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Siemens EMOTION 16-Jun User's Manual

1. 318 Pelvis Emotion 16 kV Effective mAs Quality ref mAs Rotation Time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTD yoy Effective dose Emotion 6 kV Effective mAs Quality ref mAs Rotation Time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTD yoy Effective dose Pelvis 130 120 1 0 sec 16x 1 2mm 1 2 mm 5 0 mm 28 8 mm 1 50 5 0 mm B41s 13 44 mGy Male 5 32 mSv Female 9 14 mSv Pelvis 130 120 1 0 sec 6x 2 0mm 2 0mm 5 0 mm 18 0 mm 1 50 5 0 mm B41s 13 08 mGy Male 5 13 mSv Female 8 76 mSv 319 Pelvis Contrast medium IV injection Start delay 50 sec Flow rate 2 0 3 0 m sec Total amount 100 120 ml If the examination performed requires a full urinary bladder wait at least 3 minutes following IV adminis tration of the contrast medium 320 321 Pelvis PelvisVol Indications Spiral mode for pelvis studies e g processes of the prostate urinary bladder rectum gynecological indi cations etc Two recon jobs are predefined for reconstruction the first for axial the second for coronal studies in 3D images display view For SOMATOM Emotion 16 slice configuration A typical range of 20 cm will be covered in 8 94 sec For SOMATOM Emotion 6 slice configuration A typical range of 20 cm will be covered in 13 11 sec Emotion 16 kV
2. Lower Extremities Foot Indications Spiral mode for foot bone study e g trauma orthope dic indications etc For SOMATOM Emotion 16 slice configuration A range of 15 cm will be done in 21 53 sec For SOMATOM Emotion 6 slice configuration A range of 15 cm will be done in 31 41 sec 352 Lower Extremities Emotion 16 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTDlyoi Effective dose Emotion 6 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTDlyoi Effective dose Hints Foot 2 reconstr 130 60 1 0 sec 16x 0 6 mm 0 6 mm 3 0 mm 1 0 mm 7 7 mm 0 80 3 0 mm 0 7 mm U90s U90s 7 50 mGy Male 0 02 mSv Female 0 01 mSv Foot 2 reconstr 130 60 1 0 sec 6x1 0 mm 1 0 mm 3 0 mm 1 25 mm 5 1 mm 0 85 3 0 mm 0 8 mm U90s U90s 7 62 mGy Male 0 02 mSv Female 0 02 mSv e For image reconstruction of soft tissue use kernel B30s B31s 353 Lower Extremities ExtrRoutineHR Indications Spiral mode for high resolution bone study e g trauma orthopedic indications etc For SOMATOM Emotion 16 slice configuration A range of 10 cm will be done in 57 56 sec For SOMATOM Emotion 6 slice configuration A range of 10 cm will be done in 41 22 sec 354 Lower
3. A typical range of 15 cm covered in 16 71 sec 562 Children Emotion 16 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTD yoy Effective dose Emotion 6 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTD yoy Effective dose Spine 2 4 reconstr 110 60 1 0 sec 16 x 0 6mm 0 6 mm 2 0mm 1 0 mm 6 2 mm 0 65 2 0 mm B41s 4 80 mGy Male 1 28 mSv Female 1 43 mSv 0 7mm B60s SpineRoutine 2 4reconstr 110 78 1 0 sec 6x 2 0mm 2 0mm 3 0mm 2 5mm 10 2 mm 0 85 3 0 mm B41s 5 54 mGy Male 2 36 mSv Female 4 86 mSv 1 5mm B60s The conversion factor for a 7 year old child and a scan range of 160 mm was used 563 Children Hints e Children with a body weight of more than 55 kg should be examined with an adult protocol e To work without CARE Dose 4D use for children lt 25 kg 30 mAs 25 34 kg 55 mAs 35 54 kg 120 mAs 564 565 Children SpineThinSlice Indications Spiral mode for the spine when Multi Planar Reforma tion MPR are intended for example post traumatic changes tumors malformations etc For SOMATOM Emotion 6 slice configuration A typical range of 15 cm covered in 47 45 sec Emotion 6 kV Effective mAs Quality ref mAs Rotation time A
4. Example 20 Ex Patient has exhaled to 80 20 In Patient has inhaled to 20 493 Respiratory Gating Prospective respiratory triggering ver sus retrospective respiratory gating With prospective respiratory triggering the lung vol ume for example is covered in a step and shoot tech nique The patient s respiratory signal is used to start sequential scans at a predefined respiratory level of the patient s respiratory curve With retrospective res piratory gating the lung volume is covered continu ously by a spiral scan The patient s respiratory signal is recorded simultaneously to allow a retrospective selec tion of the respiratory level used for image reconstruc tion Prospective respiratory triggering has the benefit of smaller patient dose than respiratory gated spiral scanning since scan data is acquired at the previously selected respiratory level only It does not however provide continuous volume coverage with overlapping slices and misregistration of anatomical details may occur Furthermore reconstruction of images in differ ent levels of the respiratory cycle for functional evalu ation needs repeated CT examination of each of the desired respiration levels along the same volume in z direction using Prospective Triggering technique Since respiratory triggered sequential scanning depends on a reliable prediction of the patient s next Inspiration maximum and expiration minimum the method should not
5. Acquisition 6x 1 0mm Slice collimation 1 0mm Slice width 5 0mm 3 0mm 3 0mm Feed Rotation 5 1 mm Pitch Factor 0 85 Increment 5 0 mm 3 0mm 3 0mm Kernel H70s H30s H60s CTDlyo 9 63 mGy Effective dose Male 0 20 mSv Female 0 25 mSv Contrast medium IV injection Start delay 45 sec Flow rate 2 0 ml sec Total amount 75 ml Hint e For low dose studies use only 20 mAs 197 Head Orbit Indications Spiral mode for orbital studies e g fracture For SOMATOM Emotion 16 slice configuration A range of 50 mm will be covered in 8 51 sec For SOMATOM Emotion 6 slice configuration A range of 50 mm will be covered in 11 80 sec Emotion 16 kV Effective mAs Quality ref mAs Rotation Time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTDlyo Effective dose 198 Orbit 2 4 reconstr 130 70 1 0 sec 16x 0 6mm 0 6 mm 5 0mm 1 0 mm 7 7 mm 0 80 5 0 mm 0 7 mm H70s H70s 18 62 mGy Male 0 50 mSv Female 0 54 mSv Head Emotion 6 kV Effective mAs Quality ref mAs Rotation Time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTD yoy Effective dose Orbit 130 70 1 0 sec 6x7 0mm 1 0 mm 5 0 mm 5 1 mm 0 85 5 0 mm H70s 19 25 mGy Male 0 25 mSv Female 0 32 mSv Contrast medium IV injection Start delay Flow rate Total amount Hint 45 sec 2 4 reconstr 1 25 mm
6. Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Scan Kernel CTDho Effective dose HeadSeq 130 270 1 5 sec 6x 3 0mm 3 0mm 6 0 mm 18 0mm H60s 6 0 mm 18 0 mm H31s 59 40 mGy Male 3 05 mSv Female 3 17 mSv 433 Specials Additional Important Information e You can select which protocol is the emergency pro tocol For long range scanning please pay attention to the scannable range mark on the table mattress while positioning the patient e In some cases it might be advisable to position the patient feet first so that there will be more space for the intensive care equipment around e The Trauma protocol is predefined with a Topo length of 1024 mm the Poly Trauma protocol with a Topo length of 1536 mm Note You should press the Hold Measurement but ton whenever the range shown on the real time growing topogram is long enough in order to avoid unnecessary radiation 434 435 Specials Interventional CT Biopsy To facilitate CT interventional procedures we created dedicated multislice and single slice sequential modes Any of these protocols can be appended to a spiral pro tocol for CT interventional procedures such as biopsy abscess drainage pain therapy minimum invasive operations joint studies and arthrograms Adjust the mAs according to the body region before loading 10 scans are predefined You can repeat it by cl
7. e Prospectively respiratory triggered sequential scan ning e Retrospectively respiratory gated spiral scanning In both cases the respiration signal is recorded and used to either initiate prospective image acquisition triggering or to perform retrospective image recon struction gating Only scan data acquired in a user selectable phase of the respiration cycle is used for image reconstruction Respiratory Triggering Sequential scans are triggered by respiration signal during a predefined amplitude of inhalation or exhala tion Triggering is based on the maximum and minimum of the predicted respiration amplitude of the next 100 inspiration 491 Respiratory Gating Respiratory gating The respiration of the patients is simultaneously recorded during the Spiral acquisition Data are acquired during the entire respiration cycle and Images are reconstructed by matching data to the respiration trace The respiration level amplitude is defined as an abso lute value The display of the respiratory curve is opti mized by an auto adjustment regarding e Gain showing inspiration maximum as 100 of inspiration and expiration minimum as 100 of expiration and e Offset showing the curve optimal to vertical display extent 492 The timebase of the respiratory curve is realtime in an updating mode Images can be reconstructed at any user defined Inha lation or Exhalation level 100 Inspiration
8. 0 5 mm H90s 8 90 mGy Male 0 27 mSv Female 0 28 mSv InnerEar 110 90 1 0 sec 6x 1 0mm 1 0 mm 1 25 mm 5 1 mm 0 85 1 0 mm H90s 16 56 mGy Male 0 13 mSv Female 0 12 mSv The conversion factor for a 7 year old child and a scan range of 45 mm was used 531 Children Contrast medium IV injection Startdelay exam dependent Flow rate dependent upon needle size Access site Total 1 2 ml per kg of body weight amount Hints e Children who are older than age 6 should be scanned with an adult protocol as the skull by this time is fully grown In order to optimize image quality versus radiation dose scans are provided within a maximum scan field of 300 mm with respect to the iso center No recon job with a field of view exceeding those limits will be possible Therefore patient positioning has to be performed accurately to ensure a centered loca tion of the skull e To work without CARE Dose 4D use for children lt 3 years 40 mAs 3 6 years 60 mAs 532 533 Children InnerEarSeq Indications Sequential mode for routine inner ear studies for example Inflammatory changes tumorous pro cesses of pyramids cerebellopontine angle tumors post traumatic changes etc For SOMATOM Emotion 16 slice configuration A scan range is predefined with 4 3 cm For SOMATOM Emotion 6 slice configuration A scan range is predefined with 8 3 cm Note Same as for adults except for the FoV o
9. 1 0 sec 16x0 6mm 0 6 mm 4 0mm 1 0 mm 14 4mm 1 50 4 0mm B41s 6 25 mGy Male 0 02 mSv Female 0 02 mSv 0 7mm B70s Lower Extremities Emotion 6 ExtrCombi 24 reconstr kV 130 Effective mAs 50 Quality ref mAs Rotation time 1 0 sec Acquisition 6x 1 0mm Slice collimation 1 0 mm Slice width 4 0 mm 1 25 mm Feed Rotation 9 0 mm Pitch Factor 1 50 Increment 4 0 mm 0 8 mm Kernel B41s B70s CTDlhya 6 35 mGy Effective dose Male 0 01 mSv Female 0 01 mSv Adjust the mAs value to the body region Hint e For image reconstruction of soft tissue use kernel B30s B31s 359 Vascular Overview In this chapter you will find all scan protocols relating to the Vascular region their descriptions individual indications and important hints on using them You can use the following scan protocols to clarify for example vascular abnormalities stenosis or occlu sions coarse plaques anomalies aneurysm and embolism 360 Vascular For SOMATOM Emotion 16 slice configuration HeadAngio Spiral mode for routine head CTAngio studies HeadAngioVol Spiral mode for axial and coronal HeadCTAngio stud ies CarotidAngio Spiral mode for carotid CTAngio studies CarotidAngioVol Spiral mode for axial and coronal carotid CTAngio studies ThorAngioRoutine Spiral mode for routine thorax CTAngio studies ThorAngioVol Spiral mode for axial and oblique thorax CTAngio studies ThorAngioEC
10. Acquisition 4x0 6mm Slice width 0 6 0 75 1 0 1 5 2 0 3 0 4 0 5 0 mm Sequence Mode Collimation Acquisition 4x 0 6 mm 12 x 0 6mm 16 x 0 6mm 2x5mm 12x 7 2mm 2x8mm 16x1 2 mm Slice width 0 6 1 2 2 4 mm 0 6 2 4 7 2 mm 1 2 2 4 4 8 9 6 mm 5 0 10 0 mm 1 2 3 6 4 8 mm 8 0 16 0 mm 2 4 4 8 9 6 19 2 mm 25 a Scan and Reconstruction SOMATOM Emotion 6 slice configura tion Spiral Mode Collimation Slice width 7mm 1 1 25 2 2 5 3 4 5 6 8 10 mm 2mm 2 5 3 4 5 6 8 10mm 3mm 4 5 6 8 70mm Sequence Mode Collimation Slice width 1mm 1 2 3 mm 2 mm 2 4 6 12 mm 3 mm 3 6 9 18 mm 5mm 5 10 mm HR Spiral Mode Collimation Slice width 0 5 mm 0 63 0 75 1 1 25 2 2 5 3 4 5mm HR Sequence Mode Collimation Slice width 7mm 7mm 26 Scan and Reconstruction Increment The increment is the distance between the recon structed images in Z direction When the chosen incre ment is smaller than the slice thickness the images are created with an overlap This technique is useful for reducing partial volume effect giving you better detail of the anatomy and high quality 2D and 3D postpro cessing The increment can be freely adapted from 0 1 10 mm Pitch Pitch feed per rotation z coverage z coverage detector rows x collimated slice width Feed Rotation table movement per rotation The Pitch Factor can be freely adapted from 0 45 2 0 in
11. SOMATOM Emotion 6 16 slice configuration Application Guide Protocols Principles Helpful Hints Software Version syngo CT 2007E SIEMENS medical 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 MRICT 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 Emotion 6 16 slice configuration 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 Christiane Bredenhoeller Gabriel Haras Ute
12. Select the coronal image segment Enable Free Mode 77 i Workflow Information Rotate the reference lines until the best view on the sinuses is displayed in one of the other seg ments Select this segment and press button Set FoV Seg ment button Select the Matrix size for example non square 512 and adjust the FoV to your needs Define your desired reconstruction parameters e g image type SPO Start reconstruction Double oblique reconstructions of the heart For detailed information on heart reconstructions please refer to your Cardiac CT Application Guide 78 Workflow Information Workflow Patient Position A default patient position can be linked and stored to each scan protocol The SIEMENS default protocols are already linked to a default patient position Head first supine If a scan protocol is selected and confirmed in the Patient Model Dialog the linked patient position stays active until the user changes it even if a scan pro tocol with different patient position is selected Auto Reference Lines The Auto Reference lines settings defined in the Patient Model Dialog can be linked and saved to each scan protocol If a scan protocol is selected and confirmed in the Patient Model Dialog the linked Auto Reference lines settings stay active until the user changes them even if a scan protocol with different Auto Reference lines settings is selected 79 Workflow
13. Total 1 2 ml per kg of body weight amount Hints e Children older than age 6 should be scanned with an adult protocol e The second recon job is defined with kernel H60s and with an overlap for visualizing bone structures with MPR e To work without CARE Dose 4D use for children lt 3 years 40 mAs 3 6 years 60 mAs 541 Children NeckRoutine Indications Spiral mode for routine neck studies for example tumors lymphoma abscesses etc NeckRoutine For SOMATOM Emotion 16 slice configuration A typical range of 15 cm covered in 7 21 sec For SOMATOM Emotion 6 slice configuration A typical range of 15 cm covered in 8 27 sec 542 Children Emotion 16 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTDlvoi Effective dose Emotion 6 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTDlvoi Effective dose Neck 2 4 reconstr 110 50 1 0 sec 16x 1 2mm 1 2 mm 5 0 mm 1 5 mm 28 8 mm 1 50 5 0 mm B50s 3 60 mGy Male 0 69 mSv Female 0 71 mSv 1 0 mm B50s Neck 2 4 reconstr 110 50 0 8 sec 6x 2 0mm 2 0mm 5 0 mm 2 5mm 18 0 mm 1 50 5 0mm B50s 3 55 mGy Male 2 03 mSv Female 2 12 mSv 1 5 mm B50s The conversion factor for a 7 year old child and a scan range of 1
14. ered in 13 70 sec For SOMATOM Emotion 6 slice configuration A range of 30 cm for the complete thorax will be cov ered in 28 27 sec nl bl 246 Thorax Emotion 16 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTDlyoi Effective dose ThorHR 274 3r 4th recon recon recon 130 100 0 6 sec 16 x 0 6 mm 0 6 mm 5 0mm 5 0mm 1 0mm 1 0mm 14 4 mm 1 50 5 0mm 5 0mm 0 7mm 0 7mm B90s B41s B70s B41s 12 50 mGy Male 6 56 mSv Female 8 29 mSv 247 Thorax Emotion6 ThorHR 2 3M 4th recon recon recon kV 130 Effective 100 mAs Quality ref mAs Rotation 0 8 sec time Acquisition 6x 1 0mm Slice 1 0 mm collimation Slice width 5 0mm 5 0mm 1 0mm 1 0mm Feed 9 0 mm Rotation Pitch 1 50 Factor Increment 5 0mm 5 0mm 0 7mm 0 7mm Kernel B90s B41s B70Os B41s CTD o1 12 70 mGy Effective Male 6 23 mSv dose Female 8 10 mSv Hints e With studies of interstitial changes in the lungs con trast medium is not necessary e This examination is normally performed following a standard thorax study or used for regular follow up studies for high risk patient groups with a history of exposure to carcinogenic agents e g asbestos 248 249 KI Thorax ThoraxHRSeq Indications Sequence mode for high resolution lung studies for example interstitial changes in the
15. 0 8 0 6 sec 6x1 0mm 1 0mm 3 0mm 3 0mm 1 25 mm 9 0 mm 1 50 3 0mm 3 0mm 0 8mm B60s B41s B60s 3 24 mGy Male 2 82 mSv Female 3 33 mSv 4th recon 1 25 0 8 mm B41s The conversion factor for a 7 year old child and a scan range of 150 mm was used 551 Children Contrast medium IV injection Start delay exam dependent Flow rate dependent upon needle size Access site Total 1 2 ml per kg of body weight amount Hints e Children with a body weight of more than 55 kg should be examined with an adult protocol e For the 2 reconstruction the Autoload into MPRthick Range on the 3D Card is activated The images will be automatically loaded into 3D MPRthick and a coronal MPRthick Range will pop up Please notice if you are not satisfied with the Range preset adapt the parameters to your needs and link them to the series e To work without CARE Dose 4D use for children lt 25 kg 25 mAs 25 34 kg 45 mAs 35 54 kg 65 mAs 552 553 Children ThoraxHRSeq Indications Sequence mode for high resolution lung studies for example interstitial changes in the lungs using a 10 mm feed For SOMATOM Emotion 16 slice configuration A scan range is predefined with 15 1 cm For SOMATOM Emotion 6 slice configuration A scan range is predefined with 15 0 cm 554 Children Emotion 16 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Fe
16. 130 50 0 6 sec 2x5 0 mm 5 0 mm 10 0 mm 0 0 mm B31s 5 10 mGy Biopsy Single 130 50 0 6 sec 2x5 0mm 5 0 mm 10 0 mm 0 0 mm B31s 4 75 mGy Specials Interventional CT CARE Vision CARE Vision is a CT Fluoroscopic mode for interven tions with 1 or 3 combined slices and up to 10 images per sec displayed depending on the hardware config uration The Basics Any of the predefined CARE Vision scan protocols can be appended to a spiral protocol for interventional pro cedures such as biopsies abscess drainage pain ther apy minimum invasive operations joint studies and arthograms The raw data will not be available for image recon struction In case of the FoV must be changed due to movement insert a control scan by clicking on the chronicle with the right mouse button You can Append any routine protocol after the inter ventional procedure for a final check and documenta tion for example a short range of spiral scanning for the biopsy region With gantry tilt 0 the table height can be adjusted to minimum vertical position of 255 mm Automatic Patient Instruction API is not possible for CARE Vision You can change the gantry tilt on the gantry panel while the protocol is loaded 439 Specials CAREVision With this routine protocol the image will be recon structed and displayed using three times 4 8 6 0 mm or one time 10 mm slice thickness and a kernel of B30 in the CARE V
17. 20 kg or 45 Ibs for child protocols Based on that value CARE Dose 4D adapts the tube current or the mean eff mAs value to the individual patient size or body region Note Do not adapt the Image Quality Reference mAs for an individual patient s size Only change this value if you want to adjust the image quality 58 Dose Information If you change the quality ref mAs a pop up window is displayed pub TaskCards Change mAs for image quality purpose only Do not adapt the mAs for individual patient size e To change the configuration of CARE Dose 4D please open the Examination Configuration dialog box under Options gt Configuration In the window that then appears please double click the Examina tion icon to display the configuration window The adaptation strength of CARE Dose 4D may be influ enced for slim obese patients or body parts of a patient by changing the CARE Dose 4D settings in the Patient tab card This may be desirable if the automatic dose increase for obese patients or patient sections has to be stronger than the preset choose obese strong increase resulting in less image noise and a higher dose for those images 59 Dose Information if the automatic dose increase for obese patients or patient sections has to be more moderate than the preset choose obese weak increase resulting in more image noise and a lower dose for those images if the automatic dos
18. 4 Resizing and reorder the columns It is possible to reorder the table columns by drag and drop the column head For resizing the columns you just have to move the vertical column lines together 5 Modify Manual Entries Make a right mouse click into the cell and modify the information to your needs The cell background color will be changed to green as an indication Click on the enabled Apply button then the changes will be applied to the database and the cell background color will be white again 90 Workflow Information Study Continuation An existing study can be continued at a later time To load an existing study e Select the desired study in the Patient Browser e Select Register from the Patient drop down menu e The patient data is loaded in the Registration dialog box The previous scan protocol is already preselected but it is also possible to select any desired scan protocol After the patient has been registered the patient is loaded into the Examination card The ranges already scanned are listed The following chronicle entry is shown between the ranges already scanned and the new ranges Exam Continue lt Patient Position gt If you want to continue a contrast media study the sys tem asks you if the next scan should be continued as a non contrast scan instead e If you want to continue as a non contrast scan the chronicle entries for the new scan range is indicated as a non contrast scan
19. B40s e For higher sharpness as is required e g in patient protocols for cervical spine shoulder extremities thorax lung the kernels B50s B60s B7Os B80s are available In case of 3D study only the mAs value can be reduced by 50 Use kernel B10s and at least 50 overlapping for image reconstruction 349 i Lower Extremities Scan Protocols Knee Indications Spiral mode for knee bone study e g trauma orthope dic indications etc For SOMATOM Emotion 16 slice configuration A range of 15 cm will be done in 21 53 sec For SOMATOM Emotion 6 slice configuration A range of 15 cm will be done in 31 41 sec 350 Lower Extremities Emotion 16 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTDlyoi Effective dose Emotion 6 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTDlyoi Effective dose Hints Knee 24 reconstr 130 80 1 0 sec 16 x 0 6 mm 0 6 mm 3 0 mm 1 0 mm 7 7 mm 0 80 3 0 mm 0 7 mm U90s U90s 10 00 mGy Male 0 06 mSv Female 0 05 mSv Knee 2 4 reconstr 130 80 1 0 sec 6x1 0mm 1 0 mm 3 0mm 1 25 mm 5 1 mm 0 85 3 0 mm 0 8 mm U90s U90s 10 16 mGy Male 0 05 mSv Female 0 05 mSv e For image reconstruction of soft tissue use kernel B30s B31s 351
20. Effective mAs Quality ref mAs Rotation Time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTDlyo Effective Dose 322 Pelvis 2 4 reconstr 130 120 1 0 sec 16x 1 2mm 1 2 mm 5 0 mm 5 0 mm 28 8 mm 1 50 5 0 mm B41s 13 44 mGy Male 5 32 mSv Female 9 14 mSv 5 0mm B41s Pelvis Emotion 6 kV Effective mAs Quality ref mAs Rotation Time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTD yoy Effective Dose Pelvis 130 120 1 0 sec 6x2 0mm 2 0mm 5 0mm 18 0 mm 1 50 5 0mm B41s 13 08 mGy Male 5 13 mSv Female 8 76 mSv Contrast medium IV injection Start delay Flow rate Total amount 50 sec 2 0 3 0 ml sec 100 120 ml 2 4 reconstr 5 0mm 5 0mm B41s If the examination performed requires a full urinary bladder wait at least 3 minutes following IV adminis tration of the contrast medium 323 Pelvis Hip Indications Spiral mode for bone studies and soft tissue studies of the Hip E g evaluation of joint cavity masses trauma dysplasia necrosis of the head of the hip congruence evaluations orthopedic indications etc For SOMATOM Emotion 16 slice configuration A typical range of 10 cm will be covered in 8 94 sec For SOMATOM Emotion 6 slice configuration A typical range of 10 cm will be covered in 13 11 sec 324 Pelvis Emotion 16 kV
21. Effective mAs mA x RotTime Pitch Factor Pitch Factor _Feed per Rotation nrow x Slice collimation mA effective mAs __ x Pitch Factor RotTime where Slice collimation refers to the collimation of one detector row and nrow is the number of used detector rows 46 Dose Information CARE Dose 4D CARE Dose 4D is an automated exposure control which ensures constant diagnostic image quality over all body regions at the lowest possible dose CARE Dose 4D combines three different adaptation methods to optimize image quality at the lowest dose level e Automatic adaptation of the tube current to the patient size e Automatic adaptation of the tube current to the attenuation of the patient s long axis the so called z axis e Automatic adaptation of the tube current to the angular attenuation profile measured online for each single tube rotation the so called angle modu lation Based on a single a p or lateral topogram CARE Dose 4D determines the adequate mAs level for every sec tion of the patient Based on these levels CARE Dose 4D modulates the tube current automatically during each tube rotation according to the patient s angular attenuation profile Thus the best distribution of dose along the patient s long axis and for every viewing angle can be achieved 47 Dose Information Based on a user defined Image Quality Reference mAs CARE Dose 4D automatically adapts the eff mAs to the patient size
22. Kernel CDi 3 Effective dose Emotion 6 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel apie Effective dose WristHR 130 40 1 0 sec 4x0 6mm 0 6 mm 2 0 mm 1 8 mm 0 75 2 0 mm U90s 5 52 mGy Male lt 0 mSv Female lt 0 mSv WristHR 130 40 1 0 sec 6x0 5mm 0 5mm 2 0mm 2 6mm 0 85 2 0mm U90s 5 12 mGy Male 0 01mSv Female lt 0 mSv 2 4 reconstr 0 6mm 0 4mm U90s 2 4 reconstr 1 0 mm 0 6 mm U90s 337 7 Upper Extremities Hints e For image reconstruction of soft tissue use kernel B30s B31s 338 339 Upper Extremities ExtrRoutineHR Indications Spiral mode for high resolution bone study for exam ple trauma orthopedic indications etc For SOMATOM Emotion 16 slice configuration A range of 10 cm will be done in 57 56 sec For SOMATOM Emotion 6 slice configuration A range of 10 cm will be done in 41 22 sec 340 Upper Extremities Emotion 16 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CDi 3 Effective dose Emotion 6 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel api Effective dose ExtrHR 2 reconstr 130 60 1 0 sec 4x0 6mm 0 6
23. No injector symbol is shown If you continue a study as a contrast study the chroni cle entries of the new scan range are indicated as a contrast scan An injector symbol is shown 91 Workflow Information Reconstruction on the syngo CT Work place It is possible to start all reconstructions from your sat ellite console e Raw data has to be available in the local database e Select the raw data series of the patient in the Patient Browser and load it into the Recon card e Plan your recon jobs as usual 92 Workflow Information Examination Job Status You can get an overview of all recon jobs by clicking on the recon task symbol in the status bar or selecting Transfer Examination Job status in the patient main menu in the Patient Browser The Examination Job Status dialog box will appear where all recon jobs completed queued and in work are listed You can stop restart and delete each job by clicking the according button To give a selected job a higher priority click urgent The column Type shows you which kind of reconstruc tion is queued Two types are displayed Recon all recon jobs from the Recon card either on the syngo Acquisition Workplace or syngo CT Workplace Auto 3D all 3D reconstructions which you have send via Auto postprocessing automatically into the 3D Card These jobs will be deleted from the job list as soon as the patient is closed in the 3D card 93 Wo
24. Workflow Information e Logbook The goal of e Logbook is to offer an effective and effi cient functionality to process examination informa tion The e Logbook consists of three components e The e Logbook Configuration e The e Logbook subtask card area e The e Logbook Browser where all examinations can be listed for viewing sorting searching and printing e Logbook Configuration You will find the e Logbook Configuration under Options gt Configuration gt e Logbook Configuration The configuration is divided into three tab cards e General e System Entries e Manual Entries Under General you can activate and deactivate the e Logbook as default the e Logbook is activated If the e Logbook is deactivated no patient information is recorded If you do not want to have the e Logbook displayed in the subtask area you can switch it off even though the system entries will be recorded Additionally you can select a Default printer from a drop down menu 83 Over Default Time period you can determine how the recordings should be listed inside the e Logbook Browser Today which is the default setting This week This month Yesterday Last week Last month Any changes can be saved by selecting Apply 84 Workflow Information On the Manual Entries tab card you can configure the System Entries and Manual Entries that should be displayed in the e Logbook System Entrie
25. administer oral contrast medium as this impairs the editing of MIP SSD VRT images Water could be used instead if necessary Water rather than positive oral contrast agents should be used Give the last cup 200 ml just prior to positioning the patient To ensure adequate filling of the duodenal loop lay the patient on the right side for 5 minutes before performing the topogram e A pre contrast examination is usually performed only if no CT scans were previously acquired to exclude calculi in the common bile duct and to visu alize possible lesions in the liver e For pancreatic studies the arterial phase acquisition can be acquired later with a start delay of 40 50 sec It may be necessary to use a thinner collimation 279 Abdomen AbdMultiPhase AbdMultiPhase06s Indications Combination of three phase study including liver pan creas and kidney For SOMATOM Emotion 16 slice configuration A range of 20 cm including liver pancreas and kidney arterial phase acquired in 5 37 sec Emotion 16 Non Contrast kV 110 Effective mAs 75 Quality ref mAs Rotation Time 0 6 sec Acquisition 16x 1 2mm Slice collimation 1 2 mm Slice width 5 0 mm Feed Rotation 28 8 mm Pitch Factor 1 50 Increment 5 0 mm Kernel B41s CTDly 5 40 mGy Effective dose 280 Male 2 34 mSv Female 2 89 mSv Abdomen A range of 20 cm including liver pancreas and kidney arterial phase acquired in 16 83 sec Emotion 16 A
26. lost Add Siemens protocols as duplicates 118 Customized scan protocols with the same name as original Siemens protocols will get a new name extension Customized If there exists a scan protocol with this name the new copies are numbered for example HeadSpi MIAdult gt HeadSpi Customized MIAdult HeadSpi_ Customized MI Adult gt HeadSpi_ Customized2 MIAdult The original Siemens protocols will be copied in the corresponding body region folder Workflow Information If no customized scan protocols are selected the radio buttons lt Replace customized protocols with same name gt and lt Add Siemens protocols as duplicates gt will be dimmed e Select deleted Siemens scan protocols The lt Select Deleted gt checkbox is convenient for the user to select and deselect all deleted Siemens default scan protocols The checkbox is in indeterminate state when some but not all deleted Siemens default scan protocols are selected in the region protocol lists The checkbox is disabled dimmed when there is no deleted Siemens default scan protocols Step 3 Confirmation In this step the changed protocols are listed old and new Ones and the changes have to be confirmed 119 Workflow Information Step 4 Changes saved In this step you can decide if you want to pass a differ ent modification workflow or if you want to exit the Scan Protocol Assistant List all Scan Protocols and all selected
27. scanned with an adult protocol as the skull by this time is fully grown In order to optimize image quality versus radiation dose scans are provided within a maximum scan field of 300 mm with respect to the iso center No recon job with a field of view exceeding those limits will be possible Therefore patient positioning has to be performed accurately to ensure a centered loca tion of the skull e To work without CARE Dose 4D use for children lt 3 years 40 mAs 3 6 years 60 mAs 528 529 Children InnerEar Indications Spiral mode for routine inner ear studies for example malformations of the inner ear inflammatory changes pathologies of the mastoid process tumor processes of the pyramids post traumatic changes etc Note Same as for adults except for the FoV of 300 For SOMATOM Emotion 16 slice configuration A typical range of 4 0 cm covered in 7 21 sec For SOMATOM Emotion 6 slice configuration A typical range of 4 0 cm covered in 9 84 sec 530 Children Emotion 16 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTDlvoi Effective dose Emotion 6 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTDlvoi Effective dose InnerEar 110 50 1 0 sec 16x 0 6 mm 0 6 mm 0 75 mm 7 7 mm 0 80
28. the average dose will also depend on the table feed between axial scans or the feed per rotation in spiral scanning The dose expressed as the CTDly must therefore be corrected by the pitch factor of the spiral scan or an axial scan series to describe the average dose in the scanned volume For this purpose the IEC defined the term CTDl in September 2002 CTDIw Phy eke vel Pitch factor This dose number is displayed on the user interface for the selected scan parameters 42 Dose Information Note Previously the dose display on the user interface was labeled CTDly This displayed CTDI was also cor rected for the pitch and was therefore identical to the current CTDlyg The CTDI value does not provide the entire informa tion of the radiation risk associated with CT examina tion For this purpose the concept of the Effective Dose was introduced by ICRP International Commis sion on Radiation Protection The effective dose is expressed as a weighted sum of the dose applied not only to the organs in the scanned range but also to the rest of the body It could be measured in whole body phantoms Alderson phantom or simulated with Monte Carlo techniques The calculation of the effective dose is rather compli cated and has to be performed by sophisticated pro grams These have to take into account the scan parameters the system design of the individual scan ner such as X ray filtration and gantry
29. tion Here you can rename your scan protocol Default Patient Position Enter the patient position you want to have as default displayed in the Patient Model Dialog Auto reference Lines Select where you want to have displayed the Auto reference lines e On study level e On series level e Off the entry in the Auto tasking card cannot be selected Body region Select in which body region the scan protocol should be saved and displayed in the Patient Model dialog 105 Workflow Information The four buttons Column Configuration Show Hide Parameters Parameter Property and Find Replace are now available Column Configuration With the column configuration you can include or exclude specific entries that will be displayed in the sub footprint line and also change the order of the entries with the drag amp drop functionality Show Hide Parameters You can decide if you want to show hide the parame ters in the parameter area of the selected protocols Parameter Property If you select a single cell you are able to get the param eter properties displayed as a minimum and maximum value together with the units and incremental steps Find Replace For a fast and easy handling you can search for certain values and replace them with the desired value If you have selected for example the columns mAs Recon increment Auto filming Auto transfer CD DVD Auto transfer Node a so called Function ar
30. 0 37 mSv Female 0 42 mSv Contrast medium IV injection Start delay Flow rate Total amount Hint 18 sec 3 5 ml sec 75 ml e Use of CARE Bolus with monitoring scans positioned at the level of the basilar artery or carotid artery Set the trigger threshold at 120 HU or use manual trig gering 371 Vascular CarotidAngio CarotidAngio06s Indications CT angiography of the carotid arteries e g carotid stenosis or occlusion coarse plaques abnormalities of the carotids or vertebral arteries etc For SOMATOM Emotion 16 slice configuration A range of 20 cm including the aorta arch will be cov ered in 9 53 sec For SOMATOM Emotion 6 slice configuration A range of 12 cm including the aorta arch will be cov ered in 9 20 sec 372 Vascular Emotion 16 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTD yo Effective dose Emotion 6 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTD yo Effective dose CarotidAngio 110 70 0 6 sec 16 x 0 6 mm 0 6 mm 5 0mm 14 4mm 1 50 5 0mm B30s 5 60 mGy Male 1 28 mSv 2 4 reconstr 1 0 mm 0 7 mm B20s Female 1 41 mSv CarotidAngio 110 70 0 8 0 6 sec 6x1 0 mm 1 0 mm 5 0 mm 9 0 mm 1 50 5 0 mm B31s 5 81 mGy 2 4 reconstr 1
31. 0 5mm H70s 2 0 m sec 75 ml e For low dose studies use only 20 mAs 199 Head Dental Indications This is the scan protocol for the syngo Dental applica tion package It is used for evaluation and reformatting of the upper and lower jaws It enables the display and measurement of the bone structures of the upper and lower jaw as the basis for planning in oral surgery For SOMATOM Emotion 16 slice configuration A range of 50 mm will be covered in 8 51 sec For SOMATOM Emotion 6 slice configuration A range of 50 mm will be covered in 9 44 sec 200 Head Emotion 16 kV Effective mAs Quality ref mAs Rotation Time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTD yoy Effective dose Dental 130 45 1 0 sec 16x 0 6mm 0 6 mm 0 75 mm 7 7mm 0 80 0 5mm H70s 11 97 mGy Male 0 25 mSv Female 0 26 mSv 201 Head Emotion 6 kV Effective mAs Quality ref mAs Rotation Time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTD yoy Effective dose Dental 130 45 0 8 sec 6x 1 0mm 1 0 mm 1 25 mm 5 1 mm 0 85 0 6 mm H70s 12 38 mGy Male 0 19 mSv Female 0 23 mSv For further information on the scan protocols and how to use syngo Dental CT please refer to the Application Guide Clinical Applications 202 Head Hint e An automatic bone correction allows for impro
32. 0 6 sec 6 x 2 0 mm 2 0 mm 5 0 mm 2 5 mm 21 0 mm 1 75 5 0 mm 1 5 mm B31 B30s B31s 6 39 mGy Male 3 45 mSv Female 5 82 mSv 407 Vascular Contrast medium IV injection Start delay 20 sec Flow rate 3 5 ml sec Total amount 120 ml Hints e CARE Bolus may be used to optimize the bolus tim ing Set the ROI for monitoring scan in the abdominal aorta with triggering threshold of 120 HU or use manual triggering e Do not administer oral contrast medium as this impairs the editing of MIP SSD VRT images e Use water as oral contrast The length of the CM spiral in the topogram via the table position can be planned exactly by means of pre contrast images Precontrast images are used to visualize calcifica tion Excellent postprocessed images can be created using a thin slice thickness and overlapping images i e the increment should be smaller than the slice thick ness 408 409 Vascular AngioRunOff AngioRunOff06s Indications Spiral mode for CT Angio studies of the extremities For SOMATOM Emotion 16 slice configuration A range of 80 cm will be done in 17 87 sec For SOMATOM Emotion 6 slice configuration A range of 80 cm will be done in 23 42 sec 410 Vascular Emotion 16 kV Effective mAs Quality ref mAs Rotation Time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTDlyo Effective dose Emotion 6 kV Effective mA
33. 0 mm 16 mm H31s 57 24 mGy Male 1 96 mSv Female 2 17 mSv CerebrumSeq 130 270 1 5 sec 6x 3 0mm 3 0mm 6 0 mm 18 mm H31s 59 40 mGy Male 1 94 mSv Female 2 13 mSv 175 Head Contrast medium IV injection Start delay 60 sec Flow rate 2 mi sec Volume 50 60 ml Hints e An automatic bone correction allows for improved head image quality without any additional postpro cessing e In order to optimize image quality versus radiation dose scans are provided within a maximum scan field of 300 mm with respect to the iso center No recon job with a field of view exceeding those limits will be possible Therefore patient positioning has to be performed accurately to ensure a centered loca tion of the skull 176 Head InnerEarHR Indications Spiral mode for inner ear high resolution studies e g inflammatory changes tumorous processes of pyra mids cerebellopontine angle tumors posttraumatic changes etc For SOMATOM Emotion 16 slice configuration A range of 4 0 cm will be covered in 24 22 sec For SOMATOM Emotion 6 slice configuration A range of 4 0 cm will be covered in 17 69 sec 177 Head Emotion 16 kV Effective mAs Quality ref mAs Rotation Time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTD yo Effective dose Emotion 6 kV Effective mAs Quality ref mAs Rotation Time Acquisition Slice collimation Slice wi
34. 0 mm B31s 18 75 mGy Male 3 49 mSv Female 3 71 mSv 0 7mm B60s C Spine 24 recon 130 150 1 0 sec 6x17 0mm 1 0mm 2 0mm 1 25 mm 5 1mm 0 85 2 0mm B31s 19 05 mGy Male 4 27 mSv Female 4 29 mSv 0 8 mm B60s 299 Spine C SpineVol Indications Spiral mode for cervical spine studies e g prolapse degenerative changes trauma tumors etc Three recon jobs are predefined for reconstruction the first for soft tissue axial the second for soft tissue sag ittal and third for sagittal bone studies in 3D images display view For SOMATOM Emotion 16 slice configuration A range of 15 cm will be covered in 21 53 sec For SOMATOM Emotion 6 slice configuration A range of 15 cm will be covered in 31 41 sec Emotion 16 C Spine 2 3rd recon recon kV 130 Effective mAs 150 Quality ref mAs Rotation Time 1 0 sec Acquisition 16 x 0 6 mm Slice collimation 0 6mm Slice width 2 0mm 2 0mm 2 0mm Feed Rotation 7 7mm Pitch Factor 0 80 Increment 2 0mm 2 0mm 2 0mm Kernel B31s B20s B60s CTDlvoi 18 75 mGy Effective dose Male 3 49 mSv Female 3 71 mSv 300 Spine Emotion 6 C Spine 2 4 3rd recon recon kV 130 Effective mAs 150 Quality ref mAs Rotation Time 1 0 sec Acquisition 6x 1 0mm Slice collimation 1 0mm Slice width 2 0mm 2 0mm 2 0mm Feed Rotation 5 1 mm Pitch Factor 0 85 Increment 2 0mm 2 0mm 2 0mm Kernel B31s B20s B60s CTDlvoi 19 05 mGy Effective dose Male 4
35. 1 0mm 3 0mm 2 0mm 3 3mm 0 55 3 0mm 2 0mm B31s B20s 24 13 mGy Male 3 64 mSv Female 7 23 mSv 3rd recon 2 0 mm 2 0 mm B20s 307 Spine SpineSeq Indications Sequence mode for spine studies e g prolapse degenerative changes trauma tumors etc This protocol contains three ranges L3 L4 L4 L5 L5 S1 Three different typical gantry tilts are predefined for L3 L4 0 for L4 L5 5 and for L5 S1 15 For SOMATOM Emotion 16 slice configuration A scan range is predefined with 79 mm For SOMATOM Emotion 6 slice configuration A scan range is predefined with 84 mm 308 Spine Emotion 16 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Scan Kernel CTDlyoi Effective dose Male Female L3 4 130 280 1 5 sec 12x 0 6 mm 0 6 mm 2 4mm 7 2mm B31s 38 64 mGy L4 5 130 280 1 5 sec 12x 0 6 mm 0 6 mm 2 4mm 7 2mm B315s 38 49 mGy 1 75 mSv 2 15 mSv 2 45 mSv 3 78 mSv L5 S1 130 320 1 5 sec 12x 0 6 mm 0 6 mm 2 4mm 7 5mm B31s 42 66 mGy 2 43 mSv 5 56 mSv 309 A Spine Emotion 6 L3 4 L4 5 L5 S1 kV 130 130 130 Effective mAs 280 280 320 Quality ref mAS Rotation time 1 5 sec 1 5 sec 1 5 sec Acquisition 6x 6x 6x 1 0 mm 1 0 mm 1 0 mm Slice 1 0 mm 1 0 mm 1 0 mm collimation Slice width 2 0 mm 2 0 mm 2 0 mm Feed Scan 6 0 mm 6 0 mm 6 0 mm Kernel B31s B31s B31s CID 3
36. 1 94 mSv 2 53 mSv AbdPelvis 130 90 0 6 sec 16x 1 2mm 7 2mm 8 0 mm 28 8 mm 1 50 8 0 mm B41s 10 08 mGy 8 47 mSv 10 60 mSv 427 Specials For SOMATOM Emotion 6 slice configuration Ascan range of 12 14 cm will be done in 9 84 13 67 sec Emotion 6 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTDlyo Effective dose Male Female 428 Head 130 250 1 0 sec 6x 3 0mm 3 0mm 6 0 mm 15 3 mm 0 85 6 0 mm H31s 55 00 mGy 2 58 mSv 2 79 mSv Neck 130 150 1 0 sec 6 x 2 0 mm 2 0 mm 5 0 mm 12 0 mm 1 00 5 0 mm B50s 16 35 mGy 3 09 mSv 3 23 mSv Specials Take a new Topogram for the thorax and abdomen range A scan range of 20 40 cm will be done in 9 04 10 09 sec Emotion 6 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTD yoy Effective dose Male Female Thorax 130 50 0 8 0 6 sec 6x 3 0mm 3 0mm 8 0 mm 15 3 mm 0 85 8 0 mm B41s 5 10 mGy 1 73 mSv 2 27 mSv AbdPelvis 130 90 0 8 0 6 sec 6x 3 0mm 3 0mm 8 0mm 27 0mm 1 50 8 0 mm B41s 9 18 mGy 8 00 mSv 10 37 mSv 429 Specials HeadTrauma A spiral mode for emergency head studies with a max FoV of 500 mm For SOMATOM Emotion 16 slice configuration A scan range of 12 cm will b
37. 27 mSv Female 4 29 mSv 301 Spine SpineRoutine Indications Spiral mode for thoracic and lumbar spine studies e g prolapse degenerative changes trauma tumors etc For SOMATOM Emotion 16 slice configuration A range of 15 cm will be covered in 26 04 sec For SOMATOM Emotion 6 slice configuration A range of 15 cm will be covered in 27 00 sec Emotion 16 kV Effective mAs Quality ref mAs Rotation Time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTDIvol Effective dose 302 SpineRo 2 3rd utine recon recon 130 190 1 0 sec 16x 0 6mm 0 6 mm 3 0mm 1 0 mm 1 0 mm 6 2 mm 0 65 3 0 mm 0 7 mm 0 7 mm B31s B31s B70s 23 75 mGy Male 4 42 mSv Female 4 70 mSv Spine Emotion 6 Spine 2nd 3 Routine recon recon kV 130 Effective mAs 190 Quality ref mAs Rotation Time 1 0 sec Acquisition 6 x 2 0 mm Slice collimation 2 0mm Slice width 3 0mm 2 5mm 2 5mm Feed Rotation 6 0 mm Pitch Factor 0 50 Increment 3 0mm 1 5 mm 1 5 mm Kernel B31s B31s B60s CTDlvoi 20 70 mGy Effective dose Male 4 93 mSv Female 11 26 mSv 303 Spine SpineThinSlice Indications Spiral mode for thin slice thoracic and lumbar spine studies e g prolapse degenerative changes trauma tumors etc For SOMATOM Emotion 6 slice configuration A range of 10 cm will be covered in 32 30 sec Emotion 6 Spine 2nd 3rd ThinSlice recon recon kV 1
38. 6 sec Acquisition 16 x 0 6 mm Slice collimation 0 6mm Slice width 5 0mm 3 0mm Feed Rotation 14 4mm Pitch Factor 1 50 Increment 5 0mm 3 0mm Kernel B31s B20s CTD yo 5 60 mGy Effective dose Male 1 28 mSv Female 1 41 mSv 376 Vascular Emotion 6 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTD yo Effective dose CarotidAngio 24 reconstr 110 70 0 8 sec 6x1 0 mm 1 0 mm 5 0 mm 3 0 mm 9 0 mm 1 50 5 0 mm 3 0 mm B31s B20s 5 81 mGy Male 0 57 mSv Female 0 62 mSv 377 Vascular Contrast medium IV injection Start delay 15 sec Flow rate 4 ml sec Total amount 90 ml Hints CARE Bolus may be used to optimize the bolus tim ing Set the ROI for monitoring scan in the aortic arch with triggering threshold of 120 HU or use manual triggering High quality 2D amp 3D postprocessing can be achieved using a thin slice thickness and 50 overlapping increments Thick MPRs and ThinMIPs can be created very quickly on the 3D Task Card by just clicking on the appropri ate icons The thickness of these reconstructed images can be defined by clicking on the icons with the right mouse to open the entry field 378 379 Vascular ThorAngioRoutine ThorAngioRoutine06s Indications Spiral mode for thorax CT Angio studies e g visualiza tion of tumors metastases lymphoma lymph nodes vascula
39. 6 slice configuration RT_Head Spiral mode for routine radiation therapy planning head studies RT_Thorax Spiral mode for routine fradiation therapy planning thoracic studies RT_Breast Spiral mode for routine radiation therapy planning studies of the breast RT_Abdomen Spiral mode for routine radiation therapy planning abdominal studies RT_Pelvis Spiral mode for routine radiation therapy planning pelvis studies 471 Radiation Therapy RT_Head Indications Spiral mode for routine radiation therapy planning head studies For SOMATOM Emotion 16 slice configuration A range of 12 cm will be covered in 20 05 sec For SOMATOM Emotion 6 slice configuration A range of 12 cm will be covered in 30 27 sec Emotion 16 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTD yoy Effective dose 472 Head 24 recon 130 240 1 5 sec 16x 1 2mm 1 2 mm 3 0 mm 3 0 mm 10 6 mm 0 55 3 0 mm H31s 57 60 mGy Male 2 66 mSv Female 2 88 mSv 3 0 mm H60s Radiation Therapy Emotion 6 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTD yoy Effective dose Head 130 250 1 5 sec 6x 2 0mm 2 0mm 3 0mm 6 6 mm 0 55 3 0mm H315s 58 75 mGy Male 2 76 mSv Female 2 98 mSv 2 4 recon 3
40. B41s have about the same visual sharpness as B30s respectively B40s the image appearance however is more agreeable due to a fine grained noise structure quite often the low contrast detect ability is improved by using B31s B41s instead of B30s B40s For higher sharpness as is required e g in patient protocols for cervical spine shoulder extremities thorax lung the kernels B50s B60s B7Os B80s are available The special kernels are mostly used for physical measurements with phantoms e g for adjustment procedures S80s for constancy and acceptance tests S80s U90s or for specification purposes U90s For special patient protocols S80s and U90s are cho sen e g for osteo S80s and for high resolution bone studies U90s We recommend using the high resolution specification kernel U90s only with small objects like the wrist otherwise artifacts will occur in the images 335 Upper Extremities Scan Protocols WristHR Indications Spiral mode for resolution bone study of thewrist for example trauma orthopedic indications etc For SOMATOM Emotion 16 slice configuration A range of 6 cm will be done in 35 33 sec For SOMATOM Emotion 6 slice configuration A range of 6 cm will be done in 25 53 sec 336 Upper Extremities Emotion 16 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment
41. Cardio there is a fixed pitch down to 0 1 With the SOMATOM Emotion 6 16 slice configuration you select the slice collimation together with the slice width desired The slice width is independent of pitch i e what you select is always what you get Actually you do not need to be concerned about the algorithm any more the software does it for you Pitch values with a step width of 0 05 can be selected for all modes We recommend to use a Pitch Factor of 0 45 for MPR reconstructions 27 Scan and Reconstruction Kernels There are 4 different types of kernels H stands for Head B stands for Body C stands for ChildHead and S stands for Special Application e g syngo 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 Head Kernels Kernel description H10s very smooth H19s very smooth H20s smooth H21s smooth H22s smooth FR H29s smooth H30s medium smooth H31s medium smooth H32s medium smooth FR H37s medium smooth Emotion 16 slice configuration only H39s medium smooth H40s medium H41s medium H42s medium FR H45s medium H47s medium smooth Emotion 16 slice configuration only H48s medium smooth Emotion 16 slice configuration only H50s sharp H60s medium H70s very sharp H80s inner ear H90s inner ear 28 Scan and Reconstruction S Body Kernels Ker
42. Dose 4D but will be well adapted to the patient s attenuation resulting in improved image quality Starting from that setting reduce the Image Quality Reference mAs step by step to meet the necessary image quality level Store the scan protocol with the adapted image qual ity reference mAs 62 Dose Information Additional Important Information For ideal dose application it is very important to posi tion the patient in the isocenter of the gantry Example for an a p topogram X ray tube Patient centered Detector Patient is positioned in the isocenter optimal dose and image quality X ray tube Patient not centered Detector Patient is positioned too high increased mAs X ray tube Patient not centered etector Patient is positioned too low reduced mAs and increased noise 63 Workflow Information WorkStream4D Recon Jobs In the Recon card you can define up to eight recon struction jobs for each range with different parameters either before or after you acquire the data When you click on Recon these jobs are performed automatically in the background If you want to add more than eight recon jobs simply click the icon for an already completed recon job in the chronicle with the right mouse button and select delete recon job Another recon job will now become available on the Recon tab card Note What you delete is just the job from the display not the
43. Effective mAs Quality ref mAs Rotation Time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTD yoy Effective Dose Emotion 6 kV Effective mAs Quality ref mAs Rotation Time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTD yoy Effective Dose Hip 130 100 1 0 sec 16x 0 6mm 0 6 mm 5 0 mm 14 4 mm 1 50 5 0 mm B70s 12 50 mGy Male 2 31 mSv Female 5 93 mSv Hip 130 100 1 0 sec 6x 1 0 mm 1 0 mm 5 0 mm 9 0 mm 1 50 5 0 mm B70s 12 70 mGy Male 3 60 mSv Female 3 16 mSv 2 4 reconstr 1 0 mm 0 7 mm B70s 2 4 reconstr 1 25 mm 0 8 mm B70s 325 Pelvis Hints e In case of 3D study only images should be recon structed with at least 50 overlapping and kernel B10 e If only one side is examined it is advisable to enter the side in the comment line on the Routine card 326 327 Pelvis HipVol Indications Spiral mode for bone studies and soft tissue studies of the Hip e g evaluation of joint cavity masses trauma dysplasia necrosis of the head of the hip congruence evaluations orthopedic indications etc Two recon jobs are predefined for reconstruction the first for axial the second for coronal studies in 3D images display view For SOMATOM Emotion 16 slice configuration A typical range of 10 cm will be covered in 8 94 sec For SOMATOM Emotion 6 slice
44. Export Root from the CT Data Transfer drop down menu e Select the raw data files you want to transfer in the content area of the Patient Browser From the browser open the Patient main menu and select the item Transfer CT Data e The raw data includes the ECG file Transfer files to USB storage device e Insert an USB memory device into the USB port A new folder is added to the File Browser USB storage device F e Select the desired files and send them via the right mouse button menu to the USB storage device Transfer files to floppy e Select the desired files and send them via the right mouse button menu on a floppy disk 152 Application Information Burn on CD Do not write files to CD R while other jobs are being transferred Make sure that the volume of data to be recorded does not exceed the CD R storage capacity Select the desired files and copy amp paste or drag amp drop them into the folder CDBurn or send them via the right mouse button menu to the folder CDBurn Open the LocalJobStatus in the Patient Browser and clear all entries Select Record to Offline in the Transfer menu of the Patient Browser CD writing starts Hint Offline files can only be written to CD in a sin gle session When recording is successfully completed the entries in the subdirectory CDBurn will be deleted automati cally Litt i 0O0OGOOOO ooo 153 Application Information Review repo
45. Extremities Emotion 16 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTDlhya Effective dose ExtrHR 2d reconstr 130 60 1 0 sec 4x0 6 mm 0 6 mm 2 0 mm 0 6 mm 1 8 mm 0 75 2 0 mm 0 4 mm U90s U90s 8 28 mGy Male 0 01 mSv Female 0 01 mSv 355 Lower Extremities Emotion 6 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTDhyo1 Effective dose ExtrHR 24 reconstr 130 60 1 0 sec 6x0 5mm 0 5mm 2 0mm 1 0 mm 2 6mm 0 85 2 0mm 0 6 mm U90s U90s 7 68 mGy Male 0 01 mSv Female 0 01 mSv Adjust the mAs value to the body region Hint e For image reconstruction of soft tissue use kernel B30s B31s 356 357 Lower Extremities ExtrCombi Indications Spiral mode for the combination of bone and soft tis sue studies e g masses trauma disorders of the joint etc For SOMATOM Emotion 16 slice configuration A range of 15 cm will be done in 12 42 sec For SOMATOM Emotion 6 slice configuration A range of 10 cm will be done in 13 11 sec Emotion 16 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTDho1 Effective dose 358 ExtrCombi 2 4 reconstr 130 50
46. Protocols To list all available protocols select the List all proto cols icon in the lower left corner of any arbitrary step Comparisons between Siemens default and custom ized protocols is possible with this table You are able to print export to floppy and export this sheet as a xml file under H SiteData protocols The same can be done with all selected Protocols as well 120 121 Contrast Medium Contrast Medium The Basics The administration of intravenous IV contrast mate rial during spiral scanning improves the tissue and lesion characterization as well as the opacity of ves sels The contrast scan will yield good results only if acquisition is performed during the optimal phase of enhancement in the region of interest Therefore it is essential to initiate the acquisition with the correct start delay Since multislice spiral CT can provide much faster speeds and shorter acquisition times it is even more critical to get the right timing to achieve optimal results 40 s scan 10 s scan Longer scan time Shorter scan time 122 Contrast Medium The dynamics of the contrast enhancement is deter mined by e Patient cardiac output e Injection rate e Total volume of contrast medium injected e Concentration of the contrast medium e Type of injection uni phasic or bi phasic e Patient pathology Aortic time enhancement curves after i v contrast injection computer simulation All cu
47. a range of 30 cm will be cov ered in 17 87 sec 258 Thorax Emotion 16 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTDlyoi Effective dose 2nd recon 3rd recon 4th recon Lung CARE 110 15 0 6 sec 16 x 0 6 mm 0 6 mm 5 0mm 5 0mm 14 4 mm 1 0mm 1 0mm 1 50 5 0mm 5 0mm B41s B90s 1 20 mGy Male 0 64 mSv Female 0 81 mSv 0 7mm 0 7mm B41s B7Os 259 Thorax Emotion 6 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTD 1 Effective dose 260 Lung 2nd 34 CARE recon recon 110 15 0 8 0 6 sec 6x1 0 mm 1 0 mm 5 0mm 5 0mm 1 25m m 10 8 mm 1 80 5 0mm 5 0mm 0 8mm B41s B90s B41s 1 25 mGy Male 0 63 mSv Female 0 81 mSv 4th recon 1 25 m 0 8 mm B70s Thorax Contrast medium IV injection Start delay 30 sec Flow rate 2 5 ml sec Total amount 50 70 ml Hints e For lung cancer evaluation this protocol can be com bined with protocol Neck Routine or you can use the protocol NeckThorax e Low dose lung images are usually evaluated using lung window setting Soft tissue bone window set tings may be used to visualize the presence of calci fications in the nodules It is essential to use the same protocol for follow u
48. be covered in 24 22 sec For SOMATION Emotion 6 slice configuration A range of 40 mm will be covered in 17 69 sec Emotion 16 Inner 2nd 34 Ear recon recon kV 130 Effective mAs 130 Quality ref mAs Rotation Time 1 0 sec Acquisition 4x 0 6 mm Slice collimation 0 6mm Slice width 2 0mm 2 0mm 2 0mm Feed Rotation 1 1 mm Pitch Factor 0 45 Increment 2 0mm 2 0mm 2 0mm Kernel H90s H90s H90s CTDlyo 38 35 mGy Effective dose Male 0 74 mSv Female 0 78 mSv 180 Head Emotion 6 Inner 2nd 34 Ear recon recon kV 130 Effective mAs 130 Quality ref mAs Rotation Time 1 0 sec Acquisition 6x0 5mm Slice collimation 0 5 mm Slice width 2 0mm 2 0mm 2 0mm Feed Rotation 2 6mm Pitch Factor 0 85 Increment 2 0mm 2 0mm 2 0mm Kernel H90s H90s H90s CTD yo 35 88 mGy Effective dose Male 0 57 mSv Female 0 59 mSv 181 Head Contrast medium IV injection Start delay 60 sec Flow rate 2 mi sec Volume 50 60 ml Hints e For image reconstruction of soft tissue use kernel H30s H31s e An automatic bone correction allows for improved head image quality without any additional postpro cessing e In order to optimize image quality versus radiation dose scans are provided within a maximum scan field of 300 mm with respect to the isocenter No recon job with a field of view exceeding those limits will be possible Therefore patient positioning has to be performed accurately to ensure a centered loca tion of th
49. changed protocols are listed with both the old and the changed parameters and they have to be confirmed Step 5 Changes saved In this step you can decide if you want to pass a differ ent modification workflow or if you want to exit the Scan Protocol Assistant 116 Workflow Information Import scan protocols from SOMATOM LifeNet CD In this workflow you can import new scan protocols either from SOMATOM LifeNet if a remote connection is available or from CD Before you can import new scan protocols you have to download them from the SOMATOM LifeNet This workflow consists of three steps Step 2 Import scan protocols Follow the instructions on this page to import the scan protocols Step 3 Changes saved In this step you can decide if you want to pass a differ ent modification workflow or if you want to exit the Scan Protocol Assistant 117 Workflow Information Restoring protocols to Siemens default This workflow consists of four steps Step 2 Select the scan protocols you want to restore to Siemens default In this workflow you can restore or import Siemens default scan protocols Adult and Child protocols are managed apart e Select what you want to do Replace customized protocols with same name All selected modified scan protocols will be replaced with the Siemens default scan protocol settings All changed protocols made by the user which are marked with a black dot in front will be
50. following changes can be made Auto transfer 1 2 3 e Auto Viewing e Auto Recon e Auto Filming e Auto Postprocessing e Auto Reference lines only if selected in the protocol Body Part Examined 114 Workflow Information Trigger Select single all all sequence or all spiral scan proto cols with trigger e When include scan range and recon information is selected an information line for each scan range and reconstruction is listed before the recon jobs belong ing to this scan range you might have to scroll to the right side of the line to get the information visible In the subsection you can make the following changes Sequence Spiral Mixed Synthetic Trigger X xX X ECG Pulsing X Phase Start in or ms X X X Phase Start X X X MultiPhase X ACV X X X 115 Workflow Information Some parameters listed are associated with each other If you input a value which influences another value and therefore causes a conflict the influenced param eter values are auto corrected and displayed in green If an invalid protocol is loaded the parameters with the incorrect value will be highlighted in yellow If you insert incorrect values these will be marked in yellow and will be auto corrected All the values will be adjusted after the first change is made State Color valid white changed amp valid green after an action invalid yellow read only gray Step 4 Confirmation In this step the
51. for thin slice spine studies e Upper Extremities Low Extremities ExtrRoutineHR Spiral mode for routine high resolution extremity studies ExtrCombi Spiral mode for the combination of thin slice and routine studies e Vascular HeadAngio HeadAngio06s Spiral mode for head CTAngio studies CarotidAngio CarotidAngio06s Spiral mode for carotid CTAngio studies BodyAngioRoutine BodyAngioRoutine06s Spiral mode for body CTAngio studies BodyAngioFast BodyAngioFast06s Spiral mode for fast body CTAngio studies e Specials NeonateBody NeonateBody06s Spiral mode for neonate studies 511 Children General Hints e Topograms 256 mm lateral topograms are defined for the head modes and 512 mm AP topograms are defined for the body modes Please keep in mind that the children s size can be dramatically different You should press the Hold Measurement button whenever the range shown on the real time growing topogram is long enough in order to avoid unneces sary radiation In a consistent effort to reduce the total dose of an examination all topograms of the pediatric proto cols are defined at 80 kV with minimum current 50mA Gantry tilt is available for sequence scanning not for spiral scanning For all head studies it is very important for image quality purposes to position the patient in the center of the scan field Use the lateral laser beam to make sure that the patient is positioned in the cent
52. geometry the scan range the organs involved in the scanned range and the organs affected by scattered radiation For each organ the respective dose delivered during the CT scanning has to be calculated and then multiplied by its radiation risk factor Finally the weighted organ dose numbers are added up to get the effective dose The concept of effective dose allows the comparison of radiation risk associated with different CT or X ray exams i e different exams associated with the same effective dose would have the same radiation risk for the patient It also allows a comparison of the applied X ray exposure to the natural background radiation for example 2 3 mSv per year in Germany 43 Dose Information ImpactDose For most of the scan protocols the effective dose num bers for standard male and female are calculated and listed the result in the description of each scan pro tocol The calculation was performed using the commercially available program ImpactDose Wellhoefer Dosime try For pediatric protocols the ImpactDose calculation and the correction factors published in Radiation Exposure in Computed Tomography are used These only include conversion factors for ages 8 weeks and 7 years e eee u rE The Calculation of Dose from External Photon Expo sures Using Reference Human Phantoms and Monte Carlo Methods M Zankl et al GSF report 30 91 Radiation Exposure in Computed Tomogr
53. have this preset dese lect the Auto load in 3D and save your scan protocol Some of the scan protocols are preset in the protocol with links to a post processing protocol If you prefer not to have this preset please delete the Range Parallel preset or overwrite them with your own settings 95 Workflow Information Scan Protocol Creation You can modify or create your scan protocols in two different ways e by editing saving scan protocols e via scan protocol manager Edit Save Scan Protocol If you want to modify an existing protocol or create a new one for example you want to have two Abdo menRoutine Protocols with different slice widths we recommend you do this directly on the Examination task card 96 Workflow Information User specific scan protocols can be saved with the fol lowing basic procedure Register a patient you can choose any patient posi tion in the Patient Model Dialog Select an existing scan protocol in the Patient Model Dialog Modify the scan protocol change parameters add new ranges etc to adapt the new protocol to your requirements Scan your patient as usual Check that all parameters are as you desire Select Edit Save Scan Protocol in the main menu Select the folder where you want the new protocol to appear and the scan protocol name in the pop up dialog box You can either use the same name to overwrite the existing scan protocol or enter a new name which will cre
54. head studies for example stroke brain tumors cranial trauma cerebral atrophy hydrocephalus and inflammation etc For SOMATOM Emotion 16 slice configuration A range for the base of 4 cm will be covered in 14 36 sec a range for the cerebrum of 8 cm will be covered in 14 36 sec For SOMATOM Emotion 6 slice configuration A range for the base of 4 cm will be covered in 28 00 sec a range for the cerebrum of 8 cm will be covered in 28 00 sec ae 168 Head Emotion 16 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Rotation Pitch factor Increment Kernel CTD vo Effective dose Base 130 220 1 5 sec 16x0 6mm 0 6 mm 4 0mm 5 3mm 0 55 4 0mm H315s 58 52 mGy Male 1 33 mSv Female 1 43 mSv Cerebrum 130 240 1 5 sec 16x 1 2mm 1 2 mm 6 0 mm 10 6 mm 0 55 6 0 mm H31s 57 60 mGy Male 1 98 mSv Female 2 21 mSv 169 Head Emotion 6 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Rotation Pitch factor Increment Kernel CTDl yo Effective dose 170 Base 130 220 1 5 sec 6x 1 0mm 1 0 mm 4 0mm 2 4mm 0 40 4 0mm H31s 60 50 mGy Male 0 94 mSv Female 0 98 mSv Cerebrum 130 250 1 5 sec 6x 2 0mm 2 0 mm 6 0mm 4 8mm 0 40 6 0 mm H31s 58 75 mGy Male 1 72 mSv Female 1 90 mSv Head Contrast medium IV injection Start delay 60 sec Flow
55. improved by using H31s H41s instead of H30s H40s In emergency examinations kernels H22s H32s and H42s can be used because they allow fast reconstruc tion FR and easy patient positioning 50 cm FoV To ensure best performance special online bone correc tion PFO is not used High Resolution head studies should be performed with H50f H60f for example for dental and sinuses It is essential to position the area of interest in the cen ter of the scan field For a better gray white brain tissue differentiation use the H37s H38s or H47s kernel Emotion 16 slice con figuration only Child Head Kernels For head scans of small children the kernels C20s C30s for example for soft tissue studies and C60s for example provided for sinuses should be chosen instead of the adult head kernels H20s H30s and H60s 32 Scan and Reconstruction Body Kernels As standard kernels for body tissue studies B30s or B40s are recommended softer images are obtained with B20s or B10s extremely soft The kernels B31s or B41s have about the same visual sharpness as B30s respectively B40s the image appearance however is more acceptable due to a fine grained noise struc ture quite often the low contrast detectability is improved by using B31s B41s instead of B30s B40s For higher sharpness as is required for example in patient protocols for cervical spine shoulder extremi ties thorax the kernels B50s B60s B7
56. is called a Quick scan Quick scans are employed to reduce motion artifacts and improve the temporal resolution Dynamic Multiscan Multiple continuous rotations at the same table posi tion are performed for data acquisition Normally it is applied for fast dynamic contrast studies such as syngo Neuro Perfusion CT Dynamic Serioscan Dynamic serial scanning mode without table feed Dynamic serio can still be used for dynamic evaluation such as Test Bolus The image order can be defined on the Recon subtask card 22 Scan and Reconstruction UFC detector Siemens proprietary high speed Ultra Fast Ceramic UFC detector enables a virtually simultaneous read out of two projections for each detector element The detector configuration with the routine acquisition of the Emotion 6 16 slice configuration SOMATOM Emotion 16 slice configuration Axi 2mm 16x00 60m 4x1 2mm raay LLL LL EREEREEREEREEEE 4x0 6mm HR Neuro mode Genoa SOMATOM Emotion 6 slice configuration mamm tanm o Shamma Tuam 2x1 mn 7 imm oT Rede 2h Ee nm optional MHN PAREIS 23 Scan and Reconstruction Acquisition 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 6 x 1 0mm f
57. lymph nodes vascular anomalies etc Four recon jobs are predefined for reconstruction the first for soft tissue axial the second for lung axial the third for soft tissue coronal and fourth for soft tissue coronal studies in 3D images display view For SOMATOM Emotion 16 slice configuration A range of 30 cm will be covered in 13 70 sec For SOMATOM Emotion 6 slice configuration A range of 30 cm will be covered in 23 82 sec 240 Thorax Emotion 16 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTDlyoi Effective dose Thor 2nd 3K 4th Combi recon recon recon 130 70 0 6 sec 16x0 6mm 0 6 mm 5 0mm 5 0mm 5 0mm 5 0mm 14 4 mm 1 50 5 0mm 5 0mm 5 0mm 5 0mm B41s B70s B41s B70s 8 75 mGy Male 4 51 mSv Female 5 78 mSv 241 Thorax Emotion6 Thor 2nd 3K 4th Combi recon recon recon kV 130 Effective 70 mAs Quality ref mAs Rotation 0 8 sec time Acquisition 6x 1 0mm Slice 1 0 mm collimation Slice width 5 0mm 5 0mm 5 0mm _ 5 0mm Feed 10 8 mm Rotation Pitch 1 80 Factor Increment 5 0mm 5 0mm 5 0mm 5 0mm Kernel B41s B7Os B41s B7Os CTDhyo1 8 89 mGy Effective Male 4 52 mSv dose Female 5 85 mSv For the 3 and 4 reconstruction a non square matrix 3D recon job is predefined 242 Thorax Contrast medium IV injection Start delay 25 sec Flow rate 2 5 ml
58. omes E teen ae esang ma eagan e oa aeea mm te r oe i amegan lt T map are e 146 Application Information Image Converter The CT application Common DICOM Adapter can con vert different DICOM data sets to formats provided by other CT vendors You will find the converter in the Applications menu of the Patient Browser s pa lOni 03 02 1220 ws Gu un uw Pa A GD 19 B84 Coren Fite OF 147 Application Information In the pop up window you can select the application for which you want to convert the images 148 Application Information Split Up Multi Phase Series 1 Select Split up series according to trigger delay from the section Split up Heartview 4D series if you intend to split up the series of multi phase heart reconstruction according to the different heart phases included Or 2 Select Split up series according to slice position to split up the series according to the different slice positions it contains After conversion you can load these data sets into the application of your choice 149 Application Information Report Template Configuration Under Options Configuration you will find the Report Template Configuration With the Report Configuration you can edit the basic information e g clinic information for your report templates of the applications syngo Calcium Scoring syngo Colonography CT syngo Lung CARE CT Additio
59. on the light marker on the Gantry to localize the entry point and then start patient preparation 5 Open the Patient Model Dialog Check the check box Append Select one of the predefined CAREVi sion scan protocols under Specials protocols and then click OK 6 Select the HandCARE position on the scan card 7 Click Load and the Cancel Move to scan on the pre selected table position 8 Press the footswitch to start the Fluoroscopy 445 Specials You can change the following Scan Parameters on the examination task card during radiation Gantry Tilt Table position Table movement type Position Feed in Feed out Movernert s my Hints e Press the footswitch either to position the needle or to control the needle position Without HandCARE every time you release the foot switch max the last scanned 3 sec of acquired images are automatically saved to the local data base With HandCARE every time you release the foot switch one image per rotation is automatically saved to the local database e If CARE View is used only the middle slice of the last image is displayed after release of the footswitch 446 Specials Additional Important Information Pause CARE Vision Scan Range If you pause the CARE Vision Scan Range the SlicePo sition and TableHeight will be displayed in the Image Text Reference Image Display To display a reference image during the examination procedure the Viewing ta
60. open the entry field Editing is necessary for SSD display of the thoracic aorta without the bone 382 383 Vascular ThorAngioVol Indications Spiral mode for thorax CT Angio studies e g visualiza tion of tumors metastases lymphoma lymph nodes vascular anomalies etc Two recon jobs are predefined for reconstruction the first for axial the second for double oblique studies in 3D images display view The oblique view images will be reconstructed as MIP images For SOMATOM Emotion 16 slice configuration A range of 30 cm will be covered in 13 70 sec For SOMATOM Emotion 6 slice configuration A range of 30 cm will be covered in 28 27 sec Emotion 16 ThorAngio 27d reconstr kV 110 Effective mAs 70 Quality ref mAs Rotation time 0 6 sec Acquisition 16 x 0 6 mm Slice collimation 0 6mm Slice width 5 0mm 3 0mm Feed Rotation 14 4 mm Pitch Factor 1 50 Increment 5 0 mm 3 0 mm Kernel B31s B30s CTDlya 5 60 mGy Effective dose 384 Male 2 92 mSv Female 3 78 mSv Vascular Emotion 6 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTD yo Effective dose ThorAngio 2 4 reconstr 110 70 0 8 sec 6x1 0 mm 1 0 mm 5 0 mm 3 0 mm 9 0 mm 1 50 5 0 mm 3 0 mm B31s B30s 5 81 mGy Male 2 96 mSv Female 3 83 mSv 385 Vascular Contrast medium IV injection Start delay 10 25 se
61. sec Total amount 80 ml Hint e In addition to the mediastinum and the lungs it may be necessary to evaluate the axillary fatty tissue and the bilateral mammary glands A third reconstruc tion can be set up with a wider FoV in the Recon task card e For lung cancer evaluation this protocol can be com bined with protocol NeckRoutine 243 ql Thorax ThoraxFast ThoraxFast06s Indications Fast spiral mode for lung studies e g when a patient has difficulty with breathhold For SOMATOM Emotion 6 slice configuration Acomplete thorax scan in a range of 30 cm will be cov ered in 7 87 sec with ThoraxFast QA 244 Thorax Emotion 6 kV Effective mAs Quality ref mAs Rotation Time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTD yoy Effective dose ThorFast 130 70 0 8 0 6 sec 6x 3 0mm 3 0mm 6 0mm 27 0 mm 1 50 6 0 mm B41s 7 14 mGy Male 4 12 mSv Female 5 25 mSv Contrast medium IV injection Start delay Flow rate Total amount Hints 25 30 sec 2 5 ml sec 80 ml 2 recon 6 0 mm 6 0 mm B7Os e For lung cancer evaluation this protocol can be com bined with protocol Neck Routine 245 Thorax ThoraxHR Indications Spiral mode for high resolution studies e g interstitial changes in the lungs For SOMATOM Emotion 16 slice configuration A range of 30 cm for the complete thorax will be cov
62. setting to the individual preference for image quality we rec ommend keeping track of this value and comparing it with the values used without CARE Dose 4D 56 Dose Information The Quality reference mAs value is displayed on the Scan tab card This defines the overall image quality of the scan protocol currently being used This value can be adapted for each protocol according to the user s individual requirements of image quality Here you can also view the effective mAs value that the system is going to use for the current scan range You can also deselect CARE Dose4D on this tab card 57 Dose Information Adjusting the Image Noise The correlation between attenuation and tube current is defined by the analytical function described above This function may be adjusted to adapt the image qual ity image noise according to the diagnostic require ments and the individual preference of the radiologist To adapt the image noise for a scan protocol the Image Quality Reference mAs value in the Scan tab card may be adjusted This value can be adapted for each protocol according to the user s individual pref erences of image quality and reflects the mean eff mAs value that the system will use for a reference patient with that protocol and the corresponding body region The reference patient is defined as a typical adult 70 kg to 80 kg or 155 to 180 Ibs for adult protocols or as a typical child 5 years appr
63. studies the use of CARE Bolus CT is recommended In a case where it is not available use Test Bolus Once completed load images into DynEva task card for calculation of Time to Peak enhancement For multiphase examinations for example three phase liver the maximum start delay can be set to 600 sec The countdown of the delay always starts after scanning of the previous phase For more information regarding the general use of drugs and doses mentioned in this guide please refer to page 2 125 Contrast Medium Bolus Tracking An automatic Bolus Tracking program is available which enables triggering of the spiral scanning at the optimal phase of the contrast enhancement Additional Important Information 1 This mode can be used in combination with any spi ral scanning protocol Simply insert Bolus Tracking by clicking the right mouse button in the chronicle This inserts the entire set up including pre monitor ing i v bolus and the monitoring scan protocol You can also save the entire set up in your own scan pro tocols 2 The pre monitoring scan is used to determine the position of the monitoring scans It can be per formed at any position of interest You can also increase the mAs setting to reduce the image noise when necessary 3 To achieve the shortest possible spiral start delay 2 s the position of the monitoring scans relative to the beginning of spiral scan must be optimized A snapping functi
64. the table position can be planned exactly by means of pre contrast images Precontrast images are used to visualize calcifica tion Excellent postprocessed images can be created using a thin slice thickness and overlapping images i e the increment should be smaller than the slice thick ness 400 401 Vascular BodyAngioVol Indications Spiral mode for abdominal CT Angio studies Two recon jobs are predefined for reconstruction the first for axial the second for coronal studies in 3D images display view The coronal view images will be reconstructed as MIP images For SOMATOM Emotion 16 slice configuration A typical study in a range of 40 cm will be covered in 17 87 sec For SOMATOM Emotion 6 slice configuration A typical study in a range of 20 cm will be covered in 19 38 sec Emotion 16 kV Effective mAs Quality ref mAs Rotation Time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTDlyo Effective dose 402 BodyAngio 274 reconstr 110 90 0 6 sec 16x 0 6 mm 0 6 mm 5 0mm 3 0mm 14 4mm 1 50 5 0mm 3 0mm B31s B30s 7 20 mGy Male 5 04 mSv Female 6 36 mSv Vascular Emotion 6 kV Effective mAs Quality ref mAs Rotation Time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTDlyo Effective dose BodyAngio 27d reconstr 110 90 0 8 sec 6x7 0mm 1 0 mm 5 0 mm 3
65. the injector side and confirm the parameters The injector is armed and ready for the examination Note If the scan mode is unloaded the injector will also be disabled 131 Contrast Medium After the injector is armed the scan and the injector can be started by pressing either the Start button Footswitch at the scanner or the Start button at the injector panel outside of the scan room or directly at the injector inside the scan room Note If the injector is not ready the scan cannot be started If both systems are ready to START and the user disarms the injector the bubble Check Injector is shown again 132 Contrast Medium Additional Important Information If Coupled Mode is selected the CT checks if there is an injector available The scan mode cannot be loaded if a connection can not be established or if the injector does not accept coupling The injector will not accept coupling while injecting A message appears Injector is not connected Scanning interrupted If the injector does not accept the START from the CT the scan mode is cancelled If the scanner is suspended by the user or if technical problems occur the injector will be stopped too Injector stopped If the injector is stopped by the user the scan will be stopped too If the injector is interrupted by pressing the Hold button the scan will be continued 133 Contrast Medium The injector reports a technical problem The c
66. this mixture to help reduce the bitter taste and make it more pleasing to the child apple juice fruit drink mixes are just a few of these Barium may of course be used in some cases as well Negative contrast agents such as water are becoming more popular for delineation of stomach or bowel wall borders or when 3D reconstructions are needed You need to be aware of all the contraindications of any of the con trast agents you use Please refer to the specific ver idor s recommednations e I V contrast administration In general 1 2 ml per kg of body weight should be applied however since the scanning can be completed in just a few seconds please keep in mind that the total injection time should not be longer than the sum of start delay time and the scan time do not inject contrast after the scanning is completed The use of CARE Bolus is recommended in order to achieve optimal contrast enhancement Both start delay time and injection rate are exam patient dependent I V injection with a power injector is recommended for all scans whenever possible Some guidelines to follow with respect to flow rate are noted in the chart below Note These injector guidelines are based on an antecubital injection site These guidelines may need to be adjusted if the site is more peripheral 513 Children Needle Size gauge Flow Rate ml sec 22 15 20 2 0 3 0 18 3 0 5 0 Central lines and ports may need to be hand in
67. ured before The list can be printed e Select from the main menu File gt Print The whole list will be printed at the Default printer which is configured under Options gt Configuration gt e Log book gt General The list can be exported e Select from the main menu File gt Export A Save As dialog pops up e The list will be automatically exported to H Site Data e Logbook A file name can be given The number of columns inside the displayed list depend on the configurations under Options gt Config uration gt e Logbook gt System Manual Entries 89 Workflow Information Hints for the Record List 1 Calling up Patient Browser When you double click on any record in the e Logbook Browser the patient data of the Patient Browser will be opened if still available and the customer has the chance to edit the patient information This change will also be updated inside the e Logbook 2 Updating the Recon List The e Logbook is updated automatically when the examination data has changed within the Patient Browser with Correct and Rearrange Patient name date of birth patient ID and study ID will be updated automatically 3 Sorting data within the Recon List You can decide if the data in the Record List should be listed in ascending or descending order The default sorting order is ascending Just click on the column head and a small arrow will appear clicking on it will change the sorting order
68. will be covered in 40 50 sec Emotion 16 Shoulder 24 3m recon recon kV 130 Effective mAs 100 Quality ref mAs Rotation Time 1 5 sec Acquisition 16 x 0 6 mm Slice collimation 0 6 mm Slice width 5 0 mm 5 0 mm 5 0 mm Feed Rotation 9 6 mm Pitch Factor 1 0 Increment 5 0 mm 5 0 mm 5 0 mm Kernel B60s B31s B60s CTDIvol 12 50 mGy Effective dose Male 3 38 mSv Female 3 75 mSv 224 Shoulder Emotion 6 kV Effective mAs Quality ref mAs Rotation Time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTDlvoi Effective dose Hints Shoulder 274 recon 130 100 1 5 sec 6x1 0 mm 1 0 mm 5 0 mm 6 0 mm 1 0 5 0 mm B60s 12 70 mGy Male 2 96 mSv Female 3 52 mSv 5 0 mm 5 0 mm B20s 3rd recon 5 0 mm 5 0 mm B20s e Use raw data to review a target region if necessary e For image reconstruction of soft tissue use kernel B31s and a slice width of 5 0 mm e Coronal and sagittal 2D planar reconstructions are important for evaluation of the joint space amp bursa sacs in CT arthograms 3D renderings are helpful for complex fractures amp dislocations 225 Thorax Overview In this chapter you will find all scan protocols relating to the Thorax region their descriptions individual indications and important hints on using them You can use the following scan protocols to clarify for example tumors metastases lymphoma lym
69. 0 You can choose different window settings under Options gt Configuration gt Examination gt Interven tion these settings correspond to the window values list e Save and Auto Stop functions The icon for Auto Stop at saved TP will be highlighted in green after you have pressed the button for save current Table Position you will find a new entry in the Drop down menu of the subtask card By moving the table to another position the icon will be displayed in gray until you reach the saved Table position then it will turn to green again If you activate the Auto Stop at saved TP function and use the Joystick or the but tons on the Gantry the table will stop automatically at the desired position so it is easier for you to reposition the patient again This function will stay active until you press the button Auto Stop at saved TP again The same behavior happens if you use the Auto Stop at Last Interventional Scan Position function If you press Auto Stop at Last Interventional Scan Position and use the Gantry buttons to position your patient the Gantry buttons will flash and show you in which direction you need to move the table to get back to your interventional table position again 451 Specials e Screen layout In the interventional Toolbar for CARE Vision you can change the Layout of the Display There are three dif ferent modes available Blow up one big image CARE View three equal sized images CARE Vi
70. 0 mSv ExtrCombi 110 25 1 0 sec 6x1 0 mm 1 0 mm 3 0 mm 9 0 mm 1 50 3 0 mm B41s 2 08 mGy Male lt 0 mSv Female lt 0 mSv 2 4 reconstr 1 0 mm 0 7 mm B70s 2 4 reconstr 1 25 mm 0 8 mm B70s The conversion factor for a 7 year old child and a scan range of 100 mm was used 571 Children Contrast medium IV injection Start delay exam dependent Flow rate dependent upon needle size Access site Total 1 2 ml per kg of body weight amount Hints e Children with a body weight of more than 55 kg should be examined with an adult protocol e To work without CARE Dose 4D use for children lt 25 kg 26 mAs 25 34 kg 35 mAs 35 54 kg 70 mAs 572 573 Children HeadAngio HeadAngio06s Indications Spiral mode for head CT Angio studies for example cerebral vascular abnormalities tumors etc For SOMATOM Emotion 16 slice configuration A typical range of 6 cm covered in 3 70 sec For SOMATOM Emotion 6 slice configuration A typical range of 6 cm covered in 5 20 sec Emotion 16 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTDlyo Effective dose 574 HeadAngio 2 4 reconstr 80 80 0 6 sec 16 x 0 6 mm 0 6 mm 2 0 mm 1 0 mm 14 4 mm 1 50 2 0 mm C30s 6 16 mGy Male 0 20 mSv Female 0 21 mSv 0 7mm C30s Children Emotion 6 kV Effective mA
71. 0 mm 3 0mm H60s 473 Radiation Therapy RT_Thorax Indications Spiral mode for routine radiation therapy planning tho racic studies For SOMATOM Emotion 16 slice configuration A range of 30 cm will be covered in 12 92 sec For SOMATOM Emotion 6 slice configuration A range of 30 cm will be covered in 25 13 sec Emotion 16 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTDlyo Effective dose 474 Thorax 24 recon 130 90 0 6 sec 16x 1 2mm 1 2 mm 8 0 mm 15 4 mm 0 80 8 0 mm 8 0 mm B41s B70s 10 08 mGy Male 5 53 mSv Female 7 35 mSv 8 0 mm Radiation Therapy Emotion 6 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTD yoy Effective dose Thorax 130 90 0 8 sec 6x 2 0mm 2 0mm 8 0mm 10 2 mm 0 85 8 0mm B41s 9 81 mGy Male 4 98 mSv Female 6 45 mSv 2 4 recon 8 0 mm 5 0mm B70s 475 Radiation Therapy RT_Breast Indications Spiral mode for routine radiation therapy planning tho racic studies of the mammae For SOMATOM Emotion 16 slice configuration A range of 30 cm will be covered in 12 92 sec For SOMATOM Emotion 6 slice configuration A range of 30 cm will be covered in 25 13 sec Emotion 16 kV Effective mAs Quality ref mAs Rotation
72. 0 mm 9 0 mm 1 50 5 0 mm 3 0 mm B31s B30s 7 47 mGy Male 2 83 mSv Female 3 51 mSv 403 Vascular Contrast medium IV injection Start delay 20 25 sec Flow rate 3 0 3 5 ml sec Total amount 100 120 ml Hints e CARE Bolus may be used to optimize the bolus tim ing Set the ROI for monitoring scan in the abdominal aorta with triggering threshold of 120 HU or use manual triggering e Do not administer oral contrast medium as this impairs the editing of MIP SSD VRT images e Use water as oral contrast The length of the CM spiral in the topogram via the table position can be planned exactly by means of pre contrast images Precontrast images are used to visualize calcifica tion Excellent postprocessed images can be created using a thin slice thickness and overlapping images i e the increment should be smaller than the slice thick ness 404 405 Vascular BodyAngioFast BodyAngioFast06s Indications Spiral mode for longer coverage and larger vessels For SOMATOM Emotion 6 slice configuration A typical study of the whole aorta including its bran chiocephalic trunk and iliac arteries in a range of 30 cm will be covered in 9 77 sec 406 Vascular Emotion 6 kV Effective mAs Quality ref mAs Rotation Time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTDly Effective dose BodyAngio 2d reconstr Fast 110 90 0 8
73. 1s B90s 1 28 mGy Male 0 68 mSv Female 0 86 mSv 3rd 4th recon recon 1 0mm 1 0mm 0 7mm 0 7 mm B41s B7Os 255 Thorax Emotion 6 LungLowDose 2 4 recon kV 110 Effective mAs 16 Quality ref mAs Rotation Time 0 8 0 6 sec Acquisition 6 x 2 0mm Slice collimation 2 0 mm Slice width 5 0 mm 5 0 mm Feed Rotation 12 0 10 2 mm Pitch Factor 1 00 0 85 Increment 5 0 mm 5 0 mm Kernel B70s B30s CTD yoy 1 14 mGy Effective dose Male 0 57 mSv Female 0 62 0 74 mSv 256 Thorax Contrast medium IV injection Start delay 30 sec Flow rate 2 5 ml sec Total amount 50 70 ml Hints e For lung cancer evaluation this protocol can be com bined with protocol Neck Routine e Low dose lung images are usually evaluated using lung window setting Soft tissue bone window set tings may be used to detect the presence of calcifica tions in the nodules e It is essential to use the same protocol for follow up studies to check for progression e CARE Dose 4D is off as default because for LungLow Dose protocols the lowest mAs values are used 257 Thorax LungCARE LungCARE06s Indications Spiral lung study with low dose setting for early visual ization of pathologies used for the application Lung CARE For SOMATOM Emotion 16 slice configuration A typical thorax study in a range of 30 cm will be cov ered in 13 70 sec For SOMATOM Emotion 6 slice configuration A typical thorax study in
74. 25 mm 0 8 mm B20s Male 0 57 mSv Female 0 62 mSv 373 Vascular Contrast medium IV injection Start delay 15 sec Flow rate 4 ml sec Total amount 90 ml Hints CARE Bolus may be used to optimize the bolus tim ing Set the ROI for monitoring scan in the aortic arch with triggering threshold of 120 HU or use manual triggering High quality 2D amp 3D postprocessing can be achieved using a thin slice thickness and 50 overlapping increments Thick MPRs and ThinMIPs can be created very quickly on the 3D Task Card by just clicking on the appropri ate icons The thickness of these reconstructed images can be defined by clicking on the icons with the right mouse to open the entry field 374 375 Vascular CarotidAngioVol Indications CT angiography of the carotid arteries e g carotid stenosis or occlusions coarse plaques abnormalities of the carotids and vertebral arteries etc Two recon jobs are predefined for reconstruction the first for axial the second for coronal studies in 3D images display view The coronal view images will be reconstructed as MIP images For SOMATOM Emotion 16 slice configuration A range of 20 cm including the aorta arch will be cov ered in 9 53 sec For SOMATOM Emotion 6 slice configuration A range of 12 cm including the aorta arch will be cov ered in 12 27 sec Emotion 16 CarotidAngio 2 reconstr kV 110 Effective mAs 70 Quality ref mAs Rotation time 0
75. 30 Effective mAs 190 Quality ref mAs Rotation Time 1 0 sec Acquisition 6x 1 0 mm Slice collimation 1 0mm Slice width 3 0mm 1 25mm 1 25 mm Feed Rotation 3 3 mm Pitch Factor 0 55 Increment 3 0 mm 0 8 mm 0 8 mm Kernel B31s B31s B7Os CTD yoy 24 13 mGy Effective dose Male 3 64 mSv Female 7 23 mSv 304 Spine SpineVol Indications Spiral mode for thoracic and lumbar spine studies e g prolapse degenerative changes trauma tumors etc Three recon jobs are predefined for reconstruction the first for soft tissue axial the second for soft tissue sag ittal and third for coronal bone studies in 3D images display view For SOMATOM Emotion 16 slice configuration A range of 15 cm will be covered in 26 04 sec For SOMATOM Emotion 6 slice configuration A range of 10 cm will be covered in 32 30 sec Emotion 16 Spine 2 recon 3 recon kV 130 Effective mAs 190 Quality ref mAs Rotation Time 1 0 sec Acquisition 16 x 0 6 mm Slice collimation 0 6mm Slice width 3 0mm 2 0mm 2 0mm Feed Rotation 6 2 mm Pitch Factor 0 65 Increment 3 0mm 2 0mm 2 0mm Kernel B31s B20s B20s CTD yoy 23 75 mGy Effective dose Male 4 42 mSv Female 4 70 mSv 305 A Spine Emotion 6 kV Effective mAs Quality ref mAs Rotation Time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTDlyo Effective dose 306 Spine 2d recon 130 190 1 0 sec 6x 1 0mm
76. 5 56 35 56 40 64 mGy mGy mGy Effective dose Male 0 88 mSv 0 91 mSv 0 81 mSv Female 1 44mSv 1 96 mSv 3 52 mSv Hint e You could repeat the same protocol by simply click ing the chronicle with the right mouse button for repeat 310 311 Spine Osteo This is the scan protocol for the syngo Osteo CT appli cation package to assist the physician with the quanti tative assessment of vertebral bone mineral density BMD in the diagnosis and follow up of osteopenia and osteoporosis Emotion 16 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Scan Kernel CTDlyo Effective dose Emotion 6 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Scan Kernel CID Effective dose 312 Osteo 80 220 1 0 sec 2x5 0mm 5 0mm 10 0 mm 0 0 mm S80s 5 72 mGy Male 0 48 mSv Female 0 71 mSv Osteo 80 220 1 0 sec 2x5 0mm 5 0mm 10 0 mm 0 0 mm S80s 5 50 mGy Male 0 21 mSv Female 0 49 mSv Spine e With CAREDose 4D the mA values are adapted for each osteo range according to the patient diameter Therefore special obese protocols for the osteo eval uation are not longer necessary Load all ranges in the application syngo Osteo CT For further information please refer to the Application Guide Clinical Applications 313 Overview In this chapter you will find all scan
77. 70 mm was used 543 Children Contrast medium IV injection Start delay exam dependent Flow rate dependent upon needle size Access site Total 1 2 ml per kg of body weight amount Hints e If necessary scan down to the aortic arch or medi astinum to include the entire lesion e Cooperative children can be instructed to hold their breath during the acquisition Children older than age 6 should be scanned with an adult protocol e To work without CARE Dose 4D use for children lt 3 years 40 mAs 3 6 years 60 mAs 544 545 Children ThoraxRoutine ThoraxRoutine06s Indications Spiral mode for routine thorax studies for example pneumonia tumors metastases lymphoma vascular abnormalities etc For SOMATOM Emotion 16 slice configuration A typical range of 15 cm covered in 4 33 sec For SOMATOM Emotion 6 slice configuration A typical range of 15 cm covered in 6 20 sec 546 Children Emotion 16 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTDlyoi Effective dose Thor 2nd 3 4th Routine recon recon recon 110 39 0 6 sec 16x 1 2 mm 1 2 mm 3 0mm 3 0mm 1 5mm 1 5mm 28 8 mm 1 50 3 0mm 3 0mm 1 0mm 1 0mm B41s B60s B41s B60s 2 81 mGy Male 1 21 mSv Female 1 49 mSv 547 Children Emotion 6 kV Effective mAs Quality ref mAs Rotation time Acquisition S
78. CT Angio studies For SOMATOM Emotion 16 slice configuration A typical study in a range of 40 cm will be covered in 17 87 sec For SOMATOM Emotion 6 slice configuration A typical study in a range of 20 cm will be covered in 14 53 sec 398 Vascular Emotion 16 kV Effective mAs Quality ref mAs Rotation Time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel ae Effective dose Emotion 6 kV Effective mAs Quality ref mAs Rotation Time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTDlyo Effective dose BodyAngio 2 4 reconstr 110 90 0 6 sec 16x 0 6mm 0 6 mm 5 0mm 1 0 mm 14 4 mm 1 50 5 0 mm 0 7 mm B31s B20s 7 20 mGy Male 5 04 mSv Female 6 36 mSv BodyAngio 27d reconstr 110 90 0 8 0 6 sec 6x 1 0 mm 1 0 mm 5 0 mm 1 25 mm 9 0 mm 1 50 5 0 mm 0 8 mm B31s B20s 7 47 mGy Male 2 83 mSv Female 3 51 mSv 399 Vascular Contrast medium IV injection Start delay 20 25 sec Flow rate 3 0 3 5 m sec Total amount 100 120 ml Hints e CARE Bolus may be used to optimize the bolus tim ing Set the ROI for monitoring scan in the abdominal aorta with triggering threshold of 120 HU or use manual triggering e Do not administer oral contrast medium as this impairs the editing of MIP SSD VRT images e Use water as oral contrast The length of the CM spiral in the topogram via
79. E06s Spiral mode used for the application syngo Lung CARE CT 228 Thorax General Hints e Topogram AP 512 mm Patient positioning Patient lying in supine position arms positioned comfortably above the head in the head arm rest lower legs supported Contrast medium administration in general IV injections are employed in all mediastinal examina tions but not in routine High Resolution studies of diffused interstitial lung diseases An IV contrast medium injection improves the vascular opacifica tion and facilitates the visualization of the lesions lymph nodes and the vessels Stasis of contrast medium in the arm amp superior vena cava often result in high density streak artifacts either in the region of the aortic arch or in the region of the subclavian vein A caudo cranial bottom to top scanning direction should be used to reduce this artifact by simply acquiring the data in this region at the later phase of the spiral scan In addition if the patient cannot hold his her breath for the duration of the entire scan breathing motion will be less appar ent in the apex than in the lower lobes CARE Bolus optional may be used to optimize the bolus timing Set the ROI for monitoring scan in the aorta at the level of the diaphragm with triggering threshold of 120 HU or use manual triggering 229 Thorax Lung images should be documented in both soft tis sue window and lung window It is also pos
80. Feuerlein Jessica Amberg Thomas Flohr Rainer Raupach Bettina Hinrichsen Axel Barth Kristin Pacheco 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 _ct application hotline med siemens de Editors Wang Jian Chen Ma Hao Overview a User Documentation o Scan and Reconstruction P Dose Information o Workflow Information o Contrast Medium J Pr ication Information o Head E Neck E Shoulder Thorax E Abdomen P Spine Pelvis E Upper Extremities A Lower Extremities Vascular Specials Radiation Therapy 16 18 42 64 122 136 162 204 218 226 262 294 314 332 346 360 416 462 Overview Respiratory Gating 484 Children 508 Overview Contents a User Documentation E Scan and Reconstruction Concept of Scan Protocols e Scan Set Up Feed in Feed out Topo Length Scan Modes Sequential Scanning Spiral Scanning Quick Scan Dynamic Multiscan Dynamic Serioscan UFC detector 16 18 18 19 19 20 21 21 21 22 22 22 25 Acquisition Slice Collimation and Slice Width 24 SOMATOM Emotion 16 slice configuration 25 SOMATOM Emotion 6 slice configuration 26 Increment Pitch Kernels Head Kernels Child Head Kernel
81. G Spiral mode for ECG gated thorax CTAngio studies using a collimation of 1 2 mm Embolism Spiral mode for routine pulmonary embolism studies BodyAngioRoutine Spiral mode for body CTAngio studies BodyAngioVol Spiral mode for axial and coronal body CTAngio studies AngioRunOff Spiral mode for long distance extremity CTAngio studies WholeBodyAngio Spiral mode for whole body angio studies 361 Vascular For SOMATOM Emotion 6 slice configuration HeadAngio HeadAngio06s Spiral mode for routine head CTAngio studies HeadAngioVol Spiral mode for axial and coronal HeadCTAngio stud ies CarotidAngio CarotidAngio06s Spiral mode for carotid CTAngio studies CarotidAngioVol Spiral mode for axial and coronal carotid CTAngio studies ThorAngioRoutine ThorAngioRoutineO6s Spiral mode for routine thorax CTAngio studies ThorAngioVol Spiral mode for axial and oblique thorax CTAngio studies ThorAngioECGO6s Spiral mode for ECG gated thorax CTAngio studies ThorAngioECGSeq Sequential mode for ECG triggered chest CTAngio studies Embolism Embolism06s Spiral mode for routine pulmonary embolism studies BodyAngioRoutine BodyAngioRoutined6s Spiral mode for body CTAngio studies BodyAngioVol Spiral mode for axial and coronal body CTAngio studies BodyAngioFast BodyAngioFast06s Spiral mode for fast body CTAngio studies AngioRunOff AngioRunOff06s Spiral mode for long distance extremity CTAng
82. Gy Effective dose Male 6 77 mSv Female 11 34 mSv Contrast medium IV injection Start delay 50 60 sec Flow rate 3 0 ml sec Total amount 100 ml Hints e You could repeat the same protocol simply by click ing the chronicle with the right mouse button for repeat E g when both non contrast and contrast studies are required Water rather than positive oral contrast agents should be used Give the last cup 200 ml just prior to positioning the patient To ensure adequate filling of the duodenal loop lay the patient on the right side for 5 minutes before performing the topogram A pre contrast examination is usually performed only if no CT scans were previously acquired to exclude calculi in the common bile duct and to visu alize possible lesions in the liver 289 Abdomen Colonography Colonography06s Spiral mode used for the application syngo Colonogra phy For SOMATOM Emotion 16 slice configuration A complete colon in a range of 40 cm will be covered in 17 87 sec For SOMATOM Emotion 6 slice configuration A complete colon in a range of 40 cm will be covered in 27 87 sec 290 Abdomen Emotion 16 kV Effective mAs Quality ref mAs Rotation Time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTDIvo Effective dose Colo_supine 130 50 0 6 sec 16 x 0 6mm 0 6mm 1 0 mm 14 4 mm 1 50 0 7 mm B41s 6 25 mGy Male 4 48 mSv F
83. Information Navigation within the Topogram Navigation within the topogram helps you to plan a reconstruction range The minimum conditions for its use are a scanned range and the availability of RTD Real time display images After scanning an orange line is displayed within the topogram This line corre sponds to the axial image in the tomo segment If you scroll through the axial image stack the orange line in the topogram is displayed as a refer ence line to the currently displayed axial image in the tomo segment If you change the reconstruction begin or end the orange reference line automatically jumps to this new position and the axial image in the tomo seg ment will be updated accordingly to the newly selected position If you move the whole recon box in the topogram the orange reference line automatically jumps to this new position and the axial image in the tomo seg ment will be updated accordingly to the newly selected position 80 Workflow Information API Language The API language can now be selected directly in the Patient Model Dialog When the API language is selected only the relevant language specific API entries can be selected in the Scan subtask card This way it is much easier to select the correct patient instruction 81 Before recording a new API text first define the API lan guage in the API setup dialog under Setup gt API Com ment Setup in the main menu 82
84. Os B80s are available Special Application Kernels The special kernels are mostly used for physical mea surements with phantoms e g for adjustment proce dures S80s for constancy and acceptance tests S80s S90s or for specification purposes S90s For special patient protocols S80s and S90s are chosen e g for osteo S80s Note In case of 3D study only use kernel B10s and at least 50 overlapping for image reconstruction Do not use different kernels for body parts other than what they are designed for 33 Scan and Reconstruction Extended FoV SOMATOM Emotion 16 6 slice configuration offers the extended field of view The range can be individually adapted by the user from 50 cm up to 70 cm To use this feature you have to select the extended FoV checkbox on the Recon subtask card The default setting is 65 cm but can be modified Extended FoV can be used with each scan protocol The extended FoV value should be adapted carefully to the exact patient size in order to achieve best possi ble image quality outside the standard scan field 34 Scan and Reconstruction Auto FoV After scanning a topogram the available ranges are dis played in the topo segment They can be automatically adapted according to the patient contours When mov ing the scan range over the topogram and press the ctrl key simultaneous the adaptation will be done automatically Please make sure that the whole object i
85. SOMATOM Emotion 16 slice configuration A typical range of 20 cm will be covered in 28 04 sec For SOMATOM Emotion 6 slice configuration A typical range of 20 cm will be covered in 17 29 sec 208 Neck Emotion 16 kV Effective mAs Quality ref mAs Rotation Time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTD yoy Effective dose Emotion 6 kV Effective mAs Quality ref mAs Rotation Time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTDIvo Effective dose NeckRoutine 2 4 reconstr 130 130 1 0 sec 16x 0 6mm 0 6 mm 5 0mm 1 0 mm 7 7mm 0 80 5 0 mm 0 7 mm B50s B50s 16 25 mGy Male 3 61 mSv Female 3 90 mSv NeckRoutine 130 85 0 8 sec 6 x 2 0 mm 2 0 mm 5 0 mm 10 2 mm 0 85 5 0 mm B50s 9 27 mGy Male 2 36 mSv Female 2 48 mSv 209 Neck Contrast medium IV injection Start delay 45 sec Flow rate 2 0 m sec Total amount 120 ml Hints e Due to its iodine content the thyroid gland is hyper dense in relation to the neighboring muscles both before and after an IV CM injection For displays of the parotid or thyroid gland or the floor of the mouth the slice thickness should be lt 5 mm and the length of the range should be adapted to match the anatomic region e Target the FoV to ensure adequate coverage of the region of interest in the upper neck amp middle neck levels as we
86. Slice width Feed Rotation Pitch Factor Increment Kernel CTD yoy Effective dose Emotion 6 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTD yoy Effective dose AbdRoutine 110 60 0 6 sec 16x 1 2mm 1 2 mm 5 0 mm 28 8 mm 1 50 5 0 mm B41s 4 32 mGy Male 2 78 mSv Female 3 38 mSv AbdRoutine 110 60 0 8 0 6 sec 6x 2 0mm 2 0mm 5 0 mm 18 0 mm 1 50 5 0 mm B41s 4 26 mGy Male 7 95 mSv Female 12 17 mSv The conversion factor for a 7 year old child and a scan range of 200 mm was used 559 Children Contrast medium IV injection Start delay exam dependent Flow rate dependent upon needle size Access site Total 1 2 ml per kg of body weight amount Hints e Delayed scans may be required for the kidneys amp bladder e Rectal contrast may be required for evaluation of pel vic mass e Children with a body weight of more than 55 kg should be examined with an adult protocol e To work without CARE Dose 4D use for children lt 25 kg 30 mAs 25 34 kg 55 mAs 35 54 kg 100 mAs 560 Children Spine SpineRoutine Indications Spiral mode for spine studies for example post trau matic changes tumors malformations orthopedic indication etc For SOMATOM Emotion 16 slice configuration A typical range of 15 cm covered in 26 04 sec For SOMATOM Emotion 6 slice configuration
87. Three recon jobs are predefined for reconstruction the first for axial the second for coronal and third for sagg ittal studies in 3D images display For SOMATOM Emotion 16 slice configuration A typical range of 20 cm will be covered in 28 04 sec For SOMATOM Emotion 16 slice configuration A typical range of 20 cm will be covered in 32 97 sec Emotion 16 Neck 2nd 3M recon recon kV 130 Effective mAs 130 Quality ref mAs Rotation Time 1 0 sec Acquisition 16 x 0 6 mm Slice collimation 0 6mm Slice width 5 0mm 5 0mm 5 0 mm Feed Rotation 7 7mm Pitch Factor 0 80 Increment 5 0mm 5 0mm 5 0 mm Kernel B50s B20s B20s CTDlvoi 16 25 mGy Effective dose Male 3 61 mSv Female 3 90 mSv 214 Neck Emotion 6 kV Effective mAs Quality ref mAs Rotation Time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTDlvoi Effective dose Neck 2nd recon 130 130 0 8 sec 6x1 0 mm 1 0 mm 5 0 mm 5 1 mm 0 85 5 0 mm B50s 16 51 mGy Male 4 06 mSv Female 4 25 mSv 5 0 mm 5 0 mm B20s 3rd recon 5 0 mm 5 0 mm B20s 215 Neck Contrast medium IV injection Start delay 45 sec Flow rate 2 0 ml sec Total amount 120 ml Hints e Due to its iodine content the thyroid gland is hyper dense in relation to the neighboring muscles both before and after an IV CM injection For displays of the parotid or thyroid gland or the floor of the mouth the sli
88. V Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTDlyoi Effective dose 236 2nd recon 3rd recon 4th recon Thor Combi 130 70 0 6 sec 16 x 0 6 mm 0 6 mm 5 0mm 5 0mm 14 4 mm 1 0mm 1 0 mm 1 50 5 0mm 5 0mm 0 7mm _ 0 7mm B41s B90s B41s B70s 8 75 mGy Male 4 51 mSv Female 5 78 mSv Thorax Emotion6 Thor 2nd 3rd 4th Combi recon recon recon kV 130 Effective 70 mAs Quality ref mAs Rotation 0 8 0 6 sec time Acquisition 6x 1 0mm Slice 1 0 mm collimation Slice width 5 0mm 5 0mm 1 25m 1 25m m m Feed 10 8 9 0 mm Rotation Pitch 1 80 1 50 Factor Increment 5 0mm 5 0mm 0 8mm 0 8mm Kernel B41s B90s B41s B7Os CTDlyoi 8 89 mGy Effective Male 4 52 4 46 mSv dose Female 5 85 5 79 mSv 237 Thorax Contrast medium IV injection Start delay 25 sec Flow rate 2 5 ml sec Total amount 80 ml Hints e In addition to the mediastinum and the lungs it may be necessary to evaluate the axillary fatty tissue and the bilateral mammary glands A third reconstruc tion can be set up with a wider FoV in the Recon task card e For lung cancer evaluation this protocol can be com bined with protocol Neck Routine 238 239 Thorax ThoraxVol Indications Routine spiral studies for the region of thorax e g visualization of tumors metastases lymphoma
89. V to your needs Define your desired reconstruction parameters e g image type SPO Start reconstruction e Oblique reconstruction of the vascular tree Scan a topogram Plan your spiral scan range Axial reconstruction of the spiral images RTD images Select Recon job Type oblique Select button MIP Thin as image type for the planning volume on the toolbar Enable Free Mode Rotate the reference lines until the best view of the entire vascular tree is displayed in one of the other segments Select the coronal image segment Select this segment and press the Set FoV Seg ment button Adjust the FoV to your needs Define your desired reconstruction parameters e g Type MIP Thin Start reconstruction 75 Workflow Information Non square Matrix for 3D Recon If you perfrom a 3D reconstruction of your spiral scan you have the possibility to choose between three dif ferent FoV matrices 512 square 512 non square 256 non square In some cases it is already saved to the scan protocol Spine CarotidAngio set up a new scan protocol or want to modify an existing one you can save the non square matrix together with the recon parameters e 512 square the FoV stays quadratic with a 512x512 matrix size e 512 non square the FoV can be adjusted as a rectan gle to your needs for example spine reconstruction Its max side ratio is 1 4 e 256 non square the FoV can be
90. Workflow Information Change parameters This workflow consists of five steps Step 2 Select the scan protocols you want to change Here you can select e scan protocols with certain recon jobs e all scan protocols with ECG e all customized or Siemens scan protocols for modifi cation e all scan protocols Additionally you can choose in the protocol list e single scan protocols e all scan protocols within a body region e several body regions Adult and Child protocols are managed apart Step 3 Change parameters In this step a second footprint section is added con sists of Protocol Topogram Scan Recon Auto tasking Trigger 103 Workflow Information All scan protocols selected in Step 2 are displayed For each parameter you can select the scan protocols you want to apply your changes The lt Select All gt check box is convenient for the user to select and deselect all scan protocols listed If the parameter values in the selected rows are the same the value will appear in the corresponding entry otherwise if the parameter val ues in the selected rows are different no value is dis played in the subsection 104 Workflow Information Protocol Select single scan protocol or all scan protocols you want to modify in this subsection In the subsection Protocol the following changes can be made Protocol Name This entry is only available in single protocol selec
91. a scan range of 120 mm was used 519 Children Contrast medium IV injection Start delay exam dependent Flow rate dependent upon needle size Access site Total 1 2 ml per kg of body weight amount Hints e Children who are older than age 6 should be scanned with an adult protocol as the skull by this time is fully grown e When bone structure is of interest use kernel C60s for image reconstruction An advanced algorithm allows for improved head image quality without additional post processing In order to optimize image quality versus radiation dose scans are provided within a maximum scan field of 300 mm with respect to the iso center No recon job with a field of view exceeding those limits will be possible Therefore patient positioning has to be performed accurately to ensure a centered loca tion of the skull e To work without CARE Dose 4D use for children lt 6 month 90 mAs 6 month 3 years 150 mAs 3 6 years 220 mAs 520 Children HeadSeq Indications Sequential mode for routine head studies for children for example tumors hydrocephalus hemorrhaging abnormalities etc For SOMATOM Emotion 16 slice configuration A scan range is predefined with 8 5 cm For SOMATOM Emotion 6 slice configuration A scan range is predefined with 9 0 cm Emotion 16 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Scan Kernel CTD yoy Effect
92. a gt A checkbox lt Including topogram gt is shown below the parameter grid When the checkbox is selected an information line is added to the parameter grid The line is placed immediately before the ranges belonging to the topogram you might have to scroll to the right side of the line to get the information visible 108 It is possible to insert the Autorange brackets in a selected Multi Range by using the right mouse button and removing the Pause from the protocol You are also able to put a pause into your selected Ranges so you are scanning the ranges seperatly 109 E Workflow Information Scan Parameters Spiral Sequence Multisca CareVision Mixed Mode Mode n Mode Mode Mode mAs X X X X eff mAs X X CARE X X X Dose type Dose X x X modulation Quality Ref X xX X mAs kV X X X X X Slice X X X X X Cycle Time X Rotation X X X X X Time Pitch X Table feed X Scan Time X X X X Scan X X Direction HandCARE X Start Delay X X X X Range Start X X X X X API X X X X API Cluster X Range X X X X X Name Comment X X X X X 110 Workflow Information Recon You can select all recon jobs Sequence Spiral Multi scan and CareVision Scan Entries you want to modify in this subsection of course you can also only select single Recon jobs out of the list Additionally you can display information about the scan range e When lt include scan range information gt is selected an information li
93. adjusted as a rectan gle to your needs but with a lower matrix size and a lower resolution for example RunOff Cardiac recon structions The maximum side ratio is then 1 8 If you use the non square matrix and you extend the side length of your FoV more then the max ratio then the shorter side will be stretched to fit into the ratio again You will find the FoV displayed in the image text for the non square matrix It will be displayed like this FoV X x FoV Y 76 Workflow Information Case Examples for 3D Recon and Non Square Matrix Some scan protocols are delivered with predefined oblique and non square matrix reconstructions These protocols are marked with the suffix VOL Coronal and sagittal reconstruction of the spine Scan a topogram Plan your axial spiral scan range Reconstruction of the spiral images RTR RTD images Select Recon job Type sagittal coronal Select the axial image segment Press button Set FoV Segment Select the Matrix size for example non square 512 and adjust the FoV to your needs Define your desired reconstruction parameters e g image type SPO Start reconstruction Repeat the reconstruction steps for the other orientation sagittal coronal e Oblique reconstruction of the carotid Scan a topogram Plan your spiral scan range Axial reconstruction of the spiral images RTR RTD images Select Recon job Type oblique
94. ale 0 01 mSv e For image reconstruction of soft tissue use kernel B30s B31s 345 E Lower Extremities Overview In this chapter you will find the scan protocol relating to the Lower Extremities region its description indi vidual indications and important hints on using it You can use the following scan protocol to clarify for example masses disorders of the joint and orthope dic indications For SOMATOM Emotion 16 slice configuration Knee Spiral mode for routine joint studies Foot Spiral mode for routine foot studies ExtrRoutineHR Spiral mode for routine high resolution extremity studies ExtrCombi Spiral mode for the combination of thin slice and routine studies 346 Lower Extremities For SOMATOM Emotion 6 slice configuration Knee Spiral mode for routine joint studies Foot Spiral mode for routine wrist studies ExtrRoutineHR Spiral mode for routine high resolution extremity studies ExtrCombi Spiral mode for the combination of thin slice and routine studies 347 Lower Extremities General Hints e Topogram AP 256 mm for joint studies e Patient positioning Depends on the region of examination In general for bilateral studies you should always try to posi tion the patient evenly whenever the patient can comply e For knee scan Patient lying in supine position feet first promote relaxation by placing Bocollo pillows between knees and
95. ale 9 33 mSv Female 10 11 mSv 1 5 mm Vascular Contrast medium IV injection Start delay 10 20 sec Flow rate 3 0 3 5 m sec Total amount 120 150 ml Hints e CARE Bolus may be used to optimize the bolus tim ing e Set the ROI for monitoring scan with triggering threshold of 120 HU or use manual triggering e If Topo length 1024 mm is not long enough you can also choose the 1540 mm long Topogram e Position the patient as feet first Bend the feet together if necessary 415 Specials Overview The examination protocols designed for some of these applications are under the Special folder Trauma In any trauma situation time means life and the qual ity of life for the survivor To facilitate the examina tions five protocols are provided For SOMATOM Emotion 16 slice configuration Trauma This is a one range mode for fast screening TraumaVol This is an one range mode for fast screening for coronal and sagittal studies PolyTrauma This is a combined mode for the examination of mul tiple ranges for example Head Neck Thorax Abdo men and Pelvis HeadTrauma Spiral head protocol for trauma studies with a FoV of 500 and therefore lowered image quality HeadTraumaSeq Sequential head protocol for trauma studies with a FoV of 500 and therefore lowered image quality 416 Specials For SOMATOM Emotion 6 slice configuration PolyTrauma PolyTrauma06s This is a com
96. ality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTDlvoi Effective dose Emotion 6 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTDlvoi Effective dose CarotidAngio 80 40 0 6 sec 16 x 0 6 mm 0 6 mm 3 0mm 14 4mm 1 50 3 0mm B41s 1 28 mGy Male 0 29 mSv Female 0 28 mSv CarotidAngio 80 60 0 8 0 6 sec 6x 1 0 mm 1 0 mm 3 0 mm 9 0 mm 1 50 3 0 mm B41s 1 98 mGy Male 1 79 mSv Female 1 83 mSv 2 4 reconstr 1 0 mm 0 7mm B31s 2 4 reconstr 1 25 mm 0 8 mm B31s The conversion factor for a 7 year old child and a scan range of 170 mm was used 579 Children Contrast medium IV injection Start delay exam dependent Flow rate dependent upon needle size Access site Total 1 2 ml per kg of body weight amount Hints e Children older than age 6 should be scanned with an adult protocol e CARE Bolus may be used to optimize the bolus timing with a triggering threshold of 120 HU or use manual triggering e To work without CARE Dose 4D use for children lt 3 years 100 mAs 3 6 years 150 mAs 580 Children BodyAngioRoutine BodyAngioRoutine06s Indications For abdominal CT Angio studies for example vascular abnormalities aneurysms etc For SOMATOM Emotion 16 slice configurati
97. ample CD or USB stick use RMB menu Send to Drag amp drop and copy paste to any storage device is not possible within the File Browser e To display the main menu set ToggleView Com pact oture ew E I i e X Bbh Eir y Compact view d e AVI files can only be played on the syngo CT Work place e For further information on how to operate the Camtasia tool please refer to the Help menu 159 Application Information Patient Protocol Scan kV mAs ref mAs TI cSL CTD DLP Total DLP Total mAs Patient Protocol 160 number of scan range kilo Volt averaged applied mAs of the range quality ref mAs of the range Rotation Time collimated Slice CTDIw Pitch Factor For further information please refer to the chapter Dose Information Dose Length Product CTDI o_x length collimated slice 10 DLP value of the entire examination actual mAs value of the entire examination Overview In this chapter you will find all scan protocols relating to the Head region their descriptions individual indi cations and important hints on using them You can use the following scan protocols to clarify for example stroke brain tumors cranial trauma cere bral atrophy hydrocephalus and inflammatory changes 162 Head For SOMATOM Emotion 16 slice configuration HeadRoutine Spiral mode for routine head studies HeadNeuro Special spiral mode usi
98. an start the 3D recon struction on your syngo CT Workplace It is also possible to perform the reconstruction with non square matrix 65 Workflow Information Workflow Description WorkStream 4D improves your workflow whenever non axial images of a CT scan are required for example examinations of the spine 3D reconstructions are possible spiral scan is needed as soon as one scan range is finished and at least one axial reconstruction job has been performed RTD or RTR images 3324597 Reon ee Senes dev tot Recon pe toe ma a Rocce a 3 Keene Qi Tw si vanm Popow Di Recon aowwt a to Sages po eres zj Rone an Auto Ti Select a new recon job and mark Recon Job Type 3D on the Recon card The first recon job that is suitable for the 3D reconstruction is used as Available plan ning volumes 66 Workflow Information Additional Important Information Pitch factor for 3D Recon For reconstruction of 3D recon jobs the maximum pitch factor is 1 5 If the pitch factor is gt 1 5 a message window informs you that this 3D recon job cannot be started and may be deleted In this case use the standard 3D task card with an axial image series for reconstruction 67 Workflow Information Three planning segments in perpendicular orienta tions will appear in the upper screen area You can choose between MPR Thick 3 mm and MIP Thin 10 mm as the image type for your planning volume u
99. and attenuation changes within the scan region With the setting of the Image Quality Reference mAs you can adjust image quality image noise to the diagnostic requirements and the individual preference of the radiologist Note The Image Quality Reference mAs should not be adjusted to the individual patient size 48 Dose Information How does CARE Dose 4D work CARE Dose 4D combines two types of tube current modulation 1 Axial tube current modulation Based on a single Topogram a p or lateral the atten uation profile along the patient s long axis is measured in direction of the projection and estimated for the per pendicular direction by a sophisticated algorithm 10000 Lateral 1000 100 10 a D i fe 5 E v gt E lt Scan Range Example of lateral and a p attenuation profile evalu ated from an a p Topogram Based on these attenuation profiles axial tube current profiles lateral and a p and the resulting eff mAs for every table position are calculated The correlation between attenuation and tube current is defined by an analytical function which results in an optimum dose and image noise in every slice of the scan 49 Dose Information 2 Angular tube current modulation Based on the above described axial eff mAs profiles the tube current is modulated during each tube rota tion Therefore the angular attenuation profile is mea sured automatically dur
100. ange all recon ranges will be shown in the topo segment The two numbers on the right hand side at the beginning of each recon range indicate the recon job the range belongs to The first number stands for the scan range the second number stands for the recon job to which the range belongs If no recon job is pending only the scan ranges are shown in the topo segment Only one number on the right hand side at the beginning of each scan range indicates which scan the range belongs to e If the first recon job is saved as an Oblique recon job RTD images are displayed after scanning and the Examination task card is automatically switched to 3D reconstruction e Patient Browser for each double oblique recon job one series is added in the Patient Browser e If Auto Reference Lines is selected the correspond ing reference image is added to the 3D recon series e All reconstructions are performed in the background e Do not use high resolution images e Do not use extended FoV e If no entry is selected in the chronicle all open reconstructions are automatically reconstructed e If Autorecon is selected on the Recon tab card this recon job axial and oblique will be automatically reconstructed after scanning 73 Workflow Information Recon Planning During planning of a 3D recon range the image dis played in the FoV segment will be updated to the new position of the recon start and end position The corresponding referenc
101. aphy edited by Hans Dieter Nagel published by COCIR c o ZVEI Stresemannallee 19 D 60596 Frankfurt Ger many 44 Dose Information Effective mAs In sequential scanning the dose D q applied to the patient is the product of the tube current time mAs and the CTDly per mAs Dseq DcTpiw X MAS In spiral scanning however the applied dose D pirai iS influenced by the conventional mAs mA x Rot Time and additionally by the pitch factor For example if a Multislice CT scanner is used the actual dose applied to the patient in spiral scanning will be decreased when the pitch factor is greater than 1 and increased when the pitch factor is less than 1 for constant mA Therefore the dose in spiral scanning has to be cor rected by the pitch factor Dspiral Dctpiw X MA x Rot Time Pitch Factor To simplify this task the concept of the effective mAs was introduced with the SOMATOM Multislice scan ners The effective mAs takes into account the influence of pitch on both the image quality and dose Effective mAs mAs Pitch Factor To calculate the dose you simply multiply the CTDl per mAs with the effective mAs of the scan Dostel Dcr pw X effective mAs 45 Dose Information For spiral scan protocols the indicated mAs is the effective mAs per image The correlation between tube current and effective mAs of spiral scans on a Multi slice CT scanner is expressed by the following formula
102. are not longer necessary Body Kernels e As standard kernels for body tissue studies B30s or B40s are recommended softer images are obtained with B20s or B10s extremely soft The kernels B31s or B41s have about the same visual sharpness as B30s respectively B40s the image appearance however is more agreeable due to a fine grained noise structure quite often the low contrast detect ability is improved by using B31s B41s instead of B30s B40s For higher sharpness as is required e g in patient protocols for cervical spine shoulder extremities thorax lung the kernels B50s B60s B7Os B80s are available 297 a Spine Scan Protocols C Spine Indications Spiral mode for cervical spine studies e g prolapse degenerative changes trauma tumors etc For SOMATOM Emotion 16 slice configuration A range of 15 cm will be covered in 21 53 sec For SOMATOM Emotion 6 slice configuration A range of 15 cm will be covered in 31 41 sec 298 Spine Emotion 16 kV Effective mAs Quality ref mAs Rotation Time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTDIvo Effective dose Emotion 6 kV Effective mAs Quality ref mAs Rotation Time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTDIvo Effective dose C Spine 2 4 recon 130 150 1 0 sec 16x0 6mm 0 6 mm 2 0mm 1 0 mm 7 7 mm 0 80 2
103. are saved depending on con figuration e Conf 1ima s Central image after 1st second Central image after 2nd second Central image after 3rd second Central image after 3 5 seconds last All together 4 images e Conf 1ima s last 3 CARE View images Central image after 1st second Central image after 2nd second Central image after 3rd second Head Central Feet images after 3 5 seconds All together 6 images e Conf 1 3ima s Head Central Feet images after 1st second Head Central Feet images after 2nd second Head Central Feet images after 3rd second Head Central Feet images after 3 5 seconds All together 12 images Auto load You have the possibility to turn the CARE Vision auto on The system will then automatically load the CARE Vision Mode and display the axial images so that you can plan on which table position you want to perform your interventional procedure by using the Move table position to displayed image position function If you prefer to reconstruct the images first you can switch this function off 457 Specials Routine Subtask card Move table scanrange to displayed image position The function Move Table Scanrange to displayed image position in the Routine subtask card allows you to move the table to the position of the displayed tomo image in the selected segment If you use the CARE View Mode you can use the Head of th
104. ate a new protocol name and will not alter any of the existing protocols already stored If you want to save an old protocol again you may have to modify the protocol name The old protocol with the old name must be cancelled explicitly 97 Workflow Information Additional important information e You can save your scan protocol at any time during the examination It is recommended that you save your own scan pro tocol under a new name in order to avoid overwrit ing the default scan protocol e Do not use special characters or blanks Allowed are all numbers from 0 to 9 all characters from A to Z and a to z and explicitly the _ under score but no country specific characters for example a a fi Do not rename scan protocol files at Windows level This will lead to inconsistencies e You can now save your own scan protocols in any pre defined folder The organ characteristics will belong to the scan protocol not to the region In the Patient Model Dialog the modified scan pro tocols are marked by a dot in front of the protocol Scan Protocol Assistant If you want to modify special parameters for several existing scan protocols or you want to modify the folder structure we recommend doing this in the Scan Protocol Assistant You will find the Scan Protocol Assistant under Options gt Configuration in the main menu 98 Workflow Information Step 1 What do you want to do Four d
105. ation Slice width Feed Rotation Pitch Factor Increment Kernel CTDlyoi Effective dose Emotion 6 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTDlyoi Effective dose AbdCombi 130 130 0 6 sec 16 x 0 6 mm 0 6 mm 5 0 mm 14 4 mm 1 50 5 0 mm B41s 16 25 mGy Male 6 66 mSv Female 8 09 mSv AbdCombi 130 130 120 0 8 0 6 sec 6x 1 0 mm 1 0 mm 5 0 mm 9 0 mm 1 50 5 0 mm B41s 16 51 15 24 mGy 2 4 reconstr 1 0 mm 0 7 mm B41s 2 4 reconstr 1 25 mm 0 8 mm B41s Male 6 32 5 84 mSv Female 7 85 7 25mSv 271 Abdomen Contrast medium IV injection Start delay 50 65 sec Flow rate 3 0 ml sec Total amount 100 ml Hints e You could repeat the same protocol simply by click ing the chronicle with the right mouse button for repeat E g when both non contrast and contrast studies are required e Delayed scans may be required for the kidneys amp bladder If you want to use this protocol for a two phase study repeat the same protocol as mentioned below and choose start delay time for arterial phase as 20 25 sec In this case the thin slice reconstruc tion can also be used for post processing Do not administer oral contrast medium as this impairs the editing of MIP SSD VRT images Water could be used instead if necessary Water rather than positive oral contras
106. be used for patients with arrhythmic breathing and irregular respiratory rates and the affin ity to cough and to sigh 494 Respiratory Gating Curve Editor The respiration curve editor is used to modify the res piratory signal This editing tool is available after spiral scan data has been acquired By using the right mouse menu on the Trigger tabcard you have access to several modification tools for the respiratory Syncs purple dots above and below the curve such as Delete Dis able Insert In patients with only single or few extra respiratory peaks caused e g by coughing and sighing overall image quality may be improved by editing the respiratory curve prior to reconstruction Deleting the corresponding respiratory peaks prevents image reconstruction in the periods of coughing or arrhyth mic breathing Although respiratory gated spiral scan ning is less sensitive to variable respiratory rates than respiratory triggered sequential scanning the exami nation of patients with arrhythmic breathing that results in unpredictable variations of the respiratory cycles can result in limited image quality and should be performed in exceptional cases only 495 The recorded Respiration curve can be edited similar to the ECG Trace editing in Cardiac CT Inspiration Syncs can be deleted disabled and inserted Expiration Syncs can be deleted disabled and inserted BE iz a A a A a Ss Wes mi 496 Respiratory Gatin
107. bined mode for the examination of mul tiple ranges for example Head Neck Thorax Abdo men and Pelvis HeadTrauma Spiral head protocol for trauma studies with a FoV of 500 and therefore lowered image quality HeadTraumaSeq Sequential head protocol for trauma studies with a FoV of 500 and therefore lowered image quality 417 Specials Interventional CT For SOMATOM Emotion 16 slice configuration Biopsy This is the multislice biopsy mode With three times 4 8 mm the images will be reconstructed and dis played for each scan BiopsySingle This is a single multislice biopsy mode One 10mm slice is aquired CARE Vision The CARE Vision protocol is a spiral mode without table feed using a three times 4 8 mm slice thick ness CARE VisionSingle The CARE Vision protocol is a spiral mode without table feed using a 10 mm slice thickness CARE VisionBone The CARE Vision protocol is a spiral mode without table feed using a three times 4 8 mm slice thick ness with a bone kernel 418 Specials For SOMATOM Emotion 6 slice configuration Biopsy This is the multislice biopsy mode With three times 6 0 mm the images will be reconstructed and dis played for each scan BiopsySingle This is a single multislice biopsy mode One 10mm slice is aquired CARE Vision The CARE Vision protocol is a spiral mode without table feed using a three times 6 0 mm slice thick ness CARE Visio
108. bone studies for the cervical spine SpineRoutine Spiral mode for routine lumbar and thoracic spine studies 294 Spine SpineVol Spiral mode for axial and sagittal lumbar and tho racic spine studies SpineSeq Sequential mode for lumbar and thoracic evaluation of the discs Osteo Sequential mode used for the application syngo Osteo CT For SOMATOM Emotion 6 slice configuration C Spine Spiral mode for cervical spine studies C SpineVol Spiral mode for axial sagittal soft tissue and sagittal bone studies for the cervical spine SpineRoutine Spiral mode for routine lumbar and thoracic spine studies SpineVol Spiral mode for axial and sagittal lumbar and tho racic spine studies SpineThinSlice Spiral mode for thin slice lumbar and thoracic spine studies SpineSeq Sequential mode for lumbar and thoracic evaluation of the discs Osteo Sequential mode used for the application syngo Osteo CT 295 Spine General Hints e Topogram Lateral 512 mm for thoracic and lumbar spine and 256 mm for the C spine Patient positioning for thoracic and lumbar spine studies Patient lying in supine position arms positioned comfortably above the head in the head arm rest lower legs supported Patient positioning for cervical spine studies Patient lying in supine position hyperextend neck slightly secure head well in head holder Patient respiratory instruction do not breath
109. c Flow rate 3 5 ml sec Total amount 75 ml Hint e Use of CARE Bolus with monitoring scans positioned at the level of the basilar artery or carotid artery Set the trigger threshold at 120 HU or use manual trig gering 368 369 Vascular HeadAngioVol Indications Spiral mode for cerebral CT Angio studies e g cerebral vascu lar abnormalities tumors and follow up studies etc Two recon jobs are predefined for reconstruction the first for axial the second for coronal studies in 3D images display view The coronal view images will be reconstructed as MIP images For SOMATOM Emotion 16 slice configuration A range of 8 0 cm will be covered in 7 45 sec For SOMATOM Emotion 6 slice configuration A range of 8 0 cm will be covered in 14 15 sec Emotion 16 HeadAngio 27d reconstr kV 110 Effective mAs 70 Quality ref mAs Rotation time 0 6 sec Acquisition 16 x 0 6 mm Slice collimation 0 6mm Slice width 3 0mm 4 0mm Feed Rotation 7 7mm Pitch Factor 0 80 Increment 3 0mm 4 0mm Kernel H31s H20s CTDhya 12 46 mGy Effective dose Male 0 43 mSv Female 0 48 mSv 370 Vascular Emotion 6 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTDlyoi Effective dose HeadAngio 2 4 reconstr 110 70 0 8 sec 6x 1 0 mm 1 0 mm 3 0 mm 4 0 mm 5 1 mm 0 85 3 0 mm 4 0 mm H31s H20s 12 88 mGy Male
110. c Flow rate 2 5 ml sec Total amount 80 ml Hints e CARE Bolus may be used to optimize the bolus tim ing Set the ROI for monitoring scan in the aortic arch with triggering threshold of 120 HU or use manual triggering Thick MPRs and ThinMIPs can be created very quickly on the 3D Task Card by just clicking on the appropri ate icons The thickness of these reconstructed images can be defined by clicking on the icons with the right mouse to open the entry field Editing is necessary for SSD display of the thoracic aorta without the bone 386 387 Vascular ThorAngioECG ThorAngioECGO6s Indications This is a spiral scanning protocol using a collimation of 1 2 mm and an ECG gating technique for thorax CTAn gio studies For SOMATOM Emotion 16 slice configuration A range of 25 cm will be covered in 18 13 sec For SOMATOM Emotion 6 A range of 15 cm will be covered in 19 95 sec 388 Vascular Emotion 16 kV Effective mAs Quality ref mAs Rotation Time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel Temp resolution CTDly Effective dose ThorAngioECG 130 280 0 5 sec 16x1 2 mm 1 2 mm 3 0 mm 7 3 mm 0 38 3 0 mm B31s up to 125 ms 31 36 mGy Male 13 88 mSv 24 reconstr 1 5 mm 0 8 mm B31s Female 18 66 mSv depends on heart rate 389 Vascular Emotion 6 kV Effective mAs Quality ref mAs Rotation Time Acquisit
111. ce thickness should be lt 5 mm and the length of the range should be adapted to match the anatomic region e Target the FoV to ensure adequate coverage of the region of interest in the upper neck amp middle neck levels as well as to include the axilla in the lower neck level if required 216 217 Shoulder Overview In this chapter you will find all scan protocols relating to the Shoulder region their descriptions individual indications and important hints on using them You can use the following scan protocols to clarify for example masses trauma dislocations and orthope dic indications For SOMATOM Emotion 16 slice configuration Shoulder Spiral mode for bone shoulder routine studies ShoulderVol Spiral mode for axial coronal and sagittal shoulder studies For SOMATOM Emotion 6 slice configuration Shoulder Spiral mode for bone shoulder routine studies ShoulderVol Spiral mode for axial coronal and sagittal shoulder studies 218 Shoulder General Hints e Topogram AP 256 mm e Patient positioning Patient lying in supine position the uninjured arm placed above the head the injured arm placed flat against his body If only one side is under investiga tion position this side in the center and support the other side with a Bocollo pillow optional e If only one side is examined it is advisable to enter the side in the comment line on the routine card Contrast m
112. cols from SOMATOM LifeNet CD P Contrast Medium Contrast Medium The Basics IV Injection Bolus Tracking Test Bolus using CARE Bolus Test Bolus CARE Contrast Application Information SOMATOM LifeNet General Information Key Features SOMATOM LifeNet offline SOMATOM LifeNet online e Image Converter Report Template Configuration File Browser Camtasia Key features Additional Important Information Patient Protocol H Head Overview General Hints Head Kernels Scan Protocols HeadRoutine HeadNeuro HeadSeq InnerEarHR 103 117 122 122 122 125 126 128 129 130 136 136 136 137 138 140 147 150 151 155 155 159 160 162 162 165 166 168 168 172 174 177 Contents InnerEarHRVol InnerEar InnerEarSeq Sinus SinusVol Orbit Dental a Neck Overview General Hints Body Kernels e Scan Protocols NeckRoutine NeckThinSlice NeckVol Shoulder Overview General Hints Body Kernels e Scan Protocols Shoulder ShoulderVol I Thorax Overview General Hints Body Kernels Scan Protocols ThoraxRoutine ThoraxRoutineO6s ThoraxCombi ThoraxCombi06s ThoraxVol ThoraxFast 180 184 188 192 196 198 200 204 204 206 207 208 208 212 214 218 218 219 219 220 220 224 226 226 229 231 232 232 235 240 Contents E Abdomen ThoraxFast06s Tho
113. configuration A typical range of 10 cm will be covered in 13 11 sec Two recon jobs are predefined for reconstruction the first for axial the second for coronal studies in 3D images display view Emotion 16 Hip 2 4 reconstr kV 130 Effective mAs 100 Quality ref mAs Rotation time 1 0 sec Acquisition 16 x 0 6 mm Slice collimation 0 6mm Slice width 5 0mm 5 0 mm Feed Rotation 14 4 mm Pitch Factor 1 50 Increment 5 0 mm 5 0 mm Kernel B70s B60s CTDlyo 12 50 mGy Effective Dose 328 Male 2 31 mSv Female 5 93 mSv Pelvis Emotion 6 Hip 27d reconstr kV 130 Effective mAs 100 Quality ref mAs Rotation time 1 0 sec Acquisition 6x 1 0mm Slice collimation 1 0mm Slice width 5 0 mm 5 0 mm Feed Rotation 9 0 mm Pitch Factor 1 50 Increment 5 0 mm 5 0 mm Kernel B70s B60s CTD yoy 12 70 mGy Effective Dose Male 3 60 mSv Female 3 16 mSv Hint e In case of 3D study only images should be recon structed with at least 50 overlapping and kernel B10 e If only one side is examined it is advisable to enter the side in the comment line on the routine card 329 Pelvis SI_Joints Indications Spiral mode for bone studies of the sacral iliac joints e g evaluation of joint cavity masses trauma dyspla sia necrosis congruence evaluations orthopedic indi cations etc For SOMATOM Emotion 16 slice configuration A typical range of 8 cm will be covered in 7 56 sec For SOMATOM Emotion 6 s
114. cquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTD yoy Effective dose SpineThinSlice 24 reconstr 110 78 1 0 sec 6x1 0 mm 1 0 mm 2 0 mm 1 25 mm 3 3 mm 0 55 2 0 mm B41s 6 47 mGy Male 2 55 mSv Female 3 02 mSv 0 8 mm B60s The conversion factor for a 7 year old child and a scan range of 160 mm was used 566 Children Hints e Children with a body weight of more than 55 kg should be examined with an adult protocol e To work without CARE Dose 4D use for children lt 25 kg 40 mAs 25 34 kg 70 mAs 35 54 kg 90 mAs 567 Children ExtrRoutineHR Indications Spiral mode for high resolution bone studies for example tumors post traumatic changes orthopedic indications etc For SOMATOM Emotion 16 slice configuration A typical range of 6 cm covered in 35 33 sec For SOMATOM Emotion 6 slice configuration A typical range of 10 cm covered in 35 33 sec Emotion 16 ExtrHR kV 110 Effective mAs 50 Quality ref mAs Rotation time 1 0 sec Acquisition 4x0 6mm Slice collimation 0 6 mm Slice width 0 6 mm Feed Rotation 1 8mm Pitch Factor 0 75 Increment 0 4mm Kernel U90s CTDly 4 70 mGy Effective dose Male 0 01 mSv Female 0 01 mSv The conversion factor for a 7 year old child and a scan range of 60 mm was used Adjust the mAs value to the body region 568 Children Emotion 6 kV Effective mAs Quality ref mAs Rotatio
115. culi in the common bile duct and to visu alize possible lesions in the liver e For pancreatic studies the arterial phase acquisition can be acquired later with a start delay of 40 50 sec It may be necessary to use a thinner collimation 276 277 7 Abdomen AbdomenFast AbdomenFast06s Indications Fast spiral mode for abdominal studies e g when a patient has difficulty with breathhold For the SOMATOM Emotion 6 slice configuration A range of 20 cm will be covered in 5 64 sec with AbdomenFast06s Emotion 6 AbdFast kV 130 Effective mAs 120 Quality ref mAs Rotation time 0 8 0 6 sec Acquisition 6 x 3 0mm Slice collimation 3 0mm Slice width 6 0mm Feed Rotation 27 0mm Pitch Factor 1 50 Increment 6 0 mm Kernel B41s CTDlyoi 12 24 mGy Effective dose 278 Male 5 34 mSv Female 6 91 mSv Abdomen Contrast medium IV injection Start delay 25 30 sec Flow rate 2 5 ml sec Total amount 80 ml Hints e You could repeat the same protocol simply by click ing the chronicle with the right mouse button for repeat E g when both non contrast and contrast studies are required Delayed scans may be required for the kidneys amp bladder If you want to use this protocol for a two phase study repeat the same protocol as mentioned below and choose start delay time for arterial phase as 20 25 sec In this case the thin slice reconstruc tion can also be used for post processing Do not
116. dren InnerEarHR Indications Spiral mode for high resolution inner ear studies for example malformations of the inner ear inflamma tory changes pathologies of the mastoid process tumor processes of the pyramids post traumatic changes etc Note Same as for adults except for the FoV of 300 For SOMATOM Emotion 16 slice configuration A typical range of 4 0 cm covered in 24 22 sec For SOMATOM Emotion 6 slice configuration A typical range of 4 0 cm covered in 17 69 sec 526 Children Emotion 16 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTDlvoi Effective dose Emotion 6 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTDlvoi Effective dose InnerEar 110 50 1 0 sec 4x0 6mm 0 6 mm 0 6 mm 1 8 mm 0 75 0 4 mm H90s 10 30 mGy Male 0 25 mSv Female 0 25 mSv InnerEar 110 90 1 0 sec 6x0 5mm 0 5mm 0 6 mm 2 6mm 0 85 0 5mm H90s 17 19 mGy Male 0 12 mSv Female 0 11 mSv The conversion factor for a 7 year old child and a scan range of 45 mm was used 527 Children Contrast medium IV injection Startdelay exam dependent Flow rate dependent upon needle size Access site Total 1 2 ml per kg of body weight amount Hints e Children who are older than age 6 should be
117. dth Feed Rotation Pitch Factor Increment Kernel CTDlyo Effective dose 178 InnerEar 130 130 1 0 sec 4x0 6mm 0 6 mm 2 0mm 1 1 mm 0 45 2 0 mm H90s 38 35 mGy Male 0 74 mSv Female 0 78 mSv InnerEar 130 130 1 0 sec 6x0 5mm 0 5mm 2 0mm 2 6mm 0 85 2 0mm H90s 35 88 mGy Male 0 57 mSv Female 0 59 mSv 2nd reconstr 0 75 mm 0 6mm H90s 2nd reconstr 0 6 mm 0 4 mm H90s Head Hints e For image reconstruction of soft tissue use kernel H30s H31s e An automatic bone correction allows for improved head image quality without any additional postpro cessing e In order to optimize image quality versus radiation dose scans are provided within a maximum scan field of 300 mm with respect to the iso center No recon job with a field of view exceeding those limits will be possible Therefore patient positioning has to be performed accurately to ensure a centered loca tion of the skull 179 Head InnerEarHRVol Indications Spiral mode for high resolution inner ear studies e g malformations of the inner ear inflammatory changes pathologies of the mastoid process tumor processes of the pyramids posttraumatic changes etc Three recon jobs are predefined for reconstruction the first for axial bone structure the second and third for the double oblique for each side in 3D images display view For SOMATION Emotion 16 slice configuration A range of 40 mm will
118. e for routine studies Seq for sequence studies Fast use a higher pitch for fast acquisition ThinSlice use a thinner slice collimation Combi use a thinner and a thicker slice collimation 05s use the rotation time of 0 5 seconds ECG use a ECG gated or triggered mode Neuro for neurologicial examinations with a special mode Vol use the 3D Recon workflow HR use a thin slice width for High Resolution studies A prefix of the protocol name is as follows RT for radio therapy studies The availability of scan protocols depends on the sys tem configuration Resp for respiratory gated studies The availability of scan protocols depends on the sys tem configuration 18 Scan and Reconstruction 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 chron icle 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 Feed in Feed out The performance of the different buttons soft but tons gantry buttons control box buttons is standard ized as follows e in NOT loaded modes 1mm e in loaded Biopsy mode Feed In Out slice width x No slic
119. e do not swallow Any possible injuries to the spinal column should be determined before beginning the examination and taken into account when repositioning the patient e In case of 3D study only images should be recon structed with at least 50 overlapping and kernel B10 In case of SSD study only mAs value can be reduced by 50 Use kernel B10 and 50 overlapping image reconstruction e For lumbar studies place a cushion under the patient s knees This will reduce the curve in the spine and also make the patient more comfortable e For image reconstruction of bone study use kernel B60 e The CT scan following myelography must be per formed within 4 6 hours of the injection otherwise the contrast density in the spinal canal will be too high to obtain artifact free images Also if possible it is a good idea to roll the patient once or scan in a prone position This will prevent the contrast from pooling posterior to the spinal cord e If a prone scan is performed breathing instructions are recommended to avoid motion artifact in axial source and MPR images 296 Spine e To further optimize MPR image quality we recom mend that you reduce one or more of the following collimation reconstruction increment and slice width for image reconstruction e With CAREDose 4D the mA values are adapted for each osteo range according to the patient diameter Therefore special obese protocols for the osteo eval uation
120. e Feet image for adjusting your table position as well Incremental continuous table movement You can switch between incremental and continuous table movement while the scan is loaded the default step size will be changed according to the chosen slice thickness default is always half the current slice thick ness but adapt the increment in 0 5 steps Biopsy Icon In the Routine subtask card you will find a button for switching on the biopsy Mode for every sequential scan protocol The box where you can define if you want to scan cranio caudal or caudo cranial will then change and you can decide if you want to move the table with an incremental or continuous table move ment Then the interventional Toolbar will be available as well Move table top only If you want to only move the Table top and have the Top Support fixed you can use the function Move table top only in the Routine Card Make sure that the Top Support table is completely out 458 Specials Additional Important Information Independently from the Interventional Window but tons on the Interventional Toolbar you can use for faster windowing the function keys F2 F3 and F4 are implemented with standard window settings for Abdo men Lung and Bone Modifying them is possible under Options gt Configuration gt Examination gt Win dowing If you repeat a CARE Vision or Biopsy scan range the window setting last used will be applied to your new images Ins
121. e covered in 20 05 sec For SOMATOM Emotion 6 slice configuration A scan range of 12 cm will be covered in 30 27 sec Emotion 16 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTDhya Effective dose 430 1 5 sec 16x1 2 mm 1 2 mm 6 0 mm 10 6 mm 0 55 6 0 mm H31s 57 60 mGy Male 2 63 mSv Female 2 88 mSv 2 4 reconstr 6 0 mm 6 0 mm H60s Specials Emotion 6 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTDlyoi Effective dose Head 130 250 1 5 sec 6 x 2 0 mm 2 0 mm 6 0 mm 6 6 mm 0 55 6 0 mm H31s 58 75 mGy Male 2 76 mSv Female 2 98 mSv 2 4 reconstr 6 0 mm 6 0 mm H60s 431 Specials HeadTraumaSeq A sequence mode for emergency head studies with a max FoV of 500 mm For SOMATOM Emotion 16 slice configuration A scan range is predefined with 12 5 cm For SOMATOM Emotion 6 slice configuration A scan range is predefined with 12 0 cm Emotion 16 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Scan Kernel CTDho Effective dose 432 HeadSeq 130 270 1 5 sec 2x5 0 mm 5 0 mm 5 0 mm 10 0 mm H31s 58 32 mGy Male 2 55 mSv Female 2 81 mSv 5 0 mm 10 0 mm H60s Specials Emotion 6 kV
122. e decrease for slim patients or patient sections has to be stronger than the preset choose slim strong decrease resulting in more image noise and a lower dose for those images if the automatic dose decrease for slim patients or patient sections has to be more moderate than the preset choose slim weak decrease resulting in less image noise and a higher dose for those images On the Patient tab card you can adjust the image qual ity for more information see chapter How does CARE Dose 4D work Note Changing this adaptation strength effects all protocols 60 Dose Information Activating and Deactivating CARE Dose 4D may be activated or deactivated for the current scan in the Scan tab card If CARE Dose 4D is activated as default the Image Quality Reference mAs value is set to the default value of the protocol After deactivating CARE Dose 4D the Image Quality Reference mAs is dimmed and the eff mAs value has to be adjusted to the individual patient s size If CARE Dose 4D is switched on again the Image Quality Reference mAs is reactivated Note that the last setting of the Image Quality Reference mAs or the eff mAs will be restored when you switch from and back to CARE Dose 4D usage The default activation state of CARE Dose 4D may be set in the Scan Protocol Man ager CARE Dose 4D must be selected column CARE Dose type The corresponding column for activating CARE Dose 4D is called CARE Dose 4D wit
123. e for routine spiral studies of the sinuses and paranasal sinuses for example sinusitis pneuma tization polyposis malformations tumors etc Spiral mode for routine studies of the orbitae for example fracture For SOMATOM Emotion 16 slice configuration A typical range of 6 cm covered in 9 81 sec For SOMATOM Emotion 6 slice configuration A typical range of 4 cm covered in 9 84 sec 538 Children Emotion 16 Sinus 24 3rd 4th Orbi recon recon recon kV 110 Effective 50 mAs Quality ref mAs Rotation 1 0 sec time Acquisition 16x0 6mm Slice 0 6 mm collimation Slice width 3 0mm 3 0mm 1 0mm 1 0mm Feed 7 7mm Rotation Pitch Factor 0 80 Increment 3 0mm 3 0mm 0 7mm _ 0 7mm Kernel C60s C30s C60s C30s CTDlyoi 8 90 mGy Effective Male 0 29 mSv dose Female 0 31 mSv 539 Children Emotion6 Sinus 2nd 3rd 4th Orbi recon recon recon kV 110 Effective 50 mAs Quality ref mAs Rotation 1 0 sec time Acquisition 6x 1 0mm Slice 1 0 mm collimation Slice width 3 0mm 3 0mm 1 25 1 25 mm mm Feed 5 1 mm Rotation Pitch 0 85 Factor Increment 3 0mm 3 0mm 0 8mm 0 8mm Kernel C60s C30s C60s C30s CTDlyoi 9 20 mGy Effective Male 0 04 mSv dose Female 0 04 mSv The conversion factor for a 7 year old child and a scan range of 60 mm was used 540 Children Contrast medium IV injection Start delay exam dependent Flow rate dependent upon needle size Access site
124. e line displayed in both planning segments is the reference line to the actual image displayed in the FoV segment One click on the start or end position of the recon range displays either the reference image to the start position of the recon range or the reference image to the end position of the recon range in the FoV seg ment Case Examples Some scan protocols are supplied with predefined oblique reconstructions These protocols are marked with the suffix VOL Coronal and sagittal reconstruction of the spine Scan a topogram Plan your axial spiral scan range Reconstruction of the spiral images RT images Select Recon job Type sagittal coronal Select the axial image segment Press button Set FoV Segment Adjust the FoV to your needs Define your desired reconstruction parameters for example image type SPO Start reconstruction Repeat the reconstruction steps for the other orientation sagittal coronal 74 Workflow Information e Oblique reconstruction of the sinuses Scan a topogram Plan your axial spiral scan range Reconstruction of the spiral images RT images Select Recon job Type oblique Select the sagittal image segment Enable Free Mode Rotate the reference lines until the best view of the sinuses is displayed in one of the other segments Select this segment and press the Set FoV Seg ment button Adjust the Fo
125. e mAs Quality ref mAs Rotation Time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTDlyo Effective dose AbdCombi 130 130 0 8 6x7 0mm 1 0 mm 5 0 mm 9 0 mm 1 50 5 0 mm B41s 16 51 mGy Male 6 32 mSv Female 7 85 mSv Contrast medium IV injection Start delay Flow rate Total amount 50 65 sec 3 0 ml sec 100 ml 2 4 recon 5 0 mm 5 0 mm B30s 275 Abdomen Hints e You could repeat the same protocol simply by click ing the chronicle with the right mouse button for repeat E g when both non contrast and contrast studies are required e Delayed scans may be required for the kidneys amp bladder If you want to use this protocol for a two phase study repeat the same protocol as mentioned below and choose start delay time for arterial phase as 20 25 sec In this case the thin slice reconstruc tion can also be used for post processing Do not administer oral contrast medium as this impairs the editing of MIP SSD VRT images Water could be used instead if necessary Water rather than positive oral contrast agents should be used Give the last cup 200 ml just prior to positioning the patient To ensure adequate filling of the duodenal loop lay the patient on the right side for 5 minutes before performing the topogram e A pre contrast examination is usually performed only if no CT scans were previously acquired to exclude cal
126. e positions per scan 2 19 1 Scan and Reconstruction Topo Length SOMATOM Emotion 16 Length mm 128 256 512 768 1024 1500 Slice width mm 4x0 6 Angle Top Bottom Lateral SOMATOM Emotion 6 Length mm 128 256 512 768 1024 1500 1536 2000 2048 Slice width mm 3x1 Angle AP PA Lateral only in combination with PET and SPECT option only in combination with SPECT option only in combination with PET option 20 Scan and Reconstruction Scan Modes Sequential Scanning This is an incremental slice by slice imaging mode in which there is no table movement during data acquisi tion 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 per formed 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 recon structed at any arbitrary slice position Unlike the sequence mode spiral scanning does not require addi tional radiation to obtain overlapping slices 21 Scan and Reconstruction Quick Scan The data is usually acquired during a full 360 rotation this is a Full scan Data acquisition not using a full 360 rotation
127. e skull 182 183 Head InnerEar Indications Spiral mode for inner ear studies e g inflammatory changes tumorous processes of pyramids cerebel lopontine angle tumors post traumatic changes etc For SOMATOM Emotion 16 slice configuration A range of 4 cm will be covered in 7 21 sec For SOMATOM Emotion 6 slice configuration A range of 4 cm will be covered in 9 84 sec 184 Head Emotion 16 kV Effective mAs Quality ref mAs Rotation Time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTDl o Effective dose Emotion 6 kV Effective mAs Quality ref mAs Rotation Time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTD yo Effective dose InnerEar 130 120 1 0 sec 16x 0 6mm 0 6 mm 2 0mm 7 7mm 0 80 2 0mm H90s 31 92 mGy Male 0 77 mSv Female 0 83 mSv InnerEar 130 120 1 0 sec 6x7 0mm 1 0 mm 2 0 mm 5 1 mm 0 85 2 0 mm H90s 33 00 mGy Male 0 57 mSv Female 0 60 mSv 2nd reconstr 0 75 mm 0 5mm H90s 2nd reconstr 1 25 mm 0 8 mm H90s 185 Head Contrast medium IV injection Start delay 60 sec Flow rate 2 mi sec Total amount 50 ml Hints e For image reconstruction of soft tissue use kernel H30s H31s e An automatic bone correction allows for improved head image quality without any additional postpro cessing e In order to optimi
128. eO6s Spiral mode for three phases liver studies AbdomenSeq Sequential mode for abdominal studies Colonography Colonography06s Spiral mode used for the application syngo Colonography 263 Abdomen General Hints e Topogram AP 512 e Patient positioning Patient lying in supine position arms positioned comfortably above the head in the head arm rest lower legs supported Patient respiratory instruction inspiration e Oral administration of contrast medium For abdominal studies it is necessary to delineate the bowel from other structures such as lymph nodes abdominal masses amp abscesses Various types of bowel opacifying agents can be used Diluted barium suspension 1 2 e g EZCAT Water soluble agent 2 4 e g Gastrografin Water alone as a negative contrast agent Timing of the oral contrast administration is important to ensure its even distribution in the bowel Upper abdomen Minimum 600 ml of contrast divided into 3 cups approximately 200 250 ml 15t cup to drink 30 minutes before exam 27d cup to drink 15 minutes before exam 3 cup to drink 5 minutes before exam Abdomen Pelvis Minimum 1000 ml of contrast divided into 4 cups 1stcup to drink 1hour before exam 244th cups every subsequent 15 minutes Start exam 5 minutes after the 4 cup is administered 264 Abdomen In general for abdominal studies such as liver gall bladder query stones pancreas gastrointestinal studie
129. ea will be accessible and over a drop down menu task specific instructions are selectable 106 Workflow Information Topogram Select single scan protocol or all scan protocols you want to modify in this subsection In the subsection topogram the following changes can be made mA Set the mA value for the topogram Topogram length All available topo lengths are listed in the dropdown list Tube position Set the tube position either to Top or Lateral kV Can be defined individually to the Scan value Auto transfer modes Sends images automatically Auto Viewing and Filming Loads images automatically into the Viewing or Film ing card API Select one of the predefined breathing commands from the dropdown list Scan direction Select Head to Feed or Feed to Head from the drop down list 107 Workflow Information Scan Select single scan protocol or all scan protocols you want to modify in this subsection Additionally you can select the scan mode entries Sequence Spiral Multiscan CAREVision The displayed parameters depend on the selection you have made e If no special scan mode is selected the so called mixed mode is active The mixed mode means the user can choose scan ranges from different modes Spiral Sequence Multiscan or CAREVi sion modes If the control in one mode is not appli cable the control in mixed mode is not shown in lt Parameters Are
130. eadNeuro using an acquisition 16 x 0 6 mm in the base and an acquisition of 4 x 0 6 mm in the cere brum We recommend using this special protocol for dedi cated Neuro examinations For fast standard examinations such as rule out of hemorrhage or ischemia the Routine protocol should be used 37 Scan and Reconstruction Automatic Bone Correction The head protocols provide significant improvements regarding image quality for heads An automatic bone correction algorithm has been included in the standard image reconstruction Using a new iterative technique typical artifacts arising from the beam hardening effect for example Hounsfield bar are minimized without additional post processing This advanced algorithm produces excellent images of the posterior fossa but also improves head image quality in general Bone correction is activated automatically for body region Head The reconstruction algorithm for Head also employs special adaptive convolution kernels which help to improve the sharpness to noise ratio More precisely anatomic contours are clearly dis played while noise is suppressed at the same time without causing a blurring of edges Head image without Head image with correction corrections 38 Scan and Reconstruction Positioning In order to optimize image quality versus radiation dose scans in body regions Head and AngioHead are provided within a maximum scan field of 300 mm
131. ed Scan Kernel CTDIvo Effective dose Emotion 6 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Scan Kernel CTDIvo Effective dose ThoraxHRSeq 110 36 1 0 sec 4x0 6mm 0 6 mm 1 2 mm 10 0 mm B90s 0 81 mGy Male 0 31 mSv Female 0 39 mSv ThoraxHRSeq 110 36 1 0 sec 1x1 0 mm 1 0 mm 1 0 mm 10 0 mm B90s 0 24 mGy Male 0 20 mSv Female 0 24 mSv The conversion factor for a 7 year old child and a scan range of 200 mm was used 5959 Children Hints e Children with a body weight of more than 55 kg should be examined with an adult protocol e If you want to acquire the patient at full inspiration or full expiration you should practice breathing with the patient a few times before beginning the scan to improve reproductbility e To work without CARE Dose 4D use for children lt 35 kg 30 mAs 35 54 kg 40 mAs 556 557 Children AbdomenRoutine AbdomenRoutine06s Indications Spiral mode for routine studies in the region of abdo men and pelvis for example tumors lymphoma abscesses post traumatic changes etc For SOMATOM Emotion 16 slice configuration A typical range of 20 0 cm covered in 5 37 sec For SOMATOM Emotion 6 slice configuration A typical range of 30 0 cm covered in 11 20 sec 558 Children Emotion 16 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation
132. ed gantry opening and its scan plane located only 35cm from the gantry front Using the external laser markers and the connected workstations the system provides the complete proce dure of Virtual Simulation in RTP much faster and more easily The patient can leave the department after only a few minutes of CT scanning The SOMATOM Emotion 16 6 slice configuaration table supports all kinds of patient positioning immobilization and verification accessories ensuring the same patient position as on the LINAC table for example RT table tops Beekleys masks IR cameras new laser guidance system If non diagnostic CT examinations have to be per formed dedicated low dose protocols for virtual simu lation are provided Because external simulation SW might not be able to handle complete spiral data sets sequence scans are available as well The treatment planning can be performed later maybe when the patient is no longer present Applications for virtual simulation are available on the COHERENCE Dosimetrist or the syngo Multi Modality Workplace from where the results can be sent to the LINAC for patient treatment 462 Radiation Therapy COHERENCE Dosimetrist Remember the challenges of Radiation Therapy e Precisely locate and delineate the tumor volume e Establish reliable external references on the patient surface 463 Radiation Therapy e Spare as much healthy tissue as possible e Precisely position
133. edium is required for soft tissue mass evaluation To further optimize MPR image quality we recom mend that you reduce one or more of the following collimation reconstruction increment and slice width for image reconstruction Body Kernels e As standard kernels for body tissue studies B30s or B40s are recommended softer images are obtained with B20s or B10s extremely soft The kernels B31s or B41s have about the same visual sharpness as B30s respectively B40s the image appearance however is more agreeable due to a fine grained noise structure quite often the low contrast detect ability is improved by using B31s B41s instead of B30s B40s e For higher sharpness as is required e g in patient protocols for cervical spine shoulder extremities thorax lung the kernels B50s B60s B70s B80s are available 219 Shoulder Scan Protocols Shoulder Indications Spiral mode for bone studies and soft tissue e g evaluation of joint cavities masses trauma disloca tions orthopedic indications etc For SOMATOM Emotion 16 slice configuration A scan range of 15 cm will be covered in 26 44 sec For SOMATOM Emotion 6 slice configuration A scan range of 15 cm will be covered in 40 50 sec 220 Shoulder Emotion 16 kV Effective mAs Quality ref mAs Rotation Time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTD yoy Effective dose Emoti
134. emale 6 85 mSv Colo_prone 130 30 0 6 sec 16 x 0 6mm 0 6 mm 1 0 mm 14 4 mm 1 50 0 7 mm B20s 3 75 mGy Male 2 64 mSv Female 4 11 mSv 291 E Abdomen Emotion 6 Colo_supine Colo_prone kV 130 130 Effective mAs 50 30 Quality ref mAs Rotation Time 0 8 0 6 sec 0 8 0 6 sec Acquisition 6x 1 0 mm 6x 1 0 mm Slice collimation 1 0 mm 1 0 mm Slice width 1 25 mm 1 25 mm Feed Rotation 10 8 9 0 mm 10 8 9 0 mm Pitch Factor 1 80 1 50 1 80 1 50 Increment 0 8 mm 0 8 mm Kernel B41s B20s CTDlvoi 6 35 mGy 3 81 mGy Effective dose Male 4 61 4 53 mSv 2 77 2 72 mSv Female 7 01 6 96 mSv 4 20 4 18 mSv Contrast medium IV injection Start delay 50 60 sec Flow rate 3 0 ml sec Total amount 100 ml CARE Dose 4D is off as default because for CT Colonog raphy protocols the lowest mAs values are used For further information on the scan protocols and how to use syngo Colonography please refer to the Appli cation Guide Clinical Applications 292 293 Overview In this chapter you will find all scan protocols relating to the Spine region their descriptions individual indi cations and important hints on using them You can use the following scan protocols to clarify for example prolapse degenerative changes trauma and tumors For SOMATOM Emotion 16 slice configuration C Spine Spiral mode for cervical spine studies C SpineVol Spiral mode for axial sagittal soft tissue and sagittal
135. ement Kernel CTDlyo1 Effective dose Slice width Increment Kernel Trauma 130 85 0 6 sec 16x 1 2 mm 1 2 mm 8 0 mm 8 0 mm 28 8 mm 1 50 8 0 mm B31s 9 52 mGy Male 7 02 mSv Female 8 81 mSv 8 0 mm B30s 4 recon 8 0 mm 8 0 mm B70s 2 d recon 3 recon 8 0 mm 8 0 mm B30s 5th recon 8 0 mm 8 0 mm B70s 425 Specials PolyTrauma PolyTrauma06s Two combined ranges are predefined head with neck and thorax with abdomen For SOMATOM Emotion 16 slice configuration Ascan range of 12 14 cm will be done in 13 36 9 68 sec Emotion 16 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTD yoy Effective dose Male Female 426 Head 130 240 1 0 sec 16x 1 2mm 1 2 mm 6 0 mm 10 6 mm 0 55 6 0 mm H31s 57 60 mGy 2 63 mSv 2 88 mSv Neck 130 150 1 0 sec 16x1 2 mm 1 2 mm 5 0 mm 19 2 mm 1 00 5 0 mm B50s 16 80 mGy 3 08 mSv 3 37 mSv Specials Take a new Topogram for the thorax and abdomen range A scan range of 20 40 cm will be done in 9 01 9 53 sec Emotion 16 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTD yoy Effective dose Male Female Thorax 130 50 0 6 sec 16x 1 2mm 1 2 mm 8 0 mm 15 4 mm 0 80 8 0 mm B41s 5 60 mGy
136. ensure optimal enhancement after the contrast medium injection The syngo Dynamic Evaluation function may be used to generate the time density curve You will find the Test Bolus scan protocol in the chapter Specials Method 1 Select the spiral mode that you want to perform and then Append the Test Bolus mode under Special protocols 2 Insert the Test Bolus mode above the contrast spiral scan of interest using cut paste with right mouse button 3 Perform the topogram and define the slice position for the test bolus 4 Check the start delay number of scans and cycle time before loading the mode 5 A test bolus with 10 20 ml is then administered with the same flow rate as during the subsequent spiral scan Start the contrast media injection and the scan at the same time 129 Contrast Medium 6 Load the images into the DynEva task card and determine the time to peak enhancement Alterna tively on the image segment click select series with the right mouse button and position an ROI on the first image This ROI will appear on all images in the test bolus series Find the image with the peak HU value and calculate the time delta t taken to reach the peak HU value do not forget to add the preset start delay time This time can then be used as the optimal start delay time for the spiral scan CARE Contrast With the injector coupling the bolus injector can now be connected to your CT scanner Key features e Sy
137. er e Warm surroundings and dimmed lighting are helpful to make children more cooperative Sedation Although the advent of the Multislice CT scanner has enabled the user to scan through an area of interest much faster than ever sometimes patient motion can still result in severe motion arti facts which are seen on the resultant images This becomes a factor especially with infants and younger children who are unable to hold still for the exam Your institution may consider sedating such patients Of course appropriate protocols need to be set up at your institution For instance the drug of choice for specific ages weights of these patients taking into consideration the total time of the exam the form of administration patient preps adequate monitoring of the patient pre scan dur ing the exam and post scan etc should all be taken into consideration The proper personnel and equipment must also be readily available in the event of a problem 512 Children e Oral and rectal contrast administration Depending on the reason for the exam status of the patient oral contrast may or may not be given to these patients In general oral contrast is recommended to opacify the intestinal tract as unopacified bowel can have the appearance of abdominal fluid or mass effect Oral as well as rectal contrast may be required Usu ally a diluted mixture of iodine and water is used as an oral agent Different substances can be added to
138. erting the next scan range by using the Patient Model Dialog will reset this function so that the default window setting will be applied If you want to change the window values you can do this under Option gt Configuration gt Viewing gt Evalu ation General but be aware you do not change it for the Interventional values only but for all window set tings If you don t want to change it for all window val ues you can for example change it for the Abdomen to 350 50 and save this as a new window setting with a new name then you can apply these values as your interventional window settings and have the General window settings set as before 459 Specials TestBolus Protocol TestBolus This mode can be used to test the start delay of an opti mal enhancement after the contrast medium injec tion Emotion 16 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Scan Kernel CTD hyo Emotion 6 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Scan Kernel CTDhyoi 460 TestBolus 110 40 0 6 sec 2x5 0mm 5 0 mm 10 0 mm 0 0 mm B31s 2 60 mGy TestBolus 110 40 0 6 sec 2x5 0mm 5 0mm 10 0 mm 0 0 mm B31s 2 48 mGy 461 Radiation Therapy Radiation Therapy Planning The SOMATOM Emotion 16 6 slice configuration are very well suited to Radiation Therapy Planning RTP with its ergonomic enlarg
139. espiratory Gating Additional important Information e For operating the respiratory gating system AZ 733V Anzai Medical Japan please refer to the Operational manual Respiratory Gating or Anzai Users manual e For the usage of Anzai s respiratory phantom for the respiratory gating system AZ 733V Anzai medical Japan please refer to the User s manual e The images are reconstructed from data acquired in one Inspiration or Expiration phase Multi Phase reconstruction is not available For each Inspiration or Expiration phase a new recon job can be added e Preview Series is not yet available To determine the best Inspiration or Expiration phase InSpace 4D can be used 499 Respiratory Gating Scan Protocol RespSeq Indications A sequential mode for studies with respiration trigger ing For SOMATOM Emotion 16 slice configuration The scan length is predefined with 30 5 cm For SOMATOM Emotion 6 slice configuration The scan length is predefined with 30 3 cm Emotion 16 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Scan Kernel CTD ho Effective dose 500 RespSeq 130 16 0 6 sec 16x 1 2mm 1 2 mm 2 4 mm 19 2 mm B31s 1 79 mGy Male 0 92 mSv Female 1 18 mSv Respiratory Gating Emotion 6 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Scan Kernel CTD h
140. ew Blow up one big and two smaller images on each side If you choose certain slice thicknesses and collimations in the Routine subtask card which are marked in bold letters you will get in addition to your center an image that will be towards the head and one towards the feed Then you can use the CARE View and CARE View Blow up mode as well for your interventional proce dure You can change these modes while you are in the loaded process or while you are not applying radiation the layout changes will be applied if you start scan ning In the Interventional Toolbar for Biopsy you can change the layout of the display There are three differ ent modes available Blow up one big image Two segment CARE View three equal sized images The Image Layout can be changed in the interventional Toolbar regardless of the chosen slice thickness or col limation from Blow up Mode to the two segment Mode If you choose certain slice thicknesses and colli mations which are marded in bold letters you have the option to get the images displayed in the CARE View Mode as well The changes will be applied directly during the Biopsy porcedure 452 CAREView The item CAREView indicates when a combined image is displayed When the number of Slice Positions per scan is three CARE View is activated and shown on the Routine subtask card On the Recon subtask card you can select the CARE View image position depending on t
141. f 300 Emotion 16 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Scan Kernel CTD yoy Effective dose 534 InnerEarSeq 110 50 1 0 sec 12 x 0 6mm 0 6 mm 0 6 mm 7 2mm H90s 10 00 mGy Male 0 23 mSv Female 0 23 mSv Children Emotion 6 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Scan Kernel CTD yo Effective dose InnerEarSeq 110 90 1 0 sec 6x1 0mm 1 0 mm 1 0 mm 6 0 mm H90s 16 56 mGy Male 0 41 mSv Female 0 42 mSv The conversion factor for a 7 year old child and a scan range of 40 mm was used 535 Children Contrast medium IV injection Startdelay exam dependent Flow rate dependent upon needle size Access site Total 1 2 ml per kg of body weight amount Hints e Children who are older than age 6 should be scanned with an adult protocol as the skull by this time is fully grown In order to optimize image quality versus radiation dose scans are provided within a maximum scan field of 300 mm with respect to the iso center No recon job with a field of view exceeding those limits will be possible Therefore patient positioning has to be performed accurately to ensure a centered loca tion of the skull e To work without CARE Dose 4D use for children lt 3 years 40 mAs 3 6 years 60 mAs 536 537 Children SinusOrbit Indications Spiral mod
142. feet bind feet together The only exceptions are extremely light patients The latter can remove the leg not being examined from the gantry by bending it 90 at the hip and the knee and placing the bottom of the same foot against the gantry casing For ankle and feet scan Patient lying in supine position feet first Bind both ankles together if necessary to assure the AP position of both feet Special positioning is not necessary since the real time MPR could simulate any view of secondary reconstruction Retrospective reconstruction can be done a Use B50s kernel for soft tissue evaluation b For targeted FoV images on the affected side it is advisable to enter the side being examined in the comment line In case of 3D study only use kernel B10 and at least 50 overlapping image reconstruction To further optimize MPR image quality we recom mend that you reduce one or more of the following collimation reconstruction increment and slice width for image reconstruction 348 Lower Extremities Body Kernels e As standard kernels for body tissue studies B30s or B40s are recommended softer images are obtained with B20s or B10s extremely soft The kernels B31s or B41s have about the same visual sharpness as B30s respectively B40s the image appearance however is more agreeable due to a fine grained noise structure quite often the low contrast detect ability is improved by using B31s B41s instead of B30s
143. ff mAs value for the scan range The mAs value recorded in the images is the local eff mAs value 52 Dose Information Special Modes of CARE Dose 4D For certain examination protocols CARE Dose 4D uses modified tube current modulation to meet specific conditions for example e for Adult Head protocols the tube current is adapted to the variation along the patient s long axis and not to the angular attenuation profile e for Extremities CARE Vision syngo Neuro Perfusion CT syngo Body Perfusion CT and other special proto cols indicated as CARE Dose only angular tube cur rent modulation is supported e for Osteo and Cardio protocols the mAs setting is adjusted to the patient size and not modulated dur ing the scan except if ECG pulsing is switched on 53 Dose Information Scanning with CARE Dose 4D If the settings of Image Quality Reference mAs are cor rectly predefined no further adjustment of the tube current is required to perform a scan CARE Dose 4D automatically adapts the tube current to different patient sizes and anatomic shapes but it widely ignores metal implants Note Otherwise the magnification of the topogram would be distorted which would lead to an under estimation or overestimation of the required eff mAs For an accurate mAs adaptation to the patient s size and body shape with CARE Dose 4D the patient should be carefully centered in the scan field When using protocols wi
144. g Synthetic Trigger Sync By default the Synthetic Trigger Respiratory trig gered scanning or Synthetic Sync Respiratory gated scanning is activated for all predefined Respiratory scan protocols It is recommended to always keep it activated for examinations with contrast medium In case of Respiratory signal loss during the acquisi tion this will ensure the continuation of the triggered scans or allows a Respiratory signal to be simulated for retrospective gating If it is deactivated the scanning will be aborted in case of Respiratory signal loss during the acquisition 497 Respiratory Gating Workflow Reconstruction and Post processing For respiratory gating a slice width of 3 mm and an increment of 1 9 mm is used for image acquisition Two recon jobs are predefined e 20 Inspiration e 80 Expiration If more Inspiration or Expiration phases are necessary new recon jobs can be added After acquisition the 4D volume data set can be recon structed at different respiration levels to visualize the tumor movement over the whole respiration cycle and to display the anatomy in space 3D and time 4D InSpace 4D as an approved 4D application minimizes the time to e choose the appropriate phase or e 4D data visualization in multiple planes e Creation of 4D movie loops For further information on InSpace 4D please refer to the chapter InSpace 4D in the Clinical Applications 2 application guide 498 R
145. gen tubing are not trapped under the patient or between the table and the cradle Make allowance for the length of tubing required for the topogram scan range Never leave patients unattended at any time during the procedure Observe the vital signs e g ECG respiration etc at all times during the procedure Finish the examination in the shortest possible time 422 423 Specials Trauma This is a one range mode for fast screening for emer gency studies For SOMATOM Emotion 16 slice configuration A scan range of 50 cm will be done in 11 62 s Emotion 16 kV Effective mAs Quality ref mAs Rotation Time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTDIvol Effective dose 424 Trauma 2 recon 130 85 0 6 sec 16x 1 2mm 1 2 mm 8 0 mm 2 0 mm 28 8 mm 1 50 8 0 mm 1 5 mm B31s B31s 9 52 mGy Male 7 02 mSv Female 8 81 mSv 3rd recon 2 0 mm 1 5 mm B70s Specials TraumaVol This is a one range mode for fast screening for emer gency studies Three recon jobs are predefined for reconstruction the first for axial the second for coronal and the third sag ittal studies in 3D images display view For SOMATOM Emotion 16 slice configuration A scan range of 50 cm will be done in 11 62 sec kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Incr
146. gents should be used Give the last cup 200 ml just prior to positioning the patient To ensure adequate filling of the duodenal loop lay the patient on the right side for 5 minutes before performing the topogram e A pre contrast examination is usually performed only if no CT scans were previously acquired to exclude calculi in the common bile duct and to visu alize possible lesions in the liver Furthermore this also ensures exact positioning for the CTA spiral e For pancreatic studies the arterial phase acquisition can be acquired later with a start delay of 40 50 sec It may be necessary to use a thinner collimation of 3mm 286 287 Abdomen AbdomenSeq Indications This protocol is created for measurement with sequen tial mode in the region of the abdomen For SOMATOM Emotion 16 slice configuration A scan range is predefined with 19 5 cm For SOMATOM Emotion 6 slice configuration A scan range is predefined with 30 8 cm Emotion 16 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Scan Kernel Cis Effective dose 288 AbdSeq 130 120 0 6 sec 2x5 0mm 5 0mm 5 0mm 10 0 mm B41s 12 24 mGy Male 4 85 mSv Female 5 68 mSv Abdomen Emotion 6 AbdSeq kV 130 Effective mAs 120 Quality ref mAs Rotation time 0 8 sec Acquisition 6 x 2 0mm Slice collimation 2 0mm Slice width 4 0 mm Feed Scan 12 0 mm Kernel B41s CTDlyo1 13 08 m
147. ges independent of the patient s axis e Enable the Free View Mode and rotate the reference lines in the three segments until the desired image orientation is displayed The vertical and horizontal line are always perpendicular to each other With the default orientation button you can reset the image orientation at any time It is only possible to reconstruct images with a squared matrix Set the field of view to the active segment by clicking the Set FoV button The result images will then be orientated as in the FoV segment You can adjust the extension perpendicular to the field of view in the same way in the other two segments 71 Workflow Information To define the reference image topogram to the active segment click on the Set Reference Segment button This defines the orientation of the reference image which will be added to the result images Once you have finished the adjustment start calcula tion of the result images by clicking on the Recon but ton You can start a recon job at any time indepen dently of other ongoing jobs asynchronous reconstruction After starting the recon job the layout of the Examination task card changes back to the standard layout If auto recon is selected all defined recon jobs start automatically after scanning The progress of reconstruction is displayed by the slider in the tomo segment 72 Workflow Information Additional Information As soon as you define a new recon r
148. h possible default on or off Conversion of Old Protocols into Proto cols with CARE Dose 4D Protocols of SW versions VA70 VA47 and VA45 may be converted to CARE Dose 4D in the Scan Protocol Man ager Prior to activating CARE Dose 4D an Image Quality Ref erence mAs value has to be set in the corresponding column 61 Dose Information If you are unsure about the correct Image Quality Ref erence mAs value follow this simple procedure Enter the eff mAs value used for that type of pro tocol without CARE Dose 4D There is a simple way of ascertaining what eff mAs CARE Dose 4D will use along the scan range When the topogram is complete shrink the scan range to it s minimum As you move this small box over the topogram you can see how the eff mAs displayed in the Routine and Scan tab card varies along the patient s body To achieve a certain eff mAs at a patient s particular body region you can move the small scan range to this position and then adjust the Quality reference mAs so that the displayed eff mAs value is as desired After resizing the scan range to the range for the examination carefully observe the displayed mean eff mAs After the subsequent scan is com pleted inspect the image quality to ensure that the chosen Quality reference mAs is the right value With that setting perform the first scan and carefully inspect the image quality In that first step the dose may not be lower than without CARE
149. he Advanced Applica tion Training may take quite some time Shutting down the system in between will interrupt the down load Downloaded PDFs can be found offline under Options gt File Browser gt H SiteData Manuals SIEMENS 141 Application Information The E training is automatically installed as soon as it is downloaded and can be started within the SOMATOM LifeNet offline section under SOMATOM Educate gt E Training For syngo Acquisition Workplaces you can down load and install scan protocols To install the downloaded protocols open the Scan Protocol Manager via Options gt Configuration Select Import Scan Protocols in the menu Scan Proto col You can select which protocols you want to import and which not from a selection box which opens allowing you to choose the protocols you want to copy to your Customer Folder These protocols are then ready to use for your next examination 142 All new protocols including those you did not choose to import to the Customer Folder will also be stored in the Siemens Folder so that they can be copied later All downloaded scan protocols are named DL_ so they can be easily identified when mixed with pre installed protocols SIEMENS Am me esas ie mrs OR Oe me ating ne el pene nm ote oy Tee me ne ee pn mn an mom he me whet he nem poma s ONE oe HOTT FR Saat ENT a o Nem Paaa OF eae FONE oe ty HOMANONE CF Reames ANG Te Steet mre worn ONE Ta reas fe npor pe
150. he patient posi tion e g if you want to display the images which is closer to the head of the patient on the left hand side of the image area select Head Left 453 Specials CARE Vision and Biopsy layout for Single image display CARE Vision layout for CAREView large size display 454 Specials CARE Vision and Biopsy layout for CAREView equal size display Biopsy two segment 455 Specials Configuration CARE Voom tres aya Wet I CARE Vee nas CARE Wisonimage Rage ime some CARE Veen ate oat Dose Display The maximum displayed value of the Dose is set as a default to 2000 mGy It is possible to configure this from 100 200 mGy under Options gt Configura tion gt Examination gt Intervention Exceeding this con figuration maximum value will not stop the scan just the Dose scale bar will change to red If you start scan ning again the Dose scale bar will be reset Storage rate All three CAREView images Head Center and Feet can be saved if you select it under Configura tion gt Examination gt Intervention prior to your exami nation The image storage rate is also configurable under Option gt Configuration gt Examination gt Intervention depending on your system You can choose between an image storage rate of 1 2 4 5 images sec for SOMATOM Emotion 16 6 slice configuration and 1 3 images per second 456 Specials Example 3 5 second scan done Then at least four images
151. hoose system specific trial software under SOMATOM Expand gt Trial Licenses After click ing on Order Trial and confirming a license agreement for trial use software you will enter your contact data and then submit the license request The trial software will be installed within eight working days and you will then be informed about the success ful installation via the SOMATOM LifeNet news ticker window that appears during system start up Trial licenses are valid for 90 days and can only be ordered once Forwarding Information via Email 145 Application Information Forwarding information via Email This service enables those customers who do not have a printing device connected to their CT Scanner but would like to have the information provided in SOMA TOM LifeNet sent to their regular email account or for warded to a contact person of interest as an email Information about current courses and clinical training programs as well as CT accessories can be sent from the scanner to any email account This information can then be printed or a quote requested from your local Siemens representative SIEMENS pe vom F omaa F tomes f toe faae oe Eq s0 mcr janie ame lieve omen ee a mp Dim imes tom wt h toe e ees onl rate org Be ee Caen Tete cee me wee Ct ot Coen Pm tow we dn unng sst tren pme baus won aur buritan oo Tr na nage ee aatan e teem me neeesser s ranten poa
152. hosen instead of the adult head kernels H20s H30s and H60s e For soft tissue head studies the standard kernel is H40s softer images are obtained with H30s or H20s H10s sharper images with H50s The kernels H21s H31s H41s yield the same visual sharpness as H20s H30s H40s the image appearance however is more agreeable due to a fine grained noise struc ture quite often the low contrast detectability is improved by using H31s H 41s instead of H30s H40s For the standard head protocols we propose C20s and C30s High resolution head studies should be performed with H60s H7Os for example for dental and sinuses and H80s H90s for example inner ear 515 Children Body Kernels uu The endings s or f depend on the rotation time e As standard kernels for body tissue studies B30s or B40s are recommended softer images are obtained with B20s or B10s extremely soft The kernels B31s or B41s have about the same visual sharpness as B30s respectively B40s the image appearance however is more agreeable due to a fine grained noise structure quite often the low contrast detect ability is improved by using B31s B41s instead of B30s B40s For higher sharpness as is required for example in patient protocols for cervical spine shoulder extremities thorax the kernels B50s B60s B7Os B80s are available The special kernels are mostly used for physical measurements wi
153. ice configuration A range of 30 cm will be covered in 18 85 sec 232 Thorax Emotion 16 kV Effective mAs Quality ref mAs Rotation Time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTD yoy Effective dose Emotion 6 kV Effective mAs Quality ref mAs Rotation Time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTD yoy Effective dose ThorRoutine 130 70 0 6 sec 16x 1 2mm 1 2 mm 5 0 mm 15 40 mm 0 80 5 0 mm B41s 7 84 mGy Male 4 36 mSv Female 5 55 mSv ThorRoutine 130 70 0 8 0 6 sec 6x2 0mm 2 0mm 5 0mm 10 2mm 0 85 5 0 mm B41s 7 63 mGy Male 3 87 mSv Female 5 02 mSv 2 4 recon 5 0mm 5 0 mm B7Os 2 4 recon 5 0mm 5 0mm B7Os 233 Thorax Contrast medium IV injection Start delay 25 30sec Flow rate 2 5 ml sec Total amount 80 ml Hint e For lung cancer evaluation this protocol can be com bined with protocol NeckRoutine 234 Thorax ThoraxCombi ThoraxCombi06s Indications Combining thin slice lung and routine thorax studies with one spiral scan E g thorax studies in general and interstitial changes in the lungs For SOMATOM Emotion 16 slice configuration A range of 30 cm will be covered in 13 70 sec For SOMATOM Emotion 6 slice configuration A range of 30 cm will be covered in 21 20 sec 235 Thorax Emotion 16 k
154. ice width Feed Rotation Pitch Factor Increment Kernel CTDlyo Effective dose 284 Arterial Phase 2 recon 110 120 0 8 0 6 sec 6x 2 0mm 2 0mm 5 0 mm 2 5 mm 10 2 mm 0 85 5 0 mm B41s 8 52 mGy Male 3 24 mSv Female 4 03 mSv 1 7 mm B31 B41s Abdomen A range of 20 cm including liver pancreas and kidney arterial phase acquired in 12 96 sec Emotion 6 kV Effective mAs Quality ref mAs Rotation Time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTDlyo Effective dose Venous Phase 130 120 0 8 0 6 sec 6x 2 0mm 2 0mm 5 0mm 10 2 mm 0 85 5 0mm B41s 13 08 mGy Male 5 06 mSv Female 6 30 mSv Contrast medium IV injection Start delay 20 25 sec arterial phase 50 75 sec venous phase Flow rate 4 5 ml sec Total amount 100 120 ml CARE Bolus may be used to optimize the bolus tim ing Set the ROI for monitoring scan in the abdominal aorta at the beginning of the scan range with trig gering threshold of 120 HU or use manual trigger ing 285 Abdomen Hints e You could repeat the same protocol simply by click ing the chronicle with the right mouse button for repeat E g when both non contrast and contrast studies are required e Do not administer oral contrast medium as this impairs the editing of MIP SSD VRT images Use water instead if necessary Water rather than positive oral contrast a
155. icking the chronicle with the right mouse button and select repeat or simply change the number of scans to 99 before you start the first scan You can Append any routine protocol after the inter ventional procedure for a final check and documenta tion e g a short range of spiral scanning for the biopsy region The table height can be adjusted to a minimum of 255 mm Zoom and pan of the images is possible within the Biopsy Mode 436 Specials Biopsy With this routine protocol images will be reconstructed with three time 4 8 6 0 mm or one time 10 mm slice thickness Emotion 16 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Scan Kernel CTD o Emotion 6 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Scan Kernel CTDho Biopsy 130 110 0 6 sec 12x 1 2mm 1 2 mm 4 8 mm 0 0 mm B31s 12 10 mGy Biopsy 130 110 0 6 sec 6x 3 0mm 3 0mm 6 0mm 0 0 mm B31s 11 22 mGy 437 Specials Biopsy Single One 10 mm slice images will be reconstructed and dis played for each scan Emotion 16 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Scan Kernel CTDho1 Emotion 6 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Scan Kernel CTDlhyoi 438 Biopsy Single
156. iew mode Emotion 16 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Scan Increment Kernel CTDh oi Emotion 6 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Scan Increment Kernel CTDh oi 440 CAREVision 130 30 0 6 sec 16 x 0 6mm 0 6 mm 4 8 mm 0 0 1 0 mm B31s 3 75 mGy CAREVision 130 30 0 6 sec 6x 3 0mm 3 0mm 6 0mm 0 0 1 0 mm B31s 3 06 mGy Specials CAREVisionSingle The images will be reconstructed and displayed with one time 10 mm slice thickness and a kernel of B30 Emotion 16 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Scan Increment Kernel CTD hyo Emotion 6 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Scan Increment Kernel CTDho CAREVision 130 30 0 6 sec 2x5 0mm 5 0 mm 10 0 mm 0 0 1 0 mm B31s 3 06 mGy CAREVision 130 30 0 6 sec 2x5 0mm 5 0mm 10 0 mm 0 0 1 0 mm B31s 2 85 mGy 441 Specials CAREVisionBone The images will be reconstructed and displayed in the CARE View mode with three times 4 8 6 0 mm or one time 10 mm slice thickness and a kernel of B50 Emotion 16 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Scan Increment Kernel CTD hyo Emo
157. ifferent operation types are possible e Manipulate Scan protocols cut copy paste and delete e Change parameters e Import scan protocols from SOMATOM LifeNet CD e Restore protocols to Siemens default Additional important information e Each workflow consists of up to five steps indicated by the footprints Depending on the workflow step you can list all scan protocols or all selected scan protocols The lt Export gt button exports the listed scan protocols in MS Excel recognizable format The export file is always created in H SiteData proto cols folder The folder selection cannot be changed e The section Change Parameters is preselected as default e Depending on the selected workflow in Step 1 the Scan protocol Assistant leads you through the cor responding steps From Step 3 an lt Undo gt and lt Redo gt button are added Both buttons only affect the last operation e You can navigate through the selected workflow via the footprints or with the Back and Next buttons With the Quit Button you can leave the Scan Proto col Assistant at any time without any changes saved 99 Workflow Information Manipulate scan protocols This workflow consists of four steps Step 2 Manipulate scan protocols cut copy paste delete To be able to modify existing scan protocols you just have to click with the right mouse button onto the pro tocol you want to cut copy or delete there a menu will be d
158. images that have been reconstructed Once reconstructed these completed recon jobs stay in the browser until deleted from the local database You can also reconstruct images for all scans per formed by not selecting any range in the chronicle prior to clicking Recon Another entry you will find in the right mouse menu is copy replace recon parameters This function is available for spiral scans only The main goal is to support the transfer of volume parameters between oblique recon jobs of ranges which cover mainly the same area e g two spiral scans with without contrast media 64 Workflow Information 3D Recon 3D Recon allows you to perform oblique and or double oblique reconstructions in any user defined direction directly after scanning No further post processing or data loading is needed The high quality SPO spiral oblique images are calcu lated by using the system s raw data Key Features e Reconstruction of axial sagittal coronal and oblique double oblique images 3 planning images in the 3 standard orientations coronal axial sagittal e Image types for planning MPR Thick 10 mm MIP Thin 3 mm e Field of view and reference image definition possible in each planning segment e Asynchronous reconstruction several reconstruc tion jobs are possible in the background axial and non axial e Workstream 4D performs reconstructions on the basis of CT raw data If the raw data are saved you c
159. ine special settings for recording amtasia Record v wit xX a or View or change program se AVI to define Video and Audio options File to define the output options files and folders e Hotkeys to define special hotkeys e g for start stop recording e Live to define live source options 156 Application Information e Program to define capture options Program r Capture Options Pause before starting capture I Boost priority during capture 7 Hide capture rectangle I Solid capture rectangle V Play movie after saving file IV Play AVI files with Camtasia Player Report dropped frames I Always on top V Round frame size to a 4 pixel boundary Disable display acceleration during capture Capture layered windows I Single frame capture I Quick capture V Enable tips 157 1 Appli cation Information The Effects Options dialog box allows you to set options fo Cursor r your recording for example cursor effects Cursor Highlight Cursor re Half scale Highlight Mouse Clicks N WA Shape Circle Color Size j1 Translucent Semi translucent C Opaque Left Shape Rings v Color Size Right Shape Rings X Color Size 158 Application Information Additional Important Information e To transfer avi files from the file browser to any exter nal storage device for ex
160. ing the scan and the tube cur rent is modulated accordingly in real time to achieve an optimum distribution of the X ray intensity for every viewing angle m ee ee a quadind aqn aduasajas Ayyjend abeuw rel tube current o j LAA i LE OO Eee l FLL oe COL l SO o i i i i j RO os 1 5 2 25 0 6 ws 3s 2 rel attenuation reference attention Relation between relative attenuation and relative tube current The adaptation strength may be adjusted by user separately for the left branch slim and the right branch obese of the curve This adjust ment effects all examinations The gray lines here indicates the theoretical limits of the adaptation con stant dose resp constant image noise The absolute eff mAs value is scaled with the Image Reference mAs value which may be adjusted in the Scan Card by the user 50 ScanwithconstantmA based on topogram 51 Dose Information Principle of automatic tube current adaptation by CARE Dose 4D for a spiral scan from shoulder to pelvis very high table feed for demonstration High tube current and strong modulation in shoulder and pelvis lower tube current and low modulation in abdomen and thorax The dotted lines represent the min and max tube current at the corresponding table position and result from the attenuation profile of the Topo gram The mAs value displayed in the user interface and in the patient protocol is the mean e
161. io studies 362 Vascular General Hints e Topogram AP 512 1024 LAT 256 e Patient positioning Patient lying in supine position arms positioned comfortably above the head in the head arm rest lower legs supported Patient respiratory instructions inspiration Oral administration of contrast medium The use of water will not obscure the blood vessels thus allowing CTA processing to be performed easily afterwards Be careful when examining pheochromocytoma patients Administration of an IV CM injection in such cases may trigger a hypertensive crisis To further optimize MPR image quality we recom mend that you reduce one or more of the following collimation reconstruction increment and slice width for image reconstruction 363 Vascular Head Kernels e For soft tissue head studies the standard kernel is H40s softer images are obtained with H30s or H20s H10s sharper images with H50s The kernels H21s H31s H41s yield the same visual sharpness as H20s H30s H40s the image appearance however is more agreeable due to a fine grained noise struc ture quite often the low contrast detectability is improved by using H31s H41s instead of H30s H40s For the standard head protocols we propose H21s H31s H41s 364 Vascular Body Kernels e As standard kernels for body tissue studies B30s or B40s are recommended softer images are obtained with B20s or B10s extremely soft The kernels B31s o
162. io06s 372 CarotidAngioVol 376 ThorAngioRoutine ThorAngioRoutine06s 380 ThorAngioVol 384 ThorAngioECG ThorAngioECGO6s 388 ThorAngioECGSeq 392 Embolism Embolism06s 394 BodyAngioRoutine BodyAngioRoutineO6s 398 BodyAngioVol 402 BodyAngioFast BodyAngioFast06s 406 AngioRunOff AngioRunOff06s 410 WholeBodyAngio 414 Specials 416 Overview 416 Trauma 416 Interventional CT 418 Test Bolus 420 Trauma Protocols 422 General Information 422 Trauma 424 TraumaVol 425 12 Contents PolyTraumal PolyTrauma06s 426 HeadTrauma 430 HeadTraumaSeq 432 Additional Important Information 434 Interventional CT Biopsy 436 Biopsy 437 Biopsy Single 438 Interventional CT CARE Vision 439 The Basics 439 CAREVision 440 CAREVisionSingle 441 CAREVisionBone 442 HandCARE 443 Additional Important Information 447 General Information for Biopsy and CARE Vision 450 Interventional Toolbar 450 CAREView 453 Configuration 456 Routine Subtask card 458 Additional Important Information 459 TestBolus Protocol 460 TestBolus 460 Radiation Therapy 462 Radiation Therapy Planning 462 Benefits 465 Workflow 468 Scan Protocols 470 Overview 470 RT_Head 472 RT_Thorax 474 RT_Breast 476 RT_Abdomen 478 RT_Pelvis 480 Additional Important Information 482 Contents 14 Respiratory Gating 484 e Key Features 486 Respiratory Gating 486 Respirat
163. ion Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel Temp resolution CTDlyo Effective dose ThorAngioECG 2 reconstr 130 210 0 6 sec 6x 2 0mm 2 0mm 5 0mm 2 5mm 4 8mm 0 40 5 0mm 1 5 mm B31s B31s up to 150 ms 22 89 mGy Male 5 87 mSv Female 8 12 mSv depends on heart rate 390 Vascular Contrast medium IV injection Start delay 4 10 sec Flow rate 2 5 m sec Total amount 80 100 ml Hints e CARE Bolus may be used to optimize the bolus tim ing e Set the ROI for monitoring scan in the aortic arch with triggering threshold of 120 HU or use manual triggering 391 Vascular ThorAngioECGSeq Indications Sequential ECG triggered study for location and extent of aneurysms dissection and ruptures of the thoracic aorta with typical scan range of 29 9 cm Emotion 6 ThorAngioECG kV 130 Effective mAs 80 Quality ref mAs Rotation Time 0 8 sec Acquisition 6x 1 0 mm Slice collimation 1 0 mm Slice width 1 0 mm Feed Scan 6 0 mm Kernel B31s Temp resolution up to 400 ms CTD yoy 10 16 mGy Effective dose Male 6 92 mSv Female 9 00 mSv depends on heart rate Contrast medium IV injection Start delay 10 30 sec Flow rate 2 5 ml sec Total amount 80 ml Hints e CARE Bolus may be used to optimize the bolus tim ing e Set the ROI for monitoring scan in the aortic arch with triggering threshold of 120 HU or use manual triggeri
164. ion Slice width Feed Rotation Pitch Factor Increment Kernel CTD yoy Effective dose Abdomen 130 150 0 8 sec 6x 2 0mm 2 0mm 8 0 mm 10 2 mm 0 85 8 0 mm B41s 16 35 mGy Male 6 33 mSv Female 7 87 mSv 2 4 recon 8 0 mm 8 0 mm B60s 479 Radiation Therapy RT_Pelvis Indications Spiral mode for routine radiation therapy planning pel vis studies For SOMATOM Emotion 16 slice configuration A range of 20 cm will be covered in 8 94 sec For SOMATOM Emotion 6 slice configuration A range of 20 cm will be covered in 13 11 sec 480 Radiation Therapy Emotion 16 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTD yoy Effective dose Emotion 6 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTD yoy Effective dose Pelvis 2 4 recon 130 150 1 0 sec 16x 1 2mm 1 2 mm 3 0 mm 28 8 mm 1 50 3 0 mm 3 0 mm B41s B60s 16 80 mGy Male 6 68 mSv Female 11 42 mSv 3 0 mm Pelvis 2 4 recon 130 150 1 0 sec 6x2 0mm 2 0mm 3 0mm 18 0 mm 1 50 3 0mm 3 0mm B41s B60s 16 35 mGy Male 6 41 mSv Female 10 95 mSv 3 0 mm 481 Radiation Therapy Additional Important Information HU values The HU values are of crucial importance for the therapy planning systems of radiat
165. ion Slice width Feed Scan Kernel CID Effective dose 252 ThoraxECGHR 130 70 0 5 sec 4x0 6mm 0 6 mm 1 2 mm 10 0 mm B90s 2 32 mGy Male 0 74 mSv Female 0 98 mSv Thorax Emotion 6 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Scan Kernel CTDlyo1 Effective dose Hints ThoraxECGHR 130 70 0 8 sec 1x1 0 mm 1 0 mm 1 0 mm 10 0 mm B90s 0 71 mGy Male 0 21 mSv Female 0 29 mSv e With studies of interstitial changes in the lungs con trast medium is not necessary e If you want to reconstruct thin slices every 10 or 20 mm instead of 15 mm as predefined simply change the Feed Scan before loading the mode 253 Thorax LungLowDose LungLowDose06s Indications Spiral lung studies with low dose setting e g early visualization of pulmonary nodules For SOMATOM Emotion 16 slice configuration A typical thorax study in a range of 30 cm will be cov ered in 19 95 sec For SOMATOM Emotion 6 slice configuration A typical thorax study in a range of 30 cm will be cov ered in 18 85 sec 254 Thorax Emotion 16 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTD o1 Effective dose 2nd recon Lung Low Dose 110 16 0 6 sec 16x0 6mm 0 6 mm 5 0mm 5 0mm 9 6 mm 1 00 5 0mm 5 0mm B4
166. ion 16 RespMode 2 4 reconstr kV 130 Effective mAs 320 Quality ref mAs Rotation time 1 0 sec Acquisition 16 x 1 2mm Slice collimation 1 2mm Slice width 3 0mm 3 0mm Feed Rotation 2 5 Pitch Factor 0 13 Increment 2 1mm 2 1mm Kernel B31s B31s CTD oi 35 84 mGy 504 Respiratory Gating Emotion 6 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTD oi RespMode 130 320 0 8 sec 6x 2 0mm 2 0mm 3 0mm 1 2 0 10 2 0mm B31s 34 88 mGy 2 d reconstr 3 0 mm 0 10 2 0 mm B31s 505 Respiratory Gating RespLowBreathRate Indications A spiral mode for patients with a respiration rate per minute greater than 6 5 using respiration gating For SOMATOM Emotion 16 slice configuration A scan range of 18 cm will be covered in 87 23 sec For SOMATOM Emotion 6 slice configuration A scan range of 11 cm will be covered in 93 67 sec Emotion 16 RespLow 24 reconstr kV 130 Effective mAs 320 Quality ref mAs Rotation time 1 0 sec Acquisition 16 x 1 2mm Slice collimation 1 2mm Slice width 3 0mm 3 0mm Feed Rotation 2 1 Pitch Factor 0 11 Increment 2 1mm 2 1mm Kernel B31s B31s CTD oi 35 84 mGy 506 Respiratory Gating Emotion 6 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTD oi Effective d
167. ion Monitoring 486 Respiration Synchronization 487 Positioning of the respiratory sensor belt 488 Scanning Information 490 Scan Parameters 490 Temporal Resolution 491 Technical Principles 491 Respiratory Triggering 491 Respiratory gating 492 Prospective respiratory triggering versus retrospective respiratory gating 494 Curve Editor 495 Synthetic Trigger Sync 497 Workflow 498 Reconstruction and Post processing 498 Additional important Information 499 Scan Protocol 500 RespSeq 500 Resp 502 RespModBreathRate 504 RespLowBreathRate 506 Children 508 Overview 508 General Hints 512 Head Kernels 515 Body Kernels 516 Scan Protocols 518 HeadRoutine 518 HeadSeq 522 InnerEarHR 526 InnerEar 530 InnerEarSeq 534 SinusOrbit 538 NeckRoutine 542 Contents 15 ThoraxRoutine ThoraxRoutineO6s ThoraxCombil ThoraxCombi06s ThoraxHRSeq AbdomenRoutine AbdomenRoutine06s Spine SpineRoutine SpineThinSlice ExtrRoutineHR ExtrCombi HeadAngio HeadAngio06s CarotidAngio CarotidAngio06s BodyAngioRoutine BodyAngioRoutineO6s BodyAngioFast BodyAngioFast06s NeonateBody NeonateBody06s 546 550 554 558 562 566 568 570 574 578 582 586 587 User Documentation For further information about the basic operation please refer to the corresponding syngo CT Operator Manual syngo CT Operator Manual Volume 1 syngo Security Package Siemens Virus P
168. ion therapists With huge objects the CT value is independent of the kernel With smaller objects edge effects pro duced by the kernel influence the HU values as well as the scanning Feed and collimation do not have any influence An extended FoV of 800 mm means that only 500 mm are scanned the rest will be interpolated The effect on the HU values of having carbon plate tagged additionally to the patient table should be negligible and not measurable e CARE Dose 4D does not have any effect on the HU values HU values and the conversion of the electron densi ties depend on the applied spectrum e g kV prefil tration kV prefiltration etc HU values depend on the use of the online bone cor rection PFO 482 483 Respiratory Gating When imaging of the chest or abdomen is performed by CT there may be artifacts produced causing prob lems with reproducibility and resolution of images due to patient respiration Organs will move with every res piratory motion Especially in the radiation therapy planning using a lin ear accelerator for tumor treatment normal tissues around a focus might be unnecessarily exposed to radi ation if the target is located in a movable organ because the field of irradiation has to be set wider than the actual size of the tumour due to the organ s motion during respiration As far as the respiratory motion is periodical and repet itive the organs in the chest or abdomen mo
169. isplayed where you can choose what you want to do Cutting a scan protocol out of one of the folders and putting it into another one can be done with cut and then click again on the right mouse button on the desired folder and you will get the option to paste this scan protocol there If you want to leave the scan pro tocol in the old folder and save it into another one you just use the copy paste function Removing a scan pro tocol will delete it Adult and Child protocols are man aged separately 100 Workflow Information Setting the Emergency Protocol One protocol must be labeled as the emergency pro tocol if you want to change the default emergency protocol you have to select the desired protocol and click onto the Emergency icon An Application Restart is necessary to set the new default emergency proto col The emergency protocol is displayed with the Emer gency icon in front of the protocol name This protocol can not be deleted Workflow Information Step 3 Confirmation Here you can check the modifications and save the changes All relevant information such as the Name of the manipulated scan protocols destination Folder Name of the deleted protocols and the changed Emer gency protocols are displayed inside the Change over view Step 4 Changes saved In this step you can decide if you want to pass a differ ent modification workflow or if you want to exit the Scan Protocol Assistant 102
170. itioning for topo gram scans 1 degree e Simplified horizontal positioning of the table During an examination a table feed position can be stored enabling fast and easy repositioning of a patient back to the previous table position e Proven DICOM connectivity to radiation therapy planning software 467 Radiation Therapy Workflow Simulation 1 Patient positioning on CT table external lasers 2 Patient marking external lasers 3 CT scan 4 Offline Virtual Simulation and Dose Planning Treatment 1 Patient positioning on the therapy table external lasers 2 Verification of irradiation area light field projection 3 Treatment The default scan protocols provide the first recon job used for soft tissue studies and the second recon job for bone structures 468 469 Radiation Therapy Scan Protocols Overview You can use the following scan protocols for the Radia tion Therapy Planning For SOMATOM Emotion 16 slice configuration RT_Head Spiral mode for routine radiation therapy planning head studies RT_Thorax Spiral mode for routine fradiation therapy planning thoracic studies RT_Breast Spiral mode for routine radiation therapy planning studies of the breast RT_Abdomen Spiral mode for routine radiation therapy planning abdominal studies RT_Pelvis Spiral mode for routine radiation therapy planning pelvis studies 470 Radiation Therapy For SOMATOM Emotion
171. ive dose 522 HeadSeq 110 260 1 5 sec 2x5 0mm 5 0mm 5 0mm 10 0 mm C30s 37 44 mGy Male 1 83 mSv Female 1 96 mSv Children Emotion 6 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Scan Kernel CTDl yo Effective dose HeadSeq 110 260 1 5 sec 6x 2 0mm 2 0mm 6 0 mm 12 0 mm C30s 40 82 mGy Male 1 86 mSv Female 1 84 mSv The conversion factor for a 7 year old child and a scan range of 117 mm was used 523 Children Contrast medium IV injection Start delay exam dependent Flow rate dependent upon needle size Access site Total amount 1 2 ml per kg of body weight Hints e Children who are older than age 6 should be scanned with an adult protocol as the skull by this time is fully grown e When bone structure is of interest use kernel C60s for image reconstruction An advanced algorithm allows for improved head image quality without additional post processing In order to optimize image quality versus radiation dose scans are provided within a maximum scan field of 300 mm with respect to the iso center No recon job with a field of view exceeding those limits will be possible Therefore patient positioning has to be performed accurately to ensure a centered loca tion of the skull e To work without CARE Dose 4D use for children lt 6 month 90 mAs 6 month 3 years 150 mAs 3 6 years 220 mAs 524 525 Chil
172. jected or power injected at a very low flow rate 1 ml sec PIC lines and 24 gauge or smaller lines are usually hand injected All of these protocols should be decided on by your institution s appropriate personnel e Applications with 80 kV For CTA protocols the tube voltage was set to 80 kV and the mAs values were raised by a factor of 1 5 over the reduced 120 kV val ues This measure roughly reduces the dose again by a factor of 2 At a lower kV substances with a high atomic number such as iodine have a significantly higher CT value vascular contrast lodine CT val ues at 80 kV are about 50 higher than at 120 kV 80 kV was also used for applications when the low est achievable mAs at 120 kV was still higher than necessary for sufficient noise level for technical rea sons generators need to operate at a certain mini mum current for stable operation For applications such as neonate or airway scanning the low tube output at 80 kV can be used to further reduce the dose to the patient To further optimize MPR image quality we recom mend that you reduce one or more of the following collimation reconstruction increment and slice width for image reconstruction 514 Children Head Kernels un The endings s or f depend on the rotation time e For head scans of small children the kernels C20s C30s for example for soft tissue studies and C60s for example for sinuses are provided should be c
173. left mouse clicking the START radio button If you do not want to use automatic triggering you can set your trigger threshold num ber extremely high so that it will not trigger auto matically and start the spiral when you want to 127 Contrast Medium Test Bolus using CARE Bolus You can use the CARE Bolus option as a Test Bolus Method 1 Insert a Bolus Tracking via the context menu prior to the spiral 2 Insert contrast from the context menu Note By inserting contrast you are interrupting the Auto range function preventing an automatic start of the spiral 3 Start with the topogram 4 Position the premonitoring scan and the spiral 5 Perform the premonitoring scan position and accept the ROI 6 Start the monitoring scans and a small amount of contrast medium 20 ml 2 5 ml sec The rate of the injection on the monitoring scans should match the rate of injection used for the spiral scan Note When you start the spiral manually the sys tem switches to the Trigger tab card The trigger line is not shown at this stage 7 Now you can read the proper delay from the Trigger tab card 8 Insert the delay in the Routine tab card and load the spiral 9 Start the spiral and injector at the same time with the appropriate amount of contrast for the study being performed 128 Contrast Medium Test Bolus This is a low dose sequential protocol without table feed used to calculate the start delay of a spiral scan to
174. lice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTDlvoi Effective dose ThorRoutine 110 26 0 8 0 6 sec 6 x 2 0 mm 2 0 mm 5 0 mm 18 0 mm 1 50 5 0 mm B41s 1 85 mGy Male 1 69 mSv 2 4 reconstr 5 0mm 5 0mm B60s Female 1 98 mSv The conversion factor for a 7 year old child and a scan range of 150 mm was used 548 Children Contrast medium IV injection Start delay exam dependent Flow rate dependent upon needle size Access site Total 1 2 ml per kg of body weight amount Hints e Children with a body weight of more than 55 kg should be examined with an adult protocol e The first and second recon jobs are defined for visu alization of the mediastinum and the lungs respec tively e To work without CARE Dose 4D use for children lt 15 kg 17 mAs 15 24 kg 20 mAs 25 34 kg 30 mAs 35 54 kg 60 mAs 549 Children ThoraxCombil ThoraxCombi06s Indications Combining thin slice and routine thorax studies with one spiral scan for example thorax studies in general and interstitial changes in the lungs For SOMATOM Emotion 6 slice configuration A typical range of 15 cm covered in 11 20 sec 550 Children Emotion 6 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTD o1 Effective dose ThorC 2 74 3rd ombi recon recon 110 39
175. lice configuration A typical range of 8 cm will be covered in 10 89 sec 330 Pelvis Emotion 16 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTD yoy Effective dose Emotion 6 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTD yoy Effective dose SI_Joints 130 120 1 0 sec 16 x 0 6 mm 0 6 mm 3 0mm 14 4mm 1 50 3 0mm B70s 15 00 mGy Male 2 21 mSv Female 5 44 mSv SI_Joints 130 120 1 0 sec 6x1 0 mm 1 0 mm 3 0 mm 9 0 mm 1 50 3 0 mm B70s 15 24 mGy Male 2 83 mSv Female 3 82 mSv 2 d reconstr 1 0 mm 0 7 mm B70s 2 4 reconstr 1 25 mm 0 8 mm B70s 331 Upper Extremities Overview In this chapter you will find the scan protocol relating to the Upper Extremities region its description indi vidual indications and important hints on using it You can use the following scan protocol to clarify for example trauma masses disorders of the joint and orthopedic indications 332 Upper Extremities For SOMATOM Emotion 16 slice configuration WristHR Spiral mode for routine high resolution wrist studies ExtrRoutineHR Spiral mode for routine high resolution extremity studies ExtrCombi Spiral mode for the combination of thin slice and routine studie
176. ll as to include the axilla in the lower neck level if required 210 211 Neck NeckThinSlice Indications Spiral mode using thin slices for soft tissue studies e g the functional study of the throat For SOMATOM Emotion 6 slice configuration A typical range of 20 cm will be covered in 32 97 sec Emotion 6 kV Effective mAs Quality ref mAs Rotation Time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTD yo Effective dose 212 NeckThinSlice 2 4 reconstr 130 130 0 8 sec 6x 1 0mm 1 0mm 5 0mm 1 25 mm 5 1 mm 0 85 5 0 mm B50s 16 51 mGy Male 4 06 mSv Female 4 25 mSv 0 8 mm B50s Neck Contrast medium IV injection Start delay 45 sec Flow rate 2 0 ml sec Total amount 120 ml Hints e Due to its iodine content the thyroid gland is hyper dense in relation to the neighboring muscles both before and after an IV CM injection For displays of the parotid or thyroid gland or the floor of the mouth the slice thickness should be lt 5 mm and the length of the range should be adapted to match the anatomic region e Target the FoV to ensure adequate coverage of the region of interest in the upper neck amp middle neck levels as well as to include the axilla in the lower neck level if required 213 Neck NeckVol Indications Spiral mode for soft tissue studies in the cervical region e g tumors lymphoma abscesses etc
177. lungs using a feed of 10 mm For SOMATOM Emotion 16 slice configuration A scan range is predefined with 30 1 cm For SOMATOM Emotion 6 slice configuration A scan range is predefined with 30 0 cm Emotion 16 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Scan Kernel CTDhyoi Effective dose 250 a ThorHRSeq 130 100 1 0 sec 4x0 6 mm 0 6 mm 1 2 mm 10 0 mm B90s 3 31 mGy Male 1 65 mSv Female 2 13 mSv Thorax Emotion 6 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Scan Kernel CTDlyo1 Effective dose Hints ThorHRSeq 130 100 1 0 sec 1x1 0 mm 1 0 mm 1 0 mm 10 0 mm B90s 1 01 mGy Male 0 49 mSv Female 0 63 mSv e If you want to reconstruct thin slices every 10 or 20 mm instead of 15 mm as predefined simply change the Feed Scan before loading the mode e With studies of interstitial changes in the lungs con trast medium is not necessary 251 Thorax ThoraxECGHRSeq Indications Sequence mode for High Resolution ECG triggered lung studies e g interstitial changes in the lungs For SOMATOM Emotion 16 slice configuration A scan range is predefined with 19 1 cm For SOMATOM Emotion 6 slice configuration A scan range is predefined with 12 0 cm Emotion 16 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimat
178. mm 2 0mm 0 6 mm 1 8mm 0 75 2 0mm 0 4mm U90s U90s 8 28 mGy Male 0 02 mSv Female 0 02 mSv ExtrHR 2 4 reconstr 130 60 1 0 sec 6x0 5mm 0 5mm 2 0mm 1 0 mm 2 6mm 0 85 2 0mm 0 6 mm U90s U90s 7 68 mGy Male 0 01 mSv Female 0 02 mSv 341 p Upper Extremities Hint e For image reconstruction of soft tissue use kernel B30s B31s 342 343 Upper Extremities ExtrCombi Indications Spiral mode for the combination of bone and soft tis sue studies e g masses trauma disorders of the joint etc For SOMATOM Emotion 16 slice configuration A range of 15 cm will be done in 12 42 sec For SOMATOM Emotion 6 slice configuration A range of 10 cm will be done in 13 11 sec Emotion 16 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTDho1 Effective dose 344 ExtrCombi 2 4 reconstr 130 50 1 0 sec 16 x 0 6 mm 0 6 mm 4 0mm 1 0 mm 14 4 mm 1 50 4 0mm B41s 6 25 mGy Male 0 02 mSv Female 0 02 mSv 0 7mm B7Os Upper Extremities Emotion 6 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTs Effective dose Hint ExtrCombi 2 reconstr 130 50 1 0 sec 6x1 0mm 1 0 mm 4 0mm 1 25 mm 9 0 mm 1 50 4 0 mm 0 8 mm B41s B70s 6 35 mGy Male 0 01 mSv Fem
179. n time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTD yoy Effective dose ExtrHR 110 50 1 0 sec 6x0 5mm 0 5mm 0 6 mm 3 0mm 1 00 0 3mm U90s 4 25 mGy Male 0 01 mSv Female 0 01 mSv The conversion factor for a 7 year old child and a scan range of 60 mm was used Adjust the mAs value to the body region Hints e Children with a body weight of more than 55 kg should be examined with an adult protocol e To work without CARE Dose 4D use for children lt 25 kg 26 mAs 25 34 kg 40 mAs 35 54 kg 80 mAs 569 Children ExtrCombi Indications Spiral mode for the combination of bone and soft tis sue studies for example masses trauma disorders of the joint etc For SOMATOM Emotion 16 slice configuration A typical range of 10 cm covered in 8 94 sec For SOMATOM Emotion 6 slice configuration A typical range of 10 cm covered in 13 11 sec Children Emotion 16 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTD yoy Effective dose Emotion 6 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTD yoy Effective dose ExtrCombi 110 25 1 0 sec 16 x 0 6 mm 0 6 mm 3 0mm 14 4mm 1 50 3 0mm B41s 2 00 mGy Male lt 0 mSv Female lt
180. nSingle The CARE Vision protocol is a spiral mode without table feed using a 10 mm slice thickness CARE VisionBone The CARE Vision protocol is a spiral mode without table feed using a three times 6 0 mm slice thick ness with a bone kernel 419 Specials Test Bolus For SOMATOM Emotion 16 slice configuration TestBolus This mode can be used to test the start delay of opti mal enhancement after the contrast medium injec tion For SOMATOM Emotion 6 slice configuration TestBolus This mode can be used to test the start delay of opti mal enhancement after the contrast medium injec tion 420 421 Specials Trauma Protocols In any trauma situation time means life and the qual ity of life for the survivor General Information Check that the emergency drug trolley is well stocked and that all accessories such as in room oxy gen supply respirator and resuscitation equipment that may be required during the examination are in working order Prepare the CT room before admitting the patient e g load IV contrast into the injector Know observe and practice the standard hospital operating policy for handling a patient in distress e g Code Blue for cardiac and respiratory arrest Any possible injuries to the spinal column should be determined before beginning the examination and taken into account when shifting and positioning the patient Ensure that all vital lines e g IV tubing and oxy
181. nally you can insert your logo and select which reference data you want to use 150 Application Information File Browser The File Browser provides you with a secure means of accessing and managing data in a private folder which is a well defined part of the computer file system This user partition is strictly separated from the system operating file system The user partition is shared read only and may be used for transferring data from the scanner to other com puters for example transferring DICOM images export to offline transferring AVls or accessing files PDF files which were downloaded via SOMATOM LifeNet Key Features e Copy images and files to the CD Burn folder e Raw data transfer e Access to all created reports and movies AVI files e Access to the offline folder e Access to downloaded files Open the File Browser via main menu entry Options gt File Browser The File Browser provides special folders for CT applica tions The created reports and movies are saved within these folders With an external PC connected you can access your offline data on the external PC for post processing 151 Application Information Raw data transfer Raw data set can be transferred First configure the directory where the raw data should be transferred to e Open the File Browser e Choose the desired directory from the navigation tree to the left of the File Browser e Select the item Set as
182. nchronized scanning and contrast injection e One button control from the CT console and from the injector The scan start can be initiated by the injector and also by the CT scanner without having to press both start buttons at the same time The start by the CT can also be done via the foot switch The Start of the CT scanner including the start delay can be initiated also by the start button at the bolus injector The injector and the CT have to be coupled explicitly You can store protocols where the injector coupling is selected 130 Contrast Medium Workflow To start a contrast enhanced examination in coupled mode e Select the Scan subtask card e Select under the menu field Scan Start either the entry Injector coupled Start button or the entry Injector coupled Footswitch Injector coupled Start button The Start button of the CT scanner will start the injector Injector coupled Footswitch The footswitch of the CT scanner will start the injector patty vet mA AME Oot Mer a j rire marn R naen ine 2e en n fs i Roae Reon Att M If an injector is connected load the scan mode first and then arm the injector Depending on the injector it might be not possible to arm the injector before the scan protocol is loaded see User manual of the injector When the mode is loaded the CT scanner will ask you to check the injec tor and to arm it Check the parameters at
183. nd recon 130 35 1 0 sec 6x1 0mm 1 0 mm 5 0mm 5 0mm 5 1 mm 0 85 5 0mm 5 0mm H70s H30s 9 63 mGy Male 0 20 mSv Female 0 25 mSv Contrast medium IV injection Start delay Flow rate Total amount Hint 45 sec 2 0 ml sec 75 ml 3rd recon 1 25 0 8 mm H70s e For low dose studies use only 20 mAs 194 4th recon 1 25 0 8 mm H30s 195 Head SinusVol Indications Spiral mode for axial and coronal paranasal sinuses studies e g sinusitis mucocele polyposis tumor cor rections etc Three recon jobs are predefined for reconstruction the first for axial bone structure and the second for the coronal soft tissue in 3D images display view and the third for the coronal bone structure in 3D images dis play view For SOMATOM Emotion 16 slice configuration A range of 80 mm will be covered in 12 42 sec For SOMATOM Emotion 6 slice configuration A range of 80 mm will be covered in 17 69 sec Emotion 16 Sinus 2nd 34 recon recon kV 130 Effective mAs 35 Quality ref mAs Rotation Time 1 0 sec Acquisition 16 x 0 6 mm Slice collimation 0 6 mm Slice width 5 0mm 3 0mm 3 0mm Feed Rotation 7 7mm Pitch Factor 0 80 Increment 5 0mm 3 0mm 3 0mm Kernel H70s H30s H60s CTDlyo 9 31 mGy Effective dose Male 0 32 mSv Female 0 36 mSv 196 Head Emotion 6 Sinus 2nd 34 recon recon kV 130 Effective mAs 35 Quality ref mAs Rotation Time 1 0 sec
184. ne for each scan range is listed before the recon jobs belonging to this scan range you might have to scroll to the right side of the line to get the information visible If no special scan mode is selected the so called mixed mode is active The mixed mode means the user can choose scan ranges from different modes Spiral Sequence Multiscan or CAREVision modes If the control in one mode is not applicable the control in mixed mode is not shown in lt Param eters Area gt 111 E Workflow Information In the subsection Recon the following changes can be made Scan Parameters Spiral Sequence Multisca CareVision Mixed Mode Mode n Mode Mode Mode Slice X X X X Recon Increment Kernel Window Mirror x Xx Xx Xx No of images Extended FoV Recon type x X XxX XxX X x XxX XxX XxX X Series description Recon job type Recon axis XX 3 KK X XXXX KX xx X KK KK KKK OX Image Order Non square X X matrix 3D Recon X X 112 AutoTasking Select single recon job or all recon jobs you want to modify in this subsection Additionally you can display information about the scan range e When include scan range information is selected an information line for each scan range is listed before the recon jobs belonging to this scan range you might have to scroll to the right side of the line to get the information visible 113 Workflow Information In the subsection Auto Tasking the
185. nel description BO8s very smooth B10s very smooth B19s very smooth B20s smooth B29s smooth B30s medium smooth B31s medium smooth B35s HeartView medium B39f HeartView medium B40s medium B41s medium B46s medium B50s medium sharp B60s sharp B65s sharp B70s very sharp B75s very sharp Emotion 16 slice configu ration only B80s ultra sharp B90s ultra sharp Child Head Kernels Kernel description C20s smooth C30s medium smooth C60s sharp 29 Scan and Reconstruction Topogram Kernels Kernel T10s T20s T21s T80s T81s T90s description smooth standard standard sharp sharp ultra sharp Special Application Kernel 30s S80s S90s U90s 30 description Shepp Logan Shepp Logan with notch filter Shepp Logan without notch filter specification kernel Scan and Reconstruction PET Kernel Kernel PET B19s smooth B29s medium smooth B39s medium H19s smooth H29s medium smooth H39s medium SPECT Kernel Kernel SPECT HO8s very smooth BO8s very smooth 31 Scan and Reconstruction Head Kernels For soft tissue head studies the standard kernel is H40s softer images are obtained with H30s or H20s H10s sharper images with H50s The kernels H21s H31s H41s yield the same visual sharpness as H20s H30s or H40s respectively The image appearance however is more acceptable due to a fine grained noise structure quite often the low contrast detect ability is
186. ng 392 393 Vascular Embolism Embolism06s Indications Spiral mode for pulmonary embolism studies For SOMATOM Emotion 16 slice configuration A range of 30 cm will be covered in 13 70 sec For SOMATOM Emotion 6 slice configuration A range of 28 cm will be covered in 19 87 sec 394 Vascular Emotion 16 kV Effective mAs Quality ref mAs Rotation Time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTD Effective dose Emotion 6 kV Effective mAs Quality ref mAs Rotation Time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CDi Effective dose Embolism 24 reconstr 110 80 0 6 sec 16x 0 6mm 0 6 mm 3 0mm 0 75 mm 14 4mm 1 50 3 0mm 0 5mm B315s B20s 6 40 mGy Male 3 28 mSv Female 4 26 mSv Embolism 2 4 reconstr 110 80 0 8 0 6 sec 6x17 0mm 1 0 mm 3 0mm 1 25 mm 10 8 9 0 mm 1 80 1 50 3 0 mm 0 8 mm B31s B20s 6 64 mGy Male 3 25 3 21 mSv Female 4 23 4 18 mSv 395 Vascular Contrast medium IV injection Start delay 6 10 sec Flow rate 4 ml sec Total amount 80 100 ml Hints e CARE Bolus may be used to optimize the bolus tim ing e Set the ROI for monitoring scan in the pulmonary trunk with triggering threshold of 120 HU or use manual triggering 396 397 Vascular BodyAngioRoutine BodyAngioRoutine06s Indications Spiral mode for abdominal
187. ng an acq of 4x 0 6 mm HeadSeq Sequential mode for routine head studies InnerEarHR Spiral mode for high resolution inner ear studies InnerEarHRVol Spiral mode for high resolution inner ear stud ies and double oblique studies InnerEar Spiral mode for routine ear studies InnerEarSeq Sequential mode for inner ear studies Sinus Spiral mode for routine sinus studies SinusVol Spiral mode for axial and coronal sinus studies Orbit Spiral mode for routine orbital studies Dental Spiral mode for the application syngo Dental CT 163 E Head For SOMATOM Emotion 6 slice configuration HeadRoutine Spiral mode for routine head studies HeadSeq Sequential mode for routine head studies InnerEarHR Spiral mode for high resolution inner ear studies InnerEarHRVol Spiral mode for high resolution inner ear studies and double oblique studies InnerEar Spiral mode for routine ear studies InnerEarSeq Sequential mode for inner ear studies Sinus Spiral mode for routine sinus studies SinusVol Spiral mode for axial and coronal sinus studies Orbit Spiral mode for routine orbital studies Dental Spiral mode for the application syngo Dental CT 164 Head General Hints e Topogram Lateral 256 mm Patient positioning Patient lying in supine position arms resting against body secure head well in the head holder support lower legs Gantry tilt is available for sequence
188. o Effective dose RespSeq 130 16 0 6 sec 6 x 3 0 mm 3 0 mm 3 0 mm 18 0 mm B31s 1 63 mGy Male 1 29 mSv Female 1 81 mSv 501 Respiratory Gating Resp Indications A spiral mode for patients with a respiration rate per minute greater than 10 using respiration gating For SOMATOM Emotion 16 slice configuration A scan range of 30 cm will be covered in 94 95 sec For SOMATOM Emotion 6 slice configuration A scan range of 30 cm will be covered in 86 04 sec Emotion 16 Resp 24 reconstr kV 130 Effective mAs 320 Quality ref mAs Rotation time 0 6 sec Acquisition 16x 1 2mm Slice collimation 1 2mm Slice width 3 0mm 3 0mm Feed Rotation 1 9 Pitch Factor 0 1 Increment 2 1 mm 2 1 mm Kernel B31s B31s CTD ho 35 84 mGy 502 Respiratory Gating Emotion 6 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTDh oi Resp 130 230 0 8 sec 6x 2 0mm 2 0mm 3 0mm 1 8 0 15 2 0mm B315s 25 07 mGy 2 reconstr 3 0 mm 2 0 mm B31s 503 Respiratory Gating RespModBreathRate Indications A spiral mode for patients with a respiration rate per minute greater than 7 5 using respiration gating For SOMATOM Emotion 16 slice configuration A scan range of 23 cm will be covered in 94 15 sec For SOMATOM Emotion 6 slice configuration A scan range of 14 cm will be covered in 94 93 sec Emot
189. ocols AbdomenRoutine AbdomenRoutine06s Indications Spiral mode for routine studies in the region of abdo men e g evaluation follow up examinations etc For SOMATOM Emotion 16 slice configuration A scan range of 20 cm will be covered in 9 01 sec For SOMATOM Emotion 6 slice configuration A scan range of 20 cm will be covered in 12 96 sec 266 Abdomen Emotion 16 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTDlyo Effective dose Emotion 6 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTDlyoi Effective dose AbdRoutine 130 120 0 6 sec 16x1 2 mm 1 2 mm 5 0 mm 15 4 mm 0 80 5 0 mm B41s 13 44 mGy Male 5 81 mSv Female 7 15 mSv AbdRoutine 130 120 0 8 0 6 sec 6x 2 0mm 2 0mm 5 0mm 10 2 mm 0 85 5 0 mm B41s 13 08 mGy Male 5 06 mSv Female 6 30 mSv 267 Abdomen Contrast medium IV injection Start delay 50 60 sec Flow rate 3 0 m sec Total amount 100 ml Hints e You could repeat the same protocol simply by click ing the chronicle with the right mouse button for repeat E g when both non contrast and contrast studies are required Delayed scans may be required for the kidneys amp bladder If you want to use this protocol for a two phase study re
190. ominal studies e Spine Spine Spiral mode for routine spine studies e Upper Extremities Low Extremities ExtrRoutineHR Spiral mode for routine high resolution extremity studies ExtrCombi Spiral mode for the combination of thin slice and routine studies e Vascular HeadAngio Spiral mode for head CTAngio studies CarotidAngio Spiral mode for carotid CTAngio studies BodyAngioRoutine Spiral mode for body CTAngio studies e Specials NeonateBody Spiral mode for neonate studies 509 Children For eH SOMATOM Emotion 6 slice configuration ead HeadRoutine Spiral mode for routine head studies HeadSeq Sequential mode for routine head studies InnerEarHR Spiral mode for high resolution inner ear studies InnerEar Spiral mode for inner ear studies InnerEarSeq Sequential mode for routine inner ear studies SinusOrbit Spiral mode for routine sinus and orbital studies Neck NeckRoutine Spiral mode for soft tissues routine neck studies Thorax 510 ThoraxRoutine ThoraxRoutine06s Spiral mode for routine thorax studies ThoraxCombi ThoraxCombi06s Spiral mode for the combination of thin slice lung and routine thorax studies ThoraxHRSeq Sequential mode for high resolution lung studies Children e Abdomen AbdomenRoutine AbdomenRoutine06s Spiral mode for routine abdominal studies e Spine SpineRoutine Spiral mode for routine spine studies SpineThinSlice Spiral mode
191. on A typical range of 20 0 cm covered in 9 53 sec For SOMATOM Emotion 6 slice configuration A typical range of 15 0 cm covered in 11 20 sec 582 Children Emotion 16 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTDlvoi Effective dose Emotion 6 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTDlvoi Effective dose BodyAngio 80 80 0 6 sec 16 x 0 6 mm 0 6 mm 3 0mm 14 4mm 1 50 3 0mm B41s 2 56 mGy Male 1 34 mSv Female 1 66 mSv BodyAngio 80 80 0 8 0 6 sec 6x1 0 mm 1 0 mm 3 0 mm 9 0 mm 1 50 3 0 mm B41s 2 64 mGy 2nd reconstr 1 0 mm 0 7 mm B31s 2nd reconstr 1 25 mm 0 8 mm B31s Male 0 04 2 18 mSv Female 2 50 mSv The conversion factor for a 7 year old child and a scan range of 200 mm was used 583 Children Contrast medium IV injection Start delay exam dependent Flow rate dependent upon needle size Access site Total 1 2 ml per kg of body weight amount Hints e Children with a body weight of more than 55 kg should be examined with an adult protocol e CARE Bolus may be used to optimize the bolus tim ing Set the ROI for monitoring scan in the abdominal aorta with triggering threshold of 120 HU or use manual triggering e To
192. on 6 kV Effective mAs Quality ref mAs Rotation Time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTD yoy Effective dose Shoulder 130 100 1 5 sec 16 x 0 6 mm 0 6 mm 5 0 mm 9 6 mm 1 0 5 0 mm B60s 12 50 mGy Male 3 38 mSv Female 3 75 mSv Shoulder 130 100 1 5 sec 6x1 0 mm 1 0 mm 5 0 mm 6 0 mm 1 00 5 0 mm B60s 12 70 mGy Male 2 96mSv Female 3 52 mSv 2 4 recon 1 0 mm 0 7 mm B60s 2 4 recon 1 25 mm 0 8 mm B60s 221 Shoulder Hints e Use raw data to review a target region if necessary e For image reconstruction of soft tissue use kernel B31s and a slice width of 5 0 mm e Coronal and sagittal 2D planar reconstructions are important for evaluation of the joint space amp bursa sacs in CT arthograms 3D renderings are helpful for complex fractures amp dislocations 222 223 Shoulder ShoulderVol Indications Spiral mode for bone studies and soft tissues e g eval uation of joint cavities masses trauma dislocations orthopedic indications etc Three recon jobs are predefined for reconstruction the first for soft tissue axial the second for soft tissue coro nal and third for sagittal bone studies in 3D images dis play view For SOMATOM Emotion 16 slice configuration A scan range of 15 cm will be covered in 26 44 sec For SOMATOM Emotion 6 slice configuration A scan range of 15 cm
193. on is provided After the topogram is performed the predefined spi ral scanning range and the optimal monitoring posi tion will be shown If you need to redefine the spiral scanning range you should also reposition the monitoring scan in order to keep the shortest start delay time 2 s The distance between the beginning of the spiral scan ning range and the monitoring scan will be the same 126 Contrast Medium Move the monitoring scan line toward the optimal position and release the mouse button it will be snapped automatically Trick if you move the mon itoring scan line away from the optimal position the snapping mechanism will be inactive 4 Place a ROI in the premonitoring scan on the target area or vessel used for triggering with one left mouse click The ROI is defined by double circles the outer circle is used for easy positioning and the inner circle is used for the actual evaluation You can also zoom the reference image for easier posi tioning of the ROI 5 Set the appropriate trigger threshold and start con trast injection and monitoring scans at the same time The relative enhancement of the target ROI will be displayed for the duration of the monitoring scan When the predefined density is reached the spiral acquisition will be triggered automatically 6 You can also initiate the spiral any time during the monitoring phase manually either by pressing the START button or by
194. on respira tory information both needed for high precision radia tion therapy planning and treatment as well The mentioned increase of RT accuracy results in a decrease of RT side effects by minimizing excessive irradiation dose to healthy tissue 485 Respiratory Gating Key Features Respiratory Gating e is capturing slow moving anatomical structures such as lung lesions during respiration up to a respiration cycle time of 10sec by low pitch spiral helps the radio oncologists in selecting the appropri ate phase of the respiratory cycle in order to plana treatment more accurately helps visualizing the tumor excursion for a better understanding of the target volume using InSpace 4D results in a more accurate description of the ROI and is considering tumor motion into the PTV planned target volume Respiration Monitoring e Accurate determination of respiratory motion e Respiration change recognition cough sneeze movement Support for monitoring of free breathing and breath hold respiration protocols 486 Respiratory Gating Respiration Synchronization e Synchronization of CT data acquisition with respira tion 4D CT prospectively Respiratory Triggering or retrospectively Respiratory Gating e Synchronization of 4D simulation data with respira tion e Synchronized Treatment triggered beaming on off on Linac Linear Accelerator 487 Respiratory Gating Positioning of the respirato
195. onnection between scanner and injector is inter rupted or the injection was stopped due to technical problems In this case the scan continues and an error message pops up The user can decide if he wants to stop the scan or if he would like to continue e If the injection is longer than the CT scan the CT scanner does not stop the injection A new scan mode can be loaded If the new mode is a coupled mode the scan can only be started if the injector is ready e When a coupled range is pasted or repeated the start condition for the new scan is reset to uncou pled 134 135 Application Information SOMATOM LifeNet General Information SOMATOM LifeNet is our information and service por tal that can be accessed directly at the syngo Acquisi tion Workplace syngo CT Workplace and syngo MultiModality Workplace It provides up to date news about your scanner helpful configuration infor mation about your system and enables you to access the SOMATOM LifeNet online area where you will find further functions to ease your daily work To benefit from the SOMATOM LifeNet online area a Siemens Remote Service connection is required The SOMATOM LifeNet online area allows you to order 90 day Trial Licenses for free download application guides or find interesting information and services related to your CT system Siemens Remote Service is part of your service con tract and is also prerequisite for other services for yo
196. or the SOMATOM Emotion 6 slice configura tion or 16 x 0 6mm for the SOMATOM Emotion 16 slice configuration Slice width is the FWHM full width at half maximum of the reconstructed image With the SOMATOM Emotion 6 16 slice configuration 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 If Metrorecon Fastrecon is not selected you will rou tinely get Real Time images The Recon icon on the chronicle will be labeled with RT After the scan the Real Time displayed image series has to be recon structed In some cases this depends also on Scan pitch 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 The Acq Acquisition is displayed on the Examination task card The Acquisition is simply number of slices acquired per rotation x width of one slice 24 Scan and Reconstruction SOMATOM Emotion 16 slice configu ration Spiral Mode Collimation Acquisition 16x0 6mm 16x 171 2mm Slice width 0 75 1 0 1 5 2 0 3 0 4 0 5 0 mm 1 5 2 0 3 0 4 0 5 0 6 0 8 0 10 0 mm HR Neuro Spiral Mode Collimation
197. ose RespLow 130 320 1 0 sec 6x 2 0mm 2 0mm 3 0mm 1 2 0 10 2 0mm B31s 34 88 mGy Male 6 40 mSv Female 9 14 mSv 2 reconstr 3 0 mm 2 0mm B31s 507 Children Overview The scan protocols for children are defined according to body regions Head Neck Thorax Abdomen Spine Upper Extremities Lower Extremities Vas cular and Specials As default the quality reference mAs with CARE Dose 4D is defined for 20 kg and or five year old children For children older than six years use the adult protocols with the CARE Dose 4D For a few protocols 80 kV is used instead of 120 kV either to exploit the significantly higher image con trast of iodine contrast media at 80 kV or to reach a lower dose level than possible with 120 kV For SOMATOM Emotion 16 slice configuration e Head HeadRoutine Spiral mode for routine head studies HeadSeq Sequential mode for routine head studies InnerEarHR Spiral mode for high resolution inner ear studies InnerEar Spiral mode for inner ear studies InnerEarSeq Sequential mode for routine inner ear studies SinusOrbit Spiral mode for routine sinus and orbital studies 508 Children e Neck NeckRoutine Spiral mode for soft tissues routine neck studies e Thorax ThoraxRoutine Spiral mode for routine thorax studies ThoraxHRSeq Sequential mode for high resolution lung studies e Abdomen AbdomenRoutine Spiral mode for routine abd
198. ows for improved head image quality without any additional postpro cessing e In order to optimize image quality versus radiation dose scans are provided within a maximum scan field of 300 mm with respect to the isocenter No recon job with a field of view exceeding those limits will be possible Therefore patient positioning has to be performed accurately to ensure a centered loca tion of the skull 173 Head HeadSeq Indications Sequence mode for routine head studies e g stroke brain tumors cranial trauma cerebral atrophy hydro cephalus and inflammation etc Two ranges are predefined for the base of the skull and for the cerebrum For SOMATOM Emotion 16 slice configuration A scan range is predefined with 12 30 cm For SOMATOM Emotion 6 slice configuration A scan range is predefined with 12 80 cm 174 Head Emotion 16 kV Effective mAs Quality ref mAs Rotation Time Acquisition Slice collimation Slice width Feed Scan Kernel CTD yoy Effective dose Emotion 6 kV Effective mAs Quality ref mAs Rotation Time Acquisition Slice collimation Slice width Feed Scan Kernel CHD Effective dose BaseSeq 130 270 1 5 sec 2x5 0mm 5 0mm 5 0 mm 10mm H315s 58 32 mGy Male 1 08 mSv Female 1 20 mSv BaseSeq 130 250 1 5 sec 6x 2 0mm 2 0mm 4 0mm 12 mm H31s 58 75 mGy Male 1 11 mSv Female 1 15 mSv CerebrumSeq 130 270 1 5 sec 2 x8 0 mm 8 0 mm 8
199. p studies to check for progression e CARE Dose 4D is off as default because for syngo Lung CARE protocols the lowest mAs values are used For further information on the scan protocols and how to use syngo Lung CARE please refer to the Applica tion Guide Clinical Applications 261 7 Abdomen Overview In this chapter you will find all scan protocols relating to the Abdomen region their descriptions individual indications and important hints on using them You can use the following scan protocols to clarify for example liver pancreas and kidney abnormalities For SOMATOM Emotion 16 slice configuration AbdomenRoutine Spiral mode for routine abdominal studies AbdomenCombi Spiral mode for the combination of thin slice and routine abdominal studies AbdomenVol Spiral mode for axial and coronal abdomen studies 262 Abdomen AbdMultiPhase Spiral mode for three phases liver studies AbdSeq Sequential mode for abdominal studies Colonography Spiral mode used for the application syngo Colonography For SOMATOM Emotion 6 slice configuration AbdomenRoutine AbdomenRoutine06s Spiral mode for routine abdominal studies AbdomenCombi AbdomenCombi06s Spiral mode for the combination of thin slice and routine abdominal studies AbdomenVol Spiral mode for axial and coronal abdomen studies AbdomenFast AbdomenFast06s Spiral mode for fast abdominal studies AbdMultiPhase AbdMultiPhas
200. peat the same protocol as mentioned below and choose start delay time for arterial phase as 20 25 sec In this case the thin slice reconstruc tion can also be used for post processing Do not administer oral contrast medium as this impairs the editing of MIP SSD VRT images Water could be used instead if necessary Water rather than positive oral contrast agents should be used Give the last cup 200 ml just prior to positioning the patient To ensure adequate filling of the duodenal loop lay the patient on the right side for 5 minutes before performing the topogram e A pre contrast examination is usually performed only if no CT scans were previously acquired to exclude calculi in the common bile duct and to visu alize possible lesions in the liver e For pancreatic studies the arterial phase acquisition can be acquired later with a start delay of 40 50 sec It may be necessary to use a thinner col limation 268 269 Abdomen AbdomenCombil AbdomenCombi06s Indications Combination of thin slice and routine abdominal stud ies with one spiral scan For SOMATOM Emotion 16 slice configuration A range of 20 cm for liver pancreas or kidneys will be covered in 9 53 sec For SOMATOM Emotion 6 slice configuration A range of 20 cm for liver pancreas or kidneys will be covered in 14 53 sec 270 Abdomen Emotion 16 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collim
201. ph nodes vascular anomalies and interstitial changes in the lungs 226 Thorax For SOMATOM Emotion 16 slice configuration ThoraxRoutine Spiral mode for routine thorax studies ThoraxCombi Spiral mode for the combination of thin slice lung and routine thorax studies ThoraxVol Spiral mode for axial coronal soft tissue and coronal lung studies ThoraxHR Spiral mode for high resolution lung studies ThoraxHRSeq Sequential mode for high resolution lung studies ThoraxECGHRSeq Sequential mode for high resolution ECG triggered lung studies LungLowDose Spiral mode with very low dose for early visualiza tion of pathologies LungCARE Spiral mode used for the application syngo Lung CARE CT 227 i Thorax For SOMATOM Emotion 6 slice configuration ThoraxRoutine ThoraxRoutine06s Spiral mode for routine thorax studies ThoraxCombi ThoraxCombi06s Spiral mode for the combination of thin slice lung and routine thorax studies ThoraxVol Spiral mode for axial coronal soft tissue and coronal lung studies ThoraxFast ThoraxFast06s Spiral mode for fast chest studies ThoraxHR Spiral mode for high resolution lung studies ThoraxHRSeq Sequential mode for high resolution lung studies ThoraxECGHRSeq Sequential mode for high resolution ECG triggered lung studies LungLowDose LungLowDose06s Spiral mode with very low dose for early visualiza tion of pathologies LungCARE LungCAR
202. protocols relating to the Pelvis region their descriptions individual indi cations and important hints on using them You can use the following scan protocols to clarify for example abnormalities of the prostate urinary blad der rectum joint cavity masses and trauma For SOMATOM Emotion 16 slice configuration Pelvis Spiral mode for routine soft tissue pelvis studies PelvisVol Spiral mode for axial and coronal pelvis studies Hip Spiral mode for routine hip studies HipVol Spiral mode for axial and coronal hip studies SI_Joints Spiral mode for sacral iliac joints studies 314 Pelvis For SOMATOM Emotion 6 slice configuration Pelvis Spiral mode for routine soft tissue pelvis studies PelvisVol Spiral mode for axial and coronal pelvis studies Hip Spiral mode for routine hip studies HipVol Spiral mode for axial and coronal hip studies SI_Joints Spiral mode for sacral iliac joints studies 315 Pelvis General Hints e Topogram AP 512 mm for pelvis studies and 256 mm for studies of the hip and SI Joints Patient positioning Patient lying in supine position arms positioned comfortably above the head in the head arm rest lower legs supported A breathing command is not necessarily required for the pelvic examination since respiration does not negatively influence this region Rectal contrast medium administration Rectal contrast media is usually requi
203. r B41s have about the same visual sharpness as B30s respectively B40s the image appearance however is more agreeable due to a fine grained noise structure quite often the low contrast detect ability is improved by using B31s B41s instead of B30s B40s 365 Vascular Scan Protocols HeadAngio HeadAngio06s Indications Spiral mode for cerebral CT Angio studies e g cerebral vascular abnormalities tumors and follow up studies etc For SOMATOM Emotion 16 slice configuration A range of 80 mm will be covered in 7 45 sec For SOMATOM Emotion 6 slice configuration A range of 80 mm will be covered in 10 61 sec 366 Vascular Emotion 16 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTDlyoi Effective dose Emotion 6 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTDlyoi Effective dose HeadAngio 110 70 0 6 sec 16 x 0 6 mm 0 6 mm 3 0mm 7 7mm 0 80 3 0mm H315 12 46 mGy Male 0 43 mSv Female 0 48 mSv HeadAngio 110 70 0 8 0 6 sec 6x1 0mm 1 0 mm 3 0 mm 5 1 mm 0 85 3 0 mm H31s 12 88 mGy Male 0 37 mSv Female 0 42 mSv 2 4 reconstr 1 0 mm 0 7 mm H20s 2 4 reconstr 1 25 mm 0 8 mm H20s 367 Vascular Contrast medium IV injection Start delay 18 se
204. r anomalies etc For SOMATOM Emotion 16 slice configuration A range of 30 cm will be covered in 13 70 sec For SOMATOM Emotion 6 slice configuration A range of 30 cm will be covered in 21 20 sec 380 Vascular Emotion 16 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTD yo Effective dose Emotion 6 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTD yo Effective dose ThorAngio 2 reconstr 110 70 0 6 sec 16 x 0 6 mm 0 6 mm 5 0mm 1 0 mm 14 4mm 1 50 5 0 mm B31s 5 60 mGy Male 2 92 mSv Female 3 78 mSv 0 7mm B20s ThorAngio 2 4 reconstr 110 70 0 8 0 6 sec 6x1 0 mm 1 0 mm 5 0 mm 1 25 mm 9 0mm 1 50 5 0 mm B31s 5 81 mGy Male 2 96 mSv Female 3 83 mSv 0 8 mm B20s 381 Vascular Contrast medium IV injection Start delay 10 25 sec Flow rate 2 5 ml sec Total amount 80 ml Hints e CARE Bolus may be used to optimize the bolus tim ing Set the ROI for monitoring scan in the aortic arch with triggering threshold of 120 HU or use manual triggering Thick MPRs and ThinMIPs can be created very quickly on the 3D Task Card by just clicking on the appropri ate icons The thickness of these reconstructed images can be defined by clicking on the icons with the right mouse to
205. rate 2 mi sec Total amount 50 60 ml Hints e An automatic bone correction allows for improved head image quality without any additional postpro cessing e In order to optimize image quality versus radiation dose scans are provided within a maximum scan field of 300 mm with respect to the iso center No recon job with a field of view exceeding those limits will be possible Therefore patient positioning has to be performed accurately to ensure a centered loca tion of the skull 171 Head HeadNeuro Indications Special spiral neuro mode for dedicated head studies Two ranges are predefined for the base of the skull using an acquisition of 16x0 6 mm and for the cere brum using an acquisition of 4x0 6 mm A range for the base of 4 cm will be covered in 9 58 sec a range for the cerebrum of 8 cm will be cov ered in 68 67 sec Emotion 16 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Rotation Pitch factor Increment Kernel CTDlyo Effective dose 172 Base 130 250 1 0 sec 16x 0 6 mm 0 6 mm 4 0mm 5 3mm 0 55 4 0mm H31s 66 50 mGy Male 1 52 mSv Female 1 73 mSv Cerebrum 130 270 1 0 sec 4x 0 6 mm 0 6 mm 5 0 mm 1 3 mm 0 55 5 0 mm H31s 79 65 mGy Male 2 29 mSv Female 2 55 mSv Head Contrast medium IV injection Start delay 60 sec Flow rate 2 mi sec Total amount 50 60 ml Hints e An automatic bone correction all
206. raxHR ThoraxHRSeq ThoraxECGHRSeq LungLowDose LungLowDose06s LungCARE LungCAREO06s Overview General Hints Body Kernels e Scan Protocols oi Spin AbdomenRoutine AbdomenRoutine06s AbdomenCombil AbdomenCombi06s AbdomenVol AbdomenFast AbdomenFast06s AbdMultiPhase AbdMultiPhase06s AbdomenSeq Colonography Colonography06s e Overview General Hints Body Kernels e Scan Protocols 10 C Spine C SpineVol SpineRoutine SpineThinSlice SpineVol 244 246 250 252 254 258 262 262 264 265 266 266 270 274 278 280 288 290 294 294 296 297 298 298 300 302 304 305 Contents SpineSeq Osteo Pelvis Overview General Hints Body Kernels Scan Protocols Pelvis PelvisVol Hip HipVol SI_Joints E Upper Extremities Overview General Hints Body Kernels Scan Protocols WristHR ExtrRoutineHR ExtrCombi P Lower Extremities Overview General Hints Body Kernels Scan Protocols Knee Foot ExtrRoutineHR ExtrCombi 308 312 314 314 316 317 318 318 322 324 328 330 332 332 334 335 336 336 340 344 346 346 348 349 350 350 352 354 358 11 Contents Vascular 360 Overview 360 General Hints 363 Head Kernels 364 Body Kernels 365 Scan Protocols 366 HeadAngio HeadAngio06s 366 HeadAngioVol 370 CarotidAngio CarotidAng
207. re precise RTP radiation therapy planning e Potential for sparing of healthy tissue minimization of PTV planned target volume and less side effects e Potential for dose acceleration and higher cure rate To minimize motion artifacts two requirements are mandatory for a CT system Fast gantry rotation to raise the temporal resolution for artifact free images Prospective triggering of image acquisition in a sequential mode or retrospective gating of image reconstruction in a spiral mode based on the record ing of the respiratory curve in order to obtain images during inspiration and expiration phases Scan Parameters A respiratory gated lung spiral with cone correction will be provided To be able to work also with low breathing rates a fixed pitch factor of a min of 0 1 is needed Slice widths and collimation are the same as for cardio spiral In the Specials folder different scan protocols are pre defined for different breathing rates 490 Respiratory Gating Temporal Resolution Temporal resolution also called time resolution repre sents the time window of the data that is used for image reconstruction It is essential for respiratory CT imaging The higher the temporal resolution the fewer the motion artifacts A temporal resolution of a half of the Rotation Time can be achieved Technical Principles Basically there are two different technical approaches for respiration correlated CT acquisition
208. reases sharpness e Faster than raw data reconstruction e Enhances high contrast detectability e Automatic post processing a Image taken without Image taken with the the HCE filter HCE filter ASA The Advanced Smoothing Algorithm ASA filter reduces noise in soft tissues while edges with high contrast are preserved e Reduces noise without blurring of edges Enhances low contrast detectability e Individually adaptable e Automatic post processing 41 Dose Information CTDI and CTDi The average dose in the scan plane is best described by the CTDly for the selected scan parameters The CTDly is measured in dedicated plastic phantoms 16 cm diameter for head and 32 cm diameter for body as defined in IEC 60601 2 44 For scan modes with z Sharp the CTDI100 is calculated using the single num ber of tomographic sections not doubled by z Sharp to remain within the terms of IEC 60601 2 44 The z coverage with and without z Sharp is the same and so is the dose This dose index gives a good estimation of the average dose applied in the scanned volume as long as the patient size is similar to the size of the respective dose phantoms Since the body size can be smaller or larger than 32 cm the CTDl value displayed can deviate from the dose in the scanned volume The CTDly definition and measurement are based on single axial scan modes For clinical scanning i e scan ning of entire volumes in patients
209. red to delineate the rectum and sigmoid colon if lower pelvic mass or pathology is suspected In some cases air may be substituted for a positive contrast agent The use of vaginal tampon may be helpful in adult female patients with suspected pelvis pathology To further optimize MPR image quality we recom mend that you reduce one or more of the following collimation reconstruction increment and slice width for image reconstruction 316 Pelvis Body Kernels e As standard kernels for body tissue studies B30s or B40s are recommended softer images are obtained with B20s or B10s extremely soft The kernels B31s or B41s have about the same visual sharpness as B30s respectively B40s the image appearance however is more agreeable due to a fine grained noise structure quite often the low contrast detect ability is improved by using B31s B41s instead of B30s B40s e For higher sharpness as is required e g in patient protocols for cervical spine shoulder extremities thorax the kernels B50s B60s B7Os B80s are avail able 317 Pelvis Scan Protocols Pelvis Indications Spiral mode for routine pelvis studies e g processes of the prostate urinary bladder rectum gynecological indications etc For SOMATOM Emotion 16 slice configuration A typical range of 20 cm will be covered in 8 94 sec For SOMATOM Emotion 6 slice configuration A typical range of 20 cm will be covered in 13 11 sec
210. rement Kernel CTDlvoi Effective dose NeonateBody 80 35 0 6 sec 16x 1 2mm 1 2 mm 5 0 mm 28 8 mm 1 50 5 0 mm B41s 1 02 mGy Male 0 96 mSv Female 1 07 mSv NeonateBody 80 35 0 8 0 6 sec 6x 2 0mm 2 0mm 5 0 mm 18 0 mm 1 50 5 0mm B41s 1 02 mGy Male 3 23 mSv Female 4 12 mSv The conversion factor for a 8 week old child and a scan range of 150 mm was used 588 Children Contrast medium IV injection Start delay exam dependent Flow rate dependent upon needle size Access site Total 1 2 ml per kg of body weight amount Hints e CARE Bolus may be used to optimize bolus timing Set the ROI for monitoring scan in the abdominal aorta with triggering threshold of 120 HU or use manual triggering 589 Manufacturer Siemens Shanghai Medical Equipment Ltd SSME 278 Zhou Zhu Road 201318 Shanghai P R China Telephone 86 21 38895000 Authorized Representative according to the Medical Device Directive 93 42 EEC Siemens Medical Siemens AG Solutions that help Medical Solutions Henkestr 127 2002 2007 Siemens AG D 91052 Erlangen Order No G 2 025 630 16 01 21 ermany Printed in China Telephone 49 9131 84 0 06 2007
211. rkflow Information Auto Load in 3D and Postprocessing Presets You can activate the Auto load in 3D function on the Examination task card Auto Tasking and link it to a recon job for example the 2 recon job with thinner slice width in some of the examination protocols If the post processing type is chosen from the pull down menu the reconstructed images will be loaded auto matically into the 3D task card on the syngo Acquisi tion Workplace with the corresponding post process ing type On the 3D task card you can create parallel and radial ranges for Multi Planar Reconstruction MPR and Thin Maximum Intensity Projection MIP Thin which can be linked to a special series For example if you always perform sagittal MPRs for a spine examination as soon as you load a spine exami nation into the 3D task card select the image type MPR orientation and open the Range Parallel func tion Adapt the range settings image thickness dis tance between the images etc and click the link but ton and save your settings You now have a predefined post processing protocol linked to the series descrip tion of a spine examination 94 Workflow Information The same can be done for VRT presets In the main menu under Type gt VRT Definition you can link VRT presets with a series description Some of the scan protocols primarily for Angio exami nations are already preset in the protocol with Auto load in 3D If you prefer not to
212. rotection Basics SOMATOM LifeNet syngo Patient Browser syngo Data Set Conversion Camtasia SaveLog E Logbook syngo Viewing syngo Filming syngo CT Operator Manual Volume 2 Preparations Examination MPPS HeartView CT Respiratory Gating CT CARE Bolus CT CARE Vision CT syngo CT Operator Manual Volume 3 syngo 3D syngo Dental CT syngo Osteo CT 16 User Documentation syngo CT Operator Manual Volume 4 syngo LungCARE CT syngo Pulmo CT syngo Neuro Perfusion CT syngo Body Perfusion CT syngo CT Operator Manual Volume 5 syngo Calcium Scoring syngo Circulation syngo Volume Calculation syngo Dynamic Evaluation syngo Neuro DSA CT syngo CT Operator Manual Volume 6 syngo InSpace 4D CT syngo Colonography 17 Scan and Reconstruction Concept of Scan Protocols The scan protocols for adult and children are defined according to body regions Head Neck Shoulder Thorax Abdomen Pelvis Spine Upper Extremities Lower Extremities Vascular RT Specials and optional Cardiac PET SPECT and Private The protocols for special applications are defined in the Application Guide Clinical Applications or in the case of a Heart View examination in the Application Guide Cardiac CT The general concept is as follows All protocols without a suffix are standard spiral modes For example Sinus means the spiral mode for the sinus The suffixes of the protocol name are follows Routin
213. rterial Phase 2 4 recon kV 110 Effective mAs 120 Quality ref mAs Rotation Time 0 6 sec Acquisition 16 x 0 6 mm Slice collimation 0 6mm Slice width 5 0mm 1 0 mm Feed Rotation 7 7 mm Pitch Factor 0 80 Increment 5 0 mm 0 7 mm Kernel B41s B41s CTD yoy 9 60 mGy Effective dose Male 4 05 mSv Female 4 84 mSv 281 n Abdomen A range of 20 cm including liver pancreas and kidney arterial phase acquired in 9 01 sec Emotion 16 kV Effective mAs Quality ref mAs Rotation Time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTDlyo Effective dose 282 Venous Phase 130 120 0 6 sec 16x 1 2mm 1 2 mm 5 0 mm 15 4 mm 0 80 5 0 mm B41s 13 44 mGy Male 5 89 mSv Female 7 15 mSv Abdomen For SOMATOM Emotion 6 slice configuration A range of 20 cm including liver pancreas and kidney arterial phase acquired in 7 87 sec Emotion 6 kV Effective mAs Quality ref mAs Rotation Time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTDlyo Effective dose Non Contrast 110 75 0 8 0 6 sec 6x 2 0mm 2 0mm 5 0mm 18 0 mm 1 50 5 0mm B41s 5 33 mGy Male 2 14 mSv Female 2 71 mSv 283 Abdomen A range of 20 cm including liver pancreas and kidney arterial phase acquired in 12 96 sec Emotion 6 kV Effective mAs Quality ref mAs Rotation Time Acquisition Slice collimation Sl
214. rts and movies e Select the desired files and double click on them e The corresponding program for example Movie Media Player will be opened and you can review what you have saved e You can now transfer these files to floppy disk or copy them onto a CD Additional Important Information e Files with the following extensions cannot be started opened from the File Browser bat cmd com exe reg dot htm html pl vbs js wsf wsh xml e To transfer avi files from the File Browser to any external storage device for example CD or USB stick use RMB menu Send to Drag amp drop and copy paste to any storage device is not possible within the File Browser 154 Application Information Camtasia Camtasia is a separate software tool that allows you to film your desktop activities You can save these record ings as avi files for documentation and presentation purposes Key features e Camtasia Recorder to capture avi files Before starting recording you can select the area you want to capture amp Camtasia Recorder _ oJ x in xXx B E yr Press Record or F9 to capture e Camtasia Player to play avi files e Camtasia Producer to edit avi files To open the Camtasia tool select in the main menu Application gt Desktop gt Camtasia Recorder 155 Application Information Under Tools gt Options you can def
215. rves are based on the same patient parameters male 60 year old 75 kg Radiology 1998 207 647 655 123 Contrast Medium f Relative Enhancement HU Relative Enhancement HU Tmel Injection rate 2 ml s Injection rate 4 ml s 120 ml 300 mg l mil 120 ml 300 mg l mil Time s Time s Total volume of contrast Total volume of contrast medium injected 80 ml medium injected 120 ml 4 ml s 300 mg l ml 4 ml s 300 mg I ml lt 3 z E g 3 a Z E Relative Enhancement HU Time s Time s Type of injection Uni Type of injection Bi phase phase 140 ml 4 ml s 70 ml 4 ml s 370 mg l mil plus 70 ml 2 ml s 370 mg l ml 124 Contrast Medium IV Injection The administration of a contrast medium depends on the indication and on the delay times to be used during the examination The patients weight and circulatory situation also play a role In general no more than 3 ml per kg of body weight for adults and 2 ml per kg of body weight for children should be applied For a CTA study arterial phase the principle is to keep the contrast flowing throughout the duration of the scan Thus the total amount of contrast medium needed should be calculated with the following for mula CM start delay time scan time x flow rate CARE Bolus CT or Test Bolus may be used for optimal contrast bolus timing Please refer to the special proto cols To achieve optimal results in contrast
216. ry sensor belt The correct placement of the abdominal belt is essen tial in order to receive a clear respiratory signal result ing in precise generation of inspiration and expiration gates Improper positioning of the respiratory belt will result in an unstable respiratory signal which is sensi tive to movements of the patient during the scan and can cause image artifacts due to small metallic compo nents of the sensor please position the respiratory belt outside of the scan range 488 Respiratory Gating For proper belt positioning please follow the instruc tions below Step 2 patient patient s abdomen load cell fixing belt Wind the load cell fixing belt around the The blue part should apply to the back of the body so that the pocket load cell part patient applies ontojust below the diaphragm Step 4 load cell connection cable Be careful load cell connection cable may Securely fasten the fixing belt around the not entangle with the patient patient For further information on the respiratory gating sys tem AZ 733V Anzai Medical Japan please refer to the Operational manual Respiratory Gating or Anzai User s manual 489 Respiratory Gating Scanning Information The expected benefits in radiation treatment planning e g for lung and abdominal tumors are Information about tumor motion in 3D coordinates and over time e More accurate tumor shape delineation and there fore a mo
217. s Body Kernels Special Application Kernels 33 Extended FoV Auto FoV Neuro Modes Automatic Bone Correction Positioning Image Filters Dose Information CTDly and CTDlyo ImpactDose Effective mAs 27 27 28 32 32 33 34 35 37 38 39 40 42 42 44 45 Contents CARE Dose 4D How does CARE Dose 4D work Special Modes of CARE Dose 4D Scanning with CARE Dose 4D Adjusting the Image Noise Activating and Deactivating 47 49 53 54 58 61 Conversion of Old Protocols into Protocols with CARE Dose 4D 61 Additional Important Information E Workflow Information WorkStream4D Recon Jobs 3D Recon 1 Sagittal Coronal Reconstructions 63 64 64 64 65 71 2 Oblique Double oblique Reconstructions Non square Matrix for 3D Recon 71 76 Case Examples for 3D Recon and Non Square Matrix Workflow Patient Position Auto Reference Lines Navigation within the Topogram API Language e Logbook e Logbook Configuration e Logbook subtask card area e Logbook Browser Study Continuation 77 79 79 79 80 81 83 83 87 88 91 Reconstruction on the syngo CT Workplace Examination Job Status 92 93 Auto Load in 3D and Postprocessing Presets Scan Protocol Creation Edit Save Scan Protocol Scan Protocol Assistant Manipulate scan protocols 94 96 96 98 100 Contents Change parameters Import scan proto
218. s For SOMATOM Emotion 6 slice configuration WristHR Spiral mode for routine high resolution wrist studies ExtrRoutineHR Spiral mode for routine high resolution extremity studies ExtrCombi Spiral mode for the combination of thin slice and routine studies 333 Upper Extremities General Hints e Topogram AP 256 mm for joint studies e Patient positioning Depends on the region of examination In general for bilateral studies you should always try to position the patient evenly whenever the patient can comply For wrists and elbow scans Patient lying in prone position hands stretched above the head and lying flat on a Bocollo pillow optional ankles supported with a pad Both wrists should be examined together when necessary Retrospective reconstruction can be done a Use B50s kernel for soft tissue evaluation b For targeted FoV images on the affected side it is advisable to enter the side being examined in the comment line In case of 3D study only use kernel B10 and at least 50 overlapping image reconstruction To further optimize MPR image quality we recom mend that you reduce one or more of the following collimation reconstruction increment and slice width for image reconstruction 334 Upper Extremities Body Kernels e As standard kernels for body tissue studies B30s or B40s are recommended softer images are obtained with B20s or B10s extremely soft The kernels B31s or
219. s Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTD yoy Effective dose HeadAngio 80 80 0 8 0 6 sec 6x1 0 mm 1 0 mm 2 0 mm 9 0 mm 1 50 2 0 mm C30s 6 40 mGy Male 0 16 mSv Female 0 16 mSv 2 4 reconstr 1 25 mm 0 8 mm C30s The conversion factor for a 7 year old child and a scan range of 60 mm was used 575 Children Contrast medium IV injection Start delay exam dependent Flow rate dependent upon needle size Access site Total 1 2 ml per kg of body weight amount Hints Children older than age 6 should be examined with an adult protocol CARE Bolus may be used to optimize the bolus timing with a triggering threshold of 120 HU or use manual triggering An advanced algorithm allow for improved head image quality without any additional post process ing e To work without CARE Dose 4D use for children lt 3 years 100 mAs 3 6 years 150 mAs 576 577 Children CarotidAngio CarotidAngio06s Indications Spiral mode for carotid CT Angio studies for example carotidstenosis or occlusion vascular abnormalities of thecarotids or vertebral arteries etc For SOMATOM Emotion 16 slice configuration A typical range of 17 cm covered in 8 28 sec For SOMATOM Emotion 6 slice configuration A typical range of 20 cm covered in 14 53 sec 578 Children Emotion 16 kV Effective mAs Qu
220. s Quality ref mAs Rotation Time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTDly Effective dose AngioRunOff 110 90 0 6 sec 16x 1 2mm 1 2 mm 6 0 mm 28 8 mm 1 50 6 0 mm B31s 6 48 mGy Male 4 98 mSv 24 reconstr 1 5 mm 1 0 mm B31s Female 5 08 mSv AngioRunOff 110 90 0 8 0 6 sec 6x 2 0mm 2 0mm 6 0 mm 21 6mm 1 80 6 0mm B31s 6 39 mGy 2 4 reconstr 2 5mm 1 5mm B31s Male 2 95 mSv Female 1 94 mSv 411 Vascular Contrast medium IV injection Start delay 25 30 sec Flow rate 3 0 3 5 m sec Total amount 120 150 ml Hints e CARE Bolus may be used to optimize the bolus timing and with a triggering threshold of 120 HU or use manual triggering e If Topo length 1024 mm is not long enough you can also choose the Topo length of 1500 mm e Position the patient as feet first Bend the feet together if necessary 412 413 Vascular WholeBodyAngio Indications For CT Angio spiral studies of the whole body For SOMATOM Emotion 16 slice configuration A range of 80 cm will be done in 17 87 sec Emotion 16 kV Effective mAs Quality ref mAs Rotation Time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CDi Effective dose 414 WholeBody 274 reconstr 110 90 0 6 sec 16x 1 2mm 1 2 mm 6 0 mm 28 8 mm 1 50 6 0 mm 1 0 mm B31s B31s 6 48 mGy M
221. s focal lesion of the kidneys and CTA studies it is sufficient to use just water Water is more effec tive than positive oral contrast agent in depicting the linings of the stomach amp intestines in post enhance ment studies In addition the use of water will not obscure the blood vessels thus allowing CTA process ing to be performed easily afterwards For patients with bowel obstruction only water or water soluble contrast can be used Barium suspen sion is a contraindication Be careful when examining pheochromocytoma patients Administration of an IV CM injection in such cases may trigger a hypertensive crisis To further optimize MPR image quality we recom mend that you reduce one or more of the following collimation reconstruction increment and slice width for image reconstruction Body Kernels e As standard kernels for body tissue studies B30s or B40s are recommended softer images are obtained with B20s or B10s extremely soft The kernels B31s or B41s have about the same visual sharpness as B30s respectively B40s the image appearance however is more agreeable due to a fine grained noise structure quite often the low contrast detect ability is improved by using B31s B41s instead of B30s B40s For higher sharpness as is required e g in patient protocols for cervical spine shoulder extremities thorax lung the kernels B50s B60s B70s B80s are available 265 7 Abdomen Scan Prot
222. s are automatically filled out by the sys tem and displayed in the e Logbook as read only if they are configured Default settings are e Date of Examination e Patient Name e Patient ID e Date of birth e Scan Protocol Name e Total mAs The Continuous Number field is an incremental num ber to mark each recorded study within a defined time range In addition the Start No can be set to ensure for example an ongoing numbering after a software update 85 Furthermore the Continuous Number can be set to Daily Monthly Yearly If you set Continuous Number to Daily the continu ous number starts with one each day eo ag g s g e 86 Workflow Information Additionally the user can define Manual Entries which will also be displayed in the e Logbook These infor mation can be pre configured and then selected over a drop down menu in the e Logbook To configure new entries of the drop down menu for each Manual Entry just type the desired information inside and click on add To remove already existing entries just select the entry and click on delete Additionally you can customize up to five Manual Entries fields If you want to rename the customized entry fields type select Rename e Logbook subtask card area nisse BEIE 4 matau agav ojo Rnd comet 4 lene are 2 ewes come Gi If you close the current patient examination you will get an e Logbook subtask area which shows
223. s covered within the default FoV In case the FoV is too small please press the ctrl key and move the scan range over the object once and it will be adapted automatically The Auto FoV will also work with the snap function when an examination has two or more ranges The snap function will also cover the Auto FoV and there fore you have the possibility to merge different ranges To be able to use the snap function it is necessary to have the same FoV and the same x and y coordinates for all available ranges Do not use Auto FoV for asymmetric objects e g only one arm within the scan field 35 Scan and Reconstruction Hints e When positioning the arms along the body the Auto FoV will also cover the arms When scanning two extremities at the same time the Auto FoV will also cover both extremities 36 Scan and Reconstruction Neuro Modes In addition to the standard collimations the SOMA TOM Emotion 16 slice configuration provides a special mode which is optimized for Neuro applications Excel lent low contrast and detail resolution are achieved For spiral scans 4 x 0 6 acquisition mode is provided in the range of the cerebrum This approach shows a min imized partial volume effect i e low level of artifacts in the base of the skull or near vertebral bodies as 0 6 mm detector rows are used and the narrow colli mation reduces scattered radiation One scan protocol is predefined for adults H
224. scanning However image artifacts may occur if spirals are acquired with a tilt angle greater than 8 For all head studies it is very important for image quality to position the patient in the center of the scan field Use the lateral laser beam to make sure that the patient is positioned in the center In order to optimize image quality versus radiation dose scans are provided within a maximum scan field of 300 mm with respect to the iso center No recon job with a field of view exceeding those limits will be possible Therefore patient positioning has to be performed accurately to ensure a centered loca tion of the skull 165 Head Head Kernels e For soft tissue head studies the standard kernel is H40s softer images are obtained with H30s or H20s H10s sharper images with H50s The kernels H21s H31s H41s yield the same visual sharpness as H20s H30s H40s the image appearance however is more agreeable due to a fine grained noise struc ture quite often the low contrast detectability is improved by using H31s H 41s instead of H30s H40s For the standard head protocols we propose H21s H31s H41s High Resolution head studies should be performed with H60s H70s e g for dental and sinuses and H80s H90s e g inner ear It is mandatory to position the area of interest in the center of the scan field 166 167 Head Scan Protocols HeadRoutine Indications Spiral mode for routine
225. sible to interleave the soft tissue amp lung setting images in one film sheet This can be set up in the configuration for filming To further optimize MPR image quality we recom mend that you reduce one or more of the following collimation reconstruction increment and slice width for image reconstruction 230 Thorax Body Kernels e As standard kernels for body tissue studies B30s or B40s are recommended softer images are obtained with B20s or B10s extremely soft The kernels B31s or B41s have about the same visual sharpness as B30s respectively B40s the image appearance however is more agreeable due to a fine grained noise structure quite often the low contrast detect ability is improved by using B31s B41s instead of B30s B40s e For higher sharpness as is required e g in patient protocols for cervical spine shoulder extremities thorax lung the kernels B50s B60s B7Os B80s are available A special High Resolution lung kernel is supplied with B90s by using kernel B90s practically the same image impression is obtained as with HCE filtering of a B40s image 231 Thorax Scan Protocols ThoraxRoutine ThoraxRoutine06s Indications Routine spiral studies for the region of thorax e g examination of tumors metastases lymphoma lymph nodes vascular anomalies etc For SOMATOM Emotion 16 slice configuration A range of 30 cm will be covered in 12 92 sec For SOMATOM Emotion 6 sl
226. sing the relevant buttons In each segment you will find a pink rectangle which represents the boundary of the result images The image with the right down marker represents the field of view FoV of the result images viewing direction Reference lines 68 Workflow Information The rectangle with the grid represents the reference image topogram which is added to the Topogram series including the reference lines after reconstruc tion Topographics indicator Recon area 69 Workflow Information Preview Image A preview of the actual FoV is now available e After pressing the button Preview Image the actual FoV to be reconstructed will be displayed e Clicking again on the button deactivates the preview image and displays the whole reference image again e Double clicking into the FoV image activates or deac tivates the Preview Image function as well If the Preview Image function is active and you move or rotate the box or change the recon begin and end position the Preview image in the FoV segment will be updated accordingly 70 Workflow Information Depending on the desired resultant images choose coronal sagittal or oblique recon axis 1 Sagittal Coronal Reconstructions e Adjust the field of view size to your needs e It is only possible to reconstruct images with a squared matrix 2 Oblique Double oblique Reconstructions If you want to define the orientation of the result ima
227. sk card can be displayed on a second monitor Additional Dose Information CARE Vision uses scan parameters and operating con ditions which are unique and may require additional care and radiation protection measures To avoid unnecessary exposure in any case the scan time should be kept as short as possible 447 Specials Radiation exposure to patients e CARE Vision applies continuous exposure at moder ate mA levels Due to the potentially long scan times and the lim ited scan volume the dose for certain slices may increase to levels significantly higher than those known from standard CT applications e The patient s exposure levels is usually estimated by CTDIvol e This unit is designed to give the average dose in the scanned volume Before starting the scan the dose rate CTDIvol in mGy per second is displayed on the monitor During the CARE Vision scan the accumulated dose CTDI vol reflecting the patient exposure is dis played on the monitor The display scale ranges from zero to 3000 mGy If the table is shifted during the examination the accumulated dose will be distributed to different slices and will be lower than indicated by the display e When a new scan is loaded the dose display starts again from zero 448 Specials Radiation exposure to personnel During the procedure the physician is in the scan room and close to the exposed scan plane e Take special care to avoid excessi
228. t agents should be used Give the last cup 200 ml just prior to positioning the patient To ensure adequate filling of the duodenal loop lay the patient on the right side for 5 minutes before performing the topogram e A pre contrast examination is usually performed only if no CT scans were previously acquired to exclude calculi in the common bile duct and to visu alize possible lesions in the liver e For pancreatic studies the arterial phase acquisition can be acquired later with a start delay of 40 50 sec It may be necessary to use a thinner collimation 272 273 Abdomen AbdomenVol Indications Spiral mode for all routine studies in the region of abdomen e g follow up examinations etc Two recon jobs are predefined for reconstruction the first for axial the second for coronal studies in 3D images dis play view For SOMATOM Emotion 16 slice configuration The whole scan range of 20 cm will be covered in 9 53 sec For SOMATOM Emotion 6 slice configuration The whole scan range of 20 cm will be covered in 19 38 sec Emotion 16 kV Effective mAs Quality ref mAs Rotation Time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTDly Effective dose 274 AbdCombi 130 130 2 4 recon 0 6 16x 0 6mm 0 6 mm 5 0mm 5 0mm 14 4mm 1 50 5 0mm B41s 16 25 mGy Male 6 66 mSv Female 8 09 mSv 5 0mm B30s Abdomen Emotion 6 kV Effectiv
229. tamus Pa mara FF t tent tr a hot ened The spe sim pnan ON po E ERED Re AA uam Ne eng benm paeme edee te tema mrema Ar own meg ome pea res ad tne o mee pua on Po homama Ameo baa ar Also see the chapter Scan Protocol Assistant for more information 143 E Application Information Contact Function Contacting Siemens via Email is possible directly from your scanner and even DICOM images can be attached to your message To attach an image please first select the images on your Viewing task card first and then export these images to H SiteData Offline as a DICOM image After exporting the image open the Siemens Extranet and choose Contact After entering your message you can easily attach the image by selecting the images from the File Browser with the shortcut CTRL and C and paste it with the shortcut CTRL and V into the Extranet Every patient image is made anonymous before send ing Because the SOMATOM LifeNet window is always in the foreground we recommend to restore minimize it to be able to switch between both screens the File Browser and the SOMATOM LifeNet window 144 Application Information Trial Order and Installation As a SOMATOM CT user you can request trial clinical software directly from the scanner The requested soft ware will be made available and installed automati cally through our Siemens Remote Services connec tion After you have accessed the SOMATOM LifeNet online area you can c
230. th CARE Dose 4D for body regions other than those they are designed for the image quality should be carefully evaluated As CARE Dose 4D determines the eff mAs for every slice of the topogram a topogram must be obtained for use of CARE Dose 4D For Siemens scan protocols of SW version syngo CT 2007E the settings of CARE Dose 4D are already pre defined but may be changed to meet the customer s preference of image quality image noise 54 Dose Information Outside the topogram range CARE Dose 4D will con tinue the scan with the last available topogram infor mation Without a topogram CARE Dose 4D cannot be switched on Repositioning of the patient on the table and excessive motion of the patient must be avoided between the topogram and the scan If two topograms of the same projection exist for one scan range the last acquired will be used for determining the eff mAs If a lateral and a p topogram exist for one scan range both will be used for determining the eff mAs 55 Dose Information After the topogram has been scanned the eff mAs value in the Routine tab card displays the mean eff mAs estimated by CARE Dose 4D based on the topo gram After the scan has been performed this value is updated to the mean eff mAs that was applied The values may differ slightly due to the online modulation according to the patient s angular attenuation profile When tuning the CARE Dose 4D parameter
231. th phantoms for example for adjustment procedures S80s for constancy and acceptance tests S80s S90s or for specification purposes S90s For special patient protocols S80s and S90s are cho sen for example for osteo S80s It is mandatory to position the area of interest in the center of the scan field Use ExtrCcombi mode when a scan FoV gt 25 cm is necessary 516 517 Children Scan Protocols HeadRoutine Indications Spiral mode for routine head studies for example tumors hydrocephalus hemorrhaging abnormalities etc For SOMATOM Emotion 16 slice configuration A typical range of 12 cm covered in 20 05 sec For SOMATOM Emotion 6 slice configuration A typical range of 8 5 cm covered in 56 13 sec 518 Children Emotion 16 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTD yoy Effective dose Emotion 6 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTD yoy Effective dose Head 110 230 1 5 sec 16x 1 2mm 1 2 mm 4 0 mm 10 6 mm 0 55 4 0 mm C30s 36 80 mGy Male 2 83 mSv Female 2 89 mSv Head 110 230 1 5 sec 6x 1 0mm 1 0 mm 5 0mm 2 4mm 0 40 5 0mm C30s 42 32 mGy Male 1 70 mSv Female 1 69mSv The conversion factor for a 7 year old child and
232. the patient for treatment for the entire course of treatment typically 25 35 fractions 464 Radiation Therapy Benefits e No limitations for patient set up within 85 cm gantry opening and the ability to scan at a low table posi tion thereby maximizing gantry freespace e Complete anatomical visualization for optimized localization and dose calculation with extended 85 cm FOV 465 Radiation Therapy e High volume coverage in time 16 X2 0 mm in 0 6 s minimizing motion artifacts and breath hold time F SOMATOM Emotion 6 slice scanner 16 slice configuration RT edition Slice 1 5mm Slice 2 5mm Rot 0 6s Rot 1s Pitch 1 5 Pitch 1s Volume Coverage olume Coverage 25cmin10s 15cmin 10s e Thin slice imaging for high quality DRRs Digitally Reconstructed Radiograph and MPRs especially for conformal 3D therapy and IMRT Intensity Modu lated Radiation Therapy Complete CT simulation solution providing higher geometrical accuracy of table and lasers and the integration of flat table inserts 466 Radiation Therapy e New long range gantry laser lights with position adjustment possible without opening gantry covers for easier installation and synchronization with room RTP lasers e Integrated solution for Virtual Simulation with syngo based COHERENCE Dosimetrist or VSim on syngo MultiModality Workplace e Display of gantry tilt angle in 0 5 degree increments e Greater accuracy of X ray tube pos
233. time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTDlyo Effective dose 476 Breast 2 4 recon 130 90 0 6 sec 16x 1 2mm 1 2 mm 8 0 mm 15 4 mm 0 80 8 0 mm 8 0 mm B41s B70s 10 08 mGy Male 5 69 mSv Female 7 11 mSv 8 0 mm Radiation Therapy Emotion 6 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTD yoy Effective dose Breast 130 90 0 8 sec 6x 2 0mm 2 0mm 8 0mm 10 2 mm 0 85 8 0 mm B41s 9 81 mGy Male 4 98 mSv Female 6 45 mSv 2 4 recon 8 0 mm 5 0mm B7Os 477 Radiation Therapy RT_Abdomen Indications Spiral mode for routine radiation therapy planning abdominal studies For SOMATOM Emotion 16 slice configuration A range of 20 cm will be covered in 9 01 sec For SOMATOM Emotion 6 slice configuration A range of 20 cm will be covered in 17 29 sec Emotion 16 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTDlyo Effective dose 478 Abdomen 2 4 recon 130 150 0 6 sec 16x 1 2mm 1 2 mm 8 0 mm 15 4 mm 0 80 8 0 mm 8 0 mm B41s B60s 16 80 mGy Male 7 36 mSv Female 8 94 mSv 8 0 mm Radiation Therapy Emotion 6 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimat
234. tion 6 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Scan Increment Kernel CTD hyo 442 CAREVision 130 30 0 6 sec 16x 0 6mm 0 6 mm 4 8mm 0 0 1 0 mm B50s 3 75 mGy CAREVision 130 30 0 6 sec 6x 3 0mm 3 0mm 6 0 mm 0 0 1 0 mm B50s 3 06 mGy Specials HandCARE HandCARE is a dedicated algorithm for dose reduction during the interventional procedure It switches off the x ray exposure for a 100 angle between three different positions 10 00 12 00 and 2 00 o clock Thus provides a significant dose saving to the opera tor s hand while keeping the image quality constant 443 Specials The HandCARE item list offers None and three select able protection areas You can select this values inde pendent of the current or a future patient position The list elements are sorted clockwise from a view to the front of the gantry Values None 10 00 o clock 12 00 o clock 2 00 o clock default None label HandCARE The HandCARE position is graphically displayed on the Routine subtask card HandCARE positions 444 Specials Application Procedure 1 Load and scan a spiral protocol of the interested body region 2 Scroll through the images to define a target slice 3 Click on Same TP under Table position in the routine card Move the table to the desired table position 4 Turn
235. ur CT system which optimize your system s availability and efficiency 136 Application Information Key Features SOMATOM LifeNet offline All users e General Information about your system and configu ration e Access to syngo E Learning SOMATOM LifeNet online In combination with a Sie mens Remote Service connection e Newsticker archive and FAQ frequently asked ques tions section e Free trial software order and installation Download of information manuals and scan proto cols e Log Book order functionality A contact function for an easy and fast interface to Siemens including the possibility to attach up to two DICOM images 137 Application Information SOMATOM LifeNet offline Start SOMATOM LifeNet by selecting SOMATOM LifeNet under Options in your syngo menu bar and you will find a browser window that allows you to access various information about your hard and soft ware environment Under System Information for example you will find information such as software version or a scan second counter Under Customer Information you can enter your contact data Access to syngo E Learning Start the syngo E Learning to learn more about your software and the use of basic and advanced applica tions 138 Application Information The syngo Basics E Learning is pre installed on your system and can directly be used by selecting E Train ing The syngo Advanced Application E Learning can be do
236. used to optimize the bolus timing e For image reconstruction of bone structure use ker nel B60 e Patient positioning is very important for artifact free images The thoracic girdle should be positioned as far as possible in the caudal direction This can be done using a strap with a permanent loop or Velcro fastener at its end The ends of the strap must be attached to the patients wrists Then the strap must be wrapped around the patients feet with his legs extended and under tension The entire thoracic gir dle is thus pulled toward the patients feet 206 Neck Body Kernels e As standard kernels for body tissue studies B30s or B40s are recommended softer images are obtained with B20s or B10s extremely soft The kernels B31s or B41s have about the same visual sharpness as B30s respectively B40s the image appearance however is more agreeable due to a fine grained noise structure quite often the low contrast detect ability is improved by using B31s B41s instead of B30s B40s For higher sharpness as is required e g in patient protocols for cervical spine shoulder extremities thorax lung the kernels B50s B60s B7Os B80s are available In case of 3D study only use kernel B10s and at least 50 overlapping for image reconstruction 207 Neck Scan Protocols NeckRoutine Indications Spiral mode for soft tissue studies in the cervical region e g tumors lymphoma abscesses etc For
237. utomatic bone correction allows for improved head image quality without any additional postpro cessing e In order to optimize image quality versus radiation dose scans are provided within a maximum scan field of 300 mm with respect to the iso center No recon job with a field of view exceeding those limits will be possible Therefore patient positioning has to be performed accurately to ensure a centered loca tion of the skull 190 Head Sinus Indications Spiral mode for paranasal sinuses studies e g sinusi tis mucocele pneumatization polyposis tumor cor rections etc For SOMATOM Emotion 16 slice configuration A range of 80 mm will be covered in 12 42 sec For SOMATOM Emotion 6 slice configuration A range of 80 mm will be covered in 17 69 sec 192 Head Emotion 16 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTDlyoi Effective dose 2nd recon 4th recon 3rd recon Sinus 130 35 1 0 sec 16 x 0 6 mm 0 6 mm 5 0mm 5 0mm 7 7mm 1 0mm 1 0mm 0 80 5 0mm 5 0mm 0 7mm 0 7mm H70s H30s H70s H30s 9 31 mGy Male 0 32 mSv Female 0 36 mSv 193 Head Emotion 6 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTD o1 Effective dose Sinus 2
238. ve and unnecessary radiation exposure Protection against primary x ray exposure e In the worst case any body parts in the scan plane may receive approximately the accumulated dose as shown on the CTDI display e Avoid being directly exposed to the x ray beam Protection against stray radiation e The x ray beam is limited to the imaged scan vol ume but a significant portion of the x rays is scat tered and distributed in the scan room stray radia tion e Wear protective clothing to reduce exposure e A table with measured data of this stray radiation is included in the chapter on Safety in your SOMATOM Operator Manual 449 Specials General Information for Biopsy and CARE Vision Interventional Toolbar If you want to perform a CareVision or Biopsy Scan you can activate the new Interventional Tool Bar in the main menu under Imange Intervention The Interventional Toolbar will be displyed as soon as an Interventional Scan entry is being loaded Interventional Window 1 2 3 V2i3 l Save current Table Position TP C iw 2 Auto Stop at Saved Table Position TP e Ss Auto Stop at last Interventional Scan Posi _ ef ah tion SP Blow Up CARE View S CARE View Blow Up D E 450 Specials Interventional Window 1 2 3 With the special window toggle button you can apply three different window settings to your image the default values are Abdomen 300 40 Lung 1200 600 and Bone 1500 45
239. ve period ically and repetitively according to respiratory motion Therefore the diagnostic artifacts and image degrada tion and the treatment dangers can be avoided if pre cise detection of respiratory motion and its conse quent synchronized imaging or irradiation is available 484 Respiratory Gating The respiratory gating hardware AZ 733V is com posed of a Respiratory Sensor RS to detect patient s abdomi nal motions pressure changes to get a patient s res piratory information Sensor Port SP to amplify and to transmit analog signals from RS Wave Deck WD to receive the respiratory signal from the said SP and to convert them to a digital sig nal to be sent to the host computer PC of the CT system The respiration curve as well as scan and reconstruc tion parameters are displayed on the CT user interface and embedded into the examination workflow The respiration curve will be displayed before and dur ing spiral acquisition and saved in the respiration file After scanning the user can select the respiration level in of inspiration or expiration for reconstruction A synthetic sync signal and a respiration curve editing functionality are available Regarding an imaging device such as SOMATOM Emotion 6 16 slice configuration the respiratory gat ing functionality offers an increase of image resolution and reproducibility as well as a decrease of motion artefacts by image reconstructions based
240. ved head image quality without any additional postpro cessing e In order to optimize image quality versus radiation dose scans are provided within a maximum scan field of 300 mm with respect to the iso center No recon job with a field of view exceeding those limits will be possible Therefore patient positioning has to be performed accurately to ensure a centered loca tion of the skull 203 Neck Overview In this chapter you will find all scan protocols relating to the Neck region their descriptions individual indi cations and important hints on using them You can use the following scan protocols to clarify for example tumors lymphoma and abscesses 204 Neck For SOMATOM Emotion 16 slice configuration NeckRoutine Spiral mode for soft tissue routine neck studies NeckVol Spiral mode for axial coronal and sagittal neck stud ies For SOMATOM Emotion 6 slice configuration NeckRoutine Spiral mode for soft tissue routine neck studies NeckThinSlice Spiral mode for thin slice soft tissue neck studies NeckVol Spiral mode for axial coronal and sagittal neck stud ies 205 Neck General Hints e Topogram Lateral 256 mm or AP 512 mm e Patient positioning Patient lying in supine position hyperextend neck slightly secure head well in head holder e Patient respiratory instruction do not breathe do not swallow e For contrast studies CARE Bolus optional may be
241. with respect to the iso center No recon job with a field of view exceeding those limits will be possible There fore patient positioning has to be performed accu rately to ensure a centered location of the skull correct positioning wrong positioning of the head of the head For trauma examinations of the head we provide two protocols to be found in the specials folder HeadTrauma HeadTraumaSeq The scan protocols enable you to utilize the full 50 cm FoV resulting in easier patient positioning for trauma examinations and to ensure the highest performance the dedicated PFO head filter is not used 39 a Scan and Reconstruction Image Filters If you use kernels the images are reconstructed again with the selected kernel value If you use image filters the images are not reconstructed again and the result is much quicker Three different filters are available LCE The Low contrast enhancement filter enhances low contrast detectability It reduces the image noise e Similar to reconstruction with a smoother kernel e Reduces noise Enhances low contrast detectability e Adjustable in four steps e Automatic post processing Image taken without Image taken with the LCE the LCE filter filter 40 Scan and Reconstruction HCE The High contrast enhancement HCE filter enhances high contrast detectability It increases the image sharpness similar to reconstruction with a sharper kernel e Inc
242. wnloaded in the SOMATOM LifeNet online area or is sent to you automatically on CD if trial soft ware is requested via SOMATOM LifeNet In case a pdf document e g Application Guides is not visible in the SOMATOM LifeNet window after being opened please minimize or move the Browser window of the SOMATOM LifeNet platform since it might be hidden in the background 139 Application Information SOMATOM LifeNet online When you start up your system you will receive up to date information in the Newsticker and see the expi ration date of installed trial software Access the Siemens Extranet by clicking on SOMATOM LifeNet online After entering your CT system serial number you will be forwarded to the information and service portal You can find the serial number by selecting system information in the offline part of SOMATOM LifeNet You will be able to view up to date information and make use of various services SIEMENS Oe a_a esan son m eu memes s oe nd mos mot LA peere at at E 140 Application Information Download of Files Each download will be performed in the background and even if you disconnect your SOMATOM LifeNet online session and start to work with the CT scanner it will continue the process until the download is com pleted Due to bandwidth restrictions it is only possible to perform one download at a time Depending on your connection speed downloading of larger files like for example t
243. work without CARE Dose 4D use for children lt 25 kg 40 mAs 25 34 kg 75 mAs 35 54 kg 130 mAs 584 585 Children BodyAngioFast BodyAngioFast06s Indication Spiral mode for fast abdominal CT Angio studies for example vascular abnormalities aneurysms ect For SOMATOM Emotion 6 slice configuration A range of 15 cm will be covered in 11 20 sec with BodyAngioFast06s Emotion 6 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTDly Effective dose 586 BodyAngioFast 80 80 0 8 0 6 sec 6 x 2 0 1 0 mm 2 0 1 0 mm 3 0 mm 21 0 9 0 mm 1 75 1 50 3 0 mm B41s 2 32 2 64 mGy Male 2 68 2 63 mSv Female 4 21 4 12 mSv Children NeonateBody NeonateBody06s Indications Spiral mode for neonate body studies for example tumors abnormalities malformations abscesses etc For SOMATOM Emotion 16 slice configuration A typical range of 15 cm covered in 4 33 sec For SOMATOM Emotion 6 slice configuration A typical range of 15 cm covered in 6 20 sec 587 Children Emotion 16 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Increment Kernel CTDlvoi Effective dose Emotion 6 kV Effective mAs Quality ref mAs Rotation time Acquisition Slice collimation Slice width Feed Rotation Pitch Factor Inc
244. you all the information that will be saved in your system Here you can edit the manual entries and save these as well by clicking on ok 87 Workflow Information e Logbook Browser You will find the e Logbook Browser in the main menu under Patient gt e Logbook browser or you can use F12 key on your keyboard You can list the e Logbook recordings by date Select your desired timeframe in the calendar and click List now If you want to list the e Logbook recordings from today click on Today and the recordings will be dis played immediately no confirmation is needed A shortcut to yesterday s recordings is accessible over the black arrow on the right side of the Today button The system behaves the same if you want to list the recordings from This Week Last Week and This Month Last Month 88 Workflow Information Additional to the dates certain criteria can be selected to have a more specific search Search criteria can be defined for all entries recorded inside the e Logbook For example the entry Number of images is recorded A search for datasets which have a certain amount of images can be defined Additional conditions can be defined in this case is greater than greater or equal is less than less or equal equals The conditions vary with the selected search criteria You will find under the only within drop down menus only the System and Manual Entries you have config
245. ze image quality versus radiation dose scans are provided within a maximum scan field of 300 mm with respect to the iso center No recon job with a field of view exceeding those limits will be possible Therefore patient positioning has to be performed accurately to ensure a centered loca tion of the skull 186 187 Head InnerEarSeq Indications Sequence mode for inner ear studies e g inflamma tory changes tumorous processes of pyramids cere bellopontine angle tumors post traumatic changes etc For SOMATOM Emotion 16 slice configuration A scan range is predefined with 8 6 mm For SOMATOM Emotion 6 slice configuration A scan range is predefined with 4 7 mm 188 Head Emotion 16 kV Effective mAs Quality ref mAs Rotation Time Acquisition Slice collimation Slice width Feed Scan Kernel CTD Effective dose Emotion 6 kV Effective mAs Quality ref mAs Rotation Time Acquisition Slice collimation Slice width Feed Scan Kernel CID Effective dose InnerEarSeq 130 140 1 0 sec 12x 0 6mm 0 6 mm 0 6 mm 7 2mm H90s 42 00 mGy Male 1 51 mSv Female 1 62 mSv InnerEarSeq 130 140 1 0 sec 6x71 0mm 1 0mm 1 0 mm 6 0 mm H90s 38 50 mGy Male 0 68 mSv Female 0 79 mSv 189 Head Contrast medium IV injection Start delay 60 sec Flow rate 2 mil sec Total amount 60 ml Hints e For image reconstruction of soft tissue use kernel H30s H31s e An a

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