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41

HeartView CT

CoronaryCARE0.5s

Indications:

This is a spiral scanning protocol, using a Rotation
Time of 0.5 s, ECG gating technique and a dedicated
cardiac filter which can reduce images noise thus
makes the dose reduction possible for coronary CTA
studies.

Topogram: 
AP, 512 mm.
Approximately, from
the carina until the
apex of the heart.
A typical range of 
12 cm covering the
entire heart can 
be done in 18.4 s.

CoronaryCARE0.5s

kV

120

Effective mAs

267

Slice collimation

0.75 mm

Slice width

1 mm

Feed/Rotation

3.4 mm

Rotation time

0.5 sec.

Temporal resolution

Up to 125 ms*

Kernel

B30f

Increment

0.5 mm

Image order

cr-ca

CTDI

w

22.4 mGy

Effective dose

Male: 3.8 mSv
Female: 5.5 mSv

* Depends on heart rate.

Summary of Contents for SOMATOM Sensation Cardiac Version A60

Page 1: ...SOMATOM Sensation Cardiac Application Guide Software Version A60 ...

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

Page 3: ...3 3 Overview General 8 HeartView CT 22 Bolus Tracking 54 WholeBodyAngio 62 LungCARE 64 CT Colonography 66 Children 68 Head 88 Neck 98 Thorax 102 Abdomen 112 Extremities 124 ...

Page 4: ...econstruction 9 Slice Collimation and Slice Width 9 Pitch 10 Recon Job 11 Kernels 11 Image Filter 11 Effective mAs 12 Dose Information 13 CARE Dose 16 How does it work 16 Workflow 18 Contrast Medium IV Injection 19 How to Create your own Scan Protocols 20 ...

Page 5: ...E 29 CardioSharp 29 How to do it 30 Calcium Scoring 30 Hints in General 30 Placement of ECG Electrodes 31 CaScoreSpiStd 32 CaScoreSpiStd0 5s 33 CaScoreSeqStd 34 Coronary CTA 35 General Hints 36 CoronaryStd 37 CoronaryStd0 5s 38 CorStd_LowHeartRate 39 CoronaryCARE 40 CoronaryCARE0 5s 41 CoronarySharp 42 CoronarySharp0 5s 44 ECGTrigCTA 46 Aortic and Pulmonary Studies 48 General Hints 48 PulmonaryECG...

Page 6: ...ion 60 WholeBodyAngio 62 LungCARE 64 CT Colonography 66 Children 68 Hints in General 69 HeadSpi05s 72 HeadSeq0 5s 74 HeadAngio 76 CarotidCTA 78 NeonateBody 80 ChestRoutine 82 AbdPelRoutine 84 AbdCTA 86 Head 88 Overview 88 Hints in General 89 Angio Head 90 AngioThinSlice 92 HeadSeq0 5s 94 HeadSpi0 5s 96 Neck 98 Overview 98 Hints in General 99 AngioCarotid 100 ...

Page 7: ...al 103 LungLowDose 104 PulmonaryEmboli 106 ThoraxCombi 108 ThoraxRoutine 110 Abdomen 112 Overview 112 Hints in General 113 AbdRoutine 116 AngioFast 118 AngioRoutine 120 AbdomenSeq 122 Extremities 124 Overview 124 Hints in General 125 AngioRunOff 126 ...

Page 8: ...ies ThinSlice uses 0 75 mm slice collimation for thin slice studies Combi uses 0 75 mm as slice collimation and reconstruct images as both thinner slice width for HiRes or CTA and thicker slice width for soft tissue studies Seq stands for Sequence E g HeadSeq means the sequence mode for the head Spi stands for Spiral E g HeadSpi means the spiral mode for the head Scan Set Up Scans can be simply se...

Page 9: ...you On the SOMATOM Sensation Cardiac some slice widths are marked as fast blue background These images will be reconstructed with highest performance up to 6 10 images per second All others will be recon structed with up to 3 images per second The reconstruction time depends on slice collimation and the reconstructed slice width To get the fast performance slice width has to be at least 3 times th...

Page 10: ... collimation 5 mm table moves 5 mm per rotation then pitch 1 With the SOMATOM Sensation Cardiac in Siemens Multislice CT we differentiate between Feed Rotation the table movement per rotation Volume Pitch the table movement per rotation single slice collimation E g single slice collimation 1 5 mm table moves 24 mm per rotation then the Volume Pitch 16 Pitch Factor the table movement per rotation c...

Page 11: ...ou click Recon Kernels There are 5 different types of kernels H stands for Head B stands for Body and C stands for ChildHead The image sharpness are defined by the numbers the higher the number the sharper the image the lower the number the smoother the image Note Do not use different kernels for other body parts than designed for Image Filter There are 4 different filters available PFO To reduce ...

Page 12: ...asier 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 Cardiac you simply have to multiply the CTDIw per mAs with the effective mAs of the scan Dspiral DCTDIw x effective mAs Fo...

Page 13: ...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 com plica...

Page 14: ... i e different exams associated with the same effective dose would have the same radiation risk for the patient It also allows comparing the applied x ray exposure to the natural background radiation e g 2 3 mSv per year in Germany For most of our scan protocols we calculated the effective dose numbers for standard male and female and listed the result in the description of each scan protocol The ...

Page 15: ...version and ICRP60 currently valid Please note Effective dose values were calculated with the WinDose Software Version 2 1 which was optimized for SOMATOM Volume Zoom scanners SOMATOM Sensation Cardiac has modified shaped filters which might cause slightly different effective dose numbers difference not expected to be more than 5 An update of WinDose for the SOMATOM Sensation Cardiac is currently ...

Page 16: ...ends the capacity for volume scanning with thinner slices 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 1 This is done on the fly i e the scann...

Page 17: ...s 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 lateral 1 00 0 75 0 50 0 25 rel units a p time Object attenuation Modulated tube current ...

Page 18: ...y to create for MPR and MIPthin Range Parallel and Radial protocols which can be linked to a special series For example if you always do some sagittal Multipla nar 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 b...

Page 19: ... 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 20: ...an protocol Set the table position to 0 either at the gantry panel or on the topogram routine card Modify the scan protocol change parameters add new ranges etc Do not load the scan protocol Select Edit Save Scan Protocol in the main menu Select the organ region and the scan protocol name in the pop up dialog You can either use the same name to modify the existing scan protocol or enter a new name...

Page 21: ...ocol names Don t rename scan protocol files on Windows NT level this will lead to inconsistencies Do not mix head and body scan protocols e g do not save a head mode in the abdomen directory System Run offers the tool Restore Default Scan Protocols which allows one to remove user specific scan protocols and to restore the Siemens default settings System Edit offers save delete Scan Protocols Syste...

Page 22: ...e superior and inferior vena cava and pumps it into the right ventricle Right ventricle receives the deoxygenated blood from the right atrium and pumps it into the pulmo nary circulation through the pulmonary arteries Left atrium receives the oxygenated blood back from the pulmonary circulation through the pulmo nary veins and pumps it into the left ventricle Left ventricle receives the oxygenated...

Page 23: ...th atria Fig 2 Atria contract blood enters ventricles A Aorta P Pulmonary Artery RV Right Ventricle LV Left Ventricle RA Right Atrium LA Left Atrium Fig 3 Ventricles contract blood enters into aorta and pulmonary arteries RA LA A P RV LV ...

Page 24: ...y artery supplies blood to the left atrium left ventricle and a large part of the ventricular septum SVC Superior Vena Cava IVC Inferior Vena Cava RA Right Atrium RV Right Ventricle A Aorta PA Pulmonary Artery Fig 4 Front view Fig 5 Conventional Angiography LM Left Main Artery LAD Left Anterior Descending Artery Cx Circumflex Artery Fig 6 Front view Fig 7 Conventional Angiography RV PA RA A IVC SV...

Page 25: ...mage acquisition or retrospective reconstruction based on the ECG recording in order to produce the image during the diastolic phase when the least motion happens Temporal Resolution Temporal resolution also called time resolution represents the time window of the data that is used for image reconstruction It is essential for cardiac CT imaging the higher the temporal resolution the fewer the moti...

Page 26: ... and used to either initiate prospective image acquisition ECG triggering or to perform retrospective image reconstruction ECG gating A given temporal relation relative to the R waves is predefined and can be applied with the following possibilities Relative delay a given percentage of R R interval _RR relative to the onset of the previous or the next R wave Fig 9 10 Time Time ECG t ECG t 50 of R ...

Page 27: ...tion Preview series can be used to define the optimal time window before the full series is reconstructed Click on the preview series button in the Trigger card The slice position of the preview series is based on the currently displayed image in the tomogram segment which has to be chosen by the user Fig 11 Time Estimated R Peak ECG t 400 msec Scan Recon Fig 12 Time ECG t 400 msec Scan Recon ...

Page 28: ... Disable Insert To reset the ECG curve select the check box Original ECG ECG Pulsing ECG Pulsing is a dedicated technique used for online dose modulation for Cardiac imaging The tube current is ECG controlled and reduced during systolic phases of the cardiac cycle while maintained normal during diastolic phases when best image quality is required As shown in figure 13 essential dose reduction up t...

Page 29: ...ed in a pre defined scan protocol called CoronaryCARE CardioSharp This is a dedicated reconstruction kernel used for better edge definition in coronary artery imaging It is applied in a pre defined cardiac scan protocol called CoronarySharp Image examples are shown in figure 15 Fig 15 Image reconstruction with 15b and without 15a Cardio Sharp kernel 15a 15b ...

Page 30: ...scoring studies To ensure the best image quality and correlation to known reference data other kernels are not recom mended Use the ECG triggered protocol generally except for patients with arrhythmia Use the ECG gated protocol when accuracy and or reproducibility are essential e g follow up studies of calcium scoring or compari son studies with conventional angiography The protocol with 0 42 s Ro...

Page 31: ... clavicular line 6 or 7 intercostal space Red Electrode right mid clavicular line 6 or 7 intercostal space Placement of ECG Electrodes Europe Version IEC standard Red Electrode on the right mid clavicular line directly below the clavicle Yellow Electrode on the left mid clavicular line 6 or 7 intercostal space Black Electrode right mid clavicular line 6 or 7 intercostal space ...

Page 32: ...12 mm From the carina until the apex of the heart A typical range of 15 cm covering the entire heart can be done in 11 6 s CaScoreSpiStd kV 120 Effective mAs 133 Slice collimation 1 5 mm Slice width 3 mm Feed Rotation 5 7 mm Rotation time 0 42 sec Temporal Resolution Up to105 ms Kernel B35f Increment 1 5 mm Image order cr ca CTDIw 9 6 mGy Effective Dose Male 2 1 mSv Female 3 1 mSv Depends on heart...

Page 33: ...nds Topogram AP 512 mm From the carina until the apex of the heart A typical range of 15 cm covering the entire heart can be done in 11 7 s CaScoreSpiStd0 5s kV 120 Effective mAs 133 Slice collimation 1 5 mm Slice width 3 mm Feed Rotation 6 8 mm Rotation time 0 5 sec Temporal Resolution Up to125 ms Kernel B35f Increment 1 5 mm Image order cr ca CTDIw 9 6 mGy Effective Dose Male 2 1 mSv Female 3 1 ...

Page 34: ... 1 5 mm Slice width 3 mm Feed Rotation 18 mm Rotation time 0 42 sec Temporal resolution 210 ms Kernel B35f Image order cr ca CTDIw 2 2 mGy Effective Dose Male 0 5 mSv Female 0 7 mSv If you apply API for image acquisition please make sure that the breathhold interval in the Patient Model Dialog is longer than the total scan time e g 50 s otherwise the image acquisition will be interrupted by the de...

Page 35: ...ate below 50 bpm CoronaryCARE Spiral scanning protocol with rotation time 0 42 s and dedicated cardiac filter Cardio CARE which reduces image noise thus makes dose reduction possible CoronaryCARE0 5s Spiral scanning protocol with rotation time 0 5 s and dedicated cardiac filter Cardio CARE which reduces image noise thus makes dose reduction possible CoronarySharp Spiral scanning protocol with rota...

Page 36: ... speaking the ECG gated protocol is recom mended for premium image quality of the coronary arteries and whenever 3D postprocessing such as MPR MIP VRT or Fly Through is required Always use the ECG gated protocol for patients with arrhythmia ...

Page 37: ...y from the carina until the apex of the heart A typical range of 12 cm covering the entire heart can be done in 18 7 s CoronaryStd kV 120 Effective mAs 500 Slice collimation 0 75 mm Slice width 1 mm Feed Rotation 2 8 mm Rotation time 0 42 sec Temporal resolution Up to 105 ms Kernel B30f Increment 0 5 mm Image order cr ca CTDIw 42 0 mGy Effective dose Male 7 0 mSv Female 10 2 mSv Depends on heart r...

Page 38: ...y from the carina until the apex of the heart A typical range of 12 cm covering the entire heart can be done in 18 4 s CoronaryStd0 5s kV 120 Effective mAs 500 Slice collimation 0 75 mm Slice width 1 mm Feed Rotation 3 4 mm Rotation time 0 5 sec Temporal resolution Up to 125 ms Kernel B30f Increment 0 5 mm Image order cr ca CTDIw 42 0 mGy Effective dose Male 7 0 mSv Female 10 2 mSv Depends on hear...

Page 39: ...pogram AP 512 mm Approximately from the carina until the apex of the heart A typical range of 12 cm covering the entire heart can be done in 23 7 s CoronaryStdLow kV 120 Effective mAs 500 Slice collimation 0 75 mm Slice width 1 0 mm Feed Rotation 2 2 mm Rotation time 0 42 sec Temporal resolution Up to 105 ms Kernel B30f Increment 0 5 mm Image order cr ca CTDIw 42 0 mGy Effective dose Male 7 0 mSv ...

Page 40: ...TA studies Topogram AP 512 mm Approximately from the carina until the apex of the heart A typical range of 12 cm covering the entire heart can be done in 18 7 s CoronaryCARE kV 120 Effective mAs 267 Slice collimation 0 75 mm Slice width 1 mm Feed Rotation 2 8 mm Rotation time 0 42 sec Temporal resolution Up to 105 ms Kernel B30f Increment 0 5 mm Image order cr ca CTDIw 22 4 mGy Effective dose Male...

Page 41: ...TA studies Topogram AP 512 mm Approximately from the carina until the apex of the heart A typical range of 12 cm covering the entire heart can be done in 18 4 s CoronaryCARE0 5s kV 120 Effective mAs 267 Slice collimation 0 75 mm Slice width 1 mm Feed Rotation 3 4 mm Rotation time 0 5 sec Temporal resolution Up to 125 ms Kernel B30f Increment 0 5 mm Image order cr ca CTDIw 22 4 mGy Effective dose M...

Page 42: ...pogram AP 512 mm Approximately from the carina until the apex of the heart A typical range of 12 cm covering the entire heart can be done in 18 7 s CoronarySharp kV 120 Effective mAs 500 Slice collimation 0 75 mm Slice width 1 mm Feed Rotation 2 8 mm Rotation time 0 42 sec Temporal resolution Up to 105 ms Kernel B46f Increment 0 5 mm Image order cr ca CTDIw 42 0 mGy Effective dose Male 7 0 mSv Fem...

Page 43: ...43 HeartView CT ...

Page 44: ...pogram AP 512 mm Approximately from the carina until the apex of the heart A typical range of 12 cm covering the entire heart can be done in 18 4 s Depends on heart rate CoronarySharp0 5s kV 120 Effective mAs 500 Slice collimation 0 75 mm Slice width 1 mm Feed Rotation 3 4 mm Rotation time 0 5 sec Temporal resolution Up to 125 ms Kernel B46f Increment 0 5 mm Image order cr ca CTDIw 42 0 mGy Effect...

Page 45: ...45 HeartView CT Fig 1 Image reconstruction with a and without b Cardio Sharp kernel a b ...

Page 46: ...athhold acquisition please make sure that the breathhold interval in the Patient Model Dialog is longer than the total scan time e g 50 s otherwise the image acquisition will be interrupted by the default breathhold interval This does not apply when API is not activated For longer ranges e g the entire thoracic aorta that can not be acquired within a single breathhold please ensure that the breath...

Page 47: ...TA kV 120 Effective mAs 120 Slice collimation 1 5 mm Slice width 1 5 mm Feed Scan 18 mm Rotation time 0 42 sec Temporal resolution 210 ms Kernel B30f Image order cr ca CTDIw 8 64 mGy Effective dose Male 1 5 mSv Female 2 2 mSv ...

Page 48: ...ary Studies The following scan protocol is predefined PulmonaryECG Spiral scanning protocol with ECG gating General Hints The PulmonaryECG protocol is recommended for aortic or pulmonary studies e g aorta dissection or pulmonary emboli ...

Page 49: ...CG kV 120 Effective mAs 200 Slice collimation 1 5 mm Slice width 3 0 mm Feed Rotation 5 6 mm Rotation time 0 42 sec Temporal resolution Up to 105 ms Kernel B30f Increment 2 0 mm Image order cr ca CTDIw 14 4 mGy Effective dose Male 5 7 mSv Female 7 3 mSv Topogram AP 512 mm From the aorta arch until the tip of the sternum A typical range of 30 cm can be covered in 23 s Depends on heart rate ...

Page 50: ... protocols Fig 1 and 2 And it is recommended to keep it always activated for examinations with contrast medium In case of ECG signal loss during the acquisition this will ensure the continuation of the triggered scans or allows an ECG to be simulated for retrospective gating If it is deactivated the scanning will be aborted in case of ECG signal loss during the acquisition Fig 2 Fig 1 ...

Page 51: ...r bi phase image reconstruction The image temporal resolution of 105 ms can be achieved with ACV By default it is switched on for all coronary CTA scan protocols and switched off for all calcium scoring scan protocols And it is not recommend to change this default setting Fig 3 ...

Page 52: ...y CTA examination you load once the images into the 3D Card Select the image type e g MIPthin and the orientation and then open the Range Parallel function Adapt the range settings Image thickness Distance between the images etc hit the link button and save From now on you have a predefined post processing protocol linked to the series description of a coronary CTA examination Exactly the same can...

Page 53: ...or easier identification of small lesions you can blowup the display 5 You can customize hospital office information on the final report using Report Configuration 6 You can generate HTML report including site spe cific information free text and clinical images This then can be saved on floppy disc and or printed 7 The results are displayed online in a separate segment including the following info...

Page 54: ...nitiate the acquisition with the correct start delay Since Multislice spiral CT can provide much faster speed and shorter acquisition time it is even more critical to get the right timing to achieve optimal results Fig 1a 1b The dynamics of the contrast enhancement is determined by Patient cardiac output Injection rate Fig 2a 2b Total volume of contrast medium injected Fig 3a 3b Concentration of t...

Page 55: ... Bi phase 70 ml 4 ml s plus 70 ml 2 ml s 370 mg I ml Radiology 1998 207 647 655 Relative Enhancement HU Time s 0 20 40 60 80 100 120 300 250 200 150 100 50 0 Relative Enhancement HU Time s 0 20 40 60 80 100 120 300 250 200 150 100 50 0 Relative Enhancement HU Time s 0 20 40 60 80 100 120 400 350 300 250 200 150 100 50 0 Relative Enhancement HU Time s 0 20 40 60 80 100 120 300 250 200 150 100 50 0 ...

Page 56: ...right mouse button in the chronicle This inserts the entire set up including pre monitoring i v bolus and monitoring scan protocol You can also save the entire set up as your own scan protocols please refer to page 20 How to Create your own Scan Protocols 2 The pre monitoring scan is used to determine the level of monitoring scans It can be performed at any level of interest You can also increase ...

Page 57: ...Place an ROI in the premonitoring scan on the target area or vessel used for triggering The ROI is defined with double circles the outer circle is used for easy positioning and the inner circle is used for the actual evaluation You can also zoom the reference image for easier positioning of the ROI 5 Set the appropriate trigger threshold and initiate the contrast injection and monitoring scans at ...

Page 58: ...s mode can be used to test the start delay of an optimal enhancement after the contrast medium injection TestBolus kV 120 Effective mAs 30 Slice collimation 5 0 mm Slice width 10 mm Feed Scan 0 mm Rotation time 0 5 sec Kernel B40f Cycle time 2 s ...

Page 59: ...stered with the same flow rate as during the following spiral scan Start the contrast media injection and the scan at the same time 6 Load the images into the Dynamic Evaluation function and determine the time to the peak enhance ment 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 t...

Page 60: ...ibrium phase 3 The trigger threshold is not an absolute value but a relative value compared to the non contrast scan E g if the CT value is 50 HU in the non contrast image and your trigger level is 100 MU then the absolute CT value in the contrast image will be 150 HU 4 If you change slice collimation rotation time or kV in the spiral scanning protocol after CARE Bolus is inserted a longer spiral ...

Page 61: ... the predefined start delay time E g if the predefined the start delay is 2 s and the API lasts 5 s the spiral will start 5 s after the threshold is reached 6 In case you have to interrupt the monitoring scanning due to injection problem you can repeat it afterwards by inserting CARE Bolus again with a right mouse click The same Topogram can still be used ...

Page 62: ...mm Rotation time 0 5 sec Kernel B30f B20f Increment 6 mm 1 5 mm Image order cr ca The 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 MPRthick WholeBodyAngio coronal Image thickness 3 Distance b...

Page 63: ...63 WholeBodyAngio ...

Page 64: ... 6 mSv Female 0 7 mSv A dedicated low dose Spiral mode for the syngo Lung CARE evaluation 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 We recommend using a tube voltage of at least 120 kV For further information on the syngo Lung CARE Application please refer to the Application Guide...

Page 65: ...65 LungCare ...

Page 66: ...vered in 13 9 s CT Colonography 2nd Reconstr kV 120 Effective mAs 100 Slice collimation 0 75 mm Slice width 5 0 mm 1 0 mm Feed Rotation 15 0 mm Rotation time 0 5 sec Kernel B30f B30f Increment 5 0 mm 0 7 mm Image order cr ca CTDIw 7 8 mGy Effective dose Male 4 5 mSv Female 6 9 mSv ...

Page 67: ...ient The patient has to start with a diet and bowel cleaning two days prior to the examination like for a conventional Colonoscopy Patient examination The bowels can be delineated with air Or if desired with carbon dioxide water or iodine barium suspen sion Have patient inflate colon with air to maximum tolerance To decrease colon spasm e g Buscopan or Glucagon can be given IV Usually a prone and ...

Page 68: ...hs 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 is 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 HeadSpi0 5s For routine head spiral studies HeadSeq0 5s For routine ...

Page 69: ...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 70: ...trast 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 weight shoul...

Page 71: ...e 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 operate at a c...

Page 72: ...jection 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 90 1...

Page 73: ... 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 Children ...

Page 74: ...njection 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 20 8 M...

Page 75: ... 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 Children ...

Page 76: ... 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 77: ...te 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 parameters ...

Page 78: ... width 5 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 ...

Page 79: ...e Access 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...

Page 80: ...ons abscesses etc NeonateBody kV 80 Effective mAs 25 Slice collimation 1 5 mm Slice width 6 0 mm Feed Rotation 24 mm Rotation time 0 5 sec Kernel B30f Increment 6 0 mm Image order cr ca CTDIw 0 55 mGy Effective mAs Male 0 5 mSv Female 0 7 mSv The conversion factor for an 8 week old and a scan range of 150 mm was used ...

Page 81: ...ify 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 ...

Page 82: ...stases lymphoma 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 ...

Page 83: ...t 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 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 F...

Page 84: ...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 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 25 34 kg...

Page 85: ...pon 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 Children ...

Page 86: ... B30f B20f Increment 3 0 mm 0 7 mm Image order cr ca 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 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 87: ...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 88: ...ickness AngioThinSlice For CT Angio studies using 0 75 mm slice collimation and 0 75 mm slice thickness HeadSeq0 5s Sequence mode for base of the skull and cerebrum routine studies and a 0 5 s rotation time HeadSpi0 5s Spiral mode for base of skull and cerebrum routine studies and a 0 5 s rotation time ...

Page 89: ...or spiral scanning 4 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 5 For image reconstruction of bone structure use kernel H60 6 In general cerebrum studies with contrast medium except CTA and nasopharynx can be performed by hand injection Start...

Page 90: ...90 Head 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 ...

Page 91: ... 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 Ra...

Page 92: ...inSlice 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 ...

Page 93: ...rotid 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 ...

Page 94: ...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 ...

Page 95: ...v Female 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 Cont...

Page 96: ...Spi0 5s Indications 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 ...

Page 97: ...Sv Male 1 1 mSv Female 0 8 mSv Female 1 2 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 s...

Page 98: ...98 Neck Overview AngioCarotid For CTA studies ...

Page 99: ...piratory instruction do not breathe do not swallow 4 For image reconstruction of bone structure use kernel B60 5 In case of 3D study only the mAs value can be reduced by 50 Use kernel B10 and 50 over lapping for image reconstruction 6 For examinations in the Neck Shoulder region at least 120 kV is recommendable for optimized image quality For large patients 140 kV is advisable ...

Page 100: ...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 aortic arch will be covered in 8 9 s ...

Page 101: ...he 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 ...

Page 102: ... low dose for special lung studies e g early visualization 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 ...

Page 103: ...y 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 4 For image reconstruction of mediastinum use kernel B30 5 For image reconstruction of the lung use kernel B80 6 If the voltage is lowered from 120 kV to 80 kV significant higher mAs values have to be used at least by a facto...

Page 104: ...104 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 Thorax ...

Page 105: ...f Increment 5 0 mm 0 7 mm Image order cr ca CTDIw 1 6 mGy Effective dose Male 0 6 mSv Female 0 7 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 30 sec Flow rate 2 5 ml sec Total amount 50 70 ml Thorax ...

Page 106: ...i Indications 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 Thorax ...

Page 107: ... 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 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 Flow rate 4 ml sec Total amount 100 120 ml Thorax ...

Page 108: ...ith 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 A range of 30 cm will be covered in 10 6 s ...

Page 109: ...ec Kernel B31f 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 If you want to reconstruct thin slices in every 2 mm or 10 mm instead of 0 7 mm as predefined simply change the increment before image reconstruction Contrast medium IV injection Start delay 25 sec Flow rate 2 5 ml sec Total amount 80 ml ...

Page 110: ...110 Thorax ThoraxRoutine Indications Routine studies for the region of thorax e g screening of tumors metastases lymphoma lymphonodes vascular anomalies etc A range of 30 cm will be covered in 5 6 s ...

Page 111: ... Increment 6 0 mm Image order cr ca CTDIw 7 0 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 Contrast medium IV injection Start delay 25 30 sec Flow rate 2 5 ml sec Total amount 80 ml ...

Page 112: ...112 Abdomen Overview AbdRoutine For routine abdominal studies AngioFast For long range CTA studies AngioRoutine For CTA routine studies AbdomenSeq Sequence mode for 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 4 Timing of the oral contrast administration is impor tant to ensure its even distribution in the bowels 4 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 minu...

Page 114: ...formed easily afterwards For patients with bowel obstruction only water or water soluble contrast can be used Barium suspension is contraindicated 5 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 contraindicat...

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: ...118 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 Abdomen ...

Page 119: ...eshold 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 up Please notice if you are not satisfied with the Range preset adapt the parameters...

Page 120: ...120 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 Abdomen ...

Page 121: ... scan in the abdominal aorta at the beginning of the scan range with trigger ing 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 p...

Page 122: ...enSeq Indications Sequential mode for addomen studies AbdomenSeq kV 120 Effective mAs 140 Slice collimation 5 0 mm Slice width 5 0 mm Feed Scan 10 0 mm Rotation time 0 5 sec Kernel B31f Image order cr ca Abdomen ...

Page 123: ...123 Abdomen ...

Page 124: ...124 Extremities Overview AngioRunOff For long range CTA studies ...

Page 125: ...m for CTA 2 If Topo length 1024 mm is not long enough you can also choose the 1540 mm long Topogram 3 Position the patient as feet first Bend the feet together if necessary 4 If the Pelvis region is included in the scan range we recommend at least 120 kV ...

Page 126: ...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 127: ...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 128: ...ocal Siemens Sales Representative for the most current information 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 2216 1 7600 Printed in Germany BKW 42216 BA 12020 3 ...

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