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SOMATOM Volume Zoom Application Guide

Special Protocols Software Version A40

We express our sincere gratitude to the many customers who contributed valuable input. Special thanks to Loke-Gie Haw, Claudia Scherf, Bernd Ohnesorge, Christoph Suess, Lutz Guendel, and Ernst Klotz for their valuable assistance.

Overview
HeartView CT . . . . . . . . . . . . . . . . . . . . . . . . 6 Bolus Tracking . . . . . . . . . . . . . . . . . . . . . . . 42 Dental CT . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 Osteo CT . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 Pulmo CT . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 Perfusion CT . . . . . . . . . . . . . . . . . . . . . . . . 60 Interventional CT . . . . . . . . . . . . . . . . . . . . 66 Trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 CARE Dose . . . . . . . . . . . . . . . . . . . . . . . . . 76 Appendix . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 General Considerations . . . . . . . . . . . . . . . 85

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Contents
HeartView CT . . . . . . . . . . . . . . . . . . . . . .
6 s The basics . . . . . . . . . . . . . . . . . . . . . . . . 6 - Important anatomical structures of the heart - Cardiac cycle and ECG - Temporal resolution - Technical principles - ECG Pulsing - Cardio CARE - Cardio Sharp - Effective mAs - Dose information s How to do it . . . . . . . . . . . . . . . . . . . . . 20 - Calcium Scoring - Coronary CTA - Aortic and Pulmonary studies s Additional important information . . . 35

Bolus Tracking . . . . . . . . . . . . . . . . . . .

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s The basics . . . . . . . . . . . . . . . . . . . . . . . 42 s How to do it . . . . . . . . . . . . . . . . . . . . . 44 - CARE Bolus - Test Bolus s Additional important information . . . 47

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. . . 52 s The basics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 s How to do it . . . 56 s How to do it . . . . . . . . . . . . . . . 57 s Additional important information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 s The basics . . 60 s The basics . . . . . . . . . . . . . . . . . . . . . . 49 s Additional important information . . . . . . . . . . . . . . . . . . . . . 58 Perfusion CT .Contents Dental CT . . . . 52 s How to do it . . . . . . . . . . . . . . . . . . . . . . . 56 s The basics . . . . . . . 61 s Additional important information . . . . 48 s How to do it . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 s Additional important information . . . . . . . . . . . . . . . . . 54 Pulmo CT . . . . . . . . . . . . 63 3 . . . . 50 Osteo CT . . . . . . . . . . . . . . . . .

. . . . . . . . 70 Trauma . . . . . . .BiopsyCombine . . . . . . .Trauma s Additional important information . 73 . . . 66 s How to do it . . . 66 s The basics . . . . . . .Contents Interventional CT . . . . . . . . 77 4 . . . . . . 73 s How to do it . . . . . . . . 76 s The basics . . . . . . . . . . . . . . . . . . . .CARE Vision CT s Additional important information . . . . . . . . . . . . . . .Polytrauma . . . . . . . . . . 72 s The basics . . . . . . . . . . . . . . . 75 CARE Dose . . . . . . . . .Biopsy . . . . . . . . . . . . . . . . . . . . . . . . . . 76 s How does it work . . . . . . . . . . . . . . . . . . . . . . . . 76 s Additional important information . . . . . . . . . . . . . . . . . . . . . 67 . . . . . . . . . . .

. . . . . . . . . . . . . 85 5 . . . 78 s BodyPerfCT and BodyDynCT . . . . . . . . . . . . . . 81 General Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . 78 s Osteo CT . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 s Pulmo CT . .Contents Appendix . . . . . .

HeartView CT HeartView CT is a clinical application package specifically tailored to cardiovascular CT studies. and pumps it into the left ventricle • Left ventricle – receives the oxygenated blood from the left atrium. s The basics Important anatomical structures of the heart Four chambers: • Right atrium – receives the deoxygenated blood back from the body circulation through the superior and inferior vena cava. 3: Ventricles contract. 2: Atria contract. blood enters ventricles A: P: RV: LV: RA: LA: Fig. blood enters into aorta and pulmonary arteries Aorta Pulmonary Artery Right Ventricle Left Ventricle Right Atrium Left Atrium 6 . and pumps it into the pulmonary circulation through the pulmonary arteries • Left atrium – receives the oxygenated blood back from the pulmonary circulation through the pulmonary veins. and pumps it into the right ventricle • Right ventricle – receives the deoxygenated blood from the right atrium. and pump it into the body circulation through the aorta A P LA RA LV RV Fig. 1: Blood fills both atria Fig.

a small part of the ventricular septum. 5: Conventional Angiography • Left coronary artery (LCA) Left coronary artery supplies blood to the left atrium. 4: Front view SVC: Superior Vena Cava IVC: Inferior Vena Cava RA: Right Atrium RV: Right Ventricle A: Aorta PA: Pulmonary Artery Fig. right ventricle. 6: Front view LM: Left Main Artery LAD: Left Anterior Desending Artery Cx: Circumflex Artery ➝ ➝ Fig. 7: Conventional Angiography 7 . LM LAD Cx ➝ Fig. SVC A PA RA RV IVC Fig. left ventricle and a large part of the ventricular septum.HeartView CT Coronary arteries: • Right coronary artery (RCA) Right coronary artery supplies blood to the right atrium.

HeartView CT Cardiac cycle and ECG The heart contracts when pumping blood and rests when receiving blood. This activity and lack of activity form a cardiac cycle. 8). which can be illustrated by an Electrocardiograph (ECG) (Fig. R P Q S Relaxation T U Ventricular contraction Systolic phase Atrial contraction Diastolic phase Diastolic phase Fig. 8 8 .

9: 500 ms scan without ECG-Trigger Fig. 10: 500 ms scan with ECG-Trigger Fig.HeartView CT To minimize motion artifacts in cardiac images. the following two requirements are mandatory for a CT system: • Fast gantry rotation time in order to achieve fast image acquisition time • Prospective synchronization of image acquisition or retrospective reconstruction based on the ECG recording in order to produce the image during the diastolic phase when the least motion happens. 11: 250 ms scan with ECG-Trigger 9 . Fig.

13 10 Recon . With the SOMATOM Volume Zoom. It is essential for cardiac CT imaging – the higher the temporal resolution. temporal resolution for cardiac imaging can be achieved at down to 125 ms. represents the time window of the data that is used for image reconstruction. 13). Images Z-Position Scan Feed Delay Scan R R R Time R ECG Fig. • Retrospectively ECG gated spiral scanning (Fig.HeartView CT Temporal resolution Temporal resolution. 12). Technical principles Basically. the fewer the motion artifacts. 12 Z-Position Recon Recon Delay Recon “3D“ Image data us tinuo Feed Con an & al Sc Sp ir ECG R R R R Time Fig. also called time resolution. there are two different technical approaches for cardiac CT acquisition: • Prospectively ECG triggered sequential scanning (Fig.

HeartView CT In both cases. 50 % of R-R Scan/ Recon ECG (t) Time Fig. 14. or to perform retrospective image reconstruction (ECG gating). 15 11 . A given temporal relation relative to the R-waves is predefined and can be applied with the following possibilities: Relative – delay: a given percentage of R-R interval ( RR) relative to the onset of the previous or the next R-wave (Fig. 15). an ECG is recorded and used to either initiate prospective image acquisition (ECG triggering). 14 -50 % R-R Scan/ Recon ECG (t) Time Fig.

17).400 msec Time Fig. 400 msec Scan/ Recon ECG (t) Time Fig. 16 Absolute – reverse: a fixed time delay prior to the onset of the next R-wave (Fig. Estimated R-Peak Scan/ Recon ECG (t) . 17 12 .HeartView CT Absolute – delay: a fixed time delay after the onset of the R-wave (Fig. 16).

and the beginning of the P wave. the optimal timing may vary for the individual patient. For image reconstruction in the systolic phase. For RCA (Right Coronary Artery) HR [bpm] 40-59 60-65 > 65 T-Reverse [msec] -450 -400 -500 RR-Delay [%] 50% 55% 40% 3. the best image quality can be achieved if the image acquisition or reconstruction is positioned in the “ideal time window” i. e. use absolute delay of 100 ms. Recommendations to start with are listed below. For LCA (Left Coronary Artery) HR [bpm] 40-59 60-65 > 65 T-Reverse [msec] -450 -400 -350 RR-Delay [%] 50% 55% 55% 2. 1. Adjustment according to the individual heart rate may be necessary. 13 . between the end of the T wave .HeartView CT Recommended reconstruction relative to the R-wave: In principle. However.

The tube current is ECG-controlled and reduced during systolic phases of the cardiac cycle while maintained normal during diastolic phases when best image quality is required (Fig. 1). It can be switched on/off by the user (Fig. Fig.HeartView CT ECG Pulsing ECG Pulsing is a dedicated technique used for online dose modulation for Cardiac imaging. 3 14 . Fig. 1: Image acquisition and reconstruction in diastolic phase and systolic phase. 3). 2: Dose modulation with ECG pulsing. essential dose reduction up to 50% can be achieved. Fig. As shown in figure 2.

Image examples are shown in figure 1. the comparable ” image quality can be achieved with a dose reduction of 30%.HeartView CT CardioCARE This is a dedicated cardiac filter which can reduce image noise thus provides the possibility of dose reduction. Fig. ” a b Fig. As shown in figure 1. 1b: Image acquired with 266 effective mAs and Cardio CARE filter. CardioSharp This is a dedicated reconstruction kernel used for better edge definition in coronary artery imaging. 1: Image reconstructed with (1b) and without (1a) Cardio Sharp kernel. a b Fig. It is applied in a pre-defined scan protocol called “CoronaryCARE. 15 . 1a: Image acquired with 400 effective mAs. It is applied in a pre-defined cardiac scan protocol called “CoronarySharp.

16 . The tube current will be adapted according to: 4-slice modes: mA = (Eff. the concept of “Effective mAs” was introduced with the SOMATOM VolumeZoom. however. Therefore. mAs = mAs x 4 / pitch To calculate the dose on the SOMATOM VolumeZoom. the dose (Dseq ) applied to the patient is estimated as the product of the tube currenttime (mAs) and the CTDIw per mAs: Dseq = DCTDIw x mAs In spiral scanning. independent of pitch. mAs/Rotation time) x (Pitch/4) 2-slice modes: mA = (Eff. the applied dose (Dspiral) is influenced additionally by the pitch factor. The Effective mAs takes into account the influence of pitch on both the image quality and dose: Eff. and increased when pitch is smaller than 4. mAs/Rotation time) x (Pitch/2) You should change the mAs according to the patient size. if a multislice CT scanner (4-slice) is used. the dose in spiral scanning has to be corrected by the pitch factor: Dspiral = (DCTDIw x mAs) /pitch To make it easier for the users. mAs The Effective mAs can be selected by the user for a defined image quality and dose. VZ = DCTDIw x Eff. the actual dose applied to the patient in spiral scanning will be decreased when pitch is larger than 4. however when the tube load (mA) reaches its highest limitation. you simply have to multiply the CTDIw per mAs with the effective mAs: Dspiral. For example. You should always define the scan range before you change the mAs. the “Scan Assistant” will be available to give you the possibility to adjust either the scan time or the mAs value.HeartView CT Effective mAs: In sequential scanning.

HeartView CT Dose information: The dose as described by CTDIw is displayed on the user interface for the selected scan parameters. i. the concept of the “Effective Dose” was introduced by ICRP (International Commission on Radiation Protection). the respective dose delivered during the CT scanning has to be calculated and then multiplied by its radiation risk factor. such as x-ray filtration and gantry geometry. the system design of individual scanner. These have to take into account the scan parameters. 17 .2 . It also allows comparing the applied x-ray exposure to the natural background radiation. For each organ. e. different exams associated with the same effective dose would have the same radiation risk for the patient. The CTDI is measured in the dedicated plastic phantoms – 16 cm diameter for head and 32 cm diameter for body (as defined in IEC 60601 . Finally the weighted organ dose numbers are added up to get the effective dose. The effective dose is expressed as a weighted sum of the dose applied not only to the organs in the scanned range. the scan range. the organs involved in the scanned range and the organs affected by scattered radiation.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. e. the CTDI value displayed can deviate from the dose in the scanned volume. For this purpose. For most of our scan protocols. g. we calculated the effective dose numbers for standard male* and female* and listed the result in the description of each scan protocol. The concept of effective dose would allow the comparison of radiation risk associated with different CT or x-ray exams. The CTDIw value does not provide the entire information of the radiation risk associated with the CT examination. Since the body size can be smaller or larger than 32 cm. 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 complicated and has to be done by sophisticated programs. 2-3 mSv per year in Germany.

HeartView CT The calculation was done by the commercially available program “WinDose”(Wellhoefer Dosimetry) – as shown in figure 1-3. 2: A graphic interface of WinDose allows to specify the anatomical scan range. 18 . Fig. All parameters necessary for the effective dose calculation have to be specified. 1: User interface of the PC program WinDose. Fig.

HeartView CT Fig. GSF report 30/91 19 . * The Calculation of Dose from External Photon Exposures Using Reference Human Phantoms and Monte Carlo Methods. 3: Results as output of WinDose with the organ dose readings and the effective dose according to ICRP26 (previous version) and ICRP60 (currently valid). M. Zankl et al.

using a pitch of 1.Sequential scanning protocol with ECG triggering. It can be performed with both ECG triggering (sequential scanning) and gating (spiral scanning) techniques.8.Fast spiral scanning protocol with ECG gating. using a pitch of 1.HeartView CT s How to do it Calcium scoring This application is used for identification and quantification of calcified lesions in the coronary arteries.Standard spiral scanning protocol with ECG gating.5. 20 . • CaScoreSpiFast . The following scan protocols are predefined: • CaScoreSeq . • CaScoreSpiStd .

18 21 . Fig. other kernels are not recommended. directly below the clavicle 3. Placement of ECG Electrodes (Fig. Left arm (LA): on the left mid-clavicular line. e.HeartView CT Hints in general: • Kernel B35f is dedicated to calcium scoring studies. g. follow-up studies of calcium scoring or comparison studies with conventional angiography. Use the ECG gated protocol when accuracy and/or reproducibility are essential. • Use the ECG triggered protocol generally except for patients with arrhythmia. 18): 1. left leg (LL): on the left mid-clavicular line. • The standard protocol (pitch 1. directly below the clavicle 2. To ensure the best image quality and correlation to known reference data. at the 6th or 7th intercostal space. • The fast protocol (pitch 1. Right arm (RA): on the right mid-clavicular line.8) can be applied when the heart rate is consistently greater than 80 bpm.5) is recommended whenever the entire scan range can be covered within a single breathhold and the heart rate is greater than 40 bpm.

otherwise the image acquisition will be interrupted by the default breathhold interval. Fig. From the carina until the apex of the heart.3 mGy 117.5 mm 10 mm 0. 512 mm.8 mSv If you apply API for image acquisition.5 mm 2. e. Topogram: AP. Fig. 19 kV Effective mAs Slice collimation Slice width Feed/Scan Rotation time Temporal resolution Kernel CTDIw Scan range Effective Dose 120 35 4 x 2. This does not apply when API is not activated.5 mm male: 0. 50 s.5 s 250 ms B35f 3.HeartView CT CaScoreSeq Indications: This is a sequential scanning protocol using an ECG triggering technique for coronary calcium scoring studies. please make sure that the breath-hold interval in the Patient Model Dialog is longer than the total scan time. g.5 mSv female: 0. 21 22 . A typical range of 12 cm covering the entire heart can be done in 20-30 s (depends on heart rate). 20 Fig.

22 kV Effective mAs Slice collimation Slice width Feed/Rotation Rotation time Temporal resolution Kernel Increment CTDIw Scan range Effective Dose *Depends on heart rate. From the carina until the apex of the heart. 512 mm. Topogram: AP. using an ECG gating technique for coronary calcium scoring studies.2 mSv female: 3.2 mSv Fig.5 s Up to 125 ms* B35f 1.5 mGy 120 mm male: 2. 23 Scan 1:67 mm3 Fig. A typical range of 12 cm covering the entire heart can be done in 16 s. 120 133 4 x 2. 24 Scan 2:64 mm3 23 .5 mm 12.5 mm 3 mm 3. Fig.75 mm 0.HeartView CT CaScoreSpiStd Indications: This is a standard spiral scanning protocol.

Topogram: AP.5 s Up to 125 ms ** B35f 1. kV Effective mAs Slice collimation Slice width Feed/Rotation Rotation time Temporal resolution Kernel Increment CTDIw Scan range Effective Dose **Depends on heart rate.5 mm 10. From the carina until the apex of the heart. using an ECG gating technique for coronary calcium scoring studies.3 mGy 120 mm male: 1. 512 mm. A typical range of 12 cm covering the entire heart can be done in 14 s.8 mSv female: 2.7 mSv 24 .5 mm 0.5 mm 3 mm 4. 120 110 4 x 2.HeartView CT CaScoreSpiFast Indications: This is a fast spiral scanning protocol.

HeartView CT Fig. 26 Fig. 27 25 .

coronary bypass. It can be performed with both ECG triggering and gating techniques.5 is recommended whenever the entire scan range can be completed within a single breathhold. • CoronaryCARE .Spiral scanning protocol with ECG gating and dedicated reconstruction kernel for better edge definition in coronary artery imaging. using a pitch of 1. if the heart rate is less than 40 bpm. The following scan protocols are predefined: • ECGTrigCTA .g. • CoronaryFast . 26 .5. is required. • The ECG gated standard protocol using a pitch of 1. e.Standard spiral scanning protocol with ECG gating. using a pitch of 1. or.Sequential scanning protocol with ECG triggering. • The ECG gated fast protocol using a pitch of 1.Fast spiral scanning protocol with ECG gating.8 can be applied if the heart rate is greater than 80 bpm consistently.Spiral scanning protocol with ECG gating and dedicated cardiac filter (Cardio CARE) which reduces image noise thus makes dose reduction possible. • CoronarySharp . • The ECG triggered protocol is recommended when image acquisition for a longer range is necessary and it can not be completed by spiral scanning within a single breathhold. • Always use the ECG gated protocol for patient with arrhythmia.HeartView CT Coronary CTA This is an application for imaging of the coronary arteries with contrast medium. • CoronaryStd .8. VRT or Fly through. and whenever 3D postprocessing. the ECG gated protocol is recommended for premium image quality of the coronary arteries. General Hints: • Generally speaking. such as MPR.

From the aortic arch until the apex of the heart. g. e. Topogram: AP. e. 29 Fig. that can not be acquired within a single breathhold. the entire thoracic aorta. Fig.g. otherwise the image acquisition will be interrupted by the default breathhold interval.5 s 250 ms B30f 11.5 mm 2.3 mGy 117. For longer ranges. 28 kV Effective mAs Slice collimation Slice width Feed/Scan Rotation time Temporal resolution Kernel CTDIw Scan range Effective Dose 120 120 4 x 2. 50 s. Fig.5 mm male: 1. according to the patient’s level of cooperation.7 mSv If you apply API for a single breathhold acquisition.HeartView CT ECGTrigCTA Indications: This is a sequential scanning protocol with an ECG triggering technique for coronary CTA studies. aortic dissection. 512 mm.8 mSv female: 2. please make sure that the breathhold interval in the Patient Model Dialog is longer than the total scan time. please ensure that the breathhold interval in the Patient Model Dialog is set up correctly. It could also be applied for aortic CTA studies. A range of 16 cm can be covered in 32 s. 30 27 . This does not apply when API is not activated. g. e.5 mm 10 mm 0.

Fig.5 mm 0.1 mSv Fig.5 s Up to 125 ms * B30f 0.6 mSv female: 11. 31 kV Effective mAs Slice collimation Slice width Feed/Rotation Rotation time Temporal resolution Kernel Increment CTDIw Scan range Effective Dose *Depends on heart rate. 120 400 4 x 1 mm 1.25 mm 1. A typical range of 10 cm covering the entire heart can be done in 34 s. Topogram: AP. 32 Fig.HeartView CT CoronaryStd Indications: This is a standard spiral scanning protocol with an ECG gating technique for coronary CTA studies. Approximately. from the carina until the apex of the heart.6 mGy 120 mm male: 7.8 mm 45. 512 mm. 33 28 .

Approximately.8 mm 0. Topogram: AP. from the carina until till the apex of the heart. 512 mm. 35 Fig.5 s Up to 125 ms * B30f 0.HeartView CT CoronaryFast Indications: This is a fast spiral scanning protocol using a pitch of 1. A typical range of 10 cm covering the entire heart can be done in 28 s.8 mm 37.6 mGy 120 mm male: 6.25 mm 1. Fig.8 with an ECG gating technique for coronary CTA studies. 36 29 .2 msv Fig. 120 330 4 x 1 mm 1.3 mSv female: 9. 34 kV Effective mAs Slice collimation Slice width Feed/Rotation Rotation time Temporal resolution Kernel Increment CTDIw Scan range Effective Dose *Depends on heart rate.

A typical range of 10 cm covering the entire heart can be done in 34 s.25 mm 1. Approximately.5 mm 0.1 mSv female: 7. kV Effective mAs Slice collimation Slice width Feed/Rotation Rotation time Temporal resolution Kernel Increment CTDIw Scan range Effective Dose *Depends on heart rate.HeartView CT CoronaryCARE Indications: This is a spiral scanning protocol using ECG gating technique and a dedicated cardiac filter which can reduce images noise thus makes the dose reduction possible for coronary CTA studies.4 mSv Image acquired with 400 effective mAs.4 mGy 120 mm male: 5. 30 . 120 267 4 x 1 mm 1.5 s Up to 125 ms * B30f 0.8 mm 30. Topogram: AP 512 mm. . Image acquired with 266 effective mAs and Cardio CARE filter. from the carina until till the apex of the heart.

5 s Up to 125 ms * B46f 0.6 mSv female: 11.25 mm 1.6 mGy 120 mm male: 7. 31 .HeartView CT CoronarySharp Indications: This is a spiral scanning protocol using ECG gating technique and a dedicated cardiac reconstruction kernel for better edge definition in coronary artery imaging. .8 mm 45. A typical range of 10 cm covering the entire heart can be done in 34 s. kV Effective mAs Slice collimation Slice width Feed/Rotation Rotation time Temporal resolution Kernel Increment CTDIw Scan range Effective Dose *Depends on heart rate.5 mm 0. Topogram: AP 512 mm. 120 400 4 x 1 mm 1. from the carina until till the apex of the heart. Approximately.1 mSv 1a 1b Image reconstruction with (1b) and without (1a) Cardio Sharp kernel.

g. e. The following scan protocols are predefined: • LungECGHires . • PulmonaryECG . General Hints: • The general purpose of these applications is to reduce motion artifacts in the lungs due to the cardiac pulsation. aorta dissection or pulmonary emboli.Sequential scanning protocol with ECG triggering. or when imaging the aorta and pulmonary arteries with contrast medium and ECG gating technique.HeartView CT Aortic and pulmonary studies This application can be used for high-resolution interstitial lung studies with an ECG triggering technique. • The PulmonaryECG protocol is recommended for aortic or pulmonary studies. • The LungECGHires protocol is recommended for detection and localization of the lesions adjacent to the heart or the interlobar fissures. using a pitch of 2. 32 .Spiral scanning protocol with ECG gating. It should not be applied when the heart rate is less than 60 bpm.

39 375 msec. 1 mm without ECG-trigger Fig. 1 mm with ECG-trigger 33 .7 mGy 300 mm male: 1.HeartView CT LungECGHires Indications: This is a sequential scanning protocol with an ECG triggering technique for interstitial studies of the lungs. 37 kV Effective mAs Slice collimation Slice width Feed/Scan Rotation time Temporal resolution Kernel CTDIw Scan range Effective Dose 120 120 4 x 1 mm 1 mm 15 mm 0. . From the apex of the lung till the lung base. Topogram: AP 512 mm. Arange of 26 cm can be covered in 36 s Fig.5 mSv female: 1. especially for the lesions in the pericardial region.9 mSv Fig.75 s 375 ms B70s 13. 38 750 msec.

A typical range of 15 cm can be covered in 16 s.8 mGy 300 mm male: 7. aortic dissection or pulmonary emboli. From the aorta arch until the tip of the sternum.8 mSv Fig. Topogram: AP. 42 34 .HeartView CT PulmonaryECG Indications: This is a spiral scanning protocol using a pitch of 2 with an ECG gating technique for aortic and pulmonary studies. 120 200 4 x 2. e.5 mSv female: 9.5 mm 3 mm 5 mm 0. Fig. g. 40 kV Effective mAs Slice collimation Slice width Feed/Rotation Rotation time Temporal resolution Kernel Increment CTDIw Scan range Effective Dose *Depends on heart rate. 41 Fig. 512 mm.5 s Up to 125 ms * B30f 2 mm 18.

HeartView CT
s Additional important information
• While all the other arteries receive arterial blood supply during the systolic phase, the coronary arteries are most appropriately supplied with blood during the diastolic phase. Therefore, for imaging the coronary arteries, image reconstruction is usually performed in the diastolic phase – not only for minimal motion artifact, but also for optimally filled coronary arteries. • You may see different heart rates displayed on the inroom ECG monitor and the monitor on the console since they are calculated in different ways: 1. On the ECG monitor – the heart rate displayed is based on the “R-R” intervals for every 15 s. 2. On the console – the heart rate displayed for ECG gating is based on every “R-R” interval, and for ECG triggering, it is based on the average of the previous 3 or 5 “R-R” intervals (this can be configured with Option/Configuration/HeartView). • For the LungECGHires protocol, it is recommended to use the cluster scanning mode. You can set up the predefined breathhold interval in the “Patient Model Dialog” . • The postprocessed VRT images of the coronary arteries can be matched according to the “standard projections” of the conventional angiography. Image examples are shown below (Fig. 43-49). For easier comparison, the Fig. 43b, 44b and 45b are mirrored. Views which can not be achieved by conventional angiography are shown in Fig. 50.

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HeartView CT

LCA, RAO 15

Fig. 43a

Fig. 43b

LCA, RAO 30

Fig. 44a

Fig. 44b

LCA, AP Cranial

Fig. 45a

Fig. 45b

LCA, LAO 60/0

Fig. 46a

Fig. 46b

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HeartView CT

LCA, LAO 90/0

Fig. 47a

Fig. 47b

RCA, RAO 30

Fig. 48a

Fig. 48b

RCA, LAO 60

Fig. 49a

Fig. 49b

Top view

Fig. 50a

Base view

Fig. 50b

Views which can not be achieved by conventional Angiography

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HeartView CT
• Why can’t I use a higher pitch for ECG gated scanning?

Z-Position

Recon

Recon

Delay

Recon

us d e tinuo Con an & Fe al Sc Spir

“3D“ Image data

ECG R

R

R

R

Time Fig. 51

Z-Position

“3D“ Gap

Recon

Recon

Delay

Recon

ECG R

R

R

R

Time Fig. 52

X: ECG trace (time) Y: Z-position Slope: Table feed speed

If a higher pitch would be used, gaps will be produced in the volume acquisition as shown in Fig. 52.

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Recon

Recon

In case of ECG signal loss during the acquisition.HeartView CT • By default. 54 39 . the “Synthetic Trigger” (ECG triggered scanning) or “Synthetic Sync” (ECG gated scanning) is activated for all predefined cardiac scan protocols (Fig. 53 and 54). 53 Fig. the scanning will be aborted in case of ECG signal loss during the acquisition. Fig. And it is recommended to keep it always activated for examinations with contrast medium. If it is deactivated. this will ensure the continuation of the triggered scans or allows an ECG to be simulated for retrospective gating.

The image temporal resolution of 125 ms can be achieved with ACV. Fig. it is switched on for all coronary CTA scan protocols. and switched off for all calcium scoring scan protocols. By default. And it is not recommend to change this default setting. 55) is a dedicated algorithm for bi-phase image reconstruction. 55 40 .HeartView CT • ACV (Adaptive Cardio Volume) (Fig.

7.This then can be saved on floppy disc and/or printed.Score (Agatston method) 8. 41 .Calcium mass (mg calcium Hydroxyapatite) . you can use freehand ROI for the definition of lesions. free text and clinical images.The results cab be printed on laser film. 4. however. 2. 3. The separation and modification of lesions within a defined volume (depth in mm) can be performed not only on 2D slices.Peak density (in HU) . but also with 3D editing. You can generate HTML report including site specific information.Volume (in mm3) . you can blowup the display. The results are displayed online in a separate segment includiong the following information: . In addition to the seeding method. paper printer or saved into data base.HeartView CT • Calcium Scoring evaluation is performed on a separate syngo task card: 1. The threshold of 130 HU is applied for score calculation by default.Area (in mm3) . you can modify it accordingly. For easier identification of small lesions. 6. 5. You can customize hospital/office information on the final report using Report Configuration.

as well as the opacity of vessels. 1a Shorter scan time Fig. Since multislice spiral CT can provide much faster speed and shorter acquisition time. it is essential to initiate the acquisition with the correct start delay.Bolus tracking s The basics The administration of intravenous (IV) contrast material during spiral scanning improves the detection and characterization of lesions. 3b) • Concentration of the contrast medium (Fig.The contrast scan will yield good results only if the acquisition occurs during the optimal phase of enhancement in the region of interest. Therefore. 3a. 1a. 4b) • Patient pathology 42 . 3b. 2b) • Total volume of contrast medium injected (Fig. 1b). 1b The dynamics of the contrast enhancement is determined by: • Patient cardiac output • Injection rate (Fig. 4a. 40 s scan 10 s scan Longer scan time Fig. 4a) • Type of injection – uni-phasic or bi-phasic (Fig. it is even more critical to get the right timing to achieve optimal results (Fig. 2a.

370 mg I/ml Bi-phase 70 ml. 300 mg I/ml Fig. 4 ml/s. 4 ml/s. 4b *Radiology 1998. 2b 80 ml. 2 ml/s. contrast injection (computer simulation*). 300 mg I/ml Fig. plus 70 ml. 60-year-old. 300 mg I/ml Fig. 2 ml/s.655 43 . 4 ml/s.Bolus tracking Aortic time-enhancement curves after i.120 ml. 75 kg). 300 mg I/ml Fig. 3b Uni-phase Fig. 370 mg I/ml Fig. 4a 140 ml. 3a 120 ml.120 ml. 4 ml/s. All curces are based on the same patient parameters (male. v. 207:647. 2a 4 ml/s.

use of CARE Bolus is recommended (optional). 3.This mode can be applied in combination with any spiral scanning routine protocol. General Hints: 1. (The distance between the beginning of the spiral scanning range and the monitoring scan will be the same). it will be snapped automatically. To achieve the shortest possible spiral start delay (2 s). • If you need to redefine the spiral scanning range. CARE Bolus (optional) This is an automatic bolus tracking program. A “snapping” function is provided: • After the Topogram is performed. which enables triggering of the spiral scanning at the optimal phase of the contrast enhancement. (Trick: if you move the monitoring scan line away from the optimal position the “snapping” mechanism will be inactive).Bolus tracking s How to do it To achieve optimal results in contrast studies. use Test Bolus. v. the predefined spiral scanning range and the optimal monitoring position will be shown. i. Simply insert “Bolus tracking” by clicking the right mouse button in the chronicle. • Move the monitoring scan line towards the optimal position and release the mouse button. The pre-monitoring scan is used to determine the level of monitoring scans. bolus and monitoring scan protocol. You can also increase the mAs setting to reduce the image noise when necessary. you should also reposition the monitoring scan in order to keep the shortest start delay time (2 s). This inserts the entire set up including pre-monitoring. 2. You can also save the entire set up as your own scan protocols (please refer to the application guide for routine protocols). In case it is not available. You can even predefine several pre-monitoring scans by defining a short range and then selecting the optimal image in which to place the trigger ROI. 44 . It can be performed at any level of interest. the position of the monitoring scans relative to the beginning of spiral scan must be optimized.

5. (The ROI is defined with double circles – the outer circle is used for easy positioning. you can set the trigger level to its maximum (800 HU). You can also initiate the spiral any time during the monitoring phase manually – either by pressing the START button or by clicking the START key.You can also zoom the reference image for easier positioning of the ROI. you can also use the “Test Bolus” . If you do not have this option. 5 45 . If you do not want to use automatic triggering. and initiate the contrast injection and monitoring scans at the same time.Bolus tracking 4. there will be simultaneous display of the relative enhancement of the target ROI. An image example is shown below (Fig. 5). 6. and the inner circle is used for the actual evaluation). During the monitoring scans. When the predefined density is reached. If you would like more information on this option. the spiral acquisition will be triggered automatically. Place an ROI on the target area or vessel used for triggering. please contact your local Siemens representative. Set the appropriate trigger threshold. Abdominal aortic aneurysm (MIP) Fig. and start the trigger manually.

A test bolus with 10-20 ml is then administered with the same flow rate as during the following spiral scan. 46 . 3. time Kernel Cycle time TestBolus 120 30 4 x 2. kV mAs Slice collimation Slice width Feed/Rot. 6. and then “Append” the TestBolus mode under Special protocols. This time can then be used as the optimal start delay time for the spiral scan. This ROI will appear on all images in the test bolus series. number of scans and cycle time before loading the mode. on the image segment. Load the images into the Dynamic Evaluation function and determine the time to the peak enhancement.Bolus tracking Test Bolus Indications: This mode can be used to test the start delay of an optimal enhancement after the contrast medium injection. Rot. Perform the Topogram. and calculate the time “∆t” taken to reach the peak HU value (do not forget to add the preset start delay time). 5. Check the start delay. Insert the Test Bolus mode above the spiral mode for contrast scan by “cut/paste” (with right mouse button). click “select series” with the right mouse button and position an ROI on the first image. and define the slice position for TestBolus.5 B30f 2s Application procedures: 1. Find the image with the peak HU value. 4.5 10 0 0. Alternatively. Select the spiral mode that you want to perform. Start the contrast media injection and the scan at the same time. 2.

The same Topogram can still be used. there may be residual contrast in the liver and kidneys prior to scanning. e. 3. 6.The preset start delay time for monitoring scans depends on whether the subsequent spiral scan will be acquired during the arterial phase or venous phase. it is recommended that you modify the parameters of the spiral scanning before inserting the CARE Bolus. The default value is 10 s. 14 s. the spiral will start 5 s after the threshold is reached. g. g. It should be pointed out that when using “Test Bolus” . e. and the API lasts 5 s.Bolus tracking s Additional important information 1. if the CT value is 50 HU in the non-contrast image. In case you have to interrupte the monitoring scanning due to injection problem. This may result in an inaccurate arterial and equilibrium phase. The trigger threshold is not an absolute value but a relative value compared to the non-contrast scan. 47 . rotation time or kV in the spiral scanning protocol after CARE Bolus is inserted. you can repeat it afterwards by inserting CARE bolus again with a right mouse click. g. You can modify it accordingly. and your trigger level is 100 MU. This is due to the necessary mechanical adjustments. if the predefined the start delay is 2 s. then the absolute CT value in the contrast image will be 150 HU. 4. If you change slice collimation. moving the slice collimators. If API is used in conjunction with CARE Bolus. 5. a longer spiral start delay time will be the result. the actual start delay time for the spiral will be as long as the length of API including the predefined start delay time. g. Therefore. E. E. 2.

s The basics What is the relevant anatomical information for oral surgery planning and dental implantation? • Location of the socket for dental implant. • Buccal and lingual thickness of the cortical component of the alveolar process. It enables the display and measurement of the bone structures of the upper and lower jaw (especially for a 1:1 scale) as the basis for OR planning in oral surgery. • Presentation of results in the form of multiple image display with reference markings. Panoramic view Fig. The layout of the film sheet is predefined such that it can accommodate the maximum number of reformatted images. 2 48 .Dental CT This is an application package for reformatting panoramic views and paraxial slices through the upper and lower jaw. 1 Paraxial view Fig. • Extent of the nasal sinuses and • Position and width of the floor of the nasal cavity. • Position of the mandibular canal and the mental foramen. What can Dental CT do? • Reformatting of a curvilinear range of panoramic views along the jaw-bone. • Reformatting of linear views of selectable length and at selectable intervals perpendicular to the panoramic views. • Images are documented on film in “life-size” so that the direct measurement of the anatomic information with a ruler is possible.

For either jaw: jaw bone in parallel to the scan plane.3 mSv female: 0. in order to minimize the scan length for the same anatomical region. time Kernel Increment Scan range CTDIw Effective Dose Dental CT 120 70 4 x 1 mm 1 mm 2. • Gantry tilt is not necessary since you have the possibility to tilt the reference line to generate an axial reformatted image at the desired plane.8 mm 45 mm 19.For the upper and lower jaw: occlusal plane in parallel to the scan plane. • It is recommended to end the exam first. and then start the Dental evaluation. it is recommended to position the patient’s head at the appropriate scan plane whenever possible: .3 mSv • It is mandatory to position the patient head in the center of the scan field – use the lateral laser light marker for positioning.7 mm 0. Rot.75 s H60s 0.Dental CT s How to do it Scan protocol: kV mAs Slice collimation Slice width Feed/Rot. However. 49 .3 mGy male: 0. .

3 s Additional important information • This protocol delivers high resolution images for dental CT evaluation. AP-cranial view Fig. e. you can also reconstruct images with softer kernel. 4b 50 . 4a Caudal view Fig.Dental CT Delineation of the desired views Fig. for 3D/SSD postprocessing. H20s. however.g.

. 5 51 . over individual sockets at different locations (Fig. a “B” stands for “Begin" and an “E” for “End". • It is better to change the image windowing on the virtual film sheet.5). a number of paraxial lines and copy the lines to another location. the results of the latest Dental CT Film are stored in the Pateint Browser in the folder “Film” . • A semi-automatic detection tool can be used to mark and outline the mandibular canal on both paraxial and panoramic images for easy viewing and filming.In the panoramic view. film directly from the dental card instead of Patient Browser. such as vessels. For easy reprinting. • ROI definition for statistical evaluations and deletion of graphics are possible. • Since Dental CT provides you with the possibility to generate the curved MPR in a range. • Multiple paraxial ranges can be defined on one reference image by “cluster & copy function” I. you can group .In the paraxial view. e. • Filming: for the maximum use of the film. simply drag & drop it back. e. you may try to use it for the evaluation of the other anatomic region. Fig.Dental CT • Image orientation: . g. If not. a “B” indicates buccal and a “L ” lingual. The lingual marker “+” must always be positioned at the tongue..

Siemens reference data: The Siemens reference data was acquired at three European centers. What is “Z-score”? This is the deviation of average BMD of the patient from that of a healthy person of the same age.and boneequivalent calibration phantom. 52 . s The basics This program enables the quantitative determination of bone mineral density of the spine in mg/ml of calcium hydroxyapatite (CaHA) for the diagnosis. It is an indicator of biological variability. including 135 male and 139 female subjects. 20 to 80 years of age. What is “T-score”? This is the deviation of average BMD of the patient from that of a young healthy control. The patient is scanned together with the water. and follow-up of osteopenia and osteoporosis with CT. staging. It represents bone loss with reference to the peak bone mass.Osteo CT This is an application package for the quantitative assessment of vertebral bone mineral density for the diagnosis and follow-up of osteopenia and osteoporosis.

time Kernel Cycle time CTDIw Effective Dose Osteo OsteoObese 80 80 125 350 4 x 2. Support the knees to compensate for lordosis. It is recommended to use image comments L1.1 mSv female: 0. • Patients should be positioned so they are as parallel to the patient table as possible.g.04 mSv male: 0.05-0. Scanning: • Typically. L3 prior to scanning. the cut-lines for each vertebra on the topogram.5 mm 10 mm 10 mm 0 mm 0 mm 0.5° to +30°.6 mGy 10. Rot.The gantry tilt will be available from –28. or T12 instead of TH12. • The calibration phantom should be positioned directly below the target region.2 mGy male: 0. e.Osteo CT s How to do it kV mAs Slice collimation Slice width Feed/Rot.03-0. These comments will be displayed with the Osteo evaluation results. i. one scan each is performed at L1. 53 . • Before ending the examination. you can drag&drop the chronicles to the topogram segment to get the Topographics.3 mSv Patient positioning: • Set the table height at 125.1-0. Note: no blanks or other deviations are allowed for the comments.5 s S80f S80f 3s 3s 3. L2 and L3 levels.5 mm 4 x 2. e. use L3 instead of L 3.1 mSv female: 0.5 s 1. L2. Put the Gel-pad between the calibration phantom and the patient to exclude air pockets.

and then start the Osteo evaluation. please refer to the Appendix. • Call up the Osteo card and you will see the new icon “Export results” on the lower. 2 s Additional important information 1. right part of the screen • Click this icon to copy the evaluation results to floppy disk (Note: with every mouseclick on the icon. • Position the cut line of scanning through the middle of the vertebra. with MS Excel. • Activate the checkbox “Enable Export of Results” . e. e. i. How to save the results on your PC? • Select Option/Configuration from the main menu and click icon "CT Osteo” . bi-sector between the angle of the upper and lower end plate. use “OsteoObese” for obese patient. • “Exit” the configuration dialog. Fractured vertebrae are not suited for Osteo CT evaluation since the more compact nature of these vertebrae result in bone mineral density value that is much higher than one would expect. • The data file can be transferred to your PC for further evaluation. the previous result file will be appended). 1 Phantom inside the FOV Fig.Osteo CT • Select the appropriate scan protocol according to the patient size. • It is recommended to end the exam first. e.g. 54 . Topographic Fig. i. 2. • The phantom must be included in the FOV of the images for evaluation. Note: for detailed information about the data file.

and click “film” icon. Select images or series with Edit > Select all. 55 . 3. Filming layout Fig. you will get a standard layout of 9 segments as seen in Fig. It is recommended to film directly from the Osteo card.Osteo CT 3. 3 Note: it is not recommended to use filming setting of 4 x 5 segments since the image text elements of the result image are overlapped and hard to read.

The scan parameters used are dependent on the indications and objectives of the study design. Full Inspiration Full Expiration Lung density at full inspiration/expiration Fig. Studies had shown that reproducibility is high and is unlikely to be improved by using spirometric gating [1]. Repeatability of Quantitative CT Indexes of Emphysema in Patients Evaluated for Lung Volume Reduction Surgery. Radiology 2001 220: 448-454 56 . which serves for quantitative evaluation of the lung density to aid the diagnosis and follow-up of diffuse lung diseases. usually at either full inspiration or full expiration. Scan protocols for routine thorax imaging can be used.1). Gierada et al. For example. David s. s The basics • No specific scan protocols were set up for this option. spiral mode for lung volume evaluation or HR sequence mode for interstitial lung diseases. Literatures 1.Pulmo CT This is an application package. sarcoidosis. panbronchiolitis and silicosis. 1 • Examinations should be acquired at the same respiratory level. such as pulmonary emphysema. • Lung density is influenced by respiratory status (Fig.

Please contact the local Siemens representative for further information. • User-specific reference data It is possible to integrate in your own reference data. Select the images that you want to evaluate. Since Pulmo CT program does not provide spirometric triggering for the acquisition of the data set.Pulmo CT • Siemens reference data: It was acquired from lung healthy individuals at 50 % vital capacity.g. 57 . e. and then start the Pulmo evaluation. s How to do it It is recommended to end the exam first. it is not meaningful to use Siemens reference data for comparison unless the data is acquired under the same conditions. data acquired at full inspiration. and activiate the program by clicking on the “Pulmo” icon. for the evaluation.

right part of the screen. • The data file can be transferred to your PC for further evaluation. (Note: with every mouseclick on the icon. the previous result file on the floppy will be appended). if you want to determine the percentage area of the lung within a specific HU range. How to export the evaluation results to a floppy disc? • Select Option/Configuration from the main menu and click icon “Pulmo”.Pulmo CT s Additional important information 1. with MS Excel. please refer to the Appendix. e. 2. 3. This allows direct visualization of the different densities distribution within the lung. • “Exit” the configuration dialog. 58 . • Call up the Pulmo card and you will see the new icon “Export results” on the lower. The auto-contour detection can be used as editing function for 3D postprocessing of lung images.g. Standard and expert mode can be configured to your needs. • Select Option/Configuration/Pulmo. use the card “Subranges” on the Configuration/Pulmo dialog. 4. Color-coded display of HU subranges and percentiles is possible. • Activate the checkbox “Enable Export of Results” . • Click this icon to copy the evaluation results onto floppy disk. Note: for detail information about the data file. For example.

Pulmo CT Pulmo CT task card. 59 .

Perfusion CT This is an application software package for the quantitative evaluation of dynamic CT data of the brain following injection of a highly concentrated iodine contrast bolus. s The basics • The current software is available with the syngo implementation. The main application is in the differential diagnosis and management of acute ischemic stroke. the time to local perfusion onset (Time-to-Start) and the time to local perfusion peak (Time-to-Peak). 60 . which allows multi-slice processing. Example: A 44-year-old man was brought to the hospital about 2 hours after the start of severe neurological symptoms of stroke in the right hemisphere. cerebral blood volume (CBV). • Parameters generated include among others cerebral blood flow (CBF). • The software optimally supports the stringent time and workflow requirements in an emergency setting where time is brain.

• The time-to-peak image shows a general prolongation of values in the MCA territory indicating delayed bolus arrival. In comparison to the left hemisphere the remaining supply area of the middle cerebral artery shows moderately reduced flow. if it is compared to the same area on the left side. however. Rot.3 mSv 2*10 mm narrow collimation 0 mm 1s 40 s H30s 1s Such a standard protocol may be slightly modified for specific reasons. 61 . time Scan time Kernel Increment Multiscan 80 250 5. e. • The CBV image shows the same severe reduction in insular cortex and lentiform nucleus. the blood volume in the remaining right MCA territory is close to normal.g.Perfusion CT The CBF image shows a severe perfusion disturbance (flow close to zero) in the insular cortex and the posterior portion of the lentiform nucleus. In contrast to the CBF image. s How to do it Scan protocols: BrainPerfCT kV mAs Effective Dose Slice Collimation Feed/Rot. the start delay can be increased by a few seconds for patients with very low cardiac output.

The original studies were performed mostly using 50 ml injected at 10 ml/s.V. like using a large gauge cannula (16 or 18 are usually sufficient) and warming the contrast media to body temperature to reduce its viscosity. Note: As with any contrast medium application. should be considered. that by sacrificing some of the spatial resolution. The smaller the total amount the more helpful it is to consider a saline chaser bolus. Image quality will be reduced but the technique will still be diagnostic. 62 . a state-of-the-art power injector is recommended. the protocol can be reduced to 40 ml at 5ml/s. if at all possible you should try to explain the course of the examination to the patient and use additional head fixation in any case. verify that the particular models and brands that you use in the chain injector/contrast medium/cannula are approved by their respective manufactures for the use with the parameters you select. • Additional measures to facilitate the injection. • Motion during acquisition must be avoided. the examination can also be done with smaller amounts of contrast (35 to 40 ml) and correspondingly smaller flow rates.Perfusion CT I. In any case. • The standard examination slice is best positioned such that it cuts through the basal ganglia at the level of the inner capsule. The routine application has shown.370 8 ml/s 40 ml ˜5s 4s The technique requires a short bolus. Therefore. This selection includes those vascular territories of the brain that are frequently affected by perfusion impairment associated with acute stroke in the carotid territory. injection protocol: Contrast medium Concentration Injection rate Total volume Total injection time Start delay time Non-ionic 300 . If a flow rate of 8 ml/s is considered not recommendable for a specific patient.

This requires a compact bolus for optimal time resolution and a certain minimum amount of contrast for optimal signal to noise ratio. it is essential to understand that they are “functional“ or “parameter“ images that display a different type of information than standard CT images: 63 . • The eye lens should never be positioned in the scan plane. the angulation should be adjusted perpendicular to the occipital segment of the superior sagittal sinus well above the confluence of sinuses. 3 to 5 seconds) and a relatively small fractional blood volume (approx. contrast-enhanced and Perfusion CT images show? In order to interpret Perfusion CT images correctly. Example of a standard slice through the basal ganglia in a lateral topogram. 2 to 5%). Bolus definition can be significantly improved and the amount of contrast necessary reduced by using a saline chaser bolus with the same flow rate directly following the CM injection.Perfusion CT • The slice should be selected “flatter“ than in normal head CT scan. s Additional important information • Why short injection times are necessary? The brain has a very short transit time (approx. • What do normal.

• What do pixel values mean in the Perfusion CT images? It is very important to realize that pixel values now have a different meaning. g. g. So if you point the cursor into a parameter image bear in mind that you do not read a CT-value but a functional unit.Perfusion CT Normal CT images basically show only morphological properties of tissues by displaying their x-ray attenuation relative to that of water as CT-values in HU-units. color images can be printed via the filming task card. Standard contrast-enhanced CT extends this limitation either to make a compartment visible that normally has low contrast (e. For each voxel this process yields a variety of numbers which describe different aspects of tissue perfusion. Perfusion CT tries to utilize all the information hidden in the temporal changes of contrast enhancement by fitting a mathematical model to the local time attenuation curves. displays numbers proportional to blood flow. It is recommended to send the color images from the Viewing task card after having saved them on the Perfusion task card. A time-to-peak image. As the human eye is so much faster and better suited to interpret images than large amounts of numbers it makes sense to display these quantities in the form of images. A CBF image. • Filming color images If a color hardcopy device is connected to the system. for example. tumors or multiphase liver studies). so smaller numbers indicate lower flow. 64 . on the other hand. displays numbers proportional to the time until the bolus peak is reached. vascular structures in CTA) or to qualitatively display major perfusion differences of tissues (e. so higher numbers mean later bolus arrival. which depends on the type of image currently displayed.

Perfusion CT • How to fine-tune the color mapping? 1. 65 . 2. For “Time images” (Time to Start and Time to Peak) – the color palette for the time images maps increasing time values on a spectral scale: Violet ¡ blue ¡ green ¡ yellow ¡ red Display should be adjusted with the arrow buttons such that the areas with latest arrival times are just slightly red. For “flow images” (CBF and CBV) – the color palette for the flow image is designed such. As with the flow image black means no calculation (CSF space. that after optimal adjustment with the arrow buttons the following approximate correspondence will result for a normal brain: red green/yellow blue black ¡ ¡ ¡ ¡ vessels gray matter white matter no calculation (CSF space) After adjustment (use non-ischemic hemisphere as guideline) ischemic areas will therefore be displayed either in violet (very low flow) or as a mismatch with the nonischemic side (gray matter is blue instead of green). or areas with extremely low flow ¡ no time assessment possible).

pain therapy. abscess drainage. you can also de-activate the soft key – “Biopsy” in the routine card. joint studies. The raw data will not be available for image reconstruction.Interventional CT To facilitate CT interventional procedures. especially those sensitive organs. minimum invasive operations. insert a control scan by clicking on the chronicle with the right mouse button. If you need only few slices. HandCARE™ is a dedicated algorithm for dose reduction during the interventinal procedure (Fig. thus provides a significant dose saving to the operator’s hand and to the patient. In case of the FOV must be changed due to movement. You can “Append” any routine protocol after the interventional procedure for a final check and documentation. a short range of spiral scanning for the biopsy region. display. 1). e. g. The table height can be adjusted to minimum 255 mm. • CARE Vision CT This is a CT Fluoroscopic mode with 1 combined slice and up to 7 images/sec. and move the table by changing the table feed. and arthrograms. the following programs are provided: • Biopsy This is the multislice biopsy mode. g. such as biopsy. s The basics Any of these protocols can be appended to a spiral protocol for CT interventional procedures. 4 slices (e. • BiopsyCombine This is the biopsy mode with 1 combined slice. while maintaining effective mAs to assure image quality.1: Principle of HandCARE™. 66 . It switches off the x-ray exposure between 10:00 and 2:00 o’clock position. Gantry tilt is possible whenever necessary. Fig. 5 mm each) will be reconstructed and displayed for each scan.

It can be appended to any other scan protocol. Click “Same TP” under Table position in the routine card. e. 67 . Click “Load” and then “Cancel move” Press the “Start” . 3.5 B30f kV mAs Slice collimation Slice width Feed/Rot.Interventional CT s How to do it Biopsy Indications: This is the multislice biopsy mode. Application procedures: 1. you’ll get another 4 images with the same slice position. Select “Biopsy” mode under Special protocols. 6. 4.g. and then click “Append” . and then start the patient preparation. 2. you can increase this by changing the number of scans in the Routine card. and move the table. Perform a spiral scan first to define a target slice. time Kernel *region of interest and study dependent. however. This can be repeated 10 times as default. button and 4 images will be displayed. Press “Start” again. ThoraxRoutine for biopsy procedures in the thorax. Turn on the light marker to localize the Entry point. Rot. Four slices (5 mm each) will be reconstructed and displayed for each scan. Biopsy 120 150* 4x5 5 0 0. Change the mAs setting accordingly before you load the mode. 5.

2. Rot. This can be repeated 10 times as default. Turn on the light marker to localize the Entry point. Select “BiopsyCombine” mode under Special protocols. however.Interventional CT BiopsyCombine Indications: This is the biopsy mode with 1 combined slice. you’ll get another image with the same slice position. ThoraxRoutine for biopsy procedures in the thorax. It can be appended to any other scan protocol. Change the mAs setting accordingly before you load the mode. g. Perform a spiral scan first to define a target slice. Click “Load” and then “Cancel move” Press the “Start” . and then click ”Append” . Click “Same TP” under Table position in the routine card. BiopsyCombine 120 150* 4x5 10 0 0. and then start the patient preparation. you can increase this by changing the number of scans in the Routine card. 5. Press “Start” again. 6.5 B30f kV mAs Slice collimation Slice width Feed/Rot. button and 1 image will be displayed. 4. e. Application procedures: 1. time Kernel *region of interest and study dependent. 3. 68 . and move the table.

3.Interventional CT CARE Vision CT Indications: This is a CT fluoroscopic mode with 1 combined slice and up to 7 images/sec. e. 5. switch to start the scan or keep it pressed for continuous scanning.5 B30f Application procedures: 1. It can be appended to any other scan protocol. Turn on the light marker to localize the Entry point. Click “Load” and then “Cancel move” Press the foot.5 10 0 0. Rot. Perform a spiral scan first to define a target slice. ThoraxRoutine for biopsy procedures in the thorax. Change the mAs setting accordingly before you load the mode. and move the table. and then click ”Append” . g. Click “Same TP” under Table position in the routine card. Select “CARE VisionCT” mode under Special protocols. and then start the patient preparation. display. kV mAs Slice collimation Slice width Feed/Rot. 2. time Kernel CARE Vision CT 120 21 4 x 2. 69 . 4.

• You can chose either “Continuous” or “Incremental” mode for table movement (Fig. 2). • Image can be displayed with full screen and 1024 x 1024 matrix. 3 70 . the table will move 0. 2 Fig.Interventional CT s Additional important information • In the BiopsyCombine mode. 3). And in the “Incremental” mode. table begin and table end are all the same.5 mm each time you touch the joystick shortly. the slice position. It might be advisable to choose the increment either equal to the slice width or half of the slice width so that it is easier to adjust the table position to visualize the needle. table begin and table end are different. table position. • Dose & Time Watch is displayed for continuous observation (Fig. Fig. In the “Continuous” mode. the slice position. you can define incremental table movement in mm. table position. • In the Biopsy mode.

Image 1 Image 2 Image 3 Image 4 SP SP SP SP Fig.5 mm Image 2 2.5 mm Image 4 2. 1).: Biopsy 1: Image 1 2.5 mm Image 3 2. Image 1 Image 2 Image 3 Image 4 Table “position” Fig. And then.5 mm Table position: -100 Table out Biopsy 2: Image 1 Image 2 Image 3 Table in Image 4 Table position: -105 Image 1 Image 2 Image 3 Image 4 Biopsy 3: Table position: -95 71 . type the value into the “Table position” . 3 • How to shift the center of the four image? The principle is “plus shift” for table out or “minus shift” for table in.g. Image 1 Image 2 Image 3 Image 4 Table “Begin” Table “End” Fig. 2). E. 2 c) The table “Begin” means the center of the first image. 3). and the table “End” means the center of the last image (Fig.Interventional CT a) The SP (slice position) in each image means the center of the image (Fig. 1 b) The “Table position” means the central position of the 4 (or 2) images and will also be the position of the positioning light marker (Fig.

Ensure that all vital lines e. abdomen and pelvis. ECG. 72 . g. Code Blue for cardiac and respiratory arrest. two protocols are provided: • PolyTrauma This is a combined mode for the examination of multiple ranges. Prepare the CT room before admitting the patient. neck. g. g. Check that the emergency drug trolley is well-stocked and that all accessories such as in-room oxygen supply.. e. at all . IV tubing and oxygen tubing are not trapped under the patient or between the table and the cradle. respirator and resuscitation equipment that may be required during the examination are in working order. respiration. observe and practice the standard hospital operating policy for handling a patient in distress e. 3. Make allowance for the length of tubing required for the topogram scan range.. Never leave patients unattended at any time during the procedure. etc. 2.g. Finish the examination in the shortest possible time. g. e. • Trauma This is a one-range mode for fast screening. thorax. head. times during the procedure. 5.Trauma In any trauma situation. load IV contrast into the injector. time means life and the quality of life for the survivor. 8. 6. Any possible injuries to the spinal column should be determined before beginning the examination and taken into account when shifting and positioning the patient. Know. In order to facilitate the examinations. 7 Observe the vital signs e. 4. s The basics 1.

Rot.1 mGy male: 2.5 5 12. you could either combine different protocols.5 B30f 5 cr-ca 150 mm 14.5 8 8. 73 .5 B40f 7 cr-ca 250 mm 9.2 mSv AbdPelvFast 120 155 4x5 7 25 0. time Kernel Increment Direction Scan range CTDIw Effective Dose HeadFastSpi 120 260 4 x 2.75 H30s 8 cr-ca 110 mm 59 mGy male: 2.3 mGy male: 8.0 mSv female: 2.6 mSv In different polytrauma cases.5 mGy male: 3.5 0.8 0.1 mSv ThoraxFast 140 110 4x5 7 25 0.2 mSv female: 4. or delete any of the chronicle from the predefined protocol if they are not needed.0 mSv female: 11.1 mSv NeckFastSpi 120 150 4 x 2.Trauma s How to do it PolyTrauma Scan Protocol: kV mAs Slice collimation Slice width Feed/Rot.0 mSv female: 2.5 B30f 7 cr-ca 400 mm 13.

Trauma Trauma Scan Protocol: Trauma 120 115 4x5 10 40 0. 74 .9 mGy male: 10.4 mSv female: 12. time Kernel Increment Direction Scan range CTDIw Effective Dose You can adjust the mAs setting according to the region to be examined.5 B30f 7 cr-ca 720 mm 9.8 mSv kV mAs Slice collimation Slice width Feed/Rot. Rot.

Trauma s Additional important information 1. and type them into the routine card as “table begin” and “table end” . 3. If a Topo length of 1024mm is not long enough. 2. it might be advisable to position the patient as Feet first so that there will be more space for the intensive care equipment around. please pay attention to the mark of scannable range on the table mattress while positioning the patient. record the table position of the desired scan range while positioning the patient. For long range scanning. 75 . In some cases.

the scanner adapts the mA in real-time. 1: Example of scanning in the region of shoulder. This is done “on-the-fly” i. especially in the regions of shoulder and pelvis.CARE Dose CARE Dose is a clinical application package (optional) that provides real-time tube current modulation for Spiral and Sequential Scanning. . according to the patient’s attenuation profile (Fig. It can also improve image quality by increasing mA and thus reducing image noise on the lateral views. high mA Low attenuation. e. It decreases tube load. in the lateral projection (Fig. 2). e. larger volumes or Multi-phase studies. which extends the capacity for volume scanning with thinner slices. s The basics CARE Dose reduces patient dose significantly. 1). 76 . low mA Fig.g. High attenuation. s 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.

s Additional important information • CARE Dose is pre-selected by default for all standard protocols*. 2: Principle of CARE Dose tube current adaptation. It can be switched on/off in the scan card with a mouse click (Fig. 77 . • The application of CARE Dose does not require any changes in the scan parameters.CARE Dose Fig. * In case of software upgrade. Fig. The mean value of the mAs applied will be lower than what you have selected. If you want to make it as default for a scan protocol. simply switch it on and save the protocol. you have to switch CARE Dose on for your former scan protocols manually. 3: CARE Dose can be switched on/off in the scan card with a mouse click. from VA20 to VA40. • The mean value of the effective mAs applied is shown in the image text. 3 ). e. g.

These may be used with the Dynamic Evaluation function for the descriptive analysis of contrast enhancement of tissues. Scan parameter details such as mAs. increment etc. slice width. depend on the organ to be studied.Appendix s BodyPerfCT and BodyDynCT These are protocols templates for the analysis of contrast enhancement dynamics in the body. 78 .

55. 43.3. 20. <TML>. <CMT>.7.6. <Scan number>. IMAGE. 45.5.0. 26.5. 11:12:18. <TMR>.5.3. <CSR>. <TSR>. 192. 11:12:18. <Sex of patient> IMAGE. Male IMAGE.1.1. <CSL>. <Scan date>. <Patient name>. 192. L4. <BMD reference data. <TSL>. 29. 49. 180. 234. 236. age matched>.1. 55.5 Data Structure of the result file: PATIENT. <TST>.3. 21.3.4. 178.8. 59.3. 21.3 .7.8. 61. 20. 3. 27-JAN-1998. <T-Score>. 27-JAN-1998. 44. 22.2 REFDATA. <Patient ID>. 205. 47 49.Appendix s Osteo CT Example for one patient with three Osteo tomograms: PATIENT. 48. <CMR>. 23. 20. 43. <Z-Score>. 54. L3. 191. John Smith.3. <Age of young normal>. <Age of patient>.9. Male. young control>.0. 4. <Vertebra name>. IMAGE. <Sex of patient>. 64.1. 2. <Age of patient>.0. -4. 238.9. 50.7.9. 201.5 . 20. <CST> REFDATA. <Image number>. <BMD reference data. 50. 007. 125. 64.5. 11:12:17.5. <Standard deviation reference data> 79 .3.4.4.6. 210. <CML>. -3. 75. 47 52.8. <Scan time>.12.35. 21. 60. <TMT>.8. 27-JAN-1998.6. L2. 198.

Appendix Abbreviations: TML TMR TMT TSL TSR TST CML CMR CMT CSL CSR CST Trabecular Mean Left Trabecular Mean Right Trabecular Mean Total Trabecular Standard Deviation Left Trabecular Standard Deviation Right Trabecular Standard Deviation Total Cortical Mean Left Cortical Mean Right Cortical Mean Total Cortical Standard Deviation Left Cortical Standard Deviation Right Cortical Standard Deviation Total 80 .

-211 PERCENTILE.0 PERCENTILE. 100. 1. -799. <Mean>. 19. -885. 15. <Patient name>. RIGHT. -933.1. 234. 1000. 2. -1023.3 SUBRANGE. John Smith.1 RESULTS. -400. TOTAL.8 SUBRANGE. 112.1. limit>. -112 …… Data structure of the result file: START. RIGHT.5. <Image number>. 100. LEFT. <FWHM>. -784. 93.0. <Patient ID>. -884. -943. -1024. 33. -944.2 SUBRANGE.6. -886. 0. <Scan number>. -899. 234. 0. 234.5. 200. -934.1 SUBRANGE. -903. <Area>. 1. 22.9. 21. -888. -905. 34. 1000. 15. 0. TOTAL. -785. -793. <Threshold Contour>. <LEFT / RIGHT / TOTAL>.0 SUBRANGE. 234. 1. 0. <Scan date and time>.4. 80. 0. 234. 15. -793. <Accumulated Height> 81 .1. <Date and Time of the evaluation start> PATIENT. 100. TOTAL. -1024. 0. limit>.4. -1024. 3071. 234. 100. -400.5. 0. 0. RIGHT. 78.9. 3071. 234. 43. 200. -1023. LEFT. 25.Appendix s Pulmo CT Example of result file: START. -1024. -400. 64. -1024. 0.5. 25. 200. 007. 64. RIGHT. 234. 100. 2. <Sex of patient> IMAGE. -885.1 RESULTS. 1. 2. 234. <Number of Shrinkings> RESULTS. -1012. 3. 100. -800. <Image number>. -887. 75. 1. 1000. LEFT.-200. -1000.0. 2. LEFT. <Standard Deviation>.0 SUBRANGE. <Lower eval. 30. 234. -1000. TOTAL.1 RESULTS. 21. 234.0. -953. 2. Male IMAGE. 25. 1. 85. 27-JAN-1998 11:12:17. -954. <Upper eval. 3071. 234. 20-FEB-1998 12:01:17 PATIENT. 38. <Age of patient>. -112 PERCENTILE. -1000. 234. -1024. <Accumulated Volume>.

Appendix SUBRANGE..... <PATIENT / REFERENCE / RATIO>. <Upper Limit>. <Standard deviation last segment>. <Distance>. <Standard deviation first segment>... <Subrange Number>. <LEFT / RIGHT / TOTAL>. <W=Whole / C=Central / P=Peripheral >. . . age matched>. always 1>. <Subrange Number>.. <Upper HU value first percentile>.... <Increment>. limit>. <Percent Area last subrange> PERCENTILE.. <Mean>. young control>... <Lower Limit>. <Reference data. . <Image number>... <Lower Limit>. <Increment>.... <Number of segments>. <Percent Area first subrange>.. <Age of young normal>. <FWHM>. ... <Lower HU value last percentile>... . . <Segmentation number. <Area>. <Mean value last segment>. <A=Area / H=Heights>. <Area first segment>. <Number of segments>. <Upper HU value first percentile (or difference for DIFFERENCE)>. .. <ROI width>. <Date and Time of the evaluation end> 82 . <Upper Limit>.. <AP-Gradient> MANSEGMENT. <Standard deviation first segment>. <Increment>. <Area last segment>.. <Image number>. <Lower HU value last percentile (or difference for DIFFERENCE)>.. . <Area first segment>. <Increment>. <Upper Limit>. <T-Score>.. <Image number>. <Upper Limit>.. <Lower Limit>... <Mean value first segment>. <Sex of patient>. <Reference data. <PATIENT / REFERENCE / DIFFERENCE>. <Area last segment> TOTALRESULTS. <AP gradient : 0=no / 1=yes>. <Lower eval. . <Accumulated Height> TOTALSUBRANGE.. <Mean value first segment>.. <Upper eval. <Lower HU value first percentile (or difference for DIFFERENCE)>.. <LEFT / RIGHT >. limit>. <Standard deviation last segment>. <Standard deviation reference data> END. <Upper HU value last percentile> AUTOSEGMENT. <LEFT / RIGHT / TOTAL>.. . . . <Percent Area last subrange (or Ratio for RATIO)> TOTALPERCENTILE. <Age of patient>. <LEFT / RIGHT / TOTAL>. <Image number>. <Mean value last segment>. .. <Segmentation number>. <Percentile range number>.. <Lower Limit>. <Percentile range number>... <Accumulated Volume>. <Z-Score>. <Standard Deviation>. <Percent Area first subrange (or Ratio for RATIO)>.. <Lower HU value first percentile>. <Upper HU value last percentile (or difference for DIFFERENCE)> REFDATA. <LEFT / RIGHT >. .

83 .

Notes 84 .

no.siemens. Please contact us: CT Application Hotline: Tel. We assume no responsibility whatsover for the correctness of this information. suggestions and comments. Xiaoyan Chen 85 . to be used for any purpose in that regard. +49-9191-18 80 88 (outside Germany) 01 80-3 11 22 44 (in Germany) Fax no.. This material does not substitute for that duty and is not intended by Siemens Medical Solutions Inc. The statutory source for the technical data are the corresponding data sheets. The drugs and doses mentioned herein were specified to the best of our knowledge.hotline@med. we would highly appreciate your questions. Any health care practitioner reading this information is reminded that they must use their own learning. Variations may prove necessary for individual patients. The pertaining operating instructions must always be strictly followed when operating the SOMATOM Volume Zoom.General Considerations 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. training and expertise in dealing with their individual patients.de Author: Dr. To improve future versions of this application guide. The treating physician bears the sole responsibility for all of the parameters selected. +49-91 91-18 99 98 eMail: ct-application.

Please contact your local Siemens Sales Representative for the most current information.com Order No. A91100-M2100-A419-1-7600 Printed in Germany CC 63419 BA 11015. . Siemens AG.Siemens reserves the right to modify the design and specifications contained herein without prior notice. Note: Of necessity. Medical Engineering Computed Tomography Siemensstrasse 1. Germany Corporate Headquarters: Berlin and Munich Siemens AG. D -80333 München. D-91301 Forchheim. original images always lose a certain amount of detail when reproduced. Germany Internet: SiemensMedical. Wittelsbacher Platz 2.