Sensation 10 - 16 Application Guide Software Version VB10

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 herein 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 Operating Instructions must always be strictly followed when operating the MR/ CT System. The source for the technical data is the corresponding data sheets. The pertaining operating instructions must always be strictly followed when operating the SOMATOM Sensation 10/16. The statutory source for the technical data are the corresponding data sheets. We express our sincere gratitude to the many customers who contributed valuable input. Special thanks to Thomas Flohr, Rainer Raupach, Bettina Klingemann, Axel Barth, Kristin Pratt and the CT-Application Team 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

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Overview General

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Children

64

Head

116

Neck

140

Shoulder

148

Thorax

154

Abdomen

172

Pelvis

190

Spine

200

Upper Extremities

216

Lower Extremities

226

Vascular

238

Specials

278

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Content General 10 · User Documentation 10 · Concept for Scan Protocols 12 · Straton-Tube (optional) 13 · Scan Set Up 13 · Scan Modes 14 – Sequential Scanning 14 – Spiral Scanning 14 – Dynamic Multiscan 14 – Dynamic Serioscan 14 · Slice Collimation and Slice Width 15 · Increment 17 · Pitch 18 · Kernels 19 · Image Filters 20 · Improved Head Imaging 22 · Dose Information 23 – CTDIW and CTDIVol 23 – Effective mAs 25 · CARE Dose 4D 26 – How does CARE Dose 4D work? 27 – Special Modes of CARE Dose 4D 30 – Scanning with CARE Dose 4D 30 – Adjusting the Image Noise 31 – Activating and Deactivating CARE Dose 4D 33 – Conversion of Old Protocols into Protocols with CARE Dose 4D 33 · 100kV-Protocols 36 · WorkStream 4D 38 – Recon Job 38 – 3D Recon 38 – Key Features 39 – Description 39 – Display of Recon Ranges in the Toposegment 43 – Case Examples 44 · Workflow 46 – Recon Job 46 – Examination Job Status 47 · Auto Load in 3D and Postprocessing Presets 48 · How to Create your own Scan Protocols 49 4

Content General · Contrast Medium – The Basics – IV Injection – Bolus Tracking – General Hints – Test Bolus using CARE Bolus – Test Bolus · General Application Information – Image Converter – Report Template Configuration – File Browser – Patient Protocol Children · Overview · Hints in General – Head Kernels – Body Kernels · HeadRoutine · HeadRoutine05s · HeadSeq · HeadSeq05s · InnerEar · InnerEarSeq · SinusOrbi · NeckRoutine · ThoraxRoutine · ThoraxCombi · ThoraxHRSeq · AbdomenRoutine · SpineRoutine · SpineThinSlice · ExtrUHRRoutine · ExtremityCombi · HeadAngio · CarotidAngio/CarotidAngio042s (optional) · BodyAngio/BodyAngio042s (optional) · NeonateBody/NeonateBody042s (optional)

53 53 55 55 56 58 59 60 60 61 62 63 64 64 69 72 73 74 76 78 80 82 84 86 90 92 94 96 98 100 102 104 106 108 110 112 114 5

Content

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Head · Overview · Hints in General – Head Kernels · HeadRoutine · HeadRoutine05s · HeadRoutineSeq · HeadSeq · HeadSeq05s · InnerEarUHR · InnerEarSeq · SinusOrbi · SinusOrbiVol (optional) · Dental

116 116 118 119 120 122 124 126 128 130 132 134 136 138

Neck · Overview · Hints in General – Body Kernels · NeckRoutine · NeckThinSlice

140 140 141 142 144 146

Shoulder · Overview · Hints in General – Body Kernels · Shoulder

148 148 149 150 152

Thorax · Overview · Hints in General – Body Kernels · ThoraxRoutine · ThoraxCombi · ThoraxHR · ThoraxHRSeq · ThoraxECGHRSeq (optional) · LungLowDose · LungCARE

154 154 155 156 158 160 162 164 166 168 170

Content Abdomen · Overview · Hints in General – Body Kernels · AbdomenRoutine · AbdomenCombi · AbdMultiPhase · AbdSeq · CTColonography

172 172 173 175 176 178 182 186 188

Pelvis · Overview · Hints in General – Body Kernels · Pelvis · Hip · SI_Joints

190 190 191 192 194 196 198

Spine · Overview · Hints in General – Body Kernels · C-Spine · SpineRoutine · SpineThinSlice · SpineVol (optional) · SpineSeq · Osteo

200 200 201 203 204 206 208 210 212 214

Upper Extremities · Overview · Hints in General – Body Kernels · WristUHR · ExtrRoutineUHR · ExtrCombi

216 216 217 218 220 222 224

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Content

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Lower Extremities · Overview · Hints in General – Body Kernels · KneeUHR · FootUHR · ExtrRoutineUHR · ExtrCombi

226 226 227 228 230 232 234 236

Vascular · Overview · Hints in General – Head Kernels – Body Kernels · HeadAngio · HeadAngio100kV (optional) · CarotidAngio · CarotidAngioVol (optional) · ThoraxAngioRoutine/ ThoraxAngio042s (optional) · ThoraxAngioVol (optional) · ThoraxAngioECG/ThoraxAngioECG042s/ ThoraxAngioECG037s (optional) · Embolism/Embolism042s (optional) · Embolism100kV · BodyAngioRoutine · BodyAngioFast/BodyAngio042s (optional) · BodyAngioVol (optional) · AngioRunOff · WholeBodyAngio

238 238 240 241 241 242 244 246 248 250 254 256 258 262 264 266 270 272 276

Content Specials · Overview · Trauma · The Basics · How to do it – Trauma – PolyTrauma – Additional Important Information · Interventional CT – Scan Protocols · CARE Vision – The Basics – Scan Protocols – CAREView – HandCARE · Application Procedure – Hints · TestBolus

278 278 279 279 280 280 281 283 284 285 287 287 288 291 292 293 295 296

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General 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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General syngo CT Operator Manual Volume 4: syngo Colonography syngo InSpace 4D syngo LungCARE CT syngo CT Operator Manual Volume 5: syngo Argus syngo Vessel View

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General 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 Cardiac, and PET. The protocols for special applications are defined in the Application Guide “Clinical Applications 1” and “Clinical Applications 2“ – or in case of Heart View examinations, in the Application Guide “Heart View“. The general concept is as follows: All protocols without suffix are standard spiral modes. E. g. “Shoulder” means the spiral mode for the shoulder. The suffixes of the protocol name are follows: “Routine“: for routine studies “Seq”: for sequence studies “Fast“: use a higher pitch for fast acquisition “ThinSlice“: use a thinner slice collimation for thin slice Multi-Planar-Reconstruction – or Maximum-Intensity-Projection studies “Combi“: use a thinner slice width for Multi-PlanarReconstruction – or Maximum-Intensity-Projection studies and thicker slice width for soft tissues studies “042”: use the rotation time of 0.42 seconds “037”: use the rotation time of 0.37 seconds “UHR“: use a thinner slice width for Ultra High Resolution studies and a FoV of 250 mm* “ECG“: ECG gated or trigged mode “100kV”: use the Tube Voltage 100* “Vol”: use the 3D-Recon Workflow* The availability of scan protocols depends on the system configuration. *optional 12

General Straton-Tube (optional) The SOMATOM Sensation 16 CT-system is now equipped with the “Straton”-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 60 kW can be applied for a 20 s spiral, providing considerable dose reserves even for adipose patients. As an example, in the “Thorax Combi“ protocol (120 kV, 100 mAs, 0.5 s rot, 16 x 0.75 mm, pitch 1.25) a scan range of 400 mm can be covered in 14 s and dose can be increased up to 200 mAs without reduction of the table feed.

Scan Set Up Scans can be simply 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 “load“. 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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General 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 movements are performed simultaneously for the entire scan duration. There is no inter-scan delay and a typical range can be acquired in a single breath hold. Each acquisition provides a complete volume data set, from which images with overlapping 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 mode without table feed. Dynamic serio can still be used for dynamic evaluation such as Test Bolus.

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General 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. 16 x 0.75 mm for the SOMATOM Sensation 16 or 10 x 0.75 mm for the SOMATOM Sensation 10). Slice width is the FWHM (full width at half maximum) of the reconstructed image. With the SOMATOM Sensation 10/16, 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 care about the algorithm any more; the software does it for you. On the SOMATOM Sensation 10/16 some slice widths are marked as “fast” (blue background). These images are reconstructed with highest performance. All others will be reconstructed up to 3 images per second. The reconstruction time depends on slice collimation and the reconstructed slice width. To get the fast performance, slice width has to be at least 3 times the slice collimation. During scanning the user normally will get “Real Time” reconstructed images in full image quality, if the “fast” slice has been selected. In some cases – this depends also on Scan range, Feed/Rotation and Reconstruction increment – the Recon icon on the chronicle will be labeled with “RT”. This indicates the Real Time display of images during scanning. The Real Time displayed image series has to be reconstructed after completion of spiral.

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General 1. For SOMATOM Sensation 10: Slice Collimation and Slice Width for Spiral Mode 0.75 mm: 1.5 mm: 3.0 mm:

0.75, 1, 1.5, 2, 3, 4, 5, 6, 7, 8, 10 mm 2, 3, 4, 5, 6, 7, 8, 10 mm 4, 5, 6, 7, 8, 10 mm

Slice Collimation and Slice Width for Sequence Mode 0.75 mm: 1.5 mm: 3.0 mm: 5.0 mm:

0.75, 1.5, 3, 6 mm 1.5, 3, 6 mm 3, 6, 9 mm 5, 10 mm

UHR Spiral Mode 0.6 mm: 0.75 mm:

0.6, 0.75, 1, 1.5, 2, 3, 4, 5, 6 mm (optional) 0.75, 1, 1.5, 2, 3, 4, 4.5, 5, 6, 7, 8, 10 mm

UHR Sequence Mode 0.6 mm: 1.0 mm:

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0.6, 1.2 mm (optional) 1, 2 mm

General 2. For SOMATOM Sensation 16: Slice Collimation and Slice Width for Spiral Mode 0.75 mm: 1.5 mm:

0.75, 1, 1.5, 2, 3, 4, 5, 6, 7, 8, 10 mm 2, 3, 4, 5, 6, 7, 8, 10 mm

Slice Collimation and Slice Width for Sequence Mode 0.75 mm: 1.0 mm: 1.5 mm: 5.0 mm:

0.75, 1.5, 3, 4.5, 9 mm 1, 2 mm 1.5, 3, 4.5, 6, 9 mm 5, 10 mm

UHR Spiral Mode 0.6 mm: 0.75 mm:

0.6, 0.75, 1, 1.5, 2, 3, 4, 5, 6 mm (optional) 0.75, 1, 1.5, 2, 3, 4, 5, 6, 7, 8, 10 mm

UHR Sequence Mode 0.6 mm: 0.75 mm: 1.0 mm:

0.6, 1.2 mm (optional) 0.75, 1.5, 3, 4.5, 9 mm 1, 2 mm

Increment The increment is the distance between the reconstructed images in the Z direction. When the increment chosen is smaller than the slice thickness, the images are created with overlap. This technique is useful to reduce partial volume effect, giving you better detail of the anatomy and high quality 2D and 3D postprocessing.

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General 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. With the SOMATOM Sensation 10/16, in Siemens Multislice CT, we differentiate between: Feed/Rotation, the table movement per rotation Volume Pitch, table movement per rotation/single slice collimation. Pitch Factor, table movement per rotation/complete slice collimation. For SOMATOM Sensation 10: E. g. slice collimation = 10 x 0.75 mm, table moves 7.5 mm per rotation. Then volume pitch = 10, pitch factor = 1. For SOMATOM Sensation16: E. g. slice collimation = 16 x 1.5 mm, table moves 24 mm per rotation. Then volume pitch = 16, pitch factor = 1. Pitch Factor, table movement per rotation/complete slice collimation. With the SOMATOM Sensation 10/16, 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. We recommend to use a Pitch Factor of 0.45 for MPR reconstructions.

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General Kernels There are 5 different types of kernels: “H“ stands for Head, “B“ stands for Body, “U“ stands for High Resolution, “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 36 kernels is supplied with the SOMATOM Sensation 10/16 Software, consisting of • 14 body kernels B10s/f, B20s/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 • 6 high resolution kernels U30u, U40u, U70u, U80u, U90u, U95u • 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.

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General Image Filters There are 3 different filters available: LCE: The Low-contrast enhancement (LCE) filter enhances low-contrast detectability. It reduces the image noise. • Similar to reconstruction with a smoother kernel • Reduces noise • Enhances low-contrast detectability • Adjustable in four steps • Automatic post-processing

HCE: The High-contrast enhancement (HCE) filter enhances high-contrast detectability. It increases the image sharpness, similar to reconstruction with a sharper kernel. • Increases sharpness • Faster than raw-data reconstruction • Enhances high-contrast detectability • Automatic post-processing

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