CT Osteo Somaris X

SIEMENS Healthineers CT OSTEO Job Aid SOMARIS X; SOMATOM go. & SOMATOM X.cite HOOD05162003159417 Effective: 02/02/2021 Unrestricted © Siemens Healthineers, 2020 CT OSTEO* – Table of Contents SIEMENS Healthineers • Clinical Overview • Required Hardware • Default Protocol • Patient Positioning • Scanning • Reconstructions • Post Processing • Osteo Results • Caution and Configuration *CT Osteo is an optional plug-in for CT View&GO on all SOMARIS 10 scanners 2 Unrestricted © Siemens Healthineers, 2020 CT OSTEO – Clinical Overview SIEMENS Healthineers • Osteoporosis, a metabolic disease, causes bones to become weak and Normal bone brittle — so brittle that a fall or even mild stresses such as bending over or coughing can cause a fracture. Osteoporosis-related fractures most commonly occur in the hip, wrist or spine. • Bone is living tissue that is constantly being broken down and replaced. Osteoporosis occurs when the creation of new bone doesn't keep up with the loss of old bone. • Osteoporosis affects men and women of all races. But white and Asian Osteoporotic bone women — especially older women who are past menopause — are at O MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH. ALL RIGHTS RESERVED. highest risk. Medications, healthy diet and weight-bearing exercise can help prevent bone loss or strengthen already weak bones. 3 https://www.mayoclinic.org/diseases-conditions/osteoporosis/symptoms-causes/syc-20351968 Unrestricted © Siemens Healthineers, 2020 CT OSTEO – Clinical Overview SIEMENS Healthineers There typically are no symptoms in the early stages of bone loss. But once your bones have been weakened by osteoporosis, you might have signs and symptoms that include: • Back pain, caused by a fractured or collapsed vertebra • Loss of height over time • A stooped posture MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH . ALL RIGHTS RESERVED • A bone that breaks much more easily than expected Prevention: • Good nutrition and regular exercise are essential for keeping your bones healthy throughout your life. 4 https://www.mayoclinic.org/diseases-conditions/osteoporosis/symptoms-causes/syc-20351968 Unrestricted © Siemens Healthineers, 2020 CT OSTEO – Clinical Overview SIEMENS Healthineers • The diagnosis and follow-up of osteoporosis are commonly carried out by non-invasive measurements of the bone mineral density (BMD). • These measurements must be highly reproducible because they are required to determine small changes in the bone mineral density. • Siemens CT Osteo evaluation requires the use of special hardware and scan protocols for image acquisition. For that reason the Siemens SOMATOM CT Scanners offer a special default Osteo CT scan protocol. 5 Unrestricted © Siemens Healthineers, 2020 CT OSTEO - Hardware SIEMENS Healthineers Required Hardware for CT Osteo scanning: • Osteo Positioning Mattress – to hold the phantom • Reference Phantom – to measure bone mineral density Osteo positioning mattress Use the Osteo positioning mattress to position the patient appropriately for the Osteo examination. Table top mattress • Gel Pack – to fill the air gap in lower back between skin/phantom The table top mattress has a cut-out in the vertebral region for the reference phantom and the gel pack. Reference phantom and gel pack TOP Use the table top mattress in combination with the reference phantom and the gel pack. Other non-Osteo examinations For standard examinations, use the Osteo positioning mattress with the PE pad. Reference phantom and gel pack 6 Unrestricted © Siemens Healthineers, 2020 CT OSTEO – Protocol SIEMENS Healthineers Siemens Default CT Osteo protocol: • Is found in the Patient Model Dialogue under the “Spine” region • It consists of a Topogram and 3 separate vertebral scan ranges • On the go.Now the scan ranges are spiral due to no gantry tilt available • On the other go.Family and X.cite scanners, the scan ranges are sequential because the gantry may be tilted. Protocol: Osteo [factory] -Indications: quantitative assessment of vertebral bone mineral density (BMD) in the diagnosis and Topogram follow-up of osteopenia and osteoporosis, wo CM Osteo -Scan modes: RoutineSequenceAdultOsteo2d, RoutineSequenceAdultOsteo2d Osteo RoutineSequenceAdultOsteo2d Osteo 7 Unrestricted © Siemens Healthineers, 2020 CT OSTEO – Protocol SIEMENS Healthineers Default protocol parameters: Table Position X • Scan Mode = RoutineSequenceAdultOsteo2d (spiral if go.Now) mm • 1 x 10 acquisition mode with 10mm slice thickness (no increment) Position -750.0 Height 150.0 mm K • CARE kV (if applicable) = Manual kV (optimized for Non-Contrast) Tilt O • Kernel = Or40 (special Osteo kernel – do not change)! Cancel Move • Table Height MUST be at 150mm. Scan/Recon CHI Scan Favorites × Scan/Recon Scan Mode KV mA CTDIvol DLP Feed Rot. Time [mGy] [mGy*cm] Acquisition [mm] [mm] [s] Topogram Scanplanning TopoAdultSn Sn 140 55 SPR (32 cm) ... 3.6 6 × 0.6 Osteo RoutineSequenceAdultOsteo2d 80 1 × 10.0 0.0 1.00 Osteo RoutineSequenceAdultOsteo2d 80 1 × 10.0 0.0 1.00 Osteo RoutineSequenceAdultOsteo2d 80 1 × 10.0 0.0 1.00 8 Unrestricted © Siemens Healthineers, 2020 CT OSTEO – Protocol SIEMENS Healthineers For a standardized comparison with reference data, the image data set must fulfill the following conditions: • Data must have been acquired with an Siemens CT Osteo default protocol using the Siemens reference phantom for Osteo scanning (the phantom is specifically calibrated to the scanner). • Scan at least three (3) vertebral bodies (evaluation requires at least 3 vertebrae). • Typically the three bodies are L1, L2, and L3 level. However, if there is metal or damage in those areas, use a different level and/or scan more than 3 and choose which are best for the evaluation • Use image comments for labels (i.e. L1, L2, L3, L4, L5, or T12). These comments will be used for Osteo evaluation results. 9 Unrestricted © Siemens Healthineers, 2020 CT OSTEO – Patient Positioning SIEMENS Healthineers Osteo [factory] (Adult) • Place the required Osteo mattress pad with Phantom on the table top; with the Topogram word “Top” towards the Gantry • Patient Position – HF Supine or FF Supine (be sure area of interest directly over HF supine HF prone HF right HF left Phantom) Best way to line up the patient is to position the bottom of the phantom at a FF supine FF prone FF right FF left • level between the Iliac Crest and ASIS. Length 512 mm CTDIvol SPR (32 cm) 0.07 ›mGy • Place gel pack under the patient’s Lumbar Spine (to reduce air gap) DLP 3.6 mGy cm MA 55 KV Sn 140 Exposure Time 3.32 5 Check metal detection . Osteo . Osteo Osteo Reconstruction 10 Unrestricted © Siemens Healthineers, 2020 CT OSTEO – Scanning SIEMENS Healthineers • If on a SOMATOM go.Now, you will only be able to scan spiral. Be sure to include at least 3 usable vertebral bodies. L3 • If on other SOMATOM go.Family or SOMATOM X.cite scanner you will use sequence and tilt to each vertebral body • If you see this yellow exclamation in the recon job, it may mean your tilt is too great (fully investigate to make sure this is the reason). • If the Osteo Phantom is not in the image, no evaluation will be able to be performed Water Bone equivalent equivalent 11 Unrestricted © Siemens Healthineers, 2020 CT OSTEO – Scanning SIEMENS Healthineers OSTEO SCAN H 12345 SOMATOM X.cite OSTEO SCAN syngo CT VA30A 12345 SOMATOM X.cite OSTEO SCAN H *12/29/1963, M. 57Y HFS *12/29/1963, M. 57Y syngo CT VA30A 12345 SOMATOM X.cite HFS *12/29/1963, M. 57Y syngo CT VA30A 1 2/29/2020 1 2/29/2020 1 2/29/2020 HFS 9:59:47.01 PM 9:59:47.01 PM 2 IMA 1 TP1 -1,083.2 9:59:47.01 PM TP1 -1,113.2 2 IMA 1 TP1 -1,151.9 TOP 200 TP2 -1,093.3 2 IMA 1 LEN 10.1 TOP 200 TP2 -1,123.2 LEN 10.0 TOP 200 TP2 -1,162.0 TP -750.0 LEN 10.1 FOV 250x250 TP-750.0 FOV 250x250 TP -750.0 FOV 249×249 GT -11 GT 4 GT 10 A Dcm 10cm 1.0cm KV Sn140 KV Sn140 KV Sn140 mA 55 mA 55 TI 5.88 TI 5.88 mA 55 L TI 5.88 SL 130 SL 512 0/0 130 SL 51 2 0/0 512 0/0 130 Tr20fA.n .. :0000A:1At.CU1agA Filter Sn 108 Tr20fA.n .. :0000A:1At.CU1 agA Filter Sn 108 Tr20fA.n .. :0000A:1At.CU1 agA Filter Sn 108 L1 L2 L3 12 Unrestricted © Siemens Healthineers, 2020 CT OSTEO – Reconstructions SIEMENS Healthineers Recon Favorites General Recon Recon&GO | Image Impression | Recon Box Slice Thickness No. of Image Order Comment 1 Comment 2 Recon Ranges Scan/Recon [mm] Images Topogram Osteo 10.00 Or40 L2 10.00 Head to Feet L2 Osteo Recon Favorites General Recon Recon&GO | Image Impression | Recon Box Scan/Recon Slice Thickness No. of [mm] Images Image Order Comment 1 Comment 2 Osteo Osteo 10.00 Or40 L3 10.00 Head to Feet L3 Osteo Recon Favorites General Recon Recon&GO | Image Impression | Recon Box Scan/Recon Slice Thickness No. of [mm] Images Image Order Comment 1 Comment 2 Osteo 10.00 Or40 L4 10.00 Head to Feet L4 13 Unrestricted © Siemens Healthineers, 2020 CT OSTEO – Post Processing SIEMENS Healthineers Post processing workflow: • Load the image data into CT View&GO • You must select an image segment from the layout in order for the Osteo icon to become active. • Click the “Osteo” icon from either the Tool Gallery or Favorites Tools. • It will populate and automatically create the contours of the vertebrae. Osteo • If for some reason (usually due to motion) the contours fail, the system will prompt you to assist in manually creating the contour. Follow the instructions on the screen. • You can also adjust the contours if you wish by moving the dots with the mouse. 14 Unrestricted © Siemens Healthineers, 2020 CT OSTEO – Post Processing SIEMENS Healthineers Select a segment and the OSTEO icon becomes available; Click OSTEO icon to begin evaluation. CT View&GO X Stack 3x2 Stack 4x4 Folow Up 2TP MPR VRT MPR MIP MPR Compare A R R Favorite Tools AH Osteo Ref. Physician: H-SP Ward: 10-Apr-2014 10:38 Physician: Operator: Total MAS 675 MAS CTDIW Topogramm 888 TH12 AWN - 8888 7 NNN Please drag data from Series Navigator + 15 Unrestricted © Siemens Healthineers, 2020 CT OSTEO – Post Processing SIEMENS Healthineers CT Osteo opens, loads the data, and automatically contours the vertebral bodies. H AH A R T C 2/11 Exclude R TH11 Reset Comparison with Reference Data Age: 73; Sex: F Bone Mineral Density Values [mg CA-HA/ml] TH11 Reference Data: Siemens Default Total BMD Age: 73. Sex: F TH12 T-Score (20y): 2.1 [mg CA-HA/m] Z-Score: 0.8 >120 BMD [mg CA-HA/T] 4 Total BMD 102.6 80-120 80 260 Vertebral Cortical Cortical Trabecular 240 Scan No. Left Right Total Cortical Trabecular +2 SD Left Right Total Trabecular 220 200 TH11 273.2 433.9 347.9 88.6 134.4 110 8 180 TH12 160 Mean 140 L1 306.9 254.0 283.3 103.3 85.4 94.5 120 100 2 SD + 102.6 TOTAL 290.0 344.0 315.6 80 95.9 109.9 102.6 60 40 20 Accept Results o 10 20 30 40 150 70 80 90 Age [years, 00 16 Unrestricted © Siemens Healthineers, 2020 CT OSTEO – Post Processing SIEMENS Healthineers Contour Labels: • (A) Anterior point of the vertebral body • (L) Left Intermediate point • (C) Center of the spinal canal • (T) Posterior point of the vertebral body • (R) Right Intermediate point 17 Unrestricted © Siemens Healthineers, 2020 CT OSTEO – Post Processing SIEMENS Healthineers • Click on each vertebral body in the table and evaluate the contours for each vertebral bodies. • If you do not agree with the contours, you may correct them. • To correct, move a base point, by left mouse button (LMB) click on that base point and drag to the new position. Bone Mineral Density Values [mg CA-HA/ml] Age: 73; Sex: Fli ertebra/ Cortical Cortical Trabecular Trabecular can No. Left Right Total Cortical Left Right Total Trabecular TH11 273.2 433.9 347.9 88.6 134.4 110.8 TH12 281.7 273.2 277.8 111.4 93.0 103.0 L1 306.9 254.0 283.3 103.3 85.4 94.5 TOTAL 287.2 320.4 303.0 101.1 104.2 102.8 Accept Results 18 Unrestricted © Siemens Healthineers, 2020 CT OSTEO – Post Processing SIEMENS Healthineers • There may be the occasion the automatic contouring fails (e.g. patient motion). • The affected vertebral body will show no results in ROIs not Found the table. Exclude R TH12 If this occurs, a pictogram will be displayed. Follow Draw a line between the • center of the spinal canal (C) and the anterior point Reset the instructions on the pictogram to manually on the vertebra (A). create the contour • “Draw a line between the center of the spinal canal (C) and the anterior point on the vertebra (A)” Bone Mineral Density Values [mg CA-HA/ml) Age: 73. Sex: F • Once you draw the line, the contour will Vertebral Cortical Cortical Total Cortical Trabecular rabecular Total Trabecular automatically be created. Scan No. Left Right Left Right 1470 1100 TH12 COCO GOOD TOTAL 290.0 344.0 315.6 95. 109.9 102.6 Accept Results 19 Unrestricted © Siemens Healthineers, 2020 CT OSTEO – Post Processing SIEMENS Healthineers • Once you are satisfied with the contours, click “ACCEPT RESULTS” to create the findings. • DICOM Results are created of the: 1. Reference Data Comparison Graph 2. Bone Mineral Density Values Table 1 ... _ OsteoResult_Contours_[1] [ ... Patient Protocol OsteoResult_ Co 3. Images of contours 1 ... _ OsteoResult_Tables_[1] [1009] [501] [50-1] ntours_[1] [10. 1 ... _ OsteoResult_Graph_[1] [1011] OsteoResult_Ta OsteoResult_Gr Vertebra/ Cortical Cortical Trabecular Trabecular bles_[1] [1009] .. aph_[1] [1011] .-. Scan No. Left Right Total Cortical Left Right Total Trabecular TH11 273.2 433.9 347.9 88.6 134.4 110.8 TH12 281. 273.2 277.8 111.4 93.0 103.0 L1 306. 254.0 283.3 103.3 85.4 94.5 TOTAL 287.2 320.4 303.0 101.1 104.2 102.8 Accept Results 20 Unrestricted © Siemens Healthineers, 2020 CT OSTEO – Results SIEMENS Healthineers Comparison with Reference Data Age: 73; Sex: F TH11 Reference Data: TH12 T-Score (20y): Siemens Default Total BMD -2.0 [mg CA-HA/ml] 0 1 Z-Score: 0.9 >120 BMD Total BMD: 102.8 80-120 [mg CA-HA/ml] 280 + < 80 • Reference Data Comparison Graph 260 240 220 +2 SD 200 180 160 Mean 140 120 -2 SD 100 + 102.8 80 60 40 20 10 20 40 50 60 70 80 100 Bone Mineral Density Values [mg CA-HA/ml] Age: 73; ex: FI Vertebra/ Cortical Trabecular Trabecular Scan No Left Total Cortical Right Left Right otal Trabecular • Bone Mineral Density Values Table TH11 273.2 433.9 347.9 88.6 134.4 110.8 TH12 281.7 273.2 277.8 111.4 93.0 103.0 L1 306.9 254.0 283.3 103.3 85.4 94.5 TOTAL 287.2 320.4 303.0 101.1 104.2 102.8 Accept Results AH AH AH • Images of contours R TH11 TH12 L1 L 21 Unrestricted © Siemens Healthineers, 2020 CT OSTEO – Results SIEMENS Healthineers T-Score (what the doctors typically look for) • This is the deviation of average BMD of the patient from that of a young healthy control. It represents bone loss with reference to the peak bone mass. Z-Score • This is the deviation of average BMD of the patient from that of a healthy person of the same age. It is an indicator of biological variability. 22 Unrestricted © Siemens Healthineers, 2020 CT OSTEO – Results SIEMENS Healthineers • CT Osteo has an age restriction. • If a patient is age 81 or higher, no results will be provided. • The database cuts off at age 81. (e.g. an 80 y/o will get results, but an 81 y/o will not). • CT Osteo also provides results based on gender (male/female). • Be sure to assure both gender and the correct D.O.B. are provided. • NOTE: It is NOT acceptable to change the patient D.O.B. in order to obtain CT Osteo results! 23 Unrestricted © Siemens Healthineers, 2020 CT OSTEO – Caution and Configuration SIEMENS Healthineers Configuring the Osteo phantom The Osteo phantom is configured in the Administration Portal. 1 A Siemens Healthineers service technician must configure the Osteo phantom before you can use the Osteo application and perform an Osteo scan. In certain cases, you can configure the Osteo phantom: Examinations for Osteo reconstructions / You have at least service level 3 access rights. The Osteo Configuration workspace is open. - > Opening the Application Configuration Observe the following safety information when performing an examination for an Osteo 1. To configure the Osteo phantom, enter the following Osteo phantom values in the corresponding fields: reconstruction. Osteo Phantom Offset: the HU-offset of the Osteo phantom's water compartment Osteo Scale Factor: used for calculating the Ca-HA concentration of the Calcium A CAUTION compartment: Ca-HA concentration = Osteo Scale Factor * (200 mg Ca-HA/ml*) Osteo Phantom Number: a unique ID (serial number) that identifies the Osteo phantom Osteo images are created with an incorrect scan protocol, or incorrect scan parameters and 1 All values are stamped on the lateral sides of the reference phantom. table height! Incorrect diagnosis caused by incorrect scan values. For Osteo scans, only perform scans with a standard Osteo scan protocol provided by Siemens Healthineers. 15674 / 43937/10430 4.83 HU TOP + For adjustable patient tables, make sure you use the calibrated table height. Example of an Osteo phantom configuration CAUTION (1) Osteo Phantom Number The last number stamped on the lateral side of the front end of the Osteo phantom Use of other than original and configured Siemens Healthineers osteo phantoms! identifies the Osteo Phantom Number. Wrong diagnosis due to incorrect information. (2) Osteo phantom front end The label TOP identifies the front end of the Osteo phantom. + Only the original and configured osteo phantom must be used. (3) Osteo phantom bottom end Before first use, the phantom factor must be configured by the Customer Service at (4) Osteo Scale Factor Siemens Healthineers. The Osteo Scale Factor is stamped on the lateral side of the bottom end of the Osteo Always verify that the used phantom is paired to the CT system. phantom and can be identified by S =. (5) Osteo Phantom Offset The Osteo Phantom Offset is stamped on the lateral side of the bottom end of the Osteo phantom and can be identified by HU. 24 Unrestricted © Siemens Healthineers, 2020 Thank you SIEMENS Healthineers for your enthusiasm! Siemens Healthineers Instructor Training and Development Center (TDC) • Name: Cary, NC USA • Phone Number: siemens-healthineers.com • Email: [email protected] 25 Unrestricted © Siemens Healthineers, 2020