Siemens EMOTION 16-6 User Manual

SOMATOM Emotion 6/16-slice configuration

Application Guide

Protocols

Principles

Helpful Hints

Software Version syngo CT 2007E

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 herein 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 MR/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 Emotion 6/16-slice configuration. 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 Christiane Bredenhoeller, Gabriel Haras, Ute Feuerlein, Jessica Amberg, Thomas Flohr, Rainer Raupach, Bettina Hinrichsen, Axel Barth, Kristin Pacheco and the CT-Application Team for their valuable assistance.

To improve future versions of this application guide, we would highly appreciate your questions, suggestions and comments.

Please contact us: USC-Hotline:

Tel. no. [phone]

email [e-mail]

Editors: Wang Jian, Chen Ma Hao

Overview

	User Documentation	16
	Scan and Reconstruction	18
	Dose Information	42
	Workflow Information	64
	Contrast Medium	122
	Application Information	136
	Head	162
	Neck	204
	Shoulder	218
	Thorax	226
	Abdomen	262
	Spine	294
	Pelvis	314
	Upper Extremities	332
	Lower Extremities	346
	Vascular	360
	Specials	416
	Radiation Therapy	462

3

Overview

	Respiratory Gating	484
	Children	508

4

Overview

5

Contents

	User Documentation		16
	Scan and Reconstruction		18
	• Concept of Scan Protocols		18
	• Scan Set Up		19
	• Feed in/Feed out		19
	• Topo Length		20
	• Scan Modes		21
-		Sequential Scanning	21
-		Spiral Scanning	21
-		Quick Scan	22
-		Dynamic Multiscan	22
-		Dynamic Serioscan	22
	• UFC detector		23
	• Acquisition, Slice Collimation and Slice Width
			24
	- SOMATOM Emotion 16-slice configuration
			25
	- SOMATOM Emotion 6-slice configuration 26
	• Increment		27
	• Pitch		27
	• Kernels		28
-		Head Kernels	32
-		Child Head Kernels	32
-		Body Kernels	33
	- Special Application Kernels 33
	• Extended FoV		34
	• Auto-FoV		35
	• Neuro Modes		37
	• Automatic Bone Correction		38
	• Positioning		39
	• Image Filters		40
	Dose Information		42
	• CTDIW and CTDIVol		42
	• ImpactDose		44
	• Effective mAs		45

6

• Scan Protocol Creation

- Edit/Save Scan Protocol - Scan Protocol Assistant

- Manipulate scan protocols

Contents

• CARE Dose 4D	47
- How does CARE Dose 4D work?	49
- Special Modes of CARE Dose 4D	53
- Scanning with CARE Dose 4D	54
- Adjusting the Image Noise	58
- Activating and Deactivating	61

-Conversion of Old Protocols into Protocols with CARE Dose 4D 61

-		Additional Important Information	63
	Workflow Information		64
	• WorkStream4D		64
-		Recon Jobs	64
-		3D Recon	65
-		1. Sagittal/Coronal Reconstructions	71
-		2. Oblique/Double-oblique Reconstructions
			71
	- Non-square Matrix for 3D Recon		76
	- Case Examples for 3D Recon and Non-Square
		Matrix	77
	• Workflow		79
-		Patient Position	79
-		Auto Reference Lines	79
	- Navigation within the Topogram		80
-		API Language	81
	• e - Logbook		83
-		e- Logbook Configuration	83
	- e- Logbook subtask card area		87
-		e- Logbook Browser	88
-		Study Continuation	91
	- Reconstruction on the syngo CT Workplace
			92
-		Examination Job Status	93

- Auto Load in 3D and Postprocessing Presets 94 96 96 98

100

7

Contents

-		Change parameters	103
-		Import scan protocols from SOMATOM
		LifeNet/CD	117
	Contrast Medium		122
	• Contrast Medium		122
-		The Basics	122
-		IV Injection	125
	• Bolus Tracking		126
	• Test Bolus using CARE Bolus		128
	• Test Bolus		129
-		CARE Contrast	130
	Application Information		136
	• SOMATOM LifeNet		136
-		General Information	136
-		Key Features	137
-		SOMATOM LifeNet offline	138
-		SOMATOM LifeNet online	140
	• Image Converter		147
	• Report Template Configuration		150
	• File Browser		151
	• Camtasia		155
-		Key features	155
-		Additional Important Information	159
	• Patient Protocol		160
	Head		162
	• Overview		162
-		General Hints	165
-		Head Kernels	166
	• Scan Protocols		168
-		HeadRoutine	168
-		HeadNeuro	172
-		HeadSeq	174
-		InnerEarHR	177

8

Contents

-		InnerEarHRVol	180
-		InnerEar	184
-		InnerEarSeq	188
-		Sinus	192
-		SinusVol	196
-		Orbit	198
-		Dental	200
	Neck		204
	• Overview		204
-		General Hints	206
-		Body Kernels	207
	• Scan Protocols		208
-		NeckRoutine	208
-		NeckThinSlice	212
-		NeckVol	214
	Shoulder		218
	• Overview		218
-		General Hints	219
-		Body Kernels	219
	• Scan Protocols		220
-		Shoulder	220
-		ShoulderVol	224
	Thorax		226
	• Overview		226
-		General Hints	229
-		Body Kernels	231
	• Scan Protocols		232
-		ThoraxRoutine/
		ThoraxRoutine06s	232
-		ThoraxCombi/
		ThoraxCombi06s	235
-		ThoraxVol	240
-		ThoraxFast/

9

Contents

		ThoraxFast06s	244
-		ThoraxHR	246
-		ThoraxHRSeq	250
-		ThoraxECGHRSeq	252
-		LungLowDose/
		LungLowDose06s	254
-		LungCARE/
		LungCARE06s	258
	Abdomen		262
	• Overview		262
-		General Hints	264
-		Body Kernels	265
	• Scan Protocols		266
-		AbdomenRoutine/
		AbdomenRoutine06s	266
-		AbdomenCombi/
		AbdomenCombi06s	270
-		AbdomenVol	274
-		AbdomenFast/
		AbdomenFast06s	278
-		AbdMultiPhase/
		AbdMultiPhase06s	280
-		AbdomenSeq	288
-		Colonography/
		Colonography06s	290
	Spine		294
	• Overview		294
-		General Hints	296
-		Body Kernels	297
	• Scan Protocols		298
-		C-Spine	298
-		C-SpineVol	300
-		SpineRoutine	302
-		SpineThinSlice	304
-		SpineVol	305

10

Contents

-		SpineSeq	308
-		Osteo	312
	Pelvis		314
	• Overview		314
-		General Hints	316
-		Body Kernels	317
	• Scan Protocols		318
-		Pelvis	318
-		PelvisVol	322
-		Hip	324
-		HipVol	328
-		SI_Joints	330
	Upper Extremities		332
	• Overview		332
-		General Hints	334
-		Body Kernels	335
	• Scan Protocols		336
-		WristHR	336
-		ExtrRoutineHR	340
-		ExtrCombi	344
	Lower Extremities		346
	• Overview		346
-		General Hints	348
-		Body Kernels	349
	• Scan Protocols		350
-		Knee	350
-		Foot	352
-		ExtrRoutineHR	354
-		ExtrCombi	358

11

Contents

	Vascular		360
	• Overview		360
-		General Hints	363
-		Head Kernels	364
-		Body Kernels	365
	• Scan Protocols		366
-		HeadAngio/
		HeadAngio06s	366
-		HeadAngioVol	370
-		CarotidAngio/
		CarotidAngio06s	372
-		CarotidAngioVol	376
-		ThorAngioRoutine/
		ThorAngioRoutine06s	380
-		ThorAngioVol	384
-		ThorAngioECG/
		ThorAngioECG06s	388
-		ThorAngioECGSeq	392
-		Embolism/
		Embolism06s	394
-		BodyAngioRoutine/
		BodyAngioRoutine06s	398
-		BodyAngioVol	402
-		BodyAngioFast/
		BodyAngioFast06s	406
-		AngioRunOff/
		AngioRunOff06s	410
-		WholeBodyAngio	414
	Specials		416
	• Overview		416
-		Trauma	416
-		Interventional CT	418
-		Test Bolus	420
	• Trauma Protocols		422
-		General Information	422
-		Trauma	424
-		TraumaVol	425

12

Contents

-		PolyTrauma/
		PolyTrauma06s	426
-		HeadTrauma	430
-		HeadTraumaSeq	432
-		Additional Important Information	434
	• Interventional CT - Biopsy		436
-		Biopsy	437
-		Biopsy Single	438
	• Interventional CT - CARE Vision		439
-		The Basics	439
-		CAREVision	440
-		CAREVisionSingle	441
-		CAREVisionBone	442
-		HandCARE	443
-		Additional Important Information	447
	• General Information for Biopsy and CARE
	Vision		450
-		Interventional Toolbar	450
-		CAREView	453
-		Configuration	456
-		Routine Subtask card	458
-		Additional Important Information	459
	• TestBolus Protocol		460
-		TestBolus	460
	Radiation Therapy		462
	• Radiation Therapy Planning		462
-		Benefits	465
	• Workflow		468
	• Scan Protocols		470
-		Overview	470
-		RT_Head	472
-		RT_Thorax	474
-		RT_Breast	476
-		RT_Abdomen	478
-		RT_Pelvis	480
-		Additional Important Information	482

13

Contents

	Respiratory Gating		484
	• Key Features		486
-		Respiratory Gating	486
-		Respiration Monitoring	486
-		Respiration Synchronization	487
	• Positioning of the respiratory sensor belt		488
	• Scanning Information		490
-		Scan Parameters	490
-		Temporal Resolution	491
-		Technical Principles	491
-		Respiratory Triggering	491
-		Respiratory gating	492
	- Prospective respiratory triggering versus
		retrospective respiratory gating	494
-		Curve Editor	495
-		Synthetic Trigger/Sync	497
	• Workflow		498
	- Reconstruction and Post processing		498
	• Additional important Information		499
	• Scan Protocol		500
-		RespSeq	500
-		Resp	502
-		RespModBreathRate	504
-		RespLowBreathRate	506
	Children		508
	• Overview		508
-		General Hints	512
-		Head Kernels	515
-		Body Kernels	516
	• Scan Protocols		518
-		HeadRoutine	518
-		HeadSeq	522
-		InnerEarHR	526
-		InnerEar	530
-		InnerEarSeq	534
-		SinusOrbit	538
-		NeckRoutine	542

14

Contents

-	ThoraxRoutine/
	ThoraxRoutine06s	546
-	ThoraxCombi/
	ThoraxCombi06s	550
-	ThoraxHRSeq	554
-	AbdomenRoutine/
	AbdomenRoutine06s	558
-	Spine/
	SpineRoutine	562
-	SpineThinSlice	566
-	ExtrRoutineHR	568
-	ExtrCombi	570
-	HeadAngio/
	HeadAngio06s	574
-	CarotidAngio/
	CarotidAngio06s	578
-	BodyAngioRoutine/
	BodyAngioRoutine06s	582
-	BodyAngioFast/
	BodyAngioFast06s	586
-	NeonateBody/
	NeonateBody06s	587

15

User Documentation

For further information about the basic operation, please refer to the corresponding syngo CT Operator Manual:

syngo CT Operator Manual Volume 1:

syngo Security Package Siemens Virus Protection Basics

SOMATOM LifeNet syngo Patient Browser

syngo Data Set Conversion Camtasia

SaveLog E-Logbook syngo Viewing syngo Filming

syngo CT Operator Manual Volume 2:

Preparations

Examination

MPPS

HeartView CT

Respiratory Gating CT

CARE Bolus CT

CARE Vision CT

syngo CT Operator Manual Volume 3:

syngo 3D

syngo Dental CT syngo Osteo CT

16

User Documentation

syngo CT Operator Manual Volume 4: syngo LungCARE CT

syngo Pulmo CT

syngo Neuro Perfusion CT syngo Body Perfusion CT

syngo CT Operator Manual Volume 5:

syngo Calcium Scoring syngo Circulation

syngo Volume Calculation syngo Dynamic Evaluation syngo Neuro DSA CT

syngo CT Operator Manual Volume 6:

syngo InSpace 4D CT syngo Colonography

17

Scan and Reconstruction

Concept of Scan Protocols

The scan protocols for adult and children are defined according to body regions - Head, Neck, Shoulder,

Thorax, Abdomen, Pelvis, Spine, Upper Extremities, Lower Extremities, Vascular, RT, Specials and optional Cardiac, PET, SPECT and Private.

The protocols for special applications are defined in the Application Guide “Clinical Applications” or in the case of a Heart View examination, in the Application Guide “Cardiac CT“.

The general concept is as follows: All protocols without a suffix are standard spiral modes. For example, “Sinus” means the spiral mode for the sinus.

The suffixes of the protocol name are follows:

“Routine“: for routine studies

“Seq”: for sequence studies

“Fast“: use a higher pitch for fast acquisition

“ThinSlice“: use a thinner slice collimation

“Combi“: use a thinner and a thicker slice collimation

“05s”: use the rotation time of 0.5 seconds

“ECG“: use a ECG-gated or triggered mode

“Neuro“: for neurologicial examinations with a special mode

“Vol“: use the 3D Recon workflow

“HR“: use a thin slice width for High Resolution studies

A prefix of the protocol name is as follows:

“RT”: for radio therapy studies

The availability of scan protocols depends on the system configuration.

“Resp”: for respiratory gated studies

The availability of scan protocols depends on the system configuration.

18

Scan and Reconstruction

Scan Set Up

Scans can be simply set up by selecting a predefined examination protocol. To repeat any mode, just click the chronicle with the right mouse button for repeat. To delete it, select cut. Each range name in the chronicle can be easily changed before load.

Multiple ranges can be run either automatically with auto range, which is denoted by a bracket connecting the two ranges, or separately with a pause in between.

Feed in/Feed out

The performance of the different buttons (soft buttons, gantry buttons, control box buttons) is standardized as follows:

•in NOT loaded modes 1 mm

•in loaded Biopsy mode:

Feed In/Out = slice width x No. slice positions per scan 2

19

Scan and Reconstruction

Topo Length

SOMATOM

Emotion 16

Length [mm]	128, 256, 512, 768, 1024,
	1500
Slice width [mm]	4x0.6
Angle	Top, Bottom, Lateral
SOMATOM
Emotion 6
Length [mm]	128, 256, 512, 768, 1024,
	1500, 1536*, 2000**,
	2048***
Slice width [mm]	3x1
Angle	AP, PA, Lateral

* only in combination with PET and SPECT, option

**only in combination with SPECT, option

***only in combination with PET, option

20

Scan and Reconstruction

Scan Modes

Sequential Scanning

This is an incremental, slice-by-slice imaging mode in which there is no table movement during data acquisition. A minimum interscan delay in between each acquisition is required to move the table to the next slice position.

Spiral Scanning

Spiral scanning is a continuous volume imaging mode. The data acquisition and table movements are performed simultaneously for the entire scan duration. There is no inter-scan delay and a typical range can be acquired in a single breath hold.

Each acquisition provides a complete volume data set, from which images with overlapping can be reconstructed at any arbitrary slice position. Unlike the sequence mode, spiral scanning does not require additional radiation to obtain overlapping slices.

21

Scan and Reconstruction

Quick Scan

The data is usually acquired during a full 360° rotation

– this is a Full scan. Data acquisition not using a full 360° rotation is called a “Quick scan”. Quick scans are employed to reduce motion artifacts and improve the temporal resolution.

Dynamic Multiscan

Multiple continuous rotations at the same table position are performed for data acquisition. Normally, it is applied for fast dynamic contrast studies, such as syngo Neuro Perfusion CT.

Dynamic Serioscan

Dynamic serial scanning mode without table feed. Dynamic serio can still be used for dynamic evaluation such as Test Bolus. The image order can be defined on the Recon subtask card.

22

Scan and Reconstruction

UFC detector

Siemens’ proprietary, high-speed Ultra Fast Ceramic (UFC) detector enables a virtually simultaneous readout of two projections for each detector element.

The detector configuration with the routine acquisition of the Emotion 6/16-slice configuration:

SOMATOM Emotion 16-slice configuration:

SOMATOM Emotion 6-slice configuration:

23

Scan and Reconstruction

Acquisition, Slice Collimation

and Slice Width

Slice collimation is the slice thickness resulting from the effect of the tube-side collimator and the adaptive detector array design. In Multislice CT, the Z-coverage per rotation is given by the product of the number of active detector slices and the collimation (e.g. 6 x 1.0mm for the SOMATOM Emotion 6-slice configuration or 16 x 0.6mm for the SOMATOM Emotion 16slice configuration ).

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

With the SOMATOM Emotion 6/16-slice configuration, you select the slice collimation together with the slice width desired. The slice width is independent of pitch, i.e. what you select is always what you get. Actually, you do not need to care about the algorithm any more; the software does it for you.

If Metrorecon/Fastrecon is not selected you will routinely get “Real Time” images. The Recon icon on the chronicle will be labeled with “RT”. After the scan the Real Time displayed image series has to be reconstructed.

In some cases – this depends also on Scan pitch and Reconstruction increment – the Recon icon on the chronicle will be labeled with “RT”. This indicates the Real Time display of images during scanning. The Real Time displayed image series has to be reconstructed after completion of spiral.

The Acq (Acquisition) is displayed on the Examination task card. The Acquisition is simply "number of slices acquired per rotation" x "width of one slice".

24

Scan and Reconstruction

SOMATOM Emotion 16-slice configuration

Spiral Mode

Collimation/ Slice width

Acquisition

16 x 0.6 mm 0.75, 1.0, 1.5, 2.0, 3.0, 4.0, 5.0 mm

16 x 1.2 mm 1.5, 2.0, 3.0, 4.0, 5.0, 6.0, 8.0, 10.0 mm

HR/Neuro Spiral Mode

Collimation/ Slice width

Acquisition

4 x 0.6 mm 0.6, 0.75, 1.0, 1.5, 2.0, 3.0, 4.0, 5.0 mm

Sequence Mode

Collimation/	Slice width
Acquisition
4 x 0.6 mm	0.6, 1.2, 2.4 mm
12 x 0.6 mm	0.6, 2.4, 7.2 mm
16 x 0.6 mm	1.2, 2.4, 4.8, 9.6 mm
2 x 5 mm	5.0, 10.0 mm
12 x 1.2mm	1.2, 3.6, 4.8 mm
2 x 8 mm	8.0, 16.0 mm

16 x 1.2 mm 2.4, 4.8, 9.6, 19.2 mm

25

Scan and Reconstruction

SOMATOM Emotion 6-slice configuration

Spiral Mode

Collimation	Slice width
1 mm	1, 1.25, 2, 2.5, 3, 4, 5, 6, 8, 10 mm
2 mm	2.5, 3, 4, 5, 6, 8, 10 mm
3 mm	4, 5, 6, 8, 10 mm
Sequence Mode

Collimation	Slice width
1 mm	1, 2, 3 mm
2 mm	2, 4, 6, 12 mm
3 mm	3, 6, 9, 18 mm
5 mm	5, 10 mm
HR Spiral Mode

Collimation	Slice width
0.5 mm	0.63, 0.75, 1, 1.25, 2, 2.5, 3, 4,
	5 mm
HR Sequence Mode
Collimation	Slice width
1 mm	1 mm

26

Scan and Reconstruction

Increment

The increment is the distance between the reconstructed images in Z direction. When the chosen increment is smaller than the slice thickness, the images are created with an overlap. This technique is useful for reducing partial volume effect, giving you better detail of the anatomy and high quality 2D and 3D postprocessing.

The increment can be freely adapted from 0.1 - 10 mm.

Pitch

Pitch = feed per rotation z-coverage

z-coverage = detector rows x collimated slice width

Feed/Rotation = table movement per rotation

The Pitch Factor can be freely adapted from 0.45 – 2.0, in Cardio, there is a fixed pitch down to 0.1.

With the SOMATOM Emotion 6/16-slice configuration, you select the slice collimation together with the slice width desired.

The slice width is independent of pitch, i.e. what you select is always what you get. Actually, you do not need to be concerned about the algorithm any more; the software does it for you.

Pitch values with a step width of 0.05 can be selected for all modes.

We recommend to use a Pitch Factor of 0.45 for MPR reconstructions.

27

Scan and Reconstruction

Kernels

There are 4 different types of kernels: “H“ stands for Head, “B“ stands for Body, “C“ stands for ChildHead and ”S” stands for Special Application, e.g. syngo Osteo CT.

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

Head Kernels:

Kernel	description
H10s	very smooth
H19s	very smooth
H20s	smooth
H21s	smooth +
H22s	smooth FR +
H29s	smooth +
H30s	medium smooth
H31s	medium smooth +
H32s	medium smooth FR +
H37s	medium smooth (Emotion 16-slice
	configuration only)
H39s	medium smooth
H40s	medium
H41s	medium +
H42s	medium FR
H45s	medium
H47s	medium smooth (Emotion 16-slice
	configuration only)
H48s	medium smooth (Emotion 16-slice
	configuration only)
H50s	sharp
H60s	medium
H70s	very sharp
H80s	inner ear
H90s	inner ear

28

Scan and Reconstruction

Body Kernels:

Kernel	description
B08s	very smooth
B10s	very smooth
B19s	very smooth
B20s	smooth
B29s	smooth
B30s	medium smooth
B31s	medium smooth +
B35s	HeartView medium
B39f	HeartView medium
B40s	medium
B41s	medium+
B46s	medium
B50s	medium sharp
B60s	sharp
B65s	sharp
B70s	very sharp
B75s	very sharp (Emotion 16-slice configu-
	ration only)
B80s	ultra sharp
B90s	ultra sharp
Child Head Kernels:

Kernel	description
C20s	smooth
C30s	medium smooth
C60s	sharp

29

Scan and Reconstruction

Topogram Kernels:

Kernel	description
T10s	smooth
T20s	standard
T21s	standard
T80s	sharp
T81s	sharp
T90s	ultra sharp
Special Application:
Kernel	description
S30s	Shepp-Logan
S80s	Shepp-Logan with notch filter
S90s	Shepp-Logan without notch filter
U90s	specification kernel

30