The Siemens Inno Molecular Imaging Leadership Innovation Leadership For more than 130 years, Siemens Healthcare has been a recognized leader in medical innovation. From the first electromedical devices in 1896 to the latest PET hybrid technologies, we have a long history of pioneering technological achievements that have helped make the A Focus on Return on Innovation Driven by this passion to make a difference, the core of Siemens Molecular Imaging is based upon the assumption that achieving the highest technical performance is only important when it meets the needs of our customers and the patients they serve. To gain a deep understanding of our impossible possible. We have always customers’ needs and the environments believed that even the farthest technical they work in, we collaborate closely with horizons were temporary and could be leading medical experts from around the surpassed with consistent dedication to world. This cooperation is the driving force improved healthcare. This visionary behind our innovative solutions and approach, backed up by the largest R&D services. From the earliest stages of budgets in the medical imaging industry, research, product development and design, has made Siemens an undisputed we rely upon the advice and innovation leader in molecular imaging. recommendations of our customers to determine our focus. As a result, our products are able to offer you the highest return on innovation possible. Clinical Return Workflow Return Financial Return4
ovation From the beginning, one of the most frequent demands of our customers has been to improve diagnostic decision making to enable greater confidence. At the same time, healthcare is facing the dual mandates to improve patient safety and increase productivity, while ensuring the highest quality and cost-efficient patient care. Introducing the new Biograph mCT Our dedicated team of molecular imaging experts have helped shape the diagnostic imaging world with their inventions and ideas. And we are continuing this tradition of innovation by continuously pioneering new technologies. With the introduction of the new Biograph™ mCT, we offer our With a focus on fulfilling your clinical, customers ever-increasing opportunities to workflow and financial needs, our mandate benefit from their investments in is to deliver innovations that consistently innovation. No matter which way you look meet the following three criteria: at it, Siemens Molecular Imaging is helping you to expand your Return on Innovation. • Lead the way in technological and medical advancement • Maximize workflow efficiency • Make state-of-the-art molecular imaging affordable 5
Biograph mCT – molecular CT. quantification redefined. With today’s PET/CT, the smallest details can go unnoticed, lowering diagnostic confidence. Inaccurate quantification may mislead treatment response monitoring. Longer examination times lead to fewer patients per day, and unnecessary dose could compromise patient safety. Addressing these challenges requires a PET/CT designed from the ground up that improves diagnostic confidence by offering reproducible quantification, the highest image resolution* and speed in both PET and CT, all while minimizing radiation dose. The new Biograph mCT. Bringing accurate and reproducible quantification to PET·CT imaging by ensuring that each element of the measurement chain is optimized. Starting with the industry’s highest volumetric image resolution*, Biograph mCT features unique daily quality control, SMART registration technologies and intelligent software to bring accuracy and reproducibility to PET/CT imaging. In addition, innovative CARE technologies ensure the lowest possible dose is administered. With the new Biograph mCT, now you can detect, characterize and monitor the tiniest cancer lesions with reproducible quantification, making cancer treatment more cost effective. Now you can quantify absolute myocardial blood flow, making more accurate treatment decisions, minimizing risk to your patients. Now you can potentially** quantify amyloid deposits in the brain, making dementia diagnosis possible, slowing disease progression. Now, more than ever, you are able to rely on molecular imaging with quantification that is accurate and reproducible. For results that will redefine clinical decision making. The confirmation you need for more diagnostic certainty and more informed treatment planning. Study after study. Scan after scan. Without question.6 * Based on competitive literature available **This product is under development and is not yet at time of publication. Data on file. commercially available in the U.S. Due to regulatory reasons its future availability cannot be guaranteed.
ContentIntelligently 8ReproducibleQuantificationFinest Volumetric 24Image Accuracy*Minimum Dose and 42Maximum SpeedEngineered Clinical 58Flexibilitysyngo®.via 72Customer Care 74Molecular Imaging 78Biomarker Research 7
Intelligently Reproducible QuantificationIntelligently In order to help physicians make sound decisions, imaging must not only be quantifiable –Reproducible it must be accurate and consistent. With conventional technology, customers face the issueQuantification of variability in results due to both software and hardware challenges. Inherent scanner drift and inaccurate attenuation correction through misregistration of anatomical andFinest Volumetric functional images have a direct impact on reproducibility and accuracy of acquiredImage Accuracy quantitative data. In addition, standard measurement techniques and inter-user variability affect accurate diagnostic results.Minimum Dose and Now, for the first time, Biograph mCT gives you quantifiable results that are precise.Maximum Speed Reproducible. And consistent over time. With its unique combination of intelligent software, daily calibration and precise anatomical and functional co-registrationEngineered Clinical Biograph mCT makes a quantifiable difference in diagnostic confidence, therapy planningFlexibility and treatment monitoring.syngo.viaCustomer CareMolecular ImagingBiomarker Research10
Return onInnovation Clinical Return Workflow Return Financial Return • Increased confidence in quantitative • Fast and consistent perfusion results • Accurate and reproducible results with automatic daily quality with automatic cardiac registration quantification attracts more control with normalization referring physicians and patients • Generate simultaneous PET and CT • Enhanced precision in staging and results with intelligent one-click • Grow beyond oncology with unique follow-up with inter-user segmentation quantitative offerings in neurology reproducibility of SUV values and cardiology 11
Intelligently Reproducible QuantificationIntelligently Daily calibration ensures consistent Better attenuation correction for more Quantitative assessments with syngo.viaReproducible performance over time accurate, quantifiable data Advanced syngo clinical applications provideQuantification Leaving nothing to chance, Biograph mCT’s The desire for perfect attenuation correction essential tools to get more accurate and automatic quality check process was lies at the heart of our SMART (Siemens reproducible, quantifiable measurements inFinest Volumetric designed to provide confidence that Molecular & Anatomical Registration neurology, cardiology and oncologyImage Accuracy performance is consistent and Technologies) research development imaging. SUVpeak, new in the syngo.mCT measurements are accurate, day after day. philosophy. With SMART innovations, Oncology Engine, provides consistent andMinimum Dose and With Quanti•QC, you can begin each day Siemens continues to pioneer new ways to reproducible quantitative assessments ofMaximum Speed knowing that overnight your scanner was address PET attenuation. From a unique hot spots. Myocardial Blood Flow (MBF) can calibrated and tuned to precisely the right patient handling system that eliminates be used as an absolute quantificationEngineered Clinical specifications, using phantom data that differential deflection to Auto Cardiac method to assess balanced disease in allFlexibility allows for daily PET normalization and Registration which automatically aligns CT areas of the heart. And an exciting optimal performance. In addition the tightly and PET heart images and reduces variability quantative tool in neurology, part of thesyngo.via regulated water-cooled gantry ensures between users. And Siemens novel SMART syngo.mCT Neurology Engine*, system temperature stability for consistent Neuro AC enables you to correct automatically registers brain data to aCustomer Care performance. neurological PET data without a CT scan*. normals database to assist in the assessment The result in each case is accurate of neurological disorders.Molecular Imaging attenuation correction and reliableBiomarker Research quantitative measurements.12 * SMART Neuro AC and syngo.mCT Neurology Engine are pending 510k clearance, and are not yet commercial available in the United States.
SummaryIn order to help physicians make sounddecisions, imaging must not only bequantifiable – it must be accurate andreproducible. Siemens Biograph mCT hasbeen intelligently engineered to meet thisneed. The new technologies incorporated inBiograph mCT are an exciting step forwardin furthering the understanding of disease,its progression and response to treatment.From daily system normalization and precisePET and CT alignment with SMARTinnovations to intelligent software thatassists with the interpretation of dementia,evaluation of balanced myocardial diseaseand accurate assessment of treatmentresponse on oncology. Accuracy andreproducibility is the key to preciselyassessing disease status. 13
How it works Intelligently Reproducible QuantificationIntelligently Biograph mCT gives you quantifiable precise PET and CT alignment with SMART • Daily calibration ensures consistent Reproducible results that are accurate and reproducible innovations and intelligent software, performance over timeQuantification by overcoming inherent variabilities faced Biograph mCT brings accuracy and • Better attenuation correction for more by conventional PET/CT systems. By reproducibility to daily routine. accurate, quantifiable dataFinest Volumetric incorporating daily system normalization,Image Accuracy • Quantitative assessments with syngo.viaMinimum Dose andMaximum Speed Quality Control PET and CT Registration Quantification SoftwareEngineered ClinicalFlexibility Daily SMART Intelligent Software Normalization Correction SUVpeaksyngo.via No Detector Drift OKCustomer Care Absolute PerfusionMolecular ImagingBiomarker Research Ratio Analysis*14 * This feature is under development and is not yet commercially available in the United States. Due to regulatory reasons its future availability cannot be guaranteed.
How it worksQuanti·QCBiograph mCT’s Quanti•QC assures day-to- Environmental factors such as temperature Day Day Day Dayday consistency in your system response fluctuations in the scan room have long 01 16 30 90 18 Fand quantitative reproducibility. The been recognized as a potential source ofcomprehensive daily quality check and system performance drift. Biograph mCTcalibration can be scheduled to run vastly reduces such influence with the Conventionalautomatically overnight so the scanner is tightly regulated integrated water-coolingready to begin imaging before the first system which ensures system temperaturepatient arrives. stability for consistent performance. Correlation of PET calibration to initial cross calibrationQuanti•QC is performed with a 20 cm • Daily normalization is routineGermanium-68 uniformity phantom of • Can be scheduled to run overnight Day Day Day Dayknown activity. This method allows for 01 16 30 90correlation with the dose calibrator via daily • Allows for correlation with dose calibrator 18 F Ge 68comparison to previously acquired cross via daily comparison to previouslycalibration – bringing increased confidence acquired cross calibration for assurance of Quanti•QCin the quantification efficacy of the system. quantitative accuracyOnce the phantom scan is completed,normalization results are reported, includinga PET calibration factor check confirmingcorrect computation of the absolute imagecalibration. 15
How it works SMART PHSIntelligently Biograph mCT employs a SMART patient Conventional SMART PHSReproducible handling system (PHS) that was specificallyQuantification designed for use in PET/CT imaging. Its unique cantilever design, in which theFinest Volumetric pedestal and table move as one unit,Image Accuracy supports a full 227 kg (500 lb) without any differential deflection between PET and CT CT PET CT PETMinimum Dose and acquisitions. This no-flex feature ensuresMaximum Speed accurate attenuation correction for more precise quantification.Engineered Clinical • Unique cantilever designFlexibility • Full 227 kg (500 Ib) table capacitysyngo.via • No differential deflectionCustomer CareMolecular ImagingBiomarker Research16
How it worksSMART Auto Cardiac RegistrationSMART Auto Cardiac Registration quickly, • Automatic and fast PET and automatically and precisely registers CT and CT registrationPET scans during cardiac imaging. Using a • Reproducible between usersproprietary algorithm, SMART Auto CardiacRegistration identifies the heart and aligns • Consistently accurate quantificationthe molecular and anatomical images foroptimal attenuation correction.SMART Auto Cardiac Registration isintegrated within the cardiac acquisitionworkflow. A rapid reconstruction of the non- Conventional SMART Auto Cardiac Registrationattenuation corrected PET image isautomatically registered to the CT foroptimal registration confirmation. PETattenuation corrected images arereconstructed based on the confirmedoptimal registration.SMART Auto Cardiac Registration reducesthe variability between users, providingconsistently accurate and reproduciblequantification. 17
Conventional CT AC CT mu-map Attenuation-corrected PET How it works SMART Neuro ACIntelligently SMART Neuro AC* enables quantification of SMART Neuro ACReproducible PET data without requiring a CT scan forQuantification attenuation correction. The ability to perform attenuation correction without a CT Calcualted mu-map Attenuation-corrected PETFinest Volumetric scan avoids any co-registration problemsImage Accuracy that can occur due to patient motion. Siemens SMART Neuro AC assesses andMinimum Dose and applies an appropriate attenuation map toMaximum Speed the PET data to make accurate corrections without requiring a CT scan, relieving theEngineered Clinical patient of further radiation exposure andFlexibility eliminating the chance of registration inaccuracies.syngo.via • Calculated attenuation correctionCustomer Care • Quantitative PET data • Minimize radiation doseMolecular ImagingBiomarker Research18 * SMART Neuro AC is pending 510k clearance, and is not yet commercially available in the United States.
How it worksSUVpeakSUVpeak employs a 1 cm3 sphere volume ofinterest (VOI) within a lesion for morerobust evaluation of uptake . SUVpeakautomatically identifies the peak valuewithin a VOI. Compared to the conventionalsingle pixel SUVmax, SUVpeak can decrease theinfluences of noise and together with thepre-set 1 cm3 volume and automatic peakalgorithm, can potentially reduce readervariability. This method provides accurateand reproducible information for therapyresponse assessment.• Automatic identification of 1 cm3 SUV peak volume within VOI• Fixed dimensions of peak volume reduces inter-operator variability• Reduced susceptibility to noise 19
How it works Myocardial Blood FlowIntelligently Conventional myocardial perfusion imagingReproducible assesses the blood’s relative distribution,Quantification assuming that at least one section of the heart performs normally and can be used asFinest Volumetric a reference. The myocardial blood flowImage Accuracy (MBF) application is an absolute quantification method that helps toMinimum Dose and confidently assess balanced disease in allMaximum Speed areas of the myocardium. This technology now supports 82 Rubidium as well as 13NEngineered Clinical Ammonia imaging.Flexibility • Non-invasive quantitative assessment of myocardial blood flow and coronary flowsyngo.via reserveCustomer Care • Supports 82Rb and 13N Ammonia biomarkersMolecular ImagingBiomarker Research20
How it works PET Neurology Quantification syngo.PET Neuro DB Comparison* includes currently exist. Siemens is presently working a PET FDG normals which database provides to develop another quantitative tool in quantitative assessment of biomarker neurological imaging, which would assess uptake in the brain to aid in the assessment the biomarker activity ratio** between two of neurological disorders such as dementia. regions of the brain (i.e. a region of interest The application registers brain data to a compared to a reference region such as the normals database automatically, so regional cerebellum). volume of interest (VOI) generation and • Clear and quick assessment of hyper- and statistical analysis can be obtained. The hypo-metabolic brain regions comparison quickly reveals abnormalities if present. • Standard voxel-by-voxel reporting of statistics As an innovation leader, Siemens is continually looking towards the future to • Predefined 3D anatomical brain regions find ways to answer tomorrow’s challenges sooner. New biomarkers are steadily being researched and developed. Such biomarkers often benefit from different tools than* syngo.PET Neuro DB Comparison is pending 510k clearance, **This feature is under development and is not yet commercially available in the United States. 21 and is not yet commercial available in the United States. Due to regulatory reasons its future availability cannot be guaranteed.
Intelligently syngo.PET Neuro DB Comparison*Reproducible automatically registers brain data to a normals database so VOI canQuantification be generated for quantitative assesment of biomarker uptakeFinest VolumetricImage AccuracyMinimum Dose andMaximum SpeedEngineered ClinicalFlexibilitysyngo.viaCustomer CareMolecular ImagingBiomarker Research22 * syngo.PET Neuro DB Comparison is pending 510k clearance, and is not yet commercial available in the United States. Due to regulatory reasons its future availability cannot be guaranteed.
Volume of interest withSUVpeak providesrobust and reproduciblequantification Myocardial blood flow provides an absolute quantification method to assess balanced disease in the myocardium 23
Finest VolumetricImage Accuracy*24 * Based on competitive literature available at time of publication. Data on file.
Finest Volumetric Image Accuracy*Intelligently An accurate diagnosis starts with an accurate image in all dimensions. With conventionalReproducible technology, small or low-grade lesions can go undetected or lose definition towards theQuantification edge of the FOV and are subject to motion blurring thereby lowing diagnostic confidence. Siemens recognizes that at the core of a good image is an accurate detection system, whichFinest Volumetric begins with optimized components. From the very beginning of Siemens PET·CTImage Accuracy technology, image quality has been the first priority, this is still true today. Biograph mCT optimizes the components of the detection system into a superbly designed imaging chain.Minimum Dose and From the design and configuration of the isotropic LSO crystals to the high speed Maximum Speed electronics to the industry’s best 400 x 400 reconstruction matrix, all resulting in the finest volumetric image accuracy*. Combined with high definition technologies that bringEngineered Clinical uniform resolution and images virtually free of motion, it’s now possible to diagnose withFlexibility the increased confidence that this exquisite molecular clarity provides.syngo.viaCustomer CareMolecular ImagingBiomarker Research26 * Based on competitive literature available at time of publication. Data on file.
Return onInnovation Clinical Return Workflow Return Financial Return • Superb visualization, particularly of • Reduced time to image review • Attract patients and referring small tumors with industry-leading enabled by fast and consistent physicians with high-definition 87 mm3 volumetric resolution* reconstruction times image quality • Increased diagnostic confidence • One-click gating integrated in daily • Reduction of false negatives with the finest uniform resolution* routine associated with breathing artifacts and a 4x increase in signal-to-noise 27
Finest Volumetric Image AccuracyIntelligently Patented OptisoHD Detection System highly renowned and compact STRATON™ No motion for full HD lesion detection,Reproducible delivers the industry’s finest volumetric tube with z-Sharp™ delivers true temporal accurate SUV quantificationQuantification resolution* resolution of up to 150 ms for motion- HD·Chest is a breakthrough technology from artifact free CT imaging of the heart. Siemens continues to deliver exquisite Siemens that eliminates the tradeoffFinest Volumetric diagnostic image quality. The unique between diagnostic confidence andImage Accuracy Uniform resolution throughout OptisoHD Detection System provides a examination time. An innovative the field of view robust foundation comprised of optimized combination of hardware and software,Minimum Dose and components enabling peak performance Siemens ultraHD·PET delivers increased HD·Chest virtually freezes respiratoryMaximum Speed throughout the scanner. Biograph mCT image quality, easily outperforming motion, enabling full HD lesion detection continues to set the standard for image conventional PET/CT technology. It and accurate standard uptake value (SUV)Engineered Clinical quality by delivering the finest NEMA* and combines two important innovations: quantification. Best of all, HD·Chest isFlexibility volumetric resolution in the market. HD·PET, which provides uniform resolution designed to be as fast as a conventional PET throughout the FOV; and Time of Flight examination, so you can have increasedsyngo.via Excellence in Cardiac imaging (TOF), which doubles improvement in diagnostic confidence without affecting signal-to-noise. Combined with z-Sharp™ your patient schedule.Customer Care Biograph mCT provides excellence in cardiac technology that provides an isotropic imaging through innovative PET and CT resolution of 0.33 mm at any positionMolecular Imaging technologies. The patented Prompts Gamma within the scan field, Biograph mCTBiomarker Research Correction provides clarity in PET cardiac continues to push the boundaries of spatial imaging with a reduction in noise while the resolution.28 * Based on competitive literature available at time of publication. Data on file.
SummaryImage clarity and precise localization are keyto disease detection, accurate staging andimproved therapy planning. Biograph mCT’sOptisoHD Detection System and innovativetechnologies like Prompts Gamma Correction, Time of Flight, z-Sharp andHD·Chest work together to acquire andreconstruct images that accurately representmolecular processes with superb imagequality in all dimensions. So cardiac studiesare more exact. Tumors are more clearlydefined. Brain lesions can be preciselymapped. Siemens new Biograph mCT is aquantum leap forward, refining images andsetting another new standard in diagnosticimaging. 29
How it works OptisoHD Detection SystemIntelligently Siemens OptisoHD Detection system is Ultrafast detector electronics, combinedReproducible designed for optimum performance. The with the speed of LSO and the unique block Quantification Lutetium Oxyorthosilicate (LSO) crystals – design of OptisoHD Detection System, manufactured by Siemens and long allow fast coincidence timing with efficientFinest Volumetric recognized for their density, fast scintillation rejection of random events. This providesImage Accuracy decay time (the fastest of all PET scintillators very high count rates that are essential to currently in use) and light output – are the high-speed PET scanning. Ultimately,Minimum Dose and foundation of the system. These isotropic the result is superb clarity and betterMaximum Speed LSO crystal elements are tightly packed and localization of events. These events are then incorporate Siemens patented air reflector reconstructed using the industry’s highestEngineered Clinical technology which optimizes the light output matrix size of 400 x 400*, delivering superbFlexibility for even greater timing performance and image quality with leading NEMA energy resolution. resolution*.syngo.via • Patented air reflector technologyCustomer Care • High resolution – 4 x 4 x 20 mm LSO crystalsMolecular Imaging • Industry’s highest matrix size of Biomarker Research 400 x 400*30 * Based on competitive literature available at time of publication. Data on file.
135 mm3In a three-dimensional world, decisions • Volume resolution 87 mm3 Conventionalshould be made with three-dimensional • Up to 35% finer volumetric resolution information. And a simple comparison of than conventional systemsvoxel size helps explain the volumetricresolution advantage of Biograph mCT. • Decreased partial volume effectConventional equipment uses larger, non-isotropic elements; Biograph mCT employs 87 mm3smaller isotropic elements. These smallerelements and fine axial sampling help tocreate extraordinary images in anydimension, resulting in the industry’s finestvolumetric resolution* of only 87mm3,up to 35% smaller than conventionalsystems. Sampling statistics reduce partialvolume effects and achieve an increasedquantitative accuracy for detection ofsmaller lesions. Volume Resolution 31
How it works Cardiac CT AnodeIntelligently High quality cardiac CT depends on a decreasing the detector elements’ size to Cathode HeatReproducible number of system performance features improve spatial resolution, z-Sharp utilizesQuantification including high temporal resolution, fine two overlapping X-ray beams, resulting in spatial resolution and flexible acquisition significantly increased spatial resolutionFinest Volumetric techniques that adapt to different patients. without a corresponding increase in dose.Image Accuracy Biograph mCT addresses all these This provides you with the industry’s highest requirements with 0.3 sec rotation speed, isotropic resolution of 0.33 mm at any scanMinimum Dose and 0.33 mm isotropic resolution and up to 128 and rotation speed, and at any positionMaximum Speed acquired slices per rotation. within the scan field. This for instance allows motion-artifact free imaging of the The core technology that allows the new Cooling oilEngineered Clinical heart to perform accurate stenosis Biograph mCT to deliver clinical excellenceFlexibility measurements or stent planning with in cardiac CT, is the highly renowned outstanding precision. STRATON™ tube with z-Sharp™. Itssyngo.via revolutionary design based on a direct • Compact tube design with 0.3 sec rotation anode cooling eliminates the need for heat speedCustomer Care storage and results in an unmatched • 150 ms temporal resolution compact design thus allowing true temporalMolecular Imaging resolution of up to 150 ms. Instead of • 0.33 mm isotropic resolutionBiomarker Research32
How it worksPrompts Gamma CorrectionSiemens patented Prompts Gamma ConventionalCorrection is the solution for cardiacimaging with rubidium-82 (82Rb), providingimproved image accuracy through areduction in image noise. The third gammathat 82Rb emits results in a additional andincorrect lines of response to be calculated.Left uncompensated, this additional gamma leads to distortions with increased image More noise reduces image claritynoise and possible quantitative errors.Prompts Gamma Correction automatically Prompts Gamma Correctionaddresses this anomaly in its scattercorrection algorithms, resulting in morereliable, more accurate imaging.• Noise reduction for improved image contrast• More quantitative accuracy Less noise for greater image clarity• Correction automatically incorporated in patented scatter correction algorithm 33
Conventional Time of Flight T1 How it works Time T2 of FlightIntelligently Siemens TOF measures the actual timeReproducible difference between the detection of eachQuantification coincidence photon. This additional timing information is used to better localize theFinest Volumetric event within a small range along each line-Image Accuracy of-response (LOR). The better localization of each event using TOF reduces noise in theMinimum Dose and reconstructed image.Maximum Speed • 2x improvement in signal-to-noiseEngineered Clinical • 2x improvement in contrastFlexibility • Signogram mode TOF with fixed and fast reconstruction timessyngo.viaCustomer CareMolecular ImagingBiomarker Research34
Conventional HD·PET Crystals Crystals Crystals Crystals LOR Photon LOR Photon Wrong LOR Crystals Crystals Photon LOR Photon How it works Wrong LORHD·PET Photon LOR Photon HD uniformity · HD resolution · 2x HD contrast • HD·PET improves resolution • Delivers uniform resolution throughout the FOV • 2x improvement in signal-to-noise Without HD·PET With HD·PET 1 Measurements were taken with a line source suspended in air at radial positions from the centerAverage Resolution (mm FWHM)1 Conventional PET uses the same HD·PET incorporates millions of accurately to 28 centimeters in Conventional reconstruction principles across the entire measured point spread functions (PSF) in 4 centimeter steps. The FOV and does not take into account the the reconstruction algorithms. Using Biograph HI-REZ-FBP data detector geometry and mispositioning of measured PSFs, HD·PET effectively positions were reconstructed with HD·PET and ultraHD·PET the LORs. This results in fuzzy edges and the LORs in their actual geometric location, a standard filtered increased distortion further from the which dramatically reduces blurring and backprojection algorithm center of the FOV. distortion in the final image. after FORE rebinning and the HD·PET data were reconstructed with the TrueX algorithm using six Radial Distance/cm iterations and 14 subsets. 35
How it works ultraHD·PET TOF HD ultraHD·PETIntelligently By combining Siemens HD·PET with TOF, theReproducible result is up to 4 times improvement in signal + =Quantification to noise for ultraHD contrast and uniform resolution throughout the FOV.Finest Volumetric • Uniform resolution throughout the FOVImage Accuracy • 4x improvement in signal-to-noiseMinimum Dose and • Fast and consistent reconstruction timeMaximum SpeedEngineered Clinical Segments of Segments of Segments ofFlexibility response response response (“time bins”) (“time bins”) (“time bins”)syngo.via Accurately locates the Effectively positions the line ultraHD·PET reduces blurringCustomer Care annihilation along the line of of response in it’s actual of the signal from all axis response geometric locationMolecular ImagingBiomarker Research36
How it works Alternating focal spots 1 2z-Sharp 0.4 mm objects STRATON™ X-tay tube 0.4 mm objects 0.6 mmIncreased resolution without increased Over-dose. z-Sharp uses two intersecting X-ray samplingbeams that produce isotropic resolution of0.33 mm at any scan and rotation speed, 0.6 mmand within any position in the scan field – Oversamplingall without an increase in dose. conventional technology 128-channel data acquisition electronicsFor wrist, joint or inner ear studies, Siemensproprietary technology, z-UHR, adapts the Measured signal per detector element Measured signal per detector elementsystem for ultra-high resolution bone 0.6 mm 0.6 mm 1 1imaging. In this case, providing 0.24 mmistotropic resolution. 0 0 1 1 1 1 1 1 1 1 1 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2• Increased resolution without dose penalty Resulting resolution Resulting resolution • Isotropic 0.33 mm resolution throughout the FOV • z-UHR provides 0.24 mm Isotropic resolution 37
How it works HD·Chest ex h a ale inh leIntelligently Full HD lesion detection OptimalReproducible Accurate SUV quantification ImagingQuantification One-click routine Region • Amplitude based gating automaticallyFinest Volumetric 4D Gating 4D Gating analyzes each patient’s individualImage Accuracy Image Image breathing pattern Acquisition ReconstructionMinimum Dose and • Identifies portion of the respiratory cycleMaximum Speed with the least motion and the most data – HD·Chest HD·Chest the optimum imaging area Image ImageEngineered Clinical Acquisition ReconstructionFlexibilitysyngo.via HD·Chest applies an innovative algorithm to With HD·Chest, image data from the optimal analyze each patient’s individual breathing portion of the breathing cycle goes to makeCustomer Care pattern and identify the portion of the up the image. The system then reconstructs respiratory cycle with the least motion. a single, high resolution image withMolecular Imaging This area of the cycle is where most data superior lesion conspicuity. The entireBiomarker Research can be collected, without motion, in the process is automated, which means it is shortest amount of time. operator independent, saving you valuable time.38
Conventional Examination HD·Chest Full HD lesion detection With less noise and more data, small moving lesions are clearer and their edges are sharper.In the conventional scan, respiratory motion causes With HD·Chest, the lesion is clearly visible.the lesion to be obscured.Conventional Examination SUVmax4 HD·Chest SUVmax9 Accurate SUV quantification HD·Chest’s motion freeze also enables more accurate standard uptake value (SUV) measurement.In this example, the conventional scan shows a HD·Chest greatly improves quantification of lesionssingle lesion blurred by respiratory motion. normally blurred by respiratory motion.Clinical Workflow One-click routinePatient 1 Patient 2 HD·Chest enables automatic acquisition and reconstruction of virtually motion-free images in less time than conventional gating techniques.Conventional Full-count HD·Chest acquisitionHD·Chest Accquisition Reconstruction and (6 gates) manual selection of the “best gate”4D Gating Preparation Acquisition Reconstruction 39
Superb visualizationof small tumorswith industry-leadingvolumetric resolution*IntelligentlyReproducibleQuantificationFinest VolumetricImage AccuracyMinimum Dose andMaximum SpeedEngineered ClinicalFlexibilitysyngo.viaCustomer CareMolecular ImagingBiomarker Research40 * Based on competitive literature available at time of publication. Data on file.
Biograph mCT optimizes every ultraHD·PET brings uniformcomponet of the detection resolution throughout the fieldsystem into a superbly of view and 4 times thedesigned imaging chain, improvement in signal-to-noisefor excellent image quality 41
Minimum Dose and Maximum SpeedIntelligently Two of the most challenging issues facing healthcare today are the dual mandates toReproducible improve patient safety and increase productivity. From a patient care and economicQuantification perspective, each is critically important. With conventional systems, clinicians have to choose between protecting patients with minimum dose, or greater productivity with fasterFinest Volumetric scanning. The new Biograph mCT offers innovative imaging solutions where the lowestImage Accuracy dose can be used, while still scanning patients faster than ever before. Now, clinicians can have it all – scans with half dose and double speed. By reducing dose and increasing speed,Minimum Dose and patient safety is improved, costs are dramatically reduced, while increased utilization canMaximum Speed also be achieved.Engineered ClinicalFlexibilitysyngo.viaCustomer CareMolecular ImagingBiomarker Research44
Return onInnovation Clinical Return Workflow Return Financial Return • Half the dose and the acquisition • Whole-body PET scans in only • Reduce imaging radioisotope costs time while maintaining highest 5 minutes by reducing injected dose image quality • Lowest possible dose and high- • Attract more referrals by increasing • Minimum dose, especially to critical speed workflow enabled by patient comfort with shorter exam patients (children and patients with FAST CARE technologies times frequent follow-up exams) 45
Minimum Dose and Maximum SpeedIntelligently CARE FAST Half the dose, twice the speedReproducible Achieving the highest technical An increasingly competitive and rapidly Biograph mCT is meeting both of the coreQuantification performance is only important when it changing healthcare market requires needs of improving patient safety and meets the needs of the patient and our improvements in quality and throughput. increasing productivity, at the same time,Finest Volumetric customers. In molecular imaging, patient Utilizing FAST (Fully Assisting Scanner through our commitment: “Minimum DoseImage Accuracy safety translates primarily into dose Technologies) innovations, typically time and Maximum Speed.” By combining FAST reduction. consuming and complex procedures during and CARE technologies, Biograph mCT offersMinimum Dose and the scan process are extremely simplified innovative imaging solutions enabling halfMaximum Speed Principles such as “As Low as Reasonably and automated, not only improving the dose to be used while doubling the scan Achievable” (ALARA) have developed as a workflow efficiency and scanner utilization, speed. By reducing dose and increasingEngineered Clinical guideline to reduce all radiation exposure to but optimizing the overall clinical outcome speed, costs are dramatically reduced, whileFlexibility the lowest possible level. With CARE by creating reproducible results, making increased utilization can also be achieved. (Combined Applications to Reduce diagnosis more reliable and reducing patientsyngo.via Exposure), Siemens has been highly burden through streamlined examinations. successful in integrating many innovations In addition, faster scans result in less patientCustomer Care into the Siemens scanners that significantly motion, so image quality and the overall reduce radiation dose in comparison to patient experience can be optimized.Molecular Imaging other systems available on the market.Biomarker Research46
SummaryIn order to address two of the mostimportant concerns in healthcare today,improving patient safety and increasingproductivity, Siemens lives by thephilosophy of minimum dose and maximumspeed, which benefits both the patient andprovider. At the core of this philosophy arethe innovative FAST and CARE technologieswhich improve the patient experiencethrough increased scan speeds, while usingas little exposure as possible, all withoutsacrificing image quality. For the provider,increased speed improves throughput formore efficient operation.Siemens is moving the technology forward– to create faster and safer imaging whilemaintaining the highest of standards forimage quality. 47
How it works Minimum Dose and Maximum SpeedIntelligentlyReproducible LSO True V ultraHD·PETQuantification Without TrueV • Cornerstone of • 2x lower dose • 2x lower dose With TrueV T1Finest Volumetric low-dose or T2 • 2x faster scan Image Accuracy imaging speed • 2x faster scan • 8x faster crystalMinimum Dose and speedMaximum SpeedEngineered ClinicalFlexibility Dose Adaptive Dose SAFIRE** CARE Dose4D Shield Shieldsyngo.via • Iterative • Up to 68% lower • Up to 25% lower reconstruction doseCustomer Care dose Raw data Image data Image software Dose recon recon correction • Fully automated Shield • Fully automated • Fast recon in Molecular Imaging image and rawBiomarker Research data space48 * SMART Neuro AC, FAST Planning, CARE kV, X-CARE, SAFIRE and FAST Cardio Wizard are pending 510k clearance, and are not yet commercially available in the United States.
FAST Planning* Time of Flight CARE kV* SMART Neuro AC* 70 kV 80 kV• Improves • 2x lower dose • Up to 60% lower • No CT dose T1 100 kV 120 kV NO workflow 140 kV dose CT T2 • 2x faster scan • PET attenuation efficiency speed • Optimize ontrast- c correction• Minimizes wait to-noise-ratio without CT times for patientsAdaptive Cardio X-ray low X-CARE* X-ray UFC FAST CardioSequence wizard* • Up to 60% lower • Up to 30% lower • 1 – 3 mSv Cardio dose dose • Intuitive step-by- UFC step guidance• Fully automated • Reduce exposure • Fast acquisition X-ray on in sensitive areas • Higher reliability and reproducibility Light in cardiac CT 49
How it works TrueVIntelligently TrueV high-speed technology widens the TrueV = ½ injected dose or 2x speed due to ultraHD·PET + TrueV = ½ injected dose ANDReproducible axial FOV and features 30% fewer bed 70% increase in NEC performance. 2x speed due to 70% increase in NECQuantification positions when compared to a standard performance and 4x improved signal to ultraHD·PET and TrueV as combined FOV. With an increased count rate noise. technologies make a 5-minute PET scanFinest Volumetric performance of more than 70%, you can possible – unprecedented for a routine Minimum Dose and Maximum SpeedImage Accuracy lower dose rates of scan time. For example, clinical. benefits: a scan time reduced to 10 minutes or a 50%Minimum Dose and less injected dose to the patient. • Provides 2x lower doseMaximum Speed • Offers 2x faster scan speedEngineered ClinicalFlexibility TrueV widens the axial field of view by 33% Conventional field of view Biograph with TrueVsyngo.viaCustomer CareMolecular ImagingBiomarker Research50
How it worksultraHD·PET =HD·PET + Time of FlightBy combining Siemens HD·PET with Time of Conventional PET detects coincidence photons andFlight (TOF), the result is up to 4 times records individual LORs between the crystals. The actual location where the annihilation occurredimprovement in signal to noise for ultraHD along the LOR is not measured, which inherently contrast. Conventional PET generates blurring in the reconstructed image.Minimum Dose and Maximum Speed Siemens ultraHD·PET with TOF measures the actualbenefits: time difference between the detection of each• Provides 2x lower dose coincidence photon. This additional timing information is used to better localize the event• Offers 2x faster scan speed within a small range along each LOR. The better localization of each event using TOF reduces• Enables a five-minute, whole-body scan blurring in the reconstructed image. with TrueV T1 ultraHD·PET T2 51
How it works Adaptive Dose Shield Conventional tube collimationIntelligently As part of the STRATON X-ray tube, the Pre-Spiral Dose Post-Spiral DoseReproducible unique Adaptive Dose Shield movesQuantification collimators on the X-ray tube to block Image area unnecessary radiation dose. The shieldFinest Volumetric dynamically opens at the onset of a spiralImage Accuracy range and dynamically closes at the end, eliminating all clinically irrelevant dose. The Conventional TechnologyMinimum Dose and result can be up to 25% lower CT doses.Maximum Speed Minimum Dose and Maximum Speed benefits:Engineered ClinicalFlexibility • Reduces CT dose exposure by up to 25% STRATON with Adaptive Dose Shield • Significantly reduces the possibility of syngo.via over-radiationCustomer Care • Shields the patient from pre- and post- No Pre-Spiral Dose No Post-Spiral Dose helical radiationMolecular Imaging Image areaBiomarker Research Adaptive Dose Shield52
How it works SAFIRE SAFIRE* – Sinogram Affirmed Iterative Standard Filtered SAFIRE Reconstruction – should allow you to utilize Back Projection raw-data information (which is visualized in the so-called sinogram) in the iterative image reconstruction process. Raw data recon Raw data recon Image data recon Image correction* SAFIRE is pending 510k clearance, and is not yet commercially available in the United States. 53
How it works CARE kVIntelligently Siemens has introduced the first automatedReproducible voltage setting to optimize contrast-to-Quantification noise-ratio and reduce dose by up to 60%. 70 kV The automated selection is based on patient 80 kVFinest Volumetric habitus and specific exam. CARE kV* is 100 kVImage Accuracy especially useful in pediatric imaging, 120 kV sparing smaller patients from unnecessary 140 kVMinimum Dose and exposure.Maximum Speed Minimum Dose and Maximum Speed benefits:Engineered ClinicalFlexibility • Optimize contrast-to-noise-ratio • Up to 60% dose reductionsyngo.viaCustomer CareMolecular ImagingBiomarker Research Example: For a contrast media enhanced vessel examination of a small patient, CARE kV proposes to scan with 70 kV and sets the other values accordingly.54 * CARE kV and FAST Planning are pending 510k clearance, and are not yet commercially available in the United States.
How it worksFAST PlanningSiemens’ Fully Assisting ScannerTechnologies (FAST) features helpradiologists and technicians plan andprepare for examinations and minimize thewait time for patients.FAST Planning* performs an immediate,organ-based setting of the scan andreconstruction ranges. The goal is a saferand faster experience for the patient andmore predictable workflow at the scanner.Minimum Dose and Maximum Speedbenefits:• Minimizes wait times for patients• Automatic detection of scan field based Conventional FAST Planning on organ characteristics 55
Superb image quality with 1/2 injected dose using TOF technologyIntelligentlyReproducibleQuantificationFinest VolumetricImage AccuracyMinimum Dose andMaximum SpeedEngineered ClinicalFlexibilitysyngo.viaCustomer CareMolecular ImagingBiomarker Research56
Whole-body PET with halfinjected dose and a 5-minuteacquisition time 57
Engineered Clinical FlexibilityIntelligently In order to grow your business, you need a system that is flexible to accommodate allReproducible patients* and procedures in PET and CT, today and in the future. With a conventional PET/Quantification CT system a standard bore size does not allow access to all patients, nor does it integrate high-end CT. The new Biograph mCT is engineered as a true dual-use solution to helpFinest Volumetric customers multiply studies and increase business growth. Biograph mCT provides theImage Accuracy clinical flexibility to use high resolution CT in conjunction with high definition PET imaging, or as a standalone CT. And with the industry’s only 78 cm bore, Biograph mCT canMinimum Dose and accommodate a wide range of patients, including bariatric for both PET and CT studies.Maximum Speed The engineered flexibility and scalability allows customers to configure a system which best meets their needs, and of course their patient needs today and tomorrow.Engineered ClinicalFlexibilitysyngo.viaCustomer CareMolecular ImagingBiomarker Research60 * Up to 227 kg (500 lb)
Return onInnovation Clinical Return Workflow Return Financial Return • Improve diagnostic accuracy with • Image bariatric PET and CT patients • Increase revenue with a 78 cm bore less patient movement enabled by without impacting schedule for imaging a wider variety of large bore and fast scan times patients and procedures • Streamline dual modality workflow • Expand clinical capabilities on both with engineered integration of • Reduce operating cost by uniting PET and CT with a complete portfolio state-of-the-art PET and premium CT stand-alone PET and CT services into of advanced applications a single integrated offering 61
Engineered Clinical FlexibilityIntelligently Maximizing patients base Maximize modality performance Flexible scalability and upgradeabilityReproducible Today’s conventional technology often falls Biograph mCT is engineered as a true dual- Biograph mCT is designed as a remarkablyQuantification short for a simple reason – it fails to modality scanner which integrates the best scalable PET·CT platform and is designed to accommodate a wide patient demographic performance of both PET and CT modalities grow as business and clinical needs change.Finest Volumetric and therefore inhibits the growth a wider into a single compact system. Available in Biograph mCT offers a variety of in-fieldImage Accuracy referral base can generate. Siemens has CT configurations of up to 128 acquired upgrades, from increasing the number of CT engineered Biograph mCT for clinical slices per rotation, it offers the capability of slices up to 128 to expanding the PET fieldMinimum Dose and flexibility and growth, with a large 78 cm entire-body CT scans in just 10 seconds, of view up to 21.6 cm. With such flexibleMaximum Speed bore, short tunnel and a 227 kg (500 lb) and whole-body PET scans in as little as scalability and upgradability Biograph mCT table capacity which improves patient 5 minutes. Biograph mCT transforms a provides returns and referrals now and wellEngineered Clinical comfort and accessibility. Additionally, with single room into a fast, dual-modality into the future.Flexibility features such as a powerful 100 kW CT scanning facility. Now customers can offer generator – which provides ample X-ray advanced CT and PET imaging with onesyngo.via power reserves for high quality imaging and room; one team; one integrated system; HD FoV* (field of view) which improves one schedule; and if required, oneCustomer Care image quality beyond the standard CT comprehensive exam. Such clinical flexibility diagnostic FoV, Siemens is making bariatric saves precious space, time and cost whileMolecular Imaging PET imaging more accurate with excellent maximizing dual-modality utilization andBiomarker Research image quality. enabling business growth.62 * HD FoV is pending 510k clearance, and is not yet commercially available in the United States.
Summary To enable growth a PET/CT system must be able to accommodate even the most challenging patient situations, such as bariatric imaging, while providing high-end imaging applications in both modalities. The new Biograph mCT has been engineered with the clinical flexibility to meet these needs now and in the future. Its large 78 cm bore and shorter tunnel accommodate even the largest patient*, so your referral base is greatly expanded. And its multi-functionality (CT, PET and PET/ CT) delivers savings in space, staffing and scheduling so clinical workflow is more efficient. The bottom line however, remains performance. Biograph mCT produces superb image quality, precise quantification and patient comfort and safety while delivering clinical flexibility that benefits everyone.* up to 227 kg (500 lb) 63
How it works Large Bore and Short TunnelIntelligently The 78 cm bore of Biograph mCT can • Wide 78 cm boreReproducible comfortably accommodate a greater range • Short tunnelQuantification of patients in both PET and CT. Unlike conventional systems, whose narrow bore • 227 kg (500 Ib) table capacity Finest Volumetric and long tunnel can make patients feelImage Accuracy claustrophobic, Biograph mCT features a wider bore – 78 cm wide – and a shorterMinimum Dose and tunnel for a more open scanningMaximum Speed experience. The large bore also allows better Conventional Biograph mCT positioning of RTP devices, such as breastEngineered Clinical boards.Flexibility The wider bed provides comfortable support even for obese patients and has a capacitysyngo.via of up to 227 kg (500 lb). And the design of the bed eliminates the CT and PET 70 cm 78 cmCustomer Care registration artifacts that can occur in bariatric imaging with a conventionalMolecular Imaging system.Biomarker Research64
How it works HD FoV Conventional FOV for CT is 50 cm, but in • Improved CT image quality some cases (e.g., with bariatric patients) CT and HU > 50 cm measurements are truncated and image • Enhanced PET image quality > 50 cm artifacts in PET attenuation-corrected (AC) images may result. Until now this problem • Advanced PET quantification was addressed using the extended field of view method (EFoV), but Siemens recently introduced an improved way to process truncated data sets in CT scans. This Conventional HD FoV innovative new method, HD FoV*, provides better image quality and improved Houndsfield Unit (HU) stability between 50 and 65 cm resulting in more quantitative PET images. This allows for more precise radiation therapy planning for bariatric patients and patients positioned outside the Biograph mCT isocenter.* HD FoV is pending 510k clearance, and is not yet commercially available in the United States. 65
How it works High End CTIntelligently The premium CT integrated into Biograph • Isotropic 0.33 mm resolution Speed 0.30 s Resolution 0.24 mmReproducible mCT is based on Siemens SOMATOM® anywhere in the scan fieldQuantification Definition AS platform, offering full CT • High temporal resolution functionality with up to 128 acquired slices of 150 msFinest Volumetric per rotation, into a compact dual modalityImage Accuracy design. • 128 slices per rotation Scan any The revolutionary design of the STRATONMinimum Dose and patient with: X-ray tube features a direct anode cooling 78 cm opening,Maximum Speed which eliminates the need for heat storage 227 kg weight limit, and results in a compact design thus 198 cm co-scanEngineered Clinical allowing true temporal resolution of up to range**Flexibility 150 ms. z-Sharp technology delivers the industry’s highest isotropic resolution ofsyngo.via 0.33 mm* at any scan and rotation speed, and at any position within the scan field.Customer Care Engineered to deliver such high performance and clinical flexibility, Biograph Coverage 128-slice Power 100 kWMolecular Imaging mCT opens doors to growth in all areas ofBiomarker Research PET and CT imaging.66 * Based on Competitive Literature available at time of publication. **With TrueV and utilizing pallet extensions. Data on file.
How it worksDual Use – Room CT Room PET/CT RoomBy seamlessly integrating high end PET andpremium CT, Biograph mCT provides thepower of two high-end modalities in a singlesolution, thereby offering efficiencies insquare footage, utilities, service andstaffing. Now you can offer high quality PETand CT in one room. With one schedule.One team. One user interface that has beenengineered for simplicity and speed. Andwith Biograph mCT’s new FAST CARE Biograph mCT Roomtechnologies, every step of the examinationprocess has been streamlined, from scanpreparation to image review.• Single room• High-end PET• Premium CT 67