Siemens SOMATOM Sensation Cardiac Version A60 Operations Instructions

SOMATOM Sensation CardiacApplication GuideSoftware Version A70

10GeneralThe following tables show you the possibilities of imagereconstruction in spiral and sequential scanning.Slice Collimation and Slice Width fo

100HeadOverview• AngioHeadFor CT Angio studies using 0.75 mm slice collimationand a 1.0 mm slice thickness• AngioHead100kVThis protocol is identical t

101HeadHints in General1. Topogram: Lateral, 256 mm.2. Patient positioning:Patient lying in supine position, arms resting againstbody, secure head wel

102HeadAngioHeadIndications:Spiral mode for cerebral CT Angios, e. g. cerebralvascular abnormalities, tumors and follow up studiesetc.A range of 80 mm

103HeadAngioHead 2ndReconstr.kV 120Effective mAs 100Slice collimation 0.75 mmSlice width 4.0 mm 1.0 mmFeed/Rotation 15.0 mmRotation time 0.5 sec.Kerne

104HeadAngioHead100kVIndications:For cerebral CT Angio studies, with one reconstructionjob for a 0.75mm slice thickness.E.g. cerebral vascular abnorma

105HeadAngioHead 2ndReconstr.kV 100Effective mAs 120Slice collimation 0.75 mmSlice width 4.0 mm 1.0 mmFeed/Rotation 15.0 mmRotation time 0.5 sec.Kerne

106HeadHeadSeq05sIndications:Sequence mode for routine head studies, e. g. stroke, brain tumors, cranial trauma, cerebral atrophy,hydrocephalus, and i

107HeadThinSliceSeq RoutineSeqkV 120 120mAs 250 250Slice collimation 0.75 mm 1.5 mmSlice width 4.5 mm 9.0 mmFeed/Scan 9.5 mm 19.0 mmRotation time 0.5

108HeadHead05sIndications:Spiral mode for routine head studies, e. g. stroke, brain tumors, cranial trauma, cerebral atrophy, hydro-cephalus, and infl

109HeadThinSlice RoutinekV 120 120Effective mAs 320 320Slice collimation 0.75 mm 1.5 mmSlice width 4.0 mm 8.0 mmFeed/Rotation 6.8 mm 13.7 mmRotation t

11GeneralRecon JobIn the Recon card, you can define up to 3 reconstruc-tion jobs with different parameters either before orafter you acquire the data.

110NeckOverview• AngioCarotidFor CTA spiral studies

111NeckHints in General1. Topogram: AP, 512 mm.2. Patient positioning:Patient lying in supine position, hyperextend neckslightly, secure head well in

112NeckAngioCarotidIndications:Noninvasive CT angiography of carotid stenosis or occlusions, plaques course abnormalities of the carotids and vertebra

113NeckAngioCarotid 2ndReconstr.kV 120Effective mAs 120Slice collimation 0.75 mmSlice width 5.0 mm 1.0 mmFeed/Rotation 12.0 mmRotation time 0.5 sec.Ke

114ThoraxOverview• LungLowDoseSpiral mode with very low dose for special lung studies, e. g. early visualization of pulmonary nodules• EmbolismSpiral

115ThoraxHints in General1. Topogram: AP, 512 mm.2. Patient positioning:Patient lying in supine position, arms positionedcomfortably above the head in

116LungLowDoseIndications:Lung spiral studies with low dose setting, e.g. earlyvisualization of pulmonary nodules.A typical thorax study in a range of

117LungCARE 2ndReconstr.kV 120Effective mAs 20Slice collimation 0.75 mmSlice width 5.0 mm 1.0 mmFeed/Rotation 18.0 mmRotation time 0.5 sec.Kernel B50f

118EmbolismIndications:For Pulmonary Emboli studies.There are two recon jobs predefined. The first one,with 5 mm slice thickness, the second reconstru

119Embolism 2ndReconstr.kV 120Effective mAs 100Slice collimation 0.75 mmSlice width 5.0 mm 1.0 mmFeed/Rotation 15.0 mmRotation time 0.5 sec.Kernel B40

12General100kV-ProtocolsThe additional tube voltage 100 kV is now supported.The system offers a spectrum of 4 kV settings (80 kV,100 kV, 120 kV and 14

120Embolism100kVIndications:For Pulmonary Emboli studies.There are two recon jobs predefined. The first one,with 5 mm slice thickness, the second reco

121Embolism 2ndReconstr.kV 100Effective mAs 120Slice collimation 0.75 mmSlice width 5.0 mm 1.0 mmFeed/Rotation 15.0 mmRotation time 0.5 sec.Kernel B40

122ThoraxThoraxCombiIndications:Combining thin slice lung and routine thorax studieswith one spiral scan. E.g. thorax studies in general andinterstiti

123ThoraxThoraxCombi 2ndReconstr.kV 120Effective mAs 100Slice collimation 0.75 mmSlice width 5.0 mm 1.0 mmFeed/Rotation 15.0 mmRotation time 0.5 sec.K

124ThoraxThoraxRoutineIndications:Routine spiral studies for the region of thorax, e.g.screening of tumors, metastases, lymphoma, lymphnodes,, vascula

125ThoraxThoraxRoutinekV 120Effective mAs 100Slice collimation 1.5 mmSlice width 6.0 mmFeed/Rotation 30.0 mmRotation time 0.5 sec.Kernel B41fIncrement

126AbdomenOverview• AbdRoutineFor routine abdominal spiral studies• AngioFastFor long-range CTA spiral studies• AngioRoutineFor CTA routine spiral stu

127AbdomenHints in General1. Topogram: AP, 512 or 768 mm.2. Patient positioning:Patient lying in supine position, arms positionedcomfortably above the

128AbdomenNote: In general, for abdominal studies such as liver,gall bladder (query stones), pancreas, gastrointestinalstudies, focal lesion of the ki

129AbdomenKernels:The VA70 provides two new kernels for body regionprotocols: B31 and B41. The endings “s” or “f” dependon the rotation time.They are

13GeneralFig. 1: Iodine contrast-to-noise ratio as a function of the phantom diameter for various kV-settings at aconstant dose.4030201000 4

130AbdomenAbdRoutineIndications:All routines in the region of abdomen, e.g. screening,follow-up examinations etc.A complete abdomen/pelvis scan, in a

131AbdomenAbdRoutinekV 120Effective mAs 160Slice collimation 1.5 mmSlice width 5.0 mmFeed/Rotation 24.0 mmRotation time 0.5 sec.Kernel B31fIncrement 5

132AngioFastIndications:Long range CTA studies.E.g.: a typical study of the whole aorta including itsbranchiocephalic trunk and iliac arteries in a ra

133AngioFast 2ndReconstr.kV 120Effective mAs 130Slice collimation 1.5 mmSlice width 5.0 mm 2.0 mmFeed/Rotation 36.0 mmRotation time 0.5 sec.Kernel B30

134AngioRoutineIndications:For abdominal CTA studies.E. g.: a typical study of renal arteries in a range of 40 cm will be covered in 13.9 sec.Abdomen

135AngioRoutine 2ndReconstr.kV 120Effective mAs 130Slice collimation 0.75 mmSlice width 5.0 mm 1.0 mmFeed/Rotation 15.0 mmRotation time 0.5 sec.Kernel

136AbdomenSeqIndications:This protocol is created for measurement with sequential mode in the region of the abdomen.AbdomenSeqkV 120mAs 140Slice colli

137Abdomen

138ExtremitiesOverview• AngioRunOffFor long range CTA spiral studies

139ExtremitiesHints in General1. Topogram: AP, 1024mm for CTA.2. If Topo length 1024 mm is not long enough, youcan also choose the 1540 mm long Topog

14GeneralEffective mAsIn sequential scanning, the dose (Dseq) applied to thepatient is the product of the tube current-time (mAs)and the CTDIwper mAs:

140AngioRunOffIndications:For CTA studiesA range of 100 cm will be done in 21.4 sec.AngioRunOff 2ndReconstr.kV 120Effective mAs 130Slice collimation 1

141* CARE Bolus may be used to optimize the bolus timing.Set the ROI for monitoring scan in the abdominal aorta at the beginning of the scan range wit

Siemens reserves the right to modify the design and specifications containedherein without prior notice. Please contact your local Siemens Sales Repre

15GeneralDose InformationCTDIWand CTDIVolThe average dose in the scan plane is best described bythe CTDIwfor the selected scan parameters. The CTDIwis

16GeneralThe CTDIwvalue does not provide the entire informationof the radiation risk associated with CT examination.For the purpose, the concept of th

17GeneralFig. 1: User interface of the PC program WinDose. All parameters necessary for the effective dose calcu-lation have to be specified.Fig. 2: A

18GeneralFig.3: Results as output of WinDose with the organdose readings and the effective dose according to ICRP26 (previous version) and ICRP60 (cur

19GeneralFig. 1: Example of scanning in the region of shoulder.CARE DoseCARE Dose is a clinical application package that pro-vides real-time tube curr

2The information presented in this application guide is for illustration only and is not intended to be reliedupon by the reader for instruction as to

20GeneralWorkflowFig. 2: Principle of CARE Dose tube current adaptation.lateral1.000.750.500.25rel. unitsa.p.timeObject attenuationModulated tube curr

21GeneralAuto Load in 3D and Postprocessing PresetsYou can activate the “Auto load in 3D” function on theExamination Card/Auto Tasking and link it to

22GeneralHow to Create your own Scan ProtocolsUser-specific scan protocols can be saved with the following basic procedure:– Register a test patient,

23General– Modify the scan protocol, change parameters, add new ranges etc.– Do not load the scan protocol.– Select Edit/Save Scan Protocol in the mai

24HeartView CTHeartView CTHeartView CT is a clinical application packagespecifically tailored to cardiovascular CT studies.The BasicsImportant Anatomi

25HeartView CTFig. 1: Blood fills both atriaFig. 2: Atria contract, bloodenters ventriclesA: AortaP: Pulmonary ArteryRV: Right VentricleLV: Left Ventr

26HeartView CTCoronary arteries:• Right coronary artery (RCA)Right coronary artery supplies blood to the rightatrium, right ventricle, and a small par

27HeartView CTCardiac Cycle and ECGThe heart contracts when pumping blood and restswhen receiving blood. This activity and lack of activityfrom a card

28HeartView CTTechnical PrinciplesBasically, there are two different technical approachesfor cardiac CT acquisition:• Prospectively ECG triggered sequ

29HeartView CTAbsolute – delay: a fixed time delay after the onset ofthe R-wave (Fig. 11).Absolute – reverse: a fixed time delay prior to the onsetof

33OverviewGeneral 8HeartView CT 24Bolus Tracking 60WholeBodyAngio 72Interventional CT 68LungCARE 74CT Colonography 76Children 78Head 100Neck 110Thorax

30HeartView CTProspective ECG-triggering Versus RetrospectiveECG-gatingWith prospective ECG-triggering, the heart volume iscovered in a “step-and-shoo

31HeartView CTPlacement of ECG-electrodesThe correct placement of the ECG electrodes is essential inorder to receive a clear ECG signal with marked R-

32HeartView CTPreview Series ReconstructionThe Preview Series should be used to define the optimaltime window for image reconstruction in ECG-gatedspi

33HeartView CTExample of a preview series at the correct anatomicallevel (mid RCA), demonstrating the importance of opti-mized phase setting. Patient

34HeartView CTECG-PulsingECG-pulsing is a dedicated technique used for onlinedose modulation in ECG-gated spiral scanning. Duringthe spiral scan, the

35HeartView CTACV on/offOn the Trigger card, ACV (Adaptive Cardio Volume recon-struction) can be switched on/off by the user. WithACV off, single segm

36HeartView CTFig. 15: Temporal resolution as a function of thepatient’s heart rate for 0.42 s gantry rotation time.FWHM of the TSP in ms for 0.42 sHe

37HeartView CTASA-FilterFor the VA70 the special kernel B46f and the ASA-filterare now routinely available and can be selected in eachECG-gated spiral

38HeartView CTHow to do itCalcium ScoringThis application is used for identification and quan-tification of calcified lesions in the coronary arteries

39HeartView CTHints in General• Kernel B35f is dedicated to calcium scoring studies,providing most accurate determination of the HU-value of small cal

4ContentGeneral 8· Concept 8· Scan Set Up 8· Scan and Reconstruction 9– Slice Collimation and Slice Width 9– Pitch 10– Recon Job 11– Kernels 11– Image

40HeartView CTCaScoreRoutineIndications:This is a standard spiral scanning protocol, using an ECG gating technique for coronary calcium scoringstudies

41HeartView CT* Depends on heart rate.** Reduced by 30%-50% with ECG-pulsing.CaScoreFastVolumeIndications:This is a standard spiral scan protocol usin

42HeartView CTCaScoreSeqIndications:This is a sequential scanning protocol with ECG-triggering and simultaneous acquisition of six 3 mmslices for coro

43HeartView CTCoronary CTAThis is an application for imaging the coronary arterieswith contrast medium. With the software version VA70both, 12- and 16

44HeartView CT• CoronaryCTAAdaptSpeed– This protocol is identical to CoronaryCTAFastVolume,except that it uses 0.5 s gantry rotation time insteadof 0.

45HeartView CT• We generally recommend using ECG-gated spiralprotocols for optimized image quality of the coronaryarteries and to provide high-quality

46HeartView CTCoronaryCTARoutineIndications:This is a standard spiral protocol with ECG-gatingwhich has been clinically used so far, relying on 12-sli

47HeartView CTCoronaryCTAFastVolumeIndications:ECG-gating using 16-slice acquisition, 0.75 mm collimation and 0.42 s gantry rotation time. With thesup

48HeartView CTCorCTALowHeartRateIndications:This spiral scanning protocol is identical to CoronaryCTAFastVolume, except that it uses a reducedtable fe

49HeartView CTCoronaryCTA100kVIndications:This is a spiral scanning protocol, using a rotation time of 0.42 s, and 100 kV tube voltage, with an ECGgat

5ContentHeartView CT 24· The Basics 24– Important Anatomical Structures of the Heart 24– Cardiac Cycle and ECG 27– Temporal Resolution 27– Technical P

50HeartView CTCoronaryCTAAdaptSpeedIndications:This is a spiral scanning protocol, using a rotation timeof 0.5 s, with an ECG gating technique for cor

51HeartView CTAortic and Pulmonary StudiesThe purpose of these applications is to reduce motionartifacts in the lung, the aorta and the pulmonary arte

52HeartView CTAngioECGIndications:This is a spiral scanning protocol using a rotation time of 0.42 s with an ECG gating technique for aorticand pulmon

53HeartView CT

54HeartView CTAngioECGSeqIndications:This is a sequential scanning protocol with an ECG triggering technique for coronary CTA studies. It couldalso be

55HeartView CTThorECGkV 120mAs 120Slice collimation 1.5 mmSlice width 1.5 mmFeed/Scan 18 mmRotation time 0.42 sec.Temporal resolution 210 msKernel B30

56HeartView CTAdditional Important InformationBy default, the “Synthetic Trigger” (ECG triggered scanning) or “Synthetic Sync” (ECG gated scanning) is

57HeartView CTYou can activate the “Auto load in 3D” function on theExamination Card/Auto Tasking and link it to a reconjob. If the postprocessing typ

58HeartView CTCalcium Scoring evaluation is performed on a separatesyngo task card:1. The threshold of 130 HU is applied for score calculation by defa

59HeartView CTUser interface of syngo Calcium Scoring

6ContentBolus Tracking 60· The Basics 60· How to do it 62· CARE Bolus 62– General Hints 62· Test Bolus 64– Application Procedures 65· Additional Impor

60Bolus TrackingThe BasicsThe administration of intravenous (IV) contrast mate-rial during spiral scanning improves the visualizationand characterizat

61Bolus TrackingAortic time-enhancement curves after i.v. contrastinjection (computer simulation*).All curves are based on the same patient parameters

62Bolus TrackingHow to do itTo achieve optimal results in contrast studies, use ofCARE Bolus is recommended. In case it is not available,use Test Bolu

63Bolus Tracking• After the Topogram is performed, the predefined spiral scanning range and the optimal monitoringposition will be shown.• If you need

64Bolus TrackingTestBolusIndications:This mode can be used to test the start delay of optimal enhancement after the contrast mediuminjection.TestBolus

65Bolus TrackingApplication Procedures:1. Select the spiral mode that you want to perform,and then “Append” the TestBolus mode under Specialprotocols.

66Bolus TrackingAdditional Important Information1. The preset start delay time for monitoring scansdepends on whether the subsequent spiral scan willb

67Bolus Tracking5. If API is used in conjunction with CARE Bolus, theactual start delay time for the spiral will be as longas the length of API includ

68Interventional CTTo facilitate CT interventional procedures, we createddedicated multislice and single slice sequential modes. • BiopsyThis is the m

69Interventional CTHow to do itBiopsyIndications: This is the multislice biopsy mode. Four slices, 4.5 mm each, will be reconstructed and displayedfor

7ContentThorax 114· Overview 114· Hints in General 115– Kernels 115· LungLowDose 116· Embolism 118· Embolism100kV 120· ThoraxCombi 122· ThoraxRoutine

70Interventional CT5. Click “Load” and then “Cancel move”. Press the“Start” button and 4 images will be displayed.6. Press “Start” again, you’ll get a

71Interventional CTAdditional Important Information• In the BiopsyCombine mode, the slice position, tableposition, table begin and table end are all t

72WholeBodyAngioThis scan protocol can be used for a whole Body Angio.A range of 100 cm can be covered in 14.5 sec.WholeBody 2ndReconstr.kV 120Effecti

73WholeBodyAngio

74LungCARELungCAREkV 120Effective mAs 20Slice collimation 0.75 mmSlice width 1.0 mmFeed/Rotation 13.5 mmRotation time 0.5 sec.Kernel B50fIncrement 0.5

75LungCAREUser interface of syngo LungCARE

76CT ColonographyThis is a promising application, dedicated to visualizeand evaluate lesions in the colon. This study is not onlynon-invasive, but a m

77CT ColonographyWe recommend using a tube voltage of at least 120 kV.A comprehensive study consists of four sections:Preparation, examination in supi

78Children OverviewThis folder contains 8 organ specific pediatric proto-cols with 2 to 5 age or weight dependant subgroups.For your convenience, the

79Children Hints in General1. Topograms: 256 mm lateral topograms are definedfor the head modes, and 512 mm AP topograms aredefined for the body modes

8GeneralConceptThe scan protocols for adult are defined according to body regions – Head, Neck,Thorax, Abdomen,Extremities.The pediatric scan protocol

80The proper personnel and equipment must also be readily available in the event of a problem.6. Oral and rectal contrast administration: Dependingon

81Note: these are injector guidelines based on an antecubital injection site. These guidelines may needto be adjusted if the site is more peripheral.N

82Children Head kernelsThe VA70 provides three new kernels for head proto-cols: H21, H31, H41.The endings “s” or “f” depend on the rotation time.They

83Children

84Head05sIndications:Spiral mode for routine head studies, e.g. tumors,hydrocephalus, hemorrhaging, abnormalities, etc.HeadkV 120Effective mAs *Slice

85Tips• Children, who are more than 6 years old, should be scanned with an adult protocol as the skull by thistime is fully grown.• When bone structur

86HeadSeq05sIndications:Sequential mode for routine head studies for children, e.g. tumors, hydrocephalus, hemorrhaging,abnormalities, etc.HeadSeqkV 1

87Tips• Children, who are more than 6 years old, should be scanned with an adult protocol as the skull by thistime is fully grown.• When bone structur

88HeadAngioIndications:Spiral mode for head CT angiography, e.g. cerebralvascular abnormalities, tumors etc.HeadAngio 2ndReconstr.kV 80Effective mAs *

89Tips• Children, who are more than 12 years old should bescanned with an adult protocol.• The first recon job is defined for soft tissue visuali-zati

9GeneralScan and ReconstructionSlice Collimation and Slice WidthSlice collimation is the slice thickness collimated bythe tube collimator, which deter

90Children CarotidCTAIndications:CT angiography of the carotid arteries, e.g. carotid stenosis or occlusion, vascular abnormalities of thecarotids or

91Children Tips• Children, who are more than 12 years old should bescanned with an adult protocol.• The first recon job is defined for soft tissue vis

92Children NeonateBodyIndications:Spiral mode for routine neonate body studies, e. g.tumors, abnormalities, malformations, abscesses, etc.NeonateBodyk

93Children Tips• You can modify the slice width for image reconstruc-tion according to the clinical indications.Contrast medium IV injectionStart dela

94Children ThoraxRoutineIndications:Spiral mode for routine thorax studies, e.g. pneumonia, tumors, metastases, lymphoma, vascularabnormalities etc.Th

95Children Tips• Children with a body weight of more than 54 kgshould be examined with an adult protocol.• The first and second recon jobs are defined

96AbdPelRoutineIndications:Spiral mode for routine studies in the region of abdomen and pelvis, e.g. tumors, lymphoma,abscesses, post-traumatic change

97Contrast medium IV injectionStart delay exam dependentFlow rate dependent upon needle size/Access siteTotal amount 1– 2 ml per kg of body weightTips

98Children AbdCTAIndications:For abdominal CT Angio studies, e. g. vascular abnormalities, aneurysms, etc.AbdCTA 2ndReconstr.kV 80Effective mAs *Slice

99Children Contrast medium IV injectionStart delay exam dependentFlow rate dependent upon needle size/Access siteTotal amount 1– 2 ml per kg of body w