Dual Energy 101: Principles Methods and Dose

So good afternoon everybody. Carlos Ramirez I'm a scientist working with Siemens here in the United States. I take I am part of a team of scientific collaborations. Dual energy CT is actually a topic and I've been working for about the last 10 years. First, while I was training at the Mayo Clinic with Doctor Cynthia McCullough and then at Siemens for the last five years, when obviously it's been a topic of major interest. Here is a brief outline of what I'm going to be talking about. 1st, I'm going to describe some of the principles and fundamentals of dual energy. I will connect that with some of the different acquisition modes. Understandably, most of the focus will be in the Siemens approaches to dual energy, although I will mention some others briefly to have them in context. Then I'm going to dive a little bit into radiation exposure with the Dual energy CT an I'll finish up with some comments about the different dual energy image types in context of course of the capabilities of dual energy in terms of post processing. So Twister, I guess a lot of you guys get us this question a lot an I found personally that short answer is always good. So what is dual energy CT? Do allergies city in a very basic level, is to acquire city data with two different Spectra and to get to different Spectra. There are different approaches how to do that once approach, for example, that seeming has text since the introduction of the dual source is actually to acquire with two different KBP. So you put a different cavey in each of the tubes and then you get yourself to a spectrum. In this conference we have her alot. The term multi energy city on again in in Protivin simpler a simple not similar 20 energy city basically means acquiring two or more Spectra in a more generic sense. Most importantly then as well, that's how you define dual energy, but probably most important and hopefully this is something you've been hearing throughout the conference on later in the talks in this session is why dual energy is relevant, while we interested in dual energy. Well, the quick answer is that it provides information well beyond just anatomical information. We now have the ability to quantify to do some mass masses characterization. For example, here incidents on findings you can do some level of functional analysis. You can reduce artifacts an improvement civilization, so it really is more than the pretty colors that now dual energy can offer. So it really provide this tremendous new opportunities. So how new is dual energy actually is not that new IT pretty much was conceptualised from the very beginning, so here is some barbarian from Doctor Confirm Hansfield paper back in 1983. He very clearly outlined that if you actually use two different energies in this case, 100 KB and 140 KV, you actually will be able to discriminates on materials at the time he was intrigued by the ability to discriminate between calcium and iron. So again, it might be our concept that we are getting more in the clinic nowadays, but it's really thought of since the inception of CT. So let's go a little bit deeper on the actual principle and then how using different energies allow us to discriminate materials or kind of tease out more information beyond anatomy. So I have a very complicated Phantom here, so this is basically pork chops that you can get in a buttery. And then. You put that in a water bath and then you put some Iran as the one you can get it now in hospital and then you put a lot together and you put this in a CT scanner and apply different VPS. There are certain behavior that you will start to notice in this elaborated Phantom. So first if you look to the bones where this calcium and iodine that is in this range that is noted there you will notice that as you change the KVP. The attenuation or the brightness that you perceive in this specific points in the image changes as a function of the cavey that is used. Likewise, if you look to the fat of the pork chops that someone like me actually like to eat, you'll see that actually the signal of the fat at the low KV instead of getting brighter, actually gets darker when you go to the other side to the 140 KBP, actually gets a little brighter so. So again, higher cavey. Again, depending on the KBP you're using, you have differing husband of different materials, and there are also some other materials that actually it doesn't matter. The KBP you use the city numbers they have or the brightness they show up in. The image is pretty constant, that's true for example for water or for sub tissues. Unless your scanner is not calibrated. If it is assuming scanner probably will be sorry toward the joke. Bad joke. So again now if we try to. Are to to follow up with the prior slide. You probably notice that the larger difference is when you have the lower cavey and the higher cavey. That intuitively is what spectral separation tells you, because when you used to the most different your Spectra, the higher the difference between through materials you're looking at, so it will always be advantageous that you respect rise very different from each other. And now if you take specific points in that image dataset. I you kind of plug the city numbers of the low and the high KB as shown here in the graph, you will see that depending on the materials they will fall in different places in this map. If there are material that happened to be very close to each other, then it's going to be very difficult to tease them apart and if this material happened to be very separated from each other, so it's going to be easier to separate them. So again, intuitively this is really what dual energy. How it works? Again, the better the separation of the two Spectra. The better job you can do in that sense, also very important to note is that dual energy cannot separate everything. Normally 2 energy is really very good. Differentiating High Z materials, so not every materials can be differentiated with dual energy. So it's very important to acknowledge this limitation of again by basic principles of the technique. So how can we actually realize dual energy CT? So one approach is, as we alluded to, we kind of scan the patient with two different Spectra. For example, we can use two different caves. We can use different pre filters in the Spectra right after the X Ray tube. We will explain that a little bit better and we can also have detector that actually respond differently depending that they're looking to low energy or high energy an in the future. There is already lot of investigation you might have heard of in this conference and others that in the future we might have energy resolving detectors or foreign counting. Again. What we always attempt with this is that with different inspectress there's going to be different specific energies that again if we go back to that example I showed you before of the pork chops, being able to tease out these different materials that are present. Let's dive in a little bit in how to actually acquire the data. Again, notice that you are still talking only about the machine and how you kind of dissolve the parameters for the data acquisition, so one of the approaches for acquiring to Energy City is a technique called fast KB switching. The concept is relatively straightforward. You do is that you very quickly toggle the KBP that is applied as the X Ray tube is rotating through the in the country. So you basically at every view you're quite a different KBP. And in this way you acquire a low low energy Spectra and higher energy Spectra. This technology actually was originally developed back in the 80s. We did have not a prototype but actually a product in Siemens where we were able to do fast gave switching just as little historical note at the time. Probably the. To add bounds for his time, although one of the application that seemed to get more traction at the time was for bone mineral density applications. Another acquisition mode that there is implemented in some scanners, for example, is what we could refer to as a dual spiral model is located switching. So basically you do two runs or two different spirals separated in time. You do some rate image registration between the two and you get yourself dual Energy Information of that would have certain limitations when you're going to do for example contrast enhance examination, but usually for any hand city examination the technology actually works pretty well. Another technology for Dual energy acquisition. Instead of separating the Spectra that the X Ray tube level is actually done at the detector. In this case, when you have multiple layers, you can have layers that are sensitive to, for example, the low energy photons and the high energy for us. So this is one of that example. Here, the one you can see and then you end up with two different aspects are again allow energy Spectra. On the high energy spectrum. Recently introduced technology that we developed with Team is is called the Twin being technology. Some are referred to it as also as a split filter. So the idea is that in your X Ray tube you put a filter that you can mechanically move when you were going to use this technique so you mechanically move this filter and it actually has half of it is going to shadow in the Z direction is going to shadow the X Ray beam with gold. And then the other half is going to shadow the beam with tin. Tin is actually going up harder in the beam, so he's going to achieve the Spectra to the right, so that's going to generate a high energy Spectra, sorry. It's going to create a high energy Spectra on the goal because of the K edge of the goal. Actually, when the X Ray beam goes through the goal, actually the Spectra is going to be shifted to the left a little bit because of the way it showed that will actually generate a low energy spectrum. Finally we have the dual source mode, in which you actually operate freely. Each of the two tubes at a different KB PS. And you also have the ability to independently filter each of these tubes, so you have against simultaneous acquisition. You can independently control them and the cavi, because now you can freely choose your low energy cavey. Also, you have more power available when you need it. For example for larger patients. And again, you can also have better spectral separation in this case. For example with the team filter with, which would be up in Tejas and again this will be yet another technology which you can acquire low energy and high energy spectrums. A little bit graphically, how this is spectral look like before and after the filtration. In this case I'm describing the 80KV and 140K via Spectra. Very common in many different acquisition modes or the scanners available. So when you use a team filter here, I'm referring to it as the SPS for selected photo and SHIELD. You see that when the X Ray beam goes through, that filter is really hardens. The beam which hardening means that the energies shift more to the right. So this again increases spectral separation. Sorry, this jumped on me. OK, so for those of you that might have some of these systems and dual source systems, these are some of the KV pairs available in the initial definition platform. You only have two KB AVAILABLES 18140 in the Flash platform. You actually now have number one. You'll see that little SN symbol that does the chemical symbol for 14. For the high energy Spectra you also have now 8100 KBP available. So for example for larger page and now you have this availability of. A higher energy law, low energy beam and therefore you have yet even more freedom in the K BPS that you choose again, WHI. I'ma referring so much about this spectral separation. I hope I'm not gonna scare some of you on the on the audience here showing some equations, but actually it was shown from early on in dual Energy City research that for the post process image in dual energy CT, the larger the spectral separation actually lowered the noise in the post process image. So again this is some fundamental work going back in the 1779, but calx a group actually here in the California area. And basically what they show is that when you when you change the different Spectra, the spectral separation that will impact the signature of each material and the higher the difference between those materials they want that I highlighted that in the bottom right the better dual energy you will be able to achieve, so it is indeed one distinctive feature of scanners when you can indeed improve spectral separation. So here is more an example of how this will actually impact so we have here a basic diagram again that is illustrating dual energy and locate be on high KV. So basically in this case we are interested in separating iodine and calcium. So as I alluded to at the beginning, there's going to be in this. In this plot, calcium material is going to kind of cloud together at different concentrations. And then the same for the Iran. So in dual energy. Basically what we do is we try to trace a bisector that basically will everything Bob that about that slope is going to be one material and everything below is going to be a different material of interest. So when you apply a very spectral separation what we do is that actually we widen that difference, that is spectral separation. So again the materials are going to cloud in their characteristics lobes. But now because that notices low bar open up now even with less those we would be able to do a better job is going to be easier to separate. The easier it is, the less those. For example you might need or the more sensitive you would be, for example, for lower concentration, that's another consequences if you go more to when the lines right to intersect, if they are very close to each other, noise is not going to allow you to be very sensitive to small changes, so again, that's another benefit of the specular separation. And here you have a nice example before and after. The filtrate that additional filtration you can see that pass challenging task like for example, like automated bone removal for the carrots. It becomes much easier with this barrel spectral separation. So here is a summary again of some of this acquisition modes, so we have the dual source technology that I just described and we have different technologies that allow us also to use dual energy acquisition on single source scanners. There is a very nice paper published couple years ago, but they Mayo Group and radiology that also has some very nice description of the different technologies, most of which I discussed here today. Let's talk a little bit about radiation exposure. The dose in dual energy CT. Surprisingly, there is not huge number of papers published that have looked to this at the time. Of course there are some. Here is 1. Probably the earliest want this was for demonstrating dual energy CT, at least in the dual source platform at the time. Those proving those neutrality Cohen comparing dual energy acquisition versus conventional CT. So this is a a short summary here of their. Their main conclusion is that see T can be performed routinely in dual energy mode without additional dose or compromising image quality, and I want to bring attention that when they made that statement a very carefully do not only brought up the point that they match something, for example, like the CTI that those but equally important for the same dose you expect to achieve analogous quality. So you want to have is always good to have both. We can always dial down the doors, but that doesn't guarantee that the quality is going to follow. So this is an example. In this case an example. An early example here from the Mayo Clinic in patient with Pat cell or cell carcinoma patient is counting conventional City 120 KVP and then with dual energy. It was kind of one of the early experience with the technology. As you see, radiation exposure and image quality very compatible between the two. Here is another example from the Cleveland Clinic. Again, these are relatively older example here on the Flash and again you have similar level of enhancement noise as well as the exposure. Our in our summer in most of our platforms when you use dual energy CT you do not really have to give up in any of the standard dose reduction features. For example, in all the examples I provided in the duals or platform in between being ordered or spiral, you can always use, for example, automatic exposure control. We have modes for example in the dual source, where you can still use technologies like X care, organ, organ, those based modulation. And again, you cannot as well use iterative reconstruction, for example, so it's important also to know how you don't really have to give up in those basic to reduction features that are really not exclusive of single Energy City are readily applicable to dual energy as well. Anna to finish the discussion on the doors I have here a nice example from a study from the collaborator of hours in Saint Louis Children Hospital. Now using Pediatrics or Pediatrics, probably one of the most challenging application where in at least in terms of radiation exposure very commonly you would use lower K BPS, lower doses so will be a good test scenario to test the limits of in those perspective. For dual energy CT. So let's start with our nice example. Again, this is courtesy of Doctor Siegel Sandwich Children Hospital, so this is a 12 year old boy post surgery for repair pulmonary atresia. An as you see here, they were able to establish not only anatomically well there normally too, but at least from the point of view perfusion. Although there were scenarios that may show a little bit decreased perfusion, it seem it was still rated as as overall good perfusion through the image, and in this case exposure was in the Lebanon of 1 Milli Gray. And many of you would say, well, this of course it is single example that we actually work with them with Doctor Siegel. In a study was published last year in a jar, so you do not call her of 79 patient where they actually use dual energy CT. They observed that the radiation exposures both in terms of CTI and SDE, where comperable there were no significant difference if anything. Actually, the trend seemed to favor a little bit the dual energy. An image quality follow a similar trend. Again, keep in mind that in pediatric setting we are not comparing 220 KBP, but frequently to 7080 or 100 KBP, depending on the application. So the conclusion here in pediatric body CT oranges, Siti results in radiation exposures compatible or lower than those that single energy, maintaining contrast and CNR. Alright, so to finish here I'm going to be talking a little bit about the post processing so up to here I've been only talking about the acquisition part and the dose that you will end up with. Now what do we do when we acquire the dual energy data? So what do we get beyond traditional anatomy? So one of the simpler image types with dual energy post processing is mixed images. So in this case every time you do a scan, especially when you have image based dual energy city like in the case of most our platforms that Siemens you have a locate BP image available. You have a high KBP image available an for conventional examination. Normally what you do is that you put all the photons together and create an image that is being shown already to be equivalent. To your conventional single energy city. So that's the first image type. Relatively straightforward and hopefully for those of you familiar with the dual energy technology. I'm sure something you heard about before. Probably a more interesting type of use of the dual energy city data is virtual monoject virtual monogenic images. These are energy selective image is basically what you do here that you take the data from the lower high cave, and now you synthetize virtually the because you were able to. Separate the materials in the images. For example, a water and item basis. Now you can you are able to infer what is going to be the enhancement of a given boxer, because you know that, for example, the concentration of iodine. So you're able to infer what's going to be the attenuation or the OR the brightness are different caves. So for example, most commonly in a range between 42190 KV, we can actually infer what they image character is is are going to be, and I'm sure later. Today we're going to hear how we can use this type of data, but here, at least to identify where it comes from. So again, these artificial monergistic images. Another type of dual energy data is the so-called material specific images. So basically for material specific images, we have to rely in material decomposition for the Siemens platform we use a technology called tree material decomposition. So basically you always define three basis material. So let me give you the example of our liver BNC tool. So for this application we use three materials as basis. One of them is fat. They want here that shows in green we have tissue. The wonder in the middle and we also have Iran. Obviously, is what we traditionally used for contrast enhance city, so we have display Nan every every boxer in the image. For example, in a contrasting hands examination is going to be a mixture of fat tissue on Iran. So the goal of the dual energy post processing of the order through material decomposition is going to be to give us as an output what is the percent or the contribution of iodine. The contribution of fat and the contribution of soft tissue in this case? Hepatic tissue. Oh liver tissue. So for example, if we go for a specific boxer we can establish bisector to see with Iran we can establish actually was the Iran content amount, so we can quantify and give up a value in milligram purmela, Byron. We can remove it from the image because if we can quantify it, we can actually also virtually remove it from the images, and that's what gives as output. For example, as shown here, the virtual adding has images. So some of the major application for this material specific images will be iron quantification. So we can create a BNC on the Iran Maps and I presume we're going to be here in some examples of later how these are used clinically for various application. Arguably liver and renal masses are probably two of the most frequently used applications for item quantification or or iron removal. Another application is that when one of those bases materials I alluded to. An A modification of this technique is actually where instead of Iran calcium is used as that term material. So when you actually virtually remove Iran, you are left with bone marrow for something. This key applications here is a nice example courtesy of Vancouver General Hospital an some of the application for this type of imaging, for example is for detection of edema, something that will be traditionally observed with MRI. Another of the application for dual energy will be material differentiation, so this will work very similar to the example I'd shown earlier for the bone removal. So again characteristics of a given material they will fall in different places of this is Los that you see here, illustrated and when given Trescott slope is trace at everything above that is going to be classified in one material and everything below will be a different material. You will be sort of a binary classification. The example shown here, for example is for the kidney stones. So for example, if the city ratio of a given stone or the box off of 1 stone, for example, fall above the slope. In this case they will be classified as a calcified or no uric acid kidney stones. For example, for instance an if those attenuation property armor below the slope Tresco they're going to be classified as uric acid. Some other currently I won't have time to go through every single application currently in the market. In the case of Siemens, but again, all of these techniques will use different flavor of the post processing of dual energy either for material specific images for material differentiation. Or they are also for regular mix images, or that virtual monogenic images. And I think with this I'm actually closing now, so we discuss some about the principles of dual energy CT. Some of the different acquisition methods that exists we discussed as well of the radiation exposure and how can dual energy being actually be in those neutral compared to conventional? See T and we end up describing some of the different types of dual energy images which are the output of different postprocessing algorithms that are applied to the dual energy data. And with that, thank you very much for your attention. Thank you.

DE 2 DE 2 SCNATC* SIEMENS ... SIEMENS SIEMENS .. Juan Carlos Ramirez Giraldo, Ph.D Dual Energy CT — Principle Dual Energy CT — Dose Dual Energy CT of the Chest Dual-SourgsCT. 3 Generations Methods Dual-Source CT: 3 Generations Dual-Source CT: Dual Source 3 Generations Dual Energy CT — Acquisition Methods Dual Energy Postprocessing and Image Types Healthineers Healthineers • DE Data Acquisition Methods: Dual-Layer ('Sandwich') Detectors DE Data Acquisition Methods: Dual Source DE Data Acquisition Methods : Dual-Energy First Implementation DE Data Acquisition Methods: Dual-Spiral ('Slow' kV switch) DE Data Acquisition Methods: Fast kV Switching DE Data Acquisition Methods : Twin Beam Dual En DE Data Acquisition Methods : Twin Beam Dual Energ DE Data Acquisition Methods : Twin Beam Dual Energy DE Data Acquisition Methods: Dual-Energy First ImkV mwitchion Summary 9234 Use in Pediatrics Spectral Separation TecWcaI tor AcÜing Data Set AcÜing Data Material Specific Images Material Differentiation Mixed Images Energy Selective Images (Virtual Monoenergetic Images) ORIGINAL ARTICLE 1st layer detects low-energy photons, 2nd layer detects high-energy photons Two tubes are operated at a different potential to exploit the kVp-dependent AJR, October 2016 Two consecutive CT scans at two different kV values Dual-Source CT Dual Source Vertebral Bone Mineral Analysis: Different energies allow us to discriminate materials Dose Tube potential is switched between successive views How to realize Dual Energy CT? Repaired Pulmonary Atresia CT. 5.3 Dose Neutral DE 0000 Movable filter s. M. sp Dose4D os -100 Effects of Dual-Energy Technique 80 kV 100 kV 080 kV • 140 kV 100 kV DE Bone Marrow + SPS Principles Dual Source Dual-Source CT 15 1. 100 3. 2. • Only materials with substantially different attenuation behavior (effective atomic nature of attenuation • DE Bone Removal WITHOUT SPS: Separation of iodine and bone • DE Bone Removal WITHOUT SPS: Separation of Modified 2-material decomposition: Characterization of kidney stones Bodine Iodine iodine DE Bone Removal WITHOUT SPS: Separation of Dual Energy CT — Principle Dual Energy CT of the Chest Dual Energy CT — Dose iodine and bone AJR 3B 600 400 40 O.S • Images at energies (40 — 190 keV) can be calculated from Dual Energy datasets WHY DUAL / MULTI ENERGY CT? Single Source What is Dual Energy CT? An Integrated Approach with CTI DISCLAIMER CT-value 140 CT-value 80 Single Energy equiv Cm CT x 104 10kV 840kV 140kV Dual-Energy 101: 79 40 70 6.70 L on Radiation Exposure and Image Urine + calcified stones / uric acid stones How About the Dose? 100 kV 140 kV 120 kV IOOkV 120 kV 100 kV 80 kV 140kV Mean X-ray spectrum energy varies 97 820kV 80 kV 140 kV 140kV 80kV 120kV 100 kV 15 100 125 65 (low-high-kV images) number z eff) can be discriminated using DECT. "Two pictures are taken of the same slice, one at and the other 100 kV 80 kV 140 kV Low kV 10kV 140kV 772 Se aration line Iodine Mix (MO.5) O Parameters Sni40kV 8ni40kV Acquisition Methods 80kV 120kV 140 kV 140kV 820kV 100 kV 2. Jan C. • Sommer. MD. Jan C. • MD. Jan C. • Sommer. MD, Jan C. • Sommer. MD. Gisela C. • MD. Willi A. Kalender, PhD • Ernst Klotz, Dipl Phys • Christoph Suess, Dipl Phys The statements by the Siemens' customer Quality in Pediatric Body CT Sn with the applied tube voltage (kV). 100 kV 140kV CAFMIRE X-CARE CARE CAFIRE Real-time • Scan patient at two different spectra at 140 kv HU at 140 kV at 140 kV •t 140 kV SureView ... so that areas of high atomic numbers can be enhanced. MD. R MD, Christoph R R MD, R. MD, Principles, Methods and Dose DICOM SR IRIS Acquisition of CT datasets with two different IDENTITY Imaging Creates Low & high Information Beyond Anatomy Dashboard Simultaneous DE acquisition R. C MD • R C MD • 60 Al Iodine Overlay Iodine pixels Iodine content Virtual Unenhanced 80 kV 80kV 140 kV 80/140 kV 140kV at 140 kV 100 kV mix END OF DUAL COMMANDS described herein are based on results that were Iodine pixels Iodine content 100 kV 80/140 kV 140kV low kV Tests carried out to date have shown that iodine (z = 53) can be 100 kV low kV low Z 140 kV 080 kV high high Z Conclusion: Dual Energy CT is feasible without additional dose. There is no gnaging Imaging asm3 Energy Spectra Energy Spectra 140kVp spectra spectra (eg. using two different kV) •d Dose Bone (SKV) KV SEPERATION Quantification (eg iodine, mono+) Dose Related Parameter aoxplot• Dose Related Parameter 30xpIot. Dose Related parameter 30xpIot. kV nos patient's weight 185 1b 4100 125 • Quality/accuracy of DE-based material discrimination depends on the separation voltap: 140 kV + SPS (z = 20)" achieved in the customer's unique setting. Since readily differentiated from calcium SIEMENS ... at 80 kV at 840 kV at 140 kV at 140 kv for Single and Dual Energy Protocols for Single and Dual Energy Protocol' Blood Highlights (MAT) Use two different kilovoltage (kV) MATERIAL DECOMPOSITION ISCT Iodine pixels Iodine content 85 85 wp 65 Arterial DE mixed SD= Arterial DE mixed 19 Low vdtage: significant difference in image noise, while CNR can be doubled with nay H yd-oxylapaie Juan Carlos Ramirez-Giraldo, Ph.D 140 kV a 140 kv 80 kV 0140 w 100 kV 140 kv Independent mA for 140 w 140kV Mass characterization (MAT) (MON) MONOENERGETIC IMAGE t": high Z high there is no "typical" hospital and many variables between the high and low-kV spectra. Better spectral separation is desired. N = 79 patients N 79 patients Dual Energy Postprocessing and Image Types DE Postprocessing and Image Types DE image types CZONCLUSION. In pediatric body CT, the use of DECT results in radiation exposures Bone pixels Healthineers Bodine pixels Iodine pixels 100 150 10kV Water 0120 w 53 cm Blood+lodine Fie" of of Staff Scientist, Collaborations Manager SE Region • or different pre-filters or different detector layers (MIX) SOMATOM DEFINITION FLASH SOMATOM DEFINITION DLASH SOMATOM DEFINITION DS LIN COMBINED IMAGE UIN COMBINED IMAGE both high and low kV 140keV 80 kV 70keV 80keV 120kV 840kV SOMATOM DEFINITION FLASH SOMATOM FORCE DEC T scans vs CARE kev (Estimates) DECT scans vs CARE kev (Estimates) Function optimized dual energy CT reconstructions. A restriction in collimation is 720 or 1440 exist (e.g., hospital size, case mix, level of IT NO. Of be SECT while mlintaining contrast and contrast-to-noise ratio. (ELE) 0100 w a 100 w ELECTRON DENSITY IMAGE a kv SECT while contrast and contrast-to-noise ratio. with SIEMENS .. 1 14:22 14:22 ... What is Multi Energy CT? A of CT G. Hounsfield, 1973* ISCT • or an energy-resolving detector ( ..."future") CTDI and SSDE were comparable (or lower) with ENTER FILE NUMBERS Adaptive Ada tive Dose Alert 4s delay 080 kv 100 kV 80 kV 65 60 15 -100 kv Reduction of artifacts Ada tive Adaptive adoption) there can be no guarantee that other CAFIRE by 2 by SADMIRE X-CARE 3 37 kVp Healthineers ISCT San Francisco, 2017 Cardio & Notification Fat • Noise in dual-energy material-specific image is inversely proportional to the difference in the DE ratio required for dose-neutrality at 140/80 kVp, whereas this is not necessary at ECG-Pulsing Dose Dose4D y sti MARC REVEW/SELECT 800/140Sn kV 140 kV 80/140 kV • Tissue tissue More power for DECT Nigh kVp Ngh kVp Sequence CT-value 140 customers will achieve the same results. (difference in slopes in the DE plane) Improved Visualization Monoenergetic images (0-7) SELECT OPTION Acquisition of CT datasets with two or more spectra Acquisition of CT datasets with two differenspectra of CT with of CT with 2 different Dual-Spiral Fast kV Switching Dual-Layer Dual-Rotation Dual-Spiral Twin Beam whith -1000 -100 low kV images Soft 100/140Sn kV 90/150Sn kV 800/140Sn kV 80/150Sn kV 100/140Sn kV 10 /140 n kV of 140 Sn/100 kVp. Thus, CT can be performed routinely in Dual Energy mode 80 kV 140 kV 100 kV 140kV 10kV 80/140 kV low kV 80 kV MIOESSMaster parameter ettaöle MOESSMaster parameter ettaöle low Z low kV (3 Generations) tissue • Tissue 5.3 Detectors Detector N = 16 patients (subset) Recons ot range Blood Low High Attenuation B Attenuation g Attenuation A are the 80 kV - Senes 190 kev 100 kV 80 kV Air 40 kev kev d«ee d"ee ot ot SE - Sensation 16 DE Mixed (0.5) - Flash DE Mixed (06) - Flash 'V 8 •140kV urces U high • 140 kV at 140 kV 80 kV 800/140Sn kV higher CT-value at 80kV: iodine, bone, metal Marrow 129 t 29 Energy -100 100 Marrow+bone 120 without additional dose or com romises in ima e uali DEC T scans vs CARE kev (actual scans) ns vs CARE kev (actual scans) of ons, DE Abd8 to "e Better spectral separation Spectral Separation Spectrum DEC'. Arterial Phase Arterial Phase Ml • — ' Ml • (DE Limitation: Shunt intact ran" 70/150Sn Indication: HCC BCC Indication: Similar contrast, CNR and CT DI 100 kV 100 • 80 kV 100kV Uririe IJririe • higher CT-value at 140kV: fat, plastic, uric acid -100 3100 2100 DE of due to tin filter More than just color! 30 April 2009 fusion Courtesy Of Universitätsspital Basel / Basel, Switzerland Courtesy of Universitätsspital Basel I Basel, Switzerland Selective Stellar Ada tive 6100 200 2100 6100 Dose Bhield 5100 4100 • no separation for materials at same position in diagram 6100 4100 6100 -100 HU at 140 kV HU at 140 k at 140 kv (Small) Noise increase X-CARE Dose hield Overall good perfusion Photon Shield Detectors Dose Shield Recons Ot this range Recons Of this ranae 50 60 70 150 200 100V 100 -100 100kV Kalender, W. A. , Klotz, E. , & Suess, C. (1987). Vertebral bone mineral Photon Shield Detectors -100V 15 Energy I kev 15.59 mGy HU at 140 kV in HU at 140 SN kV HU at 140 k High kVp Nigh kVp Kelcz et al Med Phys 1979; Primak et al Med Phys 2007 270 200 500 300 Lowh Energy Spectrum High Energy Spectrum Low Energy Spectrum go 130 500 100 100 Energy Spectra HU at 140 kV photon energy (keV) -90 50 -100 6100 -900 600 60 analysis: an integrated approach with CT. Radiology, 164(2), 419-423. *Hounsfield G.N. Computarized transverse axial scanning (tomography): Part l. Description of system. British Journal of Radiology, 1016-1022, 121 125 • CT and DECT are not sensitive to chemical binding Low kVp low kV MIOESSSlme parameter dirnrned pMarneter dirrrned Courtesy of Vancouver General Hospital, Vancouver BC, Canada patient's weight 185 1b Courtesy Marilyn Siegel, Wash. High kVp Hgh kVp Nigh kVp 2005 2013 0000 5009 500 50 "In clinical practice, the use of SAFIRE and ADMIRE may reduce CT patient dose depending on the clinical task, patient size, anatomical location, and clinical 2009 2005 2013 Energy Spectra High Energy Spectrum McCollough CH et al. Dual- and Multi-Energy CT: Principles, Technical Approaches and Clinical Applications, Radiology Vol 276(3), 2015 2009 1973. Lowh Energy Spectrum CTD1v011.24 mG *(FIash scanner) Ngh kVp 70 photon energy (keV)100 photon energy (keV)1 Siegel MJ et al. Siegel MJ et al. AJR, October 2016 AJR, October 2016 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 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 Siemens Medical Solutions USA, Inc., 2017 JC Schenzle et. al. Investigative Radiology • Volume 45, Number 6, JC Schenzle et. al. Investigative Radiology • Volume 45, Number 6, June 2010 University St Louis June 2010 Siemens Medical Solutions USA, Inc., 2016-2017 • Removal of iodine from the image: virtual unenhanced image IA Courtesy of, Clinical Innovation Center, Mayo Clinic Rochester, USA Courtesy Cleveland Clinic Siemens Medical Solutions LISA. 2016-2017 Siemens Medical Solutions UISA, Inc., 2016-2017 Siemens Medical Solutions LIJSA, Inc., 2016-2017 Siemens Medical Solutions IJSA, Inc., 2016-2017 Arterial SE 120 kV SD=20.O HU Lowh Energy Spectrum High Energy Spectrum •Separate License required *Separate License required page 1 Page 24 Page 27 page 2 page 23 page 6 page 32 page 7 page 27 page 10 page 12 page 30 page 18 page 17 page 28 page 19 page 29 page 13 Page 26 page 22 page 8 page 14 page 15 page 20 page 34 page 3 page 5 page 11 page 33 Page page page 72 page 9 page page 24 page 26 page I Page 5 page Il Page 28 Page Page 6 Page 7 clinical task." page 31 Page 2 page 16 Page I Page 1