True Dual Energy - DRG.de · SOMATOM Force 80/Sn150kV, 90/Sn150kV, ... Courtesy of Hospital Povisa, Vigo, Spain ... True Dual Energy – DEfinitely Siemens Dual Spiral Dual …

DEfinitely

Siemens

Answers for life.

International version. Not for distribution in the US.

Unrestricted © Siemens AG 2015 All rights reserved.The products/features (here mentioned) are not commercially available in all countries. Due to regulatory reasons their future

availability cannot be guaranteed. Please contact your local Siemens organization for further details.

True Dual EnergyDr. Stefan Ulzheimer, Siemens Healthcare GmbH

Siemens

Answers for life.

History

March 2014Page 2 H IM CR

SOMATOM DR

History

Since the introduction of the SOMATOM Definition, the number of annual publications on Dual Energy has skyrocketed from 0 to ~300.

Nu

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rtic

les

70

80

90

100130


1989 1990 1991 1992 1993 1994 2006 2007 2008

10

20

30

40

Nu

mb

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ori

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al a

rtic

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Introduction of theSOMATOM Definition

= Publications on Dual Energy with the SOMATOM Definition and Definition Flash

2005

02009

50

60

2010

Two steps ahead in Decision Making:Precise Dual Energy quantification

Courtesy of UMM, Mannheim, Germany

SOMATOM Force

� 80/Sn150kV, 90/Sn150kV, 100/Sn150kV

� min. rotation time 0.25s

� FOV B-detector: 350 mm

� collimations: 64x0.6mm, 128x0.6mm,


� collimations: 64x0.6mm, 128x0.6mm,

196x0.6mm

� 2d anti scatter grid

� 50% thicker tin filter (×2)

� Vectron tubes (up to 1300mA)

� low noise StellarInfinity detectors

SOMATOM Definition Flash Dual Source Dual Energy (DE)

• Characterize, highlight and quantify material

• Dose-neutral compared to a single 120 kV scan

DE with Selective Photon Shield

Selective

Photon Shield II


• Improved spectral separation

high kV

Attenuation B

low kV

Attenuation A

SOMATOM Definition Flash/ SOMATOM Force Dual Source Dual Energy

Conventional Dual Energy CT DE with Selective Photon Shield I and II


• Significant spectral overlap

• Limits energy separation

• Limits dose efficiency

• Minimized spectral overlap

• Up to 80% better energy separation

• Complete dose neutrality

Technical realization of dual-energy CTDual-Source CT

Dual source CT

� Fast rotation (0.28 s), reliable imaging of moving organs

� Flexible choice of scan

parameters (mA, pitch, ...)to individually adapt radiation dose

x 10415

S1: 80 kV

80 kV

S2: 140 kV + SPS


to individually adapt radiation dose to the patient

� Selective Photon Shield

� Optional tin pre-filtration

� Improves spectral separation

� Makes dual energy dose-neutral

� equivalent to a 120 kV scan

10

5

0 50 100 150X-ray photon energy (keV)

80 kV

140 kV

0.4 mm tin

140 kV

+ SPS

Technical highlightBest spectral separation in the market

100 kV / 140 kV Sn 90 kV / 150 kV Sn


Up to 30% increased energy separation for

better DE imaging outcomes

Comparison Definition DS SE / Flash DE(DE composition 0.6)

Ultravist

315.3 320.2

Definition DS SE standard

Body Angio (120kV)

Definition Flash DE

100kV/Sn140kV


Noise & Contrast & Dose equivalent to single energy on Definition DS

(for FAST body bone removal protocol)

NH4Cl Bone MgSO4

NaBr

466.8 466.0

256.2 258.8

102.5 96.0 98.490.0

27.624.6

SDSD

CTDIvol=8.65mGy

Proven Dose Neutrality

March 2014Page 10 H IM CRCourtesy of Mayo Clinic Rochester, MN, U.S.A.

Dual Energy Principle

� Many materials show different attenuation at different X-ray energies� Different attenuation mechanisms: photo effect �� Compton effect

1.0E+01

1.0E+02

ray a

bs

op

rtio

n

Iodine solutionBone

E1E2


� Attenuation change from low to high energy characterizes the material

� Energy-resolved CT can determine chemical composition

1.0E-01

1.0E+00

1.0E+01

10 30 50 70 90 110 130 150X-ray energy / keV

X-r

ay a

bs

op

rtio

n

Small increase

for bone

Large increase

for iodine

Where does the infomation come from?

80kV 140kV

Blood

BoneIodine

CT-value

80 kV

IDENTITY

0 HU


� need stable CT values; excellent scanner calibration� no separation for materials at same position in diagram

� CT and DECT are not sensitive to chemical binding

Air

Water

FatCT-value

140 kV

0 HU

-1000 HU

Processing of DE data

Bone550 HU Iodine

425 HU

� Clinical application: Separation of two materials

� Assume mixture of blood + Iodine and bone marrow + bone

HU

at

80

kV 400

500

600

Separation line

Iodine pixels

Bone pixels


140kV

Bone400 HU Iodine

250 HU

80kV

-100-100 0 100 200 300 400 500 600

HU at 140 kV

HU

at

80

kV

0

100

200

300

400

� Additional postprocessing to improve classification at low HU numbers

Blood+Iodine

Marrow+bone

Softtissue

Bone pixels

TwinBeam Dual Energy* in combination withcarotid angiography reveals total occlusion of RIC and stenosis of LIC

collimation: 64 x 0.6 mm

scan time: 6 s

scan length: 337 mm

rotation time: 0.30 s

tube setting:

TwinBeamDual Energy

March 2015Page 14

Unrestricted © Siemens AG 2015 All rights reserved.

HC IM CRPage 14 March 2015 HC IM CR


tube setting:

AuSn120 kV, 365 eff. mAs

CTDIvol: 7.65 mGy

DLP: 279 mGycm

Eff. Dose: 0.87 mSv

Courtesy of University Hospital Erlangen-Nuremberg, Erlangen, Germany

*TwinBeam Dual Energy is pending 510(k) clearance and is not yet commercially available in the United StatesPost processing software is under development. Not available for sale in the U.S.

Applications of Dual Energy CT

xlow (HU)

body materials+

contrast agent

contrast

xlow (HU)

material

map

xlow (HU)

other body materials

Material Decomposition Material Labeling Material

Highlighting


� Optimum Contrast� Monoenergetic

xhigh (HU)

body materials

VNC

xhigh (HU)

common body material

separation line

xhigh (HU)

enhanced visualizatiuon

Image Quality

Improvement

Generic Material

Differentiation

� Dual Energy Index

� ρe/Zeff decomposition** non product

The first Urate Stone


Page 16 Jul-14 Siemens AG H IMBernhard Krauss

• heavy patient• scanned at 90/Sn150kV

• perfect separation between uric acid stone and calcium

Co

urt

esy

of H

osp

ita

l Po

vis

a, V

igo

, S

pa

in


Co

urt

esy

of H

osp

ita

l Po

vis

a, V

igo

, S

pa

in

syngo.CT DE

Virtual Unenhanced

syngo.CT DE

Lung Analysissyngo.CT DE

Direct Angio

True Dual Energy CTExpand your clinical capabilities for Dual Source Dual Energy

syngo.CT DE Gout Optimum Contrast syngo.CT DE

Calculi Characterization


syngo DE

Xenon

October 2014Page 18 H IM CR MK C

syngo.CT DE

Bone Marrowsyngo.CT DE

Heart PBV

syngo.CT DE

Brain HemorrhageMonoenergetic

syngo.CT DE

Monoenergetic Plus

syngo.CT DE

Hardplaque Display

syngo DE

Musculoskeletal

syngo.CT DE

Lung Nodulessyngo.CT DE Rho/Z

True Dual Energy – DEfinitely Siemens

Dual Spiral Dual Energy

TwinBeamDual Energy

Dual Source Dual Energy


March 2015Page 19 HC IM CR

SOMATOMPerspective

SOMATOMDefinition AS

SOMATOMDefinition AS+

SOMATOMDefinition Edge

SOMATOMDefinition Flash

SOMATOMForce

SOMATOMDefinition AS+

SOMATOMDefinition Edge

SOMATOMScope Power

TwinBeam Dual Energy

Improve patient outcome with

TwinBeam Dual Energy

• Simultaneous acquisition of high and low

energy spectra

• All dose reduction technologies applicable,



• All dose reduction technologies applicable,

such as CARE Dose4D, SAFIRE, ADMIRE, etc.

• Routine ready with FAST DE Results (direct

transfer of Dual Energy images to the PACS)

*This feature is 510(k) pending. Not available for sale in the U.S

Single Source Dual Energy (SSDE)TwinBeam

MoveableSplit Filter

Spectrum behind filter

Spectrum in front of filter

Low Energy



High Energy

Overall result:

• convenient workflow (one topo only, 50cm FOV)

• DE evaluation results typically better than Definition DS120 kV

30cm phantom, default abdomen protocol, same dose

TwinBeam Dual EnergyDose-neutrali DE



Dose neutral:

• up to 40cm diameter less noise than 120kV

• all default scan protocols SE / TBDE have same dose

TBDE

True Dual Energy CTExpand your clinical capabilities for TwinBeam Dual Energy

syngo.CT DE Goutsyngo.CT DE syngo.CT DE syngo.CT DEsyngo.CT DE


Monoenergetic

Optimum Contrast

Confidential © Siemens AG 2014. All rights reserved.

October 2014Page 23 H IM CR MK C

syngo.CT DE Goutsyngo.CT DE

Calculi Characterization

syngo.CT DE

Lung Analysissyngo.CT DE

Virtual Unenhanced

syngo.CT DE

Direct Angio

syngo.CT DE

Brain Hemorrhage

syngo.CT DE

Monoenergetic Plus

syngo.CT DE

Hardplaque Displaysyngo.CT DE Rho/Z

TwinBeam Dual Energy – Composed image

C-Images (AuSn120kV)

• Good image quality

• Patient dose as in routine imaging



For internal use only © Siemens AG 2014 All rights reserved.

October 2014Page 24 H IM CR MK P

= 5.5 mSv

Courtesy of Universitätsklinikum Erlangen, Radiology Department

Bone removal with TwinBeam Dual Energy* shows infra-renalabdominal aortic aneurysm (AAA)


scan time: 44 s

scan length: 1534 mm


tube setting:

TwinBeamDual Energy





tube setting:


CTDIvol: 6.44 mGy

DLP: 1007.8 mGycm

Eff. dose: 8 mSv

Dual Energy run off with bone removal shows excellent image quality

Courtesy of University Hospital Erlangen-Nuremberg, Erlangen, Germany*This feature is 510(k) pending. Not available for sale in the U.S.

Post processing software is under development. Not available for sale in the U.S.

Thorax/abdomen scanTwinBeam Dual Energy delivers additional diagnostic information

collimation: 64x0.6 mm

scan time: 17.7 s

scan length: 575 mm


tube setting:

TwinBeamDual Energy





tube setting:

AuSn120 kV, 379 effective mAs

DLP: 480 mGycm

CTDIvol: 8.09 mGy

eff. dose: 7.2 mSv

Rule out of pulmonary embolism in thorax/abdomen scan

Courtesy of University Hospital Erlangen-Nuremberg, Erlangen, Germany*This feature is 510(k) pending. Not available for sale in the U.S.


Perfusion Defect


• only 4s scan time; 55ml contrast agent• scanned at 90/Sn150kV


TwinBeam Dual Energy* in Oncology showing a hypodense lesion in the liver and the right kidney


scan time: 19.6 s

scan length: 634 mm


tube setting:

TwinBeamDual Energy





tube setting:


CTDIvol: 8.8 mGy

DLP: 582.1 mGycm

Eff. Dose: 8.7 mSv

VNC/iodine FusedMonoenergetic 50 keVMonoenergetic 70 keV Tumor evaluation with TwinBeamDual Energy

Courtesy of University Hospital Erlangen-Nuremberg, Erlangen, Germany

*TwinBeam Dual Energy is pending 510(k) clearance and is not yet commercially available in the United States. Post processing software is under development. Not available for sale in the U.S.

True Dual Energy CTExpand your clinical capabilities for Dual Spiral Dual Energy

syngo.CT DE Goutsyngo.CT DE

Calculi CharacterizationMonoenergetic

syngo.CT DE

Bone Marrow


Restricted © Siemens AG 2014 All rights reserved.


syngo.CT DE (Liver VNC)

Virtual Unenhancedsyngo.CT DE

Brain Hemorrhage

Calculi Characterization Bone Marrow

syngo.CT DE

Monoenergetic Plussyngo.CT DE Rho/Z

Gout evaluation with TwinBeam Dual Energy*


scan time: 8 s

scan length: 218 mm


tube setting:

TwinBeamDual Energy





tube setting:


CTDIvol: 6.4 mGy

DLP: 141 mGycm

Eff. dose: 0.11 mSv

Courtesy of Luzerner Kantonsspital, Luzern, Switzerland

*This feature is 510(k) pending. Not available for sale in the U.S.


Metal artifact reductionDual Spiral Dual Energy acquisition mode for basic metal artifact reduction


spatial resolution: 0.30 mm

scan time: 11.0 s

scan length: 414 mm

SOMATOM Definition Edge

March 2015Page 31


HC IM CRMarch 2015Page 31 HC IM CR


scan length: 414 mm


tube setting:

80/140 kV, 600/142 mAs

CTDIvol: 11.07/14.39 mGy

DLP: 482/629 mGy cm

Eff. Dose: 7.20/9.40 mSv

Monoenergeticimaging withexcellent imagequality

Courtesy of LMU Grosshadern, Munich, Germany

SOMATOM Force – Dual EnergyNew Dual Energy Contrasts - Bone Marrow Edema/Fat

collimation: 2x 192 x 0.6 mm

spatial resolution: 0.24 mm

SOMATOM Force

Restricted © Siemens AG 2014 All rights reserved.

April 2014Page 32 P. Aulbach


April 2014Page 32 P. Aulbach

Courtesy of LMU Großhadern, Germany


tube setting:

90/150 kV

CTDI 9.9

DLP 350

Precise DE information also in heavier patients

Spectral Resolution

previous scanners


� 15mg/ml Ultravist� 20ml / 20mm diameter

� 20cm water phantom

* research license required

Dual Energy workflow improvement

Filter Type

FAST DE Results:

Direct transfer of Dual Energy results from scanner to PACS.


DE Mono 40 keV DE Mono <70 keV

DE Mono 50 keV DE Mono >100 keV

DE Mono 70 keV DE Mixed

DE Mono 100 keV DE Iodine

DE Mono 120 keV DE VNC

DE Mono 140 keV DE Iodine+VNC

DE Mono 190 keV DE Optimum Contrast

PACS

DEfinitely

Siemens

Copyright © Siemens AG 2012. All rights reserved.

International Version. Not for distribution in the U.S.

Answers for life.

True Dual EnergyComputed Tomography.

Siemens

Answers for life.

Copyright © Siemens AG 2012. All rights reserved.

International Version. Not for distribution in the U.S.This product is 510(k) pending. Not available for sale in the U.S.

Documents

True Dual Energy - DRG.de · SOMATOM Force 80/Sn150kV, 90/Sn150kV, ... Courtesy of Hospital Povisa, Vigo, Spain ... True Dual Energy – DEfinitely Siemens Dual Spiral Dual …