somatom sessions 16

Picture

SOMATOMSessions

No.16/June 2005Stanford University’s 7th Annual International Symposium on Multidetector-Row CT June 15-18, 2005

www.siemens.com/medical

COVER STORYThink Clinical!Page 4

NEWSSOMATOM Sensation – 40-Slice Technology2

BUINESSSOMATOM Spirit – “And itruns, and runs, and runs...“Page 15

CLINICAL OUTCOMESsyngo Body Perfusion CT – Differential Diagnosis of a PancreasPage 20

SOMATOM Emotion 6 High Resolution OrthopedicsExaminationPage 24

SCIENCEArchaeology – High-techMeets HistoryPage 33

CUSTOMER CARE

LIFE Educate – A Win-Win SituationPage 35

Highlights

It is Siemens’ goal to remain the trend-setter in Computed Tomography (CT) technology and

clinical applications, and to provide innovative multislice CT and workflow solutions for all clinical

needs – from the cost-optimized SOMATOM® Spirit up to the leading edge SOMATOM Sensation

64. More than 100 of our brand-new multislice SOMATOM Spirit CT scanners are in use all over

the world, from the highlands of Tibet to Milwaukee, USA. Within one year, more than 250

SOMATOM Sensation 64-slice CT scanners have been installed in the world’s leading academic

institutions and in busy hospitals and practices. First peer-reviewed reports in leading medical

and scientific journals definitely substantiate the advantages of Siemens' proprietary z-SharpTM

Technology in neuro, chest, vascular and cardiac CT applications. Moreover, the first SOMATOM

Sensation 40 scanners, providing access to z-Sharp’s benefits at attractive investment levels, are

running successfully in Europe and the USA. And our new SOMATOM Emotion 16, which was

introduced at the ECR 2005 in Vienna, will bring advanced 16-slice CT performance to day-to-

day clinical practice at even lower investment levels. And there is much, much more in the

pipeline…

As the amount of data acquired per study is increasing, high-performance workflow and appli-

cation solutions gain importance. We have devoted most of this issue to discuss the challenges

and solutions for the efficient management of large data sets. Find out about our latest inno-

vations in clinical workflow design for cardio-vascular applications and for highly sensitive early

diagnosis of cancer. Our authors and editors have put together another outstanding collection of

useful information. Join us on a fascinating journey in space and time through the human body.

We are looking forward to your comments, suggestions, and contributions.

Sincerely,

Bernd Ohnesorge, PhD,

Vice President CT Marketing and Sales

Dear Reader,

Bernd Ohnesorge, PhD, Vice President CT Marketing and Sales

2 SOMATOM Sessions 16

EDITOR’S LETTER

SOMATOM Sessions 16 3

CONTENT

COVER STORY4 Think Clinical!

8 The Fast Lane to Cardiac Diagnosis

9 Benefits of Computer-Aided Detection

10 Continuous Software Enhancements

NEWS11 CT on its Way Beyond Slices?

11 Advanced Performance at Low Cost

12 40-Slice Technology

12 LEONARDO in Anatomy Teaching

BUSINESS13 Cardiologists and Radiologists Unite Forces

13 Free Trial Clinical Software

14 Driving Initiatives against Colon Cancer

14 Demo Poster

15 “And it runs, and runs, and runs...“

CLINICAL OUTCOMES16 SOMATOM Sensation 64: Low Dose Cardiac Scanning of a Neonate in one Second

18 SOMATOM Sensation 40: Peripheral Runoff

20 SOMATOM Sensation 16: Differential Diagnosis of a Pancreas

22 SOMATOM Sensation Open: Paget Sarcoma Disease in the Tibia

24 SOMATOM Emotion: High Resolution Orthopedics Examination

26 SOMATOM Spirit: Pre-operative Neurosurgical Planning

SCIENCE28 z-Ultra-High Resolution Mode

30 Combining Forces to Improve Patient Care

33 High-tech Meets History

CUSTOMER CARE35 A Win-Win Situation

36 Cross-country Postprocessing Events

36 CT Imaging and Cherry Blossoms

37 Exploring the Riches of Multislice CT

37 Service: Frequently Asked Questions

38 Service: CT Online

38 Information and Services Available Directly at Your CT Scanner

38 Service: Upcoming Events and Courses

39 Imprint

COVER STORY


Siemens Computed Tomography is setting new trends in clinical workflow.

Think Clinical!

By Louise A. McKenna, PhD, Global Product and Marketing Manager CT-Workplaces, and Stefan Wünsch, PhD,

Global Product and Marketing Manger Clinical Solutions, Siemens AG, Medical Solutions, CT Division

Think clinical! One of the hottest topics in medical imaging

today is how to deliver a fast, confident diagnosis in an

increasingly demanding clinical environment. Both physi-

cians and patients have high clinical expectations, exam vol-

umes are on the increase, scan times are faster than ever,

datasets are large, plus there is demand for improved patient

safety in terms of dose, without compromising result. Deliv-

ering excellent clinical outcomes in medical imaging today is

no longer only about having thinnest slices, the most pow-

erful tube and fastest rotation time. It is about having the

most innovative Computed Tomography (CT) scanner in

combination with well designed clinical workflow solutions.

“From the clinicians’ viewpoint, achieving a fast, confident

diagnosis relies on two key factors: the right CT technology

in combination with the right clinical workflow,” says Elliot K.

Fishman, MD, Professor of Radiology and Oncology at Johns

Hopkins Medical Center, Baltimore, USA. “In my opinion,

Siemens is setting the trend in modern diagnostic imaging,

combining the most innovative scanner technologies with

intelligent workflow tools and new intuitive clinical software

applications. Siemens is leading the way in seamlessly inte-

grated CT solutions that help us to be fast in reaching the

right clinical outcomes reliably and efficiently, everyday.”

Leadership in Workflow SolutionsThe innovation explosion in Multislice CT technology and the

introduction of 64-slice CT has revolutionized medical imag-

ing, paving the way for a wealth of new and exciting clinical

applications: fast cardiac CT in under eight seconds, whole

body vascular CT with exquisite detail in under 20 seconds,

highly sensitive virtual imaging of the colon and perfusion

CT, to name but a few. And true to it’s tradition as an innova-

Siemens offers a solution that sets benchmarks for dose

management: CARE Dose4DTM provides a fully automated

dose modulation workflow designed to deliver the lowest

possible dose with the best possible image quality. The auto-

mated protocol facilitates a fast workflow, because it is not

necessary to adapt protocols manually for each new patient.

For optimal cardiac studies, Siemens ECG-pulsing modulates

dose so that maximum dose is given during expected

diastole and only 20 percent dose during all other phases.

For contrast media management, CARE Bolus CT and a new,

COVER STORY


tion leader, Siemens is setting new trends in clinically orien-

tated diagnostic imaging. The unique portfolio of syngo®

based workflow tools and software applications are intuitive

and intelligent, designed to get clinicians to the right diag-

nosis as quickly and as efficiently as possible. The goal?

Enhanced clinical outcomes for improved patient care.

Improved Efficiency with CARE SolutionsScanning with speed and efficiency is prerequisite for

improving throughput and enjoying all the clinical benefits

of ultra-fast scan times. This can only be optimally achieved

via more task automation within the scanning workflow.

Dose and contrast management are key areas where

automation can save precious time, improve reliability and

enhance clinical outcomes, especially for interventional pro-

cedures. Automated real-time dose modulation and contrast

media management offer two key benefits: they allow

radiologists to offer more patient-friendly exams with no

compromise in diagnostic image quality. Reliably improving

efficiency through task-automation was one of the main

drivers behind the development of Siemens unique portfolio

of CARE solutions.

Excellent image quality is only one step towards a confident physician’s diagnosis. Well designed clinical workflow solutions have become equally important.

»CARE Dose4D helps us to reduce

complexity… The software provides

us with a fully automated, real-time

anatomy based dose regulation,

resulting in a simplified workflow

without the need for individualized

protocol optimization.«Professor Werner Bautz, MD,

University of Erlangen, Germany.


COVER STORY

Siemens exclusive CARE Contrast CT are the right answer to

the increasing demand for fast, contrast enhanced CT scan-

ning. State-of-the-art, 64-slice CT scanners such as the

SOMATOM Sensation 64, image the entire chest, abdomen,

and pelvis in less than ten seconds. These fast scan times

raise unique challenges to the contrast media injector

devices and the use of intravenous contrast media. Today’s

Multislice CT scanners are so fast that if the injection param-

eters are not adjusted, the scan will be completed before the

entire volume of contrast is injected. These shorter scan

times create an opportunity to reduce the total amount of

intravenous contrast administered, decreasing costs and

improving patient care.

Siemens’ unique CARE Bolus CT software enables the

improvement of planning procedures and diagnosis due to

an optimized spiral scan start after contrast injection. As

soon as a predefined contrast enhancement threshold is

reached, the diagnostic scan is triggered and begins after a

short, preset delay. In terms of workflow, CARE Bolus

negates the need for a test bolus, facilitates contrast phase

shaping, and the fully automated triggering protocol maxi-

mizes efficiency also for emergency exams. With the newest

member of the CARE family, Siemens offers an industry first

– CARE Contrast CT. CARE Contrast CT couples the CT with

the injector. The fully automated workflow is initiated by a

single click, which is especially useful for trauma and acute

care patients.

Data Management par Excellence – the WorkStream4D WayData management plays a pivotal role in workflow efficiency.

The typical number of images for a CT exam has risen from

around 300 five years ago to well over 2000 with the

SOMATOM Sensation 64. Such large data sets can only be

managed electronically. In addition, the paradigm shift from

2D to volumetric 3D reading is driving medical imaging

departments to adopt an efficient, filmless workflow where

fast reconstruction and 3D volume rendering are essential

for achieving an efficient diagnostic workflow. Siemens has

been a pioneer of this paradigm shift and is the industry

leader in innovative data management solutions.

Managed the traditional way, multiple reconstruction and

re-formatting steps not only reduce workflow efficiency,

they also compromise image quality with a knock-on effect

on diagnostic confidence. Siemens' innovative Work-

Stream4DTM is specifically designed to efficiently manage

large data sets with fully automated reconstruction and re-

formatting of raw data – assuring the best possible image

quality, which is good news for diagnostic confidence. With

direct 3D reconstruction, all diagnostic information is cap-

tured in 3D slices, which economizes on data storage in dai-

ly workflow, as data volume can be reduced by up to a factor

of ten. WorkStream4D also offers pre-programmed, multi-

phase 4D reconstruction protocols, enhancing the advanced

clinical spectrum for dynamic evaluation in cardiac CT, for

example. This deliberate optimization of the 2D, 3D and 4D

workflow is designed to ensure that users can realize the full

clinical benefit of Multislice CT. WorkStream4D is also

designed to make workflow as flexible as possible, uniquely

CARE Dose4D

500 mA

30 mA

Reduced doselevel based ontopogram

Scan withconstant mA

Real-timeangular dosemodulation

X-raydose

Slice position

CARE Dose4D

Instead of just taking into account the patient’sexternal dimensions and apparent size, CAREDose4D analyzes the cross-sectional anatomy inreal-time and adjusts the emitted X-ray doseaccordingly – providing excellent image qualitywith minimized exposure.


COVER STORY

WorkStream4D

Scan

WorkStream4D

ReadTime

Reconstruct & Reformat

Conventional Workflow

ReadTimeScan

WorkStream4D virtually eliminates the need for time-consuming manualreconstruction steps – the software does this automatically.

enabling fully automated reconstruction in parallel to acquisi-

tion at both Navigator and Wizard CT-workplaces, offering

users a high degree of workflow synergy.

Leadership in Clinical ApplicationsSiemens is also setting new standards in clinical CT through

on-going innovation in integrated clinical software applica-

tions. The latest enhancements focus on improving speed

and efficiency through simplifying workflow, increasing

automation and integrating clinically orientated tasks into

single software solutions. The current portfolio of syngo

software offers the industry’s most comprehensive range of

clinical solutions for cardiovascular CT, preventive care,

oncology, neurology and routine imaging.

The introduction of the SOMATOM Sensation 16 in 2001,

closely followed by the SOMATOM Sensation 64, revolution-

ized cardiac and vascular CT. For the first time, CT was able to

deliver the exceptional spatial and temporal resolution cou-

pled with the exquisite image quality needed for non-inva-

sive cardiac and vascular imaging. With a focus on automa-

tion, speed and simplicity, syngo Circulation* is the newest

addition to the portfolio of advanced cardiac workflow tools

designed to help clinicians realize the full diagnostic poten-

tial of cardiac CT imaging. Designed in close collaboration

with Radiologists and Cardiologists, syngo Circulation pro-

vides the entire toolset for a comprehensive cardiac CT exam

based on a one-time loaded data-set. This includes an intelli-

gently designed 1-click workflow for robust coronary vessel

segmentation, automated stenosis quantification and opti-

mized stent planning, automated quantification of ejection

fraction, end-diastolic and systolic volume plus stroke vol-

ume, and 4D evaluation of up to 24 phases.

Enhancing clinical workflow for vascular CT has been the

focus in the further development of syngo InSpace4DTM.

Concentrating on clinician’s requirements for more automat-

ed tools, particularly for removal of bony structures for faster

vascular analysis, a fully automated advanced bone removal

application is an integrated feature of the latest syngo

InSpace4D. In combination with syngo Vessel View, users

can really optimize diagnostic workflow for a broad range of

vascular pathologies.

For preventive care and oncology, syngo LungCARE CT and

syngo Colonography are part of the new generation of intel-

ligent clinical software solutions. They incorporate a number

automated features such as measuring tools, synchroniza-

tion for easy evaluation of follow-up studies or prone/supine

reads and pre-filled reports, all designed to reduce the man-

ual workflow of the clinicians so that they can focus on diag-

nosis. In combination with Siemens’ CT technology, a lung or

colon exam, from scan to report, can be completed in less

than 20 minutes – the clinician input representing about ten

minutes for diagnosis and reporting.


COVER STORY

Computed Tomography (CT) fulfils many

clinical needs – be it in neurology, oncol-

ogy, angiography, in the emergency

room or, increasingly, also in cardiology

and preventive care. Siemens Medical

Solutions offers specialized solutions for

the specific needs of each of the respec-

tive clinical departments. “Supplying our

customers with hardware dedicated to

their needs is not enough”, says Bernd

Montag, PhD, President of Siemens

Medical Solutions’ CT division. “We also

want to give applications and workflow

tools to them that are explicitly de-

signed to meet the needs of their specific

clinical department – from patient regis-

tration to reporting.”

syngo Circulation* is the first of Siemens’

new generation clinical software solu-

tions. syngo Circulation is a dedicated

solution for cardiac evaluation, uniquely

designed to offer fast, robust morpho-

logical and functional analysis in one in-

tuitive software application.

”An accurate but fast diagnosis is crucial

in cardiovascular imaging in order to

ensure the best quality of care for the

patient. This is why the workflow must

be extremely fast and well organized,“

states Lars Hofmann, MD, Global Prod-

uct and Marketing Manager for Cardiac

CT at Siemens.

syngo Circulation was developed in

close collaboration with leading cardiac

experts. It features a unique user-friendly

workflow that guides the clinician

through cardiac evaluation from auto-

mated heart segmentation, through

coronary vessel segmentation and

stenosis quantification, fully automated

functional analysis and reporting, in

under 10 minutes.

A typical workflow begins with fast load-

ing of up to 24 phases, at highest image

resolution. With a single click, the heart

can be isolated from the rib cage facili-

tating rapid assessment of the overall

cardiac anatomy. Fully automated seg-

syngo Circulation offers physicians the industry’s most comprehensive software solution for cardiac CT, setting a new benchmark for improving clinical outcomes through innovative software solutions.

D E D I C AT E D S O LU T I O N S

The Fast Lane to Cardiac Diagnosis

mentation and stenosis quantification

tools provide for fast, confident evalua-

tion of the coronary vessels and opti-

mized stent planning. syngo Circulation

also offers tools for full functional analysis

including cine display for evaluation of

wall motion defects, automated left

ventricle segmentation and quantifica-

tion of ejection fraction, stroke volume,

end systolic and diastolic volumes. All

qualitative and quantitative results are

integrated in a single, customizable re-

port.

”The new software helps to facilitate

and increase workflow for physicians

with a busy clinical practice by incorpo-

rating intuitive reporting functionality

and integrating many time-saving, ac-

curate and guided procedures for the

rapid examination of cardiac CT stud-

ies”, says Michael Poon, MD, Director of

Cardiology at the Cabrini Mecial Center

and Associate Professor at the Mount

Sinai School of Medicine, New York, USA.

*syngo Circulation is pending 510(k) review and is not yet commercially available in the U.S.


COVER STORY

Siemens users are also in a unique position to benefit from

state-of-the-art computer-assisted reading tools for lung

nodules and colon lesions. syngo LungCARE CT with NEV

(Nodule Enhanced Viewing) and syngo Colonography with

PEV (Polyp Enhanced Viewing) represent an on-going com-

mitment to development of automated tools that improve

diagnostic confidence through the use of computer-assisted

second readers, which may have real impact on treatment

decisions. Centers that have already been working exten-

sively with syngo LungCARE NEV have realized a significant

improvement in daily workflow. Klinikum Rechts der Isar in

… in chest CT examinations“In my opinion, reliable detection of early stages of lung can-

cer is a difficult but crucial task. There is no question that

reading screening or diagnostic CT studies is susceptible to

detection errors due to the huge amount of imaging data

that has to be reviewed. In a recently published study, we

demonstrated that the use of ‘second reader’ technology

considerably increases the radiologist’s sensitivity for detec-

tion of pulmonary nodules.

Therefore, to ensure the highest

possible sensitivity for detection

of early-stage lung cancer in the

screening process, I am strongly

in favor of double-checking the

images with a Computer-Aided

Detection (CAD) system. Prelimi-

nary results suggest that applica-

tion of CAD might even be time-

efficient. Finally, CAD is not only

valuable in lung cancer screen-

ing, but also improves detection

of lung metastases when staging

or re-staging oncology patients.“

… in CT colonography“Computer-Aided Detection (CAD) has been very successful

in mammography and is being used for early detection of

lung cancer. In my opinion, if CAD could accurately detect

colon polyps in CT colonography (CTC), with a relatively low

false positive rate, it might become another very important

clinical application. Currently, most of the radiologists who

are experienced in CTC would not want to interpret more

than 3–5 studies per day.

Reading CTC is a demanding,

meticulous process, requiring

focused and extremely atten-

tive concentration. Given the

fact that there are not

enough radiologists to inter-

pret the growing number of

CT scans performed in the

United States, any assistance

in interpreting CTC will be

embraced enthusiastically by

radiologists.“

Dag Wormanns, MD,Department of Diagnos-tic Radiology, University Clinic Muenster, Muenster, Germany

Mark Baker, MD, Section of Abdominal Imaging, Division of Radiology, TheCleveland Clinic Founda-tion, Cleveland, Ohio, USA

S E C O N D R E A D E R TO O L S

Benefits of Computer-Aided Detection

Munich, Germany has been able to reduce the number of

reading physicians since introducing syngo LungCARE NEV:

“With this tool, we reduced the need for the second read by

a second physician screening all our chest datasets for lung

nodules, and therefore improved our diagnostic work-up

and follow-up findings,” says Christoph Engelke, MD,

Department of Diagnostic Imaging, Technical University

Munich, Germany.

The innovation continues in software solutions for neurology,

particularly for stroke and tumor perfusion. syngo Neuro

Perfusion CT is an established tool for the fast assessment of

»Siemens’ syngo Neuro Perfusion CT provides a cutting-edge imaging technology that

allows us to speed up patient diagnosis. The method allows us to differentiate definitively

damaged brain tissue from penumbra in less than two minutes. «Bernd Tomandl, MD, Assoc. Professor, Department of Interventional Radiology, Klinikum Süd, Nuremberg, Germany.


COVER STORY

syngo C T 2 0 0 6 A / G

Continuous Software Enhancements

In addition to new software developments, Siemens

Medical Solutions continuously enhances existing

clinical applications for Computed Tomography (CT).

The latest developments provide various new fea-

tures, such as improved workflow solutions, excellent

image quality in the brain due to superior image opti-

mization algorithms, as well as enhanced access to

online information and services directly from the

scanner console. This allows a faster download of

scan protocols and – depending on the system con-

figuration – facilitates innovative new clinical applica-

tions such as

• syngo InSpace4D with integrated bone removal

package for enhanced visualization of vascular

structures

• syngo Body Perfusion CT for quantitative evaluation

of dynamic CT data of organs and tumors, following

the injection of a compact bolus

• CARE Contrast CT for a simplified contrast workflow,

due to synchronized scanning and contrast media

application.

Newly shipped SOMATOM CT systems are pre-in-

stalled with the latest complimentary versions – and

with the latest optional versions, if ordered. To

increase clinical performance for already installed

SOMATOM CT scanners, complimentary versions are

included in the syngo Evolve contract as part of a

Siemens Service Contract. The optional software

applications can be ordered as upgrade packages, if

desired. More information about the syngo Evolve

Packages can be obtained online. For questions

regarding the individual Evolve status of a CT scanner,

the local Siemens representative should be contacted. Further Information: www.siemens.com/ct-evolvek

syngo InSpace4D with advanced bone removal facilitatesfast segmentation and removal of bony structures for fastervisualization of vessels.

stroke, with a complete exam requiring less than 15 minutes

[1], which is critical for stroke patients. syngo Neuro Perfu-

sion CT is also designed to be versatile and is ideal for the

analysis of brain tumor perfusion for brain tumor angio-

genesis or assessing treatment efficacy in oncology.

Currently, Siemens offers around 30 workflow and clinical

applications, providing solutions to meet a comprehensive

range of clinical needs from cardiac CT to oncology. With a

keen eye on the future, Siemens will continue to set new

trends for the next generation of clinical CT solutions…

[1] Tomandl B., et al. Comprehensive imaging of ischemic stroke

with multislice CT. Radiographics 2003; 23: 565-592


NEWS

S O M ATO M E m o t io n 16

Advanced Performance at Low Cost

V I S I O N O F T H E F U T U R E

CT on its Way Beyond Slices?

With the new SOMATOM Emotion 16,

Siemens Medical Solutions again proves

its cost-consciousness and clinical ex-

pertise. The SOMATOM Emotion 16 de-

livers the performance required for ad-

vanced clinical applications at low

life-cycle costs. It is based on the suc-

cessful SOMATOM Emotion product line

with more than 3,500 installations

A future vision of CT, as shown at RSNA 2004by Siemens’ Computed Tomography Division– a system combining several X-ray sourcesand detector domains

worldwide. The new system enables

hospitals and private practices with lim-

ited budgets and/or space allocations to

install a 16-slice CT.

Being air cooled, the SOMATOM Emotion

16 and all its components require only

18.5 square meter installation space. In

addition to the economical purchase

price, this minimal space requirement

and the overall low life cycle costs also

contribute to it’s cost efficiency.

From a clinical perspective, the new

scanner offers every advantage of a

modern 16-slice system: short breath

hold times alowing image acquisition

without movement artifacts, high diag-

nostic image quality due to a collimation

of down to 16 x 0.6 millimeters, a mini-

mum gantry rotation time of down to

0.5 seconds, and a comprehensive set

of routine and advanced clinical applica-

tions.

The number of slices acquired per rota-

tion has doubled every 18 months in the

last few years, and still the innovators at

Siemens’ Computed Tomography (CT)

Division continue to challenge the fu-

ture limits of CT technology and applica-

tions. “To just continue the current slice

race will not be the right path to open up

new clinical possibilities”, says Bernd

Ohnesorge, PhD, Vice President Market-

ing and Sales. “It’s time to explore totally

new CT concepts, and to move beyond

the simple adding of more detector

rows."

Last year’s RSNA visitors saw a visionary

CT concept at the Siemens booth’s Inno-

vation Pavilion that may redefine clinical

CT in the future: a very slim gantry de-

sign with a wide gantry opening allow-

ing for easy patient access and higher

patient comfort. A large area detector

with over 15 centimeter z-coverage per

rotation enabling dynamic and volum-

etric imaging of entire organs and body

regions, such as the heart, liver and

brain. Several X-ray sources generate

separate X-ray fan beams, while raw

data is acquired by an arrangement of

different detectors. A slim tube design

similar to Siemens' STRATON® is a key

prerequisite for such a concept. Sources

and detector segments are combined

differently in order to optimally adapt to

the needs of each respective clinical ap-

plication. Thus, this visionary concept

offers numerous advantages for various

clinical applications:

1. Examination of entire organs in one

rotation, e.g. for brain, organ and tu-

mor perfusion and for dynamic CTA

examinations of the heart and other

organs is made possible by utilizing

the above mentioned area detector.

2.Simultaneously operating several

source-detector subsystems may be a

way to a temporal resolution below

100 milliseconds, eventually even

below 50 milliseconds, independent

of heart rate, with today’s rotation

time of 0.33 seconds. Robust cardiac

imaging at high and irregular heart

rate may become feasible, without b-blockers and without drawbacks of

multi-segment reconstruction algo-

rithms – by using data from only one

heart beat.

3. In the same way, more X-ray power is

available for high quality imaging of

obese patients at maximum volume

coverage speed. More power is ap-

plied within shorter scan times, so

that radiation exposure is not neces-

sarily increased. High diagnostic quali-

ty can be achieved in obese patients

where most X-ray energy is absorbed

in the surrounding fat tissue.

4.Totally new opportunities can be ex-

plored with multiple source-detector

subsystems operated with different

X-ray energy levels, thus enabling

spectral CT imaging. This may allow

for raw-data based “built-in” separa-

tion of bone, vessel lumen and calcifi-

cations, or for characterization of liq-

uids, such as blood and pus, in

emergency diagnostics.

The SOMATOM Emotion 16 unitesmodern 16-slice technology withthe cost-efficiency of the SOMATOMEmotion product line.

With the SOMATOM Sensation 40, SiemensMedical Solutions rounds out its extensivehigh-end product portfolio in CT.


NEWS

LE R N E R C O LLE G E O F M E D I C I N E

LEONARDO in Anatomy Teaching

S O M ATO M S e n s at io n P R O D U C T L I N E

40-Slice Technology

Students in the anatomy classes at

Cleveland Clinic Lerner College of Medi-

cine at Case Western Reserve University,

Cleveland, OH., are enjoying very spe-

cial insights into the human body. Each

week starts with a session at the Col-

lege’s LEONARDO Workstation. Faculty

members demonstrate – with syngo

InSpace and other applications – and ex-

Two new Siemens Computed Tomogra-

phy (CT) systems were recently intro-

duced to the market. The world’s first

SOMATOM Sensation 40 scanner was

installed at the radiology department of

Alamance Regional Medical Center,

Burlington, NC., replacing the clinic’s

SOMATOM Sensation 10. And Mayo Clinic

in Rochester, MN., was one of the first

clinics to install a SOMATOM Sensation

Open with 40-slice technology. The sys-

tem features an extra-large, 82 cen-

timeter gantry bore and field of view.

A new, optional high-capacity patient

table, developed as part of the CT Clini-

cal Innovation Center partnership be-

tween Mayo and Siemens, was installed

with the system to permit advanced CT

imaging of extremely heavy patients.

The table allows the scanning of pa-

tients weighing up to 615 lbs, compared

to 440 lbs for conventional patient ta-

bles. “With these features, the

SOMATOM Sensation Open is ideally

suited for very heavy patients and our

Bariatric Surgery Program,” says Cynthia

plain multiple views of the body regions

they will cover during the coming week.

Students then return several times dur-

ing the week to review images as they

proceed on their weekly learning mat-

ter. New cases to demonstrate specific

examples of anatomy are added onto

the LEONARDO regularly. “The use of

this technology has directly enhanced

the students’ understanding of anatomy

and their ability to visualize structures,”

says Richard Drake, PhD, Director of

Anatomy. He is also involved in prepar-

ing images on the LEONARDO for a pub-

lishing project of Gray’s Anatomy family

of educational material.

McCollough, PhD, Associate Professor of

Radiological Physics at the Mayo Clinic

College of Medicine. “In addition, the

STRATON tube provides the X-ray output

needed for high-quality images in very

large patients. These are exactly the

clinical and technical attributes we were

seeking, especially for bariatric care and

image guided interventions.”

Both new systems feature Siemens rev-

olutionary z-Sharp Technology, which

utilizes an electron beam that is accu-

rately and rapidly deflected, creating

two alternating and overlapping X-ray

projections reaching each detector ele-

ment. This doubles the scan information

without a corresponding increase in

dose, and routinely enables acquisition

of 40 slices per rotation with unprece-

dented image quality and the industry’s

highest image resolution of below 0.4

millimeter. z-Sharp Technology firmly

established a new benchmark for diag-

nostic excellence, as proven with almost

300 installations of z-Sharp powered

systems worldwide.

The large bore of the SOMATOM SensationOpen is ideal for examinations of bariatricand cancer patients.

Further Information:

www.clevelandclinic.org/cclcm

k


BUSINESS

S O C I ET Y O F C A R D I OVAS C U L A R C T

Cardiologists and Radiologists Unite ForcesBy Lars Hofmann, MD, Global Product and Marketing Manager Cardiac CT,

Siemens AG, Medical Solutions, CT Division, Forchheim, Germany

s y n g o LU N G C A R E C T W I T H N E V

Free Trial Clinical Software

On March 7, 2005, the Society of Cardio-

vascular Computed Tomography (SCVCT)

and the Society of Cardiac Computed

Tomography (SCCT) merged to form a

new society called “Society of Cardio-

vascular CT” (SCCT). Both former soci-

eties were relatively new, having just

been formed in January 2005. They

soon realized that they shared common

goals and that a single, strong society

would be more effective.

The SCCT is represented by a 15-member

Board of Directors and five executive of-

ficers. Four of them and the vast majori-

ty of the Board of Directors are long

term Siemens Computed Tomography

(CT) users. Executive officers of the SC-

CT are: Stephan Achenbach, MD, Presi-

dent, Erlangen, Germany; Michael

Siemens Computed Tomography (CT)

now offers their latest computer assist-

ed detection software syngo LungCARE

CT with NEV (Nodule Enhanced View-

ing), on a free, 90-day trial basis. This

software is designed to enhance physi-

cians’ diagnostic confidence as a second

reader tool, confirming the presence or

absence of lung lesions. Double reading

with a second reader software offers a

significantly increased sensitivity com-

pared to conventional double reading.

Thus, computer assisted detection is a

valuable tool for the detection of pul-

monary nodules, and should be used as

second opinion.1

Poon, MD, President-Elect, New York,

NY; Daniel Berman, MD, Vice President,

Los Angeles, CA; Gilbert Raff, MD, Secre-

tary, Royal Oak, MI, and Joao Lima, MD,

Treasurer, Baltimore, MD.

“Computed Tomography has gone

through rapid technical development in

the past years, and is increasingly appli-

cable to imaging of the heart, coronary

arteries and vascular system. It is impor-

tant that researchers and clinicians in

this field work together to create a body

of evidence strong enough to support

recommendations as to which patients

are most likely to benefit from the new

diagnostic modalities and to assure that

CT imaging performed by appropriately

trained physicians will be available to

these patients. I am confident that the

newly formed Society of Cardiovascular

CT will be very helpful in establishing

the appropriate clinical role for cardio-

vascular CT,” said Dr. Achenbach, SCCT

President.

The SCCT is an international organization

committed to the further development

of cardiovascular CT through standards

setting, advocacy, education, training, ac-

creditation, quality control and research.

Its members are physicians, scientists,

technologists, and others who work in

the field of cardiovascular CT. Siemens

CT division strongly supports the new

society and encourages users of cardiac

CT to join the society to support this fas-

cinating technology.

Trial licences are available

• via LifeNet: Customers with SRS con-

nectivity can order their trial software

directly from their scanner. The soft-

ware will then be automatically in-

stalled and ready for use.

• via the local Siemens Representative:

Customers can contact their local

Siemens Representative. He/she will

discuss the available trial options with

them and schedule an appointment

for the installation of the trial soft-

ware. 1 Wormanns D, Beyer F, Diederich S, et al. Diag-

nostic performance of a commercially available

CAD system for automatic detection of pulmonary

nodules: Comparison with single and double read-

ing. Röfo 2004 Jul; 176(7): 953-958


www.siemens.com/SOMATOMExpand

k

syngo LungCARE CT with NEV identifiespotential lung lesion that were overlookedduring the radiologist’s first read.

Further Information: www.scct.orgk

BUSINESS


C T C O LO N O G R A P HY

Demo Poster

I N V E ST I N G I N P E O P LE

Driving Initiatives against Colon CancerSiemens Medical Solutions, Daimler

Chrysler AG, Henkel KGaA, BASF AG and

E.ON Ruhrgas AG, in cooperation with

their respective occupational health

centers, have all initiated screening pro-

grams for colon cancer. Siemens Med-

ical Solutions in Germany invited em-

ployees aged 45 plus, together with

those at risk (e.g. familial history) to un-

dergo a Fecal Occult Blood Test (FOBT)

as a primary screening tool. Employees

with a positive test were offered two al-

ternatives for further investigation: a

traditional colonoscopy or – true to the

tradition of innovating health care – the

opportunity to undergo a CT-Colonog-

raphy (CTC) on the University of Erlan-

gen’s SOMATOM Sensation 64. The

hugely successful take-up of this initia-

tive reflects the increased awareness of

the benefits of early detection: 1,110 em-

ployees signed up; of the 2.5 percent

with a positive FOBT test, 60 percent

chose to follow-up with a CTC. The suc-

cess of the project had much to do with

the close collaboration with Siemens

Betriebskrankenkasse (SBK), and also

with the department of radiology at the

University of Erlangen.

“This screening initiative represents a

huge opportunity for us to gather more

evidence for the use of virtual colonog-

raphy as a highly sensitive and specific

screening tool for colon cancer,” explains

Rolf Janka, MD, Department of Radio-

logy, University of Erlangen, Germany.

“A virtual colonoscopy using CT is non-

invasive, patient friendly, and relatively

low cost. These are key pre-requisites

for screening procedures. The more clin-

ical data we can gather, the greater our

chance of getting approval for CTC for

colon cancer screening. In my opinion,

that can only lead to one thing: better

patient care!”

The use of CT for early detection of

colon cancer is a hotly debated topic.

Several publications have demonstrat-

ed that with Multislice CT, radiologists

can achieve a sensitivity and specificity

to match conventional colonoscopy.

Currently, experts across the globe are

working hard on providing further data

supporting the reliability of CTC for de-

tection of clinically relevant polyps. One

of the largest clinical trials will take place

in the US, where the American College

Imaging Network and the National Can-

cer Institute aim to accrue over 2,000

patients over the next 2.5 years.

CT Colonography (CTC) is emerging as

an attractive alternative to colonoscopy

for the detection and evaluation of le-

sions of the colon in terms of excellent

diagnostic outcomes, high patient ac-

ceptance and lower cost. It is ideally suit-

ed for patients who are unable or unfit

to undergo conventional colonoscopy,

as well as for asymptomatic and screen-

ing patients. Around 600 Siemens Mul-

tislice CT users are currently utilizing

syngo Colonography for efficient evalu-

ation of the colon.

Thomas Mang, MD, and co-workers

from the Medical University of Vienna,

Austria, have performed around 280

CTC exams on their SOMATOM Sensa-

tion 16 Scanner over the last two years.

Based on their experience with virtual

colonoscopy, they have designed a

poster demonstrating the spectrum of

CTC findings in colon diseases. All dis-

eases are briefly described and exten-

sively demonstrated on 3D and 2D CT

images, guiding and assisting users in

the reporting of findings in CTC exami-

nations.

The poster has been produced together

with Siemens Medical Solutions, Aus-

tria, and is available free of charge in ei-

ther German or English.

To obtain a free CT Colonography Poster,

please send an e-mail with your postal

address to

[email protected],

subject “CTC Poster”.Each disease is briefly described anddemonstrated, based on CT images.


BUSINESS

Fudan University – Zhongshan Hospi-

tal, Shanghai City, China, and Werner-

Wicker-Klinik, Bad Wildungen, Ger-

many, were among the first to install a

SOMATOM Spirit. SOMATOM Sessions

asked Professor Zeng MengShu, MD,

and Carsten Figge, MD, about their

experience with the new system.

What types of examinations are youusing the SOMATOM Spirit for?Dr. Figge: We use the SOMATOM Spirit

for all exams in daily clinical routine.

With our outpatients, there are more

head, thoracic, and abdominal exams,

while our inpatients mainly need ex-

aminations of the spine. We examine

between 15 and 20 patients per day.

Prof. MengShu: We do routine head

and thoracic examinations, high reso-

lution lung scans, abdominal contrast

examinations, spine examinations,

and other routine examinations. On

average, we scan 60 patients per day

with the SOMATOM Spirit.

You have been working with theSOMATOM Spirit for over sixmonths. What is your experience,compared to other CT scanners?Dr. Figge: Compared to our former

SOMATOM AR.Star, the SOMATOM

Spirit – as a dual-slice system – broad-

ens our spectrum of examinations, to

CT-Angiographies of the head, or mul-

tiphase exams of the abdomen, at

thinner collimation.

What is your opinion about the userguidance and simplicity of the userinterface?Prof. MengShu: Our technologists

are very satisfied with the user inter-

face; it is easy to understand and to

operate. Qualified technicians can do

simple examinations after only five

minutes of training.

Dr. Figge: The SOMATOM Spirit is very

easy to operate because of its syngo

user interface. Many workflow steps

can be automated, which reduces the

workload for our technologists and

shortens examination times. Sec-

ondary postprocessing like Multi-Pla-

nar Reformatting, Maximum Intensity

Projection, or Volume Rendering

Technique (VRT) are readily available

for diagnosis. The ease of use surpris-

es and pleases at the same time.

Where do you use VRT?Dr. Figge: I use VRT for the visualiza-

tion of complex diagnosis in meetings

and demonstrations. This way, I can

give surgeons an overview of complex

anatomy; details can then be worked

out in the primary slice images.

Prof. MengShu: We use VRT for many

kinds of examination, such as tracheal

and bronchia examinations. Especially

with CT-Angiography, we can see the

abdominal artery after removing the

bone and other organs. The value of

VRT is well acknowledged, the doc-

tors can see the area of interest directly

in the 3D structure.

What is your overall impression ofthe SOMATOM Spirit?Dr. Figge: And it runs, and runs, and

runs ...

To which customers would you rec-ommend the SOMATOM Spirit?Dr. Figge: I would recommend it to

any customer who needs an easy to

use system for their daily clinical rou-

tine, and, at the same time, wants

high cost efficiency. Particularly small,

outlying clinics utilizing teleradiology

can profit from the excellent handling

concept.

Prof. MengShu: The SOMATOM Spirit

is the ideal system for hospitals with

less than 500 beds that buy their first

CT, and for large hospitals that buy an

additional CT for routine examinations.

S O M ATO M S p ir i t

“And it runs, and runs, and runs...“

Interview

Werner-Wicker-Klinik specializes in

acute care for spinal marrow injuries,

congenital and acquired spine dis-

eases (German Center for Scoliosis),

neuro-urology, and neuro-surgery.

Its Radiological Institute collaborates

closely with the Radiology Institute

Bad Zwesten, Practice of Drs. Mariß/

Aref/Figge. Together, they attend not

only to the outpatients of all hospitals

of the Wicker-Group, but also serve as

a teleradiology center for 14 acute-care

hospitals. As a polyclinic, ZhongshanHospital focuses on the diagnosis

and treatment of liver, kidney and lung

cancer. The clinic has 1,272 beds, 1.2

million outpatients and 25 thousand

inpatients per year. There are 2,300

employees working in the hospital, in-

cluding 360 professors and associate

professors, plus three CAS (Chinese

Academy of Science) and CAE (Chi-

nese Academy of Engineering) acade-

micians.

Carsten Figge, MD: “We experienceup to 30 percent dose reduction,thanks to the SOMATOM Spirit’sCARE Dose functionality.”


SOMATOMSensation

SOMATOMEmotion

SOMATOMSpirit

CLINICAL OUTCOMES

DIAGNOSIS

CT revealed atypical coarctation, associated with very large

patent ductus arteriosus, supplying descending aorta with

blood.

On the first acquisition [Fig. 1 and 2], only patent ductus arte-

riosus, descending aorta and left subclavian artery were opaci-

fied, due to the right to left shunt between ductus arteriosus

and descending aorta. The aortic arch was not visualized.

A second acquisition was performed with a longer start delay

to accommodate this unusual anatomical configuration. The

aortic arch was opacified, and MIP images clearly showed

Case 1:Low Dose Cardiac Scanning of a Neonate in one SecondBy Jean-François Paul, MD, Anne Sigal-Cinqualbre MD, Department of Radiology, and V. Lambert, MD,

Department of Cardiopediatry, Marie Lannelongue Hospital, Le Plessis-Robinson, France

HISTORY

An 1 day old infant was referred for cardiac CT for differential

diagnosis prior to surgical intervention for severe aortic

coarctation from total interruption of aortic arch.

Previous foetal echocardiography had revealed asymmetry

of ventricles associated with an enlarged right ventricle, and

there was suspicion of coarctation of the aortic arch. At birth,

echocardiography was not able to assess whether the baby

was suffering from severe aortic coarctation or if the aortic

arch was totally interrupted.

SCANNING PROCEDURE

Due to the high rotation speed (0.33s) of the SOMATOM Sen-

sation 64 gantry, the entire thorax could be captured in only

1 second and hence it was not necessary to sedate the infant.

Five cc of contrast medium were injected at a flow rate of

0.6 cc/s in a small cubital vein. After the analysis of the first

acquisition data set, an additional acquisition was necessary

to visualize the aortic arch. Indeed, the aortic arch was not

visualized at first-pass because most of the contrast flow was

going from the pulmonary artery directly to the descending

aorta (via patent ductus arteriosus), bypassing the aortic

arch. A second acquisition 10 seconds later was necessary to

get the aortic arch opacified [Fig. 3].

CARE Dose4D was applied, enabling us to perform the exam

with an exposure that was as low as reasonably achievable,

in this case at 80 kV and 20 mAs. Total DLP for 2 acquisitions

was 15, and the estimated exposure for the exam was very

low at 0.6 mSv.

Images were reconstructed at 1 mm using MIP and VRT recon-

structions for a complete description of anatomical disor-

ders.

[ 1 ] Left lateral view usingVRT display. First acquisitionshowed very large patentductus arteriosus in connec-tion with descending aorta.Left subclavian artery is origi-nating from the junction of the two vessels. Aortic arch is not opacified. PDA: patent ductus arteriosus; DA: descending aorta; LSCA: left subclavian artery; LPA: left pulmonary artery

[ 2 ] Same acquisition in a more posterior view


[ 4 ] VRT display of the aortic arch,in a left lateral view. Note that theaortic narrowing is hidden by thepatent ductus arteriosus.PDA: patentductus arteriosus; DA: descendingaorta; LSCA: left subclavian artery;IA: innominate artery; LCA: left carotidartery; LPA: left pulmonary artery

EXAMINATION PROTOCOL

Scanner SOMATOM Sensation Cardiac 64

Scan area thorax

Scan length 64 mm

Scan time 1 s

Scan direction caudo-cranial

Heart rate 140

ACV no ECG gating

kV 80 kV

Effective mAs 20 mAs

Rotation time 0.33 s

Slice collimation 0.6 mm

Slice width 1 mm

Table feed 46 mm / s

Reconstruction increment 0.7 mm

CTDI 0.49 mGy

Kernel B30

Contrast

Volume 5 ml

Flow rate 0.6 ml / s

Start delay 10 s (central venous access)

Postprocessing MIP, VRT

[ 3 ] Second acquisition (10 sec-onds after first pass): MIP viewshowed opacified aortic arch withsevere coarctation (arrow). AA:Aortic arch; DA: descending aorta

[ 5 ] VRT display in a posteriorview shows the complex anatomyassociated with the aortic coarcta-tion. PDA: patent ductus arterio-sus; DA: descending aorta; LSCA:left subclavian artery; LCA: leftcarotid artery; AA: aortic arch

CLINICAL OUTCOMES

that the aorta was severely narrowed, but not totally inter-

rupted [Fig. 3]. Additional VRT images depicted this complex

configuration [Fig. 4 and 5].

Surgical intervention by lateral thoracotomy was successful.

The baby was discharged from our institution at day 10, with-

out complication.

COMMENTS

This is an exemplary case for the application of 64-slice CT

scanning for congenital heart disease patients, especially in

newborns. Very short acquisition times, associated with thin

collimation, provide very high quality images in non-inter-

ventional procedures, associated with low radiation expo-

sure. These data may be crucial in such critical conditions. In

case of interrupted arch, the surgical approach would have

required sternototomy with bypass circulation instead of lat-

eral thoracotomy. In case of doubt at echocardiography, a

conventional aortography may be indicated, but angiogra-

phy is a very risky examination, especially in neonates. Multi-

slice CT is the ideal alternative to avoid such an invasive

imaging technique. Here, CT was preferred to MR due to

superior spatial resolution, speed of acquisition (and thus

absence of respiratory artefacts), and no need for sedation.

Radiation dose delivered by CT was below 1 mSv.

SOMATOMSensation

SOMATOMEmotion

SOMATOMSpirit

CLINICAL OUTCOMES


HISTORY

A 56 year old male patient was presented with pain in the

muscle of the left leg after slight exercise. A CTA runoff with

the latest 40-slice CT technology was scheduled to rule out

claudication.

DIAGNOSIS

CTA revealed an occlusion of the left common iliac artery just

distal to its origin. Occlusion of the proximal two thirds of the

left external iliac artery is present. Collateral reconstitution of

the distal left external iliac artery/common femoral artery is not-

ed. Distal vessels are not affected due to collateral blood supply.

COMMENT

The case demonstrates the clinical impact of CT for non-inva-

sive assessment of vascular structures with the SOMATOM

Sensation 40. Due to the excellent speed and an isotropic

resolution below 0.4 mm, even finest structures can be

resolved without venous overlap.

Case 2:Peripheral RunoffGeoffrey Browne, MD, Chris DeAngelo RT ( R ), ( CT ), Alamance Regional Medical Center, Burlington, USA

[ 1 ] VRT showing occlusion of the left iliac artery afterbone removal performed with syngo InSpace4D


Scanner SOMATOM Sensation 40

Scan area Lower extremity runoff

Scan length upper leg: 545.5 mm; feet: 238 mm

Scan time upper leg: 19 s; feet: 8 s

Scan direction craniocaudal

kV 120 kV

Effective mAs 170 mAs (CARE Dose4D)

Rotation time 0.37 s


Slice width 0.75 mm

Pitch 1


Contrast 370 Isovue

Volume 100 ml

Flow rate 3 ml / s

Start delay Care Bolus CT triggered at 100 HU

with the reference ROI on the aorta

Postprocessing syngo InSpace4D with bone removal

[ 2 ] MIP image showing occluded femoral arteryfrom the origin, filling by collateral circulation fromthe peripheral part


CLINICAL OUTCOMES

[ 3 ] Curved MPR shows calcified and non-calcifiedplaques as well as the thrombus responsible for theocclusion.

[ 4 ] VRT of the collateral vessels

A B

[ 5A and 5B ] VRT images show the normal bloodsupply through the collaterals of the tibial vesselsand supply of the feet.

SOMATOMSensation

SOMATOMEmotion

SOMATOMSpirit

CLINICAL OUTCOMES


Case 3:Differential Diagnosis of a PancreasBy Xue Hua Dan, MD, and Jin Zheng Yu, MD, Department of Radiology,

Peking Union Medical College Hospital, Beijing, China

HISTORY

The patient was a 65 year old man, who had suffered from

hypoglycemia for 5 years, aggravated by vertigo and spells

of unconsciousness during the past 2 years. Due to the

severe symptoms, an insulinoma, a tumor of the pancreas,

was suspected. A previous enhanced CT scan (one month

earlier) indicated no abnormalities. The surgeon asked for an

additional CT scan that revealed a pancreatic tumor.

DIAGNOSIS UND COMMENTS

Only a decade ago, the sensitivity of finding insulinomas with

CT was rather low. Today, using high resolution MSCT in the

early arterial phase, we can quite easily detect these small

pancreatic lesions. Arterial spiral CT showed a small, but

strongly enhancing lesion of 1.3 cm at the tail of the

pancreas. Tumor feeding arteries originating from the

splenic artery were also delineated using MIP and MPR.

Additional dynamic scanning confirmed the diagnosis of

insulinoma. With syngo Body Perfusion CT, it was possible to

further characterize the lesion. It showed the typical behavior

of a benign tumor with significantly increased flow and

blood volume, but normal permeability. The patient was

referred for tumor resection. Pathological findings confirmed

the CT results.

The syngo Body Perfusion CT option* allows for the quanti-

tative evaluation of dynamic CT data of organs and tumors,

following the injection of a compact bolus. By providing

images of blood flow, blood volume and permeability from

one set of dynamic CT data, syngo Body Perfusion CT permits

the assessment of irregular perfusion and of perfusion

changes during therapy. Using specific evaluation protocols

for different organs and motion correction for improved

accurate anatomical object alignment, it can be particularly

helpful for differential diagnosis and monitoring of tumors.

NEW: syngo Body Perfusion CTFunctional Diagnosis of Organs and Tumors

Scanner SOMATOM Sensation 16

Non-contrast Arterial phase Dynamic scanphase

Scan area From From Pancreasdiaphragm horizontal levelto iliac crest part of

duodenumto diaphragm

Scan length 25 cm 11.52 cm 2.4 cm

Scan time 11.77 s 3.22 s 35 s

Scan direction cranial-caudal caudal-cranial –

kV 120 kV 120 kV 80 kV

Effective mAs 160 mAs 160 mAs 140 mAs

Rotation time 0.5 s 0.5 s 1.0 s

Slice 0.75 mm 1.5 mm 1.5 mmcollimation

Slice width 1.0 mm 2.0 mm 3.0 mm

Table feed / 12.0 mm 24.0 mm 0 mmrotation

Reconstruction 0.7 mm 1.0 mm –increment

Kernel B10f B20f H30f

Contrast – omnipaque omnipaque(350 mg (350 mgiodine / ml) iodine / ml)+saline +saline

Volume – 70 ml + 20 ml 50 ml + 20 ml

Flow rate – 5 ml / s 5 ml / s

Start delay/Bolus tracking – 5 s 5 s

Postprocessing – MPR/MIP/VRT syngo Body

Perfusion CT


*syngo Body Perfusion CT is available for SOMATOM Emotion Duo, 6, and 16,

and SOMATOM Sensation scanners with syngo CT 2006 A/G.

CLINICAL OUTCOMES


[ 1A and 1B ]MPR and MIPimages show thesmall endocrinetumor as a highlyenhanced nodule(arrow), located at the tail of thepancreas, with thenutritional arteryvisible.

[ 2 ] Functional parameter maps calculated in two adjacent 3 mm slices (upper and lower row) using syngo Body Perfusion CT. The maps show increased blood flow (left, red color) and blood volume (middle, red color), butnormal permeability (right, green color). Note the excellent spatial delineation of this small tumor made possibleby robust modeling of data from thin slices and acquired in only 35 s (one breath hold).

A B

SOMATOMSensation

SOMATOMEmotion

SOMATOMSpirit

CLINICAL OUTCOMES

HISTORY

An 80 year old female with monostotic Paget’s disease of the

right tibia presents with progressive pain and soft tissue

swelling of the right leg. A biopsy was taken that confirmed the

exact pathologic diagnosis of the lesion arising from Paget’s

disease and a sarcomatous transformation to osteosarcoma.

DIAGNOSIS

Paget’s disease of the bone is a common disorder affecting

approximately 3–4% of the population over 40 years old.

The pathologic abnormality in Paget’s disease is excessive

and abnormal remodeling of the bone. Three phases have

classically been described as discrete and distinctive,

although in reality they represent a continuum: the lytic

phase (incipient-active), in which osteoclasts predominate;

the mixed phase (active), in which osteoblasts begin to


Case 4:Paget Sarcoma Disease in the Tibia By J. Dinkel, MD, U. Mende, MD, PhD, Department of Radiation Oncology, and J. Debus, MD, PhD, Director,

Department of Radiation Oncology, University of Heidelberg, Germany

appear superimposed on osteoclastic activity and eventually

predominate; and finally, the blastic phase (late-inactive), in

which osteoblastic activity gradually declines.

Monostotic disease (10–35% of cases) is more often seen in

the axial view of the skeleton, although any site can be the

sole region of involvement. Polyostotic disease (65–90 %) is

more frequent than monostotic disease. The patient presented

here had monostotic disease localized in the right tibia only.

VRT and MPR images of the tibia show the radiological char-

acteristic manifestations of Paget’s disease: a diffuse cortical

and trabecular thickening involving the entire bone.

The combination of progressive osteoclastic and osteoblastic

activity leads to the dichotomy of osseous enlargement but

weakening of the bone. Sequelae of this osseous weakening

are the most common complication of Paget’s disease. An

anterior bowing of the tibia is seen in the VRT reconstruction.

1A 1B

[ 1A and 1B ] Osteoblastic tumor mass (arrow) extending into the soft tissue with infiltration of the skin and skin metastases

CLINICAL OUTCOMES



Scanner SOMATOM Sensation Open, 40 slices

Scan area extremity

Scan length 451 mm

Scan time 41.5 s

Scan direction cranio-caudal

kV 120 kV

Effective mAs 66 mAs (CARE Dose4D) 90 mAs ref.

Rotation time 1 s


Slice width 0.6 mm

Pitch 0.9


CTDI 7.24 mGy

Kernel B20 / B60

Postprocessing syngo InSpace

[ 2 ] Arterioscle-rosis of posterior tibial artery (thinarrow); diffuse cortical and tra-becular thicken-ing involving theentire bone withanterior bowing(thick arrow)

[ 3 ] Nodularmineralizationsof metastaticlymph nodes(arrow)

[ 4 ] Disorga-nized areas are seen in thedistal cortex of the distal tibia

Disorganized areas are seen in the cortex of the distal tibia.

The fractured fibula was not affected by Paget’s disease.

Since the patient refused the recommended surgical treat-

ment, radiation therapy was performed.

COMMENTS

Neoplastic complications of Paget’s disease are relatively

rare. Sarcomatous degeneration is estimated to occur in 1%

of patients with longstanding disease. In case of severe

polyostotic disease, the relative risk of sarcomatous transfor-

mation is up to 5–10%.

A Paget sarcoma can have different appearances depending

on the matrix produced (osteolytic, osteoblastic, mixed). In

this case, the CT scan shows the osteoblastic tumor mass

extending into the soft tissue with infiltration of the skin and

skin metastases. Moreover, the CT scan of the popliteal

region reveals nodular mineralizations of metastatic lymph

nodes.

The high isotropic resolution provided by the SOMATOM

Sensation Open with 40 x 0.6 mm slices produced during

each rotation, allows for the detection of small changes after

the radiation therapy. Spiral artifacts e.g. aliasing artifacts

that manifest as streaks emerging from high contrast

objects, and windmill artifacts, are almost completely elimi-

nated with z-Sharp Technology, even at higher pitch values.

In addition, z-Sharp Technology reduces image noise when

the reconstructed slice width is the same thickness as the

collimation.

SOMATOMSensation

SOMATOMEmotion

SOMATOMSpirit

CLINICAL OUTCOMES


Case 5:High Resolution Orthopedics ExaminationLy Thai Bach, MD, Chief of Radiology Unite, & Eric Devilaine, Chief of X-ray Technician Team,

Centre Hospitalier Robert Morlevat, Semur en Auxois, France

heel bone, but also at the level of the anterior-inferior part of

the talus and at the level of the anterior part of the extremi-

ty distal of the tibia.

Furthermore, calcifications, probably of cartilagenous origin,

were also visible on both sides of the talus in the frontal view,

confirming the evidence of a chondrocalcinosis (deposition

of multiple small calcified islands of bone within the synovi-

um of the joint). Also, edema of the soft tissue around the

ankle at the subcutaneous level could be observed.

COMMENTS

Especially for examinations of bone joints and the inner ear,

we primarily use the high resolution mode in order to detect

smallest details, such as micro calcification. This feature

allows us to provide an improved differential diagnosis com-

pared to normal scan modes.

HISTORY

A 75 year old woman was referred for a detailed evaluation

of her left ankle because of degenerative arthropathy, which

also entails mechanical pain. She benefited from a local infil-

tration of anaesthetics some time ago, with good results.

Prior standard x-rays confirmed a subastragalar arthropathy

of the talus (astragalus) and probably also astragalo-scaphoid

and tibio-tarsal. A high resolution CT scan was requested in

order to examine the different injuries of the region.

DIAGNOSIS

Using the high resolution mode of our SOMATOM Emotion 6

with a collimation of 6 x 0.5 millimeter, we were able to view

the degenerative processes in the tibio-astragalus region

with posterior constriction. We identified the presence of

several subchondral geodes-like formations (sphere shaped

structure which contains a hollow cavity), some 17 mm

diameter, mainly visible at the level of the anterior part of the

The SOMATOMEmotion scanners -from the single-slice SOMATOMEmotion to thenew, 16-sliceSOMATOM Emo-tion 16 – reliablyperform routineand advancedapplications.

CLINICAL OUTCOMES


[ 1 ] The axial view shows irregular, roughly spherical,bodies (arrowhead) in the anterior part of the heel boneas well as the presence of micro calcifications (arrow).

[ 2 ] Sagital view of degenerative processes of thetibio-astralagus part of the talus (arrows) with posteriorconstriction

[ 3 ] The coronal view shows the presence of microcalcifications, probably of cartilagenous origin (arrow-head), and edema of the soft tissue (arrow).

[ 4 ] VRT of the tibia shows the geodes-like structures ofthe anterior part of extremity distal of the tibia (arrow).


Scanner SOMATOM Emotion 6, high resolution mode

Scan area extremity

Scan length 80 mm

Scan time 32 s

Scan direction craniocaudal

kV 130 kV

Effective mAs 90 mAs (CARE Dose4D)

Rotation time 1.0 s

Slice collimation 6 x 0.5 mm

Slice width 0.6 mm

Table feed / rotation 2.5 mm


Kernel U90s

SOMATOMSensation

SOMATOMEmotion

SOMATOMSpirit

CLINICAL OUTCOMES


Case 6:Pre-operative Neurosurgical Planning By Carsten Figge, MD, Radiology Institute/Practice Drs. Mariß/Aref/Figge, Bad Zwesten, Germany

HISTORY

A 36 year old female with a suspected tumor was admitted

for neurosurgical evaluation after increasingly frequent

headaches during the last months, anosmia and emotional

labililty. The patient refused to undergo MR scanning due to

high grade claustrophobia. Pre-operative CT scanning was

requested by the neurosurgeons to provide more informa-

tion of possible tumor proliferation, infiltration into the

sinuses and dislocations of vessels.

DIAGNOSIS UND COMMENTS

The CT scan showed an inhomogeneous frontobasal

enhancing mass, a suspected meningioma of the olfactory

groove due to related symptoms with heterogeneous rim-

like enhancement. A peritumoral edema with compression

of the ventricles was also noted. CTA revealed a dislocation

of the arteriae cerebri anteriores and identified the feeding

arteries of the tumor. Additionally, a hyperosteosis in the

lamina cribrossa can be seen. Tumor growth in the sinuses

can be excluded.

In this specific case, having a patient with claustrophobia, the

combination of CTA, MIP and MPR reconstructions allowed

for successful surgical planning. This case demonstrates the

beneficial value of CT scanning as an alternative to MR scan-

ning in the preparation for surgical interventions.

The SOMATOM Spirit is a sub-

second, dual-slice CT scanner

for day-to-day clinical routine.

It is ideally suited for outlying

satellite clinics utilizing tele-

radiology as well as medical

fields other than radiology,

such as ENT, dental surgeons,

and general practitioners. By

adding CT to their medical serv-

ices, virtually any practice or

facility can improve the quality

of patient care and increase

patient volume.

New Multisclice CT – SOMATOM Spirit

The attractive design of the SOMATOM Spirit helps alleviate patients’ inhibitions.



Scanner SOMATOM Spirit

Scan area cerebrum

Scan length 110 mm

Scan time 25 s

Scan direction caudo-cranial

kV 130 kV

Effective mAs 50 mAs

Rotation time 0.8 s

Slice collimation 2 x 1 mm

Slice width 1.25 mm

Contrast Non ionic contrast media

Volume 120 ml

Flow rate 3 ml / s

Start delay 25 s

Postprocessing MIP, MPR, VRT

CLINICAL OUTCOMES

[ 1A ] Axial image showing a subfrontal extra-axialenhancing mass, with compression of the frontal lobes

[ 2 ] CTA of tumor feeding vessels

[ 3 ] Sagital MPR of the tumor [ 4 ] VRT of the menigeoma

Pitch 1.8


Kernel H21

SOMATOM Sensation 64z-Ultra-High Resolution ModeBy Thomas Flohr, PhD, Head of Physics and Application Development, and Karl Stierstorfer, PhD,

Physics and Application Development, Siemens AG, Medical Solutions, CT Division

A special ultra-high resolution mode, called z-UHR, providing

considerably enhanced spatial resolution, will be introduced

for new SOMATOM Sensation 64 scanners, starting in sum-

mer 2005: up to 0.24 millimeter isotropic resolution can

then be achieved in clinical routine. With z-UHR, the

SOMATOM Sensation 64 has reached a level of resolution

previously known only from non-clinical research CT sys-

tems using CsI-aSi flat-panel detectors. “The combination of

the revolutionary z-Sharp Technology and the unique z-UHR

functionality offers our users, in daily clinical routine, an

isotropic detail in the range of MicroCT technology,” says

Alexander Zimmermann, Global Product and Marketing

Manager SOMATOM Sensation.

The new mode is intended for ultra-high resolution bone-

imaging, in particular for wrists, joints, and inner ear studies.

Pre-requisite for z-UHR ultra-high resolution mode is the

unique z-Sharp Technology enabled by the Siemens propri-

etary STRATON X-ray tube. A moveable tantalum comb (grid)

is positioned in front of the detector elements, covering the

outer detector rows and effectively reducing the z-aperture

of the inner six detector rows from 0.6 millimeter to 0.35

millimeter at iso-center [Fig. 1]. Without z-Sharp Technology,

collimated 0.35 millimeter slices would be acquired with this

set-up – but unfortunately with a sampling distance of 0.6

millimeter and a corresponding “dead zone” of 0.25 millime-

ter, so that the slices would not be adjacent in the z-direction

and volume coverage would be incomplete. However,

z-Sharp Technology provides measurement data in these

dead zones as well. Using z-Sharp Technology, rays of subse-

quent readings are shifted by 0.3 millimeter at iso-center in

the longitudinal (z-) direction. Two subsequent six-slice read-

ings are interleaved and result in one twelve-slice projection

with 0.3 millimeter z-sampling distance and 0.35 millimeter

detector z-aperture – without gaps in the longitudinal direc-

tion. The data acquired with z-UHR correspond to those

obtained with a conventional detector with 0.3 millimeter

detector elements. The grid covers six adjacent 0.6 millime-

ter central detector elements, and thus provides the data of

12 x 0.3 millimeter collimated slices with z-UHR. Well defined

slices with 0.4 millimeter slice-width are reconstructed in a

spiral mode. Both in the scan plane and along the z-axis, an

isotropic resolution of 0.24 millimeter (240 micron) is

achieved. This can be demonstrated using the CATPHAN

(The Phantom Laboratories, Salem, NY). Turning the high

resolution insert by 90°, the bar patterns become roughly

oriented along the z-direction. Fig. 2 shows an MPR of this

phantom in the longitudinal direction, proving that 21 lp/cm,

corresponding to 0.24 millimeter object size, can be

resolved. Early clinical experience demonstrates that both

inner ear and wrist studies show significantly improved z-axis

resolution with increased clarity of sub-millimeter anatomic

structures [Fig. 3].


SCIENCE

Detector set-up

X-ray focus

Grid

0.35 mm

Scanfield z-axis

[ 1 ] Schematic illustration of the detector set-upused for z-UHR. A moveable tantalum grid is positioned in front of the detector elements,reducing their z-aperture to 0.35 millimeter atiso-center. z-Sharp technology is used to acquirereadings with a z-shift of 0.3 millimeter at iso-center. Two subsequent readings are interleavedand result in projection data with 0.3 millimeterz-sampling distance and 0.35 millimeter detectorz-aperture.


SCIENCE

3

[ 2 ] MPR of the high resolution insert ofthe CATPHAN, demonstrating 0.24 milli-meter isotropic resolution with z-UHRavailable for the SOMATOM Sensation 64.

[ 3 ] MPR of a wrist fracture acquired with 0.24 millimeter isotropic resolution.The image demonstrates a level of resolu-tion previously known only from researchCT systems with flat-panel detectors. (Image courtesy of Klinikum Großhadern, Munich,

Germany).

2

0.24

0.25

0.26

0.27

z-axis (mm)

SCIENCE


The 2004 introduction of Symbia with TruePoint SPECT·CT

technology definitely created new momentum in medical

imaging. A breakthrough in healthcare and medical imaging,

it provides a new tool to improve workflow efficiency and

accelerate patient diagnoses. Building on the foundation of

Siemens’ history of innovation and technology, Symbia is the

perfect merger of two equal modalities, single photon emis-

sion computed tomography (SPECT) and computed tomog-

raphy (CT), into one hybrid imager that will make a differ-

ence in the way medical imaging is delivered. SPECT imaging

is predominantly used to reveal a patient’s functional or vital

processes, such as blood circulation and the metabolism and

vitality of organs and tumors. The addition of CT to this imag-

ing technique provides the anatomical map for pinpointing

the exact location of disease in the body, in order match

metabolic or “functional” information.

A New ConceptSymbia’s imaging modalities, SPECT, SPECT·CT and Multislice

CT, can be used independently or together. Used in combi-

nation, TruePoint SPECT·CT provides contemporaneously

acquired, coregistered SPECT and diagnostic CT images, an

advance with immediate benefits for oncology and cardiology,

experts say.

“Experience from PET/CT tells us that there is an advantage

to having a diagnostic CT along with the nuclear medicine

study to aid in tumor localization and surgical planning,” says

Homer Macapinlac, MD, Deputy Chairman, Department of

Nuclear Medicine, M. D. Anderson Cancer Center, who is

planning for the installation of 5 Symbia TruePoint SPECT·CT

imagers in 2005. “M. D. Anderson Cancer Center’s mission is to

eliminate cancer, and our goal specifically in the Division of

Diagnostic Imaging is to provide the best imaging possible to

empower our physicians to help cancer patients,” Macapinlac

said, “Because the anatomical detail is essential to have in

combination with the functional information, TruePoint

Symbia TruePoint SPECT·CTCombining Forces to Improve Patient Care

Single Photon Emission Computed Tomography (SPECT) and ComputedTomography (CT) come together to revolutionize medical imaging

By Claudette Yasell, Nuclear Medicine Division,

Siemens Medical Solutions, Hoffmann Estates, IL, USA

SPECT·CT is going to help us in the diagnostic interpretation

of clinical exams. Ultimately, the person who benefits from

this new technology will be the patient.”

Experts believe that Symbia will also have a profound effect

on cardiac imaging. “I’m pretty excited,” says Edward Ficaro,

Ph.D., an assistant research scientist in the Department of

Radiology at the University of Michigan Health System, the

very first clinical installation of Symbia. Ficaro has spent

more than a decade working to improve the accuracy of

SPECT imaging, from acquisition through physician review.

He works closely with cardiac specialists and expects that

with Symbia, they will be able to register SPECT and CT

images of the heart with increased precision and accuracy.

“Registering these images isn’t being done routinely because

it's so difficult,‘ says Ficaro. The problem is that the thorax

isn't a rigid structure. So registration is not just a fixed point

rigid transformation, it’s often an actual morphing of the

body based upon known landmarks.“ With TruePoint

SPECT·CT technology, Symbia enables the examination of

function and perfusion of the right ventricle of the heart,

that, at just 1 to 4 mm thickness, is usually obscured in tradi-

tional SPECT studies.

Thinking AheadInnovations in technology have been the backbone of

Siemens' success. Innovations such as TruePoint SPECT·CT

were facilitated through an integrated team of engineers

and scientists from nuclear medicine and CT working togeth-

er to create new possibilities in the care of cardiac and cancer

patients.

After the incredible growth of PET/CT, customers and engi-

neers alike began to imagine the possibilities of SPECT and CT

together. Extensive customer surveys led to an initial con-

cept involving basic CT capabilities added to the powerful

SPECT capabilities of the e.cam Signature Series. The success

of PET/CT systems involving high-end CT technology and the


SCIENCE

explosive growth in Multislice CT studies, however, ultimate-

ly led the company to design the current line-up of Symbia

scanners, the T, T2 and T6 systems, involving single-, dual-,

or six-slice CT technology drawn directly from Siemens CT

Division.

Designing a Hybrid SuccessHaving already designed the best in SPECT, the design team

gave Symbia everything the e.cam has to offer, including HD

detectors, and unparalleled image quality and speed in

nuclear imaging. The team decided early-on to avoid the

“washer-dryer” approach of simply coupling two existing sys-

tems with a common patient bed, in favor of a more tightly

integrated design, using as many existing components as

possible.

The goal was to achieve a 200-cm scan range through both

systems’ fields of view without requiring an impractically

long patient motion range. An excessively long patient

motion range would have made it difficult to site the system

in standard nuclear medicine and radiology rooms.

Minimizing the patient motion range meant minimizing the

distance between the CT and SPECT fields of view. One pos-

sible solution, of course, would have been to mount the CT

and SPECT components on the same rotation gantry so that

they shared a field of view. However, the team rejected this

design because the weight of the SPECT heads would have

severely limited the gantry rotation speed and thus the

imaging speed achievable by the CT components. If state-of-

the-art Multislice CT components were to be used, the sys-

tem needed to be capable of the sub-second gantry rotation

speeds expected in modern Siemens' CT scanners. So the

team opted for maintaining distinct but closely spaced sub-

systems.

Fusing the two technologies was not simply a matter of

shoehorning the components of two existing systems into a

slightly larger housing. The system is highly integrated,

mechanically and electronically. While striving to make use

of existing components wherever possible, the team often

had to reconfigure and redesign components from each

technology in the interest of meeting their compactness

goals. The SPECT drive system was pushed to the outside,

which allowed the CT components to be brought closer to

the SPECT heads. The CT gantry was essentially redesigned,

allowing the components to be as close as possible. With the

SPECT and CT components tightly integrated, the resulting

system offers many possible modes of operation.

Meeting the Integration ChallengeThe push for tight integration extended to the software as

well. The team aimed at keeping the individual user inter-

faces the same as those employed in the component sys-

tems. The software operation of the Symbia TruePoint

SPECT·CT system is based on Siemens' exclusive syngo com-

mon medical imaging software platform that provides multi-

modality connectivity using the DICOM standard.

At the heart of the software lies the Flash 3D SPECT image

reconstruction software, based on an iterative maximum-

likelihood algorithm that allows for modeling and correction

of data degradations such as attenuation, collimator blur-

ring, and scatter. Obviously, the CT images can be used to

estimate the attenuation experienced by the SPECT photons,

but not directly. CT X-ray sources produce photons with a

broad range of energies, typically centered around 70 keV,

while SPECT radionuclides most commonly emit photons of

140 keV. To convert a CT image into a SPECT attenuation

map, it is necessary first to determine the effective average

energy of the photons contributing to the CT image, and

then to apply appropriate conversion factors to each pixel.

The conversion has to be accurate for all isotopes and SPECT

acquisition parameters. Moreover, the great difference in

resolution between CT and SPECT images must be bridged in

order for the CT images to be registered with SPECT for

attenuation correction.

Securing Clinical SuccessTo date, the intuitive interfaces of Symbia have been success-

ful in creating workflow efficiencies since the very first

national and international clinical installations were com-

pleted. The very first user, University of Michigan Health Sys-

tem, in Ann Arbor, MI, completed installation prior to the

2004 RSNA and the very first clinical images from Symbia

with TruePoint SPECT·CT were presented there. “The Symbia

SPECT and CT imaging come together in Symbia TruePoint SPECT·CT technology.


SCIENCE

with TruePoint SPECT·CT technology will allow us to take

nuclear cardiac imaging to the next level. We expect that

within the next year, we’ll be doing 80 to 90 percent of our

cardiac studies on these systems,” said James Corbett, MD,

professor of Radiology and Internal Medicine, Director of

Cardiovascular Nuclear Medicine, UMMC. “As we integrate

this new system into our clinical practice, we expect diag-

nostic accuracy to be improved significantly, as the amount

of information gathered will be considerably increased. This

should make the Nuclear Medicine SPECT images more accu-

rate, and the information from the spatially registered CT

scan will provide additional correlative data. We expect this

will prove to be important for patient care and significantly

enhance the diagnostic and prognostic value to the com-

bined imaging procedure, compared to conventional SPECT

imaging alone.”The University of Erlangen in Germany was

recently the first European recipient of Symbia. Professor

Torsten Kuwert, MD, Chairman of the Department of Nuclear

Medicine is confident that the addition of this hybrid imager

will ultimately achieve the same success as PET/CT. “By com-

bining SPECT and CT, it is possible to combine high biochem-

ical resolution with high anatomical resolution to really local-

ize neoplastic lesions, which should be expected to add to

the quality of diagnosis. Hybrid PET/CT systems have already

proven the diagnostic benefit, and most believe it’s not too

much of a stretch to expect the same from SPECT·CT.”

Siemens expects the Symbia hybrid imaging system to

appeal to a number of different medical specialists, including

radiologists, cardiologists and, of course, nuclear medicine

specialists. Fittingly for a system born of cooperation and

integration, it may actually realize its full potential when

used in concert across departmental lines, with interpreta-

tion of the diagnostic-quality CT scans and SPECT data ulti-

mately improving patient care.

HISTORYAn 82 year old male, 77 kg (169.2 lbs), with known coronary

artery disease, poorly controlled hypertension, insomnia and

other problems, came in for a routine follow-up after experi-

encing minor bouts of chest pain. His resting EKG was abnor-

mal. During exercise, he experienced greater than 1 to 2 mm

ST depression, but did not experience chest pain at that time.

DIAGNOSISA TruePoint SPECT·CT study was performed with the Symbia

hybrid imager using standard SPECT protocol in combination

with a 6-slice CT scan. The SPECT portion of the examination

revealed an apical and anterior defect that is mostly

reversible and an inferior and inferior-septal defect that is

significantly reversible. The scan also detected post-stress

LV dilatation.

Case StudyMyocardial PerfusionUsing TruePoint SPECT·CT

Images show an apical andanterior defect that’s mostlyreversible and an inferior and inferior-septal defect that is significantly reversible. CT attenuated corrected (AC) images show greaterreversibility of inferior defectthan uncorrected images.Also noted is post-stress LVdilatation.

By James Corbett, MD, Professor of Radiology and

Internal Medicine, Director of Cardiovascular Nuclear

Medicine, University of Michigan, Ann Arbor, MI, USA


SCIENCE

ArchaeologyHigh-tech Meets History

Siemens Computed Tomography (CT) scanners help unravel the past: In January 2005, the ancient Egyptian mummy Tutankhamen was examinedby an Egyptian team utilizing a SOMATOM Emotion 6 to explore how old he was at death, if he had suffered from any diseases, what he died of, and todetermine the condition of the mummy itself. The following results wereannounced in Cairo in March 2005.

Was King Tutankhamen killed? Zahi Hawass, PhD, Secretary

General of Egypt’s Supreme Council of Antiquities, stated

that there is no evidence that the young king was actually

murdered. This murder theory is based upon an X-ray exam-

ination of the pharaoh’s head in 1968 which revealed a

cloudy area at the back of the skull. The project’s scientists

have now agreed that there is no evidence of murder. There

is nothing that indicates a blow to the rear of the skull. There

are two bone fragments loose in the skull, but these cannot

possibly have been from an injury causing death – they

would have become stuck in the embalming resin. The sci-

entists have matched these pieces to the fractured cervical

vertebra and foramen magnum, and believe these were bro-

ken either during the embalming process or in 1925 by the

mummy’s discoverers, who were trying to get access to the

gold artifacts wrapped with the mummy.

Careful MummificationBased on the identification of at least five different types of

resin and the many episodes of its introduction to the body

and cranial cavity, the scientists concluded that great care

was taken in the mummification of the pharaoh. This coun-

ters previous arguments that the body was prepared hur-

riedly and carelessly, perhaps to cover up a crime. However,

the remains of Tutankhamen are in very poor shape, primarily

due to the damage done by the Howard Carter team that dis-

covered the tomb in 1922. The body is in several pieces.

Bones and skin are broken in numerous places. The king’s

arms, originally folded across his chest, are now by his sides.

Many parts are missing, although fragments remain loose in

the sand tray where the mummy is resting.

The scientists noted a fracture of the left lower femur, at the

level of the epiphyseal plate. This fracture appears different

from the breaks caused by Carter’s team: it has ragged

[ 1 ] One of Tutankhamen’s wisdom teeth is still impacted.

[ 2 ] The king had a small cleft in his hard palate.

[ 3 ] Whole body of pharaohTutankhamen

Clinical images courtesy of Supreme Council of Antiquities

edges, and there are two layers of resin inside. Some scien-

tists believe that the resin indicates that this can only have

occurred during Tutankhamen’s life or the embalming pro-

cess. They note that this type of fracture, unlike many others,

is possible in young men. There is no obvious evidence of

healing, but such indications may be masked by the resin.

Since the associated skin wound would still have been open,

this fracture would have had to occur shortly before death.

Carter’s team had noted that the patella on his left leg was

1

2

3

SCIENCE


loose, possibly suggesting further damage to his body. Now

the patella is completely separated, and has been wrapped

with the left hand. Scientists also noted a fracture of the

right patella and right lower leg. Based on this evidence, they

suggested the king may have suffered an accident in which

he broke his leg, leaving an open wound. Although the break

itself would not have been life-threatening, infection could

have set in. However, it is also possible, although less likely,

that this fracture was caused by the embalmers. Other sci-

entists maintain that the fracture can only have been inflict-

ed by Carter’s team during extraction of the body from the

coffin. They argue that if such a fracture had been suffered in

life, there would have been evidence of hemorrhage or

hematoma in the CT scan. They believe the resin was pushed

into the fracture by Carter’s team.

The examination confirmed that Tutankhamen had died at

about the age of 19. The fusion of the epiphyseal plates

matches the development of a young man of 18 or more,

and 20 or less. The wisdom teeth are not completely grown.

One of them [Fig. 1] is impacted, and there is a slight thin-

ning of the sinus cavity above. The king had a small cleft in

his hard palate [Fig. 2], not associated with an external

expression such as a hare-lip. His lower teeth were slightly

misaligned. He had large front incisors and the overbite char-

acteristic of other kings from his family. Tutankhamen had a

dolichocephalic skull. As the cranial sutures are not prema-

turely fused, this is most likely a normal anthropological vari-

ation rather than any pathology. There is a slight bend in his

spine; the scientists agreed that this is not scoliosis, since

there is no rotation and no associated deformation of the

vertebrae. The bend thus most likely reflects the way the

mummy was positioned by the embalmers.

The sternum and a large percentage of the front ribs of the

mummy are missing. Their ends appear to have been cleanly

cut by a sharp instrument. The scientists agree that this can-

not mirror extensive trauma to the chest, as such trauma

would have left marks elsewhere in the body. Opinion is

divided as to whether the ribs and sternum had been

removed by the embalmers or by Carter’s team. Archaeological

investigation will continue in an attempt to resolve this issue.

Tutankhamen was approximately 170 centimeters tall [Fig. 4],

as extrapolated from the measurement of the tibia. Judging

from his bones, which indicate a slight build, he had been

well-fed and healthy, and had not suffered major childhood

malnutrition or infectious diseases. His internal organs, as is

usual for Egyptian mummies, are not present in the body,

and thus could not be analyzed.

The Egyptian scientific team, headed by Dr. Hawass, consisted

of radiologists, pathologists, and anatomists from the Faculty

of Medicine at Cairo University. The team later invited three

foreign consultants to work with them.

The examination was part of a research project being con-

ducted by Egypt’s Supreme Council of Antiquities. The project

also includes meticulous CT scans of a large number of other

Egyptian mummies. To support the project, Siemens Medical

Solutions and the National Geographic Society have provided

a SOMATOM Emotion 6 installed in a trailer – making it trans-

portable to wherever it is needed. With this device, the fragile

remains of Egypt’s ancient people can be studied with a min-

imum of movement and disturbance with the ultimate view

of prolonging preservation.


www.ngs.org; www.guardians.net/hawass/

k

The Great Art Detective

Using CT for ancient relics is not only restricted to

human remains. At RSNA 2004, a group of Belgian

scientists led by Marc Ghysels, MD, illustrated the

spectrum of CT findings in wooden, ivory, pottery and

stone sculptures. Using a SOMATOM Volume Zoom,

these experts are able to disclose manufacturing tech-

niques, natural damage, repairs, restoration and

fakes. When a collector is interested in an art work,

one of his primary concerns is to establish its authen-

ticity. This is based on both subjective factors and

scientific analysis such as stylistic analysis, thermolu-

minescence or carbon-14 analysis, dendrochronologi-

cal study, spectroscopic or microscopic analysis etc.

Unlike these tests, which focus mainly on the visible

parts of the work or on a few samples, CT has the

advantage of describing the inner state of the object,

without damaging it in any way.

[ 4 ] Zahi Hawass, PhD, Secretary General of theSupreme Council of Antiquities, takes a close look atthe mummy of Tutankhamen. Photo courtesy of Brando Quilici

CUSTOMER CARE


L i f e : E D U C AT E

A Win-Win SituationWith the SOMATOM Sensation Cardiac 64 taking cardiac CT to the next level,the need for dedicated customer training increases. Siemens Medical Solutionssupports its customers, providing firsthand know-how, and the possibility toexchange experience with well-versed medical colleagues.

Siemens’ Life customer care solutions

offer an array of measures to customers

to get the most value out of their

systems by maximizing their clinical

know-how. In addition to a full range of

continuous learning programs – from

extensive start-up and technical training

to applications support and web-based

courses – customers can attend work-

shops, fellowships, and symposiums

held in close cooperation with

renowned clinical partners.

Workshops on cardiac computed

tomography (CT) are being held at

Erasmus Medical Center, Rotterdam, The

Netherlands; Friedrich-Alexander Uni-

versity Clinic, Erlangen, Germany; Uni-

versity Hospital Muenster, Germany and

other distinguished institutions. In

co-operation with Siemens, these part-

ners offer regular courses for both

radiologists and cardiologists, combin-

ing lectures and hands-on training on

the SOMATOM Sensation Cardiac 64.

Participants have the chance to observe

patient exams, attend lectures and par-

ticipate in case studies review sessions.

Some physicians just starting with

cardiac CT and with no experience in

radiology, appreciate an even deeper

insight. Frans Santosa, MD, from the

cardiovascular Waringin Medika clinic in

Jakarta, Indonesia, is a German-trained

internist, cardiologist and angiologist,

who was not very familiar with radio-

logy. However, he saw the advantages

of cardiac CT and purchased two

SOMATOM Sensation Cardiac 64s in late

2004, one for his clinic, one for a private

practice he started with some col-

leagues. Just before installation, he

spent quite some time at the Friedrich-

Alexander University Clinic in a fellow-

ship program. “I really appreciate the

chance to learn from my experienced

German colleagues. Everyone has been

very generous sharing their knowledge,

and I now see even more clinical capabil-

ities of the SOMATOM Sensation Cardiac

64 than I thought before,” he resumes.

Not only do the trainees profit from the

fellowship program, but the hosting

clinics as well. Says Stefan Martinoff,

MD, Director of the Clinic for Radiology

and Nuclear Medicine at the German

Heart Center in Munich (DHM), “We

Stefan Martinoff, MD: "Not only doour guests profit from us, we alsoprofit from them. It is a win-winsituation."

Frans Santosa, MD (2nd from right):“Thanks to Siemens’ Life Program,I’ve been able to optimally utilizemy new SOMATOM SensationCardiac 64 right from installation.”

have made some excellent international

connections during the past years. We

are very proud of our worldwide net-

work of physicians and scientists. Our

joint objective is to steadily increase the

quality of medical care.”

Radiologists and cardiologists at the

DHM diagnose CT images together.

“Coronary CT is at its best and optimal

patient care is ensured only when both

specialties sit together at the same

table,” emphasizes Martinoff. “A physi-

cian can not be both a radiologist and a

highly trained cardiologist at the same

time,” he offers with conviction. “This is

why cooperation is a must, although it is

not practiced everywhere due to fre-

quent competition between the two

specialties.”


EDUCATIONCUSTOMER CARE

E D U C AT E

Cross-country Post-processing Events

T E C H N O LO G I ST E D U C AT I O N SYM P O S I U M

CT Imaging and Cherry Blossoms

Following last year’s success, Siemens

Medical Solutions again supported

hands-on training sessions at Professor

Elliot Fishman’s popular “Advanced Top-

ics in Computed Tomography (CT) Scan-

ning” CME accredited courses in Los An-

geles (April 1–3rd, 2005) and Baltimore

(April 8–10th, 2005). Over 300 radiolo-

gists and technologists took advantage

of the opportunity to learn more about

the principles of 3D and virtual imaging

with syngo InSpace4D, CT-Angiography,

cardiac CT, virtual colonography and

lung imaging. Siemens provided 20

LEONARDO workplaces enabling partici-

pants to work individually during each

of the clinical hands-on sessions. Ses-

sions, lead by both experienced Hopkins

faculty and Siemens applications spe-

cialists, gave attendees the opportunity

to work through a wealth of specially

selected clinical cases. Everyone walked

away with a firm grasp of the principles

and clinical application of 3D and virtual

post-processing techniques.

ESGAR’s 3rd CME accredited Hands-on

Workshop, “CT-Colonography” (April 26–

28th, 2005) was hosted by Phillipe Lef-

ere, MD, and Stefaan Gryspeerdt, MD,

from Stedelijk Ziekenhuis, Roeselare, Bel-

gium. Places were limited to 40 for each

of the two concurrent workshops, and a

total of 80 radiologists joined the invited

faculty in the beautiful ancient city of

Bruges, Belgium, for a packed two day

program. The first day of each workshop

was comprehensive with lectures and

hands-on demos on the essentials of CT-

Many customers took advantage of the

outstanding possibility to benefit from

the integrated approach across modali-

ties that Siemens offers for radiology, car-

diology, and oncology solutions. This

year's Technologist Education Sympo-

sium took place in Washington DC, USA

from April 17th to 19th and offered

sessions related to cardiac and vascular

angiography, diagnostic radiology,

computed tomography (CT), magnetic

resonance (MR), nuclear medicine/PET,

oncology, and ultrasound, including

various lectures and hands-on training.

Once again this was a successful event

for everyone who came to learn about

clinical routine and topics encompassing

the cutting edge of medical imaging

technology. The first day, all participants

met for a for a general preview of the

Colonography (CTC) from leading CTC

experts including Johannes Wessling,

MD, (Munster, Germany) and Andrea

Laghi, MD, (Rome, Italy). Day two was

dedicated to tutored hands-on sessions

with faculty members present to guide

the participants through over 100 spe-

cially selected cases. Siemens Medical

Solutions supported the workshop with

six LEONARDO workplaces running syngo

Colonography software. “The workshop

ideally balanced between lectures and

plenty of time for hands-on training. Hav-

ing a clinical expert guiding us through

the more challenging test cases was very

helpful. I came away with useful tips that

will certainly enhance my CTC workflow,“

says Christian Lauer, MD, O.L.V.V. Lour-

des-Ziekenhuis, Belgium.

educational symposium, reviewing case

studies and overall topics concerning

the different healthcare sectors. The

evening ended with a welcome recep-

tion. During the following two days, all

participants had the chance to attend lec-

tures for cardiac & vascular angiography,

diagnostic radiology, CT, MR, or breakout

sessions, according to their own fields of

interest. For CT, there were speakers from

Siemens as well as from well known insti-

tutions, like Andy Trovinger from Radiolo-

gy Imaging Associates and Williams

Jonathan, MD, from Shands Jacksonville.

Several companies exhibited their filming

products, injector systems and MRI ac-

cessories. But even with such an exciting

program, all participants still had enough

time to enjoy Washington’s cherry blos-

soms and socialize at the dinner buffet.

Both, the courses at “Advanced Topics in CT Scanning“ (left), and the Hands-on Workshop “CT-Colonography” at ESGAR (right), were met with enthusiasm.

During the LEONARDO hands-onsession, participants worked withthe latest applications.

CUSTOMER CARE

Via the SOMATOM World User Lounges, Siemens applica-

tions specialists answer your questions on “how to …” easily

use Siemens Computed Tomography scanners and applica-

tions in daily clinical practice. Additionally, SOMATOM Sessions

offers a regular column with frequently asked questions for

offline reference.

Why can’t I remove patient protection to delete studiesfrom the browser?Reload the study back into the exam card, check for open

recon jobs and delete the open recon jobs, if present. Take

note of the position of the chronicle bars: if any are indented,

patient protection is applied. Once the chronicle bars are all

to the left, the study is no longer protected.

Patient information is incorrect. Can I change it afterscanning is completed?After reconstructions are complete, select the patient in the

browser. Be sure that the study is not open in any platform,

no open recon jobs exist and the study is not delete protected.

S E R V I C E

Frequently Asked Questions

On the browser drop down menu, select ’Edit and Correct‘.

A warning box will appear that this is an external document;

select ’Continue‘. The correct platform will then open. The

major topics are on the left side of the vertical tabs and the

right side has the details for each section. Make the neces-

sary changes and sign off with your initials (minimum of

3 letters) in the upper right hand corner of the platform and

then click ‘OK‘ in the bottom left corner.

Why are the images that I sent to filming in reverse order?The order of the images depends on the configuration of

your browser. The sort functions on the browser vary with

each level of the patient study. The selections for the patients

name are alphabetical, chronological, work status or reverse

order. On the series level, multiple and modality specific

selections are also available. Simply select the local database

heading and sort for ’DB Date and Time‘, for the study level

select ’Study Date and Time‘, and the series level should be

set to ’Instance Number‘. Also make sure to deselect any level

with reverse order activated.

7 T H I N T E R N AT I O N A L S O M ATO M C T U S E R C O N F E R E N C E

Exploring the Riches of Multislice CT

of outstanding clinical results in the vari-

ous fields of CT imaging. The 17th centu-

ry Teatro Capranica provided beautiful

surroundings for 60 luminary speakers,

lecturing on topics such as “Technology

Principles of Multislice CT”, “Head and

Neck“, “Chest“, “Cardiac“, “Abdominal“,

and “Vascular CT“, and “New Frontiers in

CT”. The lectures were supplemented by

panel discussions, case demonstrations,

hands-on workstation sessions, and a

poster exhibition.

Professor Roberto Passariello, MD, head

of the Department of Radiologic Sciences,

was chairman of the conference, sup-

ported by Carlo Catalano, MD, Associate

Professor at the same department (both

University Hospital La Sapienza, Rome,

Italy). Professor Elliot Fishman, MD, Johns

Hopkins Hospital, Baltimore, MD. USA,

and Professor Yutaka Imai, MD, Tokai

University, Tokyo, Japan, were co-chair-

men. A CD of the conference will be

available soon.

The more than 150 participants alsoenjoyed the view over Rome’s ancientroofs at an exclusive social event.

High-end clinical applications were at

the center of the 7th International

SOMATOM Computed Tomography (CT)

User Conference, held in conjunction

with the University Hospital La Sapienza,

in Rome, Italy, in May 2005.

The “Eternal City” alone, with its impres-

sive art and architecture, the Forum and

Coliseum, the baroque churches and

the Vatican, would have been enough

to fill everybody’s senses. But there

have been remarkable achievements in

CT technology and applications since

the last Siemens User Conference in

2002, and all participants were eagerly

awaiting the latest information from

research groups from around the world.

Renowned speakers presented a wealth



CUSTOMER CARE

C T O N LI N E

CT on the World Wide Web

www.insideinspace.comInside InSpace introduces technicians

and physicians to syngo InSpace, the

volume imaging application for interac-

tive display of volume datasets from

Computed Tomography and 3D Angio-

graphy. The website offers complete

information on all software features

and specifications. Hints and tips, plus

an 'Ask the Experts' button support

users in getting the most out of syngo

InSpace4D in their daily clinical work. A

selection of feature articles and lectures

is available for reference. The latest

syngo InSpace4D presets are offered for

download. A video and image gallery

introduces interesting cases. The infor-

mation is supplemented by CME course

dates for syngo InSpace.

k

S I E M E N S R E M OT E S E R V I C E

Information and Services AvailableDirectly at Your CT Scanner

In addition, you can always find the latest CT courses offered by Siemens Medical Solutions at www.siemens.com/SOMATOMEducate.

Upcoming Events & Courses

Title Location Short Description Date Contact

6th International Boston, USA International Meeting July 21–23, 2005 cme.med.harvard.edu Conference on Cardiac CT

ESC Stockholm, European Society of Sept. 3–7, 2005 www.escardio.orgSweden Cardiology Congress

ASTRO Denver, USA American Society for Oct. 16–20, 2005 www.astro.orgTherapeutic Radiology and Oncology Congress

TCT Washington, USA Transcatheter Cardiovascular Oct. 17–21, 2005 www.tct2005.comTherapeutics Sympoisium

ESTRO Paris, France European Society for Oct. 30–Nov. 3, 2005 www.estroweb.orgTherapeutic Radiology and Oncology Congress

AHA Dallas, USA American Heart Association Nov. 13–16, 2005 www.americanheart.orgScientific Sessions www.scientificsessions.org

RSNA Chicago, USA Radiological Society of Nov. 27–Dec. 2, 2005 www.rsna.orgNorth America Congress

CME Courses Johns Hopkins University, Focus on multislice CT Regular events, www.CTisus.comUniversity, Baltimore, USA; scanning and please see websiteand other US locations post-processing

Working efficiently in a radiology department becomes more and more dependent

on information. How about finding the latest application guide online? Or easily

receiving information about new software that might simplify daily workflow? Or try-

ing new applications before purchasing? This and much more is possible with

SOMATOM LifeNet, the information

and service portal available free of

charge directly at your Computed

Tomography (CT) scanner consoles.

As a Siemens customer, you can even

download the latest scan protocols to

make sure they are always up to date.

To find out how SOMATOM LifeNet

can help you with your daily work,

simply go to SOMATOM LifeNet under

Options in your syngo menu bar. The

only prerequisite is Siemens Remote

Service, a feature provided at no addi-

tional cost in the Siemens service

agreement.

LifeNet offeres easy access to thelatest information – directly at theCT scanner console.

CUSTOMER CARE

SOMATOM SESSIONS – IMPRINT

PublisherSiemens AG

Medical Solutions

Computed Tomography Division

Siemensstraße 1

D-91301 Forchheim

Responsible for Contents:Bernd Ohnesorge, PhD

EditorsDoris Pischitz, M.A.

([email protected])

Stefan Wuensch, PhD

([email protected])

Editorial BoardJessica Amberg

Joachim Buck, PhD

Thomas Flohr, PhD

Chad DeGraaff

André Hartung

Sandra Jeleazcov

Matthew Manuel

Louise McKenna, PhD

Axel Lorz

Jens Scharnagl

Authors of this IssueGeoffrey Browne, MD,


Burlington, USA

Chris DeAngelo RT (R), (CT),


Burlington, USA

J. Debus, MD, PhD,

Department of Radiation Oncology,

University of Heidelberg, Germany

Eric Devilaine, Chief of X-ray Technician Team,

Centre Hospitalier Robert Morlevat,

Semur en Auxois, France

J. Dinkel, MD,



Carsten Figge, MD,

Radiology Institute/Practice Drs. Mariß/Aref/Figge,

Bad Zwesten, Germany

V. Lambert, MD,

Department of Cardiopediatry,

Marie Lannelongue Hospital,

Le Plessis-Robinson, France

U. Mende, MD, PhD,



Jean-François Paul, MD,

Department of Radiology,



Jin Zheng Yu, MD,


Peking Union Medical College Hospital,

Beijing, China

Anne Sigal-Cinqualbre MD,




Ly Thai Bach, MD, Chief of Radiology Unite,

Centre Hospitalier Robert Morlevat,

Semur en Auxois, France

© 2005 by Siemens AG, Berlin and Munich, All rights reserved

Xue Hua Dan, MD,

Department of Radiology

Peking Union Medical College Hospital,

Beijing, China

Tony De Lisa, freelance writer

Jessica Amberg; Chad DeGraaff; Thomas Flohr,

PhD; Lars Hofmann, MD; Louise McKenna, PhD;

Per Anselm Mahr; Bernd Ohnesorge, PhD; Rainer

Raupach, PhD; Gitta Schulz; Karl Stierstorfer, PhD;

Heiko Tuttas; Claudette Yasell; all Siemens Medical

Solutions

ProductionNorbert Moser, Siemens Medical Solutions

Layoutindependent Medien-Design

Widenmayerstrasse 16, D-80538 Munich

PrintersFarbendruck Hofmann

Gewerbestraße 5, D-90579 Langenzenn

Printed in Germany

SOMATOM Sessions is also available on the

internet: www.siemens.com/SOMATOMWorld

Note in accordance with § 33 Para.1 of the German Federal Data Protection

Law: Despatch is made using an address file which is maintained with the

aid of an automated data processing system.

SOMATOM Sessions with a total circulation of 35,000 copies is sent free of

charge to Siemens Computed Tomography customers, qualified physicians

and radiology departments throughout the world. It includes reports in the

English language on Computed Tomography: diagnostic and therapeutic

methods and their application as well as results and experience gained with

corresponding systems and solutions. It introduces from case to case new

principles and procedures and discusses their clinical potential.

The statements and views of the authors in the individual contributions do

not necessarily reflect the opinion of the publisher.

The information presented in these articles and case reports is for illustra-

tion 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 to

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

herein are consistent with the approval labeling for uses and/or indications

of the drug. The treating physician bears the sole responsibility for the diag-

nosis and treatment of patients, including drugs and doses prescribed in

connection with such use. The Operating Instructions must always be strictly

followed when operating the CT System. The sources for the technical data

are the corresponding data sheets. Results may vary.

Partial reproduction in printed form of individual contributions is permitted,

provided the customary bibliographical data such as author's name and title

of the contribution as well as year, issue number and pages of SOMATOM

Sessions are named, but the editors request that two copies be sent to

them. The written consent of the authors and publisher is required for the

complete reprinting of an article.

We welcome your questions and comments about the editorial content of

SOMATOM Sessions. Manuscripts as well as suggestions, proposals and

information are always welcome; they are carefully examined and submitted

to the editorial board for attention. SOMATOM Sessions is not responsible

for loss, damage, or any other injury to unsolicited manuscripts or other

materials. We reserve the right to edit for clarity, accuracy, and space.

Include your name, address, and phone number and send to the editors,

address above.


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SOMATOMSessions

No.16/June 2005Stanford University’s 7th Annual International Symposium on Multidetector-Row CT June 15-18, 2005

www.siemens.com/medical

COVER STORYThink Clinical!Page 4

NEWSSOMATOM Sensation – 40-Slice TechnologyPage 12

BUINESSSOMATOM Spirit – “And itruns, and runs, and runs...“Page 15

CLINICAL OUTCOMESsyngo Body Perfusion CT – Differential Diagnosis of a PancreasPage 20

SOMATOM Emotion 6 High Resolution OrthopedicsExaminationPage 24

SCIENCEArchaeology – High-techMeets HistoryPage 33

CUSTOMER CARE

LIFE Educate – A Win-Win SituationPage 35

Highlights

SOM

ATO

MSe

ssio

ns

© 06.2005 Siemens SOMATOM Sessions

Order No. A91100-M2100-3416-1-7600

Printed in Germany

CC 43416 WS 060535.

On account of certain regional limitations of sales

rights and service availability, we cannot guarantee

that all products included in this brochure are

available through the Siemens sales organization

worldwide. Availability and packaging may vary

by country and is subject to change without prior

notice. Some/All of the features and products

described herein may not be available in the

United States.

The information in this document contains general

technical descriptions of specifications and options

as well as standard and optional features which do not

always have to be present in individual cases.

Siemens reserves the right to modify the design, pack-

aging, specifications and options described

herein without prior notice. Please contact your local

Siemens sales representative for the most current

information.

Note: Any technical data contained in this document

may vary within defined tolerances. Original images

always lose a certain amount of detail when

reproduced.

Please find fitting accessories:

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Siemens AGWittelsbacher Platz 2D-80333 MunichGermany

HeadquartersSiemens AG, Medical SolutionsHenkestr. 127, D-91052 ErlangenGermanyTelephone: +49 9131 84-0www.siemens.com/medical

Contact AddressSiemens AG, Medical SolutionsComputed TomographySiemensstr. 1, D-91301 ForchheimGermanyTelephone: +49 9191 18-0

SOMATOM SessionsIssue No.16/June 2005

somatom sessions 16

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