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C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 2 Friday, April 8, 2005 9:55 AM The information presented in this Application Guide 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.
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C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 7 Friday, April 8, 2005 9:55 AM Contents • Contrast Medium - The Basics - IV Injection - Bolus Tracking - Test Bolus using CARE Bolus - Test Bolus Application Information • • • • SOMATOM life - General Information - Key Features - Description - Access to Computer Based Training or Manuals on CD ROM - SRS Based Services - Download of Files - Contact incl.
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C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 13 Friday, April 8, 2005 9:55 AM Contents syngo Dynamic Evaluation • • • Prerequisites Workflow - 1. Loading the Images - 2. Inspecting the Input Images - 3. Generation of Parameter Images - 4. Creating a Baseline Image - 5. Evaluation of Region of Interests - 6. Enhancement Curve - 7.
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C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 16 Friday, April 8, 2005 9:55 AM Scan and Reconstruction Concept of Scan Protocols The scan protocols for adult and children are defined according to body regions – Head, Neck, Shoulder, Thorax, Abdomen, Pelvis, Spine, Upper Extremities, Lower Extremities, Specials, and Vascular. The general concept is as follows: All protocols without suffix are standard spiral modes. E.g., “Shoulder” means the spiral mode for the shoulder.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 17 Friday, April 8, 2005 9:55 AM Scan and Reconstruction Scan Set Up Scans can be simply set up by selecting a predefined examination protocol. To repeat any mode, just click the chronicle with the right mouse button for “repeat”. To delete it, select “cut“. Each range name in the chronicle can be easily changed before “load“.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 18 Friday, April 8, 2005 9:55 AM Scan and Reconstruction Scan Modes Sequential Scanning This is an incremental, slice-by-slice imaging mode in which there is no table movement during data acquisition. A minimum interscan delay in between each acquisition is required to move the table to the next slice position. Spiral Scanning Spiral scanning is a continuous volume imaging mode.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 19 Friday, April 8, 2005 9:55 AM Scan and Reconstruction Slice Collimation and Slice Width Slice collimation is the slice thickness resulting from the effect of the tube-side collimator and the adaptive detector array design. In Multislice CT, the Z-coverage per rotation is given by the product of the number of active detector slices and the collimation (e.g., 2 x 1.0 mm). Slice width is the FWHM (full width at half maximum) of the reconstructed image.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 20 Friday, April 8, 2005 9:55 AM Scan and Reconstruction Slice Collimation and Slice Width for Spiral Mode and HR Spiral Mode 1 mm: 1.5 mm: 2.5 mm: 4 mm: 5 mm: 1, 1.25, 2, 3, 5 mm 2, 3, 5, 6 mm 3, 5, 6, 8, 10 mm 5, 6, 8, 10 mm 6, 8, 10 mm Slice Collimation and Slice Width for Sequence Mode and HR Sequence Mode 1.0 mm: 1.5 mm: 2.5 mm: 4.0 mm: 5.0 mm 20 1, 2 mm 1.5, 3 mm 2.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 21 Friday, April 8, 2005 9:55 AM Scan and Reconstruction Increment The increment is the distance between the reconstructed images in the Z direction. When the increment chosen is smaller than the slice thickness, the images are created with an overlap. This technique is useful to reduce partial volume effect, giving you better detail of the anatomy and high quality 2D and 3D post-processing.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 22 Friday, April 8, 2005 9:55 AM Scan and Reconstruction Pitch In single slice CT: Pitch = table movement per rotation/slice collimation E.g.,: slice collimation = 5 mm, table moves 5 mm per rotation, then pitch = 1. With the Siemens Multislice CT, we differentiate between: Feed/Rotation, the table movement per rotation Volume Pitch, table movement per rotation/single slice collimation.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 23 Friday, April 8, 2005 9:55 AM Scan and Reconstruction Window values The Scale of the CT Hounsfield Units is from -1024 to +3071. The displayed window values have to correspond to the anatomical structure. Windowing is used to optimize contrast and brightness of images.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 24 Friday, April 8, 2005 9:55 AM Scan and Reconstruction Kernels There are 3 different types of kernels: “H“ stands for Head, “B“ stands for Body, “C“ stands for ChildHead. The image sharpness is defined by the numbers – the higher the number, the sharper the image; the lower the number, the smoother the image.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 25 Friday, April 8, 2005 9:55 AM Scan and Reconstruction Image Filters There are 3 different filters available: LCE: The Low-contrast enhancement (LCE) filter enhances low-contrast detectability. It reduces the image noise.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 26 Friday, April 8, 2005 9:55 AM Scan and Reconstruction HCE: The High-contrast enhancement (HCE) filter enhances high-contrast detectability. It increases the image sharpness, similar to reconstruction with a sharper kernel.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 27 Friday, April 8, 2005 9:55 AM Scan and Reconstruction Improved Head Imaging An automatic bone correction algorithm has been included in the standard image reconstruction. Using a new iterative technique, typical artifacts arising from the beam-hardening effect, e.g., Hounsfield bar, are minimized without any additional post-processing.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 28 Friday, April 8, 2005 9:55 AM Dose Information CTDI and CTDI W Vol The average dose in the scan plane is best described by the CTDIW for the selected scan parameters. The CTDIW is measured in the dedicated plastic phantoms – 16 cm diameter for head and 32 cm diameter for body (as defined in IEC 60601 –2 – 44).
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 29 Friday, April 8, 2005 9:55 AM Dose Information The CTDIvol value does not provide the entire information of the radiation risk associated with CT examination. For the purpose, the concept of the “Effective Dose“ was introduced by ICRP (International Commission on Radiation Protection). The effective dose is expressed as a weighted sum of the dose applied not only to the organs in the scanned range, but also to the rest of the body.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 30 Friday, April 8, 2005 9:55 AM Dose Information Effective mAs In sequential scanning, the dose (Dseq) applied to the patient is the product of the tube current-time (mAs) and the CTDIw per mAs: Dseq = DCTDIw x mAs In spiral scanning, however, the applied dose (Dspiral) is influenced by the “classical“ mAs (mA x Rot Time) and in addition by the Pitch Factor.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 31 Friday, April 8, 2005 9:55 AM Dose Information For spiral scan protocols, the indicated mAs is the effective mAs per image.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 32 Friday, April 8, 2005 9:55 AM Dose Information CARE Dose CARE Dose is a clinical application package that provides real-time tube current modulation for Spiral and Sequential Scanning. CARE Dose reduces patient dose significantly, especially in the regions of shoulder and pelvis. It decreases tube load, which extends the capacity for volume scanning with thinner slices, larger volumes or Multi-phase studies.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 33 Friday, April 8, 2005 9:55 AM Dose Information High attenuation, high mA Low attenuation, low mA Example of scanning the shoulder region. lateral Object attenuation Modulated tube current rel. units TOP time Principle of CARE Dose tube current adaption. • CARE Dose is pre-selected by default for most standard protocols. It can be switched on/off in the Scan subtask card.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 34 Friday, April 8, 2005 9:55 AM Dose Information • For the average patients examination, CARE Dose does not require any manual changes to the scan protocol. However, the mAs must be adapted manually for obese and pediatric patients. • The mean value of the mAs applied will be lower than what you have selected.
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C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 36 Friday, April 8, 2005 9:55 AM Workflow Information Recon Jobs In the Recon card, you can define up to 3 reconstruction jobs for each range with different parameters, either before or after you acquire the data. When you deselect all chronicle entries, all open recon jobs will be automatically reconstructed after you click on “Recon“.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 37 Friday, April 8, 2005 9:55 AM Workflow Information Examination Job Status You can get an overview of all recon jobs by clicking on the recon task symbol in the status bar or selecting Transfer – Examination Job Status in the main menu of the Patient Browser. The Examination Job Status dialog will appear where all recon jobs (completed, queued and in work) are listed. You can stop, restart and delete each job by clicking the according button.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 38 Friday, April 8, 2005 9:55 AM Workflow Information Auto Load in 3D and Postprocessing Presets You can activate the Auto load in 3D function on the Examination card/Auto Tasking and link it to a recon job. For example, the 2nd recon job with thinner slice width in some of the examination protocols.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 39 Friday, April 8, 2005 9:55 AM Workflow Information How to Create your own Scan Protocols There are two different ways to modify and create your scan protocols: Edit/Save Scan Protocol If you want to modify an existing protocol or create a new one, e.g., you want to have two “AbdomenRoutine-Protocols” with different slice width, we recommend to do this directly on the Examination card.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 40 Friday, April 8, 2005 9:55 AM Workflow Information Hints • You can save your scan protocol at any time of the examination. • It is recommended that you save your own scan protocol with a new name in order to avoid overwriting the default scan protocol. • Do not use special characters. In addition, do not even use any blank spaces. Allowed are all numbers from 0 to 9, all characters from A to Z and a to z and explicitly the _ (underscore).
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 41 Friday, April 8, 2005 9:55 AM Workflow Information • Change one (or more) parameters for all Customer protocols: Select “Edit – Find/Replace”. Open the “Column“ list box and choose the desired parameter. Select a new function of this parameter in the “Function“ list box. Under the button next to the Function entry you can choose special selections, e.g., you can in-/decrease all mAs values by a certain percentage, e.g., 5%. Select “Replace All”.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 42 Friday, April 8, 2005 9:55 AM Workflow Information • Define a protocol as Emergency protocol. Select the desired scan protocol with the right mouse button. Select entry “Set as new emergency protocol”. The selected protocol is marked with a red cross. • Change the structure of the protocol tree. You can sort all Customers protocols as needed. Select the desired protocols, press right mouse button.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 43 Friday, April 8, 2005 9:55 AM Workflow Information Hints • With the Find/Replace function you can easily insert an API command for all protocols as needed. • Also all Auto Tasking actions, e.g., the transfer to configured network nodes can be set within one action. Within the “Function” button you can set your transfer actions depending on the slice width.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 44 Friday, April 8, 2005 9:55 AM Workflow Information Additional Information: 1.System/Run offers the tool “Restore Default Scan Protocols“ which allows you to remove user specific scan protocols and to restore the Siemens default settings. 2.The main menu entry “Edit” offers save/delete Scan Protocols. 3.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 45 Friday, April 8, 2005 9:55 AM Workflow Information Contrast Medium The Basics The administration of intravenous (IV) contrast material during spiral scanning improves the tissue characterization and characterization of lesions, as well as the opacity of vessels. The contrast scan will yield good results only if the acquisition occurs during the optimal phase of enhancement in the region of interest.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 46 Friday, April 8, 2005 9:55 AM Workflow Information Relative Enhancement [HU] Relative Enhancement [HU] Aortic time-enhancement curves after i.v. contrast injection (computer simulation*). All curves are based on the same patient parameters (male, 60-year-old, 75 kg).
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 47 Friday, April 8, 2005 9:55 AM Workflow Information IV Injection* The administration of a contrast medium depends on the indication and on the delay times to be used during the examination. The patients weight and circulatory situation also play a role. In general, no more than 3 ml per kg of body weight for adults and 2 ml per kg of body weight for children should be applied.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 48 Friday, April 8, 2005 9:55 AM Workflow Information Bolus Tracking This is an automatic Bolus Tracking program, which enables triggering of the spiral scanning at the optimal phase of the contrast enhancement. General Hints • This mode can be applied in combination with any spiral scanning protocol. Simply insert “Bolus Tracking” by clicking the right mouse button in the chronicle. This inserts the entire set up including pre-monitoring, i.v.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 49 Friday, April 8, 2005 9:55 AM Workflow Information – Move the monitoring scan line towards the optimal position and release the mouse button, it will be snapped automatically. (Trick: if you move the monitoring scan line away from the optimal position the “snapping” mechanism will be inactive). • Place a ROI in the premonitoring scan on the target area or vessel used for triggering with one left mouse click.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 50 Friday, April 8, 2005 9:55 AM Workflow Information Test Bolus using CARE Bolus You can use the CARE Bolus option as a “Test Bolus“. How to do it 1.Insert a Bolus tracking via the right mouse button submenu prior to the spiral. 2.Insert “contrast“ from the right mouse button context menu prior to the monitoring scans.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 51 Friday, April 8, 2005 9:55 AM Workflow Information Test Bolus This is a low dose sequential protocol without table feed used to calculate the start delay of a spiral scan to ensure optimal enhancement after the contrast medium injection. The Dynamic Evaluation function may be used to generate the time density curve. You can find the “Test Bolus“ scan protocol in the chapter “Specials“. How to do it 1.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 52 Friday, April 8, 2005 9:55 AM Workflow Information 6. Load the images into the Dynamic Evaluation function and determine the time to the peak enhancement. Alternatively, on the image segment, click “select series” with the right mouse button and position an ROI on the first image. This ROI will appear on all images in the Test Bolus series.
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C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 54 Friday, April 8, 2005 9:55 AM Application Information SOMATOM life General Information SOMATOM life @ Your Scanner provides actual news around your scanner, shows you helpful configuration information of your system and enables you to access the Siemens Extranet where you will find further opportunities to enhance your possibilities to use the CT system. To benefit from the Siemens Extranet, a Siemens Remote Service connection is required.
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C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 56 Friday, April 8, 2005 9:55 AM Application Information Description All users: Start SOMATOM life @ Your Scanner by selecting SOMATOM life under "options" in your syngo menu bar and you will find a browser window that allows you to access different information about your hard- and software environment. Under e.g., "System Information" you have information such as software version or scan second counter.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 57 Friday, April 8, 2005 9:55 AM Application Information Access to Computer Based Training or Manuals on CD ROM Start the Computer Based Training to learn more about your software and enhance your clinical knowledge. Note: The syngo Basics Training is pre-installed on your system and can directly be used by selecting SOMATOM Educate.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 58 Friday, April 8, 2005 9:55 AM Application Information SRS Based Services During the start up of your system you will receive actual information in the "Newsticker" and see the expiration date of installed trial software. Note: Siemens will send you a Newsticker whenever there is helpful information for CT users. The trial licenses are valid for 90 days and can only be ordered once. Access the Siemens Extranet by clicking on "Extranet".
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 59 Friday, April 8, 2005 9:55 AM Application Information Download of Files Each download will be performed in the background. If you disconnect your Siemens Extranet session and start to work with the CT scanner, the download will continue until it is completed. Due to bandwidth reasons it is only possible to perform one download at a time. Note: Depending on your connection speed, the download of larger files like e.g.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 60 Friday, April 8, 2005 9:55 AM Application Information Downloaded Scan Protocols are stored in the update folder until installation. To install all downloaded protocols, choose the Scan Protocol Manager via Options/ Configuration and select "Import Scan Protocols" in the menu tab "Scan Protocol". After successful import, all downloaded protocols can be found under the name that is stated in the Extranet in the "Siemens Folder".
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 61 Friday, April 8, 2005 9:55 AM Application Information Note: Every patient image will be made anonymous before sending. Because the SOMATOM life window is always in front, we recommend to restore/ minimize it to be able to switch between both screens, the File Browser and the SOMATOM life window.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 62 Friday, April 8, 2005 9:55 AM Application Information Trial Order and Installation As a SOMATOM CT user you can request trial clinical software directly from the scanner. The requested software will be provided and installed automatically through our Siemens Remote Services connection. After you have accessed the SOMATOM life Extranet, you can choose system specific trial software under SOMATOM Expand.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 63 Friday, April 8, 2005 9:55 AM Application Information At the same time, you are informed that you can expect the trial option to be installed within 8 working days and you will then be informed about the successful installation via the SOMATOM life message window that appears during system start-up.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 64 Friday, April 8, 2005 9:55 AM Application Information Image Converter The CT Application Common DICOM Adapter provides conversion between different DICOM data sets as they may be provided by other CT vendors. – You will find the converter in the Application menu of the Patient Browser. In the pop-up window you can select the application for which you want to convert the images.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 65 Friday, April 8, 2005 9:55 AM Application Information After conversion you can load these data sets into the application of your choice.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 66 Friday, April 8, 2005 9:55 AM Application Information File Browser The File Browser provides the ability to access and to manage your created files: • • • • Copy images and files to the CD Burn folder. Access to all created reports and movies (AVI files). Access to the offline folder. Access to downloaded files. Open the File Browser via the main menu entry "Options – File Browser". The File Browser provides special folders for our Applications.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 67 Friday, April 8, 2005 9:55 AM Application Information Review reports and movies: – Select the desired files and double-click on them. – The corresponding program, e.g., Movie Media Player will be opened and you can review what you have saved. – Now you can send these files to floppy or burn it on CD.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 68 Friday, April 8, 2005 9:55 AM Application Information Patient Protocol Scan: kV: mAs: ref. mAs: TI: cSL: CTDIvol: DLP: number of scan range kilo Volt averaged applied mAs of the range quality ref. mAs of the range Rotation Time collimated Slice CTDIw Pitch Factor For further information please refer to the chapter “Dose Information“.
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C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 71 Friday, April 8, 2005 9:55 AM Head Hints in General • Topogram: Lateral, 256 mm. • Patient positioning: Patient lying in supine position, arms resting against body, secure head well in the head holder, support lower legs. • Gantry tilt is available for both, sequence and spiral scanning. However, image artifacts may occur if spirals are acquired with a tilt angle greater than 8°.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 72 Friday, April 8, 2005 9:55 AM Head HeadRoutine Indications: Spiral mode for routine head studies, e.g., stroke, brain tumors, cranial trauma, cerebral atrophy, hydrocephalus, and inflammation, etc. Two ranges are predefined for the base of the skull and cerebrum. A range for the base of 4 cm will be covered in 23 sec., a range for the cerebrum of 8 cm will be covered in 27 sec.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 73 Friday, April 8, 2005 9:55 AM Head kV Effective mAs Rotation time Slice collimation Slice width Feed/Rotation Pitch Factor Increment Kernel CTDIVol Effective dose Base 130 110 1.5 sec 1.5 mm 3.0 mm 3.0 mm 1.0 3.0 mm H31s 25.05 mGy Male: 0.37 mSv Female: 0.38 mSv Cerebrum 130 110 1.5 sec 2.5 mm 8.0 mm 5.0 mm 1.0 8.0 mm H31s 25.05 mGy Male: 0.70 mSv Female: 0.77 mSv Contrast medium IV injection Volume 50 – 60 ml Flow rate 2 ml/sec.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 74 Friday, April 8, 2005 9:55 AM Head HeadSeq Indications: Sequence mode for routine head studies, e.g., stroke, brain tumors, cranial trauma, cerebral atrophy, hydrocephalus, and inflammation, etc. Two ranges are predefined. One for the base of the skull and one for the cerebrum, the scan length for the entire head is 12.4 mm. For both ranges a typical gantry tilt of -20° is predefined.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 75 Friday, April 8, 2005 9:55 AM Head kV Effective mAs Rotation time Slice collimation Slice width Feed/Scan Kernel CTDIVol Effective dose BaseSeq 130 240 1.5 sec 1.5 mm 3.0 mm 3.0 mm H31s 54.65 mGy Male: 0.77 mSv Female: 0.80 mSv CerebrumSeq 130 240 1.5 sec 4.0 mm 8.0 mm 8.5 mm H31s 51.43 mGy Male: 1.52 mSv Female: 1.68 mSv Contrast medium IV injection Start delay 60 sec. Flow rate 2 ml/sec.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 76 Friday, April 8, 2005 9:55 AM Head InnerEarHR Indications: Spiral mode for inner ear High Resolution studies, e.g., inflammatory changes, tumorous processes of pyramids, cerebellopontine angle tumors, post-traumatic changes, etc. A range of 2.5 cm will be covered in 22 sec. kV Effective mAs Rotation time Slice collimation Slice width Feed/Rotation Pitch Factor Increment Kernel CTDIVol Effective dose 76 InnerEar 2nd reconstr. 130 70 1.5 sec 1.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 77 Friday, April 8, 2005 9:55 AM Head Hints • For image reconstruction of soft tissue, use kernel H31s. • An automatic bone correction allows for improved head image quality, without any additional post-processing. • In order to optimize image quality versus radiation dose, scans are provided within a maximum scan field of 300 mm with respect to the iso-center. No recon job with a field of view exceeding those limits will be possible.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 78 Friday, April 8, 2005 9:55 AM Head InnerEarHRSeq Indications: Sequential mode for inner ear studies, e.g., inflammatory changes, tumorous processes of pyramids, cerebellopontine angle tumors, post-traumatic changes, etc. A typical gantry tilt of -20 degree is predefined. A range of 2.5 cm will be covered. kV Effective mAs Rotation time Slice collimation Slice width Feed/Scan Kernel CTDIVol Effective dose InnerEarSeq 130 140 1.5 sec 1.0 mm 1.0 mm 2.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 79 Friday, April 8, 2005 9:55 AM Head Hints • For image reconstruction of soft tissue, use kernel H31s. • An automatic bone correction allows for improved head image quality, without any additional post-processing. • In order to optimize image quality versus radiation dose, scans are provided within a maximum scan field of 300 mm with respect to the iso-center. No recon job with a field of view exceeding those limits will be possible.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 80 Friday, April 8, 2005 9:55 AM Head Sinus Indications: Spiral mode for paranasal sinuses studies, e.g., sinusitis, mucocele, pneumatization, polyposis, tumor, corrections etc. A range of 7 cm will be covered in 37 sec. kV Effective mAs Rotation time Slice collimation Slice width Feed/Rotation Pitch Factor Increment Kernel CTDIVol Effective dose Sinus 2nd reconstr. 130 60 1.0 sec 1.0 mm 3.0 mm 1.25 mm 2.0 mm 1.0 3.0 mm 0.8 mm H70s H70s 13.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 81 Friday, April 8, 2005 9:55 AM Head Hints • An automatic bone correction and an advanced algorithm allows for improved head image quality, without any additional post-processing. • In order to optimize image quality versus radiation dose, scans are provided within a maximum scan field of 300 mm with respect to the iso-center. No recon job with a field of view exceeding those limits will be possible.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 82 Friday, April 8, 2005 9:55 AM Head SinusSeq Indications: Sequential mode for paranasal sinuses studies, e.g., sinusitis, mucocele, pneumatization, polyposis, tumor, corrections etc. A range of 4.2 cm will be covered. kV Effective mAs Rotation time Slice collimation Slice width Feed/Scan Kernel CTDIVol Effective dose SinusSeq 130 120 1.0 sec 1.5 mm 3.0 mm 3.0 mm H70s 27.32 mGy Male: 0.22 mSv Female: 0.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 83 Friday, April 8, 2005 9:55 AM Head Hints • An automatic bone correction and an advanced algorithm allows for improved head image quality, without any additional post-processing. • In order to optimize image quality versus radiation dose, scans are provided within a maximum scan field of 300 mm with respect to the iso-center. No recon job with a field of view exceeding those limits will be possible.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 84 Friday, April 8, 2005 9:55 AM Head Orbita Indications: Spiral mode for orbital studies, e.g., fracture. A range of 2 cm will be covered in 12 sec. kV Effective mAs Rotation time Slice collimation Slice width Feed/Rotation Pitch Factor Increment Kernel CTDIVol Effective dose Orbita 130 100 1.0 sec 1.0 mm 3.0 mm 2.0 mm 1.0 3.0 mm H70s 22.77 mGy Male: 0.10 mSv Female: 0.11 mSv 2nd reconstr. 1.25 mm 0.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 85 Friday, April 8, 2005 9:55 AM Head Hints • An automatic bone correction and an advanced algorithm allows for improved head image quality, without any additional post-processing. • In order to optimize image quality versus radiation dose, scans are provided within a maximum scan field of 300 mm with respect to the iso-center. No recon job with a field of view exceeding those limits will be possible.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 86 Friday, April 8, 2005 9:55 AM Head Dental This is the scan protocol for the syngo Dental CT application package. It is used for evaluation and reformatting of the upper and lower jaws. It enables the display and measurement of the bone structures of the upper and lower jaw as the basis for planning in oral surgery. Indications: Spiral mode for dental studies. A range of 5 cm will be covered in 27 sec.
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C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 89 Friday, April 8, 2005 9:55 AM Neck Hints in General • Topogram: Lateral, 256 mm • Patient positioning Patient lying in supine position, hyperextend neck slightly, secure head well in head holder. • Patient respiratory instruction: do not breathe, do not swallow. • For contrast studies, CARE Bolus may be used to optimize the bolus timing. • For image reconstruction of bone structures, use kernel B60.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 90 Friday, April 8, 2005 9:55 AM Neck Body Kernels • As standard kernels for body tissue studies B31s or B41s are recommended; softer images are obtained with B20s. • For higher sharpness, as is required e.g., in patient protocols for cervical spine, shoulder, extremities, thorax, the kernels B50s, B60s, B70s are available. • In case of 3D study only, use kernel B20s and at least 50% overlapping for image reconstruction.
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C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 92 Friday, April 8, 2005 9:55 AM Neck Neck Indications: For soft tissue spiral studies in the cervical region, e.g., tumors, lymphoma, abscesses etc. A typical range of 20 cm will be covered in 42 sec. kV Effective mAs Rotation time Slice collimation Slice width Feed/Rotation Pitch Factor Increment Kernel CTDIVol Effective dose Neck 130 70 1.0 sec 2.5 mm 5.0 mm 5.0 mm 1.0 5.0 mm B50s 7.55 mGy Male: 1.79 mSv Female: 1.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 93 Friday, April 8, 2005 9:55 AM Neck Hints • Due to its iodine content, the thyroid gland is hyperdense in relation to the neighboring muscles both before and after an IV CM injection. For displays of the parotid, thyroid or the floor of the mouth, the slice thickness should be < 5 mm and the length of the range should be adapted to match the anatomic region.
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C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 95 Friday, April 8, 2005 9:55 AM Shoulder Hints in General • Topogram: TOP, 256 mm. • Patient positioning: Patient lying in supine position, the uninjured arm placed above the head, the injured arm placed flat against his body. Position side under examination in the center and support the other side with a Bocollo pillow. • If only one side is examined, it is advisable to enter the side examined in the comment line.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 96 Friday, April 8, 2005 9:55 AM Shoulder Shoulder Indications: Spiral mode for bone studies and soft tissue, e.g., evaluation of joint cavities, masses, trauma, dislocations, orthopedic indications etc. A scan range of 10 cm will be covered in 35 sec.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 97 Friday, April 8, 2005 9:55 AM Shoulder kV Effective mAs Rotation time Slice collimation Slice width Feed/Rotation Pitch Factor Increment Kernel CTDIVol Effective dose Shoulder 130 70 1.0 sec 1.5 mm 2nd reconstruction 3.0 mm 3.0 mm 1.0 3.0 mm B60s 7.55 mGy Male: 0.94 mSv Female: 1.13 mSv 2.0 mm 1.5 mm Hints • Use raw data to review a target region if necessary. • For image reconstruction of soft tissue, use kernel B31s and a slice width of 5.
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C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 99 Friday, April 8, 2005 9:55 AM Thorax Hints in General • Topogram: TOP, 512 mm. • Patient positioning: Patient lying in supine position, arms positioned comfortably above the head in the head-arm rest, lower legs supported. • Contrast medium administration: in general, IV injections are employed in all mediastinal examinations, but not in routine high resolution studies of diffuse interstitial lung diseases.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 100 Friday, April 8, 2005 9:55 AM Thorax • Lung images should be documented in both soft tissue window and lung window. • It is also possible to interleave the soft tissue & lung setting images in one film sheet. This can be set up in the configuration for filming. • To further optimize MPR image quality, we recommend that you reduce one or more of the following parameters: collimation, reconstruction increment, and slice width for image reconstruction.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 101 Friday, April 8, 2005 9:55 AM Thorax Body Kernels • As standard kernels for body tissue studies B31s or B41s are recommended; softer images are obtained with B20s. • For higher sharpness, as is required e.g., in patient protocols for cervical spine, shoulder, extremities, thorax, the kernels B50s, B60s, B70s are available.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 102 Friday, April 8, 2005 9:55 AM Thorax ThoraxRoutine/ ThoraxRoutine08s Indications: Routine spiral studies for the region of thorax, e.g., examination of tumors, metastases, lymphoma, lymph nodes, vascular anomalies etc. A range of 30 cm will be covered in 23/18 sec.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 103 Friday, April 8, 2005 9:55 AM Thorax ThorRoutine kV Effective mAs Rotation time Slice collimation Slice width Feed/Rotation Pitch Factor Increment Kernel CTDIVol Effective dose 2nd reconstruction 130 60 0.8/1.0 sec 4.0 mm 5.0 mm 14.4 mm 1.8 5.0 mm B41s 6.47 mGy Male: 3.28 mSv Female: 4.23 mSv 5.0 mm 5.0 mm B70s Contrast medium IV injection Start delay 25 – 30 sec. Flow rate 2.5 ml/sec.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 104 Friday, April 8, 2005 9:55 AM Thorax ThoraxFast Indications: Fast spiral mode for lung studies, e.g., when a patient has difficulty with breathhold. A complete thorax scan in a range of 30 cm will be covered in 14 sec.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 105 Friday, April 8, 2005 9:55 AM Thorax kV Effective mAs Rotation time Slice collimation Slice width Feed/Rotation Pitch Factor Increment Kernel CTDIVol Effective dose ThorFast 130 60 0.8 sec 5.0 mm 8.0 mm 20.0 mm 2.0 8.0 mm B41s 6.47 mGy Male: 3.38 mSv Female: 4.39 mSv 2nd reconstr. 8.0 mm 8.0 mm B70s Contrast medium IV injection Start delay 25 – 30 sec. Flow rate 2.5 ml/sec.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 106 Friday, April 8, 2005 9:55 AM Thorax ThoraxHRSeq Indications: Sequence mode for HiRes lung studies, e.g., interstitial changes in the lungs. Images are acquired with a range of 30.1 cm.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 107 Friday, April 8, 2005 9:55 AM Thorax kV Effective mAs Rotation time Slice collimation Slice width Feed/Scan Kernel CTDIVol Effective dose ThorHRSeq 130 100 1.0 sec 1.0 mm 1.0 mm 10.0 mm U90s 2.16 mGy Male: 1.02 mSv Female: 1.33 mSv Hints • If you want to reconstruct thin slices every 15 or 20 mm instead of 10 mm as predefined, simply change the Feed/Scan before loading the mode.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 108 Friday, April 8, 2005 9:55 AM Thorax LungLowDose Indications: Spiral lung studies with low dose setting, e.g., early visualization of pulmonary nodules. A typical thorax study in a range of 30 cm will be covered in 32 sec.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 109 Friday, April 8, 2005 9:55 AM Thorax kV Effective mAs Rotation time Slice collimation Slice width Feed/Rotation Pitch Factor Increment Kernel CTDIVol Effective dose LungLowDose 130 30 1.0 sec 5.0 mm 8.0 mm 10.0 mm 1.0 8.0 mm B70s 3.23 mGy Male: 1.69 mSv Female: 2.08 mSv Contrast medium IV injection Start delay 30 sec. Flow rate 2.5 ml/sec.
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C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 111 Friday, April 8, 2005 9:55 AM Abdomen Hints in General • Topogram: TOP, 512. • Patient positioning: Patient lying in supine position, arms positioned comfortably above the head in the head-arm rest, lower legs supported. • Patient respiratory instruction: Inspiration. • Oral administration of contrast medium: For abdominal studies, it is necessary to delineate the bowel from other structures such as lymph nodes, abdominal masses & abscesses.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 112 Friday, April 8, 2005 9:55 AM Abdomen • In general, for abdominal studies such as liver, gall bladder (query stones), pancreas, gastrointestinal studies, focal lesion of the kidneys and CTA studies, it is sufficient to use just water. Water is more effective than positive oral contrast agent in depicting the linings of the stomach & intestines in post enhancement studies.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 113 Friday, April 8, 2005 9:55 AM Abdomen Body Kernels • As standard kernels for body tissue studies B31s or B41s are recommended; softer images are obtained with B20s. • For higher sharpness, as is required e.g., in patient protocols for cervical spine, shoulder, extremities, thorax, lung, the kernels B50s, B60s, B70s are available.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 114 Friday, April 8, 2005 9:55 AM Abdomen AbdomenRoutine/ AbdomenRoutine08s Indications: Spiral mode for all routine studies in the region of abdomen, e.g., evaluation, follow-up examinations etc. A typical abdomen scan in a range of 20 cm will be covered in 16/13 sec.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 115 Friday, April 8, 2005 9:55 AM Abdomen kV Effective mAs Rotation time Slice collimation Slice width Feed/Rotation Pitch Factor Increment Kernel CTDIVol Effective dose AbdRoutine 130 60 0.8/1.0 sec 4.0 mm 5.0 mm 14.4 mm 1.8 5.0 mm B41s 6.47 mGy Male: 2.61 mSv Female: 3.32 mSv Contrast medium IV injection Start delay 50 – 60 sec. Flow rate 1.0 – 2.0 ml/sec.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 116 Friday, April 8, 2005 9:55 AM Abdomen AbdomenFast Indications: Fast spiral mode for abdominal studies, e.g., when a patient has difficulty with holding their breath. A range of 20 cm will be covered in 9.6 sec.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 117 Friday, April 8, 2005 9:55 AM Abdomen kV Effective mAs Rotation time Slice collimation Slice width Feed/Rotation Pitch Factor Increment Kernel CTDIVol Effective dose AbdFast 130 60 0.8 sec 5.0 mm 8.0 mm 20.0 mm 2.0 8.0 mm B41s 6.47 mGy Male: 2.59 mSv Female: 3.29 mSv Contrast medium IV injection Start delay 25 – 30 sec. Flow rate 2.5 ml/sec.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 118 Friday, April 8, 2005 9:55 AM Abdomen AbdMultiPhase/ AbdMultiPhase08s Indications: Spiral scan to assist the physician with differential diagnosis of liver diseases. A typical native range of 20 cm will be covered in 15 sec.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 119 Friday, April 8, 2005 9:55 AM Abdomen kV Effective mAs Rotation time Non Contrast 130 80 1.0 sec Slice collimation Slice width Feed/Rotation 5.0 mm Pitch Factor Increment Kernel CTDIVol Effective dose 1.5 8.0 mm B41s 8.62 mGy Male: 3.34 mSv Female: 4.19 mSv 8.0 mm 15.0 mm Arterial Phase 130 80 0.8/1.0 sec 5.0 mm Venous Phase 130 80 1.0 sec 6.0 mm 14.0/ 15.0 mm 1.4/1.5 6.0 mm B41s 8.62 mGy Male: 3.34 mSv Female: 4.19 mSv 6.0 mm 15.0 mm 5.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 120 Friday, April 8, 2005 9:55 AM Abdomen Hints • Do not administer oral contrast medium, as this impairs the editing of MIP/SSD/VRT images. Use water instead if necessary. • Water, rather than positive oral contrast agents should be used. Give the last cup of 200 ml just prior to positioning the patient. To ensure adequate filling of the duodenal loop, lay the patient on the right side for 5 minutes before performing the topogram.
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C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 122 Friday, April 8, 2005 9:55 AM Abdomen AbdomenSeq Indications: Sequential mode for all routine studies in the region of abdomen, e.g., evaluation, follow-up examinations etc. The whole scan length covers 15.2 cm. kV Effective mAs Rotation time Slice collimation Slice width Feed/Scan Kernel CTDIVol Effective dose AbdSeq 130 70 1.0 sec 4.0 mm 8.0 mm 8.0 mm B41s 7.55 mGy Male: 2.35 mSv Female: 2.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 123 Friday, April 8, 2005 9:55 AM Abdomen Hints • You could repeat the same protocol by simply clicking the chronicle with the right mouse button for “repeat“, e.g., when both non-contrast and contrast studies are required. • Water, rather than positive oral contrast agents should be used. Give the last cup 200 ml just prior positioning the patient.
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C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 125 Friday, April 8, 2005 9:55 AM Pelvis Hints in General • Topogram: TOP, 512 mm for pelvis studies and 256 mm for studies of the hip and SI Joints. • Patient positioning: Patient lying in supine position, arms positioned comfortably above the head in the head-arm rest, lower legs supported. • A breathing command is not necessarily required for the pelvic examination, since respiration does not negatively influence this region.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 126 Friday, April 8, 2005 9:55 AM Pelvis Pelvis Indications: Spiral mode for routine pelvis studies, e.g., processes of the prostate, urinary bladder, rectum, gynecological indications etc. A typical range of 20 cm will be covered in 12 sec.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 127 Friday, April 8, 2005 9:55 AM Pelvis kV Effective mAs Rotation time Slice collimation Slice width Feed/Rotation Pitch Factor Increment Kernel CTDIVol Effective dose Pelvis 130 80 1.0 sec 5.0 mm 8.0 mm 20.0 mm 2.0 8.0 mm B41s 8.62 mGy Male: 3.24 mSv Female: 5.51 mSv Contrast medium IV injection Start delay 50 sec.* Flow rate 2.0 – 3.0 ml/sec.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 128 Friday, April 8, 2005 9:55 AM Pelvis Hip Indications: Spiral mode for HiRes bone studies and soft tissue studies of the Hip, e.g., evaluation of joint cavity, masses, trauma, dysplasia, necrosis of the head of the hip, congruence evaluations, orthopedic indications etc. A typical range of 10 cm will be covered in 35 sec.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 129 Friday, April 8, 2005 9:55 AM Pelvis kV Effective mAs Rotation time Slice collimation Slice width Feed/Rotation Pitch Factor Increment Kernel CTDIVol Effective dose Hip 130 70 1.0 sec 1.5 mm 3.0 mm 3.0 mm 1.0 3.0 mm B70s 7.55 mGy Male: 1.78 mSv Female: 1.66 mSv 2nd reconstr. 2.0 mm 1.5 mm B70s Hints • In case of 3D study only, images should be reconstructed with at least 50% overlap in image reconstruction and kernel B20s.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 130 Friday, April 8, 2005 9:55 AM Pelvis SI_Joints Indications: Spiral mode for bone studies of the sacroiliac joints. A typical range of 8 cm will be covered in 18 sec. kV Effective mAs Rotation time Slice collimation Slice width Feed/Rotation Pitch Factor Increment Kernel CTDIVol Effective dose 130 SI_Joints 130 80 1.0 sec 2.5 mm 2nd reconstruction 3.0 mm 5.0 mm 1.0 3.0 mm B70s 8.62 mGy Male: 1.44 mSv Female: 1.93 mSv 3.0 mm 2.
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C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 133 Friday, April 8, 2005 9:55 AM Spine Hints in General • Topogram: Lateral, 512 mm for thoracic and lumbar spine and 256 mm for the C-spine. • Patient positioning for thoracic and lumbar spine studies: Patient lying in supine position, arms positioned comfortably above the head in the head-arm rest, lower legs supported.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 134 Friday, April 8, 2005 9:55 AM Spine • The CT scan following myelography must be performed within 4 – 6 hours of the injection, otherwise, the contrast density in the spinal canal will be too high to obtain artifact-free images. Also, if possible, it is a good idea to roll the patient once, or scan in a prone position. This will prevent the contrast from pooling posterior to the spinal cord.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 135 Friday, April 8, 2005 9:55 AM Spine Body Kernels • As standard kernels for body tissue studies B31s or B41s are recommended; softer images are obtained with B20s. • For higher sharpness, as is required e.g., in patient protocols for cervical spine, shoulder, extremities, thorax, lung, the kernels B50s, B60s, B70s are available.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 136 Friday, April 8, 2005 9:55 AM Spine C-Spine Indications: Spiral mode for cervical spine studies, e.g., prolapse, degenerative changes, trauma, tumors etc. A range of 15 cm will be covered in 52 sec.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 137 Friday, April 8, 2005 9:55 AM Spine kV Effective mAs Rotation time Slice collimation Slice width Feed/Rotation Pitch Factor Increment Kernel CTDIVol Effective dose C-Spine 130 90 1.0 sec 1.5 mm 3.0 mm 3.0 mm 1.0 3.0 mm B50s 9.70 mGy Male: 2.02 mSv Female: 2.07 mSv 2nd reconstr. 2.0 mm 1.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 138 Friday, April 8, 2005 9:55 AM Spine C-SpineSeq Indications: Sequential mode for cervical spine studies, e.g., prolapse, degenerative changes, trauma, tumors, etc. with a typical length for each range of 1.2 cm. This protocol contains five ranges: C2-C3, C3-C4, C4-C5, C5-C6, C6-C7 kV Effective mAs Rotation time Slice collimation Slice width Feed/Scan Kernel CTDIVol Effective dose 138 C2-3 130 170 1.5 sec 1.0 mm C3-4 130 170 1.5 sec 1.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 139 Friday, April 8, 2005 9:55 AM Spine kV Effective mAs Rotation time Slice collimation Slice width Feed/Scan Kernel CTDIVol Effective dose C5-6 130 170 1.5 sec 1.0 mm 2.0 mm 2.0 mm B50s 18.33 mGy Male: 0.66 mSv Female: 0.73 mSv C6-7 130 190 1.5 sec 1.0 mm 2.0 mm 2.0 mm B50s 20.48 mGy Male: 0.30 mSv Female: 0.50 mSv Hints • Dental artifacts can be reduced by tilting the gantry.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 140 Friday, April 8, 2005 9:55 AM Spine Spine Indications: Spiral mode for thoracic and lumbar spine studies, e.g., prolapse, degenerative changes, trauma, tumors etc. A range of 15 cm will be covered in 48 sec.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 141 Friday, April 8, 2005 9:55 AM Spine Spine kV Effective mAs Rotation time Slice collimation Slice width Feed/Rotation Pitch Factor Increment Kernel CTDIVol Effective dose 2nd reconstruction 130 120 1.5 sec 2.5 mm 3.0 mm 5.0 mm 1.0 3.0 mm B31s 12.94 mGy Male: 2.94 mSv Female: 6.75 mSv 3.0 mm 2.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 142 Friday, April 8, 2005 9:55 AM Spine SpineSeq Indications: Sequence mode for spine studies, e.g., prolapse, degenerative changes, trauma, tumors etc. with a typical length for each range of 1.5 cm.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 143 Friday, April 8, 2005 9:55 AM Spine kV Effective mAs Rotation time Slice collimation Slice width Feed/Scan Kernel CTDIVol Effective dose L3-4 130 220 1.5 sec 1.5 mm L4-5 130 220 1.5 sec 1.5 mm L5-S1 130 235 1.5 sec 1.5 mm 3.0 mm 3.0 mm B31s 23.72 mGy Male: 0.58 mSv Female: 0.92 mSv 3.0 mm 3.0 mm B31s 23.72 mGy Male: 0.63 mSv Female: 1.21 mSv 3.0 mm 3.0 mm B31s 25.33 mGy Male: 0.64 mSv Female: 2.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 144 Friday, April 8, 2005 9:55 AM Spine Osteo This is the scan protocol for the syngo Osteo CT application package to assist the Physician with the quantitative assessment of vertebral bone mineral density (BMD) in the diagnosis and follow-up of osteopenia and osteoporosis. kV Effective mAs Rotation time Slice collimation Slice width Feed/Scan Kernel CTDIVol Effective dose Osteo 80 81 1.0 sec 5.0 mm Osteo 80 81 1.0 sec 5.0 mm Osteo 80 81 1.0 sec 5.
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C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 147 Friday, April 8, 2005 9:55 AM Upper Extremities Hints in General • Topogram: TOP, 256 mm for joint studies. • Patient positioning: Depends on the region of examination. In general, for bilateral studies, you should always try to position the patient symmetrical whenever the patient can comply. For wrists and elbow scans: Patient lying in prone position, hands stretched above the head and lying flat on a Bocollo pillow, ankles supported with a pad.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 148 Friday, April 8, 2005 9:55 AM Upper Extremities Body Kernels • As standard kernels for body tissue studies B31s or B41s is recommended; softer images are obtained with B20s. • For higher sharpness, as is required e.g., in patient protocols for cervical spine, shoulder, extremities, thorax, lung, the kernels B50s, B60s, B70s are available.
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C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 150 Friday, April 8, 2005 9:55 AM Upper Extremities WristHR Indications: Spiral mode for HiRes bone study of the wrist, e.g., trauma, orthopedic indications etc. A range of 6 cm will be covered in 32 sec.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 151 Friday, April 8, 2005 9:55 AM Upper Extremities WristHR kV 130 Effective mAs 30 Rotation time 1.0 sec Slice collimation 1.0 mm Slice width 2.0 mm Feed/Rotation 2.0 mm Pitch Factor 1.0 Increment 2.0 mm Kernel U90s CTDIVol 3.23 mGy Effective dose Male: < 0.01 mSv Female: < 0.01 mSv 2nd reconstruction 1.25 mm 0.8 mm U90s Hint • For image reconstruction of soft tissue, use kernel B31s.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 152 Friday, April 8, 2005 9:55 AM Upper Extremities ExtrRoutineHR Indications: Spiral mode for HiRes bone study, e.g., trauma, orthopedic indications etc. A range of 10 cm will be covered in 52 sec. kV Effective mAs Rotation time Slice collimation Slice width Feed/Rotation Pitch Factor Increment Kernel CTDIVol Effective dose ExtrHR 130 30 1.0 sec 1.0 mm 2nd reconstruction 2.0 mm 2.0 mm 1.0 2.0 mm U90s 3.23 mGy Male: < 0.01 mSv Female: < 0.01 mSv 1.
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C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 155 Friday, April 8, 2005 9:55 AM Lower Extremities Hints in General • Topogram: TOP, 256 mm for joint studies. • Patient positioning: Depends on the region of examination. In general, for bilateral studies, you should always try to position the patient symmetrical whenever the patient can comply. • For knee scan: Patient lying in supine position, feet first, promote relaxation by placing Bocollo pillows between knees and feet, bind feet together.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 156 Friday, April 8, 2005 9:55 AM Lower Extremities Body Kernels • As standard kernels for body tissue studies B31s or B41s is recommended; softer images are obtained with B20s. • For higher sharpness, as is required e.g., in patient protocols for cervical spine, shoulder, extremities, thorax, lung, the kernels B50s, B60s, B70s are available. • In case of 3D study only, the mAs value can be reduced by 50%.
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C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 158 Friday, April 8, 2005 9:55 AM Lower Extremities KneeHR Indications: Spiral mode for high resolution studies of the knee, e.g., masses, trauma, disorders of the joint etc. A range of 10 cm will be covered in 52 sec.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 159 Friday, April 8, 2005 9:55 AM Lower Extremities kV Effective mAs Rotation time Slice collimation Slice width Feed/Rotation Pitch Factor Increment Kernel CTDIVol Effective dose KneeHR 130 35 1.0 sec 1.0 mm 2nd reconstruction 3.0 mm 2.0 mm 1.0 3.0 mm U90s 3.77 mGy Male: 0.01 mSv Female: 0.01 mSv 1.25 mm 0.8 mm U90s Hint • For image reconstruction of soft tissue, use kernel B31s.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 160 Friday, April 8, 2005 9:55 AM Lower Extremities FootHR Indications: Spiral mode for high resolution studies of the foot, e.g., masses, trauma, disorders of the joint etc. A range of 10 cm will be covered in 52 sec. kV Effective mAs Rotation time Slice collimation Slice width Feed/Rotation Pitch Factor Increment Kernel CTDIVol Effective dose FootHR 2nd reconstruction 130 30 1.0 sec 1.0 mm 3.0 mm 1.25 mm 2.0 mm 1.0 3.0 mm 0.8 mm U90s U90s 3.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 161 Friday, April 8, 2005 9:55 AM Lower Extremities ExtrRoutineHR Indications: Spiral mode for HiRes bone study, e.g., trauma, orthopedic indications etc. A range of 10 cm will be covered in 52 sec. kV Effective mAs Rotation time Slice collimation Slice width Feed/Rotation Pitch Factor Increment Kernel CTDIVol Effective dose ExtrHR 2nd reconstruction 130 30 1.0 sec 1.0 mm 2.0 mm 1.25 mm 2.0 mm 1.0 2.0 mm 0.8 mm U90s U90s 3.23 mGy Male: 0.
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C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 163 Friday, April 8, 2005 9:55 AM Vascular Hints in General • Topogram: TOP, 512/1024 or LAT 256 • Patient positioning: Patient lying in supine position, arms positioned comfortably above the head in the head-arm rest, lower legs supported. • Patient respiratory instructions: inspiration. • Oral administration of contrast medium: The use of water will not obscure the blood vessels, thus allowing CTA post-processing to be performed easily afterwards.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 164 Friday, April 8, 2005 9:55 AM Vascular HeadAngio/HeadAngio08s Indications: Spiral mode for cerebral CT Angios, e.g., cerebral vascular abnormalities, tumors and follow-up studies etc. A range of 6 cm will be covered in 32/26 sec. kV Effective mAs Rotation time Slice collimation Slice width Feed/Rotation Pitch Factor Increment Kernel CTDIVol Effective dose 164 HeadAngio 130 50 0.8/1.0 sec 1.0 mm 2nd reconstruction 3.0 mm 1.25 mm 2.0 mm 1.0 3.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 165 Friday, April 8, 2005 9:55 AM Vascular Contrast medium IV injection Start delay 18 sec. Flow rate 3.5 ml/sec. Total amount 75 ml Hints • Use of CARE Bolus with monitoring scans positioned at the level of the basilar artery or carotid artery. Set the trigger threshold at 120 HU, or use manual triggering. • An automatic bone correction and an advanced algorithm allow for improved head image quality, without any additional post-processing.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 166 Friday, April 8, 2005 9:55 AM Vascular CarotidAngio/CarotidAngio08s Indications: Noninvasive CT angiography of carotid stenosis or occlusions, plaques course abnormalities of the carotids and vertebral arteries, etc. A range of 12 cm will be covered in 32/26 sec. kV Effective mAs Rotation time Slice collimation Slice width Feed/Rotation Pitch Factor Increment Kernel CTDIVol Effective dose 166 CarotidAngio 130 55 0.8/1.0 sec 1.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 167 Friday, April 8, 2005 9:55 AM Vascular Contrast medium IV injection Start delay 15 sec. Flow rate 4 ml/sec. Total amount 90 ml Hints • CARE Bolus may be used to optimize the bolus timing. • Set the ROI for monitoring scan in the aortic arch with triggering threshold of 120 HU, or use manual triggering. • High quality 2D & 3D post-processing can be achieved using a thin slice thickness and 50% overlap in image reconstruction.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 168 Friday, April 8, 2005 9:55 AM Vascular ThorAngio/ThorAngio08s Indications: Spiral study for location and extent of aneurysms, dissection, and ruptures of the thoriac aorta. A range of 20 cm will be covered in 24/19 sec. ThorAngio 2nd reconstruction kV 130 Effective mAs 55 Rotation time 0.8/1.0 sec Slice collimation 2.5 mm Slice width 5.0 mm 3.0 mm Feed/Rotation 9.0 mm Pitch Factor 1.8 Increment 5.0 mm 2.0 mm Kernel B31s B31s CTDIVol 5.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 169 Friday, April 8, 2005 9:55 AM Vascular Contrast medium IV injection Start delay 10 – 25 sec. Flow rate 2.5 ml/sec. Total amount 80 ml Hints • CARE Bolus may be used to optimize the bolus timing. • Set the ROI for monitoring scan in the aortic arch with triggering threshold of 120 HU, or use manual triggering. • High quality 2D & 3D post-processing can be achieved using a thin slice thickness and 50% overlap in image reconstruction.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 170 Friday, April 8, 2005 9:55 AM Vascular Embolism Indications: Spiral mode for Pulmonary Emboli studies. A range of 15 cm will be covered in 24 sec. Embolism 2nd reconstruction kV 130 Effective mAs 55 Rotation time 0.8 sec Slice collimation 1.5 mm Slice width 3.0 mm 2.0 mm Feed/Rotation 5.4 mm Pitch Factor 1.8 Increment 3.0 mm 1.5 mm Kernel B31s B31s CTDIVol 5.93 mGy Effective dose Male: 1.56 mSv Female: 2.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 171 Friday, April 8, 2005 9:55 AM Vascular Contrast medium IV injection Start delay 6 – 10 sec. Flow rate 4 ml/sec. Total amount 80 – 100 ml Hints • CARE Bolus may be used to optimize the bolus timing. • Set the ROI for monitoring scan in the pulmonary trunk with triggering threshold of 120 HU, or use manual triggering. • You could repeat the same protocol by simply clicking the chronicle with the right mouse button for "repeat".
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 172 Friday, April 8, 2005 9:55 AM Vascular BodyAngioRoutine/ BodyAngioRoutine08s Indications: Spiral mode for abdominal CTA studies. A range of 20 cm will be covered in 39/31 sec. . kV Effective mAs Rotation time Slice collimation Slice width Feed/Rotation Pitch Factor Increment Kernel CTDIVol Effective dose 172 BodyAngio 130 55 0.8/1.0 sec 1.5 mm 2nd reconstruction 5.0 mm 3.0 mm 5.4 mm 1.8 5.0 mm 2.0 mm B31s B31s 5.93 mGy Male: 2.17 mSv Female: 2.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 173 Friday, April 8, 2005 9:55 AM Vascular Contrast medium IV injection Start delay 20 – 25 sec. Flow rate 3.0 – 3.5 ml/sec. Total amount 100 – 120 ml Hints • CARE Bolus may be used to optimize the bolus timing. • Set the ROI for monitoring scan in the abdominal aorta with triggering threshold of 120 HU, or use manual triggering. • Do not administer oral contrast medium, as this impairs the editing of MIP/SSD/VRT images. • Use water as oral contrast.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 174 Friday, April 8, 2005 9:55 AM Vascular BodyAngioFast Indications: Spiral mode for longer coverage and larger vessels. A range of 20 cm will be covered in 18 sec. BodyAngio kV Effective mAs Rotation time Slice collimation Slice width Feed/Rotation Pitch Factor Increment Kernel CTDIVol Effective dose 174 2nd reconstruction 130 55 0.8 sec 2.5 mm 5.0 mm 3.0 mm 10.0 mm 2.0 5.0 mm 2.0 mm B31s B31s 5.93 mGy Male: 2.23 mSv Female: 2.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 175 Friday, April 8, 2005 9:55 AM Vascular Contrast medium IV injection Start delay 20 sec. Flow rate 3.5 ml/sec. Total amount 120 ml Hints • CARE Bolus may be used to optimize the bolus timing. • Set the ROI for monitoring scan in the abdominal aorta with triggering threshold of 120 HU, or use manual triggering. • Do not administer oral contrast medium, as this impairs the editing of MIP/SSD/VRT images. • Use water as oral contrast.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 176 Friday, April 8, 2005 9:55 AM Specials Overview The examination protocols designed for some of these applications are under the “Special” folder. Trauma In any trauma situation, time means life and the quality of life for the survivor. In order to facilitate the examinations, two protocols are provided. – PolyTrauma: This is a combined mode for the examination of multiple ranges, e.g.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 177 Friday, April 8, 2005 9:55 AM Specials Trauma In any trauma situation, time means life and the quality of life for the survivor. This is a combined mode for the examination of multiple ranges, e.g., Head, Neck, Thorax, Abdomen and Pelvis.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 178 Friday, April 8, 2005 9:55 AM Specials PolyTrauma Two times 2 combined recon jobs are predefined, head with neck and thorax with abdomen. A range for the Head of 11 cm will be covered in 20 sec., a range for the Neck of 14 cm will be covered in 30 sec. kV Effective mAs Rotation time Slice collimation Slice width Feed/Rotation Pitch Factor Increment Kernel CTDIVol Effective dose Head 130 110 1.5 sec 5.0 mm 6.0 mm 10.0 mm 1.0 6.0 mm H31s 25.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 179 Friday, April 8, 2005 9:55 AM Specials A range for the Thorax of 25 cm will be covered in 15 sec., a range for the AbdPelvis of 20 cm will be covered in 12 sec. kV Effective mAs Rotation time Slice collimation Slice width Feed/Rotation Pitch Factor Increment Kernel CTDIVol Effective dose Thorax 130 40 1.0 sec 5.0 mm 8.0 mm 20.0 mm 2.0 8.0 mm B41s 4.31 mGy Male: 1.82 mSv Female: 2.45 mSv AbdPelvis 130 60 1.0 sec 5.0 mm 8.0 mm 20.0 mm 2.0 8.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 180 Friday, April 8, 2005 9:55 AM Specials HeadTrauma A spiral mode for emergency head studies with a max. FoV of 500 mm. A typical scan range of 40/80 cm will be covered in 23/27 sec. kV Effective mAs Rotation time Slice collimation Slice width Feed/Rotation Pitch Factor Increment Kernel CTDIVol Effective dose 180 Base 130 110 1.5 sec 1.5 mm 3.0 mm 3.0 mm 1.0 3.0 mm H31s 25.05 mGy Male: 0.37 mSv Female: 0.51 mSv Cerebrum 130 110 1.0 sec 2.5 mm 8.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 181 Friday, April 8, 2005 9:55 AM Specials Interventional CT To facilitate CT interventional procedures, the following protocols are provided. Any of these protocols can be appended to a spiral protocol for CT interventional procedures, such as biopsy, abscess drainage, pain therapy, minimum invasive operations, joint studies, and arthrograms. Adjust the mAs according to the body region before loading. 10 scans are predefined.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 182 Friday, April 8, 2005 9:55 AM Specials Biopsy Indications: This is the conventional sequential mode without table feed using a 10 mm slice. kV Effective mAs Rotation time Slice collimation Slice width Feed/Scan Kernel CTDIVol Biopsy 130 80 1.0 sec 5.0 mm 10.0 mm 0.0 mm B31s 8.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 183 Friday, April 8, 2005 9:55 AM Specials TestBolus Indications: This mode can be used to test the start delay of an optimal enhancement after the contrast medium injection. kV Effective mAs Rotation time Slice collimation Slice width Feed/Scan Kernel CTDIVol TestBolus 80 110 1.0 sec 5.0 mm 10.0 mm 0.0 mm B31s 3.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 184 Friday, April 8, 2005 9:55 AM Children Overview The scan protocols for children are defined according to body regions – Head, Neck, Shoulder, Thorax, Abdomen, Pelvis, Spine, Upper Extremities, Lower Extremities, Vascular, Specials and Private. For children six (6) years and older, use the adult protocols.
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C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 187 Friday, April 8, 2005 9:55 AM Children Hints in General 1.Topograms: 256 mm lateral topograms are defined for the head modes, and 512 mm TOP topograms are defined for the body modes. Please keep in mind that the children’s size can be dramatically different. You should press the “Hold Measurement“ button whenever the range shown on the real-time growing topogram is long enough, in order to avoid unnecessary radiation. 2.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 188 Friday, April 8, 2005 9:55 AM Children The proper personnel and equipment must also be readily available in the event of a problem. 6.Oral and rectal contrast administration: Depending on the reason for the exam/status of the patient, oral contrast may or may not be given to these patients. In general, oral contrast is recommended to opacify the intestinal tract, as unopacified bowel can have the appearance of abdominal fluid or mass effect.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 189 Friday, April 8, 2005 9:55 AM Children It is recommended to use CARE Bolus in order to achieve optimal contrast enhancement. Both start delay time and injection rate are exam-/ patient-dependent. Whenever possible, I.V. injection with a power injector is recommended for all scans . Some guidelines to follow with respect to flow rate are noted in the chart below. Note: these injector guidelines are based on an antecubital injection site.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 190 Friday, April 8, 2005 9:55 AM Children Head Kernels • For head scans of small children, the kernels C20s, C30s (e.g., for soft tissue studies) and C60s (e.g., for sinuses are provided) should be chosen instead of the ”adult” head kernels H21s, H31s and H60s. • For the standard head protocols, we recommend C20s and C30s. • High resolution head studies should be performed with H60s, H70s (e.g., for dental and sinuses) and H80s (e.g., inner ear).
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 191 Friday, April 8, 2005 9:55 AM Children Body Kernels • As standard kernels for body tissue studies B31s or B41s is recommended; softer images are obtained with B20s. • For higher sharpness, as is required e.g., in patient protocols for cervical spine, shoulder, extremities, thorax, the kernels B50s, B60s, B70s are available. The special kernels are mostly used for ”physical” measurements with phantoms, e.g.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 192 Friday, April 8, 2005 9:55 AM Children HeadRoutine_Baby Indications: Routine head spiral studies, e.g., brain tumors, cranial trauma, hydrocephalus, hemorrhaging and other abnormalities etc. A range of 8 cm will be covered in 27 sec. kV Effective mAs Rotation time Slice collimation Slice width Feed/Rotation Pitch Factor Increment Kernel CTDIVol Effective dose Head 80 122 1.5 sec 2.5 mm 3.0 mm 5.0 mm 1.0 3.0 mm C30s 7.89 mGy Male: 0.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 193 Friday, April 8, 2005 9:55 AM Children Hints • Use this protocol for children below 6 months of age. • When bone structure is of interest, use kernel C60s for image reconstruction. • In order to optimize image quality versus radiation dose, scans are provided within a maximum scan field of 300 mm with respect to the iso-center. No recon job with a field of view exceeding those limits will be possible.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 194 Friday, April 8, 2005 9:55 AM Children HeadRoutine_Child Indications: Routine head spiral studies, e.g., brain tumors, cranial trauma, hydrocephalus, hemorrhaging and other abnormalities etc. A range of 8 cm will be covered in 27 sec. kV Effective mAs Rotation time Slice collimation Slice width Feed/Rotation Pitch Factor Increment Kernel CTDIVol Effective dose Head 130 60 1.5 sec 2.5 mm 3.0 mm 5.0 mm 1.0 3.0 mm C30s 13.66 mGy Male: 0.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 195 Friday, April 8, 2005 9:55 AM Children Hints • Children, who are more than 6 years old, should be scanned with an adult protocol as the skull by this time is fully grown. • When bone structure is of interest, use kernel C60s for image reconstruction. • In order to optimize image quality versus radiation dose, scans are provided within a maximum scan field of 300 mm with respect to the iso-center.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 196 Friday, April 8, 2005 9:55 AM Children HeadSeq_Baby Indications: Sequential mode for routine head studies for children, e.g., tumors, hydrocephalus, hemorrhaging, abnormalities, etc. A range of 8.25 cm is predefined. kV Effective mAs Rotation time Slice collimation Slice width Feed/Scan Kernel CTDIVol Effective dose HeadSeq 80 250 1.5 sec 2.5 mm 2.5 mm 5.0 mm C30s 16.18 mGy Male: 1.71 mSv* Female: 1.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 197 Friday, April 8, 2005 9:55 AM Children Hints • Use this protocol for children below 6 months of age. • When bone structure is of interest, use kernel C60s for image reconstruction. • In order to optimize image quality versus radiation dose, scans are provided within a maximum scan field of 300 mm with respect to the iso-center. No recon job with a field of view exceeding those limits will be possible.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 198 Friday, April 8, 2005 9:55 AM Children HeadSeq_Child Indications: Sequential mode for routine head studies for children, e.g., tumors, hydrocephalus, hemorrhaging, abnormalities, etc. A range of 8.25 cm is predefined. kV Effective mAs Rotation time Slice collimation Slice width Feed/Scan Kernel CTDIVol Effective dose HeadSeq 130 120 1.5 sec 2.5 mm 2.5 mm 5.0 mm C30s 27.32 mGy Male: 1.09 mSv* Female: 1.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 199 Friday, April 8, 2005 9:55 AM Children Hints • Children, who are more than 6 years old, should be scanned with an adult protocol as the skull by this time is fully grown. • When bone structure is of interest, use kernel C60s for image reconstruction. • In order to optimize image quality versus radiation dose, scans are provided within a maximum scan field of 300 mm with respect to the iso-center.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 200 Friday, April 8, 2005 9:55 AM Children InnerEar Indications: High Resolution Spiral mode for inner ear studies, e.g., malformations of the inner ear, inflammatory changes, pathologies of the mastoid process, tumor processes of the pyramids, post-traumatic changes, etc. A range of 2.5 cm will be covered in 22 sec.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 201 Friday, April 8, 2005 9:55 AM Children Hints • Children, who are more than 6 years old, should be scanned with an adult protocol as the skull by this time is fully grown. • When soft tissue is of interest, use kernel H31s for image reconstruction. • In order to optimize image quality versus radiation dose, scans are provided within a maximum scan field of 300 mm with respect to the iso-center.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 202 Friday, April 8, 2005 9:55 AM Children SinusOrbi Indications: Spiral mode for routine spiral studies of the sinuses and paranasal sinuses, e.g., sinusitis, pneumatization, polyposis, malformations, tumors etc. A range of 4 cm will be covered in 22 sec. SinusOrbi kV Effective mAs Rotation time Slice collimation Slice width Feed/Rotation Pitch Factor Increment Kernel CTDIVol Effective dose 2nd reconstruction 80 81 1.0 sec 1.0 mm 3.0 mm 1.25 mm 2.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 203 Friday, April 8, 2005 9:55 AM Children Contrast medium IV injection Start delay exam dependent Flow rate dependent upon needle size/ Access site Total amount 1 – 2 ml per kg of body weight Hints • Children, who are more than 6 years old, should be scanned with an adult protocol. • In order to optimize image quality versus radiation dose, scans are provided within a maximum scan field of 300 mm with respect to the iso-center.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 204 Friday, April 8, 2005 9:55 AM Children Neck Indications: Spiral mode for routine neck studies, e.g., tumors, lymphoma, abscesses, etc. A range of 15 cm will be covered in 19 sec. kV Effective mAs Rotation time Slice collimation Slice width Feed/Rotation Pitch Factor Increment Kernel CTDIVol Effective dose Neck 130 26 1.0 sec 2.5 mm 5.0 mm 9.0 mm 1.8 5.0 mm B50s 2.80 mGy Male: 2.40 mSv* Female: 2.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 205 Friday, April 8, 2005 9:55 AM Children Hints • If necessary, scan down to the aortic arch or mediastinum to include the entire lesion. • Cooperative children can be instructed to hold their breath during the acquisition. • Children, who are more than 6 years old should be scanned with an adult protocol. • Please change the mAs value according to the age of the child: 3 – 6 years 39 mAs.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 206 Friday, April 8, 2005 9:55 AM Children ThoraxRoutine_Baby Indications: Spiral mode for routine thorax studies, e.g., pneumonia, tumors, metastases, lymphoma, vascular abnormalities etc. A range of 15 cm will be covered in 17 sec.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 207 Friday, April 8, 2005 9:55 AM Children ThorRoutine kV Effective mAs Rotation time Slice collimation Slice width Feed/Rotation Pitch Factor Increment Kernel CTDIVol Effective dose 2nd reconstruction 80 41 1.0 sec 2.5 mm 5.0 mm 5.0 mm 10.0 mm 2.0 5.0 mm 5.0 mm B41s B60s 1.13 mGy Male: 1.55 mSv* Female: 1.85 mSv* * The conversion factor for an 8-week-old child, and a scan range of 150 mm was used.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 208 Friday, April 8, 2005 9:55 AM Children ThoraxRoutine_Child Indications: Spiral mode for routine thorax studies, e.g., pneumonia, tumors, metastases, lymphoma, vascular abnormalities etc. A range of 15 cm will be covered in 17 sec.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 209 Friday, April 8, 2005 9:55 AM Children ThorRoutine kV Effective mAs Rotation time Slice collimation Slice width Feed/Rotation Pitch Factor Increment Kernel CTDIVol Effective dose 2nd reconstruction 130 26 1.0 sec 2.5 mm 5.0 mm 5.0 mm 10.0 mm 2.0 5.0 mm 5.0 mm B41s B60s 2.80 mGy Male: 1.46 mSv* Female: 1.72 mSv* * The conversion factor for a 7-year-old child, and a scan range of 150 mm was used.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 210 Friday, April 8, 2005 9:55 AM Children ThoraxHRSeq_Baby Indications: Sequence mode for High Resolution lung studies, e.g., interstitial changes of the lung parenchyma, etc. A range of 20.1 cm is predefined. kV Effective mAs Rotation time Slice collimation Slice width Feed/Scan Kernel CTDIVol Effective dose ThorHRSeq 80 90 1.0 sec 1.0 mm 1.0 mm 10.0 mm U90s 0.50 mGy Male: 0.88 mSv* Female: 1.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 211 Friday, April 8, 2005 9:55 AM Children Hints • Use this protocol for children below 35 kg. • If you want to acquire the patient at full inspiration or full expiration, you should practice the breathing with the patient a few times before beginning the scan, so that reproducibility may be improved.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 212 Friday, April 8, 2005 9:55 AM Children ThoraxHRSeq_Child Indications: Sequence mode for High Resolution lung studies, e.g., interstitial changes of the lung parenchyma, etc. A range of 20.1 cm is predefined. kV Effective mAs Rotation time Slice collimation Slice width Feed/Scan Kernel CTDIVol Effective dose ThorHRSeq 130 70 1.0 sec 1.0 mm 1.0 mm 10.0 mm U90s 1.51 mGy Male: 1.02 mSv* Female: 1.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 213 Friday, April 8, 2005 9:55 AM Children Hints • Children with a body weight of more than 55 kg should be examined with an adult protocol. • If you want to acquire the patient at full inspiration or full expiration, you should practice the breathing with the patient a few times before beginning the scan, so that reproducibility may be improved.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 214 Friday, April 8, 2005 9:55 AM Children Abdomen_Baby Indications: Spiral mode for routine studies in the region of abdomen and pelvis, e.g., tumors, lymphoma, abscesses, post-traumatic changes, etc. A range of 30 cm will be covered in 32 sec. kV Effective mAs Rotation time Slice collimation Slice width Feed/Rotation Pitch Factor Increment Kernel CTDIVol Effective dose Abdomen 80 41 1.0 sec 2.5 mm 5.0 mm 10.0 mm 2.0 5.0 mm B41s 1.13 mGy Male: 3.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 215 Friday, April 8, 2005 9:55 AM Children Hints • Use this protocol for children below 35 kg. • Delayed scans may be required for the kidneys and bladder. • Rectal contrast may be required for evaluation of pelvic mass. • Please change the mAs value according to the weight of the child: 25 – 34 kg 70 mAs.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 216 Friday, April 8, 2005 9:55 AM Children Abdomen_Child Indications: Spiral mode for routine studies in the region of abdomen and pelvis, e.g., tumors, lymphoma, abscesses, post-traumatic changes, etc. A range of 30 cm will be covered in 32 sec. kV Effective mAs Rotation time Slice collimation Slice width Feed/Rotation Pitch Factor Increment Kernel CTDIVol Effective dose Abdomen 130 41 1.0 sec 2.5 mm 5.0 mm 10.0 mm 2.0 5.0 mm B41s 4.42 mGy Male: 4.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 217 Friday, April 8, 2005 9:55 AM Children Hints • Delayed scans may be required for the kidneys and bladder. • Rectal contrast may be required for evaluation of pelvic mass. • Children with a body weight of more than 55 kg should be examined with an adult protocol.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 218 Friday, April 8, 2005 9:55 AM Children Spine_Baby Indications: Spiral mode for spine studies, e.g., post-traumatic changes, tumors, malformations, orthopedic indications, etc. A range of 15 cm will be covered in 32 sec. Spine kV Effective mAs Rotation time Slice collimation Slice width Feed/Rotation Pitch Factor Increment Kernel CTDIVol Effective dose 2nd reconstruction 80 110 1.0 sec 2.5 mm 3.0 mm 5.0 mm 1.0 3.0 mm B41s 3.03 mGy Male: 1.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 219 Friday, April 8, 2005 9:55 AM Children Hints • Use this protocol for children below 35 kg. • Please change the mAs value according to the weight of the child: 25 – 34 kg 160 mAs.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 220 Friday, April 8, 2005 9:55 AM Children Spine_Child Indications: Spiral mode for spine studies, e.g., post-traumatic changes, tumors, malformations, orthopedic indications, etc. A range of 15 cm will be covered in 32 sec. Spine kV Effective mAs Rotation time Slice collimation Slice width Feed/Rotation Pitch Factor Increment Kernel CTDIVol Effective dose 2nd reconstruction 130 70 1.0 sec 2.5 mm 3.0 mm 5.0 mm 1.0 3.0 mm B41s 7.55 mGy Male: 1.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 221 Friday, April 8, 2005 9:55 AM Children Hint • Children with a body weight of more than 55 kg should be examined with an adult protocol.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 222 Friday, April 8, 2005 9:55 AM Children ExtrHR_Baby Indications: Spiral mode for high resolution extremity studies, e.g., post-traumatic changes, tumors, malformations, etc. A range of 10 cm will be covered in 27 sec. kV Effective mAs Rotation time Slice collimation Slice width Feed/Rotation Pitch Factor Increment Kernel CTDIVol Effective dose ExtrHR 80 50 1.0 sec 1.0 mm 1.25 mm 4.0 mm 2.0 0.8 mm B70s 1.38 mGy Male: < 0.01 mSv* Female: < 0.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 223 Friday, April 8, 2005 9:55 AM Children Hints • Use this protocol for children below 35 kg. • Please change the mAs value according to the weight of the child: 15 – 34 kg 80 mAs.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 224 Friday, April 8, 2005 9:55 AM Children ExtrHR_Child Indications: Spiral mode for bone studies, e.g., tumors, posttraumatic changes, orthopedic indications, etc. A range of 10 cm will be covered in 27 sec. kV Effective mAs Rotation time Slice collimation Slice width Feed/Rotation Pitch Factor Increment Kernel CTDIVol Effective dose ExtrHR 130 40 1.0 mm 1.0 mm 1.25 mm 4.0 mm 2.0 0.8 mm B70s 4.31 mGy Male: < 0.01 mSv* Female: < 0.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 225 Friday, April 8, 2005 9:55 AM Children Hint • Children with a body weight of more than 55 kg should be examined with an adult protocol.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 226 Friday, April 8, 2005 9:55 AM Children HeadAngio Indications: Spiral mode for head CT angiography, e.g., cerebral vascular abnormalities, tumors etc. A range of 6 cm will be covered in 32 sec. kV Effective mAs Rotation time Slice collimation Slice width Feed/Rotation Pitch Factor Increment Kernel CTDIVol Effective dose HeadAngio 80 81 1.0 sec 1.0 mm 2nd reconstruction 2.0 mm 2.0 mm 1.0 2.0 mm C30s 5.24 mGy Male: 0.12 mSv* Female: 0.13 mSv* 1.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 227 Friday, April 8, 2005 9:55 AM Children Hints • Children, who are more than 12 years old, should be scanned with an adult protocol as the skull by this time is fully grown. • CARE Bolus may be used to optimize the bolus timing with a triggering threshold of 120 HU, or use manual triggering. • An advanced algorithm allows for improved head image quality, without any additional post-processing.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 228 Friday, April 8, 2005 9:55 AM Children HeadAngio08s Indications: Spiral mode for head CT angiography, e.g., cerebral vascular abnormalities, tumors etc. A range of 6 cm will be covered in 26 sec. HeadAngio kV Effective mAs Rotation time Slice collimation Slice width Feed/Rotation Pitch Factor Increment Kernel CTDIVol Effective dose 2nd reconstruction 80 65 0.8 sec 1.0 mm 2.0 mm 2.0 mm 1.0 2.0 mm C30s 4.21 mGy Male: 0.10 mSv* Female: 0.10 mSv* 1.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 229 Friday, April 8, 2005 9:55 AM Children Hints • Please change the mAs value according to the age of the child: 6 – 12 years 80 mAs.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 230 Friday, April 8, 2005 9:55 AM Children CarotidAngio Indications: Spiral mode for the carotid arteries, e.g., carotid stenosis or occlusion, vascular abnormalities of the carotids or vertebral arteries, etc. A range of 10 cm will be covered in 27 sec. kV Effective mAs Rotation time Slice collimation Slice width Feed/Rotation Pitch Factor Increment Kernel CTDIVol Effective dose CarotidAngio 80 50 1.0 sec 1.0 mm 2nd reconstr. 3.0 mm 4.0 mm 2.0 3.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 231 Friday, April 8, 2005 9:55 AM Children Hints • Please change the mAs value according to the age of the child: 6 – 12 years 75 mAs. • Children, who are more than 12 years old should be scanned with an adult protocol. • CARE Bolus may be used to optimize the bolus timing with a triggering threshold of 120 HU, or use manual triggering.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 232 Friday, April 8, 2005 9:55 AM Children CarotidAngio08s Indications: Spiral mode for the carotid arteries, e.g., carotid stenosis or occlusion, vascular abnormalities of the carotids or vertebral arteries, etc. A range of 10 cm will be covered in 22 sec. kV Effective mAs Rotation time Slice collimation Slice width Feed/Rotation Pitch Factor Increment Kernel CTDIVol Effective dose CarotidAngio 80 50 0.8 sec 1.0 mm 2nd reconstr. 3.0 mm 4.0 mm 2.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 233 Friday, April 8, 2005 9:55 AM Children Hints • Please change the mAs value according to the age of the child: 6 – 12 years 75 mAs. • Children, who are more than 12 years old should be scanned with an adult protocol. • CARE Bolus may be used to optimize the bolus timing with a triggering threshold of 120 HU, or use manual triggering.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 234 Friday, April 8, 2005 9:55 AM Children BodyAngio Indications: Spiral mode for abdominal CT Angio studies, e.g., vascular abnormalities, aneurysms, etc. A range of 10 cm will be covered in 19 sec. kV Effective mAs Rotation time Slice collimation Slice width Feed/Rotation Pitch Factor Increment Kernel CTDIVol Effective dose BodyAngio 80 41 1.0 sec 1.5 mm 2nd reconstr. 3.0 mm 6.0 mm 2.0 3.0 mm B41s 1.13 mGy Male: 0.73 mSv* Female: 0.84 mSv* 2.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 235 Friday, April 8, 2005 9:55 AM Children Hints • Please change the mAs value according to the weight of the child: 35 – 44 kg 45 mAs 45 – 54 kg 60 mAs. • Children with a body weight of more than 55 kg should be examined with an adult protocol. • CARE Bolus may be used to optimize the bolus timing. Set the ROI for the monitoring scan in the abdominal aorta with triggering threshold of 120 HU, or use manual triggering.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 236 Friday, April 8, 2005 9:55 AM Children BodyAngio08s Indications: Spiral mode for abdominal CT Angio studies, e.g., vascular abnormalities, aneurysms, etc. A range of 10 cm will be covered in 15 sec. kV Effective mAs Rotation time Slice collimation Slice width Feed/Rotation Pitch Factor Increment Kernel CTDIVol Effective dose BodyAngio 80 35 0.8 sec 1.5 mm 2nd reconstr. 3.0 mm 6.0 mm 2.0 3.0 mm B41s 0.96 mGy Male: 0.62 mSv* Female: 0.72 mSv* 2.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 237 Friday, April 8, 2005 9:55 AM Children Hints • Please change the mAs value according to the weight of the child: 35 – 44 kg 45 mAs 45 – 54 kg 60 mAs. • Children with a body weight of more than 55 kg should be examined with an adult protocol.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 238 Friday, April 8, 2005 9:55 AM Children NeonateBody Indications: Spiral mode for routine neonate body studies, e.g., tumors, abnormalities, malformations, abscesses, etc. A range of 15 cm will be covered in 17 sec. kV Effective mAs Rotation time Slice collimation Slice width Feed/Rotation Pitch Factor Increment Kernel CTDIVol Effective dose NeonateBody 80 41 1.0 sec 2.5 mm 5.0 mm 10.0 mm 2.0 5.0 mm B41s 1.13 Male: 1.59 mSv* Female: 2.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 239 Friday, April 8, 2005 9:55 AM Children Hints • Use this protocol for children below 1 month of age. • CARE Bolus may be used to optimize the bolus timing. Set the ROI for the monitoring scan in the abdominal aorta with triggering threshold of 120 HU, or use manual triggering. • You can modify the slice width for image reconstruction according to the clinical indications.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 240 Friday, April 8, 2005 9:55 AM syngo 3D The 3D card offers the possibility to combine twodimensional images to form three-dimensional views. To do this, the 3D card provides you with the following methods: Multi Planar Reconstruction (MPR) Interactive navigation through 3D volumes in arbitrary orientations. • Orthogonal, oblique or double-oblique orientation. • Easy scrolling through 3D volume data set. • Real-time reconstruction of secondary slices.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 241 Friday, April 8, 2005 9:55 AM syngo 3D Shaded Surface Display (SSD) Surface display of complex anatomies. • 3D display of surfaces from a series of contiguous slices using a variable threshold. • The displayed volume consist of voxels whose HU are in a range defined by two limit values, an upper and a lower threshold (= HU limits). • Display and analyze various anatomy, e.g., from the cranium, pelvis, extremities, e.g.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 242 Friday, April 8, 2005 9:55 AM syngo 3D Prerequisites At least 3 and maximum of 1600 images must have been loaded to process 3D; (with more than 1600 images the series will be split up). All images must have the same x/y coordinates and FoV. • You should close any data sets that you no longer need in order to release memory space and maintain application performance. • CT volume data sets are best acquired with overlapping thin slice CT technique.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 243 Friday, April 8, 2005 9:55 AM syngo 3D Image Representation on the 3D Card The image area on the 3D card is divided into four segments: – Reference segment (sagittal view) – Reference segment (coronal view) – Reference segment (transversal view) – Output segment The first three segments are reference segments, the fourth segment is an output segment.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 244 Friday, April 8, 2005 9:55 AM syngo 3D Defining Output Types You can change the output type for a segment at any time, i.e., from Multi Planar Reconstruction (MPR) to Maximum Intensity Projection (MIP), to Shaded Surface Display (SSD), or to Volume Rendering Technique (VRT). Depending on your working method, you will first generate a reference image, for example, in MPR in the desired view and then switch to MIP, SSD or VRT display.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 245 Friday, April 8, 2005 9:55 AM syngo 3D Radial Ranges For output types MPR, MPR Thick and MIP Thin you generate a series of cut images arranged in a star shape. For output types MIP, SSD and VRT you generate a series of projections and views of the volume each rotated around a defined angle. In this way, you simulate a step-by-step rotation. For example, for colored VRT images, showing a process from different angles.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 246 Friday, April 8, 2005 9:55 AM syngo 3D Editing A common problem in evaluating medical images is that areas relevant to an examination are hidden by other structures, especially bones. The necessary image information is contained in the volume data set but must be made visible with suitable editing steps. 1.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 247 Friday, April 8, 2005 9:55 AM syngo 3D 3. 3D Object Editor: Easy elimination of obstructing information. • Easy volume confinement with clip-box or variable editing slab. • Fast object creation with threshold operations or automatic volume growing. • Multiple editor objects can be displayed with differently colored SSD. • Complete object subtraction with dilatation and erosion functions.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 248 Friday, April 8, 2005 9:55 AM syngo 3D Region Growing Normally in the first step you will generate one or more “objects“ from the volume data set originally loaded in 3D. By specifying a limited voxel value range you extract only a section of the voxels from the original data set. In this way, you generate an object in the result segment.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 249 Friday, April 8, 2005 9:55 AM syngo 3D Like editing volume data sets in the VOI mode, you can use the 3D Editor, too. You are provided with tools for cutting out structures from an object that you have previously generated. Using the Slab Editor you can define your own cutting depth. Morphological Operations In some cases it will not be simple to separate the structures of an object using the cutting tools.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 250 Friday, April 8, 2005 9:55 AM syngo 3D Workflow for a CT Extremity Examination Using MPR/MPR Thick 1. Load the series to MPR. 2. Manipulate the volume to evaluate anatomy: a)Orientate the image volume for the best view of the anatomy. b)Adjust the window as necessary. c) Pan and zoom image as necessary. 3. Scroll through the volume quickly using the 3D cross-hair or dog-ears to gain a three-dimensional impression. 4.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 251 Friday, April 8, 2005 9:55 AM syngo 3D Using SSD 1. Load the series to SSD. Hint: Do not use a series with a high resolution kernel, e.g., kernel 10 or 20 is recommended. 2. Manipulate the volume to evaluate anatomy: a)Orientate the image volume for the best view of the anatomy. b)Adjust the threshold as necessary. c)Pan and zoom image as necessary. d)To eliminate unwanted structures, use VOI punching/3D Object Editor. 3.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 252 Friday, April 8, 2005 9:55 AM syngo 3D Workflow for a CT Angiography Using MIP/MIP Thin 1. Load the series to MIP. 2. Manipulate the volume to evaluate anatomy: a)Orientate the image volume for the best view of the anatomy. b)To eliminate unwanted bone, either activate MIP Thin or use VOI punching/3D Object Editor. c)Adjust the window as necessary. d)Pan and zoom image as necessary. 3. Measure, annotate and document as needed. 4.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 253 Friday, April 8, 2005 9:55 AM syngo 3D Using VRT/VRT Thin/Clip 1. Load the series to VRT. 2. Manipulate volume to evaluate anatomy: a)Orientate the image volume for the best view of the anatomy. b)To eliminate unwanted bone, either activate VRT Thin/Clip or use VOI punching/3D Object Editor. c)Select VRT preset from VRT gallery. d)Adjust window, opacity, color and lighting effects as necessary. e)Pan and zoom image as necessary. 3.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 254 Friday, April 8, 2005 9:55 AM syngo 3D Hints in General Setting Views in the Volume Data Set Three-dimensional image processing allows you to create images in any orientation and position within the data volume. You can "move" through the volume and rotate it in any direction. Depending on the method you are using, various aids are available to you.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 255 Friday, April 8, 2005 9:55 AM syngo 3D The plane is then no longer perpendicular to either of the coordinate axes. The image orientation is displayed as a combination of three orientation labels. – The subtask card Orientation will always give you the ability to return immediately back to the beginning or to any standard view. – View perpendicular to reference image (Ortho Sync).
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 256 Friday, April 8, 2005 9:55 AM syngo 3D If the default settings are not appropriate for your diagnostic problem, you can alter them individually. In that way you can emphasize the structures of interest in an optimum way. – Ramp and trapezoid manipulation: Ramps and trapezoids are functions which define window and rendering settings. Trapezoids can also be used to differentiate a tissue classification range (e.g.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 257 Friday, April 8, 2005 9:55 AM syngo 3D Auto Load in 3D and Post-processing Presets You can activate the Auto load in 3D function on the Examination card/Auto Tasking and link it to a recon job. On the 3D card you have the possibility to create Ranges Parallel and Radial protocols which can be linked to a special series name.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 258 Friday, April 8, 2005 9:55 AM syngo Fly Through syngo Fly Through is a Virtual CT Endoscopy Software integrated into the syngo 3D functionality. It offers the possibility to render endoluminal views of structures such as the airways and vessels from volume data sets. Virtual CT Endoscopy simulates diagnostic conventional endoscopic procedures e.g., bronchoscopy and colonoscopy, that are usually uncomfortable and more invasive to the patient.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 259 Friday, April 8, 2005 9:55 AM syngo Fly Through Prerequisites This software works with CT, MR and conventional Angiographic data sets. CTA data set with good vessel enhancement for virtual angioscopy. Volume data set acquired with overlapping thin slice CT technique.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 260 Friday, April 8, 2005 9:55 AM syngo Fly Through Endoscopic Viewing Parameters/Fly Cone Settings In general, the shape of a pyramidal cone can be used to represent visualization of an endoscopic volume. The boundaries and the viewing perspective of the endoscopic volume are defined by adjusting the shape and size of this cone. Cone setting for flying through the airways.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 261 Friday, April 8, 2005 9:55 AM syngo Fly Through • Standing Point – The cone rotates around the viewing point. • Viewing Point – The complete cone moves. • Clipping Point – The cone rotates around the standing point. • Viewing Angle – Is changed by moving one of the sides of the angle. • Viewing Distance – The distance from the standing to the viewing point. • Viewing Depth – Moving the Front/Back Clip Plane changes the viewing depth.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 262 Friday, April 8, 2005 9:55 AM syngo Fly Through Patient Preparation Bony and cartilaginous structures such as the central airway and bronchial tree, the osteomeatal system of the Paranasal Sinuses are inherently filled with air and therefore ideal for performing Virtual CT Endoscopy. No special preparations are required. For CT endoscopic evaluation of the vessel (virtual CT angioscopy), a good CTA data set with good vessel enhancement is required.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 263 Friday, April 8, 2005 9:55 AM syngo Fly Through Workflow Load the images in 3D. The following standard layout is displayed: Segment 1: Sagittal view Segment 2: Coronal view Segment 3: Transversal view Segment 4: Fly segment with perspective SSD as default Scroll through the MPR images until you reach an image where you would like to start the CT endoscopic evaluation.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 264 Friday, April 8, 2005 9:55 AM syngo Fly Through Position the Reference lines at that point of interest e.g., in the trachea. Click the Fly Through icon to activate the endoscopic display in the fourth segment. The default endoscopic display has the same orientation (viewing direction) as the last selected image segment in which you placed the point of interest and invoked the syngo Fly Through option.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 265 Friday, April 8, 2005 9:55 AM syngo Fly Through Navigation of the Endoscopic Volume • Manual Navigation Click with the right mouse button in the Fly segment to activate the SmartSelect menu. The following controls are available: – auto-navigation – push/pull – rotate around viewing point – rotate view Adjust the viewing direction and select push/pull. Click and hold the left mouse button.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 266 Friday, April 8, 2005 9:55 AM syngo Fly Through Fly Path Planning Open the Fly Path Planning. Create a path by inserting path points in the volume during navigation.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 267 Friday, April 8, 2005 9:55 AM syngo Fly Through The relevant settings (viewing direction, viewing angle etc.) are stored along the path. After defining and storing a path, it is possible to play back the entire navigation along the path as a movie or to jump straight to the section of the endoscopic volume predefined by the path points. Note: Only one path can be saved with each data set.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 268 Friday, April 8, 2005 9:55 AM syngo Dental CT This is an application package for reformatting panoramic views and paraxial slices through the upper and lower jaw. It enables the display and measurement of the bone structures of the upper and lower jaw (especially for a 1:1 scale) as the basis for oral surgery planning.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 269 Friday, April 8, 2005 9:55 AM syngo Dental CT Panoramic view Paraxial view Scan Protocols You will find the Dental scan protocols under body region “Head”: kV Effective mAs Rotation time Slice collimation Slice width Feed/Rotation Pitch Factor Increment Kernel CTDIVol Effective dose Dental 130 45 1.0 sec 1.0 mm 1.25 mm 2.0 mm 1.0 0.5 mm H60s 10.25 mGy Male: 0.13 mSv Female: 0.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 270 Friday, April 8, 2005 9:55 AM syngo Dental CT • It is mandatory to position the patient head in the center of the scan field – use the lateral laser light marker for positioning. • Gantry tilt is not necessary since you have the ability to tilt the reference line to generate an axial reformatted image at the desired plane.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 271 Friday, April 8, 2005 9:55 AM syngo Dental CT Additional Important Information • The Dental scan protocol delivers high resolution images for syngo Dental CT evaluation, however, you can also reconstruct images with softer kernel, e.g., H20s, for 3D/SSD post-processing.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 272 Friday, April 8, 2005 9:55 AM syngo Dental CT • Image orientation: – In the paraxial view, a “B” indicates buccal and a “L” lingual. The lingual marker “+” must always be positioned at the tongue. If not, simply drag & drop it back. – In the panoramic view, a “B” stands for “Begin” and an “E” for “End”. • Filming: for the maximum use of the film, film directly from the Dental card instead of Patient Browser.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 273 Friday, April 8, 2005 9:55 AM syngo Dental CT • ROI definition for statistical evaluations and deletion of graphics is possible. Paraxial lines using ”Cluster”. • In the control area, you can configure if you want to display the paraxial lines orthogonal to the reference line.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 274 Friday, April 8, 2005 9:55 AM syngo Osteo CT This is an application package for the quantitative assessment of vertebral bone mineral density for the diagnosis and follow-up of osteopenia and osteoporosis.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 275 Friday, April 8, 2005 9:55 AM syngo Osteo CT Scanning Procedure Scan Protocols You will find the Osteo scan protocols under body region “Spine”: kV Effective mAs Rotation time Slice collimation Slice width Feed/Scan Kernel CTDIVol Effective dose Osteo 80 81 1.0 sec 5.0 mm 10.0 mm 0.0 mm S80s 2.23 mGy Male: 0.03 mSv Female: 0.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 276 Friday, April 8, 2005 9:55 AM syngo Osteo CT The special kernels are mostly used for ”physical” measurements with phantoms, e.g., for adjustment procedures (S80s), for constancy and acceptance tests (S80s, U90s), or for specification purposes (U90s). For special patient protocols, S80s and U90s are chosen, e.g., for Osteo (S80s) and for high resolution bone studies (U90s). Patient positioning: • Set the table height at 125.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 277 Friday, April 8, 2005 9:55 AM syngo Osteo CT • Position the cut line of scanning through the middle of the vertebra, i.e. bi-sector between the angle of the upper and lower end plate. • The phantom must be included in the FoV of the images for evaluation. • It is recommended to end the exam first, and then start the syngo Osteo CT evaluation.
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C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 279 Friday, April 8, 2005 9:55 AM syngo Osteo CT How can you save the results on your PC? – Select Option/Configuration from the main menu and click icon ”CT Osteo”. – Activate the checkbox “Enable Export of Results”. – “Exit” the configuration dialog. – Call up the Osteo card and you will see the new icon “Export results” on the lower, right part of the screen.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 280 Friday, April 8, 2005 9:55 AM syngo Osteo CT Example for one patient with three Osteo tomograms: PATIENT; John Smith; 007; 64; Male IMAGE; L2; 234; 2; 27-JAN-1998; 11:12:17; 61.7; 48.9; 55.3; 20.8; 20.1; 21.5; 205.8; 192.0; 198.7; 50.6; 47.5; 49.5 IMAGE; L3; 236; 3; 27-JAN-1998; 11:12:18; 60.4; 54.5; 49.3; 22.3; 21.1; 21.8; 210.5; 191.9; 180.7; 50.4; 47.5; 52.3 IMAGE; L4; 238; 4; 27-JAN-1998; 11:12:18; 59.3; 43.1; 55.0; 20.6; 29.0; 23.3; 201.8; 178.
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C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 282 Friday, April 8, 2005 9:55 AM syngo Osteo CT Evaluation Workflow After loading the images into the syngo Osteo CT application, press “Start Evaluation“. Check the correct positioning of the ROIs in the Calibration phantom. You can change the position by moving the two circles. Water equivalent Bone equivalent Correcting contour lines You can perform correction of the contours by moving the base points.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 283 Friday, April 8, 2005 9:55 AM syngo Osteo CT 1.Center of the spinal canal (C) 2.Uppermost point of the cortical spinal body (A) 3.Intermediate point (L) 4.Intermediate point (R) 5.Uppermost point of the spinal canal (T) – Click on a base point with the mouse. – Move it keeping the left mouse key pressed. If you are satisfied with the contours press “Accept Contours” otherwise skip the image.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 284 Friday, April 8, 2005 9:55 AM syngo Osteo CT The other summary image displays a graph which shows the comparison of all evaluated vertebrae with the selected Reference Data. “T-score” This is the deviation of average BMD of the patient from that of a young healthy comparison group. It represents bone loss with reference to the peak bone mass.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 285 Friday, April 8, 2005 9:55 AM syngo Osteo CT The second and the fourth segment belong together. The second segment shows the tomogram images with the contours superimposed. The fourth segment shows the calculated results of the corresponding tomogram image. Both segments are bordered by the same color. If you scroll through one of these segments the other segment is updated to same vertebra.
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C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 287 Friday, April 8, 2005 9:55 AM syngo Osteo CT Additional Important Information • Fractured vertebrae are not suited for syngo Osteo CT evaluation since the more compact nature of these vertebrae result in bone mineral density value that is much higher than one would expect. • When you examine a patient who is older than 80 years, the patient examination data cannot be compared with the reference data base.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 288 Friday, April 8, 2005 9:55 AM syngo Volume Evaluation Volume is an evaluation function which allows most accurate calculation of a volume out of a stack of twodimensional images. This can be done by Volume-of-Interest (VOI) definition and by limiting the minimum and maximum density (HU) values for calculation. Different views of the image data provide fast navigation and easy volume definition.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 289 Friday, April 8, 2005 9:55 AM syngo Volume Evaluation • Interactive outlining of freehand and elliptical Regions-of-Interest is available, with the possibility to define evaluation (HU) limits inside the VOI. • Automatic interpolation between two pending ROIs is performed, i.e. the user only has to define the ROI in selected images within the stack.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 290 Friday, April 8, 2005 9:55 AM syngo Volume Evaluation Prerequisites The images must fulfill the following conditions: • Only images of one patient must be loaded for evaluation with Volume. • The scans must have been acquired with the same table height and the same gantry tilt. • Only image data sets with the same slice orientation must be used; (the selection should not include a topogram image).
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 291 Friday, April 8, 2005 9:55 AM syngo Volume Evaluation Workflow 1. Loading the Images After loading the images into syngo Volume Evaluation, the following layout is displayed: • Segment 1: Display of sagittal images. The images are sorted from left to right, according to the patient’s anatomy. • Segment 2: Display of coronal images. The images are sorted from front to back, according to the patient’s anatomy.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 292 Friday, April 8, 2005 9:55 AM syngo Volume Evaluation 2.Preparing Volume Calculation Before you start the volume definition, first optimize the display of the images.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 293 Friday, April 8, 2005 9:55 AM syngo Volume Evaluation 3.1. Planning a Volume with Automatic Volume Detection The automatic method is best used to evaluate a structure which has a different contrast (HU) than the surrounding tissue, such as the lung. You plan the volume with just a few clicks. Automatic Volume Detection uses the 3D region growing method. You enter thresholds that are to be considered for region growing and set seed points.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 294 Friday, April 8, 2005 9:55 AM syngo Volume Evaluation Restricting Automatic Volume Detection You can restrict Automatic Volume Detection to a defined smaller volume. • Draw an ROI around the image area of interest on at least the first and the last image that you want to be included in the volume. The ROIs define the bounding box for the automatic approach. • Check the Thresholds and set the seed point inside the object to be detected.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 295 Friday, April 8, 2005 9:55 AM syngo Volume Evaluation The contours of the ROIs define the outer border of the evaluated volume. You do not need to define the ROIs on every slice. The system automatically interpolates ROIs on the images which lie between the images with defined ROIs. • Check the images and search for the desired object structure. • You can start on any image in segments 3 or 4.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 296 Friday, April 8, 2005 9:55 AM syngo Volume Evaluation • To include only a specific range of HU values into the volume, change the Evaluation Limits. By default, the Evaluation Limits take all HU values of the last evaluation. • To start the evaluation, click the Start Evaluation button. The evaluation results are displayed in segment 4. The volume is colored on all images in all views. • You can define a new volume.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 297 Friday, April 8, 2005 9:55 AM syngo Volume Evaluation Overlap and Mark&Link Method You can define complex volumes using the automatic (overlap) and manual (mark&link) method. • Overlapping method Drawn ROIs that overlap each other vertically for at least a few pixels are automatically combined to one volume. Interpolated ROIs (dotted line) are shown in the intermediate images.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 298 Friday, April 8, 2005 9:55 AM syngo Volume Evaluation With the Overlap method, you can also create a volume from two ROIs that do not overlap in the first step. It is then necessary to draw an ROI in an image which lies between the two other ROIs, so that the new ROI overlaps with the two previous ROIs. This way, you can easily define a VOI around tortuous body structures.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 299 Friday, April 8, 2005 9:55 AM syngo Volume Evaluation 4. Evaluation Results When you click the Start Evaluation button, the system calculates the planned volume within the evaluation limits. The evaluation results are displayed in segment 4. Only the statistic parameters that are set in the configuration dialog box are calculated. Volume pixels and evaluation results are the same color.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 300 Friday, April 8, 2005 9:55 AM syngo Volume Evaluation 5. Documentation of Results If all volumes are evaluated, you can save and film the results. Save – stores to your local database: • The transversal images with the color-coded VOI • The reformatted images (sagittal, coronal, MPR/MIP) • The displayed result sheet Two new series are created.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 301 Friday, April 8, 2005 9:55 AM syngo Volume Evaluation • ROI and Volume Definition – If you insert/modify an ROI, the system automatically plans the ROIs on the preceding/following images (interpolated ROIs) up to that image with the previous/next user-defined ROI. – User-defined ROIs have a solid contour line, whereas interpolated ROIs have a dotted contour line.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 302 Friday, April 8, 2005 9:55 AM syngo Volume Evaluation • Restrictions for Linking and Unlinking There are some restrictions for linking and unlinking: – Linking can be done on user-defined ROIs as well as on interpolated ROIs. If you link an interpolated ROI (dotted line), it becomes a user-confirmed ROI (solid line). – You cannot unlink interpolated ROIs. The unlinking only works with user-confirmed ROIs.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 303 Friday, April 8, 2005 9:55 AM syngo Volume Evaluation Configuration In the Volume Configuration dialog box, you define which evaluation results are given by Volume Evaluation. – Unit of Volume mm3 Volume is given in mm3. cm3 Volume is given in cm3.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 304 Friday, April 8, 2005 9:55 AM syngo Volume Evaluation – Statistical Parameters Volume Volume is calculated in the defined unit: mm3 or cm3. Max. height [cm] Maximum height of the reconstructed volume. Max. width [cm] Maximum width of the reconstructed volume. Max. depth [cm] Maximum depth of the reconstructed volume. Mean value [HU] Mean CT value of the volume in HU. Standard deviation [HU] Pixel standard deviation.
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C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 306 Friday, April 8, 2005 9:55 AM syngo Dynamic Evaluation Dynamic evaluation is a function which allows you to analyze the absolute or relative enhancement of Hounsfield values within a Region of Interest. The enhancement value is computed from a stack of CT images which are obtained at different points in time after contrast agent injection.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 307 Friday, April 8, 2005 9:55 AM syngo Dynamic Evaluation • Use of syngo functions like dog-ears or cine mode for fast paging through the image stack. • Easy selection, modification and deletion handling for the ROIs.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 308 Friday, April 8, 2005 9:55 AM syngo Dynamic Evaluation Prerequisites In dynamic evaluation, images that were scanned as part of an examination with contrast agent at a constant table position are evaluated. • • • • The selection consists only of CT tomogram images. The images belong to the same study. The images were acquired within 1 hour. Images of at least 4 different time positions must be loaded to Dynamic Evaluation.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 309 Friday, April 8, 2005 9:55 AM syngo Dynamic Evaluation Workflow 1. Loading the Images After loading the images into syngo Dynamic Evaluation, the following layout is displayed: • Tomo segment The loaded input images are displayed in the upper left-hand segment. The images are sorted by the acquired time.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 310 Friday, April 8, 2005 9:55 AM syngo Dynamic Evaluation • Baseline image segment The baseline image is displayed in the lower left hand segment (base for enhancement calculation). By default, the first image of the loaded images is used as the baseline image. • Result segment It is black after loading. 2.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 311 Friday, April 8, 2005 9:55 AM syngo Dynamic Evaluation Each time you make a change to the original data set (by removing images, and/or defining a new baseline image) your system recalculates the parameter images based on the existing images. – The average image is an averaged addition of all pixels at each pixel location across the images of the tomo segment.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 312 Friday, April 8, 2005 9:55 AM syngo Dynamic Evaluation – Peak Enhancement image: Parameter image where each pixel indicates the enhancement at that pixel location. CT value of a pixel = maximum value found at that pixel location (pixel value of the MIP image) – CT value of the baseline image at that pixel location. With a Peak Enhancement image, for example, you can easily detect structures that were not completely filled with contrast.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 313 Friday, April 8, 2005 9:55 AM syngo Dynamic Evaluation 4. Creating a Baseline Image A baseline image is used as a basis for all enhancement calculations. The enhancement is calculated relatively to the baseline image. Therefore, the baseline image must show the state before enhancement starts. By default, the first image of the loaded images is used as the baseline image.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 314 Friday, April 8, 2005 9:55 AM syngo Dynamic Evaluation 5. Evaluation of Region of Interests You select the image regions to be evaluated by marking them with ROIs or applying the pixel lens (a circular ROI with a fixed but configurable diameter). An absolute/relative CT-value calculation is performed for these selected image. • You can draw either elliptical or freehand ROIs.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 315 Friday, April 8, 2005 9:55 AM syngo Dynamic Evaluation 6. Enhancement Curve As soon as you have defined an ROI, an enhancement curve (time-density curve) is calculated and displayed in the fourth segment. To facilitate identification, this curve has the same color and numbering as the associated ROI. The maximum CT-value of the ROI first drawn is indicated by a dashed sampling line.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 316 Friday, April 8, 2005 9:55 AM syngo Dynamic Evaluation 7. Documentation of Results During the evaluation you have drawn individual ROIs and have generated enhancement curves and result tables. You can save and print out this information or store it on a floppy for further processing. To document the evaluation, two new series are stored to your local database.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 317 Friday, April 8, 2005 9:55 AM syngo Dynamic Evaluation General Hints • Slice Position with Multi-Row Scanners When you use a multi-row scanner, several slice positions are scanned per acquisition. When you load the images, the window Slice Selection is displayed, in which you can define the slice position to be analyzed. You can evaluate either the scanned examination data or an averaged slice position.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 318 Friday, April 8, 2005 9:55 AM syngo Dynamic Evaluation • Filtering To reduce noise in the Time to Peak and Peak Enhancement image you can apply a smoothing filter. Filtering does not affect the evaluation of ROIs. • Moving the Sampling Line If you want to evaluate the enhancement values for a different point in time, move the sampling line in the horizontal direction.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 319 Friday, April 8, 2005 9:55 AM syngo Dynamic Evaluation • Relative Enhancement Curve Time Axis (X) The point of time for an image is computed relative to the point of time at which the first input image was acquired: Point of Time = Acquisition Time – Acquisition Time of the First Image + Delay • Enhancement Axis (Y) The mean CT value of each ROI is plotted on the enhancement axis of the enhancement curve.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 320 Friday, April 8, 2005 9:55 AM syngo Dynamic Evaluation • Configuring Dynamic Evaluation You can make the following settings in DynEva Configuration: – Calculate Time to Peak Image A Time to Peak Image is generated and displayed in the upper right-hand segment. You can use the image for ROI definition. – Calculate Peak Enhancement Image A Peak Enhancement Image is generated and displayed in the upper right-hand segment.
C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 321 Friday, April 8, 2005 9:55 AM Manufacturer Siemens Shanghai Medical Equipment Ltd. (SSME) 278 Jin Hu Road 201206 Shanghai, P.R. China Telephone: +86 21 50320300 Authorized Representative according to the Medical Device Directive 93/42/EEC Siemens AG Medical Solutions Henkestr. 127 D-91052 Erlangen Germany Telephone: +49 9131 84-0 www.siemens.com/medical © 2002-2005, Siemens Shanghai Medical Equipment Ltd. (SSME) Order No. C2-025.630.01.01.
