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RSNA-Edition
Nov. 27th
Dec. 2nd, 2005
www.siemens.com/medical
COVER STORY
Dual Source CT Imaging
A New Era in Computed
Tomography
Page 4
NEWS
CT Clinical Engines Speed
and Confidence
Page 19
BUINESS
SOMATOM Emotion Excellent Price-Performance Ratio
Page 25
Revenue Investment
Pays Off
Page 27
CLINICAL OUTCOMES
Oncology Respiratory Gating
Page 34
Acute Care Diagnosis and
Surgical Planning in Traumatic
Paraplegia
Page 42
SCIENCE
Increased Speed and Resolution Make a Difference in
Coronary Artery Imaging
Page 46
CUSTOMER CARE
EDUCATE
Free CME-Credited CD-Set
Page 49
SOMATOM
Sessions
EDITORS LETTER
Dear Reader,
The number of slices acquired per rotation has doubled every 18 months in the last years,
with Siemens being an innovation leader in both technical concepts and clinical applications.
At RSNA 2003, Siemens set another landmark as the first company to introduce 64-slice CT.
Only two years later, our SOMATOM Sensation 64 is installed in over 500 institutions
world-wide the largest installed base in this segment.
At Siemens, we continue to challenge the future view on CT technology and clinical applications. We understand that supplying our users with innovative hardware is not enough. Introducing our new CT Clinical Engines, we provide perfect clinical CT solutions in neurology, diagnostic oncology, cardiovascular and acute care available across Siemens' CT product line and
based on Siemens' unique syngo platform.
The time has come to explore totally new CT concepts and to move beyond the simple adding
of more detector slices. At RSNA 2005, Siemens moves CT into a new era with the introduction
of the world's first Dual Source CT, the SOMATOM Definition a breath-taking innovation that
started with a simple scribble and was designed in cooperation with the world's leading clinical
experts. Experience completely new dimensions of CT. Redefine the clinical role of CT in cardiac imaging and acute care. Explore new clinical frontiers with dual energy scanning. Join us
to reach new levels of excellence in CT.
Now, enjoy reading this 17th issue of the SOMATOM Session magazine. It is the introduction
to another great CT year in a year in which Siemens will once again set the trend.
Sincerely,
SOMATOM Sessions 17
CONTENT
COVER STORY
4
12
NEWS
19
21
21
22
Proven Leadership
22
23
Enhanced Workflow
BUSINESS
24
24
25
26
Reimbursement in the US
27
CLINICAL OUTCOMES
28
30
32
34
36
38
40
Neurology: Bone Subtraction CTA for Vascular Mapping in Head and Neck Imaging
42
Acute Care: 40-Slice CT for Diagnosis and Surgical Planning in Traumatic Paraplegia
SCIENCE
44
46
CUSTOMER CARE
48
Customer Event
48
48
49
49
50
50
51
Imprint
SOMATOM Sessions 17
COVER STORY
Buzz. Its what fills the air when people take note of an
exciting new trend, a technological revolution that
promises to change the future, an innovation so creative
it defines out of the box thinking.
Buzz. Its what energized the room when four computed
tomography (CT) experts gathered in Cleveland, Ohio, to
envision the future of imaging, and how it will change
with the introduction of a revolutionary new technology:
dual source CT.
The first system worldwide to contain this new technology
is Siemens SOMATOM Definition. Overcoming the
convention of thinking in terms of numbers of slices, it is
equipped with two X-ray source/detector systems that
rotate in synchrony, simultaneously capturing image data
in half the time required with conventional technology.
Two X-ray sources, two detectors, a multitude of clinical
possibilities.
At the table were neuroradiologist Michael Modic, M.D.,
chairman of radiology at the Cleveland Clinic Foundation;
radiologist Richard White, M.D., head of the section of
cardiovascular imaging at the Cleveland Clinic Foundation;
cardiologist Gilbert Raff, M.D., director of CT and MRI
research at William Beaumont Hospital, Royal Oak,
Michigan; and medical physicist Cynthia McCollough,
Ph.D., director of the CT Clinical Innovation Center at Mayo
Clinic, Rochester, Minnesota.
SOMATOM Sessions 17
Coronary CTA
examination with
83 ms temporal
resolution of
a patient with
varying heart
rate of 85-93 bpm
during the scan.
COVER STORY
CYNTHIA MCCOLLOUGH,
Ph.D., medical physicist,
director of the CT Clinical
Innovation Center, Mayo
Clinic, Rochester, Minnesota
SOMATOM Sessions 17
COVER STORY
Four CT experts from the US gathered in Cleveland to envision the future of imaging, and how it will change with the
introduction of dual source CT.
SOMATOM Sessions 17
COVER STORY
Cardiac Imaging
Dual source CT meets all of these challenges. Consider cardiac
imaging: Each of the two source/detector systems must travel
only 90 degrees to acquire image data, resulting in a doubling
of temporal resolution. It provides a temporal resolution of 83
ms a factor of two better than the 165-ms temporal
resolution of the best single source CT scanners. Together with
a spatial resolution of less than 0.4 mm, it enables SOMATOM
Definition to visualize the smallest anatomical structures with
exceptional quality without the compromises associated with
beta blockers and ECG-gated, multisegment reconstruction.
SOMATOM SESSIONS: How will dual source CT solve some of
the challenges you continue to face in cardiac imaging?
DR. RAFF: Even in patients that we consider ideal today, there
is always cardiac motion and subtle amounts of blurring at the
level of the stenosis. The only way were going to push coronary
CTA to achieve the quality we need to make key clinical
decisions is with higher temporal resolution.
DR. WHITE: Any opportunity to capture that coronary artery
as its flying by is a major gain. With 83-ms temporal resolution,
independent of the heart rate, youre also getting away from
the need for segmented reconstruction approaches.
SOMATOM SESSIONS: Lets talk about multisegment
reconstruction. Its said to improve temporal resolution and
overcome problems associated with a high heart rate. Are the
images of consistently high quality?
DR. WHITE: Multisegmental
reconstruction is not a panacea, and
quite often its detrimental rather than
beneficial. Youre averaging data from
multiple cardiac cycles, and thats not
the most desirable approach.
Multisegment reconstruction should
not be relied upon as the answer to
temporal resolution.
DR. MCCOLLOUGH: If you average
two cardiac cycles and the heart
doesnt come back to exactly the same
spot on a submillimeter level, youve
just blurred out that 1- or 2-mm artery
youre trying to see.
SOMATOM SESSIONS: High temporal
resolution eliminates the need to give
beta blockers. We have discussed the
operational benefits, but is there also
a clinical benefit?
SOMATOM Sessions 17
COVER STORY
Radiation Dose
SOMATOM Definition delivers the lowest possible radiation
exposure in cardiac CT imaging today, despite using two
X-ray sources instead of one. How? Dual source CT images
the heart twice as fast; therefore, Adaptive ECG-pulsingTM
delivers the dose necessary for cardiac imaging in less than
half the time as the most dose-efficient single source CT
scanner. In addition, dual source CT easily acquires images
even at the highest
heart rates, thus allowing for scanning at higher table speed.
Higher table speed results in lower radiation exposure
compared to single-source CT.
SOMATOM SESSIONS: Is dose exposure a big issue in
cardiac CT?
DR. RAFF: Yes, its a concern. When the dose gets to be
higher than for a coronar y angiogram, theres a
psychological barrier, and everyone from patients to
government regulators become reluctant.
DR. MCCOLLOUGH: Radiation dose becomes a very hotbutton topic because people dont understand it. If someone
comes to the emergency room and its clearly important to
evaluate them with CT, then the dose risk is negligible in
comparison to the medical necessity of the exam. But in
those patients that come for rule-out examinations,
minimizing radiation exposure is very important. Reducing
the dose in cardiac CT by a factor of two will be an important
prerequisite for further establishing the technique in clinical
practice.
DR. RAFF: Im concerned about the patient who has CT after
equivocal results on a stress test. Theyve had a nuclear
procedure with radiation, a CT scan with radiation, and they
may go on to cardiac catheterization, with more radiation.
Anything we can do along that pathway to minimize
radiation exposure is critically important.
SOMATOM SESSIONS: Does radiation dose resonate with
your patients? Could you draw patients to your center by
emphasizing that dual source CT offers excellent image
quality at half the dose?
DR. MODIC: Absolutely.
DR. WHITE: Why not put it out there as a mandate? We
should tell patients: This is one of our core values, to reduce
dose without sacrificing image quality. Lowering dose is the
right thing to do for multiple reasons.
Acute Care
A combination of the highest temporal resolution and the
highest power available in the industry enables dual source
CT to easily image critical and challenging acute care
patients. This includes not only patients who are short of
breath or have a high heart rate, but also obese patients.
SOMATOM Sessions 17
COVER STORY
SOMATOM Sessions 17
COVER STORY
Financial Justification
10
SOMATOM Sessions 17
COVER STORY
Evolution or Revolution?
SOMATOM SESSIONS: Many of the advances in CT over the
last several years have been evolutionary. The increasing
number of slices with each new scanner is the most obvious
example. Is dual source CT another evolutionary change, or
is it revolutionary?
DR. MCCOLLOUGH: This scanner jumps off the curve,
because its not about the slices, its about rotation time.
We went from a half-second to 0.42 seconds to 0.37 seconds
to 0.33 seconds, and the gains were 0.08 and 0.05 and 0.04
seconds. Now we jump off a curve thats reaching its upper
limit and virtually cut rotation time in half, thats a big deal.
DR. WHITE: I think its both. You can count on it being
evolutionary on day one as we learn how to use it. But then,
the prospects for this technology to set a whole new
direction are amazing, and it will sustain that for quite some
time.
DR. RAFF: We have to consider the potential impact on
cardiology, and, through it, on medicine in general and the
healthcare system. Better coronary imaging at this level is
going to revolutionize the treatment of coronary disease,
and coronary disease is the most common serious health
problem in the developed world.
Author: Catherine Carrington is a medical editor in Vallejo,
California.
SOMATOM Sessions 17
11
COVER STORY
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SOMATOM Sessions 17
COVER STORY
X-ray unit 1
Rotation of
X-ray unit
and detector
X-ray unit 2
Gantry
Patient table
Detector 1
Dual Source
CT Imaging
The Idea behind
the Technology
With the introduction of the Dual
Source CT technology at this years RSNA,
Siemens once again demonstrates its
leadership in technology and clinical
applications, moving beyond the simple
adding of more detector rows a race
that had dominated CT technology for
the past couple of years.
Detector 2
SOMATOM Sessions 17
13
COVER STORY
Advantages at a Glance
SOMATOM Definitions heart rate independent resolution
is 83 milliseconds, permitting scans of virtually every heart
and any heart rate from acute chest pain evaluation to
coronary visualization to functional analysis of the heart.
Together with the high spatial resolution of below 0.4 mm, it
makes the visualization of the smallest anatomical structures
possible with exceptional quality.
In combination with a 78-cm large gantry bore and field of
view, 200-cm scan range, and its high generator power, the
system allows most accurate scans or acute patients,
independent of size or condition. And all this at the lowest
possible dose. Additionally, SOMATOM Definition offers the
widest range of clinical applications, allowing fast and most
confident diagnoses to comprehensive reporting in only a
matter of minutes. Intuitive and computer-assisted reading
tools also assist physicians in early detection, fast evaluation,
and precise follow up of malignant diseases, sometimes even
enabling them to review results before the patient is off the
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SOMATOM Sessions 17
Cardiac Imaging
Optimal cardiac imaging can be best achieved in the diastolic
phase of the heartbeat. The faster the heart rate, the shorter
this phase becomes. With a single source CT scanner, the
X-ray source/detector system has to obtain data projections of
180 degrees to take an image within the diastolic phase. With
Dual Source CT, each of the two source/detector combinations
needs to travel only 90 degrees to acquire an exceptional
cardiac image. Based on 0.33 s rotation time, this concept
provides an unprecedented temporal resolution of 83 ms,
independent of the heart rate.
COVER STORY
At higher or varying
heart rates, the diastolic
phase is too short
for a single source CT
scanner, resulting in
poor image quality.
Dual Source CT, on the
other hand, delivers
sharp and detailed
cardiac images in a
short diastolic phase
and even in the systolic
phase.
SOMATOM Sessions 17
15
COVER STORY
Heartbeat-controlled
dose modulation
60 bpm single source CT
To overcome insufficient
temporal resolution at
high heart rates, single
source CT scanners use
multisegment reconstruction with high dose
and limited reliability.
Dual Source CT, on the
other hand, maintains
the lowest dose, independent of the heart rate.
Heartbeat-controlled
dose modulation
100 bpm single source CT
Dose Reduction
At the same time, SOMATOM Definition offers the lowest
possible radiation exposure in cardiac CT. Thanks to Dual
Source CT, the CT gantry needs to travel only 90 degrees to
acquire an exceptional cardiac image with unprecedented
temporal resolution of 83 ms, independent of the heart
rate. Monitoring the ECG in real-time, Siemens Adaptive
ECG-pulsing instantly reacts to any changes of the heart
rate. Now that cardiac acquisition is twice as fast, the time
of high exposure during the heart beat, controlled by dose
modulation, can be cut by more than half compared to
single source CT scanners.
Instead of using multisegment reconstruction at higher
heart rates, Dual Source CTs highest temporal resolution
allows to acquire cardiac images from single heartbeats, at
any heart rate. Using automated table speed adaptation,
SOMATOM Definition increases the pitch with higher heart
rates, resulting in a faster table speed and a corresponding
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SOMATOM Sessions 17
Obese Patients
Scanning obese patients with single source CT usually results in
a trade-off between speed and image quality. Dual Source CT
overcomes this limitation of restricted power reserves with a
second X-ray source. In other words, it accumulates the power
of the two independent sources, resulting in unprecedented
160 kW, providing sufficient X-ray power reserves for high quality
imaging of patients whether tall or small, thin or large at
maximum volume coverage speed and fastest rotation time.
And, because scan speeds can be increased, the higher power
is used to improve quality, while dose maintains the same as in
single source CT. And the large bore of SOMATOM Definition
makes patient positioning much easier.
COVER STORY
Scan speed
Quality
Power
Dose
Scan speed
Quality
Power
Dose
SOMATOM Sessions 17
17
COVER STORY
Object
80 kV
Attenuation B
140 kV
Attenuation A
Tissue Differentiation
It has always been an aim to collect as much information
as possible for differentiation of tissues. Dual Source CT
assists in opening the door beyond visualization, moving
into a new world of characterization. Permitting the use of
two sources simultaneously at different energies, SOMATOM
Definition makes it possible to acquire two data sets
simultaneously from a single scan, running the tubes at two
different kV levels. The result are two data sets with diverse
information, which can allow the user to differentiate,
characterize, isolate, and distinguish the imaged tissue and
material obtaining specific details about the scanned
object beyond morphology.
Spectacular research topics lie ahead, waiting to be explored,
as dual energy helps pave the way for a broad spectrum of
potential clinical uses. Possible application fields are: direct
subtraction of either vessels or bone during scanning,
classification of tumors in oncology, characterization of
plaques in vessels and the differentiation of body fluids in
emergency diagnostics.
18
SOMATOM Sessions 17
Energy 2:
Energy 1:
Bone 670 HU
80 kV
Iodine
296 HU
Bone 450 HU
Iodine
144 HU
140 kV
NEWS
C T CLINIC AL ENGINES
Full Confidence
in Neuro CT
The CT Neuro Engine delivers the technology required to perform artifact-free
imaging with the high spatial and temsyngo Circulation as a
key component of the CT
Cardiac Engine offers
physicians the industrys
most comprehensive
software for cardiac CT,
setting a new benchmark
for improving clinical
outcomes through innovative software solutions.
SOMATOM Sessions 17
19
NEWS
poral resolution needed for fast and accurate visualization of complex neurological disorders of head, neck, and spine,
as well as injuries and stroke. Siemens
unique portfolio of syngo automated
software tools for neuro CT will help to
deliver excellent diagnostic outcomes
with bone subtraction in neuro CT DSA
studies for comprehensive evaluation of
complex vascular structures, with fast
brain perfusion for stroke patients and
differentiation of brain tumors.
Faster Diagnosis
in Acute Care
The Siemens CT Acute Care Engine
offers the complete solution for emergency and trauma imaging with CT. In
acute care, the requirements for CT
imaging are very challenging and
diverse from acute chest pain and
complex polytrauma to stroke assessThe CT Acute Care
Engine offers a fast onestop diagnostic confidence in all emergency
room situations.
20
SOMATOM Sessions 17
Siemens CT Division not only takes care of the outer appearance of their existing
SOMATOM Emotion and SOMATOM Sensation product lines they also introduce
CT Clinical Engines that offer users the ultimate CT solution in key clinical areas.
From Staging to
Follow-up in Oncology
CT Imaging
Siemens CT Oncology Engine offers a
unique combination of the most innovative scanner and syngo solutions for
diagnostic imaging, evaluation, and follow-up in any diagnostic oncology setting. syngos intuitive computer-assisted
reading tools, combined with intelligent
evaluation, automated follow-up, and
image guided intervention offer a new
level of confidence for preventive care,
staging, follow-up exams, and realtimeguided biopsies. Additionally, comprehensive tumor perfusion enables a fast
and easy visualization of tumor enhancement and aids in differentiating tumors. Fusing images from PET or SPECT
with high resolution CT images helps
not only to better localize tumors, but
also therapy planning. Siemens soltions
for interventional CT extend the clinical
spectrum towards differential diagnosis
and treatment.
These first generation CT Clinical Engines
offer Siemens users something very special: a totally unique combination of CT
technology and syngo, delivering a clinically optimized workflow, designed for
speed and diagnostic confidence for
every patient, every time. And this is only the beginning: with a keen eye on the
future, Siemens will continue to set new
trends for the next generation of clinical
CT solutions
NEWS
Life
syngo InSpace4D
Formerly: LEONARDO
k www.insideinspace.com
SOMATOM Sessions 17
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NEWS
S O M AT O M S e n s a t i o n
Proven Leadership
C AR E Cont rast C T
22
SOMATOM Sessions 17
NEWS
syngo 2006A
Enhanced Workflow
syngo 2006A, Siemens newest workflow software, will be delivered on new
syngo MultiModality workplaces1 by the
end of January 2006. Continuing the
Think Clinical theme, it gives users access to new features and functionalities
designed to enhance workflow and diagnostic confidence.
ond reader tool for the automated detection of colon lesions. Together with
syngo LungCARE CT with NEV (Nodule
Enhanced Viewing), Siemens offers its
users an exceptional level of confidence
for early detection and follow-up exams
of the colon and lung.
Another new addition to the oncology
portfolio, syngo Body Perfusion CT, enables the user to obtain an accurate picture of a tumors dynamic profile, helping to optimize treatment decisions. On
top of the new clinical functionalities,
syngo 2006A provides the user with significant improvements of workflow performance. DICOM transfer of up to 21
images per second can be achieved, as
well as loading capacity of up to 3,200
images.
Formerly: LEONARDO
SOMATOM Sessions 17
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BUSINESS
S I E M E N S R E M OTE S E RVI C E
usage of various data media and internet connections. As long as our customers did not optimize their workflow
through network connectivity, there
was no need for such services, says
Wolfgang Heimsch, PhD, head of
Siemens Medical Solutions Customer
Service Division. Now healthcare providers are increasingly using networked
systems, so the market needs a suitable
virus protection solution.
* depending on software configuration
S O M AT O M S p i r i t
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SOMATOM Sessions 17
BUSINESS
Interview
S O M AT O M E m o t i o n
Johann-C. Steffens,
MD: The SOMATOM
Emotion 16 enables
us to achieve low
image noise and high
resolution.
SOMATOM Sessions 17
25
BUSINESS
CARDIAC C T
Reimbursement in the US
New Current Procedural Terminology Category III codes
for Cardiac CT released by AMA to become effective January 1, 2006
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SOMATOM Sessions 17
k www.ama-assn.org/ama/pub/
category/12850.html
NEWSBUSINESS
SECTION
REVENUE
A Giant Leap
Hospital Moinhos de Vento, Porto Alegre,
Brazil, took one giant leap forward when
it replaced two single-slice scanners with
one SOMATOM Sensation Cardiac 16 in
2004. When comparing the database of a
six-month period prior to the installation
to a six-month period after the installation, they realized that the average time
for scheduling an examination was reduced from 26 to 11 minutes; that the
number of examination increased by
52 percent; that the average contrast volume was reduced by 25 percent; and that
the number of examinations with patient
Step by Step
Of course, one expects such savings from
a major upgrade step even if one new
scanner replaces two old ones. But it also
pays off to be among the early adopters
of new CT technology. The Chairman of
the Radiology Department at a huge US
hospital compared core data from several
systems, starting with the SOMATOM Plus
4, the SOMATOM Volume Zoom and the
SOMATOM Sensation 16, up to the SOMATOM Sensation 64. One basic result:
Acquisition and reconstruction times decreased dramatically over the years, enabling higher patient throughput. The
clinic has increased its patient volume
from less than 20 patients per day with
the SOMATOM Plus 4 to well over 60
Time (Minutes)
Acquisition
Patient Transit
Recon
Plus4
Volume Zoom
Sensation 16
Sensation 64
while enabling on demand examinations instead of the long waiting lists common with the older systems. In spite of
higher staffing required to run the
SOMATOM Sensation 64, the expenses,
as a percentage of the revenue, trend
down. This is due to higher patient volume, and also to a different staffing skill
mix. Today, more aides are hired for tasks
that do not require the expertise of a technologist to ensure the same patient transit time and patient care. With this combination of measures, the clinic has been
able to continuously reduce expenses;
from more than 60 US$ per exam to 45,
despite rising market prices for the scanners. As a result, expenses as a percentage of net revenue have decreased from
over 16 to only 9 percent. In summary, increased coverage, speed, resolution, applications, indications and availability not
only increase patient care: When it comes
down to finances, these improvements
also decrease spending. A detailed presentation, now available on CD, was held
by the clinic's radiology chairman at the
7th
SOMATOM CT User Conference
2005 (see page 49).
Results may vary. Data on File.
Expense Trends
Percent
18
16
14
12
10
8
6
4
2
0
Plus4
Volume Zoom
Sensation 16
Sensation 64
SOMATOM Sessions 17
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CLINICAL OUTCOMES
Cardiovascular
Oncology
Neuro
Acute Care
Case 1:
CT Angiography of Chest, Abdomen, Pelvis and
Upper Extremities with CARE Dose4D and z-Sharp
By Dominik Fleischmann, MD, Jeffrey C. Hellinger, MD, and Geoffrey D. Rubin, MD, Department of Radiology,
Cardiovascular Imaging Section, Stanford University Medical Center, Stanford, CA, USA
HISTORY
A 34-year-old woman with right arm numbness was referred
for CTA of the upper extremities as well as the chest,
abdomen and pelvis. The patient's past medical history was
significant for a right brachial artery aneurysm presumably
caused by vasculitis which had been treated with a
reversed vein graft and secondary interventions over the
past 10 years. The patient also had a history of bilateral iliac
artery aneurysms.
50
100
150
200
250
300
73
0
50
245
100
150
200
93
250
300
350
400
450
500
160
106
longitudinal distance in mm
550
600
252
650
700
750
800
Image Noise
(HU)
Dose Modulation
(eff. mAs)
158
[ 1 ] Consistently excellent image quality throughout the entire scanning range in vascular territories
within the body and in the upper extremities off-center at an average of 180 effective mAs
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SOMATOM Sessions 17
NEWS
SECTION
CLINICAL
OUTCOMES
DIAGNOSIS
Incidentally noted is a left vertebral artery origin directly off
the aortic arch. Otherwise, the supraaortic vessels are within
normal limits. The right subclavian and axilary arteries are
patent. Multiple focal areas of mild dilatation (11 to 14 mm in
diameter) are seen within the right brachial artery reversed
vein graft. The graft is patent with mild stenosis distally. The
radial, ulnar, and interossea arteries are patent.
A high-grade stenosis of the celiac artery origin, due to
median arcuate ligament impingement, is noted. The thoraco-abdominal aorta and its visceral branches are otherwise
unremarkable. A 15 mm right common iliac artery aneurysm
and a small, 11 mm left internal iliac artery aneurysm are
seen in the pelvis.
COMMENTS
The patient was positioned in supine position with her arms
placed at the sides of her body, to enable coverage of the
entire chest-abdomen-pelvis and upper extremities vessel territories within a single CTA acquisition, and with a single injection of contrast medium. Although such positioning may
cause streak artifacts in the shoulder region and excessive
noise within the upper extremities, the use of automated tube
current modulation (CARE Dose4DTM) and high spatial resolution using z-Sharp Technology resulted in virtually artifact-free
visualization of all clinically relevant vessels at unprecedented
image quality.
EXAMINATION PROTOCOL
Scanner
SOMATOM Sensation
64-slice configuration
Scan area
Scan length
77.5 mm
Scan time
29 s
Scan direction
cranio-caudal
kV
120 kV
Effective mAs
Rotation time
0.5 s
Slice collimation
0.6 mm
Slice width
1 mm
Pitch
0.7
Reconstruction increment
0.7 mm
CTDI
13.41 mGy
Kernel
B25f
Contrast
Volume
Start delay
5s
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CLINICAL OUTCOMES
Cardiovascular
Oncology
Neuro
Acute Care
Case 2:
Peripheral Runoff
By Jean-Bernard DHarcour, MD, Cliniques du Sud-Luxembourg,
site St. Joseph, Arlon, Belgium
HISTORY
COMMENTS
DIAGNOSIS
CTA shows severe aorto iliac athromatosis and complete
occlusion of the left iliac axis. Left aorto femoral bypass is
patent. On the left side, a short occlusion of the distal superficial femoral artery (SFA) is disclosed. On the right side,
there is no significant stenosis of the iliac axis but a long
occlusion of the SFA is shown. On both sides, peripheral
arteries are patent.
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SOMATOM Sessions 17
CLINICAL OUTCOMES
EXAMINATION PROTOCOL
Scanner
SOMATOM Emotion
16-slice configuration
Reconstruction increment
1 mm
Kernel
B20s smooth
Scan area
Scan length
1560 mm
Scan time
25 s
Contrast
Scan direction
Cranio-caudal
Volume
kV
110 kV
Effective mAs
Rotation time
0.6 s
Start delay
5s
Slice collimation
16 x 1.2 mm
Slice width
1.5 mm
Pitch
1.5
Postprocessing
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CLINICAL OUTCOMES
Cardiovascular
Oncology
Neuro
Acute Care
Case 3:
Optimizing Clinical Workflow in CT Colonography
Using syngo Colonography PEV
By Anno Graser, MD, and Christoph R. Becker, MD, Department of Clinical Radiology,
University Hospital Munich-Grosshadern, Munich, Germany
At our center, the demand for colorectal cancer screening is
growing and the number of CT colonography (CTC) examinations is increasing rapidly. We are constantly looking for
tools that help us to improve speed and enhance confidence
and offer our patients the highest possible level of care. A
study performed at our institution to be presented at this
years Radiologic Society of North America (RSNA) annual
meeting (Session SSG 10-07, Tuesday, November 29) shows
that PEV reaches 94% sensitivity in the detection of polyps in
the important 5-9 mm size range. In addition, the study
shows that PEV can be integrated into clinical routine due to
its short running time of 4 minutes per dataset. With PEV
running in the background, syngo Colonography PEVs performance remains unrivalled, delivering excellent performance in everyday clinical routine increasing reader confidence and shortening evaluation time.
The case presented here shows how PEV improves human
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CLINICAL OUTCOMES
Case 4:
Improved Workflow for Detection
of Pulmonary Nodules
By Marco Das, MD, Andreas Horst Mahnken, MD, Georg Mhlenbruch, MD, Joachim Ernst Wildberger, MD,
Department of Diagnostic Radiology, Rolf. W Gnther, MD, Director, Department of Diagnostic Radiology, and
Thomas Kraus, MD, Department of Occupational Health, RWTH Aachen University, Aachen, Germany
ENHANCED CONFIDENCE
syngo LungCare CT with NEV facilitates the detection workflow and provides easy objective quantification and reporting
of pulmonary nodules. Fig. 1 shows a routine low-dose chest
MDCT examination of a 66-year-old male patient (120 kV, 10
mAs eff., 16 x 0.75 mm collimation, rotation time 0.5 sec,
table feed/rotation 18 mm, 1 mm slice thickness, 0.5 mm
reconstruction). With initial standard reading using Maximum-Intensity-Projection (MIP technique; 5 mm thick section), a pulmonary nodule was not detected, probably
because of its central location closely surrounded by large
vessels. During initial standard reading, the NEV algorithm
runs in the background and marks potential lesion candidates
for reviewing after the initial read. The nodule was detected
and marked by the software automatically [Fig. 2] and was
confirmed by the reading radiologist. With one additional
mouse-click, quantification of the nodule was performed
[Fig. 3]. After final reporting, the patient underwent CT-guided, fine-needle aspiration biopsy and small-cell lung cancer
was finally diagnosed during cytopathological work-up.
SOMATOM Sessions 17
33
CLINICAL OUTCOMES
Cardiovascular
Oncology
Neuro
Acute Care
Case 5:
Respiratory Gated CT-Imaging
in Radiation Therapy of Lung Cancer
By J. Dinkel, MD, A. Jensen, MD, U. Mende, MD, PhD, Department of Radiation Oncology, and J. Debus MD, PhD,
Director, Department of Radiation Oncology, University of Heidelberg, Germany
HISTORY
A 62-year-old female patient under chemotherapy treatment
for a non-small-cell lung cancer and cerebral metastases
was examined using the SOMATOM Sensation Open with a
4D respiratory gated data acquisition protocol in order to
determine the full range of motion of critical internal structures and the lung cancer during respiration. This method
was used to achieve a more targeted radiation treatment.
DIAGNOSIS
Respiratory gating supplies information about tumor motion
during the patient's breathing cycle. The introduction of the
latest generation multislice CT systems with short acquisition times permits the evaluation of thoracic structures with
a temporal resolution of 250 ms. Short acquisition times in
this set-up are achieved by simultaneous acquisition of 24 or
40 transverse sections, half-second scanner rotation, and
advanced respiratory-gated reconstruction algorithms. In
34
SOMATOM Sessions 17
CLINICAL OUTCOMES
3A
3B
[ 3A, 3B ] Two reconstructions corresponding to different phases of the breathing cycle demonstrate the
range of motion of critical internal structures and the lung cancer during respiration.
the x-axis (L-R), 6.2 mm in the y-axis (A-P) and 5.2 mm in the
z-axis. The mass, however, did not show a deformation during the breathing cycle. Visualization of structure motion is
possible with dedicated software syngo Inspace4D.
EXAMINATION PROTOCOL
Scanner
Scan area
Thorax
Scan length
300 mm
COMMENTS
Scan time
51.85 s
Breathing frequency
> 12 cycles/min.
kV
120 kV
Effective mAs
400 mAs
Rotation time
0.5 s
Slice collimation
1.2 mm
Slice width
1.5 mm
Pitch
0.1
Reconstruction increment
1 mm
CTDI
35.63 mGy
Kernel
B10f
Postprocessing
syngo Inspace4D
SOMATOM Sessions 17
35
CLINICAL OUTCOMES
Cardiovascular
Oncology
Neuro
Acute Care
Case 6:
Restaging Bronchial Carcinoma
after Radiotherapy Treatment
By Jan Capoen, MD, Radiologist, Jan Yperman Ziekenhuis, Ypres, Belgium
HISTORY
A 70-year-old female presented with increasing dyspnea and
general detoriation. She was known with an inoperable right
sided bronchial carcinoma, treated with radiotherapy. A CT
scan was performed in order to restage this carcinoma and
to look for any further complications or progression.
EXAMINATION PROTOCOL
Scanner
SOMATOM Spirit
Reconstruction increment
2.8 mm
Scan area
Thorax
CTDIvol.
5.42 mGY
Scan length
288.5 mm
DLP
169 mGY
Scan time
17 s
Kernel
B41s
Scan direction
Caudo-cranial
kV
130 kV
Effective mAs
Contrast
Iomeron 300
Rotation time
0.8 s
Volume
80 cc
Slice collimation
4.0 mm
Flow rate
2.6 cc/s
Slice width
5.0 mm
Start delay
25 s
Table feed/rotation
14.4 mm
Pitch
1.8
Postprocessing
MPR
36
SOMATOM Sessions 17
CLINICAL OUTCOMES
[ 4 ] Tumoral encasement of
the inferior pulmonic vein
SOMATOM Sessions 17
37
CLINICAL OUTCOMES
Cardiovascular
Oncology
Neuro
Acute Care
Case 7:
Making a Difference with PET and
CT in Complex Cases
The powerful functional imaging in Positron Emission Tomography (PET) became even more powerful with the addition of
anatomical data from CT. The diagnostic limitations of standalone PET and CT procedures are eliminated with combined
PET/CT imaging technology, which has become the gold
standard for tumor diagnosis and staging. Siemens Biograph
DIAGNOSIS
In addition to several pulmonary lesions and the NSCLC, the
PET/CT study, obtained on the Biograph 16 HI-REZ, identified
multiple bone lesions within the spine [Fig. 1, Fig. 2], two
38
SOMATOM Sessions 17
COMMENTS
PET has a major role in early detection, staging and treatment
planning of lung cancer and related metastases. FDG PET
influences patient management decisions, effecting treatment outcomes and quality of life. Adding co-registered,
detailed anatomical data acquired with a diagnostic CT scan
increases the diagnostic accuracy and provides the reading
and referring physician with the possibility to assess functional and structural changes in one exam.
Using hybrid PET/CT scanning was critical in diagnosing the
additional, unexpected bone metastases and lesions in the
thoracic wall. Some of these bone lesions would have been
difficult to detect using a stand-alone CT. However due to the
patients extreme case of scoliosis, an exact correlation of
stand-alone PET data to the corresponding vertebras was only
possible by using co-registered functional (PET) and anatomical (CT) information provided by the PET/CT hybrid imaging
scan. The HI-REZ PET imaging technology of the Biograph 16,
with its unmatched additional resolution, also played a significant role in accurately identifying the smaller lesions in the
thorax wall, allowing greater diagnostic confidence to the
interpreting physician.
CLINICAL OUTCOMES
EXAMINATION PROTOCOL
Scanner
Biograph 16
Slice width
5.0 mm
FDG
11mCi
Table feed/rotation
24 mm
Uptake time
62 min
Pitch
Beds
Reconstruction increment
5.0 mm
3 min
HI-REZ
yes
Scan area
Whole body
Scan direction
Cranial-caudal
Volume
Effective mAs
30 mAs
Rotation time
0.5 s
Dual phase
CT acquisition of the thorax and
(arterial and portal venous) upper abdomen
Slice collimation
1.5 mm
Contrast
90 cc
SOMATOM Sessions 17
39
CLINICAL OUTCOMES
Cardiovascular
Oncology
Neuro
Acute Care
Case 8:
Bone Subtraction CTA for Vascular Mapping
in Head and Neck Imaging
By Michael Lell, MD and Ulrich Baum, MD, Institute of Radiology, University Erlangen-Nuremberg; Ernst Klotz and
Hendrik Ditt, Physics and Application Development, Siemens AG, Medical Solutions, CT Division, Forchheim; all Germany
HISTORY
COMMENTS
To achieve good results, it is of great importance to carefully
instruct the patient not to move between the two scans. For
subtraction purposes, a low dose scan in addition to a regular contrast enhanced scan is sufficient to create threedimensional, volume-rendered images of the head and neck
vasculature, comparable to rotational angiography.
EXAMINATION PROTOCOL
Scanner
Scan area
C6 zygomatic arch
Scan length
150 mm
Scan time
3.4 s
Scan direction
Caudo-cranial
kV
Effective mAs
120 kV
50 mAs
Rotation time
Slice collimation
64 x 0.6 mm
Slice width
0.75 mm
Pitch
0.9
Reconstruction
increment
CTDI
140 mAs
0.33 s
0.5 mm
7.87 mGy
Kernel
21.88 mGy
H20
Contrast
DIAGNOSIS
CT did not show recurrent tumor or lymph node metastasis.
Chronic osteomyelitis of the mandible and a bone fistula
could be detected on the left side, with inflammatory soft
40
SOMATOM Sessions 17
Volume
50 cc
Flow rate
5.0 cc/s
Start delay
Postprocessing
CLINICAL OUTCOMES
1A
2A
1B
2B
1C
2C
SOMATOM Sessions 17
41
CLINICAL OUTCOMES
Cardiovascular
Oncology
Neuro
Acute Care
Case 9:
40-Slice CT for Diagnosis and Surgical
Planning in Traumatic Paraplegia
By Steffen Gnther, MD, and Markus F. Berger, MD, Institute of Diagnostic Radiology,
Swiss Paraplegic Center, Nottwil, Switzerland
HISTORY
A 22-year-old man was brought to our hospital by emergency
transport helicopter (REGA) with incomplete paraplegia sub
L2 (ASIA D) following a motorcycle accident. Prior to admission, the patient had been completely healthy. A vertebral
fracture was suspected and CT scanning of the lumbar spine
for diagnosis and surgical planning was performed. Following
initial posterior instrumentation, a follow-up examination
was performed to document the operative result and to
assess the need for additional anterior stabilisation.
DIAGNOSIS
CT scanning revealed a traumatic burst type vertebral body
fracture of L2 with loss of spinal stability. Bony compromise of
the spinal canal was present. An additional MR scan showed
traumatic injury to the conus medullaris, as the patient unfortunately also had a tethered cord.
Follow-up CT after initial treatment by posterior USS-titanium
stabilisation from L1 to L3 demonstrated an exellent opera-
42
SOMATOM Sessions 17
COMMENTS
By using 1.0 s rotation and z-Sharp Technology's flying focal
spot, the SOMATOM Sensation scanner with 40 slices allows
us to achieve both extended coverage and the highest resolution in one examination. Vertebral fractures can be
assessed from whole body datasets in multiple planes and
unprecedented detail. Due to the marked reduction of metal
artefacts, imaging of the postoperative spine has dramatically improved. We can now see what was completely invisible
before. The volume rendered images created with the syngo
InSpace4D application on the CT workstation are simply stunning.
CLINICAL OUTCOMES
EXAMINATION PROTOCOL
Scanner
Rotation time
1.0 s
1.0 s
Slice collimation
0.6 mm
0.6 mm
Scan area
Lumbar spine
Lumbar spine
Slice width
0.75 mm
0.75 mm
Scan length
250 mm
194 mm
Pitch
0.45
0.9
Scan time
46 s
18 s
Kernel
B25s
B25s
Scan direction
Caudal-cranial
Caudal-cranial
kV
120 kV
120 kV
Effective mAs
482 mAs
261 mAs
Postprocessing
InSpace4D
InSpace4D
SOMATOM Sessions 17
43
SCIENCE
Multislice CT Angiography
Head and Neck Imaging
By Michael Lell, MD, Institute of Radiology, University Erlangen-Nuremberg; Bernd F. Tomandl, MD, Department of
Neuroradiology, Klinikum Bremen; Axel Barth, Product Manager Applications, Siemens AG, Medical Solutions, CT Division,
Forchheim; Emeka Nkenke, MD, Department of Maxillofacial Surgery, University Erlangen-Nuremberg; all Germany
44
SOMATOM Sessions 17
Imaging Protocol
Prior to entering the CT suite, an 18-gauge intravenous
catheter is placed in the right antecubital vein, and all mobile
dentures are removed. The patient is placed in supine position with the head bedded in a headrest. A biphasic CT scan
is performed with a 16-slice or 64-slice spiral CT scanner
(SOMATOM Sensation 16 or 64). The arterial phase study is
used to create 3D angiographic images, the delayed phase
study for tumor staging. CARE Bolus can be applied to determine the individual start delay (TimeDelay) for the arterial
phase. Alternatively, the test-bolus method (10 ml contrast
media, 30 ml NaCl 0.9%) can be used: the test-bolus
sequence is then loaded in the Dynamic Evaluation application, and contrast enhancement curves of the arterial and
venous system can be analyzed in detail. Time-to-peak plus
2s is used as the delay between injection of the full contrast
bolus and the scan.
100 ml of a non-ionic contrast agent are injected with a power
injector at a rate of 4-5 ml/s followed by a saline flush of 3050 ml. The scan volume includes the inferior margin of the
bottom of C6 to the zygomatic arch and the skull base to the
thoracic inlet for the late phase scan. The scanner settings are
2
SCIENCE
Review of Images
Axial 0.75 mm slices of the arterial phase are reconstructed at
an increment of 0.5 mm with a field of view (FOV) of 180 mm
and a matrix of 512x512, applying a soft tissue kernel. This
data set is transferred to a CT-workstation for 3D volume rendering. A default setting for volume rendering (syngo 3D
platform) is used to limit postprocessing. The analysis of the
vessels is done interactively. In selected cases, thin slab-maximum intensity projections (thin-MIP) or multiplanar reformations (MPR) may be applied.
The late phase scan is used for tumor staging and is routinely
reconstructed in contiguous 3 mm axial slices and 3 mm
coronal slices (direct 3D reconstruction). In unclear cases, thin
slice reconstruction may be performed for MPR evaluation.
Results of MSCT-Angiography
In a recently published study [9], we compared the ability of
16-slice CTA and selective carotid DSA in the evaluation of the
ECA and side-branches. For the complete number of vessel
branches detected in each of the two different imaging
modalities, a statistically significant difference could not be
found for the two examiners (PCTA = 0.59, PDSA = 0.41). DSA
was able to show more vessel segments than CTA, especially
vessels within narrow bony canals (infraorbital or inferior
alveolar artery), but considering vessels suitable for reconstructive surgery, no statistically significant difference
between CTA and DSA was found. All CTA studies were diagnostic; no examination had to be repeated.
CT Examination Protocol
Discussion
For preoperative vascular mapping of head and neck region,
CTA is a less invasive and more cost effective alternative to
DSA. Tumor staging and vascular mapping can be performed
with a biphasic CT protocol within a single session. No additional contrast agent injections are necessary, and catheter
associated risks can be avoided completely. The information
provided by CTA seems to be sufficient for the planning of
microvascular reconstructions. In addition, three-dimensional image reconstruction uniquely demonstrates anatomical relationships between blood vessels, bones, and soft tissue. Osseous pathology can be assessed in detail, and virtual
preoperative planning as well as computer-aided selection
or preparation of transplant material becomes possible.
1 Ehrenfeld M, Riediger D, Wolburg H, Thron A. Angiographic visualization
and morphology of anastomosed vessels in microsurgical tissue transplantation. Fortschr Kiefer Gesichtschir 1987; 32: 7174
2 Fleischmann D. Present and future trends in multiple detector-row CT
applications: CT angiography. Eur Radiol 2002; 12 Suppl 2: S1115
3 Herzog C, Dogan S, Wimmer-Greinecker G, Balzer JO, Mack MG, Vogl TJ. Multidetector-row CT: cardiosurgery indications. Eur Radiol 2003; 13 Suppl 5: M8287
Arterial phase
Delayed phase
Scanner
SOMATOM
Sensation
16-slice
configuration
SOMATOM
Sensation
64-slice
configuration
SOMATOM
Sensation 16
16-slice
configuration
SOMATOM
Sensation 64
64-slice
configuration
kV
Effective
mAs
Rotation
time
Slice
acquisition
Recon. slice
thickness
Reconstruction interval
120
110
120
140
120
150
120
150
0.5 s
0.33 s
0.5 s
0.33 s
16 x 0.75 mm 64 x 0.6 mm
16 x 0.75 mm 64 x 0.6 mm
0.75 mm
0.75 mm
3 mm
3 mm
0.5 mm
0.5 mm
3 mm
3 mm
Contrast
Volume
100 cc
Flow rate
4 cc/s
Postprocessing:
100 cc
5 cc/s
4 Remy-Jardin M, Tillie-Leblond I, Szapiro D, et al. CT angiography of pulmonary embolism in patients with underlying respiratory disease: impact of
multislice CT on image quality and negative predictive value. Eur Radiol
2002; 12: 19711978
5 Wiesner W, Hauser A, Steinbrich W. Accuracy of multidetector row
computed tomography for the diagnosis of acute bowel ischemia in a nonselected study population. Eur Radiol 2004
6 Ropers D, Baum U, Pohle K, et al. Detection of coronary artery stenoses
with thin-slice multi-detector row spiral computed tomography and multiplanar reconstruction. Circulation 2003; 107: 664666
7 Catalano C, Napoli A, Fraioli F, Venditti F, Votta V, Passariello R. Multidetector-row CT angiography of the infrarenal aortic and lower extremities
arterial disease. Eur Radiol 2003; 13 Suppl 5: M8893
8 Lell M, Wildberger JE, Heuschmid M, et al. CT-angiography of the carotid
artery: First results with a novel 16-slice-spiral-CT scanner. Fortschr Rntgen
str 2002; 174: 11651169
9 Lell M, Tomandl BF, Anders K, Baum U, Nkenke E. Computed tomography
angiography versus digital subtraction angiography in vascular mapping for
planning of microsurgical reconstruction of the mandible. Eur Radiol 2005; 15:
15141520
SOMATOM Sessions 17
45
SCIENCE
SOMATOM Sensation
Increased Speed and Resolution Make a Difference
in Coronary Artery Imaging
By Stephan Achenbach, MD, Department of Internal Medicine II, University of Erlangen, Germany, President of the Society
of Cardiovascular CT (SCCT)
64-slice CT
Recently, 64 slice scanners have been introduced. What
advantages have they brought about? Clinically, the
improvements that can be attributed to the development of
64-slice scanners are very obvious. Increased gantry rotation
speed (now 330 ms) with higher temporal resolution makes
it easier to acquire images free of motion artifacts (even
though in most cases, lowering the heart rate is still
advised). The fact that data are acquired in 64 slices within
each rotation provides for coverage of the complete volume
of the heart in 912 seconds or less. This has proven to be a
tremendous clinical advantage breath holds of that duration are truly easy to perform for almost any patient, and the
amount of contrast agent needed can be decreased to less
than 60 ml. An especially important improvement is the fact
that the acquired data sets now provide practically isotropic
spatial resolution the ability to visualize small structures
[ Table 1 ]
Publication
Number of patients
Sensitivity
Leschka et al [5]
67
94%
97%
Leber et al [6]
JACC 2005
59
87%*
91%*
Raff et al [7]
JACC 2005
70
86%+/91%++
95%+/92%++
46
Per-segment analysis
++
SOMATOM Sessions 17
Per-artery analysis
Specificity
SCIENCE
2A
2B
Future Developments
What future developments would translate into clinical advantages for coronary imaging? Clearly, simply adding more slices
will not solve the remaining problems. The only advantage
would be a decreased overall scan time, which, however, is no
longer an obstacle of any significance. Further decreasing slice
collimation would require a parallel, disproportionate increase
in x-ray tube current and radiation exposure to avoid excessive
image noise. The most desirable improvement would therefore be an increase in true temporal resolution, as it is possible
with the new Dual Source CT technology. This will make image
quality even more stable and predictable and will potentially
obviate the need to use medication in order to lower the
patients heart rate in preparation for the scan. Cardiac CT
scans are even easier to perform. Potentially, higher temporal
resolution might even permit prospective triggering of X-ray
tube output (instead of retrospective gating of image reconstruction) and thus effectively lower radiation exposure.
2C
SOMATOM Sessions 17
47
NEWS SECTION
CUSTOMER
CARE
S O M AT O M U S E R S M E E T I N G B R A Z I L
Customer Event
Aiming at partnership and exchange of
information among magnetic resonance
(MR), computed tomography (CT) and
molecular imaging (MI) users at MERCOSUR (Argentina, Bolivia, Brazil, Chile,
Paraguay and Uruguay), Siemens Medical
Solutions organized the second regional
users meeting in Brazil. 170 Siemens
users, among them nuclear physicians,
calcified lesions and stents was outstanding. Cardiologists, who had never been
in touch with cardiac CT before, are
now convinced of the robustness of the
new technology. Participants from other
SOMATOM Sensation 64-slice sites highly
appreciated the teaching aspect and the
hands-on session on the new CT workstations featuring syngo Circulation.
k www.sth.org.hk/e/index.html
S O M AT O M U S E R S M E E T I N G I N D I A
48
SOMATOM Sessions 17
the Powai Lake. The event was attended by 110 radiologists and computed tomography (CT) technologists.
Recently, the interest in 64-slice CT in
India has increased dramatically and
more than ten Siemens 64-slice scanners have been installed in 2005.
International speakers were Konstantin Nikolaou, MD, University Hospital
Munich Grosshadern, Germany, and
a delegation from Siemens Medical
Solutions, CT Division, Germany. Invitees witnessed the power of SOMATOM
CUSTOMER
NEWS SECTION
CARE
L i f e : E D U C AT E
SERVICE
k www.siemens.com/SOMATOMEducate
k www.siemens.com/SOMATOMWorld
k www.ctisus.org
How can I save a list and/or print a copy of the scan protocols on the system?
On systems running VA70/VB10 software versions, this can be
accomplished by going to System->Run->List Scan Protocols.
Here you can save the list of the protocols (which includes site
specific protocols as well as Siemens default scan protocols)
onto a floppy disk. Insert floppy into A: drive, and then go to
File->Save As, and make sure the 3 _ floppy (A:) drive is selected at the dropdown in Save In field. Click Save to put a copy of
this protocol list to the floppy. Wait until the drive has stopped
activity to remove floppy. You can also print using Print at the
top of the platform if you have a network printer connected to
system. On systems starting with VA47/VA70, it is necessary to
press the <Ctrl> key and the <N> key together to get a second
window that has the command dropdowns at the top of it,
then accomplish the tasks above. In syngo CT 2006 A/G, this
function is in the Main Menu of the Scan Protocol Manager
(Options->Configuration) under View List. Close the List and
the Scan Protocol Manager, and open the File Browser
(Options->File Browser). You will find the html-file in the folder
H:\SiteData\offline.
SOMATOM Sessions 17
49
CUSTOMER CARE
C T ONLINE
k www.siemens.com/medicalnews
Siemens Computed Tomography (CT) Division has expanded
its customer information service, and started the Siemens
Medical CT Newsletter. The regular e-newsletter includes a
highlight article either on a business, clinical outcomes, science or customer care topic, as well as the latest information
on upcoming Siemens CT courses, answers to frequently
asked questions plus a section with tricks and tips on how to
efficiently use Siemens CT scanners and applications in
daily clinical practice. Customers can either subscribe via the
above link, or with the postcard attached to the back cover
of this issue of SOMATOM Sessions.
Location
Description
Date
Contact
4th International
Multislice CT
Symposium
GarmischPartenkirchen,
Germany
Jan.1821, 2006
www.ct2006.org
Arab Health
Dubai, UAE
www.arabhealthonline.com
22nd Annual
Computed Body
Tomography 2006:
The Cutting Edge
Orlando, USA
CME Course
Feb.1619, 2006
www.ctisus.com
ECR
Vienna, Austria
Congress
www.ecr.org
ACC
Atlanta, USA
www.acc.org
Scientific talks
and lectures
www.ryalsmeet.com/
Advanced Topics
in CT Scanning
www.ctisus.com
Advanced Topics
in CT Scanning
Baltimore, USA
ITEM
Yokohama, Japan
Trade fair
www.j-rc.org
Mannheim,
Germany
72. Jahrestagung
www.dgk.org
Deutscher
Rntgenkongress
Berlin, Germany
www.drg.de
Stanford Symposium
radiologycme.stanford.edu
Society of Cardiovascular CT
Washington, DC, USA 1st Annual Scientific Meeting in cooperation with the 7th International Conference on Cardiac CT
www.scct.org
Advanced Topics
in Multidetector
CT Scanning
Cruise to the
Mediterranean
www.ctisus.com
CME Course
In addition, you can always find the latest CT courses offered by Siemens Medical Solutions at www.siemens.com/SOMATOMEducate.
50
SOMATOM Sessions 17
CUSTOMER CARE
M. Das, MD,
Department of Diagnostic Radiology,
RWTH University Aachen, Germany
G. Mhlenbruch, MD,
Department of Diagnostic Radiology,
RWTH University Aachen, Germany
E. Nkenke, MD,
Department of Maxillofacial Surgery,
University Erlangen, Germany
B. F. Tomandl, MD,
Department of Neuroradiology,
Klinikum Bremen, Germany
J. Dinkel, MD,
Department of Radiation Oncology,
University of Heidelberg, Germany
J. E. Wildberger, MD,
Department of Diagnostic Radiology,
RWTH University Aachen, Germany
A. Graser, MD,
Department of Clinical Radiology,
University Hospital Grosshadern,
Munich, Germany
R. W. Gnther, MD,
Department of Diagnostic Radiology,
RWTH University Aachen, Germany
A. Jensen, MD,
Department of Radiation Oncology,
University of Heidelberg, Germany
T. Kraus, MD
Department of Occupational Health,
RWTH University Aachen, Germany
M. Lell, MD,
Institute of Radiology,
University Erlangen, Germany
A. H. Mahnken, MD,
Department of Diagnostic Radiology,
RWTH University Aachen, Germany
U. Mende, MD, PhD,
Department of Radiation Oncology,
University of Heidelberg, Germany
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 CT System. The sources for the technical
data are the corresponding data sheets. Results may vary.
Partial reproduction in printed form of individual contributions is permitted,
provided the customary bibliographical data such as author's name and title
of the contribution as well as year, issue number and pages of SOMATOM
Sessions are named, but the editors request that two copies be sent to
them. The written consent of the authors and publisher is required for the
complete reprinting of an article.
We welcome your questions and comments about the editorial content of
SOMATOM Sessions. Manuscripts as well as suggestions, proposals and
information are always welcome; they are carefully examined and submitted to the editorial board for attention. SOMATOM Sessions is not responsible for loss, damage, or any other injury to unsolicited manuscripts or other
materials. We reserve the right to edit for clarity, accuracy, and space.
Include your name, address, and phone number and send to the editors,
address above.
Title page: Image Courtesy of University of Erlangen
SOMATOM Sessions 17
51
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No 17/December 2005
RSNA-Edition
Nov. 27th
Dec. 2nd, 2005
www.siemens.com/medical
SOMATOM
Sessions
COVER STORY
Dual Source CT Imaging
A New Era in Computed
Tomography
Page 4
NEWS
CT Clinical Engines Speed
and Confidence.
Page 19
BUINESS
SOMATOM Emotion Excellent Price-Performance Ratio
Page 25
Revenue Investment
Pays Off
Page 27
CLINICAL OUTCOMES
Oncology Respiratory Gating
Page 34
Acute Care Diagnosis and
Surgical Planning in Traumatic
Paraplegia
Page 42
SCIENCE
Increased Speed and Resolution Make a Difference in
Coronary Artery Imaging
Page 46
CUSTOMER CARE
EDUCATE
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Page 49
17
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SOMATOM
Sessions
D-91294 Forchheim
Germany
Siemens AG
Medical Solutions
Computed Tomography Division
Marketing/Customer Care
P.O. Box 1266
SOMATOM Sessions
Issue No.17/Dez. 2005
Siemens AG
Wittelsbacher Platz 2
D-80333 Munich
Germany
Headquarters
Siemens AG, Medical Solutions
Henkestr. 127, D-91052 Erlangen
Germany
Telephone: +49 9131 84-0
www.siemens.com/medical
Contact Address
Siemens AG, Medical Solutions
Computed Tomography
Siemensstr. 1, D-91301 Forchheim
Germany
Telephone: +49 9191 18-0