DECT Help Guide

syngo.CT Dual Energy Help Guide syngo.via Instructions for Use— syngo.CT Dual Energy VB30 SIEMENS Healthineers siemens-healthineers.us syngo®. CT Dual Energy is designed to operate with CT images which have been acquired with Siemens Dual Source scanners. The various materials of an anatomical region of interest have different a enuation coefficients, which depend on the used energy. tt Depending on the region of interest, contrast agents may be used. These differences provide information on the chemical composition of the scanned body materials. syngo.CT Dual Energy combines images acquired with low and high energy spectra to visualize this information. The functionality of the syngo.CT Dual Energy applications is as follows: General Viewing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Optimum Contrast Viewing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Bone Removal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Liver VNC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Virtual Unenhanced. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Monoenergetic Plus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Brain Hemorrhage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Kidney Stones . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Gout . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Lung Analysis . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Bone Marrow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 2 General Viewing General Viewing combines the basic functions of CT Dual Energy. It provides tools to perform an initial diagnosis. In addition to the basic viewing mode, General Viewing provides the Optimum Contrast and Monoenergetic modes. These modes allow you to maximize the contrast-to-noise ratio and to simulate images that are equivalent to images scanned with a single photon energy beam. syngo.via® VB30 – CT Dual Energy General Viewing 1. From the Patient Worklist, load an appropriate data set into the CT Dual Energy Workflow: If the examination has been correctly mapped, double click to load • If manual mapping is required, right-click the examination and select • Open With > CT Dual Energy 2. The DE FOV icon shows or hides the Dual Energy field of view, which is indicated in the segments by the yellow lines/circles. Only within the yellow lines/circles is full dual energy information available for the current task. FOV O O 3 3 syngo.via® VB30 – CT Dual Energy General Viewing 3. Extend ROI Text displays all available evaluation results for all ROIs. [3] CT [3] CT App: Au120/ Sn120/ Mixed 0.8 App: Au120/ Sn120/ Mixed 0.8 Mean: 128.3/ 110.6/ 124.7 HU Mean: 128 3/ 110 6/ 124.7 HU Extend Stddev: 21.2/ 34,5/ 18.5 HU Stddev; 21.2/ 34.5/ 18.5 HU Area: 12.7 cm2 Min: 54.0/ -43.0/ 64.0 HU ROI Text Max: 200.0/ 251.0/ 194.0 HU Area: 12.7 cm2 DEI: 0.008 4. Reset Layout resets the display and the associated s ettin gs to the default values of the selected layout. Reset Layout 5. The Optimum Contrast mode combines the increased contrast from the low energy data and the low noise from the high energy data into an optimized data set with a maximum contrast-to-noise ratio for the iodine contrast agent. To view Optimum Contrast images: Toggle to the Optimum Contrast icon (if not already displayed). • The contrast-to-noise-ratio of the images for iodine is maximized. • The Optimum Contrast mini toolbar provides sliders for individual customization • of the center (C slider) and width (W slider). Click the Optimum Contrast icon again to return to the General Viewing mode. • Optimum Contrast Optimum Contrast Optimum Contrast Windowing Mono E $300 500 W 200 500 4 syngo.via® VB30 – CT Dual Energy General Viewing 6. The Monoenergetic mode allows for the display of images that are equivalent to images acquired with a monoenergetic x-ray beam of selectable energy. To view Monoenergetic images: Toggle to the Mono E icon. • Images equivalent to images acquired with a single photon energy • beam are calculated. In the mini toolbar, move the Monoenergetic keV slider to a desired keV value, • or in the diagram segment move the vertical white line. Click the Mono E icon again to return to the General Viewing mode. • Optimum Contrast 19 Optimum Contrast Mono E Monoenergetic 70 100 7. The Result State icon displays the name of the series that have been marked or will be marked for archiving. Result State 8. The Table Removal icon automatically removes the table and head holder from 3D images. Table Removal 9. The Heart Isolation and Lung Isolation icons show or hide the examined body part—the heart or lungs—if the “Body Part Examined” is set to Heart (for hearts) or the Lung Analysis application is configured for this body part (for lungs). Lung Isolation Heart Isolation Lung Isolation 5 5 syngo.via® VB30 – CT Dual Energy General Viewing 10. The Archive Results icon sends the current status of the data to the Series Navigator and marks it for archiving. Archive Results 11. The Publish Results icon stores the displayed results in the Series Navigator and can be accessed by other applications. Publish Results 12. The Application Profile provides tools and functions for interactive 3D reading of CT Dual Energy data specific to various body parts and examination types. Application Profile Abdomen (CA) Activating the Optimum Contrast Viewing Mode The Optimum Contrast mode is one of the viewing modes of General Viewing. 1. In the Case Navigator, click the Viewing pal ette. Optimum Contrast 2. Click the Show Optimum Contrast icon to switch to the Optimum Contrast mode. Optimum Contrast The contrast-to-noise ratio of the images for iodine is maximized. 3. Click the Show Optimum Contrast icon again to switch to the General Viewing mode. 6 Changing the Optimum Contrast Blending In the Optimum Contrast Windowing mini toolbar, the sliders for center (C slider) and width (W slider) allow for an individual optimization of the images. The Optimum Contrast mode is activated. 1. In the Optimum Contrast Windowing mini toolbar of the segments, move the C slider to change the blending window center. Optimum Contrast Windowing 2. In the Optimum Contrast Windowing mini toolbar of the segments, move the W slider to C 300 change the blending window width. 150 500 W Activating the Monoenergetic Viewing Mode The Monoenergetic mode is one of the viewing modes of General Viewing. Optimum Contrast 1g Optimum Contrast 1. In the Case Navigator, click the Viewing palette. Mono E 2. Click the Show Monoenergetic icon to switch to the Monoenergetic viewing mode. Images equivalent to images acquired with a single photon energy beam are calculated. Bone Removal Application Classes Bone Removal automatically removes bone or dense plastic from CT angiography (CTA) data sets. The prerequisite for a bone removal is the decomposition of the material into its component parts: blood, contrast agent, and bone. There are two application classes: Head Bone Removal This application class is particularly designed for the visualization of head angiographies, including carotid scans. Body Bone Removal This application class is particularly designed for the visualization of the contrast agent in the body and extremities, for example, for runoff CT angiography. 7 7 Bone Removal Image Types and Calculation Formula The bone removal images are mixed images, in which bone and calcifications are removed by means of CT Dual Energy analysis. The Dual Energy algorithms set all bone information to the fixed value of -300 HU to remove bone/bony structures from the image. If you measure the CT value by drawing a Dual Energy ROI on bone, you measure the real value of the mixed image. The Dual Energy composition is the low energy fraction of the image. It is determined by the DE Composition reconstruction parameter of the scan protocol. Adapting Calculation Parameters for the Bone Removal Step In the Bone Removal step you can change the calculation parameters of the loaded data. 1. Enter the resolution value in the Resolution field to adapt the range of the smoothing filter (in units of the pixel size). Low resolution values are better for spatial resolution. High resolution values are better for large, compact bones. 2. Enter a threshold in the Maximum [HU] field to remove all voxels in mixed images that are above this value. 3. Enter a value in the Iodine Ratio field to display more contrast agent voxels or more potential bone voxels. If you increase the value, more potential bone voxels are removed. The optimal setting of this parameter is case dependent. 4. Click the Recalculate icon to apply the new value to all images. Calculate 5. Click the Default Parameters icon to restore the default values that are predefined in the Configuration Panel. 6.5 Showing Plaques The Bone Removal application class is selected. The bone removal editing mode is not activated. 1. In the bone removal step, click the Show Plaques icon to show or hide hard plaques Show Plaques 8 Changing the Display Intensity V A MPR, MIP, or VRT image with bone removal information is selected. 1. In the bone removal step, activate the Fine Tuning icon. The Fine Tuning mini toolbar is displayed in the lower middle part of a segment. Fine Tuning 2. In the Fine Tuning mini toolbar, move the slider either to the left or to the right to change the ratio parameter according to your needs. The view of all MPR, MIP, or VRT images with bone removal information is changed according to the new setting. More Fine Tuning Less Bone 0 3. In the bone removal step, click the Undo All icon to undo the fine tuning. Editing of Bone Removal Results You can refine the display of bone structures resulting from preprocessing or from recalculation. Therefore, different tools are available in the bone removal editing mode. This mode is active, by default. As long as no other mode has been activated, for example, the fine tuning mode, the bone removal editing mini toolbar is displayed in the lower middle part of a segment. Segmentation Start Threshold Undo Reto Default Editing 200 _ The mini toolbar provides the following functionalities: Recalculating bone removal results with another segmentation threshold • Connecting interrupted vessel segments • Extending terminated vessels, especially in the Carotid CTAs (based on 80 kV images) • Removing calcium fragments in organs showing low enhancement or rapid motion • Restoring defects in organs or large vessels • 9 9 Connecting Interrupted Vessel Segments The bone removal editing mode is activated. A segment with one of the following display types is selected: MPR, MPR Thick, MIP, MIP Thin, VRT, or VRT Thin. 1. Move the mouse pointer over the bone removal editing watermark. 2. In the bone removal editing mini toolbar, click the Editing Mode icon. Consider that zooming, panning, and rotating with the left mouse button is not possible in this mode. Default 3. Move the mouse pointer to a position where vessel segments are disconnected. The mouse pointer changes its shape. 4. Click the vessel segment. The mouse pointer changes its shape. 5. Drag the mouse pointer to an adjacent vessel segment. The vessel segments are now connected and interruptions as well as false stenoses are removed. 10 6.9.3 Extending vessels The bone removal editing mode is activated. A segment with one of the following display types is selected: MPR, MPR Thick, MIP, MIP Thin, VRT, or VRT Thin. 1. Move the mouse pointer over the bone removal editing watermark. 2. In the bone removal editing mini toolbar, click the Editing Mode icon. Consider that zooming, panning, and rotating with the left mouse button is not possible in this mode. Default 3. Move the mouse pointer to a position where vessel segments are disconnected. The mouse pointer changes its shape. 4. Click the vessel segment. The mouse pointer changes its shape. 5. Drag the mouse pointer to an adjacent vessel segment. The vessel segments are now connected and interruptions as well as false stenoses are removed. 11 11 Liver VNC Application Class The Liver VNC (Virtual Non-Contrast & Contrast Image) application class allows you to visualize the contrast agent concentration in the liver without an additional non-contrast scan, even if there are irregular fatty infiltrations or necrotic areas. The application class generates virtual non-contrast (VNC) images by subtracting iodine from the Dual Energy data sets. The VNC images can be used for baseline density measurements. The basis for this approach is the decomposition of the liver into its component parts: iodine contrast agent, fat, and liver tissue. Before working with this application class, use the General Viewing tools in the Case Navigator to review the quality of the original images. The images displayed in General Viewing mode are suitable for primary diagnosis. Fat map The fat map can be evaluated for contrast enhanced CT scans as well as for non-contrast scans. It is obtained from the VNC image, by linear rescaling and applying a weak noise reduction filter. The base material soft tissue corresponds to 0% fat. The base material fat corresponds to 100% fat. The Dual Energy configuration can be used to refine this calibration. The fat map uses a specific color lookup table. The default settings and water and liver with more than 30% fat content are shown in grey; since fatty livers with less than 10 HU in the non-contrast image are rare Calculating and Archiving the Fat Map You can calculate and archive the fat map that displays the fat content in the liver. The data contains liver. 1. In the Liver VNC step, click the Fat Map icon. The fat map is calculated and displayed in the Fat Map layout. % Fat Map 2. In the Case Navigator, click the Store displayed result images in syngo.via icon to create a report and save the fat map in the Short Term Storage (STS). Publish Results 3. In the Case Navigator, click the Mark displayed result images as ready for archiving icon to send the fat map to the default archive. Archive Results 12 syngo.via® VB30 – CT Dual Energy Liver VNC The syngo.CT Dual Energy Liver VNC application class allows for the visualization of the contrast agent concentration in the liver without an additional non-contrast scan. It generates virtual non-contrast (VNC) images by subtracting iodine from the Dual Energy data sets. The basis for this approach is the decomposition of the liver into its component parts: iodine contrast agent, fat, and liver tissue. 1. From the Patient Worklist, load an appropriate data set into the CT Dual Energy Workflow: If the examination has been correctly mapped, double click to load • If manual mapping is required, right-click the examination and select Open With > • CT Dual Energy When data is loaded into syngo.CT Dual Energy, relevant application classes are also • loaded as configured. Select the Liver VNC application class Body Bone Removal Liver VNC Maximum [HU] 3071 lodine Ratio 3.01 2. The Liver VNC application class provides the following image types depending on the selected layout: Mixed images • Virtual non-contrast images • Iodine overlay images • Fused images • Fat Map • 3. The Dual Energy Mixing Ratio mini tool bar slider allows for the adjustment of the composition of the fused images. Move the slider to the left to display more CT image data with the colored overlay (iodine enhancement) removed. This is a DE virtual non-contrast (VNC) image of the contrast-enhanced source images. wang Rato Overlay CT Moving Rato Overay 100 % ON 465 13 13 syngo.via® VB30 – CT Dual Energy Liver VNC 4. In the Liver VNC workflow step, the calculated parameters of the loaded data can be changed, if desired: Change the Resolution filed to adapt the range of the smoothing filter • Low resolution values are better for spatial resolution Resolution 2 ª - High resolution values are better for low contrast resolution Maximum [HU] 3071 ¢ - lodine Ratio 3.01 Enter a threshold in the Maximum [HU] field to remove all voxels in • mixed images that are above this value. Enter a value in the Iodine Ratio field to change the ratio of contrast and • enhancement to low energy and high energy. Click the Calculate icon to apply the new value(s) to all images, or click • the Default Parameters icon to restore the default values that are predefined in the Configuration Panel. Calculate Default The Fat Map can be viewed by selecting the Fat Map icon on the Liver VNC - workflow step. Fat Map can be used for both contrasted and non-contrasted CT scans. Default s ettin gs display water and liver with > 30% fat content in grey, and a DE ROI will display the Fat Fraction. % Fat Map 1414 syngo.via® VB30 – CT Dual Energy Liver VNC 5. Elliptical or Freehand ROIs (Region of Interest) can be drawn to obtain additional quantitative information about the Dual Energy data set. Displayed ROI parameters —including iodine density and Fat Fraction —can be configured via the Dual Energy ROI Properties Distance Line Dual Energy ROI Properties Dual Energy ROI Circle Dual Energy ROI Circle Properties Send To Context Menu Pixel Lens Display the following evaluations Marker 2. Mean [HUI Arrow Area Jem'] lodine Densky Imgin// Rel Enhancement [%] Fraction [%] Display the following volumes ¥ VNC Low KV High W Mixed OK Cancel Delmets Virtual Unenhanced Application Class The Virtual Unenhanced application class allows you to visualize the contrast agent concentration in soft body tissue without the need of an additional non-contrast scan. It is designed for organs which contain only minor amounts of fat, such as the lungs or kidneys. It is not recommended for the analysis of a potentially f atty liver. The application class generates virtual non-contrast (VNC) images by subtracting iodine from the Dual Energy data sets. The VNC images can be used for baseline density measurements. With the Mixing Ratio mini toolbar, you can control the composition of the displayed fused images. Depending on the slider position, either more CT data or more overlay data is displayed. ET Mong Rato Owray 100% CT 15 15 Monoenergetic Plus Application Class The Monoenergetic Plus application class simulates images that are equivalent to images scanned with a single photon energy beam, depending on the energy (keV). By changing the energy (keV), you can enhance the contrast between different materials. Compared to the Monoenergetic viewing mode, the Monoenergetic Plus application class provides the following additional features: Improved algorithm for noise reduced images • Parallel display of multiple Monoenergetic Plus ROIs and their respective • attenuation curves Saving of Monoenergetic Plus ROI information for statistical evaluations • Monoenergetic Plus Diagram and Calculation Formula The Monoenergetic Plus diagram in the lower right segment displays spectral information on the drawn Monoenergetic Plus ROIs: The colored curves show the calculated CT value of the tissue on which the Monoenergetic • Plus ROI is drawn (HU depending on the monoenergetic photon energy in keV). Error bars indicate the standard deviation in HU. The curves allow the differentiation between regions with different contrast agent uptake. The purple vertical line shows the Monoenergetic energy. If you move this line, • the images are recalculated according to the new keV value. The white dotted vertical lines and PI (prosthesis imaging) indicate the energy • range of optimal metal artefact reduction (110 – 150 keV), if applicable. Showing last 5 findings 800 ET Value THU Finding 7.00 800- 500 400 300 200 100 Energy Ikech 50 80 100 120 140 180 16 Monoenergetic Plus ROI Label The label of a drawn Monoenergetic Plus ROI provides the following ROI properties: Mean values of low energy, high energy, and Mean [HU] Monoenergetic Plus data sets in HU Standard deviation of low energy, high energy, and Monoenergetic Plus data sets in HU Stddev [HU] The CT values of the original voxels are evaluated to maximize the measurement precision of the standard deviation Area [cm2] Area of Monoenergetic Plus ROI in cm2 Changing the Monoenergetic keV Setting By changing the energy (kV), you can visualize regions of interest according to your needs. For example, to visualize iodine, energies between 40 kV and 70 kV are recommended. In the mini toolbar of an MPR segment, move the Monoenergetic slider to the • desired kV value. Monoenergetic E 11 40 45 190 -or- In the diagram segment, move the vertical line to the desired kV value. The recalculated images are displayed. 17 17 Creating a Monoenergetic Plus ROI By creating ROIs, you can define regions of interest according to your needs. The number of Monoenergetic Plus ROIs is not limited. Eight different colors help to distinguish the different CT value curves in the diagram. 1. From the upper right corner menu, choose Monoenergetic Plus ROI. The mouse pointer changes into a circle. 2. Draw the Monoenergetic Plus ROI on the tissue you want to analyze. The CT value curve is displayed in the diagram in the lower right segment. The Monoenergetic Plus ROI is added to the Findings Navigator. The CT value curve is labeled with a consecutive number which can be also found in square brackets in the Findings Navigator. 3. If necessary, change the name of the finding to rename the CT value curve. The first two characters of the name of the finding replace the curve number. Monoenergetic Plus diagram and calculation formula The Monoenergetic Plus diagram in the lower right segment displays spectral information on the drawn Monoenergetic Plus ROIs: The colored curves show the calculated CT value of the tissue on which the Monoenergetic • Plus ROI is drawn (HU depending on the monoenergetic photon energy in keV). Error bars indicate the standard deviation in HU. The curves allow the differentiation between regions with different contrast agent uptake. The purple vertical line shows the Monoenergetic energy. If you move this line, the images • are recalculated according to the new keV value. The white dotted vertical lines and PI (prosthesis imaging) indicate the energy range of • optimal metal artifact reduction (110 – 150 keV), if applicable. HHHHHH 18 Brain Hemorrhage Application Class Brain Hemorrhage is an application class which allows you to distinguish a contrast agent from a hemorrhage in the brain. It is used if the head was scanned with a dedicated brain hemorrhage scan protocol and a suspicious lesion is spotted in the mixed images. With the Mixing Ratio mini toolbar, you can control the composition of the displayed fused images. Depending on the slider position, either more CT data or more overlay data is displayed. CT Mixing Ratio Overlay 50% 50% 19 19 19 Adapting Calculation Parameters for the Brain Hemorrhage Step In the Brain Hemorrhage step you can change the calculation parameters of the loaded data. 1. Enter the resolution value in the Resolution field to adapt the range of the smoothing filter (in units of the pixel size). Low resolution values are better for spatial resolution. High resolution values are better for low contrast resolution. 2. Enter a threshold in the Maximum [HU] field to remove all voxels in mixed images that are above this value. 3. Enter a value in the Iodine Ratio field to change the ratio of contrast and enhancement to low energy and high energy. 4. Click the Recalculate icon to apply the new value to all images. 5. Click the Default Parameters icon to restore the default values that are predefined in the Configuration Panel. 20 Kidney Stones Application Class The Kidney Stones application class visualizes the chemical differences between kidney stones by decomposing the kidney stones into its component parts: tissue, uric acid, and oxalate (calcium stone). This application class provides tools to analyze kidney stones, navigate through them, and supports you in the fast evaluation of kidney stones. Potential kidney stones are already analyzed during the preprocessing. The Kidney Stones application class requires non-enhanced CT data. Be aware that for an optimal post-processing, patient motion should be avoided during the scan. Before working with this application class, use the General Viewing tools in the Case Navigator to review the quality of the original images. The images displayed in General Viewing mode are suitable for primary diagnosis. [1] App Mixed/Au120/Sn120 CT-Value: 700/717/632 HU Ratio: 1.14 50 Volume: 5.29 cm3 Diameter: 35.1|7.2 mm Precision: high 50 Processing the Kidney Stones Protocol For optimum image quality, perform the following workflow steps: 1. Use the default scan protocol DE_Abdomen_KidneyStones for a targeted scan of the kidney. 2. Send the reconstructed thin slice images with the Dual Energy reconstruction kernel to a workstation that has the post-processing software syngo.CT Dual Energy. 3. Open the images with the CT Dual Energy workflow and select Kidney Stones. Follow the directions in the user hints, if applicable. 21 21 Differentiation of Stone Types In the Kidney Stones application class, there are two methods of evaluating the algorithm results: using the dominating color or using the overlay value. Although the color is sufficient to distinguish between uric acid/urate stones and non uric acid stones, the overlay value measured in the center of the stone is more robust, especially for non-ideal reconstruction parameters. Each stone type has a characteristic overlay value. This value also allows for obtaining more information about the chemical composition of blue stones. Kidney Stones Parameter Diagram The Kidney Stones Parameter diagram in the lower right segment provides the following information: The volume of all shown kidney stones is displayed. • All findings that you confirmed by setting a kidney stone • marker are displayed with colored circles and the respective number of the finding in square brackets. Reference points for typical stones such as uric acid, cystine, • hydroxylapatite, and oxalat support you in classifying a potential kidney stone. They are displayed with white circles. Depending on the ratio, the resolution, and the HU values you have entered, the reference points may be located at different positions. The white line represents the ratio of the low energy • and high energy values. You can change this value in the Configuration Panel. Findings on the red dotted lines indicate uric acid stones. • Findings on the blue dotted lines indicate calcium stones. • 1:25 Au120 kV [HU] 1.45 1.05 700 V(stones) = 5.29 cm3 O Hydroxylapatite 0.85 600 O Oxalaf 500 0.65 O Cystine 400 OUric Acid 300 200 100 - Urine Sn120 kV [HU] 0 0 50 100 150 200 250 300 350 400 450 500 550 600 650 700 22 Navigating through Potential Kidney Stones The Kidney Stones Navigator mini toolbar allows you to navigate between the views of potential kidney stones that were found during preprocessing. The mini toolbar is available in all segments that display fused MPR images. 1. In the respective segment, move the mouse pointer over the Kidney Stones Navigator watermark. The Kidney Stones Navigator mini toolbar is displayed. 2. Click the Navigate forward and view Kidney Stones [Alt+F] icon to navigate to the next potential kidney stone. 3. Click the Navigate backward and view Kidney Stones [Alt+B] icon to navigate to the previous potential kidney stone. 4. Click the Restart Kidney Stones Navigation icon to navigate to the first potential kidney stone. Kidney Stones Navigator Reset Previous Next Set Marker Kidney Stones Navigator Kidney Stone Marker Reset Previous Next Set Marko Markers are used to confirm measurements that have been identified as potential kidney stones. When you have set a marker, the following information is provided: Annotations are displayed next to the marker. • [1] The measured position of the kidney stone is displayed in the Kidney App: Mixed/80/140 • CT-Value: 1359/1757/1188 HU 50 Stones Parameter diagram. Ratio: 1:49 Volume: 2.11 cm3 Diameter. 14.0|10.5 mm A review finding is created containing a screenshot of the selected Precision: high • segment and the Kidney Stones Parameter diagram. 23 23 Gout Application Class The Gout application class images allow you to distinguish between urate, bone, bone marrow, and contrast agent. Urate and contrast agent are highlighted with different colors. V(0) 20.42 cm Gout Overlay Images The overlay image supports you in distinguishing urate, bone, and iodine from each other. Potential urate is displayed in green and iodine in purple, by default. The overlay image is based on a calculation of: The low energy and the high energy value of the CT images. • The reference values of the low energy and the high energy value of soft tissue. • They are defined by the Gout application class and can be changed in the Configuration Panel. A review finding is created containing a screenshot of the selected segment and the Kidney • Stones Parameter diagram. Side-by-Side Layout of the Gout Application Class The Side-by-Side layout provides mixed MPR and VRT images. The mixed MPR images combine the information of the low energy and high energy data sets. 2424 Lung Analysis Application Class Lung Analysis combines two application subclasses: Lung Vessels This application subclass is designed to visualize the iodine enhancement in pulmonary vessels. Different colors are assigned to differentiate between perfused and non-perfused pulmonary arteries. The iodine distribution within the lungs is displayed as color masks (overlay) in the result images. Lung PBV (Perfused Blood Volume) This application subclass is designed to visualize and quantify the iodine uptake in the lung parenchyma. Lung Vessels Overlay Images The lung vessels overlay image enables you to differentiate between the high iodine and the low iodine concentrations in lung vessels. Compared to the lung vessels color masks on the Lung PBV overlay images, the overlay information is displayed for all images. The fused image is a combination of the mixed image and the lung vessels overlay image. The calculated overlay is displayed in red and cyan. Cyan areas indicate vessels with a high iodine concentration. The corresponding overlay HU values are positive. Red areas indicate vessels with a low iodine concentration. The corresponding overlay HU values are negative. The overlay image is the result of a calculation based on: The low energy and the high energy value of the CT images • The reference values of the low energy and the high energy value of the air: • They are defined by the Lung Analysis application class and can be changed in the Configuration Panel. The ratio that is optimized by default for a differentiation between patent • and occluded vessels. Lung PBV Overlay Images The overlay image displays the iodine enhancement in the mixed image in Hounsfield units exclusively for the lung. During the preprocessing, the Dual Energy algorithms perform a material decomposition and extract the iodine enhancement. With the Mixing Ratio mini toolbar, you can control the composition of the displayed images. Depending on the slider position, either more CT data or more overlay data is displayed. The exact overlay information depends on the selected image combination. Displayed CT Mixed/Lung PBV (default) The overlay in the lung tissue is displayed in orange. • Displayed CT Mixed/Lung PBV/Lung Vessels The overlay in the lung tissue is displayed in orange. Additionally, the lung vessel overlay is • added as color masks for the segmented lung. Cyan areas indicate vessels with a high iodine concentration. The corresponding overlay HU values are positive. Red areas indicate vessels with a low iodine concentration. The corresponding overlay HU values are negative. The mask colors cannot be changed. 25 25 Selecting the Displayed Image View The Lung Analysis application class provides three combinations of the displayed MPR/VRT images. 1. In the Lung Analysis step, click the palette icon to select one of three display combinations. 2. Click the Display CT Mixed/Lung PBV icon to display the combination of CT mixed images and lung PBV overlay images (default). -or- Click the Display CT Mixed/Lung Vessels icon to display the combination of CT mixed images and lung vessels overlay images. -or- Click the Display CT Mixed/Lung PBV/Lung Vessels icon to display the combination of CT mixed images, lung PBV overlay images, and lung vessels (color masks). Lung PBV Volume 3 and PBV and Vessels Volume 3 and 2 Lung Vessels Volume Based Lung PBV Distance Based 80 [HU] InH] o 2626 Bone Marrow Application Class The Bone Marrow application class allows you to visualize the bone marrow composition which is based on non-enhanced CT data. The application class generates virtual non- calcium (VNCa) images by subtracting calcium from the Dual Energy data sets. Adapting Calculation Parameters for the Bone Marrow Step In the Bone Marrow step, you can change the calculation parameters of the loaded data. 1. Enter the resolution value in the Resolution field to adapt the range of the smoothing filter (in units of the pixel size). Low resolution values are better for spatial resolution. High resolution values are better for large, compact bones. 2. Enter a threshold in the Maximum [HU] field to exclude all voxels with higher CT values in the mixed image from analysis. 3. Enter a lower value in the Bone Threshold field if the bone marrow segmentation does not provide proper results. 4. Click the Recalculate icon to apply the new value to all images. Calculate 5. Click the Default Parameters icon to restore the default values that are predefined in the Configuration Panel. Show Plaques Hard Plaques Application Class With the Hard Plaques application class, you can highlight calcified plaques within large vessels even if they have CT values that are comparable to the neighboring contrast agent. The basis for this approach is a material decomposition into: iodine contrast agent, blood, and bone. 27 27 CT Dual Energy Rapid Results Techonology syngo.via VB20 Rapid Results enables direct communication between syngo.via and SOMATOM CT scanners, enabling zero-click postprocessing within the selected scan protocol. In this way, syngo.via automatically creates and sends ready-to-read results from wherever you are to your PACS or a film printer. Rapid Results knows what you need, just when you need it. This is reading as simple as it should be. With Rapid Results, you can automatically generate neuro perfusion maps, standard visualizations of general vessels and different anatomies in various types and orientations, or visualizations of the rib-cage 2 in an easy-to-report format. Define your workflow once, and let Rapid Results produce the basis for your decisions. Your benefits with Rapid Results: SOMATOM CT scanner En Pr ard Topo scu Auto reference peci Woe riva APILang .. ... With Rapid Results Tech performs standard scan 28 Rapid Results improves your efficiency by reducing your workflow steps. Dual Energy in combination with Rapid Results Technology also allows the automatic creation • of Dual Energy results, in desired orientations (axial/coronal/sagittal), slice thickness and image types (MPR/MIP) Different DE Application can be defined for the available recon jobs • syngo.via server PACS syngo.via pre-processes data Radiologist use results for diagnosis and distribution in PACS 29 Notes 30 Notes 31 At Siemens Healthineers, our purpose is to enable On account of certain regional limitations of sales rights healthcare providers to increase value by empowering and service availability, we cannot guarantee that all them on their journey towards expanding precision products included in this brochure are available through medicine, transforming care delivery, and improving the Siemens Healthineers sales organization worldwide. patient experience, all enabled by digitalizing healthcare. Availability and packaging may vary by country and is subject to change without prior notice. Some/All of the An estimated 5 million patients globally benefit every day features and products described herein may not be from our innovative technologies and services in the areas available in the United States. of diagnostic and therapeutic imaging, laboratory diagnostics and molecular medicine, as well as digital The information in this document contains general health and enterprise services. technical descriptions of specifications and options as well as standard and optional features, which do not We are a leading medical technology company with over always have to be present in individual cases. 170 years of experience and 18,000 patents globally. With more than 48,000 dedicated colleagues in 75 Siemens Healthineers reserves the right to modify the countries, we will continue to innovate and shape the design, packaging, specifications, and options described future of healthcare. herein without prior notice. For the most current information, please contact your local sales representative from Siemens Healthineers. Note: Any technical data contained in this document may vary within defined tolerances. Original images always lose a certain amount of detail when reproduced. For USA Distribution Only. Siemens Healthineers Headquarters Published by Siemens Healthcare GmbH Siemens Medical Solutions USA, Inc. Henkestr. 127 40 Liberty Boulevard 91052 Erlangen, Germany Malvern, PA 19355-9998, USA Phone: +49 9131 84-0 Phone: 1-888-826-9702 siemens-healthineers.com siemens-healthineers.us Published by Siemens Medical Solutions USA, Inc. · Order No. CT-19-1623 · Online Pdf · 01-2019 · ©Siemens Medical Solutions USA, Inc., 2019