Siemens A60 manuel d'utilisation

SOMA T OM Sensation Cardiac Application Guide Software V ersion A60[...]

2 The inf ormation pr esented in this application guide is f or illustration only and is not intended to be relied upon by the reader for instruction as to t he practice of medicine. Any health car e practitioner reading this information is reminded that they must use their own learning, training and e xper tise in dealing with their individual pat[...]

3 3 Ov er view General 8 HeartV iew CT 22 Bolus T racking 54 WholeBodyAngio 62 LungC ARE 64 CT Colonograph y 66 Children 68 Head 88 Neck 98 Thorax 102 Abdomen 112 Extremities 124[...]

4 Content General 8 · Concept 8 · Scan Set Up 8 · Scan and Reconstruction 9 – Slice Collimation and Slice Width 9 – Pitch 10 – Recon Job 11 – K ernels 11 – Image Filter 11 · Effective mAs 12 · Dose Information 13 · CARE Dose 16 · How does it work 16 · W orkflow 18 · Contrast Medium IV Injection 19 · How to Creat e y our own Scan[...]

5 Content HeartV iew CT 22 · The Basics 22 – Impor tant Anatomical S tructur es of the Hear t 22 – Cardiac Cycle and ECG 25 – T emporal Resolution 25 – T echnical Principles 26 – Pr eview Series Reconstruction 27 – ECG T race Edit or 28 – ECG Pulsing 28 – CardioCARE 29 – CardioSharp 29 · How to do it 30 – Calcium Scoring 30 ?[...]

6 Content Bolus T racking 54 · The Basics 54 · How to do it 56 · C ARE Bolus 56 – General Hints 56 · T est Bolus 58 – Application Procedures 59 · Additional Impor tant Information 60 WholeBodyAngio 62 LungC ARE 64 CT Colonograph y 66 Children 68 · Hints in General 69 · HeadSpi05s 72 · HeadSeq0.5s 74 · HeadAngio 76 · Car otidCT A 78 ·[...]

7 Content Thorax 102 · Overview 102 · Hints in General 103 · LungLowDose 104 · PulmonaryEmboli 106 · ThoraxCombi 108 · ThoraxRoutine 110 Abdomen 112 · Overview 112 · Hints in General 113 · AbdRoutine 116 · AngioF ast 118 · AngioRoutine 120 · AbdomenSeq 122 Extremities 124 · Overview 124 · Hints in General 125 · AngioRunOff 126[...]

8 General Concept The scan protocols for adult are defined according to body r egions – Head, Neck,Thorax, Abdomen, Extremities. The pediatric scan pr ot ocols ar e defined under the folder “Children” . The pr ot ocols f or special applications are defined under “Special” . The general concept is as follows: “ Fa s t ” : uses 1.5 mm s[...]

9 General Scan and Reconstruction Slice Collimation and Slice Width Slice collimation is the slice thickness collimated by the tube collimator , which determines the Z-coverage per r otation. In Multislice CT , this is divided by the number of active det ector channels (e. g. 16 x 0.75 mm). Slice width is the true thickness of the r econstructed im[...]

10 General The f ollowing tables show you the pos sibilities of image reconstruction in spiral and sequential scanning. Slice Collimation and Slice Width for Spiral Mode 0.75 mm 0.75, 1, 1.5, 2, 3, 4, 5, 6, 7, 8, 10 mm 1.5 mm 2, 3, 4, 5, 6, 7, 8, 10 mm Cardio Spiral Modes 0.75 mm 0.75, 1.0, 1.5, 2,3 mm 1.5 mm 2, 3, 4, 5 mm Slice Collimation and Sli[...]

11 General Recon Job In the Recon car d, y ou can define up to 3 reconstruc- tion jobs with differ ent parame ters either bef ore or after you acquire the data. When you click on “Recon”, they will all be done automatically . In case you want to add ano ther r econ job, simply click the little icon on the chr onicle with the right mouse button [...]

12 General Ef fectiv e mAs In sequential scanning, the dose (D seq ) applied to the patient is the pr oduct of the tube current-time (mAs) and the CTDI w per mAs: D seq = D CTDI w x mAs In spiral scanning, ho wev er , the applied dose (D spiral ) is influenced by the mAs (mA x Ro t Time) and in addi- tion by the Pitch F actor . F or example, if a M[...]

13 General Dose Inf ormation The dose as described by CTDI w is displayed on the user int er face f or the selected scan parame ters. The CTDI w is measur ed in the dedicated plastic phantoms – 16 cm diameter f or head and 32 cm diame ter for body (as defined in IEC 60601-2-44). This dose number gives a good estimate f or the average dose applied[...]

14 General Fig. 1: User inter face of the PC program WinDose. All parameters necessary for the effective dose calcu- lation have t o be specified. * * The Calculation of Dose fr om External Photon Expo- sures Using Refer ence Human Phantoms and Monte Carlo Methods. M. Zankl e t al. GSF repor t 30/91 ** Radiation Exposure in Computed T opograph y , [...]

15 General Fig. 2: A graphic interface of WinDose allows to specify the anatomical scan range. Fig.3: R esults as output of WinDose with the or gan dose readings and the effective dose according to ICRP26 (previous version) and ICRP60 (curr ently valid). Please no te: Effective dose values were calculated with the WinDose™ Software V ersion 2.1, [...]

16 General Fig. 1: Ex ample of scanning in the region of shoulder . C ARE Dose C ARE Dose is a clinical application pack age that pro- vides r eal-time tube curr ent modulation for Spiral and Sequential Scanning. C ARE Dose reduces patient dose significantly , espe- cially in the r egions of shoulder and pelvis. It decreases tube load, which extend[...]

17 General Fig. 2: Principle of C ARE Dose tube current adaptation. • CARE Dose is pre-selected b y default for all st andard pro tocols, ex cept head and cardiac pro tocols. It can be switched on/of f in the scan card. • The application of CARE Dose does no t r equire any changes in the scan paramet ers. The mean value of the mAs applied will [...]

18 General W orkflow Auto Load in 3D and P ostprocessing Presets Y ou can activate the “Auto load in 3D” function on the Examination Card/A uto T asking and link it t o a recon job. For ex ample, the 2 nd r econ job with thinner slice width in some of the e xamination pro tocols. If the post- proces sing type is chosen from the pull down menu, [...]

19 General Some of the Scan pr ot ocols, mainly for Angio ex ami- nations, ar e already delivered with Auto load in 3D. If y ou do no t lik e, please deselect the Aut o load in 3D and sa ve y our scan protocol. Some of the Scan prot ocols are delivered with links to a postpr ocessing prot ocol. If you do no t lik e our suggestions, please delete th[...]

20 General How to Cr eate your own Scan Pr ot ocols User -specific scan pr ot ocols can be sa ved with the follo wing basic pr ocedure: – Register a t est patient, patient position must be head-supine. – Select a scan pro tocol. – Set the table position to 0 (either at the gantr y panel, or on the t opogram routine card). – Modify the scan [...]

21 General Tips : – It is recommended that you sav e your own scan pro tocol with a new name in or der t o a void o ver - writing the default scan prot ocol. – Y ou ma y use preceding numbers (e. g. 1_Abdomen) for user specific scan protocols to mak e them appear on t op of the list and to distinguish them fr om the Siemens defaults. – Do no [...]

22 Hear tV iew CT Hear tV iew CT HeartV iew CT is a clinical application package specifically tailored to cardio vascular CT studies. The Basics Important Anat omical S tructures of the Hear t Four c hambers: • Right atrium – receiv es the deoxygenated blood back fr om the body cir culation thr ough the superior and inf erior vena cava, and pum[...]

23 Hear tV iew CT Fig. 1: Blood fills both atria Fig. 2: Atria contr act, blood enters ventricles A: Aorta P: Pulmonary Arter y RV: Right Ventricle L V: Left V entricle RA: Right Atrium L A: Left A trium Fig. 3: V entricles contract, blood enters int o aorta and pulmonar y arteries RA LA A P RV LV[...]

24 Hear tV iew CT Coronary ar teries: • Right coronar y arter y (RCA) Right cor onar y arter y supplies blood to the right atrium, right ventricle, a small par t of the v entricular septum. • Left cor onar y arter y (L C A) Left coronary artery supplies blood t o the lef t atrium, left ventricle and a large part of the v entricular septum. SVC:[...]

25 Hear tV iew CT Cardiac Cy cle and ECG The heart contracts when pumping blood and rests when r eceiving blood. This activity and lack of activity form a cardiac cy cle, which can be illustrat ed by an Electrocar diograph (ECG) (Fig. 8). T o minimize motion artifacts in car diac images, the follo wing two requirements are mandatory for a CT system[...]

26 Hear tV iew CT T echnical Principles Basically , there are two different technical appr oaches for cardiac CT acq uisition: • Pr ospectively ECG triggered sequential scanning. • Re trospectively ECG gated spiral scanning. In bo th cases, an ECG is recor ded and used to either initiate prospective image acquisition (ECG triggering), or t o pe[...]

27 Hear tV iew CT Absolute – delay: a fix ed time dela y after the onset of the R-wa ve (F ig. 1 1). Absolute – re verse : a fixed time delay prior t o the onset of the next R-wave (Fig. 12). Previe w Series Reconstruction Previe w series can be used t o define the optimal time window bef ore the full series is r econstructed. Click on the prev[...]

28 Hear tV iew CT ECG T race Editor The ECG trace edit or is used for adaptation of image reconstruction to irregular hear t rates. This editing tool can be used after the scan is acquired. By using the right mouse menu on the T rigger card you can use several modification tools for the ECG Sync, such as Delet e, Disable, Insert. T o rese t the ECG[...]

29 Hear tV iew CT Fig. 14 CardioC ARE This is a dedicat ed car diac filter which can r educe image noise thus pr ovides the possibility of dose reduc- tion. It is applied in a pr e-defined scan pr ot ocol called “CoronaryC ARE.” CardioSharp This is a dedicat ed r econstruction k ernel used for bett er edge definition in coronary ar tery imaging[...]

30 Hear tV iew CT How to do it Calcium Scoring This application is used for identification and quanti- fication of calcified lesions in the cor onar y arteries. It can be per formed with both ECG triggering (sequen- tial scanning) and g ating (spiral scanning) t echniques. The f ollowing scan prot ocols are predefined: • CaScoreSpiS td – Standa[...]

31 Hear tV iew CT Placement of ECG Electrodes: US V ersion (AHA standard) White Electrode on the right mid-cla vicular line, directly below the clavicle Black Electrode: on the lef t mid-clavicular line, 6 or 7 intercostal space Red Electrode: right mid-cla vicular line, 6 or 7 inter costal space Placement of ECG Electrodes: Europe Version (IEC sta[...]

32 Hear tV iew CT CaScoreSpiS td Indications: This is a standar d spiral scanning pr ot ocol, using an ECG gating techniq ue f or coronary calcium scoring studies, with a r otation time of 0.42 seconds. T opogr am: AP , 512 mm. Fr om the carina until the apex of the hear t. A typical range of 15 cm covering the entire hear t can be done in 11.6 s. [...]

33 Hear tV iew CT * Depends on heart rate. CaScoreSpiS td0.5s Indications: This is a spiral scanning pro tocol, using an ECG gating techniq ue f or coronary calcium scoring studies, with a r otation time of 0.5 seconds. T opogr am: AP , 512 mm. Fr om the carina until the apex of the hear t. A typical range of 15 cm covering the entire hear t can be[...]

34 Hear tV iew CT CaScoreSeqS td Indications: This is a seq uential scanning protocol using an ECG triggering t echnique f or cor onar y calcium scoring studies. T opogr am: AP , 512 mm. Fr om the carina until the apex of the hear t. CaScoreSeqStd kV 120 Effective mAs 30 Slice collimation 1.5 mm Slice width 3 mm Feed/Rotation 18 mm Rotation time 0.[...]

35 Hear tV iew CT Coronar y CT A This is an application for imaging of the cor onar y arteries with contrast medium. It can be per formed with bo th ECG triggering and gating techniq ues. The follo wing scan pr ot ocols ar e predefined: • CoronaryStd – Standard spiral scanning pro tocol with ECG gating, using a rotation time of 0.42 seconds. ?[...]

36 Hear tV iew CT General Hints: • Generally speaking, the ECG g ated protocol is recom- mended f or premium image quality of the coronar y arteries, and whene ver 3D postprocessing, such as MPR, MIP , VRT or Fly Through, is r equired. • Alwa ys use the ECG gated prot ocol f or patients with arrhythmia.[...]

37 Hear tV iew CT Cor onar yS td Indications: This is a standar d spiral scanning pr ot ocol, using a Rotation Time of 0.42 s, with an ECG gating t echnique for coronar y CT A studies. T opogr am: AP , 512 mm. Appro ximately , from the carina until the apex of the heart. A typical range of 12 cm covering the entire hear t can be done in 18.7 s. Cor[...]

38 Hear tV iew CT Cor onar yS td0.5s Indications: This is a standar d spiral scanning pr ot ocol, using a Rotation Time of 0.5 s, with an ECG gating t echnique for coronar y CT A studies. T opogr am: AP , 512 mm. Appro ximately , from the carina until the apex of the heart. A typical range of 12 cm covering the entire hear t can be done in 18.4 s. [...]

39 Hear tV iew CT CorS td_LowHeartRate Indications: This is a special spiral scanning pr ot ocol f or coronary CT A studies. It uses ECG gating t echnique and a 0.42 s ro tation time, and should be used f or patients with heart rat e below 50 bpm. T opogr am: AP , 512 mm. Appro ximately , from the carina until the apex of the heart. A typical range[...]

40 Hear tV iew CT Cor onar yC ARE Indications: This is a spiral scanning pro tocol, using a rotation time of 0.42 s, ECG gating t echnique and a dedicated cardiac filter which can reduce images noise t hus makes the dose r eduction possible for cor onar y CT A studies. T opogr am: AP , 512 mm. Appro ximately , from the carina until the apex of the [...]

41 Hear tV iew CT Cor onar yC ARE0.5s Indications: This is a spiral scanning pro tocol, using a Rotation Time of 0.5 s, ECG gating technique and a dedicated cardiac filter which can reduce images noise t hus makes the dose r eduction possible for cor onar y CT A studies. T opogr am: AP , 512 mm. Appro ximately , from the carina until the apex of th[...]

42 Hear tV iew CT Cor onar ySharp Indications: This is a spiral scanning pro tocol, using a Rotation Time of 0.42 s, ECG gating technique and a dedicated cardiac reconstruction k ernel f or bett er edge defi- nition in coronar y arter y imaging. T opogr am: AP , 512 mm. Appro ximately , from the carina until the apex of the heart. A typical range o[...]

43 Hear tV iew CT[...]

44 Hear tV iew CT Cor onar ySharp0.5s Indications: This is a spiral scanning pro tocol, using a Rotation Time of 0.5 s, ECG gating technique and a dedicated cardiac reconstruction k ernel f or bett er edge defi- nition in coronar y arter y imaging. T opogr am: AP , 512 mm. Appro ximately , from the carina until the apex of the heart. A typical rang[...]

45 Hear tV iew CT Fig. 1: Image reconstruction with (a) and without (b) Cardio Sharp kernel. a b[...]

46 Hear tV iew CT ECGT rigCT A Indications: This is a seq uential scanning protocol with an ECG triggering t echnique f or cor onar y CT A studies. It could also be applied f or aor tic CT A studies, e. g. aortic dissection. T opogr am: AP , 512 mm. F rom the aor tic arch until the apex of the heart. If y ou apply API for a single breathhold acquis[...]

47 Hear tV iew CT ECGT rigCT A kV 120 Effective mAs 120 Slice collimation 1.5 mm Slice width 1.5 mm Feed/Scan 18 mm Rotation time 0.42 sec. T em poral r esolution 210 ms K ernel B30f Image order cr-ca CTDI w 8.64 mGy Effective dose Male: 1.5 mSv Female: 2.2 mSv[...]

48 Hear tV iew CT Aortic and Pulmonary Studies The f ollowing scan prot ocol is predefined: • PulmonaryECG – Spiral scanning prot ocol with ECG g ating General Hints: • The Pulmonar yECG pr ot ocol is recommended f or aortic or pulmonar y studies, e. g. aorta dissection or pulmonar y emboli.[...]

49 Hear tV iew CT Pulmonar yECG Indications: This is a spiral scanning pro tocol with an ECG gating techniq ue f or aortic and pulmonary studies, e. g. aortic dissection or pulmonary emboli. Pulmonar yECG kV 120 Effective mAs 200 Slice collimation 1.5 mm Slice width 3.0 mm Feed/Rotation 5.6 mm Rotation time 0.42 sec. T em poral r esolution Up to 10[...]

50 Hear tV iew CT Additional Impor tant Inf ormation By default, the “Synthe tic T rigger” (ECG trigger ed scanning) or “Synthetic Sync” (ECG gated scanning) is activated for all predefined cardiac scan pr ot ocols (Fig. 1 and 2). And it is recommended t o k eep it always activated f or examinations with contrast medium. In case of ECG sign[...]

51 Hear tV iew CT ACV (Adaptive Car dio V olume) (Fig. 3) is a dedicat ed algorithm f or bi-phase image r econstruction. The image temporal resolution of 105 ms can be achie ved with ACV . By default, it is switched on for all coronary CT A scan pr ot ocols, and switc hed off for all calcium scoring scan pr otocols. And it is not recommend to chang[...]

52 Hear tV iew CT Y ou can activate the “Aut o load in 3D” function on the Examination Card/A uto T asking and link it t o a recon job. If the postpr ocessing type is chosen from the pull down menu, the reconstructed images will be loaded automatically into the 3D Card on the Navigator with the corr esponding postproces sing type. On the 3D Car[...]

53 Hear tV iew CT Calcium Scoring evaluation is performed on a separate syngo task card: 1. The threshold of 130 HU is applied f or score calculation by default, howe ver , you can modify it accordingly . 2. In addition to the seeding method, you can use freehand ROI f or the definition of lesions. 3. The separation and modification of lesions with[...]

54 Bolus T racking The Basics The administration of intra venous (IV) contrast material during spiral scanning impro ves the de tection and charact erization of lesions, as well as the opacity of ves sels. The contrast scan will yield good results only if the acq uisition occurs during the optimal phase of enhancement in the region of interest. The[...]

55 Bolus T racking Aortic time-enhancement curves after i. v . contrast injection (comput er simulation*). All curves are based on the same patient parameters (male, 60-y ear-old, 75 kg). Fig. 2a: 2 ml/s, 120 ml, 300 mg I/ml Fig. 2b: 4 ml/s, 120 ml, 300 mg I/ml Fig. 3a: 80 ml, 4 ml/s, 300 mg I/ml Fig. 3b:120 ml, 4 ml/s, 300 mg I/ml Fig. 4a: Uni-pha[...]

56 Bolus T racking How to do it T o achieve optimal r esults in contrast studies, use of C ARE Bolus is r ecommended. In case it is no t a vailable, use T est Bolus. C ARE Bolus This is an aut omatic bolus tracking prog ram, which enables triggering of the spiral scanning at the op timal phase of the contrast enhancement. General Hints: 1. This mod[...]

57 Bolus T racking • After the T opogram is performed, the predefined spiral scanning range and the optimal monitoring position will be sho wn. • If you need to redefine the spiral scanning range, you should also reposition the monitoring scan in order to k eep the shortest start delay time (2 s). (The distance be tween the beginning of the spi[...]

58 Bolus T racking T estBolus Indications: This mode can be used to test the start delay of an optimal enhancement after the contrast medium injection. T estBolus kV 120 Effective mAs 30 Slice collimation 5.0 mm Slice width 10 mm Feed/Scan 0 mm Rotation time 0.5 sec. K ernel B40f Cycle time 2 s[...]

59 Bolus T racking Application Procedures : 1. Select the spiral mode that y ou want to perform, and then “Append” the T estBolus mode under Special pro tocols. 2. Insert the T est Bolus mode above the spiral mode for contrast scan by “cut/paste” (with right mouse button). 3. P er form the T opogram, and define the slice position for T estB[...]

60 Bolus T racking Additional Impor tant Inf ormation 1. The preset st art dela y time for monit oring scans depends on whether the subseq uent spiral scan will be acquir ed during the arterial phase or venous phase. The default value is 1 0 s. Y ou can modify it accordingly . 2. It should be pointed out that when using “ T est Bolus”, ther e m[...]

61 Bolus T racking 5. If API is used in conjunction with C ARE Bolus, the actual start delay time f or the spiral will be as long as the length of API including the predefined start delay time. E. g. if the predefined the start delay is 2 s, and the API lasts 5 s, the spiral will start 5 s af ter the threshold is reached. 6. In case you have t o in[...]

62 WholeBodyAngio This scan protocol can be used for a whole Body Angio. A range of 100 cm can be covered in 21.4 s. WholeBodyAngio 2 nd Reconstr . kV 120 Effective mAs 130 Slice collimation 1.5 mm Slice width 6 mm 2 mm Feed/Rotation 24.0 mm Rotation time 0.5 sec. K ernel B30f B20f Increment 6 mm 1.5 mm Image order cr-ca The r econstruction can be [...]

63 WholeBodyAngio[...]

64 LungCare LungCare kV 120 Effective mAs 20 Slice collimation 0.75 mm Slice width 1.0 mm Feed/Rotation 18.0 mm Rotation time 0.5 sec. K ernel B50f Increment 0.5 mm Image order cr-ca CTDI w 1.7 mGy Effective dose Male: 0.6 mSv Female: 0.7 mSv A dedicat ed low dose Spiral mode for the syngo Lung C ARE ev aluation. Indications: Lung studies with lo w[...]

65 LungCare[...]

66 CT Colonograph y For Colonog raphy studies. A typically range of 40 cm can be co ver ed in 13.9 s. CT Colonograph y 2 nd Reconstr . kV 120 Effective mAs 100 Slice collimation 0.75 mm Slice width 5.0 mm 1.0 mm Feed/Rotation 15.0 mm Rotation time 0.5 sec. K ernel B30f B30f Increment 5.0 mm 0.7 mm Image order cr-ca CTDI w 7.8 mGy Effective dose Mal[...]

67 CT Colonograph y We recommend using a tube voltage of at least 120 kV . A compr ehensive study consists of four sections: Preparation, e xamination in supine & pr one positioning and post processing. • P atient pr eparation In the case of CT Colonography , adequat e prepa- ration in bowel cleansing must be done prior to the CT examination.[...]

68 Children Over view This f older contains 8 organ specific pediatric pro to- cols with 2 t o 5 age or weight dependant subg roups. For y our con venience, the prot ocols are numbered according to the body regions, i. e. fr om head to abdomen. The scan protocols for Head and Neck r egions are defined according to age, and the scan pr ot ocols f or[...]

69 Children Hints in General 1. T opograms: 256 mm lateral t opograms are defined for the head modes, and 512 mm AP topog rams ar e defined f or the body modes. Please keep in mind that the childr en’s size can be dramatically dif ferent. Y ou should pr ess the “Hold Measurement“ button when- ever the range shown on the real time gro wing top[...]

70 The pr oper personnel and eq uipment must also be r eadily available at your disposal in the event of a pr oblem. 6. Oral and r ectal contrast administration: Depending on the reason for the exam/status of the patient, oral contrast ma y or may not be given to these patients. In general, oral contrast is recommended to opacify the int estinal tr[...]

71 Not e: these ar e inject or guidelines based on an antecubital injection site. These guidelines may need to be adjust ed if the site 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 ma y need to be hand injected or pow er injected at a very low flow rate (1 ml/sec). PIC lines[...]

72 HeadSpi0.5s Indications: Spiral mode for r outine head studies, e. g. tumors, hydr ocephalus, hemorrhaging, abnormalities, e tc. HeadSpi0.5s kV 120 Effective mAs * Slice collimation 1.5 mm Slice width 4.0 mm Feed/Rotation 12.2 mm Rotation time 0.5 sec. K ernel C30f Increment 4.0 mm Image order ca-cr Contrast medium IV injection Start delay exam [...]

73 Tips • Childr en, who are more than 6 years old, should be scanned with an adult pro tocol as the skull by t his time is fully g rown. • When bone structure is of inter est, use k ernel C60s for image reconstruction. • P ost erior F ossa O ptimization Filt er PFO: T o r educe beam-hardening ar tifacts in head images, particularly in the ba[...]

74 HeadSeq0.5s Indications: Sequential mode for r outine head studies for children, e. g. tumors, hydrocephalus, hemorrhaging, abnormalities, e tc. HeadSeq0.5s kV 120 Effective mAs * Slice collimation 1.5 mm Slice width 4.5 mm Feed/Scan 18.0 mm Rotation time 0.5 sec. K ernel C30f Image order ca-cr Contrast medium IV injection Start delay exam depen[...]

75 Tips • Childr en, who are more than 6 years old, should be scanned with an adult pro tocol as the skull by t his time is fully g rown. • When bone structure is of inter est, use k ernel C60s for image reconstruction. • P ost erior F ossa O ptimization Filt er PFO: T o r educe beam-hardening ar tifacts in head images, particularly in the ba[...]

76 HeadAngio Indications: Spiral mode for head CT angiog raphy , e. g. cerebral vascular abnormalities, tumors e tc. HeadAngio 2 nd Reconstr . kV 80 Effective mAs * Slice collimation 0.75 mm Slice width 2.0 mm 1.0 mm Feed/Rotation 6.8 mm Rotation time 0.5 sec. K ernel H20f H10f Increment 2.0 mm 0.7 mm Image order ca-cr * The mAs should be adjusted [...]

77 Tips • Childr en, who are more than 12 years old should be scanned with an adult prot ocol. • The first recon job is defined for sof t tissue visuali- zation. Contrast medium IV injection Start delay 18 – 20 sec. Fl ow ra te dependent upon needle size/Access site T o tal amount 1 – 2 ml per kg of body weight MIPthin: HeadAngio coronal Im[...]

78 Children Car otidCT A Indications: CT angiograph y of the carotid ar teries, e. g. car otid stenosis or occlusion, vascular abnormalities of the caro tids or ver tebral arteries, e tc. CarotidCT A 2 nd Reconstr . kV 80 Effective mAs * Slice collimation 0.75 mm Slice width 5.0 mm 1.0 mm Feed/Rotation 12 mm Rotation time 0.5 sec. K ernel B30f B20f[...]

79 Children Tips • Childr en, who are more than 12 years old should be scanned with an adult prot ocol. • The first recon job is defined for sof t tissue visuali- zation. Contrast medium IV injection Start delay exam dependent Fl ow ra te dependent upon needle size/Access site T o tal amount 1 – 2 ml per kg of body weight MIPthin: CarotidCT A[...]

80 Children NeonateBody Indications: Spiral mode for r outine neonate body studies, e. g. tumors, abnormalities, malformations, abscesses, etc. NeonateBody kV 80 Effective mAs 25 Slice collimation 1.5 mm Slice width 6.0 mm Feed/Rotation 24 mm Rotation time 0.5 sec. K ernel B30f Increment 6.0 mm Image order cr-ca CTDI w 0.55 mGy Effective mAs* Male:[...]

81 Children Tips • Y ou can modify the slice width for image r econstruc- tion according to the clinical indications. Contrast medium IV injection Start delay exam dependent Fl ow ra te dependent upon needle size/Access site T o tal amount 1 – 2 ml per kg of body weight[...]

82 Children ChestRoutine Indications: Spiral mode for r outine thorax studies, e. g. pneumonia, tumors, metastases, lymphoma, vascular abnormalities e tc. ChestRoutine 2 nd Reconstr . kV 120 Effective mAs * Slice collimation 1.5 mm Slice width 6.0 mm 6.0 mm Feed/Rotation 24.0 mm Rotation time 0.5 sec. K ernel B30f B60f Increment 6.0 mm 6.0 mm Image[...]

83 Children Tips • Childr en with a body weight of mor e than 54 k g should be examined with an adult pr ot ocol. • The first and second recon jobs ar e defined f or visualization of the mediastinum and the lungs, respectively . Contrast medium IV injection Start delay exam dependent Fl ow ra te dependent upon needle size/Access site T o tal am[...]

84 AbdPelRoutine Indications: Spiral mode for r outine studies in the region of abdomen and pelvis, e. g. tumors, lymphoma, abscesses, post-traumatic c hanges, e tc. AbdPelRoutine 2 nd Reconstr . kV 120 Effective mAs * Slice collimation 1.5 mm Slice width 5.0 mm 5.0 mm Feed/Rotation 24.0 mm Rotation time 0.5 sec. K ernel B30f B60f Increment 5.0 mm [...]

85 Contrast medium IV injection Start delay exam dependent Fl ow ra te dependent upon needle size/Access site T o tal amount 1 – 2 ml per kg of body weight Tips • Childr en with a body weight of mor e than 54 k g should be examined with an adult pr ot ocol. • Ther e are two r econ jobs pr edefined. The second one is for the r econstruction of[...]

86 Children AbdCT A Indications: For abdominal CT Angio studies, e. g. vascular abnormalities, aneurysms, etc. AbdCT A 2 nd Reconstr . kV 80 Effective mAs * Slice collimation 0.75 mm Slice width 3.0 mm 1.0 mm Feed/Rotation 12 mm Rotation time 0.5 sec. K ernel B30f B20f Increment 3.0 mm 0.7 mm Image order cr-ca * The mAs should be adjusted to the bo[...]

87 Children Contrast medium IV injection Start delay exam dependent Fl ow ra te dependent upon needle size/Access site T o tal amount 1 – 2 ml per kg of body weight Tips • Childr en with a body weight of mor e than 54 k g should be examined with an adult pr ot ocol. • The first recon job is defined f or image viewing and filming. MIPthin: Abd[...]

88 Head Over view • AngioHead For CT Angio studies using 0.75 mm slice collimation and a 1.0 mm slice thickness • Angio ThinSlice For CT Angio studies using 0.75 mm slice collimation and 0.75 mm slice thickness • HeadSeq0.5s Sequence mode for base of the skull and cerebrum routine studies and a 0.5 s ro tation time • HeadSpi0.5s Spiral mode[...]

89 Head Hints in General 1. T opogram: Lateral, 256 mm. 2. Patient positioning: Patient lying in supine position, arms r esting against body , secure head w ell in the head holder , suppor t lower legs. 3. Gantry tilt is available f or sequence scanning, not for spiral scanning. 4. F or all head studies, it is very important for image quality t o p[...]

90 Head AngioHead Indications: Spiral mode for cerebral CT Angios, e. g. cer ebral vascular abnormalities, tumors and follow up studies etc. A range of 80 mm will be covered in 3.3 s.[...]

91 Head AngioHead 2 nd Reconstr . kV 120 Effective mAs 100 Slice collimation 0.75 mm Slice width 4.0 mm 1.0 mm Feed/Rotation 15.0 mm Rotation time 0.5 sec. K ernel H20f H10f Increment 4.0 mm 0.7 mm Image order ca-cr CTDI w 21.1 mGy Effective dose Male: 0.4 mSv Female: 0.5 mSv Use of C ARE Bolus with monitoring scans positioned at the lev el of the [...]

92 Head Angio ThinSlice Indications: For cer ebral CT Angio studies, with one reconstruction job f or a 0.75mm slice thickness. E. g. cerebral vascular abnormalities, tumor , and f ollow up studies etc. A range of 80 mm will be covered in 6.5 s.[...]

93 Head Angio ThinSlice 2 nd Reconstr . kV 120 Effective mAs 130 Slice collimation 0.75 mm Slice width 4.0 mm 0.75 mm Feed/Rotation 6.8 mm Rotation time 0.5 sec. K ernel H20f H10f Increment 4.0 mm 0.5 mm Image order ca-cr CTDI w 27.4 mGy Effective dose Male: 0.6 mSv Female: 0.7 mSv Use of C ARE Bolus with monitoring scans positioned at the lev el o[...]

94 Head HeadSeq0.5s Indications: Sequence mode for r outine head studies, e. g. strok e, brain tumors, cranial trauma, cerebral atroph y , hydr ocephalus, and inflammation, e tc. T wo ranges ar e pr edefined. One f or the base of the skull and one f or the cerebrum.[...]

95 Head ThinSliceSeq RoutineSeq kV 120 120 Effective mAs 250 250 Slice collimation 0.75 mm 1.5 mm Slice width 4.5 mm 9.0 mm Feed/Scan 9.0 mm 18.0 mm Rotation time 0.5 sec. 0.5 sec. K ernel H31f H31f Image order ca-cr ca-cr CTDI w 58.2 mGy 60.3 mGy Effective dose Male: 0.7 mSv Male: 1.6 mSv Female: 0.8 mSv Female: 1.8 mSv P osterior F os sa O ptimiz[...]

96 Head HeadSpi0.5s Indications: Spiral mode for r outine head studies, e. g. str ok e, brain tumors, cranial trauma, cerebral atr ophy , hydr o- cephalus, and inflammation, e tc. T wo ranges ar e pr edefined for the base of the skull and cer ebrum.[...]

97 Head ThinSliceSpi RoutineSpi kV 120 120 Effective mAs 320 320 Slice collimation 0.75 mm 1.5 mm Slice width 4.0 mm 8.0 mm Feed/Rotation 6.8 mm 13.7 mm Rotation time 0.5 sec. 0.5 sec. K ernel H31f H31f Increment 4.0 mm 8.0 mm Image order ca-cr ca-cr CTDI w 50.6 mGy 45.6 mGy Effective dose Male: 0.7 mSv Male: 1.1 mSv Female: 0.8 mSv Female: 1.2 mSv[...]

98 Neck Over view • AngioCaro tid For CT A studies[...]

99 Neck Hints in General 1. T opogram: Lateral, 256 mm. 2. Patient positioning: Patient lying in supine position, hyper extend neck slightly , secure head w ell in head cradle. 3. Patient respiratory instruction: do no t breathe, do not swallow. 4. F or image reconstruction of bone structure, use kernel B60. 5. In case of 3D s tudy only , the mAs v[...]

100 Neck AngioCar otid Indications: Noninvasiv e CT angiog raphy of car otid stenosis or occlusions, plaques course abnormalities of the caro tids and ver tebral arteries, e tc. A range of 20 cm including the aor tic arch will be cover ed in 8.9 s.[...]

101 Neck AngioCarotid 2 nd Reconstr . kV 120 Effective mAs 120 Slice collimation 0.75 mm Slice width 5.0 mm 1.0 mm Feed/Rotation 12.0 mm Rotation time 0.5 sec. K ernel B30f B30f Increment 5.0 mm 0.7 mm Image order cr-ca CTDI w 9.4 mGy Effective dose Male: 1.6 mSv Female: 1.7 mSv C ARE Bolus may be used to optimize the bolus timing. Set the ROI for [...]

102 Thorax Over view • LungLo wDose Spiral mode with v er y low dose for special lung studies, e. g. early visualization of pulmonary nodules • PulmonaryEmboli Spiral mode for Pulmonary Emboli studies • ThoraxCombi For the combination of thin slice lung and routine thorax studies • ThoraxRoutine For r outine thorax studies[...]

103 Thorax Hints in General 1. T opogram: AP , 512 mm. 2. Patient positioning: Patient lying in supine position, arms positioned comfortably above the head in the head-arm rest, lower legs supported. 3. CARE Bolus ma y be used to op timize the bolus timing. Set the ROI for monit oring scan in the aor ta at the level of the diaphragm with triggering[...]

104 LungLowDose Indications: Lung studies with lo w dose setting, e. g. early visuali- zation of pulmonar y nodules. A typical thorax study in a range of 30 cm will be cover ed in 8.9 s. Thorax[...]

105 LungLowDose 2 nd Reconstr . kV 120 Effective mAs 20 Slice collimation 0.75 mm Slice width 5.0 mm 1.0 mm Feed/Rotation 18.0 mm Rotation time 0.5 sec. K ernel B50f B50f Increment 5.0 mm 0.7 mm Image order cr-ca CTDI w 1.6 mGy Effective dose Male: 0.6 mSv Female: 0.7 mSv Y ou could repeat the same pr ot ocol simply by clicking the chr onicle with [...]

106 Pulmonar yEmboli Indications: For Pulmonary Emboli studies. There are two recon jobs pr edefined. The first one, with 5 mm slice thickness, the second reconstruction, with 1 mm slice thickness. A range of 30 cm will be covered in 10.6 s. Thorax[...]

107 Pulmonar yEmboli 2 nd Reconstr . kV 120 Effective mAs 100 Slice collimation 0.75 mm Slice width 5.0 mm 1.0 mm Feed/Rotation 15.0 mm Rotation time 0.5 sec. K ernel B30f B80f Increment 5.0 mm 0.7 mm Image order cr-ca CTDI w 7.8 mGy Effective dose Male: 3.0 mSv Female: 3.9 mSv * C ARE Bolus may be used t o optimize the bolus timing. Set the ROI fo[...]

108 Thorax ThoraxCombi Indications: Combining thin slice lung and routine thorax studies with one spiral scan. E. g. thorax studies in general and interstitial changes in the lungs. There are two recon jobs pr edefined. The first one, with 5 mm slice thickness, f or the mediastinum, the second reconstruction, with 1 mm slice thicknes s, for the lun[...]

109 Thorax ThoraxCombi 2 nd Reconstr . kV 120 Effective mAs 100 Slice collimation 0.75 mm Slice width 5.0 mm 1.0 mm Feed/Rotation 15.0 mm Rotation time 0.5 sec. K ernel B31f B80f Increment 5.0 mm 0.7 mm Image order cr-ca CTDI w 7.8 mGy Effective dose Male: 3.0 mSv Female: 3.9 mSv If y ou want t o reconstruct thin slices in ever y 2 mm or 10 mm inst[...]

110 Thorax ThoraxRoutine Indications: Routine studies for the region of thorax, e. g. screening of tumors, metastases, lymphoma, lymphonodes, vascular anomalies etc. A range of 30 cm will be covered in 5.6 s.[...]

111 Thorax ThoraxRoutine kV 120 Effective mAs 100 Slice collimation 1.5 mm Slice width 6.0 mm Feed/Rotation 30.0 mm Rotation time 0.5 sec. K ernel B41f Increment 6.0 mm Image order cr-ca CTDI w 7.0 mGy Effective dose Male: 2.8 mSv Female: 3.6 mSv Y ou could repeat the same pr ot ocol simply by clicking the chr onicle with the right mouse button for[...]

112 Abdomen Over view • AbdRoutine For r outine abdominal studies • AngioF ast For long-range CT A studies • AngioRoutine For CT A r outine studies • AbdomenSeq Sequence mode for r outine studies[...]

113 Abdomen Hints in General 1. T opogram: AP , 512 or 768 mm. 2. Patient positioning: Patient lying in supine position, arms positioned comfortably above the head in the head-arm rest, lower legs supported. 3. Patient respiratory instructions: inspiration. 4. Oral administration of contrast medium: For abdominal studies, it is necessar y to deline[...]

114 Abdomen Not e: In general, for abdominal studies such as liver , gall bladder (quer y stones), pancreas, gastr ointestinal studies, f ocal lesion of the kidneys and CT A studies, it is sufficient to use just wat er . Water is mor e effectiv e than positive oral contrast agent in depicting the linings of the st omach & int estines in post en[...]

115 Abdomen[...]

116 Abdomen AbdRoutine Indications: All r outines in the region of abdomen, e. g. screening, follo w-up ex aminations etc. A comple te abdomen/pelvis scan, in a range of 40 cm will be covered in 8.9 s, and a typical liv er scan in a range of 20 cm will be cover ed in 4.5 s.[...]

117 Abdomen AbdRoutine kV 120 Effective mAs 140 Slice collimation 1.5 mm Slice width 5.0 mm Feed/Rotation 24.0 mm Rotation time 0.5 sec. K ernel B31f Increment 5.0 mm Image order cr-ca CTDI w 10.0 mGy Effective dose Male: 5.8 mSv Female: 8.9 mSv Y ou could repeat the same pr ot ocol simply by clicking the chr onicle with the right mouse button for [...]

118 AngioF ast Indications: Long range CT A studies. E. g.: a typical study of the whole aorta including its branchiocephalic trunk and iliac arteries in a range of 80 cm will be covered in 19.6 s. Abdomen[...]

119 AngioF ast 2 nd Reconstr . kV 120 Effective mAs 130 Slice collimation 1.5 mm Slice width 5.0 mm 2.0 mm Feed/Rotation 21.0 mm Rotation time 0.5 sec. K ernel B30f B20f Increment 5.0 mm 1.5 mm Image order cr-ca CTDI w 9.1 mGy Effective dose Male: 10.8 mSv Female: 16.4 mSv * C ARE Bolus may be used t o optimize the bolus timing. Set the ROI for mon[...]

120 AngioRoutine Indications: For abdominal CT A studies. E. g.: a typical study of renal ar teries in a range of 40 cm will be covered in 13.9 s. Abdomen[...]

121 AngioRoutine 2 nd Reconstr . kV 120 Effective mAs 130 Slice collimation 0.75 mm Slice width 5.0 mm 1.0 mm Feed/Rotation 15.0 mm Rotation time 0.5 sec. K ernel B30f B20f Increment 5.0 mm 0.7 mm Image order cr-ca CTDI w 10.1 mGy Effective dose Male: 5.8 mSv Female: 7.5 mSv Do no t administer oral contrast medium, as this impairs the editing of MI[...]

122 AbdomenSeq Indications: Sequential mode for addomen studies. AbdomenSeq kV 120 Effective mAs 140 Slice collimation 5.0 mm Slice width 5.0 mm Feed/Scan 10.0 mm Rotation time 0.5 sec. K ernel B31f Image order cr-ca Abdomen[...]

123 Abdomen[...]

124 Extremities Over view • AngioRunOff For long range CT A studies[...]

125 Extremities Hints in General 1. T opog ram: AP , 1024mm f or CT A. 2. If T opo length 1024 mm is no t long enough, you can also choose the 1540 mm long T opogram. 3. P osition the patient as fee t first. Bend the feet t ogether if necessary. 4. If the Pelvis r egion is included in the scan range, we r ecommend at least 120 kV .[...]

126 AngioRunOf f Indications: For CT A studies A range of 100 cm will be done in 21.4 s. AngioRunOff 2 nd Reconstr . kV 120 Effective mAs 130 Slice collimation 1.5 mm Slice width 6.0 mm 2.0 mm Feed/Rotation 24.0 mm Rotation time 0.5 sec. K ernel B30s B20s Increment 6.0 mm 1.5 mm Image order cr-ca cr -ca CTDI w 9.1 mGy Effective dose Male: 4.4 mSv F[...]

127 * CARE Bolus may be used to optimize the bolus timing. Set the ROI for monitoring scan in the abdominal aorta at the beginning of the scan range with trigger- ing threshold of 120 HU, or use manual triggering. If T opo length 1024 mm is no t long enough, you can also choose the 1540 mm long T opogram. Position the patient as f eet first. Bend t[...]

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