Brain Imaging with IQ·Neuro using SZHRX Collimators Job Aid

Brain Imaging with IQ·Neuro Healthineers using SZHRX Collimators Symbia Pro.specta What is IQ·Neuro? IQ·Neuro technology includes the combination of the SMARTZOOMTM High Resolution and eX- tended magnification (SZHRX) collimators and advanced reconstruction for brain imaging. Addi- tionally, the larger imaging “sweet spot” with SMARTZOOM HRX collimators make them optimal for high-sensitivity imaging of small organs such as prostate or joints. The SZHRX collimator is based on the same multifocal collimator technology used today for cardiac imaging in the SMARTZOOM collimator and IQ·SPECT. The SZHRX design is adapted for brain imaging by using smaller collimator holes and a larger and more uniform magnification profile as compared to the SMARTZOOM collimator. Depending on the selected Radius-of-Rotation (ROR) it can operate at a higher sensitivity than the LEHR parallel hole collimator, yet with no major loss of resolution. It is designed for gamma emission energies emitted by Tc-99m and I-123. Since the SZHRX collimator is intended to be used at a ROR of 26-28 cm, the collimator is not as close to the patient as compared to typical LEHR brain scans. How to setup an imaging protocol? 1. Select the SZ180 SPECT [factory] protocol, or any other SZ180 protocol, and click Add. a. Set the patient position to Head First Supine. b. Set the following parameters: i. Orbit will always be set to Circular. ii. Time per projection – start with what you normally have for LEHR or MELP. From there, the time can be lowered once you have assessed the images and feel comfortable. iii. Number of Views: 60 per detector. c. Save as new protocol. 2. For SPECT/CT, select Brain SZ180 SPECT/CT or follow the steps below to build a SZHRX SPECT/CT protocol within Exam Designer: a. Select SZ180 SPECT [Factory] protocol and click Add. b. Add a CT Brain [factory] protocol as the second scan. c. Setup the patient position to Head First Supine. d. Under General Recon > Attenuation Correction for the SZ180 SPECT [Factory] se- lect the CT recon desired. e. Save as new protocol. Unrestricted | Published by Siemens Healthineers AG I © Siemens Healthineers AG, 2024 SIEMENS Master Template Effective Date: 10 Aug 2021 | HILS 2224 Job Aid Effective Date: 19 Nov 2024 | QR700015682 Healthineers Job Aid | Brain Imaging with IQ·Neuro Effective Date: 19 Nov 2024 | QR700015682 Please note: Do not use the Brain CT-SPECT [factory] protocol to build a SZHRX protocol. This protocol is to be used for brain scans using parallel hole collimators. This protocol positions the topogram in the lower part of the NM field of view; therefore it will be incorrect positioning for SZHRX imaging as the brain must be centered in the field of view. SMARTZoom HRX Collimator can be used with attenuation (CT attenuation correc- tion [CTAC] or calculated Smart Neuro Attenuation Correction [SNAC]) and scatter correction within the appropriate iterative reconstruction methods. Filtered back projection or Chang’s AC is not supported. Patient Positioning The patient should be positioned head first, supine with their head placed in the head holder. The following steps should be followed to ensure the brain is centered in the FOV: 1. With the detectors at 0° and 180°, move the patient table in until the brain is centered in the FOV (figure 1). This can be viewed on the gantry display (figure 2). Example, Patient1 B/23/1979 SZ 180 SPECT [factory] 10.6 11.0 Tomo Head First - Supin Press Go to load the scan Te-99m C. 99 G 200 Confirm GO Cancel Check calibration status at console E O SZHRX 345 345 Retract Dedoctors Figure 1: Move the patient table in so the brain is cen- Figure 2: Centered brain shown on the Gantry Display. tered in the field of view. 2. Rotate the detectors around to the 90° and -90° configuration (figure 3). SIEMENS Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2023 Master Template Effective Date 10 Aug 2021 | HILS 2224 Healthineers Page 2 of 5 Job Aid | Brain Imaging with IQ·Neuro Effective Date: 19 Nov 2024 | QR700015682 3. Isocenter the brain by raising or lowering the patient table. This can be viewed on the gan- try display (figure 4). 10.4 10.5 Detector kops kops Detecto 2 SIEMENS Tc-99m Energy Window C 98 100 Figure 4: Brain is shown centered on the Gantry Display. The brain localization Figure 3: Rotate detectors to 90 and -90 to ensure boxes and crosshairs, present in some software versions, are to assist with cen- brain is isocentered. tering the organ of interest. 4. Manually move in the detectors to 26 cm for perfusion imaging (it will read 260 mm on the gantry display). Patient registered O 10.8 11.3 Brain SZ 180 SPECT-CT [factory] cps kops Detector Tomo Scan Step Head First - Supine (HFS) Table:SPECT Gantry Detector 1 Detector 2: Not Tilted _-113.5 -1 260 90.00 - 260 -90.0º Table Position ( mm ) 90º Distance (mm) Position Distance (mm ) Position £ 147.6 0.0º 0.0 4 0 O Table Height (mm) Gantry Rotation Rotation Offset (mm) Rotation offset (mm) SZHRX 260 260 90 Retract Detectors Detector 2 Gantry Rotation SIEMENS Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2023 Master Template Effective Date 10 Aug 2021 | HILS 2224 Healthineers Page 3 of 5 Job Aid | Brain Imaging with IQ·Neuro Effective Date: 19 Nov 2024 | QR700015682 Please note: The radius of rotation can be up to 28 cm depending on patient con- dition. It is unnecessary to have a ROR tighter than 26 cm due to the magnifica- tion characteristics of the SZHRX collimators. This ensures the organ of interest, in this case the brain, stays in the “sweet spot” of the collimators. It is key that the brain or organ of interest is centered in the field of view. Reconstruction Recon Method can be either xSPECT – CG or xSPECT – EM. It is user preference which option to use: • xSPECT – EM is typically preferred for lesion detection and has similar reading patterns to Flash 3D or Flash 3D+. • xSPECT – CG has a different noise pattern. The unit of output of the image is PROPCPS for xSPECT-CG and xSPECT-EM reconstruction meth- ods. This differs from the Flash3D+ output of counts so they cannot be directly compared. SIEMENS ... Healthineers 2 1 Scan Recon Brain Phjantom, Test AG&DK 12 5/10/1998 (26) 04102024 Brain SZ 180 SPECT ... Recon Ranges MI View&GO Patient position Tomo Tomo Topogram Favorite Tools " CT-AC Topogram Reconstruction Close CT-AC Series 108 | 8 228 Findings Tools Manual Automatic Reset Registration Registration Registration tart reconstructions Bunund Switch to Close Planning Base Recon Next Cancel Recon Cancel Figure 5: Example reconstruction images with the brain in the center of the field of view. SIEMENS Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2023 Master Template Effective Date 10 Aug 2021 | HILS 2224 Healthineers Page 4 of 5 Job Aid | Brain Imaging with IQ·Neuro Effective Date: 19 Nov 2024 | QR700015682 Please note this learning material is for training purposes only. For the proper use of the software or hardware, please always use the Operator Manual or Instructions for Use (hereinafter collectively “Operator Manual”) issued by Siemens Healthineers. This material is to be used as training material only and shall by no means substitute the Operator Manual. Any material used in this training will not be updated on a regular basis and does not necessarily reflect the latest version of the software and hardware available at the time of the training. The Operator Manual shall be used as your main reference, in particular for relevant safety information like warnings and cautions. Please note: Some functions shown in this material are optional and might not be part of your system. Certain products, product related claims or functionalities (hereinafter collectively “Functionality”) may not (yet) be commercially available in your country. Due to regulatory requirements, the future availability of said Functionalities in any specific country is not guaranteed. Please contact your local Siemens Healthi- neers sales representative for the most current information. The reproduction, transmission or distribution of this training or its contents is not permitted without ex- press written authority. Offenders will be liable for damages. All names and data of patients, parameters and configuration dependent designations are fictional and examples only. All rights, including rights created by patent grant or registration of a utility model or design, are reserved. Siemens Healthineers HQ I Siemens Healthineers AG Siemensstr. 3 91301 Forchheim Germany Phone: +49 9191 18-0 siemens-healthineers.com SIEMENS Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2023 Master Template Effective Date 10 Aug 2021 | HILS 2224 Healthineers Page 5 of 5