ImPACT - RSNA 2004

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CT Scanning at RSNA 2004
presentations
reports & info
64-slice CT scanners become a commercial reality and are being targeted for cardiac
dosimetry &
applications. All manufacturers now offer a multi-slice large bore CT scanner for
testing radiotherapy planning. Developments on CT scanners with flat-panel and other large
r&d area detectors are still works-in-progress.
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All four major CT manufacturers are now able to offer a 64-slice CT system.
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GE presented the LightSpeed VCT, their 64-slice scanner, for the first time at RSNA.
Like the 32-slice system, it has 64 x 0.625 mm detector banks, with a total z-axis
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coverage of 40 mm. The maximum gantry rotation speed is 0.35 s and like all 64 slice
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scanners its advantages will be seen mainly in cardiac scanning. GE claim that the
VCT can image the heart in 5 beats with a temporal resolution of 43 ms. The VCT uses
GE's new Volara Data Acquisition System (DAS) which is claimed to have lower
electronic noise, leading to improved image quality at low beam strength.

Last year Philips unveiled the Brilliance CT 40 at RSNA and now they have added a 64-
slice scanner to their range. The Brilliance CT 64 has 64 x 0.625 mm detector banks,
giving a total z-axis coverage of 40 mm, and has a maximum gantry rotation speed of
0.4 s. Philips are also marketing the Brilliance Private Practice CV, a system targeted
at the private cardiology sector. The configuration features Philips Rate Responsive™
technologies, a set of software packages designed specifically for cardiac imaging.
They include Beat-to-Beat™ Variable Delay Algorithm, which recognises the
differences between systole and diastole with respect to changes in heart rate and
adapts the imaging window accordingly, as well as COBRATM Cardiac 3D cone beam
reconstruction algorithms with MaxCycle™ adaptive multi-cycle reconstruction, and
AccuTag™ for robust R-wave detection capability.

The Siemens Sensation 64 differs from the other 64-slice scanners available in that it
has only 32 x 0.6 mm detector rows, but can acquire 64 data channels with its 'z-
Sharp™ technology'. This utilises a flying focal spot along the z-axis direction to double-
sample each detector row. Some competitors claim this is not a true 64-slice scanner,
however, Siemens maintain that the double sampling improves z-axis resolution and
reduces wind-mill artefacts, which can be a problem in helical cone-beam scanning. In
addition to the 32 x 0.6 mm detector rows, the array has 8 x 1.2 mm detector rows and
so can acquire 24 x 1.2 mm channels in helical mode. The Sensation 64 has a
standard maximum gantry rotation speed of 0.37 s, and a 0.33 s option. Siemens are
marketing a 64-slice scanner dedicated to cardiac work which is available at a lower
price than the standard 64-slice system. Also announced was the Sensation 40, which

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will be available in summer 2005. This has the same hardware as the Sensation 64, so
has an easy upgrade path to 64-slices if required in the future.

The revolutionary Straton x-ray tube, introduced at last year's RSNA as an option on
the Sensation 16 scanner, has now become an integral part of the Sensation range. All
Sensation scanners with 16 slices and above will be supplied with this tube.

Siemens plan to have a 16-slice Emotion scanner available by September 2005 to

complement their range. Initially the maximum gantry rotation speed will be 0.6 s, but
this will later be upgraded to 0.5s.

Siemens unveiled a new low cost scanner, the Somatom Spirit (Figure 1). A dual slice
system, it has a 1 s maximum gantry rotation speed (0.8 s option) and a minimum slice
width of 1 mm. Currently there is not a great demand for this type of scanner in the UK,
but the low cost and low space requirements could make it attractive for small clinics or
as an additional scanner in busy departments.

Figure 1. The Siemens Somatom Sensation Spirit CT scanner

Toshiba presented the Aquilion 64, a 64-slice development of the 32-slice system
unveiled at last year's RSNA. It has the same detector array, consisting of 64 x 0.5 mm
detector rows, and a maximum gantry rotation speed of 0.4 s. The system has
'quantum denoising' software which, it is claimed, results in 15% less image noise than
on the 16-slice system. In addition, they have the Aquilion 64 CFX, a system
configured specifically for advanced cardiac applications. This features SURECardio

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and SUREPlaque cardiac software. SURECardio is designed to optimise imaging for

variable and high heart rates with adaptive multi-segment reconstruction software.
SUREPlaque identifies and quantifies soft plaque for cardiac and peripheral vessel
analysis using a colour-coding system based on tissue density.

No. of data Total z-axis Max. gantry

Scanner channels detector length rotation speed
(# x mm) (mm) (s)
GE LightSpeed VCT 64 x 0.625 40 0.35
Philips Brilliance 64 64 x 0.625 40 0.40
64 x 0.6*
Siemens Sensation 64 28.8 0.37 (0.33 option)
24 x 1.2
Toshiba Aquilion 64 64 x 0.5 32 0.40

* 64 x 0.6 mm data channels achieved using 32 x 0.6 mm detectors and z-axis flying
focal spot

Table 1: Basic specifications of 64-slice CT scanners

Radiotherapy treatment planning applications

Large bore CT scanners

CT has always been recognised as a useful tool in radiotherapy treatment planning.

With intensity modulated radiotherapy (IMRT) now being implemented clinically, the
use of CT in the treatment planning process is considered essential due to the
increased accuracy it offers in tumour localisation and tissue inhomogeneity
corrections. As a result most radiotherapy departments are now acquiring dedicated
CT scanners, often known as CT simulators.

Conventional CT scanners with gantry aperture diameters of 70 cm and reconstruction

fields of view (RFOV) of 50 cm have certain limitations in the radiotherapy planning
process, because the size of the gantry aperture does not always allow patients to be
scanned in the treatment position. The restricted field of view can result in incomplete
delineation of the patient contour, leading to inaccuracies in CT number. To overcome
these shortcomings, Philips (at the time Marconi) introduced the first large bore CT
scanner, the AcQsim CT, in 2000. This was a single slice 4th generation CT system
with a gantry aperture of 85 cm and a maximum RFOV of 60 cm. Since then, all the
major CT manufacturers have brought out large bore, multi-slice CT scanners with
gantry diameters of 80 - 90 cm and RFOVs in the range 60 - 85 cm. Siemens and GE
announced their large bore systems at last year's RSNA and Philips introduced their
Big Bore system earlier this year. The large bore system unveiled at this year's RSNA
was the Toshiba Aquilion LB (Large Bore), a 16-slice system with a gantry aperture
diameter of 90 cm and a maximum RFOV of 85 cm (Figure 2). The basic specifications
of all four multi-slice systems are shown in Table 2.

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No. of Gantry aperture Scan Maximum RFOV

Scanner
slices diameter (cm) FOV (cm) (cm)
GE LightSpeed RT 4 80 50 65
Philips Brilliance CT
16 85 60 60
Big Bore
Siemens Sensation
20 82 50 82
Open
Toshiba Aquilion LB 16 90 70 85

Table 2: Basic specifications of large bore CT scanners

Figure 2. The Toshiba Aquilion LB CT Scanner

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All the manufacturers except Philips have a RFOV which is greater than the scan FOV,
so have to use interpolation techniques to reconstruct data in this extended FOV.
Although this results in a reduced image quality in the extended region it is not
considered a problem as the data from this area is usually only required for contour
delineation purposes. Philips have increased the number of detectors in the x-y plane
to scan the full 60 cm field of view and can therefore use conventional reconstruction
methods. Toshiba have also extended their detector array to cover a scan FOV of 70
cm, compared to 50 cm on their standard systems. At 85 cm, theirs is the largest
RFOV and they claim to use a different reconstruction approach to GE and Siemens in
the extended region. Known as ASTOR, this algorithm utilises complementary rays in
cone beam geometry to fill in for the missing data, which they claim gives improved
image quality.

The large bore systems also have advantages in scanning bariatric (obese) patients
and in trauma applications, where the larger bore allows scanning with additional
medical equipment attached to the patient.

Respiratory gating

Both GE and Siemens showed methods of respiratory-gated data acquisition in CT.

The two manufacturers use different techniques for the gating. GE use an optical
tracking monitor consisting of a reflective device placed on the patient's skin used in
conjunction with a laser and optical sensor. Siemens approach is to use a chest belt
with a pressure sensor to monitor respiratory motion. This will be available on the
Sensation 64 and Open by mid-2005. The full benefits of using the respiratory-gated
CT scans for treatment planning will be realised when used in conjunction with
respiratory-gated treatment delivery.

Future developments

Toshiba displayed their 256 x 0.5 mm row detector array which has been under
development for some time now. It is now closer to becoming a commercial system
with suggested dates for the availability of an initial 128 row scanner in about 18
months time.

GE and Siemens both have flat panel detector diagnostic CT systems in development,
but no timescales for a commercial product have been given yet. There are already flat
panel systems that produce CT images available on commercial products such as
radiotherapy simulators, but these have rotation times that would be considered too
slow on a diagnostic CT system.

In the scientific sessions the presentations given by the manufacturers focussed on

developments in CT reconstruction methods for the 64-slice cone-beam scanners,
large bore CT scanners and for cardiac and respiratory-gated studies.

One presentation described a study for optimising x-ray tube voltage (kV) to patient
size and shape. Current practice is to use a fixed voltage, most commonly at 120 kV.

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Optimal results were achieved at lower kVs for small patients and higher kVs for large
patients. The adjustment of tube current to patient attenuation is now well-established
in CT, but the adjustment of kV would take protocol optimisation a stage further. The
work highlights the emphasis that is now being placed on achieving good image quality
at the lowest possible patient dose.

Combined imaging systems

SPECT / CT

New this year were combined SPECT / CT systems from Philips and Siemens. Both of
these machines make use of a full diagnostic CT scanner in combination with a dual
headed gamma camera. The Siemens Symbia (Figure 3) is available with a single,
dual or six-slice CT component, whilst the Philips Precedence (Figure 4) incorporates a
16-slice CT scanner.

Figure 3. The Siemens Symbia SPECT/CT scanner

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Figure 4. The Philips Precedence SPECT/CT scanner

Having the gamma camera and CT scanner on the same gantry allows straightforward
fusion of the two data sets. The CT provides accurate anatomical localisation of the
functional information within the gamma camera scan. In addition, the CT data can be
used for generating attenuation correction maps to increase the accuracy of the
gamma camera data. It is claimed that the accuracy of radionuclide therapy planning
can be increased by using the CT attenuation corrected SPECT data. Applications in
development include combined coronary CT angiography and myocardial perfusion
imaging.

GE's Hawkeye system (Figure 5) has been available for several years, and RSNA
2004 saw an update of the scanner in the form of the GE Millennium VG Hawkeye.
The Hawkeye consists of a dual headed gamma camera with an x-ray tube and row of
detectors housed within the gantry. The x-ray system is used to acquire low-resolution
CT scans of the patient, which are then used for attenuation correction of the
corresponding SPECT data. The CT images, which typically take 5 to 10 minutes to
acquire, can also be used for anatomical localisation of the SPECT images.

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Figure 5. The GE Millenium VG Hawkeye SPECT/CT scanner

PET / CT

A number of PET / CT scanners were on display at the meeting, including the

Discovery ST from GE, the GEMINI GXL from Philips and the Siemens Biograph 64.
PET / CT systems are now more widespread, with GE alone now have 200 Discovery
systems installed worldwide.

CT slice PET detector PET acquisition Scanner bore

Scanner
options material modes diameter (cm)
GE Discovery
4, 8, 16 BGO 2D and 3D 70
ST
Philips GEMINI 2, 6, 10, 16 GSO 3D 70
Siemens
2, 6, 16, 64 LSO 3D 70
Biograph

Table 3: PET / CT basic system specifications

The Centers for Medicare and Medicaid Services (CMS) in America issued a draft
national coverage decision in November 2004 proposing to expand Medicare coverage
for the detection of certain cancers using PET with FDG. The decision to allow more
PET scans to be reimbursed via Medicare will lead to a growth in the number of PET

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and PET / CT systems in the US, and probably drive growth worldwide.

Angiographic CT (ACT) systems

Siemens have incorporated a CT facility into their Axiom Artis FD C-arm angiography
system. The CT option, known as DynaCT utilises the flat panel detector of the
angiography system. This performs a 10 s rotation and provides images with a low
contrast resolution of 10 mm at a contrast level of 10 HU. The ACT images can be
useful in neurovascular treatment procedures where local bleeding as a result of an
aneurysm rupture can be visualised in the angio lab. The visualisation of the ventricular
system of the brain adds in diagnosing pathologic processes or to guide and monitor
placements during drainage procedures. ACT can also provide diagnostic and
interventional support in a range of abdominal procedures including puncture and
drainage. In oncology applications, it is said that its ability to visualise tumours in all
parts of the body will enable new methods for conducting biopsies and treating
tumours, such as embolisation and RF ablations.

Summary

Following their introduction at last year's RSNA and over the following year, 64-slice
scanners are now a commercial reality. Their advantages are in cardiac applications,
with efforts directed at improving the temporal resolution through high gantry rotation
speeds and developments in gated reconstruction algorithms.
Large bore CT scanners which are increasingly being bought as dedicated systems for
radiotherapy planning are another new area of interest.
CT images are now being obtained with flat panel detectors, on radiotherapy
simulators and interventional angiography systems. Developments are still in progress
on large area detectors to enable scanning of whole organs in a single rotation on
dedicated diagnostic CT scanners. Manufacturers are currently taking different
approaches to this, either with flat panel detector systems or the further extension of
matrix detector arrays. These new systems, when available, should open up more
possibilities for CT in dynamic i.e. 4D imaging.
Philips and Siemens have joined GE in the market for combined SPECT/CT systems.
The CT scanner attached to these systems is used as a tool for attenuation correction
in the SPECT images and for anatomical localisation.
PET/CT is now becoming an established diagnostic tool and it is anticipated that there
will be a significant expansion in the use of these systems over the coming year.

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