ebt clinical update

EBT CLINICAL UPDATEEBT CLINICAL UPDATENovember 2000November 2000

EBT Clinical ApplicationsEBT Clinical Applications

CARDIAC IMAGING Coronary Artery Calcium Scanning Coronary Electron Beam Angiography (EBA) Functional Cardiac ImagingBODY IMAGING Pulmonary Embolism Low-Dose Lung Scanning Abdominal Scanning Colonography Peripheral EBA (Carotid, Aorta, Renal, Femoral) Head Scan

EBT Radiation DoseEBT Radiation Dose

EBT Coronary calcium scan 50 to 63 mrem 0.5 to 0.63 mSv

EBT Coronary EBA scan 70 to 90 mrem 0.7 to 0.9 mSv

EBT Low-dose Lung scan 100 to 150 mrem 1.0 to 1.5 mSv

Background radiation in 1year 300 mrem 3.0 mSv

Cross country airplane trip 2 mrem 0.02 mSv

Chest X-ray 8 to 10 mrem 0.08 to 0.1 mSv

Abdominal X-ray 48 mrem 4.8 mSv

Lumbar Spine X-ray series 300 mrem 3.o mSv

Coronary Angiogram 500 to 600 mrem 5.0 to 6.0 mSv

Lower G.I. X-ray series 600 mrem 6.0 mSv

Radiation dose from EBT scans compared to other sources of radiation

Millirems Millisieverts

The advantage of the EBT over conventional scanners is that, instead of exposing the entire circumference of the body to the X-ray beam, the EBT X-ray beam enters from the back. Thus, anterior structures such as the breast and thyroid are subjected to a lesser dose of radiation (17% of the entrance skin dose).

Radiation Source

Functional Cardiac ImagingFunctional Cardiac Imaging

Multi-Slice ModeCine and Flow Acquisitions

Cine Mode – Functional Cardiac ImagingCine Mode – Functional Cardiac Imaging

Prospective ECG-Triggering

80% RR80% RR11 40% RR40% RR22

Flow Mode – Perfusion ImagingFlow Mode – Perfusion Imaging

Volume Mode – Coronary Imaging (Calcium & EBA)Volume Mode – Coronary Imaging (Calcium & EBA)

Cardiac ImagingCardiac Imaging

Myocardial Perfusion Scanning Protocol Flow Mode

Table is slewed for Long Axis ECG Triggered to 40% of the

R to R interval MSM 8 mm 15 to 20 images per level Injection of 35ml IV contrast @ 4ml per

second. Repeat scan post stress

Pre Dobutamine StressPre Dobutamine Stress

Post Dobutamine StressPost Dobutamine Stress


SystoleDiastolePre Dobutamine Stress

Post Dobutamine Stress Post Dobutamine Stress

Pre Dobutamine Stress Ejection Fraction Scanning Protocol Cine Mode

Table is slewed for Short Axis ECG Triggered to 0% of the

R to R interval MSM CINE mode 8 mm 15 to

20 images per level Injection of 35ml IV contrast

@ 4ml per second Repeat scan post stress


Coronary Artery Calcium Coronary Artery Calcium ScanningScanning

Step Volume ModeECG Triggered Acquisitions

Coronary Calcium ScanningCoronary Calcium Scanning

Coronary Artery Scanning Protocol

Patient Preparation: None ECG Triggered to 60-70% of

the R to R interval 3mm contiguous scans From carina to the apex

Calcium Report GenerationCalcium Report Generation Coronary Artery

Calcium Report

Agatston Calcium Score Volume Calcium Score Example Images Clinical Findings Clinical Recommendations Further Cardiac testing

Coronary Calcium ProgressionCoronary Calcium Progression

Calcium Score: 56 Calcium Score: 90 Calcium Score: 128 Volume Score: 45 Volume Score: 78 Volume Score: 113

1993 1995 1997Progression of Right coronary artery calcium score over 5 years

LAD

LCX

LM

LAD

Soft Plaque

Coronary Calcium ScanningCoronary Calcium Scanning

G.O. Kerkhoff, Alfried Krupp Hospital Essen (2000)

Visualization of Non-obstructive Plaque Formation - EBT

Coronary EBACoronary EBA

Step Volume ModeECG Triggered Acquisition

Coronary EBACoronary EBA CLINICAL INDICATIONS

Follow-up PTCA and Stents Follow-up Bypass grafts Equivocal results following stress

testing (or stress imaging) Congenital anomalies Symptomatic patients with Coronary

Calcium score Asymptomatic patients with

Coronary Calcium score greater than 400 or in the 75 percentile

Pre and post operative Heart transplant patients

People who are not willing to have an elective conventional angiogram

Coronary EBACoronary EBA Coronary EBA

Scanning Protocol

Patient Preparation: Start IV ECG Triggered to 40% of the

R to R interval 3mm x 2mm scans Injection of 150ml IV contrast

@ 4ml per second Normal algorithm, 18 cm FOV

Coronary EBA Report GenerationCoronary EBA Report Generation

Coronary Artery EBA Report

Clinical Indication Procedure Example Images Clinical Findings Clinical Recommendations Further Cardiac testing

Coronary EBACoronary EBAPosterior Descending

Coronary artery

This 3 Dimensional Volume Rendered image demonstrates normal coronary

arterial flow in the Posterior Descending Coronary artery to the

apex of the heart as well as the coronary sinus and cardiac vein.

This ECG triggered acquisition consisted of sixty, 3 mm images, each taken at 100 milliseconds. The total acquisition time was 45 seconds with an intravenous injection of 150 ml of

contrast media.


Follow Up PTCA

This 3 Dimensional Volume Rendered image demonstrates a re-stenosis in the mid LAD coronary artery in a patient post PTCA

This ECG triggered acquisition consisted of sixty, 3 mm images, each taken at 100 milliseconds. The total acquisition time was 45 seconds with an intravenous injection of 150 ml of contrast media.



Coronary Artery Stent Scanning Protocol

This 3 Dimensional Volume Rendered image demonstrates a 50% stenosis just proximal to the stent in the left anterior descending coronary artery .

This ECG triggered acquisition consisted of sixty, 1.5 mm images, each taken at 100 milliseconds. The total acquisition time was 45 seconds with an intravenous injection of 150 ml of contrast media.

Maximum intensity projection

MIPVolume rendering technique

VRT

Coronary Stent

Virtual AngioscopyFLY THROUGH

Courtesy of Milwaukee Heart Scan, Milwaukee, WI


Stent - Ave gfxTM 3,0/30mm


Coronary EBACoronary EBARight Coronary Artery Stent


Coronary EBACoronary EBARight Coronary Artery Bypass Graft – Distal anastomoisis


Coronary EBACoronary EBARight Coronary Artery Bypass Graft

Central occluded Right Coronary Artery Graft




Congenital Anomalies

This 3 Dimensional Volume Rendered image demonstrates an aberrant

circumflex coronary artery that arises from the Right coronary artery.

This ECG triggered acquisition consisted of fifty, 3 mm images, each taken at 100 milliseconds. The total acquisition time was 35 seconds with an intravenous injection of 120 ml of contrast media.

Number of Patients

Non-Evaluated Segments

Sensitivity Specifity

Moshage et al, Radiology 1995

20 ? 74% 100%

Schmermund et al, JACC 1998*

28 12% 83% 91%

Reddy et al, Radiology 1998

23 10% 88% 79%

Rensing et al, Circulation 1998**

37 18% 77% 94%

Achenbach et al, NEJM 1998

125 25% 92% 94%

Budoff et al, Am J Cardiol 1999

52 11% 78% 91%

Achenbach et al, Heart 2000

36 20% 92% 91%

Ropers et al, Z Kardiol 2000

118 24% 90% 82%

Coronary EBA Sensitivity & SpecificityCoronary EBA Sensitivity & Specificity

77.99mm76.94mm

Large Thoracic Aneurysm


Coronary and Thoracic EBACoronary and Thoracic EBA

True Lumen

False Lumen


Thoracic aortic stent (Talent MedtronicTM) in dissection of the aorta

Coronary and Thoracic EBACoronary and Thoracic EBA

Lung ScanningLung Scanning

Continuous Volume Scan


Lung Scan Protocol

Patient Preparation: None

This Continuous Volume acquisition consisted of forty seven, 6 mm images, each taken at 300 milliseconds. The total acquisition time was 18 seconds.

Findings: Asbestosis


Lung Scan Protocol


This Continuous Volume acquisition consisted of forty seven, 6 mm images, each taken at 300 milliseconds. The total acquisition time was 18 seconds.

Findings: Lung Nodule Right Upper Lobe

Pulmonary EmbolismPulmonary Embolism Pulmonary Embolism

Acute Scan Protocol


This Continuous Volume acquisition consisted of 42, 6 mm images, each taken at 100 milliseconds. The total acquisition time was 5 seconds with an intravenous injection of 50 ml of contrast media @ 3 ml per second.

Findings: Large embolism in right and left main pulmonary arteries.

Pulmonary EmbolismPulmonary Embolism Pulmonary Embolism

Chronic Scan Protocol

Patient Preparation: NPO 4 hour prior to scanning.

This Continuous Volume acquisition consisted of 120, 3 mm images, each taken at 100 milliseconds. The total acquisition time was 5 seconds with an intravenous injection of 50 ml of contrast media @ 3 ml per second.

Maximum Intensity Projections

Abdominal ScanningAbdominal Scanning


Abdominal ScanAbdominal Scan Abdomen screen

Protocol

Patient Preparation: Optional NPO after midnight the night prior to the exam. Drink 24 oz of gastrographin and H2o mix 2 hour prior and 12 oz before scanning.

This Continuous Volume acquisition consisted of, 6mm images, each taken at 400 milliseconds. The total acquisition time was 24 seconds.

Abdominal ScanAbdominal Scan Abdomen Diagnostic

Protocol

Patient Preparation: NPO after Midnight the night prior to the exam. Drink 24 oz of gastrographin and H2o mix 2 hour prior and 12 oz before scanning.

This Continuous Volume acquisition consisted of sixty one, 10 mm images, each taken at 600 milliseconds. The total acquisition time was 22 seconds with an intravenous injection of 90 ml of contrast media @ 2.0 ml per second.

EBT ColonographyEBT Colonography

EBT Colonography

Patient Preparation: 24 to 48 hour colon preparation. NPO after midnight the night prior to the exam.

This Continuous Volume acquisition consisted of 140, 3mm images, each taken at 200 milliseconds. The total acquisition time was 28 seconds with and air contrast enema.

Peripheral EBAPeripheral EBA


Renal EBARenal EBA

Renal Arteries

This coronal Maximum Intensity Projection image demonstrates

normal renal arterial flow.

This Continuous Volume acquisition consisted of seventy, 3

mm images, each taken at 400 milliseconds. The total acquisition

time was 28 seconds with an intravenous injection of 100 ml of

contrast media.

Abdominal Aortic EBAAbdominal Aortic EBA Abdominal Aortic EBA Scan Protocol

This 3D Volume Rendered image loop demonstrates arterial flow through a post operative abdominal aortic graft.

This Continuous Volume acquisition consisted of one hundred and forty, 3 mm images, each taken at 200 milliseconds. The total acquisition time was 28 seconds with an intravenous injection of 120 ml of contrast media.

Maximum intensity projection

MIPShaded surface display

SSDVolume rendering technique

VRT


Abdominal Aortic EBAAbdominal Aortic EBAPost operative Abdominal Aortic Graft

Femoral and Iliac EBAFemoral and Iliac EBA


Femoral and iliac EBA Scanning Protocol

This coronal Maximum Intensity Projection image demonstrates arterial flow through a post operative abdomenoiliac graft.

This Continuous Volume acquisition consisted of one hundred and forty, 3 mm images, each taken at 200 milliseconds. The total acquisition time was 28 seconds with an intravenous injection of 120 ml of contrast media.

Carotid EBACarotid EBA

Carotid Arteries

This 3 Dimensional Volume Rendered image demonstrate the

the carotid arteries (RED) and venous circulation (BLUE).

This Continuous Volume acquisition consisted of forty, 3 mm images, each taken at 300

milliseconds. The total acquisition time was 12 seconds with an

intravenous injection of 60 ml of contrast media.

Head ScanningHead Scanning


Cerebral EBACerebral EBA

Internal Carotid

This axial Maximum Intensity Projection image

demonstrates the Left internal carotid artery with limited flow to the Right.

This Continuous Volume acquisition consisted of

forty, 3 mm images, each taken at 600 milliseconds. The total acquisition time was 24 seconds with an

intravenous injection of 80 ml of contrast media. G.O. Kerkhoff, Alfried Krupp Hospital Essen (2000)


Cerebral AVM

This 3 Dimensional Volume Rendered image demonstrate the

Circle of Willis with an Arterial Vascular Malformation (AVM).

This Continuous Volume acquisition consisted of forty, 3 mm images, each taken at 600

milliseconds. The total acquisition time was 24 seconds with an

intravenous injection of 100 ml of contrast media.


Cerebral EBA

This axial Maximum Intensity Projection image demonstrates

cerebral arterial flow.

This Continuous Volume acquisition consisted of forty-five, 6

mm images, each taken at 600 milliseconds. The total acquisition

time was 27 seconds with an intravenous injection of 100 ml of

contrast media.

Head Scan Head Scan

Head Scanning Protocol

Patient Preparation: NPO 4 hours before the scan.

This Continuous Volume acquisition consisted of forty one, 6 mm images, each taken at 600 milliseconds. The total acquisition time was 25 seconds with an intravenous injection of 90 ml of contrast media @ 2.0 ml per second.

ebt clinical update

Documents

volume score

r intervalmsm cine mode

r interval3mm x

ebt scans

ebt xray beam

lesser dose of radiation

iv contrast

ebt clinical updatenovember