Home

Siemens 2005C User's Manual

1. Images are acquired with a range of 30 1 cm 106 Thorax ThorHRSeq kV 130 Effective mAs 100 Rotation time 1 0 sec Slice collimation 1 0mm Slice width 1 0 mm Feed Scan 10 0 mm Kernel U90s CTDIvol 2 16 mGy Effective dose Male 1 02 mSv Female 1 33 mSv Hints e If you want to reconstruct thin slices every 15 or 20 mm instead of 10 mm as predefined simply change the Feed Scan before loading the mode e With studies of interstitial changes in the lungs con trast medium is not necessary 107 Thorax LungLowDose Indications Spiral lung studies with low dose setting e g early visualization of pulmonary nodules A typical thorax study in a range of 30 cm will be cov ered in 32 sec 108 Thorax kV Effective mAs Rotation time Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTDIvol Effective dose LungLowDose 130 30 1 0 sec 5 0mm 8 0mm 10 0 mm 1 0 8 0 mm B7Os 3 23 mGy Male 1 69 mSv Female 2 08 mSv Contrast medium IV injection Start delay Flow rate Total amount Hints 30 sec 2 5 ml sec 50 70 ml e You could repeat the same protocol by simply click ing the chronicle with the right mouse button for repeat e g when both non contrast and contrast Studies are required For lung cancer evaluation this protocol can be com bined with the protocol Neck Routine Low dose lung images are usually evaluated u
2. Special thanks to Heike Theessen Christiane Bredenholler 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 a User Documentation Scan and Reconstruction w Dose Information A Workflow Information IE Application Information E Head i Neck J Shoulder E Thorax E Abdomen E Pelvis Spine aah Upper Extremities 14 16 28 36 54 70 88 94 98 110 124 132 146 ats Lower Extremities Vascular Specials Children E syngo 3D syngo Fly Through syngo Dental CT syngo Osteo CT syngo Volume Evaluation syngo Dynamic Evaluation 154 162 176 184 240 258 268 274 288 306 Contents a User Documentation ra Scan and Reconstruction Concept of Scan Protocols Scan Set Up e 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 e Pitch Window values Kernels Image Filters Improved Head Imaging il Dose Information CTDI and CTDI E
3. e For higher sharpness as is required e g in patient protocols for cervical spine shoulder extremities thorax lung the kernels B50s B60s B7Os are avail able 113 E Abdomen AbdomenRoutine AbdomenRoutine08s Indications Spiral mode for all routine studies in the region of abdomen e g evaluation follow up examinations etc A typical abdomen scan in a range of 20 cm will be covered in 16 13 sec 114 Abdomen AbdRoutine kV 130 Effective mAs 60 Rotation time 0 8 1 0 sec Slice collimation 4 0 mm Slice width 5 0 mm Feed Rotation 14 4 mm Pitch Factor 1 8 Increment 5 0 mm Kernel B41s CTDIvol 6 47 mGy Effective dose Male 2 61 mSv Female 3 32 mSv Contrast medium IV injection Start delay 50 60 sec Flow rate 1 0 2 0 ml sec Total amount 100 ml Hints e You could repeat the same protocol by simply click ing the chronicle with the right mouse button for repeat e g when both non contrast and contrast studies are required e Delayed scans may be required for the kidneys amp bladder 115 E Abdomen AbdomenFast Indications Fast spiral mode for abdominal studies e g when a patient has difficulty with holding their breath A range of 20 cm will be covered in 9 6 sec 116 Abdomen AbdFast kV 130 Effective mAs 60 Rotation time 0 8 sec Slice collimation 5 0mm Slice width 8 0 mm Feed Rotation 20 0 mm Pitch Factor 2 0 Increment 8 0mm Kernel
4. gt Enter the delay from the start of injection of the con trast to the start of the scan and confirm with the Enter key 318 syngo Dynamic Evaluation e Relative Enhancement Curve Time Axis X The point of time for an image is computed relative to the point of time at which the first input image was acquired Point of Time Acquisition Time Acquisition Time of the First Image Delay e Enhancement Axis Y The mean CT value of each ROI is plotted on the enhancement axis of the enhancement curve The value is relative to the CT values of the baseline image The mean CT value of an ROI inside the baseline image is assumed to be 0 e Absolute Enhancement Curve Enhancement Axis Y The point of time for an image is computed relative to the point of time at which the first input image was acquired Point of Time Acquisition Time Acquisition Time of the First Image Delay Enhancement Axis Y The absolute mean CT value of each ROI is plotted on the enhancement axis of the enhancement curve 319 T syngo Dynamic Evaluation e Configuring Dynamic Evaluation You can make the following settings in DynEva Config uration z Dakas Tne to Peak mage z Calculate nai Entancement image Calculate Time to Peak Image A Time to Peak Image is generated and displayed in the upper right hand segment You can use the image for ROI definition Calculate Peak Enhancement Image A Peak Enhancement
5. 40 S scan 10 S scan Longer scan time Shorter scan time The dynamics of the contrast enhancement is deter mined by e Patient cardiac output e Injection rate e Total volume of contrast medium injected e Concentration of the contrast medium e Type of injection uni phasic or bi phasic e Patient pathology 45 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 gt T o E oO v 1s Lu v gt Ay o ao Relative Enhancement HU 0 20 40 60 80 700 720 0 20 40 60 80 100 720 Time s Time s 2 ml s 120 ml 300 mg I mIl_ 4 ml s 120 ml 300 mg l ml Relative Enhancement HU Relative Enhancement HU 20 40 60 80 700 720 Time s Time s 80 ml 4 ml s 300 mg I mI_ 120 ml 4 ml s 300 mg l mil Relative Enhancement HU Relative Enhancement HU 0 20 40 60 80 100 120 0 20 40 60 80 100 120 Time s Time s Uni phase 140 ml 4 ml s Bi phase 70 ml 4 ml s 370 mg l ml plus 70 ml 2 ml s 370 mg I ml Radiology 1998 207 647 655 46 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 a
6. Multi Planar Reconstruction MPR Interactive navigation through 3D volumes in arbitrary Orientations e Orthogonal oblique or double oblique orientation e Easy scrolling through 3D volume data set e Real time reconstruction of secondary slices e Additional diagnostic information e g with sagittal or coronal reconstructions from axial images e Variable slice thickness MPR Thick MPR and dis tance with configurable default values e Calculation of arbitrarily curved cuts Maximum Intensity Projection MIP Angiographic display e Projection of pixels with highest intensity vascular information onto an arbitrarily oriented plane e Display of e g aneurysms plaques stenoses and other vascular anomalies e MIP Thin function for projection within a small slab to focus on particular vascular structure 240 syngo 3D Shaded Surface Display SSD Surface display of complex anatomies e 3D display of surfaces from a series of contiguous slices using a variable threshold e The displayed volume consist of voxels whose HU are in a range defined by two limit values an upper and a lower threshold HU limits e Display and analyze various anatomy e g from the cranium pelvis extremities e g for the purpose of planning surgical interventions e The 3D objects can be tilted and rotated in real time Volume Rendering Technique VRT True 3D visualization of volume data Projection onto an arbitra
7. 162 162 163 163 163 164 166 168 170 172 174 176 176 176 176 176 177 177 178 180 181 182 183 184 184 187 190 191 192 194 196 198 200 202 204 Contents ThoraxRoutine_Baby 206 e ThoraxRoutine_Child 208 ThoraxHRSeq_Baby 210 e ThoraxHRSeq_Child 212 Abdomen_Baby 214 e Abdomen_Child 216 e Spine_Baby 218 e Spine_Child 220 e ExtrHR_Baby 222 e ExtrHR_Child 224 e 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 gt 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 e Hints in General 254 Setting Views in the Volume DataSet 254 Changing Creating VRT Presets 255 Contents 12 Auto Load in 3D and Post processing Presets Blow up Mode syngo Fly Through e Key Features Prerequisites The Basics for CT Virtual Endoscopy SSD and VRT Presets for Endoscopic Renderings Endoscopic Viewing Parameters Fly Cone Settings Patient Preparation e Workfl
8. 180 Specials Interventional CT To facilitate CT interventional procedures the follow ing protocols are provided Any of these protocols can be appended to a spiral protocol for CT interventional procedures such as biopsy abscess drainage pain therapy minimum invasive operations joint studies and arthrograms Adjust the mAs according to the body region before loading 10 scans are predefined You can repeat it by clicking the chronicle with the right mouse button and select repeat or by simply changing the number of scans to 99 before you start the first scan You can Append any routine protocol after the inter ventional procedure for a final check and documenta tion e g a short range of spiral scanning for the biopsy region The table height can be adjusted to minimum 255 mm 181 7 Specials Biopsy Indications This is the conventional sequential mode without table feed using a 10 mm slice Biopsy kV 130 Effective mAs 80 Rotation time 1 0 sec Slice collimation 5 0mm Slice width 10 0 mm Feed Scan 0 0 mm Kernel B31s CTDIvol 8 62 mGy Hint This protocol can be appended to a spiral protocol for CT interventional procedures such as biopsy abscess drainage pain therapy minimum invasive operations joint studies and arthrograms 182 Specials TestBolus Indications This mode can be used to test the start delay of an opti mal enhancement after the contrast medium inje
9. Body Kernels AbdomenRoutine AbdomenRoutineO8s AbdomenFast AbdMultiPhase AbdMultiPhase08s AbdomenSeq 88 88 89 90 92 94 94 25 95 96 98 98 99 101 102 104 106 108 110 110 111 T13 114 116 118 122 Contents E Pelvis Overview Hints in General Body Kernels Pelvis gt Hip e SL Joints F Spine Overview e Hints in General Body Kernels e C Spine C SpineSeq e Spine SpineSeq Osteo Fel Upper Extremities Overview Hints in General Body Kernels WristHR ExtrRoutineHR l Lower Extremities Overview Hints in General Body Kernels e KneeHR e FOOtHR ExtrRoutineHR 124 124 125 125 126 128 130 132 132 133 135 136 138 140 142 144 146 146 147 148 150 152 154 154 155 156 158 160 161 Contents Vascular e Overview e Hints in General Head Kernels Body Kernels HeadAngio HeadAngio08s CarotidAngio CarotidAngio08s ThorAngio ThorAngio08s Embolism BodyAngioRoutine BodyAngioRoutine08s BodyAngioFast Specials e Overview Trauma Interventional CT Test Bolus Trauma The Basics e PolyTrauma HeadTrauma Interventional CT Biopsy TestBolus 4 Children 10 e Overview e Hints in General Head Kernels Body Kernels HeadRoutine_Baby e HeadRoutine_Child HeadSeq_Baby e HeadSeq_Child InnerEar e SinusOrbi Neck
10. Paraxial view Scan Protocols You will find the Dental scan protocols under body region Head 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 5mm Kernel H60s CTDIvol 10 25 mGy Effective dose Male 0 13 mSv Female 0 16 mSv 269 p syngo Dental CT It is mandatory to position the patient head in the center of the scan field use the lateral laser light marker for positioning Gantry tilt is not necessary since you have the ability to tilt the reference line to generate an axial refor matted image at the desired plane However in order to minimize the scan length for the same ana tomical region it is recommended to position the patient s head at the appropriate scan plane when ever possible For the upper and lower jaw occlusal plane in parallel to the scan plane For either jaw jaw bone in parallel to the scan plane It is recommended to end the exam first and then start the Dental evaluation F a F aran alki a ul i a User interface of syngo Dental CT 270 syngo Dental CT Additional Important Information e The Dental scan protocol delivers high resolution images for syngo Dental CT evaluation however you can also reconstruct images with softer kernel e g H20s for 3D SSD post processing TOP cranial view Caudal view 271 syngo Dental
11. SOMATOM Syn Spirit speaking 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 SIEMENS medical 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
12. Select Record to Offline in the Transfer menu of the Patient Browser CD burning starts Hint CD burning of offline files is only possible ina single session 66 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 e 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 xmi 67 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 CID CTDIw Pitch Factor For further information please refer to the chapter Dose Information DLP Dose Length Product CTDIvol x length collimated slice 10 Hea toe AE Taal maa 443 Pabies Foui P Tpu Ti Chita 68 69 Head Overview HeadRoutine Spiral mode for base of the skull and cerebrum rou tine studies HeadSeq Sequential mode for base of the skull and cerebrum routine studies InnerEarHR Spiral mode for inner ear studies with a high resolu tion kernel
13. gle axial scan modes For clinical scanning i e scan ning 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 CTDI Pitch Factor This dose number is displayed on the user interface for the selected scan parameters 28 Dose Information The CTDI value does not provide the entire informa tion of the radiation risk associated with CT examina tion 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 compli cated 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 radi
14. Effective mAs 30 Rotation time 1 0 sec Slice collimation 1 0mm Slice width 3 0mm 1 25 mm Feed Rotation 2 0 mm Pitch Factor 1 0 Increment 3 0 mm 0 8 mm Kernel U90s U90s CTDIvol 3 23 mGy Effective dose Male 0 01 mSv Female 0 01 mSv Hint e For image reconstruction of soft tissue use kernel B31s 160 Lower Extremities ExtrRoutineHR Indications Spiral mode for HiRes bone study e g trauma ortho pedic indications etc A range of 10 cm will be covered in 52 sec ExtrHR 2 4 reconstruction kV 130 Effective mAs 30 Rotation time 1 0 sec Slice collimation 1 0mm Slice width 2 0mm 1 25 mm Feed Rotation 2 0mm Pitch Factor 1 0 Increment 2 0mm 0 8mm Kernel U90s U90s CTDIvol 3 23 mGy Effective dose Male 0 01 mSv Female 0 01 mSv Hint e For image reconstruction of soft tissue use kernel B31s 161 Vascular Overview HeadAngio HeadAngio08s Spiral mode for head CTAngio studies CarotidAngio CarotidAngioO8s Spiral mode for carotid CTAngio studies ThorAngio ThorAngio08s Spiral mode for chest CTAngio studies Embolism Spiral mode for pulmonary embolism studies BodyAngioRoutine BodyAngioRoutine08s Spiral mode for body CTAngio studies BodyAngioFast Spiral mode for fast body CTAngio studies 162 Vascular Hints in General e Topogram TOP 512 1024 or LAT 256 Patient positioning Patient lying in supine position arms positioned comfortably above the head
15. Feed Scan 5 0 mm Kernel C30s CTDIvol 16 18 mGy Effective dose Male 1 71 mSv Female 1 87 mSv The conversion factor for an 8 week old child anda scan range of 82 5 mm was used Contrast medium IV injection Start delay exam dependent Flow rate dependent upon needle size Access site Totalamount 1 2 ml per kg of body weight 196 Children Hints e Use this protocol for children below 6 months of age e When bone structure is of interest use kernel C60s for image reconstruction e 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 197 Children HeadSeq_Child Indications Sequential mode for routine head studies for children e g tumors hydrocephalus hemorrhaging abnor malities etc A range of 8 25 cm Is predefined HeadSeq kV 130 Effective mAs 120 Rotation time 1 5 sec Slice collimation 2 5mm Slice width 2 5mm Feed Scan 5 0 mm Kernel C30s CTDIvol 27 32 mGy Effective dose Male 1 09 mSv Female 1 18 mSv The conversion factor for a 7 year old child and a scan range of 82 5 mm was used Contrast medium IV injection Start delay exam dependent Flow rate dependent upon needle size Access site
16. Hints e Please change the mAs value according to the weight of the child 35 44 kg 45 mAs 45 54 kg 60 mAs e Children with a body weight of more than 55 kg should be examined with an adult protocol 237 Children NeonateBody Indications Spiral mode for routine neonate body studies e g tumors abnormalities malformations abscesses etc A range of 15 cm will be covered in 17 sec NeonateBody kV 80 Effective mAs 41 Rotation time 1 0 sec Slice collimation 2 5mm Slice width 5 0mm Feed Rotation 10 0 mm Pitch Factor 2 0 Increment 5 0 mm Kernel B41s CTDIvol 1 13 Effective dose Male 1 59 mSv Female 2 01 mSv The conversion factor for a 7 year old child and a scan range of 150 mm was used Contrast medium IV injection Start delay exam dependent Flow rate dependent upon needle size Access site Totalamount 1 2 ml per kg of body weight 238 Children Hints e Use this protocol for children below 1 month of age e CARE Bolus may be used to optimize the bolus tim ing Set the ROI for the monitoring scan in the abdominal aorta with triggering threshold of 120 HU or use manual triggering e You can modify the slice width for image reconstruc tion according to the clinical indications 239 syngo 3D The 3D card offers the possibility to combine two dimensional images to form three dimensional views To do this the 3D card provides you with the following methods
17. 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 Res olution studies and a thicker slice width for soft tissue studies The availability of scan protocols depends on the sys tem configuration 16 Scan and Reconstruction 7 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 17 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
18. image your system recalculates the parameter images based on the existing images The average image is an averaged addition of all pixels at each pixel location across the images of the tomo segment MIP image Parameter image where each pixel is the maximum value of all images at that pixel location The image data Is checked pixel by pixel The pixels with the maximum intensity are displayed in an image Time to Peak image Parameter image where each pixel indicates the period of time in tenths of a sec ond from the time when the first image was acquired Delay 0 or the time when the contrast was injected Delay gt 0 to the time when the high est CT value is reached at that pixel location The longer the time period until the peak CT value is reached the brighter the pixels With a Time to Peak image for example you can easily detect structures in which the contrast did not spread as fast as in comparable structures Hint The time to peak in seconds at the cursor posi tion in the Time to Peak image Is the CT value displayed in the lower right corner divided by 10 311 syngo Dynamic Evaluation Peak Enhancement image Parameter image where each pixel indicates the enhancement at that pixel location CT value of a pixel maximum value found at that pixel location pixel value of the MIP image CT value of the baseline image at that pixel location With a Peak Enhancement image for example
19. you can easily detect structures that were not completely filled with contrast Hint You can activate or deactivate the calculation of the Time to Peak image and the Peak Enhancement image in the configuration 312 syngo Dynamic Evaluation 4 Creating a Baseline Image A baseline image is used as a basis for all enhancement calculations The enhancement is calculated relatively to the base line image Therefore the baseline image must show the state before enhancement starts By default the first image of the loaded images is used as the baseline image Before the enhancement starts you can also define the last image as the baseline image If you do so the mean gray values of the selected image and all the images that have been acquired before the selected image are displayed in the baseline image The result is a smoother image that can be used to define the ROls If you want to use a different baseline image proceed as follows e Scroll to the required image in the tomo segment e Click on the button Generate baseline image with the mouse 213 syngo Dynamic Evaluation 5 Evaluation of Region of Interests You select the image regions to be evaluated by mark ing them with ROIs or applying the pixel lens a circular ROI with a fixed but configurable diameter An abso lute relative CT value calculation is performed for these selected image e You can draw either elliptical or freehand ROIs
20. 0 03 mSv Female 0 05 mSv Osteo 80 81 1 0 sec 5 0 mm 10 0 mm 0 0 mm S80s 2 23 mGy Male 0 03 mSv Female 0 04 mSv For obese patients increase the mAs value to 120 Load all ranges in the application syngo Osteo CT For further information please refer to the chapter syngo Osteo CT 144 145 J Upper Extremities Overview WristHR Spiral mode for routine high resolution wrist studies ExtrRoutineHR Spiral mode for routine high resolution extremity studies 146 Upper Extremities Hints in General e Topogram TOP 256 mm for joint studies e Patient positioning Depends on the region of examination In general for bilateral studies you should always try to position the patient symmetrical whenever the patient can comply For wrists and elbow scans Patient lying in prone position hands stretched above the head and lying flat on a Bocollo pillow ankles supported with a pad Both wrists should be examined together when necessary Retrospective reconstruction can be done a Use B31s kernel for soft tissue evaluation b For targeted FoV images on the affected side it is advisable to enter the side being examined in the comment line In case of 3D study only use kernel B20s and at least 50 overlap in image reconstruction e To further optimize MPR image quality we recom mend that you reduce one or more of the following parameters collimation reconstructi
21. 05 mGy 9 70 mGy Effective dose Male Male 1 02 mSv 1 69 mSv Female Female 1 08 mSv 1 81 mSv Take a new Topogram for the thorax and abdomen ranges 178 Specials A range for the Thorax of 25cm will be covered in 15 sec a range for the AbdPelvis of 20 cm will be cov ered in 12 sec kV Effective mAs Rotation time Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTDIvol Effective dose Thorax 130 40 1 0 sec 5 0 mm 8 0mm 20 0 mm 2 0 8 0 mm B41s 4 31 mGy Male 1 82 mSv Female 2 45 mSv AbdPelvis 130 60 1 0 sec 5 0 mm 8 0 mm 20 0 mm 2 0 8 0 mm B41s 6 47 mGy Male 2 59 mSv Female 3 31 mSv e For long range scanning please pay attention to the mark of scannable range on the table mattress while positioning the patient e In some cases it might be advisable to position the patient feet first so that there will be more space for the intensive care equipment around 179 7 Specials HeadIrauma A spiral mode for emergency head studies with a max FoV of 500 mm A typical scan range of 40 80 cm will be covered in 23 27 sec Base Cerebrum kV 130 130 Effective mAs 110 110 Rotation time 1 5 sec 1 0 sec Slice collimation 1 5mm 2 5mm Slice width 3 0mm 8 0 mm Feed Rotation 3 0mm 5 0mm Pitch Factor 1 0 1 0 Increment 3 0mm 8 0mm Kernel H31s H31s CTDIvol 25 05 mGy 25 05 mGy Effective dose Male Male 0 37 mSv 0 70 mSv Female Female 0 51 mSv 0 86 mSv
22. 1 Loading the Images After loading the images into syngo Dynamic Evalua tion the following layout is displayed e Tomo segment The loaded input images are displayed in the upper left hand segment The images are sorted by the acquired time Parameter image segment Parameter images are displayed in the upper right hand segment MIP image Average image Peak Enhancement image Time to Peak image 309 syngo Dynamic Evaluation e Baseline image segment The baseline image is displayed in the lower left hand segment base for enhancement calculation By default the first image of the loaded images is used as the baseline image e Result segment It is black after loading 2 Inspecting the Input Images Before you begin the evaluation optimize the display of loaded images in the tomo segment in such away that the regions to be evaluated are clearly visible Scroll through the image stack Window zoom and pan images Remove the images that are not suitable for dynamic evaluation e g when the patient has moved during scanning 3 Generation of Parameter Images As soon as you load the original image material your system performs an evaluation of the entire image area The results parameter images are displayed in the parameter image segment 310 syngo Dynamic Evaluation Each time you make a change to the original data set by removing images and or defining a new baseline
23. 264 syngo Fly Through Navigation of the Endoscopic Volume e Manual Navigation Click with the right mouse button in the Fly segment to activate the SmartSelect menu The following controls are available auto navigation push pull rotate around viewing point rotate view Adjust the viewing direction and select push pull Click and hold the left mouse button Move the mouse up or down to navigate through the endoscopic volume manually e Auto Navigation Adjust the initial viewing direction Activate the SmartSelect menu Select the function auto navigation Click and hold with the left mouse button Give the mouse a small upward push and then hold it steady The software will automatically detect the centerline and navigate through the endoscopic volume without any user intervention To stop or change the direction of the navigation release the mouse and adjust the viewing direction accordingly before proceeding further 265 Fly Path Planning Open the Fly Path Planning Create a path by inserting path points in the volume during navigation 266 syngo Fly Through The relevant settings viewing direction viewing angle etc are stored along the path After defining and storing a path it is possible to play back the entire navigation along the path as a movie or to jump straight to the section of the endoscopic vol ume predefined by the path points Note Only one path can be save
24. B41s CTDIvol 6 47 mGy Effective dose Male 2 59 mSv Female 3 29 mSv Contrast medium IV injection Start delay 25 30 sec Flow rate 2 5 ml sec Total amount 80 ml Hint e You could repeat the same protocol by simply click ing the chronicle with the right mouse button for repeat e g when both non contrast and contrast Studies are required 117 E Abdomen AbdMultiPhase AbdMultiPhase08s Indications Spiral scan to assist the physician with differential diagnosis of liver diseases A typical native range of 20 cm will be covered in 15 sec 118 Abdomen kV Effective mAs Rotation time Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTDIvol Effective dose Non Contrast 130 80 1 0 sec 5 0 mm 8 0 mm 15 0 mm 1 5 8 0 mm B41s 8 62 mGy Male 3 34 mSv Female 4 19 mSv Arterial Phase 130 80 0 8 1 0 sec 5 0 mm 6 0 mm 14 0 15 0 mm 1 4 1 5 6 0 mm B41s 8 62 mGy Male 3 34 mSv Female 4 19 mSv Contrast medium IV injection 20 25 sec arterial phase 50 75 sec venous phase 3 0 ml sec Start delay Flow rate Total amount 100 ml Venous Phase 130 80 1 0 sec 5 0 mm 6 0 mm 15 0 mm 1 5 6 0 mm B41s 8 62 mGy Male 3 34 mSv Female 4 19 mSv CARE Bolus may be used to optimize the bolus tim ing Set the ROI for monitoring scan in the abdominal aorta at the beginning of the scan ra
25. Depth Back Clip Plane Cone Graphic and Definition 260 syngo Fly Through e Standing Point The cone rotates around the viewing point e Viewing Point The complete cone moves e Clipping Point The cone rotates around the standing point e Viewing Angle Is changed by moving one of the sides of the angle e Viewing Distance The distance from the standing to the viewing point e Viewing Depth Moving the Front Back Clip Plane changes the viewing depth e Front Clip Plane To remove foreground obscuring tissue The posi tion of the front clip plane will always be between Standing and viewing point e Back Clip Plane To remove tissue at the back of the volume The position of the back clip plane will always be behind viewing point 261 syngo Fly Through Patient Preparation Bony and cartilaginous structures such as the central airway and bronchial tree the osteomeatal system of the Paranasal Sinuses are inherently filled with air and therefore ideal for performing Virtual CT Endoscopy No special preparations are required For CT endoscopic evaluation of the vessel virtual CT angioscopy a good CTA data set with good vessel enhancement Is required In the case of CT colonography adequate preparation in bowel cleaning must be done prior to the CT exam The bowel can be delineated with air carbon dioxide water or iodine barium suspension 262 syngo Fly Through Workflow Load
26. HeadRoutine Indications Spiral mode for routine head studies e g stroke brain tumors cranial trauma cerebral atrophy hydroceph alus 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 cm will be covered in 27 sec 72 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 25 05 mGy 25 05 mGy Effective dose Male Male 0 37 mSv 0 70 mSv Female Female 0 38 mSv 0 77 mSv Contrast medium IV injection Volume 50 60 ml Flow rate 2 ml sec Start delay 50 60 sec Hints e An automatic bone correction allows for improved head image quality without any additional post pro cessing 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 73 Head HeadSeq Indications Sequence mode for routine head studies e g stroke brain tumors cranial trauma cerebral atrophy hydro cephalus and inflammation etc Two
27. Image is generated and dis played in the upper right hand segment You can use the image for ROI definition Enable export of results Enables the export feature Results can be stored on floppy disk Enable printing of results Enables the print feature Results can be printed Diameter of Pixel Lens Diameter of the circular ROI pixel lens in pixels 320 Manufacturer Siemens Shanghai Medical Equipment Ltd SSME 278 Jin Hu Road 201206 Shanghai P R China Telephone 86 21 50320300 Authorized Representative according to the Medical Device Directive 93 42 EEC Siemens AG Siemens Medical Medical Solutions Solutions that help Henkestr 127 l l 2002 2005 Siemens Shanghai D 91052 Erlangen Medical Equipment Ltd SSME Germany Order No C2 025 630 01 01 02 Telephone 49 9131 84 0 Painted nthia www siemens com medical 02 2005
28. Volume 84 Orbita 2nd reconstr 130 100 1 0 sec 1 0 mm 3 0 mm 1 25 mm 2 0mm 1 0 3 0mm 0 8 mm H70Os H70s 22 77 mGy Male 0 10 mSv Female 0 11 mSv 60 sec 2 ml sec 50 60 ml Head Hints e An automatic bone correction and an advanced algo rithm allows for improved head image quality with out any additional post processing In order to optimize image quality versus radiation dose scans are provided within a maximum scan field of 300 mm with respect to the iso center No recon job with a field of view exceeding those limits will be possible Therefore patient positioning has to be performed accurately to ensure a centered loca tion of the skull For image reconstruction of soft tissue use kernel H31s 85 Head Dental This is the scan protocol for the syngo Dental CT appli cation package It is used for evaluation and reformat ting 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 10 25 mGy Effective dose Male 0 13 mSv Female 0 16 mSv Load the study into the application syngo Dental CT For further inform
29. accessories such as in room oxy gen supply respirator and resuscitation equipment that may be required during the examination are in working order Prepare the CT room before admitting the patient e g load IV contrast into the injector Know observe and practice the standard hospital Operating policy for handling a patient in distress e g Code Blue for cardiac and respiratory arrest Any possible injuries to the spinal column should be determined before beginning the examination and taken into account when shifting and positioning the patient Ensure that all vital lines e g IV tubing and oxygen tubing are not trapped under the patient or between the table and the cradle Make allowance for the length of tubing required for the topogram scan range Never leave patients unattended at any time during the procedure Observe the vital signs e g ECG respiration etc at all times during the procedure Finish the examination in the shortest possible time 177 Specials PolyTrauma Two times 2 combined recon jobs are predefined head with neck and thorax with abdomen A range for the Head of 11 cm will be covered in 20 sec a range for the Neck of 14 cm will be covered in 30 sec Head Neck kV 130 130 Effective mAs 110 90 Rotation time 1 5 sec 1 0 sec Slice collimation 5 0mm 2 5mm Slice width 6 0mm 3 0mm Feed Rotation 10 0 mm 5 0mm Pitch Factor 1 0 1 0 Increment 6 0 mm 3 0mm Kernel H31s B50s CTDIvol 25
30. and link it to a recon job For example the 2 recon job with thinner slice 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 Recon struction MPR and Thin Maximum Intensity Projec tion 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 post processing 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 pre sets with a series description 38 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 AbdomenRou tine Protocols with different slice width we recom mend to do this directly on the Examination card User specific scan protocols can be saved with the fol lowing basic procedure Register a patient you can choose any patient posi tion in the P
31. e Set the ROI for monitoring scan in the abdominal aorta with triggering threshold of 120 HU or use manual triggering Do not administer oral contrast medium as this impairs the editing of MIP SSD VRT images Use water as oral contrast The length of the CM spiral in the topogram via the table position can be planned exactly by means of pre contrast images Pre contrast images are used to visualize calcifica tion Excellent post processed images can be created using a thin slice thickness and overlapping images i e the increment should be smaller than the slice thickness 173 7 Vascular BodyAngioFast Indications Spiral mode for longer coverage and larger vessels A range of 20 cm will be covered in 18 sec BodyAngio gna reconstruction kV 130 Effective mAs 55 Rotation time 0 8 sec Slice 2 5 mm collimation Slice width 5 0 mm 3 0 mm Feed Rotation 10 0 mm Pitch Factor 2 0 Increment 5 0 mm 2 0 mm Kernel B31s B31s CTDIvol 5 93 mGy Effective dose Male 2 23 mSv Female 2 77 mSv 174 Vascular Contrast medium IV injection Start delay 20 sec Flow rate 3 5 ml sec Total amount 120 ml Hints e CARE Bolus may be used to optimize the bolus tim ing e Set the ROI for monitoring scan in the abdominal aorta with triggering threshold of 120 HU or use manual triggering Do not administer oral contrast medium as this impairs the editing of MIP SSD VRT images Use water as oral con
32. gain a three dimensional impression The minimum slice thickness of an MPR image is one voxel but you can generate thicker slices MPR Thick for easier evaluation Measure annotate and document as needed Optionally create image series using parallel expanded or curved ranges and output them either on a film or save them to the database 250 syngo 3D Using SSD 1 Load the series to SSD Hint Do not use a series with a high resolution ker nel e g kernel 10 or 20 is recommended 2 Manipulate the volume to evaluate anatomy a Orientate the image volume for the best view of the anatomy b Adjust the threshold as necessary c Pan and zoom image as necessary d To eliminate unwanted structures use VOI punch ing 3D Object Editor 3 Measure annotate and document as needed 4 Optionally create image series using radial ranges and output them either on a film or save them to the database Using VRT 1 Load the series to VRT 2 Manipulate volume to evaluate anatomy a Orientate the image volume for the best view of the anatomy b To eliminate unwanted structures either activate VRT Thin Clip or use VOI punching 3D Object Edi tor c Select a VRT preset from the VRT gallery d Adjust window opacity color and lighting effects as necessary e Pan and zoom image as necessary 3 Measure annotate and document as needed 4 Optionally create image series using radial ranges for VRT parallel ex
33. 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 19 Scan and Reconstruction Slice Collimation and Slice Width for Spiral Mode and HR Spiral Mode 1mm 1 5mm 2 5mm 4mm 5mm 1 1 25 2 3 5 mm 2 3 5 6mm 3 5 6 8 10 mm 5 6 8 10 mm 6 8 10mm Slice Collimation and Slice Width for Sequence Mode and HR Sequence Mode 1 0mm 1 5mm 2 5mm 4 0mm 5 0 mm 20 1 2mm 1 5 3 mm 2 5 5 mm 4 8mm 5 10mm Scan and Reconstruction Increment The increment is the distance between the recon structed 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 LL Increment 3 mm Increment 5 mm Increment 10 mm Reconstruction Increment 21 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 rotati
34. is more peripheral Needle Size gauge Flow Rate ml sec 22 1 5 20 2 0 3 0 18 3 0 5 0 Central lines and ports may need to be hand injected or power injected at a very low flow rate 1 ml sec PIC lines and 24 gauge or smaller lines are usually hand injected All of these protocols should be decided on by your institution s appropriate personnel 8 For applications such as neonate or airway scanning the low tube output at 80 kV can be used to further reduce the dose to the patient 9 To further optimize MPR image quality we recom mend that you reduce one or more of the following parameters collimation reconstruction increment and slice width for image reconstruction 189 Children Head Kernels e For head scans of small children the kernels C20s C30s e g for soft tissue studies and C60s e g for sinuses are provided should be chosen instead of the adult head kernels H21s H31s and H60s e For the standard head protocols we recommend C20s and C30s e High resolution head studies should be performed with H60s H7Os e g for dental and sinuses and H80s e g inner ear 190 Children Body Kernels e As standard kernels for body tissue studies B31s or B41s is recommended softer images are obtained with B20s e For higher sharpness as is required e g in patient protocols for cervical spine shoulder extremities thorax the kernels B50s B60s B7Os are available Th
35. mSv Female lt 0 07 mSv 0 8 mm U90s e For image reconstruction of soft tissue use kernel B31s 152 153 Lower Extremities Overview KneeHR Spiral mode for high resolution routine knee studies FootHR Spiral mode for high resolution routine foot studies ExtrRoutineHR Spiral mode for high resolution routine extremity studies 154 Lower Extremities Hints in General Topogram TOP 256 mm for joint studies Patient positioning Depends on the region of examination In general for bilateral studies you should always try to posi tion the patient symmetrical whenever the patient can comply For knee scan Patient lying in supine position feet first promote relaxation by placing Bocollo pillows between knees and feet bind feet together The only exceptions are extremely light patients The latter can remove the leg not being examined from the gantry by bending it 90 at the hip and the knee and placing the bottom of the same foot against the gantry casing For ankle and feet scans Patient lying in supine position feet first Bind both ankles together if necessary to assure the TOP posi tion of both feet Retrospective reconstruction can be done a Use B31s kernel for soft tissue evaluation b For targeted FoV images on the affected side it is advisable to enter the side being examined in the comment line To further optimize MPR image quality we recom mend that you r
36. or automatic volume growing Multiple editor objects can be displayed with differ ently colored SSD Complete object subtraction with dilatation and ero sion functions Remaining volume data set after object subtraction can be displayed with all 3D representations i e VRT MPR MIP or SSD With the 3D Object Editor you can perform the fol lowing operations Object generation with Region Growing Object management in the object list Object editing with Object Punching and Morphological Operations 247 syngo 3D Region Growing Normally in the first step you will generate one or more objects from the volume data set originally loaded in 3D By specifying a limited voxel value range you extract only a section of the voxels from the original data set In this way you generate an object in the result segment Instead of extracting globally from the entire volume data set you can also proceed slice by slice in 3D blocks using the Slab Editor You can also set Seed Points in the original data set thus limiting the creation of an object to defined regions which are also connected to one another in the specified voxel area Object Punching 248 syngo 3D Like editing volume data sets in the VOI mode you can use the 3D Editor too You are provided with tools for cutting out structures from an object that you have previously generated Using the Slab Editor you can define your own cut
37. other summary image displays a graph which shows the comparison of all evaluated vertebrae with the selected Reference Data T score This is the deviation of average BMD of the patient from that of a young healthy comparison group It rep resents bone loss with reference to the peak bone mass Z score This is the deviation of average BMD of the patient from that of a healthy person of the same age It is an indicator of biological variability 284 syngo Osteo CT The second and the fourth segment belong together The second segment shows the tomogram images with the contours superimposed The fourth segment shows the calculated results of the corresponding tomogram image Both segments are bordered by the same color If you scroll through one of these seg ments the other segment is updated to same vertebra 285 After End Evaluation the evaluation results are auto matically saved in three series Summary contains both images of the third segment Contours contains the tomogram images with the contours superimposed second segment Tables contains the result tables for each vertebra fourth segment Za Beef ae el Sead el S aa Oy LESS E Te ee Se EE SCORES 286 syngo Osteo CT Additional Important Information Fractured vertebrae are not suited for syngo Osteo CT evaluation since the more compact nature of these vertebrae result in bone mineral density value that is
38. ranges C2 C3 C3 C4 C4 C5 C5 C6 C6 C7 kV Effective mAs Rotation time Slice collimation Slice width Feed Scan Kernel CTDIvol Effective dose 138 C2 3 130 170 1 5 sec 1 0 mm 2 0mm 2 0mm B50s 18 33 mGy Male 0 18 mSv Female 0 14 mSv C3 4 130 170 1 5 sec 1 0 mm 2 0mm 2 0mm B50s 18 33 mGy Male 0 39 mSv Female 0 27 mSv C4 5 130 170 1 5 sec 1 0 mm 2 0mm 2 0mm B50s 18 33 mGy Male 0 66 mSv Female 0 45 mSv Spine kV Effective mAs Rotation time Slice collimation Slice width Feed Scan Kernel CTDIvol Effective dose Hints C5 6 130 170 1 5 sec 1 0 mm 2 0mm 2 0mm B50s 18 33 mGy Male 0 66 mSv Female 0 73 mSv C6 7 130 190 1 5 sec 1 0 mm 2 0mm 2 0mm B50s 20 48 mGy Male 0 30 mSv Female 0 50 mSv e Dental artifacts can be reduced by tilting the gantry e For MPRs and 3D post processing use spiral mode with thinner slice and reconstruct images with 50 overlap in image reconstruction Define along range to cover the levels of interest in one block 139 g Spine Spine Indications Spiral mode for thoracic and lumbar spine studies e g prolapse degenerative changes trauma tumors etc A range of 15 cm will be covered in 48 sec 140 kV Effective mAs Rotation time Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTDIvol Effective dose Spine 130 120 1 5 sec 2 5mm 3 0mm 5
39. 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 CTDIvo 7 55 mGy Effective dose Male 1 79 mSv Female 1 87 mSv Contrast medium IV injection Start delay 45 sec Flow rate 2 0 ml sec Total amount 120 ml 92 Neck Hints Due to its iodine content the thyroid gland is hyper dense 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 lt 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 amp middle neck levels as well as to include the axilla in the lower neck level if required 93 7 Shoulder Overview Shoulder Spiral mode for bone shoulder routine studies 94 Shoulder Hints in General e 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
40. subtask card and load the spiral 9 Start spiral and injector with the full amount of con trast 50 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 chap ter 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 51 E Workflow Information 6 Load the images into the Dynamic Evaluation func tion and determine the time to the peak enhance ment 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 calcula
41. 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 Appli cation 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 5g Application Information Downloaded Scan Protocols are stored in the update folder until installation To install all downloaded pro tocols 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 informa tion After exporting the image open the Siemens Extranet and choose Contact After enterin
42. 0 mm Pitch Factor 1 0 Increment 2 0 mm 0 8 mm Kernel C30s C30s CTDIvol 4 21 mGy Effective dose Male 0 10 mSv Female 0 10 mSv The conversion factor for a 7 year old child and a scan range of 60 mm was used 228 Children Hints e Please change the mAs value according to the age of the child 6 12 years 80 mAs e Children who are more than 12 years old should be scanned with an adult protocol as the skull by this time is fully grown 229 Children CarotidAngio Indications Spiral mode for the carotid arteries e g carotid steno sis or occlusion vascular abnormalities of the carotids or vertebral arteries etc A range of 10 cm will be covered in 27 sec CarotidAngio 2 reconstr kV 80 Effective mAs 50 Rotation time 1 0 sec Slice 1 0 mm collimation Slice width 3 0 mm 1 25 mm Feed Rotation 4 0 mm Pitch Factor 2 0 Increment 3 0 mm 0 8 mm Kernel B41s B41s CTDIvol 1 38 mGy Effective dose Male 0 50 mSv Female 0 50 mSv The conversion factor for a 7 year old child and a scan range of 100 mm was used Contrast medium IV injection Start delay exam dependent Flow rate dependent upon needle size Access site Totalamount 1 2 ml per kg of body weight 230 Children Hints e Please change the mAs value according to the age of the child 6 12 years 75 MAS e Children who are more than 12 years old should be scanned with an adult protocol e CARE Bolus may
43. 0mm 1 0 3 0mm B31s 12 94 mGy Male 2 94 mSv Female 6 75 mSv 2nd reconstruction 3 0 mm 2 0 mm B60s 141 SpineSeq Indications Sequence mode for spine studies e g prolapse degenerative changes trauma tumors etc with a typ ical length for each range of 1 5 cm This protocol contains three ranges L3 4 L4 L5 L5 S1 Three different typical gantry tilts are predefined for L3 L4 0 for L4 L5 5 and for L5 S1 15 142 Spine kV Effective mAs Rotation time Slice collimation Slice width Feed Scan Kernel CTDIvol Effective dose L3 4 130 220 1 5 sec 1 5 mm 3 0 mm 3 0 mm B31s 23 72 mGy Male 0 58 mSv Female 0 92 mSv L4 5 130 220 1 5 sec 7 5mm 3 0mm 3 0mm B31s 23 72 mGy Male 0 63 mSv Female 1 21 mSv L5 S1 130 235 1 5 sec 1 5 mm 3 0 mm 3 0 mm B31s 25 33 mGy Male 0 64 mSv Female 2 35 mSv 143 g Spine Osteo This is the scan protocol for the syngo Osteo CT appli cation package to assist the Physician with the quanti tative assessment of vertebral bone mineral density BMD in the diagnosis and follow up of osteopenia and osteoporosis kV Effective mAs Rotation time Slice collimation Slice width Feed Scan Kernel CTDIvol Effective dose Osteo 80 81 1 0 sec 5 0 mm 10 0 mm 0 0 mm S80s 2 23 mGy Male 0 03 mSv Female 0 08 mSv Osteo 80 81 1 0 sec 5 0 mm 10 0 mm 0 0 mm S80s 2 23 mGy Male
44. 54 Application Information Key Features All users e General Information e Access to Web Based E Training or Manuals on CD ROM In combination with a Siemens Remote Service con nection e News Ticker archive and FAQ frequently asked ques tions section e Free trial software order and installation e Download of information manuals and scan proto cols e 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 55 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 per son have to be entered to be able to access the Sie mens Extranet The link to the Siemens Extranet will be visible only after you have entered this data 56 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
45. B41s B60s CTDIvol 2 80 mGy Effective dose Male 1 46 mSv Female 1 72 mSv The conversion factor for a 7 year old child and a scan range of 150 mm was used Contrast medium IV injection Start delay exam dependent Flow rate dependent upon needle size Access site Total amount 1 2 ml per kg of body weight Hints e Children with a body weight of more than 55 kg should be examined with an adult protocol e The first and second recon jobs are defined for visu alization of the mediastinum and the lungs respec tively e Please change the mAs value according to the weight of the child 45 54 kg 37 mAs 209 Children ThoraxHRSeq_Baby Indications Sequence mode for High Resolution lung studies e g interstitial changes of the lung parenchyma etc A range of 20 1 cm is predefined ThorHRSeq kV 80 Effective mAs 90 Rotation time 1 0 sec Slice collimation 1 0 mm Slice width 1 0 mm Feed Scan 10 0 mm Kernel U90s CTDIvol 0 50 mGy Effective dose Male 0 88 mSv Female 1 06 mSv The conversion factor for an 8 week old child and a scan range of 201 mm was used 210 Children Hints e Use this protocol for children below 35 kg e If you want to acquire the patient at full inspiration or full expiration you should practice the breathing with the patient a few times before beginning the scan so that reproducibility may be improved 211 E Children ThoraxHRSeq_Child Indic
46. CT e Image orientation Inthe paraxial view a B indicates buccal anda L lingual The lingual marker must always be positioned at the tongue If not simply drag amp drop it back Inthe panoramic view a B stands for Begin and an E for End Filming for the maximum use of the film film directly from the Dental card instead of Patient Browser For easy reprinting the results of the most recent syngo Dental CT Film are stored in the Patient Browser in the folder Film It is recommended to change the image windowing on the virtual film sheet e Asemi automatic detection tool can be used to mark and outline the mandibular canal on both paraxial and panoramic images for easy viewing and filming Multiple paraxial ranges can be defined on one refer ence image by cluster amp copy function l e you can group a number of paraxial lines and copy the lines to another location e g over individ ual sockets at different locations 272 syngo Dental CT e ROI definition for statistical evaluations and deletion of graphics is possible Paraxial lines using Cluster e In the control area you can configure if you want to display the paraxial lines orthogonal to the reference line 273 syngo Osteo CT This is an application package for the quantitative assessment of vertebral bone mineral density for the diagnosis and follow up of osteopenia an
47. InnerEarSeqHR Sequence mode for inner ear studies with a high res olution 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 70 Head Hints in General e 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 e For soft tissue head studies the standard kernel is H41s softer images are obtained with H31s or H21s sharper images with H5Os e High resolution head studies should be performed with H60s H7Os e g for dental and sinuses and H80s e g inner ear 71 Head
48. 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 per formed 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 recon structed at any arbitrary slice position Unlike the sequence mode spiral scanning does not require addi tional 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 18 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 1 0 mm Slice width is the FWHM full width at half maximum of the reconstructed image With the SOMATOM Spirit you select the slice collima tion 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
49. L e ROI and Volume Definition If you insert modify an ROI the system automati cally plans the ROIs on the preceding following images interpolated ROIs up to that image with the previous next user defined ROI User defined ROIs have a solid contour line whereas interpolated ROIs have a dotted contour line When you modify an interpolated ROI dotted line it becomes an user confirmed ROI and is dis played with a solid line The system never modifies the shape of a user defined ROI In case that you insert or modify an ROI the shape of previous following interpolated ROIs may change If anew ROI touches or overlaps another user defined ROI solid line the ROIs are merged dur ing volume calculation If anew ROI touches or overlaps an interpolated ROI dotted line the new ROI replaces the system defined ROI 301 E syngo Volume Evaluation e Restrictions for Linking and Unlinking There are some restrictions for linking and unlinking Linking can be done on user defined ROIs as well as on interpolated ROIs If you link an interpolated ROI dotted line it becomes a user confirmed ROI solid line You cannot unlink interpolated ROIs The unlinking only works with user confirmed ROIs If you modify the volume for example move a ROI before linking an ROI to the already selected ROI the marking is reset e Evaluation Bounding voxels where no voxel lies within the en
50. N 1998 11 12 18 60 4 54 5 49 3 22 3 21 1 21 8 210 5 191 9 180 7 50 4 47 5 52 3 IMAGE L4 238 4 27 JAN 1998 11 12 18 59 3 43 1 55 0 20 6 29 0 23 3 201 8 178 1 192 3 43 6 45 9 44 2 REFDATA 64 Male 20 4 35 3 12 75 4 125 3 26 5 Data structure of the result file PATIENT lt Patient name gt lt Patient ID gt lt Age of patient gt lt Sex of patient gt IMAGE lt Vertebra name gt lt Image number gt lt Scan numbers lt Scan date gt lt Scan time gt lt TML gt lt TMR gt lt IMT gt lt TSL gt lt TSR gt lt TST gt lt CML gt lt CMR gt lt CMT gt lt CSL gt lt CSR gt lt CST gt REFDATA lt Age of patient gt lt Sex of patient gt lt Age of young normal gt lt T Score gt lt Z Score gt lt BMD reference data age matched gt lt BMD reference data young control gt lt Standard deviation reference data gt 280 syngo Osteo CT Abbreviations TML Trabecular Mean Left TMR Trabecular Mean Right TMT Trabecular Mean Total TSL Trabecular Standard Deviation Left TSR Trabecular Standard Deviation Right TST Trabecular Standard Deviation Total CML Cortical Mean Left CMR Cortical Mean Right CMT Cortical Mean Total CSL Cortical Standard Deviation Left CSR Cortical Standard Deviation Right CST Cortical Standard Deviation Total 281 syngo Osteo CT Evaluation Workflow After loading the images into the syngo Osteo CT appli cation pre
51. 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 CTDlIvol 15 94 mGy Effective dose Male 0 17 mSv Female 0 20 mSv 76 Head Hints e For image reconstruction of soft tissue use kernel H31s e An automatic bone correction allows for improved head image quality without any additional post pro cessing e 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 77 Head InnerEarHRSeq Indications Sequential mode for inner ear studies e g inflamma tory changes tumorous processes of pyramids cere bellopontine 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 31 88 mGy Effective dose Male 0 32 mSv Female 0 38 mSv Contrast medium IV injection Start delay 60 sec Flow rate 2 ml sec Total amount 50 60 ml 78 Head Hints e For image reconstruction of soft tissue use kernel H31s e An automatic bone correction allows for improved
52. Spiral mode for Pulmonary Emboli studies A range of 15 cm will be covered in 24 sec Embolism 2 reconstruction kV 130 Effective mAs 55 Rotation time 0 8 sec Slice collimation 1 5mm Slice width 3 0mm 2 0mm Feed Rotation 5 4mm Pitch Factor 1 8 Increment 3 0mm 1 5 mm Kernel B31s B31s CTDIvol 5 93 mGy Effective dose Male 1 56 mSv Female 2 07 mSv 170 Vascular Contrast medium IV injection Start delay 6 10 sec Flow rate 4 ml sec Total amount 80 100 ml Hints e CARE Bolus may be used to optimize the bolus tim ing e Set the ROI for monitoring scan in the pulmonary trunk with triggering threshold of 120 HU or use manual triggering e You could repeat the same protocol by simply click ing the chronicle with the right mouse button for repeat 171 7 Vascular BodyAngioRoutine BodyAngioRoutineO08s Indications Spiral mode for abdominal CTA studies A range of 20 cm will be covered in 39 31 sec BodyAngio 2 4 reconstruction kV 130 Effective mAs 55 Rotation time 0 8 1 0 sec Slice 1 5 mm collimation Slice width 5 0 mm 3 0 mm Feed Rotation 5 4 mm Pitch Factor 1 8 Increment 5 0 mm 2 0 mm Kernel B31s B31s CTDIvol 5 93 mGy Effective dose Male 2 17 mSv Female 2 68 mSv 172 Vascular Contrast medium IV injection Start delay 20 25 sec Flow rate 3 0 3 5 ml sec Total amount 100 120 ml Hints e CARE Bolus may be used to optimize the bolus tim ing
53. Totalamount 1 2 ml per kg of body weight 198 Children Hints Children who are more than 6 years old should be scanned with an adult protocol as the skull by this time is fully grown When bone structure is of interest use kernel C60s for image reconstruction 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 Please change the mAs value according to the age of the child 3 6 years 160 mAs 199 Children InnerEar Indications High Resolution Spiral mode for inner ear studies e g malformations of the inner ear inflammatory changes pathologies of the mastoid process tumor processes of the pyramids post traumatic changes etc A range of 2 5 cm will be covered in 22 sec InnerEar kV 80 Effective mAs 125 Rotation time 1 5 sec Slice collimation 1 0 mm Slice width 1 25 mm Feed Rotation 2 0 mm Pitch Factor 1 0 Increment 1 0 mm Kernel H80s CTDIvol 8 09 mGy Effective dose Male 0 04 mSv Female 0 04 mSv The conversion factor for a 7 year old child and a scan range of 25 mm was used 200 Children Hints Children who are more than 6 years old should be scanned with an adult protocol as the sku
54. a positive contrast agent The use of a vaginal tampon may be helpful in adult female patients with suspected pelvis pathology To further optimize MPR image quality we recom mend that you reduce one or more of the following collimation reconstruction increment and slice width for image reconstruction For pelvis studies deselect CARE Dose for patients gt 120 kg Body Kernels e As standard kernels for body tissue studies B31s or B41s is recommended softer images are obtained with B20s 125 E Pelvis Pelvis Indications Spiral mode for routine pelvis studies e g processes of the prostate urinary bladder rectum gynecological indications etc A typical range of 20 cm will be covered in 12 sec 126 Pelvis Pelvis kV 130 Effective mAs 80 Rotation time 1 0 sec Slice collimation 5 0mm Slice width 8 0 mm Feed Rotation 20 0 mm Pitch Factor 2 0 Increment 8 0mm Kernel B41s CTDIvol 8 62 mGy Effective dose Male 3 24 mSv Female 5 51 mSv Contrast medium IV injection Start delay 50 sec Flow rate 2 0 3 0 ml sec Total amount 100 120 ml Ifthe examination performed requires a full urinary bladder wait at least 3 minutes following IV adminis tration of the contrast medium 127 E Pelvis Hip Indications Spiral mode for HiRes bone studies and soft tissue studies of the Hip e g evaluation of joint cavity masses trauma dysplasia necrosis of the head of the hip c
55. al image processing allows you to cre ate images in any orientation and position within the data volume You can move through the volume and rotate it in any direction Depending on the method you are using various aids are available to you Rotating around one axes oblique cut planes For oblique slices you rotate a slice about one axis of the patient coordinate system starting from the stan dard view The orientation is displayed in the image as a combina tion of two orientation labels One of the two reference lines in the image is now dot ted The corresponding plane is therefore oblique in relation to the displayed image Rotating around two axis double oblique cut planes You obtain cut planes in two axes whenever you rotate one slice around two different patient coordinate axes one after the other 254 syngo 3D The plane is then no longer perpendicular to either of the coordinate axes The image orientation is displayed as a combination of three orientation labels The subtask card Orientation will always give you the ability to return immediately back to the beginning or to any standard view View perpendicular to reference image Ortho Sync Usually you activate the orthogonal view to display slices along the main axis of an organ e g the heart Changing Creating VRT Presets You will use the Volume Rendering Technique VRT to obtain more precise representation and separation of tissue t
56. atic changes tumors malformations etc A range of 10 cm will be covered in 27 sec kV Effective mAs Rotation time Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTDIvol Effective dose ExtrHR 80 50 1 0 sec 1 0 mm 1 25 mm 4 0mm 2 0 0 8 mm B7Os 1 38 mGy Male lt 0 01 mSv Female lt 0 01 mSv The conversion factor for an 8 week old child and a scan range of the knee of 100 mm was used 222 Children Hints e Use this protocol for children below 35 kg e Please change the mAs value according to the weight of the child 15 34 kg 80 mAs 223 E Children ExtrHR_Child Indications Spiral mode for bone studies e g tumors post traumatic changes orthopedic indications etc A range of 10 cm will be covered in 27 sec kV Effective mAs Rotation time Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTDIvol Effective dose ExtrHR 130 40 1 0 mm 1 0 mm 1 25 mm 4 0mm 2 0 0 8 mm B7Os 4 31 mGy Male lt 0 01 mSv Female lt 0 01 mSv The conversion factor for a 7 year old child and a scan range of the knee of 100 mm was used Contrast medium IV injection Start delay Flow rate Total amount 224 exam dependent dependent upon needle size Access site 1 2 ml per kg of body weight Children Hint e Children with a body weight of more than 55 kg should be examined with an adu
57. atient 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 e 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 39 Workflow Information Hints e You can save your scan protocol at any time of the examination It is recommended that you save your own scan pro tocol with a new name in order to avoid overwriting the default scan protocol e Do not use special characters In addition do not even use any blank spaces Allowed are all numbers from O to 9 all characters from A to Z and a to z and explicitly the _ underscore e Do not rename scan protocol files on Windows level This will lead to inconsistencies e 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 proto cols are marked with a dot in front of the protocol Scan Protocol Manager If you want to modi
58. ation 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 29 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 per mAs Dseq DcTpiw X MAS In spiral scanning however the applied dose Dspiral is influenced by the classical mAs mA x Rot Time and in addition by the Pitch Factor For example if a Multislice CT scanner is used the actual dose applied to the patient in spiral scanning will be decreased when the Pitch Factor is larger than 1 and increased when the Pitch Factor is smaller than 1 Therefore the dose in spiral scanning has to be corrected by the Pitch Factor Dspiral Dctpiw X MA x Rot Time Pitch Factor To make it easier for the users the concept of the effective mAs was introduced with the SOMATOM Multislice scanners The effective mAs takes into account the influen
59. ation please refer to the chapter syngo Dental CT 86 87 Overview Neck Spiral mode for soft tissue routine neck studies 88 Neck Hints in General e 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 opti mize the bolus timing For image reconstruction of bone structures use ker nel B6O 89 Neck Body Kernels e As standard kernels for body tissue studies B31s or B41s are recommended softer images are obtained with B20s e For higher sharpness as is required e g in patient protocols for cervical spine shoulder extremities thorax the kernels B50s B60s B7Os are available e 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 90 91 g Neck Neck Indications For
60. ations Sequence mode for High Resolution lung studies e g interstitial changes of the lung parenchyma etc A range of 20 1 cm is predefined kV Effective mAs Rotation time Slice collimation Slice width Feed Scan Kernel CTDIvol Effective dose ThorHRSeq 130 70 1 0 sec 1 0 mm 1 0 mm 10 0 mm U90s 1 57 mGy Male 1 02 mSv Female 1 21 mSv The conversion factor for a 7 year old child and a scan range of 201 mm was used 212 Children Hints e Children with a body weight of more than 55 kg should be examined with an adult protocol e If you want to acquire the patient at full inspiration or full expiration you should practice the breathing with the patient a few times before beginning the scan so that reproducibility may be improved 213 E Children Abdomen_Baby Indications Spiral mode for routine studies in the region of abdo men and pelvis e g tumors lymphoma abscesses post traumatic changes etc A range of 30 cm will be covered in 32 sec Abdomen kV 80 Effective mAs 41 Rotation time 1 0 sec Slice collimation 2 5 mm Slice width 5 0 mm Feed Rotation 10 0 mm Pitch Factor 2 0 Increment 5 0 mm Kernel B41s CTDIvol 1 13 mGy Effective dose Male 3 26 mSv Female 5 05 mSv The conversion factor for an 8 week old child and a scan range of 300 mm was used Contrast medium IV injection Start delay exam dependent Flow rate dependent upon needle size Ac
61. be used to optimize the bolus timing with a triggering threshold of 120 HU or use manual triggering 231 Children CarotidAngio08s Indications Spiral mode for the carotid arteries e g carotid steno sis or occlusion vascular abnormalities of the carotids or vertebral arteries etc A range of 10 cm will be covered in 22 sec CarotidAngio 2 reconstr kV 80 Effective mAs 50 Rotation time 0 8 sec Slice 1 0 mm collimation Slice width 3 0 mm 1 25 mm Feed Rotation 4 0 mm Pitch Factor 2 0 Increment 3 0 mm 0 8 mm Kernel B41s B41s CTDIvol 1 38 mGy Effective dose Male 0 50 mSv Female 0 50 mSv The conversion factor for a 7 year old child and a scan range of 100 mm was used Contrast medium IV injection Start delay exam dependent Flow rate dependent upon needle size Access site Total amount 1 2 ml per kg of body weight 232 Children Hints e Please change the mAs value according to the age of the child 6 12 years 75 MAS e Children who are more than 12 years old should be scanned with an adult protocol e CARE Bolus may be used to optimize the bolus timing with a triggering threshold of 120 HU or use manual triggering 233 Children BodyAngio Indications Spiral mode for abdominal CT Angio studies e g vas cular abnormalities aneurysms etc A range of 10 cm will be covered in 19 sec kV Effective mAs Rotation time Slice collimation Slice wid
62. by Indications Spiral mode for routine thorax studies e g pneumo nia tumors metastases lymphoma vascular abnor malities etc A range of 15 cm will be covered in 17 sec 206 Children ThorRoutine 2nd reconstruction kV 80 Effective mAs 41 Rotation time 1 0 sec Slice 2 5mm collimation Slice width 5 0mm 5 0mm Feed Rotation 10 0 mm Pitch Factor 2 0 Increment 5 0mm 5 0mm Kernel B41s B60s CTDIvol 1 13 mGy Effective dose Male 1 55 mSv Female 1 85 mSv The conversion factor for an 8 week old child and a scan range of 150 mm was used Contrast medium IV injection Start delay exam dependent Flow rate dependent upon needle size Access site Total amount 1 2 ml per kg of body weight Hints e Use this protocol for children below 35 kg e The first and second recon jobs are defined for visu alization of the mediastinum and the lungs respec tively e Please change the mAs value according to the weight of the child 25 34 kg 60 mAs 207 g Children ThoraxRoutine Child Indications Spiral mode for routine thorax studies e g pneumo nia tumors metastases lymphoma vascular abnor malities etc A range of 15 cm will be covered in 17 sec 208 Children ThorRoutine 2nd reconstruction kV 130 Effective mAs 26 Rotation time 1 0 sec Slice 2 5mm collimation Slice width 5 0mm 5 0mm Feed Rotation 10 0 mm Pitch Factor 2 0 Increment 5 0 mm 5 0 mm Kernel
63. by planar i e flat images you can draw a cut line with any curvature freehand This cut will then be shown as an imagelseries in the output segment For example for MPRs or MIP Thin from the aorta or the peripheral arteries 245 syngo 3D Editing A common problem in evaluating medical images is that areas relevant to an examination are hidden by other structures especially bones The necessary image information is contained in the volume data set but must be made visible with suitable editing steps 1 VOI mode With a Volume of Interest VOI you extract a volume of diagnostic interest by limiting the volume to be reconstructed to a partial volume You can extract a VOI volume of interest in one of the following ways e Position and differentiate a cuboid VOI VOI Clipbox e Draw a freehand VOI VOI Punch Mode 2 Clip planes Clip planes can also be used for hiding parts of the data set Sometimes it is useful to use only a part of the volume for projection The sub area is defined by the two par allel intersection planes separation plane The dis tance between these planes is the slice thickness to be defined For example you can avoid cutting out inter fering structures MIP Thin VRT Thin Clip 246 syngo 3D 3 3D Object Editor Easy elimination of obstructing information Easy volume confinement with clip box or variable editing slab Fast object creation with threshold operations
64. c tion TestBolus kV 80 Effective mAs 110 Rotation time 1 0 sec Slice collimation 5 0mm Slice width 10 0 mm Feed Scan 0 0 mm Kernel B31s CTDIvol 3 03 mGy 183 Children Overview The scan protocols for children are defined according to body regions Head Neck Shoulder Thorax Abdo men Pelvis Spine Upper Extremities Lower Extremi ties Vascular Specials and Private For children six 6 years and older use the adult pro tocols Whenever possible 80 kV is used instead of 130 kV either to exploit the significantly higher image con trast of iodine contrast media at 80 kV or to reach a lower dose level than possible with 130 kV 184 Children e Head HeadRoutine_Baby Spiral mode for routine baby head studies HeadRoutine_Child Spiral mode for routine children head studies HeadSeq_Baby Sequential mode for routine baby head studies HeadSeg_Child Sequential mode for routine children head studies InnerEar Spiral mode for inner ear studies SinusOrbi Spiral mode for routine sinus or orbital studies e Neck Neck Spiral mode for soft tissue routine neck studies e Thorax ThoraxRoutine_Baby Spiral mode for routine baby chest studies ThoraxRoutine_Child Spiral mode for routine children chest studies ThoraxHRSeq_Baby Sequential mode for high resolution baby lung studies ThoraxHRSeq_Child Sequential mode for high resolution children lung studie
65. cations Routine head spiral studies e g brain tumors cranial trauma hydrocephalus hemorrhaging and other abnormalities etc A range of 8 cm will be covered in 27 sec Head kV 130 Effective mAs 60 Rotation time 1 5 sec Slice collimation 2 5mm Slice width 3 0mm Feed Rotation 5 0mm Pitch Factor 10 Increment 3 0mm Kernel C30s CTDIvol 13 66 mGy Effective dose Male 0 55 mSv Female 0 60 mSv The conversion factor for a 7 year old child anda scan range of 80 mm was used 194 Children Hints Children who are more than 6 years old should be scanned with an adult protocol as the skull by this time is fully grown When bone structure is of interest use kernel C60s for image reconstruction 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 Please change the mAs value according to the age of the child 3 6 years 80 mAs 195 Children HeadSeq_Baby Indications Sequential mode for routine head studies for children e g tumors hydrocephalus hemorrhaging abnor malities etc A range of 8 25 cm Is predefined HeadSeq kV 80 Effective mAs 250 Rotation time 1 5 sec Slice collimation 2 5mm Slice width 2 5mm
66. ce of pitch on both the image quality and dose Effective mAs mAs Pitch Factor To calculate the dose you simply have to multiply the CTDIw per mAs with the effective mAs of the scan Dspiral Deri x effective mAs 30 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 Mul tislice CT scanner is given by the following formula Effective mAs mA x RotTime Pitch Factor Pitch Factor ____Feed Rot_ __ nrow x Slice collimation mA effective mAs RotTime x Pitch Factor where Slice collimation refers to the collimation of one detector row and nrow is the number of used detector rows 31 Dose Information CARE Dose CARE Dose is a clinical application package that pro vides real time tube current modulation for Spiral and Sequential Scanning CARE Dose reduces patient dose significantly espe cially in the regions of shoulder and pelvis It decreases tube load which extends the capacity for volume scan ning 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 on the fly i e the scanne
67. cess site Total amount 1 2 ml per kg of body weight 214 Children Hints e Use this protocol for children below 35 kg e Delayed scans may be required for the kidneys and bladder e Rectal contrast may be required for evaluation of pel vic mass e Please change the mAs value according to the weight of the child 25 34 kg 70 mAs 215 E Children Abdomen_Child Indications Spiral mode for routine studies in the region of abdo men and pelvis e g tumors lymphoma abscesses post traumatic changes etc A range of 30 cm will be covered in 32 sec Abdomen kV 130 Effective mAs 41 Rotation time 1 0 sec Slice collimation 2 5 mm Slice width 5 0 mm Feed Rotation 10 0 mm Pitch Factor 2 0 Increment 5 0 mm Kernel B41s CTDIvol 4 42 mGy Effective dose Male 4 83 mSv Female 7 40 mSv The conversion factor for a 7 year old child and a scan range of 300 mm was used Contrast medium IV injection Start delay exam dependent Flow rate dependent upon needle size Access site Totalamount 1 2 ml per kg of body weight 216 Children Hints e Delayed scans may be required for the kidneys and bladder e Rectal contrast may be required for evaluation of pel vic mass e Children with a body weight of more than 55 kg should be examined with an adult protocol 217 Children Spine_Baby Indications Spiral mode for spine studies e g post traumatic changes tumors ma
68. construction 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 cor rections 27 Dose Information CTDi and CTDI The average dose in the scan plane is best described by the CTDly for the selected scan parameters The CTDly is measured in the dedicated plastic phantoms 16cm 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 CTDly value displayed can deviate from the dose in the scanned volume The CTDly definition and measurement is based on sin
69. curve displays the varia tion of CT values with reference to the CT values in the baseline image at every point in time 315 syngo Dynamic Evaluation 7 Documentation of Results During the evaluation you have drawn individual ROIs and have generated enhancement curves and result tables You can save and print out this information or store it on a floppy for further processing To document the evaluation two new series are stored to your local database e The DynEva Curves series consists of 3 images and the result sheet that is currently displayed One original or fused Multi slice image currently displayed The image displayed in segment 2 for example the MIP image The baseline image The displayed result sheet e The DynEva Parameter series consists of the parameter images in segment 2 The Time to Peak image if configured The Peak Enhancement image if configured The Average image The MIP image 316 syngo Dynamic Evaluation General Hints e Slice Position with Multi Row Scanners When you use a multi row scanner several slice posi tions are scanned per acquisition When you load the images the window Slice Selection is displayed in which you can define the slice position to be analyzed You can evaluate either the scanned examination data or an averaged slice position e Help to Interpret the Enhancement Parameter images that help to interpret the en
70. d 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 36 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 recon struction 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 37 Workflow Information Auto Load tn 3D and Post processing Presets You can activate the Auto load in 3D function on the Examination card Auto Tasking
71. d osteoporo S S The Basics This program enables the quantitative determination of bone mineral density BMD of the spine in mg ml of calcium hydroxyapatite CaHA to assist the physician with diagnosis staging and follow up of osteopenia and osteoporosis with CT The patient is scanned together with the water and bone equivalent calibra tion phantom Siemens Reference Data The Siemens reference data was acquired at three European centers including 135 male and 139 female subjects ranging from 20 to 80 years of age 274 syngo Osteo CT Scanning Procedure Scan Protocols You will find the Osteo scan protocols under body region Spine kV Effective mAs Rotation time Slice collimation Slice width Feed Scan Kernel CTDIvol Effective dose Osteo 80 81 1 0 sec 5 0mm 10 0 mm 0 0mm S80s 2 23 mGy Male 0 03 mSv Female 0 08 mSv 275 syngo Osteo CT The special kernels are mostly used for physical mea surements with phantoms e g for adjustment proce dures S80s for constancy and acceptance tests S80s U90s or for specification purposes U90s For special patient protocols S80s and U90s are chosen e g for Osteo S80s and for high resolution bone studies U90s Patient positioning e Set the table height at 125 The gantry tilt will be available from 22 to 22 e Patients should be positioned straight on the table Support the knees to compensate for lor
72. d with each data set To define another flight path through the same vol ume the existing path will be overwritten and deleted 267 syngo Dental CT This is an application package for reformatting pan oramic views and paraxial slices through the upper and lower jaw It enables the display and measurement of the bone structures of the upper and lower jaw espe cially for a 1 1 scale as the basis for oral surgery plan ning The Basics What is the relevant anatomical information for oral surgery planning and dental implantation e Location of the socket for dental implant e Buccal and lingual thickness of the cortical compo nent of the alveolar process e Position of the mandibular canal and the mental foramen e Extent of the nasal sinuses and position and width of the floor of the nasal cavity What can syngo Dental CT do e Reformatting of a curvilinear range of panoramic views along the jaw bone Reformatting of paraxial views of selectable length and at selectable intervals perpendicular to the pan Oramic views Presentation of results in the form of multiple image display with reference markings Images are documented on film in real size so that the direct measurement of the anatomic information with a ruler is possible The layout of the film sheet is predefined such that it can accommodate the maxi mum number of reformatted images 268 syngo Dental CT 7 Panoramic view anh N f NA D a
73. ded 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 pro tocols under the desired position 42 Workflow Information Hints e With the Find Replace function you can easily insert an API command for all protocols as needed e 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 characteris tics will belong to the protocol so it does not matter which folder you choose e The entry Set to defaults in the main menu context sensitive menu will reset all your changes to the Sie mens 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 e With the entries Save Save as Save all you can save your changes e For security purposes it is not possible to do any changes in the Siemens protocols although you can copy or drag amp drop these protocols into a Customer folder e 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 pr
74. dosis e The calibration phantom should be positioned directly below the target region Put the Gel pad between the calibration phantom and the patient to exclude air pockets Scanning For obese patients increase the mAs value to 120 Typically one scan each is performed at L1 L2 and L3 levels Use image comments L1 L2 L3 L4 L5 or T12 prior to scanning of the respective vertebrae these comments will be used for syngo Osteo CT evaluation results no blanks or other deviations are allowed e g use L4 instead of L 4 or T12 instead of TH12 Before ending the examination you can drag amp drop the recon jobs from the chronicle to the topogram segment to get the Topographics i e the cut lines for each vertebra on the topogram 276 syngo Osteo CT Position the cut line of scanning through the middle of the vertebra i e bi sector between the angle of the upper and lower end plate The phantom must be included in the FoV of the images for evaluation It is recommended to end the exam first and then start the syngo Osteo CT evaluation Do not use the calibration phantom from other CT scanners as your system Is calibrated to a particular phantom Topographic Phantom inside the FoV 277 syngo Osteo CT Configuration In the Osteo configuration you can define the follow ing parameters You can e use the Siemens standard reference database or cre ate and import your ow
75. e You can modify an ROI in any image precisely adapt ing it to the shape you feel is relevant e The number of ROIs that can be defined is limited to five you can only draw one pixel lens e The ROIs that you have drawn are transferred to the other views e To aid examination they are numbered in sequence and color coded Display of the Pixel Lens curve 314 syngo Dynamic Evaluation 6 Enhancement Curve As soon as you have defined an ROI an enhancement curve time density curve is calculated and displayed in the fourth segment To facilitate identification this curve has the same color and numbering as the associ ated ROI The maximum CT value of the ROI first drawn is indicated by a dashed sampling line In the table for each ROI the following parameters are given e Peak HU Highest CT value detected in the ROI e Time to Peak s Period of time in seconds from the time when the first image was acquired Delay 0 or the time when the contrast was injected Delay gt 0 to the time when the highest CT value is reached In an ROI e Sample HU CT value at the point of time in sec where the vertical line is positioned on the enhance ment curve Absolute Relative Enhancement curve The enhancement curves are displayed as absolute or relative curves e The Absolute Enhancement curve displays the origi nal CT value derived at every point in time during the examination e The Relative Enhancement
76. e special kernels are mostly used for physical mea surements with phantoms e g for adjustment proce dures S80s for constancy and acceptance tests S80s U90s or for specification purposes U90s 191 Children HeadRoutine_Baby Indications Routine head spiral studies e g brain tumors cranial trauma hydrocephalus hemorrhaging and other abnormalities etc A range of 8 cm will be covered in 27 sec Head kV 80 Effective mAs 122 Rotation time 1 5 sec Slice collimation 2 5mm Slice width 3 0mm Feed Rotation 5 0mm Pitch Factor 10 Increment 3 0mm Kernel C30s CTDIvol 7 89 mGy Effective dose Male 0 84 mSv Female 0 92 mSv The conversion factor for an 8 week old child and a scan range of 80 mm was used Contrast medium IV injection Start delay exam dependent Flow rate dependent upon needle size Access site Totalamount 1 2 ml per kg of body weight 192 Children Hints e Use this protocol for children below 6 months of age e When bone structure is of interest use kernel C60s for image reconstruction e 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 193 Children HeadRoutine_ Child Indi
77. educe one or more of the following parameters collimation reconstruction increment and slice width for image reconstruction 155 Lower Extremities Body Kernels e As standard kernels for body tissue studies B31s or B41s is 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 B7Os are avail able In case of 3D study only the mAs value can be reduced by 50 Use kernel B20s and at least 50 overlap in image reconstruction 156 157 Lower Extremities KneeHR Indications Spiral mode for high resolution studies of the knee e g masses trauma disorders of the joint etc A range of 10 cm will be covered in 52 sec 158 Lower Extremities kV Effective mAs Rotation time Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTDIvol Effective dose Hint KneeHR 130 35 1 0 sec 1 0 mm 3 0mm 2 0mm 1 0 3 0 mm U90s 3 77 mGy Male 0 07 mSv Female 0 07 mSv 24 reconstruction 7 25 mm 0 8 mm U90s e For image reconstruction of soft tissue use kernel B31s 159 7 Lower Extremities FOOtHR Indications Spiral mode for high resolution studies of the foot e g masses trauma disorders of the joint etc A range of 10 cm will be covered in 52 sec FootHR 2 4 reconstruction kV 130
78. efore after the first last image on which an ROI is already defined 295 syngo Volume Evaluation e To include only a specific range of HU values into the volume change the Evaluation Limits By default the Evaluation Limits take all HU values of the last evaluation To start the evaluation click the Start Evaluation but ton The evaluation results are displayed in segment 4 The volume is colored on all images in all views You can define a new volume You can correct the Evaluation Limits and restart the evaluation If the result is not satisfactory you can delete the volume 296 syngo Volume Evaluation Overlap and Mark amp Link Method You can define complex volumes using the automatic overlap and manual mark amp link method e Overlapping method Drawn ROls that overlap each other vertically for at least a few pixels are automatically combined to one volume Interpolated ROIs dotted line are shown in the intermediate images Two or more small ROIs that are drawn within one image and a big ROI in a different image that overlaps both small ROIs are automatically combined into one volume This works in both directions top down and bottom up 297 syngo Volume Evaluation With the Overlap method you can also create a vol ume from two ROIs that do not overlap in the first step It is then necessary to draw an ROI in an image which lies between the two other ROls so that the new ROI overlaps
79. ew Output segment The first three segments are reference segments the fourth segment is an output segment In the three ref erence segments the images are first shown in the views that are parallel and perpendicular to the direc tion of scanning By turning and moving the views you can define the position and orientation of the plane that is to be used as the reference image for the reconstruction of images or series The reference segments are used to display different views of the volume data set while the reference dis play the view is used as a reference for a 3D recon struction The images and series generated by various tools on the basis of the reference image are displayed in the output segment To find the best suitable reference image for planning reconstruction of images and series you can freely rotate and move all three views 243 syngo 3D Defining Output Types You can change the output type for a segment at any time i e from Multi Planar Reconstruction MPR to Maximum Intensity Projection MIP to Shaded Sur face Display SSD or to Volume Rendering Technique VRT Depending on your working method you will first gen erate a reference image for example in MPR in the desired view and then switch to MIP SSD or VRT dis play e Click on the segment for which you want to change the output type e If you want to switch over all segments you must select and switch over each o
80. f syngo functions such as Navigation lines and dog ears can be used for fast paging through each view Transversal thick slice Multi Planar Reformat MPR Maximum Intensity Projection MIP or Minimum Intensity Projection MinIP segments are available for better recognition of the Volume of Interest e Zoom amp Pan is available for each image segment which is especially helpful for Volume definition of smaller structures 288 syngo Volume Evaluation Interactive outlining of freehand and elliptical Regions of Interest is available with the possibility to define evaluation HU limits inside the VOI Automatic interpolation between two pending ROIs is performed i e the user only has to define the ROI in selected images within the stack Automatic detection of a volume using threshold based 3D region growing for quick calculation of high contrast structures such as bone lung or con trast filled organs Combination of interactive and automatic approach possible Dedicated linking methods available for fusion or separation of ROIs in order to define complex vol umes Display of color coded VOls for easy differentiation of multiple volumes Configuration of result parameters 289 syngo Volume Evaluation Prerequisites The images must fulfill the following conditions e Only images of one patient must be loaded for eval uation with Volume The scans must have been acquired with the same table height and
81. f the scan field Use the lateral laser beam to make sure that the patient is positioned in the center 4 Warm surroundings and dimmed lighting are helpful to make children more cooperative 5 Sedation Although the advent of the Multislice CT scanner has enabled the user to scan through an area of interest much faster than ever sometimes patient motion can still lead to severe motion arti facts seen on the resultant images This becomes a factor especially with infants and younger children who are unable to hold still for the exam Sedating this population may be a viable option for your insti tution Of course appropriate protocols need to be established at your specific institution For instance the drug of choice for specific ages weights of these patients taking into consideration the total time of the exam the form of administration patient preps adequate monitoring of the patient pre scan during the exam and post scan etc should all be taken into consideration 187 g Children The proper personnel and equipment must also be readily available in the event of a problem 6 Oral and rectal contrast administration Depending on the reason for the exam status of the patient oral contrast may or may not be given to these patients In general oral contrast is recommended to opacify the intestinal tract as unopacified bowel can have the appearance of abdominal fluid or mass effect Oral as well as rectal contrast ma
82. ffective mAs e CARE Dose How does CARE Dose work ae Workflow Information e Recon Jobs Examination Job Status Auto Load in 3D and Post processing Presets How to Create your own Scan Protocols Edit Save Scan Protocol Scan Protocol Manager 14 16 16 17 18 18 18 18 19 20 20 21 22 25 24 25 27 28 28 30 32 32 36 36 37 38 39 39 40 Contents Contrast Medium The Basics IV Injection Bolus Tracking Test Bolus using CARE Bolus Test Bolus Application Information e 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 m Head Overview Hints in General Head Kernels HeadRoutine HeadSeq e InnerEarHR InnerEarHRSeq Sinus SinusSeq Orbita Dental 45 45 47 48 50 51 54 54 54 55 56 57 58 J9 60 62 64 66 68 70 70 71 71 72 74 76 78 80 82 84 86 Contents C Neck Overview Hints in General Body Kernels Neck Shoulder Overview Hints in General Body Kernels Shoulder a Thorax Overview Hints in General Body Kernels ThoraxRoutine ThoraxRoutineO8s ThoraxFast ThoraxHRSeq e LungLowDose E Abdomen Overview Hints in General
83. fy special parameters for all exist ing 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 fol lowing basic procedure Open Options on the Scan Protocol Manager icon e Rename a protocol Select a scan protocol with the right mouse button Select Rename and enter a new name for the pro tocol 40 Workflow Information e 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 ind Replace Cokumn m a M4 ModeSconT ype Function finese vseb Het Condition foie Toper Find test Zen Replace wih frakencemedtyeS Rectsce at Fe mietin al E 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 nee
84. g 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 60 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 is bee ri rerh ed eee ee fer ek ar T iE E F ee ee fg eee 61 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 62 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 success ful installation via the SOMATOM life message window that appears during system start up SUERTE a ae _ me marap age FD erect Wie lE eee eer ee es eee UE ee ee E re ee ee l aa 63 Applicatio
85. hance ment are displayed in segment 2 for example the MIP image and the Peak Enhancement image e Defining the Tissue Range With Tissue Classification you can exclude all tissue regions outside the CT value range entered This allows you to emphasize the organ to be examined and remove disturbing factors HU limitation does not affect evaluation of the ROIs and only appears at the Time to Peak and the Peak Enhancement image The excluded tissue densities are masked by a color in the baseline image The excluded areas are displayed in black in the Time to Peak and Peak Enhancement images 317 syngo Dynamic Evaluation e Filtering To reduce noise in the Time to Peak and Peak Enhance ment image you can apply a smoothing filter Filtering does not affect the evaluation of ROIs e Moving the Sampling Line If you want to evaluate the enhancement values for a different point in time move the sampling line in the horizontal direction You can display the tomographic image for the time marked by the sampling line as the top image in the tomo segment To do that double click on the sam pling line e Delay of Injection You usually start the CT scans with contrast medium after a delay following contrast medium injection You can have this off set taken into account in calculation of the Time to Peak image and enhancement curves The results then refer to the time of contrast medium administration zero on the time scale
86. head image quality without any additional post pro cessing e 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 79 Head Sinus Indications Spiral mode for paranasal sinuses studies e g sinusi tis mucocele pneumatization polyposis tumor cor rections etc A range of 7 cm will be covered in 37 sec Sinus 24 reconstr 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 13 66 mGy Effective dose Male 0 21 mSv Female 0 22 mSv Contrast medium IV injection Start delay 60 sec Flow rate 2 ml sec Total amount 50 60 mI 80 Head Hints e An automatic bone correction and an advanced algo rithm allows for improved head image quality with out any additional post processing In order to optimize image quality versus radiation dose scans are provided within a maximum scan field of 300 mm with respect to the iso center No recon job with a field of view exceeding those limits will be possible Therefore patient positioning has to be performed accurately to ensure a centered loca tion
87. in the head arm rest lower legs supported Patient respiratory instructions inspiration Oral administration of contrast medium The use of water will not obscure the blood vessels thus allowing CTA post processing to be performed easily afterwards Be careful when examining pheochromocytoma patients Administration of an IV CM injection in such cases may trigger a hypertensive crisis To further optimize MPR image quality we recom mend that you reduce one or more of the following parameters collimation reconstruction increment and slice width for image reconstruction Head Kernels e For soft tissue head studies the standard kernel is H41s softer images are obtained with H31s or H21s sharper images with H50s Body Kernels e As standard kernels for body tissue studies B31s or B41s is recommended softer images are obtained with B20s 163 7 Vascular HeadAngio HeadAnglo08s Indications Spiral mode for cerebral CT Angios e g cerebral vas cular abnormalities tumors and follow up studies etc A range of 6 cm will be covered in 32 26 sec kV Effective mAs Rotation time Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTDIvol Effective dose 164 HeadAngio 2 reconstruction 130 50 0 8 1 0 sec 1 0 mm 3 0 mm 1 25 mm 2 0mm 1 0 3 0mm H31s 11 39 mGy Male 0 26 mSv Female 0 30 mSv 0 8 mm H31s Vascular Contrast medium IV injection Start delay 18
88. k an endoscopic evaluation and to create a series of endoscopic snapshots that can be saved on the database 258 syngo Fly Through Prerequisites This software works with CT MR and conventional Angiographic data sets CTA data set with good vessel enhancement for virtual angloscopy Volume data set acquired with overlapping thin slice CT technique The Basics for CT Virtual Endoscopy SSD and VRT Presets for Endoscopic Renderings In order to create endoluminal displays with CT data sets we need to differentiate the structures of interest from the rest of the anatomy This can be achieved with either positive or negative contrast enhance ment In principle there are few objects media which are suitable for endoscopic renderings e Gas e g air or carbon dioxide e Fluid e g water lodine based intravenous infusion media or Barium based oral and rectal contrast agents e Bone e Metal e g stents 259 syngo Fly Through Endoscopic Viewing Parameters Fly Cone Settings In general the shape of a pyramidal cone can be used to represent visualization of an endoscopic volume The boundaries and the viewing perspective of the endoscopic volume are defined by adjusting the shape and size of this cone Cone setting for flying through the airways Viewing direction Standing Point Image Viewing Angle Viewing Front Clip Plane PANE Distance Viewing Viewing Plane A Point Viewing 4
89. lation from the original data set change the display of the images in the MIP results segment using the display mode MaxIP MinIP or MPR and the slice thickness scroll through the image stack e window zoom and pan images showlhide image text display set evaluation limits Using the evaluation limits you can perform volume calculation within a defined HU value range 3 Planning a Volume Volume Evaluation offers different tools and methods to plan a volume e You can use the Automatic Volume Detection fea ture where the system automatically defines a vol ume around a seed point Volume CT searches for directly connected voxels within a defined HU range and assigns them to the volume e You can use the Interactive Volume Definition where you draw either elliptical or freehand regions of interest ROIs on the images The ROI contours define the outer border of the volume 292 syngo Volume Evaluation 3 1 Planning a Volume with Automatic Volume Detec tion The automatic method is best used to evaluate a struc ture which has a different contrast HU than the sur rounding tissue such as the lung You plan the volume with just a few clicks Automatic Volume Detection uses the 3D region grow ing method You enter thresholds that are to be consid ered for region growing and set seed points Volume Evaluation searches for directly connected voxels within the threshold limits and assigns them to the VOI The sys
90. le 3 28 mSv Female 4 23 mSv Contrast medium IV injection Start delay 25 30 sec Flow rate 2 5 ml sec Total amount 80 ml Hints e You could repeat the same protocol by simply click ing the chronicle with the right mouse button for repeat e g when both non contrast and contrast studies are required e For lung cancer evaluation this protocol can be com bined with the protocol Neck Routine 103 J Thorax ThoraxFast Indications Fast spiral mode for lung studies e g when a patient has difficulty with breathhold A complete thorax scan in a range of 30 cm will be cov ered in 14 sec 104 Thorax ThorFast 2 4 reconstr kV 130 Effective mAs 60 Rotation time 0 8 sec Slice collimation 5 0mm Slice width 8 0 mm 8 0 mm Feed Rotation 20 0 mm Pitch Factor 2 0 Increment 8 0mm 8 0mm Kernel B41s B7Os CTDIvol 6 47 mGy Effective dose Male 3 38 mSv Female 4 39 mSv Contrast medium IV injection Start delay 25 30 sec Flow rate 2 5 ml sec Total amount 80 ml Hints e You could repeat the same protocol by simply click ing the chronicle with the right mouse button for repeat e g when both non contrast and contrast Studies are required e For lung cancer evaluation this protocol can be com bined with the protocol Neck Routine 105 Thorax ThoraxHRSeq Indications Sequence mode for HiRes lung studies e g interstitial changes in the lungs
91. lens are automatically cop ied to all pending images of the stack and show an immediate display of the time density curves i e a calculation can be done with only one interaction 306 syngo Dynamic Evaluation e Use of syngo functions like dog ears or cine mode for fast paging through the image stack e Easy selection modification and deletion handling for the ROIs e Constant display of the time density curves with a scalable sampling line and of the tabular results which display for each separate ROI the mean Hounsfield value the time to the peak enhancement in seconds the density value HU of a given time position chosen by shifting the sampling line to that point e Separate image stack segment for further output images such as Average image Maximum Intensity Projection image Peak Enhancement image Time to Peak image e Configuration dialog to enable customized results 307 syngo Dynamic Evaluation Prerequisites In dynamic evaluation images that were scanned as part of an examination with contrast agent at a con stant table position are evaluated e The selection consists only of CT tomogram images e The images belong to the same study e The images were acquired within 1 hour e Images of at least 4 different time positions must be loaded to Dynamic Evaluation e The relevant DICOM attributes are the same on all images 308 syngo Dynamic Evaluation Workflow
92. lformations orthopedic indica tions etc A range of 15 cm will be covered in 32 sec Spine 2nd reconstruction kV 80 Effective mAs 110 Rotation time 1 0 sec Slice 2 5 mm collimation Slice width 3 0 mm 3 0 mm Feed Rotation 5 0 mm Pitch Factor 1 0 Increment 3 0 mm 2 0 mm Kernel B41s B60s CTDIvol 3 03 mGy Effective dose Male 1 90 mSv Female 4 06 mSv The conversion factor for an 8 week old child and a scan range of 150 mm was used 218 Children Hints e Use this protocol for children below 35 kg e Please change the mAs value according to the weight of the child 25 34 kg 160 mAs 219 Children Spine_Child Indications Spiral mode for spine studies e g post traumatic changes tumors malformations orthopedic indica tions etc A range of 15 cm will be covered in 32 sec Spine 2nd reconstruction kV 130 Effective mAs 70 Rotation time 1 0 sec Slice 2 5 mm collimation Slice width 3 0 mm 3 0 mm Feed Rotation 5 0 mm Pitch Factor 1 0 Increment 3 0 mm 2 0 mm Kernel B41s B60s CTDIvol 7 55 mGy Effective dose Male 1 79 mSv Female 3 78 mSv The conversion factor for a 7 year old child anda scan range of 150 mm was used 220 Children Hint e Children with a body weight of more than 55 kg should be examined with an adult protocol 221 E Children ExtrHR_Baby Indications Spiral mode for high resolution extremity studies e g post traum
93. ll by this time is fully grown When soft tissue is of interest use kernel H31s for image reconstruction In order to optimize image quality versus radiation dose scans are provided within a maximum scan field of 300 mm with respect to the iso center No recon job with a field of view exceeding those limits will be possible Therefore patient positioning has to be performed accurately to ensure a centered loca tion of the skull Please change the mAs value according to the age of the child 3 6 years 160 mAs 201 g Children SinusOrbi Indications Spiral mode for routine spiral studies of the sinuses and paranasal sinuses e g sinusitis pneumatization polyposis malformations tumors etc A range of 4 cm will be covered in 22 sec SinusOrbi 2nd reconstruction kV 80 Effective mAs 81 Rotation time 1 0 sec Slice 1 0 mm collimation Slice width 3 0 mm 1 25 mm Feed Rotation 2 0mm Pitch Factor 1 0 Increment 3 0 mm 0 8 mm Kernel C60s C60s CTDIvol 5 24 mGy Effective dose Male 0 03 mSv Female 0 04 mSv The conversion factor for a 7 year old child and a scan range of 40 mm was used 202 Children Contrast medium IV injection Start delay exam dependent Flow rate dependent upon needle size Access site Totalamount 1 2 ml per kg of body weight Hints e Children who are more than 6 years old should be scanned with an adult protocol In order to optimize image quality ver
94. lpful for complex fractures amp dislocations 97 Thorax Overview ThoraxRoutine ThoraxRoutineO8s 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 visualiza tion of pathologies 98 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 examina tions 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 amp 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 o
95. lt protocol 225 Children HeadAnglo Indications Spiral mode for head CT angiography e g cerebral vascular abnormalities tumors etc A range of 6 cm will be covered in 32 sec HeadAngio 2 reconstruction kV 80 Effective mAs 817 Rotation time 1 0 sec Slice 1 0mm collimation Slice width 2 0mm 1 25 mm Feed Rotation 2 0mm Pitch Factor 1 0 Increment 2 0mm 0 8mm Kernel C30s C30s CTDIvol 5 24 mGy Effective dose Male 0 12 mSv Female 0 13 mSv The conversion factor for a 7 year old child and a scan range of 60 mm was used Contrast medium IV injection Start delay exam dependent Flow rate dependent upon needle size Access site Total amount 1 2 ml per kg of body weight 226 Children Hints e Children who are more than 12 years old should be scanned with an adult protocol as the skull by this time is fully grown e CARE Bolus may be used to optimize the bolus timing with a triggering threshold of 120 HU or use manual triggering e An advanced algorithm allows for improved head image quality without any additional post process ing 227 Children HeadAngio08s Indications Spiral mode for head CT angiography e g cerebral vascular abnormalities tumors etc A range of 6 cm will be covered in 26 sec HeadAngio Ze reconstruction kV 80 Effective mAs 65 Rotation time 0 8 sec Slice 1 0 mm collimation Slice width 2 0 mm 1 25 mm Feed Rotation 2
96. m 2 cup to drink 15 minutes before exam 3 cup to drink 5 minutes before exam Abdomen Pelvis Minimum 1000 ml of contrast divided into 4 cups 1st cup to drink 1hour before exam 24th cups every subsequent 15 minutes Start exam 5 minutes after the 4 cup is adminis tered 111 Abdomen e In general for abdominal studies such as liver gall bladder query stones pancreas gastrointestinal Studies focal lesion of the kidneys and CTA studies it is sufficient to use just water Water is more effec tive than positive oral contrast agent in depicting the linings of the stomach amp intestines in post enhance ment studies In addition the use of water will not obscure the blood vessels thus allowing CTA process ing to be performed easily afterwards For patients with bowel obstruction only water or water soluble contrast can be used Barium suspen sion is contraindicated Be careful when examining pheochromocytoma patients Administration of an IV CM injection in such cases may trigger a hypertensive crisis To further optimize MPR image quality we recom mend that you reduce one or more of the following parameters collimation reconstruction increment and slice width for image reconstruction e For abdominal studies deselect CARE Dose for patients gt 120 kg 112 Abdomen Body Kernels e As standard kernels for body tissue studies B31s or B41s are recommended softer images are obtained with B20s
97. much higher than one would expect When you examine a patient who is older than 80 years the patient examination data cannot be com pared with the reference data base It is recommended to film directly from the Osteo card Select images or series with Edit Select all and click film icon You can also configure your film lay out e g 3 x 3 as shown in Option Configuration FilmingLayout ma IE f Ti Ei IPLE d j le Baa be J BE Filming layout Note it is not recommended to use filming layout set ting of 4 x 5 segments since the image text elements of the result image are overlapped and hard to read 287 syngo Volume Evaluation Volume is an evaluation function which allows most accurate calculation of a volume out of a stack of two dimensional images This can be done by Volume of Interest VOI defini tion and by limiting the minimum and maximum den sity HU values for calculation Different views of the image data provide fast navigation and easy volume definition Potential applications are volume measurements of a tumor or organs such as lung and kidney To do this the Volume Evaluation card provides you with the following features e Evaluation on a separate syngo card on the user interface Calculation of 5 different Volumes is possible in par allel e For easy navigation the image data Is displayed in 3 different views coronal sagittal and transversal Use o
98. n Open the Range function and adapt the range set tings Image thickness Distance between the images etc Hit the link button Save the linked preset Blow up Mode With the blow up mode you display the full screen for easier visualization by double clicking in the segment 257 syngo Fly Through syngo Fly Through is a Virtual CT Endoscopy Software integrated into the syngo 3D functionality It offers the possibility to render endoluminal views of structures such as the airways and vessels from volume data sets Virtual CT Endoscopy simulates diagnostic conven tional endoscopic procedures e g bronchoscopy and colonoscopy that are usually uncomfortable and more invasive to the patient Key Features e Add on advanced 3D functionality Fly icon inte grated in the existing familiar 3D card e One click access to perspective endoscopic render ing at a point of interest Both Shaded Surface Display SSD and Volume Ren dering Technique VRT can be used Volume Rendering Technique VRT presets can be stored in the VRT gallery and linked to specific exam ination protocol or series description Endoscopic viewing parameters e g the viewing angle depth and the viewing distance from the endoscope can be defined and linked to a data set Manual or Automatic endoscopic navigation Fly path planning creates and saves a flight path in the volume data set This offers the possibility to play bac
99. n change between 1 and 2 standard deviations dis play of the summary graph e use the Siemens Reference phantom or enter values for bone and water manually e change the age of the young controls used for the calculation of the T Score enable the export of results Le Cua en Reference Database Biemans Standard Lise Path Display of Standard Deviation L 1 SD from hean 42 2 50D from Mean Siemens Reference Phantom in Image Age of Young Controls Siemens Standard biale 20 Manual Female 20 Bone equiv HL E Waterequiv HU 0 278 syngo Osteo CT How can you save the results on your PC Select Option Configuration from the main menu and click icon CT Osteo Activate the checkbox Enable Export of Results Exit the configuration dialog pam Call up the Osteo card and you will see the new icon Export results on the lower right part of the screen Click on this icon to copy the evaluation results to floppy disk note with every mouse click on the icon the previous result file will be appended The data file can be transferred to your PC for further evaluation e g with MS Excel a 279 syngo Osteo CT Example for one patient with three Osteo tomo grams PATIENT John Smith 007 64 Male IMAGE L2 234 2 27 JAN 1998 11 12 17 61 7 48 9 55 3 20 8 20 1 21 5 205 8 192 0 198 7 50 6 47 5 49 5 IMAGE L3 236 3 27 JA
100. n 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 i 1 Pe a PT BLEI I mga In the pop up window you can select the application for which you want to convert the images 64 After conversion you can load these data sets into the application of your choice 65 Application Information File Browser The File Browser provides the ability to access and to manage your created files e Copy images and files to the CD Burn folder e Access to all created reports and movies AVI files e Access to the offline folder e Access to downloaded files Open the File Browser via the main menu entry Options File Browser The File Browser provides special folders for our Appli cations 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 amp 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
101. nd 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 con trast 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 avail able 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 47 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 e This mode can be applied in combination with any Spiral scanning protocol Simply insert Bolus Track ing by clicking the right mouse button in the chron icle This inserts the entire set up including pre mon itoring i v bolus and monitoring scan protocol You can also save the entire set up as your own scan pro tocol e The pre monitoring scan is used to determine the position of the monitoring scans It can be per formed at any position
102. ne separately one after the other Creating Series This application gives you the ability to easily create new images or even image series e g for fast display of interesting anatomical structures e With any slice thickness at least the reconstructed slice thickness e Variable distance angle between the images e Selectable number of images e Selectable range of reconstruction e Different output types Parallel Ranges With this option you generate series of cut images that are parallel to one another and perpendicular to the reference image for the output types MPR MPR Thick MIP Thin and VRT Thin For example for MPRs or MIP Thin through a process in the lung or abdomen 244 syngo 3D Radial Ranges For output types MPR MPR Thick and MIP Thin you generate a series of cut images arranged in a Star shape For output types MIP SSD and VRT you generate a series of projections and views of the volume each rotated around a defined angle In this way you simu late a step by step rotation For example for colored VRT images showing a pro cess from different angles Expanded Ranges With this option you generate images that are located in front of or behind the reference image This option too is only available for output types MPR MPR Thick or MIP Thin For example for MPRs or MIP Thin through a process in the lung or abdomen Curved Ranges If you want to view sub areas that cannot be obtained
103. nge with trigger ing threshold of 120 HU or use manual triggering 119 Abdomen Hints Do not administer oral contrast medium as this impairs the editing of MIP SSD VRT images Use water instead if necessary Water rather than positive oral contrast agents should be used Give the last cup of 200 ml just prior to positioning the patient To ensure adequate filling of the duodenal loop lay the patient on the right side for 5 minutes before performing the topogram A pre contrast examination is usually performed only if no CT scans were previously acquired to exclude calculi in the common bile duct and to visu alize possible lesions in the liver Furthermore this also ensures exact positioning for the CTA spiral For pancreatic studies the arterial phase acquisition can be acquired later with a start delay of 40 50 sec It may be necessary to use a thinner collimation of e g 2 5 mm 120 121 E Abdomen AbdomenSeq Indications Sequential mode for all routine studies in the region of abdomen e g evaluation follow up examinations etc The whole scan length covers 15 2 cm AbdSeq kV 130 Effective mAs 70 Rotation time 1 0 sec Slice collimation 4 0 mm Slice width 8 0 mm Feed Scan 8 0 mm Kernel B41s CTDIvol 7 55 mGy Effective dose Male 2 35 mSv Female 2 75 mSv Contrast medium IV injection Start delay 50 60 sec Flow rate 3 0 ml sec Total amount 100 ml 122 Abdomen Hi
104. nts e You could repeat the same protocol by simply click ing the chronicle with the right mouse button for repeat e g when both non contrast and contrast studies are required Water rather than positive oral contrast agents should be used Give the last cup 200 ml just prior positioning the patient To ensure adequate filling of the duodenal loop lay the patient on the right side for 5 minutes before performing the topogram e A pre contrast examination is usually performed only if no CT scans were previously acquired to exclude calculi in the common bile duct and to visu alize possible lesions in the liver 123 Overview Pelvis Spiral mode for routine soft tissue pelvis studies Hip Spiral mode for routine hip studies SI Joints Spiral mode for sacroiliac joints studies 124 Pelvis Hints in General e Topogram TOP 512 mm for pelvis studies and 256 mm for studies of the hip and SI Joints e Patient positioning Patient lying in supine position arms positioned comfortably above the head in the head arm rest lower legs supported A breathing command is not necessarily required for the pelvic examination since respiration does not negatively influence this region Rectal contrast medium administration Rectal contrast media is usually required to delineate the rectum and sigmoid colon if lower pelvic mass or pathology are suspected In some cases air may be substituted for
105. 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 posi tion 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 48 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 mon itoring 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 con trast injection and monitoring scans at the same time During the monitoring scans there will be
106. of the skull For image reconstruction of soft tissue use kernel H31s 81 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 27 32 mGy Effective dose Male 0 22 mSv Female 0 24 mSv Contrast medium IV injection Start delay 60 sec Flow rate 2 ml sec Total amount 50 60 ml 82 Head Hints e An automatic bone correction and an advanced algo rithm allows for improved head image quality with out any additional post processing In order to optimize image quality versus radiation dose scans are provided within a maximum scan field of 300 mm with respect to the iso center No recon job with a field of view exceeding those limits will be possible Therefore patient positioning has to be performed accurately to ensure a centered loca tion For image reconstruction of soft tissue use kernel H31s 83 M Head Orbita Indications Spiral mode for orbital studies e g fracture A range of 2 cm will be covered in 12 sec kV Effective mAs Rotation time Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTDIvol Effective dose Contrast medium IV injection Start delay Flow rate
107. on increment and slice width for image reconstruction 147 Upper Extremities Body Kernels e As standard kernels for body tissue studies B31s or B41s is recommended softer images are obtained with B20s e For higher sharpness as is required e g in patient protocols for cervical spine shoulder extremities thorax lung the kernels B50s B60s B7Os are avail able 148 149 4 Upper Extremities WristHR Indications Spiral mode for HiRes bone study of the wrist e g trauma orthopedic indications etc A range of 6 cm will be covered in 32 sec 150 Upper Extremities kV Effective mAs Rotation time Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTDIvol Effective dose Hint WristHR 130 30 1 0 sec 1 0 mm 2 0mm 2 0mm 1 0 2 0mm U90s 3 23 mGy Male lt 0 07 mSv Female lt 0 07 mSv 24 reconstruction 1 25 mm 0 8 mm U90s e For image reconstruction of soft tissue use kernel B31s 151 4 Upper Extremities ExtrRoutineHR Indications Spiral mode for HiRes bone study e g trauma ortho pedic indications etc A range of 10 cm will be covered in 52 sec kV Effective mAs Rotation time Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTDIvol Effective dose Hint ExtrHR 24 reconstruction 130 30 1 0 sec 1 0 mm 2 0mm 1 25 mm 2 0mm 1 0 2 0mm U90s 3 23 mGy Male lt 0 07
108. on single slice collimation Pitch Factor table movement per rotation complete slice collimation E g slice collimation 2 x 5mm 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 1 5 Pitch 2 Pitch Models 22 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 3000 aeaa white Window Window width W center C 0 black 1000 CT window values an l Blood Liver iD Tumor Spleen Kidneys Heart Water m ii Organ specific window values 23 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 e 6 body kernels smooth B20s medium smooth B31s medium B41s medium sharp B50s sharp B60s high res B7Os e 7 head kernels smooth H21s medium smooth H31s medium H41s medium sharp H50s sharp H60s high res H7Os ul
109. ongruence evaluations orthopedic indications etc A typical range of 10 cm will be covered in 35 sec 128 Pelvis kV Effective mAs Rotation time Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTDIvol Effective dose Hints Hip 130 70 1 0 sec 7 5mm 3 0mm 3 0mm 1 0 3 0mm B7Os 7 55 mGy Male 1 78 mSv Female 1 66 mSv 2d reconstr 2 0mm 1 5 mm B7Os e In case of 3D study only images should be recon structed with at least 50 overlap in image recon struction and kernel B20s e If only one side is examined it is advisable to enter the side in the comment line on the Routine card 129 E Pelvis SI_Joints Indications Spiral mode for bone studies of the sacroiliac joints A typical range of 8 cm will be covered in 18 sec SI_ Joints 2 4 reconstruction kV 130 Effective mAs 80 Rotation time 1 0 sec Slice 2 5mm collimation Slice width 3 0mm 3 0mm Feed Rotation 5 0mm Pitch Factor 1 0 Increment 3 0mm 2 0mm Kernel B7Os B7Os CTDIvol 8 62 mGy Effective dose Male 1 44 mSv Female 1 93 mSv 130 131 Overview C Spine Spiral mode for cervical spine studies C SpineSeq Sequential mode for cervical spine studies Spine Spiral mode for routine lumbar and thoracic spine Studies SpineSeq Sequential mode for lumbar and thoracic evaluation of the discs Osteo Sequential mode used for the application syngo Os
110. otocol recon jobs e f there are unsaved scan protocols when closing the Scan Protocol Manager you will be informed by a message e You can configure the displayed columns and their position with View configure columns 43 E Workflow Information Additional Information 1 System Run offers the tool Restore Default Scan Pro tocols 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 Pro tocols which generates an HTML table of all avail able scan protocols This list can be printed or saved on Floppy Right click in the table click View Source File Save As 44 Workflow Information Contrast Medium The Basics The administration of intravenous IV contrast mate rial during spiral scanning improves the tissue charac terization 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
111. ow Navigation of the Endoscopic Volume Fly Path Planning syngo Dental CT The Basics e Scan Protocols Additional Important Information syngo Osteo CT The Basics e Scanning Procedure Configuration e Evaluation Workflow Additional Important Information syngo Volume Evaluation Prerequisites Workflow General Hints Configuration 257 257 258 258 259 259 259 260 262 263 265 266 268 268 209 271 274 274 2 9 278 282 287 288 290 291 300 303 Contents syngo Dynamic Evaluation Prerequisites Workflow il Inspecting the Input Images Generation of Parameter Images Creating a Baseline Image Evaluation of Region of Interests Enhancement Curve 7 I HOU BW N Loading the Images Documentation of Results e General Hints 306 308 309 309 310 310 313 314 315 316 317 13 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 14 15 Scan and Reconstruction Concept of Scan Protocols
112. panded or curved ranges for VRT Thin Clip and output them either on a film or save them to the database 251 g syngo 3D Workflow for a CT Angiography Using MIP MIP Thin 1 Load the series to MIP 2 Manipulate the volume to evaluate anatomy a Orientate the image volume for the best view of the anatomy b To eliminate unwanted bone either activate MIP Thin or use VOI punching 3D Object Editor c Adjust the window as necessary d Pan and zoom image as necessary 3 Measure annotate and document as needed 4 Optionally create image series using radial ranges for MIP parallel expanded or curved ranges for MIP Thin and output them either on a film or save them to the database 252 syngo 3D Using VRT VRT Thin Clip 1 Load the series to VRT 2 Manipulate volume to evaluate anatomy a Orientate the image volume for the best view of the anatomy b To eliminate unwanted bone either activate VRT Thin Clip or use VOI punching 3D Object Editor c Select VRT preset from VRT gallery d Adjust window opacity color and lighting effects as necessary e Pan and zoom image as necessary 3 Measure annotate and document as needed 4 Optionally create image series using radial ranges for VRT parallel expanded or curved ranges for VRT Thin Clip and output them either on a film or save them to the database 253 syngo 3D Hints in General Setting Views in the Volume Data Set Three dimension
113. ppro priate icons The thickness of these reconstructed images can be defined by clicking on the icons with the right mouse to open the entry field 167 7 Vascular ThorAngio ThorAngio08s Indications Spiral study for location and extent of aneurysms dis section and ruptures of the thoriac aorta A range of 20 cm will be covered in 24 19 sec ThorAngio 2 reconstruction kV 130 Effective mAs 55 Rotation time 0 8 1 0 sec Slice collimation 2 5mm Slice width 5 0mm 3 0mm Feed Rotation 9 0mm Pitch Factor 1 8 Increment 5 0 mm 2 0mm Kernel B31s B31s CTDIvol 5 93 mGy Effective dose Male 1 91 mSv Female 2 67 mSv 168 Vascular Contrast medium IV injection Start delay 10 25 sec Flow rate 2 5 ml sec Total amount 80 ml Hints e CARE Bolus may be used to optimize the bolus tim ing Set the ROI for monitoring scan in the aortic arch with triggering threshold of 120 HU or use manual triggering High quality 2D amp 3D post processing can be achieved using a thin slice thickness and 50 over lap in image reconstruction Thick MPRs and ThinMIPs can be created very quickly on the 3D card by just clicking on the appropriate icons The thickness of these reconstructed images can be defined by clicking on the icons with the right mouse to open the entry field To display an SSD of the thoracic aorta without bone included editing is necessary 169 E Vascular Embolism Indications
114. ptimize the bolus tim ing 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 29 Thorax Lung images should be documented in both soft tis sue window and lung window It is also possible to interleave the soft tissue amp lung setting images in one film sheet This can be set up in the configuration for filming e To further optimize MPR image quality we recom mend that you reduce one or more of the following parameters collimation reconstruction increment and slice width for image reconstruction 100 Thorax Body Kernels e As standard kernels for body tissue studies B31s or B41s are recommended softer images are obtained with B20s e For higher sharpness as is required e g in patient protocols for cervical spine shoulder extremities thorax the kernels B50s B60s B7Os are available 101 J Thorax ThoraxRoutine ThoraxRoutineO8s Indications Routine spiral studies for the region of thorax e g examination of tumors metastases lymphoma lymph nodes vascular anomalies etc A range of 30 cm will be covered in 23 18 sec 102 Thorax ThorRoutine 2 reconstruction kV 130 Effective mAs 60 Rotation time 0 8 1 0 sec Slice 4 0mm collimation Slice width 5 0mm 5 0mm Feed Rotation 14 4 mm Pitch Factor 1 8 Increment 5 0 mm 5 0 mm Kernel B41s B7Os CTDIvol 6 47 mGy Effective dose Ma
115. r adapts the mA in real time according to the patient s attenuation profile 32 Dose Information Low attenuation low mA Example of scanning the shoulder region lateral Object attenuation Modulated tube current COTALO ATE BE ei rel units of A EL A vo ey A time Principle of CARE Dose tube current adaption e CARE Dose is pre selected by default for most stan dard protocols It can be switched on off in the Scan subtask card 33 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 manu ally 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 34 35 Workflow Information Recon Jobs In the Recon card you can define up to 3 reconstruc tion 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 ad
116. 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 mm For both ranges a typical gantry tilt of 20 is pre defined 74 Head kV Effective mAs Rotation time Slice collimation Slice width Feed Scan Kernel CTDIvol Effective dose BaseSeq 130 240 1 5 sec 1 5 mm 3 0 mm 3 0 mm H31s 54 65 mGy Male 0 77 mSv Female 0 80 mSv Contrast medium IV injection Start delay Flow rate Volume Hints 60 sec 2 ml sec 50 60 ml CerebrumSeq 130 240 1 5 sec 4 0mm 8 0mm 8 5mm H31s 51 43 mGy Male 1 52 mSv Female 1 68 mSv e An automatic bone correction allows for improved head image quality without any additional post pro cessing 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 75 Head InnerEarHR Indications Spiral mode for inner ear High Resolution studies e g inflammatory changes tumorous processes of pyra mids cerebellopontine angle tumors post traumatic changes etc A range of 2 5 cm will be covered in 22 sec InnerEar 2d reconstr kV 130 Effective mAs 70 Rotation time 1 5 sec Slice collimation 1 0 mm
117. rily oriented plane Density opacity and refraction information is used to generate views that optimally meet different clinical objectives Optimal display quality and differentiation of differ ent organs through independent control of color Opacity and shading in up to 4 tissue classes Predefined settings for many clinical objectives and anatomic regions are easily selected from an image gallery Pre settings can be linked to DICOM series descrip tion to automatically ensure standardized quality in clinical routine Clip planes can be used to easily scroll through the volume in VRT Thin mode Easy interaction with SmartSelect control right mouse button 241 syngo 3D Prerequisites At least 3 and maximum of 1600 images must have been loaded to process 3D with more than 1600 images the series will be split up All images must have the same x y coordinates and FoV e You should close any data sets that you no longer need in order to release memory space and maintain application performance e CT volume data sets are best acquired with overlap ping thin slice CT technique Workflow Loading the Images After loading the images into syngo 3D the following layout is displayed 242 syngo 3D Image Representation on the 3D Card The image area on the 3D card is divided into four seg ments Reference segment sagittal view Reference segment coronal view Reference segment transversal vi
118. s e Abdomen Abdomen_Baby Spiral mode for routine baby abdominal studies Abdomen_Child Spiral mode for routine children abdominal stud ies 185 Children e Spine Spine_Baby Spiral mode for routine baby spine studies Spine_Child Spiral mode for routine children spine studies e Extremities ExtrHR_Baby Spiral mode for routine baby high resolution extremity studies ExtrHR_Child Spiral mode for routine children high resolution extremity studies e Vascular HeadAngio HeadAngio08s Spiral mode for head CTAngio studies CarotidAngio CarotidAngioO8s Spiral mode for carotid CTAngio studies BodyAngio BodyAngio08s Spiral mode for body CTAngio studies e Specials NeonateBody Spiral mode for neonate studies 186 Children Hints in General _ Topograms 256 mm lateral topograms are defined for the head modes and 512 mm TOP topograms are defined for the body modes Please keep in mind that the children s size can be dramatically different You should press the Hold Measurement button whenever the range shown on the real time grow ing topogram is long enough in order to avoid unnecessary radiation 2 Gantry tilt is available for both sequence and spiral scanning However image artifacts may occur if spi rals are acquired with a tilt angle greater than 8 3 For all head studies it is very important for image quality purposes to position the patient in the center o
119. s In the Coronal Sagittal slice thickness area you can preset the slice thickness for sagittal and coronal images Select same as input images if you want to have the slice thickness of the input images applied 304 305 syngo Dynamic Evaluation Dynamic evaluation Is a function which allows you to analyze the absolute or relative enhancement of Houn sfield values within a Region of Interest The enhancement value is computed from a stack of CT images which are obtained at different points in time after contrast agent injection For dynamic evalu ation usually images from the same cross section of the body are taken such as a Multi scan through an unclear process in the liver The time to the maximum enhancement Time to Peak and the way a certain tissue or structure absorbs the contrast medium can be very helpful in differential diagnosis of a given process To do this the Dynamic Evaluation card provides you with the following methods e Evaluation on a separate syngo card on the user interface Selection dialog for slice positions to be evaluated in Multi slice studies e Volume data sets can be evaluated also e g for measurement of contrast enhancement in a vessel during spiral acquisition and further optimization of contrast injection procedure for follow up studies e Dynamic evaluation of 5 different regions circular and irregular and a pixel lens are possible in parallel ROI definition and pixel
120. sec Flow rate 3 5 ml sec Total amount 75 ml Hints e Use of CARE Bolus with monitoring scans positioned at the level of the basilar artery or carotid artery Set the trigger threshold at 120 HU or use manual trig gering e An automatic bone correction and an advanced algo rithm allow for improved head image quality with out any additional post processing 165 7 Vascular CarotidAngio CarotidAngio08s Indications Noninvasive CT angiography of carotid stenosis or occlusions plaques course abnormalities of the carotids and vertebral arteries etc A range of 12 cm will be covered in 32 26 sec kV Effective mAs Rotation time Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTDIvol Effective dose 166 CarotidAngio 2 reconstruction 130 55 0 8 1 0 sec 1 0 mm 5 0 mm 1 25 mm 4 0 mm 2 0 5 0 mm B31s 5 93 mGy Male 1 15 mSv Female 1 25 mSv 0 8 mm B31s Vascular Contrast medium IV injection Start delay 15 sec Flow rate 4 ml sec Total amount 90 ml Hints e CARE Bolus may be used to optimize the bolus tim ing Set the ROI for monitoring scan in the aortic arch with triggering threshold of 120 HU or use manual triggering High quality 2D amp 3D post processing can be achieved using a thin slice thickness and 50 over lap in image reconstruction MPR Thick and MIP Thin images can be created very quickly on the 3D card by just clicking on the a
121. simulta neous display of the relative enhancement of the tar get 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 auto matically and you can start the spiral when you desire 49 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 con text 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
122. sing lung window setting Soft tissue bone window set tings may be used to visualize the presence of calci fications in the nodules It is essential to use the same protocol for follow up Studies to check for progression 109 E Abdomen Ea ie En Cl ro yi Mes Overview AbdomenRoutine AbdomenRoutine08s Spiral mode for routine abdominal studies AbdomenFast Spiral mode for fast abdominal studies AbdMultiPhase AbdMultiPhaseO8s Spiral mode for three phase liver studies AbdomenSeq Sequential mode for abdominal studies 110 Abdomen Hints in General e Topogram TOP 512 e Patient positioning Patient lying in supine position arms positioned comfortably above the head in the head arm rest lower legs supported e Patient respiratory instruction Inspiration e Oral administration of contrast medium For abdominal studies it is necessary to delineate the bowel from other structures such as lymph nodes abdominal masses amp abscesses Various types of bowel opacifying agents can be used Diluted barium suspension 1 2 e g EZCAT Water soluble agent 2 4 e g Gastrografin Water alone as a negative contrast agent Timing of the oral contrast administration is impor tant to ensure its even distribution in the bowel Upper abdomen Minimum 600 ml of contrast divided into 3 cups approximately 200 250 ml 1stcup to drink 30 minutes before exa
123. sition This will prevent the contrast from pooling posterior to the spinal cord If a prone scan Is performed breathing instructions are recommended to avoid motion artifact in axial source and MPR images e To further optimize MPR image quality we recom mend that you reduce one or more of the following parameters collimation reconstruction increment and slice width for image reconstruction 134 Spine Body Kernels e As standard kernels for body tissue studies B31s or B41s are recommended softer images are obtained with B20s e For higher sharpness as is required e g in patient protocols for cervical spine shoulder extremities thorax lung the kernels B50s B60s B7Os are avail able 135 g Spine C Spine Indications Spiral mode for cervical spine studies e g prolapse degenerative changes trauma tumors etc A range of 15 cm will be covered in 52 sec 136 Spine kV Effective mAs Rotation time Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTDIvol Effective dose C Spine 130 90 1 0 sec 1 5 mm 3 0 mm 3 0 mm 1 0 3 0 mm B50s 9 70 mGy Male 2 02 mSv Female 2 07 mSv 2 4 reconstr 2 0mm 1 5 mm B50s 137 g Spine C SpineSeq Indications Sequential mode for cervical spine studies e g pro lapse degenerative changes trauma tumors etc with a typical length for each range of 1 2 cm This protocol contains five
124. ss Start Evaluation Check the correct positioning of the ROIs in the Calibra tion phantom You can change the position by moving the two circles Water Bone eguivalent equivalent Correcting contour lines You can perform correction of the contours by moving the base points The following order is recommended 282 syngo Osteo CT 1 Center of the spinal canal C 2 Uppermost point of the cortical spinal body A 3 Intermediate point L 4 Intermediate point R 5 Uppermost point of the spinal canal T Click on a base point with the mouse Move it keeping the left mouse key pressed If you are satisfied with the contours press Accept Contours otherwise skip the image If the contours for all images are accepted or skipped the results are automatically displayed The skipped images are not taken into account The third segment contains two summary images Displayed results include bone mineral density mg CaHA ml and standard deviation The results are listed in a table the evaluated vertebra if the comment Is correctly inserted e g L1 the scan number of the image the trabecular bone mineral density for each verte bra and the pixel standard deviation in brackets the cortical bone mineral density for each vertebra and the pixel standard deviation in brackets additionally the average and standard deviation over all evaluated vertebrae are listed 283 syngo Osteo CT The
125. sus 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 Please change the mAs value according to the age of the child 3 6 years 100 mAs 203 E Children Neck Indications Spiral mode for routine neck studies e g tumors lym phoma abscesses etc A range of 15 cm will be covered in 19 sec Neck kV 130 Effective mAs 26 Rotation time 1 0 sec Slice collimation 2 5 mm Slice width 5 0 mm Feed Rotation 9 0 mm Pitch Factor 1 8 Increment 5 0 mm Kernel B50s CTDIvol 2 80 mGy Effective dose Male 2 40 mSv Female 2 52 mSv The conversion factor for a 7 year old child and a scan range of 150 mm was used Contrast medium IV injection Start delay exam dependent Flow rate dependent upon needle size Access site Totalamount 1 2 ml per kg of body weight 204 Children Hints e If necessary scan down to the aortic arch or medi astinum to include the entire lesion e Cooperative children can be instructed to hold their breath during the acquisition e Children who are more than 6 years old should be scanned with an adult protocol e Please change the mAs value according to the age of the child 3 6 years 39 mAs 205 g Children ThoraxRoutine_Ba
126. syngo Basics Training Is pre installed on your system and can directly be used by selecting SOMA TOM Educate The syngo Advanced Application Train ing 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 vis ible after being opened e Minimize or move the Browser window of the SOMA TOM life platform Sel EPA Fae s J E Ea Under the navigation path World you can also start your manual CD ROM 5 E 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 l HEMERY 58 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
127. te 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 52 53 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 i ae _ ars i T a o Sa TT p i a E i Fa dbag RESEDA PIPE E rem med e em atp Wimmie be WERA OH e m goa mari ATO eg oo hipe Caer L re ee nhk oml ba i bhid ee mmi mF O WH UE E ri p gee e pi e i ep ed k O beper m eF pep ph r y p Fha Chn mha Bb ipai p bki m p b ad ilh re a Tu pe m ppp ppi Dihi miarana i bej p ep 8 ye arn i nea deed per Coy per ee be ee Pa T Ha ie daibb la Skinned ym eal eed Led jp aie
128. tem then generates a volume considering all voxels that are found with region growing and which CT value lies within the Evaluation Limits e Check and adapt the Thresholds if necessary e Set a seed point e To enlarge the volume set additional seed points e To only include a specific range of HU values into the volume change the Evaluation Limits By default the Evaluation Limits are identical to the Threshold e To start the evaluation click the Start Evaluation but ton The evaluation results are displayed in segment 4 The volume is colored on all images in all views e You can define a new volume You can correct the Evaluation Limits and restart the evaluation If the result is not satisfactory you can delete the volume 293 syngo Volume Evaluation Restricting Automatic Volume Detection You can restrict Automatic Volume Detection to a defined smaller volume e Draw an ROI around the image area of interest on at least the first and the last image that you want to be included in the volume The ROls define the bound ing box for the automatic approach e Check the Thresholds and set the seed point inside the object to be detected e Region growing only includes voxels that fulfill the following conditions Their HU value lies within the thresholds They are connected to the seed point They lie inside the bounding box 3 2 Planning a Volume with the Interactive Volume Definition For struc
129. teo CT 132 Spine Hints in General e Topogram Lateral 512 mm for thoracic and lumbar spine and 256 mm for the C spine e Patient positioning for thoracic and lumbar spine Studies Patient lying in supine position arms positioned comfortably above the head in the head arm rest lower legs supported e Patient positioning for cervical spine studies Patient lying in supine position hyperextend neck slightly secure head well in head holder Patient respiratory instruction do not breathe do not swallow Any possible injuries to the spinal column should be determined before beginning the examination and taken into account when repositioning the patient Hints e In case of 3D study only images should be recon structed with at least 50 overlap in image recon struction and kernel B20s In case of SSD study only mAs value can be reduced by 50 Use kernel B20s and 50 overlap in image reconstruction e For lumbar studies place a cushion under the patient s knees This will reduce the curve in the spine and also make the patient more comfortable e For image reconstruction of bone studies use kernel B6O 133 Spine e The CT scan following myelography must be per formed within 4 6 hours of the injection other wise the contrast density in the spinal canal will be too high to obtain artifact free images Also if possi ble it is a good Idea to roll the patient once or scan in a prone po
130. tered range of HU values stops region growing Check the depth of the volume in the coronal and Sagittal view To complete region growing inside the entire volume set multiple seed points if necessary You can edit the thresholds even after the volume has been evaluated You can modify or delete the last evaluated volume 302 syngo Volume Evaluation Configuration Shoe Sasha Parameters Volume Wass height ern hae Vein err Wia cept em hean Value HU Stendand daiaion PH Threshates HU Evaluation mes HL Coronal Sagita sice thickness imp Ge INOUE Tas user 300 mm In the Volume Configuration dialog box you define which evaluation results are given by Volume Evalua tion Unit of Volume mm Volume is given in mm3 cm Volume is given in cm 303 E syngo Volume Evaluation Statistical Parameters Volume Volume is calculated in the defined unit mm or cm Max height cm Maximum height of the recon structed volume Max width cm Maximum width of the recon structed volume Max depth cm Maximum depth of the recon structed volume Mean value HU Mean CT value of the volume in HU Standard deviation HU Pixel standard deviation Thresholds HU Range of CT values that have been considered for automatic volume detection in HU Evaluation limits HU Range of CT values that have been considered for volume calculation in HU Coronal Sagittal slice thicknes
131. th Feed Rotation Pitch Factor Increment Kernel CTDIvol Effective dose BodyAngio 2 reconstr 80 41 1 0 sec 7 5mm 3 0mm 2 0mm 6 0 mm 2 0 3 0mm B41s 1 13 mGy Male 0 73 mSv Female 0 84 mSv 1 5 mm B41s The conversion factor for a 7 year old child and a scan range of 100 mm was used Contrast medium IV injection Start delay Flow rate Total amount 234 exam dependent dependent upon needle size Access site 1 2 ml per kg of body weight Children Hints Please change the mAs value according to the weight of the child 35 44 kg 45 mAs 45 54 kg 60 mAs Children with a body weight of more than 55 kg should be examined with an adult protocol CARE Bolus may be used to optimize the bolus tim ing Set the ROI for the monitoring scan in the abdominal aorta with triggering threshold of 120 HU or use manual triggering 235 Children BodyAngio08s Indications Spiral mode for abdominal CT Angio studies e g vas cular abnormalities aneurysms etc A range of 10 cm will be covered in 15 sec BodyAngio 2 reconstr kV 80 Effective mAs 35 Rotation time 0 8 sec Slice 1 5mm collimation Slice width 3 0mm 2 0mm Feed Rotation 6 0mm Pitch Factor 2 0 Increment 3 0mm 1 5 mm Kernel B41s B41s CTDIvol 0 96 mGy Effective dose Male 0 62 mSv Female 0 72 mSv The conversion factor for a 7 year old child and a scan range of 100 mm was used 236 Children
132. the images in 3D The following standard layout is displayed Segment 1 Sagittal view Segment 2 Coronal view Segment 3 Transversal view Segment 4 Fly segment with perspective SSD as default h me Scroll through the MPR images until you reach an image where you would like to start the CT endoscopic evaluation 263 syngo Fly Through Position the Reference lines at that point of interest e g in the trachea Click the Fly Through icon to activate the endoscopic display in the fourth segment The default endoscopic display has the same orienta tion viewing direction as the last selected image seg ment in which you placed the point of interest and invoked the syngo Fly Through option Change the endoscopic display by adjusting the SSD threshold or change to VRT display Link the new settings to data set for future evaluation Define the Cone settings endoscopic viewing parame ters and link the cone settings to data set for future application Start the endoscopic navigation by using e Manual method e Auto navigation e Path creation Create flight path through the data set and save the path for future playback Click the Save Image button before navigating the endoscopic projection along the path A series of endoscopic snapshots will be created and saved automatically on the database These images can be documented on hardcopy or loaded to Viewer for cine display of the endoscopic movie
133. the same gantry tilt Only image data sets with the same slice orientation must be used the selection should not include a topogram image The loaded images must have the same zoom factor and the same reconstruction center At least four images must be loaded before volume evaluation can be performed The time range between the first and the last image must not exceed one hour The data capacity of the volume must not exceed 1024 images with matrix dimensions of 512 x 512 pixels 290 syngo Volume Evaluation K Workflow 1 Loading the Images After loading the images into syngo Volume Evalua tion the following layout is displayed e i Hi e Segment 1 Display of sagittal images The images are sorted from left to right according to the patient s anatomy e Segment 2 Display of coronal images The images are sorted from front to back according to the patient s anatomy e Segment 3 Display of transversal images The images are sorted from head to feet according to the patient s anatomy e Segment 4 Display of either the evaluation results or thick slice images MaxIP MinIP or MPR images that correspond to the transversal images in segment 3 291 syngo Volume Evaluation 2 Preparing Volume Calculation Before you start the volume definition first optimize the display of the images To make interactive volume definition easier you can e delete images that you do not require for volume cal cu
134. tient s anatomical ante rior to posterior orientation e Mean HU Mean CT value of the volume in HU e SD Standard deviation from the Mean value HU L Threshold HU Lower threshold considered for automatic volume detection U Threshold HU Upper threshold considered for automatic volume detection e L Eval Limit HU Lower evaluation limit considered for volume calculation e U Eval Limit HU Upper evaluation limit considered for volume calculation 299 syngo Volume Evaluation 5 Documentation of Results If all volumes are evaluated you can save and film the results Save stores to your local database e The transversal images with the color coded VOI e The reformatted images sagittal coronal MPR MIP e The displayed result sheet Two new series are created e The VolumeResult series which consists of the 4 images and the result sheet that are currently dis played e The VolumeAxial series which is a copy of the loaded transversal images and also includes the color coded ROls General Hints e Loading Images After all images are loaded your system checks whether the sorted images have an equally spaced ascending or descending timestamp If that is not the case a warning box is displayed but loading is contin ued If the distance between slices and the slice thickness of the loaded images are not identical a warning box is also displayed 300 syngo Volume Evaluation i
135. ting depth Morphological Operations In some cases it will not be simple to separate the structures of an object using the cutting tools Here we recommend eroding or shrinking the areas of the object by a specified surface thickness until the obscuring structures are no longer contained in the object You can subsequently dilate or blow up the remaining object areas by a defined surface thickness As a result the irrelevant areas contained at the outset are now removed from the representation If you perform the same operations in reverse order Small cavities in the object will be filled Documentation of Results The buttons Copy to Film sheet and Save Save As are always available You can always document intermedi ate results by using these buttons To save images you have following possibilities e Storing the new series automatically during recon struction e The Save button will store the image series with no further check e The Save as button will give you the ability to choose a name for the new the image series before storing 249 g syngo 3D Workflow for a CT Extremity Examination Using MPR MPR Thick 1 Load the series to MPR 2 Manipulate the volume to evaluate anatomy UJ D a Orientate the image volume for the best view of the anatomy b Adjust the window as necessary c Pan and zoom image as necessary Scroll through the volume quickly using the 3D cross hair or dog ears to
136. 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 recom mend that you reduce one or more of the following parameters collimation reconstruction increment and slice width for image reconstruction Body Kernels e As standard kernels for body tissue studies B31s or B41s are recommended softer images are obtained with B20s e For higher sharpness as is required e g in patient protocols for cervical spine shoulder extremities thorax lung the kernels B50s B60s B7Os are avail able 95 Shoulder Shoulder Indications Spiral mode for bone studies and soft tissue e g eval uation of joint cavities masses trauma dislocations orthopedic indications etc A scan range of 10 cm will be covered in 35 sec 96 Shoulder Shoulder 2 4 reconstruction kV 130 Effective mAs 70 Rotation time 1 0 sec Slice 1 5 mm 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 7 55 mGy Effective dose Male 0 94 mSv Female 1 13 mSv Hints e Use raw data to review a target region if necessary e For image reconstruction of soft tissue use kernel B31s and a slice width of 5 0 mm e Coronal and sagittal 2D planar reconstructions are important for evaluation of the joint space amp bursa sacs in CT arthograms e 3D renderings are he
137. tra high res H80s e 3 child head kernels smooth C20s medium C30s sharp C60s e 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 24 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 e Similar to reconstruction with a smoother kernel e Reduces noise e Enhances low contrast detectability e Adjustable in four steps e Automatic post processing 25 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 e Increases sharpness e Faster than raw data reconstruction e Enhances high contrast detectability e Automatic post processing ASA The Advanced Smoothing Algorithm ASA fil ter reduces noise in soft tissue while edges with high contrast are preserved e Reduces noise without blurring of edges e Enhances low contrast detectability e Individually adaptable e Automatic post processing 26 Scan and Reconstruction Improved Head Imaging An automatic bone correction algorithm has been included in the standard image re
138. trast The length of the CM spiral in the topogram via the table position can be planned exactly by means of pre contrast images Precontrast images are used to visualize calcifica tion Excellent post processed images can be created using a thin slice thickness and overlapping images i e the increment should be smaller than the slice thickness 175 Specials Overview The examination protocols designed for some of these applications are under the Special folder Trauma In any trauma situation time means life and the qual ity of life for the survivor In order to facilitate the examinations two protocols are provided PolyTrauma This is a combined mode for the exam ination of multiple ranges e g Head Neck Thorax Abdomen and Pelvis HeadTrauma Spiral head protocol with a FoV of 500 and therefore lowered image quality Interventional CT Biopsy The biopsy protocol is sequential mode with out table feed using a 10 mm Slice thickness Test Bolus TestBolus This mode can be used to test the start delay of an optimal enhancement after the contrast medium injection 176 Specials Trauma In any trauma situation time means life and the qual ity of life for the survivor This is a combined mode for the examination of multi ple ranges e g Head Neck Thorax Abdomen and Pelvis The Basics e Check that the emergency drug trolley is well stocked and that all
139. tures that are not so well defined it is recom mended to use the Interactive Volume Definition method You can precisely adapt the ROIs to complex body structures You can draw either elliptical or freehand ROls on the transversal images or on the thick slice images for fast navigation 294 syngo Volume Evaluation The contours of the ROIs define the outer border of the evaluated volume You do not need to define the ROls on every slice The system automatically interpolates ROIs on the images which lie between the images with defined ROls Check the images and search for the desired object Structure You can start on any image in segments 3 or 4 We recommend displaying an image that shows the center of the desired structure Draw an ROI around the area that is to be considered to be part of the object structure Do the same on another image for example the first or last image that shows the structure The system automatically inserts ROIs on the inter mediate images These ROIs are drawn with a dotted line to indicate that they are assumed for the evalua tion of the volume but that they are not confirmed by you The contour of a user defined ROI is a solid line All ROIs have the same color and number Scroll through the images and modify if necessary the interpolated ROls to the true structure of the desired volume You can edit an interpolated ROI or replace it with a new ROI To extend the volume insert an ROI b
140. with the two previous ROIs This way you can easily define a VOI around tortuous body structures e Mark amp link method If two ROIs do not have a common projection point you can link them manually for interpolation You can link non overlapping ROIs to one volume First you mark one ROI and then you link a second ROI to it The system connects the ROIs and inserts interpolated ROIs on the intermediate images 298 syngo Volume Evaluation 4 Evaluation Results When you click the Start Evaluation button the system calculates the planned volume within the evaluation limits The evaluation results are displayed in segment 4 Only the statistic parameters that are set in the configura tion dialog box are calculated Volume pixels and eval uation results are the same color The evaluation results and the thick slice images are both displayed in segment 4 To switch the display click the MIP Result icon The evaluation results include general patient informa tion date and time of the evaluation and for each vol ume the configured statistic parameters Volume cm3 mm3 Size of the volume Height cm mm Maximum height of the volume in cm corresponding to the patient s anatomical feet to head orientation Width cm mm Maximum width of the volume in cm corresponding to the patient s anatomical left to right orientation e Depth cm mm Maximum depth of the volume in cm corresponding to the pa
141. y be required Usu ally a diluted mixture of iodine and water is used as an oral agent Different substances can be added to this mixture to help reduce the bitter taste and make it more pleasing to the child apple juice and fruit drink mixes are just a few of these Barium may of course be used in some cases as well Negative con trast agents such as water are becoming more pop ular for delineation of stomach or bowel wall bor ders or when 3D reconstructions are needed The user needs to be aware of all the contraindications of any of the contrast agents they are using Please refer to the specific vendor s recommendations 7 1 V contrast administration In general 1 2 ml per kg of body weight should be applied however since the scanning can be completed in just a few sec onds please keep in mind that the total injection time should not be longer than the sum of start delay time and the scan time do not inject contrast after the scanning Is finished 188 Children It is recommended to use CARE Bolus in order to achieve optimal contrast enhancement Both start delay time and injection rate are exam patient dependent Whenever possible I V injection with a power injector is recommended for all scans Some guidelines to follow with respect to flow rate are noted in the chart below Note these injector guidelines are based on an antecu bital injection site These guidelines may need to be adjusted if the site
142. ypes To highlight certain aspects of the ana tomical region you can change the color brightness and transparency of different areas As display parameters for the VRT view customary default settings are stored on your system in the VRT gallery 255 syngo 3D If the default settings are not appropriate for your diag nostic problem you can alter them individually In that way you can emphasize the structures of interest in an optimum way Ramp and trapezoid manipulation Ramps and trap ezoids are functions which define window and ren dering settings Trapezoids can also be used to differ entiate a tissue classification range e g bone versus soft tissue in a CT image Change rendering settings using the table classifier trapezoids Moving the ramp changes the window width and center Opacity and brightness can be adjusted to optimize organ specific settings Lighting to enhance 3D The mouse cursor is used to define the direction of incident light VRT presets can be stored in the VRT gallery and linked to specific series description 256 syngo 3D Auto Load in 3D and Post processing Presets You can activate the Auto load in 3D function on the Examination card Auto Tasking and link it to a recon job On the 3D card you have the possibility to create Ranges Parallel and Radial protocols which can be linked to a special series name Select the image type Select the orientatio

Siemens 2005C User's Manual

Contents

Download Pdf Manuals

Related Search

Related Contents