SOMATOM go.Sim & SOMATOM go.Open Pro Dual Energy Workflow (VA30) - USA
SOMATOM go.Sim & SOMATOM go.Open Pro Workflow Online Training includes an introduction to Dual Energy (DE) and basic information about the different DE scan modes. It also shows the routine Dual Energy scanning workflow. Please note: This Online Training reflects software version VA30.
Congratulations. You have now completed this Dual Energy Workflow Online Training. Listed below are the key points that have been presented. Take time to review the material before you proceed to the final quiz. Select the link below to view and/or print your review material before proceeding to the final quiz. Download and print a copy of the Course Review. Introduction to Dual Energy Principle of Dual Energy Dual Energy CT is an imaging modality based on the acquisition of two CT datasets corresponding to two different X-ray spectra Different attenuation of materials at different energies enable material decomposition and characterization TwinSpiral DE scan mode The TwinSpiral DE scan mode consists of two successive spiral scans at different kV and mA levels. The two spirals are automatically coupled Well suitable for material characterization Pre-Scan Configuration Creating a DirectORGANS Structure Template Step 1: Open the Configuration Panel and navigate to Advanced Visualization > RT Automatic Contouring Configuration, then select Add Template Step 2: In the Template Name field, enter a name for the template Step 3: From the Organ Database, select the structures to be included in the structure template Step 4: Click Save to save the structure template Step 5: Click Apply to apply all changes Step 6: Click OK to save all changes and close the Configuration Panel Assigning a DirectORGANS Structure Template to a scan protocol Step 1: Open the Exam Designer and click the Scan Protocols tile Step 2: Select Factory Protocols, open the RTP folder, select the DE protocol and click on Modify Protocols Step 3: Open the Inline Options and set Inline Results to RT Automatic Contouring Step 4: Select the template you want to assign for the Structure Templates parameter Step 5: Change the name of the scan protocol and click Confirm Changes and Save Protocols Perform the Dual Energy Scan Perform routine Dual Energy examinations successfully in a step-by-step approach Step 1: Position patient correctly on the patient table Step 2: Select a registered patient from the Scheduler of the Patient Browser Step 3: Select the body region-specific Dual Energy scan protocol Step 4: Check and, if necessary, correctly adapt patient position on the Topogram taskflow card Step 5: Perform the topogram scan Step 6: Perform the tomogram scan and check the image quality Step 7: Start all configured reconstruction jobs Step 8: Perform Patient Marking Step 9: Close the current patient Step 10: Unload the patient from the patient table Image Reconstruction Dual Energy Reconstructions Spectral Recon creates primary Dual Energy CT images with the image reconstruction system (IRS) and remains full freedom of recon parameters. It allows for example the planning of oblique Dual Energy series. Inline DE results provide PACS ready series for all Dual Energy applications. Reconstructions are based on strictly axial planning. L&H reconstruction type is available for postprocessing with CT View&GO or the syngo.CT Dual Energy workflow. Scan&GO Workflow The Scan&GO workflow enables you to perform a complete diagnostic scan in the examination room. On the tablet, you can select a registered patient and a scan protocol, perform the topogram scan and the tomogram scan, and finalize the examination. You can also change the language of patient instructions. Some operations, such as connecting scan ranges or modifying parameters for image reconstruction, are only possible at the syngo Acquisition Workplace. Welcome to the Dual Energy Workflow Online Training for SOMATOM go.Sim and SOMATOM go.Open Pro. In this training you will get basic information about spectral imaging with Dual Energy CT* and you will learn more about the routine Dual Energy scanning workflow. Note: This Online Training reflects software version VA30. *referred to as Dual Energy on the following pages Upon successful completion of this course, you will be able to: Name the benefits of a Dual Energy (DE) scan Describe the TwinSpiral DE scan mode Understand the basic principles of the Exam Designer Perform a routine Dual Energy scanning workflow successfully Customize relevant reconstruction parameters for a Dual Energy CT Scan On the following pages you will learn about Principle of Dual Energy image acquisition Benefits and advantages of Dual Energy in the clinical routine TwinSpiral DE scan mode Courtesy of University Hospital Erlangen, Erlangen, Germany Dual Energy CT is an imaging modality based on the acquisition of two CT datasets corresponding to two different X-ray spectra (i. e., spectra with different effective energies). Different attenuation of materials at different energies enable material decomposition and characterization to create different image sets like Virtual Non Contrast (VNC) or monoenergetic images with additional diagnostic information. Dual Energy CT is a solution that allows you to quantify, highlight, characterize and differentiate materials moves your CT images from morphological to functional imaging supports decision-making through new insights and thereby impacts clinical pathways Clinical benefits of Dual Energy CT include: Evaluate vasculature by utilizing high-contrast dynamic applications Better characterize suspicious lesions in the course of standardized assessment thanks to increased image contrast Visualize and evaluate uric acid crystals and kidney stones Assess lung perfusion and vessel situation in pulmonary embolism Courtesy of Clinica Universidad de Navarra, Pamplona, Spain The TwinSpiral Dual Energy CT scan mode consists of two successive spiral scans at different kV and mA levels. The high-kV spiral is acquired using a tin filter to enhance spectral separation. The two spirals are automatically coupled. Scan set-up and scan parameter selection are as easy as for any standard single energy spiral. Because of the high spectral separation, TwinSpiral is particularly well suitable for material characterization. On the following pages you will see how to perform a Dual Energy scan. You will learn about the SOMATOM go. Dual Energy scanning workflow using the example of a patient with a head tumor. The examination is based on the Head Dual Energy protocol and uses the TwinSpiral DE scan mode. Let´s take a closer look at the steps to be taken during the examination and what to look for. Patient positioning is an important part of preparing for the patient examination. Correct positioning ensures reproducible patient position for radiation therapy. Also, the patient should feel as comfortable as possible while lying on the table waiting for the scan. To properly position patients for head exams, proceed as follows: Patient in supine position, headfirst, arms close to the side of the body and head in the predefined positioning device (head mask). Please note: For all studies, it is very important to position the patient in the isocenter of the scan field. Use the lateral laser beams to ensure. The Home screen is the access point for the main functions of the system. Select Examination to perform a CT examination. If your system is connected to a RIS, all scheduled patients are listed in the Scheduler of the Patient Browser. With the selection of the patient, the patient data are displayed on the Patient Registration dialog on the right side of the Patient Browser. If your system is not connected to a RIS, the patient data can be entered and saved here manually. Check the patient data and medical information. Select Exam to load the selected patient. To start the head examination, select a Dual Energy scan protocol with TwinSpiral DE scan mode in the Protocol Selection. To do this, choose the Head as desired body region on the schematic body map or the RTP folder. All available scan protocols are displayed. Select the head scan protocol. Select OK to apply the protocol. Check the patient position and select Confirm to continue. Select Go to activate the Topogram scan, then press the highlighted Start button on your control box next to you to start the Topogram scan. The Topogram is displayed in real time in the topo segment and can be suspended at any time if its length goes beyond the necessary anatomy. FAST Planning automatically places the correct recon range for you. If you wish to make additional adjustments to the recon range, grab any of the white dots and modify the recon range accordingly. Checking the patient position Learn more about checking the patient position Check the patient position and, if necessary, change it by selecting one of the eight orientation icons on the Topogram taskflow card. The patient graphic in the center of the screen indicates the selected patient position. The selected tube position and table direction are highlighted in white. If necessary, select the appropriate icons to change them. The correct patient position for a Head DE scan should be as indicated here. Please note: A wrongly selected patient position will result in invalid orientation information in CT images. Select Go to activate and load the tomogram range. Press and hold the Move button on your control box next to you until the start position of the spiral is reached. Press the Start button on your control box to initiate the first scan (for example 120kV). Make sure that the patient does not move during or between the two spiral scans. During scanning real time images will be displayed in the Tomo segment. When the scan is completed you are prompted to manually check the quality of the scan. To initiate the second scan (Dual Energy) select Go again, then press and hold the Move button on your Control Box again until the start position of the spiral is reached. Press the Start button again to start the second scan. Image Quality Check Learn more about image quality check Upon receival of the images the Check&GO algorithm is activated. The algorithm checks the anatomical coverage based on the images and the uniform and adequate distribution of contrast media if applied. The quality check stops all auto reconstructions until the quality is approved by you. You can view the coverage or image quality of the scan by right clicking, holding and moving the mouse up and down to scroll through the displayed images. After a scan is completed and the image quality is approved, you can proceed to the Reconstruction task. The reconstruction parameters are preset in the scan protocol, but they can still be adapted: In the Recon Ranges section, double-click a Recon icon of a Recon job to open the Parameter panel and edit the presets. Select Recon all in the execution control area to start all reconstruction jobs previously configured with Recon&GO. Select Next to continue with either Patient Marking or the Close step. Dual Energy Reconstructions Learn more about Dual Energy Reconstructions Tab TitleTextOverview Spectral Recon reconstructions and dedicated Inline Results reconstructions are available for Dual Energy CT scans. Spectral Recon creates primary Dual Energy CT images with the image reconstruction system (IRS) and retains full freedom of recon parameters. It allows for example the planning of oblique Dual Energy series. Inline DE results provide PACS ready series for all Dual Energy applications. Reconstructions are based on strictly axial planning. You can select the Dual Energy reconstruction types in the Recon&GO category of the parameter panel. Spectral Recon Spectral Recon types can be combined with all reconstruction parameters that are available for single energy reconstructions. Primary Dual Energy CT images are created by the image reconstruction system (IRS). Please note: Spectral Recon reconstruction jobs provide basic grey-scale reconstructions for Dual Energy images and are only available for Dual Energy protocols. The following reconstruction types are available: Parameter Description None Performs a conventional CT reconstruction of Dual Energy images. In case of a TwinSpiral scan, a mixed image of both energy spectra is generated. The mixing ratio is displayed in the image text. Monoenergetic Plus Simulates images that are equivalent to images scanned with a single photon energy beam, depending on the energy (keV). Monoenergetic Plus images can be selected in a range from 40-190 keV. L3D Performs a conventional CT reconstruction of the low energy image of a Dual Energy scan. H3D Performs a conventional CT reconstruction of the high energy image of a Dual Energy scan. Inline DE Dual Energy reconstructions with Inline DE functionality allow you to set up and activate image reconstruction and image post-processing within one step. Inline DE produces PACS ready reconstructions for dedicated clinical applications (for example visualization of gout or kidney stones). Ranges The Inline DE functionality is available for DE Parallel Ranges or DE Radial Ranges in the Recon&GO category or in the Inline Options category. You can choose application classes depending on the range types: DE Parallel Ranges (DE Parallel Ranges application classes) DE Radial Ranges (DE Radial Ranges application classes) Application classes The functionality of the Inline DE applications is as follows: Application Class Description Monoenergetic Plus Simulates images that are equivalent to images scanned with a single photon energy beam, depending on the energy (keV). Monoenergetic Plus images can be selected in a range from 40-190 keV. You can increase contrast by lowering the keV for evaluating suspicious lesions, or you can increase the keV for reducing metal artifacts. Virtual Unenhanced Visualizes the contrast agent concentration in soft body tissue without the need of an additional non-contrast scan. Virtual Unenhanced can produce Virtual Non Contrast and Iodine Maps. Iodine Maps visualize the contrast agent concentration in soft body tissue. Virtual Unenhanced generates virtual non-contrast (VNC) images by subtracting iodine. Gout Distinguishes between urate, bone, bone marrow, and contrast agent. Kidney Stones Visualizes the chemical differences between kidney stones. Bone Marrow The bone marrow reconstruction allows for the segmentation and visualization of the bone marrow based on a material decomposition into bone marrow and calcium. Brain Hemorrhage Distinguishes contrast agent from a hemorrhage in the brain. Rho/Z Measures electron density as well as effective atomic number and thus performs a basic characterization of the material of interest. Postprocessing You can select Dual Energy reconstructions for postprocessing with CT View&GO or the syngo.CT Dual Energy workflow. The following reconstruction type is available: L&H (high energy and low energy images for postprocessing) You can finalize an examination at any time even if some tasks are not yet completed. In the taskflow control, select the Close task. The Job Status tab opens. It provides an overview of all recon jobs, their status and auto tasking settings like Auto View&GO or Auto Printing. If applicable, check the Auto Tasking parameters. In the execution control, click the Close button. The patient is closed. All pending recon jobs are processed in the background. After closing the patient the Scheduler will open automatically. Now you can select the next patient to continue with the next examination. Once the required scans are completed, you can unload the patient from the patient table. On the Remote Scan Control or control box, press the Unload key or step on the Unload pedal of the table foot switch. The table is moved out of the gantry. If required, assist the patient in getting off the patient table. After reading the disclaimer, please proceed to the final quiz to complete the online training. Please note that the learning material is for training purposes only! For the proper use of the software or hardware, please always use the Operator Manual or Instructions for Use (hereinafter collectively “Operator Manual”) issued by Siemens Healthineers. This material is to be used as training material only and shall by no means substitute the Operator Manual. Any material used in this training will not be updated on a regular basis and does not necessarily reflect the latest version of the software and hardware available at the time of the training. The Operator Manual shall be used as your main reference, in particular for relevant safety information like warnings and cautions. Note: Some functions shown in this material are optional and might not be part of your system. The information in this material contains general technical descriptions of specifications and options as well as standard and optional features that do not always have to be present in individual cases. Certain products, product related claims or functionalities described in the material (hereinafter collectively “Functionality”) may not (yet) be commercially available in your country. Due to regulatory requirements, the future availability of said Functionalities in any specific country is not guaranteed. Please contact your local Siemens Healthineers sales representative for the most current information. The reproduction, transmission or distribution of this training or its contents is not permitted without express written authority. Offenders will be liable for damages. All names and data of patients, parameters and configuration dependent designations are fictional and examples only. All rights, including rights created by patent grant or registration of a utility model or design, are reserved. Copyright © Siemens Healthcare GmbH, 2020 On the following pages you will learn about the configurations of clinical examinations with the Exam Designer. These include: Creating a DirectORGANS structure template Setting up a scan protocol Introduction to Direct Density The availability of the workspace functionalities at your syngo Acquisition Workplace depends on the configuration of your CT system and the purchased licenses. Only users with clinical administrator access privileges can open the Exam Designer. Go to the Configuration Panel. Click the Advanced Visualization tab, select RT Automatic Contouring Configuration, then select Add Template to create a new structure template. Rename the template and add the organs to the template by using the search function. Select organs and move them to the structure template by using the arrow. Repeat the previous step until you have all organs in the template, then click Save. As soon as all organs are added to the template, click Apply. A pop-up message appears recommending a restart to the application (the restart is not necessary). Click OK to close the pop-up window. Now, click OK at the bottom of the window and start assigning the template to a scan protocol. From the Settings menu, choose Exam Designer, then click the Scan Protocols tile. In the global filter area, select Factory Protocols. This helps you to find the scan protocol you want to change. Open the RTP folder, select the DE protocol and click on Modify Protocols. To assign the DirectORGANS structure template to your scan protocol, open the Inline Options and set the Inline Results to RT Automatic Contouring. Then select the template you want to assign for the Structure Templates parameter. Before you confirm the changes, you need to change the name of the scan protocol (highlighted in yellow). Finally, select Confirm Changes and click Save Protocols. The protocol is now ready for use. Once the images are reconstructed and loaded to CT View&GO, select the data and click Sim&GO at the toolbar area to load them into the workflow. After the data are loaded to Sim&GO, create the isocenter by moving the crosshair to the region of interest and click Set POI. Press Mark Patient. The laser will reach the Z- and X-position. For the Y position, a move request for the table will appear at the bottom of the console. On the Patient Marking tab, you will see the coordinates. Press the Play button at the hand control or at the control box. After the table has reached the defined position, the laser will automatically turn on. Once the laser and the table are in defined position, all values are green and you can mark the patient's skin physically. After the patient is marked, click the Marked checkmark and you can finalize the examination. The Scan&GO workflow enables you to perform a complete diagnostic scan in the examination room without using the syngo Acquisition Workplace in the control room. The following workflow steps are available on the tablet: Selecting a registered patient and a scan protocol Performing the topogram scan and the tomogram scan Finalizing the examination However, some operations are only possible at the syngo Acquisition Workplace, for example connecting scan ranges or modifying parameters for image reconstruction. Scan&GO workflow (Head examination) Learn more about the Scan&GO workflow for an evaluation of the head Checklist TitleChecklist TypeChecklist ContentStartHTML The No patient registered screen is the first screen that is displayed after launching the Scan&GO examination workflow. Tap GO. Select PatientHTML The Patient Selection screen lists all patients that are registered for that day. The patient scheduled next is highlighted. To load the patient, tap the corresponding row. Select DE Scan ProtocolHTML On the patient model, tap on the head as the desired body region to be scanned. The matched protocols are displayed. Tap the RTP Head DE withContours protocol. Tap GO. The protocol is assigned to the patient. Hint: Scan&GO Approved workflow: This icon identifies scan protocols for complete scans with the tablet. Position the PatientHTML To change the selected position, tap the arrows around the patient model or use the swipe gestures. In the Audio Control, you can enable or disable the visual and audible patient instructions and change their language. Tap Go. Perform the Topogram scanHTML The CT system automatically selects the position that is defined in the scan protocol. Make sure that the patient position is correct. On the Ready to load Topogram screen, you can change the topogram length by tapping the Topogram Length button. Tap GO to load the topogram range. Then press the Start key on the control box or on the Remote Scan Control to perform the Topogram Scan. Perform the Tomogram scan (1/2)HTML Once the topogram is acquired, the Tomogram Planning screen is displayed. FAST planning automatically positions the recon range for you. To edit the recon range, tap and drag a handle on the borders. Tap GO to load the tomogram range. Perform the Tomogram scan (2/2)HTML After you have loaded the tomogram range, you can start the scan. Press and hold the Move key on the control box or on the Remote Scan Control to move the table to the range start position. Then press the Start key on the control box or on the Remote Scan Control to perform the Tomogram Scan. Check Image quality and start ReconstructionHTML As soon as the scan is finished, the acquired tomogram images are displayed on the screen. The Check&GO quality check ensures that any automatic recon jobs are blocked as soon as the range is scanned, and a Check&GO button is displayed in the Scan Browser. Check the quality of the images by dragging the slider on the right to scroll through the acquired images. You can also move two fingers away from each other to zoom in and move them towards each other to zoom out. If you are satisfied with the quality of the images, tap Recon All to start the reconstruction. Patient MarkingHTML At the Acquisition Workplace, load the data to Sim&GO. Create an Isocenter by moving the crosshair to the lesion. Please note: This workflow step is only possible at the acquisition workplace. Click Set POI. Press Mark Patient. The laser will reach the Z- and X-position. For the Y position, a move request for the table will appear at the bottom of the console. On the Patient Marking tab, you will see the coordinates. Press the Play button at the hand control or at the control box. After the table has reached the defined position, the laser will automatically turn on. Once the laser and the table are in defined position, all values are green and you can mark the patient's skin physically. After the patient is marked, click the Marked checkmark and you can finalize the examination. Finalize the ExaminationHTML Tap Close to close the patient. The examination closes and the data is distributed as specified. The No patient registered screen is displayed to examine the next patient.