Iterative Reconstruction Goes Mainstream in CT Imaging

SOMATOM Sessions
Answers for life in Computed Tomography
Issue Number 28 / June 2011
Stanford-Edition | June 13th – 16th 2011
Cover Story
Iterative Reconstruction
Goes Mainstream
Page 6
News
FAST CARE Hits
the Bull’s Eye
Page 12
Business
syngo.via with the
SOMATOM Defi nition-
Flash: “A Technical
Revolution”
Page 32
Clinical
Results
New 70 kV Protocol
Ensures Low Radiation
Dose in Pediatric
Patients with Congenital
Heart Disease
Page 54
Science
CARE kV – How to Opti-mize
Individualized Dose
28
Page 62

Editorial
2 “Our success with FAST CARE fully
supports our visionary perspective
and sense of responsibility to make
CT a diagnostic measure with
broad acceptance and availability
to almost all patients – worldwide.”
Walter Märzendorfer, Chief Executive Officer,
Business Unit Computed Tomography and Radiation Oncology,
Siemens Healthcare, Forchheim, Germany
Cover Page: Courtesy of University Hospital Zurich, Zurich, Switzerland
SOMATOM Sessions · June 2011 · www.siemens.com/healthcare-magazine

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Contents
Cover Story
Cover Story
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Content
60
DECT: Virtual Non-Calcium Technique
Detects Posttraumatic Bone Bruise
SOMATOM Sessions · June 2011 · www.siemens.com/healthcare-magazine 5
Acute Care
52 Dual Energy CT: Virtual Non-Con-trast
Imaging of a Complicated
Renal Cyst
54 New 70 kV Protocol Ensures Low
Radiation Dose in Pediatric Patients
with Congenital Heart Disease
56 Diagnosing Pulmonary Embolism
Using High Pitch Protocols
Orthopedics
58 Reliable Detection and Diagnoses of
Gout Using Dual Energy Acquisition
Technique
60 Dual Energy CT: Virtual Non-Calcium
Technique Detects Posttraumatic
Bone Bruise of the Knee
Science
62 CARE kV – How to Optimize
Individualized Dose
65 Choosing the kV is Now an Easy
Equation – a First In-practice Report
on CARE kV
66 Dose Neutral Dual Energy Scanning
with Dual Source CT
Clinical Results
Cardio-Vascular
38 Thoracic Triple Rule-Out in Low
Dose Acquisition Technique Using
Prospective ECG-Triggering
40 SOMATOM Definition AS+ Scanning:
Coronary Artery Anomaly
42 Retrograde Filling of Occluded
Proximal Coeliac Trunk – Confirmed
by CTA
Oncology
44 CT Examination Reveals Extremely
Small Stone in the Kidney with
SAFIRE
46 4-Phase Liver Examination with
SOMATOM Emotion 16 Unveiled
Liver Haemangioma
48 SOMATOM Emotion 16 Chest
Imaging: Ground Glass Opacity in
the Upper Right Lung
Neurology
50 SOMATOM Emotion 16: Intracranial
Head CTA – Dolichoectasia of the
Basilar Artery
Life
68 Free Trial Licenses for syngo.via
are now available
69 Experience Lounge: Hands-on
Workshops at ECR 2011
69 Clinical Workshop on Cardiac CT
at Munich University
70 New Series of Live Clinical Webinars
70 FAST CARE for All Patients of syngo
Evolve Customers
71 Investment Protection for
SOMATOM CT Scanners
72 Frequently Asked Questions:
How can Dose be Reduced with
syngo.via
73 Upcoming Events Congresses
73 Clinical Workshops 2011
74 Siemens Healthcare Publications
75 Imprint
28
Growing Demand for
Postmortem Imaging
58
Reliable Detection and Diag noses of Gout
Using Dual Energy Acquisition Technique

Coverstory
Iterative Reconstruction
Goes Mainstream
Iterative Reconstruction (IR) offers radiologists the choice: lower
the radiation dose or get better image quality. IR is now becoming part
of radiological routine.
By Eric Johnson
Flat as an ironing board, flanked by
fields of waving wheat and canola,
the 10,000-person town of Winkler
could be Central Casting’s selection for
Anytown USA, even though it sits a
15 minute’s drive north of the border in
Canadian Manitoba. Typical, average,
middle-of- the-road, with a whiff of ‘Lake
Wobegone’ – the fictional setting made
world-famous by (almost) local author
Garrison Keillor.
Just west of town in a former farming
field, Winkler’s Boundary Trails Health
Centre fits the mould. It is a general
hospital, treating the range of ailments
that afflict a regional population of some
65,000. “We’re not a specialized institu-tion
as such,” comments radiologist Bob
McGregor, MD, “here we treat all kinds
of patients, all kinds of diseases and all
regions of the body.” Ordinary as that
seems on the outside, McGregor has
“It moves us well along
the path of ALARA, but
it ensures that we still
can do our primary job,
which is to capture an
excellent diagnostic
image.”
Bob McGregor, MD, Winkler’s Boundary Trails
Health Centre, Manitoba, Canada
6 SOMATOM Sessions · June 2011 · www.siemens.com/healthcare-magazine
since last September been using a tech-nology
that clearly is extraordinary:
iterative reconstruction. IR used to
be the exclusive preserve of molecular
imaging and nuclear medicine, but
thanks to ongoing increases in comput-ing
power, now it is routinely available
for CT imaging. IR is up and running in
day-to-day practice, not just here in mid-dle
America, but also in middle Europe
and middle South America as well. Join-ing
McGregor in mainstreaming IR are
two other radiologists: Hatem Alkadhi,
MD of Switzerland’s University Hospital
Zurich, and Dany Jasinowodolinski,
MD of Brazil’s Hospital do Coração in
São Paulo.
Down with Dosage
Between the three resides some 45
years of radiological experience, much
of it logged on what is still the industry
workhorse and standard for image
creation: filtered back projection (FBP).
And good as FBP is at generating quality
images – which of course is the radiolo-gists’
primary mission – all three of them
recognize the rising pressure of ALARA.
“As low as reasonably achievable” has

Coverstory
1 The dataset of a patient with urinary stones is acquired with SAFIRE and a very low radiation dose of 1.6 mSv. Obviously the image does not
appear noisy in spite of the low dose usage. Courtesy of University Hospital Zurich, Zurich, Switzerland
1

become their byword, especially in
the wake of the notorious 2008–09
overdosing of brain-scan patients in
the US.
“People fear radiation,” observes Alka-dhi,
“partly because it’s so mysterious,
something they cannot feel or see.”
He personally believes that the public’s
angst has been hyped, not least by
sensational media reports and pseudo-scientific
claims. Still, he takes a ‘better-safe-
than-sorry’ view toward low-dos-age.
“In the case of, say, a 50-year-old
male who has lower abdominal pain
and needs a one-off scan, the exposure
is really not a significant health risk,”
he notes. “On the other hand we have
many patients – for instance, those with
a lymphoma or urinary stones – who
are younger and who need repeated
scans over relatively long periods.
Especially for these we should, as a
priority, keep doses as low as we can.”
Since coming online last November,
this is precisely what University Hospital
Zurich has been doing with its new
Sinogram Affirmed Iterative Recon-struction,
better known as SAFIRE.*,**
Alkadhi says that doses for chest scans
have tumbled nearly ten-fold from
5–7 to 0.6–0.8 mSv; for abdominal
images the exposure has been dropped
from 8–10 to about 1.6 mSv. With its
IRIS** system (Iterative Reconstruction
in Image Space), Canadian Boundary
Trails has also dropped exposure
mightily: McGregor reports declines of
45 percent in abdominal-pelvic scans
and 55 percent in chest imaging.
Also using IRIS, Hospital do Coração
is achieving radiation reduction of
50 percent that, according to Jasino-
Coverstory
“People fear
radiation, partly
because it’s so
mysterious,
something they
cannot feel or see.”
Hatem Alkadhi, MD, MPH,
University Hospital Zurich, Switzerland
* 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.
** In clinical practice, the use of SAFIRE or IRIS may reduce CT patient dose depending on the clinical task, patient size, anatomical location, and clinical practice. A
consultation with a radiologist and a physicist should be made to determine the appropriate dose to obtain diagnostic image quality for the particular clinical task.

Coverstory
wodolinski, are accompanied by 35 per-cent
less noise.
Business as Usual
Dosage drop has come at no sacrifice to
image quality. McGregor has cataloged
same-patient images taken first with
FBP and then with IRIS, and concluded
that images are equivalent. The doctors
do find that IR changes the texture
of the body views, rendering them dif-ferently
than conventional FBP. “But
after a short adjustment period, one
gets used to this change,” Alkadhi notes,
“IRIS is a big
step forward
for us.”
Dany Jasinowodolinski, MD,
Hospital do Coracao, Sao Paolo,
Brazil

Coverstory
Data recycling: the nous behind IR
Iterative reconstruction (IR) is the latest
known and applied in other fields, but
in a long line of innovations to reduce
until recently, to use it with CT imaging
radiation dose. Reconstruction refers to
in conventional clinical medicine was
the task of building an image out of
simply too time-consuming: the com-puter
a scan’s projection raw data. Iterative
took too long to reconstruct the
refers to the method. Calculations are
images. In 2009, that changed. Newly-launched
repeated over and over, to zero in on
IRIS (Iterative Reconstruction in
the best possible image, minus artifacts
and noise.
The fundamentals of IR have long been
Image Space) was powerful enough to
plough through the iterations within
acceptable cost and time limits. SAFRIE
SAFIRE*
Raw Data Space Image Data Space
(Sinogram Affirmed Iterative Reconstruc-tion),*
released shortly afterwards, is
even more powerful. Whereas IRIS first
reconstructs a master image and then
iterates on that, SAFIRE also iterates back
through the raw data itself (see graphic),
allowing even greater reductions**
in radiation-exposure and eliminating
conventional CT artifacts.
More powerful dose reduction than image-based methods
Well-established image impression
Superior image quality
Ready for clinical routine use with fast image reconstruction
performance of up to 20 images per second
Raw Data Space Image Data Space
IImmaaggee ddaattaa
rreeccoonn
Dose reduction** or image quality improvement
Fast reconstruction in image space
Compare
IRIS
MMaasstteerr
rreeccoonn
Compare
IImmaaggee ddaattaa
rreeccoonn
Exact image
correction
RRaaww ddaattaa
rreeccoonn
Full raw data
projection
Exact image
correction
* 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.
** In clinical practice, the use of SAFIRE may reduce CT patient dose depending on the clinical task, patient size, anatomical location, and clinical practice. A consultation
with a radiologist and a physicist should be made to determine the appropriate dose to obtain diagnostic image quality for the particular clinical task.

Coverstory
was with its FBP predecessor. So, too, is
Alkadhi’s with SAFIRE. “Generating
images for an abdominal dataset might
take an extra 30 seconds or so,” he
notes. Jasinowodolinski’s IRIS takes
about one minute longer to create
images than the previous FBP system.
All the doctors expect that ever-rising
computation power will in due course
eliminate that extra processing time
altogether.
IR is definitely a worthwhile investment,
they conclude. “IRIS is a big step forward
for us,” offers Jasinowodolinski.
“It moves us well along the path of
ALARA,” says McGregor, “but it ensures
that we still can do our primary job,
which is to capture an excellent diagnos-tic
image.” Ordinary aims, extraordinary
dose-reduction – that will be IR.
Eric Johnson writes about technology, business
and the environment from Zurich. Formerly
he headed what is now a Thompson-Reuters
bureau and corresponded for McGraw-Hill
World News.
adding that quality is retained with IR,
just in a slightly different way.
Although the three doctors are using IR
to slash dose, it can also be used to
improve image quality. In cases where
imaging is typically difficult – say,
bariatric patients – IR can raise results,
notes Alkadhi. Depending on the spe-cific
circumstances, quality can still be
hiked with a dose decline.
Either way, IR is quickly integrated into
radiological routine. After a short set-tling-
in period, McGregor’s day-to-day
work with IRIS is much the same as it
Leading hospitals in their countries
Boundary Trails Health
Centre
Acute services to the community are
provided by the 94-bed Boundary
Trails Health Centre, Canada. This
facility, which also acts as a regional
Hospital do Coração
The HCor – Hospital do Coração is
located in the Paraiso neighborhood
in the city of São Paulo, Brazil. It
diversified its scope of services and
offers treatment in 37 medical spe-cialties
today, such as orthopedics,
UniversitätsSpital Zürich
The University Hospital Zurich is
located in the center of Zurich,
opposite the University of Zurich and
the Federal Technical High School
(ETHZ). Comprised of 40 depart-ments
and institutes, both special-ised
and comprehensive, University
Hospital Zurich incorporates all
medical disciplines. University
health centre providing primary, sec-ondary,
and community health care
to the residents of South Central
Manitoba, is located between Win-kler
and Morden and serves a popu-lation
of about 65,000 in the area. It
traumatology, oncology, neurology,
urology, gastroenterology, surgery in
diverse specialties, image diagnosis,
sports medicine, and nutriology,
among others. In order to accomplish
its social mission as philanthropic
hospital, the HCor offers the most
Hospital Zurich is serving approxi-mately
200,000 patients a year. With
850 beds and more than 270,000
hospital days, University Hospital
Zurich is one of the largest hospitals
in Switzerland. The Institute of Diag-nostic
and Interventional Radiology
offers the full spectrum of general
diagnostic and interventional radiol-ogy
and features sub-specialization
is an integral part of the services
offered by Regional Health Authority
– Central Manitoba Inc. Currently,
there are approximately 450
employees working at the Boundary
Trails Health Centre.
advanced technology in cardiologic
procedures to needy children. The
HCor has the most advanced technol-ogy
within the health care area in Latin
America, with a highlight for the Diag-nosis
Center – which performs more
than 1,2 million exams annually.
expertise. It combines excellence in
research and outstanding education
with the highest quality health care.
The number of inpatient and outpa-tient
radiology procedures totals over
100,000 annually, which are carried
out at the request of medical special-ists
and general physicians. The hos-pital’s
expert radiologists work with
skilled technologists and nurses.

News
1 FAST Spine delivers an automatic segmentation of the spinal canal and automatic labeling of the vertebrae.
Courtesy of University Hopspital of Zurich, Switzerland
FAST CARE Hits the Bull’s Eye
FAST CARE ushers in a new era in computed tomography. After the market
launch at the RSNA 2010, the new technology platform has been up and
running in clinical institutions for several months. Experiences in Zurich,
London and Tacoma prove that FAST simplifi es and accelerates workfl ows,
and reduces radiation dose even further – thanks, in particular, to the new
CARE kV technology.
By Ingrid Horn, PhD
The latest generation SOMATOM Defini-tion
AS – the high-end, single-source CT
scanner from Siemens – has been deliv-ered
with the innovative technology
platform FAST CARE since March 2011.
“CARE” (Combined Applications to
Reduce Exposure) unite all technologies
currently used by Siemens to reduce radi-ation
doses in a unique manner. Although
enormous progress in terms of radiation
protection and dose reduction has been
made in the last 15 years, reducing
radiation doses in computed tomogra-phy
even further remains an issue for
Hatem Alkadhi, MD. “It is assumed that
all additional radiation is unhealthy
for patients. As a result, we aim to con-tinue
avoiding unnecessary radiation,
exploiting the technical potential to
reduce doses for patients to its fullest,”
explains the Zurich-based radiologist.
He researches at the Institute for Diag-nostic
Radiology based at the University
Hospital Zurich, Switzerland, a selected
test center for CARE.
Over a six month period, Alkadhi and his
team have performed an in-depth analy-sis
of CARE kV technology in clinical con-text.
CARE kV is a breakthrough addition
to CARE Dose4DTM, a tool which already
1

2 These two images show the abdomen scan in 2009 (Fig. 2A) with 140 kV and as follow-up examination in 2011 (Fig. 2B) with CARE kV and
only 100 kV. Both images have the same image quality although using lower kV in 2011.
allows maximum image quality with
minimum dose for each patient, thanks
to real-time dose modulation. So what’s
the advantage of CARE kV? The answer
is clear: in addition to the current
modulation familiar from CARE Dose4D,
CARE kV also optimizes CT examinations
and the administered dose via the auto-matic
selection of suitable voltage in
line with pertinent diagnostic issues and
the patient’s physique. The radiologist
explains the situation as follows: “We
used to be confronted frequently with
the problem of whether we should
reduce the tube voltage or not, and to
what extent. And, if so, whether the
reduced image quality jeopardizes a reli-able
diagnosis. We often used parame-ters
such as body weight or body mass
index to assist us in the decision-making
process. However, the question of which
body weight should necessitate a reduc-tion
in tube voltage and radiation dose,
and the extent of the said reduction
proved divisive. By contrast, CARE kV
plans the examination for us in advance
with an optimized radiation dose, usu-ally
decreasing this so that the patient
ultimately receives less radiation.”
Meanwhile, the radiologists in Zurich
have found scientific evidence for the
reduction in radiation dose via CARE kV.
They carried out a study of vascular
patients who require repeated CT scans
within the context of follow-up treat-ment.
Material pre-dating the launch of
CARE kV is available concerning these
patients. This permits an effective
comparison of radiation dose and image
quality with and without the use of
CARE kV. They are also currently collect-ing
relevant data for the CT examination
of the neck region with regard to bone
and soft tissue. Alkadhi summarizes:
“The additional dose reduction is huge
in the case of all patient groups exam-ined.”
He indicates a dose reduction
of between 20 and 30 percent for all
evaluated patients. If circumstances
are favorable, reductions of up to 50
percent in scans of the neck region are
even possible in isolated cases.
Olivia Egan in London, England, is also
a fan of the CARE package. She holds
the post of CT Superintendent Radiogra-pher
at the Chelsea and Westminster
Hospital and views the issue from a dif-ferent
perspective, commenting: “CARE
gives my technical team a high degree
of security as regards dose reduction.”
Olivia Egan views the easy compatibility
of CARE kV with FAST as an additional
benefit. “FAST” (Fully Assisting Scanner
Technologies) stand for all programs
designed to simplify scanning work-flows.
She goes on to outline a further
benefit of FAST Adjust, namely that it
allows less experienced technicians on
the roster to achieve the highest quality
images with the lowest radiation dose
possible. FAST Adjust ensures that scan
parameters such as scan time, pitch or
tube current can be set correctly with
just a single click. In just a few weeks,
these simple operations have become
routine for the technologists in London.
Employees at MultiCare’s Tacoma Gen-eral
Hospital trauma service in Tacoma,
Washington, USA, highly appreciate how
FAST (Fully Assisting Scanner Technolo-gies)
takes care of the finer details at the
CT and accelerates workflows in the pro-cess.
MultiCare Imaging Manager, Joe
Larson is full of praise for the FAST Spine
tech nology: “FAST Spine gives us an
enormous time advantage in the case of
suspected spinal column injuries.” The
program marks the vertebrae within a
predetermined scan area of the spine
automatically and calculates the posi-tion
of vertebrae and disks for an ana-tomically
correct image reconstruction.
Up until now, this process was per-formed
manually by a technologist ver-tebra
by vertebra, which easily took a
half-hour or more. Larson explains,
“FAST Spine accelerates the entire pro-cess
automatically and naturally. The
images are produced immediately, so
that the surgeon can evaluate them in
real time. This allows the trauma sur-geon
to decide more quickly whether to
operate.” FAST Spine also reduces the
time normally placed on CT technolo-gists,
because quick action is essential in
trauma cases. Both physicians and CT
technologists at Tacoma General Hospi-tal
point to FAST CARE as essential to
improving their working environment.
Ingrid Horn, PhD, studied biology and bio-chemistry.
She is an expert in science communi-cations
and an experienced medical writer.
www.siemens.com/fastcare
2A 2B

News
New SIERRA Expert Sub-Committee Focusing on
Pediatric Dose Reduction Established
Within SIERRA, Siemens’ expert panel on dose reduction, a new group,
concentrating on dose savings in pediatric radiology, has been formed.
By Stefan Ulzheimer, PhD, and Heidrun Endt, Computed Tomography, Siemens Healthcare, Forchheim Germany
The Siemens Radiation Reduction Alliance
(SIERRA) was founded in June 2010. Six-teen
radiologists, physicists and cardiolo-gists,
renowned for their scientific
research on dose in medical imaging,
joined the expert panel to set up tasks to
determine how dose can be further
reduced.
When imaging children, dose becomes
even more important as children are
more sensitive to radiation. Researchers
in this special field of radiology have
joined together in a SIERRA sub-commit-tee.
This sub-committee will not only
concentrate on new technologies but –
equally important – on education for
pediatric imaging. Siemens’ scanners pro-vide
a lot of innovative technologies to
reduce dose, so education should focus
on these technologies, their functionality
and optimal application in daily clinical
practice. Marilyn Siegel, MD, Mallinck-rodt
“The latest dose reduction features
like a 70 kV mode will especially
benefi t our youngest patients.
But it is also important that the
equipment is used in an optimal
fashion (…).”
Elliot Fishman, MD, Johns Hopkins University Hospital, Baltimore, U.S.
Institute of Radiology, St. Louis, U.S.,
will head this new group within SIERRA.
Siegel joined the SIERRA panel in June
2010 as did Elliot Fishman, MD, Johns
Hopkins University Hospital, Baltimore,
U.S . Additionally both will now support
the efforts concerning pediatric radiol-ogy.
CARE kV and CARE Child, the most
recent technologies that come with Sie-mens’
SOMATOM Scanners, were devel-oped
and tested in close collaboration
together with Siegel.
For Siemens, dose reduction, while deliv-ering
excellent image quality in radiology
and during interventional procedures,
has always been a top priority. Innovative
CARE (Combined Applications to Reduce
Exposure) features are an integral part of
all Siemens systems. Using lower tube
voltages in CT can dramatically reduce
dose, especially in small patients and
children1. However, this potential has not
been widely exploited because a lot of
related conditions have to be observed.
As defining the ideal tube voltage for
each patient was not an easy step to
make, this parameter was seldom
adapted to the current patient and exam-ination
in clinical practice. Now CARE kV
automatically selects the optimal tube
voltage based on the individual patient
and application. Furthermore, with CARE
Child, Siemens provides the industry’s
first-ever scans with voltage as low as
70 kV. Combining both, CARE kV and
CARE Child, leads to a dramatic reduction
of dose, especially in pediatric patients.
Fishman states: “The latest dose reduc-tion
features like a 70 kV mode will espe-cially
benefit our youngest patients. But
it is also important that the equipment is
used in an optimal fashion. Therefore, I’m
happy to work with Siemens and my
peers on optimizing protocols and on

The members of the SIERRA sub-group focusing on pediatric
imaging are Marilyn Siegel, MD, Elliot Fishman, MD, and
Joseph Foss, MD, (Arnold Palmer Hospital for Children Women,
Orlando, U.S.). Additionally, Cynthia Rigsby, MD, (Children’s
Memorial Hospital, Chicago, U.S.) and Robert Gilkeson, MD,
(University Hospital Case Medical Center, Cleveland, U.S.) have
joined the sub-committee. They will all help to optimize the use
of leading edge technology in daily clinical practice, sharing
their knowledge in this special field of radiology. The formation
and follow-up of this expert panel with its sub-committee indicates
once more, Siemens’ ongoing efforts to reduce dose to the lowest
extent possible.
Expert Advice on Dose Reduction
Always at Your Fingertips
By Heidrun Endt, Computed Tomography, Siemens Healthcare, Forchheim, Germany
Siemens SOMATOM scanners come with
innovative technologies for dose reduc-tion,
making low dose CT examinations
possible for every patient. Now a new
series of flyers is available which
includes advice on how to reduce dose
even further: experts from Siemens CT
Research Development department
share their knowledge about using these
technologies in the most efficient way.
“How to reduce dose in Pediatric CT
imaging” is one of the first flyers out of
this series. As children are more sensi-tive
to radiation than adults, it is of
utmost importance to pay attention
when imaging pediatric patients. This
flyer includes tips and tricks* to guide
the user from patient preparation to
protocol selection and application of
features such as CARE Dose4D.
Two more flyers are available: “How to
reduce dose in Cardio CT,” suitable for
News
www.siemens.com/low-dose-CT
the SOMATOM Definition AS Family
and another one for the SOMATOM
Definition Flash, both with syngo CT
2011. Which is the most appropriate
scan mode for the patient and which
reconstruction parameters should be
chosen? These flyers provide all the
information necessary in daily clinical
practice.
As the series continues, more flyers will
be available on the latest technologies,
for example CARE kV.
To have expert advice on dose reduction
always at the fingertips, flyers can be
ordered via the Customer Information
Portal, Siemens Internet.
*Appropriate for syngo CT 2010 or earlier.
www.siemens.com/CT-infoportal
Training Education;
Order your training material
education programs to make sure that
new technology is not only developed
but also adopted as fast and as broadly
as possible.”
One of the first steps of the newly estab-lished
sub-committee will be a publica-tion
that summarizes the possibilities of
dose reduction for pediatric patients.
Other activities in terms of best practice
sharing are planned, in order to transfer
the expert advice to as many radiologists
as possible who perform CT examinations
in children.
How to reduce dose in Pediatric CT
imaging and Cardio CT: three flyers out
of a new series are available providing
expert advice on dose reduction.
n
[1] Siegel MJ et al. Radiation dose and image quality in
pediatric CT: effect of technical factors and phantom
size and shape. Radiology. 2004, Nov; 233(2):515–22.

Faster Abdominal Aortic Stent Planning with
syngo.via and the CT Cardio-Vascular Engine
By Philip Stenner, PhD, Computed Tomography, Siemens Healthcare, Forchheim, Germany
Abdominal aortic aneurysms (AAA) pose
a serious threat to patients as a rupture
will cause abdominal bleeding which is
a life-threatening condition. Ruptured
aneurysms are responsible for roughly
9,000 annual deaths in the US.1 With an
occurrence of 4%-7% in adults of 65
years and older, AAAs are a common
disease worldwide.2 Up until the late
80s, the conventional treatment was an
open repair of the aorta. The treatment
of AAAs was revolutionized in 1991 by
the first endovascular aortic repair
(EVAR).3 With this technique, a stent is
inserted through a catheter to the place
of the aneurysm and expanded to stabi-lize
the surrounding vessel. Today, com-pared
to an open repair, the risks for the
patient are dramatically reduced, lead-ing
to 30-day mortality rates of only
1.2%.4
Crucial for the success of an EVAR proce-dure
is correct pre-procedural planning
to assess the anatomy and optimal stent
size for each patient. With its high spa-tial
resolution, Computed Tomography
(CT) is the method of choice. With
SOMATOM Scanners on the scanner side
and syngo.via on the post-processing
side, Siemens Healthcare provides
an excellent solution for the planning
of EVAR procedures. The software
syngo.CT Vascular Analysis* provides
an efficient and reliable assessment of
the abdominal aortic anatomy.
Due to comprehensive automated pre-processing,
like automated bone and
table removal, an immediate vascular-only
view is provided. The Autotracer**
automatically segments and labels the
vessels even before the case is opened.
The aorta is displayed in a curved planar
reformation and the centerline is auto-matically
created providing the basis for
important length measurements.
Since 95% of aortic aneurysms are infra-renal,
i.e. below the ostia of the renal
arteries, syngo.CT Vascular Analysis
provides a dedicated stent planning
template for these cases (Fig. 1). The
template guides the user through mea-suring
the length and diameters of the
aneurysm, the aorta, and the left and
right illiac arteries. The distance of the
aneurysm to the renal arteries and to
the illiac bifurcation are also included.
Along with the registration of all mea-surements
in the Findings Navigator, all
diameter measurements are automati-cally
saved in the stent planning tem-plate
which is easily accessed in the
report editor. The automation greatly
facilitates the workflow and allows for a
reliable assessment of abdominal aortic
stent parameters thus providing a sound
basis for EVAR procedures.
www.siemens.com/ct-cardiology
News
1 Macari M, et al. Radiology 2006,
Vol. 241, No. 3, 908–914.
2 Katzen BT, et al. Circulation 2005;
112: 1663–1675.
3 Parodi JC, et al. Ann Vasc Surg. 1991;
5: 491–499.
4 Prinssen M, et al. N Engl J Med 2004;
351:1607–1618.
1 The success of endovascular aortic repair strongly depends on correct pre-procedural
planning. syngo.via and the CT Cardio-Vascular Engine provide a powerful means for
efficient and reliable assessment of the abdominal aortic anatomy and all parameters
necessary for stent planning.
1
*syngo.CT Vascular Analysis is available either
as a stand-alone software package or as one of
several software and hardware features in the CT
Cardio-Vascular and Acute Care Engines.
**Available in the Acute Care Engine Pro and CT
Cardio-Vascular Engine Pro

1 Assessment of tumor change over time is essential for efficient oncological follow up. Being able to decide about response, stable or progres-sive
disease determines the decision for therapy continuation or change in the oncological regimen. Radiologists can benefit vastly from having
the right diagnostic software like syngo.via and the CT Oncology Engine at their disposal.
syngo.via Powers CT Oncology Engine for
Oncological Assessment
By Jochen Dormeier, MD, Computed Tomography, Siemens Healthcare, Forchheim, Germany
Oncological diagnosis and assessment of
effectiveness of cancer therapeutics
make use of standards like RECIST 1
(response evaluation criteria in solid
tumors) and standards set by the WHO
(World Health Organization).2 Therefore,
easy access to the right measurement
tools as well as dedicated reporting capa-bilities
are essential to report on response
or progression comparing the most cur-rent
with the baseline examination.
Either in parallel to conventional report-ing
from PACS or by reporting directly
using the CT Oncology Engine, syngo.via
facilitates this assessment by bundling a
variety of dedicated functionalities for
oncological reading.
Even before the case is opened,
syngo.via works in the background to
pre-fetch relevant patient image data
from previous examinations. In addition,
for lung cases, computer aided detection,
and for virtual colonoscopy cases, polyp-enhanced
viewing algorithms prepare
the cases as second reader tools – its
Especially for volumetric approaches,
scientific publications have shown
significant deviations in disease assess-ment
compared to RECIST and WHO
and requests for large studies have been
formulated.3 Here the CT Oncology
Engine immediately provides the right
tools at the fingertips.
1 Eisenhauer EA et al. New response evaluation
criteria in solid tumors: revised RECIST
guideline (version 1.1). J. Eur J Cancer. 2009
Jan; 45(2): 228-47
2 World Health Organization, WHO Handbook for
Reporting Results of Cancer Treatment, Offset
Publication No. 48, Geneva, 1979
3 Prasad SR, et. al. CT tumor measurement for
therapeutic response assessment: comparison
of uni-dimensional, bi-dimensional, and
volumetric techniques-initial observations.
Radiology 2002; 225(2): 416–419
www.siemens.com/ct-oncology
results being immediately available.
For comparison with previous examina-tions,
the current and baseline images
are loaded into the reading physician’s
preferred layout. The datasets are auto-matically
registered so that the same
anatomical areas are displayed in both
datasets while scrolling through the
scans. If measurements have already
been performed with syngo.via for the
baseline, these measurements are avail-able
in the findings navigator for easy
call-up and comparison with the specific
lesion in the current scan. As soon as the
lesion in the baseline and the current
examination are measured and linked,
the report provides relevant information
about RECIST and volumetric changes of
the tumor size.
In contrast to conventional 2-dimensional
PACS based reading, syngo.via’s approach
of working with data volumes and utiliz-ing
automated segmentation algorithms
provides access to reproducible results for
volumetric assessment of tumor burden.
1

News
SOMATOM Emotion – The Most Popular CT
in the World* – Now with IRIS**
By Rami Kusama, Computed Tomography, Siemens Healthcare, Forchheim, Germany
The success story of over 7,000
SOMATOM Emotion installations
con tinues. To meet present and future
demands for higher quality and cost-efficient
healthcare, Siemens has intro-duced
IRIS – Iterative Reconstruction in
Image Space – at this year’s ECR 2011
on the SOMATOM Emotion 16 as well
as the SOMATOM Emotion Excel
Edition. With the introduction of IRIS on
the world’s biggest installed base, this
compact scanner is set to offer not
only improved image quality or lower
dose** for better patient care, but will
also help users to stay at the forefront
in an increasingly competitive and
rapidly changing healthcare market.
There is no doubt that medical imaging
saves lives and thus its utilization has
increased immensely over the years.
With its increased utilization, radiation
dose and radiation dose reduction have
become one of the most discussed
topics in and outside of the imaging
community.
As an innovation leader in dose reduc-tion,
Siemens has long applied CARE
(Combined Applications to Reduce
Standard FBP
Dose savings may vary according to body region. Data on file.
Exposure), a comprehensive approach
to all areas of diagnostic and inter-ventional
imaging. Today, the Siemens
CARE standard brings together a wide
variety of advanced technologies and
applications to meet the needs of
patients and physicians for appropriate
radiation dose with the best possible
outcomes for diagnoses and interven-tions.
In addition, depending on the system
configuration, IRIS can also be added
retrospectively for already installed
SOMATOM Sensations as well as
SOMATOM Emotion 16-slice configu-rations.
“Bringing IRIS on the Emotion, our
widest installed base, means offering
low dose to the widest possible patient
population,” says Peter Seitz, Vice
President Marketing CT.
The SOMATOM Emotion produces clini-cally
excellent results, while reducing
ongoing costs, and protecting business
through superb system reliability.
Siemens also continues to offer a
consistent software platform, syngo®,
throughout all product lines to make
training faster, more efficient, and less
expensive to facilities worldwide. If you
are a radiologist, technologist, or finan-cial
administrator, you will also enjoy
the knowledge that you own the world’s
most popular CT scanner*, now with IRIS.
* Based on the number of systems worldwide.
** Expected availability summer 2011.
In clinical practice, the use of Iterative Reconstruc-tion
IRIS may reduce CT patient dose depending on
the clinical task, patient size, anatomical location,
and clinical practice. A consultation with a radiolo-gist
and a physicist should be made to determine
the appropriate dose to obtain diagnostic image
quality for the particular clinical task.
www.siemens.com/
SOMATOMEmotion
IRIS
Image data
recon
Image
correction
Raw data
recon
Limited dose reduction
Ultra-fast recon without iterations
Significant dose reduction
Image quality improvement
Fast recon in image space
Dose reduction with CT has been limited by the currently used filtered back projection reconstruc-tion
algorithm as displayed on the left. Using IRIS results in increased image quality or dose savings
for a wide range of clinical applications.

The New SOMATOM Spirit – Modern. Easy. Reliable.
By Florian Belohlavek, Computed Tomography, Siemens Healthcare, Forchheim, Germany
The new SOMATOM Spirit sets standards
in the segment of entry-level CT.
Siemens´ sub-second, multi-slice CT
scanner stands out due to simplicity and
excellent reliability without loss of
quality. “Making state-of-the-art CT
affordable is one of the key goals in the
Siemens CT vision. With the SOMATOM
Spirit – a modern, easy-to-use and reli-able
multi-slice CT, Siemens provides an
adequate answer for day-to-day examina-tions
in clinical practice,” says Peter Seitz,
Vice President Marketing, Business Unit
CT, Siemens Healthcare. “A combination
of well-proven components and modern
features like a gantry-front display, fast
computer hardware and an adjustable
patient table are setting new standards in
the entry-level segment.”
Modern
The SOMATOM Spirit is a synonym for
efficient system design. This philosophy
is easily recognized in the slim and
highly efficient gantry that has become
the benchmark in the CT industry.
And, starting with the 2011 models, the
SOMATOM Spirit comes equipped with a
gantry-front display showing parameters
News
protocols make it easy for all staff mem-bers
to achieve standardized results. Also
important for rapid and reliable workflow
is the state-of-the-art computer hardware
with an excellent recon speed of five
images per second. In addition, the new
patient table facilitates easy patient posi-tioning
and contributes to efficient and
profitable workflow.
Reliable
Siemens believes that the only time that
can be afforded is UPTIME, so engineering
and production efforts emphasize this
goal. Results from the almost 2,000 sys-tems
installed around the globe indicate
that the SOMATOM Spirit has a 99.6%*
UPTIME rate and regularly achieves 10,000
scans – and more – without a single glitch.
Addressing all needs of an affordable
multi-slice CT used in daily routine, the
SOMATOM Spirit is modern, easy and reli-able.
A system that can be trusted.
www.siemens.com/
SOMATOMSpirit
such as tube current, tube voltage, scan
time, table position and gantry tilt, all
particularly useful, for example, for
interventional and other procedures.
Equipped with the industry leading
detector material UFC,TM the SOMATOM
Spirit offers a segment-leading, high-contrast
resolution of 15.5 lp/cm at 0%
modulation transfer function (MTF).
The SOMATOM Spirit offers a compre-hensive
spectrum of CT applications to
perform all the 2D and 3D functions that
are required in daily routine. Addition-ally,
a wide selection of optional features
is available to equip the scanner for spe-cial
needs, for example Neuro Perfusion,
Dental CT or automated bone removal.
Easy
Siemens has designed a tailor-made,
ease-of-use, syngo user interface for the
SOMATOM Spirit. A “follow-me” approach
is used that quickly takes the user – step
by step – through all the procedures
required for a successful scan. The user is
logically guided through procedures for
patient registration, protocol selection
and patient positioning in preparation for
the scan. Standardized procedures and
The new
SOMATOM Spirit
is equipped
with a gantry-front
display.
* Results may vary. Data on file.

News
Successful RSNA 2010 for
Siemens’ Research Partners
Researchers from the Medical University of South
Carolina (MUSC) were especially successful and
received three awards from the conference committee.
By Heidrun Endt and Stefan Ulzheimer, PhD, Computed Tomography, Siemens Healthcare, Forchheim Germany
Thomas Henzler, MD, Prof. Joseph Schoepf,
MD, (Director of Cardiovascular Imaging and
CT Research and Development, MUSC) and
Markus Weininger, MD, presenting the cer-tificates
for their successful, prize-winning
research.
sels, cardiac function and perfusion.
Markus Weininger, MD, concluded that
one examination may provide all the
information that is necessary for the
diagnosis of coronary artery disease.
Thus SOMATOM scanners are used for
scientific research very successfully pro-viding
innovative technology and soft-ware
features that improve patient care.
SOMATOM Defi nition Flash – the Gold Standard in CT
By Peter Aulbach, Computed Tomography, Siemens Healthcare, Forchheim, Germany
A system or device is called the “gold
standard,” if it is the best and most suc-cessful
for the required task. The ECRI
is an US non-profit organization that
researches quality, cost effectiveness
and patient safety of medical equipment.
They serve more than 5,000 members
including hospitals, public and private
payers and government agencies. In the
case of CT, they assessed all relevant
competing technologies in the market
and compared their capabilities for the
most common tasks in CT.
Their conclusion was that only the
SOMATOM Definition Flash provides fast,
low-dose scanning that minimizes the
effects of patient movement, making it
especially valuable in trauma, pediatric
and cardiac cases. Special advantages are
amongst many others:
■ A Cardiac Flash mode requiring very
low dose
■ Excellent, reliable image quality at all
heart rates
■ Tripe rule-out examination for chest
pain, in less than one second
■ The Flash scan mode is a viable alter-native,
particularly for patients unable
to hold their breath or those at low
cardiac risk
■ The combination of fast imaging for
uncooperative children (Flash mode)
and dose reduction makes the system a
very useful tool for pediatric imaging
■ The Adaptive 4D Spiral that enables
good brain and excellent body perfusion
imaging with widest coverage of any
evaluated systems of up to 48 cm
■ The effective dose for a Dual Energy
scan that is the same as for a conven-tional
single energy scan
■ Excellent image quality and dose
management
■ Noise reduction, with iterative recon-struction
techniques for dose reduction
■ Whole-body studies that are completed
in under five seconds
Studying the ECRI1 results one could
conclude that the SOMATOM Definition
Flash is the best and most successful
technology for CT routine and advanced
tasks thus rightly defining the “gold
standard” in CT imaging.
www.ecri.org
1 ECRI Institute Report, HEALTH DEVICES, MARCH 2011
MUSC was awarded trainee research
prizes in three different categories:
chest radiology, emergency imaging and
cardiac. The research for these three
outstanding contributions was done on
Siemens SOMATOM scanners.
Triple-rule-out examinations obtained in
patients with acute chest pain were
further analyzed. Matthias Renker, BSC,
presented a study where an evaluation
with an automated detection algorithm
for lung nodules was added to the clini-cal
reading as some of these lesions are
overseen during emergency imaging.
Thomas Henzler, MD, is working at the
University hospital of Mannheim and
currently visiting MUSC as a research
fellow. He presented that CT examina-tions
in cases of acute pulmonary embo-lism
can additionally be used to assess
signs of right ventricular strain. Thus the
expensive measurement of a specific
biomarker for right ventricular dys-function
might no longer be necessary.
Cardiac CT with the SOMATOM
Definition Flash enables an overall
assessment in patients with coronary
artery disease: morphology of the ves-www.
rsna.org

News
International CT Image Contest 2011 –
Siemens Repeats a Previous Success
Excellent image quality is essential for accurate clinical diagnostics.
Additionally, another important ambition should be the lowest possible
radiation exposure for the patient.
By Michaela Spaeth-Dierl, medical editor, Spirit Link Medical, Erlangen, Germany
Images can be submitted until
Sep tember 18th, 2011.
The contest will close with an award-winning
ceremony at the RSNA in
Chicago at the end of November. In
addition, monthly winners will be
picked by the expert jury. Each monthly
category winner will receive a certifi cate
as “low-dose CT expert”.
Terms and conditions of entry for the
“International CT Image Contest 2011“
can be obtained here:
Siemens Healthcare wants to support its
customers in making efficient use of
hardware and software to reduce dose on
CTs and in sharing their experiences with
colleagues and other interested audi-ences.
Therefore, the first International
CT Image Contest was inaugurated in
2010 with great success. Almost 300
users of Siemens CT scanners from about
30 countries submitted their best clinical
images taken with the lowest possible
radiation dose. There was even a fan
community on Facebook with more than
1600 members, who discussed the
images submitted. In addition, internet
users were able to publically vote for their
favorite picture. The internet page
devoted to the contest received 17,000
hits within 6 months. Following up on
this amazing interest, Siemens Healthcare
has now announced the “International CT
Image Contest 2011.” The contest was
officially launched at the European Con-gress
of Radiology (ECR) 2011 in Vienna
on March 3rd. Siemens customers who
work with a Siemens SOMATOM CT scan-ner
of any performance class will have
the opportunity to compete for the title
of the best image in seven categories.
The submissions will be evaluated by an
international top-class jury made up of
acknowledged experts in the following
categories: Cardiology, Angiography,
Dual Energy, Pediatrics, Trauma,
Neu rology and areas of clinical routine
including Thorax, Abdomen and Pelvis.
www.siemens.com/image-contest
You can be a fan of the Interna-tional
CT Image Contest 2011 at
www.facebook.com/imagecontest
Following up on
the amazing
interest in the
first International
CT Image Contest
in 2010, Siemens
Healthcare has
now announced
the “International
CT Image Contest
2011.”

News
Data Analysis Aids Dose Reduction with the
New CARE Analytics
By Tiago Campos, Computed Tomography, Siemens Healthcare, Forchheim, Germany
The measurement and calculation of
radiation dose is an important topic for
efficient dose management, not only in
computed tomography (CT) but also for
all areas where X-ray exposure is uti-lized.
Siemens provides tools such as
DICOM Dose Structured Reports (DICOM
SR) and CARE Analytics.*
The DICOM SR contains comprehensive
data for each irradiation event, the
accumulated dose (CTDI and DLP) in CT,
and information about the context of
the exposure. The data is provided in
DICOM standard format that can be sent
to any system which receives, stores
and/or processes dose information, such
as conventional PACS or workstations.
In order to evaluate and analyze the
information contained in the DICOM SR
files, Siemens provides a new, free tool:
CARE Analytics.
CARE Analytics allows dose received by
patients during an examination with
computed tomography systems, X-ray
and fluoroscopy devices as well as
angiography systems, to be analyzed
and evaluated. Hence, it can help
radiologists and other clinicians, for
example, to optimize their scan proto-cols,
and to work with reduced dose.
This software tool can be installed on
any office computer connected to the
hospital network and is able to retrieve
and query SRs from DICOM nodes
directly or import them from a USB
device. Dose reporting data can then be
exported and analyzed with standard
tools, such as Microsoft Excel™.
With the use of CARE Analytics, medical
staff is able to compare dose given
during different examinations in order
to further optimize the scan protocols.
In addition, it is possible to ascertain
the dose a patient has received on dif-ferent
systems over a series of examina-tions.
Dose reporting between multiple
hospitals is also possible. The increased
transparency lets clinicians improve
their working practices and be more
sparing with the dose given than in
the past. Contact your local Siemens
representative in order to obtain CARE
Analytics.
* further details in: SOMATOM Sessions 27, page
68–71
www.siemens.com/ihe
At Siemens, one of the core responsibilities is to provide medical institutions with solu-tions
that enable them to further lower radiation dose. CARE Analytics is yet another tool
to help achieve that goal.

News
“ The coupling of scan-ner
and injector in
combination with pre-defi
ned contrast
protocols promotes fast
and effective workfl ow.
The handling, com-bined
with the Medrad
injector, is simple and
dependable.”
Prof. Christoph Becker, MD, and Barbara
Wieser, Department of Radiology, Ludwig-
Maximilians-University, Campus- Grosshadern,
Munich, Germany
CARE Contrast III
By Florian Belohlavek and Ute Feuerlein, Computed Tomography, Siemens Healthcare, Forchheim, Germany
One of the biggest challenges in com-puted
tomography is a high quality con-trast
scan. In the year 2005, Siemens
Healthcare took an important step by
introducing a solution for bolus injection
coupling. By synchronizing the scan and
contrast media injection, the bolus injec-tor
workflow could be simplified and
adapted to the needs of the clinical envi-ronment.
Even if only one technician is
present, the reading physician is able to
perform high quality contrast scans on
the one hand and handle the simultane-ous
bolus injection on the other. This
unique CARE solution is based on the
international standard for the communi-cation
between CT and injector – the
CANopen application profile for medical
diagnostic add-on modules.
In 2009, another important milestone
was passed with the introduction of the
second version of CARE Contrast. CARE
Contrast II facilitates contrast enhanced
clinical workflow by synchronizing CT
scan and contrast media injection using
a single button control from either the
scanner or the injector. In addition, the
injection parameters are automatically
transferred to the patient protocol,
the e-logbook and to the Modality Per-formed
Procedure Step (MPPS) thus
completing the data for the examina-tion.
With this, no separate documenta-tion
is needed, resulting in significant
workflow improvements: e.g. the injec-tor
information is available from the pic-ture
archiving and communication sys-tem
(PACS) when reading the images or
accessible from the hospital information
system (HIS) / radiology information
system (RIS).
A new and higher level of injector cou-pled
scanning has now been reached
with the latest Siemens innovation – CARE
Contrast III. It is based upon the highly
integrated CANopen, class-4 standard
for bi-directional communications that
can reach a new level of improved con-trast
workflow. In addition to all features
of the earlier versions, CARE Contrast III
is equipped with the latest innovations:
For the first time, contrast protocols can
be defined and managed on the scanner
console and transferred to the injector.
By operating contrast management on
the scanner console, a combination of
scan and contrast protocols in inte-grated
examination protocols is possi-ble.
Protocols on the scanner can be
adjusted to cover the frequently used
cases in the clinical environment and
can be transferred to other scanners
with the same setup. CARE Contrast III is
available for the SOMATOM Definition
AS and Definition Flash family with the
latest scanner software version.
SYNC.
START

Synergies in CT –
For Better Patient Care
By Stefan Ulzheimer, PhD, Computed Tomography,
Siemens Healthcare, Forchheim, Germany
SOMATOM Sessions –
Only One Click Away
By Sandra Kolb, Computed Tomography, Siemens Healthcare, Forchheim, Germany
Medical progress very often relies on
teamwork. Both Bayer Healthcare and
Siemens Healthcare continuously strive
to improve CT quality at the lowest possi-ble
radiation levels. This happens by
combining technological and pharmaceu-tical
expertise. Both companies are pro-moting
the exchange of knowledge
among the most experienced CT users
worldwide and through researching and
working together.
This is done by sharing relevant research
results, joint scan protocol development,
attendance at expert panels, by organiz-ing
joint symposia and by publishing pod-casts
with medically interesting cases.
Reading magazines attentively is time
consuming and difficult for a radiologist
in an active, successful practice.
Would it not be great to read about the
exciting possibilities with Siemens CT
on an iPad? Scrolling through the latest
news on the Blackberry at the airport?
Or discussing an exceptional case study
with a colleague directly at the office
PC? Now we have the answer: the
online version of SOMATOM Sessions.
The online magazine is now only one
mouse click away for reading or refer-ence
24/7.
All articles and case studies can be
browsed by specialty and a smart over-view
of all the hot topics like low dose
in computed tomography and training
Almost 800 participants attended the Bayer-
Siemens Lunch Symposium at ECR 2011.
Siemens Computed Tomography magazine,
SOMATOM Sessions, is now available as online
version: www.siemens.com/somatom-sessions.
Furthermore courses at the Imaging
Science Institute in Berlin (part of the
Charité, the biggest University Hospital
in Europe) are offered where radiologists
receive hands-on training as well as
STAR (Specialized Training in Advances in
Radiology) Workshops, an international
educational forum for practizing radiolo-gists.
So far, STAR meetings have been
held in 36 countries with more than
26,000 radiologists attending.
A recent highlight of these joint activities
was the lunch symposium at ECR 2011.
Here experts like Michael Lell, MD,
Marilyn Siegel, MD, Joseph U. Schoepf,
MD, and Andreas Mahnken, MD, shared
their extensive research on iterative
reconstruction, pediatric dose optimiza-tion,
and contrast media administration
with almost 800 medical specialists
attending. Even the exhibition at
the Bayer Communication Center in
Leverkusen was a winner with over
5,000 visitors from the general public.
possibilities is offered. And readers can
now leave a comment, so it’s feasible to
interact with the editorial team or other
readers. It is also possible to subscribe
and get the latest news via email and –
if desired – forward interesting articles
to a friend by email or through social
networks.
The printed Sessions will continue to
be published twice a year. The printed
copies can be ordered on the online
sessions homepage.
Visit us now and enjoy.
News
www.star-program.com
www.siemens.com/
somatom-sessions

Five Areas of Ecological Improvements in CT
By Johann Russinger, Computed Tomography, Siemens Healthcare, Forchheim, Germany
Dose reduction for a typical Cardio scan
Siemens has a long history of ecological
improvements. Recently Siemens targeted
primarily five areas: ecological manufac-turing,
radiation minimization, life-cycle
extension, refurbishing and recycling.
Ecological Manufacturing
Siemens’ concern for environmental safety
begins long before the first scan in the
planning phase together with RD and
during prototype development. One
example is taken, lead is no longer used as
counter-weights and has been eliminated
in many other areas in newer models. All
materials are selected keeping ecological
aspects in mind. In short, potential eco-logical
“burdens” are eliminated for the
entire life-cycle of the system.
Radiation Minimization
Siemens’ SOMATOM Definition Flash was
designed primarily to make CT exams
much healthier for patients using less
radiation dosage than previous systems –
e.g. less than 1 mSv for cardiac examina-tions.
In this context, the SOMATOM
Definition Flash requires 45% less energy
for a standard thorax scan and 85% less
energy for a cardiac Flash scan compared
to previous models.
Life-cycle Extension
The third area of ecological responsibility
involves life-cycle extension – in other
words, extending the useful life of the
scanner before it needs to be replaced
with a newer model. Along with a wide
selection of software updates, Siemens
offers Evolve, a long-term and financially
attractive update program designed to
keep existing systems up-to-date and
therefore extending their useful lives.
Refurbishing
When a customer becomes ready for a
new system for his radiology department,
Siemens offers a trade-in program for their
existing scanner. Complete CT systems
and their components are dismantled and
shipped back to the factory where they
are refurbished and re-sold with a new
equipment warranty.
Recycling
Last but not least, recycling systems at
the end of their life-cycle are very impor-tant.
A possibility for responsible conduct
comes when a system simply must be
recycled. And here our story has come
full circle. All possible measures were
taken into account in the beginning
when the system was designed to make
recycling easy years later:
■ All substances contained in the product
and its packaging are documented.
■ Plastic parts are labeled for recycling.
■ Disassembly instructions for high-quality
recycling are available.
■ Product take-back is carried out
according to strict EU directives.
■ More than 97% of the used materials
can be recycled.
■ The environmental product declara-tion
is available for download via
internet.
News
120%
100%
80%
60%
40%
20%
0%
SOMATOM Sensation 16
2003
SOMATOM Defi nition
2006
SOMATOM Defi nition Flash
2009
100%
70%
39%
Development of used energy for a thoracic scan
120%
100%
80%
60%
40%
20%
0%
SOMATOM Sensation 16
2003
SOMATOM Defi nition
2006
SOMATOM Defi nition Flash
2009
100%
50%
15%
-50%
-70%
-30%
-45%
www.siemens.com/healthcare-news
Dose Dose

The SOMATOM Defi nition Flash
Helps to Deal with Everyday Clinical
Challenges
With the SOMATOM Defi nition Flash, highest clinical requirements can
be met. Six recently published scientifi c papers show the capabilities of
the system in pediatric imaging and when using iterative reconstruction.
By Heidrun Endt, Computed Tomography, Siemens Healthcare, Forchheim, Germany
while dose should be kept down. This
is especially important in this patient
population as follow-up examinations
after therapy and further observation
might be necessary in the coming years.
Applying a prospectively ECG-triggered
scan mode, known as step-and-shoot
mode, the physicians achieved impres-sively
low-dose values with a mean
radiation dose of 0.26 mSv. Image qual-ity
was rated 4.7 on a scale from 1 to 5.
All examinations provided diagnostic
image quality. According to the authors,
the study “ [...] demonstrates that tech-nological
1 A two-month-old
child underwent sur-gery
to correct trans-position
of the great
arteries. Due to the
short scan time of
0.3 seconds there
was no need for
sedation or breath-hold
in this CT exami-nation.
The image
shows a narrowing of
the tracheal lumen
(arrow).
Courtesy of Friedrich-
Alexander University
Erlangen-Nuremberg,
Germany
Imaging pediatric patients
In the field of pediatric radiology, special
conditions and clinical needs have to
be considered. Three scientific papers
report on CT examinations obtained with
children, proving the capabilities now
brought into routine clinical practice with
the system.
A group of researchers from France
examined 30 children up to six years old,
suffering from congenital heart disease
(CHD). Different anatomic structures
such as the heart, the coronary arteries
and thoracic vessels had to be assessed
im pro vements in CT allow the
acquisition of high-quality images with
very low radiation doses in pediatric
patients with CHD”.1
CT examinations of 32 children also
suffering from CHD, were analyzed
in terms of image quality, radiation dose
and diagnostic accuracy by a group
of researchers in Minnesota. The images
were obtained applying different pitch
values from 2.25 up to 3.4. In addition
the results were compared to CT scans
acquired with a conventional multi-slice-
CT scanner. Those examinations
obtained with a pitch of 3.4 with the
SOMATOM Definition Flash could be car-ried
out with the lowest possible radia-tion
dose. In addition, the young patients
were breathing normally during the
examinations. The diagnostic quality of
the CT examinations acquired under dif-ferent
clinical conditions was not influ-enced
by the scan speed and free breath-ing.
So the authors conclude that the
high pitch scan mode “[...] may be the
preferred mode of imaging for specific
pediatric patient subsets for definition
of combined cardiac and extracardiac
anatomy”.2
At the University of Erlangen, 30 children
diagnosed with CHD or cardiovascular
malformation, underwent CT examina-tion
with the SOMATOM Definition Flash.
The physicians performed these scans in
high-pitch mode. This scan mode
enabled them to obtain the diagnostic
images with a mean scan time of 0.49
News
1

News
2 Two CT examinations of the thorax obtained at different time points from a patient diagnosed with lung cancer to monitor chemotherapy.
With IRIS, a significant reduction of radiation dose from 2.8 mSv* to 1.4 mSv* could be achieved while maintaining excellent image quality.
CT examination of the thorax without IRIS, CTDIvol = 5.11 mGy, DLP = 199 mGy cm, eff.dose = 2.8 mSv* (Fig. 2A). CT examination of the thorax
with IRIS, CTDIvol = 2.54 mGy, DLP = 98 mGy cm, eff. dose 1.4 mSv* (Fig. 2B). Courtesy of Hospital Calmette, Lille, France
seconds. Despite patient motion, due to
the speed of the scan there was neither
need to sedate the young patients nor for
controlled ventilation. On the one hand,
this improves the workflow, as personnel
specialized in sedation and anesthesia in
children are not necessary. On the other
hand, even more importantly, the
patients are not exposed to additional
risks because of these anesthetic proce-dures.
The conclusion by the authors:
“High-pitch chest CT is a robust method
to provide highest image quality making
sedation or controlled ventilation [...]
unnecessary, whereas maintaining low
radiation dose values”.3
IRIS as a powerful tool to
reduce dose
SOMATOM scanners offer a wide spec-trum
of technologies developed to
reduce radiation exposure to the lowest
possible dose. IRIS, Siemens’ Iterative
Reconstruction in Image Space, has
meanwhile been repeatedly scientifically
validated.
A study published by Bittencourt et al.
reports about 55 coronary CT Angiogra-phy
examinations that were recon-structed
twice, applying filtered back
projection as the conventional recon-struction
method and in a second step
applying IRIS: image noise decreased and
higher signal to noise ratios could be
achieved with iterative reconstruction.
This was true for all three scan modes
which were chosen due to different
clinical conditions.4 Thus, dose can be
reduced for coronary CT Angiography
examinations without compromising
image quality.
Researchers from France carried out a
study that was divided in two parts. In
the first part they assessed 32 chest CT
examinations obtained with the estab-lished
scan protocol settings of their
institution. They reconstructed the imag-ing
datasets twice, once with filtered
back projection and once with IRIS.
Objective and subjective image noise
could be clearly reduced and the image
quality scores increased when images
were reconstructed with IRIS. Based on a
detailed analysis of lesion conspicuity,
the authors state that IRIS enables “[...]
significant reduction of image noise
without loss of diagnostic information
[...]”.5
For the second part of their study the
researchers evaluated chest CT examina-tions
of 80 patients. These patients
underwent a first CT examination in a
conventional mode, without IRIS. As all
of them needed a follow-up scan, a
second CT examination was performed.
The follow-up scans were obtained
with reduced dose and with the use of
IRIS. This led to a mean effective dose of
1.5 mSv* compared to 2.3 mSv* for the
conventional mode. The authors con-clude
that IRIS enables “dose reduction
without loss of diagnostic information”
and that “even higher dose reductions
than 35% may be feasible”.6
Scientifi cally validated
These publications provide an unbiased
proof: Highest clinical requirements are
met with the SOMATOM Definition
Flash, opening new possibilities for CT
in daily clinical practice.
2A 2B
1 Paul JF et al. Radiation dose for thoracic and coro-nary
step-and-shoot CT using a 128-slice dual-source
machine in infants and small children with congenital
heart disease. Pediatr Radiol. 2011 Feb; 41(2):244-9.
2 Han BK et al. Accuracy and safety of high pitch com-puted
tomography imaging in young children with
complex congenital heart disease. Am J Cardiol. 2011
May 15;107(10):1541-6.
3 Lell MM et al. High-pitch spiral computed tomography:
effect on image quality and radiation dose in pediatric
chest computed tomography. Invest Radiol. 2011 Feb;
46(2):116-23.
4 Bittencourt MS et al. Iterative reconstruction in image
space (IRIS) in cardiac computed tomography: initial
experience. Int J Cardiovasc Imaging. 2010 Dec 1.
[Epub ahead of print]
5 Pontana F et al. Chest computed tomography using
iterative reconstruction vs filtered back projection
(Part 1): Evaluation of image noise reduction in 32
patients. Eur Radiol. 2011 Mar;21(3):627-35.
6 Pontana F et al. Chest computed tomography using
iterative reconstruction vs filtered back projection
(Part 2): image quality of low-dose CT examinations in
80 patients. Eur Radiol. 2011 Mar;21(3):636-43.
*calculated using published conversion factors: 0.014
mSv/mGy cm (McCollough C et al. Strategies for
Reducing Radiation Dose in CT. Radiol Clin North Am.
2009 January; 47(1): 27–40.)

Business
Growing Demand
for Postmortem Imaging
Postmortem examination by means of computed tomography and
other imaging techniques is still a novelty in many countries.
But at the forensic institute of the University of Zurich, Switzerland,
scanning the bodies is daily routine.
By Irène Dietschi
The man’s body, after being exhumed
from the cemetery in the early morning
hours, was brought to the Institute
of Legal Medicine at the University of
Zurich around 9 a.m. The coffin was
admitted through the wide entering
gates on a trolley, pushed through the
hall, where mortuary fridges are arrayed
along the wall, and brought straight
to the adjoining imaging section of the
institute. There, the body underwent
a complete CT scan. It took no more than
ten minutes to push it through the wide
opening of the SOMATOM Definition
Flash, thereby virtually cutting the body
into thousands of razor-thin slices. All
this while the man’s body remained in
the coffin (Fig. 1).
1 The wide bore of 78 cm allows scanning of larger objects such as coffins too.
1

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Business
The Dose Report – New Feature of Utilization
Management
Typically, dose data are available to operators during every examination,
but these data are sometimes not documented afterwards for later reference
or analysis. With Siemens service offering, Utilization Management, dose
information can be accessed for SOMATOM Defi nition systems.*
By Benjamin Gutheil and Janine Krebs, Customer Service, Siemens Healthcare, Erlangen, Germany
Siemens Utilization Management (UM)
includes dose reports as a new feature.
UM is a proactive service offered from
Siemens UPTIME Services that provides
system-specific usage data. Access to
these detailed data enables users to
leverage their systems’ full potential.
They receive extensive equipment utili-zation
analyses and anonymous bench-mark
information about comparable
systems at other facilities operating in
similar environments, as well as dose
infor mation on a regular basis.
With the new dose report, operators
obtain an overview of the total number
and the percentage split of scan ranges
per selected protocol, as well as the
available dose information for the
selected month. They can see if any
specific values have been exceeded.
What are the key benefits?
■ Visibility of dose usage data on a
monthly or multi-monthly period
■ Increased awareness of radiation
exposure among clinicians
■ Easy way to track system and dose
utilization details at the point of care
■ Increased patient safety
How does the user obtain access to
these data?
With regards to Computed Tomography,
dose reports are made available through
the LifeNet UPTIME Services Portal.
This is Siemens’ secure web portal pro-viding
users with the information
needed to manage the productivity
of their Siemens diagnostic equipment.
In the dose report, users obtain
an overview of all selected protocols,
indicating if any specific values have
been exceeded and what radiation dose
has been administered.
* from software version VA20
1 All important figures are collected in the dose report. The user gets additional information about system utilization.
1

Francisco Tardáguila, MD, Head of the Department of Radiology with his team next to the SOMATOM Definition Flash which allows the acquisition of
MinDose data for full functional evaluation with syngo.via, even at minimum dose.
The radiologist is particularly impressed
by syngo.via: “The software is a techni-cal
revolution.” While patient diagnosis
used to take between 20 and 30 min-utes,
he can now perform the same task
in less than five minutes with syngo.via.
This is chiefly due to the software’s auto-mated
preparation of cases, which
allows him to concentrate more closely
on diagnosis. Carlos Delgado explains
that syngo.via segments and labels the
coronary vessels, removes ribs from
images and displays the corresponding
As soon as talk turns to the new
SOMATOM Definition Flash® and
syngo.via®, Carlos Delgado, MD, cardiac
radiologist at the Povisa private hospital
in Northern Spain, goes into raptures. In
September 2009, the hospital, located
in Vigo, Galicia, substituted its 64-slice
CT scanner for the new SOMATOM
Definition Flash and installed the imaging
software syngo.via. Says Carlos Delgado:
“Since then, we’ve been working faster
and more accurately and have also
reduced radiation doses considerably.”
Business
syngo.via with the SOMATOM
Defi nition Flash: “A Technical Revolution”
Povisa hospital was Spain’s fi rst private clinic to introduce syngo.via with the
SOMATOM Defi nition Flash CT scanner in 2009. Since then, work has become
faster and more accurate, and patient fi gures have increased.
By Manuel Meyer
Povisa Hospital, Vigo. Main entrance.

Business
“Besides improved workfl ows,
syngo.via generally
boosts diagnostic safety.”
Carlos Delgado, MD, cardiac radiologist,
Povisa private hospital, Vigo, Spain
cardiac CT automatically, performing
preparatory tasks which once had to be
done by the radiologists. “I can now dis-play
clinical images on the screen within
seconds and with a single mouse click.”
The time saved is particularly significant
in emergencies. Accident victims’ diag-noses
reach the emergency room just 15
minutes after scanning.
Greater Diagnostic Safety
However, the time reduction is not the
most important benefit. “Besides
improved workflows, syngo.via generally
boosts diagnostic safety.” This also
proves significant in emergencies, as
attending physicians or radiologists are
not always familiar with cardiac CT imag-ing.
Although Delgado believes there are
too many ways to process a CT image in
general, he finds syngo.via easy to learn
and very intuitive. Above all, the online
system means users are no longer tied to
a single workplace, but can access the CT
images anywhere in the hospital and
even from home via the internet.
This constitutes a “qualitative leap”
which, according to the radiologist,
should nonetheless be regarded in
conjunction with the new SOMATOM
Definition Flash CT scanner and its
unique Dual Source technology. With
its split-second scanning function, the
Flash mode allows him to scan the entire
heart in just a quarter of a heartbeat.
Reduced Radiation Dose
The new Siemens CT scanners offer
patients an extra advantage in terms of
pediatric radiology. “The increased scan
speed as well as dedicated algorithms
drastically reduce the radiation dose”,
comments the radiologist. Carlos Del-gado
emphasizes that CT scans which
continue to transmit radiation doses of
15 millisieverts with some conventional
64-slice CT scanners generate just 0.9
millisieverts with the new Definition
Flash scanner.
And with the new syngo.CT Cardiac
Function, it is now possible to use
MinDose data for a full functional
assessment.
The syngo.CT Cardiac Function software
defines “landmarks” in images taken dur-ing
a diastole and adapts these anatomic
regions for images taken during other
phases of the cardiac cycle. These intelli-gent
algorithms can perform highly
reliable cardiac anatomy segmentation
even with noisy low-dose data. So in
effect, not a single image is wasted.
Thorax radiologist Concha Martínez, MD,
adds: “The new Dual Energy imaging,
which permits improved characteriza-tion
of in juries and pathological tissue
changes, facilitates a more precise
diagnosis.”
However, realizing the device’s full
po ten tial took time. Povisa hospital
was the first clinic in Spain to introduce
syngo.via with the new CT scanner in
2009.
“We were testing the beta version of
syngo.via, and no one had any experi-ence
with it at the time. That means that
we could experience the very first ver-sion
of the system and consult Siemens
CT in improving the prototype with addi-tional
features and tools. And whenever
we had an issue or question, Siemens’
service was outstanding. And it still is.
Above: Carlos Delgado, MD, radiologist (left)
and Concepción Martínez, MD (right), radiologist
and Head of TAC Section, at the main entrance
of Povisa Hospital. Below Francisco Tardáguila,
MD, Head of Radiology Department, next to his
syngo.via reading workplace.

Left: SOMATOM Definition Flash examination of the abdomen. Above: Automatic pre-processing with syngo.via enables quick and easy evaluation of
the entire colon. Below: With syngo.via a CT series is compared with an MR dataset whereby the lesion is quantified with a volume measurement tool.
More Patients Thanks to the
Latest Technology
“The physicians are so impressed with
the new technology that they’re sending
us more and more patients. We used
to perform a couple of scans daily in
cardiac CT, and now we do up to five,”
confirms Francisco Tardaguila, MD, Head
Radiologist. The low radiation doses
mean that an increasing number of pedi-atricans
throughout Galicia are sending
patients, affirms the former president of
the Spanish Radiology Association.
As a Spanish reference clinic in the field
of radiology, “being equipped with the
latest radiology technology was a matter
of prestige,” says Francisco Tardaguila.
The decision not only increased the pro-ductivity
and medical opportunities
within his radiology department, but
also proved economically advantageous,
as the new CT scanner attracts wealthy
private patients from across Spain.
This is an important economic growth
factor for a private hospital, which is,
Of course, now working on a released
product we do not have many issues.
“But if I have a problem nowadays, it’s
solved by Siemens the same day,”
enthuses Carlos Delgado.
Siemens offers a 24/7 hotline support if
wished. Technical questions as well as
application questions will be answered.
Thereby the dedicated application spe-cialist
can support online via desktop
sharing, after the customer gives access
to the syngo.via server.
In general, however, the Povisa radiolo-gist’s
verdict is thoroughly positive:
“Since the acquisition of the new CT
scanner with syngo.via, we’ve not only
had to work more due to the increase in
information, but, above all, because we
treat more patients,” he jokes.
Freelance journalist Manuel Meyer lives and
works in Madrid. He regularly reports on scien-tific
and medical issues for various media.
Business
with 600 beds, considerably smaller
than Vigo’s two state hospitals. How-ever,
if Povisa was one of Spain’s “major
league” clinics specializing in radiology
before the introduction of the new
Siemens CT scanner, it certainly became
the “FC Barcelona of Spanish radiology”
afterwards, says the Head Radiologist,
playfully comparing his department’s
new image and abilities with the famous
Spanish soccer club.

themselves. One example is Franklin
Woods Community Hospital, an institu-tion
of Mountain States Health Alliance
(MSHA), USA. The vast majority of Emer-gency
Department examinations here are
walk-in patients. So obviously, waiting
time is a big factor. Therefore, MSHA has
put much focus on this and is now
actively marketing it by posting Emer-gency
Department waiting times for their
institutions online.
Because the importance of marketing is
growing for customers, Siemens has put
together a very comprehensive set of
tools to actively support their marketing
activities. This toolkit, which helps to
promote CT practice by providing the
tools necessary, consists of examples for
all typical marketing channels like print,
online and social media as well as scripts
for radio and TV advertisement. Now,
customers can simply download the
clearly structured templates. To set up an
advertisement in a magazine for exam-ple,
the respective image and text sec-tions
of the template just need to be
exchanged by the customer and the ad is
ready to use.
Siemens offers this service free of charge
to its customers. To get an overview of
the customer marketing toolkit, just visit:
In recent years, medical practice has sig-nifi
cantly changed. New applications
have been introduced that allow a safer
and more sustainable diagnosis and
treatment. But the changes did not affect
only the medical side. More and more
institutions are confronted with eco-nomic
challenges resulting from reim-bursement
cuts, competition and,
in the end, the requirement to perform
medical services profi tably. So what for-merly
was mainly the fi eld of business
driven enterprises has now become an
important aspect in the decision making
and operation of many medical institu-tions.
The battle for referrals has intensifi ed as
many limiting conditions have changed
as well. The progress in medical technol-ogy
has made high-end imaging – includ-ing
CT – affordable to a larger number of
institutions. This is, in general, a favor-able
development as, in the end, it is of
benefi t for the patients. But along with
this improvement came many new regu-lations,
limited resources or cost
increases and, fi nally, the competitor
right across the street. Consequently,
hospitals, clinical practices and imaging
centers have to make sure that they are
perceived as the fi rst choice for referrers
and patients for their services. In busi-ness,
this is known as marketing.
Many institutions have already recog-nized
this as an important part of their
business and have started to market
Business
Surviving in the Battle for Referrals
Marketing is becoming a more and more important topic for medical
institutions. No matter whether it is compensating for the new competition
down the street or simply the need to get enough patients to cover the
running costs, promoting one’s services can be a decisive factor. For this,
Siemens has launched a new customer marketing toolkit.
By Jan Freund
Computed Tomography, Siemens Healthcare, Forchheim, Germany
As one kind of marketing, the MSHA is showing online waiting times for their patients.
www.msha.com/
www.siemens.com/CT-toolkit

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