Siemens 2005C User Manual

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SOMATOM Spirit

Application Guide

Protocols Principles Helpful Hints

syngo 3D syngo Fly Through syngo Dental CT syngo Osteo CT syngo Volume Evaluation syngo Dynamic Evaluation

Software Version syngo CT 2005C

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 Spirit. The statutory source for the technical data are the corresponding data sheets.

We express our sincere gratitude to the many customers who contributed valuable input.

Special thanks to Heike Theessen, Christiane Bredenhöller, Kristin Pacheco, Karin Ladenburger, and Chen Mahao for their valuable assistance.

To improve future versions of this Application Guide, we would greatly appreciate your questions, suggestions and comments.

Please contact us:

USC-Hotline:

Tel. no.+49-1803-112244

email ct-application.hotline@med.siemens.de

Editor: Ute Feuerlein

Overview

User Documentation 14

Scan and Reconstruction 16

Dose Information 28

Workflow Information 36

Application Information 54

Head 70

Neck 88

Shoulder 94

Thorax 98

Abdomen 110

Pelvis 124

Spine 132

Upper Extremities 146

Lower Extremities 154

Vascular 162

Specials 176

Children 184

syngo 3D 240

syngo Fly Through 258

syngo Dental CT 268

syngo Osteo CT 274

syngo Volume Evaluation 288

syngo Dynamic Evaluation 306

Contents

User Documentation 14

Scan and Reconstruction 16

• Concept of Scan Protocols 16

• Scan Set Up 17

• Scan Modes 18

- Sequential Scanning 18

- Spiral Scanning 18

- Dynamic Serioscan 18

• Slice Collimation and Slice Width 19

- Slice Collimation and Slice Width for

Spiral Mode and HR Spiral Mode 20

- Slice Collimation and Slice Width for Sequence Mode and HR Sequence Mode 20

• Increment 21

• Pitch 22

• Window values 23

• Kernels 24

• Image Filters 25

• Improved Head Imaging 27

Dose Information 28

• CTDI

and CTDI

• Effective mAs 30

• CARE Dose 32

Vol

- How does CARE Dose work? 32

Workflow Information 36

• Recon Jobs 36

• Examination Job Status 37

• Auto Load in 3D and Post-processing

Presets 38

• How to Create your own

Scan Protocols 39

- Edit/Save Scan Protocol 39

- Scan Protocol Manager 40

Contents

• Contrast Medium 45

- The Basics 45

-IV Injection 47

-Bolus Tracking 48

- Test Bolus using CARE Bolus 50

- Test Bolus 51

Application Information 54

• SOMATOM life 54

-General Information 54

-Key Features 55

- Description 56

- Access to Computer Based Training or

Manuals on CD ROM 57

- SRS Based Services 58

- Download of Files 59

- Contact incl. DICOM Images 60

- Trial Order and Installation 62

• Image Converter 64

• File Browser 66

• Patient Protocol 68

Head 70

• Overview 70

• Hints in General 71

- Head Kernels 71

• HeadRoutine 72

• HeadSeq 74

• InnerEarHR 76

• InnerEarHRSeq 78

• Sinus 80

• SinusSeq 82

• Orbita 84

• Dental 86

Contents

Neck 88

• Overview 88

• Hints in General 89

-Body Kernels 90

• Neck 92

Shoulder 94

• Overview 94

• Hints in General 95

-Body Kernels 95

• Shoulder 96

Thorax 98

• Overview 98

• Hints in General 99

- Body Kernels 101

• ThoraxRoutine/ThoraxRoutine08s 102

• ThoraxFast 104

• ThoraxHRSeq 106

• LungLowDose 108

Abdomen 110

• Overview 110

• Hints in General 111

- Body Kernels 113

• AbdomenRoutine/AbdomenRoutine08s 114

• AbdomenFast 116

• AbdMultiPhase/AbdMultiPhase08s 118

• AbdomenSeq 122

Contents

Pelvis 124

• Overview 124

• Hints in General 125

- Body Kernels 125

• Pelvis 126

• Hip 128

• SI_Joints 130

Spine 132

• Overview 132

• Hints in General 133

- Body Kernels 135

• C-Spine 136

• C-SpineSeq 138

• Spine 140

• SpineSeq 142

• Osteo 144

Upper Extremities 146

• Overview 146

• Hints in General 147

- Body Kernels 148

• WristHR 150

• ExtrRoutineHR 152

Lower Extremities 154

• Overview 154

• Hints in General 155

- Body Kernels 156

• KneeHR 158

• FootHR 160

• ExtrRoutineHR 161

Contents

Vascular 162

• Overview 162

• Hints in General 163

- Head Kernels 163

- Body Kernels 163

• HeadAngio/HeadAngio08s 164

• CarotidAngio/CarotidAngio08s 166

• ThorAngio/ThorAngio08s 168

• Embolism 170

• BodyAngioRoutine/BodyAngioRoutine08s 172

• BodyAngioFast 174

Specials 176

• Overview 176

- Trauma 176

- Interventional CT 176

- Test Bolus 176

• Trauma 177

- The Basics 177

• PolyTrauma 178

• HeadTrauma 180

• Interventional CT 181

• Biopsy 182

• TestBolus 183

Children 184

• Overview 184

• Hints in General 187

- Head Kernels 190

- Body Kernels 191

• HeadRoutine_Baby 192

• HeadRoutine_Child 194

• HeadSeq_Baby 196

• HeadSeq_Child 198

• InnerEar 200

• SinusOrbi 202

• Neck 204

Contents

• ThoraxRoutine_Baby 206

• ThoraxRoutine_Child 208

• ThoraxHRSeq_Baby 210

• ThoraxHRSeq_Child 212

• Abdomen_Baby 214

• Abdomen_Child 216

• Spine_Baby 218

• Spine_Child 220

• ExtrHR_Baby 222

• ExtrHR_Child 224

• HeadAngio 226

• HeadAngio08s 228

• CarotidAngio 230

• CarotidAngio08s 232

• BodyAngio 234

• BodyAngio08s 236

• NeonateBody 238

syngo 3D 240

- Multi Planar Reconstruction (MPR) 240

- Maximum Intensity Projection (MIP) 240

- Shaded Surface Display (SSD) 241

- Volume Rendering Technique (VRT) 241

- Prerequisites 242

• Workflow 242

- Loading the Images 242

- Creating Series 244

- Editing 246

- Documentation of Results 249

• Workflow for a CT Extremity Examination 250

- Using MPR/MPR Thick 250

- Using SSD 251

- Using VRT 251

• Workflow for a CT Angiography 252

- Using MIP/MIP Thin 252

- Using VRT/VRT Thin/Clip 253

• Hints in General 254

- Setting Views in the Volume Data Set 254

- Changing /Creating VRT Presets 255

Contents

- Auto Load in 3D and Post-processing

Presets 257

- Blow-up Mode 257

syngo Fly Through 258

• Key Features 258

• Prerequisites 259

• The Basics for CT Virtual Endoscopy 259

- SSD and VRT Presets for Endoscopic Renderings 259

- Endoscopic Viewing Parameters/

Fly Cone Settings 260

- Patient Preparation 262

• Workflow 263

- Navigation of the Endoscopic Volume 265

- Fly Path Planning 266

syngo Dental CT 268

• The Basics 268

• Scan Protocols 269

• Additional Important Information 271

syngo Osteo CT 274

• The Basics 274

• Scanning Procedure 275

• Configuration 278

• Evaluation Workflow 282

• Additional Important Information 287

syngo Volume Evaluation 288

• Prerequisites 290

• Workflow 291

• General Hints 300

• Configuration 303

Contents

syngo Dynamic Evaluation 306

• Prerequisites 308

• Workflow 309

- 1. Loading the Images 309

- 2. Inspecting the Input Images 310

- 3. Generation of Parameter Images 310

- 4. Creating a Baseline Image 313

- 5. Evaluation of Region of Interests 314

- 6. Enhancement Curve 315

- 7. Documentation of Results 316

• General Hints 317

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 Preparations Examination CARE Bolus CT

syngo CT Operator Manual

Volume 2:

syngo Patient Browser syngo Viewing syngo Filming syngo 3D

syngo CT Operator Manual

Volume 3:

syngo Data Set Conversion syngo Dental CT syngo Dynamic Evaluation syngo Osteo CT syngo Volume

User Documentation

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, Specials, and Vascular.

The general concept is as follows: All protocols without suffix are standard spiral modes. E.g., “Shoulder” means the spiral mode for the shoulder.

The suffixes of the protocol name are follows:

“Routine“: for routine studies

“Seq”: for sequence studies

“Fast“: use a higher pitch for fast acquisition

“HR“: use a thinner slice width (1.0 mm) for High Resolution studies and a thicker slice width for soft tissue studies

The availability of scan protocols depends on the system configuration.

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 chron icle 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.

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 acquisi tion. 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 interscan 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.

Dynamic Serioscan

Dynamic serial scanning mode without table feed. Dynamic serio can still be used for dynamic evaluation, such as Test Bolus.

Scan and Reconstruction

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., 2 x

mm).

1.0

Slice width is the FWHM (full width at half maximum) of the reconstructed image.

With the SOMATOM Spirit, 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.

The Recon icon on the chronicle will be labeled with “RT”. After the scan, the Real Time displayed image series has to be reconstructed.

The following tables show the possibilities of image reconstruction in spiral and sequential scanning.

Scan and Reconstruction

Slice Collimation and Slice Width for Spiral Mode and HR Spiral Mode

1 mm: 1, 1.25, 2, 3, 5 mm

1.5 mm: 2, 3, 5, 6 mm

2.5 mm: 3, 5, 6, 8, 10 mm 4 mm: 5, 6, 8, 10 mm 5 mm: 6, 8, 10 mm

Slice Collimation and Slice Width for Sequence Mode and HR Sequence Mode

1.0 mm: 1, 2 mm

1.5 mm: 1.5, 3 mm

2.5 mm: 2.5, 5 mm

4.0 mm: 4, 8 mm

5.0 mm 5, 10 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 an overlap. This technique is useful to reduce partial volume effect, giving you better detail of the anatomy and high quality 2D and 3D post-process ing.

Slice Thickness = 10 mm

Increment = 10 mm

Reconstruction Increment

Increment = 5 mm

Increment = 3 mm

Scan and Reconstruction

Pitch

In single slice CT: Pitch = table movement per rotation/slice collimation

E.g.,: slice collimation = 5 mm, table moves 5 mm per rotation, then pitch = 1.

With the Siemens Multislice CT, we differentiate between:

Feed/Rotation, the table movement per rotation

Volume Pitch, table movement per rotation/single

slice collimation.

Pitch Factor, table movement per rotation/complete slice collimation.

E.g., slice collimation = 2 x 5 mm, table moves 10 mm per rotation,

then Volume Pitch = 2, Pitch Factor = 1.

With the SOMATOM Spirit, the pitch, slice, collimation, rotation time, and scan range can be adjusted. The pitch factor can be selected from 0.5-2.

Pitch 1

Pitch Models

Pitch 1.5

Pitch 2

Scan and Reconstruction

Window values

The Scale of the CT Hounsfield Units is from -1024 to +3071.

The displayed window values have to correspond to the anatomical structure.

Windowing is used to optimize contrast and brightness of images.

Hounsfield Units

Spleen

Fat

Window center C

Kidneys

Pancreas

Lung

Adrenal Glands

Blood

Heart

Window width W

Bones

Water

Breast

Air

Organ specific window values

Gray scale

white

CT-window values

Liver

Tumo r

Bladder

Colon

black

Scan and Reconstruction

Kernels

There are 3 different types of kernels: “H“ stands for Head, “B“ stands for Body, “C“ stands for ChildHead.

The image sharpness is defined by the numbers – the higher the number, the sharper the image; the lower the number, the smoother the image.

A set of 18 kernels is supplied, consisting of:

• 6 body kernels: smooth (B20s), medium smooth (B31s), medium (B41s), medium sharp (B50s), sharp (B60s), high res (B70s)

• 7 head kernels: smooth (H21s), medium smooth (H31s), medium (H41s), medium sharp (H50s), sharp (H60s), high res (H70s), ultra high res (H80s)

• 3 child head kernels: smooth (C20s), medium (C30s), sharp (C60s)

• 2 special kernels: S80s, U90s

Note: Do not use different kernels for body parts other than what they are designed for.

For further information regarding the kernels, please refer to the “Hints in General” of the corresponding body region.

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

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 tissue, while edges with high contrast are preserved.

• Reduces noise without blurring of edges

• Enhances low-contrast detectability

• Individually adaptable

• Automatic post-processing

Scan and Reconstruction

Improved Head Imaging

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 improves head image quality in general. Bone correction is activated auto matically for body region “Head”.

In order to optimize image quality versus radiation dose, scans in the body region “Head” 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.

Head image without correction.

Head image with corrections.

Dose Information

CTDIW and CTDI

Vol

The average dose in the scan plane is best described by the CTDIW for the selected scan parameters. The CTDI is measured in the dedicated plastic phantoms – 16 cm diameter for head and 32 cm diameter for body (as defined in IEC 60601 –2 – 44). This dose number gives a good estimate for the average dose applied in the scanned volume as long as the patient size is similar to the size of the respective dose phantoms.

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 CTDI

, must therefore be cor-

rected 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:

CTDI

= CTDIW/Pitch Factor

Vol

This dose number is displayed on the user interface for the selected scan parameters.

Dose Information

The CTDI tion of the radiation risk associated with CT examination. For the purpose, the concept of the “Effective Dose“ was introduced by ICRP (International Commis sion 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.

value does not provide the entire informa-

vol

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 CTDI

= D

seq

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:

= (D

spiral

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

per mAs:

x mAs

CTDIw

x mA x Rot Time)/Pitch Factor

CTDIw

To calculate the dose you simply have to multiply the CTDIw per mAs with the effective mAs of the scan:

spiral

= D

x effective mAs

CTDIw

Dose Information

For spiral scan protocols, the indicated mAs is the effective mAs per image. The correlation between tube current mA 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 =

mA =

where Slice collimation refers to the collimation of one detector row, and nrow is the number of used detector rows.

effective mAs

R o t T i m e

Feed/Rot

nrow x Slice collimation

x Pitch Factor

Dose Information

CARE Dose

CARE Dose is a clinical application package that provides real-time tube current modulation for Spiral and Sequential Scanning.

CARE Dose reduces patient dose significantly, especially in the regions of shoulder and pelvis. It decreases tube load, which extends the capacity for volume scanning with thinner slices, larger volumes or Multi-phase studies.

It can also improve image quality by increasing mA, thus reducing image noise on the lateral views.

How does CARE Dose work?

It reduces the mA for low attenuation views up to 90% and keeps the nominal higher mA for high attenuation views, e. g. in the lateral projection. This is done “onthe-fly”, i.e. the scanner adapts the mA in real-time, according to the patient’s attenuation profile.

Dose Information

Low attenuation,

low mA

Example of scanning the shoulder region.

High

attenuation high mA

rel. units

lateral

TOP

Object attenuation Modulated tube current

time

Principle of CARE Dose tube current adaption.

• CARE Dose is pre-selected by default for most standard protocols. It can be switched on/off in the Scan subtask card.

Dose Information

• For the average patients examination, CARE Dose does not require any manual changes to the scan protocol. However, the mAs must be adapted manually for obese and pediatric patients.

• The mean value of the mAs applied will be lower than what you have selected. Although the average mA for the entire scan will be lower than selected, we allow the scanner to apply increased mA levels for the high attenuation views. This may cause dif ferent results of the tube load controller when switching on and off CARE Dose.

• The mean value of the effective mAs applied is shown in the image text.

Dose Information

Workflow Information

Recon Jobs

In the Recon card, you can define up to 3 reconstruction jobs for each range with different parameters, either before or after you acquire the data. When you deselect all chronicle entries, all open recon jobs will be automatically reconstructed after you click on “Recon“. In case you want to add more than 3 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 hard drive.

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 main menu of 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

–Auto 3D

all 3D reconstructions which you have sent via “Auto post-processing” 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.

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 2 width in some of the examination protocols.

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 MPRs 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 Range Parallel function. Adapt the range settings (Image thickness, Distance between the images etc.) and hit the link but ton. 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.

recon job with thinner slice

Workflow Information

How to Create your own

Scan Protocols

There are two different ways to modify and create your scan protocols:

Edit/Save Scan Protocol

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 protocols fit 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.

• 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.

Workflow Information

Hints

• 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 _ (underscore).

• Do not rename scan protocol files on Windows level. This will lead to inconsistencies.

• You can now save your own scan protocols in any predefined 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.

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 Pro- tocol Manager”. The “Scan Protocol Manager” is opened and all protocols are loaded.

User-specific scan protocols can be saved with the following basic procedure:

Open “Options, on the “Scan Protocol Manager” icon.

• Rename a protocol: Select a scan protocol with the right mouse button.

Select “Rename” and enter a new name for the protocol.

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”.

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.

• Change the structure of the protocol tree. You can sort all Customers protocols as needed. Select the desired protocols, press right mouse button.

You will find the entries: – Cut/copy – Paste

to change the sorting of your protocol tree. You can also do this easily by dragging and dropping the protocols under the desired position.

Workflow Information

Hints

• 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.

• The entry “Set to defaults” in the main menu/ context sensitive menu will reset all your changes to the Siemens default values.

• Display of actions: – Invalid protocols or parameters are marked in yel-

low.

– Changed, but not yet saved protocols and/or

parameters are marked in green.

• With the entries Save/Save as/Save all, you can save your changes.

• For security purposes it is not possible to do any changes in the Siemens protocols, although you can copy or drag&drop these protocols into a Customer folder.

• Scan protocols can be deleted if they belong to the USER category. Only complete scan protocols can be deleted. It isn’t possible to delete scan protocol entries or scan protocol recon jobs.

• 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”.

Workflow Information

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 (Right-click in the table, click View Source/ File/Save As…).

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. There fore, it is essential to initiate the acquisition with the correct start delay. Since multislice spiral CT can pro vide much faster speed and shorter acquisition time, it is even more critical to get the right timing to achieve optimal results.

40 s scan

Longer scan time Shorter scan time

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

10 s scan

Workflow Information

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 Enhancemen t [HU]

Time [s]

Relative Enhancement [HU]

Time [s]

2 ml/s, 120 ml, 300 mg I/ml 4 ml/s, 120 ml, 300 mg I/ml

Relative Enhancement [HU]

Time [s]

Relative Enhancement [HU]

Time [s]

80 ml, 4 ml/s, 300 mg I/ml 120 ml, 4 ml/s, 300 mg I/ml

Relative Enhancement [HU]

Time [s]

Relative Enhancement [HU]

Time [s]

Uni-phase 140 ml, 4 ml/s, 370 mg I/ml

Bi-phase 70 ml, 4 ml/s, plus 70 ml, 2 ml/s, 370 mg I/ml

*Radiology 1998; 207:647 – 655

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 CTA studies (arterial phase), the principle is to keep contrast injection 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 more information regarding the general use of

drugs and doses mentioned in this guide, please refer to page 2.

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.

General Hints

• 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 protocol.

• 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.

• 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 spi-

ral scanning range and the optimal monitoring position will be shown.

– 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 scan ning range and the monitoring scan will be the same).

Workflow Information

– 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).

• 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 posi tioning of the ROI.

• 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.

• 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 num ber extremely high so that it will not trigger automatically, and you can start the spiral when you desire.

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 submenu prior to the spiral.

2.Insert “contrast“ from the right mouse button context menu prior to the monitoring scans. 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 Topogram.

4.Position the premonitoring scan and the spiral range.

5.Perform the premonitoring scan, position and accept the ROI.

6.Start monitoring scans and a short amount of con-

trast (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 subtask 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.

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 Test Bolus mode under Special protocols.

2.Insert the Test Bolus mode above the spiral mode for contrast scan by “cut/paste” (with right mouse but ton).

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.

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.

Workflow Information

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 posi tion 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.

Workflow Information

Application Information

SOMATOM life

General Information

SOMATOM life @ Your Scanner provides actual news around your scanner, shows you helpful configuration information of your system and enables you to access the Siemens Extranet where you will find further opportunities to enhance your possibilities to use the CT system.

To benefit from the Siemens Extranet, a Siemens Remote Service connection is required. The Siemens Extranet allows you to order Trial Licenses, download the necessary Application Guide or find interesting information related to your CT system.

Note: Siemens Remote Service is an optional part of your service contract that also covers remote service capabilities for your CT system to optimize the system availability and is also prerequisite for other services.

Application Information

Key Features

All users:

• General Information

• Access to Web Based E-Training or Manuals on CD ROM

In combination with a Siemens Remote Service connection:

• News-Ticker 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 ability to attach up to two DICOM images

Note: In regard to legal issues, not all services may be available in every country.

Application Information

Description

All users:

Start SOMATOM life @ Your Scanner by selecting SOMATOM life under "options" in your syngo menu bar and you will find a browser window that allows you to access different information about your hard- and soft

ware environment.

Under e.g., "System Information" you have information such as software version or scan second counter. Under Customer Information you can enter your demographic data.

Note: The institution data and at least one contact person have to be entered to be able to access the Siemens Extranet. The link to the Siemens Extranet will be visible only after you have entered this data.

Application Information

Access to Computer Based Training or Manuals on CD ROM

Start the Computer Based Training to learn more about your software and enhance your clinical knowledge.

Note: The syngo Basics Training is pre-installed on your system and can directly be used by selecting SOMA TOM Educate. The syngo Advanced Application Training can be downloaded in the Siemens Extranet or is sent to you automatically on CD if you request a trial software via the Siemens Extranet.

In case a document (e.g., Application Guide) is not visible after being opened:

• Minimize or move the Browser window of the SOMATOM life platform.

Under the navigation path "World" you can also start your manual CD ROM.

Application Information

SRS Based Services

During the start up of your system you will receive actual information in the "Newsticker" and see the expiration date of installed trial software.

Note: Siemens will send you a Newsticker whenever there is helpful information for CT users. The trial licenses are valid for 90 days and can only be ordered once.

Access the Siemens Extranet by clicking on "Extranet". After entering your CT system serial number you will be forwarded to the workspace. You can find the serial number in the system information in the offline part of SOMATOM life @ Your Scanner.

Now you have the ability to view information and use the different services.

Application Information

Download of Files

Each download will be performed in the background. If you disconnect your Siemens Extranet session and start to work with the CT scanner, the download will continue until it is completed. Due to bandwidth rea sons 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 a long time.

Downloaded files can be found in the "Offline" folder which can be accessed under menu: Options/ File Browser/ Offline.

After the download, the WBT will install itself and can be started within the SOMATOM life offline part under SOMATOM Educate.

Application Information

Downloaded Scan Protocols are stored in the update folder until installation. To install all downloaded protocols, choose the Scan Protocol Manager via Options/ Configuration and select "Import Scan Protocols" in the menu tab "Scan Protocol". After successful import, all downloaded protocols can be found under the name that is stated in the Extranet in the "Siemens Folder".

Also, see the chapter Scan Protocol Manager for more information.

Contact incl. DICOM Images

You are able to send emails to Siemens directly from your scanner. For further explanation, even DICOM images can be attached. To add an image, select the images you want to send on your Viewing card and export these images to H:\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 "P" into the Extranet.

Application Information

Note: Every patient image will be made anonymous

before sending. Because the SOMATOM life 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 life window.

Application Information

Trial Order and Installation

As a SOMATOM CT user you can request trial clinical software directly from the scanner. The requested soft ware will be provided and installed automatically through our Siemens Remote Services connection.

After you have accessed the SOMATOM life Extranet, you can choose system specific trial software under SOMATOM Expand. After clicking on "Order Trial" and confirming a License Agreement for Trial-Use Soft ware, you need to enter your contact data. You can then submit the license request.

Application Information

At the same time, you are informed that you can expect the trial option to be installed within 8 working days and you will then be informed about the successful installation via the SOMATOM life message window that appears during system start-up.

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 Application menu

of the Patient Browser.

In the pop-up window you can select the application for which you want to convert the images.

Application Information

After conversion you can load these data sets into the

application of your choice.

Application Information

File Browser

The File Browser provides the ability to access and to manage your created files:

• Copy images and files to the CD Burn folder.

• Access to all created reports and movies (AVI files).

• Access to the offline folder.

• Access to downloaded files.

Open the File Browser via the main menu entry "Options – File Browser".

The File Browser provides special folders for our Applications. Therein the created reports and movies are saved.

With an external PC connected you can access your offline data on the external PC for post-processing.

Transfer files to floppy: – Select the desired files and send them via the right

mouse button menu on a floppy disk.

Burn on CD: – Select the desired files and drag & drop them into the

folder “Burn on CD” (or send them via the right mouse button menu to the folder “Burn on CD“).

– 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.

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.

– Now you can send these files to floppy or burn it on

CD.

Hint

• 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“.

Application Information

Patient Protocol

Scan: number of scan range kV: kilo Volt mAs: averaged applied mAs of the range ref. mAs: quality ref. mAs of the range TI: Rotation Time cSL: collimated Slice CTDI

: CTDIw

vol

DLP: Dose Length Product

Pitch Factor

For further information please refer to the chapter “Dose Information“.

CTDIvol x (length + collimated slice)

Application Information

Head

Overview

– HeadRoutine

Spiral mode for base of the skull and cerebrum routine studies

– HeadSeq

Sequential mode for base of the skull and cerebrum routine studies

– InnerEarHR

Spiral mode for inner ear studies with a high resolution kernel

– InnerEarSeqHR

Sequence mode for inner ear studies with a high resolution kernel

– Sinus

Spiral mode for sinus studies

– SinusSeq

Sequence mode for sinus studies

– Orbita

Spiral mode for orbital studies

– Dental

Spiral mode for dental studies

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 both, sequence and spiral

scanning.

However, image artifacts may occur if spirals are acquired with a tilt angle greater than 8°.

• 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 loca tion of the skull.

Head Kernels

• For soft tissue head studies, the standard kernel is H41s; softer images are obtained with H31s or H21s sharper images with H50s.

• High resolution head studies should be performed with H60s, H70s (e.g., for dental and sinuses) and H80s (e.g., inner ear).

Head

HeadRoutine

Indications:

Spiral 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 cerebrum.

A range for the base of 4 cm will be covered in 23 sec., a range for the cerebrum of 8 27 sec.

cm will be covered in

Head

Base Cerebrum

kV 130 130 Effective mAs 110 110 Rotation time 1.5 sec 1.5 sec Slice collimation 1.5 mm 2.5 mm Slice width 3.0 mm 8.0 mm Feed/Rotation 3.0 mm 5.0 mm Pitch Factor 1.0 1.0 Increment 3.0 mm 8.0 mm Kernel H31s H31s CTDIVol

Effective dose Male:

Contrast medium IV injection

Volume 50 – 60 ml Flow rate 2 ml/sec. Start delay 50 – 60 sec.

25.05 mGy 25.05 mGy Male:

0.37

mSv

Female:

0.38

mSv

0.70 Female:

0.77

mSv

Hints

• An automatic bone correction allows for improved head image quality, without any additional post-pro cessing.

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. One for the base of the skull and one for the cerebrum, the scan length for the entire head is 12.4

For both ranges a typical gantry tilt of -20° is predefined.

mm.

Head

BaseSeq CerebrumSeq

kV 130 130 Effective mAs 240 240 Rotation time 1.5 sec 1.5 sec Slice collimation 1.5 mm 4.0 mm Slice width 3.0 mm 8.0 mm Feed/Scan 3.0 mm 8.5 mm Kernel H31s H31s CTDIVol

Effective dose Male:

Contrast medium IV injection

Start delay 60 sec. Flow rate 2 ml/sec. Volume 50 – 60 ml

54.65 mGy 51.43 mGy Male: 1.52 mSv

0.77

mSv

Female:

0.80

mSv

1.68

mSv

Hints

• An automatic bone correction allows for improved head image quality, without any additional post-pro cessing.

Head

InnerEarHR

Indications:

Spiral mode for inner ear High Resolution studies, e.g., inflammatory changes, tumorous processes of pyramids, cerebellopontine angle tumors, post-traumatic changes, etc.

A range of 2.5 cm will be covered in 22 sec.

InnerEar 2

kV 130 Effective mAs 70 Rotation time 1.5 sec Slice collimation 1.0 mm Slice width 2.0 mm 1.25 mm Feed/Rotation 2.0 mm Pitch Factor 1.0 Increment 2.0 mm 0.8 mm Kernel H80s H80s CTDIVol

Effective dose Male: 0.17 mSv

15.94 mGy

Female: 0.20 mSv

reconstr.

Head

Hints

• For image reconstruction of soft tissue, use kernel H31s.

• An automatic bone correction allows for improved head image quality, without any additional post-processing.

Head

InnerEarHRSeq

Indications:

Sequential mode for inner ear studies, e.g., inflammatory changes, tumorous processes of pyramids, cerebellopontine angle tumors, post-traumatic changes, etc.

A typical gantry tilt of -20 degree is predefined. A range of 2.5

cm will be covered.

InnerEarSeq

kV 130 Effective mAs 140 Rotation time 1.5 sec Slice collimation 1.0 mm Slice width 1.0 mm Feed/Scan 2.0 mm Kernel H80s CTDIVol

Effective dose Male: 0.32 mSv

Contrast medium IV injection

Start delay 60 sec. Flow rate 2 ml/sec. Total amount 50 – 60 ml

31.88 mGy

Female: 0.38 mSv

Head

Hints

• For image reconstruction of soft tissue, use kernel H31s.

• An automatic bone correction allows for improved head image quality, without any additional post-processing.

Head

Sinus

Indications:

Spiral mode for paranasal sinuses studies, e.g., sinusitis, mucocele, pneumatization, polyposis, tumor, corrections etc.

A range of 7 cm will be covered in 37 sec.

Sinus 2

kV 130 Effective mAs 60 Rotation time 1.0 sec Slice collimation 1.0 mm Slice width 3.0 mm 1.25 mm Feed/Rotation 2.0 mm Pitch Factor 1.0 Increment 3.0 mm 0.8 mm Kernel H70s H70s CTDIVol

Effective dose Male: 0.21 mSv

Contrast medium IV injection

Start delay 60 sec Flow rate 2 ml/sec Total amount 50 – 60 ml

13.66 mGy

Female: 0.22 mSv

reconstr.

Head

Hints

• An automatic bone correction and an advanced algorithm allows for improved head image quality, without any additional post-processing.

• For image reconstruction of soft tissue, use kernel H31s.

Head

SinusSeq

Indications:

Sequential mode for paranasal sinuses studies, e.g., sinusitis, mucocele, pneumatization, polyposis, tumor, corrections etc.

A range of 4.2 cm will be covered.

SinusSeq

kV 130 Effective mAs 120 Rotation time 1.0 sec Slice collimation 1.5 mm Slice width 3.0 mm Feed/Scan 3.0 mm Kernel H70s CTDIVol

Effective dose Male: 0.22 mSv

27.32 mGy

Female: 0.24 mSv

Contrast medium IV injection

Start delay 60 sec Flow rate 2 ml/sec Total amount 50 – 60 ml

Head

Hints

• An automatic bone correction and an advanced algorithm allows for improved head image quality, without any additional post-processing.

• For image reconstruction of soft tissue, use kernel H31s.

Head

Orbita

Indications:

Spiral mode for orbital studies, e.g., fracture.

A range of 2 cm will be covered in 12 sec.

Orbita 2

kV 130 Effective mAs 100 Rotation time 1.0 sec Slice collimation 1.0 mm Slice width 3.0 mm 1.25 mm Feed/Rotation 2.0 mm Pitch Factor 1.0 Increment 3.0 mm 0.8 mm Kernel H70s H70s CTDIVol

Effective dose Male:

Contrast medium IV injection

Start delay 60 sec Flow rate 2 ml/sec Volume 50 – 60 ml

22.77 mGy

0.10

mSv

Female:

0.11

mSv

reconstr.

Head

Hints

• An automatic bone correction and an advanced algorithm allows for improved head image quality, without any additional post-processing.

• For image reconstruction of soft tissue, use kernel H31s.

Head

Dental

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.

Indications:

Spiral mode for dental studies.

A range of 5 cm will be covered in 27 sec.

Dental

kV 130 Effective mAs 45 Rotation time 1.0 sec Slice collimation 1.0 mm Slice width 1.25 mm Feed/Rotation 2.0 mm Pitch Factor 1.0 Increment 0.5 mm Kernel H60s CTDIVol

Effective dose Male: 0.13 mSv

10.25 mGy

Female: 0.16 mSv

Load the study into the application “syngo Dental CT”. For further information, please refer to the chapter "syngo Dental CT".

Head

Neck

Overview

– Neck

Spiral mode for soft tissue routine neck studies

Neck

Hints in General

• Topogram: Lateral, 256 mm

• Patient positioning

Patient lying in supine position, hyperextend neck slightly, secure head well in head holder.

• Patient respiratory instruction:

do not breathe, do not swallow.

• For contrast studies, CARE Bolus may be used to optimize the bolus timing.

• For image reconstruction of bone structures, use kernel B60.

Neck

Body Kernels

• As standard kernels for body tissue studies B31s or B41s are recommended; softer images are obtained with B20s.

• For higher sharpness, as is required e.g., in patient protocols for cervical spine, shoulder, extremities, thorax, the kernels B50s, B60s, B70s are available.

• In case of 3D study only, use kernel B20s 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.

Neck

Indications: For soft tissue spiral studies in the cervical region, e.g.,

tumors, lymphoma, abscesses etc.

A typical range of 20 cm will be covered in 42 sec.

Neck

kV 130 Effective mAs 70 Rotation time 1.0 sec Slice collimation 2.5 mm Slice width 5.0 mm Feed/Rotation 5.0 mm Pitch Factor 1.0 Increment 5.0 mm Kernel B50s CTDIVol

Effective dose Male: 1.79 mSv

7.55 mGy

Female: 1.87 mSv

Contrast medium IV injection

Start delay 45 sec. Flow rate 2.0 ml/sec. Total amount 120 ml

Neck

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, thyroid 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.

Shoulder

Overview

– Shoulder

Spiral mode for bone shoulder routine studies

Shoulder

Hints in General

• Topogram: TOP, 256 mm.

• Patient positioning:

Patient lying in supine position, the uninjured arm placed above the head, the injured arm placed flat against his body. Position side under examination 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 examined 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 parameters: collimation, reconstruction increment, and slice width for image reconstruction.

Body Kernels

• As standard kernels for body tissue studies B31s or B41s are recommended; softer images are obtained with B20s.

• For higher sharpness, as is required e.g., in patient protocols for cervical spine, shoulder, extremities, thorax, lung, the kernels B50s, B60s, B70s are avail able.

Shoulder

Indications:

Spiral mode for bone studies and soft tissue, e.g., evaluation of joint cavities, masses, trauma, dislocations, orthopedic indications etc.

A scan range of 10 cm will be covered in 35 sec.

Shoulder

Shoulder 2nd reconstruction

kV 130 Effective mAs 70 Rotation time 1.0 sec Slice

collimation Slice width 3.0 mm 2.0 mm Feed/Rotation 3.0 mm Pitch Factor 1.0 Increment 3.0 mm 1.5 mm Kernel B60s CTDIVol

Effective dose Male:

Hints

• Use raw data to review a target region if necessary.

• For image reconstruction of soft tissue, use kernel B31s and a slice width of 5.0 mm.

• Coronal and sagittal 2D planar reconstructions are important for evaluation of the joint space & bursa sacs in CT arthograms.

• 3D renderings are helpful for complex fractures & dislocations.

1.5 mm

7.55 mGy

0.94

mSv

Female:

1.13

mSv

Thorax

Overview

– ThoraxRoutine/ThoraxRoutine08s

Spiral mode for routine chest studies

– ThoraxFast

Spiral mode for fast chest studies

– ThoraxHRSeq

Sequential mode for high resolution lung studies

– LungLowDose

Spiral mode with very low dose for early visualization of pathologies

Thorax

Hints in General

• Topogram: TOP, 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 diffuse interstitial lung diseases. An IV contrast medium injection improves the vascular opacifica tion 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 appar ent in the apex than in the lower lobes.

• CARE Bolus 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.

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 parameters: collimation, reconstruction increment, and slice width for image reconstruction.

100

Siemens 2005C User Manual

Specifications and Main Features

Frequently Asked Questions

User Manual

User Documentation

Scan and Reconstruction

Concept of Scan Protocols

Scan Set Up

Scan Modes

Sequential Scanning

Spiral Scanning

Dynamic Serioscan

Slice Collimation and Slice Width

Slice Collimation and Slice Width for Spiral Mode and HR Spiral Mode

Slice Collimation and Slice Width for Sequence Mode and HR Sequence Mode

Increment

Pitch

Window values

Kernels

Image Filters

Improved Head Imaging

Dose Information

Effective mAs

CARE Dose

How does CARE Dose work?

Workflow Information

Recon Jobs

Examination Job Status

Edit/Save Scan Protocol

Scan Protocol Manager

Contrast Medium

The Basics

Bolus Tracking

Test Bolus using CARE Bolus

Test Bolus

Application Information

SOMATOM life

General Information

Key Features

Description

Access to Computer Based Training or Manuals on CD ROM

SRS Based Services

Download of Files

Contact incl. DICOM Images

Trial Order and Installation

Image Converter

File Browser

Patient Protocol

Head

Overview

Hints in General

Head Kernels

HeadRoutine

HeadSeq

InnerEarHR

InnerEarHRSeq

Sinus

SinusSeq

Orbita

Dental

Neck

Overview

Hints in General

Body Kernels

Neck

Shoulder

Overview

Hints in General

Body Kernels

Shoulder

Thorax

Overview

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