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CT SOMATOM Definition AS Sliding Gantry Turnover Workbook

CT SOMATOM Definition AS Sliding Gantry Turnover Workbook

SIEMENS SIEMENS SOMATOM Definition AS User Services usa.healthcare.siemens.com/education SOMATOM Definition AS Sliding Gantry Turnover Workbook Answers for life. Turnover Workbook | SOMATOM Definition AS - Sliding Gantry User Services. Driven by More. More: Our philosophy for a lifelong improvement through continuing education and consulting. Working closely with you, we develop your personalized education and consulting strategy and support you and your staff with our comprehensive User Services to help gain: • More: Routine Confidence • More: Clinical Expertise • More: Superior Performance More: Personalized training, education, and consulting services from Siemens Healthcare Customer Services. For your leading edge in medical care. User Services. Driven by More. More: Personalized More: More: Superior Clinical Performance Expertise 2 Turnover Workbook | SOMATOM Definition AS - Sliding Gantry I. Contact Information Summary Welcome to Siemens Healthcare Discover. Try. Buy. on webShop Siemens Healthcare is dedicated to helping you Do you want to “Discover. Try. Buy.” options, accessories, get the most out of your investment throughout and clinical education to make the most of your the entire product life cycle and beyond. Our goal imaging equipment? Discover images, case studies, is to enable you to take technology further, and video demonstrations with the latest clinical profitability higher, and patient care to the next applications. Try advanced applications utilizing level. Find the information, resources, and tools free software trials. Buy applications, coils, clinical you need to get the most out of your recent education, and accessories, conveniently at any time. investment and stay up-to-date. Visit Visit www.usa.siemens.com/webShop today! www.usa.siemens.com/Welcome2Healthcare. Clinical Training and Siemens Training Centers Continuing Education Siemens Clinical Education Training Center – TDC2 Siemens Customer Care Center: 110 Mac Alyson Court Call 1-800-888-7436 Cary, NC 27511 • Troubleshooting assistance • Immediate assistance for software applications and workflow issues Please provide the Functional Location Number when calling for assistance. Clinical Education Offerings: Call 1-888-221-8010 (follow the prompts) • Classroom Training (Offerings, Registration & Scheduling) • Educational Symposia • On-site Training • Printed Self-studies • Virtual Education (Offerings & Registration) • Workshops & Fellowships Visit www.usa.siemens.com/clinicaleducation for more information regarding the current Siemens Clinical Training and Continuing Education portfolio. 3 Turnover Workbook | SOMATOM Definition AS - Sliding Gantry II. Contents I. Contact Information Summary .............................................................................................. 3 II. Contents ............................................................................................................................. 4 III. Training Agenda.................................................................................................................. 6 Day 1 - System Overview .................................................................................................... 6 Day 2................................................................................................................................. 6 Day 3................................................................................................................................. 6 Day 4 ................................................................................................................................ 7 Exercises ............................................................................................................................ 7 IV. Training Objectives.............................................................................................................. 8 1 Overview of CT Scanner Components .................................................................................... 9 1.1 Objectives .................................................................................................................. 10 1.2 Gantry ....................................................................................................................... 10 1.3 Patient Table .............................................................................................................. 13 1.4 syngo® Acquisition Workplace Overview...................................................................... 14 1.5 Accessories................................................................................................................. 17 2 System Start Up and Shut Down .......................................................................................... 18 2.1 Objectives .................................................................................................................. 18 2.2 Start System............................................................................................................... 18 2.3 Shutdown System....................................................................................................... 19 2.4 Rebooting the System................................................................................................. 20 3 System Safety ..................................................................................................................... 21 3.1 Objectives .................................................................................................................. 21 3.2 Stop Keys - Control Box and Gantry.............................................................................. 21 3.3 Emergency Off Power (EOP) on Wall ............................................................................ 21 3.4 Radiation ON Indicator Lights ...................................................................................... 22 3.5 Communication System .............................................................................................. 22 4 System Maintenance........................................................................................................... 23 4.1 Objectives .................................................................................................................. 23 4.2 Checkup and Calibration ............................................................................................. 23 4.3 Daily Quality Measurements........................................................................................ 23 5 syngo® System Software .................................................................................................. 25 5.1 Objectives .................................................................................................................. 25 5.2 Monitor Layout........................................................................................................... 25 5.3 Task Cards .................................................................................................................. 25 5.4 Patient Browser .......................................................................................................... 25 6 Scanning a Patient.............................................................................................................. 27 6.1 Objectives .................................................................................................................. 27 6.2 Step 1 - Register a Patient ........................................................................................... 27 6.3 Step 2 – Select a Scan Protocol .................................................................................... 28 6.4 Step 3 – Define Patient Position................................................................................... 28 4 Turnover Workbook | SOMATOM Definition AS - Sliding Gantry 6.5 Preparing the Examination .......................................................................................... 29 6.6 Performing the Examination........................................................................................ 36 6.7 Reconstructing Images................................................................................................ 39 6.8 Generating 3D Reconstructions/WorkStream 4D ........................................................... 42 6.9 Ending the Examination.............................................................................................. 44 7 Contrast Enhancement........................................................................................................ 46 7.1 Objectives .................................................................................................................. 46 7.2 CARE Bolus ................................................................................................................. 46 7.3 Test Bolus................................................................................................................... 47 8 Reviewing and Postprocessing Images ................................................................................. 48 8.1 Objectives .................................................................................................................. 48 8.2 Viewing Task Card Overview........................................................................................ 48 8.3 Viewing Tab Cards ...................................................................................................... 49 8.4 Properties for Tools and Graphic Objects ...................................................................... 50 8.5 Selecting Images ........................................................................................................ 52 9 3D Task Card....................................................................................................................... 54 9.1 Objectives ................................................................................................................. 54 9.2 MPR ........................................................................................................................... 54 9.3 How to create an MPR ................................................................................................ 55 9.4 Generating a series of parallel images ......................................................................... 55 9.5 MIP: Maximum Intensity Projection.............................................................................. 58 9.6 SSD: Surface Shaded Display ....................................................................................... 59 9.7 VRT: Volume Rendered Technique................................................................................ 60 9.8 syngo® 3D Bone Removal............................................................................................ 61 9.9 MIP, SSD and VRT - Radial Ranges................................................................................. 65 10 Data Management ............................................................................................................ 66 10.1 Objectives ................................................................................................................ 66 10.2 Storing Data ............................................................................................................ 66 10.3 Networking .............................................................................................................. 68 10.4 Deleting Data ........................................................................................................... 69 11 Sliding Gantry Installations................................................................................................ 70 11.1 Objectives ................................................................................................................ 70 11.2 Sliding Gantry in the Angiography Suite – Miyabi....................................................... 70 11.3 Sliding Gantry in Radiation Oncology - CTVision™ ...................................................... 71 11.4 Sliding Gantry in the Operating Room........................................................................ 71 11.5 Sliding Gantry in the Emergency Department – Trauma Solutions ............................... 76 12 Sliding Gantry Safety, Tips and Tricks ................................................................................. 77 13 Exercises .......................................................................................................................... 78 14 References........................................................................................................................ 80 15 Glossary ........................................................................................................................... 81 5 SIEMENS SOMATOMA Turnover Workbook | SOMATOM Definition AS - Sliding Gantry III. Training Agenda Day 1 - System Overview CT scanner intro: Overview of scanner components Demonstration of Sliding Gantry movement and operation Acquisition Workplace Computers and computer software input units Storage media and drives Accessories Switching on/off procedure, safety information, and quality control procedures syngo® software general functions Monitor layout Task cards Patient Browser Menu and toolbar Introduction to scan procedure Day 2 Scan procedure Managing scan protocols Reviewing and postprocessing images Day 3 Performing patient scans Managing scan protocols Reviewing and postprocessing images 6 Turnover Workbook | SOMATOM Definition AS - Sliding Gantry Day 4 Review Patient imaging continued Discuss IQ Questions Exercises 7 Definition AS Turnover Workbook | SOMATOM Definition AS - Sliding Gantry IV. Training Objectives The purpose of this training session is to provide you with the skills and knowledge to safely operate your CT Sliding Gantry system. Learning Objectives After completing this training session, you will be able to: • Correctly perform startup and shutdown procedures. • Identify the key hardware features of the CT system. • Describe the key features of the syngo® interface on the Acquisition Workplace. • Correctly perform a patient registration. • Utilize the examination task card to perform a patient procedure from start to end. • List and perform Quality Control procedures. • Modify and save protocols. • Identify task cards and tool cards and describe their functions. • Perform image reconstructions. • List the steps needed in order to archive patient data. 8 Turnover Workbook | SOMATOM Definition AS - Sliding Gantry 1 Overview of CT Scanner Components This section gives an overview of the components of your computed tomography system. Power Distribution and Image Reconstruction Cabinets Scan Unit - Sliding Gantry Scan Console - Acquisition Workplace The CT system consists of the following components: • Gantry • Rail system • Cable column • Patient Table • Acquisition Workplace with input devices • Image reconstruction system • Power distribution cabinets • Accessories Notes 9 Turnover Workbook | SOMATOM Definition AS - Sliding Gantry Notes 5 4 (1 SIEMENS 2 SOMAYOU 2 ..... 3 3 1. Gantry with display 2. Gantry operator panel 3. Rail system 4. Cable column 5. Ceiling assembly 1.1 Objectives After this session you will be able to: • Identify the primary hardware components of the Sliding Gantry CT system • Identify the input devices used to interface with the scanner and system software 1.2 Gantry The interior of the gantry consists of a rotating X-ray detector system. This X-ray detector system consists of the X-ray tube, the collimator, and the Ultra Fast Ceramic (UFC) detector. Additionally, the gantry contains the following components: • Generator • Motor drive • Data acquisition system • Unit control • Laser light markers for vertical and horizontal positioning • Cooling system • Microphone and loudspeaker for the intercom system 10 Turnover Workbook | SOMATOM Definition AS - Sliding Gantry Gantry operator panels Notes • On the front and the back (optional) of the gantry, there are operator panels and displays that enable gantry movement, laser lights and in-room scan initiation. O • Gantry movements: • Speed key • Horizontal zeroing • Laser light marker • Scan operation • Start key/radiation warning • Suspend key • Stop key Depending on your system version, the following may not be operational or present • Horizontal/vertical movement keys • Offset key/table retraction Gantry Tilt • The gantry can be tilted up to 30° forward (+) or 30° backward (-) in 0.5° increments • The Gantry Tilt must be at ZERO to move gantry into the “PARK” position Gantry Display The gantry display is located at the top front of the gantry. In this display you can observe your system operation. The following information is displayed: • Scan parameter • Sliding Gantry positions and gantry tilt • Other (e.g., patient name, radiation indication) 11 Turnover Workbook | SOMATOM Definition AS - Sliding Gantry The display information in the lower part of the gantry display depends on the Notes current operation. (Patient name, Radiation warning, Delay time) 140 kV 666 mA 0.00 s 1 2 300 -2000.0 1. Vertical Table Position 2. Horizontal Table Position (These may be fixed values depending on type of installation.) Gantry Movements • As opposed to conventional CT systems where the patient is moved through the gantry on the table, a Sliding Gantry system allows the table to remain in place and the gantry moves over the patient on an installed rail system. • Routine wheeled equipment such as portable X-ray, C-Arms, hospital beds & stretchers can be moved over rails. • The rails are covered with magnetic strips. Care should be taken if removing the strips, as the rail mechanism can be sharp. • During examination, the gantry movement is controlled: • With the Move key on the control box, you move the gantry to the position preset on the screen. (->Control box) • You can move the Gantry toward and away from the table directly at the gantry control panel. (->Gantry operator panels) • At floor level along the entire front and rear of the sliding gantry is a proximity switch. Gantry movement will stop and the system will reset automatically should this switch make contact with anything on the floor. 12 Turnover Workbook | SOMATOM Definition AS - Sliding Gantry Cable Column Notes 1 2 3 1. System Status lamps: • White Light ON/Green Light OFF =CT parked. Angio & C- Arm available • White Light ON/Green Light ON =CT available to move, however still in PARK/C-Arm parked. • White Light OFF/Green Light ON =CT available; not parked/Angio not available 2. Physiological measurement module e.g. for ECG connections 3. Rotary control for gantry movement. This switch can be used in case of malfunction of the move keys on the gantry control panels. 1.3 Patient Table As there are multiple installation solutions which include 3rd party OEM equipment, we will defer this training to on-site applications. 13 Turnover Workbook | SOMATOM Definition AS - Sliding Gantry 1.4 syngo® Acquisition Workplace Overview Notes This section describes the components associated with the operator console, including computers, input devices, and storage media. 000 1 1 2 2 1.4.1 Computers The CT scanner is controlled by two main computers, one workplace computer and one image reconstruction system. Depending on the delivery date, the design of these computers may vary. 1. Workplace computer – You work with this computer! This is the computer on which you make all your entries. With it, you control the CT scanner, evaluate your studies, and store them. 2. Image reconstruction system (IRS) – The image reconstruction system communicates with the scan system. It uses the measured data of the detector system to calculate the images for each slice. It then passes on the data to the syngo® Acquisition Workplace. 14 Turnover Workbook | SOMATOM Definition AS - Sliding Gantry 1.4.2 Input Devices Notes You use the keyboard, mouse, and control box to inform the CT computer what actions to perform. • Keyboard/syngo® Symbol Keypad (1) (2) (3) (4) (1) Function keys (2) Typewriter keyboard (3) Cursor keys (4) syngo® symbol keypad With the keyboard, you enter text, numbers, and commands. The syngo® symbol keypad is not for numeric inputs but for quick access to commonly needed functions. Window Center +/- Window Width +/- + Scrolling Configurable Study +/- Send to + B Scrolling Node 1 Series +/- Correct + D - Mark Scrolling Image +/- + Copy to Film Sheet Patient Registration Browser 15 Turnover Workbook | SOMATOM Definition AS - Sliding Gantry Notes • Mouse • You can use the mouse to operate the CT software and to control the CT system. • Your mouse has three keys: • The left key is used to select objects. • The right key is used to call up popup menus. • The center key is used for window setting. • Control Box • The control box allows for multiple functions to be performed from the operator console. You can move the gantry, start a scan, suspend a scan, communicate with the patient, and stop a scan in the event of an emergency. Communication system Switching the system on and off Equipment for communication with the patient On/Off keys + Using the intercom system System on key System off key 3( volume controls loud OO Computer on +/- listening to the speaker OO Switching on patient --- Suspend key speaking to the patient Controlling table movement and measurement STOP STOP key Terminating system movements and radiation WARNING The Kery ust mag le ferpeou Start key move table ta petart and spa eor andirss sele Controlling table movement and measurement move table out move ta move table down 1.4.3 Storage Media and Drives • DVDs, CDs and drives - You can use the following types of discs on your system: • CD-ROM (read only) • CD-R • DVD-ROM (read only) • DVD-R • CDs and DVDs are exchange media and not suitable for long-term storage. • Only use medical grade CD-Rs and DVD-Rs. Medical grade media are available through your Siemens representative. 16 Turnover Workbook | SOMATOM Definition AS - Sliding Gantry Notes • DVD recorder • With the DVD recorder, you can read and write data from or onto CDs and DVDs. PLEXTOR PX-760A A.S RW RW DVD (ist!! (1) (2) (3) (4) (1) DVD tray (2) LED indicating operation mode (3) Opening for manual disc ejection (4) Open/Close/STOP key 1.5 Accessories Phantoms and Positioning Aids • Positioning aids - Your system is equipped with several accessories for positioning the patient safely and comfortably. • For more details, please see: • Life Card > Operator Manual > SOMATOM > System Description / Accessories • Life Card > Operator Manual > SOMATOM > System Description / System Overview • www.medical.siemens.com > USA > Products & Solutions > Accessory Solutions 17 Turnover Workbook | SOMATOM Definition AS - Sliding Gantry 2 System Start Up and Shut Down 2.1 Objectives Notes After this session, you will be able to: • Start the system, shut down the system, and reboot the system 2.2 Start System • On the rear of the control box, press the Sys On key. • The corresponding LED starts blinking. Gantry and computer are switched on. Startup window of syngo® is displayed on the screen. • The whole system is ready for operation when the Sys On LED is lit and the operating elements on the control box (see above labeled with a, b) are backlit. Sys On key (on the rear) SIEMENS STOP • Alternative: It is possible to switch on the operator console/computers only and not the gantry (e.g., If you do not intend to scan but need to access patient data, or if the gantry is being serviced). • Press the Comp On instead of the Sys On key. 18 Turnover Workbook | SOMATOM Definition AS - Sliding Gantry 2.3 Shutdown System Notes • Before you can shut down the system, you must confirm the gantry tilt is zero and move the Sliding Gantry to the PARK position. You should exit all examinations and applications. • A syngo® CT Workplace that is connected to the system must be shut down first. • In the main menu: Select System > End. • The End Session dialog box is displayed. Click System | He Shutdown System and confirm with Yes in the dialog box displayed. End Eun • The Sys On LED and the operating elements on the control box turn off. • The System Off LED starts blinking. • The whole CT system is switched off when the System Off LED is lit. System Off LED Shut down Resis Application 2 19 Turnover Workbook | SOMATOM Definition AS - Sliding Gantry 2.4 Rebooting the System Notes • To ensure best system performance, it is recommended to reboot the system once a day. • With the second option in the End Session dialog box, you shut down the system and restart it. System Run End Session Log Off Shutdown System ... .. Restart System ... Restart Application .. Standby. Cancel Help 20 Turnover Workbook | SOMATOM Definition AS - Sliding Gantry 3 System Safety 3.1 Objectives Notes After this session, you will be able to: • Stop the system in the event of an emergency • Appreciate when radiation is ON during system scanning 3.2 Stop Keys - Control Box and Gantry • In the event of danger, you can stop system movements and radiation using the stop keys. • Once a STOP button is pushed, the gantry can be moved utilizing the rotary control switch located on the cable column at the gantry. The STOP keys are located on the gantry control panels (front and back) and the control box. - STOP • If you want to continue working, you must reactivate the system by selecting Setup > Continue at the workplace computer. 3.3 Emergency Power Off (EPO) on Wall • In extreme cases, you can press an Emergency Off key to shut down the whole system. CT Radiation and CT system movements will be stopped. The Emergency Off key must only be pressed in one of the following situations: If the Stop key on the CT system does not CT EPO • respond. • If situations arise that could cause injury to the patient or user or damage to the equipment (e.g., liquids or particles getting into the equipment, damage of cover parts, fire). • Note: The Emergency Off key interrupts the power supply of the CT system. Data can be lost. 21 Turnover Workbook | SOMATOM Definition AS - Sliding Gantry 3.4 Radiation ON Indicator Lights Notes • The radiation warning lamps on the gantry operator panels, in the gantry display, and on the control box as well as site radiation warning lamps to be provided by the customer must light up if scanning has been triggered. 120 KV 500 mA 0.5 g 300.0 -2000.0 3.5 Communication System • The gantry is equipped with a communication device that consists of a speaker and a microphone. It is located in the upper part of the gantry. (4) (3) (1) (2) (1) Microphone (gantry front) (2) Loudspeaker (gantry front) (3) Microphone (gantry back) (4) Loudspeaker (gantry back) • For detailed safety instructions of the system, please see: Life Card > Operator Manual > SOMATOM > Operation > Safety and System 22 Turnover Workbook | SOMATOM Definition AS - Sliding Gantry 4 System Maintenance 4.1 Objectives Notes After this session, you will be able to: • Perform a system Checkup and Calibration • Perform Daily Quality Measurements 4.2 Checkup and Calibration • Check up and Calibration should be performed any time the system is started to optimize the unit for scanning. • When you start the system, the tube is not at operating temperature and the detectors have not yet been calibrated. Incorrect diagnosis resulting from image artifacts or other image quality issue may arise. • Calibration should be done anytime the system has been idle for 1-2 hours via Setup>Calibration. • The checkup procedure is started in the Checkup dialog box, which will be displayed after system startup. Checkup For best image quality please run checkup procedure. Please leave the scan room The table will move out of the gantry X-rays will be produced during the checkup procedure. Click on Checkup to start procedure. Click on Cancel to skip procedure. Checkup Cancel Help • For detailed system checkup and calibration instructions of the system, please see: Life Card > Operator Manual > SOMATOM > Operation 4.3 Daily Quality Measurements • To ensure the best possible image quality, you must perform quality measurements regularly. • The daily quality measurements only require checking of three parameters on the water phantom: • The CT value of water and the homogeneity of the images are calculated in Hounsfield units (HU). • The pixel noise of images is calculated as a standard deviation. • Tube voltages are measured directly at the X-ray tube. • These measurements are performed for the head mode and the body mode. • The images of the Daily Quality Check measurements are stored as images of the “Quality Assurance Patient.” 23 Turnover Workbook | SOMATOM Definition AS - Sliding Gantry Notes • For all 3rd party tables the Phantom holder must be used. • Note: For ALL MPT table tops: remove the screw of the phantom and secure the phantom holder to the table first, before positioning the phantom on the table! • The phantom holder must ALWAYS be used for Sliding Gantry (Also with MPT-3) • For detailed information on quality control, please see: Life Card > Operator Manual > SOMATOM > Quality Assurance / Daily Quality Measurements > Performing quality measurements, or see step-by-step instructions on education website. 24 Turnover Workbook | SOMATOM Definition AS - Sliding Gantry 5 syngo® System Software Your system uses Siemens’ proprietary imaging software, syngo®. This Notes software is used to perform all aspects of patient scanning, image evaluation, and data postprocessing. • Hint: When calling the Customer Care Center, Information about the software and installed software packs (function, custom, and service packs) is listed in the Version dialog box. You can display the Version dialog box with Options > Version in the main menu. 5.1 Objectives After this session, you will be able to: • Identify the major components of the syngo® software and system user interface • Navigate the Patient Browser 5.2 Monitor Layout • The monitor layout in all task cards will have several common features: • A Main Menu bar across the top of the task card that contains all functions available for that card. • Shortcuts icons for the most commonly used functions. • A Status Bar along the bottom showing background functions that are currently running. • The Image Area is the portion of a task card that displays images. 5.3 Task Cards • Task cards provide access to the most basic functionalities of the syngo® software. They offer an efficient means of displaying multiple applications or windows at the same time, without cluttering the user interface. Some task cards are present on all systems, even across modalities, like: • Examination • Viewing • Filming • 3D • A few things to remember about Task Cards are: • Operations and functions on one task card are independent of those on another task card. • It is very easy to switch between task cards to perform a variety of tasks, without having to “close” any application • When a new application is opened, it usually presents as an additional task cards. 5.4 Patient Browser • The Patient Browser is where all of the patient and examination data is stored on the system. If there is an optional CT Workplace, the Patient Browser is shared between the two consoles and patient data is accessible on both. Acquisition Workplace Database CT Workplace 25 Turnover Workbook | SOMATOM Definition AS - Sliding Gantry • The Patient Browser is Used for: • locating known patients • postprocessing images • archiving or networking • scheduling • correcting or rearranging data • filming or printing Patient Browser 0 X Main Menu Patient Applications Transfer Edit View Filter Evaluation Sort Options Help Toolbar Ca Filter Patient Study Series [1] Topogram 0.6 T20s Local Database_ DANDY. JM Vascular Embo [2] Embolism 10 B301 Scheduler PHAN, TOM Head HeadRou Embolism 3.0 B30f DVD_ROM LE PEW, PEPE Thorax ROUTIN [501] Patient Protocol DVD_RW MAYKET, WILLY .. [601] Raw Data WOWNT, BETTY Navigation Area Information Patient name DANDY, JIM Patient ID 12345678 Area Study description Vascular Embolism (Adult) Date of birth 3/7/196 Study date 3/17/2009 Modality CT 3 7 Content 110.0 110.5 4 111.0 111.5 112.0 1125 113.0 113.5 Area 114.0 10 -114.5 115.0 .12_ 115.5 118. 14 .116.5 1170 117.5 Querying database Current Fiter: Not Marked Image Stamps Menu and Toolbar: • The Main Menu Bar and Tool Bar offer text drop downs and graphical icons that serve as shortcuts to most every feature and function you will need in the Patient Browser Navigation Area: • The Navigation Area is where you will find all patient data that is on the system or connected storage media (CD/DVD). The database is arranged in a hierarchy from entire exams to individual scan series to single images. External devices. • External disk drives connected to the scanner will be displayed here. Here you can view, import, and export patient studies that have been saved to a CD or DVD. Information Area: • Displays general information about the data object selected. Content Area: • The Content Area of the Patient Browser is where images selected above will be displayed. The view of the content area can be changed from Image Stamps to Image text. Filters and Sorting: • The contents of the Patient Browser can be configured to display in a variety of ways: • Sorting the Browser content allows data to be arranged alphabetically, chronologically, by slice location, or by image number. • Filters can be used to display only a desired sub segment of exams in the database, like patients that have not yet been archived to PACS. A pink “coffee filter” icon indicates a filter is in use - this is important to remember when you’re unable to find something you’re looking for because a filter means you’re likely not seeing all of your available studies. • For detailed information on syngo® software general functions, please see: Life Card > Operator Manual > syngo® CT > General/Basic Functionalities 26 Turnover Workbook | SOMATOM Definition AS - Sliding Gantry 6 Scanning a Patient 6.1 Objectives Notes After this session, you will be able to: • Register a patient for an examination • Select a pre-defined scan protocol • Modify technical parameters on-the-fly to meet the scanning needs of the immediate patient examination • Reconstruct scanned images • Generate 3D reconstructions within the examination by using Workstream4D • End the examination 6.2 Step 1 - Register a Patient • Registration means that you give your system all the information about a patient that it requires for an examination. • Before the examination can begin, the boxes with the boldface labels must be filled in. This satisfies the minimal DICOM requirement for the images.Patient-relevant information may be supplied by HIS/RIS*. All that is left to do is to choose the type of study. Once the Exam button is pressed and the data confirmed, the examination task card is displayed. Patient Registration PATIENT PROCEDURE Last name Accession No First name Requested * Patient ID procedure[s) Date of birth [M/d/yyyy] Sex Male Female Other Study list Age Years HOSPITAL Referring physician Add Delete Admitting diagnosis Study Werd Admission D Institution name 1. Performing physician 1. Operator NOTINITISNI Prerepiste Exam Search Cancel Emergency Help *HIS – Hospital Information System • The goal of a HIS is to use computers and communication equipment to collect, store, process, retrieve, and communicate patient care and administrative information for all hospitals’ affiliated activities and satisfy the functional requirements of all authorized users. *RIS – Radiology Information System • A RIS system automates departmental operations such as patient administration, order entry, film tracking, transcription, electronic signatures, and report distribution. • Hint: In case of emergency, you may click Emergency instead of Exam. All mandatory fields will be filled automatically with dummy attributes which later have to be corrected. 27 Turnover Workbook | SOMATOM Definition AS - Sliding Gantry 6.3 Step 2 – Select a Scan Protocol Notes • In the Patient Model Dialog: • Select Adult or Child NOTE – For best image quality and dose reduction when scanning body regions, consider patient weight as opposed to patient age. For head examinations, patient age is preferred. • Move the mouse over the desired body region or one of the predefined categories (e.g, Cardiac protocols). • In the selection list: • Select the desired scan protocol. (e.g., AbdomenRoutine) Patient Model Dialog . Adult Qual Ener Protocol . Replace . Child . Append Pardia Topogram . Cut Vascular Abdomen SAFIRE . Keep AbdomenRoutine DSXXL_Abdomen AbdMultiPhase Auto reference lines None AbdomenSeq Colonography AbdomenIntervention rivat API Language German OK Cancel 6.4 Step 3 – Define Patient Position • Ensure that the correct patient position is selected, (e.g., head first-supine.) • Confirm your choices by clicking OK. 6.4.1 One room solution Patient Model Dialog . Adult Energy Protocol . Replace Child Abmend Cardia Topogram · Cut Vascular . Keep RT Auto reference lines None Specials Privat API Language German OK Cancel 6.4.2 Two room solution Patient Model Dialog . Adult > Supine al Ener Protocol . Replace . Child Prone . Append Left lateral ardia Right lateral Topogram @ Cut . Keep Room 1 Room 2 RT Auto reference lines None Specie Privat API Language German OK Cancel **When the scan protocol is loaded for scanning, the registered patient table and room and the gantry position are compared. If the locations differ, a warning is displayed. Be aware: Scanning is still possible! 28 Turnover Workbook | SOMATOM Definition AS - Sliding Gantry 6.4.3 Special Considerations for Sliding Gantry Notes • Due to the varying applications for the sliding gantry, your Siemens Applications Specialist will review patient positioning with you once onsite. • Third party tables can be used in combination with the sliding gantry, however NO communication between the table and the CT scanner exists. • For intraoperative installations, it is suggested to perform a “gantry movement test” after the patient has been positioned on the surgical table, prior to placement of sterile drapes. This will ensure no collision between gantry and 3rd party patient holding devices. • In general: • Move the Sliding Gantry into position with the operator panel which is now lit and available. • Continue gantry movement using the operator panel again, table now inside gantry, perform scan. • Pay attention to any body parts or other material that can obstruct the movement of the gantry. • For two-room solutions, patient orientation always refers to the gantry front side, regardless of the actual physical location of the patient table (either in front of or behind the gantry). • Use only positioning aids meeting CT requirements with respect to artifacts and x-ray attenuation. • Avoid collision during scanning when gantry tilt is used. 6.5 Preparing the Examination 6.5.1 STEP 1 – The Topogram Check topogram parameters • In the chronicle, select the “Topogram” entry. • In the Routine subtask card, check the topogram parameters. • Topogram length [mm]. • Tube position. • Scan direction. • Correct the topogram length and tube position, if necessary AbdomenRoutine (Adult) Abdomen 123 Total mAs: Topogram MA 36 1 Abdomen RT KV 120 Scentime 5.3 s Slice 0.6 mm Chronicle Topogrem length 512 mm Tube position Top & Bottom Later 1 Comments Table: Position H Height Load 328.5 - 100.0 Craniocaudal Recor Routine Scan Auto Tasking SimFE closed 27-Nov-2007 14:33: 56 2 29 Turnover Workbook | SOMATOM Definition AS - Sliding Gantry Load topogram Notes • Click Load. • The topogram parameters are confirmed. The Press START message is displayed next to the “Topogram” entry. Acquire topogram • On the control box, press the Start key. Topogram Press START 1 Abdomen • Hint: You can manually stop the topogram as soon as the desired scan region has been covered (Suspend button in the chronicle or Suspend key on the control box). • The topogram is displayed in the upper left segment (= topo segment) of the Examination task card. • The CARE Profile (in green) appears to the left of the topogram. 3 dinl'aire Car pat yna Sich Insia areve Bieter EN Examination Viewing -Topo segment AbcomenRetire (Adil, atconven. 123 10.10.14-13:24:07-STD- Total mas opa gran 205 Abdomen NIF- 1111 reyen 1' :3 Lelag Slice 50 Load Beco -1129.0 1253 Craniocoude Routine Scen Recor Auto Tasking • The scan and reconstruction ranges of the subsequent scans are displayed in the topogram. 30 Turnover Workbook | SOMATOM Definition AS - Sliding Gantry 6.5.2 STEP 2 - Planning the Spiral Scan Notes Select chronicle entry • In the chronicle, select the desired entry of the scan protocol. Example: Abdomen • The scan range or the first recon range of the Abdomen scan is selected in the topo segment, respectively. 2 AbdomenRoutine (Aciut) abdomen. 123 10.10.14-13-24.07-8TD- Total mks Topagram Abciorran P 111 . ram K Tall: Ficher LOS ILL 82293 Rovine Scon Recon Auto Toaking Move range • In the center of the range, drag the mouse (holding the mouse button pressed). The range is moved to the new position. • Hint: To move multiple recon jobs of a single spiral scan, move the blue scan range frame. 3 3 AbdononAquina (Adu:) abcloren, 123 10.10.14-13:24-07-STD. Totalmks: 184 Topoprem Abdamen OP 111 1 /3g(r cantir - Remo Bor E 130.C 23.0 Rocon | Auto Tasking Change length of range • Select the upper or lower handle of the range. • Drag the mouse (holding the mouse button pressed). • The length of the range is changed. 31 Turnover Workbook | SOMATOM Definition AS - Sliding Gantry Change FoV Notes • Select the left or right handle of the range. • Drag the mouse (holding the mouse button pressed). • The FoV is changed. Examination | Viewing AbdomenRoutine JAduts gbdamner 123 10.10.14-15:24:07-STD- Told me 18.4 Topopran FT TH Abdomen DLS: 11/ 13y'CT 5 30 Comment leicht -10220 - Scan Recon Auto Tasking Check and optimize parameters • In the chronicle, select the desired entry of the scan protocol. Example: Abdomen • In the Routine and Scan subtask card, check the spiral parameters and correct them, if necessary. • Hint: To resolve the scan parameter conflict, click the Adjust button (optional). Adjust • Hint: To avoid unwanted automatic image processing, check the parameters on the Auto Tasking subtask card as well. • Hint: To show all features of dose optimization which are activated for the selected examination, click the Show CARE Dashboard button. 32 Turnover Workbook | SOMATOM Definition AS - Sliding Gantry CARE Profile Notes • Overview • CARE Profile is a graphical display of the mAs distribution along the z-axis of the prescribed scan. It can indicate areas where system resources may be insufficient to meet scanning needs based on current parameter settings. • CARE Profile Curves • The CARE Profile will display in a variety of colors and patterns depending on the parameters and scan modes selected. By pointing out where conflicts occur, the area of the CARE Profile which exceeds system limits is colored depending on the amount of the exceedance. 285 MA. 247 241 200 1600 370 ............ V • CARE Profile-Green Curve • If you see the CARE Profile displayed in green, then the effective mAs needed for the scan can be applied by the scanner with no interaction to adjusting. • The load button is available to proceed to scan. 10.10.02-14:33:03-DST-Spec 10.10.02-14:33:03-DST-1.3.1 SOMATOM Definition Flash "18-Nov-1858. 0. 151Y CT 2011A 1.01 POS FOTOS :512 00 . ....................................... :1201 UOPO 1eva 33 Turnover Workbook | SOMATOM Definition AS - Sliding Gantry Notes • CARE Profile-Yellow Curve • If the yellow profile curve is present, then the effective mAs needed for the scan exceeds the system limit. The scan is invalid and action is required. The load button will NOT be available to proceed to scan. 247 10.10.07-14:33.03-DST-Speciali SOMATON DenDor Flash sp. 103 CT 2011A1 01_POO ............ .............................. OTOO s.3 ......................................................... 51200. 350 50 • CARE Profile-Yellow Peak • The yellow peak displayed on the profile curve suggests the system cannot deliver the effective mAs needed for the whole scan range. 10.10.02-14:33:03-DST-Specials ... H 241 10.10.02-14:33.03-DST-1.3.1 ... SOMATOM Definito "18 Nov 1858, 0, 151Y CT 2011A 1.01 :02-Oct-2010 :14 33 38 56 MA 35 512 0/0 T2Of UOPO leva ....................... • For example, if an obese patient or tube temperature conflict occurs, then action to adjust the parameters is recommended. Loading the protocol is possible and the scan range can be scanned but image quality may be insufficient. If the system parameters are not adjusted then the yellow peak is cut and the maximum mAs value is applied to that area. Normally, adjusting scan time or pitch would resolve the conflict. 34 Turnover Workbook | SOMATOM Definition AS - Sliding Gantry Notes • CARE Profile – Green Striped Peak • If the dose profile presents a green striped peak, then this area exceeds the system limit but image quality will be sufficient. Image quality issues are negligible and the load button is possible to proceed to scan. 10.10.02-14:33:03-DST-Specials ... H Hospita :10.10.02-14:33:03-DST-1.3.1. SOMATOM Dednion Flash "18-Nov 1858. 0. 151Y CT 2011A 1.01 POO -7510 KV mA 35 OTOO 512 00 T2OfUOPO leva .......... • If the scan is loaded, the striped area will be removed and the peak mAs will be cut to the maximum mAs. The length and strength of the striped range will affect the decision to adjust parameters. If parameters need to be adjusted, simply increase your scan time and the system limit will be resolved. • For detailed information on CARE Profile, please see: Life Card>Operator Manual>syngo® CT>Examination/Dose Management and Optimization 35 Turnover Workbook | SOMATOM Definition AS - Sliding Gantry 6.5.3 STEP 3 - Switching on API Notes Select chronicle entry • You can assign APIs (Automated Patient Instructions, or breathing instructions) to each range of a scan protocol. • In the chronicle, select the desired entry of the scan protocol. Example: Abdomen Examination Viewing 3D AbdomenRouting [Acht) abdamen, 123 10.10.14-13:24:07-9TD- Total m/s. 104 Topagram Abcionar K C1 más Gravine meat 821: 50 Language Eng sh Routine Recon AUlo Tasking Select the Scan subtask card. • Select the desired patient instruction from the list. API is activated for this range (API button is active). 6.6 Performing the Examination 6.6.1 STEP 1 – Load spiral scan • Click Load Load • The scan parameters are confirmed. • The Press MOVE message is displayed next to the “Abdomen” entry. Topogram Eff. r 1 Abdomen E Press MOVE 36 Turnover Workbook | SOMATOM Definition AS - Sliding Gantry 6.6.2 STEP 2 – Move Gantry Notes • On the control box, press the Move key until the gantry stops AbdomenRoutine (Acht) abdomen 123 205 m33 50 KV 8 95 3 6.0 mm /08 bclorien LPYoss START SP 1136 PROM riz. of na; : Fid TANA PORMor Herar Care -180.0 -7535 -25.0 Routine Been Recon Auto Tasking • The Press START message is displayed next to the “Abdomen” entry. Topogram Eff. r 1 Abdomen E Press START 37 Turnover Workbook | SOMATOM Definition AS - Sliding Gantry 6.6.3 STEP 3 – Start spiral scan Notes • On the control box, press the START key 3 Examination real-time images are AT 6J LI displayed in the TOMO SEGMENT TOPOGRAM SEGMENT AbdomenRoutine (Acht) abdamen. 123 10.10.14-13:24:07-STD-' Total mas 154 Topogran Abcloren 6 8 CHRONICLE Fid -230 5 - 2550 Fraiscasal H equine Been Recon Auto Tasking Results: • Display of remaining scan time in the chronicle • Display of current scan position in the topogram • Real-time images are displayed in the tomo segment 38 Turnover Workbook | SOMATOM Definition AS - Sliding Gantry 6.7 Reconstructing Images Notes 6.7.1 Step 1 – Select chronicle entry • At least one recon job is predefined for every chronicle entry. In order to start the first recon job: • Select the chronicle entry you want to reconstruct. reconstruction target Abdarenko.fine (AcL.E) abdomen, 123 10.10:14-13:24:07-31D' Total mhs 2349 Topogram Recon job 2 3 4 5 6 7 8 Series description Abdomen 1.0 B301 Abcborren Sices/rot: 256 Sice 1.0mm -J Recon job type · Axial . 30 K SAFIRE Recon region Narrow Wide . 1 Kernel B30f medium smooth None FAST - Window Abdomen Begin position -1473.0 mm 2 End position -1673.0 mm 24 HD FOV FoV 300 mm:2/ Image order Craniocaudal Center X 0 mm il Increment 0.15 mm 2/ Overview Center Y 0 mmes No. of images 1334 23 Mirroring None Comment Extended CT scale Routhe Scon Auto Tasking 2 6.7.2 STEP 2 – Create recon job Recon job 4 5 0-4 • A reconstruction target is displayed in the topo segment. • Check the parameters and change them as desired. • Hint: To create an additional recon job, click another Recon job. 6.7.3 STEP 3 – Adapt FoV In the tomo segment: • Zoom the image in or out by dragging the mouse up or down. • Adapt the FoV in the tomo segment, if necessary. 6.7.4 STEP 4 – Start reconstruction • Click Recon • Reconstruction starts. In the tomo segment, all images Recon calculated are displayed one after the other. 39 Turnover Workbook | SOMATOM Definition AS - Sliding Gantry 6.7.5 SAFIRE/Iterative Reconstruction* Notes Overview - Sinogram Affirmed Iterative Reconstruction • You can either use default SAFIRE protocols or adapt your own protocols. *Disclaimer: In clinical practice, the use of SAFIRE may reduce CT patient dose depending on the clinical task, patient size, anatomical location, and clinical practice. A consultation with a radiologist and a physicist should be made to determine the appropriate dose to obtain diagnostic image quality for the particular clinical task. The following test method was used to determine a 54 to 60% dose reduction when using the SAFIRE reconstruction software. Noise, CT numbers, homogeneity, low-contrast resolution and high contrast resolution were assessed in a Gammex 438 phantom. Low dose data reconstructed with SAFIRE showed the same image quality compared to full dose data based on this test. Data on file. Choose Default SAFIRE Protocols • SAFIRE default protocols can be found in the patient model dialog with the name SAFIRE in the protocol name. Abdomen SAFIRE AbdomenRoutine DSXXL_Abdomen AbdMultiPhase AbdomenSeq Colonography AbdomenIntervention • These protocols already have a reduced dose of approximately 20-30%. Adapt Your Own Protocols with SAFIRE • Switch on SAFIRE by clicking in the checkbox on the recon subtask card. Recon job 1 2 3 4 5 6 7 8 Slice 0.5 mm - SAFIRE Strength 3 Algorithm 130f medium smooth • The kernel will automatically change into the “partner” algorithm, (e.g., B40 becomes I40.) • All SAFIRE reconstruction jobs are marked in blue. • Click the preview function icon on the recon subtask card to determine SAFIRE strength. • Scroll through the scanned dataset and use the slider to pick the image that you want to use for the preview function. 40 Turnover Workbook | SOMATOM Definition AS - Sliding Gantry Notes • Select the different strengths from 1 to 5. • 1 = smooth • 3 = average (our default) • 5 = less smooth • The strength describes the intensity with which the iterative reconstruction algorithms are applied. The higher the strength, the lower the image noise in the reconstructed image but the more modified the image may appear. • By clicking on the numbers you select or deselect them. Black means “selected” and grey means “deselected”. • Then click on the preview icon. The strength you have chosen will show up in the image text. • In addition, you may also change the algorithm at this point or you can exit the preview mode and change the algorithm on the recon subtask card if desired. • After the preview, click on the image you like the most. It will be highlighted by a magenta border. • Click on “Accept” and all the parameters will be set in the recon subtask card. 11.09.29-1 11.09.29-11:15:57-DST-Spec 11.09.29-11:15 57-061-1 11.09.29-11:15 57-061.1 ... COMATOM DESAISON FUR 1.09.29-11 :15:57-DST- www 1868. 0. 162Y SOMATOM Definition Flart: CT 20128 0_201107 19_0 Now 1968. 0. 152Y 201 107 109 29-11:55:57-DST. CY 20120 0 201107 12-0 29-Se>-2011 H.SP.CR. 8. Now 1808. 0. 152Y 29-Sep- 2011 :11:17:00.37 Sep 2011 :101 IMA 1 11:17:00.41 1517:00.62 RTO 2 101 IMA 2 01 IMA 3 RTO 2 SP - 1902.0 SP -1107.0 -1112.0 T10.5 OTOO OTOO :442 -16/0 442-180 : D-4OF SORD ADeva Algorithm 126f medium smooth ASA Strength 1 2 345 V Abdomen_SAFIRE (Adult) 11.09.28-11:15:57-DST-Specials PolyTraun 11.09.28-11:15:57-DST TotAccept912 Topogram Recon job 1 2 3 4 5 6 78 Series description Abdomen 1.0 126f 3 Abdome Slice 1.0 mm Recon job type o Axial 3D SAFIRE Strength 3 4 Recon region: Narrow Wide . Algorithm 126f medium smooth ASA Upper Abdomen - Diaphragm to lliac crest • All preview images are stored in the local database. These images can be displayed on the viewing task card or networked to your physicians for review. For detailed information on SAFIRE, please contact the Siemens Customer Care Center at 1-800-888-7436 or see step-by-step instructions on education website. 41 Turnover Workbook | SOMATOM Definition AS - Sliding Gantry 6.8 Generating 3D Reconstructions/WorkStream 4D Notes 6.8.1 STEP 1 – Select chronicle entry • Prerequisites: 1. Raw data of spiral scan 2. Axial series is reconstructed from the raw data of the scan range 3. Center X, Center Y and FoV are the same for all images of the series • Select the chronicle entry you want to reconstruct as a 3D recon job. Example: Abdomen Patent Applications Edit bosert View Setup Image Options System Help 122 HoopHal AS dansa Examination Viewing 122 15.Apr-1001, N. 45Y "15 Ap+ 1201, M. G 122 23-Nr+2003 23- No4-2006 10:30 -42.72 23-8re-2003 10 :38:4272 a) coronal b) axial c) sagittal LA F BL J.D Resolution 512 square Planning base Abdomen 5.0 B30f AbdomenRoutine (Adult) Abdomen 123 Total mAs: 1277 Topogram Recon job 8 Series description Abdomen 1.0 SPO Abdomen Recon job type axial Sice 1.0 mm Recon axis oblique 1 Type SP oblique Kemel B20f smooth Window Abdomen mage order Head to feet Position increment 0.7 mm 2 FOV 285 mm x 285 mm ] No. of images 238 | Comments Recon Routine Scan Recon | Auto Tasking SimFE closed 13-Dec-2007 16:27:0 6.8.2 STEP 2 – Select 3D recon job • In the Recon subtask card: • Click 3D as Recon job type. • The three 3D recon segments are displayed. Each segment shows one plane of the image volume. • Example: a. planning segment (coronal) b. output segment (axial) c. planning segment (sagittal) 42 Turnover Workbook | SOMATOM Definition AS - Sliding Gantry 6.8.3 STEP 3 – Change recon axis Notes • In the Recon axis selection list: • Select the desired recon axis. Patient Applications Edit Image Options System Hek Examination Preview ""coronal 123 "15 A2+- 1201, M. - GY 23-Hre2003 10:36:42 72 23-Hre2003 10-50:42 7 Viewing Filmit LAL BLO.D Resolution 512 square Planning base en 5.0 B30f AbdomenRoutine (Adult) Abdomen 123 otal mAs: 1277 Topogram Series description Abdomen 1.0 SPO cor Abdomen Recon job type axial 5 30 Sice 1.0 mm Recon axis coronal Type SP oblique Kemel B20f smooth Window Abdomen Image order Anterior to posterior Position increment 0.7 mm 2 FOV 285 mm x 285 mm 31 No. of images Comments Recon Routine Scan Recon |Auto Tasking imFE closed 13-Dec-2007 16 28 1 6.8.4 STEP 4 – Create preview • To check the recon parameters, you can create a preview image. • Click Preview Image • The preview image is displayed in the output segment. • To display another preview image: • Move the cut line of a planning segment. 43 Turnover Workbook | SOMATOM Definition AS - Sliding Gantry 6.8.5 STEP 5 – Optimize recon range and image display Notes • In a planning segment (segment 2 or 3): • Optimize the recon range. • Select a 3D recon segment. • Optimize the image display (window, zoom, pan). Patient Applications Edit bsert View Setup Image Options System Help Hospital Examination "15 A2+- 1201, M, GY 122 15.Apr-1961, M. 45Y 122 "15 A2+- 1201, M, GY 23-Hre2003 10:36:42 72 23- Now-2006 23-Nr+2003 10:58:4272 JPM 3 Viewing 5 AA Resolution 512 square Planning base Abdomen 5.0 B30f AbdomenRoutine (Adult) Abdomen 123 Total mAs: 1277 Topogram Reconjob ~ ~ 2 2 8 6 8 Series description Abdomen 1.0 SPO cor Abdomen Recon job type ercial 5 30 Sice 1.0 mm Recon axis coronal Type SP oblique Kemel B20f smooth 6 Window Abdomen mage order Anterior to posterior Position increment 0.7 mm 2| FOV 285 mm x 285 mm ] No. of images 408 | Comments Load Recon Routine Scan Recon |Auto Tasking SimFE closed 13-Dec-2007 16:28 6.8.6 STEP 6 – Start 3D reconstruction • Click Recon. • The system returns to the two-segment screen layout. The reconstructed images are displayed in the tomo segment. 6.9 Ending the Examination • Before ending the examination, please make sure that • all reconstruction jobs have been initiated (if possible) • scans are protected and cannot be deleted if reconstruction jobs are incomplete • individual series will not auto-send until reconstruction is complete 6.9.1 STEP 1 – Complete examination • Click Close current patient. 44 Turnover Workbook | SOMATOM Definition AS - Sliding Gantry 6.9.2 STEP 2 – End examination Notes • In the Chronicle dialog box: • Click Yes. Yes ....................................................... • All images of the patient are closed and removed from the Examination task card. Chronicle Do you want to close the current patient ? Yes A‘ No For detailed examination instructions of the system, please see: Life Card > Operator Manual > syngo® CT > Examination 45 Turnover Workbook | SOMATOM Definition AS - Sliding Gantry 7 Contrast Enhancement Overview Notes • This section discusses contrast enhancement and the importance of bolus timing. • We determine the optimal time delay for: • Maximum uniform opacification • Reduced contrast dosage • More precise phase scanning HU Early Late Optimal Window Time 7.1 Objectives After this session, you will be able to: • Utilize CARE Bolus and/or Test Bolus to monitor contrast enhancement during an examination 7.2 CARE Bolus • Automatic Bolus Tracking (CARE Bolus) monitors the flow of CM in the vessel and triggers the scan at a predefined HU value. It does not require an additional injection of CM but uses the injected CM for the diagnostic scan (spiral, sequence, adaptive 4D spiral, multiscan, Heart Perfusion scan, etc.). Principles of CARE Bolus: Pre-monitoring Start Injection Monitoring reference scan Spiral scan scans --- -- • Tracks the arrival of the contrast bolus in real time. • Tailors the start of the spiral scan to each patient. • Achieves optimal enhancement without guesswork. • Fast response to trigger (~2 seconds). • Automatic API and scan start after trigger. • Manual start is possible. 46 Turnover Workbook | SOMATOM Definition AS - Sliding Gantry Injection protocol example: Notes • 65-150 ml @ 4-6 ml/second • With or without 50 ml saline chaser @ 4-6 ml/sec • Ascending aorta • Scan delay of 10 seconds • Cycle time of 2 seconds 7.3 Test Bolus • Small compact bolus of about 20 ml @ 4-5 ml/second • Scan at the level of the ascending aorta • Low dose Test Bolus protocol with an image at ~2 second intervals • Scan delay of about 10 seconds (default value in protocol) • Use Dynamic Evaluation to determine time to peak TEST BOLLE 9Min 930 B/24/2005 14: 34: 22.47 240 63D O 9 102 436 170 204 238 242 ROI placement in ascending aorta DynEva Time-to-Peak Graph For detailed information on CARE Bolus, please see: Life Card > Operator Manual > syngo CT > Examination / CARE Bolus CT 47 Turnover Workbook | SOMATOM Definition AS - Sliding Gantry 8 Reviewing and Postprocessing Images 8.1 Objectives Notes After this session, you will be able to: • View images and perform basic image manipulation using the Viewing Task Card 8.2 Viewing Task Card Overview The Viewing task card is your tool for viewing, optimizing, and evaluating the patient’s images for diagnosis. It is able to display the acquired images in several layouts. It provides many advanced functions for evaluation such as distance measurements and ROIs (regions of interest). Up to three patient “folders” may be opened at a time. Contains tool cards for: • View • Image • Tools • Patient • Evaluation The Viewing task card consists of 4 areas: 1. Main Menu The Main Menu provides you access to all functions of the Viewing task card. The menu item corresponds to the tool cards. 2. Image Area The images are displayed in the segments of the Image Area. You can scroll through series and studies and optimize the images. 3. Control Area The Control Area consists of a Patient Information Area (3 folders) and the tool cards. 4. Status Bar This area will show background functions that are currently running, information and error messages, and a graphic representation of the Image and Data capacities of the system. Main Menu Tools Scrol Exslysdon Options System CT. Abd w Eslayed Diedider F-OP-OR Ed ww Delayed Ela: 15.3542 19 Control Area Image Area Status Bar 07-Oct-2013 Tools Cards 48 Turnover Workbook | SOMATOM Definition AS - Sliding Gantry 8.3 Viewing Tab Cards Notes Tools Card Tools Image View • ROI Circle • ROI Rectangle • ROI Irregular • Distance • Pixel Lens • Freehand Distance • Angle • Annotation • Crosshair :::"::::: 49 Turnover Workbook | SOMATOM Definition AS - Sliding Gantry 8.4 Properties for Tools and Graphic Objects Notes To modify the Properties of a Tool before use, right-click on a tool icon on the Tool palette and choose Properties from the Context popup menu. Image Card Tools Image View • Magnify by 2.0 • Zoom/Pan • Mirror Vertical R • Mirror Horizontal • Rotate 90° • Window 1 & 2 N. Modifying or creating new window settings: • Select Options > Configuration from the main menu. mage Options System Help • Double-click on the Viewer icon in the Configuration panel. • Select the Evaluation General tab in the Viewer Configuration window (third tab). • Select the desired window from the drop-down list. • Change values or add new windows as required. • Select Apply at the bottom of the window for each window that is modified or created. • Remove windows with the Delete button. Example – zooming images • Click the Zoom/Pan icon. • Place the mouse close to the edge of the image. The mouse cursor changes shape. • Drag the mouse up - the image size is enlarged- or down -the image size is reduced. • To restore the original display, click the Reset Zoom/Pan icon. 50 Turnover Workbook | SOMATOM Definition AS - Sliding Gantry Example – panning images Notes If parts of the zoomed images extend beyond the image segment: • Click Zoom/Pan icon. • Place the mouse in the center part of the image and the mouse cursor changes shape. • Drag the mouse up, down, right or left. Now you can move the image accordingly. In the View task card, you can change the screen layout as desired. View Card Tools Image View • Image Stripe • Series Stack • Interactive Movie • 1:1 to 64:1 Display Layouts • Multi View Patient Card • Patient Register Patient Eva • Close Patient • Scheduler (Browser) • Film Preview • Copy to Film • Local Database (Browser) • 3D/MPR (CT) 51 Turnover Workbook | SOMATOM Definition AS - Sliding Gantry 8.5 Selecting Images Notes Selecting a single image • Click an image to select it or use the arrow keys of the keyboard to change the current selection. The image is marked with a dashed border. Selecting images explicitly • Hold the Ctrl key down and click individual images (multi-select) or hold the Shift key down to select several consecutive images. The selected images are marked with a continuous line border. Selecting images up to the end of series • Select a single image. • Select Edit > Select On Succeeding from the main menu. 52 Turnover Workbook | SOMATOM Definition AS - Sliding Gantry Selecting complete series Notes • Select an image from each required series individually. • Select Edit > Select Series from the main menu. 53 Turnover Workbook | SOMATOM Definition AS - Sliding Gantry 9 3D Task Card This section discusses postprocessing programs: Notes • MPR-Multi-Planar Reformations • MIP-Maximum and Minimum Intensity Projection • SSD-Shaded Surface Display • VRT-Volume Rendered Technique (optional) • 3D Bone Removal 9.1 Objectives After this session, you will be able to: • Manipulate and post-process images using MPRs, MIPs, SSDs, and VRTs • Create parallel and radial ranges • Perform Bone Removal 9.2 MPR Multi-Planar Reformations are 2D reconstructions based on a volume relative to a certain axis. Standard views can be generated in these planes: • Coronal: a plane view from the front or back • Sagittal: viewed from the left or right side • Paraxial: a straight line angled off of the X, Y or Z axis • Curved: a curved plane image 54 Turnover Workbook | SOMATOM Definition AS - Sliding Gantry 9.3 How to create an MPR Notes STEP 1: Open the patient browser. STEP 2: Select the series you want to create MPRs from. STEP 3: Load selected images into the 3D task card via Applications > 3D > MPR or choose the icon in the toolbar of the patient browser. a) Type Otion .. | Image A Reference lines C) The images are displayed as multiplanar reconstructions (MPR) on the 3D task card. a.) sagittal view b.) coronal view c.) axial view Colored reference lines in the image indicate the position of the other two slice planes. Example: Sagittal image (red border) and red reference lines in the other two segments 9.4 Generating a series of parallel images STEP 1: Select a reference line • Click the desired image. • Click a reference line, e.g., coronal reference line. 2 Setti .. Tools 55 Turnover Workbook | SOMATOM Definition AS - Sliding Gantry STEP 2: Create a parallel range in the Settings subtask card: Notes • Click Parallel Ranges. • The dialog box 3D Parallel Ranges opens. • Displays on the screen: • in the reference image: horizontal range (yellow) • in the 4th segment: center image of the range STEP 3: Define the range Example: Adapting the distance between the images • In the dialog box 3D Parallel Ranges: • Ensure that Constant Number of Images is pressed. • Drag the outmost line of the range. The distance between the images is adapted. The number of images remains unchanged. Aidaven 123 15-AT-1561 , 14 45Y 23-Nov-3009 10:58 4275 5 M40 3D: Parallel Ranges Presets AngoCarod mage thickness 3.0 mm Distance between images 2. mm Number of imanas Stert glose Help Alternative: You may also define the range by adapting the number of images. In this case, deselect the Constant Number of Images icon and drag the outmost line of the range. The number of images is adapted. The distance between the images remains unchanged. Hint: To change to a vertical orientation, click Vertical Ranges. 56 Turnover Workbook | SOMATOM Definition AS - Sliding Gantry STEP 4: Move the range Notes • Place the mouse on the center point of the range. • The mouse cursor changes shape. • Drag the center point of the range to the new position. 1-23 16-AR-1561,N. 4BY 22 Nov.2009 10:53:42 75 5 MAO 5 23 18-AR-1561,N. 4BY 12. Nov.2009 0 53 42 75 MAO STEP 5: Tilt the range • Place the mouse on the center line of the range (not the center point). • The mouse cursor changes shape. • Rotate the line about the center point. STEP 6: Generate the image series • Click Start. The 3D range is displayed as an image stack in the 4th segment. 3D: Parallel Ranges Presets Defaut Parallels29 X Image thickness 10 mm Distance between images 5.0 mm Number of images 20 Start Close Help 6 A 57 Turnover Workbook | SOMATOM Definition AS - Sliding Gantry STEP 7: Click Save Notes The image series is stored to the database. Hint: To assign a specific name to the reconstructed image series, click Save As. 9.5 MIP: Maximum Intensity Projection • Maximum Intensity Projection images display the highest densities found within the volume and can be viewed from any direction. The blood vessels with contrast are shown very clearly while other tissues appear gray. • Differentiation between calcium and contrast medium is clearly visible. • Used most commonly for display of vascular structures in 3-Dimensional views. 10 mm MIP Thin 70 mm MIP Thin MIP (Volumetric MIP) • Renders MIP images in any volumetric projection or view. • May be rotated in the X-, Y-, or Z-axes interactively or at specified angles. MIP Thin (Thin slab MIP) • Renders a definable MIP slab. • Can be used with the Parallel Ranges function. 58 Turnover Workbook | SOMATOM Definition AS - Sliding Gantry VOI Clip Box and VOI Punch Mode Notes • Bony structures may cause interference in MIP images because of their similar densities to contrast medium-enhanced vasculature. • The principle is to remove bone structures from images so that only the remaining structures, usually the vessels, can be displayed in the rendered MIP. • Also useful when using SSD and VRT. A 9.6 SSD: Surface Shaded Display Con • Used to show surfaces of all objects within threshold. • Bone rendering is the most common use for SSD. • Density information is lost. 59 Turnover Workbook | SOMATOM Definition AS - Sliding Gantry SSD Threshold Notes • Threshold=Density • Right-click on the SSD icon to call up the SSD Definition box. • A setting of 150 is typical for bone. • Other threshold values may be used. SSD Definition x Presets Default CT -1024 |1 307 1 Low value 150: 3071 Highvalue High Quality Close Help 9.7 VRT: Volume Rendered Technique • VRT renders the entire volume of data rather than just surfaces (SSD, single threshold) or maximum density values (MIP). • A number of anatomical structures can be simultaneously displayed with various brightness levels, degrees of opacity, and different colors. • VRT images can be transparent, allowing visualization of what is behind overlying anatomic structures (lower opacity values with a “see-through” effect). • Edit interactive with clip planes to remove unwanted data. SPIT 3T RA Volumetric rendering • Useful for angio mapping. • Often eliminates the need to edit away overlying structure. • Use with Radial Ranges for 360° rotational views of the anatomy. • Unlike MIP or SSD, you are able to window anatomy in or out of the image. 60 Turnover Workbook | SOMATOM Definition AS - Sliding Gantry VRT Thin Notes • Similar to MIP Thin and MPR with adjustable slab definition, but able to window anatomy in or out of the image. • Can be used with Parallel Ranges. 9.8 syngo® 3D Bone Removal The syngo® 3D Bone Removal function provides a set of algorithms that you can use for CT datasets. With this function you can create an edited version of the volume by masking out bones. After you have identified structures in the volume as bone, you can choose different approaches to visualize or hide the bones in the dataset. 1. Open the Patient Browser by selecting Patient > Browser from the upper left hand corner menu. 2. Select Local Database, which will display all of the patient examinations currently available on the system. 3. Find the desired patient and single-click on the patient name, highlighting it in blue. 4. Single-click on the desired study series (preferably a series of thinly-sliced images with overlap). Singleclick the series to highlight it in blue. 5. Load the series into the 3D application by selecting Applications > 3D > MPR from the upper left hand corner menu. 6. Select the Bone Removal icon on the Settings palette: Setti ... Tools 3D Bone Removal 7. The 3D Bone Removal dialog box guides you through the masking process in three easy steps: 61 Turnover Workbook | SOMATOM Definition AS - Sliding Gantry Step 1: Select Region Notes • Click the icon that corresponds to the body part scanned. • Body: body (thorax, abdomen, pelvis, extremities). • Head: head and neck CTAs. • Fracture: Used to separate two opposing joints for evaluation of fractures. 3D: Bone Removal X Step 1: Select Region Advanced >> Step 2: Refine Step 3: Finish Close Help • Once you select the body region, the software will automatically begin the segmentation. Step 2: Refine • Once the segmentation is complete, the Step 2 dialogue box opens. 3D: Bone Removal x Step 1: Select Region Step 2: Refine Advanced >> Step 3: Finish Close Help 62 Turnover Workbook | SOMATOM Definition AS - Sliding Gantry • Step 2 allows you to refine the bone mask. Notes 3D: Bone Removal x Step 1: Select Region Step 2: Refine Set marker Advanced >> Step 3: Finish Close Help • To use, click on the Set Marker icon. By setting markers in the images you are able to: • remove bone fragments that are not removed in the automatic segmentation. • redisplay vessels, plaques and stents which were removed by the automatic segmentation. • Click on the desired anatomy to include or exclude it :11-Oct-1971, M, 36Y Emotion 16 (2007) *11-Oct-19 18-Mar-2008 CT 2007E 18-Mar-20 Step 1: Select Regi 10:28:16.22 10:28:16.2 9 IMA O 9 IMA 0 Step 2: Refine MPR MPR Spin: -90 Click on cortical bone R Advanced >> Step 3: Finish SL 0.75 881 SL 0.75 • You may use the undo / redo buttons to go back or forward steps. • Continue this process until the desired anatomy has been selected. 63 Turnover Workbook | SOMATOM Definition AS - Sliding Gantry Step 3: Finish Notes • In the Step 3: Finish tab card you can control the visualization of the segmented volume and save the results and the bone mask. 3D: Bone Removal X Step 1: Select Region Step 2: Refine Set marker Advanced >> Step 3: Finish Close Help • The Display Mode offers four display options: • Bone: the bone mask is inverted. The bone is shown and any non-bone tissue is hidden. • Highlight: Displays the Bone Region in color inside the VRT Transparent. • Non Bone: The bone mask is used to remove the bone from the volume that is displayed. • Both: the bone mask is NOT used; the whole volume is displayed as it was loaded. • The Opacity slide bare allows you to set the opacity of the segmented anatomy when viewing in the composite mode. • Use the Save icon to save your work in the current state. • Close the Bone Removal tool when done. 8. The resulting data set can be displayed as a VRT or a volume MIP. You can then create radial ranges or other images for transfer and archival to PACS or external media. 64 Turnover Workbook | SOMATOM Definition AS - Sliding Gantry 9.9 MIP, SSD and VRT - Radial Ranges Notes The Radial Ranges function renders rotational views of MIP, SSD and VRT in any projection or view, including the X-, Y-, or Z-axes. Setti .. Tools • This button is located on the Settings sub task card. Default 3D layout X N Default 3D layout showing the planning segments for the X -, Y- and Z- axes. X-axis rotations are planned from a lateral presentation. Also known as R to L axis. Basic Rotational Views For more information on 3D Y-axis rotations are planned from an AP or PA presentation. Also known as A to P axis postprocessing, please see: Life Card > syngo CT > Routine Postprocessing Z-axis rotations are planned from an axial presentation. Also known as H to F axis. Life Card > Workflow Assistant 65 Turnover Workbook | SOMATOM Definition AS - Sliding Gantry 10 Data Management 10.1 Objectives Notes After this session, you will be able to: • Store images to external media, network images to remote devices, and delete data from the system. 10.2 Storing Data STEP 1: Select data You can store your data to approved media such as CD or DVD. Note: CDs and DVDs are not suitable for long-term storage. Note: Only use medical grade CDs and DVDs. Medical grade media are available through your Siemens representative. Example: Storing to DVD • Insert the DVD into the drive. • In the Patient Browser: Select the data you want to store. Patient Applications Transfer Edit View Filter Evaluation Sort Options Heb Import Col+l XH Eject from DV 2 Eject from .. Finalize Medium and Ejectfrom DVD-Combo Local Job Status .. Ctrl+L Local Database Network Job Status .. COM+N (602] Scheduler gort from Off-line Export to Off-I ne [5] Abdomen 10 DVD.Combo Record Off-Ine Files [501] Patient Protocol Export To Destination DVD. Writer Compression |Queli ... |Label on medium |Medium Capacity|Total Capacity None 665 31 MB 700 31 MB Export Cancel Help 66 Turnover Workbook | SOMATOM Definition AS - Sliding Gantry Notes • Select Transfer > Export to. The Export To dialog box opens. STEP 3: Choose media Export To X Destination Compression |Quali ... Label on medium | Medium Capacity Total Capacity DVD-Vinter None 665 31 MB 700 31 MB Enter Label X Export Ce Device DVD-Writer Help 3 Label on medium ABOMEN Viewing tool OK Cancel Help • Select DVD-Writer from the list. • IV Click Export. The Enter Label dialog box opens. STEP 4: Store data • Enter a label for the DVD. • Click OK. • The series is stored to DVD. STEP 5: Eject DVD • In the Patient Browser, click Finalize Medium and Eject from DVD-Writer (selectable only if storage is completed). The DVD is ejected. 67 Turnover Workbook | SOMATOM Definition AS - Sliding Gantry 10.3 Networking Notes STEP 1: Select data If your system is connected to a network, you can send data to other workstations via the network. • In the Patient Browser, select the data you want to transfer via the network. STEP 2: Launch transfer Click Transfer > Send to. The Send To dialog box opens. Alternative: To send data to predefined network addresses (set up by Siemens Service) click a Send to Node button (e.g., Node 1). STEP 3: Choose network node • Select the desired network node from the list. STEP 4: Send data • Click Send. The data is sent to the selected network node. 68 Turnover Workbook | SOMATOM Definition AS - Sliding Gantry 10.4 Deleting Data Notes STEP 1: Select data Note: You can delete patient data only if no other application is accessing the same data. • In the Patient Browser, select the data you want to delete. Example: Image series Patient Browser Patient Applications Transfer Edit View Fiter Evaluation Sort Options Help ?? 3D_Sub_Patient_1 Local Database Abdomen Abdomen Abd [602] Scheduler Antwerp_VENUS, M [5] Abdomen 1. DVD-Combo Argus, Anton [501] Patient Protocol Argus_Test Delete Confirmation Do you realy want to delete the selected objects? Yes No Help STEP 2: Delete data X • Click Delete. • Confirm with Yes in the dialog box displayed. The selected series is deleted from the database. For more details, please see: Life Card > syngo CT > General Life Card > Operator Manual > SOMATOM > System Handling 69 Turnover Workbook | SOMATOM Definition AS - Sliding Gantry 11 Sliding Gantry Installations The CT Sliding Gantry has multiple applications depending on the Notes environment of its installation. • Miyabi: CT/Angio C-Arm (Artis) • CTVision™ Radiation Therapy • Intra-Operative 1 and 2 room solutions • Trauma Solutions 11.1 Objectives After this session, you will be able to: • Appreciate the versatility of the CT Sliding Gantry system as used in angiographic, radiation therapy, operative, and trauma environments. 11.2 Sliding Gantry in the Angiography Suite – Miyabi Siemens’ SOMATOM Sliding Gantry in conjunction with an AXIOM Artis angiographic system opens new horizons for image-guided angiographic interventions. Both the sliding gantry CT and the angiographic system operate with a common patient table, which accommodates the floating features required for DSA and fluoroscopy applications and the fixed table required for sliding gantry CT. The SOMATOM Sliding Gantry CT system offers better low-contrast resolution than available with an angiography system, and can display data as a 3D volume. The addition of CT imaging makes vessel navigation during intervention much simpler. 70 Turnover Workbook | SOMATOM Definition AS - Sliding Gantry 11.3 Sliding Gantry in Radiation Oncology - CTVision™ Notes CTVision™ System is a fully integrated image-guided radiation therapy (IGRT) solution that enables in-room CT imaging immediately prior to radiation treatment. Tumors often shift over the course of radiation treatment due to internal organ movements and volume changes. CTVision solves this challenge by offering precise, 3D tumor localization immediately prior to treatment through the integration of the SOMATOM Sliding Gantry within the treatment room. 11.4 Sliding Gantry in the Operating Room SOMATOM Sliding Gantry enables high resolution CT imaging to be utilized during surgical procedures without the need to move the anaesthetized patient. The SOMATOM Definition or Sensation is installed in a sliding gantry configuration within the operating room. When used in conjunction with a radiolucent operating table, the SOMATOM Sliding Gantry CT enables real- time scanning to correct operative techniques for any shift in organ position since imaging planning was undertaken. 71 Turnover Workbook | SOMATOM Definition AS - Sliding Gantry Intra-Operative 1 room solution: front Patient Table Gantry Parking Position Examination range Working with a one room solution is similar as working with a normal CT Scanner. A gantry movement towards the patient table is displayed as a negative value. A gantry movement away from the patient table is displayed as a positive value. 72 Turnover Workbook | SOMATOM Definition AS - Sliding Gantry Intra-Operative 2 room solution: Room 1 Room 2 front Patient Table Gantry Transfer Zone Examination range Parking Position • Examination Range: It is possible to scan in this area • Transfer Zone: It is NOT possible to scan in this area. The gantry will stop when moving into the transfer zone. • Press the marked gantry panel button and then the gantry can be moved in and out the transfer zone 73 Turnover Workbook | SOMATOM Definition AS - Sliding Gantry Notes Patient Model Dialog Box for 2 room solution: Patient Model Dialog . Adult · Supine Enero Protocol . Replace Child Prone Append Left lateral di Right lateral Topogram @ Cut Room 1 Room Scu o Keep RT Auto reference lines None beci iva API Language German OK Cancel Routine Subtask Card: Room 1 in Use mA 35 KV 120 - Scan time 5.2 s Slice 0.6 mm Topogram length 5mm Tube position Top . Bottom · Lateral Comments Position 2352.0 Craniocaudal 04 Routine Stubtask Card: Room 2 in Use: MA 35 kV 120 - Scan time 5.2 s Slice 0.6 mm Topogram length -12mm Tube position . Top Bottom . Lateral Comments [ Position 2352.0 Craniocaudal 74 Turnover Workbook | SOMATOM Definition AS - Sliding Gantry Notes • In room 1 facing the gantry the behavior is the same as with the one-room solution. • In room 2 behind the gantry a gantry movement towards the patient table is displayed as a positive value. A gantry movement away from the patient table is displayed as a negative value. The size of the examination, travel and parking zones will be defined during installation and can vary from site to site and room to room. 2011/10/20 12. ..... 75 Turnover Workbook | SOMATOM Definition AS - Sliding Gantry 11.5 Sliding Gantry in the Emergency Department – Trauma Notes Solutions A SOMATOM Sliding Gantry solution has the potential to further optimize the use of CT in the emergency room and eliminate the need for multiple patient transfers between different rooms and imaging tables. The application of a sliding gantry solution means that the CT system can move instead of the trauma victim, both saving time and reducing the risks associated with patient movement. 76 Turnover Workbook | SOMATOM Definition AS - Sliding Gantry 12 Sliding Gantry Safety, Tips and Tricks Third party tables can be used in combination with the sliding gantry. Notes • CAUTION: When you move the gantry there is NO communication between the table and the scanner system • 2 room applications: Patient position can be difficult when using room 2 (back of gantry). Take care to observe patient at all times during system movements • The Gantry Tilt must be at ZERO to move gantry into the “PARK” position • Table movement is only possible with table controls • It is not possible to use gantry panels for table movements • Rails are normally installed on the floor; however, ceiling mounted rail systems may be possible • Daily QA: Secure the phantom holder to the table prior to placing phantom on the holder. • When C-Arm is installed too, then the gantry must be in the Parking Zone to let the C-Arm system move. • When the gantry is tilted it is not possible to move into the transfer zone. Tilt must be 0°. • Tilt is not possible when the gantry is in the transfer zone • When the gantry is on the transfer zone this icon will indicate it in the status bar. 77 Turnover Workbook | SOMATOM Definition AS - Sliding Gantry 13 Exercises Exercise 1 : Notes Perform the daily quality measurement. Exercise 2: 1. Position patient for head CT. 2. Register the patient. 3. Select a head scan protocol. 4. Scan. 5. Store images (film and send to PACS). 6. End the exam. Exercise 3: Describe the steps involved when turning the scanner on and off. Exercise 4 : Sort the browser in chronological order and describe each step. Exercise 5: 1. Position patient for an abdomen and pelvis CT. 2. Register the patient. 3. Select the appropriate protocol. 4. Scan. 5. Create a set of sagittal and coronal MPRs in the WorkStream4D. Describe each step. 6. Store all images. 7. End the exam. Exercise 6: 1. Reload an existing abdomen/pelvis CT back into the Exam card to reconstruct thin, overlapped data for MPR spine (disc space) reconstructions. 2. Change the FoV to the vertebras. 3. Describe each step to your Education Specialist. 4. Create axial MPRs through the disc spaces of at least two vertebras. 5. Label each disc space. 6. Save and send to PACS. Exercise 7: 1. Load an abdomen case into the viewing task card. 2. Make a distance measurement of the left kidney and make one HU measurement. 3. Save this image as a separate series in the browser. Exercise 8: 1. Explain the difference of thin MIP and MIP. 2. Create a range of thin MIPs of a CTA in the 3D task card. 78 Turnover Workbook | SOMATOM Definition AS - Sliding Gantry Exercise 9: Notes 1. Create an MIP of a CTA (no bones). 2. Explain what tools you use and what the steps are. 3. Label and save the MIP images as a separate series in the browser. Exercise 10: 1. Filter the browser so you only see cases that have not been archived yet. 2. Describe the steps necessary to archive from the browser. Exercise 11: 1. Walk your Education Specialist through the steps of scanning a CTA including what contrast enhancement tool you will be using. Describe the steps it takes for optimal peak enhancement. Exercise 12: 1. Describe dose reduction protocols and techniques as implemented in your scanner, and describe to your Education Specialist what they mean and how they work on a very high level. 79 Turnover Workbook | SOMATOM Definition AS - Sliding Gantry 14 References 1. Operator Manual Notes 2. Life Card 3. syngo® Basics workbook 4. CT Essentials 5. Quick starter Definition AS 80 Turnover Workbook | SOMATOM Definition AS - Sliding Gantry 15 Glossary Acquisition Time This is the time from when the data acquisition starts until it ends. Algorithm An algorithm is a mathematical calculation used to enhance image quality in a CT image. From the acquired data set, images can be calculated with good edge definition (sharp), but also a high noise level, or a lower noise level (smooth), but also reduced edge definition. This is also called a Kernel. Analog to Digital Converter Function A group of electronic components for converting an analog input signal, usually in the form of a voltage, into a digitally coded output signal describing the input magnitude. Attenuation The reduction of the intensity of an X-ray beam as it passes through an object. Artifacts The various structures or patterns that may appear in a CT image but are not found in the original object. Back Projection The process of forming an image from projections collected during scanning. Beam Hardening Artifact An effect caused by the attenuation of low energy photons in the middle of the object, resulting in an increase in the X-ray energy at the center of the object. C.A.R.E Siemens’ marketing acronym for Combined Applications to Reduce Exposure. C.A.R.E. Bolus An automated software package to aid in determining the scan delay time for CT to obtain peak opacification of vessels. Generically called bolus tracking. Collimator The device used for collimating the X-ray beam to a desired slice width. There are normally two uses for the word collimator in a Siemens Multislice CT system. 1. The tube collimator: Used for collimating the width of the X-ray beam immediately leaving the tube, also called the “prepatient collimator.” It determines the width of the beam profile and thus the slice collimation, i.e., how much of the detector array is being exposed to radiation. 2. The detector collimator: Synonymous with detector size. When you select the collimator size, you are actually telling the system which detector size to use, e.g., 1.2 mm vs. 0.6 mm. Combi Scan This feature allows image reconstruction for both high and low contrast studies from a single spiral run. For example, using narrow slice collimation for data acquisition, then reconstructing images as narrow slice widths (for Hi-Res studies, or better postprocessing) and as thick slice widths for soft tissue studies. With a single slice CT, the acquisition has to be done twice. Contrast Resolution A CT’s ability to display, as distinct entities, two objects that differ in density by a small amount. Conventional CT Scanning The tube/detector rotates around the patient and the table would then move to the next slice position. This process would be repeated until the selected area is scanned. See Sequence Scanning. Convolution Kernel The factor used on raw data to calculate the sharpness of a pixel in a CT image. See Algorithm above. D.A.S. The Data Acquisition System is the computer system within the gantry responsible for collecting the electronic signal from the detector and converting it into digital form as an input for the image reconstruction system. Data Refers to information collected by the DAS before convolution and back projection and the actual image reconstruction. It may also refer to image data, which is the actual image. Detector The device that receives the transmitted radiation from the patient and converts it into an electronic signal. All Siemens scanners are equipped with UFC detectors. Detector “dead space and shadow effect” Dead space is the mechanical divider in between each detector row, absorbs X-rays, but does not provide any signal output, thus reducing the dose efficiency of the detector. Analogous to grid cutoff in plane film radiography. Display Field of View Size or FoV of image display on monitor. Dose The number of X-ray quanta used to generate the image, measured in mGy. The higher the dose, the lower the image noise. As a rule of thumb, noise is reduced by a factor of 1.4 when dose is doubled. Feed/Rotation Time The distance the table feeds during one rotation of the tube/detector system. Flying Focal Spot The electromagnetic deflection of the beam focus resulting in double sampling within a single projection. 81 Turnover Workbook | SOMATOM Definition AS - Sliding Gantry Full Width Half Max Point spread profile of a wire phantom measurement used to determine the slice thickness of an image. Generator The generator is the device that generates the high voltage and applies it to the X-ray tube for generating X-ray output. Gray Scale The computer presents pixels in an image Hounsfield correlation. This is in a scale: Air = -1024; Air = 0 and the maximum measurable density = 3071. Hardware Collective term for all electrical and electronic switching circuitry. Also, the gantry, table, and computer components. Homogenous Beam An X-ray beam where all the photons have the same energy. Hounsfield Unit A unit of measurement named after Sir Godfrey Hounsfield, the inventor of CT. It is used to represent the density or attenuation capability of an object in a numerical sense. 0 represents the density of water. Also known as CT numbers or pixel values. Image Reconstruction Image computation of preprocessed scan data (back projection). In-plane Resolution The resolution in the acquired image plane, which includes high contrast, low contrast, and temporal resolution. Interpolation A mathematical technique in which an unknown value can be estimated given two known values on either side of it. Isotropic Resolution This is obtained when the image voxels have equal size in all directions, i.e., when the in-plane resolution equals the z-resolution. Kernel See Algorithm above. Linear Attenuation Coefficient The constant of proportionality, which connects the decrease in intensity of the X-rays as it passes a very short distance through an object, with the intensity of the X-rays and with the distance. Low Contrast Resolution The system’s ability to distinguish small objects and details from surrounding structures with very little density difference. Often called contrast detectability. Matrix A grid arrangement of rows and columns of pixels. CT typically used a 512 x 512 matr ix. Maximum or Minimum Intensity Projection (MIP) A postprocessed image, which is based upon the highest densities within the image. Commonly used for CTA and MRA. Metro Recon Image reconstruction during the acquisition of a spiral scan. Multi-Planar Reformat (MPR) Reformatting image volume data into different planes, i.e., coronal and sagittal. Noise Undesirable fluctuations of pixel values usually caused by unsatisfactory amount of photons reaching the detectors. Noise can also be caused by the system itself. Partial Scan Data acquisition not using a full 360-degree rotation. Normally, the data are acquired during 2/3 of a full 360-degree rotation, which is used for a faster data acquisition in order to reduce motion artifacts and improve temporal resolution. Partial Volume Averaging/Artifact A single voxel element contains two or more structures partially included in the slice being scanned. The result is less accurate pixel readings. Smaller or overlapping slices will decrease this effect. Pitch in single slice CT Is the relation of the table speed to the slice thickness. Pitch factor is the table speed divided by the slice thickness. In multi-slice CT, pitch is the ratio of table movement per rotation over the collimated slice thickness of one of the detector rows. Pixel (Picture element) A two-dimensional square element of data. Pixel size = Field of view divided by the matrix size. Postprocessing The use of CT images in various evaluation image manipulation programs after the images are acquired, e.g., 3D,Lung CARE, Colon, etc. Projection The measure of the total absorption along a straight line or set of “ray sums.” 82 Turnover Workbook | SOMATOM Definition AS - Sliding Gantry Rotation Time Rotation time refers to the amount of time it takes the detector and X-ray tube to rotate 360 degrees during a CT acquisition. Scan Field of View The reconstruction circle. The circular region from which the transmission measurements are recorded during scanning. This region specifically refers to the scan field of view.Abbrevcontinued) Scan Time The amount of time from X-ray on until X-ray off, either for one rotation (in sequential scanning) or for multiple rotations (in Spiral scanning). Scan Volume The acquired data from one spiral CT scan. Sequence A conventional CT scan mode where a table position is scanned, then the table is moved to a new stationary position and another scan acquired. Shaded Surface Display (SSD) A 3-dimensional representation of an object using a def ined HU threshold range to generate the surface of body structures. Slice Collimation For single slice CT, slice collimation is the slice thickness collimated by the tube collimator, which determines the z-coverage per rotation. For multi-slice CT, slice collimation is the total slice thickness collimated by the tube collimator and then by the number of active detector channels, e.g., 16 x 1.2 mm or 64 x 0.6 mm. Slice Reconstruction Increment The number selected in the review platform, which determines the distance between the reconstructed images. Slice Width The true thickness of the reconstructed image. In multislice spiral scanning, the user selects the slice collimation in combination with the desired slice width. Slip Ring Conductive rings and brushes or capacitive coupling component in the gantry of spiral CT scanners that allow the tube/detector system to rotate in one direction continuously while sending power and data to the main computer of the system. This mechanism eliminated the cable handling system (wind and rewind motion) of earlier CT systems. Spatial Resolution A CT’s ability to display, as separate entities, small objects of varying density a small distance apart. Also called High Contrast Resolution. Spiral CT A fast CT scanning technique where the patient is moved through the gantry while X-rays are being produced to obtain a volume of data for CT image processing. Standard Deviation Measures the spread of the values in a data set. Temporal Resolution This is also called “time resolution,” and is determined by the total data acquisition time for an image. The shorter the acquisition time, the higher the temporal resolution. Tube Heat Dissipation The ability of a CT tube t o cool itself. Volumetric Data Set A data set collected from a Spiral Acquisition. During scanning, the X-ray tube and detectors rotate around the patient to collect views, tracing a Spiral-Helical path of an entire volume of tissue, versus a slice-by-slice acquisition. Voxel A 3-dimensional element consisting of the pixel and the slice thickness representing the actual tissue volume scanned. Window Center The center CT number of the displayed window width. Window Width Range of CT numbers equally divided below and above the window center. X-axis The plane that goes from right to left. Y-axis The plane that extends from the anterior to posterior of patients on their backs. Z-axis The plane that correlates to the long axis of the patient lying on the table. Also, refers to the depth or thickness of a standard transaxial CT image slice. 83 Turnover Workbook | SOMATOM Definition AS - Sliding Gantry Notes 84 On account of certain regional limitations of sales rights and service availability, we cannot guarantee that all products included in this brochure are available through the Siemens sales organization worldwide. Availability and packaging may vary by country and is subject to change without prior notice. Some/All of the features and products described herein may not be available in the United States. The information in this document contains general technical descriptions of specifications Local Contact Information and options as well as standard and optional Siemens Medical Solutions USA, Inc. features which do not always have to be 51 Valley Stream Parkway present in individual cases. Malvern, PA 19355-1406 Siemens reserves the right to modify the USA design, packaging, specifications and options Telephone: +1-888-826-9702 described herein without prior notice. Please www.usa.siemens.com/healthcare contact your local Siemens sales representative for the most current information. Global Business Unit Note: Any technical data contained in this Siemens AG document may vary within defined tolerances. Medical Solutions Original images always lose a certain amount Computed Tomography & of detail when reproduced. Radiation Oncology Siemensstr. 1 DE-91301 Forchheim Order No. A914CX-CS-14467-P1-4A00 Germany Printed in USA 01-2014 | All rights reserved Telephone: +49 9191 18-0 ® 2014 Siemens Medical Solutions USA, Inc. www.siemens.com/healthcare Global Siemens Headquarters Global Siemens Healthcare Siemens AG Headquarters Wittelsbacherplatz 2 Siemens AG 80333 Muenchen Healthcare Sector Germany Henkestrasse 127 91052 Erlangen Germany Telephone: +49 9131 84-0 www.siemens.com/healthcare www.siemens.com/healthcare

  • CT SOMATOM Definition AS Sliding Gantry Turnover Workbook