Sensation 64 Application Guide Software Version syngo CT 2005A

The information presented in this application guide is for illustration only and is not intended to be relied upon by the reader for instruction as to the practice of medicine. Any health care practitioner reading this information is reminded that they must use their own learning, training and expertise in dealing with their individual patients. This material does not substitute for that duty and is not intended by Siemens Medical Solutions Inc., to be used for any purpose in that regard. The drugs and doses mentioned are consistent with the approval labeling for uses and/or indications of the drug. The treating physician bears the sole responsibility for the diagnosis and treatment of patients, including drugs and doses prescribed in connection with such use. The pertaining operating instructions must always be strictly followed when operating the SOMATOM Sensation 64. The statutory source for the technical data are the corresponding data sheets. The names and birthdates included in this guide have been selected for the purpose of demonstration only and do not represent actual patient data. We express our sincere gratitude to the many customers who contributed valuable input. Special thanks to Thomas Flohr, Rainer Raupach, Karl Stiersdoerfer, Christoph Suess, Bettina Klingemann, Heike Theessen, Kristin Pratt, Johann Uebler and Alexander Zimmermann for their valuable assistance. To improve future versions of this application guide, we would highly appreciate your questions, suggestions and comments. Please contact us: USC-Hotline: Tel. no.+49-1803-112244 email: [email protected] Editors: Christiane Bredenhöller and Ute Feuerlein

Overview User Documentation

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Scan and Reconstruction

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Dose Information

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Workflow Information

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Application Information

80

Head

96

Neck

122

Shoulder

136

Thorax

144

Abdomen

166

Pelvis

186

Spine

200

Upper Extremities

218

Lower Extremities

228

Vascular

240

Specials

288

Children

310

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Contents User Documentation

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Scan and Reconstruction

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• Concept of Scan Protocols • Scan Setup • Scan Modes

- Sequential Scanning - Spiral Scanning - Dynamic Multiscan - Dynamic Serioscan • Straton-Tube - Double z-Sampling - 64-channel UFC detector • Acquisition • Slice Collimation and Slice Width - Acquisition, Slice Collimation and Slice Width for Spiral Mode - Acquisition, Slice Collimation and Slice Width for Sequence Mode - Acquisition, Slice Collimation and Slice Width for UHR Spiral Mode - Acquisition, Slice Collimation and Slice Width for UHR Sequence Mode • Increment • Pitch • Kernels • Head Modes • Extended FoV • Neuro Modes • Head Imaging • Image Filters

Dose Information • CTDIW and CTDIVol • Effective mAs • CARE Dose 4D

- How does CARE Dose 4D work?

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14 15 16 16 16 16 16 17 19 21 22 22 23 23 24 24 24 25 26 27 28 29 30 32

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Contents - Special Modes of CARE Dose 4D - Scanning with CARE Dose 4D - Adjusting the Image Noise - Activating and Deactivating CARE Dose 4D • 100kV-Protocols

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Workflow Information

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• WorkStream4D

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- Recon Jobs - 3D Recon - Key Features - Description - Display of Recon Ranges in the Toposegment - Case Examples - Reconstruction on Wizard • Workflow - Examination Job Status - Auto Load in 3D and Post-Processing Presets - How to Create your own Scan Protocols • Contrast Medium - The Basics - IV Injection - Bolus Tracking - Test Bolus using CARE Bolus - Test Bolus

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Application Information

80

• SOMATOM life

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- General Information - Key Features - Description - Access to Computer Based Training or Manuals on CD ROM - SRS Based Services

82 83

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Contents - Download of Files - Contact incl. DICOM Images - Trial Order and Installation • Image Converter - Split-Up Multi-Phase Series • Report Template Configuration • File Browser - Key Features • Patient Protocol

Head • Overview • Hints in General

- Head Kernels • HeadRoutine • HeadNeuro • HeadRoutineSeq • HeadNeuroSeq • InnerEarUHR • InnerEarUHRVol • InnerEarUHRSeq • Sinus • SinusVol • Orbit • Dental

Neck • Overview • Hints in General

- Body Kernels • NeckRoutine • NeckVol • NeckThorax • NeckThorAbd

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84 86 87 89 90 91 92 92 95

96 96 98 99 100 102 104 106 108 110 112 114 116 118 120

122 122 123 124 126 128 130 132

Contents Shoulder • Overview • Hints in General

- Body Kernels • ShoulderRoutine • ShoulderVol

Thorax • Overview • Hints in General

- Body Kernels • ThoraxRoutine • ThoraxVol • ThorAbd • ThoraxHR • ThoraxSeqHR • ThoraxECGSeqHR • LungLowDose • LungCARE

Abdomen • Overview • Hints in General

- Body Kernels • AbdomenRoutine • AbdomenVol • AbdMultiPhase • AbdomenSeq • CTColonography

Pelvis • Overview • Hints in General

- Body Kernels • PelvisRoutine

136 136 137 138 140 142

144 144 146 147 148 150 152 156 158 160 162 164

166 166 167 169 170 174 178 182 184

186 186 187 188 190

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Contents Vascular • Overview • Hints in General

- Head Kernels - Body Kernels • HeadAngioRoutine • HeadAngioVol • CarotidAngioRoutine/CarotidAngio037s/ CarotidAngio033s • CarotidAngioVol • ThorAngioRoutine/ThorAngio037s/ ThorAngio033s • ThorAngioVol • ThorAngioECG037s/ThorAngioECG033s • ThorAngioECGFast • Embolism/Embolism037s/Embolism033s • BodyAngioRoutine/BodyAngio037s/ BodyAngio033s • BodyAngioVol • BodyAngioECG037s/BodyAngioECG033s • AngioRunOff/AngioRunOff037s/ AngioRunOff033s • WholeBodyAngio/WholeBodyAngio037s/ WholeBodyAngio033s

Specials • Overview • 1. Trauma • 2. Biopsy • 3. CAREVision • 4. TestBolus • Trauma

- The Basics - Trauma - TraumaVol - PolyTrauma - HeadTrauma - Additional Important Information

240 240 242 242 243 244 246 248 252 256 260 262 264 266 270 274 276 280 284

288 288 288 288 288 288 288 289 290 291 292 293 294

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Contents • Interventional CT • CARE Vision

- The Basics - CAREView - HandCARE - Application Procedure • Additional important information - Additional Dose Information - Radiation exposure to patients - Radiation exposure to personnel • TestBolus

Children • Overview • Hints in General

- Head Kernels - Body Kernels • HeadRoutine • HeadNeuro • HeadRoutineSeq • HeadNeuroSeq • InnerEarUHR • InnerEarUHRSeq • Sinus • Orbit • NeckRoutine • ThoraxRoutine • ThoraxSeqHR • AbdomenRoutine • SpineRoutine • SpineNeuro • ExtrRoutineUHR • Extremity • HeadAngio • CarotidAngio/CarotidAngio037s/ CarotidAngio033s • BodyAngio/BodyAngio037s/ BodyAngio033s • NeonateBody/NeonateBody037s/

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296 298 298 301 302 303 306 306 306 307 308

310 310 313 316 317 318 320 322 324 326 328 330 334 336 338 340 342 344 346 348 349 350 352 356

Contents NeonateBody033s

360

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User Documentation User Documentation For further information about the basic operation, please refer to the corresponding syngo CT Operator Manual: syngo CT Operator Manual Volume 1: Security Package Basics Preparations Examination HeartView CT CARE Bolus CT CARE Vision CT syngo CT Operator Manual Volume 2: syngo Patient Browser syngo Viewing syngo Filming syngo 3D syngo CT Operator Manual Volume 3: syngo Data Set Conversion syngo Calcium Scoring syngo Dental CT syngo Dynamic Evaluation syngo Osteo CT syngo Perfusion CT syngo Pulmo CT syngo Volume

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User Documentation syngo CT Operator Manual Volume 4: syngo Colonography syngo InSpace4D syngo LungCARE CT syngo CT Operator Manual Volume 5: syngo Argus syngo Vessel View

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Scan and Reconstruction Concept of Scan Protocols The scan protocols for adult and children are defined according to body regions – Head, Neck, Shoulder, Thorax, Abdomen, Pelvis, Spine, Upper Extremities, Lower Extremities, Vascular, Specials, Private and optional PET. The protocols for special applications are described in the Application Guide “Clinical Applications 1” and “Clinical Applications 2“ – or in the case of a Heart View examination, in the Application Guide “Heart View“. The general concept is as follows: All protocols without suffix are standard spiral modes. E.g., “Sinus” means the spiral mode for the sinus. The suffixes of the protocol name are follows: “Routine“: for routine studies “Seq”: for sequence studies “Fast“: use a higher pitch for fast acquisition “033s”: use the rotation time of 0.33 seconds “037s”: use the rotation time of 0.37 seconds “UHR“: use a thinner slice width for Ultra High Resolution studies and a FoV of 300 mm “ECG“: ECG-gated or -triggered mode “Vol”: use the 3D Recon Workflow "Neuro": for neurological examinations with a special mode The availability of scan protocols depends on the system configuration.

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Scan and Reconstruction Scan Setup Scans can simply be set up by selecting a predefined examination protocol. To repeat any mode, just click the chronicle with the right mouse button for “repeat”. To delete it, select “cut“. Each range name in the chronicle can be easily changed before loading the scan protocol. Multiple ranges can be run either automatically with “auto range“, which is denoted by a bracket connecting the two ranges, or separately with a “pause” in between.

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Scan and Reconstruction Scan Modes Sequential Scanning This is an incremental, slice-by-slice imaging mode in which there is no table movement during data acquisition. A minimum interscan delay in between each acquisition is required to move the table to the next slice position. Spiral Scanning Spiral scanning is a continuous volume imaging mode. The data acquisition and table movement are performed simultaneously for the entire scan duration. A typical range can be acquired in a single breath hold. Each acquisition provides a complete volume data set, from which images with overlapping slices can be reconstructed at any arbitrary slice position. Unlike the sequence mode, spiral scanning does not require additional radiation to obtain overlapping slices. Dynamic Multiscan Multiple continuous rotations at the same table position are performed for data acquisition. Normally, it is applied for fast dynamic contrast studies, such as Perfusion CT. Dynamic Serioscan Dynamic serial scanning is performed without table feed. Dynamic serio can still be used for dynamic evaluation such as Test Bolus.

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Scan and Reconstruction Straton-Tube The SOMATOM Sensation 64 CT-system is equipped with the 0 MHU STRATON x-ray tube. This newly developed X-ray tube offers significantly reduced cooling times for shorter interscan delays and increased power reserves. The full X-ray power of 50 kW, providing considerable dose reserves even for patients with a large body habitus. As an example, in the “Thorax Routine“ protocol (120 kV, 75 mAs, 0.5 s rot, 20 x 1.2 mm, pitch factor 1.2) a scan range of 300 mm can be covered in 6 s and dose can be increased up to 170 mAs without reduction of the table feed.

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Scan and Reconstruction

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Scan and Reconstruction Double z-Sampling • The unique STRATON X-ray tube utilizes an electron beam that is accurately and rapidly deflected, creating two precise focal spots alternating 4,640 times per second. This doubles the X-ray projections reaching each detector element. The two overlapping projections result in an oversampling in z-direction, known as the so called Double z-Sampling. The resulting measurements interleave half a detector slice width, doubling the scan information without an increase in dose. • The purpose of this technique is two-fold: First, by doubling the sampling, the slice width can be reduced. With the SOMATOM Sensation 64, it is possible to reconstruct 0.6 mm slices at any pitch (≤ 1.5) with best image quality. With overlapping 0.6 mm slices, a z-axis resolution of 0.4 mm is obtained. Second, the improved sampling almost completely removes, at any pitch, the so-called windmill artifacts frequently visible in Multislice CT images in the vicinity of sharp contrasts in axial direction. Of course, since the dose is distributed over the two overlapping measurements, there is no dose penalty. • z-Sharp is used with all spiral modes in 0.6 mm collimation.

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Scan and Reconstruction

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Scan and Reconstruction 64-channel UFC detector Siemens’ proprietary, high-speed Ultra Fast Ceramic (UFC) detector enables a virtually simultaneous readout of two projections for each detector element resulting in a full 64-slice acquisition.

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