DEfinitely
Siemens
Answers for life.
International version. Not for distribution in the US.
Unrestricted © Siemens AG 2015 All rights reserved.The products/features (here mentioned) are not commercially available in all countries. Due to regulatory reasons their future
availability cannot be guaranteed. Please contact your local Siemens organization for further details.
True Dual EnergyDr. Stefan Ulzheimer, Siemens Healthcare GmbH
Siemens
Answers for life.
History
March 2014Page 2 H IM CR
SOMATOM DR
History
Since the introduction of the SOMATOM Definition, the number of annual publications on Dual Energy has skyrocketed from 0 to ~300.
Nu
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70
80
90
100130
March 2014Page 3 H IM CR
1989 1990 1991 1992 1993 1994 2006 2007 2008
10
20
30
40
Nu
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Introduction of theSOMATOM Definition
= Publications on Dual Energy with the SOMATOM Definition and Definition Flash
2005
02009
50
60
2010
Two steps ahead in Decision Making:Precise Dual Energy quantification
Courtesy of UMM, Mannheim, Germany
SOMATOM Force
� 80/Sn150kV, 90/Sn150kV, 100/Sn150kV
� min. rotation time 0.25s
� FOV B-detector: 350 mm
� collimations: 64x0.6mm, 128x0.6mm,
March 2014Page 4 H IM CR
� collimations: 64x0.6mm, 128x0.6mm,
196x0.6mm
� 2d anti scatter grid
� 50% thicker tin filter (×2)
� Vectron tubes (up to 1300mA)
� low noise StellarInfinity detectors
SOMATOM Definition Flash Dual Source Dual Energy (DE)
• Characterize, highlight and quantify material
• Dose-neutral compared to a single 120 kV scan
DE with Selective Photon Shield
Selective
Photon Shield II
March 2014Page 5 H IM CR
• Improved spectral separation
high kV
Attenuation B
low kV
Attenuation A
SOMATOM Definition Flash/ SOMATOM Force Dual Source Dual Energy
Conventional Dual Energy CT DE with Selective Photon Shield I and II
March 2014Page 6 H IM CR
• Significant spectral overlap
• Limits energy separation
• Limits dose efficiency
• Minimized spectral overlap
• Up to 80% better energy separation
• Complete dose neutrality
Technical realization of dual-energy CTDual-Source CT
Dual source CT
� Fast rotation (0.28 s), reliable imaging of moving organs
� Flexible choice of scan
parameters (mA, pitch, ...)to individually adapt radiation dose
x 10415
S1: 80 kV
80 kV
S2: 140 kV + SPS
March 2014Page 7 H IM CR
to individually adapt radiation dose to the patient
� Selective Photon Shield
� Optional tin pre-filtration
� Improves spectral separation
� Makes dual energy dose-neutral
� equivalent to a 120 kV scan
10
5
0 50 100 150X-ray photon energy (keV)
80 kV
140 kV
0.4 mm tin
140 kV
+ SPS
Technical highlightBest spectral separation in the market
100 kV / 140 kV Sn 90 kV / 150 kV Sn
March 2014Page 8 H IM CR
Up to 30% increased energy separation for
better DE imaging outcomes
Comparison Definition DS SE / Flash DE(DE composition 0.6)
Ultravist
315.3 320.2
Definition DS SE standard
Body Angio (120kV)
Definition Flash DE
100kV/Sn140kV
March 2014Page 9 H IM CR
Noise & Contrast & Dose equivalent to single energy on Definition DS
(for FAST body bone removal protocol)
NH4Cl Bone MgSO4
NaBr
466.8 466.0
256.2 258.8
102.5 96.0 98.490.0
27.624.6
SDSD
CTDIvol=8.65mGy
Proven Dose Neutrality
March 2014Page 10 H IM CRCourtesy of Mayo Clinic Rochester, MN, U.S.A.
Dual Energy Principle
� Many materials show different attenuation at different X-ray energies� Different attenuation mechanisms: photo effect �� Compton effect
1.0E+01
1.0E+02
ray a
bs
op
rtio
n
Iodine solutionBone
E1E2
March 2014Page 11 H IM CR
� Attenuation change from low to high energy characterizes the material
� Energy-resolved CT can determine chemical composition
1.0E-01
1.0E+00
1.0E+01
10 30 50 70 90 110 130 150X-ray energy / keV
X-r
ay a
bs
op
rtio
n
Small increase
for bone
Large increase
for iodine
Where does the infomation come from?
80kV 140kV
Blood
BoneIodine
CT-value
80 kV
IDENTITY
0 HU
March 2014Page 12 H IM CR
� need stable CT values; excellent scanner calibration� no separation for materials at same position in diagram
� CT and DECT are not sensitive to chemical binding
Air
Water
FatCT-value
140 kV
0 HU
-1000 HU
Processing of DE data
Bone550 HU Iodine
425 HU
� Clinical application: Separation of two materials
� Assume mixture of blood + Iodine and bone marrow + bone
HU
at
80
kV 400
500
600
Separation line
Iodine pixels
Bone pixels
March 2014Page 13 H IM CR
140kV
Bone400 HU Iodine
250 HU
80kV
-100-100 0 100 200 300 400 500 600
HU at 140 kV
HU
at
80
kV
0
100
200
300
400
� Additional postprocessing to improve classification at low HU numbers
Blood+Iodine
Marrow+bone
Softtissue
Bone pixels
TwinBeam Dual Energy* in combination withcarotid angiography reveals total occlusion of RIC and stenosis of LIC
collimation: 64 x 0.6 mm
scan time: 6 s
scan length: 337 mm
rotation time: 0.30 s
tube setting:
TwinBeamDual Energy
March 2015Page 14
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HC IM CRPage 14 March 2015 HC IM CR
Unrestricted © Siemens AG 2015 All rights reserved.
tube setting:
AuSn120 kV, 365 eff. mAs
CTDIvol: 7.65 mGy
DLP: 279 mGycm
Eff. Dose: 0.87 mSv
Courtesy of University Hospital Erlangen-Nuremberg, Erlangen, Germany
*TwinBeam Dual Energy is pending 510(k) clearance and is not yet commercially available in the United StatesPost processing software is under development. Not available for sale in the U.S.
Applications of Dual Energy CT
xlow (HU)
body materials+
contrast agent
contrast
xlow (HU)
material
map
xlow (HU)
other body materials
Material Decomposition Material Labeling Material
Highlighting
March 2014Page 15 H IM CR
� Optimum Contrast� Monoenergetic
xhigh (HU)
body materials
VNC
xhigh (HU)
common body material
separation line
xhigh (HU)
enhanced visualizatiuon
Image Quality
Improvement
Generic Material
Differentiation
� Dual Energy Index
� ρe/Zeff decomposition** non product
The first Urate Stone
Courtesy of UMM, Mannheim, Germany
Page 16 Jul-14 Siemens AG H IMBernhard Krauss
• heavy patient• scanned at 90/Sn150kV
• perfect separation between uric acid stone and calcium
Co
urt
esy
of H
osp
ita
l Po
vis
a, V
igo
, S
pa
in
Page 17 Jul-14 Siemens AG H IMBernhard Krauss
Co
urt
esy
of H
osp
ita
l Po
vis
a, V
igo
, S
pa
in
syngo.CT DE
Virtual Unenhanced
syngo.CT DE
Lung Analysissyngo.CT DE
Direct Angio
True Dual Energy CTExpand your clinical capabilities for Dual Source Dual Energy
syngo.CT DE Gout Optimum Contrast syngo.CT DE
Calculi Characterization
March 2014Page 18 H IM CR
syngo DE
Xenon
October 2014Page 18 H IM CR MK C
syngo.CT DE
Bone Marrowsyngo.CT DE
Heart PBV
syngo.CT DE
Brain HemorrhageMonoenergetic
syngo.CT DE
Monoenergetic Plus
syngo.CT DE
Hardplaque Display
syngo DE
Musculoskeletal
syngo.CT DE
Lung Nodulessyngo.CT DE Rho/Z
True Dual Energy – DEfinitely Siemens
Dual Spiral Dual Energy
TwinBeamDual Energy
Dual Source Dual Energy
Unrestricted © Siemens AG 2015 All rights reserved.
March 2015Page 19 HC IM CR
SOMATOMPerspective
SOMATOMDefinition AS
SOMATOMDefinition AS+
SOMATOMDefinition Edge
SOMATOMDefinition Flash
SOMATOMForce
SOMATOMDefinition AS+
SOMATOMDefinition Edge
SOMATOMScope Power
TwinBeam Dual Energy
Improve patient outcome with
TwinBeam Dual Energy
• Simultaneous acquisition of high and low
energy spectra
• All dose reduction technologies applicable,
Unrestricted © Siemens AG 2015 All rights reserved.
March 2015Page 20 HC IM CR
• All dose reduction technologies applicable,
such as CARE Dose4D, SAFIRE, ADMIRE, etc.
• Routine ready with FAST DE Results (direct
transfer of Dual Energy images to the PACS)
*This feature is 510(k) pending. Not available for sale in the U.S
Single Source Dual Energy (SSDE)TwinBeam
MoveableSplit Filter
Spectrum behind filter
Spectrum in front of filter
Low Energy
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March 2015Page 21 HC IM CR
High Energy
Overall result:
• convenient workflow (one topo only, 50cm FOV)
• DE evaluation results typically better than Definition DS120 kV
30cm phantom, default abdomen protocol, same dose
TwinBeam Dual EnergyDose-neutrali DE
Unrestricted © Siemens AG 2015 All rights reserved.
March 2015Page 22 HC IM CR
Dose neutral:
• up to 40cm diameter less noise than 120kV
• all default scan protocols SE / TBDE have same dose
TBDE
True Dual Energy CTExpand your clinical capabilities for TwinBeam Dual Energy
syngo.CT DE Goutsyngo.CT DE syngo.CT DE syngo.CT DEsyngo.CT DE
March 2014Page 23 H IM CR
Monoenergetic
Optimum Contrast
Confidential © Siemens AG 2014. All rights reserved.
October 2014Page 23 H IM CR MK C
syngo.CT DE Goutsyngo.CT DE
Calculi Characterization
syngo.CT DE
Lung Analysissyngo.CT DE
Virtual Unenhanced
syngo.CT DE
Direct Angio
syngo.CT DE
Brain Hemorrhage
syngo.CT DE
Monoenergetic Plus
syngo.CT DE
Hardplaque Displaysyngo.CT DE Rho/Z
TwinBeam Dual Energy – Composed image
C-Images (AuSn120kV)
• Good image quality
• Patient dose as in routine imaging
Unrestricted © Siemens AG 2015 All rights reserved.
March 2015Page 24 HC IM CR
For internal use only © Siemens AG 2014 All rights reserved.
October 2014Page 24 H IM CR MK P
= 5.5 mSv
Courtesy of Universitätsklinikum Erlangen, Radiology Department
Bone removal with TwinBeam Dual Energy* shows infra-renalabdominal aortic aneurysm (AAA)
collimation: 64 x 0.6 mm
scan time: 44 s
scan length: 1534 mm
rotation time: 0.33 s
tube setting:
TwinBeamDual Energy
March 2015Page 25 HC IM CR
Unrestricted © Siemens AG 2015 All rights reserved.
March 2015Page 25 HC IM CR
Unrestricted © Siemens AG 2015 All rights reserved.
tube setting:
AuSn120 kV, 301 eff. mAs
CTDIvol: 6.44 mGy
DLP: 1007.8 mGycm
Eff. dose: 8 mSv
Dual Energy run off with bone removal shows excellent image quality
Courtesy of University Hospital Erlangen-Nuremberg, Erlangen, Germany*This feature is 510(k) pending. Not available for sale in the U.S.
Post processing software is under development. Not available for sale in the U.S.
Thorax/abdomen scanTwinBeam Dual Energy delivers additional diagnostic information
collimation: 64x0.6 mm
scan time: 17.7 s
scan length: 575 mm
rotation time: 0.30 s
tube setting:
TwinBeamDual Energy
March 2015Page 26 HC IM CR
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March 2015Page 26 HC IM CR
Unrestricted © Siemens AG 2015 All rights reserved.
tube setting:
AuSn120 kV, 379 effective mAs
DLP: 480 mGycm
CTDIvol: 8.09 mGy
eff. dose: 7.2 mSv
Rule out of pulmonary embolism in thorax/abdomen scan
Courtesy of University Hospital Erlangen-Nuremberg, Erlangen, Germany*This feature is 510(k) pending. Not available for sale in the U.S.
Post processing software is under development. Not available for sale in the U.S.
Perfusion Defect
Page 27 Jul-14 Siemens AG H IMBernhard Krauss
• only 4s scan time; 55ml contrast agent• scanned at 90/Sn150kV
Courtesy of UMM, Mannheim, Germany
TwinBeam Dual Energy* in Oncology showing a hypodense lesion in the liver and the right kidney
collimation: 64 x 0.6 mm
scan time: 19.6 s
scan length: 634 mm
rotation time: 0.3 s
tube setting:
TwinBeamDual Energy
March 2015Page 28 HC IM CR
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March 2015Page 28 HC IM CR
Unrestricted © Siemens AG 2015 All rights reserved.
tube setting:
AuSn120 kV, 410 eff. mAs
CTDIvol: 8.8 mGy
DLP: 582.1 mGycm
Eff. Dose: 8.7 mSv
VNC/iodine FusedMonoenergetic 50 keVMonoenergetic 70 keV Tumor evaluation with TwinBeamDual Energy
Courtesy of University Hospital Erlangen-Nuremberg, Erlangen, Germany
*TwinBeam Dual Energy is pending 510(k) clearance and is not yet commercially available in the United States. Post processing software is under development. Not available for sale in the U.S.
True Dual Energy CTExpand your clinical capabilities for Dual Spiral Dual Energy
syngo.CT DE Goutsyngo.CT DE
Calculi CharacterizationMonoenergetic
syngo.CT DE
Bone Marrow
March 2014Page 29 H IM CR
Restricted © Siemens AG 2014 All rights reserved.
March 2014Page 29 H IM CR
syngo.CT DE (Liver VNC)
Virtual Unenhancedsyngo.CT DE
Brain Hemorrhage
Calculi Characterization Bone Marrow
syngo.CT DE
Monoenergetic Plussyngo.CT DE Rho/Z
Gout evaluation with TwinBeam Dual Energy*
collimation: 64 x 0.6 mm
scan time: 8 s
scan length: 218 mm
rotation time: 0.5 s
tube setting:
TwinBeamDual Energy
March 2015Page 30 HC IM CR
Unrestricted © Siemens AG 2015 All rights reserved.
March 2015Page 30 HC IM CR
Unrestricted © Siemens AG 2015 All rights reserved.
tube setting:
AuSn120 kV, 298 eff. mAs
CTDIvol: 6.4 mGy
DLP: 141 mGycm
Eff. dose: 0.11 mSv
Courtesy of Luzerner Kantonsspital, Luzern, Switzerland
*This feature is 510(k) pending. Not available for sale in the U.S.
Post processing software is under development. Not available for sale in the U.S.
Metal artifact reductionDual Spiral Dual Energy acquisition mode for basic metal artifact reduction
collimation: 128 x 0.6 mm
spatial resolution: 0.30 mm
scan time: 11.0 s
scan length: 414 mm
SOMATOM Definition Edge
March 2015Page 31
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HC IM CRMarch 2015Page 31 HC IM CR
Unrestricted © Siemens AG 2015 All rights reserved.
scan length: 414 mm
rotation time: 0.5 s
tube setting:
80/140 kV, 600/142 mAs
CTDIvol: 11.07/14.39 mGy
DLP: 482/629 mGy cm
Eff. Dose: 7.20/9.40 mSv
Monoenergeticimaging withexcellent imagequality
Courtesy of LMU Grosshadern, Munich, Germany
SOMATOM Force – Dual EnergyNew Dual Energy Contrasts - Bone Marrow Edema/Fat
collimation: 2x 192 x 0.6 mm
spatial resolution: 0.24 mm
SOMATOM Force
Restricted © Siemens AG 2014 All rights reserved.
April 2014Page 32 P. Aulbach
Unrestricted © Siemens AG 2014 All rights reserved.
April 2014Page 32 P. Aulbach
Courtesy of LMU Großhadern, Germany
rotation time: 0.25 s
tube setting:
90/150 kV
CTDI 9.9
DLP 350
Precise DE information also in heavier patients
Spectral Resolution
previous scanners
Page 33 Jul-14 Siemens AG H IMBernhard Krauss
� 15mg/ml Ultravist� 20ml / 20mm diameter
� 20cm water phantom
* research license required
Dual Energy workflow improvement
Filter Type
FAST DE Results:
Direct transfer of Dual Energy results from scanner to PACS.
March 2014Page 34 H IM CR
DE Mono 40 keV DE Mono <70 keV
DE Mono 50 keV DE Mono >100 keV
DE Mono 70 keV DE Mixed
DE Mono 100 keV DE Iodine
DE Mono 120 keV DE VNC
DE Mono 140 keV DE Iodine+VNC
DE Mono 190 keV DE Optimum Contrast
PACS
DEfinitely
Siemens
Copyright © Siemens AG 2012. All rights reserved.
International Version. Not for distribution in the U.S.
Answers for life.
True Dual EnergyComputed Tomography.
Siemens
Answers for life.
Copyright © Siemens AG 2012. All rights reserved.
International Version. Not for distribution in the U.S.This product is 510(k) pending. Not available for sale in the U.S.