1. GE Healthcare
clarity
CT
§
Veo Ultra Low Dose – p. 32
THE MAGAzINE oF CT • JuNE 2011
Spectral CT: A Brave CTA Changing Veo: A New Breakthrough
New World of Quantitative, Patient Management is Re-writing the Rules
Functional Imaging in the ED of Low-dose CT Imaging
Page 11 Page 26 Page 32
imagination at work
§
Veo is 510(k) pending at FDA. Not commercially available
in the united States.

2. TA B L E o F CoNTENTS Case Study:
CT Perfusion 4D Imaging
in Stroke Assessment
page 48
Clinical Value:
Making Reliable Low-dose
GE Healthcare News: First-time CT a Clinical Reality
CT users Embrace Brivo CT325§ page 20
page 10
GE Healthcare News Clinical Value
Welcome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4 Spectral CT: A Brave New World
of Quantitative, Functional Imaging . . . . . . . . . . . . . . . . . . 11 - 19
South America Embraces
the Latest GE CT Technologies . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5 Making Reliable Low-dose CT a Clinical Reality . . . . . . . . 20 - 24
New Tools to Analyze Vessel Lumen, Diseased Tissue . . . . . . .6 CTA Changing
Patient Management in the ED . . . . . . . . . . . . . . . . . . . . . . . 26 - 29
Quantitative Assessment of the Lung . . . . . . . . . . . . . . . . . . . . . . .6
Kenya Hospital Extends
unravelling the Mystery Behind Mummies . . . . . . . . . . . . . . . . . .7
Quality CT Imaging to More Residents . . . . . . . . . . . . . . . . 30 - 31
GSI Shines at Conferences, Journal Competition . . . . . . . . . . . .8
Veo‡: A New Breakthrough is Re-writing
optima CT660‡ the Rules of Low-dose CT Imaging . . . . . . . . . . . . . . . . . . . 32 - 37
Reaches Milestones . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9
Reaching New Heights
First-time CT users Embrace Brivo CT325 . . . . . . . . . . . . . . . . . 10 in CT Cardiac Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 - 39
Eco, Patient, and Physician Friendly:
Advanced Low-dose Imaging
Without Compromise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 - 41
Make Every Study Exceptional . . . . . . . . . . . . . . . . . . . . . . . 42 - 43
Publications Team: GE Contributors:
Kelley Knutson & Jodi Young Andrew Ackerman Morris Buliva
CT Clarity Editors CT Marketing Manager Account Manager, East Africa
CT Education Managers Olivier Adda Roger Cepeda
John Allenstein CT Super Premium Strategic Product Associate General Counsel, Diagnostic Imaging
Marketing Communications Manager Manager, Europe, Middle East & Africa Lawrence Chia
CT and Advantage Workstation Dr. Karthik Anantharaman CT Modality Manager, Southeast Asia,
CT Marketing Manager, South Asia Australia & New zealand
Mary Beth Massat
Christophe Argaud DeAnn Haas
Writer/Editorial Consultant
CT Advanced Applications Manager, CT Marketing Manager, Leadership
Nilesh Shah Europe, Middle East & Africa Segment, Americas
Chief Marketing officer, CT Paul Ayestaran Takuya Hiramoto
J. Eric Stahre Advanced Applications Specialist, Product Marketing Specialist, Japan
General Manager, Global Premium CT Europe, Middle East & Africa John Jaeckle
Chelsea Beeler Regulatory Affairs Manager
Integré
Communications Manager Gina Larkin
Design/Production
Chuck Bisordi CT Marketing Manager
Jennifer Coppersmith CT Product Development Specialist Huayang Liu
Design/Production Consultant
Valerie Brissart China HDCT Product Leader
CT Marketing Director, Europe, Pascal Lucien
Middle East & Africa CT Modality Manager, Africa
2 A GE Healthcare CT publication • June 2011

3. TA B L E o F C o N T E N T S
Technical Innovation:
The Model-Based Paradigm: Beyond the Scan:
A New Frontier in Image Working Together Towards
Reconstruction the Sub-mSv CT Exam
page 63 page 69
Case Study Beyond the Scan
High Quality, Reduced Dose Imaging Techniques to Lower CT Dose . . . . . . . . . . . . . . . . . . . . . . . . 66 - 68
in the Comprehensive Evaluation
Working Together Towards
of Potential Kidney Donors . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 - 45
the Sub-mSv CT Exam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 - 71
Characterization
CT Clinical Education in the uS,
of Renal Stones using GSI. . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 - 47
Europe, Middle East, and Africa . . . . . . . . . . . . . . . . . . . . . . 72 - 73
CT Perfusion 4D in Stroke Assessment . . . . . . . . . . . . . . . . 48 - 49
Low-dose CT Imaging
of CPAM for Surgical Planning . . . . . . . . . . . . . . . . . . . . . . . . 50 - 52
Technical Innovation
System Design Combines High Performance
with Patient, Earth Friendliness . . . . . . . . . . . . . . . . . . . . . . 53 - 55
one Seamless Workflow Environment . . . . . . . . . . . . . . . . 56 - 58
To receive future issues of CT Clarity,
The Importance of Spatial Resolution please subscribe at: www.gehealthcare.com/CTclarity
for High-quality Cardiac CT Exams . . . . . . . . . . . . . . . . . . . 59 - 62
The Model-based Paradigm: A New Frontier
*
Discovery, optima, Brivo, ASiR, Veo, LightSpeed, BrightSpeed,
in Image Reconstruction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 - 65 Gemstone, SnapShot, SmartmA, AutomA, Performix, VCAR, Volara,
VolumeShuttle, Dexus, Centricity, CardIQ, and AppsLinq are
trademarks of General Electric Company.
§
Brivo CT325 is not for sale in the united States. Not cleared
Andrew Menden Karen Procknow
by the uS FDA.
Regulatory Affairs Leader CT Product Development Specialist
‡
optima CT660 and Veo are 510(k) pending at FDA.
Thierry Modica Linda Pucek Not commercially available in the united States.
CT-AW Advanced Application Specialist, Africa CT Segment Marketing Manager,
© 2011 General Electric Company, doing business as GE Healthcare.
Daniel Morris oncology, Americas
All rights reserved. The copyright, trademarks, trade names and
CT Global Marketing Manager Dario Salvadori other intellectual property rights subsisting in or used in connection
Enrique Garcia-Muñiz CT Performance & Value Strategic Product with and related to this publication are the property of GE Healthcare
Manager, Europe, Middle East & Africa unless otherwise specified. Reproduction in any form is forbidden
CT Marketing Manager, Latin America without prior written permission from GE Healthcare.
Christoph Obermeier Saad Sirohey, PhD
LIMITATION OF LIABILITY: The information in this magazine is
CT Clinical Education Business Manager, Global Product Manager, intended as a general presentation of the content included herein.
Europe, Middle East & Africa CT Advanced Applications While every effort is made by the publishers and editorial board
Stephen Slavens to see that no inaccurate or misleading data, opinion or statements
Tracey Ortiz occur, GE cannot accept responsibility for the completeness,
Regulatory Affairs Leader Regulatory Affairs Director, AW currency or accuracy of the information supplied or for any opinion
Konstantin Osadchiy, MD, PhD Cristian Toader expressed. Nothing in this magazine should be used to diagnose
CT Advanced Applications Specialist, Russia & CIS CT Premium Strategic Product Manager, or treat any disease or condition. Readers are advised to consult
Europe, Middle East & Africa a healthcare professional with any questions. Products mentioned
Helen Peng in the magazine may be subject to government regulation and
Regulatory Affairs Leader Wayne Zhang may not be available in all locations. Nothing in this magazine
Marketing Product Manager constitutes an offer to sell any product or service.
A GE Healthcare CT publication • June 2011 3

4. Welcome
Steve Gray, Vice President and General Manager,
Computed Tomography, GE Healthcare
At GE Healthcare CT, we believe that great care happens For over three decades, GE has made a commitment to
by design. our organization makes decisions regarding developing technologies that lower radiation dose. our
CT product development with one purpose in mind: to help long-standing vision is clear—to be a leader in patient-centric
healthcare providers deliver the best patient care. You, our solutions, to design systems that deliver high-performance
customers, have spoken and we heard your voices loud imaging, and to continue developing innovations that drive
and clear. even lower dose.
You told us you want to deliver high image quality for But how low can we go? At GE Healthcare, our goal is the
diagnosis at ever lower doses for all of your patients who 1 mSv study across all pathologies, anatomies, and studies.
need a CT. We heard that you want to expand the diagnostic Lowering dose is a core commitment in our effort to deliver
capabilities of CT—to let you know more about the pathology great care by design. In past issues of CT Clarity, you’ve read
you are viewing to aid you in making precise, confident how dose-reduction technologies like ASiR* deliver high
clinical decisions. You want a CT system with high spatial image quality while lowering dose. Now, in this issue, we
resolution to deliver excellent image quality that drives present our latest dose-lowering advancement, Veo§.
advanced applications and productivity.
Veo is our next generation dose-lowering technology.
In this issue of CT Clarity, you can read how GE Healthcare Learn how several healthcare providers around the world
is delivering solutions to address your clinical needs and have achieved remarkable breakthroughs in high-quality,
to help you provide great care to your patients. impressively low-dose CT imaging with Veo (page 34).
We believe this new technology will play a key role in moving
on page 11, read how Gemstone* Spectral Imaging (GSI)
us toward our goal of the 1 mSv study across all exams
is opening up an exciting and promising new world for
and will help you achieve your diagnostic needs at before
CT imaging—where clinicians can obtain quantitative
unheard of doses without any compromise in image quality.
information on tissue characterization, reduce artifacts from
In fact, you’ll learn that some clinicians actually experienced
metal instrumentation, and enhance contrast material.
an increase in image clarity while they reduce dose when
In an article on spatial resolution (page 40), you can learn using Veo. Clearly, the rules of CT imaging have changed.
how the high spatial resolution on the Discovery* CT750 HD
Read on and you’ll understand why we at GE Healthcare
improves cardiac CT imaging and why it is an important
are so excited about the future of CT. This last decade
consideration as you investigate solutions that improve
was a phenomenal one—widespread adoption of the
cardiac care at a lower dose.
multi-detector CT was heralded as a major advancement
We introduced three new systems that are designed with in medical imaging. At GE we’ll continue to pursue innovation
great care to expand the reach of CT to patients throughout that drives a more confident diagnosis at the lowest dose
the world. These include the optima* CT660§ system that is in the delivery of care—together with you, great care by
ecomagination and healthymagination validated (page 42); design can impact healthcare across the world.
the BrightSpeed* Elite that demonstrates our commitment
Please read and enjoy. And as always, thanks for your
to bring advanced applications and dose lowering technology
continued support.
across our product platforms (page 44); and the Brivo* CT325,‡
a system that extends modern CT technology to healthcare
facilities so they can provide advanced medical imaging
services to their patients—patients who may otherwise
not have access to CT imaging (page 32).
§
Veo is 510(k) pending at FDA. Not commercially available for sale in the united States.
Brivo CT325 is not for sale in the united States. Not cleared by the uS FDA.
‡
4 A GE Healthcare CT publication • June 2011

5. ANNouNCEMENTS G E H E A LT H C A R E N E W S
South America Embraces
the Latest GE CT Technologies
Advances in CT generate excitement Low-dose CT makes its mark in Argentina
in Southern Brazil Innovative leadership. That’s how Dr. Sergio Julio Moguillansky,
Powered by the first new CT scintillator material in two Director of Medicina XXI SA (Neuquen, Argentina) describes
decades, the Discovery* CT750 HD generates excellent, high GE Healthcare and its exclusive ASiR dose lowering technology.
definition image quality. This capability inspired Carlos Jader “The concept of reducing dose whenever possible to achieve
Feldman, MD, at SIDI – Medicina por Imagem (Porto Alegre, the appropriate diagnosis is inherent to our specialty,” he says.
Brazil) to select the Discovery CT750 HD and become the “Thus, we consider every technological advance that allows
second site in South America to acquire this system. us to reduce the dose a priority.”
Anticipating tomorrow’s needs, Dr. Feldman saw the ability The hospital recently installed ASiR technology on its LightSpeed*
to capture high definition images that characterize complex VCT and is experiencing dramatic low-dose results. While the
lesions, such as coronary artery stenosis, as the most actual dose level is closely related to the type of exam and the
impressive benefit to his patients and practice. “I believe the expected results required for appropriate patient management,
Discovery CT750 HD will allow me to accurately diagnose Dr. Moguillansky is excited to offer less dose to his patients who
ischemic patients,” he says. With excellent image clarity and are becoming increasingly aware of CT radiation dose.
spatial resolution, Dr. Feldman expects the system will allow “Patients are addressing the dose issue with our clinicians,
for faster clinical decisions by clinicians. most notably the pediatricians,” he says. “With ASiR, we
Located in Brazil’s fourth largest metropolitan area with nearly can demonstrate our commitment to providing the proper
four million inhabitants, SIDI and Dr. Feldman have long trusted diagnosis through the ALARA principle.”
GE Healthcare’s technological leadership. While it was a natural At Medicina XXI SA, CT imaging volume averages 40 patients
choice to look to GE for the next generation in CT imaging, each day across a wide spectrum of indications—abdominal,
Dr. Feldman saw the potential of Gemstone* Spectral Imaging thoracic, vascular, and neurological conditions. High-quality
(GSI) to help him deliver a new level of care to his patients. and fast imaging capabilities are a primary objective at the
“Today’s clinical path leads to anticipating etiology of diseases, facility, says Dr. Moguillansky. By offering substantial dose
thus, it means earlier diagnostics and more accurate treatments,” reductions at a similar image quality, ASiR fulfills the facility
he says. With GSI, HD, and ASiR* * all available on one system, requirements and helps alleviate concerns over dose.
Dr. Feldman is thrilled at the potential to deliver a higher level “our expectations are very high,” adds Dr. Moguillansky,
of exam accuracy while enhancing patient comfort. “I will be “and we are pleased to implement this technology due to the
able to provide patients and referring physicians a confident increasing benefit that it will bring to our clinical practices
CT diagnosis and broader range of exams,” he adds. and particularly, to our patients.” n
“I will be able to provide
patients and referring
physicians a confident
CT diagnosis and broader
range of exams.”
**In clinical practice, the use of ASiR may reduce CT patient dose depending on the – Dr. Carlos Feldman
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.
A GE Healthcare CT publication • June 2011 5

6. G E H E A LT H C A R E N E W S ANNouNCEMENTS
New Tools to Analyze Vessel Lumen, Diseased Tissue
CT imaging is changing the way clinicians diagnose cardiac customizable color mapping to improve visualization of plaque
disease. Yet, the large volume of data generated by today’s pathology for a better understanding of the severity of disease.
advanced systems can impede workflow if clinicians don’t
The GE exclusive relative perfusion tools use sophisticated
have the right tools to process the information. As an integral
segmentation techniques to color code the myocardial tissue.
part of Dexus*, CardIQ* Xpress Reveal, streamlines your
Hypodense lesions are displayed to better visualize ischemic
workflow so that exams of the heart and coronary anatomy
heart disease to aid in treatment planning. Plus, the new hybrid
are ready to review the instant you’re ready to read.
display view combines the coronary arteries and perfusion
Two enhanced tools are designed to help clinicians improve their map to correlate the vessels to diseased tissue.
diagnosis. The new PlaqID plaque analysis tool allows clinicians
CT is an excellent non-invasive alternative for diagnosing
to visualize both calcified and non-calcified plaque to determine
coronary artery disease. using CardIQ Xpress Reveal speeds
the amount of atherosclerosis. This new tool also offers
assessment of the patient’s cardiac disease state by delivering
more information in a simpler, faster, smarter way. n
Coronary tree Cardiac perfusion PlaqID
Quantitative Assessment of the Lung
Now available, Thoracic VCAR* provides the physician with Together these capabilities provide an integrated application
a set of quantitative tools that will aid the physician in the for a comprehensive evaluation of a lung CT image. The analysis
assessment of thoracic disease diagnosis and management. tools are married to an easy-to-use reporting capability that
The software provides automatic segmentation of the lungs automatically captures
and airway tree, as well as tracking of the airway tree. The the analysis results. The
software will also provide the quantification of Hounsfield units end result is a clear and
and display by color the thresholds within a segmented region. concise clinical report
that is generated during
Key features include:
the reading process and
• Automated segmentation of right and left lung airways— specifically designed for
ease of use assists in quantification of lungs and airways; the communication of
• one touch 3D airway tracking with automated vital medical information
measurements—simple user interface aids in analysis to referring clinicians
and review; and patients. n
• Lung Lobe segmentation—intuitive interactive lobe Parenchyma analysis
segmentation that allow for reporting of quantitative
measurements by lobes; and
• Parenchyma analysis—parenchyma protocol for generating
quantitative measurements displayed as percentage/
liters of volumes of abnormal density.
Lung lobe segmentation Volume rendering segmented lobes
6 A GE Healthcare CT publication • June 2011 with segmented trachea

7. ANNouNCEMENTS G E H E A LT H C A R E N E W S
unravelling the Mystery
Behind Mummies
Finding out the details underneath the bandages of the Then again in 2006, another scan using better technology
mummies from the Milwaukee Public Museum is what Carter revealed a silver dollar-sized hole in his skull, leading
Lupton, PhD, Curator of Ancient History, Department Head the anthropologists to conclude he had undergone
at the museum, hopes to do thanks to the most advanced a primitive form of brain surgery.
CT technology by GE Healthcare, the Discovery* CT750 HD.
To best help the museum unravel the mummy mystery,
Three of the mummies from the museum collection were
GE Healthcare provided a cutting-edge Discovery CT750 HD
scanned in April, 2011 to find out more information about
along with Gemstone* Spectral Imaging (GSI), which
their gender, age and causes of their death.
offered high quality images and a dramatic level
In collaboration with GE Healthcare, researchers of detail. GSI also allows researchers to distinguish
from the Milwaukee Public Museum used one type of tissue from another in order to better
the latest GE CT imaging technology understand the makeup of the mummies’ bodies
to look back through time and start and other material.
unraveling details about how three
Dr. Lupton and his research team used the high
mummies—two from ancient
resolution images from the CT scanner to learn
Egypt and one from Peru—lived
more about ancient medical skills and knowledge,
and died.
as well as create 3D holographic representations
This isn’t the first time the of what the mummies would have looked
anthropologists have turned like when they were alive.
to GE Healthcare for
“We’ve been doing this for 25 years with GE.
assistance, and as GE’s
Every time we’ve come out, it’s a different
CT imaging technology has
generation of technology, better imaging,
improved, so too has their
better information, better ways, and it’s
knowledge of the mummies’
faster too,” Dr. Lupton added. n
history. one of the Egyptian
mummies, named Djed-Hor,
was first scanned in 1986.
An ancient Egyptian mummy is scanned.
CT scan of a Peruvian mummy.
A GE Healthcare CT publication • June 2011 7

8. G E H E A LT H C A R E N E W S ANNouNCEMENTS
GSI Shines at Conferences, Journal Competition
American Society of Spine Radiology “We found that the readers had improved sensitivity, specificity,
At the American Society of Spine Radiology (ASSR) conference, and diagnostic confidence when using the material density
Dual Energy Spectral CT of the Instrumented Spine: Tuned images with color and the attenuation curves compared to
Monochromatic Imaging Improves Quality over Traditional 140 kVp or 70 keV images alone,” Dr. Ruhland says. “of
Techniques won third place in the Mentor Award Program. clinical importance is that using the spectral CT data, the
The authors, James M. Kessler, MD, MPH; J. Rios, MD, PhD; M. radiologists were able to accurately determine whether
Ellestad; P. Pawha, MD; A. Doshi, MD; E.G. Stein, MD, PhD; the renal lesion was enhancing or non-enhancing, thereby
and Lawrence N. Tanenbaum, MD, FACR, demonstrated avoiding unnecessary and costly additional tests.”
how employing Gemstone* Spectral Imaging (GSI) in Dr. Ruhland acknowledges that while further study is needed,
patients post-spinal fusion produced excellent image she is hopeful that this first place paper demonstrating
quality with reduced spinal canal artifact and optimal the successful use of spectral CT to characterize renal
hardware visualization. lesions will ultimately help reduce healthcare costs associated
“Historically, quality imaging of the spine in patients post with working up indeterminate renal lesions seen with CT.
hardware fusion remained fraught with prohibitive Also at SGR, the university of Alabama at Birmingham
artifacts utilizing traditional polychromatic CT scanners,” earned the award for First Place Poster. Desiree E. Morgan,
explains Dr. Kessler. MD, Vice Chair for Clinical Research, accepted the award
The authors displayed examples of CT myelography for the poster, Dual Energy Spectral MDCT of the Pancreas:
with and without the benefits of spectral imaging and Imaging Beyond Anatomy.
demonstrated a markedly improved capacity for clear “The poster captures an exciting new area that deserves
visualization of the central spinal canal and its contents, further exploration by demonstrating the large number of
including the spinal cord and nerve roots. Dr. Kessler notes applications for spectral CT imaging,” says David N. Bolus, MD,
that in many cases, spectral CT myelography differentiated Assistant Professor, a co-author.
soft tissue in a similar manner to MRI allowing for
optimal depiction of the nerve roots and adjacent soft Dr. Morgan agrees that spectral CT created excitement
tissue structures. and “a groundswell such that I have not seen before at a
clinical symposium. The images were clearly different than
“This technique virtually eliminates the artifact,” he explains, traditional CT—my fellow gastrointestinal radiologists and
“and the ability to generate the same high quality exam as genitourinary radiologists all wanted to learn more about this
we would expect in non-instrumented patients opens up intriguing new technique.”
a new opportunity for patient management in those who
might otherwise have persistent chronic symptoms.” “The ability to capture material density,” Dr. Morgan continues,
“and quantitatively differentiate things such as fat and iron
Society of Gastrointestinal Radiology in the liver, for example, is quite remarkable.”
GSI won two different awards at this year’s Abdominal
Radiology Course meeting, a joint meeting of the Society
of Gastrointestinal Radiology (SGR) and the Society of
uroradiology (SuR). The first place paper from the SuR
was awarded to Jessica Ruhland, MD; Amy Hara, MD;
Alvin Silva, MD; Rishi Gosalia, MD; and Qing Wu, MD,
of the Mayo Clinic Arizona for the Assessment of Renal Lesion
Enhancement: Comparison of Single and Dual Energy CT.
According to Dr. Ruhland, the study reported on the
Drs. Morgan and Bolus stress that what is truly important
evaluation of five image datasets by two radiologists blinded
will be the future impact on patient care—and how
to diagnosis: 140 kVp; 70 keV monochromatic; material
radiologists, by utilizing spectral CT, can aid referring
density (MD) water/iodine; MD iodine with color; and
physicians in making patient management decisions.
attenuation curves from 40 to 140 keV.
Adds Dr. Bolus, “When our research helps propel further
utilization of a technique, so that it is widely used
throughout the medical community, then for us it truly
becomes ‘groundbreaking’.”
8 A GE Healthcare CT publication • June 2011

9. ANNouNCEMENTS G E H E A LT H C A R E N E W S
Chinese Journal of Radiology After the thorough evaluation, the committee selected
Initiated by renowned radiology opinion leaders and senior eleven papers—all using GE Healthcare’s GSI—for publication
editors, the Chinese Journal of Radiology (CJR) held the in the Spectral CT Special Edition this past spring.
Spectral CT Research Paper Competition in September, 2010. Professor Hong Gao, Editor-in-Chief of CJR, says, “CT
Thirty-four spectral CT research papers were submitted Spectral Imaging is an exciting new study area of radiology.
covering in-vitro experiments, impact on image quality, From all of the 34 submitted research papers, we saw
artifact reduction, tissue characterization, differentiated its fundamental impact on our CT practice and research.
diagnosis in oncology, hemodynamic studies, and We look forward to more promising clinical applications
therapy evaluation. and research in the future.” n
optima CT660 Reaches Milestones
GE Healthcare is pleased to announce the 100th optima* CT660§ Program, and Dr. Mohammad Alshaji, Director of the Medical
will be delivered to olbia Hospital in Sardinia for the S. Department, and the Royal Commission Hospital team
Raffaele Foundation. Since the global introduction of the to celebrate the installation of this new system. This new
system in April, 2010 over 200 orders worldwide have system will deliver excellent CT imaging to the Al Jubail area
been received. in the Eastern Province of the Kingdom of Saudi Arabia.
of the 200-plus orders, nearly half of the sites are installed Inauguration symposium at St. Rembert Hospital
and operational as of April, 2011. This high demand An inauguration symposium took place in Torhout, Belgium
demonstrates that the optima CT660 is answering the at the St. Rembert Hospital—the first European site to
clinical imaging needs of radiologists. receive the optima CT660 with ASiR and overlapped
Reconstruction options. The overlapped Reconstruction
feature enables 128 slices per axial rotation.
The symposium included invited speakers on cardiac
CT and dose reduction technologies, a live demonstration
on post-processing applications, and a lecture comparing
CT with conventional radiology.
St. Rembert is a medium-sized hospital with a 250-bed
capacity and offers healthcare services to a population
of 50,000 in West Flanders. The CT system is being used
for all protocols, including emergency, cardiovascular,
and cardiac imaging, and current daily patient volume
Royal Commission Hospital Team
is approximately 40 patients.
Royal Commission Hospital Geert Bibau, MD, Chief of the Radiology Department,
GE Healthcare recently installed the first optima CT660 explained that among the reasons for choosing
with ASiR in the Middle East region. The local GE team joined optima CT660 with ASiR were the excellent post-processing
Mr. Abdul-Rahman Alhewar, Director of Health Service capabilities and dose reduction technologies. n
optima CT660 is 510(k) pending at FDA. Not commercially available in the united States.
§
A GE Healthcare CT publication • June 2011 9

10. G E H E A LT H C A R E N E W S ANNouNCEMENTS
First-time CT users Embrace Brivo CT325
Across the world, healthcare providers who are first-time CT Just as the compact system fits new users’ needs, GE’s service
system buyers are discovering they don’t have to compromise and support is designed to offer the same. The latest advances
between value and performance. The Brivo* CT325§, a in service technology, such as remote diagnostics, help maximize
GE Healthcare CT scanner developed and manufactured system uptime and resolve many service calls remotely.
in China, achieves the balance of an attainable, reliable, and Maintenance and service elements coupled with comprehensive,
capable CT scanner. flexible training solutions, enables each organization to meet
its service and support needs.
“This is reverse innovation at its best,” says Wayne zhang, Product
Manager, GE Healthcare, China. “We’ve designed the Brivo CT325 “The images and the applications are excellent and reliable,”
with advanced GE technologies and leading-edge features in an says zeng Xianming, MD, Director of the Radiology Department,
ultra-compact, space-saving system that provides the efficiency Anhua Traditional Chinese Medicine Hospital, Hunan province.
and resolution required for many types of routine CT procedures.” “With the speed of the system, we can image as many as 30 to 40
patients in one day without any overtime scanning. This has
Brivo CT325 was created with the new user in mind—by reducing
helped us provide better support to other departments
the number of steps needed to position and release the patient,
in the hospital.”
the table design helps streamline CT exam workflow and increase
throughput. The operating console combines both image Brivo CT325 combines simplicity with performance—
acquisition and post-processing with advanced applications, incorporating CT perfusion, CT colonography, vessel analysis,
simplifying management of multiple tasks from a single location. and advanced volume analysis including averaging, MIP,
MinIP, and volume rendering.
“The Brivo CT325 imaging capabilities fulfill the various clinical
needs of the average user,” says Qui Jianxing, MD, PhD, Peking “Priced affordably for facilities that couldn’t previously afford
university First Hospital and the clinical evaluation site for to implement CT, Brivo CT325 embraces GE’s healthymagination
the system. “The system is very reliable, enabling us to scan initiative and increases access to CT imaging,” zhang adds.
patients all day.”
In fact, for 67% of the sites implementing Brivo CT325, this
Reliable, high-quality imaging is assured with Auto mA to is the first CT system purchased. After a successful launch in
improve signal-to-noise ratio and optimize dose; the bowtie China, Brivo CT325 was introduced in Asia-Pacific, India, Latin
X-ray beam-shaping filters to maintain uniform X-ray at the America and Africa. Learn more how one facility in Kenya—
detector, minimize surface dose, and reduce X-ray scatter; Jocham Hospital—is using the Brivo CT325 to better serve
the beam-tracking system, which contributes to higher dose its patients (page 32). n
efficiency by automatically measuring the position of the
beam and adjusting the collimator using data transferred
in real time; and, the high-absorption efficiency
(98%) and stability of GE detectors for high
image quality with optimized dose.
A head exam on Brivo CT325 at Anhua Qingdao No. 5 People’s Hospital.
Traditional Chinese Medicine Hospital.
§
Brivo CT325 is not for sale in the united States.
Not cleared by the uS FDA.
10 A GE Healthcare CT publication • June 2011

11. GEMSToNE SPECTRAL IMAGING CLINICAL VALuE
Spectral CT:
A Brave New World
of Quantitative,
Functional Imaging
CT has long been considered an excellent method for viewing high-resolution images
of human anatomy in a non-invasive manner. It has been used in conjunction with
PET and MRI—devices that can image tissue and organ function—to bring together
anatomic and morphologic information for a more precise patient diagnosis and
treatment plan.
While CT is “an excellent technique with good spatial and temporal resolution, the
soft tissue contrast and ability to discriminate normal and pathological tissues is
sometimes inferior to other imaging techniques,” says Valentin Sinitsyn, MD, PhD,
Chief of the Radiology Department at the Federal Center of Medicine and Rehabilitation
“GSI’s spectral (Moscow) and Professor and Chair of Radiology, School of Fundamental Medicine
at Moscow State university. This limitation has led to the utilization of other functional
Hu curve and imaging techniques in conjunction with CT imaging—which may result in additional
studies and potentially higher healthcare costs.
material-basis analysis
However, CT is closing the gap between anatomical and alternative functional imaging
provides us with thanks to advances in spectral CT and the introduction of Gemstone* Spectral Imaging
information on material (GSI) on the Discovery* CT750 HD scanner. Today, GSI is beginning to change the way
radiologists across the world utilize CT imaging.
characterization and
quantification—this
is revolutionary.”
– Prof. Xiao-Peng Zhang
A GE Healthcare CT publication • June 2011 11

12. CLINICAL VALuE GEMSToNE SPECTRAL IMAGING
Gemstone Spectral Imaging
Gemstone Spectral Imaging (GSI) is a
dual-energy scan mode that acquires “GSI is breaking down a barrier by bringing a new type of functional imaging to CT,”
data of an object by rapidly switching explains Jean-Nicolas Dacher, MD, PhD, Professor of Radiology and Diagnostic Imaging
between low kVp and high kVp energies and the Chief of the Department of Diagnostic Imaging at Rouen university Hospital,
in less than half a millisecond. This (France). He routinely uses GSI, performing approximately 20 cases each week. “Plus,
generates data with different attenuation with CT we have the advantage of a quick examination that can be more comfortable
values based on the corresponding for the patient,” he adds. This is compared to traditional functional imaging studies
energy levels. The result is a near-perfect, (MR, SPECT and PET) that can last a minimum of 20 minutes to one hour, an important
simultaneous dual-energy acquisition consideration for very sick and elderly patients.
at the full 50 cm scan field of view (SFoV)
producing projection (raw) data at two After conducting more than 1,500 GSI scans and 20 pilot studies in the first three
different energy levels that has virtu- months of using GSI, Xiao-Peng zhang, MD, Professor and Chairman of Radiology,
ally no misregistration. This enables raw Peking university Cancer Hospital and Institute (China), clearly sees its clinical value.
data-based reconstruction of dual-energy “We believe GSI will change the way that doctors practice and interpret CT,” he says.
data with the associated benefits of “GSI’s spectral Hu curve and material-basis analysis provide us with information
quantitative material decomposition on material characterization and quantification—this is revolutionary.”
and beam-hardening reduction from Revolutionary is a statement echoed by Lawrence Tanenbaum, MD, FACR, Director
monochromatic energy synthesis. of MRI, CT, and outpatient/Advanced Development, Mt. Sinai School of Medicine (uSA).
Projection-based reconstruction is used “Spectral CT offers potentially revolutionary information when compared to traditional
to process the data. Based on known polychromatic CT,” he says, “including the ability to reduce certain artifacts, such
attenuation curves, the process as streak and beam hardening from metal, enhance contrast resolution that will
mathematically transforms low and high perhaps make iodine more or less conspicuous, or improve contrast resolution
kVp attenuation measurements into by alternating energy levels to differentiate two different tissues.”
effective material density (MD) basis-pair
images. This is also known as material Tissue characterization
decomposition. GSI produces these
MD pairs which are not available with GSI enhances tissue characterization through its ability to derive images that separate
conventional contrast-enhanced CT materials such as calcium, iodine, and water.
imaging. The make-up or composition “What really impresses me is the rich tissue characterization capability of spectral CT,” says
of the MD pairs can be selected based Dr. Tanenbaum. “To look at a dense brain lesion and know whether it is hemorrhagic,
on the clinical question being investigated enhancing or calcified is very helpful, particularly in difficult case scenarios.”
and materials of interest, such as iodine-
water, iodine-calcium, or water-calcium. The 101 selectable energies and monochromatic images of GSI, explains Prof. zhang,
GSI also produces a monochromatic enable easier and clearer detection of extremely tiny structures—for example, the
image, which is synthesized from the pancreatic duct and membranous structures such as the greater omentum. “This
MD images and depicts how the object is rarely achieved using conventional CT,” he adds.
would look if the X-ray source produced
only X-ray photons at a single energy.
Specific tools have been created in the GSI
Viewer to support the data analysis of this
rich information. Tissue characterization
“With the GSI-generated iodine
can be aided with the help of Hounsfield maps, I can clearly see the
unit (Hu) spectral curves; metal artifact
reduction is enabled by interactively severity of perfusion deficit.”
switching to the optimal monochromatic
energy level. Additionally, material – Prof. Valentin Sinitsyn
identification is made possible by
displaying the effective atomic number
histograms of objects, particularly
kidney stones.
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13. GEMSToNE SPECTRAL IMAGING CLINICAL VALuE
Pulmonary embolism
Prof. Valentin Sinitsyn
GSI represents what is lacking in a typical CT study, says Prof. Sinitsyn. After
the Discovery CT750 HD scanner with GSI was installed at the Federal Center
in November 2009, he immediately began investigations on pulmonary emboli.
“Traditionally, CT provided an excellent depiction of the pulmonary vessels, thrombi
and emboli,” he explains. “However, it could not give us full information on the
Valentin Sinitsyn, MD, PhD, is Chief of the Radiology
severity of pulmonary embolism obstruction or perfusion deficit defects. With the Department at the Federal Center of Medicine
GSI-generated iodine maps, I can clearly see the severity of perfusion deficit.” and Rehabilitation (Moscow, Russia) and
Professor and Chair of Radiology, School
upon closer review, Prof. Sinitsyn discovered he could also detect tiny thrombus of Fundamental Medicine at Moscow State
or embolus inside the pulmonary artery, which often causes the perfusion defect. university. Prof. Sinitsyn is also the elected
President of the Russian National Congress
“In patients with chronic embolism,” he adds, “it is clear that if we see multiple of Radiology 2011; Vice-President of the European
perfusion defects there exists a strong indication to support surgical removal of the Society of Cardiac Radiology; and a member
of the ECR Program Planning Committee. His
thrombi.” He cites a recent study where the occurrence and severity of the perfusion interests include cardiovascular imaging, MR,
defect as determined by spectral CT is a strong predictor of patient prognosis. contrast media, education, and internet and
computer applications in radiology. Prof. Sinitsyn
Prof. Dacher also uses GSI on a daily basis to generate iodine maps for lung perfusion has authored and co-authored more than
studies (by centering the images on the iodine). Most exciting, he says, is the capability 110 articles and eight books on radiology and
internet applications, edited Russian versions
to view the pulmonary artery anatomy for helping to detect clots at the same time
of two international textbooks on MRI and CT,
he obtains a lung perfusion map. He can then use the anatomical and functional and serves on the editorial boards of the
information—obtained during the same study—to assess the pulmonary emboli. “It International Journal of Cardiovascular Imaging,
is very interesting to see there is no match between the extension of the pulmonary the Journal of Cardiovascular Magnetic
Resonance, Diagnostic Imaging (Europe) and
embolus and the pulmonary perfusion abnormality,” he explains. Imaging Decisions.
In one particularly interesting case at the university Hospital of Rouen, pulmonary
embolus was suspected in a patient presenting with chest pain. Prof. Dacher
performed a GSI study and discovered the pulmonary artery was encased by a tumor.
“The flow was limited and there was hypo perfusion that was completely obvious on
the GSI study because we could see the anatomy and function,” he explains. “If we
had performed only scintigraphy—historically the exam of choice for these cases—
we would have only noted the reduced perfusion of the upper lobe.” This could have
resulted in an incorrect diagnosis of pulmonary embolism and possibly led to the
patient unnecessarily receiving an anticoagulant, he explains.
Images courtesy of the Federal Center of Medicine and Rehabilitation (Moscow)
About the facility
The Federal Center of Medicine and Rehabilitation
(Moscow) is well known as a modern surgical
hospital specializing in high-tech neurosurgery,
abdominal surgery, gynecology, orthopedics, and
sports injury rehabilitation. The Department of
Radiology performs all radiological examinations,
including CT, MR, and nuclear scans, around-the-clock
as needed. It is also focused on scientific research
regarding new imaging technologies and contrast
media agents. As an academic hospital, the Center
offers residency and postgraduate programs as
well as clinical faculty positions in the School of
Fundamental Medicine at Moscow State university.
The first-in-Russia Discovery CT750 HD scanner
Figure 1A. A GSI iodine map depicts a wedge-shaped Figure 1B. A small embolus inside the corresponding was installed here in November 2009.
perfusion defect in the 9th segment of the left lung. segmental branch of the left pulmonary artery
can be seen with GSI.
A GE Healthcare CT publication • June 2011 13

14. CLINICAL VALuE GEMSToNE SPECTRAL IMAGING
Oncology
For Prof. zhang, the most significant use of spectral CT is to quantitatively characterize
lesions via the spectral Hu curve, which graphically displays the attenuation
characteristic of a region across all 101 spectral energies.
“using the monochromatic images, we can visualize anatomic and internal structures
of lesions, which is important for early detection.” says Prof. zhang. He finds the
“GSI is not simply material characterization and quantification very useful in helping him identify
different types of lesions and diseases, and gaining information on cancer
a new study area, at different stages.
rather it is changing Additionally, GSI provides rich and reliable hemodynamic information of tissue
with iodine quantification. “It helps us accurately identify infiltrated areas with the
the way we think and iodine-based images,” adds Prof. zhang, “and with a reliable method to evaluate
practice CT imaging.” hemodynamic status, we can evaluate therapy results more confidently.”
– Prof. Xiao-Peng Zhang
Lymphoma
Images courtesy of Peking university Cancer Hospital and Institute
Figure 2A. Affected lymph node of the neck. Figure 2B. Affected lymph node of the porta pulmonis.
Figure 2C. Affected lymph node of the mediastina. Figure 2D. Affected node of the spleen.
14 A GE Healthcare CT publication • June 2011

15. GEMSToNE SPECTRAL IMAGING CLINICAL VALuE
one clinical question that a traditional CT exam cannot answer is whether
or not a lesion enhances. This is often evaluated in terms of Hounsfield units, Prof. Xiao-Peng Zhang
explains Prof. Sinitsyn. Yet the value assigned may not be precise, as the
enhancement may be partially due to beam hardening artifact or artificially
inflated via image processing.
“When I see a small enhancement, I may not be able to determine if it is true or
artificial,” he says. “By comparing water and iodine images, I get the information Xiao-Peng zhang, MD, is the Professor of Radiology,
Peking university Health Science Center, and
to quantify the area of interest based on the accumulation of iodine and objectively Chairman of Radiology Department, Peking
determine if the lesion is a concern that requires follow-up.” university Cancer Hospital and Institute. Prof. zhang
also holds the positions of Chairman of oncology
Renal stones Imaging Committee, China Anti-Cancer
Prof. Sinitsyn also uses GSI to assess renal stones. often, where there is one kidney Association; Managing Editor, Chinese Journal
of Medical Imaging Technology; and Editor
stone, there are more, so it is important to know the material composition. “GSI can of the Chinese Journal of Radiology, Chinese
help quantify the renal stone, whether it is a calcified stone or predominantly a soft Journal of Clinical oncology, and Chinese Journal
stone containing uric acid,” he says. The latter can be treated with techniques other of Practical Surgery. He authored three radiology
textbooks and more than 80 research papers
than surgery, Prof. Sinitsyn adds. globally. Prof. zhang’s research interests include
abdominal and thoracic oncology imaging
for the early detection, accurate staging, and
therapy evaluation of cancer.
Graph courtesy of Peking university Cancer Hospital and Institute
In the Radiology Department of Peking university
Cancer Hospital and Institute, a GSI team of
20 experienced radiologists and researchers,
led by Professor Xiao-Peng zhang, has conducted
more than 1,500 routine GSI scans and 20 pilot
studies in the first three months of using GSI.
They have achieved numerous promising results,
submitted 30 research abstracts and 15 research
papers to prominent journals of radiology.
About the facility
Peking university Cancer Hospital and Institute is
one of China’s most-respected centers dedicated
exclusively to cancer patient care, research,
education, and prevention. Each year, more than
300,000 patients turn to the institute for cancer
care in the form of surgery, chemotherapy,
Figure 3. Spectral Hu curves show the same pattern of different affected lymph nodes in the same patient radiation therapy, immunotherapy, or combinations
with lymphoma, which indicate these lymph nodes are of the same nature as lymphoma. of these and other treatments.
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16. CLINICAL VALuE GEMSToNE SPECTRAL IMAGING
Reducing artifact
With the continued increase in metal instrumentation—hip and knee prosthesis and
spinal fusion, for example—the issue of artifact degrading image quality is becoming
more pronounced, explains Dr. Tanenbaum. Reducing these artifacts is an important
benefit that GSI provides in his daily practice.
“Between 33% and 40% of our routine spine exams involve instrumentation,” he says.
Images courtesy of Mt. Sinai Medical Center (New York)
Figure 4. Note the lack of metal artifact in patient with spinal instrumentation in the 110 keV image on the right compared
to the 70 keV image on the left.
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17. GEMSToNE SPECTRAL IMAGING CLINICAL VALuE
Dr. Lawrence Tanenbaum
name of author
Traditional techniques are challenged by implanted metal hardware, leading to images
with beam hardening and streak artifacts.
“Spectral CT generates virtually pristine images in these most challenging circumstances
where traditional techniques often fail,” Dr. Tanenbaum adds. “We can restore the
information in areas that were previously deteriorated by artifact and thus, substantially info about N. Tanenbaum, MD, FACR,
Lawrence clinic, etc.
improve the imaging results in these difficult cases.” is Director of MRI, CT, and outpatient/Advanced
Development, Mount Sinai School of Medicine
Recently at the European Congress of Radiology (ECR) 2011 annual meeting, (MSSM). The school opened its doors in the fall
Prof. Dacher presented a study demonstrating that he could more easily obtain high of 1968 and has since become one of the
world’s foremost centers for medical and
quality images of the femoral arteries in patients with metallic hip prosthesis by using scientific training. Located in Manhattan,
GSI. “We cannot accept limitations in the investigation of the femoral artery, MSSM works in tandem with The Mount Sinai
so this may be a strong advantage of GSI.” Hospital to facilitate the rapid transfer of
research developments to patient care and
clinical insights back to the laboratory
for further investigation.
Enhancing contrast resolution
Iodine-based contrast material used in CT imaging is very well suited to being About the facility
manipulated—either enhanced or eliminated, explains Dr. Tanenbaum. “Not only Mount Sinai Medical Center, named to u.S. News
can we make the iodine more useful, but it provides an opportunity to deal with & World Report’s 2009-2010 Best Hospitals
sub-optimal contrast administration,” he adds. Honor Roll and ranked 19th nationally, treats
nearly 47,000 inpatients and 427,000 outpatients
Radiologists can either make the contrast more conspicuous in the image by adjusting each year. Renowned for its spinal cord and brain
the energy or create a material-based image that eliminates visibility of the contrast. injury rehabilitation, Mount Sinai was the first
medical school to establish a Department
“With this capability, we have additional information in situations where, historically, of Geriatrics, as well as departments
we’ve performed both a non-contrast and post-contrast CT study,” Dr. Tanenbaum adds. of environmental and occupational medicine.
With more than 3,000 full-time and voluntary
Prof. Dacher also sees an opportunity to use GSI in cases where optimal opacification physicians on staff, the hospital is a regional
(contrast enhancement) is not ideal, particularly in older patients or those without leader in numerous specialties and the world’s
only center for the diagnosis and care of Jewish
good venous access. “When we acquire images with GSI, it is possible to decrease
genetic diseases.
keV and enhance the small amount of contrast media in the patient vessel.”
“Spectral CT generates virtually pristine
images in these most challenging
circumstances where traditional
techniques often fail.”
– Dr. Lawrence Tanenbaum
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18. CLINICAL VALuE GEMSToNE SPECTRAL IMAGING
“We cannot accept limitations
in the investigation of the femoral
artery, so this may be a strong
advantage of GSI.”
– Prof. Jean-Nicolas Dacher
Images courtesy of university Hospital of Rouen (France)
Figure 5. 3D reconstructed image on left at 140 kVp demonstrates lack of imaging data due to artifact from metal
instrumentation. Note the GSI image (right) at 70 keV plus MAR ( metal artifact reduction) clearly depicts the right femoral
artery even in the presence of metal.
Figure 6. GSI helps reduce artifact and provides a diagnostic-quality study even in the presence of metal instrumentation.
The GSI image on the right at 70 keV plus MAR clearly demonstrates the reduction in artifact versus the 140 kVp image
on the left.
18 A GE Healthcare CT publication • June 2011