Professional Documents
Culture Documents
User Manual
5951015-1EN
Revision 1
© 2023 GE HealthCare.
GE is a trademark of General Electric Company used under trademark license.
Contents
1 User Information . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1.2 User Documentation . . . . . . . . . . . . . . . . . . . . . . . 1
1.3 GE Approved Accessories, Components and Compatible 3rd Party Medical Devices . . . . 2
2 Regulatory Information. . . . . . . . . . . . . . . . . . . . . . . . 5
2.1 Applicable Regulations and Standards . . . . . . . . . . . . . . . . . . 5
2.2 Product Description. . . . . . . . . . . . . . . . . . . . . . . . 8
2.3 Product Manufacturer . . . . . . . . . . . . . . . . . . . . . . . 9
3 Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
3.1 General Safety Guidelines . . . . . . . . . . . . . . . . . . . . . .11
3.2 Safety Conventions . . . . . . . . . . . . . . . . . . . . . . . .12
3.3 Symbols and Warning Labels . . . . . . . . . . . . . . . . . . . . .13
3.3.1 Symbols . . . . . . . . . . . . . . . . . . . . . . . . .13
3.3.2 Equipment Warning Labels . . . . . . . . . . . . . . . . . . .18
3.4 Radiation Safety . . . . . . . . . . . . . . . . . . . . . . . . .27
3.5 Implantable Device Safety. . . . . . . . . . . . . . . . . . . . . .32
3.6 Electrical Safety . . . . . . . . . . . . . . . . . . . . . . . . .33
3.7 Electromagnetic Compatibility Safety . . . . . . . . . . . . . . . . . .37
3.8 Fire Safety . . . . . . . . . . . . . . . . . . . . . . . . . . .37
3.9 Mechanical Safety . . . . . . . . . . . . . . . . . . . . . . . .37
3.9.1 General Mechanical Safety . . . . . . . . . . . . . . . . . . .37
3.9.2 Patient Positioning . . . . . . . . . . . . . . . . . . . . . .38
3.9.3 Gantry Air Inlets . . . . . . . . . . . . . . . . . . . . . . .45
3.10 Use of Defibrillator. . . . . . . . . . . . . . . . . . . . . . . .47
3.11 Emergency Devices and Emergency Egress . . . . . . . . . . . . . . . .47
3.12 Laser Safety . . . . . . . . . . . . . . . . . . . . . . . . . .51
3.13 Reconstructed Image Orientation . . . . . . . . . . . . . . . . . . .54
3.14 Data Safety . . . . . . . . . . . . . . . . . . . . . . . . . .56
3.15 Application Specific Safety Topics . . . . . . . . . . . . . . . . . . .58
3.15.1 Axial and Helical Scanning . . . . . . . . . . . . . . . . . . .58
3.15.2 Cardiac Imaging . . . . . . . . . . . . . . . . . . . . . .59
3.15.3 CT Integrated Cardiac Module . . . . . . . . . . . . . . . . . .61
3.15.4 Advanced Application Safety . . . . . . . . . . . . . . . . . .61
3.15.5 Measurements . . . . . . . . . . . . . . . . . . . . . . .61
4 Read Me First . . . . . . . . . . . . . . . . . . . . . . . . . . 89
4.1 About This Manual . . . . . . . . . . . . . . . . . . . . . . . .89
4.2 Scan Monitor . . . . . . . . . . . . . . . . . . . . . . . . . .90
4.2.1 Home and Health Dashboards . . . . . . . . . . . . . . . . . .91
4.2.2 New Patient . . . . . . . . . . . . . . . . . . . . . . . .95
4.2.3 Patient Schedule. . . . . . . . . . . . . . . . . . . . . . .96
4.2.4 Using Remote Control Panel Patient Positioning Controls with AVIMOS. . . . . .98
4.2.5 Scan Setup . . . . . . . . . . . . . . . . . . . . . . . 104
4.3 Image Monitor . . . . . . . . . . . . . . . . . . . . . . . . 111
4.4 User Interface Conventions . . . . . . . . . . . . . . . . . . . . 120
4.5 System Troubleshooting Tips . . . . . . . . . . . . . . . . . . . . 124
8 Equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . 159
8.1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . 159
8.2 UDI Marking . . . . . . . . . . . . . . . . . . . . . . . . . 159
8.3 Scanner Desktop. . . . . . . . . . . . . . . . . . . . . . . . 159
8.4 Auto Positioning Depth Xtream Camera . . . . . . . . . . . . . . . . 178
8.5 Xtream Tablet Gantry Display . . . . . . . . . . . . . . . . . . . . 178
8.5.1 Overview . . . . . . . . . . . . . . . . . . . . . . . . 178
8.5.2 Tool bar and Cradle/Tilt Information . . . . . . . . . . . . . . . 180
11 Scan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 275
11.1 Overview. . . . . . . . . . . . . . . . . . . . . . . . . . 275
11.2 Scan Theory. . . . . . . . . . . . . . . . . . . . . . . . . 276
11.2.1 Dose Deterministic Effects . . . . . . . . . . . . . . . . . . 276
11.2.2 CT Perfusion. . . . . . . . . . . . . . . . . . . . . . . 279
11.2.3 Total Scan Time . . . . . . . . . . . . . . . . . . . . . 284
11.2.4 Automatic Exposure Control. . . . . . . . . . . . . . . . . . 284
11.2.5 Slice Thickness Reference Noise Index and Noise Index Values . . . . . . . 288
11.2.6 SmartmA/ODM . . . . . . . . . . . . . . . . . . . . . . 290
11.2.7 Auto Prescription . . . . . . . . . . . . . . . . . . . . . 299
11.3 Exam Workflow . . . . . . . . . . . . . . . . . . . . . . . . 310
11.3.1 Exam Workflow Concepts . . . . . . . . . . . . . . . . . . 311
11.3.2 Exam Workflow Windows. . . . . . . . . . . . . . . . . . . 311
11.3.3 Exam Workflow Procedures . . . . . . . . . . . . . . . . . . 318
11.4 Scan Parameters . . . . . . . . . . . . . . . . . . . . . . . 378
11.4.1 Scan Type . . . . . . . . . . . . . . . . . . . . . . . 378
11.4.2 Coverage Speed collection . . . . . . . . . . . . . . . . . . 380
11.4.3 kV and mA Control . . . . . . . . . . . . . . . . . . . . . 384
11.4.4 Anatomy Selection. . . . . . . . . . . . . . . . . . . . . 400
11.4.5 Scan parameters workflow . . . . . . . . . . . . . . . . . . 401
11.5 Timing Parameters . . . . . . . . . . . . . . . . . . . . . . 424
11.5.1 Timing Parameters collection . . . . . . . . . . . . . . . . . 424
11.5.2 Timing parameters workflow . . . . . . . . . . . . . . . . . 425
11.6 Recon Parameters . . . . . . . . . . . . . . . . . . . . . . . 427
11.6.1 Recon Parameter descriptions . . . . . . . . . . . . . . . . . 427
11.6.2 Primary Recon collection. . . . . . . . . . . . . . . . . . . 444
11.6.3 Primary Recon parameters workflow . . . . . . . . . . . . . . . 447
14 Cardiac . . . . . . . . . . . . . . . . . . . . . . . . . . . . 573
14.1 Overview. . . . . . . . . . . . . . . . . . . . . . . . . . 573
14.2 Patient preparation and set up before Scanning . . . . . . . . . . . . . 573
14.2.1 Consent Forms . . . . . . . . . . . . . . . . . . . . . . 573
14.2.2 Exam Prep Instructions . . . . . . . . . . . . . . . . . . . 573
14.2.3 Breathing instructions . . . . . . . . . . . . . . . . . . . 573
14.2.4 IV setup and contrast . . . . . . . . . . . . . . . . . . . . 576
17 Filming . . . . . . . . . . . . . . . . . . . . . . . . . . . . 705
17.1 Overview. . . . . . . . . . . . . . . . . . . . . . . . . . 705
17.2 Film Composer . . . . . . . . . . . . . . . . . . . . . . . . 705
17.2.1 Tools on the Film Composer . . . . . . . . . . . . . . . . . . 705
17.3 Filming . . . . . . . . . . . . . . . . . . . . . . . . . . 712
17.3.1 Filming from Navigation Viewport in Scan/Review Session . . . . . . . . 712
17.3.2 Filming from File Manager . . . . . . . . . . . . . . . . . . 713
17.3.3 Filming from Navigation Viewport in Scan/Review Session and File Manager . . 714
17.3.4 Scout Image with Cross Reference Line . . . . . . . . . . . . . . 714
18 Reformat . . . . . . . . . . . . . . . . . . . . . . . . . . . 729
18.1 Overview. . . . . . . . . . . . . . . . . . . . . . . . . . 729
18.2 Reformat . . . . . . . . . . . . . . . . . . . . . . . . . . 730
18.2.1 Open Reformat . . . . . . . . . . . . . . . . . . . . . . 730
18.2.2 Use the Reformat Image Controls for Volume Share 5 Applications. . . . . . 731
18.2.3 Use the Reformat Image Controls for Volume Share 7 Applications. . . . . . 733
18.2.4 Use the keyboard shortcuts . . . . . . . . . . . . . . . . . . 737
18.2.5 Use the right-click functions . . . . . . . . . . . . . . . . . 738
18.3 Display . . . . . . . . . . . . . . . . . . . . . . . . . . 739
18.3.1 Annotation . . . . . . . . . . . . . . . . . . . . . . . 740
18.3.2 ROI . . . . . . . . . . . . . . . . . . . . . . . . . 740
18.3.3 Modify active (red) annotation . . . . . . . . . . . . . . . . . 741
18.3.4 Review Controller screen . . . . . . . . . . . . . . . . . . 743
18.3.5 Toolbar . . . . . . . . . . . . . . . . . . . . . . . . 745
18.3.6 Export Summary Table screen . . . . . . . . . . . . . . . . . 748
18.3.7 ROI Preferences screen . . . . . . . . . . . . . . . . . . . 752
18.3.8 Annotate an image . . . . . . . . . . . . . . . . . . . . 753
18.3.9 Save preset annotation . . . . . . . . . . . . . . . . . . . 753
18.3.10 Measure . . . . . . . . . . . . . . . . . . . . . . . 754
18.3.11 Manage Colormaps . . . . . . . . . . . . . . . . . . . . 755
18.3.12 Add an ROI . . . . . . . . . . . . . . . . . . . . . . . 756
18.4 View Types . . . . . . . . . . . . . . . . . . . . . . . . . 756
18.5 Volume Render . . . . . . . . . . . . . . . . . . . . . . . . 759
18.5.1 Up ramp VR adjustments . . . . . . . . . . . . . . . . . . 761
18.5.2 Surface rendering . . . . . . . . . . . . . . . . . . . . . 762
18.5.3 Render modes . . . . . . . . . . . . . . . . . . . . . . 762
18.5.4 VR Controls screen . . . . . . . . . . . . . . . . . . . . 763
18.5.5 Create a multi-VR object . . . . . . . . . . . . . . . . . . . 766
18.6 Segmentation . . . . . . . . . . . . . . . . . . . . . . . . 767
18.7 Batch . . . . . . . . . . . . . . . . . . . . . . . . . . . 778
18.7.1 Batch types . . . . . . . . . . . . . . . . . . . . . . . 778
18.7.2 Batch protocol . . . . . . . . . . . . . . . . . . . . . . 778
18.7.3 Preview, film, or save a batch . . . . . . . . . . . . . . . . . 779
18.7.4 Export Docking Station . . . . . . . . . . . . . . . . . . . 779
20 Protocols . . . . . . . . . . . . . . . . . . . . . . . . . . . 879
20.1 Overview. . . . . . . . . . . . . . . . . . . . . . . . . . 879
20.2 Manage Protocols . . . . . . . . . . . . . . . . . . . . . . . 880
20.3 Protocol Management with kV Assist/Auto Prescription . . . . . . . . . . . 887
20.3.1 Considerations when enabling Auto Prescription in a Protocol . . . . . . . 887
20.3.2 Build a protocol with Auto Prescription . . . . . . . . . . . . . . 891
20.3.3 Auto Prescription Profile Editor . . . . . . . . . . . . . . . . . 893
20.3.4 Create Auto Prescription User Profile . . . . . . . . . . . . . . . 894
20.3.5 Considerations when enabling kV Assist . . . . . . . . . . . . . . 897
20.3.6 Build a protocol with kV Assist . . . . . . . . . . . . . . . . . 898
20.4 SmartPlan Settings in Protocol Management . . . . . . . . . . . . . . 899
20.4.1 SmartPlan Overview . . . . . . . . . . . . . . . . . . . . 899
20.4.2 SmartPlan Theory . . . . . . . . . . . . . . . . . . . . . 899
20.4.3 Enabling SmartPlan . . . . . . . . . . . . . . . . . . . . 899
20.4.4 SmartPlan Management . . . . . . . . . . . . . . . . . . . 904
20.5 Auto ROI (Option) Settings in Protocol Management . . . . . . . . . . . . 906
20.6 Auto ROI (Option) Management. . . . . . . . . . . . . . . . . . . 907
20.7 Auto Voice Management . . . . . . . . . . . . . . . . . . . . . 909
20.8 Auto Gating Configuration . . . . . . . . . . . . . . . . . . . . 913
20.9 Protocol Exchange . . . . . . . . . . . . . . . . . . . . . . . 918
20.10 IPM Service . . . . . . . . . . . . . . . . . . . . . . . . 925
20.11 GSI Profile Editor . . . . . . . . . . . . . . . . . . . . . . . 927
The original language of this document is English, Direction Number 5951015-1EN, Revision 1, and is applica-
ble to Revolution™ CT, Revolution™ CT ES 1.0 software, version 23MW17.xx.
1 User Information
1.1 Introduction
Anyone who operates this system should have received prior training before they attempt to
scan patients. This training should include medical and X-ray education, If necessary, additional
training is available from a GE Applications Specialist. Contact your institution’s GE Healthcare sales
representative for additional information about further safety and operational training. This manual
does not provide medical explanations, but it does suggest potential applications for some of the
software features. It describes potential safety problems and how to avoid them.
Everyone who uses this equipment must read and understand all instructions, precautions and
warnings. Procedures and safety precautions described in the Safety chapter should be read
periodically.
Only designated persons (service personnel) are to install this system. They are to refer to the proper
pre-installation and installation manuals when installing the system.
Only designated persons are to perform service on this system. They are to refer to the proper service
manuals when servicing this system.
Do not use the equipment if a known safety problem exists. Call your local service provider and
have the system repaired.
NOTE
For desktop host computer systems that use:
-Z800
-Z420
A PMT tower (along with a USB interface) will be utilized. Figure 79 on page 161
showing the PMT now too please.
• Click the icon, and select Learning Solutions from the drop-down menu.
• Select AWS from the drop-down menu.
• Select the language in which you want to view the documentation.
Type Model
Type Manufacturer/Model
QA Phantom 5477995
Strap 46-297629P1
IV holder 2309994-2
Type Manufacturer/Model
Patient contrast injector: Nemoto Dual Shot Alpha 7 (GE CiA425 Class IV)
For Enhanced Xtream Injector Option Nemoto Dual Shot Alpha (GE CiA425 Class IV)
Nemoto Dual Shot GX (GE CiA425 Class IV)
Medrad Stellant D (GE CiA425 Class IV)
Medrad Stellant Flex (GE CiA425 Class IV)
Medrad Centargo (GE CiA425 Class IV)
RTP Flat Tabletop (CT Cradle Overlay) Diacor OGS-4 (GE E6315JE)
CIVCO MTIL3311 (GE E8505MJ)
*See Revolution™ CT, Revolution™ CT ES User Manual Section 9.4 Power Loss with Partial UPS for
functional description
NOTE
Not all accessories are available in all markets.
2 Regulatory Information
IEC 60601-1:2005 Medical electrical equipment - Part 1: General requirements for basic safety and
essential performance
ES 60601-1:2005
EN 60601-1:2006
IEC 60601-1-2:2007 Medical electrical equipment - Part 1-2: General requirements for basic safety
and essential performance - Collateral standard: Electromagnetic compatibility -
Requirements and tests
IEC 60601-1-2:2014 Medical electrical equipment - Part 1-2: General requirements for basic safety
and essential performance - Collateral standard: Electromagnetic disturbances -
Requirements and tests
IEC 60601-1-3:2008 Medical electrical equipment – Part 1-3: General requirements for basic safety and
essential performance – Collateral standard: Radiation protection in diagnostic
X-ray equipment
(CT SCANNER with radiation protection in accordance with IEC 60601-1-3:2008)
IEC 60601-2-28:2010 Medical electrical equipment - Part 2-28: Particular requirements for the basic
safety and essential performance of X-ray tube assemblies for medical diagnosis
(X-RAY TUBE ASSEMBLY Tube Unit Assembly IEC 60601-2-28:2010)
IEC 60601-2-28:2017 Medical electrical equipment - Part 2-28: Particular requirements for the basic
safety and essential performance of X-ray tube assemblies for medical diagnosis
(X-RAY TUBE ASSEMBLY Tube Unit Assembly IEC 60601-2-28:2017)
IEC 60601-2-44:2009 Medical electrical equipment - Part 2-44: Particular requirements for the basic
safety and essential performance of X-ray equipment for computed tomography
(CT SCANNER products stated above IEC 60601-2-44:2009)
The products comply with the requirements of the following regulations and standards:
Regulation (EU) 2017/745 of the European Parliament and of the Council concerning medical devices
when it bears the following CE marking of conformity:
Mark of conformity with the This product meets the requirements of the Technical
Technical Regulations. Regulations on medical devices, approved by Resolution
No. 753 of the Cabinet of Ministers of Ukraine of 2 October
2013.
NOTE
Only after Ukrainian regulatory registration is
complete, this label will be located on the Gan-
try
to be generated at energies selected from the available spectrum to visualize and analyze information
about anatomical and pathological structures.
Gemstone Spectral Imaging (GSI) provides information of the chemical composition of renal calculi
by calculation and graphical display of the spectrum of effective atomic number. GSI Kidney stone
characterization provides additional information to aid in the characterization of uric acid versus non-
uric acid stones. It is intended to be used as an adjunct to current standard methods for evaluating
stone etiology and composition.
2.2.3 Contraindications
None known.
Revolution™ CT GE Hangwei Medical Systems Co. West Area of Building No.3, No.1
Revolution™ CT ES Ltd Yongchang North Road,
Beijing Economic and Technologi-
cal Development Area,
BEIJING 100176 CHINA
3 Safety
CAUTION
Any serious incident related to the use of this GE Healthcare device should be reported to both the
manufacturer and the health authority/competent authority where the device is installed.
To report to GE Healthcare: either contact your local service representative or report to: In-
box.complaints@ge.com.
Please provide the following information:
• The catalog number or the model designation of the device as stated on its identification plate
affixed on the device
• The System ID/serial number/lot number of the device
• Date of incident
• Description of incident, including any patient or user impact/injury
• Your contact information (facility, address, contact name, title, and telephone number).
• Although this equipment incorporates a high degree of protection against X-ray and laser
radiation outside the useful beam, and also makes the X-ray radiation dose to patient and laser
output power low enough to be proportionate to its intended use, it is impossible to eliminate the
X-ray radiation risks inherent with the use of X-ray technology and the laser radiation risk with the
use of the laser light marker completely without impacting the benefit of the product. See X-ray
radiation safety and laser safety section to reduce the unintended/excessive radiation risks as far
as possible.
• This product was designed and manufactured to ensure maximum safety of operation. It should
be operated and maintained in strict compliance with the safety precautions, warnings and
operating instructions contained herein, and in any other documentation specific to the product.
• The system has been designed to meet all the safety requirements applicable to medical
equipment. However, anyone attempting to operate the system must be fully aware of potential
safety hazards.
• The manufacturer or vendor of the equipment makes no representation, however, that the act of
reading this manual renders the reader qualified to operate, test or calibrate the system.
• The owner should make certain that only properly trained, fully qualified personnel are
authorized to operate the equipment. A list of authorized operators should be maintained.
• This manual should be kept at hand, studied carefully and reviewed periodically by the
authorized operators.
• Unauthorized personnel should not be allowed access to the system.
• Do not leave the patient unobserved at any time.
• Become familiar with the functional hardware so that you can recognize serious problems. Do not
use the system if it appears damaged or fails. Wait for qualified personnel to correct the problem.
• Abbreviations used in the operator manuals can be found in this manual.
• If the product does not operate properly or if it fails to respond to the controls as described in this
manual, the operator should:
• First ensure the safety of the patient.
• Next ensure the protection of the equipment.
• Evacuate the area as quickly as possible in any potentially unsafe situation.
• Follow the safety precautions and procedures as specified in this manual.
• Immediately contact the local service office, report the incident and await further
instructions.
• The images and calculations provided by this system are intended as tools for the competent
user. They are explicitly not to be regarded as a sole incontrovertible basis for clinical diagnosis.
Users are encouraged to study the literature and reach their own professional conclusions
regarding the clinical utility of the system.
• Understand the product specifications, system accuracy, and stability limitations. These
limitations must be considered before making any decision based on quantitative values. In case
of doubt, please consult your sales representative.
• Do not block the ventilation ports of the electronic equipment. Always maintain at least 6
inches (15 cm) clearance around the ventilation ports to prevent overheating and damage to the
electronic hardware.
• The supplier will make available on request circuit diagrams, component parts lists, descriptions,
calibration instructions which will assist the user's appropriately qualified technical personnel to
repair those parts designated to be repairable.
DANGER
WARNING
CAUTION
This manual uses pictures, or icons, to reinforce the printed message. It uses the corresponding
international symbol or icon next to the danger, warning or caution message. For example, the upright
hand with the lightning bolt across it warns of electrical hazards.
3.3.1 Symbols
This chapter uses the international symbol or icon along with the danger, warning or caution message.
Symbol Description
Alternating current
ON / Power ON
Input power
Output Power
Caution or warning
Hand Pinch
Radiation
Emergency Stop
WEEE: This symbol indicates that when the end-user wants to dis-
card this product, it must be sent to separate collection facilities
for recovery and recycling.
Symbol Description
Pushing prohibited
Legal Manufacturer
Date of manufacture
Dust-tight
Protected against the effects of continuous immersion in water
Serial number
Catalog number
Medical Device
Minimum filtration
Laser symbol
Focal Spot XL
Focal Spot L
Focal Spot S
Figure 1 Warning labels located at the bottom of the gantry cover (Reference 21CFR 1040.10
(g)(4))
CAUTION
LASER RADIATION
DO NOT STARE INTO BEAM
CLASS 2 LASER PRODUCT
CAUTION
LASER RADIATION
Do Not Stare into Beam
635, 670nm Laser Diode
1 Milliwatt Maximum Output
Class II Laser Product
Figure 2 Labels on the front of the gantry (Reference 21CFR 1040.10 (h))
CAUTION
LASER APERTURE
Do not stare into beam
Figure 3 Labels on the front of gantry, rear of table, back of PDU, back of Scanner Desktop, and
side of System Cabinet.
CAUTION
Figure 4 Label located on Scan Control Interface (Reference 21CFR 1020.30 (j))
WARNING
WARNING
Figure 6 Weight limit warning label located on the standard weight capacity table
WARNING
Figure 7 Weight limit label located on the standard weight capacity table
Figure 8 Weight limit label located on the heavy weight capacity table
WARNING
PDU CAN MOVE AND DAMAGE CABLES. DO NOT LEAN ON OR MOVE WHEN
CONNECTED TO POWER.
CAUTION
PDU CAN MOVE AND DAMAGE CABLES. DO NOT LEAN ON OR MOVE WHEN
CONNECTED TO POWER.
CAUTION
CAUTION
WARNING
CAUTION
WARNING
CAUTION
WARNING
CAUTION
WARNING
WARNING
Authorized Users
This equipment incorporates a high degree of protection against X-ray radiation outside the useful
beam. But this equipment cannot substitute the essential requirement that every user must take
adequate precautions to prevent the possibility of any person carelessly, unwisely, or unknowingly
exposing themselves or others to radiation.
Everyone having anything to do with X-ray equipment must receive proper training and become
fully acquainted with the recommendations of the National Council on Radiation Protection and
Measurements and the International Commission on Radiation Protection.
NCRP reports are available from:
NCRP Publications
7910 Woodmont Avenue
Room 1016
Bethesda, Maryland 20814
WARNING
All persons authorized to use the equipment must understand the dangers posed by X-ray exposure so
that they can prevent any injury or damage that may result from such exposure. GE Healthcare urges
you to use protective materials and devices to prevent any injury or damage from X-ray exposure.
WARNING
• Stay behind a lead screen or lead glass shield during each X-ray exposure.
• Use technique factors prescribed by the radiologist or diagnostician. Use a dose that produces the
best diagnostic results with the least X-ray exposure.
• The x-ray exposure indicator is an amber light located on the secondary gantry display on the
front and rear of the gantry directly below the primary gantry display.
CAUTION
WARNING
A warning message is posted when Confirm Settings is selected for the following scan types:
SmartPrep, Cine, Axial or SmartStep scans with zero table increment (scan interval)
WARNING
After reading the message, if you wish to continue with the scan, click Continue, otherwise click
Cancel.
WARNING
WARNING
NOTE
Images 1-12, 13-28 is an example of a location where Geometric Efficiency in Z is less
than 70%.
WARNING
3.4.7 CTDIvol
As you setup the scan parameters from the Scan Settings screen, the Dose Information area at the
bottom center of the scan monitor contains updated dose information. This dose information is based
on a measurement of the CTDI or CT Dose Index, which is the current standard for CT dosimetry
and performance. By using a measurement called CTDIvol, a single value is provided to estimate the
relative dose for an exam.
The CTDIvol is a weighted average measurement in a reference phantom. This dose is expressed in
milliGrays. For additional information on specific CTDIvol doses and their calculations, refer to your
Technical Reference manual.
The DLP or Dose Length Product is the product of the CTDIvol and the scan length for a group of scans.
This number can be summed over the entire exam to give an estimate of the total dose. The value is
expressed in milliGray centimeters.
The Projected DLP shows the DLP that would result from scanning the current group or groups.
The Accumulated DLP displays the total exam DLP up to the current point in time. Scout dose is
included in the DLP totals but is generally a very small part of the exam.
The dose information updates when technique values such as kV, mA, scan time, slice thickness, and
scan field of view are changed.
Dose information is saved as a screen save image in Series 999 upon selecting End Exam. Series 997
contains the DICOM Dose Structured Report.
NOTE
For procedures such as CT Perfusion or CT Interventional scans that require
scanning over the electronic medical device for more than a few seconds, attending
staff should be ready to take emergency measures to treat adverse reactions if they
occur.
NOTE
Recommendations from FDA Preliminary Public Health Notification: Possible
Malfunction of Electronic Medical Devices Caused by Computed Tomography (CT)
Scanning date July 14, 2008.
WARNING
DANGER
DANGER
DANGER
DANGER
To avoid electrical shocks or burns caused by the use of the wrong type of fire extinguisher, make sure
that only fire extinguishers approved for use on electrical fires are used.
Surplus lengths of power cords or other cables from mobile accessory units that may be used during
patient scanning should be stored in safe and isolated areas. For example: Excess cable may be wound
in a figure eight and stored at the base of the stationary equipment. This minimizes signal interference
and protects cables from damage due to traffic.
CAUTION
CAUTION
CAUTION
CAUTION
A CT System combined with GE approved accessories complies with the IEC 60601-1 standards related
to safety and performance of medical electrical systems. Refer to the standard for more information.
• Do not connect electric devices to the CT System that are not approved by GE. Do not connect
additional extension cords or outlet strips. It may create increased electrical leakage current and
there is possibility of electric shock.
• The manufacturer is not responsible for any interference caused by using other than
recommended interconnect cables or by unauthorized changes or modifications to this
equipment. Unauthorized changes or modifications could void the users' authority to operate
the equipment.
• The GE console monitors, video amp and media tower are intended to be powered by the CT
System using cables provided. Do not connect these devices to power sources other than the
CT system (for example, wall outlets, or other electrical equipment). It may create increased
electrical leakage current and there is possibility of electric shock.
• Note that some external powered equipment may only be connected by a signal cable to GE
equipment (for example, a network hub). A separation device is required for equipment that is
powered by a different power source.
The design of the CT scanner uses an equal potential grounding system. All components within the
system are provided power on a common ground, so all the components are suitable for use in the
patient environment. Three primary grounding points exist, they include:
• A system power ground point located in the NGPDU.
• A reference ground point located between the gantry and the table base.
• A protective earth ground points located at the rear of the gantry for accessory use.
ALL patient-accessible metal surfaces are grounded to the same potential as the A1 Disconnect.
Power Indicator Light Locations
Gantry Indicator Locations: Gantry control buttons backlight, Gantry primary and secondary
display and service panel 120VAC LED.
System ON: gantry control panel backlighting, service panel 120VAC LED will be lit and
primary gantry display will display the table vertical position.
Sleep: On the secondary gantry display the crescent moon will be statically lit (no flash-
ing).
Scanner Desktop Indicator Locations: Monitors Power ON/OFF buttons lights, Scanner Desktop/NIO Cabinet
power on/off light located at the front.
System Cabinet Indicators: System Cabinet provides a green light to the service personal to indicate is
(Image Genera- energized. SDA computer and disks and Image Generation computer front panel Power
tion) ON/OFF lights.
(continued)
Component Indicator Light Location
System On light Indicator: Optional light, customer provided, it indicates that the PDU is energized (A1
breaker is ON).
DO NOT USE THE TABLE BASE AS A FOOT REST. YOU COULD ENTRAP AND
INJURE YOUR FOOT WHILE LOWERING THE TABLE. DO NOT PLACE YOUR
HANDS BETWEEN THE TABLE BASE AND THE TABLE SIDE PANELS.
CAUTION
WARNING
WARNING
DANGER
WARNING
Figure 25 Weight limit label located on the standard weight capacity table
CAUTION
CAUTION
WARNING
WARNING
Check the length of all patient health lines (IV tubing, oxygen line, etc.) and make sure they
accommodate cradle travel. Position these lines so they cannot catch on anything within the patient
vicinity or between the table and gantry during cradle travel.
WARNING
CAUTION
CAUTION
CAUTION
WARNING
WARNING
WARNING
THE HEAD HOLDER MAY CRACK, POSSIBLY INJURING THE PATIENT'S HEAD
OR NECK, IF THE PATIENT TRIES TO BRACE HIMSELF OR HERSELF ON THE
HEAD HOLDER DURING POSITIONING. THE HEAD HOLDER AND CRADLE
EXTENDER ARE ONLY DESIGNED TO SUPPORT 75 POUNDS (34 KG). ASK
THE PATIENT TO MOVE UP INTO THE HEAD HOLDER OR MANUALLY HELP
THE PATIENT INTO POSITION.
CAUTION
CAUTION
CAUTION
CAUTION
WARNING
WARNING
CAUTION
CAUTION
CAUTION
CAUTION
CAUTION
Figure 29 Gantry Air Inlet Location examples (only left side shown)
in progress, and data obtained prior to the abort can become corrupt or lost. Use the System
Emergency OFF button for catastrophic emergencies, such as fire or earthquake.
CAUTION
Number Description
Press an Emergency Stop button in the event of a patient related emergency or if the cradle, table
or gantry starts to move unexpectedly.
• Once an Emergency Stop button is pressed, the Reset gantry control button, on the gantry
control panel, flashes about once every two seconds.
• Press the Reset gantry control button to restore power to the gantry and table.
When Emergency Stop is applied, the maximum stopping distance of the moving cradle is 10 mm.
Emergency Stop Button Symbols
Emergency Stop buttons may be accompanied by one of the symbols below.
CAUTION
THE X-RAY AND DRIVE POWER IS DISABLED. PLEASE WALK INTO THE SCAN
ROOM AND PRESS THE RESET BUTTON ON THE GANTRY CONTROL PANEL.
• Press PAUSE SCAN to pause scanning after the current scan completes.
• During an exam, the system pauses between scans if you Press any button on the control panel
other than the alignment lights. It stops X-ray if you Press the same button(s) during a scan.
• Select Resume on the screen to continue the exam.
A landmark must be set before you click Confirm Settings. At Done Scanning, the landmark is cleared.
For scan setup details, see the Set up and position the patient procedure.
WARNING
• Tell all patients to close their eyes before you switch ON the
alignment lights.
• Instruct your patients to keep their eyes closed until you turn OFF the
alignment lights.
NOTE
Closely monitor infants and infirm patients, and prevent them from accidentally staring
into the beam.
WARNING
• Warning labels regarding laser safety are provided on the gantry, as described in the Warning
Labels and Symbols section.
Maintenance
• Laser alignment lights do not require user maintenance.
• Qualified service personnel must inspect the lights periodically to assure proper alignment.
CAUTION
The patient position information stored in the image header correctly reflects the orientation (RAS)
information for the patient. Viewing applications will correctly reflect Right (R), Left (L), Anterior (A)
and Posterior (P) of the patient.
The reconstructed image orientation may differ from preferred anatomical viewing presentation in
which the patient's Right is on the viewers Left and patient's Left is on the viewers Right. For example,
when the patient is scanned Head First and Prone the patients’s Left is on the viewer’s Left and the
patient’s Right is on the viewer’s Right. The image presentation will need to be modified to display
preferred anatomical viewing. Some viewing stations may not have the capability to flip the image
presentation, but if the capability exists, you must use display tools such as Flip to change the
presentation of the image.
Some remote viewing stations may have the capability to set default viewing protocols. This is another
tool that can be used to set an anatomical viewing presentation.
Post processing applications automatically orient images in anatomical viewing orientation. These
applications create axial images in anatomical viewing presentation. Please see Display Applications
for more information. The system also provides the capability to create Gray Scale Presentation State
Objects (GSPS) to flip the image orientation.
WARNING
WARNING
WARNING
WARNING
WARNING
WARNING
WARNING
LOW IMAGE SPACE. PLEASE REMOVE IMAGES AND EMPTY THE RECYCLE
BIN.
WARNING
CAUTION
NOTE
The Patient Schedule chapter is in the User Manual.
CAUTION
CAUTION
CAUTION
WARNING
WARNING
CAUTION
CAUTION
CAUTION
ENSURE THE ECG PATCHES ARE NOT PAST EXPIRATION DATE AND THAT
THE GEL ON THE PADS IS STILL MOIST FOR PROPER CONDUCTION OF THE
ECG SIGNAL FOR SUCCESSFUL GATING.
CAUTION
CAUTION
CAUTION
WARNING
WARNING
3.15.5 Measurements
CAUTION
WARNING
CAUTION
WARNING
WARNING
WARNING
CAUTION
CAUTION
CAUTION
NOTE
Users should be familiar with the guideline for interventional studies provided
by American College of Radiology (http://www.acr.org): ACR–SIR–SPR PRACTICE
PARAMETER FOR THE PERFORMANCE OF IMAGE-GUIDED PERCUTANEOUS NEEDLE
BIOPSY (PNB).
CAUTION
CAUTION
CAUTION
WARNING
Clinicians working in the scan room should wear appropriate protective clothing. Lead aprons, groin
and thyroid protection, as well as protective eye wear are available through the GE Accessories
Catalog.
CAUTION
WARNING
CAUTION
CAUTION
CAUTION
CAUTION
WARNING
CAUTION
The ability to separate materials into the corresponding material basis pair is a function of both
the material itself and the attenuation characteristics of the basis pairs. If the basis pairs chosen
have attenuation characteristics that are similar or close to each other, the resulting material density
images will not produce adequate separation and may result in images that have less than optimal
image quality.
CAUTION
AXIAL GSI SCANS AT THE 0.625 AND 1.25 MM SLICE THICKNESSES MAY
HAVE A CENTER SMUDGE ARTIFACT. YOU MAY REDUCE THE CENTER
SMUDGE ARTIFACT BY RECONSTRUCTING IN A WIDER SLICE THICKNESS.
CAUTION
CAUTION
BODY SCAN FIELD OF VIEW DOES NOT HAVE HEAD SPECIFIC CORRECTIONS
FOR BEAM HARDENING. SUB-OPTIMAL IMAGE QUALITY MAY BE SEEN IN
THE HEAD ANATOMY.
3.15.10.2 Measurements
WARNING
CAUTION
THE WINDOW WIDTH AND WINDOW LEVEL FOR GSI IMAGES WILL VARY
DEPENDING ON THE KEV SELECTED COMPARED TO NON-GSI IMAGES.
PLACE AN ROI ON AN ANATOMICAL AREA AND NOTE THE MEAN VALUE. SET
THE WINDOW LEVEL TO MEAN VALUE AND ADJUST THE WINDOW WIDTH
TO THE DESIRED VIEWING LEVEL.
CAUTION
WARNING
WARNING
WARNING
WARNING
WARNING
THE USE OF MAR WHEN USED WITH METAL OUTSIDE THE BODY IN
THE SCANNED VOLUME MAY EMULATE PATHOLOGY SUCH AS SUBDURAL
HEMATOMA. IF AN AREA OF CONCERN IS SEEN, RECONSTRUCTION
WITH AND WITHOUT MAR SHOULD BE DONE FOR COMPARATIVE IMAGE
REVIEW OR USE ANOTHER DIAGNOSTIC MEANS TO DISTINGUISH BETWEEN
POTENTIAL ARTIFACT OR PATIENT PATHOLOGY.
WARNING
CAUTION
WARNING
CAUTION
THE USE OF IMAGE ENHANCE FILTERS MAY CHANGE THE TEXTURE OF THE
IMAGE. IF AN AREA OF CONCERN IS SEEN, RECONSTRUCTION WITH AND
WITHOUT IMAGE ENHANCE FILTERS SHOULD BE DONE FOR COMPARATIVE
IMAGE REVIEW.
THE USE OF DLIR IMAGES HAS NOT BEEN VALIDATED FOR CALCIUM
SCORING AND PERFUSION APPLICATION QUANTITATIVE ANALYSIS. DLIR
IMAGES SHOULD NOT BE USED FOR THIS PURPOSE.
WARNING
WARNING
CAUTION
WARNING
CAUTION
CAUTION
CAUTION
When scanned object extends in- Water CT Number Accuracy Skin Line Accuracy
to DFOV region
WARNING
CAUTION
IF THE SKIN LINE OF THE PATIENT JUST TOUCHES THE EDGE OF THE 50
CM SCAN FIELD OF VIEW, IT IS POSSIBLE FOR THIS TO RESULT IN SHADING
OF MAXFOV 2 RECONSTRUCTED IMAGES. IF THE PATIENT BOUNDARY GOES
OUTSIDE OR STAYS INSIDE OF THIS CENTRAL 50 CM REGION THEN NO
SHADING SHOULD OCCUR. FROM THE SHOW LOCALIZER IMAGE WITH A
HELICAL SCAN PRESCRIBED, USE THE IRRADIATION LINES ON THE AP AND
LATERAL SCOUT TO VERIFY THAT THE SKIN EDGE IS EITHER INSIDE OR
FULLY OUTSIDE THE INDICATED SFOV LINE. IF THE SKIN EDGE IS JUST
TOUCHING THE SFOV LINE, USE BODY STRAPS TO WRAP THE PATIENT OR
MOVE THE TABLE ELEVATION 0.5 TO 1 MM UP OR DOWN. TAKE ANOTHER
AP AND LATERAL SCOUT TO CONFIRM THE SKIN EDGE IS OFF THE SFOV
LINES.
During table motion to the scout scan start position, make sure to keep
observing the patient for potential collision of the patient body with the
CT gantry due to patient motion, or damages to devices connected to
the patient like intravenous injectors, anesthesia machines or ECG gating
devices.
Pressing the Pause button on the gantry display or any of the motion
buttons on the control panel can stop the Auto Positioning motion.
In case of emergency, press the emergency button to stop the Auto
Positioning motion immediately.
CAUTION
The accuracy of the scout scan range determined by the Auto Positioning
option is affected by the sheets/blankets/body strap covering the patient
body, blockage of the depth camera view by people/devices around
and /or above the patient table, lighting conditions and existence of highly
reflective surfaces. Make sure to check the validity of the scan range on the
patient video shown on the gantry display, and adjust it manually on the
video when necessary, before starting the automatic table motion.
CAUTION
Number Description
1 isocenter
2 Y-axis
3 X-axis
4 Z-axis
6 scan plane
7 patient table
THE IMAGE SET RESOLUTION, THAT IS, THE DIMENSIONS OF THE VOXELS
(VOLUME ELEMENTS) THAT CONSTITUTE THE IMAGE SET, IS DETERMINED
BY THE SIZE OF THE FIELD-OF-VIEW, THE MATRIX SIZE, AND THE INTER-
SLICE DISTANCE. IDEALLY, VOXELS SHOULD BE ISOTROPIC (WITH THE
SAME DIMENSIONS ALONG ALL THREE AXES). THAT IS, THE INTER-SLICE
DISTANCE SHOULD BE THE SAME AS THE VOXEL DIMENSION IN THE
ACQUISITION PLANE. IN PRACTICE, HOWEVER, CONSIDERATIONS SUCH
AS PATIENT IRRADIATION DOSE LEVELS WILL USUALLY LEAD TO THE
CHOICE OF A LARGER INTER-SLICE DISTANCE. BE AWARE THAT DETAILS
WITH DIMENSIONS IN THE ORDER OF OR LESS THAN THE INTER-SLICE
DISTANCE CANNOT BE IDENTIFIED OR MEASURED WITH ANY DEGREE OF
RELIABILITY.
3.17.5 ROI
CAUTION
CAUTION
3.17.6 CT Number
(Reference 1020.33 (j)(1), 1020.33 (j)(2))
Besides anatomic location and area, each CT pixel also represents a CT number, which in turn
indicates tissue density.
An image pixel represents a three dimensional volume, or voxel. It represents anatomy with a
location, an area, and a pixel (density) value. The system flattens the 0.625, 1.25, 2.5, 3.75, and 5
mm scan thickness into a two dimensional screen image. If a pixel represents a variety of tissues,
the system averages the contents to produce an averaged, rather than accurate, pixel value. Uniform
tissues (within the voxel) produce fairly accurate pixel values.
CT pixel shading shows relative density. Denser materials weaken X-ray and produce whiter pixels.
(Assumes Inverse Video OFF)
Reformat displays non axial planes created from contiguous pixels extracted from multiple images.
3D locates similar pixel values within contiguous images, and generates a mathematical model to
produce images that appear three dimensional. BMD samples pixel values to estimate bone or tissue
density.
Reconstruction assigns one value to every image pixel. CT uses pixel values of -32767 to +32767.
MR uses pixel values of +16,000. The screen pixel translates the assigned value into one of the 256
shades of gray. Vary the gray scale window width and level to select anatomy for display. Window
Width determines the quantity of gray pixel values. Window Level selects the center Window Width
pixel value.
Example: Two windows may contain identical widths of 100 values, but display completely different
anatomy, because one has a level of -100 and the other has a level of 150.
The system provides, using the image display software, the capability to draw and edit rectangular and
elliptical regions of interest (ROI), with the ability to calculate and report the mean value and standard
deviation of the image pixel data contained within the ROI and the area of the ROI.
It also provides the capability to draw and edit a circular region of interest, with the ability to calculate
and report the mean value, standard deviation, minimum, maximum and area (mm2) of the image
pixel data contained within the ROI.
WARNING
WARNING
CAUTION
WARNING
WARNING
WITH EACH USE, CHECK ALL ACCESSORIES FOR DAMAGE AND REMOVE
THEM FROM SERVICE IF DAMAGED OR CRACKED.
WARNING
WARNING
WARNING
WARNING
WARNING
WARNING
WARNING
WARNING
WARNING
WARNING
WARNING
Environmental Concerns
This symbol indicates that the waste of electrical and electronic equipment must not be disposed
of as unsorted municipal waste and must be collected separately. Please contact an authorized
representative of the manufacturer for information concerning the decommissioning of your
equipment.
Patient Cradle Clean pads and inside of the cra- Between each patient
dle.
(continued)
Item Required Maintenance Service Interval
Pads, Straps, Patient Accessories Clean all areas that were touched Between each patient
by the patient. Clean other areas as
needed
Head Holder Insert Inspect for bodily fluids, dispose Between each patient
and replace if saturated
Follow the labeled instructions of the cleaning agent manufacturer and observe the dilution/
concentration and contact time instructions. Use tap (utility) water for dilution.
Always clean and disinfect the equipment between each patient.
NOTE
As preferred cleaning and disinfection practices change and new products become
available, GE Healthcare continues to test the material compatibility of these agents
for GE devices. See https://cleaning.gehealthcare.com/?cmpid=covid-quick-links for any
newly qualified agent.
WARNING
WARNING
The X-ray Tube Assembly contains the following potentially hazardous materials:
• Lead: Lead salts are toxic and their ingestion may cause serious problems. The manipulation/
handling of lead is subject to regulations.
• Oil: Univolt 54 and Crosstrans 206 mineral oil are not toxic, but the prevailing environmental
regulations should be observed for their disposal or recuperation. For example, it is forbidden to
dispose of these oils in the wastewater or sewage system or in the natural environment.
Your local GEMS field service will advise you on the suitable means of disposal of equipment.
The X-ray Tube Assembly to be discarded should be forwarded to the GEMS Service network, and it will
be disposed of in a GEMS recycling center.
Precautions
Take all the necessary precautions for the personnel handling the recovery or destruction of X-ray
Tube Assemblies, and in particular against the risks due to lead.
These personnel must be informed of the danger involved and of the necessity to observe the safety
measures.
Mercury
Revolution™ CT, Revolution™ CT ES systems manufactured before January, 2015 include LCD monitors
that contain mercury.
Dispose according to Local, State, or Federal laws.
CAUTION
CAUTION
CAUTION
CAUTION
4 Read Me First
4.1.1 Notices
The following notice symbols are used to emphasize information that is considered important,
requires special notice, or includes helpful troubleshooting tips.
NOTICE
NOTE
Note provides additional information that is helpful to you. It may emphasize certain
information regarding special tools or techniques, items to check before proceeding, or
factors to consider about a concept or task.
Troubleshooting tips provide information that allow you to investigate the resolution of
some type of problem, locate the difficulty, and make adjustments to solve the problem.
Number Description
Icon Description
New Patient Opens the New Patient window to create a new patient entry. Once the patient
information is completed and the protocol is selected, the Scan Setup window
opens.
Patient Schedule
Opens the Patient Schedule to preprogram or retrieve patient information from
Digital Imaging and Communications in Medicine (DICOM) or Hospital Information
System/Radiology Information System (HIS/RIS).
Number Description
NOTE
This is a closed circuit system and does not store video images.
Display Description
A (Upper Left Quadrant) Display side camera image - monitor laser light and landmark position
Double click mouse left button Double click display quadrant to enlarge to full-
screen view.
When full screen view, Double Click return to 4-quad-
rant view
System Restart Single click to restart the application and the Opera-
tion System followed with a confirmation message.
System Shutdown Single click to shut down the display application and
the Operation System followed with a confirmation
message.
Table 14
3 Warning Message
WARNING
4 RCP Instruction or Ready for selec- Select any button below, then press Move to Scan on the
Error Message tion Scan Control Interface when prompted.
Movement Control Press and hold Move to Scan on the Scan Control Interface to
Button selected begin table motion. Release to stop table motion. To clear the
selection click anywhere within the panel. Communicate with
the patient any instructions or actions to expect.
Alignment Light or Press Move to Scan on the Scan Control Interface to activate
External Landmark selected control. To clear the selection click anywhere within
Control Button se- the panel. Communicate with the patient any instructions or
lected actions to expect.
RCP Error Inter- Remote Control Panel cannot be activated. Gantry hardware
face unavailable. Perform a Scan Hardware Reset from the Service
Tools menu. If problem persists, contact your service repre-
sentative
RCP Error Hard- Remote Control Panel is deactivated. Press Reload to attempt
ware to re-establish connection. Verify that during use the physical
gantry controls are not being pressed, E-Stop has not been
activated, and the cradle is latched.
RCP Error Soft‐ System software error. If in a active scan session complete
ware the exam using the gantry controls. Or perform a System
Restart from the Mode menu. If problem persists, contact
your service representative.
RCP not available Remote Control Panel is not available. Close if any of the
following application(s) are running: [applicable applications
will be listed]
Click button for Desired action Click RCP Move to Scan function
button
NOTE
System Preference for auto position
is On: the cradle moves to pre-de-
termined position of the prescribed
landmark location.
Toggle internal Alignment Light On/ Off Flashing green indicates ready
Button changes to green to indicate when Press and release to perform selected action
ready Move to Scan becomes inactive upon release.
Re-select desired action if necessary
Set External Landmark
NOTE
RCP cannot be opened after pressing Confirm in a scan task series or during an
active scan.
NOTE
RCP cannot be used during a SmartStep interventional series.
2. Click desired positioning control button on RCP.
3. Follow on screen instructions for Move to Scan function button when flashing.
Number Description
1 Tabs area.
Displays the patient session.
2 State area.
Indicates the scanning state of the system.
• Scanning
• Done Scanning
(continued)
Number Description
9 Navigation viewport.
Displays scouts and QC images. Show Localizer viewport for graphic scan prescription.
Number Description
Number Description
1 Scan Timeline
2 ECG Trace
4 Real-Time Information
Number Description
1 Prep delay
3 Inter-group delay
4 Total Scan Time of group; calculated by Prep delay + Exposure time of all groups +
Group delay
Number Description
3 Status of injector
Number Description
3 Image Viewports
4 File Manager
1 Mode Icon Opens the Mode menu with the following selections:
• Protocol Management
• Protocol Management
• Auto Gating Configuration
• Auto Voice Management
• Auto ROI Management (Available on Apex Select 40mm sys-
tems)
• SmartPlan Management
• GSI Profile Editor
• Auto Prescription Profile Editor
• Protocol Exchange
• Access Controls
• User Admin Tool
• Dose Check Management
• Audit Tool
• Audit Log Viewer
• System Preferences
• Learning Solutions
• Switch User
• Power Management
• Restart
• Sleep
• Power Down
2 System Utilities Icon A collection of all necessary user maintenance calibration routines and other
utility functions.
Opens the System Utilities menu with the following selections:
• Daily Prep
• Tube Warm Up
• Fast Cal
• System Tools
• Message Viewer
• Save Cybersecurity Audit Logs
• Service
• Service Tools
• Check Security
(continued)
Number Icon Description
• Troubleshooting
• iLinq
• Unix Shell
• SPR Snap
• Close Volume Viewer/Reformat
• Restart Application
• TiP Virtual Assist
4 System Messages Click on the message for a list of all system messages.
Number Description
1 Task List
2 Add Recon
5 Image Tools
6 Command Line
7 Task Status
Number Description
File Manager serves three main functions: exam organization and status, accessing files, and opening
an exam.
Number Description
1 Controls area
2 Exam list
3 Series list
Number Description
Multiple contiguous Click a start point in the list, press Shift, click an end point in the list, and all items
items between start and end are selected.
4.4.2 Cancel
Cancel closes a window without executing the actions or implementing parameters described on a
window.
Anchored Popover
For updated settings that are invalid, the background is highlighted white with a red
outline, and the settings collection is flagged with an alert icon notifying the user.
Confirm Settings is also disabled.
White Background
Red Outline
White Background
Settings updated by the system are outlined in blue.
Blue Outline
White Background
Indicates settings copied from the primary recon.
Green Outline
Indicates a Severe Alert. Click on the icon in the Status area for the system message.
Red Alert
Indicates a Notification Alert. Click on the icon in the Status area for the system
message.
Blue Alert
On, displayed
Use the gantry controls navigation button to toggle between which selection to
display.
Indicates that a tab has been created, but patient information entry
and protocol selection have not been completed.
Indicates the patient currently on the table but this session’s patient
tab is not selected by the user.
Click and drag Click and hold the left mouse button while moving the
mouse.
Right-click and Click and hold the right mouse button while moving the
drag mouse.
Scroll wheel-click Click and hold the scroll wheel while moving the mouse.
and drag
Triple-click Click the left mouse button three times in rapid succes-
sion.
• In general, wait for a screen transition to take place before making another selection. Typing
values before the user interface displays can result in the wrong screen displayed or the wrong
value entered.
• If the scanner desktop becomes unresponsive, but the mouse is still moveable, select Alt + F3.
This will reconnect the system.
• If the scanner desktop becomes unresponsive for several minutes, click and select Shutdown,
then Restart to restart the system. If you cannot select Shutdown, turn off the scanner desktop
power switch, wait 10 seconds, then turn the power switch back on.
• In some cases, the system will notify you of errors and steps to recover from the error. You should
contact your services representative as soon as possible, if notified.
5.1 Overview
Use special care when imaging patients outside the typical adult size range. GE Healthcare strongly
suggests reducing radiation dose to ALARA (As Low As Reasonably Achievable) in all patients,
especially pediatric and small patients, whenever it is determined that a CT scan is necessary. CT
is an extremely valuable tool for diagnosing injury and disease, but its use is not without risk. This
chapter discusses the importance of minimizing the radiation dose in small patients and children
consistent with ALARA principles.
Figure 67 Relationship between dose and phantom size for head and body filters at 120 kV.
Similar curves are obtained for the 70, 80, 100, and 140 kVs.
Another consideration about dose is since it is not possible to characterize dose given to individual
patients, the CT dose indices are provided to help make relative comparisons. These dose index
values can be used to compare CT systems and to help select appropriate operating conditions for
scanning. However, it is important to recognize that the dose reported by these indices is inversely
proportional to phantom size (see the above chart). This means that for the same scan technique,
smaller phantoms (patients) will produce a higher absorbed dose than larger phantom (patients).
Therefore, it is critical to remember that the body filter uses the 32 cm CTDI phantom and the head
filter uses the 16 cm CTDI (Computed Tomography Dose Index) phantom for dose reporting purposes
(CTDIvol is displayed in the Dose Information area on the Scan Settings window). The table below
indicates the phantom size used for calculating dose for each SFOV (Scan Field Of View).
In other words, when looking at the actual absorbed dose to the patient, understand that the dose
may be higher than reported if the part scanned is smaller than the phantom tested. Keep this in mind
when adjusting scan parameters to fit patients who are smaller than the phantoms tested.
Ped Head
Head
Ped Body
32 cm phantom
Small Body
Medium Body
Large Body
Cardiac Small
Cardiac Medium
Cardiac Large
• This is especially important using automatic exposure control techniques such as SmartmA, and
Organ Dose Modulation to further reduce unnecessary radiation exposure.
• Patients not properly centered may be under or over exposed to radiation if the table height is set
too high or too low.
Once you select the Pediatric selector, the Pediatric Protocol List displays. Next to the name of the
protocol a color icon along with the zone number will be indicated. The notes area of the protocol
selector will display the zone ranges for weight and length, color name and the weight/color zone
number.
NOTE
Weight-specific protocols are enforced for all anatomical areas except Head, Orbit, and
Miscellaneous. Protocols in the Head and Orbit categories are usually defined based on
patient age as opposed to patient weight/height.
Zone number Zone color Zone weight (lb) Zone weight (kg) Zone length (cm)
2. From the Patient Information area, type data into the appropriate fields.
• Press Tab to advance to the next field. Alternatively, use the mouse to navigate to each field.
3. If you have not entered a value in the Age field, click Pediatric.
4. From the Pediatric Protocol Selection screen, click an anatomical area.
• With the patient's weight entered, the system automatically selects the appropriate pediatric
color code area for the anatomical area selected.
• Use the arrows to scroll through the list.
• Click a protocol from the list to download the scan parameter values.
5. From the Pediatric Protocol Category screen, select the weight/length category based on the size
of your patient or verify the correct Color category has been selected if you entered a weight.
• The protocols in the selected color code are then displayed accordingly.
• The default weight/color selector displays the patient weight entered on the Patient
Information screen, or the last weight/color selection (if no patient information was
entered).
• If you enter a patient weight on the Patient Information screen and select a color/weight
that is not consistent with the entered information, a red alert displays next to the protocol
name. You must acknowledge that you have chosen a protocol that does NOT match the
patient size.
Alert message: Selected color is not suitable for the entered patient weight of 29 Kg (65 lbs).
5.3.5.1 Adjust the parameters by size, age, weight, height, and indications
Use pediatric protocols based on the age, weight, height, and indications to avoid over exposure.
• Recommended pediatric color coded protocols are installed on the system and are arranged in
colors according to height and weight for easy selection.
• These protocols should be considered as a baseline. It is strongly encouraged that you work with
your radiologist and medical physicist to determine the lowest possible dose at the image quality
desired.
• Consider the diameter of the part being scanned as a final determination before scanning. For
instance, the part may be smaller or larger than what is indicated by the weight of the patient.
• To assure sufficient X-ray penetration, the following chart is intended as a relative guide to the
maximum patient diameter that can be scanned based on a kV and mA’s selection. It does not
indicate a recommended technique factor (that is generally higher) since the technique factor
also depends on the image quality needed for the diagnostic task.
Figure 70 Maximum patient diameter guide for low kV selection (1) and Lateral Patient Diameter
in cm (2)
6 Large Patient
6.1 Overview
CT is an extremely valuable imaging tool for diagnosis of injury and disease. In the radiology
community, it is widely understood that very large patients (> 300 lb / 136 kg) are a challenge for
imaging due to the increase of the X-ray attenuation in this patient population. The degree of X-ray
attenuation in these large patients may degrade image quality as the patient size increases using the
same scan technique as used for normal sized patients (< 300 lb (136 kg)). The system allows patients
with weights up to 500 lb (227 kg).
This section presents the concepts necessary to successfully scan large patients.
6.2.2.2 High kV
It is important to use higher kilovoltage selections on the very large patient. Using 140 kV is
recommended for large patients because it provides higher X-ray penetration of anatomical structures
being imaged. On the other hand, higher kV selections can decrease HU (Hounsfield Unit) values so the
window width for viewing the images may need to be decreased to maintain a similar appearance.
6.2.2.3 mA adjustment
The reasonable use of scan technique with SmartmA on a large patient can reduce patient dose
effectively. However, significant differences may exist between the selected noise index and the
image standard deviation when a very large patient provides insufficient detector signal (or prevents
sufficient detector signal). In this case, electronic noise sources can become the dominant image noise
source vs. X-ray noise. Under these conditions, special projection data dependent filters are applied at
various threshold levels to help preserve image quality.
For more information on SmartmA refer to SmartmA in the Scan Parameters section.
NOTE
If the size of the large patient section is beyond 50 cm SFOV, SmartmA technique is not
recommended since noise and mA prediction may not always be reliable. Manual mA is
recommended.
NOTE
Using lower pitches, slower rotation times, or axial instead of helical with large patients
to improve image quality, comes at the cost of longer scan times which means longer
breath holds.
NOTE
When utilizing the Hyper Drive option with 80 mm detector coverage and 1.375:1 and
1.531:1 pitch, it is better to use faster rotation times to minimize motion artifacts.
Consider the following to offset increasing acquisition times beyond the patient's capability to hold
their breath:
• If multi-phase studies are needed, use lower dose techniques for the non-contrast series
compared to the contrast series and limit the scan to only the organ or anatomical region
indicated.
• Break the imaging range into multiple groups to match patient's breath-hold capability.
It is critical to remember that the body filter only uses the 32 cm CTDI phantom for dose reporting
purposes (CTDIvol displayed in the Dose Information area on the Scan Settings screen and the Dose
Report). In other words, when looking at the actual absorbed dose for the large patient, understand
that the dose may be lower than reported if the part scanned is larger than the phantom tested. Keep
this in mind when adjusting scan parameters to fit patients who are larger than the phantoms tested.
NOTE
You have to balance between image quality level for diagnosis and responsibility for the
delivery of higher radiation doses for larger patients, especially in abdomen and pelvis
exams.
7 Dose Check
7.1 Overview
NOTE
7.1.1 Introduction
Dose Check alerts you when the estimated dose index is above the limit set by the operating group,
practice, or institution. Dose Check complies with the NEMA XR-25 standard.
Dose Check creates awareness of the dose index of the prescribed scan, and launches a notification if
the dose index is above the limit. The notification is set at a level above routine or normally expected
doses, but not so high as to pose a significant risk to the patient. Depending on patient size or imaging
requirements, it may be appropriate to scan at a value above the Notification Value (NV).
Notification Values are not necessarily the same as the published Diagnostic Reference Levels (DRLs).
However, these may be consulted as a guide to determine the appropriate NV for your site and patient
population. Because routine scanning does involve a range of applicable techniques due to patient
sizes and imaging needs, another consideration on where to set the notification level will be the
frequency in which your practice would want it posted.
Dose Check also issues an alert when the accumulated dose index would exceed the institution’s
established range. GE has pre-populated the system-level Alert Value (AV) at 1000 mGy CTDIvol in
accordance with the FDA November 8, 2010 letter to MITA.
Dose Check should be incorporated into your department’s Quality Assurance (QA) processes to assure
that scan protocols are defined with the “as low as reasonably achievable” (ALARA) parameters, and to
vary examination protocols to take into account patient body habitus. The feature provides for audit
capability and tracking when Notification and Alert Values are exceeded and the capability to output
the protocols on the system and the associated NVs entered for them.
Dose Check provides the following:
• Checks against a Notification Value and issues an alert if the estimated dose for the scan is above
your limit.
• Checks against an Alert Value where the user needs specific authority to continue the scan at the
current estimated dose without changing the scan parameters.
• Defines Alert Values for Adult and Pediatric imaging with an age threshold.
• Audit logging and review.
7.1.3 Terminology
NOTE
The user should be someone with administrative privileges.
4. Click the Local Users tab.
5. From the Local Users tab, click Add Local User.
6. From the Add User window, enter the following:
• User ID
• Full Name
• Password
• Confirm Password
NOTE
The User ID must be unique from others used on the system.
7. Click Add User.
8. Click the Groups tab.
9. From the Groups tab, click Add Local Group.
NOTE
Alternately, the system can be configured for enterprise groups if enterprise
authentication has been enabled. Refer to the Access Controls chapter for
information on configuring enterprise authentication.
10. From the Add Local Group window, type a unique group name.
11. Click Add Group.
• The group is highlighted in the Local Groups list.
• All information and buttons in the center panel refer to the highlighted group.
12. From the Roles area, select Dose Check Administrator and click Apply Roles.
• A green label confirms the applied roles.
• An error message displays if it is unsuccessful.
NOTE
Roles can be assigned at either the User or Group level.
NOTE
The user should be someone with administrative privileges.
4. Click the Local Users tab.
5. From the Local Users tab, click Add Local User.
6. From the Add User window, enter the following:
• User ID
• Full Name
• Password
• Confirm Password
NOTE
The User ID must be unique from others used on the system.
7. Click Add User.
8. Click the Groups tab.
9. From the Groups tab, click Add Local Group.
NOTE
Alternately, the system can be configured for enterprise groups if enterprise
authentication has been enabled. Refer to the Access Controls chapter for
information on configuring enterprise authentication.
10. From the Add Local Group window, type a unique group name.
12. From the Roles area, select Dose Check AV Exceeding User and click Apply Roles.
• A green label confirms the applied roles.
• An error message displays if it is unsuccessful.
NOTE
Roles can be assigned at either the User or Group level.
NOTE
The system default for Notification Value (NV) Checking is CTDIvolOn and DLP Off.
The GE Reference protocols will not contain any NV values.
4. From the Dose Check Management window, in the AV (Alert Value) Checking area, select CTDIvol
and/or DLP.
NOTE
The Alert Value (AV) should be determined by the site’s radiologist and physicist.
5. Enter a value for CTDIvol and/or DLP.
• The maximum AV value for CTDIvol is 2,000 mGy.
6. Click Save.
7. Enter Logon Name, Password , then click Accept or click Cancel to close with out saving changes.
NOTE
During protocol management, the AV (Alert Value) under Age Threshold is always used if
prescribed.
1. From the image monitor, click .
2. From the Mode menu, click Access Controls, then Dose Check Management.
3. From the Dose Check Management window, in the AV (Alert Value) Checking area, select Age
Threshold and enter the patient’s age.
5. Click Save.
6. Enter Logon Name, Password, then click Accept or click Cancel to close with out saving changes.
4. Click OK.
You will then be able to accept protocol parameter updates when building protocols.
11. In the Diagnostic Reason field, enter the reason for the scan exceeding the NV value.
12. Click Confirm to accept the Diagnostic Reason.
13. Click Confirm Changes to accept the protocol scan parameters.
14. Click Save or Save As to return to the Protocol Selection window.
NOTE
Viewing or exporting a Protocol Summary in the Audit Tool should be done after the
protocols are saved, not while editing.
Adjust the scan parameters for the series until the exceeded AV value is below the prescribed AV
value. If the AV value is still exceeded after you click Confirm, a confirmation message will display. The
scan cannot be confirmed until the AV value is no longer exceeded, or a user with a Dose Check AV
Exceeding user role has authorized the scan.
Performing a scan exceeding an AV value demands a high degree of consideration for appropriateness.
In most cases, you will click Cancel to go back to adjust parameters. If there is a true diagnostic need
to perform a scan exceeding an AV value, enter the diagnostic reason.
1. Type the Logon Name.
2. Type the Password.
3. In Diagnostic Reason field, enter the reason for exceeding the AV value.
Adjust the scan parameters for the scan group until the exceeded NV value is below the prescribed NV
value. If the NV value is still exceeded after you click Confirm, a confirmation message will display. The
scan cannot be confirmed until the NV value is no longer exceeded, or you have entered a diagnostic
reason for continuing the scan with the exceeded NV value.
1. In Diagnostic Reason field, enter the reason for exceeding the NV value.
2. Click Confirm to proceed to scanning.
NOTE
If the log data is near the maximum size, the system posts a message to export it.
NOTE
USB must be conditioned to FAT32 file type before media copying begins.
NOTE
If Protocol Summary is selected, also select either All Protocols or Invalid
Protocols.
7.
8. Click OK.
5. Click Search to apply the search parameters. Click Reset to cancel search if needed.
NOTE
When Export is selected all Image Analysis reports are exported.
4. Double click to open the folder.
5. Click IA_report.html.
6. The report will open in a web browser.
7. Right click and select Print Preview.
8. Change orientation to landscape
9. Select print in preview window.
8 Equipment
8.1 Overview
NOTE
This chapter helps you to become familiar with your specific CT system, including the system
components and hardware.
For more general information about CT system components and hardware, refer to the following
sections:
• X-ray Source
• CT Detector
• Gantry
• Power Distribution Unit
• Table
• System Cabinet
• Scanner Desktop
Number Description
1 Media Tower
2 Scan monitor
3 Display monitor
5 Mouse
6 Computer
NOTE
Your system may include the Media Tower. This is a DVD-RW drive, which writes to
DVD-RAM bare media, DVD-R, and CD-R.
Number Description
USB Connection
Located in lower-right corner of the media tower. The CD/DVD/USB recognizes Hard Disk Drive
(USB drive) or USB key (Flash memory) with VFAT format. It does not recognize any hardware
with extension 3 format.
• Supports connecting a USB media storage device to:
• Use Media Creator to write and restore images.
• Use Data Export to export data to non DICOM file type.
2
• Use to Export Protocols.
• Use to export Dose Check Audit log information.
• Use to save scan files, protocols, and service files to USB.
• Only one USB for saving scan data can be connected at a time.
• The storage device should have a minimum size of 32 GB to store/restore system state data.
Scan data typically requires external USB drives with storage capacity of 1 TB and above.
3 • The Service key should always be removed prior to any software reboot if left in by your
local service.
• The service ports on the front of the computer chassis include an Ethernet connection and
USB port. The Ethernet port is for service laptop connection to the system. The USB port
can be used for external storage device connection but suggested location is the PMT tower
USB ports. Intended use is only for trained service personnel.
Number Description
1 Scan monitor
2 Display monitor
4 Mouse
5 Computer
Number Description
USB Connection
Located in lower-right corner of the computer. The CD/DVD/USB recognizes Hard Disk Drive (USB
drive) or USB key (Flash memory) with VFAT format. It does not recognize any hardware with
extension 3 format.
• Supports connecting a USB media storage device to:
• Use Media Creator to write and restore images.
• Use Data Export to export data to non DICOM file type.
2
• Use to Export Protocols.
• Use to export Dose Check Audit log information.
• Use to save scan files, protocols, and service files to USB.
• Only one USB for saving scan data can be connected at a time.
• The storage device should have a minimum size of 32 GB to store/restore system state data.
Scan data typically requires external USB drives with storage capacity of 1 TB and above.
3 • The Service key should always be removed prior to any software reboot if left in by your
local service.
• The service ports on the front of the computer chassis include an Ethernet connection and
USB port. The Ethernet port is for service laptop connection to the system. The USB port
can be used for external storage device connection but suggested location is the PMT tower
USB ports. Intended use is only for trained service personnel.
Number Description
1 Scan monitor
2 Display monitor
4 Mouse
5 Computer
Number Description
NOTE
To Power up the system, the user does not need to press the Power button of the
SCIM. Press the power button of the desktop computer only. The system will begin
the boot sequence and start.
USB Connection
Located in lower-right corner of the computer. The CD/DVD/USB recognizes Hard Disk Drive (USB
drive) or USB key (Flash memory) with VFAT format. It does not recognize any hardware with
extension 3 format.
• Supports connecting a USB media storage device to:
• Use Media Creator to write and restore images.
• Use Data Export to export data to non DICOM file type.
2
• Use to Export Protocols.
• Use to export Dose Check Audit log information.
• Use to save scan files, protocols, and service files to USB.
• Only one USB for saving scan data can be connected at a time.
• The storage device should have a minimum size of 32 GB to store/restore system state data.
Scan data typically requires external USB drives with storage capacity of 1 TB and above.
Number Description
1 Scan monitor
2 Display monitor
4 Mouse
5 Computer
6 Power Box
Number Description
NOTE
To Power up the system, the user does not need to press the Power button of the
SCIM. Press the power button of the desktop computer only. The system will begin
the boot sequence and start.
USB Connection
Located in lower-right corner of the computer. The CD/DVD/USB recognizes Hard Disk Drive (USB
drive) or USB key (Flash memory) with VFAT format. It does not recognize any hardware with
extension 3 format.
• Supports connecting a USB media storage device to:
• Use Media Creator to write and restore images.
• Use Data Export to export data to non DICOM file type.
2
• Use to Export Protocols.
• Use to export Dose Check Audit log information.
• Use to save scan files, protocols, and service files to USB.
• Only one USB for saving scan data can be connected at a time.
• The storage device should have a minimum size of 32 GB to store/restore system state data.
Scan data typically requires external USB drives with storage capacity of 1 TB and above.
8.3.1 Computer
The system uses a PC computer running Linux operating system. The system includes system, image
and scan data disks and stores up to 700,000 5122 images, with one terabyte for 1500 scan data files.
The computer is usually located under the Scanner Desktop.
8.3.3 Monitors
The system includes two monitors, a scan monitor and a display monitor.
Number Description
1 Scan monitor
2 Display monitor
NOTICE
NOTE
If you leave your system on overnight, you should turn off the monitors to minimize
burn-in.
If a monitor experiences burn-in, turn off the monitor and leave it off for the same
duration as caused the burn-in.
Exposure indica-
2 Illuminates when an exposure is taking place.
tor
F1 Film Image
F4 Film Series
F5 Previous
F6 Abdomen
F7 Head
F8 Lung
F9 Mediastinum
F10 Spine
F11 Vertebrae
Use the Page Up and Page Down to review the next and prior images in a viewport.
Use these keys to change the W/L settings for images in a viewport. The Up/Down keys increase/
decrease the window level and the Left/Right keys decrease/increase the window width.
Click and drag Click and hold the left mouse button while moving the
mouse.
Right-click and Click and hold the right mouse button while moving the
drag mouse.
Scroll wheel-click Click and hold the scroll wheel while moving the mouse.
and drag
Triple-click Click the left mouse button three times in rapid succes-
sion.
8.5.1 Overview
A touch screen display is mounted above the gantry control panel on the left and right sides of the
gantry front cover. The touch screen display provides the following functions:
• Create New Patient or Unknown Patient exam.
• Set up the Automatic Patient Positioning and Scout scanning with Auto Patient Positioning option
installed.
• Display gantry and table position information.
• Display multiple system status.
• Display patient and exam information.
• Display Patient ECG waveform.
• Play movie.
1. Gantry Display
Depending on the current state, the Tool bar display the following icons.
Breath hold Light Pressing this allows you to demonstrate to the patient how to use
the Breath hold Light and Countdown Timer.
Table and Gantry Tilt Press this icon to view the current scannable range based on the
Movement Limits table position on the Gantry Display.
2. NOTE
The “Scannable Range” is calculated based on a lim-
it and collision matrix, taking into account the table
height and the reference point position.
Movie Press this icon to access movies that help to explain CT examina-
tion procedures to patients.
3.
4. Settings Press this icon to set the functions of the Gantry Display.
There are the following three types of setting configurations.
7. Electrocardiogram, ECG Indicate the status of ECG leads are not connected to
patient.
Indicate the status of ECG connection error to
9. Cradle information Press this icon to display or hide the vertical height and horizon-
tal cradle position, and tilt degree of the gantry.
The vertical height indicator displays the height of the cradle in
relation to ISO center.
The horizontal cradle position displayed is the position of the cra-
dle based on the established anatomic reference of the patient.
This reference is established using the internal or external land-
mark. The number is preceded by an S if the position is superior
to the reference point or an I if the position is inferior to the
reference point.
10. Used to check impedance values between ICM leads and patient
body.
The Cradle/Tilt information area displays the following indicator icons. Depending on the system
status, an indicator icon may be highlighted and the corresponding status is activated.
Collision Indicator The Collision light illuminates and a picture of CT system with
high-lighted collision sensors is posted on the gantry display
(Figure8-13) when there is a possibility that the table, cradle and
gantry could collide.
The light also illuminates when reaching the travel limits of table
and cradle motion. In the case of interference, you may need to
1. raise or lower the table or determine if resistance is being caused
by any patient restraints, accessories, or by the patient.
NOTE
The picture of CT scanner with high-lighted collision
sensors on the gantry display can be hidden by touch-
ing the display.
Cradle Unlocked Indicator The Cradle Released indicator illuminates indicating the cradle is
unlatched. When the cradle is unlatched, it is free floating.
2.
After the user presses the Emergency Stop button, the Gantry Display shows the emergency stop
status and indicates how to reset the system.
8.6 Gantry
1 Table/Cradle Information Area Displays information related to the table elevation and
the cradle location. This information is used in the scan
room while positioning the patient.
3 Patient Exam Information Area Shown when Patient/Exam Information is selected via
or the Menu area display button (see row at end of table).
ECG Area (Not shown above)
NOTE
The orientation of the gantry in this display
is not linked to the orientation configured for
the operator console. The gantry is always
displayed orientated on the right.
4 Menu Area Displays user selectable menu items. Navigate this area
using the Back/Enter/Forward buttons on the Gantry
Controls panel.
Movie
The Movie menu item is used to display explanatory
movies and slideshows.
Scannable Range
The Scannable Range menu item is used to display
scannable range information in the Patient Orienta-
tion/Entry Area.
Patient/Exam Information
Select to display Patient/Exam information in
thePatient/Exam Information – ECG area.
ECG
Select to display ECG information in the Patient/Exam
Information – ECG area.
Impedance Check
Select to initiate an impedance measurement, if the
internal ECG trigger device is selected and active.
The gantry secondary display shown below provides gantry and table status information as described
in the following table.
Exposure indicator
The Laser Light Indicator illuminates when the laser alignment light is
on.
Laser light indicator
CAUTION
3
FOR PATIENT SAFETY, IT IS IMPORTANT TO HAVE
PATIENTS CLOSE THEIR EYES ANYTIME THE LASER
ALIGNMENT LIGHT IS ON.
The face blinks to let the patient know they will need to hold their
Breathing light breath. The total breath hold time is shown to let them know for how
long. This prepares them for the upcoming breath hold.
5
The face turns solid during the breath hold and the numbers start
counting down.
The illuminated face turns off when the timer gets to 0.
Breath hold timer Displays the count down of the breath hold time.
Display Range: 0 - 99 s
6
Display Precision: +/- 1 s
Display Accuracy: +/- 1 s
Number Description
7 Ground
Number Description
10 Accessory Grounds
NOTE
Gantry and console outlets should not be used for the MedRad injector
components or ISI900. A separate grounding cable should be attached
between the injector and the CT system.
Number Description
3 Accessory Grounds
NOTE
Gantry and console outlets should not be used for the MedRad injector
components or ISI900. A separate grounding cable should be attached
between the injector and the CT system.
Number Description
3 Accessory Grounds
NOTE
Gantry and console outlets should not be used for the MedRad injector
components or ISI900. A separate grounding cable should be attached
between the injector and the CT system.
CAUTION
THESE RECEPTACLES ARE NOT FOR GENERAL USE. THE RPM POWER
CONSUMPTION SHOULD NOT EXCEED 720 WATTS. THE INJECTOR POWER
CONSUMPTION SHOULD NOT EXCEED 780 WATTS.
DANGER
NOTE
4 Table Up When the table elevation is below the mini-
mum scan height, the elevation speed will
be the fast speed when only the slow con-
trol is enabled.
CAUTION
NOTE
The laser alignment light switch is provided
as an alternative to beam attenuators.
Figure 104 Patient Grounding Strap, Cable, and Grounding Connection Behind Integrated Cardiac
Module
See grounding strap manufacturer’s website, referenced on product packaging, for cleaning
instructions.
2. Plug the power connection for the cardiac trigger monitor into the electrical connection port (4).
3. Connect the coaxial cable to the connection port above the heart (5).
NOTE
Do not loop the cable. This could introduce noise into the ECG trace.
4. Connect the Ethernet cable from the cardiac trigger monitor to the port labeled Monitor (6).
5. On the Gantry Display Menu Area, select Settings > ECG Settings to select the External ECG as the
primary cardiac device. The External ECG can also be selected from the Console user interface.
8.7 Table
NOTE
All patient tables may not be available in all regions.
The standard table configuration has a weight limit of 500 pounds (227 kg) with an incremental
accuracy of ±0.25 mm. The vertical range of the table is 50 to 103 cm. Refer to Table 163 on page 1008 in
the General Information section for table scannable range.
The heavy table configuration has a weight limit of 675 pounds (306 kg) with an incremental accuracy
of ±0.25 mm. The vertical range of the table is 56 to 103 cm. Refer to Table 163 on page 1008 in the
General Information section for table scannable range.
When interruption of Supply Mains occurs, the maximum stopping distance of the moving cradle is 220
mm.
To safely remove the patient in an emergency egress situation, grab and squeeze the Cradle Handle
release switch. Continue to squeeze the Cradle Handle release switch while pulling the cradle to its out
position.
Sensors are located underneath the front and back of the table. These sensors indicate where there is
potential for collisions with items such as wheel chairs or stretchers. When a sensor is touched, table
and gantry movement stops immediately. In this event, clear the area and continue positioning the
table.
There is a mark on the cradle for maximum scannable range.
CAUTION
CAUTION
To move the patient into the gantry, press and hold the Load pedal.
To move the patient out of the gantry, press and hold the Unload pedal until the table is at a suitable
position to remove the patient from the table.
• The Load and Unload pedals are only to be used when first positioning the patient on the
table for an exam and when removing the patient after the exam is complete.
4. Rubber shims may have been installed on the head holder or foot extender to give it a tighter fit.
Please take care when latching the accessory to make sure that it is completely latched. Push the
latch forward until you hear a click. Verify that the latch is fully latched.
NOTE
Do not place the cardiac trigger monitor on the tray. The tray’s weight limit is 19.8
pounds (9 kg).
To remove the table tray from the table:
1. Remove any straps used to secure objects.
2. Remove the tray from the top of the support form.
3. Remove the legs of the tray-support form from the holes at the rear of the table.
8.7.3.5 IV pole
To attach the intravenous (IV) pole to the table:
1. Insert the IV pole into the hole at the rear of the table or into the table tray.
The maximum weight that can be attached to the IV Pole is 10 pounds (4.5 kg).
2. Tighten the extension lock to secure the pole.
8.7.4 Table X-Y Accuracy for the Flat Table Top Workflow
4. Press the Cradle In button to position the cradle between 890 mm to 850 mm and then
• The cradle must cycle the number of times as determined in the Verify the table lateral
motion procedure.
• Determine the number of extension/retraction cycles needed based on testing.
5. Center a landmark on the flat table top using the sagittal room alignment laser line.
6. Use the external room laser light to position patient elevation as desired and draw temporary
alignment marks on the skin.
7. Fasten radio-opaque fiducial markers on the temporary alignment marks.
8. Press the Laser Alignment Light button .
9. Press the Cradle In button until the axial landmark location for imaging placed in Step 7
(for example, sternal notch) aligns with the axial internal laser light.
10. Adjust the patient elevation until the gantry elevation laser matches the patient alignment marks
placed in Step 7.
11. Press the Internal Landmark button to establish as the scan reference.
15. Change the table elevation to match the patient alignment marks placed in Step 7.
16. Review the images and confirm that the radio-opaque markers placed in Step 7 align with the
image coordinate isocenter.
17. Determine treatment isocenter with simulation software such as Advantage Sim.
18. Adjust room lasers as defined by simulation software.
19. Tattoo the patient for therapy.
post-elevation adjustment images with less than 1.0 mm distance between image center and the QA
device feature.
Materials
• flat table top
• 100 pounds of standard weights (25-pound plates recommended)
• MedTec CT Simulation Laser QA device phantom or equivalent device (requires 2 IPPS™ Lok-Bars)
Figure 110 CT orthogonal reformat image of laser QA device (abdomen window level)
Elevation adjustment
1. Position the weights and attach the QA device to notches near the center of the flat cradle.
Figure 111 Side view of weights and placements relative to the QA device
Number Description
1 table
2 weights
3 QA device
5 notch 1
• The room sagittal laser light intersects the top QA device lines.
3. Start an exam.
4. Acquire the Scout over the range of the QA device.
5. Use Graphic Rx to define an Axial scan that produces between 10 mm - 20 mm of images at
the thinnest slice width available.
Table Elevation
(QA aligned to room laser)
Table Elevation
(QA realigned to gantry laser)
Room 1
Figure 113 Sample image prior to elevation adjustment using gantry sagittal laser
4. Use the measurement tool to determine the distance from image center to the center of the QA
feature.
Figure 114 Sample image after to elevation adjustment using gantry sagittal laser
NOTE
Green lines represent lines drawn using a measurement tool; numerical report out
is shown in red.
5. Record the number in the results as “pre-adjustment distance”.
Table Elevation
(QA aligned to room laser)
Table Elevation
(QA realigned to gantry laser)
Room 1
Table Elevation
(QA aligned to room laser)
Table Elevation
(QA realigned to gantry laser)
Room 1
Results
Post-adjustment QA distance represents the accuracy of table vertical position achievable with the
Recommended Workflow for Treatment Planning.
The post-adjustment image center to QA distance should be less than 1.0 mm, verifying that the gantry
lasers (with elevation adjustment) and room lasers both indicate image center, using the QA feature
location in the image as evidence.
Label Record
Measurement Location H2
Room 1 0.0 mm
Room 2 -3.5 mm
Room 3 -3.5 mm
Room 4 -4.5 mm
Room 5 -4.5 mm
Room 6 -5.5 mm
Results
Depending upon the desired level of offset, this method can be used to determine the number of
cycles needed.
• From “Room 6”, note that the initial cradle lateral shift was 5.5 mm. Therefore, if the cradle was
not cycled prior to scanning, the offset at the scan plane relative to the room lasers could be this
large.
• One cycle equals a cradle in and out motion. Some systems may only require one cycle; others
may require three cycles.
• In this example, after one cycle (extend between 890 mm to 850 mm, then retract), the offset at
the scan plane improves by 3.5 mm. Therefore, the actual offset is 2.0 mm (5.5 mm to 3.5 mm)
• In this example, after two cycles, the offset at the scan plane improves by 4.5 mm. Therefore, the
actual offset is 1.0 mm (5.5 mm to 4.5 mm).
Setup
• Install flat table top on cradle.
• If your system is a PET/CT system, move table base to CT position.
• Set elevation at 150 mm below isocenter.
When reading the metric scale, it is important to read to 0.5 mm.
NOTE
Determine the number of ½ cradle cycles required for cradle to be centered.
1. From the gantry controls, press the Cradle Out button to return to the home position.
Number Description
1 table
2 weights
3 metric ruler
5. Press the Cradle In button until the ruler aligns with the overhead room laser.
Number Description
Figure 117 Example shows a piece of paper that defines left as positive and right as negative
9. Press the Cradle In button until the internal gantry laser aligns with the long edge of the
ruler.
Results
Use this table to record the results.
Label Record
Measurement Location
Weight
Room 1 mm
Scan Plane 1 mm
Room 2 mm
Room 3 mm
Scan Plane 2 mm
Room 4 mm
Room 5 mm
Scan Plane 3 mm
Room 6 mm
described in the table below. The cradle may be positioned with the HHC or by unlatching the cradle
to manually position the patient.
Hand-Held Controller Buttons
10 Cradle move out Moves the cradle away from the gantry.
8.9.1 Components
Pre-Patient Collimator
The collimator contains two independently controlled blades. The motion of the blades provides
continuously variable beam thickness and Z-axis position. The collimator also has three bow-tie beam
filters that filter and shape the beam to optimize dose and image quality.
Gemstone Clarity Detector
Features a unique 3-dimensional post patient collimator to ensure HU uniformity and to minimize
scatter / beam hardening artifacts associated with wide coverage systems.
• Provides 160 mm coverage, 512 slices from 256 detector rows in the Z direction. The 256 rows are
0.625 mm in the Z direction.
or
• Provides 80mm coverage, 256 slices from 128 detector rows in the Z direction. The 128 rows are
0.625 mm in the Z direction.
8.9.2 Coverage
The Axial Detector Coverage/Beam Collimation:
• For the 512 slice system are 5, 20, 40, 80, 100, 120, 140, and 160 mm beam collimation/detector
coverage (0.625 mm).
• For the 256 slice system are 5, 20, 40 and 80 mm beam collimation/detector coverage (0.625 mm).
Interleaved helices minimize helical artifact and give the best detail. Interspaced helices have
more interpolated data and increased helical artifact when compared to interleaved mode. Using
interspaced helices compared to interleaved helices will provide lower dose.
NOTE
For the 256 slice system, 80 mm configuration, collimations greater than 80 mm are not
selectable.
8.9.5.1 Axial
The parameters selected to set the detector coverage (detector configuration) determine the slice
thickness and speed.
• Beam Collimation or detector coverage allows selection of 5, 20, 40, 80, 100, 120, 140, and 160
mm.
• Axial slice thickness choices range from 0.625 to 5.0 mm thick.
• Number of images per rotation is equal to the detector coverage divided by the slice thickness,
except for the 1.25i slice thickness.
• Rotation Time can be adjusted to optimize acquisition time. Rotation Times are 0.28, 0.35, 0.5, 0.6,
0.7, 0.8, 0.9 and 1.0 seconds.
8.9.5.2 Helical
There are five main parameter selections for helical.
• Detector Coverage determines the beam collimation, 20 mm, 40 mm or 80 mm, in the Z direction.
• Helical Thickness determines the primary and secondary reconned image slice thickness.
• Slice thickness choices range from 0.625 mm to 5.0 mm.
• Pitch, detector coverage and rotation time used determines the speed of the table per gantry
rotation. There are two pitch selections with associated table speed.
• Rotation Time determines the speed the gantry rotates in 360°.
• Rotation Time can be adjusted to optimize acquisition time. Rotation Times are 0.28, 0.35, 0.5, 0.6,
0.7, 0.8, 0.9 and 1.0 seconds.
Use the Emergency Stop to stop all table and gantry motions. X-ray
is stopped, and laser alignment lights are turned off. The cradle and
3 Emergency Stop base are also unlatched.
The system aborts any data collection acquisition in progress and
attempts to save any data acquired.
NOTE
Your system cabinet type will depend on your system software configuration.
NOTE
Not all Purchasable Options are available in all markets or in all configurations.
Option Description
Cardiac Scan Modes Enables Cardiac scan acquisition modes, External ECG gating
and guides the user in selecting the appropriate cardiac imag-
ing mode based on patient profile.
Provides retrospective review of the gating information and
capability to edit the triggering information on the ECG wave-
form.
ECG Gating Enables internal ECG trigger device. Provides capability to dis-
play and view the ECG waveform on the operator console.
Smart Arrhythmia Management Enables automatic retry, if needed when an arrhythmia is de-
tected during gated acquisitions.
SmartMar (metal artifact reduction) A reconstruction technique that reduces photon starvation ar-
tifacts caused by metal implantations.
SmartPrep with Dynamic Transition Enables real-time monitoring of IV contrast and a user-se-
lectable mode to dynamically transition to the diagnostic
scan phase when a user entered Enhancement Threshold is
reached in the Transition ROI.
HyperDrive Enables 0.28s and 0.35s rotation time with 1.375 and 1.531
pitch modes for Helical scanning. Check with product data
sheet for more information and details.
Organ Dose Modulation mA profile as a function of tube angle to reduce organ specific
dose.
Dynamic Perfusion Enables protocols that use multiple groups to accomplish vari-
able sampling.
CARDIQ Xpress Provides the user with multiple tools to post process images
from cardiac data sets.
CARDIQ Xpress 2.0 Reveal Provides the user with multiple tools to post process images
from cardiac data sets.
CardIQ Xpress Reveal DL (OC) With the CardIQ Xpress Reveal DL Option, users will benefit
from an improved Heart Segmentation with the implementa-
tion of a new DL-based algorithm to generate Heart Volume
Rendering.
Advanced Vessel Analysis Xpress — AVA Ex- Provides enhanced analysis of vascular features, which in-
press clude stenosis analysis, pre/post stent planning procedures
and directional vessel tortuosity visualization.
VesseIIQ Xpress and AutoBone (OC) VesselIQ Xpress and AutoBone software option facilitates re-
moval of bone and CT table from CT Angiography (CTA) studies
of the abdomen and lower extremities.
It provides enhanced analysis of vascular features, which in-
clude stenosis analysis, pre/post stent planning procedures
and directional vessel tortuosity visualization.
CT Colon (CTC) Pro 3D_EC — CT Colon Pro 3D Provides comprehensive software package for evaluation of
quick, accurate, noninvasive colon exams.
Volume Viewer 5.0 — Volume Viewer Provides protocols for reformat, 3D rendering and volume ren-
dering.
Volume Viewer 7.0 — Volume Viewer Volume Viewer provides excellent 3D visualization and pro-
cessing capabilities for reading and comparing CT, MR, 3D
X-ray, PET, PET/MR and PET/CT datasets.
Volume Viewer also features a broad portfolio of high perform-
ancea nalysis tools, automating routine tasks and helping to
make 3D image processing a stress-free component of your
routine workflow. Volume Viewer is the pre-requisite to the
following Image analysis tools on-console:
• AutoBone Xpress and Vessel IQ Xpress
• CardIQ Xpress 2.0
• CT Perfusion 4D Neuro
CT Perfusion 4D Multi-Organ — Perfusion 4D Multi-organ package includes protocols for neuro stroke and
tumor perfusion imaging and body tumor including liver per-
fusion imaging.
CT Perfusion 4D Neuro — Perfusion 4D Neuro Package includes protocols for neuro stroke and brain tumor
perfusion.
CT Perfusion 4D Neuro enhanced (OC) Perfusion 4D Neuro software option is a fast, easy-to-use auto-
mated software for analyzing CT Perfusion images related to
stroke. Its simple user interface and automated perfusion post-
processing make it easy to diagnose quickly and accurately.
The protocol-driven design leads the user step-by-step, reduc-
ing keystrokes and improving repeatability so you get the in-
formation you want quickly and reliably.
Revolution Multi-Phase CTA Stroke Protocol Enables Multi-Pass Head and Neck CTA protocols.
GSI Software Option (GSI Xtream) Enables processing of different energy image data sets to char-
acterize materials.
Available only with GE Tube
Tube License Enables non-GE tube usage for High Definition and GSI Soft‐
ware Option (GSI Xtream).
Revolution CT Recon Server Xtream Enables additional computational hardware to increase image
reconstruction throughput.
Xtream Stroke Enables optimization of system workflow for stroke use cases
[CID Stroke category].
Pre-Requisite: Revolution CT Recon Server Xtream
DLIR for GSI Enables deep learning image reconstruction to create TrueFi-
delity™ CT Images for GSI reconstruction types
Advanced Cybersecurity Controls Enables advanced security features for access control and data
security.
SmartScore 4.0 (OC) SmartScore 4.0 software option is designed to identify the
presence of regional and global coronary artery calcification
from a CT scan, then measure and score the results.
Scores can be calculated using a standard Agatston/Janowitz
(AJ) method. When correlated with a patient’s personal infor-
mation, the score can yield an estimation of a patient’s risk for
coronary artery disease.
AntiMalware McAfee ePO McAfee ePolicy Orchestrator (McAfee ePO) provides a central-
ized management console that simplifies and accelerates your
security effectiveness with visibility and control from device to
cloud.
Requires connecting to EPO server for Virus Definition updates
and license verification.
9.1 Overview
This section describes how to power the system on and off and how to log on and off of the system. It
includes quality control information to verify that your system is operating properly.
For optimal performance, you should restart your system at least once every 24 hours. It is
recommended to shut down and start up the system at least once per week.
• Check supplies.
Element Description
Sign on Name Enter your sign on name. Your system administrator can setup a unique
sign on name through your hospital enterprise system.
Password Enter your password. The password is assigned by the system administra-
tor.
(continued)
Element Description
EmergencySign on Launches the Emergency Sign on window when Access Controls (EA3) is
enabled. It does not require an ID or password on your enterprise system.
You must enter your name in the field before Emergency Sign on will be
allowed.
9.2.2.2 Sign On
If Access Controls is enabled, use the following procedure to sign on to the system.
1. From the Sign on window, enter your sign on name.
2. Enter your password.
NOTE
If you do not have a valid account, click Emergency Sign on. The Emergency Sign
on window displays. Signing on does not require an ID or password. You must enter
your name in the field before sign on will be allowed.
3. Click Sign on.
NOTE
Signing off does not prohibit other users from signing on. Sign off is designed to protect
patient privacy. It is not intended to stop approved users from signing on. When you sign
back on after a sign off, the system returns to your last known state.
NOTE
When signed on as Emergency User, only 5 exams can be scanned. The user is then
prompted to sign back on to the system to be able to scan additional exams.
NOTE
Switch User is not active when the system is in the scanning state, that is, if scan
confirmed and scan monitor is on the scan progress screen.
NOTICE
NOTE
It May take up to 30 minutes for the detector to reach an optimal thermal state after
startup.
SmartID verifies the tube ID at start up. If the tube ID verification fails, attention messages display
indicating that the X-ray tube is not recognized. You can continue scanning; however, you will need
to contact your service representative. Hi Res and GSI scanning are disabled when a non-GE tube is
installed.
1. Make sure the power switch on the back of the computer cabinet, in the upper right corner is
turned ON.
2. Make sure no USB device is connected.
3. Determine power state of system.
• The power button on the scan control interface will be lit when the system is in an
operational state.
• If the system is in a power down or sleep state, the power button on the scan control
interface flashes slowly. When the operator console is powered off, the moon icon on the
gantry display is lit.
• Power was off to the entire system (Main disconnect Control A1 Power Panel breaker is
turned off)
Follow any instructions on the console display as the system starts up.
NOTE
Systems with Configuration 3 or 4 scanner desktop do not require pressing the
power on button on the scan control interface to that the system.
NOTICE
MOVING THE SYSTEM INTO POWER DOWN STATE WILL LOSE THE THERMAL
STATE OF THE DETECTOR.
System Restart should be done daily. Restart shuts down applications and operating system software
as well as resetting the scan hardware. There is no wait time needed for the rotor to stop during the
Restart processes. The system returns to operational state without user intervention.
NOTE
If a save or restore of scan data is in progress, wait for the process to complete,
exit Scan Data Manager, and remove the USB device. If the system shuts down
unexpectedly while a USB drive is connected, remove the USB drive prior to
restarting the system.
3. From the image monitor, click .
4. From the Mode menu, click Power Management, then select Power Down, Sleep or Restart.
5. Check the console display for messages that require your attention. Follow any instructions.
6. From the dialog box , click Power Down or Restart.
7. The system indicates when it is entering the power down/sleep state or when restart is complete.
If power down or sleep was selected, the monitors will turn off when process is complete. If
restart was selected, the system indicates when the restart is complete.
9.3.2 Calibration
Single kV Fast Cal was completed When a single kV Fast Cal was done
and current. within last 24 hours, calibration is
fresh and in good condition. Users
can use the system normally.
NOTE
Hover the mouse over the
Fast Cal card and a mes-
sage will be displayed,
showing the timestamp
of the last single kV Fast
Cal run.
Single kV Fast Cal has not been A Fast Cal needs to occur once ev-
completed within 24 hours. ery 24 hours, in order to ensure
good image quality.
Run single kV Fast Cal.
Messages will vary depending on if GSI software option has been installed.
Both single kV and GSI Fast Cal are When a Fast Cal was done with-
good. in last 24 hours and, a GSI Fast
Cal was done within 168 hours (7
days).
GSI Fast Cal is good however, sin- The last single kV Fast Cal was
gle kV Fast Cal has not been com- done more than 24 hours ago how-
pleted within 24 hours. ever, a GSI Fast Cal was done with-
in 168 hours (7 days).
Run single kV Fast Cal.
GSI Fast Cal has not been complet- GSI FastCal was not done within
ed within 168 hours (7 days). last 168 hours.
Run Fast Cal with GSI.
The last single kV Fast Cal run is If the single kV Fast Cal completion
unknown however, GSI Fast Cal is timestamp file is missing or Cal his-
good. tory cannot be determined, user
must run Fast Cal to ensure good
image quality.
Run single kV Fast Cal.
A new timestamp will be created to
record the completion of the new
Fast Cal just ran.
The last single kV Fast Cal run is If the GSI Fast Cal completion time-
known however, GSI Fast Cal is un- stamp file is missing or Cal history
known. cannot be determined, user must
run Fast Cal with GSI to ensure
good image quality.
Run Fast Cal with GSI.
A new timestamp will be created to
record the completion of the new
Fast Cal just ran.
When both the last single kV and If the Fast Cal completion time-
GSI Fast Cal were run however, stamp files for both single kV and
both are unknown. GSI are missing, Cal history cannot
be determined, user must run Fast
Cal with GSI to ensure good image
quality.
Run Fast Cal with GSI.
A new timestamp will be created to
record the completion of the new
Fast Cal just ran.
The number of tube warmup scans depends on the current temperature of the tube.
The system finishes the Fast Cal procedure by performing a set of 3 scans.
1. Bad Channel
2. BasisAir
3. GSIRefreshAir (only if GSI Software Option (GSI Xtream) option installed)
NOTE
If the system has an unrecognized X-ray tube:
• The performance of the system cannot be guaranteed.
• Tube warmup scans may cause subsequent tube cooling delays. The tube warmup
will run in Auto scan mode.
• Fast calibration techniques are designed specifically for GE tubes. GE cannot
guarantee that the performance of the system will meet specifications with an
unrecognized tube.
Tube is cold. Run tube Click the tube icon, or Condition Now.
warmup. Time indicates how long the tube can re-
main idle before tube warmup is required.
• Perform conditioning when the status is tube warm up is recommended or when the tube is cold.
• For the best care of your tube, never skip the tube conditioning.
• To avoid delays in scanning, check the tube state before moving patients into the scan room.
• If a patient exam is started when the system is below the optimal thermal state, the system
displays a message to the user describing scanning limitations; mA is limited and GSI scanning is
prohibited in this state. You must accept scanning limitation or you can end the exam, ensure the
patient is out of the room and perform Condition Now or Choose Conditioning.
Table 57 Cold mA Limits by Focal Spot and kV Standard Resolution Performix™ HDw
Table 58 Cold mA Limits by Focal Spot and kV High Resolution Performix™ HDw
Acceptable mAs (mAs = mA × Rotation Time) can be achieved by changing rotation times as
needed.
• If the detectors are cold due to an A1 Power Panel (breaker) being off, turn the system on and
wait two hours before performing a tube warmup. This allows the detectors to return to operating
temperature.
Condition Now
1. Ensure no one is present in the scan room.
2. Click System Dashboard Tab.
3. Click Condition Now. The Tube Conditioning status bar displays.
4. Press Start Scan button on the keyboard. The Tube Conditioning status bar displays progress and
closes upon completion. The tube conditioning scans can be paused and resumed or cancelled by
clicking the applicable button.
• If the detector is not at operating temperature, a message will indicate when the detector is at the
appropriate temperature.
• If there is a large shift in room temperature (±10 degrees), perform a Fast Cal to maintain optimum
IQ. Once the room temperature has stabilized, perform another Fast Cal.
For the permissible environmental operating conditions for the CT scanner, see Technical
Reference Manual Chapter 7 Systems Specifications, Environmental Specifications.
• The system will indicate if more than 24 hours have elapsed since the last Fast Cal.
• If a scan abort occurs during Fast Cal, notify your Service Engineer.
• The system will indicate if an unrecognized tube has been installed on the system. Fast
Calibration techniques are designed specifically for GE tubes and GE cannot guarantee that the
performance of the system will meet specifications with an unrecognized tube. Fast Cal will run in
AutoScan mode.
• When the GSI option is installed, GSI calibrations will be performed during Fast Cal.
1. Clear the gantry of any objects or personnel. Any obstruction in the gantry may lead to artifacts in
scanned images.
2. From the Utilities menu, click Daily Prep, then Fast Cal.
The Service-Calibration Tools window opens.
3. Click Run.
4. Press Start Scan. Respond to all messages that display during the calibration (approximately 15
to 20 minutes). Execute any necessary actions indicated in the messages.
• If the system detects a dirty scan window (which may be caused by a beam obstruction,
something in the gantry, contrast, dirt, or other matter on the scan window), a message
displays. Clean the scan window and click Retry or click Continue to skip the check.
• The following automated calibration check procedures occur: tube warmup (if needed),
balance check, scan window check, bad channel, collimator screening, focal spot air, focal
spot size monitor and basis air scans. If the GSI option is installed GSI refresh air scans will be
taken every 7 days. Read the screen messages for calibration status.
5. The system returns to the Service-Calibration Tools window when the checks are complete. Click
Dismiss to exit the window.
Table 59
SW Update
No software update available.
SW Update
• Software Update Available and being download-
ed
• Showing percentage completed
SW Update
• Software Update Available.
• Installation time: xx min
• Restart and Install Updates(s)
SW Update
Update Available, call GE service to install.
1. Click System State Tab > > System Health to view the SW Update Card.
3. If the current signed-in user in not authorized to install the SW Update, the system opens a dialog
box with the message Please login as an authorized user to install this SW update.
4. Once the authentication (if required) is successful, the Software Delivery Manager displays listing
the SW updates available to install.
5. On the IRIS Software Delivery Manager, the user can perform one of the following actions:
a. Click Details to see more details about the SW Update.
b. Click Decline to open a form to document the reason to decline the update. The information
provided is logged on the system and sent to InSite back office. A Decline System Update
confirmation displays. Type First Name, Last Name, Role, Reason for Declining. Click box
I acknowledge that I am declining download of recommended update(s). Click Decline
Update.
7. If the SW update is a full load (LFC) that will delete all data on the system disk, then the following
alert displays for the user to confirm:
a. The user is aware of the potential loss of data that was not backed up.
b. The system is going to be restarted.
NOTE
Before powering down, restarting the system or going into sleep mode, please close
any open Exam tab sessions and complete pending recon jobs. Failure to do so will
result in the loss of data currently in progress.
8. At this point the system will reboot and the SW update will be installed.
9. In case of a Service Pack, once the SP installation has completed successfully, the following
message displays:
11. In case of an LFC, multiple boots might follow. During the installation process, the following
progress bar displays:
12. Once the LFC process has completed successfully, the following message displays.
13. If the LFC process has completed with warnings, the following message displays,
14. If the LFC process has failures, the following message displays.
10 Patient Schedule
10.1 Overview
Use Patient Schedule to enter patient information and protocols in advance of the patient's arrival.
Patient Schedule can also display patient information from the HIS/RIS.
At scan time, select a patient from the list, enter the patient ID number, enter the accession number or
use the optional bar code reader to open the patient's information.
You can edit patient information from the Schedule. If this patient record was entered at the scanner,
you can proceed with the exam or save the updated information back to the schedule. If the patient
record came from the HIS/RIS you can update patient information only if you proceed with the exam.
You can select the columns to display or hide on the Schedule by right clicking on the table header and
using the Column Chooser drop-down as shown below. The changes you make display each time the
drawer is opened, even after restarting the system.
NOTE
Take care to add only the columns you need. Too many columns on a table can make it
more difficult to find the information you need, and may slow you down when using the
table.
You can change the order in which columns display by clicking and holding the cursor
1. Position the cursor over the heading of the column you want to move.
2. Press and hold the left mouse button.
3. Drag the column to the location you want it to appear.
4. Release the left mouse button.
Element Description
Refresh List Update the Schedule from HIS/RIS. This menu item is
visible only if a HIS/RIS is configured on this system.
The drop-down selection also displays the time since
the last update.
HIS/RIS Search Open the search window. This menu item is visible
only if a HIS/RIS is configured on this system.
Delete All Completed Delete all completed exams from the Schedule.
NOTE
When accessing patient information from the HIS/RIS you should have only new records
in your schedule list. Having completed records may cause scanning a patient with
the wrong accession number. To clear completed records; select Preferences from the
Schedule drop-down menu. Then select Scheduler Configuration UI and Configuation
UI. Uncheck the Show Completed WL box . This setting assures that completed records
are not added to the schedule list.
3. From the pull down, click Save to Schedule to add the patient to the schedule or Cancel to close
the window without adding the patient.
NOTE
If a protocol is selected, clicking Accept at this point will begin the exam.
NOTE
If there is already a Patient on the table session active, Save to Schedule or Cancel
will be the only choices presented.
NOTE
You cannot edit patient records from HIS/RIS if Enable RIS Worklist Edit is not selected
in Patient Schedule Preferences.
1. From the scan monitor, click the Patient Schedule drawer.
2. From the Schedule window, select a patient.
3. Click on the Information icon on the left of the patient record or:
Select the patient you wish to edit, right click and select Edit Patient.
4. Edit the patient information.
5. Click Save.
Figure 128 Patient information card open with MORE tab displayed
Figure 129 Patient information card open with Less tab displayed
NOTE
The above pictures are showing how the user can obtain additional information from
the order entry. The "More" expanded view will automatically display, if there is
additional DICOM information embedded into the RIS order pertaining to:
• (0x0010,0x21C0) PregnancyStatus
• (0x0010,0x2000) MedicalAlerts
• (0x0010, 0x2110) ContrastAllergies
• (0x0038, 0x0500) PatientState
• (0x0038, 0x0050) SpecialNeeds
If the user does not want to see this information set during a one-time patient exam;
simply click the "Less" button at the bottom.
If the user no longer wants to see information automatically populate the Pregnancy
Status, Medical Alerts, Contrast Allergies, Patient State, Special Needs fields; the user
must finish all patient exams before any steps are followed:
1. Open patient scheduler tray
2. On the top right, click the 3-bar icon
3. Select the WF Preferences option
4. Navigate to the Return Tag Configuration UI and open the folder
5. Remove all the DICOM tags you are no longer interested in displaying
*If you choose to unselect boxes for certain associated DICOM tags, those DICOM tags
will not be available in the scanned image, since it is not returning during a RIS query.
NOTE
Return tag configuration needs application restart to apply the changes.
patients. Alternatively, click Delete All Completed from the schedule drop-down menu to remove
all the completed patients, those marked with C.
4. Click OK to confirm.
3. Select desired protocol and then click Accept. The system displays the scan series tasks in the
protocol.
3. Click and drag the scroll bar to browse through the list.
Type a character in the search box at the top right of the Schedule. All patient names, patient IDs and
exam descriptions that contain that character display both on the Schedule and on the drop-down list
below the search box.
The drop-down list indicates the field containing the characters. The schedule title bar highlights
orange when the list is filtered. For each additional character typed, the list of patients is filtered. The
search/filter is case sensitive.
4. Define the search parameters using the Date Range check boxes. For example, find all patients
scheduled for exams on the current day by clicking Today.
5. Define the search parameters using the Search RIS for check boxes.
• This system — searches for patients scheduled only on the scanner on which you are
working.
• This modality — searches for patients scheduled on all CT systems on the HIS/RIS
connection
• All Modalities — searches for patients scheduled on all devices, such as CT and MR scanners.
All patient names, patient IDs and exam descriptions that contain that character display both on the
Schedule and on the drop-down list below the search box.
The drop-down list indicates the field containing the characters, up to 5 entries for each field. If there
are more than 5, a link at the bottom of the category indicates how many more matches were found,
such as: “35 more”. If the user clicks on that link, it searches only that field for those entries and shows
the matches in the schedule. For each additional character typed, the list of patients is filtered. The
search/filter ignores the case of any characters entered.
Figure 133 Schedule Refresh Setup window showing This System selected
The local system's calling AE title is generally the same as the hostname but it can be a
different value depending on the site-specific operation of the hospital HIS/RIS server. Check
with Modality Worklist’s site IT administration to identify what Calling AE title should be
configured for this system.
• Select This Modality to pull the patient schedule for all of the CT systems on the HIS/RIS
connection.
• Define the search parameters using the Date Range check boxes. For example, pull all exams
scheduled for the current day by clicking Today.
• Select All Modalities to pull the patient schedule for all of the systems on any modality
(for example CT, MR, etc.) on the HIS/RIS connection. This is the default setting. Not
recommended. Depending on your site, this may be a very long list.
5. Click Save to update Refresh Setup with your changes or Close to quit Refresh Setup without
changing the settings.
To update the patient schedule from the HIS/RIS and Modality Work List, follow these steps:
1. From the scan monitor, click the Patient Schedule drawer.
2. Select Refresh List from the Schedule drop-down menu.
NOTE
Patient records may fail to display if the record has data contained in DICOM fields that
does not follow the DICOM standard. A message will be posted to the system error log
noting the faulty DICOM field.
Patient records will also fail to display in Patient Schedule if DICOM tag 0008, 0005 or
Specific Character Set is not filled with the correct character set designation.
Character sets supported are:
• ISO_IR 100 Latin 1 (example Swedish and Latin alphabet)
• ISO_IR 87 Japanese/Kanji
• ISO_IR 6 US-ASCII
3. Select MWL SCP Configurations, then SCP Configuration from the menu tree on the left of the
window.
4. To add a new host, click the New button. To edit an existing host, double click the host from the
list at the top of the window.
5. Your service engineer can provide you with the specific values for these fields.
• Host/IP: This is the name given to the network node of the currently selected node. The
IP represents the location of the node within the network. You must enter the IP (Internet
Protocol) address correctly or the connection cannot be made.
• Port Number: This is a predetermined number specific to the type of host and the protocol
used.
• AE Title: The AE Title of HIS RIS Server.
• Default Selected: Check this box to indicate that the connection you are configuring is to be
considered the default.
6. Once you have entered or updated the information about the host, click Ping to make certain the
connection has been made correctly.
7. Click Save to add the configuration.
3. Select Return Tag Configuration UI, then Return Tag Configuration from the menu tree on the
left of the window.
11 Scan
11.1 Overview
NOTICE
11.1.1 Considerations
• If you encounter a message that you need to remove images to be able to scan the current series,
first remove images to create space for scanning.
• In general, if a scan fails and a request to Resume is posted, click Resume to continue. Click
Resume again if the first action fails. If the scan still fails to restart, shutdown and restart the
system.
Cine scan duration (sec.) at 200mA required to meet 1Gy CTDI100 Peripheral
Ped Body
Ped Head Medium Body Large Body
SFOV Head Small Body
Small Head Cardiac Medium Cardiac Large
Cardiac Small
CTDI
16cm 16cm 32cm 32cm 32cm
Phantom
Focal Spot XL L S XL L S XL L S XL L S XL L S
160 N/A 167 167 N/A 137 137 N/A 301 301 N/A 254 254 N/A 311 311
70
140 N/A 165 165 N/A 136 136 N/A 301 301 N/A 254 254 N/A 307 307
Ped Body
Ped Head Medium Body Large Body
SFOV Head Small Body
Small Head Cardiac Medium Cardiac Large
Cardiac Small
CTDI
16cm 16cm 32cm 32cm 32cm
Phantom
Focal Spot XL L S XL L S XL L S XL L S XL L S
120 N/A 161 163 N/A 133 133 N/A 295 295 N/A 249 249 N/A 301 304
100 N/A 161 161 N/A 133 133 N/A 219 234 N/A 246 246 N/A 301 301
80 N/A 156 156 N/A 129 129 N/A 283 283 N/A 239 239 N/A 292 292
40 N/A 155 155 N/A 128 128 N/A 280 280 N/A 237 237 N/A 289 289
20 N/A 142 148 N/A 117 122 N/A 257 267 N/A 217 225 N/A 265 275
10 N/A 121 129 N/A 100 106 N/A 219 234 N/A 185 197 N/A 226 241
5 N/A 94 103 N/A 78 85 N/A 172 188 N/A 145 159 N/A 177 194
160 N/A 111 111 N/A 93 93 N/A 207 207 N/A 170 170 N/A 198 198
140 N/A 110 110 N/A 92 92 N/A 207 207 N/A 170 170 N/A 196 196
120 N/A 108 109 N/A 90 90 N/A 202 202 N/A 166 166 N/A 192 194
100 N/A 108 108 N/A 90 90 N/A 150 160 N/A 164 164 N/A 192 192
80 80 N/A 104 104 N/A 87 87 N/A 194 194 N/A 159 159 N/A 186 186
40 N/A 103 103 N/A 86 86 N/A 192 192 N/A 158 158 N/A 184 184
20 N/A 95 98 N/A 79 82 N/A 176 183 N/A 145 150 N/A 169 175
10 N/A 81 86 N/A 67 72 N/A 150 160 N/A 123 131 N/A 144 153
5 N/A 63 69 N/A 53 58 N/A 118 129 N/A 97 106 N/A 113 123
160 N/A 62 62 N/A 52 52 N/A 113 113 N/A 94 94 N/A 104 104
140 N/A 61 61 N/A 51 51 N/A 113 113 N/A 94 94 N/A 102 102
120 N/A 60 60 N/A 50 50 N/A 111 111 N/A 92 92 N/A 100 101
Ped Body
Ped Head Medium Body Large Body
SFOV Head Small Body
Small Head Cardiac Medium Cardiac Large
Cardiac Small
CTDI
16cm 16cm 32cm 32cm 32cm
Phantom
Focal Spot XL L S XL L S XL L S XL L S XL L S
160 40 40 40 34 34 34 72 72 72 61 61 61 65 65 65
140 40 40 40 34 34 34 72 72 72 60 61 61 65 65 65
120 39 39 39 33 33 33 71 71 71 60 60 60 63 63 64
100 39 39 39 33 33 33 53 53 56 59 59 59 63 63 63
120 80 38 38 38 32 32 32 68 68 68 57 57 57 61 61 61
40 37 37 37 32 32 32 67 67 67 57 57 57 61 61 61
20 N/A 34 35 29 29 30 62 62 64 52 52 54 56 56 58
10 N/A 29 31 25 25 27 53 53 56 44 44 47 47 47 51
5 23 23 25 19 19 21 41 41 45 35 35 38 37 37 41
160 29 29 29 25 25 25 51 51 51 43 43 43 45 45 45
140 28 28 28 24 24 24 50 51 51 43 43 43 45 45 45
120 28 28 28 24 24 24 50 50 50 42 42 42 44 44 44
100 28 28 28 24 24 24 37 37 39 42 42 42 44 44 44
140 80 27 27 27 23 23 23 48 48 48 41 41 41 43 43 43
40 27 27 27 23 23 23 47 47 47 40 40 40 42 42 42
20 N/A 24 25 21 21 22 43 43 45 37 37 38 39 39 40
10 N/A 21 22 18 18 19 37 37 39 31 31 34 33 33 35
5 16 16 18 14 14 15 29 29 32 25 25 27 26 26 28
11.2.2 CT Perfusion
NOTICE
NOTE
Refer to the accompanying documents.
See the system Technical Reference Manual, Dose and Performance chapter for
information on dose measurements and calculations.
Axial/Cine 40, 80, 100, 120, 140, 160 adjustable Intermittent scanning
mm lowers dose
Cardiac Axial 40, 80, 100, 120, 140, 160 adjustable Intermittent scanning
mm lowers dose
Communication of Table 63 on page 281 should be conveyed by the facility to the radiologist, qualified
medical physicist and radiologic technologist.
The exam duration for tumor perfusion, whether in the head or body, needs to extend over a longer
time interval than a general perfusion scan, starting prior to the arrival of the contrast bolus and
include a period of approximately 3 to 3.5 minutes to adequately support the collection of data for
the computation of permeability maps. Initially, the temporal sampling rate must be the same as that
used for stroke protocols in order to adequately measure the first passage of contrast material through
the region. Subsequently, sparser sampling can occur, with temporal intervals ranging from 5 to 20
seconds. This reduces dose by decreasing the number of exposures.
NOTE
NOTE
The effects of kV and mA or mAs on dose are multiplicative. For example, a three-fold
increase in dose that occurs from increasing kV combined with a two-fold increase in
dose from doubling the mA will result in a six-fold increase in overall dose.
shape of the bolus, follow the bolus with saline, and use an injector capable of delivering the required
injection rates.
The contrast injection rate should be determined by referring to the applicable section of this user
manual, contrast agent labeling, and in consultation with a physician. Special consideration should be
given for children due to their smaller size.
4. Cenic, A, DG Nabavi, RA Craen, AW Gelb, and TY Lee. 1999. “Dynamic CT measurement of cerebral
blood flow: A validation study”, American Journal of Neuroradiology 20 : 63-73.
5. Dillon, WP, and D Gress. 1999. “Intraarterial thrombolysis for cerebral infarction: To treat or not to
treat, and how?”, AJNR 20 : 1194-96.
6. Hunter GJ, Hamburg LM, Ponzo JA, Huang-Hellinger FR, Morris PP, Rabinov J, Farkas J, Lev MH,
Schaefer PW, Ogilvy CS, Schwamm L, Buonanno FS, Koroshetz WJ, Wolf GL, Gonzalez RG. “Rapid
assessment of cerebral perfusion and arterial anatomy in hyperacute stroke with 3D functional
computed tomography: early clinical results”, AJNR 19 (1):29-39, 1998.
7. Nabavi, DG, A Cenic, RA Craen, AW Gelb, JD Bennet, R Kozak, and T Lee. 1999. “CT assessment
of cerebral perfusion: Experimental validation and initial clinical experience”, Radiology 213 :
141-149.
8. J. A. Bauhs, T. J. Vrieze, A. N. Primak, M. R. Bruesewitz, and C. H. McCollough, 2008, "CT dosimetry:
comparison of measurement techniques and devices," Radiographics Vol. 28, pp. 245-253.
9. ACR-ASNR-SPR Practice Guideline for the Performance of Computed Tomography (CT) Perfusion
in Neuroradiologic Imaging at American College of Radiology website
10. AAPM CT Scan Protocols website
11. FDA website on "Radiation Dose Quality Assurance: Questions and Answers"
level of image quality/noise at a lower patient dose than would be possible with a fixed scanner
radiation output. In general, CT systems may accomplish AEC in two ways:
1. Modulating the mA dynamically during scanning in the X-Y and/or Z dimensions to adapt to
variations in the patient’s attenuation.
2. Adjusting the mAs to a fixed value based on measurement and calculation of the patient’s
overall attenuation: the mAs is constant during scanning, but its value has been quantitatively
determined so as to yield an average pre-set level of image noise.
Most AEC systems operate as described in list item #1 above. Discussion of AEC, hereafter, applies to
these types of systems unless otherwise indicated.
11.2.4.5 AEC does not guarantee reduction of radiation doses in all patients
The use of AEC does not always result in dose reduction, especially when compared to a fixed mA/mAs
protocol. For example, when providing the desired image noise/quality criterion setting for a large
patient, AEC might appropriately increase the scanner radiation output as compared to that for an
average-sized patient. For most examinations of average-sized or small patients, and for the same
image noise/quality criterion settings, AEC use will result in the same or lower CTDIvol as that of a fixed
mA/mAs protocol. (However, a larger patient would appropriately require more fixed mA than for a
smaller patient.)
NOTE
Radiologic technologists must be fully aware that proper patient centering is critical
for accurate AEC function. Improper patient centering can result in an exposure that is
either too high or too low to achieve the desired image noise/quality criterion. Note that
proper patient centering can be more challenging for smaller pediatric patients, and so
special care should be taken. Use the output from the patient centering feature to aid in
properly centering the patient.
• Radiation doses may be lower than optimal when using AEC with the following conditions.
• AP scout and the patient is positioned more than 2 cm below isocenter.
• PA scout and the patient is positioned more than 2 cm above isocenter.
The lateral scout is not impacted by the magnification/minification effect of vertical positioning and
will provide more consistent dose levels with AEC. However, patient centering remains critical for
optimal image quality in this case.
The patient centering feature helps to detect suboptimal centering prior to the diagnostic scan. For
each z-position on the scout, the system estimates center of mass of the projection. Based on this
information, the system displays a line at the weighted average of projection centered over the entire
scout.
11.2.4.11 Summary
AEC is a versatile and powerful tool designed to tailor the scanner’s radiation output to each patient
based on the patient’s size, age, shape and attenuation and the user’s requested level of image
noise/quality criterion. AEC technology uses estimated patient attenuation values to adjust the mA
dynamically in order to achieve the requested level of image noise/quality criterion. However, AEC
settings must be chosen with the same care used to choose all other parameters that affect radiation
dose to the patient. Before the scan parameters are confirmed, careful attention must be paid
to CTDIvol and DLP displayed on the user interface; scanner radiation output associated with the
prescribed protocol must be checked and confirmed prior to scanning. Used properly, AEC is a key
technology to help ensure that the appropriate radiation dose is used for every patient.
A guide for how to adjust for Noise Index at another slice thickness is given in the equation in
SmartmA/ODM.
When SmartmA is enabled, if the user changes the slice thickness, the Noise Index will change
according to the following equation to maintain approximate equivalent dose.
Where factors for each slice thickness are given in Table 64 on page 289.
5 0.71
3.75 0.82
2.5 1
1.25 1.41
0.625 1.8
For example, if a prescription for the primary recon has a prescribed Noise Index of 10 for a slice
thickness of 5 mm, and the user changes the slice thickness to 2.5 mm, then the prescribed Noise
Index will change according to the following:
NOTE
The Noise Index values in this table do not adjust based on Slice Thickness Factors.
These values are recommended values for each anatomical area.
11.2.6 SmartmA/ODM
11.2.6.1 SmartmA
Figure 138 Example small patient (120 kVp, 1.25 mm, 0.5 s axial) with factor of 5 noise increase
(simulated): 1 = SD 8 @ 640 mA, 2 = SD 40 @ 25 mA
As an example, for a given fixed exposure scan technique, the quantum noise can vary by at least a
factor of 5 from the smallest to the largest patient. Figure 138 on page 290 shows an example of a
five times noise increase simulated for a small patient. With a fixed mA scan protocol, the technologist
must select the mA using a qualitative estimate of the patient attenuation. This may be accomplished
using the patient's weight and/or waist diameter measurements, body mass index, or with qualitative
visual classification. Because these methods provide rough X-ray attenuation estimates and do not
account for attenuation changes within the patient region being scanned, the technologist must
use a high enough technique margin to avoid compromising the diagnostic quality of the images.
Theoretically, radiation dose is inversely related to the square of the noise, so many patients are likely
receiving more dose than necessary for the required diagnostic quality using such manual methods.
GE's suite of Automatic Exposure Control (AEC) features enable substantial patient dose reduction,
while maintaining diagnostically acceptable image quality. Specifically, SmartmA is an automatic tube
current modulation feature that makes the necessary mA adjustments much more accurately than
those manually estimated for the patient, and can thereby achieve a more consistent image noise
in spite of the wide range of patient size. Since image noise variability is substantially reduced, a
significant overall patient dose reduction is possible with proper scan parameter selection.
by a least squares fit of the noise measurements from a set of phantoms representing a clinical range
of patient sizes and shapes.
Knowing the reference noise and the difference between the reference technique and the user
selected prescribed technique, the mA required to obtain the prescribed Noise Index is calculated
using well known X-ray physics relationships. It is known that the noise is inversely related to the
number of photons and the number of photons is related to the slice thickness, image acquisition
time, and mA. In the GE SmartmA design, adjustment factors for helical pitch are also incorporated
in the calculation to account for noise differences that scale between helical selections and the axial
reference technique.
Practical SmartmA Example
Patient exposure for a SmartmA scan is reduced when compared to a similar scan employing fixed mA.
This is demonstrated in Figure 139 on page 292 which shows the mA as a function of rotation angle for
fixed mA and SmartmA scan of a uniform oval polyethylene phantom. The image on the left overlays
the fixed mA and SmartmA mA profiles as a function of X-ray tube angle, with the accompanying
reduction in overall patient exposure using SmartmA clearly indicated by a reduction in relative mAs
as a function of tube rotation angle. The exact mA reduction range when using SmartmA, and the
consequent reduction in patient dose, depends on the prescribed Noise Index, and the size and shape
of the patient, with a greater reduction expected for a relatively larger and more asymmetric patient
when a relatively low Noise Index is prescribed.
NOTE
Note that values are illustrative, with exact values dependent on the specific
implementation of SmartmA.
While the SmartmA mA table specifies different mA values per rotation, corresponding to the mA
in the anterior-posterior direction and in the lateral direction, i.e. at 0 and 180° and 90° and 270°,
respectively, the actual mA is continually varying in a smooth fashion between the specified mA values
as a function of X-ray tube angle to the patient, as shown in Figure 139 on page 292.
11.2.6.1.3 References
1 L. Kopka and M. Funke, "Automatically adapted CT tube current: Dose reduction and image quality in
phantom and patient studies," Radiology 197 (P), 292 (1995)
2 D. R. Jacobson, W. D. Foley, S. Metz, and A. L. Peterswen, "Variable milliampere CT: Effect on noise
and low contrast detectability," Radiology 210 (P), 326 (1996)
Example:
Why is the standard deviation I measure in the image different than the Noise Index I selected for
the scan?
• There are many factors that can account for this. But, first consider that the prescribed Noise
Index causes the tube current to be adjusted so that the system projects a similar X-ray intensity
through the patient to the detector. Hence it regulates the X-ray noise or quantum noise in the
scan projection data. The noise in the image depends on additional factors within the image
reconstruction chain, including, but not limited to, the selection of reconstruction algorithms,
reconstructed slice thickness selection (if different than your prospective selection), and the use
of image space filters. In addition, it is very difficult to make standard deviation measurements
on patient data since the standard deviation is affected by small CT number variations of the
heterogeneous anatomy and by patient motion or beam hardening artifacts. Even with uniform
phantoms, standard deviation measurements will produce some variability in measured results
because of the inherent nature of quantum statistics.
• Another situation that can cause significant differences between the selected Noise Index and the
image standard deviation is when very large patients provide insufficient detector signal. In these
cases, electronic noise sources can become the dominant image noise source instead of X-ray
noise. In these cases at various threshold levels, special projection data dependent filters begin
to be applied to help preserve image quality. These filters on the projection data affect the noise
properties of the reconstructed image. The highest kV is recommended when excessively large
patients need to be scanned.
• Another factor is how well the patient is centered in the SFOV. Image noise can increase
significantly if the patient is mis-centered. This occurs because the bowtie filter projects
maximum X-rays intensity at isocenter since this is the region of maximum attenuation if the
patient is centered. If the patient is mis-centered, there are fewer X-rays projected to the thickest
part of the patient, and hence image noise will increase. The optimum strategy is to find the
highest Noise Index sufficient for the clinical task and let SmartmA select the mA without using
significant constraints.
attenuation may not match the actual attenuation of the heterogeneous anatomy being imaged.
Thus, if images appear noisier when SmartmA is employed, the user may need to use a lower
Noise Index. This may be the case if the user finds that the average mA employed for the
population of patients in question using SmartmA is generally lower than using previous fixed
mA protocols. This situation indicates that the user is now employing lower dose compared to
previous protocols and hence higher noise levels would be expected.
• Certain patient images may also be noisier than the experience of the user suggests. For example,
experience leads the user to expect significantly lower noise in thin patients than obese patients,
while SmartmA attempts to make the image noise approximately similar for all patient sizes. Most
importantly, the user needs to find the highest Noise Index to enable a confident diagnosis of the
clinical indication since this results in the lowest patient dose.
• If the user desires somewhat lower noise in small patients, the user may want to create Small,
Nominal, and Large patient protocols. The user can then use a slightly lower Noise Index for the
smaller patients and a slightly higher Noise Index for larger patients.
• A noise limiting strategy that can be employed is to increase the minimum mA setting in the
SmartmA protocol. If the user determines that image quality is generally not acceptable below
some minimum mA value, then the user may set this value as the low mA range limit. This will
prevent the SmartmA feature from using mA values that are lower than desired. Note that this
strategy can sometimes defeat the overall purpose of SmartmA, causing image noise to fall below
the prescribed Noise Index, and furthermore increase dose to the patient.
• Another possibility for higher noise than is expected is if the user looks at multiple reconstructed
images that have thinner slices than the prospective scan prescribed slice thickness. SmartmA
uses prospective slice thickness as a factor when the mA table is generated. The user must ensure
that the Noise Index is set for the first prospective image based on image thickness used for axial
image viewing (see the first FAQ). This caveat applies equally for fixed mA and SmartmA scanning.
• Higher noise images can occur when patients are not well centered in the scan field of view. The
bowtie filter attenuation increases with distance from isocenter, hence the thickest part of the
patient should be approximately centered in the scan field of view, in line with the minimum filter
attenuation, otherwise image noise will increase since the patient thickness adds to the bowtie
filter thickness. This is especially important for highly asymmetric anatomy such as shoulder
anatomy. Again, this effect applies equally for fixed mA and SmartmA scanning.
• Recognize also that there are some obese patients that exceed the capabilities of the tube and
generator to satisfy the selected Noise Index. This is also no different than fixed mA scanning. For
such obese patients, one strategy is to select a higher kV setting when possible.
Why is the mA annotated on the image sometimes slightly different than the mA I see in the mA
table?
The mA displayed on the image is determined by measuring the generator mA during the scan and
averaging the measured result over the total number of views used to reconstruct the image. The
number of views used to produce the image may be more than one gantry rotation for a helical scan.
Hence the annotated value is a combination of the mA table values that depends on how many views
from each rotation were used for the image. In addition, the generator is automatically adjusting the
filament current to account for changing conditions during the scan to keep the mA within the desired
tolerance of the commanded mA table. For example, this is why you may see an mA value of 41 in the
image where the mA table indicated 40.
I understand that noise in the image changes with reconstruction parameter selections, but
why is the noise sometimes different when I retro reconstruct the same scan data at a different
display field of view?
When you select a parameter within a reconstruction algorithm, the system may sometimes readjust
the actual filter kernel. This readjustment will change the image standard deviation. This will happen
if the display field of view (DFOV) selection exceeds a certain dimension for each reconstruction
algorithm and is especially apparent with higher resolution algorithms such as bone and edge. The
change in kernel is required when the DFOV selection makes the pixel size too large to support the
intended spatial resolution. This characteristic is independent of SmartmA.
What are the appropriate kV and mA to use for a scout scan to ensure accuracy of AEC?
The AEC algorithm calculates the patient’s size and shape from the most recently scanned scout and
uses this information to help determine the optimal mA profile (when SmartmA is enabled) and kV
(when kV Assist or Auto Prescription is enabled).
If too low a kV and/or mA are used to scout the patient, the scout image may have relatively low
signal, causing AEC to calculate an inaccurate patient size and shape. This could ultimately lead to an
inaccurate SmartmA profile or kV selection, resulting in suboptimal dose and/or IQ.
Therefore, it is important to use a kV and mA for the scout scan that is appropriate to the patient size
to assure accuracy of AEC.
In general, it is recommended that the user scan at the kV and mA prescribed in the GE Reference
Protocols. For convenience, the recommended kV and mA for scout scans are summarized in the table
below.
It is recommended to avoid scanning adults and larger pediatric scouts at 70 kV.
to achieve NI prescribed. Image noise will increase, however, ASiR-V percentage will offset the noise
increase.
11.2.6.2 SmartmA
In addition to adjusting for patient attenuation in the z-axis, SmartmA adjusts patient exposure as a
function of X-ray tube angle as the tube rotates around the patient, thus leading to mA modulation in
the x, y and z-axes. For each scanned section in the z-axis direction, the system calculates an mA for
the lateral and anterior-posterior patient axes from an estimation of the patient attenuation through
the long and short axes, respectively.
Patient exposure for a SmartmA scan is reduced when compared to a similar scan employing manual
mA. This is shown in Figure 139 on page 292 which illustrates the mA as a function of rotation angle for
manual mA and SmartmA of a uniform oval shaped phantom. The image on the left shows the fixed
mA and SmartmA mA profiles as a function of X-ray tube angle, with an accompanying reduction in
overall patient exposure. In this case a manual mA technique can be thought of as the equivalent of an
AutomA based modulation, as employed in the AutomA feature on previous products.
While the SmartmA mA table specifies different mA values per rotation, corresponding to the mA in the
anterior-posterior direction and in the lateral direction, i.e. at 0, 180° and 90° and 270°, respectively,
the actual mA is continually varying in a smooth fashion between the specified mA values as a function
of X-ray tube angle to the patient, as shown in Figure 139 on page 292.
Figure 139 on page 292 shows a sample SmartmA mA profile as a function of gantry rotation for a
uniform oval polyethylene phantom with the same prescribed Noise Index using (blue) Manual mA and
(orange) the SmartmA mode of Automatic Exposure Control (AEC). The reduction in patient exposure
enabled by SmartmA is clearly illustrated as a function of X-ray tube angle compared to the patient
exposure illustrated by the manual mA profile. The expected mA reduction range when using SmartmA
depends on the size and shape of the patient, and on the prescribed Noise Index, with a greater
reduction expected for a relatively larger and more asymmetric patient, when a relatively low Noise
Index is prescribed.
Figure 140
Number Description
2 Head first
3 Feet first
The mA reduction rate on front side of the patient and the mA reduction tube angle are below.
Image noise may increase up to 10 percent while maintaining diagnostic quality within the prescribed
ODM range (axial) or within the prescribed ODM range plus half the detector coverage on each side
(helical).
11.2.7.1 Overview
Auto Prescription is a profile driven feature that selects scan parameters defined for a patient by
patient size and works with SmartmA to optimize dose and image quality. The benefits of Auto
Prescription include providing a consistent desired image quality across a wide range of patient sizes,
eliminating multiple size- based protocols and reducing the amount of patient size dependent scan
parameter adjustments at scan time. A Auto Prescription Profile specifies the patient size ranges and
specifies which settings are changed by patient size. kV and mA limits are required settings for each
patient size range and optional settings may be selected including, SFOV, ASIR-V%, Rotation Time,
Pitch and Noise Index (NI). If NI is set in the profile, then a reference slice thickness will also be set in
the Profile.
Auto Prescription determines the patient size from the attenuation information of the patient’s scout
over the prescribed scan range and then applies the scan settings specified for that patient size range
within the Auto Prescription Profile. In addition, If NI is not set in the profile’s patient size range,
Prescribed NI defined in the protocol will be adjusted based on the Size Adjusted Noise Index (SANI)
and Clinical Task settings within the Auto Prescription Profile. SmartmA utilizes the selected kV and NI
parameters to determine mA.
NOTE
NI is not adjusted from the value in the protocol if the patient size falls in the Reference
Patient Size Range.
in the patient) in the scan data used to reconstruct the image. These factors impact the CT image
quality indicator Contrast-to-Noise Ratio (CNR). CNR gives an indication of how well structures can be
seen through the image noise. CNR can be improved by increasing the contrast between structures,
lowering the noise level, or both.
Image quality is impacted by what X-rays the system generates (how many [tube current] and at
what energies [tube voltage]), and how much they are attenuated (patient size and composition). The
patient attenuation is impacted by the size and composition of the anatomical region being scanned.
While mA has a large impact on image noise, kV has a large impact on both image noise and image
contrast. Tube current selection is related to the desired image noise, but it must be noted that it is
also greatly impacted by the tube voltage selection. Tube voltage is related to desired image contrast
because individual materials have different levels of x-ray attenuation at different X-ray energies. For
example, Iodine has a relatively large change in attenuation at different energies providing more
image contrast, and water has relatively little change in attenuation at different energies proving very
little change in image contrast.
CNR ↑ ↑ ↑ ↓ Fixed
Because of these IQ impacts resulting from kV selection, lowering kV can be used to optimize patient
exams in the following ways:
• improving image quality in terms of image contrast
• decreasing the amount of contrast agent delivered to the patient
• lowering the amount of radiation dose associated with a CT scan
CT image contrast increases as kV decreases. This effect is relatively small for non-enhanced soft
tissue and relatively large for bone and iodine. Relative to a Reference kV, an increase in image
contrast (C) from a lower kV scan can be offset by an equal increase in image noise (N) to maintain
contrast-to-noise ratio (CNR).
For many cases, maintaining the CNR of a particular material may not be clinically acceptable. Instead,
both CNR and overall image noise should be taken into account. Auto Prescription balances the
consideration of CNR and image noise based on your selection of Clinical Task.
Changing kV also impacts CT number (Hounsfield unit) measurement, therefore there are some
clinical cases where changing kV may not be clinically acceptable.
Changing kV and mA will also change the overall appearance of the images, therefore it is advised to
adjust ww/ wl accordingly.
convert the values to the selected size units. The profile must contain a size range that includes the
Reference Size Patient. The patient range inclusive of the Reference Size Patient will be designated
with the icon
NOTE
The Reference Patient Size of 28.9 cm Dw converts to different AP, LAT, or AP + LAT
depending on the scan field of view type that is used at scan time, as illustrated in the
table below. For Head and Body SFOVs, the Reference Patient size of 28.9 cm Dw is
converted to AP, LAT, and AP + LAT using a Chest/Abdomen/Pelvis conversion factor. For
Cardiac SFOVs, the Reference Patient size of 28.9 cm Dw is converted to AP, LAT, and AP
+ LAT using a Thorax conversion factor, which is more appropriate for Cardiac scanning.
However, note that the Reference Patient Size that is shown in the Auto Prescription
Profile Editor always corresponds to the Reference Patient Size for a Body SFOV.
Reference Patient Size (Head and Reference Patient Size (Cardiac Size Units
Body SFOV) SFOV)
Dw Dw is the term used for Water Equivalent Diameter, which is the diameter (in
cm) of a cylinder of water that would give the same x-ray attenuation of the
object or patient being scanned. More details can be found in AAPM Reports
204 and 220.
The conversion from Dw to other Patient Size Metrics is based on work from previous studies1, 2, 3 that
analyzed phantom and clinical datasets and derived formulas to convert between Dw and AP + Lat, AP,
Lat, Weight, and BMI. In general, AP + Lat has a strong correlation to Dw, and so AP + Lat is the default
Patient Size Metric used in the GE Reference Profiles. While not as strongly correlated to Dw, Lat may
be appropriate for chest or cardiac scans.
BMI and Weight, on the other hand, are generally poor correlates for patient attenuation. Therefore,
while the user can set up a profile in Weight or BMI, they must switch to another Patient Size Metric
before being able to save a profile. When switching from one Patient Size Metric to another, all size
values in the profile will automatically convert to the newly selected Patient Size Metric.
Note: See Scout Based Attenuation Characterization for more information on Dw.
[ 1 ] Menke J. Comparison of Different Body Size Parameters for Individual Dose Adaptation in Body CT
of Adults. Radiology 2005; 236:565–571.
[ 2 ] Burton CS., Szczykutowicz TP. Evaluation of AAPM Reports 204 and 220: Estimation of effective
diameter, water-equivalent diameter, and ellipticity ratios for chest, abdomen, pelvis, and head CT
scans. J Appl Clin Med Phys 2018; 19:1: 228–238.
[ 3 ] Boone JM, Strauss KJ, Cody DD, et al. Size-specific Dose Estimates (SSDE) in Pediatric and Adult
Body CT Examinations. AAPM Report 204, 2011.
NOTE
NI adjustment will be a relative increase when the kV is lower than the reference kV and will be
a relative decrease when the kV is higher than the reference kV.
Soft Tissue Non-Contrast Small adjustment of Noise Index across kV, optimized
for scan situations where contrast agents are not
used. The regions of primary importance are non-en-
hanced tissue regions.
Soft Tissue +C Low Contrast Moderate adjustment of Noise Index across kV, opti-
mized for scan situations where iodinated contrast
agents are used. The regions of primary importance
are both enhanced and non-enhanced tissue regions
with lower noise compared to Soft Tissue +C High
Contrast.
Soft Tissue +C High Contrast Moderate adjustment of Noise Index across kV, opti-
mized for scan situations where iodinated contrast
agents are used. The regions of primary importance
are both enhanced and non-enhanced tissue regions
with higher noise compared to Soft Tissue +C Low
Contrast.
Gated High Contrast Large adjustment of Noise Index across kV, optimized
for scan situations where iodinated contrast agents
are used. The regions of primary importance are en-
hanced tissue regions.
Smaller than Reference Patient Size Larger than Reference Patient Size
No Change No Change
NOTE
For any given Size Adjusted Noise Index strength, the percent increase or decrease in the
Noise Index (relative to the Noise Index set in the protocol) gets larger as the patient size
gets further away from the Reference Patient Size. For example, the increase in Noise
Index for a patient that is much larger than the Reference Patient Size will be greater
than that for a patient that is only slightly larger than the Reference Patient Size.
Figure 141 on page 307 shows the estimated relative decrease or increase in NI across patient size for
each SANI strength setting relative to using a constant NI. For patient sizes smaller than the Reference
Patient Size, the noise will never decrease by more than 45% relative to the Reference NI. For patient
sizes larger than the Reference Patient Size, the noise will never increase by more than 60% relative to
the Reference NI.
At scan time, Size Adjusted Noise Index adjusts the Noise Index set in the protocol based on the patient
size calculated from the scout.
Table 71 on page 308, Table 72 on page 309 and Table 73 on page 310 show the estimated relative
decrease or increase in CTDIvol across patient size for each SANI strength for the specific scan settings
shown. Example 1, figure 1, Example 2, figure 1 and Example 3, figure 1 show CTDIvol relative to the
Reference Patient Size, whereas Example 1, figure 2, Example 2, figure 2 and Example 3, figure 2 show
CTDIvol relative to if the same patient size were scanned at a constant NI. Note that these figures show
estimated relative CTDIvol for the fixed scan settings described in the figure headings (e.g., 120 kV, 9
NI, 5mm slice thickness, and specific pitch and rotation time values commonly used for small, average,
and large sized patients). The actual relative increase or decrease in CTDIvol for a given patient size and
SANI strength may vary based on the maximum achievable tube output at each kV, pitch, and rotation
time setting for the prescribed Noise Index and scan range.
The following table summarizes Figures Example 1, Figure 1 through Example 3, Figure 2.
Figure What does it show Patient Size Range kV / NI / Slice Detector Cover-
Thickness age / Pitch / Rota-
tion Time
(continued)
Figure What does it show Patient Size Range kV / NI / Slice Detector Cover-
Thickness age / Pitch / Rota-
tion Time
Example 3, figure 1 CTDIvol relative to 60 – 100 AP + LAT 120 kV / 9 NI / 5mm 80mm / p0.508 /
Reference Patient 1.0s
Size
Example 3, figure 2 CTDIvol relative to 60 – 100 AP + LAT 120 kV / 9 NI / 5mm 80mm / p0.508 /
if same patient size 1.0s
were scanned at
constant NI
Table 71 Relative CTDIvol versus Patient Size using Constant Noise Index - Example 1
CTDIvol Relative to
Reference patient
size
CTDIvol relative
to same patient
size using constant
noise index
Table 72 Relative CTDIvol versus Patient Size using Constant Noise Index - Example 2
CTDIvol Relative to
Reference patient
size
CTDIvol relative
to same patient
size using constant
noise index
The decrease in rel-
ative CTDIvol begin-
ning around patient
sizes less than 25
AP + Lat is due to
the system reaching
the minimum mA
limit for all SANI
strength settings.
Table 73 Relative CTDIvol versus Patient Size using Constant Noise Index - Example 3
CTDIvol Relative to
Reference patient
size
The flattening of the
relative CTDIvol be-
ginning around pa-
tient sizes greater
than 80 AP + Lat
is due to the sys-
tem reaching the
maximum mA lim-
it across each SANI
strength setting.
CTDIvol relative
to same patient
size using constant
noise index
The increase in rel-
ative CTDIvol begin-
ning around patient
sizes greater than
80 AP + Lat is due to
the system reaching
the maximum mA
limit across each
SANI strength set-
ting.
See Set up the patient's information for character limits in each field.
If user clicks anywhere within the yellow box area (as shown in Figure 143 on page 313), the user can
change: Landmark, Orientation, Position, Copy Forward & Auto Voice.
Element Description
Anatomical Landmark Reference Choose a preset center point, or designate a center point with a two
Point letter abbreviation or 0. This should be set the same as your scout
images.
Preset Center Points
• OM: (orbital-meatal line)
• SN: (sternal notch)
• XY: (xyphoid process
• IC: (illiac crest)
• AJ: (ankle joint)
• KN: (knee)
• SP: (symphysis pubis)
Copy Forward Select to copy Patient Orientation and Patient Position settings from
the previously scanned series.
Auto Voice Language Click to set the Auto Voice language for the exam.
NOTE
The Scan Settings window will change based on the scan type selected.
Element Description
Create New Scout Series Set up a new scout series for the exam.
Create New Axial Series Set up a new Axial series for the exam.
Element Description
NOTE
This is not available if the patient has not been landmarked or if
invalid parameters exist in the Scan Settings window.
Element Description
Paste Right-click on the series where you want the copied series to be pasted below it.
Add Smart Prep Group Right-click on a group task to add a Smart Prep scan task.
Link All Links all groups within a series. This allows you to adjust the start location of the
first group and the end location of the last group, and to adjust the location of
scan rotation boundaries between the groups while keeping the groups contigu-
ous. The link icon appears on the scan series task when Link All is enabled.
Link All enabled assures a full field of view contiguous data set between groups,
when at least one group of axial or cardiac scan type contains a detector coverage
of 80 mm or greater.
DFOV, Image Thickness and Interval must be the same when Link All is enabled.
Primary recon of linked groups will not start until the scan is complete and
Continue is selected.
An Invalid DMPR task message displays when All Anatomy Recon, which contain
at least one group of axial or cardiac scan type, contains a detector coverage of 80
mm or greater and are not Linked. If DMPR is desired, select Link All.
Scanned groups cannot be unlinked.
Duplicate Groups is not valid for scanned linked groups.
Unlink All Unlinks all scan groups in the series, allowing them to be moved independently.
Split Splits any One or More table position prescription within a single physical scan
group and separates them into individual physical scan groups.
Split and Link Splits any One or More table position prescription within a single physical scan
group and separates them into individual physical scan groups; then the start and
end between groups are linked and contiguous.
Element Description
Task color in- Indicates the Show Localizer Group Color on the task when enabled in System Preferences
dication
NOTE
After 6 groups have been added, subsequent groups will be added with the
group 1 color. If groups 2-6 are deleted, when adding or duplicating a group, the
color added will be the same as the last group deleted.
Tab color in- Underlines the group name on the group tab.
dication
• Blocked reference channels can cause image artifacts. Make sure that there are no blankets,
clothing, tubing, or straps hanging down below the table when scanning. Keep items
wrapped close to the table by using the patient restraint straps.
4. Press and hold the Load button on the table foot pedal, GCP or RCP.
• The table moves up to a height of 210 mm and advances the table and cradle into the gantry.
If a protocol has been selected, the table will move to a preset height and location based on
the anatomical reference in the protocol.
• Release the foot pedal when the patient is properly positioned. Use the gantry controls to
further adjust the position.
5. Make the patient comfortable and immobilize as needed. Connect body straps to the cradle and
wrap them around the patient.
• Use the head holder straps to immobilize the patient's head.
• Make sure items such as blankets and straps are not hanging off the table or allowed to touch
or be dragged through the gantry during the scan, otherwise artifacts may appear in the
images.
NOTE
If it is not possible to move the table down:
• Check to make sure there is nothing blocking the table or gantry path.
• Check the gantry display or the message log for collision sensor errors, which
prevent downward movement.
• Resolve any issues and press the table up/down buttons.
• If the problem persists, contact your service representative.
9. Press the Internal Landmark button if using internal alignment lights or press External
Landmark if using external alignment lights to align patient. You cannot click Confirm Settings
until after you have pressed a landmark button.
• The landmark sets a known anatomical reference for the radiologist to correlate anatomy.
• The landmark sets the zero location. When scanning towards the patient’s head, you are
scanning superior to the zero location. When scanning towards the patient’s feet, you are
scanning inferior to the zero location. You should set the zero location to known anatomy.
For example, when scanning a head, the landmark or zero location is typically the orbital
meatal (OM) line.
• A landmark or zero reference point is required before you scan a patient. It can be set before
or after you start a new patient exam.
• When using the external laser alignment light to position the patient, be aware that the
patient’s elevation may be slightly lower with the cradle extended than with the cradle fully
retracted. The cradle may bend slightly under the patient’s weight. Take this difference into
consideration for applications where patient position is critical, such as treatment planning.
To minimize these effects, after positioning the patient using the external laser alignment,
advance the patient to the CT scan plane. Turn on the CT alignment lights to determine
if they line up with the markers on the patient. Compensate for the bend in the cradle
by elevating the table. When the CT alignment lights line up with the markers, reset the
landmark for the scan using the Internal laser alignment light.
10. From the Scan Control Interface, set volumes with the Patient-to-Operator and Operator-to-
Patient , or Auto Voice communication controls. Press the Talk control to test the Operator-to-
Patient volume level.
Field Parameters
Month/Day/Year (MM/DD/YYYY)
Birthdate Day/Month/Year (DD/MM/YYYY)
Year/Month/Day (YYYY/MM/DD)
Age NOTE
Maximum age that can be entered is 150
years.
Radiologist Up to 64 characters
Operator Up to 64 characters
History Up to 60 characters
2. From the Patient Information window, enter data into the appropriate fields.
• Press Tab to advance to the next text field, or use the mouse to navigate to each field.
• The cursor must be within the Patient Information window for the input to be accepted.
• Patient ID is a required field. If the patient does not have an identification number, enter text
in the field or if information is unknown use the Unknown Patient feature Enter Patient ID
and Patient Name using Unknown Patient.
• Once an identification number has been assigned, you can edit exam information using Edit
Patient after Close Exam.
• Select Delete All Completed exams when patient information is updated from the HIS/
RIS. This ensures that completed accession numbers are not inadvertently selected for a
second scanning. This could cause patient reconciliation issues on the Picture Archiving
Communications System (PACS).
• Birth dates can only be entered for the past 150 years. The format for date entry depends on
your system settings: MM/DD/YYYY, YYYY/MM/DD, DD/MM/YYYY.
• Patients in Japan may know their birth date only by emperor reign year. Configure the birth
date fields to YYYY/MM/DD date format and enter the reign year in the year field. For example,
enter S26, if your patient was born in the 26th year of Showa's reign, which corresponds
to 1951. The Era codes are Heisel (H), Showa (S), Taisho (T), Meiji (M). The system stores
the converted birth year in the birth date field on the New Patient and Patient Schedule
windows and in the image header.
• If needed, select items from any of the stored Preset Selection values: Referring Physician,
Radiologist, Operator, Exam Description. The selections are displayed as you type a
character and the list is filtered.
• The patient session will not be created if the following characters are used in the patient
information fields:
Language Characters
Dutch IJ, ij
Finnish Š, š, Ž, ž
French €, Œ, œ, Ÿ
German €
NOTE
Patient information selected from Patient Schedule in which the patient name is
blank or needs to be updated with non-English characters will not be able to be
edited if DICOM tag 0008, 0005, or Specific Character Set is not filled with the correct
character set designation.
For example, if Swedish characters are desired for patient name, DICOM tag 0008,
0005 must reference ISO_IR 100.
Character sets supported are:
• ISO_IR 100 Latin 1 (example Swedish and Latin alphabet)
• ISO_IR 87 Japanese/Kanji
• ISO_IR 6 US-ASCII
NOTE
The Patient ID and Last Name field cannot be edited if the Unknown Patient icon has
been selected. To enter Patient ID or Last Name, deselect the Unknown Patient icon.
11.3.3.2.2 Enter patient ID or accession number with the bar code reader
1. From the scan monitor, click .
2. To populate the field on the Patient Information window, aim the bar code reader at either the
Patient ID or Accession Number bar codes on the patient requisition.
3. Enter any remaining patient information.
4. Select desired protocol(s) and begin the exam.
• Referring Physician
• Radiologist
• Operator
• Exam Description
• Contrast Oral
• Contrast IV
NOTE
For Referring Physician, Radiologist or Operator, enter the first name, last name or
both.
NOTE
Selecting another Preferences tab will save the data entered.
Change an item on the list
1. From the Preset fields window, select the item you want to change.
2. Enter the new information in the text field.
3. Press Enter.
NOTE
Suggested Protocols box displays only when Intelligent Protocoling Option is installed.
NOTE
The value in the Worklist Key dropdown box on the Intelligent Protocol System
Preference screen determines which Worklist Key is used. Refer to Intelligent
Protocoling System Preferences.
1. If the Intelligent Protocoling Option is installed, the system tracks the most commonly selected
protocols for the Worklist Key from the patient worklist and displays up to 6 protocols in the
Suggested Protocol area. The suggested protocols display only if a protocol has been selected at
least 5 times for a given Worklist Key.
NOTE
Only recommended protocols from adult protocols display when the adult selector
is displayed and only recommended protocols from pediatric protocols display
when the pediatric selector is displayed.
If the AutoSelect protocol preference is set to On, and a protocol has been selected
at least 20 times for a given modality worklist entry and the confidence is 30 percent
higher than the next highest protocol, the system selects a protocol and displays it
in the Selected Protocols area. The user can click Accept to use this protocol(s) for a
patient scan. Prior to selecting Accept, read and verify the protocol name(s) selected
are the protocols desired for the exam. If not, use the X icon next to the protocol
name to delete a protocol that is not desired and select the desired protocol(s) from
any protocol per select a protocol.
2. Select the desired protocol category, then search for a specific protocol using one of the following
methods.
NOTE
Multiple protocols can be selected
• Select a protocol from the Favorites list area.
• Select an anatomical region and then select a protocol.
• Search for a protocol in the Protocol Search field and then select a protocol.
• Select a protocol from the Suggested Protocol area.
NOTE
Prior to selecting Accept, read and verify the protocol name(s) selected are the
protocols desired for the exam. If not, use the X icon next to the protocol name to
delete a protocol that is not desired and select the desired protocol(s)
NOTE
When multiple protocols are selected the protocol name shown on the right
monitor is the protocol name of the last protocol selected. Tasks listed start with the
tasks from the first protocol selected, then 2nd protocol and so on.
NOTE
If you click Accept when a scan data save or restore is in progress, a message
displays indicating that the scan resource cannot be acquired.
1. Confirm that the patient orientation matches the patient orientation in the Patient Position area
of the Scan Settings window.
• Click on the patient image to change to a head-first or feet-first orientation.
• Click on the table or above the patient body to rotate the body in 90° increments.
2. From the Scout collection on the Scan Settings window, confirm the Start and End locations, kV,
mA, and Auto Voice settings (if applicable).
• To change a parameter, open the desired settings collection and click in the field to enter a
new value. Plus (+) can be used for S values and Minus (-) for I values when using the ten-digit
key pad.
• A user message dialog displays when the system updates the Start and End Location to be
S-I. The Start and End Locations have been updated to set scan range from S to I. Verify Start
and End Locations are as desired
• A blue alert message displays when the Start or End location is outside the table range.
Start or End Location has been updated to be within the table range. Verify Start and End
Locations are as desired.
• Technique factors are set low (120 kV and a low mA are common), since these scans are
normally used only for planning purposes.
• When Fast Scout is used on larger patients, use a higher mA value than you would use for a
normal speed scout.
• Dose calculation for the scout scan uses the effective mA value. This value can be found in
DICOM tag 0045, 1066 SmartScout effective mA.
• 90° = 3 o'clock
• 180° = 6 o'clock
• 270° = 9 o'clock
4. In the Window Width and Window Length fields, type the desired values.
5. When performing a gated exam, set up the patient monitor and check that a trace is displayed to
verify that the system is receiving the ECG monitor signal.
• Click On to enable gating.
• If the ECG signal has not been detected, the system displays a message to check the
connection. Check that all ECG leads are connected to the patient and that the monitor
power is on. See the Cardiac chapter for more details.
NOTE
Move to Scan flashes green on the scan control interface indicating you need to
press it.
Press Stop Move if you need to stop table movement.
8. Press Start Scan.
NOTE
When a 90° or 270° azimuth scout is acquired, the system will assess patient
centering. If the patient is centered, a single green line with a check mark will
display on the image. If the patient is off‐centered greater than 2 cm, the system will
display the table height location and an up or down arrow to indicate the elevation
needed to reach that height. Use the gantry control to press and hold the indicated
button along with the fast button to move the table to the recommended height.
• In Helical scans, the entire scan is completed. Use Stop Scan; not Pause Scan.
9. Repeat the previous two steps to acquire the second scout scan.
10. Click Continue to move to the next scan task.
Figure 151 Patient Centering Line and Recommended Table Elevation Height on Lateral Scout
Image
Manually adjust the table elevation height to the recommended value with the gantry controls, so the
patient is centered properly in the gantry, thereby optimizing technique for the prescribed scan. Do
not use the Load or Unload pedals while doing this adjustment. The patient centering line and
recommended table elevation height will be cleared from the scout image when the user proceeds to
the next scan or scan prescription edit.
Considerations
• The recommended table elevation height for a specific scout image can also be found in the
System Messages area.
• If a patient centering line is displayed but not the recommended table elevation height, the
patient is already centered for the diagnostic scan.
• Always make sure that the patient centering line is appropriate for your clinical need. The user
is ultimately in control of table elevation adjustments and patient positioning for the scan. The
patient centering notification should be used to estimate center line for simple cases.
• Zoom operations in the viewport may hide the patient centering line and recommended table
elevation. Reset the viewport option with right-click menu options.
• This feature is always enabled and cannot be turned on or off.
NOTE
If a patient centering line cannot be estimated or truncated data was detected, the
following notification will be displayed:
“System is not able to calculate optimal patient centering position. Verify that table
elevation is centered to the body part of interest and the resultant CTDIvol and DLP meet
the clinical goal for the acquisition and follow the radiation exposure guidelines for your
department.”
NOTE
Patient positioning accessories may affect dose and image quality. AEC will compensate
for changes in attenuation due to the accessories by adjusting mAs to achieve
the prescribed image noise/quality criterion. Consult the accessory manufacturer’s
instructions for use for recommended adjustments, if needed, for manual scan modes.
Table 79 Icons
1.
Emergency Patient
Patient List Patient List with Patient's Name, ID, Date of Birth or Age, Exam
Date and Time, Exam Description, Exam Session Number.
Refresh
Search Box
Finds the patient with the Patient Name or ID, then select the
4.
patient to create new exam.
The user can drag the scroll bar on the right of the Patient List to look through patients.
If you want to exit Patient Schedule without selecting any patients, you can press the Patient Schedule
icon in the top left corner to exit Patient Schedule.
If the user selects Emergency Patient on the Gantry Display initial screen, the tag area displays only
Trauma tags.
The protocol list includes only protocols with trauma tags.
Patient Information
Exam Description
Operator Name
To be confirmed before scan start. Exam description and Opera-
1. tor name can select from list. To register the data in the list, use
Patient Data Entry in System Preference.
6. Key Words Search Field Desired protocols can be searched from this. By touching the
field, a key board is displayed and you can type the keywords.
7. Protocol List
8. Exit
9. Confirm
Touch this button whenever the desired protocols are selected.
The screen moves to the Scout Progress screen. (if the selected
protocol does not have a scout scanning, it directly goes to the
Scan progress screen.)
When desired scan protocol is high-lighted, then touch Confirm button to proceed to scout scan.
Figure 158 Related protocols Interface (1: Related / Favorite / Protocol Anatomy Selection Box, 2:
Key Word Selection Box)
In case the automatically identified information is not accurate, user can change these keywords to
refine the resultant protocol list.
Related protocols work within the selected GE/User and Adult/Pediatric combination, so when user
switches between GE/User or between Adult/Pediatric, the resultant protocol list is updated.
In order to exit Related Protocols, any of the following can be used:
• Close the Related protocols list by pressing the “X” icon of the search field
• Select any other categories from Related/Favorite/Protocol Anatomy Selection Box
• Select anatomy from the Related/Favorite/Protocol Anatomy Selection Box
• Select anatomy on the Anatomy Selector
• Select anatomy from the nine icons around the Anatomy Selector
When desired scan protocol is high-lighted, then touch Confirm button to proceed to scout scan.
NOTE
A mismatch bay be seen between Auto Positioning and Patient Centering
recommendations after lateral scout is acquired. Always make sure that the patient
centering line is appropriate for your clinical need. If the mismatch is seen consistently,
verify the Adjustment Factor set in System Preferences for Auto Table Elevation.
NOTE
Auto Positioning sets the scan range based on the Anatomical Reference set in the scan
protocol.
Anatomical References supported by Auto Positioning include:
• OM – Orbital Meatal line
• SN – Sternal Notch
• XY – Xyphoid
• IC – Iliac Crest
• SP-Symphysis pubis
• KN – Knee
• AJ – Ankle Joint
If the anatomical reference set in the scan protocol is not in the above list, the Scout Image Range
Indicator will not show up automatically. If this occurs, use Internal Landmark or External Landmark
button to position patient manually.
1. Patient Information Displays Patient Name, Patient ID, Accession Number, Birth Date,
Age, Gender, Exam Description , Operator and selected protocol
number and title.
2. Patient Position area Displays Patient Orientation and Anatomical Reference in the
selected protocol. The system recognizes the patient orientation,
if it is different from the protocol setting, this area turns to red
like below.
CAUTION
3. Scout Parameter Displays start/end locations, kV and mA, and scout plane.
Changes according to the setting of Scout Range Indicator.
eo. Touching this icon turns off real-time anatomical reference se-
lection and scout range recommendations, and the icon changes
to
5. Scout Range Indicator The blue lines with handles indicate scan range, and the solid
box represents start location and the open box represents end lo-
cation. Those handles can be touched and moved to the desired
location.
NOTE
The accuracy of scout scant range determined by
the system is affected by the sheets/blankets/body
strap covering the patient body, blockage of the depth
camera view by people/devices around and/or above
the patient table, lighting conditions and existence of
highly reflective surfaces. Make sure to check validity
of the scan range shown on the gantry display and
adjust it manually on the video when necessary before
starting the automatic table motion.
Confirm and table move in When all the setting is confirmed for scan, touch this button. The
table moves into the gantry and stops at the scan start location.
6. After the system gets ready for scanning, then Scan Start button
on Gantry Panel and Scan Control Interface start to blink.
7.
During the movement of the table, the user can pause and resume the movement on the Touch
Screen.
Once the table has arrived at the position and stopped, the system is ready for the scout scan.
NOTE
For patient safety, Xtream camera will predict potential collision area (such as patient
body or accessories) with gantry and highlighted in orange on the video. User needs to
clear the collision area to enable table automatic movement or user can confirm scout
scan under collision condition but press foot LOAD pedal continuously to move table to
the target position.
Keep watching during auto motion for patient movement and collisions.
During scanning, the Exposure Indicator on the Gantry Panel and Scan Control Interface is illuminated.
When you touch the screen, the movie's control icons are displayed.
Touch the icon to play the movie. Touch the screen during play the movie to pause and touch the X in
the upper right to end play the movie.
Selection Description
Cut Lines Toggles between individual cut lines and scan volume graphic over-
lays. Not valid for an Axial scan type with detector coverage 80 mm or
greater.
Dimensions Displays text boxes for Start Location, End Location, and DFOV.
SFOV Displays SFOV indication lines based on the selected bowtie filter.
IEC Displays X-ray irradiation lines for Helical scan types only.
Selection Description
Localizer Displays localizer graphic objects over the top of scout images. Click
the button to turn Off and ON the Localizer display.
All Groups / Selected Groups Displays all groups when highlighted and only selected groups when
Off. Click the button to turn Off and ON the All Groups / Selected
Groups display.
Projected NI (Noise Index) Displays orange lines showing areas where the prescribed noise index
is exceeded. Click the button to turn Off and ON the Projected NI
(Noise Index) display.
Detailed View OFF / ON Displays detailed view for Cardiac Axial scan types only. Click the
button to turn Off and ON the Detailed View display.
/
Enlarge Viewport Enlarges the Show Localizer viewport to 768 x 768 image size.
Click the button to toggle between 512 x 512 and 768 x 768 image size.
ODM Displays ODM modulated range in pink. Click the button to turn Off
and ON the ODM display.
NOTE
For Axial scans, ODM is constrained to the detector cover-
age range. For Helical scans, ODM is constrained to the
detector coverage x pitch.
Represented as an X.
• Left‐click on X moves the slices in the slice direction
only. If all groups are selected, then X moves all
groups simultaneously.
3 Move/Adjust Scan Range / RAS • Shift and left‐click on X moves the lines to adjust
the Start Location and End Location, and the Right
Anterior Superior (RAS) coordinates simultaneously.
For RAS coordinates, shift and left‐click on X moves
the lines up and down on a lateral scout, and side-
to-side on an Anterior/Posterior (A/P) scout.
Represented as a diamond.
• Left‐click on ◊ to adjust the DFOV and keep the RAS
coordinates fixed.
4 DFOV • Shift and left‐click on ◊ to adjust the DFOV and
RAS coordinates at the same time. Adjusts the DFOV
center by keeping the opposite DFOV handle from
the selected side anchored.
Selection Description
Outside of SFOV Represented as cross-hatch line. The desired DFOV for the image re-
construction should be inside of the SFOV. When the DFOV is outside
of SFOV, the image reconstructed will display incomplete anatomy.
The Cross-hatch line will alert the user that the DFOV falls outside of
the SFOV.
Right-click and drag Zooming. Use this control to minimize the scout image display to see
the entire extent of the scout image and the scan range prescribed.
1. Press and hold Shift and click and drag the center X to position the graphic lines over the
anatomy you want to cover.
NOTE
There is no default indication of the SFOV on the scout image during Graphic Rx.
When move the DFOV outside of the SFOV, there will show up the SFOV line and
cross-hatched line outside of the SFOV. And blue alert message also shows to
remind the user.
• The slices are represented as a solid overlay group of lines on the scout image.
• Adjust the position of the scan range and RAS coordinates to the desired location.
• If you change the landmark after the scout has been completed, Graphic Rx will not let you
to change A/P centers on a lateral scout. Since the landmark changed, a new scout should be
acquired so Graphic Rx can be used.
NOTE
The start Location is not the same when row edit is On and it is adjusted graphically.
This may occur when making small adjustments in Graphic Rx quickly. Always
verify that the Start and End locations for each scan group are as desired prior to
confirming the scan.
NOTE
For Axial or Cardiac scan types, the position set is the full FOV location.
NOTE
Press Shift and simultaneously click and drag either the solid or empty box to adjust
both the start and end locations at the same time.
4. Click and drag the diamond key to set the Display Field of View (DFOV) equally around the center
of the DFOV.
Alternatively, press Shift and simultaneously click and drag the diamond key to adjust the DFOV
and the R/L center or A/P center on the selected side.
5. From the Graphic Rx viewport, right-click and choose an option to show or hide the slices.
• Select Cut Lines to show a line for each image reconstructed.
• Deselect Cut Lines to show a transparent area of coverage with no slice lines displayed.
6. From the Graphic Rx viewport, right-click and deselect IEC to remove the indicators of the helical
scan irradiated area.
• For helical acquisitions, the full X-ray irradiated area is shown for all groups using a pair of
magenta lines that are the length of the SFOV.
• For multiple groups, solid magenta lines are shown for the primary scan group selected.
Dashed magenta lines are shown for secondary scan groups.
7. Review the Graphic Rx values in the Anatomy Selection collection to make sure they are correct.
Selection Description
IV Contrast On or Off. When On, images are labeled +C. Contrast Agent settings
are optional.
NOTE
When IV contrast is Off and a SmartPrep task is added,
IV contrast is turned On automatically and the Contrast
Volume is set to 0. DICOM tag 0018, 1041 will not be added
to the image header unless the Volume setting is greater
that 0.
Enhanced Xtream Injector On - Communication enabled between the CT Scanner and the In-
jector. Injection Settings are shared between the scanner and the
injector and injection starts with the Start Scan button on the CT
System.
Off- No communication between CT Scanner and Injector. Injection
Settings on the scanner are informational and will need to be adjust-
ed manually to reflect the actual settings on the Injector. Injection
will need to be started with controls on the injector and manually
coordinated with the start of scanning.
Injector Settings Displays Phase, Volume, Flow Rate, Pressure Limit and Duration when
IV Contrast is ON. Clicking on this settings opens the IV Contrast/Oral
Contrast pop-over window to IV Contrast settings.
The default values of these settings are as follows:
• Phase 1
• Volume 100 ml
• Flow Rate 2.0 ml/s
• Duration 50 s
• Pressure Limit 150 psi
NOTE
Be sure to enter the correct Volume to be injected, even
if Enhanced Xtream Injector is OFF, to have the correct
value stored in the Contrast Volume DICOM tag. When IV
contrast is Off and a SmartPrep task is added, IV contrast
is turned On and the Contrast Volume is set to 0. DICOM
tag 0018, 1041 will not be added to the image header
unless the Volume setting is greater that 0.
Oral Contrast Settings Displays the concentration and volume. Clicking this setting will open
the IV Contrast/Oral Contrast pop-over window to Oral Contrast
Settings.
NOTE
The Oral Contrast Volume field does not accept a value
greater than three digits. If volume amount is greater than
three digits, enter the volume in the Contrast Agent
Name field.
IV Contrast/ Oral Contrast Pop Over Click the IV Contrast Tab or the Oral Contrast Tab to switch the
Window display to the applicable settings screen.
IV Contrast settings:
Select an Agent and Concentration preset or enter Agent and Concen-
tration and click Add.
Enter the Pressure Limit.
Click Add Phase for the # of phases needed.
For each phase, enter Injection Delay, Type, Flow Rate, Volume and
Duration. See Table 72 for setting details.
Oral Contrast settings:
Enter Agent, Concentration and Volume.
NOTICE
NOTE
+C annotation is displayed when IV contrast is On and indicates that IV contrast was
used for the series.
NOTE
Once the IV Contrast Setting or Oral Contrast Setting has been selected, they
cannot be changed after a scan has been acquired.
4. Select a contrast preset from the list to enter agent and concentration. Enter volume, flow rate,
duration for each contrast phase.
NOTE
If the agent and concentration are not listed in the preset list, enter the Agent Name,
enter Concentration and click Add.
5. If you are using an integrated injector with the scanner, click On for Enhanced Xtream Injector to
enable communication with a compatible injector to share Injector Settings and synchronize start
of injection with start of scan. Refer to Enhanced Xtream Injector.
6. Click Apply.
Considerations
• Press Stop Scan to stop scans between multiple helical groups and do not press Stop Move.
• Scan aborts may occur during Scout, Axial or Helical scanning. Always be aware of the scan
progress during an exam and select Resume to continue.
• The scan may fail to confirm, posting a message that not enough image space exists, even though
the disk image space icon indicates there is enough space or File Manager may not have
exams listed.
This occurs because images are stored on the system disk in more than one partition. Remove
consecutive exams to free up image space to confirm and proceed with the scan.
Disk Status
NOTE
If you encounter the message that you need to delete images to be able to scan
the current series, first check the recycle bin and remove images to create space for
scanning, next if scouts have not been acquired, end the exam and start a new exam.
However, if scouts have been acquired, use Revisit Settings and prescribe the series
again.
NOTE
Hovering the cursor over the status icon displays an estimate of the number of images
remaining based on an average image file size.
Recycle Bin Status
NOTE
The Prep Delay for group 1 is set to zero.
NOTE
The Smart Prep group will be remembered if the series contained Smart Prep. Delete the
Smart Prep group if it is not needed.
NOTE
For helical scans, you need to evaluate each situation. Pause Scan will not stop a helical
scan in progress. The scan will complete and the system will stop and not scan any
additional groups. Stop Scan will stop a helical scan. Resume will resume a helical scan
from the location it was stopped.
NOTE
Prior to scanning make sure that GSI profiles and scan protocols have been created in
Protocol Management that will support the clinical indication being scanned.
1. Select the GSI protocol in the desired anatomical area from the GE Reference or Adult selector.
2. Acquire a scout. A scout series is required for GSI Assist mA mode to be available.
3. Define the Start/End locations manually or graphically.
4. Confirm that the Clinical Category and Clinical Identifier match the clinical task. If not, update.
5. If the GSI prescription is a Helical scan type, set the desired Interval.
6. Verify your selections if using a predefined protocol or select your desired options
a. For GSI kV Mode, confirm if GSI Assist or GSI Manual mA mode is on.
b. Check if CID Link is On. If it is set to On, the system links to the GSI Profile that is mapped to
the Clinical Category/Clinical Identifier pair. If CID Link is Off, the GSI profile can be directly
selected.
i. Verify the Noise Index meets the need of the clinical intent
ii. Review the Dose and Scan settings chosen by GSI Assist
iii. If changes are desired, click the Adjust button on the GSI Image Quality Widget.
i. Verify Dose and Scan Settings for desired Clinical ID meet Clinical Intent.
ii. If other settings are desired change the GSI Family via the Adjust button widget.
iii. If other settings not shown in the widget, the GSI Profile may be changed.
7. Review/Set the timing parameters in the Timing Collection.
NOTE
Use of appropriate CID is critical to image quality for the following specific
recon tasks:
• Gout analysis images must use Extremity.Gout.
• Non-contrast head image must use Neuro.Routinehead.
vii. Recon settings will populate from the GSI Profile mapped to the Clinical Category and
Clinical Identifier.
viii. Or alternatively turn off CID Link to directly select a GSI profile.
b. Recons setup not Linked to GSI Assist — The primary recon is setup on the left monitor as
with non-GSI and the parameters selected are limited. MAR is not permitted for the primary
recon. Monochromatic images, High kVp, kVp-like images and Data File are supported.
i. Open Primary Recon collection.
ii. Set recon parameters.
iii. Set GSI Image Type. Choose between Monochromatic, High kVp, kVp-Like or if needed
Data File.
Element Description
Scan Type Enables one of the following scan types: Axial, Helical, Cardiac, or Cine.
Hi Res Mode Enables and disables Hi Res Mode. Hi Res Mode is compatible with Axial,
Helical, and Cardiac scan types.
Rotation Time The available rotation times depend on the scan type selected. See Rotation
Time.
11.4.1.1 Axial
Axial scanning is the traditional “step and shoot” method of acquiring data. The X-ray tube and Data
Acquisition System (DAS) expose and rotate one 360° loop. The table and patient move a preset
distance (interval) and the process is repeated.
11.4.1.2 Helical
Helical or spiral scanning is a method of acquiring images in a continuous data set. The X-ray tube
and DAS expose and rotate continuously through 360° while the patient is passed through the area of
exposure at a set rate of movement depending on the rotation time and helical pitch. The information
gathered is then reconstructed into images of the prescribed slice thickness and interval.
11.4.1.4 Cine
Cine is a method of scanning that rotates the gantry 360° continuously with no delay in between
passes while gathering input from one location over time. You may set the acquisition in groups
expanding the time to be scanned. This is especially beneficial when determining the function of
anatomy and physiology (example: hemangioma).
NOTE
Hi Res Mode is available for the following scan types and detector coverages.
• Axial – 20, 40, 80, 100, 120, 140, 160 mm detector coverage
NOTE
For the 256 slice system, 80 mm configuration, collimations greater than 80 mm are
not selectable.
• Helical
• 0.531:1 pitch 20mm detector coverage
• 0.516:1 pitch 40 mm detector coverage
• 0.984:1 pitch 40 mm detector coverage
• Cardiac Axial – 40, 80, 100, 120, 140, 160 mm detector coverage
NOTE
For the 256 slice system, 80 mm configuration, collimations greater than 80 mm are
not selectable.
Hi Res images are annotated with HR in the lower‐left annotation area of the image.
NOTE
For Advantage 4D scans, rotation times less than 0.5 s should not be used.
• Cardiac Axial – 0.28 s, 0.35 s
Element Description
Detector Coverage • Smart Coverage (system adjusts to best coverage based on the start
and end location prescribed)
• 5.0 mm
• 40 mm
• 80 mm
• 100 mm
• 120 mm
• 140 mm
• 160 mm
Also see the Equipment chapter; Detector Configuration section for more
information.
NOTE
For the 256 slice system, 80 mm configuration, collimations
greater than 80 mm are not selectable.
Number of Passes The number of rotations for the data acquisition. Only available if the inter-
val is 0.
Minimum Time Between The time between rotations for the data acquisition when the interval is 0.
Passes The minimum time is dependent on the rotation time.
• 0.28 s rotation – 0.88 s minimum
• 0.35 s rotation – 0.95 s minimum
• 0.5 s rotation – 1.2 s minimum
• 0.6 s rotation – 1.5 s minimum
• 0.7 s rotation – 1.6 s minimum
• 0.8 s rotation – 1.7 s minimum
• 0.9 s rotation – 1.8 s minimum
• 1.0 s rotation – 1.9 s minimum
Rotation Time 0.28 s, 0.35 s, 0.5 s, 0.6 s, 0.7 s, 0.8 s, 0.9 s, 1.0 s
Total Exposure Time The coverage time determines the total X-ray On duration of the scan.
Element Description
Detector Coverage • 40 mm
• 80 mm
Also see the Equipment chapter; Detector Configuration section for more
information.
NOTE
0.508:1, 0.992:1, 1.375:1 and 1.531:1 pitch (80 mm detector cov-
erage) are not valid with Ped Head, Small Head or Head SFOV.
Coverage Speed Determined by the detector configuration and rotation time used.
Rotation Time 0.28 s, 0.35 s, 0.5 s, 0.6 s, 0.7 s, 0.8 s, 0.9 s, 1.0 s
Total Exposure Time Determined by the coverage speed and the scan range prescribed.
Element Description
Detector Coverage • Smart Coverage (system adjusts to best coverage based on the start
and end location prescribed)
• 40 mm
• 80 mm
• 100 mm
• 120 mm
• 140 mm
• 160 mm
Also see the Equipment chapter; Detector Configuration section for more
information.
NOTE
For the 256 slice system, 80 mm configuration, collimations
greater than 80 mm are not selectable.
Minimum Time Between The time between rotations for the data acquisition when the interval is 0.
Passes The minimum time is 1.5 seconds.
Number of Passes The number of rotations for the data acquisition at the same table position.
Total Exposure Time Determined by the table positions, number of passes and phase ranges for
each acquisition part.
Element Description
Detector Coverage • 40 mm
• 80 mm
• 100 mm
• 120 mm
• 140 mm
• 160 mm
Also see the Equipment chapter; Detector Configuration section for more
information.
NOTE
For the 256 slice system, 80 mm configuration, collimations
greater than 80 mm are not selectable.
Duration 1–60 s
Scan Interval 0
11.4.3.1 kV Mode
From the kV and mA Control collection, select the applicable mode from the dropdown menu.
Additional settings will be required based on the initial kV mode selected.
In this software release, to help compensate for patient size and tissue composition without impacting
workflow, two options for assisted kV selection have been integrated into the scanner, kV Assist and
Auto Prescription.
Auto Prescription offers greater control in setting kV and other scan parameters for different patient
sizes and will completely replace kV Assist in a future software release. Your protocols with kV Assist
will continue to work. However, GE recommends that you begin to modify the protocols to utilize Auto
Prescription.
To encourage the use of Auto Prescription, the kV Mode dropdown menu will show kV Assist only
under certain circumstances. In Protocol Management, kV Assist will be an available selection only if
the protocol being edited previously had kV Assist. At scan time, kV Assist will appear in the menu
only if the selected protocol already has a group with kV Assist prescribed. If the selected protocol has
manual kV or kV Assist, then kV Assist will be available as a selection.
kV Assist determines the recommended technique based on the baseline protocol, the scan
conditions.
kV Assist will optimize the scan parameters based on the selected clinical task.
In each clinical task, the system determines the patient size from the scout projection data. This is
used in conjunction with a reference protocol (i.e., the X-ray scan technique factors that would be used
without kV Assist) to determine the expected amount of image contrast for the relevant materials. The
system then determines the Noise Index/tube current needed to provide the proper balance between
CNR and image noise at each of the tube voltages. The combination of tube voltage and Noise Index/
tube current that results in the lowest CTDIvol at the desired image quality is then selected. Note that
the tube voltage with the lowest CTDIvol may not be selected for some patient sizes and applications
in order to maintain the desired image quality (e.g., in order to avoid situations where potential image
artifacts could occur).
For cardiac scans with kV Assist, the system determines a size adjustment of the Noise Index (for
SmartmA scans), SFOV and mA based on the patient size from the scout projection data. The NI/mA for
a reference size patient is given in the protocol, and this is adjusted by kV Assist prior to (and used in)
the kV selection. This allows for the inclusion of size-specific image quality needs in cardiac scanning
without having multiple size-based protocols
kV Assist works with manual mA, SmartmA or SmartmA ODM.
• SmartmA will utilize the prescribed NI and kV settings after kV Assist runs to set the mA values.
• SmartmA will propose adjusted solutions if the prescribed NI cannot be achieved.
kV Assist requires a scout scan at the same patient position and orientation of the diagnostic series in
order to determine the Patient Size.
See the Protocol chapter for additional details on setting up kV Assist in protocols.
collimation, scan range or AP, RL locations. Based on the estimated patient attenuation from the scout,
Auto Prescription then matches the re-calculated patient size to a kV Profile Patient Size Range and all
settings within that size range are applied to the scanning protocol.
Auto Prescription is a profile driven feature that selects scan parameters defined for a patient by
patient size and works with SmartmA to optimize dose and image quality. A Auto Prescription Profile
specifies the patient size ranges and specifies which settings are changed by patient size. kV and mA
limits are required settings for each patient size range and optional settings may be selected including,
SFOV, ASIR-V%, Rotation Time, Pitch and Noise Index (NI). If NI is set in the profile, then a reference
slice thickness will also be set in the Profile.
Auto Prescription determines the patient size from the attenuation information of the patient’s scout
over the prescribed scan range and then applies the scan settings specified for that patient size range
within the Auto Prescription Profile. In addition, If NI is not set in the profile’s patient size range,
Prescribed NI defined in the protocol will be adjusted based on the Size Adjusted Noise Index (SANI)
and Clinical Task settings within the Auto Prescription Profile. SmartmA utilizes the selected kV and NI
parameters to determine mA.
NOTE
NI is not adjusted from the value in the protocol if the patient size falls in the Reference
Patient Size Range.
Auto Prescription works only in conjunction with SmartmA or SmartmA ODM.
• SmartmA will utilize the prescribed NI and kV settings after Auto Prescription runs to set the mA
values.
• SmartmA will propose adjusted solutions if the prescribed NI cannot be achieved
Auto Prescription requires a scout scan at the same patient position and orientation of the diagnostic
series in order to determine the patient size.
If the patient size is outside of a patient size range, a blue alert displays and Auto Prescription provides
a solution for the closest size range in the profile.
When using Auto Prescription, the selected kV Profile is critical to the success of the exam. Before
changing a Auto Prescription profile, ensure that you have reviewed the profile and understand how
the profile uses NI. When the profile sets NI in the protocol, it is important that the protocol NI is set for
the Reference kV of the selected profile.
At scan time, changing any parameter set in the Auto Prescription profile, except the minimum and
maximum mA range, will override the Auto Prescription solution. The kV mode changes to User
Override. The Auto Prescription widget displays the values that are different and provide ability to
re-apply the Auto Prescription settings if desired.
When a scan is prescribed using SmartmA, scan setup uses limits for the min/max mA to allow you to
limit the range over which the system can modulate the mA. The maximum mA limit allows the user
to restrict the maximum amount of radiation emitted from the system during the scan. When kV is
changed manually, ensure that the min/max mA values are sufficient to achieve the desired patient
scan.
11.4.3.3 mA Mode
From the kV and mA Control collection, select mA Mode. The X-ray system provides focal spots S, L
and XL that are automatically selected by the system based on kV, mA and exposure time.
The focal spot that will be used is shown in the kV and mA Control collection.
Refer to the Revolution™ CT, Revolution™ CT ES Technical Reference Manual, System Specifications
(Chapter 7), CT System X-ray Tube Ratings (Section 6) for the maximum tube power limits. The mA
value may be adjusted based on the tube power limits to indirectly select the focal spot.
Images reconstructed from a SmartmA enabled scan are annotated with a tilde symbol (~) next to the
Noise Index, as shown in Image Annotation.
NOTE
SmartmA is disabled if the patient orientation does not match the scout orientation.
The system will inform and instruct you that Patient Orientation or Patient Position has
changed from the previous series, and that AEC features have been disabled. You can
choose to reacquire a new scout image to reorient the patient to be consistent with the
orientation of the previous scout or change to Manual mA Mode.
The following message will be displayed if SmartmA is unavailable due to patient orientation or
position mismatch:
NOTICE
The system uses the patient attenuation data collected from the most recent scout scanned for the
exam, the patient habitus, the prescribed, and other settings in the mA table to determine the mA to
be used for the acquisition. You can view the predicted mA values for each rotation of the acquisition
by accessing the mA table. The Patient Orientation and Patient Position for the series must match the
scout. If there is no scout or the patient orientations do not match, SmartmA will be disabled, and the
following message will be displayed:
NOTE
NOTE
Even if you are using SmartmA, the Manual mA field should be filled in with a reasonable
value in case SmartmA should be inadvertently disabled.
Element Description
Start Location / End Displays the start and end location of the ODM region.
Location When the ODM feature is enabled, the first start and end location are set by
default at the starting edge of the scan range.
ODM region By default, one set of start and end location entry fields are created.
The maximum number of ODM regions within a group is one.
When enabled the entire scan range for the group is included.
When the scan range is changed, and is less than the previous scan range, ODM
range will adjust to stay within the valid scan range.
mA Table Information When ODM is applied, the mA Table shows the maximum mA within each rotation
for each of the following regions: (A) anterior, (P) posterior, (L) left of the patient,
(R) right of the patient.
Scan rotations where ODM is applied have an accompanying drop in the applied
mA in the (A) anterior direction when compared to the (P) posterior direction,
and will be indicated with an asterisk (*) next to the rotation. If the Patient
Orientation changes from, Head First to Feet First, then the positions of (L) and (R)
are reversed.
ODM can be set in Protocol Management.
NOTE
The mA Table shows a decimated version of the full mA profile that
will be scanned. Because the mA Table displays the maximum mA
for each rotation for each direction, there may be cases in which the
displayed anterior mA in the mA Table is the same as the displayed
posterior mA, even though ODM is applied for that rotation.
For example, this may occur when a helical rotation contains both
a region with ODM applied and a region without ODM applied. In
this case, the maximum mA displayed for both the anterior and pos-
terior directions is likely to come from the region within the rotation
where ODM is not applied, since it is likely to be higher mA than
the region where ODM is applied. It is important to understand that
this is a caveat of how mA is displayed in the mA Table and that
the actual scanned mA profile is appropriately reducing the mA in
regions where ODM is applied.
On the scout localizer image, the prescribed ODM region will be displayed in purple if ODM is selected
in the Graphic Rx toolbar.
NOTE
The ODM region can be moved only in the z-direction, not for A/P or R/L direction.
When ODM is enabled for a scan, it will be indicated in the kV and mA Control collection. ODM will be
set in one or more locations in the scan group. It does not mean all the rotations in the scan group
have ODM applied.
NOTE
SmartmA is ON when ODM is enabled.
ODM is available with standard Axial, Helical or Cine scanning modes.
ODM is not available for Cardiac scan types.
ODM is not available for scan groups which are not compatible with AEC scan modes.
If ODM is enabled and the scan type is modified to a state which is not valid for ODM, the system will
notify the user.
The following message will be posted when ODM is not available:
NOTICE
ODM HAS BEEN DISABLED. VERIFY , MIN MA / MAX MA, RESULTANT CTDIVOL
AND DLP MEET THE CLINICAL GOAL OF THE ACQUISITION AND FOLLOW
THE RADIATION EXPOSURE GUIDELINES FOR YOUR DEPARTMENT.
Image Annotation
To indicate that an image was generated within a scan region where ODM is enabled, an asterisk is
added after the Noise Index value.
and the required patient exposure increases with a decrease in the prescribed Noise Index. You can
specify the Noise Index in the Noise Index field. The Noise Index field is enabled only when one of the
following mA modes is enabled:
• SmartmA
• SmartmA & ODM
• GSI Assist
A change in prescribed Noise Index necessarily adjusts dose to the patient, which is viewable at the
bottom center of the Dose Display area. Patient dose will be decreased or increased as the Noise Index
is accordingly increased or decreased.
The Projected Noise Index can be viewed from the Image Quality widget on the Scan Settings
window. Projected noise index calculation shows the mA modes for which the Projected Noise Index is
displayed. For helical scans with more than one rotation or cardiac or axial scans containing multiple
exposures at different locations, an estimate of the noise can be calculated for each z-location along
the scan range. The Projected Noise Index value displayed in the Image Quality Widget is calculated
from the estimated noise values at each z-location along the prescribed scan range according to
Projected noise index calculation.
SmartmA & ODM the maximum of the estimated noise values at each
z-location along the prescribed scan range
When using GSI Manual mode, the Image Quality widget displays only the Projected Noise Index.
When using the other three mA modes shown in the table above, the Image Quality widget will
also display the Prescribed Noise Index and indicate whether the Prescribed Noise Index will be
met. When the Projected Noise Index is higher than the Prescribed Noise Index, the Projected Noise
Index will be highlighted orange. When selected, Adjust will display recommended solutions to
change scan parameters to help meet the Prescribed Noise Index. The Solutions window displays
the recommended parameters, the change in noise and the change in DLP associated with the change.
NOTE
The Max mA recommended will take into account tube cooling.
Figure 191 Graphic Rx shows orange bars through shoulder region, indicating that the prescribed
Noise Index cannot be met in this region.
Projected noise index calculation shows the Projected Noise Index indication vs. Prescribed Noise
Index for the scout scan shown in Graphic Rx shows orange bars through shoulder region, indicating
that the prescribed Noise Index cannot be met in this region. The Projected Noise Index shown in the
Image Quality Widget for a GSI scan is the average of the estimated noise values along the prescribed
scan range. Because it is an average, the Projected Noise Index may be lower than or equal to the
Prescribed Noise Index, even in cases where orange bars appear in some region or regions along the
scout
Element Description
(continued)
Element Description
DFOV Allows you to target a particular piece of anatomy for display and determines
how much of the SFOV is reconstructed into an image.
A/P center Allows you to define the DFOV center of the image in the Anterior/Posterior
directions relative to the SFOV.
R/L center Allows you to define the DFOV center of the image in the Right/Left directions
relative to isocenter of the SFOV.
Clinical Identifier Allows you to define clinical categories and specific procedure identifiers
to enable specific behavior for image reconstruction and/or to automate
associated post processing tasks. CID can be used to optimize work flow for
specific clinical use cases.
1. From the Scan Settings window, select a scan task from the protocol.
NOTE
You must execute each scan task in order. Click Confirm Settings for each scan task,
and then scan that scan series. You may then click Continue to move to the next
scan task. Scan tasks can be deleted if you want to skip them. Scan tasks can also be
reviewed when completed.
2. Make sure the patient orientation is the same as it was for the scout.
If necessary, click the patient image in the Patient Position area to change the patient orientation
and position.
NOTE
There may be times when you change the patient’s position from the way it was
built in the protocol. In this case, you will have to change the patient’s orientation
each time you advance to the next series unless you use the Copy Forward feature.
3. Choose the Scan Type.
4. Set the Coverage Speed options.
5. Set the Primary Recon options.
See Recon Parameters for details.
6. Set kV and mA Control.
• Set the mA.
• Set the kV.
• Click Cine when one location needs to be scanned over a period of time, such as for
hemangioma studies.
Full is continuous exposure that supports table movement equal to the beam collimation or
no table movement, where the scan is taken at one table position.
• Click Cardiac to help freeze motion of the heart and vascular structures with a Helical-gated
or Cine-gated scan.
If the Scan Type is changed from another scan type, the mA value automatically updates. Review
it to be sure it is acceptable.
3. For Hi Res Mode, click On in combination with the Axial, Helical, or Cardiac scan type to produce
images with improved resolution in the x and y directions.
• Hi Res Mode is supported to enable collection of more views in the x and y directions to
support increased resolution using HD algorithms or improvement in IQ as a result of having
more views, such as for off‐center DFOV imaging.
• The standard set of reconstruction algorithms are compatible with Hi Res acquisitions,
however, the inherent resolution will be reduced to match non Hi Res acquisitions.
• The Hi Res Modes supported include the following:
• Axial – 40, 80, 100, 120, 140, 160 mm detector coverage
NOTE
For the 256 slice system, 80 mm configuration, collimations greater than 80
mm are not selectable.
• Helical
0.516:1 pitch 40 mm detector coverage
0.984:1 pitch 40 mm detector coverage
0.508:1 pitch 80 mm detector coverage
NOTE
For the 256 slice system, 80 mm configuration, collimations greater than 80
mm are not selectable.
5. Click Save.
NOTE
Total Exposure Time is updated automatically when a pitch is selected.
• The pitch is the table travel in millimeters per rotation divided by the detector coverage.
• 4 Row Interleaved provides a 40% mAs reduction, is 1.5 to 3 times faster than single slice
helical and has minimal helical artifacts, but interleaved pitch 0.5:1 provides only one
third of the coverage compared to interspaced mode.
• 4 Row Interspaced provides data acquisition 2 to 6 times faster than single slice
helical, but requires more interpolation, has more helical artifacts, and only a 20% mAs
reduction.
• Helical pitches include: 0.508:1, 0.516:1, 0.984:1, 0.992:1, 1.375:1 and 1.531:1.
4. For Axial, Cine and Cardiac scan types, the detector coverage and slice thickness determine the
images per rotation.
4
5 1i 8i 16i 20i 24i 28i 32i
i
N
5z NA 15i 31i 39i 47i 55i 63i
A
8
2.5 2i 16i 32i 40i 48i 56i 64i
i
N
2.5z NA 31i 63i 79i 95i 111i 127i
A
1
1.25 4i 632i 64i 80i 96i 112i 128i
i
N
1.25i 1i NA NA NA NA NA NA
A
N
1.25z NA 63i 127i 159i 191i 223i 255i
A
3
0.625 NA 264i 128i 160i 192i 224i 256i
i
6
0.625z NA 4128i 256i 319i 384i 448i 512i
i
• The choice for one determines the choices for the other. Some combinations are not allowed.
• The choice of detector coverage and slice thickness determines the images per rotation.
Some combinations are not allowed.
NOTE
For the 256 slice system, 80 mm configuration, collimations greater than 80 mm are
not selectable.
5. For an Axial or Cine scan type, the interval is set equal to the detector coverage. The interval value
can be increased or decreased. If the interval is greater than the detector coverage, the gap is
between each rotation of data, not between the slices.
For an Axial scan type, the interval or spacing defaults to the equal number of images per
rotations multiplied by the slice thickness.
• The interval for Axial scanning can be zero, equal to, or greater than the width of the detector
configuration.
• Axial interval with skip refers to a gap between scan groups. This can be useful, for example,
when performing a survey exam, such as a high resolution chest exam.
NOTE
The Total Exposure Time shown in the Coverage Speed collection does not account for
the interscan delay prescribed in the protocol.
• For cardiac scans, see guidelines for AEC with Cardiac Modes.
3. Click Apply.
4. Review: For SmartmA and ODM scans, review if the scan is meeting the prescribed Noise Index
from the Image Quality widget to view the calculated X and Y, or A, P, R and L values.
If not, click Adjust to be presented with a list of solutions with dose changes to realize the noise
versus dose in the prescribed Noise Index.
• This can only be done during scan set up and not in Protocol Management.
• The system will display an indication when one or more rotations are at the Min mA or
Max mA value specified for SmartmA. If the system indicates this condition, check the scan
parameters in the mA Table to ensure the acquisition will provide the expected results.
NOTE
Prior to enabling either kV Assist or Auto Prescription at scan time ensure that you
review kV Assist Theory, Auto Prescription Editor, and Building Auto Prescription in
a Protocol.
Option 2: Auto Prescription, kV Profile setting is displayed, select an appropriate kV Assist Profile
from the dropdown menu.
Option 3: kV Assist, click on the kV Assist popover.
Select the Clinical Task, select the clinical task appropriate for the exam.
Select the kV Min, enter a kV
Select the kV Max, enter a kV
Ensure that the kV Baseline was set appropriately for the average size patient.
NOTE
Auto WW/WL On when Auto Prescription in enabled, allows the system to adjust
WW/ WL based on the change in image contrast and noise when kV changes at scan
time. Auto WW/WL may be turned On or Off at scan time in both the Primary Recon
and Secondary Recons.
Any secondary recons added will have Auto WW/WL On by default if Auto WW/WL is
On in the primary recon. Auto WW/WL can be enabled in Secondary recons only if
Auto WW/WL is On for the Primary Recon group. To manually change the WW and
WL values for a group, kV Mode must be set to User Override, Auto WW/WL must be
turned Off.
2. Acquire the Scout acquisition. Auto Prescription will not run with an invalid scout.
3. For each group within the series, set the scan range.
NOTE
If the patient’s size does not match a size range within the Auto Prescription
profile, the system displays the Auto Prescription solution of the closest size
range.
The maximum mA will update based on the tube heat and exposure time limits.
4. Review all settings and the image quality widget. Make any necessary adjustments to meet dose
and IQ for the exam.
NOTE
Changing any profile setting value, except minimum or maximum mA, will override
the Auto Prescription Solution. kV mode will change to User Override and the
Widget will highlight the values that differ. Click Revert to kV Assist Solution to
change the values back to the Auto Prescription solution.
kV values that are lower or higher than the reference size patient kV may impact the WW/WL
and the contrast brightness. Make necessary adjustments to these settings. See WW/WL
Considerations when using Auto Prescription.
5. Click Confirm.
At scan time, if the user overrides the kV selected by Auto Prescription, the system automatically
adjusts the prescribed NI to maintain a similar Contrast-to-Noise ratio, based on the clinical task from
the profile, as the kV and NI that was chosen by Auto Prescription. The system displays a yellow
notification banner, and the user has the option to keep the recommended adjusted NI or to revert to
the previous NI.
Scanning with kV Assist
Use this procedure to prescribe a scan with kV Assist. See the Protocols chapter for information about
kV Assist.
1. Select a protocol and verify the Manual kV, mA or applicable SmartmA (Noise Index minimum/
maximum mA), Slice Thickness, Rotation Time, Pitch, SFOV, and WW/WL values that are
acceptable.
2. From the kV and mA Control collection, set the kV Mode to kV Assist.
NOTE
Auto WW/WL will be On in the Primary Recon collection by default for the primary
recon to optimize the protocol’s reference WW and WL based on the expected
change in image contrast and noise when kV Assist is enabled. Select On to use the
WW and WL values set in the Primary Recon. To change the WW and WL values, kV
mode must be set to Manual kV or kV Assist Delta.
3. Specify the Clinical Task for the study.
4. Review the resulting kV, Noise Index or Manual mA and WW/WL values to ensure they are
acceptable.
NOTE
Manual mA or Smart mA parameters cannot be changed when kV Assist is on. Be
sure to set these settings prior to turning on kV Assist. Secondary recons will not
automatically adjust WW and WL.
Once kV Assist has been enabled, kV Assist Delta mode can be selected.
Changing kV, Manual mA or SmartmA parameters when kV Assist is on will reset the kV Mode to
kV Assist Delta mode.
For Cardiac scans, changing SFOV will also reset the kV Mode to kV Assist Delta mode. When
kV Mode is switched to kV Assist Delta, the kV Assist Delta values will be reset to the currently
selected values.
Re-select kV Assist mode to run kV Assist with the modified baseline parameters.
In the following conditions, SmartPlan may not optimally identify the scan start and end
locations, A/P centering, R/L centering or DFOV. Please adjust the anatomy selection settings
manually in these conditions.
• Scout image does not contain the anatomy prescribed by the CID in the protocol. For
example, if the CID is Thoracic.Chest Abd Pelvis but the scout image contains only the
abdomen and pelvis.
• Scout image does not include entire anatomy of interest that SmartPlan algorithm utilizes to
determine the localizer positions. This could happen if the scan range is insufficient or if the
patient clinical condition does not contain all the necessary anatomical landmarks.
• Scout is not valid for the prescribed CID. This could occur if patient position is changed, or if
the required scout plane is not acquired prior to the SmartPlan series.
• Scan range is reduced by 50% or more as a result of the user adjusted SmartPlan offsets. The
system displays the following message: SmartPlan Offsets applied, intended anatomy may
not be included. Adjust scan range manually. Notify your protocol manager to adjust Offsets in
SmartPlan Management
• Scan range is 0 or scan direction changes as a result of the applied user adjusted SmartPlan
offsets. The system displays the following message: SmartPlan Offsets not applied, intended
anatomy was not found. Adjust scan range manually. Notify your protocol manager to adjust
Offsets in SmartPlan Management.
4. Review scan primary recon and secondary recon settings, make any necessary adjustments.
5. Click Confirm.
NOTE
Cardiac Medium is limited to 36 cm DFOV.
NOTE
Image reconstruction includes native reconstruction to reduce artifacts from beam
hardening.
11.4.5.5.3 Set the Display Field of View (DFOV) for the primary recon
Follow these steps to enter a DFOV that covers the anatomy of interest. This allows you to target a
particular piece of anatomy for display and determines how much of the SFOV is reconstructed into an
image. Within the DFOV, an image center must be set with R/L Center and A/P Center.
1. From the Scan Settings window, click the Anatomy Selection collection.
2. Click DFOV.
3. Enter the value of the patient's measurements.
• Measure the patient at the widest point and add 2 cm. This will show all the anatomy and the
soft tissue around it.
• If an R/L value or A/P value is more than half of the DFOV, then the R/L, A/P image annotation
does not display on the images. For example, if the DFOV is 10 cm and the R value is 56 mm,
the image annotation displays R. Use an R/L value or A/P value that is less than half of the
DFOV in mm to avoid this.
• The minimum DFOV is 5.0 cm.
• The maximum DFOV depends on the selected SFOV.
NOTE
Alternatively, set the DFOV graphically. On the Show Localizer image, click and drag the
diamond handles to increase or decrease the DFOV. The system automatically updates
the value in the feature area.
11.4.5.5.4 Set the R/L Center coordinates for the primary recon
Use this procedure to set the R/L Center parameter, which allows you to define the DFOV center of the
image in the Right/Left directions relative to isocenter of the SFOV. This is useful for minor adjustments
to imperfections in centering the patient on the table or if an offset structure, such as the spine or
kidney, is what you want centered. If large adjustments are needed, consider repositioning the patient
on the table.
1. From the Scan Settings screen, click the Anatomy Selection collection.
2. Click R/L Center.
3. To find the coordinates, place the mouse over the Show Localizer Anterior/Posterior (AP) scout
image and look at the Right (R) and Left (L) readout at the bottom of the image.
4. Type an R or L prefix and the R/L center coordinates, in millimeters.
• The range of values can be from 0 to one-half the SFOV (example: Head SFOV is 32 cm so the
maximum offset R/L is 16 cm or 160 mm). Typically, you would not want the offset to exceed
one-half the DFOV or the resulting image does not show a right or left marker; it does show
markers as R-R or L-L.
• Entering a value other than zero off centers the image in the right and left axes of the patient.
• Plus + can be used for R values and Minus - for L values for faster data entry using the ten key
pad.
NOTE
Alternatively, the R/L Center may be set graphically using the X annotation on the A/P
scout image reference lines. Press and hold Shift, and then click and drag the X to center
over the area of interest.
11.4.5.5.5 Set the A/P Center coordinates for the primary recon
Use this procedure to set the A/P Center parameter, which allows you to define the DFOV center of the
image in the Anterior/Posterior directions relative to the SFOV. This is useful for minor adjustments to
imperfections in centering the patient on the table or if an offset structure, such as the spine or kidney,
is what you want centered. If large adjustments are needed, consider repositioning the patient on the
table.
1. From the Scan Settings screen, click the Anatomy Selection collection.
2. Click A/P Center.
3. To find the coordinates, place the mouse over the Show Localizer lateral scout image and look at
the Anterior (A) or Posterior (P) readout at the bottom of the image.
4. Type an A or P prefix and the A/P Center coordinates, in millimeters.
• The maximum offset for A/P Center is one half the SFOV from isocenter selected (example:
Head SFOV is 32 cm so the maximum offset A/P is 16 cm or 160 mm).
• Entering a value other than zero off centers the image in the anterior and posterior axes of
the patient.
• Plus + can be used for Anterior (A) values and Minus - for Posterior (P) values for faster data
entry using the ten key pad.
NOTE
Alternatively, the A/P Center may be set graphically using the X annotation on the lateral
scout image reference lines. Press and hold Shift, and then click and drag the X to center
over the area of interest.
NOTE
You must select a Category before selecting a Clinical Identifier.
4. Click the Clinical Identifier drop-down and select the appropriate clinical identifier:
Routine Head BRAIN GE GSI recon processing optimized for non contrast
Head head scans
NC • DLIR optimized reconstruction for thick
slice, 2.5 or 5mm soft tissue imaging with
manual kV mode, Recon type Standard
and Enhanced Contrast is: {Off, EB1, EB2,
or EB3 non contrast (C-) or delay contrast
(+C). Not applied when kV is 100. When
the soft tissue reconstruction is enabled
the images will be annotated with an
additional /ST after the DL setting, e.g.
DL-H/ST
• Head specific Image Enhancement Fil-
ters are enabled
Orbits ORBIT
CTA HEAD- GE
NECK Head
Neck
CTA
COW CIRCLEOF- GE
WILLIS Head
CTA
Multiphase HEAD-
CTA NECK
Sinus PARANA-
SALSINUS
IAC_Tempo- IAC
ral Bone
CTA CIRCLEOF-
WILLIS
Multiphase HEAD-
CTA NECK
CCTA CORONAR-
YARTERY
LV Function PULMO-
NARYA
CACS HEART
TAVI THORACI-
CAORTA
PE PULMO-
NARYA
Myocardial HEART
Viability
Morphology HEART
Aorta THORACI- GE
CAORTA Chest
CTA
PE PULMO- GE
NARYA Chest
CTA
Respiratory CHEST
Gated
CTA THORACI- GE
CAORTA Chest
CTA
NOTE
Primary recon does not have to be enabled to prescribe a secondary recon.
1. From the Scan Settings screen, click on the Anatomy Selection collection.
2. Click Clinical Identifier.
NOTE
Use of appropriate CID is critical to image quality for the following specific recon
tasks:
• Gout analysis images must use CID Extremity.Gout
• Non-contrast head images must use CID Neuro.RoutineHead
3. Click the Category drop-down and select: Neuro, Stroke, Cardiac, Trauma, Thoracic, Abdominal,
Pelvis or Extremity.
NOTE
You must select a Category before selecting a Clinical Identifier.
4. Click the Clinical Identifier drop-down and select the appropriate clinical identifier. See table
above.
If Lock Group Delay was set to On, the system will display an alert if the group delay changes
by 5 seconds or more from the delay prescribed in the protocol. If the Increased Group Delay
message is displayed, either change the settings to reduce the group delay, or click Disable
Lock Group Delay.
NOTE
Lights/Timer is not valid with Cardiac, not valid with Pre Only, and Post Only.
5. To start the scan, click Confirm Settings.
NOTE
The minimum Prep Delay may be affected by parameter choices: SFOV, Rotation Time,
Pitch, and Start Location prescribed relative to the prior group. The system updates the
group delay in the Scan Settings window to meet system requirements. Please check
the system message bar on the right monitor before scanning.
1. From the Scan Settings window, click Timing.
2. From the Timing collection, click Prep/Group Delay.
3. Type a scan delay time (in seconds).
NOTE
The system starts to acquire the scan after you press Start Scan and the Prep Delay time
counts down to zero.
Start the injection at the same time as starting the scan to ensure accuracy when the
intravenous (IV) bolus arrives in the appropriate anatomy.
The Prep Delay will be set to zero when resuming a scan after Stop Scan or Pause Scan
is selected during the Prep Delay countdown.
NOTE
ISD is available for Axial scans only.
1. From the Scan Settings window, click Timing.
2. From the Timing collection, click Inter Scan Delay.
3. Type a scan delay time (in seconds) between each Axial scan.
• The value is dependant on the detector coverage selected when One or More is selected.
• When the scan interval is zero, the value is set by the system based on the selected Rotation
Time and Minimum Time Between Passes.
• The valid range is 1 to 300 seconds.
• Typically, the ISD is set at 1 to 1.7 seconds so the exam is done as quickly as possible.
NOTE
The edge enhancement provided by the Lung setting may not be appropriate in
some clinical cases and image characteristics may vary with larger DFOVs. Please take
individual viewing preferences into account when you choose the Lung setting.
11.6.1.3 Hi Res
Hi Res reconstruction algorithms provide the capability to select reconstruction algorithms that
enhance the inherent resolution in Hi Res mode acquisitions or use the additional views to reduce
aliasing artifacts, improve off‐center DFOV imaging, and decrease streaking from dense structures. The
algorithms that have a HD prefix added to the algorithm name provide increased resolution for DFOV
of 25 cm or less. The normal algorithms can be used, which will not provide improved resolution but
may be useful when large DFOV is used followed by a targeted reconstruction smaller DFOV, reducing
aliasing and view spacing artifact.
GSI annotation information will not be displayed in AW applications on the operator console or on AW
4.3 or below.
11.6.1.7 Full and Plus Recon Modes for Helical scan types
The system provides the ability to manage dose, slice profile, and helical artifact through the Full and
Plus recon modes.
• Full mode provides a thinner slice profile but requires 10–15% more mA than Plus mode with
equal image noise.
• Plus mode has up to a 20% wider slice profile than Full, but requires 15–20% less mA with equal
noise. At the same mA, Plus mode provides reduced image noise.
• Reduction of helical artifacts can be seen with Plus mode.
• Plus mode uses additional views of data to reconstruct an image.
• When acquiring images in Plus mode, exposure time increases slightly to assure that enough
views are collected to reconstruct all image locations prescribed.
An "E" displays on the image next to the annotation for to indicate IQ Enhance is enabled for the
acquisition.
NOTE
IQ Enhance is not compatible with Axial, Cine or Cardiac scan types.
11.6.1.10 Enhanced Contrast for Axial and Helical scan types with Head
SFOV
Enhanced Contrast is a special reconstruction option to boost the differentiation between the gray
and white matter regions in the brain. The Enhanced Contrast reconstruction option enables improved
visual contrast between gray and white matter regions without the noise amplification present when
using a narrow window width display setting.
Six levels of Enhanced Contrast are selectable: EC1, EC2, EC3, EB1, EB2 and EB3 where the higher
number corresponds to additional differentiation between gray and white matter. EC selections focus
on CT number separation of gray and white matter for better differentiation, EB selections focus on
improving the gray and white edge boundary resolution for better differentiation. As the reconstructed
CT number is modified by the Enhanced Contrast option, it is recommended that it not be used for
quantitative soft tissue imaging.
If you select Axial or Helical scan type with Head, Small Head or Ped Head SFOV, 100, 120 or 140
kV, HiRes Off, Soft, Soft #, Stnd or Stnd # algorithm and Number of Passes: 1, Enhanced Contrast is
available in the Primary Recon and Secondary Recon parameter collections.
Figure 198 Enhanced Contrast – Off (Left); Enhanced Contrast – EC2 (Middle); Enhanced Contrast
– EB3 (Right)
Reconstruction Type (for example, Kernel) Bone, Bone Plus, Edge, Ultra, HD Bone, HD Bone Plus,
HD Ultra, HD Edge
NOTE
Fine Z is not available when Clinical Category is Stroke and Clinical Identifier is
Perfusion.
In this figure, the middle and right images have an edge Image Enhancement Filter applied. The right
image does not have the dark undershoot at the boundary present on the middle image. The strength
of the head-specific filters (EH1, EH2, EH3) is also lower than the traditional filters (E1, E2, E3) as the
highest strength of the traditional filters is not applicable to soft tissue imaging.
The head-optimized Image Enhance Filters are used when the scan field of view is Small Head,
Ped Head or Head AND the Clinical Identifier is the one of the following: {Neuro. Routine Head,
Neuro.Routine Head w Contrast, Trauma.Routine Head, or Trauma.Routine Head w Contrast,
Stroke.Routine Head, or Stroke.Routine Head w Contrast} and the Recon Type is: {Stnd, Stnd#,
Soft, or Soft#}. The images will be annotated with an "H" in the filter description to indicate a
head-specific filter, e.g. E3 vs. EH3.
NOTE
DLIR for GSI has not been tested for compatibility with Low Dose CT Lung Cancer
Screening.
When DLIR is applied to a Helical scan, the following settings must be applied
• Interval must be equal to the slice thickness or a half of the slice thickness for 1.25 mm to 5 mm
slice thickness.
• Interval must be equal to the slice thickness for 0.625 mm slice thickness.
If the GSI for DLIR option is installed, Head SFOV DLIR will be not compatible with GSI Reconstructions.
For GSI reconstruction tasks, DLIR can be prescribed only if the Recon Type is Standard and if the
interval is equal to or one half the slice thickness. DLIR for GSI may not be prescribed under the
following conditions:
• SFOV is Head and Cardiac
• GSI Image Type is High kVP
• Scan Range is less than 40 mm.
DLIR can be set in a reconstruction task at scan time or within a GSI Profile.
This reconstruction is used when the scan field of view is Small Head, Ped Head or Head, AND the
Clinical Identifier is one of the following: {Neuro.Routine Head, Neuro.Routine Head w Contrast,
Trauma.Routine Head, or Trauma.Routine Head w Contrast, Stroke.Routine Head, or Stroke.Routine
Head w Contrast} AND Recon Type is Stnd and Enhanced Contrast is: {Off, EB1, EB2, or EB3}. Image
annotation will display /SH after the DLIR setting.
This soft tissue reconstruction is designed for non-contrast and delay contrast scanning (C-) and (C+),
wherein the images are typically viewed in thicker slices (e.g. 2.5 mm or 5 mm).
NOTE
ASIR-V will be set to OFF automatically and cannot be re-enabled unless DLIR is set
to OFF.
3. Set all parameters for the reconstruction task.
NOTE
Helical recon interval setting must be equal to the slice thickness or one half the
slice thickness. DLIR will be set to OFF if any other interval is set.
Recon Type is Stnd or HD Stnd depending on the scan type. If any other recon type
is set, the system will notify the user that the recon type is incompatible with DLIR.
4. Select Run.
NOTE
DLIR annotation is not not displayed in Reformat, Volume Viewer or any of the other
Volume Viewer post processing applications. This occurs when SmartMAR is On in
conjunction with DLIR. View images in the File Manager or Review Session to view
the DLIR annotation.
Figure 204 Object being scanned extends outside of the SFOV over more than 90 degrees
NOTICE
When MaxFOV 2 option is installed, the user is able to prescribe a DFOV between 50.1 cm and 80 cm.
MaxFOV 2 is available only in secondary recon prescriptions when SFOV is Large Body, and Collimation
less than or equal to 40 mm.
MaxFOV 2 is not compatible with GSI, SmartPrep, SmartStep, Cardiac and Hi-Res scan types.
MaxFOV 2 is not compatible with the following reconstruction settings:
• DLIR
• IQ Enhance
• SmartMAR
• Ultra
• Edge
NOTE
Flip / Rotate options cannot be selected for images being acquired in the decubitus
patient positions.
NOTE
Flip/Rotate options are only available after service checks that the viewing stations will
display the data correctly.
Enhanced Contrast is available in Primary or Secondary reconstructions. In the GSI Profile Editor,
Enhanced Contrast is selectable for Head profiles that satisfy the conditions above.
Figure 206 GSI Enhanced Contrast – Off (Left); Enhanced Contrast – EB2 ( Middle); Enhanced
Contrast – EB3 (Right)
Element Description
Enhanced Contrast Enables Enhanced Contrast recon option. See Enhanced Contrast for Axial and Helical
scan types with Head SFOV for detailed information.
Fine Z Only available for Axial Hi Res Head SFOV with slice thickness of 0.625Z. See Fine Z
selections
Image Enhance E1, E2, E3 or S1, S2, S3, lu See Image Enhance Filters
Filter
SnapShot Freeze Only available for Cardiac. See the Cardiac chapter for detailed information.
Phase Only available for Cardiac. See the Cardiac chapter for detailed information.
Element Description
Enhanced Contrast Enables Enhanced Contrast recon option. See Enhanced Contrast for Axial and Helical
scan types with Head SFOV for detailed information.
IQ Enhance See IQ Enhance for Helical scan types for detailed information.
Image Enhance E1, E2, E3 or S1, S2, S3, lu See Image Enhance Filters
Filter
NOTE
Auto Voice Language category is not copied forward across each series when changed in
a single series. Update the language category in each series prior to confirm and scan of
the first series. Auto Voice language category can only be changed if no scans have been
taken in the series.
NOTE
Copy Forward is set at the destination or recipient series.
For example, if Copy Forward was turned “On” in Series 2 of a protocol, and during
scan Patient Orientation, Patient Position and Anatomical Reference were changed from
Head First, Supine, SN to Feet First, Prone, OM for Series 1, these three settings will be
automatically copied for scanning Series 2.
Similar to Copy Patient Orientation / Position, Copy Forward works within the same
patient exam.
The Copy Series feature can be used to duplicate (reuse) the following parameters from the primary
reconstruction in the previous scanned series.
• Start Location
• End Location
• Time Between Passes (Cine scan type only)
• Interval (Helical scan type only)
• DFOV
• R/L Center
• A/P Center
The Copy Forward feature can also be used to duplicate (reuse) the following parameters within series
from primary reconstruction to secondary reconstructions:
• Start Location
• End Location
• Time Between Images (Cine scan type only)
• Interval (Helical scan type only)
• DFOV
• R/L Center
• A/P Center
To activate Copy Forward, type d or D (duplicate) in the Parameter text field in the receiving
reconstruction or subsequent scan series.
NOTE
There is a potential for artifacts, such as basket weave or aliasing, to be visible when
higher noise recon types are viewed in a standard window width and window level.
It is important to utilize the appropriate window width and window level for the
selected recon type to avoid these potential artifacts. If reconstruction is limited
to a single series, it is recommended to use Standard recon type and apply Image
Enhance Filters or CT visualization post filters in Volume Viewer ( E1, E2, E3 or Lung)
and view with Bone window width/ window level.
•
Figure 209 Example of Basketweave Artifact
Click Soft for tissues with similar densities, but not useful for non-enhanced scans.
• Click Soft # for head anatomy with similar densities. Results in finer texture and similar noise
compared to Soft.
NOTE
Soft # is only available when Head, Small Head or Ped Head is selected, scan
type is Axial or Helical and Hi Res mode is Off.
• Click Stnd for routine exams, e.g., chest, abdomens, and pelvis scans.
• Click Stnd # for head anatomy with similar densities. Results in finer texture and similar noise
compared to Stnd.
NOTE
Stnd # is only available when Head, Small Head or Ped Head is selected, scan
type is Axial or Helical and Hi Res mode is Off.
• Click Detail for post myelograms, where hybrid tissue detail and bone edges are important.
• Click Lung for interstitial lung pathology.
• Click Bone for high resolution exams and sharp bone detail.
• Click Bone Plus for sub mm detailed head work. It can be used for any study that normally
used the bone algorithm, but is very useful in cases where the Edge algorithm was used.
This is because the Bone Plus algorithm has no reconstruction penalty and is very close in
standard deviation to Edge.
• Click Edge for small bone work in the head, as well as high resolution scans.
• Click Chest for mediastinum and lung detail studies. It provides soft tissue resolution and
contrast when viewing the images in a soft tissue/mediastinal W/L and high resolution of the
lung tissue when viewing the images in a lung W/L.
• Click Ultra for improved detail in the inner ear.
NOTE
Cardiac scan mode choices are: Soft, Stnd, Detail, Lung and Bone.
4. If Hi Res mode is enabled, select a higher resolution algorithm that has similar characteristics to
the non-Hi Res algorithms.
• HD Stnd
• HD Lung
• HD Detail
• HD Bone
• HD Bone Plus
• HD Edge
• HD Ultra
5. If Cardiac Hi Res mode is enabled, select a higher resolution cardiac algorithm that has the same
characteristics as the non-Hi Res cardiac algorithms.
• HD Soft
• HD Stnd
• HD Stnd Plus
• HD Detail
• HD Detail Plus
• HD Lung
• HD Edge
NOTE
Plus Recon mode is not annotated on the Series Text Page.
Full mode is not allowed with 0.625 mm slice thickness at either 0.508:1 pitch, 0.969:1, 0.984:1 pitch,
1.375:1 pitch or 1.531:1 pitch.
11.6.3.5.2 IQ Enhance
To adjust IQ Enhance, click IQ Enhance to select either On or Off.
IQ Enhance is used to minimize artifacts seen in helical thin slice images.
IQ Enhance is allowed with both 0.625 mm and 1.25 mm slice thickness, and the image interval can
either be 50% or 100% of the slice thickness.
IQ Enhance annotation is added to the left side of the image.
11.6.3.7 Enhanced Contrast for Axial and Helical Head SFOV types
Follow these steps to enable Enhanced Contrast.
1. From the Primary Recon or Secondary Recon parameter collection, click Enhanced Contrast.
2. Click on the Enhanced Contrast menu to select the desired value: EC1, EC2, EC3. EB1, EB2 or EB3.
• Enhanced Contrast is used to boost the differentiation between the gray and white matter regions
in the brain.
• Enhanced Contrast is allowed with Axial and Helical scan types, Head, Small Head and Ped Head
protocols, 100, 120 and 140 kV, Hi Res Off, Number of Passes: 1, and Soft, Soft #, Stnd or Stnd #
kernels.
• Enhanced Contrast annotation is added to the left side of the image.
11.6.3.8 Adjust Window Width and Window Level for all scan types
Follow these steps to adjust Window Width and Window Level.
1. Open the Primary Recon collection.
2. Click Window Width and type the desired value.
3. Click Window Level and type the desired value.
The Image Flip Orientation option is turned off when software is delivered. A service representative
can enable it once you are sure that remote viewing stations display the flipped and rotated images
correctly.
Images are annotated with:
• FI: LR
• FI: TB
• FI: Rotate 180
All Image Flip Orientation annotations display on the left side of the image when prescribed in recon.
NOTE
Flip and Rotate is valid only for Supine and Prone patient position. Filp and Rotate
selection is not shown and is not valid when the scan type is Cardiac.
NOTE
Image Flip Orientation and non-Image Flip Orientation images can not be mixed in the
same series.
NOTE
If Image Flip Orientation in Recon and Continuous Cursor are enabled on a system, the
RAS coordinates displayed on the left side of the image have the Image Flip Orientation
annotation intermixed with the RAS information. If Image Flip Orientation was not
applied to the image, there is a blank space in between the RAS information.
NOTE
lu filter is not valid when SFOV is Head.
Element Description
Enhanced Contrast Enables Enhanced Contrast recon option. See Enhanced Contrast for Axial and Helical
scan types with Head SFOV for detailed information.
Image Enhance E1, E2, E3 or S1, S2, S3, lu See Image Enhance Filters
Filter
Element Description
Enhanced Contrast Enables Enhanced Contrast recon option. See Enhanced Contrast for Axial and Helical
scan types with Head SFOV on page 432 for detailed information.
IQ Enhance See IQ Enhance for Helical scan types on page 431 for detailed information.
Image Enhance E1, E2, E3 or S1, S2, S3, lu See Image Enhance Filters
Filter
The following parameters may be automatically copied from the primary reconstruction with the Copy
Forward feature.
• Start Location
• End Location
• Time Between Images (Cine scan type only)
• Interval (Helical scan type only)
• DFOV
• R/L Center
• A/P Center
NOTE
These parameters will have a green box around them when Copy Forward is active.
Graphic Rx for secondary reconstructions will indicate if Copy Forward is “On” with a salmon colored
handle on the graphic object. If the user adjusts the handle, Copy Forward is disabled, and the handle
goes back to the original group color; the green box is also removed from the text fields. Alternatively,
if the user types in a text field where Copy Forward is enabled, is no longer outlined in green and the
corresponding handle on the graphic object returns to the original group color.
Rather than relying on creating additional reconstructions post scan for additional data sets, you are
able to create these sets prospectively. This frees the operator from sitting at the console, directly
contributes to increased productivity, and reduces the opportunity for error.
Secondary reconstructions are assigned series numbers based on the series they are prescribed in,
e.g., in the scenario where Series 2 has three additional secondary reconstructions, these are listed in
the task list display indented from the original series. These reconstructions become Series 301, 302,
and 303 in the exam.
To add a secondary reconstruction, from the image monitor, in the Reconstruction and Image
Processing area, select Duplicate Recon or Add Recon for a particular series. You can also select
which viewport a reconstruction will display in. Refer to the View Images chapter for more details.
Follow the primary reconstruction workflow to set the reconstruction parameters.
A reformat step can also be added on secondary reconstructions, as well as output and transfer
options. Refer to the Display Applications chapter for more details.
NOTE
To display Graphic Rx when Recon All contains multiple groups, double click on the
Recon task.
• Cine:
• 40 mm detector coverage — 0.625 mm, 1.25 mm, 2.5 mm, 5.0 mm
• 80 mm detector coverage — 0.625 mm, 1.25 mm, 2.5 mm, 5.0 mm
• 100 mm detector coverage — 0.625 mm, 0.625 z mm, 1.25 mm, 1.25 z mm, 2.5 mm, 2.5 z mm,
5.0 mm, 5.0 z mm
• 120 mm detector coverage — 0.625 mm, 1.25 mm, 2.5 mm, 5.0 mm
• 140 mm detector coverage — 0.625 mm, 1.25 mm, 2.5 mm, 5.0 mm
• 160 mm detector coverage — 0.625 mm, 1.25 mm, 2.5 mm, 5.0 mm
• Helical:
• 40 mm detector coverage — 0.625 mm, 1.25 mm, 2.5 mm, 3.75 mm, 5.0 mm
• 80 mm detector coverage — 0.625 mm, 1.25 mm, 2.5 mm, 3.75 mm, 5.0 mm
• Cardiac Axial:
• 40 mm detector coverage — 0.625 mm, 1.25 mm, 2.5 mm
• 80 mm detector coverage — 0.625 mm, 1.25 mm, 2.5 mm
• 100 mm detector coverage — 0.625 mm, 1.25 mm, 2.5 mm
• 120 mm detector coverage — 0.625 mm, 1.25 mm, 2.5 mm
Considerations:
• 1024 reconstruction matrix size is available only in Secondary Recon, not in Primary Recon.
• The max image number per series for 1024 matrix is 2000.
• Use appropriate clinical parameters to provide the image improvement, such as improved local
detail resolution in Lung exams acquired with large DFOV; IAC on Axial plane; better resolution for
cardiac stent.
• Image size (megabytes) for 1024 matrix is 4 times larger compared to a 512 matrix.
• Recon times and transfer times are longer.
• Due to an increase in image noise for 1024 recons (especially at wider DFOVs), narrow windows
(e.g., Soft Tissue) might not provide acceptable IQ.
• Potential aliasing artifact as resolution is increased for Edge/Edge Plus reconstruction algorithms.
• High resolution artifacts such as aliasing (For example using Edge/Edge Plus reconstruction
algorithms) can be increased in 1024 matrix. If an area of concern is seen, perform a
reconstruction using 512 matrix.
The graphic object for the scout or axial image will be displayed in the group color when System
Preferences > Viewports > Show Localizer Group Color is enabled.
Function Definition/Action
Reset All Reset all images in the series to normal display settings
Axial images from the primary recon must be complete and available on the system in order to display
in the axial Graphic Rx viewport.
If all the images from the primary recon are not available, the Axial Graphic Rx viewport will remain
blank.
1. From the Reconstruction and Image Processing task list, select the secondary reconstruction task
to prescribe. For multigroup image series, the first group will be active, and all 4 image viewports
will be displayed as in Figure 1. Note: The Axial Graphic Rx Viewport will not be displayed when
multiple group tabs are selected in the recon settings screen.
2. In the Axial Graphic Rx Viewport, click and drag on any of the blue squares on the circle to change
the size of the circle to set the DFOV for the reconstruction. The circle can be adjusted to any value
between the minimum DFOV and maximum DFOV.
3. Click and drag on the + at the center of the circle to define the RL and AP centers for your
reconstruction.
NOTE
To adjust DFOV and AP/RL centering simultaneously, Shift +Left Click and drag on
any of the blue boxes.
4. Adjust WW/ WL of the image in the viewport and click to set the WW/ WL for the
reconstruction.
5. Scroll through the images to find where you would like the reconstruction to begin. Click on
the Axial Graphic Rx tool bar to set this as the Start location.
6. Scroll through the images to find where you would like the reconstruction to end. Click to set
as the End Location.
7. To apply DFOV, R/L, AP and WW/WL settings to all groups, click the Propagate icon , then
adjust the size of the circle, the centering of the circle and adjust the WW/WL values. To set Start
and End Locations for all groups, use the Scout Graphic Rx Viewports or select multiple groups
and utilize multi-row edit.
8. Make any other adjustments to recon settings.
9. Click Run to generate images.
• German (Female)
• German (Male)
• Italian
• Japanese
• Korean
• Mongolian
• Polish
• Portuguese (European)
• Portuguese (Brazil)
• Punjabi
• Russian
• Spanish (European)
• Spanish (Latin America)
• Swedish
• Vietnamese
NOTE
After any scan is taken in the current series, the language cannot be changed.
The language can be changed if a new series is started.
4. Set the playback option for the message set. This can be set for each scan group. There are three
selections available: Pre and Post, Pre Only, or Post Only.
NOTE
Lights/Timer is not valid with Cardiac, not valid with Pre Only, and Post Only.
NOTE
When an abort or pause occurs the post message instruction will always play. On
Resume, only the message instruction will play, if Post was selected, there will be
only the Pre message played. Manually breathe the patient in these cases.
5. Turn on Breathing Lights.
NOTE
Breathing Lights does not require that the voice is selected.
6. Turn on Timer, if desired.
7. Click OK.
When multiple groups are included in a series, the system enables group edit for the following subset
of parameters:
Timing • Voice
• Lights
• Timer
Primary Recon • WW
• WL
kV and mA Con- • kV
trol • mA
• NI
Timing • ISD
• Voice
• Lights
• Timer
Multi-group is enabled when the parameter label and all groups are highlighted dark gray.
Series level parameters cannot be enabled for multi-group edit. kV mode or mA mode in kV mA
Control cannot be enabled for multi-group edit.
To edit a parameter across groups, follow these steps:
1. If not enabled, click on the parameter label you want to edit across groups.
2. Click on the parameter field and enter the desired value.
Select the option that is most reasonable for the patient exam.
1. From the Optimize Message bar, select the parameter that is best for your prescription.
• Change one parameter (In the example, mA) to continue the scan.
• Up Front Delay is the time before you can proceed with scanning.
• This parameter can be changed by the amount shown in the Delay button selection.
• The Start Scan button is not active until the Up Front Delay time expires.
• The following message will be posted when no Up Front Delay is possible:
"Up Front Delay not possible, recommended delay is greater than 10 minutes."
• The mA parameter can be changed to what displays in the Change mA button selection.
• If you choose to reduce mA, you may be reducing image quality.
• Make sure that you always use enough mA to get the best image quality.
• If multiple groups are prescribed, the Optimize Message bar updates for each group,
allowing you to make choices for each group.
• Once you have made choices that satisfy the system without compromising image quality, a
message displays that tube cooling is no longer needed.
2. Select a GSI Preset family and mA from the list to continue the scan. Values that are indicated with
a yellow border and triangle may require an additional Up Front Delay, the time before you can
proceed with scanning. In some cases there may not be an Up Front Delay possible. The Start
Scan button is not active until the Up Front Delay time expires.
• If you choose to reduce mA, you may be reducing image quality.
• Make sure you always use enough mA to get the best image quality.
2. Select a GSI Preset family and mA from the list to continue the scan. Values that are indicated in
yellow may require an additional Up Front Delay, the time before you can proceed with scanning.
In some cases there may not be an Up Front Delay possible. The Start Scan button is not active
until the Up Front Delay time expires.
• If you choose to reduce mA, you may be reducing image quality.
• Make sure you always use enough mA to get the best image quality.
11.8.4.2 SmartmA
SmartmA modulates X-ray tube mA to account for specific patient anatomy based on data gathered
from the scout image. You input the desired image quality (Noise Index) and the system adjusts the mA
to achieve this within the bounds of the inputted minimum and maximum mA.
11.8.4.5 SmartHelical
SmartHelical is integrated into all GE CT systems. It decreases image noise as measured by pixel
standard deviation.
Auto Prescription is a profile-driven feature that selects scan parameters defined for a patient by
patient size and works with SmartmA to optimize dose and image quality. It uses the scout to evaluate
patient attenuation to calculate patient size and a kV/mA table for selecting kV, mA, SFOV, and ASiR-V
level for the protocol.
11.8.5.1 Prerequisites
Before DICOM Structured Dose Report is turned on, confirm that your PACS or other receiving station
supports structured reports.
Contact your service representative to enable DICOM SR Dose Report.
NOTE
If you edit patient information for an exam, the Dose SR report will be excluded from
the edited patient information due to the format of the files. Dose Report Series 999
will be updated using the edited information.
Number Description
2 Dose Report
12 Scan Applications
12.1 Overview
NOTICE
The following applications can be applied in Scan. If an application is not available, it may not be
included with your system options.
12.2 ASiR-V
12.2.1 ASiRTM-V Theory
ASiR-V is a reconstruction technique that enables reduction in image noise (standard deviation), streak
artifact at low signal condition and improvement in LCD (Low Contrast Detectability), while preserving
the structure details in the image.
ASiR-V can be used to reduce the image noise (standard deviation) and streak artifact in diagnostic
images and thereby reduce the dose required for routine imaging.
The scanner allows you to select levels of ASiR-V.
These “levels” provide a varying degree of noise removal from the images. As shown in 10% and 50%
MTF performance MTF remains constant as the ASiR-V level is increased.
If manual mA is selected, the software does not make mA adjustment automatically when ASiR-V is
enabled. These changes need to be calculated using the following tables to make changes to manual
mA values. Refer to mA adjustment factor and Return to a value for a non-ASiR protocol for guidance in
making parameter step adjustments during ASiR-V evaluation process.
Before using ASiR-V, the site physicist, in collaboration with the radiologist, should conduct image
quality evaluations with varying degrees of ASiR-V and different scan techniques, both at routine dose
and decreased dose. This should be done using your site’s preferred method and phantoms. Using this
information, an appropriate starting point for ASiR-V level and diagnostic scanning techniques can be
incorporated into your site’s protocols.
A general guideline for parameter step adjustment is:
Dose Reduction increments of about 20% ASiR-V level increments of 10%.
Whether ASiR-V is used for dose reduction or image quality improvement, parameter settings
should be made in steps and then reviewed for diagnostic image quality until the desired clinically
appropriate image quality is achieved.
ASiR-V Normal
10% 0.87
20% 0.74
30% 0.63
40% 0.52
50% 0.44
60% 0.35
70% 0.29
80% 0.23
90% 0.18
100% 0.14
For example, if 40% ASiR-V is selected, multiply the mA displayed in the mA control screen by 0.52, as
indicated in mA adjustment factor to obtain the new mA for protocol using ASiR-V, that needs to be
entered into the mA field on the mA control screen.
Multiply the Noise Index or manual mA values that were adjusted for an ASiR-V applied protocol by the
adjustment factors in Return to a value for a non-ASiR protocol.
Use the following factors to return any manual mA values adjusted for ASiR-V to non- ASiR-V value.
10% 1.15
20% 1.35
30% 1.59
40% 1.92
50% 2.27
60% 2.86
70% 3.45
80% 4.35
90% 5.56
100% 7.14
12.2.3 Reconstruction
Reconstruction of ASiR-V images involves defining the level of noise reduction desired for the
parameters used for various applications. Image reconstruction is a blending of the original images
and a percentage of an ASiR-V image. There are 10 blending levels available that are the amount of
noise reduction based on the maximum of the 100% image reconstructed with the original image data.
Reconstruction of ASiR-V images can be prescribed retrospectively in Retro Recon. A New Series should
be selected for each reconstruction of the data with ASiR-V applied so comparisons and identification
of series with ASiR-V can be made more easily.
ASiR-V is located on the Primary and secondary recon settings collection. ASiR-V Setup Selection is 0%
to 100%.
For example, AR60 denotes ASiR-V reconstruction mode with 60% of the 100% ASiR-V was blended
with the original image.
NOTE
ASiR-V annotation information is not displayed in Advantage Workstation (AW)
applications on the operator console.
12.3 SmartPrep
SmartPrep™ allows intermittent monitoring of IV contrast enhancement in one particular section of
anatomy that is in the area of interest. The contrast flow is monitored by low-dose scans until the
contrast enhancement reaches the preferred point and you initiate the diagnostic scan or the Dynamic
Transition level has been reached.
You can add SmartPrep to a group of any scan type.
A SmartPrep prescription is a series with a SmartPrep task enabled. Only one SmartPrep task may be
added to a series. If a scout series is included in the study prior to the SmartPrep series, the scout
may be used to determine the monitor location. The series will contain the SmartPrep task and the
prescription for the contrast enhanced scans to be taken when the contrast enhancement level is
reached. These scans are referred to as the diagnostic scans.
If SmartPrep is enabled for a series, the system cancels the AutoView display for any images in the
recon queue when the SmartPrep series is started. These images are selected from the browser for
review once they have been reconstructed. Only images from the series with SmartPrep and those
after the SmartPrep series are displayed in AutoView viewport.
There are three phases to a SmartPrep scan.
• Baseline phase — A single unenhanced image is acquired in the anatomy where the monitoring
occurs and the Region of Interest (ROI) is established.
• Monitor phase — Uses the ROI defined in the baseline phase to display a graph that helps
you determine the peak enhancement value. Up to 40 low-dose scans can be taken during the
injection of IV contrast.
• Scan phase — Acquires the data based on the scan setup parameters. You start the scan when the
contrast is at the peak on the curve or by when a preset Hounsfield value is reached.
You do not need to set SmartPrep parameters each time you use SmartPrep. The parameters can
be included in any protocol using SmartPrep. SmartPrep parameters allow for checking the contrast
enhancement both visually and graphically.
You can use Protocol Management to set up SmartPrep, including the ability to set the Dynamic
Transition enable/disable field.
Element Description
Scan Timeline The Scan Timeline for SmartPrep is shown above the viewport and in-
cludes a minimum of three sections and some number of delays:
• Delay - Represented as a circle with the time of the delay shown
underneath.
• SP Baseline - First rectangular section under the SP label and repre-
sents the baseline scan.
• SP Monitor - Second rectangular section and represents the monitor
scan. The timeline represents a single monitor scan. As scans are
taken, the timeline will fill and then clear for the next monitor scan.
You can edit the Baseline and Monitor collection values by clicking
Revisit Settings.
• Diagnostic Scan - Third rectangular section and represents the diag-
nostic scan for the SmartPrep series. When this is a multi-group
series, a rectangular section is shown for each group.
Scout Image The last scout image taken at the current landmark is shown with a cut line
that will allow the monitor location to be specified. Moving the cut line will
correspondingly change the Monitor Location in the Baseline & Monitor
Collection.
Settings Collections The collections for the SmartPrep parameters are located just below the
Scan Timeline.
SmartPrep has two collections:
• Contrast Collection - Allows contrast data to be specified for the
study. In this area you can: enable or disable the integrated injector,
set manual IV contrast (if Integrated Injector is disabled), and set oral
contrast values.
The contrast collection should have the same settings that were con-
firmed in the Baseline settings screen except that the injector will be
disabled if it was enabled and the retake monitor option was selected
after the injector started. You can choose to re-enable the injector.
The contrast agent and its concentration are associated with the
series. All groups in a series that has contrast will have the same val-
ues for agent and concentration if contrast is enabled for the series.
Contrast can be enabled for any series except a Scout.
The volume of the contrast injected is associated with a series. Once
contrast is injected in a series in an exam, all subsequent series are
considered contrast series.
Refer to Enter contrast descriptions for more information .
• Baseline and Monitor Collection - Allows setup of the parameters
controlling the Baseline and Monitor scans. See Set up a SmartPrep
series for more information.
The prescription for the baseline scan and for the monitor scans must
be the same, unless the monitor scan is below 0.35s, then the rota-
tion speed of the baseline scan will be 0.35s and mA is automatically
adjusted to maintain mAs of the monitoring scan.
Revisit Settings The Revisit Settings button, available from any of the SmartPrep steps, is
active when the scan is paused or aborted or when 40 scans have been
taken in the monitor phase.
You can edit the Baseline and Monitor collection values by clicking Revisit
Settings.
When you select Revisit Settings:
• The diagnostic scan task is unconfirmed.
• If no baseline scan had been taken, the SmartPrep task is un-confirmed.
• If a baseline scan had been taken, the SmartPrep task is marked as
skipped.
NOTE
Once the SmartPrep task is skipped you can no longer change
SmartPrep parameters. To enable SmartPrep again for the ser-
ies, duplicate the current scan series task, delete the unscan-
ned original diagnostic scan and confirm the duplicated scan.
• The diagnostic task is selected and the settings displayed.
Skip to Diagnostic Skip the monitor phase and go directly into the diagnostic scan. If you click
Skip to Diagnostic to transition to the diagnostic scan, the SmartPrep task
is set to skipped.
1 SP baseline
2 Delay
3 SP monitor
4 Diagnostic scan
Figure 226 Monitor Phase setup with 1 region of interest (ROI) deposited and Dynamic Transition
selected
Element Description
Baseline Image The baseline image displays allowing ROIs to be placed on the image.
ROI Placement Use these tools to put ROIs on the baseline image. You may place from 0
to 3 ROIs on the image. You can drag ROIs in the Anterior/Posterior and
Right/Left directions. You can also resize them.
Hide (Show) ROIs — Hide or show graphics (ROIs)
Box ROI, Elipse ROI — Deposit up to three ROIs total with any combina-
tion of box and ellipse.
Explicit Magnify — 0.5, 1.0, 1.5, 2.0, or enter a different value.
Erase — Erase or delete selected ROI.
Dynamic Transition ROI Select the ROI to be used as the dynamic transition ROI. This can be Off
or any one.
The system sets the first ROI you add as the transition ROI if Dynamic
Transition is enabled.
The system sets the first ROI as the transition ROI when you enable
Dynamic Transition, either using the Enable Dynamic Transition button
or when changing this value in the Baseline or Monitor Collection, and
there is at least one ROI present.
If the transition ROI is deleted and there is at least one remaining ROI, the
new ROI #1 will be set as the transition ROI. If the last ROI is deleted, the
transition selection is set to “None”.
Retake Baseline Selecting the Retake Baseline will return to the SmartPrep Setup win-
dow.
Begin Monitoring Select to begin the monitor scanning phase of the exam
Element Description
Baseline Image The baseline image with the ROIs that have been set will display on the
lower right side of the window.
Monitor Image The latest image from the monitor phase that corresponds to the image
used to calculate the HU level on the Enhancement Chart and Enhance-
ment Graph is shown in the upper right viewport. The ROIs that were set
are shown on this image.
Enhancement Graph The timeline on the Enhancement Graph is shown in seconds. Scroll to
show the latest points when the time expands beyond the number of
seconds that can fit in the viewer. The zero point is the time that the
Start Scan button was pressed. All points are relative to this time even if
there is a pause in scanning. The time for each data point is the midpoint
of the scan time for the scan from which the HU level is calculated. The
HU level is calculated for each ROI and is shown relative to the HU level
of the corresponding ROI that was on the baseline image. If an ROI is
selected as the transition ROI, that is shown in yellow.
The x-axis displays time. The y-axis displays relative HU level -relative
to the HU level in the ROI on the baseline scan. A separate line for each
ROI is shown on the graph with a point for each monitor scan. A white
horizontal line indicating the enhancement threshold that was set in the
SmartPrep setup is also shown. This provides a visual indication of when
the level on an ROI reaches or exceeds this level.
Enhancement Chart The data in the Enhancement chart is the same as the data shown on
the graph. The Elapsed time is the time since the Start Scan button
was pushed. If the scan is paused, no empty rows are added to this
table. When more rows are needed than what fits on the view, the data
is scrolled down so that the latest is visible. The latest data is always
shown on the bottom.
Dynamic Transition On the top row of the Enhancement Graph is a check box that allows
Dynamic Transition to be disabled. This displays only if an ROI has been
designated as the transition ROI.
Real Time Information At the bottom of the window is the Real Time Information, showing
Patient Handling, Scanning and Injector Status information. The Injector
Status information is available only when Integrated Injector is enabled.
Pause Will pause the current monitor scanning. When paused, the options to
Skip to Diagnostics, Resume, or Revisit Settings will be available.
Begin Scan Now Whether or not Dynamic Transition is enabled, the Begin Scan Now
button is available. Use this button to start the Diagnostic Scan.
Retake Monitor Selecting the Retake Monitor will return to the SmartPrep Setup window.
2. If the diagnostic scan tasks are not confirmed, confirm the settings for these groups. After the last
is confirmed, the SmartPrep Setup window opens.
NOTE
Once Confirm for the diagnostic scan is selected, recon is moved to SmartPrep
mode and the system places any active reconstruction jobs in the pending state. Do
not select Confirm until all images that are needed have completed reconstruction.
The Acquire Baseline will be insensitive until recon is ready for SmartPrep scanning.
3. From the scout localizer on the display monitor, click and drag the slice line to define the Monitor
location. Alternatively, type in the S/I location in the Monitor Location text field in the Baseline
and Monitor Collection, for example, S110.
4. Expand the Baseline and Monitor Collection and enter the following values:
•
• Baseline mA is the mA used during the Baseline Phase. Baseline scan rotation speed and
mA are automatically adjusted if the monitoring scan is faster than 0.35s. The baseline mA is
adjusted to maintain mAs at 0.35s.
• kV is a non-editable field and is the same as the value set for the first diagnostic scan. If this
needs to be changed, go back to the Diagnostic scan task and change the settings there.
• Monitoring Delay (0 to 60 seconds in 1-second increments) sets the time before monitoring
scans begin. The time varies based on the anatomy being monitored.
• Monitoring Inter Scan Delay (1 to 60 seconds in 1-second increments) sets the time
between monitoring scans.
• Auto Voice is available if Auto Voice is prescribed in the diagnostic scan. If Auto Voice is
enabled for the series, the pre-message will be played as part of the diagnostic delay. The
diagnostic delay will be increased to accommodate the length of the Auto Voice message.
Auto voice is not editable from the Baseline setup screen. Make any changes to it in the
diagnostic settings.
5. Set the contrast settings. If the integrated injector option is enabled, see the Enhanced Xtream
Injector section in this chapter. If the integrated injector option is not enabled, see the Enter
Contrast Description section in the Scan chapter.
6. From the SmartPrep Setup window, click Acquire Baseline.
NOTE
Acquire Baseline will be insensitive until recon is ready for SmartPrep scanning.
7. Review and respond to the potential alert message that indicates that the projected dose
efficiency had fallen below 70%.
8. Proceed to Acquire a scan without Dynamic Transition or Acquire a scan with Dynamic Transition.
1. After the SmartPrep settings are confirmed, the Baseline scan is taken. When the Baseline scan is
complete, the Monitor Phase Setup window displays.
2. Review the values on the Scan Timeline for the monitor and scan phases.
3. If the baseline scan is not correct (for example if the patient moved or the scan location is not
right), click Retake Baseline and return to Set up a SmartPrep series.
NOTE
Changes to the Contrast collection, Monitor Delay, Monitor Inter Scan Delay,
Enhancement Threshold, Auto Minimum or Diagnostic Delay can be made without
having to click Revisit Settings on the Monitor Phase Setup window.
4. Press Move to Scan to advance the table to the monitoring location.
5. Press Start Scan.
6. Once the scan is complete, from the reconstructed image on the display monitor, click Ellipse ROI
or Box ROI to place a maximum of three ROIs over areas of interest. Monitor ROIs are colored
blue.
For example, if scanning a liver, place an ROI in liver parenchyma away from vessels, if evaluating
a vessel place the ROI over the vessel.
Use, as needed, the zoom, roam, display normal, hide/show graphics, erase, or explicit mag
(factor range: 0.5 to 2.0) from the SmartPrep display control panel.
7. Click Begin Monitoring to continue to the Monitor Phase.
NOTE
The following parameters can be changed after the baseline scan has been taken
and before the Monitor Phase is started:
• All parameters in the Contrast collection
• Monitor Delay, Monitor Inter Scan Delay, Enhancement Threshold, Auto
Minimum On/Off or Diagnostic Delay.
1. After the Monitor scan settings are confirmed, the Start Scan button begins to flash.
2. Simultaneously press Start Scan and start the IV contrast injection. A maximum of 40 monitoring
scans is available. Move To Scan is typically not required since the last scan was at the baseline
location.
NOTE
If using an integrated injector, the step to start the IV contrast injection is not
needed as the command will be sent by the scanner to the injector to start the
injection.
3. The system waits the time set in the Monitoring Delay area, then begins acquiring images at the
time set for the interscan delay (ISD). The total SmartPrep monitor scan time shows next to the
elapsed timer. The ISD countdown displays on the Real Time Information area at the bottom of
the Monitor Phase window.
4. Using the tools on the Monitor Phase window (refer to Monitor Phase window) to determine when
the contrast has reached a sufficient level to take the diagnostic scan. When this occurs, use the
Begin Scan Now button to transition to the Scan Phase (refer to Scan Phase - Diagnostic Scan .
Use, as needed, the zoom, roam, display normal, hide/show graphics, erase, or explicit mag
(factor range: 0.5 to 2.0) from the SmartPrep display control panel.
7. Select one of the ROIs to be used for the dynamic transition. The dynamic transition ROI is
colored orange-yellow.
8. Click Begin Monitoring to continue to the Monitor Phase.
NOTE
If using an integrated injector, the step to start the IV contrast injection is not
needed as the command will be sent by the scanner to the injector to start the
injection.
3. The system waits the time set in the Monitoring Delay area and then begins acquiring images at
the time set for the ISD. The total SmartPrep monitor scan time and Interscan Delay time between
monitor images is displayed on the Real Time Information screen on the Monitor Phase screen.
4. Use the tools on the Monitor Phase window (refer to Monitor Phase window) to determine when
to switch to the diagnostic scan phase. In all the viewports with ROI information, the Dynamic
Transition ROI will be visually distinct from the other ROIs.
5. The system will auto-transition when the HU Enhancement level has been reached on the ROI
selected as the transition ROI.
6. Using the tools on the Monitor Phase window, monitor the progress of the contrast.
a. If it looks like the dynamic transition will happen too early, uncheck the Dynamic Transition
checkbox to disable this function. Once this is done, you must click Begin Scan Now to
transition to the diagnostic scan.
b. If it looks like the dynamic transition will happen too late, click Begin Scan Now to transition
to the diagnostic scan. If you click Skip to Diagnostic to transition to the diagnostic scan, the
SmartPrep task is marked as skipped. Clicking Begin Scan Now sets the SmartPrep task to
completed.
• SmartPrep Scan Group must include a valid Diagnostic Regionthat supports Auto ROI
Diagnostic Region:
• Thoracic - Pulmonary
• Thoracic - Aorta
• Cardiac
• Abdomen
• Pelvis
NOTE
1. When the user modifies the baseline or monitor ROI position manually, the color of the
modified baseline or ROI changes from purple to blue.
2. If Dynamic Transition is turned on with a single ROI, the ROI sets as yellow even with
Auto ROI ON.
The accuracy of Baseline and ROI location predicted by Auto ROI might be affected by internal
and external interference. Make sure the predications by Auto ROI are reviewed or make necessary
adjustments prior to confirming the baseline location on scout images and Monitor ROI on the
baseline axial image.
When Auto ROI is enabled, an indicator message will be shown below the scout image with
baseline location and Baseline Axial image for the Monitor ROI set up. Baseline location is set by
Auto ROI. Verify Baseline location and adjust manually if needed. ROI position is set by Auto ROI. Verify
ROI position and adjust manually if needed.
1. From the Mode Menu, select Protocol Management, then select Auto ROI Management
2. For each Diagnostic Region enter the desired Offset for the Baseline location in mm.
The offset range is S80 to I80. No decimal is allowed.
The default offset value is S0.
3. For Abdomen set the Baseline Preference and for Cardiac set the Monitor ROI Preference.
The default baseline selection of Abdomen is Top of diaphragm.
The default Monitor ROI for Cardiac is Descending Aorta.
4. Click Save
protocol and creation of an Injector Report at End Exam of what was delivered by the injector. The
system and injector are operated independently after the start scan button is pressed on the system.
The supported injectors are CiA425 compliant and are compliant with the Class 4 injector as defined
in CiA425. Only the Medrad Stellant D and Nemoto DualShot Alpha / DualShot GC/GXV injectors
are supported. Connecting any other injector will disable the ability to use the integrated injector
capabilities.
NOTE
This option is only the communication protocol and bus interface needed to
communicate with a validated compatible OEM injector (availability may vary
regionally).
2. Open the Injector Settings window by clicking the icon next to the Injector Settings field. The
injector parameters can also be defined in Protocol Management.
NOTE
Pressure Limit A Red Alert is shown for a PSI val-
ue of 350 when injector is MedRad.
This is due to an error in the con-
version of PSI to kPA to PSI. Enter
325 PSI to clear the alert.
Contrast
Saline
(Not Displayed The system displays the remaining volume
when En- of contrast media and saline.
hanced
Xtream Injec-
tor is Off.)
Get Injector
Parameters Selecting Get Injector Parameters retrieves
(Not Displayed the values currently set on the injector and
when En- displays them in the Injector Settings popo-
hanced ver. Click Apply to choose these values or
Xtream Injec- click Cancel to return to the original values.
tor is Off.)
NOTE
There is no Xtream Injector button for Scout scans.
NOTE
Selecting Done Scanning before the Injection Complete message posted on the injector
may result in the Injector Report not being created.
To set up the Enhanced Xtream Injector after the patient and the injector are prepared, follow these
steps. Review the injector status messages.
1. Prepare the injector.
2. From the Contrast collection, select Enhanced Xtream Injector from the IV Contrast field drop-
down menu.
• The button turns on and synchronizes the start of the scan and injector.
• IV contrast is automatically turned on when Enhanced Xtream Injector is turned on.
3. Set injector settings on the Injector Settings window. To open this window, click the icon next to
the Injector Settings field. The injector parameters can also be defined in Protocol Management.
4. Click Apply on the Injector Settings window when you have adjusted the settings.
5. From the Scan Settings screen, set the scan parameters.
6. Click Confirm Settings.
• If there is an alert next to the Contrast Collection, check and resolve the injector parameters
on the system or the Injector. Confirm Settings is only active when both the system and the
injector are ready. Some errors may require a power cycle of the injector to resolve.
• Complete any required fields and note the injector status information on the Scan Progress
screen.
NOTE
IF YOU STOP THE SCAN OR THE SYSTEM ABORTS, THE SCAN THE INJECTOR DOES
NOT STOP. -OR- IF YOU STOP THE INJECTOR OR THE INJECTOR ABORTS, THE
SYSTEM DOES NOT STOP SCANNING.
If either of these scenarios occur, verify the remaining volume to be injected before
resuming the injection or scan. You may need to update parameters on the Scan
Settings screen.
NOTE
If you have the Enhanced Xtream Injector option, after you end the exam, a contrast
report is saved as Series 996.
12.6 SmartStep
SmartStep is a mode of scanning designed to be used by the clinician during interventional
procedures. SmartStep uses the Hand-Held Controller and foot switch.
The Radiologist or Physician usually inserts a needle or catheter into a patient and then needs to see
images showing the position of the needle or catheter.
Both single-slice (1i) and triple-slice (3i) imaging modes are selectable by the user at scan prescription.
1i mode is available at 5 mm and 10 mm aperture modes, and 3i imaging modes can be selected from
overlapped and non-overlapped 3i mode at 5 mm, 10 mm and 20 mm aperture modes.
10 10 5 2.5 + 5 + 2.5
20 N/A 10 5 + 10 + 5
Overlap mode
Non Overlap mode
Only the 0.5 second rotation scan time is available for SmartStep. The Soft, Stnd, Detail, Lung, Bone
and Bone Plus recon types are available for reconstructions.
Once the patient has been prepared for the interventional procedure, the image acquisition is setup in
the SmartStep mode.
During the SmartStep scan, the clinician can view the images and use the HHC to adjust window width
and level.
Figure 239 Access plate is located on the front side of the gantry
1 HHC outlet
Engaging
Push the plug straight into the receptacle.
Latched
Once firmly latched, connection cannot be bro-
ken by pulling on the cable or any other compo-
nent part other than the outer release sleeve.
Disengaging
Disengage the connector by a single, straight
pull on the outer release sleeve. This first disen-
gages the latches, then withdraws the plug from
the receptacle.
• Close the access plate cover once you have plugged in the foot switch and HHC.
NOTE
The cradle handle may have some small lateral movement. This is normal.
3. Position the ceiling-suspended, in-room display monitor so the clinician can view the images.
Care should be taken in positioning the in-room monitor so that it does not interfere with patient
loading and unloading.
Additional considerations when adjusting the in-room display monitor: Note that in references to
the system below, the system includes the monitor, spring arm and extension arm.
a. When the spring arm and the extension arm are positioned at 180° to each other (see figure
below), the attachment cannot be moved in the direction of the ceiling column. Repeated
exertion of a force of greater than 25 Neutons may cause damage to the attachment.
b. Move the system only by the handle provided. Always hold the system firmly until you have
finished moving it. Never allow the arms to swing outward in an uncontrolled manner.
c. Do not overload the system beyond the maximum weight marked on the system.
d. Do not stand or work beneath the system.
e. The manufacturer must be immediately informed of any damage caused to the system. The
system must not be used until the damage has been rectified. Disconnect the system from
the mains. Do not stand or work beneath the system.
f. GE is not responsible for unauthorized or inappropriate handling of or changes to the system.
Unauthorized changes to the system may adversely affect on the smooth operation, safety
and reliability of the system.
4. Prepare the patient and supplies (for example biopsy tray) for the procedure.
a. Follow your departmental procedure for patient preparation.
b. Give the patient breathing instructions.
Once the patient has been prepared for the interventional procedure, follow these steps to set up the
image acquisition in the SmartStep mode.
1. Select a protocol that contains an interventional series or Select Create a new interventional
series from the scan task list.
2. Position the patient and set the patient orientation and patient position settings to match in the
Patient Position Area in all series.
3. Proceed with scout and any additional planning series.
5. Click Start Location and type the initial image location where you want to start. The + and -
symbols may be substituted for S1 and I2. S = + and I = -.
Alternately, set the start location, DFOV, R/L and A/P center graphically from the Show Localizer
viewport.
6. Click SFOV and type the desired scan field of view value.
7. Click kV and select the desired kV value.
8. Click mA and select or type the desired mA value.
NOTE
Maximum mA is 300mA for systems with a Quanitx 160 tube.
9. Click Slice Mode and select 1i or 3i.
10. Click Recon Mode and select Overlap or Non Overlap (Overlap or Non Overlap is valid only if 3i
Mode is selected).
• Overlap mode provides 3 images of the same slice thickness with data overlap between each
slice.
• Non Overlap mode provides 3 images with asymmetric slice thickness where the center slice
is thicker than the outside slices.
11. Click Thickness and select desired thickness. Thickness selection shown in SmartStep settings
collections.
12. Click Exposure Time and type an exposure time. Exposure Time is the maximum allowable
cumulative exposure time in the SmartView scan, which may be set up to 90 seconds.
13. Click Bump Distance and type the distance you want the cradle to bump in or out. The default
Bump Distance is half of the selected Slice Thickness.
14. Click Confirm, which displays the warning message, "This series contains one or more groups
with multiple scans at the same tomographic plane, i.e., the same location. Do you wish to
continue?"
15. Click Continue.
16. Proceed to Acquire a scan Acquire a scan.
Maximize/Minimize Viewport
12.6.5.1 Prerequisite
• Verify that the foot switch and the HHC devices are plugged into the gantry.
• If you want to enable the alignment lights during a SmartStep procedure, use the button on the
HHC. If the Alignment Light button is selected on the gantry controls, the gantry decelerates and
stops.
• The SmartStep Remaining time and Accumulative time message areas on the in-room monitor
update with each step of the SmartStep scan procedure. If the remaining time is 0, a message
displays on the in-room monitor instructing you to re-prescribe the interventional scan.
12.6.5.2 Scan
1. Press Prep from either the HHC or from the Scan progress screen.
Screen messages:
• "PRESS PREP"
• "PREP in PROGRESS" once Prep is selected
NOTE
Prep may fail to complete or an exposure cannot be made if the table transporter
is not at the full-in position. The HHC is not able to move the cradle past the table
transporter position. Manually move the cradle to the full-in position.
2. From the HHC, press Move to Start Location.
The Light Emitting Diode (LED) display is illuminated by the Move to Start Location button when
the table is not at the prescribed scan location for the first scan or at the last scanned location for
subsequent scans.
3. Press the foot pedal to make a single rotation exposure. The Prep LED on the HHC flashes while
the system is prepping.
Screen messages:
• "READY TO SCAN" indicates you can press foot pedal
• "XRAY ON" displays when scan is active
4. Release the foot pedal when the exposure is finished. Following each rotation, you must release
the foot pedal before you can scan again.
• Screen message:
"RELEASE PEDAL" displays if the exposure pedal is not released.
• Cradle Release can be used to freely move the cradle in/out of the gantry.
*The position resolution on CT gantry display is 0.5 mm, the table position resolution is more accurate
than 0.5 mm. A very small overlap between SmartStep Group 2 and Group 3 may not be recognized
from the CT gantry display, the accumulated dose will be 15 mGy pre scan and 20 mGy post scan in
this case.
Number Description
4 Reference viewport. If a scout series was acquired, the most recent scout image
displays automatically. Can be changed to any selected image for this patient. Line
on scout illustrates the planned scan location and last scanned location.
5 Viewport Order Graphic illustrates the order and the recon mode. RAS Compass
displays the RAS coordinates for the image based on patient position/ orientation
and flip and rotate settings.
7 Remaining Time
8 Accumulative Time
10 Dose indicators:
• Max CTDIvol (mGy) in Scan Coverage - for the current location
• DLP (mGy/cm)- for the entire exam
NOTE
The total accumulated exposure time for all SmartStep scan groups and series displays
on the Dose Text page.
NOTE
For the safety of SmartStep exams, you can only expose the patient for 90 seconds per
session.
Control panel
See Display SmartStep images to view the display functions for manipulating an image.
NOTE
HHC image operation is not available if the foot pedal is pressed.
1. From reference viewport hover menu, click .
2. From the File Manager, select the desired Exam and Series.
3. Click Accept to display the selected image.
4. Select any tool from the SmartStep control panel to manipulate the image.
NOTE
Scan data from a SmartStep series cannot be reconstructed retrospectively.
12.7 GSI
Medium 66 73
Large 68 74
NOTE
HU values between kVp-like and true single kVp scans may not be exactly the same since
values can vary based on patient size and scan settings.
kVp-like images should be used as a guide to choosing the keV. Users may find another
keV that works best.
CAUTION
GSI MAR IMAGES SHOULD BE REVIEWED WITH BOTH GSI MAR APPLIED
AND NOT APPLIED TO HAVE A COMPARISON BETWEEN THE NATIVE IMAGE
AND THE IMAGE WITH METAL REMOVED.
When you copy a GE Reference Profile, it is given a unique name. The copied, renamed profile is now a
User Profile and can be edited, renamed and deleted, as well.
1. Select the User tab on the Main Page under the search bar.
2. Right-click on the profile you would like to rename and select Rename from the drop-down menu.
3. Enter a new, unique name for the profile in the pop up that appears.
4. Click Save.
1. Select the User tab on the Main Page under the search bar.
2. Right-click on the profile you would like to delete and select Delete from the drop-down menu.
3. Confirm the deletion by clicking the Delete button that appears in the pop up.
a new selection in one of the three drop-down menus per Preset Family.
WW WL WW WL
WW WL WW WL
Iodine(Fat) 155 40 - -
Fat(Water) 750 50 - -
NOTE
Only 10 GSI-specific tasks can be defined in the profile.
Copy a Recon
1. Find the recon you want from any GE Reference or User Profile.
2. Click the Copy button at the right side of the recon to copy a single recon or click the Copy button
at the top of the recon settings window to copy all of the recons.
3. Return to the profile where you would like to add the copied recon.
4. Click the Paste button at the top right corner of the Recon Settings screen. The copied recon is
appended to the current profile’s Recon Settings.
5. (Optional) Rename the copied recon.
Delete a Recon
1. Find the recon to be deleted.
2. Click the Delete button at the far right side of the recon.
3. Confirm the deletion by clicking the Delete button in the pop up that appears.
1. Filter the list of Clinical Identifiers using the box on the right of the Clinical Identifier to Profile
Mapping page.
You can filter the list by any combination of Clinical Category, Clinical ID and Profile. You can
change the filter using the drop-down menus or clear all filters using the Clear All Filters button.
2. The center box, Current Profile Mapping shows current mappings between Clinical Identifiers
and profiles. Click on a row of this list to select a Clinical Identifier you want reassign/unassign to
a particular profile. You can also select all clinical identifiers using the Select All button or clear all
selections using the Clear All Selections button.
Once you make or change an assignment, the filtered list contains the changed records.
NOTE
Use of appropriate CID is critical to image quality for the following specific recon tasks:
• Gout analysis images must use CID Extremity.
• Gout Non-contrast head images must use CID Neuro.RoutineHead.
GE Head Intended for head con- SFOV: Head Head/ Large/ 70 keV Stnd AR40 100/40
Contrast trast Collimations: 40 40mm/0.8/ 0.516 Iodine(Water) Stnd AR40
Primary imaging fac- mm Head/ Large/ 115/40
tors: Pitches: 0.516, 40mm/0.8/ 0.984 Water(Iodine) Stnd
Low Contrast Detectabil- 0.984 Head/ Large/ AR4090/1025
ity Rotation Speeds: 40mm/1.0/ 0.516
Spatial Resolution 0.5, 0.8, 1.0 Head/ Large/
Secondary imaging fac- Scan Type: Helical 40mm/1.0/ 0.984
tor: Head/ Large/
MD Accuracy 40mm/0.5/ 0.516
Head/ Large/
40mm/0.5/ 0.984
GE Head Intended for head non- SFOV: Head Head/ Large/ 70 keV Stnd AR40 100/40
NC contrast Collimations: 40 40mm/0.8/ 0.516 70 keV Bone AR40
Primary imaging fac- mm Head/ Large/ 2000/350
tors: Pitches: 0.516, 40mm/0.8/ 0.984 Iodine(Water) Stnd AR40
Low Contrast Detectabil- 0.984 Head/ Large/ 115/40
ity Rotation Speeds: 40mm/1.0/ 0.516 Water (Iodine) Stnd AR40
Spatial Resolution 0.5, 0.8, 1.0 Head/ Large/ 90/1025
Secondary imaging fac- Scan Type: Helical 40mm/1.0/ 0.984
tor: Head/ Large/
MD Accuracy 40mm/0.5/ 0.516
Head/ Large/
40mm/0.5/ 0.984
GE Head Intended for head CTA SFOV: Head Head/ Large/ 70 keV Stnd AR40 800/150
CTA Primary imaging fac- Collimations: 40 40mm/0.5/ 0.516 Water(Iodine) Stnd AR40
tors: mm Head/ Large/ 90/1025
Low Contrast Detectabil- Pitches: 0.516, 40mm/0.5/ 0.984 Iodine(Water) Stnd AR40
ity 0.984 Head/ Large/ 115/40
Spatial Resolution Rotation Speeds: 40mm/0.8/ 0.516
MD Accuracy
GE Head Intended for head and SFOV: Head Head/ Large/ 70 keV Stnd AR40 800/150
Neck CTA neck CTA Collimations: 40 40mm/0.5/ 0.984 55 keV Stnd AR40 800/150
Primary imaging fac- mm Head/ Large/ Water(Iodine) Stnd AR40
tors: Pitches: 0.984 40mm/0.8/ 0.984 90/1025
Low Contrast Detectabil- Rotation Speeds: Head/ Large/ Iodine(Water) Stnd AR40
ity 0.5, 0.8, 1.0 40mm/1.0/ 0.984 115/40
Spatial Resolution Scan Type: Helical
Secondary imaging fac-
tor:
MD Accuracy
GE Soft Intended for Soft Tissue SFOV: Large Large Body/ Large/ 70 keV Stnd AR40: 400/40
Tissue Neck protocols. Collimations: 80 80 mm/ 0.8/ 0.992 55 keV Stnd AR40: 630/75
Neck Primary imaging fac- mm Large Body/ Large/ Iodine(Water) Stnd AR40:
tors: Contrast Timing Pitches: 0.992 80mm/1.0/ 0.992 150/50
Low Contrast Detectabil- Large Body/ X-Large/ Water(Iodine) Stnd AR40:
ity. Rotation Speeds:
0.8 , 1.0 80mm/0.8/ 0.992 300/1000
Secondary Imaging Large Body/ X-
factors: Artifact Reduc- Scan Type: Helical VUE Stnd AR40: 400/40
Large /80mm//1.0/
tion 0.992
GE Neck Intended for Circle of SFOV: Large Large Body/ Large/ 70 keV Stnd AR40: 800/150
CTA Willis Carotids protocols. Collimations: 80 80 mm/0.5/ 0.992 Iodine(Water) Stnd AR40:
Primary imaging mm Large Body/ Large/ 150/50
factors: Pitches: 0.992 80 mm/0.6/ 0.992 Water(Iodine) Stnd AR40:
Spatial resolution Rotation Speeds: Large Body/ Large/ 300/1000
Contrast Timing 0.5, 0.6, 0.8 80 mm/0.8/ 0.992
GE Chest Intended for PE studies SFOV: Large Large Body/ Large/ 70 keV Stnd AR40: 400/40
CTA and general Chest CTA Collimations: 80 80 mm/0.5/ 0.992 50 keV Stnd AR40: 630/75
protocols. mm Large Body/ Large/ Iodine(Water) Stnd AR40:
Primary imaging Pitches: 0.508, 80 mm/0.6/ 0.992 150/50
factors: 0.992 Large Body/ Large/ Water(Iodine) Stnd AR40:
Temporal resolution Rotation Speeds: 80 mm/0.8/ 0.992 300/1000
Spatial resolution 0.5, 0.6, 0.8 Large Body/ Large/
Contrast timing/CNR Scan Type: Helical 80 mm/0.5/ 0.508
Secondary imaging
factors:
Material Density Accura-
cy
Z coverage
GE Fast Intended for PE studies SFOV: Large Large Body/ Large/ 70 keV Stnd AR40: 400/40
Chest and general Chest CTA Collimations: 80 80 mm/0.5/ 1.531 50 keV Stnd AR40: 630/75
protocols. mm Large Body/ Large/ Iodine(Water) Stnd
Primary imaging Pitches: 1.375, 80 mm/0.6/ 1.531 AR40:150/50
factors: 1.531 Large Body/ Large/ Water(Iodine) Stnd AR40:
Temporal resolution Rotation Speeds: 80 mm/0.6/ 1.375 300/1000
Spatial resolution 0.5, 0.6, 0.8 Large Body/ Large/
Contrast timing/CNR Scan Type: Helical 80 mm/0.8/ 1.375
Secondary imaging
factors:
Material Density Accura-
cy
Z coverage
GE Abdo- Intended for Kidney SFOV: Large Large Body/ 70 keV Stnd AR40: 400/40
men NC Stone protocols. Collimations: 80 Large/80 mm/ 0.8/ Water(Iodine) Stnd AR40:
Primary imaging factor: mm 0.992 300/1000
Material density accura- Pitches: 0.508, Large Body/ Iodine(Water) Stnd AR40:
cy 0.992 Large/80 mm/0.5/ 150/50
0.508
Rotation Speeds: Uric Acid(Calcium)Stnd
0.5, 0.8, 1.0 Large Body/ AR40: 160/1045
Large/80 mm/1.0/
Scan Type: Helical 0.992
GE Rou- Intended for Routine SFOV: Large Large Body/ 70 keV Stnd AR40: 400/40
tine Ab- Abdominal/Pelvis proto- Collimations: 80 Large/80 mm/ 0.6/ 50 keV Stnd AR40: 600/40
domen cols. mm 0.992
Contrast Iodine(Water) Stnd AR40:
Primary imaging Pitches: 0.508, Large Body/ 150/50
factors: 0.992 Large/80 mm/ 0.8/
0.992 Water(Iodine) Stnd AR40:
Low/appropriate dose Rotation Speeds: 300/1000
General consistent im- 0.5, 0.6, 0.8, 1.0 Large Body/
Large/80 mm/0.6/ VUE Stnd AR40: 400/40
age quality Scan Type: Helical 0.508
Secondary imaging
factors: Large Body/
Large/80 mm/0.5/
Spatial Resolution 0.508
MD Accuracy Large Body/
Large/80 mm/0.8/
0.508
Large Body/
Large/80 mm/1.0/
0.992
Large Body/
Large/80 mm/1.0/
0.508
GE Abdo- Intended for multi- SFOV: Large Large Body/ 70 keV Stnd AR40: 400/40
men phase liver protocols. Collimations: 80 Large/80 mm/0.8/ 50 keV Stnd AR40: 600/40
Contrast Primary imaging mm 0.992
Iodine(Water) Stnd AR40:
factors: Pitches: 0.508, Large Body/ X- 150/50
Contrast timing/CNR 0.992 Large/80 mm/0.8/
0.992 Water(Iodine) Stnd AR40:
Low Contrast Detectabil- Rotation Speeds: 300/1000
ity 0.5, 0.8, 1.0 Large Body/
Large/80 mm/0.5/ Fat(Iodine) Stnd AR40:
Material Density Accura- XL Focal Spot in- 0.508 300/1000
cy cluded VUE Stnd AR40: 400/40
Large Body/
Scan Type: Helical Large/80 mm/1.0/
0.992
Large Body/ X-
Large/80 mm/1.0/
0.992
GE Fast Intended for Routine Ab- SFOV: Large Large Body/ 70 keV Stnd AR40: 400/40
Abdo- dominal / Pelvis proto- Collimations: 80 Large/80 mm/0.6/ 50 keV Stnd AR40: 600/40
men cols. mm 1.375
Iodine(Water) Stnd AR40:
Primary imaging Pitches: 1.375, Large Body/ 150/50
factors: 1.531 Large/80 mm/0.6/
1.531 Water(Iodine) Stnd AR40:
Low/appropriate dose Rotation Speeds: 300/1000
general consistent im- 0.6, 0.8 Large Body/
Large/80 mm/0.8/ VUE Stnd AR40: 400/40
age quality XL Focal Spot in- 1.375
Secondary imaging cluded
factors: Large Body/ X-
Scan Type: Helical Large/80 mm/0.8/
Spatial Resolution 1.375
MD Accuracy Large Body/
Large/80 mm/0.8/
1.531
Large Body/ X-
Large/80 mm/0.8/
1.531
GE Abdo- Intended for general Ab- SFOV: Large Large Body/ 70 keV Stnd AR40: 400/40
men CTA dominal CTA protocols. Collimations: 80 Large/80 mm/0.6/ 55 keV Stnd AR40:
Primary imaging mm 0.992 1000/250
factors: Pitches: 0.992, Large Body/ Iodine(Water) Stnd AR40:
Contrast timing/CNR 1.375, 1.531 Large/80 mm/0.8/ 150/50
0.992
Z coverage Rotation Speeds: Water(Iodine) Stnd AR40:
0.6, 0.8 Large Body/ X- 300/1000
Secondary imaging Large/80 mm/0.8/
factors: XL Focal Spot in- 0.992 VUE Stnd AR40: 400/40
Spatial resolution cluded
Large Body/
Temporal resolution Scan Type: Helical Large/80 mm/0.8/
1.531
Large Body/
Large/80 mm/0.6/
1.375
Large Body/ X-
Large/80 mm/0.8/
1.531
GE Run- Intended for Runoff pro- SFOV: Large Large Body/ 70 keV Stnd AR40: 800/150
off CTA tocols where outrunning Collimations: 40 Large/40 mm/0.5/ 55 keV Stnd AR40:
the contrast bolus is a mm 0.984 1000/250
concern. Large Body/
Pitch: 0.984 Iodine(Water) Stnd AR40:
Primary imaging Large/40 mm/0.6/ 150/50
factors: Rotation Speeds: 0.984
0.5,0.6, 0.8, 1.0 Water(Iodine) Stnd AR40:
Contrast Timing Large Body/ 300/100
Scan Type: Helical Large/40 mm/0.8/
Z Coverage Iodine(Calcium) Stnd
0.984
Secondary imaging AR40: 150/-180
factors: Large Body/
Large/40 mm/1.0/ Calcium(Iodine) Stnd
Spatial resolution 0.984 AR40: 130/660
Temporal Resolution
GE Run- Intended for long z cov- SFOV: Large Large Body/ 70 keV Stnd AR40: 800/150
off CTA erage runoff protocols Collimations: 80 Large/80 mm /0.5/ 55 keV Stnd AR40:
Plus where outrunning the mm 0.992 1000/250
contrast bolus is a con- Large Body/
cern. Pitches: 0.992 Iodine(Water) Stnd AR40:
Large/80 mm/0.6/ 150/50
Primary imaging Rotation Speeds: 0.992
factors: 0.5,0.6, 0.8, 1.0 Water(Iodine) Stnd AR40:
Large Body/ 300/1000
Contrast Timing XL Focal Spot in- Large/80 mm/0.8/
cluded 0.992 Iodine(Calcium) Stnd
Z Coverage AR40: 150/-180
Scan Type: Helical Large Body/
Secondary imaging Calcium(Iodine) Stnd
factors: Large/80 mm/1.0/
0.992 AR40: 130/660
Spatial resolution
Large Body/ X-
Temporal Resolution Large/80 mm/0.5/
0.992
Large Body/ X-
Large/80 mm/0.6/
0.992
GE CTA Intended for CTA proto- SFOV: Large Large Body/ 70 keV Stnd AR40: 800/150
General cols where outrunning Collimations: 40 Large/40 mm/0.6/ 55 keV Stnd AR40:
the contrast bolus is a mm. 80 mm 0.984 1000/250
concern. Large Body/
Pitches: 0.984, Iodine(Water) Stnd AR40:
Primary imaging 0.516, 0.992 Large/40 mm/0.8/ 150/50
factors: 0.984
Rotation Speeds: Water(Iodine) Stnd AR40:
Contrast Timing 0.5,0.6, 0.8, 1.0 Large Body/ 300/1000
Z Coverage Large/40 mm/1.0/
Scan Type: Helical 0.984 Iodine(Calcium) Stnd
Secondary imaging AR40: 150/-180
factors: Large Body/
Large/40 mm/0.6/ Calcium(Iodine) Stnd
Spatial resolution 0.516 AR40: 130/660
Temporal Resolution Large Body/
Large/40 mm/0.8/
0.516
Large Body/
Large/80 mm/0.8/
0.992
Large Body/
Large/80 mm/0.5/
0.992
GE CTA Intended for CTA proto- SFOV: Large Large Body/ 70 keV Stnd AR40: 800/150
General cols where outrunning Collimations: 80 Large/80 mm/0.5/ 55 keV Stnd AR40:
Plus the contrast bolus is a mm 0.992 1000/250
concern. Large Body/
Pitches: 0.508, Iodine(Water) Stnd AR40:
Primary imaging 0.992, 1.375 Large/80 mm/0.6/ 150/50
factors: 0.992
Rotation Speeds: Water(Iodine) Stnd AR40:
Contrast Timing 0.5,0.6, 0.8, 1.0 Large Body/ 300/1000
Z Coverage Large/80 mm/0.8/
Scan Type: Helical 0.992 Iodine(Calcium) Stnd
Secondary imaging AR40: 150/-180
factors: Large Body/
Large/80 mm/1.0/ Calcium(Iodine) Stnd
Spatial resolution 0.992 AR40: 130/660
Temporal Resolution Large Body/
Large/80 mm/0.6/
0.508
Large Body/
Large/80 mm/0.8/
0.508
Large Body/
Large/80 mm/1.0/
0.508
Large Body/
Large/80 mm/0.5/
1.375
Large Body/
Large/80 mm/0.6/
1.375
GE Body Intended for Body proto- SFOV: Large Large Body/ 70 keV Stnd AR40: 400/40
Artifac- cols with metal implants Collimation: 80 Large/80 mm/0.8/ 70 keV MAR On Stnd AR40:
tRed and stents. mm 0.992 400/40
Primary imaging Pitches: 0.508, Large Body/ X- 110 keV Bone AR0:
factors: 0.992 Large/80 mm/0.8/ 2000/350
Contrast timing/CNR 0.992
Rotation Speeds: 110 keV MAR On Bone AR0:
Z coverage 0.5, 0.8, 1.0 Large Body/ 2000/350
Large/80 mm/0.5/
Secondary imaging XL Focal Spot in- 0.508
factors: cluded
Large Body/
Spatial resolution Scan Type: Helical Large/80 mm/1.0/
Temporal resolution 0.992
Large Body/X-
Large/80 mm/1.0/
0.992
Large Body/
Large/80 mm/1.0/
0.508
GE MSK Intended for Spine and SFOV: Large Large Body/ 70 keV Stnd AR40: 400/40
NC Arti- general MSK protocols. . Collimations: 40 Large/80 mm/0.6/ 70 keV MAR On Stnd AR40:
factRed Primary imaging mm, 80 mm 0.508 400/40 110
factors: Pitches: 0.508, Large Body/ keV Bone Plus AR40:
Spatial Resolution 0.516, 0.984 Large/40 mm/0.8/ 2000/350
0.516
Artifact Reduction Rotation Speeds: 110 keV MAR On Bone Plus
0.6, 0.8, 1.0 Large Body/ AR40: 2000/350
Secondary imaging Large/40 mm/1.0/
factor: Scan Type: Helical 0.516
Low Contrast Detectabil- Large Body/
ity Large/40 mm/0.8/
0.984
Large Body/
Large/40 mm/1.0/
0.984
Large Body/
Large/80 mm/1.0/
0.508
GE Ex- Intended for Extremity SFOV: Medium Medium Body/ 70 keV Stnd AR40: 400/40
tremity protocols as an optional Collimations: 40 Large/40 mm/0.5/ 110 keV Bone AR40:
approach. mm 0.516 2000/350
Primary imaging Pitches: 0.516, Medium Body/ 125 keV Bone AR40:
factors: 0.984 Large/40 mm/0.6/ 2000/350
Spatial Resolution 0.516
Rotation Speeds:
Artifact Reduction 0.5, 0.6, 0.8, 1.0 Medium Body/
Large/40 mm/0.5/
Secondary imaging Scan Type: Helical 0.984
factor:
Medium Body/
Low Contrast Detectabil- Large/40 mm/0.6/
ity 0.984
Medium Body/
Large/40 mm/0.8/
0.984
Medium Body/
Large/40 mm/1.0/
0.984
GE Gout Intended for Gout proto- SFOV: Medium Medium Body/ 70 keV Stnd AR40
cols as an optional ap- Collimations: 40 Large/40 110 keV Bone AR40
proach. Primary imaging mm mm/0.5/0.516
factors include Spatial Uric Acid(HAP) Stnd AR40
Pitches: 0.516, Medium Body/
Resolution and Artifact Large/40 HAP(Uric Acid) Stnd AR40
Reduction. Low Contrast 0.984
mm/0.6/0.516
Detectability is a Secon- Rotation Speeds:
dary imaging factor. Medium Body/
0.5, 0.6, 0.8, 1.0 Large/40
Scan Type: Helical mm/0.5/0.984
Medium Body/
Large/40
mm/0.6/0.984
Medium Body/
Large/40
mm/0.8/0.984
Medium Body/
Large/40
mm/1.0/0.984
GE Body GE Ref Body All for 40 SFOV: Large Large Body/ 70 keV Data File On Stnd
40 mm mm collimation Collimations: 40 Large/40 mm/0.5/ AR40: 400/40
All mm 0.516 55 keV Stnd AR40:
Pitches: 0.516, Large Body/ 1000/250
0.994, 1.375 Large/40 mm/0.6/ 110 keV Bone AR40:
0.516 2000/350
Rotation Speeds:
0.5, 0.6, 0.8, 1.0 Large Body/ 110 keV Mar On Bone
Large/40 mm/0.8/ AR40: 2000/350
Scan Type: Helical, 0.516
Axial Iodine(Water) Stnd AR40:
Large Body/ 150/50
Large/40 mm/1.0/
0.516 Water(Iodine) Stnd AR40:
300/1000
Large Body/
Large/40 mm/0.5/ VUE Stnd AR40: 400/40
0.984 High kVp Stnd AR40:
Large Body/ 400/40
Large/40 mm/0.6/ 120 kVp Like Stnd AR40:
0.984 400/40
Large Body/
Large/40 mm/0.8/
0.984
Large Body/
Large/40 mm/1.0/
0.984
Large Body/
Large/40 mm/0.5/
1.375
Large Body/
Large/40 mm/0.6/
1.375
Large Body/
Large/40
mm/0.8/1.375
Large Body/
Large/40 mm/1.0/
1.375
Large Body/
Large/40 mm/0.5/
Axial
Large Body/
Large/40 mm/0.6/
Axial
Large Body/
Large/40 mm/0.8/
Axial
Large Body/
Large/40 mm/1.0/
Axial
GE Body GE Ref Body All for 80 SFOV: Large Large Body/ 70 keV Data File On Stnd
80 mm mm collimation Collimations: 80 Large/80 mm/0.5/ AR40: 400/40
All mm 0.508 55 keV Stnd AR40:
Pitches: 0.508, Large Body/ 1000/250
0.992, 1.375, 1.531 Large/80 mm/0.6/ 110 keV Bone AR40:
0.508 2000/350
Rotation Speeds:
0.5, 0.6, 0.8, 1.0 Large Body/ 110 keV Mar On Bone
Large/80 mm/0.8/ AR40: 2000/350
Scan Type: Helical 0.508
Iodine(Water) Stnd AR40:
Large Body/ 150/50
Large/80 mm/1.0/
0.508 Water(Iodine) Stnd AR40:
300/1000
Large Body/
Large/80 mm/0.5/ VUE Stnd AR40: 400/40
0.992 High kVp Stnd AR40:
Large Body/ 400/40
Large/80 mm/0.6/ 120 kVp Like Stnd AR40:
0.992 400/40
Large Body/
Large/80 mm/0.8/
0.992
Large Body/
Large/80 mm/1.0/
0.992
Large Body/
Large/80 mm/0.5/
1.375
Large Body/
Large/80 mm/0.6/
1.375
Large Body/
Large/80 mm/0.8/
1.375
Large Body/
Large/80 mm/1.0/
1.375
Large Body/
Large/80 mm/0.5 /
1.531
Large Body/
Large/80 mm/0.6/
1.531
Large Body/
Large/80 mm/0.8/
1.531
Large Body/
Large/80 mm/1.0/
1.531
Large Body/ X-
Large/80 mm/0.5/
0.508
Large Body/ X-
Large/80 mm/0.6/
0.508
Large Body/ X-
Large/80 mm/0.8/
0.508
Large Body/ X-
Large/80 mm/1.0/
0.508
Large Body/ X-
Large/80 mm/0.5/
0.992
Large Body/ X-
Large/80 mm/0.6/
0.992
Large Body/ X-
Large/80 mm/0.8/
0.992
Large Body/ X-
Large/80 mm/1.0/
0.992
Large Body/ X-
Large/80 mm/0.5/
1.375
Large Body/ X-
Large/80 mm/0.6/
1.375
Large Body/ X-
Large/80 mm/0.8/
1.375
Large Body/ X-
Large/80 mm/1.0/
1.375
Large Body/ X-
Large/80 mm/0.5 /
1.531
Large Body/ X-
Large/80 mm/0.6/
1.531
Large Body/ X-
Large/80 mm/0.8/
1.531
Large Body/ X-
Large/80 mm/1.0/
1.531
GE Gout Extremity.Gout
280 15.51
320 17.90
365 20.31
Head/Large/40mm 0.5 0.516/0.984
405 22.69
445 25.08
485 27.44
280 18.38
320 21.22
360 24.10
Head/Large/40mm 0.6 0.516/0.984
400 26.94
440 29.76
480 32.61
275 23.9
315 27.67
355 31.48
Head/Large/40mm 0.8 0.516/0.984
395 35.22
435 38.93
475 42.68
270 29.55
315 34.26
355 38.97
Head/Large/40mm 1 0.516/0.984
395 43.63
435 48.27
475 52.92
200 4.69
240 5.75
280 6.82
320 7.89
LARGE BODY/LARGE/80 mm 0.5 0.508/0.992/1.375/1.531
365 8.96
405 10.02
445 11.09
485 12.15
195 5.54
235 6.8
280 8.08
320 9.35
LARGE BODY/LARGE/80 mm 0.6 0.508/0.992/1.375/1.531
360 10.63
400 11.89
440 13.15
480 14.44
190 7.09
230 8.76
275 10.4
315 12.06
LARGE BODY/LARGE/80 mm 0.8 0.508/0.992/1.375/1.531
355 13.75
400 15.39
435 17.04
480 18.7
185 8.73
230 10.79
270 12.84
315 14.9
LARGE BODY/LARGE/80 mm 1 0.508/0.992/1.375/1.531
355 16.97
395 19.01
435 21.04
475 23.09
530 13.27
LARGE BODY/-X-LARGE/80 mm 0.5 0.508/0.992/1.375/1.531
579 14.4
525 15.78
LARGE BODY/-X-LARGE/80 mm 0.6 0.508/0.992/1.375/1.531
565 17.08
520 20.46
LARGE BODY/-X-LARGE/80 mm
0.8 0.508/0.992/1.375/1.531 560 22.1
520 25.23
LARGE BODY/-X-LARGE/80 mm 1 0.508/0.992/1.375/1.531
560 27.3
200 4.8
240 5.89
280 6.98
320 8.08
LARGE BODY/LARGE/40 mm 0.5 0.516/0.984/1.375 Axial
365 9.18
405 10.27
455 11.36
485 12.44
195 5.66
235 6.96
280 8.26
320 9.56
LARGE BODY/LARGE/40 mm 0.6 0.516/0.984/1.375 Axial
360 10.86
400 12.16
440 13.44
480 14.74
190 7.25
230 8.95
275 10.63
315 12.32
LARGE BODY/LARGE/40 mm 0.8 0.516/0.984/1.375 Axial
355 14.03
400 15.72
440 17.39
480 19.07
185 8.93
230 11.02
270 13.11
315 15.22
LARGE BODY/LARGE/40 mm 1 0.516/0.984/1.375 Axial
355 17.33
395 19.42
435 21.5
475 23.59
280 7.63
320 8.82
365 10.01
MEDIUM BODY/LARGE/40 mm 0.5 0.516/0.984/1.375
405 11.2
445 12.37
485 13.55
280 9.01
320 10.42
360 11.84
MEDIUM BODY/LARGE/40 mm 0.6 0.516/0.984/1.375
400 13.25
440 14.64
480 16.05
275 11.57
315 13.4
355 15.26
MEDIUM BODY/LARGE/40 mm 0.8 0.516/0.984/1.375
400 17.08
440 18.9
480 20.72
270 14.26
315 16.54
355 18.82
MEDIUM BODY/LARGE/40 mm 1 0.516/0.984/1.375
395 21.08
435 23.24
475 25.6
NOTE
When choosing GSI ASiR-V greater than 50%, care should be taken to ensure dose levels
are high enough based on clinical intent.
The Clinical Category and Clinical Identifier will populate in secondary recon Anatomy Selection to the
same selection as the Patient Collection Clinical Category and Clinical Identifier in the scan Anatomy
Selection when a secondary GSI Recon is added. You can select a different Clinical Category and
Clinical Identifier by turning Off GSI Assist Link.
When the GSI mA mode is GSI Manual and GSI Assist Link is turned On, recon settings are applied
based on Clinical Category and Clinical Identifier selected in Anatomy Selection in secondary recon
settings. The recon settings used are for the GSI Profile mapped to the Clinical Category and Clinical
Identifier defined in GSI Profile Editor. See Clinical Identifiers for this mapping.
NOTE
A GSI-specific recon task cannot be duplicated. To create an additional GSI-specific
recon, duplicate the common parameter task and assign the GSI-specific recon task the
desired image type.
Common parameters are the same across all GSI specific recon tasks and include the following:
Recon Settings:
• Thickness
• Recon Options
• IQ Enhance
• Interval
• Flip/Rotate
Anatomy Selection:
• Start
• End
• Number of images
• DFOV
• A/P Center
• R/L Center
• Clinical Identifier
NOTE
Use of appropriate CID is critical to image quality for the following specific recon
tasks:
• Gout analysis images must use CID extremity.gout
• Non-contrast head images must use CID neuro.routinehead.
NOTE
Only 10 GSI-specific tasks can be added in each secondary recon.
NOTE
DLIR for GSI can be prescribed only if the Recon Type is Standard and if the interval is
equal to or one half the slice thickness. DLIR for GSI may not be prescribed under the
following conditions:
• SFOV is Head or Cardiac
• GSI Image Type is High kVP
• Scan Range is less than 40 mm
NOTE
Three levels of Enhanced Contrast are available for GSI: EB1, EB2, and EB3. Enhanced
Contrast for GSI may be prescribed only under the following conditions:
• SFOV is Head, Small Head, or Ped Head
• Recon Type is Stnd or Soft
• GSI Image Type is Monochromatic 70 keV, 65 keV, or 60 keV
• DataFile is OFF
12.8.1 Overview
NOTICE
The following applications can be applied in Scan. If an application is not available, it may not be
included with your system options.
Volume Shuttle is specially designed for perfusion scanning and can extend the coverage of
tissue imaged, thus dispersing the dose over a wider area and decreasing peak skin dose. The
temporal sampling rate is reduced for any specific anatomic location compared with continuous and
intermittent exposure modes where the table remains stationary. The user must ensure that the
sampling frequency remains adequate for the post-processing software.
In axial shuttle mode, scanning is performed at two adjacent axial locations by moving the table
between X-ray exposures, thereby increasing the amount of anatomy that is imaged. As with
intermittent scanning, the X-rays are not turned on continuously, and thus peak skin dose and overall
delivered X-ray radiation dose are reduced (compared with continuous mode), while overall exam time
remains the same.
The ISD is fixed to 0.96 sec for manual mA mode, and 1.5sec for SmartmA mode.
The table control algorithm for Volume Shuttle Mode has been optimized to provide the shortest
possible transit time between the two locations. The average sample interval is 2.92 seconds (0.5sec
rot) or less, even for large patients (up to 181 kg / 400 lbs.), and easily meets the time sampling
requirements described previously.
Another benefit of Volume Shuttle data is that it can be reconstructed to thin slice sections, e.g. 0.625
mm thick. The resulting images can be used as a dynamic 4D CT angiogram. The table “Two” position
is available only with 40 mm detector coverage axial mode.
12.8.3 Considerations
If the temporal sampling period extends beyond 3.2 seconds, there may be errors present in the data
when processed by Head CT Perfusion. There is pop-up to notify the operator the MTBP is larger than
3.2 seconds together with warning scan at the same location after clicking Confirm.
SmartmA will increase the MTBP beyond the 3.2 seconds and extend the temporal sampling period.
If the MTBP is smaller than 3.2 seconds, only a message indicating multiple scans at same location
displays.
12.8.4 Reconstruction
There is no QC image for Axial Shuttle to secure the timing performance, and the Autoview is enabled
with diagnostic level images for he user. The user can monitor the Autoview images, if no contrast
agent during the exposure, pause or stop the scan to save the doses.
Wrap the table straps around the body to prevent the arms from dragging on the table that might
interfere with table travel in/out of the gantry.
3. From the Protocol Selection window, select a protocol and click Accept.
4. Acquire a scout.
5. From the Scan Settings window, click Continue.
6. Click Scan Type, then select Axial.
7. For Rotation Time, click 0.5.
Rotation time should be 0.5 seconds to meet temporal sampling requirements for perfusion
processing.
8. Click Coverage Speed.
9. Select Two as the Table position
10. Set the Detector Coverage to 40mm.
For the Start/End Location, the coverage is limited to 80 mm.
The Number of Images is determined by the settings in Thick/Speed.
Set the Slice Thickness to 5 mm. Prospectively only 2.5 and 5 mm slices can be reconstructed.
Thinner slices can be created in Secondary Recon.
Set the Coverage time or Number of Passes to the desired value to meet clinical requirements. At
least 13 passes are needed. The maximum number of passes is 60.
Set the SFOV, as needed.
For kV, click 80.
Set the mA to 500.
11. Set the Timing parameters, as needed.
Set the Prep Delay to 5.
The user can find the total elapsed time by checking Total Scan Time.
By pooling the data collected under this protocol from many national and international institutions,
I-ELCAP was able to show, in several 2006 publications that:
1. Lung cancers diagnosed under screening were typically small, including small-cell cell
carcinomas.
2. The estimated cure rate of patients whose lung cancer was diagnosed under screening.
After long-term follow-up of 31,456 asymptomatic participants, 484 of whom had lung cancer
diagnosed under CT screening of which 414 (86%) had clinical Stage I disease, the estimated overall
cure rate for the 484 patients diagnosed under CT screening was 80% (95% CI: 74% - 85%).
In addition to the above, findings from this study and its protocol that included only high risk patients,
the following other conclusions were made.
CT screening creates a counseling opportunity that results in greater smoking cessation.
The cost of CT screening for lung cancer compares favorably with breast, cervical and colon cancer
screenings.
Research is ongoing, incorporating larger pools of patient data to reaffirm early findings and suggest
new directions for future research and recommendations.
that the evidence is sufficient to add a lung cancer screening counseling and shared decision
making visit, and for appropriate beneficiaries, annual screening for lung cancer with low-
dose computed tomography (LDCT), as an additional preventive service benefit under the
Medicare program.
It has a comprehensive list of criteria that must be met, part of which is the Beneficiary Eligibility
Criteria:
• Age 55 – 77 years
• Asymptomatic (no signs or symptoms of lung cancer)
• Tobacco smoking history of at least 30 pack-years (one pack-year = smoking one pack per day for
one year; 1 pack = 20 cigarettes)
• Current smoker or one who has quit smoking within the last 15 years; and receives a written order
for LDCT lung cancer screening that meets certain criteria.
In conclusion, these studies and analyses provided valuable information on the importance of low-
dose Lung Cancer Screening for high risk individuals when performed within the established inclusion
criteria of programs/protocols that have been approved and published by either governmental body
or professional medical society.
It is advised that you refer to these references when establishing a Lung Cancer Screening program at
your institution and developing CT protocols for Lung Cancer Screening.
or develops a health problem that substantially limits life expectancy or the ability or willingness to
have curative lung surgery.
The CMS Beneficiary Eligibility Criteria is:
• Age 55 – 77 years;
• Asymptomatic (no signs or symptoms of lung cancer);
• Tobacco smoking history of at least 30 pack-years (one pack-year = smoking one pack per day for
one year; 1 pack = 20 cigarettes);
• Current smoker or one who has quit smoking within the last 15 years; and
• Receives a written order for LDCT lung cancer screening that meets certain criteria
LCS protocols are designed and intended as a starting point. They should be reviewed with your
Radiologist, Physicist and Radiation Safety Officers prior to clinical use and should be monitored as
revised as needed to meet the clinical needs of your department and the Lung Cancer Screening
program protocol that your site is following.
The Lung Cancer Screening Option installs three size based protocols in the GE Reference Protocols.
To customize LSC protocols follow instructions in Protocol Management to create user protocols by
copying and pasting a GE Reference Lung Cancer Screening protocol into User Protocols.
NOTE
Use of doses substantially below those found in the GE CT Low Dose Lung Cancer
Screening reference protocols may not produce clinically acceptable image quality,
primarily due to high image noise and low signal strength. Several other CT image
quality metrics may be affected as well, such as: CT Number Accuracy, CT Number
Uniformity, MTF, Visual Resolution (Image Artifacts), Noise Power Spectrum, Slice
Thickness and Contrast to Noise Ratio (CNR). The protocols defined in the Reference
Protocol Guide have been evaluated via CNR and Visual Inspection on phantoms to
provide sufficient image quality for Low Dose CT Lung Cancer Screening use.
When evaluating or changing Lung Cancer Screening Protocols consider the following:
Follow your department Quality Assurance guidelines. For more information, review the Quality
Assurance chapter in the Technical Reference Manual for your system. No additional QA procedures
are required for Lung Cancer Screening use beyond those provided in the Technical Reference Manual
or specified in your department's QA procedures
CAUTION
CAUTION
WARNING
CAUTION
The accuracy of measurements obtained with on-view graphics depends on various factors, in
particular the size of the ROI being measured. The rotation angle of a graphic (e.g., ellipse) also
affects accuracy.
• Using a straight line segment or straight line distance graphic, measurement accuracy for the
displayed length is equal to +/– one image pixel size.
• Using angle graphics, measurement accuracy depends on the length of the segments, and
improves as the length of the segments increases. As an example, for an angle measured between
segments, which are 100x the image pixel size, the measurement accuracy of the displayed angle
value is equal to +/– 1 degree.
CAUTION
2D Measurements
• Distance measurements are accurate to within the inter-slice distance.
• Angles measured between segments at least five times larger than the inter-slice distance are
accurate to ten degrees. Accuracy improves with the length of the segment.
When you place the measurement points yourself, the apparent diameter can differ by one or more
pixels depending on the W/L settings, thereby adding another factor of uncertainty.
Making a Measurement
14 Cardiac
14.1 Overview
This chapter covers Cardiac scanning in depth. This includes Calcium scoring scan, patient prep, ECG
setup and testing, scan parameters as well as cardiac profiles and some post processing options.
Administration of Beta Blockers and/or Sublingual Nitroglycern Spray can be used according to your
site's policy.
Please refer to the Society of Cardiovascular CT Guidelines at www.scct.org for more patient
preparation information.
starts and for the heart rate to stabilize before the scan. This time prevents the patient from
breathing in during data acquisition, which results in image motion.
• Use the Preset Delay feature in Auto Voice to program an additional 1–7 seconds prior to X-ray On,
as needed for each patient.
• The scan time for the contrast enhanced cardiac gated acquisition is approximately 1 second for
a single scan location that covers the entire heart. The heart rate stabilizes 2–7 seconds after a
breath hold. Therefore, have the patient start the breath hold 3–5 seconds prior to X-ray exposure.
Watch the ECG waveform display so you can determine when the patient's heart rate stabilizes
within the breath hold. Adjust your breath hold instructions to achieve as stable of a heart rate as
possible during the contrast enhanced cardiac gated scan.
• According to your physician and site's policy, deliver 2–4 liters of oxygen via nasal cannula if the
patient has difficulty holding his breath. This can help lower the heart rate.
• Practice the breathing instructions with the patient.
NOTE
The patient’s heart rate is automatically recorded during the Scout, Timing Bolus,
Calcium Scoring (Smart Score), or other CT scan series as long as the scan duration
is at least as long as the breath hold duration.
NOTE
Auto Gating uses the patient’s heart rate prior to the breath hold recording up to the
Irregular Beat Window Length. The system preset is set to 60 seconds.
5. Click Save.
NOTE
The patient’s heart rate is automatically recorded during the Scout, Timing Bolus,
Calcium Scoring (Smart Score), or other CT scan series as long as the scan duration
is at least as long as the breath hold duration.
5. Click Apply or Save.
6. Click Record New HR from the Acquisition Window and Heart Rate widget with Auto Gating “on”.
• The system indicates Recording Prep while the selected Auto Voice message plays, giving
pre-message breathing instructions.
• The system indicates Recording in blue while the Heart Rate is being recorded.
• When recording is completed, Auto Voice plays the post-message breathing instructions.
7. A jump point is added to the viewer. Click the jump point to review the recorded trace.
NOTE
If a patient's heart rate characteristics have changed, use Record to re-record the
heart rate during a breath hold and generate new scan settings.
NOTE
If the gantry display shows ICM is disconnected, even though it is connected, clear
the connection status alert by selecting Cardiac settings from the gantry display
menu. Select a menu selection such as Active Lead and change the setting. The
disconnection alert will then clear.
NOTE
You can change the selected ECG trigger device (internal or external) from the tool
menu on the gantry display. See Gantry Display on page 580.
5. Place the patient grounding strap on the patient’s wrist. The strap should have direct contact with
the patient’s skin.
6. Connect the grounding strap cable from the grounding point behind the integrated cardiac
module to the patient grounding wrist strap.
7. Trim any excess hair at ECG electrode placement site, if needed.
8. Place the patient’s arms above their head and elevate with pillows or sponges.
Do not place the arms flat on the table or gantry. This position can limit vessel flow and cause arm
and shoulder motion. As the table moves into the gantry during the scan, it tends to cause the
patient to arch his back, raising the chest and causing incorrect registration artifacts.
9. With the patient's arms above their head, place the RA and LA electrodes, midline of the clavicle
bone & also below the clavicle bone. Do not place any electrodes over muscle, scar tissue, or hair
for the following reasons:
• Muscle: The ECG can register muscle electrical activity due to the above head arm position.
Help the patient relax his arms and reduce shoulder muscle fatigue.
• Scar tissue: This is denser than normal tissue, which makes it difficult to get a good signal.
If the patient has scar tissue in the shoulder area, place the electrode out onto the patient's
arm. In the chest area, place the electrode where there is no scar tissue.
• Hair: Electrodes placed over a very hairy area do not allow good skin contact. If necessary,
shave a 4 inch square area for electrode placement.
10. To remove any lotion or oils, gently scrub the electrode location with cotton gauze until the skin is
a healthy pink. Do not use alcohol to prepare the electrode area.
To ensure proper skin preparation and ensure good ECG signal quality, GE recommends using
Nuprep® skin prep gel to prepare the patient’s skin prior to placing the ECG electrodes. Nuprep®
gel strips away the top layer of skin and moistens the underlying skin layer, which lowers the
patient’s skin impedance while minimizing patient discomfort. Follow the instructions for use
provided with Nuprep® gel.
11. With the patient in the scan position (arms above the head), apply the ECG electrodes and leads
to the patient no more than 5–10 minutes before the scan.
Electrode Description
RA US (white); EU (red)
LA US (black); EU (yellow)
RL US (green); EU (black)
LL US (red); EU (green)
12. Review the ECG waveform. Ensure the patient’s heart rate is within allowable system limits for
scanning: 30–200 beats per minute.
a. If the internal ECG trigger device is selected and active, you can display the ECG status area
by selecting the ECG waveform icon using the back, forward and enter keys on the gantry.
b. If the external ECG trigger device is selected and active, the ECG waveform will display on the
external device only. It will not display on the gantry display.
13. If the ECG waveform looks noisy and/or improper R-peak triggering occurs at any time prior to
the diagnostic scan series, use the impedance measurement utility on the ECG trigger device to
ensure proper electrode connection. See Check Electrode Impedance on page 581.
Reposition any electrodes with poor electrode connection and recheck the impedance value.
After repositioning any electrodes, initiate another impedance measurement. Repeat this process
until all electrodes indicate successful impedance measurements.
14. Check the waveform. The more abnormal the waveform, the less chance for a successful cardiac
exam. A calm patient keeps the heart rate steady with a repeatable rhythm. A significantly varying
heart rate can result in non-diagnostic images. A low and stable heart rate typically allows for a
high-quality study with low radiation dose.
1. Using the back, forward and enter keys on the gantry, select the ECG settings icon on the gantry
display.
2. Select the ECG trigger device, and adjust the ECG settings as needed.
Internal ECG trigger device settings that can be edited include:
• Active Lead: lead I, lead II, lead III or auto
• ECG Waveform Auto Display: enabled or disabled
• Alternatively, Active Lead Selection can be changed from the gantry display.
a. Press the forward or back arrow on the gantry controls to select the Active Lead
Selection button .
b. Press Enter.
c. Press Enter until the desired lead is displayed.
NOTE
If the external ECG trigger device is selected, all other menu options are disabled.
See accompanying user documentation for instructions.
Gantry Display
The gantry display allows you to initiate an impedance measurement, if the internal ECG trigger device
is selected and active.
1. From the gantry display, select the Check Impedance icon.
Figure 252 Good and Poor Electrode Connections and Active Lead
NOTE
Lead I (LA & RA): is going to tell you about the top portion of the heart.
Lead II (RA & LL): is going to tell you about the right side of the heart (Right Ventricle &
Right Atrium).
Lead III (LL & LA): is going to tell you about the left side of the heart (Left Ventricle & Left
Atrium).
Lead RL: is a reference point used by all lead types. It is imperative that proper patient
prep is adhered to ensure best outcomes.
On the scan monitor:
The ECG trace will indicate the lead to check.
Figure 253
Click Run Impedance Check to check the signal again, or click Override to ignore the low signal
condition for the rest of the exam. Reposition any ECG electrodes that fail the impedance check.
NOTE
Override may cause erratic triggering and possibly a scan abort. Use Override only
when absolutely necessary.
Number Description
3 Reconstruction window
When Auto Gating is “On”, scan settings in the ECG and Gating collection are automatically updated
when a patient breath hold ECG is recorded. These settings are indicated by a white dot, and are
highlighted when an update occurs.
The ECG Trace is automatically displayed on the Scan Settings window when an ECG-gated scan mode
is selected.
For scan modes that are not ECG-gated, the ECG Trace is displayed when the ECG option is "On" in the
ECG and Gating collection. Note this can be preset for each series in a protocol.
Place the cursor in the ECG Trace viewer and right-click to display the Statistics menu.
• Select Reset Statistics to reset or clear the current statistics if the patient's heart rate has
changed. This step may be desired if there has been a change in the patient's heart rate or if a
modification of the electrodes or leads has caused changes to the waveform.
• Select Preferences to open the Stats Preferences window. From the Stats Preferences window,
select values for any of the following options:
• Select Stats Window to define the moving window of time during which the heart rate
statistics are calculated (Min, Avg, Max). Heart rate is a real-time heart rate. Minimum HR
is the minimum heart rate detected within the time frame you specify. Maximum HR is the
maximum heart rate detected within the time frame you specify. Average HR is the heart
rate averaged within the time frame you specify. The default is 30 seconds and the allowable
range is 5–60 seconds.
• Click Apply.
2. Select Cardiac.
3. Click Apply.
After the scan, additional cardiac phase type selections are available. See Cardiac Recon for more
details.
In the example shown above, a 1 beat acquisition was performed, with available phases from 15–
110%. Enabling the One Heart Cycle option will cause the annotated phases to always be between
1–99%, or in this example, 0–95% by 5% intervals.
• Cardiac Helical is a lower pitch helical scan and is available for cardiac applications in conjunction
with the Cardiac Helical option. In this scanning mode, heart rate monitoring is performed during
the helical acquisition and the associated EKG gating information is stored with the scan mode
such that a cardiac gated SnapShot reconstruction algorithm can be applied for prospective and
retrospective images. SnapShot reconstruction is used to minimize the motion of the heart in the
resultant images. The pitch factor for the cardiac helical scan is determined by the system and is
a function of the patient heart rate and scan speed. Pitch factor table at different scan speed is in
table xxx
53-60 0.16
61-68 0.18
69-74 0.2
75-80 0.22
81-86 0.24
87-92 0.26
(continued)
Scan Speed BPM Pitch factor
93-99 0.28
100+ 0.3
41-49 0.18
50-57 0.2
58-65 0.22
66-70 0.24
71-75 0.26
76-80 0.28
81-85 0.3
86+ 0.32
• When using Cardiac Helical at higher heart rates, not all coronary vessels may be motion free at
all phases. If the heart rate change is less than 15 BPM, at least 1 phase will have vessel motion
frozen.
• When using Cardiac Helical with higher heart rates, consider generating the following on an AW
system: Secondary Recon with Temporal Enhance and post processing with SnapShot Freeze.
• Images acquired with Cardiac Helical are annotated SSEG.
• It is an acquisition and reconstruction method used to generate retrospectively ECG-gated images
using data from one cardiac cycle in a half-scan reconstruction technique.
For very low heart rates, such as below 50–55 BPM, it may be possible to reduce this value when doing
mid-diastolic (for example, 75%) imaging, as the quiescent duration is long enough that acquisition of
the exact prescribed phase may not be required.
Allowed values are 0 to 10 BPM.
The user inputs the top and bottom of the region where imaging is required. The system generates
scan prescription parameters that will cover these top and bottom locations out to the edge of the
DFOV specified for the primary reconstruction. Additional image slices will also be reconstructed
above and below these locations to the extent allowed by the geometry of the system. The first and
last image locations are displayed, and these values can be indirectly changed by specifying where full
field of view images are required.
14.3.7.1 Considerations
The advanced, wide coverage system is able to generate high temporal-resolution images throughout
most of the imaged volume. Additionally, the system generates images with excellent spatial
resolution but with increased susceptibility to motion artifact in the outer radial portions of several of
the first and last images. For this reason, we recommend that the scanned region extend at least 1 cm
beyond the heart in all directions.
Gating workflow provides the capability to record heart rate statistics during a breath hold to
determine the acquisition settings best suited for the heart rate characteristics of the patient.
For example, at higher heart rates, end-systolic phases are usually preferred due to the lack of a
diastasis period in mid-diastole. Auto Gating automatically uses heart-rate specific acquisition settings
(called “profiles”) from predetermined lookup tables.
A patient's heart rate can change over the course of a cardiac examination and result in suboptimal
results if adjustments are not made prior to the diagnostic cardiac CT scan. A patient's heart rate
should be assessed throughout an exam to watch for heart rate changes.
Consider the following factors that can impact a patient's heart rate during Coronary CT Angiography
(CCTA). These factors should remain consistent between the practice breath hold and the gated
cardiac exam to ensure that the pre-scan heart rate assessment is accurate.
• Breath Hold Technique — end inspiration, mid inspiration, suspended breathing, et cetera
• Time Delay — after the breath hold command
• Contrast — total volume, injection rate
• Beta Blockers — oral and or IV
• Vasodilators — can lead to slight increase in heart rate
• Patient aspects — sex, age, electrophysiological disease, cardiac function issues
Number Description
3 Diagnostic scan
The Acquisition Window Parts, described below, set the desired areas of the cardiac cycle to be
imaged and thus determine the overall exposure time of the scan(s). The kV and mA Control settings
determine the mA values as a function of the heart cycle and thus determine the dose of the scan(s).
75%
70%-80%
40%-80%
40%-55%
End-systolic
Tighter acquisition
window. Only targets
mid-diastole or end-
systolic; never both.
73 BPM
Immediate transition
from mid-diastole to
Narrow end-systolic (73 BPM).
Peak End-diastolic range
is slightly narrower
41-53% compared to
Low Dose CCTA. This
profile is should be
used in conjunction
with 0.234s option.
Tighter acquisition
76 BPM window. Only targets
mid-diastole or end-
systolic; never both.
CACS Immediate transition
from mid-diastole to
end-systolic (76 BPM).
No usage of 0.35 s/
rot.
Beat Window Length, and selected Auto Gating profile (GE Adult Coronary). The system preset for
the Irregular Beat Window is set to 60 seconds. Auto Gating uses the patient's recorded heart rate
information to predict the heart rate behavior during a CCTA scan to optimize the parameters for
each patient. You can acquire a recording automatically during scan acquisition (timing bolus, calcium
scoring series, etc.) or manually during a practice breath hold by using the Record New HR option in
the Acquisition Window and Heart Rate widget.
NOTE
Irregular Beat Window Length is set in System Preferences on the ECG tab.
• Minimum will generate images with some susceptibility to motion artifacts in the outer region of
axial slices near the table position boundary. This is the pre-populated setting in the GE Reference
protocols.
• More overlap will generate images with optimal temporal resolution, and hence, minimal
susceptibility to motion artifacts throughout the axial slices near the table position boundary.
The increased overlap results in a higher dose scan than Minimum.
• The heart icon on the gantry display indicates that the internal monitor is connected to the
gantry.
• The instantaneous BPM heart rate is shown on the user console and gantry display.
• If the heart rate does not display and a lead off message is displayed, follow these guidelines:
• Check Gating box to view the ECG trace on the scan monitor.
• Check electrode placement. Consider an alternative placement to improve the cardiac
signal.
The exposure starts immediately following the R-peak and terminates following the next R-peak such
that a full heart cycle can be reconstructed. Robustly covers heart rates down to 30 BPM. If a early beat
is encountered during the exposure, the exposure will be extended for one additional beat. If multiple
early beats are detected, the exposure is extended for one beat total.
The phases, time, or beats to be acquired are shown graphically in the Acquisition Window and Heart
Rate widget.
Allowed values for the Acquisition Window are from 0 – 300%, 0 –1000 ms, or 1–3 beats. A typical
value is 75%, typically corresponding to mid-diastole. Values greater than 100% are for phases to be
acquired from the following beat, most commonly used for Acquisition Window Part 2 or Acquisition
Window Part 3.
Set the mA value for this Acquisition Window to a percentage of the value specified in the kV and mA
Control setting. Lower values reduce dose, but will also increase the amount of noise in the images.
The mA value set here is the 100% level for Acquisition Window Part 2 or Acquisition Window Part 3
below.
If acquiring data for multiple purposes (coronary, function, et cetera), Coronary Assessment
acquisitions should be prescribed in Acquisition Window Part 1.
Widen for SnapShot Freeze (SSF)
Set the Widen for SnapShot Freeze gating parameter to “On” to ensure that the system will acquire
sufficient data to support SnapShot Freeze processing at all of the prescribed phases or times.
For example, if Acquisition Window Part 1 is 70%–80% and the Widen for SSF gating setting is
enabled, then as long as the heart rate is within HR Variation Allowance of the predicted heart rate, the
system will be able to generate images to support SnapShot Freeze processing at both a 70% and 80%
target phase, and any target phase in between.
Applying this parameter to a part of the Acquisition Window can result in a slightly larger data
acquisition window. To reduce patient dose, this parameter should not be applied to the part or parts
of the Acquisition Window that will not be used for coronary assessment.
NOTE
The system limits the number of automatic rescans to 1 per location and 2 per scan
series.
NOTE
Smart Arrhythmia Management may be enabled only if the number of passes is set to 1.
NOTE
Do not scan until you have an acceptable cardiac waveform and heart rate.
7. Secure both IV tubing and ECG cables. Make sure that the cables do not dangle from the table.
ECG lead wire movement during the scan can result in a degraded signal.
8. Review breathing instructions with the patient.
9. From the Protocol Selection window, select a cardiac protocol and click Accept.
10. From the Scan Settings window, review the current settings and click Confirm Settings.
11. Press Move to Scan.
NOTE
When a 90° or 270° azimuth scout is acquired, the system will assess patient
centering. If the patient is centered, a single orange line will display on the image. If
the patient is off‐centered greater than 2 cm, the system will display the table height
location and an up or down arrow to indicate the elevation needed to reach that
height. Use the gantry control to press and hold the indicated button along with the
fast button to move the table to the recommended height.
12. Deliver the breathing and table movement instructions.
13. Press Start Scan.
14. Repeat steps 11–13 to acquire an orthogonal scout scan.
15. Proceed to Acquire a heart localizer or calcium score scan (optional, but recommended) on
page 610.
NOTE
Override may inhibit the ability to start the scan, cause erratic triggering, or result in
the scan being acquired using simulated R-peaks if the patient's ECG R-peak signal
is lost during the scan.
Number Description
NOTE
Elapsed time represents the time from the first non-scout image acquired in the
exam.
a. Count each tick mark to the peak of the curve.
b. Multiply the number of tick marks by two.
c. Add 5 seconds for prep group delay.
• This time represents the time it takes for the contrast once injected to reach the aortic
root where the coronary arteries branch off (Time to Peak enhancement).
• If you use the GE reference protocol, image number one is at 5 seconds and the tick
marks are 2 seconds apart, as shown in the graph above.
d. Add 3–4 seconds to allow for filling of the distal coronary vessels. The minimum total time
should be set to 24 seconds or greater.
In the example below, total time = 24 seconds. The value will be entered in the Prep Group
Delay fields in the Timing collection on the Scan Settings window, for the contrast enhanced
cardiac scan.
• (7 tick marks × 2 = 14 seconds)
• (+5 for prep group delay = 19 seconds for peak enhancement time)
NOTE
If total time >= 24 seconds, no additional delay is required.
NOTE
When a Cardiac SFOV is selected, dose is computed based on a 32 cm phantom.
Cardiac Small 25 32
Cardiac Medium 25 36
Cardiac Large 25 50
Ped Body 25 32
3. Position the scan lines to cover the complete heart from approximately 1 cm superior to the left
main coronary artery ostium to 1 cm inferior to the apex of the heart.
4. Confirm that a cardiac scan mode is selected.
5. Review the heart rate measurements made during the breath hold recording, and the ECG and
Gating settings that were adjusted based on those measurements. If you have not recorded a
breath hold recording, do so now.
6. Review the ECG and Gating settings.
• The data acquisition windows/parts indicate the portion or portions of the cardiac cycle that
will be imaged.
• When using Auto Gating, the acquisition windows/parts will change depending on the
patient's heart rate during the most recent ECG recording during a breath hold.
• The expected dose and number of scans are shown assuming no rescans are required, which
is the nominal case.
• This value can be changed after setting Auto Gating to “Off”. Change this value if it is not
appropriate.
8. Enter the prep delay that you determined from the MIROI timing bolus scan. The typical prep
delay time is Peak + 9 seconds, assuming the time bolus scan had a prep delay of 5 seconds.
9. The primary reconstruction for the scan series and may influence scan parameters. If needed,
prescribe additional secondary reconstructions.
10. From the Contrast collection, enter the contrast description and amount for the IV Contrast
setting.
Alternatively, you may choose one of any preset items from the list.
11. Program the contrast injector.
• The protocol to use varies depending on the contrast type, patient size, and injector
capability.
• Consider adjusting the volume of contrast on the second phase to ensure a 6 second range
from the end of the contrast injection to the start of X-ray on. This delay time ensures that
if using saline, you are getting the advantage of the saline bolus in the right chamber. If you
start the scan too soon, you will not see enough saline flush through the SVC. If you start the
scan too late, you will completely flush out the right chamber.
• The time delay from the end of the contrast injection (3) to the start of the scan (5) should not
exceed 6 seconds.
• Skip the next step if Smart Prep is not selected.
Number Description
2 Phase 1
3 Phase 2
5 X-ray on
12. See the Scan Applications chapter; Smart Prep section for more details.
Typical Smart Prep parameters for cardiac scans:
• mA = 40–60
• Monitoring Delay = 10.0 seconds
• Monitoring Inter-Scan Delay (ISD) = 1.7 seconds produces an image every 2.0 seconds
• Enhancement Threshold = 150
• Diagnostic Delay = Auto Minimum or desired delay time
NOTE
In the event patient ECG R-peaks signal is lost after pressing Start Scan the system
proceeds with scanning using simulated R-peaks corresponding to the last recorded
patient heart rate. The system displays a message indicating this condition in the
real time alerts patient handling window. If the user does not wish to proceed with
scanning using simulated R-peaks they may pause or abort the scan. Refer to Check
Electrode Impedence for troubleshooting poor ECG signal.
1. From the image monitor, in the Reconstruction and Imaging Processing area, select the
secondary recon task and click Add Recon.
2. The window displays all of the recon settings available for the secondary reconstruction.
3. Optional:
Type the Start and End locations that fall within the range of the selected group. Add an S (+) or I
(-) prefix to the location.
4. Optional:
Click Thickness and enter a thickness that populates all groups.
• If you only need to change the thickness for one group, or only one of multiple groups, select
the thickness area for that group.
• The original detector configuration at which the patient was scanned affects how you can
change the slice thickness. The thickness in black is available for reconstruction.
5. Optional:
Click DFOV and type a DFOV value.
The system defaults to the DFOV used for the scan acquisition.
6. Optional:
Click R/L Center. Type an offset value. Use one of the following methods to determine the offset
value:
Place the real-time cursor in an image and view the upper‐left corner for the RAS coordinates.
7. Optional:
Click A/P Center and enter an offset value.
8. Optional:
Click Recon Type and select the algorithm.
9. From the ECG and Gating settings collection, click the Recon mode for the phase prescription
method.
This allows you to select the phases of the cardiac cycle from which images are created.
• Single Phase (post-scan only): User specified single %, ms or beats value and interval to be
used for reconstruction.
• Multi-phase (post-scan only): User specified range of %, ms or beats values to be used for
reconstruction.
• Center Phase (1): A reconstruction will occur at the center of acquisition part 1.
• Center Phase (all): Reconstructions will occur at the center of acquisition part 1 and at any
additional acquisition parts with mA greater than 50% of peak mA.
• Smart Phase: A reconstruction that automatically selects the phase of least motion within
the earliest acquisition part with mA greater than 50% of peak mA (e.g. if acquisition parts of
70-80% and 40-50% are prescribed, then the 40-50% range will be evaluated).
• Smart Phase (All): A reconstruction that automatically selects the phase of least motion
within each acquisition part with mA greater than 50% of peak mA (e.g. if acquisition parts of
70-80% and 40-50% are prescribed, then the 70-80% and 40-50% ranges will be evaluated).
• Earliest to Latest: A multi-phase reconstruction based on the scan prescription with a user-
defined increment.
• Earliest to Latest (All): A multi-phase reconstruction adapted to the available data acquired
with a user-defined increment.
The manual options, Single Phase, Multi-phase and Smart Phase, for defining the reconstruction
timing relative to the cardiac cycle, are only available after the scan has been acquired. Smart
Phase -- manual is helpful when you would like the system to search for the phase of least motion
within an explicit phase range.
A typical Multi-phase prescription is 70–80% in 5% intervals, which is applied to all available heart
cycles during X-ray ON. To adjust Smart Phase manually, see Smart Phase.
10. In ECG and Gating settings, select the mode (Single Phase, Multi-phase, et cetera) and enter the
desired phase(s) for reconstruction.
• %R displays standard phase percent reconstruction
• +ms displays absolute millisecond reconstruction
• -ms displays reverse absolute millisecond reconstruction
11. For Multi-phase, enter the Start phase, End phase, and Interval to reconstruct.
• The recommended reconstruction phases are 70–80% with a 5% increment.
• If you are acquiring a functional imaging exam for ejection fraction and wall motion,
prescribe phases from 5–95% in increments of 10% and consider reconstructing the data
with a 2.5 mm thickness.
• One Heart Cycle recon option will restrict the system to only reconstruct one heart cycle of
data and label the images between 0-99%.
• Enabling the Cardiac Multiphase Fixed Interval Recon option in the system preferences will
ensure that multiphase reconstructions using Earliest to Latest or Earliest to Latest (all) recon
types are integer multiples of the prescribed phase interval. For example, if the option is
enabled and a 5% interval is selected, the system will always reconstruct multiples of 5 – 0%,
5%, 10%, 15% etc.
NOTE
A DICOM compliant ECG trace image is automatically saved after each primary and
secondary image reconstruction request. These traces are saved in a dedicated Series
labeled as 599.
Use these images only as a record of the trace used to the generate images. The images
should not to be used for diagnostic purposes.
Shown above is the Smart Phase recon collection when viewed in Protocol Management. Similar to
the manual Phase Type options, Smart Phase Region will be user configurable only after the scan
has been acquired. When the recon collection is observed either in protocol management or prior to
acquiring the scan (e.g. during scan setup) Smart Phase Region will be constrained to Auto and Region
Selected will not be displayed on the UI.
As depicted below, when the recon collection is viewed post-scan the Smart Phase Region and Region
Selected fields are both displayed. The Smart Phase Region will have selectable dropdown values
of Auto in addition to the total number of table locations scanned. The values listed correlate to the
chronological order of table locations scanned. The Region Selected field is also displayed indicating
the corresponding z-locations for the selected SmartPhase Region. If Auto is selected this field also
displays the corresponding scan number.
Number Description
Heart rate statistics are displayed: minimum, maximum, average heart rates and
1
number of irregular beats.
Secondary reconstructions parameters are displayed: start phase, end phase, and
2
interval.
The trigger point on the ECG Trace for each R-peak is displayed, as well as the X-ray on
3
interval, and the image reconstruction timing when images will be generated.
4 Click the Save icon to save your modified trigger locations with exam information.
5 Click the Restore icon to restore the original ECG Trace information for the acquisition.
Click the Measure icon to measure, in msec, the distance between two defined points
6
on the waveform. Place the cursor on the trace and click and drag right or left.
Click the Magnify icon or the Minimize icon to magnify or minimize the ECG wave-
7
form.
8 Click and drag the navigation bar to view the selected portion of the waveform.
Purple indicates simulated R-peak. If the R-wave trigger timeout occurs after “start
scan” has been pressed – either during the prep delay, during a SmartPrep monitor
scan or after ECG-gating has been enabled - the system will begin simulating R-peaks
9
based on the last known patient heart rate as measured by the system. Cardiac scan
will continue using the simulating R-peaks. Simulated R-peaks will be colored as
purple in the ECG Editor window.
1. Place the cursor in the ECG Editor, and right-click and select Switch Scan.
2. The reconstruction window moves from one acquisition to the other acquisition.
When SSF reconstruction is selected, a special 3-phase image series is generated for subsequent
motion correction processing on the AW workstation (or AW Server) with the CardIQ Xpress Process
application.
SSF is prescribed at a specified target phase location appropriate for coronary imaging. In the case of
higher heart rate exams, you may, for example, wish to prescribe SSF at both a 75% R-to-R target phase
(mid-diastole) as well as a ~45% R-to-R target location (approximate end-systole).
All Cardiac Axial scan acquisitions are inherently SSF compatible, meaning that for at least the target
phase location corresponding to the center of the acquisition window, SSF is available. However, when
prescribing an acquisition with a given phase range (70-80% R-to-R for example), if coronary motion
correction is also desired across this full phase range, ensure that Widen for SSF is explicitly enabled
as part of the scan Acquisition Window prescription (Otherwise, in the example above, SSF recon may
only be available at the 75% phase location.).
Constraints
SnapShot Freeze is not available with the following:
• Cardiac Axial PLUS mode reconstruction
• 0.625 Z, overlapped reconstruction 2.5 mm
• DFOV < 15cm
• ASiR-V 90-100%
• Multi-phase reconstruction
• Multiple scans at the same location
• Unlinked groups
• 1024 Matrix
Considerations
• Appropriate cardiac target phase selection (mid-diastole and/or end-systole) is essential for
optimal performance.
• Ensure a sufficient acquisition phase range for the anticipated SSF target phase(s). For ease of
use, utilize the Widen for SSF option within Auto Gating.
• For a single-beat/single-table position acquisition, position the heart well within the wide-
coverage Cardiac Axial scan.
• For an acquisition series that requires more than one axial scan location given clinical coverage
needs (perhaps a bypass graft assessment for example), ensure that the native coronaries are well
within the coverage of one axial scan to prevent having a higher motion vessel near an axial scan
boundary.
• Avoid an excessive image noise level. Select the appropriate kV / mA technique (using the AEC
Noise Index parameter) for optimal performance, and utilize ASiR-V as needed.
• Select a recon type that is appropriate for coronary imaging.
• Poor contrast opacification of the coronary vessels (low or non-uniform HU enhancement from
poor or missed bolus, venous contamination, et cetera) can result in sub-optimal SnapShot
Freeze motion correction.
• Streak artifacts from surgical clips, pacemaker lead wires, etc., in close proximity to the
coronaries, can result in sub-optimal SnapShot Freeze motion correction.
• Utilize targeted reconstruction to maximize pixel resolution; however the prescribed DFOV should
allow for at least 2 cm of tissue between the edge of the DFOV and the heart. Do not “over-zoom”.
• As SnapShot Freeze targets coronary motion, for an acquisition series with a scan range
significantly longer than the heart itself, select only the axial scan location(s) containing the
heart to streamline subsequent SSF motion correction processing.
• Millisecond-based phase prescription and the ECG Editor are fully compatible with SnapShot
Freeze. Utilize as needed.
NOTE
SnapShot Freeze is not available for a Primary Recon.
1. From the image monitor, in the Reconstruction and Imaging Processing area, select the
appropriate Secondary Recon task (prescribed as part of the protocol) or add a Secondary Recon
task using Add a Recon.
2. Click on an existing Secondary Recon task or add a new one to open the editing panel to the right
of the task list.
• Adjust Thickness and Images per rotation as needed.
• ASIR-V can be adjusted by clicking on the recon settings ASiR-V % menu.
• Adjust any other parameters as needed.
3. Open the Anatomy Selection collection to adjust the recon Start Location, End Location, DFOV,
A/P Center offset, and R/L Center offset as needed.
• The DFOV has to be at least 15 cm.
• The prescribed DFOV should allow for at least 2 cm of tissue between the edge of the DFOV
and the heart.
5. To automatically transfer this series for motion reduction processing with SnapShot Freeze, open
Transfer Options and select the desired hosts. AW or AWS with CardIQ Xpress to process with
SnapShot Freeze.
15 View Images
15.1 Overview
You view images through a series of viewports and access images using the File Manager. You can
also view and work with images and set image-viewing preferences on the Reconstruction and Image
Processing window. This window is available during the scan session and when accessing raw scan
data via Scan Data Manager.
Scout Acquisition viewports These viewports display scout images as they are acquired. The acquired scout
images alternate between these viewports.
By default, the most recent scout image appears in the bottom viewport.
On the bottom viewport, you can select next or previous series to see different
scout series in the exam.
Auto-View viewport The Auto-View viewport displays the quality control image being acquired in
real-time as each volume is being reconstructed.
You can page through these images.
Quality control images are displayed in this viewport as the volume is created.
This allows you to ensure the images being acquired are adequate, without
having to wait for a full reconstruction to complete. QC images are marked
“QC/Quality Check”.
Navigation viewport Quality control images are displayed in this viewport if they are acquired. QC
images are marked “QC/Quality Check.”
window, including set up, monitoring and transferring. It also allows you to view the images created
for any image-processing series.
Several image-processing tasks work only with raw or unprocessed scan data. For this reason the
Reconstruction and Image Processing Task List and its functionality is available during the initial scan
session, when it opens on the right monitor. You also access the Reconstruction and Image Processing
Task List by opening an exam in the File Manager.
2. From the Exam List, double-click the exam you want to view. The exam opens in a patient session
tab, and the File Manager drawer closes. Alternatively, click the Select Patient icon to the left of
the patient’s name, or right-click the exam and then click Open Exam.
NOTE
If the exam fails to open or a error dialog is shown, try opening the exam from the
Scan Data Manager. See Add reconstruction in Data Management.
Refer to the File Manager section of the Data Management chapter for information sorting the Exam list
and on setting which columns display on the list.
2 Toolbar containing frequently used tools 4 Images scroll bar – click and drag to show the
images in the series
Page — click this icon to use the left mouse button to page through the images.
Pan/Roam — click this icon to use the left mouse button to pan and move around the
image in the viewport.
Zoom— click this icon to use the left mouse button to zoom in and out on the image
in the viewport.
Window width/Window level — click this icon to use the left mouse button to adjust
the window width and window level of the image in the viewport.
NOTE
WW and WL values are not propagated to images that have already
been displayed in the File Manager Viewer. This occurs if WW and WL
are changed before all images in the series have been loaded into the
memory. Wait for 5-10 seconds before changing WW and WL, especially
for data sets of more than 1000 images.
Reset All — Return all images in series to original zoom and orientation
Copy All — Copy all ROIs and user annotations applied to the image
Paste All — Paste ROIs and user annotations applied to the image
Save State — Save the state of the image and create a gray scale presentation state
(GSPS).
NOTE
Scout images that have had a Save State applied are rotated 90 degrees
even if no rotation has been selected for the Save State. The image RAS
annotation is indicated correctly.
Left arrow ← and Right arrow → Left arrow decreases and Right arrow increases window
width
Up arrow ↑ and Down arrow ↓ Up arrow increases and Down arrow decreases window
level
3 Hover-over top of viewport to display tool- 4 Images scroll bar – click and drag to show the images
bar in the series
1 Toolbar containing frequently used tools 2 Images scroll bar – click and drag to show the images
in the series
Figure 278 Right mouse menu on the Reconstruction and Image Processing viewport
Reset All — Return all images in series to original zoom and orientation
Copy All — Copy all ROIs and user annotations applied to the image
Paste All — Paste ROIs and user annotations applied to the image
Save State — Save the state of the image and create a gray scale presentation state
(GSPS)
which viewport each image series is to be displayed. In Protocol Management you can enter the
setting for each reconstruction or image processing set of images. Mouse over the icon to enlarge it,
then click on the viewport in which you want to view the recon or reformat series.
NOTE
Window Width (WW) and Window Level (WL) values do not change in any viewports
except the Auto View Viewport once Auto View starts until the recon task is complete.
This is because the cursor focus is locked to the Auto View Viewport when recon is
active. Wait until recon completes to change the WW and WL.
Figure 279 Viewport selector in Reconstruction and Image Processing Task List
15.2.3.1 Auto-View
The upper left viewport will always auto view the primary and secondary recons unless the recon
Clinical ID is Stroke.Perfusion. Once reconstruction of the volume is complete images will display
automatically in the viewport.
NOTE
Paging series with an unequal number of images does not keep paging synchronized. To
view individual series use the Next/Prior Series arrows from the hover menu bar.
1. From the Reconstruction and Image Processing window, load the series you want to view into a
viewport.
2. From the viewport control panel, click the arrow next to Export, then click the Cine icon .
3. In the Cine area, click the Play icon , which uses all the default settings. Alternatively,
Define the range of slices in the Check Play All to play all of the
cine display images in the series, or click Play
Range and enter the image num-
bers in the From and To fields.
Select a viewing mode Click the Loop icon to view the Loop icon
series from start to end, then
from start to end. For example, Rock icon
if there are 20 images in the ser-
ies, the images display 1-20, 1–
20, 1-20, and so on.
Click the Rock icon to view the
series from start to end, and then
end to start. For example, if there
are 20 images in the series, the
images display 1-20, 20-1, 1-20,
and so on.
Play the cine loop forward and Click the Play icon to play the Play icon
backward cine loop.
Pause the cine loop Click the Pause icon. Pause icon
Go to the end of the cine loop Click the End icon. End icon
Go to the beginning of the cine Click the Beginning icon. Beginning icon
loop
(continued)
To do this: Use this setting: Icon:
Step forward through the cine Click the Step Forward icon. Step Forward icon
loop, one image at a time
Step backward through the cine Click the Step Backward icon. Step Backward icon
loop, one image at a time
NOTE
To change the series, load the new series into the viewport.
You can also select Display Normal from the right mouse button menu on the viewport.
enhancement and E3 applies the most. When these filters are used, the image is annotated with E1, E2,
E21, E22, E23 or E3.
The smoothing filters decrease the appearance of noisy images or enhance low-contrast areas when
filming soft tissue. There are five Smoothing filters, S1, S11, S2, S22 and S3. S1 applies the least
amount of smoothing and S3 applies the most. When these filters are used, the images is annotated
with S1, S11, S2, S22, or S3.
The Lung Enhancement filter is designed specifically to use when filming lung windows. When the
Lung Enhancement filter is applied, the image is annotated with lu.
15.3.2.1 Considerations
• Smoothing and edge filters are not additive. Only one filter may be applied to an image at a time.
Applying a new filter negates the previously applied values.
• A new series is not created for the filtered images.
• Filters are applied to image data only.
NOTE
It is recommended to use Clinical Identifier Neuro Routine Head, Neuro Routine
Head with Contrast, Stroke.Routine Head, Stroke Routine Head with Contrast,
Trauma Routine Head, or Trauma Routine Head with Contrast to enable Head-
specific filters that reduce artifact near the bone brain interface.
3. To turn off the filters, click None for the filter type.
Alternatively, click the Display Normal icon from the Image Display set of tools.
1. From the viewport control panel, click the arrow next to Image Display, then click the Filters icon
.
1. From the viewport control panel, click the arrow next to Image Display.
2. Click the icon corresponding to how you want to reorient the image.
(continued)
To reorient the image in this direction: Click this icon:
3. To return the image to its normal orientation, click the Display Normal icon from the Image
Display set of tools.
NOTE
Display Normal does not affect the orientation of secondary focus viewports. Put the
viewport in primary focus and select Display Normal again.
2. From the viewport control panel, click the arrow next to Export, then click the Save State icon
.
The GSPS object will be saved as series 10,000 for the current exam.
3. To view additional GSPS objects in the series, click the Image List icon and select the
desired GSPS from the list, then select the image view icon .
Place an elliptical matte Type ematte in the Command box and press Enter.
Place a rectangular matte Type rmatte in the Command box and press Enter.
To propagate the matte to all images in the series, type prop a in the Command box and press Enter.
NOTE
To remove all graphics from a viewport, click the Remove all Graphics icon
on the viewport right mouse menu.
Hold down the Control (Ctrl key), and right-click in the viewport, and drag the image to the desired
position.
15.3.10.1 Mouse
1. Place the cursor over any viewport.
2. To adjust only the window’s width, middle-click and drag the mouse:
• to the right to widen the window width (make the image gray).
• to the left to narrow the window width (make the image more black and white).
4. Middle-click and drag diagonally to change both the window width and the level.
15.4 Measurements
Figure 285 Measure/Annotate tools
NOTE
Freehand ROI shows distance statistics, not ROI statistics. Use Ellipse or Box ROI for
ROI statistics.
NOTE
The Ellipse ROI button is also available from the hover menu bar which appears
when you hover your cursor over a viewport.
3. Position the cursor on the image and click to deposit the insertion point.
• For Draw free hand ROI, move the solid blue box to the start point. Press and hold Shift, then
click and drag to define the area for the trace.
• For Rectangular ROI or Ellipse ROI, click and drag on the small box in the upper-right corner
of the ROI to resize or click the ROI number and drag to a new location.
1. From the viewport control panel, click the arrow next to Measure/Annotate to display
measurement icons.
2. Click the MIROI button to open the MIROI controls window.
3. Define the region of interest using either the eillipse ROI button or the rect ROI button.
4. Click and drag the ROI to the anatomy of interest. Size the ROI to fit completely inside the aorta.
5. Click Plot.
6. Use the graph to calculate the scan delay.
7. Optionally, screen save the graph. Right click and select Screen Save
NOTE
Elapsed time represents the time from the first non-scout image acquired in the exam.
2. Click and drag the center point of the grid to move it.
3. To remove the grid, click the Grid icon again.
NOTE
You can click the Add Line ROI icon from the viewport hover bar, which displays
when you hover your cursor over a viewport.
3. Click and drag either end point of the start and end locations to adjust the line segment size.
4. Click the arrow next to Image Display. Select ROI Text page.
• This is useful when more than three measurements are on a viewport.
• You can screen save Text page ROI.
NOTE
You can click the Report Cursor icon from the viewport hover menu, which displays
when you hover your cursor over a viewport.
3. Click Report Cursor again to turn it off.
4. Move the mouse to the selected viewport and enter the text.
• To move the annotation, click on the blue box and drag.
• To move the end of the line, click and drag the arrowhead.
• To remove the line, click and drag it into the box.
6. Click theErase all graphics icon on the viewport toolbar to remove all annotations.
3. Click either the Exam Textpage, Series Textpage or ROI Textpage button.
4. Click the Save as Secondary Image icon to save the displayed information to series 98.
You can also right click on the image, then click Screen Save.
2. To remove measurements, select the measurement, then click the Erase Selected Graphics. icon
or press the Delete button on the keyboard.
3. To hide graphics:
a. Select the annotation you want to hide.
b. Click Hide Graphics icon .
c. To remove graphics, click theErase all graphics icon on the viewport toolbar.
NOTE
Screen Save images are not PPS aware. Images created in Reformat, 3D, and Navigator
are not PPS aware. Image types INPR is posted in the PPS column in the browser even
though PPS is not enabled.
1. From the viewport control panel, click Export.
2. Click the Save as Secondary Image icon to save the displayed information to Series 99.
You can also right click on the image, then click Screen Save.
For example, if you wanted to display lines showing previously scanned locations for the third series,
images 1 through 20, with the lines appearing on every third image, you would type: xr 3 1–20:3
into the Accelerator Line, and then press Enter.
The table below lists available commands with descriptions and their applicable applications.
Image moni-
Scan moni-
Scan moni- tor (right)
tor (left),
Command / Description tor (left) patient ses-
scout view-
viewport sion view-
port
port
ac
Applies custom annotation to the image displayed as defined by X X X
Display Preferences settings.
af
X X X
Restores full annotation to the image displayed.
an
X X X
Removes all annotation from the image displayed.
ang
Creates an angle type measurement cursor by explicitly describing X X X
the end points of the lines that make up the cursor.
ap
Applies partial annotation to the image displayed as defined by X X X
Display Preferences dialog box on Exam Rx screen.
dist
X X X
A measure distance line will appear on the screen.
eag
X X X
Removes all graphics from the selected image.
eg
X X X
Removes selected graphics from the selected image.
el
X X X
Creates an ellipse type measurement cursor.
ematte
Displays an elliptical black matte or mask around the image. Size is
adjustable with the mouse by a left click and drag on the red open X X X
box. Position is adjustable by a click and drag on the edge of the
matte or the red solid box.
fi <filter name> filter names: e1; e2; e21; e22; e23; e3; lung; (for
edge enhancement) s1; s11; s2; s21; s3; (for smoothing filters)
and none
Apply/remove edge enhancement and smoothing filters on selec-
ted images. Edge enhancement filter names are, from least sharp- X X
ening to most: e1, e2, e3, lung; smoothing filters are named s1,
s2, s3. Entering the command fi e1 applies the least image sharp-
ening,; entering fi lung applies the most. For example: fi e1, fi e2, fi
e3, fi lung, fi s1, fi s2, fi s3, fi none.
flr
X X X
Flips the image left/right.
flrtb
X X X
Flips the image left/right and top/bottom.
ftb
X X X
Flips the image top/bottom.
fo <rows>< columns>
For example: fo 4 3
Formats the display screen as specified by rows and columns. The X
above example displays images across the screen in four rows and
three columns, or common twelve-on-one.
freehand
Displays a small solid red box that can be used to draw a freehand
trace for an ROI. You must click on the image where you want to X X X
start. Then select the red box while holding Shift on the keyboard
and move the mouse cursor around the screen to draw the trace.
hg
Hides all graphics on the selected image. The undo function is X X X
show graphics.
inv
X X X
Reverses the blacks and whites on the image.
ns
Displays the first image of the next series from the displayed exam X
in the selected viewport.
no
Restores the image display to display normal mode: removes all X X X
zoom, filter, pan, annotations etc. applied to the viewport. Displays
the image from the disk as created.
nori
X
Takes reference image off of selected image.
noria
X
Takes reference image off all images in the selected series.
noxr
X
Removes cross-reference lines from the image display.
pi <interval>
Allows you to set the interval for paging. The pa command must be X X
used prior to setting paging interval.
pm <spatial/temporal>
Allows you to change the mode for paging. Selecting temporal will X X
display the images in a loop mode. Spatial will display images in a
back-and-forth mode.
ps
Displays first image of the previous series of the displayed exam in X
the selected viewport.
prop <range>
range: a= all images in series; s = series; i = image range (1-15)
For example,: prop a or prop i 1-15)
Displays selected graphics on the specified images. The “i” is lower
X X X
case sensitive. In the first example, the graphic displays on all
images called into the viewport until cleared by another command
(such as erase graphics) or a different series is displayed in the
viewport. In the second example, the graphic is applied only to
images 1 through 15 in the current series.
rc
Displays (reports) current mouse cursor location in pixel coordi- X X X
nates, and a single pixel ROI reading.
rect
X X X
Creates a rectangle measurement cursor. Used for ROI.
ri
X
Puts a reference image on the selected image.
ria
X
Puts a reference image on all images in the series.
rl
X X X
Rotates the image 90 degrees counterclockwise.
rmatte
Displays a rectangular, black matte or mask around the image.
You can adjust the by clicking and dragging the red open box. You X X X
can adjust the position by a clicking and dragging the edge of the
matte or the red solid box.
rr
X X X
Rotates the image 90 degrees clockwise.
rs
X X X
Reset image to initial display parameters.
scnsave
Captures the selected image exactly as it is displayed, and creates
a new image with a series number of 99 on the system disk that in- X
cludes all graphics and display factors applied to the image and/or
viewport at the time of capture.
scroll <dx><dy>
X X X
Scroll images by delta x and delta y pixels.
sg
Shows, or re-displays all graphics on the selected image which X X X
were hidden with the hide graphics command.
siw
X X X
Applies default window width and level setting to the display.
tpe
X
Displays text page for the exam.
tm <on> or <off>
Displays or removes horizontal and vertical tick marks (rulers) X X X
along the border of the image.
tpr
Displays a text page for the image in the primary viewport which X
lists all the ROI cursors and their statistics.
tps
X
Displays text page for the exam/series.
ua
X X X
Displays specified text in a user annotation field on the image.
wl <level>
X X X
Applies specified window-level setting to the display.
ww <width>
X X X
Applies specified window-width setting to the display.
zo <factor>
Factor: magnification factor
Magnifies the image by the factor specified. For example, zo 1.5 X X X
displays the image one and one half times larger than its display
size.
autofit
X X X
Returns or sets zoom to a factor of one.
Figure 289 Right mouse menu on image to set annotation level — image at full annotation
You set the default annotation level from the Viewports tab of System Preferences. Refer to Set
Viewport Preferences for more information.
viewport control panel. The system series binding setting for the viewport until you click the button to
change the setting.
You set the default series binding from the Viewports tab of System Preferences. Refer Set Viewport
Preferences to for more information.
16 Display Applications
16.1 Overview
NOTICE
Add/Subtract
Direct Multi Planar Reformat (DMPR)
Exam Split
16.2 Add/Subtract
Considerations:
• Add/Subtract can process a maximum of 1,000 images. To select a range of images, select the first
image in the range, hold the shift key and select the last image in the range.
• Add/Subtract images are displayed in the series type column of the Series list as either processing
pairs (Proc) or combination (Comb).
• Proc is the result of processing pairs of images that have identical locations in the patient’s
body. Proc series can be used like any other series of acquisition images, for example,
geometrical measurements, reformatting, 3D reconstructions, etc.
• Comb is the result of a combination of images having different locations in the patient’s
body. The absolute anatomical coordinates accompanying Comb series are not accurate
and therefore only relative geometrical measurements (for example, distance, angle or area)
made within a resulting image are accurate.
Image addition Adds image intensity values pixel by pixel and is useful for adding thin slices
together to get a thicker slice.
Image subtraction Subtracts image intensity values pixel by pixel and is useful to evaluate con-
trasted vessels.
NOTE
Patient movement and breathing between the images can affect
the quality of the subtraction.
Maximum pixel value extrac- Locates maximum image-intensity values pixel by pixel. This is useful for
tion contrasted vessels or calcifications.
Minimum pixel value extrac- Locates minimum image intensity values pixel by pixel. Useful when evaluat-
tion ing soft tissue.
Binding Series Creates a new series consisting of copies of selected images from one or more
existing series. Useful if you have images in two separate series and want
them in one series to perform 3D or Reformat.
NOTE
Save State information is not maintained in the new series gener-
ated with Binding Series.
Accept negative pixels Allows negative pixel values in the resulting image, otherwise all negative pixel
values are set to zero.
Ratio slider When both Select Set buttons are used during addition or subtraction, equal
weighting is applied to the two pixels in each pair. You can change that with
the Ratio slider.
Disable Normalization Performs a pixel-by-pixel addition or subtraction. The images are not normal-
ized.
Element Description
Equal (=) Runs the process and generates the new images.
Ratio slider Adjusts the pixel weighting ratio between the two sets. The slider is available only
during addition and subtraction when both Select Set buttons are selected.
Save Series Displays the current series and starting image number of the saved series. By
default, images resulting from subsequent operations are added onto the end of the
same series unless you click New Save Series.
Enter the name of the series in the Description field.
New Save Series Places images resulting from subsequent operations into a new series in the File
Manager series list for this exam. If you do not select this option, the images are
saved in the current saved series.
Mode
Button Description
Max Creates a new series that finds the highest corresponding signal intensity values in the
selected set or sets of images.
Plus (+) Creates a new series that adds the image intensity values of the selected image sets.
Minus (-) Creates a new series that subtracts the image intensity values of the selected image sets.
Min Creates a new series that finds the lowest corresponding signal intensity values in the
selected set or sets of images.
Bind Creates a new series that consists of copies of the selected images from one or more existing
series.
Figure 301 Add/Subtract window with Minus mode button selected showing Accept Negative
Pixel box
Disable Normalization
Performs a pixel-by-pixel addition or subtraction. The images are not normalized.
• Disable Normalization is available for both addition and subtraction.
• If Accept Negative Pixels is not selected the negative pixels are scaled to zero and the resultant
images are clipped to 16–bits if they go beyond the bounds of 16–bit images.
• If both Accept Negative Pixels and Disable Normalization are selected, then Add/Subtract accepts
input of negative pixels and performs a true pixel-by-pixel subtraction. A message displays if any
overflow beyond the 16–bit image size occurs.
Clear Selection
Clears the values associated with the Select Set buttons.
5. Click + or -.
6. For subtraction, click Accept Negative Pixels unless you want the negative pixel values set to 0 in
the resulting image.
7. Typically, use the system provided series number.
8. Click = (equal sign) to generate the images in the exam defined by the left Select Set button.
9. To repeat the add/subtract procedure with a new series number and description, click New Save
Series.
Use the system-provided series number, or enter a new series number in the Save Series field and
a name in the Description field.
6. Click = to generate the images in the exam defined by the left Select Set button.
7. To repeat the add/subtract procedure with a new series number and description, click New Save
Series.
No matter how reformats are applied, they appear in the Reconstruction and Image Processing Task
List.
DMPR allows for:
To combine groups, the following parameters must be identical within each group:
• Scan Type
• Thickness
• Interval
• DFOV
• R/L Center
• A/P Center
Once the recon and multi-planar reformat batch images are created, the Reconstruction and Image
Processing Task List allows you to select and view image sets.
Considerations
• Each group must be contiguous to be able to be combined with the prior group in a DMPR
session. DMPR can be prescribed with primary and secondary recons. DMPR reformats are limited
to 2,000 images. Additional reformat protocols can be added from the Volume Viewer Reformat
application which can be accessed with the File Manager.
• Any scans acquired after scanning has completed on the original scan group using Add Group
are not added to the DMPR session unless Link was selected for the original scan group prior to
scanning. Remember to include all of the desired coverage area in the original scan prescription.
• If the patient orientation is prescribed as Decubitus (right or left), you will observe that the Paging
slider for the sagittal image will scroll images in DMPR coronal viewport and vice versa. This
is because in Decubitus orientation, patient’s sagittals and coronals are switched. Hence, the
DMPR sagittal viewport contains the coronals from patient’s reference axis, and the DMPR coronal
viewport contains the sagittals from the patient’s reference axis.
• Make sure the interval between groups is appropriate to support DMPR in secondary recons 2-10
if the slice thickness prescribed for the groups in primary recon 1 is different.
16.3.1.1 Icons
On the Reconstruction and Image Processing task list, an icon identifies a reformat task.
Indicator: Means:
Currently processing
Transfer in progress
Transfer completed
NOTE
The settings for the reformat are contained in sections on the Reformat Settings panel.
These sections are collapsible. When these sections are collapsed, the current settings
for the reformat are shown on the collapsed panel.
NOTE
The minimum thickness is limited to the
pxiel size of the recon series from which
the DMPR is prescribed. Refer to 23.6 Image
Display on page 1025
NOTE
The minimum interval is limited to the pix-
el size of the recon series from which the
DMPR is prescribed. Refer to 23.6 Image Dis-
play on page 1025
NOTE
FOV is limited to be less than or equal to
the FOV of the recon series from which the
DMPR is prescribed.
Number of images Set the number of images. This value updates based
on slice thickness, angle between images and start
and end location.
NOTE
The minimum thickness is limited to the
pxiel size of the recon series from which
the DMPR is prescribed. Refer to 23.6 Image
Display on page 1025
Preview tool
Before you save or print a batch, you can preview what the batch will look like using the Preview tool
in the Batch Options section of the Reformat Settings panel.
Series Description You can enter a description for the series in this field.
If you do not enter a description, the series will take
the name of the pre-selected protocol. If you are
not using a pre-selected protocol, the series will take
the name “Processed Images”. The Series Description
will always match the Series Description on the Re-
construction and Image Processing Task List for that
reformat.
Host name Select the hosts to which you want to send the refor-
mat when it is complete.
Host default level Standard Selects the priority level of the host. Standard priority
is sent after any High priority entries
Host default level High Indicates the Hosts default priority as set in Sys-
tem Preferences/Networking. Highest priority jobs are
sent as high as long as the maximum number of jobs
for a destination has not been reached
Host default level Low Indicates the Hosts default priority as set in System
Preferences/Networking. Lowest priority jobs are sent
after any Standard or High Priority jobs
Host default level Override Overrides the default priority of the host to High.
Highest priority jobs are sent as high as long as the
maximum number of jobs for a destination has not
been reached.
Select the option corresponding to how you want to send the reformat. Select either Series Complete
or Images Reconstructed
The default is to send each series as reconstruction for it is complete. However, for exams that take a
long time to reconstruct, you can transfer each image as soon as it is reconstructed.
Transferring an exam
You can transfer the entire exam and exam level reports using the button next to each protocol name.
This sends all series in the exam to the selected network locations when:
• You press Done Scanning or Close Exam and
• All recons are complete and
• All reformats are complete
Stopping a transfer
Cancel a transfer before it begins by unchecking the box next to that location. Once a transfer has
started, it cannot be stopped. Once a file transfer has taken place to a selected host, you can no longer
uncheck the selected host box.
When the button is in this state: The reformat is in this state: Clicking the button does this:
Auto-Run You are prescribing the reformat If the button is grayed out, select
task. the appropriate protocol from the
Protocol section.
Click the button to autorun the re-
format after recon data has been
acquired.
Run The recon data is available, but the Click the button to run the refor-
reformat has not been run. mat.
This button is grayed out if you
have not selected a protocol or de-
fined a batch reformat manually,
or an Auto Batch has been run.
2. Select the protocol you want to use from the Reformat Settings panel.
3. Check the Auto Run box in the lower right of the window to enable auto run. DMPR images will be
generated automatically.
NOTE
If Close Exam is selected from the Patient Session, any DMPR with Auto Run enabled
will not generate images. If Auto Run is desired, do not close the Patient Session
until the DMPR Task has completed.
WARNING
SYSTEM HAS DETECTED REFORMAT AUTO RUN JOBS FOR THIS EXAM.
AUTO RUN JOBS IN PROGRESS OR QUEUED WILL NOT COMPLETE AND
REFORMAT AUTO RUN JOBS NOT QUEUED WILL NOT QUEUE IF CLOSE
EXAM IS SELECTED. CLICK RESUME EXAM TO KEEP THE EXAM SESSION
OPEN TO COMPLETE AUTO RUN REFORMAT JOBS THEN SELECT CLOSE
EXAM ONCE ALL REFORMAT JOBS HAVE COMPLETED.
2. Select the protocol you want to use from the Reformat Settings panel. Adjust the settings for the
protocol. Auto Run is not selected.
3. After the source images have been reconstructed, select the reformat task.
4. Adjust the prescription parameters.
5. Click Run.
1. From the Reconstruction and Image Processing Task List, click the down arrow on the series you
want to reformat.
2. Select the protocol (or generic batch) you want to use from the Reformat Settings panel. Adjust
the settings for the protocol.
3. The default reformat views appear in the viewports: left upper viewport-oblique, left lower
viewport-sagittal, right upper viewport-axial, right lower viewport-coronal. If a protocol has been
selected, batch lines appear on the views.
4. Enter the batch prescription parameters and graphically adjust the location.
5. Click Run.
NOTE
Once a Batch is run, it cannot be modified or re-run. Add a new reformat task to create
additional Batch Reformat image sets.
1 Handle to extend coverage, number of images 3 Handle to move the entire reformat plan
in any plane
2 Handle to rotate the reformat angle 4 Handle to adjust the FOV in any plane. IN sagittal
or coronal planes the FOV handle adjusts the magni-
fication of the view, not the z location range.
1 Handle to move the entire reformat plan 3 Numbers showing start and end of reformat
2 Handle to change the angle between the slices 4 Handle to change the range of numbers be-
tween start and end of reformat
Figure 310
16.3.2.7 3D cursor
Use the 3D cursor to point to the same location in all viewports.
Place the 3D cursor by clicking a viewport and dragging the cursor into position, or you can move the
mouse over an area and press the Shift key.
Retrospectively procedures from the HIS/RIS that were not selected at scan time can be selected.
NOTE
Exam Split requires that a worklist server be configured.
NOTE
If multiple accession numbers are selected, lowest accession number selected is listed in
the image header. The accession number is stored in a different DICOM field (0040, 0275)
when multiple records are selected. Use Exam Split to send images to the PACS with the
associated accession number for a particular procedure.
4. From the Default host dropdown menu, select the desired host. This is the host to which images
are always sent.
5. Click the box next to the name you wish to have available for selection in the Split window Hosts
dropdown menu.
NOTE
Patient information added manually and Saved to Schedule using New Patient icon
cannot be selected in Exam Split.
2. In File Manager, highlight the examwant to work with, right click and select Open With, then
select Exam Split.
Figure 314 Accessing Exam Split from File Manager exam list
(continued)
Screen Element Description
3. From the Exam Split window, confirm that the desired procedures are listed.
4. To add a procedure, select .
8. Type the first image number and last image number desired or adjust the slider bar to select
range.
9. Select icon to edit the series description if desired. Click in the series description area
10. Select to check any additional hosts to send the split images to. To
12. If another Split is desired, select Close and repeat steps 2 through 10.
When you build a protocol you can save a pre-configured procedure code for the protocol in the
Recon Output Option settings. When scanning, if there is a pre-configured procedure code for the
protocol, the system compares the recon procedure code prescription with the patient study code. If
they match, the procedure code displays in the Requested Procedure field.
If the recon procedure code prescription and patient study code do not match, the pre-configured
procedure code displays in the Requested Procedure field and the field is outlined in red. In either
case, you can select a different accession number from the patient information in RIS.
You enter, edit and delete pre-configured procedure codes in Set Exam Split Preferences. You can also
use this function to import recently scanned exam procedures for use as pre-configured procedure
codes.
3. Highlight all three exams in Patient Schedule, then click Select Patient. You will not be able to
open multiple exams if the patient names, birth dates and IDs are not identical.
4. Select the protocols for each exam. In this case, select a Head protocol and a Chest/Abdomen/
Pelvis protocol.
5. Run the scout scan. Add a secondary reconstruction to the scout scans for each accession number
in the exam that you want to attach the scouts.
6. For each recon group to be sent to another workstation, in the Output Options group:
a. Set Exam Split to On.
b. In the Requested Procedure, select the name of the procedure to be sent to the other
workstation. The procedures come from the procedures you entered in Step 2.
Figure 318 Output Options showing Exam Split set to On with drop-down list of
procedures
You can leave the Requested Procedure field blank. If there is a pre-configured procedure
code for the recon group and it matches the patient study code, it displays in the field.
If the pre-configured procedure code and patient study code do not match, the field is
outlined in red. You can override the alert or select a different accession number from the
patient information in RIS.
c. In the Transfer Options group, click on the network host to which the exam is to be
transferred.
7. Scan the remaining groups.
8. Dose reports will be automatically added to each procedure selected.
NOTE
Applications available for Advanced Processing follow the Authorized Product Matrix
Manual.
1. From the Reconstruction and Image Processing Task List, click the down arrow on the series on
which you want to use Advanced Processing.
3. Select the application you want to use from the Advanced Processing panel. Check the Auto Run
box in the lower right of the window to enable auto run if needed.
17 Filming
17.1 Overview
The Film Composer is the interface with your camera that allows you to manually film images.
The available film formats are determined by your camera. This section presents the procedures
necessary to successfully film images. To configure a DICOM or Post Script printer contact your service
representative.
ICON Functions
NOTE
Any images added in the Film
Compser will be removed when the
composer is closed. Make sure to
print images if desired prior to clos-
ing the composer.
4 Printer selection
6 Layout Selection
Auto Clear Clear images from the film composer automatically when the print
finishes.
Favorite Layouts Three favorite layouts can be defined (1x1 to 8x8), and the buttons are
displayed. Click on the Layout icon to set.
Film Size and Orientation Sets the film size and orientation to use for the printer selected.
NOTE
The film size and film orientation used will be the last size
and orientation used when the Filmer is opened again.
NOTE
Expose Order is applied only to the current page. You need
to set the expose order on each individual page.
Layout Setting Sets Favorite Layout format and base format for Custom layouts. Click
and drag on the grid to select the desired format.
4. Click and drag to set number of rows and columns for the base format.
5. Click on the film frame you want to resize.
6. Click and drag the yellow line to resize.
7. Repeat with the other film frames until you have the design you want.
8. Enter a name for the layout.
9. Click Save Layout.
The viewport of Film Composer supports the image drag and drop by mouse operation to change the
frame in the page.
The viewport of Film Composer supports the pull-down menu by pressing right mouse button as
follows.
Function Definition/Action
Cut Image Cuts the image in the frame and moves to clip board.
Insert Image Inserts the last image cut or copied into the frame.
Auto Pack Images When checked, assures that blank frames are at the end of the last
sheet when images are deleted automatically and removes blank
frames on layout change to all pages.
Annotation Level Sets the Annotation Level of the film frame. Selections are Full,
Partial, No Annotation or Custom Annotation.
Pack Images Pack Page Fills in blank frames on a single sheet and places blank
frames at the end of the sheet.
Pack All Page Fills in blank frames on all sheets and places blank
frames at the end of the last sheet.
17.3 Filming
Film format selection • As is --- Keep the current Film Composer format
• Customize --- Apply the selected format (1x1 to 8x8)
Image Selection Select All for all images in the series or select Images From to indicate image
numbers to be printed.
Only 500 images can be loaded at a time. If the number of images in the series
exceeds 500, select multiple image ranges to film all images in the series.
Load images Specified images are loaded onto the Film Composer.
NOTE
The graphic objects are added on the film frame when added from the Film Manager,
they are not copied.
Cross Reference can be disabled or enabled from one pull-down menu of right mouse click by
selecting None.
NOTE
The first 5 tools (excluding 1 settings button) on this panel are set by the system and
cannot be changed. The user can select a maximum of another 19 tools from the
settings options available under this panel.
Icon Functions
Apply grid
Display Normal
Add Annotation
Invert video
Propagate ROI
17.4.2 Measure
The Measure Tools collections support the functions in the table below.
Icon Functions
Report cursor
Hide/Show Graphics
17.4.3 Annotate
The Annotate Tools collections support the functions in the table below.
Icon Functions
17.4.4 Analyze
The Analyze Tools collections support the functions in the table below.
Icon Functions
Apply filters
The Filming status for the series can be displayed in the File Manager as Filmed status when images
are filmed from the File Manager viewer only.
The Filming status icon can show the status below.
• Full --- All or Partial images are printed.
Figure 340 Filming Status in File Manager (Left: Exam Level, Right: Series Level)
18 Reformat
18.1 Overview
Use the Reformat software, launched from File Manager, to display and manipulate Reformat data
sets.
NOTICE
• Different Display Field Of Views and Gantry Tilts can be loaded, however you have to select
between different sources of images to view them. The source annotation is located in the upper‐
left corner of the image. You can change between sources by clicking on the red annotation.
18.1.4 Considerations
• If Volume Viewer hangs, simultaneously press Alt and X to clear the issue.
• If a message is displayed indicating images are too far apart or failed to build a reformat model for
series with a large number of images, wait several seconds and launch Reformat again. When the
series has a large number of images, the system may not have identified how many images are in
the series before Reformat tries to start.
• Reformat does not include the slice location for axial images. If axial slice location is needed,
generate the images in DMPR or generate secondary recons of the data.
18.2 Reformat
Reformatting allows you to define and display cross-sections of a 2D stack or 3D volume of image data
that are oriented differently from the original acquisition images.
A baseline view is a basic axial, coronal or sagittal view. Of these, the acquisition view displays
the images in the acquisition plane of the original image set, the other two are the corresponding
orthogonally reformatted views. They can be moved to show any location in the 3D volume, but
remain aligned parallel to the three main axes of the Right Anterior Superior (RAS) coordinate system.
An oblique view is a plane reformatted view that can be both moved and rotated to any location and
orientation within the 3D volume.
If a feature of interest extends beyond a single plane, standard baseline or oblique view reformatting
cannot show the entire feature no matter how you position the oblique plane. To create a single view
that includes the entire feature, use curved reformatting to create a curved cross-section.
Depending on system configuration, the system supports Volume Share 5 Applications on console and
Volume Share 7 Applications on console. User instructions for Volume Share 7 Application on console
are found by selecting Learning Solutions, then selecting AWS.
3. Change the view type by selecting a view type from the red annotation.
Click an icon on the top row to set the action of the left mouse button when placed over the image.
Changing the selection in the Image Control area updates the on-view Mouse Modes menu selection.
The icons can be in one of three states:
1. Selected (depressed)
2. Unselected (light blue)
3. Unavailable (grey)
2. Click and drag to rotate 3D/Oblique views and page axial/sagittal/coronal views.
No rotation handle is displayed on 3D/Oblique views when this mode is selected.
2. Click and drag the image to move it up and down and left and right (only applicable if the image
has been zoomed in).
2. Click and drag over an image to adjust the window width (left‐right motion) or the window level
(up-down motion).
Click an image orientation icon to change the plane or a 3D or oblique reformat image.
Button Description
S Superior
I Inferior
A Anterior
P Posterior
L Left
R Right
The Multi Oblique Mode button (left) displays three oblique planes defined by three adjustable color
axis (orange, green, blue).
1. Adjust any axis to update the two other oblique planes.
2. Click again to deactivate the Multi Oblique mode, which keeps the orientations defined in oblique
viewports.
The Single Oblique Mode button (right) displays a line cursor in Reformat, which is used to define a
new plane.
1. Set the function of one viewport to Oblique.
2. Make another viewport primary and then click the Single Oblique Mode button.
A solid yellow line appears, which represents the plane of the Oblique reformat.
3. Place the cursor on the solid yellow line and click and drag it to tilt the yellow line to the desired
plane.
Click an icon to set the action. A user can do this by Left‐clicking the mouse button when placed over
the icon of interest.
The icons can be in one of three states:
1. Selected (Highlighted blue background)
2. Unselected (No Highlighted blue background)
3. Unavailable (grey)
-The user can click the down arrow to visualize more icons within the docking station.
-The user can Left‐click the mouse on an icon, continue holding it down and drag it within the docking
station, to a new location for further customization.
-If the user wants to display additional icons to be immediately visualized within the docking station,
not immediately observed by clicking the down arrow; please perform the following:
1. Preferences
2. ToolBar
3. All docking stations will now display. Select additional icons via the check box so they are added
to the active use docking stations.
4. Once finished, click the X on the top right of the window as changes will be immediate.
2. Click and drag to rotate 3D/Oblique views and page axial/sagittal/coronal views.
No rotation handle is displayed on 3D/Oblique views when this mode is selected.
2. Click and drag the image to move it up and down and left and right (only applicable if the image
has been zoomed in).
2. Click and drag over an image to adjust the window width (left‐right motion) or the window level
(up-down motion).
Locate the Visualization docking station. Click an image orientation icon to change the plane, 3D or an
oblique reformat image.
Button Description
S Superior
I Inferior
A Anterior
P Posterior
L Left
R Right
The Multi Oblique Mode button (left) displays three oblique planes defined by three adjustable color
axis (orange, green, blue).
1. Adjust any axis to update the two other oblique planes.
2. Click again to deactivate the Multi Oblique mode, which keeps the orientations defined in oblique
viewports.
The Single Oblique Mode button (right) displays a line cursor in Reformat, which is used to define a
new plane.
1. Set the function of one viewport to Oblique.
2. Make another viewport primary and then click the Single Oblique Mode button.
A solid yellow line appears, which represents the plane of the Oblique reformat.
3. Place the cursor on the solid yellow line and click and drag it to tilt the yellow line to the desired
plane.
Indicator/Key Description
Film keys Press F1 - F4 for manual filming with the Manual Film Composer.
Space Bar Press the Space Bar to show/hide the MyTools palette.
Press Ctrl and simultaneously move the mouse to page through the
Ctrl Key + moving the mouse
slices.
Press Shift and simultaneously click and drag to draw a trace line as
Shift + click and drag
you move the mouse.
Alt + s Press Alt and s simultaneously to save the image as you name it.
Save Save All Images - saves all images displayed on the screen, individually, as DICOM
images.
Save Screen - saves all images displayed on the screen as DICOM images, as a 4:1
layout.
Save to Report (if ap- Save Image to Report - sends the selected image to the Report Tool.
plicable) Send Screen to Report - sends the whole screen to the Report Tool.
Hide 3D cursor - removes the 3D cursor from the screen. Toggles back with Show 3D
cursor.
Hide Cross-References -
Show all planes -
Reference image - displays a small reference image showing the plane orientation
Display Properties and position of the current image.
Lock orientation - locks image orientation (3D and 2D oblique only). It is not possible
to change the orientation with the mouse in the locked view.
Center on cursor - centers the image on the cursor.
Center on FOV - centers the image on the FOV.
Center on object - centers the image on an object (useful after segmentation).
No Annotation - hides all annotations including the right and left markers.
Full Annotation - shows all annotations. This option is available when full annota-
tions are not shown.
Partial Annotation - hides or shows part of the image annotations (scan parameters).
Annotations
Custom Annotation - shows the annotations that have been checked in the Annota-
tion tab of the Display panel.
User Graphics - shows only the user graphics (including measurements and annota-
tions).
When a trace has been defined with the Display Trace tool, this option is available.
Create trace - create a trace on the image.
Trace Clear last point - deletes the last point deposited.
Clear trace - deletes all points.
Lock cursor to trace - locks the 3D cursor on the trace.
Returns the object back to the center of the viewport. Use this tool if there are blank
Reset Pointer
viewports.
18.3 Display
In most respects, a 3D display view is like any other view. You can adjust window width and level
as required, zoom, and scroll the image. You can add text annotations and change the color of the
displayed object. In theory, you can also perform measurements or define and perform a scalpel cut
on a 3D view since you can mark points and create traces on it. In practice, this is highly inadvisable,
because on the 3D view you have no indication how deep into the 3D object the 3D cursor is located,
and the result may not be at all what you wanted or expected.
A 3D view is different in that it displays an image of the 3D model (which may consist of one or more 3D
objects), and that you can manipulate this 3D model.
On a 3D view, you can:
• Rotate and tilt the 3D model in all directions.
• Define one or more cut planes and display the 3D model with part of it removed, showing a cross
section of the 3D model at the location of the cut plane.
• Place a spherical shutter (mask) on the view to show only an essential part of the model, with the
remainder masked out.
• Use colors, in particular to distinguish merged 3D models in merged 3D views.
• Extract a 3D object or volume of interest from the original 3D models using the Segment tools.
18.3.1 Annotation
There are two types of annotation:
• System annotation which is automatically supplied by the system and is always displayed in the
same place. The type and amount of annotation displayed can be modified but not moved.
• User annotation which is annotation you add. This annotation can be text or measurements and
can be placed anywhere on the viewport.
Text annotation
You can add notes and comments directly on the views, and use a marker with the annotation to point
out anatomical features. User text annotations can be edited, moved or deleted as necessary. When
images are saved, any annotations shown on the images are saved with them.
Preset annotation
Preset annotations are those which have already been created and saved for future use. These
annotations can consist of text or text with measurement annotations. The preset measurement
annotations vary depending on the current protocol. In addition to the supplied default annotations
supplied, you can create and save annotations.
Measurement annotation
You can create and view various measurements (voxel value, distance, angle, area, volume) on the
views. Like text annotations, they can be moved, deleted or edited as necessary.
18.3.2 ROI
The Region of Interest (ROI) tools exist in 2D and 3D. Several shapes are available to measure a region
of interest in any view plane/volume: circle, elliptic, rectangle, and cubic for 3D ROIs. You can use the
ROI tools to obtain information, volumes, areas and statistics of anatomy or pathology. The ROI tools
allow you to:
• measure the pixel intensity value at a specific point on the image
• display the area or volume
• display the mean, standard deviation and minimum and maximum pixel values within the ROI
In order to perform measurements on an image that can be expressed in absolute values (mm), the
image must be calibrated, i.e. the relationship between image pixels and true anatomical distance in
the patient’s body (the scale factor) must be known. For images such as CT and MR this information
is automatically recorded during image acquisition and stored with the image. Measurements on such
images can therefore be expressed directly in mm, using the patient-based Right Anterior Superior
(RAS) coordinate system.
Right-click and select a view type from the menu to change the plane
or select a 3D model. The type of view displayed in each of the four
1 Plane or View Type views of the viewing area is determined by the selected protocol. During
image processing, you can change the view at any time using the active
annotations.
Smooth 1 to 3, Edge 1 to 3, and Lung filters are 2D display filters and are
available only on Axial, Sagittal, Coronal, and Oblique viewports.
Smooth 3D Plus is a 3D anisotropic filter that smoothes the whole vol-
ume. It can be applied on any 2D or 3D viewport.
3 NOTICE
NOTE
CT Filters can be applied on thick slabs only when rendering
is set to “Average”.
NOTE
CT Display filters can be combined with Cardiac filters when
in Cardiac applications.
4 Image Roam Click and move the image within the viewport.
1 Maneuver Docking Stations The Main Docking Station control panel (signified by the black dots
& the yellow arrow pointing to it), can be Left‐mouse clicked and
held down to new locations. The user can place the Main Docking
station as:
1. Top justified
2. Left justified
3. Bottom justified
4. Right justified
2 Paging Direction/Speed a = Click and drag either side button to change the Thickness of the
MIP image. Slice thickness adjustment is not available on 3D views.
b = Click and drag the middle slider to page through the image set.
To page, you can also press Ctrl and click and drag the mouse up
and down.
18.3.5 Toolbar
The Preferences, Toolbar selection tab contains the following tools.
Icon Description
Arrow Tool Deposits an arrow on the screen. Click and drag the end of the arrow to re-size and rotate
it. Click and drag anywhere on the arrow to move it.
Report Cursor Deposits a point on the viewports to display a RAS coordinate and vector ROI at the
current cursor position.
2D ROIs Displays statistics as average, minimum and maximum voxel values, standard deviation,
and area within the 2D ROI.
• Elliptic ROI
• Rectangular ROI
3D ROIs Displays statistics as average, minimum and maximum voxel values, standard deviation,
and volume within the 3D ROI.
The 3D color ROI provides the ability to colorize voxels inside the ROI based on ranges of
voxel value. Additional Statistics such as volume can be calculated for each colored area.
• Sphere ROI
• 3D Box ROI
Annotation Opens the Annotate control panel, which allows you to use predefined annotations on
the views or create new annotation.
Many of the options are linked to measurement tools. For example, the Distance Annota-
tion allows you to link an annotation with a measurement (e.g., Stenosis: xx.x mm).
Preset Annotation Opens the Preset Annotation control panel, which allows you to place preset annotations
on an image.
Straight Distance Opens the Measure Distance control panel, which allows you to perform measurements
on an image.
Measure Angle Opens the 2D Angle control panel, which allows you to deposit thee points on an image.
Measure Volume Opens the Volume control panel, which allows you to deposit a point to obtain a volume
measurement.
Set Color Opens the Set Color control panel, which allows selection of a color map or custom color
to apply to non-VR viewports.
Trace Opens the Trace control panel, which allows you to create and manipulate a curved
reformation, a Profile, or an X-Section.
Rotate/Translate Opens the Rotate/Translate control panel, which you can set rotation by degree and
direction and translation by distance.
Link/Unlink Opens the Link/Unlink control panel, which allows you to unlink multiple volumes to
allow manual registration adjustment.
Cine Opens the Cine control panel, which allows you to automatically page through all of the
slices of a single phase series or control a 4D Cine of multiphase series.
MPR/3D Opens the MPR/3D control panel, which guides you through the creation of 3D or multi-
planar image views. From this panel you can adjust slab thickness and select render
modes such as MIP, Average, MinIP, and Volume Rendering.
2. The user right clicked on the 3D Box ROI and the pop-up menu displayed. Navigate down to 'Color
Coded Display: Activate" and left click now.
3. You will now see the ROI box fill with different colors representing different Housfield Units.
4. Navigate to the Export Docking Station and select: Summary Table icon. You will now be able to
see the summary table display with the ROI information data set.
-Right click on the ROI entry and ensure to click "Color Coded" with a left click of the mouse.
5. You will now see the summary table display data specific to your ROI.
Copy Sets the display of the ROI on one or all viewports for the images.
Statistics Allows any combination of minimum, maximum, average, standard deviation and vol-
ume values.
Size Type in a height, width and depth. There is no depth for the sphere ROI. This will become
the default size of the ROI, but it can be modified directly on the image.
4. On the Annotate screen, click the annotation type (simple, linked, or measure).
5. Place the cursor on the image and click to deposit the cursor and default text.
6. Enter new text in the Annotation text screen.
18.3.10 Measure
Use these procedures to activate a measure tool to obtain information, distances, and areas of
anatomy or pathology.
1. Open Reformat.
2. Click the Display tab.
3. Follow one of the measure procedures below.
2. After the user clicks the Straight Distance icon and places it on a viewport, right clicking on the
line itself now shows the following:
• Color
• Select from the seven default colors
• Thickness
• The user can select from 1px, 3px or 5px.
• Show/Hide
• Hide Statistics
• Hide ID
6. Click the Statistics tab to view range percentages for each color.
7. Change the values of the ROI on the viewport.
a. Click the Configuration tab to change the values of the ROI on the viewport.
b. Click a value in the Min Value column, and type a new value.
c. Click a value in the Max Value column and type a new value.
d. Click a Range name column text box to type a name.
8. To change a color in the color ramp, select a color in the Color column.
a. From the Select new color screen, drag the cursor over a color on the color wheel.
b. View the Current selected color.
c. Click Apply.
9. To add or remove a color in the color ramp, click Add or Remove.
10. Click the Presets tab to load and save Colormap presets.
11. Click Save to save setting adjusted in the Configuration tab.
12. To load a color map preset, select the color ramp preset from the menu.
13. Click OK.
1. Open Reformat.
2. Click the Display tab.
3. Select the desired ROI tool.
3D color ROI is available one color MR or multi-color CT.
4. Define your preferences on the ROI panel.
a. Choose an ROI propagation option.
• Select One Volume to view the ROI on only the viewport on which the ROI is displayed.
• Select All Volumes to view the ROI and statistics on all viewports.
b. Select one or more Statistic options to view any combination of minimum, maximum,
average, standard deviation and area (2D) or volume (3D).
c. Explicitly adjust the size of the ROI.
• For 2D ROIs, type a diameter in the Vertical and Horizontal Diameter fields.
• For 3D VOIs, type a VOI size for the XY-plane and Z-axis depth.
• The sphere VOI does not have a depth entry.
NOTE
To delete the ROI, right-click on the ROI and select Delete ROI.
An image plane dividing the body into left and right por-
Sagittal
tions.
An image plane that has been tilted through the body rather
Oblique
than following the long axis. It can look like a axial image.
4. As you trace, the curved image updates automatically in the curved reformat viewport.
3. For a cross-section (X Section) histogram, in the viewport containing the anatomy of interest,
press Shift and simultaneously click the image to deposit points on the area of interest to create a
trace.
NOTE
The histogram values and statistics are those of the current 3D model, not those of
the original exam. If the 3D model contains only a given range of voxel values, only
voxels within that range will appear in the histograms. Statistics and computed values
of surface area or volume displayed on the histograms are subject to the same accuracy
limitations as other on-view measurements. This tool can be used for cross-section and
volume measurements of specific anatomic features if the feature to be measured can
be clearly defined by a range (class) of voxel values.
Letter Description
(A) Ramp up
Description
Left = Structures presenting density value associated with high opacity reflect light:
they are visible.
Right: = Structures presenting density value associated with low opacity transmit light:
they are translucent.
Description
Left = 100%
Middle = 50%
Right = 25%
Description
0 Low Threshold
50 Low Threshold
Mode Function
Exists only if the model was built using volume mode and is used to display the surface of a
Volume Rendering
model.
Displays the model using the High Definition Maximum Intensity Projection mode. The mode
HD MIP is identical to the MIP mode as described below, except that image definition is greater but
the system speed is slower.
Weighted MIP Displays MIP rendering enhancing front voxels and fading voxels in the back.
Displays the model using the Maximum Intensity Projection mode. In this mode, the density
MIP
of each point on the screen is the maximum density along a line perpendicular to the screen.
Displays the model using the Minimum Intensity Pixel mode. In this mode, the density of
Min IP
each point on the screen in the minimum density along a line perpendicular to the screen.
Displays the model by summing the model’s intensity along lines perpendicular to the
Ray Sum
screen. This mode simulates conventional radiography images.
Displays only the surface of the model, but the density of each surface point is equal to the
Integral
sum of densities along a shallow depth below the displayed surface point.
Enhance Contours Enhances boundaries of structures. This is useful to display vessels or orthopedic
cases.
Transparency Makes internal objects transparent and makes objects boundaries more visible.
Histogram Displays the voxel distribution (number of voxels per voxel value) in the image. Peaks
correspond to voxel values that are highly represented in the image.
Vertical Red Line Represents the numerical value of the voxel at the location of the 3D cursor. Moving
the 3D cursor on the image will change the location of the red line.
White box Represents the Opacity Threshold values. When using Ramp-up shape:
• Drag the lower white box to the right to remove soft tissue from an exam to
modify the maximum opacity of voxels.
• Click the upper white box at the top of the ramp and drag up or down to modify
the opacity of all visible voxels.
Blue Box Allows you to shift the whole ramp. Click and drag the solid blue box on the ramp to
change the upper and lower values of the ramp.
Red Box Represents the scale of voxel values. Click and drag the box left or right to shift the
display.
• Zoom in or out with the Zoom icons upper-right corner.
• Right-click the main control to return to the original zoom.
VR Ramp Represents the voxel opacity in the VR images as a function of the voxel values. It
means that voxels with identical value will have the same opacity.
Color Activates the color. An unchecked box displays the VR in black and white.
Partial Volume Filter Attenuates the partial volume by associating partial volume voxels with adjacent
voxels that represent the more opaque object. It improves the visibility of structures
that would otherwise be hidden by partial volume voxels and improves the color
coding of voxels in color mode.
Active Color Use to select the active color. Click the square color button below the ramp (the
triangle above the color gets black). Click Active Color to change the color.
Brightness The amount of light displayed in the model. Type in a value greater than 100 to
increase the light in the model.
5. Click Add.
6. Click Yes to clear the upper‐left viewport.
7. From any 2D view, click and hold on the object you want to add.
A green filter will fill the object while this object is being reconstructed in the upper‐left viewport.
8. In a viewport, right-click and select Mouse Modes > Left Mouse: Selection.
9. Drag the VR viewport and drop it on the viewport of the isolated object where the message, Drop
here to reassign views displays.
10. From the Tools section, click the VR tab.
11. From the Visualization Docking Station, click the Multi Objects icon .
18.6 Segmentation
To display a specific feature within the image, you can define what part of the exam data should be
visible, and what part should not. The main Segment tools include:
• Threshold: To extract a region of interest by selecting a range of voxel values that represents a
specific tissue or anatomical feature.
• Scalpel: To perform cuts in the 3D volume to define the region of interest.
• Paint: To mark the region of interest with colored paint and then display only this region.
• Auto Select: To select an object and add it on or remove it from the selected view.
The process of removing structures is sometimes referred to as volume segmentation because the 3D
volume is segmented, or split, in two parts: the volume of interest that is currently displayed, and the
remainder that is removed from view.
After volume segmentation, the displayed part of the 3D model consists of one or more 3D objects. A
3D object is a part of the 3D model that is separate from other parts. Two 3D objects are separate if
there is at least one voxel width of empty space between them.
Sometimes two seemingly separate objects still act as one, because they are still connected
somewhere by a bridge of voxels. It is also possible that a seemingly single object turns out to consist
of two or more parts, separated by narrow gaps. The tools on the Advanced Processing screen can
help you to deal with these effects.
Auto Select Allows you to select an object and add or remove it from the selected view.
Auto Contour Click the center of the structure or use the click and drag method to define a
diameter. Adjust contour if needed. Accept and Measure. Click Auto Contour icon
again to initiate a new contour.
Threshold Opens a screen from which you extract a region of interest by selecting a range of
voxel values that represents a specific tissue or anatomical feature.
Remove Object Opens a screen from which you remove or keep isolated objects or display
removed structures.
Scalpel Cut outside or inside region. Opens a screen from which you cut the 3D volume,
split an object into separate object, define a volume of interest or remove part of
the 3D volume.
Paint on Slices Opens a screen from which you trace contours on the baseline (axial, sagittal
and coronal) views, to outline and mark the region of interest on the slices that
intersect the region.
Quick Paint Opens a screen from which you paint with an adjustable sphere-shaped cursor
on reformatted slices to define the volume of interest.
Advanced Processing Opens the Advanced Processing screen that consolidates many advanced seg-
menting processes.
One Click AVA The One Click AVA button is activated with VesselIQ Xpress licenses and allows
vessel tracking in one click.
Two Click AVA The Two Click AVA button is activated with VesselIQ Xpress licenses and allows
vessel tracking in two clicks.
Cut Inside Click and drag around the object of interest and then click the appropriate
button to either cut inside or outside the trace. The trace may appear either red
or green.
Cut Depth Allows changing the Scalpel from a restricted depth defined by the text field or
an Infinite depth.
Undo Undoes the last operation performed. If the view on which the last operation
was performed is changed, the possibility of undoing the last operation is
permanently lost.
Keep Object Keeps all the voxels that are attached to the object of interest under the cursor.
Determines the number of layers you want to add or remove. Change the value by
Size in Voxels
using the slider or by typing in a value.
Add one or more layers (20 maximum) of voxels to the surface of the current 3D
Dilate objects. This feature can restore voxels that were removed by operations like thresh-
olding, erosion, or opening bridges.
Removes one or more layers (20 maximum) of voxels from the surface of the current 3D
Erode
objects.
Fills in the gaps and connects the adjacent features. Adjacent features in the 3D
volume that appear to consist of a single object may be composed of more than one
3D object when you try to use Keep Object or Remove Object. This can be caused
by the presence of narrow gaps, often only a few voxels in size, that separate the
features. This mostly occurs when using thresholding to define a feature of interest,
when the threshold setting is marginal. You can try to modify the threshold setting or
alternatively use Close Gaps to fill in the gaps and connect the adjacent features. You
set the size in voxels of the gaps you want filled in.
This function resembles the Dilate function, but only gaps up to the specified size are
Close Gaps filled in; the rest of the objects are not dilated.
This function consists of performing a dilation followed by an erosion. Since erosion
does not totally remove the voxels added by dilation, some small gaps or holes are
filled in. A closing size of N is obtained by N dilations followed by N erosions. This
means that small gaps or holes having one of their X, Y, or Z dimensions less than 2N
are filled in. For example, a closing size of 3 is obtained by three dilations followed by
three erosions. This means that small gaps having one of their three dimensions less
than six are filled in.
Open Bridges describes the opposite function.
Removes residual bridges and separates adjacent features in the 3D volume. You set
the size in voxels of the bridges you want removed. This function resembles the Erode
function, but only the bridges up to the specified size are eroded.
This function consists of an erosion followed by a dilation. Since dilation does not
totally restore the voxels removed by erosion, some fine structures remain eroded. An
Open Bridges
opening size of N is obtained by N erosions followed by N dilations. Fine structures
having one of their X, Y, or Z dimensions less than 2N are removed. For example,
an opening size of 3 is obtained by three erosions followed by three dilations. Fine
structures having one of their three dimensions less than six are removed.
Close Gaps describes the opposite function.
Resets any such inner holes to the original voxel values. When using thresholding, this
can result in holes appearing inside the 3D volume (i.e., closed spaces inside the 3D
volume where the voxel value is outside the selected range).
By default, the voxel value inside such inner holes will be set to the same value as the
Close Holes
outside of the 3D volume (empty space).
If you have used the Scalpel or Paint tools to remove part of the 3D model, any holes
enclosed within the 3D volume resulting from these operations will also be re-filled
when you use this feature.
Removes all data from the inside of the current 3D objects, leaving only the surface.
Since the inside of the objects no longer contain any data, little if any further process-
ing is possible.
Use this function to speed up the display after you have fully defined your region or
Extract Surface objects of interest; e.g., during rotation or batch filming, or to modify 3D shading. Enter
a surface thickness of at least 2 to guarantee connectivity information for any further
operations such as selecting or removing objects. With a value of 1, the result appears
visually correct, but the surface is too thin to be considered as one or more coherent
objects.
Intersection keeps only the voxels that exist in the same location in both objects. The
Intersection
values of the resulting voxels are those of the original object in the primary view.
Set Addition keeps all the voxels that exist in either of the objects. If a voxel belongs
to both objects, its value in the primary view is kept. Use Set Addition to combine
structures obtained using different processing tools. For example, you may need differ‐
ent tools and settings to process a vessel from the left side of the patient and another
Set Addition vessel from the right side. By treating the two vessels separately and storing the results
in the Save/Recall panel, you can optimize the processing for each side.
After recalling both from the Save/Recall panel in two separate views, the set addition
operation allows you to join and display them as a single object.
Set Subtraction removes all the voxels in the primary view that also exist in the
secondary view. In other words, the secondary view is subtracted from the primary
view.
Using a set operation on the data from two 3D models results in a single object (3D
model). As an example, you can start by using thresholding to select the entire hip
bone structure and store the result in the Save/Recall panel. Next, isolate and select
Set Subtraction only the femur (using paint or scalpel) and store the result separately. Subtracting the
femur from the complete bone structure may now allow you to see the extent of a hip
bone fracture that was obscured by the femur.
This is different from the merge operations, which allow you to display more than one
3D model at the same time and show their spatial relation by means of cut planes and
different levels of transparency. Merge operations are strictly a display feature; they do
not combine the separate 3D models.
Filter Floaters allow you to remove small residual objects in the 3D model that can
Filter Floaters
appear after thresholding, usually resulting from noise in the original image set.
Place the cursor over pixels representing the pixel intensities you want to keep. Keep
Keep Object
Object keeps all pixels with the selected intensity; all other pixels are discarded.
• Views of interest display red and green borders. Other views should not have color borders.
• To adjust red and green borders, click the view to set red, the other view will turn green.
11. The Advanced Processing panel will now display, perform one of the following functions.
• Click the Subtraction icon to remove all the voxels in the primary view that also exist
• Click the Intersection icon to keep only the voxels that exist in the same location in
both objects.
• Click the Addition icon to keep all the voxels that exist in either of the objects.
9. Repeat the process until your reach the last slice containing the structure to contour.
10. Click Apply.
6. Click Apply Threshold to display only the part of the 3D volume with voxel values inside the set
range.
7. To further refine segmentation, select the object on the viewport and choose to remove or keep
the object.
• Click Remove Object to remove all voxels connected to the object.
• Click Keep Object to remove all objects not connected to the object.
18.7 Batch
The Batch function allows you to rapidly set up a set of regularly spaced images, preview the set as an
animated sequence (batch loop) and film and save it.
When creating and saving your own custom batch protocol, you have two options:
• Add it to the list of existing batch protocols for the current loading/processing protocol.
• Combine it with the current loading/processing protocol to create a new loading/processing
protocol. Create a custom multiple-batch protocol by combing two or more batch protocol
setups.
Batch Creates rotation, loop or oblique batch images based on your prescription.
Movie Creates a comprehensive movie including different rotations, zoom and pan of the
volume.
Quick Export Exports in a single click a batch of rotations of a 3D view or a full batch of contiguous
images for 2D images.
NOTE
Video Export does not work on the Operators Console.
Save State Saves current status of Volume Viewer (3D Model, displays, ROIs) as an additional
series of the exam. A One-Touch protocol entitled Save State will appear in the
Application field providing the ability to restore Volume Viewer State.
Save/Recall Opens a clipboard where you can drag and drop objects for temporary storage
within the current Volume Viewer session.
Summary Table The summary table is a standard Volume Viewer feature which automatically cap-
tures measurements as they are made during a VV session. The summary table
is optimized in advanced applications to provide a user friendly display of the
statistics.
Statistics can be compared over time to a reference date, which can be easily
modified and will display the percentage of change on comparison measurements.
Figure 363 Batch screen — Loop tab Figure 364 Batch screen — Oblique tab
Prescription mode • Oblique displays a set of lines to define the reformat planes.
• Rotation defines projection planes. The defined planes rotate 180°.
• Loop defines the first and last slices of your projection planes that can be set to
any degree of rotation.
The displayed values are those of the current protocol and can be modified. The text
fields change depending on the mode you select (oblique, rotation or loop).
Copies Appears only if Print or Print & Save are selected as an Output mode. Enter a value in
the text field.
Output Modes • > Print > allows filming of the projection images and makes the Format and
Reference Image buttons available. Select a film format and select the film that
you want the reference image to appear on.
• > Save > creates a new series in the browser. The series type is determined from
the Film/Save Options screen. Note that if Color Save has been turned on from
the Film/Save Options screen, the projections will be saved as SSAVE images
even if Rfmt is selected as the image type. Screen saves cannot be filtered or
measured.
• > Filmer Images > drops all generated images into the filmer (AW only).
• > Print/Save > allows for both filming the generated images and saving a new
series to the browser.
• > Filmer Movie > drops the generated images in the filmer as a movie to be
exported as .mpeg or .avi image type.
Format Appears only if Print or Print & Save are selected as an Output mode. The Format
menu allows you to make a format selection.
Reference Image Appears if Print or Print & Save are selected as an Output mode. Select which film
you want the reference image to appear on: the first film, all films, or no film. The
reference image is the first image of a rotation that has the following items displayed
on it: number of views, rotation degrees, and the direction arrows icon.
Preview Displays the planes in a movie prior to filming or saving the images.
OK Saves and previews the images simultaneously. If Save or Print & Save is the selected
as output mode, a new series is created in the Patient List.
Advanced Allows you add a new batch step for oblique or rotation. Click the arrow button and set
the parameters as desired.
Element Description
Current Description Choose either an existing description from the drop-down box, or be prompted to enter
a new description before saving. Each new description gets stored in the drop-down
box.
Format • Color saves non-VR images in Color SCPT. Due to DICOM format restrictions, Win-
dow Level and Width of color SCPT images cannot be modified. It is then recom-
mended to unselect this option to be able to perform windowing adjustments
when reading saved images in PACS or other DICOM viewers.
• Color (VR images) saves VR images in Color SCPT.
• Hide Cursor on Copies saves images with cursor hidden.
• Key Image Note when checked, all saved images are referenced into a single Key
Image series (DICOM standard) when exiting Volume Viewer. This Key Image series
can be opened in the Viewer or any compatible PACS or other workstation (all
referenced images must be pushed on a remote host).
• Save State: saves the current status of Volume Viewer (3D Model, displays, ROIs…)
at the same time as saving the image. This Saved State can be used later on to
restore the Volume Viewer State.
• Force Saving Square Images: When sending rectangular viewport, adjusts the
image in a square format (no resize but adding space around image). This option is
mainly used for PACS or other DICOM systems not supporting rectangle images.
• High Definition: Saves the image in high resolution.
• Save as Reformatted or PJN: Images saved under these formats contain geomet-
rical information so that they can be reloaded in 3D software and freely windowed.
• Check Save as Reformatted or PJN to save images in this format every time it is
possible. Images saved under these formats contain geometrical information so
that they can be reloaded in 3D software and freely windowed. Click the link [when
possible] to display the list of image types that can be saved as Reformatted and
PJN according to DICOM requirements.
Uncheck the option Save as Reformatted or PJN to benefit from Color and Save State
capabilities every time you save an image.
Color and Save State options are not compatible with Reformatted DICOM format.
These settings cannot apply to images which were saved as Reformatted.
Select Printer Printer options are displayed in the menu. Note that the camera selected from this menu
can be different from the camera selected from the Film Composer.
Current Batch De- Allows you to use the Patient List series description name for the saved series. Select Ask
scription for description when you want to be prompted to provide a description.
FOV is a multiple Enter a multiple by which the FOV is changed when clicking on the red DFOV annotation.
of For example, if the FOV is set to 130, the FOV is adjusted as a multiple of 130 – 6.5 mm/13
mm/26 mm. It is not possible to set the DFOV higher than the acquired FOV or lower than
a DFOV of 8 mm.
Format • Color Save (non-VR Images) - saves non-Volume Rendered images in color.
• Color Save (VR Images) - saves Volume Rendered images in color.
• Hide Cursor on Copies - hides or shows the cursor on the saved or filmed image.
• High Definition - films images along the Z direction in high definition.
Image Type for Re- When saving reformatted images, you can select the image type. The image type deter-
format mines functions that can be performed on the image and how the annotations are
stored.
SCPT:
• Allows W/L adjustments of saved images.
• Saves only annotation (system or user entered) that is currently visible on the view.
These annotations are part of the image: they can no longer be edited or deleted.
Reformatted:
• Allows W/L adjustments, measurements, and filtering of saved images.
• Automatically saves all system annotations with the view, even if they are hidden
at the moment that you save the image. However, the user annotations (text and
measurements) are saved only if they are shown at the moment that you save the
image.
6. Click OK.
The Spacing between views and slice thickness can be set independently of each other creating a
gap, contiguous or overlapped images.
Number Description
2 Tilt handle
3 Move handle
2. Type in the number of images or angle between images in the appropriate field.
5. Click OK.
3. Enter the Number of Images, Spacing Between Images, Slice Thickness, Rendering Mode, and
FOV.
4. Select the desired output mode from the menu.
• Choose Print to send generated images to the default printer (setup the Format and the
display of a Reference Image).
• Choose Save to save generated images in a new series in the browser.
• Choose Print/Save to film the generated images from a default printer and save them in a
new series.
5. Click OK.
19 Data Management
19.1 Overview
The File Manager allows you to manage your acquired images. This section contains information on
how to save, restore, delete and network images using File Manager. It also includes procedures on
how to make an anonymous patient and edit patient data.
File Manager has four sections:
• A Controls Area, which allows you to select databases, search databases, and access functions
that you can use on exams.
• The Exam List, which shows the exams in the selected database. Status information for exams is
also provided here.
• The Series List, which shows the series and image information for the exams selected in the Exam
List. Status information for series and images is provided here.
• A navigation viewport, which shows images you select from the Series List.
1 Source menu – select the database you 3 Search box – typing a string of characters
are using in this box will search for that string in
any of the searchable fields of the source
2 Applications – gives you shortcuts to database
launching applications
Search results appear in the exam list. The exam list changes color to indicate that you are looking at a
filtered list.
To remove the filter, click the Close icon in the search box. The filter is also removed if you close
the File Manager, or if you choose a different source database.
NOTE
When selecting the USB device from the Source Menu, the USB may fail to be read. To
read the USB, select Media Creator from the File Manager controls area, close Media
Creator and select USB from File Manager Source Menu.
Icon Description
Indicates: The Recycle Bin The Recycle Bin The Recycle Bin The Recycle Bin The Recycle Bin
is between 0% is between 13% is between 38% is between 63% is between 89%
and 12% full and 37% full and 62% full and 88% full and 100% full
1200 images 1201-3700 im- 3701-6200 im- 6201-8800 im- 8801-10,000 im-
ages ages ages ages
To see the contents of the Recycle Bin, click the Recycle Bin icon.
Restore an exam from the Recycle Bin Highlight the exam and then click Restore
Delete an exam from the Recycle Bin Highlight the exam and then click Delete
Delete all exams from the Recycle Bin Click Empty Recycle Bin
• Patient name (in the format configured for the system) (last name, first name or first name last
name).
• Exam description
• Patient ID
• Exam networked flag
• Exam archived flag
• Examination date
You can configure the Exam list to display these additional columns:
• Exam ID
• Accession number
• Referring physician
• Examination time
• Patient name in ideographic form (certain locations only)
• PPS flag – this flag is displayed if PPS commands have been sent (available only at sites where
PPS has been configured)
See Configuring the Exam List on page 802 for information about configuring, arranging, and resizing
the columns displayed in the Exam list.
The exam is open in a tab, but the patient is not on the table. (For example, the patient scan is
complete and the patient is no longer on the table, but you are performing image processing
tasks.)
To bring the exam tab to the front, click the icon or double-click the exam.
Image processing is not completed, but the tab for the exam is closed.
If the exam was aborted before image processing was complete, you can reopen the exam and
continue with image processing.
The exam is being pulled from a remote network host, a DVD, or USB media.
The exam has been partially networked. (One or more series in the exam have been net-
worked.)
NOTE
The icons change depending on the language used in the user interface.
Hovering over a network status icon displays a pop-up list showing the destinations to which the exam
was networked. The list is limited to 10 destinations.
Destinations to which there has been a network error are shown in red.
For partially networked exams, see the network status flags in the Series list for information about
where the series in the exams are networked.
The exam has been partially archived. (One or more series in the exam have been archived.)
NOTE
The icons change depending on the language used in the user interface.
• Open Exam — Select to open exam in the Reconstruction and Image Processing Task List. You can
also do this by double clicking an exam in the exam list.
• Send Exam To — Send the exam to another device on the network. Available devices display in a
drop-down menu
• Anonymize Patient — Select to remove identifying information from the images of this exam.
• Edit Patient — Select to open the patient record for updates/changes.
• Exam Split — Select to open an Exam Split session, allowing you to "split" a series of patient
images into separate groups. Refer to Exam Split in the Display Applications chapter for more
information.
• Add/Sub — Select to access the Add Subtract function. Refer toAdd Subtract in the Display
Applications chapter for more information.
• Reformat — Select to access the Reformat function. Refer to Reformat for more information.
• Additional image processing options— Select to access additional image processing functions.
Additional options purchased will be listed on the menu.
• Send PPS — Select either complete or discontinue the performed procedure step (PPS) for a
patient. Refer to Performed Procedure Step (PPS) on page 803 for more information.
• Delete Exam — Select to delete the highlighted exam. Refer to Deleting exams on
page 801Deleting Exams for more information.
NOTE
Changes to the sort order are retained, even after a reboot.
You can change the order of columns (except for the Name column) by clicking and
dragging the column headings.
NOTE
There are some conditions that prevent you from deleting exams:
• The exam is for the patient on the table
• The exam is open in a tab
• The exam has open processing
• Networking or archiving for the exam is in process
If you try to delete an exam that has any of the above conditions, the system displays a
message informing you why the exam cannot be deleted.
NOTE
You cannot change the width of columns that show only icons.
The Series List sorts the series in an exam by the series number, although you can sort the columns by
any of the columns. The series types are indicated with text labels.
SCOUT Scout: acquired scan data that can be viewed, W/L, measured, and so on.
PROSP Prospective: acquired scan data that can be viewed, W/L, measured, and so on.
COMB Combined: result of a combination of image data that can be W/L. Produced by Add/Sub from
images at different locations.
SSAVE Screen Save: screen capture data that can be W/L. Produced by the Viewer, 3D, and Reformat
applications.
Dose Report: generated by each exam if Dose Report is enabled on the system. CDTIvol, DLP,
and Dose Efficiency displays during scan prescription and provides patient dose information.
PROC Processed: post-processed data that can be W/L and measured. Produced by Add/Sub from
images at the same location.
REFMT Reformat: post-processed data that can be W/L, filtered, and measured.
SR Structured Report: generated by each exam if Structured Dose Report is enabled on the
system. A CT Dose Report can enable tracking of dose for the patient by the hospital radiation
tracking system/HIS/RIS.
GSPS Gray Scale Presentation State: produced by the Viewer to be used in conjunction with
the original series to capture presentation information (W/L, flip, rotate, zoom). It can be
networked to review stations that support this DICOM type.
Jobs Menu
The Show jobs menu filters the list of Registered jobs and Completed jobs displayed in the tables. The
selections include:
• All jobs
• All PPS jobs (only for sites with PPS, HIS or RIS systems)
Job Queue
The Job Queue area displays the list of registered jobs as defined from the Show All Jobs menu.
Click and drag the edges of each title in the menu bar to expand or contract the field.
Click on the arrow and select the job type by which you want to filter the list.
The job status types include:
• Paused — indicates that stops the progress of a transmission
• Failed
• Running — indicates the job is active
Completed Jobs
The Completed Jobs area displays when a successful transfer is completed the job is listed. The most
recent job is listed at the top of the list.
Click Clear to remove all jobs from the Completed Jobs list.
Queue Controls
• Click Pause to place the selected items in the list into a paused state. To resume the job, select the
item and click Resume/Retry.
• Click Resume/Retry to initiate the job of the selected items in the list.
• Click Delete to remove a transmission from the Registered Jobs list. A pop-up requires your
confirmation for deletion.
• Click Clear to delete all items from the Completed Jobs list.
19.4 Archive/Network
Archive
The CT Scanner is intended for short-term storage of data only and does not act as an Archive.
An archive device is a network device set up as an archive destination by your service personnel. When
an image is archived, the icon in the Archive column of the Exam List and Series List indicates that it
has been archived. The archive flag does not display when an image is saved to a CD, USB or DVD.
There are two methods of archiving. You can manually archive images, which allows you to save only
those specified by you. You can also automatically archive images. In this case, all exams are auto
archived upon scan completion.
The archive and network status columns on the Exam List and Series List contains information
regarding archive or network status.
When saving images to a remote archive device such as a PACS, items queued to be saved to the device
will be listed in the Job Management window.
The archive status is displayed in the Job Management window and in the status area of the window.
Network
Networks link image acquisition systems and workstations together, providing a way to quickly
and easily transfer images between your scanner, remote workstations, and other image acquisition
systems. You may view images that are supported by your scanner from any station, or view images
from other stations networked to your scanner.
You can network images between your system and any DICOM compatible device. Images transferred
from your system can be automatically networked upon reconstruction or manually networked upon
your initiation. You may also get images from another networked device. Before networking images,
check to see that there is enough room on the receiving system's disk to accommodate the images
being transferred.
Network status information is displayed on the Job Management window in the Feature Status area.
NOTE
Images cannot be sent to an IRIX-based CT system.
Archive/Network queues: Job Management
The archive and network queues are viewed from the Job Management window. When you choose to
view an archive or network job, the queues provide a snapshot of the status of the archive or network
tasks occurring on the system. You are able to pause, resume and delete the archive and network
tasks.
The Job Management window also provides a history of archive and network events. The list allows
you to check and verify that an exam, series or image has been sent to an archive or network node. If
an entire exam or series has been selected, only one transfer is executed and one entry is displayed
in the queue. If specific series or images have been selected, a separate transfer is executed and a
separate entry is displayed for each selection. When saving images to a remote archive device such
as a PACS, items queued to be saved remotely will be listed in the Archive Queue under the Remote
archive list.
NOTE
After a system crash or reboot, check the queue status and restart, if necessary. The
restore and save queues are maintained even after a shutdown has been performed.
You can also view the configured remote networks from the Source menu above the Exam List in File
Manager,
• Host Name: The name given to the network node of the currently selected node. This name is
typically entered by the service engineer.
• Display Name: The name that is shown in both the source menu and Archive and Network
destinations.
• IP Address: The location of the node within the network. You must enter the IP (Internet
Protocol) address correctly or the connection cannot be made. Your service engineer can help
you determine the IP address.
• Port: A predetermined number specific to the type of host and the protocol used. Your service
engineer can provide you with this number.
• AE title: This title is provided by the service engineer.
• Comments: A space to enter text that is associated with the selected node.
To be a successful archive node, the node must meet certain DICOM requirements so that when the
data is transferred from the host system to the node, the DICOM handshake can be successful. The
remote host must be a DICOM storage permit provider. This is not necessary for networking images.
The same handshake is not required.
The storage commitment host details are populated from the selected Remote Host Information area.
These fields can be edited
Save
Click Save to save the settings for the currently selected node.
NOTE
Both the CT Scanner and the receiving network host must have applicable
certification. See Certificate Management for DICOM over TLS to install certificates
on the CT Scanner.
6. In the Services area, select your options.
7. Click Save to save the settings for the currently selected node.
8. Click OK.
NOTE
During openssl command execution, the user must enter input for each item:
• Country Name (2 letter code) [AU]:
• State or Province Name (full name) [Some-State]:
• Locality Name (eg, city) []:
• Organization Name (i.e. company) [Internet Widgits Pty Ltd]:
• Organizational Unit Name (i.e, section) []: e.g. CT
• Common Name (i.e. server FQDN or YOUR name) []: e.g. hostname
• Email Address []:
cd /USB
copy <path to certificates> /USB
NOTE
The Application tab is not displayed when the current user is not in the EA3 admin or GE
Service role.
The host certificate needs to be imported using USB.
Click the Import host certificate button. The following screen displays:
Click Confirm to delete the certificate. Certificates configured to an application will not be deleted. An
error message displays in this case.
NOTE
Attempting to import an existing certificate brings up the error message “Certificate
Name already Exists hence failed to save”.
19.4.4.1 Overview
Anti-virus is a software used to prevent, detect and remove malware/viruses.
McAfee Endpoint Security for Linux Threat Prevention as an option. Once installed, the Antivirus
software starts protecting your CT system from threats. The software uses the latest anti-malware
engine from McAfee.
When enabled, the software checks for viruses, trojans, unwanted programs and other threats by
scanning files and folders on local drives, network-mounted volumes and removable media whenever
a file is created or accessed. On-Access scans are disabled by default for performance reasons.
You can also run scans on demand. An on-demand scan can be initiated from the Security Center by
clicking the Antivirus menu item in the left navigation area.
McAfee Endpoint Security (ENSL) is installed when AntiMalware_McAfee_standalone or
AntiMalware_McAfee_EPO option is installed. ENSL can be configured to work in the two modes:
Managed mode (i.e., with ePO Server) or Standalone mode (i.e., without ePO server). For managed
systems, the ePO administrator configures and manage the protection configuration policies using
these servers.
• McAfee® ePolicy Orchestrator® (McAfee ePO™)
• McAfee® ePolicy Orchestrator® Cloud (McAfee ePO™ Cloud)
To integrate with ePO, additional configuration procedure is required in EPO side. Server-side
procedure/methods for configuration of ePO Server are not in scope of this document and need
to refer to McAfee Installation / Product Guide for details.
When ePO Server is configured, Virus signature database (DAT) should be updated or scheduled using
ePO. Virus scans should also be scheduled from the ePO Server
NOTE
19.4.4.2 Standalone license mode (when ePO server does not exist)
Installation of Anti-Malware solution
When the AntiMalware_McAfee_standalone option is installed, McAfee Endpoint Security (ENSL) is
installed by default with a full license.
Launching McAfee Agent in Stand-alone Mode
NOTE
Antivirus version installed on the console may be different from that shown above.
Stand-alone Mode Cron jobs
When the AntiMalware_McAfee_standalone option is installed, a weekly cron job is scheduled to run
the antivirus scans and engine and DAT updates.
The user can specify the antivirus scan time by running /usr/g/scripts/
schedule_antivirus.sh. The default scan time is 3:00 AM every Friday.
The Anti-virus scan will take about 30 minutes to an hour or more, based on system available
resources. Wait to complete anti-virus scan.
When the scan is complete. the message Antivirus scan is completed is shown in the Status
Information pane.
3. Click on the Occurs dropdown menu in Edit Job Schedule and choose the occurrence.
4. Based on the occurrence selected, choose time accordingly.
5. Click on Submit in Edit Job Schedule. The system Successfully updated displays when the
cronjob has been updated or displays a message on why the update failed.
NOTE
You can select more than one exam, series, or image. Shift‐click to select a
contiguous list, or Control-click to select items one-by-one.
You cannot retrieve series or images from different exams in the same transfer. Select the series
or images you want to retrieve from an exam, start the retrieval, and then transfer the series or
images from the other exam.
5. To retrieve exams, right click the exam, then click Retrieve Exam.
To retrieve series, right click the series, then click Retrieve Series.
To retrieve images, right click the images, then click Retrieve Images.
6. The selected items transfer to your system.
The system indicates that exam transfers are taking place with an animated icon next to the
exams. The system status bar shows the progress of the transfer. You can check the status of the
transfer using the Job Management window.
• Jobs are performed on a first-come, first-served basis.
• When the data has been transferred to the local database, the Archive flag is set for the
transferred data.
• When the data has been successfully transferred to a network host, the Networked flag is set
for the data.
• Hover the cursor over the Archive or Networked flag to see more information.
NOTE
If there is an error in retrieving an exam, it will be indicated in the local Exam List
with a red icon. Click the icon to open the Job Management screen.
NOTE
You can select more than one exam, series, or image. Shift‐click to select a
contiguous list, or Control-click to select items one-by-one.
You cannot send series or images from different exams in the same transfer. Select the series
or images you want to retrieve from an exam, start the retrieval, and then transfer the series or
images from the other exam.
3. To send to a non-archive host, right-click the selected item, click Send Exam To (or Send Series To
or Send Image To, and then click the host name.
The data transfer process begins.
4. To send to an archive, right click the selected item and then click Archive Exam (or Archive Series,
or Archive Image). If there is more than one archive available on your network, select the archive.
5. View the Job Management window or the archive and network status in the Feature Status area to
view the state of the images as they are transferred to the archive or network host.
• Jobs are performed on a first-come, first-served basis.
• When saving images to a remote archive device such as a PACS, items queued are performed
on a first-come, first-served basis.
• When the data has been successfully transferred to an archive device, the Archive flag is set
for the data.
• When the data has been successfully transferred to a network host, the Networked flag is set
for the data.
• Hover the cursor over the Archive or Networked flag to see more information.
2. On the Job Manager tab, click the down arrow button on the Show Jobs box and select an
5. 6. Click Close.
2. On the Job Manager tab, click Clear to remove the selected jobs from the list.
3. Click Close.
Manager toolbar.
4. The system asks which device you want to eject. Select the device, and then click Eject.
5. The system displays a message when it is safe to remove the device.
6. In the case of DVD and CD drives, the drive will open. If you have ejected a USB device, unplug the
USB device.
5. Click Close.
19.4.10 Workarounds
• Images archived on an Advantage Windows system may fail to restore on the system. Use Network
to transfer images from the Advantage Windows to the system.
• If the system is unable to read the media, remove the write protect and see if the system is able to
recover the media to access the data.
NOTE
CD/DVD/USB interchange is available for writing DICOM images onto the compatible
media listed in Table 149 on page 831. It is not considered a method for long-term
image storage.
CD-R DVD-R
Pay attention to the following declarations about media and operation requirements when you use
CDs and DVDs.
• Only supports single layered CD-R and DVD-R media. No other media types are supported,
including but not limited to DVD-RW.
• Dual layered CD-R and DVD-R media are not supported.
• Only supports 700 MB single layer CD-R media.
• Only supports 4.7 GB single layer DVD-R media.
Operation Requirements
Pay attention to the following operation requirements for CD/DVD/USB interchange.
• Only supports single-write session. Multi-session mode is not supported.
• Cannot append write data to media that has already been written.
• CD/DVD/USB interchange is NOT INTENDED for archive or backup purposes! These features make
only “temporary copies” for interchange purposes. GEHC will not “recover” any interchange
media (it should just be burned again if necessary using patient data restored from authorized/
provided archive media).
• It is advised to not write to CD/DVD/USB interchange media during a scan operation.
• It is advised to not open post-processing applications requiring high computer usage while
writing to CD/DVD/USB.
NOTE
USB must be conditioned to FAT32 file type before media copying begins.
NOTICE
• Store the disc in a protective case. Proper storage helps protect the data from damage due to
scratches on the disc surface.
• Do not leave the disc in direct sunlight or in a hot, humid environment. These conditions can warp
and damage the disc.
• Use only a felt tip permanent pen when labeling. Write only on the clear, inner diameter of the
disk (or the printed area of a CD-R). Never use a ballpoint or hard point pen. Do not use adhesive
labels.
• Use a soft, lint-free cloth to remove spots, dust, or fingerprints from the disc. Always wipe from
the center to the outside edge of the disc. Do not wipe the disc in a circular motion.
• Do not use any chemical-based cleaners. These can damage the disc.
• Do not use the CD/DVD/USB interchange program to permanently store your data. If the
CD/DVD/USB is damaged there is no recovery of the data.
Use these steps to save images from your system to a CD, DVD or USB device.
You can record DICOM image data to either a blank, compatible CD/DVD that is placed in the CD/DVD
read/write external drive or to a USB device inserted into one of the USB ports. If saving to CD/DVD,
once you close the drawer with the CD/DVD in it, wait until the CD/DVD drive light turns off. This is an
indication that the CD-R or DVD-R is spinning up to speed.
• Images may copy very slowly or may fail to copy to USB from Media Creator. Use a USB3.0 device
with a write speed of greater than or equal to 45 mb/s. The USB must be formatted in VFAT
or FAT32 format. Format the USB on a system running Windows. If the system does not allow
formatting the USB, download a tool such as HP USB Disk Storage Format Tool.
• Data on a CD-R and DVD-R can be recorded only in a single session. Data on USB can be recorded
in multiple sessions. All image data that you want to record must be selected beforehand. The
data will be recorded in a single pass. It is not possible to add data on a CD-R, DVD-R or USB.
• Image data can also be recorded in Portable Document Format (PDF) or HTML format by using the
Data Export function.
• You can load images on a USB that already has data on it. The system informs you that the USB
contains data and asks How would you like to proceed? You can either select Append Data to add
the images to the USB or Delete Data and Continue to erase the data from the USB and add the
images.
• Do not connect two USB devices at the same time for save/restore of scan data.
• The following information will be displayed for CT images: Hospital Name, Patient Name, Date
of Birth, Acquisition Date, Exam/Series/Image information, Anatomical Reference, Slice Location,
DFOV, Recon Algorithm, Series Description, kV, mA Noise Index Values, Pitch, Rotation Time, Tilt,
Slice Thickness, Scan Time of Day, RAS coordinates, and WW/WL values.
3. From the Media Creator window, select the media type from the Media menu.
If you opened the Media Creator window before you inserted a device into a drive, click the
Refresh icon to update the Select Media menu.
b. Click Remove.
8. Click the Write icon to start the recording process.
• Do not begin recording until all desired series have been added to the list. You cannot record
more data to the CD-R or DVD-R once you have started the recording process.
• The progress bar (1) and message bar (2) displays messages indicate the progression of the
copy activity.
• Error prompts may appear if the media is damaged, if the media contains corrupted or
unsupported data or the files are too large for a single media, etc.
• The progress bar displays 100% and a message appears in the message area when recording
is completed.
• Very large data sets can take a very long time (more than one hour) to copy to CD. If you
change your mind about copying the files to CD/DVD, you can stop copying and start it over
at a time more convenient. Click Exit to cancel the copy process and upon clicking OK to the
confirmation prompt, the copy process is stopped and the Media Creator window closes. An
alternative is to click Cancel.
• If you click Exit before the save process has completed, a confirmation prompt appears. If
you confirm the Exit, then the save process is canceled.
• The Cancel icon stops burning data.
• The CD/DVD drive automatically opens when the CD/DVD save is finished. Only click Eject to
stop the CD/DVD save process.
• Removing the USB device without ejecting it can results in errors that may require the device
to be reformatted.
• Do not remove the USB device during copy process. Make sure you first Stop the copy
process before you remove the device from the drive.
4. To retrieve exams, right click the exam, then click Retrieve Exam.
To retrieve series, right-click the series and then click Retrieve Series.
To retrieve images, right-click the images and then click Retrieve Images.
5. To view the restore process status, see the View the Backlog/Queue procedure.
6. After the restore process completes, click the Eject icon (next to the Source list in File
Manager).
The CD Viewer automatically launches. If an Auto Play window displays, click Run CDViewer.exe.
2. Click Accept to the license agreement.
3. From the DataSelector, select an exam and wait until the data is loaded.
Your PC or laptop must contain Java run time environment as JRE1.5_14 or higher version. If not,
the Java, bundled with the application, is installed on demand.
4. Select a series to view.
5. Use the Media Viewer image controls, located at the top of the Media Viewer, to manipulate the
images.
Icon Description
Erase All Graphics (right-click menu), removes all the Graphics (ROIs, User
Annotation, Grid) from the selected viewport.
Zoom (right-click menu), selects the left mouse drag operation as zoom.
Roam (right-click menu), selects the left mouse drag operation as roam.
Save to my PC Right-click menu item, exports the image of the selected viewport to the local
system in JPEG/PNG format.
NOTE
In the case of double-sided DVD-RAM media, take care to insert the media back into
cartridge with the same orientation as it was removed. If media is inserted upside down,
any labeling on the cartridge will not be consistent with data on the disk.
Follow the procedure and precautions outlined below to remove the disc from the cartridge.
1. Remove the disc.
a. Push and remove the cartridge-locking pin with a sharp-tipped object, such as a ballpoint
pen.
b. Open the cover by pushing the sharp-tipped object into the gap on the left‐front side of the
cartridge.
2. Do not touch the recording surface. Fingerprints, dirt, dust and scratches on the recording surface
can destroy previously recorded data and prevent recording of additional data.
3. Open the cover with care. If you damage the cover, you may not be able to close it again.
4. Use a felt-tipped marker to write on the label. Never stick a new label on a disc.
5. Clean dirty discs only with the special DVD-RAM disc cleaner and cleaning fluid (not included).
6. Always return a disc to its cartridge for storage.
7. Make sure the printed side of the shutter and the printed side of the disc is facing the same side
when returning the disc to its cartridge. Also, note the setting of the write-protect tab.
8. Place bare DVD-RAM media back in cartridge for storage.
9. Close cartridge lid once DVD-RAM media is fully inserted into cartridge.
Selection
Displays the patient name, exam and series number, the number of images in the series, the file size of
the images with the current compression selection and matrix size.
Conversion Format
Click the Conversion Format drop-down menu to select the image format for the currently selected
data set. Format choices include: JPEG, PNG, AVI, MPEG, and MOV. AVI, MPEG, and MOV are all
movie-type formats. Choose the format that is compatible with the movie player on your PC or laptop.
Compression Factor and Image/Sec
Move the Compression Factor slider to choose a compression value for JPEG and MPEGs. The lower
the number, the less the compression, the higher the image quality but the larger the file.
Select an Image/Sec rate for the movie play back speed. It is only applicable for MPEG, AVI, or MOV
files.
Annotation
In the Annotation area, choose the level of annotation for the images: none, full, partial (a subset of
the full annotation, or custom. Click Customize to turn on specific annotation fields.
NOTE
DMPR viewports will show image annotation even if the annotation level is set to None
in the system preferences.
Series + or -
Click Series + or - to navigate through a series within the exam.
Select Propagate Image Operations to apply the image manipulations (W/L, zoom, scroll) you have
performed on all images forward from the currently displayed image within a series.
Play/Stop
Click Play to preview the MPEG, AVI, or MOV file.
Click Stop to quit playing the movie.
Image Viewport
The image viewport displays the current images by scrolling through them in a cine loop. Press Page
Up and Page Down to scroll through the images.
Image Conversion
• In the Report Name menu field, select or enter a name to display at the top of the report. The
name also appears in the Export Data list. Typically the patient’s name and type of file are entered
as the report name. There can be no spaces or characters other than alpha numeric.
• In the Folder Name menu field, select or enter the name of the folder where you want to file the
report name. From the Export tab, you can view the data listed within each folder. The data within
a folder is sorted by file type. For example, if you added 10 JPEGs from the T1 series and 20 JPEGs
from the T2 series you will see a list of 30 JPEGs in that folder. If you want these JPEGs separated,
you must place them in separate folders.
• Select Save Preferences to save the changes you have made on Data Export screen.
• Select Anonymous to have the patient’s name replaced with Anonymous and the exam number
when the images are added to the report.
• Click Add to Report to add the current data set to the report from which you can burn the
information to a CD-R. A Data Conversion progress window displays the status.
• Click Cancel if you want to stop the data conversion.
click Quit Data Export until they have been deleted through this method.
Click Move to Report to move the selected item to a destination of your choice. For example, you can
select an item in the Type list and add it to a particular folder in the Folder list. The folder size is listed.
Click the Delete icon to remove selected items from the list. Items remain on the list after you
click Quit until they have been deleted through this method.
Type Name List
Contains of all the file types within the selected folder. Keep in mind that the only items displayed in
the list are the item types. If, for example, you added 20 T1 JPEG images to Folder 1 and then added
another 20 T2 JPEG images to Folder 1, the number of JPEGs in folder 1 is 40. The quantity and size of
each data type is listed.
Click the Delete icon to remove selected items from the list. Items remain on the list after you
click Quit until they have been deleted through this method.
click Quit until they have been deleted through this method.
Conversion Formats
In the Conversion Format area, choose a file type. Typically select HTML.
In the Media Label field, enter a name for the CD.
Media Type
Select the media type to export the data as.
Media information
This area of the Data Export tab changes based on the media selection.
Click the Select USB Disk menu to select a specific USB device if more than one device is inserted into
the USB ports.
Click Refresh to update the Select USB Disk menu if you insert another USB device into a second port
after you have opened the Data Export window.
The Total Disk Space, Free Disk Space, and Total Data Size fields provide information about the
selected USB device. Verify that you have sufficient space on the device before you click Save.
Click Save to start the transfer process.
Click Close to close this area of the Data Export window.
4. Click the Conversion Format menu and select an image format that is compatible with the movie
player on your PC.
5. In the Image Range Selection area, choose the image range.
If you want a subset of the images, select Custom, and then type the range in the text box.
6. Move the Compression Factor slider to select a value.
The smaller the number, the higher the image quality and the larger the file size.
7. In the Annotation area, choose your desired annotation display format.
If you want the patient name to be displayed as Anonymous with the exam number, select
Anonymous.
8. Once you are satisfied with the image appearance (W/L, zoom, scroll), select Propagate Image
Operations.
9. Enter a name for both the report and the folder (only use alpha numeric characters, no spaces).
10. Click Add to Report.
If you change your mind and decide not to add the data to the report, click Cancel from the
progress bar screen.
11. To add another data set to the report, repeat these steps.
12. Click the Export tab to export the report (for details see Export a Report) or click Quit to exit Data
Export.
media, but the integrity of the data cannot be guaranteed and the time for the system to
recognize the media will be excessive.
b. Carefully seat the media in the drive. Wait until the drive has sensed the media and the drive
light goes off, then click Create CD.
c. Click OK.
When the CD writing step is completed, the CD ejects from the drive.
d. Click OK to the CD Written Successful prompt.
9. To copy the data to a USB drive:
a. Select a USB device.
b. Click Save.
10. Click Quit.
• Reports stay listed in the Export tab until you remove them.
• Consider how long you will want to keep the file in the program based on if you need to burn
another CD or USB.
4. Click Quit.
The Anonymize Patient feature assists you in removing patient identifiers by electronically removing
certain exam information and replacing it with anonymous information. An anonymous patient can be
created by exam, series or image.
Two modes are available for you to remove patient identifiers:
• Full mode removes most patient identifiers from an exam, image or series. However, the use
of Full mode does not guarantee exams, series, or images will be rendered anonymous in
compliance with applicable data privacy laws. Review the exam, series, or image data processed
by the feature to ensure compliance with applicable data privacy laws before sharing the
information with third parties.
• Partial mode removes a subset of patient identifiers including, but not limited to, patient name,
patient ID, patient date of birth and patient age. Site name, exam and series descriptions remain
unchanged.
Anonymization occurs after the patient has been scanned, so you must enter a name when you start a
new patient.
The default level of annotation for Anonymize Patient is set in the Image Database tab of the System
Preferences.
NOTE
Screen save images, such as Exam or Series text pages or Contrast Report text pages
are not anonymized, and are not included in the exam if anonymize by exam has been
selected.
Table 152 Fields removed from exams, series, or images using Full or Partial Anonymous modes
• If the text field is empty, click in the field, and enter the new data.
• If the field contains data, place your cursor in the field and select the text you want to change.
Once selected, either press Delete or enter new data.
• If you make an error, you can reset the individual text box or all the text boxes. Click Reset
Selected Value or Reset All Values. The Exam Number field cannot be edited.
• When entering data in the Birthdate field, the month, day, and year can be separated by a hyphen
(-), forward slash (/), comma (,) or period (.). The year must contain four digits.
4. From the Edit Patient Data window, edit the text fields.
• Click the text you want to edit and enter your changes.
5. Click Save when you are satisfied with the changes and you have entered your initials in the
Edited By field. A confirmation window opens.
6. At the confirmation window, click Accept.
• A percentage countdown menu displays until Edit Patient is closed and the Patient
Information Edit Log is updated.
• It takes approximately two minutes to update a 100-image exam.
• The original exam is replaced with the edited exam and is indicated by e+1 in the description
field. The number indicates how many times the exam has been edited.
NOTE
Refer to the DICOM Conformance Statement for the system.
NOTE
USB must be conditioned to FAT32 file type before before saving scan data to USB. A
prompt will ask the user if the USB can be converted to EXT3/EXT4 file type before and
saving of system state backup to USB occurs.
19.5.3 Save Images on page 834:"USB3.0 device with a write speed of greater than or
equal to 45 mb/s
NOTE
Only scan data from a Revolution™ CT system can be restored on a Revolution™ CT
system. Restoring and processing scan data from sources other than the Revolution™ CT
scanner is not authorized for clinical use since safety and effectiveness have not been
established.
The system overwrites the oldest scan files on the system when restoring scan data.
When you restore scan data, the system locks scan files to make sure the system does
not overwrite them. You will have to manually unlock scan files when they are no longer
needed.
Scan Data Manager
From the File Manager control panel, click the Scan Data Manager icon .
5 Group Information
You can sort all three of the areas on Scan Data Manager by column heading to help find the records
you need. Click a column heading to sort the table by that heading. Click the heading again to reverse
the display order.
The Controls contains the Source menu and a search box. Selecting anything other than Scan Data
from the Source menu will close the Scan Data Management window. You can type a search string into
the Search box to find exams (this is like searching for exams in the File Manager).
The Exam List contains a list of exams for which there is scan data available. This list works similarly to
the Exam List in the File Manager.
There is a Locked status column that indicates which exams (or partial exams) have been locked
against automatic deletion.
Blank (no flag) The exam is unlocked and will be deleted when the system requires space for data
from new scans.
The scan data for the exam is locked against automatic deletion.
Part of the exam scan data has been locked against automatic deletion.
3. In the Scan Data Manager, highlight the exam, series, and scan for which you want to lock or
unlock scan data. Hold down the Control key while selecting to choose multiple records.
4. To lock the scan data for the item, right click Lock Scan Data. To unlock scan data, right click
Unlock Scan Data.
3. In the Scan Data Manager, right-click the exam, series, or group for which you want to add a new
reconstruction.
4. Click Open Exam Session.
5. The Reconstruction and Post Processing window opens. The item you selected in the Scan Data
Manager will be selected in the task list. Use the task list to create the reconstruction (as you
would do after a scan).
The Exam Summary page opens on the Scan Display (as it does at the completion of a scan).
NOTE
Scan must be idle when you start this procedure. Each cardiac, non-Hi Res scan file
takes approximately 5 minutes to save, if it was a 0.28 second scan. Scan times can be
longer based on the length of the exposure.
Make sure the selected scan files do not exceed the space available on the USB.
1. Connect a USB device to the USB port on the front of the media tower or the front of the operator
console computer.
2. In File Manager, highlight any exam to activate the control panel icons.
3. From the File Manager control panel, click the Scan Data Manager icon .
4. Highlight the exam/series you wish to save anonymously. Hold down the Control key while
selecting to choose multiple records.
5. Right click and select Send Scan Data As.
6. Select Anonimized Copy or Full Copy.
NOTE
Make sure the USB to which you are sending the data has enough disk space to store
the data. The system does not check disk space before sending.
NOTE
If USB fails to mount, a message is displayed. This may indicate that the USB is not
formatted to the required format. Use the following steps to format the USB From
the display monitor:
a. Click Troubleshooting, then Unix Shell. A Unix Shell window opens.
b. At the prompt, enter the operating system password for ctuser.
NOTE
If your system is configured in a language other than English, the
Unix Shell may show unreadable text when first opened. Enter the
operating system password for ctuser.
c. Type mkfsUSB and press Enter. Depending on the size of the USB it may take
some time for the formatting to complete.
d. When the prompt returns, disconnect the USB
e. Click the X in the upper corner of the Unix Shell window to close it.
f. Return to step 1.
7. Click Close to exit.
8. Once the save is complete to the USB device, exit Scan Data Manager and disconnect the USB
device. Then, resume scanning.
NOTE
If a patient exam session is in the scanning state and you select Save or Restore, a
message displays indicating that the Scan Resource cannot be acquired.
“Could not acquire Scan Hardware Resource. This may have occurred due to one of the
following:
• Scan Data Save or Restore is in progress
• Daily Prep is in progress
• Service scanning tools are in use
• Scanning Session is open
Please wait for completion or cancel the job or queue in progress by the application. If
this is not the case, please perform a Scan Hardware Reset from the Service Tools menu.
If problem persists, please contact your service representative.”
NOTE
See Fields removed from exams, series, or images using Full or Partial Anonymous
modes (page 19-47) to view the data that is removed.
NOTE
Only scan data from a Revolution™ CT system can be restored on a Revolution™ CT
system. Restoring and processing scan data from sources other than the Revolution™ CT
scanner is not authorized for clinical use since safety and effectiveness have not been
established.
The system overwrites the oldest scan files on the system when restoring scan data.
When you restore scan data, the system locks scan files to make sure the system does
not overwrite them. You will have to manually unlock scan files when they are no longer
needed.
1. Select USB Drive from the drop-down menu at the left of the controls area of Scan Data Manager.
2. Highlight the exam, series or group you want to restore. Hold down the Control key while
selecting to choose multiple records.
4. When you no longer need the data, unlock it to allow the system to overwrite it to conserve space.
Refer to 19.8.1 Locking and unlocking scan data on page 861
NOTE
If a patient exam session is in the scanning state and you select Save or Restore, a
message displays indicating that the Scan Resource cannot be acquired.
“Could not acquire Scan Hardware Resource. This may have occurred due to one of the
following:
• Scan Data Save or Restore is in progress
• Daily Prep is in progress
• Service scanning tools are in use
• Scanning Session is open
Please wait for completion or cancel the job or queue in progress by the application. If
this is not the case, please perform a Scan Hardware Reset from the Service Tools menu.
If problem persists, please contact your service representative.”
1 Primary recon for first scan series — the first recon listed under each scan series, identified with a triangle
in the upper left corner of its task bar
5 Image tools
6 For multi-group acquisitions, a label to the right of the recon bar indicates the part of the scanned anatomy
the recon covers. Reformats and AW tasks do not have an anatomy label.
If the recon start and end points correspond exactly with the entire scan acquisition (including all scan
groups if there are multiple groups) the label All displays.
If the recon start and end points correspond exactly with a single scan group, the label is G# (e.g. G1 or G2)
where # is the scan group number.
The Reconstruction and Image Processing Task List opens on the Image Display when you open the
exam and organizes image processing tasks in relation to the scan series set up in the Scan Display
scan task list. Under each image processing scan series are the recons, reformats and AW tool bars that
can be prescribed via protocol or before or after an exam.
The Reconstruction and Image Processing Task List also opens when you open an exam in a tab via File
Manager.
NOTE
If scan data for a series no longer exists, the Add Recon button is disabled.
If the scan is already completed, the primary recons are reconstructed and you pressed Continue to
start any secondary recons for this primary recon, when the new secondary recon is created, you must
click Run to start/queue the recon. You can also start/queue the recon by closing the panel.
The new recon is processed last on the recon list once scan data is available.
NOTE
Primary recon settings are not editable on the Image Display, only on the Scan Display
DMPR 601-689
701-789
801-889
Text Pages 98
(exam, series, roi)
Secondary Capture 99
Dose SR 997
Dose SC 999
NOTE
For primary or secondary recons and DMPR that exceed the number of series allocated,
any additional series will go into Series 1001+.
Mouse over the icon to enlarge it, then click on the viewport in which you want to view the recon or
reformat series.
Figure 437 Viewport selector in Reconstruction and Image Processing Task List
19.10.5.1 Auto-View
The upper left viewport will autoview each primary and secondary recon unless the Clinical ID is
Stroke.Perfusion.
Autoview does not display every single image on systems with Xtream Recon, as images are
reconstructed in bursts of more than one image. Use the right monitor review viewport to review
all images.
Figure 438 Reconstruction and Image Processing Task List — image tools
Series Description You can enter a description for the series in this field.
If you do not enter a description, the series will take
the name of the primary reconstruction’s series de-
scription.
20 Protocols
20.1 Overview
A protocol is a series of pre-programmed scan and recon parameters used for imaging a particular part
of the body. The system is equipped with a set of GE Adult and GE Pediatric Reference Protocols that
can be used for common types of examinations. You can use these protocols or modify them to fit
particular clinical needs. Protocols are used as a basis for routine or established procedures. Refer to
known sources for techniques and dose information for viable parameters, as proper techniques must
be used to ensure patient safety and image quality.
A protocol must be selected to initiate the scanning sequence. Once chosen for use, any protocol
may have any parameters modified as needed for individual case purposes. Any protocol parameter
in the individual exam may be adjusted without affecting the established protocol. If an established
protocol has a parameter or parameters you wish to permanently change, this can be done through
the Protocol Management feature.
Protocol Management provides a place to create established protocols with preset scan and recon
parameters for a specific clinical exam. This saves time when prescribing scan parameters for each
patient. Each series can be viewed, and scan values may be changed to see the effect on other values
or other available options. When building protocols, care should be taken to think about the order
and importance of getting reconstructed images to a physician review station (IE workstation or PACS).
This is extremely important, especially when building protocols that will be used in a trauma setting.
You must have permissions to access Protocol Management. Permissions are enforced by a user
authentication window.
Protocol Management also provides a structure to organize the presentation of the protocols on the
protocol selection screen that will aid in protocol selection at scan time.
Protocols can be saved and restored via System State, Protocol Exchange or IPM Services. It is
recommended to save Protocols, Autovoice and Display preferences when protocol changes are made.
In order to save to USB the Protocols, Autovoice, Display preferences & etc; use at least USB 3.0 for fast
writing speeds, otherwise the user will see the message.
NOTE
USB must be conditioned to FAT32 file type before before a system state backup is
started. A prompt will ask the user if the USB can be converted to EXT3/EXT4 file type
before saving of system state backup to USB occurs.
Finally, insert a new Hyperlink back up to Section 18.5.3 Save Images: "USB3.0 device
with a write speed of greater than or equal to 45 mb/s
If System State is used to restore protocols with Intelligent Protocoling selected, do not select Dismiss
and Restart. Instead perform system restart from Mode > Power Management > Restart.
NOTE
Do not restore protocols from a system with a Quantix 160 tube to a system with a
Performix™ HDw tube. Protocols and Profiles are not backward compatible to older
software releases.
• GE Reference Pediatric: A set of predefined protocols for pediatric patients that cannot be
modified but can be copied and used. These protocols are factory installed. They have been
developed in collaboration with clinical partners to provide users with a convenient and
clinical relevant starting point for tailoring your departmental protocols.
• Recently Scanned Protocols: A copy of the last 90 protocols reside exactly as they were used.
These protocols can be copied and used but cannot be modified or deleted.
• Service: Used by a service representative.
• GE Service: A set of predefined protocols for use by a GE service representative.
• Manufacturing: Used by a manufacturing representative.
NOTE
Head, Orbit, and Miscellaneous are not color coded.
4. Protocol numbers consist of two parts. The first part is based on the Category and anatomical
region and the second number is numerically assigned as it is saved to that region.
User area numbers: Adults = 1 to 10, Pediatrics = 11 to 20, Service = 90
GE area numbers: Adults = 21 to 30, Pediatrics = 31 to 40, Service =40, Recently Scanned =50, and
Manufacturing= 60
To see protocol numbers, right-click in the upper right corner of the Protocol Selection window
and select Protocol Numbers.
5. Search – the user can search by protocol number or protocol name. This will filter the list of
protocols displayed.
6. Favorites
Displays protocols tagged as favorite within a protocol region at the top of the list of protocols.
To Manage Favorites:
• Add a protocol to favorites. Select an anatomical region, right-click on a desired protocol in
the all protocol list and click Add to Favorites.
• Remove a protocol from favorites. Select an anatomical region, right-click on a desired
protocol in the favorites list and click Remove from Favorites.
NOTE
Protocols marked as Favorites when copied are marked as favorites when
pasted into any anatomical category. If you do not wish the newly pasted
protocol to be a favorite, right click on the protocol name and select Remove
from Favorite. refer to the Define a User Protocol section of the user manual.
7. Protocol Tags
Within the Adult and Pediatric categories, protocols can be tagged as Draft, Radiation Therapy,
Research and/or Trauma.
To add Tags:
a. Select an anatomical area, right-click on a desired protocol and select Tags.
b. The list of Tags displays,
c. Click on the desired tag. Note multiple tags can be selected.
d. Once all desired Tags selected, click on the protocol name.
e. Tags selected will be listed in
To delete Tags
a. Select an anatomical area, right-click on a desired protocol and select Tags.
b. The list of Tags displays,
c. Click on the desired tag. Note multiple tags can be selected.
d. Once all desired tags are deleted, click on the protocol name.
NOTE
Protocols marked with Tags when copied retain the Tags when pasted into any
anatomical category. If you do not wish the newly pasted protocol to be tagged,
follow Delete Tags prior to copying the protocol.
8. All
Displays all protocols in the anatomical region in this list of protocols. Unless the search feature is
activated.
9. Sort Protocols
Right-click in the upper right to display the sort menu.
NOTE
GE Reference protocols are read-only and cannot be edited.
1. Several option packages may be purchased and installed on your system, including the setup of
various protocols. You need to have some understanding of their functions to use them in your
protocols. These options include Cardiac Scan modes and 3D Dose Modulation. Please review
Scan and Recon Parameters prior to building protocols.
2. From the image monitor, click .
3. Click Protocol Management, then click Protocol Management again.
4. From the CT Login authentication window, enter your Log On Name and Password.
5. From the Protocol Selection window, use the category and anatomical selector or the search field
to identify the starting protocol to edit or create a new protocol. You can create a new protocol
by copying and pasting a starting protocol or by editing a protocol with the Save As option. It is
recommended to use the Edit and Save As option to create pediatric protocols in the different
color weight categories.
6. Copy and Paste a starting protocol:
NOTE
Protocols marked as Favorites when copied are marked as favorites when pasted
into any anatomical category. If you do not wish the newly pasted protocol to be a
favorite, right click on the protocol name and select Remove from Favorite. refer to
the Define a User Protocol section of the user manual.
a. Click the desired category and anatomy selections to view that protocol list.
b. Select the protocol to be copied.
c. Right-click and select Copy.
d. Select the anatomical category as the destination to paste the protocol.
e. Right-click in the protocol list area and select Paste
f. Rename the protocol as needed.
i. Click the protocol.
ii. Right-click and select Rename to enter the New name.
iii. Click OK.
7. Select a protocol you wish to edit.
8. Click Edit if you are making changes to an existing protocol.
9. From the Scan Settings window, you will be able to define the scan acquisition, recon and image
processing tasks, and set the desired scan and recon parameters within each task for the clinical
intent of the protocol. You will be able to enable Prospective Exam Split with pre-configured
procedure codes and set the transfer options for each image series as well as the exam. You will
be able to set notification values for dose check for each protocol. These settings are described
throughout this manual. Please review how they will impact the protocol before use.
Dose values displayed in the Dose Display area of the Scan Settings window use the Manual
mA and Manual kV values, and for Cardiac scans the baseline SFOV is defined in the protocol to
calculate the CTDIvol and DLP. The SmartmA, SmartmA ODM or Cardiac Modulation settings are
not used.
10. Click Changes Complete, then click the appropriate button for the desired result.
• Exit without Save - will close the edit session. No changes will be made to the protocol.
• Save- to save the changes to the current protocol
• Save As - will save changed as a new protocol, You will be prompted to enter the settings for
the new protocol in the Protocol Save window.
11. In the Protocol Save window, enter the desired settings for the new protocol. Enter Protocol
Name, select the Protocol Category, and Anatomy from the drop-down menu. Note that when
the Category is Pediatric, and the selected Anatomy region supports weight-based protocols, you
will need to make a Color Selection.
NOTE
Only protocols in the Adult or Pediatric categories can be deleted.
1. From the image monitor, click .
GE Thorax (Adult) This profile is intended for use during routine thoracic scans for evaluation of chest
region for abnormalities.
GE Small Ves- This profile is intended for use during non-gated Thoracic CTA scans for evaluation of
sel Thoracic CTA small thoracic vasculature (e.g., Pulmonary Embolism).
(Adult)
GE Large Ves- This profile is intended for use during non-gated Thoracic CTA scans for evaluation of
sel Thoracic CTA large thoracic vasculature (e.g., Thoracic Aorta).
(Adult)
GE CCTA (Adult) This profile is intended for use during prospectively gated Cardiac axial scans for
evaluation of coronary arteries.
GE CCTA Hi Res This profile is intended for use during prospectively gated Cardiac axial scans utilizing
(Adult) HiRes scan mode for evaluation of coronary arteries.
GE Abd/Pel (Adult) This profile is intended for use during routine Abdomen Pelvis scans for evaluation of
abnormalities of abdominal and pelvic structures.
GE Small Vessel This profile is intended for use during body CTA for evaluation of small abdominal
Body CTA (Adult) vasculature.
GE Large Vessel This profile is intended for use during body CTA for evaluation of abdominal aortic
Body CTA (Adult) aneurysm and other large abdominal vasculature.
GE L/T Spine (Adult) This profile is intended for evaluation of soft tissue and bony structures of the lumbar or
thoracic spine.
GE High Pitch Thor- This profile is intended for use during routine thoracic scans using high pitch for
ax (Adult) evaluation of chest region for abnormalities.
GE High Pitch Thor- This profile is intended for use during Thoracic CTA scans using high pitch for evaluation
ax CTA (Adult) of thoracic vasculature (e.g., Pulmonary Embolism).
GE Runoff (Adult) This profile is intended for use during runoff scans for evaluation of vascular structures
of abdomen, femurs and lower extremities
GE CAP (Pediatric) This profile is intended for use during routine pediatric Chest, Abdomen and Pelvis
scans for evaluation of abnormalities of abdominal, pelvic, and thoracic structures
GE Gated Thoracic This profile is intended for use during gated Thoracic CTA scans for evaluation of small
CTA (Adult) and large thoracic vasculature.
Profile Name Clinical SANI Be- SANI Min Max kV Min Max Rota- Pitch
Task low Ref Above Ref Size Size mA mA tion
Size Size (AP + (AP + Time
Lat) Lat) [s]
GE Small Ves- ST+C Large De- Small In- 39 42 70 100 500 0.35 -
sel Thoracic High crease crease
CTA (Adult) 42 54 80 100 600 0.35 -
GE Large Vessel ST+C Large De- Small In- 39 42 70 100 500 0.35 -
Thoracic CTA High crease crease
(Adult) 42 58 80 100 600 0.35 -
GE Abd/Pel ST+C Large De- Very Small 39 50 80 250 600 0.5 0.992
(Adult) Low crease Increase
50 56 100 100 720 0.5 0.992
GE Small Ves- Angio Large De- Small In- 39 47 70 220 500 0.5 -
sel Body CTA crease crease
(Adult) 47 52 80 100 600 0.5 -
GE Large Vessel Angio Large De- Small In- 39 52 70 220 500 0.5 -
Body CTA crease crease
(Adult) 52 60 80* 100 600 0.5 -
GE High Pitch ST+C Large De- Small In- 39 45 70 300 500 0.35 -
Thorax (Adult) High crease crease
45 54 80 100 600 0.35 -
GE High Pitch ST+C Small De- Large In- 39 46 80 100 600 0.35 -
Thorax CTA High crease crease
(Adult) 46 50 100 100 720 0.35 -
Auto Prescription can only be enabled when the mA mode is SmartmA or SmartmA ODM. It is
important that Noise Index, minimum mA and maximum mA settings be appropriate for the kV of the
Reference Size Patient in the Auto Prescription Profile that will be used (Noise Index Values). The kV
setting for manual kV mode should be set to same value as the kV for the Reference Size Patient.
In protocol management, parameters within the Reference Size Patient Range of the Scan Profile are
displayed in the protocol. Dose display is based on the settings for Manual kV mode and Manual mA
mode. As Auto Prescription can be overridden at scan time, the settings in the protocol should be set
for manual kV mode to be the same as the Reference Size Patient Range settings in the kV Profile.
NI Set in Protocol: Auto Prescription adjusts NI for changes in technique based on Size Adjusted NI
(SANI) strength setting and Clinical Task settings in the kV Profile.
NI set in Profile: The NI in the corresponding Patient Size Range will be applied.
NOTE
Because Auto Prescription can be overridden at scan time, first set the technique in
manual mA and manual kV mode that is intended for the Reference Size Patient.
1. From the image monitor, click .
2. Click Protocol Management, then click Protocol Management again.
3. From the CT Login authentication window, enter your Log On Name and Password.
4. From the Protocol Selection window, create a new protocol or select a protocol to edit.
5. Click Edit if you are making changes to an existing protocol.
6. Set the Scout parameters. A scout scan is required for using Auto Prescription.
7. Set the scan parameters for each group.
a. From the Scan Settings window, set the kV Mode and mA Mode to manual and set the
parameters:
• mA
• kV
• Slice Thickness
• Rotation Time
• Pitch
• SFOV
• ASIR V
• WW
• WL
to match the settings of the Reference Size Patient in the planned kV Profile.
b. Click mA mode and change to SmartmA or SmartmA ODM. Set the minimum mA and
maximum mA to match the Reference Size Patient in the planned kV Profile. Set the Noise
Index based on the Reference kV, slice thickness, anatomy and clinical task.
c. Click kV Mode, select Auto Prescription.
d. Select the Auto Prescription Profile- each group can have a different kV Profile.
Once you select a Auto Prescription profile in Protocol Mangement, the kV is set to the
Reference kV of the profile. If the Reference kV of the profile is different than the kV that
was set before selecting the profile, the system automatically adjusts the prescribed NI for
the Reference kV. This is done to maintain a similar a Contrast-to-Noise Ratio, based on the
clinical task from the profile, as the previous kV and NI. The system will display a yellow
notification banner, and the user has the option to keep the recommended adjusted NI or to
revert to the previous NI.
At this point, all parameters specified within the kV Profile will be designated with a white dot.
In Protocol Management the values displayed are from the Reference Size Patient Range, at scan
time these will adjust based on the patient size calculated from the scout scan.
8. Auto WW/WL of WW/ WL is set to ON automatically for primary and secondary recons when kV
Mode is Auto Prescription unless the original protocol had set the Auto WW/WL to Off.
Click Primary Recon Settings Collection to set Auto WW/WL to OFF for the primary recon, which
will automatically disable Auto WW/WL for all secondary recons associated with this group.
Click Secondary Recon Settings Collection to set Auto WW/WL to OFF for individual secondary
recons.
9. For scans with multiple groups where timing between groups is critical for a successful exam,
click Timing and set Group Delay Lock to Enabled. This results in an alert at scan time if any
factors such as SFOV, rotation time or pitch increase the intergroup delay by 5 seconds over the
protocol delay value.
10. Continue with specifying the parameters for the series.
11. Verify the remaining parameters for the subsequent series in the protocol.
12. Save the protocol.
Each Auto Prescription profile consists of a unique name, a description, the Noise Index mode and
applicable settings: Slice Thickness or Size Adjusted Noise Index strength and Clinical Task, minimum
and maximum values defining the patient size ranges, and scan settings applicable to a specified size
range.
5. Create the desired number of Patient Size Ranges for the profile.
The ranges are continuous (max of one range always equals min of the next range) and will adjust
accordingly as ranges are added and/or deleted.
Ensure that the size ranges are accurate for intended patient population.
a. Click [+] to add or [X] to delete until the correct number of size ranges are displayed, up to a
maximum of 9 size ranges.
b. Click the drop down to select the Patient Size Units you want to use to set the minimum
and maximum size values. Note that Weight and BMI can be used for viewing and editing.
However, the protocol cannot be saved with these units. The values will be converted when
changing between units.
• Dw ( cm)
• AP+ Lat ( cm)
• AP ( cm)
• Lat ( cm)
• Weight ( kg)
• Weight ( lbs)
• BMI
c. Enter the Minimum (MIN) and Maximum (MAX) size values to create the Patient Size Range.
AP: 0 41.63
AP_Lat: 0 96.31
Lat: 0 58.51
Weight(lbs): 0 364.34
Weight(kg): 0 165.27
BMI: 0 57.78
6. Select where the Noise Index should be managed for Auto Prescription. This setting is in the
window Where do you want to set Noise Index? See description below for Setting NI in Protocol
or Setting NI in Profile.
A. Setting NI in Protocol
Auto Prescription will update the NI in accordance with the kV selected at scan time to maintain
a consistent CNR relative to that which would be achieved for the Reference Patient Size. The
level of NI adjustment is determined by Size Adjusted Noise Index (SANI) settings and the Selected
Clinical Task.
a. Ensure that the NI in the protocol is appropriate for the kV and scan settings for the Reference
Size Patient Size Range.
b. Determine if you would like to adjust NI strength for patients smaller or larger than the
Reference Patient Size and by how much.
Smaller than Reference Patient Size Larger than Reference Patient Size
No Change No Change
c. Select the Clinical Task. The drop down is in order from the smallest to largest NI adjustment
across kV.
B. Setting NI in Profile
a. In the window What is your Primary Recon slice thickness?, set the Slice Thickness for the
Primary Recon (this will only appear when Setting NI in Profile.
b. Enter the NI value in each patient size range.
7. In the window What additional parameters do you want to change with Patient Size?, click all
parameters that will be set for each Patient Size Range, SFOV, Rotation Time, Pitch and/or ASIR-V.
8. Select individual parameters that you would like to specify for a specific size:
SFOV, ASIR-V, Rotation Time, Noise Index, Pitch
9. For each size range enter the values for kV, minimum mA, maximum mA, NI if NI Set in Profile
is selected, and any other settings clicked from the other parameters window. During scanning,
patient size will be calculated from the scout scan and the settings from the applicable Patient
Size Range will be applied to the scanning protocol.
Note that minimum and maximum mA values default to the minimum and maximum mA for the
selected kV. If alternate values are entered to limit the mA range, ensure that they are appropriate
for the technique parameters prescribed within that Patient Size Range.
10. Save. See Build a protocol with Auto Prescription.
kV Assist recommendations for kV and NI/mA are optimized based upon typical clinical tasks or
scanning and imaging conditions.
kV Assist does not utilize profiles, all settings must be set within in protocol.
kV Assist can be used with manual mA, Smart mA or SmartmA with ODM. It is important that mA
or Noise Index and minimum/ maximum mA values set within the protocol be appropriate for the
baseline kV for an average size patient.
NOTE
Because Auto Prescription can be overridden at scan time, first set the technique in
manual mA and manual kV mode that is intended for the Reference Size Patient.
1. From the image monitor, click .
2. Click Protocol Management, then click Protocol Management again.
3. From the CT Login authentication window, enter your Log On Name and Password.
4. From the Protocol Selection window, select a protocol to edit that has kV Assist enabled.
5. Click Edit if you are making changes to an existing protocol.
6. Set the Scout parameters. A scout scan is required for using kV Assist.
7. Set the Axial scan parameters.
a. From the Scan Settings window, set the baseline parameters for Noise Index, Mode, Slice
Thickness, Rotation Time, Pitch and SFOV.
b. From the Scan Settings window, open the kV and mA Control collection and then click kV
and set the baseline Manual kV value.
c. From the kV Mode area, select kV Assist.
d. Select a clinical task.
e. Select a Minimum kV and Maximum kV value to define the kV range. Set a Baseline kV. This
selection allows the user to avoid using tube voltages that are too low or too high.
NOTE
The Baseline kV must be within the kV range. When the Baseline kV is changed
to less than the Minimum kV, Minimum kV is lowered to the Baseline kV value.
Conversely, when the Baseline kV is raised to a value higher than the Maximum
kV and Maximum kV are increased to the baseline value.
f. Note that Auto WW/WL of WW/ WL is set to ON automatically when kV Mode is kV Assist
unless the original protocol had set the Auto WW/WL to Off. Click Primary Recon Settings
Collection to set Auto WW/WL to OFF.
8. Continue with specifying the parameters for the series.
9. Verify the remaining parameters for the subsequent series in the protocol.
10. Save the protocol.
• Combination anatomies:
• Chest + Abdomen
• Abdomen + Pelvis
• Chest + Abdomen + Pelvis
SmartPlan can only be applied to head, chest, abdomen and pelvis regions based on the supported
CID.
NOTE
If a head, neck, chest, abdomen and pelvis is to be scanned in a single group, do not
enable SmartPlan. In these cases, select the scan range manually.
b. Enter Start (Full FOV Start), End (Full FOV End), DFOV, A/P center and R/L center based on the
series landmark setting in case SmartPlan does not run at scan time due to invalid scout or
inability to identify anatomical landmarks.
NOTE
SmartPlan cannot be enabled if Copy Forward (“d” duplicate) is entered in Start
or End Location. DFOV/Center Adjust cannot be enabled when Copy Forward
(“d” duplicate) is entered in DFOV, A/P center or R/L center.
c. Click Clinical Identifier and select a supported clinical category/clinical identifier pair for the
desired SmartPlan anatomical region. Refer to Table 158 on page 902.
d. Click SmartPlan and set to On.
e. Click Center Adjust set to On or Off.
f. Click DFOV Adjust set to On or Off.
NOTE
Center Adjust and DFOV Adjust will default to ON for all CID categories except
Neuro. When CID Categrory is Neuro, Center Adjust defaults to ON, and DFOV
Adjust defaults to OFF.
Thoracic.Chest Abd Pelvis Chest + Abdomen + Pelvis bilateral lung apex ischial tuberosity
A SmartPlan Profile defines coverage settings based on clinical intent as defined by the clinical
identifier mapping; any changes to the offsets will be applied to all associated CIDs, as described in
table above SmartPlan supported Clinical Identifiers.
8. If desired, click in DFOV Adjust, enter + for wider or - for narrower and a value between 0 and 5
cm.
NOTE
if + or – are not entered, the setting will widen the DFOV and display +.
9. Click Save.
NOTE
Clicking X without Save closes the window without saving the edited values.
1. From the Mode Menu, select Protocol Management, then select Auto ROI Management.
2. For each Diagnostic Region enter the desired Offset for the Baseline location in mm.
• The offset range is S80 to I80. No decimal is allowed.
• The default offset value is S0.
3. For the Abdomen set the Baseline Preference and for Cardiac set the Monitor ROI Preference.
• The default baseline selection of Abdomen is Top of diaphragm.
• The default Monitor ROI for Cardiac is Descending Aorta.
4. Click Save.
4. Enter Type and Description and follow Steps 4-9 of 20.7.4 Record an Auto Voice message on
page 911.
NOTE
To save a language, at least one message set must be recorded within the language.
• Valsalva
• Don’t Move
• User 1
• User 2
*These are pre-recorded messages sets within each factory installed language.
• The Description should be easily identifiable (example - Mary S. Inspiration); this helps
identify whose voice is being used and the content of the message.
4. Select Pre.
5. Click Record and begin the pre-message.
• Click and hold Record until you are ready to begin your message. Normally, you are recording
a pre-message first (example - “Take in a breath and hold it.”). When you release the mouse
button, the recording starts.
• Begin your message right away.
• Speak clearly into the microphone located on the scan control interface.
7. Select Post.
8. Click Record and begin the post-message.
9. Click Save.
NOTE
An Auto Voice message can only be saved if both a pre-message and post-message
are recorded.
10. To hear a recorded message, select the pre-message or post-message and click Play in the Auto
Voice Message area.
NOTE
The three pre-recorded messages cannot be deleted.
4. Click Delete Message from the drop-down menu.
4. Click Copy and in the Profile Name field, type or edit the name of the profile.
Once saved, any User Profile can be renamed by selecting the profile and clicking Rename or
deleted by clicking Delete.
5. Within the profile you may set individual settings for a given heart rate and heart rate rhythm
which are customizable via the table. Define the Average Heart Rate (BPM) andHR Rhythm
categories in the table, click on the box for each setting and enter text.
6. Define the Heart Rate Rhythm Thresholds. These thresholds define how Auto Gating will
categorize the patient’s heart rate based on the breath hold recording.
• Variable Beat to Beat Threshold: Max beat to beat variability before the HR Rhythm is
classified as “Variable”.
• Irregular Threshold: Max number of irregular beats before the HR Rhythm is classified as
“Irregular”.
• Highly Irregular Threshold: Max number of irregular beats before the HR Rhythm is classified
as “Highly Irregular”.
• Arrhythmia Rescan Threshold (%): The percent error from the prescribed phase location
before the system rescans when the acquisition part is in percent R-to-R. If the user
prescribed the acquisition window in milliseconds after R-peak, then the system will only
rescan if there is significant R-peak variation during the exposure (approximately 30% beat-
to-beat variation).
• Arrythmia Rescan Delay (s): Defines how long the system must wait after the first exposure
before reattempting a rescan. Some users may wish for the system to rescan as soon as
possible to avoid contrast washout, while in other cases the user may wish to use a longer
delay as a chance for the heart rate to stabilize.
7. Define the Average Heart Rate (BPM) ranges. Click on the gray box at the top of each column and
edit the value. The value in the box needs to be greater than the previous cell and less than the
next cell. To expand the range of HR values, edit the last few HR values to 199, 198 and 197; then
edit the other columns. The heart rate range supported is 30-200 BPM.
8. Click in a cell within the table, to define the ECG Gated Scan Settings for a given HR Range and
Rhythm. This cell will be blue.
9. Edit the Scan Settings below the table.
The title bar of the Scan Settings area is updated with the exact boundaries selected in the
Average Heart Rate (BPM) / Heart Rate Rhythm category table.
Whenever the setting cannot be edited, it is disabled.
10. When all desired settings are entered. Click Save.
Name Description
Slowest Allowable Rota- Slowest gantry speed that would be suggested if prescribed Noise Index
tion Speed cannot be achieved by SmartmA
Acquisition Part1 Defines the phases of the cardiac cycle that will be acquire during the scan,
Acquisition Part2 and the relative mA (%) that will be applied for each part of the cardiac
cycle.
Acquisition Part3
Acquisition Parts can be defined in R-R %, ms offset from prior R-peak, or
number of heart beats (1, 2, or 3).
Widen for SSF Enabling this feature directs the system to acquire data so a SSF image may
be generated at the specified cardiac phases or times.
For background information about R-wave, R-wave to R-wave, and % phase,
see the Cardiac Phase Background section.
Adaptive Gating A feature used to avoid scanning during the beat immediately after an irreg-
ular (short) beat. The system continuously monitors the R-peak Triggers in
real-time.
If the system detects an irregular beat, it pauses to avoid scanning during
the subsequent beat. The system then resumes scanning when the ECG
trace returns to normal.
Smart Arrhythmia Man- Turning On Smart Arrhythmia Management enables the system to automat-
agement ically rescan exposures where the prescribed cardiac phases were not suc-
cessfully acquired. While this may double the dose for some patients with
irregular heart rates, having two acquisitions increases the chances that at
least one of the scans will be diagnostic, using the same contrast injection.
Patients without heart rate irregularities during scanning will not have any
increased dose.
Name Description
Scan mode The Scan mode area allows you to define the scan mode for Cardiac Axial and
Cardiac Helical scans.
Slowest Allowable Rota- Slowest gantry speed that would be suggested if prescribed Noise Index can
tion Speed not be achieved by SmartmA.
Acquisition Part1 Defines the high mA and low mA phases of the cardiac cycle that will be
Acquisition Part2 acquired during the scan, and the relative mA (%) that will be applied for
each part of the cardiac cycle.
Acquisition Part3
Acquisition Parts 1 or 2 can be defined in R-R %, ms offset from prior R-peak.
Acquisition Parts 3 is always defined as 0-100 R-R % and can’t change.
You can also do a free-text search to find a specific protocol using the box labeled Type Protocol
Name.
4. Select the data source from which you want to import. The protocols on the USB device display in
the Available Protocols column.
5. Click the protocols you want to import on the Available Protocols column. The protocols you
select display in the Selected Protocols column on the right of the screen.
6. Click the Import Select button.
7. Resolve any naming conflicts using the prompts displayed.
have occurred since the last since the last time the system was restarted. The pushed protocols will
automatically be installed to the device upon the next system restart.
The cloud protocols are considered the master and will overwrite all protocols on the CT device.
If it is necessary to revert to prior version of protocols on the device, login to Protocol Exchange,
click Replace All, and select the desired backup from the list under Select Protocols to Import, Click
Continue on the Replace All pop-up window.
To interact with IPM service requires setting the Cloud Connectivity System Preferences. System
Preferences settings include entering the URL and Advanced Settings to Activate connection to the
cloud. Once activated, the device preferences can be changed to disconnect or re-enroll. During
activation or re-enrollment, the system will require user logon and password. Contact your service
representative to Activate, or Re-enroll the CT device to the cloud.
21 Access Controls
GE has a long-standing reputation for providing customizable, clinical solutions that protect the
privacy and security of your organization’s unique clinical workflow, as well as your patient’s
confidentiality.
Make sure to understand the intended use of the product when determining privacy risk relative to
patient care and safety. GE is very concerned with providing the best care to patients, and in some
cases, we have determined that patient care is more important than the risk to privacy. In these cases,
GE takes every precaution to minimize privacy risk.
Security and privacy are maintained across a healthcare system. Any product that is placed into an
uncontrolled environment will not be secure and cannot protect privacy. GE designs systems to be
implemented in a “secure environment”. A secure environment is based on multiple layers of security,
a concept known as “defense in depth”.
It is the healthcare enterprise's responsibility to ensure the product is installed and operated in a safe
and secure manner.
Audit Logging and Accountability Controls that support security surveillance and privacy and security
investigations and reporting.
De-identification (anonymization and pseudonymization) capabilities to limit privacy and security
risks to sensitive information.
Firewall protections that block unauthorized incoming network connections.
Use of a commercial network vulnerability scan tool to identify high risk vulnerabilities that are
mitigated prior to release of the CT system software. The tool probes all TCP/IP and UDP/IP ports on
the system looking for known vulnerabilities.
The CT system protects this information by access controls and retains this information until the user
removes it.
The details of all personal information collected by the product and how it is used is described in
the DICOM Conformance Statements and IHE Integration statements. These are found at the following
URLs:
http://ge.com/dicom
http://ge.com/ihe
http://ge.com/hl7
Local Port 4006 Open to DICOM server, DICOM Storage Service SCP
21.2.1 Introduction
Access Controls using EA3 requires logging in to the system and logging out when you are done
scanning for a period of time. If you do not log out, the system will log you out and you will need to log
back in.
Access Controls using EA3 contains the following user permissions after logging in:
• GE Service – Can perform all functions
• Administrator – Can set up, add or delete users and view the Audit Log
• Standard User – Can perform scanning functions and modify protocols
• Limited User – Can perform all scanning functions
NOTE
Emergency User login has Limited User permissions. When logged in as an Emergency
User you are limited to scanning 5 exams. The system will log you out and require you to
log back into the system again.
When adding users to local databases certain rules apply.
You must use the following guidelines:
• Users/Groups:
• Lower case letters and numbers only
• Cannot start with a number
• No limit on length
• Passwords:
• Must be at least eight characters long; no null characters and no more than 63 characters.
• Can contain uppercase letters, numbers and special characters
Access Controls is an option that can be enabled or disabled by setting the Access Control preference
in System Preferences.
If the authentication login screen is turned off, then security of system may be compromised.
Disabling the access control feature greatly reduces the control of access to sensitive information
on the CT system.
NOTE
Ask your administrator or GE Service for a Username and Password.
To configure EA3, you must have administrative privileges.
1.
Field Description
NOTE
“In context” is a HIPAA term indicating that all selections and buttons in the center panel
apply to the selected user or group.
NOTE
“In context” is a HIPAA term indicating that all selections and buttons in the center panel
apply to the selected user or group.
Field Description
Configurable delay after When password entered is not valid for user name and sign in fails,
authentication failure this is the time delay until the user can attempt to sign in again.
(Seconds) Time can be between 0 and 120 seconds.
Custom Message to display on Enter text for a custom message to display to any user on the login
login page screen.
Field Description
• Login authorization.
Enable Enterprise • If unchecked, only local EA3 users can login.
Authentication • If checked, both local users and enterprise EA3 users can
login; the local EA3 user database is tried first.
• Time the EA3 login process waits for a response from the
enterprise directory server.
• There is frequently a network latency when connecting
to servers, which is dependent on your network configu-
ration.
Enterprise Authentication
Latency (Seconds) • If the amount of time is reached without a response
from the enterprise directory server, the EA3 login proc-
ess returns a failed login. A value of 5 seconds is usually
enough time to allow a properly configured directory
server to respond, without causing undue user incon-
venience.
3. Modify the properties in the text fields provided to allow an enterprise directory server
connection.
NOTE
Use SSL must be checked for a secure LDAP connection.
4. Click Apply Configuration to accept the configuration changes.
Click Restore Configuration to undo any changes not yet applied.
• If the DNS allows service lookups, EA3 executes an auto-detection with the enterprise
directory server. If it cannot find the server, it is not an error. Continue with these steps
to configure the server.
3. In the Server Configuration area, type the Server Name/IP of the enterprise directory server that
EA3 should connect to.
The system must have DNS enabled or static information in a hosts file (/etc/hosts).
4. Select the Authentication Type that the enterprise directory server supports.
• For a Microsoft Active Directory Server, typically select Kerberos.
For a Novell eDirectory Server, typically select LDAP.
If you do not know this information, check with the owner of the enterprise directory server.
• If the enterprise directory server supports SSL connections, select the Use SSL option.
• If you use LDAP authentication without SSL, passwords are not sent securely. This is not
recommended. An alert is posted for this configuration. With Kerberos and non-SSL, the
authentication is encrypted, but the LDAP traffic is not.
5. Click Test Connection to test if the machine can connect to the enterprise directory server.
• If the connection is successful, CONNECTION OK is displayed next to Test Connection.
• If the connection is unsuccessful, CONNECTION BAD is displayed next to Test Connection.
This indicates there is a problem connecting to the enterprise directory server.
Check the following:
• Server Name/IP
• If the system has DNS running.
• If the system can resolve the Server Name/IP.
6. Once the Test Connection is successful, select the Server Type for the enterprise directory server
(Microsoft Active Directory, Novell eDirectory, et cetera).
7. Click Generate Defaults to populate the Realm Name, Format, DN, Login Attribute, First Name
Attribute, Last Name Attribute, and Group Attribute fields with default values for the enterprise
directory server type.
• If the enterprise directory type is MSAD, both the Realm Name and the DN are populated.
• If the enterprise directory type is eDirectory, the Realm Name is left blank. If you are
configuring an enterprise directory server that is not MSAD or Novell eDirectory, the
configuration must be done manually. Get the correct LDAP property information from the
owner of the enterprise directory server.
• If this is a non-MSAD, non-eDirectory server, or is a server with a non-default configuration,
manually change properties, as needed.
8. Enter a Username and Password for a user that resides on the enterprise directory server.
9. Click Login to see if the login is successful.
• The First Name, Last Name, and any Group Memberships for the user are displayed. If First
Name, Last Name, or Group Memberships are not found, a warning is posted indicating:
• The LDAP properties are not configured correctly (First Name Attribute, Last Name
Attribute, and/or Group Attribute).
• The user does not have a First Name, Last Name, or any Group Memberships configured
on the enterprise directory server.
• If you get these warnings, contact the owner of the enterprise directory server to verify it is
configured properly.
• If the test login was successful and you’re satisfied with the First Name, Last Name, or any
Group Memberships information, the enterprise directory server is configured properly.
Field Description
• The LDAP base DN of the LDAP server to which you are con-
necting.
• Typically this is the fully qualified domain name separated by
DN clusters of DC=.
• For example, if the fully qualified domain name of the direc-
tory server is example.com, it is likely that the DN is DC=exam-
ple,DC=com.
(continued)
Field Description
First Name Attribute The LDAP attribute used for the user's first name.
Last Name Attribute The LDAP attribute used for the user's last name.
Group Attribute
NOTE
EA3 finds all instances of this attribute (not just the first,
like it does for other attributes). If a user belongs to
more than one group, EA3 finds all memberships.
NOTE
Regarding LDAP parameter configurations, EA3 finds the first instance of the configured
attribute for a user, except for Group Membership. If you configure the First Name
Attribute to be an attribute listed multiple times, EA3 assumes the first one found during
an LDAP query is the correct First Name. For Group Membership, EA3 finds all instances
of that attribute.
Save changes
• No changes are saved to EA3 on a tab unless you click Apply Configuration before you navigate to
another tab, or click Confirmation. If there is more than one Apply Configuration on a tab, click
the one associated with the data you changed (buttons are grouped with the data they manage in
a bordered panel).
• Click Apply Configuration or Restore Configuration.
Within 5 seconds a message indicates whether the changes were saved or not, respectively:
• Enable Authorization
• Limited User
• Inactivity Timeout (Minutes)
• Emergency Prompt
• Apply Configuration
The user accounts for the OS are root, ctuser and insite. These are user accounts that have embedded
permissions.
These OS user accounts have default passwords, that are set during software installation by the
service representative and should be provided to your user with administrator role. Passwords are
reset to the default values when software is installed and will need to be set again.
NOTE
The Applications Menu is not displayed when the current user does not have
Administrator or GE Service role.
To Change the OS password
1. From the Utilities Menu, select Service to open the service desktop.
2. Select Utilities Tab, select Security Center.
3. Select Application.
4. Select OS Password Change.
5. Select the user account (root, ctuser or insite) from User Name drop-down menu.
6. Enter the Old Password
7. Enter the New Password that complies with OS password strength rules in New Password and
Retype New Password.
OS Password Strength Rules
• Update the 8 characters including 1 upper case, 1 lower case, 1 numeric, 1 special character
and cannot contain 3 repeating characters.
• The default passwords cannot be used.
• Note that the reuse of a password is prohibited for 5 password changes.
8. Click Submit. A message will be displayed to indicate Password Changed Successfully or why the
password change was not accepted.
To reset an OS Password (this should only be used when the password is unknown)
1. From the Utilities Menu, select Service to open the service desktop.
2. Select the Utilities tab, then select Security Center.
3. Select Applications, select OS Password Reset.
4. Select User Name from the dropdown menu (root, ctuser, insite).
5. Enter the New Password that complies with OS password strength rules in New Password and
Retype New Password.
OS Password Strength Rules
• All passwords must have a minimum of 8 (normal) alphanumeric characters.
• All passwords must have at least one uppercase alphabetic character
• All passwords must have at least one lowercase alphabetic character
• All passwords must have at least one numeric character
NOTE
The reuse of a password is prohibited for 5 password changes.
6. Select Submit.
7. Close Security Center when Done.
22 System Management
22.1 Overview
Use these procedures for system management level functions.
2. From the Utilities menu, click System Tools, then Message Viewer.
The Current Messages window opens.
3. Click one of the following options:
• Clear: Removes the message displayed in the message area.
• View Log: Opens the system log for more detailed information about messages and errors.
Click Select Viewing Level, select the type of messages to display: User for user messages or
Class A for service messages and click OK.
• Close: Closes the message window.
• Memo: Allows you to leave a note in the message log for the service engineer.
2. From the Utilities menu, click System Tools, then Save Cybersecurity Audit Logs. The message
Remove all other USB media and connect only the USB media where you want to backup
Cybersecurity Audit Logs displays.
3. Remove all other media devices attached to the system, insert USB and click on Save to USB
button. The message Please wait for some time while storing Cybersecurity Audit logs into USB
media should display.
NOTE
If the USB media does not have enough disk space, the message Connected USB
media does not have enough free space to copy Cybersecurity Audit Logs. Please
clean up data from USB media or connect another USB media displays.
Once the audit logs are saved completely, following message Export to USB is complete displays
and all the archived audit logs (/var/log/audit/auditlogs) will be deleted from the system.
The audit logs will be copied in the following directory on the USB: 5. NOTE
/<mountdir>/ cslogs_<hostname>
4. Remove the USB drive.
NOTE
If the save to USB fails, the message below displays the next time the audit log size is
checked.
Audit Log data is near maximum number of records that can be stored on system.
To prevent audit log data from being over-written, please insert a USB media into the
USB port on the computer and select Save Now or select Save Later to do this at a
later time by selecting Tools, System Tools, Save Cybersecurity Audit Logs.
Failure to save the audit logs may result in the permanent loss of some audit log
records.
NOTE
All the logs that are saved to USB are deleted from the local system.
NOTE
For system software version information, select Revolution-CT-SW.
22.3.1 Introduction
The following preference require a system restart to take effect:
• Enable Access Control
• Calling AE Title setting on
• Simultaneous Transfer Mode
• Simultaneous Transfer Per Host
• All settings in Performed Procedure Step Preference tab
2. Click Save to save the new preference, or Save and Close to additionally close the System
Preferences window.
NOTE
DMPR viewports will show image annotation even if the annotation level is set to No
Annotation in the Viewport System Preferences.
To view annotations in a larger font, click Customize Large Font and select the specific
annotation group to enlarge.
NOTE
The system preset is set to Full Annotation.
2. Click Save to save the new preference, or Save and Close to additionally close the System
Preferences window.
2. Click Save to save the new preference, or Save and Close to additionally close the System
Preferences window.
2. Click Save to save the new preference, or Save and Close to additionally close the System
Preferences window.
Figure 481 Group Color - Soft- Figure 482 Group Color - Figure 483 Group Color -
toned Bright Pastel
Figure 484 Scan task list color Figure 485 Group tab scan settings
Follow this procedure to customize the color scheme used for show localizer groups.
1. In the Show Localizer Group Color select one of the following parameters: Classic: standard
blue tones. This is the default setting. Bright: 6-color vibrant palette, Soft-Toned: 6-color muted
palette, Pastel: 6-color pastel palette
2. Click Save to save the new preference or Save and Close to additionally close the System
Preferences window.
• Operator
• Exam Description
The procedures to add, edit or delete are the same for these presets.
NOTE
The following characters cannot be used in the first or last name field for Referring
Physician, Radiologist and Operator: =, /, ^
NOTE
Selecting another Preferences tab will save any entered information.
3. Click Save to save the new preference, or Save and Close to additionally close the System
Preferences window.
4. In the Anonymize Patient Image Annotation Level area, select: Full or Partial mode.
NOTE
Full mode is the most HIPAA-compliant.
For detailed information on how to anonymize patient data, see Patient Data.
3. Click Add Requested Procedure to enter a new RIS description. Click Save. The new procedure
can now be associated with a protocol for use with Prospective Exam Split.
4. Click Import Recent Procedures to import the most recent RIS procedure codes from the scanner
database. Click Save. The new procedures can now be used with Prospective Exam Split.
NOTE
The system preset is 18 years old.
5. Click Save to save the new preference, or Save and Close to additionally close the System
Preferences window.
b. Edit an existing entry by selecting the entry on the list, then making changes to the name in
the Agent field or the value in the Concentration field.
c. Delete an entry by selecting the entry in the list then clicking the X next to the entry.
2. For Oral Contrast:
a. Add an agent by typing a name in the Agent field, then enter a concentration (in mg/ml) for
the agent. Click the Add button.
b. Edit an existing entry by selecting the entry on the list, then making changes to the name in
the Agent field or the value in the Concentration field.
c. Delete an entry by selecting the entry in the list then clicking the X next to the entry.
3. Click Save to save the new preference, or Save and Close to additionally close the System
Preferences window.
NOTE
200mm/s is available only if the Fast Scout option in installed.
12. In the Statistics Window Length area, enter a value for seconds (0–99).
13. In the Irregular Beat Window Length area, enter a value for seconds (0–999).
NOTE
The system default is set to 60 seconds. Decrease this value to 30-45 seconds if you
want Auto Gating to use a smaller time window for heart rate measurements.
14. In the Breathhold Record Length area, enter a value for seconds (0–99).
15. In the Cardiac Multiphase Fixed Interval Recon field, select On to activate the feature, or set to
Off, the default value.
16. Click Save to save the new preference, or Save and Close to additionally close the System
Preferences window.
4. In the WW and WL area, enter a label, a window width value and a window level value.
22.3.14.2 Patient ID
1. Select On to show the Patient ID on the display. This is the default setting. Select Off to keep the
Patient ID off of the display.
2. Click Save to save the new preference, or Save and Close to additionally close the System
Preferences window.
4. The Calling AE (Application Entity) title is used when opening the association to the HIS/RIS. This
AE will also be used in the Scheduled Station AE Title (0040,0001) tag in the C-FIND request if ‘This
System’ option is selected in the Schedule Refresh Setup menu refer to Setting up the HIS/RIS
Refresh.
The calling AE title for the CT system is used by the Patient Schedule application when a Modality
Worklist C-FIND request is performed. If the local system's calling AE title does not match the
expected AE in the remote HIS/RIS configuration (or the local system is not configured on the
remote HIS/RIS), the remote HIS/RIS may fail to return worklist entries to the local system.
5. Click Save to save the new preferences, or Save and Close to additionally close the System
Preferences window.
6. Click >Troubleshooting > Restart Application to enable Scheduler SCU Configuration.
NOTE
Only recommended protocols from adult protocols display when the adult selector
is displayed and only recommended protocols from pediatric protocols display
when the pediatric selector is displayed.
If the AutoSelect protocol preference is set to On, and a protocol has been selected
at least 20 times for a given modality worklist entry and the confidence is 30 percent
higher than the next highest protocol, the system selects a protocol and displays it
in the Selected Protocols area. The user can click Accept to use this protocol(s) for a
patient scan. Prior to selecting Accept, read and verify the protocol name(s) selected
are the protocols desired for the exam. If not, use the X icon next to the protocol
name to delete a protocol that is not desired and select the desired protocol(s) from
any protocol per select a protocol.
4. Click Save to save the new preferences, or Save and Close to additionally close the System
Preferences window.
From the Related Protocols tab the user can configure key words (lexicon), including contrast type and
anatomies. These are used to match related protocols based on Exam Description and protocol names.
Six contrast types are defined:
• Non-Contrast
• Regular Contrast
• CTP (CT Perfusion)
• CTU (CT Urography)
• CTV (CT Venography)
• CTA (CT Angiography)
5. Input the desired file name in the File name field, and then click Ok to save. If you select USB,
insert USB device first and then click Ok to save.
6. Click Ok to close the dialog message.
5. Select the lexicon you want to restore, then click Ok. An attention message displays.
6. Select Continue to restore the lexicon. This restarts the application. Or select Cancel to leave the
lexicon unchanged.
A Unix Shell window will open. At the prompt, enter the operating system password for ctuser.
NOTE
If your system is configured in a language other than English, the Unix Shell may
show unreadable text when first opened. Enter the operating system password for
ctuser.
3. Click the X in the upper corner of the Unix Shell window to close it.
NOTE
Do not initiate an SPR Snap if the system is actively collecting data with X-ray on.
1. From the display monitor, click .
If you need to continue scanning patients click Cancel and collect the data at the next available
time.
Click OK to continue. An attention message will open to indicate the SPR Snap is in progress.
Attention: SPRsnap is in progress. Do not start any scan acquisition until the snap is complete.
3. When SPR Snap is finished, the sprsnap window will close. The SPR information will be stored
in the following system directory: /service/SPRSnaps/ for (Z440, P520 host computers with
a service partition) or /usr/g/service/log/SPRSnaps/ (Z420 older computers without a
service partition), and can be retrieved be your service representative. Note the directory location
for future use.
4. Click Cancel to stop data collection. Proceed with urgent scanning need and then repeat steps for
Collect Data with SPR Snap.
ATTENTION
System Time Adjustment Tool needs application software shutdown, and system
reboot after completing time adjustment.
Before application shutdown, please close any open Exam tab sessions and
complete pending recon jobs. Failure to do so will resume in the loss of data
currently in progress.
Please click the "OK" button to proceed the tool, and it takes approx 30sec, to
complete application shutdown.
4. The System Time Adjustment Tool screen is posted.
5. Set new time by using arrows or manual input from the keyboard.
6. Click Accept to exit.
NOTE
New Time needs to be in the Available Time Range. If it is outside of the range,
another popup window will be posted. Click Accept to exit.
ATTENTION
NOTE
If the system is connected to NTP Server, the message below is displayed.
ATTENTION
NTP (Time Server) is configured. System Time Adjustment Tool is not available.
2. Click Troubleshooting, then Fast Cal with GSI Refresh. The Service-Calibration Tools window
opens.
3. Click Run.
4. When Fast Cal with GSI Refresh is complete, perform a quality assurance scan.
2. Click Troubleshooting, then Xtream Camera Reset. The Reset in Progress dialog opens. After
approximately 10 seconds the message Xtream Camera Connection Reset successfully displays.
If InSite is running the Remote Safety test, New Patient does not open. To access New Patient:
• Call InSite and request they abort the test
• Navigate to the Service Desktop and select CleanUp option to cancel the test in progress
2. Click Troubleshooting, then TiP Virtual Assist. The Tip Virtual Assist desktop will open.
4. Click Accept to allow access with GE default password or click Change Session Password to
generate a Password specific to this session.
5. Click Cancel to decline remote access.
23 General Information
23.1 Introduction
This section provides a simple introduction to CT, or Computed Tomography, for people with no
detailed physics or medical diagnostic education.
23.1.3 CT Description
Computed tomography (CT) is a medical imaging method employing tomography created by
computer processing. Digital geometry processing is used to generate a three-dimensional image
of the inside of an object from a large series of two-dimensional X-ray images taken around a single
axial of rotation. The word "tomography" is derived from the Greek tomos (slice) and graphein (to
write). Computed tomography is known as computed axial tomography (CAT or CT scan).
CT produces a volume of data, which can be manipulated, through a process known as windowing,
in order to demonstrate various bodily structures based on their ability to block the X- ray/Röntgen
beam. Although historically the images generated were in the axial or transverse plane, orthogonal
to the long axis of the body, modern scanners allow this volume of data to be reformatted in various
planes or even as volumetric (3D) representations of structures.
23.2.2 CT Detector
The CT Detector is a wide coverage cone beam detector with multiple detector rows along the
longitudinal plane. The Detector channels are arranged as an arc diametrically opposite to the X- ray
tube on the rotating CT gantry. The detector consists of a scintillator that converts X-rays into light,
diodes for light conversion into current and analog to digital converter that converts the current into
digital signal. The Data Acquisition System (DAS) samples each detector cell up to about 2496 times
per gantry rotation, amplifies and quantifies the current from the cells and transmits the resultant
data to the scanner desktop.
256 rows = 256 (for 160 mm configured systems) or 128 rows = 128 (for 80 mm configured systems)
or 64 rows=64 (for 40 mm configured systems) unique physical cell locations in Z-axis. Detector cell
segregation in the Z-axis provides 3-D post-patient collimation.
23.2.3 Gantry
The stationary and rotating structure and drive system which controls the rotation and angular
positioning of the Detector and X-ray Source.
Variable rotation scan speeds (0.28, 0.35, 0.5, 0.6, 0.7, 0.8, 0.9, 1.0 seconds per rotation).
23.2.5 Table
The Table provides support and vertical/longitudinal motion of the patient relative to the CT
scanner. The Table also mechanically houses and electrically interfaces to the integrated ECG
unit. This subcomponent includes patient positioning and support accessories (pads, straps, poles,
headholders) as well as foot pedals.
Number Description
2 X-ray Tube
3 Centered Patient
4 Gantry Opening
5 Detector DAS
Parameter
SFOV 500 mm
NOTE
Helical scan range varies based on the helical pitch and gantry rotation speed selected.
23.4 Network
All of the above features are optional on the Revolution™ CT, Revolution™ CT ES Scanner.
Speeds and duplex modes supported: 10Mbps, 100Mbps, and 1Gbps half and full duplex
Auto-negotiate
Licensed/optional/required optional
Communication Partner Device/IP Address/Network Any network device supporting the DICOM application
layer protocol(s) listed below
Traffic characterization and bandwidth requirements On demand, local user initiated. The bandwidth is
dependent on the local site.
Licensed/optional/required optional
Communication Partner Device/IP Address/Network Any network device supporting the DICOM application
layer protocol(s) listed below
Traffic Characterization and Bandwidth Requirements On demand, local user initiated. The bandwidth is
dependent on the local site.
Licensed/optional/required optional
Communication Partner Device/IP Address/Network Any network device supporting the DICOM application
layer protocol(s) listed below
Application Layer Protocol and Encoding Study Root Query/Retrieve Information Model - FIND
Study Root Query/Retrieve Information Model - MOVE
Traffic Characterization and Bandwidth Requirements On demand, local user initiated. The bandwidth is
dependent on the local site.
Usage Type/Function/Purpose Used to confirm that local DICOM images have been
permanently stored on a remote DICOM device
Licensed/optional/required optional
Communication Partner Device/IP Address/Network Any network device supporting the DICOM application
layer protocol(s) listed below
Application Layer Protocol and Encoding Storage Commitment Push Model SOP Class
Traffic Characterization and Bandwidth Requirements On demand, local user initiated. The bandwidth is
dependent on the local site.
Licensed/optional/required optional
Communication Partner Device/IP Address/Network Any network device supporting the DICOM application
layer protocol(s) listed below
Application Layer Protocol and Encoding Basic Modality Worklist Information Model – FIND
SOP Class
Traffic Characterization and Bandwidth Requirements On demand, local user initiated. The bandwidth is
dependent on the local site.
Licensed/optional/required optional
Communication Partner Device/IP Address/Network Any network device supporting the DICOM application
layer protocol(s) listed below
Application Layer Protocol and Encoding Modality Performed Procedure Step SOP Class
Traffic Characterization and Bandwidth Requirements On demand, local user initiated. The bandwidth is
dependent on the local site.
Licensed/optional/required optional
Communication Partner Device/IP Address/Network Any network device supporting the DICOM application
layer protocol(s) listed below
Application Layer Protocol and Encoding Microsoft Active Directory / Novell eDirectroy
Traffic Characterization and Bandwidth Requirements On demand, local user initiated. The bandwidth is
dependent on the local site.
• Port: A predetermined number specific to the type of host and the protocol used. Your service
engineer can provide you with this number.
• AE title: This title is provided by the service engineer.
• Comments: A space to enter text that is associated with the selected node.
To
* Some 3rd party stations use the ODINA network protocol. In this case use DICOM protocol and port
number 104.
** Query capability is available only if station is a query retrieve provider.
NOTE
LightSpeed™ VCT, LightSpeed™ Pro32, BrightSpeed based systems do not support
Advantage Network Protocol.
From
AW 1.X AW 2.X AW 3.X AW4.X BrightSpeed Series,
BrightSpeed Select
Series, LightSpeed
QX/i, Plus, Ultra, RT,
RT16, Xtra, Pro16,
Pro32/VCT Select,
VCT/VCT XT or Rev-
olution™ CT, Revo-
lution™ CT ES, Dis-
covery™ CT750HD,
Optima CT660, Op-
tima CT520, Opti-
ma CT540, Optima
CT580, Discovery
CT590, Revolution
EVO
AW 1.X SdC Net SdC Net SdC Net SdC Net DICOM
Query Query Query Query Query
Send Send Send Send Send
Receive Receive Receive Receive Receive
AW 2.X SdC Net SdC Net SdC Net SdC Net DICOM
Query Query Query Query Query
Send Send Send Send Send
Receive Receive Receive Receive Receive
AW 3.X SdC Net SdC Net SdC Net SdC Net DICOM
V1 V2 V3 Query Query
Query Query Query Send Send
Send Send Send Receive Receive
Receive Receive Receive
AW 4.X SdC Net SdC Net SdC Net SdC Net DICOM
Query Query Query Query Query
Send Send Send Send Send
Receive Receive Receive Receive Receive
NOTE
Advantage Windows systems do not support Query Retrieve provider. Send images from
the Advantage Windows to the BrightSpeed Series, LightSpeed™ QX/i, LightSpeed™ Plus,
LightSpeed™ Ultra, LightSpeed™ Pro16, LightSpeed™ Pro32/VCT Select, LightSpeed™
VCT/VCT XT, Revolution™ CT, Revolution™ CT ES, Discovery™ CT750HD, Optima CT660,
Optima CT580, Optima CT520, Optima CT540, Discovery CT590.
23.5.1 Overview
The system provides powerful data collection capability with following scan modes:
• Scout
• Axial
• Cine
• Helical
• Cardiac Axial
• Gemstone Spectral Imaging (GSI)
• SmartStep
23.5.2 Scout
Scout imaging is used for anatomical location in conjunction with scan and recon prescription, to
provide an anatomical cross-reference for axial images, and to provide quick feedback to the user as to
the anatomy scanned.
Scout supports the following features:
• Selectable kV (70, 80, 100, 120, 140 kV)
• Tube current limited to 250 mA with Focal Spot L
• Approximately 100 mm/s table speed, with option Fast Scout preference 200 mm/s
• Detector coverage: 5 mm
• Scout orientation: 0, 90, 180, 270 degrees
23.5.3 Axial
Axial imaging features include:
• All kV and mA stations available, dependent on generator and tube limitations.
• Rotation times: 0.28, 0.35, 0.5, 0.6, 0.7, 0.8, 0.9, 1.0 second
• Detector coverage: 5, 40, 80, 100, 120, 140, 160 mm
• Variable image thickness selections: 0.625, 0.625z, 1.25z, 2.5z, 5.0z overlapped, 1.25, 1.25i, 2.5, 5.0
mm
• Sample rates: 984 Hz-8571Hz
• Revolution™ CT, Revolution™ CT ES can acquire up to 512 axial slices per rotation on the 160 mm
system, Revolution™ CT, Revolution™ CT ES can acquire up to 256 axial slices per rotation on the
80 mm system
23.5.4 Cine
Cine imaging features include:
• All kV and mA stations available, dependent on generator and tube limitations
• Maximum scan time: 60 seconds
• Rotation times: 0.28, 0.35, 0.5, 1.0 second
• Detector coverage: 40, 80, 100, 120, 140, 160 mm
• Variable image thickness selections: 0.625, 1.25, 2.5, and 5.0 mm
• Sample rates: 984 Hz-8571Hz
• Revolution™ CT, Revolution™ CT ES can acquire up to 512 axial slices per rotation
23.5.6 Helical
Helical imaging features:
• All kV and mA stations available, dependent on generator and tube limitations
• Maximum scan time: 60 seconds
• Rotation times: 0.28, 0.35, 0.5, 0.6, 0.7, 0.8, 0.9, 1.0 second
• Detector coverage: 40 mm, 80 mm
• Variable image thickness selections: 0.625, 1.25, 2.5, 3.75, and 5.0 mm
• Sample rates: 984 Hz-8571 Hz
• Pitches: 0.508:1, 0.516:1, 0.984:1, 0.992:1, 1.375:1 and 1.531:1
23.5.8 ECG-Modulated mA
imaging different periods of the heart cycle. The user may specify phases of the heart cycle to acquire
and the relative tube current level for each part of the acquisition window. The system responds
to the patient’s heart rate and modulates the tube current to acquire the cardiac phases requested
by the user. This tube current modulation, in conjunction with prospective ECG gating of the X-ray
exposure, allows the system to acquire the requested cardiac phases while minimizing dose to the
patient. If Auto Gating is enabled, the system will automatically adjust the scan parameters based on
the patient’s heart rate and heart rate variability during scan prescription. This allows the system to
intelligently respond to heart rate changes and optimize the scan parameters prior to acquisition.
The tube current utilized for cardiac acquisition window part 1 (100% mA) may be set by the user
manually or automatically by the system (see Auto mA) based on the user specified Noise Index (NI).
In addition to the user-specified ECG-based mA modulation, the system will also modulate the tube
current during each cardiac acquisition phase to minimize patient dose. Although projection data is
acquired for a duration of at least one complete rotation, the temporal resolution is, on average, half
of the gantry rotation time (e.g. 140 ms when the gantry rotation time is 280 ms). The additional
projection data beyond 140 ms is used for the outer few slices, and for image quality improvements
throughout the volume. The system typically modulates the tube current (mA) to 20% for the outer
views, so that the additional image information can be provided with minimal increase in patient
dose.
Example 1: Coronary Imaging for 75BPM Patient
Description: Acquire systolic and diastolic phases of the heart cycle
• Acq. Window Part 1: 70-80% R-to-R, 100% of specified mA (based on Auto mA or prescribed
manual mA)
• Acq. Window Part 2: 40-50% R-to-R, 100% of specified mA
Example 1, dark grey indicates the approximate range of phases available for image recon at 100% mA;
light grey indicates full range of phases available for recon, with increasing image noise as the recon
phase moves further away from the 100% mA ranges at 40-50% and 70-80%
Example 2: Coronary + Functional Imaging for 60BPM Patient:
Description: Acquire low-noise coronary images at diastole and lower dose data for functional
assessment over the full cardiac cycle.
• Acq. Window Part 1: 75% R-to-R, 100% of specified mA
• Acq. Window Part 2: 0-95% R-to-R, 20% of specified mA
Example 2, dark grey indicates approximate range of phases available for image recon at 100% mA and
20% mA
In the event that the patient should experience a premature ventricular contraction (PVC) or other
irregular heart rhythm, there is the possibility that low noise images could become shifted from the
prescribed phases.
23.5.9 SmartTrack
The purpose of SmartTrack (also known as z-axis tracking, or beam tracking) is to follow the focal
spot so that we can keep the most uniform part of the X-ray beam and the narrowest possible beam
on the detector to reduce dose and still avoid artifacts. The focal spot moves in the z-axis due to
thermal changes in the tube and mechanical forces during gantry rotation. In order to maintain the
narrowest possible beam, the system employs a closed loop control system called "Z-Axis Tracking".
The closed loop control system uses measured beam position data from the detector to position the
collimator cams in real time. Each blade is automatically and independently adjusted for optimal
beam performance1.
1T.Toth, et al., "A dose reduction X-ray beam positioning system for high-speed multi-slice CT
scanners", Medical Physics, Vol 27, No.12, (Dec 2000)
sets that are temporally registered to within micro-seconds. The acquisition of the two kV samples that
are temporally well registered, provides the ability to use the feature for a broad range of applications.
Gemstone Spectral Imaging has the following image quality benefits and capabilities:
• Improved Beam Hardening performance - Streaking and shading artifacts in traditional CT
imaging, which is caused by the presence of bone or metal, is mitigated when using Gemstone
Spectral Imaging.
• Improved Contrast Visualization - The Gemstone Spectral Imaging feature allows for improved
contrast visualization by providing the capability to visualize the data at lower derived
monochromatic spectral energy settings.
• Virtual Contrast Subtraction - The Gemstone Spectral Imaging feature allows for virtual
"subtraction" of virtual non-contrast like images.
• Iodine/Calcium Separation - The Gemstone Spectral Imaging feature enhances CT Angiographic
capabilities to better discern the differences between contrast opacified vessels and surrounding
bone structures.
The Gemstone Spectral Imaging features provides better accuracy and sensitivity of identification of
materials and may lead to new uses or applications that require more accurate quantification than
achievable with current CT imaging.
The feature has the ability to generate multiple image representations including:
• Material Basis Pair Images (in mg/cm3, μg/cm3)
• Monochromatic – Data File Images – Contains Transform Data
• kVp-like Images – A monochromatic image made guided based on choosing the keV level that will
look most like a 100 or 120 kVp image
• Monochromatic Images
• High kVp Images
• QC High kVp Images
• VUE
With the rapid switching of the kV values, it is helpful to think of the data as "Mean Low Energy" and
"Mean High Energy". The concept of Mean Energy is illustrated in the figure below. As the CT detector
integrates the signal during one sample or one view, the kV value for each view will also be an integral
of the rise and fall curves as illustrated.
Two important specifications that are impacted by the non-static beam energy are X-ray dose
reporting and kV accuracy. X-ray dose measurements using the standard CTDIw metric will be
performed using a scan with the rapid kV switching. A separate set of CTDI100 measurements have
been defined and reported in the Dosimetry section. Further, since the kV is rapidly switched view by
view, an accuracy specification has been defined for the GSI modes.
23.5.11 SmartStep
SmartStep imaging is designed to be used by the Radiologist or Physician during interventional
procedures using the integrated Hand Held Controller (HHC) and foot switch.
SmartStep imaging features include:
• All kV and mA stations available, dependent on generator and tube limitations.
• SmartStep scan mode does not use Focal Spot XL.
• Maximum scan time: 90 seconds
• Rotation times: 0.5 second
The Revolution™ CT, Revolution™ CT ES system reconstructs axial and continuous images of 512 x 512
pixels. Images from other scanners may display 64, 128, 320, or 1024 pixel image matrices.
The amount of anatomy represented by each pixel equals the Display Field of View diameter in mm
divided by the matrix width/height.
The system assigns a unique CT number value, originally called a Hounsfield Unit, to each pixel.
The two dimensional pixel represents a three dimensional portion of patient tissue. The pixel value
represents the proportional amount of X-ray beam that passed through anatomy and entered the
detector.
23.6.1 CT Number
Image reconstruction supports two ranges of pixel CT Numbers, the "normal range" and an "extended
range".
• Normal Range is -1024 to 3071
• Extended Range is -31743 to 31743
However, the system display supports pixels with a range of -32,767 to +32,767.
The system references CT number zero to water and CT number -1000 to Air. Lung and fat have
negative pixel values and normally appear black. A CT number over 200 represents dense material like
contrast agent, calcium, bone, and normally appears white.
Inverse Video reverses video white to black, but pixel values remain the same.
Variables that can affect CT Number accuracy:
• Partial volume effects of anatomy
• Scans acquired with IV or oral contrast agents
• X-ray tube deterioration
• Improperly calibrated system (poorly centered phantom, used wrong phantom, replaced current
calibration files with extremely old Cal files)
• Beam hardening due to patient anatomy, especially bone.
Example: Prescribe scan thickness of 5 mm or less to scan a lesion with a 10 mm thickness. (Display an
axial image and use the Measure Distance and ROI functions to determine the size of the pathology.)
Center ROI measurements over the midpoint of the pathology to minimize partial volume effects.
The mixture of tissue types, such as fat with tissue within the same voxel (a pixel with depth), varying
patient sizes, differences between CT machines and X-ray tubes, all lead to CT number variance. In a
well calibrated scanner, water has a CT number that ranges from -3 to +3. The CT number remains
uniform across all kV settings. However, as the X-ray tube ages, kV decreases and pixel values become
less dependable.
The Window Width and Window Level for GSI images will vary depending on the keV selected
compared to non-GSI images. Place an ROI on an anatomical area and note the mean value. Set
the Window Level to the mean value and adjust the Window Width to the desired viewing level.
23.6.2 Pixels
The anatomic image consists of rows and columns of small, square, picture elements called pixels. The
monitor displays 1,048,576 pixels in a matrix of 1024 horizontal rows of 1024 pixels. Add number of
viewports selected for viewing to determine the number of pixels used for display in each viewport.
The monitor pixel size remains the same, but the amount of anatomy the pixels represent varies with
the scan and display field of view (SFOV & DFOV). A pixel also represents a specific anatomic area. The
system identifies each two dimensional pixel by its location, area and value.
NOTE
The illustration above represents a 512 x 512 matrix viewport.
• RAS: Anatomic distance from the center of the landmark slice
Target the image; decrease the DFOV diameter. Center the reconstruction on coordinates other than
the SFOV center.
Magnifying and targeting can displace the central SFOV pixel from the central monitor pixel. Look at
the DFOV coordinates and magnification annotation to find the SFOV center, or display the grid. The
grid always appears over the pixel in the center of the DFOV Matrix (coordinate 255,255).
Table 166
Inferior: Scan location falls between the selected landmark and patient's
feet
Superior: Scan location falls between the selected landmark and patient's
head
Table 167
5 0.10 0.05
10 0.20 0.10
15 0.29 0.15
20 0.39 0.20
22 0.43 0.22
25 0.49 0.25
30 0.59 0.30
35 0.68 0.34
40 0.78 0.39
45 0.88 0.44
50 0.98 0.49
Example: A monitor pixel represents 0.5 by 0.5 mm. Magnify pixel size by 2. Each monitor pixel now
represents 0.25 by 0.25 mm of anatomy.
An image pixel represents a three dimensional volume, or voxel. It represents anatomy with a
location, an area, and a pixel (density) value. The system flattens the 0.625, 1.25, 2.5, 3.75, and 5
mm scan thickness into a two dimensional screen image. If a pixel represents a variety of tissues,
the system averages the contents to produce an averaged, rather than accurate, pixel value. Uniform
tissues (within the voxel) produce fairly accurate pixel values.
CT pixel shading shows relative density. Denser materials weaken X-ray and produce whiter pixels.
(Assumes Inverse Video OFF)
Reformat displays non axial planes created from contiguous pixels extracted from multiple images.
3D locates similar pixel values within contiguous images, and generates a mathematical model to
produce images that appear three dimensional. BMD samples pixel values to estimate bone or tissue
density.
Reconstruction assigns one value to every image pixel. CT uses pixel values of -32767 to +32767.
MR uses pixel values of +16,000. The screen pixel translates the assigned value into one of the 256
shades of gray. Vary the gray scale window width and level to select anatomy for display. Window
Width determines the quantity of gray pixel values. Window Level selects the center Window Width
pixel value.
Example: Two windows may contain identical widths of 100 values, but display completely different
anatomy, because one has a level of -100 and the other has a level of 150.
Figure 517 35cm Polyethylene Phantom with Water Equivalent Diameter = 33.6cm (OR=1)
Figure 518 20x32cm Polyethylene Phantom shown with overlay indicating: Left - Water
Equivalent Diameter = 24.3 cm (OR=1) and Right - Ellipse based on Dw and OR (OR=1.58)
Figure 519 Thorax Phantom shown with overlay indicating: Left - Water Equivalent Diameter =
22.1cm (OR=1) and Right - Ellipse based on Dw and OR (OR=1.08)
Figure 520 Large Thorax Phantom shown with overlay indicating: Left - Water Equivalent
Diameter = 33.8cm (OR=1) and Right - Ellipse based on Dw and OR (OR=1.14)
Since these metrics are dependent on the attenuation distribution, Dw and OR measurements can
vary across the entire anatomical region. In an anatomical area like the abdomen, which contains little
air pockets, the Dw is similar to the average physical diameter of the patient. But for an area like the
chest, which contains the lungs, Dw may be significantly smaller than the average diameter.
An example of this behavior can be seen in the figure below of a scout torso phantom with the
measured Dw and OR at different locations.
Figure 521 Scout of Torso Phantom in Lateral View (middle) with measured Water Equivalent
Diameter (top) and (bottom) Oval Ratio Torso images from the scout are shown with their
representative Dw and OR characterizations.
Figure 522 Torso Phantom shown with overlay indicating: Left - Water Equivalent Diameter =
26.3cm (OR=1) and Right - Ellipse based on Dw and OR (OR=1.80)
Figure 523 Torso Phantom shown with overlay indicating: Left - Water Equivalent Diameter =
25.6cm (OR=1) and Right - Ellipse based on Dw and OR (OR=1.24)
Attention pop up dialog. Message area (1) and message history pull down (2) of
the System Status Area on the image monitor.
Real Time information area (1) of the scan progress Scan Settings parameter alerts.
screen on the left monitor.
(continued)
Areas where messages are posted to the user interface
Gantry Display
Command to disable Gantry rotation failed. Command to disable Gantry rotation failed.
1 Power to Gantry rotation has been removed. Power to Gantry rotation has been removed.
See service log for details. See service log for details.
4 If unable to Resume, please perform a Scan Hard- If unable to Resume, please perform a Scan Hard-
ware Reset from the Service Tools menu. ware Reset from the Service Tools menu.
If problem persists, contact your service repre- If problem persists, contact your service repre-
sentative. sentative.
7 If unable to Resume, please perform a Scan Hard- If unable to Resume, please perform a Scan Hard-
ware Reset from the Service Tools menu. ware Reset from the Service Tools menu.
If problem persists, contact your service repre- If problem persists, contact your service repre-
sentative. sentative.
12 Please perform a Scan Hardware Reset from the Please perform a Scan Hardware Reset from the
Service Tools menu. Service Tools menu.
If problem persists, contact your service repre- If problem persists, contact your service repre-
sentative. sentative.
Gantry is too hot to operate. Contact your service Gantry is too hot to operate. Contact your service
14 representative to determine cause of overheat- representative to determine cause of overheat-
ing. ing.
16 If unable to Resume, please perform a Scan Hard- If unable to Resume, please perform a Scan Hard-
ware Reset from the Service Tools menu. ware Reset from the Service Tools menu.
If problem persists, contact your service repre- If problem persists, contact your service repre-
sentative. sentative.
Scan hardware is too hot to operate. Scanning Scan hardware is too hot to operate. Scanning
may be available after 30 minutes of cooling. may be available after 30 minutes of cooling.
17
Contact your service representative to determine Contact your service representative to determine
cause of overheating. cause of overheating.
Control panel on gantry front left is disconnected. Control panel on gantry front left is disconnected.
18
Please use alternative gantry control panel. Please use alternative gantry control panel.
Control panel on gantry front right is disconnec- Control panel on gantry front right is disconnec-
19
ted. Please use alternative gantry control panel. ted. Please use alternative gantry control panel.
Control panel on gantry rear left is disconnected. Control panel on gantry rear left is disconnected.
20
Please use alternative gantry control panel. Please use alternative gantry control panel.
Control panel on gantry rear right is disconnec- Control panel on gantry rear right is disconnec-
21
ted. Please use alternative gantry control panel. ted. Please use alternative gantry control panel.
X-Ray Tube is not in optimal operating state. X-Ray Tube is not in optimal operating state.
Maximum mA allowed will be limited for the ex- Maximum mA allowed will be limited for the ex-
am which may impact image quality. am which may impact image quality.
GSI acquisition cannot be confirmed until Tube GSI acquisition cannot be confirmed until Tube
22 Warm-up is completed. Warm-up is completed.
Select Done Scanning, if available. Select Done Scanning, if available.
Select Tools, Daily Prep, Tube Warm-up and com- Select Tools, Daily Prep, Tube Warm-up and com-
plete Tube Warm-up to enable full mA range ca- plete Tube Warm-up to enable full mA range ca-
pability and GSI acquisition. pability and GSI acquisition.
X-Ray Tube is not in optimal operating state. X-Ray Tube is not in optimal operating state.
Maximum mA allowed will be limited for the ex- Maximum mA allowed will be limited for the ex-
am which may impact image quality. am which may impact image quality.
23 Select Done Scanning, if available. Select Done Scanning, if available.
Select Tools, Daily Prep, Tube Warm-up and com- Select Tools, Daily Prep, Tube Warm-up and com-
plete Tube Warm-up to enable full mA range ca- plete Tube Warm-up to enable full mA range ca-
pability. pability.
System detected problem with detection compo- System detected problem with detection compo-
nent. nent.
24 Please run Fast Calibration. Please run Fast Calibration.
If problem persists contact your service represen- If problem persists contact your service represen-
tative. tative.
Detector thermal control has detected a system Detector thermal control has detected a system
pressure that has exceeded a pressure limit or pressure that has exceeded a pressure limit or
25
has lost all pressure sensors. System is entering has lost all pressure sensors. System is entering
protect mode and will shut down. protect mode and will shut down.
System configuration mismatch. Patient scanning System configuration mismatch. Patient scanning
26 will be disabled. will be disabled.
Please contact your service representative. Please contact your service representative.
SPRsnap is in progress. Do not start any scan SPRsnap is in progress. Do not start any scan
1
acquisition until the snap is complete. acquisition until the snap is complete.
Do not execute during acquisition! Complete cur- Do not execute during acquisition! Complete cur-
2 rent acquisition before proceeding. Select OK to rent acquisition before proceeding. Select OK to
Continue. Continue.
Data Collection Hardware configured incorrectly. Data Collection Hardware configured incorrectly.
4 Slip ring miswired. Slip ring miswired.
Please contact your service representative. Please contact your service representative.
Failed to start exposure due to system problem. Failed to start exposure due to system problem.
Scan time out. Scan time out.
9
If problem persists, please contact your service If problem persists, please contact your service
representative. representative.
Actual dose information for the scanned group Actual dose information for the scanned group
unavailable, recorded dose has been estimated unavailable, recorded dose has been estimated
10 from the scan prescription. from the scan prescription.
If problem persists, contact your service repre- If problem persists, contact your service repre-
sentative. sentative.
Firmware reset occurred. Please wait until reset is Firmware reset occurred. Please wait until reset is
11
completed. completed.
13 Prescribed interscan delay not met. Prescribed interscan delay not met.
System configuration data is invalid or corrupt. System configuration data is invalid or corrupt.
Please perform a System Restart from the Mode Please perform a System Restart from the Mode
15 menu. menu.
If problem persists, contact your service repre- If problem persists, contact your service repre-
sentative. sentative.
The system configuration has changed since the The system configuration has changed since the
system was started. system was started.
Please perform a System Restart from the Mode Please perform a System Restart from the Mode
17
menu. menu.
If problem persists, contact your service repre- If problem persists, contact your service repre-
sentative. sentative.
System could not detect ECG Triggers. System could not detect ECG Triggers.
18
Please check ECG lead connection. Please check ECG lead connection.
System detected software error during scanning. System detected software error during scanning.
Please perform a System Restart from the Mode Please perform a System Restart from the Mode
19 menu. menu.
If problem persists, contact your service repre- If problem persists, contact your service repre-
sentative. sentative.
System is recovering after serious error, please System is recovering after serious error, please
20 check suspended image reconstructions in the check suspended image reconstructions in the
queue. queue.
Table position detected outside of scan start and Table position detected outside of scan start and
end positions during AEC scan. end positions during AEC scan.
21
If problem persists, please contact your service If problem persists, please contact your service
representative. representative.
X-ray exposure terminated by backup timer in- X-ray exposure terminated by backup timer in-
22 stead of normal control. stead of normal control.
Please contact your service representative. Please contact your service representative.
Pause failed. Please retry Pause, press Stop Scan, Pause failed. Please retry Pause, press Stop Scan,
23
or press E-stop. or press E-stop.
24 Stop Scan failed. Please retry or press E-stop. Stop Scan failed. Please retry or press E-stop.
Laser alignment lights are automatically turned Laser alignment lights are automatically turned
25
off during scanning. off during scanning.
Scan has completed but the injection is still in Scan has completed but the injection is still in
26
progress. progress.
Cannot open a new review session while on scan Cannot open a new review session while on scan
progress screen. Please complete the scan in pro- progress screen. Please complete the scan in pro-
27 gress and then open the desired session. gress and then open the desired session.
Close if any of the following application(s) are Close if any of the following application(s) are
running: running:
Protocol Management is not available while in an Protocol Management is not available while in an
active scan session. active scan session.
28
Close if any of the following application(s) are Close if any of the following application(s) are
running: running:
Auto Gating Management is not available while in Auto Gating Management is not available while in
an active scan session. an active scan session.
29
Close if any of the following application(s) are Close if any of the following application(s) are
running: running:
Auto Voice management is not available while in Auto Voice management is not available while in
an active scan session. an active scan session.
30
Close if any of the following application(s) are Close if any of the following application(s) are
running: running:
User Admin application is not available while in User Admin application is not available while in
an active scan session. an active scan session.
31
Close if any of the following application(s) are Close if any of the following application(s) are
running: running:
Dose Check Management is not available while in Dose Check Management is not available while in
an active scan session. an active scan session.
32
Close if any of the following application(s) are Close if any of the following application(s) are
running: running:
Audit Tool application is not available while in an Audit Tool application is not available while in an
active scan session. active scan session.
33
Close if any of the following application(s) are Close if any of the following application(s) are
running: running:
Switch User cannot be completed at this time. Switch User cannot be completed at this time.
Please complete the scan in progress and then Please complete the scan in progress and then
34 switch users. switch users.
Close if any of the following application(s) are Close if any of the following application(s) are
running: running:
Fast Cal application is not available while in an Fast Cal application is not available while in an
active scan session. active scan session.
35
Close if any of the following application(s) are Close if any of the following application(s) are
running: running:
Scan cannot be resumed as a irrecoverable sys- Scan cannot be resumed as a irrecoverable sys-
tem error has occurred. tem error has occurred.
36
Please select Done Scanning and start a new pa- Please select Done Scanning and start a new pa-
tient session or restart the system. tient session or restart the system.
Low ECG signal. Verify the following: Low ECG signal. Verify the following:
• Select the lead with the highest amplitude, • Select the lead with the highest amplitude,
typically Lead II or AUTO. typically Lead II or AUTO.
• The proper placement of the ECG electro- • The proper placement of the ECG electro-
des. The ECG electrodes may need to be des. The ECG electrodes may need to be
repositioned. repositioned.
39 • The ECG electrodes still have moist conduc- • The ECG electrodes still have moist conduc-
tive gel. tive gel.
• Perform impedance test to check ECG sig- • Perform impedance test to check ECG sig-
nal. nal.
Override may cause erratic triggering and possi- Override may cause erratic triggering and possi-
bly a scan abort. Override only when absolutely bly a scan abort. Override only when absolutely
necessary. necessary.
40 Low signal warning has been overridden by user. Low signal warning has been overridden by user.
Queuing of Auto Transfer jobs failed. Please trans- Queuing of Auto Transfer jobs failed. Please trans-
fer images, series or exam manually from the File fer images, series or exam manually from the File
41 Manager. Please perform Application Restart from Manager. Please perform Application Restart from
the Troubleshooting menu to restart the Auto the Troubleshooting menu to restart the Auto
Transfer application. Transfer application.
One of the following fields contains a character One of the following fields contains a character
42
that is not supported. that is not supported.
Could not acquire Scan Hardware Resource. Could not acquire Scan Hardware Resource.
This may have occurred due to one of the follow- This may have occurred due to one of the follow-
ing: ing:
• Scan Data Save or Restore is in progress • Scan Data Save or Restore is in progress
43 • Daily Prep is in progress • Daily Prep is in progress
• Service scanning tools are in use • Service scanning tools are in use
• Scanning Session is open • Scanning Session is open
Please wait for completion or cancel the job or Please wait for completion or cancel the job or
queue in progress by the application. queue in progress by the application.
Dynamic Transition is enabled and there is no Dynamic Transition is enabled and there is no
dynamic transition ROI selected. Please add an dynamic transition ROI selected. Please add an
44
ROI to the baseline image or disable dynamic ROI to the baseline image or disable dynamic
transition in the Baseline and Monitor Collection transition in the Baseline and Monitor Collection
You are about to exit the SmartPrep workflow. You are about to exit the SmartPrep workflow.
If you exit and still want to include a SmartPrep If you exit and still want to include a SmartPrep
45 phase, you will need to duplicate the series and phase, you will need to duplicate the series and
delete the un-scanned group in the current ser- delete the un-scanned group in the current ser-
ies. Are you sure you want to continue? ies. Are you sure you want to continue?
Post processing application is open. Please close Post processing application is open. Please close
46 the post processing application to enable Con- the post processing application to enable Con-
firm Settings. firm Settings.
Reconstruction System error occurred. Please Reconstruction System error occurred. Please
47 wait for the following number of seconds for the wait for the following number of seconds for the
recovery: recovery:
Integrated Hand-held controller connection error. Integrated Hand-held controller connection error.
48
Please check the connection. Please check the connection.
Integrated Hand-held controller connection error. Integrated Hand-held controller connection error.
49
Please check the connection. Please check the connection.
Integrated Hand-held controller connection error. Integrated Hand-held controller connection error.
50
Please check the connection. Please check the connection.
Integrated Hand-held controller connection error. Integrated Hand-held controller connection error.
51
Please check the connection. Please check the connection.
Interventional Foot pedal connection error. Interventional Foot pedal connection error.
52
Please check the connection. Please check the connection.
Interventional Foot Pedal Stuck. Please check the Interventional Foot Pedal Stuck. Please check the
53
foot pedal. foot pedal.
Abnormal heart beat detected during Smart Ar- Abnormal heart beat detected during Smart Ar-
rhythmia Management Scan. System reacquiring rhythmia Management Scan. System reacquiring
54
scan. Review the ECG Editor in the secondary scan. Review the ECG Editor in the secondary
recon for details. recon for details.
Lost connection with the X-Ray foot Pedal. Lost connection with the X-Ray foot Pedal.
Check that the pedal is connected. Check that the pedal is connected.
If it is and problem persists, Revisit Settings, de- If it is and problem persists, Revisit Settings, de-
55 lete any unscanned interventional groups or ser- lete any unscanned interventional groups or ser-
ies to continue with non-interventional scans. ies to continue with non-interventional scans.
If problem still persists, contact your service rep- If problem still persists, contact your service rep-
resentative. resentative.
System has detected the X-Ray foot Pedal has System has detected the X-Ray foot Pedal has
been depressed for more than 10 seconds. been depressed for more than 10 seconds.
Check that the foot pedal is not depressed. Check that the foot pedal is not depressed.
56 If it is not and problem persists, delete any un- If it is not and problem persists, delete any un-
scanned interventional groups or series to con- scanned interventional groups or series to con-
tinue with non-interventional scans. tinue with non-interventional scans.
If problem still persists, contact your service rep- If problem still persists, contact your service rep-
resentative. resentative.
Unrecognized System Configuration detected. Pa- Unrecognized System Configuration detected. Pa-
tient Scanning may still be possible with poten- tient Scanning may still be possible with poten-
57 tially degraded performance and/or functionality. tially degraded performance and/or functionality.
Please contact your service representative. Please contact your service representative.
SmartPlan does not support Secondary Recon- SmartPlan does not support Secondary Recon-
58 structions associated with linked groups. Please structions associated with linked groups. Please
use Copy Forward or Unlink the primary groups. use Copy Forward or Unlink the primary groups.
SmartPlan Clinical Category Clinical Identifier SmartPlan Clinical Category Clinical Identifier
pair selection is incompatible with selected pa- pair selection is incompatible with selected pa-
59 tient position. Please select a different patient tient position. Please select a different patient
position in the Patient Collection or change the position in the Patient Collection or change the
SmartPlan setting SmartPlan setting
Copy Forward and SmartPlan cannot be enabled Copy Forward and SmartPlan cannot be enabled
60 together. Please select only one of SmartPlan and together. Please select only one of SmartPlan and
Copy Forward. Copy Forward.
SmartPlan CID selection has automatically SmartPlan CID selection has automatically
61 changed the setting of SmartPlan DFOV/Center changed the setting of SmartPlan DFOV/Center
Adjust. Please confirm the setting. Adjust. Please confirm the setting.
SmartPlan was unable to determine the location SmartPlan was unable to determine the location
of the anatomy requested by Clinical Category of the anatomy requested by Clinical Category
62
Clinical Identifier pair. Please adjust scan range Clinical Identifier pair. Please adjust scan range
manually. manually.
SmartPlan does not support the selected Clini- SmartPlan does not support the selected Clini-
cal Category Clinical Identifier pair. Please select cal Category Clinical Identifier pair. Please select
63
a supported Clinical Category Clinical Identifier a supported Clinical Category Clinical Identifier
pair. pair.
Lost connection with the Integrated Hand-held Lost connection with the Integrated Hand-held
Controller: Controller:
Check that the controller is connected. Check that the controller is connected.
64 If it is and problem persists, Revisit Settings de- If it is and problem persists, Revisit Settings de-
lete any unscanned interventional groups or ser- lete any unscanned interventional groups or ser-
ies to continue with non-interventional scans. ies to continue with non-interventional scans.
If problem still persists, contact your service rep- If problem still persists, contact your service rep-
resentative. resentative.
The scan database encountered an error. The scan database encountered an error.
65
Please restart applications to recover. Please restart applications to recover.
Image Generation was NOT ready. Image Generation was NOT ready.
Press Resume. Press Resume.
66 If problem persists, Pause Scan, Revisit Settings, If problem persists, Pause Scan, Revisit Settings,
Confirm Settings, and press Prep Confirm Settings, and press Prep
If problem still persists, contact your service rep- If problem still persists, contact your service rep-
resentative. resentative.
DLIR processing cannot be applied with the cur- DLIR processing cannot be applied with the cur-
rently selected recon type. rently selected recon type.
67
Please select a compatible recon type to enable Please select a compatible recon type to enable
the selection of DLIR processing. the selection of DLIR processing.
DLIR processing cannot be applied in combina- DLIR processing cannot be applied in combina-
tion with 0.625mm thickness, pitch 0.5 and Full tion with 0.625mm thickness, pitch 0.5 and Full
68 Recon mode. Recon mode.
Please select Plus Recon Mode, or a different slice Please select Plus Recon Mode, or a different slice
thickness in order to enable DLIR processing. thickness in order to enable DLIR processing.
DLIR processing cannot be enabled when the DLIR processing cannot be enabled when the
scan range is less than 40mm. scan range is less than 40mm.
69
Set the scan range to 40mm or greater to enable Set the scan range to 40mm or greater to enable
DLIR processing. DLIR processing.
Patient orientation/position has changed from Patient orientation/position has changed from
the previous series. the previous series.
1 Please verify the orientation/position of this ser- Please verify the orientation/position of this ser-
ies is as intended or change the orientation/posi- ies is as intended or change the orientation/posi-
tion, if needed. tion, if needed.
The table landmark has been changed. This The table landmark has been changed. This
changes the location of all scans you have pre- changes the location of all scans you have pre-
2
scribed. Double check all scans locations before scribed. Double check all scans locations before
you start scanning. you start scanning.
Dynamic Transition in Smart Prep is ON. Sys- Dynamic Transition in Smart Prep is ON. Sys-
tem will automatically transition into Scan Phase tem will automatically transition into Scan Phase
3 when enhancement level for Transition ROI rea- when enhancement level for Transition ROI rea-
ches the HU value set for threshold. Please con- ches the HU value set for threshold. Please con-
firm that the Transition ROI is set appropriately. firm that the Transition ROI is set appropriately.
Image generation failed, scanning is paused: Use Image generation failed, scanning is paused: Use
4 the elapsed time to determine when to select the elapsed time to determine when to select
Begin Scan Now. Begin Scan Now.
The baseline location has changed. The baseline location has changed.
You may proceed, but ROIs and dynamic transi- You may proceed, but ROIs and dynamic transi-
5 tion will be disabled. If you wish to use ROIs, tion will be disabled. If you wish to use ROIs,
please select [Retake Baseline] to acquire a new please select [Retake Baseline] to acquire a new
baseline image. baseline image.
The baseline location has changed. Dynamic The baseline location has changed. Dynamic
Transition is disabled. Transition is disabled.
6 Use the Monitor images to determine the transi- Use the Monitor images to determine the transi-
tion or select [Revisit Settings] to start a new tion or select [Revisit Settings] to start a new
Smart Prep series. Smart Prep series.
Injector is not armed. Please arm the injector or Injector is not armed. Please arm the injector or
7 select Disable the Injector from the Contrast col- select Disable the Injector from the Contrast col-
lection. lection.
The injector is not communicating or is not in the The injector is not communicating or is not in the
right state. right state.
Please cycle power on the injector or disable the Please cycle power on the injector or disable the
8
Injector in the Contrast collection. Injector in the Contrast collection.
If the problem persists, contact your service rep- If the problem persists, contact your service rep-
resentative. resentative.
There is a mismatch with the Injector settings. There is a mismatch with the Injector settings.
9 Please check the injection settings in the Contrast Please check the injection settings in the Contrast
collection. collection.
Please select Revisit Settings and check Injector Please select Revisit Settings and check Injector
10 settings or disable the Injector from the Contrast settings or disable the Injector from the Contrast
collection. collection.
Injector is not ready. Please cycle power on the Injector is not ready. Please cycle power on the
11 injector or select Injector Off to disable the Injec- injector or select Injector Off to disable the Injec-
tor from the Contrast collection. tor from the Contrast collection.
System detected internal communication error. System detected internal communication error.
Please select [Done Scanning] or [Close Exam] Please select [Done Scanning] or [Close Exam]
and perform a Scan Hardware Reset from the and perform a Scan Hardware Reset from the
13 Service Tools menu. Service Tools menu.
If problem persists, contact your service repre- If problem persists, contact your service repre-
sentative. sentative.
ODM has been disabled. Verify Noise Index, Min ODM has been disabled. Verify Noise Index, Min
mA/Max mA, resultant CTDIvol and DLP meet the mA/Max mA, resultant CTDIvol and DLP meet the
14
clinical goal of the acquisition and follow the ra- clinical goal of the acquisition and follow the ra-
diation exposure guidelines for your department. diation exposure guidelines for your department.
Projected noise index is less than the prescribed Projected noise index is less than the prescribed
15 noise index. Review and reduce minimum mA, if noise index. Review and reduce minimum mA, if
appropriate. appropriate.
SmartmA, ODM and kV Assist unavailable due SmartmA, ODM and kV Assist unavailable due
to patient orientation/position mismatch. Scan a to patient orientation/position mismatch. Scan a
16
scout with the same patient orientation/position scout with the same patient orientation/position
or Manual mA and kV must be set. or Manual mA and kV must be set.
SmartmA, ODM, and kV Assist unavailable due SmartmA, ODM, and kV Assist unavailable due
to new landmark. Scan a scout with the current to new landmark. Scan a scout with the current
17
landmark if appropriate or Manual mA and kV landmark if appropriate or Manual mA and kV
must be set. must be set.
kV Assist mode has been enabled. kV Assist mode has been enabled.
Verify kV, Noise Index, Min mA/Max mA, or kV, Verify kV, Noise Index, Min mA/Max mA, or kV,
18 Manual mA values and resultant CTDIvol and DLP Manual mA values and resultant CTDIvol and DLP
meet the clinical goal for the acquisition and fol- meet the clinical goal for the acquisition and fol-
low the radiation exposure guidelines for your low the radiation exposure guidelines for your
department. department.
Manual kV mode enabled or kV Assist baseline (kV Manual kV mode enabled or kV Assist baseline
Assist Delta) has been enabled. has been enabled.
Verify kV, Noise Index, Min mA/Max mA, or kV, Verify kV, Noise Index, Min mA/Max mA, or kV,
19 Manual mA values and resultant CTDIvol and DLP Manual mA values and resultant CTDIvol and DLP
meet the clinical goal for the acquisition and fol- meet the clinical goal for the acquisition and fol-
low the radiation exposure guidelines for your low the radiation exposure guidelines for your
department. department.
Manual mA mode has been enabled. Verify the Manual mA mode has been enabled. Verify the
prescribed mA and resultant CTDIvol and DLP prescribed mA and resultant CTDIvol and DLP
20 meet the clinical goal for the acquisition and fol- meet the clinical goal for the acquisition and fol-
low the radiation exposure guidelines for your low the radiation exposure guidelines for your
department. department.
Prescribed NI cannot be achieved with selected Prescribed NI cannot be achieved with selected
29
scan parameters. scan parameters.
SmartmA has been enabled. Verify the Noise In- SmartmA has been enabled. Verify the Noise In-
dex, Min mA/Max mA values and resultant CTDIvol dex, Min mA/Max mA values and resultant CTDIvol
30 and DLP meet the clinical goal for the acquisition and DLP meet the clinical goal for the acquisition
and follow the radiation exposure guidelines for and follow the radiation exposure guidelines for
your department. your department.
SmartmA with ODM has been enabled. Verify the SmartmA with ODM has been enabled. Verify the
Noise Index, Min mA/Max mA, ODM range and Noise Index, Min mA/Max mA, ODM range and
31 the resultant CTDIvol and DLP meet the clinical the resultant CTDIvol and DLP meet the clinical
goal for the acquisition and follow the radiation goal for the acquisition and follow the radiation
exposure guidelines for your department. exposure guidelines for your department.
33 Irregular heart beats detected prior to scan. Irregular heart beats detected prior to scan.
Preparing to scan extremely high heart rate with Preparing to scan extremely high heart rate with
34 highly irregular beats. Verify the heart rate is valid highly irregular beats. Verify the heart rate is valid
for clinical indication. for clinical indication.
Preparing to scan extremely high heart rate with Preparing to scan extremely high heart rate with
35 irregular beats. Verify the heart rate is valid for irregular beats. Verify the heart rate is valid for
clinical indication. clinical indication.
Preparing to scan high heart rate with highly ir- Preparing to scan high heart rate with highly ir-
36 regular beats. Verify the heart rate is valid for regular beats. Verify the heart rate is valid for
clinical indication. clinical indication.
Preparing to scan high heart rate with irregular Preparing to scan high heart rate with irregular
37 beats. Verify the heart rate is valid for clinical beats. Verify the heart rate is valid for clinical
indication. indication.
Preparing to scan intermediate heart rate with Preparing to scan intermediate heart rate with
highly irregular beats using narrow phase range. highly irregular beats using narrow phase range.
38
Verify that the acquisition phase range is valid for Verify that the acquisition phase range is valid for
clinical indication. clinical indication.
Preparing to scan intermediate heart rate with Preparing to scan intermediate heart rate with
irregular beats using narrow phase range. Verify irregular beats using narrow phase range. Verify
39
that the acquisition phase range is valid for clini- that the acquisition phase range is valid for clini-
cal indication. cal indication.
Preparing to scan with extremely high and varia- Preparing to scan with extremely high and varia-
40 ble heart rate. Verify the heart rate is valid for ble heart rate. Verify the heart rate is valid for
clinical indication. clinical indication.
Preparing to scan with extremely high heart rate. Preparing to scan with extremely high heart rate.
41
Verify the heart rate is valid for clinical indication. Verify the heart rate is valid for clinical indication.
There are still scan tasks to be completed. Done There are still scan tasks to be completed. Done
42 Scanning will end the scanning portion of this Scanning will end the scanning portion of this
exam. Are you sure you are done scanning? exam. Are you sure you are done scanning?
Tube temperature is too cold. Warm-up is nee- Tube temperature is too cold. Warm-up is nee-
43
ded. ded.
Attention Attention
An unrecognized tube has been installed on the An unrecognized tube has been installed on the
system. system.
44 Fast Calibration techniques are designed specifi- Fast Calibration techniques are designed specifi-
cally for GE tubes and GE cannot guarantee that cally for GE tubes and GE cannot guarantee that
the performance of the system will meet specifi- the performance of the system will meet specifi-
cations with an unrecognized tube. cations with an unrecognized tube.
An unrecognized X-Ray tube has been installed on An unrecognized X-Ray tube has been installed on
the system. the system.
GE cannot assure that system performance will GE cannot assure that system performance will
conform to specifications. conform to specifications.
45
Advisory messages will be posted to the operator Advisory messages will be posted to the operator
about an unrecognized tube during tube warm- about an unrecognized tube during tube warm-
up, during Fast Calibration, and in the dose re- up, during Fast Calibration, and in the dose re-
port. port.
Gantry balance sensing hardware unavailable. Gantry balance sensing hardware unavailable.
46 Fast Cal and Detailed Cal will not be possible. Fast Cal and Detailed Cal will not be possible.
Please contact your service representative. Please contact your service representative.
Patient Name, ID or Date of Birth is mismatched. Patient Name, ID or Date of Birth is mismatched.
47 Please edit the patient information on the RIS, Please edit the patient information on the RIS,
refresh the list and retry. refresh the list and retry.
Cannot start a New Patient scan session while in Cannot start a New Patient scan session while in
an active scan session. an active scan session.
48
Close if any of the following application(s) are Close if any of the following application(s) are
running: running:
Cannot switch patient sessions while on the scan Cannot switch patient sessions while on the scan
progress screen. progress screen.
49
Close if any of the following application(s) are Close if any of the following application(s) are
running: running:
Patient Information currently displayed is from a Patient Information currently displayed is from a
previous selection in the Patient Schedule or a previous selection in the Patient Schedule or a
manual entry. manual entry.
50
Select the X at the top of the New Patient tab Select the X at the top of the New Patient tab
and then re-enter patient information manually and then re-enter patient information manually
or from the Patient Schedule or from the Patient Schedule
This scan prescription has selected one of the op- This scan prescription has selected one of the op-
tions for Recon based ACR Image Flip and Rotate. tions for Recon based ACR Image Flip and Rotate.
51 Please ensure that this desired orientation is dis- Please ensure that this desired orientation is dis-
played appropriately on all remote viewing devi- played appropriately on all remote viewing devi-
ces. ces.
Maximum number of exam sessions are currently Maximum number of exam sessions are currently
open. open.
Please complete, as needed, at least one exam Please complete, as needed, at least one exam
52
session. session.
Once a session is closed, start a new patient ses- Once a session is closed, start a new patient ses-
sion. sion.
Integrated Hand-held Controller is not connec- Integrated Hand-held Controller is not connec-
53 ted. Please check the connection to enable Con- ted. Please check the connection to enable Con-
firm Settings. firm Settings.
The Integrated Hand-held Controller hardware is The Integrated Hand-held Controller hardware is
unavailable. Remove the Interventional series to unavailable. Remove the Interventional series to
54
continue. If problem persists, contact your serv- continue. If problem persists, contact your serv-
ice representative ice representative
Integrated Hand-held controller hardware is un- Integrated Hand-held controller hardware is un-
55 available. Please contact your service representa- available. Please contact your service representa-
tive. tive.
Scan Center Location is outside table limits. Enter Scan Center Location is outside table limits. Enter
56 a location within table limits, or set a different a location within table limits, or set a different
landmark to enable Confirm Settings. landmark to enable Confirm Settings.
Exposure time is less than the minimum limit 1.0 Exposure time is less than the minimum limit 1.0
s. s.
57
Select Revisit Settings and Adjust the Total Expo- Select Revisit Settings and Adjust the Total Expo-
sure time. sure time.
SmartStep software option is not installed, inter- SmartStep software option is not installed, inter-
ventional series is disabled in the protocol. to ventional series is disabled in the protocol. to
continue scanning delete the Interventional ser- continue scanning delete the Interventional ser-
58 ies. ies.
Please contact your service representative to veri- Please contact your service representative to veri-
fy your configuration. fy your configuration.
System is not ready to perform the Interventional System is not ready to perform the Interventional
series. Select [Confirm Settings] again. If problem series. Select [Confirm Settings] again. If problem
59
persists, please select [Done Scanning] and then persists, please select [Done Scanning] and then
select System Restart from the Mode menu. select System Restart from the Mode menu.
System is not ready to perform the Intervention- System is not ready to perform the Intervention-
al series. Please select [Prep] again. If problem al series. Please select [Prep] again. If problem
60
persists, select [Done Scanning] and then select persists, select [Done Scanning] and then select
System Restart from the Mode menu. System Restart from the Mode menu.
System is not functional. Please select Revisit System is not functional. Please select Revisit
Settings and select Confirm Settings to continue. Settings and select Confirm Settings to continue.
61
If problem persists, select Done Scanning and If problem persists, select Done Scanning and
then select System Restart from the Mode menu. then select System Restart from the Mode menu.
The following installed option keys are not valid The following installed option keys are not valid
with the detected system configuration and will with the detected system configuration and will
62 be disabled. be disabled.
Please review any protocols utilizing these op- Please review any protocols utilizing these op-
tions to ensure they are still clinically relevant tions to ensure they are still clinically relevant
The group delay has increased from the protocol The group delay has increased from the protocol
value. Changing SFOV and or rotation time be- value. Changing SFOV and or rotation time be-
tween groups can cause large group delays which tween groups can cause large group delays which
63 may negatively affect contrast timing. Please re- may negatively affect contrast timing. Please re-
view and type the desired group delay value. If view and type the desired group delay value. If
changes between these parameters are desired, changes between these parameters are desired,
then turn Off Lock Group Delay. then turn Off Lock Group Delay.
Lock Group Delay has been turned Off. Please Lock Group Delay has been turned Off. Please
64 review the Group Delay value in the Timing Col- review the Group Delay value in the Timing Col-
lection. lection.
Image Enhance Filters are not compatible with Image Enhance Filters are not compatible with
Snapshot Freeze image reconstruction. Set Image Snapshot Freeze image reconstruction. Set Image
65 Enhance Filters to “None” in Recon Options or Enhance Filters to “None” in Recon Options or
turn Off Snap Shot Freeze in ECG and Gating Set- turn Off Snap Shot Freeze in ECG and Gating Set-
tings in secondary recon. tings in secondary recon.
No valid solutions available. Please select a dif- No valid solutions available. Please select a dif-
ferent clinical category from the Patient Collec- ferent clinical category from the Patient Collec-
66 tion, then select an appropriate Clinical Identifier tion, then select an appropriate Clinical Identifier
or change the mA Mode to GSI Manual and select or change the mA Mode to GSI Manual and select
a valid GSI Profile a valid GSI Profile
Invalid GSI profile, Please select a different clin- Invalid GSI profile, Please select a different clin-
ical category from the Patient Collection, then ical category from the Patient Collection, then
68 select an appropriate Clinical Identifier or change select an appropriate Clinical Identifier or change
the mA Mode to GSI Manual and select a valid GSI the mA Mode to GSI Manual and select a valid GSI
Profile Profile
GSI Assist has been enabled. Verify the Noise GSI Assist has been enabled. Verify the Noise
Index and resultant CTDIvol and DLP meet the Index and resultant CTDIvol and DLP meet the
69
clinical goal for the acquisition and follow the ra- clinical goal for the acquisition and follow the ra-
diation exposure guidelines for your department. diation exposure guidelines for your department.
GSI Manual mA mode has been enabled. Verify GSI Manual mA mode has been enabled. Verify
the GSI Settings and resultant CTDIvol and DLP the GSI Settings and resultant CTDIvol and DLP
70 meet the clinical goal for the acquisition and fol- meet the clinical goal for the acquisition and fol-
low the radiation exposure guidelines for your low the radiation exposure guidelines for your
department department
Intervals less than 0.3125 are not supported with Intervals less than 0.3125 are not supported with
71
MAR, Turn off MAR or select an interval >= 0.3125 MAR, Turn off MAR or select an interval >= 0.3125
Currently selected GSI Profile does not have %s Currently selected GSI Profile does not have %s
scan type included. Change the scan type or se- scan type included. Change the scan type or se-
72
lect a GSI Profile that contains the scan type de- lect a GSI Profile that contains the scan type de-
sired. sired.
Image Enhance Filters are not compatible with Image Enhance Filters are not compatible with
GSI Data File. Set Image Enhance Filters to GSI Data File. Set Image Enhance Filters to
73
“None” in Recon Options or turn off Data File in “None” in Recon Options or turn off Data File in
primary or secondary recon. primary or secondary recon.
Table received an invalid request. Please retry Table received an invalid request. Please retry
positioning the table. positioning the table.
1 If problem persists, select Done Scanning and If problem persists, select Done Scanning and
perform a Scan Hardware Reset from the Service perform a Scan Hardware Reset from the Service
Tools menu. Tools menu.
Table did not reach position. Please retry posi- Table did not reach position. Please retry posi-
tioning the table. tioning the table.
2 If problem persists, select Done Scanning and If problem persists, select Done Scanning and
perform a Scan Hardware Reset from the Service perform a Scan Hardware Reset from the Service
Tools menu. Tools menu.
Serious error detected during table operation. Serious error detected during table operation.
Please stop all table motions immediately using Please stop all table motions immediately using
E-stop. E-stop.
5 Please select Done Scanning and perform a Scan Please select Done Scanning and perform a Scan
Hardware Reset from the Service Tools menu. Hardware Reset from the Service Tools menu.
If problem persists, contact your service repre- If problem persists, contact your service repre-
sentative. sentative.
6 All table motion shall be controlled from the table All table motion shall be controlled from the table
service panel. Gantry control panels will be disa- service panel. Gantry control panels will be disa-
bled. bled.
An error was detected in the table firmware. An An error was detected in the table firmware. An
auto-recovery will be attempted. If the problem auto-recovery will be attempted. If the problem
7
persists, please contact your service representa- persists, please contact your service representa-
tive. tive.
Table has entered a fault state due to the repea- Table has entered a fault state due to the repea-
ted occurrence of the indicator listed below. ted occurrence of the indicator listed below.
Try to recover by pressing the Emergency Stop Try to recover by pressing the Emergency Stop
8
button and then the Driver Recovery button. button and then the Driver Recovery button.
If the problem persists, please contact your serv- If the problem persists, please contact your serv-
ice representative. ice representative.
Can't establish Insite connection. Please check Can't establish Insite connection. Please check
1
your network configuration. your network configuration.
System firewall is not working or not configured. System firewall is not working or not configured.
3
System is vulnerable to security threats. System is vulnerable to security threats.
System detected a mismatch on the displayed System detected a mismatch on the displayed
information. information.
4
If the problem persists, please perform a Scan If the problem persists, please perform a Scan
Hardware Reset from the Service Tools menu. Hardware Reset from the Service Tools menu.
System detected internal communication error. System detected internal communication error.
5 Please perform a Scan Hardware Reset from the Please perform a Scan Hardware Reset from the
Service Tools menu. If problem persists, contact Service Tools menu. If problem persists, contact
your service representative. your service representative.
Low image space. Please remove images and Low image space. Please remove images and
6
empty the recycle bin. empty the recycle bin.
To run SPR Snap first press Revisit Settings. To run SPR Snap first press Revisit Settings.
7 Close if any of the following application(s) are Close if any of the following application(s) are
running: running:
The currently logged user does not have a role The currently logged user does not have a role
8
assigned. assigned.
Recon self test found reconstruction errors. Recon self test found reconstruction errors.
10
Please contact service Please contact service
Unable to verify system functionality on startup. Unable to verify system functionality on startup.
Please perform a System Restart from the Mode Please perform a System Restart from the Mode
11 menu. menu.
If the problem persists, please contact your serv- If the problem persists, please contact your serv-
ice representative. ice representative.
One, or more components failed to report their One, or more components failed to report their
configuration. configuration.
Assuming previous configuration. Assuming previous configuration.
12 Please perform a System Restart from the Mode Please perform a System Restart from the Mode
menu. menu.
If problem persists, please contact your service If problem persists, please contact your service
representative. representative.
Appendix B Abbreviations
B.1 Abbreviations
Table 173 Abbreviations
Abbreviations Acronym
AW Advantage Workstation
cm Centimeter
CT Computed Tomography
HAP Hydroxyapatite
HU Hounsfield Units
HV High Voltage
ISO Iso-center
IV Intra-venous
Abbreviations continued
Abbreviations Acronym
kg Kilogram
kV kilo-volts
kW kilo-watts
lb Pound
mA milli-amps
MD Material Density
mGy Milligray
ml Milliliter
mm Millimeter
ms millisecond
PM Planned Maintenance
QA Quality Assurance
Abbreviations continued
Abbreviations Acronym
UL Underwriters’ Laboratories
WL Window Level
WW Window Width
Weight Kilogram kg
Weight Pounds lb
Height Centimeter cm
Height Inches in
Interval Millimeter mm
ISD Second s
DFOV Centimeter cm
Duration Second s
Thick Millimeter mm
Gantry Degree °
SFOV Centimeter cm
Midscan Seconds s
Height Centimeter cm
Weight Kilogram kg
Table 181 Display result on an image for Image Measurements - Ellipse ROI / Box ROI / Trace ROI
Distance Millimeter mm
Angle Degree °
Angle Degree °
kV Kilovolt kV
mA Milliampere mA
Time Second s
Thk Millimeter mm
Thick Millimeter mm
Gantry Degree °
SFOV Centimeter cm
Midscan Seconds s
FOV Centimeter cm
DFOV Centimeter cm
kV Kilovolt kV
mA Milliampere mA
Thickness Millimeter mm
Appendix D Lexicon
D.1 Lexicon
For the CT technologist who operates multiple scanner models, perhaps from multiple manufacturers,
the variability in names for important scan acquisition and reconstruction parameters can lead to
confusion, reduced comfort and an increased potential for error. The intent of this CT terminology
lexicon is to allow users to translate important CT acquisition and reconstruction terms between
different manufacturers' systems.
The following tables provide the SABMI (Scout Adjusted Body Mass Index) terminology for GE and is a
result of the AAPM CT Terminology working group. It identifies relevant from established lexicon (e.g.,
Radlex and DICOM) and other relevant literature published.
The AAPM website will provide updates when changes in standardization of terminology occur. Visit
www.aapm.org, search CT Protocols, and select Lexicon for full listing of terminology across various
manufactures of CT equipment.
The generic descriptions or terms in the first column are intended to orient the user to the relevant
concepts; they are not consensus "preferred terms." The generic descriptions are not based on any
single existing or pending terminology standard; however the references cited below were consulted
in developing the generic descriptions.
A number of individuals and groups have advocated for terminology standardization in CT, including
at a March 30-31, 2010 FDA (Food and Drug Administration) public meeting entitled "Device
Improvements to Reduce Unnecessary Radiation Exposure from Medical Imaging" (transcripts
available at the FDA website: www.fda.gov in Medical Devices). Participants proposed a cooperative
effort among professional organizations (AAPM, ASRT, ACR, etc.), industry, and the FDA.
D.1.1 Scan acquisition and user interface basics on page 1070 Scan acquisition and user interface
basics
D.1.2 Dose modulation and reduction tools on page 1071 Dose modulation and reduction tools
D.1.3 Multi-slice detector geometry on page 1071 Multi-slice detector geometry
D.1.4 Image reconstruction and display on page 1072 Image reconstruction and display
D.1.5 Contrast media tools on page 1073 Contrast media tools
D.1.6 Multi-planar formats and 3D processing on page 1074 Multi-planar formats and 3D processing
D.1.7 Service and application tools on page 1074 Service and application tools
D.1.8 Workflow on page 1074 Workflow
The portion of the user interface where scans are prescribed Scan Settings
Other portions of the user interface, such as where reconstructed images are Patient tabs or File Manager
viewed
CT localizer radiograph (i.e. the scanned projection radiograph, often ac- Scout
quired by the CT system to allow the user to prescribe the start and end
locations of the scan range)
Axial scan mode: Data acquisition while the patient table remains stationary; Axial
the table position may be incremented between X-ray exposures to collect
data over a longer z axis range.
Helical or Spiral scan mode: Data acquisition while the patient table is Helical
continuously moving along the z axis.
Dynamic scan mode - single detector width: Data acquisition at multiple Cine or zero interval Axial
time points over the same anatomic location(s) while the patient table re-
mains stationary; X-ray exposure can be continuous or intermittent
Dynamic scan mode - multiple detector widths: Data acquisition at multi- Not used on this system
ple time points over the same anatomic location(s) while the patient table
cycles back and forth between designated start and end locations in order
image a region wider than the detector
Table increment (mm) per 360 degree rotation of the X-ray tube (axial scan Scan Interval
mode)
Table feed per 360 degree rotation of the X-ray tube (helical scan mode) Speed (mm/rot)
Field of measurement: Diameter of the circular region within the scan plane Scan Field of View (SFOV, cm)
over which projection data are collected. Nominally equal to the diameter of
the primary beam at isocenter in the axial plane.
Tube current: Number of electrons accelerated across an X-ray tube per unit mA
time, expressed in units of milliampere (mA)
Tube current-time product: The product of tube current and exposure time Shown as read only in the
per rotation, expressed in units of milliampere • seconds (mAs). In axial scan mA mode menu under Rela-
mode, this is equal to tube current × (scan angle ÷ 360) × rotation time. In ted Settings
helical scan mode, this is equal to tube current × rotation time.
Effective tube current-time product: In helical scan mode, this is the prod- Not used on this system
uct of tube current and rotation time (expressed in units of milliampere •
seconds (mAs) ÷ pitch)
Tube potential: The electric potential applied across an X-ray tube to acceler- kV
ate electrons towards a target material, expressed in units of kilovolts (kV)
Pitch: Unitless parameter used to describe the table travel during helical CT; Pitch
equal to table travel (mm) per gantry rotation ÷ total nominal beam width
(mm)
Automatic exposure control (AEC): A scanner feature that automatically Available in SmartmA
adapts the X-ray tube current to the overall patient size to achieve a specified
level of image quality
Detector rows (N) and slice thickness (T) selection console screen image
Window width: Range of CT numbers (maximum - minimum) that are distrib- Window Width
uted over the viewable grey scale of the display device or film
Window center: The CT number in the center of the viewable grey scale Window Level
Reconstruction field of view: Width of the square region mapped to the Display Field of View (DFOV)
reconstructed image matrix (cm)
Prescribing the reconstruction parameters prior to scan acquisition Primary and Secondary recon
Prescribing the reconstruction parameters after scan acquisition Post Scan Secondary recon
Helical interpolation options to achieve a wider or narrower section sensitivi- Full (narrower) or Plus (wider)
ty profile mode
Fast but lower-quality reconstructed images for rapid review of entire exam Quality Check
Image modifications to alter sharpness or smoothness (done in image space Image Filters
without reconstructing images)
Bolus tracking: Scanner feature to automatically initiate a prescribed axial, Smart Prep
helical or dynamic scan when a threshold level of contrast enhancement is
reached at a specified region of interest
Test Bolus: Scan mode used to measure the contrast transit time using a Take axial scans at zero table
small injection of contrast media feed and process with MIROI
Time-attenuation curve (TAC): Graph of the contrast enhancement versus Smart Prep graph or MIROI
time graph
Threshold: CT number (HU) where bolus tracking tool will trigger the system Transition ROI Threshold
to begin the scan
Scanner feature used to quantitatively evaluate the TAC MIROI (multiple image region
of interest)
Monitoring delay: Time from injection to the start of monitoring scans (Time Monitoring Delay
1 in figure below)
Monitoring interval: Time between consecutive monitoring scans to (Time 2 Monitor ISD (InterScan Delay)
in figure below)
Scan delay: Time from when threshold is reached and prescribed axial, Diagnostic delay
helical or dynamic scan begins (Time 3 in figure below)
Reformatted image at an oblique plane (not an axial, coronal, or sagittal) Oblique reformat
Saving images at various viewing angles about a volume or surface rendered Batch Loop
object
Surface-rendered object 3D
D.1.8 Workflow
Table 194 Workflow terms
Scheduled (but not yet scanned) patient list is called Patient Schedule
Data page summarizing scan parameters, CTDIvol and DLP Exam Text Page, Series Text
Page, or Dose SC
D.1.9 References
IEC 60601-2-44 ed3.0 (2009-02) Medical electrical equipment – Part 2-44: Particular requirements for
the basic safety and essential performance of X-ray equipment for computed tomography.
Kalra, M. K. and S. Saini. 2006. Standardized nomenclature and description of CT scanning techniques.
Radiology 241, 657-660.
National Electrical Manufacturer's Organization. 2009. Digital Imaging and Communications in
Medicine (DICOM). (Downloadable from: www.nema.org)
RadLex Tree Browser (www.radlex.org)
Weber, N. M., C. L. Siegle, J. E. Miller, M. K. Hudson, J. M. Kofler, M. R. Bruesewitz, and C. H.
McCollough. How to be a "multi-lingual" CT technologist: understanding scan parameters from
different manufacturers’ equipment. 2004 RSNA Annual Meeting poster (www.mayo.edu in Research).
Weigold, W.G., et al. 2011. Standardized Medical Terminology for Cardiac Computed Tomography: A
Report of the Society of Cardiovascular Computed Tomography. Journal of Cardiovascular Computed
Tomography (downloadable from: www.scct.org in Documents).
Chapter Section
Chapter Section
Estimates of the maximum CTDIvol increase and measured noise decrease are shown in Table x.
Note that the actual differences in CTDIvol, noise, and image texture/artifacts relative to the previous
release are dependent on the scanned anatomy and scan technique. Table x: Estimates of maximum
difference in CTDIvol and measured noise of current ODM relative to previous release.
Figure 525 ODM angular region for body scans before and after the change.
Table 197 Estimates of maximum difference in CTDIvol and measured noise of current ODM
relative to previous release
With this release, an additional SANI strength setting is introduced. The level of noise adjustment with
patient size for this new setting is between that of the previous “Small” and “Moderate” settings. The
names of the SANI settings have been updated according to the table below.
Name of Size Adjusted Noise Index Strength Set- New Name for this Size Adjusted Noise Index
ting in Previous Release Strength Setting in Current Release
Auto Prescription GE Reference Profiles and User Profiles that previously used “Moderate” or “Large”
SANI settings will automatically update to show “Large” or “Very Large” SANI setting, respectively.
Note that this is only a change in the name of the SANI settings relative to the previous release, and
importantly, the underlying Noise Index adjustment behavior, and thus dose behavior, will remain the
same as before.
For example, assume a User Profile was set up in the previous release with the following SANI settings
T
• SANI Below Reference Patient Size = Moderate Decrease
• SANI Above Reference Patient Size = Large Increase
hen this profile will be automatically updated in the current release to show the following SANI
settings:
• SANI Below Reference Patient Size = Large Decrease
• SANI Above Reference Patient Size = Very Large Increase
The Noise Index adjustment across patient size and resultant dose at scan time will remain the same
as the previous release; only the name of these two settings has changed.
Revolution CT, Revolution CT ES GE Small Vessel Thoracic CTA Increase rotation time of largest
(Adult) patient size range from 0.5s to 0.6s
to allow ~20% more dose and im-
proved image quality for patients
larger than 75cm AP + LAT
www.gehealthcare.com