Siemens SOMATOM Sensation 16 Application Manual Download Page 70

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Head

Overview

• AngioHead

For CT Angio studies using 0.75 mm slice collimation
and a 1.0 mm slice thickness

• AngioThinSlice

For CT Angio studies using 0.75 mm slice collimation
and 0.75 mm slice thickness

• HeadSeq

Sequence mode for base of the skull
and cerebrum routine studies

• HeadSpi

Spiral mode for base of skull and
cerebrum routine studies

• InnerEarSeq

Sequence mode for inner ear ultra high-resolution
studies using 0.6 mm slice thickness

• InnerEarSpi

Spiral mode for inner ear ultra high-resolution
studies using 0.75 mm slice thickness

• OrbiSinusSpi

Spiral mode for orbital and sinus studies

Summary of Contents for SOMATOM Sensation 16

Page 1: ...SOMATOM Sensation 16 Application Guide Routine Protocols Software Version A50 ...

Page 2: ...ole responsibility for all of the parameters selected The pertaining oper ating instructions must always be strictly followed when operating the SOMATOM Sensation 16 The statutory source for the technical data are the corres ponding data sheets To improve future versions of this application guide we would highly appreciate your questions suggestions and comments Please contact us CT Application Ho...

Page 3: ...3 3 Overview General 8 Children 24 Head 70 Neck 86 Shoulder 94 Thorax 98 Abdomen 112 Pelvis 126 Spine 132 Extremities 138 ...

Page 4: ... in 3D and Postprocessing Presets 19 Contrast Medium IV Injection 20 How to Create your own Scan Protocols 21 Children 24 Overview 24 Hints in General 26 Head Spi 30 HeadSeq 32 SinusRoutine 34 SinusMPR 36 InnerEarSeq 38 InnerEarSpi 40 HeadAngio 42 NeckRoutine 44 CarotidCTA 46 NeonateBody 48 ChestRoutine 50 ChestCombi 52 ThoraxSeqHR 54 AbdPelRoutine 56 AbdCTA 58 SpineSpiral 60 SpineMPR 62 Extremity...

Page 5: ...al 87 AngioCarotid 88 NeckRoutine 90 ThinSliceSpi 92 Shoulder 94 Overview 94 Hints in General 95 ShoulderSpi 96 Thorax 98 Overview 98 Hints in General 99 LungLowDose 100 PulmonaryEmboli 102 ThoraxCombi 104 ThoraxRoutine 106 ThoraxHiRes 108 ThoraxSeqHiRes 110 Abdomen 112 Overview 112 Hints in General 113 AbdRoutine 116 AbdThinSlice 118 AbdMultiPhase 120 AngioFast 122 AngioRoutine 124 ...

Page 6: ...eral 127 HipSpi 128 PelvisRoutine 130 Spine 132 Overview 132 Hints in General 133 RoutineSeq 134 ObeseSeq 135 SpineSpi 136 ThinSliceSpi 137 Extremities 138 Overview 138 Hints in General 139 AngioRunOff 140 CombiSpi 142 ExtrUHRSeq 144 ExtrUHRSpi 146 ...

Page 7: ...7 Content ...

Page 8: ...m slice colli mation depending on the region of interest for routine studies ThinSlice uses 0 75 mm slice collimation for thin slice studies HiRes uses 0 75 mm slice collimation and rotation time of 0 75 s for High resolution studies UHR uses a 0 75 mm slice collimation in Spiral mode and a 0 6 mm slice collimation in Sequence mode a rotation time of 0 75 s and a scan FOV of 250 mm for ultra high ...

Page 9: ...or channels e g 16 x 0 75 mm Slice width is the true thickness of the reconstructed image With the SOMATOM Sensation 16 you select the slice collimation together with the slice width desired the slice width is independent of pitch and algorithm i e what you select is always what you get Actually you do not need to care about the algorithm any more the software does it for you On the SOMATOM Sensat...

Page 10: ...on in spiral and sequential scanning Slice Collimation and Slice Width for Spiral Mode 12 16 x 0 75 mm 0 75 1 1 5 2 3 4 5 6 7 8 10 mm 12 16 x 1 5 mm 2 3 4 5 6 7 8 10 mm Cardio Spiral Modes 12 x 0 75 mm 0 75 1 0 1 5 2 3 mm 12 x 1 5 mm 2 3 4 5 mm Slice Collimation and Slice Width for Sequence Mode 12 x 0 75 mm 0 75 1 5 3 4 5 9 mm 12 x 1 5 mm 1 5 3 4 5 6 9 mm 2 x 5 mm 5 10 mm Perfusion Modes 12 x 1 5...

Page 11: ...the scan range scan time slice colli mation and rotation time is defined the software will adapt the table feed per rotation accordingly The Pitch Factor can be freely adapted from 0 5 to 1 5 Recon Job In the Recon card you can define up to 3 reconstruction jobs with different parameters either before or after you acquire the data When you click on Recon they will all be done automatically In case...

Page 12: ...r other body parts than designed for Image Filter There are 4 different filters available PFO To reduce beam hardening artifacts in head images particularly in the base of the skull use the Posterior Fossa Optimization PFO filter ASA The Advanced Smoothing Algorithm ASA filter reduces noise in soft tissue while edges with high con trast are preserved LCE The Low contrast enhancement LCE filter enh...

Page 13: ... easier for the users the concept of the effective mAs was introduced with the SOMATOM Multislice scanners The effective mAs takes into account the influence of pitch on both the image quality and dose Effective mAs mAs Pitch Factor To calculate the dose on the SOMATOM Sensation 16 you simply have to multiply the CTDIw per mAs with the effective mAs of the scan Dspiral DCTDIw x effective mAs For s...

Page 14: ...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 It could be measured in whole body phantoms Alderson phantom or simulated with Monte Carlo techniques The calculation of the effective dose is rather compli ca...

Page 15: ...e effective dose numbers for standard male and female and listed the result in the description of each scan protocol The calculation was done by the commercially available program WinDose Wellhoefer Dosimetry as shown in figure 1 3 For pediatric protocols we used the WinDose calcula tion and the correction factors published in Radiation Exposure in Computed Topography in which there only the conve...

Page 16: ...Methods M Zankl et al GSF report 30 91 Radiation Exposure in Computed Topography edited by Hans Dieter Nagel published by COCIR c o ZVEI Stresemannallee 19 D 60596 Frankfurt Germany Please note Effective dose values were calculated with the WinDose Software Version 2 1 which was optimized for SOMATOM Volume Zoom scanners SOMATOM Sensation 16 has modified shaped filters which might cause slightly d...

Page 17: ...lices larger volumes or Multi phase studies It can also improve image quality by increasing mA and thus reducing image noise on the lateral views How Does it Work It reduces the mA for low attenuation views up to 90 and keeps the nominal higher mA for high attenuation views e g in the lateral projection Fig 4 This is done on the fly i e the scanner adapts the mA in real time according to the patie...

Page 18: ...lt for all standard protocols It can be switched on off in the scan card The application of CARE Dose does not require any changes in the scan parameters The mean value of the mAs applied will be lower than what you have selected The mean value of the effective mAs applied is shown in the image text ...

Page 19: ...ty to create for MPR and MIPthin Range Parallel protocols which can be linked to a special series For example if you always do some sagittal Multiplanar Reconstructions for a Spine examination you load once a Spine examination into the 3D Card Select the image type MPR MIPthin select the orientation and open the Range Parallel function Adapt the range settings Image thickness Distance between the ...

Page 20: ... of body weight for adults and 2 ml per kg of body weight for children should be applied As a rule of thumb the contrast medium injection should be stopped when the scan or acquisition is finished Keep this in mind you may save contrast medium in your routine study since the multislice spiral scan can be up to 32 times faster than a 1 second single slice spiral scan For CTA study arterial phase th...

Page 21: ...fy the existing scan protocol or enter a new name Tips It is recommended that you save your own scan protocol with a new name in order to avoid over writing the default scan protocol You may use preceding numbers e g 1_Abdomen for user specific scan protocols to make them appear on top of the list and to distinguish them from the Siemens defaults Do not use special characters like or within scan p...

Page 22: ...stem Edit offers save delete Scan Protocols System Run also offers the tool List Scan Protocols which generates an HTML table of all available scan protocols This list can be printed or saved on Floppy File Save As ...

Page 23: ...23 General ...

Page 24: ...ective mAs is set to the lowest category e g less than 6 months in head modes and the suggested effective mAs values for the other cate gories are written in additional lines in the chronicle For a few protocols 80 kV was used instead of 120 kV either to exploit the significantly higher image contrast of iodine contrast media at 80 kV or to reach a lower dose level than possible with 120 kV HeadSp...

Page 25: ...Combi Thin slice mode for combination of vascular and soft tissue studies ThoraxSeqHR High resolution sequential mode for lung studies AbdPelRoutine For routine abdominal studies AbdCTA For abdominal CT Angio studies SpineSpiral For routine spine spiral studies SpineMPR Thin slice mode for spine spiral studies when Multi Planar Reformations are necessary ExtremitySpiral For routine extremity spira...

Page 26: ...ateral laser beam to make sure that the patient is positioned in the center 4 Warm surroundings and dimmed lighting are helpful to make children more cooperative 5 Sedation Although the advent of the multislice scanner has enabled the user to scan through an area of interest much faster than ever sometimes patient motion can still lead to severe motion artifacts seen on the resultant images This b...

Page 27: ...ative contrast agents such as water are becoming more popular for delineation of stomach or bowel wall borders or when 3D recon structions are needed The user needs to be aware of all the contraindications of any of the contrast agents they are using It is recommended to refer to the spe cific vendors recommendations regarding this 7 I V contrast administration In general 1 2 ml per kg of body wei...

Page 28: ...s the dose by another factor of 2 At a lower kV substances with a high atomic number such as iodine have a significantly higher CT value vascular contrast Iodine CT values at 80 kV are about 50 higher than at 120 kV 80 kV was also used for applications when the lowest achievable mAs at 120 kV was still higher than neces sary for sufficient noise level for technical reasons generators need to opera...

Page 29: ...29 Children ...

Page 30: ...IV injection Start delay exam dependent Flow rate dependent upon needle size Access site Total amount 1 2 ml per kg of body weight The mAs should be adjusted to the age of the child The conversion factor for an 8 week old and a scan range of 90 mm was used The conversion factor for a 7 year old 260 mAs and a scan range of 110 mm was used Body Weight kV mAs CTDIw Effective dose mGy mSv 6 months 120...

Page 31: ...ol as the skull by this time is fully grown When bone structure is of interest use kernel C60s for image reconstruction Posterior Fossa Optimization Filter PFO To reduce beam hardening artifacts in head images particularly in the base of the skull use the Posterior Fossa Optimization PFO filter ...

Page 32: ... IV injection Start delay exam dependent Flow rate dependent upon needle size Access site Total amount 1 2 ml per kg of body weight The mAs should be adjusted to the age of the child The conversion factor for an 8 week old and a scan range of 90 mm was used The conversion factor for a 7 year old 260 mAs and a scan range of 117 5 mm was used Age kV mAs CTDIw Effective dose mGy mSv 6 months 120 90 2...

Page 33: ...ol as the skull by this time is fully grown When bone structure is of interest use kernel C60s for image reconstruction Posterior Fossa Optimization Filter PFO To reduce beam hardening artifacts in head images particularly in the base of the skull use the Posterior Fossa Optimization PFO filter ...

Page 34: ...Kernel H30s H60s Increment 3 0 mm 3 0 mm Image order cr ca 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 The mAs should be adjusted to the age of the child The conversion factor for an 8 week old and a scan range of 30 mm was used The conversion factor for a 7 year old 100 mAs and a scan range of 4...

Page 35: ...ould be scanned with an adult protocol as the skull by this time is fully grown The second recon job is defined with kernel H60s for the interest of bone structures If the study is focused on bone structure only the mAs can be reduced to 20 for all age groups ...

Page 36: ...usitis pneumatization polyposis malformations tumors etc SinusMPR SinusMPR Soft tissue Bone reconstr kV 120 Effective mAs Slice collimation 0 75 mm Slice width 3 0 mm 1 0 mm Feed Rotation 6 1 mm Rotation time 0 75 sec Kernel H30s H60s Increment 3 0 mm 0 7 mm Image order cr ca The mAs should be adjusted to the age of the child ...

Page 37: ... factor for an 8 week old and a scan range of 30 mm was used The conversion factor for a 7 year old 100 mAs and a scan range of 40 mm was used Age kV mAs CTDIw Effective dose mGy mSv 3 years 120 40 8 9 Male 0 4 Female 0 4 3 years 120 60 13 4 Male 0 5 6 years Female 0 5 MPRthick SinusMPR coronal Image thickness 2 Distance between images 2 Number of images 30 For the 2nd reconstruction the Autoload ...

Page 38: ...ear inflammatory changes pathologies of the mastoid process tumorous processes of the pyramids post traumatic changes etc InnerEarSeq kV 120 Effective mAs Slice collimation 0 6 mm Slice width 0 6 mm Feed Scan 1 0 mm Rotation time 0 75 sec Kernel U80u Image order cr ca The mAs should be adjusted to the age of the child ...

Page 39: ...rest use kernel U30 for image reconstruction 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 The conversion factor for an 8 week old and a scan range of 30 mm was used The conversion factor for a 7 year old 100 mAs and a scan range of 40 mm was used Age kV mAs CTDIw Effective dose mGy mSv 3 years 120...

Page 40: ...atory changes pathologies of the mastoid process tumorous processes of the pyramids post traumatic changes etc InnerEarSpi kV 120 Effective mAs Slice collimation 0 75 mm Slice width 2 0 mm Feed Rotation 6 8 mm Rotation time 0 75 sec Kernel U80u Increment 2 0 mm Image order cr ca The mAs should be adjusted to the age of the child ...

Page 41: ...g of body weight The conversion factor for an 8 week old and a scan range of 30 mm was used The conversion factor for a 7 year old 100 mAs and a scan range of 40 mm was used Age kV mAs CTDIw Effective dose mGy mSv 3 years 120 40 9 0 Male 0 4 Female 0 4 3 years 120 60 13 4 Male 0 5 6 years Female 0 5 The reconstruction can be loaded in the 3D Card MPR Select the Range function and a predefined rang...

Page 42: ... mm Rotation time 0 5 sec Kernel H20f H10f Increment 2 0 mm 0 7 mm Image order ca cr The mAs should be adjusted to the age of the child The conversion factor for an 8 week old and a scan range of 40 mm was used The conversion factor for a 7 year old and a scan range of 60 mm was used Age kV mAs CTDIw Effective dose mGy mSv 6 years 80 100 8 4 Male 0 4 Female 0 4 6 years 80 150 12 6 Male 0 3 12 year...

Page 43: ...site Total amount 1 2 ml per kg of body weight MIPthin HeadAngio coronal Image thickness 3 Distance between images 3 Number of images 35 For the 2nd reconstruction the Autoload into MIPthin Range on the 3D Card is activated The images will be automatically loaded into 3D MIPthin and a coronal MIPthin Range will pop up Please notice if you are not satisfied with the Range preset adapt the parameter...

Page 44: ...0 75 sec Kernel B30s B60s Increment 6 0 mm 3 0 mm Image order cr ca The mAs should be adjusted to the age of the child The conversion factor for an 8 week old and a scan range of 80 mm was used The conversion factor for a 7 year old and a scan range of 120 mm was used Age kV mAs CTDIw Effective dose mGy mSv 3 years 120 40 2 9 Male 0 7 Female 0 8 3 years 120 60 4 3 6 years 6 years 120 90 6 5 Male 0...

Page 45: ... be scanned with an adult protocol The second recon job is defined for bone structure visualization 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 Children ...

Page 46: ...0 mm 1 0 mm Feed Rotation 12 mm Rotation time 0 5 sec Kernel B30f B20f Increment 5 0 mm 0 7 mm Image order cr ca The mAs should be adjusted to the age of the child The conversion factor for an 8 week old and a scan range of 80 mm was used The conversion factor for a 7 year old and a scan range of 120 mm was used Age kV mAs CTDIw Effective dose mGy mSv 6 years 80 100 2 6 Male 0 6 Female 0 7 6 years...

Page 47: ...site Total amount 1 2 ml per kg of body weight MIPthin CarotidCTA coronal Image thickness 3 Distance between images 3 Number of images 20 For the 2nd reconstruction the Autoload into MIPthin Range on the 3D Card is activated The images will be automatically loaded into 3D MIPthin and a coronal MIPthin Range will pop up Please notice if you are not satisfied with the Range preset adapt the paramete...

Page 48: ...5 sec Kernel B30f Increment 6 0 mm Image order cr ca CTDIw 0 55 mGy Effective dose Male 0 5 mSv Female 0 7 mSv Tips You can modify the slice width for image reconstruc tion according to the clinical indications 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 The conversion factor for an 8 week old an...

Page 49: ...49 Children ...

Page 50: ...mphoma vascular abnormalities etc ChestRoutine 2nd reconstr kV 120 Effective mAs Slice collimation 1 5 mm Slice width 6 0 mm 6 0 mm Feed Rotation 24 0 mm Rotation time 0 5 sec Kernel B30f B60f Increment 6 0 mm 6 0 mm Image order cr ca The mAs should be adjusted to the body weight of the child Children ...

Page 51: ...xam dependent Flow rate dependent upon needle size Access site Total amount 1 2 ml per kg of body weight The conversion factor for an 8 week old and a scan range of 100 mm was used The conversion factor for a 7 year old and a scan range of 150 mm was used Body weight kV mAs CTDIw Effective dose mGy mSv 15 kg 120 17 1 2 Male 0 6 Female 0 8 15 24 kg 120 20 1 4 25 34 kg 120 30 2 1 Male 0 9 Female 1 1...

Page 52: ...mphoma vascular abnormalities etc ChestCombi 2nd reconstr kV 120 Effective mAs Slice collimation 1 5 mm Slice width 3 0 mm 2 0 mm Feed Rotation 30 0 mm Rotation time 0 5 sec Kernel B30f B60f Increment 3 0 mm 1 0 mm Image order cr ca The mAs should be adjusted to the body weight of the child Children ...

Page 53: ... 100 mm was used The conversion factor for a 7 year old and a scan range of 150 mm was used Body Weight kV mAs CTDIw Effective dose mGy mSv 25 kg 120 25 1 8 Male 0 9 Female 1 1 25 44 kg 120 45 3 2 Male 1 4 Female 1 6 45 54 kg 120 65 4 6 MPRthick ChestCombi coronal Image thickness 3 Distance between images 3 Number of images 60 The 2nd reconstruction can be loaded in the 3D Card MPR Select the Rang...

Page 54: ...more than 54 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 The mAs should be adjusted to the body weight of the child The conversion factor for an 8 week old and a scan range of 150 mm was used Body...

Page 55: ...55 Children ...

Page 56: ...tion time 0 5 sec Kernel B30f B60f Increment 5 0 mm 5 0 mm Image order cr ca The mAs should be adjusted to the body weight of the child Children The conversion factor for an 8 week old and a scan range of 100 mm was used The conversion factor for a 7 year old and a scan range of 150 mm was used Body weight kV mAs CTDIw Effective dose mGy mSv 15 kg 120 20 1 4 Male 0 9 Female 1 2 15 24 kg 120 35 2 5...

Page 57: ...pendent upon needle size Access site Total amount 1 2 ml per kg of body weight Tips Children with a body weight of more than 54 kg should be examined with an adult protocol There are two recon jobs predefined The second one is for the reconstruction of the lungs in the upper range ...

Page 58: ... Increment 3 0 mm 0 7 mm Image order cr ca The mAs should be adjusted to the body weight of the child Children The conversion factor for an 8 week old and a scan range of 100 mm was used The conversion factor for a 7 year old and a scan range of 200 mm was used Body weight kV mAs CTDIw Effective dose mGy mSv 15 kg 80 30 0 8 Male 0 4 Female 0 6 15 24 kg 80 50 1 3 25 34 kg 80 75 1 9 Male 0 9 Female ...

Page 59: ...he first recon job is defined for image viewing and filming MIPthin AbdCTA sagittal Image thickness 3 Distance between images 3 Number of images 60 For the 2nd reconstruction the Autoload into MIPthin Range on the 3D Card is activated The images will be automatically loaded into 3D MIPthin and a sagittal MIPthin Range will pop up Please notice if you are not satisfied with the Range preset adapt t...

Page 60: ... sec Kernel B30s B60s Increment 3 0 mm 3 0 mm Image order cr ca The mAs should be adjusted to the body weight of the child Children The conversion factor for an 8 week old and a scan range of 100 mm was used The conversion factor for a 7 year old and a scan range of 200 mm was used Body weight kV mAs CTDIw Effective dose mGy mSv 15 kg 120 26 1 9 Male 1 0 Female 1 0 15 24 kg 120 55 4 0 25 34 kg 120...

Page 61: ...n needle size Access site Total amount 1 2 ml per kg of body weight Tips Children with a body weight of more than 54 kg should be examined with an adult protocol If the study is focused on bone structures only the mAs can be reduced up to 30 for children with a body weight of more than 25 kg ...

Page 62: ...d Rotation 13 5 mm Rotation time 0 75 sec Kernel B30s B60s Increment 0 7 mm 0 7 mm Image order cr ca The mAs should be adjusted to the body weight of the child Children The conversion factor for an 8 week old and a scan range of 100 mm was used The conversion factor for a 7 year old and a scan range of 200 mm was used Body weight kV mAs CTDIw Effective dose mGy mSv 15 kg 120 21 1 7 Male 1 0 Female...

Page 63: ...is focused on bone structures only the mAs can be reduced up to 30 for children with a body weight of more than 25 kg MPRthick SpineMPR sagittal Image thickness 3 Distance between images 3 Number of images 20 The reconstructions can be loaded in the 3D Card MPR Select the Range function and a predefined range linked to the series will pop up Please notice if you are not satisfied with the Range pr...

Page 64: ...reconstr kV 120 Effective mAs Slice collimation 0 75 mm Slice width 5 0 mm 1 0 mm Feed Rotation 12 0 mm Rotation time 0 75 sec Kernel B30s B60s Increment 5 0 mm 0 7 mm Image order cr ca The mAs should be adjusted to the body weight of the child Children Body weight kV mAs CTDIw mGy 15 kg 120 21 1 7 15 34 kg 120 35 2 9 35 54 kg 120 70 5 9 ...

Page 65: ...used on bone structures only the mAs can be reduced up to 30 for children with a body weight of more than 25 kg MPRthick ExtremitySpiral coronal Image thickness 2 Distance between images 2 Number of images 30 For the 2nd reconstruction can be loaded in the 3D Card MPR Select the Range function and a predefined range linked to the series will pop up Please notice if you are not satisfied with the R...

Page 66: ...dic indi cations etc ExtremityUHRSeq kV 120 Effective mAs Slice collimation 0 6 mm Slice width 0 6 mm Feed Scan 1 0 mm Rotation time 0 75 sec Kernel U80u Image order cr ca The mAs should be adjusted to the body weight of the child Children Body weight kV mAs CTDIw mGy 15 kg 120 26 3 3 15 34 kg 120 40 5 1 35 54 kg 120 80 10 3 ...

Page 67: ...oft tissue is of interest use kernel U30 for image reconstruction MPRthick ExtremityUHRSeq coronal Image thickness 2 Distance between images 2 Number of images 30 The 2nd reconstruction can be loaded in the 3D Card MPR Select the Range function and a predefined range linked to the series will pop up Please notice if you are not satisfied with the Range preset adapt the parameters to your needs and...

Page 68: ...ions etc ExtremityUHRSpi kV 120 Effective mAs Slice collimation 0 75 mm Slice width 0 75 mm Feed Rotation 9 0 mm Rotation time 0 75 sec Kernel U80u Increment 0 5 mm Image order cr ca The mAs should be adjusted to the body weight of the child Children Body weight kV mAs CTDIw mGy 15 kg 120 26 2 2 15 34 kg 120 40 3 4 35 54 kg 120 80 6 7 ...

Page 69: ...oft tissue is of interest use kernel U30 for image reconstruction MPRthick ExtremityUHRSpi coronal Image thickness 2 Distance between images 2 Number of images 30 The 2nd reconstruction can be loaded in the 3D Card MPR Select the Range function and a predefined range linked to the series will pop up Please notice if you are not satisfied with the Range preset adapt the parameters to your needs and...

Page 70: ...ickness HeadSeq Sequence mode for base of the skull and cerebrum routine studies HeadSpi Spiral mode for base of skull and cerebrum routine studies InnerEarSeq Sequence mode for inner ear ultra high resolution studies using 0 6 mm slice thickness InnerEarSpi Spiral mode for inner ear ultra high resolution studies using 0 75 mm slice thickness OrbiSinusSpi Spiral mode for orbital and sinus studies ...

Page 71: ...or spiral scanning For all head studies it is very important for image quality to position the patient in the center of the scan field Use the lateral laser beam to make sure that the patient is positioned in the center For image reconstruction of bone structure use kernel H60 In general cerebrum studies with contrast medium except CTA and nasopharynx can be performed by hand injection Start the s...

Page 72: ...72 AngioHead Indications Spiral mode for cerebral CT Angios e g cerebral vascular abnormalities tumors and follow up studies etc A range of 80 mm will be covered in 3 3 s Head ...

Page 73: ...carotid artery Set the trigger threshold at 120 HU or use manual triggering MIPthin AngioHead coronal Image thickness 3 Distance between images 3 Number of images 35 For the 2nd reconstruction the Autoload into MIPthin Range on the 3D Card is activated The images will be automatically loaded into 3D MIPthin and a coronal MIPthin Range will pop up Please notice if you are not satisfied with the Ran...

Page 74: ...Indications For cerebral CT Angio studies with one reconstruction job for a 0 75mm slice thickness E g cerebral vascular abnormalities tumor and follow up studies etc A range of 80 mm will be covered in 6 5 s Head 74 ...

Page 75: ...id artery Set the trigger threshold at 120 HU or use manual triggering MPRthick AngioThinSlice coronal Image thickness 3 Distance between images 3 Number of images 35 For the 2nd reconstruction the Autoload into MPRthick Range on the 3D Card is activated The images will be automatically loaded into 3D MPRthick and a coronal MPRthick Range will pop up Please notice if you are not satisfied with the...

Page 76: ...s 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 Head 76 ...

Page 77: ...emale 0 8 mSv Female 1 8 mSv PosteriorFossaOptimization Filter PFO To reduce beam hardening artifacts in head images particularly in the base of the skull use the Posterior Fossa Optimization PFO filter If you want to set up the scan with only one range i e either 12 x 0 75 mm or 12 x 1 5 mm you can easily delete one mode by clicking the chronicle with the right mouse button and select cut Contras...

Page 78: ...dications Spiral mode for routine head studies e g stroke brain tumors cranial trauma cerebral atrophy hydro cephalus and inflammation etc Two ranges are predefined for the base of the skull and cerebrum Head 78 ...

Page 79: ... Male 1 4 mSv Female 0 9 mSv Female 1 6 mSv PosteriorFossaOptimization Filter PFO To reduce beam hardening artifacts in head images particularly in the base of the skull use the Posterior Fossa Optimization PFO filter If you want to set up the scan with only one range i e either 16 x 0 75 mm or 16 x 1 5 mm you can easily delete one mode by clicking the chronicle with the right mouse button and sel...

Page 80: ...ies using 0 6 mm slice collimation E g Inflammatory changes tumorous processes of pyramids cerebellopontine angle tumors post traumatic changes etc Note UHR mode requires a 250 mm scan FOV And it is mandatory to position the patient in the center of the scan Field of View Head 80 ...

Page 81: ...h 0 6 mm Feed Scan 1 0 mm Rotation time 1 0 sec Kernel U90u Image order ca cr CTDIw 39 6 mGy Effective dose Male 0 6 mSv Female 0 6 mSv For image reconstruction of soft tissue use kernel U30 Contrast medium IV injection Start delay 60 sec Flow rate 2 ml sec Total amount 60 ml 81 ...

Page 82: ...enter of the scan Field of View Head InnerEarSpi kV 120 Effective mAs 120 Slice collimation 0 75 mm Slice width 0 75 mm Feed Rotation 5 0 mm Rotation time 1 0 sec Kernel U90u Increment 0 5 mm Image order ca cr CTDIw 26 9 mGy Effective dose Male 0 4 mSv Female 0 4 mSv The images can be loaded in the 3D Card MPR Select the Range function and a predefined range linked to the series will pop up Please...

Page 83: ...struction of soft tissue use kernel U30 MPRthick InnerEarSpi sagittal Image thickness 1 Distance between images 1 Number of images 30 Contrast medium IV injection Start delay 60 sec Flow rate 2 ml sec Total amount 50 ml 83 ...

Page 84: ...on jobs are predefined for image reconstruction of the soft tissue and bone structure Head OrbiSinusSpi 2nd reconstr kV 120 Effective mAs 100 Slice collimation 0 75 mm Slice width 4 0 mm 1 0 mm Feed Rotation 5 0 mm Rotation time 0 75 sec Kernel H30s H60s Increment 4 0 mm 0 7 mm Image order ca cr CTDIw 22 4 mGy Effective dose Male 0 8 mSv Female 0 8 mSv 84 ...

Page 85: ...yes closed This will reduce the possibility of small streak artifacts from eye movement If the study is focused on bone structure only you can reduce the mAs to 20 MPRthick OrbiSinusSpi coronal Image thickness 3 Distance between images 3 Number of images 30 The 2nd reconstruction can be loaded in the 3D Card MPR Select the Range function and a predefined range linked to the series will pop up Plea...

Page 86: ...86 Neck Overview AngioCarotid For CTA studies NeckRoutine For routine soft tissue studies ThinSliceSpi For soft tissue thin slice studies ...

Page 87: ...e reconstruction of bone structure use kernel B60 In case of 3D study only the mAs value can be reduced by 50 Use kernel B10 and 50 overlapping for image reconstruction For multiple ranges of cervical spine studies simply click on the chronicle with right mouse button and select Repeat For examinations in the Neck Shoulder region at least 120 kV is recommendable for optimized image quality For lar...

Page 88: ...rotid Indications Noninvasive CT angiography of carotid stenosis or occlusions plaques course abnormalities of the carotids and vertebral arteries etc A range of 20 cm including the aorta arch will be covered in 8 9 s ...

Page 89: ...e aortic arch with triggering threshold of 120 HU or use manual triggering MIPthin AngioCarotid coronal Image thickness 3 Distance between images 3 Number of images 20 For the 2nd reconstruction the Autoload into MIPthin Range on the 3D Card is activated The images will be automatically loaded into 3D MIPthin and a coronal MIPthin Range will pop up Please notice if you are not satisfied with the R...

Page 90: ...Neck NeckRoutine Indications For soft Tissue studies in the cervical region E g tumors lymphoma abscesses etc A typical range of 20 cm will be covered in 7 2 s 90 ...

Page 91: ... images The thoracic girdle should be positioned as far as possible in the caudal direction This can be done using a strap with a permanent loop or Velcro fastener at its end The ends of the strap must be attached to the patients wrists Then the strap must be wrapped around the patients feet with his legs extended and under tension The entire thoracic girdle is thus pulled toward the patients feet...

Page 92: ...lices for soft tissue studies E g the functional study of the throat Two recon jobs are predefined thinner slice recon struction used for post processing and thicker slice reconstruction for soft tissue A typical range of 16 cm will be covered in 10 9 s 92 ...

Page 93: ...n and reconstruct the images with 1 mm slice width and increment of 0 7 mm for performing MPRs This would help differ entiate tumor lesions from normal pharyngeal mucosa MPRthick ThinSliceSpi sagittal Image thickness 3 Distance between images 3 Number of images 20 The 2nd reconstruction can be loaded in the 3D Card MPR Select the Range function and a predefined MPR range linked to the series will ...

Page 94: ...94 Shoulder Overview ShoulderSpi Spiral mode for HiRes bone studies and soft tissues ...

Page 95: ...lat against his body If only one side is under investiga tion position this side 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 in the comment line For examinations in the Shoulder region at least 120 kV is recommendable for optimized image quality For large patients 140 kV is advisable ...

Page 96: ...r ShoulderSpi Indications Spiral mode for HiRes bone studies and soft tissues E g evaluation of joint cavities masses trauma dislocations orthopedic indications etc A scan range of 15 cm will be covered in 17 9 s ...

Page 97: ...get region if necessary The first reconstruction is used for soft tissue images kernel B30 and slice width 5 mm The second recon struction is used for bone studies kernel B60 and slice width 1 mm MPRthick ShoulderSpi coronal Image thickness 2 Distance between images 2 Number of images 25 The 2nd reconstruction can be loaded in the 3D Card MPR Select the Range function and a predefined MPR range li...

Page 98: ...alization of pulmonary nodules PulmonaryEmboli Spiral mode for Pulmonary Emboli studies ThoraxCombi For the combination of thin slice lung and routine thorax studies ThoraxRoutine For routine thorax studies ThoraxHires Spiral mode for HiRes lung studies ThoraxSeq HR Sequence mode for HiRes lung studies ...

Page 99: ...be used to optimize the bolus timing Set the ROI for monitoring scan in the aorta at the level of the diaphragm with triggering threshold of 120 HU or use manual triggering For image reconstruction of mediastinum use kernel B30 For image reconstruction of the lung use kernel B80 If the voltage is lowered from 120 kV to 80 kV substantially higher mAs values have to be used at least by a factor of 2...

Page 100: ...LungLowDose Indications Lung studies with low dose setting e g early visuali zation of pulmonary nodules A typical thorax study in a range of 30 cm will be covered in 8 9 s 100 Thorax ...

Page 101: ...TDIw 1 6 mGy Effective dose Male 0 6 mSv Female 0 7 mSv 101 You could repeat the same protocol simply by clicking the chronicle with the right mouse button for repeat E g when both non contrast and contrast studies are required For lung cancer staging this protocol can be combined with protocol Neck Routine Contrast medium IV injection Start delay 30 sec Flow rate 2 5 ml sec Total amount 50 70 ml ...

Page 102: ...dications For Pulmonary Emboli studies There are two recon jobs predefined The first one with 5 mm slice thickness the second reconstruction with 1 mm slice thickness A range of 30 cm will be covered in 10 6 s 102 Thorax ...

Page 103: ...f B80f Increment 5 0 mm 0 7 mm Image order cr ca CTDIw 7 8 mGy Effective dose Male 3 0 mSv Female 3 9 mSv 103 CARE Bolus may be used to optimize the bolus timing Set the ROI for monitoring scan in the truncus pulmonalis with triggering threshold of 120 HU or use manual triggering Contrast medium IV injection Start delay 12 15 sec Total amount 100 120 ml Thorax ...

Page 104: ...tine thorax studies with one spiral scan E g thorax studies in general and interstitial changes in the lungs There are two recon jobs predefined The first one with 5 mm slice thickness for the mediastinum the second reconstruction with 1 mm slice thickness for the lung ...

Page 105: ...mm instead of 0 7 mm as predefined simply change the increment before image reconstruction MPRthick ThoraxCombi coronal Image thickness 3 Distance between images 3 Number of images 60 The 2nd reconstruction can be loaded in the 3D Card MPR Select the Range function and a predefined range linked to the series will pop up Please notice if you are not satisfied with the Range preset adapt the paramet...

Page 106: ...Thorax ThoraxRoutine Indications Routine studies for the region of thorax e g screening of tumors metastases lymphoma lymph nodes vascular anomalies etc A range of 30 cm will be covered in 5 6 s 106 ...

Page 107: ... mGy Effective dose Male 2 8 mSv Female 3 6 mSv You could repeat the same protocol simply by clicking the chronicle with the right mouse button for repeat E g when both non contrast and contrast studies are required For lung cancer staging this protocol can be combined with protocol Neck Routine Contrast medium IV injection Start delay 25 30 sec Flow rate 2 5 ml sec Total amount 80 ml 107 ...

Page 108: ...interstitial changes in the lungs or peripheral emboli Two recon jobs are predefined thinner slice recon struction used for post processing and thicker slice reconstruction for soft tissue A range of 30 cm for the complete thorax will be covered in 17 6 s ...

Page 109: ...lies for peripheral emboli studies In this case you should reconstruct images with kernel B30 and use mediastinum window for image display MPRthick ThoraxHiRes coronal Image thickness 2 Distance between images 2 Number of images 70 The 2nd reconstruction can be loaded in the 3D Card MPR Select the Range function and a predefined range linked to the series will pop up Please notice if you are not s...

Page 110: ...110 Thorax ThoraxSeqHiRes Indications Sequence mode for HiRes lung studies E g interstitial changes in the lungs Images are acquired in 15 mm intervals ...

Page 111: ...width 1 0 mm Feed Scan 15 0 mm Rotation time 0 75 sec Kernel B80f Image order cr ca CTDIw 1 1 mGy Effective dose Male 0 1 mSv Female 0 1 mSv If you want to reconstruct thin slices in every 10 or 20 mm instead of 15 mm as predefined simply change the Feed Scan before loading the mode ...

Page 112: ...outine For routine abdominal studies AbdThinSlice For abdomen thin slice studies AbdMultiPhase For combination of CTA and two phases soft tissue studies AngioFast For long range CTA studies AngioRoutine For CTA routine studies ...

Page 113: ...agents can be used Diluted barium suspension 1 2 e g EZCAT Water soluble agent 2 4 e g Gastrografin Water itself as a negative contrast agent Timing of the oral contrast administration is important to ensure its even distribution in the bowels Upper abdomen Minimum 600 ml of contrast divided into 3 cups approximately 200 250 ml 1st cup to drink 30 minutes before exam 2nd cup to drink 15 minutes be...

Page 114: ...performed easily afterwards For patients with bowel obstruction only water or water soluble contrast can be used Barium suspension is contraindicated Be careful when examining pheochromocytoma patients Administration of an IV CM injection in such cases may trigger a hypertensive crisis For more information regarding the general use of drugs and doses including specific indications and contraindica...

Page 115: ...115 Abdomen ...

Page 116: ...tions All routines in the region of abdomen e g screening follow up examinations etc A complete abdomen pelvis scan in a range of 40 cm will be covered in 8 9 s and a typical liver scan in a range of 20 cm will be covered in 4 5 s ...

Page 117: ...ncrement 5 0 mm Image order cr ca CTDIw 10 0 mGy Effective dose Male 5 8 mSv Female 8 9 mSv You could repeat the same protocol simply by clicking the chronicle with the right mouse button for repeat E g when both non contrast and contrast studies are required Contrast medium IV injection Start delay 50 60 sec Flow rate 4 0 ml sec Total amount 100 ml ...

Page 118: ...or soft tissue studies E g a range of 20 cm for liver pancreas or kidneys will be covered in 8 9 s Two recon jobs are predefined thinner slice recon struction used for post processing and thicker slice reconstruction for soft tissue 118 Abdomen ...

Page 119: ...trast medium as this impairs the editing of MIP SSD VRT images Water could be used instead if necessary You can repeat the same protocol simply by clicking the chronicle with the right mouse button for repeat E g when both non contrast and contrast studies are required MPRthick AbdThinSlice coronal Image thickness 3 Distance between images 3 Number of images 50 The 2nd reconstruction can be loaded...

Page 120: ... in 4 8 s for venous phase image recon structed in 5 mm for soft tissue only 120 Abdomen Native Arterial Venous phase phase kV 120 120 120 Effective mAs 120 140 120 Slice collimation 1 5 mm 0 75 mm 1 5 mm Slice width 5 0 mm 5 0 mm 5 0 mm 1 0 mm Feed Rotation 24 0 mm 12 0 mm 24 0 mm Rotation time 0 5 sec 0 5 sec 0 5 sec Kernel B30f B30f B30f Increment 5 0 mm 5 0 mm 5 0 mm 0 7 mm Image order cr ca c...

Page 121: ...oronal Image thickness 3 Distance between images 3 Number of images 50 For the 2nd reconstruction of the Arterial Phase the Autoload into the MIPthin Range on the 3D Card is acti vated The images will be automatically loaded into 3D MIPthin and coronal MIPthin Range will pop up Please notice if you are not satisfied with the Range preset adapt the parameters to your needs and link them to the seri...

Page 122: ...AngioFast Indications Long range CTA studies E g a typical study of the whole aorta including its branchiocephalic trunk and iliac arteries in a range of 80 cm will be covered in 19 6 s 122 Abdomen ...

Page 123: ...g scan in the abdo minal aorta at the beginning of the scan range with triggering threshold of 120 HU or use manual triggering MIPthin AngioFast sagittal Image thickness 3 Distance between images 3 Number of images 60 For the 2nd reconstruction the Autoload into the MIPthin Range on the 3D Card is activated The images will be automatically loaded into 3D MIPthin and sagittal MIPthin Range will pop...

Page 124: ...AngioRoutine Indications For abdominal CTA studies E g a typical study of renal arteries in a range of 40 cm will be covered in 13 9 s 124 Abdomen ...

Page 125: ...n in the abdo minal aorta at the beginning of the scan range with triggering threshold of 120 HU or use manual triggering MIPthin AngioRoutine sagittal Image thickness 3 Distance between images 3 Number of images 60 For the 2nd reconstruction the Autoload into the MIPthin Range on the 3D Card is activated The images will be automatically loaded into 3D MIPthin and sagittal MIPthin Range will pop u...

Page 126: ...126 Pelvis Overview HipSpi Spiral mode for HiRes bone and soft tissue studies of the Hip PelvisRoutine Spiral mode for routine pelvis studies ...

Page 127: ...ectal contrast medium administration Rectal contrast media is usually required to delineate the rectum and sigmoid colon if lower pelvic mass or pathology is suspected In some cases air may be substituted for a positive contrast agent The use of vaginal tampon may be helpful in adult female patients with suspected pelvis pathology For Pelvis examination we recommend at least 120 kV For obese patie...

Page 128: ...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 9 5 s ...

Page 129: ...ed up to 50 images should be reconstructed with 50 over lapping and kernel B10 If only one side is examined it is advisable to enter the side in the comment line MPRthick HipSpi coronal Image thickness 2 Distance between images 3 Number of images 30 The 2nd reconstruction can be loaded in the 3D Card MPR Select the Range function and a predefined range linked to the series will pop up Please notic...

Page 130: ... Pelvis PelvisRoutine 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 4 8 s ...

Page 131: ... Kernel B30f Increment 5 0 mm Image order cr ca CTDIw 9 8 mGy Effective dose Male 3 3 mSv Female 4 8 mSv If the examination performed requires a full urinary bladder wait at least 3 minutes following IV admini stration of the contrast medium Contrast medium IV injection Start delay 50 sec Flow rate 2 0 3 0 ml sec Total amount 100 120 ml ...

Page 132: ...ne Overview RoutineSeq Sequence mode for routine spine studies ObeseSeq Sequence mode for studies of obese patients SpineSpi Spiral mode for spine studies ThinSliceSpi Thin slice spiral mode for spine studies ...

Page 133: ...ar studies place a cushion under the patients knee This will reduce the curve in the spine and also make the patient more comfortable For image reconstruction of bone study use kernel B60 The CT scan following myelography must be per formed 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 g...

Page 134: ...se degenerative changes trauma tumors etc RoutineSeq kV 120 Effective mAs 200 Slice collimation 0 75 mm Slice width 1 5 mm Feed Scan 9 0 mm Rotation time 1 0 sec Kernel B30s Cycle time 3 0 sec Image order cr ca CTDIw 16 8 mGy Effective dose Male 0 4 0 5 mSv Female 0 7 1 5 mSv ...

Page 135: ...ose are needed e g prolapse degenerative changes trauma tumors etc ObeseSeq kV 120 Effective mAs 400 Slice collimation 0 75 mm Slice width 1 5 mm Feed Scan 9 0 mm Rotation time 1 5 sec Kernel B30s Cycle time 3 0 sec Image order cr ca CTDIw 33 6 mGy Effective dose Male 0 7 0 9 mSv Female 1 4 2 9 mSv ...

Page 136: ...nges trauma tumors etc A range of 20 cm will be covered in 12 1 s SpineSpi kV 120 Effective mAs 300 Slice collimation 1 5 mm Slice width 3 0 mm Feed Rotation 13 5 mm Rotation time 0 75 sec Kernel B20f Increment 3 0 mm Image order cr ca CTDIw 21 6 mGy Effective dose Male 6 0 mSv Female 10 2 mSv ...

Page 137: ...rement 3 0 mm 0 6 mm Image order cr ca CTDIw 27 7 mGy Effective dose Male 6 6 mSv Female 13 2 mSv MPRthick ThinSliceSpi sagittal Image thickness 3 Distance between images 3 Number of images 20 For the 2nd reconstruction the Autoload into the MPR Range on the 3D Card is activated The images will be automatically loaded into 3D MPR and a coronal MPRthick Range will pop up Please notice if you are no...

Page 138: ...nge CTA studies CombiSpi Combination for HiRes bone and soft tissue studies ExtrUHRSeq Spiral mode for bone ultra high resolution studies using 0 6 mm collimation ExtrUHRSpi Spiral mode for bone ultra high resolution studies using 0 75 mm collimation ...

Page 139: ...acing Bocollo pillows between knees and feet bind feet together The only exceptions are extremely light patients The latter can remove the leg not being examined from the gantry by bending it 90 at the hip and the knee and placing the bottom of the same foot against the gantry casing c For ankle and feet scan Patient lying in supine position feet first Bind both ankles together if necessary to ass...

Page 140: ...4 s AngioRunOff 2nd reconstr kV 120 Effective mAs 130 Slice collimation 1 5 mm Slice width 6 0 mm 2 0 mm Feed Rotation 24 0 mm Rotation time 0 5 sec Kernel B30s B20s Increment 6 0 mm 1 5 mm Image order cr ca cr ca CTDIw 9 1 mGy Effective dose Male 4 4 mSv Female 3 2 mSv Extremities ...

Page 141: ...soft tissue done by the first reconstruction If the Pelvis region is included in the scan range we recommend at least 120 kV MIPthin AngioRunOff coronal Image thickness 3 Distance between images 3 Number of images 50 For the 2nd reconstruction the Autoload into the MIPthin Range on the 3D Card is activated The images will be automatically loaded into 3D MIPthin and coronal MIPthin Range will pop u...

Page 142: ...142 CombiSpi Indications Combination for HiRes bone and soft tissue studies E g masses trauma disorders of the joint etc Extremities ...

Page 143: ... 6 mGy Effective dose Male 0 01 mSv Female 0 01 mSv MPRthick CombiSpi coronal Image thickness 2 Distance between images 2 Number of images 30 The 2nd reconstruction can be loaded in the 3D Card MPR Select the Range function and a predefined range linked to the series will pop up Please notice if you are not satisfied with the Range preset adapt the parameters to your needs and link them to the ser...

Page 144: ...ndications Sequence mode for ultra HiRes bone study E g trauma orthopedic indications etc Note UHR mode requires a 250 mm scan FOV and it is mandatory to position the patient in the center of the scan field Extremities ...

Page 145: ...01 mSv MPRthick ExtrUHRSeq coronal Image thickness 2 Distance between images 2 Number of images 30 The 2nd reconstruction can be loaded in the 3D Card MPR Select the Range function and a predefined range linked to the series will pop up Please notice if you are not satisfied with the Range preset adapt the parameters to your needs and link them to the series For image reconstruction of soft tissue...

Page 146: ...Indications Spiral mode for ultra HiRes bone study E g trauma orthopedic indications etc Note UHR mode requires a 250 mm scan FOV and it is mandatory to position the patient in the center of the scan field Extremities ...

Page 147: ...stance between images 2 Number of images 30 This protocol is used for ultra high resolution studies It is not recommended to use this protocol for 3D studies For image reconstruction of soft tissue use kernel U30 The 2nd reconstruction can be loaded in the 3D Card MPR Select the Range function and a predefined range linked to the series will pop up Please notice if you are not satisfied with the R...

Page 148: ...cal Siemens Sales Representative for the most current information Note Original images always loose a certain amount of detail when reproduced Siemens AG Medical Solutions Computed Tomography Siemensstrasse 1 D 91301 Forchheim Germany www SiemensMedical com Order No A91100 M2100 A726 1 7600 Printed in Germany CC 63726 BA 06023 ...

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