SOMATOM go.All, go.Top, and X.cite Advanced Workflows Classroom Workbook

SIEMENS SOMATOM go.All/Top and SOMATOM X.cite Advanced Workflows Classroom Workbook SIEMENS www.siemens-healthineers.us Healthineers HOOD05162003089290 I. Contact Information Summary Welcome to Siemens Healthineers Visit www.usa.siemens.com/clinicaleducation for more information regarding the current Siemens Siemens Healthineers is dedicated to helping you get the Clinical Training and Continuing Education portfolio. most out of your investment throughout the entire product life cycle and beyond. Our goal is to enable you Discover. Try. Buy. on webShop to take technology further, profitability higher, and patient care to the next level. Find the information, resources, and Do you want to “Discover. Try. Buy.” options, accessories, tools you need to get the most out of your recent and clinical education to make the most of your investment and stay up-to-date. imaging equipment? Discover images, case studies, Visit https://new.siemens.com/us/en.html. and video demonstrations with the latest clinical applications. Try advanced applications utilizing Clinical Training and Continuing Education free software trials. Buy applications, coils, clinical education, and accessories, conveniently at any time. Customer Care Center - Clinical Application Support: Visit www.usa.siemens.com/webShop today! Call 1-800-888-7436 Siemens Training Centers Troubleshooting assistance • Immediate assistance for software Siemens Clinical Education • applications and workflow issues Training Center – TDC2 110 Mac Alyson Court Please provide the Functional Location Number when • Cary, NC 27511 calling for assistance. Clinical Education Offerings: Call 1-888-221-8010 (follow the prompts) Classroom Training (Offerings, Registration • & Scheduling) Educational Symposia • On-site Training • Printed Self-studies • Virtual Education (Offerings & Registration) • Workshops & Fellowships • 2 II. Contents I. Contact Information Summary ...........................................................................................................................2 II. Contents ..................................................................................................................................................................3 III Course Description ................................................................................................................................................4 III Agenda ......................................................................................................................................................................5 1. Basics Overview ..................................................................................................................................................... 6 2. Cardiac .................................................................................................................................................................. 48 3. CT Neuro Perfusion .......................................................................................................................................... 108 4. Dual Energy ........................................................................................................................................................ 132 5. Guide&Go ............................................................................................................................................................ 148 6. Course Assessment ............................................................................................................................................167 3 III Course Description Course Overview: The SOMATOM go.All, SOMATOM go.Top and SOMATOM X.cite syngo® CT Advanced course will introduce the user to advanced workflows focusing on CT Cardiac , CT Neuro Perfusion, CT Single Source Dual Energy and CT Intervention. Lectures, hands-on labs using simulators, and actual CT scanner sessions at our training center will introduce the technologist to the advanced software operation as implemented on Siemens multi-slice CT system. Prior participation in a Siemens’ SOMATOM go or SOMATOM X.cite syngo® CT Basic class and/or a minimum of 6 months clinical experience is not mandatory but highly recommended. NOTE: Examinations will be performed on simulation consoles using anonymized patient data. Live patients will NOT be scanned. Key topics: Go Technologies • myExam Companion • CT Neuro Perfusion • CT Cardiac • TAVI/TAVR • Single Source Dual Energy Imaging • CT Guide&GO (Intervention) • 4 III Agenda Day One 08:30 – 11:30 Welcome /Safety /Introduction Basics Review go Technologies Scan/Recon Parameters myExam Companion Dose Considerations Contrast Enhancement 11:30 – 12:30 Lunch Break 12:30 - 4:30 At go.Top and/or X.cite Scanners - TDC1 Mobile Workflow FAST 3D Camera - Review Hands-on Scanning Day Two 08:30 – 09:00 Review of Day 1 and Q & A 09:00 – 11:30 Cardiac CT - Calcium Score & Coronary CTA & Chest Pain Cardiac Physics, Protocols, Patient Prep, Anatomy Cardiac myExam Compass and Clinical Decision Trees Cardiac Post-Processing Calcium Score Workflow Coronary CTA Vessel Evaluation 11:30 - 12:30 Lunch Break 12:30 - 4:30 TAVI/TAVR Protocol Selection Scanning Post processing Day Three 08:30 – 09:00 Review Day 2 with Q & A 09:00 – 11:30 Neuro Perfusion CT Physics, Protocols, Scanning Post Processing TwinSpiral and TwinBeam Dual Energy CT DE basic physics, Protocols, Scanning DE myExam Compass and Clinical Decision Trees DE Recon&GO DE CT View&GO 12:30 - 4:30 Additional Hands-On Tablet/simulator for Neuro Perfusion and DE Guide&GO Presentation Tablet Day Four 08:30 – 09:00 Review and Q & A 09:00 – 11:30 At go.Top and/or X.cite Scanners – TDC1 Guide&GO Additional Hands-on practice 5 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows 1. Basics Overview SIEMENS Healthineers SOMATOM go.All/Top and SOMATOM X.cite BASICS Overview HOOD05162003093437 Effective 06/23/2020 Restricted @ Siemens Healthineers, 2020 DISCLAIMER SIEMENS Healthineers. Please note that the learning material is for training purposes only! All patient data visible are randomized generated by a Simulation SW. There is no relation to real patients available. For the proper use of the software or hardware, please always use the Operator Manual issued by Siemens. 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. Functionalities described in the material or parts of this functionality may not yet be released for customers and not yet be commercially available in every country. Due to regulatory requirements, the future availability of said functionalities or parts thereof in any specific country is not guaranteed. The Operator's Manual shall be used as your main reference, in particular for relevant safety information like warnings and cautions. 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 rights, including rights created by patent grant or registration of a utility model or design, are reserved. Computed Tomography Restricted @ Siemens Healthineers, 2020 2 Notes 6 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows SIEMENS Healthineers ... GO Technologies Computed Tomography 3 Restricted @ Siemens Healthineers, 2020 GO technologies SIEMENS . Healthineers ... Operate efficiently with a holistic set of intuitive technologies that speak your clinical language. Benefits Standardize and ease the full departmental workflow Reduce repetitive workflow steps thanks to automation Focus more on the patient and less on routine tasks myExam Companion Scan&GO Check&GO Recon&GO CT View&GO Patient preparation Quality checks Image reconstruction Viewing Image acquisition Postprocessing Data distribution Computed Tomography Restricted @ Siemens Healthineers, 2020 Notes 7 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows New usability concept with the Guided Path SIEMENS Healthineers .. For easy and undisrupted operation Use tablet for basic operation Use Acquisition Workplace (AWP) for expert mode SIEMENS Thorax und Abdome Recon Ranges Doe, John 0 x 1/2/2000 ------ Thorax and Abdomen (Aouit)S Hond First - Supino 4.60 SPR (16 cm) 0.08 6.1 13 130 < 768 m Guided V path Back Go º ¥ -750.0 125.0 0º Computed Tomography 5 Restricted @ Siemens Healthineers, 2020 SIEMENS . Healthineers ... Scan&GO Computed Tomography Restricted @ Siemens Healthineers, 2020 Notes 8 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows Scan&GO - Tablets SIEMENS Healthineers .... Coronary CTA (Adult) Head First - Supine 0 23 (32 cm) 0.83 Scan Time [og Coronary CTA (Adult) Mad First_ Supine 0 23 (32 cm) 0.83 141 -4/18/1977.M 11 18 58.49AM IVA+ TCP 150 GP 740 0 12163544AM A 8.2s) Il EE 125 19 4 61 = 125 3 3s 33 15 Rapoat Topogram Repeat Topegram Buck ¥ -1262.0 125.0 0º ¥ -1262.0 125.0 0º Lenovo (10") for HP (12") for SOMATOM X.cite SOMATOM go.All/Top magnetic dock Computed Tomography 7 Restricted @ Siemens Healthineers, 2020 Scan&GO - Patient Preparation SIEMENS Healthineers ... Access your RIS worklist from the tablet or the AWP Select next patient from RIS ... ... or register a new one if needed Doe, John O x 1/2/2000 Time . Patient Name Requested Procedure 8:30 AM Moody, Adolph Abdomen 9:30 AM Jenkins, Ernie AbdomenRoutine 10:08 AM Doe, John 1/2/2008 12:30 PM. Hall, Ricardo Abdomen 7/27/1954. Male 5:15 PM Buckner, Florence HeadRoutine 4/11/1962, Famale Start Emergency Exam Back GO -750.0 125.0 0º Computed Tomography Restricted @ Siemens Healthineers, 2020 Notes 9 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows Scan&GO - Patient positioning SIEMENS Healthineers ... Visualize all parameters at a glance Scan direction ig Patient registered Topogram X orientation Recon Ranges moraux factory (AGut) Head First - Supine Topogram AA length ...................... 512 ............... Change mm API -887.5 125.0 -8ª Patient position Computed Tomography Restricted @ Siemens Healthineers, 2020 9 Scan&GO - Change API language on the Tablet Audio Control from the tablet interface Audio Control Patient registered allows you to change the language and mute on/off Visuals Thorax (factory ] ( Adult) @ Head First - Supine Audio Language Arabic Bulgarian Chinese Dutch < English French 512 mm. German V Greek Audio Control Hindi Italian GO X -887.5 125.0 -8 Computed Tomography 10 Restricted @ Siemens Healthineers, 2020 Notes 10 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows Intuitive scanning - color-coded scan browser timeline SIEMENS Healthineers ... Tablet Scan browser 3.3s) 125 6.9s) 11 (0.3s 1s 105 24s 9.58 Delay Console Timeline ...... Breathhold Scan time Contrast Media commands 5 mlis 5 ml's 5.6s 10.45 10 0 5 10 15 25 Injector coupling Delay Breathhold ..... .... with CARE Contrast Scan time commands Computed Tomography 11 Restricted @ Siemens Healthineers, 2020 SIEMENS Healthineers ... Check&GO Computed Tomography 12 Restricted @ Siemens Healthineers, 2020 Notes 11 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows Check&GO - Metal Detection 0 X Coronary CTA (Adult) @ EEGT/EZ/2. Head First - Supine 3.32 SPR (32 cm) 0,01 0.5 60 Sn 100 Motivation Monitor image quality and correct pitfalls on Metal detected, remove if possible the fly Benefits Automatic detection of metal that can be removed on topogram, to avoid artifacts Visual alert on both the tablet and console my Exam @ 10.35) Repeat Topogram Back GO -750.0 100.0 O Computed Tomography Restricted @ Siemens Healthineers, 2020 Check&GO - Metal Detection Detects any metal objects on or near the patient which should be removed to ¡ ¡ = Scan 42 = Recon 0 2019.06.21-12:26:20-051-Trauma * 11/18/1858 (160) O 2019.06 21-12:25-20- avoid artifacts, including objects MA Thorax and Abdome .. 2019-06:21-12:25:20-D51-Trauma 2010.06 21-12:25:20-DS1-1.3.12.2.1107.5.1.7 *11/10/1850, 0, 160Y Topogram MAC_24283a1 7db84 required for the examination, for 21/2019. 2 20.05,22 FIM SIMA1 TOP 100 example, ECG wires. Q. Q. C. C. Yellow boxes on the topogram image SPR (32 cm) 0.02 INGY highlight the areas where metal has MA Sn 100 Exposure Time 2.89 been detected Check metal detection ::::::::::: Metal detected. Please check The CT system does not detect metal objects inside the patient, for example, Timing screws or metal plates Check& GO Metal Debisction Scan Sart Cri Start Button Computed Tomography 14 Restricted @ Siemens Healthineers , 2020 Notes 12 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows Check&GO - Metal Detection Console - Topogram Task If metal has been detected, in the Topogram task or on the tablet UI, click Check metal detection the Mark Metal button to hide or display the detected areas on the topogram image. Metal detected. Please check. Remove all metal objects from the Tablet UI patient that are not required for the examination before starting the scan, for Mark Metal example, keys or zippers. . Proceed with the examination 1.6s 10.3 7.6s Computed Tomography Restricted @ Siemens Healthineers, 2020 Check&GO - Optimal image quality for every scan SIEMENS .. : Healthineers ... Monitor image quality and correct pitfalls on the fly Scan Time 8.59 Benefits Check image quality V Confirm correct organ coverage and contrast Coverage check result: agent distribution, even in small vessels Scanned volume is sufficient. Automate ROI identification and HU calculations Contrast check result: for the aorta with FAST ROI Contrast enhancement is sufficient. Deliver the right images on the first attempt Avoid archiving or transferring suboptimal images Show QC Image Repeat Scan Start Auto Tasking Computed Tomography 16 da Siemens Healthingers 2020 Restricted @ Siemens Healthineer Notes 13 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows Check&GO - Optimal image quality for every scan SIEMENS Healthineers ... Doe, John MIP as Coverage check result: 1/1/2000 Scanned volume is sufficient. Thorax (Adua) Head first - supthe cor y for 2017-18. 13: 15: 42:04-061-1.3.12.2.1387.5.99.3 Contrast check result: 348 41.15 PM Start auto Contrast enhancement is sufficient. Coverage Start Auto Tasking tasks Contrast Repeat Scan and contrast qua ! jeck Repeat Scan Start Auto Tasking Show real-time images MEE SMANE Repeat 135 scan @ -400.0 100,0 0' Computed Tomography Restricted C Siemens Healthineers, 2020 SIEMENS. Healthineers ** Recon&GO Computed Tomography 18 Restricted @ Siemens Healthineers, 2020 Notes 14 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows Recon&GO - Zero-click post-processing SIEMENS Healthineers .... Recon&GO delivers fast and standardized results irrespective of the operator. With Al (artificial intelligence) recognizing patient landmarks and anatomies, it automates post-processing tasks to reduce repetitive workflow steps. Even spectral imaging becomes routine. Recon&GO automatically creates zero-click results. It offers a fully automated recon process for certain organs - including vascular views for contrast- enhanced CT reporting. Computed Tomography 1 Restricted @ Siemens Healthineers, 2020 Recon&GO - Zero-click post-processing SIEMENS Healthineers .. Recon&GO offers as STANDARD features: Multi-Recons - Simultaneous reconstruction of different MPR orientations (axial, sagittal, coronal) or image impressions (kernel and window settings) Inline Anatomical Ranges - Powered by ALPHA (Automatic Landmark Parsing of Human Anatomy) which automatically recognizes anatomical landmarks in the acquired images and creates ready-to-read standard orientations for different joints and body regions Inline Table and Bone Removal - zero-click bone-free VRT reconstruction that facilitates a precise vascular assessment by visualizing blood vessels without interfering anatomical structures Inline Vessel Ranges - zero-click vessel centerline extraction and anatomical labeling of main vessels (aorta, run-offs and carotids) with display of curved planar reconstruction Computed Tomography Restricted @ Siemens Healthineers Notes 15 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows Recon&GO - Zero-click post-processing SIEMENS Healthineers Recon&GO offers as OPTIONAL features: Inline Spine Ranges - anatomically aligned spine reconstructions. The software detects and labels vertebrae within a predetermined scan area, and calculates their position for anatomically correct image reconstruction. Inline Radial/Parallel Rib Ranges - radial and parallel rib specific visualization displaying all ribs spread out in one plane. Automated rib labeling and numbering. Inline Lung CAD - zero-click Lung CAD series reconstruction, designed as a second reader to assist radiologists in the detection of pulmonary nodules. Computed Tomography 21 Restricted @ Siemens Healthineers, 2020 Recon&GO - Zero-click postprocessing SIEMENS ..... Healthineers ... Make post-processing part of the standard reconstruction tasks with inline results. ung CAD Parallel Ranges Benefits Ready-to-read technology for instant evaluation Standardize image quality without the need for Vascular CPR: Radial Spine manual preparation of most scan types Save time and reduce workflow steps by combining reconstructions and post-processing Vascular CPR: Parallel Rib Ranges, parallel Automatic post-processing for better focus on the patient Radial Rib Ranges, radial Computed Tomography 22 Restricted @ Siemens Healthineer Notes 16 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows Recon&GO - Easy combination of multiple orientations and SIEMENS Healthineers .. windows Easily visualize window settings zero click Thorax und Abdome- auto auto auto or recon orientations auto autoÏ or combine multiple window or orientations in the same recon auto auto Computed Tomography 23 Restricted @ Siemens Healthineers, 2020 SIEMENS. Healthineers ... CT View&GO Computed Tomography 24 Restricted @ Siemens Healthineers, 2020 Notes 17 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows CT View&GO - Available on the Acquisition Workplace (AWP) SIEMENS Healthineers .. scanner Thorax and Abdome ... Recon Ranges Keep both Optimize investment by acquisition and post- providing processing in postprocessing sight1) directly on the AWP 1) Second monitor is optional Computed Tomography Restricted @ Siemens Healthineers, 2020 CT View&GO SIEMENS Healthineers ** CT View&GO includes the following standard features: Table and Bone Removal Tools Vessel Extension Spine Ranges Endoscopic View Lung Lesion Segmentation 2D and 3D image types (MPR, MPR Thick, MIP, MIP Thin, MinIP, VRT, VRT Thin) Filming and Printing V Evaluation tools - (e.g. ROI, ROI HU Threshold, Diameter/WHO area, Distance & Angle Measurements, Pixel Lens, Crosshairs, Image annotation and labeling) Computed Tomography 26 Restricted @ Siemens Healthineers, 2020 Notes 18 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows CT View&GO SIEMENS Healthineers ... CT View&GO offers the following optional features: CT Osteo - non-invasive measurement of the bone mineral density of the lumbar spine to help early diagnosis of osteopenia and osteoporosis. Neuro DSA - digital subtraction angiography offers single-click bone-free visualization for quick and easy neurovascular assessment. Lung CAD - this computer aided detection (CAD) is a fully automated, second reader tool, designed to assist radiologists in the detection of pulmonary nodules during review of chest CT examinations. Dual Energy ROI - basic evaluation of the behavior of different tissues at different energies as an indication of their atomic composition. Interactive Spectral Imaging (ISI) - for Dual Energy Mixed and Monoenergetic Plus. Interact with Dual Energy information and select the energy level at which implants, clamps or screws have the smallest impact on image quality. Computed Tomography 27 Restricted @ Siemens Healthineers, 2020 CT View&GO - All-in-one cross-specialty viewing SIEMENS Healthineers ... Favorite Tools Take advantage of intuitive and customizable cross-specialty viewing. Benefits ROI Diameter Spine Treshold WHO ... Ranges Optimize investment by providing post-processing directly on the scanner Same look and feel for all your modalities and Lung CAD Neuro Remove Series DSA Bones reading software Optimize departmental communication Boost sensitivity and specificity in diagnosis with Endoscopic Osteo Define matured CAD algorithms1) View Vessels + 1) Lung CAD @ CT View&GO (part of the syngo.CT Extended Functionality) Computed Tomography 28 @ Siemens Healthineers , 2020 Notes 19 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows SIEMENS Healthineers Scan/Recon Parameters Computed Tomography 29 Restricted @ Siemens Healthineers, 2020 Recon Parameters - Overview SIEMENS ..... Healthineers ... .................................. The categories are always there, but the parameters only show if available. -. .................. ............. Recon Favorites General Recon Recon&GO Image Impression | Recon Box Physio Recon Auto Tasking Inline Options Scan/Recon Inline Results Multi Recons Image Type Image Order Kernel Window@120kV Slice Thickness Thorax 5.00 Br60 A3 cor Front to Back Thorax 5,00 Br60 A3 sag None Orientation Multi Recons (2) MIP Thi Right to Left Br60 Lung 5.00 5.00 Computed Tomography 30 iemens Healthineers, 2020 Notes 20 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows Recon Parameters SIEMENS Healthineers ... RECON FAVORITES: In this tab you can list the recon parameters which are frequently used. Each column which is not listed yet in the Recon Favorites can be added via a right mouse button (RMB) click on the desired column title and select "Add to Recon Favorites". To remove an entry, right mouse button (RMB) click on a column in the Recon Favorites and select "Remove Column from Favorites". Recon Favorites General Recon Recon&GO Image Impression | Recon Box 1 Physio Recon Auto Tasking Inline Options Scan/Recon Inline Results Multi Recons Image Type Image Order |Kernel Window@120kV Slice Thickness Increment [mm] [mm] Thorax 5.00 Br60 A3 cor ons (2) Wir Thin Front to Back Thorax 5.00 Br60 A3 sag Impression | ht to Left Recon Box Physio Recon Recon Box Physio Recon Auto Tas Add to "Recon Favorites" Comment 2 Kernel Slice Thickness Increment Remove Column from Favorites Br40 Soft Tissue 5.00 5.00 Computed Tomography Restricted @ Siemens Healthineers, 2020 Recon Parameters SIEMENS Healthineers ... GENERAL RECON: Here you can find general reconstruction parameters like: Slice Thickness in [mm]; Increment [mm]; Number of Images; Image Order; Comment 1; Comment 2; and Recon Strategies. In General Recon, to change the values for a recon parameter, click and select them from a dropdown. Recon Favorites General Recon Recon&GO Image Impression Recon Box Physio Recon Auto Tasking Inline Options Scan/Recon Slice Thickness Increment No. of [mm] [mm] Images Image Order Comment 1 Comment 2 Recon Strategies Whole Body 5.00 Br40 A3 cor 5.00 96 Front to Back Whole Body 5.00 Br40 A3 ax 5.00 117 lead to Feet Whole Body soft tissue or bone [factory].standar .... 1.50 2.00 3.00 4.00 5.00 6.00 7.00 8.00 10 00 Computed Tomography Restricted @ Siemens Healthineers, 2020 Notes 21 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows Recon Parameters SIEMENS ... Healthineers RECON&GO: In this tab you can change the settings for different Recon&GO options. Here you find: Inline Results; Multi Recons; and Fix Axial. You will learn more about these types of recons later on. Recon Favorites General Recon Recon&GO Image Impression Recon Box Physio Recon Auto Tasking Inline Options Scan/Recon Inline Results Multi Recons Whole Body 5.00 Br40 A3 cor Whole Body 5.00 Br40 A3 ax None Orientation Multi Recons (2) Computed Tomography 33 Restricted @ Siemens Healthineers, 2020 Recon&GO - Recon Parameters SIEMENS .. Healthineers ... IMAGE IMPRESSION: In this tab all relevant image impression parameters are shown: Window@120 kV; FAST Window; Kernel; Iterative Reconstruction IR* (ADMIRE or SAFIRE); IR strength; iBHC; and iMAR (all of which are license and scanner dependent). Recon Favorites General Recon Recon&GO Image Impression Recon Box | Physio Recon Auto Tasking nline Options Scan/Recon Image Type Window@120kV FAST Window Kernel ADMIRE Strength iBHC iMAR Lung Whole Body 5.00 Br60 A3 cor Lung Whole Body 5.00 Br60 A3 sag MIP Thin Lung On Br60 On 3 Off Off Lung Whole Body 5.00 Br60 A3 ax Some entries only show up if a certain reconstruction is "on" and offers more settings: Recon Favorites General Recon Recon&GO e Impres ... Recon Box Physio Recon Auto Tasking | Inline Options Scan/Recon Window@120kV FAST Window Kernel ADMIRE ADMIRE Strength iBHC iBHC Material iMAR MAR Type Whole Body 1.50 Br40 A3 Soft Tissue On Br40 On On Bone On Spine Implants *Iterative Reconstruction type is scanner dependent Computed Tomography 34 Restricted @ Siemens Healthineers, 2020 Notes 22 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows Recon Parameters SIEMENS Healthineers. RECON BOX: In this tab all relevant recon box parameters are shown: Fix Axial; Image Orientation; FAST Planning; FAST Planning Width; Matrix Size; Matrix; Width [mm]; Height [mm]; Center X [mm]; Center Y [mm]; and HD FoV Recon Favorites General Recon Recon&GO | Image Impression Recon Box Physio Recon Auto Tasking Inline Options Scan/Recon Fix Axial Image FAST Planning FAST Planning Width Matrix Size Matri [mm] Heigh [ mm] Center Orientation Imml FoV Whole Body 1.50 Br40 A3 On Axial CAP - Lung Apex to Ischium Wide 512 Square 482 482 2.00 0.00 Off Computed Tomography 35 Restricted @ Siemens Healthineers, 2020 Recon Parameters SIEMENS Healthineers .... PHYSION RECON: In this tab all relevant physio recon parameters are shown (only if the optional ECG-triggered/gated Cardiac scan was performed): Recon Type; Recon Phase(s); Recon Phase Unit; and True Stack are visible. For Respiratory Gated scans, relevant recon parameters will show up accordingly. Recon Favorites General Recon Recon&GO Image Impression Recon Box Physio Recon Auto Tasking Inline Options Scan/Recon e.g. Routine scan without ECG-triggering/gating Thorax 5.00 Br40 A3 ax Recon Favorites General Recon Recon&GO | Image Impression Recon Box Physio Recon Auto Tasking Inline Options Scan/Recon Recon Type Recon Recon Phase Unit True Tempora Resolution [ms] e.g.: Cardiac Scan with ECG-triggering/gating Calcium Scoring 3.00 Sa36 BestDiast BestPhase (diastolic) 75 Of 150 45 75 100 66 78 65 70 60 75 100 78 65 70 60 73 bpm Min: 45 Max: 100 Notes 23 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows Recon Parameters SIEMENS Healthineers AUTO TASKING: In the auto tasking tab you can set: Auto Recon; Recon Reference Lines; Requested Procedure; Body Part Examined; Transfer Nodes; Auto View&GO; Auto Printing; Local Application (license dependent); and syngo.via Workflow/Datarole (if configured). Recon Favorites | General Recon Recon&GO Image Impression | Recon Box Physio Recon Auto Tasking Inline Options Scan/Recon Auto Recon Recon Ref Requested Procedure Body Par Examine Transfer Auto View&GO Auto weapplication SY Via Datarole | Whole Body 1.50 Br40 A3 On Off Kidney Stone ABDOMEN Off Off None None Auto Recon Favorites General Recon Recon&GO Image Impression Recon Box Physio Recon Auto lasking& Inline Options Scan/Recon Auto Reco Recon Ref. Requested Body Par Transfe Auto Auto Auto Local syngo. vi 549ª Via Ines Procedure Examined Transt VIEW ... Printing Workflo Datarole Thorax 5.00 Br36 A3 cor On Off CHEST VIA Off Thorax 5.00 Br36 A3 sag Off Off None Auto Off Off Off None Auto: Computed Tomography 37 Restricted @ Siemens Healthineers, 2020 Recon Parameters SIEMENS .. Healthineers ... INLINE OPTIONS: In this tab all relevant Inline Options are listed. This column is linked to the "Recon&GO" tab. If no dedicated Recon&GO Inline Result is selected, there are no Inline Options. Let's have a closer look at all the new Recon&GO Inline Results! Recon Favorites General Recon Recon&GO | Image Impression Recon Box Physio Recon | Auto Tasking Inline Options Scan/Recon Inline Results e.g. No Recon&GO inline result selected Whole Body 1.50 Br40 A3 None Recon Favorites General Recon Recon&GO Image Impres ... Recon Box Physio Recon Auto Tasking Inline Options Scan/Recon Inline Results Whole Body 1.50 Br40 A3 None e.g. Recon&GO Inline Result options available from drop down menu None Parallel Ranges Radial Ranges Applications RT Automatic Contouring Restricted o stemens realtimeers, zuzu Notes 24 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows Scan Parameters - Overview SIEMENS Healthineers .................... ............... i The categories are always there, but the parameters only show if available. ........................... Scan Favorites General Scan Dose Timing Config Physio Scan Contrast CTDIvol [mGy] DLP Scan/Recon Scan Mode KV [mGy*cm) Acquisition [mm] Pitch Rot. Time [s] Abdomen RoutineSpiralAdultAbdomen 120 128 x 0.6 (z-sharp) 0.80 0.50 Computed Tomography 39 Restricted @ Siemens Healthineers, 2020 Scan Parameters SIEMENS .. : Healthineers ... SCAN FAVORITES: In this tab you can list the scan parameters which are frequently used. Each column which is not listed yet in the Scan Favorites can be added via a right mouse button (RMB) click on the desired column title and select "Add to Scan Favorites". To remove an entry, right mouse button (RMB) click on a column in the Scan Favorites and select "Remove Column from Favorites". Scan Favorites General Scan Dose Timing Config Physio Scan Contrast Scan/Recon Scan Mode KV CTDIvol [mGy] DLP [mGy*cm] Acquisition [mm] Pitch Rot. Time [s] | Abdomen RoutineSpiralAdultAbdomen 120 128 x 0.6 (z-sharp) 0.80 0.50 Add to "Scan Favorites" KV CTDIvol [mGy] Remove Column from Favorites Computed Tomography 40 Restricted @ Siemens Healthineers, 2020 Notes 25 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows Scan Parameters SIEMENS Healthineers GENERAL SCAN: Here you can find general scan parameters like: Patient Type; Organ Characteristic; Target Region; Scan Mode; Decision Trees; Scan Strategies; Tilt[0]; Acquisition [mm]; Scan Direction; and Table Direction When a scan parameter is preceded by a vertical green line, that means it is being controlled by a Decision Tree and cannot be changed manually. If you must change the parameter, consider changing the responses to the myExam Compass questions or deactivating the Decision Tree(s). CHI Scan Favorites General Scan Dose Timing Config Physio Scan Contrast Scan/Recon Patient Type Organ Characteristic Target Region Scan Mode Decision Trees Scan Strategies Tilt [o] Acquisition [mm] Scan Direction Table Direction Abdomen Adult Abdomen Abdomen RoutineSpiralAdultAbdomen Abdomen FoV [factory] Abdomen FoV [factory .. 0 128 x 0.6 (z-sharp) Head to Feet Indicates a Clinical Decision Tree is Scan Mode Decision Trees controlling the Scan Mode Deactivated RoutineSpiralAdultAbdon RoutineSpiralAdultAbdomen RoutineSequenceAdultAbdomen Computed Tomography 41 RoutineSpiralAdultAbdomenSn Restricted @ Siemens Healthineers, 2020 Scan Parameters SIEMENS .. : Healthineers ... DOSE: In this tab all relevant Dose parameters are listed: Care Dose4D & CARE KV; CARE KV Grouping; CARE KV optimized for; CARE kV Quality ref. MAS@120kV; kV; CTDIV.| [mGy]; DLP [mGy*cm]; Shaped Filter; Dose Notification ref. CTDI [mGy]; and Dose Notification ref. DLP [mGy*cm]. Scan Favorites | General Scan Dose Timing Config Physio Scan Contrast Scan/Recon CARE Dose4D & CARE KV CARE KV CARE KV optimized for CARE KV Quality CTDIVO Dose Notification Grouping ref. mAs @120 kV KV DLP Shaped Dose Notification [mGy] [mGy*cm] ref. CTDI [mGy] ref. DLP [mGy*cm] Abdomen Full Off Soft Tissue with Contrast 129 120 Standard 0.00 0.0 Computed Tomography 42 Restricted @ Siemens Healthineers, 2020 Notes 26 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows Scan Parameters SIEMENS .. Healthineers ... TIMING: In this tab all parameters affecting scan time are listed: Pitch; Rotation Time [s]; Exam Time [s]; Patient Instruction; Absolute Start Delay [s] CH Scan Favorites General Scan Dose Timing Config Physio Scan Contrast Scan/Recon Pitch Rot. Time [s] Exam Time [s] Patient Instruction Absolute Start Delay [s] Abdomen 0.80 0.50 6.50 Inspiration 6.0 Computed Tomography 43 Restricted @ Siemens Healthineers, 2020 Scan Parameters SIEMENS Healthineers ... CONFIG: In this tab all configuration parameters are listed: Memo (displayed in the Taskflow); Check&GO; Check&GO Image Type (MPR or MIP Thin); Check&GO Orientation (axial, sagittal, coronal); Scan Start; Scan Ref. Lines. CH Scan Favorites | General Scan 1 Dose Timing Config Physio Scan Contrast Scan/Recon Memo Check&GO Check&GO Check&GO Orientation Scan Start Scan Re Image Type Lines Abdomen Coverage MPR Coronal Start Button Off Computed Tomography 44 Restricted @ Siemens Healthineers, 2020 Notes 27 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows Scan Parameters SIEMENS Healthineers PHYSIO SCAN: In this tab all relevant ECG-trigger/gating Cardiac* parameters are shown: Pulsing Mode; Phase Start; Phase End; Phase Unit; and Est. Heart Rate. For Respiratory Gated* scans, relevant recon parameters will show up accordingly. CH Scan Favorites General Scan Dose Timing Config Physio Scan Contrast Scan/Recon e.g. Routine scan without ECG/Respiratory-triggering/gating Abdomen CH Scan Favorites General Scan Dose Timing Config Physio Scan Contrast Scan/Recon Pulsing Mode Phase Start Phase End Phase Unit Est. Heart Rate CTA Coronary Standard e.g.: Cardiac Scan with ECG-triggering/gating 70 80 % Auto 65 65 65 65 68 60 65 68 65 65 65 68 60 65 68 Scan Parameters SIEMENS. Healthineers CONTRAST: In this tab all CARE Contrast III* parameters are listed: Memo (displayed in the Taskflow); Check&GO; Check&GO Image Type (MPR or MIP Thin); Check&GO Orientation (axial, sagittal, coronal); Scan Start; Scan Ref. Lines. CH Scan Favorites 1 General Scan Dose Timing Config Physio Scan Contrast - - Scan/Recon Injector Coupling e.g.: CARE Contrast III* Injector Coupling turned off = either a non-contrast Abdomen Off study or no license available Scan Favorites General Scan Dose Timing Config Physio Scan Contrast Scan/Recon Injector Contrast Protocol CM Name lodine Concentration [mg/ml] e.g.: CARE Contrast III* Injector Injector [factory] Coupling turned on Abdomen On Isovue 300 *Option Computed Tomography Restricted @ Siemens Healthineers, 2020 Notes 28 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows SIEMENS Healthineers myExam Companion Computed Tomography 47 Restricted @ Siemens Healthineers, 2020 myExam Companion - Overview SIEMENS ..... Healthineers ... myExam Companion launches the era of intelligent imaging. Using the new possibilities of digitalization, it turns data into built-in expertise. This helps users efficiently achieve reproducible results - by unlocking your modality's full potential. myExam Companion consists of the following: myExam Compass myExam Cockpit* myExam Companion guides users through any procedure, so they can interact easily and naturally with both patient and technology. No matter the user, patient, or throughput, it helps generate consistent, comprehensive results. *Option on SOMATOM go.All/Top; Standard on SOMATOM X.cite Computed Tomography 48 iemens Healthineers, 2020 Notes 29 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows myExam Companion - Overview SIEMENS Healthineers ... myExam Compass, using default Clinical Decision Trees (CDT), optimizes settings for image quality, standardized results and always the right dose by enabling an optimum usage of our CARE, FAST and GO Technologies. Especially useful for less experienced users, myExam Compass suggests which settings are more appropriate for every patient based on the procedure and patient characteristics, finding the optimal combination of acquisition and reconstruction parameters. myExam Cockpit* - the central engine of myExam Compass. Is the expert mode for creation, customization and configuration of Scan Strategies and Clinical Decision Trees (CDT), making them available through myExam Compass. *Option on SOMATOM go.All/Top; Standard on SOMATOM X.cite Computed Tomography Restricted @ Siemens Healthineers, 2020 myExam Companion - Overview SIEMENS. Healthineers ... The purpose of myExam Companion is to collect information about the current patient to dynamically adapt the scan parameters or exchange recon jobs according to the patient's characteristics Depending on the information that is needed: > You are prompted to answer questions referring to the patient and/or examination > Specific values are retrieved from the patient registration or from measurements of medical equipment that is connected to the patient myExam Compass with Clinical Decision Trees (CDT) help reduce protocol redundancy (i.e. instead of 3 different shoulder protocols, you only need one with a Clinical Decision Tree) myExam Compass is visible on both the Acquisition Workplace (AWP) console and the tablet The system comes with Siemens Default Clinical Decision Trees already linked to several Siemens default scanning protocols Computed Tomography 50 Restricted @ Siemens Healthineers, 2020 Notes 30 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows myExam Companion - Overview SIEMENS . Healthineers ... jj = Scan 1 = Raron, von Siemens, Wemer C. - 4/15/1932 (88) M 2020.04.15-09.36.27-05 ... Thoray [factory] (Adult) Recon Ranges myExam Compass Topogram HF supine HF prone HF right HF left Thorax wo Q. Q. C. C. FF supine FF prone FF right Thorax with IV Length 512 CTDIvol SPR (32 cm) 0.02 mGy DLP 0.9 mGy cm MA 55 KV Sn1 100 Exposure Time 3.32 5 Q Check metal detection Thorax wo .Thorax with IV Reconstruction Close Confirm patient position Cancer EN Computed Tomography 51 Restricted @ Siemens Healthineers, 2020 myExam Companion - Shoulder Example SIEMENS Healthineers ... To avoid ad hoc changes or the need for 3 separate protocols myExam Compass Clinical Decision Tree simply asks: Which recon do you want to perform? Both Right Left Based on the answer by the user, the system would choose the desired recon side(s) automatically. Shoulder [factory] (A. myExam Compass Recon Ranges myExam Compass Topogram Topogram Questions Shoulder Which recon do you want to perform? both right Reconstruction Shoulder Close Computed Tomography 52 Restricted @ Siemens Healthineers, 2020 Notes 31 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows myExam Companion - Shoulder Example SIEMENS Healthineers ... At the Acquisition Workplace (AWP) console, the exam user interface looks like this: Questions Which recon do you want to perform? both right left Dependent on the answer Topogram Topogram the system takes only the dedicated recons. In this example, the selection "both" will reconstruct all recon jobs (right & left) Computed Tomography 53 ted @ Siemens Healthineers, 2020 myExam Companion - Shoulder Example SIEMENS Healthineers ... At the Tablet, the user interface looks like this: Topogram Hickman, Debora O x Shoulder [factory] (Adult) @ Head First - Supine Breathing Instruction Practice Audio Control Questions Select answer Topogram both night Topogram GO * * * - 1254.5 125.0 0º Computed Tomography Restricted @ Siemens Healthineers, 2020 Notes 32 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows myExam Companion - Example SIEMENS Healthineers myExam Companion guides you through your CT Angiography FAST 3D Camera Asturete and reprodusible CARE Contrast posent positioning high AI AI check&Go ReconAGO Dedium Let ALPHA' Check&GO de the rest Metal Detection AI AI myExam Compass Al Low, mid Be high low creatinina le FAST RODO19 High Power De All Artificial Intelligence inside Automatic Landmarking and Parsing of Human Anatomy Computed Tomography 55 Restricted @ Siemens Healthineers, 2020 SIEMENS. Healthineers ... Dose Considerations Computed Tomography 5 Restricted @ Siemens Healthineers, 2020 Notes 33 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows CARE Dose4D and CARE KV SIEMENS Healthineers 0 SOMATOM go.All SOMATOM go. Top SOMATOM X.cite CareDose4D CARE KV 70kV 80kV 90kV 100kV 110kV 120kV 130kV 140kV 150kV Sn100kV Sn110kV Sn120kV Sn130kV Sn140kV Sn150kV Computed Tomography Restricted @ Siemens Healthineers, 2020 CARE Dose4D SIEMENS. Healthineers ... CARE Dose4D - SOMARIS X - Automated tube current Scan with Reduced dose level angular dose adjustment for optimum diagnostic image quality at constant mA based on Topogram modulation lowest possible dose, depending on patient size and anatomy. Xray dose The calculations are based on A.P. and Lateral patient WWA attenuation profiles extracted from one Topogram. Isocentric positioning is essential for a reliable Slice position estimation of attenuation! CARE Dose4D calculates the full 3D modulated tube current profiles before scanning the patient. Computed Tomography Restricted @ Siemens Healthineers, 2020 Notes 34 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows CARE Dose4D - Topogram SIEMENS Healthineers If the patient is not positioned in X-ray tube - the isocenter of the gantry, the patient appears larger or smaller in the topogram, which leads to an Patient- overestimation or underestimation of the patient attenuation. Detector X Patient positioning off center in direction of the tube (too high) can lead to more dose - image magnified Patient positioning off center away from the tube (too low) can lead to more noise - image minimized Computed Tomography 59 Restricted @ Siemens Healthineers, 2020 CARE Dose4D - Topogram SIEMENS .. : Healthineers ... The body's center of gravity shall be positioned in the scanner isocenter for optimal performance of CARE Dose4D and optimal overall image quality Centering of the organ - for example the spine or heart - is NOT recommended × Computed Tomography 60 Restricted @ Siemens Healthineers, 2020 Notes 35 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows CARE KV SIEMENS Healthineers ... CARE KV automatically tailors tube voltage to each patient and clinical indication. With optimal kV levels in every case, CARE kV keeps dose low. It further simplifies the process by aligning the tube current with the selected kV. 90 K 100 IV In combination with CARE Dose4D, it allows the patient-specific 110 IV 120 1V 150 IV adaptation of both dose relevant parameters: tube current and 140 IV tube voltage. If CARE KV is turned on, the system automatically adjusts the appropriate kV and effective mAs settings to optimize the applied dose while the image quality, technically defined as the contrast-to-noise ratio (CNR) is maintained. CARE KV is turned on if CARE Dose4D & CARE KV is set to Full or CARE Dose4D & CARE KV Manual kV. Full Y Manual kV Off Full Computed Tomography Restricted @ Siemens Healthineers, 2020 CARE KV SIEMENS Healthineers ... If CARE kV is turned on (Full or Manual kV), the CARE kV Relevant Contrast parameter is available (CARE KV Optimized for), which allows you to select the examination type: CARE KV optimized for Non-Contrast for non-contrast examinations Bone / Calcium for bone examinations Soft Tissue with Contra Soft Tissue for contrast examinations Non-Contrast Bone / Calcium Vascular for vascular examinations Soft Tissue with Contrast Vascular CARE KV Quality ref. mAs @ 120 kV guarantees consistent image quality in all scan modes In Manual kV mode, you can specify the kV value for the tube voltage and the value for the required image quality (CARE kV Quality ref. mAs @120 kV). In Full mode, you can specify the value for the required image quality (CARE kV Quality ref. mAs @120 kV) and the kV range (CARE KV min. kV and CARE kV max. kV) in which CARE kV selects the optimal kV value for the tube voltage. In both modes, during the tomogram scan, the Eff. mAs value represents the effective mAs resulting from the CARE KV and CARE Dose4D optimizations. Computed Tomography Restricted @ Siemens Healthineers, 2020 Notes 36 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows CARE KV - FAST Window SIEMENS Healthineers ... 'Non-Contrast' 'Vascular' FAST Window is the 140 k 80 k 2.7 mGy 80 KV 0.94 automatic adaptation of 21 eff.mAs 2.6 mGy 102 eff.mAs 36 eff.mAs nGy viewing window to visually maintain image impression 8-11 1HU 11.9HU 223 SHU W=400 W=400 80 kV 2.7 mGy 80 KV 102 eff.mAs 0.94 36 eff.mAs Gy W=430 W=780 FAST Window Computed Tomography 63 Restricted @ Siemens Healthineers, 2020 CARE KV - CARE KV Grouping SIEMENS Healthineers ... CARE KV selects the same kV for A mi 12 : scons a Pocono Abdomen Multi Phas ... Recon Ranges all ranges within the CARE KV group. Q. C. C. C. ------ kV optimization criterion: lowest CURVA SPR (32 051 0 01 GY 58 100 sum of DLP values of the Non Contrast Liver individual scan ranges. Promonitoring a Monitoring w Autorial Pluse Abdomen #f Venous Phase Abdomen CARE kV Grouping is found in the Vcnous Phane Abdomen Scan Parameters > Dose tab. Confem patient position CARE KV Group Computed Tomography 64 Restricted @ Siemens Healthineers, 2020 Notes 37 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows Flex Dose Profile SIEMENS Healthineers ... In combination with CARE Dose4D and FAST Planning, Flex Dose Profile allows a more optimal modulation of the X Thorax and Abdome ... dose in long scan ranges where different quality Topogram Premonitoring TOP 160 references might be needed, for instance, in regular Monitoring Preconditions 50% Thorax-Abdomen (60%/100%) or in Chest Pain Thorax and Abdomen (50%/100%) examinations. 120 Check image quality The Flex Dose Profile is displayed at the AWP and at the Reconstruction 100% Close Scan&GO tablet with the same visual logic as any other procedures, so users of any level of experience can utilize it right away. Activate Premonitoring se The high dose area of the Flex Dose Profile can be defined on the Topogram by the shaded area in the CARE Profile. Computed Tomography 65 Restricted @ Siemens Healthineers, 2020 CARE Profile SIEMENS Healthineers ... 2016 01 24-14-15:22-STD- 1.3.12.2.1107 5 99 3 max Doe, John max Doe. John 403 2018.01.24-14:15:22-STD-1.3.12.2.1107.5.99.3 4.08 2018.01.24-14:15:22-STD-1.3.12.2.1107.5.99.3 mAs *1/24/1974, 44Y MAS +1/24/1974, 44Y 2.19 12.90 PM 1/24/2018 1/24/2018 2:19:12:90 PM 2:19:12 90 PM TOP 200 2 IMA 1 2 IMA 1 TOP 200 TOP 200 SPESUU U SP -800.0 The CARE Profile is green if no conflict The mAs slightly exceeds the system In case of an image quality conflict, occurs. limits for some regions. Loading the the theoretically optimal tube current scan range is recommended, since the profile cannot be applied because it impact on the image quality will be exceeds the maximum possible tube negligible. The peak of the CARE Profile will be lowered to the current. In the yellow areas in z-direction, the maximum possible mAs in this case. image quality may be reduced. Computed Tomography 6 Restricted @ Siemens Healthineers, 2020 Notes 38 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows CARE Profile SIEMENS Healthineers ... Doe, John 469 2018.01.24-14:15:22-STD-1.3.12.2.1107.5.99.3 MAS *1/24/1974, 44Y 29299374 1815:22-8TD 1/24/2018 2:33:15.51 PM 4 IMA 1 TOP 500 SP -850.0 If the Topogram only partially covers TAI the scan range, all uncovered parts are yellow. In the yellow areas in z- The Topogram does not cover The tube cooling time exceeds direction, the image quality may be the scan range. 10 minutes. reduced. Computed Tomography 67 Restricted @ Siemens Healthineers, 2020 FAST Adjust SIEMENS Healthineers ** Topogram If the system limits are exceeded because the parameters are Preconditions FAST Planning unsuitable for the size of the patient, the FAST Adjust helps you to Scan Parameter Check quickly adapt the required parameter settings to the appropriate FAST Adjust values by a direct scan parameter adjustment at the push of a button. ose exposure exceeds system limits. Press Adjust or change parameters! FAST Adjust Configured Applied The Adjust button is displayed in the execution control in case of an Max. MAS 25 % Scan Time os image quality conflict or tube load conflict and offers the possibility to Thorax solve such conflicts by changing current-related parameters. CTDIvol (32 cm) 34.29 mGy DLP 1.046.8 mGy cm Eft. MAS 265 CH KV 140 Scan Time 4.73 Scan/ Check image quality O Check preconditions Thorax Activate Thorax scan Check preconditions ctivate Thorax scan Adjust GO Cancel Adjust GO Cancel Computed Tomography Restricted @ Siemens Healthineers, 2020 Notes 39 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows FAST Adjust SIEMENS Healthineers ... The FAST Adjust option uses default limits for the following parameters (these limits can be changed in the Exam Designer with Admin Logon) FAST Adjust Upper Limit Scan Time [s] - controls max possible scan time > FAST Adjust Lower Limit max mAs [%] - controls the max possible mAs and Eff. mAs decrease FAST Adjust Lower Limit Pitch Factor - controls the minimal acceptable pitch value CH Config X Memo Check&GO Check&GO Image Type Check&GO Scan Start Scan R FAST Adjust Upper FAST Adjust Lower FAST Adjust Lower Orientation Lines Limit Scan Time [s] -imit max. mAs [%] Limit Pitch Factor Start Button Coverage MPR Coronal Start Button 10 25 0.95 Computed Tomography Restricted @ Siemens Healthineers, 2020 SAFIRE1) (Sinogram Affirmed Iterative Reconstruction) SIEMENS .. Healthineers .. SOMATOM go.All/Top SAFIRE1) enables dose reduction while maintaining excellent image quality. filtered back projection DOXI Benefits measured data SAFIRE1 reduces image noise without loss of validation with neasured data validation with final image image quality or detail visualization by measured data introducing multiple iteration steps now also in raw data image data the raw-data in the reconstruction process. space space O O forward projection artifacts noise 1) 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. As determined from SOMATOM Definition Flash data, SAFIRE enables up to 60% dose reduction. Data on file. Computed Tomography 70 Restricted @ Siemens Healthineers, 2020 Notes 40 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows ADMIRE1 (Advanced Modeled Iterative Reconstruction) SIEMENS .. Healthineers ... SOMATOM X.cite ADMIRE FBP Raw data statistical modeling Benefits ADMRE1 images will additionally benefit from higher resolution at organ borders and improved Measured data Model-based noise delineation of edges, e.g. to better localize cancellation lesions. Validation with Final image measured data Validation with measured data Moreover, ADMIRE smoothly integrates iterative reconstruction in the daily routine. Thick slices are now reconstructed with a more natural image impression, even from ultralow-dose scans. ADMIRE forward projection artifacts noise 1 1 Advanced system modeling 1Image quality as defined by low-contrast detectability using a model observer method for evaluation. As demonstrated using SOMATOM Force data, equivalent low-contrast detectability can be achieved with 80% to 85% less dose using ADMIRE at the highest strength level for thin (0.6 mm) reconstruction slices in measured and simulated body and head phantoms for low-contrast objects with different contrasts. In clinical practice, the use of ADMIRE 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. See ADMIRE data sheet for further information. Computed Tomography 71 Restricted O Siemens Healthineers, 2020 Dose Notification / Dose Alert SIEMENS Healthineers .... Dose Notification and Dose Alert are two dedicated safety features that inform you if a certain critical preconfigured X-ray dose has been exceeded. > Dose Notification - For each scan range, you can set a threshold for CTDIVo] (Dose Notification ref. CTDI [mGy] parameter) and a threshold for DLP (Dose Notification ref. DLP [mGy*cm] parameter). > Dose Alert - You can configure Dose Alert thresholds for both Adult and Child examinations in the Clinical Configuration (must be logged in as Admin) Computed Tomography 72 Restricted @ Siemens Healthineers, 2020 Notes 41 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows Dose Notification SIEMENS . Healthineers .. Preconditions The Dose Notification monitors the Scan Parameter Check V Dose Notification CTDIvol, as well as, the DLP for each Dose Notification scan range or auto range. It informs Notification Configured Unit A Dose values exceed their configured notification values. CTDIvol (32 cm) 0.07 mGy Notification Value you if the specified notification values Applied Value DLP 3.0 mGy cm i-Sequence Thorax will be exceeded when performing the CTDIvol 2.10 (32 cm) 2.16 mGy DLP 3.0 3.2 mGy'cm scan. -Sequence Thorax Last / Next The Dose Notification is displayed in CTDIvol (32 cm) 2.16 mGy the taskflow control, as well as, a Last / Next Diagnostic Reaso DLP 3.2 Gy'cm dialogue box after loading the scan. Eff. MAS 108 Confirm Cancel KV 80 Scan Time Full 0.33 Computed Tomography 15 Restricted @ Siemens Healthineers, 2020 Dose Alert SIEMENS Healthineers ... The Dose Alert monitors the maximum of the accumulated CTDIV01, as well as, the Dose Alert x accumulated DLP for all scan ranges of the A dose alert value will be exceeded current examination. It informs you if one Please reconsider the cubiermay cm) will locally exceed the alert value (5 mGy"cm for Adult). of the specified alert values will be Hint. The currently used scan protocol can not be saved! exceeded when performing the scan. User Name (mandatory) Diagnostic Reason If you are loading a scan range for which the defined thresholds exceed the alert Password values, the Dose Alert dialog box opens Confirm Cancel A Dose Alert Password must be entered to proceed Computed Tomography 74 Restricted @ Siemens Healthineers, 2020 Notes 42 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows SIEMENS Healthineers Contrast Enhancement Computed Tomography 75 Restricted @ Siemens Healthineers, 2020 Contrast Enhancement - Influences on Optimal Enhancement SIEMENS .: Healthineers Optimize a uniform opacification HU Reduce contrast medium dosage Early - Lessen contrast associated artifacts Late Optimal Window Time Computed Tomography 76 Restricted @ Siemens Healthineers, 2020 Notes 43 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows Contrast Enhancement - Types of Injection Delays SIEMENS . Healthineers Empirical Delay - is a user specified time delay based on averages and experience (i.e. setting a 65 sec delay for a routine abdomen/pelvis for portal venous) CARE Bolus (Bolus Tracking) - Real-time injection monitoring using a ROI in the desired anatomy. It is incorporated into the scan with a pre-monitoring and monitoring scan. The user sets a HU trigger threshold for anticipated peak enhancement. Test Bolus - consists of a small pre-scan to measure the time to peak. This is used more commonly in Cardiac CTA as it is more specific to an individual patients cardiac output vs averages. Computed Tomography Restricted @ Siemens Healthineers, 2020 y 77 CARE Bolus CT SIEMENS .... Healthineers After you prepared a diagnostic range for Bolus Tracking, the Pre-monitoring range and the Monitoring range are added in the timeline. CARE Bolus CT in timeline 0.8 15.3 II 3 10 15.6 15 20 25 Pre- Monitoring Diagnostic monitoring range ange range Computed Tomography 78 Restricted @ Siemens Healthineers, 2020 Notes 44 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows CARE Bolus - FAST ROI SIEMENS Healthineers .... Scan, Parameters FAST ROI is part of the standard Check&GO Technology. 123456 *4/24/1 983, F, 37Y yngo CT VA HFS 4/24/2020 6:29:43.22 PM The FAST ROI feature automatically identifies regions of 2 IMA 1 MON 200 TP -1,262.0 interest and calculates HU in the aorta or the pulmonary trunk for automatic triggering of bolus tracking examinations. Dose Timing Config Post Bolus Delay (BT) [s] FAST ROI Trigger Level Auto @12 kV [ ... Trigger Aorta 10.00 None Quality ref. MAS 31 Aorta Pulmonary Trunk 966 8,91 x10.0 Bx361A.n. : 0240A.DAGABAlagA Computed Tomography 79 Restricted @ Siemens Healthineers, 2020 CARE Contrast III* SIEMENS Healthineers ... Facilitates contrast enhanced clinical workflow by synchronizing CT scan and contrast media injection using a single button (Control Box, RSC or Footswitch). CT scan CANNOT be triggered by the injector. Contrast protocols can be defined and managed on the scanner console and transferred to the injector. SYNC Combine scan and contrast protocols into integrated START examination protocols and export to other scanners. Default contrast protocols delivered with the scanner The default contrast protocols can be edited in the Exam Designer (Admin logon only) *Option Computed Tomography Restricted @ Siemens Healthineers, 2020 Notes 45 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows CARE Contrast III* - Default Contrast Protocols SIEMENS Healthineers Exam Designer The Siemens default contrast protocols Scan Protocols Exam Configuration can be edited in the Exam Designer (Admin logon only) If the CARE Contrast Ill license is not available, the tile "Contrast Protocols" will not be visible in the Exam Designer Contrast Protocols *Optional Computed Tomography 81 Restricted @ Siemens Healthineers, 2020 CARE Contrast III* - Default Contrast Protocols SIEMENS ..... Healthineers ... Contrast Protocols Bart Designer Contrast Protocols 1.Select Contrast Protocols 2. Modify Contrast Protocols 3. Confirm Changes Select Contrast Protocols Scanner: Contrast protocols are sent to the injector Brain [factory] Neck [factory] Thorax [factory] Abdomen [factory] Brain and Neck CTA [factory] You can modify all relevant contrast CTA [factory] Pulmonary CTA [factory] parameters: Coronary CTA [factory] Brain Perfusion [tactory] Liver Perfusion [factory] CM name Phase Type > Flow, Volume, Duration and CM CM Nam Phase Type Flow [ml/s] Volume [ml] Duration [s] CM Ratio [%] Ratio lodine Contrast 3.0 OU 20 100 All changes are marked in green! 2.5 16 Contrast Saline Dual Flow Option Pause Computed Tomography 82 Restricted @ Siemens Healthineers, 2020 Notes 46 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows CARE Contrast III* - Timeline SIEMENS .... Healthineers ... 3 mlis 3 ml/s A 3.3s 4.1s 6 II 6 0 10 o 20 25 pure CM is green Dual Flow is mixed green & blue Pause is gray Saline is blue 3 ml/'s 3 ml/s 3 ml/s o 20 *Option Computed Tomography 83 lealthineers, 2020 SIEMENS .... Healthineers ... Thank You! Training Center Americas CT Application Notes 47 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows 2. Cardiac SIEMENS Healthineers : SOMATOM go.All/Top and SOMATOM X.cite CT Cardiac (Option) HOODO5162003093658 Effective 06/22/2020 Restricted @ Siemens Healthineers, 2020 DISCLAIMER SIEMENS ... Healthineers ** Please note that the learning material is for training purposes only! All patient data visible are randomized generated by a Simulation SW. There is no relation to real patients available. For the proper use of the software or hardware, please always use the Operator Manual issued by Siemens. 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. Functionalities described in the material or parts of this functionality may not yet be released for customers and not yet be commercially available in every country. Due to regulatory requirements, the future availability of said functionalities or parts thereof in any specific country is not guaranteed. The Operator's Manual shall be used as your main reference, in particular for relevant safety information like warnings and cautions. 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 rights, including rights created by patent grant or registration of a utility model or design, are reserved. Computed Tomography Restricted @ Siemens Healthineers, 2020 Notes 48 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows Scanners SIEMENS Healthineers ... SOMATOM SOMATOM SOMATOM go.A go. Top X.cite Calcium Scoring* Coronary CTA* TAVI* Option Computed Tomography Restricted @ Siemens Healthineers, 2020 SIEMENS Healthineers PART 1: CT Cardiac Physics Notes 49 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows Requirements for CT Cardiac Scanning SIEMENS . Healthineers .... TEMPORAL RESOLUTION - minimize motion artifacts - fast gantry rotation HIGH SPATIAL RESOLUTION - thin collimation to depict cardiac anatomy (4mm-1mm diameter and smaller) FAST CONTINUOUS COVERAGE - whole heart in one short breath-hold - Multi-Slice CT SYNCHRONIZATION TO THE HEART BEAT - consistent cardiac phase - ECG Gating Computed Tomography Restricted @ Siemens Healthineers, 2020 Temporal Resolution SIEMENS .... Healthineers .. Temporal resolution is the time that it takes to acquire an image A good example of temporal resolution is the shutter speed on a camera. The faster it takes a picture the less motion is seen. Shutter speed determines image quality of objects in motion. Reducing or eliminating motion is especially useful when trying to image the beating heart. So, the faster the rotation time the faster the exposure will be. Slow Shutter Speed = Blurred Motion Image Fast Shutter Speed = Clear Still Image Computed Tomography 6 Restricted @ Siemens Healthineers, 2020 Notes 50 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows CT Cardiac Scanners - SOMATOM go.All/Top SIEMENS . Healthineers ... To reconstruct a cardiac image, we only need data from half of the rotation time SOMATOM go.ALL: 32 x 0.7 slice acquisition / 64 reconstructed (fast continuous coverage) 0.33 sec rotation time 165 ms temporal resolution with Single Phase reconstruction 83 ms temporal resolution with BiSegment Phase reconstruction SOMATOM go.Top: 64 x 0.6 slice acquisition / 128 reconstructed (fast continuous coverage) 0.33 sec rotation time 165 ms temporal resolution with Single Phase reconstruction 83 ms temporal resolution with BiSegment Phase reconstruction Computed Tomography 7 Restricted @ Siemens Healthineers, 2020 CT Cardiac Scanners - SOMATOM X.cite SIEMENS . Healthineers ... To reconstruct a cardiac image, we only need data from half of the rotation time SOMATOM X.cite: 64 x 0.6 slice acquisition / 128 reconstructed (fast continuous coverage) 0.3 sec rotation time 150 ms temporal resolution with Single Phase reconstruction 75 ms temporal resolution with BiSegment Phase reconstruction Computed Tomography & Restricted @ Siemens Healthineers, 2020 Notes 51 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows High Spatial Resolution SIEMENS Healthineers . High Spatial Resolution is the ability to see small objects in detail 0.3 mm 0.7 mm 1.0 mm 4 mm Courtesy of Medical University of South Carolina, Charleston, USA Computed Tomography Restricted @ Siemens Healthineers, 2020 SIEMENS Healthineers ... PART 2 : What you need to know or do before you scan Notes 52 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows CT Cardiac SIEMENS Healthineers ... . Patient Preparation Patient Positioning and Scan Range ECG Lead Placement ECG Trace Explanation of Procedure to Patient Computed Tomography Restricted @ Siemens Healthineers, 2020 CT Cardiac - Patient History and Clinical Requirements SIEMENS Healthineers Obtain a thorough clinical history for determining the coronary risk profile Obtain patient consent for the exam and any medications given Ask the patient if they have had prior CT scans before Ask the patient if they have had an exam where iodinated IV contrast media was used. If yes, ask if they did OK with it or if they had any adverse reactions to the contrast media Ask the patient if they have had any heart surgeries; especially, bypass graft, LIMA/RIMA graft, or a stent placement. This is relevant for the area to be scanned 18-gauge or larger intravenous needle in the antecubital vein (right AC is preferred to prevent streak artifacts from contrast accumulation in the left Subclavian vein) Injection site tested and flushed with saline Computed Tomography Restricted @ Siemens Healthineers, 2020 Notes 53 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows CT Cardiac - Beta Blockers SIEMENS Healthineers .. Beta Blockers are used prior to the exam to reduce the heart rate and or steady an arrhythmic sinus rhythm There are two types of Beta Blockers: 1. ORAL Beta Blockers 2 . IV Beta Blockers The amounts and regiment of any Beta Blocker given are the sole responsibility of the radiologist/cardiologist or the treating physician. Computed Tomography 13 Restricted @ Siemens Healthineers, 2020 CT Cardiac - Nitrates SIEMENS .. Healthineers ** Nitrates are used to dilate (enlarge) the coronary arteries Nitrates can be given two ways: 1. Tablet form 2. Oral spray The caveat is nitrates typically cause a reflex tachycardia (increased heart rate) The use of Beta Blockers cancels the tachycardia The amounts and regiment of any Nitrates given are the sole responsibility of the radiologist/cardiologist or the treating physician. Computed Tomography 14 Restricted @ Siemens Healthineers, 2020 Notes 54 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows CT Cardiac - Suggested Heart Rate SIEMENS . Healthineers go.All < 60 bpm go.Top/X.cite < 70 bpm NOTE: These values are based on best practice scenarios. Your facility may have their own heart rate protocols for use when scanning Cardiac CT exams. Your Education Specialist will discuss with you what heart rates work best for what type of Cardiac CT protocol for your facility and scanning practices. Computed Tomography 15 Restricted @ Siemens Healthineers, 2020 CT Cardiac SIEMENS. Healthineers .. Patient Preparation . Patient Positioning and Scan Range ECG Lead Placement ECG Trace Explanation of Procedure to Patient Computed Tomography 16 Restricted @ Siemens Healthineers, 2020 Notes 55 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows CT Cardiac - Patient Comfort SIEMENS Healthineers ... Patient lying on back (supine) Feet first is common practice. Make sure the patient is comfortable. Build up the area under the arms so they are relaxed. Place the knee cushion under the patient so their back is not stressed. Remember that the patient might be on the table for an extended period of time and ANY STRESS can cause the heart rate to elevate. Heart centered in the scan FoV. Patient can be placed slightly to the right on the table to isocenter the heart. × Computed Tomography 17 Restricted @ Siemens Healthineers, 2020 CT Cardiac - Scan Range SIEMENS .. Healthineers .. Scan Direction is head - foot, unless directed to scan foot - head A scan range of 12-15 cm from the carina to the apex of the heart is usually sufficient. If a calcium scoring exam is done prior to the coronary CTA exam, the scan range for the calcium score can be a little longer. This will give you a reference for the coronary CTA exam. The apex of the heart can be misleading through the diaphragm when viewing the topogram, so you might want to make the scan range a little longer. The targeted FoV is 150 to 220 mm FAST Planning for automated range planning BYPASS LIMA/RIMA FAST Planning HEART Bypass + Cardiac Bypass LIMA/RIMA Heart Computed Tomography 18 Restricted @ Siemens Healthineers, 2020 Notes 56 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows CT Cardiac SIEMENS. Healthineers ... Patient Preparation Patient Positioning and Scan Range . ECG Lead Placement ECG Trace Explanation of Procedure to Patient Computed Tomography Restricted @ Siemens Healthineers, 2020 CT Cardiac - ECG Lead Placement SIEMENS Healthineers ... The use of ECG leads during a prospectively or retrospectively gated Cardiac exam allows for the real-time acquisition of a patient's cardiac rhythm during the exam · Quality ECG information is critical for the successful reconstruction of diagnostic Cardiac images Ensure the patient is lying down on the table with his/her arms above their head BEFORE placing the ECG leads on . For male patients, you may need to shave the area . Clean the area where the leads will be placed; however, refrain from using alcohol based cleaning products since they can remove the oil and can potentially make a poor ECG connection ECG gating is REQUIRED for ALL Cardiac examinations! Computed Tomography 20 Restricted @ Siemens Healthineers, 2020 Notes 57 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows CT Cardiac - ECG Lead Placement SIEMENS. Healthineers ... Physiological measurement module (PMM) is an optional device on the SOMATOM go.All/Top and X.cite It provides the receptacle for the electrocardiogramaCG) electrodes and a push button for changing the ECG channel. The PMM evaluates the ECG signal to detect the R-peaks. > 1 PMM interface - ECG electrodes are connected here 2) Push button - channel selector WARNING Rate meters may continue to count the pacemaker rate occurrences of cardiac arrest or arrhythmia! ECG leads to wrong diagnosis. Keep pacemaker patients under close surveillance. Computed Tomography 21 Restricted @ Siemens Healthineers, 2020 CT Cardiac - ECG Lead Placement SIEMENS Healthineers Attach the leads to the pad BEFORE placing on the patient Attach the leads to the patient in the following manner, making sure the wires are not tangled and the hub is out of the Scan FoV. Observe ECG trace to ensure a good signal. If the signal is not adequate, adjust the leads. > Ideally, all pads should be placed above the level of the ribs if possible. If you have to remove a pad, then replace it with a new one. Color Coding according to the AHA Black electrode = left mid-clavicular line, directly below clavicle Red electrode = left mid-clavicular line, at 6th or 7th intercostal space White electrode = right mid-clavicular line, directly below clavicle Green electrode = right mid-clavicular line, at 6th or 7th intercostal space Computed Tomography 22 Restricted @ Siemens Healthineers, 2020 Notes 58 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows CT Cardiac SIEMENS ... Healthineers. Patient Preparation Patient Positioning and Scan Range ECG Lead Placement . ECG Trace . Explanation of Procedure to Patient Computed Tomography 23 Restricted @ Siemens Healthineers , 2020 CT Cardiac SIEMENS .... Healthineers ... ECG Trace is available as soon as an ECG is connected Observe ECG trace to ensure a good signal. If the signal is not adequate, adjust the leads ECG Trace is displayed in the following areas: Tablet > Protocol Selection Tab > Examination page Computed Tomography 24 Restricted @ Siemens Healthineers, 2020 Notes 59 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows CT Cardiac - Good/Bad Trace SIEMENS . Healthineers ... You can cycle through the three ECG channels to change the QRS complex by pressing the ECG channel selection button on the PMM ECG Socket - connection for ECG cables Heart Rate (bpm) Min: 60 Max 60 Avg: 60 . ECG channel selection button 60 60 60 60 60 60 60 Heart Rate (bpm) Min: 56 Max 68 Avg: 61 63 61 60 56 58 58 Computed Tomography 25 Restricted @ Siemens Healthineers, 2020 CT Cardiac SIEMENS Healthineers ... 1. R-peaks (syncs try to match R-peaks) 2. Scan/Recon window (the width corresponds to the temporal resolution of the images) 3 . Syncs (set by R-peak detection algorithm, retrospectively editable). Dots above the trace indicate detected R-peaks. The corresponding heart rate in bpm is displayed between R-peaks 4. Edit ECG trace icon 5 . Heart rate (in beats per minute). Minimum, maximum, and average heart rates based on the last 10 cycles. 2 3 ¥ 60 bpm Min: 60 Max: 60 5 Computed Tomography 26 Restricted @ Siemens Healthineers, 2020 Notes 60 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows CT Cardiac SIEMENS .; Healthineers ... 6. Low dose level 7. Pulsing window (defines the area where the entered dose is applied). Color in recon boxes indicates the dose corresponding to the dose profile. 8. Phase start - delay for starting the scan window (sequence, prospective triggering), delay for positioning the recon window (spiral, retrospective gating). 9. Green line indicates that radiation is on during and after scanning. ¥ 60 bpm Min: 60 Max: 60 9 8 7 6 mography 27 Restricted @ Siemens Healthineers, 2020 CT Cardiac - Demo Mode SIEMENS Healthineers ... Available if Cardiac license is available. Physiological Signal Requires PMM hardware module ECO Demo Demo mode creates regular 60 bpm Connecting the ECG leads to the patient switch on/off automatically switches off demo mode Physiological Signal Demo mode is clearly labeled in the ECC Demo workflow if active 60 60 ECG Demo Computed Tomography Restricted @ Siemens Healthineers, 2020 Notes 61 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows CT Cardiac - ECG Synthetic Sync Spiral SIEMENS Healthineers .. Ensures scan continuation in case of a missing ECG signal (e.g.: an electrode fell off the patient) If the ECG monitor fails to detect R-peaks for more than 3.5 seconds during an examination, the scan will be continued with synthetic syncs. If ECG Synthetic Sync Spiral is disabled and the system detects a missing ECG signal during an examination, the scan is canceled after 3.5 seconds after the last R-peak has been detected. The gap between the last detected sync and the first synthetic sync in the recorded ECG trace of a spiral scan is not automatically filled. There might be artifacts/mis-registration! Key things to note: Enabled by default For spiral protocols only If the ECG signal is lost during a sequential scan, the scan will be aborted. Computed Tomography 29 Restricted @ Siemens Healthineers, 2020 CT Cardiac - ECG Sinus Rhythm SIEMENS Healthineers ... In general, we differentiate between two cardiac phases where we can acquire cardiac data without a lot of motion: Diastolic and Systolic The area of the Diastolic phase is usually just before the P wave - relaxation - big left ventricle The area of the Systolic phase is usually just after the T wave - contraction - small left ventricle The RCA with a high heart rate can sometimes be imaged better in the Systolic phase when the heart is contracted R (1) P (4) (3) (2) (1) R-wave (2) Ventricular relaxation (3) Ventricular contraction ( 4) Atrial contraction Computed Tomography 30 Restricted @ Siemens Healthineers, 2020 Notes 62 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows CT Cardiac - Systolic/Diastolic SIEMENS Healthineers Systolic Diastolic Systolic R Diastolic Computed Tomography 31 Restricted @ Siemens Healthineers, 2020 CT Cardiac - Perfect Sinus Rhythm SIEMENS .... Healthineers ... A perfect sinus rhythm would have the same distance from one R peak to the other R peak throughout the scan. In reality there are no perfect sinus rhythms due to varying heart rates and cardiac arrhythmias. But, if the patient is prepped correctly and does not have any cardiac arrhythmias, you can get pretty close. . When you look at the sinus rhythm after the scan, you would like to see the Best Diastolic phase (dark blue bar in this example) the same distance from the right R peak on all the R to R intervals. Left Right Computed Tomography 32 Siemens Healthineers, 2020 Notes 63 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows CT Cardiac - ECG Sinus Rhythm - Examples SIEMENS Healthineers ... Normal sinus Heart Rate (bpm) Min 60 Max 60 Avg 60 Pacemaker 51 72 51 rhythm 20 30 31 32 33 35 Abnormal 30 . 30 . 30 - 30 . 39 . 59 . 59 22 . 08 . 108 . 81 . 38 . 06 . 100 - 111 . 77 . 70 A-Fib - Atrial sinus rhythm Fibrillation - adjust leads PAC -Premature Loss Of P wave PVC - Atrial Premature Contraction Ventricular Contraction Computed Tomography 33 Restricted @ Siemens Healthineers, 2020 CT Cardiac SIEMENS Healthineers Patient Preparation Patient Positioning and Scan Range ECG Lead Placement ECG Trace . Explanation of Procedure to Patient Computed Tomography 3 Restricted @ Siemens Healthineers, 2020 Notes 64 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows CT Cardiac SIEMENS Healthineers .... Scanning hearts is a CT exam that requires total patient cooperation for the exam to be successful Most patients are nervous and apprehensive, which can lead to elevated/erratic heart rates >> It is the technologist's responsibility to make sure that the patient is comfortable, relaxed and understands every aspect of the exam When a patient fully understands all the exam steps, his/her heart rate is more likely to remain steady and does not elevate There is a dedicated default Cardiac API utilizing the hyperventilation technique: "Take in a breath" (pause) "Blow it out." (pause) "Take in another breath and hold it." Computed Tomography 35 Restricted @ Siemens Healthineers, 2020 CT Cardiac SIEMENS .... Healthineers ... Motion artifact caused by breathing during the scan can mean the difference between an optimal scan and a non-diagnostic scan. You cannot edit out motion artifact Computed Tomography 36 Restricted @ Siemens Healthineers, 2020 Notes 65 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows SIEMENS Healthineers : PART 3 : CT Cardiac Clinical Decision Trees CT Cardiac SIEMENS .. Healthineers ... Cardiac CT made easy independent of operator skills Specially useful for users less experienced in CT Cardiac procedures, myExam Compass suggests which settings are more appropriate for every patient based on the procedure and patient characteristics, finding the correct combination of acquisition and reconstruction parameters for optimal image quality, standardized results and always the right dose. Computed Tomography 38 Restricted @ Siemens Healthineers, 2020 Notes 66 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows myExam Companion SIEMENS .. Healthineers' ... guides users of any skill level through CT cardiac procedures Coronary x CTA Doe, John Calcium High HR Coronary CTA (Adult) Head first - supine Patient Orientation 60 .!!! III Score Systole Mid HR Breathing Instruction Practice .... Diastole Audio Control Real time ECG characterization during Recon&GO Patient Characteristics breathing practice, Check&GO Best Phase Heart Rate Variability 0 bom Regular Irregular Arhythmic topogram and CaScore Low HR Heart Rate 60 FAST Planning Low Medium Customer Questions Did the patient drink coffee in the Select anew inst 4 hours? Information Ploaso perform breath hold training and make sure the p Individualized procedures, standardized results Back GO Optimal combination of acquisition and reconstruction parameters for standardized results at always the right dose ......... Computed Tomography 39 Restricted @ Siemens Healthineers, 2020 CT Cardiac - Patient Characteristics SIEMENS Healthineers' ... Two of the new Patient Characteristics* are needed for Cardiac scans: > Heart Rate (bpm) >> Heart Rate Variability (bpm) Patient Characteristics Age (Years) Weight (kg) Before the scan, the HR and HRV are 35 60 60 100 measured automatically in real time Young Adult Adult Senior Slim Average Obese Based on the threshold values listed in CREA (mg/dl) (e)GFR (ml/min/1.73m2) the Patient Characteristics, the system 1.5 60 30 chooses the right pulsing parameters for Normal Elevated High Normal Decreased Severely decreased the cardiac scan (e.g. Diastolic "% vs Systolic ms) Heart Rate (bpm) Rate Variability (bpm) 65 They are linked to Cardiac Decision Trees 72 12 Low Moderate High Regular Unstable Arrhythmic *Accessed in Exam Designer by Admin Logon only Computed Tomography 4 Restricted @ Siemens Healthineers, 2020 Notes 67 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows CT Cardiac - Console Workflow SIEMENS Healthineers ... After registering and positioning the patient, and loading the exam, myExam Compass will be available at the console in the Taskflow . Coronary CTA [factor ... identified by a yellow compass symbol. myExam Compass Once the Cardiac Practice Breathing* instruction is completed the system Topogram will automatically adjust the protocol scan/recon parameters based on Calcium Scoring the Patient Characteristics: Heart Rate and Heart Rate Variability. Premonitoring The user always has the opportunity to manually change what myExam Monitoring Compass automatically selected, however, the system will no longer re- CTA Coronary evaluate the heart rate throughout the entire exam if this is done. Reconstruction Close Additionally, there may be some questions specific to the protocol selected which will appear and await your answer. *ONLY available on the tablet Computed Tomography 41 Restricted @ Siemens Healthineers, 2020 TE CT Cardiac - Console Workflow SIEMENS Healthineers ... If your selected protocol has additional questions needing to be myExam Compass answered they will appear under the Patient Characteristics header "Questions". Heart Rate Variability Regular Unstable Arrhythmic Heart Rate Low Moderate High The user simply has to answer the Questions questions according to how the scan focus of the CTA scan needs to be on image quality with increased dose ." routine dose image quality should be performed and the system Is your focus on image quality with s Postprocessing, for example, CT FFRe increase in dose for advanced routine dose image quality will make the scan/recon adjustments automatically. Computed Tomography 42 Restricted @ Siemens Healthineers, 2020 Notes 68 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows CT Cardiac - Tablet Workflow SIEMENS . Healthineers This is the default view of the ECG curve on the screen. Tap the Up Arrow icon or the ECG curve to hide the display of the ECG curve. :: Tap the Electrodes icon to open a popover that provides information on the quality of the ECG signal. This popover opens automatically if one of the ECG electrodes is disconnected. Tap to close. with h / h h h / 100 ! II If signal quality is poor, check that the N electrode is properly attached. Some electrodes seem to have lost contact. Please check electrodes and reattach if necessary. Impedance was last measured at: 11:29:49 Computed Tomography 43 Restricted O Siemens Healthineers, 2020 CT Cardiac - Tablet Workflow SIEMENS Healthineers Coronary CTA [factory] (Adult) @ Head First - Supine After registering and positioning the patient, the myExam Compass, including Cardiac Breathing Breathing Instruction Practice Instruction Practice will automatically open at the Practice the breathing instructions with the patient. The heart tablet. rale will be measured. Audio Control NOTE: this breathing instruction is ONLY available Patient Characteristic Heart Rate Variability on the tablet, not the console. Regular Unstable Arrhythmic Heart Rate Low Moderate High On the tablet, the ECG trace is measured in real time Pressing the "play" button will play a practice breath hold command. Back GO Computed Tomography 44 Restricted @ Siemens Healthineers, 2020 Notes 69 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows CT Cardiac - Tablet Workflow SIEMENS. Healthineers ... Coronary CTA [factory] ( Adult) @ Head First head First - Supine Patient Orientation During the Breathing Instruction 60 com! III Practice, the Heart Rate and the Heart Rate Variability are evaluated. Breathing Instruction Practice Afterwards the dedicated scan mode is Audio Control selected automatically. Patient Characteristics Heart Rate Variability [opm] 0.0 Regular Unstable Arrhythmic A stable ECG ends up in a regular & Heart Rate [bpm] low selection thus having the correct 60 Low Moderate High pulsing parameters. Back GO Computed Tomography 45 Restricted C Siemens Healthineers, 2020 CT Cardiac - Tablet Workflow SIEMENS . Healthineers Coronary CTA [factory] ( Adult ) @ Head First - Supine Patent mentation An irregular ECG trace will be identified 50 e.!! III as a high & arrhythmic HR, therefore the system switched to a different Breathing Instruction Practice selection in scan modes. udio Control Patient Characteristics Heart Rate [bpm] 75 Low Moderate High Heart Rate Variability Ibpmi Regular 18:3 Unstable Arrhythmic Back GO Computed Tomography 46 Restricted @ Siemens Healthineers, 2020 Notes 70 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows CT Cardiac - Tablet Workflow SIEMENS Healthineers ... To reach the Breathing Instruction X Practice manually press the Compass icon in the upper part of the tablet. Coronary CTA Function [factory] Vead First - Supine (Adult) Patient Orientation You can replay the practice breathing 0.84 (32 cm) 0.64 instruction as often as desired prior to 8.9 18 80 Exposure Time [s] CTDIvol ImGy] DLP [mGycm] EN MAS starting the scan. bpm Breathing Instruction Practice The user can always overrule the Practice the breathing instruct heart rate will be measuredons with the patient. The Audio Control automatic selection by pressing one of the buttons from the Patient Patient Characteristics characteristics selection. Heart Rate Variability Regular Unstable Arrhythmic Heart Rate Low Moderate High Computed Tomography 47 Restricted @ Siemens Healthineers , 2020 SIEMENS Healthineers . PART 4 : CT Cardiac Acquisition and Reconstruction Notes 71 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows CT Cardiac SIEMENS Healthineers ... Protocols Computed Tomography 4 Restricted @ Siemens Healthineers , 2020 CT Cardiac - Protocols SIEMENS . Healthineers ... CORONARY CALCIUM SCORING Sa36 reconstruction for 120kV equivalent Agatston Scoring CORONARY CTA Thin slice axial, PACS ready Recon CPR coronary vessel & cardiac axis ( 4-chamber / short ). Coronary CTA Function - for multiphase reconstruction to obtain ventricular ejection fraction* Coronary CTA HeartFlow - designed for use with advanced processing software such as CT FFR ** THORAX CORONARY CTA · Utilizing Flex Dose Profile (50%/100%) for dose optimization Triple Rule-Out/Chest Pain TAVI . AutoRange: ECG Gated Spiral + BodyAngio Range * syngo.via required for the evaluation of multiphase scan data ** Option only available for the SOMATOM go. Top and SOMATOM X.cite Computed Tomography 5 Restricted @ Siemens Healthineers, 2020 Notes 72 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows CT Cardiac - Coronary Calcium Scoring SIEMENS. Healthineers Scan modes*: CardiacSequenceAdult = Prospective CardiacSequenceAdultSn = Prospective with a Tin Filter CardiacSpiralAdult = Retrospective Recon Ranges Topogram Protocol: Coronary Calcium Scoring [factory] Calcium Scoring -Indications: identification, quantification of Topogram calcified lesions in the coronary arteries, wo CM -Scan modes: CardiacSequenceAdult Calcium Scoring ca auto *Available scan modes are license and scanner dependent Computed Tomography 51 Restricted @ Siemens Healthineers, 2020 CT Cardiac - Any kV Calcium Score SIEMENS .... Healthineers ... 80 KV 100 kV Achieve Agatston-equivalent coronary 120 kV calcium scoring at any kV between 70-140 kV as well as Sn100-Sn140 kV (Tin Filter) 140 kV Freedom of patient specific selection of tube voltage: any kV CaScoring Original [HU] A special reconstruction kernel (Sa36) providing material corrected images corresponding to a 120 kV equivalent spectra Artificial 120 [HU] Computed Tomography 52 Restricted @ Siemens Healthineers, 2020 Notes 73 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows CT Cardiac - Coronary CTA (also Function and HeartFlow) SIEMENS Healthineers Recon Ranges Scan modes*: Topogram CardiacSequenceAdultAngio = Prospective CardiacSequenceAdultAngioFlex = Prospective Calcium Scoring CardiacSpiralAdultAngio = Retrospective CardiacSpiralAdultAngioBisegment = Retrospective auto Premonitoring Protocol: Coronary CTA [factory] Monitoring -Indications: identification, quantification of calcified lesions in the coronary arteries, wo CM; Topogram stenosis of the coronary arteries, w CM Calcium Scoring -Scan modes: CardiacSequenceAdult, PremonitoringSequenceAdult2d, Premonitoring MonitoringSequenceAdult2d, CTA Coronary CardiacSpiralAdultAngio Monitoring CTA Coronary *Available scan modes are license and scanner dependent Computed Tomography 53 Restricted @ Siemens Healthineers, 2020 CT Cardiac - Thorax Coronary CTA (Flex Dose Profile) SIEMENS. Healthineers .. The system provides a dose modulation mechanism to reduce radiation outside of an organ by a certain factor. Within one scan, you can acquire two different organ specific ranges with organ adapted image quality. Scan Mode*: CardiacSpiralAdultAngioFlexdose = Retrospective For example, with the Thorax Coronary CTA for Chest Pain, you can acquire Recon Ranges images of the thorax and heart within a single scan to clarify the reasons for Topogram non-specific chest pain. As images of the heart require a larger amount of dose than the remaining Premonitoring thorax area, less dose can be applied to the thorax. Protocol: Thorax Coronary CTA [factory] Monitoring -Indications: chest pain, triple rule out, vascular Topogram anomalies, aneurysms, dissection, ruptures of the thoracic aorta, pulmonary embolism, stenosis of Premonitoring the coronary arteries, w CM -Scan modes: PremonitoringSequenceAdult2d, Monitoring CTA Thorax Coronary MonitoringSequenceAdult2d, CardiacSpiralAdultAngioFlexdose CTA Thorax Coronary *Available scan modes are license and scanner dependent Computed Tomography 54 Restricted @ Siemens Healthineers , 2020 Notes 74 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows CT Cardiac - Thorax Coronary CTA (Flex Dose Profile) SIEMENS. Healthineers 132 827c9108-a873-4cb7-9848-719e87ac04c3 SOMATOMI *11/20/1981. M syngo CT /MIN As soon as the topogram has been 3:06:42:54 PM 1 IMA 1 acquired, The Flex Dose Profile consists -1491 0 of a low and high dose area graphically on the topogram within the CARE Profile to plan the organ-specific ranges ........................................................................................................ You can adjust the area of low dose and 1 high dose simply by moving the bold green line. The shaded area indicates high dose area. 2 WWWWWWWWW > 1 = Low Dose Area 2 = High Dose Area kV Sn100 mA 60 LAJ TI 3.32 SL 512 0/0 Tr201A.n0. 0000A 1 A! ES1a1A Filter Sn Computed Tomography 55 Restricted @ Siemens Healthineers, 2020 CT Cardiac - TAVI SIEMENS .... Healthineers ... The TAVI protocol consists of an ECG gated cardiac scan for Aortic Valve evaluation and a non-gated (NO ECG) CTA of the body to evaluate vascular access set up as an AUTO-RANGE by default for minimal interscan delay. Recon Ranges Scan modes*: Topogram Valve Scan - ECG Gate Spiral (i.e. Coronary CTA) = Retrospective TAVI Planning Scan - SpiralAdultAngioBodyFAST (non-gated) Test Bolus Protocol: TAVI [factory] Valve -Indications: TAVI/TAVR, the evaluation of the Topogram access route (peripheral, transapical, subclavian, transaortic), aortic root and aortic annulus Test Bolus dimensions, as well as aortic valve structure and calcification, w CM Valve -Scan modes: TestbolusSequenceAdult2d, TAVI Planning CardiacSpiralAdultAngio, TAVI Planning RoutineSpiralAdultAngioBodyFast *Available scan modes are license and scanner dependent Computed Tomography 56 Restricted @ Siemens Healthineers, 2020 Notes 75 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows CT Cardiac SIEMENS Healthineers : Acquisition Computed Tomography 57 Restricted @ Siemens Healthineers, 2020 CT Cardiac - Physio Scan tab SIEMENS Healthineers ... The Physio Scan tab in Scan Parameters provides input columns for: Pulsing Mode (None or Standard) - for dose modulation Phase Start and Phase End - for window of dose modulation (where you want full dose) Phase Unit (% or ms) - which unit you are using to determine phase start/end Estimated Heart Rate (Auto or Fixed) - controls the timing of the scan (e.g. pitch) Scan Favorites General Scan Dose Timing Config Physio Scan Scan/Recon Pulsing Mode Phase Start Phase End Phase Unit Est. Heart Rate CTA Coronary Standard 75 75 % Auto Computed Tomography Restricted @ Siemens Healthineers, 2020 Notes 76 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows Synchronization to Heart Beat (ECG Gating/Triggering) SIEMENS Healthineers In order to create images that are motion free, it is very important to scan in synchronization with the heart beat. This is achieved by using an ECG to trigger or gate the scanning process. Two Ways: Prospective Sequential ECG Triggering - The ECG signal is used to trigger a CT scan at the appropriate heart phase. It is triggered with a certain delay after the R-wave. Retrospective ECG Spiral - data acquisition continuously proceeds while the patient table is moving forward with a constant pitch. Due to the continuous data acquisition, the spiral mode allows maximum flexibility for data reconstruction at any time point within the cardiac cycle. Computed Tomography 59 Restricted @ Siemens Healthineers, 2020 Prospective Sequential ECG Triggering SIEMENS . Healthineers ... . Prospective ECG triggering combined with step-and-shoot acquisition of axial slices acquires the appropriate amount of scan data needed for image reconstruction during the previously selected heart phase. The ECG signal of the patient is monitored during examination, and axial scans are started with a predefined time offset relative to the R-waves. In the prospective ECG-triggered sequence mode, the patient table moves the patient to the first z-position. The scan is triggered depending on the ECG. Then the patient is moved to the next z- position. The procedure is repeated until the range to be scanned is completed. Reconstruction is done prospectively based on timestamps from the recorded ECG. After you start the scan, it is no longer possible to change the trigger delay time. 60 60 60 60 60 60 60 60 60 60 60 Computed Tomography 6 Restricted @ Siemens Healthineers, 2020 Notes 77 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows Prospective Sequential ECG Triggering SIEMENS Healthineers ... In the Physio Scan category, you can define the area of the heart phase range that is intended for high dose reconstructions in % or ms values with a start and end phase value. You can set the following parameters for a cardiac sequence range: > Phase Start, Phase End, and Phase Unit Scan Favorites | General Scan | Dose Timing Config Physio Scan Contrast Scan/Recon ase Start Phase End Phase Unit Calcium Scoring 75 75 60 Computed Tomography 61 Restricted @ Siemens Healthineers, 2020 Prospective Sequential ECG Triggering SIEMENS. Healthineers . The Scan Time parameter and the Cycle Time parameter depend on the heart rate and cannot be modified. The Scan Time represents the single length of a scan. The Exam Time of the sequence depends on the heart rate. The more irregular the heart rate, the longer the sequence scanning will take. Scan Favorites General Scan Dose Timing Config Scan/Recon Rot. Time [s] Scan Time [s] Exam Time [s] Cycle Time [s] Patient Instruction Absolute Start Delay [s] | Calcium Scoring 0.30 0.20 8.20 2.00 Cardiac 10.0 60 60 60 60 60 60 60 60 60 Computed Tomography Restricted @ Siemens Healthineers, 2020 Notes 78 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows Retrospective ECG Spiral SIEMENS . Healthineers In retrospective cardiac spiral CT, data acquisition proceeds continuously while the patient table is moving forward with a constant pitch. The ECG and the CT raw data are recorded simultaneously throughout the entire heart cycle. Due to the continuous data acquisition, the spiral mode allows maximum flexibility for data reconstruction. If necessary, you can also edit the ECG in this mode for challenging patients. 60 60 60 60 60 60 60 60 60 Computed Tomography 63 Restricted @ Siemens Healthineers, 2020 Retrospective ECG Spiral SIEMENS. Healthineers Compared with non-gated spirals, the pitch depends on the heart rate of the patient. Therefore, very low pitch values of approximately 0.3 (= lowest possible pitch value) are required. You can see the dimmed pitch parameter in the Scan Parameter tab "Timing". This may be at the expense of higher radiation dose; however, to alleviate this effect, the tube current is modulated with ECG Pulsing, depending on the current heart phase. Scan Favorites | General Scan Dose Timing Config Physio Scan Scan/Recon Pitch Rot. Time [s] Exam Time [s] Patient Instruction CTA Coronary 0.31 0.30 4.84 Cardiac Computed Tomography 64 Restricted @ Siemens Healthineers, 2020 Notes 79 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows Retrospective ECG Spiral SIEMENS Healthineers ... ECG Pulsing lowers the dose during heart phases that are of less interest. ECG Pulsing is a time-based dose modulation according to the patient's current heart phase. Automatic pitch adaptation (Est. Heart Rate) calculates the optimal table speed based on the patient's heart rate. An ECG triggers the modulation of the X-ray intensity, where the high dose reconstruction (in % or ms) area can be restricted to a particular range of the cardiac cycle using Phase Start and Phase End. There are two ECG Pulsing Modes available: None = Dose 100% and Standard = Dose 10% CH Scan Favorites General Scan Dose Timing Config Physio Scan Scan/Recon Pulsing Mode Phase Start Phase End Phase Unit Est Heart CTA Coronary Standard 70 80 % Auto Standard None Computed Tomography 6 Restricted @ Siemens Healthineers, 2020 CT Cardiac - ECG Pulsing SIEMENS. Healthineers ** Pulsing Mode = NONE (100% Dose) Scan Favorites General Scan Dose Timing Scan/Recon Pulsing Mode Phase Start Phase End Phase Unit Est. Heart Rate CTA Coronary None 70 80 % Auto 65 65 65 68 60 65 68 Computed Tomography Restricted @ Siemens Healthineers, 2020 Notes 80 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows CT Cardiac - ECG Pulsing SIEMENS. Healthineers Pulsing Mode = STANDARD (10% Dose) Scan Favorites General Scan Dose Timing - Scan/Recon Pulsing Mode Phase Start Phase End Phase Unit Heart CTA Coronary Standard 70 80 % Auto Standard None 68 60 65 68 65 65 65 68 60 Computed Tomography 67 Restricted @ Siemens Healthineers, 2020 Retrospective ECG Spiral SIEMENS ..... Healthineers ... . It is possible to adapt the pitch automatically or manually according to the heart rate of the patient. The heart rate is monitored during at least 10 heart cycles to achieve a stable heart rate overview. Set the Est. Heart Rate parameter to Auto. The automatic pitch adaption is activated. The pitch is adapted automatically to the minimum heart rate. Automatic pitch adaption calculates an optimal table speed based on the last 10 heart cycles. The pitch is adapted until the GO button is clicked. After you click GO to activate the scan, the current heart rate is compared to the estimated heart rate that is specified in the scan protocol. Scan Favorites General Scan Dose Timing Config Physio Scan Scan/Recon Pulsing Mode Phase Start Phase End Phase Unit Est Heart Rate CTA Coronary Standard 70 80 % Auto Standard None Computed Tomography 68 Restricted @ Siemens Healthineer Notes 81 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows CT Cardiac - Estimated (Est.) Heart Rate SIEMENS Healthineers ... Set the Estimated (Est.) Heart Rate parameter to Auto. Est. Heart > The automatic pitch adaptation is activated. The pitch is adapted Rate automatically to the minimum heart rate. Automatic pitch adaptation calculates an optimal table speed based on the last 10 heart cycles. Auto - OR - Auto Set the Estimated (Est.) Heart Rate parameter to a Fixed value (i.e. >60). >40 >50 The pitch is adapted to the specified value and will not automatically 55 65 adjust if patient HR drops below the fixed value. >60 >70 >80 >90 >100 Computed Tomography 69 Restricted @ Siemens Healthineers, 2020 CT Cardiac - Contrast SIEMENS .. Healthineers .. Using CARE Bolus CT, you can synchronize the cardiac scan with administration of the contrast medium. CARE Bolus is included by default to the cardiac examination *. After you have set the scan and trigger parameters of the range, the cardiac scan is started like any CARE Bolus examination as soon as the defined Bolus threshold is reached. In addition to the ECG signal, the HU diagram is also displayed. CTA Coronary Min: 60 Max: 60 13.35 8.2s 9.35 *Test Bolus is default for the TAVI protocol Computed Tomography 70 Restricted @ Siemens Healthineers , 2020 Notes 82 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows CT Cardiac - Physio Recon tab SIEMENS Healthineers The Physio Recon tab in Recon Parameters provides input columns for: Recon Type - Best Phase, manual or multi Recon Phases(s) - to indicate which cardiac phase you wish to reconstruct Recon Phase Unit (% or ms) - which unit do you want the phase reconstructed with True Stack - determines if reconstruction with have overlap Temporal Resolution - for which temporal resolution are you performing the recon with Recon Favorites General Recon Recon&GO | Image Impression Recon Box Physio Recon Auto Tasking Inline Options Scan/Recon Recon Type Recon Phase(s) Recon Phase Unit True Stack Resolution [ms] CTA Coronary 0.80 Bv40 A3 BestSyst BestPhase (systolic) 350 ms Off 150 Computed Tomography 71 Restricted @ Siemens Healthineers, 2020 CT Cardiac - Cardio Best Phase SIEMENS Healthineers ... The Cardio Best Phase is a tool that can adapt to the individual patient's heart motion and automatically identifies the optimal diastolic and systolic phases for cardiac reconstruction. . Under the Recon Type tab of the Physio Recon folder you will see four options: 1. Single Phase - for defining a new phase or to determine best phase manually 2. Multi Phase - additional recon for ejection fraction evaluation using syngo.via* Best Phase (diastolic) - best relaxation phase W 4 . Best Phase (systolic) - best contraction phase Recon Favorites | General Recon Recon&GO Image Impression | Recon Box Physio Recon Scan/Recon Recon Type Recon Phase(s) Recon Phase Unit True Stack Temporal Resolution [ms] | CTA Coronary 0.80 Bv40 A3 BestDiast BestPhase (diastolic) 75 Off 150 Single Phase Multi Phase BestPhase (diastolic) 68 65 65 65 BestPhase (systolic) 60 65 68 65 65 65 *syngo.via is an option Computed Tomography Restricted @ Siemens Healthineers, 2020 Notes 83 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows CT Cardiac - Phase Definition SIEMENS . Healthineers The Recon Phase, represented here by the orange bar, is in the middle of the green scan box and not the beginning. In this example, 60 = heart rate (60 bpm). General Recon Recon&GO | Image Impression Recon Box Physio Recon& Recon Type Recon Phase(s) Recon Phase Unit True Stack Temporal Resolution [ms] Single Phase 65 % Off 150 65% 60 60 60 60 160 160 60 60 60 Computed Tomography 73 Restricted @ Siemens Healthineers, 2020 CT Cardiac - % vs ms SIEMENS. Healthineers ... Phase Unit Using a percentage is familiar and it is easy to express . However, that does not mean that you cannot go back and use positive milliseconds to try and get better results if using % percentage did not give you the best phase % ms Recon Favorites General Recon Recon&GO Image Impression | Recon Box Physio Recon Scan/Recon Recon Type Recon Phase(s) Recon Phase True Stack Temporal Unit Resolution [ms] CTA Coronary 0.80 Bv40 A3 BestDiast BestPhase (diastolic) 75 Off 150 ms Computed Tomography 74 Restricted @ Siemens Healthineers, 2020 Notes 84 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows CT Cardiac - % vs ms SIEMENS Healthineers ... The temporal relation of the image data (within a cardiac cycle) can be defined as a relative percentage of the R to R interval or the absolute time (milliseconds) as an offset to the R-waves Percentages (%) Positive milliseconds 70 % * 700ms " Computed Tomography 75 Restricted @ Siemens Healthineers, 2020 CT Cardiac - % vs ms SIEMENS Healthineers ... Relative Percentages (%) The percentage method is more forgiving in many circumstances because the assumption is that even if the heart rate changes a little the diastolic phase will still begin at about same point relative to the entire cycle. 100% is always 100%. Percentages measure from the left R peak to the right R peak. O 100% 70% 70% Lett Right Computed Tomography Restricted @ Siemens Healthineers, 2020 76 Notes 85 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows CT Cardiac - % vs ms SIEMENS .. Healthineers ... Absolute (+) milliseconds When using the positive absolute method, the increments are expressed in positive milliseconds (there are no negative ms values). This means that if a patient has a heart rate of 60 beats per minute, the distance between any R-to-R peak would be one second, or 1000 milliseconds. Of course, as the heart rate changes, which it surely will do, the time either gets longer or shorter. 0 1000ms 1000ms So, to reconstruct an image during the diastolic phase -o for any given cardiac cycle, we will need to tell the 700ms computer to create images during the diastolic phase. 700ms Left Right It will be expressed as X number of milliseconds from the left R peak. Computed Tomography Restricted @ Siemens Healthineers, 2020 CT Cardiac - True Stack SIEMENS . Healthineers ... With True Stack reconstruction, the individual cardiac cycles can be displayed without or with data overlap (10% overlap). With True Stack turned "ON", you create a reconstruction without stack overlapping, which generates an image set with sharp boundaries. With True Stack turned "OFF", you create a reconstruction with data overlap (10%) Recon Favorites General Recon Recon&GO | Image Impression Recon Box Physio Recon ( Scan/Recon Recon Type Recon Phase(s) necon Phase True Stack Temporal Resolution [ms] CTA Coronary 0.80 Bv40 A3 BestDiast BestPhase (diastolic) 75 % On 150 Computed Tomography 7 Restricted @ Siemens Healthineers, 2020 Notes 86 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows CT Cardiac - BiSegment Temporal Resolution SIEMENS. Healthineers ... To improve the temporal resolution, you can acquire and reconstruct a retrospective cardiac spiral and perform a BiSegment reconstruction. A BiSegment scan mode must be used to acquire the data, otherwise, the temporal resolution is fixed (e.g. 150ms for X.cite; 165ms for go.All/Top) BiSegment spiral is recommended for increased heart rates. A high temporal resolution is not guaranteed. In the case of a dedicated BiSegment spiral scan mode, the Temporal Resolution [ms] is a dropdown menu. This can be changed to e.g. 75ms* instead of the standard 150ms! Recon Favorites General Recon Recon&GO | Image Impression Recon Box Physio Recon Scan/Recon Recon Type Recon Phase(s) Recon Phase Unit True Stack Temporal Resolution [ms] CTA Coronary 0.80 Bv40 A3 BestDiast BestPhase (diastolic) 75 Off 150 75 150 *Available Temporal Resolution, including BiSegment, is scanner dependent Computed Tomography 79 Restricted @ Siemens Healthineers, 2020 CT Cardiac SIEMENS . Healthineers ... Reconstructions Computed Tomography 8 Restricted @ Siemens Healthineers, 2020 Notes 87 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows CT Cardiac - Calcium Scoring Recon&GO Inline Results SIEMENS Healthineers ... Inline results > Application > CT CaScoring Calcium Scoring Inline results > Reference Database > select desired database Image with Comment 2 showing Agatson Score Both BestDiast and BestSyst phase series are saved auto Recon Favorites | General Recon Recon&GO | Image Impression Recon Box Scan/Recon Inline Results Reference Database Calcium Scoring 3.00 Sa3 ... CT CaScoring Raggi, Circulation, 2000 (USA, 9730 patients) HNR, Schmermund, Atheroscl, 2006 (Germany, 4275 patients) Hoff, Am J Cardiol, 2001 (USA, 35246 patients) Raggi, Circulation, 2000 (USA, 9730 patients) 60 65 68 65 65 55 MESA, McClelland, Circulation, 2006 (USA, 6110 patients) 68 Rumberger, Mayo Clin Proc, 1999 (USA, 1898 patients) Computed Tomography Restricted @ Siemens Healthineers, 2020 CT Cardiac - Calcium Scoring Recon&GO Inline Results SIEMENS. Healthineers ... BestDiast and BestSyst phase Image with "Comment 2" showing series are saved by default automatic Agatston Score Series BOMATOM X CHE Series Number A Series Description Modality # Instances in ... | Series Archiv 1 Topogram 0.60 Tr20 cor 2 Calcium Scoring 3.00 Sa36 BestDiast 70% 4 CT CaScoring Scored Volume [2] CT CaScoring Results [2] 6 Calcium Scoring 3.00 Sa36 BestSyst 300ms 7 CT CaScoring Scored Volume [6] CT CaScoring Results [6] Instances Author | Department 8 Restricted @ Siemens Healthineers, 2020 Notes 88 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows CT Cardiac - Long/short Axis and Four Chamber View SIEMENS Healthineers Prerequisites: Inline Results = Parallel Ranges , Organ =Heart The three planes are combined in one reconstruction job! This can be combined with Multi Recons. Recon Favorites General Recon Recon&GO Image Impression Recon Bo Physio Recon Auto Tasking Inline Options Scan/Recon Inline Results Organ Multi Recons age Type Image Orientation Kernel Slice Thickness [mm] Increment [mm] Window@120kV CTA Coronary 3.00 Bv40 A3 BestDiast four chamber Heart Four Chamber CTA Coronary 3.00 Bv40 A3 BestDiast long axis Parallel Ranges Heart Orientation Multi Recons (3) MPR Heart Long Axis By40 3.00 3.00 Soft Tissue CTA Coronary 3.00 Bv40 A3 BestDiast short axis Heart Short Axis Computed Tomography 83 Restricted @ Siemens Healthineers, 2020 CT Cardiac - Long/short Axis and Four Chamber View SIEMENS .... Healthineers .: CURRENT CURRENT CURRENT 4/30/2020 8:31-10 AR PM 11 IMA. 33 SP F703.0 IF THINGPARALLEL 1500 50 MIF THINGPARALLEL 1.500 tie Resuk, 60tpm, 70% D. 150ms Automatic Result. 60bpm, 70% D. 150ms Automatio Resuk, 60bpm. 70 % D . 150rms Notes 89 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows CT Cardiac - Heart and Coronary Tree Isolation SIEMENS Healthineers ... Prerequisites: contrast enhanced examination (no Calcium Scoring) Inline Results: Radial Ranges + Organ >> Heart or Coronary Tree > Image Type MIP or VRT Recon Favorites | General Recon Recon&GO | Image Impression Recon Box Physio Recon Auto Tasking Inline Options Scan/Recon nline Results Organ Images.een VRT Preset love Bones Viewing Direction High Resolution RCA CTA Coronary Bv40 A3 BestDiast sag Radial Radial Ranges No Organ Vascular General On Left to Right Off No Organ Thorax Cardiac Heart Coronary Tree + Pelvis Computed Tomography 85 Restricted @ Siemens Healthineers, 2020 CT Cardiac - Heart and Coronary Tree Isolation SIEMENS Healthineers CURRENT Heart Coronary CURRENT 7:41:02.32 PM 7:41:02.32 PM Tree 5cm A] LA SL SL Manip VRT Manip VRT 60bpm, 70% D. 150ms 60bpm. 70% D. 150ms Notes 90 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows CT Cardiac - PACS Ready Coronary Vascular Ranges SIEMENS Healthineers ... Prerequisites: Inline Results = Radial Vascular Ranges or Parallel Vascular Ranges Inline Options: choose vessel from "Vessel" dropdown menu. Each coronary vessel represents one sperate reconstruction job None Recon Favorites | General Recon | Recon&GO Image Impression Recon Box Physio Recon Auto Tasking Inline Options Parallel Ranges Parallel Ranges can/Recor line Results CPR Type Vessel Vesse abel Angle Between Images [%] High Resolution Parallel Vascular Ranger Parallel Rib Ranges Spine Ranges RCA CTA Coronary 3.00 Bv40 A3 BestDiast Rad. Radial Vascular Ranges Curved RCA (Auto) Off Radial Ranges Radial Ranges Radial Vascular Ranges Physio Recon Auto Tasking Inline Options Radial Rib Ranges Recon Favorites General Recon Recon&GO nage Impression Recon Box RCA Scan/Recon Inline Results CPR Type Vessel Label Angle Between Resolution images ["] Aorta A. Carotis L Int RCA CTA Coronary 3.00 Bv40 A3 BestDiast Rad Radial Vascular Ranges Curved LAD (Auto) Off A. Carotis R int Runoff L Runoff R Recon Favorites | General Recon Recon&GO Image Impression | Recon Box Physio Recon Auto Tasking Inline Options RCA LAD Scan/Recon Inline Results CPR Type Vessel Vessel Angle Between Images [*] Resolution CX RCA CTA Coronary 3.00 Bv40 A3 BestDiast Ra Radial Vascular Ranges Curved CX (Auto) Off Computed Tomography 87 Restricted @ Siemens Healthineers, 2020 CT Cardiac - Radial Vascular Ranges SIEMENS . Healthineers .. RCA LAD Cx CURRENT Automatic Rezult, 606pm, 70% D. 150mg Automatic Result, 600 pm, 70% D, 150mg Automatic Result, 600pm, 70 % D. 150mg Notes 91 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows CT Cardiac - Parallel Vascular Ranges SIEMENS . Healthineers .. RCA LAD CX CURREN CURRENT CURRENT 3 IMA 19 5 IMA 26 7 IMA 17 SL 400 40 Do not measure on left side of the image! Do not measure on lett side of the image! Automatic Result, 60bpm, 703 D. 150ms Do not measure on left side of the image! Automatio Result.60bpm, 70 3 D, 150ms Automatio Result, Bibpm, 70% D. 150ms CT Cardiac - Coronary CTA Function Multi phase Recons SIEMENS .. Healthineers' ** Multi Phase recons are for the evaluation of ventricular ejection fraction. In the Physio Recon tab, choose Recon Type Multi Phase, > Recon Phase Unit - % or ms Phase Unit Recon Phase Step - 5%, 10%, 20% or 50ms, 100ms, 200ms % There are no negative values in the selection available, only positive based on a valid maximum of the slowest R-R cycle. ms After the scan the system checks the measured R-R intervals and Recon Phase Sten Recon Phase evaluates the maxima. Based on this the useful Multi Phase recon values Step Step will be set automatically (Recon Phase Step). 10 Y 50 50 10 100 20 200 % ms Computed Tomography 90 Restricted @ Siemens Healthineers, 2020 Notes 92 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows CT Cardiac - Coronary CTA Function Multiphase Recons SIEMENS Healthineers ... Recon Favorites General Recon Recon&GO Image Impression Recon Box Physio Recon CTA Coronary Scan/Recon Recon Typ Recon Phase Step Recon Phase(s) Recon Phase True Stack Resolution [ms] CTA Coronary 0.80 Bv4 .. Multi Pha 0%; 5%; 10%; 15%; 20%; 25%; 30%; 35%; 40%; 45 ... Off 150 60 60 60 5% 60 60 60 60 60 60 60 60 10% 60 50 60 60 60 60 60 60 60 60 20% Computed Tomography 91 Restricted @ Siemens Healthineers, 2020 CT Cardiac SIEMENS ... Healthineers .. ECG Editing Computed Tomography 92 Restricted @ Siemens Healthineers, 2020 Notes 93 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows CT Cardiac - ECG Editing SIEMENS Healthineers ... For additional reconstruction of 60 60 60 Cardiac CT spiral scans, you can 60 move, delete, insert, and disable syncs on the offline ECG trace. 60 bpm Min: 60 Max: 60 The syncs are indicated by dots that are located above the R-peaks. A sync dot is a visual Move Delete Insert Disable Reset representation of a detected 60 60 60 60 60 60 R-peak. The temporal resolution is fixed for Cardiac spiral ranges. Therefore, you cannot edit the Temporal Resolution parameter. -. Computed Tomography 93 Restricted @ Siemens Healthineers, 2020 CT Cardiac - ECG Editing SIEMENS. Healthineers Button Action Insert Disable Move If enabled, click and drag a sync dot to move it to a 60 60 60 new position. Example: You can reposition a sync in case the sys- tem has misinterpreted a high P-wave as an R-peak. Delete If enabled, click a sync dot to delete it. Insert If enabled, click into the upper ECG trace area to Move Delete Disable insert a new sync dot. 50 30 60 The corresponding scan window will be considered for image reconstruction. Disable If enabled, click into a heart cycle to disable it. The corresponding scan window will not be consid- ered for image reconstruction. Example: You can disable a sync to skip extra sys- Move Delete Insert Disab Reset toles. 60 60 60 60 Reset Reverts your settings in the modified ECG signal and displays the original ECG signal. Computed Tomography Restricted @ Siemens Healthineers, 2020 Notes 94 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows SIEMENS .... Healthineers .. PART 5 : Cardiac Anatomy Cardiac Anatomy SIEMENS Healthineers ... . Anatomy of the heart - overview Blood flow through the heart ECG Basics Heart Valves Coronary circulation Axial CT Images Computed Tomography 96 Restricted @ Siemens Healthineers, 2020 Notes 95 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows Cardiac Anatomy - Anatomy of the Heart SIEMENS Healthineers ... The heart is comprised of 4 chambers: > Two upper chambers called Atria 1. RA - right atrium LA 2. LA - left atrium RA > Two lower chambers called ventricle 1. RV - right ventricle RV 2. LV - left ventricle The wall of muscle that separates the heart into right and left is called the septum RA = right atrium LA = left atrium RV = right ventricle LV = left ventricle @2009 WebMD, LLC. Copyright@ 2009 WebMD, LLC Computed Tomography Restricted @ Siemens Healthineers, 2020 97 Cardiac Anatomy SIEMENS .. Healthineers ... Anatomy of the heart - overview . Blood flow through the heart ECG Basics Heart Valves Coronary circulation Axial CT Images Computed Tomography 98 Restricted @ Siemens Healthineers, 2020 Notes 96 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows Cardiac Anatomy - Blood Flow through the Heart SIEMENS Healthineers' ... Right atrium receives deoxygenated blood from SVC Superior (superior vena cava) and the IVC (inferior vena cava) Vena Cava Aorta Right atrium contracts sending blood into right ventricle through the tricuspid valve Pulmonary Vein Right ventricle contracts sending blood into pulmonary Left Atrium Mitral artery Valve Right Atrium Newly oxygenated blood enters left atrium through Aortic Valve pulmonary vein Tricuspid Pulmonary Valve Valve Ventricle Left atrium contracts pushing blood through bicuspid Right Ventricle valve into left ventricle Left ventricle contracts pushing blood into aorta nferior Vena Cava Computed Tomography 99 http://masteringanatomyandphysiologysite.blogspot .com/2013/07/ what-you-should-know-about-anat -and .html Restricted @ Siemens Healthineers, 2020 Cardiac Anatomy - Blood Flow through the Heart SIEMENS . Healthineers .. The aorta is the largest artery. It carries oxygen-rich Oxygen-poor blood from the blood from the heart to the rest of the body. upper parts of the body The chamber of the left returns to the heart through atrium collects oxygen-rich the superior vena cava. blood returning from the lungs Superior and then forces it through the Vena Cava mitral valve and into The pulmonary arteries carry the left ventricle. blood from the heart to the lungs to pick up oxygen. The pulmonary veins carry oxygen-rich blood from the lungs back to the heart. The chamber of the right atrium collects oxygen-poor Right blood returning from the body The left ventricle is the largest and then forces it through the and strongest chamber in the tricuspid valve and into Valve heart. The left ventricle's the right ventricle. walls are only about a half-inch thick, but they Right have enough force to push Oxygen-poor blood from blood through the aortic valve the lower parts of the body and into your body. returns to the heart through the inferior vena A wall of muscle called the cava. The chamber of the right septum separates the left ventricle collects oxygen-poor and right atria and the left blood from the right atrium and right ventricles. and then forces it through the pulmonary valve and into the lungs. Computed Tomography 100 http://masteringanatomyandphysiologysite.blogspot.com/2013/07/what-you-should-know-about-anatomy-and.html Restricted @ Siemens Healthineers, 2020 Notes 97 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows Cardiac Anatomy - Anterior and Posterior Heart Anatomy SIEMENS Healthineers ... Brachiocephalic trunk - Left common carotid artery Superior vena cava Left subclavian artery Right pulmonary Aortic arch artery Ligamentum arteriosum Left pulmonary artery Ascending aorta Pulmonary trunk - Left pulmonary veins Right pulmonary Anterior view Auricle of left atrium veins Right atrium Circumflex artery Right coronary artery - Left coronary artery Anterior cardiac vein - Right ventricle Left ventricle Right marginal artery - Great cardiac vein Small cardiac vein Anterior interventricular artery Inferior vena cava Apex Aorta - Superior vena cava Left pulmonary artery- Right pulmonary artery Left pulmonary veins Right pulmonary veins Auricle of left atrium Right atrium Left atrium Inferior vena cava Posterior view Circumflex branch Coronary sinus of left coronary artery Small cardiac vein Great cardiac vein Right coronary artery Posterior vein of left ventricle Posterior interventricular artery Left ventricle Middle cardiac vein Right ventricle Apox Computed Tomography 101 https://www.anatomynote.com/human-anatomy/heart/external-anatomy-of-heart-anterior-view-and-posterior-view/ Restricted C Siemens Healthineers, 2020 Cardiac Anatomy SIEMENS . Healthineers Anatomy of the heart - overview Blood flow through the heart . ECG Basics Heart Valves Coronary circulation Axial CT Images Computed Tomography 102 Restricted @ Siemens Healthineers, 2020 Notes 98 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows Cardiac Anatomy - ECG Basics SIEMENS. Healthineers ... The heart contracts when pumping blood R and rests when receiving blood. This activity and lack of activity from a cardiac cycle can P IT be illustrated by an Electrocardiogra U Chambers undergo alternating periods of O S relaxation and contraction: > Diastole = relaxation Ventricular contraction Ventricular Systolic phase Relaxation > Systole = contraction Atrial contraction Diastolic phase P: wave contraction of the atria Q,R,S: waves due to contraction of ventricles T: wave recovery of the ventricles Copyright@ Siemens AG 2012 . All Rights Reserved Computed Tomography 103 Restricted @ Siemens Healthineers, 2020 Cardiac Anatomy SIEMENS . Healthineers .. Anatomy of the heart - overview Blood flow through the heart ECG Basics . Heart Valves Coronary circulation Axial CT Images Computed Tomography 104 Restricted @ Siemens Healthineers, 2020 Notes 99 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows Cardiac Anatomy - Heart Valves SIEMENS. Healthineers ... Heart Valves act as gates allowing blood to pass between chambers or from chamber to associated blood vessel. There are 4 Heart Valves: Tricuspid, Pulmonary, Bicuspid (Mitral), and Aortic The tricuspid valve regulates The mitral valve lets oxygen-rich Diastole Systole blood flow between the RA and blood from your lungs pass from RV the LA into the LV The pulmonary valve controls Mitral The aortic valve opens the way for blood flow from the RV into the valve C Aortic oxygen-rich blood to pass from the valve pulmonary arteries, which carry Pulmonary LV into the aorta, your body's valve blood to your lungs to pick up largest artery, where it is delivered oxygen. to the rest of your body Texas Heart . org Computed Tomography 105 Restricted @ Siemens Healthineers, 2020 Cardiac Anatomy SIEMENS Healthineers Anatomy of the heart - overview Blood flow through the heart ECG Basics Heart Valves . Coronary circulation Axial CT images Computed Tomography 106 Restricted @ Siemens Healthineers, 2020 Notes 100 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows Cardiac Anatomy - Coronary Circulation SIEMENS ..... Healthineers * Heart muscle, like every other organ or tissue, needs oxygen-rich blood to survive. Blood is supplied to heart by its own vascular system, called coronary circulation. The Aorta branches off into two main coronary arteries: Aorta Left 1. Right Coronary Artery (RCA) - supplies blood Main mainly to the right side of the heart Artery Right Circumflex Coronary Artery 2. Left Main Coronary Artery (LM) - branches into Artery Left Anterior Descending (LAD) Artery and the Left Anterior Circumflex (CX) Artery; which mainly supplies Descending blood to the left side of the heart Copyright 2005 Lippincott, Williams & Wilkins Computed Tomography 107 Restricted @ Siemens Healthineers, 2020 Cardiac Anatomy SIEMENS Healthineers Anatomy of the heart - overview Blood flow through the heart ECG Basics Heart Valves Coronary circulation .Axial CT Images Computed Tomography 108 Restricted @ Siemens Healthineers, 2020 Notes 101 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows Cardiac Anatomy - Axial CT Image SIEMENS .. Healthineers ... Ascending Rt Ventricle Aorta Left Anterior Rt Atrium Descending SVC Lt Atrium Rt Superior Lt Superior Pulmonary Vein Pulmonary Vein Thoracic Aorta Courtesy Massachusetts General Hospital, U.S.A. Computed Tomography 109 Restricted @ Siemens Healthineers, 2020 Cardiac Anatomy - Axial CT Image SIEMENS. Healthineers .... Rt Coronary Rt Ventricle Left Anterior Artery Descending Rt Atrium Lt Ventricle Ascending Circumflex Aorta Lt Atrium Courtesy Massachusetts General Hospital, U.S.A. Computed Tomography 110 Restricted @ Siemens Healthineers, 2020 Notes 102 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows Cardiac Anatomy - Axial CT Image SIEMENS. Healthineers ... RCA LAD LEFT MAIN Courtesy Massachusetts General Hospital, U.S.A. Computed Tomography 111 Restricted @ Siemens Healthineers, 2020 Cardiac Anatomy - Axial CT Image SIEMENS .. Healthineers ... LAD RCA LEFT MAIN Courtesy Massachusetts General Hospital, U.S.A. Computed Tomography Restricted @ Siemens Healthineers, 2020 Notes 103 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows Cardiac Anatomy - Axial CT Image SIEMENS Healthineers'. RCA LAD LEFT MAIN CIRCUMFLEX Courtesy Massachusetts General Hospital, U.S.A. Computed Tomography 113 Restricted @ Siemens Healthineers, 2020 Cardiac Anatomy - Axial CT Image SIEMENS .: Healthineers ... Courtesy Massachusetts General Hospital, U.S.A Computed Tomography 114 Restricted @ Siemens Healthineers, 2020 Notes 104 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows Cardiac Anatomy - Axial CT Image SIEMENS . Healthineers ... Courtesy Massachusetts General Hospital, U.S.A. Computed Tomography 115 Restricted @ Siemens Healthineers, 2020 Cardiac Anatomy - 90 Degree Oriented Cardiac Planes SIEMENS . Healthineers ... Orthogonal Anatomical Planes Echocardiogramhic Imaging Planes of the Human Body of the Human Heart Coronal or Frontal Plane Sagittal Me pam Mid- right clavicl LV apex ong-Axis (LAX) Cardiac (LV) ong -Axis Cardiac (LV) Short-Axis Cardiac 1. SAX - Short Axis Short-Axis (SAX) Cardiac 2. LAX - Long Axis Four-Chamber (4C) long-axis 3. 4C - Four Chamber View Sagittal (Median) or Long-Axis Planes 4x15 https://www.sciencedirect.com/topics/medicine-and-dentistry/color-doppler-echocardiogramhy Computed Tomography 116 Restricted @ Siemens Healthineers, 2020 Notes 105 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows Cardiac Anatomy - Cardiac Planes SIEMENS . Healthineers Courtesy Massachusetts General Hospital, U.S.A. Computed Tomography 117 Restricted @ Siemens Healthineers, 2020 Cardiac Anatomy - Typical Angiographic views of LCA/RCA SIEMENS. Healthineers ... LCA LCA RCA RCA Courtesy Massachusetts General Hospital, U.S.A. Computed Tomography 118 Restricted @ Siemens Healthineers, 2020 Notes 106 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows Cardiac Anatomy - Typical Angiographic Views SIEMENS ..... Healthineers **** Courtesy Massachusetts General Hospital, U.S.A. Computed Tomography 119 Restricted O Siemens Healthineers, 2020 SIEMENS .. : Healthineers ... Thank You! Training Center Americas CT Application Notes 107 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows 3. CT Neuro Perfusion SIEMENS Healthineers ... SOMATOM go.All/Top and SOMATOM X.cite CT Neuro Perfusion (Optional) .... HOOD05162003094225 Effective 06/22/2020 Restricted O Siemens Healthineers, 2020 DISCLAIMER SIEMENS . Healthineers Please note that the learning material is for training purposes only! All patient data visible are randomized generated by a Simulation SW. There is no relation to real patients available. For the proper use of the software or hardware, please always use the Operator Manual issued by Siemens. 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. Functionalities described in the material or parts of this functionality may not yet be released for customers and not yet be commercially available in every country. Due to regulatory requirements, the future availability of said functionalities or parts thereof in any specific country is not guaranteed. The Operator's Manual shall be used as your main reference, in particular for relevant safety information like warnings and cautions. 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 rights, including rights created by patent grant or registration of a utility model or design, are reserved. Computed Tomography 2 Restricted @ Siemens Healthineers, 2020 Notes 108 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows Scanners SIEMENS . Healthineers ... SOMATOM SOMATOM SOMATOM go.All go. Top X.cite Brain Perfusion (Sequential) Body Perfusion (Sequential) Flex 4D Spiral (Dynamic) Computed Tomography 3 Restricted @ Siemens H Siemens Healthineers, 2020 Scanners SIEMENS Healthineers' .... SOMATOM SOMATOM SOMATOM go.Al go. Top X.cite SOMATOM go.A go. Top x.cite Sequential Perfusion Available with detector width* Brain Perfusion 8.47 cm 8.49 cm 9.79 cm Body Perfusion 11.74 cm 18.49 cm 19.58 cm DynAngio head/neck 26.64 cm 28.54 cm DynAngio body 43.78 cm *selectable via the Scan Mode (maybe activate accessible Scan Mode first via the Exam Designer) Computed Tomography 4 Restricted @ Siemens Healthineers, 2020 Notes 109 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows CT Neuro Perfusion SIEMENS ..... Healthineers ... . What is Perfusion? What is a Stroke? Perfusion Protocol Dose Considerations with Perfusion CT Post Processing Computed Tomography Restricted @ Siemens Healthineers, 2020 CT Neuro Perfusion SIEMENS . Healthineers ... Perfusion is the passage of blood through the Blood flow Capillary Microcirculation circulatory system to the capillary bed of an organ or a tissue. Interstitial fluid Hydrostatic pressure Osmotic pressure Capillary - Venous end Image Retrieved from: https://training.seer.cancer.gov/anatomy/cardiovascular/blood/physiology.html Computed Tomography 6 Restricted @ Siemens Healthineers, 2020 Notes 110 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows Clinical Situations SIEMENS Healthineers Non - Enhanced CT is performed 1 Bleeding is detected Cath LAB or therapy Computed Tomography Restricted @ Siemens Healthineers, 2020 Clinical Situations SIEMENS . Healthineers ... Non - Enhanced CT is performed 2 No Hemorrhage is detected Cerebral Blood Flow and Cerebral Blood Volume are the most important keys Computed Tomography Restricted @ Siemens Healthineers, 2020 Notes 111 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows Clinical Situations SIEMENS Healthineers' ... Case 1 Cerebral Blood Flow VERY LOW Non - Viable Cerebral Blood Volume VERY LOW Tissue Case 2 Cerebral Blood Flow VERY LOW Cerebral Blood Volume NORMAL Tissue at risk Computed Tomography 9 Restricted @ Siemens Healthineers, 2020 CT Neuro Perfusion SIEMENS .... Healthineers .. What is Perfusion? . What is a Stroke? Perfusion Protocol Dose Considerations with Perfusion CT Post Processing Computed Tomography 10 Restricted @ Siemens Healthineers, 2020 Notes 112 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows CT Neuro Perfusion SIEMENS Healthineers .... Cerebral Infarction, Cerebrovascular Accident (CVA), brain attack Area of brain affected by stroke A stroke is an interruption of the blood CAS supply to any part of the brain resulting in damage to the brain tissue Carotid artery Blood clot Image Retrieved from: https://www.medicalimages.com/stock-photo-image-image9928705.html Computed Tomography 11 Restricted @ Siemens Healthineers, 2020 CT Neuro Perfusion - Clinical Impact SIEMENS Healthineers Stroke is the 5th leading cause of death in the U.S. in 2017* Stroke is the leading cause of severe, long-term disability Approximately 795,000 people suffer a stroke each year in the U.S. ** More than 140,000 die each year in the U.S. ** Someone in the U.S. has a stroke approximately every 45 seconds *Centers for Disease Control. (2017). FastStats - Leading Causes of Death. Retrieved from https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm ** The Internet Stroke Center (n.d.). Stroke statistics: U.S. statistics. Retrieved from http://www.strokecenter.org/patients/about-stroke/stroke-statistics Computed Tomography 12 Restricted @ Siemens Healthineers, 2020 Notes 113 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows CT Neuro Perfusion - Types of Strokes? SIEMENS .... Healthineers ... There are two types of strokes: 1. Ischemic Stroke - accounts for approximately ~80% and can be potentially treated with thrombolytic medication 2. Hemorrhagic Stroke - accounts for approximately ~20% and can reliably be seen with standard non-contrast CT (primary imaging modality) Truelsen, T ., Begg, S ., & Mathers, C. (2000). The global burden of cerebrovascular disease. Retrieved from World Health Computed Tomography Organization website: http://www.who.int/healthinfo/statistics/bod_cerebrovasculardiseasestroke.pdf Restricted @ Siemens Healthineers, 2020 y 13 CT Neuro Perfusion - Ischemic Stroke SIEMENS . Healthineers Ischemic Stroke Ischemic Stroke Thrombosis - caused by a blockage of blood Ischemic stroke is a life-threatening event Embolism - a blood clot that has migrated and now in which part of the brain does not receive occludes a vessel in the brain or neck enough oxygen, usually due to a Stenosis - constriction or narrowing of an artery in the blood clot lodged in a cerebral artery. brain or neck Blood clot Ischemic Stroke Therapy Early medical intervention with tPA (tissue plasminogen activator - e.g. Activase®) dissolves clots; however, this treatment must be selective and is not for everyone! Additionally, the drug must be administered within a Carotid artery disease specified amount of time to improve recovery chances* Wikimedia Commons. (2017). Stroke.png [Illustration]. Retrieved from https://commons.wikimedia.org/wiki/File:Blausen 0836 Stroke.png eart Association, Inc. (2017). Ischemic stroke treatment: tPA, the Gold Standard. Retrieved from American Heart Association, InCROKE http://www.strokeassociation.org/STROKEORG/AboutStroke/Treatment/Stroke-Treatments_UCM_310892_Article.jsp#.Wlu6VVMrKCg Computed Tomography 1 Restricted @ Siemens Healthineers, 2020 Notes 114 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows CT Neuro Perfusion - Hemorrhagic Stroke SIEMENS Healthineers ... Hemorrhagic stroke Hemorrhagic Stroke Bleeding - caused by bleeding of a blood vessel(s) into the surrounding brain tissue Hemorrhagic Stroke Therapy Non-contrast CT scan only Blood clotting medication Bleeding occurs inside or around brain tissue Computed Tomography 15 Alamy Stock Photos. (2017). [Illustration]. Retrieved from http://www.alamy.com/stock-photo-hemorrhagic-vs-ischemic-stroke-7710779.html Restricted C Siemens Healthineers, 2020 CT Neuro Perfusion - Diagnosis SIEMENS Healthineers CT as the primary modality in stroke diagnosis should answer 3 questions: 1. Is there a stroke (ischemic or hemorrhagic), or some other underlying non-ischemic disease? 2. What is the extent of the currently infarcted brain (core), and is there associated brain tissue at risk of irreversible ischemic damage (i.e. Tissue at Risk - TAR)? 3. Are any vessels occluded? And if yes, which vessels? Computed Tomography 16 Restricted @ Siemens Healthineers, 2020 Notes 115 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows CT Neuro Perfusion SIEMENS. Healthineers What is Perfusion? What is a Stroke? · Perfusion Protocol Dose Considerations with Perfusion CT Post Processing Computed Tomography 17 Restricted @ Siemens Healthineers, 2020 CT Neuro Perfusion - Perfusion Protocol SIEMENS. Healthineers Why CT Brain Perfusion? Early signs in the first two hours after infarct are not always clearly visible; however, CT Neuro Perfusion provides clear diagnostic information Advantage: precise treatment decisions like tPA medication In severely hypo-perfused regions of the brain, reperfusion might cause severe damage by inducing hemorrhagic complications Advantage: clear triage of patients Possible extension of therapeutic window for tPA treatment if the whole amount of "tissue at risk" is defined Advantage: leads to a selective and more individual treatment plan for each patient Computed Tomography 18 Restricted @ Siemens Healthineers, 2020 Notes 116 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows CT Neuro Perfusion - Stroke Protocol SIEMENS Healthineers Non-contrasted/non-enhanced Head CT- primary imaging modality . Proven excellence in demonstrating or ruling out hemorrhagic stroke Absence of major early CT signs is the accepted standard criterion for systemic thrombolysis CT is readily available and provides immediate results Patient positioning: Placement of 18 g needle in a cubital vein; Power injector with 150 ml contrast material Perfusion CT- shows hemodynamic status Non enhanced CT Type and extent of ischemic process End of Exames Hemorrhage› Quality of collateral flow Y No CT Perfusion (CTP) CTP Evaluation CT Angiography (CTA) CT Angiography- provides information about vascular pathology CTA Reconstruction Shows/confirms occlusion type and location CTA Visualization Initial Evaluation for Decision Making ¥12 Improves planning of potential interventions. Further Evaluation (Film) Documentation Computed Tomography 19 Restricted @ Siemens Healthineers, 2020 SOMATOM go.All/Top and X.cite SIEMENS ..... Healthineers .. SEQUENTIAL PERFUSION (PCT) Protocol: Brain Perfusion [factory] -Indications: stroke, hemorrhage, ischemia, Topogram malperfusion, aneurysm, w and wo CM Static perfusion that depends on the -Possible application: CT Neuro Perfusion Non Contrast Brain -Scan modes: RoutineSpiralAdultHead, DynamicSpiralAdultHead, Perfusion Brain detector width PremonitoringSequenceAdult2d, MonitoringSequenceAdult2d, Premonitoring RoutineSpiralAdultAngioHead Monitoring CTA Brain and Neck BRAIN/BODY PERFUSION WITH FLEX 4D SPIRAL* Protocol: Brain Perfusion Prolonged [factory] High quality perfusion mode -Indications: stroke, hemorrhage, ischemia, Topogram malperfusion, aneurysm, w and wo CM -Possible application: CT Neuro Perfusion Non Contrast Brain Max pitch 0.5 for brain perfusion / Cycle -Scan modes: RoutineSpiralAdultHead, DynamicSpiralAdultHead, Perfusion Brain PremonitoringSequenceAdult2d, Time 1.00 - 1.57 MonitoringSequenceAdult2d, Premonitoring RoutineSpiralAdultAngioHead Monitoring Max pitch 0.5. or 1.0 for body perfusion / CTA Brain and Neck Cycle Time 1.40 - 1.80 Protocol: Liver Perfusion [factory] -Indications: hemorrhage, ischemia, malperfusion, Topogram aneurysm, w and wo CM -Scan modes: RoutineSpiralAdultAbdomen, Non Contrast Liver DynamicSpiralAdultBody BRAIN PERFUSION PROLONGED Perfusion Liver Extended scan time to 60s for RAPID users / Cycle Time 1.00 - 1.57 Max. scan time: 120s *Prerequisite for Flex 4D Spiral: Vario2 table Computed Tomography 20 Restricted @ Siemens Healthineers, 2020 Notes 117 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows SOMATOM go. Top and X.cite SIEMENS ... Healthineers ... DYNAMIC ANGIO HEAD/NECK WITH FLEX 4D SPIRAL* Higher range but lower image quality Pitch 1.0 or 1.5 Protocol: Brain Dynamic CTA [factory] -Indications: stenosis, aneurysm, occlusion, plaques, abnormalities of the vertebral arteries, Topogram COW, w CM Premonitoring -Scan modes: PremonitoringSequenceAdult2d, MonitoringSequenceAdult2d, Monitoring DynamicSpiralAdultHeadAngio Dynamic CTA Brain Max. scan time: 120s *Prerequisite for Flex 4D Spiral: Vario2 table Computed Tomography 21 Restricted O Siemens Healthineers, 2020 SOMATOM X.cite SIEMENS Healthineers DYNAMIC ANGIO BODY WITH FLEX 4D SPIRAL* Protocol : Thorax Dynamic CTA [factory] Higher range but lower image quality -Indications: vascular anomalies, aneurysms, Topogram dissection, ruptures of the thoracic aorta, w CM Pitch 1.0 or 1.5 -Scan modes: PremonitoringSequenceAdult2d, Premonitoring MonitoringSequenceAdult2d, DynamicSpiralAdultBodyAngio Monitoring Dynamic CTA Thorax DYNAMIC CTA EXTREMITY Protocol: Extremity Dynamic CTA [factory] -Indications: stenosis, occlusion, plaques, Topogram Higher range but lower image quality abnormalities, ruptures of the femoral arteries, w CM Premonitoring -Scan modes: PremonitoringSequenceAdult2d, MonitoringSequenceAdult2d, Monitoring · Pitch 1 or 1.5 / Cycle Time 2.0 - 3.0 DynamicSpiralAdultBodyAngio Dynamic CTA Extremity Max. scan time: 120s *Prerequisite for Flex 4D Spiral: Vario2 table Computed Tomography 22 Restricted @ Siemens Healthineers, 2020 Notes 118 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows Perfusion - Flex 4D Spiral SIEMENS. Healthineers ... The length of the scan range is freely selectable (between the min and the max value) Cycle Time depends on scan range Number of swipes depends on Cycle Time and Exam time Number of swipes can only be changed by adjusting Exam time Pitch is fixed in Brain / selectable in Body Exposure Pattern can be adjusted Scan Favorites General Scan Dose Timing Config Physio Scan Contrast Scan/Recon Pitch Cycle Time [s] Exposure Pattern [s] Eff AS CTDIvol [mGy] DLP [mGy*cm] 3.47 (+0.00) Perfusion Brain 0.50 1.52 47.14 4.99 (+1.52) 36 (16 cm) 38.26 456.8 6.52 (+3.05) 8.04 (+4.57) 9.57 (+6.10) 11.09 (+7.62) 12.61 (+9.15) 14.14 (+10.67) 15.66 (+12.20) 17.19 (+13.72) ¥ 18.71 (+15.24) 2.5s 20.24 (+16.77) 21.76 (+18.29) 23.28 (+19.82) 24.81 (+21.34) 3.47 (+0.00), 4.99 (+1.52), 6 Computed Tomography 23 Restricted C Siemens Healthineers, 2020 Perfusion - Number of swipes (cycles) SIEMENS Healthineers ... Number of swipes can only be changed by adjusting scan time Number of swipes depends on cycle time and scan time Cycle Time depends on scan length C Scan Favorites General Scan Dose Timing Config Scan Favorites General Scan Dose Scan/Recon Pitch Rot Exam Time Time [s] Cycle Scan/Recon Patient Instruction Absolute Start [s] Time [s] Pitch Time [s] [s] . Time Cycle Delay [s] Pattern [s] | Perfusion Brai 0.50 0.30 24.96 | Perfusion Brain 0.50 0.30 46.94 1.57 None 2.0 3.49 (+0,00) .... 46.9s 0 Computed Tomography 24 Restricted @ Siemens Healthineers, 2020 Notes 119 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows Perfusion - Cycle Pattern (1) SIEMENS Healthineers Cycle pattern can be adjusted in Timing Tab - Exposure Pattern _ 3.59 (+0.00) Cycles can be removed & re-added via the tick box v 5.59 (+2.00) 7.59 (+4.00) Dropdown displays: 9.59 (+6.00) > time since start of scan (first number (Delay + 1st cycle)) 11.59 (+8.00) v 13.59 (+10.00) > cumulative cycle time (second number in brackets) 15.59 (+12.00) v 17.59 (+14.00) v 19.59 (+16.00) 21.59 (+18.00) Scan Favorites | General Scan Dose Timing Config 23.59 (+20.00) Scan/Recon Pitch Rot. Time [s] Exam Time Cycle Absolute Start Exposure V [s] Time [s ] Patient Instruction Delay [s] 25.59 (+22.00) Pattern [s] 27.59 (+24.00) Dynamic CTA Extremity 41.19 None 2.0 3.59 (+0.00); .. 29.59 (+26.00) 1.00 0.30 31.59 (+28.00) Computed Tomography , 25 Restricted @ Siemens Healthineers, 2020 Perfusion - Cycle Pattern (2) SIEMENS . Healthineers ... 4.09 (+0.00) Favorites & General Scar Dose Timing Config v 7.09 (+3.00) Pitch Time [S] 15 Time ( s ) Patient Instruction Absolute Start Exposure Delay [s] Pattern [s] 10.09 (+6.00) 13.09 (+9.00) 1.50 0.30 40.19 None .09 (+0.00) 16.09 (+12.00) 19.09 (+15.00) 22.09 (+18.00) v 25.09 (+21.00) 28.09 (+24.00) 31.09 (+27.00) 4.09 (+0.00) 40.25 34.09 (+30.00) ¥ 7.09 (+3.00) 37.09 (+33.00) 10.09 (+6.00) is 20 is 40.09 (+36.00) 13.09 (+9.00) 16.09 (+12.00) 19.09 (+15.00) 22.09 (+18.00) 25.09 (+21.00) 28.09 (+24.00) 31.09 (+27.00) 2.75 40.2s 34.09 (+30.00) 37.09 (+33.00) 0 40.09 (+36.00) Computed Tomography 26 Restricted @ Siemens Healthineers, 2020 Notes 120 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows Perfusion - Cycle Time (1) SIEMENS Healthineers Cycle time is adjusted depending on Pitch and scan length System will adjust number of cycle to keep scan time about the same Focus is on the clinical outcome 8/16/2019. HES 11:03:19.15 AM 1 MA1 TP1-1.127.5 TOP 100 TP2 - 1,291.6 TP -750.0 LEN 164:1 R A Ci Scan Favorites General Scan Dose Scan/Recor Pitch Exam Time Cycle Time [s] Perfusion Liver 1.00 46.38 Computed Tomography Restricted C Siemens Healthineers, 2020 27 Perfusion - Cycle Time (2) SIEMENS ..... Healthineers *** The Cycle time depends on scan length (e.g.: Brain) / Pitch fixed in Brain ............................................................. .............................. Scan Favorites General Scan CH Scan Favorites & General Scan | Dose can/Recor Pitch Tim Cycle Time Scan/Recon Pitch am Time Cycle Time Perfusion Brain 0.50 45.37 Perfusion Brain 0 45.40 45.4s 2 15 20 25 30 35 40 45 Computed Tomography 28 Restricted @ Siemens Healthineers, 2020 Notes 121 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows Perfusion - Cycle Time (3) SIEMENS Healthineers .... The Cycle time depends on scan length AND Pitch (e.g.: Liver Perfusion) .:: ..... : .......... WV Sm100 TI 5,88 LA w 350 512 0/0 Tr201A 1. 0000A 1 AL CU1094 Scan Favorites General Scan Dose Timing Scan Favorites General Scan Dose Timing Scan/Recon Pitch Rot. Time [s] Exam Time [s] Cycle Time [s] Patient Scan/Recon Pitch Rot. Time [s] Exam Time [s] Cycle Time Patient Perfusion Live 030 Perfusion Live 1.00 0.30 The scan range reduces automatically when changing the Pitch! Caution: the scan range will change the position and will not keep for example the start position! Computed Tomography 29 Restricted @ Siemens Healthineers , 2020 Perfusion - Adjusting Pitch SIEMENS . Healthineers .. Max. Scan range depends on pitch Cycle time depends on the length of the scan Scan length "free" selectable (total length limited) LAT CH Scan Favorites General Scan Dose Scan Favorites General Scan Dose Scan/Recon Pitch Exam Time Cycle Time [s] [s] Pitch 1.00 Scan/Recon ch 13 Cyde Time Pitch 1.00 Perfusion Liver 46.37 Cycle time 1.80 Perfusion Liver Cycle time 1.55 Restricted Computed Tomography 30 d @ Siemens Healthineers, 2020 Notes 122 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows Perfusion - Recon Pattern SIEMENS Healthineers .... Number of recons depends on acquired swipes Recons can be switched off by unticking checkbox Clinical use e.g. recon thin slices for vascular analysis from single cycle Recon Favorites General Recon Recon&GO Image Impression Recon Box | Physio Recon Auto Tasking Scan/Recon Slice Thickness Increment No. of Reconstruction [mm] [mm] mage Order Images Comment 1 Comment 2 Pattern [s] Dynamic CTA Extremity 5.00 Bv36 4.095 - 4. 5.00 3.00 Head to Feet v 4.09 (+0.00) 7.09 (+3.00) 10.09 (+6.00) 13.09 (19.00) v 16.09 (+12.00) 19.09 (+15.00) 22.09 (+18.00) 25.09 (+21.00) TO 28.09 (+24.00) 2.7s 40.2s 31.09 (+27.00) 34.09 (+30.00) 45 20 25 V 37.09 (+33.00) 40.09 (+36.00) Computed Tomography 31 Restricted C Siemens Healthineers, 2020 CT Neuro Perfusion - Contrast Injection SIEMENS Healthineers Contrast Injection Parameters Time is the issue with perfusion injections, not flow rate Injection rate must roughly equal cerebral circulation time Begin contrast and scan simultaneously Acquire images for ~40 seconds 20 10 + 0 H 1 7 13 19 25 31 Computed Tomography 32 Restricted @ Siemens Healthineers, 2020 Notes 123 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows CT Neuro Perfusion - Contrast Injection SIEMENS .... Healthineers ... 20 - 10 + H 1 7 13 19 25 31 20 ₸ 10 + 7 13 25 31 Computed Tomography Restricted @ Siemens Healthineers, 2020 y 33 CT Neuro Perfusion - Perfusion Map Results SIEMENS ..... Healthineers CBF CBV TTP MTT Cerebral Blood Flow Cerebral Blood Volume Time to Peak Mean Transit Time (ml/100ml/min) (ml/100ml) (s) (s) Flow rate of volume Volume of flowing blood Time of local peak Time required for blood of blood through Scaled 1000:1, so a value Enhancement to pass through cerebral vasculature of 30 = 3% blood volume Scaled in 0.1s, so a value tissue of 182 = 18.2 seconds Notes 124 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows CT Neuro Perfusion - Contrast Injection SIEMENS Healthineers ... Normal brain: CBF > 50 ml/100g brain tissue/min Benign Oligemia: CBF 20-50ml/100g/min Penumbra/Tissue at Risk: (tissue can potentially be rescued) CBF 10-20ml/100g/min Infarct Core: (non-viable, dead brain tissue) CBF < 10ml/100g/min 10 ml/100g/min Infarct Core 20-50ml/ 100g/min Penumbra Benign Oligemia mL/100g/min Annals of Indian Academy of Neurology. (2017). Figure 6: A schematic representation of the Ischaemic Penumbra and the absolute cerebral blood flow values associated with the infarct core, penumbra and benign oligaemia [Illustration]. Retrieved from http://www.annalsofian.org/viewimage.asp?img=AnnIndianAcadNeurol_2008_11_5_12_41715_8.jpg Computed Tomography 35 Restricted @ Siemens Healthineers, 2020 CT Neuro Perfusion - Tissue at Risk SIEMENS ..... Healthineers CBF Images - Tissue at Risk = yellow; Non-viable Tissue = red Notes 125 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows CT Neuro Perfusion - Brain Tumors SIEMENS. Healthineers Brain Tumors: Second leading cause of cancer-related deaths in children under 20* Second leading cause of cancer-related deaths in males 20-39* Fifth leading cause of cancer-related deaths in females 20-39* Types: Primary tumors and metastatic tumors Brain tumors are graded based on histologic findings as well as biological behavior *American Brain Tumor Association (n.d.). Brain tumor statistics. Retrieved from http://www.abta.org/about-us/news/brain-tumor-statistics Computed Tomography 37 Restricted @ Siemens Healthineers, 2020 CT Neuro Perfusion - Brain Tumors SIEMENS. Healthineers Extension of CT Neuro Perfusion Scan/Recon Additional imaging of neurovascular leakage Brain Perfusion (Adult) Blood/Brain barrier imaging Topogram Clinical Indications: Baseline; Therapy Monitoring; and Non Contrast Brain Follow-up Perfusion Brain Premonitoring Monitoring CTA Brain NOTE: if your site scans the CTA Brain before the CT Perfusion, you must wait at least 5 minutes between the CTA and Perfusion to allow the blood to leave the tumor. Computed Tomography 38 Restricted @ Siemens Healthineers, 2020 Notes 126 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows CT Neuro Perfusion - Brain Tumors SIEMENS Healthineers ... Tumor Perfusion Artery Analysis of Time Blood/Brain Attenuation Curves (TACs) Barrier Disruption: 10- Tumor Extravasation causes slower wash-out Normal Sinus 20 30 Computed Tomography 3 Restricted @ Siemens Healthineers, 2020 CT Neuro Perfusion - Brain Tumors SIEMENS Healthineers Morphology Blood Volume Permeability Notes 127 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows CT Neuro Perfusion SIEMENS ... Healthineers ... What is Perfusion? What is a Stroke? Perfusion Protocol . Dose Considerations with Perfusion CT Post Processing Computed Tomography 41 Restricted @ Siemens Healthineers, 2020 CT Neuro Perfusion SIEMENS Healthineers ... Four Key Dose Parameters: kV; Z-axis coverage; mAs; and Scan time Siemens Default = 80 kV Optimal contrast visualization at 80 kV Lowest dose for a specific iodine contrast to noise ration (CNR) Increased kV can result in unnecessary and unacceptable high dose values Computed Tomography 42 Restricted @ Siemens Healthineers, 2020 Notes 128 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows Perfusion - Flex 4D and dose SIEMENS Healthineers ... CARE Dose4D available CARE KV available for Flex 4D spiral calculates average mA from the Topogram switched on by default no z-modulation automatic switch between 70kV and 80 kV no angle modulation CH Scan Favorites General Scan Dose Timing Config | Physio Scan Contrast Scan/Recon & Dose4D & CARE KV CARE KV Grouping CARE KV optimized for CARE KV Quality ref. mAs @120 kV KV CTDIvol [mGy] DLP [mGy*cm] Shaped Filter Dose Notification ref. CTDI [mGy] Dose Notification ref. DLP [mGy*cm] Perfusion Brain Full Off Soft Tissue with Contrast 70 Standard 0.00 0.0 Reliable good image quality Restricted Computed Tomography Siemens Healthineers, 2020 43 CT Neuro Perfusion SIEMENS Healthineers Consult with physician to determine optimal coverage for clinical needs of patient Avoid unnecessary large coverage and radiation to eye lenses More z-axis coverage can result in unnecessary and unacceptable high dose values Use Siemens suggested default mAs for your scanner Keep in mind that mAs selection may depend on the coverage Increased mAs can result in unnecessary and unacceptable high dose values Computed Tomography 44 Restricted @ Siemens Healthineers, 2020 Notes 129 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows CT Neuro Perfusion SIEMENS ..... Healthineers ... Default protocol results in 40 - 45 second scan time Use dose-sensitive approach to patients with weak cardiac output Longer scan times can result in unnecessary and unacceptable high dose values AVOID repeat exams! Correct patient positioning - motion prevention Appropriate IV contrast injection protocol Leverage Siemens' two model approach when post-processing Computed Tomography 45 Restricted @ Siemens Healthineers, 2020 CT Neuro Perfusion SIEMENS . Healthineers ** What is Perfusion? What is a Stroke? Perfusion Protocol Dose Considerations with Perfusion CT . Post Processing Computed Tomography Restricted @ Siemens Healthineers, 2020 Notes 130 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows Perfusion - Recon SIEMENS Healthineers Only fixed axial CT Neuro Perfusion Fast planning available Stroke Iterative reconstruction (SAFIRE/ADMIRE), iMAR and iBHC available 25,50s To post process you must open the dynamic series with the workflow CT Neuro Perfusion* available via Auto Tasking tab > Local 1: Motion Correction Application (assigned on Siemens default if license available) Exclude Exclude Baseline Range Physio Recon Auto Tasking Inline Options 2: Segmentation Auto ® min 20 HU View ... Auto Local Applicati ... Reduce Brain Printing Segment max 100 HU Off Of 3: Vessel Definition None None max. Enhance CT Neuro Perfusion CT CaScoring CT Dental CT Dual Energy 4: Results Preview MM RT Image Suite 5. Results * Option Computed Tomography 4 Restricted @ Siemens Healthineers, 202 CT Neuro Perfusion SIEMENS . Healthineers ... Siemens' Two Model Approach: 1. Deconvolution Model (Siemens Default) Ideal when there is little to no motion 2. Maximum Slope Model Ideal where there is motion or weak cardiac output > No Mean Transit Time (MTT) or Time to Drain (TTD) results available Computed Tomography 48 Restricted @ Siemens Healthineers, 2020 Notes 131 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows 4. Dual Energy SIEMENS Healthineers . SOMATOM go.All/Top and SOMATOM X.cite Dual Energy HOOD05162003094238 Effective 06/25/2020 Restricted @ Siemens Healthineers, 2020 DISCLAIMER SIEMENS Healthineers ... Please note that the learning material is for training purposes only! All patient data visible are randomized generated by a Simulation SW. There is no relation to real patients available. For the proper use of the software or hardware, please always use the Operator Manual issued by Siemens 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. Functionalities described in the material or parts of this functionality may not yet be released for customers and not yet be commercially available in every country. Due to regulatory requirements, the future availability of said functionalities or parts thereof in any specific country is not guaranteed. The Operator's Manual shall be used as your main reference, in particular for relevant safety information like warnings and cautions. 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 rights, including rights created by patent grant or registration of a utility model or design, are reserved. Computed Tomography 2 Restricted @ Siemens Healthineers, 2020 Notes 132 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows Dual Energy SIEMENS. Healthineers .. . What is Dual Energy CT (DECT)? System Clinical Decision Trees Reconstructions Computed Tomography Restricted @ Siemens Healthineers, 2020 3 What is Dual Energy? SIEMENS Healthineers With Dual Energy, it is possible to obtain additional information about the chemical composition of body materials. During a Dual Energy scan, CT datasets are acquired with different kV levels (e.g. 80 kV/Sn140 KV or AuSn120). This allows visualization of differences in the energy dependence of the attenuation coefficients of different materials. These images are used to get both morphological and functional information. There are two ways of acquiring Dual Energy Data on the SOMATOM go.All/Top and SOMATOM X.cite scanners: TwinSpiral Dual Energy Scanning (TSDE) > TwinBeam Dual Energy Scanning* (TBDE) - SOMATOM go. Top and SOMATOM X.cite *Option Computed Tomography Restricted @ Siemens Healthineers, 2020 / 4 Notes 133 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows TwinSpiral Dual Energy (TSDE) SIEMENS Healthineers .... TwinSpiral DE Single Source Dual Energy routine ready for all patients and situations, and is dose neutral Get both morphological and functional information in non-contrast exams by acquiring datasets at two different energies (Low kV & High kV). Key factor for the image quality of TwinSpiral Dual Energy is its improved spectral separation due to the Tin Filter and its better dose distribution. The well-known GO technologies are now introduced for the first time in spectral imaging for extra advanced automation. When combined with a dedicated optional Spectral Viewing package it allows for comprehensive assessment. No matter if you prefer to do your post-processing directly at the acquisition workplace (AWP) console or rather have it sent automatically to PACS by Recon&GO - it offers a solution for all clinical workflows. Computed Tomography 5 Restricted @ Siemens Healthineers, 2020 TwinBeam Dual Energy (TBDE) SIEMENS Healthineers .. TwinBeam DE TwinBeam DE technology acquires low and high kV datasets in a single scan and is dose neutral. This produces rich diagnostic information that a conventional single energy scan cannot deliver and is especially useful for characterizing contrast media examinations. TwinBeam is available for 120 kV and 140 kV. It is applicable with CARE kV and all other dose reduction technologies achieving excellent image quality and optimal dose for all situations and patients. Full number of projections for both spectra with no compromise on image quality. Separate reconstruction of low and high energy image series Composed reconstruction enables single-energy image dataset with diagnostic image quality. Computed Tomography 6 Restricted @ Siemens Healthineers, 2020 Notes 134 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows What is Dual Energy? SIEMENS Healthineers Dual Energy CT = scan the same volume of the patient with 2 spectra . higher CT-value at 80kV: iodine, bone, metal ... higher CT-value at 140kV: fat, plastic, uric acid ... (almost) same CT-value: water, soft tissue, blood ... bright iodine + dark fat 80KV 100kV 120kV 140kV iodine fat plastic Computed Tomography 7 Restricted @ Siemens Healthineers, 2020 What is Dual Energy? SIEMENS. Healthineers ... Low kV Calcium lodine 670 HU 296 HU High kV Calcium lodine 450 HU 144 HU Computed Tomography Restricted @ Siemens Healthineers, 2020 Notes 135 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows What is Dual Energy? SIEMENS Healthineers ... lodine ‚ Bone 80KV CT-value 80 kV 140KV IDENTITY 0 HU Blood Water Fat CT-value -1000| HU 140 kV Air O HU Computed Tomography 9 Restricted @ Siemens Healthineers, 2020 What is Dual Energy? SIEMENS Healthineers ** Image quality is crucial for reliable DECT imaging since dual energy data processing is sensitive to small changes Number of quanta of the Hounsfield units. SOMATOM Force 80 kV Relevant criteria comprise the spectral separation and Sn150 kV temporal coherence of the low and high energy data, as overlap well as, the temporal and spatial resolution of the CT SOMATOM Drive SOMATOM Definition Flash images, but of course also the dose efficiency or the 80 kV workflow aspects play an important role in enabling 0 Sn140 kV efficient DECT imaging in daily routine. The spectral separation manifests itself in the overlap of ................. DE with Tin Filter Photon energy the detected low and high energy X-ray spectrum, with a better spectral separation meaning less overlap. Computed Tomography 10 Restricted @ Siemens Healthineers, 2020 Notes 136 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows Dual Energy SIEMENS Healthineers .. What is Dual Energy CT (DECT)? . System . Clinical Decision Trees Reconstructions Computed Tomography 11 Restricted @ Siemens Healthineers, 202 Dual Energy - System SIEMENS . Healthineers ... SOMATOM SOMATOM SOMATOM go.All go. Top X.cite TwinSpiral Dual Energy* TwinBeam Dual Energy ** *The TwinSpiral Dual Energy protocols are standard on all SOMATOM go scanners. ** Option Computed Tomography 12 Restricted @ Siemens Healthineers, 2020 Notes 137 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows Dual Energy - Acquisitions SIEMENS Healthineers .. TwinSpiral DE - SOMATOM go.All/Top and TwinBeam DE* - SOMATOM go. Top and SOMATOM X.cite SOMATOM X.cite 1 st scan 2 nd scan Sn = High Energy Au = Low Energy *Option Computed Tomography 13 Restricted @ Siemens Healthineers , 2020 TwinSpiral Dual Energy (TSDE) SIEMENS Healthineers Low kV and High kV are scanned in opposite directions. Automatic kV selection with CARE KV Optimized spectral separation by combination with Tin filter SOMATOM SOMATOM go.All go. Top Scan and Recon parameters of the two scans are coupled SOMATOM go.All / SOMATOM go.Top: 80/Sn140kV > 100/Sn140kV 2nd scan Sn140/150 KV 80/90/100 KV 1st scal SOMATOM X.cite: 80/Sn150kV SOMATOM 90/Sn150kV X.cite 100/Sn150kV Computed Tomography 14 Restricted @ Siemens Healthineers, 2020 Notes 138 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows TwinSpiral Dual Energy (TSDE) SIEMENS .. Healthineers ... TwinSpiral Scan mode cannot be combined with any kind of bolus injection (CARE Bolus or Test Bolus) BEFORE the scan, but it can be added for subsequent scans after the TwinSpiral scan. No application classes that would require contrast injection Special behavior on scan abort - If unable to complete the full scan (low and high kV), the system will reconstruct what you do have (i.e. - you were able to acquire the entire low kV scan, but only half of the high kV scan). The full low kV dataset will be available and Dual Energy data where you have both low and high kV available. Special patient breathing command (API) Optimized workflow - two subsequent scans without delay and automated inline reconstructions Computed Tomography 15 Restricted @ Siemens Healthineers, 2020 TwinSpiral Dual Energy (TSDE) SIEMENS. Healthineers ... Unified Dual Energy Scan UI: One entry in timeline represents both scans. During pause, Sn filter moves into place and kV changes to scan back in opposite direction API A Spiral 1 Spiral 2 API B Motion Pattern Pause Table Movement Table Movement Topogram Tin Filter Inserted Scan back and forth with the same pitch values API: 15s Absolute Scan Delay InterScan Delay 10.6 seconds, dedicated for the newly developed Exam Time TwinSpiral DE scan mode. This informs the patient (first x-ray on till last x-ray off) there will be a pause in the middle of the examination and to keep holding their breath Computed Tomography 16 ed C Siemens Healthineers, 2020 Notes 139 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows TwinBeam Dual Energy* (TBDE) SIEMENS Healthineers The TwinBeam filter is divided into a tin part (Sn) and a gold part (Au) >> Sn represents the high kV > Au represents the low kv SOMATOM SOMATOM SOMATOM go.Top and SOMATOM X.cite: go.Top X.cite > AuSn120kV > AuSn140kV Both energy spectra can be scanned simultaneously in order to reduce the impact of patient motion Can be scanned with contrast Automatic kV selection with CARE KV Sn = High Energy Au = Low Energy *Option Computed Tomography 17 Restricted @ Siemens Healthineers, 2020 TwinBeam Dual Energy (TBDE) Spectrum before filter Spectrum after filter 120KV Low Energy 120KV Moveable - split-filter intensity intensity 0 20 40 60 80 100 120 140 energy [key 0 20 40 60 80 100 120 140 High Energy 120KV -Sn120kV intensity 0 20 40 60 80 100 120 140 energy [keV] Computed Tomography 18 Restricted @ Siemens Healthineers, 2020 Notes 140 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows 19 Dual Energy Protocols SIEMENS .... Healthineers .. Protocols contain both Dual Energy and single energy Scan Modes within the same protocol to be able to quickly switch if Dual Energy is unachievable. Only 2 protocols have TwinSpiral and TwinBeam scan modes available: Gout and Kidney Stones, but TwinSpiral is preferred for better spectral separation. Scan Favorites General Scan Dose Timing Config Physio Scan Contrast Scan/Recon Scan Mode Decision Trees Scan Strategies Kidney Stones MultienergySpiralAdultAbdomenTwinspiral (max. 100 cm) Kidney TwinSpiral DE possible [factory] Kidney TwinSpiral DE possible [factory].TwinSpiral DE Scan Mode MultienergySpiralAdultAbdomen Twinspiral (max. 100 cm) MultienergySpiralAdultAbdomen Twinbeam MultienergySpiralAdultAbdomen Twinspiral (max. 100 cm) RoutineSpiralAdultAbdomen Single Energy RoutineSpiralAdultAbdomenSn Computed Tomography 19 Restricted @ Siemens Healthineers, 2020 Dual Energy SIEMENS Healthineers .. What is Dual Energy CT (DECT)? System . Clinical Decision Trees Reconstructions Computed Tomography 20 Restricted @ Siemens Healthineers, 2020 Notes 141 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows Dual Energy - myExam Compass with Clinical Decision Trees SIEMENS Healthineers In some cases Dual Energy is unachievable and/or DE results would not be acceptable: patient diameter is too large, so that Dual Energy results will not be acceptable (e.g. > 45cm on topogram) patient cannot or does not cooperate (e.g. too young, breathing, can't hold still) In these cases the single energy scan mode should be selected (meaning Dual Energy evaluation will no longer be possible) myExam Compass will automatically switch from Dual to Single Energy in case of patient characteristic too young or from the topogram it determines the patient is too large. manual change of strategy is also possible from myExam Compass > In either case, the user is informed about the switch Computed Tomography 21 Restricted @ Siemens Healthineers, 2020 Dual Energy - myExam Compass with Clinical Decision Trees SIEMENS Healthineers .. Kidney DE Stones [f ... Tom myExam Compass myExam Compass Patient Characteristics Topogram Kidney Stones Dual Energy Recommendation Dual Energy Single Energy Reconstruction Close Kidney DE Stones [f ... myExam Compass my Exam Compas Patient Characteristics Topogram Kidney Stones Dual Energy Recommendation Single Energy Reconstruction Close Information No Dual Energy information. Please check patient instruction Accept Computed Tomography 22 Restricted @ Siemens Healthineers, 2020 Notes 142 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows Dual Energy SIEMENS Healthineers .... What is Dual Energy CT (DECT)? . System . Clinical Decision Trees . Reconstructions* * Ultra-Fast IRS required Computed Tomography 23 Restricted @ Siemens Healthineers, 2020 Dual Energy - Recon&GO - Spectral Recon TwinSpira None To perform conventional CT reconstructions of DE images (no motion econ Recon&GO correction) Spectral Recon None Monoenergetic Plus* None Monoenergetic Plus To reconstruct images that are equivalent to images scanned with a single L3D photon energy beam, depending on the keV selected (motion correction is H3D performed) VNC and lodine* (TwinBeam ONLY) TwinBeam To reconstruct virtual non-contrast images from a contrasted study and Spectral Recon Inline provide lodine overlay information (motion correction is performed) None N None L3D and H3D Monoenergetic Plus (max. 200 cm) creates a low kV or high kV series only with no DE information. They are not VNC (max. 200 cm) suitable for DE post-processing. These can be used if the DE scan fails/is lodine (max. 200 cm) L3D aborted (no motion correction) H3D Depending on IRS version, 100cm or 200cm can be calculated Computed Tomography 2 Restricted @ Siemens Healthineers , 2020 Notes 143 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows Dual Energy - Recon&GO - Inline Results SIEMENS Healthineers .... For Dual Energy scan modes the following Multi Energy Inline Results1,2 are available: All Dual Energy application classes (color/greyscale images) Recon&GO Image Impression DE Parallel Ranges Inline Results Mu DE Radial Ranges SPP - Spectral Post Processing - for further processing in CT None None View&GO or the [email protected] Dual Energy Workflow1 Parallel Ranges L&H - generates a low kV energy and a high kV energy Radial Ranges Applications dataset (2 series) for further processing in CT View&GO or Multi Energy the [email protected] Dual Energy Workflow1 DE Parallel Ranges DE Radial Ranges SPP L&H 11.9s RT Automatic Contouring NOTE: Inline Results and Spectral Recons cannot be combined 1Option 2Ultra Fast IRS Required Computed Tomography Restricted C Siemens Healthineers, 2020 TwinSpiral Dual Energy (TSDE) - Inline Results SIEMENS Healthineers : DE Parallel Ranges brings up the following DE Application Classes: Application Class Mixed Rho/Z Mixed MIX Monoenergetic Plus Bone Marrow Mixed auto Monoenergetic Plus Kidney Stone Bone Marrow (Full Body) Kidney Stones Gout Gout Rho/Z Bone Marrow Bone Marrow (Full Body) DE Radial Ranges brings up the following DE Application Classes: Application Class O Monoenergetic Plus Bone Marrow Monoenergetic Plus MODE Kidney Stone Bone Marrow (Full Body) Monoenergetic Plus auto Kidney Stones Gou Gout Bone Marrow Bone Marrow (Full Body) Computed Tomography 26 Restricted @ Siemens Healthineers, 2020 Notes 144 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows TwinBeam Dual Energy (TBDE) - Inline Results SIEMENS Healthineers ... Application Class Data DE Parallel Ranges brings up the following DE Application Classes: Mixed Mixed Mixed Gout Monoenergetic Plus Liver VNC Virtual Unenhanced MIX Monoenergetic Plus Rho/Z Body Bone Removal auto Body Bone Removal (Strong) Liver VNC/Virtual Unenhanced FatMap Head Bone Removal Head Bone Removal (Strong) Kidney Stones Body/Head Bone Removal Lung Analysis 8s Gout Rho/Z Kidney Stones FatMap Lung Analysis Lung Analysis (Dense Lung) DE Radial Ranges brings up the following DE Application Classes: Application Class Monoenergetic Plus Monoenergetic Plus Gout Monoenergetic Plus Body Bone Removal Body/Head Bone Removal . Lung Analysis Body Bone Removal (Strong) auto Head Bone Removal Kidney Stones Head Bone Removal (Strong) Kidney Stones Gout Lung Analysis Lung Analysis (Dense Lung) Computed Tomography 27 Restricted @ Siemens Healthineers, 2020 Dual Energy - Inline Results SIEMENS .... Healthineers ... In Addition: When an Application Class is chosen, either for TwinSpiral or TwinBeam, extra columns may appear for additional choices pertaining to the specific Inline Result (e.g. DE Parallel or DE Radial Range) and Application Class (e.g. Mixed, Kidney Stone, Lung Analysis, etc.). For Example: General Recon Recon&GO Image Impression Recon Box hysio RE .... Inline Options Data Set: Inline Results Organ Viewing Direction Resolution Application Class Data Set Fused = Grayscale + Color Overlay DE Parallel Ranges No Organ Feet to Head Off 3D = original thin slice images that Kidney Stone Fused Mixed can be used in CT View&GO Classified (Gray y Fused avori .. General Recon Recon&GO Image Impres ... Recon Box Physio Recon | Auto Tasking Inline Options Lung Analysis View: Inline Results Organ Angle Between RT Preset Viewing Direction Application Class ung Analysis View Choose which subclass you want Images [*] DE Radial Ranges No Organ 10 DE Lung PBV Front to Back Lung Analyst processed. If both desired, create two Lung PBV Lung PBV recon jobs, one for each view. Lung Vessels Note: if the "High Resolution" box is marked "On" the matrix will be 1024 x 1024 Computed Tomography 28 Restricted @ Siemens Healthineers, 2020 Notes 145 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows Dual Energy - Inline Results SIEMENS Healthineers ... Not permitted: Spectral Recon must be set to "None" in order to select a Multi Energy Inline Result (or vice versa). Attempting to choose both Spectral Recon and Inline Results will result in an error and the system advising to change settings. Recon Favorites General Recon Recon&GO Image Impression | Recon Box Physio Recon Auto Tasking Inline Options Scan/Recon Spectral Recon Inline Results Multi Recons Venous Phase Abdomen 3.00 Qr40 A3 cor Venous Phase Abdomen 3.00 Qr40 A3 ax None DE Parallel Ranges Orientation Multi Recons (2) None Recon Favori ... | General Recon Recon&GO ( Image Impres ... ] Recon Box | Physio Recon Auto Tasking | Inline Options Scan/Recon Spectral Recon Inline Results Multi Recons Fix Axial CTA Abdomen 1.50 Qr40 A3 H3D L&H On 0 Selected inline result is not compatible with selected Spectral Recon type. Please change Spectral Recon type or inline results Computed Tomography Restricted @ Siemens Healthineers, 2020 Dual Energy - Inline Results SIEMENS Healthineers .. Inline Results: SPP Mano Selecting SPP under Inline Results > Multi Energy, opens the Application SPP Class column where you select either: auto Conventional CT - use for a conventional CT recon of the low and high energy images. Monoenergetic Plus - by selecting this, the parameter Energy in keV is displayed where you can select different keV values Recon Favorites General Recon Recon&GO Image Impression | Recon Box Physio Recon Auto Tasking Inline Options Scan/Recon Inline Results Application Class Energy in keV Kidney Stones 1.50 Qr40 A3 SPP Monoenergetic Plus 70 Conventional CT Monoenergetic Plus Computed Tomography Restricted @ Siemens Healthineers , 2020 Notes 146 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows Dual Energy - Inline Results Spectral Post Processing (SPP) The interactive Spectral Imaging (ISI) feature uses a single post-processing series in the file format Spectral Post Processing* (SPP) which contains all the necessary DE information. Thus, separate high and low kV datasets is no longer needed Improve your clinical workflow by bundling the spectral low and high kV series into one spectral post processing (SPP) data series Interactive Spectral Imaging gives you the possibility to interactively change different monoenergetic energy levels and evaluate certain dual energy representations such as Monoenergetic Plus in View&GO The SPP series shows a conventional CT Image or a generated Monoenergetic Plus Image, readable in your PACS system. Ultra-Fast IRS required Computed Tomography Restricted @ Siemens Healthineers, 2020 Dual Energy - Inline Results SIEMENS . Healthineers ... Inline Results: L&H Selecting L&H under Inline Results > Multi Energy does not bring up any other columns in Inline Options. auto L&H Recon Favorites General Recon Recon&GO Image Impression Recon Box Physio Recon Auto Tasking nline Options Scan/Recon Inline Results Kidney Stones 1.50 Qr40 A3 L&H Computed Tomography 32 Restricted @ Siemens Healthineers, 2020 Notes 147 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows 5. Guide&Go SIEMENS. Healthineers SOMATOM go.All/Top and SOMATOM X.cite Guide&GO (Optional) ... OOD05162003094243 Effective 06/25/2020 Restricted @ Siemens Healthineers, 2020 DISCLAIMER SIEMENS Healthineers Please note that the learning material is for training purposes only! All patient data visible are randomized generated by a Simulation SW. There is no relation to real patients available. For the proper use of the software or hardware, please always use the Operator Manual issued by Siemens. 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. Functionalities described in the material or parts of this functionality may not yet be released for customers and not yet be commercially available in every country. Due to regulatory requirements, the future availability of said functionalities or parts thereof in any specific country is not guaranteed. The Operator's Manual shall be used as your main reference, in particular for relevant safety information like warnings and cautions. 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 rights, including rights created by patent grant or registration of a utility model or design, are reserved. Computed Tomography 2 Restricted @ Siemens Healthineers, 2020 Notes 148 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows Guide&GO - Introduction to Interventional CT Assisted by CT imaging, position a needle at the desired anatomic location with minimal damage of structures in the needle path - Minimally invasive Diagnosis > Biopsy Treatment / therapy > Tumor ablation Spine: pain therapy > Spine: Vertebroplasty Restricted @ Siemens Healthineers, 2020 Guide&GO - Hardware Re-use existing HW for basic CT Intervention: Tablet > Remote Scan Control (RSC) Restricted @ Siemens Healthineers , 2020 Notes 149 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows Guide&GO - Hardware Tablet holder Maximum flexibility >> Mount on the table side of the operator or opposite side >> Attach to the rail with "Quick Claw" SOMATOM go.Top > 360º possible in 60º steps >> Can be combined with a sterile cover > Flexible gooseneck to minimize reflections Alternative: The tablet can also be attached to the gantry during the examination! Restricted @ Siemens Healthineers, 2020 5 Guide&GO - Hardware SIEMENS. Healthineers .. Remote Scan Control (RSC) holder > Can be combined with a sterile cover >> Attach to the rail with "Quick Claw" > Can be used optionally * Use standard sterile covers. Due to regulatory D restraints, the remote control reach does not go beyond the scanner room! Please also point towards SIEMENS the gantry. Alternative: The RSC can also be attached to the Gantry during the examination! Restricted @ Siemens Healthineers, 2020 6 Notes 150 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows Guide&GO - Hardware There are different ways to attach the tablet with the sterile cover to the gooseneck tablet holder. ARF 10-6219EU 1802619 Ipad Cover 2023-02 EC REP Premier Guar bV. You can also use a sterile US RAP drape to cover the tablet nha Datict Guangzhou. 31147's PRC while docked on the Gantry CONTENTS OF UNOPENED, UNDAMAGED PACKAGE ARE STERILE MAINTAIN STERILE CONDITIONS WHEN HANDLING CONTENTS SINGLE USE, DISPOSABLE, NOT FOR REUSE cover. Restricted @ Siemens Healthineers, 2020 7 Guide&GO - Hardware Smartphone like direct interaction with images via touch screen gestures > Zoom/Pan Windowing > Distance Measurements Works with sterile cover and gloves Restricted @ Siemens Healthineers , 2020 Notes 151 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows Guide&GO - Start Possibilities Which device? Where? How to initiate the Useful information scan? Control Box Control room Press the Start key When planning a CT-guided intervention, it is recommended to leave the examination room Remote Scan Control (RSC) Start key before starting the planning on the control box scan to avoid being exposed to radiation. Foot Switch Examination Press the Start key room When triggering the scan from inside the examination room, Start key move to an area where radio- on the Remote Scan tion exposure is reduced to a Control (RSC) minimum. (+ Page 121 Radio- tion exposure) room Step on the X-ray foot switch once During a CT-guided interven- tion, when the needle is injec- ted into the patient's body, you can press the X-ray foot switch to start the intervention scan while holding the needle in place. (+ Page 148 Starting the X-ray foot switch CT-guided intervention) When triggering the scan from inside the examination room, move to an area where radia- tion exposure is reduced to a minimum. (> Page 121 Radia- tion exposure) Restricted @ Siemens Healthineers, 2020 9 Guide&GO - Slice Thickness Basic Tablet CT Intervention i-Sequence mode only 3 slices SOMATOM go.All 3 x 3 mm 3 × 5 mm SOMATOM go. Top 3 x 3 mm .... > ... > 3 × 5 mm SOMATOM X.cite 3 x 3 mm 3 × 5 mm Restricted @ Siemens Healthineers, 2020 10 Notes 152 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows Guide&GO - Protocols - Console Intervention Folder (Console) Thorax Intervention Adult Abdomen Intervention Intervention (3) Spine Pain Therapy (Adult only) Trauma Thorax Intervention RTP Abdomen Intervention Specials Spine Pain Therapy Intervento Child Intervention (2) Thorax Intervention e.g.: Abdomen Intervention Adult Abdomen Intervention CH Scan Favorites General Scan | Dose Timing Config Physio Scan Contrast Scan/Recon Scan Mode kV Eff. mAs CTDIVOl DLF [mGy*cm) Acquisitio [mm] Feed Scan Time [s] Line CARE Dose4D & | i-Sequence Abdomen InterventionSequenceAdultAbdomen2d 120 50 (32 cm) 3.44 5.2 3 x 5.0 0.0 Full 0.33 Off Off 11 Restricted @ Siemens Healthineers, 2020 Guide&GO - Protocols - Console Recon Ranges Topogram Timeline and color coded reconstruction only visible on the console Planning Spiral Thorax i-Sequence Thorax Spiral Thorax 3.3s 2.1s 0.5s 2.1s auto 0 Restricted @ Siemens Healthineers , 2020 12 Notes 153 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows Guide&GO - Protocols - Console iMAR Three Interventional Windows Switch on at console Adjustable in Clinical Configuration Physio Recon Auto Intervention Bone 1500 400 iMAR iMAR Type Intervention Lung 1200 -600 On Spine Implants Intervention Soft Tissue 400 40 Tin (Sn) Filter for dose saving Computed Tomography 13 Restricted @ Siemens Healthineers , 2020 Guide&GO - Protocols - Tablet Intervention Folder (Tablet) Patient registered No patient registered Thorax Intervention General Radiotherapy intervention User Position Abdomen Intervention Spine Pain Therapy (Adult only) Adult Folder Category Adult Intervention ------- O Trauma - Thorax Intervention Image Information Intervention Abdomen Intervention Image Tust "indications: biopsy. abiscess in the abdomen, wiwo CM -Scan modes ange soatoromenta RoutineSpiralAdultAbdomen Intervention SequenceAdultAbdomendo Show Lantance Lines Everywhere Topogram - Spine Pain Therapy GO * * - 750.0 125.0 System test is pending * * - 1110.5 120.0 Computed Tomography Restricted @ Siemens Healthineers, 2020 Notes 154 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows Guide&GO - Configuration on Tablet No patient registered The Position of Physician is dependent on the which General Radiotherapy ntervention side of the table they are standing (left or right side), User Position not on the patients side! Packtion of Playsichan Image Information Inage Text Angle Measurements Fordistance lees, Glilay the angle is the vertical Show Umtance Lines Everywhere Shoo dslance lees is al sther sices and scans No patient registered General Radiotherapy Intervention User Position Position of Physician Left or Right Side of the Table O Image Information Image Text Show text in image comers -1110.5 120.0 0º Computed Tomography Restricted @ Siemens Healthineers, 2020 15 Guide&GO - Configuration on Tablet The Image Text can be switched off to remove text from the image corners. No patient registered General Radiotherapy Intervention User Position Position of Physician Left or Right Side of the Table O tenue canning or finalize Image Information Finalizo Image Text Show Bed in image comers = - 1479.5 100.0 Proga START ® Computed Tomography 16 Restricted @ Siemens Healthineers, 2020 Notes 155 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows Guide&GO - Configuration on Tablet No patient registered General Radiotherapy Intervention In the Intervention configuration tab you can User Position additionally O Image Information > Enable angle measurements Inage Tuxt Show todd in image canters Angle Measurements For distance ines, doplay the angle lo ther vertical > Show distance lines everywhere Show Distance Lines Everywhere wir distance me af uther sices and scans Angle Measurements or distance lines, display the angle to the vertical Show Distance Lines Everywhere Show distance lines in all other slices and scans * * - 1110.5 120.0 Computed Tomography 17 Restricted @ Siemens Healthineers, 2020 Guide&GO - Angle Measurements 0º Angle measurements functionality: Last/Next 1.55 1:39 Accumulated 12.5 108 Angle measurements are available, if the function is enabled in the settings page: Angle Measurements 30 ) 40 mm 131" distance lines, display the angle to the vertical > The vertical line (= 0º) is not displayed. It is used to measure the angle between the distance line and the vertical line Do >> The angle between the distance line and the vertical line is measured and que scanning or finalize displayed next to the distance Continue forvention 70 mm |30" Finalizo GO > The degree value is always positive! -1479.5 100.0 Computed Tomography Restricted @ Siemens Healthineers, 2020 18 Notes 156 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows Guide&GO - Distance Lines Show distance line functionality Show distance lines in all other slices and scans @ X LastNext 3.43 Acoanulated 3.99 78 4 A distance measurement will be shown DOMATOM 99.THE 8:24.00 06 AL as a straight white line in a slice. IMA 14 EN 300 50 -1,245 > If you scroll through the available slices, the distance line will be propagated to all other slices and displayed as a dashed white line. > This is possible in both planning and scanning layouts > It is also possible to edit the line in any Finaliza Go slice it is displayed (solid or dashed) -1361.5 100.0 Computed Tomography Restricted @ Siemens Healthineers, 2020 Guide&GO - Distance Lines SIEMENS .... Healthineers .. Patient registered Movie Activate acan or finalizo Finalize GO * * * . 966,5 125,0 09 | Multiplo ecans at the same postkor Courtesy of Practice for Radiology at Dreifaltigkeits- Hospital Lippstadt , Lippstadt , Germany Computed Tomography 20 Restricted @ Siemens Healthineers, 2020 Notes 157 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows Guide&GO - Tablet UI Patient registered Toggle between 2 layouts Zoom/Pan Window Presets Free Windowing Distance Measurement (with magnifying glass) Activate scan or finalize Continue scanning or finalize Finalize GO Finalize -966,5 125.0 tulipto scans at the same position / = - 1479.5 100.0 0 Planning Scanning Computed Tomography 21 Restricted @ Siemens Healthineers, 2020 Guide&GO - Tablet UI SIEMENS Healthineers Parameter change during scanning Accumulated 4.94 > KV Abdomen Intervention (Adult) Head First - Supine Accumulated 7,42% (32 cm) men 83-nov-emt Slice Thickness (go.Up) ention (Adult) @ Head First - Supine 9.50 Rotation Time EX MAS 3x 3.0 4 3x 5.0 > mAs > Changed protocol has to be confirmed with "GO". Head First - Supine Abdomen Int ... Full 0.33 Br40 Full 0 33 120 Br40 Full 1.00 Computed Tomography 22 Restricted @ Siemens Healthineers, 2020 Notes 158 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows Guide&GO - Tablet UI Save key images function: Last/Next 3.43 5.14 Accumulated 25.0 196 CTDlver (12 cm) |may2 key mage has been saved SOMATOM go.Top syngo CT VA30A In the toolbar you can find the "save key images" (= Snapshot) icon: > After pressing the icon, a message pops up at the upper part of the tablet: 100 Activate scan or finalize Key image has been saved intervention Finalize GO > Possible in both layouts. The saved images are - - 1289.0 100.0 Multiple scans at the serve porcion immediately visible in CT View&GO Computed Tomography 23 Restricted @ Siemens Healthineers, 2020 Guide&GO - Tablet UI - Laser Crosshair Button The laser crosshair button is found on the first level in the UI By clicking the icon you can toggle the red laser crosshair over the image tinue scanning or finalize Finalize GO o X = - 1246.0 100.0 0º Computed Tomography 24 Restricted @ Siemens Healthineers, 2020 Notes 159 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows Guide&GO - Tablet UI - Windowing Window 1/2/3: Bone/Mediastinum/Lung Can be customized in clinical configuration by Admin Free Windowing Head Computed Tomography Restricted @ Siemens Healthineers, 2020 Guide&GO - Workflow - Planning Layout Patient registered 8 X Last/Next 3.44 5.15 Accumulated 0depromotion humory After scanning a Topogram and a ntervention. QuideLGO 23456 10/5/1983. F. 34Y 42/2016 planning scan, the images will 1:18:45.60 AM LIMA 17 IPI 200 JR .1.267.7 appear on the tablet and the console. The tablet and the console are not synchronized! Store Position Activate scan or finalize Finalize GO 1506.5 125.0 Computed Tomography 20 Restricted @ Siemens Healthineers, 2020 Notes 160 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows Guide&GO - Workflow - Planning Layout Patient registered Scroll through images via the slider (axial images only) The selected slice will be your target position Target Position set to - 1284.0 mm Press the MOVE button (control ativato acan or finalize box or RSC) to move to the Finalize GO selected target position -966,5 125,0 Computed Tomography 27 Restricted @ Siemens Healthineers, 2020 Guide&GO - Workflow - Planning Layout Patient registered Another way to set the target position is to tap on 300 40 the small Topogram. Activate scan or finalize intervention It will enlarge and the Finalize GO range can be graphically moved with your finger moved. A Target Position set to -1284.0 mm Tap the area again to minimize the Topogram Store Position activate scan or finalize Finalize GO # # -1506.5 125.0 Multipla scars at the same Deskbien Computed Tomography 28 Restricted @ Siemens Healthineers, 2020 Notes 161 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows Guide&GO - Workflow - Measurements Touch Ruler icon to measure Repeat steps to make multiple measurements 2 ways to Measure Tip - Tip Tip - Move Computed Tomography 29 Restricted @ Siemens Healthineers, 2020 Guide&GO - Workflow - Measurements 10/5/1983, F, 34Y For better visualization, 4/5/2018 11:18:45.92AM magnification is possible 2 IMA LE Measurements on and visible during other slices are measurement displayed with a dot on the scroll bar (several This is done by touching are possible) and keeping finger pressed on the screen Laser display stays visible Computed Tomography Restricted C Siemens Healthineers, 2020 ‘ 30 Notes 162 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows Guide&GO - Workflow - Pan/Zoom and Measurements SIEMENS Healthineers ... Patient registered Accumulated 3.44 79.0 Movie SOMATOM " A: synDO CT VASCA HEP Activate scan or finalize GO 9 / - - 966.5 125.0 0 Multiple scarpe at the same position Courtesy of Practice for Radiology at Dreifaltigkeits-Hospital Lippstadt , Lippstadt , Germany Computed Tomography 31 Restricted @ Siemens Healthineers, 2020 Guide&GO - Workflow - Display Laser and Measurements SIEMENS Healthineers Patient registered Movie Planning Finalize GO # # -966.5 125.0 crypto scans at the same position Courtesy of Practice for Radiology at Dreifaltigkeits-Hospital Lippstadt, Lippstadt, Computed Tomography 32 Germany Restricted C Siemens Healthineers, 2020 Notes 163 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows Guide&GO - Workflow - Measurements Patient registered Last/Next 3.44 5.15 To edit a measurement, activate Accumulated 4:08- 03 um mon topmoney lervention, Quide&GO 3456 0/5/1983, F. 34Y the distance line by pressing on it $/2018 915:45.92 AM MA 16 HI 200 -1.262.7 with your finger; blue crosses will Intervention soft Tissue Window appear. Press on the blue cross with your finger and move to new a position 94 mm To delete a measurement, press on it with your finger holding down approx. 3 secs. A blue garbage can 400 40 appears - press the garbage can to Activate scan or finalize intervention delete the line. Finalize GO 0 4 -1506.5 125.0 Computed Tomography 33 Restricted @ Siemens Healthineers, 2020 Guide&GO - Workflow - Scanning Layout Last/Next 3.44 5.15 Accumulated 8,38 2Damitman 20 Most recent i-Sequence scan is displayed The center image is magnified Select Thumbnail Head or Feet: > Selected thumbnail will display in large segment > A new target position to "Follow the Needle" will be marked as target. Pressing move will move the table to this new position. Contor Continuo scanning or finalla Finalize GO * - 1262.5 125.0 0º Computed Tomography Restricted @ Siemens Healthineers, 2020 Notes 164 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows Guide&GO - Workflow - Scanning Layout Switch between different intervention scans e.g.: Navigate back to previous i-Sequence scans or forward to the latest Back 1) latest scan Center Head The bold white number (here 1) is indicating the latest scan Computed Tomography 35 Restricted @ Siemens Healthineers, 2020 Guide&GO - Hardware - Remote Scan Control (RSC) Move Concept Always moves to last > Move button brings table to target position target position > Target position: Position of large (center) segment > Default behavior: Move button brings table to the last scan position In/Out always possible after scan = > Free moving of the table via remote control buttons new target (< and ->) is always available. Simply push Move to return to target position D > Tilt is possible Short move = The move concept is only Incremental movement supported if the gantry tilt SIEMENS 1.5mm go. Now/Up (3×3) remains unchanged 2.5mm go.Up (3x5) Computed Tomography 36 Restricted @ Siemens Healthineers , 2020 Notes 165 Classroom Workbook SOMATOM go.All/Top & SOMATOM X.cite Advanced Workflows Guide&GO - Tilt Behavior "As a clinical user I want to have a tilt workflow that recognizes the change of the system tilt and applies it to the next i-Sequence range to be performed." Workflow: > Scan protocol contains any unperformed intervention Ranges > Gantry tilt is changed via Positioning UI or tablet Table/ Gantry Position Actual Position > New system tilt value is automatically applied to all -1126.0 100.0 15º unperformed intervention Ranges in the protocol Table Presets Note: Gantry tilt operations at any other time in the workflow A: 400.0 150.0 are ignored, e.g. if the system is tilted and afterwards an iSeq 7600.0 150.0 range is added via append. Computed Tomography Restricted @ Siemens Healthineers, 2020 Guide&GO - Hints & Tips Console > Workflow is optimized on the Tablet > Fallback workflow on console is possible - Not Synchronized with Tablet > Distance measurements can only be created on the Tablet, but can be saved as Key Image - will be displayed on the console / CT View&GO Gantry Tilt > Tilted i-Sequence scans are supported when angle remains the same Computed Tomography Restricted @ Siemens Healthineers, 2020 Notes 166 6. Course Assessment 167 On account of certain regional limitations of sales rights and service availability, we cannot guarantee that all products included in this brochure are available through the Siemens sales organization worldwide. Availability and packaging may vary by country and is subject to change without prior Local Contact Information notice. Some/All of the features and Siemens Medical Solutions USA, Inc. products described herein may not be 40 Liberty Blvd. available in the United States. Malvern, PA 19355-9998 USA The information in this document Telephone: +1-888-826-9702 contains general technical descriptions siemens.com/healthcare of specifications and options as well as standard and optional features which do not always have to be present in Legal Manufacturers Computed Tomography & individual cases. Radiation Oncology Siemensstr. 1 DE-91301 Forchheim Siemens reserves the right to modify the Germany design, packaging, specifications and Telephone: +49 9191 18-0 options described herein without prior siemens.com/healthcare notice. Please contact your local Siemens sales representative for the most current information. Siemens Shanghai Medical Equipment Ltd. 278 Zhou Zhu Road Note: Any technical data contained in Shanghai 201318 this document may vary within defined P.R. China tolerances. Original images always lose a certain amount of detail when reproduced. Siemens Healthcare Headquarters Siemens Healthcare GmbH Healthcare Sector Henkestr. 127 91052 Erlangen Germany Phone: +49 9131 84-0 siemens.com/healthcare Published by Siemens Healthcare GmbH · Order No. HOOD05162003112034· Printed in USA · 0000.x · © Siemens Healthcare GmbH, 2017 168