Symbia VB20 Software Upgrade

By the end of this module, you will be able to:       Describe the SPECT new features and enhancements that will be available for your Symbia scanner.       Describe the new calibration procedures for xSPECT Quant and Broad Quant.       List the CT features that are available for the new software.     Describe the product improvements for the Symbia system.   Welcome to the Symbia VB20 Software Upgrade web based training. This tutorial will guide you through the changes that you will see on your system after you have received this upgrade. Images courtesy of Siemens Healthineers Clinical Education I. Systems Receiving the Upgrade II. SPECT New Features and Enhancements a. Quantification Features b. Calibration Procedures for xSPECT Quant and Broad Quant c. xRecon Activity III. CT Features IV. Product Improvements Camera Systems Receiving Upgrade — SPECT Only Systems  Symbia E Symbia S   Symbia Evo Symbia Evo Excel Symbia T Series Symbia Intevo & Symbia Intevo Excel Symbia.net MI Workplace Symbia.net Server No changes to: Cedars Corridor 4DM Emory Scenium xSPECT Quant for Tc99m Bq/ml SUV Laid the foundation for absolute quantification Specific uses are beginning to emerge VB20A Upgrade Expanding accurate and reproducible quantification Supports wide range of user defined quantitative protocols     xSPECT Quant Extended Support xSPECT Quant I123 xSPECT Quant In111 *xSPECT Quant Lu177   Dose calibrator independent quantification High precision calibration + cross calibration = Standardized Quantification Measured system model per collimator used with xSPECT option        *xSPECT Quant 177Lu is not commercially available in some countries, including the US.177Lu, referenced herein. US.177Lu is not currently recognized by the US FDA as being safe and effective, and Siemens does not make any claims regarding its use.  Due to regulatory reasons, its future availability cannot be guaranteed. Please contact your local Siemens organization for further details.   I123 MIBG Neuroblastoma planning I131 MIBG therapy Therapy response evaluation Absolute tracer concentration SUV estimation Improves patient dose selection for I131 MIBG Therapy Accurate estimation of tumor burden            Sequential SPECT/CT images using xSPECT Quant acquired 24 and 48 hours after injection of 415 MBq of 123I-MIBG to a patient with a metastatic pheochromocytoma.  Study shows tracer-avid liver metastases with SUVmax of 5.95n the 24-hour image, which remains unchanged in the study acquired the next day (SUVmax of 5.91 in the 48-hour study).  The normally functioning left adrenal gland shows simiar focal uptake in both studies [Data courtey of CHIUV, Lausanne, Switzerland]   I123 FPCIT (DaTscan) Characterization and classification of Parkinson’s disease and related neurodegenerative disorders SUV to quantify striatal DAT binding May improve characterization of Parkinson’s disease, especially in early stages                123I-Ioflupane (DaTscan) SPECT/CT study with xSPECT Quant demonstrating normal striatal uptake in a patient with normal striatal dopaminergic receptor density.  Study shows SUV estimation in both striatum with SUVmax of 9.42 in the right and 10.38 in the left striatum.  Analysis of striatal binding ratio shows right and left SBR or 5.35 and 5.46, respectively, with normal putamen/caudate ratio (0.99-Rt 0.93-Lt). The SUV at the center of the left caudate marked by cursor is 10.08. [Data courtesy of CHUV, Lausanne, Switzerland]   In111 Octreotide Initial staging Follow up after Y90 DOTATOC* or Lu177 DOTATOC Therapy Provides reliable evaluation of tracer transit into and from tumor and critical organs *90Y-DOTATOC is not currently recognized by the US FDA as being safe and effective, and Siemens does not make any claims regarding its use.           24-hour post-injection         Sequential quantitative 111In-octreotide SPECT/CT studies in a NET patient without metastases showing gradual increase in renal and splenic uptake activity over the course of 24 hours. [Data courtesy of CHUV, Lausanne Switzerland] 2-hour post-injection       Lu177 DOTATATE Peptide Receptor Radionuclide Therapy (PRRT) Somatostatin analog for patients with advanced neuroendocrine tumors β emitter ɣ emitter Allows for planar or SPECT imaging to be performed after Tx dose. Demonstration of tumor uptake Estimation of tumor and critical organ dose * 177Lu-DOTATATE is not currently recognized by the US FDA as being safe and effective, and Siemens does not make any claims regarding its use.           Sequential quantitative SPECT/CT over four time points following therapeutic dose of 177Lu-DOTATATE in a patient with metastatic NET. [Data courtesy of Ludwig Maximillans University, Munich Germany]            LEHR – Low Energy, High Resolution LPHR – Low Penetration, High Resolution MELP – Medium Energy, Low Penetration Supports all clinically relevant collimator/isotope combinations besides Bremsttrahlung isotopes Supported isotopes include: Co57, Ga67, I123, I131, In111, Lu177, Se75, Tc99m, Tl201, Ra223, Re186, Sm153, Xe133, Am241, Ba133, Gd153, I125, Kr81, Kr85, Rb81, Xe127, Yb169, C11, Cu62, F18, Ge68, N13, O15, and Rb82 Dose calibrator dependent quantification Manual calibration Generic system model     Sensitivity Calibration with a Point Source Calibrate the system’s sensitivity                                        Volume Sensitivity Calibration Calibrate a volume sensitivity factor (VSF) per isotope/collimator combination       Co57 Calibration/Peaking Source Kit Used for LEHR and LPHR collimators Half-life is 271.79 days     Note: If your scanner has Automatic Quality Control (AQU), your kit will not have a peaking source in your kit. Co57 peaking source Precision Co57 Calibration Source and Shield Dose Calibrator Source Holder      Used for MELP Collimators Half-life is 119.78 days Se75 peaking source Precision Se75 Calibration/Peaking Source and Shield Dose Calibrator Source Holder Performed for each camera preset/collimator combination and each dose calibrator used Sensitivity calibration using point source of respective clinical isotope measured in dose calibrator Preparation Isotope to be inserted in the cone portion of vial Yielding count rate 5-30 kcts/sec Tc99m – 1-5 mCi In111 – 1-5 mCi I123 – 1-5 mCi *Lu177 – 10-30 mCi Do not overfill the vial or splash activity on its sides *xSPECT Quant 177Lu is not commercially available in some countries, including the US.177Lu, referenced herein, is not currently recognized by the US FDA as being safe and effective, and Siemens does not make any claims regarding its use.  Due to regulatory reasons, its future availability cannot be guaranteed. Please contact your local Siemens organization for further details.                       Uniform Cylinder Phantom Prepared with a known activity concentration reported from dose calibrator The phantom contains no inserts. The phantom has an approximate inner diameter of 20 cm. The phantom has a nominal volume of 6000-7000 ml.   Prior to acquiring the Sensitivity Calibration or Cross Calibration, the following must be completed: The system is homed. The system is tuned and peaked with appropriate sources. The appropriate collimators are installed. Unscrew vial holder cap from the end of the integrated source holder Loosen thumb screw on the top of peaking source Slide peaking source over end of the source holder Remove the calibration source from the room   Register patient If Performing the Sensitivity Calibration: Select Sensitivity Calibration workflow from the Calibration category If Performing the Cross Calibration: Select the Cross Calibration workflow from the Calibration category Camera Parameters Sub Tab Camera Preset pull down menu: Se75 – SC-Se75-LME-NMG Co57 – SC-Co57-NMG   Go to the Analyzer Tab Peak the system Put away peaking source Install the collimators   Registration (New Source) Select Entry Type from pull down Label Menu: Enter source serial number Assay: Enter dose information from system apparent activity on source label. Assay Date Make sure correct isotope is selected on the Camera Parameters tab. Save Your registered source will show in the Registered Labels pull down menu. Calibrator Registration  (New Dose Calibrator) Enter the dose calibrator name in the Label field Make sure the correct isotope is selected on the Camera Parameters tab. Select Save   Screw it to the end of the integrated source holder Active element is contained in the sphere at the pointed end of the calibration source. Position the active element over the center of the detectors   Insert the point source of the isotope into end of integrated source holder Position the cotton over the center of the detectors Verify that the count rate is between 5 and 30 kcts/sec per detector   Select Prepare Acquisition System initiates motion to the position the detectors with a 10 cm source to collimator distance.   Select Start Acquires an uncorrected image for both detectors simultaneously Proceeds to Sensitivity Calculation activity Processes the Calibration data 1. Review: Patient Collimator Isotope Presets Crystal Thickness 2. Photopeak menu    Photopeak Measured sensitivity results are displayed If results acceptable Accept These Calibrations and Make Them Current If results not acceptable  Reject These Calibrations and Use Existing Set      Click Complete Image data and Sensitivity Calculation save screen are saved to the patient database Remove calibration source Retract integrated source holder Series Information Tab Shows available calibrations for collimators and presets   Enables quantification of most clinically relevant tracer/collimator combinations Uses an onsite measured point source for a clinically used isotope Volume sensitivity calibration of a cylinder phantom Steps for full procedure (in order) Tuning and Peaking Sensitivity Calibration Volume Sensitivity Calibration   Broad Quantification Sensitivity Calibration Prior to acquiring the Broad Quantification Sensitivity Calibration, the following must be completed: The system is homed. The system is tuned and peaked with appropriate sources. The appropriate collimators are installed. Insert point source into the end of the integrated source holder Position cotton over the center of the detectors Suggested activity is 1-5 mCi. Make sure the count rate is between 5 and 30 kcts/sec per detector.   Register patient Select Sensitivity Calibration Workflow from Calibration category Camera Parameters Tab Camera Preset pull down menu: Select isotope that is being used for calibration   Series Information Tab Dose numeric value in µCi, mCi, MBq or KBq Measured time and date   Select Prepare Acquisition System initiates motion to the position the detectors with a 10 cm source to collimator distance Select Start Acquires an uncorrected image for both detectors simultaneously Proceeds to Sensitivity Calculation activity Processes the Calibration data 1. Review: Patient Collimator Isotope Presets Crystal Thickness 2.Photopeak menu Photopeak Measured sensitivity results are displayed If results acceptable  Accept These Calibrations and Make Them Current If results not acceptable  Reject These Calibrations and Use Existing Set Prior to acquiring the Broad Quantification Volume Sensitivity Calibration, the following must be completed: The system is homed. Sensitivity calibration has been performed with a point source of the relevant clinical isotope. Appropriate collimators are installed. A uniform cylinder phantom has been prepared with a known activity concentration, as reported by a dose calibrator. The phantom is placed on the patient bed and in the field-of-view. The count rate should be between 5 and 30 kcts/sec per detector.       Register patient Select Volume Sensitivity Calibration Workflow from Calibration category   Series Information Tab Enter the following: Dose numeric value and unit (μCi, mCi, MBq, KBq) Date and time the isotope was measured Volume Solution:  Volume amount of the solution in the phantom Dose Calibrator ID: Select Dose Calibrator used to assay dose If applicable, enter the Residual Dose information and Dose Calibrator ID   Stop Conditions Tab Stop Condition (counts - default is 100 kcts/view) Orbit (Circular or Noncircular)   Select Prepare Acquisition The system enables the Start button if all data and parameters pass system validation Select Start The SPECT acquisition begins Upon completion, the workflow proceeds to the CT Acquisition activity CT Acquisition Select Prepare Perform the CT Acquisition with the parameters set by the workflow   Two xRecon  Activities Reconstructs the data 1st xRecon creates a SPECT image for registration Image Registration activity used to review registration and readjust alignment, if needed 2nd xRecon proceeds to second and final image reconstruction   Pre-positioned spherical VOI Center and resize VOI if necessary Double-select within the VOI boundary to enable editing Single select outside to complete the edits Avoid phantom boundaries Information Displayed: Collimator, Isotope, Camera Preset VOI statistics Calculated Volume Sensitivity Factor True Activity Concentration Select Accept These Calibrations and Make Them Current  -OR- Select Reject These Calibrations and Use Existing Set Series Information Tab Check Enable Quantification Acquisition Select the appropriate isotope and pharmaceutical Initial Assay Dose Value Dose Unit Assay Date Assay Time Injection Date Injection Time Dose Calibrator ID (if used) Residual Dose Dose Value Assay Date Assay Time Dose Calibrator ID (if used) Camera Parameters Tab Ensure that Study Based Setup is checked Stop Conditions Tab Ensure that Advanced Data is selected for the data type 1st xRecon activity - used for creating a SPECT image for registration Image Registration activity used to review registration and readjust alignment , if needed 2nd xRecon activity – used for final image reconstruction   Settings Tab Showing the Parameters view Show Image and Edit Parameters toggle Initiates the Recon process Shows the raw data and reconstructions associated with this activity   Images courtesy of Siemens Healthineers Clinical Education Progress bar appears when the Start Recon button is initiated     Images courtesy of Siemens Healthineers Clinical Education   All slices are reconstructed by default WB Zipping is performed with the reconstruction algorithm       Images courtesy of Siemens Healthineers Clinical Education Cross calibration can also be accessed. Procedure: Select Edit Dose Info Make edits Select OK     Images courtesy of Siemens Healthineers Clinical Education Toggles to scroll through jobs Display Selector   Images courtesy of Siemens Healthineers Clinical Education Advanced Options Reconstruction Parameters Scatter Estimation Window Weights Filtering Attenuation Coefficients Determination Energy Settings Beam Model Filtering   Exam Type Selects the appropriate parameters for the type of study being performed. All exam types decay correct to the injection time, except WholeBody Theranostic, which decay corrects to acquisition Start time Zone Preset: only available for Skeletal. Bone preset only selection. User-defined Enter your own parameters   Created for an organ or structure to produce xSPECT Bone images. Skeletal is only option 1st xRecon Activity Parameter Settings: Ultra-Fast and User Defined 2nd xRecon  Activity Parameter Settings: Fast, Standard, Best, or User Defined   Based on total counts of the study and desired image quality 1st Recon: Ultra Fast and User Defined 2nd Recon: Fast, Normal, Best and User Defined   All CT features are purchasable Contact your Siemens Sales Representative for availability and system requirements Only Available on Symbia Intevo Bold SAFIRE iMAR IVR SSDE FAST kV (standard)                                    Symbia Intevo 6/16/16+ and Symbia T6/T16 FAST kV FAST 3D Align Symbia Intevo 2/6/16/Bold and Symbia T2/T6/T16 Multi-Series CT AC   Raw data based iterative reconstruction More powerful dose reduction than image based methods Well established image impression Fast Improved workflow with variable settings   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. SAFIRE can be enabled manually on the recon card of most protocols SAFIRE reconstruction jobs displayed blue “Kernels” automatically become partner “algorithms” Further dose reduction may be implemented if desired                                 Full Dose: 5.94 mGy                                           SAFIRE: 2.92 mG7                                  Half-Dose: 2.92 mGy Example 1:  CT enterography at 80 kV. Images were reconstructed at 2-mm slices using the 840 kernel for the full-dose and half-dose exam.  The corresponding I40 kernel was utilized for reconstructing the half-does SAFIRE images. Images copyright 2011, Mayo Foundation for Medical Education and Research. The statements by Siemens customers described herein are based on results that were achieved in the customer's unique setting. Since there is no “typical” hospital and many variables exists (e.g., hospital size, case mix, level of IT adoption) there can be no guarantee that other customers will achieve the same results. Example 2: Pediatric Congenital Heart Disease: RVOT conduit at 80 kV, DLP 12. Left: standard weighted FBP reconstruction (B36 kernel). Right: SAFIRE reconstruction (I36 kernel). Images copyright 20, Minneapolis Heart Institute Foundation. The statements by Siemens customers described herein are based on results that were achieved in the customer's unique setting. Since there is no “typical” hospital and many variables exists (e.g., hospital size, case mix, level of IT adoption) there can be no guarantee that other customers will achieve the same results. Causes of metal artifacts Beam Hardening Scatter Partial Volume Effect Photon Starvation   Images courtesy of Siemens Healthineers MI HQ      Combines three successful approaches to reduction of artifacts Beam Hardening Correction Sinogram Inpainting Frequency Split        Select the eye icon Select the implant type Select the proper window setting Without iMAR   With iMAR Images courtesy of Siemens Healthineers MI HQ Without iMAR   With iMAR Images courtesy of Siemens Healthineers MI HQ Allows data reconstruction for improved spatial resolution in the z-direction Reconstructs 32 overlapping slices from the acquired 16 This feature is used for sub mm slice protocols             Images courtesy of Siemens Healthineers Clinical Education InnerEarHR_IVR HeadAngio_IVR CarotidAngio_IVR WholeBodyAngio_IVR ExtrCombi_IVR   One CT tube; two successive spiral scans One automated procedure Two scans performed at different kV and mA levels High temporal and spatial resolution Both spirals are performed at half the dose Enhanced chemical difference in tissues kVs are set to 80 and 130 Delay can be set for the first entry but not the second Effective mAs and Quality Reference mAs can be set for the first entry but not the second SNR will be corrected automatically   Auto-range of two spiral scans Cannot split auto-range and insert additional scans. Only parameters of the first entry can be modified. Changes will be inherited into the second entry. New kernels available: DE Mono 40 keV to DE Mixed Image evaluation is performed on syngo.via using Dual Energy Applications     DE_Abdomen_KidneyStones DE_Abdomen_Monoenergetic DE_Foot_Gout   Differentiating hemorrhage from iodine-uptake in bleeds and lesions Assists in visualization of iodine concentration and distribution in the brain Lesions and bleeds may show significant iodine uptake Inactive hemorrhages are not enhanced   Image courtesy of Siemens Training and Development Center                     Accurate and non-invasive diagnosis of gout Acute cases where aspiration cannot be performed Uric acid concentration in the blood not reliable indicator Visualization of uric acid crystals   Image courtesy of Siemens Training and Development Center FAST kV is indicated in the drop down kV list kV value highlighted in yellow indicates a scan conflict Default kV value is marked with a home icon             Higher kV Reduces image noise Decreased image contrast Increased dose FAST kV Maintains the same dose level when you adjust the kV value Tube current is automatically raised and lowered when you increase or decrease the kV value Difference of CTDIvol, before and after kV adaption is within 5% Optional Feature Allows merging of multiple overlapping spiral CT scans into one data series, or wholebody series  Series can be used to provide AC for SPECT data Conditions for Merging All FOV must match All CT scans must overlap All CT scans must have the same kV           Steps to merge CT: Open the Patient Browser and open the study to view the examination data series. Select the CT scans that are to be used for attenuation correction, and then select the Merge Multiple CTs icon to launch the merge tool. Enter an easily identifiable name for the new CT data series then set the reconstructed slice Thickness and Increment for the merged series. The default values are those last used. Select Complete to finish the merge process. Upon successful completion, the new CT dataset will appear as a new data series in the study. Select the new CT data series from the menu to use it for attenuation correction. Light Rail Touch Pads: Cardiac armrest & elbow tips are outside the FOV Cardiac armrest & elbow tips are inside the FOV Four new contact sensors to cover the light rail and L-arms Improvement only for new systems                                    Warning: NCO prescan not selected Popup warning message Occurs to prevent artifact truncation   Now that you have completed this web-based training, you should be able to:     Describe the SPECT upgrades that will be available for your Symbia scanner.       Describe the new calibration procedures for xSPECT Quant and Broad Quant.       List the CT Features that are available for the new software.       Describe the product improvements for the Symbia system.