CT definition flash - SIEMENS


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CT definition flash - SIEMENS

  1. 1. Boosted by syngo.viaFlash Speed. Lowest Dose.SOMATOM Definition FlashAnswers for life.
  2. 2. SOMATOM Definition Flash SOMATOM Definition Flash
  3. 3. Siemens CT Vision Siemens CT Vision Today’s reality product development, and design, relies upon the advice and recommendations The justification for the existence of the of external medical experts to determine entire medical industry is, of course, our focus – and this focus has been on better healthcare for all patients. But the the needs and demands of our end users. realities of clinical practice often make this Over the years, this focus has been fine- simple-to-understand goal quite difficult tuned in four key areas: to realize: stay within budgets, reduce • to lead technological and medical hospital stays, speed up time to diagnosis, advancement and deal with personnel issues, while • to maximize workflow efficiency maintaining high clinical standards and • to make state-of-the-art CT affordable volume/throughput. At the same time, • to set the standard in customer care. patients demand better and faster results. Our vision Our approach As a partner of our customers, we create In order to meet our share of responsibility CT innovations, that lift clinical practice in addressing these challenges, Siemens, to a next level of excellence and enable from the earliest stages of research, wide access to better patient care. We4
  4. 4. believe that even the farthest technical Patient-centric productivity Siemens CT Vision 4 horizons are temporary and can be surpassed with consistent dedication Now, we are again setting the bar higher SOMATOM Definition Flash 8 to improved healthcare. This visionary with FAST CARE technologies. Fully approach, backed up by the, by far, largest Assisting Scanner Technologies (FAST) Split-Second Scanning 10 R&D budgets in the healthcare industry, make complex procedures faster, more Defining Low Dose CT 22 has made Siemens the undisputed inno- intuitive, and more reproducible than ever. Dual Source DE for all Patients 34 vation leader in CT over the last 35 years. For example, preparing an anatomically And our ambitious global team continues correct reconstruction of the whole spine Customer Care 46 to set the trend in an always changing now takes only 30 seconds, compared to environment, providing Answers for Life. 30 minutes when doing it manually. At the Configuration Overview 48 same time, our Combined Applications toLeading patient care Reduce Exposure (CARE) are now stream- lined to make dose reduction easier for all Today, more than 700 institutions examinations while providing a transparent worldwide have already taken this dose-saving management. FAST CARE opportunity to improve patient healthcare delivers a new dimension in clinical and push their clinical boundaries to a efficiency and patient care. We call it: higher level utilizing Dual Source CT. patient-centric productivity. 5
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  7. 7. Flash speed. Lowest dose. SOMATOM Definition Flash Flash speed children, patients who cannot hold their complex CT procedures: the scanning breath for long), thus causing no process becomes more intuitive, more The SOMATOM® Definition Flash opens a time-consuming interruptions in your daily automated, and results become more door to new levels of patient friendliness practice. And now Siemens is once again reproducible. Integrating the capabilities with the speed to cover the entire thorax redefining speed: the new SOMATOM of the recently developed syngo®.via* in less than a second – if necessary even Definition Flash, with the new FAST CARE image management platform with its without a breath hold. A whole-body scan technology platform, allows you to many powerful automated preprocessing requires only five seconds, while for maximize clinical outcomes – meaning steps and intuitive user interface, the perfusion or dynamic vascular imaging you will have the best possible clinical complete examination – from scan long-range scans become routine and results, but with significantly less preparation, scanning, reconstruction, and pediatric scans become sub-second resources bound to the CT system. The data assessment – is streamlined, leading procedures. Your patients will be off the ultimate goal is to provide you with more to a fast and reliable diagnosis with less table faster than ever before – with time for patients and diagnosis – in effect, patient burden. Ultimately, the combination positive feelings about their scan patient-centric productivity. Our Fully of highest image quality and highest experience. Flash is also the solution for Assisting Scanner Technologies (FAST) on patient-centric productivity is the lever to scanning your most difficult patients the new SOMATOM Definition Flash maximizing your clinical outcomes. (i.e. obese and trauma patients, restless simplify typically time-consuming and8
  8. 8. Lowest dose With the new SOMATOM Definition Flash Add SAFIRE**, the first, raw-data-based with FAST CARE, Siemens introduces iterative reconstruction, and define low Maybe even more important – and several innovative Combined Applications dose for all body regions to take best care impressive – is the incredible reduction in to Reduce Exposure (CARE). CARE kV, for of your patients’ well-being. dose for all scans, resulting, e.g. in dose instance, is the industry’s first tool that down to sub-mSv for cardiac imaging. automatically solves the complex equation Now in its second generation, Dual Energy for optimal image quality at lowest automatically provides a second contrast possible dose for each individual CT exam for the best possible diagnosis and added while considering tube voltage, tube diagnostic confidence so that each scan current, and contrast changes at different *syngo.via can be used as a stand-alone device can now become a Dual Energy scan. At voltages and attenuation. This allows you or together with a variety of syngo.via-based the same time, X-CARE protects individual to benefit from the industry’s widest tube software options, which are medical devices in their own rights. organs and the most radiation-sensitive voltage range – not only 140 kV for body regions – for example, female bariatric imaging but now, if necessary, **The information about this product is being breasts – by accurately and efficiently also down to 70 kV for new safety and provided for planning purposes. minimizing exposure while preserving image quality standards in pediatric The product is pending 510(k) review, and is image quality. imaging. not yet commercially available in the U.S. 9
  9. 9. 10 Split-second scanning
  10. 10. Split-SecondScanningHow often has your daily practice been interrupted or delayed by fragile,sick, or traumatic patients who either cannot hold their breath or becomeimpatient during regular scan procedures? Finding a solution to thesehindrances is what has motivated us to design the world’s fastest CT, byutilizing Dual Source for Flash-like scan speeds of up to 458 mm/s.With Flash Spiral scanning, holding breath and motion lose theirsignificance, making the SOMATOM Definition Flash the optimal patient-friendly CT. We introduce you to the new, cutting-edge of FAST CAREtechnology that raises the standard of your patient-centric productivity,e.g. through FAST Cardio Wizard, that breaks down the restrictions ofprevious CT scanning in cardiology. Today, split-second scanning isproving its value in actual practice. Emergency department trauma scansof an entire body in less than five seconds with dose usually under 5 mSvhave also been made possible by the Flash’s speed. Now, with the help ofthe FAST Spine feature, making the preparation of complex vertebraeand disc reconstructions a matter of one click and 30 seconds, we taketrauma imaging and neurological CT examinations to the next efficiencylevel for earlier and more accurately targeted treatment. 11
  11. 11. Introduction Split-Second Scanning < 1 sec Body imaging in adult and Definition Flash with FAST CARE now pediatric patients offers Siemens’ unique FAST (Fully Assisting Scanner Technologies) platform Scanning an entire thorax in only to support you in finding and applying the 0.6 seconds for motion-artifact-free ideal settings for every individual studies that revolutionizes triple-rule-out examination to get to a safe, sound, and Tube 1 Tube 2 Vol protocols. The scan speed is fast enough sustainable diagnosis. Sub-second thorax scan for triple-rule-out and a dose to image the thorax without any breath below 5 mSv. hold and also produces crystal clear Cardiac imaging in a quarter imaging of the coronary arteries, thus of a heartbeat < 1 sec routinely enabling sub-second triple-rule- out with less than 5 mSv dose. The system’s unique split-second scanning capability allows scanning the heart in Bringing this scan speed to imaging only 250 ms, a quarter of a heartbeat. children makes sedation a thing of the Together with its highest temporal past. Now Flash Spiral scans are resolution of 75 ms, available in all cardiac consistently fast enough to produce sharp scan modes, it freezes any cardiac motion Tube 1 Tube 2 Vol pediatric images without sedation. This safely, irrespective of the heart rate. Sub-second pediatric scan without the need for sedation shortens prep time, eliminates repeating or anesthesia. scans due to motion, and reduces risk as Fastest scanning preparation well as anxiety. < 4 sec The challenge for each CT scan is to find Fastest emergency CT and apply the ideal settings for every individual patient, but at the same time For several years now, CT has been the achieve a high degree of reproducibility. ideal modality for trauma cases. However, Now, with FAST, scan and recon planning in the most severe cases the time required can become as fast and easy as just to produce useful images often placed the one click. Tube 1 Tube 2 Vol patient at risk. With Flash speed, scan time Whole body imaging in less than 4 seconds without is no longer an issue. The new SOMATOM motion artifacts.12 Split-second scanning
  12. 12. Automated scan and recon possible. FAST Cardio Wizard helps youplanning achieve high-quality clinical outcomes in every situation. Flash Spiral scanning – Decisive for the ideal settings for scan, reconstruction, and image evaluation are Ready for review in one click no breath hold required the organs and body regions. Based on the respective organ, the chosen examination FAST Spine, another prominent feature Sharp coronaries at all heart rates type, and, at the end, also expected of the FAST technology, enhances rapid – even without beta-blockers images, in-depth knowledge of the trauma and neuro imaging, saving up to appropriate system settings is normally 30 minutes with a single click compared Pediatric scans without sedation required. Imagine the time the system to conventional workflows. Again easing, can save you by automatically planning accelerating, and standardizing the Whole body trauma scan < 4 sec the subsequent reconstruction fields in workflow in CT scanning. a whole body trauma. The SOMATOM Both guided and standardized Definition Flash with FAST and syngo.via syngo.via-based diagnosis cardiac workflow now automatically assist you in solving this challenge, making possible even Let us look at only one example of more shorter time to diagnosis and more than 17 functions that syngo.via, the Accurate spine recons with interaction with patients. outstanding multimodality imaging just a single click platform, performs: a triple-rule-outAll heart rates, all patients assessment in less than four minutes Immediate, organ-based scan and automatically (at no click), coronal Not only does the selection of the and sagittal images for your referring planning appropriate scan mode for imaging every physicians located anywhere in your cardiac patient demand expertise, but also clinical network. The reading physician the preparation for image evaluation is can immediately start with the evaluation anything but trivial. It is important that of the case without wasting efforts in case you feel safe in having done everything in preparation. order to achieve the best clinical outcome 13
  13. 13. How it works Flash Spiral Even the most advanced single-source CTs The SOMATOM Definition Flash guarantees are limited in their scan speed by the fast and accurate ED imaging by putting maximum table feed that can be used and you in the position to achieve earlier and still allow the acquisition of contiguous more accurately targeted treatment data. The SOMATOM Definition Flash decisions that positively affect the patients breaks through this barrier primarily by 30-day adverse event rate and reduce simultaneously integrating data from a repeated visits.(2) second source during the scan. By combining this Dual Source technology Revolutionizing the with fastest available hardware triple-rule-out components, including a gantry that rotates at 0.28 seconds, a patient table In case of acute chest pain, scanning that can handle immense table feeds, and with the SOMATOM Definition Flash ultra-fast data transmission technology, significantly saves time because it is now makes possible the fastest scan mode in possible to assess pulmonary arteries, CT history. The result is an unprecedented coronary arteries, and the aorta in a single scan speed of up to 458 mm/s, fast split-second scan. Scientific validation in enough to scan an entire adult patient large cohorts demonstrate impressive in less than four 4 seconds. results. Due to the SOMATOM Definition Flash’s split-second scanning capabilities Increased patient friendliness physicians obtain “motion-artifact-free and accurate visualization” in these Patients who cannot hold their breath or challenging examinations “at a very low suffer from shortness of breath, patients radiation exposure.”(2) Mean scan times are Single-source CT requires slower table feeds to prevent who are restless or impatient, who are 0.7 seconds while a radiation dose of only gaps in the acquired volume (bottom). uncooperative, obese patients or young 4.1 mSv or less is applied. Researchers find children, are no longer a problem. Due to that the Flash Spiral technology “has the its unprecedented scan speed, the Flash potential to revolutionize triple-rule-out Source Spiral mode even stops motion entirely, protocols.”(1) 1: Barns E. et al, High-pitch DSCT offers speedy images; preventing image artifacts that might www.AuntMinnie.com, Nov 30, 2009. obscure image quality and affect your 2: Press release, Andrew Stewart, Radiology Manager, sound diagnosis.(1) St George’s Hospital, UK, published online, Jan 1, 2010.14 Split-second scanning
  14. 14. Barrier-free pediatric Avoiding repetition of scansimaging Another and widely underestimated Bringing this scan speed to imaging risk factor is eliminated as well by the children, the most delicate patient group, Flash Spiral technology: the unnecessary opens new possibilities by eliminating repetition of scans in young children due the need for sedation or anesthesia. to failed sedation, which unfortunately Researchers state that mean examination is the case in 29% of conventional times of only 0.49 seconds provide examinations, shown in a large trial.(2) highest image quality making sedation or controlled ventilation unnecessary, Sub-second scanning of up to 458 mm, Tube 1 Tube 2 while maintaining low radiation dose with a wide 78 cm bore for unrestricted values.(1) access to your most sensitive patients, makes a true difference in your pediatric Dual Source CT combines the data from two detectors for Being independent of this time-consuming scanning, from saving prep time and faster table feeds above a pitch of three for revolutionary and potentially dangerous procedure can staff, repeating scans due to motion, to triple-rule-out scanning and barrier-free pediatric imaging save you up to 80 minutes of preparation reducing risk as well as anxiety. Yet without sedation. time and involves less personnel. another proof for the SOMATOM Definition A positive economic side effect of the Flash being the healthiest CT available. SOMATOM Definition Flash for pediatric imaging is that you can do without the expensive services of the anesthetist. Source 1: Lell MM. et al, Invest Radiol. Sep 17, 2010. [Epub ahead of print]. 2: Malviya S. et al, British Journal of Anesthesia 84 (6): 743–8 (2000). 15
  15. 15. How it works FAST Cardio Wizard All heart rates, all patients Guidance for high-quality clinical outcomes in every The SOMATOM Definition Flash is the fastest cardiac scanner in the industry, situation offering a true single-segment temporal resolution of 75 ms. Its Flash Spiral But cardiac CT examinations are also acquires the entire heart in around among the most sophisticated and 250 ms – within a single heartbeat. demanding procedures in CT, requiring It alternatively enables robust diagnostic careful preparation and a high degree of outcomes, even in the presence of high expertise. All the more, it is important that heart rates and arrhythmia, and has been the user feels sure that he has done repeatedly proven by a wide range of everything correctly in order to achieve clinical studies. This permits imaging the the best clinical outcome possible and to heart without the clinical, workflow, and avoid any unnecessary radiation of the financial aspects of utilizing beta-blockers patient. Additionally, it allows you to when using the Flash cardio sequence. define your individual institutional guided The realities of healthcare today often do cardiac workflow for standardization to not permit the interruptions in workflow, guarantee continuous high-quality clinical The modifiable text in the guided workflow allows you to longer patient preparation times, and use outcomes in every situation. define your standards and quality goals that users have to of personnel required by the use of beta- follow in order to always achieve an optimal cardiac scan. blockers. Not to mention the fact that Therefore, the new SOMATOM Definition some patients should not receive beta- Flash offers the FAST Cardio Wizard, blockers, such as in certain cases of explaining to the operator on a step-by- pulmonary disease. All this makes the step basis what needs to be done to Flash Cardio Sequence the industry’s most achieve an optimal cardiac scan, either in versatile low dose mode for cardiac real-time when preparing a scan or for imaging. training purposes.16 Split-second scanning
  16. 16. How it works FAST Planning Fastest emergency CT through FAST Planning uses defined automated planning anatomical landmarks to set the correct recon ranges within a large In time-critical emergency situations, scan field of view – as in trauma long scan ranges involving different body imaging – for faster results when regions and organs are common. The every second counts. planning of the scan and reconstruction field of view is prone to error and eat up precious time to diagnosis. FAST Planning focuses explicitly on this critical part of the scan process. Based on the topogram, FAST Planning assists the scan and reconstruction planning to provide an easier, faster, and standardized workflow in CT scanning. The selection of the anatomical region of interest (ROI) from a list automatically defines prospectively the scan and reconstruction ranges. The scan ROIs are automatically detected based on the characteristics of the organ that is to be scanned. In addition, the corresponding scan ranges are proposed in the topogram as well. In the case of head scans, the iso-center is automatically adapted according to the position of the patient’s head to prevent cutting off important information during the emergency examination. 17
  17. 17. syngo.via Additional Benefits with syngo.via Make lifesaving decisions, when every second counts … Acute Care imaging often requires multiple clinical disciplines such as radiologists, cardiologists, neurologists, and trauma surgeons to review images to develop a structured and prioritized treatment plan. syngo.via’s unique information sharing makes it easy to involve all required disciplines into the therapeutic decision-making process. The client/server architecture allows you to access the data independently with up to five users for fast parallel reading. It allows clinicians to review the same images on their individual workplaces For example, it enables you to conduct Dual-monitor layout for instant emergency reading to discuss decisions remotely. a thorough analysis of the major blood process. This is the first view directly after loading vessels of the body with their curved the patient. The Acute Care Engine helps you in more multi-planar reformations (MPR) and demanding cases by automatically adding appropriate display layouts the moment incremental information for your diagnosis you open the case. Additionally, it and supports you with a powerful set of automatically provides you with coronal, intelligent tools. sagittal reconstructions of the patient’s data that can be displayed in the entire clinical network such as the ICU, the PACS workplace, the OR, or when you discuss the patient’s diagnosis in your office.18 Split-second scanning
  18. 18. Rule out coronary heart The syngo.CT Cardiac Function – as part ofdisease in under a minute the CT Cardio-Vascular Engine – allows you to read and diagnose CT angiography The moment you open a cardiac case, the images of the left side of the heart for the Automated Case Preparation has already evaluation of ischemia or cardiomyopathy. preprocessed the images and displays them in your appropriate layout together Additionally, the application can evaluate with the adequate evaluation tools. This the late or early myocardial enhancement means that you can immediately start of single energetic CT data which is evaluating the coronary vessels, the displayed as a color overlay. The Cardio- functional parameters, and the prepared Vascular Engine’s Pro level provides right calcium score. ventricular volumetric analysis,* which may have prognostic value for congestive The comprehensive layout for display of heart failure, chronic pulmonary disease, multiple CPRs permits the review of the and pulmonary emboli. coronary tree at the blink of an eye. All your findings and key images are collected in the Findings Navigator on-the-fly as you Single-click stenosis aneurysm measurement. read the case. Your result: rule-out and Three reference lines are already predefined. reporting of coronary artery disease in less than a minute. *The CT Acute Care Engine is pending 510(k) review and is not yet commercially available in the U.S. 19
  19. 19. Split-second scanning Clinical Results Motion-free emergency room trauma Flash Spiral scans of an entire body in Split-second scanning of the human heart with Flash less than four seconds with dose usually under 5 mSv. Spiral in only 250 ms for motion-free and sharp coronary arteries due to unmatched 75 ms temporal resolution.20 Split-second scanning
  20. 20. Organ-based setting of scan and recon ranges with FAST Planning for a fast and more Restless children or patients who cannot hold their breathstandardized workflow at the scanner. FAST Spine allows the preparation of anatomically no longer cause time-consuming interruptions.aligned spine recons with just a single click. 21
  21. 21. 22 Defining low dose CT
  22. 22. Defining Low Dose CT Applying the lowest radiation dose possible is of the utmost importance for both you and, of course, your patients. Therefore you always want to be assured that you have taken every means available to protect your patient from unnecessary radiation. This desire lies at the heart of our CARE (Combined Applications to Reduce Exposure) research and development philosophy. Consequently, with Siemens’ continuing effort to achieve highest dose protection, the new SOMATOM Definition Flash now combines all features to reduce radiation as low as possible: next to its already outstanding dose protection portfolio from the initial product generation, it now adds a wide range of new and improved dose reduction features. CARE kV, for instance, is the industry’s first tool for automatically solving the complex equation for optimal image quality at lowest possible dose for each individual CT exam while considering tube voltage, tube current, and contrast changes at different voltages and attenuation. This allows you to benefit from the industry’s widest tube voltage range – not only 140 kV for bariatric imaging but now, if necessary, also down to 70 kV where the Definition Flash sets new standards in pediatric safety. Add the first, raw-data-based iterative reconstruction SAFIRE* and define low dose for all body regions to take best care of your patients well-being.*The information about this product is being provided for planning purposes. The product is pending 510(k) review, and is not yet commercially available in the U.S. 23
  23. 23. Introduction Defining Low Dose CT Sub-mSv heart – CARE kV – solving a complex the ultimate CARE feature equation Discussions regarding dose in cardiac But CT scanning is not only about adapting scanning have changed because dose mAs values: the right kV settings play an values down to under 1 mSv are so equal, if not more important, role in frequent that Sub-mSv heart can be choosing the right parameter to achieve considered routine for Siemens SOMATOM optimal clinical outcome at lowest Definition Flash owners. Such low routine possible dose. Siemens’ unique CARE kV values have opened realistic discussions now addresses this consideration, and about the use of Flash Spiral for early supports the user in exploiting the detection of coronary artery disease. remaining dose-saving capabilities in kV adaptation. Optimizing tube current and voltage < 1 mSv As early as 1994, Siemens introduced the first versions of CARE Dose4D to actively Flash Spiral allows for ultra-fast spiral acquisition at modulate the applied power for scans 75 ms temporal resolution with scan speed of up to depending on the patient’s anatomy. With 458 mm/s for maximum dose efficiency in your daily FAST CARE the configuration options have clinical practice. now been made more flexible and can be perfectly adjusted for every patient so that you can achieve lowest possible dose at optimal image quality in every examination.24 Defining low dose CT
  24. 24. Taking care of children Preventing unnecessary radiation The Flash Spiral scan has proven to be Routine Sub-mSv cardiac CT a robust method for scanning children and SOMATOM Definition Flash eliminates infants without sedation while providing unnecessary pre- and post-spiral opens the door to early detection high image quality at lowest possible over-radiation with its two Adaptive Dose dose.(1) Shields offering dose reductions up to Lowest dose in all organs 25%. It also protects dose-sensitive body With CARE Child, offering the 70 kV regions, such as the female breast, Adaptive Dose Shields eliminate STRATON tube redesign together with a set eyeballs, the thyroid glands, or the unnecessary dose of dedicated pediatric scan protocols, the gonads, through X-CARE with possible new SOMATOM Definition Flash offers a dose reductions up to 40% while Protect radiation-sensitive organs unique solution to provide even healthier preserving the image quality. scanning for your youngest patients. Dose reductions in a wide range With CARE kV you now benefit from the Iterative reconstruction of protocols with iterative industry’s widest tube voltage range – down to 70 kV where the new SOMATOM Siemens now introduces SAFIRE*, the first reconstruction Definition Flash sets new standards in low raw-data-based iterative reconstruction, dose pediatric imaging. that is a unique approach allowing for up to 60% additional dose savings. *The information about this product is being Source provided for planning purposes. 1: Lell MM. et al, Invest Radiol. Sep 17, 2010. The product is pending 510(k) review, and is [Epub ahead of print]. not yet commercially available in the U.S. 25
  25. 25. How it works Sub-mSv Heart 20 mSv Dose down to below 1 mSv Low dose cardiac for all heart rates Single source With the SOMATOM Definition Flash, 15 mSv discussions regarding high dose versus When fully flexible X-ray pulsing meets low dose cardiac scanning will change, 75 ms of temporal resolution, the result 10 mSv because, even under unfavorable is the Flash Cardio Sequence, the most conditions, the patient exposure with the versatile low dose cardio scan mode on SOMATOM Definition Flash is less than the market. 5 mSv what is required for diagnostic cardiac cath. Many clinical trials demonstrate that The intelligently triggered sequence shuts 1 mSv high dose cardiac CT no longer exists with off radiation in the systolic phase when Siemens equipment.(1, 2, 3) With Flash Spiral, not required and dynamically reacts to Single-source cardiac spiral scanning requires dose values down to under 1 mSv – irregularities during the ECG trace. The overlapping data acquisition, resulting in relatively high especially important for the most dose- real-time ECG monitoring reacts instantly patient exposure (top). sensitive patients – are so frequent they and stops the scan until the heart rate can be considered routine. becomes stable again. This arrhythmia compensation method allows for high 5 mSv Such low values can open realistic dose savings and an increased robustness discussions about the use of CTA for early of the scan. 4 mSv detection of coronary artery disease, 3 mSv taking advantage of its ability to scan the For the first time, a step-and-shoot mode entire heart in only 250 ms – a quarter is robust and fast enough to freeze the 2 mSv of a heartbeat. And, for less favorable heart and visualize the coronary arteries conditions, such as high heart rate or even at high heart rates, thus allowing 1 mSv arrhythmia, the Flash Cardio Sequence even low dose cardiac CT without the Flash with its automated arrhythmia need for beta-blockers. compensation still allows dose below diagnostic cath. Its unique dual pulsing Source Flash Spiral with Dual Source CT allows for ultra-fast spiral even calculates the heart’s ejection 1: Leschka S. et al, Eur Radiol. 2009 Dec; 19(12): 2896–903. acquisition for maximum dose efficiency in your daily fraction. 2: Lell M. et al, Eur Radiol. 2009 Nov; 19(11): 2576–83. clinical practice (bottom). 3: Achenbach S. et al, Eur Heart J. 2010 Feb; 31(3): 340–6.26 Defining low dose CT
  26. 26. How it works CARE kV and CARE Child Real-time dose modulation CARE kV, an extension of CARE Dose4D, can now automatically suggest kV and CARE Dose4D aims to regulate the effective mAs to optimize the contrast-to- mAs so that image quality is uniform noise-ratio (CNR) of the image while across the whole scan range. CARE Dose limiting the applied dose. The system’s Configurator provides the user the ability proposal is based on the attenuation as to select reference curves for each body measured in the topogram and the user- region and for each body habitus defined acquisition type (non-contrast, individually. With the new SOMATOM bone, soft tissue, vascular). The system Definition Flash with FAST CARE the also identifies bariatric patients and configuration options have now been consequently sets the parameters to make made even more flexible for perfect full use of the system’s reserves. CARE kV 70 kV 80 kV adjustment for every patient. is, of course, fully customizable, meaning 100 kV that the user can choose the degree of 120 kV Solving a complex equation system assistance between none, semi, 140 kV and full. The dose saving and image quality potential of the right kV settings play an Taking care of children equal, if not more important, role to achieve optimal clinical outcomes. But With the new improved STRATON tube changing kV values always comes along the voltage range is extended from 80 with the need to adapt all other values down to 70 kV where it sets new standards according to the respective patient and in low dose pediatric imaging with CARE the proposed examination. Unfortunately, Child. The new 70 kV scan mode further up to now this had to be done manually reduces the dose to small pediatric or Example: For a vessel examination of a small and required a lot of expertise. These neonate patients. These dedicated patient, CARE kV proposes scanning with 70 kV dependencies are described in a complex pediatric scan modes take care of the well- and sets the other values for optimal image quality physical equation, so that often the full being of our youngest patients. Overall, at lowest dose accordingly. potential for dose reduction remained with these features, an additional dose untapped with 120 kV being used in reduction of up to 60% is possible and almost every adult patient. easy to achieve in clinical practice. 27
  27. 27. How it works X-CARE X-ray low Additional dose reduction of up to 40% Siemens has recognized the importance of dose-sensitive scanning, especially for female patients, but also when directly radiating the eye lens or the thyroid gland. A simple but effective approach to lower dose for the most dose-sensitive body regions is partial CT scanning, that has been integrated into dedicated protocols X-ray on of the SOMATOM Definition Flash. It protects these areas from direct X-ray Conventional scanning X-CARE nearly switches the exposure by nearly switching the X-ray applies radiation permanently tube current off within a tube off for a certain range of projections, during the full rotation, thus certain range of projections, while automatically adjusting tube resulting in direct exposure of minimizing direct exposure currents for the remaining projections radiation-sensitive organs, for highly dose-sensitive to prevent deteriorating image quality. for example for the breasts. body regions. The result with X-CARE is reduced sensitive-area exposure up to 40% without loss of image quality.28 Defining low dose CT
  28. 28. How it works SAFIRE Iterative Reconstruction with homologous reference data. This Standard Filtered SAFIRE* procedure can be regarded as validating Back Projection SAFIRE* – Sinogram Affirmed Iterative (or affirming) the current images. Reconstruction – for the first time allows to utilize the full dose-saving potential An updated image is then again recon- of the iterative reconstruction in clinical structed, using the detected deviation practice. Now, raw-data information information. In each iteration a dynamic (which is visualized in the so-called raw-data-based noise model is applied Raw data sinogram) is actually being utilized in that allows for reduction of image noise recon Raw data Image data Image the image improvement process. without noticeable loss of sharpness. This recon recon correction optimization process thus makes even After the initial reconstruction using the better use of the diagnostic information weighted filtered back projection (WFBP) contained in the raw data. Using multiple the first iterative reconstruction loop is iterations, geometrical imperfections of performed. The CT images are retrans- the WFBP are corrected in addition to ferred to raw data which models all incrementally reducing image noise. relevant geometrical properties of the CT scanner. This step reproduces CT raw data With this, SAFIRE* allows for a radiation Ultra-fast reconstruction More powerful dose like a real scanner does. By comparing dose reduction of up to 60% or improved without iterations reduction than image- this synthetic raw data with the acquired image quality in regards to contrast, Well-established image based methods data, differences are identified. A further sharpness, and noise. impression Well-established image iteration loop compares the images Limited dose reduction impression Superior image quality Fast reconstruction in image and raw-data space and improved workflow with variable settings *The information about this product is being provided for planning purposes. The product is pending 510(k) review, and is not yet commercially available in the U.S. 29
  29. 29. syngo.via Additional benefits with syngo.via CT Acute Care Engine disease, aortic dissection, or pulmonary embolism. syngo.CT Coronary Analysis, Make lifesaving decisions, when every as a part of the CT Acute Care Engine, second counts … evaluates the coronary status and quantifies stenoses in less than one CT is the modality of choice when it minute through Single Click Stenosis comes to diagnostic imaging in acute care measurement. syngo.CT’s Cardiac Function situations, whether it is for a triple-rule-out is also able to evaluate whether the of acute chest pain, for stroke assessment, myocardial function has already been polytrauma, or for acute abdominal pain. affected by an infarction, while syngo.CT The CT Acute Care Engine provides clinical Vascular Analysis with VesselSURF is the functionality that delivers decisive results perfect tool to assess the extent of an Tube 1 Tube 2 for all of these challenging indications. aortic dissection, or to evaluate a syngo.via’s workflow is another remarkable pulmonary embolism. feature, as the Direct Image Transfer, Dual Source CT combines the data from two detectors Study Split for parallel assessment with Flash Spiral scanning of the for faster table feeds above a pitch of three. up to five parallel readers, together with entire thorax below 4 mSv Automated Case Preparation, make the CT Acute Care Engine the zero-delay The prospectively triggered Flash Spiral diagnostic tool. Above all, speed and scan perfectly meets the need for patients dependability add confidence for critical who present with acute chest pain to decisions made against the clock. exclude coronary artery disease, pulmonary embolism, and aortic The CT Acute Care Engine* provides dissection. The average dose for this high comprehensive image-processing speed examination is 1.6 mSv for patients functionality for triple-rule-out of acute who can be scanned with 100 kV protocols chest pain caused by coronary heart and 3.2 mSv for patients who can be * The CT Acute Care Engine is pending 510(k) review and is not yet scanned with 120 kV protocols. commercially available in the U.S.30 Defining low dose CT
  30. 30. The prospectively triggered high-pitchFlash Spiral scan mode for triple-rule-outallows motion-artifact-free and accuratevisualization of the entire thoracic vessels,including the aorta, pulmonary, andcoronary arteries at dose levels, beforeunseen, of below 4 mSv.syngo.via automatically displays theacquired data in the appropriate layoutand has preprocessed it according to thetriple-rule-out specific (disease-oriented)workflow for a quick rule-out in less thanfour minutes. Triple-rule-out of coronary artery disease, aortic dissection, or pulmonary embolism in less than four minutes. 31
  31. 31. Defining low dose CT Clinical Results CARE Child, with the 70 kV STRATON tube, defines new low dose Sub-mSv heart, the ultimate CARE feature. Dose values down to under safety and image quality standards in pediatric imaging. 1 mSv are so frequent that Sub-mSv heart can be considered routine for SOMATOM Definition Flash users.32 Defining low dose CT
  32. 32. Thoracoabdominal aorta examination, including the coronary arteries, with 1.9 mSv low dose Flash Spiral scan together with iterative reconstruction ofdose below 5 mSv, automatically preprocessed in syngo.via, showing aortic a newborn after perinatal complications.insufficiency. 33
  33. 33. 34 Dual Source DE for all patients
  34. 34. Dual Source DEfor all PatientsIt has always been a CT goal to collect as much information as possible inorder to differentiate tissues. With Dual Energy scanning, the SOMATOMDefinition and SOMATOM Definition Flash open the door to a new worldof characterization, visualizing the chemical composition of material. Theidea of Dual Energy is not new to the CT community. Earlier approaches,including two subsequent scans at different tube voltages or twosubsequent scans at the same position, failed to seamlessly align theimaged anatomy and to capture the same phase of contrastenhancement.Dual Energy was first successfully introduced into clinical practice withDual Source CT, i.e. two X-ray tubes and two UFC (Ultra-Fast Ceramic)detectors mounted at 90 degrees from each other and perfectlysynchronized during scans. And, to date, Dual Source remains the onlymodality that enables the usage of Dual Energy in daily practice at a dosecomparable to a conventional 120 kV scan and with optimum spectraseparation for highest value DE information.With 12 FDA-cleared applications and more than 700 Dual Source CTsinstalled, the number of Dual Energy scans has skyrocketed worldwideand is expected to continue increasing at an even higher rate. DualEnergy with Dual Source CT adds the decisive diagnostic confidence forsustainable and sound treatment decisions – it is the advantage thatproves itself over and over in daily practice. 35
  35. 35. Introduction Dual Source DE for all Patients Selective Dual Source Dual Energy Dose-neutral every day Photon Shield setting the standards Dual Energy imaging Dual Source Dual Energy (DE) CT An additional benefit is the fact that all acquisition provides an expanded set of renowned dose-saving techniques, such diagnostic capabilities and alters CT as CARE Dose4D, Adaptive Dose Shield, imaging in significant ways. Clinicians in and X-CARE, can be applied to effectively 700 international institutions, working achieve dose-neutral Dual Energy imaging with SOMATOM Definition and Definition for everyday usage without a dose Flash, are setting the technological and penalty compared to a conventional 120 kV clinical benchmark in Dual Energy scan.(1, 2, 3) Moreover, with Dual Source imaging. Dual Energy you can now get motion-free 80 kV 140 kV diagnostic images with a temporal Attenuation B Attenuation A Most important and most obvious with the resolution of down to 75 ms in Cardiac Dual Source approach: detector units can Dual Energy imaging. Always a dose-neutral operate at different tube potentials during second contrast. the synchronous CT acquisition. This avoids spectral contamination or waste of applied dose occurring during kV-switching time intervals. Furthermore, the Dual Source approach allows the introduction of X-ray filters such as the Selective Photon Shield for even further spectral separation. Source 1: Schenzle JC. et al, Radiol. 2010 Jun; 45(6): 347–53. 2: Graser A. et al, Invest Radiol. 2010 Jul; 45(7): 399–405. 3: Thomas C. et al, Invest Radiol. 2010 Jul; 45(7): 393–8.36 Dual Source DE for all patients
  36. 36. Dual Energy for all patients Already clinical routine Dual Source DE brings new levels of More than 130 peer-reviewed publications Always second contrast at no dose contrast, for instance with Optimum for our 12 FDA-approved DE applications Contrast, to all images over a broad range provide evidence and identify the penalty of routine examinations. It offers improvements in clinical outcome as a significant patient benefit improving result of their implementation. 800,000 Wide range of 12 FDA-cleared diagnostic outcomes through improved successful DE examinations have already applications lesion detection, removal of bone and helped to detect pulmonary embolisms in plaque, improved visualization of metal lung vessels, to directly remove bone and Optimum Contrast in every image prostheses, chemical analysis of normal plaque in angiographies, to characterize and pathologic tissue, and iodine mapping. renal calculi, or to allow for enhanced Improved visualization of metal It may grant the decisive diagnostic lesion conspicuity through Optimum information for a safe, sound, and Contrast, or simply to speed up workflow prostheses sustainable diagnosis and treatment through Virtual Non-Contrast Imaging. planning in any of the patients entrusted 75 ms high temporal resolution DE to you. freezing any cardiac motion syngo.via automatic virtual non- contrast bone and hard plaque removal syngo.via auto-preprocessing for immediate sagittal/coronal display 37
  37. 37. How it works Single-Source CT Dual Source Dual Energy (DE) The X-ray tube’s kilo voltage (kV) Benefits of determines the average energy level of Dual Source scanning the X-ray beam. Changing the kV setting 120 kV results in an alteration of photon energy Using the two Z-Sharp STRATON tubes, and a changed attenuation of the Dual Source data acquisition allows for materials scanned. For instance, scanning at least 1,152 projections per rotation Single-source CT only provides one energy level for an object with 80 kV results in a different and spectrum. This provides homogeneous morphology imaging. attenuation than with 140 kV. In addition, image quality over the entire FOV. this attenuation depends also on the type In spiral mode the same slice is acquired of tissue scanned. While the CT value for within the same time interval for both iodine is highest at the low-energy scans, spectra, so the reconstructed images show it can be less than half in the high-energy no time offset. The fast gantry rotation of Dual Source CT scans. The attenuation of bones, on the 0.28 seconds, with only 0.24 ms sampling other hand, changes much less when time, minimizes motion artifacts, while all exposed to low-energy scans compared renown dose-saving techniques can be to high-energy voltage examinations. applied, such as CARE Dose4D, Adaptive Dose Shield, and X-CARE. In addition, The material-specific difference in IRIS and SAFIRE* iterative reconstruction attenuation enables an easy classification techniques can be applied. of the elementary chemical composition of the scanned tissue. In addition, a fused Monoenergetic imaging image is provided for initial diagnosis. Using the SOMATOM Definition Flash also allows obtaining monoenergetic CT images. These are similar to images acquired with a synchrotron X-ray beam 80 kV 140 kV Attenuation B Attenuation A of single photon energy. The equivalent *The information about this product is being photon energy between 40 keV and provided for planning purposes. 190 keV (151 steps) can be optimized Two X-ray sources set to different kV levels simultaneously The product is pending 510(k) review, and interactively to provide best contrast for acquire two data sets at different attenuation levels. is not yet commercially available in the U.S. the lesion of interest.38 Dual Source DE for all patients
  38. 38. How it works Selective Photon Shield Without Selective Photon Shield number of quanta 80 kV 140 kV overlap Eliminating unnecessary Better dose efficiency radiation While Dual Source technology has already An important factor in making dose overcome this limitation, the Selective neutrality viable is the development of Photon Shield further increases dose the Selective Photon Shield that blocks efficiency by filtering out unnecessary unnecessary photons of the X-ray energy photons of the high-energy X-ray tube. spectrum. The result is a much better The remaining photon spectrum is photon energy separation of the 80 kV and 140 kV therefore better focused and more clearly images, as the second detector is 25% separated from the photons emitted by With Selective Photon Shield larger than previously. the low-energy tube. The result is a much number of quanta better separation of the 80/140 kV images, 80 kV In effect, the Selective Photon Shield increasing bone-iodine differentiation 140 kV assures dose neutrality for single-dose by up to 80% while reducing overall dose. overlap Dual Energy by avoiding unnecessary Therefore, the high-quality 80/140 kV exposure. Thus it makes Dual Energy as mode is ideal for the head and extremities, dose-efficient as conventional 120 kV especially CT angiographies. scans. So all the diagnostic advantages of Dual Energy imaging are now available The spectral separation through the with the same dose as a single energy Selective Photon Shield on the other hand, scan. opens the possibility to use 100/140 kV imaging with still 30% better bone-iodine contrast and more power reserves for photon energy cardio, abdomen, pelvis, and larger patients in general, making Dual Energy a The Selective Photon Shield increases energy clinical application for all your patients. separation and reduces unnecessary dose by blocking low-energy photons out of the high-energy X-ray tube’s spectrum. This results in optimal information quality and dose neutrality compared to a conventional 120 kV scan. 39
  39. 39. How it works Optimum Contrast Maximizing anatomic the detail from the 140 kV images in non- information enhanced areas, an optimized image can be automatically calculated. It is especially Dual Energy can be used to enhance the helpful in enhancing conspicuity of lesions iodine signal. It is well-known that the for a safe, sound, and sustainable therapy iodine signal is potentiated at low tube planning that may improve outcome, cost energies (80 and 100 kV), yet lower tube effectiveness, and patient comfort. energies are not employed in general CT scanning because of increased noise. syngo.via enhanced This is what builds the foundation of Dual DE imaging Energy Optimum Contrast. 80 kV scan 140 kV scan syngo.via dose not only provides you Focus: iodine, high Focus: soft tissue Optimum Contrast with the result images, for instance of contrast and low image noise Optimum Contrast, in all standard views The images obtained at 80 and 140 kV such as coronal, sagittal, and axial. It also automatically exploit the spectral behavior automatically removes bone and hard of certain materials or tissues in syngo.via. plaque in the major vessels for a easier Additionally, average images can be assessment of the true lumen. calculated to provide a ”normal” CT image, because the 140 kV images lack contrast, With syngo.via clients, your results, such while the 80 kV images are naturally more as Dual Energy Brain Hemorrhage images, noisy. can be instantaneously displayed in the OR* or the angio suite. By adding more of the contrast information from the 80 kV images in Best of both worlds to maximize areas of iodine enhancement, and more of anatomic information: less noise and more contrast than standard *Usage of syngo.via for an emergency case CT images. requires customer to provide respective emergency measures in case of non-availability of system or network.40 Dual Source DE for all patients
  40. 40. How it works High Temporal Resolution DE Dual Energy Flash Cardio Dual Energy Heart Perfused Blood Volume Another CT first: the SOMATOM Definition Flash allows scanning the entire heart, With its high temporal resolution, Dual and then evaluating the coronaries with a Source CT has greatly improved coronary full temporal resolution of 75 ms as well CT angiography, because it is less sensitive as, in a second reconstruction, visualizing to high heart rates or arrhythmia than perfusion defects in the myocardium, other types of scanners. With Dual thus combining the maximum speed of Energy CT, it is now possible to highlight 80 kV 140 kV Dual Source CT with Dual Energy imaging iodine content to visualize organ Attenuation B Attenuation A in a single scan. This has been made perfusion. Prospectively triggered possible with our latest reconstruction sequence or retrospectively gated spiral technology, that allows achieving Dual acquisition modes are available for first Source temporal resolution from image pass or late enhancement Dual Energy components acquired at different energy myocardial perfusion studies. The levels. The result is the ability to obtain corresponding syngo Dual Energy Heart diagnostic Dual Energy CT images without PBV software color-codes myocardial the use of beta-blockers. perfusion, so that both coronary artery 140 ms reconstruction 75 ms high temporal morphology and myocardial perfusion (low spatial frequencies) resolution reconstruction can be assessed in a single CT scan. (high spatial frequencies) Result: high temporal resolution DE High 75 ms temporal resolution Dual Energy freezes even cardiac motion and allows color-coded perfused myocardial blood pool evaluation, for example for patients suspected of having an acute myocardial infarction. 41
  41. 41. syngo.via Additional Benefits with syngo.via Speed in routine – power in challenging cases The new CT Cardio-Vascular Engine offers excellent functionality for the automatic anatomical evaluation, quantification, and functional assessment of CT angiography images of the heart or the peripheral vessels, while allowing manual interaction for challenging cases at any time. Before you open a case, the Automated Case Preparation has already pre- processed the images, including the Dual Energy direct bone and hard plaque removal and displays them in your appropriate layout together with the adequate evaluation tools. You can immediately start evaluating syngo.via showing a severely calcified the major blood vessels of the body with thoracic aorta in which Dual Energy their curved multi-planar reformations direct bone and hard plaque removal was (MPR) and appropriate display layouts. automatically applied in the background – Additionally, it automatically provides you before you opened the case. A single with coronal, sagittal reconstructions of click on your patient in your private the patient’s data that can be displayed in Worklist opens the case the way it is the entire clinical network such as the ICU, displayed here. the PACS workplace, or when you discuss the patient’s diagnosis in your office. *Not commercially available in the US.42 Dual Source DE for all patients
  42. 42. From scan to diagnosis status of the vascular structures andin under ten minutes the brain tissue for these patients – from scanning to diagnosis in less than CT Neuro imaging is very often a matter ten minutes including Dual Energy data of life-and-death therapeutic decision- into the disease-oriented workflow for making. From infarctions caused by stroke seamless integration into your clinical and extensive bleeding, to subarachnoid practice. Using data delivered by the hemorrhage and a ruptured aneurysm – Adaptive 4D Spiral, perfusion assessment seeing them clearly is essential because of the brain can easily be integrated in the of the huge difference it makes in assessment. The CT Neuro Engine also determining treatment. The new CT Neuro helps identify fractures after an accident Engine provides tools and workflows that and, for instance, uncovers the potential help deliver a complete and accurate stenosis when looking at the vascularity of the neck. If a Dual Energy examination, such as a Dual Energy Brain Hemorrhage calculation was made, the data is automatically displayed together with all your other pre- processed data. So Dual Energy data, seamlessly integrated in syngo.via, may give you the decisive diagnostic information for taking sound, safe, and sustainable treatment decisions in any patient. 43
  43. 43. Dual Source DE for all patie Clinical Results Single dose Dual Energy shows a lung perfusion defect in the right Dual Energy direct hard plaque and bone removal for immediate true lumen lower segment – unveiling the effect of pulmonary emboli. assessment. Automatically preprocessed in syngo.via with coronal, sagittal, and axial reformats for sound treatment decisions.44 Dual Source DE for all patients
  44. 44. nts Monoenergetic imaging, on the right, provides improved visualization of the Dual Energy Optimum Contrast (right) combines the advantages of low and high kV metal screws relative to the surrounding bone tissue. CT scans for enhanced lesion conspicuity in iodine-enhanced CT images. 45
  45. 45. Customer Care Dedicated to Your Success Remain one step ahead and tap the Upgrades and migration: Services and support full potential of your Siemens CT system Evolve, Expand, Elevate with our customer care program, Life. Feel confident with our proactive As a worldwide innovation leader in Stay competitive with up-to-date systems service solutions medical imaging, Siemens has gained unmatched knowledge in Computed Due to increasing healthcare demands you High system availability, diagnostic Tomography. You can profit from excellent have to stay on the cutting edge to be confidence, and optimized workflow CT systems and innovative, flexible, and competitive. We will help you to keep your are crucial for the success of your comprehensive service solutions that solutions up-to-date and to keep pace with CT service. To meet your performance enable you to concentrate on what is the latest technological advancements expectations, we systematically focus most important for you: patient care. through the syngo Evolve program. syngo on being proactive. Based on real-time The customer care program, Life, is Evolve offers certainty in budget planning, system monitoring we detect system the unique solution from Siemens that feature enhancements for your CT, access errors and alert you before problems helps you to maximize the return on to new applications, and lower cost occur. The Siemens Guardian Program™ investment throughout the entire life upgrades for your CT system. helps to make unplanned downtime a cycle of your system. thing of the past.46 Customer Care
  46. 46. Education and training Information and communication Broaden your knowledge and expertise Be informed – get connected Know-how is the key to success. With our extensive portfolio of education and To ensure you are always up-to-date training programs you can deepen your on what is happening in the CT world, knowledge and clinical expertise. We we offer you a variety of information show you how to maximize the benefits services including easily accessible that can be achieved with our advanced information portals, monthly newsletters, technology. This will help you to optimize our customer magazine SOMATOM your workflows so you can offer an even Sessions, and the SOMATOM World higher quality of care for your patients. Summit, our scientific user conference. 47