Siemens Software version syngo CT 2005C manuel d'utilisation

SOMA T OM Spirit Application Guide Protocols Principles Helpful Hints syngo 3D syngo Fly Thro ugh syngo Dental CT syngo Osteo CT syngo Vol u me Ev a lu at io n syngo Dynamic Evaluat ion Software V ersion syngo CT 2005C C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 1 Friday, April 8, 2005 9:55 AM[...]

2 The information pr esented in this Application Guide is for illustration only and is no t intended t o be relied upon by the r eader for instruc tion as to the practice of medicine. Any healt h care practitioner r eading this information is r eminded that they must use their own learning, training and exper t ise in dealing with their individual [...]

Ov er vie w 3 User Documentation 14 Scan and Reconstruction 16 Dose Inf ormation 28 Wor kflow Inf ormation 36 Application Inf ormation 54 Head 70 Neck 88 Shoulder 94 Thorax 98 Abdomen 110 Pelvis 124 Spine 132 Upper Extremities 146 C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 3 Friday, April 8, 2005 9:55 AM[...]

4 Lower Extremities 154 Vascular 162 Specials 176 Children 184 syngo 3D 240 syngo Fly Through 258 syngo Dental CT 268 syngo Osteo CT 274 syngo V olume Evaluation 288 syngo Dynamic Evaluation 306 C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 4 Friday, April 8, 2005 9:55 AM[...]

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6 Contents User Documentation 14 Scan and Reconstruction 16 • Concept of Scan Pro tocols 16 • Scan Set Up 17 • Scan Modes 18 - Sequential Scanning 18 - Spiral Scanning 18 - Dynamic Serioscan 18 • Slice Collimation and Slice Width 19 - Slice Collimation and Slice Width for Spiral Mode and HR Spir al Mode 20 - Slice Collimation and Slice Widt[...]

Contents 7 • Contrast Medium 45 - The Basics 45 -I V I n j e c t i o n 4 7 -B o l u s T r a c k i n g 4 8 - T est Bolus using C ARE Bolus 50 - T est Bolus 51 Application Inf ormation 54 • SOMA T OM life 54 -G e n e r a l I n f o r m a t i o n 5 4 -K e y F e a t u r e s 5 5 - Description 56 - Access t o Computer Based T raining or Manuals on CD [...]

8 Contents Neck 88 • Overview 88 • Hints in General 89 -B o d y K e r n e l s 9 0 • Neck 92 Shoulder 94 • Overview 94 • Hints in General 95 -B o d y K e r n e l s 9 5 • Shoulder 96 Thorax 98 • Overview 98 • Hints in General 99 - Body K ernels 101 • ThoraxRoutine/Th oraxRoutine08s 102 • ThoraxF ast 104 • ThoraxHRSeq 106 • Lun[...]

Contents 9 Pelvis 124 • Overview 124 • Hints in General 125 - Body K ernels 125 • Pelvis 126 • Hip 128 • SI_Joints 130 Spine 132 • Overview 132 • Hints in General 133 - Body K ernels 135 • C-Spine 136 • C-SpineSeq 138 • Spine 140 • SpineSeq 142 • Osteo 144 Upper Extremities 146 • Overview 146 • Hints in General 147 - Bod[...]

10 Contents Vascular 162 • Overview 162 • Hints in General 163 - Head K ernels 163 - Body K ernels 163 • HeadAngio/HeadAngio08s 164 • Caro tidAngio/CarotidAngio08s 166 • ThorAngio/ThorAngio08s 168 • Embolism 170 • BodyAngioRou tine/BodyAngioRoutine 08s 172 • BodyAngioFast 174 Specials 176 • Overview 176 - T rauma 176 - Interventio[...]

Contents 11 • ThoraxRoutine_Baby 206 • ThoraxRoutine_Child 208 • ThoraxHRSeq_Baby 210 • ThoraxHRSeq_Child 212 • Abdomen_Baby 214 • Abdomen_Child 216 • Spine_Baby 2 18 • Spine_Child 220 • ExtrHR_Baby 222 • ExtrHR_Child 224 • HeadAngio 226 • HeadAngio08s 228 • Caro tidAngio 230 • Caro tidAngio08s 232 • BodyAngio 234 • [...]

12 Contents - Auto Load in 3D and P ost-proces sing Presets 257 - Blow-up Mode 257 syngo Fly Through 258 • Ke y Features 258 • Prereq uisites 259 • The Basics for CT Virtual Endos cop y 259 - SSD and VRT Prese ts for Endoscopic Renderings 259 - Endoscopic Viewing Paramete rs/ Fly Cone Settings 260 - Patient Preparation 262 • Workflow 263 - [...]

Contents 13 syngo Dynamic Evaluation 306 • Prereq uisites 308 • Workflow 309 - 1. Loading the Images 309 - 2. Inspecting the Input Images 310 - 3. Generation of Pa ramete r Images 310 - 4. Creating a Baseline Image 313 - 5. Evaluation of Re gion of Int erests 314 - 6. Enhancement Cur v e 315 - 7. Documentation of Results 316 • General Hints 3[...]

14 For further inf ormation ab out the basic operation, please ref er to the corr esponding syngo CT Operator Manual: syngo CT Operator Manual Vo lu m e 1 : Security Package Basics Preparations Examination C ARE Bolus CT syngo CT Operator Manual Vo lu m e 2 : syngo Patient Br owser syngo Viewing syngo Filming syngo 3D syngo CT Operator Manual Vo lu[...]

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16 Scan and Reconstruction Concept of Scan Pr ot ocols The scan pro tocols for adult and childr en are defined according t o body regions – Head , Neck , Shoulder , Thorax , Abdomen , Pelvis , Spine , Upper Extremities , Lowe r Extremities , Specials , and Va sc ul ar . The general concept is a s follo ws: All pro tocols without suff ix ar e st a[...]

Scan and Reconstruction 17 Scan Set U p Scans can be simply set up by selec ting a predefined examination pr ot ocol. T o repeat any mode, just click the chronicle with the right mouse button f or “ repeat ”. T o delete it, select “ cut “. Each range name in the chr on - icle can be easily changed befor e “ load “. Multiple ranges can b[...]

18 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 betw een each acquisition is required to mov e the table to the next slice position. Spiral Scanning Spiral scanning is a contin uous volume imagin[...]

Scan and Reconstruction 19 Slice Collimation and Slice Width Slice collimatio n is the slice thicknes s resulting from the effect of the tube -side collimator and the adap tive det ector arra y design. In Multislice CT , the Z-coverage per ro t ation is given by the pr oduct of the number of active det ector slices and the collimation (e.g., 2 x 1.[...]

20 Scan and Reconstruction Slice Collimation and Slice Width for Spiral Mode and HR Spiral Mode Slice Collimation and Slice Width for Sequence Mode and HR Sequence Mode 1 mm: 1, 1.25, 2, 3, 5 mm 1.5 mm: 2, 3, 5, 6 mm 2.5 mm: 3, 5, 6, 8, 10 mm 4 mm: 5, 6, 8, 10 mm 5 mm: 6, 8, 10 mm 1.0 mm: 1, 2 mm 1.5 mm: 1.5, 3 mm 2.5 mm: 2.5, 5 mm 4.0 mm: 4, 8 mm [...]

Scan and Reconstruction 21 Increment The increment is the distance between the recon - struct ed images in the Z di r ection. When the increment chosen is smaller than the slice thicknes s, the images are cr eated with an o verlap. This technique is useful t o reduce partial volume effect, giving you bett er detail of the anatomy and high quality 2[...]

22 Scan and Reconstruction Pitch In single slice CT : Pitch = table movement per r otation/slice collimation E.g.,: slice collimation = 5 mm, table moves 5 mm per ro tation, then pitch = 1. With the Siemens Multislice CT , we differentiat e between: Feed/Rotation , the table movement per r otation Vo l u m e P i t c h , table movement per r otation[...]

Scan and Reconstruction 23 Window values The Scale of t he CT Hounsfield U nits is fr om -1024 to +3071. The displayed windo w values have to corr espond to the anatomical structur e. Windowing is used to optimi ze contrast and brightness of images. Organ specific window values Gray scale white black CT -window values Window center C Window width W[...]

24 Scan and Reconstruction Ke r n e l s There are 3 differ ent types of kernels: “H“ stands for Head, “B“ stands for Body , “C“ st ands for ChildHead. The image sharpness is defined b y the numbers – the higher the number , the sharper the imag e; the lower the number , the smoo ther the image. A set of 18 k ernels is s upplied, consi[...]

Scan and Reconstruction 25 Image Filt ers There ar e 3 different filte rs available: LCE: The Low-contrast enhancement (LCE) filt er enhances low-contrast detec tability . It reduces the image noise. • Similar to reconstruction with a smoo ther kernel • Reduces noise • Enhances low-contrast detec t ability • Adjustable in four st eps • Au[...]

26 Scan and Reconstruction HCE: The High-contrast enhancement (HCE) filter enhances high-contrast detec t ability . It inc reases the image sharpness, similar t o reconstruction with a sharper k ernel. • Increases sharpness • F aster than raw-data reconstruc tion • Enhances high-contrast detec tability • Automatic post-pr ocessing ASA: The [...]

Scan and Reconstruction 27 Impr ov ed Head Imaging An automatic bone corr ection algorithm has been included in the st andard image reconstruction. Using a new iterativ e technique, typica l ar tifacts arising from the beam-hardening effect, e.g., Hounsfield bar , are minimized without any addi tional post-pr o cessing. This advanced algorithm allo[...]

28 Dose Information CTDI W and CTDI Vol The av erage dose in the scan plane is best described by the CTDI W for the selec ted scan parameters. The CTDI W is measured in the dedicat ed plastic phantoms – 16 cm diamet er for head and 32 cm diamet er for body (as defined in IEC 60601 –2 – 44). This dose number gi ves a good estimate for the a ve[...]

Dose Information 29 The CT DI vol value does not pr ovide the entire inf orma- tion of the radiation risk associated with CT examina - tion. For the purpose, the concept of the “Effec tive Dose“ was introduced b y ICRP (International Commis - sion on Radiation Pro tection). The effectiv e dose is expres sed as a weighted sum of t he dose applie[...]

30 Dose Information Ef fec tive mAs In sequential scanning, the dose (Dseq) applied to the patient is the product of the tube curr ent-time (mAs) and the CTDI w per mAs: In spiral scanning, howev er , the applied dose (Dspiral) is influenced b y the “clas sical“ mAs (mA x Rot Time) and in addition by the Pitc h F actor . For exam ple, if a Mult[...]

Dose Information 31 For spiral scan pro tocols, the indicated mAs is the effective mAs per image. The correlation be tween tube current mA and effectiv e mAs of spiral scans on a Mul - tislice CT scanner is given by the f o llowing f ormula: where Slice collimation refers t o the collimation of one det ector r ow, and nr ow is the number of used de[...]

32 Dose Information CA R E D o s e CA RE Dose is a clinical application package that pr o - vides real-time tube curr ent modulation for Spiral and Sequential Scanning. CA RE Dose reduces patient dose significantly , espe - cially in the r egions of shoulder and pelvis. It decreases tube load, which extends the capacity f o r volume scan - ning wit[...]

Dose Information 33 Example of scanning the shoulder region. Principle of C ARE Dose tube current adaption. • CARE Dose is pre-selected by default for most stan - dard pr ot ocols. It can be switched on/off in the Scan subtask card. High attenuation , high mA Low att enuation, low mA Object attenuation Modulated tube current lateral TOP time rel.[...]

34 Dose Information • For the av erage patients examination, CARE Dose does not require an y manual changes to the scan prot ocol. However , the mAs must be adapt ed manu - ally for obese and pediatric patients. • The mean value of the m As applied will be lower than what you hav e selected. Although the a verage mA for the entir e scan will be[...]

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36 Wo r k f l ow I n f o r m a t i o n Recon Jobs In the Recon card, y ou can define up to 3 reconstruc - tion jobs for each range with different parame ters, either befor e or after you acquire the data. When y ou deselect all c hronicle entries, all open r econ jobs will be automatically r econstructed after y ou click on “Recon“. In case you[...]

Wo r k f l ow I n fo r m a t i o n 37 Examination Job S tatus Y ou can get a n overview of al l recon jobs by clicking on the recon task symbol in the status bar or selecting T ransfer – Examination Job St atus in the main menu of the Patient Browser . The Ex amination Job Status dialog will appear where all recon jobs (comple ted, queued and in [...]

38 Wo r k f l ow I n f o r m a t i o n Aut o Load in 3D and Post- pr ocessing Pr esets Y ou can activat e the Auto load in 3D function on the Examination car d/ Auto T asking and link it to a recon job. For exam ple, the 2 nd recon job wit h thinner slice width in some of the ex amination pro tocols. On the 3D card y ou have the ability t o create [...]

Wo r k f l ow I n fo r m a t i o n 39 How t o Creat e y our own Scan Pr ot ocols There are tw o different ways t o modify and creat e your scan pro tocols: Edit/Sa ve Scan Pro tocol If you want to modify an ex isting pro tocol or creat e a new one, e.g., y ou want to ha ve two “ AbdomenRou - tine-Pro tocols” wit h dif ferent slice width, w e re[...]

40 Wo r k f l ow I n f o r m a t i o n Hints • Y ou can save yo ur scan prot ocol at any time of the examination. • It is recommended that you sa ve your own scan pr o - tocol with a ne w name in order to a void overwriting the default scan pro tocol. • Do not use special ch aracters. In addition, do not even use an y blank spaces. Allowed ar[...]

Wo r k f l ow I n fo r m a t i o n 41 • Change one (or mor e) paramet ers for all Cust omer pro tocols: Select “ Edit – F ind/Replace ”. Open the “ Column “ list box and choose the desire d parameter . Selec t a new function of t his parameter in t he “ Fu n c t i o n “ list box. Under the button next to the F unction entr y you can[...]

42 Wo r k f l ow I n f o r m a t i o n • Define a pro tocol as Emergency pr ot ocol. Select the desired scan pr ot ocol with the right mouse button. Select entr y “ Set as new emer gency pro tocol ”. The selec ted pro tocol is marked with a re d cro ss. • Change the structure of the pr otocol tr ee. Y ou can sor t all Customers pro tocols a[...]

Wo r k f l ow I n fo r m a t i o n 43 Hints • With the Fi nd/Replace function you can easily insert an API command f or all prot ocols as needed. • Also all Auto T asking ac tions, e.g., the transfer to configured network nodes can be set within one action. Within the “Func tion” button you can set your transfer ac tions dep ending on the s[...]

44 Wo r k f l ow I n f o r m a t i o n Additional Information : 1. System/Run offers the tool “Restor e Default Scan Pro - tocols“ which allow s you to remo ve user specific scan prot oc ols and to rest ore the Siemens default settings. 2. The main menu entr y “ Edit ” of fers sa ve/delet e Scan Pro tocols. 3. System/Run or the main menu en[...]

Wo r k f l ow I n fo r m a t i o n 45 Contrast Medium The Basics The administration of intrav enous (IV) contrast mate - rial during spiral scanning improv es the tissue charac - terization and charac terization of lesions, as well as the opacity of ves sels. The cont rast scan will yield good results only if the acq uisition occurs during the opti[...]

46 Wo r k f l ow I n f o r m a t i o n Aortic time-enhancement cur v es after i.v . contrast injection (comput er simulation*). All cur ves are based on the same patient paramet ers (male, 60-year -old, 75 kg). * R adiology 19 98; 207:647 – 655 2 ml/s, 120 ml, 300 mg I/ml 4 ml/s, 120 ml, 300 mg I/ml 80 ml, 4 ml/s, 300 mg I/ml 120 ml, 4 ml/s, 300 [...]

Wo r k f l ow I n fo r m a t i o n 47 IV Injection* The administration of a contrast medium depends on the indication and on the delay times t o be used during the examination. The patients weight and circulat or y situation also play a role. In general, no mor e than 3 ml per k g of body weight f or adults and 2 ml per kg of body weight f or child[...]

48 Wo r k f l ow I n f o r m a t i o n Bolus T racking This is an automatic Bolus T racki ng program, which enables triggering of the spi ral scanning at the optimal phase of the contrast enhancement. General Hints • This mode can be applied in combination with an y spiral scanning pro tocol. Simply insert “Bolus T rack - ing” by clicking the[...]

Wo r k f l ow I n fo r m a t i o n 49 – Mov e the monitoring scan line towards the optimal position and release the mouse button, it will be snapped automatically . (T rick: if you move the mon - itoring scan line away from the optimal position the “snapping” mechanism will be inac tive). • Place a ROI in the pr emonitoring scan on the targ[...]

50 Wo r k f l ow I n f o r m a t i o n T est Bolus using CA RE Bolus Y ou can use the CARE Bolus option as a “T est Bolus“. How t o do it 1. Inser t a Bolus tracking via the right mouse button submenu prior to t he spiral. 2. Inser t “contrast“ from the right mouse butt on con - text menu prior to the monit oring scans. Hint: By inserting ?[...]

Wo r k f l ow I n fo r m a t i o n 51 T est Bolus This is a low dose sequential prot ocol without table feed used t o calculate t he star t delay of a spiral scan to ensure optimal enhancement after the contrast medium injection. The Dynamic Evaluation func tion may be used to generat e the time density cur ve. Y ou can find the “ T est Bolus“ [...]

52 Wo r k f l ow I n f o r m a t i o n 6. Load the images into the Dynami c Evaluation func - tion and det ermine 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 firs t image. This ROI will appear on all images in the T est Bolus series. [...]

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54 Application Information SOMA T OM life General Information SOMA T OM life @ Y our Scanner provides actual ne ws around y our scanner , shows you helpful configuration information of y our system and enables you t o access the Siemens Extranet where y o u will find fur ther opportunities to enhance your pos sibilities to use the CT system. T o be[...]

Application Information 55 Key F e a t u r e s All users: • General Inf ormation • Access t o Web Based E- T raining or Manuals on CD ROM In combination with a Siemens Remot e Ser vice con - nection: • News- Ticker a rchive and F A Q (frequently a sked q ues - tions) section • F ree trial software order and installation • Download of inf [...]

56 Application Information Description All users: Start SOMA TOM life @ Y our Scanner by selecting SOMA T OM life under "options" in your syngo menu bar and you will find a br owser window that allow s you to access different info rmation about your hard- and soft - ware environ ment . Under e.g., "System Information" y ou have [...]

Application Information 57 Access to Computer Based T raining or Manuals on CD ROM Start the Computer Based T raining t o learn more about your software and enhance your clinical knowledge. Note : The syngo Basics T raining is pre-installed on your system and can dir ectly be used by selecting SOMA - TOM Educat e. The syngo Advanced Application T r[...]

58 Application Information SRS Based Services During the star t up of your system you will receive actual inf ormation in the "Newstick er" and see the expiration date of installed trial software. Note : Siemens will send you a Newstick er whenever there i s helpful inf ormation for CT users. The trial licenses are valid f o r 90 days and[...]

Application Information 59 Download of Files Each download will be per formed in the back ground. If you disconnect y our Siemens Extranet ses sion and star t to work with the CT scanner , the do wnload will continue until it is completed. Due t o bandwidth rea - sons it is only possible to per form one download at a time. Note : Depending on y our[...]

60 Application Information Downloaded Scan Pro tocols are stored in the upda te folder until installation. T o instal l all downloaded pro - tocols, choose the Scan Pr ot ocol Manager via Options/ Configuration and select "Imp ort Scan Pro tocols" in the menu tab "Scan Prot ocol". Af ter successful import, all downloaded prot oc[...]

Application Information 61 Note : Every patient image will be made anon ymous befor e sending. Because the SOMA T OM life window is always in front, we recommend t o restore/ minimize it to be able to switch be tween both screens, the F ile Bro wser and t he SOMA T OM life window . C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 61 Friday, Ap[...]

62 Application Information T rial Order and Installation As a SOMA T OM CT user you can r equest trial clinical software direc tly from the scanner . The req uested sof t - ware wi ll be pro vided a nd installed automatically through our Siemens Remot e Ser vices connection. After y ou hav e accessed the SOMA T OM lif e Extranet, you can choose sys[...]

Application Information 63 At the same time, you ar e informed t hat you can expect the trial option t o be installed within 8 working days and yo u will then be informed about the success - ful installation via the SOMA TOM life mes sage window that appears during system star t-up. C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 63 Friday, A[...]

64 Application Information Image Conv er ter The CT Application Common DIC OM Adapter provides conv ersion between differ ent DIC OM data sets as they may be pr ovided by ot her CT vendors. – Y ou will find the conv er ter in the Application menu of the Patient Browser . In the pop-up window y ou can select the application for whic h you want to [...]

Application Information 65 After conversion y ou can load these data sets int o the application of your ch oice. C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 65 Friday, April 8, 2005 9:55 AM[...]

66 Application Information File Br owser The File Brow ser pro vides the ability to acces s and to manage your cr eated files: • Copy images and files to the CD Burn folder . • Access t o all created reports and movies (A VI files). • Access t o the offline fo lder . • Access to downloaded files. Open the File Brow ser via the main menu ent[...]

Application Information 67 Revie w reports and movies : – Select the desir ed f iles and double-click on them. – The corresponding prog ram, e.g., Movie Media Player will be opened and y ou can revie w what you hav e sav ed. – Now you can send these files to floppy or burn it on CD. Hint • Files with the following extensions canno t be star[...]

68 Application Information Patient Pr ot ocol Scan: number of scan range kV: kilo V olt mAs: av eraged applied mAs of the range ref. mA s: quality ref. mAs of the range TI: Rotation Time cSL: collimat ed Slice CTDI vol : C TDIw Pitch F actor For further information please ref er to the chap ter “Dose Inf ormation“. DLP: Dose Length Product CTDI[...]

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70 Head Over view – HeadRoutine Spiral mode f or base of the skull and cer ebrum rou - tine studies – HeadSeq Sequential mode f or base of the skull and cerebrum routine studies – InnerEarHR Spiral mode f or inner ear studies with a high resolu - tion k ernel – InnerEarSeqHR Sequence mode f or inner ea r studies with a high res - olution k [...]

Head 71 Hints in General • T opogram: Lateral, 256 mm. • Patient positioning: Patient lying in supine posi tion, arms resting against body , secure head well in the hea d holder , suppor t lower legs. • Gantr y tilt is av ailable for bo th, sequence and spiral scanning. Howe ver , image ar tifacts may occur if spirals ar e acquir ed with a ti[...]

72 Head HeadRoutine Indications : Spiral mode for r outine head studies, e.g., stroke, brain tumors, cranial trauma, cerebral atroph y , hydroceph - alus, and inflammation, e tc. T wo ranges are predefined for the base of the skull and cerebrum. A range for t he base of 4 cm will be covered in 23 sec., a range f or the cerebrum of 8 cm will be co v[...]

Head 73 Hints • An automatic bone correc tion allows for impro ved head image qu ality , without any additional post-pro - cessing. • In order t o optimize image quality v ersus radiation dose, scans are provided wit hin a maximum scan field of 300 mm with r espect t o the iso-center . No recon job with a field of vi ew ex ceeding those limits [...]

74 Head HeadSeq Indications : Sequence mode f or routine head studies, e.g., str o ke, brain tumors, cranial trauma, cerebral atroph y , hydro - cephalus, and inflammation, etc. T wo ranges are predefined. One f or the base of the skull and one for the cer ebrum, the scan length for the entire hea d is 12.4 mm. For both ranges a typical gantr y til[...]

Head 75 Hints • An automatic bone correc tion allows for impro ved head image qu ality , without any additional post-pro - cessing. • In order t o optimize image quality v ersus radiation dose, scans are provided wit hin a maximum scan field of 300 mm with r espect t o the iso-center . No recon job with a field of vi ew ex ceeding those limits [...]

76 Head InnerEarHR Indications: Spiral mode f or inner ear High Resolution studies, e.g., inflammator y changes, tumorous processes of pyra - mids, cerebellopontine ang le tumors, post-traumatic changes, etc. A range of 2.5 cm will be cover ed in 22 sec. InnerEar 2 nd reconstr . kV 130 Effective mAs 70 Rotation time 1.5 sec Slice collimation 1.0 mm[...]

Head 77 Hints • For image reconstruc tion of sof t tissue, use kernel H31s. • An automatic bone correc tion allows for impro ved head image qu ality , without any additional post-pro - cessing. • In order t o optimize image quality v ersus radiation dose, scans are provided wit hin a maximum scan field of 300 mm with r espect t o the iso-cent[...]

78 Head InnerEarHRSeq Indications : Sequential mode fo r inner ear s tudies, e.g., inflamma - tory changes, tumorous proces ses 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 cov ered. InnerEarSeq kV 130 Effective mAs 140 Rotation time 1.5 sec [...]

Head 79 Hints • For image reconstruc tion of sof t tissue, use kernel H31s. • An automatic bone correc tion allows for impro ved head image qu ality , without any additional post-pro - cessing. • In order t o optimize image quality v ersus radiation dose, scans are provided wit hin a maximum scan field of 300 mm with r espect t o the iso-cent[...]

80 Head Sinus Indications : Spiral mode for paranasal sinuses studies, e.g., sinusi - tis, mucocele, pneumatizatio n, polyposis, tumor , cor - rec tions etc. A range of 7 cm will be cov ered in 37 sec. Sinus 2 nd 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 F[...]

Head 81 Hints • An automatic bone correc tion and an advanced algo- rithm al lows f or impro ved head image quality , with- out any additional post-proces sing. • In order t o optimize image quality v ersus radiation dose, scans are provided wit hin a maximum scan field of 300 mm with r espect t o the iso-center . No recon job with a field of v[...]

82 Head SinusSeq Indications : Sequential mode f or paranasal sinuses studies, e.g., sinusitis, mucocele, pneumatiz ation, polyposis, tumor , correc tions etc. A range of 4.2 cm will be cover ed. 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 Ke r n e l H70s CTDI Vol 27.32 mGy Ef[...]

Head 83 Hints • An automatic bone correc tion and an advanced algo- rithm al lows f or impro ved head image quality , with- out any additional post-proces sing. • In order t o optimize image quality v ersus radiation dose, scans are provided wit hin a maximum scan field of 300 mm with r espect t o the iso-center . No recon job with a field of v[...]

84 Head Orbita Indications : Spiral mode for orbital studies, e.g., fr acture. A range of 2 cm will be cov ered in 12 sec. Orbita 2 nd reconstr . kV 130 Effective mAs 100 Rotation time 1.0 sec Slice collimation 1.0 mm Slice width 3.0 mm 1.25 mm Feed/Rotation 2.0 mm Pitch Factor 1.0 Increment 3.0 mm 0.8 mm Ke r n e l H70s H70s CTDI Vol 22.77 mGy Eff[...]

Head 85 Hints • An automatic bone correc tion and an advanced algo- rithm al lows f or impro ved head image quality , with- out any additional post-proces sing. • In order t o optimize image quality v ersus radiation dose, scans are provided wit hin a maximum scan field of 300 mm with r espect t o the iso-center . No recon job with a field of v[...]

86 Head Dental This is the scan pro tocol fo r the syngo Dental CT appli - cation package. It is used for evaluation and ref ormat - ting of the upper and low er jaw s. It enables the displa y and measurement of the bone structures of t he upper and lower jaw as the basis f or planning in oral surgery. Indications : Spiral mode for dental studies. [...]

Head 87 C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 87 Friday, April 8, 2005 9:55 AM[...]

88 Neck Over view – Neck Spiral mode for soft tissue routine neck studies C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 88 Friday, April 8, 2005 9:55 AM[...]

Neck 89 Hints in General • T opogram: Lateral, 256 mm • Patient positioning Patient lying in supine position, hyper extend neck slightly , secure head well in head holder . • Patient respirat o r y instruction: do not br eathe, do not swallow . • For contrast studies, CARE Bolus may be used to opti - mize the bolus timing. • For image r e[...]

90 Neck Body K ernels • As standard kernels f or body tissue studies B31s or B41s are recommended; softer images are obtained with B20s. • For higher sharpness, as is req uired e.g., in patient pro tocols fo r cer vical spine , shoulder , extremities, thorax, the kernels B50s, B60s, B70s a re available. • In case of 3D study only , use kernel[...]

Neck 91 C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 91 Friday, April 8, 2005 9:55 AM[...]

92 Neck Neck Indications : For soft tissue spiral studies in the cer vical region, e.g., tumors, lymphoma, abscesses e t c. 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 m m Ke r n e l B50s CTDI V[...]

Neck 93 Hints • Due to its iodine cont ent, the thyr oid gland is hyper - dense in relation t o the neighboring muscles bo th befor e and after an IV CM injection. For displays of the parotid, th yroid or the floor of the mouth, the slice thickness should be < 5 mm and the length of the range should be adapt ed to match t he anatomic reg io n [...]

94 Shoulder Over view – Shoulder Spiral mode for bone shoulder r outine studies C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 94 Friday, April 8, 2005 9:55 AM[...]

Shoulder 95 Hints in General • T opogram: TOP , 256 m m. • Patient positioning: Patient lying in supine position, the uninjured arm placed above the head, the injur ed 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 advisa[...]

96 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 co vered in 35 sec. C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 96 Friday, April 8, 2005 9:55 AM[...]

Shoulder 97 Hints • Use raw da ta to re view a target region if neces sar y . • For image reconstruc tion of sof t tissue, use kernel B31s and a slice width of 5.0 mm. • Coronal and sagittal 2D planar r econstructions are important for evaluation of the joint space & bursa sacs in CT ar thograms. • 3D renderings ar e helpful for complex[...]

98 Thorax Over view – ThoraxRoutine/ThoraxRoutine08s Spiral mode for r outine chest studies – ThoraxFast Spiral mode f or fast chest studies – ThoraxHRSeq Sequential mode f or high resolution lung studies – LungLowDose Spiral mode with ver y low dose for early visualiza - tion of patholo gies C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book[...]

Thorax 99 Hints in General • T opogram: TOP , 512 m m. • Patient positioning: Patien t lying in supine position, arms positioned comf or tably above the head in the head-arm rest, low er legs suppor ted. • Contrast medium administration: in general, IV injections are em ployed in all mediastinal examina - tions, but not in r outine high resol[...]

100 Thorax • Lung images should be documented in bo th soft tis - sue window and lung window. • It is also possible to interlea ve the soft tissue & lung setting images in one film shee t. This can be set up in the configur ation for filming. • T o fur ther optimize MP R image quality , we recom - mend that you r educe one or more of the [...]

Thorax 101 Body K ernels • As standard k e rnels f or body tissue studies B31s or B41s are r ecommended; softer images are obtained with B20s. • For higher sharpness, as is r equired e.g., in patient pro tocols f or cer vical spine , shoulder , extremities, thorax, the kernels B50s, B60s, B70s are available. C2-025.630.01.01.02_APPLICATIONGUIDE[...]

102 Thorax ThoraxRoutine/ ThoraxRoutine08s Indications : Routine spiral studies f or the region of thorax, e .g., examination of tumors, me tast ases, lymphoma, lymph nodes, vascular anomalies etc. A range of 30 cm will be cov ered in 23/18 sec. C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 102 Friday, April 8, 2005 9:55 AM[...]

Thorax 103 Hints • Y ou could repeat the same prot ocol by simply click - ing the chronicle with the right mouse butt on for “ repeat “, e.g., when both non-contrast and contrast studies are r equir ed. • For lung cancer ev aluation, this pro tocol can be com - bined with the pro tocol “Neck Routine”. ThorRoutine 2 nd reconstruction kV [...]

104 Thorax ThoraxF ast Indications : F ast spiral mode for lung studies, e.g., when a patient has diff iculty with breathhold. A comple te thorax scan in a range of 30 cm will be cov - ered in 14 sec. C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 104 Friday, April 8, 2005 9:55 AM[...]

Thorax 105 Hints • Y ou could repeat the same prot ocol by simply click - ing the chronicle with the right mouse butt on for “repeat“, e.g., when bo th non-contras t and contrast studies are r equir ed. • For lung cancer ev aluation, this pro tocol can be com - bined with the pro tocol “Neck Routine”. ThorF ast 2 nd reconstr . kV 130 Ef[...]

106 Thorax ThoraxHRSeq Indications: Sequence mode fo r HiRes lung studies, e.g., interstitial changes in the lungs. Images are acq uired with a range o f 30.1 cm. C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 106 Friday, April 8, 2005 9:55 AM[...]

Thorax 107 Hints • If you want to r econstruct thin slices every 1 5 or 20 mm instead of 10 mm as predefined, simply change the F eed/Scan before loading the mode. • With studies of interstitial ch anges in the lungs, con - trast medium is not necessary. ThorHRSeq kV 130 Effect ive m As 100 Rotation time 1. 0 sec Slice collimation 1.0 mm Slice [...]

108 Thorax LungLowDose Indications : Spiral lung studies wit h lo w dose se tting, e.g., early visualization of pulmonar y nodules. A typical thorax study in a range of 30 cm will be cov - ered in 32 sec. C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 108 Friday, April 8, 2005 9:55 AM[...]

Thorax 109 Hints • Y ou could repeat the same prot ocol by simply click - ing the chronicle with the right mouse butt on for “repeat“ , e.g., when both non-contrast and contrast studies are r equir ed. • For lung cancer ev aluation, this pro tocol can be com - bined with the pro tocol “Neck Routine”. • Low dose lung images are usually[...]

110 Abdomen Over view – AbdomenRoutine/AbdomenRoutine08s Spiral mode for routine abdominal studies – AbdomenFast Spiral mode f or fast abdominal studies – AbdMultiPhase/AbdMultiPhase08s Spiral mode f or three-pha se liver studies – AbdomenSeq Sequential mode f or abdominal studies C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 110 Fr[...]

Abdomen 111 Hints in General • T opogram: TOP , 512. • Patient positioning: Patient lying in supine po sition, arms positioned comfortably above the head in the head-arm re st, lower legs supported. • Patient respirat or y i nstruction: Inspiration. • Oral administration of contrast medium: For abdominal studies, it is necessary to delineat[...]

112 Abdomen • In general, for abdominal studies such as liver , gall bladder (query stones), pancreas, gastr ointestinal studies, focal lesion of the kidneys and CT A studies, it is suf ficient to use just water . Water is more effec - tive than positive oral contrast agent in depicting the linings of the stomach & intestines in post enhance [...]

Abdomen 113 Body K ernels • As standard k e rnels f or body tissue studies B31s or B41s are r ecommended; softer images are obtained with B20s. • For higher sharpness, as is r equired e.g., in patient pro tocols f or cer vical spine , shoulder , extremities, thorax, lung, the k ernels B 50s, B60s, B70s are a vail - able. C2-025.630.01.01.02_APP[...]

114 Abdomen AbdomenRo utine/ AbdomenRo utine08s Indications: Spiral mode f or all rout ine studies in the r egion of abdomen, e.g., evaluation, follow-up examinations etc. A typical abdomen scan in a range of 20 cm will be cover ed in 16/13 sec. C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 114 Friday, April 8, 2005 9:55 AM[...]

Abdomen 115 Hints • Y ou could repeat the same prot ocol by simply click - ing the chronicle with the right mouse butt on for “ repeat “, e.g., when both non-contrast and contrast studies are r equir ed. • Delay ed scans may be required f or the kidneys & bladder . AbdRoutine kV 130 Effect ive m As 60 Rotation time 0.8/1.0 sec Slice col[...]

116 Abdomen AbdomenF ast Indications : F ast spiral mode for abdominal studies, e.g., when a patient has difficulty with holding their breath. A range of 20 cm will be cov ered in 9.6 sec. C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 116 Friday, April 8, 2005 9:55 AM[...]

Abdomen 117 Hint • Y ou could repeat the same prot ocol by simply click - ing the chronicle with the right mouse butt on for “repeat“, e.g., when bo th non-contras t and contrast studies are r equir ed. AbdF ast kV 130 Effect ive m As 60 Rotation time 0.8 sec Slice collimation 5.0 mm Slice width 8.0 mm Feed/Rotatio n 20.0 mm Pitch F actor 2.0[...]

118 Abdomen AbdMultiPhase / AbdMultiPhase08s Indications : Spiral scan to assist the ph ysician with differential diagnosis of liver diseases. A typical native range of 20 cm will be covere d in 15 sec. C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 118 Friday, April 8, 2005 9:55 AM[...]

Abdomen 119 * CAR E Bolus may be used to optimize the bol us tim - ing. Set the ROI for monitoring scan in the abdominal aor ta at the beginning of the scan range with trigger - ing threshold of 120 HU, or use manual triggering. Non Contrast Arterial Phase Ve n o u s Phase kV 130 130 130 Effect ive m As 80 80 80 Rotation time 1.0 sec 0.8/1.0 sec 1.[...]

120 Abdomen Hints • Do not administer oral co ntrast medium, as this impairs the editing of MIP/SSD/VRT images. Use water instead if necessar y . • Wat er , rather than positi ve oral contrast agents should be used. Giv e the last cup of 200 ml just prior to positioning the patient. T o ensure adequat e filling of the duodenal loop, lay the pat[...]

Abdomen 121 C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 121 Friday, April 8, 2005 9:55 AM[...]

122 Abdomen AbdomenSeq Indications: Sequential mode f or all routine studies in the r egion 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 Ke r n e l B41s CTDI Vol 7.55 m Gy Effective dos[...]

Abdomen 123 Hints • Y ou could repeat the same prot ocol by simply click - ing the chronicle with the right mouse butt on for “repeat“, e.g., when bo th non-contras t and contrast studies are r equir ed. • Wat er , rather than positi ve oral contrast agents should be used. Give the last cup 200 ml just prior positioning the patient. T o ens[...]

124 Pelvi s Over view – Pelvis Spiral mode for routine soft tissue pelvis studies – Hip Spiral mode for r outine hip studies – SI_Joints Spiral mode for sacroiliac joints studies C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 124 Friday, April 8, 2005 9:55 AM[...]

Pelvis 125 Hints in General • T opogram: TOP , 512 mm for pelvis studies and 256 mm for studies of the hip and SI Joints. • Patient positioning: Patient lying in supine po sition, arms positioned comfortably above the head in the head-arm re st, lower legs supported. • A breathing command is no t necessarily requir ed for the pelvic examinati[...]

126 Pelvi s Pelvis Indications: Spiral mode for r outine pelvis studies, e.g., proces ses of the prostate, urinary bla dder , rectum, gynecological indications etc. A typical range of 20 cm will be covered in 12 sec. C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 126 Friday, April 8, 2005 9:55 AM[...]

Pelvis 127 * If the ex amination performed requires a full urinary bladder , wait at least 3 minutes follo wing IV adminis - tration of the contrast medium. Pelvis kV 130 Effect ive m As 80 Rotation time 1.0 sec Slice collimation 5.0 mm Slice width 8.0 mm Feed/Rotatio n 20.0 mm Pitch F actor 2.0 Incremen t 8.0 mm Ke r n e l B41s CTDI Vol 8.62 mGy E[...]

128 Pelvi s Hip Indications : Spiral mode for HiRes bone studies and soft tissue studies of the Hip, e .g., evaluation of joint cav ity , masses, trauma, dysplasia, necrosis of the head of the hip, congruence evaluatio ns, orthopedic indications etc. A typical range of 10 cm will be covered in 35 sec. C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.boo[...]

Pelvis 129 Hints • In case of 3D study on ly , images should be recon - struct ed with at least 50% o verlap in image recon - struction and kernel B20s. • If only one side is examined, it is advisable to enter the side in the comment line on the Routine card. Hip 2 nd reconstr . kV 130 Effect ive m As 70 Rotation time 1. 0 sec Slice collimation[...]

130 Pelvi s SI_Joints Indications : Spiral mode for bone studies of the sacroiliac joints. A typical range of 8 cm will be cover ed in 18 sec. SI_Joints 2 nd reconstruction kV 130 Effective mAs 80 Rotation time 1.0 sec Slice collimation 2.5 mm Slice width 3.0 mm 3.0 mm Feed/Rotation 5.0 mm Pitch Factor 1.0 Increment 3.0 mm 2. 0 mm Ke r n e l B70s B[...]

Pelvis 131 C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 131 Friday, April 8, 2005 9:55 AM[...]

132 Spine Over view – C-Spine Spiral mode for cervical spine studies – C-SpineSeq Sequential mode f or ce r vical spine studies – Spine Spiral mode for r outine lumbar and thoracic spine studies – SpineSeq Sequential mode f or lumbar and thoracic evaluation of the discs – Osteo Sequential mode used for the application syngo Osteo CT C2-02[...]

Spine 133 Hints in General • T op ogram: Lateral, 512 mm for thoracic and lumbar spine and 256 mm for the C-spine. • Patient positioning for thoracic and lumbar spine studies: Patient lying in supine po sition, arms positioned comfortably above the head in the head-arm re st, lower legs supported. • Patient positioning for cer vical spine stu[...]

134 Spine • The CT scan follo wing my elography must be per - for me d w it hi n 4 – 6 hours of the in jection, ot her - wise, the contrast density in the spinal canal will be too high t o obtain ar tifact-fre e images. Also, if possi - ble, it is a good idea to r oll the patient once, or scan in a prone position. This will prev ent the contras[...]

Spine 135 Body K ernels • As standard k e rnels f or body tissue studies B31s or B41s are r ecommended; softer images are obtained with B20s. • For higher sharpness, as is r equired e.g., in patient pro tocols f or cer vical spine , shoulder , extremities, thorax, lung, the k ernels B 50s, B60s, B70s are a vail - able. C2-025.630.01.01.02_APPLI[...]

136 Spine C-Spine Indications : Spiral mode for cervical spi ne studies, e.g., prolapse, degenerative changes, trauma , tumors etc. A range of 15 cm will be cov e red in 52 sec. C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 136 Friday, April 8, 2005 9:55 AM[...]

Spine 137 C-Spine 2 nd recons tr . kV 130 Effect ive m As 90 Rotation time 1. 0 sec Slice collimation 1.5 mm Slice width 3.0 mm 2. 0 mm Feed/Rotatio n 3.0 mm Pitch F actor 1.0 Incremen t 3.0 mm 1. 5 mm Ke r n e l B50s B5 0s CTDI Vol 9.70 mGy Effec tive d ose Male: 2.02 mSv Fema le: 2.07 mSv C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 137 [...]

138 Spine C-SpineSeq Indications : Sequential mode f or cer vical spine studies, e.g., pro - lapse, degenerative changes, trauma, tumors, etc. with a typical length f or each range of 1.2 cm. This pro tocol contains five ranges: C2-C3, C3-C4, C4-C5, C5-C6, C6-C7 C2-3 C3-4 C4-5 kV 130 130 130 Effective mAs 170 170 170 Rotation time 1.5 sec 1.5 sec 1[...]

Spine 139 Hints • Dental artifacts can be reduced by tilting the g antr y . • For MPRs and 3D post-pr ocessing, use spiral mode with thinner slice and reconstruct images with 50% ov erlap in image reconstruct ion. Define a long range to cov er the levels of inter est in one block. C5-6 C6-7 kV 130 130 Effect ive m As 17 0 190 Rotation time 1.5 [...]

140 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. C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 140 Friday, April 8, 2005 9:55 AM[...]

Spine 141 Spine 2 nd reconstruction kV 130 Effect ive m As 120 Rotation time 1.5 sec Slice collimation 2.5 mm Slice width 3.0 mm 3.0 mm Feed/Rotatio n 5.0 mm Pitch F actor 1.0 Incremen t 3.0 mm 2.0 mm Ke r n e l B31s B60 s CTDI Vol 12.94 mGy Effec tive d ose Male: 2.94 mSv Fema le : 6.75 mSv C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 141[...]

142 Spine SpineSeq Indications : Sequence mode for spine studies, e.g., prolapse, degenerative changes, trauma, tumors e tc. with a typ - ical length f or each rang e of 1.5 cm. This pro tocol contains three ranges: L3-4, L4-L5, L5-S1 Three different typical gant r y tilts are pr edefined: for L3-L4: 0°, f or L4-L5: + 5° and for L5-S1: +15° C2-0[...]

Spine 143 L3-4 L4-5 L5-S1 kV 130 130 130 Effect ive m As 220 220 235 Rotation time 1.5 sec 1.5 sec 1.5 sec Slice collimation 1.5 mm 1.5 mm 1.5 mm Slice width 3. 0 mm 3.0 mm 3.0 mm Feed/Scan 3.0 mm 3.0 mm 3.0 mm Ke r n e l B31s B31 s B31s CTDI Vol 23.72 mGy 23.72 mGy 25.33 mGy Effec tive d ose Male: 0.58 mSv Fema le: 0.92 mSv Male: 0.63 mSv Fema le:[...]

144 Spine Ost eo This is the scan pro tocol fo r the syngo Osteo CT appli - cation package t o assist the Physician with the q uanti - tative as sessment of vert ebral bone mineral density (BMD) in the diagnosis and f ollow-up of osteopenia and osteoporosis. For obese patients, increase the mAs value to 120. Load all ranges in the application “ s[...]

Spine 145 C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 145 Friday, April 8, 2005 9:55 AM[...]

146 Upper Extremities Over view – Wri s tH R Spiral mode for r outine high resolution wrist studie s – ExtrRoutineHR Spiral mode for r outine high resolution extr emity studies C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 146 Friday, April 8, 2005 9:55 AM[...]

Upper Extremities 147 Hints in General • T opogram: TOP , 256 mm for joint studies. • Patient positioning: Depends on the region of examination. In general, f or bilateral studies, you should alwa ys tr y to position the patient symme trical whenever the patient can comply . For wrists and elbow scans: Patient lying in prone position , hands st[...]

148 Upper Extremities Body K ernels • As standard kernels f or body tissue studies B31s or B41s is recommended; softer imag es are obtained with B20s. • For higher sharpness, as is req uired e.g., in patient pro tocols fo r cer vical spine , shoulder , extremities, thorax, lung, the k ernels B50s, B60s, B70s are a vail - able. C2-025.630.01.01.[...]

Upper Extremities 149 C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 149 Friday, April 8, 2005 9:55 AM[...]

150 Upper Extremities Wr i s t H R Indications : Spiral mode for HiRes bone study of the wrist, e.g., trauma, or thopedic indications etc. A range of 6 cm will be cov ered in 32 sec. C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 150 Friday, April 8, 2005 9:55 AM[...]

Upper Extremities 151 Hint • For image reconstruc tion of sof t tissue, use kernel B31s. Wr istHR 2 nd reconstruction kV 130 Effect ive m As 30 Rotation time 1.0 sec Slice collimation 1.0 mm Slice width 2.0 mm 1.25 mm Feed/Rotatio n 2.0 mm Pitch F actor 1.0 Incremen t 2.0 mm 0.8 mm Ke r n e l U90s U90s CTDI Vol 3.23 m Gy Effec tive d ose Male: &l[...]

152 Upper Extremities ExtrRoutineHR Indications : Spiral mode for HiRes bone study , e.g., trauma, or tho - pedic indications etc. A range of 10 cm will be cov e red in 52 sec. Hint • For image reconstruction of soft tissue, use k ernel B31s. ExtrHR 2 nd reconstruction kV 130 Effective mAs 30 Rotation time 1.0 sec Slice collimation 1.0 mm Slice w[...]

Upper Extremities 153 C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 153 Friday, April 8, 2005 9:55 AM[...]

154 Low er Extremities Over view – KneeHR Spiral mode for hig h resolution r outine knee studies – FootHR Spiral mode for hig h resolution r outine foo t studies – ExtrRout ineHR Spiral mode for hig h resolution r outine extr emity studies C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 154 Friday, April 8, 2005 9:55 AM[...]

Low er Extremities 155 Hints in General • T opogram: TOP , 256 mm for joint studies. • Patient positioning: Depends on the region of examination. In general, for bilat eral studies, you should alwa ys try to posi - tion the patient symmetrical whenev er the patient can comply . • For knee scan: Patient lying in supine position, feet fi r s t,[...]

156 Low er Extremities Body K ernels • As standard kernels f or body tissue studies B31s or B41s is recommended; softer imag es are obtained with B20s. • For higher sharpness, as is req uired e.g., in patient pro tocols fo r cer vical spine , shoulder , extremities, thorax, lung, the k ernels B50s, B60s, B70s are a vail - able. • In case of 3[...]

Low er Extremities 157 C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 157 Friday, April 8, 2005 9:55 AM[...]

158 Low er Extremities KneeHR Indications : Spiral mode for high r esolution studies of the knee, e.g., masses, trauma, disor ders of the joint etc. A range of 10 cm will be cov e red in 52 sec. C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 158 Friday, April 8, 2005 9:55 AM[...]

Low er Extremities 159 Hint • For image reconstruc tion of sof t tissue, use kernel B31s. KneeHR 2 nd reconstruction kV 130 Effect ive m As 35 Rotation time 1.0 sec Slice collimation 1.0 mm Slice width 3. 0 mm 1.25 mm Feed/Rotatio n 2.0 mm Pitch F actor 1.0 Incremen t 3.0 mm 0.8 mm Ke r n e l U90s U90s CTDI Vol 3.77 mGy Effec tive d ose Male: 0.0[...]

160 Low er Extremities FootHR Indications : Spiral mode for high r esolution studies of the fo ot, e.g., masses, trauma, disor ders of the joint etc. A range of 10 cm will be cov e red in 52 sec. Hint • For image reconstruction of soft tissue, use k ernel B31s. FootHR 2 nd reconstruction kV 130 Effective mAs 30 Rotation time 1.0 sec Slice collima[...]

Low er Extremities 161 ExtrRoutineHR Indications : Spiral mode for HiRes bone study , e.g., trauma, or tho - pedic indications etc. A range of 10 cm will be co vere d in 52 sec. Hint • For image reconstruc tion of sof t tissue, use kernel B31s. ExtrHR 2 nd reconstruction kV 130 Effect ive m As 30 Rotation time 1.0 sec Slice collimation 1.0 mm Sli[...]

162 Va s c u l a r Over view – HeadAngio/HeadAngio08s Spiral mode for head CT Angio studies – CarotidAngio/Car otidAngio08s Spiral mode for car otid CT Angio studies – ThorAngi o/ThorAngio0 8s Spiral mode f or chest CT Angio studies – Embolism Spiral mode for pulmonary embolism studies – BodyAngioRoutine/B odyAngioRoutine08s Spiral mode f[...]

Va s c u l a r 163 Hints in General • T opogram: TOP , 512/1024 or L A T 256 • Patient positioning: Patient lying in supine po sition, arms positioned comfortably above the head in the head-arm re st, lower legs supported. • Patient respirat or y i nstructions: inspiration. • Oral administration of contrast medium: The use of water will no [...]

164 Va s c u l a r HeadAngio/HeadAngio08s Indications : Spiral mode for cer ebral CT Angios, e.g., cer ebral vas - cular abnormalities, tumors and f ollow-up s tudies etc. A range of 6 cm will be cov ered in 32/26 sec. HeadAngio 2 nd reconstruction kV 130 Effective mAs 50 Rotation time 0.8/ 1.0 sec Slice collimation 1.0 mm Slice width 3.0 mm 1.25 m[...]

Va s c u l a r 165 Hints • Use of C ARE Bolus with monitoring scans positioned at the lev el of the basilar arter y or caro tid ar ter y . Set the trigger threshold at 120 HU , or use manual trig - geri ng. • An automatic bone correc tion and an advanced algo - rithm allo w for impr oved head image quality , with - out any additional post-proce[...]

166 Va s c u l a r Car otidAngio/Car otidAngio08s Indications : Noninvasiv e CT angiography of carotid st enosis or occlusions, plaques course abnormalities of the caro tids and vertebral ar teries, etc. A range of 12 cm will be cov e red in 32/26 sec. CarotidAngio 2 nd reconstruction kV 130 Effective mAs 55 Rotation time 0.8/1.0 sec Slice collimat[...]

Va s c u l a r 167 Hints • C ARE Bolus may be used t o optimize the bolus tim - ing. • Set the ROI f or monitoring scan in the aor tic arch with triggering threshold of 1 20 HU, or use manual triggering. • High quality 2D & 3D post-processing can be achiev ed using a thin slice thickness and 50% over - lap in image reconstruction. • MPR[...]

168 Va s c u l a r ThorAngio/ThorAngio08s Indications : Spiral study for loca tion a nd extent of aneurysms, dis - section, and ruptur es of the thoriac aor ta. A range of 20 cm will be cov e red in 24/19 sec. ThorAngio 2 nd reconstruction kV 130 Effective mAs 55 Rotation time 0.8/1. 0 sec Slice collimation 2.5 mm Slice width 5.0 mm 3.0 mm Feed/Rot[...]

Va s c u l a r 169 Hints • C ARE Bolus may be used t o optimize the bolus tim - ing. • Set the ROI f or monitoring scan in the aor tic arch with triggering threshold of 1 20 HU, or use manual triggering. • High quality 2D & 3D post-processing can be achiev ed using a thin slice thickness and 50% over - lap in image reconstruction. • Thi[...]

170 Va s c u l a r Embolism Indications : Spiral mode f or Pulmonary Emboli studies. A range of 15 cm will be cov e red in 24 sec. Embolism 2 nd reconstruction kV 130 Effective mAs 55 Rotation time 0.8 sec Slice collimation 1.5 mm Slice width 3.0 mm 2.0 mm Feed/Rotation 5.4 mm Pitch Factor 1.8 Increment 3.0 mm 1.5 mm Ke r n e l B31s B31s CTDI Vol 5[...]

Va s c u l a r 171 Hints • C ARE Bolus may be used t o optimize the bolus tim - ing. • Set the ROI f or monitoring scan in the pulmonar y trunk with triggering threshold of 120 HU, or use manual triggering. • Y ou could repeat the same prot ocol by simply click - ing the chronicle with the right mouse butt on for "repeat". Contrast [...]

172 Va s c u l a r BodyAngioRoutine/ BodyAngioRoutine08s Indications : Spiral mode f or abdominal CT A studies. A range of 20 cm will be cov e red in 39/31 sec. . BodyAngio 2 nd reconstruction kV 130 Effective mAs 55 Rotation time 0.8/1.0 sec Slice collimation 1.5 mm Slice width 5.0 mm 3.0 mm Feed/Rotation 5.4 mm Pitch Factor 1.8 Increment 5.0 mm 2[...]

Va s c u l a r 173 Hints • C ARE Bolus may be used t o optimize the bolus tim - ing. • Set the ROI f or monitoring scan in the abdominal aort a with triggering thre shold of 120 HU, or use manual triggering. • Do not administ er oral co ntrast medium, as this impairs the editing of MIP/SSD/VRT images. • Use wat er as oral contrast. • The [...]

174 Va s c u l a r BodyAngioF ast Indications : Spiral mode for longer co verage and lar ger vessels. A range of 20 cm will be cov e red in 18 sec. BodyAngio 2 nd reconstruction kV 130 Effective mAs 55 Rotation time 0.8 sec Slice collimation 2.5 mm Slice width 5.0 mm 3.0 mm Feed/Rotation 10.0 mm Pitch Factor 2.0 Increment 5.0 mm 2.0 mm Ke r n e l B[...]

Va s c u l a r 175 Hints • C ARE Bolus may be used t o optimize the bolus tim - ing. • Set the ROI f or monitoring scan in the abdominal aort a with triggering thre shold of 120 HU, or use manual triggering. • Do not administ er oral co ntrast medium, as this impairs the editing of MIP/SSD/VRT images. • Use wat er as oral contrast. • The [...]

176 Specials Over view The examination pr otocols designed for some of these applications are under t he “Special” folder . Tr a u m a In any trauma situation, time means lif e and the qual - ity of lif e for the survivor . In order to facilitat e the examinations, two pr otocols a re pr ovided. – PolyT rauma : This is a combined mode for the[...]

Specials 177 Tr a u m a In any trauma situation, ti me means life and the qual - ity of lif e for t he sur vivor . This is a combined mode for the examinatio n of multi - ple ranges, e.g., Head, Neck, Thorax, Abdomen and Pelvis. The Basics • Check that the emergency drug trolley is well stock ed and that all accessories such as in-r oom oxy - gen[...]

178 Specials PolyT raum a T wo times 2 combined recon jobs are predefined, head with neck and t horax with abdomen. A range f or the Head of 11 cm will be cover ed in 20 sec., a range for the Neck of 14 cm will be cov ered in 30 sec. T a ke a new T opogram for the thorax and abdomen ranges. Head Neck kV 130 130 Effective mAs 110 90 Rotation time 1.[...]

Specials 179 A range f or the Thorax of 25 cm will be cov ered in 15 sec., a range for the AbdPelvis of 20 cm will be cov - ered in 12 sec. • For long range scanning, pl ease pa y attention t o the mark of scannable range on the table mattress while positioning the patient. • In some cases, it might be advisable to position the patient fee t fi[...]

180 Specials HeadT rauma A spiral mode for emer gency head studies with a max. FoV of 500 mm. A typical scan range of 40/80 cm will be cov ered in 23/27 sec. Base Cerebrum kV 130 130 Effective mAs 110 110 Rotation time 1.5 sec 1.0 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 Incremen[...]

Specials 181 Inter ventional CT T o facilitate CT inter ventional procedures, the follow - ing pro tocols are pr ovided. Any of these pr otocols can be appended to a spiral pr otocol f or CT interventional procedures, such as biopsy , abscess drainage, pain therapy , minimum invasive operations, joint studies, and ar thrograms. Adjust the mAs accor[...]

182 Specials Biopsy Indications: This is the conv entional sequential mode without table feed using a 10 mm slice. Hint This pro tocol can be appended to a spiral pro tocol for CT interventional procedur es, such as biopsy , abscess drainage, pain therapy , minimum invasive operations, joint studies, and arthrograms. Biopsy kV 130 Effective mAs 80 [...]

Specials 183 Te s t B o l u s Indications : This mode can be used to test the start delay of an opti - mal enhancement after the contrast medium injec - tion. Te s t B o l u s kV 80 Effect ive m As 110 Rotation time 1.0 sec Slice collimation 5.0 mm Slice width 10.0 mm Feed/Scan 0.0 mm Ke r n e l B31s CTDI Vol 3.03 mGy C2-025.630.01.01.02_APPLICATIO[...]

184 Children Over view The scan pro tocols for childr en are defined accor ding to body regions – Head, Neck, Shoulder , Thorax, Abdo - men, Pelvi s, Spine, Upper Extr emities, Lower Extremi - ties, V ascular , Specials and P rivate. For childr en six (6) years and older , use the adult pro - toc ol s . Whenev er possible, 80 kV is used instead o[...]

Children 185 • Head – HeadRoutine_Baby Spiral mode for routine baby head studies – HeadRoutine_Child Spiral mode for routine children head studies – HeadSeq_Baby Sequential mode f or routine baby head studies – HeadSeq_Child Sequential mode f or routine childr en head studies – InnerEar Spiral mode for inner ear studies – SinusOrbi Sp[...]

186 Children • Spine – Spine_Baby Spiral mode f or routine bab y spine studies – Spine_Child Spiral mode for r outine children spine studies • Extremities – ExtrHR_Baby Spiral mode for r outine baby high resolution ext remi ty s tu di es – ExtrHR_Child Spiral mode f or routine c hildren high r esolution ext remi ty s tu di es • Va s c[...]

Children 187 Hints in General 1. T opograms: 256 mm lateral topograms are defined for the head modes, and 512 mm T OP topograms are defined fo r the body modes. Please k eep in mind that the children’s size can be dramatically different. Y o u should press the “Hold Measur ement“ button wheneve r the range shown on t he real-time g row - ing [...]

188 Children The proper personnel and equipment must also be readily a vailable in the ev ent of a problem. 6. Oral and rec tal contrast adminis tration: Depending on the reaso n for the e xam/status of the patient, oral contrast may or ma y not be given t o these patients. In general, oral contrast is recommended to opacify the intestinal trac t, [...]

Children 189 It is recommended t o use C ARE Bolus in order to achieve op timal cont rast enhancement. Both star t delay ti me and injection rat e are exam-/ patient-dependent. Whenever pos sibl e, I.V . injection with a power inject or is recommended fo r all scans . S o m e g u i d e l i n e s t o f o l l o w w i t h r e s p e c t t o f l o w r a[...]

190 Children Head K ernels • For head scans of small children, the k ernels C20s, C30s (e.g., for soft tissue studies) and C60s (e.g., for sinuses are pro vided) should be chosen instead of the ”adult” head k ernels H21s, H31s and H60s. • For the standard head pro tocols, we recommend C20s and C30s. • High resolution head studies should b[...]

Children 191 Body K ernels • As standard k e rnels f or body tissue studies B31s or B41s is recommended; sof ter images are obtained with B20s. • For higher sharpness, as is r equired e.g., in patient pro tocols f or cer vical spine , shoulder , extremities, thorax, the kernels B50s, B60s, B70s are available. The special k ernels are mostly use[...]

192 Children HeadRoutine_Baby Indications : Routine head spiral studies, e.g., brain tumors, cranial trauma, hydr ocephalus, hemorrhaging and other abnormalities etc. A range of 8 cm will be covered in 27 sec. * The conversion fac tor f or an 8-week -old child, and a scan range of 80 mm was used. Head kV 80 Effective mAs 122 Rotation time 1.5 sec S[...]

Children 193 Hints • Use this pro tocol for childr en below 6 months of age. • When bone structure is of inter est, use kernel C60s for image r econstruction. • In order t o optimize image quality v ersus radiation dose, scans are provided wit hin a maximum scan field of 300 mm with r espect t o the iso-center . No recon job with a field of v[...]

194 Children HeadRoutine_Child Indications : Routine head spiral studies, e.g., brain tumors, cranial trauma, hydr ocephalus, hemorrhaging and other abnormalities etc. A range of 8 cm will be cov ered in 27 sec. * The conversion fac tor f or a 7-year -old child, and a scan range of 80 mm was used. Head kV 130 Effective mAs 60 Rotation time 1.5 sec [...]

Children 195 Hints • Children, who a re more tha n 6 years old, should be scanned with an adult prot ocol as the skull by this time is fully grown. • When bone structure is of int erest, use k ernel C60s for image r econstruction. • In order t o optimize image quality v ersus radiation dose, scans are provided wit hin a maximum scan field of [...]

196 Children HeadSeq_Baby Indications : Sequential mode for routine head studies for children, e.g., tumors, hydrocephalu s, hemorrhaging, abnor - malities, e tc. A range of 8.25 cm is predefined. * The conversion fac tor f or an 8-week -old child, and a scan range of 82.5 mm was used. HeadSeq kV 80 Effective mAs 250 Rotation time 1.5 sec Slice col[...]

Children 197 Hints • Use this pro tocol for childr en below 6 months of age. • When bone structure is of inter est, use kernel C60s for image r econstruction. • In order t o optimize image quality v ersus radiation dose, scans are provided wit hin a maximum scan field of 300 mm with respect t o the iso-center . No recon job with a field of vi[...]

198 Children HeadSeq_Child Indications : Sequential mode for routine head studies for children, e.g., tumors, hydrocephalu s, hemorrhaging, abnor - malities, e tc. A range of 8.25 cm is predefined. * The conversion fac tor f or a 7-year -old child, and a scan range of 82.5 mm was used. HeadSeq kV 130 Effective mAs 120 Rotation time 1.5 sec Slice co[...]

Children 199 Hints • Children, who a re more tha n 6 years old, should be scanned with an adult prot ocol as the skull by this time is fully grown. • When bone structure is of int erest, use k ernel C60s for image r econstruction. • In order t o optimize image quality v ersus radiation dose, scans are provided wit hin a maximum scan field of [...]

200 Children InnerEar Indications : High Resolution Spiral mode f or inner ear studies, e.g., malf ormations of the inner ear , inflammatory changes, pathologies of the mastoid proces s, tumor proces ses of the pyramids, post-traumatic changes, etc. A range of 2.5 cm will be co vered in 22 sec. * The conversion fac tor f or a 7-year -old child, and[...]

Children 201 Hints • Children, who a re more tha n 6 years old, should be scanned with an adult prot ocol as the skull by this time is fully grown. • When soft tissue is of inter est, use k ernel H31s for image reconstruction. • In order t o optimize image quality v ersus radiation dose, scans are provided wit hin a maximum scan field of 300 [...]

202 Children SinusOrbi Indications : Spiral mode for r outine spiral studies of the sinuses and paranasal sinuses, e.g., sinusitis, pneumatization, polyposis, malf ormations, tumors etc. A range of 4 cm will be covered in 22 sec. * The conversion fac tor f or a 7-year -old child, and a scan range of 40 mm was used. SinusOrbi 2 nd reconstruction kV [...]

Children 203 Hints • Children, who a re more tha n 6 years old, should be scanned with an adult prot ocol. • In order t o optimize image quality v ersus radiation dose, scans are provided wit hin a maximum scan field of 300 mm with respect t o the iso-center . No recon job with a field of vi ew ex ceeding those limits will be possible. Ther efo[...]

204 Children Neck Indications : Spiral mode for r outine neck studies, e.g., tumors, lym - phoma, abscesses, e tc. A range of 15 cm will be cov e red in 19 sec. * The conversion fac tor f or a 7-year -old child, and a scan range of 150 mm was used. Neck kV 130 Effective mAs 26 Rotation time 1.0 sec Slice collimation 2.5 mm Slice width 5.0 mm Feed/R[...]

Children 205 Hints • If necessary , scan down t o the aortic arch or medi - astinum to include the entire lesion. • Cooperative childr en can be instructed to hold their breath during the acq uisition. • Children, who a re more tha n 6 years old should be scanned with an adult prot ocol. • Please change the mAs value according t o the age o[...]

206 Children ThoraxRoutine_Baby Indications : Spiral mode f or routine t horax studies, e.g., pneumo - nia, tumors, metastases, lymphoma, vascular abnor - malities e tc. A range of 15 cm will be covered in 17 sec. C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 206 Friday, April 8, 2005 9:55 AM[...]

Children 207 * The conv ersion fact or for an 8-week -old child, and a scan range of 150 mm was used. Hints • Use this pr otocol f or children below 35 k g. • The first and second recon jobs are defined for visu - alization of the mediastinum and the lungs, respec - tively . • Please change the mAs value according t o the weight of t he child[...]

208 Children ThoraxRoutine_Child Indications : Spiral mode f or routine t horax studies, e.g., pneumo - nia, tumors, metastases, lymphoma, vascular abnor - malities e tc. A range of 15 cm will be covered in 17 sec. C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 208 Friday, April 8, 2005 9:55 AM[...]

Children 209 * The conversion fact or for a 7-year -o ld child, and a scan range of 150 mm was used. Hints • Children with a body weight of more than 55 k g should be examined with an adult pr ot ocol. • The first and second recon jobs are defined for visu - alization of the mediastinum and the lungs, respec - tively . • Please change the mAs[...]

210 Children ThoraxHRSeq_Baby Indications : Sequence mode f or High Reso lution lung studies, e.g., interstitial changes of the lung parench yma, etc. A range of 20.1 cm is predefined. * The conversion fac tor f or an 8-week -old child, and a scan range of 201 mm was used. ThorHRSeq kV 80 Effective mAs 90 Rotation time 1.0 sec Slice collimation 1.0[...]

Children 211 Hints • Use this pr otocol f or children below 35 k g. • If you want t o acquire the patient at full inspiration or full expiration, y ou should practice the br eathing with the patient a fe w times before beginning the scan, so that repr oducibility may be impr oved. C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 211 Friday[...]

212 Children ThoraxHRSeq_Child Indications : Sequence mode f or High Reso lution lung studies, e.g., interstitial changes of the lung parench yma, etc. A range of 20.1 cm is predefined. * The conversion fac tor f or a 7-year -old child, and a scan range of 201 mm was used. ThorHRSeq kV 130 Effective mAs 70 Rotation time 1.0 sec Slice collimation 1.[...]

Children 213 Hints • Children with a body weight of more than 55 k g should be examined with an adult pr ot ocol. • If you want t o acquire the patient at full inspiration or full expiration, y ou should practice the br eathing with the patient a fe w times before beginning the scan, so that repr oducibility may be impr oved. C2-025.630.01.01.0[...]

214 Children Abdomen_B ab y Indications: Spiral mode f or routine studi es in the r egion of abdo - men and pelvis, e.g., tumors, lymphoma, abscesses, post-traumatic changes, etc. A range of 30 cm will be cov e red in 32 sec. * The conversion fac tor f or an 8-week -old child, and a scan range of 300 mm was used. Abdomen kV 80 Effective mAs 41 Rota[...]

Children 215 Hints • Use this pr otocol f or children below 35 k g. • Delay ed scans may be required f or the kidneys and bladder . • Rectal contrast ma y be requir ed for e valuation of pel - vic mass. • Please change the mAs value according t o the weight of t he child: 25 – 34 kg 70 mAs. C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book[...]

216 Children Abdomen_C hild Indications: Spiral mode f or routine studi es in the r egion of abdo - men and pelvis, e.g., tumors, lymphoma, abscesses, post-traumatic changes, etc. A range of 30 cm will be cov e red in 32 sec. * The conversion fac tor f or a 7-year -old child, and a scan range of 300 mm was used. Abdomen kV 130 Effective mAs 41 Rota[...]

Children 217 Hints • Delay ed scans may be required f or the kidneys and bladder . • Rectal contrast ma y be requir ed for e valuation of pel - vic mass. • Children with a body weight of more than 55 k g should be examined with an adult pr otocol. C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 217 Friday, April 8, 2005 9:55 AM[...]

218 Children Spine_Baby Indications : Spiral mode for spine stud ies, e.g., post-traumatic changes, tumors, malformations, or thopedic indica - tions, etc. A range of 15 cm will be covered in 32 sec. * The conversion fac tor f or an 8-week -old child, and a scan range of 150 mm was used. Spine 2 nd reconstruction kV 80 Effective mAs 110 Rotation ti[...]

Children 219 Hints • Use this pr otocol f or children below 35 k g. • Please change the mAs value according t o the weight of t he child: 25 – 34 kg 160 mAs. C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 219 Friday, April 8, 2005 9:55 AM[...]

220 Children Spine_Child Indications : Spiral mode for spine stud ies, e.g., post-traumatic changes, tumors, malformations, or thopedic indica - tions, etc. A range of 15 cm will be covered in 32 sec. * The conversion fac tor f or a 7-year -old child, and a scan range of 150 mm was used. Spine 2 nd reconstruction kV 130 Effective mAs 70 Rotation ti[...]

Children 221 Hint • Children with a body weight of more than 55 k g should be examined with an adult pr otocol. C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 221 Friday, April 8, 2005 9:55 AM[...]

222 Children ExtrHR_Baby Indications : Spiral mode f or high r esolution extr emity studies, e.g., post-traumatic changes, tumors, m alformations, etc. A range of 10 cm will be covered in 27 sec. * The conversion fac tor f or an 8-week -old child, and a scan range of the knee of 100 mm was used. ExtrHR kV 80 Effective mAs 50 Rotation time 1.0 sec S[...]

Children 223 Hints • Use this pr otocol f or children below 35 k g. • Please change the mAs value according t o the weight of t he child: 15 – 34 kg 80 mAs. C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 223 Friday, April 8, 2005 9:55 AM[...]

224 Children ExtrHR_Child Indications: Spiral mode for bone stud ies, e.g., tumors, post- traumatic changes, orthopedic indications, etc. A range of 10 cm will be cov e red in 27 sec. * The conversion fac tor f or a 7-year -old child, and a scan range of the knee of 100 mm was used. ExtrHR kV 130 Effective mAs 40 Rotation time 1.0 mm Slice collimat[...]

Children 225 Hint • Children with a body weight of more than 55 k g should be examined with an adult pr otocol. C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 225 Friday, April 8, 2005 9:55 AM[...]

226 Children HeadAngio Indications : Spiral mode for head CT angiograph y , e.g., cerebral vascular abnormalities, tumors etc. A range of 6 cm will be cov ered in 32 sec. * The conversion fac tor f or a 7-year -old child, and a scan range of 60 mm was used. HeadAngio 2 nd reconstruction kV 80 Effective mAs 81 Rotation time 1.0 sec Slice collimation[...]

Children 227 Hints • Children, who ar e more than 12 y ears old, should be scanned with an adult prot ocol as the skull by this time is fully grown. • C ARE Bolus may be used to op t imize the bolus timing with a triggering threshold of 120 HU, or use manual triggering. • An advanced algorithm allows f or impro ved head image quality , withou[...]

228 Children HeadAngio08s Indications : Spiral mode for head CT angiograph y , e.g., cerebral vascular abnormalities, tumors etc. A range of 6 cm will be cov ered in 26 sec. * The conversion fac tor f or a 7-year -old child, and a scan range of 60 mm was used. HeadAngio 2 nd reconstruction kV 80 Effective mAs 65 Rotation time 0.8 sec Slice collimat[...]

Children 229 Hints • Please change the mAs value according t o the age of the child: 6 – 12 years 80 mAs. • Children, who ar e more than 12 y ears old, should be scanned with an adult prot ocol as the skull by this time is fully grown C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 229 Friday, April 8, 2005 9:55 AM[...]

230 Children Car otidAngio Indications: Spiral mode for the car otid arteries, e.g., caro tid steno - sis or occlusion, vascular a bnormalities of the caro tids or vertebral arteries, e tc. A range of 10 cm will be cov e red in 27 sec. * The conversion fac tor f or a 7-year -old child, and a scan range of 100 mm was used. CarotidAngio 2 nd rec ons [...]

Children 231 Hints • Please change the mAs value according t o the age of the child: 6 – 12 years 75 mAs. • Children, who ar e more than 12 y ears old should be scanned with an adult prot ocol. • C ARE Bolus may be used to op t imize the bolus timing with a triggering threshold of 120 HU, or use manual triggering. C2-025.630.01.01.02_APPLIC[...]

232 Children Car otidAngio08s Indications: Spiral mode for the car otid arteries, e.g., carotid st eno - sis or occlusion, vascular a bnormalities of the caro tids or vertebral arteries, e tc. A range of 10 cm will be cov e red in 22 sec. * The conversion fac tor f or a 7-year -old child, and a scan range of 100 mm was used. CarotidAngio 2 nd rec o[...]

Children 233 Hints • Please change the mAs value according t o the age of the child: 6 – 12 years 75 mAs. • Children, who ar e more than 12 y ears old should be scanned with an adult prot ocol. • C ARE Bolus may be used to op t imize the bolus timing with a triggering threshold of 120 HU, or use manual triggering. C2-025.630.01.01.02_APPLIC[...]

234 Children BodyAngio Indications: Spiral mode for abdominal CT Angio studies, e.g., vas - cular abnormalities, aneur ysms, etc. A range of 10 cm will be cov e red in 19 sec. * The conversion fac tor f or a 7-year -old child, and a scan range of 100 mm was used. BodyAngio 2 nd recons tr . kV 80 Effective mAs 41 Rotation time 1.0 sec Slice collimat[...]

Children 235 Hints • Please change the mAs value according t o the weight of t he child: 35 – 44 kg 45 mAs 45 – 54 kg 60 mAs. • Children with a body weight of more than 55 k g should be examined with an adult pr ot ocol. • C ARE Bolus may be used t o optimize the bolus tim - ing. Set the ROI f or the monitoring scan in the abdominal aor t[...]

236 Children BodyAngio08s Indications: Spiral mode for abdominal CT Angio studies, e.g., vas - cular abnormalities, aneur ysms, etc. A range of 10 cm will be cov e red in 15 sec. * The conversion fac tor f or a 7-year -old child, and a scan range of 100 mm was used. BodyAngio 2 nd recons tr . kV 80 Effective mAs 35 Rotation time 0.8 sec Slice colli[...]

Children 237 Hints • Please change the mAs value according t o the weight of t he child: 35 – 44 kg 45 mAs 45 – 54 kg 60 mAs. • Children with a body weight of more than 55 k g should be examined with an adult pr ot ocol. C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 237 Friday, April 8, 2005 9:55 AM[...]

238 Children NeonateBody Indications : Spiral mode f or routine neonate body studies, e.g., tumors, abnormalities, malf ormations, abscesses, etc. A range of 15 cm will be cov e red in 17 sec. * The conversion fac tor f or a 7-year -old child, and a scan range of 150 mm was used. NeonateBody kV 80 Effective mAs 41 Rotation time 1.0 sec Slice collim[...]

Children 239 Hints • Use this pro tocol f or children below 1 month of age. • C ARE Bolus may be used t o optimize the bolus tim - ing. Set the ROI f or the monitoring scan in the abdominal aor ta with triggering threshold of 120 HU, or use manual triggering. • Y o u can modify the slice width fo r image reconstruc - tion according to the cli[...]

240 syngo 3D The 3D car d of fers the pos sibility to combine two- dimensional images to form three-dimensional vie ws. T o do this, the 3D card pr ovides you with the f ollowing methods: Multi Planar Reconstruction (MPR) Interactiv e navigation thr ough 3D volumes in arbitrar y orientations. • Or thogonal, oblique or do uble-oblique orientation.[...]

syngo 3D 241 Shaded Sur face Display (S SD) Sur face display of complex anatomies. • 3D display of surfaces from a series of contiguous slices using a var iable threshold. • The display ed volume consist of vo xels whose HU are in a range defined by two limit values, an upper and a lower threshold (= HU limit s). • Display and analyze various[...]

242 syngo 3D Prerequisites At least 3 and maximum of 1600 images must hav e been loaded to proces s 3D; (with more than 1600 images the series will be split up). All images must hav e the same x/y coordinates and FoV . • Y ou should close any data sets that you no longer need in order t o release memor y space and maintain application performance[...]

syngo 3D 243 Image Representation on the 3D Card The image area on the 3D card is divided into four seg - ments: – Refer ence segment (sagittal view) – Refer ence segment (coronal view) – Refer ence segment (transversal view) – Output segment The first thre e segments are r efer ence segments, the fourth segment is an o utput segment. In th[...]

244 syngo 3D Defining Output T ypes Y ou can change the output type fo r a segment at any time, i.e., from Multi Planar Reconstruction (MPR) to Maximum Intensity Pr ojection (MIP), t o Shaded Sur - face Display (SSD), or t o Volume Rendering T echnique (VRT). Depending on your working me thod, you will first gen - erate a ref erence image, for exam[...]

syngo 3D 245 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 generat e a series of projections a nd views of the volume each ro tated around a defined ang le. In this way , you simu - late a step-b y-step rotation. For exam ple, for color[...]

246 syngo 3D Editing A common problem in evaluating medical images is that areas r elevant t o an examination are hidden b y other struc tures, especially bones. The necessary image information is contained in the volume data set but must be made visible wi th suitable editing steps. 1. VO I mo de : With a V olume of Interest (V OI), you extract a [...]

syngo 3D 247 3. 3D Object Editor: Easy elimination of obstructing informa tion. • Easy volume confinement with clip-box or variable editing slab. • F ast object creation with thr eshold operations or automatic volume gro wing. • Multiple editor objec ts ca n be displayed wit h differ - ently colored SSD. • Complet e object subtrac t io n wi[...]

248 syngo 3D Regi on Gr owing Normally in th e first step yo u will generate one or mo re “objects“ from the v olume data set originally loaded in 3D. By specifying a limited vox el value range you extract only a section of the vox e ls from the original data set. In this wa y , you generate an objec t in the result segment. Instead of extra ct[...]

syngo 3D 249 Like editing v olume data sets in the VOI mode, you can use the 3D Editor , too. Y ou are prov ided with tools f or cutting out str uctures from an object that you ha ve previously generat ed. Using the Slab Editor yo u can define your own cutting depth. Morphological Operations In some cases it will not be simple t o separate the stru[...]

250 syngo 3D W o rkflow f or a CT Extremity Examination Using MPR/MPR Thick 1. Load the series to MPR. 2. Manipu late the volume to evaluate anatom y: a) Orientate the image volume f or the best view of the a natomy . b)Adjust the window as necessar y . c) Pan and zoom image as necessary . 3. Scroll thr ough the vo lume quickl y using the 3D cros s[...]

syngo 3D 251 Using SSD 1. Load the series to S SD. Hint: Do not use a series with a high resolution k er - nel, e.g., kernel 10 or 20 is r ecommended. 2. Ma ni pula te th e volu me to eva lu ate an atomy: a)Orientate the image v olume for the best view of the anatom y . b)Adjust the threshold as neces sar y . c)Pan and zoom image as necessar y . d)[...]

252 syngo 3D Wo r k f l o w fo r a C T Angiograph y Using MIP/MIP Thin 1. Load the series to MIP . 2. Manipu late the volume to evaluate anatom y: a)Orientate the image volume f or the best view of the anatom y . b)T o eliminate unwanted bone, either ac tivate MIP Thin or use V OI punching/3D Objec t Editor . c)Adjust the window as necessary . d)Pa[...]

syngo 3D 253 Using VRT/VRT Thin/Clip 1. Load the series to VRT . 2. Manipulate volume to evaluat e anatom y: a)Orientate the image vo lume for the best view of the anatom y . b)T o eliminate unwanted bone, either ac tivate VRT Thin/Clip or use VOI punc hing/3D Object Edit or . c)Select VRT pr eset fr om VRT galler y . d)Adjust window , opacity , co[...]

254 syngo 3D Hints in General Setting View s in the V olume Data Set Three-dimensional image pr ocessing allows y ou to cr e - ate images in any orientation and position within the data volume. Y ou can "move" thr ough the volume and ro tate it in any direc tion. Depending on the me thod you ar e using, various aids are available t o you.[...]

syngo 3D 255 The plane is then no longer perpendicular t o either of the coordinate ax es. The image orient ation is display ed as a combination of three orientation labels. – The subtask card Orientation w i l l a l w a y s g i v e y o u t h e ability to re turn immediately back to the beginning or to an y st andard view . – View perpendicular[...]

256 syngo 3D If the default settings are not appr opriate f or your diag - nostic problem, y ou can alter them individually . In that way y ou can emphasize the structur es of interest in an optimum wa y . – Ramp and trapezoid manipulation: Ramps and trap - ezoids are functions whic h define window and ren - dering settings. T rapezoids can also [...]

syngo 3D 257 Auto Load in 3D and Post-proces sing Presets Y ou can activate the Auto load in 3D func tion on the Examination card/ Auto T asking and link it to a recon job. On the 3D car d you ha ve the possibility t o create Ranges Parallel and Radial pro tocols which can be linked t o a special series name. – Select the image type – Select th[...]

258 syngo Fly Through syngo Fly Through is a Vir tual CT Endoscopy Sof tware integ rated into t he syngo 3 D f u n c t i o n a l i t y . I t o f f e r s t h e possibility to r ender endoluminal views of struc tures such as the air ways and v essels from v olume data sets. Vir tual CT Endoscopy simulates diagnostic conv en - tional endoscopic proced[...]

syngo Fly Through 259 Prer equisites This sof tware w orks with CT , MR and conv entional Angiographic data sets. CT A dat a set with good vess el enhancement for virtual angioscopy . V olume data set acquired with ov er lapping thin slice CT technique. The Basics f or CT V ir tual Endoscopy SSD and VRT Presets for Endoscopic Renderings In order to[...]

260 syngo Fly Through Endoscopic Viewing Parameters/Fly Cone Settings In general, the shape of a py ramidal cone can be used to repr esent visualization of an endoscopic volume. The boundaries and the viewing perspec tive of the endoscopic volume are defined b y adjusting the shape and size of this cone. Cone setting f o r flying through t he airwa[...]

syngo Fly Through 261 • Standing P oint – The cone rotat es around the vie wing point. • Viewing Point – The complet e cone moves. • Clipping Point – The cone rotat es around the standing point. • Viewing Angle – Is changed by mo ving one of the sides of the angle. • Viewing Distance – The distance from the standing t o the view[...]

262 syngo Fly Through Patient Preparation Bony and cartilaginous structures such as the central airway and bronch ial tree, the osteomeatal syst em of the Paranasal Sinuses are inhe r ently filled with air and theref ore ideal for performing Vir tual CT Endoscopy . No special preparations ar e required. For CT endoscopic ev aluation of the vessel ([...]

syngo Fly Through 263 Wo rk f l ow Load the images in 3D. The following standard lay o ut is display ed: Segment 1: Sagittal view Segment 2: Coronal view Segment 3: T r ansversal vie w Segment 4: Fly segment wi th perspectiv e SSD as default Scroll through the MPR images until you r each an image where yo u would like t o star t the CT endoscopic e[...]

264 syngo Fly Through Position the Reference lines at that point of interest e.g., in the trachea. Click the Fly Thr ough icon to ac tivate the endoscopic display in the f our th segment. The default endoscopic displ ay has the same orienta - tion (viewing dir ection) as the last select ed image seg - ment in which you placed the point of inter e s[...]

syngo Fly Through 265 Navig ation of the Endoscopic V olume •M a n u a l N a v i g a t i o n Click with the right mouse button in the Fly segment to ac tivate the SmartSelect menu. The following contr ols are av ailable: – auto-na vigation – push/pull – ro tate around viewing point –r o t a t e v i e w Adjust the viewing direc tion and se[...]

266 syngo Fly Through Fly Path Planning Open the Fly Path Planning. Create a path by inserting path points i n the volume during navig ation. C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 266 Friday, April 8, 2005 9:55 AM[...]

syngo Fly Through 267 The relevant se ttings (viewing direction, vie wing angle etc.) ar e stored along the path. After defining and storing a path, it is pos sible to play back the entire na vigation along the path as a movie or to jump straight t o the section of the endoscopic v ol - ume predefined by the path points. Note: Only one pat h can be[...]

268 syngo Dental CT This is an application package for r eformatting pan - oramic views and pa raxial slices through the upper and lower jaw . It enabl es the display and measurement of the bone structures of t he upper and lower jaw (espe - cially for a 1:1 scale) as the basis f or oral surger y plan - ning. The Basics What is the relevant anatomi[...]

syngo Dental CT 269 Panoramic view Paraxial view Scan Pr ot ocols Y ou will find the Dental scan pro tocols under body regio n “ Hea d”: Dental kV 130 Effect ive m As 45 Rotation time 1.0 sec Slice collimation 1.0 mm Slice width 1.25 mm Feed/Rotatio n 2.0 mm Pitch F actor 1.0 Incremen t 0.5 mm Ke r n e l H60s CTDI Vol 10.25 mGy Effec tive d ose[...]

270 syngo Dental CT • It is mandatory to position the patient head in the center of the scan field – use the lateral laser light mark er for positioning. • Gantr y tilt is not necessary since you have the ability to tilt the ref erence line to generate an axial refor - matted image at the desired plane. Ho wever , in order to minimize the sca[...]

syngo Dental CT 271 Additional Impor tant Inf ormation • The Dental scan pro tocol delivers high resolution images for syngo Dental CT evaluation, ho wever , you can also reconstruc t images with sof ter kernel, e.g., H20s, for 3D/S S D post-processing. TO P-c ranial view Caudal view C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 271 Frida[...]

272 syngo Dental CT • Image orientation: – In the paraxial vie w , a “B” indicates buccal and a “L ” lingual. The lingual marker “+” must always be positioned at the tongue. If not, sim ply drag & drop it bac k. – In the panoramic view , a “B” stands for “Begin” and an “E” for “End”. • Filming : for th e maxi[...]

syngo Dental CT 273 • ROI definition f or statistica l evaluations and deletion of graphics is possible. Paraxial lines using ”Cluster”. • In the control area, y ou can configure if you want to display the paraxial lines orthogonal to the r eference line. C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 273 Friday, April 8, 2005 9:55 A[...]

274 syngo Osteo CT This is an ap plication package for the quantitative assess ment of vertebral bone mineral density f or the diagnosis and f ollow-up of osteopenia and osteopor o - sis. The Basics This program enables the qu antitative det ermination of bone mineral density (BMD) of the spine in mg/ml of calcium hydr oxyapatite (CaHA) t o assist [...]

syngo Osteo CT 275 Scanning Pr ocedure Scan Protocols Y ou will find the Osteo scan pr ot ocols under body region “Spine”: Osteo kV 80 Effect ive m As 81 Rotation time 1.0 sec Slice collimation 5.0 mm Slice width 10.0 mm Feed/Scan 0.0 mm Ke r n e l S80s CTDI Vol 2.23 mGy Effec tive d ose Male: 0.03 mSv Female: 0.08 mSv C2-025.630.01.01.02_APPLI[...]

276 syngo Osteo CT The special k ernels are mostly used for ”ph ysical” mea - surements with phantoms, e.g., for adjustment pr oce - dures (S80s), f o r constancy and acceptance tests (S80s, U90s), or for specification purposes (U90s). For special patient pro tocols, S80s and U90s are chosen, e.g., for Osteo (S80s) and f or high resolution bone[...]

syngo Osteo CT 277 • Position the cut line of scanning through the middle of the vertebra, i.e. bi-sect or 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 t o end the exam first, and t hen star t the syngo Osteo CT ev aluation. • Do not use the c[...]

278 syngo Osteo CT Configuration In the Ost eo configuration you can define the follo w- ing parame ters: Yo u c a n • use the Siemens standard ref erence database or cre - ate and import your own • change betw een 1 and 2 standard deviations (dis - play of the summar y graph) • use the Siemens Reference phant om or enter values for bone and [...]

syngo Osteo CT 279 How can you sav e the results on your PC? – Selec t Option/Co nfiguration from the main menu and click icon ”CT Osteo”. – Activat e the checkbo x “Enable Expor t of Results”. – “Exit” the configuration dialog. – C a l l u p t h e Osteo card and you will see the new icon “Expor t results” on the lower , rig[...]

280 syngo Osteo CT Example for one patient with three Ost eo tomo - grams : P A TIENT; 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; 20 5.8; 192.0; 198 .7; 50.6; 47.5; 49.5 IMAGE; L3; 236; 3; 27-JAN-1998; 11:12:18; 60. 4; 54.5; 49.3; 22.3; 21.1; 21.8; 21 0.5; 191.9; 180 .7; 50.4; 47.5; 52.3[...]

syngo Osteo CT 281 Abbreviations: TML T r abecular Mean Left TMR T rabecular Mean Right TMT T rabecular Mean T otal TSL T r abecular Standard Deviation Left TSR T r abecular S tandard Deviation Right TST T rabecular Standard Dev iation T otal CML Cortical Mean Lef t CMR Cortical Mean Right CMT Cor tical Mean T otal CSL Cortical Standar d Deviation [...]

282 syngo Osteo CT Evaluation W orkflow After loading the images i nto the syngo Ost eo CT appli - cation, pres s “Start Evaluation“. Check the corr ect positioning of the ROIs in the Calibra - tion phantom. Y ou can change the position by moving the two cir cles. Correcting cont our lines Y ou can per form corr ection of the contours b y movin[...]

syngo Osteo CT 283 1. Center of the spinal canal (C) 2. Uppermos t point of the co rtical spinal body (A) 3. Intermediate point (L) 4. Intermediate point (R) 5. Uppermos t point of the spinal canal (T) – Click on a base point w ith the mouse. – Mov e it keeping t he left mouse k ey pres sed. If you are satisfied wit h the contours press “ Acc[...]

284 syngo Osteo CT The other summar y image displays a graph whic h shows the comparison of all e valuated vertebrae with the select ed Reference Data. “T - s c o re ” This is the deviation of av erage BMD of the patient from tha t of a young health y comparison gr oup. It rep - resents bone loss with r eference t o the peak bone mass . “Z-sc[...]

syngo Osteo CT 285 The second and the four th segment belong toge ther . The second segment shows the tomogram images with the contours superim posed. The fourth segment shows the calculat ed resu lts of the corresponding tomogram image. Both segments ar e bordered by the same color . If you scr oll through one of these seg - ments the other segmen[...]

286 syngo Osteo CT After “End Evaluation“ the ev aluation results are auto - matically sav ed in three series: – Summar y contains both images of the third segment –C o n t o u r s contains the tomogram images with t he contours superimposed (second segment) –T a b l e s contains the result tables f or each vertebra (fourth segment ) C2-0[...]

syngo Osteo CT 287 Additional Impor tant Inf ormation • F ractur ed vertebrae are not suited f or syngo Osteo CT evaluation since the mor e compact natur e of these vertebrae result in bone mineral density value that is much higher than one would expect. • When you ex amine a patient who is older than 80 years, the patient examination data cann[...]

288 syngo Vo l u m e E v a l u a t i o n V olume is an evaluat ion function which al lows most accurate calculation of a vo lume out of a st ack of two- dimensional images. This can be done by V olume-of-Inter est (VOI) defini - tion and by limiting the minim um and maximu m den - sity (HU) values for calculation. Different views of the image data [...]

syngo Vo l u m e E v a l u a t i o n 289 • Interac tive outlining of freehand and elliptical Regions-of-Interest is a vaila ble, with the possibility to define evaluation (HU) limits inside the V OI. • Aut omatic interpolat ion between tw o pending ROIs is per formed, i.e. the user only has to define the ROI in select ed images within the stack[...]

290 syngo Vo l u m e E v a l u a t i o n Prer equisites The images must fulf ill the following conditions: • Only images of one patient must be loaded for eval - uation with Volume. • The scans must ha ve been acquir ed with the same table height and the same gantry tilt. • Only image data sets with the same slice orientat ion must be used; ([...]

syngo Vo l u m e E v a l u a t i o n 291 Wo rk f l ow 1. Loading the Images After loading t he images int o syngo Volume E valua - tion, the following la yout is displayed: • Segment 1: Display of sagittal im ages. The images are sorted fr om left to right, according to the patient ’s anatomy . • Segment 2: Display of coronal images. The imag[...]

292 syngo Vo l u m e E v a l u a t i o n 2. Preparing Volume Calculation Before y ou star t the volume definition, f irst optimize the display of the images. T o mak e interactiv e volume definition easier , you can • delete images t hat you do not re quire f o r volume cal - culation from the original data set • change the display of the image[...]

syngo Vo l u m e E v a l u a t i o n 293 3.1. Planning a Volume with Automatic V olume Detec - tion The automatic met hod is best used to evaluat e a struc - ture which has a different contrast (HU) t han the sur - rounding tissue, such as the lung. Y o u plan the volume with just a few clicks. Auto matic V olume De tec tion uses the 3D r egion gro[...]

294 syngo Vo l u m e E v a l u a t i o n Restrict ing Automa tic V olume Det ection Y ou can restrict Aut omatic V olume Detection t o a defined smaller volume. • Draw an ROI aro und the image area of inter est on at least the first and the last image that you w ant to be included in the volume. The ROIs define t he bound - ing box f or the autom[...]

syngo Vo l u m e E v a l u a t i o n 295 The contours of the ROIs define the out er border of the evaluated v o lume. Y ou do not need t o define the ROIs on every slice. The system automatically interpolat es ROIs on the images which lie be tween the images with defined ROIs. • Check the images and searc h for the desired objec t structure. • [...]

296 syngo Vo l u m e E v a l u a t i o n • T o include only a specific range of HU values int o the volume, change the Evaluation Limits. By default, the Evaluation Limit s take all HU values of the last evaluation. • T o star t the evaluati on, click the Start Evaluation bu t - ton. The evaluation re sults are displayed in segment 4. The volum[...]

syngo Vo l u m e E v a l u a t i o n 297 Overlap and Mark&Link Method Y ou can define complex volumes using the automatic (overlap) and manual (mark&link) me thod. • Overlapping me thod Drawn ROIs that overlap each o ther ver tically for at least a few pix els are automatically combined to one volume. Interpolat ed ROIs (dott ed line) are[...]

298 syngo Vo l u m e E v a l u a t i o n With the Ov erlap method, y ou can also create a v ol - ume from two ROIs that do not overlap in t he first step. It is t he n n ece ss ary t o d ra w a n RO I in an im age wh ic h lies between the tw o other ROIs, so that the ne w ROI overlaps wit h the two pre vious ROIs. This way , you can easily define a[...]

syngo Vo l u m e E v a l u a t i o n 299 4. Evaluation Results When you click the Start Eval uation button, the system calculates the planned volume within t he evaluation limits. The evaluation results are displa yed in segment 4. Only the statistic parameters that are set in the configura - tion dialog box ar e calculated. V olume pixels and eval[...]

300 syngo Vo l u m e E v a l u a t i o n 5. Documentation of Results If all volumes are e valuated, you can sa ve and film the result s. Sa ve – st ores to your local database: • The transv ersal image s with the color -coded VOI • The refo rmatted images (s agittal, cor onal, MPR/MIP) • The displayed result shee t T wo new series are creat[...]

syngo Vo l u m e E v a l u a t i o n 301 • ROI and V olume Definition – If y ou inser t/modify an ROI, the system automati - cally plans the ROIs on the preceding/following images (interpolated ROIs) up to that image with the pre vious/next user-defined ROI. – User -defined ROIs have a solid contour line, whereas int erpolated ROIs ha ve a do[...]

302 syngo Vo l u m e E v a l u a t i o n • Restrictions for Linking and Unlinking There are some restrictions f or linking and unlinking: – Linking can be done on user-defined ROIs as well as on interpolated ROIs. If you link an interpolated ROI (dott ed line), it beco mes a user-confirmed ROI (solid line). – Y ou cannot unlink interpolated R[...]

syngo Vo l u m e E v a l u a t i o n 303 Configuration In the V olume Configuration dialog box, you define which evaluation results are giv en by V olume Evalua - tion. – Unit of V olume mm 3 V olume is given in mm 3 . cm 3 Vo lume is given in cm 3 . C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 303 Friday, April 8, 2005 9:55 AM[...]

304 syngo Vo l u m e E v a l u a t i o n – Statistical Parameters Volume V olume is calculate d in the defined unit: mm 3 or cm 3 . Max. height [cm] Maximum height of the r econ - struct ed volume. Max. width [cm] Maximum width of the recon - struct ed volume. Max. dep th [cm] Maximum dep th of the r econ - struct ed volume. Mean value [HU] Mean [...]

syngo Vo l u m e E v a l u a t i o n 305 C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 305 Friday, April 8, 2005 9:55 AM[...]

306 Dynamic ev aluation is a func tion which allows y ou to analyze the absolute or r e lative 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 e valu - ation, usually images fr om th[...]

syngo Dynamic Evaluation 307 •U s e o f syngo functions lik e dog-ea rs or cine mode for fast paging through the image stack. • Easy selection, modificati on and dele tion handling for the ROIs. • Constant display of the time-density curves with a scalable sampling line, and of t he tabular results which display f or each separate ROI – the[...]

308 syngo Dynamic Evaluation Prer equisites In dynamic evaluation, images that wer e s canned as part of an examination with contrast agent at a con - stant table position are evaluated. • The selection consists only of CT tomogram images. • The images belong to t he same study . • The images were acq uired within 1 hour . • Images of at le[...]

syngo Dynamic Evaluation 309 Wo rk f l ow 1. Loading the Images After loading t he images int o syngo Dynamic Evalua - tion, the follo wing layout is displa yed: • T omo segment The loaded input images are display ed in the upper left-hand segment. The images are sorted by the acquir ed time. • Paramet er image segment Paramet er images are dis[...]

310 syngo Dynamic Evaluation • Baseline image segment The baseline image is displa yed 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. • Result segment It is black after loading. 2. Inspecting the Input Images Befor e you begin the e valuation, op[...]

syngo Dynamic Evaluation 311 E a c h ti m e y o u m a k e a c h a n g e t o t h e o r i g i na l d a t a s e t (by remo ving images, and/or defining a new baseline image) your syst em recalculates the paramet er images based on the existing images. – The av erage image is an averaged addition of all pixels at eac h pixel location acro ss the imag[...]

312 syngo Dynamic Evaluation – Peak Enhancement image: Paramet er image wher e each pixel indicates the enhancement at that pix el location. CT value of a pixel = maximum value found at that pixel location (pixel value of the MIP image) – CT value of the baseline imag e at that pixel lo cation. With a Peak Enhancement image, for example, y ou c[...]

syngo Dynamic Evaluation 313 4. Creating a Baseline Imag e A baseline image is used as a basis for all enhancement calculations. The enhancement is calculated r elatively t o the base - line image. Therefor e, the baseline image must show the state befor e enhancement star ts. By default, the first image of the loaded images is used as the baseline[...]

314 syngo Dynamic Evaluation 5. Evaluation of Region of Interests Y ou select the image regions t o be evaluated b y mark - ing them with ROIs or applying the pixel lens (a circular ROI with a fixed but configurable diame ter). An abso - lute/r elative C T -value calculation i s performed f or these select ed image. • Y ou can draw either ellipti[...]

syngo Dynamic Evaluation 315 6. Enhancement Curve As soon as you hav e defined an ROI, an enhancement cur ve (time-density cur ve) is calculated and displa yed in the fourth segment. T o facilitate identification, this cur ve has the same color and numbering as the associ - ated ROI. The maximum CT -value of the ROI first drawn is indicated by a da[...]

316 syngo Dynamic Evaluation 7. Documentation of Results During the evaluation you ha ve dra w n individual ROIs and hav e generated enhancement curves and r esult tables. Y ou can sav e and print out this inf ormation or stor e it on a floppy f or fur ther processing. T o document the evaluation, two ne w series are stored to y our local database.[...]

syngo Dynamic Evaluation 317 General Hints • Slice Position with Multi-Row Scanners When you use a multi-r ow scanner , several slice posi - tions are scanned per acquisition. When y ou load the images, the window Slice Selection is displa yed, in which you can define the slice position t o be analyzed. Y ou can evaluate either the scanned examin[...]

318 syngo Dynamic Evaluation • Filtering T o reduce noise in the Time to Peak and Peak Enhance - ment image you can apply a smoothing filter . Filtering does no t af fect the evaluation of ROIs. • Moving the Sam pling Line If you want t o evaluate the enhancement values f or a different point in time, move the sampling line in the horizontal di[...]

syngo Dynamic Evaluation 319 • Relative Enhancement Curve Time Axis (X) The point of time f or an image is comput ed relativ e to the point of time at which the fir st input image was acquir ed: Point of Time = Acquisit ion Time – Acq uisition Time of the First Image + Delay • Enhancement Axis (Y) The mean C T value o f each ROI is plotted on[...]

320 syngo Dynamic Evaluation • Configuring Dynamic Evaluation Y ou can make the f ollowing settings in DynEva Config - uration: – Calculate Time to Peak Image A Time to Peak Image is generat ed and displayed in the upper right-hand segment. Y o u can use the image for RO I definition. – Calculate Peak Enhancement Image A Peak Enhancement Imag[...]

Autho rized Repres entative according to the Med ical Device Directiv e 93/42/EEC Siemens AG Medical Solution s Henkestr . 127 D-91052 Erlangen Germany T elephone: +49 9131 84-0 www .siemens.com/medical Manufac turer Siemens Shanghai Medical Equipment Ltd . (SSME) 278 Jin Hu Road 201206 Shanghai, P .R. China T elephone: +86 21 50320300 © 2002-2005[...]