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Cover Story
Performance is Becoming
More Accessible
Page 6
SOMATOM Denition
Edge: Low Dose,
Quality Images
Page 16
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SOMATOM Sessions
News
Business
US Edition
Clinical
Results
Diagnosis of an
Intracranial
Dual-Aneurysm
using the new
SOMATOM Perspective
Page 54
Science
Beating Cancer
Treating Individuals
Page 69
Editorial
Imprint
Editorial Board:
Xiaoyan Chen, MD; Andreas Fischer; Jan Freund;
Tanja Gassert; Sandra Kolb; Axel Lorz; Heidrun Endt;
Julia Hlscher; Monika Demuth, PhD; Peter Seitz;
Stefan Ulzheimer, PhD
Photo Credits:
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City
State
Walter Mrzendorfer, Chief Executive Officer, Business Unit Computed Tomography and Radiation Oncology,
Siemens Healthcare, Forchheim, Germany
Clinical Editor:
Xiaoyan Chen, MD
(xiao_yan.chen@siemens.com)
Country
Chief Editors:
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(monika.demuth@siemens.com)
Stefan Ulzheimer, PhD
(stefan.ulzheimer@siemens.com)
Editorial
Peter Seitz,
Vice President Marketing,
Computed Tomography,
Siemens Healthcare,
Forchheim, Germany
Dear Reader,
Over the past few months, several breakthroughs in CT have been implemented
in clinical practice. These innovations
address an increasing demand for efficiency in diagnostic imaging, as well as
the possibility to individualize imaging
for each patient.
When investing in high-end technology,
such as 128-slice CT scanners, the balance between performance and cost has
become the key criterion in many buying
decisions. The Sainte-Marie Hospital near
Paris is an example of where high expectations in imaging quality have to be
matched with the need to manage high
patient numbers. In this issue, read how
the SOMATOM Perspective was rapidly
implemented at this hospital providing
the perfect balance for both requirements.
At the German Heart Center in Leipzig,
syngo.via has helped to reduce the time
required for vessel segmentation tenfold,
a considerable difference especially
when handling complicated cases. Its
automatic pre-processing also speeds
up TAVI planning significantly.
Peter Seitz
Content
Content
Cover Story
22
34
Siemens International
CT Image Contest 2011
Cover Story
06 Performance is Becoming
More Accessible
News
Business
32 Straton X-ray Tube: HighPerformance under Challenging
Conditions
34 Low Dose, High Resolution for
Pediatric Cardiology
38 eMode on SOMATOM Perspective
a Chance to Optimize Total Cost
of Ownership in Clinical Routine
Clinical Results
Cardio-Vascular
40 Adaptive 4D Spiral CT Angiography
for the Diagnosis of a Capillary
Hemangioma
42 Diagnosis of Coronary-Ventricular
Fistula with Giant Coronary Aneurysm
using Flash Mode
44 Diagnosis of Truncus Arteriosus
using Flash CT Scanning
46 Follow-up on CABG using iTRIM
Method for Coronary CTA
Content
62
Diagnosis of Sub-acute Pulmonary
Emboli using Flash mode, SAFIRE and
100 kV
72
Education and Awareness Brings
Condence to Decision-making in
Medical Imaging
74
Siemens Hands-on Workshops
at the ECR and ESC
Customer
Excellence
48 Diagnosis and Follow-up of
RCA Aneurysm using Flash Scanning
at 0.3 mSv
Oncology
50 Xenon Ventilation Imaging using
Dual Energy CT in Combined
Pulmonary Fibrosis and Emphysema
52 Non-Hodgkin Lymphoma with
Rare Metastases in the Pancreas
Pulmonology
64 Dynamic Volumetric Expiratory
Imaging for Diagnosis of Tracheobronchomalacia using Flash CT
Scanning
Neurology
54 Diagnosis of an Intracranial
Dual-Aneurysm using the new
SOMATOM Perspective
56 Whole Brain Perfusion CT Reveals
Acute Misery Perfusion
Acute Care
58 CT Perfusion Identifies Delayed
Cerebral Ischemia after Subarachnoid
Hemorrhage
60 Time Resolved CT Angiography in
Patients after EVAR
Science
1 In the Sainte-Marie Clinic in Osny, France, about 800 patients have been already examined with the new SOMATOM Perspective.
Almost all pathologies have been successfully investigated. This follow-up study of a spine fracture is an example of osteoarticular
imaging. Courtesy of Sainte-Marie Clinic, Osny, France
Cover Story
Performance is Becoming
More Accessible
At the beginning of 2012, the Sainte-Marie Clinic in Osny, France, was one
of the rst places in the world to have the SOMATOM Perspective CT scanner
installed. The event was welcomed by the whole medical imaging team,
which received the new piece of Siemens equipment and which has already
noticed its diagnostic, economic, and ecological performance.
By Christian Rayr
operator who works with the two scanners, SOMATOM Definition AS and
SOMATOM Perspective. Perspective is a
little bit slower than SOMATOM Definition
AS. With the SOMATOM Perspective, we
can do a thorax examination in 3 seconds
(1.5 seconds with SOMATOM Definition
AS), pelvic abdominal examination in
8 seconds, and lumbar rachis in 10 seconds. The device is extremely easy to use.
And the reconstruction module means
Cover Story
The use of the eMode software allows the team in Osny to work at more or less
80 percent of the systems maximum intensity, which extends a longer life cycle.
Cover Story
The atmosphere in the examination room can be softened thanks to the Illumination Moodlight.
This lighting system can be adjusted in terms of color and intensity.
examinations. We also do a lot of oncology work, with patients who have had to
undergo numerous repetitive examinations. Thanks to this new CT scanner and
Sinogram Affirmed Iterative Reconstruction SAFIRE* in short , which we also
use with SOMATOM Definition AS, we
have observed that the radiation doses
are markedly reduced. After four to six
weeks of use, the team believes that the
reduction of the doses is around 50 percent, which they think is very significant.
Cover Story
With the SOMATOM Perspective, Alexandre Fuchs, MD can obtain high-quality images very quickly.
After that the images can be reviewed immediately at the syngo.via workplace.
At the end of January 2012, as one of the first worldwide, the all-new SOMATOM Perspective
scanner was installed in Sainte-Marie imaging center.
Cover Story
www.siemens.com/
SOMATOM-Perspective
11
News
1A
1B
1C
1 Example of a bypass follow-up study done with the Stellar Detector. Courtesy of German Heart Center Munich, Munich, Germany
News
Stefan Martinoff, MD, and Jrg Hausleiter, MD, are talking about the new Stellar Detector
technology in their SOMATOM Definition Flash and how it creates a win-win situation for them
and their patients.
As radiologists, we especially
appreciate the increase in precision
we see with the new detector.
13
News
The German Heart Center in Munich is now utilizing the full performance
of the new Stellar Detector in their SOMATOM Definition Flash CT.
MARTINOFF: Doctors save time in immediately seeing top images after scanning,
also during post-processing. In addition,
readers can diagnose much more reliably
when everything is so well-depicted
the radiologist is visibly more relaxed. If,
as a diagnostician, you are seeing even
the branches of branches, you have a very
good feeling.
News
15
News
The new SOMATOM Definition Edge, the first single source CT to use the newly developed Stellar Detector
is the latest acquisition by the Inselspital in Bern.
News
The 86-year-old lady had all the symptoms of a wake-up stroke when she
was admitted to the Institute of Neuroradiology at Bern University hospital,
the so-called Inselspital, one morning
at the end of March 2012. Suffering
from hemiplegia on her left, she was in
a bad clinical condition. Thats why
we decided not to have her examined by
MRI, which we usually recommend for
strokes, but to do the diagnostics by CT
instead, explains PD Christoph Ozdoba,
MD, senior neuroradiologist at the Inselspital. Given the seriousness of the case,
Ozdoba and his team were able to test in
full the capacity of the institutes latest
acquisition: the new SOMATOM Definition
Edge, the first single source CT to use
the newly developed Stellar Detector by
Siemens.
While the patient lay on the table, anaesthetized, Ozdoba and head technologist
Nadja Feusi ran through almost all the
features provided by the new tomograph,
including the possibility to visualize the
perfusion of the entire brain a crucial
parameter in stroke diagnostics. When
the first images appeared on the screen,
displaying the infarct of this patient in its
entire dimension, we were immediately
convinced that our CT diagnosis would be
accurate, says Ozdoba. Chief physician
Prof. Gerhard Schroth is pleased beyond
expectations: The images yielded by this
CT are cutting-edge, he says. The speed
of the machine is quite astonishing,
adds Nadja Feusi, who is becoming more
familiar with the Definition Edge every
day she operates it.
Decisive argument:
dose reduction
Bern University hospital is the very first
clinic worldwide where the single source
CT SOMATOM Definition Edge has been
introduced into clinical application. Apart
from the machine at the Institute of
Neuroradiology, a second scanner will be
provided for the new emergency room,
due at the beginning of July. When we
evaluated the system in October 2011
we were soon convinced that we wanted
to have it, although we didnt foresee
at that time that we would be the first
ones to actually operate it, says Ozdoba.
17
News
Head technologist Nadja Feusi already ran through almost all the features provided by the new
computed tomograph and is becoming more familiar with it every day she operates it.
Advanced post-processing
software
What is even more important than speed
in neuroradiology are excellent images
and sharp resolution, combined with an
advanced post-processing software such
as an advanced vascular program all
of which the Definition Edge comprises.
The system must cover the whole scope
of neurological CT diagnostics where
microstructures are just as important as
whole brain visualizations, says Ozdoba.
In the first phase after the installation
he and his team have mainly been busy
News
19
News
Iterative Reconstruction
Lower Dose in Clinical Routine
Siemens Iterative Reconstruction solutions prove their dose
reduction value in facilities worldwide. Now the dose reduction
potential is enhanced with SAFIRE.
By Jan Freund
Computed Tomography, Siemens Healthcare, Forchheim, Germany
Siemens IR is independently
validated
SAFIRE dose reductions potential was
also recognized by the scientific community. Many publications on IRIS and
SAFIRE have shown the dose reduction
potential for various body regions and
their clinical suitability. [14]
The distribution of SAFIRE increased to
approximately 1,000 installations worldwide as of mid-2012, covering more
than a third of the installed SOMATOM
Definition AS and SOMATOM Definition
Flash systems. The unique combination
of proven dose reduction with a perfor-
References
[1] Bulla S et al. Eur J Radiol. 2011 Jun 8.
[Epub ahead of print]
[2] Hu XH et al. Clin Radiol. 2011 Nov;66(11):1023-9.
[3] Moscariello A et al. Eur Radiol. 2011
Oct;21(10):2130-8.
[4] Winklehner A et al. Eur Radiol. 2011
Dec;21(12):2521-6.
2 VRT image of the same patient which also clearly illustrates the correct placement of the prosthesis. Courtesy of University Hospital Zurich, Switzerland
21
News
Siemens International
CT Image Contest 2011
At the start of last years congress of the Radiological Society of
North America (RSNA), Siemens Healthcare announced the winners
of the International CT Image Contest 2011. More than 160 institutes
and hospitals from 43 countries from all continents had submitted
over 600 clinical cases, acquired using Siemens CT scanners with low
radiation dose.
Monika Demuth, PhD, and Tiago Campos, Computed Tomography, Siemens Healthcare, Forchheim, Germany
www.siemens.com/image-contest
News
1
1
2
2
23
News
3
3
4
4
Submitter: Teh Hui Seong, MD, and Trishna Sumer Shikhare, MD,
Khoo Teck Puat Hospital, Singapore
Patients History: A 69-year-old male patient presented with
a pulsating abdominal mass and an acute onset of lower abdominal
pain. CT Angiography was performed and an abdominal aortic
aneurysm was detected for which the patient underwent Endovascular
Aortic Aneurysm Repair (EVAR) and aorto- iliac stent implantation.
Diagnosis: Post EVAR CT Dual Energy (DE) imaging showed neither
evidence of a contrast leak or haemorrhage, nor haemoperitoneum
or retroperitoneal collection.
Scanner: SOMATOM Definition Flash
Dose: 5.9 mSv
5
5
News
6
6
7
7
8
8
25
News
News
syngo.CT Dynamic Angio helps Lukas Lehmkuhl, MD with the evaluation of AAA stent patency based on 4D image data.
Boosting assessment of 4D
EVAR1 follow-ups
Lehmkuhl further appreciates new
diagnostic possibilities with syngo.CT
Dynamic Angio. Since this application
www.siemens.com/
ct-clinical-engines
27
News
News
SOMATOM Definition AS+ features a rotation time as fast as 0.30 s, stroke imaging of the entire brain, plus the recently
added sequential Dual Energy scanning.
Plus it also ships with state-of-the-art
dose-saving features such as CARE kV,
IRIS (Iterative Reconstruction in Image
Space) and SAFIRE (Sinogram Affirmed
Iterative Reconstruction), the Adaptive
Dose Shield and X-CARE.
The SAFIRE algorithm is currently rolled
out free-of-charge to the international
installed base of SOMATOM Definition
customers who already use IRIS, showing
Siemens commitment to making low
dose CT as widely available as possible
for optimum patient care.
78%
Evangelist
67%
67%
67%
65%
Naysayer
64%
55%
45%
18%
10%
0%
9%
11%
8%
21%
7%
0%
Siemens
SOMATOM
Definition
Flash
Vendor A
64-slice CT
Vendor B
64-slice CT
Vendor B
Siemens
320-slice CT SOMATOM
Definition
AS 64
Vendor C
Vendor A
256-slice CT 64-slice
HD CT
Vendor C
64-slice CT
1 This chart compiled by KLAS researchers compares Evangelists and Naysayers for a range
of CT scanners in active use: The blue bars in the chart represent the percentage of users who
would recommend and actively speak in favor of the product. The orange bar represents the
number of users who would actively speak against the CT system.
KLAS CT 2011: Focused On Dose report, 11/2011, www.KLASresearch.com, 2011 KLAS Enterprises, LLC.
All rights reserved.
29
News
Pushing Boundaries in CT
Latest Research in Functional Imaging
Ground-breaking research published in a special edition of Investigative
Radiology reveals insights into new functional imaging methods.
By Heidrun Endt, MD
Computed Tomography, Siemens Healthcare, Forchheim, Germany
Perfusion CT imaging as a
quantitative imaging method
When evaluating new therapy methods
in oncology, a change of thinking is
required. New drugs or treatments may
trigger other reactions in the tumor tissue
that cannot be measured at an early
stage with current criteria (e.g. tumor
size). Perfusion CT needs to be assessed
comprehensively to prove its worth as
a reliable biomarker.
A group of researchers from Zurich,
Switzerland, analyzed perfusion patterns
of primary malignant liver tumors and
hepatic metastases in 30 patients with
computed tomography (CT) and ultrasound examinations. [1] A SOMATOM
Definition Flash was used for the CT part
of the study. With the Adaptive 4D Spiral
a scan range of 14.8 cm was covered
enabling perfusion imaging of the whole
organ. By using this technology repeatly,
bi-directional table movements are performed. As many patients may not be
able to hold their breath for the duration
required, motion correction is crucial for
1A
1B
1C
1D
References
[1] Goetti R et al. Quantitative perfusion analysis
of malignant liver tumors: dynamic computed
tomography and contrast-enhanced ultrasound.
Invest Radiol. 2012 Jan;47(1):18-24.
[2] Reiner CS et al. CT perfusion of renal cell
carcinoma: impact of volume coverage on
quantitative analysis. Invest Radiol. 2012
Jan;47(1):33-40.
[3] Apfaltrer P et al. Contrast-enhanced dualenergy CT of gastrointestinal stromal tumors: is
iodine-related attenuation a potential indicator
of tumor response? Invest Radiol. 2012
Jan;47(1):65-70.
[4] Nance JW et al. Optimization of contrast
material delivery for dual-energy computed
tomography pulmonary angiography in
patients with suspected pulmonary embolism.
Invest Radiol. 2012 Jan;47(1):78-84.
[5] Fink C et al., Functional Computed Tomography
Imaging. Invest Radiol. 2012 Jan;47(1):1
http://journals.lww.com/
investigativeradiology/
toc/2012/01000
2A
2B
2C
2D
31
Business
Emitter
Rotation
Cathode
Deflection coils
Anode
Motor
Electron beam
X-rays
Focal spot
1 Schematics of the STRATON tube with anode directly attached to the tube envelope.
Business
2A
2B
10 cm
2 The compact design of the STRATON tube (Fig. 2A) allows two acquisition systems
within one scanner for dual source and dual energy scanning. A conventional tube is shown
for comparison (Fig. 2B).
Distribution of failure
100%
ideal
90%
x-ray tube
80%
70%
60%
50%
40%
30%
20%
10%
0%
time
3 Distribution of failure versus time for an ideal case with only one cause of failure
(blue line). In case of multiple failure causes which can occur at different times
(like wear caused in an X-ray tube) a linear relationship results (red line). With continuous
tube optimization the failure rate over time can be decreased (green line).
www.siemens.com/TubeGuard
33
Business
2 An anomalous RCA from ascending aorta from a 17-year-old child weighing 200 lb.
Courtesy of Minneapolis Heart Institute and Childrens Hospital and Clinics of Minnesota,
Minneapolis, USA
Business
The experts David Dassenko, MD, Kelly Han, MD, and John Lesser, MD, (from left to right)
were discussing about lower radiation doses, higher temporal resolution and patient comfort
for their cardiology patients during the interview with SOMATOM Sessions.
SOMATOM Definition Flash is that sedation may not be indicated in all cases
because of the Flashs extraordinary high
speed. It can allow for some patient
movement and may not require a breathholding sequence due to its scan speed
of up to 458 mm/s. There is also a definite increase in patient friendliness and
patient comfort with the Flash technology. When sedation is not used, parents
can take their child home right after
the scan is finished. This is a significant
35
Business
The Flash CT is
a much better
answer to those
questions than
the older generation scanners
used to be.
Kelly Han, MD, Director of Congenital
Cardiac Imaging, Childrens Hospitals
and Clinics of Minnesota
zation is vital later in life. Lesser simplifies the diagnostic decision tree to two
simple questions: Number one: What
do I need? And number two: What is
the least risk? According to Han, The
SOMATOM Definition Flash CT is a much
better answer to those questions than
the older generation scanners used to
be.
Kelly Han, MD, explains to the patient what will happen during the imaging procedure.
notes that teamwork was not well established with the use of the older generation scanners. Han is currently using
Flash CT clinically to diagnose children
with complex anatomy who are less
than eight years of age, because of its
favorable risk profile.
www.siemens.com/
SOMATOM-Definition-Flash
Because the
radiation dose is
so low, we can do
multiple scans for
different purposes
now if necessary.
John Lesser, MD,
Director of Cardiovascular Computed
Tomography and Magnetic Resonance
Imaging at the Minneapolis Heart Institute
37
Business
The Application Specialist can provide instant support for any application.
Business
eMode and a respective service benefit program allows operating the SOMATOM Perspective in a patient friendly and financially efficient way.
paring a special CT examination especially for things that need to be done less
often this saves me lots of time. Having
now worked on a Siemens system for the
first time, Im extremely happy as a new
user that the Siemens expert can connect
to the system remotely and immediately
help me with all my questions. I feel
more secure.
39
Case 1
Adaptive 4D Spiral CT Angiography for
the Diagnosis of a Capillary Hemangioma
By Xiang-ming Fang, MD,* Xiao-yun Hu, MD,* Hong-wei Chen, MD,* Ping-yan Qian, MD,*
Gang-feng Hu, MD,* Hui-jun Lu, MD,* Chenwei Li, MD**
**Department of Radiology, Wuxi Peoples Hospital Affiliated to Nanjing Medical University, Wuxi, P. R. China
**Healthcare Sector, Siemens Ltd. China, Shanghai, P. R. China
HISTORY
A 29-year-old female patient presented
herself to the hospital with a tumor
on the ulnar side of her left ring finger.
The tumor had appeared a month earlier,
small and asymptomatic. It however
1 The VRT image shows that the tumor (arrow) is well defined
and clearly separated from the phalanx.
DIAGNOSIS
COMMENTS
EXAMINATION PROTOCOL
Scanner
SOMATOM
Definition Flash
Scan area
Hand
Scan length
150 mm
Scan Mode
Adaptive 4D Spiral
Scan direction
Caudo-cranial
and cranio-caudal
Scan time
24 s
Tube voltage
100 kV
Tube current
120 mAs
CTDIvol
100 mGy
DLP
1520 mGy cm
Effective Dose
1.2 mSv
Rotation time
0.285 s
Slice collimation
32 x 1.2 mm
Slice width
1.5 mm
Reconstruction
increment
1.0 mm
Reconstruction kernel
B20f
Contrast
Volume
50 ml
Flow rate
3.5 ml/s
Start delay
Bolus tracking
41
Case 2
Diagnosis of Coronary-Ventricular
Fistula with Giant Coronary Aneurysm
using Flash Mode
By Kai Sun, MD,* Ruijuan Han, MD,* Lijun Ma, MD,* Ligang Li, MD,** Gang Wang, MD,* Hailiang Jia, MD*
** Department of Radiology, Baotou Central Hospital, Inner Mongolia, P. R. China
** Healthcare Sector, Siemens Ltd. China, Shanghai, P. R. China
HISTORY
DIAGNOSIS
COMMENTS
EXAMINATION PROTOCOL
Scanner
Scan area
Heart
Rotation time
0.28 s
Scan length
13 cm
Pitch
3.4
Scan direction
Cranio-caudal
Slice collimation
128 x 0.6 mm
Scan time
0.23 s
Slice width
0.75 mm
Tube voltage
100 kV
Reconstruction increment
0.4 mm
Tube current
Reconstruction kernel
B26f
Dose modulation
CARE Dose4D
Contrast
CTDIvol
3.59 mGy
Volume
60 mL
DLP
59 mGy cm
Flow rate
5 mL/s
Effective Dose
0.8 mSv
Start delay
8s
16 Images show a giant coronary aneurysm (Figs. 35, solid arrows) originating off a fistula
(Figs. 1, 2, 5, dashed arrows) connecting the left coronary artery and the right ventricle, and an
anomalous single coronary artery arising from the left sinus of Valsalva (Figs. 12, arrowheads).
The right coronary artery (RCA) and the left circumflex coronary artery (LCx) are absent.
43
Case 3
Diagnosis of Truncus Arteriosus
using Flash CT Scanning
By Vasco Silva, MD,* Joo Carlos Costa, MD,** Constana Palma Borges, MD,* Joana Costa, MD,*** Marisa Gonalves, RT,**
M. Reis, RT,** P. Miguel, RT,* M. Sozinho, RT,* A. Nchanduca, RT,* C. Rosa, RT,* S.Bastos, RT,* Ana Chaves ****
**** Radiology Department, Clinica Girassol, Luanda, Angola
**** Radiology Department, Hospital Particular de Viana do Castelo, Portugal
**** Radiology Department Institut Jules Bordet, Brussels
**** CT Application Specialist, Siemens Healthcare, Portugal
HISTORY
A 4-year-old girl, weighing 7.5 kg with
a provisional diagnosis of congenital
heart disease, was transferred by the
National Board of Health from Angola to
the Girassol private practice in Luanda.
Despite the previous administration of
beta-blockers, her heart rate remained
at 93 bpm when CT was performed to
evaluate the complex structure of the
heart.
DIAGNOSIS
The cardiac CT Angiography confirmed
the diagnosis of a truncus arteriosus
with ventricular septal defect (Collett and
Edwards type I; Van Praagh type 1A). A
common arterial trunk arised from both
ventricles, which communicated via a
large perimembranous ventricular septal
defect (VSD) (Fig. 1). The arterial trunk
divided into the aorta and the main
pulmonary artery. The main pulmonary
artery subsequently divided into the left
and right branched pulmonary arteries.
(Figs. 2 and 3). Both coronary arteries
arised from the common arterial trunk
proximal to the main pulmonary arteries
(Fig. 4). The anatomical abnormalities
were confirmed and repaired in subsequent surgery.
rate, reduced exposure dose and minimizes the necessary amount of contrast
media (in this case, 93 bpm, 0.8 mSv
and 10 mL). This is particularly important
for pediatric cardiac CT examinations
of congenital heart disease where the
patients normally have a higher heart rate
and incompatibility with beta-blockers.
EXAMINATION PROTOCOL
Scanner
Scan mode
Scan area
Heart
Scan length
98 mm
Scan direction
Cranio-caudal
Scan time
4s
Tube voltage
100 kV
Tube current
99 eff. mAs
Rotation time
0.28 s
Slice collimation
128 x 0.6 mm
Slice width
0.75 mm
Reconstruction increment
0.4 mm
Temporal Resolution
75 ms
Reconstruction kernel
B30f
CTDIvol
4.11 mGy
DLP
57 mGy cm
Effective Dose
2.26 mSv
Contrast
COMMENTS
Truncus arteriosus is a congenital heart
disease resulting from the failure of
Volume
10 mL contrast media
Flow Rate
2 mL/s
Start delay
6s
1 MPR image shows a common arterial trunk arising from both ventricles, which communicate via a large perimembranous ventricular
septal defect (arrow).
23 MIP (Fig. 2) and VRT (Fig. 3) images demonstrate the arterial trunk which divides into the aorta and main pulmonary artery,
and the main pulmonary artery subsequently divides into the left and right branch pulmonary arteries.
4 MIP image reveals both coronary arteries arising from the common arterial trunk proximal to the main pulmonary arteries.
45
Case 4
Follow-Up on CABG using
iTRIM Method for Coronary CTA
By Yingning Wang, MD, Jian Cao, MD, Zhou Li, MD
Department of Radiology, Peking Union Medical College, Beijing, P.R. China
HISTORY
DIAGNOSIS
1 VRT image demonstrates an overview of both LIMA and SVG grafts which are patent.
LIMA graft remains intact at its origin (arrow) off the subclavian artery and is grafted to
the LAD artery (dashed arrow). A left SVG was laid over the pulmonary artery and originated proximally off the anterior wall of the ascending aorta. A mild stenosis in mid-RCA
(arrowhead) can also be visualized.
2 Curved
MPR image
presents the
entire course
of the LIMA
graft and its
patent anastomosis to the
LAD.
3 Curved MPR
shows RCA with
mild stenosis
from soft plaque
(arrowheads).
COMMENTS
In CABG follow-up studies, especially
those with saphenous vein grafts, catheter angiography is often difficult. Cardiac
CT can obtain both 2D and 3D images,
to depict in detail the course and status
of the grafts. Generally, to avoid motion
artifacts, a high temporal resolution
is required. This involves sophisticated
hardware to speed up the rotation time.
Alternatively, image reconstruction algorithms, such as the iterative Temporal
Resolution Improvement Method (iTRIM)
can be used to improve the temporal
resolution. iTRIM enhances temporal
resolution by 20% [1], allowing temporal
resolution to be improved to 192 ms
potentially aiding the physician in making
a reliable diagnosis.
5 Curved MPR
shows severe stenosis,
from non-calcified
plaque in LM, occlusion from both soft
and calcified plaque
in proximal LAD and
severe stenosis from
non-calcified plaque
in proximal D1.
6 Curved MPR
shows CX is small
in caliber with
no evidence of
stenosis.
EXAMINATION PROTOCOL
Scanner
SOMATOM Perspective
Scan area
Heart
Scan length
250 mm
Scan direction
Cranio-caudal
Scan time
12 s
Tube voltage
130 kV
Tube current
CTDIvol
28.35 mGy
DLP
877.82 mGy cm
Effective dose
12.3 mSv
Rotation time
0.48 s
Pitch
0.27
Slice collimation
64 x 0.6 mm
Slice width
0.75 mm
Temporal Resolution
192 ms
Reconstruction increment
0.5 mm
Reconstruction kernel
B31s
35 53 bpm
Contrast
References
[1] Schndube H et al. Evaluation of a novel CT
image reconstruction algorithm with enhanced
temporal resolution, Proc. SPIE 7961,
79611N (2011).
Volume
Flow rate
5 mL/s
Start delay
23 s
47
Case 5
Diagnosis and Follow-up of
RCA Aneurysm using Flash Scanning
at 0.3 mSv
By Fahim H. Jafary, MD, FACC, FSCAI, Senior Consultant Cardiologist,* Jagajothi Devadoss,
Senior Radiographer,* Erdie Q. Dizon, Radiographer,* Wynne Chia, Senior Application Specialist, CT**
** Department of Cardiovascular Medicine, Tan Tock Seng Hospital, Singapore
** Siemens Healthcare, Regional Headquarters, Asia, Australia
HISTORY
DIAGNOSIS
COMMENTS
A coronary aneurysm is rare, especially
in young patients. Follow-up CT scans
are necessary to monitor the progress of
the aneurysm. Therefore, it is important
to minimize the exposure dose to the
patient. Flash scanning uses an ECGtriggered spiral scan to acquire the entire
heart in one heart cycle. This provides
a very short scan time (0.3 s) and a very
low, consistent dose (0.3 mSv), as seen
in these two follow-up CT examinations
of the patient.
EXAMINATION PROTOCOL
Scanner
SOMATOM Definition
Flash
Scan area
Heart
Scan length
138 mm
Scan direction
Cranio-caudal
Scan time
0.3 s
Tube voltage
80 kV
Tube current
CTDIvol
1.26 mGy
DLP
24 mGy cm
Effective dose
0.3 mSv
Rotation time
0.28 s
Pitch
3.4
Slice collimation
128 x 0.6 mm
Slice width
0.6 mm
Temporal
Resolution
75 ms
Reconstruction
increment
0.3 mm
Reconstruction
kernel
B26f
Contrast
Volume
60 mL
Flow rate
6 mL/s
Start delay
49
Case 6
Xenon Ventilation Imaging using
Dual Energy CT in Combined Pulmonary
Fibrosis and Emphysema
Keishi Sugino, MD, PhD,* Masahiro Kobayashi, MD,** Fumiaki Ishida, MD,* Naoshi Kikuchi, MD,* Nao Hirota, MD,*
Keita Sato, MD,* Go Sano, MD,* Kazutoshi Isobe, MD, PhD,* Susumu Sakamoto, MD, PhD,* Yujiro Takai, MD, PhD,*
Nobuyuki Shiraga, MD, PhD,** and Sakae Homma, MD, PhD*
**Department of Respiratory Medicine, Toho University Omori Medical Center, Tokyo, Japan
**Department of Radiology, Toho University Omori Medical Center, Tokyo, Japan
HISTORY
A 76-year-old man was admitted to our
hospital complaining of progressive dyspnea during exertion. He had a 50-year
smoking history averaging 20 cigarettes
per day. He had no known exposure to
1A
1B
1 Chest CT revealed paraseptal and centrilobular emphysematous lesions significantly in both upper lobes and reticular lesions
with honeycombing formations bilaterally in the sub-pleural lower lobes.
DIAGNOSIS
Based upon the results of the increased
serum inflammatory markers (KL-6 and
SP-D), the mixed-ventilatory impairment
with decreased diffusing capacity and
the chest CT results, the patient was diag-
EXAMINATION PROTOCOL
Scanner
SOMATOM
Definition Flash
Scan area
Chest
COMMENTS
Scan length
345.0 mm
10.09 s
Scan direction
Cranio-caudal
kV
80 kV / 140 kV
Effective mAs
230 / 95 mAs
Rotation time
0.28 s
Slice collimation
64 x 0.6 mm
Reconstructed
slice thickness
2 mm
Increment
1.5 mm
Kernel
D30f
2, 3 3D Xenon-CT imaging and coronal MPR showed large focal xenon ventilation defects in the upper lobes, and in contrast, slightly
decreased xenon ventilation with several defects and volume loss with diffuse hypoventilation in the fibrotic lesions in the lower lobes.
51
Case 7
Non-Hodgkin Lymphoma with Rare
Metastases in the Pancreas
By Harald Seifarth, MD, Christoph Schlke, MD, Johannes Wessling, MD
Department of Clinical Radiology, University of Muenster, Germany
HISTORY
COMMENTS
DIAGNOSIS
EXAMINATION PROTOCOL
planar reformations, can clearly demonstrate the multiple lesions and structures
involved. In this case, the metastases in
the parenchyma of the pancreas and the
slight ectasia of the distal duct could be
clearly visualized.
Scanner
Scan area
Thorax
Abdomen
Scan length
286 mm
420 mm
Scan direction
Caudo-cranial
Cranio-caudal
Scan time
4s
9s
Tube voltage
120 kV
120 kV
Tube current
86 mAs
104 mAs
Dose modulation
CARE Dose4D
CARE Dose4D
CTDIvol
5.8 mGy
8.5 mGy
DLP
177 mGy cm
307 mGy cm
Effective dose
2.48 mSv
4.6 mSv
Rotation time
0.28 s
0.5 s
Pitch
0.6
0.6
Slice collimation
128 x 0.6 mm
128 x 0.6 mm
Slice width
1.0 mm
1.5 mm
Reconstruction increment
0.5 mm
0.7 mm
Reconstruction kernel
B30
B20
Volume
90 mL
100 mL
Flow rate
2.5 mL/s
3 mL/s
Start delay
45 s
85 s
Contrast
53
Case 8
Diagnosis of an Intracranial
Dual-Aneurysm using the new
SOMATOM Perspective
By Johann Steffens, MD
Department of Radiology, Israelitisches Krankenhaus, Hamburg, Germany
HISTORY
An 84-year-old female patient with
a known small left internal carotid
aneurysm was admitted to the hospital
due to a sudden onset of ptosis and a
lack of right eye abduction.
COMMENTS
DIAGNOSIS
CT images showed a large aneurysm,
measuring 2.9 cm in diameter, at the
right internal carotid artery (ICA) siphon,
compressing the right orbital apex.
EXAMINATION PROTOCOL
Scanner
SOMATOM Perspective
Scan area
Rotation time
0.6 s
Scan length
316 mm
Slice collimation
64 x 0.6 mm
Scan direction
Caudo-cranial
Slice width
0.75 mm
Scan time
4s
Reconstruction increment
0.4 mm
Tube voltage
110 kV
Reconstruction kernel
I 30
Tube current
68 eff. mAs
Contrast
CTDIvol
5.08 mGy
Volume
50 mL
DLP
224.45 mGy cm
Flow rate
3 mL/s
Effective dose
1.5 mSv
Start delay
12 s
3 VRT image reveals a small aneurysm at the left ICA siphon (arrow).
55
Case 9
Whole Brain Perfusion CT Reveals
Acute Misery Perfusion
By Jyoji Nakagawara, MD
Department of Neurosurgery and Stroke Center, Nakamura Memorial Hospital, Sapporo, Japan
16
CBF, MTT and CBV images acquired before (Figs. 13) and after (Figs. 46) treatment.
8A
8B
HISTORY
An 84-year-old patient was referred to
the hospital with transient left-sided
hemiparesis. A cervical echo-arteriogram
revealed a stenosis of the right cervical
carotid artery. The hemi-paresis gradually progressed after admission. MRI was
contra-indicated, since the patient had
a pacemaker. Instead a whole brain
perfusion CT and an IMP-SPECT1 were
ordered.
DIAGNOSIS
The cervical CT Angiography showed
severe stenosis of the right internal
carotid artery (ICA, Fig. 8A). The whole
brain perfusion CT demonstrated a critical perfusion state of the right cerebral
hemisphere a decrease of Cerebral
Blood Flow (CBF, Fig. 1), an increase of
Cerebral Blood Volume (CBV, Fig. 3) and
a prolongation of Mean Transit Time
(MTT, Fig. 2), which definitely suggested
an acute misery perfusion state. The
patient was diagnosed with a progressing
stroke due to severe stenosis of the right
ICA. The IMP-SPECT also showed reduced
blood flow to the same area (Fig. 7). An
emergency carotid artery stenting (CAS)
was performed. After the CAS treatment,
the left-sided hemiparesis immediately
improved and then disappeared. An
emergency treatment of the left internal
COMMENTS
Patients suffering from an ischemic
penumbra with abrupt occlusion of the
cerebral arteries in embolic stroke and
acute misery perfusion with hemodynamic cerebral ischemia could be candidates for acute revascularization procedures. Up to now, image modality was
not sufficient to confirm the diagnosis of
an acute misery perfusion with hemodynamic cerebral ischemia in routine clinical
practice. In patients with progressing
strokes, whole brain perfusion CT allows
the identification of a critical perfusion
state such as an acute misery perfusion
of the affected cerebral hemisphere.
Emergency CAS treatment has not yet
been established in the Japanese stroke
management guidelines. However, whole
brain perfusion CT could reveal a critical
perfusion state, such as an acute misery
perfusion, and could therefore be useful
EXAMINATION PROTOCOL
Scanner
Scan area
Whole brain
Scan length
96 mm
Scan time
45 s
Scan direction
Caudo-cranial and
cranio-caudal
Tube voltage
80 kV
Tube current
Rotation time
0.3 s
5 mm
Increment
5 mm
Kernel
H22f
CTDIvol
198.7 mGy
Effective dose
4.8 mSv
Contrast
Volume
30 mL iodine
+ 20 mL saline
Flow Rate
6 mL/s
Start delay
5s
57
Case 10
CT Perfusion Identies Delayed Cerebral
Ischemia after Subarachnoid Hemorrhage
By Andre Kemmling, MD, Ludger Feyen, MD
Department of Clinical Radiology, University Hospital, Muenster, Germany
HISTORY
A 61-year-old female patient was admitted to the hospital suffering from a thunderclap headache, followed by a rapid
deterioration of her consciousness level
and then coma. Non-enhanced CT (Fig. 1)
and CT Angiography (CTA), upon admission, showed an acute subarachnoid
hemorrhage (SAH) due to an anterior
communicating aneurysm (Hunt-Hess
grade 3, Fisher grade 3). The aneurysm
was promptly secured by surgical clipping;
however, the intubated patient remained
in a deep coma after the initial event.
Therefore, a neurological evaluation of
her consciousness level and the detection
of new focal deficits were not possible.
DIAGNOSIS
An initial CT Perfusion (CTP, Fig. 3A)
scan was performed on day 4 for the
evaluation of delayed cerebral ischemia
(DCI) and vasospasm. There was severe
reduction in tissue perfusion in the
anterior watershed white matter of the
right hemisphere (mean transit time
1
1 Non-enhanced CT on admission
showed subarachnoid hemorrhage.
2A
2B
COMMENTS
2 DSA image showed severe proximal vasospasm before treatment (Fig. 2A).
Follow-up DSA demonstrated normalized perfusion after treatment (Fig. 2B).
3A
Topic
3 Initial CTP
images showed
severe DCI in the
right hemisphere
(Fig. 3A).
A follow-up CTP
scan revealed
a normalized
perfusion of the
former ischemic
right hemisphere
(Fig. 3B).
3B
EXAMINATION PROTOCOL
Scanner
Scan mode
Adaptive 4D Spiral
Scan area
Head
Scan length
96 mm
Scan direction
Cranio-caudal / caudo-cranial
Scan time
45 s
Tube voltage
80 kV
Tube current
200 mAs
Rotation time
0.285 s
Slice collimation
32x 1.2mm
Slice width
10 mm
4 CT Dynamic
Reconstruction
kernel
H20f
CTDIvol
256.38 mGy
DLP
3036 mGy/cm
Effective Dose
6.4 mGy cm
Contrast
Ultravist 370
Volume
Flow
6 mL/s
References
[1] Vergouwen MDI, Hemorrhage PitIM-DCCotCCMoS.
Neurocritical Care 2011;15:308-311.
[2] http://www.ajnr.org/content/27/1/26.full
[3] Greenberg ED, et al. American Journal of Neuroradiology
2010;31:1853-1860.
[4] Wintermark M et al. Cerebrovascular diseases
(Basel, Switzerland) 2008;26:163-170.
[5] Wintermark M,et al. AJNR American Journal of Neuroradiology
2006;27:26-34.
[6] Washington CW, Zipfel GJ, Hemorrhage PitIM-DCCotCCMoS.
Neurocritical Care 2011;15:312-317.
[7] Sanelli PC et al.Neuroradiology 2011;53:425-434.
[8] van der Schaaf et al. Stroke 2006;37:409-413.
Angio collateral
assessment:
time resolved
collateral filling
in early arterial
phase (right vs.
left hemisphere).
Case 11
Time Resolved CT Angiography
in Patients after EVAR
By Claudia Andres, MD, Borek Foldyna, MD, Christian Lcke, MD, Matthias Gutberlet, MD, Lukas Lehmkuhl, MD
Department of Diagnostic and Interventional Radiology, University of Leipzig, Heart Center, Leipzig, Germany
HISTORY
DIAGNOSIS
1A
1B
1C
2A
2B
2C
12 Axial (Fig. 1) and VRT (Fig. 2) images showing the different points in time after reaching the bolus tracking threshold.
(Fig. 1A/2A) 12 s p.t.: significantly enhanced stentgraft, no endoleak visible.
(Fig. 1B/2B) 17 s p.t.: well-enhanced stentgraft, and a type IIA endoleak in the ventral aneurysm sac could be visualized.
(Fig. 1C/2C) 32 s p.t.: no longer enhanced stentgraft, however a well-enhanced endoleak.
3A
3B
3C
3D
3 Relative time density curves in the aorta (curve 1, yellow), the endoleak (curve 3, orange)
and the aneurysm sac (curve 2, green) together with the respective cross-sections where the
ROIs were placed: aorta (Fig. 3B), endoleak (Fig. 3C), aneurysm sac (Fig. 3D).
COMMENTS
Contrary to the contrast media ultrasound
examination, the dynamic CT Angiography
helped determine the existence of an
endoleak and helped the physician to
determine an explanation for the missing
reduction in size of the aneurysm sac.
Dynamic CTA may aid the physician
in detecting the flow patterns of the
different endoleaks by using multiple
acquisitions at different time points and
thereby increases both the sensitivity
and the specificity for the detection of
endoleaks. The gathered information
concerning the dynamic of endoleaks
considerably eases classification.[1]
References
[1] Lehmkuhl et al., Dynamic computed tomography angiography (dCTA) after abdominal aortic
endovascular aneurysm repair (EVAR): Differences in contrast agent dynamics in the aorta
and endoleaks Preliminary results J Vasc Interv
Radiol. 2012 Apr 9. [Epub ahead of print]
EXAMINATION PROTOCOL
Scanner
Scan area
Abdomen
Scan length
283 mm
Scan direction
Cranio-caudal / caudo-cranial
Scan time
54 s
10
Temporal resolution
5s
Tube voltage
80 kV
Tube current
120 mAs
CTDIvol
28.47 mGy
DLP
629 mGy cm
Effective dose
9.4 mSv
Rotation time
0.285 s
Slice collimation
128 x 0.6 mm
Slice width
1.5 mm
Reconstruction kernel
B30f
Contrast
Volume Contrast
80 mL
Flow rate
4 mL/s
Volume Saline
40 mL
61
Case 12
Diagnosis of Sub-acute Pulmonary Emboli
using Flash Mode, SAFIRE and 100 kV
By Savvas Nicolaou, MD,* Jennifer Powell**, Karl Krzymyk***
*** Vancouver General Hospital, Department of Emergency Trauma Radiology, Vancouver, Canada
*** CS Applications, Siemens Healthcare, Canada
*** CT Collaborations USA, Siemens Healthcare, USA
HISTORY
DIAGNOSIS
1A
1B
2A
1C
1D
2C
2B
12 Images showed extensive bilateral pulmonary emboli involving the posterior segment of the right upper lobe (arrow, Fig. 1A),
all segments of the right lower lobe (arrowheads, Figs. 12) and the posterior segment of the left upper lobe (dashed arrow, Fig. 2B).
COMMENTS
PE can be life threatening, and PE
patients generally have difficulties holding their breath during a CT scan. Using
Flash mode, the image acquisition of the
entire thorax can be completed in less
than one second (in this case 0.6 seconds). Therefore, motion artifacts can
be avoided even without breath-hold.
Since regular follow-up CT scans are
necessary for PE patients, radiation dose
reduction is essential. In this case, the
patients effective dose was reduced to
1.46 mSv by combining the Flash mode,
SAFIRE (Sinogram Affirmed Iterative
Reconstruction) and 100 kV.
EXAMINATION PROTOCOL
Scanner
Scan area
Thorax
Pitch
3.2
Scan length
287 mm
Slice collimation
128 x 0.6 mm
Scan direction
Cranio-caudal
Slice width
0.75 mm
Scan time
0.67 s
Reconstruction increment
0.5 mm
Tube voltage
100 kV
Reconstruction kernel
I26f
Tube current
Contrast
Dose modulation
CARE Dose4D
Volume
CTDIvol
3.01 mGy
70 mL (Optiray 350)
+ 30 mL saline
DLP
104 mGy cm
Flow rate
4.5 mL/s
Effective dose
1.46 mSv
Start delay
18 s
Rotation time
0.28 s
63
Case 13
Dynamic Volumetric Expiratory Imaging
for Diagnosis of Tracheobronchomalacia
using Flash CT Scanning
By Kianoush Ansari Gilani, MD, Leslie Ciancibello, RT, and Prof. Robert C. Gilkeson, MD
University Hospital Radiology, Cleveland, Ohio, USA
HISTORY
An 82-year-old female patient with a
long history of asthma was presented to
the radiology department complaining
of a persistent cough, which did not
respond to inhalers and standard asthma
therapy. A High Resolution CT (HRCT)
was requested to evaluate bronchiectasis
and interstitial lung disease.
A standard non-contrast volumetric CT
was performed, followed by a dynamic
volumetric expiratory imaging to evaluate
a suspected tracheomalacia.
DIAGNOSIS
The dynamic volumetric expiratory
imaging demonstrated significant
COMMENTS
Expiratory collapse of the central airways,
termed tracheomalacia, is an important
and often unrecognized cause of chronic
cough. Traditional airway imaging assessment includes a series of selected axial
images taken in end-expiration to evaluate parenchymal air trapping and tracheobronchial airway collapse. End-expiratory
imaging is limited in the evaluation of
airway collapse as it fails to capture the
EXAMINATION PROTOCOL
Scanner
Scanner
Scan area
Thorax (standard)
Scan area
Thorax (expiratory)
Scan length
24.2 mm
Scan length
Scan direction
Cranio-caudal
Scan direction
Cranio-caudal
Scan time
3s
Scan time
0.9 s
Tube voltage
120 kV
Tube voltage
120 kV
Tube current
Tube current
40 Eff. mAs
Dose modulation
CARE Dose4D
Dose modulation
CARE Dose4D
CTDIvol
17.96 mGy
CTDIvol
2.2 mGy
DLP
532 mGy cm
DLP
47 mGy cm
Rotation time
0.5 s
Rotation time
0.28 s
Pitch
1.2
Pitch
Slice collimation
128 x 0.6 mm
Slice collimation
128 x 0.6 mm
Slice width
2 mm
Slice width
2 mm
Spatial Resolution
0.33 mm
Spatial Resolution
0.33 mm
Reconstruction increment
1 mm
Reconstruction increment
1 mm
Reconstruction kernel
B31f
Reconstruction kernel
B31f
1A
1B
2A
2B
3A
3B
13 Comparison of
images acquired in
inspiratory phase (A)
and expiratory phase (B)
demonstrates the normal
airways (A) and the
tracheomalacia (B) in
axial images (Fig. 1),
fly-through images
(Fig. 2) and VRT images
(Fig. 3).
65
Science
Prof. Norinari Honda, Chairman of the Department of Radiology, Saitama Medical Center,
Saitama Medical University reported that Xenon Dual Energy CT ventilation of the whole
lung in single-breath technique may depict ventilation.
Science
1A
1B
1C
1D
1E
1F
1G
1H
1 Xenon Dual Energy CT ventilation images acquired in single-breath technique after inhalation of 41% (Figs. 1 A, B), 60% (Figs. 1 CE), 80%
(Figs. 1 FH) xenon mixed with 59, 40, 20% oxygen respectively. A maximum enhancement was measured for the highest xenon concentration.
Clinical applications
References
[1] Honda N et al. Radiology 2012; 262: 262-268
[2] The 4th Japanese Society of Pulmonary Functional Imaging meeting, 10-12 February 2012,
Otsu, Shiga, Japan, http://jspfi4.umin.ne.jp/
(Japanese)
[3] Yanagita H, et al. Prediction of postoperative
pulmonary function by single-breath dual
energy xenon CT: a preliminary report. Insight
into imaging (ECR2012 Book of abstracts)
2012:3 Suppl 1;B-0030
[4] The 4th Japanese Society of Pulmonary Functional Imaging meeting, 10-12 February 2012,
Otsu, Shiga, Japan, http://jspfi4.umin.ne.jp/
(Japanese)
www.saitama-med.ac.jp/
kawagoe/ (Japanese)
67
Science
1A
1B
20 kV
1C
1E
40 kV
1D
160 kV
180 kV
1 This trophy a skull penetrated by a long nail was scanned with Dual Energy CT.
Among the monoenergetic images generated (Figs. 1AD) the image at 180 kV (Fig. 1D)
delivered a precise image of the object despite the metallic implant (Fig. 1E).
Courtesy of University Medical Center Mannheim, Germany
2A
2B
2 These Dual Energy CT images show calcifications (arrows) in the femoral vessels of
a mummy found in South Africa (Figs. 2AB). With Dual Energy plaque identification software these calcifications could be characterized as typical of arteriosclerosis (Fig 2B).
Courtesy of University Medical Center Mannheim, Germany
Science
www.umm.uni-heidelberg.de/
inst/ikr/pdf/2011_12_
Anthropologie.pdf (German)
www.g-o.de/dossier-detail-570-4.
html (German)
www.rem-mannheim.de
Combining Professional
Expertise
The German Federal Government offers
structural funding for leading-edge tech-
69
Science
Bench to Bedside Establishment of Biomarkers in Therapy Response is supervised by the aforementioned physicians
at the Institute for Clinical Radiology, part
of the University Hospital in Grohadern
Munich (Director: Prof. Reiser, MD).
Siemens always advocates the importance
of such fundamental research. As a result,
the company has made significant contributions to this influential, prestigious
project and supports the concerted efforts
through the provision of technical expertise and considerable financial assistance.
1A
1B
The Project
Day 7
Therapy
Day 0
1D
Control
1C
Science
2A
2B
2C
2D
2E
2F
2 CT perfusion maps of a patient with pleural metastases of a renal cell carcinoma (red arrow,
top row: before treatment, bottom row: after treatment). The perfusion screening with CT provides proof of therapy response showing a significant decline in the perfusion of this metastasis
after just two weeks of treatment (bottom row) with a tyrosine-kinase inhibitor (TKI).
Project Objectives
In the first three-year project phase, Prof.
Konstantin Nikolaou, MD, Clemens Cyran,
MD, and their scientific team will conduct
pre-clinical trials on tumor models in
rats. In one model, for example, a colon
carcinoma implanted subcutaneously is
treated with regorafenib, an angiogenesis
inhibitor. The tumor is examined via CT
perfusion before and after treatment
and the results correlated with an immunohistochemical tumor analysis. This
initial project phase aims to optimize
both CT methods and the standardized
quantification of tumor perfusion as a
non-invasive imaging biomarker of therapy response.
The second project phase runs parallel
to the first. Methods established in the
experimental model will be made more
rapidly available in the clinic, e.g. for
patients with colon carcinomas under-
71
Science
Scrutiny is increasing over medical imaging scans and the use of radiation. The
study reveals that awareness and familiarity with medical imaging tests leads
to clearer decisions for American adults
about their healthcare.
In the survey of more than 1000 American adults, several questions were asked
Science
Marilyn Siegel, MD, from the Mallinckrodt Institute of Radiology in St. Louis is a SIERRA panel physician.
Customer Excellence
www.siemens.com/
SOMATOMEducate
Customer Excellence
www.siemens.com/
SOMATOMEducate
correlation is available for the CT Angiography cases. The faculty will be available to provide help and guidance during
the whole course.
This course is most suited for cardiologists and radiologists who have basic
knowledge of cardiac computed tomography, who want to improve their interpretation skills and gather experience
in recognizing typical and more complex
findings.
Patrizia Pernter, MD from Bolzano/Italy:
I enjoyed the Cardio Workshop in
Erlangen completely because it fulfilled
my expectations. The practical exercises
are exactly what is needed to learn the
www.siemens.com/
SOMATOMEducate
75
Customer Excellence
Why are two different Quality Reference Tube Current Values Displayed?
Since 2011, CARE kV has been available
on Siemens high-end scanners.* CARE kV
can set the tube voltage (kV) automatically for individual examinations which
optimizes contrast-to-noise ratio and
reduces dose by up to 60%. CARE kV sets
the correct kV values based on patient
size and examination type.
When changing the kV value manually,
the tube current (mAs) needs to be re-cal-
1 The original tube current value is marked in green on the scan subtask card (arrowhead).
In the left lower corner of the image, the new calculated tube current value (ref.mAs) is highlighted in green (arrow).
Customer Excellence
Date
Location
Course Director
Link
June 12 15
Edinburgh, UK
ESGAR S. Halligan, MD
www.esgar.org
June 28 30
Dubrovnik, HR
www.oncoic.org
Clinical Workshop on
Cardiac CT / Cardiac
July 4 6
Munich, GER
Siemens Healthcare
Prof. C. Becker, MD
www.siemens.com/
SOMATOMEducate
July 17 20
London, UK
www.bir.org.uk
Aug 25 29
Munich, GER
Siemens Healthcare
www.siemens.com/ESC
Sept 11 14
London, UK
www.bir.org.uk
Sept 14 15
Gttingen, GER
P. Schramm, MD
www.kelcon.de/_d-upl/
Programm_Hands_on_
Workshop_Goettingen.pdf
Sept 19 21
Valencia, S
ESGAR L. Marti-Bonmati
www.esgar.org
Sept 27 28
Erlangen, GER
Siemens Healthcare
Prof. D. Ropers, MD
www.siemens.com/
SOMATOMEducate
Clinical Workshop on
Cardiac CT / Cardiac
Oct 17 19
Munich, GER
Siemens Healthcare
Prof. C. Becker, MD
www.siemens.com/
SOMATOMEducate
Clinical Workshop on
DE / Dual Energy
Nov 2 3
Forchheim,
GER
Siemens Healthcare
Prof. T. Johnson, MD
www.siemens.com/
SOMATOMEducate
Clinical Workshop on
Cardiac CT / Cardiac
Dec 12 14
Munich, GER
Siemens Healthcare
Prof. C. Becker, MD
www.siemens.com/
SOMATOMEducate
In addition, you can always find the latest CT courses offered by Siemens Healthcare at www.siemens.com/SOMATOMEducate
Dates
Short Description
Location
Contact
ESTI
June 22 24
www.esti2012.org/
SCCT
July 19 22
Society of Cardiovascular
Computed Tomography
Baltimore,
Maryland
www.scct.org/
ESC
Aug 29 Sept 2
Munich, Germany
www.escardio.org
AOCR
Aug 30 Sept 2
Sydney, Australia
www.aocr.org/
ASTRO
Oct 28 31
Boston, U.S.
www.astro.org/
Medica
Nov 14 17
Dusseldorf, Germany
www.medica-tradefair.com/
RSNA
Nov 25 30
Chicago, U.S.
www.rsna.org/
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