manua siemes.pdf

8/10/2019 manua siemes.pdf

1/461

SOMATOM DefinitionApplication Guide

ProtocolsPrinciplesHelpful Hints

Software Version syngoCT 2007A


2/461

To improve future versions of this application guide we

would greatly appreciate your questions, suggestions,and comments. The information presented in thisapplication guide is for illustration only and is notintended to be relied upon for instruction in the prac-tice of medicine.

Any healthcare practitioner reading this information is

reminded that they must use their own learning, train-ing, and expertise in dealing with their individualpatients. This material is no substitute for that dutyand is not intended by Siemens Medical Solutions Inc.,to be used for any purpose in that regard.

The drugs and doses mentioned are consistent with

the approval labeling for uses and/or indications of thedrug. The treating physician bears the sole responsibil-ity for the diagnosis and treatment of patients, includ-ing drugs and doses prescribed in connection withsuch use.

The pertaining operating instructions must always be

strictly followed when operating a SOMATOM Defini-tion scanner. The statutory source for the technicaldata are the corresponding data sheets.

The available options depend on the system configura-tion. Please contact your local Siemens representativefor further information.

We would like to express our sincere gratitude to themany customers who contributed valuable input.

Special thanks go to Alexander Zimmermann, AndreasSchaller, Heike Theessen, Herbert Bruder, Rainer Rau-pach, and Michele Sohlden, for their valuable assis-tance.

Please contact us:International CT Application Hotline:

Tel. no. +49-1803-112244

email: [email protected]

Editors: Christiane Bredenhller and Ute Feuerlein


3/461

Overview

3

User Documentation 14

Scan and Reconstruction 20

Dose Information 56

Workflow Information 86

Application Information 116

Contrast Medium 142

Head 152

Neck 180

Shoulder 202

Thorax 212

Abdomen 242

Spine 268

Pelvis 286

Upper Extremities 300

Lower Extremities 306

Cardiac CT 314

Vascular 316

Specials 370
http://-/?-http://-/?-http://-/?-http://-/?-http://-/?-http://-/?-


4/461


5/461

Overview

5


6/461

6

Contents

User Documentation 14- Application Guides 14

- SOMATOM Operator Manual 15

- syngoCT Operator Manual 16

- System Owner Manual 18

- Online Help 18

Scan and Reconstruction 20

Concept of Scan Protocols 20

Scanner Features 22

- Straton-Tube 22

- z-Sharp Technology 24

- UFC detector 26

- Shaped Filter for Dose Reduction 27

Scan Modes 29

- Sequential Scanning 29

- Spiral Scanning 29

- Dynamic Multiscan 30

- Dynamic Serioscan 30

- Cardiac Scanning with Dual Source CT 30

Scan Set-up 32

- Acquisition, Slice Collimation and

Slice Width 33

- Recon Increment 36

- Pitch and Pitch adaptation 36

- Kernels 39

- Extended FoV 45

- Topo Length 46

- Feed in/Feed out 46 Image Filters 47

Head Imaging 49

- Head Modes 49

- Neuro Modes 50

- Automatic Bone Correction 51

- Positioning 52- Automatic Isocenter Adaptation 53


7/461


8/461

8

Contents

- SOMATOM LifeNet online 120

Image Converter 128 Report Template Configuration 131

File Browser 132

Camtasia 136

- Key features 136

- Additional Important Information 140

Patient Protocol 141

Contrast Medium 142

The Basics 142

IV Injection 145 Bolus Tracking 146

Test Bolus using CARE Bolus 148

Test Bolus 149

Head 152 Overview 152

- General Hints 154

- Head Kernels 155

Scan Protocols 156

- HeadRoutine 156

- HeadNeuro 160- HeadRoutineSeq 162

- HeadNeuroSeq 166

- InnerEar 168

- Sinus 172

- SinusVol 174

- Orbit 176- Dental 178

Neck 180

Overview 180

- General Hints 182

- Body Kernels 183

Scan Protocols 186


9/461

Contents

9

- NeckRoutine 186

- NeckVol 190- NeckThorax 194

- NeckThorAbd 198

Shoulder 202

Overview 202

- General Hints 203

- Body Kernels 204

Scan Protocols 206

- ShoulderRoutine 206

- ShoulderVol 210

Thorax 212

Overview 212

- General Hints 214

- Body Kernels 215 Scan Protocols 218

- ThoraxRoutine 218

- ThoraxVol 220

- ThoraxHR 224

- ThoraxSeqHR 226

- ThoraxECGSeqHR 228- LungLowDose 230

- LungCARE 234

- ThorAbd 238

Abdomen 242

Overview 242

- General Hints 244

- Body Kernels 246

Scan Protocols 248

- AbdomenRoutine 248

- AbdomenVol 252

- AbdMultiPhase 256
http://-/?-http://-/?-


10/461


11/461


12/461

12

Contents

- Trauma 374

- TraumaVol 375- PolyTrauma 376

- HeadTrauma 379

- HeadTraumaSeq 380


TestBolus Protocol 382

- Test Bolus 382

Radiation Therapy 384

Radiation Therapy Planning 384

- Benefits 387 Workflow 391

Scan Protocols 392

- Overview 392

- RT_Head 393

- RT_Thorax 394

- RT_Breast 395- RT_Abdomen 396

- RT_Pelvis 398


Children 402 Overview 402

- General Hints 406

- Head Kernels 410

- Body Kernels 411

Scan Protocols 412

- HeadRoutine 412- HeadRoutineSeq 416

- InnerEar 420

- Sinus 424

- Orbit 428

- NeckRoutine 430

- ThoraxRoutine 434

- ThoraxSeqHR 438

- AbdomenRoutine 440


13/461

Contents

13

- SpineRoutine 444

- Extremity 446- HeadAngio 448

- CarotidAngio 450

- BodyAngio 454

- NeonateBody 458


14/461

14

User Documentation

Welcome to SOMATOM Definition - The World's

First Dual Source CT

As a SOMATOM Definition user you will have access tocutting-edge technology, comprehensive imagingapplications, and a wide range of powerful workflowsolutions.

The SOMATOM CT user documentation is intended forhealthcare practitioners, helping you to optimally useyour CT scanner in daily clinical work and cutting edgeresearch. The following components of the user docu-mentation will support you to fully utilize the SOMA-TOM Definition's unprecedented image quality whileproviding increased imaging speed.

The applications available on your SOMATOM Defini-tion depend on your system configuration.

Application Guides

The Application Guides complete the SOMATOM Defi-nition user documentation. The Application Guides areavailable in English, German, French, Spanish, Japa-nese, and Chinese. They consist of a scanner-specificguide, a cardiac guide, and one for the post-processingapplications:

The SOMATOM Definition Application Guidecon-tains:

Protocols

Principles

Helpful Hints


15/461

User Documentation

15

The Cardiac CT Application Guidecontains:

ProtocolsPrinciples

Helpful Hints

syngoCalcium Scoring

syngoInSpace 4D CT

syngoCirculation

The Clinical Applications Application Guidecon-tains:

syngo3D

syngoColonography CT

syngoDental CTsyngoPulmo CT

syngoLungCARE CT

syngoVolume Calculation

syngoDynamic Evaluation

syngoNeuro DSA CT

syngoNeuro Perfusion CTsyngoBody Perfusion CT

In addition to the Application Guides, the SOMATOMOperator Manual, the syngoCT Operator Manual, the

System Owner Operator Manual, and the Online Helpare also supplied.

SOMATOM Operator Manual

In this manual, you will find a description of the hard-ware components of the system and its operation. TheRelease Note is also included.


16/461

16

User Documentation

syngoCT Operator Manual

The syngoCT Operator Manuals are a workflow orien-tated description for operation of the system softwareand its frequently used functions. They contain step-by-step instructions from registration to examinationas well as evaluation and documentation of your

examination results.For further information about basic software opera-tion, please refer to the corresponding syngoCT Oper-ator Manual:

syngoCT Operator Manual Volume 1:

syngoSecurity Package

Siemens Virus Protection

Basics

Life

Patient Browser

Data Set ConversionCamtasia

Savelog


Preparations

Examination

MPPS

HeartView CT

Care Bolus CT

Viewing

Filming


17/461

User Documentation

17


syngo3D

syngoDental CT

syngoVolume Calculation

syngoDynamic Evaluation

syngoCT Operator Manual Volume 4:syngoLung CARE CT

syngoPulmo CT

syngoNeuro Perfusion CT

syngoBody Perfusion CT


syngoCalcium Scoring

syngoCirculation

syngoNeuro DSA CT

syngoCT Operator Manual Volume 6:syngoInSpace4D CT



18/461

18

User Documentation

System Owner Manual

In this manual, you will find details and preconditionsfor the operation of the CT scanner.

Online Help

The Online Help explains the operation of the systemssoftware. It is available in English, German, French,Spanish, Japanese, and Chinese.


19/461

User Documentation

19


20/461

20

Scan and Reconstruction

Concept of Scan ProtocolsThe scan protocols for adults and children are definedaccording to body regions Head, Neck, Shoulder,Thorax, Abdomen, Pelvis, Spine, Upper Extremities,Lower Extremities, Vascular, RT, Specials,Private

and Cardiac.

The protocols for special applications are described inthe Application Guide "Clinical Applications"or in thecase of a Heart View examination, in the ApplicationGuide "Cardiac CT".

The general concept is as follows: All protocols withouta suffix are standard spiral modes. For example,"Sinus" means the spiral mode for the sinus.

The suffixes of the protocol names are as follows:

"Seq": for sequence studies

"Routine": for routine studies

"ECG": use an ECG-gated or -triggered mode

"Vol": use the 3D Recon workflow

"Neuro": for neurological examinations with a specialmode


21/461


21

The prefixes of the protocol names are as follows:

"RT": for radiation therapy planning studies

"DS": for Dual Source CT scans

The availability of scan protocols depends on the sys-tem configuration.


22/461

22


Scanner Features

Straton-Tube

The SOMATOM Definition CT system is equipped withtwo STRATON X-ray tubes.

These newly developed X-ray tubes offer significantlyreduced cooling times for shorter interscan delays andincreased power reserves. The full X-ray power of160 kW provides the needed dose for patients with alarge body habitus.

Example for a one tube mode is the ThoraxRoutineprotocol (120 kV, 100 mAs, 0.5 s rot, 64 x 0.6 mm,pitch factor 1.4):

a scan range of 300 mm can be covered in 6.58 s

dose can be increased up to 170 mAs without areduction of table feed.


23/461


23

Conventional anode cools down slowly after exposure

STRATON accumulates very little heat during the expo-sure, which is dissipated quickly

Slow heat exchange

Anode within vacuum

Cooling oil

Anode in direct contactwith cooling oil

Cooling oil

Fastest heat exchange


24/461

24


z-Sharp Technology

The unique STRATON X-ray tube utilizes an electronbeam that is accurately and rapidly deflected, creat-ing two precise focal spots alternating 4,608 timesper second. This doubles the X-ray projections reach-ing each detector element. The two overlapping pro-

jections result in oversampling in the z-direction,known as z-Sharp Technology. The resulting mea-surements interleave half a detector slice width,doubling the scan information without a corre-sponding increase in dose.

The purpose of this technique is two-fold: First, by

doubling the sampling, the slice width can bereduced. With SOMATOM Definition it is possible toreconstruct 0.6 mm slices at any pitch (1.5) withbest image quality. With overlapping 0.6 mm slices,a z-axis resolution below 0.4 mm is obtained. Sec-ond, the improved sampling completely removes, atany pitch, the so-called windmill artifacts frequently

visible in Multislice CT images in the vicinity of sharpcontrasts in axial direction. Of course, since the doseis distributed over the two overlapping measure-ments, there is no dose penalty.


25/461


25

z-Sharp is used with all spiral modes in 0.6 mm colli-

mation.

Alternating focal spots of Straton Tube

Alternating focal spots

STRATON tube

64-slice DAS

Over-

sampling

Anode

Heat

Cooling oil

Cathode


26/461

26


UFC detector

Siemens proprietary, high-speed Ultra Fast Ceramic(UFC) detector enables a virtually simultaneous read-out of two projections for each detector elementresulting in up to a 64-slice acquisition.


27/461


27

Shaped Filter for Dose Reduction

SOMATOM Definition provides an additional filter forall cardiac, head, and pediatric modes, which will beapplied automatically. The shaped filter reduces thedose by approx. 20%. It is recognizable by the reducedCTDIvolwhich is shown on the Routinetab card.

Shaped filters

ts

Additionalshaped filter

Permanentshaped filter


28/461

28


Head:

The scan field of view is limited to 300 mm as before,which is also shown graphically on the topogram.

Cardiac:The scan field of view of 300 mm will be displayed bythe system for cardiac scanning. You can also recon-struct with a field of view greater than 300 mm. Inthis case the temporal resolution will slowlydecrease.

Children:For pediatric examinations, in particular, it is neces-sary to keep the dose low. We therefore apply theshaped filter in all pediatric protocols. You can alsoreconstruct with a field of view greater than300 mm. In this case the temporal resolution willslowly decrease.

ts


29/461


29

The shaped filter is not applied in the following scan

protocols: HeadAngio, HeadTrauma, HeadTrau-maSeq, and ChestPainECG. In these cases you canalso use a scan field of view of 500 mm.

Scan Modes

Sequential Scanning

This is an incremental, slice-by-slice imaging mode in

which there is no table movement during data acquisi-tion. A minimum interscan delay between each acqui-sition is required to move the table to the next sliceposition.

Spiral Scanning

Spiral scanning is a continuous volume imaging mode.The data acquisition and table movement are per-formed simultaneously for the entire scan duration. Atypical range can be acquired in a single breath hold.

Each acquisition provides a complete volume data set,

from which images with overlapping slices can bereconstructed at any slice position.


30/461

30


Dynamic Multiscan

Multiple continuous rotations at the same table posi-tion are performed for data acquisition. Normally, it isapplied for fast dynamic contrast studies, such assyngoBody Perfusion CTor syngoNeuro PerfusionCT. The increment represents the time between recon-

structed images, for example, if the increment is1.0 sec., then one image will be reconstructed everysecond. The image order can be defined on the Recontab card.

Dynamic Serioscan

Dynamic serial scanning is performed without tablefeed. Dynamic serio can be used for dynamic evalua-tion such as Test Bolus. The image order can bedefined on the Recontab card.

SOMATOM Definition permits the use of two X-raysources and two detectors at the same time.

SOMATOM Definitions heart rate independent tempo-ral resolution of 83 ms allows a very robust scanningtechnique with any heart rate, for example, in coro-nary visualization and in functional analysis of theheart.

Cardiac Scanning with Dual

Source CT


31/461


31

Clinical benefits

Reliable imaging of all heart rates without betablockers.

Industrys highest heart rate independent temporalresolution of 83 ms.

Down to 42 ms temporal resolution for accurate

functional imaging using bi-segment reconstruc-tion.

Fast cardiac acquisition within the shortest breath-hold time.

Improved plaque delineation and higher accuracy of

in-stent imaging. Ability to scan arrhythmic patients.

Highly accurate coronary lesion measurement.

50% lower dose at typical heart rates compared withtodays most dose-efficient, Single Source CT scan-

ners. The possibility to reconstruct the end-systolic phase.

Makes patient positioning much easier due to the78 cm gantry bore, field of view, and 200 cm scanrange.


32/461

32


Optimal heart rate occurs in the diastolic phase of the

heart beat. The faster the heart rate, the shorter thediastolic phase becomes. With a Single Source CT scan-ner, the X-ray tube/detector system has to obtain pro-jection data through 180 degrees to take an image.

With Dual Source CT, each of the two tube/detectorcombinations only needs to travel 90 degrees to

acquire an image. Based on a 0.33 s rotation time, thisconcept provides an unprecedented temporal resolu-tion of 83ms irrespective of the heart rate.

Scan Set-up

Scans can be set up simply by selecting a predefinedexamination protocol. To repeat any mode, just clickthe chronicle with the right mouse button for repeat.To delete it, select cut. Each range name in the chron-icle can be easily changed before loading the scan pro-tocol.

Multiple ranges can be run either automatically withauto range, which is denoted by a bracket connectingthe two ranges, or separately with a pauseinbetween.

Up to 19 scan ranges can be combined to auto range.


33/461


33

Acquisition, Slice Collimation and

Slice Width

Slice collimation is the slice thickness resulting fromthe effect of the tube-side collimator and the adaptivedetector array design. In Multislice CT, the Z-coverageper rotation is given by the product of the number of

active detector slices and the collimation.

Slice width is the FWHM (full width at half maximum)of the reconstructed image.

With SOMATOM Definition, you select the slice collima-tion together with the slice width desired. The slicewidth is independent of pitch, i.e. what you select isalways what you get. Actually, you do not need to beconcerned about the pitch value any more; the soft-ware does it for you.

By doubling the sampling, the slice width can bereduced. With SOMATOM Definition, it is possible toreconstruct 0.6 mm slices at any pitch ( 1.5) with bestimage quality. The improved sampling almost com-pletely removes, at any pitch, the so-called windmillartifacts frequently visible in Multislice CT images inthe vicinity of sharp contrasts in the axial direction. Ofcourse, since the dose is distributed over the two over-lapping measurements, there is no dose penalty. The

Acq.(Acquisition) is displayed on the Examinationtask card.

Acquisition = No. slices/ rotation x width of one slice


34/461

34


RT images are reconstructed during acquisition (real-

time display). Select Autoreconon the Reconstruc-tiontask card for each job, otherwise, you will have topress Reconfor each recon job separately.

Spiral Mode

*depends on the rotation time and scan protocol

Acquisi-

tion

Collima-

tion

Slice width z-

Sharp

DS*

64 x 0.6 0.6 0.6, 0.75,

1, 1.5, 2, 3,

4, 5, 6, 7,

8, 10 mm

X X

20 x 0.6

(Neuro

mode)

0.6 0.6, 0.75,

1, 1.5, 2, 3,

4, 5, 6, 7,

8, 10 mm

X

24 x 1.2 1.2 1.5, 2, 3, 4,5, 6, 7, 8,

10 mm

X


35/461


35

Sequence Mode

*depends on the rotation time and scan protocol

Acquisition Collimation Slice width DS*

24 x 1.2 1.2 1.2, 2.4,

4.8, 7.2,

9.6,

14.4 mm

X

12 x 1.2

(Neuro

mode)

1.2 2.4, 4.8,

7.2, 14.4

6 x 3 3 3, 6, 9 mm X

1 x 5

(Neuro

mode)

5 5 mm

1 x 10 10 10 mm


36/461

36


Recon Increment

The recon increment is the distance between thereconstructed images in Z direction. When the chosenincrement is smaller than the slice thickness, theimages are created with an overlap. This technique isuseful for reducing partial volume effect, giving you

better detail of the anatomy and high quality 2D and3D post-processing.The increment can be freely adapted from0.1 - 10 mm.

Pitch and Pitch adaptation

You select the slice collimation together with the slicewidth desired. The slice width is independent of pitch,i.e. what you select is what you get. You no longer

need to be concerned with the algorithm: the softwaredoes it for you.

The pitch factor can be freely adapted from 0.45 - 2.0.Pitch values with a step width of 0.05 can be selectedfor all modes.

Pitch= feed per rotation z-coverage

Z-coverage = detector rows x collimated slice width

Feed/Rotation = table movement per rotation


37/461


37

Data from scans with pitch factors between 1.5 and 2

can be reconstructed with a slice thickness 7 mm(collimation 1.2 mm) and a slice thickness 5 mm (col-limation 0.6 mm) only.

For cardiac scanning SOMATOM Definition automati-cally adapts the pitch to the heart rate. Prior to thepatient's scan, the system monitors the heart rate and

automatically calculates the best pitch value for thesubsequent scan. SOMATOM Definition increases thepitch with higher heart rates, resulting in a faster tablespeed and a corresponding reduction of dose expo-sure. The higher the heart rate, the less time isrequired for imaging the heart, and consequently the

lower the dose needed.

Diagram of the taken pitch, depending on the heartrate

ts

bpm (beats per minute)

Pmono-segmentPbi-segment

Pitchfactor


38/461

38


To adapt the pitch automatically, the Estimated Heart

Rate(Est.HR) is set to auto on the Triggertab card, bydefault.The heart rate can also be selected manuallyvia the drop-down menu.

Observe the patients heart rate and select the corre-sponding entry. The system will choose a pitch valuefor the selected heart rate.


39/461


39

Kernels

There are five different types of kernels: Hstands forHead, Bstands for Body, Cstands for ChildHead, and Sstands for Special Application.

The image sharpness is defined by the numbers: thehigher the number, the sharper the image; the lower

the number, the smoother the image.

The endings "s" or "f" indicate the mode: "s" stands forstandard mode, "f" for fast mode, and "h" for high res-olution modes.

Head Kernels

For soft tissue head studies, the standard kernel isH40s; softer images are obtained with H30s or H20s,H10s, sharper images with H50s. The kernels H21s,H31s, H41s yield the same visual sharpness as H20s,H30s or H40s respectively. The image appearance,however, is more acceptable due to a "fine-grained"noise structure; quite often, the low contrast detect-ability is improved by using H31s, H41s instead ofH30s, H40s.

In emergency examinations, kernels H22s, H32s, andH42s can be used because they allow fast reconstruc-tion (FR) and easy patient positioning (50 cm FoV). Toensure best performance, special online bone correc-tion (PFO) is not used.


40/461

40


High Resolution head studies should be performed

with H60s, H70h (for example, for dental and sinuses).It is essential to position the area of interest in the cen-ter of the scan field.

Kernel Description

H10f, H10s very smooth

H20f, H20s smoothH21f, H21s smooth +

H22f, H22s smooth FR

H30f, H30s medium smooth

H31f, H31s medium smooth +

H32f, H32s medium smooth FRH37f, H37s medium

H40f, H40s medium

H41f, H41s medium +

H42f, H42s medium FR

H45f, H45s medium

H47f, H47s medium

H48f, H48s medium

H50f, H50s sharp

H60f, H60s medium

H70h very sharp


41/461


41

Body Kernels

As standard kernels for body tissue studies B30s orB40s are recommended; softer images are obtainedwith B20s or B10s (extremely soft). The kernels B31sor B41s have about the same visual sharpness as B30sor B40s respectively. The image appearance, however,is more acceptable due to a "fine-grained" noise struc-

ture. Quite often, the low contrast detectability isimproved by using B31s, B41s instead of B30s, B40s.

For higher sharpness, as is required, for example, inpatient protocols for cervical spine, shoulder, extremi-ties and thorax, the kernels B50s, B60s, B70s, B75h,B80s are available.

The kernels B25s (smooth++) and B26s (HeartViewsmooth) offer the resolution of a standard kernel forbody tissue studies implying an advanced noise reduc-tion algorithm. The noise level will be reduced to val-ues comparable with an extremely soft kernel butkeeping the standard sharpness at contours. B25 and

B26 improve the image quality of, for example, MIPswithout the drawbacks of the loss of spatial resolutionby simply using an extremely soft kernel.


42/461

42


For heart reconstructions, as required, for example, in

MIPs for coronary CTAs, the kernel B26s is available.

Kernel Description

B10f, B10s very smooth

B18f, B18s very smooth

B20f, B20s smooth

B25f, B25s smooth ++

B26s HeartView smooth

B30f, B30s medium smooth

B31f, B31s medium smooth +

B35f, B35s HeartView medium

B36f HeartView mediumB40f, B40s medium

B41f, B41s medium+

B45f, B45s medium

B46f, B46s HeartView sharp

B50f, B50s medium sharp

B60f, B60s sharp

B70f, B70s very sharp

B75h, B75f very sharp

B80f, B80s ultra sharp


43/461


43

ChildHead Kernels

For head scans of small children, the kernels C20s,C30s (for example, for soft tissue studies) and C60s(for example, provided for sinuses) should be choseninstead of the "adult" head kernels H20s, H30s, andH60s.

Special Applications

Select S80s and S90s for special patient protocols andHigh Resolution bone studies (S90s).

Note:

For 3D studies only use kernel B10s with at least 50%overlapping for image reconstruction.

For vascular studies use B25s and for cardiac studiesuse kernel B26s for high resolution with reducednoise.

Do not use kernels for body parts other than whatthey are designed for.

Kernel Description

C20f, C20s smooth

C30f, C30s medium smooth

C60s sharp

Kernel Description

S80f, S80s Shepp-Logan with notch filter

S90f, S90s Shepp-Logan without notch filter


44/461

44


Topogram Kernels

Kernel Description

T10s smooth

T20s standard

T21s standard

T80s sharp

T81s sharp

T90s ultra sharp


45/461


45

Extended FoV

SOMATOM Definition provides an extended field ofview. The range can be individually adapted by theuser from 50 cm up to 78 cm.

To use this feature you have to select the extendedFoVcheckbox on the Recontab card. The default set-

ting is 65 cm, but can be modified.

Extended FoVcan be used with each scan protocol.

The extended FoV value should be adapted carefullyto the exact patient size in order to achieve best possi-ble image quality outside the standard scan field.


46/461


47/461


47

Image FiltersIf you use kernels, the images are reconstructed againwith the selected kernel value. If you use image filters,the images are not reconstructed again and the resultis much quicker.

Three different filters are available:

"LCE": The Low-contrast enhancement filterenhances low-contrast detectability and reduces theimage noise.

Similar to reconstruction with a smoother kernel

Reduces noise Enhances low-contrast detectability

Adjustable in four steps

Automatic post-processing

Image taken without

the LCE filter

Image taken with the LCE

filter


48/461

48


"HCE": The High-contrast enhancement filter

enhances high-contrast detectability. It increases theimage sharpness, similar to reconstruction with asharper kernel.

Increases sharpness

Faster than raw data reconstruction

Enhances high-contrast detectability


"ASA": Advanced Smoothing Algorithmreduces noise in soft tissues while edges with highcontrast are preserved.

Reduces noise without blurring edges Enhances low-contrast detectability

Individually adaptable


Image taken without

the HCE filter

Image taken with the

HCE filter


49/461


49

Head Imaging

Head Modes

For a given (eff.) mAs, the CTDI values (16 cm CTDIphantom) are lower for a lower tube voltage.

kV Increase of

mAs

Reduction of

CTDI vol

80 30% 15%

100 20% 13%120 15% 12%


50/461

50


Neuro Modes

In addition to the standard collimations, SOMATOMDefinition provides a special mode that is optimized forNeuro applications. Excellent low contrast, and detailresolution are achieved.

For sequence scans, a 12 times 1.2 mm acquisition and

a single 5 mm slice with optimized dose utilization andimage quality can be acquired. A 20 x 0.6 acquisitionmode is provided for spiral scans. Both approachesshow a minimized partial volume effect, i.e. low levelof artifacts in the base of the skull or near vertebralbodies, as 0.6 mm detector rows are used and the nar-

row collimation reduces scattered radiation.Three scan protocols are predefined for adults and chil-dren:

HeadNeurousing an acquisition of 20 x 0.6 mmand

HeadNeuroSequsing an acquisition of 1 x 5 mm.

SpineNeurousing an acquisition of 20 x 0.6 mm

We recommend using these special protocols for dedi-cated Neuro examinations.

For fast standard examinations such as rule out ofhemorrhage or ischemia, the "Routine" protocol shouldbe used.


51/461


51

Automatic Bone Correction

The head protocols provide significant improvementsregarding image quality for heads. An automatic bonecorrection algorithm has been included in the standardimage reconstruction. Using a new iterative tech-nique, typical artifacts arising from the beam harden-

ing effect, for example, Hounsfield bar, are minimizedwithout additional post-processing. This advancedalgorithm produces excellent images of the posteriorfossa, but also improves head image quality in general.Bone correction is activated automatically for bodyregion "Head". The reconstruction algorithm for "Head"also employs special adaptive convolution kernels that

help to improve the sharpness to noise ratio. More pre-cisely, anatomic contours are clearly displayed whilenoise is suppressed at the same time without causinga blurring of edges.

Head image withoutcorrection.

Head image withcorrections.


52/461

52


Positioning

In order to optimize image quality versus radiationdose, scans in the "Head" body region are providedwith a maximum scan field of 300 mm with respect tothe isocenter. No recon job with a field of view exceed-ing those limits will be possible. Therefore, patient

positioning has to be performed accurately to ensurethe skull is centered in the isocenter using the intersec-tion of the lasers.

correct positioning wrong positioningof the head of the head

For trauma examinations of the head two protocols areprovided which you will find in the Specialsfolder:

HeadTrauma

HeadTraumaSeq.

The scan protocols enable you to utilize the full 50 cmFoV, resulting in easier patient positioning for traumaexaminations. To ensure the highest performance,dedicated online bone correction (PFO) is not used.


53/461


53

Automatic Isocenter Adaptation

Automatic adaptation of the table height allows you toposition the object exactly in the isocenter. To achievebest image quality, it is necessary to position thepatient exactly in the isocenter. You see the isocenterin the topogram graphical display and can adapt the

table height after scanning the topogram. As the tablemoves, the graphic position is also updated.


54/461

54


The table position can be adapted in two ways:

Click on the Feed Up, Feed Downbuttons on theRoutinetab card.

Enter the new table height manually on the Routinetab card.

Note:

Adaptation is only possible with lateral topograms.

If the table has been vertically repositioned based onthe active field of view in a topogram, the topogramis still valid for scan planning and reconstructions.

Hint:We recommend using the automatic isocenteradaptation, especially for head examinations, because

of the image quality.


55/461


55


56/461

56

Dose Information

CTDIW

and CTDIVol

The average dose in the scan plane is best described bythe CTDIWfor the selected scan parameters. The CTDIWis measured in dedicated plastic phantoms 16 cmdiameter for head and 32 cm diameter for body (as

defined in IEC 60601 2 44). For scan modes with z-Sharp the CTDI100 is calculated using the single num-ber of tomographic sections (not doubled by z-Sharp)to remain within the terms of IEC 60601-2-44. The z-coverage with and without z-Sharp is the same and sois the dose. This dose index gives a good estimation ofthe average dose applied in the scanned volume, aslong as the patient size is similar to the size of therespective dose phantoms.

Since the body size can be smaller or larger than32 cm, the CTDIWvalue displayed can deviate from thedose in the scanned volume.

The CTDIWdefinition and measurement are based onsingle axial scan modes. For clinical scanning, i.e.scan-ning of entire volumes in patients, the average dosewill also depend on the table feed between axial scansor the feed per rotation in spiral scanning. The dose,expressed as the CTDIW, must therefore be corrected by

the pitch factor of the spiral scan or an axial scan seriesto describe the average dose in the scanned volume.


57/461


58/461

58

Dose Information

The CTDIw value does not provide the entire informa-

tion of the radiation risk associated with CT examina-tion. For this purpose, the concept of the EffectiveDose was introduced by ICRP (International Commis-sion on Radiation Protection). The effective dose isexpressed as a weighted sum of the dose applied notonly to the organs in the scanned range, but also to the

rest of the body. It could be measured in whole bodyphantoms (Alderson phantom) or simulated withMonte Carlo techniques.

The calculation of the effective dose is rather compli-cated and has to be performed by sophisticated pro-grams. These have to take into account the scan

parameters, the system design of the individual scan-ner, such as X-ray filtration and gantry geometry, thescan range, the organs involved in the scanned rangeand the organs affected by scattered radiation. Foreach organ, the respective dose delivered during theCT scanning has to be calculated and then multipliedby its radiation risk factor. Finally, the weighted organ

dose numbers are added up to get the effective dose.

The concept of effective dose allows the comparison ofradiation risk associated with different CT or X-rayexams, i.e. different exams associated with the sameeffective dose would have the same radiation risk forthe patient. It also allows a comparison of the applied

X-ray exposure to the natural background radiation,for example, 2 3 mSv per year in Germany.


59/461


60/461

60

Dose Information

Effective mAsIn sequential scanning, the dose (Dseq) applied to thepatient is the product of the tube current-time (mAs)and the CTDIw per mAs:

In spiral scanning, however, the applied dose (Dspiral)is influenced by the conventional mAs (mA x Rot Time)and additionally by the pitch factor. For example, if aMultislice CT scanner is used, the actual dose appliedto the patient in spiral scanning will be decreasedwhen the pitch factor is greater than 1, and increasedwhen the pitch factor is less than 1 (for constant mA).Therefore, the dose in spiral scanning has to be cor-rected by the pitch factor:

To simplify this task, the concept of the "effective" mAswas introduced with SOMATOM Multislice scanners.

The effective mAs takes into account the influence ofpitch on both the image quality and dose:

Dseq

= DCTDIw

x mAs

Dspiral=(DCTDIwx mA x Rot Time)

Pitch factor

Effective mAs = mAsPitch factor


61/461


62/461


63/461

Dose Information

63

CARE Dose 4DCARE Dose 4D is an automated exposure control,which ensures constant diagnostic image quality overall body regions at the lowest possible dose.

CARE Dose 4D combines three different adaptationmethods to optimize image quality at the lowest doselevel:

Automatic adaptation of the tube current to thepatient size

Automatic adaptation of the tube current to the

attenuation of the patients long axis, the so-called z-axis.

Automatic adaptation of the tube current to theangular attenuation profile measured online foreach single tube rotation, the so-called angle modu-lation.

Based on a single a.p. or lateral topogram, CARE Dose4D determines the adequate mAs level for every sec-tion of the patient. Based on these levels, CARE Dose4D modulates the tube current automatically duringeach tube rotation according to the patients angularattenuation profile. Thus, the best distribution of dose

along the patients long axis and for every viewingangle can be achieved.


64/461

64

Dose Information

Based on a user defined Image Quality Reference

mAs, CARE Dose 4D automatically adapts the (eff.)mAs to the patient size and attenuation changeswithin the scan region. With the setting of the ImageQuality Reference mAsyou can adjust image quality(image noise) to the diagnostic requirements and theindividual preference of the radiologist.

Note: The Image Quality Reference mAs should notbe adjusted to the individual patient size!


65/461

Dose Information

65

How does CARE Dose 4D work?

CARE Dose 4D combines two types of tube currentmodulation:

1.Axial tube current modulation:

Based on a single topogram (a.p. or lateral) the atten-

uation profile along the patients long axis is measuredin the direction of the projection and calculated for theperpendicular direction by a sophisticated algorithm.

Example of lateral and a.p. mA and mAs profile evalu-ated from an a.p. topogram.

Based on these attenuation profiles, axial tube currentprofiles (lateral and a.p.) and the resulting eff. mAs forevery table position are calculated. The correlationbetween attenuation and tube current is defined by ananalytical function which results in the optimum doseand image noise in every slice of the scan.

mA,mAs

mAs meanmAs lateralmA a.p.

max

table position (mm)


66/461

66

Dose Information

This correlation is based on a clinical assessment of

diagnostical image quality. The result was that forgood diagnostical image quality at reasonable lowdose level the image noise does not need to be con-stant for all body sizes and body regions.

For every type of protocol a typical X-ray attenuation ofa standard sized patient is internally stored and a pre-

defined Quality reference mAs value is related to thisreference X-ray attenuation. You can modify the imagequality by adjusting the Quality reference mAs.

For an advanced adjustment, the slope of the right andthe left branch of the curve may be adjusted in theExamination Configurationdialog box to achieve a

stronger or weaker increase or decrease of eff. mAswith body size or body region.

weak average strong

slim/decrease A B C

obese/increase F E D

Reduced dose level rbased on topogram

Average X-ray attenuation (lo/l) resp. Body Size

Quality ref. mAs

Constant Image Noise

ReferenceA

ttenuation

D

Clinical reasonable mAs

E

F

BC

A

eff.

mAs


67/461

Dose Information

67

In the example, the reference attenuation is that for athorax protocol (600) and a Quality reference mAs of100 is selected. Based on this pair of values the eff.mAs is adapted to the body size according to the rela-tion shown in the graph. The resulting eff. mAs of thisexample for different body size and body regions islisted in the table.

Marker StandardPatient

(adult/75kg)

ObesePatient

X-rayAttenuation

eff.mAs

1 Neck 100 45

2 Neck 360 80

3 Thorax 600 100

4 Thorax 820 110

5 Abdomen 1000 120

6 Abdomen 1950 150


68/461

68

Dose Information

2.Angular tube current modulation:

Based on the above described axial eff. mAs profile,the tube current is modulated during each tube rota-tion. Therefore the angular attenuation profile is mea-sured automatically during the scan and the tube cur-rent is modulated accordingly in real time to achievean optimum distribution of the X-ray intensity for

every viewing angle.

Tube current profile along a spiral scan with CAREDose 4D: Combination of tube current adaptationalong the body axis and tube current modulation overthe rotation angle. Every single oscillation corre-sponds to half a tube rotation. The variation of the

oscillation's mean value over the table position showsthe variation of eff. mAs.

tubecurre

ntmA

table position (mm)


69/461

Dose Information

69

CARE Dose 4D allows you to reduce the patient dose

significantly (locally up to nearly 70%) while keepingthe diagnostic image quality constant or even improv-ing it and enabling longer scan ranges.

The mAs value displayed in the user interface and inthe patient protocol is the mean (eff.) mAs value forthe scan range.

The mAs value recorded in the images is the local (eff.)mAs value.

Special Modes of CARE Dose 4D

For certain examination protocols, CARE Dose 4D usesmodified tube current modulation, to meet specificconditions, for example:

for Adult Head protocols the tube current is adaptedto the variation along the patients long axis and notto the angular attenuation profile.

for Extremities, NeuroPCT and BodyPCT, and otherspecial protocols (indicated as CARE Dose), onlyangular tube current modulation is supported.

for Cardio protocols the mAs/rot setting is adjusted tothe patient size and not modulated during the scan,except if ECG pulsing is switched on.


70/461

70

Dose Information

Scanning with CARE Dose 4D

If the settings of Image Quality Reference mAs are cor-rectly predefined*, no further adjustment of the tubecurrent is required to perform a scan.

CARE Dose 4D automatically adapts the tube current todifferent patient sizes and anatomic shapes, but it

widely ignores metal implants.

Note: Otherwise the magnification of the topogramwould be distorted which would lead to an under-estimation or overestimation of the required eff.mAs.

For an accurate mAs adaptation to the patients sizeand body shape with CARE Dose 4D, the patient shouldbe carefully centered in the scan field.

When using protocols with CARE Dose 4D for bodyregions other than those they are designed for, theimage quality should be carefully evaluated.

As CARE Dose 4D determines the (eff.) mAs for everyslice of the topogram, a topogram must be obtainedfor use of CARE Dose 4D.

*For Siemens scan protocols of SW version syngo CT2007A, the settings of CARE Dose 4D are already pre-defined but may be changed to meet the customerspreference of image quality (image noise).


71/461

Dose Information

71

Outside the topogram range, CARE Dose 4D will con-

tinue the scan with the last available topogram infor-mation. Without a topogram, CARE Dose 4D cannot beswitched on. Repositioning of the patient on the tableand excessive motion of the patient must be avoidedbetween the topogram and the scan. If two topogramsof the same projection exist for one scan range, the

last acquired will be used for determining the (eff.)mAs. If a lateral and a.p. topogram exist for one scanrange, both will be used for determining the (eff.)mAs.


72/461

72

Dose Information

After the topogram has been scanned, the (eff.) mAs

value in the Routinetab card displays the mean (eff.)mAs estimated by CARE Dose 4D based on the topo-gram*. After the scan has been performed this value isupdated to the mean (eff.) mAs that was applied. Thevalues may differ slightly due to the online modulationaccording to the patients angular attenuation profile.

*When tuning the CARE Dose 4D parameter setting tothe individual preference for image quality, we rec-ommend keeping track of this value and comparingit with the values used without CARE Dose 4D.


73/461

Dose Information

73

The Quality reference mAsvalue is displayed on the

Scantab card. This defines the overall image quality ofthe scan protocol currently being used. This value canbe adapted for each protocol according to the usersindividual requirements of image quality. Here you canalso view the effective mAs value that the system isgoing to use for the current scan range.

You can also deselect CARE Dose4D on this tab card.


74/461


75/461


76/461

76

Dose Information

if the automatic dose increase for obese patients (or

patient sections) has to be more moderate than thepreset (choose obese: weak increase), resulting inmore image noise and a lower dose for thoseimages.

if the automatic dose decrease for slim patients (orpatient sections) has to be stronger than the preset

(choose slim: strong decrease), resulting in moreimage noise and a lower dose for those images.

if the automatic dose decrease for slim patients (orpatient sections) has to be more moderate than thepreset (choose slim: weak decrease), resulting inless image noise and a higher dose for those images.

On the Patienttab card you can adjust the image qual-

ity (for more information see chapter How does CAREDose 4D work).

Note: Changing this adaptation strength effects allprotocols!


77/461

Dose Information

77

Activating and Deactivating

CARE Dose 4D may be activated or deactivated for thecurrent scan in the Scan tabcard. If CARE Dose 4D isactivated as default, the Image Quality ReferencemAsvalue is set to the default value of the protocol.After deactivating CARE Dose 4D, the Image Quality

Reference mAsis dimmed and the (eff.) mAs valuehas to be adjusted to the individual patients size! IfCARE Dose 4D is switched on again, the Image QualityReference mAs is reactivated. Note that the last settingof the Image Quality Reference mAs or the (eff.) mAswill be restored when you switch from and back toCARE Dose 4D usage. The default activation state of

CARE Dose 4D may be set in the Scan Protocol Man-ager. CARE Dose 4D must be selected (column CAREDose type). The corresponding column for activatingCARE Dose 4D is called CARE Dose (4D), with possibledefault onor off.


78/461

78

Dose Information

If you are unsure about the correct Image Quality Ref-

erence mAs value, follow this simple procedure:

Enter the (eff.) mAs value used for that type of pro-tocol without CARE Dose 4D.

There is a simple way of ascertaining what eff. mAsCARE Dose 4D will use along the scan range: When

the topogram is complete shrink the scan range toit's minimum. As you move this small box over thetopogram you can see how the eff. mAs displayed inthe Routine and Scantab card varies along thepatient's body.To achieve a certain eff. mAs at a patient's particularbody region you can move the small scan range to

this position and then adjust the Quality referencemAs so that the displayed eff. mAs value is asdesired. After resizing the scan range to the rangefor the examination, carefully observe the displayedmean eff. mAs. After the subsequent scan is com-pleted inspect the image quality to ensure that the

chosen Quality reference mAs is the right value. With that setting perform the first scan and carefully

inspect the image quality. In that first step the dosemay not be lower than without CARE Dose 4D butwill be well adapted to the patients attenuation,resulting in improved image quality.

Starting from that setting, reduce the Image QualityReference mAs step by step to meet the necessaryimage quality level.

Store the scan protocol with the adapted image qual-ity reference mAs.


79/461

Dose Information

79

Additional Important Information

For ideal dose application it is very important to posi-tion the patient in the isocenter of the gantry.

Example of an a.p. topogram:

Patient is positioned in the isocenter - optimal doseand image quality

Patient is positioned too high - increased mAs

Patient is positioned too low - reduced mAs andincreased noise

Detector

X-ray tube

Patient

(centered)

Patient(centered)

X-ray tube

Detector

X-ray tube

Detector

Patient

(not centered)

Patient

X-ray tube

(not centered)

Detector


80/461

80

Dose Information

Three different table positions are displayed in the fol-

lowing patient protocols according to the topograms:

The first scan was performed in the isocenter. Here areasonable total mAs value was achieved.

The second topogram scan was performed abovethe isocenter. Here the mAs value was increased.

The third topogram scan was performed below theisocenter. The mAs value was significantly lower andthe resulting images had increased image noise.


81/461

Dose Information

81

Clinical Benefits of CARE Dose 4D

The same scan protocol can be used for slim andobese patients.

An optimal image quality in every slice can beachieved at the lowest possible dose level.

A patient dose reduction of up to 67% locally can beachieved depending on the scan protocol.


82/461

82

Dose Information

100kV ProtocolsThe system offers a spectrum of four kV settings(80 kV, 100 kV, 120 kV, and 140 kV) for individualadaptation of the patient dose in pediatric scans andfor optimization of the contrast-to-noise ratio in con-

trast-enhanced CT angiographic studies.

In contrast enhanced studies, such as CT angiographicexaminations, the contrast-to-noise ratio for a fixedpatient dose increases with decreasing tube voltage.As a result, to obtain a given contrast-to-noise ratio,the patient dose can be reduced by choosing lower kV-

settings. This effect is even more pronounced forsmaller patient diameters. It can be demonstrated byphantom measurements using small tubes filled withdiluted contrast agent embedded in plastic phantomswith different diameters. The iodine contrast-to-noiseratio for various kV-settings is depicted in the followingtable as a function of the phantom diameter. Com-pared with a standard scan with 120 kV, the same con-trast-to-noise ratio in a 24 cm phantom, correspondingto a slim adult, is obtained with 0.5 times the dose for80 kV (1.5 times the mAs) and 0.7 times the dose (1.1times the mAs) for 100 kV. Ideally, 80 kV should beused for the lowest patient dose. In practice, however,

the use of 80 kV for larger patients is limited by theavailable mA-reserves of the X-ray generator.

In these patients, 100 kV is a good compromise andthe preferable choice for CTA examinations.


83/461

Dose Information

83

Iodine contrast-to-noise ratio as a function of thephantom diameter for kV-settings at a constant dose(CTDIw in these phantoms).

80 kV

120 kV

100 kV

140 kV

IodineSignal/

Noise

Phantom Diameter, cm


84/461

84

Dose Information

Results of iodine contrast, noise and dose measure-ments for different kV settings and phantom sizes. Rel-

ative dose numbers (CTDIw in the respective phan-tom) and mAs settings needed for a certain contrast-to-noise ratio in the center of the 16 cm and 24 cmplastic phantoms. The required dose for the same con-trast-to-noise ratio is significantly lower for lower kVvalues.

80 kV 100 kV 120 kV 140 kV

Relative dose,

24 cm

0.49 0.69 1.0 1.49

Relative dose,

16 cm

0.44 0.68 1.0 1.43

Relative mAs

setting

150 110 100 100


85/461

Dose Information

85


86/461

86

Workflow Information

WorkStream4D

Recon Jobs

In the Recontab card, you can define up to eightreconstruction jobs for each range with different

parameters either before or after you acquire the data.When you click on Recon, these jobs are performedautomatically in the background. If you want to addmore than eight recon jobs, simply click the icon for analready completed recon job in the chronicle with theright mouse button and select delete recon job.

Another recon job will now become available on theRecontab card.

Note: What you delete is just the job from the display,not the images that have been reconstructed. Oncereconstructed, these completed recon jobs stay in thebrowser until they are deleted from the local database.

You can also reconstruct images for all scans per-formed by not selecting any range in the chronicleprior to clicking Recon.

Another item you will find in the right mouse menu iscopy/replace recon parameters. This function isavailable for spiral scans only.

The main goal is to support the transfer of volumeparameters between oblique recon jobs of rangeswhich mainly cover the same area, for example, twospiral scans with/without contrast media.


87/461


87

3D Recon

3D Recon allows you to perform oblique and/ or dou-ble-oblique reconstructions in any user-defined direc-tion directly after scanning.

No further post-processing or data loading is needed.The high-quality SPO (spiral oblique) images are calcu-

lated using the systems raw data.

Key Features

Reconstruction of axial, sagittal, coronal, andoblique / double oblique segments

3 planning segments in the 3 standard orientations

(coronal, axial, sagittal) Image types for planning MPR Thick (3 mm),

MIP Thin (10 mm)

Field of view and reference image definition possiblein each planning segment

Asynchronous reconstruction (several reconstruc-tion jobs are possible in the background, axial andnon-axial)

Workstream 4D performs reconstructions on thebasis of CT raw data

If the raw data is saved you can start the 3D recon-struction on your syngo CT Workplace.


88/461

88


Workflow Description

WorkStream 4D improves your workflow whenevernon-axial images of a CT scan are required, for exam-ple, examinations of the spine.

3D reconstructions are possible:

spiral scan is needed

as soon as one scan range is finished and at least oneaxial reconstruction job has been performed (RTimages).

Select a new recon job and mark Recon Job Type 3Don the Recontab card. The first recon job that is suit-able for the 3D reconstruction is used as Availableplanning volumes.


89/461


89

Additional Important Information

Pitch factor for 3D Recon

For reconstruction of 3D recon jobs the maximumpitch factor is 1.5.If the pitch factor is > 1.5 a message window informsyou that this 3D recon job cannot be started and may

be deleted. In this case use the standard 3Dtask cardwith an axial image series for reconstruction.


90/461

90


Three planning segments in perpendicular orienta-

tions will appear in the upper screen area. You canchoose between MPR Thick(3 mm) and MIP Thin(10 mm) as the image type for your planning volumeusing the relevant buttons.

In each segment you will find a pink rectangle whichrepresents the boundary of the result images. The

image with the right down marker represents the fieldof view (FoV) of the result images (viewing direction).

Right

down

marker

Reference lines


91/461


91

The rectangle with the grid represents the reference

image (topogram) which is added to the topogramseries including the reference lines after reconstruc-tion.

Topographics

indicator

Recon area

Reference lines


92/461

92


Preview Image

A preview of the actual FoV is now available.

After pressing the button Preview Imagethe actualFoV to be reconstructed will be displayed.

Clicking again on the button will deactivate the pre-view image and display the whole reference image

again.

Double clicking into the FoV image will activate ordeactivate the Preview Imagefunction as well.

If the Preview Imagefunction is active and you moveor rotate the box, or change the recon begin and end

position, the Preview image in the FoV segment will beupdated accordingly.


93/461


93

Depending on the desired resultant images, choose

axial, coronal, sagittal, or oblique recon axis.

1. Sagittal/Coronal Reconstructions

Adjust the field of view size to your needs.

It is only possible to reconstruct images with asquared matrix.

2. Oblique/Double-oblique Reconstructions

If you want to define the orientation of the resultimages independently of the patients axis:

Enable theFree View Modeand rotate the refer-ence lines in the three segments until the desired

image orientation is displayed. The vertical and hor-izontal lines are always perpendicular to each other.With the default orientation button you can reset theimage orientation at any time.

It is only possible to reconstruct images with asquared matrix.

Set the field of view to the active segment by clickingthe Set FoV button. The result images will then beorientated as in the FoV segment. You can adjust theextension perpendicular to the field of view in thesame way in the other two segments.


94/461


95/461


95

Additional Information

As soon as you define a new recon range, all reconranges will be shown in the topo segment. The twonumbers on the right-hand side at the beginning ofeach recon range indicate the recon job the rangebelongs to. The first number stands for the scan range,the second number stands for the recon job to which

the range belongs. If no recon job is pending, only thescan ranges are shown in the topo segment. Only onenumber on the right-hand side at the beginning ofeach scan range indicates which scan the rangebelongs to.

If the first recon job is saved as an Obliquerecon job,

RTD images are displayed after scanning and theExaminationtask card is automatically switched to3D reconstruction

Patient Browser:for each double oblique recon job, one series isadded in the Patient Browser.

If Auto Reference Linesis selected the correspond-ing reference image is added to the 3D recon series.

All reconstructions are performed in the background

Do not use high resolution images

Do not use extended FoV

If no entry is selected in the chronicle, all open

reconstructions are automatically reconstructed. If Autoreconis selected on the Recontab card, this

recon job (axial and oblique) will be automaticallyreconstructed after scanning.


96/461


97/461


97

Case Examples

Some scan protocols are supplied with predefinedoblique reconstructions. These protocols aremarked with the suffix VOL.

Coronal and sagittal reconstruction of the spine:

Scan a topogram

Plan your axial spiral scan range Reconstruction of the spiral images (RT images)

Select Recon job Typesagittal/coronal

Select the axial image segment

Press button Set FoV

Adjust the FoV to your needs

Define your desired reconstruction parameters(for example, image type SPO)

Start reconstruction

Repeat the reconstruction steps for the otherorientation (sagittal/coronal)


98/461

98


Oblique reconstruction of the sinuses:

Scan a topogram Plan your axial spiral scan range

Reconstruction of the spiral images(RT images)

Select Recon job Typeoblique

Select the sagittal image segment

Enable Free Mode Rotate the reference lines until the best view of

the sinuses is displayed in one of the other seg-ments

Select this segment and press the Set FoVbutton

Adjust the FoV to your needs

Define your desired reconstruction parameters(e.g., image type SPO)

Start reconstruction


99/461


100/461

100


Workflow

Patient Position

A default patient position can be linked and stored toeach scan protocol. The SIEMENS default protocols are

already linked to a default patient position (Head first -supine).

If a scan protocol is selected and confirmed in thePatient Model Dialog, the linked patient positionstays active until the user changes it, even if a scan pro-tocol with a different patient position is selected.

Auto Reference Lines

The Auto Reference linessettings defined in thePatient Model Dialogcan be linked and saved to eachscan protocol.

If a scan protocol is selected and confirmed in thePatient Model Dialog, the linked Auto Referencelinessettings stay active until the user changes them,even if a scan protocol with different Auto Referencelinessettings is selected.


101/461


102/461

102


Study Continuation

An existing study can be continued at a later time.

To load an existing study:

Select the desired study in the Patient Browser.

Select Registerfrom the Patientdrop-down menu.

The patient data is loaded in the Registrationdialogbox.

The previous scan protocol is already preselected, butit is also possible to select any desired scan protocol.

After the patient has been registered, the patient isloaded into the Examinationcard.

The ranges already scanned are listed. The followingchronicle entry is shown between the ranges alreadyscanned and the new ranges: Exam Continue.

If you want to continue a contrast media study, the sys-

tem asks you if the next scan should be continued as anon-contrast scan instead.

If you want to continue as a non-contrast scan, thechronicle entries for the new scan range is indicatedas a non-contrast scan. (No injector symbol isshown.)

If you continue a study as a contrast study, the chroni-cle entries of the new scan range are indicated as acontrast scan. (An injector symbol is shown.)


103/461


104/461

104


Examination Job Status

You can obtain an overview of all recon jobs by clickingon the Recon task icon in the status bar or selectingTransfer Examination Job statusin the patientmain menu in the Patient Browser.

The Examination Job Statusdialog box will appear

where all recon jobs (completed, queued and inprogress) are listed. You can stop, restart, and deleteeach job by clicking the corresponding button. To givea selected job a higher priority click urgent.

The column Typeshows you which kind of reconstruc-tion is queued.

Two types are displayed:

Reconall recon jobs from the Recontask card on the syngoCT Workplace

Auto 3Dall 3D reconstructions which you have sent via Auto

post-processingautomatically into the 3Dtask card.These jobs will be deleted from the job list as soon asthe patient is closed in the 3Dtask card.


105/461


105

Auto Load in 3D and Post-Processing

Presets

You can activate the Auto load in 3Dfunction on theExaminationtask card/Auto Taskingand link it to arecon job, for example, the 2ndrecon job with thinnerslice width in some of the examination protocols. If the

post-processing type is chosen from the pull-downmenu, the reconstructed images will be loaded auto-matically into the 3Dtask card on the syngoAcquisi-tion Workplacewith the corresponding post-process-ing type.

On the 3Dtask card you can create parallel and radial

ranges for Multi-Planar-Reconstruction (MPR) and ThinMaximum-Intensity-Projection (MIP Thin), which canbe linked to a special series.

For example, if you always perform sagittal MPRs for aspine examination, as soon as you load a spine exami-nation into the3Dtask card, select the image type

(MPR), orientation, and open the Range Parallel func-tion. Adapt the range settings (image thickness, dis-tance between the images etc.) and click the link but-ton and save your settings. You now have a predefinedpost-processing protocol linked to the series descrip-tion of a spine examination.


106/461

106


The same can be done for VRT presets. In the main

menu under Type > VRT Definition, you can link VRTpresets with a series description.

Some of the scan protocols, primarily for Angio exami-nations, are already preset in the protocol with Autoload in 3D. If you prefer not to have this preset, dese-lect the Auto load in 3D and save your scan protocol.

Some of the scan protocols are preset in the protocolwith links to a post-processing protocol. If you prefernot to have this preset, please delete the Range Parallelpreset or overwrite them with your own settings.

Scan Protocol Creation

You can modify or create your scan protocols in twodifferent ways:

by editing/saving scan protocols

via scan protocol manager.

Edit/Save scan protocols

If you want to modify an existing protocol or create anew one, for example, you want to have two Abdo-menRoutine Protocolswith different slice widths, werecommend you do this directly on the Examinationtask card.


107/461


107

User-specific scan protocols can be saved with the fol-

lowing basic procedure:

Register a patient, you can choose any patient posi-tion in the Patient Model Dialog.

Select an existing scan protocol in the Patient ModelDialog.

Modify the scan protocol, change parameters, add

new ranges etc. to adapt the new protocol to yourrequirements.

Scan your patient as usual.

Check that all parameters are as you desire.

Select Edit/Save Scan Protocolin the main menu.

Select the folder where you want the new protocol

to appear and the scan protocol name in the pop-updialog box.

You can either use the same name to overwrite theexisting scan protocol or enter a new name, whichwill create a new protocol name and will not alterany of the existing protocols already stored.

If you want to save an "old" protocol again, you mayhave to modify the protocol name. The old protocol(with the old name) must be cancelled explicitly.


108/461

108


Additional important information:

You can save your scan protocol at any time duringthe examination.

It is recommended that you save your own scan pro-tocol under a new name in order to avoid overwrit-ing the default scan protocol.

Do not use special characters or blanks. Allowed areall numbers from 0 to 9, all characters from A to Zand a to z and explicitly the _ (under-score), but nocountry-specific characters, for example, , , , , .

Do not rename scan protocol files at Windows level.This will lead to inconsistencies.

You can now save your own scan protocols in anypre-defined folder. The organ characteristics willbelong to the scan protocol, not to the region.

In the Patient Model Dialog, the modified scan pro-tocols are marked by a dot in front of the protocol.

Scan Protocol Manager

If you want to modify special parameters for all exist-ing scan protocols or you want to modify the folderstructure we recommend doing this in the Scan Proto-

col Manager.Call up Options > Configuration...and click on theScan Protocol Managericon in the configurationpanel. The Scan Protocol Manageris opened and allprotocols are loaded. Multiple selection of the rowsworks in the usual way via the left mouse click

together with the Ctrl key.


109/461


110/461


111/461


111

Define a protocol as the emergency protocol. Select

the desired scan protocol with the right mouse but-ton. Select item Set as new emergency protocol.The selected protocol is marked with a red cross.- Open the Scan Protocol Manager(Options > Con- figuration).- Mark the protocol, with a right mouse click and

select "Set as new emergency protocol". A red crosswill appear in front of the protocol name.- Save the changes. From now on the new protocol is used as the default when you select the emergency button in the Patient Registrationdialog box.


112/461

112


Change the structure of the protocol tree. You can

sort all customers protocols as you want to. Selectthe desired protocols, press the right mouse button.You will find the items:- Cut/Copy-Paste.To change the order of your protocol tree, you can

drag & drop the protocols into the desired position.Or use the items Move Up and Move Downfrom thecontext menu to change the sorting of your protocoltree.

With the Filter function you can reduce the numberof displayed scan protocols and Recon jobs.

for reducing the displayed Recon jobs you canchoose between:All axial Recon jobsAll sagittal and coronal Recon jobsAll oblique Recon jobs

for reducing the displayed scan protocols selectModified Scan Protocols only

for displaying all scan protocols and Recon jobsselect: Off.

Display of actions:

Invalid protocols or parameters are marked in yel-low.

Changed, but not yet saved protocols and/orparameters are marked in green.


113/461


113

Table with all possible states of tree nodes

State IconChild protocols

Adult protocols

region

SIEMENS protocol

USER protocol

changed USER protocol

invalid USER protocol

SIEMENS emergency protocol

scan protocol entry

autorange - start

autorange - middle

autorange - end

recon job


114/461

114


Additional Important Information:

With the Find/Replacefunction you can easily insertan API command for all protocols as needed.

Also all Auto Tasking actions, for example, transfer toconfigured network nodes can be set within oneaction. With the Function button you can set your

transfer actions depending on the slice width. Sorting the scan protocols will ensure that all organ

characteristics belong to the protocol, so it does notmatter which folder you choose.

For security reasons it is not possible to make anychanges in the Siemens protocols, but you can copy

or drag & drop these protocols into a Customerfolder.

You can save your changes with the items Save/Saveas/Save all.

You can delete individual Recon jobs by selecting the

Recon job in question and selecting Delete from thecontext menu.

Only those Scan protocols that belong to the USERcategory can be deleted. Only complete scan proto-cols can be deleted. It is not possible to delete scanprotocol entries or scan protocol recon jobs.

The item Set to defaultsin the main menu/ contextsensitive menuwill reset all your changes to theSiemens default values.


115/461


115

A message will inform you if not all scan protocols

have been saved when you close the Scan ProtocolManager.

You can configure the displayed columns and theirposition with View configure columns.

System/Runoffers the tool Restore Default Scan

Protocolswhich allows you to remove user-specificscan protocols and restore the Siemens default set-tings.

The main menu itemEditoffers save/delete ScanProtocols.

System/Runor the main menu item View in the

Scan Protocol Manageroffers the tool List ScanProtocolswhich generates an HTML table of allavailable scan protocols. This list can be printed orsaved to floppy disk (File/Save As).


116/461


117/461

Application Information

117

Key Features

SOMATOM LifeNet offline (All users):

General Information about your system and configu-ration

Access to E-training

SOMATOM LifeNet online (in combination with a Sie-mens Remote Service connection):

Newsticker archive and FAQ (frequently asked ques-tions) section

Free trial software order and installation

Download of information, manuals, and scan proto-cols

A contact function providing an easy and fast inter-face with Siemens including the possibility to attachup to two DICOM images


118/461

118


SOMATOM LifeNet offline

Start SOMATOM LifeNet by clicking LifeNeton the Lifetask card. For syngoMultiModality Workplace, callup Options> SOMATOM LifeNetfrom the mainmenu.

With SOMATOM LifeNet you can access various infor-

mation about your hardware and software environ-ment.

Under System Information,for example, you will findinformation such as software version or a scan secondcounter. Under Customer Informationyou can enteryour contact data.


119/461


120/461


121/461


121

Downloading files

Each download is performed in the background andeven if you disconnect your SOMATOM LifeNet onlinesession and start work with the CT scanner, it will con-tinue the process until downloading is completed. Dueto bandwidth restrictions it is only possible to performone download at a time.

Depending on your connection speed downloading oflarger files like, for example, the Advanced Applica-tion Trainingmay take quite some time. Shuttingdown the system in between will interrupt the down-load.

Downloaded PDFs can be found offline underOptions > File Browser > H:\SiteData/Manuals.


122/461

122


The E-training is automatically installed as soon as it is

downloaded and can be started within the SOMATOMLifeNet offline section under SOMATOM Educate > E-Training.

For syngoAcquisition Workplaces, you can down-load and install scan protocols.

To install the downloaded protocols open the ScanProtocol Managervia Options > Configuration.SelectImport Scan Protocolsin the menu Scan Proto-col. You can select which protocols you want to importand which not from a selection box which opens,allowing you to choose the protocols you want to copyto your Customer Folder. These protocols are then

ready to use for your next examination.


123/461


123

All new protocols, including those you did not choose

to import to the Customer Folderwill also be stored inthe Siemens Folderso that they can be copied later.

All downloaded scan protocols are named "DL_.." sothey can be easily identified when mixed with pre-installed protocols.

Also, see the chapterScan Protocol Manager for moreinformation.


124/461

124


Contact Function

Contacting Siemens via Email is possible directly fromyour scanner and even DICOM images can be attachedto your message. To attach an image, please first selectthe images on your Viewingtask card first and thenexport these images to H:\SiteData\Offline as a Dicomimage.

After exporting the image, open the Siemens Extranetand choose Contact. After entering your message youcan easily attach the image by selecting the imagesfrom the File Browser with the shortcut CTRL and C andpaste it with the shortcut CTRL and V into the Extranet.


125/461


125

Every patient image is made anonymous before send-

ing. Because the SOMATOM LifeNet window is alwaysin the foreground we recommend to restore/minimizeit to be able to switch between both screens, the FileBrowser and the SOMATOM LifeNet window.

Trial Order and Installation

As a SOMATOM CT user you can request trial clinicalsoftware directly from the scanner. The requested soft-ware will be made available and installed automati-cally through our Siemens Remote Services connec-tion.

After you have accessed the SOMATOM LifeNet onlinearea, you can choose system-specific trial softwareunder SOMATOM Expand > Trial Licenses. After click-ing on Order Trialand confirming a license agreementfor trial-use software, you will enter your contact dataand then submit the license request.


126/461


127/461


127

Forwarding information via Email

This service enables those customers who do not havea printing device connected to their CT Scanner, butwould like to have the information provided in SOMA-TOM LifeNet sent to their regular email account or for-warded to a contact person of interest as an email.

Information about current courses and clinical trainingprograms, as well as CT accessories can be sent fromthe scanner to any email account. This information canthen be printed or a quote requested from your localSiemens representative.


128/461

128


Image ConverterThe CT application Common DICOM Adapter can con-vert different DICOM data sets to formats provided byother CT vendors.

You will find the converter in the Applicationsmenu

of the Patient Browser.


129/461


129

In the pop-up window you can select the application

for which you want to convert images.


130/461

130


Split-Up Multi-Phase series

1.Select Split-up series according to trigger delayfrom the section Split-up Heartview 4D series, ifyou intend to split up a series of multi-phase heartreconstructions, according to their different heartphases.

Or2.Select Split-up series according to slice positionto

split up a series according to the different slice posi-tions it contains.

After conversion you can load these data sets into theapplication of your choice.


131/461


131

Report TemplateConfiguration

Under Options > Configurationyou will find theReport Template Configuration.

With the Report Configuration you can edit basic infor-mation, for example, clinic information for your reporttemplates for the applications:

syngo Calcium Scoring


syngoLung CARE CT

Additionally you can insert your logo and select whichreference data you want to use.


132/461

132


File BrowserThe File Browser provides you with a secure means ofaccessing and managing data in a private folder, whichis a well defined part of the computer file system. Thisuser partition is strictly separated from the system

operating file system.

The user partition is shared read only and may be usedfor transferring data from the scanner to other com-puters, for example, transferring DICOM images(export to offline), transferring AVIs, or accessing files(PDF files) which were downloaded via SOMATOM

LifeNet.

Key Features

Copy images and files to the CD Burn folder.

Raw data transfer.

Access to all created reports and movies (AVI files).

Access to the offline folder. Access to downloaded files.

Open the File Browser via main menu itemOptions > File Browser.

The File Browser contains special folders for CT applica-tions. The created reports and movies are saved withinthese folders.

If an external PC is connected you can access youroffline data on the external PC for post-processing.


133/461


133

Raw data transfer:

Raw data sets can be transferred.

First configure the directory to which you want totransfer the raw data:

Open the File Browser.

Choose the desired directory from the navigation

tree to the left of the File Browser. Select the item Set as Export Rootfrom the CT Data

Transferdrop-down menu.

Select the raw data files you want to transfer in thecontent area of the Patient Browser.

From the browser, open the Patientmain menu and

select the item Transfer CT Da

Documents

manua siemes.pdf