The article discusses the need for fast, high-quality and low-dose CT imaging in acute care and cardiology settings when diagnosing critical injuries. Two experts, Dr. Savvas Nicolaou from Vancouver General Hospital and Dr. Jörg Hausleiter from German Heart Center in Munich, emphasize the importance of CT for making timely diagnoses and treatment decisions. They expect the new Stellar Detector technology to provide improved image quality while further reducing radiation dose. The detector aims to balance diagnostic image quality with lower patient radiation, especially important for younger patients. Its ability to produce high-resolution images at high speed could help physicians make critical decisions within the "golden hour" window for treating conditions like stroke.
Feasibility of CT scan studies with triple split bolus intravenous contrast ...
Somatom session 29
1. SOMATOM Sessions
Answers for life in Computed Tomography
Issue Number 29 / November 2011
International Edition
Cover Story
A Critical “Edge”
When Seconds Count
Page 6
News
syngo.via: New Clinical
Opportunities with
Brand New CT Software
Applications
Page 12
Business
Value Added Max
Page 26
Clinical
Results
Flash Scanning
of Coronary
CTA with just 0.3 mSv
Page 38
Science
From Mannheim to
Shanghai: a Viable
Model for Future
International Research
Collaborations
Page 68
29
International Edition November 2011 29 SOMATOM Sessions
2. Editorial
2 “With the introduction of two
completely new systems at this
year’s RSNA conference, we
have shown our strength in
innovation and that we listen
carefully to our customers.”
Walter Märzendorfer, Chief Executive Officer, Business Unit Computed Tomography and Radiation
Oncology, Siemens Healthcare, Forchheim, Germany
Cover page: Courtesy of German Heart Center, Departments of Cardiology and Radiology, Munich, Germany
SOMATOM Sessions · November 2011 · www.siemens.com/healthcare-magazine
3. Editorial
Dear Reader,
In all healthcare systems around the
world, hospitals and clinics are facing the
challenge of minimizing spiraling costs
without compromising on patient care.
Our vision, to create CT innovations that
lift clinical practice to the next level of
excellence and enable wide access to
better patient care, has to meet those
challenges. By working closely with the
physicians and physicists who use our
systems in clinical routine, we are con-vinced
that this balance can be achieved.
The outcome are products, that meet
today’s demands in modern patient
care, and add innovations that help con-trol
costs and make your CT operations
economically sound.
The latest result of our extensive
research and development in this direc-tion
is the SOMATOM® Perspective1,
which is presented at this year’s RSNA
conference. This new 128-slice Single
Source CT scanner showcases a wide
range of CT technologies at an afford-able
price, and is also suitable for
smaller clinics. It scans an adult thorax
in about 3 seconds and supports our
state-of-the-art iterative reconstruction
SAFIRE2 at a speedy 15 images/second.
At the same time, its all-new eMode
allows you to operate the scanner in an
outstanding patient-friendly and finan-cially
efficient way. This thoughtful bal-ance
will help you to manage your
financial performance – which is why
we call it the business class in CT.
For added benefits in workflow optimiza-tion,
we have enhanced syngo.via3 with
a wide range of applications designed to
streamline your clinical efficiency. These
will help you to assess chronic obstructive
pulmonary disease and offer you dedi-cated
TAVI workflows – to name just two
examples. In addition, we carefully lis-tened
to your feedback and implemented
many of your suggestions to make our
paradigm-changing thin-client solution
more intuitive than ever.
But we also remain focused on innova-tions
powered by high-end technology,
such as the SOMATOM Definition Edge4 –
a completely new and extremely fast
single source scanner developed for high-resolution,
low noise imaging. Its core
technology is the unique Stellar Detec-tor,
4 the first fully-integrated detector in
the industry, featuring the highest rou-tine
spatial resolution and dose-opti-mized
Dual Energy applications. The
SOMATOM Definition Edge is ideal for
clinics introducing premium CT services,
as well as institutions that want to main-tain
a leading edge in their offerings. For
utmost performance, the Stellar Detector
will also be available on our flagship
scanner, the Dual Source SOMATOM
Definition Flash.1 Its unique scan speed
and temporal resolution will be brought
to a new level with ultra-high spatial
resolution, for finer and sharper image
details than ever.
The Stellar Detector also marks another
step in our endeavor to reduce dose in
CT. Its capability to minimize noise makes
it highly suited for your efforts to scan
with the lowest possible dose, at levels
that were thought unachieveable just a
few years ago. As such, it perfectly blends
with our raw data-based iterative recon-struction
SAFIRE, two unique tools to
help you implement the ALARA principle
in your institution – for best possible
patient care.
By working closely with our customers,
we have recognized future trends and
brought cutting-edge technology and
cost-effective solutions to the present.
See for yourself how close we are to
achieving our vision in this issue of
SOMATOM Sessions.
Feedback in the form of criticisms or
suggestions will be gladly received.
Sincerely,
Peter Seitz,
Vice President Marketing,
Computed Tomography,
Siemens Healthcare,
Forchheim, Germany
Peter Seitz
1 Under FDA review. Not available for sale in the U.S.
2 The information about this product is being provided for planning purposes. The product is pending 510(k) review, and is not yet commercially available in the U.S.
3 syngo.via can be used as a stand-alone device or together with a variety of syngo.via-based software options, which are medical devices in their own rights.
4 Under development. Not available for sale in the U.S.
SOMATOM Sessions · November 2011 · www.siemens.com/healthcare-magazine 3
4. Content
Cover Story
Cover Story
6 A Critical “Edge” When Seconds
Count
News
12 syngo.via2: New Clinical Opportuni-ties
with Brand new CT Software
Applications
15 Significant Dose Reduction with
SAFIRE3 at Wexford General Hospital,
Ireland
16 Boosting Cardiovascular Reading
with syngo.via at this Year’s CTA
Academy
17 Stroke Management – Education
and Information Exchange Online
18 International CT Image Contest
2011
20 Iterative Reconstruction is Now
Available for SOMATOM Emotion
and Sensation
22 FAST CARE Meets DSCT
23 High-End CT is on the Move
24 CT Examinations Tailored Precisely
to Individual Patient Needs
6 When it comes to diagnosing
critical injuries like in acute care
or cardiology settings,
radiologists need fast, high-quality
CT images at a low dose.
Siemens listened to radiologists’
needs and developed a
revolutionary new detector
generation: the Stellar Detector.1
Two renowned imaging experts,
the radilogist Savvas Nicolaou,
MD and the cardiologist Jörg
Hausleiter, MD share their
expectations and potential
applications for the new detector
technology.
4 SOMATOM Sessions · November 2011 · www.siemens.com/healthcare-magazine
26
Value Added Max
18
International CT Image Contest 2011
Business
26 Value Added Max
30 Accelerated Cardiovascular Assess-ment
Powered by syngo.via
31 Minimizing Scan Time Loss with
TubeGuard
32 Versatility at High Speed
Clinical Results
Cardio-Vascular
34 SOMATOM Definition Flash: Ruling
out Coronary Artery Disease and
Diagnosing Coronary Arteritis with
1.3 mSv
36 Fast and Precise Imaging of Aortic
Intimal Flap Using High Pitch Flash
Scan Protocol without ECG-Trigger-ing
or -Gating
38 Flash Scanning of Coronary CTA with
just 0.3 mSv
40 Flash Scanning for Pediatric Aortic
Abnormalities without Sedation at
0.6 mSv
Oncology
42 Examination of a Patient with Lung
Cancer with SOMATOM Definition
AS Open to Evaluate Treatment and
Calculate Dose
Content
5. Science
60 The First Single Source Dual Energy
Scan Mode with Optimized Dose
62 iTRIM – a New Method for Improving
Temporal Resolution in Cardiac
Computed Tomography
64 Stellar Detector Performance in
Computed Tomography
67 Pediatric Imaging in the Spotlight
68 From Mannheim to Shanghai: a
Viable Model for Future Interna-tional
Research Collaborations
Customer
Excellence
70 An Aura of Success: The 10th
SOMATOM World Summit
SOMATOM Sessions · November 2011 · www.siemens.com/healthcare-magazine 5
44 Low Dose Pediatric Flash CT Scan-ning
with IRIS4 – A Follow-up Study
after Neuroblastoma Relapse
46 Dose Reduction Combining CARE
Dose4D, CARE kV and SAFIRE
Techniques
48 Lung Ventilation Imaging with Dual
Energy Xenon CT in Single Breath
Technique
Neurology
50 SOMATOM Definition AS 40: VPCT
Pre- and Post-Recanalization of the
Internal Carotid Artery
52 Dual Energy CT Myelography Used to
Detect Spontaneous Spinal Cerebro-spinal
Fluid Leaks
Acute Care
54 SOMATOM Definition Flash: Low
Dose Chest Follow-up Scanning
with IRIS
56 SOMATOM Definition Flash:
Metal Artifact Reduction with
Mono Energetic Dual Energy
Imaging in a Critical Trauma Case
58 Flash CT Pulmonary Angiography in
a Freely Breathing Patient
72 Garmisch CT Symposium 2012 –
The Congress
72 Hands-on Tutorials at ESC 2011
73 FAST CARE Boosted with Expert
Advice
73 Keep Track of Developments with
Clinical Webinars
74 New Software for the SOMATOM
Emotion 16
75 The 3rd Definition Symposium held
by Siemens Japan in Tokyo
76 Frequently Asked Question
76 Upcoming Events & Congresses
77 Clinical Workshops 2012
78 Subscription
79 Imprint
58
Flash CT Pulmonary Angiography
in a Freely Breathing Patient
70
An Aura of Sucsess: The 10th
SOMATOM World Summit
64
Stellar Detector Performance in
Computed Tomography
Content
1 Under development. Not available for sale in the U.S.
2 syngo.via can be used as a stand-alone device or together with a variety of syngo.via-based software options,
which are medical devices in their own rights.
3 The information about this product is being provided for planning purposes. The product is pending 510(k)
review, and is not yet commercially available in the U.S. In clinical practice, the use of SAFIRE may reduce
CT patient dose depending on the clinical task, patient size, anatomical location, and clinical practice.
A consultation with a radiologist and a physicist should be made to determine the appropriate dose to obtain
diagnostic image quality for the particular clinical task.
4 In clinical practice, the use of IRIS may reduce CT patient dose depending on the clinical task, patient size, ana-tomical
location, and clinical practice. A consultation with a radiologist and a physicist should be made to deter-mine
the appropriate dose to obtain diagnostic image quality for the particular clinical task.
6. Cover Story
With the unique combination of high spatial resolution at uncompromised temporal resolution, the SOMATOM Definition Edge1 gives radiologists the perfect
balance of clear diagnostic images with less patient radiation. Courtesy of German Heart Center, Departments of Cardiology and Radiology, Munich, Germany
6 SOMATOM Sessions · November 2011 · www.siemens.com/healthcare-magazine
1
7. Cover Story
A Critical “Edge”
When Seconds Count
When it comes to diagnosing critical injuries like in acute care or cardiology
settings, radiologists need fast, high-quality CT images at a low dose. Siemens
listened to radiologists’ needs and developed a revolutionary new detector
generation: the Stellar Detector1. Two renowned imaging experts, the radiolo-gist
Savvas Nicolaou, MD and the cardiologist Jörg Hausleiter, MD share their
expectations and potential applications for the new detector technology.
SOMATOM Sessions · November 2011 · www.siemens.com/healthcare-magazine 7
Surrounded by cold deep ocean waters
famous for whale spotting, Vancouver,
British Columbia, located on Canada’s
western coast, is a cosmopolitan haven
for adventure seekers and foodies alike.
The city’s sleek skyscrapers compete with
the jagged mountain peaks beyond,
creating an interesting juxtaposition
of nature and urban culture. Situated in
the heart of this vibrant metropolis is
Vancouver General Hospital. Home to
one of the largest research institutes in
Canada, Vancouver General is a teaching
hospital as well as a busy level 1 trauma
center, where seconds can often mean
the difference between life and death.
At Vancouver General, radiologists use
CT images to provide information that
is critical to making a proper diagnosis
in an acute care setting. CT images are
used for a variety of clinical scenarios in
the emergency department, such as
identifying blocks in the coronary arter-ies
or rips in the bowel, or finding small,
subtle fractures in the spine, that if undis-covered,
could result in patient paralysis.
“In a trauma setting, you want to obtain
the best image quality possible, because
we often have to make decisions very
quickly about catastrophic injuries,” says
Savvas Nicolaou, MD, Director of Emer-gency/
Trauma imaging at Vancouver
General Hospital.
A diagnostic necessity
According to Nicolaou, there has been
an explosion in the utilization of CT
imaging in the acute care setting, and
CT use has increased eight-fold in recent
years. Trauma physicians work together
with radiologists “to make the right
diagnoses and clinical decisions to pro-vide
the best and safest care to our
patients,” explains Nicolaou.
At the German Heart Center in Munich,
Jörg Hausleiter, MD, also relies on CT
images to provide critical information
about patients who present with chest
pain or have a history of coronary heart
disease. The recent 2011 WHO report
states that cardio vascular diseases
(CVDs) are the leading causes of death
By Amy K. Erickson
“Modern CT tech-nology
allows me
to differentiate
between patients
who need to be
treated with coro-nary
stent place-ment
and those
patients who
don’t need it.”
1 Under development. Not available for sale in the U.S.
Jörg Hausleiter, MD,
German Heart Center, Munich, Germany
8. and disability in the world. A large pro-portion
of CVDs is preventable but obe-sity
and diabetes mellitus with athero-sclerosis
- that are often linked to CVD
- makes CT imaging a challenge in that
population. CT imaging “allows me to
differentiate between patients who
need to be treated with coronary stent
placement and those patients who don’t
need it,” says Hausleiter.
Advances in CT imaging provide radiolo-gists
with more opportunities than
ever before to image unstable trauma
patients. “We have the ability to put
people who are actively bleeding, whose
blood pressures are greatly decreased,
who are in a critical situation, into the
CT scanner and use the high-speed
acquisition technology to quickly tell the
trauma surgeon whether a patient has
a large hematoma that is crushing the
brain that needs to be evacuated
urgently or if they have a tear in the
thoracic aorta that is actively bleeding
in their chest,” says Nicolaou.
However, one of the biggest hot button
issues in radiology today is the desire
to minimize the radiation dose. Even in
the acute setting where high quality
images undoubtedly save lives, dose
8 SOMATOM Sessions · November 2011 · www.siemens.com/healthcare-magazine
reduction is at the forefront of patient
care. “For example, if you have a
23-year-old woman with chest pain, you
need to do a CT scan to exclude aortic
dissection, a pulmonary embolism, or a
coronary artery stenosis (i.e. the Triple-
Rule-Out Exam),” explains Nicolaou.
“However, we want to minimize the
radiation dose to that young woman
because the breasts, thyroid, and other
organs are very sensitive to the effects
of radiation.” He acknowledges that
there is a lot of pressure to do low-dose
imaging from within the radiology com-munity
and from physicians and patients
as well. “The challenge is to do it with-out
compromising image integrity, so
we can provide the appropriate diagno-ses
for our patients,” says Nicolaou.
Quick response in the
“golden hour”
For patients in Vancouver, Munich and
everywhere in between, trauma is the
the leading cause of death under the
age of 45. With fast and precise imaging
radiologists can offer a therapeutic
advantage to patients by providing
an accurate diagnosis within the critical
“golden hour,” the time period after an
insult during which there is the highest
likelihood that medical treatment will
prevent death. “For instance in acute
stroke, the findings on the CT are very
subtle and hard to detect in the early
stages,” says Nicolaou. “High-speed
acquisition is critical in stroke imaging
so we can very quickly tell our neurology
colleagues to administer the drugs to
dissolve the clots.”
CT can also be used to look at ischemia
of the bowel and to look for acute blood
in the abdomen. “We also need to iden-tify
traumatic tears of the bowel within
minutes so that the surgeons can make
the appropriate interventions,” explains
Nicolaou. CT also comes into play when
looking at subtle fractures in the cervical
spine. In addition, CT can be used in an
acute setting to characterize the compo-sition
of kidney stones, which can deter-mine
the course treatment, such as hav-ing
the stones broken down by an
ultrasound machine, or dissolved with
medical therapy” Nicolaou remarks. Dual
“In a trauma setting, you want to
obtain the best image quality
possible, because we often have
to make decisions very quickly
about catastrophic in juries.”
Savvas Nicolaou, MD,
Vancouver General Hospital, Vancouver, Canada
9. Cover Story
SOMATOM Sessions · November 2011 · www.siemens.com/healthcare-magazine 9
Energy information can add the respec-tive
tissue information to the morphol-ogy
to support this decision.
Chest imaging and beyond
One of the most common and critically
important issues of CT images in an
acute setting is for chest injuries and
cardiac emergencies. At the German
Heart Center, Hausleiter relies on CT
images to identify any narrowing or ath-erosclerotic
plaques in a patient’s coro-nary
arteries. “The normal coronary
artery is only 3 millimeters in diameter,
so we are talking about very, very tiny
structures,” says Hausleiter. “We often
want to assess the coronary arteries to
see if there is any narrowing or stenosis
and to detect atherosclerotic plaques.”
Once the coronary arteries are imaged,
cardiologists like Hausleiter can deter-mine
whether a patient needs to be
rushed to the cath lab to have a stent
inserted or if the patient can be medi-cally
managed and safely discharged.
Other causes of chest pain can include a
thrombotic clot within a coronary artery,
a pulmonary embolism, or pneumonia
in the lung.
Whether it is imaging a motorcycle acci-dent
victim or an individual with chest
pain, radiologists and cardiologists need
CT technology that maintains image
quality while minimizing the dose. “As
a radiologist, you can’t forget that ulti-mately
you need to make a diagnosis
based on the images,” says Nicolaou.
“I need detector technology that is
highly efficient, while providing excel-lent
clinical images. I also need to obtain
diagnostic images at a low radiation
dose. It is incumbent upon us as radiolo-gists
to minimize the dose, since we are
using CT at such a rapid pace to optimize
patient care.”
From a cardiology standpoint, Hausleiter
points out that over time, stents can re-narrow
and the stenosis can come back.
“In this case, we need to assess the inside
of the stent, and this requires a high spa-tial
resolution,” he says. “The higher the
spatial resolution, the higher our capa-bility
to detect these changes.”
Radiologists also need to benefit from a
detector that provides an extremely high
dynamic range of data preventing
potential artifacts in the image. “Cur-rently
it is very difficult to be able to
identify and utilize information at very
low contrast levels,” says Nicolaou. He
notes that in a trauma setting, patients
often come in with numerous tubes and
access lines. “A lot of artifacts can occur
when you image patients with these
extra tubes, which can preclude you
from obtaining good diagnostic images,”
says Nicolaou. “However, if we have a
detector that can take care of the noise
and get rid of the artifacts, then we can
Vancouver General Hospital (VGH) is a leading institution in trauma imaging.
10. Cover Story
obtain better diagnostic images.”
In the emergency department, patients
come in all shapes and sizes. It is often
more difficult to obtain good images
for our bariatric patients. The larger a
patient is, the higher the dose of radia-tion
that is needed in order to character-ize
the tissue to obtain high-quality
diagnostic images. “Noise is a problem
in every patient,” says Hausleiter,
“but we often have a problem with noise
in obese patients compared to slim
patients.”
The “Edge” is here
To comply with these needs of leading
radiologists and cardiologists like Nico-laou
and Hausleiter, Siemens is launching
a revolutionary new detector generation:
The Stellar Detector1. Introduced for the
SOMATOM® Definition Flash Dual Source
systems, Siemens launches it also with
the new SOMATOM Definition Edge1.
Based on the technology of the
SOMATOM Definition Flash2 with the Stel-lar
Detector this Single Source CT system.
Debuting at the 2011 RSNA annual meet-ing
in Chicago, the new Stellar Detector
and the innovative Edge Technology1, is
designed to generate ultra-thin slices to
deliver the highest spatial resolution in
CT. In the past, thinner slices delivered
more image detail, but also higher image
noise. With the Stellar Detector for the
SOMATOM Definition Flash and the
SOMATOM Definition Edge, electronic
noise and cross-talk are minimized.
Hausleiter believes that the new system
will offer cardiologists a significant
advantage in the field of cardiology.
When imaging the heart, high spatial res-olution
only makes sense when it is com-bined
with high temporal resolution.
Hausleiter points out that a primary chal-lenge
in imaging the heart is that the
muscle is constantly beating and moving,
which means the coronary arteries are
also constantly moving. “CT images need
to be obtained at a high temporal resolu-tion
to make coronary arteries sharp,”
says Hausleiter, “and the sharper they are,
the better ability we have to detect the
coronary stenosis and atherosclerotic
changes in plaque formations.”
With the unique combination of high spa-tial
resolution from the Stellar Detector
with uncompromised temporal resolu-tion,
both the SOMATOM Definition Edge
and SOMATOM Definition Flash offer the
most advanced solution for this clinical
10 SOMATOM Sessions · November 2011 · www.siemens.com/healthcare-magazine
challenge. “We need a CT technology that
gives us the possibility to safely detect
in-stent restenosis of stents smaller than
3 mm in diameter or to differentiate the
three plaque-components more pre-cisely,”
explains Hausleiter. “The new
detector system offers improved spatial
resolution.” In addition, the new gantry
on the SOMATOM Definition Edge allows
a rotation speed of 0.28 seconds like the
SOMATOM Definition Flash. This reduces
motion significantly and offers cardiolo-gists
like Hausleiter a solution for pre-cisely
imaging a beating heart.
The new detector generation is also per-fectly
suited for the acute care setting.
One of the many clinical advantages
offered by the SOMATOM Definition Flash
and SOMATOM Definition Edge is SAFIRE3
(Sinogram Affirmed Iterative Reconstruc-tion).
SAFIRE is a method of raw data-based
iterative reconstruction that
reduces noise so precisely, that dose can
be reduced by up to 60%, without com-promising
the image quality. “When you
decrease the dose or improve the resolu-tion,”
explains Nicolaou, “it inherently
leads to an increase in noise. With itera-tive
reconstruction, we can potentially
reduce the dose while having the advan-tage
of improved image quality. This is
critical when it comes to imaging vital
structures in the body.” The minimized
noise level of the Stellar Detector and the
technology of SAFIRE are the perfect
match for ultra-low dose high resolution
imaging, eliminating the contradiction of
outstanding image quality with minimal
dose.
The Stellar Detector may be ideal for
bariatric imaging, where obese patients
may attenuate a large portion of the
signal, often resulting in a signal that is
too low for diagnosis. By eliminating
electronic noise, the signal-to-noise ratio
(SNR) can be increased, giving it much
more flexibility to handle low signals.
The system’s TrueSignal Technology
significantly minimizes electronic noise
in the detector and the resulting SNR
at low signal levels is increased, so that
even very low signals are sufficiently
strong for the detector to pick up. Low-signal
images benefit from increased
clarity, because the detector can now
Doctors can’t forget that ultimately he or she need to make a diagnosis based on images.
Of course CT technology with high-speed, high-quality, low-dose CT images is preferred.
11. Cover Story
With fast image acquisition, good diagnostic image quality, and high spatial resolution, the SOMATOM Definition Edge enables radiologists to provide
an accurate diagnosis, especially within the critical “golden hour”.
www.siemens.com/
SOMATOM-Definition-Edge
SOMATOM Sessions · November 2011 · www.siemens.com/healthcare-magazine 11
differentiate the diagnostic information
of an individual voxel much better com-pared
to the surrounding image data.
Especially bariatric patients are often at
a higher risk for heart disease, stroke
and high blood pressure, and these con-ditions
must be evaluated safely, even in
these challenging patients.
“I expect that this technology will help
us with noise reduction, especially in
obese patients,” says Hausleiter.
Additionally, Dual Energy becomes avail-able
for Single Source CT imaging with
the SOMATOM Definition Edge. With the
novel capabilities of the Stellar Detector
and the dose-optimized, Single Source
Dual Energy scan mode, the Definition
Edge enables doctors to add tissue char-acteristics
to morphology, allowing for
the specification of formerly unspecific
information for a higher diagnostic out-come.
Inspiring confi dence
Radiologists and cardiologists across the
world have spoken, and Siemens has
answered with the Stellar Detector in the
SOMATOM Definition Flash and in the
new SOMATOM Definition Edge. The
new detector generation provides the
solutions that radiologists in acute care,
cardiology and other fields have been
looking for, with improved spatial resolu-tion,
reduced noise in obese patients,
improved soft tissue characterization,
and improved image quality in low signal
examinations. When these features are
added together, the new detector may
allow radiologists and cardiologists to be
more secure in their diagnoses. “I expect
that it will give me more confidence in
my diagnoses and when deciding if a
patient has advanced disease or minimal
disease,” says Hausleiter.
With the development of the Stellar
Detector, Siemens has once again looked
into the future and brought cutting-edge
technology to the present. “The
future of radiology is heading toward
optimizing low-dose imaging while main-taining
or even improving diagnostic
image quality,” says Nicolaou. “
This technology will allow us to do both:
providing excellent diagnostic images at
extremely low-dose radiation with
SAFIRE’s iterative reconstruction and the
new Stellar Detector.”
Amy K. Erickson is a widely published medical
journalist with more than a decade of experi-ence
in the health and biotech industries. Based
in the San Francisco bay area, Amy’s work has
appeared in numerous publications including
Nature Medicine, Cure magazine, the Washing-ton
Post and CNN.com.
1 Under development. Not available for sale in the U.S.
2 Under FDA review. Not available for sale in the U.S.
3 The information about this product is being provided
for planning purposes. The product is pending 510(k)
review, and is not yet commercially available in the
U.S.
In clinical practice, the use of SAFIRE may reduce CT
patient dose depending on the clinical task, patient
size, anatomical location, and clinical practice. A
consultation with a radiologist and a physicist should
be made to determine the appropriate dose to obtain
diagnostic image quality for the particular clinical
task.
The following test method was used to determine a
60% dose reduction when using the SAFIRE recon-struction
software. Noise, CT numbers, homogenity,
low-contrast resolution and high contrast resolution
were assessed in a Gammex 438 phantom. Low dose
data reconstructed with SAFIRE showed the same
image quality compared to full dose data based on
this test. Data on file.
12. News
syngo.via:
New Clinical Opportunities with Brand
new CT Software Applications1
By Susanne Hölzer, Philip Stenner, PhD, Jochen Dormeier, MD, Karin Barthel
Computed Tomography, Siemens Healthcare, Forchheim, Germany
With the launch of a new syngo.via1 ver-sion
at the RSNA 2011, Siemens is open-ing
a new era for routine diagnostics in
CT imaging. With four additional CT
workflows, six freshened-up Dual Energy
applications, and many other additional
helpful features and applications, even
for other imaging modalities, it is
designed to further diagnostic speed and
accuracy.
Dual Energy – Going beyond
visualization
The SOMATOM® Definition Flash has
brought Dual Energy examination into
routine clinical practice and has shown
the diagnostic benefits of going beyond
visualization.
With the new version the basic function-ality
of syngo.via has been enriched with
well-established features such as Opti-mum
Contrast for automatically calculat-ing
contrast-optimized images and a new
Dual Energy applications now
available on syngo.via:
■ syngo.CT DE Lung Analysis
■ syngo.CT DE Heart PBV
■ syngo.CT DE Calculi
Characterization
■ syngo.CT DE Brain Hemorrhage
■ syngo.CT DE Virtual Unenhanced
■ syngo.CT DE Direct Angio
functionality for generating monoener-getic
images at a range of 40-190 keV to
optimize the image quality. Furthermore
the assessment of kidney stones is facili-tated
with the new syngo.CT DE Calculi
Characterization. The Siemens’ unique
“Kidney Stone Navigator” makes it easy to
navigate through findings without scroll-ing
through the whole volume. Another
new application – syngo.CT DE Lung
Analysis – utilizes Siemens’ unique Dual
Source Dual Energy data for simultane-
1 2
12 SOMATOM Sessions · November 2011 · www.siemens.com/healthcare-magazine
ous assessment of both pulmonary func-tion
and of the lung vessels. After the
evaluation all diagnostic information is
being displayed in one view, allowing
pulmonary embolism to be ruled out.
Cardiovascular CT – accuracy
for TAVI planning and boosted
sensitivity in triple rule-out
examinations
Aortic stenosis is one of the most com-mon
forms of cardiovascular valve disor-der.
It is conventionally treated by replac-ing
the aortic valve with an artifi cial
valve through invasive open chest sur-gery.
However, patients affected usually
suffer from several co-morbidities and
are therefore denied surgery. Since a
couple of years, these patients may
undergo a minimally invasive replace-ment
of the aortic valve, known as trans-catheter
aortic valve implantation (TAVI).
Crucial for a successful TAVI procedure
1 syngo.CT DE Lung Analysis in syngo.via 2 Curved planar reformations of the aorta and iliac arteries facilitate the assessment
of the vessel diameters for pre-procedural TAVI planning.
13. News
“syngo.via combines all evaluation tools in one
single workfl ow. This is a real advantage because
we need less time to evaluate all anatomic
structures relevant for the TAVI procedure.”
Tobias Pfl ederer, MD, University of Erlangen-Nuremberg, Erlangen, Germany
3 The automated detection of pulmonary filling defects in syngo.CT
PE CAD3 allows for a safer evaluation of triple rule-out cases.[2]
References
[1] T. Pflederer, S. Achenbach, Journal of Cardiovascular
Computed Tomography (2010) 4, 355–364
[2] Blackmon et al., European Radiology, January 2011.
4 For an evaluation of local vessel or tissue enhancement, syngo.CT Dynamic
Angio2 displays ROI-specific time attenuation curves, as well as curve and statis-tical
parameters, such as time to peak and peak enhancement.
is accurate pre-procedural planning,
where the access path for the catheter is
assessed and the optimum device type
and size are determined.
From now on, the post-processing pow-ers
of syngo.CT Vascular Analysis and
syngo.CT Cardiac Function will be com-bined
to form a dedicated workfl ow for
streamlined CT TAVI planning.
In the fi rst step of this workfl ow, the
smallest possibly detected diameter of
the iliac arteries is localized with a single
click in syngo.CT Vascular Analysis.
Quantifi cation is easily performed with
the Stenosis Measurement Tool. The
cardiologist can now determine the
optimum access route for the catheter.
Calcifi cation removal helps radiologists
to visualize calcifi cations in the entire
aorta.
An accurate assessment of the aortic
annulus is crucial for selecting the cor-rect
implant. syngo.CT Cardiac Function
displays the aortic valve plane with a
single click, allowing the short and long
axes of the aortic annulus to be mea-sured
more quickly. The length of the
device is determined by the distances of
the coronary ostia, which are obtained in
a matter of seconds. Finally, the angula-tion
for the C-arm guided intervention is
calculated and can be transferred to the
cath lab. Predicting the optimal angula-tion
with CT has been proven to help
reducing the amount of contrast agent
4
3
applied in the cath lab by 48%.[1] This
streamlined workfl ow leads to sounder
decisions in TAVI planning.
Patients exhibiting chest pain in the
emergency department often undergo a
triple rule-out examination to distinguish
between coronary artery disease, aortic
dissections, or pulmonary embolisms.
The new syngo.via version introduces
the new application syngo.CT PE CAD3
which automatically detects pulmonary
fi lling defects and which may be particu-larly
helpful if no Dual Source Dual
Energy data is available. Combined with
the CT Coronary and CT Vascular tasks,
the workfl ow CT Chest Pain + PE CAD3
boosts sensitivity[2] in challenging triple
rule-out cases. Improved automated pre-processing
in syngo.CT Coronary Analysis
is benefi cial for such cases. In addition to
the main coronaries, major coronary
branches and saphenous vein grafts are
now also automatically segmented and
labeled.
Dynamic Vessel
Evaluation redefi ned
A great step forward in terms of dynamic
vessel evaluation has been made by
introducing the new application syngo.
CT Dynamic Angio.2 For stroke patients
or patients showing transient ischemic
attack symptoms, syngo.CT Dynamic
Angio2 helps to inspect time-resolved CT
images reconstructed from dynamic
studies. It provides a temporal maximum
intensity projection (tMIP) and a tempo-ral
average volume (tAVG) for enhanced
vessel and soft tissue visualization. For
evaluating local vessel or tissue enhance-ment,
syngo.CT Dynamic Angio displays
ROI-specifi c time attenuation curves, as
well as curve and statistical parameters,
such as time to peak and peak enhance-ment.
For a phase-specifi c evaluation,
for example of the arterial or venous
phase, the Twin Slider can restrict calcu-lation
of new CT volumes to any user-defi
ned time range within the dynamic
1 syngo.via can be used as a stand-alone device or together with a variety of
syngo.via-based software options, which are medical devices
2 The information about this product is being provided for planning purposes.
The product requires 510(k) review and is not commercially available in the U.S.
3 The product is not commercially available in the U.S.
14. scan. This means that the application
may also be used for examining the liver,
or abdominal aortic stent patency and
endovascular leakage.
Oncology – fully featured and
even more applications
The new syngo.via version enhances the
CT Oncology Engine and CT Oncology
Engine Pro packages, as well as adding
promising new applications for diagnosis
and therapy. Radiologists can now select
whether the time-saving automated
segmentation algorithms for lung and
liver lesions and lymph nodes utilize
RECIST 1.0 or 1.1, thanks to added func-tionality
for current oncological stan-dards.
Choi criteria are also evaluated
and displayed in the report for each
lesion. This additional clinical informa-tion
helps the radiologist to differentiate
between progressive disease (PD), stable
disease (SD), complete response (CR)
and partial response (PR).
To facilitate diagnosis of cases with mul-tiple
prior examinations, syngo.PET&CT
Onco Multi-Timepoint supports simulta-neous
visualization of up to eight time-points
and synchronous scrolling
through all datasets. Especially in cases
with many prior examinations and multi-modality
acquisitions such as PET/CT,
radiologists will benefi t from keeping
track of the complete patient history
visually, and the ability to compare these
data with the current examination.
Even more automation is provided
through the improvements in our sec-ond
reader tools syngo.CT Colonography
PEV and syngo.CT Lung CAD – both part
of the CT Oncology Engine Pro. These
tools now provide automated detection
of lung nodules or colon polyps with
revised algorithms.3
In addition, syngo.CT Lung CAD now not
only detects solitary pulmonary nodules
but also partial-solid nodules3 and
ground-glass nodules (GGN).3 Lung CAD
fi ndings are sorted by size in syngo.via’s
fi ndings navigator.3
The syngo.CT Colonography Advanced
package features the new Stool Removal
function, allowing the radiologist to
remove residual stool from the visualiza-tion
in the 3D endoluminal view and
multi-planar reconstruction (MPR). By
toggling quickly between Stool Removal
and the standard display, physicians can
5 syngo.CT
Coronary
Analysis now
provides zero-click
tracking
and labeling
of the main
coronaries
(RCA, LM, CX),
major coronary
branches, and
saphenous
vein grafts.
6 The CT
Oncology
Engine now
supports
RECIST 1.1 and
Choi criteria
which add
valuable clini-cal
information
for correct
diagnosis by
the radiologist.
7 syngo.CT
Pulmo 3D is the
new syngo.via
application for
assessment
and therapy
monitoring of
COPD. Users
can define
default visual-ization
options,
such as the
emphysema
index display,
according to
their preferred
workflow.
5
6
7
15. News
www.siemens.com/syngo.via
detect potential polyps which might be
hidden in residual stool cavities.
Two new applications are optional to the
CT Oncology Engine. Using the syngo.RT
Interface, physicians can register CT or
multi-modality datasets such as PET/CT
with a radiotherapy planning CT.
Segmented lesions, e.g. PET hotspots,
can be copied from the diagnostic datas-ets
to the planning CT and be exported
as DICOM RT1 structure sets. This allows
accurate functional diagnostic imaging
and morphological image processing to
be used during radiotherapy planning.
syngo.CT Pulmo 3D focuses on clinical
assessment and monitoring treatment of
chronic obstructive pulmonary disease
(COPD). Based on the user’s preference,
the application provides different auto-mated
3D quantifi cations for assessment
of emphysema and lung airways utiliz-ing
non-enhanced CT chest scans. Using
Signifi cant Dose Reduction with SAFIRE
at Wexford General Hospital, Ireland
By Tony de Lisa and Tiago Campos*
*Computed Tomography, Siemens Healthcare, Forchheim Germany
Wexford General Hospital serves a popu-lation
in excess of 135,000 in County
Wexford, Ireland. Recently replaced their
10-year-old 4-slice system was replaced
with the SOMATOM Defi nition AS 64
with the FAST CARE platform.
The CT team in Wexford has always
been dose conscious and the dose
reduction techniques available with the
new system (especially SAFIRE1,2) have
greatly assisted them in achieving sub-stantial
reduction in dose. SAFIRE (Sino-gram
Affi rmed Iterative Reconstruction)
is the 1st raw data-based iterative recon-struction
technique that allows up to
60% reduction in dose while preserving
image quality as can be seen in the com-parison
shown in Fig. 1.
Liz D’Arcy, CT Clinical Specialist, com-mented:
“From day one, the CT team at
Wexford decided to test the capabilities
of SAFIRE in terms of image quality,
workfl ow, and dose reduction. Our
immediate fi nding was that the fast
reconstruction speed and the ease of use
meant no effect on throughput or work-fl
ow when compared to FBP. Our next
step was to select an image quality
acceptable to our consultant radiologists
while continuing to reduce the dose.”
Neurological head scans are often
regarded as a benchmark for diagnostic
value in CT. The consultant radiologists
have been very pleased with both the
“We have seen a very impressive reduction in dose.
With SAFIRE we are achieving a very impressive
dose reduction of up to 75% dose reduction in
head scans (14.74 mGy vs 60 mGy) with excellent
image quality.” Richard Deignan, MD, Consultant Radiologist
1A Standard WFBP. Standard weighted
filtered back projection reconstruction
using an H40 kernel.
1B This image visualizes image quality based
on SAFIRE achieved with only 14.74 mGy.
Significantly decreased image noise without
loss of resolution or gray-white matter differenti-ation
can be seen.
1A 1B
levels of dose and the image quality.
Wexford has extended SAFIRE to all
examinations and is achieving similar
levels of dose reduction across the
clinical spectrum. Liz D’Arcy: “The level
of dose reduction is much more signi-ficant
than we felt possible. The key
spatial details, healthcare professionals
can differentiate between emphysema-dominant
and airway-dominant COPD
subtypes, which can be used for plan-ning
further treatment, such as lung
volume reduction surgery. Overall, the
new syngo.via version further supports
fast and precise oncological reading and
reporting with exciting new features.
point is that we can, and do, use SAFIRE
in our normal daily clinical routine, not
just for special cases. Therefore the total
CT dose to our patient population has
fallen substantially.”
Tony de Lisa is an external writer based
in Nuremberg, Germany.
1 The information about this product is being provided for planning purposes. The product is pending 510(k) review, and is not yet commercially available in the U.S.
2 In clinical practice, the use of SAFIRE may reduce CT patient dose depending on the clinical task, patient size, anatomical location, and clinical practice. A consultation-with
a radiologist and a physicist should be made to determine the appropriate dose to obtain diagnostic image quality for the particular clinical task. The following
test method was used to determine a 60% dose reduction when using the SAFIRE reconstruction software. Noise, CT numbers, homogenity, low-contrast resolution and
high contrast resolution were assessed in a Gammex 438 phantom. Low dose data reconstructed with SAFIRE showed the same image quality compared to full dose
data based on this test. Data on file.
15
16. News
Boosting Cardiovascular
Reading with syngo.via at
this Year’s CTA Academy
At SCCT 2011, syngo.via facilitated the evalua-tion
of cCTA and invasive angiography data sets.
Philip Stenner, PhD, Computed Tomography, Siemens Healthcare, Forchheim, Germany
Based on last year’s huge success, the
Society of Cardiovascular Computed
Tomography (SCCT) has again organized
a CTA Academy to train cardiovascular
reading in 2011. The program is aimed
at both radiologists and cardiologists,
and provides a unique opportunity to
practice the evaluation of coronary CT
Angiography (cCTA) data sets with an
international expert faculty. This year’s
Academy comprises five courses, of
which the most recent was held at the
annual meeting of the SCCT in Denver,
CO, USA. Stephan Achenbach, MD, from
the Department of Cardiology at the Uni-versity
of Gießen, Germany, and John
Lesser, MD, from the Minneapolis Heart
Institute in Minneapolis, MN, USA,
teamed up to teach this two-day course
and offered expert hands-on training for
the 20 cardiologists taking part.
To assess the cCTAs and invasive angiog-raphy
images, 11 workplaces had been
equipped with syngo.via clients pro-vided.
In addition to the basic reading
functionalities, the CT Cardio-Vascular
Engine enabled the participants to eval-uate
the cases with advanced function-alities
such as automatically generated
center lines, curved planar reformations
(CPR), and the image sharpening filter.
To make full use of syngo.via’s dual
monitor support, all workplaces were
equipped with two monitors and the pre-senter’s
screen was shown with a dual-projector
set-up. The participants
improved their cardiovascular reading
skills by evaluating 50 cCTA data sets,
“I have to say that the
advanced functions,
such as the curved
planar reconstructions,
are extremely stable
and the results are really
good and reliable.”
Stephan Achenbach, MD, Department of
Cardiology, University of Gießen, Germany
During the SCCT CTA Academy Stephan
Achenbach, MD, Gießen, Germany and
John Lesser, MD, Minneapolis, USA offered
expert hands-on training to interested
physicians.
and verified their diagnoses with the cor-responding
invasive angiography images
for each case.
“The main goal is really to learn how to
interpret cardiac CT extremely carefully,
look for the difficult findings, and cope
even with difficult situations such as
severe calcifications” says Achenbach.
According to him, the biggest challenge
of this course was the mixed level of
experience, as both beginners and expe-rienced
readers worked on the cases.
What Achenbach likes about syngo.via is
the ease of use which allowed the
beginners to quickly catch on and imme-diately
get started with cardiovascular
reading. He further states with regard to
syngo.via: “I have to say that the
advanced functions, such as the curved
16 SOMATOM Sessions · November 2011 · www.siemens.com/healthcare-magazine
17. “I am typically not a big advocate of curved
planar reformations (CPR), but this work-station
actually does a really good job of
www.siemens.com/ct-cardiology
Stroke Management – Education and
Information Exchange Online
By Monika Demuth, PhD, Computed Tomography, Siemens Healthcare, Forchheim, Germany
News
SOMATOM Sessions · November 2011 · www.siemens.com/healthcare-magazine 17
planar reconstructions, are extremely
stable now and the results are really
good and reliable.”
Quynh Truong, MD MPH, from the
Division of Cardiology at Massachusetts
General Hospital in Boston, MA, USA,
who also helped the participants with
reading the cases, believes this course
to be a good opportunity to gain experi-ence.
Since the volume of CT scans
being performed is fairly low at some
participants’ institutions, it is important
to practice on CT and cath correlations
in order to maintain the required compe-tency
level.
One of the participants, Cristiana Scridon,
MD, from the Indian River Medical Cen-ter
in Vero Beach, Fl, USA, already
Siemens Healthcare has recently launched
a new CT stroke management online
resource for healthcare professionals.
Here, a platform is provided for introduc-ing
and discussing new diagnostic oppor-tunities
to save brain and quality of life,
synergized with information on the lat-est
Siemens CT scanners and post-pro-cessing
solutions.
After a stroke, the brain loses as many
neurons as it does in almost 3.6 years
of normal aging[1] each hour it remains
untreated. Therefore, the need for faster
diagnosis and faster treatment is central
to effective stroke management. Thanks
to a dynamic brain perfusion coverage,
Siemens Computed Tomography has
clearly improved the stroke workflow
and added value to stroke management.
The new information platform for stroke
management has been published to share
these approaches and clinical outcomes.
Peter Schramm, MD, from the certified
stroke unit at the University of Göttingen,
Germany, for example, shares his work-flow
from the arrival of a stroke patient
attended a previous CTA Academy. Her
main goal was to learn from the experts
and refresh her skills in cardiovascular
reading. With regard to syngo.via, she
states that “Practically everything works
very well and it’s very smooth. The mea-surements
go easily, and the adjustment
of the image is easy to make. So it’s great.”
Will she be coming again? – “Absolutely
every year!”
outlining the CPRs.”
Quynh Truong, MD MPH, Division of Cardiology, Massachusetts General Hospital,
Boston, MA, USA
Siemens has
launched a
CT stroke
management
website for
healthcare
professionals.
References
[1] Time is brain-quantified. Saver JL. Stroke.
2006 Jan;37(1):263-6.
in the emergency department until
the decision for further treatment. In his
institution, the door-to-needle time is
less than 20 minutes. Furthermore, lead-ing
stroke specialists share their experi-ence
and protocols in webinars and pre-sentations
on the platform. Trial versions
for Siemens latest software solutions are
available for testing developments in
stroke imaging in actual clinical practice.
This educational website was launched
to improve the knowledge of stroke
diagnosis with extended brain coverage
and is designed to integrate the experi-ences
of physicians worldwide. The online
resource can be visited via the following
link.
www.siemens.com/
CT-stroke- management
18. News
International CT Image Contest 2011
By Tiago Campos, Computed Tomography, Siemens Healthcare, Forchheim, Germany
In 2009, Siemens Healthcare surprised
the healthcare industry with an original
idea that was well received by the world-wide
radiology community, the Interna-tional
CT Image Contest, encouraging
radiologists to reduce dose by using CT
hardware and software efficiently.
Participants submitted their best clinical
images achieved at a very low radiation
dose according to the contest philoso-phy
“Highest diagnostic image quality
at the lowest possible radiation dose”
and shared best practice throughout
the industry.
The 2010 International CT Image Con-test
was an extraordinary success, with
around 300 submissions from over 30
different countries. On Facebook, the
contest attracted over 1,500 fans and
page views at the Siemens Low Dose
website reached 17,000 between
November 2009 and May 2010 alone.
Continuing the success
This year’s contest even beat last year’s
success with massive 627
submissions from 43 different countries
from all 5 continents, showing that low
dose practices have no borders. Siemens
customers who work with a SOMATOM
Spirit, Emotion, Sensation, Definition,
Definition AS or Definition Flash were
given the opportunity to compete for
the title of the best image in seven cate-gories.
The submissions were evaluated
by an international jury consisting of
acknowledged experts in the following
categories: Cardiac, Vascular, Dual
Energy, Pediatrics, Trauma, Neuro and
areas of clinical routine including Thorax,
18 SOMATOM Sessions · November 2011 · www.siemens.com/healthcare-magazine
Abdomen Pelvis and Extremities. During
the entry phase, members of the jury
chose an image each month for the “Pick
of the Month” (Figs. 1–3) which ran
from March through September. After
entry deadline, a winning image of the
highest quality at the lowest radiation
dose was chosen from each category.
The winners were announced in a cere-mony
at this year’s RSNA in Chicago.1
To see all of more than the 600 cases
from 40 different countries featured in
this year’s Image Contest, or to become
a fan on Facebook, visit the following
websites.
www.siemens.com/image-contest
www.facebook.com/imagecontest
1 Picture of the Month March
Title: Dual Energy Carotid Angio
Paraganglioma
Author: Joao Carlos Costa, MD,
Diagnóstico por Imagem, Lda
System: SOMATOM Definition Flash
Jury statement:
“This is a beautiful case example for the
use of Dual Energy CT techniques for
non-invasive imaging of vessel-related
tumors and surgical planning. The low
radiation protocol selected and success-fully
applied here is of particular
importance in the investigation of
young, otherwise healthy individuals,
as in this case.”
Prof. Uwe Joseph Schoepf, MD
Medical University of South Carolina, USA
1
1 The winners were not yet known at editorial deadline.
19. News
2 Picture of the Month April
Title: SA Compression Stenosis
Author: Volodymyr Mytchenok,
MD, Poltava Regional Hospital, Ukraine
System: SOMATOM Emotion
Jury statement:
“Nice demonstration of functional lesion
at a low dose, very illustrative post pro-cessing.”
Prof. Stephan Achenbach, MD
University of Giessen, Germany
SOMATOM Sessions · November 2011 · www.siemens.com/healthcare-magazine 19
2
3 Picture of the Month June
Title: Aorta Bypass Graft
Author: Eder Quadros, MD, Hospital
Beneficencia Portuguesa, Sao Paulo, Brazil
System: SOMATOM Definition AS
Jury statement:
“Very nice dataset of axillo-bifemoral
bypass graft, achieved at a very reason-able
dose. Very elegant and tasteful
choice of rendering parameters results
in visually appealing images!”
Prof. Dominik Fleischmann, MD
Stanford University Medical Center, USA
3
20. News
Iterative Reconstruction is
Now Available for SOMATOM
Emotion and Sensation
By Tiago Campos*, Sebastian Vogt, PhD**
*Computed Tomography, Siemens Healthcare, Germany
**Siemens Medical Solutions USA, Malvern PA, USA
Siemens has recently added IRIS (Itera-tive
Reconstruction in Image Space) to
its new SOMATOM Emotion 16 scanners,
as well as existing SOMATOM Emotion
16 (2007), SOMATOM Sensation 40, 64,
and Open systems. Retrofitting this key
technology into such a vast installed
base emphasizes Siemens’ commitment
to reducing patient dose by updating
legacy systems for even better patient
care.
IRIS is available for these systems for
delivery since September 2011. One of
the largest and most diverse academic
medical centers in the United States, the
Ohio State University Medical Center
(OSUMC) was among the first sites world-wide
to evaluate IRIS on the SOMATOM
Emotion. Professor Richard D. White, MD,
and his team of radiologists welcomed
the opportunity of upgrading the
OSUMC’s installed base of SOMATOM
Emotion 16, SOMATOM Sensation 64,
SOMATOM Definition AS 64, and
SOMATOM Definition AS+ scanners with
iterative reconstruction.
1A 1B
20 SOMATOM Sessions · November 2011 · www.siemens.com/healthcare-magazine
“This represented another important and
greatly appreciated form of collabora-tion
with Siemens through investigative
interest, positive return-on-investment
implications, and image quality gains,
and clinical growth potential with
market differentiating technologies for
OSUMC”, remarks Professor White.
Although IRIS was not directly installed
at OSUMC during the pilot phase, the
datasets were reconstructed remotely
to assess the feasibility of IRIS compared
with weighted filtered back projection
1A Standard WFBP reconstruction using an B41 kernel.
Courtesy of Ohio State University Medical Center, Columbus, OH, USA
1B This figure demonstrates the high image quality achieved
with IRIS. Image noise is decreased without losing sharpness.
Courtesy of Ohio State University Medical Center, Columbus, OH, USA
21. News
References
[1] May MS, Wüst W, Brand M, Stahl C, All-mendinger
T, Schmidt B, Uder M, Lell MM. Dose
reduction in abdominal computed tomography:
intraindividual comparison of image quality of
full-dose standard and half-dose iterative recon-structions
with dual-source computed tomogra-phy.
Invest Radiol. 2011 Jul; 46(7):465-70
2A 2B
2A Standard WFBP reconstruction using a B40 kernel.
Courtesy of Ohio State University Medical Center, Columbus, OH, USA
2B This figure demonstrates the high image quality achieved with
IRIS. An improved image noise and better delineation of the liver lesion
can be achieved compared to Fig. 2A.
Courtesy of Ohio State University Medical Center, Columbus, OH, USA
SOMATOM Sessions · November 2011 · www.siemens.com/healthcare-magazine 21
(WFBP). Dozens of datasets were
assessed from routine examinations of
the head, thorax and abdomen. Experts
then analyzed the image quality based
on image noise, image quality, dose
effectiveness, and lesion conspicuity.
OSUMC’s team gave positive feedback in
all areas of the evaluation, highlighting
noise reduction, edge recovery, impres-sive
detail and sharpness among the
prominent benefits of IRIS. Professor
White concluded that “across the board
in this pilot project, there was unequivo-cal
gain in image quality thanks to the
application of IRIS. Artifact and noise
were consistently reduced, while low
contrast and edge definition were
enhanced, leading to improved visual-ization
of pathology. It is exciting to
realize that this can be achieved with
significant dose reduction. This is a tre-mendous
advancement!”
At the time of editorial deadline, OSUMC
were already preparing for the installa-tion
of IRIS.
The Friedrich-Alexander-University of
Erlangen-Nuremberg in Germany has
also evaluated IRIS. The university cur-rently
has a SOMATOM Definition Flash,
a SOMATOM Definition AS+, and a
SOMATOM Sensation 64. Prof. Michael
Lell, MD, was an early adopter of itera-tive
reconstruction when it was initially
released on the SOMATOM Definition
Flash in 2009, and has also worked with
the latest iterative reconstruction method
– SAFIRE1 (Sinogram Affirmed Iterative
Reconstruction). Although Prof. Michael
Lell, MD and his team were already
familiar with IRIS, the pilot study pro-vided
a good opportunity to assess its
performance against the SOMATOM
Definition systems.
Following the same approach as
OSUMC, datasets were reconstructed
remotely and compared with conven-tional
WFBP. Multiple patient datasets
were reconstructed, focusing on spe-cific
examinations, such as cardiac,
and routine examinations of the head,
thorax and abdomen. Once again,
experts rated the images based on
image noise, image quality, dose effec-tiveness,
and lesion conspicuity.
Lell and his team commented that “we
highly appreciate that iterative recon-struction,
which is fully integrated in our
clinical workflow with the SOMATOM
Definition scanners, is now available for
existing CT systems like our SOMATOM
Sensation. The excellent results with IRIS
significantly reduce dose while main-taining
image quality and lesion conspi-cuity.”[
1]
With the successful launch of IRIS for
the SOMATOM Emotion 16 (2007),
SOMATOM Sensation 40, 64, and Open,
Siemens, continues its commitment to
reducing radiation exposure for all rou-tine
CT examinations below 2.4 mSv.
“Bringing IRIS to the SOMATOM Emotion
and Sensation offers low dose to the
widest possible patient population,” says
Peter Seitz, Head of Marketing, Com-puted
Tomography, Siemens Healthcare.
1 The information about this product is being provided
for planning purposes. The product requires 510(k)
review and is not commercially available in the U.S.
22. News
FAST CARE Meets DSCT
Technology platform FAST CARE is now also compatible with the
Dual Source scanner SOMATOM Defi nition, giving CT users the opportunity
to leverage untapped potential in patient-centric productivity.
By Ingrid Horn, PhD
Over 5001 SOMATOM Definition scanners
have been installed globally since 2006,
and are located in both community and
university hospitals. Besides its utiliza-tion
in diagnostic imaging centers, the
scanner is deployed primarily in cardiol-ogy
departments and emergency cen-ters.
A convincing technical concept is at
the root of many modern success stories
in the field. This one is called Dual
Source. Simultaneous scanning with two
X-ray tubes convinces in the case of car-diac
CT, for example, providing high
diagnostic accuracy irrespective of heart
rate, without the use of beta blockers
and with a radiation dose 50 percent
lower than the norm. Combined with the
Dual Energy principle, tissue and depos-its
can be characterized chemically by
selecting different voltages for the two
X-ray tubes. The device proves particu-larly
efficient in emergency cases, facili-tating
a comprehensive, reliable diagno-sis
in a single examination procedure,
irrespective of the patient’s constitution
and condition.
The benefits of Dual Source Technology
can now be combined with those of the
FAST CARE platform. The Fully Assisting
Scanner Technologies (FAST) make time-consuming
and complex procedures
faster as well as far more intuitive. This
ensures that the results remain reliably
reproducible even in the event of a rota-tional
workforce. FAST Planning simpli-fies
the preparation of scan and recon
ranges. Be it heart, lungs, spinal column
or brain – one click suffices to automati-cally
adjust the optimal scan range on
the basis of anatomical landmarks. This
not only eases the workflow at the scan-ner,
but prevents inaccurate setting of
scan ranges and higher reproducibility of
similar examinations. FAST Cardio Wiz-ard
gives users a step-by-step guide to
cardiac scanning. The program provides
guidance on the optimal choice of
parameters and settings and allows
22 SOMATOM Sessions · November 2011 · www.siemens.com/healthcare-magazine
establishing individual quality standards.
FAST Spine facilitates a fully automated
preparation for reconstructions of the
spinal column. The program identifies
and marks each vertebra and disc within
the scan range automatically, and
alignes the reconstruction layers ana-tomically
correct along the curvature of
the spine. FAST Adjust guarantees safe
scan parameter adjustment to the
patient’s habitus, even by less experi-enced
personnel.
The CARE software package reduces radi-ation
dose considerably. Several publica-tions
have already scientifically proven
that a potential reduction of up to 50
percent is possible. This is due principally
to CARE kV. The program sets the appro-priate
kV for the selected examination
type and thus optimizes radiation dose in
line with pertinent diagnostic issues and
the patient’s anatomy. Other programs,
including the CARE Dose Configurator,
support this optimization process and
make it transparent for users. Together
with FAST CARE. SAFIRE2 was introduced,
joining the latest generation of iterative
image reconstruction. Departments
equipped with the SOMATOM Definition
can retrofit their device with FAST CARE.
Everyone – the hospital enterprise, per-sonnel
and patients – benefits from the
advantages of this upgrade.
Ingrid Horn, PhD, studied biology and bio-chemistry.
She is an expert in science communi-cations
and an experienced medical writer.
The benefits of
SOMATOM Definition's
Dual Source Technology
can now be combined
with those of the FAST
CARE platform.
1 Based on the number of systems sold. Data on file.
2 The information about this product is being provided
for planning purposes. The product requires 510(k)
review and is not commercially available in the U.S.
23. News
High-End CT is on the Move
With the introduction of the SOMATOM Defi nition AS in 2007, Siemens
began a unprecedented success story. Now, Siemens is moving onto the
next chapter of this success story with new sliding gantry confi gurations
for the SOMATOM Defi nition AS.
By Jan Freund, Computed Tomography, Siemens Healthcare, Forchheim, Germany
SOMATOM Sessions · November 2011 · www.siemens.com/healthcare-magazine 23
Following its release in 2007, the
SOMATOM Definition AS – the world’s
first adaptive scanner – was already in a
class of its own. As the first CT scanner
offering true 128-slice acquisition, it
pushed the boundaries of CT imaging,
providing new diagnostic options,
including high-speed and high-resolu-tion
examinations, as well as 3D-guided
CT interventions.
In 2010, FAST CARE was introduced on
the SOMATOM Definition AS, making it
the ideal choice to increase patient-centric
productivity. Being fully onsite
upgradeable from 20 up to 128 slices,
customers could tailor the system per-fectly
to their environment, and for
example grow from routine to cardiac
or acute care imaging.
With over 1,500 systems installed, the
SOMATOM Definition AS resembles
the fastest ramp up in the history of
Siemens CT. Clearly, the philosophy of
offering “one CT for all” has shown to
be the right answer to CT users’ require-ments.
In 2011, Siemens continues to evolve
this success by adding a sliding gantry
option to the SOMATOM Definition AS.
Mounting a CT scanner on rails for
moving it to a specific clinical area, such
as acute care or between radiology and
radiation therapy planning (RTP) depart-ments
is not a new idea. But the previ-ous
scanner generation considered
midrange or even entry-level today. Now
also the latest high-end CT scanner
generation is back on rails. Customers
have already benefited from the highest
standards of flexibility with the
SOMATOM Definition AS and the sliding
gantry now allows the scanner to
literally move in line with their clinical
needs.
The benefits are obvious: Clinical set-ups
and processes can be designed much
more efficiently. In acute care, the
patient does not have to be transferred
to the scanner anymore – the scanner
can be moved to the patient. Further-more,
institutions with RTP departments
that do not utilize the full capacity of the
system due to low patient volume can
share resources with conventional radi-ology.
The SOMATOM Definition AS sliding
gantry will be available as a single-room
and all AS scanner solution at the end of
2011 for all scanner configurations.
The SOMATOM Definition AS with sliding gantry adds a new dimension in flexibility.
24. News
CT Examinations Tailored Precisely
to Individual Patient Needs
Individual patient characteristics and the clinical question need to be
considered when choosing parameters and settings for a CT examination.
The latest scientifi c papers[1-4] clearly demonstrate that SOMATOM
scanners ensure CT scans are tailored to individual patient needs.
By Heidrun Endt, MD, Computed Tomography, Siemens Healthcare, Forchheim, Germany.
In the past few years, many new tech-nologies
have been introduced in
computed tomography for increasingly
automatic and individual settings of
CT scan procedures.
CARE kV – tube voltage
tailored for each examination
CARE kV is one of these new technolo-gies.
With CARE kV the tube voltage is
adjusted automatically depending on
the clinical question on a per-patient
basis. Researchers from Zurich, Switzer-land,
conducted a study for body CT
Angiography (CTA) examinations using
CARE kV on a SOMATOM Definition
AS 64.[1] In the study 40 patients were
examined and the reference setting for
the tube voltage was set to 120 kV.
CARE kV suggested the tube voltage for
each scan based on the examination
type and the topogram. This produced
the following kV settings: 80 kV
(1 patient), 100 kV (23 patients), 120 kV
(15 patients), and 140 kV (1 patient).
When changing the kV, the tube current
must also be adjusted. As CARE kV works
in combination with CARE Dose4D, this
could be achieved simultaneously and
automatically.Throughout the study
image quality was maintained, and apply-ing
CARE kV led to an overall dose reduc-tion
of 25.1% in the entire patient popu-lation,
compared to a standard 120 kV
protocol. The mean CTDIvol decreased
from 10.6 mGy to 7.9 mGy. For the
subgroup of 24 patients where the tube
voltage was reduced to either 80 kV or
1 Fig. 1 shows a CT Angiography examination with the SOMATOM Definition AS 64 in an
82-year-old patient after endovascular aortic aneurysm repair. The scan was obtained using
CARE kV and 120 kV was chosen as reference kV setting. As the patient had a low body mass index
of 19 kg/m² CARE kV proposed 80 kV for this examination. The scan could be carried out with a
CTDIvol of 2.88 mGy and 2.7 mSv effective dose. Courtesy of University Hospital Zurich, Switzerland
1
24 SOMATOM Sessions · November 2011 · www.siemens.com/healthcare-magazine
25. 100 kV, the dose reduction was 39.3%.
The authors conclude that they “[…]
could demonstrate the beneficial effect
of this technique for body CTA […].”[1]
SAFIRE1 – designed to reduce
radiation dose for every patient
Radiation dose should always be consid-ered
when performing a CT examination,
as the benefit to potential risk ratio should
be as high as possible. Iterative recon-struction
algorithms such as IRIS and
SAFIRE1 are powerful tools for reducing
dose and following the ALARA (As Low
As Reasonably Achievable) principle. An
international group of researchers evalu-ated
the potential of SAFIRE for coronary
CTA examinations at the Medical Univer-sity
of South Carolina (MUSC).[2] In this
study 65 patients were examined with a
SOMATOM Definition Flash. The exami-nations
were obtained with the protocols
established at MUSC. The first recon-struction
used the conventional method
of filtered back projection (FBP). After-wards,
a second reconstruction with
SAFIRE was performed using data from
one tube of the Dual Source system,
corresponding to a 50% reduction
in radiation dose. When applying new
reconstruction algorithms the diag-nostic
accuracy must be taken into
account. Both reconstructions and
coronary catheter angiography exami-nations
were used for the assessment
of diagnostic accuracy.
The results show that “[...] the applica-tion
of this algorithm resulted in incre-mentally
improved diagnostic accuracy
for stenosis detection”,[2] despite the
lower dose that was used. The obese
patient population of this study had a
mean body mass index of 32.4 kg / m2.
2 Fig. 2A shows a coronary CT Angiog-raphy
examination with the SOMATOM
Definition Flash from the study conducted
at MUSC. The reconstruction was done
using FBP. For image 2B data from one
tube of the Dual Source system were
used corresponding to a 50% reduction in
dose. With SAFIRE image quality is main-tained
could be reduced allowing for a more
precise diagnosis.
Courtesy of Medical University of
South Carolina, USA
References
in Fig. 2B and blooming artifacts
[1] Winklehner A et al. Automated Attenuation-
Based Tube Potential Selection for Thoracoab-dominal
Computed Tomography Angiography:
Improved Dose Effectiveness. Invest Radiol.
2011 Jul 1. [Epub ahead of print]
[2] Moscariello A et al. Coronary CT angiography:
image quality, diagnostic accuracy, and potential
for radiation dose reduction using a novel itera-tive
image reconstruction technique-comparison
with traditional filtered back projection. Eur
Radiol. 2011 Oct;21(10):2130-8. Epub 2011
May 25.
[3] Winklehner A et al. Raw data-based iterative
reconstruction in body CTA: evaluation of radia-tion
dose saving potential. Eur Radiol. 2011 Aug
6. [Epub ahead of print]
[4] Wuest W et al. Dual source multidetector CT-angiography
before Transcatheter Aortic Valve
Implantation (TAVI) using a high-pitch spiral
acquisition mode. Eur Radiol. 2011 Aug 17.
[Epub ahead of print]
The CT scans were acquired in either ret-rospectively-
gated mode or prospectively-triggered
mode. The effective dose was
6.4 mSv for FBP, and 3.2 mSv for recon-structions
with SAFIRE. Overall, the
authors conclude that the results indi-cate
“[…] the potential for substantial
radiation dose savings […], which likely
exceed the 50% margin set forth in this
current investigation.”[2]
At the University Hospital in Zurich,[3] 25
patients underwent a body CTA exami-nation
on a SOMATOM Definition Flash.
The data were reconstructed twice: once
using FBP and once with SAFIRE. As
above, only data acquired with one of
the two tubes were analyzed for the
SAFIRE reconstructions. By comparing
two reconstructions of the examination
with different reconstruction tech-niques,
the researchers could determine
diagnostic accuracy. A key finding of the
study includes the following statement:
“In body CTA a dose reduction of >50%
might be possible when using raw data-based
iterative reconstructions, while
image quality can be maintained.”[3]
TAVI planning – less contrast
agent for multimorbid patients
Transcatheter aortic valve implantation
(TAVI) is an emerging technique and pro-vides
an alternative for patients who
need a replacement of the aortic valve
but cannot be referred to open surgery
because of other pre-existing diseases.
Whether a patient is suitable for TAVI
needs to be decided based on the anat-omy
of the aortic root and the vessels
used to gain access for the procedure.
The amount of contrast agent is an
important issue as many multimorbid
patients suffer from an impaired renal
function. An interdisciplinary group of
researchers from Erlangen examined the
potential of CT scans in 42 patients
using the high-pitch mode on the
SOMATOM Definition Flash with 40 ml
of contrast agent.[4] The mean radiation
dose for these examinations was 4.5 mSv.
The conclusion highlights the benefits:
“High-pitch spiral DSCTA [Dual Source CT
Angiography] can be used to assess the
entire aorta and iliac arteries in TAVI
candidates with a low volume of con-trast
agent while preserving diagnostic
image quality.”[4]
These scientific papers prove the bene-fits
of innovative CT technology in con-tributing
to individualized patient care.
2B
SOMATOM Sessions · November 2011 · www.siemens.com/healthcare-magazine 25
2A
1The information about this product is being provided
for planning purposes. The product requires 510(k)
review and is not commercially available in the U.S.
26. Business
Value Added Max
About to debut in Hamburg, a scanner for an optimized return on
investment: Get ready for the new SOMATOM Perspective.1
By Eric Johnson
26 SOMATOM Sessions · November 2011 · www.siemens.com/healthcare-magazine
What a difference a few years make.
Since he began practicing radiology
in 1994, Johann-C. Steffens, MD, has
watched an astonishing improvement in
computed tomography. The speed at
which images are generated, the num-ber
of images per scan, the resolution
of those images, their orientations, the
elimination of artifacts – all of these
have progressed far beyond what could
have been imagined at the time. “Based
on experience, I’m sure CT performance
will continue to improve,” he says, “but
it has already reached a level that was
still in our dreams only a few years ago.”
Soon those dreams will become reality
for Steffens, when his Radiology Clinic in
Hamburg (see sidebar) takes delivery of
Siemens’ SOMATOM® Perspective1. This
CT promises not only the latest innova-tions
that deliver speed, quality, and
efficient workflow to the people in
scrubs and gowns – the radiologists,
operators, and patients. It also offers
incentives to those in business suits –
the business and financial managers of
radiology practices. The magic word
starts with an “e”, for efficiency.
Savings in your hands
Steffens is quick to point out that cost
consciousness has soared in recent
years. Even in relatively prosperous
Germany, he notes that “spending is
getting tighter and tighter, reimburse-ments
are shrinking and shrinking.” At
his own clinic, the budgeting pencil is
always kept sharp. “More than ever
before,” he says, “we are really keen
Johann-C. Steffens, MD, Radiology Clinic in Hamburg, Germany, has watched an astonishing
improvement in computed tomography during the past few years.
27. Business
to assess costs and benefits of every-thing
we do.”
Of course, Steffens is not alone. Witness
a recent letter to the New England Jour-nal
of Medicine (2010; 363:888-891)
by a trio of professors from Stanford
University’s School of Medicine. Physi-cians’
have a “near-universal ignorance
of actual costs associated with the deliv-ery
of medical care,” contended Homero
Rivas, John M. Morton, and Thomas M.
Krummel. “This lack of cost awareness
affects all other components of the
price equation, rendering us incapable
of understanding the true economic
value of medical care.”
With that kind of writing on the wall,
it might seem a no-brainer to guess
what Steffens chose to do about his cur-rent
CT, an Emotion 16 from Siemens
that he describes as “very good, pretty
much faultless.” But rather than decid-ing
to cut spending, instead he opted
to cut a check. By bringing in a brand-new
SOMATOM Perspective (which will
be his fourth scanner from Siemens),
he expects to sink the clinic’s total
cost of ownership (TCO) in computed
tomography.
Economy is so central to the new scan-ner
that it is built right into its dash-board.
The so-called eMode allows oper-ation
of the scanner in an outstanding
patient-friendly and financially-efficient
way – with a single click. An analysis of
the scan is made in real time and the
system is instantly fine-tuned to provide
the exact scan the user wants, while
simultaneously reducing wear and tear
on the system. Coupled with this is
a new ‘service plus’ approach from
Siemens: for customers who run the
SOMATOM Perspective in eMode for
more than 80 percent of its operating
time the institution will be rewarded
with eMode Service Benefits such as
maintenance scheduling out of core
working time or even a reduction of ser-vice
fees for the next contracted year.
“We think our costs of maintenance are
going to decline,” says Steffens, “and
that is a good thing to see.”
By bringing in a brand-new SOMATOM Perspective, Johann-C. Steffens, MD, expects to sink the
clinic’s total cost of ownership in computed tomography.
The new SOMATOM Perspective CT scanner
Options Benefit
Interleaved Volume
Reconstruction (IVR)
128 slices to improve spatial resolution
eMode
eMode Service Benefits
Efficient scanner usage with automated
parameter setting
Consequent eMode usage will be
rewarded with valuable eMode Service
Benefits
SAFIRE2 (Iterative Reconstruc-tion)
Dose reduction and superior image
quality
iTRIM Improved temporal resolution for
cardiac imaging
Lower waste heat and electricity Cuts electric and air-conditioning bills
Illumination MoodlightTM Comfortable scanning environment
Small footprint, 18.5 m2 Easy installation in one day. Leaves
more valuable, clinical space available
Ultra Fast Ceramic (UFC™)
Detector
Better images from less radiation
1 Under FDA review. Not available for sale in the U.S.
2 The information about this product is being provided for planning purposes. The product requires 510(k) review and is not commercially available in the U.S. 27
28. Business
Israelitisches Krankenhaus
Together with three other physicians
and ten support staff, Johann-C.
Steffens, MD. Treats some 10,000
patients each year at the Radiology
Clinic of the Israelitsches Kranken-haus
small operation in a metro area of
some 4 million residents, about half
of its patients come from the hospi-tal,
which specializes in gastroenter-ology,
ambulant cases of all types. Run as a
private practice since 2004, the clinic
uses computer tomography for intra-cranial,
and extremities examinations.
And there will be other efficiencies and
savings. Thanks to eMode's automated
approach to scanning, scan parameters
will be automatically adjusted with a
clear focus on efficient scanner usage.
Operating costs will also be reduced.
The SOMATOM Perspective’s1 small
size – a footprint of 18.5 square meters
– takes up less clinical space, and allows
it to be fully installed in just one day.
It consumes less power and radiates less
in Hamburg, Germany. A relatively
while the other half comprises
cervical, thoracic, abdominal,
heat than most scanners, which in turn
cuts bills for electricity and air-condi-tioning.
A look at the technology
In the SOMATOM Perspective, cost-consciousness
is combined with a full
palette of features. It incorporates
Siemens technologies that provide
speed and quality at low-dosage.
The SOMATOM Perspective can be
28 SOMATOM Sessions · November 2011 · www.siemens.com/healthcare-magazine
equipped with Siemens’ innovative
iTRIM to increase temporal resolution
as low as 195 milliseconds for cardiac
imaging, thereby reducing motion
artifacts. This novel iterative image
reconstruction algorithm improves
the overall image quality and reduces
image noise for obtaining accurate
diagnosis in demanding situations,
for example, in rapidly beating hearts.
Then there is the Interleaved Volume
Reconstruction (IVR) to detect even the
smallest diagnostic detail by using the
information of 128 slices, which for
Steffens’s clinic will be a major step up
from its current 16-slice model. Thanks
to this and iTRIM, the SOMATOM
Perspective is suited for any clinical field
including cardiac studies. In addition,
the scanner can acquire longer scan
ranges in a shorter period of time,
for example 50 centimeter scan cover-age
at highest image quality in only
5.2 seconds.
Dose reduction, also a key feature,
comes to the SOMATOM Perspective as
a trifecta. One element of this is CARE
Dose4D™ that adapts the X-ray tube
current for the entire scan range, aim-ing
for constant image quality for all
organs, patient shapes, and sizes – all in
real time. It overcomes the most com-mon
challenges in CT imaging that arise
because: a) the applied dose in antero
posterior and lateral positions need to
be different; b) each slice needs differ-ent
dose values; and c) patients are
quite heterogeneous (young/elderly,
small/large), so the applied dose must
vary according to the individual patient.
The second element of dose reduction
is the use of Iterative Reconstruction
(IR). Until recently, to use IR with CT
imaging in conventional clinical medi-cine
was too time-consuming: the com-puter
took too long to reconstruct the
images. With SAFIRE2 (Sinogram
Affirmed Iterative Reconstruction),
Siemens introduced the industry’s first
raw data-based iterative reconstruction
algorithm. SAFIRE achieves up to 60
percent dose reduction for a wide range
29. Business
“We think our costs of mainte-nance
are going to decline, and
that is a good thing to see.”
Johann-C. Steffens, MD,
Radiology Clinic of Israelitisches Krankenhaus, Hamburg, Germany
www.siemens.com/
SOMATOM-Perspective
SOMATOM Sessions · November 2011 · www.siemens.com/healthcare-magazine 29
of applications and delivers superior
image quality. Due to an excellent
reconstruction speed of up to 15 images
per second, SOMATOM Perspective
allows SAFIRE in daily routine.
The third element in dose-reduction
comes from Ultra Fast Ceramic (UFC™)
Detectors, which already have become
a key feature in CTs that predate the
SOMATOM Perspective. UFCs ensure
smaller X-ray doses and still radiate with
high luminance.
So they outperform conventional
detectors, which require more radiation
to generate an equal-quality image.
Inside job
Alongside features that optimize
cost and maximize performance, the
SOMATOM Perspective also has a
perspective for those who use it every
day, the operators and patients. For the
former, ‘ease your workday’ accessories
are standard, such as FAST Adjust,
Workstream 4D, a storage box and a
fast reconstruction speed with up to
20 images per second.
For patients – the ultimate end-users –
the SOMATOM Perspective provides
more comfort. Its gantry can be
equipped with an Illumination Mood-lightTM,
which helps to banish the sterile,
clinical look and feel of most examina-tion
rooms. Beyond that, says Steffens,
the SOMATOM Perspective’s speed and
accuracy makes life easier for patients.
“They spend less time holding their
breath,” he notes, “and fewer scans are
required.” All in all, he says, the
SOMATOM Perspective adds serious
value to his clinic’s offering. “We’ll offer
CT scans that are faster, better, with
less radiation – and not least, more
patient comfort.”
Eric Johnson, based in Zurich, Switzerland,
writes about technology, science, and business.
The SOMATOM Perspective can acquire longer scan ranges in a shorter period of time, for example
50 centimeter scan coverage at highest image quality in only 5.2 seconds.
1 Under FDA review. Not available for sale in the U.S.
2 The information about this product is being provided for planning purposes. The product requires 510(k) review and is not commercially available in the U.S..
30. Accelerated Cardiovascular
Assessment Powered by syngo.via
SOMATOM Defi nition Flash and syngo.via1 ensure fast workfl ows
and effi cient image management for cardiovascular reading.
By Ruth Wissler, MD
Specialists at the Cardiology Department
of Aarhus University Hospital, Skejby,
Denmark and the Department of Radiol-ogy,
University of Brescia, Italy, appreci-ate
the user-friendly and efficient read-ing
system in their daily cardiac imaging
and therapy routines. The Cardiology
Department at Aarhus University Hospi-tal
has seven angio suites and performs
between 2,500 and 3,000 cardiovascular
readings per year with the SOMATOM
Definition Flash. A five-license configura-tion
allows simultaneous access to
syngo.via in the scanner and the PACS
reading room for streamlined cardiovas-cular
evaluations.
With a three-license syngo.via configura-tion
and the SOMATOM Definition Flash,
the Department of Radiology at the Uni-versity
of Brescia performs at least 20 to
25 vascular, coronary and oncological
scans per day.
With accelerated automated pre-process-ing,
syngo.via reduces the time needed
for full cardiac assessment or aortic
stent planning. As soon as a cardiac case
is opened, automatically pre-processed
images are displayed, and the coronary
vessels, the functional parameters, and
the prepared calcium score can be evalu-ated
immediately.
Robust functional assessment
Morten Bøttcher, MD, PhD, (Cardiology
Department at Aarhus University Hospi-tal),
particularly appreciates the quick
overall cardiac assessment, the accurate
detection of ventricular borders, and the
Business
precise visualization and rapid quantifi-cation
of calcified coronary lesions. “For
functional imaging the important thing
is to detect the (ventricular) borders.
And syngo.via does that really well,”
says Bøttcher.
The combination of SOMATOM CT’s
MinDose functionality and the syngo.CT
Cardiac Function represent a highly dose-saving
symbiosis for assessing complete
global and local cardiac function.
Fast planning and placement
of aortic prosthesis
“With syngo.via, aortic stent planning is
a matter of seconds,“ says Roberto
Maroldi, MD, Head of the Department of
Radiology at the University of Brescia.
The automatic pre-processing features
remove table and rib cage and thus
ensure that the case is ready for review
when opened. The automatic segmenta-tion,
labeling, and calculation of curved
planar reformatted images2 of the aorta,
runoffs and renal arteries help to imme-diately
assess the status of the general
vessels. The stent planning template
guides the user through all measure-ments
necessary for planning of Abdom-inal
Aortic Aneurism (AAA) stents.
The specialists’ experience with the
SOMATOM Definition Flash scanner and
syngo.via at Aarhus University Hospital
Skejby, Denmark and the Department of
Radiology, University of Brescia, Italy
confirm the unique symbiosis of scanner
and software in modern diagnostic
imaging and therapy.
“For functional imaging the
important thing is to detect the
(ventricular) borders. And
syngo.via does that really well.”
Morten Bøttcher, MD, PhD, Aarhus University Hospital, Skejby, Denmark
“syngo.via is an excellent tool for
planning placement of prosthesis
for abdominal aneurysms.”
Roberto Maroldi, MD, Dept. of Radiology, University of Brescia, Italy
Ruth Wissler, MD, studied veterinary and
human medicine. She is an expert in science
communications and medical writing.
1 syngo.via can be used as a stand-alone device or together with a variety of syngo.via-based software options, which are medical devices in their own rights.
2 Available with syngo.CT Vascular Analysis – Autotracer
31. Minimizing Scan Time Loss
with TubeGuard
cussed the danger to seri-ously
injured or sick
patients where time is
critical.
Rejecting the inevitability
of such breakdowns,
Siemens scientists and
engineers have designed
the Guardian Program
including TubeGuard for all
systems of the SOMATOM
Definition family, a remote
service that continuously
(24/7) monitors ten
important functions of the
STRATON X-ray tube and
warns days in advance of
possible breakdowns.
A tube replacement can
then be scheduled at a
time convenient for the
hospital – if necessary at
two or three a.m. – causing
little or no interruption to
the radiology routine the
next morning.
Siemens’ promise:
With the Guardian Pro-gram
™ including Tube-
Guard, Siemens will predict nearly all
potential tube failures on time. Should it
fail a fair compensation policy (as deter-mined
in the users’ home country) takes
effect to minimize any scan-time loss
incurred. The local Siemens representa-tive
will provide more details.
Workfl ow assurance:
“I was very impressed when Siemens
contacted me recommending a tube
replacement based on proactive real-time
system monitoring with the Siemens
Guardian Program™ including Tube-
Guard,” said Terakado Hideji, MD, Chief
Radiologist, Jichi Medical University
By Tony de Lisa
Business
If there is any tube malfunction in a SOMATOM
Definition scanner (Fig. 1A), TubeGuard, included
in the Guardian Program, can detect it proac-tively
(Fig. 1B) and tube replacement can then be
scheduled at a time convenient for the hospital.
SOMATOM Sessions · November 2011 · www.siemens.com/healthcare-magazine 31
Normally, an automobile owner is not
aware that his dealer has checked the
profile of his auto’s tires at every major
service visit. This simple control, that
requires only a few minutes to complete,
actually delivers a lot of information:
are the tires presently safe to use, how
much longer before new tires are
required (based upon use and driving
habits) and what danger points – such
as split side-walls – can be observed
that indicate the possibility – even prob-ability
– of a blow-out. An intelligent
driver understands that tires are con-sumable
items that are subject to wear
and tear and therefore, have a maximum
life expectancy. Three factors primarily
effect these results, i.e. the quality of
the tire manufacture in the first place.
the driving habits of the auto owner
over time and mileage.
At this point, the normal reader would
suggest that comparing tires to X-ray
tubes – such as Siemens’ STRATON® – is
banal. But is it really? Why not take a
three minute diversion from your daily
routine and re-read the previous para-graph
substituting the word, “X-ray
tube” for “tire.”
This information begs the question,
“Who would not insist on having this
inspection done regularly?”
At this point, our “tire/tube” comparison
ends. With a flat tire, one mounts the
spare tire and resumes driving to the
next dealer. But the financial and organi-zational
results of a CT X-ray tube break-down
are enormous in comparison. Just
consider a radiology department that
does 50 CT scans per day. There a tube
breakdown can mean a financial loss
that runs into the thousands. One hospi-tal
director informs us that “Everything
must be re-scheduled (in event of a
breakdown) including the arrival of a
helicopter.” And we have not yet dis-
Hospital, Shimotsuke-shi, Tochigi-ken,
Japan. “This new cutting-edge service
enables us to plan the tube replacement
at a convenient time based on our
clinical workflow. As patients and
staff are scheduled accordingly, patient
satisfaction can also be significantly
increased.”
1B
Tony de Lisa is an external writer and based
in Nuremberg, Germany.
1A
32. Business
Versatility at High Speed
SOMATOM Defi nition Flash CT scanners are a quantum leap
in terms of diagnostic capabilities and patient-safety. At the same time,
they offer a uniquely wide range of applications, from sophisticated
scientifi c use to routine work.
By Justus Krüger
The PUMC Hospital in Peking is among
the best and largest medical institutions
in China. The hospital was founded in
1921 by the Rockefeller Foundation and
is known internationally as the Peking
Union Medical College Hospital (PUMC).
It has a long tradition of excellence and
of serving the public benefit: as a teach-ing
institution, as an outstanding centre
of scientific research, and as a clinic for
the general public. It houses 1,800 hos-pital
beds; every day, more than 12,000
outpatients go through its gates near
Dongdan in the Wangfujing area in
downtown Peking. With this throughput
of truly enormous proportions, it is not
surprising that the patients not only
come from the Chinese capital alone.
Nor are they exclusively Chinese.
Attracting patients from abroad
“Ours is a university hospital, and our
prime considerations are of course
social factors,” says Professor Jin
Zhengyu, MD, who knows the hospital –
and the city of Peking – like the back of
his hand. He was born and raised in the
Chinese capital, and he studied at the
PUMC. “What we do here is provide
solutions for population-based prob-lems.”
Yet, the fact that the Xiehe Hos-pital
has a reputation as a technically
sophisticated centre of medical excel-lence
attracts patients from far beyond
the boundaries of the city and even
from abroad.
Professor Jin is the Director of the Radi-ology
Department at PUMC Hospital,
as well as the doctoral supervisor and
32 SOMATOM Sessions · November 2011 · www.siemens.com/healthcare-magazine
complete scan of the heart for instance
only takes quarter of a second with the
Flash Spiral. And still with the Flash,
scans can be made at all heart rates
without using beta-blockers. Addition-ally,
patients do not need to hold their
breath during lung scans.
“This improves the imaging quality,”
says Professor Jin, “because patients are
not able to hold their breath. In such a
case, you would get a poor imaging
result with a slower scanner.” For the
same reason – the exceptional scanning
speed – young infants do not need to
be sedated when scanned, without
compromising the image quality. The
high speed of Flash Spiral CT also means
a low dose of radiation of below one
millisievert in cardiac CT. This is of great
benefit for CT heart examinations in
younger individuals that are yet still of a
lower risk of cardiac disease.
In all these respects – lung scans with-out
holding the breath, heart scans at
all heart rates without the use of beta
blockers, the capability to perform a
scan on infants without sedation, and
radiation levels below one millisievert in
daily practice – the SOMATOM Defini-tion
Flash is the only CT to deliver.
A further unique feature of the
SOMATOM Definition Flash CT is its
capacity in dynamic imaging whole
organ perfusion. Covering an area of up
to 48 centimeters the Flash offers the
longest 4D scan range in the market.
“We use the Adaptive 4D Spiral for a
variety of areas, such as liver-, kidney-and
pancreas-perfusion,” says Professor
Vice Chairman of the Chinese Society of
Radiology. “People come to our hospital
from many different countries,” he says.
“Not only from Asia, but also from all
over the world.” Part of the global pull
exercised by the hospital is its state-of-the-
art radiology department.
It goes without saying, that the PUMC
Hospital and its radiology department
use the best medical equipment avail-able.
Part of this is a set of six Siemens
CT scanner, including three SOMATOM
Definition Flash CTs. Professor Jin is
so convinced of the benefits of Flash
CT that his hospital has just ordered
another one.
The optimal diagnosis
The reason why Professor Jin and his
hospital opted for no less than four
Flash CTs is that they offer a variety of
advantages over all other CT scanners.
They are superior in virtually every
respect, ranging from their diagnostic
versatility and speed to image accuracy,
radiation levels and patient comfort.
“These two aspects – accuracy and
patient comfort – are really the same
thing,” says Professor Jin. “From my per-spective,
of course, the imaging capabil-ities
of the equipment usually are the
key consideration: you have to be able
to make the optimal diagnosis. Whether
it’s comfortable or not is a second con-sideration.
But in this case, accuracy
and patient comfort are internally con-nected.”
This is largely due to the scan speed of
the renowned Flash Spiral mode. A