Ct somatom sessions-33

SOMATOM Sessions
Answers for life in Computed Tomography
December 2013 | International Edition Issue 33
SOMATOM Force:
Bringing Personalized
Medicine to CT
Page 06
News
syngo.via Frontier –
Gateway to an Open
Research Environment
Page 31
Business
Ready for the
Next Revolution
in Stroke Care?
Page 40
Clinical Results
Coronary CTA with
Reduced Contrast
and Radiation Dose
of 0.19 mSv
Page 50
Science
Radiation Hygiene –
Transparent and Easy
Page 72

Editorial
“In a general population with
a very complex age and disease
structure, the SOMATOM Force
can solve the problems presented
by every radiological situation
for virtually every patient.”
Professor Stefan Schönberg, MD,
University Medical Center Mannheim, Germany
Cover page:
Dynamic CTA – 64 cm acquired with spiral 4D mode at 80 kV, 110 mAs,
with 45 mL contrast. The vascular structures of the complete trunk
are clearly demonstrated, and the suspected leaking from the aortic stent
could be confidently ruled out.
Courtesy of University Medical Center Mannheim, Germany
2 SOMATOM Sessions | December 2013 | www.siemens.com/SOMATOM-Sessions

Editorial
SOMATOM Sessions | December 2013 | www.siemens.com/SOMATOM-Sessions 3
In today’s fast changing global health-care
environment, Siemens’ aspiration
is to contribute in two major directions.
Together with our excellent network
of academic partners, we continue to
extend the frontiers of available diag-nostic
and treatment capabilities. At
the same time – and equally important
– we innovate to make our technology
accessible to more patients around the
world.
The cover article in this RSNA 2013
edition of SOMATOM Sessions intro-duces
the latest frontier-shifting CT
scanner from the Siemens innovation
powerhouse. The new Dual Source CT
SOMATOM Force* builds on the out-standing
clinical success of Siemens’
unique Dual Source technology push-ing
current capabilities and opening
up new possibilities. SOMATOM Force
features enhanced temporal, spatial
and contrast resolution and intro-duces
Turbo Flash scanning with up
to 730 mm per second z-coverage for
free-breathing CT imaging. Its out-standing
tube power – already avail-able
at 70 kV – makes low kV imaging
accessible to virtually all patients and
allows for unmatched iodine contrast
enhancement. All this, together with
a new level of spectral separation for
high precision Dual Energy applica-tions,
opens the door to CT examina-tions
tailored to specific patient need.
SOMATOM Force has the true poten-tial
to deliver the right diagnostic pre-cision
– at previously impossible low
radiation and contrast dose levels.
In the cover article, you will sense
the excitement about the initial expe-rience
of SOMATOM Force at the
University Medical Centre Mannheim,
Germany.
The established SOMATOM Perspective,
on the other hand, is an excellent
example of how to leverage a leading
technology position to develop a high-performance,
affordable routine sys-tem
with excellent economics. Origi-nally
introduced as a 128- and 64-slice
system, the SOMATOM Perspective
family has now expanded into the
32- and 16-slice arena*. In the related
article, you can see how affordability
and full upgradeability within the
product family together with high-tech
features such as SAFIRE, iTRIM, and
Single Source Dual Energy make these
scanners a great choice – even for
challenging economic environments.
As a complement to our CT system
portfolio, we are launching the
syngo.via software VA30** with
expanded functionality for existing
applications as well as new applica-tions,
such as syngo.CT Liver Analysis*.
Finally, I would like to thank heartily
all the participants in the International
Right Dose Image Contest for so
many truly wonderful contributions.
Enjoy reading about these and a
range of other interesting topics in
this issue of SOMATOM Sessions.
Dear Reader,
Walter Maerzendorfer,
CEO of the Computed Tomography
& Radiation Oncology Business Unit,
Imaging and Therapy Systems Division,
Siemens Healthcare,
Forchheim, Germany
** This product is 510(k) pending. Not available
for sale in the U.S.
** The products/features (here mentioned) are
not commercially available in all countries. Due
to regulatory reasons their future availability
cannot be guaranteed. Please contact your
local Siemens organization for further details.

December 2013
Contents
News
14 Getting Further in CT with New Imaging Possibilities
18 Improving Accuracy and Workflow Speed in
Transcatheter Aortic Valve Implantation
22 Fighting Aortic Aneurysms with Modern CT
Technology
26 Scientifically Validated: New Applications for CARE kV
and Adaptive 4D Spiral
28 Back Among the Pioneers
31 syngo.via Frontier – Gateway to an Open Research
Environment
32 Continuous Commitment to the Right Dose
34 Charting New Paths with True Dual Energy
36 Open Up New Opportunities with New Configurations
38 Getting to Grips with Stress Myocardial Perfusion
Imaging
Business
40 Ready for the Next Revolution in Stroke Care?
44 All-in-one
47 When Space is at a Premium – Compact High Quality
Scanning
Clinical Results
Cardiovascular
48 Myocardial Ischemia Assessment using
Adenosine-Stress Dynamic Myocardial CT Perfusion
50 Coronary CTA with Reduced Contrast and Radiation
Dose of 0.19 mSv
52 Bicuspid Aortic Valve with Anomalous Coronary
Artery Fistula – A Rare Incidental Coincidence
Neurology
54 Dynamic Volume Perfusion CT in a Case of
Childhood Moyamoya Disease before and after
Surgical Revascularization
56 Differentiating an Intracranial Hemorrhage
from Iodine in Acute Stroke after Intra-arterial
Recanalization
Acute Care
58 Diagnosis of Splenic Rupture in an 11-year-old Girl
using a Sliding Gantry CT
06 Cover Story
SOMATOM Force:
Medicine to CT

14 18 32 72
Pulmonology
60 Automated Quantification of Pulmonary Perfused
Blood Volume in Acute Pulmonary Embolism using
Dual Energy CTPA
Urology
62 Diagnosing Small Renal Calculi using Low Dose
Dual Energy CT at 0.8 mSv
64 Differentiating Stent from Stone: A New Approach
using Dual Energy CT
Pediatrics
66 Diagnosing Tracheal Stenosis in a 10-week-old Baby
without Sedation
Science
68 Image Quality in Computed Tomography
72 Radiation Hygiene – Transparent and Easy
74 Radiation Protection Scientifically Proven for
Routine Practice
Customer Excellence
76 Tips & Tricks: Easy Bone and Vessel Isolation
77 Clinical Workshops 2014
78 Upcoming Events & Congresses 2013/2014
79 Free DVD of the 11th SOMATOM World Summit
in Orlando
80 Twenty Years of STAR – A Successful Educational
Program for Radiologists
81 From Print to App: SOMATOM Sessions for Everyone
81 2014 Multislice CT Symposium in Garmisch
82 Subscriptions
83 Imprint
Contents

Cover Story
SOMATOM Force:
Medicine to CT
A quantum leap in CT engineering: Siemens’ new scanner, the SOMATOM®
Force, takes over the lead in the Dual Source CT portfolio. As such it will enable
radiologists not only to perform even more individualized diagnostics, but also
to contribute to personalized medicine and new therapy concepts. Interdisci-plinary
imaging experts at the University Medical Center Mannheim, Germany,
share their experience of the first SOMATOM Force installed worldwide.
By Irène Dietschi
Curtain up on Siemens’ latest accom-plishment
in outstanding engineering:
The new SOMATOM Force CT scanner
– the lead Dual Source scanner now
in the market, re-writes the way CT
will be used in the future for diagno-sis
and treatment decisions. The
premiere takes place at the German
University Medical Center Mann-heim,
where the Institute of Clinical
Radiology is proud to be the very
first research institution worldwide to
install the new CT system. The inter-disciplinary
Mannheim specialists
were excited to start working and
doing translational research with their
new scanner, not only because the
SOMATOM Force is almost twice as
1A
High resolution stent imaging – coronary CTA images acquired with Turbo Flash mode in only 0.18 s, at 70 kV and pitch 3.2,
with 0.43 mSv. The patient’s heart rate varied between 58 to 70 bmp during the examination. The VRT image (Fig. 1A) shows
nicely two long stents in both LAD and Cx. The curved MPR image (Fig. 1B) shows the details in the LAD stent.
1
1B

Cover Story
The Institute of Clinical Radiology at the University Medical Center in Mannheim, Germany, is the very first place worldwide to install the new
SOMATOM Force (Associate Professor Thomas Henzler, MD, left, Professor Stefan Schönberg, MD, right, patient, middle).
fast, more precise, and even more
patient friendly than any of its prede-cessors,
but also because they believe
that it is possibly a vehicle for a new
medical paradigm. “From now on,
imaging is no longer limited to classi-cal
diagnostics,” says Professor Stefan
Schönberg, MD, director of the hospi-tal,
and he explains: “As radiologists,
we now have the possibility to create
value-based medicine by targeting
the clinical endpoint of medical proce-dures:
the recovery of the patient.”
CT is the imaging technique that in
comparison with MRI or PET, delivers
the most robust data in the long run,
adds Professor Lothar Schad, PhD,
director of computer-assisted clinical
medicine at the faculty. “The consis-tency
of quantitative data that we are
able to produce using the high-end CT
device cannot be equalled using any
other imaging system,” he says. Schad
thinks that CT will become more and
more accepted as an imaging bio-marker,
which will set the benchmark
for other imaging techniques.
The Medical Faculty Mannheim, part
of Heidelberg University, has been
focusing on medical technology for
over a decade, according to the facul-ty’s
dean Professor Uwe Bicker, MD,
PhD. The renowned University Medical
Center is located near the center
of the city, on a campus designed
for translational clinical research.
The immediate proximity between
the hospital, patients, and research
is regarded as a huge advantage by
the dean: Mannheim was successful
in the national competition for the
so-called research campus, funded
by the German Ministry of Education
and Research, which in Mannheim
involves a public private partnership
with Siemens.
In this context, dean Uwe Bicker also
points out some of the limits of tech-nological
progress: “Technology by
itself is useless unless its application
is affordable for healthcare providers,”
he says. In his opinion, this equation
is one of the most challenging for the
future.
So, how does the SOMATOM Force
contribute to solving this challenge?
It does so in the first place with a
number of engineering milestones,
which are believed to change behav-ior
patterns in CT imaging. Schönberg
is enthusiastic: “In a general popula-tion
with a very complex age and
disease structure, this new scanner
can solve the problems presented by
every radiological situation for virtu-ally
every patient,” he says. Associate
Professor Thomas Henzler, MD, head
of cardio-thoracic imaging at the Insti-tute
of Clinical Radiology, is equally
excited. He is convinced that “With
the SOMATOM Force we have elimi-nated
almost all contraindications for

The immediate proximity between hospital, patients, and research is regarded as a huge advantage
by dean Professor Uwe Bicker, MD, PhD: University Medical Center Mannheim was successful in the
national competition for the so called research campus, funded by the German Ministery of Educa-tion
and Research, which in Mannheim involves a public private partnership with Siemens. Bicker is
very proud of the reputation and the amount of expertise that has been accumulated at the campus
lately, especially in imaging. He is reassured by research student Sonja Sudarski who considers
Mannheim to be “invaluable for young researchers with a vision,” especially as the medical faculty
is equipped with the latest technology.
CT. The scanner allows precise and
individualized imaging of all patients
and thus changes our thinking of CT
completely.” In his and Schönberg’s
view the new system is especially
promising in individualized diagnos-tics:
Every patient should have his or
her best possible diagnostic proce-dure,
meaning that “the CT scan of
an 85-year-old woman, weighing 60
kilograms, has in terms of parameter
settings little in common with that
of a 40-year-old morbidly obese man
with a BMI of 40 as far as required
“With the SOMATOM Force we have elimi-nated
almost all contraindications for CT.
The scanner allows precise and individu-alized
imaging of all patients and thus
changes our thinking of CT completely.”
dose are concerned. Only this high-end
CT system is capable of offering
the variety of parameters for such an
individualized approach.”
Individualized diagnostics is related
to precision medicine. In the future,
imaging will contribute substantially
to the response evaluation of certain
therapies, for example for cancer
patients. Large nations are revising
their healthcare policies radically in
this respect: Henceforth, it will increas-ingly
depend on the response rate –
the ‘endpoints’, as Schönberg puts it –
whether medical treatment will be
reimbursed or not. In such an environ-ment,
novel high-end systems such as
the SOMATOM Force are fundamental
for precise and sound decision-making
by provision of quantitative data.
The SOMATOM Force is expected to
lead to positive changes in a number
of areas. First of all, it is two steps
ahead in contrast-to-noise.
Low-kV imaging for
all patients
The engineers have put huge effort
into lowering the tube voltage, while
maintaining very high photon flux at
a very small focal spot. Low kV exams
are no longer only possible for small
children and slim adults, but will be
possible for practically all adults and
even obese patients from now on.
This, as a matter of routine, results
in a reduction in radiation dose, and
more: With the SOMATOM Force,
the contrast-to-noise ratio has been
Associate Professor Thomas Henzler, MD,
Cover Story

Cover Story
“As radiologists, we now have the
possibility to create value-based
medicine by targeting the clinical
endpoint of medical procedures:
the recovery of the patient.”
Professor Stefan Schönberg, MD,
2
Low dose for challenging patient – 63 cm acquired with
Turbo Flash mode in only 1.2 s, at 80 kV and pitch 2.4,
with 1.9 mSv. The image quality is excellent although the
patient’s left arm had to be kept in the scan field of view.
2
3
Dual Energy lung PBV – 32 cm acquired in only 4 s,
with 55 mL contrast, at 90 / Sn 150 kV. An wedge shaped
perfusion defect area is depicted in the left upper lobe,
although no pulmonary emboli is present. The image
quality is excellent due to greater spectrum separation.
3
improved to such an extent that a scan
can be done with much lower con-trast
medium amounts than previously.
Whereas the average CT scanner
requires between 90 and 110 milliliters
for a certain application, the SOMATOM
Force will produce the same image
quality with just a fraction of the con-trast
medium dose. For a thoracic CT,
for example, volumes as low as 25 to
35 milliliters are expected.
This aspect is especially important
with regard to kidney protection, as
Henzler explains: “In radiology, we’ve
been discussing CT doses for years,
even though we’ve known that nephro-pathy
induced by iodinated contrast
is the greater problem with some
people undergoing computed tomog-raphy.”
Up to 20 percent of patients,
especially if they are older and suffer-ing
from chronic diseases such as
diabetes, might have to undergo pro-longed
pre- and after-care because
the contrast agent may harm their
kidneys. With the new scanner, this
time and cost intensive procedures
might no longer be necessary. In
short: SOMATOM Force is a versatile
scanner. “We are expecting to be able
to examine all patients adequately,
even those suffering from renal
insufficiency,” says Henzler.

Cover Story
Dynamic CTA – 64 cm acquired with spiral 4D mode at 80 kV, 110 mAs,
with 45 mL contrast. The vascular structures of the complete trunk are clearly
demonstrated, and the suspected leaking from the aortic stent could be
confidently ruled out.
4
4
Lowest dose for early
detection of lung and colon
diseases
For lung and colon scans, the contrast-to-
noise ratio is also expected to rise
significantly. Why? The SOMATOM
Force has further developed the pop-ular
Flash Spiral mode into the new
‘Turbo Flash mode’: Besides being
almost twice as fast, it now uses two
selective photon shields instead of
one. The two tin filters optimize the
X-ray spectrum to boost contrast
between soft tissue and air in patient
scans. The resulting increase in the
contrast-to-noise ratio can be ‘rein-vested’
in lowering the dose, allowing
a reduction of approximately 30 per-cent
compared with other high-end
CT’s.
What this means for clinical practice
is explained by Schönberg: “Computed
tomography could very well become
an important tool for the early detec-tion
of lung cancer. The radiation dose
for the risk evaluation of bronchial car-cinoma
has dropped to an extent that
dose is no longer an issue compared
with the added value which you create
with this exam.”
Moreover, the ‘Turbo Flash mode’
might not only reveal lung lesions, but
could also be used for the exclusion
or early detection of two other major
diseases: coronary heart disease and
susceptibility to stroke. As for the
detection of colon diseases, studies
have produced excellent evidence in
support of colon CT. “The results have
shown that colon CT is almost equal
to classical coloscopy, indicating that it
could at least be applied in cases where
classical coloscopy is not possible,”
Schönberg says.
The SOMATOM Force is not only
characterized by low doses, new con-trasts,
and reduced need for contrast
medium, but also by speed. Compared
with its predecessors, it moves breath-takingly
fast.
Free breathing for all patients
One problem frequently found in con-ventional
scans is motion artifacts,
often resulting in insufficient image
quality. Studies show that in cases of
pneumonia, for example, a significant
number of scans carried out with a
standard system are unsatisfactory due
to blurring. This leads to readmissions
that could otherwise have been pre-vented.
If doctors ask their colleagues
in the radiology department to redo a
scan, in one of three cases the reason
is impaired image quality. The new
SOMATOM Force and its novel Turbo
Flash mode can help to minimize this
problem: Compared with the former
Flash Spiral scan mode, Turbo Flash
is almost twice as fast, scanning at
737 mm/s. This means that the Turbo
Flash mode literally freezes respira-tion,
or other motion induced by the

Cover Story
5
Whole liver perfusion –
22 cm acquired at
80 kV, 100 mAs,
with 17.58 mSv only,
for an obese patient
(118 kg) with liver
tumor.
5A 5C
5B 5D
diaphragm or the bowel. So, free
breathing no longer impedes image
quality.
This is a relief, for instance, for older
or maybe overweight patients who have
trouble holding their breath. It is also
relevant for trauma patients who are in
considerable pain and/or unconscious,
and in pediatric CT where doctors can
now perform a CT exam without the
need for sedation or controlled breath-ing
in children. Finally, speed is a crucial
factor in cardiac CT. “So far we have
been able to perform a cardiac CT far
below 1 mSv in patients whose heart
rate was below 65,” says Henzler.
“With the new system we will move to
a situation in which we can examine
higher heart rates and still remain
below 1 mSv, acquiring robust results
we haven’t seen before.” Henzler
believes that those facts will also
generate ‘clinical value’: Cardiac CT
will be more consistently integrated
in the workflow of the emergency
room as an algorithm for patients with
intermediate cardiac risk.
Larger field of view
With the SOMATOM Force, Siemens
engineers have extended the field
of view of the Flash Spiral mode to
up to 50 centimeters. They accom-plished
this major improvement by
introducing the new powerful
VECTRON tube which evolved from
technology initially introduced with
the renowned STRATON tube, and
with the StellarInfinity detector. Based
on the innovative Stellar technology,
the new detector now additionally
enhances resolution by 25%, and more-over
extends the former z-coverage
by 50%. The combination of two
VECTRON tubes and two StellarInfinity
detectors in a Dual Source CT enable
the realizing of the unique Turbo
Flash mode. Henzler is intrigued by
this masterpiece of engineering and
innovation. “The geometry of the
detector has been changed in an
ingenious way that we haven’t seen
so far in computed tomography,” he
says. “We will be able to show even
the smallest vessels such as the coro-nary
arteries or calcified lesions in
perfect resolution, without having
to worry about the dose or motion
artifacts.” Moreover, the extended
field of view will enable radiologists
to scan practically all patients in
Turbo Flash scan mode, including
obese adults as well as patients with
kidney disease. With the SOMATOM
Force it is expected that the Turbo

Cover Story
Flash mode will become standard,
establishing ultra-high pitch scanning
as the true successor of conventional
spiral modes.
Finally, the SOMATOM Force is likely
to become the diagnostic CT tool of
choice for personalized medicine: It
offers precision CT at its best and is
therefore two steps ahead in func-tional
analysis and decision making.
Dynamic perfusion at half
the dose
Although MRI will probably remain
the benchmark for functional imaging,
CT is gaining ground very fast. “CT
has unmatched advantages if you
need imaging in large quantities and
within time limits,” Schönberg says.
The SOMATOM Force offers dynamic
perfusion – which usually requires
high radiation doses – at up to half
the dose compared with conventional
state-of-the-art CT’s, e.g. for the per-fusion
of the liver. The engineering
solution lies in the new StellarInfinity
detector (with TrueSignal technology
plus its 50 percent wider coverage)
and the redesign of the Adaptive
Dose Shield, already known from the
SOMATOM Definition Flash scanner.
Matching the scan speed of the
SOMATOM Force, the collimator blades
can be opened and closed at twice
the speed.
Clinical application is possible for
various organs, such as pancreas,
abdomen, kidneys or the liver.
Dynamic perfusion of the liver, for
6
example, which at present requires
doses between 60 and 70 mSv, is
expected to be possible at the dose of
a conventional 4-phase liver protocol.
Why does this make sense? “Think of
Bevacizumab,” says Henzler: “On the
one hand, Bevacizumab is an impres-sive
drug which suppresses angio-genesis
in various cancers, including
colorectal, lung or kidney. However, it
is a costly drug. If you want to know
whether patients are responding to
the treatment, one way is to monitor
these patients with repetitive perfu-sion
CT.” Short-term monitoring can
reveal which patients respond to anti-angiogenesis
treatment, and which
patients do not. Long-term CT moni-toring
with functional parameters may
help to detect recurrence.
6
Dynamic Runoff –
61 cm acquired with
spiral 4D mode at
70 kV, 130 mAs, with
1.39 mSv and 45 mL
contrast. MIP images
show nicely the
dynamic flow of the
vascular details,
and additionally, the
tendons as well.

Cover Story
Irène Dietschi is an award-winning Swiss
science and medical writer. She writes for
the public media, such as the Neue Züricher
Zeitung and has published several books.
The product is pending 510(k) clearance, and is
not yet commercially available in the United States.
The statements by Siemens customers described
herein are based on results that were achieved
in the customer’s unique setting. Since there is no
“typical” hospital and many variables exist (e.g.,
hospital size, case mix, level of IT adoption) there
can be no guarantee that other customers will
achieve the same results.
Further Information
www.siemens.com/
SOMATOM-Force
At the University Medical Center in Mannheim, the medical faculty has defined three fundamental
topics it wants to pursue with the SOMATOM Force in various clinical studies: treatment response,
nephroproctection and motion artifact reduction. From left to right: Professor Stefan Schönberg, MD,
director of Radiology and Nuclear Medicine, Professor Lothar Schad, PhD, director of computer-assisted
clinical medicine, Florian Lietzmann, MD, team leader of CT physics research at the institute
of computer-assisted clinical medicine, Thomas Henzler, MD, head of cardio-thoracic imaging.
In other tumors such as gastrointestinal
stromal tumors, the most promising
way to assess treatment response is Dual
Energy. In various studies conducted
in Mannheim, iodine-related attenua-tion
has proven to be a very robust
response parameter, as Thomas Henzler
explains. Whereas the Dual Energy
scanners of the first generation had
certain limits in coverage, the new
scanner increases energy separation
by 30 percent. “We expect that the
SOMATOM Force will produce a clear-cut
improvement because of the
spectral upgrade,” says Henzler. In his
view, Dual Energy is clearly gaining
ground: Many vascular questions can
be answered spectrally in post process-ing,
because the two energies have
been separated so effectively.
In Mannheim, the medical faculty
has defined three major topics that it
wants to pursue with the SOMATOM
Force in various clinical studies:
treatment response, nephroprotec-tion,
and motion artifact reduction.
Researchers believe that the new
standing of computed tomography
could affect the workflow of a clinic
substantially: CT could evolve into an
all-in-one triage for new diagnostics
and therapy models. One field in
which this progress is already begin-ning
to emerge is cardiology and
the treatment of acute coronary syn-drome:
At the University Medical
Center Mannheim, if a patient at risk
shows no relevant stenosis of the
coronary arteries in cardiac CT, he or
she is automatically excluded from
cardiac catheter examination. “With
this we have achieved three goals,”
Schönberg explains: “First, we have
supported our colleagues in cardiol-ogy
in their daily work by making sure
that catheter exams are conducted
with higher therapeutic yield; second,
we are more cost-effective; third,
we’ve enriched the interventional
scope of cardiology by referring to our
colleagues those patients who actu-ally
need an intervention.” Analysis
of this new workflow modality has
shown that it is actually cost effec-tive.
In the view of dean Uwe Bicker,
this is the key factor for any techno-logical
innovation: If it is cost effec-tive,
it will prove itself on the market.
CT for cardiovascular issues is a role
model for interdisciplinary workflow
and decision making. But the other
important domain that he and his
radiology group are aiming for is
oncology. Schönberg believes that
cancer is the future market for the
high-end CT system SOMATOM Force.
“My vision is that in five years from
now, oncologists around the world
will prescribe innovative molecular
substances based on functional imag-ing.
“If you have to attend to millions
of people globally, you need an
efficient imaging system in order to
apply those substances cost-effec-tively.
And this will most likely be CT.”

News
Getting Further in CT
with New Imaging Possibilities
Siemens continues to improve its advanced visualization platform syngo.via for
CT: Combined with continuous scanner innovations, Siemens’ syngo.via VA30*
offers a range of additional options for diagnosis and pre-procedural planning.
By Arjen Bogaards, PhD, Jochen Dormeier, MD, Susanne Hölzer, Dominik Panwinkler, Philip Stenner, PhD
Computed Tomography, Siemens Healthcare, Forchheim, Germany
Comprehensive evaluation of myocardial perfusion with
syngo.CT Cardiac Function – Enhancement.
2
1 2
rendered more flexible, too, as phy-sicians
can view images on mobile
devices. Sharing findings with col-leagues
is also easier for fast and
reliable clinical decisions. syngo.via
software guides users through the
entire workflow, identifying human
anatomy, and enabling radiologists to
deliver reliable and meaningful quan-titative
results. Therefore, syngo.via
VA30 is designed to meet as many
clinical challenges as possible.
all modalities, managing both day-to-day
and more challenging cases suc-cessfully.
For this reason, the software
must be based on concepts that are
efficient, flexible, and intelligent. Auto-mated
pre-fetching of prior examina-tions
and pre-processing saves valuable
time, allowing physicians, technicians
and IT professionals to focus on their
core patient-centric tasks. Modular
licensing models offer flexibility so
that the system can grow in line with
needs and budget. Workflows are
Every year, clinical routine is becom-ing
more and more demanding. Phy-sicians
and clinical staff need to make
best use of diagnostic technology tools
available at their particular medical
institution. It is essential to their job to
understand diseases more comprehen-sively
and make the right treatment
decisions faster. This requires technol-ogy
providers to continuously innovate
medical imaging equipment. Siemens’
syngo.via software is designed to fur-thermore
accelerate workflow across
Automatic completion of manufacturer-specific
AAA graft order forms
with syngo.CT Rapid Stent Planning**.
1

syngo.CT Bone Reading enriched
by Spine CAD.
3 4
syngo.CT Liver Analysis**: In-depth analysis of liver vascularization combined 4
with surgery planning.
3
Automated AAA stent
planning
Pre-procedural planning for the treat-ment
of an abdominal or thoracic
aortic aneurysm requires a precise
assessment of several anatomical para-meters.
Numerous vendors offer stent
grafts, each of which requires its own
set of measurements. Anatomical
assessment and completion of the graft
order forms can be tedious and time-consuming.
The new syngo.CT Rapid
Stent Planning** introduces automatic
completion of manufacturer-specific
stent order forms. That holds out the
prospect of skipping all the cumber-some
steps and streamlining abdomi-nal
aortic stent planning. It represents
an ideal extension to the Rapid Results
Technology: Dedicated protocols guide
the user through all length and dia-meter
measurements, which are then
automatically stored in the correspond-ing
order form. For delivery purposes,
syngo.CT Rapid Stent Planning** pro-vides
three order forms as PDFs: Gore
Excluder, Zenith Flex, and Medtronic
Endurant. Furthermore, new order
form templates can be generated to
match the specific requirements of
other vendors.1
Comprehensive myocardial
perfusion analysis
Coronary CTA is a well-established
method of ruling out coronary artery
stenosis. Often, an intermediate ste-nosis
is found whose hemodynamic
relevance may be unclear. In such cases,
a myocardial stress perfusion exami-nation
can help to decide whether a
patient should undergo PCI2 or not.
As a “one-stop shop”, CT is becoming
increasingly important in the assess-ment
of myocardial perfusion. Differ-ent
approaches are currently available,
but Siemens is the only manufacturer
to offer the full spectrum of myocardial
perfusion analysis: Whether simple
first-pass enhancement, Dual Energy
perfusion scanning, or quantitative
dynamic myocardial perfusion. With
syngo.via VA30 and the new perfu-sion
evaluation feature in syngo.CT
Cardiac Function-Enhancement, it is
now possible to evaluate comprehen-sively
all types of myocardial perfusion.
Rather than simply looking at a first-pass
enhancement scan, the quantifi-cation
of iodine concentration in the
myocardium and inspection of quan-titative
blood flow and volume data
provide additional clinical benefits.3
The visualization in AHA-compliant
17-segment polar maps and the direct
overlay in MPR segments help to
pinpoint the perfusion defect. With
syngo.via VA30, the evaluation of
myocardial perfusion becomes faster,
easier, and more reliable.
Advanced oncological
analysis
Assessment of tumor perfusion in
follow-up examinations allows iden-tification
of tumor viability before
changes in tumor sizes are visible.
Identifying these changes at an early
stage of oncological treatment adds
supplementary clinical information
especially when following up on
state-of-the-art treatment with anti-angiogenic
drugs. The “body perfu-sion”
functionality is now available in
syngo.via and provides quantification
of blood flow, blood volume, and per-meability,
combined with automated
motion correction for improved ana-tomical
alignment. In addition to its
1 Adobe Acrobat Professional required; 2 PCI: Percutaneous coronary intervention; 3 CT DE Heart PBV and/or syngo VPCT Body-Myocardium required

News
5 6
use in oncology, a further clinical
application is to assess perfusion in
cases of organ transplantation.
The new syngo.CT Liver Analysis**
delivers in-depth clinical insights based
on comprehensive analysis of CT data-sets
and tools for surgery planning.
For the surgeon it is crucial to know
the precise size and location of tumors
before the operation. It is also essen-tial
to assess the amount of liver tissue
that is to be resected and the exact
anatomical vascular supply to the
affected liver segments. By dissecting
the liver virtually using the software,
the physician is able to compare the
amount of resected and residual
liver tissue – one of the key factors in
the surgery outcome. syngo.CT Liver
Analysis** supports these pre-opera-tive
planning steps by combining
tailored functions and tools with intu-itive
workflow guidance.
Extended bone reading
support
Building on the success of syngo.CT
Bone Reading, the application has
been enhanced with CAD* (Computer
Assessment of diffuse tumor infiltrations with
syngo.CT DE Bone Marrow**.
Aided Detection) functions to identify
suspicious spine lesions. Intended for
use as a second reader tool after the
initial read has been completed, this
supplementary tool draws the radiol-ogists
attention to regions of interest
(ROI) that may have been initially
overlooked. In addition to the revolu-tionary
new visualization in bone read-ing
– which adapts complex anatomies
to reading needs – this new feature
has demonstrated potential in detect-ing
lytic and blastic metastasis as
reported in a scientific publication
from the Department of Radiology,
University Hospital Erlangen.[1]
With these new additions, syngo.via
VA30 offers a comprehensive portfolio
enabling holistic oncological reading.
CT imaging – the cornerstone
of stroke care
Across the globe, 1 in 6 people will
suffer a stroke at some point in their
life. It is one of the world’s most threat-ening
diseases. Almost two million
brain cells could be lost every minute
if a stroke patient is left untreated.
Fast treatment is essential to improve
the chances of a good outcome. How-ever,
the time it takes from the stroke
patient arriving in the emergency
department to receiving thrombolytic
drugs (door-to-needle times) remains
a major challenge in many hospitals.
An important element in this cascade
of events is the imaging software that
is connected to the CT scanner. It is
decisive to increase speed and confi-dence
of the diagnosis and conse-quently
for the implementation and
monitoring of effective treatment.
Generally, a non-contrast CT scan
and single phase CT Angiography will
be administered to exclude bleeding
and confirm the presence of an occlu-sion
in order to determine eligibility
for thrombolytic drug administration.
syngo.CT Neuro Perfusion can help
to visualize the size of the core infarct
and penumbra; the latter represents
tissues that may be salvaged through
further reperfusion therapy.
Excitingly, 4D CT Angiography is
used increasingly and several novel
applications are beginning to emerge.
syngo.CT Dynamic Angio can create
View of the neurovasculature from 6
arch to vertex with syngo.CT Neuro DSA.
5

7 Evaluation of multiple monoenergetic ROIs with syngo.CT DE Monoenergetic Plus**.
News
** The products/features (here mentioned) are
not commercially available in all countries. Due
to regulatory reasons their future availability
cannot be guaranteed. Please contact your local
Siemens organization for further details.
** This product is 510(k) pending. Not available
for sale in the U.S.
movies that visualize the flow of con-trast
from arterial to venous phase and
depict tMIPs. This can help the clini-cian
better assess the collateral status
and define the occlusion length in
stroke.[3] As such, 4D CT Angiography
has potential in helping to select the
patient optimally suited for interven-tional
clot retrieval. All indications at
the present suggest that CT imaging
will remain the cornerstone of stroke
care.
New boost for Dual Energy
CT with syngo.via VA30
True Dual Energy offers extended
diagnostic possibilities
taking CT imag-ing
beyond morphology by enabling
exploration of functional and quanti-tative
aspects. And progress still con-tinues.
A highlight of the syngo.via VA30
is the new Dual Energy application
syngo.CT DE Bone Marrow**. The bone
marrow can be affected by various
pathologies, such as bone bruises after
trauma as well as by diffuse tumor
infiltrations. Until today, the major
modality for imaging these patholo-gies
has been MRI. With the benefit of
True Dual Energy, CT imaging can now
also aid in the diagnosis. syngo.CT DE
Bone Marrow** allows for the seg-mentation
and the visualization (color-coding)
of the bone marrow based on
a material decomposition into bone
marrow and calcium. This application
can be used for both Dual Source and
Single Source Dual Energy datasets.
Furthermore the syngo.CT DE Virtual
Unenhanced* application has been
complemented in order to address a
wider clinical spectrum. While the
well-established Liver VNC algorithm
enables quantification of the iodine
uptake in the liver tissue, the new Vir-tual
Unenhanced algorithm has been
improved for optimized visualization
of those organs that – in contrast to
the liver – do not contain variable
amounts of fat, such as the lung, kid-ney,
and pancreas. The iodine uptake
may give additional indications about
the malignancy of a lesion. Moreover,
the effectiveness of a therapy can be
validated by evaluating the develop-ment
of the iodine uptake in the treated
lesion before and after treatment.
Monoenergetic imaging has become
a reliable application to improve
image quality as well as for effectively
reducing metal artifacts. syngo.via
VA30 together with syngo.CT DE Mono-energetic
Plus** offers a new, power-ful
algorithm allowing for a better
quantitative assessment of different
tissues and lesions by displaying
multiple monoenergetic ROIs and the
associated absorption curves. A further
benefit for research and diagnostic
tasks is the ability to export the statis-tical
information to the file system for
more in-depth evaluation.
syngo.via VA30 offers a broader
range of tools to meet today’s grow-ing
clinical requirements with the
support of high quality CT imaging.
References
[1] Automatic detection of lytic and blastic
thoracolumbar spine metastases on
computed tomography. Hammon M.
et al; Eur Radiol. 2013 July; 23(7):
1862–1870.
[2] Meretoja A et al. Reducing in-hospital
delay to 20 minutes in stroke throm-bolysis.
Neurology. 2012, 79:306-13.
[3] Frölich AM et al. 4D CT Angiography
More Closely Defines Intracranial
Thrombus Burden Than Single-Phase CT
Angiography. AJNR Am J Neuroradiol.
Published online before print April 25,
2013.
Further Information
www.siemens.com/
ct-clinical-engines
7a 7B
Further steps will follow opening
up to users the opportunity to fully
exploit their diagnostic technology.
syngo.via can be used as a standalone device
or together with a variety of syngo.via-based
software options, which are medical devices in
their own right.
Not for diagnostic use.

News
Improving Accuracy and Workflow
Speed in Transcatheter Aortic Valve
Implantation
Computed tomography provides valuable information for the
planning of transcatheter aortic valve implantation, and the
syngo.CT Cardiac Function – Valve Pilot application of syngo.via speeds
up workflow while increasing accuracy and safety for patients.
By Sameh Fahmy, MS
selected. Choosing a prosthesis that
is too small can lead to a paravalvular
leak, for example, while fitting one that
is too large could cause a catastrophic
rupture of the aortic root. In addition,
the catheters used in the procedure
are relatively large, so physicians must
be able to reliably assess calcifications,
ment.[1] However, careful planning
of this advanced procedure which is
necessary for optimal patient outcome
can present a number of challenges
for physicians.
Exact measurements of the anatomy
of the heart are necessary so that
the appropriate sized prosthesis is
Transcatheter aortic valve implanta-tion
(TAVI, also known as transcatheter
aortic valve replacement (TAVR) in
the U.S.) has been shown to signifi-cantly
prolong the lives of those severe
aortic valvular stenosis patients, who –
because of comorbidities – are not
candidates for surgical valve replace-
syngo.CT Cardiac Function – Valve Pilot: physicians are able to work with zero-delay for quantitative
assessment of the aortic annulus.
1
1

Professor Stephan Achenbach, MD,
Department of Cardiology, University of Erlangen-
Nürnberg
stenoses, and the diameter of the
peripheral arteries, in order to select
a suitable access route and avoid
potentially fatal complications.
Despite these challenges, physicians
such as Professor U. Joseph Schoepf,
MD and Professor Stephan Achenbach,
MD are able to plan the TAVI procedure
efficiently, accurately, and with confi-dence.
Joseph Schöpf is Professor of
Radiology and Medicine and Director of
CT Research and Development at the
Medical University of South Carolina in
the United States. Stephan Achenbach
is Chairman of the Department of Car-diology
at the University of Erlangen-
Nürnberg in Germany. They both were
among the first to test the application
syngo.CT Cardiac Function – Valve
Pilot.
The software provides a dedicated
workflow for CT TAVI planning; auto-matically
measuring the dimensions
of the aortic annulus providing single-click
localization and quantification of
the smallest iliac diameter, and auto-matically
calculating the corresponding
C-arm angulation for a given projection.
“It enhances our workflow efficiency,
which is an aspect that is becoming
increasingly significant – especially
in centers with extremely high vol-umes,”
Schoepf says. “What is more
important for me is that it enhances
accuracy and safety for patients.”
Assessing critical
structures easily
Worldwide, an estimated 40,000
patients have received TAVI.[2] The
landmark, multicenter trial PARTNER
(Placement of AoRTic TraNscathetER
Valve) demonstrated that the TAVI
procedure reduced all-cause mortal-ity
by nearly 50% in patients who
were ineligible for the open proce-dure.[
1] Furthermore, key secondary
end points, such as patient condition,
had significantly improved by the
time of the one-year follow up. In the
group of patients who were defined
as having a high surgical risk, TAVI
was found to be non-inferior to surgi-cal
aortic valve implantation. Mortal-ity
rates after one year were 24.2%
for TAVI, compared with 26.8% for the
surgical procedure.[3]
While the clinical trials that led to the
introduction of the TAVI procedure
used echocardiography and conven-tional
angiography for pre-procedural
planning, Achenbach stresses that CT
provides the information that improves
the safety and accuracy of the proce-dure.
“The question of whether there
are arteries of the body, especially in
the legs, available to use for an access
route can, by far, be best answered
by CT,” Achenbach says. “And we now
have data that clearly show that CT is
the best tool for choosing the correct
size of prosthesis.”
The manual detection and measure-ment
of the annulus – the structure
demarcated by the hinges of the
aortic valve leaflets – is a particularly
cumbersome and time-consuming
process, but one at which the soft-ware
excels. As the case is opened, it
displays the annular plane and calcu-lates
critical measures, such as the
area, and long and short axes of the
annulus. The ostium views help to
determine the distance between the
coronary ostia and the annulus plane.
A process that could otherwise take
“CT adds tremendously
to the TAVI procedure by
making it safer.”
News

News
up to approximately 20 minutes now
happens almost instantaneously, and
with an unparalleled level of repro-ducibility.
In a study presented at the 2012
annual meeting of the Radiological
Society of North America, Schoepf
and his colleagues found that the
software was in excellent agreement
with human observers.[4] He adds
that even in cases where manual
adjustments are necessary, the use
of the software still saves time by
giving radiologists a good starting
point from which they can work.
“These sorts of measurements are
crucial going into the procedure, but
they’re also where substantial human
error can occur – with pretty dire
consequences,” Schoepf says. “The
beauty of having a computer algo-rithm
to do it is that if you give it the
same task twice, it comes up with
the same measure.”
Choosing the appropriate prosthesis
is a balancing act for physicians.
Patients who develop a paravalvular
leak have a higher likelihood of death
following TAVI;[5] however, a recent
study demonstrated that using CT
substantially reduces the incidence
of paravalvular aortic regurgitation,
when compared to transesophageal
echocardiography based sizing – with
rates of 7.5% and 21.9%, respec-tively.[
6]
A similar balancing act occurs in
measuring the ostia. A measurement
that is too short will result in the
unnecessary exclusion of a patient,
while one that is too large has the
potential to result in the implantation
of a prosthesis that occludes a coro-nary
artery.
Schoepf says that helping to deter-mine
a suitable access route for the
relatively large catheters required by
the procedure is another area where
the software excels. It offers single-click
localization and quantification of
the smallest iliac diameter, as well as
visualization and subtraction of aortic
calcifications. Furthermore, it auto-matically
calculates the area and dia-meter
of vessels: “Even the most expe-rienced
observers derive substantial
value from features like these because
they improve quantitative accuracy
and workflow,” Schoepf says.
Minimizing contrast dose to
improve safety
According to Achenbach, one feature
of syngo.via that is of particular bene-fit
to patients is the automatic calcula-tion
of the corresponding C-arm angu-lation
for a given CT projection. This
“The fundamental
advantage of the software
is that it finds the aortic
annulus automatically.”
Professor U. Joseph Schoepf, MD,
Department of Radiology,
Medical University of South Carolina, Charleston, U.S.

News
With the SOMATOM Definition Flash very little amounts of contrast are required
to acquire the entire anatomy relevant for TAVI planning (only 40 mL in this case)
Courtesy of University of Erlangen-Nürnberg, Erlangen, Germany
feature improves workflow, while also
increasing the accuracy of the proce-dure
as physicians in the cath lab use
the best-possible viewing angle.
Achenbach notes that a large percent-age
of patients undergoing TAVI have
renal insufficiency, which makes keep-ing
contrast dose usage to a minimum
an important consideration for patient
safety. “There are several methods to
find the optimum viewing angle in the
cath lab, but they all require contrast
dose,” Achenbach says. “If you know
which angle to use to look at the aortic
valve, you don’t have to do extra imag-ing
in the cath lab to find this out.”
Achenbach and Schoepf both use a
SOMATOM® Definition Flash Dual Source
CT scanner for TAVI planning to fur-ther
minimize contrast dose. Planning
the procedure requires a relatively
large scan range, from the shoulder to
the hip, but the speed with which the
scanner acquires data allows them to
keep contrast dose to a minimum. In a
study of 42 patients, Achenbach and
his colleagues were able to assess aortic
root anatomy and vascular access in
less than 2 seconds, using 40 mL of
iodinated contrast agent.[7] “That we
can do everything so quickly and with
so little contrast is of great benefit to
patients undergoing the TAVI proce-dure,”
Achenbach says, “and you’re not
sacrificing any image quality.”
Improving outcomes,
reducing costs
Patients who undergo TAVI have sub-stantially
shorter hospital stays than
those undergoing surgical valve replace-ment.[
3] Also, patients treated medi-cally
have higher rates of rehospital-ization
than those undergoing TAVI.[1]
By improving patient outcomes, the
accuracy and safety offered by syngo.via
has the potential to decrease costs
further. Achenbach notes that TAVI pro-cedures
require a large clinical team;
therefore, even saving 10 to 15 min-utes
during the procedure by deter-mining
the optimal viewing angle in
advance can make a big difference.
As physicians’ experience with the pro-cedure
grows, Schoepf and Achenbach
believe that there will be fewer compli-cations
and better outcomes. Currently,
2
2A
two major manufacturers produce
the prostheses, but the physicians
expect increased competition from
other manufacturers to drive down
costs further.
TAVI is currently indicated for patients
who are inoperable because of comor-bid
conditions, as well as those who
are considered a high surgical risk.
However, the minimally invasive nature
of the procedure makes it appealing
to younger and healthier patients:
“As the results of the procedure get
better and better, there’s less incen-tive
to do conventional surgery,
even maybe in healthier patients,“
Achenbach says. “So the question of
who receives this procedure and who
undergoes conventional surgery will
constantly need to be recalibrated.”
References
[1] Leon MB, et al. Transcatheter aortic-valve
implantation for aortic stenosis in
patients who cannot undergo surgery.
N Engl J Med. 2010;363:1597-607.
[2] Holmes DR, et al. 2012 ACCF/AATS/SCAI/
STS expert consensus document on
transcatheter aortic valve replacement.
J Thorac Cardiovasc Surg. 2012 Sep;
144(3):e29-84.
[3] Smith CR et. al., Transcatheter versus
Surgical Aortic-Valve Replacement in
High-Risk Patients N Engl J Med 2011;
364:2187-2198).
[4] Schoepf JU et. al., Automated annulus
assessment accuracy in comparison to
standard software and manual assess-ment.
RSNA 2012
[5] Tamburino C et. al., Incidence and
predictors of early and late mortality
after transcatheter aortic valve implan-tation
in 663 patients with severe aortic
stenosis. Circulation, 123 (2011),
pp. 299-308
[6] Jilaihawi H, et al. Cross-sectional
computed tomographic assessment
improves accuracy of aortic annular
sizing for transcatheter aortic valve
replacement and reduces the incidence
of paravalvular aortic regurgitation.
J Am Coll Cardiol. 2012;59:1275-1286
[7] Wuest W, et al. Dual source multide-tector
CT-angiography before Trans-catheter
Aortic Valve Implantation (TAVI)
using a high-pitch spiral acquisition
mode. Eur Radiol. 2012 Jan;22(1):51-8.
Sameh Fahmy, MS, is an award-winning
freelance medical and technology reporter
based in Athens, Georgia, USA.
The statements by Siemens’ customers described
2B
Further Information
www.siemens.com/CT-TAVI

Svenja Hennigs, MD, is Head of the hospital’s Department of Radiology and Nuclear Medicine at the “Knappschaftskrankenhaus” in Bottrop, Germany.
Fighting Aortic Aneurysms
with Modern CT Technology
A hospital that formerly served coal workers and their families
has reinvented itself as a modern center of medical care. A distinct
focus lies on the catheter-based treatment of life-threatening
aortic aneurysms, a method that requires regular CT follow-up.
The SOMATOM® Definition Edge has helped the hospital
“Knappschaftskrankenhaus” in Bottrop in Germany to speed up
these examinations and to reduce radiation exposure considerably.
By Philipp Grätzel von Grätz, MD

Without modern radiology, and particularly modern CT examinations, stent treatments
of aortic aneurysms are unthinkable – even in Knappschaftskrankenhaus in Bottrop.
News
The abdominal aorta is the main sup-plier
of blood to the abdomen and the
lower extremities. Technically, it is a
flexible tube with an average diameter
of around two centimeters. Most peo-ple
will never be aware of what is the
largest artery in the human body. It is
an organ that normally works silently
for decades. But there are exceptions:
Approximately one in thirty adults will
develop an aneurysm in the abdominal
aorta – defined as an increase in
vessel diameter to more than three
centimeters.
Stent treatment as a new
standard of care
Aortic aneurysms with a diameter of
more than four to five centimeters are
considered critical from a medical point
of view. The larger the diameter, the
higher the risk of a rupture. And a rup-ture
of this high-volume, high-pressure
artery can easily result in death: Nine
out of ten patients with this condition
will die. The perfidious thing about
these ruptures is that they happen with-out
warning, which is why abdominal
aortic aneurysms are sometimes called
the “silent killers.”
Ruptures of aortic aneurysms, in other
words, need to be avoided at all costs,
and they can be. Aortic aneurysms are
a treatable condition. For decades,
open surgery was the method of choice.
Today, most aortic aneurysms are
treated by catheter-based implantation
of aortic stents – a quicker and far
less invasive method of permanently
stabilizing the artery. The Knappschafts-krankenhaus
in Bottrop is one of sev-eral
hospitals that have specialized in
this new method. “Our vascular sur-geons
perform more than 150 of these
procedures per year. This means that
our hospital is among the leading insti-tutions
in Germany in this field,” says
Svenja Hennigs, MD, Head of the hos-pital’s
Department of Radiology and
Nuclear Medicine.
CT as a tool for planning
and follow-up
There is a good reason why Svenja
Hennigs, as a radiologist, is such an
advocate of aortic stenting: Without
modern radiology, and particularly
modern CT examinations, stent treat-ments
of aortic aneurysms would
be unthinkable. Every single patient
needs numerous CT examinations
before and after the stent implanta-tion.
The radiologist is the indispens-able
partner of the vascular surgeon
who is confronted with an aneurysm
patient.
First of all, the CT is a planning tool:
“We need a good reconstruction of
the aorta and the origins of the renal
and mesenteric arteries before the
intervention to choose the ideal pros-thesis,”
explains Hennigs. “This is why
we use thin slices of one millimeter
to get the necessary raw data and to
be able to provide a proper 3D model
for our surgeons.”
After the stent implantation, the CT
examination becomes the single most
important tool for following up the
patients. The vascular surgeons at the
Knappschaftskrankenhaus examine
the patients on the day after the
implantation. There are further follow-up
examinations after three, six and
twelve months. Later on, the frequency
of examinations depends on the indi-vidual
situation. Most patients come
at least once a year. “This means
that we have far more CT examina-tions
of aortic aneurysm patients per
year than we have surgeries. At the
moment, the department of radiology
performs 15 such examinations per
week. And this number will probably
increase further in the years to come.”
Watching out for endoleaks
The most important reason for
regular CT follow-up examinations is
the search for endoleaks. These are
defined as persistent blood flow within
the aneurysm sac. There are five dif-ferent
types of endoleak with different
characteristics and different degrees
of clinical relevance. As a rule, an endo-leak
increases the risk of an expan-sion
of the aneurysm and, ultimately,
the risk of rupture. This is why endo-leaks
need to be detected and closely
monitored. In some cases, a second
intervention may be necessary.
The problem with repeated CT exami-nations
is that they add up to fairly
high radiation dosages over the years.
“Together with tumor patients, aortic
aneurysm patients are probably the
patients with the highest radiation
exposure,” says Hennigs. But there is
good news for the aneurysm patients
at the Knappschaftskrankenhaus.
Thanks to the new SOMATOM
Definition Edge CT system that was
installed in Bottrop in March 2013,
the average radiation dose per exam-ination
has been reduced considerably.
Cutting-edge technology
slashes radiation dose
Hennigs recalls that the hospital had
been working with a 64-slice CT sys-tem
for many years. “At some time,

News
The Knappschaftskrankenhaus in Bottrop is among the leading institutions in Germany
in treating aortic aneurysms by catheter-based implantation of aortic stents.
we started thinking about upgrading
to a new one. When I heard about the
SOMATOM Definition Edge in 2012,
I was immediately interested. We
learned that the new Stellar detector
and the iterative reconstruction algo-rithm
SAFIRE can lead to a reduction
in radiation dose of up to 60 percent*
under optimal conditions. This really
thrilled us, because it was exactly
what we were looking for.”
Siemens Stellar detector is the first
fully-integrated detector. It reduces
electronic noise, which helps to reduce
radiation dose and to improve spatial
resolution by generating ultra-thin
slices.
When the new CT was installed in
Bottrop, the radiologists there were
quickly convinced of the system’s
benefits.
“In a lean patient with an aortic aneu-rysm,
we often need less than half
the radiation dose than we did with
the previous 64-slice system.” As
expected, adipose patients are some-what
more challenging. “But even in
these situations, the dose is down by
20 to 30 percent in many patients.”
Together with Siemens, Hennigs is
currently evaluating the average dose
reduction that was achieved with the
SOMATOM Definition Edge in a series
of 50 aortic aneurysm patients.
Assistants allowed to think
The reduction in radiation dose is not
only good for aortic aneurysm patients:
“It’s good for every patient who needs
a CT. And it is particularly good for
tumor patients or certain patients with
neurological conditions who need to
be examined again and again,” explains
Hennigs. Another impressive example
that she cites is patients who need
preventive CT examinations for lung
tumors. Such examinations are being
carried out on asbestos workers. But
they are also increasingly recommended
for heavy smokers. “In past days, a
conventional lung CT would require a
radiation dose of 8 to 10 millisievert
(mSv). Modern low-dose CTs bring that
down to 3 to 4 mSv. With the SOMATOM
Definition Edge, we are able to do a low-dose
CT of the lung at 1 to 1.5 mSv. And
believe it or not, we had one patient
who needed as little as 0.8 mSv.”
In combination with the new Stellar
detector, the iterative image recon-struction
technology SAFIRE is the key
to achieving the outstanding low radi-ation
doses. SAFIRE features a set of
pre-specified programs. It also allows
for a certain degree of manual control,
as Svenja Hennigs explains: “We turn
SAFIRE on for practically every patient.
The radiological assistant then decides
individually whether he or she can risk
going down a little further or not. The
SOMATOM Definition Edge is, in fact,
the first CT system for many years that
allows the radiological assistant to
think in new directions.”
Quicker examinations,
higher image quality
Having worked with the SOMATOM
Definition Edge for four months,
Hennigs and her colleagues have dis-covered
various additional benefits
The Knappschaftskrankenhaus Bottrop opened in
1931 as a hospital for miners who worked in the
numerous coal mines of the Ruhr Basin in Germany –
at that time, the powerhouse of Central Europe.
There is still a small sculpture in the entrance hall
that reminds visitors and patients of these roots:
St. Barbara, patron saint of miners. Today, the Knapp-schaftskrankenhaus
is a modern hospital for acute
and regular care with 346 beds in nine clinical depart-ments.
More than 50,000 patients are treated per
year, a large number of which are outpatients. The
department of radiology keeps nine radiologists and
15 radiology assistants busy. Apart from the SOMATOM
Definition Edge, they have a Siemens MRI, three
angiography systems, a mammography unit, and two
workplaces plus nuclear medicine and ultrasound.
Coal in the genes

Image comparison for follow-up scan of same patient between previous 64-slice system (Fig. 1A) and new
SOMATOM Definition Edge (Fig. 1B) with SAFIRE at half the dose with comparable diagnostic image quality.
Courtesy of Knappschaftskrankenhaus Bottrop, Germany
News
to the new system. First of all, speed.
“We are now able to perform a thoracic
CT within 3 seconds, and an abdomen
takes around 12 seconds. It’s extremely
quick. The limiting factor is not the
examination, but getting the patient in
and out again.”
Hennigs is also very impressed by
the image quality that the SOMATOM
Definition Edge provides: “I would put
it this way: The images are more bril-liant.
This becomes particularly obvious
with CT examinations of bone fractures.
When I compare high-resolution images
of fracture lines from the same patient
recorded with the previous 64-slice CT
against the new one, the overall impres-sion
is totally different. It is far better
now, much clearer and more detailed.”
A quantum leap
When looking at the modern CT sys-tems
available on the market last year,
Hennigs also considered other vendors
instead of SOMATOM Definition Edge
system. “But I thought that the more
compact system in combination with
high end detector technology fitted
our needs better.” The fact that the
SOMATOM Definition Edge also fea-tures
Dual Energy (DE) technology
made the decision even easier: “Our
urologists and nephrologists, in par-ticular,
asked us to provide DE tech-nology
for visualizing urinary tract
stones and uric acid crystals. So we
decided to also acquire the DE appli-cations
that come with the SOMATOM
Definition Edge, and we are now
using it regularly. It provides excellent
DECT images.“
All in all, neither the radiologists nor
radiological assistants in Bottrop miss
the previous 64-slice system: “The
SOMATOM Definition Edge really is
a quantum leap forward. We are still
discovering new possibilities with it.
And once you have learned to work
with all its features, the results are
fantastic.”
* In clinical practice, the use of SAFIRE may reduce
CT patient dose depending on the clinical task,
patient size, anatomical location, and clinical
practice. A consultation with a radiologist and a
physicist should be made to determine the appro-priate
dose to obtain diagnostic image quality
for the particular clinical task. The following test
method was used to determine a 54 to 60%
dose reduction when using the SAFIRE reconstruc-tion
software. Noise, CT numbers, homogeneity,
low contrast resolution and high contrast resolu-tion
were assessed in a Gammex 438 phantom.
Low dose data reconstructed with SAFIRE showed
the same image quality compared to full dose
data based on this test. Data on file.
1A
Previous 64-slice system (Fig. 1A) SOMATOM Definition Edge (Fig. 1B)
kV-Setting 120 kV, 95 mAs 100 kV, 92 mAs
DLP 318 mGy cm 158 mGy cm
CTDI 7.32 mGy 3.66 mGy
1
1B
Philipp Grätzel von Grätz is a medical
doctor turned freelance writer and book
author based in Berlin, Germany. His focus
is on biomedicine, medical technology,
health IT, and health policy.

Recently published scientific studies
present evidence of the additional
benefits of CARE kV and the Adaptive
4D Spiral – which until now had only
been described in terms of potential.
CARE kV
Adjusting the tube voltage for every
CT scan can help deliver the right
dose to every patient; and varying kV
values for different applications can
help achieve optimal image quality.
This potential was known but the
adjustments were too complicated to
do manually, as the tube current then
needs to be adapted accordingly.
CARE kV automatically selects the
tube voltage and CARE Dose4D adapts
the tube current.
Many scientific studies have shown
the benefits of CARE kV for different
types of examination.[1,2] Yet, stud-ies
focusing on pediatric CT imaging
with CARE kV had been lacking until
researchers from Mallinckrodt Institute
of Radiology, St. Louis, US, published
their latest results. In their study
they first evaluated the potential of
CARE kV for CT Angiography exami-nations
using three different-sized
pediatric phantoms.[3]
In the second step, these findings
were used in a study with 87 pediatric
patients.[4] The tube voltage set as
reference was 120 kV. With CARE kV,
the tube voltage was lowered to
100 kV, 80 kV, or even 70 kV in 82
of these 87 patients (i.e. 94% of the
cases). Image quality was assessed
subjectively; 15 of these cases were
also compared with a previous
CT scan
at 120 kV. Contrast-to-noise ratio
(CNR) was evaluated in these cases.
The authors outline the implications
for patient care: “Use of automated
kilovoltage selection technology
appears to be an effective strategy
for optimizing tube voltage selection
and reducing radiation dose while
maintaining image quality in contrast-enhanced
pediatric CT and should
be introduced into routine clinical
practice.”[4]
Adaptive 4D Spiral
CT Perfusion imaging with Adaptive
4D Spiral delivers qualitative and
quantitative information about perfu-sion
patterns. In recent years, scien-tific
studies have been published that
focus on different organs and tumor
entities.[5,6] Usually, the examina-tions
had to be performed with a tube
This examination of a baby was
included in a study.[4] The VRT shows
well enhanced mediastinal vessels and
a persistent left superior vena cava
(arrow). The effective dose for this scan
was 0.36 mSv.
Courtesy of Mallinckrodt Institute of
Radiology, Saint Louis, USA
1
voltage of 100 kV. In a phantom study,
CT perfusion examinations with
SOMATOM® Definition Flash – either
with conventional detector technology
or the Stellar detector – were com-pared
at 80 kV and 100 kV. In view of
the minimized electronic noise, the
authors conclude: “The Stellar detector
allows the routine use of 80 kV for
abdominal perfusion imaging. For
identical CNR this reduces the dose by
35% compared to 100 kV.”[7]
New cancer treatment options –
including anti-angiogenic drugs that
influence blood supply to a tumor –
have been introduced and are still
under intense evaluation.
Researchers from University of Lille,
France have used Adaptive 4D Spiral
technology to assess treatment out-comes
in the case of non-small-cell
lung cancer (NSCLC).[8] In group 1,
17 patients received conventional
chemotherapy, 23 patients in group 2
were also given an anti-angiogenic
drug (Bevacizumab). The perfusion
information was derived before treat-ment
begin and then at three later
points in time. Perfusion was quanti-fied
using two new parameters: total
tumor vascular volume (TVV, in mL),
which is based on blood volume; and
total tumor extravascular flow (TEF,
in mL/min), which is based on the
volume transfer constant ktrans – also
known as flow extraction product. In
addition, RECIST (Response Evaluation
Criteria in Solid Tumors) data was col-lected
to assess tumor size. Given the
changes in perfusion parameters and
in RECIST, the authors summarized
a key finding: “Specific therapeutic
effects of anti-angiogenic drugs can be
detected before tumour shrinkage.”[8]
News
By Heidrun Endt, MD
1
New Applications for CARE kV
and Adaptive 4D Spiral

Outlook
Since the introduction of CARE kV
and Adaptive 4D Spiral, several studies
have been published indicating broad
potential application. This portfolio
has now been extended. In the case
of CARE kV, initial studies have shown
the benefits when scanning young
patients. Further research is expected
on low kV imaging in pediatric CT, in
particular. For Adaptive 4D Spiral, the
perfusion evaluation of tumors was
scientifically validated for different
clinical questions.[5,6] New develop-ments
in other areas, such as with
the Stellar detector, may lead to new
options for existing technologies.[7]
The possibility of perfusion imaging
at 80 kV will be of great interest to
the scientific community. The study
from France shows that with Adap-tive
4D Spiral technology a prediction
of a treatment response to anti-angio-genic
drugs is possible for cases of
NSCLC. In their conclusion, the authors
indicate the potential: “If these prom-ising
preliminary results can be con-firmed
by larger studies, perfusion CT
could represent a very useful non-invasive
tool for thoracic oncologists
to manage anti-angiogenic treat-ments
in clinical
practice with the
objective of avoiding pointless thera-pies
and their potential adverse
events as well as cost savings.”[8]
The examination of this 62-year-old patient suffering from an adenocarcinoma
of the lung in the left lower lobe was included in the study.[8]
Images on the left-hand side show the situation before treatment, images
on the right-hand side were obtained after one cycle of therapy (including
anti-angiogenic drugs).
Conventional images (mediastinal window) are shown in Fig. 2A and 2B. Perfusion
information can be derived from Fig. 2C and 2D (TVV) and 2E and 2F (TEV).
The perfusion maps show a decrease in vascularity (TVV from 4.4 mL to 1.6 mL;
TEF from 4.3 mL to 2.2 mL) whereas no change in tumor size could yet be seen
in the mediastinal images.
Courtesy of University Hospital of Lille, France
2
News
2A
2C
2E
2B
2D
2F
References
[1] Eller A, et al. Invest Radiol. 2012
Oct;47(10):559-65.
[2] Park YJ, et al. J Cardiovasc Comput
Tomogr. 2012 May-Jun;6(3):184-90.
[3] Siegel MJ, et al. Invest Radiol. 2013
Aug;48(8):584-9.
[4] Siegel MJ, et al. Radiology. 2013
Aug;268(2):538-47.
[5] Goetti R, et al. Invest Radiol. 2012
Jan;47(1):18-24.
[6] Reiner CS, et al. Invest Radiol. 2012
Jan;47(1):33-40.
[7] Klotz E, et al. Performance evaluation
of a new CT detector with minimal
electronic noise for low dose abdominal
perfusion imaging. Insights Imaging
(2013) 4 (Suppl 1):200
[8] Tacelli N, et al. Eur Radiol. 2013
Aug;23(8):2127-36.

The initial positive assessment of the SOMATOM Perspective has continued at Sainte-Marie Medical Imaging Center in Osny, near Paris, France.
Back Among the Pioneers
One of the first ever installations of a SOMATOM® Perspective CT scanner
was at Sainte-Marie Medical Imaging Center in Osny, near Paris, France in
January 2012. One and a half years later, SOMATOM Sessions returned to the
center to discover whether the initial enthusiasm and hopes were justified.
The positive assessment made at that time was entirely confirmed.
And – particularly attractive in this era of austerity – at an affordable price.
By Christian Rayr

“eMode reduces material
wear, extends the machine’s
lifetime, and eliminates
downtime. We’ve had
no breakdowns or annoying
problems to report.”
Alexandre Fuchs, MD,
Sainte-Marie Medical Imaging Center, Osny, France
News
Alexandre Fuchs, MD is a doctor, spe-cialising
in diagnostic and co-director
of Imagerie Medicale Sainte Marie.
His initial, positive assessment of the
SOMATOM Perspective has not changed.
The center is guided by the principle of
achieving the utmost excellence and,
therefore always seeks the best diag-nostic
equipment for its patients. And
this means that Fuchs is in a position
to make comparisons. “The SOMATOM
Perspective delivers perfect diagnostic
efficiency“ he notes. So far, almost
10,000 patients have benefited from
its use. Franck Lamesa, general super-visor
of the Sainte-Marie Medical
Imaging Center, adds: “The number of
scans conducted currently stands at
12,400. With the SOMATOM Perspective,
we have performed approximately
5,500 abdominopelvic scans, as well
as 2,300 thoracic scans, 1,200 lumbar
scans, 800 brain scans, and 800 sinus
scans.”
Good results have been achieved in all
pathological areas: cancer, pediatrics,
rheumatology, cardiology, and neurol-ogy,
to name just a few. “Work in oncol-ogy
is ongoing here,” Fuchs points out,
“because we collaborate closely with
the Sainte-Marie Medical Imaging
Center and its cancer treatment center
next door. For us, the work involves
standard scans. Image acquisition is
perfect, and all the preparatory and
analytical work is carried out with the
help of syngo.via. We are one of the
major users of this software, espe-cially
its applications for oncology.”
Post-treatment image data are vali-dated
by the radiologist and are then
stored automatically so that treat-ment
process can be tracked.
Significantly lower radiation
doses
Levels of radiation dose pose an acute
problem both in oncology and pedi-atrics.
There must be no question of
radiation overdoses when examining
a child’s abdomen, thorax, or head.
Extreme caution is also essential with
cancer pathology where multiple
images are required for diagnosis,
during treatment, and at the regular
check-ups that follow. Thanks to
iterative reconstruction with SAFIRE
(Sinogram Affirmed Iterative Recon-struction),
significantly lower radia-tion
doses are possible. “In overall
terms, we are satisfied with SAFIRE
for pediatrics as well as oncology,”
Fuchs comments. Based on experience,
the technicians and radiologists at
the Sainte-Marie Imaging Center stated
that SAFIRE enables an average dose
reduction of 30 to 40 percent, or
even 50 percent compared to scans
without SAFIRE. In most cases, reduc-ing
the power – and therefore the
radiation – does not affect the quality
of the image.
Surgery and treatment for overweight
persons are among the fields in which
the Sainte-Marie Medical Imaging
Center excels. This year again, the
clinic was placed among the top ten
clinics in the Ile-de-
France region
according to the 2013 Ranking of
Hospitals and Clinics” published by le
Figaro Magazine.“ “We work in liaison
with the obesity treatment center
at the Sainte-Marie Medical Imaging
Center,” Fuchs explains. “Radiography
and echography are the first investi-gations
requested prior to bariatric
surgery.” When talking about CT-scans,
Fuchs explains, “we mostly deploy
the SOMATOM Perspective to detect
pathologies – or, more often, multi-pathologies
– related to overweight.”
Improved temporal
resolution for heart scans
In cardiology, temporal resolution is
the most important factor. To achieve
the lowest possible value, the spiral
must rotate as fast as possible. On
the SOMATOM Perspective, especially
with the help of iTRIM software,
satisfactory results can be achieved.

With optimizing protocols to the right dose, a perfect balance between image quality
and radiation exposure can be achieved.
Technicians praise the simple operation of the
SOMATOM Perspective.
Christian Rayr is a freelance journalist based
in Paris, France. He writes for various medical
publications and covers medical topics for the
general media.
Likewise for imaging of the inner ear
and the petrous portion of the tem-poral
bone, centralized collection and
analysis of the raw data have made
it possible to optimize the protocols.
That delivers more than satisfactory
results in terms of slice thickness and
perfect balance between image qual-ity
and radiation dose.
An efficient, economic
scanner
Overall it is evident that the SOMATOM
Perspective is the preferred choice for
radiology centers. A large number of
SOMATOM Perspective scanners have
been sold in France and a lot of them
are now in use in the Paris region. Ever
since the SOMATOM Perspective was
installed at the Sainte-Marie Imaging
Center, it has attracted visits from
numerous specialists from countries
such as Belgium, Switzerland, the USA,
Korea, Japan, and Australia. Although
economic constraints exercise ever-greater
pressure on budgets, reducing
the quality of care is not an accept-able
option at all. Everyone is aware
of the good price position and low
operating costs for the SOMATOM
Perspective. It can be installed easily
and quickly – in just one day. It is
very lightweight and so does not
require floor reinforcements, nor does
it take up much space. Thanks to its
air-cooling system, it does not require
water-cooling, and use of the eMode
software makes this scanner even
more reliable and durable.
eMode for a perfect scan
eMode is a software that automati-cally
sets the scan parameters to
encourage economical use of the sys-tem,
but without ever compromising
image quality or dose. “This feature
reduces material wear, extends the
machine’s lifetime, and eliminates
downtime. We’ve had no breakdowns
or annoying problems to report,”
Fuchs notes.
Technicians praise the simple opera-tion
of the SOMATOM Perspective.
They use eMode on almost every scan,
with an average usage of at least
99 percent. Only cases of massive
obesity leads to non-eMode scans.
They also appreciate the machine’s
rapid image acquisition with eMode.
If the slightest problem arises in the
scan settings – for example, should
a patient go beyond the standard
protocols − a warning lamp lights up.
To adjust the scan parameters, the
technician simply has to press the
‘Fast Adjust’ button to automatically
adjust the scan parameters and to scan
on eMode again. “With this machine,
a technician could easily carry out
12 scans per hour,” Fuchs comments.
“We perform six per hour: One patient
every ten minutes, including emergen-cies,
which is a fairly good rate. What’s
more, we investigate some patholo-gies
that take longer such as cancers
or vascular problems. As a matter of
fact, it’s no longer the machine that
sets the limit nowadays, it’s actually
the radiologist. We need to be able to
duplicate ourselves!”
Further Information
www.siemens.com/
SOMATOM-Perspective
News

Gateway to an Open Research Environment
online community to share experi-ences
with fellow researchers and
Siemens experts. The global exchange
of research ideas may help to trans-form
individual research endeavors
with limited resources into effective
collaborative efforts and may even
facilitate the set-up and management
of international multicenter studies.
New developments
With the launch of syngo.via Frontier,
Siemens is opening up access to
a range of cardiovascular and Dual
Energy CT research prototypes. In the
future, new prototypes may also be
made available in other fields and
from other external partners, giving
the user the chance of a head start
on current research questions. For
customers with strong programmer
know-how, an optional package is
available that allows design and
implementation of new prototypes.
That will help to leverage personal
research endeavors.
via Frontier –
cated prototype store. The research
prototypes are not medical devices
and are therefore not intended for
use in clinical routine. They are not
tied to the regular product develop-ment
cycle. Thus new prototypes are
available for research much sooner
than released applications.
The idea behind opening access to
research software with syngo.via
Frontier is as follows: Traditional stand-alone
research software is often
installed on a computer away from the
everyday reading location. This is a
clear downside, because this lack of
integration into the routine reading
workflow results in tedious data and
result transfers. The new syngo.via
Frontier, however, provides a direct
connection between the clinical
syngo.via server and the dedicated
syngo.via Frontier server. The research
prototypes may thus be accessed from
any syngo.via client in the institution
and are directly integrated in the usual
syngo.via user interface. This tight
integration enables the researcher
to send and retrieve data and result
images easily for inclusion in an
ongoing on site research study, for
instance.
With syngo.via Frontier, the user also
obtains access to an international
At the RSNA 2013, Siemens introduced
syngo.via Frontier*, a novel concept in
the field of medical imaging. It opens
up access to research prototypes, pro-vides
the means for individual prototype
development, and allows participation
in a global network of fellow research-ers.
Engaging in state-of-the-art research
will therefore be possible for a larger
group of interested CT users.
Research in medical imaging is as
important and rewarding as it is excit-ing
– whether evaluating new scan
protocols for clinical practice, monitor-ing
treatment success, or testing and
analyzing new advanced imaging
software. Before entering the market,
underlying algorithms within these
applications have already been thor-oughly
tested by Siemens together
with collaborating customers. Active
participation in an initial evaluation of
a prototype has been reserved to insti-tutions
with a collaboration agreement
with Siemens – until now.
Opening access to research
syngo.via Frontier is a novel research
tool offered to literally every clinical
institution. Any interested syngo.via
user can buy and install it. Prototypes
currently under development can then
easily be downloaded from the dedi-syngo.
1
The prototype Siemens DE Rho/Z maps helps to
differentiate tissue based on electron density and
effective atomic number.**
1 The prototype Siemens DE Scatter Plots
visualizes energy dependencies for detailed
analysis of material homogeneity.**
2
Further Information
www.siemens.com/
syngo.via-frontier
By Philip Stenner, PhD
News
2
IodineLine BoneLine TissueLine
Low kV (100) Value [HU]
High kV (Sn 140) Value [HU]
* This product is 510(k) pending. Not available for sale in the U.S. ** Accessible with syngo.via Frontier. Not for clinical use.

News
Continuous Commitment
to the Right Dose
tube or the fully integrated detector design from the
Stellar and StellarInfinity detectors. By implementing new
advanced models of these crucial scanner geometry com-ponents
into the iterations cycles, ADMIRE can support
new levels of image quality.
Without compromising on the dose reduction capabilities,
ADMIRE now enables improved sharpness or low-contrast
detectability, minimized artifacts – even applied to thicker
slices of 3 or 5 mm. This, combined with a new genera-tion
of image-processing computers, will allow ADMIRE
to transfer its potential into clinical practice. Introduced
together with the SOMATOM Force at the RSNA 2013,
ADMIRE will be made available for all systems with Stellar
detectors later in 2014.
International Right Dose Image Contest 2013
Once again, the International CT Image Contest has
attracted excellent submissions from users of SOMATOM
CT scanners from across the globe. Siemens Healthcare
announced the winners of the competition in eight clinical
categories. Over 320 cases were submitted from more
than 135 institutes and hospitals in countries from all
continents. Any users of a CT scanner from the SOMATOM®
family had the chance to present their best clinical images
to an international jury of recognized experts. The winning
images were shown during the congress of the 99th RSNA
2013 in Chicago.
New award for sustainable dose
management
In addition to the existing eight clinical categories
(Cardiac, Dual Energy, Neuro, Oncology, Pediatrics, Routine,
Trauma, and Vascular) a further award was included in
this year’s competition for the institution with the best
dose reduction strategy.
Expert jury
Leading radiologists from around the world formed the jury:
Professor Harold Litt, MD, University of Pennsylvania,
Philadelphia (USA),
Professor Willi A. Kalender, MD, PhD, University of
Erlangen-Nuremberg Germany),
Professor Marilyn J. Siegel, MD, Mallinckrodt Institute
of Radiology, St. Louis (USA),
By Ivo Driesser and Jan Freund
At the 99th Radiological Society of North America (RSNA)
2013 in Chicago, Siemens underlined its commitment to
delivering the right balance between image quality and
radiation dose – or in short: the CARE Right philosophy.
Showcasing innovations as well as impressive clinical results
from the “Right Dose Image Contest”, Siemens highlighted
clearly its role as trendsetter in delivering sustainable solu-tions
to minimize radiation exposure.
ADMIRE – Next generation iterative
reconstruction
Along with the SOMATOM Force, Siemens also introduced
its latest milestone in right dose technology: Advanced
Modeled Iterative Reconstruction – ADMIRE. In 2010,
Siemens introduced its raw-data based iterative recon-struction
SAFIRE (Sinogram Affirmed Iterative Reconstruc-tion).
With proven dose reduction potential of up to 60%*
together with performance values that make it truly
suitable for clinical routine, SAFIRE is now used daily at
hundreds of sites – often for every examination.
Building on these proven outcomes, ADMIRE now addition-ally
leverages Siemens’ superior scanner technologies
such as the flying focal spot in the STRATON and VECTRON
ADMIRE now addition-ally
leverages Siemens
superior scanner
technologies like the
flying focal spot in the
STRATON and VECTRON
tube or the fully-integrated
detector
design from the
Stellar and StellarInfinity
detectors.

News
Pick of the Month June*
Submitter: Ronald Booij, Erasmus Medical Center Rotterdam,
the Netherlands
Patient History: A seven-month-old child with severe aortic
coarctation was referred for CT imaging. The patient indicated
absence of groin pulsations and hypertension in upper body
part. Examination by ultrasound suggested presence of double
aortic arch.
Diagnosis: The investigation results showed indication of
a normal relationship between the atria, ventricles, and large
vessels. A severe aortic coarctation distal of the left subclavian
artery and strong collaterals through the intercostal artery to
the aorta descendens could be depicted. There was no evidence
of double aortic arch.
Dose management: We scanned the young patient with
the CARE kV option. We use almost all of our adult and child
protocols with this option to keep our image quality preferences
constant. In this case, the system used 70 kV and 16 eff. mAs.
With the help of SAFIRE, CARE kV (the dose optimization
slider on position 11) and a strong dose modulation curve for
CARE Dose4D the optimal image quality with the lowest dose
was achieved.
Comments: Due to the high pitch technology, even this
free-breathing patient had no motion artifact. No anesthetics
were used.
Scanner: SOMATOM Definition Flash
Effective dose: 0.28 mSv
*Winners had not been decided at the time of the editorial deadline.
Associate Professor Peter Schramm, MD, University
Medicine Goettingen (Germany),
Professor Elliot K. Fishman, MD, Johns Hopkins University,
Baltimore (USA),
Professor Hyun Woo Goo, MD, University of Ulsan
(South Korea),
Professor Hatem Alkadhi, MD, University Hospital Zurich,
(Switzerland),
Aaron Sodickson, MD, PhD, Harvard Medical School,
Boston (USA),
Kheng-Thye Ho, MD, PhD, Khoo Teck Puat Hospital
(Singapore)
and Professor Uwe Joseph Schoepf, MD, Medical
University of South Carolina (USA).
Facebook community
This year, the Facebook fan page has been particularly
successful inviting everyone to interesting discussions about
the most impressive cases submitted. Over the five-month
duration of the contest – from June to October 2013 –
a fan community of over 17,200 users “liked”, viewed, and
commented on the images. Image Contest fans could also
vote for their favorite picture in a public vote. The Siemens
Internet page devoted to the contest received over 84,700
hits. This level of interest suggests that the aim of the
contest was achieved – to raise awareness of sustainable
dose management and the importance of balancing low
dose with diagnostic quality imaging.
More information on the Image Contest including all
clinical details and respective protocols is available at:
Further Information
www.siemens.com/care-right
www.siemens.com/image-contest
* In clinical practice, the use of SAFIRE may reduce CT patient dose depending
on the clinical task, patient size, anatomical location, and clinical practice. A
consultation with a radiologist and a physicist should be made to determine
the appropriate dose to obtain diagnostic image quality for the particular
clinical task. The following test method was used to determine a 54 to 60%
dose reduction when using the SAFIRE reconstruction software. Noise, CT
numbers, homogeneity, low-contrast resolution and high contrast resolution
were assessed in a Gammex 438 phantom. Low dose data reconstructed
with SAFIRE showed the same image quality compared to full dose data based
on this test.
Data on file.

News
Charting New Paths with True Dual Energy
Siemens True Dual Energy provides many applications available for daily
clinical use. True Dual Energy not only enables faster and more reliable
diagnoses, but also further extends the application spectrum of CT and
turns complex examinations into easy routine.
By Susanne Hölzer and Jürgen Merz, PhD
Thanks to pioneering application
development, CT examination meth-ods
such as Dual Energy (DE) scan-ning
have expanded into many new
clinical fields.
Single Source DE to charac-terize
tissue or calculi
The introduction of Single Source DE
imaging for the SOMATOM® Definition
Edge and SOMATOM Definition AS
made it possible to add tissue charac-terization
to morphology. The routine-ready
Single Source DE scan mode
is available on every SOMATOM
Definition AS – even on the 20-slice
configuration – and has just recently
also been introduced for the
SOMATOM Perspective family. With
Single Source DE, a range of applica-tions
has emerged such as syngo.CT
DE Calculi Characterization.* By visu-alizing
uric acid crystals in joints, a
diagnosis of gout can be confirmed
with certainty. Monoenergetic imag-ing
for routine-ready metal artifact
reduction can overcome many diffi-culties
in CT imaging. More confident
diagnostic evaluation prior to surgical
procedures – such as the removal
of metal plates or screws – is also
possible.
Introducing new applications
For SOMATOM Definition AS+ and
SOMATOM Definition Edge scanners,
two more application classes are
being introduced: syngo.CT DE Virtual
Unenhanced* is designed to perform
a material decomposition into iodine
contrast agent, fat, and liver tissue.
It also creates a virtual non-contrast
image. Additionally, syngo.CT DE Brain
Hemorrhage* is designed to identify
bleedings and lesions by displaying the
contrast agent concentration in the
brain.
Dose-optimized DE
All of these DE applications are per-formed
in a dose-optimized DE scan
mode. In order to avoid doubling the
dose, both scans are performed at
approximately half the dose of a con-ventional
120 kV scan. Furthermore,
Siemens Single Source DE scan mode
utilizes all dose reduction functional-ities:
e.g. CARE Dose4D for real-time
tube current modulation, or SAFIRE**
for the reduction of tube current
through iterative reconstruction.
Full flexibility for system
configuration and future
upgrades
The new Single Source DE functionality
is not only limited to new installations.
Systems already installed can also
benefit: SOMATOM Definition AS+ and
SOMATOM Definition Edge scanners
can easily be upgraded with the new
Single Source DE applications.
Single Source DE scan:
Monoenergetic shows a metal
artifact-reduced image for
undisturbed view of the implants
and the surrounding tissue.
Courtesy of LMU Grosshadern,
Munich, Germany
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Single Source DE scan: syngo.CT DE Brain Hemorrhage* shows iodine concentration in the brain,
to rule-out intra-cranial bleeding. Courtesy of CHU Carémeau, Nîmes, France
3 * This product is 510(k) pending.
Not available for sale in the U.S.
** In clinical practice, the use of SAFIRE
may reduce CT patient dose depending
on the clinical task, patient size, ana-tomical
location, and clinical practice.
A consultation with a radiologist and a
physicist should be made to determine
the appropriate dose to obtain diagnostic
image quality for the particular clinical
task.
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2
Further Information
www.siemens.com/
dual-energy
Single Source DE scan:
syngo.CT DE Virtual
Unenhanced* shows
enhanced lesion in the
liver.
Courtesy of LMU
Grosshadern,
Munich, Germany
News

News
Open Up New Opportunities
with New Configurations
Service providers in healthcare are facing growing economic challenges.
At the same time, the demand for seamless healthcare has intensified.
To address both these aspects, new SOMATOM® Perspective 16- and 32-slice
configurations have been introduced to the SOMATOM Perspective family.
By Florian Hein
The majority of countries in Europe
have to deal with the consequences
of the crisis in the global economy
leading to shrinking purchasing power
and reduced national budgets. Health-care
service providers are greatly
affected by this vicious circle, as health-care
expenditure is one of the largest
costs for these countries. In the U.S.,
too, where affordable healthcare
is a major goal for the next few years,
healthcare institutions have to do
more with less, because of tremen-dous
budget cuts. On the other hand,
clinical demands worldwide are
increasing rapidly – high-end clinical
care, which a decade ago was avail-able
only in selected regions and for
some patients, has now become the
standard level of care. This is why a
well thought-out investment and the
efficient use of medical devices are
key today to success in clinical prac-tice
worldwide.
To meet these requirements, Siemens
offers the SOMATOM Perspective –
the most economical CT of its class.
With a new 16- and 32-slice configu-ration*,
the SOMATOM Perspective is
entering into a new market segment.
The two new configurations combine
first-class clinical care and an opti-mized
total-cost-of-ownership posi-tion
for healthcare institutions. The
features and technologies of the
SOMATOM Perspective family are
designed to accomplish these two
objectives, especially in the 16- and
32-slice market segments.
A broad clinical portfolio is now
available with the new SOMATOM
Perspective family from routine
scanning in oncology and
neurology to complex cardiac
imaging.
Courtesy of Radiology Department
of Israelitisches Krankenhaus,
Hamburg, Germany and
SAMS Hospital, Lisboa, Portugal
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