Beruflich Dokumente
Kultur Dokumente
Cover Story
Growth of Denition
Family Signals New
Era in CT
Page 6
News
syngo 2008A Automating Routine Workow
Page 14
Clinical
Outcomes
The SOMATOM
Denition AS With the
CT Oncology Engine
Page 28
Science
Adaptive 4D Spiral
a Flexible Solution for
Dynamic Scanning
Page 46
Life
Life Behind the Scenes
Page 55
Editorial
A SOMATOM Definition CT is
much more about delivering
healthcare than delivering
images, its a tool for
managing the whole patient.
Bernd Montag, PhD, President of Computed Tomography,
Siemens Medical Solutions, Forchheim, Germany
Cover Page: Follow-up examination (7 s) of a patient with thoracic carcinoma, scanned with the SOMATOM Denition AS.
The artefact free visualization of detailed tissue structures shows, amongst others, the complete course of the aortic-arch.
Courtesy of Department of Diagnostic Radiology, University of Erlangen-Nuremberg, Erlangen, Germany
Editors Letter
Andr Hartung,
Vice President Marketing and Sales
Dear Reader,
Every hospital, physician and medically
related organization wants to deliver the
best patient care possible. Yet increasingly,
theyre faced with the clear mandate to
shorten hospital stays, reduce time-todiagnosis and trim costs. Additionally,
as innovations develop faster and faster,
patients have become more knowledgeable. They expect and demand more
from healthcare. We asked ourselves
what role CT could and should play
in meeting these difficult demands.
Our conclusion: a paradigm shift in
thinking from what CT has always been
to what it should be in the current
medical environment. We call this The
SOMATOM Definition Era, where we
change CT from almost to always. We
have gone beyond fixed components to
engineering a smart dynamic architecture
for true adaptability. Now you can scan
virtually any patient, even the most
challenging, without compromise. Chest
care, stroke, or polytrauma patients will
need only a single CT scan to determine
next steps. From where to what - we
go beyond grey-scaled images that only
visualize anatomical detail, to seeing
functionality and tissue differentiation
that enable characterization of disease.
From there to everywhere - we go
beyond CT as a stand-alone imaging
procedure to a completely integrated,
digital exam readily available to the
entire clinical team, whenever and
wherever they need it. We began realizing our vision the SOMATOM Definition
Era in 2005 with the SOMATOM Definition, the worlds first Dual Source CT.
We continue today with the introduction
of the SOMATOM Definition AS, the
worlds first Adaptive CT Scanner. Introducing a fundamentally new way to use
single source CT, it intelligently adapts,
on the fly, to virtually every clinical situation, producing more than just clear
images, but also clear solutions to clinical
questions. It is the only CT to adept to
any patient - even the most challenging
pediatric, obese, cardiac or trauma.
The SOMATOM Definition AS actively
manages dose in 100% of all exams. Its
Adaptive Dose Shield dynamically
removes clinically irrelevant dose, in
every exam, for every patient.
With its unique Adaptive 4D Spiral,
SOMATOM Definition AS moves beyond
fixed detector limitations to provide
full coverage of any organ in 4D. In stroke
or tumor assessment, this gives invaluable functional information. And, with its
built-in 3D minimally invasive suite,
SOMATOM Definition AS makes routine
and complex procedures easier.
In our SOMATOM Definition Era, CT
has become more than just a clinically
efficient imaging modality, but a
critical tool to acquire and manage a
complete patient story. Utilizing our
vast experience with classical clinical
Andr Hartung
Content
Content
17
SOMATOM Definition AS
Cover Story
Cover Story
The Definition family of CT scanners
now consists of the original Definition
Dual Source scanner and the new
Definition AS, the worlds first adaptive
scanner. Together they offer an
impressive combination of strength and
flexibility, successfully imaging even
the most challenging patients,
replacing multiple diagnostic tests with
a single CT examination, adding new
information to CT images, and
distributing images and information to
the point of clinical decision-making. In
an interview with SOMATOM Sessions,
four experts discuss how the SOMATOM
Definition AS expands the SOMATOM
Definition Era by adapting to any
patient, for complete dose protection,
for new dimensions and to your space.
News
14 syngo 2008A Automating Routine
Workflow
16 The SOMATOM Spirit Provides new
Options: More Power for Corpulent
Patients
16 Dose Efficiency and Robustness
Business
17
Content
everywhere
24
52
Clinical Outcomes:
Detection of an excentric plaque
CT of sediment cores
Clinical Outcomes
Cardiovascular
20 Assessment of a Coronary Anomaly
and a Huge Myocardial Bridge by
Dual Source CT-Angiography
22 SOMATOM Definition: Ultra low
Dose Cardiac CTA-Sequence
24 Detection of an Excentric Plaque
Causing a Relevant Stenosis of
Proximal Right Coronary Artery
Using Dual Source CT
26 Acute Myocardial Infarction and
Complication of Non-Calcified Plaque
in Left Anterior Descending
Coronary Artery
Oncology
28 The SOMATOM Definition AS With the
CT Oncology Engine Outstanding
Clinical Outcomes From Diagnosis to
Treatment for Everyday Oncology
32 Hide and Seek CT Colonoscopy
Solves the Riddle
34 Follow-up of Pediatric Patient With
Lymphoma Enhanced Diagnostic
Confidence With syngo CT Oncology
36 Quantitative Measurement of Emphysema Using the Automated Lung
Parenchyma Analysis Software of
syngo InSpace
Science
Neurology
38 Dual Energy for Ruling out Sinus
Thrombosis or Cerebral Abscess From
Acute Parenchymal Hemorrhage at
Right Parietal Lobe
40 Multisection CT for Complete Evaluation of Patients With Subarachnoid
Hemorrhage (SAH)
Acute Care
42 Dual Source CT Perfusion Defect
Visualization With Spiral Dual Energy
Scanning
44 Trauma Scan: Active Areas of Contrast
Extravasation Detect Active
Hemorrhage
Life
55 Life Behind the Scenes
57 Free 90 Day Trial Licenses for
Clinical Applications
58 In Step With the Future
58 SOMATOM World Summit 2007
59 Clinical Workshops 2008
60 Virtual CTA Course
60 SOMATOM Sessions Online
61 Clinical Poster Gallery
61 Frequently Asked Questions
62 New CT Customer Information Portal
62 Upcoming Events & Courses
63 Imprint
Cover Story
1
1 CT plays an
Cover Story
SOMATOM Definition AS
Adapts for
New Dimensions
Full coverage of any organ
in 4D. Real-time 3D image
guidance in minimally invasive procedures.
Cover Story
SOMATOM Definition
Faster
Than Every
Beating Heart
It performs reliable cardiac
imaging, independent of heart
rate, with no beta-blockers, no
multi-segment reconstruction,
no exceptions.
Full
Cardiac Detail at
Half the Dose
The heart can be imaged twice
as fast, with the lowest possible
radiation exposure 50% lower
dose in cardiac CT.
One-Stop
Diagnosis
in Acute Care
Accurate triage of chest-pain patients in ten minutes. Easy routine
scanning regardless of size and
condition of patient.
Beyond
Visualization
with Dual Energy
In a single scan, differentiation,
characterization, isolation and
distinguishing the imaged tissue
and material is possible.
Cover Story
2
2 Whole brain
perfusion study
for comprehensive tissue at
risk classification in the entire organ.
Cover Story
3
3A
From Where to
What: the
SOMATOM Definition Era adds vital
information to CT
images and helps
diagnosing not
only where the
disease is located
(Figs. 3A, 4A) but
also characterizing
the disease , e.g.
the chemical composition of kidney
stones with dual
energy (Fig. 3B) or
3D perfusion of a
neck-tumor with
Adaptive 4D Spiral
(Figs. 4B, 4C, 4D).
3B
4A
4C
4B
4D
Cover Story
The new Adaptive Scanner, Denition AS, enables us to address any clinical question in any
situation.
Joseph Schoepf, MD, Department of Radiology,
Medical University of South Carolina, Charleston, USA
11
Cover Story
At the Ludwig-Maximilians-University of
Munich, the Definition Dual Source CT
scanner is fueling a busy cardiac imaging
program. In the last 18 months, more than
500 patients have undergone cardiac studies on the dual source scanner, says Konstantin Nikolaou, MD, associate professor
of radiology, associate chair for clinical operations, and section chief for body CT at
the Grosshadern campus.
Most patients are referred for exclusion of
coronary artery disease, a bread-andbutter application. However, Dual Source
CT is opening up entirely new imaging
opportunities as well, for example, evaluation of patients with atrial fibrillation,
either to determine the cause of the
arrhythmia or to prepare for an electrophysiologic procedure.
Cover Story
13
News
Oncology
syngo CT Oncology is the industrys first
software product to offer fully automated
Lung Disease
Another growth area for clinical software
is evaluation of chronic lung diseases.
1
1 Follow-up of liver
News
Neurology
15
News
Business
Professor Dr. Anders Persson, Director, of the Center for Medical Image Science Visualization (CMIV)
17
Business
3D/4D Images
Anytime and Everywhere
Professor Persson sees good cooperation
with clinicians in the adjacent rooms of the
University Hospital Linkping as an important key to the success of the CMIVs research projects. We listen carefully to
where clinical applications can be improved. In return, we receive feedback from
the clinicians on our efforts, explains Persson. Previously, he discussed radiological
reports, for example, with vascular surgeons at morning case meetings using 2D
images from PACS. In order to plan operations better, surgeons want to see what we
see, and not simply imagine it, explains
Persson. This is now possible anytime
and from anywhere. Using syngo
WebSpace, we can call up 3D CT images
from a standard computer or laptop this
provides us with a completely different
way of working, says Persson enthusiastically.
The easy, password-protected Internet connection to a syngo WebSpace server enab-
Speed is playing
an increasingly
important role
in modern
medical care.
Professor Anders Persson, MD
Business
Virtual Autopsies
Clarify Criminal Cases
Because of its modern equipment, the
CMIV also works on solving criminal cases.
According to Persson, since the centers
founding in 2003, it has performed almost
200 virtual autopsies. In some of the
cases, with our modern imaging capabilities we came up with a cause of death
different than the obvious one, reports
Persson proudly. High-resolution 3D imaging provides fast, precise information on
injuries and fractures. Using syngo
WebSpace, the information is sent just
as quickly to the corresponding police
stations and district attorneys offices.
Professor Persson is very satisfied with
the capabilities that syngo WebSpace and
syngo InSpace4D offer his radiology team
and the clinicians at the university hospital, especially in vascular analysis and the
planning for surgery, as well as in training.
I hope that we will also be able to view
3D/4D images from other applications
at our morning meetings, such as blood
flow and oncology. By keeping a focus
on the big picture, Perssons research and
that of the CMIV do not stop with imaging.
Overview: Center of
Medical Image Science
Visualization (CMIV),
Linkping, Sweden
19
Case 1
Assessment of a Coronary Anomaly and
a Huge Myocardial Bridge With Dual Source
CT-Angiography
By W. Alexander Leber, MD, Konstantin Nikolaou, MD, Christoph Becker, MD,
Department of Clinical Radiology, University Hospital of Munich-Grosshadern, Munich, Germany
HISTORY
A 77-year-old patient was admitted to
the hospital with stable angina during
stress and apical hypokinesia under
dobutamine stress echocardiography.
DIAGNOSIS
Dual Source CT- Angiography delineated
a coronary anomaly with the left coronary artery (LCA) originating from the
ostium of the right coronary artery (RCA).
COMMENTS
The symptoms as well as the stress induced wall motion abnormality are
explained by this large myocardial bridge.
1A
1B
1 Curved multiplanar CT images showing excellent visualization of the course of the left coronary artery (Fig. 1A)
2A
2B
2 Cath Lab view (inverted MIP) allows rule-out of stenotic atherosclerotic lesion.
3A
3B
3 Due to Spiral Dual Energy VRT the course of the LCA can be excellently visualized (Fig. 3A). Ostium hidden in the
EXAMINATION PROTOCOL
Scanner
SOMATOM Definition
Scan area
Cardiac Scan
Rotation time
0.33 s
Scan time
8s
Slice collimation
64 x 0.6 mm
Scan direction
cranio-caudal
Slice width
0.75 mm
Heart rate
60 bpm
Pitch
Tube voltage
100 kV
Temporal resolution
HR Independent 83 ms
Reconstruction increment
0.5 mm
Spatial resolution
0.33 mm
Kernel
B26f
Tube current
287 mAs/rot.
21
Case 2
SOMATOM Definition:
Ultra low Dose Cardiac CTA-Sequence
By Joerg Hausleiter, MD, Franziska Herrmann, MD, Stefan Martinoff, MD, German Heart Center, Munich, Germany
HISTORY
A 66-year-old male patient was presented
to rule-out severe calcification and significant stenosis. The patient had a history
1
1 Rule-out of
signicant
stenosis in all
major vessels at
lowest dose of
1,5 mSv.
DIAGNOSIS
Calcium scoring excluded significant calcifications, with the resulting score
below the age-related 10th percentile.
CT Angiography revealed multiple, very
minor, soft plaques without any hemodynamic relevance (Fig. 13), but did not
reveal any high-grade stenosis.
EXAMINATION PROTOCOL
Scanner
SOMATOM Definition
Scan area
Heart
Scan length
133 mm
Scan time
14 s
Heart rate
50 bpm
Tube voltage
120 kV
Tube current
210 mAs/rot.
COMMENTS
Temporal resolution
Spatial resolution
0.33 mm
Rotation time
0.33 s
Slice collimation
0.6 mm
Slice width
1.2 mm
Reconstruction increment
0.75 mm
CTDIvol
11.96 mGy
Kernel
B20
Contrast
Volume
110 ml
Flow rate
4.5 ml/s
Start delay
7s
Postprocessing
syngo InSpace
23
Case 3
Detection of an Excentric Plaque Causing
a Relevant Stenosis of Proximal Right Coronary
Artery Using Dual Source Computed Tomography
By Johannes Rixe, MD, Andreas Rolf, MD, Guido Conradi, MD, and Thorsten Dill, MD, FESC,
Kerckhoff Heart Center, Department of Cardiology/Cardiovascular Imaging, Bad Nauheim, Germany
HISTORY
A 62-year-old female patient was admitted to hospital with recurrent episodes of
tachycardia. On ECG paroxysmal atrial
fibrillation was documented. Since she
was highly symptomatic with shortness
of breath and chest pain during tachycardia, radiofrequency ablation of atrial
fibrillation was successfully performed.
As there was one episode of tachycardia
with ST-segment depression associated
with chest pain, but coronary artery
disease had been ruled out invasively
two years prior, she was referred for CT
coronary angiography.
1
1 Volume rendering
technique image
(VRT) of the right
coronary artery
(RCA) demonstrating
a relevant stenosis
of the proximal vessel segment.
DIAGNOSIS
The patient was scanned on a Dual
Source CT (DSCT) scanner. Since she was
on continuous beta-blocker medication
no beta-blocker was given, but nitroglycerine was administered sublingually.
During CT scan, mean heart rate was
56 bpm. DSCT coronary angiography
accurately demonstrated an extensive
excentric mixed coronary plaque causing
a subtotal stenosis of the lumen of the
proximal right coronary artery.
Thus, invasive angiography was performed
and the patient received a 3.5 mm bare
metal stent. She was discharged from
hospital, symptom-free, two days later.
2 Maximum intensity
projection (MIP)
of the proximal segment of RCA, demonstrating a mixed
coronary plaque
with signs of atherosclerotic vessel
remodeling.
3
3 The VRT image of
COMMENTS
4
4 The VRT image of
EXAMINATION PROTOCOL
Scanner
SOMATOM Definition
Scan area
Heart
Slice width
0.75 mm
Scan length
124 mm
Pitch
Scan time
11.57 s
Scan direction
Cranio-caudal
Reconstruction increment
Heart rate
57 bpm
CTDIvol
53.72 mGy
Tube voltage
120 kV
Kernel
B26f
Temporal resolution
Contrast
Iopamidole 370
Spatial resolution
0.33 mm
Volume
65 ml
Tube current
400 mAs/rot.
Flow rate
5 ml/s
Rotation time
0.33 s
Start delay
Slice collimation
0.6 mm
Postprocessing
25
Case 4
Acute Myocardial Infarction and Complication of
Non-Calcified Plaque in Left Anterior Descending
Coronary Artery
A. De La Vega, MD*, P. Urdiales, MD**, J. Pereyra, MD**, A. Schroeder, MD*,**
*Department of Radiology, Institute of Imaging, Neuqun, Argentina
**Department of Cardiology, Cardiovascular Institute of South, Cipolletti, Argentina
HISTORY
2 Atherosclerotic
non-calcified
plaque in proximal
segment of left
anterior descending coronary artery with significant stenosis
(arrow).
A 63-years-old female patient with atypical chest pain and suspicions of acute
aortic syndrome arrived at our institution.
The echocardiogram demonstrated abnormal findings in right Valsalva sinus
like intimal tear which was confirmed by
transesophageal echocardiogram. Contrast enhanced MR angiography of the
thoracic aortic artery was performed
without signs of dissection, haematoma,
or intimal tears and was complemented
with cardiac exploration. Hypokinesis of
anterobasal wall was visualized in cine
MR acquisition and acute transmural infarction with no reflow area of the anterior wall was found in late enhancement.
A cardiac CT scan was performed to investigate possible lesion of the left anterior descending coronary artery.
DIAGNOSIS
The root aortic artery and Valsalva sinus
were visualized and clearly determined to
be free of dissection, intramural haematoma, or intimal tears. In addition, threedimensional reconstruction of the heart
coronary arteries was made using the
multi-modality workstation. syngo
InSpace4D and syngo Circulation were
used for anatomic coronary arteries
evaluation as well as morphologic and
functional left ventricular analysis.
The left anterior descending artery showed
atherosclerotic, non-calcified plaque in
the proximal segment with significant
stenosis. The left main coronary artery
and left circumflex coronary artery
showed both vessels free of significant
stenosis and atherosclerotic plaque disease. The right coronary artery was visualized with an atherosclerotic plaque in
proximal segment without significant stenosis. The percutaneous coronary angiography of the left anterior descending
coronary artery shows significant stenosis complicated with intimal dissection
and abnormal blood flow type TIMI II. An
Angioplasty and stent placement (Evolution 3.5 x 18 mm) in the lesion site was
performed to restore blood flow to the left
anterior descending coronary artery.
COMMENTS
In this patient with non-typical chest pain,
the MR angiography was able to eliminate
acute aortic syndrome and, at the same
time, anterobasal transmural infarction
with no-reflow area could be demonstrated.
Using the previously installed SOMATOM
Sensation 64 Multislice CT, we were able
to identify the etiologic cause of anterior
infarction and characterization of responsible atherosclerotic plaque, leading to
endovascular therapeutic resolution.
EXAMINATION PROTOCOL
Scanner
Scan area
heart
Slice width
0.6 mm
Scan length
118.4 mm
Pitch
0.2
0.3 mm
Scan time
14.7 s
Reconstruction increment
Scan direction
cranio-caudal
CTDIvol
59 mGy
Heart rate
65 bpm
Kernel
B40f
Tube voltage
120 kV
Contrast
350 mg/iodine/ml
Temporal resolution
up to 83 ms
Volume
70 ml
4.5 ml/s
Spatial resolution
0.33 mm
Flow rate
Tube current
Start delay
21 s
Rotation time
0.33 s
Postprocessing
syngo Circulation
Slice collimation
0.6 mm
27
Case 5
The SOMATOM Definition AS With the
CT Oncology Engine Outstanding Clinical
Outcomes From Diagnosis to
Treatment for Everyday Oncology
By Cathrin Boehner, MD, Department of Diagnostic Radiology, University of Erlangen-Nuremberg, Erlangen, Germany
Louise McKenna, PhD, MBA, Jan Chudzik and Andreas Blaha, CT Division, Siemens Medical Solutions, Forchheim, Germany
29
1A
1B
1C
1D
1E
1 Target lesion 1 (Fig. 1A, 1B) and lesion 2 (Fig.1C upper images)
HISTORY
syngo CT Oncology was used for followup of target lesions and sequential evaluation revealed significant growth (Fig. 1).
This SW facilitates automated lesion
matching, which is particularly useful in
2 Auto needle detection facilitates accurate path-planning in sagittal, axial and coronal images (top). Original scan images
are seen in the second row. Users can select further images such as topogram and colored VRT images for easy reference
during the procedure. Images are updated in real time and the layout can be changed at the click of a button.
31
Case 6
Hide and Seek CT Colonoscopy
Solves the Riddle
By Rolf Janka, MD, Department of Diagnostic Radiology,
University of Erlangen-Nuremberg, Erlangen, Germany
HISTORY
DIAGNOSIS
The patient was scanned using our standard, low-dose protocol on a SOMATOM
Sensation 64 in both the prone and supine positions. The CT images immediately
revealed the reason behind the difficulties
experienced by the gastroenterologist.
The patient exhibited the anatomical
anomaly, situs inversus, a partial malrotation of the colon where the internal organs are reversed inside the abdominal
cavity and the small bowel is located lateral to the descending colon. If this condition has not been previously identified
in a patient, it is impossible for the gastroenterologist to recognize during an optical procedure.
Using CTC, we were able to demonstrate
the exact size and location of the polyp
(Fig. 1) to the gastroenterological surgeon. The global view together with the
1
1 The 1.66 cm polyp (2b)
2
2 An additional 0.5 cm
COMMENTS
This case clearly demonstrates the clinical
benefit of x-ray vision for difficult anatomical cases. CTC gave us a clear picture
of the entire anatomy and, using syngo
Colonography CT, we were able to confidently guide the surgeons to a successful
clinical outcome.
EXAMINATION PROTOCOL
Scanner
Scan area
Abdomen
Scan length
500 mm
Scan time
9s
Scan direction
cranio-caudal
Tube voltage
120 kV
Tube current
Rotation time
0.5 s
Slice collimation
0.6 mm
Slice width
1.0 mm
Pitch
1.4
Reconstruction increment
0.7 mm
Kernel
B20/ B10
Postprocessing
syngo Colonography CT
33
Case 7
Follow-up of Pediatric Patient With
Lymphoma Enhanced Diagnostic Confidence
With syngo CT Oncology
By Tanja Radkow, MD, and Axel Kuettner, MD, Department of Diagnostic Radiology,
University of Erlangen-Nuremberg, Erlangen, Germany.
HISTORY
DIAGNOSIS
ally, the previous CT images were acquired during expiration, while current
images were acquired during inspiration,
leading to a considerable displacement of
target lymph nodes. This is not an unusual situation, particularly when scanning
young children or other low compliance
patients.
Using syngo CT Oncology, we were able
to register the two exams and automatically propagate all target lesions to the
follow-up exam. Due to the precise registration it was relatively easy to confirm
COMMENTS
Having access to software that supports
routine diagnostic oncology workflow with
automated tools that facilitate precise
alignment, plus calculation of tumor size
and growth, provides increased diagnostic confidence that is particularly appreciated in sensitive pediatric cases like this.
EXAMINATION PROTOCOL
Scanner
Scan area
Thorax Abdomen
Scan length
500 mm
Scan time
11 s
Scan direction
cranio-caudal
Tube voltage
120 kV
Tube current
80 eff. mAs
Rotation time
0.5 s
Slice collimation
0.6 mm
Slice width
1.0 mm
Pitch
1.2
Reconstruction increment
0.8
Kernel
B41f/B70f
Postprocessing
syngo CT Oncology
2 Overall, the total tumor burden has remained constant indicating that there has been no disease progression in
the 19 months since treatment, comparing initial examination (left) with last follow-up.
35
Case 8
Quantitative Measurement of Emphysema
Using the Automated Lung Parenchyma Analysis
Software of syngo InSpace4D
By Florian F. Behrendt, MD*, Rolf W. Gnther, MD*, Marco Das, MD*, Thomas Kraus, MD**
*Department of Diagnostic Radiology, University Hospital, RWTH-Aachen University, Germany
**Department of Occupational Health, University Hospital, RWTH-Aachen University, Germany
HISTORY
A 59-year-old asbestos-exposed, male
patient who underwent MDCT as part of a
lung cancer screening trial was evaluated1.
DIAGNOSIS
The patient showed severe centrilobular
emphysema with architectural destruction.
Further analysis was performed using
syngo InSpace4D with a new automated
lung parenchyma analysis software. After
initial 3D segmentation of the lung, the
program automatically detects the lung
contours and the airways. Then attenuation areas below -950 HU are segmented
as emphysema. This threshold has been
pathologically validated in several studies2,
3, 4
. Total lung volume (TLV) and emphysema volume (EV) were calculated. Furthermore, areas of emphysema were segmented into four clusters with different volumes
(cluster 1: 2 8 l; cluster 2: 865 l; cluster 3: 65 187 l; cluster 4: > 187 l).
Software analysis showed a TLV of 8010 ml
and an EV of 26.2 percent. Analysis of em-
COMMENTS
The automated lung parenchyma analysis
software which is integrated in syngo
InSpace4D allows quick and reliable threedimensional evaluation of emphysema,
including TLV and EV. Furthermore pattern
diagnosis and distribution of emphysema
can be calculated. Regional differences can
be observed and the exact localisation of
the emphysema can be described which
yields potential benefit before volume reduction surgery of the lung and therapy
response control. In a further step, an
analysis of different emphysema cluster,
which result in a so called bulla index (BI)
was performed. This type of analysis is a
new feature compared to previous quantification software (e.g. syngo Pulmo CT)5, 6.
This advanced evaluation of the emphy-
1
1 The software allows
EXAMINATION PROTOCOL
Scanner
SOMATOM
Scan area
chest
Slice collimation
0.75 mm
Scan length
372 mm
Slice width
1 mm
Scan time
16 s
Sensation
Pitch
Scan direction
cranio-caudal
Reconstruction increment
0.7 mm
Kernel
B40
Tube voltage
120 kV
Tube current
63 eff. mAs
Rotation time
0.5 s
Contrast
none
Postprocessing
syngo InSpace4D
Automated Lung
Parenchyma
Analysis Software
2A
2B
2C
2D
the lung. The absolute volume of size 4 clusters (red colored) is 23.2 percent
of the whole lung volume, which indicates a severe emphysema.
References
1 Das M, Muhlenbruch G, Mahnken AH, et al. Asbestos Surveillance Program Aachen (ASPA): Initial
results from baseline screening for lung cancer in
asbestos-exposed high-risk individuals using low-dose
multidetector-row CT. Eur Radiol 2007;17:1193-9.
2 Gevenois PA, de Maertelaer V, De Vuyst P, et al.:
Comparison of computed density and macroscopic
morphometry in pulmonary emphysema. Am J
Respir Crit Care Med 1995;152:653-7.
3 Gevenois PA, De Vuyst P, de Maertelaer V, et al.:
emphysema analysis: comparison of different quantitative evaluations and pulmonary function test.
Chest 2005;128:3212-20.
6 Zaporozhan J, Ley S, Weinheimer O, et al.: Multidetector CT of the chest: influence of dose onto
quantitative evaluation of severe emphysema:
a simulation study. J Comput Assist Tomogr
2006;30:460-8.
37
Case 9
Dual Energy for Ruling out Sinus Thrombosis
or Cerebral Abscess From Acute Parenchymal
Hemorrhage at Right Parietal Lobe
By Dominik Morhard, MD, Thorsten R. Johnson, MD, Prof. Maximilian F. Reiser, MD, and Christoph Becker, MD, PD,
Department of Clinical Radiology, University Hospital of Munich-Grohadern, Munich, Germany
HISTORY
COMMENTS
EXAMINATION PROTOCOL
Scanner
SOMATOM Definition
Scan area
Head
Scan length
180 mm
Scan time
23 s
Scan direction
cranio-caudal
140 kV / 80 kV
Rotation time
0.33 s
Slice collimation
0.6 mm
DIAGNOSIS
Slice width
1 mm
Pitch
0.8
Reconstruction increment
0.75 mm
CTDIvol
29 mGy
Kernel
D31
Contrast
Volume
95 ml
Flow rate
2.4 ml/s
Start delay
180 s
Postprocessing
images shows a solitary, pathological contrast enhancement in the centre of the hemorrhage (arrow).
4 MRI, performed six hours after the DECT, shows a good correlation
39
Case 10
Multisection CT for Complete Evaluation of
Patients With Subarachnoid Hemorrhage (SAH)
By Bernd F. Tomandl, MD, Department of Neuroradiology, Klinikum Bremen, Bremen, Germany
HISTORY
COMMENTS
EXAMINATION PROTOCOL
Scanner
SOMATOM Sensation
Scan area
Scan length
15 cm
Scan time
20 s
Scan direction
Caudo-cranial
Tube voltage
120 kV
Tube current
Rotation time
0.5 s
Slice collimation
4 x 1 mm
Slice width
1.25 mm
Pitch
0.875
Reconstruction increment
0.5 mm
CTDIvol
27.8 mGy
Kernel
B30
FoV
120 mm2
Contrast
Volume
80 ml
Flow rate
4 ml/s
Start delay
Bolus tracking
Postprocessing
1A
1B
1C
1 Small Aneurysm (arrow) of the distal internal carotid artery at the origin of the anterior choroids artery
demonstrated on thin section (15 mm) MIP and volume rendered CTA in comparison to DSA.
2A
2B
3A
3B
41
Case 11
Dual Source CT Perfusion Defect Visualization
With Spiral Dual Energy Scanning
Benot Ghaye, MD and Jean-Franois Monville, MD,
Department of Medical Imaging, University Hospital of Lige, Lige, Belgium
HISTORY
DIAGNOSIS
COMMENTS
In the dual energy mode, two x-ray sources
are operated simultaneously at different
1
1 Excellent visualization of
EXAMINATION PROTOCOL
Scanner
SOMATOM Definition
Scan area
Thorax
Scan length
342mm
Scan time
8s
Scan direction
Caudo-cranial
140 kV / 80 kV
Rotation time
0.5 s
Slice collimation
0.6 mm
1.5 mm
Spatial Resolution
0.33 mm
Increment
0.5 mm
CTDIvol
6.96 mGy
Kernel
D30f
Contrast
Contrast Amount
5 ml/s
Start delay
CARE Bolus
Postprocessing
2
2 A massive pulmonary embolism and
43
Case 12
Trauma Scan: Active Areas of Contrast
Extravasation Detect Active Hemorrhage
By Savvas Nicolaou, MD, Department of Radiology, Vancouver General Hospital, Vancouver, Canada
HISTORY
DIAGNOSIS
1 The initial phase of the study reveals inactive (arrow-head) and active (red arrow)
3 The active hemorrhage was identied because the CT scan made active bleeding (white arrows)
fines of the spleen, areas of greater attenuation were also more clearly recognized.
The regions of increased attenuation
being pathognomonic for areas of active
contrast extravasation clearly indicating
areas of active hemorrhage.
Consequently, the patient was transferred
to the radiological suite, where the pseudoaneurysms and the active areas of hemorrhage were successfully embolized.
COMMENTS
This case is an excellent example of the
clinical utility of the SOMATOM Definition
for trauma scanning. It was the fast and
accurate diagnosis that made it possible to
intervene just as fast and accurately and
successfully treat the hemorrhage.
EXAMINATION PROTOCOL
Scanner
SOMATOM Definition
Scan area
Abdomen
Scan length
400 mm
Scan time
10 s
Scan direction
cranio-caudal
Tube voltage
120 kV
Tube current
Rotation time
0.5 s
Slice collimation
0.6 mm
Slice width
0.6 mm
Pitch
1.2
Reconstruction increment
0.5 mm
CTDIvol
11.5 mGy
Kernel
B20
Contrast
Volume
Flow rate
4 ml/s
Start delay
CARE Bolus
Postprocessing
syngo InSpace4D
45
Science
1A
1B
0s
1E
1,2 s
1F
4,8 s
6,0 s
1 Inow and outow of contrast media into the cerebral vasculature of a pig (courtesy of
Aachen University, Germany). One run of the dynamic spiral was acquired every 1.2 s.
Science
The first ten years after the broad introduction of multi-detector row CT (MDCT)
into clinical practice were characterized
by a race for more slices. 4-slice, 8-slice,
16-slice, 32-slice and 64-slice CT-systems
were introduced in rapid succession. With
the latest generation of 64-slice CT-scanners, the whole body can be examined
with isotropic sub-millimetre resolution
1C
Source CT, as an example, can dramatically improve the temporal resolution of cardiac examinations. Dual energy acquisitions have the potential to expand the
scope of CT beyond the mere depiction of
the patients anatomy towards functional
imaging. Yet another challenge is the visualization of dynamic processes in extended anatomical ranges, e.g. to charac-
1D
2,4 s
1G
3,6 s
1H
7,2 s
8,4 s
47
Science
detector
detector
width
width
scan area
table movement
2 Acquisition principle of the adaptive 4D spiral: time-resolved scanning of areas larger than
Science
49
Science
1A
1B
1C
1D
1 Comparison of standard non-enhanced CT and dual energy virtual non-enhanced CT reconstruction. A 43-year-old female patient with
a history of chronic urinary stone disease. Fig. 1A + B: Standard non-enhanced CT reconstructions at the level of the kidneys show
a staghorn calculus in the right renal pelvis (Fig. 1A: transverse image; Fig. 1B: volume rendered image). Fig. 1C + D: Virtual nonenhanced CT reconstructions from contrast-enhanced. Dual Energy CT similarly demonstrate the right pelvic urinary stone (Fig. 1C:
transverse image; Fig. 1D: volume rendered image).
Science
introduced SOMATOM Definition CT scanner utilizing two x-ray tubes for the acquisition of dual energy data simultaneously2.
The other major problem of initial Dual
Energy CT was the weak power reserve of
the x-ray tube when it was operated with
low voltage: images did not reach an adequate noise level when compared to images that were acquired with high tube
voltages4. Both recent developments in
tube and detector technology and the
above mentioned advantage of dual energy data acquisition is the key to the
clinical application of Dual Source, Dual
Energy CT, i.e. virtual non-enhanced images can be reconstructed from the
nephrographic phase CT data set when
scanned in the dual energy mode. This
technique allows for the diagnosis of urinary stone disease with good sensitivity
and an excellent specificity. Iodine subtraction to generate a virtual non-enhanced CT image is one possible application of Dual Energy CT using the above
described software algorithm from contrast-enhanced CT data. Three false-negative ratings occurred only in obese patients. It is most likely that this finding
represents the general problem of CT imaging in obese patients that goes along
with a higher image noise, and thereby is
responsible for a deterioration of diagnostic accuracy. It appears that standard
non-enhanced CT should be considered in
abdominally obese patients rather than
virtual non-enhanced CT through dual
energy acquisition. Taken together, virtual non-enhanced CT images reconstructed
from contrast-enhanced Dual Energy CT
2A
allows for the accurate detection of urinary stones with a good sensitivity and
excellent specificity, keeping in mind that
sensitivity is reduced in obese patients.
2B
2 A 70-year-old female patient presenting with acute pyelonephritis and left sided ureteral obstruction. CT was performed after nephros-
tomy and pigtail insertion on the left side. Fig. 2A: Standard non-enhanced CT image at the level of the kidneys shows bilateral urinary
stones (arrows). Fig. 2B: Virtual non-enhanced CT image similarly demonstrates the urinary stones on both sides.
51
Science
1 Submersible image of dense colonies of the cold-water coral Lophelia pertusa a 350m waterdepth.
Science
Computed Tomography
Changes in coral preservation, their
three-dimensional arrangement and the
sedimentary structures help unravel the
mound history related to past oceanographic and climatic changes. Their positions can tell, for example, if the coral
colonies are still in their original life positions or were tumbled-over and transported by currents. Previously, an understanding of the third dimension had to be
2A
2 Oceanographic
2B
53
Science
3 Deep-sea sediments and coral mounds grown over thousands of years can be analyzed with gravity cores. One-meter segment of
a sediment core showing glacial moraine deposits with rock fragments in the lower half of the last ice-age, overlaid by cold-water
coral deposits of the present warm-period. Conventional 2D core cut with corals visible as small white cross-sections (left), x-ray slice
showing the pronounced boundary of dense glacial sediments appearing light, and mud with corals above (middle), 3D-rendering
of rock-fragments and corals and their position in the sediment.
4 A SOMATOM Sensation high-resolution, 3D-visualization of corals in the sediment core,
References
1 Freiwald, A., Foss, J.H., Grehan, A., Koslow,
T. & Roberts, J.M. (2004): Cold-water Coral Reefs.
UNEP-WCMC, Cambridge, UK, 84 pp.
2 Roberts, J.M., Wheeler, A.J., Freiwald, A. (2006):
Reefs of the deep: the biology and geology of coldwater coral ecosystems. Science 312: 543547.
This research was supported by HERMES-project,
EC contract no. GOCE-CT-2005-511234
www.cool-corals.de
www.eu-hermes.net
Life
whether they are from Norway; South Africa or New Zealand. We cover everything
from basic training for beginners to training on specific software versions to expert
training on new features like syngo Dual
Energy or Cardiac imaging. We also support
them with e-learning and live web casts to
ensure quickest knowledge distribution.
The goal, of course, is to make sure that all
Applications Specialists worldwide are
thoroughly qualified to train our customers
on the usage of their systems.
55
Life
What are the most important challenges that you encounter in your job?
Well, first, keeping our own knowledge
level up-to-date. In the fast development
cycle we are in, this can sometimes be
challenging. Second, Id say time difference is always an issue, but with e-mail,
most questions can be answered easily.
And third, adapting to different cultures
to make sure that all attendees get the
most out of our training efforts. What really helps is the companionship you can
feel within Siemens its universal.
What was your most interesting
business trip?
This, I can answer right away. I was in
Kutaisi, Georgia in the middle of winter,
and I received my luggage on the last day
of my 5 day visit. It was quite an experience, buying european clothes in Kutaisi!
As a member of the Customer Care
team, how do customers influence
your job?
Most customers dont realize how many
of their ideas and suggestions influence
our organization they are the number
one motivation for our product development. Once these ideas are implemented,
I visit customers to train them on the
latest applications. So, it is really a never
ending cycle.
What do you like most about your job?
Definitely, to work and help people from
all over the world, to influence and guide
future developments, and to travel to
places I would never have the chance to
see otherwise.
Life
syngo CT Oncology
syngo CT Oncology is the very first software designed to enhance diagnostic
outcomes across your entire routine oncology imaging workflow, which covers
60 percent of your daily routine:
Fully automated lesion measurement,
segmentation and follow-up.
Auto-pilot for lung and liver lesions,
plus lymph nodes.
Diagnostic certainty in 3 minutes.**
Experience a new level of speed and
accuracy, improving results for referring
physicians and the level of patient care:
This software gives reliable and consistent information. It virtually eliminates
human error and the variations in measurement that can occur when doing it manually. Eventually, software like this will be
standard for any follow-up of oncology
Schramm, P., et al.: Comparison of CT and CT Angiography Source Images With Diffusion-Weighted Imaging in
Patients With Acute Stroke Within 6 Hours After Onset.
Stroke. 2002;33:2426-2432
Lev, MH, et al.: Utility of Perfusion-Weighted CT Imaging
57
Life
www.siemens.com/
somatomeducate
Free of charge: The complete e-learning package
of this conference is available on DVD.
Life
Workshop Title
Dates
Location
27.29.02.08
Erlangen/Germany
English
15.16.02.08
16.17.05.08
12.13.09.08
Paris/France
English
21.23.04.08
23.25.06.08
Munich/Germany
English
31.01. 01.02.08
17.18.04.08
12.13.06.08
Erlangen/Germany
English
03.05.03.08
03.05.11.08
Mnster/Germany
English
Kuching/Malaysia
English
04.05.04.08
Monte Carlo/Monaco
English
CT-Colonography Workshop
14.15.03.08
Bruessels/Belgium
English
03.04.07.08
Zrich/Switzerland
German
Mnster/Germany
English
Refresher Course
for Multislice CT Scanner
22.24.01.08
04.06.03.08
20.22.05.08
Siemens
Training Center
Erlangen/Germany
English/
German
15.16.02.08
29.30.04.08
19.20.09.08
Berlin/Germany
German
25.26.01.08
11.12.04.08
11.12.07.08
Forchheim/Germany
English
23.25.01.08
Linkping/Sweden
English
Dr. A. Persson
09.10.03.08
Linkping/Sweden
Swedish
Dr. A. Persson
21.22.01.08
Linkping/Sweden
English
Dr. A. Persson
10.12.12.08
Linkping/Sweden
Swedish
Dr. A. Persson
Course dates are subject to change. For latest information please refer to the course selector at www.siemens.com/life-courses
59
Life
www.cardiactraining.com
SOMATOM Sessions
Now Online
It is our great pleasure to introduce the new SOMATOM Sessions
Online. From now on, the latest customer magazin can be read not
only printed but also online. Adapted to our customers specific requirements, the online edition offers such exciting extra features as
the integrated image viewer for modifying zoom, contrast and brightness of clinical images. Additionally, movies can be found, a search
function is available as well as the ability to download specific content.
www.siemens.com/
somatom-sessions
Life
SOMATOM Life:
Clinical Poster
Gallery
Educate welcomes a new building block
in the wide range of continuous learning
programs the Clinical Poster Gallery.
After the successful introduction of the
CT Cardiac Anatomy poster, we are happy to announce two more additions to the
Gallery: CT Neuro Anatomy* and CT
Colonography Spectrum of Diseases*.
Together with Stephan Kloska, MD, from
Muenster University, Muenster, Germany,
Siemens Medical Solutions designed a
poster focusing on anatomy and CT-specific landmarks relevant for CT angiographies of neck and head vessels. Information about a recommended stroke
workflow is also included. The radiology
department of Muenster performs around
5500 neuro examinations per year, providing the faculty with extensive experience in neuroradiology.
www.siemens.com/ct-poster
61
Life
Location
Short Description
Date
Contact
Moscow Healthcare
Moscow, Russia
International exhibition
www.zdravo-expo.ru/en
5 International
Symposium of
Multislice CT
GarmischPartenkirchen,
Germany
Scientific talks
and lectures
www.ct2008.org
Arab Health
Dubai, UAE
www.arabhealthonline.com
Orlando, USA
CME Course
www.hopkinscme.net
ECR
Vienna, Austria
Exhibition and
scientific congress
www.ecr.org
Deutsche
Gesellschaft fr
Kardiologie
Mannheim,
Germany
www.dgk.org
ACC
Chicago, USA
March 29
April 1, 2008
www.acc08.acc.org
ITEM
Yokohama, Japan
Trade fair
www.j-rc.org
ECIO
Florence, Italy
www.ecio2008.org
ESGAR CTC
Workshop
Vigo, Spain
Hands-on workshop
on CT-colonography
www.esgar.org
Deutscher
Rntgenkongress
Berlin, Germany
Exhibition and
scientific congress
April 30
May 3, 2008
www.drg.de
Stanford CME
course and exhibition
radiologycme.
stanford.edu
th
In addition, you can always find the latest CT courses offered by Siemens Medical Solutions at www.siemens.com/SOMATOMEducate
Imprint
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system.
SOMATOM Sessions with a total circulation of 35,000 copies is sent free of charge to Siemens
Computed Tomography customers, qualified physicians and radiology departments throughout
the world. It includes reports in the English language on Computed Tomography: diagnostic and
therapeutic methods and their application as well as results and experience gained with corresponding systems and solutions. It introduces from case to case new principles and procedures
and discusses their clinical potential.
The statements and views of the authors in the individual contributions do not necessarily reflect
the opinion of the publisher.
The information presented in these articles and case reports is for illustration only and is not intended to be relied upon by the reader for instruction as to the practice of medicine. Any health
care practitioner reading this information is reminded that they must use their own learning,
training and expertise in dealing with their individual patients. This material does not substitute
for that duty and is not intended by Siemens Medical Solutions to be used for any purpose in that
regard. The drugs and doses mentioned 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.
Partial reproduction in printed form of individual contributions is permitted, provided the customary bibliographical data such as authors name and title of the contribution as well as year, issue
number and pages of SOMATOM Sessions are named, but the editors request that two copies be
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SOMATOM Sessions
The Difference in Computed Tomography
Issue no. 21 / November 2007
RSNA-Edition
November 25th 30 th, 2007
Cover Story
Growth of Denition
Family Signals New
Era in CT
Page 6
News
syngo 2008A Automating Routine Workow
Page 14
Clinical
Outcomes
The SOMATOM
Denition AS With the
CT Oncology Engine
Page 28
Science
Adaptive 4D Spiral
a Flexible Solution for
Dynamic Scanning
Page 46
Life
Life Behind the Scenes
Page 55
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