R. Biuening A. Kuellnei T. Flohi (Eds.

)
ProtocoIs for MuItisIice C7
Second Edilion
R. Biuening A. Kuellnei T. Flohi (Eds.)
ProtocoIs
for MuItisIice C7
Wilh 202 Figuies

Second Edilion
Roland Biuening, M.D.
Depailmenl of Neuioiadiology
Inslilule of Clinical Radiology
Clinic of lhe Univeisily of Munich
Maichioninisli. 15
81377 Munich
Geimany
Thomas Flohi, Ph.D.
Siemens Medical Solulions
Compuled Tomogiaphy
Siemenssli. 1
91301 Foichheim
Geimany
Axel Kuellnei, M.D.
Depailmenl of Diagnoslic Radiology
Univeisily Clinic Eilangen
Maximiliansplalz 1
91054 Eilangen
Geimany
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Piinled on acid-fiee papei
The developmenl of Mullislice (mullidelecloi iow) compuled lomogiaphy (CT) have had a
deep impacl on lhe geneial use of CT. Cl is now again being incieasingly used as compaied
lo olhei modalilies, especially magnelic iesonance imaging (MRI). Consequenlly, lhe in-
leiesl in piaclical aspecls of lhe melhod musl keep pace. While in iecenl yeais lhe ques-
lions included when and how lo use lhe syslems, dedicaled piolocols aie now iequesled
foi each impoilanl medical indicalion.
To addiess lhe moie and moie dedicaled examinalions, lhe second edilion of Proiocols
for Muliislice CT has become a mulliaulhoi volume, lhe conliibulois being well-known
expeils in lheii fields. Theii chapleis piovide sliucluied up-lo-dale infoimalion on all
iouline piolocols used foi mullislice CT. Also, lhe en bloc display is aimed lo enable iapid
appiecialion of lhe indicalions and lhe necessaiy scannei sellings.
New medical indicalions foi compuled lomogiaphy, such as caidiac CT, aie eslablished.
Theie aie six chapleis in lhis volume addiessing lhis impoilanl and fascinaling applica-
lion. Childien aie incieasingly iefeiied foi an invesligalion using a mullislice CT since lhe
lechnique is fasl, ieliable, and only a small iadialion dose is involved. A dedicaled chap-
lei addiesses lhe special piolocol and conliasl maleiial iegimen necessaiy. Mulislice CT
scanneis aie also incieasingly used lo guide inleivenlional pioceduies; lhe mosl common
aie desciibed in foui chapleis lo enable fasl appiecialion.
The way lhe CT examinalion is planned and caiiied oul has been subslanlially changed.
Inslead of individual axial slices, lheie is a lhin-collimalion acquisilion of a volume. Sub-
sequenl ieconsliuclions in diffeienl planes aie becoming moie and moie iouline and aie
indispensable foi many piolocols. Thin-collimalion acquisilion has also been iecognized
as being useful foi minimizing ailifacls.
Howevei, caie musl always be laken so as nol lo inciease lhe palienl iadialion dose
unnecessaiily. A chaplei has been dedicaled lo lhis impoilanl lopic. Accoiding lo iecenl
iecommendalions, and whenevei possible, lhe mAs musl be ieasonable even al lhin col-
limalion. Also, lhe scanned volume musl be iesliicled, especially since mulliphase whole-
body scans aie easily peifoimed. Lasl, bul nol leasl, lhe indicalion foi examinalion musl
be eslablished. The incieased speed of mullislice CT also suggesls a change in lhe use of
inliavenous conliasl agenls. While lhe diffeienl injeclion doses, velocilies, and concen-
lialions aie cuiienlly undei invesligalion, bolh lheoielical consideialions and piaclical
piolocols foi each body pail aie included in lhis book.
In lhe fiisl edilion, mosl piolocols weie oplimized foi Siemens scanneis. In lhis second
edilion, howevei, lhe piolocol layoul and lhe dala piesenled weie inlenlionally changed so
lhal lhey can be employed foi all syslems iegaidless of lhe manufacluiei. Also, all piolo-
cols weie adapled lo accommodale all scannei geneialions, including lhe lalesl available
64-slice geneialion fiom all manufacluieis. While we made subslanlial effoil lo adjusl
lhe piolocols accoiding lo cuiienl knowledge, piefeiences change quickly and may vaiy
fiom sile lo sile. Theiefoie, if lhe ieadei has any commenls oi suggeslions foi vaiialions
of lhese piolocols, please do nol hesilale lo conlacl any of us. Please nole lhal despile caie-
Preface to the Second dition
VI
ful ediling, lheie can be no liabilily on lhe pail of lhe aulhois foi lhe use of any of lhese
piolocols.
We would like lo expiess oui sinceie lhanks lo all lhe conliibulois and lo all who sup-
poiled us. Aflei lhe fiisl volume sold oul, Spiingei and LE-TeX kindly suppoiled lhe idea
of publishing lhis second edilion and again piovided us wilh invaluable assislance. We
hope lhal eveiyone enjoys ieading lhis book.
Roland Biuening Munich
Axel Kuellnei Eilangen
Thomas Flohi Foichheim
Preface to the Second dition
Preface to the Iirst dition
The iadiology communily has seen a subslanlial lechnical innovalion wilh lhe develop-
menl of mullislice compuled lomogiaphy (CT). The inlioduclion of mulliple paiallel de-
leclois is undoubledly one of lhe mosl impoilanl lechnical impiovemenls in lhe field of
CT. Moieovei, lhe new advanlages of CT may also have an impacl on lhe geneial use of CT
and magnelic iesonance imaging (MRI).
Mullislice CT is becoming incieasingly available in indusliialized counliies. Conse-
quenlly, inleiesl in piaclical aspecls of lhe melhod is also giowing. Common queslions
include when and how lo use lhe syslems. While lhe inilial scanneis weie equipped wilh
lwo oi foui delecloi iows, cuiienl advances have led lo scanneis wilh up lo 16 iows be-
coming available foi clinical use. And lheie is slill moie lo come.
As lhese mullislice CT syslems mainlain lhe geneial advanlages of CT, i.e. ieliabilily
and shoil examinalion limes, lheii abilily lo invesligale laige aieas of lhe body in a veiy
shoil lime wilh impioved liansveise iesolulion has bioadened lhe polenlial medical ap-
plicalions of CT. Thus, new medical indicalions foi CT, such as caidiac CT, have emeiged.
Some queslions in diagnoslic imaging, e.g. a non-invasive neck sludy foi suspecled ca-
iolid slenosis, may in fuluie be solved moie fiequenlly wilh mullislice CT lhan wilh MRI.
Olhei indicalions such as lhe slaging of ieclal oi laiyngeal cancei may see a highei sensi-
livily and specificily wilh mullislice CT lhan wilh single-slice syslems.
Theie is also a subslanlial change in lhe way lhe examinalion is planned and caiiied
oul. Inslead of individual axial slices, lheie is a lhin-collimalion acquisilion of a volume.
Subsequenl ieconsliuclions aie becoming moie and moie impoilanl. In some piolocols,
such as lhe cianial sinuses, only lhe coional ieconsliuclions aie iead al oui inslilulion,
while lhe axial dala aie nol used.Thin-collimalion acquisilion is also useful foi minimiz-
ing ailefacls. Il is heie lhal ieconsliuclions aie made in lhickei slices lo minimize image
noise.
Caie musl be laken so as nol lo inciease lhe palienl iadialion dose unnecessaiily. Theie-
foie, whenevei possible, lhe mAs musl be adapled and ieduced, lhe scanned volume musl
be iesliicled and lasl bul nol leasl lhe indicalion foi lhe examinalion musl be eslablished.
The incieased speed of mullislice CT suggesls a change in lhe use of inliavenous conliasl
agenls. While lhe diffeienl injeclion doses, velocilies and concenlialions aie cuiienlly
undei invesligalion, lhe piolocols in lhis book include a subjeclive iecommendalion foi
use.
This book includes a peisonal seleclion of piolocols foi applicalion wilh foui-iow oi
16-iow scanneis. These piolocols have been oplimized foi Siemens scanneis; howevei, lhe
piolocol layoul and lhe dala piesenled can also be employed wilh diffeienl bands. While
we made subslanlial effoil lo adjusl lhe piolocols lo lhe cuiienl knowledge, piefeieces on
lhe use of piolocols change quickly and also vaiy fiom sile lo sile.Theiefoie, if lhe ieadei
has any commenls oi suggeslions foi vaiialions of lhese piolocols, lhey should nol hesi-
lale lo conlacl us. Please nole lhal despile caieful pioofieading, lheie can be no liabilily
on lhe pail of lhe aulhois foi lhe use of any of lhe piolocols.
VIII
We would like lo expiess oui sinceie lhanks lo all lhe conliibulois and lo lhe local CT
lechnicians. We gialefully acknowledge Piof. Maximilian Reisei, who enabled and en-
couiaged lhis eaily clinical expeiience wilh mullislice CT in Giohadein by his peisonal
palionage and vision. Spiingei kindly suppoiled lhe idea of publishing lhis volume and
piovided us wilh invaluable assislance. We hope lhal eveiyone inleiesled in lhe lechnique
of mullislice CT finds lhis book useful.
R. Biuening Munich
T. Flohi Foichheim
Preface to the Iirst dition
Contributors
Kalhaiina Andeis
Inslilule foi Diagnoslic Radiology (IDR)
Fiiediich-Alexandei Univeisily
Eilangen-Ninbeig
Maximiliansplalz 1
91054 Eilangen
Geimany
Andiik J. Aschoff
Depailmenl of Diagnoslic Radiology
Univeisily of Ulm
Sleinhvelsli. 9 (Klinikbeieich Safianbeig)
89075 Ulm
Geimany
Uliich Baum
Inslilule foi Diagnoslic Radiology (IDR)
Fiiediich-Alexandei Univeisily
Eilangen-Ninbeig
Maximiliansplalz 1
91054 Eilangen
Geimany
Gunnai Biix
Fedeial Office foi Radialion Pioleclion
Depailmenl of Radialion and Heallh
Division of Medical Radialion Hygiene
and Dosimeliy
Ingolslllei Landsli. 1
85764 Obeischleissheim
Geimany
Roland Biuening
Depl. of Radiology
Geneial Hospilal Baimbek (AKB)
LBK Hambuig GmbH
Rbenkamp 148
22291 Hambuig
Geimany
Slephan Clasen
Depailmenl of Diagnoslic Radiology
Ebeihaid-Kails Univeisily
Hoppe-Seylei-Sli. 3
72076 Tbingen
Geimany
Floiian Dammann
Depl. of Radiology
Klinikum am Eicheil
Eicheilsli. 3
73035 Gppingen
Geimany
Rogei Eibel
Inslilule of Clinical Radiology
Clinic of lhe Univeisily of Munich -
Innensladl
Ziemssensli. 1
80336 Munich
Geimany
Biigil Eill-Wagnei
Inslilule of Clinical Radiology
Clinic of lhe Univeisily of Munich -
Giohadein
Maichioninisli. 15
81337 Munich
Geimany
Roman Fischbach
Depailmenl of Clinical Radiology
Univeisily of Mnslei
Albeil-Schweilzei-Sli. 33
48149 Mnslei
Geimany
X
Dominik Fleischmann
Depailmenl of Radiology
Slanfoid Univeisily Medical Cenlei
300 Pasleui Di., Room S-072
Slanfoid
Califoinia 94305-5105
USA
Thomas Flohi
Siemens Medical Solulions
Compuled Tomogiaphy
Siemenssli. 1
91301 Foichheim
Geimany
Thomas Helmbeigei
Clinic of Radiology
Univeisily of Lbeck
Ralzebuigei Allee 160
23538 Lbeck
Geimany
Pelei Heizog
Inslilule of Clinical Radiology
Clinic of lhe Univeisily of Munich -
Giohadein
Maichioninisli. 15
81337 Munich
Geimany
Mailin Heuschmid
Depailmenl foi Diagnoslic Radiology
Univeisily of Tbingen
Hoppe-Seylei-Sli. 3
72076 Tbingen
Geimany
Mailin Hoffmann
Depailmenl of Diagnoslic Radiology
Univeisily of Ulm
Sleinhvelsli. 9 (Klinikbeieich Safianbeig)
89075 Ulm
Geimany
Ralf-Thoislen Hoffmann
Inslilule of Clinical Radiology
Clinic of lhe Univeisily of Munich -
Giohadein
Maichioninisli. 15
81337 Munich
Geimany
Maiius Hoigei
Depailmenl of Diagnoslic Radiology
Ebeihaid-Kails Univeisily
Hoppe-Seylei-Sli. 3
72076 Tbingen
Geimany
Tobias F. Jakobs
Inslilule of Clinical Radiology
Clinic of lhe Univeisily of Munich -
Giohadein
Maichioninisli. 15
81337 Munich
Geimany
Maic Kebeile
Depailmenl of Diagnoslic Radiology
Medical High School Hanovei
Cail-Neubeig-Sli. 1
30625 Hanovei
Geimany
Andieas F. Kopp
Depailmenl foi Diagnoslic Radiology
Univeisily of Tbingen
Hoppe-Seylei-Sli. 3
72076 Tbingen
Geimany
Eva Coppenialh
Inslilule of Clinical Radiology
Univeisily of Munich - Innensladl
Nussbaumsli. 20
80336 Munich
Geimany
Raimund Kollke
Depailmenl of Diagnoslic Radiology
Ebeihaid-Kails Univeisily
Hoppe-Seylei-Sli. 3
72076 Tbingen
Geimany
Axel Kuellnei
Inslilule foi Diagnoslic Radiology (IDR)
Fiiediich-Alexandei Univeisily
Eilangen-Ninbeig
Maximiliansplalz 1
91054 Eilangen
Geimany
Contributors
XI
Andieas H. Mahnken
Depailmenl of Diagnoslic Radiology
Univeisily of Aachen
Pauwelssli. 30
52074 Aachen
Geimany
David Mainlz
Depailmenl of Clinical Radiology
Univeisily of Muenslei
Albeil-Schweilzei-Sli. 33
48149 Mnslei
Geimany
Dominik Moihaid
Inslilule of Clinical Radiology
Clinic of lhe Univeisily of Munich -
Giohadein
Maichioninisli. 15
81337 Munich
Geimany
Ulliich G. Mllei-Lisse
Inslilule of Clinical Radiology
Clinic of lhe Univeisily of Munich -
Innensladl
Ziemssensli. 1
80336 Munich
Geimany
Hans-Dielei Nagel
Philips Medical Syslems
Clinical Science & Technology Gioup
Roenlgensli. 24
22335 Hambuig
Geimany
Jean-Fianois Paul
Radiology Unil
Maiie Lannelongue Hospilal
133 av. de la Rsislance
92350 Plessis Robinson
Fiance
Philippe L. Peieiia
Depailmenl of Diagnoslic Radiology
Ebeihaid-Kails Univeisily
Hoppe-Seylei-Sli. 3
72076 Tbingen
Geimany
Rainei Raupach
Siemens Medical Solulions
Compuled Tomogiaphy
Siemenssli. 1
91301 Foichheim
Geimany
Maximilian F. Reisei
Inslilule of Clinical Radiology
Clinic of lhe Univeisily of Munich -
Giohadein
Maichioninisli. 15
81337 Munich
Geimany
Rupeil A. Schmid
Clinic foi Nucleai Medicine
Ludwig-Maximilians Univeisily
Maichioninisli. 15
81377 Munich
Geimany
Asliid Wallnfei
Inslilule of Clinical Radiology
Clinic of lhe Univeisily of Munich -
Giohadein
Maichioninisli. 15
81337 Munich
Geimany
Mailin Wiesmann
Depailmenl of Neuioiadiology
Clinic of lhe Univeisily of Munich -
Giohadein
Maichioninisli. 15
81377 Munich
Geimany
Contributors
Contents
PAR7 I: 7echnicaI Aspects and Dose Considerations
1. Technical Piinciples
and Applicalions of Mullislice CT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
2. Fuluie Peispeclives of Mullislice CT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
3. Dose Consideialions and Radialion Pioleclion Issues
in Mullislice CT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
4. Ailifacls in MSCT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
5. CT of lhe Heail and Gieal Vessels:
Piolocols in Congenilal Heail Disease Palienls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
6. Conliasl Medium Applicalions foi Mullislice CT . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
7. Indicalions foi PET-CT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
PAR7 II: 8rain
8. Acule Neuiovasculai Evenls:
Bleeding and Ischemia Diagnosed by MSCT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
9. CTA of Inliacianial Aneuiysm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
10. Imaging of lhe Ceiebial Veins and Sinuses wilh MS-CT . . . . . . . . . . . . . . . . . . . . . 87
11. Biain Peifusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
PAR7 III: Neck
12. Sinuses and Facial Skelelon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
13. Nasophaiynx, Oiophaiynx, and Oial Cavily . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
14. MSCT of lhe Hypophaiynx and Laiynx . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
PAR7 IV: Chest
15. MSCT Diagnosis of Infeclious Pulmonaiy Disease . . . . . . . . . . . . . . . . . . . . . . . . . 121
16. Paienchymal Changes of lhe Lung . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
17. MSCT Imaging of Pulmonaiy Embolism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
18. Mediaslinum, Pleuia, and Chesl Wall . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145
19. Thoiacic Aoila . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153
PAR7 V: Heart
20. Calcium Scieening . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159
21. Coionaiy Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165
22. Funclional Caidiac Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
23. Bypass Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177
XIV
24. Imaging of Coionaiy Slenls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183
25. Coionaiy Imaging al High Heail Rales . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187
PAR7 VI: Abdomen
26. Diffuse Livei Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195
27. Focal Livei Lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199
28. MSCT Imaging of Biliaiy Tiacl Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205
29. MSCT of lhe Uppei Uiinaiy Tiacl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213
30. Pancieas and Reliopeiiloneal Space . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217
31. Gaslioinleslinal Tiacl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 225
32. CT Colonogiaphy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229
PAR7 VII: MuscuIoskeIetaI
33. Musculoskelelal Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235
PAR7 VIII: 7rauma
34. Tiauma Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 249
PAR7 IX: C7-Guided Interventions
35. CT-Guided Abscess Diainage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259
36. CT-Guided Diagnoslic Puncluies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 267
37. CT-Guided Ablalion Theiapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 275
38. Veilebioplasly . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 283
Subjecl Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 287
Contents
Abbreviations
CC7 cianial CT
C7 compuled lomogiaphy
C7A CT angiogiaphy
IOV field of view
HR high iesolulion
MDC7 mullidelecloi CT
MIP maximum inlensily piojeclions
MPR mulliplanai iefoimals
MRI magnelic iesonance imaging
MSC7 mullislice CT
SSD shaded suiface display
S7S sliding lhin slices
US ulliasound
VR7 volume iendeiing lechniques
How to Read the 7abIes
In lhe following chapleis, please find a se-
leclion of scan piolocols foi vaiious calego-
iies of MDCT syslems, ianging fiom 4 lo 64
slices. These piolocols aie meanl as sugges-
lions; lhey can be modified and adapled lo
individual clinical needs oi individual pa-
lienl iequiiemenls.
Theie aie some common iules lhal apply
lo lhe scan piolocol definilions.
Pitch
E All aulhois use lhe slandaid IEC pilch
definilion, wheie pilch is defined as
lable feed pei iolalion divided by lhe
lolal widlh of lhe collimaled beam. The
lolal widlh of lhe collimaled beam is lhe
numbei of aclive delecloi iows limes lhe
collimaled widlh of one delecloi iow. Il
musl be kepl in mind lhal lhe Siemens
SOMATOM Sensalion 64, allhough ac-
quiiing 64 oveilapping 0.6-mm slices
pei iolalion, has a lolal beam widlh of
320.6 mm.
E When pilch ianges aie indicaled foi a
scan piolocol, lhey apply lo scannei
lypes wilh fieely seleclable pilch. Foi
scannei lypes wilh fixed pilch values,
lhe value closesl lo lhe indicaled pilch
iange should be chosen.
E The pilch iecommendalions show whelh-
ei an acquisilion can be peifoimed al
high pilch lo oplimize volume coveiage,
such as in lhoiax oi abdominal CTA ex-
aminalions, oi whelhei lhe pilch should
be ieduced lo oplimize image qualily,
such as in head oi spine examinalions.
E ECG-galed caidiac scanning is a special
case lhal iequiies veiy low pilch (lypi-
cally p = 0.2-0.35, depending on lhe
numbei of iows, lhe ganliy iolalion
lime, and lhe numbei of dala segmenls
fiom diffeienl caidiac cycles used foi
image ieconsliuclion) lo ensuie gap-
less coveiage of lhe heail volume in all
phases of lhe caidiac cycle.
7ube Current 7ime Product
All aulhois diffeienliale belween mAs and
effeclive mAs. Some manufacluieis, such
as Siemens, use lhe effeclive" mAs concepl
foi lheii scanneis, which includes lhe pilch
dependence inlo lhe mAs definilion by
mulliplying mAs wilh 1/p. Foi spiial scans,
(mAs)
eff
is indicaled on lhe usei inleiface
foi Siemens useis. Some olhei manufaclui-
eis, such as Toshiba and GE, use lhe con-
venlional mAs definilion.
E When compaiing lhe scan paiameleis
foi CT syslems of diffeienl manufaclui-
eis, lhe undeilying mAs definilion has lo
be laken inlo accounl. The diffeience is
mosl obvious foi low pilch piolocols, in
pailiculai foi caidiac scanning. Consid-
ei lhe example of an ECG-galed caidiac
CTA examinalion al 0.4-s iolalion lime
and pilch 0.25, using 120 kV and a lube
cuiienl of 500 mA. These paiameleis
iesull in 500 mA0.4 s = 200 mAs, bul
in 500 mA0.4 s1/0.25 = 800 eff. mAs.
To ieduce lhe confusion, lhe aulhois lisl
bolh mAs and effeclive mAs foi each
piolocol in lhe scan piolocol lables of
lhis book.
E When mAs ianges aie indicaled, lhey
usually iefei lo diffeienl palienl consli-
lulions. Adaplalion of lhe dose lo palienl
size and weighl is lhe mosl impoilanl
T. Flohi
XVIII
facloi foi ieducing iadialion exposuie
[1-3].
E As a geneial iule, lhe dose necessaiy
lo mainlain conslanl image noise has
lo be doubled if lhe palienl diamelei is
incieased by 4 cm. This is of pailiculai
impoilance in pedialiic imaging (see
Chap. 5).
7ube Current
ModuIation 7echniques
E Wilh lhis lechnique lhe lube oulpul is
aulomalically adapled lo lhe palienl ge-
omeliy duiing each iolalion of lhe scan-
nei lo compensale foi sliongly vaiying
X-iay allenualions in asymmeliical body
iegions, such as lhe shouldeis and pelvis.
The vaiialion of lhe lube oulpul is eilhei
piedefined by an analysis of lhe localiz-
ei scan (lopogiam, scoul view) oi delei-
mined online by evalualing lhe delecloi
signal. Wilh use of lhis lechnique, dose
can be ieduced by 15-35% wilhoul de-
giading image qualily depending on lhe
body iegion [4,5]. In moie sophislicaled
appioaches, lhe lube oulpul is modified
accoiding lo lhe palienl geomeliy nol
only duiing each iolalion, bul also in
lhe longiludinal diieclion lo mainlain
an adequale dose when moving lo dif-
feienl body iegions, foi inslance, fiom
lhoiax lo abdomen (aulomalic exposuie
conliol).
E Useis of scanneis equipped wilh CARE-
Dose 4D soflwaie oi olhei similai sofl-
waie should nol adapl lhe mAs sellings
manually, as indicaled in lhe scan piolo-
col iecommendalions of lhis book. This
will be done aulomalically by lhe CARE-
Dose 4D soflwaie. Inslead use a mean
mAs value wilhin lhe specified iange as
a iefeience."
Contrast MateriaI
E Conliasl maleiial iecommendalions
aie inlended foi 75-kg male palienls;
olheiwise lhe amounl, injeclion speed,
and densily of conliasl maleiial musl be
adapled.
Reconstruction kerneIs
E Each vendoi of CT scanneis piovides dif-
feienl convolulion keinels - also called
filleis" - lo liade off in-plane spalial
iesolulion and image noise accoiding
lo lhe undeilying clinical applicalion.
Since lheie is no naming convenlion foi
lhese keinels, lhe aulhois in lhis volume
use lhe leims sofl, slandaid, bone, oi
high iesolulion lo indicale lhe desiied
imaging chaiacleiislics independenl of
lhe individual scannei lype.
References
1. Donelly LF, Emeiy KH, Biody AS el al. (2001)
Minimizing iadialion dose foi pedialiic body
applicalions of single-delecloi helical CT: slial-
egies al a laige childien's hospilal. AJR 176:303-
306
2. Fiush DP, Soden B, Fiush KS, Lowiy C (2002)
Impioved pedialiic mullidelecloi body CT
using a size-based coloi-coded foimal. AJR
178:721-726
3. Wildbeigei JE, Mahnken AH, Schmilz-Rode
T, Flohi T, Slaigaidl A, Haage P, Schallei S,
Guenlhei RW (2001) Individually adapled ex-
aminalion piolocols foi ieduclion of iadialion
exposuie in chesl CT. Invesligalive Radiology
36(10):604-611
4. Kalendei WA, Wolf H, Suess C (1999) Dose ie-
duclion in CT by analomically adapled lube
cuiienl modulalion. II. Phanlom measuie-
menls. Med Phys 26:2248-2253
5. Gieess H, Wolf H, Baum U el al. (2000) Dose
ieduclion in compuled lomogiaphy by allenua-
lion-based on-line modulalion of lhe lube cui-
ienl: evalualion of six analomical iegions. Eui
Radiol 10:391-394
How to Read the 7abIes
I 7echnicaI and Dose
Considerations