SlideShare a Scribd company logo
1 of 80
Download to read offline
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
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
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
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
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.
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
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
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
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.
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.
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.
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.
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.
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
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
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
“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
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.
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
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
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.
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.
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.
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
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.
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.
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
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
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..
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
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
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
Somatom session 29
Somatom session 29
Somatom session 29
Somatom session 29
Somatom session 29
Somatom session 29
Somatom session 29
Somatom session 29
Somatom session 29
Somatom session 29
Somatom session 29
Somatom session 29
Somatom session 29
Somatom session 29
Somatom session 29
Somatom session 29
Somatom session 29
Somatom session 29
Somatom session 29
Somatom session 29
Somatom session 29
Somatom session 29
Somatom session 29
Somatom session 29
Somatom session 29
Somatom session 29
Somatom session 29
Somatom session 29
Somatom session 29
Somatom session 29
Somatom session 29
Somatom session 29
Somatom session 29
Somatom session 29
Somatom session 29
Somatom session 29
Somatom session 29
Somatom session 29
Somatom session 29
Somatom session 29
Somatom session 29
Somatom session 29
Somatom session 29
Somatom session 29
Somatom session 29
Somatom session 29
Somatom session 29
Somatom session 29

More Related Content

What's hot

What’s New & Happening at The RSNA Show?
What’s New & Happening at The RSNA Show?What’s New & Happening at The RSNA Show?
What’s New & Happening at The RSNA Show?Atlantis Worldwide LLC
 
Better Imaging equals better patient outcomes
Better Imaging equals better patient outcomesBetter Imaging equals better patient outcomes
Better Imaging equals better patient outcomesA-dec Australia
 
3D Visualization of DICOM datasets using a MakerBot
3D Visualization of DICOM datasets using a MakerBot3D Visualization of DICOM datasets using a MakerBot
3D Visualization of DICOM datasets using a MakerBotkkpandya
 
CTECH Labs by Warsito P. Taruno
CTECH Labs by Warsito P. TarunoCTECH Labs by Warsito P. Taruno
CTECH Labs by Warsito P. Tarunoppibelanda
 
Technical developmpentscardiovascularimaging
Technical developmpentscardiovascularimagingTechnical developmpentscardiovascularimaging
Technical developmpentscardiovascularimagingMeg Neal
 
Wavelength March 2013 Volume 17 No. 1
Wavelength March 2013 Volume 17 No. 1Wavelength March 2013 Volume 17 No. 1
Wavelength March 2013 Volume 17 No. 1Jerry Duncan
 
Final report AdaptVein
Final report AdaptVeinFinal report AdaptVein
Final report AdaptVeinRoslina Rosli
 
Global Computed Tomography (CT) Scanners Industry
Global Computed Tomography (CT) Scanners IndustryGlobal Computed Tomography (CT) Scanners Industry
Global Computed Tomography (CT) Scanners IndustryReportLinker.com
 
Brochure p10 (1)
Brochure p10 (1)Brochure p10 (1)
Brochure p10 (1)sumai_mmgpd
 

What's hot (19)

FieldStrength 49
FieldStrength 49FieldStrength 49
FieldStrength 49
 
Somatom sessions 26
Somatom sessions 26Somatom sessions 26
Somatom sessions 26
 
Somatom sessions 24
Somatom sessions 24Somatom sessions 24
Somatom sessions 24
 
FieldStrength 50 advanced neuro
FieldStrength 50 advanced neuroFieldStrength 50 advanced neuro
FieldStrength 50 advanced neuro
 
What’s New & Happening at The RSNA Show?
What’s New & Happening at The RSNA Show?What’s New & Happening at The RSNA Show?
What’s New & Happening at The RSNA Show?
 
FS39_Book
FS39_BookFS39_Book
FS39_Book
 
Better Imaging equals better patient outcomes
Better Imaging equals better patient outcomesBetter Imaging equals better patient outcomes
Better Imaging equals better patient outcomes
 
3D Visualization of DICOM datasets using a MakerBot
3D Visualization of DICOM datasets using a MakerBot3D Visualization of DICOM datasets using a MakerBot
3D Visualization of DICOM datasets using a MakerBot
 
CT definition flash - SIEMENS
CT definition flash - SIEMENSCT definition flash - SIEMENS
CT definition flash - SIEMENS
 
2012CNS
2012CNS2012CNS
2012CNS
 
CTECH Labs by Warsito P. Taruno
CTECH Labs by Warsito P. TarunoCTECH Labs by Warsito P. Taruno
CTECH Labs by Warsito P. Taruno
 
Real-time Vein Imaging
Real-time Vein ImagingReal-time Vein Imaging
Real-time Vein Imaging
 
Ct acute care
Ct acute careCt acute care
Ct acute care
 
Technical developmpentscardiovascularimaging
Technical developmpentscardiovascularimagingTechnical developmpentscardiovascularimaging
Technical developmpentscardiovascularimaging
 
FS31_21141
FS31_21141FS31_21141
FS31_21141
 
Wavelength March 2013 Volume 17 No. 1
Wavelength March 2013 Volume 17 No. 1Wavelength March 2013 Volume 17 No. 1
Wavelength March 2013 Volume 17 No. 1
 
Final report AdaptVein
Final report AdaptVeinFinal report AdaptVein
Final report AdaptVein
 
Global Computed Tomography (CT) Scanners Industry
Global Computed Tomography (CT) Scanners IndustryGlobal Computed Tomography (CT) Scanners Industry
Global Computed Tomography (CT) Scanners Industry
 
Brochure p10 (1)
Brochure p10 (1)Brochure p10 (1)
Brochure p10 (1)
 

Similar to Somatom session 29

Medication Barcode Scanning Essay
Medication Barcode Scanning EssayMedication Barcode Scanning Essay
Medication Barcode Scanning EssayElizabeth Kennedy
 
Sjaak van der Pouw (Siemens Healthcare) - Beeldexplosie: de mogelijkheden van...
Sjaak van der Pouw (Siemens Healthcare) - Beeldexplosie: de mogelijkheden van...Sjaak van der Pouw (Siemens Healthcare) - Beeldexplosie: de mogelijkheden van...
Sjaak van der Pouw (Siemens Healthcare) - Beeldexplosie: de mogelijkheden van...AlmereDataCapital
 
SPNC/MSC 22015 Case Study
SPNC/MSC 22015 Case Study SPNC/MSC 22015 Case Study
SPNC/MSC 22015 Case Study Jason Gwilliam
 
Salazar 10 step marketing plan for csmc ct scan
Salazar   10 step marketing plan for csmc ct scanSalazar   10 step marketing plan for csmc ct scan
Salazar 10 step marketing plan for csmc ct scanriannasalazar
 
Top 5 Trends from RSNA 2015 Day 1 | MD Buyline
Top 5 Trends from RSNA 2015 Day 1 | MD BuylineTop 5 Trends from RSNA 2015 Day 1 | MD Buyline
Top 5 Trends from RSNA 2015 Day 1 | MD BuylineMD Buyline
 
Diagnostic Imaging Market.pdf
Diagnostic Imaging Market.pdfDiagnostic Imaging Market.pdf
Diagnostic Imaging Market.pdfjtrautt21
 
Advancements in MRI_18.06.2023.pdf
Advancements in MRI_18.06.2023.pdfAdvancements in MRI_18.06.2023.pdf
Advancements in MRI_18.06.2023.pdfSHRIRAMASHOKRAJURKAR
 
Diagnostic imaging market
Diagnostic imaging marketDiagnostic imaging market
Diagnostic imaging marketameliasimon0
 
Computers in ortodontics /certified fixed orthodontic courses by Indian denta...
Computers in ortodontics /certified fixed orthodontic courses by Indian denta...Computers in ortodontics /certified fixed orthodontic courses by Indian denta...
Computers in ortodontics /certified fixed orthodontic courses by Indian denta...Indian dental academy
 
AI and the Future of Healthcare, Siemens Healthineers
AI and the Future of Healthcare, Siemens HealthineersAI and the Future of Healthcare, Siemens Healthineers
AI and the Future of Healthcare, Siemens HealthineersLevi Shapiro
 

Similar to Somatom session 29 (20)

Somatom session 27
Somatom session 27Somatom session 27
Somatom session 27
 
Recent advances in mri
Recent advances in mriRecent advances in mri
Recent advances in mri
 
Medication Barcode Scanning Essay
Medication Barcode Scanning EssayMedication Barcode Scanning Essay
Medication Barcode Scanning Essay
 
Sjaak van der Pouw (Siemens Healthcare) - Beeldexplosie: de mogelijkheden van...
Sjaak van der Pouw (Siemens Healthcare) - Beeldexplosie: de mogelijkheden van...Sjaak van der Pouw (Siemens Healthcare) - Beeldexplosie: de mogelijkheden van...
Sjaak van der Pouw (Siemens Healthcare) - Beeldexplosie: de mogelijkheden van...
 
SPNC/MSC 22015 Case Study
SPNC/MSC 22015 Case Study SPNC/MSC 22015 Case Study
SPNC/MSC 22015 Case Study
 
CT Somatom Sensation Open
CT Somatom Sensation OpenCT Somatom Sensation Open
CT Somatom Sensation Open
 
PHILIPS - Field strength 2013
PHILIPS - Field strength 2013PHILIPS - Field strength 2013
PHILIPS - Field strength 2013
 
Salazar 10 step marketing plan for csmc ct scan
Salazar   10 step marketing plan for csmc ct scanSalazar   10 step marketing plan for csmc ct scan
Salazar 10 step marketing plan for csmc ct scan
 
Top 5 Trends from RSNA 2015 Day 1 | MD Buyline
Top 5 Trends from RSNA 2015 Day 1 | MD BuylineTop 5 Trends from RSNA 2015 Day 1 | MD Buyline
Top 5 Trends from RSNA 2015 Day 1 | MD Buyline
 
Diagnostic Imaging Market.pdf
Diagnostic Imaging Market.pdfDiagnostic Imaging Market.pdf
Diagnostic Imaging Market.pdf
 
ISMRM Edition - Issue 46
ISMRM Edition - Issue 46ISMRM Edition - Issue 46
ISMRM Edition - Issue 46
 
Magnetom Flash 50 - Revista MRI
Magnetom Flash 50 - Revista MRIMagnetom Flash 50 - Revista MRI
Magnetom Flash 50 - Revista MRI
 
NAEOTOM Alpha.pdf
NAEOTOM Alpha.pdfNAEOTOM Alpha.pdf
NAEOTOM Alpha.pdf
 
VISIONS MR Special
VISIONS MR SpecialVISIONS MR Special
VISIONS MR Special
 
VC introduction v.3
VC introduction v.3VC introduction v.3
VC introduction v.3
 
Advancements in MRI_18.06.2023.pdf
Advancements in MRI_18.06.2023.pdfAdvancements in MRI_18.06.2023.pdf
Advancements in MRI_18.06.2023.pdf
 
Diagnostic imaging market
Diagnostic imaging marketDiagnostic imaging market
Diagnostic imaging market
 
Computers in ortodontics /certified fixed orthodontic courses by Indian denta...
Computers in ortodontics /certified fixed orthodontic courses by Indian denta...Computers in ortodontics /certified fixed orthodontic courses by Indian denta...
Computers in ortodontics /certified fixed orthodontic courses by Indian denta...
 
AI and the Future of Healthcare, Siemens Healthineers
AI and the Future of Healthcare, Siemens HealthineersAI and the Future of Healthcare, Siemens Healthineers
AI and the Future of Healthcare, Siemens Healthineers
 
ISMRM Edition - Issue 49
ISMRM Edition - Issue 49ISMRM Edition - Issue 49
ISMRM Edition - Issue 49
 

More from Jhon Arriaga Cordova

More from Jhon Arriaga Cordova (15)

Resonancia no ecoplanar en colesteatoma.pptx
Resonancia no ecoplanar en colesteatoma.pptxResonancia no ecoplanar en colesteatoma.pptx
Resonancia no ecoplanar en colesteatoma.pptx
 
Oído.pptx
Oído.pptxOído.pptx
Oído.pptx
 
Somatom session 29
Somatom session 29Somatom session 29
Somatom session 29
 
Neurography Supplement to Issue 50
Neurography Supplement to Issue 50Neurography Supplement to Issue 50
Neurography Supplement to Issue 50
 
Pediatric Imaging - Issue 47
Pediatric Imaging - Issue 47Pediatric Imaging - Issue 47
Pediatric Imaging - Issue 47
 
ISMRM Edition – Issue 58
ISMRM Edition – Issue 58ISMRM Edition – Issue 58
ISMRM Edition – Issue 58
 
Pediatric SPR Edition – Issue 57
Pediatric SPR Edition – Issue 57Pediatric SPR Edition – Issue 57
Pediatric SPR Edition – Issue 57
 
SCMR Edition – Issue 56
SCMR Edition – Issue 56SCMR Edition – Issue 56
SCMR Edition – Issue 56
 
Magnetom flash 55
Magnetom flash 55Magnetom flash 55
Magnetom flash 55
 
ASTRO Edition - Issue 54
ASTRO Edition - Issue 54 ASTRO Edition - Issue 54
ASTRO Edition - Issue 54
 
MR Angiography Edition – Issue 53
MR Angiography Edition – Issue 53MR Angiography Edition – Issue 53
MR Angiography Edition – Issue 53
 
SCMR Edition - Issue 51
SCMR Edition - Issue 51SCMR Edition - Issue 51
SCMR Edition - Issue 51
 
ISMRM Edition - Issue 52
ISMRM Edition - Issue 52ISMRM Edition - Issue 52
ISMRM Edition - Issue 52
 
RSNA Edition - Issue 48
RSNA Edition - Issue 48RSNA Edition - Issue 48
RSNA Edition - Issue 48
 
Feasibility of CT scan studies with triple split bolus intravenous contrast ...
Feasibility of CT scan studies with triple split bolus  intravenous contrast ...Feasibility of CT scan studies with triple split bolus  intravenous contrast ...
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