SOMATOM Emotion 6 Routine VA70

SOMATOM Emotion 6Application Guide

Routine Protocols

Software Version A70

2

The information presented in this application guide

is for illustration only and is not intended to be relied

upon by the reader for instruction as to the practice

of medicine. Any health care practitioner reading this

information is reminded that they must use their own

learning, training and expertise in dealing with their

individual patients.

This material does not substitute for that duty and is

not intended by Siemens Medical Solutions Inc., to

be used for any purpose in that regard. The drugs and

doses mentioned herein were specified to the best

of our knowledge. We assume no responsibility whats-

oever for the accuracy of this information.

Variations may prove necessary for individual patients.

The treating physician bears the sole responsibility

for all of the parameters selected. The pertaining oper-

ating instructions must always be strictly followed

when operating the SOMATOM Emotion 6.

The statutory sources for the technical data are the

corresponding data sheets.

We express our sincere gratitude to the many customers

who contributed valuable input.

Special thanks to Christiane Bredenhoeller, Christoph

Süß, Thomas Flohr and the CT-Application Team for their

valuable assistance.

To improve future versions of this application guide,

we would highly appreciate your questions, suggestions

and comments.

Please contact us:

USC-Hotline:

Tel. no. +49-1803-112244

email [email protected]

Editor: Ute Feuerlein

33

Overview

General 8

Children 24

Head 76

Neck 92

Shoulder 102

Thorax 106

Abdomen 134

Pelvis 164

Spine 172

Extremities 182

4

Content

General 8

· Concept 8

· Scan Set Up 9

· Scan and Reconstruction 9

– Slice Collimation and Slice Width 9

– Pitch 11

– Recon Job 11

– Kernels 12

– Image Filter 12

· Effective mAs 14

· Dose Information 15

– CTDIW and CTDIVol 15

– CARE Dose 17

– How Does it Work 17

· Workflow 19

– Auto Load in 3D and

Postprocessing Presets 19

· Contrast Medium IV Injection 20

· How to Create your own Scan Protocols 21

5

Content

Children 24

· Overview 24

· Hints in General 26

– Head kernels 29

– Body kernels 30

· HeadAngio 32

· HeadAngio06s 34

· Head 36

· HeadSeq 37

· Sinus 38

· InnerEar 40

· NeckRoutine 42

· CarotidCTA 44

· CarotidCTA06s 46

· NeonateBody 48

· NeonateBody06s 49

· ThoraxRoutine 50

· ThoraxRoutine06s 52

· ThoraxCombi 54

· ThoraxCombi06s 56

· ThoraxSeqHR 58

· AbdPelRoutine 60

· AbdPelRoutine06s 62

· AbdCTA 64

· AbdCTA06s 66

· Spine 68

· SpineSagittal 70

· Extremity 72

· ExtrHR 74

6

Content

Head 76

· Overview 76


· AngioHead 78

· AngioHead06s 80

· HeadSeq 82

· Head 84

· InnerEarSeq 86

· InnerEar 88

· OrbiSinus 90

Neck 92

· Overview 92


· AngioCarotid 94

· AngioCarotid06s 96

· NeckRoutine 98

· NeckThinSlice 100

Shoulder 102

· Overview 102


· Shoulder 104

Thorax 106

· Overview 106


· LungLowDose 110

· LungLowDose06s 112

· Embolism 114

· Embolism06s 116

· ThoraxCombi 118

· ThoraxCombi06s 120

· ThoraxRoutine 122

· ThoraxRoutine06s 124

· ThoraxFast 126

· ThoraxFast06s 128

· ThoraxHR 130

· ThoraxSeqHR 132

7

Content

Pelvis 164

· Overview 164


· Hip 168

· PelvisRoutine 170

Spine 172

· Overview 172


· SpineRoutineSeq 176

· SpineObeseSeq 177

· Spine 178

· C-Spine 180

Extremities 182

· Overview 182


· AngioRunOff 186

· AngioRunOff06s 188

· ExtrCombi 190

· ExtrHR 192

Abdomen 134

· Overview 134


· AbdRoutine 140

· AbdRoutine06s 142

· AbdomenCombi 144

· AbdomenCombi06s 146

· AbdMultiPhase 148

· AbdMultiPhase06s 150

· AbdFast 152

· AbdFast06s 154

· AngioFast 156

· AngioFast06s 158

· AngioRoutine 160

· AngioRoutine06s 162

8

General

Concept

The scan protocols for adult are defined according

to body regions – Head, Neck, Shoulder, Thorax, Abdomen, Pelvis, Spine, Extremities.

The pediatric scan protocols are defined under the

folder “Children“.

The protocols for special applications are defined

under “Special“ (please refer to the Application Guide

for Special applications).

The general concept is as follows:

All not specially marked protocols are standard spiral

modes. E. g. “Head” means the spiral mode for the head.

“Fast“: uses 2.0 or 3.0 mm slice collimation and

a higher pitch for fast acquisition for CT Angios or

trauma cases.

“Routine“: uses either 1.0 mm or 2.0 mm slice colli-

mation depending on the region of interest for routine

studies.

“ThinSlice“: uses 1.0 mm slice collimation for thin

slice studies.

“HR“: uses 0.5 mm (optional) or 1.0 mm slice colli-

mation and rotation time of 1.0 s for High-resolution

studies.

“Combi“: uses 1.0 mm as slice collimation and by

default, has 2 reconstruction jobs: one thin slice width

for HiRes or CTA, and one thicker slice width for soft

tissue studies.

“Seq“: stands for Sequence. E. g. “HeadSeq“ means

the sequence mode for the head.

The existence of scan protocols depend on the system

configuration. Protocols with the 0.6 sec. rotation time

are only available on systems configured with the Power

Package, also 0.5 mm slice collimation is available only

on systems with High Resolution option.

9

General

Scan Set Up

Scans can be simply set up by selecting a predefined

examination protocol. To repeat any mode, just click

the chronicle with the right mouse button for “repeat”.

To delete it, select “cut“. Each chronicle is rewriteable

before “load“.

Multiple ranges can be run either automatically with

“auto range“, which is denoted by a bracket connecting

the two ranges, or separately with a “pause” in between.

Scan and Reconstruction

Slice Collimation and Slice Width

Slice collimation is the slice thickness resulting from

the effect of the tube-side collimator and the adaptive

detector array design. In Multislice CT, the Z-coverage

per rotation is given by the product of the number of

active detector slices and the collimation

(e. g. 6 x 1.0 mm).

Slice width is the true thickness of the reconstructed

image.

With the SOMATOM Emotion 6, you select the slice

collimation together with the slice width desired. The

slice width is independent of pitch and algorithm, i. e.

what you select is always what you get. Actually, you

do not need to care about the algorithm any more; the

software does it for you.

10

General

If Metrorecon is not selected you will get routinely

“Real Time” reconstructed images in full image quality.

The Recon icon on the chronicle will be labeled with

“RT”. After the scan the Real Time displayed image series

has to be reconstructed.

The following tables show you the possibilities of image

reconstruction in spiral and sequential scanning.

Slice Collimation and Slice Width for Spiral Mode0.5 mm 0.63, 0.75, 1, 1.25, 2, 2.5, 3, 4, 5 mm

(optional)

1 mm 1.25, 2, 2.5, 3, 4, 5, 6, 8, 10 mm

2 mm 2.5, 3, 4, 5, 6, 8, 10 mm

3 mm 4, 5, 6, 8, 10 mm

Cardio Spiral Modes1 mm 1.25, 2, 3 mm

2 mm 2.5, 3, 5 mm

Slice Collimation and Slice Width for Sequence Mode1.0 mm 1.0, 2.0, 3.0 mm

2.0 mm 2, 4, 6, 12 mm

3.0 mm 3, 6, 9, 18 mm

5.0 mm 5, 10 mm

Perfusion Multiscan Modes1 mm 1, 2, 3 mm

2 mm 2, 4, 6, 12 mm

3 mm 3, 6, 9, 18 mm

5 mm 5, 10 mm

ECG triggered Modes1 mm 1.25, 2, 3 mm

2 mm 2.5, 3, 5 mm

HR Spiral Mode0.5 mm 0.63, 0.75, 1, 1.25, 2, 2.5, 3, 4, 5 mm

(optional)

1 mm 1 mm

HR Sequence Mode1 mm 1 mm

11

General

Pitch

In single slice CT:

Pitch = table movement per rotation/slice collimation

E. g.: slice collimation = 5 mm,

table moves 5 mm per rotation, then pitch = 1.

With the SOMATOM Emotion 6, in Siemens Multislice

CT, we differentiate between:

Feed/Rotation, the table movement per rotation

Volume Pitch, the table movement per rotation/

single slice collimation

E. g.: single slice collimation = 1.0 mm, table moves

6 mm per rotation, then the Volume Pitch = 6

Pitch Factor, the table movement per rotation/

collimation

E. g.: slice collimation = 6 x 1.0 mm, table moves

6 mm per rotation, then the Pitch Factor = 1

With the SOMATOM Emotion 6, you do not need to

select pitch. Once the scan range, scan time, slice

collimation, and rotation time is defined, the software

will adapt the table feed per rotation accordingly.

The Pitch Factor can be freely adapted from 0.5 – 1.8.

Recon Job

In the Recon card, you can define up to 3 reconstruction

jobs with different parameters either before or after

you acquire the data. When you click on “Recon“, they

will all be done automatically. In case you want to add

another recon job, simply click the little icon on the

chronicle with the right mouse button and select “delete

recon job“ to delete the one which has been completed,

and then one more recon job will be available in the

Recon card. (Note: what you delete is just the job from

the display, not the images that have been reconstructed.

Once reconstructed, these completed recon jobs stay

in the browser, until deleted from the hard drive). You

can also reconstruct images for all scans performed by

not selecting any range in the chronicle, prior to clicking

“Recon”.

12

General

Kernels

There are 5 different types of kernels: “H“ stands for

Head, “B“ stands for Body, “U“ stands for High Reso-

lution, “C“ stands for ChildHead, and “S“ stands for

Special Application, e. g., Osteo CT.

The image sharpness is defined by the numbers –

the higher the number, the sharper the image; the

lower the number, the smoother the image.

A set of 32 kernels is supplied with the Emotion 6 Soft-

ware, consisting of 13 body kernels B10s, B20s, B30s,

B31s, B35s, B40s, B41s, B46s, B50s, B60s, B70s, B80s,

B90s, 12 head kernels H10s, H20s, H21s, H30s, H31s,

H40s, H41s, H50s, H60s, H70s, H80s, H90s, 3 child

head kernels C20s, C30s, C60s, 4 special kernels S30s,

S80s, S90s, U90s.

Note: Do not use different kernels for other body parts

other than what they are designed for.

For further information regarding the kernels, please

refer to the “Hints in General” of the corresponding

body region.

Image Filter

There are 4 different filters available:

PFO: To reduce beam-hardening artifacts in head

images, particularly in the base of the skull, use the

Posterior Fossa Optimization (PFO) filter. It is highly

recommended to use the PFO filter for all soft tissue

reconstruction.

13

General

ASA: The Advanced Smoothing Algorithm (ASA) filter

reduces noise in soft tissue while edges with high con-

trast are preserved.

LCE: The Low-contrast enhancement (LCE) filter

enhances low-contrast detectability. It reduces the

image noise.

HCE: The High-contrast enhancement (HCE) filter

enhances high-contrast detectability. It increases the

image sharpness.

Reconstruction

with PFO filter.

Reconstruction

without PFO filter.

14

General

Effective mAs

In sequential scanning, the dose (Dseq) applied to the

patient is the product of the tube current-time (mAs)

and the CTDIw per mAs:

Dseq = DCTDIw x mAs

In spiral scanning, however, the applied dose (Dspiral)

is influenced by the “classical” mAs (mA x Rot Time) and

in addition by the Pitch Factor. For example, if a Multi-

slice CT scanner is used, the actual dose applied to the

patient in spiral scanning will be decreased when the

Pitch Factor is larger than 1, and increased when the

Pitch Factor is smaller than 1. Therefore, the dose in

spiral scanning has to be corrected by the Pitch Factor:

Dspiral = (DCTDIw x mA x Rot Time)/Pitch Factor

To make it easier for the users, the concept of the

“effective” mAs was introduced with the SOMATOM

Multislice scanners.

The effective mAs takes into account the influence of

pitch on both the image quality and dose:

Effective mAs = mAs/Pitch Factor

To calculate the dose on the SOMATOM Emotion 6,

you simply have to multiply the CTDIW per mAs with

the effective mAs of the scan:

Dspiral = DCTDIw x effective mAs

For spiral scan protocols, the indicated mAs is the effec-

tive mAs per image. The correlation between tube

current mA and effective mAs of spiral scans on a Multi-

slice CT scanner is given by the following formula:

Effective mAs = mA x RotTime/Pitch Factor

Pitch Factor =Feed/Rot

nrow x Slice collimation

mA =effective mAs

x Pitch FactorRotTime

where collimated Slice refers to the collimation of one

detector row, and nrow is the number of used detector

rows.

15

General

Dose Information

CTDIW and CTDIVol

The average dose in the scan plane is best described by

the CTDIW for the selected scan parameters. The CTDIW

is measured in the dedicated plastic phantoms – 16 cm

diameter for head and 32 cm diameter for body (as

defined in IEC 60601-2 -44). This dose number gives a

good estimate for the average dose applied in the

scanned volume as long as the patient size is similar to

the size of the respective dose phantoms.

Since the body size can be smaller or larger than

32 cm, the CTDIW value displayed can deviate from the

dose in the scanned volume.

The CTDIW definition and measurement is based on

single axial scan modes. For clinical scanning, i. e. scan-

ning of entire volumes in patients, the average dose

will also depend on the table feed in between axial scans

or the feed per rotation in spiral scanning. The dose,

expressed as the CTDIW, must therefore be corrected by

the pitch-factor of the spiral scan or an axial scan series

to describe the average dose in the scanned volume.

For this purpose the IEC defined the term “CTDIVol“ in

September 2002:

CTDIVol = CTDIW/pitch-factor

This dose number is displayed on the user interface for

the selected scan parameters.

Please note: Up to now the dose display on the

Somaris\5 user interface was labeled “CTDIW“.

This displayed CTDIW was also corrected for the pitch.

16

The CTDIVol value does not provide the entire information

of the radiation risk associated with CT examination.

For this purpose, the concept of the “Effective Dose“ was

introduced by ICRP (International Commission on

Radiation Protection). The effective dose is expressed

as a weighted sum of the dose applied not only to the

organs in the scanned range, but also to the rest of the

body. It could be measured in whole body phantoms

(Alderson phantom) or simulated with Monte Carlo

techniques.

The calculation of the effective dose is rather compli-

cated and has to be done by sophisticated programs.

These have to take into account the scan parameters,

the system design of individual scanner, such as x-ray

filtration and gantry geometry, the scan range, the

organs involved in the scanned range and the organs

affected by scattered radiation. For each organ, the

respective dose delivered during the CT scanning has

to be calculated and then multiplied by its radiation

risk factor. Finally the weighted organ dose numbers

are added up to get the effective dose.

The concept of effective dose would allow the com-

parison of radiation risk associated with different CT or

x-ray exams, i. e. different exams associated with the

same effective dose would have the same radiation risk

for the patient. It also allows comparing the applied

x-ray exposure to the natural background radiation,

e. g. 2 – 3 mSv per year in Germany.

General

17

General

CARE Dose

CARE Dose is a clinical application package that pro-

vides real-time tube current modulation for Spiral and

Sequential Scanning.

CARE Dose reduces patient dose significantly, espe-

cially in the regions of shoulder and pelvis. It decreases

tube load, which extends the capacity for volume scan-

ning with thinner slices, larger volumes or Multi-phase

studies.

It can also improve image quality by increasing mA

thus reducing image noise on the lateral views.

How Does it Work

It reduces the mA for low attenuation views up to 90%

and keeps the nominal higher mA for high attenuation

views, e. g. in the lateral projection (Fig. 4). This is done

“on-the-fly”, i. e. the scanner adapts the mA in real-time,

according to the patient’s attenuation profile (Fig. 5).

Fig. 4: Example of scanning in the shoulder region.

High attenuation,high mA

Low attenuation,low mA

18

General

Fig. 5: Principle of CARE Dose tube current adaptation.

• CARE Dose is pre-selected by default for most standard

protocols. It can be switched on/off in the scan card.

• For the average patients examination, CARE Dose

does not require any manual changes to the scan

protocol. However, the mAs must be adapted manu-

ally for obese and pediatric patients.

• The mean value of the mAs applied will be lower

than what you have selected. Although the average

mA for the entire scan will be lower than selected, we

allow the scanner to apply increased mA levels for

the high attenuation views. This may cause different

results of the tube load controller when switching

on and off CARE Dose.

• The mean value of the effective mAs applied is shown

in the image text.

lateral

1.00

0.75

0.50

0.25

rel.

un

its

a.p.

time

Object attenuation

Modulated tube current

19

General

Workflow

Auto Load in 3D and Postprocessing Presets

You can activate the “Auto load in 3D” function on the

Examination Card/Auto Tasking and link it to a recon

job. For example, the 2nd recon job with thinner slice

width in some of the examination protocols. If the post-

processing type is chosen from the pull down menu,

the reconstructed images will be loaded automatically

into the 3D Card on the Navigator with the correspond-

ing postprocessing type.

On the 3D Card you have the possibility to create MPR,

MIPthin Range Parallel and Radial protocols which can

be linked to a special series.

For example, if you always do sagittal Multiplanar

Reconstructions for a Spine examination, you load once

a Spine examination into the 3D Card. Select the image

type (MPR, MIPthin), select the orientation and open

the Range Parallel function. Adapt the range settings

(Image thickness, Distance between the images etc.)

and hit the link button. From that point on, you have a

predefined postprocessing protocol, linked to the series

description of a Spine examination.

Exactly the same can be done for VRT presets. In the

main menu, under Type/VRT Definition, you can link

VRT presets with a series description.

20

General

Some of the Scan protocols, primarily for Angio exami-

nations, are already preset in the protocol with Auto load

in 3D. If you prefer not to use this preset, please de-

select the Auto load in 3D and save your scan protocol.

Some of the Scan protocols are preset in the protocol

with links to a postprocessing protocol. If you prefer

not to have this preset, please delete the Range Parallel

preset or overwrite them with your own settings.

Contrast Medium IV Injection*

The administration of a contrast medium depends on

the indication and on the delay times to be used during

the examination. The patient’s weight and circulatory

system condition also play a role. In general, no more

than 3 ml per kg of body weight for adults and 2 ml per

kg of body weight for children should be applied.

As a rule of thumb, the contrast medium injection

should be stopped when the scan (or acquisition)

is finished. Keep this in mind, as you may save contrast

medium on your routine studies since the Multislice

spiral scan can be up to 10 times faster than a 1 second,

single slice spiral scan.

For CTA studies (arterial phase), the principle is to keep

contrast injection for the whole scan. Thus, the total

amount of contrast medium needed should be calcu-

lated with the following formula:

CM = (start delay time + scan time) x flow rate.

CARE Bolus or Test Bolus may be used for optimal

contrast bolus timing. Please refer to the Application

Guide for special protocols.

* For more information regarding the general use

of drugs and doses mentioned in this guide, please

refer to page 2.

21

General

How to Create your own Scan Protocols

User-specific scan protocols can be saved with the

following basic procedure:

• Register a test patient, patient position must be

Head First – Supine

• Select a scan protocol.

• Set the table position to 0 (either at the gantry panel,

or on the topogram routine card).

• Modify the scan protocol, change parameters, add

new ranges etc.

• Do not load the scan protocol.

• Select Edit/Save Scan Protocol in the main menu.

• Select the organ region and the scan protocol name

in the pop-up dialog. You can either use the same

name to modify the existing scan protocol, or enter

a new name, which will create a new protocol name

and will not alter any of the existing protocols already

stored.

22

General

Tips

– We recommend the use of the default scan protocols

in order to achieve adequate image quality for the

“typical” patient. Using the default scan protocols

minimizes the occurrence of tube cooling delays and

maximizes x-ray tube life.

– It is recommended that you save your own scan

protocol with a new name in order to avoid over-

writing the default scan protocol.

– You may use preceding numbers (e. g. 1_Abdomen)

for user specific scan protocols to make them appear

on top of the list and to distinguish them from the

Siemens defaults.

– Do not use special characters like ”/”, ”.”, ”\” or ”blank”

within scan protocol names.

– Do not rename scan protocol files on Windows NT

level – this will lead to inconsistencies.

– Do not mix head and body scan protocols: e. g. do

not save a head mode in the abdomen directory.

– System/Run offers the tool “Restore Default Scan

Protocols“ which allows you to remove user specific

scan protocols and to restore the Siemens default

settings.

– System/Edit offers save/delete Scan Protocols.

– System/Run also offers the tool “List Scan Protocols“

which generates an HTML table of all available scan

protocols. This list can be printed or saved on Floppy

(“File/Save As…“).

23

General

24

Children

Overview

This folder contains 24 organ specific pediatric proto-

cols with 2 to 5 age or weight dependant subgroups.

For your convenience, the protocols are numbered

according to the body regions, i. e. from Head to Extre-

mities.

The scan protocols for Head and Neck regions are

defined according to age, and the scan protocols for

the other body regions are defined according to body

weight.

As a default, the effective mAs is set to the lowest

category, e. g. less than 6 months in head modes, and

the suggested effective mAs values for the other cate-

gories are written in additional lines in the chronicle.

Whenever possible 80 kV or 110 kV are used instead of

130 kV, either to exploit the significantly higher image

contrast of iodine contrast media at 80 kV or to reach a

lower dose level than possible with 130 kV.

• Head AngioFor head CT Angio studies

• HeadAngio06sFor head CT Angio studies, using a 0.6 sec.

rotation time (optional)

• HeadFor routine head spiral studies

• HeadSeqFor routine head sequential studies

• SinusFor routine sinus spiral studies

• InnerEarHigh Resolution mode for inner ear spiral studies

with 6 x 0.5 mm slice collimation (optional)

• NeckRoutineFor routine neck spiral studies

• CarotidCTAFor carotid CT Angio studies

• CarotidCTA06sFor carotid CT Angio studies, using a 0.6 sec.


25

Children

• NeonateBodySpiral mode for neonate studies

• NeonateBody06sSpiral mode for neonate studies, using 0.6 sec.


• ThoraxRoutineFor routine chest spiral studies

• ThoraxRoutine06sFor routine chest spiral studies, using 0.6 sec.


• ThoraxCombiFor the combination of thin slice lung and routine

thorax studies

• ThoraxCombi06sFor the combination of thin slice lung and routine

thorax studies, using 0.6 sec. rotation time (optional)

• ThoraxSeqHRHigh resolution sequential mode for lung studies

• AbdPelRoutineFor routine abdominal spiral studies

• AbdPelRoutine06sFor routine abdominal spiral studies, using a 0.6 sec.


• AbdCTAFor abdominal CT Angio studies

• AbdCTA06sFor abdominal CT Angio studies, using a 0.6 sec.


• SpineFor routine spine spiral studies

• Spine SagittalThin slice mode for spine spiral studies when

Multi Planar Reformations are necessary

• ExtremityFor routine extremity spiral studies

• ExtremityHRHigh Resolution mode for extremity spiral studies

with 6 x 0.5 mm slice collimation (optional)

26

Children

Hints in General

1. Topograms: 256 mm lateral topograms are defined

for the head modes, and 512 mm AP topograms are

defined for the body modes. Please keep in mind that

the children’s size can be dramatically different. You

should press the “Hold Measurement“ button when-

ever the range shown on the real time growing topo-

gram is long enough, in order to avoid unnecessary

radiation.

2. Gantry tilt is available for both, sequence and spiral

scanning. However, image artefacts may occur if spirals

are acquired with a tilt angle greater than 8°.

3. For all head studies, it is very important for image

quality purposes to position the patient in the center of

the scan field. Use the lateral laser beam to make sure

that the patient is positioned in the center.

4. Warm surroundings and dimmed lighting are help-

ful to make children more cooperative.

5. Sedation: Although the advent of the Multislice CT

scanner has enabled the user to scan through an area

of interest much faster than ever, sometimes, patient

motion can still lead to severe motion artifacts seen on

the resultant images. This becomes a factor especially

with infants and younger children who are unable to

hold still for the exam. Sedating this population may

be a viable option for your institution. Of course, appro-

priate protocols need to be established at your specific

institution. For instance, the drug of choice for specific

ages/weights of these patients (taking into conside-

ration the total time of the exam), the form of admini-

stration, patient preps, adequate monitoring of the

patient (pre-scan, during the exam and post-scan) etc.

should all be taken into consideration.

27

Children

The proper personnel and equipment must also

be readily available in the event of a problem.

6. Oral and rectal contrast administration: Depending

on the reason for the exam/status of the patient, oral

contrast may or may not be given to these patients.

In general, oral contrast is recommended to opacify

the intestinal tract, as unopacified bowel can have

the appearance of abdominal fluid or mass effect. Oral,

as well as rectal contrast may be required. Usually, a

diluted mixture of iodine and water is used as an oral

agent. Different substances can be added to this mix-

ture to help reduce the bitter taste and make it more

pleasing to the child (apple juice, fruit drink mixes are

just a few of these). Barium may of course be used

in some cases as well. Negative contrast agents such

as water are becoming more popular for delineation

of stomach or bowel wall borders, or when 3D recon-

structions are needed. The user needs to be aware of

all the contraindications of any of the contrast agents

they are using. It is recommended to refer to the spe-

cific vendors recommendations regarding this.

7. I.V. contrast administration: In general, 1 – 2 ml per

kg of body weight should be applied, however, since

the scanning can be completed in just a few seconds,

please keep in mind that the total injection time should

not be longer than the sum of start delay time and the

scan time – do not inject contrast after the scanning is

finished.

It is recommended to use CARE Bolus in order to

achieve optimal contrast enhancement.

Both start delay time and injection rate are exam-/

patient-dependent. I.V. injection with a power injector

is recommended for all scans whenever possible.

Some guidelines to follow with respect to flow rate are

noted in the chart below.

28

Children

Note: these injector guidelines are based on an

antecubital injection site. These guidelines may need

to be adjusted if the site is more peripheral.

Needle Size (gauge) Flow Rate (ml/sec.)

22 1.5

20 2.0 – 3.0

18 3.0 – 5.0

Central lines and ports may need to be hand injected

or power injected at a very low flow rate (1 ml/sec.).

PIC lines and 24 gauge (or smaller) lines are usually

hand injected. All of these protocols should be decided

on by your institution’s appropriate personnel.

8. 80 kV was also used for applications when the

lowest achievable mAs at 110 kV was still higher than

necessary for sufficient noise level (for technical

reasons, generators need to operate at a certain mini-

mum current for stable operation). For applications

such as neonate or airway scanning, the low tube out-

put at 80 kV can be used to further reduce the dose to

the patient.

9. Please observe the recommended mAs settings in

the chronicle.

Note, that these recommendations are valid for the

default tube voltage of the specific protocol.

10. To further optimize MPR image quality we

recommend that you reduce one or more of the follow-

ing: collimation, reconstruction increment, pitch

factor while using a wider slice width for image recon-

struction.

29

Children

Head kernels:

• For head scans of small children, the kernels C20s,

C30s (e. g. for soft tissue studies) and C60s (e. g. for

sinuses) should be chosen instead of the ”adult” head

kernels H20s, H30s and H60s.

• For soft tissue head studies, the standard kernel is

H40s; softer images are obtained with H30s or H20s,

H10s, sharper images with H50s. The kernels H21s,

H31s, H41s yield the same visual sharpness as H20s,

H30s, H40s, but a more agreeable image appearance

and sometimes even better low contrast detectability,

the reason is, as with B31s and B41s, the fine-grained

noise structure.

• For the standard head protocols, we propose H21s,

H31s, H41s.

• High resolution head studies should be performed

with H60s, H70s (e. g. for dental and sinuses) and

H80s, H90s (e. g. inner ear).

30

Children

Body kernels:

• As standard kernels for body tissue studies B30s or

B40s are recommended; softer images are obtained

with B20s or B10s (extremely soft). The kernels B31s

or B41s have about the same visual sharpness as B30s,

respectively, B40s, the image appearance, however,

is more agreeable due to a ”fine-grained” noise struc-

ture; quite often, the low contrast detectability is

improved by using B31s, B41s instead of B30s, B40s.

• The 2 kernels B35s and B46s are especially designed

for cardiac application, in particular, B35s should be

used for Ca-scoring, and B46s for patency of stents.

• For higher sharpness, as is required e. g. in patient

protocols for cervical spine, shoulder, extremities,

thorax, the kernels B50s, B60s, B70s, B80s are avail-

able.

• A special high resolution lung kernel is supplied with

B90s; by using kernel B90s, practically the same

image impression is obtained as with HCE-filtering of

a B40s image.

31

Children

The special kernels are mostly used for ”physical”

measurements with phantoms, e. g. for adjustment

procedures (S80s), for constancy and acceptance

tests (S80s, U90s), or for specification purposes (U90s).

For special patient protocols, S80s and U90s are

chosen, e. g. for osteo (S80s) and for high resolution

bone studies (U90s).

We recommend to use the high resolution specifi-

cation kernel U90s only with ”small” objects, like the

wrist, otherwise artifacts will occur in the images.

32

HeadAngio

Indications:

Spiral mode for head CT angiography, e. g. cerebral

vascular abnormalities, tumors etc.

A range of 6 cm will be covered in 6.9 sec.

HeadCTAkV 80

Effective mAs *

Slice collimation 1.0 mm

Slice width 1.25 mm

Feed/Rotation 9.0 mm

Rotation time 0.8 sec.

Kernel C30s

Increment 0.8 mm

Image order ca-cr

* The mAs should be adjusted to the age of the child.

Age kV mAs CTDIVol

(mGy)< 6 years 80 80 6.5

6 years – 12 years 80 120 9.8

Children

33

Tips

• Children, who are more than 12 years old should be

scanned with an adult protocol.

Contrast medium IV injectionStart delay exam dependent

Flow rate dependent upon needle size/Access site

Total amount 1 – 2 ml per kg of body weight

Children

MIPthin: HeadAngio coronalImage thickness 3

Distance between images 3

Number of images 35

For the 1st reconstruction the Autoload into MIPthin

Range on the 3D Card is activated. The images will be

automatically loaded into 3D, MIPthin, and a coronal

MIPthin Range will pop up.

Please notice, if you are not satisfied with the Range

preset adapt the parameters to your needs and link

them to the series.

34

HeadAngio06s

Indications:

Spiral mode for head CT angiography, e. g. cerebral

vascular abnormalities, tumors etc., using a 0.6 sec.

rotation time.


HeadCTAkV 80

Effective mAs *


Slice width 1.25 mm



Kernel C30s

Increment 0.8 mm

Image order ca-cr


Age kV mAs CTDIVol

(mGy)< 6 years 80 80 6.5

6 years – 12 years 80 120 9.8

Children

35

Children

MIPthin: HeadAngio coronalImage thickness 3


Number of images 35







them to the series.

Tips






36

Children

Head

Indications:

Spiral mode for routine head studies, e. g. tumors,

hydrocephalus, hemorrhaging, abnormalities, etc.

A range of 8.5 cm will be covered in 16.2 sec.

HeadkV 110

Effective mAs *


Slice width 5.0 mm



Kernel C30s

Increment 5.0 mm

Image order ca-cr

Tips

• Children, who are more than 6 years old, should

be scanned with an adult protocol as the skull by this

time is fully grown.

• When bone structure is of interest, use kernel C60s

for image reconstruction.

• Posterior Fossa Optimization Filter



Posterior Fossa Optimization (PFO) filter.





Body Weight kV mAs CTDIVol

(mGy)< 6 months 110 60 11.4

6 months – 3 years 110 170 32.3

3 years – 6 years 110 310 59.0

37

Children

HeadSeq

Indications:

Sequential mode for routine head studies for

children, e. g. tumors, hydrocephalus, hemorrhaging,

abnormalities, etc.

HeadSeqkV 110

mAs *


Slice width 6.0 mm

Feed/Scan 12 mm


Kernel C30s

Image order ca-cr

Tips




• When bone structure is of interest, use kernel C60s


• Posterior Fossa Optimization Filter



Posterior Fossa Optimization (PFO) filter.





Age kV mAs CTDIVol

(mGy)< 6 months 110 60 9.8

6 months – 3 years 110 170 27.8

3 years – 6 years 110 310 50.7

38

Children

Sinus

Indications:

Spiral mode for routine spiral studies of the sinuses

and for the paranasal sinuses when Multi Planar

Reformation (MPR) are intended, e. g. sinusitis, pneu-

matization, polyposis, malformations, tumors etc.


Sinus 2nd reconstr.kV 110

Effective mAs *


Slice width 3.0 mm 1.25 mm



Kernel C30s C60s

Increment 3.0 mm 0.8 mm

Image order ca-cr


39

Children

Tips

• Children, who are more than 6 years old, should be


• The second recon job is defined with kernel C60s

and with an overlap for visualizing bone structures

with MPR.

• If the study is focused on bone structure only, the

mAs can be reduced to 20 for all age groups.




Age kV mAs CTDIVol

(mGy)< 3 years 110 35 6.6

3 years – 6 years 110 50 9.5

MPRthick: Sinus coronalImage thickness 2


Number of images 30

For the 2nd reconstruction the Autoload into the MPR

Range on the 3D Card is activated. The images will

be automatically loaded into 3D, MPR, and a coronal

MPRthick Range will pop up. Please notice, if you are

not satisfied with the Range preset adapt the para-

meters to your needs and link them to the series.

40

Children

InnerEar

Indications:

High Resolution Spiral mode for inner ear studies, e. g.

malformations of the inner ear, inflammatory changes,

pathologies of the mastoid process, tumor processes

of the pyramids, posttraumatic changes, etc.


InnerEarkV 110

Effective mAs *


Slice width 0.63 mm



Kernel H90s

Increment 0.5 mm

Image order ca-cr


41

Children

Tips




• When soft tissue is of interest, use kernel H30s/H31s





Age kV mAs CTDIVole(mGy)

< 3 years 110 30 5.9

3 years – 6 years 110 50 9.9

42

NeckRoutine

Indications:

Spiral mode for routine neck studies, e. g. tumors,

lymphoma, abscesses, etc.


NeckkV 110

Effective mAs *


Slice width 3.0 mm



Kernel B50s

Increment 3.0 mm

Image order ca-cr

Tips







Age kV mAs CTDIVol

(mGy)< 3 years 110 35 2.7

3 years – 6 years 110 50 3.9

Children

43

Children

44

CarotidCTA

Indications:

CT angiography of the carotid arteries, e. g. carotid

stenosis or occlusion, vascular abnormalities of the

carotids or vertebral arteries, etc.


CTA 2nd reconstr.kV 80

Effective mAs *





Kernel B41s B31s


Image order ca-cr


Age kV mAs CTDIVol

(mGy)< 6 years 80 40 1.4

6 years – 12 years 80 60 2.1

Children

45

Tips



• The first recon job is defined for soft tissue visuali-

zation.




MIPthin: CarotidCTA coronalImage thickness 3


Number of images 20

For the 2nd reconstruction the Autoload into MIPthin






them to the series.

Children

46

CarotidCTA06s

Indications:

CT angiography of the carotid arteries, e. g. carotid

stenosis or occlusion, vascular abnormalities of the

carotids or vertebral arteries, etc., using a 0.6 sec.

rotation time.


CTA 2nd reconstr.kV 80

Effective mAs *





Kernel B41s B31s


Image order ca-cr


Age kV mAs CTDIVol

(mGy)< 6 years 80 40 1.4

6 years – 12 years 80 60 2.1

Children

47

Tips



• The first recon job is defined for soft tissue visuali-

zation.




MIPthin: CarotidCTA coronalImage thickness 3


Number of images 20







them to the series.

Children

48

NeonateBody

Indications:

Spiral mode for routine neonate body studies, e. g.

tumors, abnormalities, malformations, abscesses, etc.


NeonateBodykV 80

Effective mAs 35


Slice width 5.0 mm



Kernel B41s

Increment 4.0 mm

Image order cr-ca

CTDIVol 1.1 mGy

Tips

• You can modify the slice width for image reconstruc-

tion according to the clinical indications.




Children

49

NeonateBody06s

Indications:

Spiral mode for routine neonate body studies, e. g.

tumors, abnormalities, malformations, abscesses,

etc., using a 0.6 sec. rotation time.


NeonateBodykV 80

Effective mAs 35


Slice width 5.0 mm



Kernel B41s

Increment 4.0 mm

Image order cr-ca

CTDIVol 1.1 mGy

Tips

• You can modify the slice width for image reconstruc-

tion according to the clinical indications.




Children

50

ThoraxRoutine

Indications:

Spiral mode for routine thorax studies, e. g.

pneumonia, tumors, metastases, lymphoma, vascular

abnormalities etc.


Children

51

Thorax 2nd reconstr.kV 110

Effective mAs *





Kernel B41s B60s


Image order cr-ca

Tips

• Children with a body weight of more than 55 kg

should be examined with an adult protocol.

• The first and second recon jobs are defined for

visualization of the mediastinum and the lungs,

respectively.




* The mAs should be adjusted to the body weight

of the child.

Body weight kV mAs CTDIVol

(mGy)< 15 kg 110 13 1.0

15 – 24 kg 110 17 1.3

25 – 34 kg 110 26 2.0

35 – 44 kg 110 43 3.3

45 – 55 kg 110 60 4.7

Children

52

ThoraxRoutine06s

Indications:

Spiral mode for routine thorax studies, e. g.

pneumonia, tumors, metastases, lymphoma, vascular

abnormalities etc., using a 0.6 sec. rotation time.


Children

53


Effective mAs *





Kernel B41s B60s


Image order cr-ca

Tips



• The first and second recon jobs are defined for

visualization of the mediastinum and the lungs,

respectively.





of the child.


(mGy)< 15 kg 110 13 1.0

15 – 24 kg 110 17 1.3

25 – 34 kg 110 26 2.0

35 – 44 kg 110 43 3.3

45 – 55 kg 110 60 4.7

Children

54

ThoraxCombi

Indications:

Combining thin slice lung and routine thorax studies

with one spiral scan. E. g. thorax studies in general and

interstitial changes in the lungs. There are two recon

jobs predefined. The first one, with 3 mm slice thick-

ness, for the mediastinum, the second reconstruction,

with 1.25 mm slice thickness, for the lung.

A range of 15 cm will be covered in 15 sec.

Children

55


Effective mAs *





Kernel B41s B60s


Image order cr-ca

Tips



• Two recon jobs are predefined for image reconstruc-

tion of routine thorax and thin slice lung.





of the child.


(mGy)< 15 kg 110 20

15 – 24 kg 110 26 2.4

25 – 34 kg 110 39 3.5

35 – 44 kg 110 65

45 – 55 kg 110 90 8.2

Children

56

ThoraxCombi06s

Indications:


with one spiral scan. E. g. thorax studies in general

and interstitial changes in the lungs. There are two

recon jobs predefined. The first one, with 3 mm slice

thickness, for the mediastinum, the second recon-

struction, with 1.25 mm slice thickness, for the lung,

using a 0.6 sec. rotation time.


Children

57


Effective mAs *





Kernel B41s B60s


Image order cr-ca

Tips



• Two recon jobs are predefined for image reconstruc-

tion of routine thorax and thin slice lung.





of the child.


(mGy)< 15 kg 110 20

15 – 24 kg 110 26 2.6

25 – 34 kg 110 39 3.5

35 – 44 kg 110 65

45 – 55 kg 110 90 8.2

Children

58

ThoraxSeqHR

Indications:

Sequence mode for High Resolution lung studies, e. g.

interstitial changes of the lung parenchyma, etc.

ThorHRkV 110

mAs *


Slice width 1.0 mm

Feed/Scan 10.0 mm


Kernel B90s

Image order cr-ca

Tips



• If you want to acquire the patient at full inspiration

or full expiration, you should practice the breathing

with the patient a few times before beginning the

scan, so that reproducibility may be improved.


of the child.


(mGy)< 35 kg 110 36 0.3

35 – 54 kg 110 120 0.9

Children

59

Children

60

AbdPelRoutine

Indications:

Spiral mode for routine studies in the region

of abdomen and pelvis, e. g. tumors, lymphoma,

abscesses, post-traumatic changes, etc.


AbdkV 110

Effective mAs *


Slice width 5.0 mm



Kernel B41s

Increment 5.0 mm

Image order cr-ca


of the child.

Children





(mGy)< 15 kg 110 15 1.2

15 – 24 kg 110 30 2.4

25 – 34 kg 110 50 3.9

35 – 44 kg 110 75 5.8

45 – 55 kg 110 105 8.2

61

Children

Tips



62

AbdPelRoutine06s

Indications:

Spiral mode for routine studies in the region of abdomen

and pelvis, e. g. tumors, lymphoma, abscesses, post-

traumatic changes, etc., using a 0.6 sec. rotation time.


AbdkV 110

Effective mAs *


Slice width 5.0 mm



Kernel B41s

Increment 5.0 mm

Image order cr-ca


of the child.

Children





(mGy)< 15 kg 110 15 1.2

15 – 24 kg 110 30 2.4

25 – 34 kg 110 50 3.9

35 – 44 kg 110 75 5.8

45 – 55 kg 110 105 8.2

63

Children

Tips



64

AbdCTA

Indications:

For abdominal CT Angio studies, e. g. vascular

abnormalities, aneurysms, etc.


AbdCTA 2nd reconstr.kV 80

Effective mAs *





Kernel B41s B31s


Image order cr-ca


of the child.

Children


(mGy)< 15 kg 80 40 1.4

15 – 24 kg 80 60 2.1

25 – 34 kg 80 80 2.8

35 – 44 kg 80 100 3.5

45 – 54 kg 80 130 4.6



automatically loaded into 3D, MIPthin, and a sagittal




them to the series.

65

Children




Tips



• The first recon job is defined for image viewing and

filming.

MIPthin: AbdCTA sagittalImage thickness 3


Number of images 60

66

AbdCTA06s

Indications:

For abdominal CT Angio studies, e. g. vascular abnor-

malities, aneurysms, etc., using a 0.6 sec. rotation time.


AbdCTA 2nd reconstr.kV 80

Effective mAs *





Kernel B41s B31s


Image order cr-ca


of the child.

Children


(mGy)< 15 kg 80 40 1.4

15 – 24 kg 80 60 2.1

25 – 34 kg 80 80 2.8

35 – 44 kg 80 100 3.5

45 – 54 kg 80 130 4.6



automatically loaded into 3D, MIPthin, and a sagittal




them to the series.

67

Children




Tips



• The first recon job is defined for image viewing and

filming.

MIPthin: AbdCTA sagittalImage thickness 3


Number of images 60

68

Spine

Indications:

Spiral mode for spine studies, e. g. post-traumatic

changes, tumors, malformations, orthopedic indi-

cations, etc.


Spine 2nd reconstr.kV 110

Effective mAs *





Kernel B41s B60s


Image order cr-ca


of the child.

Children


(mGy)< 15 kg 110 22 1.7

15 – 24 kg 110 47 3.7

25 – 34 kg 110 78 6.0

35 – 44 kg 110 110 8.6

45 – 55 kg 110 173 13.5

69

Children




Tips



• If the study is focused on bone structures only,

the mAs can be reduced up to 30% for children with

a body weight of more than 25 kg.

70

SpineSagittal

Indications:

Spiral mode for the spine when Multi Planar Reforma-

tion (MPR) are intended, e. g. post-traumatic changes,

tumors, malformations, CT-myelography, etc.



Effective mAs *





Kernel B41s B60s


Image order cr-ca


of the child.

Children


(mGy)< 15 kg 110 40 3.5

15 – 24 kg 110 50 4.4

25 – 34 kg 110 60 5.2

35 – 44 kg 110 70 6.1

45 – 55 kg 110 80 7.0



be automatically loaded into 3D, MPR, and a sagittal

MPRthick Range will pop up.



them to the series.

71

Children




Tips






MPRthick: Spine sagittalImage thickness 3


Number of images 20

72

Extremity

Indications:

Spiral mode for extremity studies, e. g. post-traumatic

changes, tumors, malformations, etc.


Extre 2nd reconstr.kV 110

Effective mAs *





Kernel B41s B70s


Image order cr-ca


of the child.

Children


(mGy)< 15 kg 110 15 1.4

15 – 34 kg 110 25 2.3

35 – 54 kg 110 50 4.5







them to the series.

73

Children




Tips






MPRthick: Extremity coronalImage thickness 3


Number of images 20

74

ExtrHR

Indications:

Spiral mode for High Resolution bone studies, e. g.

tumors, posttraumatic changes, orthopedic indications,

etc.

Two recon jobs are predefined for image reconstruc-

tion of the soft tissue and bone structure.


ExtrHR 2nd reconstr.kV 110

Effective mAs *





Kernel B41s U90s


Image order cr-ca


of the child.


(mGy)< 15 kg 110 35 3.3

15 – 34 kg 110 50 4.7

35 – 54 kg 110 80 7.5

Children







them to the series.

75

Tips



Children

MPRthick: Extremity coronalImage thickness 3


Number of images 20

76

Head

Overview

• AngioHeadFor CT Angio studies using 1.0 mm slice collimation

and a 1.25 mm slice thickness

• AngioHead06sFor CT Angio studies using 0.6 sec. rotation time

(optional)

• HeadSeqSequence mode for base of the skull and cerebrum

routine studies

• HeadSpiral mode for base of skull and cerebrum routine

studies

• InnerEarSeqSequence mode for inner ear High Resolution

studies using 1.0 mm slice collimation and a 1.0 mm

slice thickness

• InnerEarSpiral mode for inner ear High Resolution studies

using 0.5 mm slice collimation (optional) and a

0.63 mm slice thickness

• OrbiSinusSpiral mode for orbital and sinus studies

77

Head

Hints in General

• Topogram: Lateral, 256 mm.

• Patient positioning:

Patient lying in supine position, arms resting against

body, secure head well in the head holder, support

lower legs.

• Gantry tilt is available for both, sequence and spiral

scanning. However, image artefacts may occur if

spirals are acquired with a tilt angle greater than 8°.

• For all head studies, it is very important for image

quality to position the patient in the center of the

scan field. Use the lateral laser beam to make sure

that the patient is positioned in the center.

• In general, cerebrum studies with contrast medium,

except CTA and nasopharynx, can be performed

by hand injection. Start the scan after the injection is

completed.

• To further optimize MPR image quality we recommend

that you reduce one or more of the following: colli-

mation, reconstruction increment, pitch factor while

using a wider slice width for image reconstruction.

Head kernels:

• For soft tissue head studies, the standard kernel is

H40s; softer images are obtained with H30s or H20s,

H10s, sharper images with H50s. The kernels H21s,

H31s, H41s yield the same visual sharpness as H20s,

H30s, H40s, but a more agreeable image appearance

and sometimes even better low contrast detectability,

the reason is, as with B31s and B41s, the fine-grained

noise structure. For the standard head protocols, we

propose H21s, H31s, H41s.

• High resolution head studies should be performed

with H60s, H70s (e. g. for dental and sinuses) and

H80s, H90s (e. g. inner ear).

78

AngioHead

Indications:

Spiral mode for cerebral CT Angios, e. g. cerebral

vascular abnormalities, tumors and follow up studies

etc.

Two recon jobs are predefined for postprocessing.

A range of 80 mm will be covered in 12.3 sec.

Head

79

Head

AngioHead 2nd reconstr.kV 110

Effective mAs 70





Kernel H31s H20s


Image order ca-cr

CTDIVol 13.3 mGy

Use of CARE Bolus with monitoring scans positioned at

the level of the basilar artery or carotid artery. Set the

trigger threshold at 120 HU, or use manual triggering.

MIPthin: AngioHead coronalImage thickness 3


Number of images 35






preset adapt the parameters to your needs and link them

to the series.

Contrast medium IV injectionStart delay 18 sec.

Flow rate 3.5 ml/sec.

Total amount 75 ml

Head

80

AngioHead06s

Indications:

Spiral mode for cerebral CT Angios, e. g. cerebral

vascular abnormalities, tumors and follow up studies



A range of 80 mm will be covered in 9.2 sec.

Head

81

AngioHead 2nd reconstr.kV 110

Effective mAs 70





Kernel H31s H20s


Image order ca-cr

CTDIVol 13.4 mGy

Use of CARE Bolus with monitoring scans positioned at

the level of the basilar artery or carotid artery. Set the

trigger threshold at 120 HU, or use manual triggering.

MIPthin: AngioHead coronalImage thickness 3


Number of images 35







to the series.



Total amount 75 ml

HeadSeq

Indications:

Sequence mode for routine head studies, e. g.

stroke, brain tumors, cranial trauma, cerebral atrophy,

hydrocephalus, and inflammation, etc.

Two ranges are predefined. One for the base of the

skull and one for the cerebrum, the scan length for the

entire head is 125 mm.

For both ranges a typical gantry tilt of -20° is predefined.

Head

82

Head

BaseSeq CerebrumSeqkV 130 130

mAs 260 300

Slice collimation 2.0 mm 3.0 mm


Feed/Scan 12.5 mm 19.0 mm

Rotation time 1.5 sec. 1.5 sec.

Kernel H31s H31s

Image order ca-cr ca-cr

CTDIVol 58.8 mGy 63.2 mGy

PosteriorFossaOptimization Filter


images, use for both ranges the Posterior Fossa

Optimization (PFO) filter.


Flow rate 2 ml/sec.

Total amount 50 – 60 ml

83

Head

Indications:

Spiral mode for routine head studies, e. g. stroke,

brain tumors, cranial trauma, cerebral atrophy, hydro-

cephalus, and inflammation, etc.

Two ranges are predefined for the base of the skull

and cerebrum.

A range for the base of 40 mm will be covered in

12.0 sec., a range for the cerebrum of 80 mm will be

covered in 12.0 sec.

Head

84

Head

Base CerebrumkV 130 130

Effective mAs 240 300

Slice collimation 1.0 mm 2.0 mm


Feed/Rotation 4.0 mm 8.0 mm

Rotation time 1.0 sec. 1.0 sec.

Kernel H31s H31s


Image order ca-cr ca-cr

CTDIVol 65.9 mGy 70.7 mGy

PosteriorFossaOptimization Filter


images, use for both ranges the Posterior Fossa

Optimization (PFO) filter.


Flow rate 2 ml/sec.


85

InnerEarSeq

Indications:

Sequence mode for inner ear High Resolution studies,

e. g. inflammatory changes, tumorous processes

of pyramids, cerebellopontine angle tumors, post-

traumatic changes, etc.

The scan length is 47 mm and a typical gantry tilt of

-20° is predefined.

Head

86

Head

InnerEarSeqkV 130

mAs 180


Slice width 1.0 mm

Feed/Scan 6.0 mm


Kernel H90s

Image order ca-cr

CTDIVol 49.4 mGy

For image reconstruction of soft tissue, use kernel

H30s/H31s.


Flow rate 2 ml/sec.

Total amount 60 ml

87

InnerEar

Indications:

Spiral mode for inner ear High Resolution studies,

e. g. inflammatory changes, tumorous processes

of pyramids, cerebellopontine angle tumors, post-

traumatic changes, etc.


Head

InnerEarkV 130

Effective mAs 150


Slice width 0.63 mm



Kernel H90s

Increment 0.5 mm

Image order ca-cr

CTDIVol 42.7 mGy


H30s/H31s.


Flow rate 2 ml/sec.

Total amount 50 ml

88

Head

89

OrbiSinus

Indications:

Spiral mode for orbital and paranasal sinuses studies,

e. g. sinusitis, mucocele, pneumatization, polyposis,

tumor, corrections etc.

Two recon jobs are predefined for image reconstruction

of the soft tissue and bone structure.


Head

OrbiSinus 2nd reconstr.kV 130

Effective mAs 60





Kernel H31s H70s


Image order ca-cr

CTDIVol 16.5 mGy

90

Head

In this protocol, two recon tasks are predefined for

image reconstruction for both soft issue and bone struc-

ture. If one of them is not required, you can delete it

by clicking the icon of the recon task on the chronicle

with the right mouse button and select “delete recon

job“. You should do this before you start the recon-

struction.

When performing Orbit studies, the patient should

be told to keep his/her eyes closed. This will reduce the

possibility of small streak artifacts from eye movement.

If the study is focused on bone structure only, you can

reduce the mAs to 20.



Total amount 75 ml

91

MPRthick: Sinus coronalImage thickness 2


Number of images 30







them to the series.

92

Neck

Overview

• AngioCarotidFor CTA studies

• AngioCarotid06sFor CTA studies, using a rotation time of 0.6 sec.

(optional)

• NeckRoutineFor routine soft tissue spiral studies

• NeckThinSliceFor soft tissue thin slice spiral studies

93

Neck

Hints in General

• Topogram: Lateral, 256 mm, for CTAs AP, 256 mm


Patient lying in supine position, hyperextend neck

slightly, secure head well in head holder.

• Patient respiratory instruction:

do not breathe, do not swallow.

Body kernels:














thorax, lung, the kernels B50s, B60s, B70s, B80s are

available.

• A special high resolution lung kernel is supplied

with B90s; by using kernel B90s, practically the same


a B40s image.

• In case of 3D study only, the mAs value can be

reduced by 50%. Use kernel B10s and at least 50%

overlapping for image reconstruction.

94

Neck

AngioCarotid

Indications:

Noninvasive CT angiography of carotid stenosis

or occlusions, plaques course abnormalities of the

carotids and vertebral arteries, etc.



95

Neck

AngioCarotid 2nd reconstr.kV 110

Effective mAs 70





Kernel B31s B31s


Image order cr-ca

CTDIVol 6.4 mGy

CARE Bolus may be used to optimize the bolus timing.

Set the ROI for monitoring scan in the aortic arch

with triggering threshold of 120 HU, or use manual

triggering.

MIPthin: AngioCarotid coronalImage thickness 3


Number of images 20







to the series.


Flow rate 4 ml/sec.

Total amount 90 ml

96

Neck

AngioCarotid06s

Indications:

Noninvasive CT angiography of carotid stenosis

or occlusions, plaques course abnormalities of the

carotids and vertebral arteries, etc.


97

Neck

AngioCarotid 2nd reconstr.kV 110

Effective mAs 70





Kernel B31s B31s


Image order cr-ca

CTDIVol 6.4 mGy

CARE Bolus may be used to optimize the bolus timing.

Set the ROI for monitoring scan in the aortic arch

with triggering threshold of 120 HU, or use manual

triggering.

MIPthin: AngioCarotid coronalImage thickness 3


Number of images 20







to the series.


Flow rate 4 ml/sec.

Total amount 90 ml

Neck

NeckRoutine

Indications:

For soft tissue spiral studies in the cervical region.

E. g. tumors, lymphoma, abscesses etc.

A typical range of 20 cm will be covered in 10.5 sec.

98

Neck

NeckkV 130

Effective mAs 85


Slice width 5.0 mm



Kernel B50s

Increment 5.0 mm

Image order cr-ca

CTDIVol 9.7 mGy

Patient positioning is very important for artifact-free

images. The thoracic girdle should be positioned as far

as possible in the caudal direction. This can be done

using a strap with a permanent loop or Velcro fastener

at its end. The ends of the strap must be attached to

the patients wrists. Then the strap must be wrapped

around the patients feet with his legs extended and

under tension. The entire thoracic girdle is thus pulled

toward the patients feet.



Total amount 100 ml

99

Neck

NeckThinSlice

Indications:

Spiral mode using thin slices for soft tissue studies.

E. g. the functional study of the throat.

Two recon jobs are predefined: thinner slice recon-

struction used for post-processing, and thicker slice

reconstruction for soft tissue.


100

Neck

NeckThinSlice 2nd reconstr.kV 130

Effective mAs 130





Kernel B50s B50s


Image order cr-ca

CTDIVol 17.2 mGy

101

This protocol can also be used in case of suspected

tumor of the hypopharynx and larynx. It is recommen-

ded to acquire the images in E-phonation, and recon-

struct the images with 1 mm slice width and increment

of 0.7 mm for performing MPRs. This would help

differentiate tumor lesions from normal pharyngeal

mucosa.


Flow rate 3 ml/sec.

Total amount 100 ml

MPRthick: NeckThinSlice sagittalImage thickness 3


Number of images 20



be automatically loaded into 3D, MPR, and a sagittal




to the series.

102

Shoulder

Overview

• ShoulderSpiral mode for HiRes bone studies and soft tissues

103

Shoulder

Hints in General

• Topogram: AP, 256 mm.


Patient lying in supine position, the uninjured arm

placed above the head, the injured arm placed flat

against his body. If only one side is under investiga-

tion, position this side in the center and support the

other side with a Bocollo pillow (optional).

• If only one side is examined, it is advisable to enter

the side in the comment line on the routine card.





Body kernels:















available.




a B40s image.

104

Shoulder

Shoulder

Indications:

Spiral mode for HiRes bone studies and soft tissues.

E. g. evaluation of joint cavities, masses, trauma,

dislocations, orthopedic indications etc.

A scan range of 15 cm will be covered in 21.8 sec.

105

Shoulder

ShoulderkV 130

Effective mAs 85


Slice width 3.0 mm



Kernel B60s

Increment 2.0 mm

Image order cr-ca

CTDIVol 9.7 mGy

In case of 3D study, mAs value can be reduced by 50%.

Use raw data to review a target region if necessary.

For image reconstruction of soft tissue use kernel B31s

and a slice width of 5.0 mm.

106

Thorax

Overview

• LungLowDoseSpiral mode with very low dose for special lung

studies, e. g. early visualization of pulmonary nodules

• LungLowDose06sSpiral mode with very low dose and a rotation time

of 0.6 sec. for special lung studies. E. g. early visuali-

zation of pulmonary nodules (optional)

• EmbolismSpiral mode for Pulmonary Emboli studies

• Embolism06sSpiral mode for Pulmonary Emboli studies

using a rotation time of 0.6 sec. (optional)

107

Thorax

• ThoraxCombiFor the combination of thin slice lung and routine

thorax studies

• ThoraxCombi06sFor the combination of thin slice lung and routine

thorax studies, using a rotation time of 0.6 sec.

(optional)

• ThoraxRoutineFor routine thorax spiral studies

• ThoraxRoutine06sFor routine thorax spiral studies, using a rotation

time of 0.6 sec. (optional)

• ThoraxFastFast spiral mode for long range studies

• ThoraxFast06sFast spiral mode for long range studies, using a

rotation time of 0.6 sec. (optional)

• ThoraxHRSpiral mode for HiRes lung studies

• ThoraxSeqHRSequential mode for HiRes lung studies

108

Thorax

Hints in General

• Topogram: AP, 512 mm.


Patient lying in supine position, arms positioned

comfortably above the head in the head-arm rest,

lower legs supported.

• CARE Bolus may be used to optimize the bolus

timing.

Set the ROI for monitoring scan in the aorta at the

level of the diaphragm with triggering threshold of

120 HU, or use manual triggering.

• If the voltage is lowered from 130 kV to 110 kV

substantially higher mAs values have to be used

(at least by a factor of 2).





109

Thorax

Body kernels:















available.




a B40s image.

LungLowDose

Indications:

Lung studies with low dose setting, e. g. early visuali-

zation of pulmonary nodules.

A typical thorax study in a range of 30 cm will be


110

Thorax

LungLowDosekV 110

Effective mAs 16


Slice width 5.0 mm



Kernel B50s

Increment 5.0 mm

Image order cr-ca

CTDIVol 1.3 mGy

111

You could repeat the same protocol simply by clicking

the chronicle with the right mouse button for “repeat“.

E. g. when both non-contrast and contrast studies are

required.

For lung cancer staging, this protocol can be combined

with protocol “Neck Routine“.




Thorax

112

LungLowDose06s

Indications:

Lung studies with low dose setting, e. g. early visuali-

zation of pulmonary nodules, using a 0.6 sec. rotation

time.

A typical thorax study in a range of 30 cm will be


Thorax

113

LungLowDosekV 110

Effective mAs 16


Slice width 5.0 mm



Kernel B50s

Increment 5.0 mm

Image order cr-ca

CTDIVol 1.3 mGy




required.


with protocol “Neck Routine“.




Thorax

Embolism

Indications:

Spiral mode for Pulmonary Emboli studies.

There are two recon jobs predefined. The first one,

with 3 mm slice thickness, for the mediastinum.

The second reconstruction, with 1.25 mm slice thick-

ness, used for postprocessing.


114

Thorax

Embolism 2nd reconstr.kV 130

Effective mAs 70





Kernel B41s B41s


Image order cr-ca

CTDIVol 9.2 mGy

115

* CARE Bolus may be used to optimize the bolus timing.

Set the ROI for monitoring scan in the pulmonary

trunc with triggering threshold of 120 HU, or use

manual triggering.

Contrast medium IV injectionStart delay 12 – 15 sec.*

Flow rate 4 ml/sec.


Thorax

MIPthin: Embolism coronalImage thickness 3


Number of images 35







to the series.

116

Thorax

Embolism06s

Indications:

Spiral mode for Pulmonary Emboli studies using a

rotation time of 0.6 s.


with 3 mm slice thickness, for the mediastinum,

the second reconstruction, with 1.25 mm slice thickness,

used for postprocessing.


117

Thorax

Embolism 2nd reconstr.kV 130

Effective mAs 70





Kernel B41s B41s


Image order cr-ca

CTDIVol 9.2 mGy


Set the ROI for monitoring scan in the truncus

pulmonalis with triggering threshold of 120 HU,

or use manual triggering.


Flow rate 4 ml/sec.


MIPthin: Embolism coronalImage thickness 3


Number of images 35







to the series.

118

Thorax

ThoraxCombi

Indications:


with one spiral scan. E. g. thorax studies in general and

interstitial changes in the lungs.



the second reconstruction, with 1.25 mm slice thick-

ness for the lung.


119

Thorax

ThoraxCombi 2nd reconstr.kV 130

Effective mAs 70





Kernel B41s B70s


Image order cr-ca

CTDIVol 9.2 mGy

If you want to reconstruct thin slices in every 2 mm

or 10 mm instead of 0.8 mm as predefined, simply

change the increment before image reconstruction.



Total amount 80 ml

MIPthin: ThoraxCombi coronalImage thickness 3


Number of images 60







to the series.

120

Thorax

ThoraxCombi06s

Indications:


with one spiral scan. E. g. thorax studies in general

and interstitial changes in the lungs, using a 0.6 sec.

rotation time.



the second reconstruction, with 1 mm slice thickness,

for the lung.


121

Thorax

ThoraxCombi 2nd reconstr.kV 130

Effective mAs 70





Kernel B41s B70s


Image order cr-ca

CTDIVol 9.2 mGy

If you want to reconstruct thin slices in every 2 mm

or 10 mm instead of 0.8 mm as predefined, simply

change the increment before image reconstruction.



Total amount 80 ml

MPRthin: ThoraxCombi coronalImage thickness 3


Number of images 60

For the 2nd reconstruction the Autoload into MPRthin


automatically loaded into 3D, MPRthin, and a coronal

MPRthin Range will pop up.



to the series.

Thorax

ThoraxRoutine

Indications:

Routine spiral studies for the region of thorax, e. g.

screening of tumors, metastases, lymphoma, lymph

nodes, vascular anomalies etc.


122

Thorax

ThoraxRoutinekV 130

Effective mAs 70


Slice width 5.0 mm

Feed/Rotation 16 mm


Kernel B41s

Increment 5.0 mm

Image order cr-ca

CTDIVol 8.0 mGy




required.


with protocol “Neck Routine”.

Contrast medium IV injectionStart delay 25 – 30 sec.


Total amount 80 ml

123

124

Thorax

ThoraxRoutine06s

Indications:

Routine spiral studies for the region of thorax, e. g.

screening of tumors, metastases, lymphoma, lymph

nodes, vascular anomalies etc., using a 0.6 sec.

rotation time.


125

Thorax

ThoraxRoutinekV 130

Effective mAs 70


Slice width 5.0 mm



Kernel B41s

Increment 5.0 mm

Image order cr-ca

CTDIVol 8.0 mGy




required.





Total amount 80 ml

126

Thorax

ThoraxFast

Indications:

Fast spiral mode for lung studies, e. g. when a patient

has difficulty with breathhold.

A complete thorax scan in a range of 30 cm will be


127

Thorax

ThoraxFastkV 130

Effective mAs 70


Slice width 6.0 mm



Kernel B41s

Increment 6.0 mm

Image order cr-ca

CTDIVol 7.5 mGy




required.





Total amount 80 ml

128

Thorax

ThoraxFast06s

Indications:

Fast spiral mode for lung studies, e. g. when a patient

has difficulty with breathhold, using a 0.6 sec. rotation

time.

A complete thorax scan in a range of 30 cm will be

covered in 7.9 sec.

129

Thorax

ThoraxFastkV 130

Effective mAs 70


Slice width 6.0 mm



Kernel B41s

Increment 6.0 mm

Image order cr-ca

CTDIVol 7.5 mGy




required.





Total amount 80 ml

130

Thorax

ThoraxHR

Indications:

Spiral mode for HiRes studies, e.g. interstitial changes

in the lungs. Two recon jobs are predefined: thinner

slice reconstruction used for postprocessing, and thicker

slice reconstruction for soft tissue.

A range of 28 cm for the complete thorax will be


131

Thorax

ThoraxHR 2nd reconstr.kV 130

Effective mAs 100





Kernel B41s B70s


Image order cr-ca

CTDIVol 13.2 mGy

With studies of interstitial changes in the lungs, contrast

medium is not necessary.

MPRthick: ThoraxHR coronalImage thickness 2


Number of images 70







to the series.

132

Thorax

ThoraxSeqHR

Indications:

Sequence mode for HiRes lung studies. E. g. interstitial

changes in the lungs.

Images are acquired in 10 mm intervals.

133

Thorax

ThoraxSeqHRkV 130

mAs 100


Slice width 1.0 mm

Feed/Scan 10.0 mm


Kernel B90s

Image order cr-ca

CTDIVol 1.0 mGy

If you want to reconstruct thin slices every 10

or 20 mm instead of 10 mm as predefined, simply

change the Feed/Scan before loading the mode.

134

Abdomen

Overview

• AbdRoutineSpiral mode for routine abdominal studies

• AbdRoutine06sSpiral mode for routine abdominal studies,


• AbdCombiSpiral mode for the combination of thin slice and

routine abdominal studies

• AbdCombi06sSpiral mode for the combination of thin slice

and routine abdominal studies, using a rotation time

of 0.6 sec. (optional)

• AbdMultiPhaseSpiral mode for the combination of CTA and two

phases soft tissue studies

135

Abdomen

• AbdMultiPhase06sFor combination of CTA and two phases soft tissue

studies, using a rotation time of 0.6 sec. (optional)

• AbdFastFast mode for abdomen studies

• AbdFast06sFast mode for abdomen studies, using a rotation

time of 0.6 sec. (optional)

• AngioFastFor long-range CTA studies

• AngioFast06sFor long CTA studies, using a rotation time of 0.6 sec.

(optional)

• AngioRoutineFor CTA routine studies

• AngioRoutine06sFor CTA routine studies, using a rotation time

of 0.6 sec. (optional)

136

Abdomen

Hints in General

• Topogram: AP, 512 or 768 mm.





• Patient respiratory instructions: inspiration.

• Oral administration of contrast medium:

For abdominal studies, it is necessary to delineate

the bowel from other structures such as lymph

nodes, abdominal masses & abscesses. Various types

of bowel opacifying agents can be used:

– Diluted barium suspension (1% – 2%) e. g. EZCAT

– Water soluble agent (2% – 4%) e. g. Gastrografin

– Water alone, as a negative contrast agent.

Timing of the oral contrast administration is important

to ensure its even distribution in the bowel.

Upper abdomen:

Minimum 600 ml of contrast divided into 3 cups

(approximately 200 – 250 ml)

1st cup to drink 30 minutes before exam

2nd cup to drink 15 minutes before exam

3rd cup to drink 5 minutes before exam

Abdomen-Pelvis:

Minimum 1000 ml of contrast divided into 4 cups

1st cup to drink 1 hour before exam

2nd – 4th cups every subsequent 15 minutes

Start exam 5 minutes after the 4th cup is administered.

137

Abdomen

– In general, for abdominal studies such as liver, gall

bladder (query stones), pancreas, gastrointestinal

studies, focal lesion of the kidneys and CTA studies,

it is sufficient to use just water. Water is more effec-

tive than positive oral contrast agent in depicting the

linings of the stomach & intestines in post enhance-

ment studies. In addition, the use of water will not

obscure the blood vessels thus allowing CTA proces-

sing to be performed easily afterwards.

– For patients with bowel obstruction, only water or

water-soluble contrast can be used. Barium suspension

is a contraindication.

• Be careful when examining pheochromocytoma

patients. Administration of an IV CM injection in such

cases may trigger a hypertensive crisis!

For more information regarding the general use

of drugs and doses including specific indications and

contraindications mentioned in this guide, please

refer to page 2.





138

Abdomen

Body kernels:















available.




a B40s image.

139

Abdomen

140

Abdomen

AbdRoutine

Indications:

Spiral mode for all routine studies in the region of

abdomen, e. g. screening, follow-up examinations etc.

A complete abdomen scan in a range of 20 cm will be


141

Abdomen

AbdRoutinekV 130

Effective mAs 95


Slice width 5.0 mm

Feed/Rotation 15 mm


Kernel B41s

Increment 5.0 mm

Image order cr-ca

CTDIVol 10.8 mGy




required.



Total amount 100 ml

142

Abdomen

AbdRoutine06s

Indications:

Spiral mode for all routine studies in the region of

abdomen, e. g. screening, follow-up examinations


A complete abdomen scan in a range of 20 cm will be

covered in 9.2 sec.

143

Abdomen

AbdRoutinekV 130

Effective mAs 95


Slice width 5.0 mm



Kernel B41s

Increment 5.0 mm

Image order cr-ca

CTDIVol 10.8 mGy




required.



Total amount 100 ml

AbdomenCombi

Indications:

Combination of thin slice and routine abdominal

studies with one spiral scan, e.g. a range of 20 cm for

liver, pancreas or kidneys will be covered in 19.4 sec.


struction used for postprocessing, and thicker slice


144

Abdomen

AbdCombi 2nd reconstr.kV 130

Effective mAs 120





Kernel B41s B41s


Image order cr-ca

CTDIVol 15.8 mGy

If you want to use this protocol for a two-phase study,

repeat the same protocol as mentioned below, and

chose a start delay time for arterial phase of 20-25 s. In

this case, the thin slice reconstruction can also be used

for postprocessing. But do not administer oral contrast

medium, as this impairs the editing of MIP/SSD/VRT

images. Water could be used instead if necessary.

You can repeat the same protocol simply by clicking



required.


Flow rate 4 ml/sec.

Total amount 100 ml

145

Abdomen

MIPthin: AbdCombi coronalImage thickness 3


Number of images 50

For the 2nd reconstruction the Autoload into the MIPthin


be automatically loaded into 3D, MIPthin, and coronal




to the series.

146

AbdomenCombi06s

Indications:

Combination of thin slice and routine abdominal

studies with one spiral scan, using a 0.6 sec.

rotation time. A range of 20 cm for liver, pancreas or

kidneys will be covered in 14.6 sec.


struction used for postprocessing, and thicker slice


Abdomen

147

AbdCombi 2nd reconstr.kV 130

Effective mAs 130





Kernel B41s B41s


Image order cr-ca

CTDIVol 17.2 mGy

If you want to use this protocol for a two-phase study,

repeat the same protocol as mentioned below, and

chose start delay time for arterial phase as 20-25 s. In

this case, the thin slice reconstruction can also be used

for postprocessing. But do not administer oral contrast

medium, as this impairs the editing of MIP/SSD/VRT

images. Water could be used instead if necessary.

You can repeat the same protocol simply by clicking



required.


Flow rate 4 ml/sec.

Total amount 100 ml

Abdomen

MIPthin: AbdCombi coronalImage thickness 3


Number of images 50

For the 2nd reconstruction the Autoload into the MIPthin


be automatically loaded into 3D, MIPthin, and coronal




to the series.

AbdMultiPhase

Indications:

Combination of CTA and soft tissue studies. E. g.

a range of 20 cm including liver, pancreas and kidney:

arterial phase acquired with 2.0 mm slice collimation

in 15 s, image reconstructed in 2.5 mm for post-

processing, and 5 mm for soft tissue enhancement.

Same range followed with a scan range of 35 cm by

2.0 mm slice collimation acquisition in 25 s for venous

phase, image reconstructed in 5 mm for soft tissue only.

148

Abdomen

Do not administer oral contrast medium, as this

impairs the editing of MIP/SSD/VRT images. Use water

instead if necessary.


Set the ROI for monitoring scan in the abdominal

aorta at the beginning of the scan range with trigger-

ing threshold of 120 HU, or use manual triggering.

MIPthin: ArterialPhase coronalImage thickness 3


Number of images 50

For the 2nd reconstruction of the Arterial Phase the

Autoload into the MIPthin Range on the 3D Card is acti-

vated. The images will be automatically loaded into

3D, MIPthin, and coronal MIPthin Range will pop up.



to the series.

Contrast medium IV injectionStart delay 20 – 25 sec.* (arterial phase)

50 – 75 sec.* (venous phase)

Flow rate 4 – 5 ml/sec.


149

Abdomen

Non Arterial VenousContrast phase phase

kV 110 110 130

Effective mAs 60 90 95

Slice collimation 2.0 mm 2.0 mm 2.0 mm

Slice width 5.0 mm 5.0 mm/ 5.0 mm

2.5 mm

Feed/Rotation 18.0 mm 12.0 mm 12.0 mm

Rotation time 0.8 sec. 0.8 sec. 0.8 sec.

Kernel B41s B41s/B31s B41s

Increment 5.0 mm 5.0 mm/ 5.0 mm

1.5 mm

Image order cr-ca cr-ca cr-ca

CTDIVol 4.7 mGy 7.0 mGy 10.8 mGy

150

AbdMultiPhase06s

Indications:

Combination of CTA and soft tissue studies. E. g.

a range of 20 cm including liver, pancreas and kidney:

arterial phase acquired with 2.0 mm slice collimation

in 11.2 s, image reconstructed in 2.5 mm for post-

processing, and 5 mm for soft tissue enhancement.

Same range followed with a scan range of 35 cm by

2.0 mm slice collimation acquisition in 18.7 s for venous

phase, image reconstructed in 5 mm for soft tissue only.

Abdomen

Non Arterial VenousContrast phase phase

kV 110 110 130

Effective mAs 60 90 95

Slice collimation 2.0 mm 2.0 mm 2.0 mm

Slice width 5.0 mm 5.0 mm/ 5.0 mm

2.5 mm

Feed/Rotation 18.0 mm 12.0 mm 12.0 mm

Rotation time 0.6 sec. 0.6 sec. 0.6 sec.

Kernel B41s B41s/B31s B41s

Increment 5.0 mm 5.0 mm/ 5.0 mm

1.5 mm

Image order cr-ca cr-ca cr-ca


151








MIPthin: ArterialPhase coronalImage thickness 3


Number of images 50

For the 2nd reconstruction of the Arterial Phase the

Autoload into the MIPthin Range on the 3D Card is acti-

vated. The images will be automatically loaded into

3D, MIPthin, and coronal MIPthin Range will pop up.



to the series.

Contrast medium IV injectionStart delay 20 – 25 sec.* (arterial phase)

50 – 75 sec.* (venous phase)

Flow rate 4 – 5 ml/sec.


Abdomen

152

AbdFast

Indications:

Fast spiral mode for abdominal studies, e. g. when a

patient has difficulty with breathhold.


Abdomen

153




required.

For lung cancer staging, this protocol can be com-

bined with protocol “Neck Routine”.



Total amount 80 ml

Abdomen

AbdFastkV 130

Effective mAs 95


Slice width 6.0 mm



Kernel B41s

Increment 6.0 mm

Image order cr-ca

CTDIVol 10.1 mGy

154

AbdFast06s

Indications:

Fast spiral mode for abdomen studies, using a rotation

time of 0.6 sec., e. g. when a patient has difficulty with

breathhold.


Abdomen

155




required.

For lung cancer staging, this protocol can be com-

bined with protocol “Neck Routine”.



Total amount 80 ml

Abdomen

AbdFastkV 130

Effective mAs 95


Slice width 6.0 mm



Kernel B41s

Increment 6.0 mm

Image order cr-ca

CTDIVol 10.1 mGy

AngioFast

Indications:

Long range CTA studies.

E. g.: a typical study of the whole aorta including its

branchiocephalic trunk and iliac arteries in a range of

30 cm will be covered in 13.1 sec.

156

Abdomen

AngioFastkV 110

Effective mAs 90


Slice width 3.0 mm



Kernel B31s

Increment 3.0 mm

Image order cr-ca

CTDIVol 7.0 mGy


impairs the editing of MIP/SSD/VRT images.





Contrast medium IV injectionStart delay 20 sec.*


Total amount 120 ml

157

Abdomen

MIPthin: AngioFast coronalImage thickness 3


Number of images 35







to the series.

158

AngioFast06s

Indications:

Long range CTA studies, using a rotation time 0.6 sec.

E. g.: a typical study of the whole aorta including its

branchiocephalic trunk and iliac arteries in a range

of 30 cm will be covered in 9.8 sec.

Abdomen

159

AngioFastkV 110

Effective mAs 90


Slice width 3.0 mm



Kernel B31s

Increment 3.0 mm

Image order cr-ca

CTDIVol 7.0 mGy


impairs the editing of MIP/SSD/VRT images.







Total amount 120 ml

Abdomen

MIPthin: AngioFast coronalImage thickness 3


Number of images 35







to the series.

AngioRoutine

Indications:

For abdominal CTA studies.

A typical study in a range of 20 cm will be covered in

19.4 sec.

160

Abdomen

AngioRoutine 2nd reconstr.kV 110

Effective mAs 90





Kernel B31s B31s


Image order cr-ca

CTDIVol 8.2 mGy








MIPthin: AngioRoutine sagittalImage thickness 3


Number of images 60

For the 2nd reconstruction the Autoload into the

MIPthin Range on the 3D Card is activated. The images

will be automatically loaded into 3D, MIPthin, and

sagittal MIPthin Range will pop up.



to the series.


Flow rate 3.0 – 3.5 ml/sec.


161

Abdomen

162

AngioRoutine06s

Indications:

For abdominal CTA studies, using a rotation time 0.6 sec.

E. g.: a typical study in a range of 20 cm will be


Abdomen

163

AngioRoutine 2nd reconstr.kV 110

Effective mAs 90





Kernel B31s B31s


Image order cr-ca

CTDIVol 8.2 mGy








MIPthin: AngioRoutine sagittalImage thickness 3


Number of images 60

For the 2nd reconstruction the Autoload into the

MIPthin Range on the 3D Card is activated. The images

will be automatically loaded into 3D, MIPthin, and

sagittal MIPthin Range will pop up.



to the series.




Abdomen

164

Pelvis

Overview

• HipSpiral mode for HiRes bone and soft tissue studies

of the hip

• PelvisRoutineSpiral mode for routine pelvis studies

165

Pelvis

Hints in General

• Topogram: AP, 512 mm for pelvis studies and

256 mm for studies of the hip.





• A breathing command is not necessarily required

for the pelvic examination, since respiration does not

negatively influence this region.

• Rectal contrast medium administration:

Rectal contrast media is usually required to delineate

the rectum and sigmoid colon, if lower pelvic mass

or pathology is suspected. In some cases, air may be

substituted for a positive contrast agent. The use of

vaginal tampon may be helpful in adult female patients

with suspected pelvis pathology.





166

Pelvis

Body kernels:















available.




a B40s image.

167

Pelvis

168

Pelvis

Hip

Indications:

Spiral mode for HiRes bone studies and soft tissue

studies of the Hip. E. g. evaluation of joint cavity,

masses, trauma, dysplasia, necrosis of the head of the

hip, congruence evaluations, orthopedic indications

etc.


169

Pelvis

Hip 2nd reconstr.kV 130

Effective mAs 95





Kernel B41s B70s


Image order cr-ca

CTDIVol 12.5 mGy

In case of 3D study only, mAs can be reduced up to

50%, images should be reconstructed with at least 50%

overlapping and kernel B10s.

If only one side is examined, it is advisable to enter the

side in the comment line on the routine card.

MPRthick: Hip coronalImage thickness 3


Number of images 20







to the series.

170

Pelvis

PelvisRoutine

Indications:

Spiral mode for routine pelvis studies. E. g. processes

of the prostate, urinary bladder, rectum, gynecological

indications etc.


171

Pelvis

PelvisRoutinekV 130

Effective mAs 105


Slice width 5.0 mm



Kernel B41s

Increment 5.0 mm

Image order cr-ca

CTDIVol 11.9 mGy

* If the examination performed requires a full urinary

bladder, wait at least 3 minutes following IV admini-

stration of the contrast medium.




172

Spine

Overview

• SpineRoutineSeqSequence mode for routine spine studies

• SpineObeseSeqSequence mode for studies of obese patients

• SpineSpiral mode for thoracal/lumbar studies

• C-SpineThin slice spiral mode for cervical spine studies

173

Spine

Hints in General

• Topogram: Lateral, 512 mm for thoracic and lumbar

spine and 256 mm for the C-spine.

• Patient positioning for thoracic and lumbar spine

studies:




• Patient positioning for cervical spine studies:

Patient lying in supine position, hyperextend neck

slightly, secure head well in head holder.

Patient respiratory instruction: do not breathe,

do not swallow.

Any possible injuries to the spinal column should be

determined before beginning the examination and

taken into account when repositioning the patient.

• In case of SSD study only, mAs value can be reduced

by 50%. Use kernel B10 and 50% overlapping image

reconstruction.

• For lumbar studies, place a cushion under the

patient’s knee. This will reduce the curve in the spine

and also make the patient more comfortable.

• The CT scan following myelography must be per-

formed within 4-6 hours of the injection, otherwise,

the contrast density in the spinal canal will be too

high to obtain artifact-free images. Also, if possible,

it is a good idea to roll the patient once, or scan in

a prone position. This will prevent the contrast from

pooling posterior to the spinal cord.

• If a prone scan is performed, breathing instructions

are recommended to avoid motion artifact in axial

source and MPR images.





174

Spine

Body kernels:















available.




a B40s image.

175

Spine

176

Spine

SpineRoutineSeq

Indications:

Sequence mode for spine studies, e. g. prolapse,

degenerative changes, trauma, tumors etc.

This protocol contains three ranges:

L3-L4, L4-L5, L5-S1.

The scan length of each range is 2.8 cm

Three different typical gantry tilts are predefined:

for L3-L4: 0°, for L4-L5: +5° and for L5-S1: +15°

SpineRoutineSeqL3-4 L4-5 L5-S1

kV 130

mAs 280 280 320


Slice width 2.0 mm

Feed/Scan 6.0 mm


Kernel B31s

Cycle time 3.0 sec.

Image order cr-ca


177

Spine

SpineObeseSeq

Indications:

Sequence mode for spine studies of the obese

patients when higher dose are needed, e. g. prolapse,


This protocol contains three ranges:

L3-L4, L4-L5, L5-S1.

The scan length of each range is 2.8 cm

Three different typical gantry tilts are predefined:

for L3-L4: 0°, for L4-L5: +5° and for L5-S1: +15°

SpineObeseSeqL3-4 L4-5 L5-S1

kV 130

mAs 320 320 370


Slice width 2.0 mm

Feed/Scan 6.0 mm


Kernel B31s

Cycle time 2.5 sec.

Image order cr-ca


178

Spine

Spine

Indications:

Spiral mode for thoracic and lumbar spine studies, e. g.

prolapse, degenerative changes, trauma, tumors etc.


179

Spine


Effective mAs 190





Kernel B31s B60s


Image order cr-ca

CTDIVol 21.6 mGy

MPRthick: Spine coronalImage thickness 3


Number of images 30







to the series.

180

Spine

C-Spine

Indications:

Spiral mode for cervical spine studies, e. g. prolapse,



181

Spine

C-Spine 2nd reconstr.kV 130

Effective mAs 150





Kernel B31s B60s


Image order cr-ca

CTDIVol 19.8 mGy

MPRthick: C-Spine sagittalImage thickness 3


Number of images 20



automatically loaded into 3D, MPR, and a sagittal




to the series.

182

Extremities

Overview

• AngioRunOffFor long range CTA spiral studies

• AngioRunOff06sFor long range CTA spiral studies,


• ExtrCombiCombination for HiRes bone and soft tissue

spiral studies

• ExtrHRSpiral mode for bone High Resolution studies using

0.5 mm collimation (optional)

183

Extremities

Hints in General

• Topogram: AP, 128/256 mm for joint studies;

1024/1500 mm for CTA.


Depends on the region of examination.

In general, for bilateral studies, you should always

try to position the patient evenly whenever the

patient can comply.

a) For wrists scan

Patient lying in prone position, hands stretched

above the head and lying flat on a Bocollo pillow

(optional), ankles supported with a pad. Both wrists

should be examined together when necessary.

b) For knee scan:

Patient lying in supine position, feet first, pro-

mote relaxation by placing Bocollo pillows between

knees and feet, bind feet together.

The only exceptions are extremely light patients.

The latter can remove the leg not being examined

from the gantry by bending it 90° at the hip and

the knee and placing the bottom of the same foot

against the gantry casing.

c) For ankle and feet scan:

Patient lying in supine position, feet first.Bind both ankles together if necessary to assure

the AP position of both feet.

Special positioning is not necessary since the real

time MPR could simulate any view of secondary

reconstruction.

• In case of 3D study only, mAs can be reduced up

to 50%. Use kernel B10s and 50% overlapping image

reconstruction.





184

Extremities

Body kernels:















available.




a B40s image.

• The special kernels are mostly used for ”physical”

measurements with phantoms, e. g. for adjustment

procedures (S80s), for constancy and acceptance

tests (S80s, U90s), or for specification purposes

(U90s).

• For special patient protocols, S80s and U90s are

chosen, e. g. for osteo (S80s) and for high resolution

bone studies (U90s). We recommend to use the high

resolution specification kernel U90s only with ”small”

objects, like the wrist, otherwise artifacts will occur

in the images.

185

Extremities

186

AngioRunOff

Indications:

For CTA studies

A range of 80 cm will be done in 31.2 sec.

AngioRunOffkV 110

Effective mAs 90


Slice width 3.0 mm



Kernel B31s

Increment 1.5 mm

Image order cr-ca

CTDIVol 7.0 mGy

Extremities

187





If Topo length 1024 mm is not long enough, you can

also choose the Topo length of 1500 mm.

Position the patient as feet first. Bend the feet together

if necessary.

Extremities




MIPthin: AngioRunOff coronalImage thickness 3


Number of images 35






preset, adapt the parameters to your needs and link them

to the series.

188

AngioRunOff06s

Indications:

For CTA studies, using rotation time 0.6 sec.

A range of 80 cm will be done in 23.4 sec.

AngioRunOffkV 110

Effective mAs 90


Slice width 3.0 mm



Kernel B31s

Increment 1.5 mm

Image order cr-ca

CTDIVol 7.0 mGy

Extremities

189





If Topo length 1024 mm is not long enough, you can

also choose the 1536 mm long Topogram.

Position the patient as feet first. Bend the feet together

if necessary.

Extremities




MIPthin: AngioRunOff coronalImage thickness 3


Number of images 35







to the series.

190

ExtrCombi

Indications:

Spiral mode for the combination of HiRes bone and

soft tissue studies. E. g. masses, trauma, disorders of

the joint etc.


Extremity 2nd reconstr.kV 130

Effective mAs 40





Kernel B41s B70s


Image order cr-ca

CTDIVol 5.3 mGy

Extremities

191

Extremities

MPRthick: ExtrCombi coronalImage thickness 2


Number of images 30







to the series.

192

ExtrHR

Indications:

Spiral mode for HiRes bone study. E. g. trauma, ortho-

pedic indications etc.


Extremities

193

ExtrHRkV 130

Effective mAs 50


Slice width 0.63 mm



Kernel U90s

Increment 0.3 mm

Image order cr-ca

CTDIVol 6.8 mGy

This protocol is used for High Resolution studies.


H30s/H31s.

Extremities

Siemens reserves the right to modify

the design and specifications contained

herein without prior notice. Please

contact your local Siemens Sales

Representative for the most current

information.

Original images always loose a certain

amount of detail when reproduced.

Siemens AG

Medical Solutions

Computed Tomography

Siemensstrasse 1

D-91301 Forchheim

Germany

www.SiemensMedical.com

Order No.

A91100-M2100-2226-1-7600

Printed in Germany

BKW 42226 BA 05033.

Documents

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