True Dual Energy. Dr. Stefan Ulzheimer, Siemens Healthcare GmbH. DEfinitely Siemens
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1 DEfinitely Siemens True Dual Energy Dr. Stefan Ulzheimer, Siemens Healthcare GmbH International version. Not for distribution in the US. Unrestricted Siemens AG 2015 All rights reserved. The products/features (here mentioned) are not commercially available in all countries. Due to regulatory reasons their future availability cannot be guaranteed. Please contact your local Siemens organization for further details. Answers for life.
2 History SOMATOM DR Page 2 March 2014 H IM CR
3 History Since the introduction of the SOMATOM Definition, the number of annual publications on Dual Energy has skyrocketed from 0 to ~ Number of original article es Introduction of the SOMATOM Definition = Publications on Dual Energy with the SOMATOM Definition and Definition Flash Page 3 March 2014 H IM CR
4 Two steps ahead in Decision Making: Precise Dual Energy quantification Courtesy of UMM, Mannheim, Germany SOMATOM Force 80/Sn150kV, 90/Sn150kV, 100/Sn150kV min. rotation time 0.25s FOV B-detector: 350 mm collimations: 64x0.6mm, 128x0.6mm, 196x0.6mm 2d anti scatter grid 50% thicker tin filter ( 2) Vectron tubes (up to 1300mA) low noise Stellar Infinity detectors Page 4 March 2014 H IM CR
5 SOMATOM Definition Flash Dual Source Dual Energy (DE) DE with Selective Photon Shield Characterize, highlight and quantify material Selective Photon Shield II Dose-neutral compared to a single 120 kv scan Improved spectral separation high kv Attenuation B low kv Attenuation A Page 5 March 2014 H IM CR
6 SOMATOM Definition Flash/ SOMATOM Force Dual Source Dual Energy Conventional Dual Energy CT DE with Selective Photon Shield I and II Significant spectral overlap Limits energy separation Limits dose efficiency Minimized spectral overlap Up to 80% better energy separation Complete dose neutrality Page 6 March 2014 H IM CR
7 Technical realization of dual-energy CT Dual-Source CT Dual source CT Fast rotation (0.28 s), reliable imaging of moving organs Flexible choice of scan parameters (ma, pitch,...) to individually adapt radiation dose to the patient Selective Photon Shield Optional tin pre-filtration Improves spectral separation Makes dual energy dose-neutral equivalent to a 120 kv scan 15 x 104 S 1 : 80 kv 10 5 S 2 : 140 kv + SPS 80 kv 140 kv 140 kv + SPS 0.4 mm tin X-ray photon energy (kev) Page 7 March 2014 H IM CR
8 Technical highlight Best spectral separation in the market 100 kv / 140 kv Sn 90 kv / 150 kv Sn Up to 30% increased energy separation for better DE imaging outcomes Page 8 March 2014 H IM CR
9 Comparison Definition DS SE / Flash DE (DE composition 0.6) Definition DS SE standard Body Angio (120kV) Definition Flash DE 100kV/Sn140kV Ultravist NH 4 Cl Bone MgSO SD NaBr CTDI vol =8.65mGy 24.6 SD Noise & Contrast & Dose equivalent to single energy on Definition DS (for FAST body bone removal protocol) Page 9 March 2014 H IM CR
10 Proven Dose Neutrality Page 10 March 2014 Courtesy of Mayo Clinic Rochester, MN, U.S.A. H IM CR
11 Dual Energy Principle Many materials show different attenuation at different X-ray energies Different attenuation mechanisms: photo effect Compton effect X-ray absoprt tion 1.0E E E+00 E 2 E 1 Large increase for iodine Iodine solution Bone 1.0E-01 Small increase for bone X-ray energy / kev Attenuation change from low to high energy characterizes the material Energy-resolved CT can determine chemical composition Page 11 March 2014 H IM CR
12 Where does the infomation come from? 80kV CT-value 80 kv Iodine Bone IDENTITY 140kV 0 HU Blood Water HU Fat CT-value 140 kv Air 0 HU need stable CT values; excellent scanner calibration no separation for materials at same position in diagram CT and DECT are not sensitive to chemical binding Page 12 March 2014 H IM CR
13 Processing of DE data Clinical application: Separation of two materials Assume mixture of blood + Iodine and bone marrow + bone HU at 80 kv Iodine pixels Blood+Iodine Soft tissue Marrow+bone Separation line Bone pixels HU at 140 kv Bone 550 HU Iodine 425 HU 80kV Bone 400 HU Iodine 250 HU 140kV Additional postprocessing to improve classification at low HU numbers Page 13 March 2014 H IM CR
14 TwinBeam Dual Energy* in combination with carotid angiography reveals total occlusion of RIC and stenosis of LIC TwinBeam Dual Energy collimation: 64 x 0.6 mm scan time: 6 s scan length: 337 mm rotation time: 0.30 s tube setting: AuSn120 kv, 365 eff. mas CTDIvol: 7.65 mgy DLP: 279 mgycm Eff. Dose: 0.87 msv Unrestricted Siemens AG 2015 All rights reserved. Courtesy of University Hospital Erlangen-Nuremberg, Erlangen, Germany *TwinBeam Dual Energy is pending 510(k) clearance and is not yet commercially available in the United States Post processing software is under development. Not available for sale in the U.S. Page 14 March 2015 HC IM CR
15 Applications of Dual Energy CT Material Decomposition Material Labeling Material Highlighting body materials+ x low (HU) contrast agent x low (HU) x low (HU) contrast material map other body materials VNC body materials separation line common body material enhanced visualizatiuon x high (HU) x high (HU) x high (HU) Image Quality Improvement Optimum Contrast Monoenergetic Generic Material Differentiation Dual Energy Index ρ e /Z eff decomposition* * non product Page 15 March 2014 H IM CR
16 The first Urate Stone Courtesy of UMM, Mannheim, Germany heavy patient scanned at 90/Sn150kV perfect separation between uric acid stone and calcium Page 16 Jul-14 Bernhard Krauss Siemens AG H IM
17 Courtesy of Hospital Povisa, Vigo, Spain Page 17 Jul-14 Bernhard Krauss Siemens AG H IM
18 True Dual Energy CT Expand your clinical capabilities for Dual Source Dual Energy Gout Optimum Contrast Calculi Characterization Direct Angio Lung Analysis Virtual Unenhanced Rho/Z Monoenergetic Brain Hemorrhage Lung Nodules Monoenergetic Plus Hardplaque Display Heart PBV syngo DE Xenon syngo DE Musculoskeletal Bone Marrow Page 18 March October 2014 H IM CR H IM MK CRC
19 True Dual Energy DEfinitely Siemens Dual Spiral Dual Energy TwinBeam Dual Energy Dual Source Dual Energy SOMATOM Perspective SOMATOM Scope Power SOMATOM Definition AS SOMATOM Definition AS+ SOMATOM Definition Edge SOMATOM Definition Flash SOMATOM Force SOMATOM Definition AS+ SOMATOM Definition Edge Unrestricted Siemens AG 2015 All rights reserved. Page 19 March 2015 HC IM CR
20 TwinBeam Dual Energy Improve patient outcome with TwinBeam Dual Energy Simultaneous acquisition of high and low energy spectra All dose reduction technologies applicable, such as CARE Dose4D, SAFIRE, ADMIRE, etc. Routine ready with FAST DE Results (direct transfer of Dual Energy images to the PACS) Unrestricted Siemens AG 2015 All rights reserved. Page 20 March 2015 *This feature is 510(k) pending. Not available for sale in the U.S HC IM CR
21 Single Source Dual Energy (SSDE) TwinBeam Spectrum in front of filter Moveable Split Filter Spectrum behind filter Low Energy High Energy Unrestricted Siemens AG 2015 All rights reserved. Page 21 March 2015 HC IM CR
22 TwinBeam Dual Energy Dose-neutrali DE 30cm phantom, default abdomen protocol, same dose Overall result: convenient workflow (one topo only, 50cm FOV) DE evaluation results typically better than Definition DS 120 kv Dose neutral: up to 40cm diameter less noise than 120kV all default scan protocols SE / TBDE have same dose TBDE Unrestricted Siemens AG 2015 All rights reserved. Page 22 March 2015 HC IM CR
23 True Dual Energy CT Expand your clinical capabilities for TwinBeam Dual Energy Gout Optimum Contrast Calculi Characterization Direct Angio Lung Analysis Virtual Unenhanced Rho/Z Monoenergetic Brain Hemorrhage Monoenergetic Plus Hardplaque Display Confidential Siemens AG All rights reserved. Page 23 March October 2014 H IM CR H IM MK CRC
24 TwinBeam Dual Energy Composed image C-Images (AuSn120kV) Good image quality Patient dose as in routine imaging = 5.5 msv Unrestricted For internal use Siemens only Siemens AG 2015 AG All 2014 rights All reserved. rights reserved. Page 24 March October Courtesy of Universitätsklinikum Erlangen, Radiology Department H IM HC CR IM MK CRP
25 Bone removal with TwinBeam Dual Energy* shows infra-renal abdominal aortic aneurysm (AAA) TwinBeam Dual Energy collimation: 64 x 0.6 mm scan time: 44 s scan length: 1534 mm rotation time: 0.33 s tube setting: AuSn120 kv, 301 eff. mas CTDIvol: 6.44 mgy DLP: mgycm Eff. dose: 8 msv Dual Energy run off with bone removal shows excellent image quality Unrestricted Siemens AG 2015 All rights reserved. Page 25 March 2015 Courtesy of University Hospital Erlangen-Nuremberg, Erlangen, Germany *This feature is 510(k) pending. Not available for sale in the U.S. Post processing software is under development. Not available for sale in the U.S. HC IM CR
26 Thorax/abdomen scan TwinBeam Dual Energy delivers additional diagnostic information TwinBeam Dual Energy collimation: 64x0.6 mm scan time: 17.7 s scan length: 575 mm rotation time: 0.30 s tube setting: AuSn120 kv, 379 effective mas DLP: 480 mgycm CTDIvol: 8.09 mgy eff. dose: 7.2 msv Unrestricted Siemens AG 2015 All rights reserved. Page 26 March 2015 Rule out of pulmonary embolism in thorax/abdomen scan Courtesy of University Hospital Erlangen-Nuremberg, Erlangen, Germany *This feature is 510(k) pending. Not available for sale in the U.S. Post processing software is under development. Not available for sale in the U.S. HC IM CR
27 Perfusion Defect only 4s scan time; 55ml contrast agent scanned at 90/Sn150kV Courtesy of UMM, Mannheim, Germany Page 27 Jul-14 Bernhard Krauss Siemens AG H IM
28 TwinBeam Dual Energy* in Oncology showing a hypodense lesion in the liver and the right kidney TwinBeam Dual Energy collimation: 64 x 0.6 mm scan time: 19.6 s scan length: 634 mm rotation time: 0.3 s tube setting: AuSn120 kv, 410 eff. mas CTDIvol: 8.8 mgy DLP: mgycm Eff. Dose: 8.7 msv Monoenergetic 70 kev Monoenergetic 50 kev VNC/iodine Fused Tumor evaluation with TwinBeam Dual Energy Unrestricted Siemens AG 2015 All rights reserved. Page 28 March 2015 Courtesy of University Hospital Erlangen-Nuremberg, Erlangen, Germany *TwinBeam Dual Energy is pending 510(k) clearance and is not yet commercially available in the United States. Post processing software is under development. Not available for sale in the U.S. HC IM CR
29 True Dual Energy CT Expand your clinical capabilities for Dual Spiral Dual Energy Gout Monoenergetic Calculi Characterization Bone Marrow Rho/Z (Liver VNC) Virtual Unenhanced Brain Hemorrhage Monoenergetic Plus Restricted Siemens AG 2014 All rights reserved. Page 29 March 2014 H IM CR
30 Gout evaluation with TwinBeam Dual Energy* TwinBeam Dual Energy collimation: 64 x 0.6 mm scan time: 8 s scan length: 218 mm rotation time: 0.5 s tube setting: AuSn120 kv, 298 eff. mas CTDIvol: 6.4 mgy DLP: 141 mgycm Eff. dose: 0.11 msv Unrestricted Siemens AG 2015 All rights reserved. Page 30 March 2015 Courtesy of Luzerner Kantonsspital, Luzern, Switzerland *This feature is 510(k) pending. Not available for sale in the U.S. Post processing software is under development. Not available for sale in the U.S. HC IM CR
31 Metal artifact reduction Dual Spiral Dual Energy acquisition mode for basic metal artifact reduction SOMATOM Definition Edge collimation: 128 x 0.6 mm spatial resolution: 0.30 mm scan time: 11.0 s scan length: 414 mm rotation time: 0.5 s tube setting: 80/140 kv, 600/142 mas CTDIvol: 11.07/14.39 mgy DLP: 482/629 mgy cm Eff. Dose: 7.20/9.40 msv Monoenergetic imaging with excellent image quality Unrestricted Siemens AG 2015 All rights reserved. Page 31 March 2015 Courtesy of LMU Grosshadern, Munich, Germany HC IM CR
32 SOMATOM Force Dual Energy New Dual Energy Contrasts - Bone Marrow Edema/Fat SOMATOM Force collimation: 2x 192 x 0.6 mm spatial resolution: 0.24 mm rotation time: 0.25 s tube setting: 90/150 kv CTDI 9.9 DLP 350 Precise DE information also in heavier patients Restricted Unrestricted Siemens AG AG All All rights reserved. Page 32 April 2014 Courtesy of LMU Großhadern, Germany P. Aulbach
33 Spectral Resolution previous scanners 15mg/ml Ultravist 20ml / 20mm diameter 20cm water phantom * research license required Page 33 Jul-14 Bernhard Krauss Siemens AG H IM
34 Dual Energy workflow improvement FAST DE Results: Direct transfer of Dual Energy results from scanner to PACS. Filter Type DE Mono 40 kev DE Mono <70 kev DE Mono 50 kev DE Mono >100 kev DE Mono 70 kev DE Mixed DE Mono 100 kev DE Iodine DE Mono 120 kev DE VNC DE Mono 140 kev DE Iodine+VNC DE Mono 190 kev DE Optimum Contrast PACS Page 34 March 2014 H IM CR
35 DEfinitely Siemens True Dual Energy Computed Tomography. Copyright Siemens AG All rights reserved. International Version. Not for distribution in the U.S. This product is 510(k) pending. Not available for sale in the U.S. Answers for life.
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