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S O M ATO M S E S S I O N S
Multislice CT
Quarter Second CT
Spiral CT
Case Study
Top 10 Q & A
6
Overline
CONTENTS
Letter from the Editor Page 2
Multislice CT Page 3
Spiral CT Page 16
2
Multislice CT
• More volume
The volumes that can be covered in a given time at
a certain resolution are eight times larger than with a single
X-ray Tube
slice scanner.
Tube Collimator
• More detail
The z-axis resolution of any protocol can be increased
Collimated Slice
up to a factor of 8 enabling a tremendous improvement in
the image quality of postprocessing.
Detector Collimator
• More productivity
The number of images that can be acquired per second
has been increased from one to eight.This results in a
Adaptive Array Detector
more productive tube usage, since the warranty is given in
scan seconds.
Detector Design
There are essentially two possible approaches to designing
Graphic 1: Side view of the gantry and 3D model a multislice detector, the Fixed Matrix Detector (FMD) and
of single row and multirow detectors. the Adaptive Array Detector (AAD).
3
Multislice CT
2 x 0.5 mm
4 x 1.25 mm
4 x 1.0 mm
4 x 2.5 mm
4 x 2.5 mm
4 x 3.75 mm
2 x 8.0 mm
4 x 5 mm
4 x 5.0 mm
Fig. 1a: Available collimations and read-out schemes Fig. 1b: Available collimations and read-out schemes
for the Fixed Matrix Detector (FMD). The highlighted for the Adaptive Array Detector (AAD). The highlighted
bar indicates the collimation at the detector. For bar indicates the collimation at the detector. For
each detector configuration, prepatient collimation is each detector configuration, prepatient collimation is
adjusted correspondingly. adjusted correspondingly.
elements of fixed width. As an example consider Figure 1a. efficiency of the detector by introducing dead spaces.
The detector consists of 16 rows 1. An electronic switch • Adaptive Array Detector (AAD)
in the data acquisition system allows the combination of The Adaptive Array Detector, used in the SOMATOM Plus 4
several rows to obtain thicker slices. As an example con- Volume Zoom, optimizes detector efficiency at all slice
sider a pixel width of 1.25 mm at the center of rotation. Then, collimation settings by using varying row widths. Figure 1b
the slice collimations 2 that can be acquired are 1.25 mm, gives a schematic overview. The widths of the detector
2.5 mm, 3.75 mm and 5 mm. However, the outer detector rows increase towards the outer edges. Specifically 1 mm,
rows of the array will never be used individually, but will 1.5 mm, 2.5 mm and 5 mm are combined symmetrically,
always be combined by the electronic switch. allowing for slice collimation of 2 x 0.5 mm, 4 x 1 mm,
4 x 2.5 mm, 4 x 5 mm and 2 x 8 mm. It is evident that the
geometrical design minimizes the dead space in between
1
the detector rows. The detector in the SOMATOM Plus 4
We refer to the sets of detector pixels as rows.The output of the data
acquisition system can be a combination of several rows by means of an Volume Zoom uses the Ultra Fast Ceramic (UFC) scintillator
electronic switch.The result is called a slice.
2
material, which provides the fast response required for
With the slice collimation we refer to the width of one of the multiple
slices, scaled to the center of rotation. obtaining high resolution images at 500 msec gantry rotation.
4
Overline
For a given volume, the higher the pitch, the shorter the
Why four slices? scan time.The lower the pitch, the longer the scan time.
All multislice CT systems available today acquire four slices
When the pitch value is fixed, a compromise between z-axis
from one of the two detector designs described above.
coverage and scan time will occur. With the SOMATOM
But why can a detector made up of 16 rows not acquire 16
Plus 4 Volume Zoom, pitch value can be adapted freely
slices? The reason lies in the image reconstruction process.
from 1 to 8 by the software according to the clinical required
In CT image reconstruction, it is usually assumed that all
z-axis coverage and scan time, thus overcoming today’s
rays lie within a common image plane.This is the case
limitations of spiral scanning.
in single slice CT using “stop and go“ mode. In single slice
spiral CT, this condition can be met after an interpolation
step. In multislice CT, however, the outermost rays are not
perpendicular to the axis of rotation but are tilted with
respect to an axial plane by what is called the cone angle.
Hence the rays nutate, or wobble like a top but in a con-
trolled manner.This effect causes cone beam artifacts in
the image.The artifact level depends on the ratio of cone
angle and slice collimation. A detailed analysis shows that,
as a rule of thumb, the cone beam artifacts can be neglected
using up to four slices of detector data. When going to
a higher number of detector rows, visible artifacts appear.
The detector design of the SOMATOM Plus 4 Volume
Zoom is therefore optimized to the acquisition of four slices.
5
Multislice CT
Slice Thickness (effective)
3.5 4.5
3 4
2.5 3.5
Slice Width
2 Wide 3
1.5 2.5
Slim 2
1
0.5 1.5
0 1
0 0.5 1 1.5 2 2.5 3 1 2 3 4 5 6 7 8
Pitch Pitch
Graphic 3: Pitch, Algorithm and Eff. Slice Width. Graphic 4: With the Adaptive Axial Interpolator of the
In single slice spiral scanning, the true width of the SOMATOM Plus 4 Volume Zoom, the true width of the
reconstructed image is influenced by the pitch reconstructed image (slice width) is independent of
and algorithm applied – what you select may not be pitch and algorithm – what you select is always what
what you get. you get.
In multislice CT, although the technology behind it is so adapt the mA in order to achieve the required dose and
much more advanced, spiral scanning with the SOMATOM image quality. The user no longer has to distinguish between
Plus 4 Volume Zoom has been simplified dramatically. different kinds of algorithms. Also, for a given mAs, the
This is achieved by an innovative spiral interpolation con- dose applied will be the same as in a sequence scan, inde-
cept from Siemens, the Adaptive Axial Interpolator (AAI). pendent of the pitch. The radiation overlap that decreases
with increasing pitch values is corrected for by increasing
• What you select is what you get the tube curent for larger pitch values.The pitch-dependent
Rather than selecting a slice collimation and getting a
tube current adjustment is given by
random slice width of the reconstructed image, the user
chooses the desired slice width together with a collimation mA (tube current) = mAs per image/Rotation time x Pitch/4.
setting. Several collimation settings can produce a desired
At a certain rotation time, large pitch means short scan
slice width. The following rules of thumb apply:
time but also high tube load. Small pitch means longer
1.The reconstructed slice width can never be smaller than
scan time but reduced tube load.
the slice collimation.
2.The slice collimation determines the z-axis coverage
per rotation.
3. Thinner collimations will improve image quality (reduce
partial volume artifacts), but at the cost of longer scan time.
Clinical Applications
In single slice spiral CT, users often had to compromise
• Same mAs, same dose, same pixel noise between the scan time, the volume coverage, and the slice
Instead of selecting tube current (mA) and getting a pitch collimation. The SOMATOM Plus 4 Volume Zoom has
dependent dose, the user now selects the mAs in com- harmonized these aspects for routine clinical applications,
bination with the desired slice width. The software then will and opened up new applications.
6
Overline
• Routine applications With the SOMATOM Plus 4 Volume Zoom, clinical routine
Let’s take one of the routine studies as an example. applications benefit in the following ways:
" Anatomical regions can be acquired in a very short time
Example 1: The same volume can be covered with the with 4 x 5 mm collimation as the fast mode.
same slice collimation in a very short scan time. " Anatomical regions can be acquired in a shorter time
with 4 x 2.5 mm collimation as the routine mode.
Single slice Multi slice " Anatomical regions can be acquired in a reasonable time
Volume coverage (cm) 20 20 with 4 x 1 mm collimation as the thin slice mode.
Rotation time (s) 1 0.5
Slice collimation (mm) 5 4x5 • New Applications
Pitch 1.5 6 " Combi Scan
Scan time (s) 27 3.3 With the SOMATOM Plus 4 Volume Zoom, the data
acquired by narrow slice collimation can be used for both
narrow and thick slice reconstructions thereby avoiding
multiple exposure to the patient. The diagnostic informa-
Example 2: The same volume can be covered with even
tion for both high contrast resolution (e.g. bone structure)
thinner slice collimation in a shorter scan time.
and low contrast resolution (e.g. soft tissue) are obtained
Single Multi Multi from a single scan. This feature is called “Combi Scan“.
slice slice slice
Volume
The clinical examples*:
coverage (cm) 20 20 20
One thorax scan (4 x 1 mm) for both HiRes lung (Fig. 2b)
Rotation time (s) 1 0.5 0.5
and mediastinum study (Fig. 2a).
Slice
collimation (mm) 5 4 x 2.5 4x1 * Clinical example provided by Erlangen University, IMP.
Pitch 1.5 6 7
Scan time (s) 27 7 14
" Cardiac CT imaging
Cardiac CT studies require the following elements:
1) Synchronization of data acquisition to the
Example 3: With the same scan time and even a thinner
cardiac cycle
slice collimation, an even larger volume can be covered.
To achieve this, two methods can be applied which are
7
Multislice CT
Fig. 2a: Axial image – 5 mm slice width for soft tissue Fig. 2b: MPR – 1 mm slice width for HiRes lung study.
study.
2) The fast speed of data acquisition to freeze the • Scan given volumes in extremely short times and
heart motion. • Scan given volumes with narrow collimation for
The 500 ms full rotation with the SOMATOM Plus 4 Volume excellent 3D-resolution within practical scan times.
Zoom allows 250 ms temporal resolution per image to Particularly this last feature is crucial to optimizing image
freeze heart motion. In order to achieve the 250 ms a partial quality of transaxial slices as well as of 3D-renderings.
scan technique is used in combination with an optimized
The huge number of images, generated with such spiral
half scan reconstruction using parallel x-ray geometry.
protocols, also calls for intelligent approaches to viewing
For detailed information on Cardiac CT imaging with
and diagnosis. Volume rendering methods, as provided on
SOMATOM Plus 4 Volume Zoom see “Quarter Second CT“
the 3DVirtuoso, will become a more standard procedure
– also included in this issue.
to approach the diagnostic process in a manner oriented
towards volume viewing. Similarly cine viewing and MPRs
• Scan long volumes in practical times scan and thereby avoids multiple exposures to a patient.
8
Quarter Second CT
CARDIAC IMAGING
This article will explain the principles of prospective
Introduction ECG-triggered sequential scanning and retrospective ECG-
For the diagnosis of coronary artery disease, the Electron
gated spiral scanning with SOMATOM Plus 4 Volume
Beam CT (EBCT) used to be considered as the non-invasive
Zoom. To indicate the potential of “Quarter Second CT“ for
imaging modality, which has the potential to image the
the current and future cardiac imaging applications, the
coronary arteries for diagnostic and follow-up purposes in
first clinical results of calcium imaging and high resolution
addition to the common application of calcium scoring CT Angiography examinations of the coronary arteries will
([1], [2], [3], [4]). be presented.
tion to non-spiral scanning in ECG supported cardiac acquisition or reconstruction to the cardiac cycle, and the
investigations, 3D calcium scoring and contrast enhanced high temporal resolution. In addition, the data has to be
acquired within a single breath-hold with high 3D-resolution.
visualization of the coronary arteries using EBCT suffers
To achieve this, there are two different approaches des-
from sub-optimal volume coverage and restricted z-reso-
cribed as follows:
lution within a single breath-hold scan.
9
Quarter Second CT
ECG R R R
ECG R R R
Recon
t i
Z-Position
images Con an & Fe
(b) al Sc
Recon
Spir
Z-Position
(b)
Scan
Recon
Recon
Delay ECG
10 mm Feed
Scan
Delay
R R R R
R R R R ECG
Time Time
Fig. 1a: Principle of Prospectively ECG-Triggered Fig. 2a: Principle of Retrospectively ECG-Gated
Sequential Scanning. Spiral Scanning.
Fig. 1b: Multislice CT with Prospectively ECG-Triggered Fig. 2b: Multislice CT with Retrospectively ECG-Gated
Sequential Scanning. Spiral.
Compared to single slice CT and EBCT, the SOMATOM data that is used for image reconstruction (Figure 2a).
Plus 4 Volume Zoom acquires simultaneously 4 slices per This has already been applied to conventional single slice
prospective ECG-trigger. This provides two important CT scanners such as the SOMATOM Plus 4 with Sub-
clinical advantages: The scan time to cover heart anatomy second Cardio CT, and recent studies clearly indicated
over a 120 mm volume is reduced to about 15 sec, i.e. well the clinical validity of the method to study heart anatomy
within a single breath-hold (the exact time depends on virtually free of motion artifacts ([8]). The method was
the cardiac frequency). Further, the simultaneous acquisition observed to improve cardiac image quality compared to
of 4 adjacent slices effectively reduces the misregistration prospective ECG-triggering techniques due to reduced
of lesions (e.g. calcifications) due to significant motion of sensitivity to heart rate arrhythmia. However, in order to
the heart in the z-direction. get gap-less image reconstruction in Z-direction for diastolic
phase, an overlapping acquisition during spiral scan has to
The principle of sequential volume acquisition using a be applied. For a single slice system, it is difficult to cover
4-slice system combined with ECG-triggering is illustrated the entire heart within a practical scan time.
in Figure 1b.
With multislice spiral scanning, this has been improved.
• Retrospectively ECG-Gated Spiral Scanning The increased volume scan speed compared to a single
With this technique a continuous spiral scan is acquired with slice system easily limits the scan time to a single breath-
the ECG-signal recorded simultaneously. The scan data hold. Overlapping images (increment < slice width) that
is selected for image reconstruction with respect to a pre- are reconstructed at arbitrary z-positions provide volume
defined heart phase. Similar to ECG-triggered sequential images with improved z-resolution in predefined but
scanning a certain R-peak delay defines the start point of selectable heart phases. From the continuous multislice
10
Overline
spiral data set, data is retrospectively selected for recon- ent cycles.The pitch has to be selected according to the
struction by definition of a certain phase specific time delay minimum heart rate that is expected during the scan. We
relative to the R-peaks. 3D images can be reconstructed define the spiral pitch as table feed per full rotation norma-
in incrementally shifted heart phases from the same spiral lized to the width of one slice of the multi slice detector
data set to produce a “4D“ series that covers a complete (e.g. if the slice collimation is 4 x 1 mm, and the table feed
heart cycle.
per rotation is 2 mm, then pitch = 2). For normal heart
rates (~ 60-100 bpm) pitch values in the range of 1.5 to 2.5
For the SOMATOM Plus 4 Volume Zoom, a new spiral
have to be used.
reconstruction algorithm dedicated for Cardiac imaging has
been developed for multislice scanning, and this is opti-
The significant improvement in scan speed with multi slice
mized to improve the temporal resolution and image quality
of the beating heart. For cardiac multislice investigations, technology can be used for a reduction of the slice colli-
a low spiral pitch value is required in order to produce gap- mation for high z-resolution imaging. With 4 x 1 mm colli-
less volume reconstruction for a dedicated cardiac phase. mation and 500 msec rotation time the usual scan time for
This may result in a degradation of temporal resolution. a high resolution cardiac spiral scan is 25-30 sec – still
Therefore we developed a new partial scan based spiral within a single breath-hold. With these parameters, retro-
reconstruction approach optimized for multislice techno- spective spiral ECG-gating is a well-suited scan technique
logy which provides appropriate temporal resolution. for CT angiography of the coronary arteries.
• Calcium scoring
An example for the accumulation of volume image data
Based on the experience with EBCT, the evaluation of cal-
from stacks of axial images (shaded stacks) in consecutive
cified plaques in the coronary arteries using the established
heart cycles is shown in Figure 2b. All image stacks are
“Agatston“ scoring procedure is considered to be the “tra-
reconstructed in the same relative heart phase. It shows
ditional“ cardiac CT application. Multislice scan technology
the 4 slices relative to the patient with increasing time. In
in combination with volume based evaluation methods
each stack, images are generated equidistantly in the z-axis
according to the selected image reconstruction increment. ([10]) now promises to provide a highly reproducible and
reliable tool for quantification of coronary atherosclerosis.
Figure 2b also indicates that for continuous volume cover- Coronary calcium scoring can be performed with both
age the spiral pitch needs to be adapted to the heart rate in presented scan techniques – ECG-triggered sequence and
order to avoid gaps in between the image stacks of differ- ECG-gated spiral.
11
Quarter Second CT
An appropriate scan protocol for sequential cardiac CT count them twice. 4-slice imaging considerably reduces
is as following: this probability. Moreover, EBCT is restricted to fixed mAs
• 4 x 2.5 mm collimation setting (67 mAs). With multislice CT the mAs setting can
• 2.5 mm slice width be adjusted to the patient’s obesity in order to provide
• 500 msec rotation appropriately low image noise for accurate calcium evalua-
• 250 ms temporal resolution tion for all patients. Figure 4 shows in a representative
• 140 kV example that only the SOMATOM Plus 4 Volume Zoom
• 20-40 mAs (depending on patient obesity) can provide appropriate image data for obese patients.
• 1.5 sec cycle time (actual value depends on heart rate)
• Z-coverage of 120 mm in 18 sec.
a b
Due to the very fast scan times, the entire heart can be
conveniently covered within a single breath-hold. 250 msec
temporal resolution combined with advanced trigger
algorithms provide virtually motion-free images also for
patients with accelerated heart rates (Figure 3).
12
Overline
For calcium imaging with ECG-gated spiral CT the following ECG-gated multislice spiral CT represents a quantum leap
scan parameters are usually used: in image quality of CT angiography of the coronary arteries.
• 4 x 2.5 mm collimation Volume images based on 3 mm slice width are already of
• 3 mm slice width higher quality than sequential CT data due to overlapping
• 1 mm reconstruction increment reconstruction with 1 mm slice increment.The fast scan
• 500 msec rotation speed even allows covering the heart with 4 x 1 mm colli-
• 250 ms temporal resolution mation within a single breath-hold time (10 cm in 25-35 sec).
• 140 kV 3D reconstructions with 1.25 mm slice width and sub-
• 20-40 mAs per slice (depending on patient obesity) millimeter increment provide data of unique quality for
• Pitch 1.5-2.5 (actual value depends on heart rate) visualisation of the coronary arteries.
• Z-coverage of 120 mm in 10-15 sec
Figure 6 proves the gain in z-resolution with 1 mm colli-
Figure 5 shows an image example in comparison with the mation versus 2.5 mm collimation. Figure 6a represents a
corresponding EBCT result. sagital MPR generated in diastole from 3 mm slices with
1 mm increment. For comparison the MPR in Figure 6b
shows an equivalent plane for a different patient with com-
a b
parable heart rate. This MPR is also generated in diastole
but is now based on 1.25 mm slices and 0.5 mm increment.
A significant improvement in z-resolution can be observed,
e.g. in the calcified LADs and in the valves.
b c
13
Quarter Second CT
14
Quarter Second CT
coronary angiography.
References
[1]: Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M, Detrano R (1990)
Quantification of Coronary Artery Calcium Using Ultrafast Computed Tomography.
J Am Coll Cardiol 15:827-832.
[2]: S. Achenbach, W. Moshage, D. Ropers, K. Bachmann (1998) Curved Multiplanar
Reconstructions for the Evaluation of Contrast-Enhanced Electron-Beam CT of the
Coronary Arteries. AJR 1998 170:895-899.
[3]: S. Achenbach, W. Moshage, D. Ropers, J. Nössen, WG. Daniel (1998) Value of
Electron-Beam Computed Tomography for the Non-Invasive Detection of High-Grade
Coronary Artery Stenoses and Occlusions. N Engl J Med 339:1964-71.
[4]: PA. Wielopolski, RJM. van Geuns, PJ. de Feyter, M. Oudkerk (1998) Coronary
Arteries. Eur. Radiol. 8:873-885.
[5]: SD. Flamm (1998) Coronary Artery Calcium Screening: Ready for Prime Time?
Radiology 208:571-572.
[6]: CR. Becker, A. Knez,TF. Jakobs, S. Aydemir, A. Becker, UJ. Schöpf, R. Brüning,
R. Haberl, MF. Reiser (1999) Detection and Quantification of Coronary Artery Calcification
with Electron-Beam and Conventional CT. Eur Radiol 9:620-624.
[7]: Ultrafast CT for Coronary Calcification (1991). Lancet 337:1449-50.
[8]: M. L. Bahner, J. Boese, A. Lutz, H. Wallschlaeger, J. Regn, K. Klingenbeck-Regn,
G. van Kaick (1999) Retrospectively ECG-gated Spiral CT of the Heart and Lung.
Fig. 7d: Fly through the right coronary artery – Eur Radiol 9:106-109.
The stent patency in the RCA. [9]: K. Klingenbeck, S. Schaller,T. Flohr, B. Ohnesorge (1999) Subsecond Multi-Slice
Computed Tomography: Basics and Applications.To be published in Eur J Radiol.
Data from Institute of Diagnostic Radiology, Klinikum Großhadern [10]: TQ. Callister, B. Cooil, SP. Raya, NJ. Lippolis, DJ. Russo, P. Raggi (1998) Coronary
15
Spiral CT
CLINICAL BENEFITS
Unfortunately this increased speed was neither fast enough
Conventional CT to allow an entire anatomic region to be acquired in a single
In conventional CT, images are acquired on a slice-by-slice
breath hold nor sufficiently quick to enable differentiation of
basis, typically during a 360° rotation of the x-ray tube
contrast enhancement phases.
and detector. This was originally due to the need to supply
power to the rotating part of the CT gantry and to transfer
scan data from the gantry to the image processor. The
length of the high voltage and data cables required for this
represented a limitation to rotation of only slightly more
Spiral CT
With the advent of Spiral CT, introduced with the
than 360°.
SOMATOM Plus in 1989, a full 360° scan was slashed to
only 1 second and interscan delay was eliminated.
Throughout the history of CT, there has been a constant
Spiral CT was undoubtedly the most important innovation
striving to reduce the time required for each image and for
in CT since CT’s introduction in the early 70’s.
the entire examination so as to acquire as many images as
possible per unit of time. This has resulted in ever-decreas-
In this mode of operation, the patient is continuously moved
ing scan times and shorter and shorter interscan delays
through the scan plane while the x-ray tube and detector
(i.e. the time lapse between the end of one scan and the
constantly rotate about the patient, emitting radiation and
beginning of the next).The restriction of having to rewind
collecting scan data. Slip rings are employed for power
power and data cables following each 360° rotation pre-
supply and data transfer. Special algorithms are utilized for
vented a reduction of the interscan delay beyond 1 second.
image reconstruction, which will be discussed in some
Still, even prior to Spiral CT, this did allow about 20 images
detail below.
to be acquired in only one minute in dynamic mode, as
opposed to, say, 10 images in standard mode.
Conventional CT Spiral CT
Standard:
– Longer cycle time
but instant display I.S.D* I.S.D
Dynamic:
– Fast acquisition
but delayed display
w/ I.S.D* w/o I.S.D
Fig.1: The use of dynamic scan modes permitted Fig. 2: Spiral CT eliminated interscan delay, allowing
interscan delay to be shortened to only 1 second. more images to be acquired per unit of time.
16
Spiral CT
A number of clinical benefits derive from the use of the • Slice misregistration (i.e. double acquisition of the same
Spiral CT technique: anatomy or gaps) cannot occur, assuming acquisition is
• Longer anatomic regions can be acquired during a single limited to single breath hold.
breath hold, decreasing the probability of patient motion,
which would degrade image quality. In addition thinner
slices may be acquired in the same time (due to “pitch“
which will be discussed below) and freely definable The Next Slice May Not Be The Next Slice
overlapping images can be reconstructed, improving the
detection of small lesions and the quality of post-pro-
cessed images.
• Smaller volumes of contrast media are required, a large
number of images can be acquired during each contrast
enhancement phase, and the differentiation of these
phases is facilitated.
17
Spiral CT
Table position
In contrast to conventional CT, however, the table is con-
tinuously moved during Spiral CT. As one can imagine, this Weighted Slice Interpolation
movement results in a widening of the selected, or nomi- Fig. 5: Data from two 360° rotations are interpolated
and then used to reconstruct an image at the desired
nal, slice thickness to what is referred to as the effective
table position.
slice thickness.The degree to which the slice is widened
depends on the speed with which the table is moved
through the scan plane during each rotation.This brings us
to the next concept: pitch. As compared to conventional CT, image noise is reduced
and image contrast is increased when wide algorithms are
utilized.This is because data points from a greater volume
Pitch is the relationship between table movement per rota-
are being used. Unfortunately, some of the data points
tion and nominal slice thickness. For example, let’s assume
are located quite some distance from the slice being recon-
a slice thickness of 2 mm and a table movement of 3 mm
structed. This results in a widening of the effective slice
per rotation. That results in a pitch of 1.5. With state of the
thickness of 27% at pitch 1and 120% at pitch 2! For that
art single detector Spiral CT scanners, one can employ a reason, one should not generally employ a wide algorithm
pitch of up to three. when pitch greater than one is used.
18
Spiral CT
Measured
data A minor disadvantage of slim algorithms is that noise is
increased by 16%. Offsetting this disadvantage is the fact
that, since the data points are only 180° apart, the tem-
Comple- poral, or time, resolution is half that of the rotation time.
mentary
data So for a rotation time of 750 ms, the temporal resolution is
375 ms when a slim algorithm is employed.
Table position
Slice
A benefit inherent to Spiral CT for post-processing is the
Fig. 6: Complementary data are generated from ability to reconstruct freely definable overlapping images.
measured data. Then the data from two half rotations
For instance, 3 mm slices may be reconstructed with 1 mm
are interpolated and used to reconstruct an image
at the desired table position. reconstruction increments, so images are reconstructed
every 1 mm, i.e. with an overlap of 67%. Such an overlap
will eliminate the “steps“ sometimes seen in the highly
absorbent anatomic structures of post-processed images.
As a result, the effective slice thickness of images recon- This inherent capability dramatically improves such clinical
structed with slim algorithms is virtually the same at pitch tools as cinematic image review, multiplanar reformatted
one and only 27% greater at pitch two, as compared to images, and 3D shaded surface display images. The ability
to acquire and reconstruct a large number of thin images
conventional CT images. For this reason, use of slim algo-
at peak contrast enhancement has also led to a number
rithms is to be recommended when pitch greater than
of clinical methods not available prior to the introduction
one is employed and when images are being acquired for
of Spiral CT, such as maximum intensity projection and
post-processing purposes, i.e. MPR, 3D SSD, MIP, VRT the volume rendering technique for the visualization of the
and virtual endoscopy. vasculature and virtual intra-lumenal procedures.
19
Spiral CT
Summary
Spiral CT, introduced with the SOMATOM Plus in 1989,
was the most important innovation in CT since its invention
50% Overlap
in the early 70s. Numerous clinical benefits can be derived
from Spiral CT, and these benefits can be increased through
Fig. 8: The quality of postprocessed images is dramati- a more thorough understanding of a number of interrelated
cally improved through the use of overlapping images. spiral parameters.
20
Case Study
PULMONARY EMBOLUS
Patient History • Patient position: Supine & Head first (her head was
raised considerably due to her shortness of breath).
A 72 years old female was admitted for Drainage of Hepatic
Abscess following surgery for Cholecystectomy, suddenly • 140 kV/240 mA/1 sec
happened an Acute onset of Shortness of breath, • 3 mm Slice Thickness
Tachycardia and Hypoxia. The patient had a previous history • 4.5 mm Feed (Pitch of 1.5)
of Pulmonary Embolus following a Total Knee Replacement. • AB40
The Provision Diagnosis was Acute Pulmonary Embolism. • Scanned Caudo-cranially (bottom to top)
• Images reviewed at 1.5 mm increment for MPR’s
• Contrast injection*: start delay 15 s, 120 mls I.V at
Techniques: a flow rate of 2.5 ml/s (the patient had dreadful veins).
Remarks:
The patient was unable to hold her breath at all, and we
were unable to inject at a higher rate due to the patient’s
lack of venous access. However, due to the fast speed of
Spiral CT, we were still able to obtain a reasonably “good“
study although it was not “Text Book“ perfect but still
provided us with the diagnosis required in a minimal time.
* The drugs and doses mentioned herein are consistent with the approval
labeling for uses and/or indications of the drug.The treating physician bears
the sole responsibility for the diagnosis and treatment of patients, including
but not limited to the parameters selected during image acquisition and
postprocessing and any drugs and doses prescribed in connection with
such use.
21
FAQ
Q When using DXP, why does the scan cancel Last Row:
automatically? Adaptive Filter – 1 = on, 0 = off
A Plus/S – If the tube cooling delay exceeds 300 seconds, MBH – 1 = on, 0 = off
the system will cancel the mode. This gives you the Balancing – 1 = on, 0 = off
opportunity to adjust the scan parameters to reduce Z-Profile Algorithm – W = wide, S = slim, I = slim 2
the cooling delay. Tube Position at Start of Scan – “Clock Hour Count“
Time Since Last Calibration – Hourly Count
Q Why doesn’t the system print my last film sheet? Image Display Format –
A Plus 4/AR Spiral – Go to Film/Settings Platform and be 0 = Original, 1 = Compressed, 2 = Briefed,
sure that Auto Change is answered YES. The film will 3 = Briefed & Compressed
change when a new patient is registered.
Plus/S/HiQS – Use the command EXP/END to close Q Why don’t the procedures run after the VB31F
the job and send the last sheet to the camera. software upgrade?
A Plus/S – Go into the procedure using PROC/MOD,
then remove any “Wait“ commands that are in the
procedure.
22
Overline
Q How can I have a Reference Topogram in the Q Can I delete selected patients or images
images? from the MOD?
A Plus 4/AR Spiral – First acquire the topogram, then put A All Systems – It is only possible to delete the entire
the active segment on the topogram. Go into Filming/ side of an MOD, not individual patients.
Interactive and click the RefTopo softkey. Scan the
patient and be sure auto-filming is turned ON during Q The system is not sending my films to the camera,
scanning.The images will be filmed with a small how can I correct this without rebooting.
topogram, the topogram will not be displayed on the A Plus 4/AR Spiral – Go to System/Run, click expo_init,
monitor. This will also work when reviewing the raw then GO. Go into the Job/Control and click Continue.*
data after the scanning is completed. Plus/S/HiQ – Type EXP/INIT, then type
Plus/S/HiQ – Go into DISPLAY, SET the Permanent EXP/CONTINUE.*
Topogram, the images will appear with a small topo-
Lisa Reid
gram in the upper right corner on the monitor and
CT Application Manager
the film.
* NOTE: This will work for any images you would like to save. For example; * NOTE: This may also need to be done it for some reason the camera is
images with ROI or Distance,Topograms with the lines, Magnified images, turned off, and then on again without re-booting the system.
etc..
23
THIS ISSUE’S AUTHORS
For “Multislice CT – For “The Clinical Benefits and For “Case Study: Pulmonary Emboli”
Basics and Applications” Interrelationships of Spiral CT”
Donna Press
Xiaoyan Chen, Stefan Schaller, George Savatsky Chief Radiographer
Thomas Flohr CT Marketing
CT Product Creation RAYSCAN IMAGING
Siemens AG The Hills Private Hospital
Siemens AG Medical Engineering 499 Windsor Road
Medical Engineering Siemensstrasse 1 Baulkham Hills NSW 2153
Siemensstrasse 1 91301 Forchheim, Germany Sydney, Australia.
91301 Forchheim, Germany
For “Top 10 Q & A”
IMPRESSUM
Published by International Distribution