 mm
Image order cr-ca
CTDIVol 7.0 mGy
188
Extremities

to the series.
MIPthin: AngioRunOff coronal

Image thickness 3
Number of images 35


If Topo length 1024 mm is not long enough, you can

also choose the 1536 mm long Topogram.
Position the patient as feet first. Bend the feet together
if necessary.
189
Extremities
ExtrCombi
Indications:
Spiral mode for the combination of HiRes bone and
soft tissue studies. E. g. masses, trauma, disorders of
the joint etc.
Extremity 2nd reconstr.

kV 130
Effective mAs 40
Kernel B41s B70s
Image order cr-ca
CTDIVol 5.3 mGy
190
Extremities

to the series.
MPRthick: ExtrCombi coronal

Image thickness 2
Number of images 30
191
Extremities
ExtrHR
Indications:
Spiral mode for HiRes bone study. E. g. trauma, ortho-
pedic indications etc.
192
Extremities
ExtrHR
kV 130
Effective mAs 50
Slice width 0.63 mm
Kernel U90s
Increment 0.3 mm
Image order cr-ca
CTDIVol 6.8 mGy
This protocol is used for High Resolution studies.

H30s/H31s.
193
Siemens reserves the right to modify
the design and specifications contained
herein without prior notice. Please
contact your local Siemens Sales
Representative for the most current
information.
Original images always loose a certain

amount of detail when reproduced.
Siemens AG
Medical Solutions
Computed Tomography
Siemensstrasse 1 Order No.
D-91301 Forchheim A91100-M2100-2226-1-7600
Germany Printed in Germany
www.SiemensMedical.com BKW 42226 BA 05033.

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The scan protocols for adult are defined according

Scans can be simply set up by selecting a predefined

Scan and Reconstruction

Slice Collimation and Slice Width

If Metrorecon is not selected you will get routinely

Slice Collimation and Slice Width for Spiral Mode

For further information regarding the kernels, please

ASA: The Advanced Smoothing Algorithm (ASA) filter

In sequential scanning, the dose (Dseq) applied to the

CTDIW and CTDIVol

The CTDIVol value does not provide the entire information

How Does it Work

Fig. 4: Example of scanning in the shoulder region.

lateral Object attenuation

Fig. 5: Principle of CARE Dose tube current adaptation.

• CARE Dose is pre-selected by default for most standard

Auto Load in 3D and Postprocessing Presets

Some of the Scan protocols, primarily for Angio exami-

Contrast Medium IV Injection*

The administration of a contrast medium depends on

* For more information regarding the general use

How to Create your own

This folder contains 24 organ specific pediatric proto-

1. Topograms: 256 mm lateral topograms are defined

3. For all head studies, it is very important for image

4. Warm surroundings and dimmed lighting are help-

5. Sedation: Although the advent of the Multislice CT

The proper personnel and equipment must also

6. Oral and rectal contrast administration: Depending

7. I.V. contrast administration: In general, 1 – 2 ml per

Note: these injector guidelines are based on an

8. 80 kV was also used for applications when the

9. Please observe the recommended mAs settings in

The special kernels are mostly used for ”physical”

* The mAs should be adjusted to the age of the child.

Age kV mAs CTDIVol

For the 1st reconstruction the Autoload into MIPthin

MIPthin: HeadAngio coronal

Contrast medium IV injection

* The mAs should be adjusted to the age of the child.

Age kV mAs CTDIVol

For the 1st reconstruction the Autoload into MIPthin

MIPthin: HeadAngio coronal

Contrast medium IV injection

* The mAs should be adjusted to the age of the child.

Body Weight kV mAs CTDIVol

Contrast medium IV injection

* The mAs should be adjusted to the age of the child.

Age kV mAs CTDIVol

Contrast medium IV injection

Sinus 2nd reconstr.

Age kV mAs CTDIVol

For the 2nd reconstruction the Autoload into the MPR

MPRthick: Sinus coronal

Contrast medium IV injection

* The mAs should be adjusted to the age of the child.

Age kV mAs CTDIVole

Contrast medium IV injection

* The mAs should be adjusted to the age of the child.

Age kV mAs CTDIVol

Contrast medium IV injection