Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
Stanford-Edition
June 14th
June 17th, 2006
www.siemens.com/medical
Highlights
COVER STORY
Saving Time, Money and Lives
Page 4
NEWS
3D-Reading
Wherever You Are
Page 10
BUSINESS
Utilization Report Now Also
Available for CT Systems
Page 15
CLINICAL OUTCOMES
Cardiovascular Dual Source
CT after Left Main Coronary
Artery Stenting
Page 17
CLINICAL OUTCOMES
Neurology Complete
Occlusion of Left Carotid
Artery and Stenosis at
Right Carotid Artery
Page 29
SCIENCE
Radiation Dose with Dual
Source CT
Page 38
CUSTOMER CARE
Evolve Update Facilitates
Enhanced CT Fluoroscopy
Page 45
SOMATOM
Sessions
Picture
EDITORS LETTER
Dear Reader,
At RSNA 2005, Siemens moved CT into a new era. With the introduction of the worlds first Dual Source
CT, the SOMATOM Definition, the CT slice race is coming to an end. Now, only six months after its introduction, the first ten systems are up and running in the worlds leading clinical institutions ten out of
approximately 150 scanners that will be installed in the year 2006. In this issue, these Dual Source CT
users will share their excitement about their first clinical experiences with the new scanner, and our
technology experts will explain the miracle of dose reduction with two tubes running at the same time.
However, we at Siemens understand that supplying our users with innovative CT scanner technology is
not enough. Therefore, we have dedicated a significant part of this issue to explaining how you can
benefit from our CT Clinical Engines to continuously enhance your diagnostic performance in the key
clinical fields of cardiovascular CT, neuro CT, acute care CT and CT in diagnostic oncology. In the meantime, nearly 50 percent of our high-end CT customers decide to equip their system with one or more
CT Clinical Engine, customized to their clinical needs.
But we want to take CT workplace innovation even further. Have you ever thought about turning your
office PC or laptop computer into a high-performance CT workstation? Now you can. With syngo
WebSpace* Siemens is the first CT manufacturer to introduce a client-server solution for 3D reading
wherever you are. While you are reading this, the first clinical installations of syngo WebSpace* are
being implemented and customized for very different clinical environments from private imaging
centers to large hospital enterprises.
In this 18th SOMATOM Sessions customer magazine issue, you will discover that CT has gone beyond
innovative tube and detector technology. This issue's cover story from the chest pain unit of the Medical
University of South Carolina represents a great example that CT manufacturers have to think differently
today. New developments have to pay attention to all steps from the patient entering the CT room to
the clinical report. Now, we invite you to enjoy reading about todays synthesis of innovations in CT
scanners and workplaces that enhance your clinical workflow.
Sincerely,
SOMATOM Sessions 18
CONTENT
COVER STORY
4
NEWS
8
10
12
13
13
14
BUSINESS
15
15
CLINICAL OUTCOMES
16
17
21
23
24
26
28
29
31
33
35
36
SCIENCE
38
41
CUSTOMER CARE
45
45
46
46
47
Imprint
SOMATOM Sessions 18
COVER STORY
Looking into computed tomography as a diagnostic tool to quickly assess the cause of acute chest pain:
Christian Thilo, MD, Eric Powers, MD, and U. Joseph Schoepf, MD (from left).
SOMATOM Sessions 18
COVER STORY
ers undergo conventional work-up that includes catheterization. Schoepf explains that in these patients, the addition
of a CT scan is likely to be detrimental, as it may delay the
onset of therapy.
Those patients who present with acute chest pain but have
non-diagnostic ECG results and initially negative cardiac
markers and Schoepf says these are the vast majority of
patients are given a chance to enroll in the trial in which
the 64-slice CT scan is used as a diagnostic tool.
CT has been shown to effectively rule out coronary artery
disease as a source of chest pain and has the further benefit
of ruling out non-cardiac causes such as acute pulmonary
embolism or aortic dissection.
From a cardiologists point of view, the enthusiasm comes
from the excellent images that are taken, Powers says. "The
excellent detail of the coronary vessels that allows us to
make the assessment.
In addition to the SOMATOM Sensation in its vascular center,
MUSC has installed a second 64-slice system adjacent to its
emergency room to facilitate a smooth workflow. If a CT
scan is deemed necessary, hospital staff simply moves
patients through a single set of double doors to be scanned.
Although the CT trial is still enrolling patients, preliminary
results are promising. In patients where ECG and blood test
results were inconclusive, those who underwent CT imaging
SOMATOM Sessions 18
COVER STORY
The SOMATOM Sensation 64-slice computed tomography scanner ensures immediate access and fast diagnosis for
patients with unclear causes of chest pain.
SOMATOM Sessions 18
COVER STORY
A non-invasive test
which is diagnostically
accurate to assess the
presence of coronary
artery disease is a crucial step in the development of cardiology.
Eric Powers, MD, Professor of Medicine,
Director of the Acute Coronary
Syndrome Center, Medical University
of South Carolina, Charleston, SC
SOMATOM Sessions 18
NEWS
s y n g o C I R C U L AT I O N
SOMATOM Sessions 18
NEWS
[ 2 ] The new Plaque Analysis (PA) allows the volumetric analysis of coronary
plaque. The histogram and color coding facilitate an easy visualization of the
findings.
NEWS
N EW syngo We bSpace *
SOMATOM Sessions 18
Up to 20 Concurrent Users
I am really excited about this new product, says Axel Kuettner, MD, University of
Erlangen in Germany. Within a matter of
seconds I can connect my laptop to the
server and interact with a routine abdominal or even multiphase cardiac dataset
using full 3D and 4D capabilities. And that
is something that is really going to speed
up our clinical workflow!
For us as cardiologists, the ability of the
new thin client server solution to provide
immediate availability of original CT data
in the cath lab, in the office, or in the
cardiac care unit plays a pivotal role, says
Stephan Achenbach, MD, University of
Erlangen. In addition, therapeutic decisions in Cardiology often have to be made
very quickly. Therefore the possibility to
NEWS
Modality
Data transfer
syngo WebSpace
Thin slice short term storage
Server
PACS Archive
Data
transfer
Server access
Workplaces
Office
Computer
Home
Laptop
PACS Reading
Station
* Pending 510(k): The information about this product is being provided for planning purposes only.
This product is pending 510(k) review, and is not yet commercially available in the U.S.
SOMATOM Sessions 18
11
NEWS
Klaus Peter, MD, medical director of the University Hospital Munich (left) and Jrg-Christian Tonn, MD, (right)
inaugurate the surgery room with the SOMATOM Sensation Open sliding gantry.
S O M AT O M S e n s a t i o n O p e n
12
SOMATOM Sessions 18
The integrated solution works as follows: the position of the patient and the
surgical instruments are tracked in real
time and a dedicated software integrates this information with the pre- and
intraoperative acquired CT images.
Operations are less invasive and more
accurate," summarizes Jrg-Christian
Tonn, MD, director of the neurosurgery
department at Munich-Grosshadern.
k www.klinikum.uni-muenchen.de
NEWS
S O M AT O M S p i r i t
k www.siemens.com/computed-tomography
S O M AT O M S p i r i t
k www.ifdesign.de,
www.designpreis.de
Bernd Ohnesorge (left), PhD, Vice President CT Marketing and Sales, Karin Ladenburger, Product Manager CT Segments, and Klaus Thormann, Design Manager of
designafairs, received the "iF gold award 2006" for the SOMATOM Spirit.
SOMATOM Sessions 18
13
NEWS
HEAD IMAGING
Enhanced filter setting allows for highest image quality in the head with individualized Kernels.
A: Excellent grey-white differenciation. B: Excellent visualization of details with z-sharp.
Courtesy Vancouver General Hospital, Canada
14
SOMATOM Sessions 18
BUSINESS
s y n g o E X P E R T- I *
S I E M E N S R E M OTE S E RVI C E
SOMATOM Sessions 18
15
CLINICAL OUTCOMES
Cardiovascular
Oncology
Neurology
Acute Care
Cardiovascular
Faster Diagnosis and Full Confidence in Cardiac CT
By Lars K. Hofmann, MD, Global Product and Marketing Manager Cardiovascular CT,
Siemens AG, Medical Solutions, CT Division, Forchheim, Germany
16
SOMATOM Sessions 18
syngo InSpace4D Advanced Vessel Analysis stands for exceptional speed and image quality for quantitative vascular diagnosis and planning of interventions. With the Advanced
Vessel Analysis 1-click segmentation, the physician can automatically extract any vessel from its surrounding tissue making accurate stenosis quantification an easy task.
k www.siemens.com/computed-tomography
CLINICAL OUTCOMES
Case 1:
Dual Source CT after Left Main Coronary Artery
Stenting in a Patient with Arrhythmias
By Stephan Achenbach, MD1 ; Ulrike Ropers, MD1 ; Dieter Ropers, MD1; Katharina Anders, MD2; Axel Kttner, MD2;
Willi Kalender, PhD3; Werner Bautz, MD2 Werner G. Daniel, MD1
1
HISTORY
A 63 year old male patient with known chronic occlusion of
the left anterior descending coronary artery and previous
bypass surgery (internal mammary artery graft to left anterior descending coronary artery 15 years previously) experienced an acute coronary syndrome (non-ST elevation myocardial infarction). A high grade stenosis of the left main
coronary artery was found. Percutaneous coronary intervention (PCI) and stent placement (Taxus 5.0/12 mm) of the
left main coronary artery was performed to restore blood
flow to the left circumflex coronary artery and an intermedi-
ate branch [Fig. 1]. The left internal mammary artery bypass
graft and right coronary artery were found patent at the time
of angiography and left main intervention.
Several days after stent placement, the patient experienced
non-typical chest pain at rest and a Dual Source CT scan was
performed to investigate stent patency. During the DSCT
scan, the patient developed arrhythmias (supraventricular
ectopic beats). Image reconstruction was performed in systole
(300 ms after R-wave), and half-scan reconstruction (heart
rate independent 83 ms temporal resolution) was used.
1A
1B
SOMATOM Sessions 18
17
CLINICAL OUTCOMES
Cardiovascular
1C
Oncology
Neurology
Acute Care
1D
[ 2 ] ECG trace during DSCT data acquisition. Heart rate is highly irregular due to supraventricular ectopic beats,
rapidly changing between 48 and 90 bpm.
DIAGNOSIS
COMMENTS
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SOMATOM Sessions 18
CLINICAL OUTCOMES
3A
3B
[ 3 ] Reconstruction of the left main coronary artery stent in a frontal [ 3A ] and axial
plane [ 3B ] and in a curved multiplanar
reconstruction that shows the stent and the
left circumflex coronary artery [ 3C ]; (large
arrow: patent stent, small arrows: diffuse
disease in left circumflex coronary artery,
compare to Fig. [ 1D ]).
3C
4A
4B
SOMATOM Sessions 18
19
CLINICAL OUTCOMES
Cardiovascular
5A
Oncology
Neurology
Acute Care
5B
[ 5A, 5B ] 3-dimensional reconstruction of the heart and coronary arteries. The patent internal mammary
artery graft to the left anterior descending coronary artery can clearly be appreciated.
EXAMINATION PROTOCOL
Scanner
Pitch
0.22
Scan area
Reconstruction increment
0.3 mm
Scan length
137 mm
Kernel
B26f
Scan direction
cranio-caudal
Heart rate
Contrast
370 mg iodine/ml
(Ultravist, Schering AG)
kV
120 kV
Volume
65 ml
Effective mAs
380 mAs/rot.
Flow rate
5 ml / s
Temporal Resolution
83 ms
Start delay
23 s
Rotation time
330 ms
Slice collimation
2 x 64 x 0.6 mm
Slice width
0.6 mm
20
SOMATOM Sessions 18
CLINICAL OUTCOMES
Case 2:
CT Angiography of the Chest Triple Rule Out
By Lanett Varnell, MD, and Gordon D. Graham, MD, Imaging Center,
Chattanooga Heart Institute, Chattanooga, TN, USA
HISTORY
A 66 year old woman suffering shortness of breath was
examined. A performed echocardiography showed abnormal findings.
An ECG-synchronized multi-slice CT of the chest was performed to rule out pulmonary embolism or coronary artery
disease. Using a collimation setting of 0.6 mm resulted in a
spatial resolution 0.33 mm in order to get a detailed analysis
of coronary vessels.
SOMATOM Sessions 18
21
CLINICAL OUTCOMES
Cardiovascular
Oncology
Neurology
Acute Care
EXAMINATION PROTOCOL
SOMATOM Sensation 40-slice
configuration
Slice collimation
0.6 mm
Slice width
0.75 mm
Scan area
Pitch
0.24
Scan length
131.5 mm
Reconstruction increment
0.4 mm
Scan time
18 s
Kernel
B25f
Scan direction
cranio-caudal
kV
120 kV
Contrast
Effective mAs
795 mAs
Volume
120 ml
Rotation time
0.37 s
Flow rate
4 ml / s
Scanner
22
SOMATOM Sessions 18
Cardiovascular
Oncology
Neurology
Acute Care
CLINICAL OUTCOMES
Oncology
Faster Diagnosis and Full Confidence in Oncology CT
By Ken Field, Global Product and Marketing Manager Oncology CT, Siemens AG,
Medical Solutions, CT Division, Forchheim, Germany
k www.siemens.com/computed-tomography
SOMATOM Sessions 18
23
CLINICAL OUTCOMES
Cardiovascular
Oncology
Neurology
Acute Care
Case 3:
Silikoasbestosis of the lung with secondary
bronchial carcinoma
By Manfred Oldendorf, MD, Medical Director,
Department of Radiology, Hospital Nuremberg North, Nuremberg, Germany
HISTORY
DIAGNOSIS
The CT scan showed a Silikoasbestosis of the lung with secondary bronchial carcinoma of the lung (plate epithelium
carcinoma, histological firmed). Disseminated, military nodules with calcification were detected, as well as an interstitial
lung deformation with emphysema bubbles, which were
caused by retraction. The images clearly show a solid tumor
on the right upper lobe without necrolysis and a calcified
medistinal lymphatic gland.
2A
2B
24
SOMATOM Sessions 18
CLINICAL OUTCOMES
EXAMINATION PROTOCOL
SOMATOM Emotion
16-slice configuration
Pitch
0.8
Reconstruction increment
1.2; 6.0 mm
Scan area
Thorax
CTDIvol
14.5
Scan length
320 mm
Kernel
Scan time
13.0 s
Scan direction
Caudo-cranial
kV
130 kV
Contrast
Volume
120 ml
Rotation time
0.6 s
Flow rate
2.0 ml / s
Slice collimation
16 x 1.2 mm
Start delay
60 s
Slice width
1.5; 6.0 mm
Postprocessing
Scanner
SOMATOM Sessions 18
25
CLINICAL OUTCOMES
Cardiovascular
Oncology
Neurology
Acute Care
Case 4:
Improving Patient Outcomes with PET/CT
By John Myers, Diagnostic Services Director, Kansas City Cancer Center, Overland Park, Kansas, USA
accurate tumor diagnosis, whole-body staging, target definition, and treatment planning. As hybrid PET/CT imaging
becomes the standard diagnostic tool in oncology cases,
patients are benefiting from earlier detection of disease and
metastases, as well as more accurate assessments during
and after treatments.
DIAGNOSIS
Lymph node
Iliac artery
Ureter
Iliac vein
26
SOMATOM Sessions 18
CLINICAL OUTCOMES
COMMENTS
PET/CT plays a major role in the detection, staging and treatment of oncology cases. In this particular case, the importance of using hybrid PET/CT technology was critical, as the
management, and ultimately the outcome of this patients
case would have been significantly different if he only underwent a PET scan, or only had the CT scan during the diagnostic
evaluation. While the lymph node was not diagnosed at all in
the standalone CT, a dedicated PET scan could have potentially misinterpreted the abnormal activity as FDG in the ureter.
Only the co-registered, detailed anatomical and functional
data illustrated the true diagnosis and changed the treatment plan and overall outcome for this patient.
The HI-REZ PET imaging technology of the Siemens Biograph
16, in conjunction with the spectacular detail in the anatomical imaging of the CT, makes it possible to see detailed
anatomy and functional processes in a single exam and can
make a difference in diagnoses and outcomes in complex
oncological cases.
EXAMINATION PROTOCOL
Scanner
Biograph 16
CT Protocol
Slice width
5 mm
Pitch factor
0.75
Scan area
Whole Body
Reconstruction increment
3 mm
kV
120 kV
PET Protocol
Effective mAs
140 mAs
Dosage
Rotation time
0.5 s
Bed Times
3min/bed position
Slice collimation
16 X 1.5 mm
Recon Method
Iterative
SOMATOM Sessions 18
27
CLINICAL OUTCOMES
Cardiovascular
Oncology
Neurology
Acute Care
Neuro
Faster Diagnosis and Full Confidence in Neuro CT
By Stefan Wnsch, PhD, Global Product and Marketing Manager Neurology CT,
Siemens AG, Medical Solutions, CT Division, Forchheim, Germany
The CT Neuro Engine provides a unique combination of innovative scanner solutions and syngo
clinical applications.
Fully automated syngo Neuro Perfusion CT facilitates quantitative evaluations of brain tumors. The fast quantitative evaluation enhances the ability to grade tumors, plan biopsies
and monitor therapy.
k www.siemens.com/computed-tomography
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SOMATOM Sessions 18
CLINICAL OUTCOMES
Case 5:
Complete Occlusion of Left Carotid Artery
and Stenosis at Right Carotid Artery
By Amit Mehta, MD, Chief Radiologist, and Susan Hall, CT Technologist,
St. Catharines General Site Niagara Health System, Ontario, Canada
HISTORY
A 68 year old female admitted to our facility for a pre operative assessment for carotid endarterectomy. The patient has
experienced episodes of vision loss in the right eye over the
past 2 or 3 months, but had no speech difficulties and no
motor or sensory deficits have been detected. The patient
had a history of a carotid Doppler examination in 2003 at
which time she had severe stenosis of both internal carotid
arteries (ICA). A Doppler ultrasound in 2006 showed an
occluded left ICA and 80 90 percent stenosis of the right
ICA. She also has a history of hypertension and smokes. The
CNS exam was grossly intact. A CTA of the carotids was performed for pre-operative assessment.
SOMATOM Sessions 18
29
CLINICAL OUTCOMES
Cardiovascular
Oncology
Neurology
Acute Care
EXAMINATION PROTOCOL
Scanner
Pitch
0.95
Reconstruction increment
0.4 mm
Scan area
CTDI
15.33 mGy
Scan length
266 mm
Kernel
B20f
Scan time
5.36 s
Scan direction
Caudo-Cranial
Contrast
kV
120 kV
Volume
70 ml
Effective mAs
Flow rate
4 ml / s
Rotation time
0.33 s
Start delay
2 sec
Slice collimation
0.6 mm
Bolus Tracking
Slice width
0.6 mm
Postprocessing
30
SOMATOM Sessions 18
CLINICAL OUTCOMES
Case 6:
CT-DSA of a Common Carotid Artery
in a Young Woman
By Harald Grzer, MD, Diagnosezentrum Margareten, Vienna, Austria
HISTORY
A 46 years old woman with a history of hypertension presented an acute onset of vertigo, fatigue, severe headache and somnolence in our institution. CCT showed neither recent signs of supra- or infratentorial ischaemia, nor bleeding nor intracranial mass.
Colour coded Doppler ultrasound was not completely conclusive due to a high carotid bifurcation and a moderate elongation of
the internal carotid artery on both sides, as well as tachyarrythmia. A 60-90 percent stenosis of the left ICA was suspected, therefore the patient was scheduled for carotid CTA.
SOMATOM Sessions 18
31
CLINICAL OUTCOMES
Cardiovascular
Oncology
Neurology
Acute Care
EXAMINATION PROTOCOL
SOMATOM Emotion 16-slice
configuration
Slice width
0.75 mm
Pitch
0.8
Scan area
Kernel
B20s
Scan length
168 mm
Scan time
13.6 s
Contrast
370 mg iodine/ml
Scan direction
Caudo Cranial
Volume
70 ml
kV
130 kV
Flow rate
4 ml / s
Effective mAs
90 mAs
Start delay
2s
Rotation time
0.6 s
Slice collimation
16 x 0.6 mm
Postprocessing
Scanner
32
SOMATOM Sessions 18
CLINICAL OUTCOMES
Case 7:
Cerebral Perfusion in a Patient
with Dengue Hemorrhagic Fever
By Nitamar Abdala, MD, Radiology Professor, and Carolina Salazar, MD, Radiology Resident UMDI Unidade Mogiana
de Diagstico por Imagem, So Paulo, Brazil
HISTORY
A 53 year old male patient with acute high intensity
headache episodes and syncope (nausea) one month ago,
left hemiplegics, and no more associated symptoms, was
referred to the hospital. The patient had a history of hypertension with drug control and Dengue Hemorrhagic five
years ago.
Patients that suffer from Dengue Hemorrhagic can eventually
have low blood flow with hypo cerebral perfusion which can
cause cerebral infarction like watershed, which means,
stroke in the frontier areas. Most of these lesions occur
between the anterior and median cerebral arteries, as well
as in the basal ganglia. Since this patient had an old stroke
[ 1 ] Overview of CT
SOMATOM Sessions 18
33
CLINICAL OUTCOMES
Cardiovascular
Oncology
Neurology
Acute Care
3A
3B
[ 3 ] Perfusion data of Blood Flow [ 3A ] and Blood Volume [ 3B ] from CT Perfusion study shows hypo perfused are
a of left basal ganglia ( 3) and the old lesion in the right basal ganglia (3).
EXAMINATION PROTOCOL
Scanner
SOMATOM Spirit
Slice width
10 mm
Scan area
Basal ganglia
0 mm
Scan length
10 mm
Kernel
H31s
Scan time
40 s
Contrast
kV
80 kV
Volume
40 ml
Effective mAs
220 mAs
Flow rate
5 ml / s
Rotation time
1.5 s
Start delay
5s
Slice collimation
5.0 mm
Postprocessing
34
SOMATOM Sessions 18
Cardiovascular
Oncology
Neurology
Acute Care
CLINICAL OUTCOMES
Acute Care
Faster Diagnosis and Full Confidence
in Acute Care CT
By Lars K. Hofmann, MD, Global Product and Marketing Manager Cardiovascular CT,
Siemens AG, Medical Solutions, CT Division, Forchheim, Germany
Cardiovascular Evaluation
The CT Acute Care Engine provides the tools physicians need
to diagnose todays vascular emergency from aortic dissection or pulmonary embolism to coronary artery disease and
acute vascular obstructions.
syngo Circulations fast-track non-invasive cardiac evaluation
enables fully automated segmentation of the coronary arteries, fast and accurate stenosis quantification and reliable
wall motion and cardiac function analysis. syngo InSpace4D
Advanced Vessel Analysis stands for exceptional speed and
image quality for real-time diagnosis and interventional
planning.
Polytrauma Evaluation
syngo InSpace4D also enables exceptional visualization of
complex vasculature and fractures from head to toe. It
allows fast high quality imaging of full body scans with automated bone segmentation including transparency mode
allowing the rapid visualization of complex fractures.
The CT Acute Care Engine delivers the complete solution needed to make fast and confident decisions.
SOMATOM Sessions 18
35
CLINICAL OUTCOMES
Cardiovascular
Oncology
Neurology
Acute Care
Case 8:
Trauma Diagnosis briefly: 64-Slice
Spiral Computed Tomography
By Florian T. Schmid, MD, Bjrn Stinn, MD, Jrg-Thomas Kluckert, MD, Thomas Chlibec, MD, and Simon Wildermuth, MD, PhD,
Institute of Radiology, Kantonsspital St. Gallen, Switzerland
HISTORY
A 52 year old male fell off a 7 m high roof during maintenance work. After the arrival of the med-evac helicopter, the
emergency physician diagnosed an initial Glasgow-ComaScore (GCS) of 3, hypotonia and tachycardia. The left pupil
was fixed under direct light. An asymmetric mydriasis existed
in both eyes. A periorbital hematoma developed quickly on
the left side and there was visible blood flow out of the nose
and left ear. The patient was hemodynamically stabilized by
transfusion, intubated on site and afterwards airlifted to our
clinic. At the emergency room the patient received a rightsided pleural drain (Buelau) and a CT examination of the head
and body was performed as per standard trauma protocol.
DIAGNOSIS
The initial native CCT-scan showed frontobasal contusions on
both sides and in the right basal ganglias. A mixed subarachnoid and subdural bleeding in the left hemisphere lead to a
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SOMATOM Sessions 18
[ 2 ] The viscerogenic cranium endured a tripoidal fracture on the right and an ipsilateral blow-out fracture of
the orbital base.
SCIENCE
hematoma and active, portal-venous hemorrhage. Little perihepatic and interenteric liquid with an attenuation of 40 HU
correlate with a caudal liver capsule lesion. Mesenteric, hepatic
and gastric edema matched the patients initial shock state.
Despite a small, v-shaped perfusion defect of the left kidney,
there were no further abdominal pathologies. An arterial injury
as a cause of the perfusion defect could be reliably excluded.
The spine did not show any injuries only degenerations.
A little Pipkin 3 impact fracture of the right femur was detected.
Together with a non-dislocated fracture of the frontal pelvic
ring, including the advocated anterior acetabulum, it marked
the power vectors. A fracture of the right dorsal pelvic ring
caused instability while striding the right iliosacral joint.
COMMENTS
Already in 1976, Cowley influenced the concept of golden
hour1 and illustrated that trauma management always
means time management. The mortality of traumatized
patients increases significantly after the first hour, and
includes not only first aid and quick transport. The time
before therapy is essential. A fast and comprehensive diagnosis became the solution for a successful triage and therapy.2
Todays multislice CT with slice configurations of 40 and more
slices, short rotation times and high-performance tubes
allow a diagnosis with detailed information about the neurosurgical, traumatological, thoracic- and abdominal surgical
state of the patient.
In this case, the initial prognostic detection of shear lesions in
brainstem and cerebellum already indicated a possible lethal
outcome. Nevertheless, the perceptibility of such minimal
changes of the modern spiral CT of the brain indicates a
huge progress in technology. The findings were not only
quantitative, in terms of short examination times of large
volumes, but also qualitative with continuously better spatial
resolutions down to 0.33 mm in isotropic voxels.
A modern dose modulation method like Care Dose 4D considerably reduces the necessary dose exposure.
EXAMINATION PROTOCOL
Scanner
Head
Scan length
242.5 mm
Scan time
17.41 s
Scan direction
caudocranial
kV
120 kV
Effective mAs
380 mAs
Rotation time
1s
Slice collimation
0.6 mm
Slice width
1 mm
Pitch
0.8
Reconstruction increment
0.7 mm
CTDI
59.43 mGy
Kernel
H21s / H70h
Body
Scan length
641 mm
Scan time
21.51 s
Scan direction
craniocaudal
kV
120 kV
Ref mAs
Rotation time
0.37 s
Slice collimation
0.6 mm
Slice width
1.5 mm
Pitch
0.6
Reconstruction increment
0.7 mm
CTDI
10.84 mGy
Kernel
Contrast
Volume
150 ml (polyphasisch)
Flow rate
3.5 ml / s
Start delay
Postprocessing
InSpace 4D
SOMATOM Sessions 18
37
SCIENCE
EDUCATION
[ 1 ] VRT renderings of a 59 year old male patient with suspicion of RCA stenosis. The mean heart rate of the patient during
the scan was 85 bpm. Left: diastolic reconstruction at 65 % of the cardiac cycle. Right: end-systolic reconstruction at 28 % of the
cardiac cycle. In both cases, the coronary arteries are clearly depicted with little or no motion artifacts.
SOMATOM Definition
Radiation Dose with Dual Source CT
Reducing radiation dose is a major concern in cardiac CT. With dedicated
dose reduction mechanisms, however, radiation dose in Dual Source CT can
be efficiently reduced to a level well below that of single source CT.
By Thomas Flohr, PhD, Head of Physics and Application Development, Herbert Bruder, PhD, Karl Stierstorfer, PhD,
Physics and Application Development, Siemens AG, Medical Solutions, CT Division Forchheim, Germany,
and Cynthia McCollough, PhD, Director of the CT Clinical Innovation Center, Mayo Clinic, Rochester, Minnesota, USA
38
SOMATOM Sessions 18
SCIENCE
Recon
Recon
100%
Current
690 x 490
single source CT
20%
Dual Source CT
Time
SOMATOM Sessions 18
39
SCIENCE
+ Pitch adaptation
150%
single
source CT
100%
50%
< 55
55 - 70 70 - 90 > 90 bpm
100%
single source CT
+ ECG-pulsing
50%
Dual Source CT
< 55
55 - 70
70 - 90
> 90 bpm
40
SOMATOM Sessions 18
ray beam can be attenuated by shaped filters to reduce radiation intensity in the scan-plane (in the fan-angle direction)
with increasing distance from the iso-center. In cardiac CT,
the region of interest, the heart, is centered within the thorax,
and radiation can, in principle, be restricted to a cardiac field
of view (FOV) of about 25 cm in diameter. Thus, the radiation
dose outside the cardiac FOV can be reduced by an optimized beam-shaping filter and by the smaller scan field of view
of the second X-ray tube-detector system.
The effects of the three dose saving steps are summarized in
Fig. 3 and 4. In Fig. 3, the relative radiation dose for ECGgated cardiac CTA with DSCT is compared with the dose for a
corresponding single source CT-system, both without ECGpulsing. Dose reduction for DSCT comes from the cardiac
bowtie-filter and the adaptation of the pitch to the patients
heart rate. In Fig. 4, the effect of ECG-gated dose modulation
is additionally taken into account for both systems. Applying
the three dose saving steps, dose reduction up to a factor of
two compared with single source CT can be demonstrated
Further Reading
Flohr, T., et. al.: First performance evaluation of a dual-source CT (DSCT)
system, Eur Radiol. 2006 Feb; 16(2): 25668.
Achenbach, S., et al.: Contrast-enhanced coronary artery visualization
by dual-source computed tomography Initial experience. Eur J Radiol.
2006 Mar; 57(3): 3315.
SCIENCE
Cardiac CT
The Sarawak Experience A Report
After 18 Months in Clinical Practice
By Sim Kui Hian, MD, Head of Cardiology, Sarawak General Hospital, Kuching, Malaysia,
and Tobias Seyfarth, MD, CT Marketing Manager Asia Pacific, Siemens Medical Solutions, Singapore
Symptomatic Patients
100
STEMI
NSTEMI/
CAD
Known
CAD
+ ETT/
EAP
Equivocal
ETT/
Atypical CP
High-risk
Asymptomatic
92,9
78,9
86,7
43,8
33,3
22,2
80
77,8
56,7
60
46,2
40
20
21,1
13,3
7,1
I 3+VD
I 2VD
I 1VD
I NS CAD
SOMATOM Sessions 18
41
SCIENCE
Normal scan
Abnormal scan
43 (61.4%)
35 (81.4%)
8 (18.6%)
59 (84.3%)
46 (78.0 %)
13 (22.0%)
27 (38.6%)
18 (66.7%)
9 (33.3%)
11 (15.7%)
7 (63.6%)
4 (36.4%)
42
SOMATOM Sessions 18
Clinical Studies
The prelude to this was the identification of significant coronary disease among clinical subsets of 261 patients with cardiac symptoms2. One-third of the patients with atypical chest
pain and over 20 % of asymptomatic patients were found to
have significant coronary disease on CTA, which correlates
closely (over 95 %) with conventional angiography.
Subsequently, 70 patients at the clinic with atypical cardiac
chest pain (ACCP) were selected over a one month period
and offered a coronary CT scan. CTA confidently excluded
significant coronary disease as the cause of the chest pain for
76 % of the patients3. When the 10-year CVD risk was calculated using PROCAM and Framingham algorithms, the general finding was that despite getting a low risk profile in
PROCAM and Framingham, around 20 % (22 %; 18.6 % respectively) of the patients with ACCP had an abnormal CT scan (as
defined by a lumen stenosis of 50 % or more or significant
coronary calcification (CaSC >400)) [see table]. On the other
hand, around 65 % of patients with a mid to high risk by
PROCAM and Framingham (63.6 %; 66.7 % respectively) had
normal CT scans (defined as absence of any lesion 50 %
and CaSC of <400). This would suggest that patients might
benefit from non invasive risk stratification with the utilization of CT in addition to the current algorithms. CTA of the
coronaries can help to identify low risk patients who might
benefit from a more aggressive treatment. With coronary CTA
readily available in many centers around the world, it has the
potential to become the non-invasive investigation tool of
choice for evaluation of atypical chest pain and also helps to
enhance the risk stratification of CVD.
SCIENCE
Symptomatic Patients
35
No. of patients
30
50 75%
21,2%
25
20
>75%
15
10
28,8%
5
0
Sig. Stenosis Present
SOMATOM Sessions 18
43
SCIENCE
44
SOMATOM Sessions 18
CUSTOMER CARE
L I F E : N E W C L I N I C A L A P P L I C AT I O N S F O R I N S TA L L E D S Y S T E M S
k www.siemens.com/CT-Fluoroscopy
SERVICE
45
CUSTOMER CARE
C T ONLINE
ogists were present. Schering and Siemens are perfect partners in this educational enterprise: Much of the meetings
success is due to the close links both companies maintain
with radiologists around the world.
Location
Short Description
st
Date
Contact
Society of
Cardiovascular CT
www.scct.org
Advanced Topics
in Multidetector
CT Scanning
Cruise to the
Mediterranean
CME Course
www.ctisus.com
ESC
Barcelona, Spain
World Congress
of Cardiology 2006
www.escardio.org
ESTRO
Leipzig, Germany
www.estroweb.org
JFR
Paris, France
Socit Franaise de
Radiologie Congrs
www.sfrnet.org
TCT
Washington, USA
Transcatheter Cardiovascular
Therapeutics Symposium
www.tct2006.com
ASTRO
www.astro.org
AHA
Chicago, USA
Nov.1215, 2006
www.scientificsessions.org
Medica
Dsseldorf, Germany
MEDICA 2006
Nov.1518, 2006
www.medica.de
RSNA
Chicago, USA
Radiological Society
of North America
www.rsna.org
In addition, you can always find the latest CT courses offered by Siemens Medical Solutions at www.siemens.com/SOMATOMEducate.
46
SOMATOM Sessions 18
CUSTOMER CARE
Jessica Amberg; Nina Bastian; Andreas Blaha; Herbert Bruder, PhD; Jan Chudzik; Ana P. Pieroni De
Menezes; Ken Field; Thomas Flohr, PhD; Lars Hofmann, MD; Julia Kern-Stoll; Louise McKenna, PhD,
MBA; Doris Pischitz; Rainer Raupach, PhD; Gitta
Schulz; Peter Seitz; Tobias Seyfarth; Karl Stierdorfer,
PhD; Stefan Wnsch, PhD; Claudette Yaselle; Zimmermann Alexander; all Siemens Medical Solutions
Production
Norbert Moser, Siemens Medical Solutions
Layout
independent Medien-Design
Widenmayerstrasse 16, D-80538 Munich
Printers
Farbendruck Hofmann
Gewerbestrae 5, D-90579 Langenzenn
Printed in Germany
herein are consistent with the approval labeling for uses and/or indications
of the drug. The treating physician bears the sole responsibility for the diagnosis and treatment of patients, including drugs and doses prescribed in
connection with such use. The Operating Instructions must always be strictly
followed when operating the CT System. The sources for the technical data
are the corresponding data sheets. Results may vary.
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No 18/June 2006
Stanford-Edition
June 14th
June 17th, 2006
www.siemens.com/medical
Highlights
SOMATOM
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Picture
COVER STORY
Saving Time, Money and Lives
Page 4
NEWS
3D-Reading
Wherever You Are
Page 10
BUSINESS
Utilization Report Now Also
Available for CT Systems
Page 15
CLINICAL OUTCOMES
Cardiovascular Dual Source
CT after Left Main Coronary
Artery Stenting
Page 17
CLINICAL OUTCOMES
Neurology Complete
Occlusion of Left Carotid
Artery and Stenosis at
Right Carotid Artery
Page 29
SCIENCE
Radiation Dose with Dual
Source CT
Page 38
CUSTOMER CARE
Evolve Update Facilitates
Enhanced CT Fluoroscopy
Page 45
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SOMATOM Sessions
Issue No.18/June 2006