Professional Documents
Culture Documents
Spirit
Application Guide
Protocols
Principles
Helpful Hints
User Documentation 12
Dose Information 36
Workflow Information 56
Head 126
Neck 146
Shoulder 150
Thorax 154
Abdomen 168
Spine 182
Pelvis 196
3
Lower Extremities 212
Vascular 220
Specials 238
Children 250
4
5
Contents
User Documentation 12
Dose Information 36
• CTDIW and CTDIVol 36
• ImpactDose 38
• Effective mAs 39
• CARE Dose 4D 41
- How does CARE Dose 4D work? 42
- Special Modes of CARE Dose 4D 46
- Scanning with CARE Dose 4D 47
- Adjusting the Image Noise 49
- Activating and Deactivating 51
- Conversion of Old Protocols into Protocols
with CARE Dose 4D 52
- Additional Important Information 54
6
Contents
Workflow Information 56
• Workflow 56
- Registration 56
- API Language 58
- Recon Jobs 60
- Patient Position 61
- Auto Reference Lines 61
- Navigation within the Topogram 62
- Scan Time Indication 63
- Study Continuation 64
- Auto Load in 3D/Post-processing
Presets 65
- End Exam Information 66
• e - Logbook 68
- e- Logbook Configuration 69
- e- Logbook information 72
- e- Logbook Browser 73
• How to Create your own Scan Protocol 74
- Edit/Save Scan Protocol 74
- Scan Protocol Assistant 76
• Contrast Medium 94
- The Basics 94
- IV Injection 97
- Bolus Tracking 98
- Test Bolus using CARE Bolus 100
- Test Bolus 101
7
Contents
Head 126
• Overview 126
• Hints in General 127
• HeadRoutine 128
• HeadSeq 130
• HeadSeqCM 132
• InnerEar 134
• InnerEarHRSeq 136
• Sinus 138
• SinusSeq 140
• Orbita 142
• Dental 144
Neck 146
• Overview 146
• Hints in General 147
• Neck 148
Shoulder 150
• Overview 150
• Hints in General 151
• Shoulder 152
Thorax 154
• Overview 154
• Hints in General 155
• ThoraxRoutine/ThoraxRoutine08s 158
• ThoraxFast 160
• ThoraxHRSeq 162
• LungLowDose 164
Abdomen 168
8
Contents
• Overview 168
• Hints in General 169
• AbdomenRoutine/AbdomenRoutine08s 171
• AbdomenFast 174
• AbdMultiPhase/AbdMultiPhase08s 177
• AbdomenSeq 180
Spine 182
• Overview 182
• Hints in General 183
• C-Spine 186
• C-SpineSeq 188
• Spine 190
• SpineSeq 192
• Osteo 194
Pelvis 196
• Overview 196
• Hints in General 197
• Pelvis 198
• Hip 200
• SI_Joints 202
9
Contents
Vascular 220
• Overview 220
• Hints in General 221
• HeadAngio/HeadAngio08s 222
• CarotidAngio/CarotidAngio08s 224
• ThorAngio/ThorAngio08s 227
• Embolism 229
• BodyAngioRoutine/BodyAngioRoutine08s 231
• BodyAngioFast 234
Specials 238
• Overview 238
• Trauma 240
• PolyTrauma 242
• HeadTrauma 244
• HeadTraumaSeq 245
• Biopsy 247
• TestBolus 248
Children 250
• Overview 250
• Hints in General 252
• HeadRoutine 258
• HeadSeq 260
• InnerEar 264
• InnerEarSeq 266
• SinusOrbi 268
• Neck 270
• ThoraxRoutine 272
• ThoraxHRSeq 275
• Abdomen 277
• Spine 279
• ExtrRoutineHR 281
• HeadAngio 283
• HeadAngio08s 285
• CarotidAngio 287
• CarotidAngio08s 289
10
Contents
• BodyAngioRoutine 291
• BodyAngioRoutine08s 293
• BodyAngioFast 295
• NeonateBody 297
11
User Documentation
12
User Documentation
13
Scan and Reconstruction
14
Scan and Reconstruction
Scan Set Up
Scans can be simply set up by selecting a predefined
examination protocol. To repeat any mode, just click
the chronicle with the right mouse button for “repeat”.
To delete it, select “cut“. Each range name in the chron-
icle can be easily changed before “load“.
Multiple ranges can be run either automatically with
“auto range“, which is denoted by a bracket connecting
the two ranges, or separately with a “pause” in
between.
Up to 19 scan ranges can be combined to an auto
range.
10 mm
15
Scan and Reconstruction
Topo Length
SOMATOM Spirit
Length [mm] 128, 256, 512, 768, 1024
Slice width [mm] 2x1
Angle Top, Lateral
16
Scan and Reconstruction
Scan Modes
Sequential Scanning
This is an incremental, slice-by-slice imaging mode in
which there is no table movement during data acquisi-
tion. A minimum interscan delay in between each
acquisition is required to move the table to the next
slice position.
Spiral Scanning
Spiral scanning is a continuous volume imaging mode.
The data acquisition and table movements are per-
formed simultaneously for the entire scan duration.
There is no interscan delay and a typical range can be
acquired in a single breath hold.
Each acquisition provides a complete volume data set,
from which images with overlapping slices can be
reconstructed at any arbitrary slice position. Unlike the
sequence mode, spiral scanning does not require addi-
tional radiation to obtain overlapping slices.
17
Scan and Reconstruction
Quick Scan
The data is usually acquired during a full 360° rotation
– this is a Full scan. Data acquisition that does not use
a full 360° rotation is called a “Quick scan”. Quick scans
are employed to reduce motion artifacts and improve
the temporal resolution.
Dynamic Multiscan
Multiple continuous rotations at the same table posi-
tion are performed for data acquisition. Normally, it is
applied for fast dynamic contrast studies, such as Per-
fusion CT. The increment represents the time between
reconstructed images, e.g. if the increment is 1.0 sec.,
then one image will be reconstructed every second.
The image order can be defined on the Recon subtask
card.
Dynamic Serioscan
Dynamic serial scanning mode without table feed.
Dynamic serio can still be used for dynamic evaluation,
such as Test Bolus. The image order can be defined on
the Recon subtask card.
18
Scan and Reconstruction
Detector
The detector configuration with the routine acquisi-
tion:
19
Scan and Reconstruction
20
Scan and Reconstruction
Sequence Mode
21
Scan and Reconstruction
Increment
The increment is the distance between the recon-
structed images in the Z direction. When the increment
chosen is smaller than the slice thickness, the images
are created with overlap. This technique is useful to
reduce partial volume effect, giving you better detail of
the anatomy and high quality 2D and 3D post-process-
ing.
Slice Thickness = 10 mm
Increment = 3 mm
Increment = 10 mm Increment = 5 mm
Reconstruction Increment
22
Scan and Reconstruction
Pitch
In single slice CT:
Pitch = table movement per rotation/slice collimation
E.g.,: slice collimation = 5 mm,
table moves 5 mm per rotation, then pitch = 1.
With the Siemens Multislice CT, we differentiate
between:
Feed/Rotation, the table movement per rotation
Volume Pitch, table movement per rotation/single
slice collimation.
Pitch Factor, table movement per rotation/complete
slice collimation.
E.g., slice collimation = 2 x 5 mm,
table moves 10 mm per rotation,
then Volume Pitch = 2, Pitch Factor = 1.
23
Scan and Reconstruction
Pitch Models
24
Scan and Reconstruction
Window values
The Scale of the CT Hounsfield Units is from -1024 to
+3071.
The displayed window values have to correspond to
the anatomical structure.
Windowing is used to optimize contrast and brightness
of images.
Window Window
width W center C
black
CT-window values
Blood Liver
Tumor
Spleen Kidneys Heart
Breast
Fat
Air Lung
25
Scan and Reconstruction
Kernels
There are 4 different types of kernels: “H“ stands for
Head, “B“ stands for Body, “C“ stands for ChildHead and
”S” stands for Special Application, e.g. Osteo CT.
The image sharpness is defined by the numbers – the
higher the number, the sharper the image; the lower
the number, the smoother the image.
Head Kernels:
Kernel description
H21s smooth
H31s medium smooth
H41s medium
H50s medium sharp
H60s sharp
H70s high res
H80s ultra high res
U90s ultra high res
26
Scan and Reconstruction
Body Kernels:
Kernel description
B20s smooth
B31s medium smooth
B41s medium
B50s medium sharp
B60s sharp
B70s high res
U90s ultra high res
Kernel description
C20s smooth
C30s medium smooth
C60s sharp
Special Application:
Kernel description
S80s Shepp-Logan with notch filter
27
Scan and Reconstruction
Extended FoV
The SOMATOM Spirit offers the extended field of view.
The range can be individually adapted by the user from
50 cm up to 70 cm.
To use this feature you have to select the Extended
FoV combo list box on the Recon subtask card. The
default setting is 65 cm, but can be modified.
Extended FoV can be used with each scan protocol,
except for head protocols and biopsy mode.
The extended FoV value should be adapted carefully
to the exact patient size in order to achieve best possi-
ble image quality outside the standard scan field.
28
Scan and Reconstruction
Auto-FoV
After scanning a topogram the available ranges are dis-
played in the topo segment. They can be automatically
adapted according to the patient contours. When mov-
ing the scan range over the topogram and press the
"ctrl" key simultaneous, the adaptation will be done
automatically. Please make sure, that the whole object
is covered within the default FoV.
In case the FoV is too small, please press the "ctrl" key
and move the scan range over the object once, and it
will be adapted automatically.
The Auto-FoV will also work with the snap function,
when an examination has two or more ranges. The
snap function will also cover the Auto-FoV and there-
fore you have the possibility to merge different ranges.
To be able to use the snap function, it is necessary to
have the same FoV and the same x and y coordinates
for all available ranges.
Do not use Auto-FoV for asymmetric objects (e.g. only
one arm within the scan field).
29
Scan and Reconstruction
Hints
• When positioning the arms along the body, the Auto-
FoV will also cover the arms.
• When scanning two extremities at the same time,
the Auto-FoV will also cover both extremities.
30
Scan and Reconstruction
Head Imaging
The head protocols provide significant improvements
regarding image quality for heads. An automatic bone
correction algorithm has been included in the standard
image reconstruction. Using a new iterative technique,
typical artifacts arising from the beam hardening
effect, e.g., Hounsfield bar, are minimized without any
additional post-processing. This advanced algorithm
allows for excellent images of the posterior fossa, but
also improves head image quality in general. Bone cor-
rection is activated automatically for body region
"Head". The reconstruction algorithm for "Head" also
employs special adaptive convolution kernels which
allow for improving the sharpness to noise ratio. More
precisely, anatomic contours are clearly displayed
while noise is suppressed at the same time without
causing a blurring of edges.
31
Scan and Reconstruction
32
Scan and Reconstruction
Image Filters
There are 3 different filters available:
LCE: The Low-contrast enhancement (LCE) filter
enhances low-contrast detectability. It reduces the
image noise.
• Similar to reconstruction with a smoother kernel
• Reduces noise
• Enhances low-contrast detectability
• Adjustable in four steps
• Automatic post-processing
33
Scan and Reconstruction
34
Scan and Reconstruction
35
Dose Information
36
Dose Information
37
Dose Information
ImpactDose
For most of our scan protocols, we calculated the
effective dose numbers for standard male1) and
female1) and listed the result in the description of each
scan protocol.
The calculation was done by the commercially avail-
able program "ImpactDose" (Wellhoefer Dosimetry).
For pediatric protocols, we used the ImpactDose calcu-
lation and the correction factors published in "Radia-
tion Exposure in Computed Topography 2), in which
there are only the conversion factors for the age of 8
weeks and 7 years old available.
38
Dose Information
Effective mAs
In sequential scanning, the dose (Dseq) applied to the
patient is the product of the tube current-time (mAs)
and the CTDIw per mAs:
Dseq = DCTDIw x mAs
In spiral scanning, however, the applied dose (Dspiral) is
influenced by the “classical“ mAs (mA x Rot Time) and
in addition by the Pitch Factor. For example, if a Multi-
slice CT scanner is used, the actual dose applied to the
patient in spiral scanning will be decreased when the
Pitch Factor is larger than 1, and increased when the
Pitch Factor is smaller than 1(for constant mA). There-
fore, the dose in spiral scanning has to be corrected by
the Pitch Factor:
Dspiral = (DCTDIw x mA x Rot Time)
Pitch Factor
39
Dose Information
40
Dose Information
CARE Dose 4D
CARE Dose 4D is an automatic exposure control which
includes automatic tube current adaptation to the
patient’s size and anatomic shape together with an on-
line controlled tube current modulation for each tube
rotation. This provides well balanced image quality at
low radiation dose levels.
Based on a single a.p. or lateral Topogram, CARE Dose
4D determines the adequate tube current level for
every section of the patient. Based on these levels,
CARE Dose 4D modulates the tube current automati-
cally during each tube rotation according to the
patient’s angular attenuation profile. Thus, the best
distribution of dose along the patient’s long axis and
for every viewing angle can be achieved.
Based on a user defined Image Quality Reference
mAs CARE Dose 4D automatically adapts the (eff.) mAs
to the patient size and attenuation changes within the
scan region. With the setting of the Image Quality
Reference mAs you may adjust image quality (image
noise) to the diagnostic requirements and the individ-
ual preference of the radiologist.
Note: The Image Quality Reference mAs should not
be adjusted to the individual patient size!
Hint: Position the patient in the center of the scan field
to ensure optimal image quality and minimal dose.
41
Dose Information
Lateral
Attenuation (log)
Scan Range
42
Dose Information
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43
Dose Information
slice position
44
Dose Information
45
Dose Information
46
Dose Information
47
Dose Information
48
Dose Information
49
Dose Information
50
Dose Information
51
Dose Information
52
Dose Information
53
Dose Information
X-ray tube
Patient
(centered)
Detector
X-ray tube
Patient
(not centered)
Detector
X-ray tube
Patient
(not centered)
Detector
54
Dose Information
55
Workflow Information
Workflow
Registration
If you don’t want to insert a patient’s first name, the
entry first name can be hidden in Patient Registration
Dialog.
You can configure this entry under Options > Config-
uration > Examination. If "Display of first name field"
is unchecked, the entry "First name" in the Patient
Registration Dialog will be hidden and the entry "Last
name" will be renamed to "Name".
56
Workflow Information
57
Workflow Information
API Language
The API language can now be selected directly in
Patient Model Dialog.
58
Workflow Information
Before recording a new API text, first define the API lan-
guage in the API setup dialog under Setup > API/Com-
ment Setup in the main menu.
59
Workflow Information
Recon Jobs
In the Recon subtask card, you can define up to 3
reconstruction jobs for each range with different
parameters, either before or after you acquire the data.
When you deselect all chronicle entries, all open recon
jobs will be automatically reconstructed after you click
on “Recon“. In case you want to add more than 3 recon
jobs, simply click the icon on the chronicle with the
right mouse button and select “delete recon job“ to
delete the one which has been completed, and then
one more recon job will be available in the Recon sub-
task card.
Note: What you delete is just the job from the display,
not the images that have been reconstructed. Once
reconstructed, these completed recon jobs stay in the
browser, until deleted from the hard drive.
Asynchronous reconstruction (several reconstruction
jobs are possible in the background).
60
Workflow Information
Patient Position
A default patient position can be linked and stored to
each scan protocol. The SIEMENS default protocols are
already linked to a default patient position
(Head first – supine).
If a scan protocol is selected and confirmed in the
Patient Model Dialog, the linked patient position
stays active until the user changes it, even if a scan pro-
tocol with different patient position is selected.
61
Workflow Information
62
Workflow Information
63
Workflow Information
Study Continuation
An existing study can be continued later on.
To load an existing study:
• Select the desired study in the Patient Browser.
• Select Register from the Patient drop down menu.
• The patient data is loaded in the Registration dialog.
The previous scan protocol is already preselected, but
it is also possible to select any desired scan protocol.
After the patient is registered, the patient is loaded
into the Examination card.
The already scanned ranges are listed. Between the
already scanned ranges and the new ranges following
chronicle entry is shown: Exam Continue <Patient
Position>.
If you want to continue a contrast media study the sys-
tem asks you if the next scan should be continued as a
non contrast scan instead.
• If you want to continue as a non contrast scan, the
chronicle entries for the new scan range is indicated
as a non contrast scan. (No injector symbol is
shown.)
If you continue a study as a contrast study, the chroni-
cle entries of the new scan range are indicated as a
contrast scan. (An injector symbol is shown.)
64
Workflow Information
65
Workflow Information
66
Workflow Information
67
Workflow Information
e - Logbook
You can start the e- Logbook from the End Exam
Information sub taskcard. The goal of e-Logbook is to
offer an effective and efficient functionality to process
exam information.
The e- Logbook consists of three components:
• The e- Logbook Configuration
• The e- Logbook information for a specific patient on
the End Exam Information subtaskcard
• The e- Logbook Browser, where all examinations
can be listed for viewing, sorting, searching and
printing
68
Workflow Information
e- Logbook Configuration
You will find the e- Logbook Configuration under
Options >Configuration >e- Logbook configuration.
The configuration is divided into two tab cards:
• General
• Entries
69
Workflow Information
70
Workflow Information
71
Workflow Information
e- Logbook information
When the exam is ended, the Exam Information win-
dow is shown. If you click the e-Logbook bar in the
Exam Information sub taskcard, the information will be
hidden .
72
Workflow Information
e- Logbook Browser
You will find the e- Logbook Browser under Patient >
e- Logbook.
First you have to define the date range of examina-
tions. Additionally you can define specific search crite-
ria.
The listed examinations can be viewed,printed and
exported as txt and excel files.
73
Workflow Information
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Workflow Information
75
Workflow Information
76
Workflow Information
Hints
• Each workflow consists of up to five steps, indicated
by the footprints.
• Depending on the workflow step you can list all scan
protocols or all selected scan protocols. The
<Export> button exports the listed scan protocols in
MS Excel recognizable format.
The export file is always created in H:\SiteData\proto-
cols folder. The folder selection cannot be changed.
• The section "Change Parameters" and all its subsec-
tions are preselected as default.
• Depending on the selected workflow in Step 1, the
Scan protocol Assistant leads you through the corre-
sponding steps.
• From step 3 an <Undo> and <Redo> button are
added. Both buttons only affect the last operation.
• You can navigate through the selected workflow via
the footprints or with the "Back" and "Next" buttons.
With the "Quit" Button you can leave the Scan Proto-
col Assistant at any time without any changes
saved.
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Workflow Information
Step 3 - Confirmation
Here you can check the modifications and save the
changes. The indicated texts in the confirmation page
will be different according to the varied workflow.
Step 4 - Changes saved
In this step you can decide if you want to pass a differ-
ent modification workflow or if you want to exit the
Scan Protocol Assistant.
78
Workflow Information
Change parameters
This workflow consists of five steps.
79
Workflow Information
Protocol
Select single scan protocol or all scan protocols you
want to modify in this subsection.
In the subsection Protocol the following changes can
be made:
– Protocol Name
This entry is only available in single protocol selec-
tion. Here you can rename your scan protocol.
– Default Patient Position
Enter the patient position you want to have as
default displayed in the Patient Model Dialog.
– Auto reference Lines
Select where you want to have displayed the Auto
reference lines:
• On study level
• On series level
• Off
– Body region
Select in which body region the scan protocol should
be saved and displayed in the Patient Model dialog.
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Workflow Information
Topogram
Select single scan protocol or all scan protocols you
want to modify in this subsection.
In the subsection topogram the following changes can
be made:
– mA
Set the mA value for the topogram.
– Topogram length
All available topo lengths are listed in the dropdown
list.
– Tube position
Set the tube position either to Top or Lateral.
– API
Select one of the predefined breathing commands
from the dropdown list.
– Scan direction
Select Head to Feed or Feed to Head from the drop-
down list.
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Workflow Information
Scan
Select single scan protocol or all scan protocols you
want to modify in this subsection. Additionally you can
select the scan mode entries:
– Sequence
– Spiral
– Multiscan
The displayed parameters depend on the selection you
have made.
• If no special scan mode is selected, the so called
mixed mode is active. The mixed mode means the
user can choose scan ranges from two different
modes(spiral, sequence, or multiscan modes). If the
control in one mode is not applicable, the control in
mixed mode is not shown in <Parameters Area>.
A checkbox <Including topogram> is shown below
the parameter grid. When the checkbox is selected, an
information line for each is added to parameter grid.
The line is placed immediately before the ranges
belonging to topogram.
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Workflow Information
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Workflow Information
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Workflow Information
85
Workflow Information
Recon
Select single recon job or all recon jobs you want to
modify in this subsection. Additionally you can display
information about the scan range:
• When <include scan range information> is
selected, an information line for each scan range is
listed before the recon jobs belonging to this scan
range.
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Workflow Information
87
Workflow Information
AutoTasking
Select single recon job or all recon jobs you want to
modify in this subsection. Additionally you can display
information about the scan range:
• When "include scan range information" is selected,
an information line for each scan range is listed
before the recon jobs belonging to this scan range.
88
Workflow Information
State Color
valid white
changed & valid green
(after an action)
invalid yellow
read only gray
Step 4 - Confirmation
In this step the changed protocols are listed and the
changes have to be confirmed.
Step 5 - Changes saved
In this step you can decide if you want to pass a differ-
ent modification workflow or if you want to exit the
Scan Protocol Assistant.
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Workflow Information
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Workflow Information
91
Workflow Information
92
Workflow Information
Step 3 - Confirmation
In this step the changed protocols are listed and the
changes have to be confirmed.
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Workflow Information
Contrast Medium
The Basics
The administration of intravenous (IV) contrast mate-
rial during spiral scanning improves the visualization
and characterization of lesions, as well as the opacity
of vessels. The contrast scan will yield good results
only if the acquisition occurs during the optimal phase
of enhancement in the region of interest. Therefore, it
is essential to initiate the acquisition with the correct
start delay. Since multislice spiral CT can provide much
faster speed and shorter acquisition time, it is even
more critical to get the right timing to achieve optimal
results.
40 s scan 10 s scan
94
Workflow Information
2 ml/s, 120 ml, 300 mg I/ml 4 ml/s, 120 ml, 300 mg I/ml
Relative Enhancement [HU]
95
Workflow Information
96
Workflow Information
IV Injection*
The administration of a contrast medium depends on
the indication and on the delay times to be used during
the examination. The patients weight and circulatory
situation also play a role. In general, no more than 3 ml
per kg of body weight for adults and 2 ml per kg of
body weight for children should be applied.
For CTA studies (arterial phase), the principle is to keep
contrast injection for the whole scan. Thus, the total
amount of contrast medium needed should be calcu-
lated with the following formula:
CM = (start delay time + scan time) x flow rate.
CARE Bolus or Test Bolus may be used for optimal con-
trast bolus timing. Please refer to the special protocols.
To achieve optimal results in contrast studies, the use
of CARE Bolus is recommended. In case it is not avail-
able, use Test Bolus. Once completed, load images into
Dynamic Evaluation for calculation of Time to Peak
enhancement.
For multiphase examinations, e.g. three-phase liver,
the maximum start delay can be set to 600 sec. The
countdown of the delay always starts after scanning of
the previous phase.
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Workflow Information
Bolus Tracking
This is an automatic Bolus Tracking program, which
enables triggering of the spiral scanning at the optimal
phase of the contrast enhancement.
Additional Important Information
1.This mode can be applied in combination with any
spiral scanning protocol. Simply insert “Bolus Track-
ing” by clicking the right mouse button in the chron-
icle. This inserts the entire set up including pre-mon-
itoring, i.v. bolus and monitoring scan protocol. You
can also save the entire set up as your own scan pro-
tocol.
2.The pre-monitoring scan is used to determine the
position of the monitoring scans. It can be per-
formed at any position of interest. You can also
increase the mAs setting to reduce the image noise
when necessary.
3.To achieve the shortest possible spiral start delay
(2 s), the position of the monitoring scans relative to
the beginning of spiral scan must be optimized.
A “snapping” function is provided:
– After the Topogram is performed, the predefined spi-
ral scanning range and the optimal monitoring posi-
tion will be shown.
– If you need to redefine the spiral scanning range,
you should also reposition the monitoring scan in
order to keep the shortest start delay time (2 s). (The
distance between the beginning of the spiral scan-
ning range and the monitoring scan will be the
same).
– Move the monitoring scan line towards the optimal
position and release the mouse button, it will be
snapped automatically. (Trick: if you move the mon-
itoring scan line away from the optimal position the
“snapping” mechanism will be inactive).
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Workflow Information
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Workflow Information
100
Workflow Information
Test Bolus
This is a low dose sequential protocol without table
feed used to calculate the start delay of a spiral scan to
ensure optimal enhancement after the contrast
medium injection. The Dynamic Evaluation function
may be used to generate the time density curve.
You can find the “Test Bolus“ scan protocol in the chap-
ter “Specials“.
How to do it
1.Select the spiral mode that you want to perform, and
then “Append” the Test Bolus mode under Special
protocols.
2.Insert the Test Bolus mode above the spiral mode for
contrast scan by “cut/paste” (with right mouse but-
ton).
3. Perform the Topogram, and define the slice position
for Test Bolus.
4.Check the start delay, number of scans and cycle
time before loading the mode.
5.A Test Bolus with 10 – 20 ml is then administered
with the same flow rate as during the subsequent
spiral scan. Start the contrast media injection and
the scan at the same time.
6. Load the images into the Dynamic Evaluation func-
tion and determine the time to the peak enhance-
ment. Alternatively, on the image segment, click
“select series” with the right mouse button and posi-
tion an ROI on the first image. This ROI will appear
on all images in the test bolus series. Find the image
with the peak HU value, and calculate the time
“delta t” taken to reach the peak HU value (do not
forget to add the preset start delay time). This time
can then be used as the optimal start delay time for
the spiral scan.
101
Application Information
SOMATOM LifeNet
General Information
SOMATOM LifeNet is our information and service por-
tal directly at the scanner consoles, the Navigator and
the Wizard. It provides actual news around your scan-
ner, shows helpful configuration information of your
system and enables you to access the SOMATOM
LifeNet online area where you will find further oppor-
tunities to ease your daily work.
To benefit from the SOMATOM LifeNet online area, a
Siemens Remote Service connection is required. The
SOMATOM LifeNet online area allows you to order
90 day Trial Licenses for free, download application
guides or find interesting information and services
related to your CT system.
Note: Siemens Remote Service is part of your service
contract and is also prerequisite for other services for
your CT system that optimize your system's capability.
102
Application Information
Key Features
SOMATOM LifeNet offline (All users):
• General Information about your system and configu-
ration
• Access to Web Based E-Training or Manuals on CD
ROM
SOMATOM LifeNet online (In combination with a Sie-
mens Remote Service connection):
• Newsticker archive and FAQ (frequently asked ques-
tions) section
• Free trial software order and installation
• Download of information, manuals and scan proto-
cols
• A contact function for an easy and fast interface to
Siemens including the possibility to attach up to two
DICOM images
103
Application Information
104
Application Information
105
Application Information
106
Application Information
Download of Files
Each download will be performed in the background
and even if you disconnect your SOMATOM LifeNet
online session and start to work with the CT scanner, it
will continue the process until the download is com-
pleted. Due to bandwidth restrictions it is only possible
to perform one download at a time.
Note: Depending on your connection speed the down-
load of larger files like e.g. the Advanced Application
Training may take quite some time. Shutting down the
system in between will interrupt the download.
Downloaded PDFs can be found offline under Options/
File Browser/ H:\SiteData/Manuals.
107
Application Information
108
Application Information
109
Application Information
Contact Function
Contacting Siemens via Email is possible directly from
your scanner and even DICOM images can be attached
to your message. To attach an image, please select the
images first on your viewing card and export these
images to H:\SiteDate/ Offline as a Dicom image.
Also, see chapter Export Function for more informa-
tion.
After exporting the image, open the Siemens Extranet
and choose Contact. After entering your message you
can easily attach the image by selecting the images
from the File Browser with the shortcut CTRL and C and
paste it with the shortcut CTRL and V into the Extranet.
110
Application Information
111
Application Information
112
Application Information
113
Application Information
Image Converter
The CT Application Common DICOM Adapter provides
conversion between different DICOM data sets as they
may be provided by other CT vendors.
– You will find the converter in the Application menu
of the Patient Browser.
114
Application Information
After conversion you can load these data sets into the
application of your choice.
115
Application Information
File Browser
The File Browser provides you with a secure means of
accessing and managing data in a private folder, which
is a well defined part of the computer file system. This
user partition is strictly separated from the system
operating file system.
The user partition is shared read only and may be used
for transferring data from the scanner to other com-
puters, e.g., transferring DICOM images (export to
offline), transferring AVIs, or accessing files (PDF files)
which were downloaded via SOMATOM LifeNet.
Key Features
• Copy images and files to the CD Burn folder.
• Raw data transfer.
• Access to all created reports and movies (AVI files).
• Access to the offline folder.
• Access to downloaded files.
Open the File Browser via main menu entry Options >
File Browser.
The File Browser provides special folders for CT applica-
tions. The created reports and movies are saved within
these folders.
With an external PC connected you can access your
offline data on the external PC for post-processing.
116
Application Information
117
Application Information
Burn on CD:
• Do not burn files on CD-R parallel to other transfer
jobs.
• Make sure that the amount of data to be burned
does not exceed the CD-R storage capacity.
• Select the desired files and drag & drop them into the
folder Burn on CD (or send them via the right mouse
button menu to the folder Burn on CD).
• Open the LocalJobStatus in the Patient Browser and
clear all entries.
• Select Record to Offline in the Transfer menu of the
Patient Browser.
• CD burning starts.
Hint: CD burning of offline files is only possible in a
single session.
After successful burning the entries in the subdirectory
cdburn will be deleted automatically.
118
Application Information
119
Application Information
Camtasia
Camtasia is a separate software tool that allows you to
film your desktop activities. You can save these record-
ings as avi files for documentation and presentation
purposes.
Key features
• Camtasia Recorder: to capture avi files.
Before starting recording you can select the area you
want to capture.
120
Application Information
121
Application Information
122
Application Information
123
Application Information
Patient Protocol
124
Application Information
125
Head
Overview
– HeadRoutine
Spiral mode for routine head studies
– HeadSeq
Sequential mode for routine head studies
– HeadSeqCM
Sequential mode for head studies with and without
contrast medium
– InnerEar
Spiral mode for inner ear studies
– InnerEarSeq
Sequence mode for inner ear studies
– Sinus
Spiral mode for routine sinus studies
– SinusSeq
Sequence mode for routine sinus studies
– Orbita
Spiral mode for routine orbital studies
– Dental
Spiral mode used for the Dental studies
126
Head
Hints in General
• Topogram: Lateral, 256 mm.
• Patient positioning:
Patient lying in supine position, arms resting against
body, secure head well in the head holder, support
lower legs.
• Gantry tilt is available for both, sequence and spiral
scanning.
However, image artifacts may occur if spirals are
acquired with a tilt angle greater than 8°.
• For all head studies, it is very important for image
quality to position the patient in the center of the
scan field. Use the lateral laser beam to make sure
that the patient is positioned in the center.
• In order to optimize image quality versus radiation
dose, scans are provided within a maximum scan
field of 300 mm with respect to the iso-center. No
recon job with a field of view exceeding those limits
will be possible. Therefore, patient positioning has to
be performed accurately to ensure a centered loca-
tion of the skull.
Head Kernels
• For soft tissue head studies, the standard kernel is
H41s; softer images are obtained with H31s or H21s
sharper images with H50s.
• High resolution head studies should be performed
with H60s, H70s (e.g., for dental and sinuses) and
H80s (e.g., inner ear).
• It is mandatory to position the area of interest in the
center of the scan field.
127
Head
HeadRoutine
Indications:
Spiral mode for routine head studies, e.g., stroke, brain
tumors, cranial trauma, cerebral atrophy, hydroceph-
alus, and inflammation, etc.
Two ranges are predefined for the base of the skull and
cerebrum.
A range for the base of 4 cm will be covered in 23 sec.,
a range for the cerebrum of 8 cm will be covered in
27 sec.
128
Head
Base Cerebrum
kV 130 130
Effective mAs 110 110
Rotation time 1.5 sec 1.5 sec
Slice collimation 1.5 mm 2.5 mm
Slice width 3.0 mm 8.0 mm
Feed/Rotation 3.0 mm 5.0 mm
Pitch Factor 1.0 1.0
Increment 3.0 mm 8.0 mm
Kernel H31s H31s
CTDIVol 22.0 mGy 21.8mGy
Effective dose Male: Male:
0.39 mSv 0.64 mSv
Female: Female:
0.43 mSv 0.71 mSv
Hints
• An automatic bone correction allows for improved
head image quality, without any additional post-
processing.
• In order to optimize image quality versus radiation
dose, scans are provided within a maximum scan
field of 300 mm with respect to the iso-center. No
recon job with a field of view exceeding those limits
will be possible. Therefore, patient positioning has to
be performed accurately to ensure a centered loca-
tion of the skull.
129
Head
HeadSeq
Indications:
Sequence mode for routine head studies, e.g. stroke,
brain tumors, cranial trauma, cerebral atrophy, hydro-
cephalus, and inflammation, etc.
Two ranges are predefined. One for the base of the
skull and one for the cerebrum, the scan length for the
entire head is 11.9cm.
130
Head
BaseSeq CerebrumSeq
kV 130 130
Effective mAs 240 240
Rotation time 1.5 sec 1.5 sec
Slice collimation 1.5 mm 4.0 mm
Slice width 3.0 mm 8.0 mm
Feed/Scan 3.0 mm 8.0 mm
Kernel H31s H31s
CTDIVol 48.0 mGy 47.0 mGy
Effective dose Male: Male:
0.80 mSv 1.43 mSv
Female: Female:
0.90 mSv 1.51 mSv
Hints
• An automatic bone correction allows for improved
head image quality, without any additional post-
processing.
• In order to optimize image quality versus radiation
dose, scans are provided within a maximum scan
field of 300 mm with respect to the iso-center. No
recon job with a field of view exceeding those limits
will be possible. Therefore, patient positioning has to
be performed accurately to ensure a centered loca-
tion of the skull.
131
Head
HeadSeqCM
Indications:
Sequence mode for routine head studies, with and
without contrast medium, e.g. stroke, brain tumors,
and inflammation, etc.
Two ranges are for non contrast scan and two ranges
are for the scan with contrast medium are predefined.
One for the base of the skull and one for the cerebrum,
the scan length for the entire head is 12.3cm.
132
Head
BaseSeq CerebrumSeq
kV 130 130
Effective mAs 220 220
Rotation time 1.5 sec 1.5 sec
Slice collimation 2.5 mm 4.0 mm
Slice width 2.5 mm 8.0 mm
Feed/Scan 5.0 mm 8.0 mm
Kernel H31s H31s
CTDIVol 43.6 mGy 43.1 mGy
Effective dose Male: Male:
0.80 mSv 1.31 mSv
Female: Female:
0.89 mSv 1.38 mSv
Hints
• An automatic bone correction allows for improved
head image quality, without additional post-process-
ing.
• In order to optimize image quality versus radiation
dose, scans are provided within a maximum scan
field of 300 mm with respect to the iso-center. No
recon job with a field of view exceeding those limits
will be possible. Therefore, patient positioning has to
be performed accurately to ensure a centered loca-
tion of the skull.
133
Head
InnerEar
Indications:
Spiral mode for inner ear High Resolution studies, e.g.
inflammatory changes, tumorous processes of pyra-
mids, cerebellopontine angle tumors, post-traumatic
changes, etc.
A range of 2.5 cm will be covered in 22 sec.
134
Head
Hints
• For image reconstruction of soft tissue, use kernel
H31s.
• An automatic bone correction allows for improved
head image quality, without any additional post-
processing.
• In order to optimize image quality versus radiation
dose, scans are provided within a maximum scan
field of 300 mm with respect to the iso-center. No
recon job with a field of view exceeding those limits
will be possible. Therefore, patient positioning has to
be performed accurately to ensure a centered loca-
tion of the skull.
135
Head
InnerEarHRSeq
Indications:
Sequence mode for inner ear studies, e.g. inflamma-
tory changes, tumorous processes of pyramids, cere-
bellopontine angle tumors, post-traumatic changes,
etc.
A range of 2.5 cm will be covered in 37 sec.
InnerEarSeq
kV 130
Effective mAs 140
Rotation time 1.5 sec
Slice collimation 1.0 mm
Slice width 1.0 mm
Feed/Scan 2.0 mm
Kernel H80s
CTDIVol 28.4 mGy
Effective dose Male: 0.31 mSv
Female: 0.35 mSv
136
Head
Hints
• For image reconstruction of soft tissue, use kernel
H31s.
• An automatic bone correction allows for improved
head image quality, without any additional post-
processing.
• In order to optimize image quality versus radiation
dose, scans are provided within a maximum scan
field of 300 mm with respect to the iso-center. No
recon job with a field of view exceeding those limits
will be possible. Therefore, patient positioning has to
be performed accurately to ensure a centered loca-
tion of the skull.
137
Head
Sinus
Indications:
Spiral mode for paranasal sinuses studies, e.g., sinusi-
tis, mucocele, pneumatization, polyposis, tumor, cor-
rections etc.
A range of 8 cm will be covered in 42 sec.
138
Head
Hints
• For image reconstruction of soft tissue, use kernel
H31s.
• For low dose studies use only 20mAs.
139
Head
SinusSeq
Indications:
Sequential mode for paranasal sinuses studies, e.g.
sinusitis, mucocele, pneumatization, polyposis, tumor,
corrections etc.
A range of 4.2 cm will be covered in 29 sec.
140
Head
Hints
• For image reconstruction of soft tissue, use kernel
H31s.
• For low dose studies use only 20mAs.
141
Head
Orbita
Indications:
Spiral mode for orbital studies, e.g., fracture.
A range of 5 cm will be covered in 27 sec.
142
Head
Hints
• For image reconstruction of soft tissue, use kernel
H31s.
143
Head
Dental
This is the scan protocol for the syngo Dental applica-
tion package. It is used for evaluation and reformatting
of the upper and lower jaws.
It enables the display and measurement of the bone
structures of the upper and lower jaw as the basis for
planning in oral surgery.
Indications:
Spiral mode for dental studies.
A range of 5 cm will be covered in 27 sec.
Dental
kV 130
Effective mAs 45
Rotation time 1.0 sec
Slice collimation 1.0 mm
Slice width 1.0 mm
Feed/Rotation 2.0 mm
Pitch Factor 1.0
Increment 0.5 mm
Kernel H70s
CTDIVol 9.1 mGy
Effective dose Male: 0.11 mSv
Female: 0.11 mSv
144
Head
145
Neck
Overview
– Neck
Spiral mode for soft tissue routine neck studies
146
Neck
Hints in General
• Topogram: Lateral, 256 mm
• Patient positioning
Patient lying in supine position, hyperextend neck
slightly, secure head well in head holder.
• Patient respiratory instruction:
do not breathe, do not swallow.
• For contrast studies, CARE Bolus (Optional) may be
used to optimize the bolus timing.
• For image reconstruction of bone structure, use ker-
nel B60.
• Patient positioning is very important for artifact-free
images. The thoracic girdle should be positioned as
far as possible in the caudal direction. This can be
done using a strap with a permanent loop or Velcro
fastener at its end. The ends of the strap must be
attached to the patients wrists. Then the strap must
be wrapped around the patients feet with his legs
extended and under tension. The entire thoracic gir-
dle is thus pulled toward the patients feet.
Body Kernels
• As standard kernels for body tissue studies B31s or
B41s are recommended; softer images are obtained
with B20s.
• For higher sharpness, as is required e.g. in patient
protocols for cervical spine, shoulder, extremities,
thorax, the kernels B50s, B60s, B70s are available.
• In case of 3D study only, use kernel B20s and at least
50% overlapping for image reconstruction.
147
Neck
Neck
Indications:
For soft tissue spiral studies in the cervical region, e.g.
tumors, lymphoma, abscesses etc.
A typical range of 20 cm will be covered in 42 sec.
148
Neck
Neck
kV 130
Effective mAs 70
Rotation time 1.0 sec
Slice collimation 2.5 mm
Slice width 5.0 mm
Feed/Rotation 5.0 mm
Pitch Factor 1.0
Increment 5.0 mm
Kernel B50s
CTDIVol 6.5 mGy
Effective dose Male: 1.69 mSv
Female: 1.71 mSv
Hints
• Due to its iodine content, the thyroid gland is hyper-
dense in relation to the neighboring muscles both
before and after an IV CM injection. For displays of
the parotid, thyroid or the floor of the mouth, the
slice thickness should be < 5 mm and the length of
the range should be adapted to match the anatomic
region.
• Target the FoV to ensure adequate coverage of the
region of interest in the upper neck & middle neck
levels as well as to include the axilla in the lower neck
level if required.
149
Shoulder
Overview
– Shoulder
Spiral mode for bone shoulder routine studies
150
Shoulder
Hints in General
• Topogram: TOP, 256 mm.
• Patient positioning:
Patient lying in supine position, the uninjured arm
placed above the head, the injured arm placed flat
against his body.
• If only one side is examined, it is advisable to enter
the side examined in the comment line on the recon
card.
• Contrast medium is required for soft tissue mass
evaluation.
• To further optimize MPR image quality we recom-
mend that you reduce one or more of the following:
collimation, reconstruction increment, and slice
width for image reconstruction.
Body Kernels
• As standard kernels for body tissue studies B31s or
B41s are recommended; softer images are obtained
with B20s.
• For higher sharpness, as is required e.g. in patient
protocols for cervical spine, shoulder, extremities,
thorax, lung, the kernels B50s, B60s, B70s are avail-
able.
151
Shoulder
Shoulder
Indications:
Spiral mode for bone studies and soft tissue, e.g. eval-
uation of joint cavities, masses, trauma, dislocations,
orthopedic indications etc.
A scan range of 10 cm will be covered in 53 sec.
152
Shoulder
Hints
• Use raw data to review a target region if necessary.
• For image reconstruction of soft tissue use kernel
B31s and a slice width of 5.0 mm.
• Coronal and sagittal 2D planar reconstructions are
important for evaluation of the joint space & bursa
sacs in CT arthograms.
• 3D renderings are helpful for complex fractures &
dislocations.
153
Thorax
Overview
– ThoraxRoutine/ThoraxRoutine08s
Spiral mode for routine chest studies
– ThoraxFast
Spiral mode for fast chest studies
– ThoraxHRSeq
Sequential mode for high resolution lung studies
– LungLowDose
Spiral mode with very low dose for early visualiza-
tion of pathologies
154
Thorax
Hints in General
• Topogram: TOP, 512 mm.
• Patient positioning: Patient lying in supine position,
arms positioned comfortably above the head in the
head-arm rest, lower legs supported.
• Contrast medium administration: in general, IV
injections are employed in all mediastinal examina-
tions, but not in routine high resolution studies of
diffuse interstitial lung diseases. An IV contrast
medium injection improves the vascular opacifica-
tion and facilitates the visualization of the lesions,
lymph nodes and the vessels.
• Stasis of contrast medium in the arm & superior vena
cava often result in high density streak artifacts
either in the region of the aortic arch or in the region
of the subclavian vein. A caudo-cranial (bottom to
top) scanning direction should be used to reduce this
artifact, by simply acquiring the data in this region at
the later phase of the spiral scan. In addition, if the
patient cannot hold his/her breath for the duration of
the entire scan, breathing motion will be less appar-
ent in the apex than in the lower lobes.
• CARE Bolus (Optional) may be used to optimize the
bolus timing. Set the ROI for monitoring scan in the
aorta at the level of the diaphragm with triggering
threshold of 120 HU, or use manual triggering.
155
Thorax
156
Thorax
157
Thorax
ThoraxRoutine/
ThoraxRoutine08s
Indications:
Routine spiral studies for the region of thorax, e.g.
examination of tumors, metastases, lymphoma, lymph
nodes, vascular anomalies etc.
A range of 30 cm will be covered in 23/18 sec.
158
Thorax
ThorRoutine 2nd
reconstruction
kV 130
Effective mAs 60
Rotation time 1.0/0.8 sec
Slice 4.0 mm
collimation
Slice width 5.0 mm 5.0 mm
Feed/Rotation 14.4 mm
Pitch Factor 1.8
Increment 5.0 mm 5.0 mm
Kernel B41s B70s
CTDIVol 5.5 mGy
Effective dose Male: 2.86 mSv
Female: 3.56 mSv
Hints
• You could repeat the same protocol by simply click-
ing the chronicle with the right mouse button for
“repeat“, e.g., when both non-contrast and contrast
studies are required.
• For lung cancer evaluation, this protocol can be com-
bined with the protocol “Neck Routine”.
159
Thorax
ThoraxFast
Indications:
Fast spiral mode for lung studies, e.g. when a patient
has difficulty with breathhold.
A complete thorax scan in a range of 30 cm will be cov-
ered in 14 sec.
160
Thorax
Hints
• You could repeat the same protocol by simply click-
ing the chronicle with the right mouse button for
“repeat“, e.g., when both non-contrast and contrast
studies are required.
• For lung cancer evaluation, this protocol can be com-
bined with the protocol “Neck Routine”.
161
Thorax
ThoraxHRSeq
Indications:
Sequence mode for ThoraxHR lung studies, e.g. inter-
stitial changes in the lungs.
Images are acquired with a range of 30.1 cm.
162
Thorax
ThorHRSeq
kV 130
Effective mAs 100
Rotation time 1.0 sec
Slice collimation 1.0 mm
Slice width 1.0 mm
Feed/Scan 10.0 mm
Kernel U90s
CTDIVol 1.9 mGy
Effective dose Male: 0.94 mSv
Female: 1.12 mSv
Hints
• If you want to reconstruct thin slices every 15 or
20 mm instead of 10 mm as predefined, simply
change the Feed/Scan before loading the mode.
• With studies of interstitial changes in the lungs, con-
trast medium is not necessary.
163
Thorax
LungLowDose
Indications:
Spiral lung studies with low dose setting, e.g. early
visualization of pulmonary nodules.
A typical thorax study in a range of 30 cm will be cov-
ered in 19 sec.
164
Thorax
LungLowDose
kV 130
Effective mAs 18
Rotation time 1.0 sec
Slice collimation 5.0 mm
Slice width 6.0 mm
Feed/Rotation 18.0 mm
Pitch Factor 1.8
Increment 6.0 mm
Kernel B50s
CTDIVol 1.6 mGy
Effective dose Male: 0.88 mSv
Female: 1.10 mSv
165
Thorax
Hints
• You could repeat the same protocol by simply click-
ing the chronicle with the right mouse button for
“repeat“, e.g., when both non-contrast and contrast
studies are required.
• For lung cancer evaluation, this protocol can be com-
bined with the protocol “Neck Routine”.
• Low dose lung images are usually evaluated using
lung window setting. Soft tissue/bone window set-
tings may be used to detect the presence of calcifica-
tions in the nodules.
• It is essential to use the same protocol for follow-up
studies to check for progression.
• CARE Dose 4D is off as default because for LungLow-
Dose protocols, the lowest mAs values are used.
166
Thorax
167
Abdomen
Overview
– AbdomenRoutine/AbdomenRoutine08s
Spiral mode for routine abdominal studies
– AbdomenFast
Spiral mode for fast abdominal studies
– AbdMultiPhase/AbdMultiPhase08s
Spiral mode for three phase liver studies
– AbdomenSeq
Sequential mode for abdominal studies
168
Abdomen
Hints in General
• Topogram: TOP, 512.
• Patient positioning:
Patient lying in supine position, arms positioned
comfortably above the head in the head-arm rest,
lower legs supported.
• Patient respiratory instruction: inspiration.
• Oral administration of contrast medium:
For abdominal studies, it is necessary to delineate
the bowel from other structures such as lymph
nodes, abdominal masses & abscesses. Various types
of bowel opacifying agents can be used:
- Diluted barium suspension (1% – 2%) e.g., EZCAT
- Water soluble agent (2% – 4%) e.g., Gastrografin
- Water alone, as a negative contrast agent.
Timing of the oral contrast administration is impor-
tant to ensure its even distribution in the bowel.
Upper abdomen:
Minimum 600 ml of contrast divided into 3 cups
(approximately 200 – 250 ml)
1st cup to drink 30 minutes before exam
2nd cup to drink 15 minutes before exam
3rd cup to drink 5 minutes before exam
Abdomen – Pelvis:
Minimum 1000 ml of contrast divided into 4 cups
1st cup to drink 1hour before exam
2nd–4th cups every subsequent 15 minutes
Start exam 5 minutes after the 4th cup is adminis-
tered.
169
Abdomen
170
Abdomen
AbdomenRoutine/
AbdomenRoutine08s
Indications:
Spiral mode for all routine studies in the region of
abdomen, e.g., evaluation, follow-up examinations
etc.
A complete abdomen scan in a range of 20 cm will be
covered in 16/13 sec.
171
Abdomen
AbdRoutine
kV 130
Effective mAs 60
Rotation time 1.0/0.8 sec
Slice collimation 4.0 mm
Slice width 5.0 mm
Feed/Rotation 14.4 mm
Pitch Factor 1.8
Increment 5.0 mm
Kernel B41s
CTDIVol 5.5 mGy
Effective dose Male: 1.95 mSv
Female: 2.62 mSv
172
Abdomen
Hints
• You could repeat the same protocol by simply click-
ing the chronicle with the right mouse button for
“repeat“, e.g. when both non-contrast and contrast
studies are required.
• Delayed scans may be required for the kidneys &
bladder.
• If you want to use this protocol for a two-phase
study, repeat the same protocol as mentioned
above, and choose start delay time for arterial phase
as 20 - 25 sec. In this case, the thin slice reconstruc-
tion can also be used for post-processing. Do not
administer oral contrast medium, as this impairs the
editing of MIP/SSD/VRT images. Water could be used
instead if necessary.
• Water, rather than positive oral contrast agents
should be used. Give the last cup 200 ml just prior to
positioning the patient. To ensure adequate filling of
the duodenal loop, lay the patient on the right side
for 5 minutes before performing the topogram.
• A pre-contrast examination is usually performed
only if no CT scans were previously acquired, to
exclude calculi in the common bile duct and to visu-
alize possible lesions in the liver.
• For pancreatic studies, the arterial phase acquisition
can be acquired later with a start delay of 40 -50 sec.
It may be necessary to use a thinner collimation.
173
Abdomen
AbdomenFast
Indications:
Fast spiral mode for abdominal studies, e.g., when a
patient has difficulty with holding their breath.
A range of 20 cm will be covered in 9.6 sec.
174
Abdomen
AbdFast
kV 130
Effective mAs 70
Rotation time 0.8 sec
Slice collimation 5.0 mm
Slice width 8.0 mm
Feed/Rotation 20.0 mm
Pitch Factor 2.0
Increment 8.0 mm
Kernel B41s
CTDIVol 6.4 mGy
Effective dose Male: 2.37 mSv
Female: 2.98 mSv
175
Abdomen
Hint
• You could repeat the same protocol by simply click-
ing the chronicle with the right mouse button for
“repeat“, e.g. when both non-contrast and contrast
studies are required.
• Delayed scans may be required for the kidneys &
bladder.
• If you want to use this protocol for a two-phase
study, repeat the same protocol as mentioned
above, and choose start delay time for arterial phase
as 20 - 25 sec. In this case, the thin slice reconstruc-
tion can also be used for post-processing. Do not
administer oral contrast medium, as this impairs the
editing of MIP/SSD/VRT images. Water could be used
instead if necessary.
• Water, rather than positive oral contrast agents
should be used. Give the last cup 200 ml just prior to
positioning the patient. To ensure adequate filling of
the duodenal loop, lay the patient on the right side
for 5 minutes before performing the topogram.
• A pre-contrast examination is usually performed
only if no CT scans were previously acquired, to
exclude calculi in the common bile duct and to visu-
alize possible lesions in the liver.
• For pancreatic studies, the arterial phase acquisition
can be acquired later with a start delay of 40 - 50 sec.
It may be necessary to use a thinner collimation.
176
Abdomen
AbdMultiPhase/
AbdMultiPhase08s
Indications:
Spiral scan to assist the physician with differential
diagnosis of liver diseases.
Combination of 3 phase liver spiral study.
A typical native range of 20 cm will be covered in
12 sec.
177
Abdomen
178
Abdomen
Hints
• Do not administer oral contrast medium, as this
impairs the editing of MIP/SSD/VRT images. Use
water instead if necessary.
• Water, rather than positive oral contrast agents
should be used. Give the last cup of 200 ml just prior
to positioning the patient. To ensure adequate filling
of the duodenal loop, lay the patient on the right
side for 5 minutes before performing the topogram.
• A pre-contrast examination is usually performed
only if no CT scans were previously acquired, to
exclude calculi in the common bile duct and to visu-
alize possible lesions in the liver. Furthermore, this
also ensures exact positioning for the CTA spiral.
• For pancreatic studies, the arterial phase acquisition
can be acquired later with a start delay of 40–50 sec.
It may be necessary to use a thinner collimation of
e.g. 2.5 mm.
179
Abdomen
AbdomenSeq
Indications:
Sequential mode for all routine studies in the region of
abdomen, e.g., evaluation, follow-up examinations
etc.
The whole scan length covers 18.4 cm.
AbdSeq
kV 130
Effective mAs 70
Rotation time 1.0 sec
Slice collimation 4.0 mm
Slice width 8.0 mm
Feed/Scan 8.0 mm
Kernel B41s
CTDIVol 6.4 mGy
Effective dose Male: 2.37 mSv
Female: 2.87 mSv
180
Abdomen
Hints
• You could repeat the same protocol by simply click-
ing the chronicle with the right mouse button for
“repeat“, e.g., when both non-contrast and contrast
studies are required.
• Water, rather than positive oral contrast agents
should be used. Give the last cup 200 ml just prior
positioning the patient. To ensure adequate filling of
the duodenal loop, lay the patient on the right side
for 5 minutes before performing the topogram.
• A pre-contrast examination is usually performed
only if no CT scans were previously acquired, to
exclude calculi in the common bile duct and to visu-
alize possible lesions in the liver.
181
Spine
Overview
– C-Spine
Spiral mode for cervical spine studies
– C-SpineSeq
Sequential mode for cervical spine studies
– Spine
Spiral mode for routine lumbar and thoracic spine
studies
– SpineSeq
Sequential mode for lumbar and thoracic evaluation
of the discs
– Osteo
Sequential mode used for the application syngo
Osteo CT
182
Spine
Hints in General
• Topogram: Lateral, 512 mm for thoracic and lumbar
spine and 256 mm for the C-spine.
• Patient positioning for thoracic and lumbar spine
studies:
Patient lying in supine position, arms positioned
comfortably above the head in the head-arm rest,
lower legs supported.
• Patient positioning for cervical spine studies:
Patient lying in supine position, hyperextend neck
slightly, secure head well in head holder.
– Patient respiratory instruction: do not breathe, do
not swallow.
Any possible injuries to the spinal column should be
determined before beginning the examination and
taken into account when repositioning the patient.
183
Spine
Hints
• In case of 3D study only, images should be recon-
structed with at least 50% overlap in image recon-
struction and kernel B20s.
• In case of SSD study only, mAs value can be reduced
by 50%. Use kernel B20s and 50% overlapping image
reconstruction.
• For lumbar studies, place a cushion under the
patient’s knees. This will reduce the curve in the
spine and also make the patient more comfortable.
• For image reconstruction of bone study, use kernel
B60.
• The CT scan following myelography must be per-
formed within 4 – 6 hours of the injection, other-
wise, the contrast density in the spinal canal will be
too high to obtain artifact-free images. Also, if possi-
ble, it is a good idea to roll the patient once, or scan
in a prone position. This will prevent the contrast
from pooling posterior to the spinal cord.
• If a prone scan is performed, breathing instructions
are recommended to avoid motion artifact in axial
source and MPR images.
• To further optimize MPR image quality, we recom-
mend that you reduce one or more of the following:
collimation, reconstruction increment, and slice
width for image reconstruction.
• With CAREDose 4D the mA values are adapted for
each osteo range, according to the patient diameter.
Therefore special obese protocols for the osteo eval-
uation are no longer necessary.
184
Spine
Body Kernels
• As standard kernels for body tissue studies B31s or
B41s are recommended; softer images are obtained
with B20s.
• For higher sharpness, as is required e.g. in patient
protocols for cervical spine, shoulder, extremities,
thorax, lung, the kernels B50s, B60s, B70s are avail-
able.
185
Spine
C-Spine
Indications:
Spiral mode for cervical spine studies, e.g., prolapse,
degenerative changes, trauma, tumors etc.
A range of 15 cm will be covered in 52 sec.
186
Spine
187
Spine
C-SpineSeq
Indications:
Sequential mode for cervical spine studies, e.g., pro-
lapse, degenerative changes, trauma, tumors, etc.
with a typical length for each range of 1.2 cm.
This protocol contains five ranges:
C2-C3, C3-C4, C4-C5, C5-C6, C6-C7
188
Spine
C5-6 C6-7
kV 130 130
Effective mAs 170 190
Rotation time 1.5 sec 1.5 sec
Slice collimation 1.0 mm 1.0 mm
Slice width 2.0 mm 2.0 mm
Feed/Scan 2.0 mm 2.0 mm
Kernel B50s B50s
CTDIVol 16.3 mGy 18.2 mGy
Effective dose Male: Male:
0.19 mSv 0.24 mSv
Female: Female:
0.23 mSv 0.26 mSv
Hints
• Dental artifacts can be excluded by tilting the gantry.
• For MPRs and 3D post-processing, use spiral mode
with thinner slice and reconstruct images with 50%
overlap. Define a long range to cover the levels of
interest in one block.
• You could repeat the same protocol by simply click-
ing the chronicle with the right mouse button for
repeat.
189
Spine
Spine
Indications:
Spiral mode for thoracic and lumbar spine studies,
e.g., prolapse, degenerative changes, trauma, tumors
etc.
A range of 15 cm will be covered in 48 sec.
190
Spine
Spine 2nd
reconstruction
kV 130
Effective mAs 160
Rotation time 1.5 sec
Slice 2.5 mm
collimation
Slice width 3.0 mm 3.0 mm
Feed/Rotation 5.0 mm
Pitch Factor 1.0
Increment 3.0 mm 2.0 mm
Kernel B31s B60s
CTDIVol 14.9 mGy
Effective dose Male: 3.97 mSv
Female: 5.13 mSv
191
Spine
SpineSeq
Indications:
Sequence mode for spine studies, e.g., prolapse,
degenerative changes, trauma, tumors etc. with a typ-
ical length for each range of 1.5 cm.
This protocol contains three ranges:
L3-4, L4-L5, L5-S1
Three different typical gantry tilts are predefined:
for L3-L4: 0°, for L4-L5: +5° and for L5-S1: +15°
192
Spine
Hints
• You could repeat the same protocol by simply click-
ing the chronicle with the right mouse button for
repeat.
193
Spine
Osteo
This is the scan protocol for the syngo Osteo CT appli-
cation package to assist the Physician with the quanti-
tative assessment of vertebral bone mineral density
(BMD) in the diagnosis and follow-up of osteopenia
and osteoporosis.
Osteo
kV 80
Effective mAs 160
Rotation time 1.5 sec
Slice collimation 5.0 mm
Slice width 10.0 mm
Feed/Scan 0.0 mm
Kernel S80s
CTDIVol 3.7 mGy
Effective dose Male: 0.14 mSv
Female: 0.30 mSv
194
Spine
195
Pelvis
Overview
– Pelvis
Spiral mode for routine soft tissue pelvis studies
– Hip
Spiral mode for routine hip studies
– SI_Joints
Spiral mode for sacroiliac joints studies
196
Pelvis
Hints in General
• Topogram: TOP, 512 mm for pelvis studies and
256 mm for studies of the hip and SI Joints.
• Patient positioning:
Patient lying in supine position, arms positioned
comfortably above the head in the head-arm rest,
lower legs supported.
• A breathing command is not necessarily required for
the pelvic examination, since respiration does not
negatively influence this region.
• Rectal contrast medium administration:
Rectal contrast media is usually required to delineate
the rectum and sigmoid colon, if lower pelvic mass
or pathology are suspected. In some cases, air may
be substituted for a positive contrast agent. The use
of a vaginal tampon may be helpful in adult female
patients with suspected pelvis pathology.
• To further optimize MPR image quality we recom-
mend that you reduce one or more of the following:
collimation, reconstruction increment, and slice
width for image reconstruction.
Body Kernels
• As standard kernels for body tissue studies B31s or
B41s is recommended; softer images are obtained
with B20s.
197
Pelvis
Pelvis
Indications:
Spiral mode for routine pelvis studies, e.g., processes
of the prostate, urinary bladder, rectum, gynecological
indications etc.
A typical range of 20 cm will be covered in 19 sec.
198
Pelvis
Pelvis
kV 130
Effective mAs 80
Rotation time 1.0 sec
Slice collimation 5.0 mm
Slice width 8.0 mm
Feed/Rotation 12.0 mm
Pitch Factor 1.2
Increment 8.0 mm
Kernel B41s
CTDIVol 8.2 mGy
Effective dose Male: 3.37 mSv
Female: 6.14 mSv
199
Pelvis
Hip
Indications:
Spiral mode for bone studies and soft tissue studies of
the Hip, e.g. evaluation of joint cavity, masses, trauma,
dysplasia, necrosis of the head of the hip, congruence
evaluations, orthopedic indications etc.
A typical range of 10 cm will be covered in 30 sec.
200
Pelvis
Hints
• In case of 3D study only, images should be recon-
structed with at least 50% overlapping in image
reconstruction and kernel B20s.
• If only one side is examined, it is advisable to enter
the side in the comment line on the recon card.
201
Pelvis
SI_Joints
Indications:
Spiral mode for bone studies of the sacroiliac joints.
A typical range of 8 cm will be covered in 15 sec.
202
Pelvis
203
Upper Extremities
Overview
– WristHR
Spiral mode for high resolution wrist studies
– ExtrRoutineHR
Spiral mode for routine high resolution extremity
studies
204
Upper Extremities
Hints in General
• Topogram: TOP, 256 mm for joint studies.
• Patient positioning:
Depends on the region of examination.
In general, for bilateral studies, you should always
try to position the patient symmetrical whenever the
patient can comply.
205
Upper Extremities
Body Kernels
• As standard kernels for body tissue studies B31s or
B41s is recommended; softer images are obtained
with B20s.
• For higher sharpness, as is required e.g., in patient
protocols for cervical spine, shoulder, extremities,
thorax, lung, the kernels B50s, B60s, B70s are avail-
able.
• The special kernels are mostly used for physical mea-
surements with phantoms, e.g. for adjustmentpro-
cedures (S80s), for constancy and acceptance tests
(S80s, U90s), or for specification purposes (U90s).
• For special patient protocols, S80s and U90s are cho-
sen, e.g. for osteo (S80s) and for High Resolution
bone studies (U90s). We recommend using the High
Resolution specification kernel U90s only with
"small" objects, like the wrist, otherwise artifacts will
occur in the images.
206
Upper Extremities
WristHR
Indications:
Spiral mode for HiRes bone study of the wrist, e.g.,
trauma, orthopedic indications etc.
A range of 6 cm will be covered in 32 sec.
207
Upper Extremities
Hint
• For image reconstruction of soft tissue, use kernel
B31s.
208
Upper Extremities
ExtrRoutineHR
Indications:
Spiral mode for HiRes bone study, e.g., trauma, ortho-
pedic indications etc.
A range of 10 cm will be covered in 52 sec.
209
Upper Extremities
Hint
• For image reconstruction of soft tissue, use kernel
B31s.
210
Upper Extremities
211
Lower Extremities
Overview
– KneeHR
Spiral mode for high resolution knee studies
– FootHR
Spiral mode for high resolution foot studies
– ExtrRoutineHR
Spiral mode for high resolution routine extremity
studies
212
Lower Extremities
Hints in General
• Topogram: TOP, 256 mm for joint studies.
• Patient positioning:
Depends on the region of examination. In general,
for bilateral studies, you should always try to posi-
tion the patient symmetrical whenever the patient
can comply.
• For knee scan:
Patient lying in supine position, feet first, promote
relaxation by placing Bocollo pillows between knees
and feet, bind feet together. The only exceptions are
extremely light patients. The latter can remove the
leg not being examined from the gantry by bending
it 90° at the hip and the knee and placing the bottom
of the same foot against the gantry casing.
• For ankle and feet scans:
Patient lying in supine position, feet first. Bind both
ankles together if necessary to assure the TOP posi-
tion of both feet.
213
Lower Extremities
214
Lower Extremities
215
Lower Extremities
KneeHR
Indications:
Spiral mode for high resolution studies of the knee,
e.g., masses, trauma, disorders of the joint etc.
A range of 10 cm will be covered in 27 sec.
216
Lower Extremities
Hint
• For image reconstruction of soft tissue, use kernel
B31s.
217
Lower Extremities
FootHR
Indications:
Spiral mode for high resolution studies of the foot,
e.g., masses, trauma, disorders of the joint etc.
A range of 10 cm will be covered in 27 sec.
Hint
• For image reconstruction of soft tissue, use kernel
B31s.
218
Lower Extremities
ExtrRoutineHR
Indications:
Spiral mode for HiRes bone study, e.g., trauma, ortho-
pedic indications etc.
A range of 10 cm will be covered in 52 sec.
Hint
• For image reconstruction of soft tissue, use kernel
B31s.
219
Vascular
Overview
– HeadAngio/HeadAngio08s
Spiral mode for head CTAngio studies
– CarotidAngio/CarotidAngio08s
Spiral mode for carotid CTAngio studies
– ThorAngio/ThorAngio08s
Spiral mode for chest CTAngio studies
– Embolism
Spiral mode for pulmonary embolism studies
– BodyAngioRoutine/BodyAngioRoutine08s
Spiral mode for body CTAngio studies
– BodyAngioFast
Spiral mode for fast body CTAngio studies
220
Vascular
Hints in General
• Topogram: TOP, 512/1024 or LAT 256
• Patient positioning:
Patient lying in supine position, arms positioned
comfortably above the head in the head-arm rest,
lower legs supported.
• Patient respiratory instructions: inspiration.
• Oral administration of contrast medium:
The use of water will not obscure the blood vessels,
thus allowing CTA post-processing to be performed
easily afterwards.
• Be careful when examining pheochromocytoma
patients. Administration of an IV CM injection in
such cases may trigger a hypertensive crisis!
• To further optimize MPR image quality, we recom-
mend that you reduce one or more of the following
parameters: collimation, reconstruction increment
and slice width for image reconstruction.
Head Kernels
• For soft tissue head studies, the standard kernel is
H41s; softer images are obtained with H31s or H21s,
sharper images with H50s.
Body Kernels
• As standard kernels for body tissue studies B31s or
B41s is recommended; softer images are obtained
with B20s.
221
Vascular
HeadAngio/HeadAngio08s
Indications:
Spiral mode for cerebral CT Angios, e.g., cerebral vas-
cular abnormalities, tumors and follow-up studies etc.
A range of 6 cm will be covered in 32/26 sec.
222
Vascular
Hints
• Use of CARE Bolus with monitoring scans positioned
at the level of the basilar artery or carotid artery. Set
the trigger threshold at 120 HU, or use manual trig-
gering.
223
Vascular
CarotidAngio/CarotidAngio08s
Indications:
Noninvasive CT angiography of carotid stenosis or
occlusions, plaques course abnormalities of the
carotids and vertebral arteries, etc.
A range of 12 cm will be covered in 32/26 sec.
224
Vascular
225
Vascular
Hints
• CARE Bolus may be used to optimize the bolus tim-
ing.
• Set the ROI for monitoring scan in the aortic arch
with triggering threshold of 120 HU, or use manual
triggering.
• High quality 2D & 3D post-processing can be
achieved using a thin slice thickness and 50% over-
lap in image reconstruction.
• MPR Thick and MIP Thin images can be created very
quickly on the 3D card by just clicking on the appro-
priate icons. The thickness of these reconstructed
images can be defined by clicking on the icons with
the right mouse to open the entry field.
226
Vascular
ThorAngio/ThorAngio08s
Indications:
Spiral study for location and extent of aneurysms, dis-
section, and ruptures of the thoriac aorta.
A range of 20 cm will be covered in 24/19 sec.
227
Vascular
Hints
• CARE Bolus may be used to optimize the bolus tim-
ing.
• Set the ROI for monitoring scan in the aortic arch
with triggering threshold of 120 HU, or use manual
triggering.
• High quality 2D & 3D post-processing can be
achieved using a thin slice thickness and 50% over-
lap in image reconstruction.
• Thick MPRs and ThinMIPs can be created very quickly
on the 3D card by just clicking on the appropriate
icons. The thickness of these reconstructed images
can be defined by clicking on the icons with the right
mouse to open the entry field.
• To display an SSD of the thoracic aorta without bone
included, editing is necessary.
228
Vascular
Embolism
Indications:
Spiral mode for Pulmonary Emboli studies.
A range of 15 cm will be covered in 24 sec.
229
Vascular
Hints
• CARE Bolus may be used to optimize the bolus tim-
ing.
• Set the ROI for monitoring scan in the pulmonary
trunk with triggering threshold of 120 HU, or use
manual triggering.
230
Vascular
BodyAngioRoutine/
BodyAngioRoutine08s
Indications:
Spiral mode for abdominal CTA studies.
A range of 20 cm will be covered in 39/31 sec.
231
Vascular
.
BodyAngio 2nd reconstruction
kV 130
Effective mAs 55
Rotation time 1.0/0.8 sec
Slice 1.5 mm
collimation
Slice width 5.0 mm 2.0 mm
Feed/Rotation 5.4 mm
Pitch Factor 1.8
Increment 5.0 mm 1.5 mm
Kernel B31s B31s
CTDIVol 5.1 mGy
Effective dose Male: 1.69 mSv
Female: 2.30 mSv
232
Vascular
Hints
• CARE Bolus may be used to optimize the bolus tim-
ing.
• Set the ROI for monitoring scan in the abdominal
aorta with triggering threshold of 120 HU, or use
manual triggering.
• Do not administer oral contrast medium, as this
impairs the editing of MIP/SSD/VRT images.
• Use water as oral contrast.
• The length of the CM spiral in the topogram (via the
table position) can be planned exactly by means of
pre-contrast images.
• Pre-contrast images are used to visualize calcifica-
tion.
• Excellent post-processed images can be created
using a thin slice thickness and overlapping images,
i.e. the increment should be smaller than the slice
thickness.
233
Vascular
BodyAngioFast
Indications:
Spiral mode for longer coverage and larger vessels.
A range of 20 cm will be covered in 18 sec.
234
Vascular
BodyAngio 2nd
reconstruction
kV 130
Effective mAs 55
Rotation time 0.8 sec
Slice 2.5 mm
collimation
Slice width 5.0 mm 3.0 mm
Feed/Rotation 10.0 mm
Pitch Factor 2.0
Increment 5.0 mm 2.0 mm
Kernel B31s B31s
CTDIVol 5.1 mGy
Effective dose Male: 1.69 mSv
Female: 2.31 mSv
235
Vascular
Hints
• CARE Bolus may be used to optimize the bolus tim-
ing.
• Set the ROI for monitoring scan in the abdominal
aorta with triggering threshold of 120 HU, or use
manual triggering.
• Do not administer oral contrast medium, as this
impairs the editing of MIP/SSD/VRT images.
• Use water as oral contrast.
• The length of the CM spiral in the topogram (via the
table position) can be planned exactly by means of
pre-contrast images.
• Precontrast images are used to visualize calcifica-
tion.
• Excellent post-processed images can be created
using a thin slice thickness and overlapping images,
i.e. the increment should be smaller than the slice
thickness.
236
Vascular
237
Specials
Overview
The examination protocols designed for some of these
applications are under the “Special” folder.
Trauma
In any trauma situation, time means life and the qual-
ity of life for the survivor. In order to facilitate the
examinations, two protocols are provided.
– PolyTrauma: This is a combined mode for the exam-
ination of multiple ranges, e.g. Head, Neck, Thorax,
Abdomen and Pelvis
– HeadTrauma: Spiral head protocol with a FoV of 500
and therefore lowered image quality
– HeadTraumaSeq: Sequential head protocol for
trauma studies, with a FoV of 500 and therefore low-
ered image quality
238
Specials
Interventional CT
– Biopsy: The biopsy protocol is sequential mode with-
out table feed, using a 10 mm slice thickness.
Test Bolus
– TestBolus: This mode can be used to test the start
delay of an optimal enhancement after the contrast
medium injection.
Neuro Perfusion and Body Perfusion
– The scan protocols, further information and how to
use syngo Neuro Perfusion and Body Perfusion,
please refer to the Application Guide "Clinical Appli-
cations".
239
Specials
Trauma
In any trauma situation, time means life and the qual-
ity of life for the survivor.
This is a combined mode for the examination of multi-
ple ranges, e.g., Head, Neck, Thorax, Abdomen and
Pelvis.
General information
• Check that the emergency drug trolley is well
stocked and that all accessories such as in-room oxy-
gen supply, respirator and resuscitation equipment
that may be required during the examination are in
working order.
• Prepare the CT room before admitting the patient,
e.g., load IV contrast into the injector.
• Know, observe and practice the standard hospital
operating policy for handling a patient in distress
e.g., Code Blue for cardiac and respiratory arrest.
• Any possible injuries to the spinal column should be
determined before beginning the examination and
taken into account when shifting and positioning
the patient.
240
Specials
241
Specials
PolyTrauma
Two times 2 combined recon jobs are predefined, head
with neck and thorax with abdomen.
A range for the Head of 12 cm will be covered in
21 sec., a range for the Neck of 14 cm will be covered
in 30 sec.
Head Neck
kV 130 130
Effective mAs 110 90
Rotation time 1.5 sec 1.0 sec
Slice collimation 5.0 mm 2.5 mm
Slice width 6.0 mm 3.0 mm
Feed/Rotation 10.0 mm 5.0 mm
Pitch Factor 1.0 1.0
Increment 6.0 mm 3.0 mm
Kernel H31s B50s
CTDIVol 21.1 mGy 8.4 mGy
Effective dose Male: Male:
0.91 mSv 1.50 mSv
Female: Female:
1.01 mSv 1.56 mSv
242
Specials
Thorax AbdPelvis
kV 130 130
Effective mAs 40 60
Rotation time 1.0 sec 1.0 sec
Slice collimation 5.0 mm 5.0 mm
Slice width 8.0 mm 8.0 mm
Feed/Rotation 20.0 mm 20.0 mm
Pitch Factor 2.0 2.0
Increment 8.0 mm 8.0 mm
Kernel B41s B41s
CTDIVol 3.6 mGy 5.5 mGy
Effective dose Male: Male:
1.68 mSv 1.32 mSv
Female: Female:
2.02 mSv 1.69 mSv
243
Specials
HeadTrauma
Indications:
A spiral mode for emergency head studies with a max.
FoV of 500 mm.
A typical scan range of 12 cm will be covered in 39 sec.
244
Specials
HeadTraumaSeq
Indications:
A sequence mode for emergency head studies with a
max. Fov of 500 mm.
The scan length is predefined with 11.2 cm.
245
Specials
Note:
You should press the "Hold Measurement" Button
whennever the range shown on the real time growing
topogram is long enough, in order to avoid unneces-
sary radiation.
To facilitate CT interventional procedures, the follow-
ing protocols are provided. Any of these protocols can
be appended to a spiral protocol for CT interventional
procedures, such as biopsy, abscess drainage, pain
therapy, minimum invasive operations, joint studies,
and arthrograms. Adjust the mAs according to the
body region before loading.
10 scans are predefined. You can repeat it by clicking
the chronicle with the right mouse button and select
“repeat”, or by simply changing the number of scans to
99 before you start the first scan.
You can “Append” any routine protocol after the inter-
ventional procedure for a final check and documenta-
tion, e.g., a short range of spiral scanning for the
biopsy region.
The table height can be adjusted to minimum
255 mm.
246
Specials
Biopsy
Indications:
This is the conventional sequential mode without table
feed using a 10 mm slice.
Biopsy
kV 130
Effective mAs 80
Rotation time 0.8 sec
Slice collimation 5.0 mm
Slice width 10.0 mm
Feed/Scan 0.0 mm
Kernel B31s
CTDIVol 7.3 mGy
Hint
This protocol can be appended to a spiral protocol for
CT interventional procedures, such as biopsy, abscess
drainage, pain therapy, minimum invasive operations,
joint studies, and arthrograms.
247
Specials
TestBolus
Indications:
This mode can be used to test the start delay of an opti-
mal enhancement after the contrast medium injec-
tion.
TestBolus
kV 80
Effective mAs 110
Rotation time 0.8 sec
Slice collimation 5.0 mm
Slice width 10.0 mm
Feed/Scan 0.0 mm
Kernel B31s
CTDIVol 2.5 mGy
248
Specials
249
Children
Overview
The scan protocols for children are defined according
to body regions – Head, Neck, Shoulder, Thorax,
Abdomen, Pelvis, Spine, Upper Extremities, Lower
Extremities, Vascular, Specials.
Whenever possible, 80 kV is used instead of 130 kV,
either to exploit the significantly higher image contrast
of iodine contrast media at 80 kV or to reach a lower
dose level than possible with 130 kV.
• Head
– HeadRoutine
Spiral mode for routine head studies
– HeadSeq
Sequential mode for routine head studies
– InnerEar
Spiral mode for inner ear studies
– InnerEarSeq
Sequential mode for inner ear studies
– SinusOrbi
Spiral mode for routine sinus or orbital studies
• Neck
– Neck
Spiral mode for soft tissue routine neck studies
• Thorax
– ThoraxRoutine
Spiral mode for routine chest studies
– ThoraxHRSeq
Sequential mode for high resolution lung studies
250
Children
• Abdomen
– Abdomen
Spiral mode for routine abdominal studies
• Spine
– Spine
Spiral mode for routine spine studies
• Upper Extremities
– ExtrRoutineHR
Spiral mode for routine high resolution extremity
studies
• Lower Extremities
– ExtrRoutineHR
Spiral mode for High Resolution routine extremity
studies
• Vascular
– HeadAngio/HeadAngio08s
Spiral mode for head CTAngio studies
– CarotidAngio/CarotidAngio08s
Spiral mode for carotid CTAngio studies
– BodyAngioRoutine/BodyAngioRoutine08s
Spiral mode for body CTAngio studies
– BodyAngioFast
Spiral mode for fast body CTAngio studies
• Specials
– NeonateBody
Spiral mode for a body of a neonate
251
Children
Hints in General
1.Topograms: 256 mm lateral topograms are defined
for the head modes, and 512 mm TOP topograms
are defined for the body modes. Please keep in mind
that the children’s size can be dramatically different.
You should press the “Hold Measurement“ button
whenever the range shown on the realtime growing
topogram is long enough, in order to avoid unneces-
sary radiation.
2. Gantry tilt is available for both, sequence and spiral
scanning. However, image artifacts may occur if spi-
rals are acquired with a tilt angle greater than 8°.
3.For all head studies, it is very important for image
quality purposes to position the patient in the center
of the scan field. Use the lateral laser beam to make
sure that the patient is positioned in the center.
4.Warm surroundings and dimmed lighting are helpful
to make children more cooperative.
252
Children
253
Children
254
Children
255
Children
256
Children
Head Kernels
• For head scans of small children, the kernels C20s,
C30s (e.g., for soft tissue studies) and C60s (e.g., for
sinuses are provided) should be chosen instead of
the ”adult” head kernels H21s, H31s and H60s.
• For the standard head protocols, we recommend
C20s and C30s.
• High resolution head studies should be performed
with H60s, H70s (e.g., for dental and sinuses) and
H80s (e.g., inner ear).
Body Kernels
• As standard kernels for body tissue studies B31s or
B41s is recommended; softer images are obtained
with B20s.
• For higher sharpness, as is required e.g., in patient
protocols for cervical spine, shoulder, extremities,
thorax, the kernels B50s, B60s, B70s are available.
The special kernels are mostly used for ”physical” mea-
surements with phantoms, e.g., for adjustment proce-
dures (S80s), for constancy and acceptance tests
(S80s, U90s), or for specification purposes (U90s).
257
Children
HeadRoutine
Indications:
Spiral mode for routine head studies, e.g. brain
tumors, cranial trauma, hydrocephalus, hemorrhaging
and other abnormalities etc.
A range of 8 cm will be covered in 27 sec.
Head
kV 130
Effective mAs 80
Rotation time 1.5 sec
Slice collimation 2.5 mm
Slice width 3.0 mm
Feed/Rotation 5.0 mm
Pitch Factor 1.0
Increment 3.0 mm
Kernel C30s
CTDIVol 15.8 mGy
Effective dose Male: 0.60 mSv*
Female: 0.71 mSv*
* The conversion factor for a 7-year-old child, and a
scan range of 120 mm was used.
258
Children
Hints
• Children, who are more than 6 years old, should be
scanned with an adult protocol as the skull by this
time is fully grown.
• When bone structure is of interest, use kernel C60s
for image reconstruction.
• An advanced algorithm allows for improved head
image quality, without any additional post-process-
ing.
• In order to optimize image quality versus radiation
dose, scans are provided within a maximum scan
field of 300 mm with respect to the iso-center. No
recon job with a field of view exceeding those limits
will be possible. Therefore, patient positioning has to
be performed accurately to ensure a centered loca-
tion of the skull.
• To work without CARE Dose 4D use for children
< 6 months 80 kV with 122 mAs
6 monthes - 3 years 130 kV with 60 mAs
3-6 years 130 kV with 80 mAs
259
Children
HeadSeq
Indications:
Sequential mode for routine head studies for children,
e.g., tumors, hydrocephalus, hemorrhaging, abnor-
malities, etc.
A range of 8.25 cm is predefined.
260
Children
HeadSeq
kV 130
Effective mAs 160
Rotation time 1.5 sec
Slice collimation 2.5 mm
Slice width 2.5 mm
Feed/Scan 5.0 mm
Kernel C30s
CTDIVol 31.7 mGy
Effective dose Male: 1.18 mSv*
Female: 1.36 mSv*
261
Children
Hints
• Children, who are more than 6 years old, should be
scanned with an adult protocol as the skull by this
time is fully grown.
• When bone structure is of interest, use kernel C60s
for image reconstruction.
• In order to optimize image quality versus radiation
dose, scans are provided within a maximum scan
field of 300 mm with respect to the iso-center. No
recon job with a field of view exceeding those limits
will be possible. Therefore, patient positioning has to
be performed accurately to ensure a centered loca-
tion of the skull.
• To work without CARE Dose 4D use for children
< 6 months 80 kV with 250 mAs
6 months-3 years 130 kV with 120 mAs
3-6 years 130 kV with 160 mAs
262
Children
263
Children
InnerEar
Indications:
High Resolution Spiral mode for inner ear studies, e.g.,
malformations of the inner ear, inflammatory
changes, pathologies of the mastoid process, tumor
processes of the pyramids, post-traumatic changes,
etc.
A range of 2.5 cm will be covered in 22 sec.
InnerEar
kV 80
Effective mAs 125
Rotation time 1.5 sec
Slice collimation 1.0 mm
Slice width 1.0 mm
Feed/Rotation 2.0 mm
Pitch Factor 1.0
Increment 1.0 mm
Kernel H80s
CTDIVol 7.1 mGy
Effective dose Male: 0.09 mSv*
Female: 0.12 mSv*
264
Children
Hints
• Children, who are more than 6 years old, should be
scanned with an adult protocol as the skull by this
time is fully grown.
• When soft tissue is of interest, use kernel H31s for
image reconstruction.
• In order to optimize image quality versus radiation
dose, scans are provided within a maximum scan
field of 300 mm with respect to the iso-center. No
recon job with a field of view exceeding those limits
will be possible. Therefore, patient positioning has to
be performed accurately to ensure a centered loca-
tion of the skull.
• To work without CARE Dose 4D used for children
< 3 years 125 mAs
3-6 years 160 mAs
265
Children
InnerEarSeq
Indications:
High Resolution Sequence for inner ear studies, e.g.
malformations of the inner ear, inflammatory
changes, pathologies of the mastoid process, tumor
processes of the pyramids, post-traumatic changes,
etc.
For the SOMATOM Spirit:
The scan length is 2.25 cm.
InnerEar
kV 80
Effective mAs 125
Rotation time 1.5 sec
Slice collimation 1.5mm
Slice width 1.5 mm
Feed/Scan 3.0 mm
Kernel H80s
CTDIVol 6.9 mGy
Effective dose Male: 0.08 mSv*
Female: 0.10 mSv*
266
Children
Hints
• Children, who are more than 6 years old, should be
scanned with an adult protocol as the skull by this
time is fully grown.
• When soft tissue is of interest, use kernel H30s/H31s
for image reconstruction.
• An advanced algorithm allows for improved head
image quality, without any additional post-process-
ing.
• In order to optimize image quality versus radiation
dose, scans are provided within a maximum scan
field of 300 mm with respect to the iso-center. No
recon job with a field of view exceeding those limits
will be possible. Therefore, patient positioning has to
be performed accurately to ensure a centered loca-
tion of the skull.
• To work without CARE Dose 4D use for children
< 3 years 50 mAs
3-6 years 70 mAs.
267
Children
SinusOrbi
Indications:
Spiral mode for routine spiral studies of the sinuses
and paranasal sinuses, e.g., sinusitis, pneumatization,
polyposis, malformations, tumors etc.
A range of 4 cm will be covered in 22 sec.
268
Children
SinusOrbi 2nd
reconstruction
kV 80
Effective mAs 100
Rotation time 1.0 sec
Slice 1.0 mm
collimation
Slice width 3.0 mm 1.25 mm
Feed/Rotation 2.0 mm
Pitch Factor 1.0
Increment 3.0 mm 0.8 mm
Kernel C60s C60s
CTDIVol 5.7 mGy
Effective dose Male: 0.10 mSv*
Female: 0.12 mSv*
Hints
• Children, who are more than 6 years old, should be
scanned with an adult protocol.
• To work without CARE Dose 4D use for children
< 3 years 81 mAs
3-6 years 100mAs
269
Children
Neck
Indications:
Spiral mode for routine neck studies, e.g., tumors, lym-
phoma, abscesses, etc.
A range of 15 cm will be covered in 17 sec.
Neck
kV 130
Effective mAs 39
Rotation time 1.0 sec
Slice collimation 2.5 mm
Slice width 5.0 mm
Feed/Rotation 10.0mm
Pitch Factor 2.0
Increment 5.0 mm
Kernel B50s
CTDIVol 3.6 mGy
Effective dose Male: 0.72 mSv*
Female: 0.81 mSv*
270
Children
Hints
• If necessary, scan down to the aortic arch or medi-
astinum to include the entire lesion.
• Cooperative children can be instructed to hold their
breath during the acquisition.
• Children, who are more than 6 years old should be
scanned with an adult protocol.
• To work without CARE Dose 4D use for children < 3
years 26 mAs
3-6 years 39 mAs
271
Children
ThoraxRoutine
Indications:
Spiral mode for routine thorax studies, e.g., pneumo-
nia, tumors, metastases, lymphoma, vascular abnor-
malities etc.
A range of 15 cm will be covered in 17 sec.
272
Children
ThorRoutine 2nd
reconstruction
kV 130
Effective mAs 37
Rotation time 1.0 sec
Slice 2.5 mm
collimation
Slice width 5.0 mm 5.0 mm
Feed/Rotation 10.0 mm
Pitch Factor 2.0
Increment 5.0 mm 5.0 mm
Kernel B41s B60s
CTDIVol 3.4 mGy
Effective dose Male: 1.29 mSv*
Female: 1.84 mSv*
273
Children
Hints
• Children with a body weight of more than 55 kg
should be examined with an adult protocol.
• The first and second recon jobs are defined for visu-
alization of the mediastinum and the lungs, respec-
tively.
• To work without CARE Dose 4D use for children
< 25 kg 80 kV with 41 mAs
25-34 kg 80 kV with 60 mAs
35-44 kg 130 kV wotj 26 mAs
45-54 kg 130 kV with 37 mAs
274
Children
275
Children
ThoraxHRSeq
Indications:
Sequence mode for High Resolution lung studies, e.g.,
interstitial changes of the lung parenchyma, etc.
A range of 20.1 cm is predefined.
276
Children
ThorHRSeq
kV 130
Effective mAs 70
Rotation time 1.0 sec
Slice collimation 1.0 mm
Slice width 1.0 mm
Feed/Scan 10.0 mm
Kernel U90s
CTDIVol 1.3 mGy
Effective dose Male: 0.66 mSv*
Female: 0.81 mSv*
Hints
• Children with a body weight of more than 55 kg
should be examined with an adult protocol.
• If you want to acquire the patient at full inspiration
or full expiration, you should practice the breathing
with the patient a few times before beginning the
scan, so that reproducibility may be improved.
• To work without CARE Dose 4D use for children
< 35 kg 80 kV with 70 mAs
35-44 kg 130kV with 70 mAs
277
Children
Abdomen
Indications:
Spiral mode for routine studies in the region of abdo-
men and pelvis, e.g., tumors, lymphoma, abscesses,
post-traumatic changes, etc.
A range of 30 cm will be covered in 32 sec.
Abdomen
kV 130
Effective mAs 41
Rotation time 1.0 sec
Slice collimation 2.5 mm
Slice width 5.0 mm
Feed/Rotation 10.0 mm
Pitch Factor 2.0
Increment 5.0 mm
Kernel B41s
CTDIVol 3.8 mGy
Effective dose Male: 2.84 mSv*
Female: 4.55 mSv*
278
Children
Hints
• Delayed scans may be required for the kidneys and
bladder.
• Rectal contrast may be required for evaluation of pel-
vic mass.
• Children with a body weight of more than 55 kg
should be examined with an adult protocol.
• To work without CARE Dose 4D use for children
< 25 kg 80 kV with 41 mAs
25-34 kg 80kV with 70 mAs
35-44 kg 130 kV with 41 mAs
279
Children
Spine
Indications:
Spiral mode for spine studies, e.g., post-traumatic
changes, tumors, malformations, orthopedic indica-
tions, etc.
A range of 15 cm will be covered in 32 sec.
280
Children
Spine 2nd
reconstruction
kV 130
Effective mAs 70
Rotation time 1.0 sec
Slice 2.5 mm
collimation
Slice width 3.0 mm 3.0 mm
Feed/Rotation 5.0 mm
Pitch Factor 1.0
Increment 3.0 mm 2.0 mm
Kernel B41s B60s
CTDIVol 6.5 mGy
Effective dose Male: 2.82 mSv*
Female: 3.53 mSv*
Hint
• Children with a body weight of more than 55 kg
should be examined with an adult protocol.
• To work without CARE Dose 4D use for children
< 25 kg 80 kV with 110 mAs
25-34 kg 80kV with 160 mAs
35-54 kg 130 kV with 70 mAs
281
Children
ExtrRoutineHR
Indications:
Spiral mode for bone studies, e.g., tumors, post-
traumatic changes, orthopedic indications, etc.
A range of 10 cm will be covered in 27 sec.
282
Children
ExtrUHR / ExtrHR
kV 130
Effective mAs 40
Rotation time 1.0 mm
Slice collimation 1.0 mm
Slice width 1.25 mm
Feed/Rotation 4.0 mm
Pitch Factor 2.0
Increment 0.6 mm
Kernel U90s
CTDIVol 3.8 mGy
Effective dose Male: 0.02 mSv*
Female: <0.1 mSv*
Hint
• Children with a body weight of more than 55 kg
should be examined with an adult protocol.
• To work without CARE Dose 4D use for children
< 25 kg 80 kV with 50 mAs
25-34 kg 80kV with 80 mAs
35-54 kg 130 kV with 40 mAs
283
Children
HeadAngio
Indications:
Spiral mode for head CT angiography, e.g., cerebral
vascular abnormalities, tumors etc.
A range of 6 cm will be covered in 32 sec.
HeadAngio
kV 80
Effective mAs 82
Rotation time 1.0 sec
Slice 1.0 mm
collimation
Slice width 2.0 mm
Feed/Rotation 2.0 mm
Pitch Factor 1.0
Increment 2.0 mm
Kernel C30s
CTDIVol 4.7 mGy
Effective dose Male: 0.12 mSv*
Female: 0.13 mSv*
284
Children
Hints
• Children, who are more than 6 years old, should be
scanned with an adult protocol as the skull by this
time is fully grown.
• CARE Bolus may be used to optimize the bolus timing
with a triggering threshold of 120 HU, or use manual
triggering.
• To work without CARE Dose 4D use for children
< 6 years 65mAs
6-12 years 80 mAs
285
Children
HeadAngio08s
Indications:
Spiral mode for head CT angiography, e.g., cerebral
vascular abnormalities, tumors etc.
A range of 6 cm will be covered in 26 sec.
HeadAngio 2nd
reconstruction
kV 80
Effective mAs 82
Rotation time 0.8 sec
Slice 1.0 mm 1.0 mm
collimation
Slice width 2.0 mm 1.0 mm
Feed/Rotation 2.0 mm
Pitch Factor 1.0
Increment 2.0 mm
Kernel C30s C30s
CTDIVol 4.7 mGy
Effective dose Male: 0.12 mSv*
Female: 0.13 mSv*
286
Children
Hints
• Children, who are more than 6 years old should be
examined with an adult protocol.
• CARE Bolus may be used to optimize the bolus timing
and with a triggering threshold of 120 HU, or use
manual triggering.
• To work without CARE Dose 4D use for children
< 6 years 65 mAs
6-12 years 80 mAs
287
Children
CarotidAngio
Indications:
Spiral mode for the carotid arteries, e.g., carotid steno-
sis or occlusion, vascular abnormalities of the carotids
or vertebral arteries, etc.
A range of 10 cm will be covered in 27 sec.
288
Children
Hints
• Children, who are more than 6 years old should be
scanned with an adult protocol.
• CARE Bolus may be used to optimize the bolus timing
with a triggering threshold of 120 HU, or use manual
triggering.
• To work without CARE Dose 4D use for children
< 6 years 50 mAs
6-12 years 75 mAs
289
Children
CarotidAngio08s
Indications:
Spiral mode for the carotid arteries, e.g., carotid steno-
sis or occlusion, vascular abnormalities of the carotids
or vertebral arteries, etc.
A range of 10 cm will be covered in 22 sec.
290
Children
Hints
• Children, who are more than 6 years old should be
scanned with an adult protocol.
• CARE Bolus may be used to optimize the bolus timing
with a triggering threshold of 120 HU, or use manual
triggering.
• To work without CARE Dose 4D use for children
< 6 years 50 mAs
6-12 years 75 mAs
291
Children
BodyAngioRoutine
Indications:
Spiral mode for abdominal CT Angio studies, e.g., vas-
cular abnormalities, aneurysms, etc.
A range of 10 cm will be covered in 27 sec.
292
Children
Hints
• CARE Bolus may be used to optimize the bolus tim-
ing. Set the ROI for the monitoring scan in the
abdominal aorta with triggering threshold of 120
HU, or use manual triggering.
• To work without CARE Dose 4D use for children
< 25 kg 41 mAs
25-44 kg 45 mAs
45-54 kg 60 mAs
293
Children
BodyAngioRoutine08s
Indications:
Spiral mode for abdominal CT Angio studies, e.g., vas-
cular abnormalities, aneurysms, etc.
A range of 10 cm will be covered in 22 sec.
294
Children
Hints
• CARE Bolus may be used to optimize the bolus tim-
ing. Set the ROI for monitoring scan in the abdominal
aorta with triggering threshold of 120 HU, or use
manual triggering.
• To work without CARE Dose 4D use for children
< 25 kg 41 mAs
25-44 kg 45 mAs
45-54 kg 60 mAs
295
Children
BodyAngioFast
Indications:
Spiral mode for fast abdominal CT Angio studies, e.g.
vascular abnormalities, aneurysms, etc.
A range of 10 cm will be covered in 15 sec. with Body-
AngioFast.
296
Children
297
Children
NeonateBody
Indications:
Spiral mode for routine neonate body studies, e.g.,
tumors, abnormalities, malformations, abscesses, etc.
A range of 15 cm will be covered in 17 sec.
298
Children
NeonateBody
kV 80
Effective mAs 41
Rotation time 1.0 sec
Slice collimation 2.5 mm
Slice width 5.0 mm
Feed/Rotation 10.0 mm
Pitch Factor 2.0
Increment 5.0 mm
Kernel B41s
CTDIVol 1.0 mGy
Effective dose Male: 1.10 mSv*
Female: 1.39 mSv*
Hints
• Use this protocol for children below 1 month of age.
• CARE Bolus may be used to optimize the bolus tim-
ing. Set the ROI for the monitoring scan in the
abdominal aorta with triggering threshold of 120
HU, or use manual triggering.
• You can modify the slice width for image reconstruc-
tion according to the clinical indications.
299
Manufacturer
Siemens Shanghai Medical
Equipment Ltd. (SSME)
278 Jin Hu Road
201206 Shanghai, P.R. China
Telephone: +86 21 50320300
Authorized Representative
according to the Medical
Device Directive 93/42/EEC
Siemens AG
Medical Solutions
Henkestr. 127
© 2006, Siemens Shanghai
D-91052 Erlangen Medical Equipment Ltd. (SSME)
Germany Order No.
C2-025.630.02.02.02
Telephone: +49 9131 84-0 Printed in China
www.siemens.com/medical 03/2006