Siemens 2005C User Manual

SOMATOMSpiritApplication GuideProtocolsPrinciplesHelpful Hintssyngo 3Dsyngo Fly Throughsyngo Dental CTsyngo Osteo CTsyngo Volume Evaluationsyngo Dynam

10 Contents Vascular 162• Overview 162• Hints in General 163- Head Kernels 163- Body Kernels 163• HeadAngio/HeadAngio08s 164• CarotidAngio/CarotidAn

100 Thorax• Lung images should be documented in both soft tis-sue window and lung window.• It is also possible to interleave the soft tissue & lun

Thorax101 Body Kernels• As standard kernels for body tissue studies B31s or B41s are recommended; softer images are obtained with B20s. • For higher s

102 ThoraxThoraxRoutine/ThoraxRoutine08sIndications:Routine spiral studies for the region of thorax, e.g., examination of tumors, metastases, lymphoma

Thorax103 Hints• You could repeat the same protocol by simply click-ing the chronicle with the right mouse button for “repeat“, e.g., when both non-co

104 ThoraxThoraxFastIndications:Fast spiral mode for lung studies, e.g., when a patient has difficulty with breathhold.A complete thorax scan in a ran

Thorax105 Hints• You could repeat the same protocol by simply click-ing the chronicle with the right mouse button for “repeat“, e.g., when both non-co

106 ThoraxThoraxHRSeqIndications:Sequence mode for HiRes lung studies, e.g., interstitial changes in the lungs.Images are acquired with a range of 30.

Thorax107 Hints• If you want to reconstruct thin slices every 15 or 20 mm instead of 10 mm as predefined, simply change the Feed/Scan before loading t

108 ThoraxLungLowDoseIndications:Spiral lung studies with low dose setting, e.g., early visualization of pulmonary nodules.A typical thorax study in a

Thorax109 Hints• You could repeat the same protocol by simply click-ing the chronicle with the right mouse button for “repeat“, e.g., when both non-co

Contents11 • ThoraxRoutine_Baby 206• ThoraxRoutine_Child 208• ThoraxHRSeq_Baby 210• ThoraxHRSeq_Child 212• Abdomen_Baby 214• Abdomen_Child 216• Spine_

110 AbdomenOverview– AbdomenRoutine/AbdomenRoutine08s Spiral mode for routine abdominal studies– AbdomenFast Spiral mode for fast abdominal studies– A

Abdomen111 Hints in General• Topogram: TOP, 512.• Patient positioning: Patient lying in supine position, arms positioned comfortably above the head i

112 Abdomen• In general, for abdominal studies such as liver, gall bladder (query stones), pancreas, gastrointestinal studies, focal lesion of the kid

Abdomen113 Body Kernels• As standard kernels for body tissue studies B31s or B41s are recommended; softer images are obtained with B20s.• For higher s

114 AbdomenAbdomenRoutine/AbdomenRoutine08sIndications:Spiral mode for all routine studies in the region of abdomen, e.g., evaluation, follow-up exami

Abdomen115 Hints• You could repeat the same protocol by simply click-ing the chronicle with the right mouse button for “repeat“, e.g., when both non-c

116 AbdomenAbdomenFastIndications:Fast spiral mode for abdominal studies, e.g., when a patient has difficulty with holding their breath.A range of 20

Abdomen117 Hint• You could repeat the same protocol by simply click-ing the chronicle with the right mouse button for “repeat“, e.g., when both non-co

118 AbdomenAbdMultiPhase/AbdMultiPhase08sIndications:Spiral scan to assist the physician with differential diagnosis of liver diseases.A typical nativ

Abdomen119 * CARE Bolus may be used to optimize the bolus tim-ing. Set the ROI for monitoring scan in the abdominal aorta at the beginning of the scan

12 Contents- Auto Load in 3D and Post-processing Presets 257- Blow-up Mode 257 syngo Fly Through 258• Key Features 258• Prerequisites 259• The Basic

120 AbdomenHints• Do not administer oral contrast medium, as this impairs the editing of MIP/SSD/VRT images. Use water instead if necessary.• Water, r

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122 AbdomenAbdomenSeqIndications:Sequential mode for all routine studies in the region of abdomen, e.g., evaluation, follow-up examinations etc.The wh

Abdomen123 Hints• You could repeat the same protocol by simply click-ing the chronicle with the right mouse button for “repeat“, e.g., when both non-c

124 PelvisOverview– Pelvis Spiral mode for routine soft tissue pelvis studies– Hip Spiral mode for routine hip studies– SI_Joints Spiral mode for sacr

Pelvis125 Hints in General• Topogram: TOP, 512 mm for pelvis studies and 256 mm for studies of the hip and SI Joints.• Patient positioning: Patient ly

126 PelvisPelvis Indications: Spiral mode for routine pelvis studies, e.g., processes of the prostate, urinary bladder, rectum, gynecological indicati

Pelvis127 * If the examination performed requires a full urinary bladder, wait at least 3 minutes following IV adminis-tration of the contrast medium.

128 PelvisHipIndications:Spiral mode for HiRes bone studies and soft tissue studies of the Hip, e.g., evaluation of joint cavity, masses, trauma, dysp

Pelvis129 Hints• In case of 3D study only, images should be recon-structed with at least 50% overlap in image recon-struction and kernel B20s.• If onl

Contents13 syngo Dynamic Evaluation 306• Prerequisites 308• Workflow 309- 1. Loading the Images 309- 2. Inspecting the Input Images 310- 3. Genera

130 PelvisSI_JointsIndications:Spiral mode for bone studies of the sacroiliac joints.A typical range of 8 cm will be covered in 18 sec.SI_Joints 2nd r

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132 SpineOverview– C-Spine Spiral mode for cervical spine studies– C-SpineSeq Sequential mode for cervical spine studies– Spine Spiral mode for routin

Spine133 Hints in General• Topogram: Lateral, 512 mm for thoracic and lumbar spine and 256 mm for the C-spine.• Patient positioning for thoracic and l

134 Spine• The CT scan following myelography must be per-formed within 4 – 6 hours of the injection, other-wise, the contrast density in the spinal ca

Spine135 Body Kernels• As standard kernels for body tissue studies B31s or B41s are recommended; softer images are obtained with B20s.• For higher sha

136 SpineC-SpineIndications:Spiral mode for cervical spine studies, e.g., prolapse, degenerative changes, trauma, tumors etc.A range of 15 cm will be

Spine137 C-Spine 2nd reconstr.kV 130Effective mAs 90Rotation time 1.0 secSlice collimation 1.5 mmSlice width 3.0 mm 2.0 mmFeed/Rotation 3.0 mmPitch Fa

138 SpineC-SpineSeqIndications:Sequential mode for cervical spine studies, e.g., pro-lapse, degenerative changes, trauma, tumors, etc. with a typical

Spine139 Hints• Dental artifacts can be reduced by tilting the gantry.• For MPRs and 3D post-processing, use spiral mode with thinner slice and recons

14 For further information about the basic operation, please refer to the corresponding syngo CT Operator Manual:syngo CT Operator Manual Volume 1:Se

140 SpineSpineIndications:Spiral mode for thoracic and lumbar spine studies, e.g., prolapse, degenerative changes, trauma, tumors etc.A range of 15 cm

Spine141 Spine 2nd reconstructionkV 130Effective mAs 120Rotation time 1.5 secSlice collimation2.5 mmSlice width 3.0 mm 3.0 mmFeed/Rotation 5.0 mmPitch

142 SpineSpineSeqIndications:Sequence mode for spine studies, e.g., prolapse, degenerative changes, trauma, tumors etc. with a typ-ical length for eac

Spine143 L3-4 L4-5 L5-S1kV 130 130 130Effective mAs 220 220 235Rotation time 1.5 sec 1.5 sec 1.5 secSlice collimation1.5 mm 1.5 mm 1.5 mmSlice width 3

144 SpineOsteoThis is the scan protocol for the syngo Osteo CT appli-cation package to assist the Physician with the quanti-tative assessment of verte

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146 Upper ExtremitiesOverview– WristHR Spiral mode for routine high resolution wrist studies– ExtrRoutineHR Spiral mode for routine high resolution ex

Upper Extremities147 Hints in General• Topogram: TOP, 256 mm for joint studies.• Patient positioning: Depends on the region of examination. In genera

148 Upper ExtremitiesBody Kernels• As standard kernels for body tissue studies B31s or B41s is recommended; softer images are obtained with B20s.• For

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150 Upper ExtremitiesWristHRIndications:Spiral mode for HiRes bone study of the wrist, e.g., trauma, orthopedic indications etc.A range of 6 cm will b

Upper Extremities151 Hint• For image reconstruction of soft tissue, use kernel B31s.WristHR 2nd reconstructionkV 130Effective mAs 30Rotation time 1.0

152 Upper ExtremitiesExtrRoutineHRIndications:Spiral mode for HiRes bone study, e.g., trauma, ortho-pedic indications etc.A range of 10 cm will be cov

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154 Lower ExtremitiesOverview– KneeHR Spiral mode for high resolution routine knee studies– FootHR Spiral mode for high resolution routine foot studie

Lower Extremities155 Hints in General• Topogram: TOP, 256 mm for joint studies.• Patient positioning: Depends on the region of examination. In general

156 Lower ExtremitiesBody Kernels• As standard kernels for body tissue studies B31s or B41s is recommended; softer images are obtained with B20s.• For

Lower Extremities157 C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 157 Friday, April 8, 2005 9:55 AM

158 Lower ExtremitiesKneeHRIndications:Spiral mode for high resolution studies of the knee, e.g., masses, trauma, disorders of the joint etc.A range o

Lower Extremities159 Hint• For image reconstruction of soft tissue, use kernel B31s.KneeHR 2nd reconstructionkV 130Effective mAs 35Rotation time 1.0 s

16 Scan and ReconstructionConcept of Scan ProtocolsThe scan protocols for adult and children are defined according to body regions – Head, Neck, Shoul

160 Lower ExtremitiesFootHRIndications:Spiral mode for high resolution studies of the foot, e.g., masses, trauma, disorders of the joint etc.A range o

Lower Extremities161 ExtrRoutineHRIndications:Spiral mode for HiRes bone study, e.g., trauma, ortho-pedic indications etc.A range of 10 cm will be cov

162 VascularOverview– HeadAngio/HeadAngio08s Spiral mode for head CTAngio studies– CarotidAngio/CarotidAngio08s Spiral mode for carotid CTAngio studie

Vascular163 Hints in General• Topogram: TOP, 512/1024 or LAT 256• Patient positioning: Patient lying in supine position, arms positioned comfortably

164 VascularHeadAngio/HeadAngio08sIndications:Spiral mode for cerebral CT Angios, e.g., cerebral vas-cular abnormalities, tumors and follow-up studies

Vascular165 Hints• Use of CARE Bolus with monitoring scans positioned at the level of the basilar artery or carotid artery. Set the trigger threshold

166 VascularCarotidAngio/CarotidAngio08sIndications:Noninvasive CT angiography of carotid stenosis or occlusions, plaques course abnormalities of the

Vascular167 Hints• CARE Bolus may be used to optimize the bolus tim-ing.• Set the ROI for monitoring scan in the aortic arch with triggering threshold

168 VascularThorAngio/ThorAngio08sIndications:Spiral study for location and extent of aneurysms, dis-section, and ruptures of the thoriac aorta.A rang

Vascular169 Hints• CARE Bolus may be used to optimize the bolus tim-ing.• Set the ROI for monitoring scan in the aortic arch with triggering threshold

Scan and Reconstruction 17Scan Set UpScans can be simply set up by selecting a predefined examination protocol. To repeat any mode, just click the chr

170 VascularEmbolismIndications:Spiral mode for Pulmonary Emboli studies.A range of 15 cm will be covered in 24 sec.Embolism 2nd reconstructionkV 130E

Vascular171 Hints• CARE Bolus may be used to optimize the bolus tim-ing.• Set the ROI for monitoring scan in the pulmonary trunk with triggering thres

172 VascularBodyAngioRoutine/BodyAngioRoutine08sIndications:Spiral mode for abdominal CTA studies.A range of 20 cm will be covered in 39/31 sec..BodyA

Vascular173 Hints• CARE Bolus may be used to optimize the bolus tim-ing.• Set the ROI for monitoring scan in the abdominal aorta with triggering thres

174 VascularBodyAngioFastIndications:Spiral mode for longer coverage and larger vessels.A range of 20 cm will be covered in 18 sec.BodyAngio 2nd recon

Vascular175 Hints• CARE Bolus may be used to optimize the bolus tim-ing.• Set the ROI for monitoring scan in the abdominal aorta with triggering thres

176 SpecialsOverviewThe examination protocols designed for some of these applications are under the “Special” folder.TraumaIn any trauma situation, ti

Specials177 TraumaIn any trauma situation, time means life and the qual-ity of life for the survivor.This is a combined mode for the examination of mu

178 SpecialsPolyTraumaTwo times 2 combined recon jobs are predefined, head with neck and thorax with abdomen.A range for the Head of 11 cm will be cov

Specials179 A range for the Thorax of 25 cm will be covered in 15 sec., a range for the AbdPelvis of 20 cm will be cov-ered in 12 sec.• For long range

18 Scan and ReconstructionScan ModesSequential ScanningThis is an incremental, slice-by-slice imaging mode in which there is no table movement during

180 SpecialsHeadTraumaA spiral mode for emergency head studies with a max. FoV of 500 mm. A typical scan range of 40/80 cm will be covered in 23/27 se

Specials181 Interventional CTTo facilitate CT interventional procedures, the follow-ing protocols are provided. Any of these protocols can be appended

182 SpecialsBiopsyIndications: This is the conventional sequential mode without table feed using a 10 mm slice.HintThis protocol can be appended to a

Specials183 TestBolusIndications:This mode can be used to test the start delay of an opti-mal enhancement after the contrast medium injec-tion.TestBol

184 ChildrenOverviewThe scan protocols for children are defined according to body regions – Head, Neck, Shoulder, Thorax, Abdo-men, Pelvis, Spine, Upp

Children 185• Head– HeadRoutine_Baby Spiral mode for routine baby head studies– HeadRoutine_Child Spiral mode for routine children head studies– HeadS

186 Children• Spine– Spine_Baby Spiral mode for routine baby spine studies– Spine_Child Spiral mode for routine children spine studies• Extremities– E

Children 187Hints in General1.Topograms: 256 mm lateral topograms are defined for the head modes, and 512 mm TOP topograms are defined for the body mo

188 ChildrenThe proper personnel and equipment must also be readily available in the event of a problem.6.Oral and rectal contrast administration: Dep

Children 189It is recommended to use CARE Bolus in order to achieve optimal contrast enhancement. Both start delay time and injection rate are exam-/

Scan and Reconstruction 19Slice Collimation and Slice WidthSlice collimation is the slice thickness resulting from the effect of the tube-side collima

190 ChildrenHead Kernels• For head scans of small children, the kernels C20s, C30s (e.g., for soft tissue studies) and C60s (e.g., for sinuses are pro

Children 191Body Kernels• As standard kernels for body tissue studies B31s or B41s is recommended; softer images are obtained with B20s. • For higher

192 ChildrenHeadRoutine_BabyIndications:Routine head spiral studies, e.g., brain tumors, cranial trauma, hydrocephalus, hemorrhaging and other abnorma

Children 193Hints• Use this protocol for children below 6 months of age.• When bone structure is of interest, use kernel C60s for image reconstruction

194 ChildrenHeadRoutine_ChildIndications:Routine head spiral studies, e.g., brain tumors, cranial trauma, hydrocephalus, hemorrhaging and other abnorm

Children 195Hints• Children, who are more than 6 years old, should be scanned with an adult protocol as the skull by this time is fully grown.• When b

196 ChildrenHeadSeq_BabyIndications:Sequential mode for routine head studies for children, e.g., tumors, hydrocephalus, hemorrhaging, abnor-malities,

Children 197Hints• Use this protocol for children below 6 months of age.• When bone structure is of interest, use kernel C60s for image reconstruction

198 ChildrenHeadSeq_ChildIndications:Sequential mode for routine head studies for children, e.g., tumors, hydrocephalus, hemorrhaging, abnor-malities,

Children 199Hints• Children, who are more than 6 years old, should be scanned with an adult protocol as the skull by this time is fully grown.• When b

2The information presented in this Application Guide is for illustration only and is not intended to be relied upon by the reader for instruction as t

20 Scan and ReconstructionSlice Collimation and Slice Width for Spiral Mode and HR Spiral ModeSlice Collimation and Slice Width for Sequence Mode and

200 ChildrenInnerEarIndications:High Resolution Spiral mode for inner ear studies, e.g., malformations of the inner ear, inflammatory changes, patholo

Children 201Hints• Children, who are more than 6 years old, should be scanned with an adult protocol as the skull by this time is fully grown.• When s

202 ChildrenSinusOrbiIndications:Spiral mode for routine spiral studies of the sinuses and paranasal sinuses, e.g., sinusitis, pneumatization, polypos

Children 203Hints• Children, who are more than 6 years old, should be scanned with an adult protocol.• In order to optimize image quality versus radia

204 ChildrenNeckIndications:Spiral mode for routine neck studies, e.g., tumors, lym-phoma, abscesses, etc.A range of 15 cm will be covered in 19 sec.*

Children 205Hints• If necessary, scan down to the aortic arch or medi-astinum to include the entire lesion. • Cooperative children can be instructed t

206 ChildrenThoraxRoutine_BabyIndications:Spiral mode for routine thorax studies, e.g., pneumo-nia, tumors, metastases, lymphoma, vascular abnor-malit

Children 207* The conversion factor for an 8-week-old child, and a scan range of 150 mm was used.Hints• Use this protocol for children below 35 kg.• T

208 ChildrenThoraxRoutine_ChildIndications:Spiral mode for routine thorax studies, e.g., pneumo-nia, tumors, metastases, lymphoma, vascular abnor-mali

Children 209* The conversion factor for a 7-year-old child, and a scan range of 150 mm was used.Hints• Children with a body weight of more than 55 kg

Scan and Reconstruction 21IncrementThe increment is the distance between the recon-structed images in the Z direction. When the increment chosen is sm

210 ChildrenThoraxHRSeq_BabyIndications:Sequence mode for High Resolution lung studies, e.g., interstitial changes of the lung parenchyma, etc.A range

Children 211Hints• Use this protocol for children below 35 kg.• If you want to acquire the patient at full inspiration or full expiration, you should

212 ChildrenThoraxHRSeq_ChildIndications:Sequence mode for High Resolution lung studies, e.g., interstitial changes of the lung parenchyma, etc.A rang

Children 213Hints• Children with a body weight of more than 55 kg should be examined with an adult protocol.• If you want to acquire the patient at f

214 ChildrenAbdomen_BabyIndications:Spiral mode for routine studies in the region of abdo-men and pelvis, e.g., tumors, lymphoma, abscesses, post-trau

Children 215Hints• Use this protocol for children below 35 kg.• Delayed scans may be required for the kidneys and bladder.• Rectal contrast may be req

216 ChildrenAbdomen_ChildIndications:Spiral mode for routine studies in the region of abdo-men and pelvis, e.g., tumors, lymphoma, abscesses, post-tra

Children 217Hints• Delayed scans may be required for the kidneys and bladder.• Rectal contrast may be required for evaluation of pel-vic mass.• Childr

218 ChildrenSpine_BabyIndications:Spiral mode for spine studies, e.g., post-traumatic changes, tumors, malformations, orthopedic indica-tions, etc.A r

Children 219Hints• Use this protocol for children below 35 kg.• Please change the mAs value according to the weight of the child: 25 – 34 kg 160 mAs.C

22 Scan and ReconstructionPitchIn single slice CT:Pitch = table movement per rotation/slice collimationE.g.,: slice collimation = 5 mm,table moves 5 m

220 ChildrenSpine_ChildIndications:Spiral mode for spine studies, e.g., post-traumatic changes, tumors, malformations, orthopedic indica-tions, etc.A

Children 221Hint• Children with a body weight of more than 55 kg should be examined with an adult protocol.C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT

222 ChildrenExtrHR_BabyIndications:Spiral mode for high resolution extremity studies, e.g., post-traumatic changes, tumors, malformations, etc.A range

Children 223Hints• Use this protocol for children below 35 kg.• Please change the mAs value according to the weight of the child: 15 – 34 kg 80 mAs.C2

224 ChildrenExtrHR_ChildIndications:Spiral mode for bone studies, e.g., tumors, post-traumatic changes, orthopedic indications, etc.A range of 10 cm w

Children 225Hint• Children with a body weight of more than 55 kg should be examined with an adult protocol.C2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT

226 ChildrenHeadAngioIndications:Spiral mode for head CT angiography, e.g., cerebral vascular abnormalities, tumors etc.A range of 6 cm will be covere

Children 227Hints• Children, who are more than 12 years old, should be scanned with an adult protocol as the skull by this time is fully grown.• CARE

228 ChildrenHeadAngio08sIndications:Spiral mode for head CT angiography, e.g., cerebral vascular abnormalities, tumors etc.A range of 6 cm will be cov

Children 229Hints• Please change the mAs value according to the age of the child: 6 – 12 years 80 mAs.• Children, who are more than 12 years old, shou

Scan and Reconstruction 23Window valuesThe Scale of the CT Hounsfield Units is from -1024 to +3071.The displayed window values have to correspond to t

230 ChildrenCarotidAngioIndications:Spiral mode for the carotid arteries, e.g., carotid steno-sis or occlusion, vascular abnormalities of the carotids

Children 231Hints• Please change the mAs value according to the age of the child: 6 – 12 years 75 mAs.• Children, who are more than 12 years old shoul

232 ChildrenCarotidAngio08sIndications:Spiral mode for the carotid arteries, e.g., carotid steno-sis or occlusion, vascular abnormalities of the carot

Children 233Hints• Please change the mAs value according to the age of the child: 6 – 12 years 75 mAs.• Children, who are more than 12 years old shoul

234 ChildrenBodyAngioIndications:Spiral mode for abdominal CT Angio studies, e.g., vas-cular abnormalities, aneurysms, etc.A range of 10 cm will be co

Children 235Hints• Please change the mAs value according to the weight of the child: 35 – 44 kg 45 mAs 45 – 54 kg 60 mAs.• Children with a body weight

236 ChildrenBodyAngio08sIndications:Spiral mode for abdominal CT Angio studies, e.g., vas-cular abnormalities, aneurysms, etc.A range of 10 cm will be

Children 237Hints• Please change the mAs value according to the weight of the child: 35 – 44 kg 45 mAs 45 – 54 kg 60 mAs.• Children with a body weight

238 ChildrenNeonateBodyIndications:Spiral mode for routine neonate body studies, e.g., tumors, abnormalities, malformations, abscesses, etc.A range of

Children 239Hints• Use this protocol for children below 1 month of age.• CARE Bolus may be used to optimize the bolus tim-ing. Set the ROI for the mon

24 Scan and ReconstructionKernelsThere are 3 different types of kernels: “H“ stands for Head, “B“ stands for Body, “C“ stands for ChildHead.The image

240 syngo 3DThe 3D card offers the possibility to combine two-dimensional images to form three-dimensional views.To do this, the 3D card provides you

syngo 3D241 Shaded Surface Display (SSD)Surface display of complex anatomies.• 3D display of surfaces from a series of contiguous slices using a varia

242 syngo 3DPrerequisitesAt least 3 and maximum of 1600 images must have been loaded to process 3D; (with more than 1600 images the series will be spl

syngo 3D243 Image Representation on the 3D CardThe image area on the 3D card is divided into four seg-ments:– Reference segment (sagittal view)– Ref

244 syngo 3DDefining Output TypesYou can change the output type for a segment at any time, i.e., from Multi Planar Reconstruction (MPR) to Maximum Int

syngo 3D245 Radial RangesFor output types MPR, MPR Thick and MIP Thin you generate a series of cut images arranged in a star shape.For output types MI

246 syngo 3DEditingA common problem in evaluating medical images is that areas relevant to an examination are hidden by other structures, especially b

syngo 3D247 3. 3D Object Editor: Easy elimination of obstructing information.• Easy volume confinement with clip-box or variable editing slab.• Fast o

248 syngo 3DRegion GrowingNormally in the first step you will generate one or more “objects“ from the volume data set originally loaded in 3D. By spec

syngo 3D249 Like editing volume data sets in the VOI mode, you can use the 3D Editor, too. You are provided with tools for cutting out structures from

Scan and Reconstruction 25Image FiltersThere are 3 different filters available:LCE: The Low-contrast enhancement (LCE) filterenhances low-contrast det

250 syngo 3DWorkflow for a CT Extremity ExaminationUsing MPR/MPR Thick1. Load the series to MPR.2. Manipulate the volume to evaluate anatomy:a)Orienta

syngo 3D251 Using SSD1. Load the series to SSD. Hint: Do not use a series with a high resolution ker-nel, e.g., kernel 10 or 20 is recommended.2. Mani

252 syngo 3DWorkflow for a CT AngiographyUsing MIP/MIP Thin1. Load the series to MIP.2. Manipulate the volume to evaluate anatomy:a)Orientate the imag

syngo 3D253 Using VRT/VRT Thin/Clip1. Load the series to VRT.2. Manipulate volume to evaluate anatomy:a)Orientate the image volume for the best view o

254 syngo 3DHints in GeneralSetting Views in the Volume Data SetThree-dimensional image processing allows you to cre-ate images in any orientation and

syngo 3D255 The plane is then no longer perpendicular to either of the coordinate axes. The image orientation is displayed as a combination of three o

256 syngo 3DIf the default settings are not appropriate for your diag-nostic problem, you can alter them individually. In that way you can emphasize t

syngo 3D257 Auto Load in 3D and Post-processing PresetsYou can activate the Auto load in 3D function on the Examination card/Auto Tasking and link it

258 syngo Fly Throughsyngo Fly Through is a Virtual CT Endoscopy Software integrated into the syngo 3D functionality. It offers the possibility to ren

syngo Fly Through259 PrerequisitesThis software works with CT, MR and conventional Angiographic data sets.CTA data set with good vessel enhancement fo

26 Scan and ReconstructionHCE: The High-contrast enhancement (HCE) filterenhances high-contrast detectability. It increases the image sharpness, simil

260 syngo Fly ThroughEndoscopic Viewing Parameters/Fly Cone SettingsIn general, the shape of a pyramidal cone can be used to represent visualization o

syngo Fly Through261 • Standing Point– The cone rotates around the viewing point.• Viewing Point– The complete cone moves.• Clipping Point– The cone r

262 syngo Fly ThroughPatient PreparationBony and cartilaginous structures such as the central airway and bronchial tree, the osteomeatal system of the

syngo Fly Through263 WorkflowLoad the images in 3D.The following standard layout is displayed:Segment 1: Sagittal viewSegment 2: Coronal viewSegment 3

264 syngo Fly ThroughPosition the Reference lines at that point of interest e.g.,in the trachea.Click the Fly Through icon to activate the endoscopic

syngo Fly Through265 Navigation of the Endoscopic Volume•Manual Navigation Click with the right mouse button in the Fly segment to activate the SmartS

266 syngo Fly ThroughFly Path PlanningOpen the Fly Path Planning.Create a path by inserting path points in the volume during navigation.C2-025.630.01.

syngo Fly Through267 The relevant settings (viewing direction, viewing angle etc.) are stored along the path.After defining and storing a path, it is

268 syngo Dental CTThis is an application package for reformatting pan-oramic views and paraxial slices through the upper and lower jaw. It enables th

syngo Dental CT 269Panoramic view Paraxial viewScan ProtocolsYou will find the Dental scan protocols under body region “Head”:DentalkV 130Effective mA

Scan and Reconstruction 27Improved Head ImagingAn automatic bone correction algorithm has been included in the standard image reconstruction. Using a

270 syngo Dental CT• It is mandatory to position the patient head in the center of the scan field – use the lateral laser light marker for positioning

syngo Dental CT 271Additional Important Information• The Dental scan protocol delivers high resolution images for syngo Dental CT evaluation, however,

272 syngo Dental CT• Image orientation:– In the paraxial view, a “B” indicates buccal and a “L” lingual. The lingual marker “+” must always be posit

syngo Dental CT 273• ROI definition for statistical evaluations and deletion of graphics is possible. Paraxial lines using ”Cluster”. • In the contro

274 syngo Osteo CTThis is an application package for the quantitative assessment of vertebral bone mineral density for the diagnosis and follow-up of

syngo Osteo CT 275Scanning ProcedureScan Protocols You will find the Osteo scan protocols under body region “Spine”:OsteokV 80Effective mAs 81Rotation

276 syngo Osteo CTThe special kernels are mostly used for ”physical” mea-surements with phantoms, e.g., for adjustment proce-dures (S80s), for constan

syngo Osteo CT 277• Position the cut line of scanning through the middle of the vertebra, i.e. bi-sector between the angle of the upper and lower end

278 syngo Osteo CTConfigurationIn the Osteo configuration you can define the follow-ing parameters:You can• use the Siemens standard reference databas

syngo Osteo CT 279How can you save the results on your PC?– Select Option/Configuration from the main menu and click icon ”CT Osteo”.– Activate the ch

28 Dose InformationCTDIW and CTDIVolThe average dose in the scan plane is best described by the CTDIW for the selected scan parameters. The CTDIW is m

280 syngo Osteo CTExample for one patient with three Osteo tomo-grams: PATIENT; John Smith; 007; 64; MaleIMAGE; L2; 234; 2; 27-JAN-1998; 11:12:17; 61.

syngo Osteo CT 281Abbreviations: TML Trabecular Mean LeftTMR Trabecular Mean RightTMT Trabecular Mean TotalTSL Trabecular Standard Deviation LeftTSR T

282 syngo Osteo CTEvaluation WorkflowAfter loading the images into the syngo Osteo CT appli-cation, press “Start Evaluation“.Check the correct positio

syngo Osteo CT 2831.Center of the spinal canal (C)2.Uppermost point of the cortical spinal body (A)3.Intermediate point (L)4.Intermediate point (R)5.U

284 syngo Osteo CTThe other summary image displays a graph which shows the comparison of all evaluated vertebrae with the selected Reference Data.“T-s

syngo Osteo CT 285The second and the fourth segment belong together. The second segment shows the tomogram images with the contours superimposed. The

286 syngo Osteo CTAfter “End Evaluation“ the evaluation results are auto-matically saved in three series:– Summary contains both images of the third s

syngo Osteo CT 287Additional Important Information• Fractured vertebrae are not suited for syngo Osteo CT evaluation since the more compact nature of

288 syngo Volume EvaluationVolume is an evaluation function which allows most accurate calculation of a volume out of a stack of two-dimensional image

syngo Volume Evaluation 289• Interactive outlining of freehand and elliptical Regions-of-Interest is available, with the possibility to define evaluat

Dose Information 29The CTDIvol value does not provide the entire informa-tion of the radiation risk associated with CT examina-tion. For the purpose,

290 syngo Volume EvaluationPrerequisitesThe images must fulfill the following conditions:• Only images of one patient must be loaded for eval-uation w

syngo Volume Evaluation 291Workflow1. Loading the Images After loading the images into syngo Volume Evalua-tion, the following layout is displayed:• S

292 syngo Volume Evaluation2.Preparing Volume Calculation Before you start the volume definition, first optimize the display of the images. To make in

syngo Volume Evaluation 2933.1. Planning a Volume with Automatic Volume Detec-tion The automatic method is best used to evaluate a struc-ture which ha

294 syngo Volume EvaluationRestricting Automatic Volume Detection You can restrict Automatic Volume Detection to a defined smaller volume.• Draw an RO

syngo Volume Evaluation 295The contours of the ROIs define the outer border of the evaluated volume. You do not need to define the ROIs on every slice

296 syngo Volume Evaluation• To include only a specific range of HU values into the volume, change the Evaluation Limits. By default, the Evaluation L

syngo Volume Evaluation 297Overlap and Mark&Link Method You can define complex volumes using the automatic (overlap) and manual (mark&link) me

298 syngo Volume EvaluationWith the Overlap method, you can also create a vol-ume from two ROIs that do not overlap in the first step. It is then nece

syngo Volume Evaluation 2994. Evaluation Results When you click the Start Evaluation button, the system calculates the planned volume within the evalu

Overview3 User Documentation 14 Scan and Reconstruction 16 Dose Information 28 Workflow Information 36 Application Information 54 Head 70 Neck 88 Sho

30 Dose InformationEffective mAs In sequential scanning, the dose (Dseq) applied to the patient is the product of the tube current-time (mAs) and the

300 syngo Volume Evaluation 5. Documentation of Results If all volumes are evaluated, you can save and film the results.Save – stores to your local da

syngo Volume Evaluation 301• ROI and Volume Definition– If you insert/modify an ROI, the system automati-cally plans the ROIs on the preceding/followi

302 syngo Volume Evaluation• Restrictions for Linking and Unlinking There are some restrictions for linking and unlinking:– Linking can be done on use

syngo Volume Evaluation 303ConfigurationIn the Volume Configuration dialog box, you define which evaluation results are given by Volume Evalua-tion. –

304 syngo Volume Evaluation– Statistical Parameters Volume Volume is calculated in the defined unit: mm3 or cm3. Max. height [cm] Maximum height of th

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306 Dynamic evaluation is a function which allows you to analyze the absolute or relative enhancement of Houn-sfield values within a Region of Interes

syngo Dynamic Evaluation 307•Use of syngo functions like dog-ears or cine mode for fast paging through the image stack.• Easy selection, modification

308 syngo Dynamic EvaluationPrerequisitesIn dynamic evaluation, images that were scanned as part of an examination with contrast agent at a con-stant

syngo Dynamic Evaluation 309Workflow1. Loading the ImagesAfter loading the images into syngo Dynamic Evalua-tion, the following layout is displayed:•

Dose Information 31For spiral scan protocols, the indicated mAs is the effective mAs per image. The correlation between tube current mA and effective

310 syngo Dynamic Evaluation• Baseline image segment The baseline image is displayed in the lower left hand segment (base for enhancement calculation)

syngo Dynamic Evaluation 311Each time you make a change to the original data set (by removing images, and/or defining a new baseline image) your syste

312 syngo Dynamic Evaluation– Peak Enhancement image: Parameter image where each pixel indicates the enhancement at that pixel location. CT value of a

syngo Dynamic Evaluation 3134. Creating a Baseline ImageA baseline image is used as a basis for all enhancement calculations.The enhancement is calcul

314 syngo Dynamic Evaluation5. Evaluation of Region of InterestsYou select the image regions to be evaluated by mark-ing them with ROIs or applying th

syngo Dynamic Evaluation 3156. Enhancement CurveAs soon as you have defined an ROI, an enhancement curve (time-density curve) is calculated and displa

316 syngo Dynamic Evaluation7. Documentation of ResultsDuring the evaluation you have drawn individual ROIs and have generated enhancement curves and

syngo Dynamic Evaluation 317General Hints• Slice Position with Multi-Row ScannersWhen you use a multi-row scanner, several slice posi-tions are scanne

318 syngo Dynamic Evaluation• FilteringTo reduce noise in the Time to Peak and Peak Enhance-ment image you can apply a smoothing filter. Filtering doe

syngo Dynamic Evaluation 319• Relative Enhancement CurveTime Axis (X)The point of time for an image is computed relative to the point of time at which

32 Dose InformationCARE DoseCARE Dose is a clinical application package that pro-vides real-time tube current modulation for Spiral and Sequential Sca

320 syngo Dynamic Evaluation• Configuring Dynamic EvaluationYou can make the following settings in DynEva Config-uration:– Calculate Time to Peak Imag

Authorized Representative according to the Medical Device Directive 93/42/EEC Siemens AG Medical Solutions Henkestr. 127 D-91052 Erlangen Germany Tele

Dose Information 33Example of scanning the shoulder region.Principle of CARE Dose tube current adaption.• CARE Dose is pre-selected by default for mos

34 Dose Information• For the average patients examination, CARE Dose does not require any manual changes to the scan protocol. However, the mAs must b

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36 Workflow InformationRecon JobsIn the Recon card, you can define up to 3 reconstruc-tion jobs for each range with different parameters, either befor

Workflow Information 37Examination Job StatusYou can get an overview of all recon jobs by clicking on the recon task symbol in the status bar or selec

38 Workflow InformationAuto Load in 3D and Post-processing PresetsYou can activate the Auto load in 3D function on the Examination card/Auto Tasking a

Workflow Information 39How to Create your own Scan ProtocolsThere are two different ways to modify and create your scan protocols:Edit/Save Scan Proto

4 Lower Extremities 154 Vascular 162 Specials 176 Children 184 syngo 3D 240 syngo Fly Through 258 syngo Dental CT 268 syngo Osteo CT 274 syngo Volume

40 Workflow InformationHints• You can save your scan protocol at any time of the examination. • It is recommended that you save your own scan pro-toco

Workflow Information 41• Change one (or more) parameters for all Customer protocols: Select “Edit – Find/Replace”. Open the “Column“ list box and choo

42 Workflow Information• Define a protocol as Emergency protocol. Select the desired scan protocol with the right mouse button. Select entry “Set as

Workflow Information 43Hints• With the Find/Replace function you can easily insert an API command for all protocols as needed.• Also all Auto Tasking

44 Workflow InformationAdditional Information:1.System/Run offers the tool “Restore Default Scan Pro-tocols“ which allows you to remove user specific

Workflow Information 45Contrast MediumThe BasicsThe administration of intravenous (IV) contrast mate-rial during spiral scanning improves the tissue c

46 Workflow InformationAortic time-enhancement curves after i.v. contrast injection (computer simulation*).All curves are based on the same patient pa

Workflow Information 47IV Injection*The administration of a contrast medium depends on the indication and on the delay times to be used during the exa

48 Workflow InformationBolus TrackingThis is an automatic Bolus Tracking program, which enables triggering of the spiral scanning at the optimal phase

Workflow Information 49– Move the monitoring scan line towards the optimal position and release the mouse button, it will be snapped automatically. (T

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50 Workflow InformationTest Bolus using CARE BolusYou can use the CARE Bolus option as a “Test Bolus“.How to do it1.Insert a Bolus tracking via the ri

Workflow Information 51Test BolusThis is a low dose sequential protocol without table feed used to calculate the start delay of a spiral scan to ensur

52 Workflow Information6. Load the images into the Dynamic Evaluation func-tion and determine the time to the peak enhance-ment. Alternatively, on the

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54 Application InformationSOMATOM lifeGeneral InformationSOMATOM life @ Your Scanner provides actual news around your scanner, shows you helpful confi

Application Information 55Key FeaturesAll users:• General Information• Access to Web Based E-Training or Manuals on CD ROMIn combination with a Siemen

56 Application InformationDescriptionAll users:Start SOMATOM life @ Your Scanner by selecting SOMATOM life under "options" in your syngo men

Application Information 57Access to Computer Based Training or Manuals on CD ROMStart the Computer Based Training to learn more about your software an

58 Application InformationSRS Based ServicesDuring the start up of your system you will receive actual information in the "Newsticker" and s

Application Information 59Download of FilesEach download will be performed in the background. If you disconnect your Siemens Extranet session and star

6 Contents User Documentation 14 Scan and Reconstruction 16• Concept of Scan Protocols 16• Scan Set Up 17• Scan Modes 18- Sequential Scanning 18- Spi

60 Application InformationDownloaded Scan Protocols are stored in the update folder until installation. To install all downloaded pro-tocols, choose t

Application Information 61Note: Every patient image will be made anonymous before sending. Because the SOMATOM life window is always in front, we reco

62 Application InformationTrial Order and InstallationAs a SOMATOM CT user you can request trial clinical software directly from the scanner. The requ

Application Information 63At the same time, you are informed that you can expect the trial option to be installed within 8 working days and you will t

64 Application InformationImage ConverterThe CT Application Common DICOM Adapter provides conversion between different DICOM data sets as they may be

Application Information 65After conversion you can load these data sets into the application of your choice. C2-025.630.01.01.02_APPLICATIONGUIDE_SPIR

66 Application InformationFile BrowserThe File Browser provides the ability to access and to manage your created files:• Copy images and files to the

Application Information 67Review reports and movies:– Select the desired files and double-click on them.– The corresponding program, e.g., Movie Media

68 Application InformationPatient ProtocolScan: number of scan rangekV: kilo VoltmAs: averaged applied mAs of the rangeref. mAs: quality ref. mAs of

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Contents7 • Contrast Medium 45- The Basics 45-IV Injection 47-Bolus Tracking 48- Test Bolus using CARE Bolus 50- Test Bolus 51 Application Inform

70 HeadOverview– HeadRoutine Spiral mode for base of the skull and cerebrum rou-tine studies– HeadSeq Sequential mode for base of the skull and cerebr

Head71 Hints in General• Topogram: Lateral, 256 mm.• Patient positioning: Patient lying in supine position, arms resting against body, secure head wel

72 HeadHeadRoutineIndications:Spiral mode for routine head studies, e.g., stroke, brain tumors, cranial trauma, cerebral atrophy, hydroceph-alus, and

Head73 Hints• An automatic bone correction allows for improved head image quality, without any additional post-pro-cessing.• In order to optimize imag

74 HeadHeadSeqIndications:Sequence mode for routine head studies, e.g., stroke, brain tumors, cranial trauma, cerebral atrophy, hydro-cephalus, and in

Head75 Hints• An automatic bone correction allows for improved head image quality, without any additional post-pro-cessing.• In order to optimize imag

76 HeadInnerEarHRIndications:Spiral mode for inner ear High Resolution studies, e.g., inflammatory changes, tumorous processes of pyra-mids, cerebello

Head77 Hints• For image reconstruction of soft tissue, use kernel H31s.• An automatic bone correction allows for improved head image quality, without

78 HeadInnerEarHRSeqIndications:Sequential mode for inner ear studies, e.g., inflamma-tory changes, tumorous processes of pyramids, cere-bellopontine

Head79 Hints• For image reconstruction of soft tissue, use kernel H31s.• An automatic bone correction allows for improved head image quality, without

8 Contents Neck 88• Overview 88• Hints in General 89-Body Kernels 90• Neck 92 Shoulder 94• Overview 94• Hints in General 95-Body Kernels 95• Shoulde

80 HeadSinusIndications:Spiral mode for paranasal sinuses studies, e.g., sinusi-tis, mucocele, pneumatization, polyposis, tumor, cor-rections etc.A ra

Head81 Hints• An automatic bone correction and an advanced algo-rithm allows for improved head image quality, with-out any additional post-processing.

82 HeadSinusSeqIndications:Sequential mode for paranasal sinuses studies, e.g., sinusitis, mucocele, pneumatization, polyposis, tumor, corrections etc

Head83 Hints• An automatic bone correction and an advanced algo-rithm allows for improved head image quality, with-out any additional post-processing.

84 HeadOrbitaIndications:Spiral mode for orbital studies, e.g., fracture.A range of 2 cm will be covered in 12 sec.Orbita 2nd reconstr.kV 130Effective

Head85 Hints• An automatic bone correction and an advanced algo-rithm allows for improved head image quality, with-out any additional post-processing.

86 HeadDentalThis is the scan protocol for the syngo Dental CT appli-cation package. It is used for evaluation and reformat-ting of the upper and lowe

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88 NeckOverview– Neck Spiral mode for soft tissue routine neck studiesC2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 88 Friday, April 8, 2005

Neck89 Hints in General• Topogram: Lateral, 256 mm• Patient positioning Patient lying in supine position, hyperextend neck slightly, secure head well

Contents9 Pelvis 124• Overview 124• Hints in General 125- Body Kernels 125• Pelvis 126• Hip 128• SI_Joints 130 Spine 132• Overview 132• Hints in Gen

90 NeckBody Kernels• As standard kernels for body tissue studies B31s or B41s are recommended; softer images are obtained with B20s.• For higher sharp

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92 NeckNeckIndications:For soft tissue spiral studies in the cervical region, e.g., tumors, lymphoma, abscesses etc.A typical range of 20 cm will be c

Neck93 Hints• Due to its iodine content, the thyroid gland is hyper-dense in relation to the neighboring muscles both before and after an IV CM inject

94 ShoulderOverview– Shoulder Spiral mode for bone shoulder routine studiesC2-025.630.01.01.02_APPLICATIONGUIDE_SPIRIT.book Page 94 Friday, April 8,

Shoulder95 Hints in General• Topogram: TOP, 256 mm.• Patient positioning: Patient lying in supine position, the uninjured arm placed above the head, t

96 ShoulderShoulderIndications:Spiral mode for bone studies and soft tissue, e.g., eval-uation of joint cavities, masses, trauma, dislocations, orthop

Shoulder97 Hints• Use raw data to review a target region if necessary.• For image reconstruction of soft tissue, use kernel B31s and a slice width of

98 ThoraxOverview– ThoraxRoutine/ThoraxRoutine08s Spiral mode for routine chest studies– ThoraxFast Spiral mode for fast chest studies– ThoraxHRSeq Se

Thorax99 Hints in General• Topogram: TOP, 512 mm.• Patient positioning: Patient lying in supine position, arms positioned comfortably above the head i