Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
December 2014
Issue 34
News
Business
Clinical Results
Science
Dose Inspection
a Reason to be Proud
Page 18
Diagnosis of a Complex
Pediatric CHD using
ECG-Triggered Adaptive
Sequential Cardiac CT
Page 66
Editorial
Cover page:
A control study of a liver metastasis after microwave ablation treatment
a normal CT image with contrast (left), a monoenergetic image at 50keV
(middle), and a fused VNC/iodine image (right) show a hypodense lesion in
the liver and in the right kidney. The image contrast is greatly increased by
monoenergetic imaging. And both lesions show no significant enhancement
in the fused VNC/iodine image, therefore, residual tumor tissue can be
confidently excluded and a kidney cyst can be diagnosed.
Courtesy of University Hospital Erlangen-Nuremberg, Erlangen, Germany
Editorial
Dear Reader,
It is my great pleasure and privilege to
present our 34th SOMATOM Sessions
magazine.
As this is my first editorial for this prestigious magazine, I think a short introduction is warranted. I have been with
Siemens for 31 years now and with
Healthcare for the past 15 years. From
2003 until 2012, I was head of the
Healthcare for India and the neighboring countries. Since October 2012,
Ihave been based at CR headquarters
leading global sales. As of August 2014,
I have additionally been in charge of
global marketing.
To me, SOMATOM Sessions is really a
magazine by our users and for our users.
This is your platform to share your
experiences and knowledge with fellow
clinicians worldwide. Of course, we
also seize the opportunity to present our
exciting new technological developments. It is extremely encouraging to
see the enthusiastic participation from
many different parts of the world
Europe/Americas/Asia from research
institutes to stand-alone imaging centers from users of SOMATOM Force
to SOMATOM Scope.
In our cover story, we are delighted to
bring you details of our latest innovation TwinBeam Dual Energy1 our
pathbreaking Dual Energy solution for
SOMATOM Definition Edge and
SOMATOM Definition AS+. About 10
years back, we introduced the Dual
Energy solution to our Dual Source CT
scanners and, since then, have been
constantly setting higher standards and
developing new clinical applications
using the Dual Energy concept. With
Raghavan Dhandapany,
Vice President CT Marketing
and Sales
1
Contents
December 2014
Contents
06
Cover Story
News
Clinical Results
Cardiovascular
48 Discovery of a Type II Endoleak after EVAR in
a Patient with Renal Insufficiency using Dynamic
4D CT Angiography
50 Low Dose Coronary CT Angiography using ECG-Gated
Retrospective Spiral CT
52 Diagnosing a Bilateral Iliac Artery Stenosis using
Runoff CT Angiography
54 Comprehensive Cardiac CT Study for
Simultaneous Evaluation of the Coronary Arteries
and the Myocardium
Business
40 Flexible Flash for a Forward-Thinking Hospital
44 SAFIRE by the Numbers
46 Balancing Clinical and Business Demands
Oncology
56 CT Volume Perfusion Imaging in a Case of Suspected
Pancreatic Cancer
Acute Care
58 Whole-Body CTA with Reduced Radiation Dose and
only 20 mL of Contrast Media
60 Identification of Posterior Cruciate Ligament Avulsion
using Dual Energy CT
62 Retained Endoscopy Capsule: Metal Artifact Reduction
with Monoenergetic Imaging
Contents
18
40
66
72
Customer Excellence
64 Dual Energy CT Assessment of Amiodarone
InducedLiver Damage
Pediatrics
66 Diagnosis of a Complex Pediatric CHD using
ECG-Triggered Adaptive Sequential Cardiac CT
68 Persistent Bilateral Patent Ductus Arteriosus and
Confluent Pulmonary Arteries a Rare Congenital
Cardiac Malformation
70 Evaluation of Williams-Beuren Syndrome in a Twomonth-old Child using a Single Rotation Scan Mode
Science
72 SOMATOM Force from Translational Research
to Clinical Routine
77 FAST Spine and FAST Planning
78 Leading Concept in High-End CT Imaging
80 Dual Energy: Spectral CT More Precisely Defined
Professor Michael Lell, MD, senior radiologist at University Hospital Erlangen-Nuremberg in Germany is convinced that establishing the new
SOMATOM Definition Edge functionalities will transform routine procedures in his maximum-care hospital. TwinBeam Dual Energy brings to his
everyday clinical practice those clinical applications that have been well established in Dual Source systems. Iterative metal artifact reduction (iMAR)
enables great outcomes for patients with metallic implants undergoing cancer treatment. And ADMIRE offers further potential to reduce X-ray dose.
TwinBeam
Cover Story
1A
1B
Cover Story
2A
2B
Cover Story
Algorithm to reduce
metal artifacts
Metal artifacts also play a considerable
role in Lells everyday work. Cardiac
patients have stents, pacemakers or
implantable defibrillators. Many patients
have amalgam fillings or metal crowns,
Artifacts due
to amalgam fillings
In the case of a squamous cell car
cinoma in the mouth or throat, CT
isoften requested to determine the
infiltration depth of the tumor and
the nodal status, says Lell. However,
at least two thirds of our patients
have fillings or metal crowns in their
mouth, which can conceal smaller
lesions in the oral cavity on CT images,
even though the tumors are clinically
evident. His close collaboration with
the Departments of Head and Neck
Surgery and Oral and Maxillofacial
Surgery means that he is regularly
confronted with this problem. German
S3 guidelines therefore favour MRI
rather than CT for cancers in the oral
31520136XX_39L_SI_IMAR_Grafik.indd
1
The
new SOMATOM Definition
Edge corrects metal artifacts using the iMAR algorithm, which employs iterative artifact correction. The metal image data
is not simply suppressed; instead, the missing image information is supplemented from other parts of the sinogram. With an additional beam-hardening
correction and the adaptive sinogram mixing Siemens has developed an algorithm that exceeds standard metal artifact reduction.
01.10.14 15:07
References
E. Meyer, R. Raupach, M. Lell, B. Schmidt, and M. Kachelrie. Frequency split metal artifact reduction (FSMAR) in CT.
Med. Phys. 39(4):1904-1916, April 2012
E. Meyer, R. Raupach, M. Lell, B. Schmidt, and M. Kachelrie. Normalized metal artifact reduction (NMAR) in computed tomography.
Med. Phys. 37(10):5482-5493, October 2010
SOMATOM Sessions | December 2014 | www.siemens.com/SOMATOM-Sessions 9
Cover Story
300,000
Hip prostheses:
220,000
Knee prostheses:
170,000
Pacemakers:107,000
Implantable Cardioverter Defibrillators:
45,000
Shoulder prostheses:
8,000
Artificial discs:
7,000
5,000
2,600
2,500
1,500
reach the detector for certain projections. This makes it difficult to assess
the interface between bone and metal,
Lell explains. But this is precisely the
area of interest. Orthopedic surgeons
want to know whether the screws and
plates are placed optimally and whether
the fractures are healing adequately.
3B
Two axial images show that the image quality is greatly enhanced with ADMIRE reconstruction (Fig. 3B) although only 21 mGy dose
was applied to this three-year-old boy.
Courtesy of Luzerner Kantonsspital, Luzern, Switzerland
University Hospital Erlangen-Nuremberg is a maximum-care facility that covers the entire spectrum of clinical disciplines.
It also receives referrals of complex cases from the surrounding area.
Further Information
www.siemens.com/
SOMATOM-Definition-Edge
News
1
1
The schematic
visualization of
aTwinBeam scan
shows the simultaneous acquisition
of datasets.
2A
2B
Clinical benefits
of TwinBeam Dual Energy
TwinBeam Dual Energy enables simultaneous acquisition of high- and lowenergy datasets. Therefore it is possible
to use True Dual Energy applications
on single source CT systems with no
compromise on dose. The full range
ofdose reduction techniques such as
ADMIRE2 and CARE Dose4D can be
implemented consistently for compliance with the ALARA principle.
Among the major clinical benefits are,
for example, evaluations of pulmonary
embolism using syngo.CT DE Lung
Analysis. This application provides
immediate diagnostic information such
as location of the affected vessel and
details of the perfusion defect in the
parenchyma, at a glance. TwinBeam
Dual Energy together with syngo.CT
DE Direct Angio delivers a bone-free
view of the vascular system, making
iteasier to assess cardio-vascular
diseases.
Initial clinical results have proven the
concept of TwinBeam Dual Energy with
positive outcomes. Iodine maps in
thelungs, liver, and kidneys show the
iodine distribution throughout the
entire volume and produce artifact-free
virtual non-contrast (VNC) images.
Dual Energy bone removal also works
very well, for both the thorax-abdomen
scans as well as for the head. This indi-
Conclusion
TwinBeam Dual Energy meets the
technical requirements for the use in
clinical routine entirely without any
compromises. The Dual Energy CT
application portfolio on syngo.via
isnow available for cases acquired
using single source Dual Energy. p
News
Gudrun Feuchtner, MD, Innsbruck Medical University, Austria (left) and Francesca Pugliese, MD, PhD, William Harvey Research Institute, Queen Mary
University, London, UK (right) are both radiologists and carry out research to establish the usefulness of stress myocardial CT perfusion imaging.
News
4
1
A 56-year-old female
presented with unstable
angina chest pain to
the emergency department ten hours after
onset. ECG and cardiac
enzymes were normal.
CCTA discovered normal
RCA, CX and LAD,
but suggested septal
branch occlusion.
2A
2B
3
2
Static CT perfusion
displayed a matching
large subendocardial
anteroseptal perfusion
defect (Figs. 2A and 2B)
and the corresponding
wall motion abnormality
(Hypokinesis, Fig. 3).
SOMATOM Sessions | December 2014 | www.siemens.com/SOMATOM-Sessions 15
News
5
5
A 55-year-old female
presented to the rapid
access chest pain clinic,
showing atypical chest
discomfort (retrosternal,
triggered by stress but
with inconsistent relationship with exercise). She
had hypertension and
hyperlipidemia as cardiovascular risk factors. CCTA
showed eccentric, mild
plaque in the LM (arrow)
and moderate plaque
more distally in the LAD
(dashed arrow). RCAand
CX were normal.
6A
6B
6C
7
7
This was confirmed by invasive
angiography with fractional
flowreserve in the LAD of 0.82,
indicating no lesion-specific
ischaemia. RCA and LCxwere
confirmed to be normal.
Courtesy of Centre for Advanced
Cardiovascular Imaging, Queen Mary
University of London, London,
GreatBritain
News
News
Laurent Collignon, MD, Head of the Medical Imaging Centre at CHR La Citadelle and his team perform 40 pediatric CT scans per month.
For these especially vulnerable and all other patients, they are focussing on lowering patient exposure.
Dose Inspection
a Reason to be Proud
CHR La Citadelle in Lige, Belgium, is among the hospitals with the lowest radiation
doses in the country. For more than fifteen years, the imaging department of CHR
La Citadelle has been focused on lowering patient exposure. It regularly receives
questions from well-informed parents anxious about the level of radiation that will be
used during the medical treatment of their child. CHR La Citadelle has two SOMATOM
Perspective CT scanners from Siemens one for the emergency department and one
in the general radiology department.
Text: Erika Claessens, Photos: Bert Janssen
News
radiation doses, close to or sometimes even below the standard 25 percentile. Inorder to exclude any errors
in reporting, a second check has been
made and confirmed the 25 percentile, which became standard for La
Citadelle.
Monitoring patient
radiation dose
Raising awareness
Laurent Collignon points out: For more
than fifteen years, the Imaging Department of CHR La Citadelle has been
focused on lowering patient radiation
doses. Even my predecessor, radiologist
Leon Rausin, MD, always emphasized
the importance of lowering radiation
dose as much as possible. At the time,
people were becoming increasingly
concerned about the radiation from
medical imaging equipment, and governments and environmental organizations felt the need to start prevention
campaigns to raise awareness among
citizens.
Nevertheless, he will never refuse to
use computed tomography, he explains,
because it can be a life-saving tool. I
work in one of the busiest emergency
News
AV Controlatom
Founded in 1965, AV Controlatom
(AVC) is a certified independent,
non-profit organization licensed
by the Belgian Federal Agency
for Nuclear Control (FANC). Its
main objective is to assure the
radiation protection of workers
in nuclear environments, the
public, and the environment
against medical, industrial, and
natural sources of ionizing radi-
1A
1B
Number of Patients
6.90
60
12.96
50
40
30
20
10
0
0
10
12
14
16
18
20
22
2A
2A
Number of Patients
27.25
52.80
2B
50
40
30
20
10
0
8 10 12 14 16 18 20 22 24 26 28 30 32 34 36
Dose values in CTDIvol (mGy)
1
2A Pediatric head scans: In Belgium the recommended dose levels
for pediatric head scans are between 27.25 and 52.80 CTDIvol (mGy).
The graph above shows the dose distribution for 498 children scanned
on the two installed SOMATOM Perspective CT systems at CHR La
Citadelle in Lige, Belgium. All scans were performed far below the
max. recommended dose level of 52.80 CTDIvol (mGy).
1
ccording to the Belgian Federal Agency for Nuclear Control (FANC) recommended
A
dose levels, released on Oct 10 th, 2012.
CHR La Citadelle
CHR La Citadelle is one of the largest public hospitals
in the French-speaking part of Belgium, with 1,036
beds, of which 128 are reserved for children. Offering
a hospital for all, and health for everyone, CHR
La Citadelle employs over 400 physicians, treating all
kinds of health conditions in adults and children,
using cutting-edge technology. The childrens department of CHR La Citadelle is widely recognized as a
university reference center.
Further Information
www.siemens.com/
SOMATOM-Perspective
News
teamplay
Connecting the Imaging World
teamplay is a network of healthcare professionals and patients with the
common goal of advancing medicine and human health in a team effort. By
connecting medical institutions and their imaging devices, teamplay aspires
to create an extensive virtual imaging team with global reach. It provides
its members with tools to deal effectively with big data and the challenges
of increasing cost pressures.
By Ivo Driesser*, Florian Reinhold**
**Computed Tomography, Siemens Healthcare, Forchheim, Germany
**syngo, Siemens Healthcare, Erlangen, Germany
teamplay Usage1
teamplay Usage improves imaging
efficiency by providing a clear overview of usage data and a comparison
with readily available benchmark
information. From a daily summary
ofthe fleet, to a detailed analysis of
utilization trends, Usage enables
easyaccess to an institutions performance parameters. By continually
comparing institutional performance
with that of partners and with global
benchmarks, it offers the key to further improvement potential.
With teamplay Usage the exact usage of all the medical equipment even across multiple
sites of one institution can be monitored, and the answers to many questions can be found
with just a few clicks.
News
teamplay Dose1, 2
teamplay Dose provides easy access
to current and historical dose data to
support quality assurance processes
inmonitoring imaging radiation dose.
teamplay Dose will display data for continuous dose performance evaluation
regardless of the modality or vendor.
This allows efficient dose data analysis,
benchmarking against other institutions,
and providing comparisons with current
industry standards to increase dose
efficiency. The solution gives an overview of protocols used according to
type and target region. teamplay Dose
makes dose events visible to allow for
timely analysis and implementation
ofmeasures inresponse to abnormal
events. Display of dose events is based
on specific institutional reference levels
as well as on nationally defined targets.
teamplay Dose also provides an intuitive and easy way to map institution
protocols onto standard protocols.
teamplay Dose provides easy access to current and historical dose data to support
quality assurance processes in monitoring imaging radiation dose.
Further Information
www.siemens.com/teamplay
Professor Jrg-Christian
Tonn, MD, Professor
Stefan Zausinger, MD,
and Associate Professor
Christian Schichor, MD
(from left to right) are
convinced that using
intraoperative CTis in
the interests not only
of the patients but also
of surgical specialists
other than neurosurgeons and the administrators in their hospital
in Munich, Grosshadern.
Intraoperative CT
Better Views for Neurosurgeons
The Neurosurgical Department at the University Hospital Grosshadern
inMunich, Germany, was one of the first to introduce intraoperative CT
imaging in neurosurgery. Now the hospital is beefing up its capacities.
SOMATOM Sessions talked to three pioneers of this technology in brain
surgery, spinal surgery, and neurovascular surgery. They argue that intra
operative CT can increase patient safety, results in a smoother neuro
navigation workflow, and has a reasonable cost-benefit ratio.
Text: Philipp Grtzel von Grtz, Photos: Alberto Venzago
Neurosurgery without imaging is like
a cake without sugar almost unthinkable. When Professor Jrg-Christian
Tonn, MD, Director of Department of
Neurosurgery at the University Hospital Grosshadern, is resecting a brain
tumor, he needs to know exactly
where the malignancy is located. This
means we have to perform imaging
up-front. And we also need to check
the result of our resection.
News
can be used pre-operatively and intraoperatively. At Grosshadern, the neurosurgeons became interested in using
the SOMATOM Definition AS in a sliding gantry configuration as an intraoperative CT system some years ago.
And for a few good reasons: Compared
with MRI, CT is cheaper and requires
less maintenance; it does not need
shielding and thus major construction
activities; there is almost no interference with surgical workflows; and conventional surgical instruments can be
used.
By using intraoperative CT
it becomes easier to preserve delicate structures,
and at the same time we
can be more certain that
we have removed the
tumor as completely as
possible.
Professor Jrg-Christian Tonn, MD,
Department of Neurosurgery,
University Hospital Grosshadern, Munich
Tumor surgery:
Where exactly is the brain?
The specific benefits of intraoperative
CT are best illustrated with typical
patient scenarios. Professor Tonn uses
a neuronavigation system to resect
brain tumors with the goal of preventing further brain damage. But a neuronavigation system is only as reliable as
the images that it can draw upon: We
usually have preoperative MRI images.
However, during surgery, many things
change. When we resect tumors of the
brain tissue, the brain might shift to one
side or the other. And in meningioma
patients, the surgical field changes due
to the drilling that needs to be done to
remove this tumor, which can involve
the adjacent bony region. Using intraoperative CT allows the dataset for the
neuronavigation system to be updated
whenever necessary. The result is that
intraoperative CT imaging with the
SOMATOM Definition AS becomes easier to preserve delicate structures, and
at thesame time we can be more cer1A
1B
1
Intraoperative CT-imaging after
navigated screw placement in L4:
All screws are placed correctly and
completely within the pedicles
and vertebral bodies without
damage to surrounding structures.
Please note the dorsally positioned
radiotranslucent retractor, which
can be left in place during the
scanning procedure without
causing artifacts to the images
(Fig. 1A). Postoperative X-ray
image of the lumbar spine confirms correct position of transpedicularly placed screws in
vertebral L4 and L5 (Fig. 1B).
News
In order to minimize
risks resulting from
malpositioning of
implants, I routinely
use intraoperative
CT for spinal fusion
surgery.
Professor Stefan Zausinger, MD,
Department of Neurosurgery,
University Hospital Grosshadern,
Munich
Clipping of aneurysms:
What about perfusion?
In aneurysm surgery, there is no navigation. Nevertheless, intraoperative
CT can make abig difference. Professor
Schichor started using intraoperative
CT in patients in need of aneurysm
clipping surgery four years ago. Three
to four such surgeries are performed
in Grosshadern per week, and many
of them take advantage of intraoperative CT. Patients with complicated
vessel lesion, for example large aneurysms, or aneurysms that are partially
thrombosed, benefit most from intraoperative CT, says Schichor. When
using intraoperative CT, he looks specifically at CT angiography and CT
perfusion scans: In CT angiography,
we see whether the vessel patency is
preserved. And with CT perfusion
scans, we can have a look at the distant perfusion in order to evaluate
whether the clipping has some detrimental effect on other brain regions.
Dynamic CT imaging allows them
obtain functional information, beyond
tissue morphology. With CT perfusion
imaging it is possible to obtain information about blood flow, blood volume,
and various other perfusion metrics as
permeability, time to drain, time to
peak and mean transit time. With 4D-CT
angiography one can see movies of
blood flow from arterial to venous phase
to assess the hemodynamic status of
the tissue.
Schichor says that no other imaging
modality is capable of providing this
kind of information intraoperatively:
With MRI and ultrasound, you are
always dealing with the problem of
visual artifacts produced by the clips.
And conventional angiography tells us
nothing about distant brain perfusion.
Looking back, Schichor recalls several
patients in whom the surgeon who
performed the clipping was convinced
that he had occluded the aneurysm.
Only intraoperative CT revealed that
this was not the case. We also had
one patient in whom a large aneurysm
was pressing the clip downwards toward
the vessel. Only in the perfusion CT
did we see an elative perfusion deficit
in distant regions of the brain. We corrected the clipping, and perfusion was
back to normal.
Intraoperative CT:
Advantages in terms of
safety, usability, and costs
It is these kinds of patient that best
illustrate the benefits of intraoperative
Further Information
www.siemens.com/
sliding-gantry
News
Stellar Detector:
A Slovakian Success Story
in Coronary Artery Surgery
To improve cardiac diagnosis and follow-up after stent placement,
Jessenius diagnostic center upgraded the SOMATOM Definition Flash with
two new Stellar detectors. Following the upgrade, Jessenius is now better
able to monitor the functioning of stents and to plan treatment and coronary
artery surgeries in an optimized way.
Text: Marcela Fuknov, Photos: Thomas Steuer
During the examination, thepatient benefits from the increased image c ontrast and faster acquisition.
Economical upgrade
Martin Halaj, MD, a certified radiologist and head of the board at Jessenius
center, recognizes the Stellar detector
as a cutting-edge technology: It
improved the quality of examinations,
precision, diagnostics, and significantly
reduced the radiation dose for patients
when used in combination with SAFIRE.
News
Stent monitoring
The SOMATOM Definition Flash now
with the Stellar detector featuring innovative Edge technology allows clinicians
to streamline the monitoring of patients
with a stent. We can monitor the correct deployment of the stent, and are
able to verify the patency of the stent
much more precisely than before. We
look at sharper images with less blooming of calcifications and metal stent
struts now. The high image quality provides more diagnostic confidence making it easier to determine restenosis or
thrombosis, says Halaj.
Improved diagnostic
confidence
Further Information
www.siemens.com/
SOMATOM-Definition-Flash
News
SOMATOM Scope:
Cost-Saving Quality
As a global pioneer in a time of tight budgets, the Portuguese Institute of
Oncology, Lisbon, Francisco Gentil (IPOLFG) was the first clinic worldwide
to install the new SOMATOM Scope, delivering high-quality clinical outcomes
in an economical way.
Text: Manuel Meyer, Photos: Pedro Guimares
A world premiere
One of the ways in which we
answered this question was the acquisition of the SOMATOM Scope CT
Efficient usage
Venncio is experiencing the extremely
high reliability and low maintenance
costs of the SOMATOM Scope. The scanner features innovative eMode technology that analyzes scanning parameters
in real time and instantly finetunes the
scan with the right balance between
dose, image quality, and efficiency.
This means the system is not operated
at peak, reducing wear and tear to all
movable parts. He also cites the benefits of the eStart function, which gently
preheats the X-ray tube after extended
periods of non-use to avoid the stress
of cold starts. The result is high reliability both from the scanner and the
tube.
In IPOLFG, almost one third of all patients undergo CT imaging for diagnostic and therapeutic monitoring.
News
1A
1B
High quality
Further Information
www.siemens.com/
SOMATOM-Scope
News
The Berufsgenossenschaftliche
Unfallklinik (BGU), located close to
the University Hospital Tbingen is a
major trauma center in south-west
Germany.
In mid-2012, the hospital decided to
replace their older system with the
SOMATOM Definition Edge. BGU was
one of the first customers to install
a SOMATOM Definition Edge in combination with Dual Energy to reduce
metal artifacts. The Siemens high-end
single source CT is equipped with the
renowned Stellar detector technology
and several further dose reduction
features. It is now easier for clinicians
at BGU to evaluate tissue and bone
structures near to metal implants
(screws, nails, plates) than with previous CT generations. Metal implants
can, therefore, be removed earlier
from patients.
News
1
1
A male patients lower
extremity was scanned
with only 0.18/0.20 mSv.
Femur shaft intra
medullary nailing could
clearly be displayed by
reducing metal artifacts
providing higher diagnostic confidence.
Courtesy of BGU,
Tbingen, Germany
2
2
The monoenergetic
CTscan showed distal
radius fracture with
synostosis in the lower
extremity.
Courtesy of BGU,
Tbingen, Germany
Safe suggestions
for early implant removal
SOMATOM Definition Edge and Dual
Energy allow us to better evaluate bone
tissue in the presence of metal artifacts. On average, we tend to suggest
removal of metal implants earlier than
with our previous system, concludes
Further Information
www.siemens.com/
SOMATOM-Definition-Edge
For the Portuguese private hospital SAMS in Lisbon, where Paulo Pedro, MD is head of the cardiology
department, the SOMATOM Perspective is particularly suitable for cardiological CT.
Cardiac CT:
As Simple as That
Cardiovascular diseases are among the most frequent causes of death worldwide. Innovative diagnostic approaches are becoming increasingly important.
At the Portuguese private hospital SAMS in Lisbon, the cardiology department
has been using the SOMATOM Perspective for two years.
Text: Manuel Meyer, Photos: Miguel Ribeiro Fernandes
News
Cardiac CT really
is not difficult.
All it takes is practice,
good knowledge of
cardiological anatomy,
and an appreciation
of computer work.
Paulo Pedro, MD,
SAMS, Lisbon, Portugal
Especially user-friendly
He hopes to eliminate the reservations
of some colleagues who still regard
cardiac CT as too complicated and intricate: Cardiac CT really is not difficult.
All it takes is practice, good knowledge
of cardiological anatomy, and an
appreciation of computer work. The
53-year-old cardiologist thinks that
the SOMATOM Perspective makes
handling and diagnostics especially
user-friendly thanks to the reading
workplace syngo.via Element CT.
The automatic case preparation with
syngo.via Element CT accelerates the
News
Step 2: Patient
preparation
A few days before the examination, you should call the patient
to confirm whether he or she
is taking the medication as
instructed.
On the day of the CT scan:
Check heart rate. If necessary,
give beta blockers to reduce
heart rate.
News
Further Information
www.siemens.com/
SOMATOM-Perspective
Watch the
step-by-step
tutorial via
this QR code.
News
1
1
Ultra-low-dose
chest examination with an
effective dose
of 0.06 mSv.[1]
Courtesy of
University
Hospital Zurich,
Switzerland
News
2
2
Body perfusion
ofacomplete liver
with an effective
dose of 14.7 mSv.
Courtesy of
University Medical
Centre Mannheim,
Germany
Body perfusion
CT Perfusion (CTP) information might
be the best marker for an early and
reliable prediction of whether a particular cancer treatment is effective.
For example, it has been shown that
CTP is the best predictor of outcome
after chemoembolization of liver
metastases.[9, 10] However, in the
past, CT perfusion in the body trunk
has been limited by relatively high
radiation dose levels. Now, SOMATOM
Force can overcome this barrier. At
low kV levels previously not possible
due to the lack of X-ray power at low
kV, reasonable radiation doses comparable with conventional multi-phasic
liver examinations can be achieved
for comprehensive CTP studies of the
abdomen. p
References
[1] Gordic S, et al. Ultralow-dose chest
computed tomography for pulmonary
nodule detection: first performance
evaluation of single energy scanning
with spectral shaping, Invest Radiol.
2014 Jul;49(7):465-73. doi: 10.1097/
RLI.0000000000000037.
[2] Manichaikul A, et al. Genome-wide
study of percent emphysema on
computed tomography in the general
population. The Multi-Ethnic Study of
Atherosclerosis Lung/SNP Health Association Resource Study. Am J Respir Crit
Care Med. 2014 Feb 15;189(4):408-18.
doi: 10.1164/rccm.201306-1061OC.
[3] Newell JD Jr, et al. Very Low-Dose
(0.15mGy) Chest CT Protocols Using
the COPDGene 2 Test Object and a
Third-Generation Dual-Source CT
Scanner With Corresponding ThirdGeneration Iterative Reconstruction
Software., Invest Radiol. 2014 Sep 5.
[4] Meyer M, et al. Initial results of a new
generation dual source CT system using
only an in-plane comb filter for ultra-high
resolution temporal bone imaging. Eur
Radiol. 2014 Sep 8. [Epub ahead of print]
[5] Meinel FG, et al. Image quality and
radiation dose of low tube voltage 3rd
generation dual-source coronary CT
angiography in obese patients: a
phantom study. Eur Radiol. 2014 Jul;
24(7):1643-50. doi: 10.1007/s00330014-3194-x. Epub 2014 May 10.
[6] Meyer M, et al. Closing in on the K Edge:
Coronary CT Angiography at 100, 80,
and 70 kV-Initial Comparison of a
Second- versus a Third-Generation DualSource CT System. Radiology. 2014 May
31:140244. [Epub ahead of print]
[7] Morsbach F, et al. Performance of turbo
high-pitch dual-source CT for coronary
CT angiography: first ex vivo and patient
experience. Eur Radiol. 2014
Aug;24(8):1889-95. doi: 10.1007/
s00330-014-3209-7. Epub 2014 May 17.
[8] Gordic S, et al. High-pitch coronary CT
angiography with third generation
dual-source CT: limits of heart rate. Int J
Cardiovasc Imaging. 2014 Aug;30(6):
1173-9. doi: 10.1007/s10554-0140445-5. Epub 2014 May 11.
[9] Morsbach F, et al. Perfusion CT best
predicts outcome after radioembolization
of liver metastases: a comparison of
radionuclide and CT imaging techniques.
Eur Radiol. 2014 Jul;24(7): 1455-65. doi:
10.1007/s00330-014-3180-3. Epub
2014 May 12.
[10] Reiner CS, et al. Early treatment
response evaluation after yttrium-90
radioembolization of liver malignancy
with CT perfusion. J Vasc Interv Radiol.
2014 May;25(5):747-59. doi: 10.1016/j.
jvir. 2014.01.025. Epub 2014 Mar 13.
Business
Flexible Flash
for a Forward-Thinking Hospital
In the Regional Hospital of Bolzano, Italy, trauma victims from skiing, hiking and other
accidents often present. Others are suffering from a stroke, cardiac disease, or cancer.
Thus sophisticated diagnostic imaging capabilities are required for adequate patient care.
SOMATOM Sensation 16 and SOMATOM Definition Flash together with syngo.via and
dedicated clinical software applications help to manage this great diversity of clinical tasks
in Bolzano.
Text: Claudia Flisi, Photos: Toni Anzenberger
Business
A flash of uncertainty
tzi is not the reason that the hospital
invested in the SOMATOM Definition
Flash and syngo.via1, however. The
SOMATOM Sensation 16 arrived in
2004 and proved its worth as an allaround CT scanner, reliable and easy
to use. So it was decided to purchase
the Dual Source CT SOMATOM
Definition Flash in 2011, in part to
replace an older CT. syngo.via was
acquired at the same time, and the
idea was to use the scanner and software primarily in cardiology, as in
Bolzano hospital about 2,400 coronary
angiography exams a year are done.
Aortic dissection, type Stanford A VRT and MIP images clearly demonstrate
an aortic dissection involving the ascending aorta and the aortic arch.
The intimal tear extends into the brachiocephalic artery.
Courtesy of Regional Hospital of Bolzano, Italy
With syngo.via
Patrizia Pernter
works inter
actively with
a greater volume
of super-thin
slice images.
She and her
colleagues see
more in greater
detail and finish
diagnosis faster
than before.
Business
Business
Imaging in oncology
In the oncology department, speed is
not necessarily as important as it is for
trauma and stroke. However, detailed
resolution and low radiation dosage are
crucial. For example, hepatic tumors
require multiphasic imaging, a sequence
of CT scans without contrast, 30 seconds, 80 seconds, and five minutes
after an injection of contrast medium.
You can see the development very well
on our workstation, reports Patrizia
Pernter.
Information overload?
The problem, if any, according to the
doctor, is that one may get lost in the
information because there is so much
and it is so interesting. Occasionally,
Further Information
www.siemens.com/
syngovia-for-ct
Business
After all, we
should never
forget that we
are here for
the patients.
Laurence Rocher, MD,
Bictre Hospital, Paris, France
Business
1A
1B
1
Fig.1A was created before
SAFIRE was implemented
with a dose of CTDIvol of
17 mGy. Fig.1B shows an
equal image impression
with SAFIRE and a dose of
only 9 mGy.
2A
2B
2
Dose reduction in
combination with
SAFIRE keeps the image
impression constant.
Fig.2A shows an axial
image withthe original
dose and Fig.2B shows
SAFIRE in combination
with a dose reduction.
Further Information
www.siemens.com/care-right
Business
Balancing Clinical
and Business Demands
Pressure on healthcare providers is growing as a result of the global
economic crisis and also due to demands for increased standards of clinical
care. With SOMATOM Perspective, Siemens has developed a computed
tomography system that balances the need for high-quality diagnostic images
with the challenge of efficiency.
By Florian Hein
Computed Tomography, Siemens Healthcare, Forchheim, Germany
CT scanner hardware
The hardware components of a CT
system include an X-ray tube with a
high-voltage generator, a detector, and
a gantry upon which all moving parts
are mounted. These components are
highly interdependent; in designing
a well-balanced system the aim is to
produce a scanner that is powerful
enough to meet high clinical demands,
but still as economical as possible.
One key parameter is the distance
between tube and detector, which is
reflected in the focus-isocenter distance as well as in the focus-detector
distance. This setting determines the
space required for all further CT components and the level of generator
power needed.
Business
Image reconstruction
Together with the hardware of a CT
system, image reconstruction algorithms
are essential to calculate an image. Fast,
efficient, and artifact-free image reconstruction saves time and costs while
improving the diagnosis. Additional
algorithms are built into SOMATOM
Perspectives image reconstruction chain
in order to reduce artifacts, improve
spatial and temporal resolution for cardiac imaging, and to reduce image
noise. These factors result in overall
dose reduction to the patient as well as
reduced stress on the system.
One of the most challenging tasks for
a CT system is cardiac imaging. The temporal resolution has to be high enough
to freeze the motion of the heart. With
reconstruction methods such as iTRIM
for SOMATOM Perspective, the temporal
resolution of a cardiac image can be
improved (Fig.1). iTRIM can provide a
temporal resolution of 195 ms based
on the rotation time of 0.48 seconds
available in cardiac modes. Based on
traditional half-scan reconstruction
eCockpit
With the goal of improving the efficiency of scanner usage to meet the
business benchmarks for operation,
Siemens looked to the huge base of
over 19,000 installed scanners worldwide for clues: How do some cus
tomers achieve higher uptime, fewer
component replacements, and a
longer system lifetime? How can we
help other customers to benefit from
similar results? The answer is eCockpit,
comprising eStart, eMode, and
eSleep. These functions support the
most economic CT scanner use and
areduction in overhead costs. In its
design, the entire working day of a
CT system was taken into consideration from start-up to scanning to
stand-by to achieve great efficiencies in scanner operation.
eStart extends the tube lifetime by
pre-warming the tube after extended
periods of non-use; this may be every
morning for high throughput facilities,
or prior to each scan in smaller hos
pitals. In an X-ray tube, typically only
0.2% of the electrical energy used is
converted into X-rays. The rest is converted into heat on the X-ray tubes
anode. Even though the anode is made
of tungsten, a material with a very
Further Information
www.siemens.com/
SOMATOM-Perspective
Case 1
History
A 72-year-old male patient with
poor kidney function (GFR 40 mL/min)
was admitted to the hospital with
a suspected endoleak after an endovascular aneurysm repair (EVAR) of
the abdominal aorta. A dynamic 4D CT
angiography (CTA) was requested to
confirm the endoleak and to specify
its type.
Diagnosis
CT images showed an abdominal
aortic aneurysm (AAA) and a stent
within it, placed during EVAR. Proof
Comments
Due to the patients poor kidney function, the examination was completed
with only 12cc of contrast, at a 60%
dilution (total injected volume 20cc),
followed by a 30cc saline chaser, both
with a 5cc/s injection rate. This was
achieved by conducting the scan at
70 kV, to close the gap to the k-edge
and enhance the contrast, as well as
Examination Protocol
Scanner
SOMATOM Force
Scan area
Abdomen
Slice collimation
48 1.2 mm
Scan length
222 mm
Slice width
1.5 mm
Scan direction
Adaptive 4D spiral
Reconstruction increment
1 mm
Scan time
36 s
Reconstruction kernel
Bv36
Tube voltage
70 kV
Reconstruction increment
0.5 mm
Tube current
200 mAs
Contrast
400 mg/mL
CTDIvol
43.46 mGy
Volume
DLP
905 mGy cm
Flow rate
5 mL/s
Effective dose
13.6 mSv
Start delay
8s
Rotation time
0.25 s
1A
1B
2A
2B
12
3A
Axial (Fig.1) and sagittal (Fig.2) views of VRT (A) and MPR (B) images show the endoleak (arrows).
3B
VRT image demonstrates the feeder artery (arrows) to the aneurysm and thus confirms a type II endoleak.
Case 2
History
Diagnosis
Comments
cCTA resulted in a decisive diagnosis
for this patient considering the original
symptoms of atypical chest pain and
an equivocal stress test. The disclosed
nature of the plaques and severity of
the stenosis further helped in planning
a percutaneous interventional procedure.
The application of all supplied advanced
techniques, such as ECG pulsing, iterative reconstruction (SAFIRE1), iTrim
and lower kV setting (110 kV), resulted
in excellent image quality and a very
low effective dose of only 1.44 mSv. p
Examination Protocol
Scanner
SOMATOM Perspective
Scan area
Heart
Rotation time
0.48 s
Scan mode
ECG-gated retrospective
spiral scan
Pitch
0.27
Scan length
99.5 mm
Slice collimation
64 x 0.6 mm
Scan direction
Slice width
0.75 mm
Scan time
4.6 s
Reconstruction increment
0.5 mm
Tube voltage
110 kV
Reconstruction kernel
I30s
Tube current
87 mAs
Heart rate
5153 bpm
Temporal resolution
Contrast
370 mg/mL
CTDIvol
6.47 mGy
Volume
75 mL + 60 mL saline
DLP
103 mGy cm
Flow rate
6 mL/s
Effective dose
1.44 mSv
Start delay
Test bolus
1 In clinical practice, the use of SAFIRE may reduce CT patient dose depending on the clinical task, patient size, anatomical location, and clinical practice.
A consultation with a radiologist and a physicist should be made to determine the appropriate dose to obtain diagnostic image quality for the particular clinical
task. The following test method was used to determine a 54 to 60% dose reduction when using the SAFIRE reconstruction software. Noise, CT numbers,
homogeneity, low-contrast resolution and high contrast resolution were assessed in a Gammex 438 phantom. Low dose data reconstructed with SAFIRE showed
the same image quality compared to full dose data based on this test. Data on file.
1A
1B
2A
2B
3A
3B
13
Case 3
1A
1B
1
VRT (Fig. 1A), MIP
(Fig. 1B) and MPR
(Fig. 1C) images
show moderate
stenoses from soft
plaques in the
proximal segment
of both common
iliac arteries, and a
mild stenosis from
concentric soft
plaque at the bifurcation of the distal
abdominal aorta.
1C
History
Diagnosis
Comments
2A
2B
VRT images demonstrate moderate stenoses in the proximal segment of both common iliac arteries from two different views.
Examination Protocol
Scanner
SOMATOM Scope
Scan area
Runoff
Rotation time
0.8 s
Scan length
1158 mm
Pitch
1.5
Scan direction
Cranio-caudal
Slice collimation
16 1.2 mm
Scan time
32 s
Slice width
1.5 mm
Tube voltage
110 kV
Reconstruction increment
1 mm
Tube current
60 mAs
Reconstruction kernel
I31s
Dose modulation
CARE Dose4D
Contrast
CTDIvol
3.89 mGy
Volume
90 mL
DLP
470 mGy cm
Flow rate
4 mL / s
Effective dose
2.6 mSv
Start delay
Bolus tracking
Case 4
Comments
History
A 67-year-old male patient, with a
history of peripheral arteriosclerosis
obliterans and inferior wall myocardium infarction, had been treated with
an interventional stenting placed in
the left circumflex artery (LCx) #1314.
A comprehensive cardiac CT study,
including coronary CT angiography
(cCTA), stress myocardial dynamic
perfusion, and delayed enhancement,
was ordered to simultaneously evaluate both the coronary artery and the
myocardium.
Diagnosis
Coronary CTA images showed a left
coronary artery (LCA) dominant system (Figs.1A and 1B). Mixed plaques
could be seen in the proximal left
anterior descending artery (LAD).
1A
1B
Coronary CTA images show a LCA dominant system (Fig. 1A MIP, Fig. 1B VRT).
2A
2B
2C
Delayed enhancement CT
images show sub-endocardial
infarction from the basal septum
inferior wall to the apical inferior
wall. This became partially
transmural at the apex.
Enter
room
Vasodilator
NTG
i.v. blocker
(if needed)
Exit
room
40 min.
Stress
Myocardial
Dynamic
Perfusion
Delayed
Enhancement CT
Coronary
CTA
Examination Protocol
Scanner
Scan mode
Delayed Enhancement CT
Scan area
Left Ventricle
Heart
Left Ventricle
Scan length
67 mm
102.8 mm
69 mm
Scan direction
Shuttle
Cranio-caudal
Shuttle
Scan time
32 s
5s
9s
Tube voltage
80 kV
80 kV
80 kV
Tube current
127 mAs/rot.
197 mAs/rot.
370 mAs/rot.
Dose modulation
CARE Dose4D
CARE Dose4D
CTDIvol
28.9 mGy
8 mGy
17.9 mGy
DLP
208 mGy cm
82 mGy cm
128 mGy cm
Effective dose
2.9 mSv
1.2 mSv
1.8 mSv
Volume
40 mL
41 mL
Flow rate
5 mL/s
3.4 mL/s
Start delay
4s
17 s
Scan timing
Coronary CTA
5min
scan
Contrast
Case 5
History
A 62-year-old male patient presented
to the hospital, complaining of persistent upper abdominal pain which
was exacerbated after intake of fatty
foods. He claimed to have lost 15 kg
and to have completely quit consuming alcohol in the past two months.
Fatty defecation had not been observed,
however, a tendency toward obstipation had developed which could be
occasionally relieved by inducing
vomiting.
Comments
Diagnosis
CT images revealed a hypodense
lesion, measuring 6.4 3.2 cm, in
the corpus of the pancreas. The
lesion was compressing the portal
vein, had infiltrated the splenic vein
and reached the coeliac trunk, the
common hepatic artery and the
gastroduodenal artery. It also surrounded the left gastric artery, and
the splenic artery which was con-
No suspicious lymph nodes or metastases were seen within the chest and
abdomen. Compared with the supposedly healthy and normally perfused
tissue of the pancreatic head, the
lesion was hypoperfused.
MRI confirmed the CT findings,
showing a contrast-enhanced lesion
with moderate diffusion restriction.
References
[1] Cao N, Cao M, Chin-Sinex H, Mendonca M,
Ko SC, Stantz KM. Monitoring the Effects
of Anti-angiogenesis on the Radiation
Sensitivity of Pancreatic Cancer Xenografts
Using Dynamic Contrast-Enhanced
Computed Tomography. Int J Radiat Oncol
Biol Phys. 2014 Feb 1;88(2):4128. doi:
10.1016/j.ijrobp.2013.11.002.
[2] Miles KA, Hayball MP, Dixon AK. Measurement of human pancreatic perfusion
using dynamic computed tomography
with perfusion imaging. Br J Radiol. 1995
May;68(809):4715.
[3] Xie Q, Wu J, Tang Y, Dou Y, Hao S, Xu F,
Feng X, Liang Z. Whole-organ CT perfusion
of the pancreas: impact of iterative reconstruction on image quality, perfusion
parameters and radiation dose in 256-slice
CT-preliminary findings.
PLoS One. 2013 Nov 26;8(11):e80468.
doi: 10.1371/journal.pone.0080468.
1A
1B
1
Curved MPR (Fig.1A) and VRT
(Fig.1B) images show that the lesion
was compressing the portal vein, had
infiltrated the splenic vein and reached
the coeliac trunk, the common hepatic
artery, and the gastroduodenal artery.
It also surrounded the left gastric
artery and the splenic artery which
was constricted through the lesion.
The extensive paragastric collaterals
that were formed can also be seen.
2A
2B
2
In comparison with the normal pancreatic
tissue, the adenocarcinoma revealed hypodensity in the temporal MIP (Fig. 2A), less
blood flow (Fig. 2B), less blood volume
(Fig. 2C) and a decreased flow extraction
product (Fig. 2D).
Examination Protocol
2C
2D
3
3
Relative time-density curves
(ROI#3 in yellow =
normal pancreatic tissue;
ROI#4 in green =
adenocarcinoma).
Scanner
SOMATOM Force
Scan area
Upper Abdomen
Scan mode
VPCT
Scan length
174 mm
Scan direction
Adaptive 4D spiral
Scan time
43 s
Tube voltage
70 kV
Tube current
200 mAs
Dose modulation
CTDIvol
46.66 mGy
DLP
914.9 mGy cm
Rotation time
0.33 s
Slice collimation
48 1,2 mm
Slice width
1.5 mm
Reconstruction
increment
1.0 mm
Reconstruction
kernel
Br36
Contrast
400 mg / mL
Volume
50 mL + 50 mL
Saline
Flow rate
5 mL / s
Start delay
5s
Case 6
History
Diagnosis
1A
Comments
Aortic CTA is a valuable, fast and
non-invasive imaging tool with high
availability and diagnostic accuracy.[1]
1B
1
Sagittal MIP (Fig.1A)
and VRT (Fig.1B)
images show the
partially occluded
Stanford B dissection
beginning after the
junction of the left
subclavian artery.
References
[1] Nienaber, C.A., et al., Noninvasive
imaging approaches to evaluate the
patient with known or suspected aortic
disease. Circ Cardiovasc Imaging, 2009.
2(6): p. 499-506.
Examination Protocol
Scanner
SOMATOM Force
Scan area
Chest Pelvis
Pitch
3.2
Scan length
673.6 mm
Slice collimation
192 0.6 mm
Scan direction
Cranio-caudal
Slice width
1 mm
Scan time
0.91 s
Reconstruction increment
0.8 mm
Tube voltage
80 kV
Reconstruction kernel
Bv36 (ADMIRE 5)
Tube current
140 mAs
Contrast
400 mg / mL
Dose modulation
CARE Dose4D
Volume
CTDIvol
2.09 mGy
Flow rate
3.9 mL / s
DLP
154.6 mGy cm
Start delay
Rotation time
0.25 s
Case 7
History
Diagnosis
Comments
Mixed CT images (Fig. 2), reconstructed
using a 0.5 blend of Sn 140 kV and
80 kV data and a high spatial frequency
deconvolution kernel (B75), provided
excellent depiction of fine bony detail
and allowed best depiction of the
fracture line as it extended into the
Examination Protocol
Scanner
Scan area
Left knee
Pitch
0.7
Scan length
168 mm
Slice collimation
40 x 0.6 mm
Scan direction
Cranio-caudal
Slice width
0.75 mm
Scan time
10 s
Reconstruction increment
0.7 mm
Tube voltage
80 kV / Sn140 kV
Reconstruction kernel
Tube current
16382mAs
Contrast
Dose modulation
CARE Dose4D
Volume
CTDIvol
7.59 mGy
Flow rate
DLP
141 mGy cm
Start delay
Rotation time
0.5 s
3A
3B
3C
3D
3E
3F
4A
Axial and coronal virtual non-calcium reconstructed DE CT images (Figs. 3A, 3B, 3D, 3E) displayed extensive bone marrow
edema in the proximal left tibia which correlated almost identically with high T2 signal areas on the fat suppressed T2 weighted
MRI images (Figs. 3C and 3F).
4B
VRT DE CT image
showed the three
dimensional view
of the extensive bone
marrow edema in
the proximal left tibia.
Case 8
History
A 32-year-old female patient, with
known Crohns disease, underwent a
terminal ileum resection eight years
ago at another hospital. Three years
later a capsule endoscopy was performed, which was complicated by
capsule retention. The patient had
been complaining of an on-and-off
abdominal pain before being referred
to our hospital. A Dual Energy (DE)
CT scan was performed for further
evaluation.
Diagnosis
Examination Protocol
Scanner
SOMATOM
Definition Flash
SOMATOM
Definition Flash
Scan area
Lower Abdomen
Abdomen / Pelvis
Scan mode
Dual Energy
Spiral
Scan length
97.6 mm
442.4 mm
Scan time
3.6 s
9.4 s
Scan direction
Cranio-caudal
Cranio-caudal
kV
100 kV / Sn 140 kV
100 kV
Effective mAs
136 mAs
206 mAs
CTDIvol
11.28 mGy
8.51 mGy
DLP
131 mGy cm
390 mGy cm
Effective dose
1.97 mSv
5.85 mSv
Dose modulation
CARE Dose4D
CARE Dose4D
Rotation time
0.5 s
0.5 s
Slice collimation
32 0.6 mm
128 0.6 mm
Slice width
1 mm
1 mm
Reconstruction increment
0.8 mm
0.8 mm
Comments
Reconstruction kernel
D30f (SAFIRE)
I30f (SAFIRE)
Volume
90 mL
Flow Rate
2.5 mL / s
Start delay
90 s
Contrast
6
1
Curved reformatted CT image
showed a long, inflamed distal
ileal segment (arrowheads)
proximal to the narrowed
ileo-colic anastomosis (long
arrow) with the endoscopy
capsule trapped in the blind
ileal pouch (dashed arrow).
2A
Photograph of the
endoscopic capsule.
2B
2
Short (Fig. 2A) and long axis (Fig. 2B) views of the
endoscopic capsule displayed in soft tissue window in
themixed images (equivalent to single energy images
acquired at 120 kV). The metal artifacts obscuring the
surrounding tissues are clearly demonstrated.
3A
3B
3
Short (Fig. 3A) and long axis (Fig. 3B) views of the
endoscopic capsule displayed in soft tissue window
in the monoenergetic images at 127 keV. The metal
artifacts are significantly reduced and the surrounding
tissues are diagnosable.
4A
4B
4
Short (Fig. 4A) and long axis (Fig. 4B) views of the
endoscopic capsule displayed in soft tissue window
in the monoenergetic images at 190 keV. The metal
artifacts are almost completely removed, yet the soft
tissue contrast was somewhat suppressed.
5A
5B
5
Short (Fig. 5A) and long axis (Fig. 5B) views of the
endoscopic capsule displayed in bone window in
monoenergetic images at 190 keV. The inside structure
of the capsule can be recognized.
Case 9
History
1
1
The mixed 120 kV
image shows
higher CT attenuations in the liver
and in the spleen.
Diagnosis
2
2
Fused iodine
imaging reveals
high iodine
depositions in
the liver.
3
3
Virtual noncontrast CT
shows normal
liver density.
Comments
Amiodarone is an iodine-containing
antiarrhythmic drug available worldwide. Long-term amiodarone administration causes hepatotoxicity due to
iodine accumulation in the liver.[1,2]
The lungs, myocardium, thyroid, spleen
and pancreas are the main target organs
for iodine deposition.[1,2,3] In cases
in which amiodarone is considered life
4
4
Iodine concentration in the
liver reaches 2.4 mg/mL.
Spleen
Pancreas
Aorta
HU
117
98
67
40
Virtual Noncontrast CT
HU
67
55
40
38
Iodine Concentration
mg/dL
2.4
1.8
0.1
Examination Protocol
Scanner
Scan area
Abdomen
DLP
176 mGy cm
Scan length
200 mm
Effective dose
2.64 mSv
Scan direction
Cranio-caudal
Rotation time
0.5 s
Scan time
10 s
Pitch
0.6
Tube voltage
100 kV / Sn 140 kV
Slice collimation
32 0.6 mm
Tube current
104 / 87 mAs
Slice width
0.6 mm
Dose modulation
CARE Dose4D
Reconstruction increment
0.5 mm
CTDIvol
8.37 mGy
Reconstruction kernel
D30f
References
[1] Goldman IS, et al. Increased hepatic density and phospholipidosis
due to amiodarone. AJR 1985; 144: 541-546
[2] Harris L et al. Side effects of long-term amiodarone therapy.
Circulation 1983; 67: 45-51
[3] Kuhlman JE, et al. Amiodarone pulmonary toxicity: CT findings
in symptomatic patients. Radiology. 1990; 177: 121-125
Case 10
History
A heart murmur was detected in an
18-month-old girl six months ago. An
echocardiography revealed an atrial
septal defect (ASD), a ventricular septal defect (VSD), an overriding aorta,
a persistent left superior vena cava
(PLSVC), an anomalous pulmonary
venous connection (APVC), and pulmonary hypertension. A cardiac CT
examination was requested to specify
the diagnosis and type of APVC as
well as to demonstrate the complex
anatomical structures of the heart.
tion (PAPVC) was specified by showing the right superior pulmonary veins
(RSPV) connected with the RA. Additionally, a main pulmonary window,
a right aortic arch which caused a
tracheal stenosis, an anomalous origin of the coronary arteries, and a
pig bronchus (i.e. the right superior
bronchus is originated directly from
the supracarinal trachea) were seen.
1A
1B
1C
1D
1E
Diagnosis
Comments
2A
2B
2
VRT (Fig.2A) and MPR (Fig.2B)
images show a main pulmonary window
(asterisks) and a right aortic arch
(Fig.2B, arrow).
3
MPR images show an anomalous origin
of the coronary arteries (dashed arrows),
and a right aortic arch (Fig.3A, arrow).
4
VRT images show a pig bronchus
(dashed arrow) and a tracheal stenosis
caused by a right aortic arch (Fig.4B).
3A
4A
3B
4B
Examination Protocol
Scanner
SOMATOM
Definition AS+
Scan area
Thorax
Scan mode
ECG triggered
adaptive sequential
scan
Scan length
171.5 mm
Scan direction
Cranio-caudal
Scan time
6s
Tube voltage
80 kV
Tube current
70 mAs
CTDIvol
0.83 mGy
DLP
14 mGy cm
Effective dose
0.91 mSv
Rotation time
0.3 s
Slice collimation
128 0.6 mm
Slice width
0.75 mm
Reconstruction
increment
0.5 mm
Reconstruction
kernel
B26f
Temporal
resolution
150 ms
Heart rate
117125 bpm
Contrast
350 mg/mL
Volume
15 mL
Flow rate
1.3 mL/s
Start delay
21 s
Case 11
Diagnosis
History
A newborn baby, weighing 3 kg, with
syndromic facies was referred to the
hospital due to a prenatal diagnosis
of a complete atrioventricular septal
defect and a pulmonary atresia discovered during a fetal echocardiography. A physical examination revealed
a continuous heart murmur at the
1A
1B
2A
2B
12
Anterior (Fig.1) and posterior (Fig.2) views of VRT images show a confluent
pulmonary artery (Fig.1, asterisks), a pulmonary atresia (Fig.1, short arrows),
a left PDA (Fig.1, long arrows), and a right PDA (Fig.2, arrows).
Comments
A persistent bilateral PDA is an uncommon abnormality which occurs during
the development of the aortic arch and
the pulmonary arteries. It is most commonly seen accompanied by pulmonary
atresia and non-confluent branch pulmonary arteries and is strongly associated with heterotaxy syndrome. It is
important to thoroughly evaluate the
pulmonary arterial supply for signs of
a pulmonary atresia prior to surgery. In
this case, a rarely seen congenital cardiac
malformation is presented a bilateral
PDA with a confluent pulmonary artery.
As a non-invasive imaging modality, CT
is increasingly used in the diagnosis and
management of structural heart disease.
It provides complementary diagnostic
information to echocardiography and,
in some cases, makes an invasive angiography unnecessary. Technological
advances allow not only dose reduction
but also improved image acquisition.
The Dual Source CT Flash mode with
its high pitch spiral scanning not only
shortens the acquisition time, but also
reduces the radiation exposure. p
3A
3B
4A
4B
3C
Examination Protocol
Scanner
Scan area
Heart
Rotation time
0.28 s
Scan length
99.3 mm
Pitch
3.0
Scan direction
Cranio-caudal
Slice collimation
128 0.6 mm
Scan time
0.25 s
Slice width
0.6 mm
Tube voltage
80 kV
Reconstruction increment
0.3 mm
Tube current
28 mAs
Reconstruction kernel
B30f
Dose modulation
CARE Dose4D
Contrast
CTDIvol
0.46 mGy
Volume
6 mL
DLP
7 mGy cm
Flow rate
1 mL/s
Effective dose
0.63 mSv
Start delay
Bolus tracking
Case 12
Evaluation of Williams-Beuren
Syndrome in a Two-month-old Child
using a Single Rotation Scan Mode
By Hans-Christoph Becker, MD
Department of Clinical Radiology, University Hospital Grosshadern, Munich, Germany
History
A two-month-old boy, with known
Williams-Beuren syndrome, was presented to the hospital for surgical
repair. Prior to surgery, a CT scan was
ordered to evaluate the cardiovascular
structures. The main focus was to
define the origin of the coronary
arteries relative to the aortic stenosis.
Diagnosis
CT images clearly showed a significant stenosis of the ascending aorta
directly above the aortic root. Both
coronary arteries originated slightly
below the stenosis. A dysplastic right
pulmonary artery and a very small
Comments
CT scans are routinely used for cardiovascular evaluations. In this case, the
CT aided in the planning of the surgical correction of the aortic stenosis,
also demonstrating that resection and
re-insertion of the coronary arteries
would not be necessary. Furthermore,
it also showed a dysplastic right pulmonary artery and a very small DAPVF
(descending aorta-pulmonary vein
fistula), which would have not been
echocardiographically detected.
Examination Protocol
Scanner
SOMATOM Force
Scan area
Heart
Rotation time
0.25 s
Scan mode
Slice collimation
192 0.6 mm
Scan length
46.8 mm
Slice width
0.6 mm
Scan direction
Cranio-caudal
Reconstruction kernel
Bv40 ADMIRE
Scan time
0.15 s
Temporal resolution
66 ms
Tube voltage
70 kV
Heart rate
153 bpm
Tube current
376 mAs
Contrast
400 mg/mL
Dose modulation
CARE Dose4D
Volume
5 mL + 20 mL saline
CTDIvol
2.09 mGy
Flow rate
0.5 mL /s
DLP
12 mGy cm
Start delay
Effective dose
1.12 mSv
1A
1B
1
A VRT (Fig. 1A)
and three MIP
(Figs. 1B,1C and1D)
images show a
significant stenosis
(arrows) of the
ascending aorta
directly above the
aortic root. Both
coronary arteries
originate slightly
below the stenosis.
1C
1D
2A
2B
2
VRT (Fig. 2A) and
MIP (Fig. 2B) images
show adysplastic
right pulmonary
artery.
3A
3B
3
VRT images show
a DAPVF from two
different views.
Science
SOMATOM Force
from Translational Research
to Clinical Routine
With the recently introduced SOMATOM Force, high-precision imaging at
ultra-low dose is possible with minimized motion artifacts, the potential to
reduce sedation, and even with significantly reduced burden for the kidneys.
CT-imaging therefore has the potential to go beyond diagnostics and become
part of therapy evaluation strategies, as experts from Germany and Switzerland report.
Text: Wiebke Kathmann, PhD, Photos: Anna Schroll
SOMATOM Force is almost twice as fast, more precise, and even more patient-friendly
than any of its predecessors.
Personalized low-kV
diagnostics
Experts at the Mannheim University
Medical Centre at Heidelberg University
are convinced that almost all contraindications for CT have been eliminated
with SOMATOM Force. Mannheim was
the first site at which the SOMATOM
Force was installed worldwide. The
installation, a part of the M2OLIE
research campus initiative funded by
the German Federal Ministry of Education and Research, allows the researchers from Mannheim to continuously
1A
1B
Discovery of a type II endoleak after EVAR in a patient with renal insufficiency using dynamic 4D CT Angiography with only
12 cc contrast medium VRT images demonstrate the endoleak (Fig.1A) and the feeder artery (Fig.1B) to the aneurysm
(read the full case study on page 48). Courtesy of University Medical Centre Mannheim at Heidelberg University, Germany
Science
Since radiation dose can be so low, another future application of the SOMATOM Force might
well be early detection of coronary artery disease with submillisievert CT angiography.
This visualizes calcified as well as small non-calcified plaques and could play a larger role in
the near future, according to Professor Stefan Schnberg, MD (left) and Associate Professor
Thomas Henzler, MD (right).
For Professor Hatem Alkadhi, MD, the technical triad of high-speed data acquisition,
high resolution, and broadened field of view, allowing for free breathing scans, opens up
a new field of application: early detection of lung disease.
Science
2A
2B
Ultra-low-dose thoracic scanning with a DLP of 2 mGy cm only MPR (Fig.2A) and VRT (Fig.2B) images reveal bilateral
bronchiectasis and mosaic perfusion suggesting cystic fibrosis. Courtesy of University Hospital Zurich, Zurich, Switzerland
Therapy evaluation in
cancer patients
Early detection of cancer as well as
cost-effective use of new specific but
costly medications such as monoclonal
antibodies are indispensable objectives of todays healthcare systems.
Dynamic perfusion imaging could contribute to this goal as initial results in
patients with renal cell or gastrointestinal stromal tumors (GIST) imply.
At the Clinical Radiology Department
of University Hospital Grosshadern,
Munich, Germany, the focus has long
been on functional and perfusion
imaging using high-end CTs. As Professor Anno Graser, MD, former Head
of the CT unit for Oncological Radiology, envisioned, the SOMATOM Force
opens up the possibility of dynamic
perfusion imaging of cancerous lesions
and helps physician better determine
which patients might respond to
antiangiogenic therapies. Right now,
we are in the early stages of our
research. But we have already been
able to prove that quantification of
the therapy response with the
SOMATOM Force. More importantly,
3A
3A
Evaluation of Williams-Beuren Syndrome in a two-month-old child using single rotation scan mode with 70 kV and 5 cc contrast
medium, without sedation MIP images show a significant stenosis of the ascending aorta directly above the aortic root, and both
coronary arteries originate slightly below the stenosis (read the full case study on page 70).
Courtesy of University Hospital Grosshadern, Munich, Germany
Further Information
www.siemens.com/
SOMATOM-Force
Professor Hans-Christoph Becker, MD (right) and Professor Anno Graser, MD (left)
consider DECT as the imaging modality of choice mainly in tissue discrimination.
Science
Scan
preparation
Scan
Reconstruction/
post processing
FAST Planning
Storing
Diagnosis
FAST Spine
FAST Planning and FAST Spine tackle the critical steps of scan preparation
and reconstruction.
Further Information
www.siemens.com/FASTCARE
3
2
FAST Planning
means an immediate,
organ-based setting
of scan and recon
ranges with a single
click.
3
FAST Spine automatically labels the
vertebrae and discs
and prepares the
reconstruction in the
correct anatomical
orientation.
Science
Leading Concept
in High-End CT Imaging
For almost a decade now, Siemens Dual Source concept has spearheaded computed
tomography imaging and proven its value in exceptional products. During this time,
Dual Source CT (DSCT) has continually set new standards in CT imaging. In 2013, the
latest pinnacle was reached with the introduction of SOMATOM Force.
By Jan Freund
Computed Tomography, Siemens Healthcare, Forchheim, Germany
Concepts in high-end
CT imaging
In developing their computed tomography systems, the various vendors
have taken a variety of approaches.
Among these, three distinct concepts
can be identified in the arena of highend CT imaging:
Dual layer detector design:
Two different layers of detector
material absorb either low and high
energy photons of the X-ray beam
to evaluate two different energy
spectra
Wide detector coverage enabled by
a large detector array beyond the
established 64-row design, with up
to 16 cm coverage
Dual Source CT with two tube
detector pairs integrated at an
approximate 90-degree angle
imaging (see also page 81). But a natural drawback of this design is that in
every other non-Dual Energy examination, users have to live with the
systems drawbacks (e.g. higher electronic noise, fixed kV settings, etc.),
making it aspecialized niche scanner.
2
Science
Dynamic 4D study conducted with SOMATOM Force 796 mm acquired using dynamic 4D spiral mode at 70 kV with 1 mSv.
MIP images show nicely the dynamic flow of the vascular details in the lower extremities. In comparison to an one-time
Runoff CTA, a dynamic 4D scan provides more diagnostic information in multiple acquisition phases.
Courtesy of University Medical Centre Mannheim at Heidelberg University, Germany
Dual Source CT
In contrast to this, Dual Source CT has
shown that it can compensate these
limitations and actually achieve the
intended goal of fast large volume
coverage. With hundreds of clinical
publications based on the Dual Source
concept, this approach has clearly
established itself as the pinnacle in
References
[1] Gabbai M, et al. Material characterization
with CT: comparison of commercial
investigative technologies in phantoms.
Acta Radiol. 2014 Sep 2
[2] Li B, et al. Simulation and analysis of
image quality impacts from single source,
ultra-wide coverage CT scanner. J Xray
Sci Technol. 2012;20(4):395-404.
[3] Achenbach S, et al. Value of electronbeam computed tomography for the
noninvasive detection of high-grade
coronary-artery stenoses and occlusions.
[4] Lee H et al.. Impact of a vendor-specific
motion-correction algorithm on image
quality, interpretability, and diagnostic
performance of daily routine coronary
CT angiography: influence of heart rate
on the effect of motion-correction.
Int J Cardiovasc Imaging. 2014 Jul 20
[5] Alkadhi et al. Accuracy of dual-source CT
coronary angiography: First experience
in a high pre-test probability population
without heart rate control. Eur Radiol.
2006 Dec;16(12):2739-47.
[6] Lell MM et al. High-pitch spiral computed
tomography: effect on image quality and
radiation dose in pediatric chest computed
tomography. Invest Radiol. 2011
Feb;46(2):116-23.
[7] Sidhu MS et al. Advanced adaptive
axial-sequential prospectively electrocardiogram-triggered dual-source coronary
computed tomographic angiography
inapatient with arterial fibrillation.
J Comput Assist Tomogr. 2011 Nov-Dec;
35(6):747-8.
Further Information
www.DSCT.com
Science
With fast kV-switching, Dual Energy data can be acquired by rapidly switching
the tube voltage between CT projections.
Science
Idealized dual layer detector technology: In reality a certain amount of highand low-energy photons are registered in both layers which significantly reduces
spectral seperation.
Slow kV-switching
A third possibility to acquire Dual
Energy data is slow kV-switching.
Here, both kV and mA are switched
between half rotations of the gantry,
either in sequence or in spiral modes.
The image quality in this approach is
comparable to the fast kV-switching
technology. Again, the limitation is
the number of projections for each
kV setting (Fig.3).
The time needed to switch from 80 kV
to 140 kV and adjust the mA is typically in the order of 100 ms. During
this time, the patient is exposed to
radiation that does not provide useful
information. Thus, this method does
not follow the ALARA (as low as reasonably achievable) principle. Broad
clinical applicability of the slow kVswitching method is hindered because
of the decreased image quality and
thecomparably longer scan times. In
acute and pediatric cases especially,
Science
Successive scanning
To enable Dual Energy also on single
source scanners, Siemens introduced
Dual Spiral Dual Energy (Fig.4).
This approach is available on nearly
all Siemens scanners, starting from
SOMATOM Perspective and SOMATOM
Definition AS systems, up to
SOMATOM Definition Edge.
During a single source Dual Energy
scan, two CT datasets are acquired at
different kV and mA levels using two
successive spiral scans. The two spirals are automatically coupled. Scan
set-up and scan parameter selection
are as easy as for any standard single
energy spiral. With this scan approach,
both datasets acquire the full number
of projections for the low and high
kV setting. In a fully automated procedure, the two datasets are nonrigidly registered to compensate for
potential patient motion between the
two spirals. They match the patients
anatomy exactly. The large number
of projections and low noise values
1st scan
low kV
2nd scan
high kV
Single source Dual Energy scan mode: Two CT datasets are acquired at different kV and mA levels using two successive
spiral scans. The two spirals are automatically coupled.
Science
Evaluation of
Dual Energy data
Only well-measured data can lead to
accurate results. Any of the previously
described acquisition methods can
be used to produce colorful images or
diagrams. But in conclusion, spectral
CT in this context can rather be considered a misleading marketing term.
Dual Energy CT defines the technology
more precisely. And in consequence,
when it comes to Dual Energy imaging,
clinically useful evaluation methods
are what is really important. Siemens
offers a wide portfolio of applications.
[79] With more than 130 scientific
publications, over 1,500 installed Dual
Source CT scanners, and more than
75,000 Dual Energy examinations per
year, Siemens Dual Source Dual Energy
can be considered the leader in clinical
Dual Energy CT. p
In clinical practice, the use of SAFIRE may reduce
CT patient dose depending on the clinical task,
patient size, anatomical location, and clinical practice. A consultation with a radiologist and a physicist should be made to determine the appropriate
dose to obtain diagnostic image quality for the
particular clinical task. The following test method
was used to determine a 54 to 60% dose reduction
when using the SAFIRE reconstruction software.
Noise, CT numbers, homogenity, low contast resolution, and high contrast resolution were assessed
in a Gammex 438 phantom. Low dose data reconstructed with SAFIRE showed the same image
quality compared to full dose data based on this
test. Data on file.
2
TwinBeam Dual Energy is currently pending 510(k)
clearance and is not yet comercially available in the
United States.
1
References
[1] Kalender WA, Perman WH, Vetter JR,
Klotz E. Evaluation of a prototype
dual-energy computed tomographic
apparatus. I. Phantom studies.
Med Phys. 1986 May-Jun;13(3):334-9.
[2] Kalender WA, Klotz E, Suess C.
Vertebral bone mineral analysis:
anintegrated approach with CT.
Radiology. 1987 Aug;164(2):419-23.
[3] Kalender WA, Klotz E, Kostaridou L.
Analgorithm for noise suppression
indual energy CT material density
images. IEEE Trans Med Imaging.
1988;7(3): 218-24.
[4] Geyer LL, Scherr M, Krner M, Wirth S,
Deak P, Reiser MF, Linsenmaier U.
Imaging of acute pulmonary embolism
using a dual energy CT system with
rapid kVp switching: Initial results
[5]
Lv P, Lin XZ, Li J, Li W, Chen K. Differentiation of small hepatic hemangioma
from small hepatocellular carcinoma:
recently introduced spectral CT method.
Radiology. 2011 Jun;259(3): 720-9.
[6] Zhang D, Li X, Liu B. Objective characterization of GE discovery CT750 HD
scanner: gemstone spectral imaging
mode. Med Phys. 2011 Mar;38(3):
1178-88.
[7] Delesalle MA, Pontana F, Duhamel A,
Faivre JB, Flohr T, Tacelli N, Remy J,
Remy-Jardin M. Spectral optimization
of chest CT angiography with reduced
iodine load: experience in 80 patients
evaluated with dual-source, dual-energy
CT. Radiology. 2013 Apr;267(1): 256-66.
Further Information
www.siemens.com/dualenergy
Customer Excellence
CT Physics Workshop
Focus on Radiation Dose Optimization
By Katrin Seidel, Computed Tomography, Siemens Healthcare, Forchheim, Germany
Everyone is using terms such as
ALARA, Right Dose or low-kV scanning. When focusing on dose, it
becomes increasingly important for
physicists to exploit the full dose-saving potential of their CT scanners.
Siemens is therefore offering the
chance to learn more about dose saving possibilities of SOMATOM CT systems. The next course is scheduled
for March 2425, 2015, in Forchheim,
Germany.
Further Information
www.siemens.com/
SOMATOMEducate
Live webinars
On the Siemens educational platform users
can follow latest news in medical imaging.
Siemens Healthcares educational platform is an established and comprehensive clinical information page with a
wide range of programs offering valuable ways to improve clinical skills and
to use Siemens CT systems to their full
potential.
Further Information
www.siemens.com/
SOMATOMEducate
Customer Excellence
Date
Location
SCCT Hawaii
The Winter Meeting
January
1821, 2015
Hawaii,
USA
January
2223, 2015
Course
Language
Link
English
Society of Cardiovascular
Computed Tomography
www.scct.org/hawaii/2015/
Forchheim,
Germany
English
Siemens Healthcare
www.siemens.com/
SOMATOMEducate
March
48, 2015
Vienna,
Austria
English
Siemens Healthcare
www.siemens.com/ECR
Optimized TAVI
Procedural Planning:
CT and Angiography
March
10, 2015
Erlangen,
Germany
English
Siemens Healthcare
Prof. Stephan Achenbach, MD
Markus Kasel, MD
Martin Arnold, MD
www.siemens.com/
SOMATOMEducate
March
2425, 2015
Forchheim,
Germany
English
Siemens Healthcare
www.siemens.com/
SOMATOMEducate
April
1517, 2015
Bruges,
Belgium
English
ESGAR
Philippe Lefere, MD,
Stefaan Gryspeerdt, MD
www.esgar.org
May
78, 2015
Forchheim,
Germany
English
Siemens Healthcare
Assist. Prof. Ralf Bauer, MD
www.siemens.com/
SOMATOMEducate
Advanced Cardiovascular CT
May
1215, 2015
London,
UK
English
Siemens Healthcare
Organizers:
Ed Nicol, MD,
Simon Padley, MD,
Sujal Desai, MD
www.imperial.ac.uk
June
0912, 2015
Paris,
France
English
ESGAR
Prof. Yves Menu
www.esgar.org
Oncology Imaging
Course 2015
June
2527, 2015
Dubrovnik,
Croatia
English
OIC
Prof. Maximilian F. Reiser, MD
Prof. Christian Herold, MD
Prof. Hedvig Hricak, MD
www.oncoic.org
August 29
September 2,
2015
London,
UK
English
Siemens Healthcare
www.siemens.com/ESC
September
1618, 2015
Florence,
Italy
English
ESGAR
Assist. Prof. Emanuele Neri
www.esgar.org
October
2728, 2015
Forchheim,
Germany
English
Siemens Healthcare
www.siemens.com/
SOMATOMEducate
Coronary CTA
Interpretation Workshop
November
1213, 2015
Erlangen,
Germany
English
Siemens Healthcare
Prof. Stephan Achenbach, MD
www.siemens.com/
SOMATOMEducate
In addition, you can always find the latest CT courses offered by Siemens Healthcare
at www.siemens.com/SOMATOMEducate
SOMATOM Sessions | December 2014 | www.siemens.com/SOMATOM-Sessions 85
Customer Excellence
Date
Location
Title
Contact
November 30
December 05,
2014
Chicago, USA
RSNA
www.rsna.org
Arab Health
January
2629, 2015
Dubai, UAE
Arab Health
www.arabhealthonline.com
March
0408, 2015
Vienna, Austria
ECR
www.myesr.org
April
1618, 2015
Cannes, France
http://cardiacmri-ct.medconvent.at/
European Conference
on Interventional Oncology
April
2225, 2015
Nice, France
ECIO
www.ecio.org
April
2428, 2015
Barcelona, Spain
ESTRO
www.estro.org
May
1215, 2015
Vienna, Austria
esc
www.eurostroke.eu
May
1823, 2015
PTCOG
www.ptcog.ch
May
2023, 2015
Prague, Czech
Republic
AEPC
www.aepc.org
May 29
Jun 02, 2015
Chicago, USA
ASCO
www.am.asco.org
June
0206, 2015
Graz, Austria
ESPR
www.espr.org
June
0406, 2015
Barcelona, Spain
ESTI
www.myesti.org
June
0710, 2015
San Francisco,
USA
ISCT
www.isct.org
June
0912, 2015
Paris, France
ESGAR
www.esgar.org
July
1216, 2015
Anaheim, USA
AAPM
www.aapm.org
Society of Cardiovascular
Computed Tomography
July
1619, 2015
SCCT
www.scct.org
August 29
Sep. 02, 2015
London, UK
ESC
www.escardio.org
September
2630, 2014
Madrid, Spain
ESMO
www.esmo.org
October
1821, 2015
San Antonio,
USA
ASTRO
www.astro.org
November 29
Dec. 04, 2015
Chicago, USA
RSNA
www.rsna.org
Customer Excellence
1
1
Editing the bone
removal results is
only possible if the
bone highlighting
view is switched off
and the fine tuning
or bone opacity
modes are deactivated. To connect
vessel segments:
drag the mouse
while holding
the mouse button,
and release it on
an adjacent vessel
segment.
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Imprint
Lamaci, Mariana M., MD, Department of Cardiovascular Imaging, Hospital do Corao, So Paulo,
Brazil
Haubenreisser, Holger, MD, Institute of Clinical Radiology and Nuclear Medicine, University Medical Centre
Mannheim, Medical Faculty Mannheim, Heidelberg
University, Germany
Rochitte, Carlos E., MD, Department of Cardiovascular Imaging, Hospital do Corao, So Paulo, Brazil
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The information presented in these articles and case reports is for illustration only and
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Siemens S.A.
Medical Solutions
Avenida de Pte. Julio A. Roca No 516, Piso 7
C1067ABN Buenos Aires Argentina
Phone: +54 11 4340-8400
www.siemens.com/healthcare
USA:
Siemens Medical Solutions U.S.A., Inc.
51 Valley Stream Parkway
Malvern, PA 19355-1406
USA
Phone: +1-888-826-9702
www.siemens.com/healthcare
Europe/Africa/Middle East:
Siemens AG
Healthcare
Henkestrae 127
D-91052 Erlangen
Germany
Phone: +49 9131 84-0
www.siemens.com/healthcare
Global Siemens
Healthcare Headquarters
Siemens AG
Healthcare
Henkestrae 127
91052 Erlangen
Germany
Phone: +49 9131 84-0
www.siemens.com/healthcare
www.siemens.com/SOMATOM-Sessions