Siemens SOMATOM Sensation Cardiac Version A60 Operating instructions

SOMATOM
Sensation Cardiac
Application Guide
Protocols
Principles
Helpful Hints
syngo Calcium Scoring
syngo InSpace4D
syngo Vessel View
syngo Argus
Software Version syngo CT 2006G
The information presented in this application guide is
for illustration only and is not intended to be relied
upon by the reader for instruction as to the practice of
medicine. Any health care practitioner reading this
information is reminded that they must use their own
learning, training and expertise in dealing with their
individual patients.
This material does not substitute for that duty and is
not intended by Siemens Medical Solutions Inc., to be
used for any purpose in that regard. The drugs and
doses mentioned are consistent with the approval
labeling for uses and/or indications of the drug. The
treating physician bears the sole responsibility for the
diagnosis and treatment of patients, including drugs
and doses prescribed in connection with such use.
The Operating Instructions must always be strictly followed when operating the CT System. The source for
the technical data is the corresponding data sheets.
The pertaining operating instructions must always be
strictly followed when operating the SOMATOM Sensation Cardiac. The statutory source for the technical
data are the corresponding data sheets.
The names and birthdates included in this guide have
been selected for the purpose of demonstration only
and do not represent actual patient data.
We express our sincere gratitude to the many customers who contributed valuable input.
Special thanks to Thomas Flohr, Rainer Raupach, Karl
Stiersdorfer, Christoph Süß, Lars Hofmann, Bettina
Hinrichsen, Heike Theessen, Kristin Pacheco, Johann
Übler and Alexander Zimmermann for their valuable
assistance.
To improve future versions of this application guide,
we would highly appreciate your questions, suggestions and comments.
Please contact us:
USC-Hotline:
Tel. no. +49-1803-112244
email: ct-application.hotline@med.siemens.de
Editors: Christiane Bredenhöller and Ute Feuerlein
Overview
User Documentation
16
Scan and Reconstruction
18
Dose Information
42
Workflow Information
64
Application Information
108
HeartView CT
132
syngo Calcium Scoring
168
CoronaryCTA
192
syngo InSpace4D
220
syngo Vessel View
222
syngo Argus
260
Head
284
Neck
314
3
Overview
4
Shoulder
324
Thorax
332
Abdomen
356
Spine
376
Pelvis
396
Upper Extremities
410
Lower Extremities
420
Vascular
432
Specials
474
Radiation Therapy
508
Respiratory Gating
522
Children
542
Overview
5
Contents
User Documentation
16
Scan and Reconstruction
18
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Concept of Scan Protocols
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Scan Set Up
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Feed in/Feed out
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Topo Length
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Scan Modes
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– Sequential Scanning
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– Spiral Scanning
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– Dynamic Multiscan
23
– Dynamic Serioscan
23
Straton-Tube
24
UFC detector
25
Acquisition, Slice Collimation and
Slice Width
26
Increment
29
Pitch
30
Kernels
31
– Head Kernels
34
– Child Head Kernels
34
– Body Kernels
35
– Special Application Kernels and Ultra High
Resolution Kernels
36
Extended FoV
37
Improved Head Imaging
38
Image Filters
40
Dose Information
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6
CTDIW and CTDIVol
ImpactDose
Effective mAs
CARE Dose 4D
– How does CARE Dose 4D work?
– Special Modes of CARE Dose 4D
– Scanning with CARE Dose 4D
– Adjusting the Image Noise
– Activating and Deactivating
CARE Dose 4D
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Contents
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– Conversion of Old Protocols into Protocols
with CARE Dose 4D
56
– Additional Important Information
59
100kV-Protocols
60
Workflow Information
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WorkStream4D
– Recon Jobs
– 3D Recon
– 1. Sagittal/Coronal Reconstructions
– 2. Oblique/Double-oblique
Reconstructions
Workflow
– Patient Position
– Auto Reference Lines
– Navigation within the Topogram
– Study Continuation
– Reconstruction on Wizard
– Examination Job Status
– Auto Load in 3D and Postprocessing
Presets
Scan Protocol Creation
– Edit/Save scan protocols
– Scan Protocol Manager
Contrast Medium
– The Basics
– IV Injection
– Bolus Tracking
– Test Bolus using CARE Bolus
– How to do it
– Test Bolus
– CARE Contrast
Application Information
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SOMATOM LifeNet
– General Information
– Key Features
– SOMATOM LifeNet offline
– SOMATOM LifeNet online
Image Converter
Report Template Configuration
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7
Contents
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File Browser
Camtasia
– Key features
– Additional Important Information
Patient Protocol
HeartView CT
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Heart Anatomy
Placement of ECG Electrodes
Cardiac Scanning
– Cardiac Cycle and ECG
– Temporal Resolution
– Technical Principles
– Prospective ECG Triggering Versus
Retrospective ECG Gating
– Preview Series
– Determine ED and ES
– ECG Trace Editor
– ECG Pulsing
– ACV on/off
– Synthetic Trigger
Cardiac Reconstruction
– Axial Images
– Double-Oblique Images
– Short Axis Images
– Multiphase Reconstruction
– Reconstruction Examples
Cardiac Postprocessing on the 3D Card
– Reconstruction of the Short Heart Axis
– Auto Load in 3D and Postprocessing
Presets
syngo Calcium Scoring
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8
Scanning
CaScoreRoutine/CaScore
CaScore037s
CaScoreSeq
Postprocessing
– Prerequisites
– General Workflow
– Additional Important Information
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Contents
CoronaryCTA
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Scanning
– Contrast Medium
CoronaryCTARoutine/CoronaryCTA
CoronaryCTARoutine037s
CoronaryCTAAdaptSpeed
CoronaryCTALowHeartRate
WorkStream4D Protocols
CoronaryCTAVol
CoronaryCTAAdaptSpeedVol
CoronaryCTALowHeartRateVol
– Aortic and Pulmonary Studies
ThorCardioECG
ThorCardioECG037s
syngo InSpace4D
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4D Viewer
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syngo Vessel View
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Key Features
Prerequisites
Workflow
– Loading the Images
– Visualization
– Segmentation
– Path Modification
– Measurement Analysis
– Documentation of Results
Case Examples
– Workflow for an Aortic Aneurysm Case
– Workflow for a Coronary Case,
e.g. LM and LAD
– Workflow for a Carotid Stenosis Case
Additional Important Information
– Image quality
– Functions
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9
Contents
syngo Argus
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Key Features
Prerequisites
Scanning and Reconstruction
– Scan Protocols
– Short Axis
– Multiphase Reconstruction
– Reconstruction Examples
Post-processing on the 3D Card
Workflow
– Image Loading
– Argus Viewer
– Argus Evaluation
– Contour Drawing
– Generation of Cardiac Function Results
– Hints in General
Head
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Overview
Hints in General
– Head Kernels
HeadRoutine
HeadRoutine05s
HeadRoutineSeq
HeadSeq
HeadSeq05s
InnerEarUHR
InnerEarUHRVol
InnerEarSeqUHR
Sinus
SinusVol
Orbit
Dental
Neck
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10
Overview
Hints in General
NeckRoutine
NeckThinSlice
NeckVol
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Contents
Shoulder
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Overview
Hints in General
– Body Kernels
Shoulder
ShoulderVol
Thorax
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Overview
Hints in General
ThoraxRoutine
ThoraxCombi
ThoraxVol
ThoraxHR
ThoraxSeqHR
ThoraxECGSeqHR
LungLowDose
LungCARE
Abdomen
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Overview
Hints in General
– Body Kernels
AbdomenRoutine
AbdomenCombi
AbdomenVol
AbdMultiPhase
AbdSeq
CTColonography
Spine
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Overview
Hints in General
– Body Kernels
C-Spine
C-SpineVol
SpineRoutine
SpineThinSlice
SpineVol
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11
Contents
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SpineSeq
Osteo
Pelvis
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Overview
Hints in General
– Body Kernels
Pelvis
PelvisVol
Hip
HipVol
SI_Joints
Upper Extremities
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Overview
Hints in General
– Body Kernels
WristUHR
ExtrRoutineUHR
ExtrCombi
Lower Extremities
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Overview
Hints in General
KneeUHR
FootUHR
ExtrRoutineUHR
ExtrCombi
Vascular
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12
Overview
Hints in General
– Head Kernels
HeadAngio
HeadAngioVol
CarotidAngio
CarotidAngioVol
ThorAngioRoutine/ ThorAngio042s
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Contents
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ThorAngioVol
ThorCardioECG/ThorCardioECG042s/
ThorCardioECG037s
Embolism/Embolism042s
BodyAngioRoutine
BodyAngioFast/BodyAngioFast042s
BodyAngioVol
AngioRunOff
WholeBodyAngio
Specials
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Overview
– Trauma
– Interventional CT
– Test Bolus
Trauma
– General Information
Trauma
TraumaVol
PolyTrauma
HeadTrauma
HeadTraumaSeq
– Additional Important Information
Biopsy
Biopsy Single
CARE Vision
– The Basics
CAREVision
CAREVisionSingle
CAREVisionBone
CAREView
– HandCARE
– Application Procedure
– Additional important information
TestBolus
Radiation Therapy Planning
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Radiation Therapy
508
– Benefits
Workflow
RT_Head
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516
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Contents
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RT_Thorax
RT_Breast
RT_Abdomen
RT_Pelvis
– Additional Important Information
Respiratory Gating
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522
Key Features
524
– Respiratory Gating
524
– Respiration Monitoring
525
– Respiration Synchronization
525
Positioning of the respiratory sensor belt 526
Scanning Information
528
– Scan Parameters
528
– Temporal Resolution
529
– Technical Principles
529
– Respiratory Triggering
529
– Respiratory gating
530
– Prospective respiratory Triggering versus
Retrospective respiratory Gating
532
– Curve Editor
533
– Synthetic Trigger/Sync
535
Workflow
536
– Reconstruction and Post-processing
536
Additional important Information
537
RespSeq
538
RespLowBreathRate
539
RespModBreathRate
540
Children
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518
519
520
521
Overview
Hints in General
– Head Kernels
– Body Kernels
HeadRoutine
HeadRoutine05s
HeadSeq
HeadSeq05s
– Indications:
InnerEarUHR
InnerEarSeqUHR
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550
551
552
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558
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560
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Contents
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SinusOrbi
NeckRoutine
ThoraxRoutine
ThoraxCombi
ThoraxSeqHR
AbdomenRoutine
SpineRoutine
SpineThinSlice
ExtrRoutineUHR
ExtremityCombi
HeadAngio
CarotidAngio/CarotidAngio042s
BodyAngio/BodyAngio042s
NeonateBody/ NeonateBody042s
566
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570
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576
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580
582
584
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596
15
User Documentation
For further information about the basic operation,
please refer to the corresponding syngo CT Operator
Manual:
syngo CT Operator Manual Volume 1:
Security Package
Basics
SOMATOM LifeNet
syngo Patient Browser
syngo Data Set Conversion
Camtasia
SaveLog
syngo CT Operator Manual Volume 2:
Preparations
Examination
HeartView CT
Respiratory Gating
CARE Bolus CT
CARE Vision CT
syngo Viewing
syngo Filming
syngo CT Operator Manual Volume 3:
syngo 3D
syngo InSpace4D
16
User Documentation
syngo CT Operator Manual Volume 4:
syngo Dental CT
syngo Osteo CT
syngo Volume
syngo Dynamic Evaluation
syngo Neuro Perfusion CT
syngo Body Perfusion CT
syngo CT Operator Manual Volume 5:
syngo Argus
syngo Calcium Scoring
syngo Vessel View
syngo CT Operator Manual Volume 6:
syngo Colonography
syngo LungCARE CT
syngo Pulmo CT
17
Scan and Reconstruction
Concept of Scan Protocols
The scan protocols for adult and children are defined
according to body regions - Head, Neck, Shoulder,
Thorax, Abdomen, Pelvis, Spine, Upper Extremities,
Lower Extremities, Vascular, RT, Specials and
optional Cardiac, PET, SPECT and Private.
The protocols for special applications are defined in the
Application Guide “Clinical Applications 1” and “Clinical Applications 2“ – or in case of Heart View examinations, in the Application Guide “Heart View“.
The general concept is as follows: All protocols without
suffix are standard spiral modes. E.g. “Sinus” means
the spiral mode for the sinus.
The suffixes of the protocol name are follows:
“Routine“: for routine studies
“Seq”: for sequence studies
“Fast“: use a higher pitch for fast acquisition
“ThinSlice“: use a thinner slice collimation
“Combi“: use a thinner and a thicker slice collimation
“05s”: use the rotation time of 0.5 seconds
“042s”: use the rotation time of 0.42 seconds
“037s”: use the rotation time of 0.37 seconds
“UHR“: use a thinner slice width for Ultra High Resolution studies and a FoV of 300 mm
18
Scan and Reconstruction
“HR“: use a thin slice width for High Resolution studies
“ECG“: ECG-gated or trigged mode
“Vol”: use the 3D-Recon Workflow
A prefix of the protocol name is as follows:
“RT”: for radio therapy studies
The availability of scan protocols depends on the system configuration.
19
Scan and Reconstruction
Scan Set Up
Scans can be simply set up by selecting a predefined
examination protocol. To repeat any mode, just click
the chronicle with the right mouse button for repeat.
To delete it, select cut. Each range name in the chronicle can be easily changed before load.
Multiple ranges can be run either automatically with
auto range, which is denoted by a bracket connecting
the two ranges, or separately with a pause in
between.
Feed in/Feed out
The performance of the different buttons (soft buttons, gantry buttons, control box buttons) is standardized as follows:
• in NOT loaded modes
1 mm
• in loaded Biopsy mode:
Feed In/Out = slice width x No. slice positions per scan
2
20
Scan and Reconstruction
Topo Length
Length [mm]
Slice width [mm]
Angle
128, 256, 512, 768, 1024,
1536*, 2048*
6 x 0.6
Top, Bottom, Lateral
* only in combination with PET, option
21
Scan and Reconstruction
Scan Modes
Sequential Scanning
This is an incremental, slice-by-slice imaging mode in
which there is no table movement during data acquisition. A minimum interscan delay in between each
acquisition is required to move the table to the next
slice position.
Spiral Scanning
Spiral scanning is a continuous volume imaging mode.
The data acquisition and table movements are performed simultaneously for the entire scan duration.
There is no inter-scan delay and a typical range can be
acquired in a single breath hold.
Each acquisition provides a complete volume data set,
from which images with overlapping can be reconstructed at any arbitrary slice position. Unlike the
sequence mode, spiral scanning does not require additional radiation to obtain overlapping slices.
22
Scan and Reconstruction
Dynamic Multiscan
Multiple continuous rotations at the same table position are performed for data acquisition. Normally, it is
applied for fast dynamic contrast studies, such as
syngo Neuro Perfusion CT.
Dynamic Serioscan
Dynamic serial scanning mode without table feed.
Dynamic serio can still be used for dynamic evaluation
such as Test Bolus. The image order can be defined on
the Recon subtask card.
23
Scan and Reconstruction
Straton-Tube
The SOMATOM Sensation Cardiac CT-system is now
equipped with the Straton-tube. This newly developed
X-ray tube offers significantly reduced cooling times
for shorter interscan delays and increased power
reserves. The full X-ray power of 60 kW can be applied
for a 20 s spiral, providing considerable dose reserves
even for adipose patients. As an example, in the Thorax Combi protocol (120 kV, 45 mAs, 0.5 s rot, 16 x
1.5 mm, pitch 0.75) a scan range of 150 mm can be
covered in 5.17 s and dose can be increased up to
200 mAs without reduction of the table feed.
Slow heat exchange
Anode within vacuum
Cooling oil
Conventional anode cools down slowly after exposure
Anode in direct contact
with cooling oil
Cooling oil
Fastest heat exchange
STRATON never accumulates heat during exposure
24
Scan and Reconstruction
UFC detector
Siemens’ proprietary, high-speed Ultra Fast Ceramic
(UFC) detector enables a virtually simultaneous readout of two projections for each detector element
resulting in up to 16-slice acquisition.
The detector configuration with the routine acquisition
of the Sensation Cardiac:
25
Scan and Reconstruction
Acquisition, Slice Collimation
and Slice Width
Slice collimation is the slice thickness resulting from
the effect of the tube-side collimator and the adaptive
detector array design. In Multislice CT, the Z-coverage
per rotation is given by the product of the number of
active detector slices and the collimation (e.g.
16 x 0.75 mm).
Slice width is the FWHM (full width at half maximum)
of the reconstructed image.
With the SOMATOM Sensation Cardiac, you select the
slice collimation together with the slice width desired.
The slice width is independent of pitch, i.e. what you
select is always what you get. Actually, you do not
need to care about the algorithm any more; the software does it for you.
On the SOMATOM Sensation Cardiac some slice widths
are marked as “fast” (blue background). These images
are reconstructed with highest performance. All others
will be reconstructed up to 3 images per second.
The reconstruction time depends on slice collimation
and the reconstructed slice width. To get the fast performance, slice width has to be at least 3 times the
slice collimation.
26
Scan and Reconstruction
During scanning the user normally will get “Real Time”
reconstructed images in full image quality, if the “fast ”
slice has been selected.
In some cases – this depends also on Scan pitch and
Reconstruction increment – the Recon icon on the
chronicle will be labeled with “RT”. This indicates the
Real Time display of images during scanning. The Real
Time displayed image series has to be reconstructed
after completion of spiral.
The Acq (Acquisition) is displayed on the Examination
task card. The Acquisition is simply "number of slices
acquired per rotation" x "width of one slice".
Spiral Mode
Slice
Collimation
Slice width
0.75 mm:
0.75, 1, 1.5, 2, 3, 4, 5, 6, 7, 8,
10 mm
1.5 mm:
2, 3, 4, 5, 6, 7, 8, 10 mm
Sequence Mode
Slice
Collimation
Slice width
0.75 mm:
0.75, 1.5, 3, 4.5, 9 mm
1.0 mm:
1, 2 mm
1.5 mm:
1.5, 3, 4.5, 6, 9 mm
5.0 mm:
5, 10 mm
27
Scan and Reconstruction
UHR Spiral Mode
Slice
Collimation
Slice width
0.6 mm:
0.6, 0.75, 1, 1.5, 2, 3, 4, 5, 6 mm
(optional)
0.75 mm:
0.75, 1, 1.5, 2, 3, 4, 5, 6, 7, 8,
10 mm
UHR Sequence Mode
Slice
Collimation
Slice width
0.6 mm:
0.6, 1.2 mm (optional)
0.75 mm:
0.75, 1.5, 3, 4.5, 9 mm
1.0 mm:
28
1, 2 mm
Scan and Reconstruction
Increment
The increment is the distance between the reconstructed images in the Z direction. When the increment
chosen is smaller than the slice thickness, the images
are created with overlap. This technique is useful to
reduce partial volume effect, giving you better detail of
the anatomy and high quality 2D and 3D postprocessing.
The increment can be freely adapted from 0.1 - 10
mm.
29
Scan and Reconstruction
Pitch
Pitch = feed per rotation
z-coverage
z-coverage = detector rows x collimated slice width
Feed/Rotation = table movement per rotation
The Pitch Factor can be freely adapted from 0.45 – 2.0,
in Cardio, there is a fixed pitch down to 0.1.
With the SOMATOM SensationCardiac you select the
slice collimation together with the slice width desired.
The slice width is independent of pitch, i.e. what you
select is always what you get. Actually, you do not
need to be concerned about the algorithm any more;
the software does it for you.
Pitch values with a step width of 0.05 can be selected
for all modes.
We recommend to use a Pitch Factor of 0.45 for MPR
reconstructions.
30
Scan and Reconstruction
Kernels
There are 5 different types of kernels: H stands for
Head, B stands for Body, U stands for High Resolution,
C stands for ChildHead and S stands for Special Application, e.g. syngo Osteo CT.
The image sharpness is defined by the numbers – the
higher the number, the sharper the image; the lower
the number, the smoother the image.
The endings “s” or “f” depend on the rotation time.
Head Kernels:
Kernel
H10f, H10s
H20f, H20s
H21f, H21s
H22f, H22s
H30f, H30s
H31f, H31s
H32f, H32s
H40f, H40s
H41f, H41s
H42f, H42s
H45f, H45s
H50f, H50s
H60f, H60s
description
very smooth
smooth
smooth +
smooth FR
medium smooth
medium smooth +
medium smooth FR +
medium
medium +
medium FR +/medium FR
medium
sharp
medium
31
Scan and Reconstruction
Body Kernels:
Kernel
B10f, B10s
B20f, B20s
B30f, B30s
B31f, B31s
B35f, B35s
B36f
B40f, B40s
B41f, B41s
B45f, B45s
B46f
B50f, B50s
B60f, B60s
B70f, B70s
B80f, B80s
description
very smooth
smooth
medium smooth
medium smooth +
HeartView medium
HeartView medium
medium
medium+
medium
HeartView sharp
medium sharp
sharp
very sharp
ultra sharp
Child Head Kernels:
Kernel
C20f, C20s
C30f, C30s
C60s
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description
smooth
medium smooth
sharp
Scan and Reconstruction
Ultra High Resolution:
Kernel
U30u
U40u
U70u
U80u
U90u
U95u
description
medium smooth
medium
sharp
very sharp
ultra sharp
special applications
Special Application:
Kernel
S80f, S80s
S90f, S90s
description
Shepp-Logan with notch filter
Shepp-Logan without notch filter
PET-Kernel:
Kernel
B19s/f
B29s/f
B39s/f
H19s/f
H29s/f
H39s/f
PET
smooth
medium smooth
medium
smooth
medium smooth
medium
33
Scan and Reconstruction
Head Kernels
For soft tissue head studies, the standard kernel is
H40s; softer images are obtained with H30s or H20s,
H10s, sharper images with H50s. The kernels H21s,
H31s, H41s yield the same visual sharpness as H20s,
H30s or H40s, respectively. The image appearance,
however, is more acceptable due to a "fine-grained"
noise structure; quite often, the low contrast detectability is improved by using H31s, H41s instead of
H30s, H40s.
High Resolution head studies should be performed
with H50f, H60f (e.g. for dental and sinuses). It is mandatory to position the area of interest in the center of
the scan field.
Child Head Kernels
For head scans of small children, the kernels C20s,
C30s (e.g. for soft tissue studies) and C60s (e.g. for
sinuses are provided) should be chosen instead of the
"adult" head kernels H20s, H30s and H60s.
34
Scan and Reconstruction
Body Kernels
As standard kernels for body tissue studies B30s or
B40s are recommended; softer images are obtained
with B20s or B10s (extremely soft). The kernels B31s or
B41s have about the same visual sharpness as B30s
respectively, B40s, the image appearance, however, is
more acceptable due to a "fine-grained" noise structure; quite often, the low contrast detectability is
improved by using B31s, B41s instead of B30s, B40s.
For higher sharpness, as is required e.g. in patient protocols for cervical spine, shoulder, extremities, thorax,
the kernels B50s, B60s, B70s, B80s are available.
35
Scan and Reconstruction
Special Application Kernels and Ultra
High Resolution Kernels
For special patient protocols, S80s and U90u are chosen, e. g. for osteo (S80s) and for High Resolution bone
studies (U90u).
We recommend using the High Resolution specification kernel U90u only with "small" objects, like the
wrist, otherwise artifacts will occur in the images.
Note:
• In case of 3D study only, use kernel B10s and at least
50% overlapping for image reconstruction.
• Do not use different kernels for body parts other
than what they are designed for.
36
Scan and Reconstruction
Extended FoV
SOMATOM Sensation Cardiac offers the extended field
of view. The range can be individually adapted by the
user from 50 cm up to 70 cm.
To use this feature you have to select the extended
FoV checkbox on the "Recon" sub task card. The
default setting is 65 cm, but can be modified.
Extended FoV can be used with each scan protocol.
The extended FoV value should be adapted carefully
to the exact patient size in order to achieve best possible image quality outside the standard scan field.
37
Scan and Reconstruction
Improved Head Imaging
The software version syngo CT 2006G provides significant improvements regarding image quality for heads.
An automatic bone correction algorithm has been
included in the standard image reconstruction. Using a
new iterative technique, typical artifacts arising from
the beam-hardening effect, e.g. Hounsfield bar, are
minimized without any additional post-processing.
This advanced algorithm allows for excellent images of
the posterior fossa, but also im-proves head image
quality in general. Bone correction is activated automatically for body region “Head”. The reconstruction
algorithm for “Head” also employs special adaptive
convolution kernels which allow for improving the
sharpness to noise ratio. More precisely, anatomic contours are clearly displayed while noise is suppressed at
the same time without causing a blurring of edges.
Head image without
correction.
38
Head image with
corrections.
Scan and Reconstruction
In order to optimize image quality versus radiation
dose, scans in body regions “Head” and “AngioHead”
are provided within a maximum scan field of 300 mm
with respect to the iso-center. No recon job with a field
of view exceeding those limits will be possible. Therefore, patient positioning has to be performed accurately to ensure a centered location of the skull.
correct positioning
of the head
wrong positioning
of the head
For trauma examinations of the head we provide two
protocols, to be found in the specials folder:
– HeadTrauma
– HeadTraumaSeq.
The scan protocols enable you to utilize the full 50 cm
FoV, resulting in easier patient positioning for trauma
examinations and to ensure the highest performance,
the dedicated PFO head filter is not used.
39
Scan and Reconstruction
Image Filters
There are 3 different filters available:
LCE: The Low-contrast enhancement (LCE) filter
enhances low-contrast detectability. It reduces the
image noise.
•
•
•
•
•
Similar to reconstruction with a smoother kernel
Reduces noise
Enhances low-contrast detectability
Adjustable in four steps
Automatic post-processing
40
Scan and Reconstruction
HCE: The High-contrast enhancement (HCE) filter
enhances high-contrast detectability. It increases the
image sharpness, similar to reconstruction with a
sharper kernel.
•
•
•
•
Increases sharpness
Faster than raw-data reconstruction
Enhances high-contrast detectability
Automatic post-processing
ASA: The Advanced Smoothing Algorithm (ASA)
filter reduces noise in soft tissues while edges with
high contrast are preserved.
• Reduces noise without blurring of edges
• Enhances low-contrast detectability
• Individually adaptable
• Automatic post-processing
41
Dose Information
CTDI and CTDI
W
Vol
The average dose in the scan plane is best described by
the CTDIW for the selected scan parameters. The CTDIW
is measured in the dedicated plastic phantoms – 16 cm
diameter for head and 32 cm diameter for body (as
defined in IEC 60601–2– 44). This dose index gives a
good estimate for the average dose applied in the
scanned volume as long as the patient size is similar to
the size of the respective dose phantoms.
Since the body size can be smaller or larger than
32 cm, the CTDIW value displayed can deviate from the
dose in the scanned volume.
The CTDIW definition and measurement is based on single axial scan modes. For clinical scanning, i.e. scanning of entire volumes in patients, the average dose
will also depend on the table feed in between axial
scans or the feed per rotation in spiral scanning. The
dose, expressed as the CTDIW, must therefore be corrected by the Pitch Factor of the spiral scan or an axial
scan series to describe the average dose in the scanned
volume.
For this purpose the IEC defined the term “CTDIVol“ in
September 2002:
CTDIVol = CTDIW
Pitch Factor
42
Dose Information
This dose number is displayed on the user interface for
the selected scan parameters.
Please note: Up to now the dose display on the
Somaris\5 user interface was labeled “CTDIW“. This displayed CTDIW was also corrected for the pitch.
The CTDIw value does not provide the entire information of the radiation risk associated with CT examination. For this purpose, the concept of the “Effective
Dose“ was introduced by ICRP (International Commission on Radiation Protection). The effective dose is
expressed as a weighted sum of the dose applied not
only to the organs in the scanned range, but also to the
rest of the body. It could be measured in whole body
phantoms (Alderson phantom) or simulated with
Monte Carlo techniques.
The calculation of the effective dose is rather complicated and has to be done by sophisticated programs.
These have to take into account the scan parameters,
the system design of individual scanner, such as x-ray
filtration and gantry geometry, the scan range, the
organs involved in the scanned range and the organs
affected by scattered radiation. For each organ, the
respective dose delivered during the CT scanning has
to be calculated and then multiplied by its radiation
risk factor. Finally, the weighted organ dose numbers
are added up to get the effective dose.
The concept of effective dose allows the comparison of
radiation risk associated with different CT or x-ray
exams, i.e. different exams associated with the same
effective dose would have the same radiation risk for
the patient. It also allows comparing the applied x-ray
exposure to the natural background radiation,
e.g. 2 – 3 mSv per year in Germany.
43
Dose Information
ImpactDose
For most of our scan protocols, we calculated the
effective dose numbers for standard male* and
female* and listed the result in the description of each
scan protocol.
The calculation was done by the commercially available program "ImpactDose" (Wellhoefer Dosimetry).
For pediatric protocols, we used the ImpactDose calculation and the correction factors published in "Radiation Exposure in Computed Topography"**, in which
there are only the conversion factors for the age of 8
weeks and 7 years old available.
*The Calculation of Dose from External Photon Exposures Using Reference Human Phantoms and Monte
Carlo Methods. M. Zankl et al. GSF report 30/91
**Radiation Exposure in Computed Topography,
edited by Hans Dieter Nagel, published by COCIR c/o
ZVEI, Stresemannallee 19, D-60596, Frankfurt, Germany.
44
Dose Information
Effective mAs
In sequential scanning, the dose (Dseq) applied to the
patient is the product of the tube current-time (mAs)
and the CTDIw per mAs:
Dseq = DCTDIw x mAs
In spiral scanning, however, the applied dose (Dspiral) is
influenced by the “classical“ mAs (mA x Rot Time) and
in addition by the Pitch Factor. For example, if a Multislice CT scanner is used, the actual dose applied to the
patient in spiral scanning will be decreased when the
Pitch Factor is larger than 1, and increased when the
Pitch Factor is smaller than 1. Therefore, the dose in
spiral scanning has to be corrected by the Pitch Factor:
Dspiral = (DCTDIw x mA x Rot Time)
Pitch Factor
To make it easier for the users, the concept of the
“effective“ mAs was introduced with the SOMATOM
Multislice scanners.
The effective mAs takes into account the influence of
pitch on both the image quality and dose:
Effective mAs =
mAs
Pitch Factor
To calculate the dose on the SOMATOM Sensation Cardiac, you simply have to multiply the CTDIw per mAs
with the effective mAs of the scan:
Dspiral = DCTDIw x effective mAs
45
Dose Information
For spiral scan protocols, the indicated mAs is the
effective mAs per image. The correlation between tube
current and effective mAs of spiral scans on a Multislice CT scanner is given by the following formula:
Effective mAs = mA x RotTime
Pitch Factor
Pitch Factor = Feed per Rotation
nrow x Slice collimation
mA = effective mAs
RotTime
x Pitch Factor
where Slice collimation refers to the collimation of one
detector row, and nrow is the number of used detector
rows.
46
Dose Information
CARE Dose 4D
CARE Dose 4D is an automatic exposure control which
includes automatic tube current adaptation to the
patient’s size and anatomic shape together with an online controlled tube current modulation for each tube
rotation. This provides well balanced image quality at
low radiation dose levels.
Based on a single a.p. or lateral Topogram CARE Dose
4D determines the adequate tube current level for
every section of the patient. Based on these levels
CARE Dose 4D modulates the tube current on-line during each tube rotation according to the patient’s angular attenuation profile. Thus the best distribution of
dose along the patient’s long axis and for every viewing angle is achieved.
Based on a user defined Image Quality Reference
mAs CARE Dose 4D automatically adapts the (eff.) mAs
to the patient size and attenuation changes within the
scan region. With the setting of the Image Quality
Reference mAs the user may adjust image quality
(image noise) to the diagnostic requirements and the
individual preference of the radiologist.
Note: The Image Quality Reference mAs should not
be adjusted to the individual patient size!
Hint: Position the patient in the center of the scan field
to ensure optimal image quality and minimal dose.
47
Dose Information
How does CARE Dose 4D work?
CARE Dose 4D combines two types of tube current
modulation:
1) Axial tube current modulation:
Based on a single Topogram (a.p. or lateral) the attenuation profile along the patient’s long axis is measured
in direction of the projection and estimated for the perpendicular direction by a sophisticated algorithm.
Attenuation (log)
Lateral
Scan Range
Example of lateral and a.p. attenuation profile evaluated from an a.p. Topogram.
Based on these attenuation profiles axial tube current
profiles (lateral and a.p.) are calculated. The correlation between attenuation and tube current is defined
by an analytical function which results in an optimum
of dose and image noise in every slice of the scan.
48
Dose Information
no
ise
2) Angular tube current modulation:
Based on the above described axial tube current profiles the tube current is modulated during each tube
rotation. Therefore the angular attenuation profile is
measured on-line during the scan and the tube current
is modulated accordingly in real time to achieve an
optimum distribution of the x-ray intensity for every
viewing angle.
im
ag
e
ns
tan
t
co
m
sli
s
a tro
w vera ng
ea g d
k d e d ec rel. tube current
ec ec re
re re as
as as e
e e
se
obe
constant dose
reference attention
Image Quality
reference tube current
se
crea
ng in
e
stro
creas
in
e
g
avera
se
ea
cr
in
Weak
rel. attenuation
Relation between relative attenuation and relative
tube current. The adaptation strength may be
adjusted by user separately for the left branch (slim)
and the right branch (obese) of the curve. This adjustment effects all examinations. The gray lines here
indicates the theoretical limits of the adaptation (constant dose resp. constant image noise). The absolute
(eff.) mAs value is scaled with the Image Reference
mAs value, which may be adjusted in the Scan Card by
the user.
49
Dose Information
Reduced dose level
based on topogram
Real-time angular
dose modulation
x-ray dose
Scan with constant mA
slice position
50
Dose Information
Principle of automatic tube current adaptation by
CARE Dose 4D for a spiral scan from shoulder to pelvis
(very high table feed for demonstration): High tube
current and strong modulation in shoulder and pelvis,
lower tube current and low modulation in abdomen
and thorax. The dotted lines represent the min. and
max. tube current at the corresponding table position
and result from the attenuation profile of the Topogram.
The mAs value displayed in the user interface and in
the patient protocol is the mean (eff.) mAs value for
the scan range.
The mAs value recorded in the images is the local (eff.)
mAs value.
51
Dose Information
Special Modes of CARE Dose 4D
For certain examination protocols CARE Dose 4D uses
limited tube current modulation, to meet specific conditions, e.g.
• for Adult Head protocols the tube current is solely
adapted to the variation along the patient’s long
axis, but not adapted to the angular attenuation profile.
• for Extremities, CARE Vision, syngo Neuro Perfusion
CT, syngo Body Perfusion CT and other special applications only angular tube current modulation is supported.
• for Osteo and Cardio protocols the mAs setting is
adjusted to the patient size and not modulated during the scan.
52
Dose Information
Scanning with CARE Dose 4D
With the settings of Image Quality Reference mAs
properly predefined*, no further adjustment of the
tube current has to be made to perform a scan.
CARE Dose 4D automatically adapts the tube current to
different patient size and anatomic shapes, but it
ignores metal implants.
For an accurate mAs adaptation to the patient’s size
and body shape with CARE Dose 4D the patient should
be carefully centered in the scan field.
When using protocols with CARE Dose 4D for other
than the body regions they are designed for, the image
quality should be carefully evaluated.
As CARE Dose 4D determines the (eff.) mAs for every
slice from the Topogram, a Topogram must be performed to use CARE Dose 4D. For an optimum image
quality the kV setting for the Topogram and the subsequent scans should be identical. The range of the scan
should not exceed the range of the Topogram.
Outside the Topogram range CARE Dose 4D will continue the scan with the last available Topogram information. Without a Topogram CARE Dose 4D cannot be
switched on. Repositioning of the patient and excessive motion of the patient must be avoided between
the Topogram and the scan. If there exist concurrent
valid Topograms for one scan range, the most up-todate one will be used for determining the (eff.) mAs. If
there exist an a.p. and a lateral Topogram for one scan
range, both will be used for determining the (eff.)
mAs.
*For Siemens scan protocols of SW version syngo
CT 2006G, the settings of CARE Dose 4D are already
predefined, but may be changed to meet the customers preference of image quality (image noise).
53
Dose Information
After the Topogram has been scanned the (eff.) mAs
value in the Routine Card and Scan Card displays the
mean (eff.) mAs which was estimated by CARE Dose
4D based on the Topogram*. After the scan has been
performed this value is updated to the mean (eff.) mAs
which were applied. The values may differ because of
the on-line modulation according to the patient’s
angular attenuation profile.
Adjusting the Image Noise
The correlation between attenuation and tube current
is defined by the analytical function described above.
This function may be adjusted to adapt the image quality (image noise) according to the diagnostic requirements and the individual preference of the radiologist.
– To adapt the image noise for a scan protocol the
Image Quality Reference mAs value in the Scan Card
may be adjusted. This value reflects the mean (eff.)
mAs value that the system will use for a reference
patient with that protocol. Thereby the reference
patient is defined as a typical adult, 70 kg to 80 kg or
155 to 180 lbs. (for adult protocols) or as a typical
child, 5 years, appr. 20 kg or 45 lbs. (for child protocols). Based on that value the CARE Dose 4D adapts
the tube current (resp. the mean (eff.) mAs value) to
the individual patient size.
*For the tuning of the CARE Dose 4D parameter setting to individual preference of image quality it is recommended to keep track of this value and to compare it with the values used without CARE Dose 4D.
54
Dose Information
Important note: Do not adapt the Image Quality
Reference mAs for individual patient size. Only
change this value, if you want to adjust image
quality.
• The adaptation strength of CARE Dose 4D may be
influenced for slim or obese patients or body parts of
a patient by changing the CARE Dose 4D settings in
the “Examination Configuration”.
This may be desirable
– if the automatic dose increase for obese patients
(resp. patient sections) should be stronger than the
presetting (choose obese: strong increase), resulting in less image noise and higher dose for those
images.
– if the automatic dose increase for obese patients
(resp. patient sections) should be more moderate
than the presetting (choose obese: weak increase),
resulting in more image noise and lower dose for
those images.
– if the automatic dose decrease for slim patients
(resp. patient sections) should be stronger than the
presetting (choose slim: strong decrease), resulting
in more image noise and lower dose for those
images.
– if the automatic dose decrease for slim patients
(resp. patient sections) should be more moderate
than the presetting (choose slim: weak decrease),
resulting in less image noise and higher dose for
those images.
55
Dose Information
Activating and Deactivating CARE
Dose 4D
CARE Dose 4D may be activated or deactivated for the
current scan in the Scan Card. With CARE Dose 4D activated as default, the Image Quality Reference mAs
value is set to the default value of the protocol. After
deactivating CARE Dose 4D the Image Quality Reference mAs is dimmed and the (eff.) mAs value has to be
adjusted to the individual patient size! If CARE Dose 4D
is switched on again, the Image Quality Reference mAs
is reactivated. Note, that the last setting of the Image
Quality Reference mAs resp. the (eff.) mAs will be
restored, when switching back and forth between
CARE Dose 4D usage. The default activation state of
CARE Dose 4D may be set in the Scan Protocol Manager. CARE Dose 4D must be selected (column CARE
Dose type). The corresponding column for activating
CARE Dose 4D is named CARE Dose (4D), with possible
default on or off.
Conversion of Old Protocols into Protocols with CARE Dose 4D
Protocols of SW versions VA70, VA47 and VA45 may be
converted to CARE Dose 4D in the Scan Protocol Manager.
Prior to activating CARE Dose 4D an Image Quality Reference mAs value has to be set in the corresponding
column.
56
Dose Information
If you are unsure about the correct Image Quality Reference mAs value, follow this simple procedure:
• Enter the (eff.) mAs value used for that type of protocol without CARE Dose 4D.
• When using the protocol for the first time, perform
the Topogram and adjust the Image Quality Reference mAs in the Scan Card prior to the consequent
scan, so that the displayed (eff.) mAs value is about
that value you would have applied for that scan without CARE Dose 4D.
• With that setting perform the first scan and carefully
inspect the image quality. In that first step the dose
may not be lower than without CARE Dose 4D but
will be well adapted to the patient’s attenuation,
resulting in improved image quality.
• Starting from that setting reduce the Image Quality
Reference mAs step by step to meet the necessary
image quality level.
• Store the scan protocol with the adapted Image
Quality Reference mAs.
57
Dose Information
Note: The Image Quality Reference mAs corresponds
to the (eff.) mAs value that the radiologist would apply
for a reference patient without the use of CARE Dose
4D. The reference patient is defined as a typical adult,
70 kg to 80 kg or 155 to 180 lbs. (for adult protocols)
or as a typical child, 5 years, appr. 20kg or 45 lbs. (for
child protocols). After entering the Image Quality Reference mAs the CARE Dose type may be switched from
CARE Dose to CARE Dose 4D in the corresponding column. In the Scan Card the checkbox name will automatically change from CARE Dose to CARE Dose 4D,
the Image Quality Reference mAs will be displayed and
in the Routine Card the comment CARE Dose 4D will
added to the (eff.) mAs value when CARE Dose 4D is
activated.
Note: When using CARE Dose 4D with child protocols,
make sure that all memos in the Chronicle with the correlation between the patient’s weight and the mAs are
deleted! With CARE Dose 4D these memos loose their
meaning because the mAs are automatically adapted
to the patient size. If CARE Dose 4D is switched off
again, the mAs have to be manually adapted to the
patient size. Proposals for mAs settings may be taken
from the application guide.
58
Dose Information
Additional Important Information
For ideal dose application it is very important to position the patient in the isocenter of the gantry.
Example for an a.p. topogram:
X-ray tube
Patient
(centered)
Detector
Patient is positioned in the isocenter – optimal dose
and image quality
X-ray tube
Patient
(not centered)
Detector
Patient is positioned too high – increased mAs
X-ray tube
Patient
(not centered)
Detector
Patient is positioned too low – reduced mAs and
increased noise
59
Dose Information
100kV-Protocols
The system offers a spectrum of four kV settings (80
kV, 100 kV, 120 kV and 140 kV) for individual adaptation of the patient dose in pediatric scans and for optimization of the contrast-to-noise ratio in contrastenhanced CT angiographic studies.
In contrast enhanced studies, such as CT angiographic
examinations, the contrast-to-noise ratio for fixed
patient dose increases with decreasing tube voltage.
As a consequence, to obtain a given contrast-to-noise
ratio, patient dose can be reduced by choosing lower
kV-settings. This effect is even more pronounced for
smaller patient diameters. It can be demonstrated by
phantom measurements using small tubes filled with
diluted contrast agent embedded in plastic phantoms
with different diameters. The iodine contrast-to-noise
ratio for various kV-settings is depicted in fig. 1 as a
function of the phantom diameter. Compared to a
standard scan with 120 kV, the same contrast-to-noise
ratio in a 24 cm phantom, corresponding to a slim
adult, is obtained with 0.5 times the dose for 80 kV
(1.5 times the mAs) and 0.7 times the dose (1.1 times
the mAs) for 100 kV. Ideally, 80 kV should be used for
lowest patient dose. In practice, however, the use of
80 kV for larger patients is limited by the available mAreserves of the X-ray generator.
In these patients, 100 kV is a good compromise and
the preferable choice for CTA examinations.
60
Dose Information
80 kV
Iodine Signal/Noise
100 kV
120 kV
140 kV
Phantom Diameter, cm
Iodine contrast-to-noise ratio as a function of the
phantom diameter for kV-settings at a constant dose
(CTDIw in these phantoms).
61
Dose Information
80 kV
Relative dose, 24 cm 0.49
Relative dose, 16 cm 0.44
Relative mAs setting 150
100 kV
0.69
0.68
110
120 kV
1.0
1.0
100
140 kV
1.49
1.43
100
Table 1: Results of iodine contrast, noise and dose
measurements for different kV settings and phantom
sizes. Relative Dose numbers (CTDIw in the respective
phantom) and mAs settings needed for a certain contrast to noise ratio in the center of the 16 cm and 24
cm plastic phantoms. The required dose for the same
contrast to noise ratio is significantly lower for lower
kV values.
62
Dose Information
63
Workflow Information
WorkStream4D
Recon Jobs
In the Recon card, you can define up to 8 reconstruction jobs for each range with different parameters
either before or after you acquire the data. When you
click on Recon, they will all be done automatically in
the background. In case you want to add more than
8 recon jobs, simply click the icon on the chronicle
with the right mouse button and select delete recon
job to delete the one which has been completed, and
then one more recon job will be available in the Recon
card.
Note: What you delete is just the job from the display,
not the images that have been reconstructed. Once
reconstructed, these completed recon jobs stay in the
browser, until deleted from the local database.
You can also reconstruct images for all scans performed by not selecting any range in the chronicle,
prior to clicking Recon.
Another entry you will find in the right mouse menu is
copy/replace recon parameters. This function is
available for spiral scans only.
The main goal is to support the transfer of volume
parameters between oblique recon jobs of ranges
which cover mainly the same area, e.g., two spiral
scans with/without contrast media.
64
Workflow Information
3D Recon
3D Recon gives you the ability to perform oblique and/
or double oblique reconstructions in any user-defined
direction directly after scanning.
No further post-processing or data loading is needed.
The high-quality SPO (spiral oblique) images are calculated by using the system’s raw data.
Key Features
• Reconstruction of sagittal, coronal and oblique/ double oblique images
• 3 planning images in the 3 standard orientations
(coronal, axial, sagittal)
• Image types for planning MPR thick (10 mm),
MIPthin (3 mm)
• Field of view and reference image definition possible
in each planning segment
• Asynchronous reconstruction (several reconstruction jobs are possible in the background, axial and
non-axial)
• Workstream 4D performs reconstructions on the
basis of CT raw data
• If the raw data are saved you can start the 3D reconstruction either on your Navigator or Wizard console
(optional).
65
Workflow Information
Workflow Description
WorkStream 4D improves your workflow whenever
non-axial images of a CT scan are required, e.g. examinations of the spine.
3D reconstructions are possible:
– spiral scan is needed
– as soon as one scan range is finished and at least one
axial reconstruction job has been performed (RTD or
RTR images).
66
Workflow Information
Select a new recon job and mark Recon Job Type – 3D
on the Recon card. The first recon job that fits for the
3D reconstruction is used as Available planning volumes.
Three planning segments in perpendicular orientations will appear in the upper screen area. You can
choose between MPR thick and MIP thin as image
type via the according buttons.
67
Workflow Information
In each segment you will find a pink rectangle which
represents the boundary of the result images. The
images with the right down marker, represents the
field of view (FoV) of the result images (viewing direction).
Right
down
marker
Reference lines
68
Workflow Information
The rectangle with the grid represents the reference
image (topogram) which is added to the Topogram
series including the reference lines after reconstruction.
Topographics
indicator
Reference lines
Recon area
69
Workflow Information
Preview Image
A preview of the actual FoV is now available.
• After pressing the button Preview Image the actual
FoV to be reconstructed will be displayed.
• Clicking again on the button deactivates the preview
image and displays the whole reference image
again.
• Double clicking into the FoV image activates or deactivates the Preview Image function as well.
If the Preview Image function is active and you move
or rotate the box, or change the recon begin and end
position, the Preview image in the FoV segment will be
updated accordingly.
70
Workflow Information
Depending on the desired result images, choose coronal, sagittal or oblique recon axis.
1. Sagittal/Coronal Reconstructions
If sagittal or coronal axis is selected, the reference lines
can be moved, but not rotated
• Adjust the field of view size to your needs.
• It is only possible to reconstruct images with a
squared matrix.
2. Oblique/Double-oblique Reconstructions
If you want to define the orientation of the result
images independent of the patient’s axis.
• Enable the Free View Mode and rotate the reference
lines in the three segments until the desired image
orientation is displayed. The vertical and horizontal
line are always perpendicular to each other. With the
default orientation button you can reset the image
orientation at any time.
• It is only possible to reconstruct images with a
squared matrix.
• Set the field of view to the active segment by clicking
the Set FoV button. The result images will then be
orientated as in the FoV segment. You can adjust the
extension perpendicular to the field of view can be
adjusted in the same way in the other two segments.
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Workflow Information
To define the Reference Image (Topogram) to the
active segment, click on the Set Reference Segment
button. This defines the orientation of the reference
image which will be added to the result images.
Once you have finished the adjustment start the calculation of the result images by clicking on the Recon
button. Each 3D recon job has to be started separately.
You can start a recon job at any time, independent of
other ongoing jobs (asynchronous reconstruction).
After starting the reconjob the layout of the Examination card changes back to the standard layout.
The progress of the reconstruction is displayed by the
slider in the Tomosegment.
Additional Information
As soon as a new recon range is defined by you, all
recon ranges will be shown in the topo segment. Two
numbers on the right hand side at the beginning of
each recon range, indicate the recon job the range
belongs to. The first number stands for the scan range,
the second one stands for the recon job, where the
range belongs to. If no recon job is in planning, only
the scan ranges are shown in the topo segment. Only
one number on the right hand side at the beginning of
each scan range indicates which scan the range
belongs to.
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Workflow Information
• If the first recon job is saved as an Oblique recon job,
after scanning, RTD images are displayed and the
Examination card is automatically switched to 3D
reconstruction
• Patient Browser:
for each double oblique recon job one series is added
in the Patient Browser.
• If Auto Reference Lines is selected the corresponding reference image is added to the 3D recon series.
• All reconstructions are performed in the background
• Do not use High Resolution images
• Do not use extended FoV
• If no entry is selected in the chronicle all open reconstructions are automatically reconstructed.
• If Autorecon is selected on the Recon card, this
recon job (axial and oblique) is automatically reconstructed after scanning.
Recon Planning
During planning of a 3D recon range, the image displayed in the FoV segment will be updated accordingly
to the new position of the recon begin and end position.
The reference lines displayed in both planning segments are the reference lines to the actual displayed
image in the FoV segment.
One click on the begin or end position of the recon
range displays in the FoV segment, either the reference image to the begin position of the recon range, or
the reference image to the end position of the recon
range.
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Workflow Information
Case Examples
Some scan protocols are delivered with predefined
oblique reconstructions. These protocols are
marked with the suffix “VOL”
• Coronal and sagittal reconstruction of the spine:
– Scan a topogram
– Plan your axial spiral scan range
– Reconstruction of the spiral images (RTR/RTD
images)
– Select Recon job Type sagittal/coronal
– Select the axial image segment
– Press button Set FoV
– Adjust the FoV to your needs
– Define your desired reconstruction parameters
(e.g. image type SPO)
– Start reconstruction
– Repeat the reconstruction steps for the other
orientation (sagittal/coronal)
• Oblique reconstruction of the sinuses:
– Scan a topogram
– Plan your spiral scan range
– Axial reconstruction of the spiral images
(RTR/RTD images)
– Select Recon job Type oblique
– Select the sagittal image segment
– Enable Free Mode
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Workflow Information
– Rotate the reference lines until the best view on
the sinuses is displayed in one of the other segments
– Select this segment and press button Set FoV button
– Adjust the FoV to your needs
– Define your desired reconstruction parameters
(e.g. image type SPO)
– Start reconstruction
• Oblique reconstruction of the vascular tree:
– Scan a topogram
– Plan your spiral scan range
– Axial reconstruction of the spiral images
(RTR/RTD images)
– Select Recon job Type oblique
– Select button MIPThin as image type for the
planning volume on the toolbar
– Enable Free Mode
– Rotate the reference lines until the best view
on the entire vascular tree is displayed in one of
the other segments
– Select the coronal image segment
– Select this segment and press button Set FoV button
– Adjust the FoV to your needs
– Define your desired reconstruction parameters
(e.g. Type MIPthin)
– Start reconstruction
• Double-oblique reconstructions of the heart
For detailed information on heart reconstructions
please refer to your "Heartview" Application Guide.
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Workflow Information
Workflow
Patient Position
A default patient position can be linked and stored to
each scan protocol. The SIEMENS default protocols are
already linked to a default patient position.
(Head first - supine)
If a scan protocol is selected and confirmed in the
Patient Model Dialog, the linked patient position
stays active until the user changes it, even if a scan protocol with different patient position is selected.
Auto Reference Lines
The Auto Reference lines settings defined in the
Patient Model Dialog can be linked and saved to each
scan protocol.
If a scan protocol is selected and confirmed in the
Patient Model Dialog, the linked Auto Reference
lines settings stay active until the user changes it, even
if a scan protocol with different Auto Reference lines
settings are selected.
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Workflow Information
Navigation within the Topogram
Navigation within the topogram helps you to plan a
reconstruction range. The prerequisite to use this is a
scanned range and at least RTD (Real time display)
images being available. After scanning, an orange line
is displayed within the topogram. This line corresponds
to the axial image in the tomo segment.
• If you scroll through the axial image stack, the
orange line in the topogram is displayed as a reference line to the currently displayed axial image in the
tomo segment.
• If you change the reconstruction begin or end, the
orange reference line automatically jumps to this
new position and the axial image in the tomo segment will be updated accordingly to the newly
selected position.
• If you move the whole recon box in the topogram,
the orange reference line automatically jumps to this
new position and the axial image in the tomo segment will be updated accordingly to the newly
selected position.
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Workflow Information
Study Continuation
An existing study can be continued at a later time.
To load an existing study:
• Select the desired study in the Patient Browser.
• Select Register from the Patient drop down menu.
• The patient data is loaded in the Registration dialog.
The previous scan protocol is already preselected, but
it is also possible to select any desired scan protocol.
After the patient is registered, the patient is loaded
into the Examination card.
The already scanned ranges are listed. Between the
already scanned ranges and the new ranges following
chronicle entry is shown: Exam Continue <Patient
Position>.
If you want to continue a contrast media study, the system asks you if the next scan should be continued as a
non contrast scan instead.
• If you want to continue as a non contrast scan, the
chronicle entries for the new scan range is indicated
as a non contrast scan. (No injector symbol is
shown.)
If you continue a study as a contrast study, the chronicle entries of the new scan range are indicated as a
contrast scan. (An injector symbol is shown.)
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Workflow Information
Reconstruction on Wizard
It is possible to start all reconstructions from your satellite console.
• Raw data has to be available in the local database
• Select the raw data series of the patient in the
Patient Browser and load it into the Recon card
• Plan your recon jobs as usual
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Workflow Information
Examination Job Status
You can get an overview of all recon jobs by clicking on
the recon task symbol in the status bar or selecting
Transfer – Examination Job status in the patient
main menu in the Patient Browser.
The Examination Job Status dialog will appear where
all recon jobs (completed, queued and in work) are
listed. You can stop, restart and delete each job by
clicking the according button. To give a selected job a
higher priority click urgent.
The column Type shows you which kind of reconstruction is queued.
Two types are displayed:
– Recon
all recon jobs from the Recon card, either on the
Navigator or the Wizard
– Auto 3D
all 3D reconstructions which you have send via Auto
postprocessing automatically into the 3D Card.
These jobs will be deleted from the job list as soon as
the patient is closed in the 3D card.
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Workflow Information
Auto Load in 3D and Postprocessing
Presets
You can activate the Auto load in 3D function on the
Examination card/Auto Tasking and link it to a recon
job. For example, the 2nd recon job with thinner slice
width in some of the examination protocols. If the
postprocessing type is chosen from the pull down
menu, the reconstructed images will be loaded automatically into the 3D card on the Navigator with the
corresponding postprocessing type.
On the 3D card you have the ability to create Range
Parallel and Radial protocols for Multi-Planar-Reconstruction (MPR) and Thin Maximum-Intensity-Projection (ThinMIP) which can be linked to a special series.
For example, if you always do sagittal MPRs for a Spine
examination, once you load a Spine examination into
the 3D card, select the image type (MPR, MIPthin),
select the orientation and open the Range Parallel
function. Adapt the range settings (Image thickness,
Distance between the images etc.) and hit the link button. From that point on, you have a predefined postprocessing protocol, linked to the series description of
a Spine examination.
The same can be done for VRT presets. In the main
menu, under Type/VRT Definition, you can link VRT
presets with a series description.
81
Workflow Information
Some of the scan protocols, primarily for Angio examinations, are already preset in the protocol with Auto
load in 3D. If you do not prefer to have this preset,
deselect the Auto load in 3D and save your scan protocol.
Some of the scan protocols are preset in the protocol
with links to a postprocessing protocol. If you do not
prefer to have this preset, please delete the Range Parallel preset or overwrite them with your own settings.
82
Workflow Information
83
Workflow Information
Scan Protocol Creation
There are two different ways to modify and create your
scan protocols:
Edit/Save scan protocols
If you want to modify an existing protocol or create a
new one, e.g., you want to have two AbdomenRoutine Protocols with different slice width, we recommend to do this directly on the Examination card.
User-specific scan protocols can be saved with the following basic procedure:
• Register a patient, you can choose any patient position in the Patient Model Dialog.
• Select an existing scan protocol in the Patient Model
Dialog.
• Modify the scan protocol, change parameters, add
new ranges etc. so that the new protocol fits to your
needs.
• Scan your patient as usual.
• Check if all parameters are as you desire.
• Select Edit/Save Scan Protocol in the main menu.
• Select the folder where you want the new protocol to
appear and the scan protocol name in the pop-up
dialog.
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Workflow Information
• You can either use the same name to overwrite the
existing scan protocol, or enter a new name, which
will create a new protocol name and will not alter
any of the existing protocols already stored.
• If you want to save an "old" protocol again, you may
have to adjust the protocol name, if necessary. The
old protocol (with the old name) has to be cancelled
explicitly.
Additional Important Information:
• You can save your scan protocol at any time of the
examination.
• It is recommended that you save your own scan protocol with a new name in order to avoid overwriting
the default scan protocol.
• Do not use special characters in addition, do not
even use any blank spaces. Allowed are all numbers
from 0 to 9, all characters from A to Z and a to z and
explicitly the _ (under-score) but no country-specific
characters, e.g. à, ê, å, ç, ñ.
• Do not rename scan protocol files on Windows level.
This will lead to inconsistencies.
• You can now save your own scan protocols in any
pre-defined folder. The organ characteristics will
belong to the scan protocol, not to the region.
• In the Patient Model Dialog the modified scan protocols are marked with a dot in front of the protocol.
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Workflow Information
Scan Protocol Manager
If you want to modify special parameters for all existing scan protocols or you want to modify the folder
structure we recommend doing this in the Scan Protocol Manager.
Call up Options > Configuration... and click on the
Scan Protocol Manager icon in the configuration
panel. The Scan Protocol Manager is opened and all
protocols are loaded. The multi selection of the rows
works like usual via the left mouse click together with
the Ctrl key.
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Workflow Information
The scan protocol tree:
The scan protocol navigation tree contains all licensed
scan protocols.
The upper tree structure is "user" protocols and the
lower tree structure is default "Siemens" protocols. Following from this the branches are "adult" or "children"
and then in the different anatomical folders as in the
patient model dialog.
• Rename a protocol:
Select a scan protocol with the right mouse button.
Select Rename and enter a new name for the protocol.
87
Workflow Information
• Change one (or more) parameters for all customer
protocols:
Select Edit - Find/Replace. Open the Column list box
and choose the desired parameter. Select a new
function of this parameter in the Function list box.
Under the button next to the function entry you can
choose special selections, e.g., you can in-/decrease
all mAs values by a certain percentage, e.g., 5%.
Select Replace All.
88
Workflow Information
• Define a protocol as Emergency protocol. Select the
desired scan protocol with the right mouse button.
Select entry Set as new emergency protocol. The
selected protocol is marked with a red cross.
– Open the Scan Protocol Manager (Options > Configuration).
– In the Specials folder please mark the protocol
PolyTrauma033s, apply a right mouse click and
select "Set as new emergency protocol". A red
cross will appear in front of the protocol name.
– Save the changes.
From now on the PolyTrauma033s protocol is
used as a default, when selecting the emergency
button in the Patient Registration dialog.
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Workflow Information
• Change the structure of the protocol tree. You can
sort all customers protocols as you want to. Select
the desired protocols, press right mouse button. You
will find the entries:
- Cut/Copy
- Paste.
To change the order of your protocol tree, you can
drag and drop the protocols into the desired position.
Or use the entries Move Up and Move Down from
the right mouse menu to change the sorting of your
protocol tree.
• With the Filter function you can reduce the number
of displayed scan protocols and Recon jobs.
– for reducing the displayed Recon jobs you can
choose between:
All axial Recon jobs
All sagital and coronal Recon jobs
All oblique Recon jobs
– for reducing the displayed scan protocols select
Modified Scan Protocols only
– for displaying all scan protocols and Recon jobs
select: Off.
• Display of actions:
– Invalid protocols or parameters are marked in yellow.
– Changed, but not yet saved protocols and/or
parameters are marked in green.
90
Workflow Information
Table with all possible states of tree nodes
State
Icon
Child protocols
Adult protocols
region
SIEMENS protocol
changed SIEMENS protocol
invalid SIEMENS protocol
USER protocol
changed USER protocol
invalid USER protocol
emergency protocol
scan protocol entry
autorange - start
autorange - middle
autorange - end
recon job
91
Workflow Information
Additional Important Information:
• With the Find/Replace function you can easily insert
an API command for all protocols as needed.
• Also all Auto Tasking actions, e.g., the transfer to
configured network nodes can be set within one
action. Within the Function button you can set your
transfer actions depending on the slice width.
• By sorting the scan protocols, all organ characteristics will belong to the protocol, so it does not matter
which folder you choose.
• For security purposes it is not possible to do any
changes in the Siemens protocols, but you can copy
or drag & drop these protocols into a Customer
folder.
• With the entries Save/Save as/Save all, you can save
your changes.
• You can delete single Recon jobs by selecting the
desired Recon job and choosing Delete from the
context menu.
• Only those Scan protocols that belong to the USER
category can be deleted. Only complete scan protocols can be deleted. It is not possible to delete scan
protocol entries or scan protocol recon jobs.
• The entry Set to defaults in the main menu/ context sensitive menu will reset all your changes to
the Siemens default values.
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Workflow Information
• If there are unsaved scan protocols when closing the
Scan Protocol Manager you will be informed by a
message.
• You can configure the displayed columns and their
position with View configure columns.
Additional Information:
1.System/Run offers the tool Restore Default Scan
Protocols which allows you to remove user specific
scan protocols and to restore the Siemens default
settings.
2.The main menu entry Edit offers Save/Delete Scan
Protocols.
3.System/Run or the main menu entry View in the
Scan Protocol Manager offer the tool List Scan Protocols which generates an HTML table of all available scan protocols. This list can be printed or saved
on Floppy (File/Save As…).
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Workflow Information
Contrast Medium
The Basics
The administration of intravenous (IV) contrast material during spiral scanning improves the tissue characterization and characterization of lesions, as well as the
opacity of vessels. The contrast scan will yield good
results only if the acquisition occurs during the optimal
phase of enhancement in the region of interest. Therefore, it is essential to initiate the acquisition with the
correct start delay. Since multislice spiral CT can provide much faster speed and shorter acquisition time, it
is even more critical to get the right timing to achieve
optimal results.
40 s scan
10 s scan
Longer scan time
Shorter scan time
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Workflow Information
The dynamics of the contrast enhancement is determined by:
•
•
•
•
•
•
Patient cardiac output
Injection rate
Total volume of contrast medium injected
Concentration of the contrast medium
Type of injection – uni-phasic or bi-phasic
Patient pathology
Aortic time-enhancement curves after i.v. contrast
injection (computer simulation*).
All curves are based on the same patient parameters
(male, 60-year-old, 75 kg).
Relative Enhancement [HU]
Relative Enhancement [HU]
* Radiology 1998; 207:647 – 655
Time [s]
Time [s]
4 ml/s,120 ml,
300 mg I/ml
Relative Enhancement [HU]
Relative Enhancement [HU]
2 ml/s,120 ml,
300 mg I/ml
Time [s]
80 ml,4 ml/s,
300 mg I/ml
Time [s]
120 ml4 ml/s,
300 mg I/ml
95
Relative Enhancement [HU]
Relative Enhancement [HU]
[
]
Workflow Information
Time [s]
Uni-phase
140 ml, 4 ml/s,
370 mg I/ml
96
Time [s]
Bi-phase
70 ml, 4 ml/s,
plus 70 ml,
2 ml/s, 370 mg I/ml
Workflow Information
IV Injection*
The administration of a contrast medium depends on
the indication and on the delay times to be used during
the examination. The patients weight and circulatory
situation also play a role. In general, no more than 3 ml
per kg of body weight for adults and 2 ml per kg of
body weight for children should be applied.
For a CTA study (arterial phase), the principle is to keep
the contrast flowing throughout the duration of the
scan. Thus, the total amount of contrast medium
needed should be calculated with the following formula:
CM = (start delay time + scan time) x flow rate.
CARE Bolus or Test Bolus may be used for optimal contrast bolus timing. Please refer to the special protocols.
To achieve optimal results in contrast studies, the use
of CARE Bolus is recommended. In case it is not available, use Test Bolus. Once completed, load images into
Dynamic Evaluation for calculation of Time to Peak
enhancement.
For multiphase examinations, e.g. three-phase liver,
the maximum start delay can be set to 600 sec. The
countdown of the delay always starts after scanning of
the previous phase.
*For more information regarding the general use of
drugs and doses mentioned in this guide, please
refer to page 2.
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Workflow Information
Bolus Tracking
This is an automatic Bolus Tracking program, which
enables triggering of the spiral scanning at the optimal
phase of the contrast enhancement.
Additional Important Information
1.This mode can be applied in combination with any
spiral scanning protocol. Simply insert Bolus Tracking by clicking the right mouse button in the chronicle. This inserts the entire set up including pre-monitoring, i.v. bolus and monitoring scan protocol. You
can also save the entire set up as your own scan protocols.
2.The pre-monitoring scan is used to determine the
position of the monitoring scans. It can be performed at any position of interest. You can also
increase the mAs setting to reduce the image noise
when necessary.
3.To achieve the shortest possible spiral start delay
(2 s), the position of the monitoring scans relative to
the beginning of spiral scan must be optimized.
A snapping function is provided:
– After the Topogram is performed, the predefined spiral scanning range and the optimal monitoring position will be shown.
98
Workflow Information
– If you need to redefine the spiral scanning range,
you should also reposition the monitoring scan in
order to keep the shortest start delay time (2 s). (The
distance between the beginning of the spiral scanning range and the monitoring scan will be the
same).
– Move the monitoring scan line towards the optimal
position and release the mouse button, it will be
snapped automatically. (Trick: if you move the monitoring scan line away from the optimal position the
snapping mechanism will be inactive).
4.Place a ROI in the premonitoring scan on the target
area or vessel used for triggering with one left
mouse click. (The ROI is defined with double circles –
the outer circle is used for easy positioning, and the
inner circle is used for the actual evaluation). You
can also zoom the reference image for easier positioning of the ROI.
5.Set the appropriate trigger threshold, and start contrast injection and monitoring scans at the same
time.
During the monitoring scans, there will be simultaneous display of the relative enhancement of the
target ROI. When the predefined density is reached,
the spiral acquisition will be triggered automatically.
6.You can also initiate the spiral any time during the
monitoring phase manually – either by pressing the
START button or by left mouse clicking the START
radio button. If you do not want to use automatic
triggering, you can set your trigger threshold number extremely high so that it will not trigger automatically, and you can start the spiral when you
desire.
99
Workflow Information
Test Bolus using CARE Bolus
You can use the CARE Bolus option as a Test Bolus.
How to do it
1.Insert a Bolus tracking via the right mouse button
submenue prior to the spiral.
2.Insert contrast from the right mouse button context
menu.
Hint: By inserting contrast you are interrupting the
Auto range function,and therefore an automatic
start of the spiral is not possible!
3.Start with the Topogramm.
4.Position the premonitoring scan and the spiral.
5.Perform the premonitoring scan,position and accept
the ROI.
6.Start monitoring scans and a short amount of contrast (20 ml/2.5 ml/sec.).
Hint: With starting the spiral the system is switching
to the Trigger subtask card. The trigger line is not
shown at this stage.
7.Now you can read the proper delay from the Trigger
card.
8.Insert the delay in the Routine subtask card and load
the spiral.
9.Start spiral and injector with the full amount of contrast.
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Workflow Information
Test Bolus
This is a low dose sequential protocol without table
feed used to calculate the start delay of a spiral scan to
ensure optimal enhancement after the contrast
medium injection. The Dynamic Evaluation function
may be used to generate the time density curve.
You can find the Test Bolus scan protocol in the chapter “Specials“.
How to do it
1.Select the spiral mode that you want to perform, and
then Append the TestBolus mode under Special
protocols.
2.Insert the Test Bolus mode above the spiral mode for
contrast scan by cut/paste (with right mouse button).
3. Perform the Topogram, and define the slice position
for Test Bolus.
4.Check the start delay, number of scans and cycle
time before loading the mode.
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Workflow Information
5.A Test Bolus with 10-20 ml is then administered with
the same flow rate as during the subsequent spiral
scan. Start the contrast media injection and the scan
at the same time.
6. Load the images into the Dynamic Evaluation function and determine the time to the peak enhancement. Alternatively, on the image segment, click
select series with the right mouse button and position an ROI on the first image. This ROI will appear
on all images in the test bolus series. Find the image
with the peak HU value, and calculate the time
“delta t” taken to reach the peak HU value (do not
forget to add the preset start delay time). This time
can then be used as the optimal start delay time for
the spiral scan.
102
Workflow Information
CARE Contrast
With the injector coupling, the bolus injector can now
be connected to your CT scanner.
Key features
• Synchronized scanning and contrast injection
• One button control from the CT-console and from
the injector
– The scan start can be initiated by the injector and
also by the CT scanner, without having to press
both start buttons at the same time.
– The start by the CT can also be done via the foot
switch.
– The start of the CT scanner, including the start
delay can be initiated also by the start button at
the bolus injector.
The injector and the CT have to be coupled explicitly.
You can store protocols where the injector coupling is
selected.
Workflow
To start a contrast enhanced examination in coupled
mode:
• Select the Scan subtask card.
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Workflow Information
• Select under the menu field Scan Start either the
entry Injector coupled (Start button) or the entry
Injector coupled (Footswitch)
– Injector coupled (Start button): The Start button
of the CT scanner will start the injector.
– Injector coupled (Footswitch): The footswitch of
the CT scanner will start the injector.
If an injector is connected, load the scan mode first and
then arm the injector.
Depending on the injector it might be not possible to
arm the injector before the scan protocol is loaded (see
User manual of the injector). When the mode is
loaded, the CT scanner will ask you to check the injector and to arm it. Check the parameters at the injector
side and confirm the parameters. The injector is armed
and ready for the examination.
Note: If the scan mode is unloaded the injector will
also be disabled.
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Workflow Information
After the Injector is armed the scan and the injector
can be started by pressing either the Start button/
Footswitch at the scanner, or the Start button at the
injector panel outside of the scan room or directly at
the injector inside the scan room.
Note: If the Injector is not ready the scan cannot be
started. If both systems are ready to START and the
user disarms the injector, the bubble Check Injector is
shown again.
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Workflow Information
Additional Important Information
• If Coupled Mode is selected the CT checks if there is
an injector available.
The scan mode cannot be loaded if a connection cannot be established or if the injector does not accept
coupling (The injector will not accept coupling while
injecting).
A message appears: Injector is not connected.
• Scanning interrupted
If the injector does not accept the START from the CT
the scan mode is cancelled.
If the scanner is suspended by the user or if technical
problems occur, the injector will be stopped too.
• Injector stopped
If the injector is stopped by the user the scan will be
stopped too.
If the injector is interrupted, by pressing the Hold
button the scan will be continued.
106
Workflow Information
The injector reports a technical problem:
The connection between scanner and injector is interrupted, or the injection was stopped due to technical
problems. In this case the scan continues and an error
message pops up.
The user can decide if he wants to stop the scan or if he
would like to continue.
• If the injection is longer than the CT scan, the CT
scanner does not stop the injection.
A new scan mode can be loaded. If the new mode is
a coupled mode, the scan can only be started if the
injector is ready.
• When a coupled range is pasted or repeated, the
start condition for the new scan is reset to uncoupled.
107
Application Information
SOMATOM LifeNet
General Information
SOMATOM LifeNet is our information and service portal directly at the scanner consoles, the Navigator and
the Wizard. It provides actual news around your scanner, shows helpful configuration information of your
system and enables you to access the SOMATOM
LifeNet online area where you will find further opportunities to ease your daily work.
To benefit from the SOMATOM LifeNet online area, a
Siemens Remote Service connection is required. The
SOMATOM LifeNet online area allows you to order
90 day Trial Licenses for free, download application
guides or find interesting information and services
related to your CT system.
Note: Siemens Remote Service is part of your service
contract and is also prerequisite for other services for
your CT system that optimize your system's availability.
108
Application Information
Key Features
SOMATOM LifeNet offline (All users):
• General Information about your system and configuration
• Access to Web Based E-Training or Manuals on CD
ROM
SOMATOM LifeNet online (In combination with a Siemens Remote Service connection):
• Newsticker archive and FAQ (frequently asked questions) section
• Free trial software order and installation
• Download of information, manuals and scan protocols
• A contact function for an easy and fast interface to
Siemens including the possibility to attach up to two
DICOM images
SOMATOM LifeNet offline
Start SOMATOM LifeNet by selecting SOMATOM
LifeNet under Options in your syngo menu bar and
you will find a browser window that allows you to
access various information about your hard- and software environment.
Under e.g. System Information you will find information such as software version or a scan second counter.
Under Customer Information you can enter your contact data.
109
Application Information
Access to Computer Based E-Training or Manuals on
CD ROM
Start the Web Based E-Training to learn more about
your software and the use of basic and advanced applications.
Note: The syngo Basics Training is pre-installed on your
system and can directly be used by selecting E-Training. The syngo Advanced Application Training can
be downloaded in the SOMATOM LifeNet online area
or is sent to you automatically on CD if trial software is
requested via SOMATOM LifeNet.
110
Application Information
In case a pdf document (e.g., Application Guides) is
not visible in the SOMATOM LifeNet window after
being opened, please minimize or move the Browser
window of the SOMATOM LifeNet platform since it
might be hidden in the background.
Under the navigation path World you can also start
your Operator manual CD ROM.
111
Application Information
SOMATOM LifeNet online
During the start up of your system you will receive upto-date information in the Newsticker and see the
expiration date of installed trial software.
Access the Siemens Extranet by clicking on SOMATOM
LifeNet online. After entering your CT system serial
number you will be forwarded to the information and
service portal. You can find the serial number by
selecting system information in the offline part of
SOMATOM LifeNet.
You will be able to view up to date information and
make use of various services.
112
Application Information
Download of Files
Each download will be performed in the background
and even if you disconnect your SOMATOM LifeNet
online session and start to work with the CT scanner, it
will continue the process until the download is completed. Due to bandwidth restrictions it is only possible
to perform one download at a time.
Note: Depending on your connection speed the download of larger files like e.g. the Advanced Application
Training may take quite some time. Shutting down the
system in between will interrupt the download.
Downloaded PDFs can be found offline under Options/
File Browser/ H:\SiteData/Manuals.
113
Application Information
The Web Based Training is automatically installed after
the download and can be started within the SOMATOM
LifeNet offline section under SOMATOM Educate/ ETraining.
To install all downloaded protocols choose the Scan
Protocol Manager via Options > Configuration and
select Import Scan Protocols in the menu tab Scan
Protocol. To select which protocols you want to import
and which not, a selection box will open and you can
choose the protocols you want to copy in your Customer Folder. These protocols are then ready to use
for your next examination.
All new protocols, including those you did not choose
to import to the Customer Folder will also be stored in
the Siemens Folder so that they can be copied later.
114
Application Information
Note: All downloaded scan protocols are named
"DL_.." so they can be easily identified when mixed
with preinstalled protocols.
Also, see the chapter Scan Protocol Manager for more
information.
115
Application Information
Contact Function
Contacting Siemens via Email is possible directly from
your scanner and even DICOM images can be attached
to your message. To attach an image, please select the
images first on your viewing card and export these
images to H:\SiteDate/ Offline as a Dicom image.
Also, see chapter Export Function for more information.
After exporting the image, open the Siemens Extranet
and choose Contact. After entering your message you
can easily attach the image by selecting the images
from the File Browser with the shortcut CTRL and C and
paste it with the shortcut CTRL and V into the Extranet.
116
Application Information
Note: Every patient image will be made anonymous
before sending. Because the SOMATOM LifeNet window is always in front we recommend to restore/ minimize it to be able to switch between both screens, the
File Browser and the SOMATOM LifeNet window.
Trial Order and Installation
As a SOMATOM CT user you can request trial clinical
software directly from the scanner. The requested software will be provided and installed automatically
through our Siemens Remote Services connection.
117
Application Information
After you have accessed the SOMATOM LifeNet online
area, you can choose system specific trial software
under SOMATOM Expand/Trial Licenses. After clicking on Order Trial and confirming a License Agreement for Trial-Use Software, you need to enter your
contact data. Then submit the license request.
The Trial software will be installed within 8 working
days and you will then be informed about the successful installation via the SOMATOM LifeNet newsticker
window that appears during system start-up.
Note: The trial licenses are valid for 90 days and can
only be ordered once.
118
Application Information
Forwarding Information via Email
This service enables those customers who do not have
a printing device connected to their CT Scanner, but
would like to have the information provided in SOMATOM LifeNet also available on their regular email
account or forward it to a contact person of interest in
form of an email.
Information about current education courses and clinical training programs, as well as CT accessories, can
be sent from the scanner to any email account. This
information can then be printed or a quote requested
from the local Siemens representative.
119
Application Information
Image Converter
The CT Application Common DICOM Adapter provides conversion between different DICOM data sets as
they may be provided by other CT vendors.
– You will find the converter in the Applications menu
of the Patient Browser.
In the pop-up window you can select the application
for which you want to convert the images
120
Application Information
Split-Up Multi-Phase Series
1.Select Split-up series according to trigger delay
from the section Split-up Heartview 4D series, if
you intend to split-up the series of multi-phase heart
reconstruction according to the different heart
phases included.
Or
2.Select Split-up series according to slice position to
split-up the series according to the different slice
positions it contains.
After conversion you can load these data sets into the
application of your choice.
121
Application Information
Report Template
Configuration
Under Options/Configuration you will find the Report
Template Configuration.
With the Report Configuration you can edit the basic
information, e.g. clinic information for your report
templates of the applications:
– CalciumScoring
– Colon
– LungCARE
Additionally you can insert your logo and select which
reference data you want to use.
122
Application Information
File Browser
The File Browser provides you with a secure means of
accessing and managing data in a private folder, which
is a well defined part of the computer file system. This
user partition is strictly separated from the system
operating file system.
The user partition is shared read only and may be used
for transferring data from the scanner to other computers, e.g., transferring DICOM images (export to
offline), transferring AVIs, or accessing files (PDF files)
which were downloaded via SOMATOM LifeNet.
Key Features
•
•
•
•
•
Copy images and files to the CD Burn folder.
Raw data transfer.
Access to all created reports and movies (AVI files).
Access to the offline folder.
Access to downloaded files.
Open the File Browser via main menu entry Options –
File Browser.
The File Browser provides special folders for CT applications. The created reports and movies are saved within
these folders.
With an external PC connected you can access your
offline data on the external PC for post-processing.
123
Application Information
Raw data transfer:
Raw data set can be transferred.
First configure the directory where the raw data should
be transferred to:
• Open the File Browser.
• Choose the desired directory from the navigation
tree to the left of the File Browser.
• Select the item Set as Export Root from the CT Data
Transfer drop down menu.
• Select the raw data files you want to transfer in the
content area of the Patient Browser.
• From the browser open the Patient main menu and
select the item Transfer CT Data.
Transfer files to USB storage device:
• Insert an USB memory device into the USB port.
A new folder is added to the File Browser:
"USB storage device (F:)"
• Select the desired files and send them via the right
mouse button menu to the USB storage device.
Transfer files to floppy:
• Select the desired files and send them via the right
mouse button menu on a floppy disk.
124
Application Information
Burn on CD:
• Do not burn files on CD-R parallel to other transfer
jobs.
• Make sure that the amount of data to be burned
does not exceed the CD-R storage capacity.
• Select the desired files and drag & drop them into the
folder CDBurn (or send them via the right mouse
button menu to the folder CDBurn).
• Open the LocalJobStatus in the Patient Browser and
clear all entries.
• Select Record to Offline in the Transfer menu of the
Patient Browser.
• CD burning starts.
Hint: CD burning of offline files is only possible in a
single session.
After successful burning, the entries in the subdirectory CDBurn will be deleted automatically.
125
Application Information
Review reports and movies:
• Select the desired files and double-click on them.
• The corresponding program, e.g. Movie Media
Player will be opened and you can review what you
have saved.
• You can now send these files to floppy or burn it on
CD.
Additional Important Information:
• Files with the following extensions cannot be
started/ opened from the File Browser
“bat“, “cmd“, “com“, “exe“, “reg“, “dot“, “htm“,
“html“, “pl“, “vbs“, “js“, “wsf“, “wsh“, “xml“.
• To store avi files from the File Browser to any external
storage device, e.g. CD, or USB stick use RMB menu
Send to. Drag&drop and copy/paste to any storage
device is not possible within the File Browser.
126
Application Information
Camtasia
Camtasia is a separate software tool that allows you to
film your desktop activities. You can save these recordings as avi files for documentation and presentation
purposes.
Key features
• Camtasia Recorder: to capture avi files.
Before starting recording you can select the area you
want to capture.
• Camtasia Player: to play avi files
• Camtasia Producer: to edit avi files
To open the Camtasia tool, select in the main menu
Application > Desktop > Camtasia Recorder.
127
Application Information
Under Tools > Options you can define special settings
for recording:
• AVI – to define Video and Audio options
• File – to define the output options (files and folders)
• Hotkeys – to define special hotkeys, e.g. for start/
stop recording
• Live – to define live source options
• Program – to define capture options
128
Application Information
The Effects Options dialog allows you to set options
for your recording, e.g. cursor effects.
129
Application Information
Additional Important Information
• To store avi files from the file browser to any external
storage device, e.g. CD, or USB stick use RMB menu
Send to. Drag&drop and copy/paste to any storage
device is not possible within the File Browser.
• To display the main menu, set ToggleView - Compact.
• AVI files can only be played on the Wizard.
• For further information on how to operate the
Camtasia tool, please refer to the Help menu.
130
Application Information
Patient Protocol
Scan:
kV:
mAs:
ref. mAs
TI:
cSL:
number of scan range
kilo Volt
averaged applied mAs of the range
quality ref. mAs of the range
Rotation Time
collimated Slice
CTDIvol:
CTDIW
Pitch Factor
DLP:
For further information please refer to
the chapter “Dose Information“.
Dose Length Product
CTDIvol x (length + collimated slice)
10
Total DLP
Total mAs
DLP value of the entire examination
actual mAs value of the entire
examination
131
HeartView CT
Heart Anatomy
HeartView CT is a clinical application package specifically tailored to cardiovascular CT studies.
Important Anatomical Structures of the Heart
Four chambers:
• Right atrium – receives the deoxygenated blood
from the body circulation through the superior and
inferior vena cava, and pumps it into the right ventricle.
• Right ventricle – receives the deoxygenated blood
from the right atrium, and pumps it into the pulmonary circulation through the pulmonary arteries.
• Left atrium – receives the oxygenated blood from
the pulmonary circulation through the pulmonary
veins, and pumps it into the left ventricle.
• Left ventricle – receives the oxygenated blood from
the left atrium, and pumps it into the body circulation through the aorta.
132
HeartView CT
Blood fills both atria
Atria contract, blood enters
ventricles
Ventricles contract, blood
enters into aorta and pulmonary arteries
A:
P:
RV:
LV:
RA:
LA:
Aorta
Pulmonary Artery
Right Ventricle
Left Ventricle
Right Atrium
Left Atrium
133
HeartView CT
Coronary arteries:
• Right coronary artery (RCA)
Right coronary artery supplies blood to the right
atrium, right ventricle, and a small part of the ventricular septum:
Front view
Conventional
Angiography
134
SVC:
Superior Vena Cava
IVC:
Inferior Vena Cava
RA:
Right Atrium
RV:
Right Ventricle
A:
Aorta
PA:
Pulmonary Artery
HeartView CT
• Left coronary artery (LCA)
Left coronary artery supplies blood to the left
atrium, left ventricle and a large part of the ventricular septum.
Front view
Conventional
Angiography
LM:
Left Main Artery
LAD:
Left Anterior
Descending Artery
Cx:
Circumflex Artery
135
HeartView CT
Placement of ECG Electrodes
The correct placement of the ECG electrodes is essential in order to receive a clear ECG signal with marked
R-Waves. Incorrect placement of the electrodes will
result in an unstable ECG signal which is sensitive to
movements of the patient during the scan.
US Version (AHA standard)
White Electrode:
on the right mid-clavicular line, directly below the clavicle
Black Electrode:
on the left mid-clavicular line, 6th or 7th intercostal
space
Red Electrode:
right mid-clavicular line, 6th or 7th intercostal space
136
HeartView CT
Europe Version (IEC standard)
Red Electrode
on the right mid-clavicular line, directly below the
clavicle
Yellow Electrode:
on the left mid-clavicular line, 6th or 7th intercostal
space
Black Electrode:
right mid-clavicular line, 6th or 7th intercostal space
137
HeartView CT
Cardiac Scanning
Cardiac Cycle and ECG
The heart contracts when pumping blood and rests
when receiving blood. This activity and lack of activity
from a cardiac cycle can be illustrated by an Electrocardiograph (ECG).
Ventricular Contraction
Systolic phase
Ventricular
relaxation
Atrial contraction
Diagnostic phase
To minimize motion artifacts in cardiac images, two
requirements are mandatory for a CT system:
• Fast gantry rotation to minimize the time it takes to
acquire the necessary scan data to reconstruct an
image.
• Prospective triggering of image acquisition in a
sequential mode or retrospective gating of image
reconstruction in a spiral mode based on the ECG
recording in order to obtain images during the diastolic phase when the least amount of cardiac motion
occurs.
138
HeartView CT
Temporal Resolution
Temporal resolution, also called time resolution, represents the time window of the data that is used for
image reconstruction. It is essential for cardiac CT
imaging. The higher the temporal resolution, the
fewer the motion artifacts. With the SOMATOM Sensation Cardiac, for example, temporal resolution down to
83 ms (depending on the scanner) can be achieved.
Technical Principles
Basically, there are two different technical approaches
for cardiac CT acquisition:
• Prospectively ECG-triggered sequential scanning.
• Retrospectively ECG-gated spiral scanning.
In both cases, an ECG is recorded and used to either initiate prospective image acquisition (ECG triggering), or
to perform retrospective image reconstruction (ECG
gating). Only scan data acquired in a user-selectable
phase of the cardiac cycle is used for image reconstruction. The temporal relation of the image data interval
relative to the R-waves is predefined, which can be
either relative (given as a certain percentage of the RRinterval time) or absolute (given in ms) and either forward or reverse.
139
ECG (t)
HeartView CT
Scan/
Recon
Time
ECG (t)
Relative – delay: a given percentage of R-R interval relative to the onset of the previous R-wave.
Scan/
Recon
Time
Relative – delay: a given percentage of R-R interval relative to the onset of the next R-wave.
140
ECG (t)
HeartView CT
Scan/
Recon
Time
Absolute – delay: a fixed time delay after the onset of
the R-wave.
ECG (t)
Estimated
R-Peak
Scan/
Recon
Time
Absolute – reverse: a fixed time delay prior to the onset
of the next R-wave.
141
HeartView CT
Prospective ECG Triggering Versus Retrospective ECG Gating
With prospective ECG triggering, the heart volume is
covered in a "step-and-shoot" technique. The patient’s
ECG signal is used to start sequential scans with a predefined offset to the R-waves of the patient’s ECG.
With retrospective ECG gating, the heart volume is covered continuously by a spiral scan. The patient’s ECG
signal is recorded simultaneously to allow a retrospective selection of the data segments used for image
reconstruction. Prospective ECG triggering has the
benefit of smaller patient dose than ECG-gated spiral
scanning, since scan data is acquired in the previously
selected heart phases only. It does not, however provide continuous volume coverage with overlapping
slices and mis-registration of anatomical details may
occur. Furthermore, reconstruction of images in different phases of the cardiac cycle for functional evaluation is not possible using Prospective Triggering technique. Since ECG triggered sequential scanning
depends on a reliable prediction of the patient’s next
RR-interval by using the mean of the preceeding RRintervals, the method should not be used for patients
with arrhythmia and irregular heart rates. To maintain
the benefits of ECG-gated spiral CT but reduce patient
dose, ECG-controlled dose-modulation is available.
142
HeartView CT
Preview Series
A Heart View preview series contains images at the
same slice position and of different phases of the cardiac cycle (Phase Start). The phase interval and the
number of images can be configured in the HeartView
configuration. The slice position is determined by
selecting the appropriate image in the right segment.
The preview series is used to determine the Phase Start
for ED and ES.
• For an overview, reconstruct a series at an arbitrary
heart phase. A default value of 60% relative gating
can be used as an initial set-up for the overview
series.
• Select an appropriate slice position (e.g. middle part
of RCA) for the preview series in the 2nd segment.
• Switch to the Trigger tabcard.
• Select Phase Start 0 % to reconstruct images in %
steps.
143
HeartView CT
The preview series should be used to define the optimal time window for image reconstruction in ECGgated spiral scanning, before the full series is reconstructed.
A default value of 60% relative gating (or -400 ms
absolute reverse gating) can be used as an initial set up
for the optimization process which is best performed
as follows:
• Select an image level displaying the mid RCA.
• Choose 60% (or -400 ms) reconstruction phase setting.
• Reconstruct a preview series at this level of the RCA
by clicking on the Preview Series button in the Trigger tabcard: a series of images with different phase
settings at the selected anatomical level of the RCA
will be reconstructed.
• Choose the image with least motion artifacts.
• Reconstruct the whole data set with the phase setting you selected. Please note that you have to enter
this phase setting manually in the Trigger tabcard.
An example for a preview series at the correct anatomical level with optimal and sub-optimal selection of the
phase setting is shown below. Usually this procedure
results in good image quality for the right and the left
coronary artery, especially at higher and inconsistent
heart rates individual optimization for left and right
coronary artery may be necessary. In most cases, the
RCA requires an earlier phase in the cardiac cycle to
obtain the period of least motion, e.g. RCA at 40%, LAD
at 60%.
144
HeartView CT
Determine ED and ES
ES: end systolic, maximum contraction of the myocardium, smallest left ventricular lumen.
ED: end diastolic, minimum contraction.
Use graphics tools (zoom & pan) to enlarge the image,
switch between images to select ES and ED. It is also
helpful to use the distance tool to find the images with
maximum and minimum myocardial contraction. If ED
or ES cannot be clearly determined because there are
two adjacent images with the same contraction, use
the phase in between.
Scan box
145
HeartView CT
• Start the preview series reconstruction at a time
point over or just before the T-wave (end ventricular
systole). The settings should be sufficient to cover
the cardiac cycle up to the R-wave (end ventricular
diastole).
• Determine ED and ES on the Test Series ES: end systolic, maximum contraction of the myocardium,
smallest left ventricular lumen. ED: end diastolic,
minimum contraction. Use graphics tools (zoom &
pan) to enlarge the image, switch between images
to select ES and ED. It is also helpful to use the distance tool to find the images with maximum and
minimum myocardial contraction. If ED or ES cannot
be clearly determined because there are two adjacent images with the same contraction, use the
phase in between.
• Reconstruction of two full axial image series with the
time-points for ES and ED determined from the test
series.
• Press Preview Series button.
• A preview series will be reconstructed.
146
HeartView CT
Hint
• Do not enter any comments on the 2nd comment line
which is reserved for labeling of the cardiac phase
and heart rate in beats per minute (bpm).
Example of a preview series at the correct anatomical
level (mid RCA), demonstrating the importance of
optimized phase setting. Patient with an average
heart rate of 63 bpm.
Left: 57%, mid: 61%, right: 65% relative delay.
The image at 61% relative delay shows the least
motion artifacts. In this example, even a slight change
of the phase setting from 61% to 65% deteriorates
image quality.
147
HeartView CT
ECG Trace Editor
The ECG trace editor is used to modify the ECG signal.
This editing tool is available after spiral scan data has
been acquired. By using the right mouse menu on the
Trigger tabcard you have access to several modification tools for the ECG Sync, such as Delete, Disable,
Insert. In patients with only single or few extra-systolic
beats overall image quality may be improved by editing the ECG prior to reconstruction. Deleting the corresponding R-peaks prevents image reconstruction in
the extra-systolic heart periods. Please keep in mind
that absolute gating (in ms) must be chosen if R-peaks
are deleted. Although ECG-gated spiral scanning is less
sensitive to variable heart rates than ECG-triggered
sequential scanning, the examination of patients with
complex arrhythmia that results in unpredictable variations of the RR-intervals (e.g. complex ventricular
arrhythmia or multiple extra beats) can result in limited image quality and should be performed in exceptional cases only.
148
HeartView CT
ECG Pulsing
ECG pulsing is a dedicated technique used for online
dose modulation in ECG-gated spiral scanning. During
the spiral scan, the output of the X-ray tube is modulated according to the patient’s ECG. It is kept at its
nominal value during a user-defined phase of the cardiac cycle, in general the mid to end diastolic phase.
During the resting phase of the cardiac cycle, the tube
output is reduced to 20% of its nominal value. The
length of the plateau with full dose is 500 ms, which is
sufficient to retrospectively shift the image reconstruction interval for individual patient fine-tuning of the
image reconstruction phase. When properly placed in
the cardiac cycle this plateau length allows for a sufficient phase shift of the reconstruction box to cover
both end-systolic and diastolic reconstructions. The
tube current is reduced and not switched off to allow
for image reconstruction throughout the entire cardiac
cycle. Even though their signal-to-noise ratio is
decreased, the low-dose images are sufficient for functional evaluation. Clinical studies have demonstrated
dose reduction of up to 50% depending on the
patient’s heart rate using ECG pulsing. ECG pulsing
can be switched on/off by you on the Trigger tabcard.
When using ECG pulsing, the desired reconstruction
phase has to be estimated and entered into the Trigger
tabcard prior to scanning, since it determines the time
interval of maximum dose. ECG pulsing should not be
used for patients with irregular heart rates and
arrhythmia.
149
HeartView CT
Dose modulation with ECG pulsing
The width of the ECG pulsing window depends on the
rotation time.
Rotation time
0.37 s/ 375 ms
0.42 s/ 420 ms
0.5 s/ 500 ms
150
ECG pulsing
360 ms
420 ms
450 ms
HeartView CT
ACV on/off
On the Trigger tabcard, ACV (Adaptive Cardio Volume
reconstruction) can be switched on/off by you. With
ACV off, single segment reconstruction is performed
for all heart rates. Data acquired in one heart cycle is
used for the reconstruction of each image, and the
temporal resolution is independent of the heart rate.
Example: The temporal resolution is 187 ms for 0.37 s
gantry rotation time. With ACV on, the system automatically switches between single segment and two
segment reconstruction depending on the patient’s
heart rate. For heart rates below 65 bpm at 0.37 s gantry rotation time, single segment reconstruction is performed. For heart rates exceeding 65 bpm, two segment reconstruction is performed, using scan data
acquired in two subsequent heart cycles to improve
temporal resolution. With ACV on, temporal resolution
is constant for heart rates below 65 bpm (94 ms for
0.37 s gantry rotation time).
Temporal resolution as a function of the patient’s heart
rate is shown in the figure below. We recommend
switching ACV on.
151
HeartView CT
temporal resolution / ms
Temporal resolution at different rotation speeds
heart rate in bpm
Temporal resolution as a function of the patient’s
heart rate for 0.37 s, 0.42 s gantry rotation time.
152
HeartView CT
Synthetic Trigger
By default, the Synthetic Trigger (ECG-triggered scanning) or Synthetic Sync (ECG-gated scanning) is activated for all predefined cardiac scan protocols. It is recommended to always keep it activated for
examinations with contrast medium.
In case of ECG signal loss during the acquisition, this
will ensure the continuation of the triggered scans or
allows an ECG to be simulated for retrospective gating.
If it is deactivated, the scanning will be aborted in case
of ECG signal loss during the acquisition.
153
HeartView CT
Cardiac Reconstruction
Axial Images
Reconstruction of axial images during the examination
are used for filming/archiving and for post-processing.
A. Filming and Archiving
Use a thicker slice thickness and recon increment for
filming and archiving of the images, e.g. 3 mm slice
thickness and 3 mm increment, to produce less
images.
You can send this recon job via the Auto Tasking tabcard directly to the filmsheet or archiving node.
B. Calcium Scoring Postprocessing
Use a thicker slice thickness and a smaller recon increment to load the images afterwards in the application
syngo Calcium Scoring, e.g. 3 mm slice thickness and
1.5 mm increment.
C. 3D Postprocessing
Use a thinner slice thickness and recon increment for
post-processing of the images, e.g. 1.0 mm slice thickness and 0.7 mm increment. These images are used for
post-processing on the 3D card or with syngo
InSpace4D.
You can select different image types, e.g. MIP or VRT to
get the best view of the coronary arteries.
154
HeartView CT
3D card
syngo InSpace
155
HeartView CT
Double-Oblique Images
Reconstruction of double-oblique images are used for
post-processing.
If you want to use short axis images of the heart, there
are different possibilities to create them:
• During scanning
You can reconstruct short axis spiral oblique (SPO)
images in different heart phases directly during the
examination.
• After scanning
1.If you have saved the raw data of the Cardio scan:
You can reconstruct short axis spiral oblique (SPO)
images in different heart phases by loading the raw
data in the Examination card of your Navigator, or
you can also load the raw data in the reconstruction
card of your Wizard (optional) console.
2.After reconstruction of different axial heart phases,
you can reconstruct short axis MPR images on the 3D
card.
156
HeartView CT
Short Axis Images
Short axis reconstruction on the Examination or
Recon card:
Select
• Recon axis – oblique
• Image type – spiral oblique (SPO)
• Enable Button – FreeMode
MPR
Thick
MIP Thin Toggle FoV: Set FoV Preview
for selected image
Free Mode:
• Off: You can navigate through the volume by moving the reference lines.
The FoV does not move.
• On: The reference lines can be rotated to obtain
oblique/double-oblique views.
Select the coronal view, rotate the sagittal line to the
level of the heart valve and the sulcus.
Number of images = 10
Distance between images = 8 mm
Slice Thickness = 8 mm
157
HeartView CT
Multiphase Reconstruction
Select a new recon job on the Recon card:
Select the Multiphase button on the Trigger tabcard.
With a right mouse click on the Multiphase button you
can open the HeartView Configuration window.
158
HeartView CT
159
HeartView CT
Three different Multiphase settings are possible:
1.Protocol
displays the settings for the selected scan protocol.
2.Auto
You can define the heart phase settings with a regular interval in between, e.g. for an Argus movie.
3.Manual
You can define the irregular heart phase settings
with an interval, e.g. to calculate the ejection fraction.
All choices are available for % or ms.
160
HeartView CT
Reconstruction Examples
1.Reconstruction of the whole cardiac cycle, e.g. to
create a movie in syngo ARGUS:
Select Multiphase settings: Auto and choose %
values.
Enter "10" as Start and "100" as Stop.
Select "10" as Interval.
As result you will get 10 series with the heart phases:
10%, 20%, 30%, 40%, 50%, 60%, 70%, 80%, 90%,
100%.
2.Reconstruction of irregular heart phases, e.g. for the
ejection fraction:
Select Multiphase settings: Manual and choose %
values.
Enter "20" for the reconstruction of the ES (maximum
left ventricular lumen) and "80" for the reconstruction
of the ED (minimum left ventricular lumen).
As result you will get 2 series with the heart phases:
20% and 80%.
161
HeartView CT
3.Reconstruction of irregular heart phases, e.g. for the
best display of the coronary arteries:
LAO:
Select Multiphase settings: Manual and choose %
values.
Enter "50" "52" "55" "58" "60" to find out the best display of the LAO view.
As result you will get 5 series with the heart phases:
50%, 52%, 55%, 58%, 60%.
If you want to create your own multiphase recon job in
a cardio scan protocol:
Define either an auto or a manual setting, than select
the Multiphase settings – Protocol. Press button
Apply, close the window with OK. Then you can save
the scan protocol as usual and the selected recon job
will always be reconstructed using a multiphase.
Hints:
• To get a constant image quality for the Multiphase
reconstruction we recommend turning ECG pulsing
OFF.
• If you are not sure which heart phases are the best
one for the Multiphase reconstruction, perform a
preview series first.
• Press Recon button for each 3D reconstruction.
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HeartView CT
163
HeartView CT
Cardiac Postprocessing on the
3D Card
Reconstruction of the Short Heart Axis
• Load the first (ED) series into 3D card
• Adjust the reference plane to obtain short-axis views
of the heart
• Press button for parallel ranges
Recommended parameters:
Image thickness: 8 mm
Distance between images: 8 mm
Number of images: ~13 (adjust to cover ventricles)
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HeartView CT
• You must save this MPR range as a preset (Short-axis)
for subsequent reformatting of other time series.
• You may link one preset to the series description. By
doing this, the preset will be applied automatically
when the next series is loaded into MPR Ranges.
• Save the MPR series with a sensible description such
as Short Axis, 25%.
• Repeat the procedure with the next series.
Hint: Do not change any parameters for the MPR
ranges. Otherwise, syngo Argus is not able to sort the
images correctly.
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HeartView CT
Auto Load in 3D and Postprocessing
Presets
You can activate the Auto load in 3D function on the
Examination card/Auto Tasking and link it to a recon
job, e.g. the 2nd recon job with thinner slice width in
some of the examination protocols. If the post-processing type is chosen from the pull down menu, the
reconstructed images will be loaded automatically into
the 3D card on the Navigator with the corresponding
postprocessing type.
On the 3D card you have the ability to create Range
Parallel and Radial protocols for Multi-Planar-Reconstruction (MPR) and Thin Maximum-Intensity-Projection (MIP Thin), which can be linked to a special series.
For example, if you always do sagittal Multiplanar
reconstructions for a Spine examination, once you
load a Spine examination into the 3D card, select the
image type (MPR, MIP Thin), select the orientation and
open the parallel ranges function. Adapt the range
settings (image thickness, distance between the
images etc.) and hit the link button. From that point
on, you have a predefined postprocessing protocol,
linked to the series description of a Spine examination.
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HeartView CT
The same can be done for VRT presets. In the main
menu, under Type > VRT Definition, you can link VRT
presets with a series description.
Some of the scan protocols, primarily for Angio examinations, are already preset in the protocol with Auto
load in 3D. If you prefer not to use this preset, deselect
the Auto load in 3D and save your scan protocol.
Some of the scan protocols are preset in the protocol
with links to a postprocessing protocol. If you prefer
not to use this preset, please delete the parallel
ranges preset or overwrite them with your own settings.
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syngo Calcium Scoring
Scanning
This application is used for identification and quantification of calcified lesions in the coronary arteries.
It can be performed with both Prospective ECG triggering (sequential scanning) and Retrospective gating
(spiral scanning) techniques. The following scan protocols are predefined:
• CaScoreRoutine
– Spiral Protocol using a rotation time of 0.42 s
• CaScoreFast037s
– Spiral Protocol using a rotation time of 0.37 s
• CaScoreSeq
– Sequential scan protocol with ECG triggering
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Hints in General
• Kernel B35 is dedicated to calcium scoring studies,
providing the most accurate determination of the
HU-value of small calcified lesions. To ensure the
optimal image quality and correlation to known reference data, other kernels are not recommended.
• Use the ECG-triggered protocol for low-dose scanning except for patients with arrhythmia. Use the
ECG-gated protocol when accuracy and/or reproducibility are essential, e.g. for follow-up studies of calcium scoring.
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syngo Calcium Scoring
CaScoreRoutine
Indications:
This is a spiral scanning protocol for coronary calcium
scoring studies.
A typical scan range of 15 cm will be covered in
10.22 sec.
Topogram:
AP, 512 mm.
From the carina to
the apex of the heart.
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kV
Effective mAs/
Quality ref. mAs
Rotation Time
Acquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
Temp. resolution*
CTDIVol
Effective dose
CaSc
120
150
0.42 sec.
16 x 1.5 mm
1.5 mm
3.0 mm
6.7 mm
0.28
1.5 mm
B35f
up to 105 ms
10.5 mGy
Male: 3.47 mSv
Female: 4.36 mSv
* depends on heart rate
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CaScore037s
Indications:
This is a spiral scanning protocol, using an ECG gating
technique and a rotation time of 0.37 s for coronary
calcium scoring studies.
A typical scan range of 15 cm will be covered in
10.13 sec.
Topogram:
AP, 512 mm.
From the carina to
the apex of the heart.
kV
Effective mAs/
Quality ref. mAs
Rotation Time
Acquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
Temp. resolution*
CTDIVol
Effective dose
* depends on heart rate
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CaSc
120
170
0.37 sec.
16 x 1.5 mm
1.5 mm
3.0 mm
6.0 mm
0.25
1.5 mm
B35f
up to 94 ms
11.9 mGy
Male: 3.93 mSv
Female: 4.94 mSv
syngo Calcium Scoring
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syngo Calcium Scoring
CaScoreSeq
Indications:
This is a sequential scanning protocol with ECG triggering for coronary calcium scoring studies.
A scan range is predefined with 15.9 cm.
Topogram:
AP, 512 mm.
From the carina to
the apex of the heart.
kV
mAs/
Quality ref. mAs
Rotation Time
Acquisition
Slice collimation
Slice width
Feed/Scan
Kernel
Temp. resolution*
CTDIVol
Effective dose
* depends on heart rate
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CaScoreSeq
120
35
0.37 sec.
12 x 1.5 mm
1.5 mm
3.0 mm
18.0 mm
B35f
up to 185 ms
2.5 mGy
Male: 0.71 mSv
Female: 0.97 mSv
syngo Calcium Scoring
If you apply API for image acquisition, please make
sure that the breathhold interval in the Patient Model
Dialog is longer than the total scan time, e.g. 50 sec.,
otherwise the image acquisition will be interrupted by
the default breathhold interval. This does not apply
when API is not activated.
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syngo Calcium Scoring
Postprocessing
syngo Calcium Scoring is an evaluation software used
for quantification of calcified coronary lesions.
The data is based on a low dose acquisition with either
an ECG-triggered Sequence or a retrospectively gated
Spiral.
• Evaluation on a separate syngo task card on the user
interface.
• Scoring is facilitated with selection and automatic
growing tools for definition of lesions in the main
coronary branches (RCA, LM, LAD, CX).
• Freehand ROI definition of lesions in addition to the
seeding method.
• 3D Edit for separation and modification of lesions
within a defined volume (depth in mm), and on 2Dslices possible.
• Correlated image display in different planes using
Maximum Intensity Projection (MIP) and Multi Planar
Reformats (MPR).
• Blow-up display for easier identification of small
lesions.
• Default threshold of 130 HU for score calculation can
be modified.
• Online display of results in a separate segment:
– Interpolated Volume (in mm3).
– Calcium mass (mg Calcium Hydroxyapatite).
– Score (Agatston method).
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syngo Calcium Scoring
• Generation of HTML report including site specific
information, free text and clinical images, and saving
on floppy disk and/or printing.
• Interface to user-defined reference table can be used
for risk stratification and the corresponding risk percentile information can be included in the report.
• Printing of results on laser film, paper printer or saving into database.
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syngo Calcium Scoring
Prerequisites
To achieve standardization of the evaluation results
the image material must meet the following requirements:
• Only images of one patient must be loaded for
syngo Calcium Scoring evaluation.
• The scans must have been acquired without gantry
tilt (gantry tilt = 0).
• Only original image material must be used that has
neither been edited with 2D tools in the Viewing
task card e.g., Zoom&Pan nor with 3D tools in 3D
e.g., curved mode.
• Only image data sets with the same slice orientation
must be used.
• Only contiguously scanned and reconstructed
sequence or spiral data sets with identical slice distances and identical thickness must be evaluated.
• The slices must have been scanned at different table
positions.
• The data capacity of the volume must not exceed
1024 images with a matrix size of 512 x 512 pixels.
• Only studies without contrast medium must be
used.
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syngo Calcium Scoring
General Workflow
1. Loading the Images
After loading the images into Calcium Scoring the following layout is displayed:
The loaded images are displayed in the following projection modes:
1.Tomo segment:
Current slice in transaxial projection (caudo-cranial
direction)
2.Overview segment:
Sliding MIP mode in caudo-cranial projection (can be
changed to MIP or MPR, but will always be the reconstructed volume in transaxial projection – entire calcium detection)
3.Detail segment:
MPR mode in coronal projection (can be changed to
MIP or MIP Thin and from coronal to sagittal)
4.Result segment
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2. Evaluating Coronary Lesions
– Screening loaded images for coronary lesions with
significantly increased calcification.
– Marking the detected lesions in the tomogram.
– Editing the coronary lesions in 3D or 2D.
2.1. Screening
After loading the CT images, you can
– scroll through
– zoom
– change window for better display.
In the images of your Calcium Scoring examination all
structures with calcium values above the set threshold
value are displayed in color.
Before you start to identify coronary arteries and specific coronary lesions you should optimize the threshold settings.
Initially, the threshold value is set to a default value of
130 HU which is an empirical value. However, you can
freely configure this value yourself.
Hint: If you change the threshold value during Calcium
Scoring evaluation you will lose all the evaluation
results you have obtained so far.
If you have already performed a Calcium Scoring evaluation for a particular patient and then changed the
threshold values, those evaluation results are no
longer valid. You will then have to repeat the Calcium
Scoring evaluation for that patient.
By browsing through the axial image stack and viewing
the MIP Thin, MIP or the MPR reconstruction, you can
quickly locate suspected calcification in any of the 4
major coronary arteries.
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syngo Calcium Scoring
Hint: Once you have identified calcium plaques in the
coronary arteries you improve the image display in
both the overview and the detail segment by switching
back to the MIP Thin projection.
2.2 Marking
For easier selection when modifying and deleting calcifications, enlarge the images.
Evaluation with Calcium Scoring is based on automatic
determination of the amount of calcium in the
detected coronary lesions. Evaluation must therefore
be preceded by precise marking of the lesions in the
individual coronary arteries.
To mark calcifications, you have to edit the images in
segment 1. Calcium Scoring offers 2 methods for
marking:
– Set seed points for region growing (connected anatomic structures above the given threshold are filled
and marked with selection lesion).
– Draw a freehand ROI around a lesion.
After you have pressed Pick Lesion or Freehand ROI
button, the Artery Labels dialog box is displayed.
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syngo Calcium Scoring
1
2
3
4
5
6
Artery Labels on the Floating Palette
1.LM stands for the common branch of the left coronary artery, left main (A. coronaria sinistra).
2.LAD stands for the anterior branch of the left coronary artery, left anterior descending (A. coronaria
sinistra, R. interventricularus anterior).
3.CX stands for the circumflex branch of the left coronary artery (A. coronaria sinistra, R. circumflexus).
4.RCA stands for the right coronary artery (A. coronaria dextra).
5.Allows you to assign the marking Other to a lesion
which does not pertain to the coronary arteries.
Lesions to which this marking is assigned are not
included in the evaluation but merely highlighted.
6.Allows you to delete a marking that was not correctly
assigned.
Continue browsing through the data and mark all
other lesions. After checking the lesions (into the
depth of the volume) you can correct them if necessary.
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2.3 Editing
You can include the entire volume of adjacent pixels of
a calcification by marking the detected lesions with 3D
Region Growing.
As a result of 3D region growing calcifications of an
artery (e.g., LM) may be assigned wrong markings
(e.g., LAD) and may be evaluated as a single lesion due
the close proximity to that artery.
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syngo Calcium Scoring
You can now edit such a lesion by scrolling to the corresponding slice and splitting it into several parts and
assigning the marked parts to the corresponding arteries.
You can either edit a lesion slice by slice with 2D Edit
mode or edit the entire volume of the lesion using 3D
Edit mode. That saves you time-consuming editing of
individual slices.
– With 3D editing, you can cut a part of a lesion in the
volume and reassign it to another artery label.
– With 2D editing, you can separate mistakenly connected lesions in a slice.
– You can also delete a mistakenly marked lesion.
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syngo Calcium Scoring
3. Automatic Result Display
With 3D region growing evaluation, you have selected
lesions over a volume and evaluated them as indicated
by the markings.
The following measured values are listed in the result
table:
• Artery
The label given to the artery, the calcification
belongs to.
• Lesion Index
The number of lesions per coronary artery based on
the evaluated volume.
• Volume [mm3]
Interpolated volume for this calcification.
• Equiv. Mass [mg CaHA]
The mass of calcium per coronary artery in mg CaHA. To obtain the correct calcium mass, a scanner
specific calibration factor is used. A footnote displays
the calibration factor.
• Score
Agatston score or equivalent Agatston score
(depending on image data).
• You can find additional information with a right
mouse click under Properties.
A pop up message with appropriate lesion information
appears:
– lesion area
– mean CT
– peak, volume
– score and mass
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syngo Calcium Scoring
The Agatston score represents the amount of
detected calcium in each individual coronary artery.
For every slice, the area of each lesion is weighed by a
factor f which depends on the peak CT value of this
lesion:
f = 1 for 130 HU/Peak CT value < 200 HU
f = 2 for 200 HU/Peak CT value < 300 HU
f = 3 for 300 HU/Peak CT value < 400 HU
f = 4 for 400 HU and above
All scores of a specific artery are added for the Agatston score of this artery. All scores of all arteries are
added for the total Agatston score.
The original definition of the Agatston score is based
on contiguous 3 mm slices. For a study which was
acquired with a slice thickness different from 3 mm
(e.g., 2.5 mm), or for overlapping slices, an equivalent
Agatston score is calculated. It takes the different slice
width and interslice distance into account.
Hint: The score table will be updated immediately after
you have set a seed point or drawn a freehand ROI, or
after any modification or deletion of a calcification
marking. The floating score table window appears,
whenever you temporarily blow up the display of segment 1. Segment 4 shows the score table for each
evaluated arterial label (color-coded).
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syngo Calcium Scoring
4. Reporting and Filming
• The Report Wizard helps you to create and export
the scoring reports.
After clicking the Report Wizard icon on the Report
palette, the Calcium Scoring Report Wizard pops up.
The current Calcium Scoring report is displayed. Information about the patient (for example, patient name,
series number, date of birth) and the score table will
automatically be included in the printed report.
You can include up to six images and the result table of
the Calcium Scoring evaluation in your report and save
them for later documentation.
You can add further text to the report:
– Choose the Referring Physician from the list.
– Choose the Reading Physician from the list.
– Enter/supervise additional information:
History and Risk Factors.
– Select the desired template.
You can use customized report templates as well.
Click the Print button to finish.
The report is generated and displayed with List&Label.
You can use this tool, e.g., to print the report, or to
save it as HTML file or into a folder of the file system.
You can also copy selected images and results to the
Filming card.
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syngo Calcium Scoring
It is possible to change the layout of the film sheet in
the Filming card. The film task can be exposed either
from the Filming card or from the CaScoring card.
• Calcium Scoring images or score results are not
saved automatically.
Use the Save All function or select individual images or
the score table to save them. The images are saved as
secondary captures in the database.
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syngo Calcium Scoring
Additional Important Information
Elements of the Sliding MIP Dialog Box
The settings will change the initial thickness of the
Sliding MIP in segment 2 or 3.
– Transaxial Sliding MIP Thickness
Sets the thickness (in mm) of the Sliding MIP in segment 2 (axial direction). Default is 20.0 mm.
– Coronal/Sagittal Sliding MIP Thickness
Sets the thickness (in mm) of the MIP in segment 3
(coronal/sagittal direction). Default thickness is
10.0 mm.
Hint: You can graphically adjust the thickness for the
Sliding MIP in segment 3. Change the thickness by
dragging one of the two parallel (white) lines.
1.The white slab borders help you to adjust the Sliding
MIP.
2.The reference line indicates the image displayed in
segment 1 and 2.
3.The arrows indicate the view/ projection direction.
a)Elements of the Threshold Dialog Box
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syngo Calcium Scoring
The settings will change the threshold range for coloring pixels to recognize calcification.
– Upper Threshold
Sets the upper value of the threshold for coloring
pixels. Default is 3071 HU.
– Lower Threshold
Sets the lower value of the threshold for coloring pixels. Default is 130 HU.
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Thickness for 3D Editing
The 3D edit tool allows you to draw a masking volume
for the lesions in segment 1. The editing contour is
swept up and down at a certain distance to modify the
calcification in the volume. The thickness the 3D editing tool works is the current Sliding MIP thickness.
The customization covers:
– The information provided in the report heading
– The reference database used for diagnosis comparison.
During reporting, the Calcium Scoring software automatically adds the patient information and the score
table to a copy of the stored template files.
– Labeling marked lesions
Once you have assigned a specific lesion to a coronary artery, you might want to label this calcification
for later documentation. You can do that using
graphic tools such as lines or arrows and annotation
texts.
– Calcium Scoring images or score results are not
saved automatically. Use the Save All function or
select individual images or the score table to save
them.
– After closing the current evaluation a new status
object is created within the last result series (e.g.
CaScoring_SR).
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CoronaryCTA
Scanning
This is an application for imaging the coronary arteries
with contrast medium. We recommend using only
ECG-gated spiral scanning. The following scan protocols are predefined:
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CoronaryCTA
• CoronaryCTARoutine
– Standard spiral protocol using a rotation time of
0.42 s
• CoronaryCTARoutine037s
– Standard spiral protocol using a rotation time of
0.37s
• CoronaryCTAAdaptSpeed
– Spiral protocol used for patients with a stable
heart rate at 70 bpm.
• CoronaryCTALowHeartRate
– Spiral protocol used for patients with a very low
heart rates below 50 bpm.
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CoronaryCTA
Contrast Medium
For homogeneous contrast enhancement in the coronary arteries, optimized contrast protocols are mandatory.
The use of bolus tracking is helpful, with an automatic
start of the spiral scan as soon as a contrast threshold
of 100 – 120 HU has been reached in the ascending
aorta. Please note that correct placement of the ROI in
the ascending aorta is essential. An example for an
optimized contrast protocol is: Use 80 ml of contrast
agent with a density of 350 mg/ml at a flow rate of
4 ml/s followed by 80 – 120 ml of saline chaser at a
flow rate of 4 ml/s (double head injector).
The use of Test bolus: An example for an optimized
contrast protocol is: Use 10 ml of contrast agent with a
density of 350 mg/ml at a flow rate of 4 ml/s followed
by 60 ml at a flow rate of 4 ml/s of saline chaser (double head injector). For the CTA use 80 ml of contrast
agent with a density of 350 mg/ml at a flow rate of 4
ml/s followed by 80 – 120 ml of saline chaser at a flow
rate of 4 ml/s (double head injector).
For further information on the Bolus Tracking Application, please refer to the chapter "Contrast Medium".
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CoronaryCTA
• We recommend using ECG-gated spiral protocols for
optimized image quality of the coronary arteries and
to provide high-quality 3D image data as an input for
3D postprocessing such as MPR, MIP, VRT or Fly
Through. Although ECG-gated spiral scanning is less
sensitive to variable heart rates than ECG-triggered
sequential scanning, the examination of patients
with complex arrhythmia that results in unpredictable variations of the RR-intervals (e.g. complex ventricular arrhythmia or multiple extra beats) can result
in limited image quality and should be performed in
exceptional cases only.
• Acquisition with a minimum collimated slice width
ensures best possible image quality due to the optimized intrinsic resolution of the scan data. Once
high quality scan data has been acquired, the reconstructed slice width has to be optimized with respect
to image noise and best possible quality in MPR, MIP
and VRT reconstructions.
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CoronaryCTA
CoronaryCTARoutine
Indications:
A standard spiral protocol with ECG gating technique
for coronary CTA studies, using a rotation time of
0.42 sec.
A typical range of 12 cm covering the entire heart can
be done in 15.84 sec.
Topogram:
AP, 512 mm. Approximately, from the carina to the apex of the
heart.
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CoronaryCTA
kV
Effective mAs/
Quality ref. mAs
Rotation Time
Acquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
Temp. resolution*
CTDIVol
Effective dose
CorCTA
120
550
2nd reconstr.
0.42 sec.
16 x 0.75 mm
0.75 mm
3.0 mm
1.0 mm
3.4 mm
0.28
3.0 mm
0.5 mm
B30f
B30f
up to 105 ms
42.9 mGy
Male: 9.47 mSv
Female: 13.49 mSv
* depends on heart rate
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CoronaryCTA
CoronaryCTARoutine037s
Indications:
A standard spiral protocol with ECG gating technique
for coronary CTA studies, using a rotation time of
0.37 sec.
A typical range of 12 cm covering the entire heart can
be done in 15.75 sec.
Topogram:
AP, 512 mm. Approximately, from the carina to the apex of the
heart.
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CoronaryCTA
kV
Effective mAs/
Quality ref. mAs
Rotation Time
Acquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
Temp. resolution*
CTDIVol
Effective dose
CorCTA
120
620
2nd reconstr.
0.37 sec.
16 x 0.75 mm
0.75 mm
3.0 mm
1.0 mm
3.0 mm
0.25
3.0 mm
0.5 mm
B30f
B30f
up to 93 ms
48.4 mGy
Male: 10.68 mSv
Female: 15.20 mSv
* depends on heart rate
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CoronaryCTA
CoronaryCTAAdaptSpeed
Indications:
This spiral scanning protocol is identical to
CoronaryCTARoutine, except that it uses a rotation
time of 0.5 sec. It is intended to provide dose reserves
for obese patients with sufficiently low heart rates. It
can be also used for patients with a stable heart rate at
70 bpm.
A typical range of 12 cm covering the entire heart can
be done in 16.15 sec.
Topogram:
AP, 512 mm. Approximately, from the carina to the apex of the
heart.
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CoronaryCTA
kV
Effective mAs/
Quality ref. mAs
Rotation Time
Acquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
Temp. resolution*
CTDIVol
Effective dose
CorCTAAdap
120
550
2nd reconstr.
0.5 sec.
16 x 0.75 mm
0.75 mm
3.0 mm
1.0 mm
4.0 mm
0.33
3.0 mm
0.5 mm
B30f
B30f
up to 125 ms
42.9 mGy
Male: 9.47 mSv
Female: 13.49 mSv
* depends on heart rate
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CoronaryCTA
CoronaryCTALowHeartRate
Indications:
This spiral scanning protocol is identical to
CoronaryCTARoutine, except that it uses a lower pitch.
It is is intended for patients with a very low heart rates
below 50 bpm.
A typical range of 12 cm covering the entire heart can
be done in 19.93 sec.
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CoronaryCTA
kV
Effective mAs/
Quality ref. mAs
Rotation Time
Acquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
Temp. resolution*
CTDIVol
Effective dose
CorCTALow
120
700
2nd reconstr.
0.42 sec.
16 x 0.75 mm
0.75 mm
3.0 mm
1.0 mm
2.6 mm
0.22
3.0 mm
0.5 mm
B30f
B30f
up to 105 ms
54.6 mGy
Male: 12.06 mSv
Female: 17.17 mSv
* depends on heart rate
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CoronaryCTA
WorkStream4D Protocols
There are six protocols which have seven recon jobs
predefined. Five of these recon jobs are oblique 3D
reconstructions for special heartviews and two of
these recon job are oblique multiphase reconstruction
for creating movies and load them into the InSpace4D
application.
• CoronaryCTAVol
– Spiral protocol using a rotation time of 0.42s
• CoronaryCTAAdaptSpeedVol
– Spiral protocol using a rotation time of 0.5s
• CoronaryCTALowHeartRateVol
– Spiral protocol using a rotation time of 0.42s
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CoronaryCTA
Seven Recon jobs are predefined:
1.axial 3 mm slice,
3 mm increment for filming or archiving
2.axial 1 mm slice, increment 0.7 mm for MIPs
3.RAO
3D Reconstruction for the best LM/LAD view
with a heart phase of 55%
Image Type MIP is used.
4.LAO
3D Reconstruction for the best RCA view
with a heart phase of 55%
Image Type MIP is used.
5.CX
3D Reconstruction for the best LM/LAD/CX
view (SpiderView) with a heart phase of 55%
Image Type MIP is used.
6.ShortAxis
3D Reconstruction for the best view on the short
heart axis
Multiphase reconstruction of heart phase from
10 to 100%, interval = 10% for syngo Argus.
Image Type MPR is used.
7.EjectionFraction
3D Reconstruction for the best view on the
short heart axis
Multiphase reconstruction of heart phase 20%
(systolic) and 80% (diastolic) for syngo Argus.
Image Type MPR is used.
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CoronaryCTA
206
CoronaryCTA
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CoronaryCTA
CoronaryCTAVol
Indications:
This is a spiral scanning protocol with an ECG gating
technique for coronary CTA studies.
Use this protocol for the 3D images display view.
A typical range of 12 cm covering the entire heart can
be done in 15.84 sec.
Topogram:
AP, 512 mm. Approximately, from the carina to the apex of the
heart.
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CoronaryCTA
CorCTA
kV
Effective mAs/
Quality ref.
mAs
Rotation Time
Acquisition
Slice
collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
Temp.
resolution*
CTDIVol
Effective dose
2nd
recon.
3rd
recon.
1.0 mm
2.0 mm
0.5 mm
B30f
2.0 mm
B30f
120
550
0.42 sec.
16 x 0.75 mm
0.75 mm
3.0 mm
3.4 mm
0.28
3.0 mm
B30f
up to 105 ms
42.9 mGy
Male: 9.47 mSv
Female: 13.49 mSv
* depends on heart rate
Slice width
Increment
Kernel
4th recon.
2.0 mm
2.0 mm
B30f
5th recon.
2.0 mm
2.0 mm
B30f
Slice width
Increment
Kernel
6th recon.
8.0 mm
8.0 mm
B30f
7th recon.
8.0 mm
8.0 mm
B30f
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CoronaryCTA
CoronaryCTAAdaptSpeedVol
Indications:
This spiral scanning protocol is identical to
CoronaryCTARoutine, except that it uses a rotation
time of 0.5 sec. It is intended to provide dose reserves
for obese patients with sufficiently low heart rates. It
can be also used for patients with a stable heart rate at
70 bpm.
Use this protocol for the 3D images display view.
A typical range of 12 cm covering the entire heart can
be done in 16.15 sec.
Topogram:
AP, 512 mm. Approximately, from the carina to the apex of the
heart.
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CoronaryCTA
CorCTAAdap
kV
Effective mAs/
Quality ref.
mAs
Rotation Time
Acquisition
Slice
collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
Temp.
resolution*
CTDIVol
Effective dose
2nd
recon.
3rd
recon.
1.0 mm
2.0 mm
0.5 mm
B30f
2.0 mm
B30f
120
550
0.5 sec.
16 x 0.75 mm
0.75 mm
3.0 mm
4.0 mm
0.33
3.0 mm
B30f
up to 125 ms
42.9 mGy
Male: 9.47 mSv
Female: 13.49 mSv
* depends on heart rate
Slice width
Increment
Kernel
4th recon.
2.0 mm
2.0 mm
B30f
5th recon.
2.0 mm
2.0 mm
B30f
Slice width
Increment
Kernel
6th recon.
8.0 mm
8.0 mm
B30f
7th recon.
8.0 mm
8.0 mm
B30f
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CoronaryCTA
CoronaryCTALowHeartRateVol
Indications:
This spiral scanning protocol is identical to
CoronaryCTARoutine, except that it uses a lower pitch.
It is is intended for patients with a very low heart rates
below 50 bpm.
Use this protocol for the 3D images display view.
A typical range of 12 cm covering the entire heart can
be done in 19.93 sec.
CorCTALow
kV
Effective mAs/
Quality ref.
mAs
Rotation Time
Acquisition
Slice
collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
Temp.
resolution*
CTDIVol
Effective dose
3rd
recon.
120
700
0.42 sec.
16 x 0.75 mm
0.75 mm
3.0 mm
2.6 mm
0.22
3.0 mm
B30f
up to 105 ms
1.0 mm 2.0 mm
0.5 mm 2.0 mm
B30f
B30f
54.6 mGy
Male: 12.06 mSv
Female: 17.17 mSv
* depends on heart rate
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2nd
recon.
CoronaryCTA
Slice width
Increment
Kernel
4th recon.
2.0 mm
2.0 mm
B30f
5th recon.
2.0 mm
2.0 mm
B30f
Slice width
Increment
Kernel
6th recon.
8.0 mm
8.0 mm
B30f
7th recon.
8.0 mm
8.0 mm
B30f
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CoronaryCTA
Aortic and Pulmonary Studies
The purpose of these applications is to reduce motion
artifacts in the lung, the aorta and the pulmonary
arteries due to transmitted cardiac pulsation. It is
intended for imaging the aorta and pulmonary arteries
with contrast medium ECG-gated spiral scanning, e.g.
for aortic dissection or pulmonary emboli. The following scan protocols are predefined:
You will find these protocols under body region:
Vascular
• ThorCardioECG
– Spiral mode for ECG-gated thorax CTAngio studies
using a rotation time of 0.42 sec.
• ThorCardioECG037s
– Spiral mode for ECG-gated thorax CTAngio studies
using a rotation time of 0.37 sec.
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CoronaryCTA
215
CoronaryCTA
ThorCardioECG
Indications:
This is a spiral scanning protocol using a rotation time
of 0.42 sec. and an ECG gating technique for thorax
CTAngio studies, e.g. visualization of pulmonary
embolism, coronary stenosis, vascular anomalies etc.
A range of 25 cm including the aorta arch will be covered in 23.87 sec.
Topogram:
AP, 512 mm. From
the aortic arch to the
apex of the heart.
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CoronaryCTA
kV
Effective mAs/
Quality ref. mAs
Rotation Time
Acquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
Temp. resolution*
CTDIVol
Effective dose
ThorCorECG
120
440
2nd reconstr.
0.42 sec.
16 x 0.75 mm
0.75 mm
3.0 mm
1.0 mm
4.6 mm
0.38
3.0 mm
0.7 mm
B30f
B20f
up to 105 ms
34.3 mGy
Male: 15.19 mSv
Female: 18.02 mSv
* depends on heart rate
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CoronaryCTA
ThorCardioECG037s
Indications:
This is a spiral scanning protocol using a rotation time
of 0.37 sec. and an ECG gating technique for thorax
CTAngio studies, e.g. visualization of pulmonary
embolism, coronary stenosis, vascular anomalies etc.
A range of 25 cm including the aorta arch will be covered in 23.73 sec.
Topogram:
AP, 512 mm. From
the aortic arch to the
apex of the heart.
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CoronaryCTA
kV
Effective mAs/
Quality ref. mAs
Rotation Time
Acquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
Temp. resolution*
CTDIVol
Effective dose
ThorCorECG
120
440
2nd reconstr.
0.37 sec.
16 x 0.75 mm
0.75 mm
3.0 mm
1.0 mm
4.1 mm
0.34
3.0 mm
0.7 mm
B30f
B20f
up to 86 ms
34.3 mGy
Male: 15.19 mSv
Female: 18.02 mSv
* depends on heart rate
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syngo InSpace4D
4D Viewer
Please use the standard scan protocols with the suffix
"Vol". For further information please refer to the chapter "CoronaryCTA-WorkStream4D protocols".
In addition to its unique performance in displaying
huge static CT volume data sets, the new syngo
InSpace4D offers true 4-dimensional evaluation of the
heart, based on data reconstructed in up to 24-phases
of the cardiac cycle.
The software enables real-time visualization and diagnosis of the beating heart, evaluation of functional
defects, and navigation in any arbitrary plane.
4D reading is achieved using either clip planes or slabs
that can be positioned interactively in order to show, in
real-time, the desired anatomy.
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syngo InSpace 4D
Select multiple time-sequence volumes from the local
database (axial multiphase series). For further information about the reconstruction, please refer to the
chapter "Multiphase". Load these series into syngo
InSpace and select Use 4D from the study purifier.
For further information about the application syngo
InSpace4D, please refer to the Application Guide "Clinical Applications 2".
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syngo Vessel View
syngo Vessel View is a dedicated tool for 3D visualization and analysis of vascular structures in MR and CT
data sets.
In addition to vessel analysis, this option is also useful
for pre-surgical evaluation, which requires direct measurements in a 3D-volume data set.
Key Features
• 3D visualization with MPRs, MIPs, and Volume Rendering.
• VRT presets shared with the common gallery available with the syngo VRT option on the 3D card.
• 3D editing with clip planes or VOI punching.
• Semi-automatic segmentation of complete vessel
trees & intuitive path planning.
• Manual path planning along the vessel & manual
vessel segmentation with the Tube Mode.
• Vessel Navigator which creates a Ribbon MPR for
close-up evaluation of the vessel.
• Display up to 3 flags at the normal and minimum
diameters or cross-sectional areas of the vessel.
• Automatic calculation of the stenotic ratio in percent.
• Straight & curved distance measurements directly in
the Vessel Navigator or in the VRT segment.
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syngo Vessel View
• Angle measurements directly in the volume segment.
• Automatic contour detection and area calculation of
the vessel lumen orthogonal to the center line path.
• The quantification results are summarized in output
tables (Reports) that can be documented as hardcopy or stored together with the corresponding
images in the database.
• Setting of annotation texts either along the path in
the VRT segment or anywhere in the 3D volume in
the MPR segments to identify anatomically important coordinates.
Prerequisites
Volume data set with good opacification for vascular
analysis, with overlapping thin slice and a soft kernel
reconstruction are recommended.
To ensure optimal enhancement after the contrast
medium injection a Test bolus or Bolus Tracking using
CARE Bolus (optional) should be used. For the coronary vessels and the large thoracic vessels, best results
can be achieved with ECG-synchronized scanning
using the Heart View CT.
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syngo Vessel View
Workflow
Loading the Images
After loading the images into syngo Vessel View the
following layout is displayed:
Menu Bar
MPR
Segment
Sagittal View
MPR
Segment
Coronal View
Volume
Segment
MPR
Segment
Axial View
Control
Area
Measurements or
Vessel Navigator
Status Bar
MPR Segments
The three small segments on the left are referred to as
MPR Segments although these segments may also display MIP Thin and MPR Thick. These segments contain
manipulator lines, as in the 3D card, which allow you
to rotate and translate image planes. 2D measurements are also possible on these segments.
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syngo Vessel View
Volume Segment
This segment displays the complete volume data set
either in VRT or MIP representation.
Hint: VRT presets are shared with the common gallery
available with the VRT option on the 3D card. Since
Vessel View applies a different volume rendering
algorithm that provides no "shaded" display like the 3D
card, it may be helpful to create and save your specific
Vessel View VRT settings.
A green arrow, the so-called Focus Pointer indicates
the current position in the volume, e.g. for creation of
annotation texts. The Focus Pointer also indicates the
intersection point of the three MPR segments.
The orientation cube in the lower right corner may be
used to quickly change the orientation of the volume
data set. A single click on one side of the cube will set
the orientation of the volume to that side. A doubleclick anywhere on the cube will set the orientation and
the zoom factor of the volume back to their default values.
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syngo Vessel View
Vessel Navigator
The Vessel Navigator shows a longitudinal cut along
the center line of the vessel. An area curve of the vessel’s cross-sectional area is displayed as a graphical
overlay on the Vessel Navigator image.
You can move along the vessel and rotate the Vessel
Navigator image about the vessel axis. The Focus
Pointer (known from the Volume Segment) is represented by a green vertical line.
When moving the Focus Pointer, the three MPR Segments are synchronized to the position of the Focus
Pointer.
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syngo Vessel View
Visualization
This step is used to get an initial impression of the data
set and, if necessary, remove structures which hide the
view on the structures of interest.
To get an initial impression of the data set, you may
view it in VRT or MIP representation in the Volume Segment or page through the data set in the MPR Segments.
Working with the VRT/MIP representation in the Volume Segment you may typically
• Apply a VRT preset from the VRT Gallery.
• Create his own VRT preset.
• Change the W/C setting with the middle mouse button.
• Freely rotate the volume.
• Click on the Orientation Cube to quickly set the orientation to desired standard views.
• Blow up the Volume Segment to full screen size.
Working with the MPR Segments you may typically
• Page through the axial, sagittal and coronal views.
• Change the views to any oblique/double-oblique
view.
• Change the W/C setting with the middle mouse button.
• Blow up one MPR Segment to go to the Volume Segment.
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syngo Vessel View
Working with the Vessel Navigator you may typically
• Change W/C setting with the middle-mouse button.
• Change the Ribbon Viewer width (if less than the
full vessel width or not enough surroundings are
shown).
• Zoom/Pan to display the region of interest.
• Display curves of either the cross-sectional area of
the vessel or a combination of the minimum, maximum and equivalent diameters along the vessel’s
center line.
• Measure straight distances perpendicular to the vessel (e.g. diameter of the vessel).
• Measure curved distances along the vessel’s center
line.
• Rotate the Ribbon MPR step by step or in cine mode.
• Change the display to MIP Thin.
To remove unwanted structures you may
• Punch out unwanted structures.
• Apply clip planes.
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syngo Vessel View
Segmentation
In this step, you place certain seed points in order to
identify the vessel of interest and define paths along its
center line. These paths can be the result of a semiautomatic or fully manual segmentation procedure.
– Select Configure > Show Magnifier Window
from the main menu to set the seed points easier,
mainly on small vessels.
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syngo Vessel View
You can drag & drop the Magnifier Window to any
position on the screen.
a) Semi-Auto Segmentation
With the Semi-Auto Segmentation all path points are
automatically set by the application.
Segmentation steps:
Step 1:
Select the vessel type that you want to segment
(aorta, carotids, coronaries or other).
The segmentation algorithm is adapted to the vessel
type you selected.
Hint
Do not select Other as the segmentation may abort.
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syngo Vessel View
Step 2: Set one or more seed points.
There are two different types of seed points:
Center points – e.g. one click for the complete aorta
End points – e.g. prevents the segmentation to run
from carotids into aortic arch.
You can set points in all segments.
You may set any number of center points and/or end
points. For the segmentation of coronaries, two end
points have to be set.
Step 3: Adjust sensitivity (threshold for segmentation).
Set the required threshold value with the slider.
Voxels of an intensity below the segmentation threshold are excluded from the image segment. Check the
view and correct the setting if necessary.
Step 4: Define paths along the branches of the vessel
tree by performing two clicks into the VRT
image for each path. You may define as many
paths as necessary.
As soon as you have created all paths click Done.
Paths are displayed in the image segments as a colored
line through the middle of the vessel.
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syngo Vessel View
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syngo Vessel View
You only have to:
– Position one or more seed points anywhere in the
vessel of interest via the left mouse button.
– Position individual seed points in the most suitable
image segment (Volume or MPR segment).
– Position an end point where vessel branches run into
other vessels, if necessary.
– In many cases, e.g. the aorta, only one seed point is
necessary to trace the whole vascular tree.
– Adjust the threshold to remove bone or any other
unwanted structures. The segmentation algorithm
automatically finds the vessel limits and determines
the whole vessel tree.
– As a last step, plan as many paths as wanted in the
Volume segment.
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syngo Vessel View
Hint
For an optimal performance of the segmentation algorithm:
Limit the size and especially the complexity of the vasculature that you would like to segment.
To achieve this:
– Place at least two end points during the segmentation workflow. One end point proximal and one distal to the vasculature of interest.
– After the segmentation modify the HU threshold by
moving the slider that only the vessels of interest are
visible and all bones are excluded.
For some cases where the vessels are completely
occluded, it may be not possible to define a path along
these vessels after segmentation. As a workaround
you can use the Manual Path Creation.
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syngo Vessel View
b) Manual mode
With the manual mode all path points have to be set by
you.
– Position path points at the beginning of a vessel and
wherever the vessel changes its course and at the
end of the vessel.
– Position the individual path points in the most suitable image segment. (Volume or MPR segment).
– For the identification of branched vessels, position a
path point where the branches join.
Depending on the number as well as accuracy used in
positioning the path points, the paths represents the
actual course of the blood vessel.
Manual mode does not isolate the vessel tree from the
surrounding tissue and bones. For this purpose Tube
Mode may be used.
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syngo Vessel View
Path Modification
After segmentation has been completed, each path is
given a unique name. You may modify the path name,
e.g. to an anatomical name and add an explanatory
note to each path.
To improve the visibility of paths the translucent mode
is automatically switched on after segmentation.
You can modify the course of a path in the Volume or
the MPR Segment by using the Edit entry in the context sensitive menu (right mouse button).
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syngo Vessel View
Measurement Analysis
Flags
Flags are special area measurements. There are usually
two or three flags associated with each path, but they
can also be turned off completely. You can move them
in the Vessel Navigator to healthy (one or two flags,
called Normal A and Normal B) and stenotic (the flag
called Minimum) parts of the vessel.
When their contours (on the Vessel Orthogonal MPR)
are accepted their values are displayed in the Measurement List. Accepted area measurements and flags
are shown as (planar) contours in the Volume Segment.
They have the same color as their MPR counterpart.
Stenosis Ratio Values
Each path has a variable number of Stenotic Ratio values displaying the ratio of the Minimum flag to the
average of the Normal A flag and the Normal B flag (if
available).
Which parts of the flags are used for this ratio – area,
minimum diameter, maximum diameter and/or equivalent diameter, is determined globally in the configuration dialog.
The value that is displayed is actually 100% minus the
ratio (following the NASCET criteria), resulting in a perfectly healthy vessel being assigned a 0% stenosis and
a totally obstructed vessel being assigned a 100%
stenosis.
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syngo Vessel View
These values only appear in the list after the flags’ contours are accepted (= validated). The names are automatically created, incrementing a number at the end.
The name can then be changed by you.
Navigation along a path
After creating a path the MPR Segments are automatically set to the Vessel Orthogonal Orientation.
This means that the previously standard axial view will
now be a view orthogonal to the center line of the vessel; the previous standard coronal and sagittal views
are now views tangential to the center line of the vessel.
You have the ability to switch back to the Patient
Orthogonal Orientation. This means that the MPR
Segments remain in the true orthogonal orientations
(axial, sagittal, coronal view) as you scroll along the
path.
You can set the MPR Segments individually to display
the current view in MPR, MIP, MPR Thick or MIP Thin
representation.
Using the Focus Pointer you can move along the path
and follow the Vessel Orthogonal MPR Segments.
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syngo Vessel View
Tube
Tube is a clipping tool, which creates a cylindrical volume following the center line of the selected vessel.
The radius of the tube can be selected by you. Tube
provides a quick way to either keep the tube volume
(= the volume around the vessel) and remove the surrounding structures, or to remove the tube volume and
keep the surrounding structures.
Usually this only makes sense after a manual path creation, because the segmentation does a more precise
job in separating vessel from surrounding tissue.
Fader
Removed parts of the volume are not really deleted
from the data set. Instead, they are hidden by the
Fader. With the Fader, you may modify the transparency of the removed volume.
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Axial Cuts
This button is only enabled (ungrayed) when a path is
selected.
– The FoV of the axial MPR image represents the FoV of
the resulting Axial Cuts range: Zoom/pan the path
orthogonal MPR image to the best view, then select
button Axial Cuts in the control area.
– You can specify the begin and end of the range (in
mm).
– You can enter a distance between the cuts. The system calculates the resulting number of slices
(images).
– While this dialog is open, the VRT shows the location
of the cuts as squares.
– Pressing Cancel hides the dialog and the squares in
the VRT segment.
– Pressing Start saves the images to the database.
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syngo Vessel View
Performing measurements
You can
– Measure straight distances in MPR and VRT views
and on the Vessel Navigator (VN)
– Measure curved distances in VRT view and on the VN
– Perform automatic measurements of the vessel’s
cross-sectional area. After semi-automatic segmentation, a colored vessel contour is displayed on the
vessel-orthogonal MPR view. You can accept this
contour as official contour.
– Draw and evaluate free-hand ROIs
– Modify existing contours
– Measure angles
– Measure volume
You can hide measurements and show them again
with the menu option Configuration > Show All Measurements.
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syngo Vessel View
Documentation of Results
The buttons Save to Database and Copy to Filmsheet
are always available. You can always document intermediate results using these two buttons.
Hint: Save to Database and Copy to Film Sheet is
always applied to the currently selected segment.
Make sure that the correct segment is selected.
Save Session and Load Session
Use the menu option File/Save Session to save intermediate results of a Vessel View session. Restore the
session by first loading the patient images to Vessel
View and then selecting File > Load Session.
Do not delete the series VVIEW_NONIMAGE_SERIES
until you have fully completed the evaluation of your
patient. This series contains non-image data which is
required by the Load Session function to restore a previously interrupted session.
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syngo Vessel View
Create report
The Report button creates several output tables of the
measurement results. These tables are automatically
stored to the database and can be sent to the film
sheet.
Graphical documentation of measurements
The Measurement list displays all measurements created in this session. Selecting an entry of this list will
display the VRT and MPR images associated with this
measurement. You can then apply the buttons Save to
Database and Copy to Filmsheet to the relevant segments.
AVI-File of Volume Segment and Vessel Navigator
image
You can generate an avi-file of the Volume Segment or
the Vessel Navigator image rotating around the vessel
axis depending on which segment is currently
selected.
For movie creation Vessel View uses the MPEG-4
Codec V1. This codec must be installed on the PC on
which the movie is to be replayed.
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syngo Vessel View
Case Examples
Workflow for an Aortic Aneurysm Case
Visualization
Use VRT settings and window settings for good visualization of the aortic and iliac arteries.
Adjust the VRT view by using presets from the VRT Gallery. You can fine-tune the settings by adjusting the
trapezoids in the definition card.
If necessary, remove unwanted volume structures by
using the Clip Plane or the VOI Punch function.
Hint: Removed parts of the volume are not really
deleted from the data set. Instead, they are hidden by
the Fader. With the Fader you can modify the transparency of the removed volume parts.
Semi-Automatic Segmentation
Activate the semi-automatic segmentation mode.
Place center seed points into the aorta. In many cases,
one seed point is sufficient. Place the seed points
either in the MPR segments or in the VRT segment.
As soon as you press the Next button, an automatic
segmentation will be performed and keep mainly the
aortic lumen. After segmentation, the translucent
mode is automatically switched on.
Define paths along the aorta or other vessel branches
by two clicks for each path.
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syngo Vessel View
Editing & Merging Paths
Following segmentation of the aorta, the resultant
paths are shown as a list on the Measurement card.
You can edit the paths by repositioning the path points
along the path into the center of the vessel lumen.
You can also merge paths by selecting two paths from
the Measurement card at a time and clicking the
Merge button.
Measurements
Select the path of interest on the Measurement card.
Move the Focus Pointer, e.g. by dragging the green
vertical line in the Vessel Navigator.
The 3 MPR segments are now displayed orthogonal to
the path. These images will be updated as you change
the position of the Focus Pointer.
The following measurements can be performed:
1.Curved Distance directly in the Vessel Navigator
e.g. origins of the renal arteries to neck of the aneurysm.
2.Curved Distance in the central long axis of the aneurysm between the upper and lower necks of the
aneurysm.
3.Straight Distance for maximum diameter of the
aneurysm or any of the aortic branches, i.e. the iliac
arteries.
4.Automatic contouring and area calculation of the
lumen of the aneurysm or the aortic branches, i.e.
the iliac arteries.
5.Angle Measurement
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syngo Vessel View
Hint
For the evaluation of very large findings, e.g. aortic
dissections, where the accuracy of 3D measurements
is sufficient, we recommend to reformat MIPs/MPRs in
syngo 3D.
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syngo Vessel View
Workflow for a Coronary Case, e.g. LM
and LAD
In the area of the coronary vessels and the large thoracic vessels, best results can be achieved with ECGsynchronized images using the HeartView CT software. Motion artifacts which typically occur in the coronary vessels and in the large thoracic vessels can thus
be avoided.
Prerequisite for the evaluation is an optimum enhancement in the vessels of interest. We recommend using
Bolus Tracking.
We recommend using a heart phase where the vessels
of interest are best displayed. Also a smooth kernel is
recommended.
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syngo Vessel View
Visualization
Use VRT settings and window settings for good visualization of the Left Main (LM) and the Left Anterior
Descending Artery (LAD).
Adjust the VRT view by using presets from the VRT Gallery. You can fine-tune the settings by adjusting the
trapezoids in the definition card.
If necessary, remove unwanted volume structures by
using the Clip Plane or the VOI Punch function.
Hint: Removed parts of the volume are not really
deleted from the data set. Instead, they are hidden by
the Fader. With the Fader you can modify the transparency of the removed volume parts.
Change all MPR segments to 5 mm MIP Thin for better
visualization of the coronary arteries.
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syngo Vessel View
Semi-Automatic Segmentation
Activate the semi-automatic segmentation mode.
Place two end points into the ascending aorta, one
above and one below the bifurcation of the coronary
arteries.
Hint: If you place the seed points in the MPR segments,
you do not need to isolate the heart in the VRT segment. Make sure you switch the MPR segments from
5 mm MIP Thin back to standard MPR prior to placing
the seed points as seed points cannot be placed on MIP
Thin or MIP images.
If there are a lot of calcifications or a bypass is visible in
the coronaries:
– Set two end points into the aorta, one above and one
below the orifices of the coronaries.
– Set several center points after the calcifications or
bypass directly into the coronaries
As soon as you press the Next button, an automatic
segmentation will be performed and keep mainly the
coronary tree and part of the ascending aorta. After
segmentation, the translucent mode is automatically
switched on.
Define paths along the coronaries with two clicks for
each path.
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syngo Vessel View
Editing & Merging Paths
Following segmentation of the aorta, the resultant
paths are shown as a list on the Measurement card.
You can edit the paths by repositioning the path points
along the path into the center of the vessel lumen.
You can also merge paths by selecting two paths from
the Measurement card at a time and clicking the
Merge button.
Measurements
Select the Vessel Navigator for close-up evaluation of
the coronary artery.
A Ribbon/Longitudinal MPR along the path is displayed.
Zoom up the MPR display to the region of interest e.g.
a stenosis in the vessel.
You can rotate the MPR plane by using the Movie function. Choose a plane that demonstrates the tightest
stenosis.
You can move the Focus Pointer along the vessel by
dragging the green vertical line in the Vessel Navigator.
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The following measurements can be performed:
1.On the Vessel Navigator, vessel diameters at the
stenosis as well as proximal and distal to the stenosis
by placing straight distance measurements.
2.On the Vessel Navigator, length of the stenosis
along the vessel center line by measuring the curved
distance between the proximal and distal positions
of the narrowing.
3.On MPR views, luminal areas at the stenosis (narrowest part of the vessel), proximal and distal to the
stenosis by using the automatic contouring and area
calculation functions.
For a more accurate evaluation, it is essential to repeat
the measurements from a second plane, at 90° to the
first plane. This is essential in assessing a lesion with
non-concentric narrowing.
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syngo Vessel View
Workflow for a Carotid Stenosis Case
Visualization
Use VRT settings and window settings for good visualization of the carotids.
Adjust the VRT view by using presets from the VRT Gallery. You can fine-tune the settings by adjusting the
trapezoids in the definition card.
If necessary, remove unwanted volume structures by
using the Clip Plane or the VOI Punch function.
Hint: Removed parts of the volume are not really
deleted from the data set. Instead, they are hidden by
the Fader. With the Fader you can modify the transparency of the removed volume parts.
Semi-Automatic Segmentation
Activate the semi-automatic segmentation mode.
Place center seed points into the carotid of interest. In
many cases, one seed point is sufficient. Place the seed
points either in the MPR segments or in the VRT segment.
As soon as you press the Next button, an automatic
segmentation will be performed and keep mainly the
aortic lumen. After segmentation, the translucent
mode is automatically switched on.
Define paths along the carotid by two clicks for each
path.
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syngo Vessel View
Editing & Merging Paths
Following segmentation of the aorta, the resultant
paths are shown as a list on the Measurement card.
You can edit the paths by repositioning the path points
along the path into the center of the vessel lumen.
You can also merge paths by selecting two paths from
the Measurement card at a time and clicking the
Merge button.
Measurements
Select the Vessel Navigator for close-up evaluation of
the carotids.
A Ribbon/Longitudinal MPR along the path is displayed.
Zoom up the MPR display to the region of interest e.g.
a stenosis in the vessel.
You can rotate the MPR plane by using the Movie function. Choose a plane that demonstrates the tightest
stenosis.
You can move the Focus Pointer along the vessel by
dragging on the green vertical line in the Vessel Navigator.
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syngo Vessel View
The following measurements can be performed:
1.On the Vessel Navigator, vessel diameters at the
stenosis as well as proximal and distal to the stenosis
by placing Straight Distance measurements.
2.On the Vessel Navigator, length of the stenosis
along the vessel center line by measuring the curved
distance between the proximal and distal positions
of the narrowing.
3.On MPR views, luminal areas at the stenosis
(narrowest part of the vessel), proximal and distal to
the stenosis by using the automatic contouring and
area calculation functions.
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Additional Important
Information
Image quality
In images of poor image quality (due to strong artefacts or non optimal bolus timing) it might occur that
the algorithms are not able to segment the whole
structure.
Functions
Some functions are only available if a path is selected.
Select a path in the path list on the Measurements
card, if necessary. In order to increase the accuracy of
user-defined measurements, use the Zoom/Pan function whenever possible.
This especially helps you to identify the contours of
very small vessels.
• To return to the original (coronal) view of the volume
double-click anywhere on the orientation cube.
• Select Configure > Show Magnifier Window from
the main menu to display the Magnifier Window for
setting the seed points easier, mainly on small vessels.
• Make sure that the points for the segmentation are
placed exactly inside the vessel. Also, do not use too
many points; in most of the cases one seed point is
enough depending on the vessel anatomy.
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syngo Vessel View
• If no image is displayed in the Vessel Navigator, simply select the path from the Measurement list again.
• You have the ability to switch back to the patient
orthogonal orientation. This means that the MPR
segments remain in the true orthogonal orientations
(axial, sagittal, coronal view) as you scroll along the
path.
• You can label paths and measurements on the Measurement list.
Simply click on a selected entry and re-name it, as you
would do in normal Windows applications.
• To improve the visibility of paths, the translucent
mode is automatically switched on after segmentation. You can switch the translucent mode on and
off via the right mouse button menu.
• You can modify the course of a path in the Volume or
the MPR Segment by using the Edit entry in the context sensitive menu (right mouse button).
• With the manual mode, all path points have to be set
by you.
– Position path points at the beginning of a vessel,
wherever the vessel changes its course and at the
end of the vessel.
– Position the individual path points in the most suitable image segment (Volume or MPR segment).
– For the identification of branched vessels, also position a path point where the branches join.
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Depending on the number as well as accuracy used in
positioning the path points, the paths represent the
actual course of the blood vessels.
Manual mode does not isolate the vessel tree from the
surrounding tissue and bones. For this purpose, the
Tube Mode may be used.
• The Tube is a clipping tool, which creates a cylindrical
volume following the center line of the selected vessel. The radius of the tube can be changed by you.
The Tube provides a quick way to either keep the tube
volume (= the volume around the vessel) and remove
the surrounding structures, or to remove the tube volume and keep the surrounding structures.
Usually this only makes sense after a manual path creation, because the segmentation does a more precise
job in separating vessel from surrounding tissue.
• Use the menu option File > Save Session to save
intermediate results of a Vessel View session. Restore
the session by first loading the patient images to
Vessel View and then selecting File > Load Session.
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syngo Vessel View
Do not delete the series VVIEW_NONIMAGE_SERIES
until you have fully completed the evaluation of your
patient. This series contains non-image data which is
required by the Load Session function to restore a previously interrupted session.
• After completion of a recording, the AVI files will
automatically be stored in a directory set by the system, e.g. H:\SiteData\VesselView\Movies.
You can review the movies by opening the File
Browser via main menu entry Options > File Browser.
With an external PC connected you can access your
offline data on the external PC for postprocessing.
• Select the desired files and double-click on them.
• The corresponding program, e.g. Windows Media
Player will be opened and you can review what you
have saved.
• Now you can send these files to floppy or burn them
on to CD.
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syngo Argus
syngo Argus is a dedicated software for Cardiac Functional Analysis and 4D Visualization.
Key Features
• Support evaluation with CT and MR data sets
• Cine preview of Ventricular Wall Motion with the
time-serial images
• Manual and Automatic Detection of Cardiac Borders
• Software guided evaluation procedure
• Quantification of Cardiac Function:
– Ventricular Volumes
– Myocardial Mass
– Hemodynamic Parameters such as Ejection Fraction, Stroke Volume, Cardiac Output
– Left Ventricle Wall Thickening Analysis
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Prerequisites
syngo Argus analysis is performed with MPR images
created from a Coronary CTA acquisition with Retrospective ECG gating. This makes use of all the information available in the Coronary CTA data for the entire
cardiac cycle – a one-stop shop imaging technique for
both cardiac morphology and function.
The MPR images may be oriented parallel to the long,
short or neutral axis of the heart. A neutral-axis will
generally correspond to one of the 3 orthogonal
patient axes: axial, sagittal or coronal.
Automated contour detection is only possible with
short-axis images, which are used in most instances.
In order to compute all cardiac functional parameters,
volume curves and dynamic thickening information,
sufficient slice levels to cover the heart and time
frames to cover the cardiac cycle must be available. For
partial quantitative evaluation, only images from the
End Diastole and End Systole are required.
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Scanning and Reconstruction
If you want to use short axis images of the heart there
are different possibilities to create them:
During scanning
You can reconstruct short axis spiral oblique (SPO)
images in different heart phases directly during the
examination.
After scanning
1.If you have saved the raw data of the Cardio scan:
You can reconstruct short axis spiral oblique (SPO)
images in different heart phases by loading the raw
data in the Examination card of your Navigator, or
you can also load the raw data in the Recon card of
your Wizard (optional) console.
2.After reconstruction of different axial heart phases,
you can reconstruct short axis MPR images on the 3D
card.
Hint
Do not enter any comments on the 2nd comment line
which is reserved for labeling of the cardiac phase and
heart rate in beats per minute (bpm).
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Scan Protocols
There are six protocols which have seven recon jobs
predefined. Five of these recon jobs are oblique 3D
reconstructions for special heartviews and two of
these recon job are oblique multiphase reconstruction
for creating movies and load them into the syngo
Argus application.
• CoronaryCTAVol
• CoronaryCTAAdaptSpeedVol
• CoronaryCTALowHeartRateVol
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Seven Recon jobs are predefined:
1.axial 3 mm slice,
3 mm increment for filming or archiving
2.axial 1 mm slice, increment 0.7 mm for MIPs
3.RAO
3D Reconstruction for the best LM/LAD view
with a Heart phase of 55%
(recommended heart rate 60 bpm).
Image Type MIP is used.
4.LAO
3D Reconstruction for the best RCA view
with a Heart phase of 55%
(recommended heart rate 60 bpm).
Image Type MIP is used.
5.CX
3D Reconstruction for the best LM/LAD/CX
view (SpiderView) with a Heart phase of 55%
(recommended heart rate 60 bpm).
Image Type MIP is used.
6.ShortAxis
3D Reconstruction for the best view on the short
heart axis
Multiphase reconstruction of heart phase from
10 to 100%, interval = 10% for syngo Argus.
Image Type MPR is used.
7.EjectionFraction
3D Reconstruction for the best view on the
short heart axis
Multiphase reconstruction of heart phase 20%
(systolic) and 80% (diastolic) for syngo Argus.
Image Type MPR is used.
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Short Axis
Short axis reconstruction on the Examination or
Recon card:
Select
– Recon axis – oblique
– Image type – MPR
– Enable Button – FreeMode
MPR
Thick
MIP Thin Toggle FoV: Set FoV Preview
for selected image
Free Mode:
• Off: You can navigate through the volume by moving the reference lines.
The FoV does not move.
• On: The reference lines can be rotated to obtain
oblique/double-oblique views.
Select the coronal view, rotate the sagittal line to the
level of the heart valve and the sulcus.
Distance between Images = 8 mm
Slice Thickness = 8 mm
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Multiphase Reconstruction
Select a new recon job on the Recon card:
Select the Multiphase button on the Trigger tabcard.
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With a right mouse click on the Multiphase button you
can open the HeartView Configuration window.
Three different Multiphase settings are possible
1.Protocol
displays the settings for the selected scan protocol.
2.Auto
You can define the heart phase settings with a regular interval in between, e.g. for an Argus movie.
3.Manual
You can define the irregular heart phase settings
with an interval, e.g. to calculate the Ejection fraction.
All choices are available for % or ms.
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Reconstruction Examples
1.Reconstruction of the whole cardiac cycle, e.g. to
create a movie in ARGUS:
Select Multiphase settings: Auto and choose % values.
Enter "10" as Start and "100" as Stop.
Select "10" as Interval.
As result you will get 10 series with the heart phases:
10%, 20%, 30%, 40%, 50%, 60%, 70%, 80%, 90%,
100%.
2.Reconstruction of irregular heart phases, e.g. for the
Ejection fraction:
Select Multiphase settings: Manual and choose % values.
Enter "20" for the reconstruction of the ES (minimum
left ventricular lumen) and "80" for the reconstruction
of the ED (maximum left ventricular lumen).
As result you will get 2 series with the heart phases:
20% and 80%
3.Reconstruction of irregular heart phases, e.g.
for the best display of the coronary arteries:
LAO:
Select Multiphase settings: Manual and choose % values.
Enter "50" "52" "55" "58" "60" to find out the best display of the LAO view.
As result you will get 5 series with the heart phases:
50%, 52%, 55%, 58%, 60%.
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If you want to create your own Multiphase recon job in
a cardio scan protocol:
Define either an auto or a manual setting, than select
the Multiphase settings – Protocol. Press button
Apply, close the window with OK. Then you can save
the scan protocol as usual and the selected recon job
will be always reconstructed using a multiphase.
Hints
• To get a constant Image quality for the Multiphase
reconstruction we recommend turning ECG pulsing
OFF.
• If you are not sure which heart phases are the best
one for the Multiphase reconstruction, perform preview series before.
• Press the Recon button for each 3D reconstruction.
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Post-processing on the 3D
Card
Short-axis MPR images of the Heart
• Load the first (ED) series into 3D card
• Adjust the reference plane to obtain short-axis views
of the heart
• Press the button for parallel ranges
Recommended parameters:
Image thickness: 8 mm
Distance between images: 8 mm
Number of images: ~13 (adjust to cover ventricles)
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syngo Argus
• You must save this MPR range as a preset (Short-axis)
for subsequent reformatting of other time series.
• You may link one preset to the series description. In
turn the preset will be applied automatically when
the next series is loaded into MPR Ranges.
• Save the MPR series with a sensible description such
as Short Axis, 25%.
• Repeat the procedure with the next series.
Hint
Do not change any parameters for the MPR ranges,
otherwise Argus is not able to sort the images correctly.
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Workflow
Image Loading
• Select all short axis series in the Patient Browser and
click on the Argus button or use the main menu
entry. The series will be loaded to Argus.
Argus Viewer
Layout of the Argus card after image loading
• Selection of rows or columns
• You can select entire rows and columns by their controls. Also "Shift" and "Ctrl" works for selection.
• Each Matrix element contains a complete series,
indicated by dog ears.
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You have the ability to sort the images by two different
criteria:
Sort by Series Number, each cell with dog-ear corresponds to one series number (One Heart phase).
Sort by Position, each cell with dog-ear corresponds to
one slice position.
Movie:
• To create a movie of the pumping heart, load all
short axis images of the whole cardiac cycle (10 –
100%) into the Argus Viewer.
• Select a slice of the interesting part of the heart and
load it into the first segment.
• Change the layout and start the movie.
Movie Controls
Graphics On/Off
Movie Layout:
1 x 1, 1 x 2,
2 x 2, 2 x 4
You can save the movie via the main menu entry
ArgusTools/MovieControl/SaveMovie as AVI.
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The movie is saved:
➭ On the Wizard: H:\Site\Data\Argus\Movie
➭ On the LEONARDO: E:\Site\Data\Argus\Movie
On an external PC with a shared folder, you can open
the movie by double-clicking on it. The movie will then
be displayed using the "Windows Media Player".
Argus Evaluation
• Select the Evaluation Mode – Ventricular Analysis.
Layout of "Ventricular Analysis"
• Image display
The image matrix is now displayed without dog-ears.
Image sorting:
– into rows by slice position with increasing cardiac
phase (in%)
– into columns by cardiac phase (heart phase "xx%")
(see comment in image text).
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syngo Argus
• Cardiac Border Definition
Automatically:
1.ED and ES phase are automatically identified and
displayed in the corresponding column heading.
2.Apex and Base of each phase are automatically indicated by arrows.
3.If you are satisfied with these settings, press button
Accept ED/ES.
Manually:
1.Check if the automatic selection of ED, ES, Base and
Apex is correct.
2.If you are not satisfied Drag&Drop ED and/or ES column heading to the column of your choice.
3.Positions of Base and Apex will be maintained, indicated by arrows.
4.If you are not satisfied Drag&Drop Base and Apex
indicator (Arrow) to the image of your choice.
The base slice icon cannot be moved below the apical
slice icon and vice versa. It can be moved only in the
corresponding phase column.
5.If you are satisfied with these settings, press button
Accept ED/ES.
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Contour Drawing
Endocardium
Left
Ventricle
Epicardium
Right Ventricle
a)Select an ED image in the middle of the heart, use
the freehand drawing tool to draw the endocardial
contour manually. Double-click to close the contour line, the drawing tools will switch automatically to epicardial.
b)Draw the epicardial contour. Double-click to close
the contour line.
c) Check the ED contours, if necessary use the
nudge and/or splice tool to make adjustments.
d)Press one of the propagation buttons to propagate
your drawn contours to all images of the same
phase or any other phase.
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Generation of Cardiac Function
Results
Ventricular Volume Results
a)Proceed to the Result tabcard.
b)Click Display Volume Results.
c) Enter values for mean RR interval during examination, patient height and weight. These values are
used to calculate normalized values in respect to
body surface.
d)Click Save to save the results. All images, including
the contoured images and the result tables will be
saved.
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Wall Thickening Analysis
1.Proceed to the Result tabcard.
2.Click Thickening. The images are now divided into
several sectors. If necessary, adjust the number of
sectors and define the reference sector.
3.Propagate the sector definition to other images.
4.Press Display to show the result tables.
5.Click Save to save the images with the thickening
sectors and the thickening result tables.
6.Two types of result display are possible.
7.Figure Thickening Bulls Eye is an example of a polar
plot output of 3D ventricular thickening results. Each
ring of the plot corresponds to a different short axis
slice level. The central ring represents the most apical slice and the outer ring represents the most basal
slice. Each section of the plot corresponds to a sector
location as depicted in the sectored images. The
color scale of each section of the plot is coded with
the parameter value at that wall location. If the analysis is only performed for a slice level, the color plot
of the various sectors will be superimposed onto the
image itself.
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syngo Argus
Thickening Bulls Eye
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Thickening Result Tables
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Hints in General
• MPR series for Argus Ventricular Function analysis
should not contain overview images. It is recommended, to deselect Include the reference image
when storing the range in the 3D configuration.
• When series for Argus VF contain overview images,
it can happen that these images are sorted before
the ED/ES labeled images in the Argus splash matrix.
When computing the volume results then, Argus will
issue a warning "Volumes can not be computed for
non parallel slices. Not all results are available".
The results of the analysis are not affected.
• syngo Argus uses a special image text configuration
which can not be changed by you and which can not
be filmed.
• In reformatted images (MPR), Argus shows a slice
position in the image text. This slice position is given
in the patient coordinate system (PCS) as defined by
DICOM. The PCS slice position begins always with a
letter (A: anterior, P: posterior, F: feet, H: head, R:
right, L: left) followed by the coordinate e.g.
H 332.5.
• If original axial CT images are loaded, Argus shows
both definitions, the PCS slice position and the CT
slice position. Argus uses the PCS slice position in its
messages.
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• The Argus result table also shows normal ranges.
The range values are based on the study, Normal
human right and left ventricular mass, systolic function, and gender differences by cine magnetic resonance imaging (see: Lorenz CH, Walker ES et al,
J Cardiovasc Magn Reson. 1999;1(1):7 – 21). This
study was performed on a group of 75 healthy, predominantly Caucasian subjects.
• If original axial CT images are loaded, Argus shows
both definitions, the PCS slice position and the CT
slice position. Argus uses the PCS slice position in its
messages.
• syngo Argus requires CT MPR images reconstructed
with any version from VA70 up to now. CT images
from other vendors, or CT images that have been
reconstructed with older versions do not contain the
cardiac phase in their DICOM parameter set. In this
case Argus will try to read the cardiac phase from the
image comment line. Therefore the image comment
line has to be modified manually.
• The format of the image comment line must be
"XXXX, ZZZ %" if the phase is specified in % of RR
interval "XXXX, ZZZ ms" if the phase is specified in
milliseconds.
• XXXX is alphanumeric text of arbitrary length without comma signs, ZZZ denotes the value.
Example 1: this is just a text, 80%
Example 2: 60 Bpm, 233 ms
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283
Head
Overview
– HeadRoutine/HeadRoutine05s
Spiral mode for routine head studies
– HeadRoutineSeq
Sequential mode for routine head studies
– HeadSeq/HeadSeq05s
Sequential mode for high quality head studies
– InnerEarUHR
Spiral mode for ultra high resolution inner ear studies
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Head
– InnerEarUHRVol
Spiral mode for ultra high resolution inner ear studies and double oblique studies
– InnerEarSeqUHR
Sequential mode for high resolution inner ear studies
– Sinus
Spiral mode for routine sinus studies
– SinusVol
Spiral mode for axial and coronal sinus studies
– Orbit
Spiral mode for routine orbital studies
– Dental
Spiral mode for the application syngo Dental CT
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Head
Hints in General
• Topogram: Lateral, 256 mm.
• Patient positioning:
Patient lying in supine position, arms resting against
body, secure head well in the head holder, support
lower legs.
• Gantry tilt is available for sequence scanning, not for
spiral scanning.
• For all head studies, it is very important for image
quality to position the patient in the center of the
scan field. Use the lateral laser beam to make sure
that the patient is positioned in the center.
• In order to optimize image quality versus radiation
dose, scans are provided within a maximum scan
field of 300 mm with respect to the iso-center. No
recon job with a field of view exceeding those limits
will be possible. Therefore, patient positioning has to
be performed accurately to ensure a centered location of the skull.
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Head
Head Kernels
The endings “s” or “f” depend on the rotation time.
• For soft tissue head studies, the standard kernel is
H40s; softer images are obtained with H30s or H20s,
H10s, sharper images with H50s. The kernels H21s,
H31s, H41s yield the same visual sharpness as H20s,
H30s, H40s, the image appearance, however, is
more agreeable due to a ”fine-grained” noise structure; quite often, the low contrast detectability is
improved by using H31s, H 41s instead of H30s,
H40s.
• High resolution head studies should be performed
with H60s, H70s (e.g. for dental and sinuses).
• For very high sharpness we recommended the U70u,
U80u, U90u for bone studies. UHR mode has a maximum FoV of 300 mm.
It is mandatory to position the area of interest in the
center of the scan field.
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Head
HeadRoutine
Indications:
Spiral mode for routine head studies, e.g. stroke, brain
tumors, cranial trauma, cerebral atrophy, hydrocephalus, and inflammation, etc.
A range for the base of 40 mm will be covered in
8.06 sec., a range for the cerebrum of 80 mm will be
covered in 8.06 sec.
kV
Effective mAs/
Quality ref. mAs
Rotation Time
Aquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
CTDIVol
Effective dose
288
Base
120
320
Cerebrum
120
360
1.0 sec.
16 x 0.75 mm
0.75 mm
4.0 mm
6.6 mm
0.55
4.0 mm
H31s
67.5 mGy
Male:
1.57 mSv
Female:
1.81 mSv
1.0 sec.
16 x 1.5 mm
1.5 mm
8.0 mm
13.2 mm
0.55
8.0 mm
H31s
68.4 mGy
Male:
2.79 mSv
Female:
2.9 mSv
Head
Contrast medium IV injection
Start delay
60 sec.
Flow rate
2 ml/sec.
Total amount
50 – 60 ml
Hints
• If you want to set up the scan with only one range,
you can easily delete one mode by clicking the
chronicle with the right mouse button, and select
cut.
• An automatic bone correction and an advanced algorithm allow for improved head image quality, without any additional post-processing.
• In order to optimize image quality versus radiation
dose, scans are provided within a maximum scan
field of 300 mm with respect to the iso-center. No
recon job with a field of view exceeding those limits
will be possible. Therefore, patient positioning has to
be performed accurately to ensure a centered location of the skull.
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Head
HeadRoutine05s
Indications:
Spiral mode for routine head studies, e.g. stroke, brain
tumors, cranial trauma, cerebral atrophy, hydrocephalus, and inflammation, etc., using a rotation time of
0.5 sec.
Two ranges are predefined for the base of the skull and
cerebrum.
A range for the base of 40 mm will be covered in
4.03 sec., a range for the cerebrum of 80 mm will be
covered in 4.03 sec.
kV
Effective mAs/
Quality ref. mAs
Rotation Time
Aquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
CTDIVol
Effective dose
290
Base
120
320
Cerebrum
120
360
0.5 sec.
16 x 0.75 mm
0.75 mm
4.0 mm
6.6 mm
0.55
4.0 mm
H31f
67.5 mGy
Male:
1.57 mSv
Female:
1.81 mSv
0.5 sec.
16 x 1.5 mm
1.5 mm
8.0 mm
13.2 mm
0.55
8.0 mm
H31f
68.4 mGy
Male:
2.79 mSv
Female:
2.9 mSv
Head
Contrast medium IV injection
Start delay
60 sec.
Flow rate
2 ml/sec.
Total amount
50 – 60 ml
Hints
• If you want to set up the scan with only one range,
you can easily delete one mode by clicking the
chronicle with the right mouse button, and select
cut.
• An automatic bone correction and an advanced algorithm allow for improved head image quality, without any additional post-processing.
• In order to optimize image quality versus radiation
dose, scans are provided within a maximum scan
field of 300 mm with respect to the iso-center. No
recon job with a field of view exceeding those limits
will be possible. Therefore, patient positioning has to
be performed accurately to ensure a centered location of the skull.
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Head
HeadRoutineSeq
Indications:
Sequence mode for routine head studies with CTDIvol
below 60 mGy, e.g. for stroke, brain tumors, cranial
trauma, cerebral atrophy, hydrocephalus, and inflammation, etc.
Two ranges are predefined for the base of the skull and
cerebrum.
A scan range is predefined with 11.2 cm.
kV
Effective mAs/
Quality ref. mAs
Rotation Time
Acquisition
Slice collimation
Slice width
Feed/Scan
Kernel
CTDIVol
Effective dose
292
BaseSeq
120
310
CerebrumSeq
120
310
1.0 sec.
12 x 1.5 mm
1.5 mm
4.5 mm
18.0 mm
H31s
59.5 mGy
Male: 1.09 mSv
Female:
1.26 mSv
1.0 sec.
12 x 1.5 mm
1.5 mm
9.0 mm
18.0 mm
H31s
59.5 mGy
Male: 2.12 mSv
Female:
2.22 mSv
Head
Contrast medium IV injection
Start delay
60 sec.
Flow rate
2 ml/sec.
Total amount
50 – 60 ml
Hints
• An automatic bone correction and an advanced algorithm allow for improved head image quality, without any additional post-processing.
• In order to optimize image quality versus radiation
dose, scans are provided within a maximum scan
field of 300 mm with respect to the iso-center. No
recon job with a field of view exceeding those limits
will be possible. Therefore, patient positioning has to
be performed accurately to ensure a centered location of the skull.
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Head
HeadSeq
Indications:
Sequence mode for routine head studies, e.g. stroke,
brain tumors, cranial trauma, cerebral atrophy, hydrocephalus, and inflammation, etc.
Two ranges are predefined for the base of the skull and
for the cerebrum.
A scan range is predefined with 12.1 cm.
kV
Effective mAs/
Quality ref. mAs
Rotation Time
Acquisition
Slice collimation
Slice width
Feed/Scan
Kernel
CTDIVol
Effective dose
294
BaseSeq
120
320
CerebrumSeq
120
360
1.0 sec.
12 x 0.75 mm
0.75 mm
4.5 mm
9.0 mm
H31s
71.7 mGy
Male:
1.34 mSv
Female:
1.54 mSv
1.0 sec.
12 x 1.5 mm
1.5 mm
9.0 mm
18 mm
H31s
69.1 mGy
Male:
2.46 mSv
Female:
2.63 mSv
Head
Contrast medium IV injection
Start delay
60 sec.
Flow rate
2 ml/sec.
Total amount
50 – 60 ml
Hints
• If you want to set up the scan with only one range,
you can easily delete one mode by clicking the
chronicle with the right mouse button, and select
cut.
• An automatic bone correction and an advanced algorithm allow for improved head image quality, without any additional post-processing.
• In order to optimize image quality versus radiation
dose, scans are provided within a maximum scan
field of 300 mm with respect to the iso-center. No
recon job with a field of view exceeding those limits
will be possible. Therefore, patient positioning has to
be performed accurately to ensure a centered location of the skull.
295
Head
HeadSeq05s
Indications:
Sequence mode for routine head studies, e.g. stroke,
brain tumors, cranial trauma, cerebral atrophy, hydrocephalus, and inflammation, etc., using a rotation time
of 0.5 sec.
Two ranges are predefined for the base of the skull and
for the cerebrum.
kV
Effective mAs/
Quality ref. mAs
Rotation Time
Acquisition
Slice collimation
Slice width
Feed/Scan
Kernel
CTDIVol
Effective dose
296
BaseSeq
120
250
CerebrumSeq
120
250
0.5 sec.
12 x 0.75 mm
0.75 mm
4.5 mm
9.0 mm
H31f
56.0 mGy
Male:
1.04 mSv
Female:
1.2 mSv
0.5 sec.
12 x 1.5 mm
1.5 mm
9.0 mm
18.0 mm
H31f
48.0 mGy
Male:
1.67 mSv
Female:
1.79 mSv
Head
Contrast medium IV injection
Start delay
60 sec.
Flow rate
2 ml/sec.
Total amount
50 – 60 ml
Hints
• If you want to set up the scan with only one range,
you can easily delete one mode by clicking the
chronicle with the right mouse button, and select
cut.
• An automatic bone correction and an advanced algorithm allow for improved head image quality, without any additional post-processing.
• In order to optimize image quality versus radiation
dose, scans are provided within a maximum scan
field of 300 mm with respect to the iso-center. No
recon job with a field of view exceeding those limits
will be possible. Therefore, patient positioning has to
be performed accurately to ensure a centered location of the skull.
297
Head
InnerEarUHR
Indications:
Spiral mode for Ultra High-Resolution inner ear studies, e.g. inflammatory changes, tumorous processes of
pyramids, cerebellopontine angle tumors, post-traumatic changes, etc.
Note: UHR mode has a maximum FoV of 300 mm. It is
mandatory to position the patient in the center of the
scan FoV.
A range of 43.5 cm will be covered in 47.31 sec.
kV
Effective mAs/
Quality ref. mAs
Rotation Time
Aquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
CTDIVol
Effective dose
298
InnerEarUHR
120
120
1.0 sec.
2 x 0.6 mm
0.6 mm
2.0 mm
1.0 mm
0.8
2.0 mm
U90u
33.0 mGy
Male: 0.55 mSv
Female: 0.69 mSv
2nd recon.
0.6 mm
0.4 mm
U90u
Head
Contrast medium IV injection
Start delay
60 sec.
Flow rate
2 ml/sec.
Total amount
50 ml
Hints
• For image reconstruction of soft tissue, use kernel
U30u.
• An automatic bone correction and an advanced algorithm allow for improved head image quality, without any additional post-processing.
• In order to optimize image quality versus radiation
dose, scans are provided within a maximum scan
field of 300 mm with respect to the iso-center. No
recon job with a field of view exceeding those limits
will be possible. Therefore, patient positioning has to
be performed accurately to ensure a centered location of the skull.
299
Head
InnerEarUHRVol
Indications:
Spiral mode for Ultra High Resolution inner ear studies
and double oblique studies.
A range of 40 mm will be covered in 43.67 sec.
Three recon jobs are predefined for reconstruction: the
first for axial bone structure, the second and third for
the double oblique for each side in 3D images display
view.
300
Head
kV
Effective mAs/
Quality ref. mAs
Rotation Time
Aquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
CTDIVol
Effective dose
Inner
EarUHR
120
120
1.0 sec.
2x
0.6 mm
0.6 mm
2.0 mm
1.0 mm
0.8
2.0 mm
U90u
33.0 mGy
Male:
0.44 mSv
Female:
0.65 mSv
2nd
recon.
3d
recon.
2.0 mm
2.0 mm
2.0 mm
U90u
2.0 mm
U90u
Contrast medium IV injection
Start delay
60 sec.
Flow rate
2 ml/sec.
Total amount
60 ml
301
Head
Hints
• For image reconstruction of soft tissue, use kernel
U30u.
• An automatic bone correction and an advanced algorithm allow for improved head image quality, without any additional post-processing.
• In order to optimize image quality versus radiation
dose, scans are provided within a maximum scan
field of 300 mm with respect to the iso-center. No
recon job with a field of view exceeding those limits
will be possible. Therefore, patient positioning has to
be performed accurately to ensure a centered location of the skull.
302
Head
303
Head
InnerEarSeqUHR
Indications:
Sequence mode for Ultra High-Resolution inner ear
studies, e.g. Inflammatory changes, tumorous processes of pyramids, cerebellopontine angle tumors,
post-traumatic changes, etc.
A scan range is predefined with 43.6 mm.
kV
Effective mAs/
Quality ref. mAs
Rotation Time
Acquisition
Slice collimation
Slice width
Feed/Scan
Kernel
CTDIVol
Effective dose
304
InnerEarSeq
120
120
1.0 sec.
2 x 0.6 mm
0.6 mm
0.6 mm
1.2 mm
U90u
39.6 mGy
Male: 0.67 mSv
Female: 0.78 mSv
Head
Hints
• For image reconstruction of soft tissue, use kernel
U30u.
• An automatic bone correction and an advanced algorithm allow for improved head image quality, without any additional post-processing.
• In order to optimize image quality versus radiation
dose, scans are provided within a maximum scan
field of 300 mm with respect to the iso-center. No
recon job with a field of view exceeding those limits
will be possible. Therefore, patient positioning has to
be performed accurately to ensure a centered location of the skull.
305
Head
Sinus
Indications:
Spiral mode for paranasal sinuses studies, e.g. sinusitis, mucocele, pneumatization, polyposis, tumor, corrections etc.
Three recon jobs are predefined for image reconstruction of the soft tissue and bone structure.
A range of 80 mm will be covered in 14.12 sec.
306
Head
Sinus
kV
Effective mAs/
Quality ref. mAs
Rotation Time
Aquisition
2nd
recon.
3d
recon.
5.0 mm
1.0 mm
5.0 mm
H30s
0.7 mm
H60s
120
60
1.0 sec.
16 x
0.75 mm
Slice collimation 0.75 mm
Slice width
5.0 mm
Feed/Rotation
6.6 mm
Pitch Factor
0.55
Increment
5.0 mm
Kernel
H60s
12.7 mGy
CTDIVol
Effective dose
Male:
0.46 mSv
Female:
0.53 mSv
307
Head
SinusVol
Indications:
Spiral mode for axial and coronal paranasal sinuses
studies, e.g. sinusitis, mucocele, polyposis, tumor, corrections etc.
Three recon jobs are predefined for reconstruction: the
first for axial bone structure and the second for the
coronal soft tissue in 3D images display view and the
third for the coronal bone structure in 3D images display view.
A range of 80 mm will be covered in 10.59 sec.
308
Head
Sinus
kV
Effective mAs/
Quality ref. mAs
Rotation Time
Aquisition
2nd
recon.
3d
recon.
3.0 mm
3.0 mm
3.0 mm
H30s
3.0 mm
H60s
120
50
0.75 sec.
16 x
0.75 mm
Slice collimation 0.75 mm
Slice width
5.0 mm
Feed/Rotation
6.6 mm
Pitch Factor
0.55
Increment
5.0 mm
Kernel
H60s
10.6 mGy
CTDIVol
Effective dose
Male:
0.38 mSv
Female:
0.42 mSv
Contrast medium IV injection
Start delay
60 sec.
Flow rate
2 ml/sec.
Total amount
50 – 60 ml
309
Head
Orbit
Indications:
Spiral mode for orbital studies, e.g. fracture.
A range of 50 mm will be covered in 7.18 sec.
kV
Effective mAs/
Quality ref. mAs
Rotation Time
Acquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
CTDIVol
Effective dose
310
Orbit
120
100
0.75 sec.
16 x 0.75 mm
0.75 mm
5.0 mm
6.6 mm
0.55
5.0 mm
H60s
21.1 mGy
Male: 0.53 mSv
Female: 0.6 mSv
2nd reconstr.
1.0 mm
0.5 mm
H60s
Head
Contrast medium IV injection
Start delay
60 sec.
Flow rate
2 ml/sec.
Total amount
50 – 60 ml
311
Head
Dental
Indications:
This is the scan protocol for the syngo Dental CT application package. It is used for evaluation and reformatting of the upper and lower jaws.
It enables the display and measurement of the bone
structures of the upper and lower jaw as the basis for
planning in oral surgery.
A range of 50 mm will be covered in 7.18 sec.
kV
Effective mAs/
Quality ref. mAs
Rotation Time
Acquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
CTDIVol
Effective dose
312
Dental
120
80
0.75 sec.
16 x 0.75 mm
0.75 mm
0.75 mm
6.6 mm
0.55
0.5 mm
H60s
16.9 mGy
Male: 0.41 mSv
Female: 0.43 mSv
Head
Load the study into the application syngo Dental CT.
For further information, please refer to the Application
Guide “Clinical Applications 1“.
Hints
• An automatic bone correction and an advanced algorithm allow for improved head image quality, without any additional post-processing.
• In order to optimize image quality versus radiation
dose, scans are provided within a maximum scan
field of 300 mm with respect to the iso-center. No
recon job with a field of view exceeding those limits
will be possible. Therefore, patient positioning has to
be performed accurately to ensure a centered location of the skull.
313
Neck
Overview
– NeckRoutine
Spiral mode for soft tissue routine neck studies
– NeckThinSlice
Spiral mode for thin slice soft tissue neck studies
– NeckVol
Spiral mode for axial, coronal and sagittal neck studies
314
Neck
Hints in General
• Topogram: Lateral,
Lateral, 256 mm, for CTAs AP, 512 mm.
• Patient positioning:
Patient lying in supine position, hyperextend neck
slightly, secure head well in head cradle.
• Patient respiratory instruction:
do not breathe, do not swallow.
• For contrast studies, CARE Bolus (optional) may be
used to optimize the bolus timing.
• For image reconstruction of bone structure, use kernel B60.
• Patient positioning is very important for artifact-free
images. The thoracic girdle should be positioned as
far as possible in the caudal direction. This can be
done using a strap with a permanent loop or Velcro
fastener at its end. The ends of the strap must be
attached to the patients wrists. Then the strap must
be wrapped around the patients feet with his legs
extended and under tension. The entire thoracic girdle is thus pulled toward the patients feet.
315
Neck
Body Kernels
The endings “s” or “f” depend on the rotation time.
• As standard kernels for body tissue studies B30s or
B40s are recommended; softer images are obtained
with B20s or B10s (extremely soft). The kernels B31s
or B41s have about the same visual sharpness as
B30s, respectively, B40s, the image appearance,
however, is more agreeable due to a ”fine-grained”
noise structure; quite often, the low contrast detectability is improved by using B31s, B41s instead of
B30s, B40s.
• For higher sharpness, as is required e.g. in patient
protocols for cervical spine, shoulder,extremities,
thorax, the kernels B50s, B60s, B70s, B80s are available.
• The special kernels are mostly used for ”physical”
measurements with phantoms, e.g. for adjustment
procedures (S80s), for constancy and acceptance
tests (S80s, S90s), or for specification purposes
(S90s).
For special patient protocols, S80s and S90s are chosen, e.g. for osteo (S80s).
• In case of 3D study only, use kernel B10s and at least
50% overlapping for image reconstruction.
Patient positioning is very important for artifact-free
images. The thoracic girdle should be positioned as far
as possible in the caudal direction. This can be done
using a strap with a permanent loop or Velcro fastener
at its end. The ends of the strap must be attached to
the patients wrists. Then the strap must be wrapped
around the patients feet with his legs extended and
under tension. The entire thoracic girdle is thus pulled
toward the patients feet.
316
Neck
317
Neck
NeckRoutine
Indications:
Spiral mode for soft Tissue studies in the cervical
region, e.g. tumors, lymphoma, abscesses etc.
A typical range of 20 cm will be covered in 9.83 sec.
kV
Effective mAs/
Quality ref. mAs
Rotation Time
Acquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
CTDIVol
Effective dose
318
Neck
120
150
0.75 sec.
16 x 1.5 mm
1.5 mm
5.0 mm
18.0 mm
0.75
5.0 mm
B31s
10.5 mGy
Male: 2.35 mSv
Female: 2.31 mSv
Neck
Contrast medium IV injection
Start delay
45 sec.
Flow rate
3.0 ml/sec.
Total amount
100 ml
Hints
• Due to its iodine content, the thyroid gland is hyperdense in relation to the neighboring muscles both
before and after an IV CM injection. For displays of
the parotid or thyroid gland or the floor of the
mouth, the slice thickness should be < 5 mm and the
length of the range should be adapted to match the
anatomic region
• Target the FoV to ensure adequate coverage of the
region of interest in the upper neck & middle neck
levels as well as to include the axilla in the lower
neck level if required.
319
Neck
NeckThinSlice
Indications:
Spiral mode using thin slices for soft tissue studies, e.g.
the functional study of the throat.
A typical range of 18 cm will be covered in 16.5 sec.
kV
Effective mAs/
Quality ref. mAs
Rotation Time
Acquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
CTDIVol
Effective dose
320
NeckThinSlice
120
150
2nd reconstr.
0.75 sec.
16 x 0.75 mm
0.75 mm
5.0 mm
1.0 mm
9.0 mm
0.75
5.0 mm
0.7 mm
B31s
B31s
11.7 mGy
Male: 2.17 mSv
Female: 2.27 mSv
Neck
Contrast medium IV injection
Start delay
45 sec.
Flow rate
3 ml/sec.
Total amount
100 ml
Hint
• Patient positioning is very important for artifact-free
images. The thoracic girdle should be positioned as
far as possible in the caudal direction. This can be
done using a strap with a permanent loop or Velcro
fastener at its end. The ends of the strap must be
attached to the patients wrists. Then the strap must
be wrapped around the patients feet with his legs
extended and under tension. The entire thoracic girdle is thus pulled toward the patients feet.
321
Neck
NeckVol
Indications:
Spiral mode soft tissue studies in the cervical region,
e.g. tumors, lymphoma, abscesses etc.
Three recon jobs are predefined for reconstruction: the
first for axial, the second for coronal and third for saggittal studies in 3D images display.
A typical range of 18 cm will be covered in 16.5 sec.
kV
Effective mAs/
Quality ref. mAs
Rotation Time
Acquisition
Neck
ThinSlice
120
150
2nd
recon.
0.75 sec.
16 x
0.75 mm
Slice collimation 0.75 mm
Slice width
5.0 mm
5.0 mm
Feed/Rotation
9.0 mm
Pitch Factor
0.75
Increment
5.0 mm
5.0 mm
Kernel
B31s
B20s
11.7 mGy
CTDIVol
Effective dose
Male: 2.17 mSv
Female: 2.27 mSv
322
3rd
recon.
5.0 mm
5.0 mm
B20s
Neck
Contrast medium IV injection
Start delay
45 sec.
Flow rate
3.0 ml/sec.
Total amount
100 ml
Hints
• Due to its iodine content, the thyroid gland is hyperdense in relation to the neighboring muscles both
before and after an IV CM injection. For displaying
the parotid, thyroid or floor of the mouth, the slice
thickness should be < 5 mm and the length of the
range should be adapted to match the anatomic
region.
• Target the FoV to ensure adequate coverage of the
region of interest in the upper neck & middle neck
levels as well as to include the axilla in the lower
neck level if required.
323
Shoulder
Overview
– Shoulder
Spiral mode for bone shoulder routine studies
– ShoulderVol
Spiral mode for axial, coronal and sagittal shoulder
studies
324
Shoulder
Hints in General
• Topogram: AP, 256 mm.
• Patient positioning:
Patient lying in supine position, the uninjured arm
placed above the head, the injured arm placed flat
against his body. If only one side is under investigation, position this side in the center and support the
other side with a Bocollo pillow.
• If only one side is examined, it is advisable to enter
the side in the comment line.
• Contrast medium is required for soft tissue mass
evaluation.
• To further optimize MPR image quality we recommend that you reduce one or more of the following:
collimation, reconstruction increment and slice
width for image reconstruction.
325
Shoulder
Body Kernels
The endings “s” or “f” depend on the rotation time.
• As standard kernels for body tissue studies B30s or
B40s are recommended; softer images are obtained
with B20s or B10s (extremely soft). The kernels B31s
or B41s have about the same visual sharpness as
B30s, respectively, B40s, the image appearance,
however, is more agreeable due to a ”fine-grained”
noise structure; quite often, the low contrast detectability is improved by using B31s, B41s instead of
B30s, B40s.
• For higher sharpness, as is required e.g. in patient
protocols for cervical spine, shoulder, extremities,
thorax, the kernels B50s, B60s, B70s, B80s are available.
• The special kernels are mostly used for ”physical”
measurements with phantoms, e.g. for adjustment
procedures (S80s), for constancy and acceptance
tests (S80s, S90s), or for specification purposes
(S90s).
326
Shoulder
For special patient protocols, S80s and S90s are chosen, e.g. for osteo (S80s).
• For very high sharpness we recommended the U70u,
U80u, U90u for bone studies. UHR mode has a maximum FoV of 300 mm.
It is mandatory to position the area of interest in the
center of the scan field. Use ExtrCombi mode when a
scan FoV > 25 cm is necessary.
• In case of 3D study only, the mAs value can be
reduced by 50%. Use kernel B10s and at least 50%
overlapping for image reconstruction.
327
Shoulder
Shoulder
Indications:
Spiral mode for bone studies and soft tissues, e.g. evaluation of joint cavities, masses, trauma, dislocations,
orthopedic indications etc.
A scan range of 15 cm will be covered in 18.67 sec.
kV
Effective mAs/
Quality ref. mAs
Rotation Time
Acquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
CTDIVol
Effective dose
328
Shoulder
120
150
2nd recon.
1.0 sec.
16 x 0.75 mm
0.75 mm
5.0 mm
1.0 mm
9.0 mm
0.75
5.0 mm
0.7 mm
B31s
B60s
11.7 mGy
Male: 2.77 mSv
Female: 3.51 mSv
Shoulder
Hints
• For image reconstruction of soft tissue use kernel
B31s and a slice width of 5.0 mm.
• Use raw data to review a target region if necessary.
• Coronal and sagittal 2D planar reconstructions are
important for evaluation of the joint space & bursa
sacs in CT arthrograms.
• 3D renderings are helpful for complex fractures &
dislocations.
329
Shoulder
ShoulderVol
Indications:
Spiral mode for bone studies and soft tissues, e.g. evaluation of joint cavities, masses, trauma, dislocations,
orthopedic indications etc.
A scan range of 15 cm will be covered in 18.67 sec.
Three recon jobs are predefined for reconstruction: the
first for soft tissue axial, the second for soft tissue coronal and third for sagittal bone studies in 3D images display view.
kV
Effective mAs/
Quality ref. mAs
Rotation Time
Acquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
CTDIVol
Effective dose
Shoulder
120
150
2nd recon.
1.0 sec.
16 x 0.75 mm
0.75 mm
5.0 mm
5.0 mm
9.0 mm
0.75
5.0 mm
5.0 mm
B31s
B31s
11.7 mGy
Male: 2.77 mSv
Female: 3.51 mSv
For the 2nd reconstruction a 3D coronal recon job and
for the 3rd reconstruction a 3D sagittal recon job will be
automatically started.
330
Shoulder
Hints
• Use raw data to review a target region if necessary.
• 3D renderings are helpful for complex fractures &
dislocations.
331
Thorax
Overview
– ThoraxRoutine
Spiral mode for routine thorax studies
– ThoraxCombi
Spiral mode for the combination of thin slice lung
and routine thorax studies
– ThoraxVol
Spiral mode for axial, coronal soft tissue and coronal
lung studies
– ThoraxHR
Spiral mode for high resolution lung studies
– ThoraxSeqHR
Sequential mode for high resolution lung studies
332
Thorax
– ThoraxECGSeqHR
Sequential mode for high resolution, ECG-triggered
lung studies
– LungLowDose
Spiral mode with very low dose for early visualization of pathologies
– LungCARE
Spiral mode used for the application syngo LungCARE CT
333
Thorax
Hints in General
• Topogram: AP, 512 mm.
• Patient positioning:
Patient lying in supine position, arms positioned
comfortably above the head in the head-arm rest,
lower legs supported.
• Contrast medium administration: in general, IV
injections are employed in all mediastinal examinations, but not in routine high resolution studies of
diffused, interstitial lung diseases. An IV contrast
medium injection improves the vascular opacification and facilitates the visualization of the lesions,
lymph nodes and the vessels.
• Stasis of contrast medium in the arm & superior vena
cava often result in high density streak artifacts
either in the region of the aortic arch or in the region
of the subclavian vein. A caudo-cranial (bottom to
top) scanning direction should be used to reduce this
artifact – by simply acquiring the data in this region
at the later phase of the spiral scan. In addition, if the
patient cannot hold his/her breath for the duration of
the entire scan, breathing motion will be less apparent in the apex than in the lower lobes.
• CARE Bolus (optional) may be used to optimize the
bolus timing. Set the ROI for monitoring scan in the
aorta at the level of the diaphragm with triggering
threshold of 120 HU, or use manual triggering.
334
Thorax
• Lung images should be documented in both soft tissue window and lung window.
• It is also possible to interleave the soft tissue & lung
setting images in one film sheet. This can be set up
in the configuration for filming.
• To further optimize MPR image quality we recommend that you reduce one or more of the following:
collimation, reconstruction increment and slice
width for image reconstruction.
Body Kernels
The endings “s” or “f” depend on the rotation time.
• As standard kernels for body tissue studies B30s or
B40s are recommended; softer images are obtained
with B20s or B10s (extremely soft). The kernels B31s
or B41s have about the same visual sharpness as
B30s, respectively, B40s, the image appearance,
however, is more agreeable due to a ”fine-grained”
noise structure; quite often, the low contrast detectability is improved by using B31s, B41s instead of
B30s, B40s.
• For higher sharpness, as is required e.g. in patient
protocols for cervical spine, shoulder, extremities,
thorax, the kernels B50s, B60s, B70s, B80s are available.
335
Thorax
• The special kernels are mostly used for ”physical”
measurements with phantoms, e.g. for adjustment
procedures (S80s), for constancy and acceptance
tests (S80s, S90s), or for specification purposes
(S90s).
For special patient protocols, S80s and S90s are chosen, e.g. for osteo (S80s).
• In case of 3D study only, the mAs value can be
reduced by 50%. Use kernel B10s and at least 50%
overlapping for image reconstruction.
336
Thorax
337
Thorax
ThoraxRoutine
Indications:
Routine spiral studies for the region of thorax, e.g.
visualization of tumors, metastases, lymphoma, lymph
nodes, vascular anomalies etc.
A range of 30 cm will be covered in 6.43 sec.
kV
Effective mAs/
Quality ref. mAs
Rotation Time
Acquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
CTDIVol
Effective dose
338
ThorRoutine
120
100
2nd recon.
0.5 sec.
16 x 1.5 mm
1.5 mm
6.0 mm
6.0 mm
27.6 mm
1.15
6.0 mm
6.0 mm
B41f
B80f
7.0 mGy
Male: 3.74 mSv
Female: 4.77 mSv
Thorax
Contrast medium IV injection
Start delay
25 – 30 sec.
Flow rate
2.5 ml/sec.
Total amount
80 ml
Hint
• For lung cancer evaluation, this protocol can be combined with protocol NeckRoutine.
339
Thorax
ThoraxCombi
Indications:
Combining thin slice lung and routine thorax studies
with one spiral scan, e.g. thorax studies in general and
interstitial changes in the lungs.
A range of 30 cm will be covered in 11.87 sec.
kV
Effective mAs/
Quality ref. mAs
Rotation Time
Acquisition
Thor
Combi
120
100
2nd
recon.
0.5 sec.
16 x
0.75 mm
Slice collimation 0.75 mm
Slice width
5.0 mm
5.0 mm
Feed/Rotation
13.8 mm
Pitch Factor
1.15
Increment
5.0 mm
5.0 mm
Kernel
B31f
B70f
7.8 mGy
CTDIVol
Effective dose
Male: 3.86 mSv
Female: 4.98 mSv
340
3rd
recon.
1.0 mm
0.7 mm
B80f
Thorax
Contrast medium IV injection
Start delay
25 sec.
Flow rate
2.5 ml/sec.
Total amount
80 ml
Hints
• In addition to the mediastinum and the lungs, it may
be necessary to evaluate the axillary fatty tissue and
the bilateral mammary glands. A third reconstruction can be set up with a wider FoV in the Recon task
card.
• You could repeat the same protocol simply by clicking the chronicle with the right mouse button for
repeat. E.g. when both non-contrast and contrast
studies are required.
• For lung cancer evaluation, this protocol can be combined with protocol NeckRoutine.
341
Thorax
ThoraxVol
Indications:
Routine spiral studies for the region of thorax, e.g.,
visualization of tumors, metastases, lymphoma, lymph
nodes, vascular anomalies etc.
Four recon jobs are predefined for reconstruction: the
first for soft tissue axial, the second for lung axial, the
third for soft tissue coronal and fourth for soft tissue
coronal studies in 3D images display view.
A range of 30 cm will be covered in 11.87 sec.
342
Thorax
kV
Effective mAs/
Quality ref. mAs
Rotation time
Acquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
CTDIVol
Effective dose
Slice width
Increment
Kernel
ThorCombi
120
100
2nd recon.
0.5 sec.
16 x 0.75 mm
0.75 mm
5.0 mm
5.0 mm
13.8 mm
1.15
5.0 mm
5.0 mm
B31f
B70f
7.8 mGy
Male: 3.86 mSv
Female: 4.98 mSv
3rd recon.
5.0 mm
5.0 mm
B31f
4th recon.
5.0 mm
5.0 mm
B70f
For the 3rd and 4th reconstruction a 3D coronal recon
job will be automatically started.
343
Thorax
Contrast medium IV injection
Start delay
25 sec.
Flow rate
2.5 ml/sec.
Total amount
80 ml
Hint
• For lung cancer evaluation, this protocol can be combined with protocol NeckRoutine.
344
Thorax
345
Thorax
ThoraxHR
Indications:
Spiral mode for High Resolution studies, e.g., interstitial changes in the lungs.
A range of 30 cm for the complete thorax will be covered in 14.0 sec.
kV
Effective mAs/
Quality ref. mAs
Rotation time
Acquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
CTDIVol
Effective dose
346
ThorHR
120
100
2nd recon.
0.75 sec.
16 x 0.75 mm
0.75 mm
5.0 mm
1.0 mm
18.0 mm
1.5
5.0 mm
0.7 mm
B31s
B80s
7.8 mGy
Male: 3.86 mSv
Female: 4.98 mSv
Thorax
Hints
• With studies of interstitial changes in the lungs, contrast medium is not necessary.
• This examination is normally performed following a
standard thorax study or used for regular follow up
studies for high risk patient groups with a history of
exposure to carcinogenic agents e.g. asbestos.
347
Thorax
ThoraxSeqHR
Indications:
Sequence mode for High Resolution lung studies, e.g.,
interstitial changes in the lungs using a feed of 10 mm.
A scan range is predefined with 19.1 cm.
348
Thorax
kV
Effective mAs/
Quality ref. mAs
Rotation time
Acquisition
Slice collimation
Slice width
Feed/Scan
Kernel
CTDIVol
Effective dose
ThorSeqHR
120
100
0.75 sec.
2 x 1.0 mm
1.0 mm
1.0 mm
10.0 mm
B80s
1.7 mGy
Male: 0.5 mSv
Female: 0.6 mSv
Hints
• If you want to reconstruct thin slices every 15 or
20 mm instead of 10 mm as predefined, simply
change the Feed/Scan before loading the mode.
• With studies of interstitial changes in the lungs, contrast medium is not necessary.
349
Thorax
ThoraxECGSeqHR
Indications:
ECG-triggered sequence mode for High Resolution
lung studies, e.g., interstitial changes in the lungs
using a feed of 10 mm.
A scan range is predefined with 19.1 cm.
kV
Effective mAs/
Quality ref. mAs
Rotation time
Acquisition
Slice collimation
Slice width
Feed/Scan
Kernel
CTDIVol
Effective dose
ThoraxECGSeqHR
120
120
0.75 sec.
2 x 1.0 mm
1.0 mm
1.0 mm
10.0 mm
B80s
2.0 mGy
Male: 0.6 mSv
Female: 0.72 mSv
Hints
• If you want to reconstruct thin slices every 15 or
20 mm instead of 10 mm as predefined, simply
change the Feed/Scan before loading the mode.
• When performing studies for Interstitial lung disease, contrast medium is not necessary.
• If you apply API for a single breathhold acquisition,
please make sure that the breathhold interval in the
Patient Model Dialog is longer than the total scan
time, e.g. 50 s, otherwise the image acquisition will
be interrupted by the default breathhold interval.
This does not apply when API is not activated. For
longer ranges, e.g. the entire thoracic aorta, that
cannot be acquired within a single breathhold,
please ensure that the breathhold interval in the
Patient Model Dialog is set up correctly, according to
the patient’s level of cooperation.
350
Thorax
LungLowDose
Indications:
Lung spiral study with low dose setting, e.g. early visualization of pulmonary nodules.
A typical thorax study in a range of 30 cm will be covered in 9.33 sec.
kV
Effective mAs/
Quality ref. mAs
Rotation time
Acquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
CTDIVol
Effective dose
LungLowDose
120
20
2nd recon.
0.5 sec.
16 x 0.75 mm
0.75 mm
5.0 mm
1.0 mm
18.0 mm
1.5
5.0 mm
0.7 mm
B50f
B50f
1.6 mGy
Male: 0.77 mSv
Female: 1.0 mSv
351
Thorax
Contrast medium IV injection
Start delay
30 sec.
Flow rate
2.5 ml/sec.
Total amount
50 – 70 ml
Hints
• You could repeat the same protocol simply by clicking the chronicle with the right mouse button for
repeat. E.g. when both non-contrast and contrast
studies are required.
• For lung cancer evaluation, this protocol can be combined with protocol NeckRoutine.
• Low dose lung images are usually evaluated using
lung window setting. Soft tissue/bone window settings may be used to visualize the presence of calcifications in the nodules.
• It is essential to use the same protocol for follow-up
studies to check for progression.
• CARE Dose 4D is off as default because for LungLowDose protocols the lowest mAs values are used.
352
Thorax
LungCARE
Indications:
Lung spiral study for the application syngo LungCARE
CT with low dose setting, for visualization of pulmonary nodules.
A typical thorax study in a range of 30 cm will be covered in 9.33 sec.
kV
Effective mAs/
Quality ref. mAs
Rotation time
Acquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
CTDIVol
Effective dose
LungCARE
120
20
0.5 sec.
16 x 0.75 mm
0.75 mm
1.0 mm
18.0 mm
1.5
0.7 mm
B50f
1.6 mGy
Male: 0.77 mSv
Female: 1.0 mSv
353
Thorax
Contrast medium IV injection
Start delay
30 sec.
Flow rate
2.5 ml/sec.
Total amount
50 – 70 ml
For further information, please refer to the Application
Guide “Clinical Applications 2“.
Hints
• You could repeat the same protocol simply by clicking the chronicle with the right mouse button for
repeat. E.g. when both non-contrast and contrast
studies are required.
• For lung cancer evaluation, this protocol can be combined with protocol NeckRoutine.
• Low dose lung images are usually evaluated using
lung window setting. Soft tissue/bone window settings may be used to visualize the presence of calcifications in the nodules.
• It is essential to use the same protocol for follow-up
studies to check for progression.
• CARE Dose 4D is off as default because for LungLowDose protocols the lowest mAs values are used.
354
Thorax
355
Abdomen
Overview
– AbdomenRoutine
Spiral mode for routine abdominal studies
– AbdomenCombi
Spiral mode for the combination of thin slice and
routine abdominal studies
– AbdomenVol
Spiral mode for axial and coronal abdomen studies
– AbdMultiPhase
Spiral mode for three phases liver studies
356
Abdomen
– AbdSeq
Sequential mode for abdominal studies
– CT Colonography
Spiral mode used for the application
syngo Colonography
357
Abdomen
Hints in General
• Topogram: AP, 512 or 768 mm.
• Patient positioning:
Patient lying in supine position, arms positioned
comfortably above the head in the head-arm rest,
lower legs supported.
• Patient respiratory instructions: inspiration.
• Oral administration of contrast medium:
For abdominal studies, it is necessary to delineate
the bowel from other structures such as lymph
nodes, abdominal masses & abscesses. Various types
of bowel opacifying agents can be used:
– Diluted barium suspension (1% – 2%) e.g. EZCAT
– Water soluble agent (2% – 4%) e.g. Gastrografin
– Water alone as a negative contrast agent.
Timing of the oral contrast administration is important
to ensure its even distribution in the bowel.
Upper abdomen:
Minimum 600 ml of contrast divided into 3 cups
(approximately 200 – 250 ml)
1st cup to drink 30 minutes before exam
2nd cup to drink 15 minutes before exam
3rd cup to drink 5 minutes before exam
Abdomen-Pelvis:
Minimum 1000 ml of contrast divided into 4 cups
1st cup to drink 1 hour before exam
2nd – 4th cups every subsequent 15 minutes
Start exam 5 minutes after the 4th cup is administered.
358
Abdomen
– In general, for abdominal studies such as liver, gall
bladder (query stones), pancreas, gastrointestinal
studies, focal lesion of the kidneys and CTA studies,
it is sufficient to use just water. Water is more effective than positive oral contrast agent in depicting the
linings of the stomach & intestines in post enhancement studies. In addition, the use of water will not
obscure the blood vessels thus allowing CTA processing to be performed easily afterwards.
– For patients with bowel obstruction, only water or
water-soluble contrast can be used. Barium suspension is a contraindication.
• Be careful when examining pheochromocytoma
patients. Administration of an IV CM injection in
such cases may trigger a hypertensive crisis!
• To further optimize MPR image quality we recommend that you reduce one or more of the following:
collimation, reconstruction increment and slice
width for image reconstruction.
359
Abdomen
Body Kernels
The endings “s” or “f” depend on the rotation time.
• As standard kernels for body tissue studies B30s or
B40s are recommended; softer images are obtained
with B20s or B10s (extremely soft). The kernels B31s
or B41s have about the same visual sharpness as
B30s, respectively, B40s, the image appearance,
however, is more agreeable due to a ”fine-grained”
noise structure; quite often, the low contrast detectability is improved by using B31s, B41s instead of
B30s, B40s.
• For higher sharpness, as is required e.g. in patient
protocols for cervical spine, shoulder, extremities,
thorax, the kernels B50s, B60s, B70s, B80s are available.
• The special kernels are mostly used for ”physical”
measurements with phantoms, e.g. for adjustment
procedures (S80s), for constancy and acceptance
tests (S80s, S90s), or for specification purposes
(S90s).
360
Abdomen
361
Abdomen
AbdomenRoutine
Indications:
Spiral mode for all routine studies in the region of
abdomen, e.g. follow-up examinations etc.
A scan range of 40 cm will be covered in 12.11 sec.
kV
Effective mAs/
Quality ref. mAs
Rotation time
Acquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
CTDIVol
Effective dose
362
AbdRoutine
120
160
0.5 sec.
16 x 1.5 mm
1.5 mm
5.0 mm
18.0 mm
0.75
5.0 mm
B30f
11.2 mGy
Male: 9.18 mSv
Female: 11.6 mSv
Abdomen
Contrast medium IV injection
Start delay
50 – 60 sec.
Flow rate
4.0 ml/sec.
Total amount
100 ml
Hints
• You could repeat the same protocol simply by clicking the chronicle with the right mouse button for
repeat. E.g. when both non-contrast and contrast
studies are required.
• Delayed scans may be required for the kidneys &
bladder.
• If you want to use this protocol for a two-phase
study, repeat the same protocol as mentioned
below, and choose start delay time for arterial phase
as 20 – 25 sec. In this case, the thin slice reconstruction can also be used for post-processing. Do not
administer oral contrast medium, as this impairs the
editing of MIP/SSD/VRT images. Water could be used
instead if necessary.
• Water, rather than positive oral contrast agents
should be used. Give the last cup 200 ml just prior to
positioning the patient. To ensure adequate filling of
the duodenal loop, lay the patient on the right side
for 5 minutes before performing the topogram.
• A pre-contrast examination is usually performed
only if no CT scans were previously acquired, to
exclude calculi in the common bile duct and to visualize possible lesions in the liver.
• For pancreatic studies, the arterial phase acquisition
can be acquired later with a start delay of
40 – 50 sec. It may be necessary to use a thinner collimation.
363
Abdomen
AbdomenCombi
Indications:
Combination of thin slice and routine abdominal studies with one spiral scan.
A range of 20 cm for liver, pancreas or kidneys will be
covered in 12.11 sec.
kV
Effective mAs/
Quality ref. mAs
Rotation time
Acquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
CTDIVol
Effective dose
AbdCombi
120
160
0.5 sec.
16 x 0.75 mm
0.75 mm
5.0 mm
9.0 mm
0.75
5.0 mm
B30f
12.5 mGy
Male: 4.99 mSv
Female: 6.36 mSv
Contrast medium IV injection
Start delay
50 – 65 sec.
Flow rate
4.0 ml/sec.
Total amount
100 ml
364
2nd reconstr.
1.0 mm
0.7 mm
B20f
Abdomen
Hints
• If you want to use this protocol for a two-phase
study, repeat the same protocol as mentioned
below, and chose start delay time for arterial phase
as 20-25 sec. In this case, the thin slice reconstruction can also be used for postprocessing.
Do not administer oral contrast medium, as this
impairs the editing of MIP/SSD/VRT images. Water
could be used instead if necessary.
• You can repeat the same protocol simply by clicking
the chronicle with the right mouse button for
repeat. E.g. when both non-contrast and contrast
studies are required.
• Water, rather than positive oral contrast agents
should be used. Give the last cup 200 ml just prior to
positioning the patient. To ensure adequate filling of
the duodenal loop, lay the patient on the right side
for 5 minutes before performing the topogram.
• A pre-contrast examination is usually performed
only if no CT scans were previously acquired, to
exclude calculi in the common bile duct and to visualize possible lesions in the liver.
• For pancreatic studies, the arterial phase acquisition
can be acquired later with a start delay of 40 sec. –
50 sec. It may be necessary to use a thinner collimation of 3 mm.
365
Abdomen
AbdomenVol
Indications:
Spiral mode for all routine studies in the region of
abdomen, e.g. follow-up examinations etc.
Two recon jobs are predefined for reconstruction: the
first for axial, the second for coronal studies in 3D
images display view.
The whole scan range of 20 cm will be covered in
12.11 sec.
kV
Effective mAs/
Quality ref. mAs
Rotation Time
Acquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
CTDIVol
Effective dose
366
AbdCombi
120
160
2nd recon.
10 x 0.75 mm
0.75 mm
5.0 mm
5.0 mm
8.6 mm
1.15
5.0 mm
5.0 mm
B30f
B30f
13.1 mGy
Male: 4.81 mSv
Female: 6.95 mSv
Abdomen
Contrast medium IV injection
Start delay
50 – 65 sec.
Flow rate
4.0 ml/sec.
Total amount
100 ml
Hints
• You could repeat the same protocol by simply clicking the chronicle with the right mouse button for
repeat, e.g., when both non-contrast and contrast
studies are required.
• Delayed scans may be required for the kidneys &
bladder.
• If you want to use this protocol for a two-phase
study, repeat the same protocol as mentioned
below, and choose start delay time for arterial phase
as 20 – 25 sec. In this case, the thin slice reconstruction can also be used for post-processing. Do not
administer oral contrast medium, as this impairs the
editing of MIP/SSD/VRT images. Water could be used
instead if necessary.
• Water, rather than positive oral contrast agents
should be used. Give the last cup 200 ml just prior to
positioning the patient. To ensure adequate filling of
the duodenal loop, lay the patient on the right side
for 5 minutes before performing the topogram.
• A pre-contrast examination is usually performed
only if no CT scans were previously acquired, to
exclude calculi in the common bile duct and to visualize possible lesions in the liver.
• For pancreatic studies, the arterial phase acquisition
can be acquired later with a start delay of
40 – 50 sec. It may be necessary to use a thinner collimation.
367
Abdomen
AbdMultiPhase
Indications:
Combination of 3 phases study including liver, pancreas and kidney.
A range of 20 cm including liver, pancreas and kidney:
arterial phase acquired in 6.56 sec.
kV
Effective mAs/
Quality ref. mAs
Rotation Time
Acquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
CTDIVol
Effective dose
368
Non Contrast
120
140
0.5 sec.
16 x 1.5 mm
1.5 mm
5.0 mm
18.0 mm
0.75
5.0 mm
B30f
9.8 mGy
Male: 3.96 mSv
Female: 5.19 mSv
Abdomen
A range of 20 cm including liver, pancreas and kidney:
arterial phase acquired in 12.11 sec.
kV
Effective mAs/
Quality ref. mAs
Rotation Time
Acquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
CTDIVol
Effective dose
Arterial Phase
120
160
2nd recon.
0.5 sec.
16 x 0.75 mm
0.75 mm
5.0 mm
1.0 mm
9.0 mm
0.75
5.0 mm
0.7 mm
B30f
B20f
12.5 mGy
Male: 4.99 mSv
Female: 6.61 mSv
A range of 20 cm including liver, pancreas and kidney:
arterial phase acquired in 6.56 sec.
kV
Effective mAs/
Quality ref. mAs
Rotation Time
Acquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
CTDIVol
Effective dose
Venous Phase
120
140
0.5 sec.
16 x 1.5 mm
1.5 mm
5.0 mm
18.0 mm
0.75
5.0 mm
B30f
9.8 mGy
Male: 3.96 mSv
Female: 5.19 mSv
369
Abdomen
Contrast medium IV injection
Start delay
20 – 25 sec. (arterial phase)
50 – 75 sec. (venous phase)
Flow rate
4 – 5 ml/sec.
Total amount
100 – 120 ml
Hints
• Please notice, if you are not satisfied with the Range
preset, adapt the parameters to your needs and link
them to the series.
• You could repeat the same protocol by simply clicking the chronicle with the right mouse button for
repeat, e.g., when both non-contrast and contrast
studies are required.
• Do not administer oral contrast medium, as this
impairs the editing of MIP/SSD/VRT images. Use
water instead if necessary.
• Water, rather than positive oral contrast agents
should be used. Give the last cup 200 ml just prior to
positioning the patient. To ensure adequate filling of
the duodenal loop, lay the patient on the right side
for 5 minutes before performing the topogram.
• A pre-contrast examination is usually performed
only if no CT scans were previously acquired, to
exclude calculi in the common bile duct and to visualize possible lesions in the liver. Furthermore, this
also ensures exact positioning for the CTA spiral.
• For pancreatic studies, the arterial phase acquisition
can be acquired later with a start delay of
40 – 50 sec. It may be necessary to use a thinner collimation.
370
Abdomen
371
Abdomen
AbdSeq
Indications:
This protocol is created for measurement with sequential mode in the region of the abdomen.
A scan range is predefined with 20.5 cm.
kV
Effective mAs/
Quality ref. mAs
Rotation time
Acquisition
Slice collimation
Slice width
Feed/Scan
Kernel
CTDIVol
Effective dose
AbdSeq
120
140
0.75 sec.
2 x 5.0 mm
5.0 mm
5.0 mm
10.0 mm
B31s
8.8 mGy
Male: 3.16 mSv
Female: 3.96 mSv
Contrast medium IV injection
Start delay
50 – 65 sec.
Flow rate
4 ml/sec.
Total amount
100 ml
372
Abdomen
Hints
• You could repeat the same protocol simply by clicking the chronicle with the right mouse button for
repeat. E.g. when both non-contrast and contrast
studies are required.
• Water, rather than positive oral contrast agents
should be used. Give the last cup 200 ml just prior
positioning the patient. To ensure adequate filling of
the duodenal loop, lay the patient on the right side
for 5 minutes before performing the topogram.
• A pre-contrast examination is usually performed
only if no CT scans were previously acquired, to
exclude calculi in the common bile duct and to visualize possible lesions in the liver.
373
Abdomen
CTColonography
Spiral mode used for the application syngo Colonography. Two ranges are predefined, one for supine and the
sec-ond one for prone lying patient.
A complete colon in a range of 40 cm will be covered
in 12.11 sec.
kV
Effective mAs/
Quality ref. mAs
Rotation Time
Acquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
CTDIVol
Effective dose
374
Colo_supine
120
50
Colo_prone
120
30
0.5 sec.
16 x 0.75 mm
0.75 mm
1.0 mm
18.0 mm
1.5
0.7 mm
B30f
3.9 mGy
Male:
2.81 mSv
Female:
3.92 mSv
0.5 sec.
16 x 0.75 mm
0.75 mm
1.0 mm
18.0 mm
1.5
0.7 mm
B10f
2.3 mGy
Male:
1.68 mSv
Female:
2.35 mSv
Abdomen
Contrast medium IV injection
Start delay
50 – 60 sec.
Flow rate
4.0 ml/sec.
Total amount
100 ml
Hint
• CARE Dose 4D is off as default because for Colonography protocols the lowest mAs values are used.
Load all ranges in the application syngo Colonography.
For further information, please refer to the Application
Guide “Clinical Applications 2“.
375
Spine
Overview
– C-Spine
Spiral mode for cervical spine studies
– C-SpineVol
Spiral mode for axial, sagittal soft tissue and sagittal
bone studies for the cervical spine
– SpineRoutine
Spiral mode for routine lumbar and thoracic spine
studies
– SpineThinSlice
Spiral mode for thin slice lumbar and thoracic spine
studies
376
Spine
– SpineVol
Spiral mode for axial and sagittal lumbar and thoracic spine studies
– SpineSeq
Sequential mode for lumbar and thoracic evaluation
of the discs
– Osteo
Sequential mode used for the application syngo
Osteo CT
377
Spine
Hints in General
• Topogram: Lateral,
512 mm for thoracic and lumbar spine and 256 mm
for the c-spine.
• Patient positioning for thoracic and lumbar spine
studies:
Patient lying in supine position, arms positioned
comfortably above the head in the head-arm rest,
lower legs supported.
• Patient positioning for cervical spine studies:
Patient lying in supine position, hyperextend neck
slightly, secure head well in head cradle.
• Patient respiratory instruction:
do not breathe, do not swallow.
Any possible injuries to the spinal column should be
determined before beginning the examination and
taken into account when repositioning the patient.
• In case of 3D study only, images should be reconstructed with at least 50% overlapping and kernel
B10.
• For lumbar studies, place a cushion under the
patients knees. This will reduce the curve in the
spine and also make the patient more comfortable.
• For image reconstruction of bone study, use kernel
B60.
378
Spine
• The CT scan following myelography must be performed within 4-6 hours of the injection, otherwise,
the contrast density in the spinal canal will be too
high to obtain artifact-free images. Also, if possible,
it is a good idea to roll the patient once, or scan in a
prone position. This will prevent the contrast from
pooling posterior to the spinal cord. If a prone scan is
performed, breathing instructions are recommended to avoid motion artifact in axial source and
MPR images.
• With CAREDose 4D the mA values are adapted for
each osteo range, according to the patient diameter.
Therefore special obese protocols for the osteo and
spine evaluation are not longer necessary.
379
Spine
Body Kernels
The endings “s” or “f” depend on the rotation time.
• As standard kernels for body tissue studies B30s or
B40s are recommended; softer images are obtained
with B20s or B10s (extremely soft). The kernels B31s
or B41s have about the same visual sharpness as
B30s, respectively, B40s, the image appearance,
however, is more agreeable due to a ”fine-grained”
noise structure; quite often, the low contrast detectability is improved by using B31s, B41s instead of
B30s, B40s.
• For higher sharpness, as is required e.g. in patient
protocols for cervical spine, shoulder, extremities,
thorax, the kernels B50s, B60s, B70s, B80s are available.
• The special kernels are mostly used for ”physical”
measurements with phantoms, e.g. for adjustment
procedures (S80s), for constancy and acceptance
tests (S80s, S90s), or for specification purposes
(S90s).
For special patient protocols, S80s and S90s are chosen, e.g. for osteo (S80s).
380
Spine
381
Spine
C-Spine
Indications:
Spiral mode for cervical spine studies, e.g. prolapse,
degenerative changes, trauma, tumors etc.
A range of 16 cm will be covered in 14.83 sec.
kV
Effective mAs/
Quality ref. mAs
Rotation Time
Acquisition
Slice
collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
CTDIVol
Effective dose
382
C-Spine
120
330
2nd recon.
0.75 sec.
16 x 0.75 mm
0.75 mm
2.0 mm
1.0 mm
9.0 mm
0.75
2.0 mm
0.7 mm
B20s
B60s
25.7 mGy
Male: 4.78 mSv
Female: 4.9 mSv
Spine
Hint
• You could repeat the same protocol by simply clicking the chronicle with the right mouse button for
repeat.
• Please notice, if you are not satisfied with the Range
preset, adapt the parameters to your needs and link
them to the series.
383
Spine
C-SpineVol
Indications:
Spiral mode for cervical spine studies, e.g. prolapse,
degenerative changes, trauma, tumors etc.
Three recon jobs are predefined for reconstruction: the
first for soft tissue axial, the second for soft tissue sagittal and third for sagittal bone studies in 3D images
display view.
A range of 16 cm will be covered in 14.83 sec.
C-Spine
kV
Effective mAs/
Quality ref. mAs
Rotation Time
Acquisition
2nd
recon.
120
330
0.75 sec.
16 x
0.75 mm
Slice collimation 0.75 mm
Slice width
2.0 mm
2.0 mm
Feed/Rotation
9.0 mm
Pitch Factor
0.75
Increment
2.0 mm
2.0 mm
Kernel
B20s
B20s
25.7 mGy
CTDIVol
Effective dose
Male: 4.78 mSv
Female: 4.9 mSv
384
3rd
recon.
2.0 mm
2.0 mm
B60s
Spine
Hint
• You could repeat the same protocol by simply clicking the chronicle with the right mouse button for
repeat.
385
Spine
SpineRoutine
Indications:
Spiral mode for thoracic and lumbar spine studies, e.g.
prolapse, degenerative changes, trauma, tumors etc.
A range of 16 cm will be covered in 8.17 sec.
kV
Effective mAs/
Quality ref. mAs
Rotation Time
Acquisition
Slice
collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
CTDIVol
Effective dose
386
SpineRoutine
120
300
2nd recon.
0.75 sec.
16 x 1.5 mm
1.5 mm
3.0 mm
2.0 mm
18.0 mm
0.75
3.0 mm
1.4 mm
B20s
B60s
21.0 mGy
Male: 7.96 mSv
Female: 9.41 mSv
Spine
Hint
• You could repeat the same protocol by simply clicking the chronicle with the right mouse button for
repeat.
• Please notice, if you are not satisfied with the Range
preset, adapt the parameters to your needs and link
them to the series.
387
Spine
SpineThinSlice
Indications:
Spiral mode for thin slice thoracic and lumbar spine
studies, e.g. prolapse, degenerative changes, trauma,
tumors etc.
A range of 16 cm will be covered in 14.83 sec.
kV
Effective mAs/
Quality ref. mAs
Rotation Time
Acquisition
Spine
ThinSlice
120
300
2nd
recon.
0.75 sec.
16 x
0.75 mm
Slice collimation 0.75 mm
Slice width
3.0 mm
1.0 mm
Feed/Rotation
9.0 mm
Pitch Factor
0.75
Increment
3.0 mm
0.7 mm
Kernel
B20s
B20s
23.4 mGy
CTDIVol
Effective dose
Male: 7.82 mSv
Female: 9.36 mSv
3rd
recon.
1.0 mm
0.7 mm
B60s
Please notice, if you are not satisfied with the Range
preset, adapt the parameters to your needs and link
them to the series.
388
Spine
SpineVol
Indications:
Spiral mode for thoracic and lumbar spine studies, e.g.
prolapse, degenerative changes, trauma, tumors etc.
Three recon jobs are predefined for reconstruction: the
first for soft tissue axial, the second for soft tissue sagittal and third for sagittal bone studies in 3D images
display view.
A range of 16 cm will be covered in 14.83 sec.
389
Spine
kV
Effective mAs/
Quality ref. mAs
Rotation Time
Acquisition
Spine
ThinSlice
120
300
2nd recon. 3rd
recon.
0.75 sec.
16 x
0.75 mm
Slice collimation 0.75 mm
Slice width
3.0 mm
2.0 mm
Feed/Rotation
9.0 mm
Pitch Factor
0.75
Increment
3.0 mm
2.0 mm
Kernel
B20s
B20s
23.4 mGy
CTDIVol
Effective dose
Male: 7.82 mSv
Female: 9.36 mSv
2.0 mm
2.0 mm
B20s
Hint
• You could repeat the same protocol by simply clicking the chronicle with the right mouse button for
repeat.
390
Spine
SpineSeq
Indications:
Sequence mode for spine studies, e.g. prolapse,
degenerative changes, trauma, tumors etc.
This protocol contains three ranges: L3-L4, L4-L5, L5S1.
Three different typical gantry tilts are predefined: for
L3-L4: 0°, for L4-L5: +5° and for L5-S1: +15°.
A scan range is predefined with 25.5 mm.
391
Spine
kV
Effective mAs/
Quality ref.
mAs
Rotation time
Acquisition
Slice
collimation
Slice width
Feed/Scan
Kernel
CTDIVol
Effective dose
Male:
Female:
L3-4
120
200
L4-5
120
200
L5-S1
120
220
1.0 sec.
12 x
0.75 mm
0.75 mm
1.0 sec.
12 x
0.75 mm
0.75 mm
1.0 sec.
12 x
0.75 mm
0.75 mm
1.5 mm
9.0 mm
B31s
16.8 mGy
1.5 mm
9.0 mm
B31s
16.8 mGy
1.5 mm
9.3 mm
B31s
18.5 mGy
1.32 mSv
1.61 mSv
1.02 mSv
1.37 mSv
0.74 mSv
1.18 mSv
Hint
• You could repeat the same protocol by simply clicking the chronicle with the right mouse button for
repeat.
392
Spine
Osteo
This is the scan protocol for the syngo Osteo CT application package to assist the physician with the quantitative assessment of vertebral bone mineral density
(BMD) in the diagnosis and follow-up of osteopenia
and osteoporosis.
kV
Effective mAs/
Quality ref. mAs
Slice collimation
Slice width
Feed/Scan
Kernel
CTDIVol
Effective dose
Osteo
80
250
5.0 mm
10.0 mm
0.0 mm
S80s
5.3 mGy
Male: 0.51 mSv
Female: 0.81 mSv
• With CAREDose 4D the mA values are adapted for
each osteo range, according to the patient diameter.
Therefore special obese protocols for the osteo evaluation are not longer necessary.
Load all ranges in the application syngo Osteo CT.
393
Spine
For further information, please refer to the Application
Guide “Clinical Applications 1“.
394
Spine
395
Pelvis
Overview
– Pelvis
Spiral mode for routine soft tissue pelvis studies
– PelvisVol
Spiral mode for axial and coronal pelvis studies
– Hip
Spiral mode for routine hip studies
– HipVol
Spiral mode for axial and coronal hip studies
– SI_Joints
Spiral mode for sacral iliac joints studies
396
Pelvis
Hints in General
• Topogram: AP,
512 mm for pelvis studies and
256 mm for studies of the hip.
• Patient positioning:
Patient lying in supine position, arms positioned
comfortably above the head in the head-arm rest,
lower legs supported.
• A breathing command is not necessarily required for
the pelvic examination, since respiration does not
negatively influence this region.
• Rectal contrast medium administration:
Rectal contrast media is usually required to delineate
the rectum and sigmoid colon, if lower pelvic mass
or pathology is suspected. In some cases, air may be
substituted for a positive contrast agent. The use of
vaginal tampon may be helpful in adult female
patients with suspected pelvis pathology.
• To further optimize MPR image quality we recommend that you reduce one or more of the following:
collimation, reconstruction increment and slice
width for image reconstruction.
397
Pelvis
Body Kernels
The endings “s” or “f” depend on the rotation time.
• As standard kernels for body tissue studies B30s or
B40s are recommended; softer images are obtained
with B20s or B10s (extremely soft). The kernels B31s
or B41s have about the same visual sharpness as
B30s, respectively, B40s, the image appearance,
however, is more agreeable due to a ”fine-grained”
noise structure; quite often, the low contrast detectability is improved by using B31s, B41s instead of
B30s, B40s.
• For higher sharpness, as is required e.g. in patient
protocols for cervical spine, shoulder, extremities,
thorax, the kernels B50s, B60s, B70s, B80s are available.
• The special kernels are mostly used for ”physical”
measurements with phantoms, e.g. for adjustment
procedures (S80s), for constancy and acceptance
tests (S80s, S90s), or for specification purposes
(S90s).
398
Pelvis
399
Pelvis
Pelvis
Indications:
Spiral mode for routine pelvis studies, e.g. processes of
the prostate, urinary bladder, rectum, gynecological
indications etc.
A typical range of 20 cm will be covered in 6.56 sec.
kV
Effective mAs/
Quality ref. mAs
Rotation Time
Acquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
CTDIVol
Effective dose
400
Pelvis
120
160
0.5 sec.
16 x 1.5 mm
1.5 mm
5.0 mm
18.0 mm
0.75
5.0 mm
B31f
11.2 mGy
Male: 5.56 mSv
Female: 7.08 mSv
Pelvis
Contrast medium IV injection
Start delay
50 sec. *
Flow rate
2.0 – 3.0 ml/sec.
Total amount
100 – 120 ml
* If the examination performed requires a full urinary
bladder, wait at least 3 minutes following IV administration of the contrast medium.
401
Pelvis
PelvisVol
Indications:
Spiral mode for pelvis studies, e.g. processes of the
prostate, urinary bladder, rectum, gynecological indications etc.
Two recon jobs are predefined for reconstruction: the
first for axial, the second for coronal studies in 3D
images display view.
A typical range of 20 cm will be covered in 6.56 sec.
kV
Effective mAs/
Quality ref. mAs
Rotation Time
Acquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
CTDIVol
Effective Dose
402
Pelvis
120
160
2nd reconstr.
0.5 sec.
16 x 1.5 mm
1.5 mm
5.0 mm
5.0 mm
18.0 mm
0.75
5.0 mm
5.0 mm
B31f
B31f
11.2 mGy
Male: 5.56 mSv
Female: 7.08 mSv
Pelvis
Contrast medium IV injection
Start delay
50 sec. *
Flow rate
2.0 – 3.0 ml/sec.
Total amount
100 – 120 ml
* If the examination performed requires a full urinary
bladder, following administration of IV administration
of contrast medium, wait at least 3 minutes before
starting the scan.
403
Pelvis
Hip
Indications:
Spiral mode for HiRes bone studies and soft tissue
studies of the Hip, e.g. evaluation of joint cavity,
masses, trauma, dysplasia, necrosis of the head of the
hip, congruence evaluations, orthopedic indications
etc.
A typical range of 10 cm will be covered in 13.11 sec.
kV
Effective mAs/
Quality ref. mAs
Rotation Time
Acquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
CTDIVol
Effective Dose
404
Hip
120
150
2nd reconstr.
1.0 sec.
16 x 0.75 mm
0.75 mm
5.0 mm
1.0 mm
9.0 mm
0.75
5.0 mm
0.7 mm
B60s
B60s
11.7 mGy
Male: 4.31 mSv
Female: 1.39 mSv
Pelvis
Hints
• In case of 3D study only, images should be reconstructed with at least 50% overlapping and kernel
B10.
• If only one side is examined, it is advisable to enter
the side in the comment line.
405
Pelvis
HipVol
Indications:
Spiral mode for bone studies and soft tissue studies of
the Hip, e.g. evaluation of joint cavity, masses, trauma,
dysplasia, necrosis of the head of the hip, congruence
evaluations, orthopedic indications etc.
A typical range of 10 cm will be covered in 13.11 sec.
Two recon jobs are predefined for reconstruction: the
first for axial, the second for coronal studies in
3D images display view.
kV
Effective mAs/
Quality ref. mAs
Rotation time
Acquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
CTDIVol
Effective Dose
406
Hip
120
150
2nd reconstr.
1.0 sec.
16 x 0.75 mm
0.75 mm
5.0 mm
5.0 mm
9.0 mm
0.75
5.0 mm
5.0 mm
B60s
B60s
11.7 mGy
Male: 4.31 mSv
Female: 1.39 mSv
Pelvis
For the 2nd reconstruction a 3D coronal recon job will
be automatically started.
Hint
• If only one side is examined, it is advisable to enter
the side in the comment line.
407
Pelvis
SI_Joints
Indications:
Spiral mode for the sacroiliac joints, e.g. evaluation of
joint cavity, masses, trauma, dysplasia, necrosis, congruence evaluations, orthopedic indications etc.
A typical range of 8 cm will be covered in 5.44 sec.
408
Pelvis
kV
Effective mAs/
Quality ref. mAs
Rotation time
Acquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
CTDIVol
Effective dose
SI_Joints
120
160
2nd reconstr.
0.5 sec.
16 x 0.75 mm
0.75 mm
3.0 mm
1.0 mm
9.0 mm
0.75
3.0 mm
0.7 mm
B60f
B60f
12.5 mGy
Male: 4.27 mSv
Female: 1.42 mSv
409
Upper Extremities
Overview
– WristUHR
Spiral mode for routine high resolution wrist studies
– ExtrRoutineUHR
Spiral mode for routine high resolution extremity
studies
– ExtrCombi
Spiral mode for the combination of thin slice and
routine studies
410
Upper Extremities
Hints in General
• Topogram: AP, 256 mm for joint studies.
• Patient positioning:
Depends on the region of examination.
In general, for bilateral studies, you should always
try to position the patient evenly whenever the
patient can comply.
For wrists and elbow scans:
Patient lying in prone position, hands stretched
above the head and lying flat on a Bocollo pillow,
ankles supported with a pad. Both wrists should be
examined together when necessary.
• Retrospective reconstruction can be done:
a)Use B50s kernel for soft tissue evaluation.
b)For targeted FoV images on the affected side, it is
advisable to enter the side being examined in the
comment line.
• In case of 3D study only, use kernel B10 and at least
50% overlapping image reconstruction.
• To further optimize MPR image quality we recommend that you reduce one or more of the following:
collimation, reconstruction increment and slice
width for image reconstruction.
411
Upper Extremities
Body Kernels
The endings “s” or “f” depend on the rotation time.
• As standard kernels for body tissue studies B30s or
B40s are recommended; softer images are obtained
with B20s or B10s (extremely soft). The kernels B31s
or B41s have about the same visual sharpness as
B30s, respectively, B40s, the image appearance,
however, is more agreeable due to a ”fine-grained”
noise structure; quite often, the low contrast detectability is improved by using B31s, B41s instead of
B30s, B40s.
• For higher sharpness, as is required e.g. in patient
protocols for cervical spine, shoulder, extremities,
thorax, the kernels B50s, B60s, B70s, B80s are available.
• The special kernels are mostly used for ”physical”
measurements with phantoms, e.g. for adjustment
procedures (S80s), for constancy and acceptance
tests (S80s, S90s), or for specification purposes
(S90s).
For special patient protocols, S80s and S90s are chosen, e.g. for osteo (S80s).
• For very high sharpness we recommended the U70u,
U80u, U90u for bone studies. UHR mode has a maximum FoV of 300 mm.
It is mandatory to position the area of interest in the
center of the scan field. Use ExtrCombi mode when a
scan FoV > 25 cm is necessary.
412
Upper Extremities
413
Upper Extremities
WristUHR
Indications:
Spiral mode for High Resolution bone study of
thewrist, e.g. trauma, orthopedic indications etc.
Note: UHR mode has a maximum FoV of 300 mm. It is
mandatory to position the area of interest in the center
of the scan field.
A range of 6 cm will be done in 64.5 sec.
414
Upper Extremities
kV
Effective mAs/
Quality ref. mAs
Rotation time
Acquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
CTDIVol
Effective dose
WristUHR
120
80
2nd reconstr.
1.0 sec.
2 x 0.6 mm
0.6 mm
2.0 mm
1.0 mm
1.0 mm
0.8
2.0 mm
0.7 mm
U90u
U90u
8.6 mGy
Male: 0.01mSv
Female: 0.01 mSv
Hints
• This protocol is used for ultra high-resolution studies.
• For image reconstruction of soft tissue, use kernel
U30u.
415
Upper Extremities
ExtrRoutineUHR
Indications:
Spiral mode for Ultra High Resolution bone study, e.g.
trauma, orthopedic indications etc.
Note: UHR mode has a maximum FoV of 300 mm. It is
mandatory to position the area of interest in the center
of the scan field.
A range of 6 cm will be done in 64.5 sec.
416
Upper Extremities
kV
Effective mAs/
Quality ref. mAs
Rotation time
Acquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
CTDIVol
Effective dose
ExtrUHR
120
120
2nd reconstr.
1.0 sec.
2 x 0.6 mm
0.6 mm
2.0 mm
1.0 mm
1.0 mm
0.8
2.0 mm
0.7 mm
U90u
U90u
12.8 mGy
Male: 0.02 mSv
Female: 0.02 mSv
* Adjust the mAs value to the body region.
Hint
• For image reconstruction of soft tissue, use kernel
U30u.
417
Upper Extremities
ExtrCombi
Indications:
Spiral mode for the combination of bone and soft tissue studies, e.g. masses, trauma, disorders of the joint
etc.
A range of 15 cm will be done in 24.73 sec.
kV
Effective mAs/
Quality ref. mAs
Rotation time
Acquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
CTDIVol
Effective dose
ExtrCombi
120
90
2nd reconstr.
1.0 sec.
16 x 0.75 mm
0.75 mm
5.0 mm
1.0 mm
6.6 mm
0.55
5.0 mm
0.7 mm
B60s
B60s
7.0 mGy
Male: 0.02 mSv
Female: 0.02 mSv
Hint
• For image reconstruction of soft tissue, use kernel
B30s/B31s.
418
Upper Extremities
419
Lower Extremities
Overview
– KneeUHR
Spiral mode for routine high resolution wrist studies–
– FootUHR
Spiral mode for routine high resolution wrist studies
– ExtrRoutineUHR
Spiral mode for routine high resolution extremity
studies
– ExtrCombi
Spiral mode for the combination of thin slice and
routine studies
420
Lower Extremities
Hints in General
• Topogram: AP, 256 mm for joint studies.
• Patient positioning:
Depends on the region of examination.
In general, for bilateral studies, you should always
try to position the patient evenly whenever the
patient can comply.
• For knee scan:
Patient lying in supine position, feet first, promote
relaxation by placing Bocollo pillows between knees
and feet, bind feet together.
The only exceptions are extremely light patients. The
latter can remove the leg not being examined from
the gantry by bending it 90° at the hip and the knee
and placing the bottom of the same foot against the
gantry casing.
• For ankle and feet scan:
Patient lying in supine position, feet first.
Bind both ankles together if necessary to assure the
AP position of both feet.
Special positioning is not necessary since the real
time MPR could simulate any view of secondary
reconstruction.
421
Lower Extremities
• Retrospective reconstruction can be done:
a)Use B50s kernel for soft tissue evaluation.
b)For targeted FoV images on the affected side, it is
advisable to enter the side being examined in the
comment line.
• In case of 3D study only, use kernel B10 and at least
50% overlapping image reconstruction.
• To further optimize MPR image quality we recommend that you reduce one or more of the following:
collimation, reconstruction increment, and slice
width for image reconstruction.
Body Kernels
The endings “s” or “f” depend on the rotation time.
• As standard kernels for body tissue studies B30s or
B40s are recommended; softer images are obtained
with B20s or B10s (extremely soft). The kernels B31s
or B41s have about the same visual sharpness as
B30s, respectively, B40s, the image appearance,
however, is more agreeable due to a ”fine-grained”
noise structure; quite often, the low contrast detectability is improved by using B31s, B41s instead of
B30s, B40s.
• For higher sharpness, as is required e.g. in patient
protocols for cervical spine, shoulder, extremities,
thorax, the kernels B50s, B60s, B70s, B80s are available.
422
Lower Extremities
• The special kernels are mostly used for ”physical”
measurements with phantoms, e.g. for adjustment
procedures (S80s), for constancy and acceptance
tests (S80s, S90s), or for specification purposes
(S90s).
For special patient protocols, S80s and S90s are chosen, e.g. for osteo (S80s).
• For very high sharpness we recommended the U70u,
U80u, U90u for bone studies. UHR mode has a maximum FoV of 300 mm.
It is mandatory to position the area of interest in the
center of the scan field. Use ExtrCombi mode when a
scan FoV > 25 cm is necessary.
• In case of 3D study only, the mAs value can be
reduced by 50%. Use kernel B10s and at least 50%
overlapping for image reconstruction.
If the Pelvis region is included in the scan range, we
recommend at least 120 kV.
423
Lower Extremities
KneeUHR
Indications:
Spiral mode for ultra HiRes bone study, e.g. trauma,
orthopedic indications etc.
Note: UHR mode has a maximum FoV of 300 mm. It is
mandatory to position the area of interest in the center
of the scan field.
A range of 15 cm will be done in 43.67 sec.
424
Lower Extremities
kV
Effective mAs/
Quality ref. mAs
Rotation time
Acquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
CTDIVol
Effective dose
KneeUHR
120
140
2nd reconstr.
1.0 sec.
6 x 0.75 mm
0.75 mm
3.0 mm
1.0 mm
3.6 mm
0.8
3.0 mm
0.7 mm
U90u
U90u
12.7 mGy
Male: 0.04 mSv
Female: 0.04 mSv
Hints
• This protocol is used for ultra high-resolution studies.
• For image reconstruction of soft tissue, use kernel
U30u.
425
Lower Extremities
FootUHR
Indications:
Spiral mode for ultra HiRes bone study, e.g. trauma,
orthopedic indications etc.
Note: UHR mode has a maximum FoV of 300 mm. It is
mandatory to position the area of interest in the center
of the scan field.
A range of 15 cm will be done in 43.67 sec.
426
Lower Extremities
kV
Effective mAs/
Quality ref. mAs
Rotation time
Acquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
CTDIVol
Effective dose
FootUHR
120
120
2nd reconstr.
1.0 sec.
6 x 0.75 mm
0.75 mm
3.0 mm
1.0 mm
3.6 mm
0.8
3.0 mm
0.7 mm
U90u
U90u
10.9 mGy
Male: 0.03 mSv
Female: 0.03 mSv
Hints
• This protocol is used for ultra high-resolution studies.
• For image reconstruction of soft tissue, use kernel
U30u.
427
Lower Extremities
ExtrRoutineUHR
Indications:
Spiral mode for ultra HiRes bone study, e.g. trauma,
orthopedic indications etc.
Note: UHR mode has a maximum FoV of 300 mm. It is
mandatory to position the area of interest in the center
of the scan field.
A range of 6 cm will be done in 64.5 sec.
428
Lower Extremities
kV
Effective mAs/
Quality ref. mAs*
Rotation time
Acquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
CTDIVol
Effective dose
ExtrUHR
120
120
2nd reconstr.
1.0 sec.
2 x 0.6 mm
0.6 mm
2.0 mm
1.0 mm
1.0 mm
0.8
2.0 mm
0.7 mm
U90u
U90u
12.8 mGy
Male: 0.02 mSv
Female: 0.02 mSv
* Adjust the mAs value to the body region.
Hint
• For image reconstruction of soft tissue, use kernel
U30u.
429
Lower Extremities
ExtrCombi
Indications:
Spiral mode for the combination of bone and soft tissue studies, e.g. masses, trauma, disorders of the joint
etc.
A range of 15 cm will be done in 24.73 sec.
kV
Effective mAs/
Quality ref. mAs*
Rotation time
Acquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
CTDIVol
Effective dose
ExtrCombi
120
90
2nd reconstr.
1.0 sec.
16 x 0.75 mm
0.75 mm
5.0 mm
1.0 mm
6.6 mm
0.55
5.0 mm
0.7 mm
B60s
B60s
7.0 mGy
Male: 0.02 mSv
Female: 0.02 mSv
* Adjust the mAs value to the body region.
430
Lower Extremities
Hint
• For image reconstruction of soft tissue, use kernel
U30u.
431
Vascular
Overview
– HeadAngio
Spiral mode for routine head CTAngio studies
– HeadAngioVol
Spiral mode for axial and coronal HeadCTAngio studies
– CarotidAngio
Spiral mode for carotid CTAngio studies
– CarotidAngioVol
Spiral mode for axial and coronal carotid CTAngio
studies
432
Vascular
– ThorAngioRoutine/ThorAngioRoutine042s
Spiral mode for routine thorax CTAngio studies
– ThorAngioVol
Spiral mode for axial and oblique thorax CTAngio
studies
– ThorCardioECG/ThorCardioECG037s
Spiral mode for ECG-gated thorax CTAngio studies
– Embolism/Embolism042s
Spiral mode for routine pulmonary embolism studies
– BodyAngioRoutine
Spiral mode for body CTAngio studies
– BodyAngioFast/BodyAngioFast042s
Spiral mode for fast body CTAngio studies
– BodyAngioVol
Spiral mode for axial and coronal body CTAngio
studies
– AngioRunOff
Spiral mode for long distance extremity CTAngio
studies
– WholeBodyAngio
Spiral mode for whole body angio studies
433
Vascular
Hints in General
• Topogram: AP, 512/1024 or LAT 256
• Patient positioning:
Patient lying in supine position, arms positioned
comfortably above the head in the head-arm rest,
lower legs supported.
• Patient respiratory instructions: inspiration.
• Oral administration of contrast medium:
The use of water will not obscure the blood vessels
thus allowing CTA processing to be performed easily
afterwards.
• Be careful when examining pheochromocytoma
patients. Administration of an IV CM injection in
such cases may trigger a hypertensive crisis!
• To further optimize MPR image quality we recommend that you reduce one or more of the following:
collimation, reconstruction increment and slice
width for image reconstruction.
434
Vascular
Head Kernels
The endings “s” or “f” depend on the rotation time.
• For soft tissue head studies, the standard kernel is
H40s; softer images are obtained with H30s or H20s,
H10s, sharper images with H50s. The kernels H21s,
H31s, H41s yield the same visual sharpness as H20s,
H30s, H40s, the image appearance, however, is
more agreeable due to a ”fine-grained” noise structure; quite often, the low contrast detectability is
improved by using H31s, H 41s instead of H30s,
H40s. For the standard head protocols, we propose
H21s, H31s, H41s.
• High resolution head studies should be performed
with H60s, H70s (e.g. for dental and sinuses).
Body Kernels
• As standard kernels for body tissue studies B30s or
B40s are recommended; softer images are obtained
with B20s or B10s (extremely soft). The kernels B31s
or B41s have about the same visual sharpness as
B30s, respectively, B40s, the image appearance,
however, is more agreeable due to a ”fine-grained”
noise structure; quite often, the low contrast detectability is improved by using B31s, B41s instead of
B30s, B40s.
435
Vascular
• For higher sharpness, as is required e.g. in patient
protocols for cervical spine, shoulder, extremities,
thorax, the kernels B50s, B60s, B70s, B80s are available.
• In case of 3D study only, the mAs value can be
reduced by 50%. Use kernel B10s and at least 50%
overlapping for image reconstruction.
436
Vascular
437
Vascular
HeadAngio
Indications:
Spiral mode for cerebral CT Angios, e.g. cerebral vascular abnormalities, tumors and follow up studies etc.
A range of 80 mm will be covered in 3.9 sec.
HeadAngio
kV
100
140
Effective mAs/
Quality ref. mAs
Rotation time
0.5 sec.
Acquisition
16 x 0.75 mm
Slice collimation 0.75 mm
Slice width
4.0 mm
Feed/Rotation
13.8 mm
Pitch Factor
1.15
Increment
4.0 mm
Kernel
H20f
19.7 mGy
CTDIVol
Effective dose
Male: 0.71 mSv
Female: 0.76 mSv
438
2nd reconstr.
1.0 mm
0.7 mm
H10f
Vascular
Contrast medium IV injection
Start delay
18 sec.
Flow rate
3.5 ml/sec.
Total amount
75 ml
Hint
• Use of CARE Bolus with monitoring scans positioned
at the level of the basilar artery or carotid artery. Set
the trigger threshold at 120 HU, or use manual triggering.
439
Vascular
HeadAngioVol
Indications:
Spiral mode for cerebral CT Angios, e.g. cerebral vascular abnormalities, tumors and follow-up studies etc.
Two recon jobs are predefined for reconstruction: the
first for axial, the second for coronal studies in 3D
images display view.
The coronal view images will be reconstructed as MIP
images.
A range of 12.0 cm will be covered in 5.35 sec.
kV
Effective mAs/
Quality ref. mAs
Rotation time
Acquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
CTDIVol
Effective dose
440
HeadAngio
100
140
2nd reconstr.
0.5 sec.
16 x 0.75 mm
0.75 mm
4.0 mm
4.0 mm
13.8 mm
1.15
4.0 mm
4.0 mm
H20f
H10f
19.7 mGy
Male: 0.9 mSv
Female: 0.95 mSv
Vascular
Contrast medium IV injection
Start delay
18 sec.
Flow rate
3.5 ml/sec.
Total amount
75 ml
Hint
• Use of CARE Bolus with monitoring scans positioned
at the level of the basilar artery or carotid artery. Set
the trigger threshold at 120 HU, or use manual triggering.
441
Vascular
CarotidAngio
Indications:
CT angiography of the carotid arteries, e.g. carotid
stenosis or occlusion, coarse plaques abnormalities of
the carotids or vertebral arteries, etc.
A range of 20 cm including the aorta arch will be covered in 8.25 sec.
kV
Effective mAs/
Quality ref. mAs
Rotation time
Acquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
CTDIVol
Effective dose
442
CarotidAngio
120
120
2nd reconstr.
0.5 sec.
16 x 0.75 mm
0.75 mm
5.0 mm
1.0 mm
13.8 mm
1.15
5.0 mm
0.7 mm
B30f
B20f
9.4 mGy
Male: 2.02 mSv
Female: 1.89 mSv
Vascular
Contrast medium IV injection
Start delay
4 – 20 sec.
Flow rate
4 ml/sec.
Total amount
90 ml
Hints
• CARE Bolus may be used to optimize the bolus timing.
• Set the ROI for monitoring scan in the aortic arch
with triggering threshold of 120 HU, or use manual
triggering.
• High quality 2D & 3D postprocessing can be achieved
using a thin slice thickness and 50% overlapping
increments.
• Thick MPRs and ThinMIPs can be created very quickly
on the 3D Task Card by just clicking on the appropriate icons. The thickness of these reconstructed
images can be defined by clicking on the icons with
the right mouse to open the entry field.
443
Vascular
CarotidAngioVol
Indications:
CT angiography of the carotid arteries, e.g. carotid
stenosis or occlusions, coarse plaques abnormalities of
the carotids and vertebral arteries, etc.
Two recon jobs are predefined for reconstruction: the
first for axial, the second for coronal studies in 3D
images display view.
The coronal view images will be reconstructed as MIP
images.
A range of 20 cm including the aorta arch will be covered in 8.25 sec.
.
444
Vascular
kV
Effective mAs/
Quality ref. mAs
Rotation time
Acquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
CTDIVol
Effective dose
CarotidAngio
120
120
2nd reconstr.
0.5 sec.
16 x 0.75 mm
0.75 mm
5.0 mm
3.0 mm
13.8 mm
1.15
5.0 mm
3.0 mm
B30f
B30f
9.4 mGy
Male: 2.02 mSv
Female: 1.89 mSv
445
Vascular
Contrast medium IV injection
Start delay
4 – 6 sec.
Flow rate
4 ml/sec.
Total amount
90 ml
Hints
• CARE Bolus may be used to optimize the bolus timing.
• Set the ROI for monitoring scan in the aortic arch
with triggering threshold of 120 HU, or use manual
triggering.
• High quality 2D & 3D postprocessing can be achieved
using a thin slice thickness and 50% overlapping
increments.
• Thick MPRs and ThinMIPs can be created very quickly
on the 3D Task Card by just clicking on the appropriate icons. The thickness of these reconstructed
images can be defined by clicking on the icons with
the right mouse to open the entry field.
For further information about 3D reconstructions
please refer to the chapter "WorkStream 4D" or the
chapter "3D" in the Application Guide "Clinical Applications 2".
446
Vascular
447
Vascular
ThorAngioRoutine/
ThorAngio042s
Indications:
Spiral mode for thoracal CT Angios, e.g. visualization
of tumors, metastases, lymphoma, lymph nodes, vascular anomalies etc.
A range of 40 cm will be covered in 15.49/13.01 sec.
kV
Effective mAs/
Quality ref. mAs
Rotation time
Acquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
CTDIVol
Effective dose
448
ThorAngio
120
120
2nd reconstr.
0.5/0.42 sec.
16 x 0.75 mm
0.75 mm
5.0 mm
1.0 mm
13.8 mm
1.15
5.0 mm
0.7 mm
B30f
B20f
9.4 mGy
Male: 6.14 mSv
Female: 7.6 mSv
Vascular
Contrast medium IV injection
Start delay
10 – 15 sec.
Flow rate
2.5 ml/sec.
Total amount
80 ml
Hints
• CARE Bolus may be used to optimize the bolus timing.
• Set the ROI for monitoring scan in the aortic arch
with triggering threshold of 120 HU, or use manual
triggering.
• Thick MPRs and ThinMIPs can be created very quickly
on the 3D Task Card by just clicking on the appropriate icons. The thickness of these reconstructed
images can be defined by clicking on the icons with
the right mouse to open the entry field.
• Editing is necessary for SSD display of the thoracic
aorta without the bone.
449
Vascular
ThorAngioVol
Indications:
Spiral mode for thoracic CT Angios, e.g. visualization of
tumors, metastases, lymphoma, lymph nodes, vascular anomalies etc.
Two recon jobs are predefined for reconstruction: the
first for axial, the second for double-oblique studies in
3D images display view.
The oblique view images will be reconstructed as MIP
images.
A range of 40 cm will be covered in 15.49 sec.
450
Vascular
kV
Effective mAs/
Quality ref. mAs
Rotation time
Acquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
CTDIVol
Effective dose
ThorAngio
120
120
2nd reconstr.
0.5 sec.
16 x 0.75 mm
0.75 mm
5.0 mm
3.0 mm
13.8 mm
1.15
5.0 mm
3.0 mm
B30f
B30f
9.4 mGy
Male: 6.14 mSv
Female: 7.6 mSv
Contrast medium IV injection
Start delay
10 – 15 sec.
Flow rate
2.5 ml/sec.
Total amount
80 ml
Hints
• CARE Bolus may be used to optimize the bolus timing.
• Set the ROI for monitoring scan in the aortic arch
with triggering threshold of 120 HU, or use manual
triggering.
451
Vascular
ThorCardioECG/
ThorCardioECG037s
Indications:
This is a spiral scanning protocol using an ECG gating
technique for thorax CT Angio studies, e.g. visualization of pulmonary embolism, coronary stenosis, vascular anomalies etc.
A range of 25 cm including the aorta arch will be covered in 23.73 sec.
452
Vascular
kV
Effective mAs/
Quality ref. mAs
Rotation Time
Acquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
Temp. resolution*
CTDIVol
Effective dose
ThorCorECG
120
440
2nd reconstr.
0.42/0.37 sec.
16 x 0.75 mm
0.75 mm
3.0 mm
1.0 mm
4.6/4.1 mm
0.38/0.34
3.0 mm
0.7 mm
B30f
B20f
up to 105/
86 ms
34.3 mGy
Male: 15.19 mSv
Female: 18.02 mSv
*. depends on heart rate
Contrast medium IV injection
Start delay
10 – 15 sec.
Flow rate
2.5 ml/sec.
Total amount
80 ml
Hints
• CARE Bolus may be used to optimize the bolus timing.
• Set the ROI for monitoring scan in the aorta thoracalis with triggering threshold of 120 HU, or use manual triggering.
453
Vascular
454
Vascular
Embolism/Embolism042s
Indications:
Spiral mode for Pulmonary Emboli studies.
A range of 30 cm will be covered in 16.63/13.97 sec.
kV
Effective mAs/
Quality ref. mAs
Rotation Time
Acquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
CTDIVol
Effective dose
Embolism
100
140
2nd reconstr.
0.5/0.42 sec.
16 x 0.75 mm
0.75 mm
5.0 mm
1.0 mm
9.6 mm
0.8
5.0 mm
0.7 mm
B30f
B20f
7.0 mGy
Male: 3.63 mSv
Female: 4.33 mSv
455
Vascular
Contrast medium IV injection
Start delay
4 – 10 sec.
Flow rate
4 ml/sec.
Total amount
80 – 100 ml
Hints
• CARE Bolus may be used to optimize the bolus timing.
• Set the ROI for monitoring scan in the aortic arch
with triggering threshold of 120 HU, or use manual
triggering.
456
Vascular
BodyAngioRoutine
Indications:
Spiral mode for abdominal CT Angio studies.
A typical study in a range of 40 cm will be covered in
15.49 sec.
kV
Effective mAs/
Quality ref. mAs
Rotation Time
Acquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
CTDIVol
Effective dose
BodyAngio
120
140
2nd reconstr.
0.5 sec.
16 x 0.75 mm
0.75 mm
5.0 mm
1.0 mm
13.8 mm
1.15
5.0 mm
0.7 mm
B30f
B20f
10.9 mGy
Male: 7.16 mSv
Female: 8.87 mSv
457
Vascular
Contrast medium IV injection
Start delay
10 – 15 sec.
Flow rate
3.0 – 3.5 ml/sec.
Total amount
100 – 120 ml
Hints
• CARE Bolus may be used to optimize bolus timing.
• Set the ROI for monitoring scan in the aorta abdominalis with triggering threshold of 120 HU, or use
manual triggering.
• Do not administer oral contrast medium, as this
impairs the editing of MIP/SSD/VRT images.
• Use water as oral contrast.
• The length of the CM spiral in the topogram (via the
table position) can be planned exactly by means of
pre-contrast images.
• Precontrast images are used to visualize calcification.
• Excellent postprocessed images can be created using
a thin slice thickness and overlapping images, i.e.
the increment should be smaller than the slice thickness.
458
Vascular
BodyAngioFast/
BodyAngioFast042s
Indications:
Spiral mode for abdominal CT Angio studies, longer
coverage and larger vessels.
A typical study of the whole aorta including its branchiocephalic trunk and iliac arteries in a range of 60 cm
will be covered in 11.87 sec.
kV
Effective mAs/
Quality ref. mAs
Rotation Time
Acquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
CTDIVol
Effective dose
BodyAngio
Fast
120
140
2nd reconstr.
0.5 sec.
16 x 1.5 mm
1.5 mm
5.0 mm
2.0 mm
27.6 mm
1.15
5.0 mm
1.4 mm
B30f
B20f
9.8 mGy
Male: 9.76 mSv
Female: 13.99 mSv
459
Vascular
A typical study of the whole aorta including its branchiocephalic trunk and iliac arteries in a range of 40 cm
will be covered in 13.01 sec.
kV
Effective mAs/
Quality ref. mAs
Rotation Time
Acquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
CTDIVol
Effective dose
BodyAngio
Fast
120
140
2nd reconstr.
0.42 sec.
16 x 0.75 mm
0.75 mm
5.0 mm
1.0 mm
13.8 mm
1.15
5.0 mm
0.7 mm
B30f
B20f
10.9 mGy
Male: 7.16 mSv
Female: 8.87 mSv
Contrast medium IV injection
Start delay
10 sec.
Flow rate
3.5 ml/sec.
Total amount
120 ml
Hints
• CARE Bolus may be used to optimize bolus timing.
• Set the ROI for monitoring scan in the aorta abdominalis with triggering threshold of 120 HU, or use
manual triggering.
• Do not administer oral contrast medium, as this
impairs the editing of MIP/SSD/VRT images.
• Use water as oral contrast.
• The length of the CM spiral in the topogram (via the
table position) can be planned exactly by means of
pre-contrast images.
460
Vascular
• Precontrast images are used to visualize calcification.
• Excellent postprocessed images can be created using
a thin slice thickness and overlapping images, i.e.
the increment should be smaller than the slice thickness.
461
Vascular
462
Vascular
BodyAngioVol
Indications:
Spiral mode for abdominal CT Angio studies.
Two recon jobs are predefined for reconstruction: the
first for axial, the second for coronal studies in 3D
images display view. The coronal view images will be
reconstructed as MIP images.
A typical study in a range of 40 cm will be covered in
15.49 sec.
463
Vascular
kV
Effective mAs/
Quality ref. mAs
Rotation Time
Acquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
CTDIVol
Effective dose
464
BodyAngio
120
140
2nd reconstr.
0.5 sec.
16 x 0.75 mm
0.75 mm
5.0 mm
3.0 mm
13.8 mm
1.15
5.0 mm
3.0 mm
B30f
B30f
10.9 mGy
Male: 7.16 mSv
Female: 8.87 mSv
Vascular
Contrast medium IV injection
Start delay
10 – 25 sec.
Flow rate
3.0 – 3.5 ml/sec.
Total amount
100 – 120 ml
Hints
• CARE Bolus may be used to optimize the bolus timing.
• Set the ROI for monitoring scan in the aorta abdominalis with triggering threshold of 120 HU, or use
manual triggering.
• Do not administer oral contrast medium, as this
impairs the editing of MIP/SSD/VRT images.
• Use water as oral contrast.
• The length of the CM spiral in the topogram (via the
table position) can be planned exactly by means of
pre-contrast images.
• Precontrast images are used to visualize calcification.
• Excellent postprocessed images can be created using
a thin slice thickness and overlapping images, i.e.
the increment should be smaller than the slice thickness.
465
Vascular
466
Vascular
AngioRunOff
Indications:
For CT Angio spiral studies of the extremities.
A range of 80 cm will be done in 18.54 sec.
kV
Effective mAs/
Quality ref. mAs
Rotation Time
Acquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
CTDIVol
Effective dose
AngioRunOff
120
140
2nd reconstr.
0.5 sec.
16 x 1.5 mm
1.5 mm
6.0 mm
2.0 mm
22.8 mm
0.95
6.0 mm
1.4 mm
B30f
B20f
9.8 mGy
Male: 6.43 mSv
Female: 6.19 mSv
467
Vascular
Contrast medium IV injection
Start delay
10 – 20 sec.
Flow rate
3.0 – 3.5 ml/sec.
Total amount
120 – 150 ml
Hints
• CARE Bolus may be used to optimize the bolus timing.
• Set the ROI for monitoring scan with triggering
threshold of 120 HU, or use manual triggering.
• If Topo length 1024 mm is not long enough, you can
also choose the 1540 mm long Topogram.
• Position the patient as feet first. Bend the feet
together if necessary.
468
Vascular
WholeBodyAngio
Indications:
For CTA studies of the whole body.
A range of 80 cm will be done in 15.49 sec.
469
Vascular
kV
Effective mAs/
Quality ref. mAs
Rotation Time
Acquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
CTDIVol
Effective dose
470
WholeBody
120
140
2nd reconstr.
0.5 sec.
16 x 1.5 mm
1.5 mm
6.0 mm
2.0 mm
27.6 mm
1.15
6.0 mm
1.4 mm
B30f
B20f
9.8 mGy
Male: 13.41 mSv
Female: 14.9 mSv
Vascular
Contrast medium IV injection
Start delay
10 – 20 sec.
Flow rate
3.0 – 3.5 ml/sec.
Total amount
120 – 150 ml
Hints
• CARE Bolus may be used to optimize the bolus timing.
• Set the ROI for monitoring scan with triggering
threshold of 120 HU, or use manual triggering.
• If Topo length 1024 mm is not long enough, you can
also choose the 1540 mm long Topogram.
471
Vascular
472
Vascular
473
Specials
Overview
The examination protocols designed for some of these
applications are under the “Special” folder.
Trauma
In any trauma situation, time means life and the quality of life for the survivor. In order to facilitate the
examinations, five protocols are provided.
– Trauma
This is a one-range mode for fast screening
– TraumaVol
This is an one-range mode for fast screening for
coronal and sagittal studies
– PolyTrauma
This is a combined mode for the examination of multiple ranges, e.g. Head, Neck, Thorax, Abdomen and
Pelvis
– HeadTrauma
Spiral head protocol for trauma studies with a FoV of
500 and therefore lowered image quality
– HeadTraumaSeq
Sequential head protocol for trauma studies, with a
FoV of 500 and therefore lowered image quality
474
Specials
Interventional CT
– Biopsy
This is the multislice biopsy mode. With three times
0.6 mm, the images will be reconstructed and displayed for each scan.
– BiopsySingle
This is a single multislice biopsy mode. One 10mm
slice is aquired.
CARE Vision
– CARE Vision
The CARE Vision protocol is a spiral mode without
table feed, using a three times 4.8 mm slice thickness.
– CARE VisionSingle
The CARE Vision protocol is a spiral mode without
table feed, using a 10 mm slice thickness.
– CARE VisionBone
The CARE Vision protocol is a spiral mode without
table feed, using a three times 4.8 mm slice thickness with a bone kernel.
Test Bolus
– TestBolus
This mode can be used to test the start delay of optimal enhancement after the contrast medium injection.
475
Specials
Trauma
In any trauma situation, time means life and the quality of life for the survivor.
General Information
• Check that the emergency drug trolley is wellstocked and that all accessories such as in-room oxygen supply, respirator and resuscitation equipment
that may be required during the examination are in
workIng order.
• Prepare the CT room before admitting the patient,
e.g., load IV contrast into the injector.
• Know, observe and practice the standard hospital
operating policy for handling a patient in distress
e.g. Code Blue for cardiac and respiratory arrest.
• Any possible injuries to the spinal column should be
determined before beginning the examination and
taken into account when shifting and positioning
the patient.
• Ensure that all vital lines e.g., IV tubing and oxygen
tubing are not trapped under the patient or between
the table and the cradle. Make allowance for the
length of tubing required for the topogram scan
range.
• Never leave patients unattended at any time during
the procedure.
• Observe the vital signs e.g. ECG, respiration, etc. at
all times during the procedure.
• Finish the examination in the shortest possible time.
476
Specials
477
Specials
Trauma
Indications:
This is a one-range mode for fast screening for emergency studies.
A scan range of 50.4 cm will be done in 10.13 s.
kV
Effective mAs/
Quality ref. mAs
Rotation time
Acquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
CTDIVol
Effective dose
478
Trauma
120
140
0.5 sec.
16 x 1.5 mm
1.5 mm
7.0 mm
27.6 mm
1.15
7.0 mm
B31f
9.8 mGy
Male: 7.8 mSv
Female: 11.9 mSv
Specials
TraumaVol
Indications:
This is a one-range mode for fast screening for emergency studies.
A scan range of 75 cm will be done in 14.59 sec.
kV
Effective mAs/
Quality ref.
mAs
Rotation time
Acquisition
Slice
collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
CTDIVol
Effective dose
Trauma
120
140
2nd recon.
3rd recon.
0.5 sec.
16 x
1.5 mm
1.5 mm
7.0 mm
7.0 mm
27.6 mm
1.15
7.0 mm
7.0 mm
B30f
B30f
9.8 mGy
Male: 12.86 mSv
Female: 14.41 mSv
7.0 mm
7.0 mm
B30f
479
Specials
PolyTrauma
Indications:
Two combined ranges with two Topos are predefined,
head with neck and thorax with abdomen for emergency studies.
A scan range of 12/14 cm will be done in 6.5/4.89 sec.
kV
Effective mAs/
Quality ref. mAs
Rotation time
Acquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
CTDlVol
Effective dose
480
Head
120
260
0.75 sec.
16 x 1.5 mm
1.5 mm
6.0 mm
18.0 mm
0.75
6.0 mm
H31s
49.4 mGy
Male:
2.55 mSv
Female: 2.79 mSv
Specials
kV
Effective mAs/
Quality ref. mAs
Rotation time
Acquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
CTDlVol
Effective dose
Neck
120
150
0.5 sec.
16 x 1.5 mm
1.5 mm
5.0 mm
18.0 mm
0.75
5.0 mm
B31f
10.5 mGy
Male: 1.81 mSv
Female: 2.06 mSv
481
Specials
Take a new Topogram for the thorax and abdomen
range.
A scan range of 25/20 cm will be done in 11.92/
9.83 sec.
kV
Effective mAs/
Quality ref. mAs
Rotation time
Acquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
CTDlVol
Effective dose
482
Thorax
120
110
0.75 sec.
16 x 1.5 mm
1.5 mm
7.0 mm
18.0 mm
0.75
7.0 mm
B41s
7.7 mGy
Male:
3.31 mSv
Female: 4.35 mSv
Specials
kV
Effective mAs/
Quality ref. mAs
Rotation time
Acquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
CTDlVol
Effective dose
AbdPelvis
120
160
0.75 sec.
16 x 1.5 mm
1.5 mm
7.0 mm
18.0 mm
0.75
7.0 mm
B31s
11.2 mGy
Male: 4.59 mSv
Female: 5.89 mSv
483
Specials
HeadTrauma
A spiral mode for emergency head studies with a max.
FoV of 500 mm.
A scan range of 12 cm will be covered in 20.18 sec.
kV
Effective mAs/
Quality ref. mAs
Rotation time
Acquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
CTDIVol
Effective dose
484
Head
120
320
1.0 sec.
16 x 0.75 mm
0.75 mm
6.0 mm
6.6 mm
0.55
6.0 mm
H31s
67.5 mGy
Male: 3.16 mSv
Female: 3.4 mSv
2nd reconstr.
6.0 mm
6.0 mm
H60s
Specials
HeadTraumaSeq
A sequence mode for emergency head studies with a
max. FoV of 500 mm.
A scan range is predefined with 11.7 cm.
kV
Effective mAs/
Quality ref. mAs
Rotation time
Acquisition
Slice collimation
Slice width
Feed/Scan
Kernel
CTDlVol
Effective dose
HeadSeq
120
310
1.0 sec.
12 x 1.5 mm
1.5 mm
9.0 mm
18.0 mm
H31s
59.5 mGy
Male:
2.72 mSv
Female:
2.79 mSv
9.0 mm
H60s
485
Specials
Additional Important Information
• You can access which protocol is the emergency protocol.
• For long range scanning, please pay attention to the
mark of scannable range on the table mattress while
positioning the patient.
• In some cases, it might be advisable to position the
patient feet first so that there will be more space for
the intensive care equipment around.
• The Trauma protocol is predefined with a Topo
length of 1024 mm, the Poly Trauma protocol with a
Topo length of 1536 mm.
Note: You should press the “Hold Measurement“ button whenever the range shown on the real time
growing topogram is long enough, in order to avoid
unnecessary radiation.
486
Specials
487
Specials
Biopsy
To facilitate CT interventional procedures, we created
dedicated multislice and single slice sequential modes.
Any of these protocols can be appended to a spiral protocol for CT interventional procedures, such as biopsy,
abscess drainage, pain therapy, minimum invasive
operations, joint studies, and arthrograms. Adjust the
mAs according to the body region before loading.
10 scans are predefined. You can repeat it by clicking
the chronicle with the right mouse button and select
repeat, or simply change the number of scans to 99
before you start the first scan.
You can “Append” any routine protocol after the interventional procedure for a final check and documentation, e.g. a short range of spiral scanning for the biopsy
region.
The table height can be adjusted to a minimum of
255 mm.
488
Specials
For routine use of Biopsy use Biopsy:
With three times 6 mm slice thickness the images will
be reconstructed and displayed.
The scan length is 1.3 cm.
kV
Effective mAs/
Quality ref. mAs
Rotation time
Acquisition
Slice collimation
Slice width
Feed/Scan
Kernel
CTDlVol
Biopsy
120
50
0.5 sec.
12 x 1.5 mm
1.5 mm
4.5 mm
0.0 mm
B30f
3.6 mGy
489
Specials
Biopsy Single
If you want to use a single Slice use
BiopsySingle:
One 10 mm slice images will be reconstructed and displayed for each scan.
kV
Effective mAs/
Quality ref. mAs
Rotation time
Acquisition
Slice collimation
Slice width
Feed/Scan
Kernel
CTDlVol
490
Biopsy Single
120
50
0.5 sec.
2 x 5.0 mm
5.0 mm
10.0 mm
0.0 mm
B30f
3.2 mGy
Specials
CARE Vision
Is a CT Fluoroscopic mode for interventions with 1 or 3
combined slices and up to 10 images per sec. displayed
(depending on the hardware configuration).
The Basics
Any of the predefined CARE Vision scan protocols can
be appended to a spiral protocol for interventional procedures, such as biopsies, abscess drainage, pain therapy, minimum invasive operations, joint studies, and
arthograms.
The raw data will not be available for image reconstruction. In case of the FoV must be changed due to
movement, insert a control scan by clicking on the
chronicle with the right mouse button.
You can “Append” any routine protocol after the interventional procedure for a final check and documentation, e.g. a short range of spiral scanning for the biopsy
region.
With gantry tilt 0° the table height can be adjusted to
minimum vertical position of 255 mm.
Automatic Patient Instruction (API) is not possible for
CARE Vision.
You can change the gantry tilt while the protocol is
loaded.
491
Specials
CAREVision
For routine use of CAREVision use the scan protocol
CAREVision:
The image will be reconstructed and displayed using
three times 6 mm slice thickness and a kernel of B30 in
the CARE View mode.
kV
Effective mAs/
Quality ref. mAs
Rotation time
Acquisition
Slice collimation
Slice width
Feed/Scan
Kernel
Increment
CTDIvol
492
CAREVision
120
30
0.5 sec.
12 x 1.5 mm
1.5 mm
6.0 mm
0.0
B30f
1.0 mm
2.2 mGy
Specials
CAREVisionSingle
If you want to use a single Slice use the scan protocol
CAREVisionSingle:
With one time 10 mm slice thickness and a kernel of
B30, the images will be reconstructed and displayed.
kV
Effective mAs/
Quality ref. mAs
Rotation time
Acquisition
Slice collimation
Slice width
Feed/Scan
Kernel
Increment
CTDIvol
CAREVision
120
30
0.5 sec.
2 x 5.0 mm
5.0 mm
10.0 mm
0.0
B30f
1.0 mm
1.9 mGy
493
Specials
CAREVisionBone
For bone biopsies with a higher kernel use the scan
protocol CAREVisionBone:
With three times 6.0 mm slice thickness and a kernel of
B60, the images will be reconstructed and displayed in
the CARE View mode.
kV
Effective mAs/
Quality ref. mAs
Rotation time
Acquisition
Slice collimation
Slice width
Feed/Scan
Kernel
Increment
CTDIvol
494
CAREVision
120
30
0.5 sec.
12 x 1.5 mm
1.5 mm
6.0 mm
0.0
B60f
1.0 mm
2.2 mGy
Specials
CAREView
The item CAREView indicates when a combined image
is displayed. When the number of Slice Positions per
scan is three, CARE View is activated and shown on the
routine card.
On the recon card you can select the CARE View image
position, depending on the patient position, e.g. if you
want to display the images which is closer to the head
of the patient on the left hand side of the image area,
select Head – Left.
495
Specials
CARE Vision layout for Single image display
CARE Vision layout for CAREView large-size display
496
Specials
CARE Vision layout for CAREView equal-size display
The CAREView image display depends on the system
configuration, for further information, please contact
your Siemens representative.
497
Specials
HandCARE
HandCARE is a dedicated algorithm for dose reduction
during the interventional procedure.
It switches off the x-ray exposure for a 100° angle
between three different positions (10:00, 12:00 and
2:00 o’ clock).
X-Ray off
X-Ray on
Thus provides a significant dose saving to the operator’s hand, while keeping the image quality constant.
498
Specials
The HandCARE item list offers “None“ and three selectable protection areas. You can select this values independent of the current or a future patient position. The
list elements are sorted clockwise from a view to the
front of the gantry.
Values: {“None“, “10:00 o’ clock”, “12:00 o’ clock”,
“2:00 o’ clock}, default: “None“, label: “HandCARE“.
499
Specials
The HandCARE position is graphically displayed on the
Routine subtask card.
HandCARE positions
500
Specials
Application Procedure
1.Load and scan a spiral protocol of the interested
body region.
2.Scroll through the images to define a target slice.
3.Click on “Same TP” under Table position, in the routine card. Move the table to the desired table position.
4.Turn on the light marker on the Gantry to localize the
entry point, and then start patient preparation.
5.Open the Patient Model Dialog. Check the checkbox “Append”. Select one of the predefined “CAREVision” scan protocols under “Specials“ protocols and
then click “OK”.
6.Select the “HandCARE” position on the scan card.
7.Click “Load” and the “Cancel/Move” to scan on the
preselected table position.
8.Press the footswitch to start the Fluoroscopy.
501
Specials
You can change
the following Scan
Parameters on the
examination taskcard
during radiation:
•Gantry Tilt
•Table position
•Table movement type
•Feed in/Feed out
Hints
• Press the footswitch either to position the needle or
to control the needle position.
• Without HandCARE every time you release the footswitch max. the last scanned 3 sec. of acquired
images are automatically saved to the local database.
• With HandCARE every time you release the footswitch one image per rotation is automatically saved
to the local database.
• If CARE View is used, only the middle slice of the last
image is displayed after release of the footswitch.
502
Specials
Additional important information
Reference Image Display
To display a reference image during the examination
procedure, the Viewing task card can be displayed on a
second monitor
Additional Dose Information
CARE Vision uses scan parameters and operating conditions, which are unique and may require additional
care and radiation protection measures.
• To avoid unnecessary exposure in any case, the scan
time should be kept as short as possible.
503
Specials
Radiation exposure to patients
• CARE Vision applies continuous exposure at moderate mA levels.
• Due to the potentially long scan times and the limited scan volume, the dose for certain slices may
increase to levels significantly higher than those
known from standard CT applications.
• The patient’s exposure levels is usually estimated by
CTDIvol.
• This unit is designed to give the average dose in the
scanned volume.
• Before starting the scan, the dose rate (CTDIvol in
mGy per second) is displayed on the monitor.
• During the CARE Vision scan, the accumulated dose
(CTDI vol) reflecting the patient exposure is displayed on the monitor. The display scale ranges from
zero to 3000 mGy.
• If the table is shifted during the examination, the
accumulated dose will be distributed to different
slices and will be lower than indicated by the display.
• When a new scan is loaded, the dose display starts
again from zero.
504
Specials
Radiation exposure to personnel
During the procedure the physician is in the scan room
and close to the exposed scan plane.
• Take special care to avoid excessive and unnecessary
radiation exposure.
Protection against primary x-ray exposure:
• In the worst case, any body parts in the scan plane
may receive approximately the accumulated dose as
shown on the CTDI display.
• Avoid being directly exposed to the x-ray beam.
Protection against stray radiation:
• The x-ray beam is limited to the imaged scan volume, but a significant portion of the x-rays is scattered and distributed in the scan room (stray radiation).
• Wear protective clothing to reduce exposure.
• A table with measured data of this stray radiation is
included in the chapter on Safety in your SOMATOM
Operator Manual.
505
Specials
TestBolus
Indications:
This mode can be used to test the start delay of an optimal enhancement after the contrast medium injection.
kV
Effective mAs/
Quality ref. mAs
Rotation time
Acquisition
Slice collimation
Slice width
Feed/Scan
Kernel
CTDlVol
506
TestBolus
120
40
0.5 sec.
2 x 5.0 mm
5.0 mm
10.0 mm
0.0 mm
B40f
2.5 mGy
Specials
507
Radiation Therapy
Radiation Therapy Planning
The SOMATOM Sensation Cardiac are very well suited
for Radiation Therapy Planning (RTP) with its ergonomic enlarged gantry opening and its scan plane
located only 35cm from the gantry front.
Using the external laser markers and the connected
workstations, the system provides the complete procedure of Virtual Simulation in RTP much faster and easier. After only a few minutes of CT scanning, the
patient can leave the department directly. The SOMATOM Sensation Cardiac table supports all kinds of
patient positioning, immobilization and verification
accessories ensuring the same patient position as on
the LINAC table (e.g. RT table tops, Beekleys, masks, IR
cameras, new laser guidance system).
If non-diagnostic CT examinations have to be done,
dedicated low dose protocols for virtual simulation are
provided.
Due to the fact that external simulation SW might not
handle complete spiral data sets, sequence scans are
available as well.
The treatment planning can be done at a later time
independently of the patient being present. Applications for virtual simulation are available on the COHERENCE Dosimetrist or the LEONARDO workstation, from
where the results can be sent to the LINAC for patient
treatment.
508
Radiation Therapy
COHERENCE Dosimetrist
Remember the challenges of Radiation Therapy…
• Precisely locate and delineate the tumor volume
• Establish reliable external references on the patient
surface
509
Radiation Therapy
• Spare as much healthy tissue as possible
• Precisely position the patient for treatment throughout the entire course of treatment (typically 25-35
fractions)
510
Radiation Therapy
Benefits
• No limitations for patient set-up within 82 cm gantry
opening and the ability to scan at a low table position thereby maximizing gantry "freespace"
• Complete anatomical visualization for optimized
localization and dose calculation with extended 82
cm FOV
82 cm
Display FoV
50 cm
Scan FoV
511
Radiation Therapy
• High volume coverage in time (20*1.2 mm in 0.5 s)
minimizing motion artifacts and breath hold time
RT edition
Single-slice CT
4 generation
Slice 2.5 mm
Rot 1 s
Slice 1x 2 mm
Rot 1 s
4 slice scanner
Slice 1.5 mm
Rot
0.5 s
Pitch
1.5
Volume Coverage
65 cm in 10 s
Pitch 1 s
Volume Coverage
15 cm in 10 s
Pitch 2
Volume Coverage
4 cm in 10 s
• Thin slice imaging for high quality DRRs (Digitally
Reconstructed Radiograph) and MPRs, especially for
conformal 3D therapy and IMRT (Intensity Modulated Radiation Therapy)
• Complete CT simulation solution providing higher
geometrical accuracy of table and lasers and the
integration of flat table inserts
512
Radiation Therapy
• New long-range gantry laser lights with position
adjustment possible without opening gantry covers
for easier installation and synchronization with room
RTP lasers
• Integrated solution for Virtual Simulation with syngo
based COHERENCE Dosimetrist or VSim on
LEONARDO
• Display of gantry tilt angle in 0.5 degree increments
• Greater accuracy of x-ray tube positioning for Topogram scans: +/- 1 degree
• Simplified horizontal positioning of the table. During
an examination, a table feed position can be stored
enabling fast and easy repositioning of a patient
back to the previous table position.
• Proven DICOM connectivity to radiation therapy
planning SW
513
Radiation Therapy
Workflow
Simulation:
1.Patient positioning on CT table
(external lasers)
2.Patient marking
(external lasers)
3.CT scan
4.Offline: Virtual Simulation and Dose Planning
Treatment:
1.Patient positioning on the therapy table
(external lasers)
2.Verification of irradiation area
(light field projection)
3.Treatment
The default scan protocols provide the first recon job
used for soft tissue studies and the second recon job
for bone structures.
514
Radiation Therapy
515
Radiation Therapy
RT_Head
Indications:
Spiral mode for routine radio therapy head studies.
A range of 12 cm will be covered in 20.18 sec.
kV
Effective mAs/
Quality ref. mAs
Rotation time
Acquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
CTDIVol
Effective dose
516
Head
120
320
2nd recon.
1.0 sec.
16 x 0.75 mm
0.75 mm
3.0 mm
3.0 mm
6.6 mm
0.55
3.0 mm
3.0 mm
H31s
H60s
67.5 mGy
Male: 3.16 mSv
Female: 3.81 mSv
Radiation Therapy
RT_Thorax
Indications:
Spiral mode for routine radio therapy thoracic studies.
A range of 30 cm will be covered in 6.43 sec.
kV
Effective mAs/
Quality ref. mAs
Rotation time
Aquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
CTDIVol
Effective dose
Thorax
120
100
2nd recon.
0.5 sec.
16 x 1.5 mm
1.5 mm
8.0 mm
8.0 mm
27.6 mm
1.15
8.0 mm
8.0 mm
B41f
B80f
7.0 mGy
Male: 3.76 mSv
Female: 4.77 mSv
517
Radiation Therapy
RT_Breast
Indications:
Spiral mode for radio therapy thoracic studies of the
mammae.
A range of 30 cm will be covered in 6.43 sec.
kV
Effective mAs/
Quality ref. mAs
Rotation time
Acquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
CTDIVol
Effective dose
518
Breast
120
100
2nd recon.
0.5 sec.
16 x 1.5 mm
1.5 mm
8.0 mm
8.0 mm
27.6 mm
1.15
8.0 mm
8.0 mm
B41f
B80f
7.0 mGy
Male: 3.76 mSv
Female: 4.77 mSv
Radiation Therapy
RT_Abdomen
Indications:
Spiral mode for routine radio therapy abdominal studies.
A range of 40 cm will be covered in 12.11 sec.
kV
Effective mAs/
Quality ref. mAs
Rotation time
Acquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
CTDIVol
Effective dose
Abdomen
120
160
2nd recon.
0.5 sec.
16 x 1.5 mm
1.5 mm
8.0 mm
8.0 mm
18.0 mm
0.75
8.0 mm
8.0 mm
B30f
B60f
11.2 mGy
Male: 8.24 mSv
Female: 12.41 mSv
519
Radiation Therapy
RT_Pelvis
Indications:
Spiral mode for routine radio therapy pelvis studies.
A range of 20 cm will be covered in 6.56 sec.
kV
Effective mAs/
Quality ref. mAs
Rotation time
Acquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
CTDIVol
Effective dose
520
Pelvis
120
160
2nd recon.
0.5 sec.
16 x 1.5 mm
1.5 mm
3.0 mm
3.0 mm
18.0 mm
0.75
3.0 mm
3.0 mm
B31f
B60f
11.2 mGy
Male: 4.48 mSv
Female: 7.21 mSv
Radiation Therapy
Additional Important Information
HU values
The HU values are of crucial importance for the therapy
planning systems of radiation therapists!
• With huge objects, the CT value is independent of
the kernel. With smaller objects, edge effects produced by the kernel influence the HU values as well
as the scanning. Feed and collimation do not have
any influence.
• An extended FoV of 800 mm means that only 500
mm are scanned, the rest will be interpolated.
• The effect on the HU values of having carbon plate
tagged additionally to the patient table should be
negligible and not measurable.
• CARE Dose 4D does not have any effect on the HU
values.
• HU values and the conversion of the electron densities depend on the applied spectrum, e.g. kV, prefiltration.
• HU values depend on the use of the PFO filter
521
Respiratory Gating
When imaging of the chest or abdomen is performed
by CT, there may be artifacts produced causing problems with reproducibility and resolution of images due
to patient respiration. Organs will move with each respiratory motion.
Especially in radiation therapy using a linear accelerator for tumor treatment, normal tissues around a focus
might be unnecessarily exposed to radiation if the target located in a movable organ, because the field of
irradiation has to be set wider than the actual size of a
focus due to its organ's motion.
As far as the respiratory motion is periodical and repetitive, the organs in the chest or abdomen move periodically and repetitively according to respiratory motion.
Therefore the diagnostic artifacts and image degradation, and the treatment dangers can be avoided if precise detection of respiratory motion and its consequent, synchronized imaging or irradiation is available.
522
Respiratory Gating
The respiratory gating hardware (AZ-733V) is composed of a:
• Respiratory Sensor (RS) to detect patient's abdominal motions (pressure changes) to get a patient's respiratory information,
• Sensor Port (SP) to amplify and to transmit analog
signals from RS,
• Wave Deck (WD) to receive the respiratory signal
from the said SP and to convert them to a digital signal to be sent to the host computer (PC) of the CT
system.
The respiration curve as well as scan and reconstruction parameters are displayed on the CT user interface
and embedded into the examination workflow.
The respiration curve will be displayed before and during spiral acquisition and saved in the respiration file.
After scanning the user can select the respiration level
(in [%]) of inspiration or expiration for reconstruction.
A synthetic sync signal and a respiration curve editing
functionality are available.
Regarding an imaging device such as SOMATOM Sensation Cardiac, the respiratory gating functionality
offers an increase of image resolution and reproducibility as well as a decrease of motion artifacts by
image reconstructions based on respiratory information both needed for high-precision radiation therapy
planning and treatment as well.
The mentioned increase of RT accuracy results in a
decrease of RT side effects by minimizing excessive
irradiation dose to healthy tissue.
523
Respiratory Gating
Key Features
Respiratory Gating
• is capturing slow moving anatomical structures such
as lung lesions during respiration up to a respiration
cycle time of 10 sec by low pitch spiral.
• helps the radio-oncologists in selecting the appropriate phase of the respiratory cycle in order to plan a
treatment more accurately.
• helps visualizing the tumor excursion for a better
understanding of the target volume using InSpace
4D.
• results in a more accurate description of the ROI
• is considering tumor motion into the PTV (planned
target volume).
524
Respiratory Gating
Respiration Monitoring
• Accurate determination of respiratory motion
• Respiration change recognition (cough, sneeze,
movement)
• Support for monitoring of free-breathing and breath
hold respiration protocols
Respiration Synchronization
• Synchronization of CT data acquisition with respiration: 4D CT - Prospective respiratory Triggering or
Retrospective respiratory Gating.
• Synchronization of 4D simulation data with respiration
• Synchronized Treatment: triggered beaming on-off
on Linac (Linear Accelerator).
525
Respiratory Gating
Positioning of the respiratory
sensor belt
The correct placement of the abdominal belt is essential in order to receive a clear respiratory signal resulting in precise generation of inspiration and expiration
gates. Improper positioning of the respiratory belt will
result in an unstable respiratory signal which is sensitive to movements of the patient during the scan and
can cause image artifacts due to small metallic components of the sensor (please position the respiratory
belt outside of the scan range).
For proper belt positioning please follow the instructions below:
Step 1
Step 2
patient
patient´s abdomen
load cell fixing belt
load cell
The blue part should apply to the back of the
patient.
Step 3
the diaphragm
load cell
setting
point
navel
Wind the load cell fixing belt around the
body so that the pocket (load cell part)
applies ontojust below the diaphragm.
Step 4
load cell connection cable
Securely fasten the fixing belt around the
patient.
526
Be careful load cell connection cable may
not entangle with the patient.
Respiratory Gating
For further information on the respiratory gating system AZ-733V (Anzai Medical, Japan), please refer to
the Operational manual "Respiratory Gating" or Anzai
User's manual.
527
Respiratory Gating
Scanning Information
The expected benefits in radiation treatment planning,
e.g. for lung and abdominal tumors are:
• Information about tumor motion in 3D coordinates
and over time
• More accurate tumor shape delineation and therefore a more precise RTP (radiation therapy planning)
• Potential for sparing of healthy tissue, minimization
of PTV (planned target volume) and less side effects
• Potential for dose acceleration and higher cure rate
To minimize motion artifacts, two requirements are
mandatory for a CT system:
– Fast gantry rotation to raise the temporal resolution
for artifact free images
– Prospective Triggering of image acquisition in a
sequential mode or Retrospective Gating of image
reconstruction in a spiral mode based on the recording of the respiratory curve in order to obtain images
during inspiration and expiration phases.
Scan Parameters
A respiratory-gated lung spiral with cone correction
will be provided. To be able to work also with low
breathing rates, a fixed pitch factor of a min. of 0.1 is
needed. Slice widths and collimation are the same as
for cardio spiral.
In the Specials folder different scan protocols are predefined for different breathing rates.
528
Respiratory Gating
Temporal Resolution
Temporal resolution, also called time resolution, represents the time window of the data that is used for
image reconstruction. It is essential for respiratory CT
imaging. The higher the temporal resolution, the
fewer the motion artifacts. A temporal resolution of a
half of the Rotation Time can be achieved.
Technical Principles
Basically, there are two different technical approaches
for respiration correlated CT acquisition:
• Prospectively respiratory-triggered sequential scanning.
• Retrospectively respiratory-gated spiral scanning.
In both cases, the respiration signal is recorded and
used to either initiate prospective image acquisition
(triggering), or to perform retrospective image reconstruction (gating). Only scan data acquired in a userselectable phase of the respiration cycle is used for
image reconstruction.
Respiratory Triggering
Sequential scans are triggered by respiration signal
during a predefined amplitude of inhalation or exhalation.
Triggering is based on the maximum and minimum of
the predicted respiration amplitude of the next 100%
inspiration.
529
Respiratory Gating
Respiratory gating
The respiration of the patients is simultaneously
recorded during the Spiral acquisition.
Data are acquired during the entire respiration cycle
and Images are reconstructed by matching data to the
respiration trace.
The respiration level (amplitude) is defined as an absolute value. The display of the respiratory curve is optimized by an auto adjustment regarding
• Gain (showing inspiration maximum as 100% of
inspiration and expiration minimum as 100% of
expiration)
and
• Offset (showing the curve optimal to vertical display
extent).
The timebase of the respiratory curve is realtime in an
updating mode.
530
Respiratory Gating
Images can be reconstructed at any user defined Inhalation- or Exhalation level.
100% Inspiration
Inhalation Phase
Exhalation Phase
0% Expiration
Example:
– 20% Ex: Patient has exhaled to 80%
– 20% In: Patient has inhaled to 20 %
531
Respiratory Gating
Prospective respiratory Triggering versus Retrospective respiratory Gating
With Prospective respiratory Triggering, the lung volume for example is covered in a "step-and-shoot" technique. The patient's respiratory signal is used to start
sequential scans at a predefined respiratory level of
the patient' s respiratory curve. With Retrospective respiratory Gating, the lung volume is covered continuously by a spiral scan. The patient's respiratory signal is
recorded simultaneously to allow a retrospective selection of the respiratory level used for image reconstruction. Prospective respiratory Triggering has the benefit
of smaller patient dose than respiratory-gated spiral
scanning, since scan data is acquired at the previously
selected respiratory level only. It does not, however
provide continuous volume coverage with overlapping
slices and misregistration of anatomical details may
occur. Furthermore, reconstruction of images in different levels of the respiratory cycle for functional evaluation needs repeated CT examination of each of the
desired respiration levels along the same volume in zdirection using Prospective Triggering technique. Since
respiratory triggered sequential scanning depends on
a reliable prediction of the patient's next Inspiration
maximum and expiration minimum, the method
should not be used for patients with arrhythmic
breathing and irregular respiratory rates and the affinity to cough and to sigh.
532
Respiratory Gating
Curve Editor
The respiration curve editor is used to modify the respiratory signal. This editing tool is available after spiral
scan data has been acquired. By using the right mouse
menu on the Trigger tabcard you have access to several
modification tools for the respiratory Syncs (purple
dots above and below the curve), such as Delete, Disable, Insert. In patients with only single or few extra
respiratory peaks caused, e.g. by coughing and sighing
overall image quality may be improved by editing the
respiratory curve prior to reconstruction. Deleting the
corresponding respiratory peaks prevents image
reconstruction in the periods of coughing or arrhythmic breathing. Although respiratory-gated spiral scanning is less sensitive to variable respiratory rates than
respiratory-triggered sequential scanning, the examination of patients with arrhythmic breathing that
results in unpredictable variations of the respiratory
cycles can result in limited image quality and should be
performed in exceptional cases only.
533
Respiratory Gating
The recorded Respiration curve can be edited similar to
the ECG Trace editing in Cardiac CT.
Inspiration Syncs can be deleted, disabled and
inserted.
Expiration Syncs can be deleted, disabled and inserted.
534
Respiratory Gating
Synthetic Trigger/Sync
By default, the "Synthetic Trigger" (Respiratory-triggered scanning) or "Synthetic Sync" (Respiratory-gated
scanning) is activated for all predefined Respiratory
scan protocols. It is recommended to always keep it
activated for examinations with contrast medium.
In case of Respiratory signal loss during the acquisition, this will ensure the continuation of the triggered
scans or allows a Respiratory signal to be simulated for
Retrospective Gating. If it is deactivated, the scanning
will be aborted in case of Respiratory signal loss during
the acquisition.
535
Respiratory Gating
Workflow
Reconstruction and Post-processing
For respiratory gating a 16x1.5 acquisition mode with
a slice width 2.0 mm and an increment of 1.0 mm is
used for image acquisition.
Two recon jobs are predefined:
• 20% Inspiration
• 80% Expiration
If more Inspiration or Expiration phases are necessary
new recon jobs can be added.
After acquisition, the 4D volume data set can be reconstructed at different respiration levels to visualize the
tumor movement over the whole respiration cycle and
to display the anatomy in space (3D) and time (4D)
InSpace 4D as an approved 4D application minimizes
the time to
• choose the appropriate phase or
• 4D data visualization in multiple planes
• Creation of 4D movie loops.
For further information on InSpace 4D please refer to
the chapter InSpace 4D in the "Clinical Applications 2"
application guide.
536
Respiratory Gating
Additional important
Information
• For operating the respiratory gating system (AZ733V, Anzai Medical, Japan), please refer to the
Operational manual "Respiratory Gating" or Anzai
User´s manual.
• For the usage of Anzai´s respiratory phantom for the
respiratory gating system (AZ-733V, Anzai medical,
Japan), please refer to the User´s manual.
• The images are reconstructed from data acquired in
one Inspiration or Expiration phase – Multi Phase
reconstruction is not available. For each Inspiration
or Expiration phase, a new recon job can be added.
• Preview Series is not yet available. To determine the
best Inspiration or Expiration phase, InSpace 4D can
be used.
537
Respiratory Gating
RespSeq
For sequential studies with respiration triggering use
RespSeq:
The whole scan length covers 303 mm.
kV
Effective mAs/
Quality ref. mAs
Rotation Time
Acquisition
Slice collimation
Slice width
Feed/Scan
Kernel
CTDIvol
538
RespSeq
120
20
0.5 sec.
12 x 1.5 mm
1.5 mm
3 mm
18.0
B19f
1.4 mGy
Respiratory Gating
RespLowBreathRate
For spiral studies with respiration gating and a respiration rate per minute greater than 6 use
RespLowBreathRate:
The whole scan range of 23 cm will be covered in
97.83 sec.
kV
Effective mAs/
Quality ref. mAs
Rotation time
Acquisition
Slice
collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
CTDIvol
Effective dose
RespLow
120
400
2nd recon.
1.0 sec.
16 x 1.5 mm
1.5 mm
2.0 mm
2.4
0.1
1.4 mm
B19s
28.0 mGy
Male: 11.59 msV
Female: 14.94 msV
2.0 mm
1.4 mm
B19s
539
Respiratory Gating
RespModBreathRate
For spiral studies with respiration gating and a respiration rate per minute greater than 12 use RespModBreathRate:
The whole scan range of 23 cm will be covered in
73.38 sec.
kV
Effective mAs/
Quality ref. mAs
Rotation Time
Acquisition
Slice
collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
CTDIvol
Effective dose
540
RespMod
120
400
2nd recon.
0.75 sec.
16 x 1.5 mm
1.5 mm
2.0 mm
2.4 mm
0.1
1.4 mm
B19s
28.0 mGy
Male: 11.59 msV
Female: 14.94 msV
2.0 mm
1.4 mm
B19s
Respiratory Gating
541
Children
Overview
The scan protocols for children are defined according
to body regions - Head, Neck, Shoulder, Thorax, Abdomen, Pelvis, Spine, Upper Extremities, Lower Extremities, Vascular, RT, Specials and optional Cardiac, PET,
SPECT and Private.
As default the quality reference mAs with CARE Dose
4D is defined for 20 kg and/or five years old children.
For children older than six years use the adult protocols
with the CARE Dose 4D.
For a few protocols, 80 kV is used instead of 120 kV,
either to exploit the significantly higher image contrast of iodine contrast media at 80 kV or to reach a
lower dose level than possible with 120 kV.
• Head
– HeadRoutine/HeadRoutine05s
Spiral mode for routine head studies
– HeadSeq/HeadSeq05s
Sequential mode for routine head studies
– InnerEarUHR
Spiral mode for Ultra High Resolution inner ear studies
– InnerEarSeqUHR
Sequential mode for High Resolution inner ear studies
– SinusOrbi
Spiral mode for routine sinus or orbital studies
542
Children
• Neck
– NeckRoutine
Spiral mode for soft tissues routine neck studies
• Thorax
– ThoraxRoutine
Spiral mode for routine thorax studies
– ThoraxCombi
Spiral mode for the combination of thin slice lung
and routine thorax studies
– ThoraxSeqHR
Sequential mode for high resolution lung studies
• Abdomen
– AbdomenRoutine
Spiral mode for routine abdominal studies
• Spine
– SpineRoutine
Spiral mode for routine spine studies
– SpineThinSlice
Spiral mode for thin slice spine studies
Upper Extremities
– ExtrRoutineUHR
Spiral mode for routine high resolution
extremity studies
– ExtrCombi
Spiral mode for the combination of thin slice
and routine studies
543
Children
• Lower Extremities
– ExtrRoutineUHR
Spiral mode for high resolution routine
extremity studies
– ExtrCombi
Spiral mode for the combination of thin slice
and routine studies
• Vascular
– HeadAngio
Spiral mode for head CTAngio studies
– CarotidAngio/CarotidAngio042s
Spiral mode for carotid CTAngio studies
– BodyAngio/BodyAngio042s
Spiral mode for body CTAngio studies
• Specials
– NeonateBody/NeonateBody042s
Spiral mode for neonate studies
544
Children
Hints in General
1.Topograms: 256 mm lateral topograms are defined
for the head modes, and 512 mm AP topograms are
defined for the body modes. Please keep in mind that
the children’s size can be dramatically different. You
should press the “Hold Measurement“ button whenever the range shown on the real time growing topogram is long enough, in order to avoid unnecessary
radiation.
In a consistent effort to reduce the total dose of an
examination, all topograms of the pediatric protocols
are defined at 80 kV with minimum current (50 mA).
2. Gantry tilt is available for sequence scanning, not
for spiral scanning.
3.For all head studies, it is very important for image
quality purposes to position the patient in the center of
the scan field. Use the lateral laser beam to make sure
that the patient is positioned in the center.
4.Warm surroundings and dimmed lighting are helpful
to make children more cooperative.
545
Children
5.Sedation: Although the advent of the multislice CT
scanner has enabled the user to scan through an area
of interest much faster than ever, sometimes, patient
motion can still lead to severe motion artifacts seen on
the resultant images. This becomes a factor especially
with infants and younger children who are unable to
hold still for the exam. Sedating this population may
be a viable option for your institution. Of course,
appropriate protocols need to be established at your
specific institution. For instance, the drug of choice for
specific ages/weights of these patients (taking into
consideration the total time of the exam), the form of
administration, patient preps, adequate monitoring of
the patient (pre-scan, during the exam and post-scan)
etc. should all be taken into consideration.
The proper personnel and equipment must also be
readily available in the event of a problem.
6.Oral and rectal contrast administration: Depending
on the reason for the exam/status of the patient, oral
contrast may or may not be given to these patients.
546
Children
In general, oral contrast is recommended to opacify
the intestinal tract, as unopacified bowel can have the
appearance of abdominal fluid or mass effect. Oral, as
well as rectal contrast may be required. Usually, a
diluted mixture of iodine and water is used as an oral
agent. Different substances can be added to this mixture to help reduce the bitter taste and make it more
pleasing to the child (apple juice, fruit drink mixes are
just a few of these). Barium may of course be used in
some cases as well. Negative contrast agents such as
water are becoming more popular for delineation of
stomach or bowel wall borders, or when 3D reconstructions are needed. The user needs to be aware of
all the contraindications of any of the contrast agents
they are using. Please refer to the specific vendor’s recommendations.
7.I.V. contrast administration: In general, 1 – 2 ml per
kg of body weight should be applied, however, since
the scanning can be completed in just a few seconds,
please keep in mind that the total injection time should
not be longer than the sum of start delay time and the
scan time – do not inject contrast after the scanning is
finished.
547
Children
It is recommended to use CARE Bolus in order to
achieve optimal contrast enhancement.
Both start delay time and injection rate are exam-/
patient-dependent. I.V. injection with a power injector
is recommended for all scans whenever possible.
Some guidelines to follow with respect to flow rate are
noted in the chart below.
Note: These injector guidelines are based on an
antecubital injection site. These guidelines may need
to be adjusted if the site is more peripheral.
Needle Size (gauge)
22
20
18
Flow Rate (ml/sec.)
1.5
2.0 – 3.0
3.0 – 5.0
Central lines and ports may need to be hand injected or
power injected at a very low flow rate (1 ml/sec.).
PIC lines and 24 gauge (or smaller) lines are usually
hand injected. All of these protocols should be decided
on by your institution’s appropriate personnel.
548
Children
8.Applications with 80 kV: For CTA protocols, the tube
voltage was set to 80 kV and the mAs values were
raised by a factor of 1.5 over the reduced 120 kV values. This measure roughly reduces the dose by another
factor of 2. At a lower kV, substances with a high
atomic number (such as iodine) have a significantly
higher CT value (= vascular contrast). Iodine CT values
at 80 kV are about 50% higher than at 120 kV.
80 kV was also used for applications when the lowest
achievable mAs at 120 kV was still higher than necessary for sufficient noise level (for technical reasons,
generators need to operate at a certain minimum current for stable operation). For applications such as
neonate or airway scanning, the low tube output at 80
kV can be used to further reduce the dose to the
patient.
9.To further optimize MPR image quality we recommend that you reduce one or more of the following:
collimation, reconstruction increment and slice width
for image reconstruction.
549
Children
Head Kernels
The endings “s” or “f” depend on the rotation time.
• For head scans of small children, the kernels C20s,
C30s (e.g. for soft tissue studies) and C60s (e.g. for
sinuses are provided) should be chosen instead of
the ”adult” head kernels H20s, H30s and H60s.
• For soft tissue head studies, the standard kernel is
H40s; softer images are obtained with H30s or H20s,
H10s, sharper images with H50s. The kernels H21s,
H31s, H41s yield the same visual sharpness as H20s,
H30s, H40s, the image appearance, however, is
more agreeable due to a ”fine-grained” noise structure; quite often, the low contrast detectability is
improved by using H31s, H 41s instead of H30s,
H40s.
• For the standard head protocols, we propose C20s
and C30s.
• High resolution head studies should be performed
with H60s, H70s (e.g. for dental and sinuses) and
H80s, H90s (e.g. inner ear).
550
Children
Body Kernels
The endings “s” or “f” depend on the rotation time.
• As standard kernels for body tissue studies B30s or
B40s are recommended; softer images are obtained
with B20s or B10s (extremely soft). The kernels B31s
or B41s have about the same visual sharpness as
B30s, respectively, B40s, the image appearance,
however, is more agreeable due to a ”fine-grained”
noise structure; quite often, the low contrast detectability is improved by using B31s, B41s instead of
B30s, B40s.
• For higher sharpness, as is required e.g. in patient
protocols for cervical spine, shoulder, extremities,
thorax, the kernels B50s, B60s, B70s, B80s are available.
• The special kernels are mostly used for ”physical”
measurements with phantoms, e.g. for adjustment
procedures (S80s), for constancy and acceptance
tests (S80s, S90s), or for specification purposes
(S90s).
For special patient protocols, S80s and S90s are chosen, e.g. for osteo (S80s).
• For very high sharpness we recommended the U70u,
U80u, U90u for bone studies. UHR mode has a maximum FoV of 300 mm.
It is mandatory to position the area of interest in the
center of the scan field. Use ExtrCombi mode when a
scan FoV > 25 cm is necessary.
551
Children
HeadRoutine
Indications:
Spiral mode for routine head studies, e.g. tumors,
hydrocephalus, hemorrhaging, abnormalities, etc.
A typical range of 12 cm covered in 8.32 sec.
kV
Effective mAs/
Quality ref. mAs
Rotation time
Acquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
CTDIVol
Effective dose
Head
120
150
0.75 sec.
16 x 1.5 mm
1.5 mm
4.0 mm
13.2 mm
0.55
4.0 mm
C30s
28.5 mGy
Male: 1.78 mSv*
Female: 1.95 mSv*
* The conversion factor for a 7-year-old child, and a
scan range of 120 mm was used.
552
Children
Contrast medium IV injection
Start delay
exam dependent
Flow rate
dependent upon needle size/Access
site
Total
1 – 2 ml per kg of body weight
amount
Hints
• Children, who are more than 6 years old, should be
scanned with an adult protocol as the skull by this
time is fully grown.
• When bone structure is of interest, use kernel C60s
for image reconstruction.
• An advanced algorithm allow for improved head
image quality, without any additional post-processing.
• In order to optimize image quality versus radiation
dose, scans are provided within a maximum scan
field of 300 mm with respect to the iso-center. No
recon job with a field of view exceeding those limits
will be possible. Therefore, patient positioning has to
be performed accurately to ensure a centered location of the skull.
• To work without CARE Dose 4D use for children
< 6 month 90 mAs
6 month-3 years 150 mAs
3-6 years 220 mAs.
553
Children
HeadRoutine05s
Indications:
Spiral mode for routine head studies, e.g. tumors,
hydrocephalus, hemorrhaging, abnormalities, etc.
A typical range of 12 cm covered in 5.55 sec.
kV
Effective mAs/
Quality ref. mAs
Rotation time
Acquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
CTDIVol
Effective dose
Head
120
150
0.5 sec.
16 x 1.5 mm
1.5 mm
4.0 mm
13.2 mm
0.55
4.0 mm
C30f
28.5 mGy
Male: 1.78 mSv*
Female: 1.95 mSv*
* The conversion factor for a 7-year-old child, and a
scan range of 120 mm was used.
554
Children
Contrast medium IV injection
Start delay
exam dependent
Flow rate
dependent upon needle size/Access
site
Total
1 – 2 ml per kg of body weight
amount
Hints
• Children, who are more than 6 years old, should be
scanned with an adult protocol as the skull by this
time is fully grown.
• When bone structure is of interest, use kernel C60s
for image reconstruction.
• An advanced algorithm allow for improved head
image quality, without any additional post-processing.
• In order to optimize image quality versus radiation
dose, scans are provided within a maximum scan
field of 300 mm with respect to the iso-center. No
recon job with a field of view exceeding those limits
will be possible. Therefore, patient positioning has to
be performed accurately to ensure a centered location of the skull.
• To work without CARE Dose 4D use for children
< 6 month 90 mAs
6 month-3 years 150 mAs
3-6 years 220 mAs.
555
Children
HeadSeq
Indications:
Sequential mode for routine head studies for children,
e.g. tumors, hydrocephalus, hemorrhaging, abnormalities, etc.
A scan range is predefined with 12.1 cm.
kV
Effective mAs/
Quality ref. mAs
Rotation time
Acquisition
Slice collimation
Slice width
Feed/Scan
Kernel
CTDIVol
Effective dose
HeadSeq
120
150
0.75 sec.
12 x 1.5 mm
1.5 mm
4.5 mm
18.0 mm
C30s
28.8 mGy
Male: 1.61 mSv*
Female: 1.85 mSv*
* The conversion factor for a 7-year-old child, and a
scan range of 117 mm was used.
556
Children
Contrast medium IV injection
Start delay
exam dependent
Flow rate
dependent upon needle size/
Access site
Total amount
1 – 2 ml per kg of body weight
Hints
• Children, who are more than 6 years old, should be
scanned with an adult protocol as the skull by this
time is fully grown.
• When bone structure is of interest, use kernel C60s
for image reconstruction.
• An advanced algorithm allow for improved head
image quality, without any additional post-processing.
• In order to optimize image quality versus radiation
dose, scans are provided within a maximum scan
field of 300 mm with respect to the iso-center. No
recon job with a field of view exceeding those limits
will be possible. Therefore, patient positioning has to
be performed accurately to ensure a centered location of the skull.
• To work without CARE Dose 4D use for children
< 6 month 90 mAs
6 month-3 years 150 mAs
3-6 years 220 mAs.
557
Children
HeadSeq05s
Indications:
Sequential mode for routine head studies for children,
with a 0.5 sec. rotation time, e.g. tumors, hydrocephalus, hemorrhaging, abnormalities, etc.
A scan range is predefined with 12.1 cm.
kV
Effective mAs/
Quality ref. mAs
Rotation time
Acquisition
Slice collimation
Slice width
Feed/Scan
Kernel
CTDIVol
Effective dose
HeadSeq
120
150
0.5 sec.
12 x 1.5 mm
1.5 mm
4.5 mm
18.0 mm
C30f
28.8 mGy
Male: 1.61 mSv*
Female: 1.85 mSv*
* The conversion factor for a 7-year-old child, and a
scan range of 121 mm was used.
558
Children
Contrast medium IV injection
Start delay
exam dependent
Flow rate
dependent upon needle size/Access
site
Total
1 – 2 ml per kg of body weight
amount
Hints
• Children, who are more than 6 years old, should be
scanned with an adult protocol as the skull by this
time is fully grown.
• When bone structure is of interest, use kernel C60s
for image reconstruction.
• An advanced algorithm allow for improved head
image quality, without any additional post-processing.
• In order to optimize image quality versus radiation
dose, scans are provided within a maximum scan
field of 300 mm with respect to the iso-center. No
recon job with a field of view exceeding those limits
will be possible. Therefore, patient positioning has to
be performed accurately to ensure a centered location of the skull.
• To work without CARE Dose 4D use for children
< 6 month 90 mAs
6 month-3 years 150 mAs
3-6 years 220 mAs.
559
Children
InnerEarUHR
Indications:
Spiral mode for Ultra High Resolution inner ear studies,
e.g. malformations of the inner ear, inflammatory
changes, pathologies of the mastoid process, tumor
processes of the pyramids, post-traumatic changes,
etc.
Note: Same as for adults except for the FoV of 300.
A typical range of 4.5 cm covered in 33.14 sec.
560
Children
kV
Effective mAs/
Quality ref. mAs
Rotation time
Acquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
CTDIVol
Effective dose
InnerEarUHR
120
60
0.75 sec.
2 x 0.6 mm
0.6 mm
0.6 mm
1.0 mm
0.8
0.6 mm
U80u
16.5 mGy
Male: 0.33 mSv*
Female: 0.34 mSv*
* The conversion factor for a 7-year-old child, and a
scan range of 45 mm was used.
561
Children
Contrast medium IV injection
Start delay
exam dependent
Flow rate
dependent upon needle size/Access
site
Total
1 – 2 ml per kg of body weight
amount
Hints
• Children, who are more than 6 years old, should be
scanned with an adult protocol as the skull by this
time is fully grown.
• The UHR mode requires a 300 mm scan FoV. It is
mandatory to position the patient in the center of
the scan FoV.
• When soft tissue is of interest, use kernel U30u for
image reconstruction.
• In order to optimize image quality versus radiation
dose, scans are provided within a maximum scan
field of 300 mm with respect to the iso-center. No
recon job with a field of view exceeding those limits
will be possible. Therefore, patient positioning has to
be performed accurately to ensure a centered location of the skull.
• To work without CARE Dose 4D use for children
< 3 years 40 mAs
3-6 years 60 mAs.
562
Children
563
Children
InnerEarSeqUHR
Indications:
Sequential mode for Ultra High-Resolution inner ear
studies, e.g. Inflammatory changes, tumorous processes of pyramids, cerebellopontine angle tumors,
post-traumatic changes, etc.
A scan range is predefined with 4.0 cm.
Note: Same as for adults except for the FoV of 300.
kV
Effective mAs/
Quality ref. mAs
Rotation time
Acquisition
Slice collimation
Slice width
Feed/Scan
Kernel
CTDIVol
Effective dose
InnerEarSeq
120
60
0.75 sec.
2 x 0.6 mm
0.6 mm
0.6 mm
1.2 mm
U80u
19.8 mGy
Male: 0.38 mSv*
Female: 0.44 mSv*
* The conversion factor for a 7-year-old child, and a
scan range of 40 mm was used.
564
Children
Contrast medium IV injection
Start delay
exam dependent
Flow rate
dependent upon needle size/Access
site
Total
1 – 2 ml per kg of body weight
amount
Hints
• Children, who are more than 6 years old, should be
scanned with an adult protocol as the skull by this
time is fully grown.
• The UHR mode has a maximum FoV of 300 mm. It is
mandatory to position the patient in the center of
the scan FoV.
• When soft tissue is of interest, use kernel U30u for
image reconstruction.
• In order to optimize image quality versus radiation
dose, scans are provided within a maximum scan
field of 300 mm with respect to the iso-center. No
recon job with a field of view exceeding those limits
will be possible. Therefore, patient positioning has to
be performed accurately to ensure a centered location of the skull.
• To work without CARE Dose 4D use for children
< 3 years 40 mAs
3-6 years 60 mAs.
565
Children
SinusOrbi
Indications:
Spiral mode for routine spiral studies e.g. sinusitis,
pneumatization, polyposis, malformations, tumors
etc.
A typical range of 6 cm covered in 6.56 sec.
SinusOrbi
kV
Effective mAs/
Quality ref. mAs
Rotation time
Acquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
CTDIVol
Effective dose
2nd
recon.
120
60
0.5 sec.
16 x 0.75 mm
0.75 mm
3.0 mm
1.0 mm
5.4 mm
0.45
3.0 mm
0.7 mm
H60f
H60f
12.7 mGy
Male: 0.46 mSv*
Female: 0.52 mSv*
* The conversion factor for a 7-year-old child, and a
scan range of 60 mm was used.
566
Children
Contrast medium IV injection
Start delay
exam dependent
Flow rate
dependent upon needle size/Access
site
Total
1 – 2 ml per kg of body weight
amount
Hints
• Children, who are more than 6 years old, should be
scanned with an adult protocol.
• The second recon job is defined with kernel H60s
and with an overlap for visualizing bone structures
with MPR.
• To work without CARE Dose 4D use for children
< 3 years 40 mAs
3-6 years 60 mAs.
567
Children
NeckRoutine
Indications:
Spiral mode for routine neck studies, e.g. tumors, lymphoma, abscesses, etc.
A typical range of 17 cm covered in 8.58 sec.
kV
Effective mAs/
Quality ref. mAs
Rotation time
Acquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
CTDIVol
Effective dose
Neck
120
60
2nd reconstr.
0.75 sec.
16 x 1.5 mm
1.5 mm
6.0 mm
2.0 mm
18.0 mm
0.75
6.0 mm
1.4 mm
B30s
B60s
4.2 mGy
Male: 0.99 mSv*
Female: 1.01 mSv*
* The conversion factor for a 7-year-old child, and a
scan range of 170 mm was used.
568
Children
Contrast medium IV injection
Start delay
exam dependent
Flow rate
dependent upon needle size/Access
site
Total
1 – 2 ml per kg of body weight
amount
Hints
• If necessary, scan down to the aortic arch or mediastinum to include the entire lesion.
• Cooperative children can be instructed to hold their
breath during the acquisition.
• Children, who are more than 6 years old should be
scanned with an adult protocol.
• To work without CARE Dose 4D use for children
< 3 years 40 mAs
3-6 years 60 mAs
569
Children
ThoraxRoutine
Indications:
Spiral mode for routine thorax studies, e.g. pneumonia, tumors, metastases, lymphoma, vascular abnormalities etc.
A typical range of 15 cm covered in 3.72 sec.
kV
Effective mAs/
Quality ref. mAs
Rotation time
Acquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
CTDIVol
Effective dose
ThorRoutine
120
30
2nd reconstr.
0.5 sec.
16 x 1.5 mm
1.5 mm
6.0 mm
6.0 mm
27.6 mm
1.15
6.0 mm
6.0 mm
B30f
B60f
2.1 mGy
Male: 0.94 mSv*
Female: 1.12 mSv*
* The conversion factor for a 7-year-old child, and a
scan range of 150 mm was used.
570
Children
Contrast medium IV injection
Start delay
exam dependent
Flow rate
dependent upon needle size/Access
site
Total
1 – 2 ml per kg of body weight
amount
Hints
• Children with a body weight of more than 55 kg
should be examined with an adult protocol.
• The first and second recon jobs are defined for visualization of the mediastinum and the lungs, respectively.
• To work without CARE Dose 4D use for children
< 15 kg 17 mAs
15-24 kg 20 mAs
25-34 kg 30 mAs
35-54 kg 60 mAs
571
Children
ThoraxCombi
Indications:
Combining thin slice and routine thorax studies with
one spiral scan, e.g. thorax studies in general and
interstitial changes in the lungs.
A typical range of 15 cm covered in 5.17 sec.
kV
Effective mAs/
Quality ref. mAs
Rotation time
Acquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
CTDIVol
Effective dose
ThorCombi
120
45
2nd reconstr.
0.5 sec.
16 x 1.5 mm
1.5 mm
3.0 mm
2.0 mm
18.0 mm
0.75
3.0 mm
1.4 mm
B30f
B60f
3.2 mGy
Male: 1.41 mSv*
Female: 1.69 mSv*
* The conversion factor for a 7-year-old child, and a
scan range of 150 mm was used.
572
Children
Contrast medium IV injection
Start delay
exam dependent
Flow rate
dependent upon needle size/Access
site
Total
1 – 2 ml per kg of body weight
amount
Hints
• Children with a body weight of more than 55 kg
should be examined with an adult protocol.
• For the 2nd reconstruction the Autoload into
MPRthick Range on the 3D Card is activated. The
images will be automatically loaded into 3D,
MPRthick, and a coronal MPRthick Range will pop up.
Please notice, if you are not satisfied with the Range
preset, adapt the parameters to your needs and link
them to the series.
• To work without CARE Dose 4D use for children
< 25 kg 25 mAs
25-34 kg 45 mAs
35-54 kg 65 mAs
573
Children
ThoraxSeqHR
Indications:
Sequence mode for High Resolution lung studies, e.g.,
interstitial changes in the lungs, using a 10 mm feed.
A scan range is predefined with 20.0 cm.
kV
Effective mAs/
Quality ref. mAs
Rotation time
Acquisition
Slice collimation
Slice width
Feed/Scan
Kernel
CTDIVol
Effective dose
ThoraxSeqHR
120
30
0.75 sec.
2 x 1.0 mm
1.0 mm
1.0 mm
10.0 mm
B70s
0.5 mGy
Male: 0.23 mSv*
Female: 0.3 mSv*
* The conversion factor for a 7-year-old child, and a
scan range of 200 mm was used.
574
Children
Hints
• Children with a body weight of more than 55 kg
should be examined with an adult protocol.
• If you want to acquire the patient at full inspiration
or full expiration, you should practice the breathing
with the patient a few times before beginning the
scan, so that reproducibility may be improved.
• To work without CARE Dose 4D use for children
< 35 kg 30 mAs
35-54 kg 65 mAs
575
Children
AbdomenRoutine
Indications:
Spiral mode for routine studies in the region of abdomen and pelvis, e.g. tumors, lymphoma, abscesses,
post-traumatic changes, etc.
A typical range of 20 cm covered in 4.64 sec.
kV
Effective mAs/
Quality ref. mAs
Rotation time
Acquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
CTDIVol
Effective dose
AbdRoutine
120
55
0.5 sec.
16 x 1.5 mm
1.5 mm
5.0 mm
27.6 mm
1.15
5.0 mm
B30f
3.9 mGy
Male: 2.38 mSv*
Female: 2.9 mSv*
* The conversion factor for a 7-year-old child, and a
scan range of 200 mm was used.
576
Children
Contrast medium IV injection
Start delay
exam dependent
Flow rate
dependent upon needle size/Access
site
Total
1 – 2 ml per kg of body weight
amount
Hints
• Delayed scans may be required for the kidneys &
bladder.
• Rectal contrast may be required for evaluation of pelvic mass.
• Children with a body weight of more than 55 kg
should be examined with an adult protocol.
• To work without CARE Dose 4D use for children
< 25 kg 30 mAs
25-34 kg 55 mAs
35-54 kg 100 mAs
577
Children
SpineRoutine
Indications:
Spiral mode for thoracic and lumbar spine studies,
e.g.prolapse, degenerative changes, trauma, tumors
etc.
A typical range of 16 cm covered in 8.17 sec.
kV
Effective mAs/
Quality ref. mAs
Rotation time
Acquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
CTDIVol
Effective dose
SpineRoutine
120
55
2nd reconstr.
0.75 sec.
16 x 1.5 mm
1.5 mm
3.0 mm
2.0 mm
18.0 mm
0.75
3.0 mm
1.4 mm
B30s
B60s
6.3 mGy
Male: 3.34 mSv*
Female: 4.31 mSv*
* The conversion factor for a 7-year-old child, and a
scan range of 160 mm was used.
578
Children
Hints
• Children with a body weight of more than 55 kg
should be examined with an adult protocol.
• To work without CARE Dose 4D use for children
< 25 kg 30 mAs
25-34 kg 55 mAs
35-54 kg 120 mAs
579
Children
SpineThinSlice
Indications:
Spiral mode for the spine when Multi Planar Reformation (MPR) are intended, e.g. post-traumatic changes,
tumors, malformations, etc.
A typical range of 16 cm covered in 8.17 sec.
kV
Effective mAs/
Quality ref. mAs
Rotation time
Acquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
CTDIVol
Effective dose
SpineThinSlice
120
70
2nd reconstr.
0.75 sec.
16 x 0.75 mm
0.75 mm
2.0 mm
1.0 mm
18.0 mm
1.5
2.0 mm
0.7 mm
B30s
B60s
3.1 mGy
Male: 1.51 mSv*
Female: 1.92 mSv*
* The conversion factor for a 7-year-old child, and a
scan range of 160 mm was used.
580
Children
Hints
• Children with a body weight of more than 55 kg
should be examined with an adult protocol.
• To work without CARE Dose 4D use for children
< 25 kg 40 mAs
25-34 kg 70 mAs
35-54 kg 90 mAs
581
Children
ExtrRoutineUHR
Indications:
Spiral mode for Ultra High Resolution bone studies,
e.g. tumors, post-traumatic changes, orthopedic indications, etc.
Note: UHR mode has a maximum FoV of 300 mm. It
ismandatory to position the area of interest in the center of the scan field.
A typical range of 6 cm covered in 64.5 sec.
kV
Effective mAs/
Quality ref. mAs **
Rotation time
Acquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
CTDIVol
Effective dose
ExtrUHR
120
45
1.0 sec.
2 x 0.6 mm
0.6 mm
0.6 mm
1.0 mm
0.8
0.6 mm
U80u
4.8 mGy
Male: 0.01 mSv*
Female: 0.00 mSv*
* The conversion factor for a 7-year-old child, and a
scan range of 60 mm was used.
** Adjust the mAs value to the body region.
582
Children
Hints
• Children with a body weight of more than 55 kg
should be examined with an adult protocol.
• The UHR mode has a maximum FoV of 300 mm. It is
mandatory to position the patient in the center of
the scan FoV.
• When soft tissue is of interest, use kernel U30u for
image reconstruction.
• To work without CARE Dose 4D use for children
< 25 kg 26 mAs
25-34 kg 40 mAs
35-54 kg 80 mAs
583
Children
ExtremityCombi
Indications:
Spiral mode for the combination of bone and soft tissue studies, e.g. masses, trauma, disorders of the joint
etc.
A typical range of 10 cm covered in 12.42 sec.
584
Children
kV
Effective mAs/
Quality ref. mAs
Rotation time
Acquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
CTDIVol
Effective dose
ExtrCombi
120
45
2nd reconstr.
1.0 sec.
16 x 0.75 mm
0.75 mm
3.0 mm
1.0 mm
9.6 mm
0.8
3.0 mm
0.7 mm
B30s
B60s
3.5 mGy
Male: 0.01 mSv*
Female: 0.01 mSv*
* The conversion factor for a 7-year-old child, and a
scan range of 100 mm was used.
585
Children
Contrast medium IV injection
Start delay
exam dependent
Flow rate
dependent upon needle size/Access
site
Total
1 – 2 ml per kg of body weight
amount
Hints
• Children with a body weight of more than 55 kg
should be examined with an adult protocol.
• To work without CARE Dose 4D use for children
< 25 kg 26 mAs
25-34 kg 35 mAs
35-54 kg 70 mAs
586
Children
587
Children
HeadAngio
Indications:
Spiral mode for head CT Angio studies, e.g. cerebral
vascular abnormalities, tumors etc.
A typical range of 6 cm covered in 5.55 sec.
kV
Effective mAs/
Quality ref. mAs
Rotation time
Acquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
CTDIVol
Effective dose
HeadAngio
80
100
2nd reconstr.
0.5 sec.
16 x 0.75 mm
0.75 mm
2.0 mm
1.0 mm
6.6 mm
0.55
2.0 mm
0.7 mm
H20f
H10f
8.4 mGy
Male: 0.28 mSv*
Female: 0.34 mSv*
* The conversion factor for a 7-year-old child, and a
scan range of 60 mm was used.
588
Children
Contrast medium IV injection
Start delay
exam dependent
Flow rate
dependent upon needle size/Access
site
Total
1 – 2 ml per kg of body weight
amount
Hints
• Children, who are more than 6 years old should be
examined with an adult protocol.
• CARE Bolus may be used to optimize the bolus timing
and with a triggering threshold of 120 HU, or use
manual triggering.
• An advanced algorithm allow for improved head
image quality, without any additional post-processing.
• To work without CARE Dose 4D use for children
< 3 years 100 mAs
3-6 years 150 mAs
589
Children
CarotidAngio/
CarotidAngio042s
Indications:
Spiral mode for carotid CT Angio studies, e.g. carotidstenosis or occlusion, vascular abnormalities of thecarotids or vertebral arteries, etc.
A typical range of 17 cm covered in 10.44/8.77 sec.
590
Children
kV
Effective mAs/
Quality ref. mAs
Rotation time
Acquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
CTDIVol
Effective dose
CarotidAngio
80
100
2nd reconstr.
0.5/0.42 sec.
16 x 0.75 mm
0.75 mm
5.0 mm
1.0 mm
9.0 mm
0.75
5.0 mm
0.7 mm
B30f
B20f
2.6 mGy
Male: 0.47 mSv*
Female: 0.53 mSv*
* The conversion factor for a 7-year-old child, and a
scan range of 170 mm was used.
591
Children
Contrast medium IV injection
Start delay
exam dependent
Flow rate
dependent upon needle size/Access
site
Total
1 – 2 ml per kg of body weight
amount
Hints
• Children, who are more than 6 years old should be
scanned with an adult protocol.
• CARE Bolus may be used to optimize the bolus timing
and with a triggering threshold of 120 HU, or use
manual triggering.
• To work without CARE Dose 4D use for children
< 3 years 100 mAs
3-6 years 150 mAs
592
Children
593
Children
BodyAngio/BodyAngio042s
Indications:
For abdominal CT Angio studies, e.g. vascular abnormalities, aneurysms, etc.
A typical range of 20 cm covered in 12.17/10.22 sec.
BodyAngio
kV
Effective mAs/
Quality ref. mAs
Rotation time
Acquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
CTDIVol
Effective dose
2nd
reconstr.
80
75
0.5/0.42 sec.
16 x 0.75 mm
0.75 mm
3.0 mm
1.0 mm
9.0 mm
0.75
3.0 mm
0.7 mm
B30f
B20f
2.0 mGy
Male: 0.93 mSv*
Female: 1.12 mSv*
* The conversion factor for a 7-year-old child, and a
scan range of 200 mm was used.
594
Children
Contrast medium IV injection
Start delay
exam dependent
Flow rate
dependent upon needle size/Access
site
Total
1 – 2 ml per kg of body weight
amount
Hints
• Children with a body weight of more than 55 kg
should be examined with an adult protocol.
• CARE Bolus may be used to optimize the bolus timing. Set the ROI for monitoring scan in the abdominal
aorta with triggering threshold of 120 HU, or use
manual triggering.
• To work without CARE Dose 4D use for children
< 25 kg 40 mAs
25-34 kg 75 mAs
35-54 kg 130 mAs
595
Children
NeonateBody/
NeonateBody042s
Indications:
Spiral mode for neonate body studies, e.g. tumors,
abnormalities, malformations, abscesses, etc.
A typical range of 15 cm covered in 5.17/4.34 sec.
596
Children
kV
Effective mAs/
Quality ref. mAs
Rotation time
Acquisition
Slice collimation
Slice width
Feed/Rotation
Pitch Factor
Increment
Kernel
CTDIVol
Effective dose
NeonateBody
80
33/28
0.5/0.42 sec.
16 x 1.5 mm
1.5 mm
6.0 mm
18.0 mm
0.75
6.0 mm
B30f
0.7/0.6 mGy
Male: 0.95/0.81 mSv*
Female: 1.24/1.05 mSv*
* The conversion factor for a 8-week-old child, and a
scan range of 150 mm was used.
597
Children
Contrast medium IV injection
Start delay
exam dependent
Flow rate
dependent upon needle size/Access
site
Total
1 – 2 ml per kg of body weight
amount
Hint
• CARE Bolus may be used to optimize the bolus timing. Set the ROI for monitoring scan in the abdominal
aorta with triggering threshold of 120 HU, or use
manual triggering.
598
Children
599
Siemens AG
Wittelsbacherplatz 2
D-80333 Muenchen
Germany
Headquarters
Siemens AG
Medical Solutions
Henkestr. 127
D-91052 Erlangen
Germany
Telephone: +49 9131 84-0
www.siemens.com/medical
Contact Address
Siemens AG
Medical Solutions
Computed Tomography
Siemensstr. 1
D-91301 Forchheim
Germany
Telephone: +49 9191 18-0
© 2002-2005, Siemens AG
Order No.
C2-023.630.20.01.02
Printed in Germany
09/2005