Sensation Open 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 Open. 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, Kristin Pratt, Carsten Thierfelder, Maxim Mamin and Jan Chudzik 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

12

Scan and Reconstruction

14

Dose Information

30

Workflow Information

48

Application Information

76

SOMATOM Sensation Open

92

Head

144

Neck

162

Shoulder

176

Thorax

184

Abdomen

202

Pelvis

222

Spine

236

Upper Extremities

252

Lower Extremities

256

Vascular

260

Specials

288

Children

290

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Contents User Documentation

12

Scan and Reconstruction

14

• Concept of Scan Protocols • Scan Setup • Scan Modes

- Sequential Scanning - Spiral Scanning - Dynamic Multiscan - Dynamic Serioscan • Straton-Tube • 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 CAREVision Mode • Increment • Pitch • Kernels • Extended FoV • Neuro Modes • Head Imaging • Image Filters

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

- How does CARE Dose 4D work? - Special Modes of CARE Dose 4D - Scanning with CARE Dose 4D - Adjusting the Image Noise - Activating and Deactivating CARE Dose 4D

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14 15 16 16 16 16 16 17 18 18 19 19 19 20 21 22 23 24 25 27

30 30 32 34 35 39 40 41 43

Contents • 100kV-Protocols

45

Workflow Information

48

• WorkStream4D

48 48 49 49 50

- 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

55 56 58 59 59 60 61 67 67 70 71 73 74

Application Information

76

• SOMATOM life

76 76 77 77

- General Information - Key Features - Description - Access to Computer Based Training or Manuals on CD ROM - SRS Based Services - Download of Files - Contact incl. DICOM Images - Trial Order and Installation • Image Converter

78 79 80 82 83 85

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Contents - Split-Up Multi-Phase Series • Report Template Configuration • File Browser

- Key Features • Patient Protocol

SOMATOM Sensation Open • General

- Benefits: • Radiation Therapy Planning - Remember the challenges of Radiation Therapy… - Benefits - Typical workflow in RT • RT_Head • RT_HeadThinSlice • RT_Neck • RT_Thorax • RT_Mammae • RT_Abdomen • RT_Pelvis • RT_PelvisThinSlice • RT_C-Spine • RT_Spine • RT_Neuroaxis • RT_UpperExtremity • RT_LowerExtremity • Workflow for Emergency Patients - Additional Important Information - Benefits - Hints - Protocols • Trauma/Trauma1s • TraumaVol/TraumaVol1s • PolyTrauma/PolyTrauma1s • HeadTrauma • Interventions - Benefits • Biopsy/Biopsy1s

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86 87 88 88 91

92 92 93 94 95 96 98 99 100 101 102 103 104 105 106 107 108 109 111 112 114 115 116 117 117 118 119 120 122 123 123 125

Contents • BiopsySingle/BiopsySingle1s • CAREVision

- The Basics • CAREVision • CAREVisionSingle • CAREVisionBone • Application Procedure • Bariatric Care

- Benefits • ThoraxXXL • AbdomenXXL • PelvisXXL • SpineXXL • Technical Data

Head • Overview • Hints in General

- Head Kernels • HeadRoutine • HeadRoutineSeq • HeadNeuroSeq • Sinus/Sinus1s • SinusVol/SinusVol1s • Orbit • Dental/Dental1s

Neck • Overview • Hints in General

- Body Kernels • NeckRoutine • NeckVol • NeckThorax/NeckThorax1s • NeckThorAbd/NeckThorAbd1s

125 126 126 127 128 129 132 135 137 138 139 140 141 142

144 144 145 146 148 150 152 154 156 158 160

162 162 163 164 166 168 170 172

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Contents Shoulder • Overview • Hints in General

- Body Kernels • ShoulderRoutine • ShoulderVol

Thorax • Overview • Hints in General

- Body Kernels • ThoraxRoutine • ThoraxVol/ThoraxVol1s • ThorAbd/ThorAbd1s • ThoraxHR/ThoraxHR1s • LungLowDose/LungLowDose1s • LungCARE/LungCARE1s

Abdomen • Overview • Hints in General

- Body Kernels • AbdomenRoutine • AbdomenVol/AbdomenVol1s • AbdMultiPhase/AbdMultiPhase1s • AbdomenSeq/AbdomenSeq1s • CTColonography/CTColonography1s

Pelvis • Overview • Hints in General

- Body Kernels • PelvisRoutine • PelvisVol/PelvisVol1s • Hip

8

176 176 177 178 180 182

184 184 186 187 188 190 192 196 198 200

202 202 203 205 206 210 214 218 220

222 222 223 224 226 228 230

Contents

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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“. 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 “1s”: use the rotation time of 1 second “Vol”: use the 3D Recon Workflow "Neuro": for neurological examinations with a special mode "RT": special organ modes for radiotherapy "CAREVision"/"Biopsy": Special protocols for interventions "XXL": Special protocols for bariatric patients 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 Open 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 Acquisition A new feature on the Examination task card is that now the "Acq" (Acquisition) is displayed. The “Acquisition” is simply "number of slices acquired per rotation" x "width of one slice".

Slice Collimation and Slice Width Slice collimation is the slice thickness resulting from the effect of the tube-side collimator and the adaptive detector array design. In Multislice CT, the Z-coverage per rotation is given by the product of the number of active detector slices and the collimation (e.g. 20 x 1.2 mm). Slice width is the FWHM (full width at half maximum) of the reconstructed image. With the SOMATOM Sensation Open, you select the slice collimation together with the slice width desired. The slice width is independent of pitch, i.e. what you select is always what you get. Actually, you do not need to be concerned about the algorithm any more; the software does it for you. During acquisition RT images will be reconstructed (Real time display). Select "Autorecon" on the reconstruction tabcard for each job otherwise you have to press "Recon" for each recon job separately.

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Scan and Reconstruction Acquisition, Slice Collimation and Slice Width for Spiral Mode

Acquisition 20 x 1.2

Collimation

Slice width

1.2

1.5, 2, 3, 4, 5, 6, 7, 8, 10 mm

Acquisition, Slice Collimation and Slice Width for Sequence Mode

Acquisition

Collimation

Slice width

20 x 1.2

1.2

2.4, 4.8, 6, 12 mm

1 x 10

10

10 mm

1x5 (Neuro mode)

5

5 mm

Acquisition, Slice Collimation and Slice Width for CAREVision Mode

Acquisition

Collimation

Slice width

18 x 1.2

1.2

3 x 7.2 mm

1 x 10

1.2

10 mm

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Scan and Reconstruction Increment The increment is the distance between the reconstructed images in the Z direction. When the chosen increment is smaller than the slice thickness, the images are created with an overlap. This technique is useful to reduce partial volume effect, giving you better detail of the anatomy and high quality 2D and 3D post-processing. The increment can be freely adapted from 0.1 - 10 mm.

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Scan and Reconstruction Pitch In single slice CT: Pitch = table movement per rotation/slice collimation E.g.: slice collimation = 5 mm, table moves 5 mm per rotation, then pitch = 1. In Siemens Multislice CT: Pitch factor = table movement per rotation/total slice collimation Where the total collimation is 24 mm for acquisition 20 x 1.2. Feed/Rotation, the table movement per rotation You do not need to select pitch. Once the scan range, scan time, slice collimation, and rotation time are defined, the software will adapt the table feed per rotation accordingly. The Pitch Factor can be freely adapted from 0.45 – 2.0. With the SOMATOM Sensation Open, you select the slice collimation together with the slice width desired. The slice width is independent of pitch, i.e. what you select is always what you get. Actually, you do not need to be concerned about the algorithm any more; the software does it for you. Pitch values with a step width of 0.05 can be selected for all modes. Data from scans with pitch factors between 1.5 and 2 can be reconstructed with slice thicknesses ≥ 7 mm (collimation 1.2 mm) only.

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Scan and Reconstruction Kernels There are 4 different types of kernels: “H“ stands for Head, “B“ stands for Body, “C“ stands for ChildHead and ”S” stands for Special Application, e.g., Osteo CT. The image sharpness is defined by the numbers – the higher the number, the sharper the image; the lower the number, the smoother the image. The endings “s” or “f” depend on the rotation time. A set of 30 kernels are supplied with the SOMATOM Sensation Open Software, consisting of • 15 body kernels B10s/f, B20s/f, B25s/f, B30s/f, B31s/f, B35s/f, B36f, B40s/f, B41s/f, B45s/f, B46f, B50s/f, B60s/f, B70s/f, B80s/f, • 11 head kernels H10s/f, H20s/f, H21s/f, H30s/f, H31s/f, H40s/f, H41s/f,H45s/f H50s/f, H60s/f, H70h • 3 child head kernels C20s/f, C30s/f, C60s • 2 special kernels S80s/f, S90s/f. Note: Do not use different kernels for body parts other than what they are designed for. For further information regarding the kernels, please refer to the “Hints in General” of the corresponding body region. Note: Please note that for the Sensation Open, the beam quality in head mode has been modified with respect to the Sensation 16. To reduce patient dose, the beam filtration is now the same as in body mode (1.2 mm Titanium instead of 0.6 mm Titanium with the Sensation 16). This means: to achieve a given noise, the mAs has to be increased, but the dose is still reduced considerably with respect to the Sensation 16.

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