Professional Documents
Culture Documents
RSNA-Edition
Nov. 26th Dec. 1st, 2006
10.00
www.siemens.com/medical
Highlights
COVER STORY
syngo WebSpace: Leading
the Workflow Revolution in
Volume CT
Page 4
Two: The New
Arithmetic of CT
Page 8
NEWS
Clinically Proven: The
Benefit of syngo Lung CAD
Now PMA Approved
Page 12
BUSINESS
Life in the Global Village:
A Dialogue With
Prof. Michael Knopp, MD
Page 15
CLINICAL OUTCOMES
Oncology Improved Follow
up For Pulmonary Nodules
Page 22
Acute Care NEW: Comprehensive 3D Stroke Imaging
Page 26
SCIENCE
See the Whole Disease:
Neuro Perfused Blood
Volume Imaging
Page 32
EDUCATION & EVENTS
The Worlds First
SOMATOM Definition
Workshop
Page 35
SOMATOM
Sessions
EDITORS LETTER
Andr Hartung,
Vice President Marketing
and Sales
Dear Reader,
In recent years, developments in the computed tomography (CT) field have accelerated with
breath-taking speed and have radically improved medical imaging. Siemens was able to make a
decisive contribution to this fascinating, quantum leap in CT development. Our success is based
upon a simple principle: cooperation with the best clinical experts. We are proud to say that we
have for years maintained professional contacts to experts from around the world. From the very
earliest stages of research, product development and design, Siemens relies upon the advice and
recommendations of external medical experts to determine our focus and this focus has been on
the needs and demands of the end users. In this way, our products have been able to make a significant difference for our customers.
Our newest innovations underscore the clinical advantages of our products: The Dual Source CT
SOMATOM Definition completely eliminates the need for beta-blockers to reduce heartbeat
frequency during CT heart examinations. Image quality and speed remain outstanding under these
conditions, including emergency room and obese patients. The first clinical installations utilizing
our Dual Source CTs with two x-ray sources and two detectors permitting imaging at two different
energy levels simultaneously are already in use. And the previously difficult challenge of quickly
and efficiently managing large volumes of high-resolution images and making these images
available wherever you are has been elegantly solved with syngo WebSpace software. Efficient 3D
CT post-processing from remote computer around the world is now a reality. (For more information, see our Cover Stories). The intelligent interaction and high-performance post-processing of
diagnostic information has become increasingly more important in daily clinical routine.
The medical profession has hardly begun to utilize the full potential of computed tomography and,
as usual, Siemens is taking the lead. In teamwork with our internal and external experts, all things
are possible. And making the difference for you, our customers, is our passion!
Enjoy reading
Cover Page: Real-time, spiral dual energy volume rendering technique (VRT) of a head and neck CTA shows
the precise cerebral vasculature status. Kindly provided by the University of Munich, Grosshadern, Germany.
SOMATOM Sessions 19
CONTENT
COVER STORY
4
NEWS
12
Clinically Proven: The Benefit of syngo Lung CAD Now PMA Approved
14
14
BUSINESS
15
19
CLINICAL OUTCOMES
20
22
24
26
Acute Care: NEW Comprehensive 3D Stroke Imaging With syngo Neuro PBV
SCIENCE
28
32
36
37
37
38
38
39
Imprint
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COVER STORY
syngo WebSpace:
Leading the Workflow
Revolution in Volume CT
Until now, the potential of volume CT imaging for diagnosis and treatment
has been limited due to workstation accessibility issues. But syngo WebSpace,
a new server / thin client technology, is rapidly meeting this challenge and
making access to 3D data available from everywhere*. SOMATOM Sessions
Tim Friend talked with Prof. Elliot Fishman about the workflow implications
of this new technology.
Elliot Fishman, MD, Professor of Radiology and Oncology, Johns Hopkins Medical Institutions, Baltimore, Maryland.
SOMATOM Sessions 19
COVER STORY
By Tim Friend
The most extraordinary feature of syngo WebSpace is how
ordinary it appears.
As I look on, Elliot Fishman, MD, Professor of Radiology and
Oncology at the Johns Hopkins Medical Institutions in Baltimore, chooses a desktop computer at random in an empty
cubicle across the hall from his office. He accesses Internet
Explorer and, with a brief flash of keystrokes, downloads a
syngo WebSpace client onto the computers hard drive. After
about a minute, a new icon appears on the desktop screen.
The program is loaded and ready to run.
Fishman clicks on the icon, which accesses the Internet and
connects to a server. Up pops a menu of patients who have
undergone CT scanning in the radiology department. One
more mouse click, and the screen displays a 3D state-ofthe-art CT image of a heart. The way someone might rev the
engine to display the power of a new Ferrari, he spins the
heart and manipulates the dramatically detailed image to
display the speed at which syngo WebSpace is able to operate
over a typical broadband internet connection.
A naive bystander would not realize what has just occurred.
But physicians accustomed to using a PACS workstation for
two-dimensional images and having to wait in line to log
onto a separate workstation for access to three-dimensional
images would immediately stop in their tracks and know they
were witnessing something remarkable and brand new.
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COVER STORY
who has taught 3D courses for ten years with Siemens, one
of the things we discovered was that, back in the beginning,
people would say, This 3D stuff is okay, but Im probably not
going to do it. Then, after a few years, people started saying
Well, its interesting. Ill have to keep my eye on it. Finally,
three to four years ago, with 16-slice CT, the real change
began, and people were saying, This 3D stuff is something I
probably should do. I noticed a big difference last year at the
64-slice level courses. Suddenly I was hearing, I agree with
you, we have to do it. The problem is, we cant do it, because
there are twenty people in my group and we only have one
workstation. Its not part of our workflow. We cant get to the
system. The system is down the hall from the scanner. Yes we
agree with you that this is a valuable tool, but how do we do
workflow? Thats really what syngo WebSpace does answer.
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At Hopkins, weve been Siemens users for more than twenty years. Weve been involved in CT and using Siemens scanners since 1982. Weve seen the technology change from the
DR3 scanner through single-slice spirals, through 4-slice spirals, through 16 to 64 slices, to literally the new Dual Source
CT, SOMATOM Definition, which is being installed at Hopkins
and expected to be operational within two weeks, Fishman
says. From the beginning, one of the things we have viewed
differently from many of our colleagues elsewhere is that CT
is more than slices. CT is volumes of data, and the best way
to get information from the CT scan was to use the volume
rather than the slices. Weve always been involved with
development and working with Siemens on workstations for
visualization. So whether it was with 3D Virtuoso or currently
with the MMWP and syngo InSpace4D, our concept was
always that CT is volume visualization. CT has gone from a
study of an abdomen lets say that was 30 slices to 100
slices
to 300 and now to thousands of slices. Because of those
capabilities, our abilities have changed over time. Yes, we have
always looked at the pancreas and the liver and lungs with CT,
but now we can do it better than ever more accurately
with higher sensitivity and higher specificity. Because of all
these important changes, we have been able to develop
new applications, from CT angiography to virtual bron-
COVER STORY
k www.siemens.com/syngo-WebSpace
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COVER STORY
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COVER STORY
80 kV
Attenuation B
140 kV
Attenuation A
Contrast Scans
In dual energy mode, on the other hand, each tube uses a
different X-ray energy. We are currently exploring the full
benefits of spiral dual energy, says Mahnken. When scanning an anatomical structure at 80 kV, one obtains a different
attenuation than that obtained at 140 kV. This provides information that extends beyond the actual imaging. syngo Dual
Energy should provide us with a new look at clinical questions.
For the first time, we are able to reliably separate cartilage
from tendons in a CT image. This is truly amazing. Dual energy
broadens the application spectrum we know from computed
tomography. The new technology also helps in the visualization of the hot problems of CT, the differentiation between
hard plaques and contrast agents. We can now display the
true vessel lumen without interfering plaques. A convincing
example of how important dual energy will be in everybodys
daily Radiology work.
Mahnken, who completed two years of training in healthcare management, knows how to calculate costs and sees
another advantage of syngo Dual Energy in the area of noncontrast scans. By using the X-ray tubes at two energy levels,
the contrast medium can be masked. Previously, two scans
were required to achieve this. We now perform only a single,
contrast enhanced, spiral dual energy scan, says Mahnken.
This provides two advantages: On the one hand, we can
subtract the contrast medium out of the images, avoiding
the non-enhanced examination and saving the corresponding radiation exposure. The resulting dual energy image
helps, on the other hand, to reliably characterize liver and
kidney lesions. Now, we can, for example, quickly differentiate between contrast enhanced and hypo-lipid areas, and
immediately identify possible tumors. In addition, through
distribution of the iodine, we also obtain information on
perfusion, which in turn provides a visualization of the vitality
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COVER STORY
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COVER STORY
Further Perspectives
Mahnken also sees potential for syngo Dual Energy in
characterizing body fluids. We are just at the very beginning
in this area. It will require additional research to be able to
differentiate between blood, pus, urine, or ascites with certainty, he explains, while keeping an eye on the workflows
in the department. To date, body fluids have only been
characterized via MRI or biopsy. A spiral dual energy scan
could provide comparable results. MRI and CT would come a
step closer, without arguing over competing application
areas. It is another interesting perspective of SOMATOM
Definitions syngo Dual Energy capabilities.
Additional Voices:
David P. Nadich, MD
David P. Naidich, MD, Professor of Radiology and
Medicine, NYU Medical Center and School of
Medicine, New York, USA:
The introduction of the SOMATOM Definition has been
particularly exciting for our department. The utilization
of syngo Dual Energy allows the possibility of evaluating the distinct material components of the body in a
way that was previously not possible. As an example, we
recently performed a spiral dual energy examination on
a patient with a metallic stent graft within a thoracic
aortic aneurysm. Heterogeneous high attenuation areas
within this aneurysm had caused previous evaluations
for an endoleak to be particularly difficult. However, on
the current scan the generation of virtual contrast and
noncontrast maps from the dual energy data allowed
us to confidently diagnose an enhancing endoleak
tract within pre-existing high attenuation thrombus.
Whats more, we are looking into the characterization
of solitary pulmonary nodules. With these lesions of
just a few millimeters, it is currently difficult to tell
whether they are malignant or benign. It should be
easier to clarify this question by subtracting the energy
levels, which is now possible for the first time. Calcium
is also important. We want to use syngo Dual Energy to
look at these deposits and the area behind them.
Perhaps one day, people will examine calcium deposits
in the breast with spiral dual energy scan. Who knows?
I think that many new applications will come to us
by chance. Essentially, every fundamental CT development has proven itself. I expect nothing less from Dual
Source CTs syngo Dual Energy.
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11
NEWS
Increased Detection
Accuracy
syngo Lung CAD is based on proprietary
image processing and pattern recognition algorithms that have been trained
on a large database of thoracic CT studies. The software is designed to assist radiologists in the detection of solid pulmonary nodules during review of multidetector computed tomography (MDCT)
examinations of the chest. syngo Lung
CAD alerts the radiologist to regions of
interest (ROI) that may have been overlooked in the initial read.
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syngo Lung CAD detects a range of nodule sizes, starting at 3 mm in diameter. The added value for the radiologist
using syngo Lung CAD in the second
read has been shown to be at different
nodule sizes, including nodules greater
than or equal to 3 mm as well as nodules
greater than or equal to 5 mm. The automatically detected nodules cover the
full range of locations and contours and
the CAD software works equally well in
the presence or absence of intravenous
contrast.
While syngo Lung CAD provides essential
support for the detection of lung nodules, the syngo LungCARE CT application facilitates interpretation as well as
NEWS
[ 2 ] Automated detection of potential nodules with syngo Lung CAD (red = CAD findings).
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NEWS
AUTO - PROCESSI N G
S I E M E N S R E M OTE S E RVI C E
30
20
10
10
11
12
13
14
days
customers system
benchmark system
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k www.siemens.com/
utilizationmanagement
This is a service of Life
our customer care solution
BUSINESS
Interview
L I F E I N T H E G LO B A L V I L L A G E P E R F O R M A N C E , S P E E D , E F F I C I E N C Y
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BUSINESS
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BUSINESS
have to think a lot more about who pays for health care and
what they can afford. This is one reason why Americans
attach great importance to it. So we have a kind of paradoxical
situation that there are very high expectations for the quality
of medical services, while a significant part of the population
cannot pay for it. For our routine CT-imaging it means that
we need a system that delivers top image quality while
being cost effective. Fast imaging allows not only excellent
throughput but also reduces motion artifacts. We have to
work very efficiently, which we can definitely do with the
SOMATOM Emotion.
Could you please describe the workflow at your institution from scanning to diagnosis?
Optimized image and work flow management is not just a
question of saving time but also has to do with the increasing specialization. Today we do all the imaging with the
SOMATOM Emotion 16 according to a standardized protocol. After the scan the images are sent automatically into the
PACS system, where everyone has access to them and that
includes both source data and the 3D reconstructions. Thus,
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BUSINESS
SOMATOM Emotion
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BUSINESS
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19
CLINICAL OUTCOMES
Cardiovascular
Oncology
Neurology
Acute Care
Case 1
Stenting of a Severe, Noncalcified Stenosis:
Combining SOMATOM Definition &
AXIOM Artis dFC to Improve Workflow and Speed
By Stephan Achenbach, MD, Associate Professor, and Josef Ludwig, PhD, Associate Professor, Department
of Internal Medicine II, University of Erlangen-Nuremberg, Germany
HISTORY
His heart rate showed 81 beats per minute and scan parameters were automatically adapted to the heart rate resulting
in a six second scan. Betablockade was unnecessary due to
the high temporal resolution of the scanner. The evaluation
was performed using standard 3D evaluation software and
syngo Circulation as a dedicated cardiac CT evaluation tool.
High-resolution images revealed that RCA and LAD were
without pathology. However, a severe, non-calcified stenosis
was diagnosed in the mid segment of the left circumflex
a rather unusual finding for a 32 year-old man.
The patient was transferred to the angio suite for immediate
treatment. Using the advantages of a universal syngo Workplace, the CT data could be directly accessed and evaluated
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CLINICAL OUTCOMES
COMMENTS
With the AXIOM Sensis hemodynamic recording system connecting to the hospitals information system server, required
demographics were downloaded automatically. syngo online
IC3D measurement provided accurate values for vessel
dimensions as well as the geographic location of the stenosis
relative to the ostium of the obtuse marginal branch without
foreshortening effects. A 13 mm drug eluting stent was
deployed. In conclusion the combined use of both the Dual
Source CT and the AXIOM Artis dFC achieved positive results.
EXAMINATION PROTOCOL
Scanner
SOMATOM Definition
Scan area
Cardiac Scan
Scan length
125 mm
Scan time
6s
Scan direction
cranio caudal
Heart rate
81 bpm
kV
120 kV
Effective mAs
330 mAs/rot.
Rotation time
0.33 s
Slice collimation
0.6 mm
Slice width
0.75 mm
Pitch
0.36
Reconstruction increment
0.6 mm
CTDI
26.6 mGy
Kernel
B26f
Contrast
Volume
55 ml
Flow rate
5 ml / s
Start delay
21 s
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CLINICAL OUTCOMES
Cardiovascular
Oncology
Neurology
Acute Care
Case 2:
Improved Follow up For Pulmonary Nodules With
syngo LungCARE and syngo Lung CAD
By Marco Das, MD, Georg Mhlenbruch, MD, Andreas H. Mahnken, MD, Rolf W. Gnther, MD, Joachim Ernst Wildberger, MD,
all from the Department of Diagnostic Radiology, RWTH Aachen University, Aachen, Germany
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size and size change are the most effective way for characterization. New guidelines from the Fleischner Society1 address
this problem, for the first time providing radiologists with
practical follow up suggestions for small pulmonary nodules.
This guideline is based on recent lung cancer screening trials,
and suggests follow-up for pulmonary nodules depending
on nodule size and patient risk classification. Thus, objective
and reliable nodule detection and follow-up measurements
have become more and more important as manual measurements yield high intra- and interreader variability.
[ 1 ] A small
pulmonary nodule
(diameter 2.1 mm)
in the apical segment of the upper
lobe on the left lung
was found by the
CAD software and
marked after verification by the Radiologist. Using the
automated follow
up function [Fig. 1A],
the corresponding
counterpart in the
follow up examination is automatically
marked [Fig. 1B].
CLINICAL OUTCOMES
2A
HISTORY
This case presents a 64 year old female with colorectal cancer,
who underwent chest MDCT for detection of pulmonary
metastasis.
EXAMINATION PROTOCOL
Scanner
SOMATOM Sensation
64-slice configuration
Scan area
Lung
Scan length
250-320 mm
DIAGNOSIS
Scan time
10 s
Scan direction
cranio-caudal
The initial read was negative for pulmonary nodules, but the
use of syngo Lung CAD indicated the presence of two very
small nodules (both with a nodule diameter about 2 mm).
Short term follow-up was performed to detect potential
growth of these two nodules, and assess the degree of
metastatic disease.
kV
120 kV
Effective mAs
Rotation time
0.5 s
Slice collimation
64 X 0.6 mm
Slice width
1.0 mm
18 mm
Reconstruction increment
0.5 mm
Kernel
B50f
COMMENTS
Using the automatic follow-up mode in syngo LungCARE,
previously marked nodules were automatically aligned with
the corresponding nodule (counterpart) in the follow-up
examination. Volumetry results were directly compared and
growth rate estimated. Additionally CAD was run on the
follow up examination, enhancing diagnostic confidence.
In our experience, syngo Lung CAD is a clinically valuable
tool, helping physicians to be sure that all potential lesions
are identified. The automatic follow-up feature of syngo
LungCARE CT helps to eliminate errors in assessing the growth
progression, or regression, of lesions, thereby enhancing our
diagnostic confidence for chest exams.
1 MacMahon H, Austin JH, Gamsu G, Herold CJ, Jett JR, Naidich DP, Patz
EF Jr, Swensen SJ; Fleischner Society. Guidelines for management of small
pulmonary nodules detected on CT scans: a statement from the Fleischner
Society. Radiology 2005; 237: 395 400.
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CLINICAL OUTCOMES
Cardiovascular
Oncology
Neurology
Acute Care
1A
Case 3:
Child 11 Months:
Visualization of a Choroid
Plexus Papilloma
By Andrzej Kosciesza, MD, Piotr Nuzynski, MD, Department of
Radiology, Bogdanowicz Hospital, Warsaw, Poland
1B
HISTORY
A normally developing infant aged eleven months suffered a
minor trauma. Ultrasonographic examination disclosed
triventricular hydrocephalus and abnormal hyperechogenic
mass in midline partially involving the lateral ventricles and
the third ventricle.
DIAGNOSIS
On CT examination an abnormal mass of highly increased
density was seen, involving the lateral ventricles and the
third ventricle, associated with supratentorial hydrocephalus.
On histological examination choroid plexus papilloma was
found.
1C
COMMENTS
This case demonstrates the usefulness of CT in the assessment
of the character and precise location of well vascularized
congenital tumours in children. Short acquisition time and
secondary reconstructions of outstanding quality using a
SOMATOM Emotion 16-slice configuration enable correct
diagnosis and precise planning of surgical treatment.
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SOMATOM Sessions 19
CLINICAL OUTCOMES
SOMATOM Emotion 16-slice configuration with a wide-open gantry in the children scan room,
all painted in a very colorful way so that the small patients are not afraid of examinations.
EXAMINATION PROTOCOL
SOMATOM Emotion
16-slice configuration
Slice width
1.5 mm
Pitch
0.55
Scan area
Head
Reconstruction increment
0.6 mm
Scan length
126 mm
Kernel
H40s medium
Scan time
22 s
kV
130 kV
Contrast
Effective mAs
240 mAs
Volume
12 ml
Rotation time
1.5 s
Flow rate
manual
Slice collimation
16 x 1.2 mm
Start delay
manual
Scanner
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CLINICAL OUTCOMES
Cardiovascular
Oncology
Neurology
Case 4:
NEW: Comprehensive 3D Stroke Imaging
With syngo Neuro PBV
Acute Care
No
w
FD
AC
lea
re
By Jie Lu1, MD, Miao Zhang1, MD, Jiuhong Chen2, Prof. Kuncheng Li, MD1,
1
HISTORY
A 59 year old male was delivered to our stroke unit in the
Xuanwu hospital three hours after onset of right-sided
extremity weakness and a right-sided hemiparesis. On
examination in the emergency room, he was found to have
profound right extremity paresis, an expressive aphasia and
facial palsy on the left side. A complete stroke evaluation
was scheduled. In order to meet the demand of fast hemodynamic imaging of the entire brain, CT Perfusion and whole
brain perfused blood volume calculation using syngo Neuro
PBV (Perfused Blood Volume)* were performed. This new
approach allows for routine calculation of three-dimensional, color-coded whole brain images overcoming the
limited scan coverage of Perfusion CT.
1A
1B
1C
1D
[ 1 ] CT Perfusion demonstrates a clear infarct of the left hemisphere with delayed TTP [marked areas, Fig. 1A]
reduced cerebral blood volume [Fig. 1B] and reduced cerebral blood flow [Fig. 1C]. The tissue at risk assessment
clearly indicated the core infarct [red areas, Fig. 1D] and with a large area of tissue at risk [yellow areas, Fig. 1D]
which might be rescued after intervention.
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CLINICAL OUTCOMES
EXAMINATION PROTOCOL
Scanner
Scan area
Head
Head
Scan length
133 mm
474 mm
Scan time
9.81 s
5.96 s
Tube voltage
120 kVp
120 kVp
Effective mAs
480 mAs
150 mAs
Rotation time
1.0 s
0.5 s
Slice collimation
64 x 0.6 mm
64 x 0.6 mm
Slice width
1.0 mm
1.0 mm
Reconstruction
increment
0.8 mm
0.8 mm
Kernel
H20 S
H20 S
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SCIENCE
EDUCATION
CARE Dose4D
New Technique for Radiation Dose Reduction
Discussion of fundamental basis, clinical applications
and advantages of automatic exposure control techniques,
with particular emphasis on the CARE Dose4DTM technique
By Mannudeep K. Kalra, MD and Thomas J. Brady, MD, Division of Cardiac Imaging,
Department of Radiology, Massachusetts General Hospital, Boston, USA
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SCIENCE
eff. mAs
(compared to Quality ref. mAs)
Effect of Modulation Strengths on Radiation Dose for Slim and Obese Patients
200
constant
image noise
180
160
average increase
140
weak increase
120
100
constant dose
slim patient/ region:
weak decrease
80
60
average decrease
strong decrease
40
20
50
100
150
slim patient
obese patient
slim region
obese region
200
250
300
350
400 %
X-ray attenuation
(compared to reference attenuation)
[ 1 ] The sophisticated algorithm provides desired image quality for all patients, slim to obese. Individual
preferences on tube current increase and decrease can be realized by choosing strong, moderate or weak.
tion and lower tube current for smaller patients and anatomical regions with low attenuation in order to maintain
desired image quality at optimum radiation dose2. Lastly,
combined modulation technique (CARE Dose4D), discussed
in the following section, combines benefits of angular and
z-axis modulation techniques.
How does CARE Dose4D technique work?
From a single topogram, the CARE Dose4D technique
measures attenuation profile in the z-axis in the direction of
projection and also in the perpendicular direction with a
sophisticated algorithm4. Tube current values are calculated
and adapted to the patient size and attenuation changes
based on these attenuation profiles. Tube current adjustment
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SCIENCE
2A
2B
[ 2 ] CT image acquired with CARE Dose4D techniques reveal excellent image quality with substantial dose reduction.
[Fig. 2A] Chest-CT with 20% mean dose reduction and [Fig. 2B] abdomen-liver with 38% mean dose reduction5.
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SCIENCE
X-ray
dose
Scan with
constant mA
Reduced dose
level based on
topogram
Real-time
angular dose
modulation
Slice position
1332 mA
20 mA
References
1 Kalra MK et al. Radiology. 2004; 230: 61928.
2 Kalra MK et al. Radiology. 2004; 233: 64957.
3 Greess H et al. Eur Radiol 2002; 12: 157176.
4 Rizzo S et al. AJR Am J Roentgenol. 2006; 186: 6739.
5 Mulkens TH et al. Radiology. 2005; 237: 21323.
6 Graser A et al. Am J Roentgenol. 2006; 187: 695701.
7 Rizzo S et al. Am J Roentgenol 2005; 184: 491496.
8 Tejas Dalal et al. Radiology 2005; 236: 671675.
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SCIENCE
Introduction
Computed tomography is still the most widely used imaging
modality in the evaluation of acute stroke as magnetic resonance imaging (MRI) is hampered by its relatively limited
availability. CT angiography and perfusion CT (PCT) improve
the diagnostic yield of non-enhanced CT (NECT) by direct
visualization of cerebral vessels and assessment of cerebral
hemodynamics. PCT is used to calculate color-coded maps
of the hemodynamic parameters cerebral blood flow (CBF),
cerebral blood volume (CBV) and time to peak enhancement
(TTP) and thus allows detailed evaluation of perfusion disturbances including delineation of brain tissue with irreversible
damage and tissue at risk1. In contrast to diffusion weighted
MRI or MRI perfusion measurement, PCT evaluation is
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Imaging Protocol
CT imaging in patients with suspected acute stroke at our
institution consists of NECT followed by PCT and CTA2. The
scan delay for the CTA is derived from the time to peak
enhancement in the sagittal sinus in PCT to allow for combined arterial and venous vessel evaluation. NECT and CTA
cover the entire brain and both scans are acquired with identical detector collimation, section thickness and reconstruction increment. For the CTA, intravenous injection of
100 mL of a non-ionic high concentration contrast agent
(350 400 mg iodine/mL) followed by a saline flush of
50 mL with a flow rate of 4 mL/s is performed.
Images of the whole brain NECT and CTA data sets are loaded
into the syngo Neuro Perfused Blood Volume CT (PBV)* software for the calculation of the PBV. The software generates
PBV data sets by fully automatic registration and normalized
subtraction of the NECT data from the CTA data [Fig. 1].
The result of the subtraction operation reflects the overall
brain parenchymal enhancement. After filtering, PBV images
are displayed using a color code similar to perfusion CT maps.
In normal perfused brain parenchyma, the white matter
usually is coded in blue to dark green color corresponding to
the physiologically lower blood perfusion, whereas the basal
ganglia and cortex have higher normal perfusion values and
are displayed in yellow or green [Fig. 2].
SCIENCE
[ 2 ] Visualization
of Neuro Perfused
Blood Volume Imaging
in a patient without
perfusion abnormality.
The color-coded 3Ddataset displays regular levels of blood
volume in the white
and grey matter
Examination Protocol
Non-enhanced CT
CT angiography
Scanner
SOMATOM Sensation
16-slice configuration
SOMATOM Sensation
64-slice configuration
SOMATOM Sensation
16-slice configuration
SOMATOM Sensation
64-slice configuration
Scan area
Head
Head
Head
Head
kV
120 kV
120 kV
120 kV
120 kV
Effective mAs
360 mAs
480 mAs
130 mAs
175 mAs
Rotation time
1s
1s
1s
0.5 s
Slice collimation
16 x 0.75 mm
64 x 0.6 mm
16 x 0.75 mm
64 x 0.6 mm
Slice width
1 mm
1 mm
1 mm
1 mm
Reconstruction increment
0.8 mm
0.8 mm
0.8 mm
0.8 mm
Kernel
H20 S
H20 S
H20 S
H20 S
Tube voltage
120 kVp
120 kVp
120 kVp
120 kVp
Field of view
230 mm
230 mm
230 mm
230 mm
350400 mg iodine/mL
Contrast
Volume
50 ml (volume of saline)
4 ml / s
Flow rate
Postprocessing
PBV -version
PBV -version
SOMATOM Sessions 19
33
SCIENCE
3A
3B
[ 3 ] 81 year-old
3C
3D
34
SOMATOM Sessions 19
E D U C AT I O N
SOMATOM Sessions 19
35
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SOMATOM Sessions 19
C T- O N L I N E : C O U R S E S C H E D U L E
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SOMATOM Sessions 19
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C T ONLINE
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Arab Health
Dubai, UAE
www.arabhealthonline.com
ESGAR CTC
Workshop
Nice, France
Hands-on Workshop
on CT Colonography
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Orlando, USA
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Vienna, Austria
Exhibition and
Scientific Congress
www.ecr.org
ACC
Annual Scientific
Session and Exposition
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Deutsche Gesellschaft
fr Kardiologie
Mannheim,
Germany
73. Jahrestagung
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ITEM
Yokohama, Japan
Trade fair
www.j-rc.org
Advanced Topics
in CT Scanning:
Baltimore, USA
CT Angiography, 3D:
Current State of the Art,
focus: Cardiac CT
www.hopkinscme.org/
Deutscher Rntgenkongress
Berlin, Germany
www.drg.de
Stanford Symposium
radiologycme.stanford.edu
In addition, you can always find the latest CT courses offered by Siemens Medical Solutions at www.siemens.com/SOMATOMEducate.
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SOMATOM Sessions 19
CUSTOMER CARE
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Highlights
COVER STORY
syngo WebSpace: Leading
the Workflow Revolution in
Volume CT
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Two: The New
Arithmetic of CT
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NEWS
Clinically Proven: The
Benefit of syngo Lung CAD
Now PMA Approved
Page 12
BUSINESS
Life in the Global Village:
A Dialogue With
Prof. Michael Knopp, MD
Page 15
CLINICAL OUTCOMES
Oncology Improved Follow
up For Pulmonary Nodules
Page 22
Acute Care NEW: Comprehensive 3D Stroke Imaging
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SCIENCE
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EDUCATION & EVENTS
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SOMATOM Sessions
Issue No.19/ November 2006