Management of Scan and Contrast Media Injection - USA

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Assessment Slide 2.3 OLT_Management of Scan and Contrast Media injection_for_HRT_round2_20210126 Master Template HOOD05162003052540 | Effective Date: 26-Nov-2019 Management of Scan and Contrast Media Injection – Online Training This online training will offer you useful insights into the issue of contrast media in CT, and will cover the following four learning objectives: 1 2 3 4 Define Different Types of Contrast Media and Applications Summarize CARE Bolus, Test Bolus and Dynamic Evaluation (DynEva) Identify CARE Contrast I-III Learn about Contrast Management Welcome audf_cont_media_title_page_01.mp3 Welcome to the Management of Scan and Contrast Media Injection Online Training. This online training will offer you useful insights into the issue of contrast media in CT, and will cover the following four learning objectives: Define Different Types of Contrast Media and Applications Management of Scan and Contrast Media Injection – Online Training Define Different Types of Contrast Media and Applications Define Different Types of CM and Applications Day 0 - perfusion CT perfusion demonstrates a large defect involving the superior division of the right MCA territory. Definition of contrast media Examples of contrast media applications Types of contrast media Saline flush Things to check before injection Emergency action Overview audf_cont_media_dif_type_overview_03.mp3 This chapter will offer you an overview of different types of contrast media and their applications. Contrast Media What is contrast media? ? Why do we need contrast media? What kind of contrast media do we use in CT? Saline flush? What to check before injection? What to do in case of emergency? Contrast Media audf_cont_media_dif_type_cm_04.mp3 When we talk about contrast media in CT, a number of questions need to be addressed. What are contrast media? Why do we need contrast media? What kind of contrast media do we use in CT? Do we need a saline flush? What to check before the injection? And what to do in case of emergency? You are going to obtain the answers to these questions in the next slides.   What is contrast media? Contrast media are substances that are introduced into the body to enhance the contrast of the tissue structures or fluids. CM Oral CM Oral + Intravenous (IV) Contrast Media What is contrast media? audf_cont_media_dif_type_cm_def_05.mp3 What are contrast media?   Contrast media are substances that are introduced into the human body in order to enhance the contrast of the tissue structures or fluids.   Why do We need Contrast Media? The inherent contrast of some human tissues is not sufficient to make images with high contrast and consequently reliable diagnoses. Examples of contrast media applications: Parenchymal contrast (detection of lesions) Angiography (CTA) Cardiac diagnostics Gastrointestinal tract (transit time, virtual colonography) Perfusion (organ perfusion) Interstitial contrast (inflammation, tumors) Why do We need Contrast Media audf_cont_media_dif_type_why_06.mp3 Why do we need contrast media?   The inherent contrast of some human tissues is not sufficient to make images with high contrast and consequently reliable diagnoses.   Contrast media are used for such applications as:   Parenchymal contrast for the detection of lesions, Angiography as a CTA procedure, Cardiac diagnostics, Gastrointestinal tract (for example, for transit time test or virtual colonography), Perfusion, or Interstitial contrast to detect inflammation or tumors. Types of Contrast Media What types of contrast media do we use in CT? Positive contrast media absorb more X-rays Negative contrast media absorb fewer X-rays Gastrografin® Peritrast® Solutrast® Imeron® Mannitol Air Carbon dioxide Types of Contrast Media audf_cont_media_dif_type_types_07.mp3 There are two types of contrast media that are used in CT:   Positive contrast media that absorb more X-rays, and Negative contrast media that absorb fewer X-rays.   Examples of Cases with Contrast Media CT-Angiographie CT Abdomen Angiography IV CT Head IV CT Abdomen Oral + IV almutawacarcinoidax1.jpg cerebralmets-ct0003.jpg Examples of Cases with Contrast Media audf_cont_media_dif_type_examp_08.mp3 Contrast media are used in such cases as:   CT angiography of the abdomen, CT of the head with intravenous contrast media administration, or CT of the abdomen with oral and intravenous contrast media administration. Examples of Cases with Contrast Media CTScan-virtuelleKoloskopie.jpg A 3D image of the heart from the Philips Brilliance iCT scanner Day 0 - perfusion CT perfusion demonstrates a large defect involving the superior division of the right MCA territory. Virtual Colonography Intra-Rectal Air/CO2 CT Cardiac Angiography IV CT Brain Perfusion IV Examples of Cases with Contrast Media audf_cont_media_dif_type_examp_2_09.mp3 They are also applied in:   Virtual colonography with the administration of air or carbon dioxide as negative contrast media, CT cardiac angiography, or CT brain perfusion with intravenous contrast media administration. Saline Flush Saline Flush with Contrast The use of a saline chaser, which pushes the contrast bolus forward, also influences scan timing. This figure shows the enhancement over time following the injection of a contrast bolus with (yellow curve) and without (orange curve) a saline chaser. The saline chaser hastens the arrival of the contrast bolus by 4 seconds and increases peak enhancement by 30%. C:\Users\gbzbc\Pictures\Saline flush.JPG Saline Flush Contrast Saline Flush audf_cont_media_dif_type_sal_fl_10.mp3 But what about the saline flush? Why do we need it?   The use of a saline chaser, which pushes the contrast bolus forward, also influences scan timing.   The figure on the right shows the enhancement over time following the injection of a contrast bolus with (depicted as a yellow curve) and without (presented by the orange curve) a saline chaser. The saline chaser hastens the arrival of the contrast bolus by 4 seconds and increases peak enhancement by 30 percent. Checklist before Injection Depending on the departmental protocol, the following aspects of patient history are commonly vetted prior to contrast administration: Patient allergies (iodine, preservative agent) Metformin prescription (to prevent CIN lactic acidosis) Metformin should be withheld for 48hrs after the administration of contrast media. Blood values of the kidneys: Creatinine (max 1.5 mg/dL) eGFR* (>60) (new: 45) Thyroid function test levels: TSH, fT3, fT4 (in populations susceptible to iodine-induced thyroid dysfunction) Venous catheter for the contrast media (extravasation) *Estimated Glomerular Filtration Rate Checklist before Injection audf_cont_media_dif_type_check_11.mp3 Prior to contrast media administration, it is important to check some aspects of the patient’s history. Your checklist shall include the following items: The patient´s allergies; Metformin prescription: It is important to know this, because contrast-induced renal failure may cause toxic accumulation of Metformin, since it cannot be excreted. This, in turn, increases the risk of lactic acidosis, which has a mortality rate of up to 30 to 50 percent.   You also need to check: The blood values of kidneys and the thyroid, and The venous catheter for the contrast media.   Emergency What to do in case of emergency? Call the emergency unit! Medication: Cortisone (Prednisolone) H1, H2 (Antihistamine, e.g. Fenistil, Tagamed) Oxygen IV fluids (NaCl) Emergency audf_cont_media_dif_type_emerg_12.mp3 An emergency can occur quickly and without warning. The emergency procedure is as follows:   Call the emergency unit! Have medication available (such as cortisone, H1, H2). Administer oxygen and sodium chloride intravenous saline solution.   Summarize CARE Bolus, Test Bolus and DynEva Management of Scan and Contrast Media Injection – Online Training Summarize CARE Bolus, Test Bolus and DynEva Summarize CARE Bolus, Test Bolus and DynEva S40_CT_UROGRAPHY_DAMMED_URETERS_VB20_ALAMANCE_REGIONAL_USA CARE bolus Test bolus DynEva (Dynamic Evaluation) Overview 2.14 Overview_v2.mp3 This chapter will introduce you to the options of contrast media application. A detailed explanation of the methods of CARE bolus, test bolus and DynEva, which stands for dynamic evaluation, will be provided. CARE Bolus / Test Bolus / DynEva CT-Angiographie Possibilities of a perfectly timed application of contrast media: Bolus tracking (CARE bolus) Test bolus (with Dynamic Evaluation – DynEva) Fix delay CARE Bolus / Test Bolus / DynEva audf_cont_media_care_possib_15.mp3 There are three possibilities of a perfectly timed application of contrast media, namely:   Bolus tracking also referred to as a CARE bolus, A test bolus (with dynamic evaluation), or A so-called fix delay. CARE Bolus S40_CT_UROGRAPHY_DAMMED_URETERS_VB20_ALAMANCE_REGIONAL_USA It can be used for a bolus-triggered contrast agent analysis CARE bolus is an option CARE Bolus audf_cont_media_care_care_bol_16.mp3 CARE bolus can be used for a bolus-triggered contrast agent analysis.   The CARE bolus function shall be considered as an option.   SOMATOM Somaris 5 Systems SOMATOM Scope SOMATOM Perspective SOMATOM Scope Power P:\03_TransferProjekte\SI_CT\SI-CT021_ECR\01_Input\02_Kunde\03_Bildpool-Siemens\lowRes-pptx\SH_CT_38740_14_V3.jpg P:\03_TransferProjekte\SI_CT\SI-CT021_ECR\01_Input\02_Kunde\03_Bildpool-Siemens\lowRes-pptx\SH_CT_38740_14_V3.jpg SOMATOM Somaris 5 Systems   Here are the Somaris 5 scanners that utilize CARE Bolus, Test Bolus and DynaEva. SOMATOM Somaris 7 Systems SOMATOM Definition AS SOMATOM Definition AS+ SOMATOM Confidence SOMATOM Definition Edge SOMATOM Edge Plus SOMATOM Definition Flash SOMATOM Force SOMATOM Drive \\ww005.siemens.net\meddfsroot\DE\MED\CT\apps\CRM-CTM-MarCom\Produkt_und_klinisches_Marketing\Drive\03_Images\02_3D_Renderings\01_FINAL\Healthineers\16_to_9_tif\SOMATOM_Drive_FullHD_0000.tif SOMATOM Somaris 7 Systems   Here are the Somaris 7 scanners that utilize CARE Bolus, Test Bolus and DynaEva. CARE Bolus 2 Somaris 5/7 Step 1: Load the desired examination. CARE Bolus - Steps audf_cont_media_care_5_7_step1_17.mp3 And this is how the CARE bolus application works:   Step 1: Load the desired examination from the Patient Model Dialog.   Abdomen02 Somaris 5/7 2 CARE Bolus Step 2: Scan the topogram. Step 2 audf_cont_media_care_5_7_step2_18.mp3 Step 2: Scan the topogram.   docu0012 Somaris 5/7 CARE Bolus Step 3: Insert the bolus tracking scan (click with the right mouse button). Step 3 audf_cont_media_care_5_7_step3_19.mp3 Step 3: Insert the bolus tracking scan. To do so, click with the right mouse button on the appropriate row in the chronicle. The bolus tracking entry will appear before the selected row.   Abdomen03 Somaris 5/7 CARE Bolus Step 4: Select the position of the slice to perform bolus tracking on. For this scan event, only one slice will be scanned once. Step 4.1 audf_cont_media_care_5_7_step4_20.mp3 Step 4: Select the position of the pre-monitoring scan level. This level will be monitored for contrast arrival.   Only one slice will be scanned. Abdomen03 Somaris 5/7 CARE Bolus Step 4 (cont.): If the tracking level needs to be repositioned, we can repeat the pre-monitoring scan as needed. 4.2 audf_cont_media_care_5_7_step4_cont_21.mp3 If the level needs to be repositioned during this step, simply right-click on the pre-monitoring row, and repeat the pre-monitoring scan as required. Step 5: Set the Region of Interest (ROI) in the dedicated vessel by clicking on the displayed axial image. Abdomen05 adbo0010 Somaris 5/7 CARE Bolus Step 5.1 audf_cont_media_care_5_7_step5_22.mp3 Step 5: Set the Region of Interest (widely referred to as ROI) in a dedicated vessel. To do so, click once on the appropriate location on the scanned sectional image as shown in the orange box on this slide.   This region of interest may be resized or moved as needed. Only one region of interest can be selected.   Make sure that the ROI is not too small, nor that it covers any area with a high degree of calcification.   Click Accept to confirm the ROI position. Note: If contrast media have been defined, they can be selected from the Name of CM drop menu here. Important: The Auto trigger threshold HU is relative! This means that if a structure has a native HU of 60 HU, and the Auto trigger has been set to 100 HU, the scan will only be triggered when the value of 160 HU has been reached in the ROI. Step 5 (cont.): The Auto trigger threshold can be adjusted in the Contrast (Somaris 7) / IV Bolus (Somaris 5) row. Somaris 5/7 CARE Bolus Auto trigger can also be unchecked from here. Step 5.2 audf_cont_media_care_5_7_step5_cont_23.mp3 During this step, you can also adjust the thresholds if needed. Please note that the threshold is relative, and denotes the net increment in Hounsfield units over the original native HU value of the region of interest.   Somaris 7 How to deactivate Auto trigger: CARE Bolus How to deactivate Auto trigger - Somaris 7 audf_cont_media_care_7_deact_24.mp3 In Somaris 7, the Auto trigger box can be unchecked from the Contrast card in the chronicle. Somaris 5 CareBolus1 CareBolus2 CareBolus3 CARE Bolus How to deactivate Auto trigger: How to deactive Auto trigger - Somaris 5 audf_cont_media_care_5_deact_25.mp3 To deactivate Auto trigger in Somaris 5, select the I.V.  Bolus subtask card of the monitoring scan entry. Then deselect the Auto trigger box. Step 5 (cont.): If needed, the delay and cycle times can be adjusted from the Monitoring row. Following that, press Accept when the scan is ready to start. Somaris 5/7 Note: Cycle time is the time between each consecutive monitoring scan. Delay time is the time after pressing the Start/Scan button and the first radiation cycle event. The tracking ROI cannot be changed after pressing Accept. If changes have to be made to the size or location of the bolus tracking region after this point, the pre-monitoring scan shall be repeated. CARE Bolus Step 5.3 audf_cont_media_care_5_7_step5_cont_26.mp3 As soon as all parameters have been adjusted, press Accept.   Please note that you can no longer edit the tracking ROI after pressing Accept. If changes have to be made to the size or location of the bolus tracking region, you will need to repeat the pre-monitoring scan.   CARE Bolus Abdomen04 adbo0010 Somaris 5/7 Step 6: Apply the contrast media and start the scan. Step 6 audf_cont_media_care_5_7_step6__27.mp3 Step 6: Apply the contrast media and start the scan.   Somaris 5/7 e-images abdomen0019 e-images abdomen0001 e-images abdomen0002 e-images abdomen0003 e-images abdomen0004 e-images abdomen0005 e-images abdomen0006 e-images abdomen0007 e-images abdomen0008 e-images abdomen0009 e-images abdomen0010 e-images abdomen0011 e-images abdomen0012 e-images abdomen0013 e-images abdomen0014 e-images abdomen0015 e-images abdomen0016 e-images abdomen0017 e-images abdomen0018 adbo0010 adbo0010 adbo0010 adbo0010 adbo0010 adbo0010 CARE Bolus Procedure? audf_cont_media_care_curve_28.mp3 This procedure is based on repetitive low-dose monitoring scans on one slice level, and the analysis of the time-density curve in the region of interest. The image reconstruction and the time-density curve are displayed online on the Navigator console. As soon as a pre-defined contrast enhancement threshold has been reached, the diagnostic scan will be triggered and it will begin after a short, pre-set delay.   Somaris 5/7 If there is extravasation, the contrast pump is not working correctly, the saline is in the wrong syringe, other similar errors are involved, … the scan will not start! CARE Bolus The scan will not start, if ... audf_cont_media_care_no_start_29.mp3 However, the scan will not start if:   there is extravasation, the contrast pump is not working correctly, the saline is in the wrong syringe, or other threshold-related errors are involved. Somaris 5/7 Contrast_Config CARE Bolus Defining contrast media: Some hospitals have an automated billing system. In this case, you can enter the name and the ID of the contrast media used.  Options / Configuration / Examination Defining Contrast Media audf_cont_media_care_abs_30.mp3 Some hospitals have an automated billing system, where the contrast media have to be defined.   In this case, you can enter the name and the ID of the contrast media used.   To do so, open the Options / Configuration / Examination, and then the Contrast subtask card.   bolustrackin2 Manual scan start is possible at any time! Tips: CARE Bolus For small structures, zoom the pre-monitoring scan to make it easier to draw and set the ROI. The shorter the cycle time, the more precise the bolus curve (but: more scans  higher dose). Bolus tracking can also be used without Auto trigger start (e.g. in a carotid angiogram: The user can manually press the scan Start button upon contrast visualization). If Auto trigger is disabled, the HU can still be monitored in the ROI during the bolus tracking scans. Tips audf_cont_media_care_tips_31.mp3 Please observe some general tips regarding the use of the CARE bolus function.   For very small structures, you can zoom in the pre-monitoring scan; this will make it much easier to draw and set the ROI. The shorter the cycle time, the more precise the bolus curve will be. But do not forget that an increased number of scans also involves a higher dose. Bolus tracking can also be used without Auto trigger start (for example, a carotid angiogram can be launched by pressing Start after contrast visualization). Manual scan start is possible at any time. If Auto trigger is disabled, the Hounsfield units can still be monitored in the ROI during the bolus tracking scans. CARE Bolus / Test Bolus / DynEva S40_CT_UROGRAPHY_DAMMED_URETERS_VB20_ALAMANCE_REGIONAL_USA Test bolus Test bolus is available on every scanner as a standard feature. Test Bolus audf_cont_media_care_test_standard_32.mp3 The next possibility of contrast media application we are going to address is termed test bolus.   Test bolus is available on every scanner as a standard feature. Test Bolus 2 Somaris 5 */7 ** *SOMATOM Scope, SOMATOM Scope Power, SOMATOM Perspective ** SOMATOM Definition AS, SOMATOM Confidence, SOMATOM Definition AS+, SOMATOM Definition Edge, SOMATOM Edge Plus, SOMATOM Definition Flash, SOMATOM Drive, SOMATOM Force Step 1: Load the desired examination. Step 1 audf_cont_media_care_test_5_7_step1_33.mp3 The test bolus option works as follows:   Step 1: Load the desired examination. Abdomen02 Test Bolus Somaris 5/7 Step 2: Scan the topogram. Step 2 audf_cont_media_care_test_5_7_step2_34.mp3 Step 2: Scan the topogram. Somaris 5/7 docu0012 Test Bolus Step 3: Insert the test bolus (with the right mouse button). Step 3 audf_cont_media_care_test_5_7_step3_35.mp3 Step 3: Insert the test bolus by clicking with the right mouse button.   Somaris 5/7 Abdomen03 Test Bolus Step 4: Select the level where the test bolus scan should be performed. Step 4 audf_cont_media_care_test_5_7_step4_36.mp3 Step 4: Select the position where you want to perform the test bolus procedure.   Somaris 5/7 Abdomen04 adbo0010 Test Bolus Step 5: Apply the test bolus of contrast media. Tip: In general, do not terminate the test bolus scan until the contrast has started to fade out in the ROI! Step 5.1 audf_cont_media_care_test_5_7_step5_37.mp3 Step 5: Apply the contrast media. The test bolus scan can be cancelled once you have seen that the contrast bolus has arrived, peaked, and faded out in the region of interest.   You should generally not terminate the scan until the “fade out” has begun, and the four discrete time points have been imaged unless you suspect extravasation, or there is an emergency. Somaris 5/7 adbo0010 adbo0010 adbo0010 adbo0010 adbo0010 adbo0010 Test Bolus Step 5.2 audf_cont_media_care_test_5_7_proced_38.mp3 This procedure is based on repetitive low-dose monitoring scans on one slice level. DynEva S40_CT_UROGRAPHY_DAMMED_URETERS_VB20_ALAMANCE_REGIONAL_USA For perfusion evaluation (vessels, tissue) For a better timing of contrast media examinations Test bolus A spiral scan on one table position CM enhancement over the time Dynamic evaluation uses the time-density curve DynEva audf_cont_media_care_dyneva_39.mp3 The next procedure we need to address is the dynamic evaluation, also termed DynEva .   DynEva is used for:   Perfusion evaluation of vessels and tissues, And a better timing of contrast media examinations, such as a test bolus, a spiral scan on one table position, or contrast media enhancement over the time.   Dynamic evaluation uses the time-density curve. Calculation of the delay 1 1 DynEva Select the relevant series in the Patient Browser. Load into the DynEva application. Calculation of the Delay 2.42 Calculation_v2.mp3 Here you can perform calculation of the delay:   To do so, select the relevant series in the Patient Browser and load it into the dynamic evaluation application. 2 DynEva This dialog will pop up for multi-slice CT. Use the default setting, and simply click OK. Multi-Slice CT audf_cont_media_care_dyneva_mult_41.mp3 This dialog will pop up for multi-slice CT.   Use the default setting, and simply click OK. 3 1 2 3 Important: DynEva requires at least 4 images/time points to work! DynEva All loaded images (scrollable stack) Results Baseline image Images audf_cont_media_care_dyneva_segment_42.mp3 In this picture you can see three segments:   Segment 1 loads all images. Segment 2 loads the results. Segment 3 loads the baseline image. 4 DynEva Draw and set the ROI in the vessel you want to measure. You can select different curves. Image Selection audf_cont_media_care_dyneva_vessel_43.mp3 Draw and set the ROI in the vessel you want to measure.   You can select either an absolute or a relative curve to be displayed. FILTER DynEva Important: Insert the delay of the test bolus! This will shift the curve to the correct point in time! TTP = the time that was needed to reach the peak of the contrast in the ROI for the test bolus scan. Insert Delay of Test bolus audf_cont_media_care_dyneva_import_44.mp3 When working with the DynEva function, you shall consider the following:   Insert the delay of the test bolus! This will shift the curve to the correct point in time!   Time to peak is the time that was needed to reach the contrast peak in the test bolus scan. Identify CARE Contrast I-III Management of Scan and Contrast Media Injection – Online Training Identify CARE Contrast I-III audf_cont_media_contrast_intro_45.mp3 Identify CARE Contrast I-III Challenges Solution Benefits CARE Contrast I-III Contrast Protocols Overview audf_cont_media_contrast_overview_46.mp3 This chapter will address the issue of CARE Contrast. You will get a chance to obtain some insights into its functionality as well as the associated challenges and benefits. CARE Contrast H:\Projekte\10_CT_Projekte\RSNA_2013\PPTs\Susanne\CT_Icon_CARE_Contrast\CT_Icon_CARE_Contrast_.png CARE Contrast audf_cont_media_contrast_syncstart_47.mp3 CARE Contrast facilitates contrast-enhanced clinical workflow with coupled start of scanning and injection, either via the CT scanner or by means of the bolus injector. Challenge Synchronizing CT scan and contrast media injection, even with one technician only Standardized and pre-defined scan protocols with bolus injector coupling Separated and decoupled documented injector information Solution Simplified bolus injector coupling via CARE Contrast Definition and management of contrast protocols on the scanner console Combined scan and contrast protocols Benefits Single button control from either the scanner or the injector Standardized communication between scanner and injector CARE Contrast - Why do we need it? CARE Contrast - Why do we need it? audf_cont_media_contrast_why_48.mp3 Why do we need CARE Contrast?   Contrast media application is associated with a number of challenges, such as: Synchronizing CT scanning and contrast media injection with one technician only, Standardized and pre-defined scan protocols with bolus injector coupling, or Separated and decoupled documentation of injector data.   The solution we offer consists in: Simplified bolus injector coupling via CARE Contrast, Definition and management of contrast protocols on the scanner console, and Combined scan and contrast protocols.   This results in the following benefits: Single-button control from either the scanner or the injector, as well as Standardized communication between the scanner and the injector. Injector Manual Settings CARE Contrast - Synchronization and management of scan and contrast media injection Definition and management of contrast protocols on the scanner console Transfer of contrast protocols from the scanner console to the injector Transfer of contrast protocols to the patient protocol, MPPS, etc. Combining scan and contrast protocols to integrated examination protocols, and exporting them to other scanners Synchronization and Management of Scan and Contrast Media Injection audf_cont_media_contrast_sync_manag_49.mp3 Synchronization and management of scan and contrast media injection allows: Definition and management of contrast protocols on the scanner console, Transfer of contrast protocols from the scanner console to the injector, Transfer of contrast protocols to the patient protocol, MPPS, or the like, and Combining scan and contrast protocols to integrated examination protocols, and exporting them to other scanners. START Contrast media injector Conventional solution CARE Contrast I - Synchronization of scan and contrast media injection Integrated solution START CARE Contrast I - Synchronization of Scan and Contrast Media Injection audf_cont_media_contrast_I_sync_50.mp3 CARE Contrast I ensures synchronization of scan and contrast media injection in an integrated solution.   CARE Contrast I - Synchronization of scan and contrast media injection Key features and clinical benefits Synchronized scanning and contrast injection – safe and easy to use One-button control from the CT console or from the injector Ready for future applications – future-proof interface technology with plug-and-play features Supported by leading injector manufacturers Supported scan types Sequence and spiral scanning Multiscans Bolus monitoring scans Cardio modes Respiratory modes Key Features, Benefits and Supported Scan Types audf_cont_media_contrast_I_sync_feature_51.mp3 CARE Contrast I boasts the following key features and clinical benefits:   Synchronized scanning and contrast injection, safe and easy to use, One-button control from the CT console or from the injector, Readiness for future applications thanks to the future-proof interface technology with plug-and-play features, and Compatibility with the systems of the leading injector manufacturers.   The scan types supported are:   Sequence and spiral scanning, Multiscans, Bolus monitoring scans, Cardio modes, and Respiratory modes. Start in the control room Simplify your routine CARE Contrast I - Synchronization of scan and contrast media injection Start in the scan room Watch for extravasation Start in Control and Scan Room audf_cont_media_contrast_I_sync_room_52.mp3 Thanks to this system, you can start the procedure in the control room to simplify your routine, or in the scan room to stay near the patient and watch for extravasation. CARE Contrast I - Synchronization of scan and contrast media injection Prerequisites The injector and the CT have to be coupled explicitly. The user can store protocols with enabled injector coupling. Prerequisites audf_cont_media_contrast_I_sync_prereq_53.mp3 There are some prerequisites that have to be met for CARE Contrast I operation:   The injector and the CT have to be coupled explicitly. The user can store protocols with enabled injector coupling.    ScanStart Anwahl CARE Contrast I - Start injector coupling To start a contrast-enhanced examination in a coupled mode… Select the Scan subtask card. Select either Injector coupled (start button) or Injector coupled (foot switch) for the Scan start option. Injector coupled (start button): The Start button of the CT scanner will start the injector. Injector coupled (foot switch): The Foot switch of the CT scanner will start the injector. Start Injector Coupling audf_cont_media_contrast_I_start_inj_54.mp3 To start contrast-enhanced examination in a coupled mode, please proceed as follows: Select the Scan subtask card. Select either Injector coupled (start button) or Injector coupled (foot switch) for the Scan start option. With the Injector coupled (start button), the Start button of the CT scanner will start the injector. With the Injector coupled (foot switch), the Foot switch of the CT scanner will start the injector. InjectornotConnected CARE Contrast I - Start injector coupling If the coupled mode has been selected, the CT checks if there is an injector available. The scan mode cannot be loaded if no connection can be established or if the injector does not accept coupling (the injector will not accept coupling during the injecting process). The “Injector is not connected” message will appear. Start Injector Coupling - Message audf_cont_media_contrast_I_coup_mode_55.mp3 If the coupled mode has been selected, the CT checks if there is an injector available. The scan mode cannot be loaded if no connection can be established or if the injector does not accept coupling (the injector will not accept coupling during the injecting process). The “Injector is not connected” message will then appear.   ScanStart Anwahl1 CARE Contrast I - Loading the scan If an injector is connected, load the scan mode first and then arm the injector. Depending on the injector, it may be not possible to arm the injector before the scan protocol has been loaded (see User Manual of the injector). The user must be familiarized with the documentation of both the injector and the CT system to work with the injector coupling! Loading the Scan audf_cont_media_contrast_I_loading_56.mp3 If an injector is connected, load the scan mode first, and then arm the injector. Depending on the injector type, it may be not possible to arm the injector before the scan protocol has been loaded. (Please consult the User Manual of the injector.)   The user must be familiarized with the documentation of both the injector and the CT system to work with the injector coupling! CheckInjector CARE Contrast I - Arming the injector When the mode is loaded, the CT scanner will prompt you to check the injector and to arm it. Check the parameters at the injector side. Confirm the parameters. The injector is now armed and ready for the examination. If the scan mode has been cancelled, the injector will be disabled as well. Arming the Injector audf_cont_media_contrast_I_arming_57.mp3 When the mode is loaded, the CT scanner will prompt you to check the injector and to arm it. Check the parameters at the injector side. Confirm the parameters. The injector is now armed and ready for the examination.   If the scan mode has been cancelled, the injector will be disabled as well. CheckInjectorBubble CARE Contrast I - Starting the scan and the injection As soon as the injector has been armed, you can start the scan and the injector by pressing either The Start button / Foot switch at the scanner, or The Start button at the injector panel outside the scan room, or directly at the injector inside the scan room. If both systems are ready to start and the user disarms the injector, the prompt will appear again. CheckInjector Starting the Scan and the Injection audf_cont_media_contrast_I_start_scan_58.mp3 As soon as the injector has been armed, you can start the scan and the injector by pressing either:   The Start button or the Foot switch at the scanner, or The Start button at the injector panel outside the scan room or directly at the injector inside the scan room. If both systems are ready to start and the user disarms the injector, the prompt “Check Injector” will appear again. Table with 3 columns and 7 rows Problem Description Scanner Injector Injector does not accept the START from CT. Mode cancelled Armed, but will not start Scanner will be suspended by the user or system. Suspended Stopped Injector has been stopped by the user. Stopped Stopped Injector has been suspended (by pressing the Hold button). Continues scanning Stopped The connection between scanner and injector has been interrupted. Continues, an error message pops up Stopped Technical problem at the injector has occurred. Continues, an error message pops up Stopped CARE Contrast I - Error handling Error Handling I audf_cont_media_contrast_I_error_table_59.mp3 The table on this slide offers you an overview of errors that might occur, and how these can affect the scan mode and the injector. ScanStart Anwahl CARE Contrast I - Error handling If the injection is longer than the CT scan, the injection will not be stopped by the CT. A new scan mode can be loaded. If the new mode is a coupled one, the scan can only be started if the injector is ready. When a coupled range is copied or repeated, the start condition for the new scan will be reset to uncoupled. Error Handling II audf_cont_media_contrast_I_error_handl_60.mp3 If the injection is longer than the CT scan, the injection will not be stopped by the CT.   A new scan mode can be loaded.   If the new mode is a coupled one, the scan can only be started if the injector is ready.   When a coupled range is copied or repeated, the start condition for the new scan will be reset to “uncoupled”. Kontroller CARE Contrast II - Transfer of contrast protocol to patient protocol, MPPS, etc. CARE Contrast II audf_cont_media_contrast_II_transfer_61.mp3 In CARE Contrast II, the contrast protocol is transferred to the patient protocol, and the Modality Performed Procedure Step as well as other related processes take place. CARE Contrast II - Transfer of contrast protocol to patient protocol, MPPS, etc. Automated synchronized start of scan and injection from the user interface of the scanner or that of the injector Display of injection parameters on the contrast card Automatic read-out of injection parameters Documentation of injection parameters in the patient protocol, e-logbook, and MPPS Overview audf_cont_media_contrast_II_transfer_cont_62.mp3 The following features are available here: Automated synchronized start of the scan and injection from the user interface of the scanner or that of the injector, Display of injection parameters on the contrast card, Automatic read-out of injection parameters, and Documentation of injection parameters in the patient protocol, e-logbook, and the MPPS. Contrast protocols can be defined and managed on the scanner console and transferred to the injector. Contrast Protocols in CARE Contrast III You can combine scan and contrast protocols into integrated examination protocols, and export them to other scanners. Kontroller Contrast Protocols in CARE Contrast III audf_cont_media_contrast_III_cp_63.mp3 With CARE Contrast III, contrast protocols can be defined and managed on the scanner console, and then transferred to the injector. You can combine scan and contrast protocols into integrated examination protocols, and export them to other scanners.   Contrast Protocols in CARE Contrast III Contrast protocol definition on the CT scanner (via Scan Protocol Assistant) Linking of contrast protocols with scan protocols Automatic transfer of injection parameters from the CT scanner to the injector Contrast protocols can be defined and managed on the scanner console and transferred to the injector. Contrast Protocols in CARE Contrast III audf_cont_media_contrast_III_cp_spa_64.mp3 CARE Contrast III allows:   Contrast protocol definition on the CT scanner (via the Scan Protocol Assistant), Linking of contrast protocols with scan protocols, as well as Automatic transfer of injection parameters from the CT scanner to the injector.   Learn about Contrast Management Management of Scan and Contrast Media Injection – Online Training Learn about Contrast Management audf_cont_media_con_man_intro_65.mp3 Learn about Contrast Management CMSPRAPage1 Injector status Scan Protocol Assistant (SPA) Overview audf_cont_media_con_man_overview_66.mp3 The last chapter will introduce you to the contrast management system. You will be offered an insight into its features and functions. Indications of the Injector Status The Syringe symbol is displayed at the bottom of the screen and shows you the status of the connection between the scanner and the injector. Indications of the Injector Status audf_cont_media_con_man_indication_67.mp3 The Syringe symbol indicates the status of the connection between the scanner and the injector. Please take a close look at the table to learn more about different states and their meaning. Scan Protocol Assistant CMSPRAPage1 Contrast protocol can be defined via Scan Protocol Assistant (SPA). Select Define contrast protocols. Scan Protocol Assistant 2.70 Scan Protocol.mp3 Contrast protocols can be defined by means of the Scan Protocol Assistant feature. Select Define contrast protocols for this purpose. This is only available with the care contrast three license.   Add or Select Protocols CMSPRAPage3 CMSPRAPage3 Add a new protocol or select an existing one. Move the right mouse button over one of the existing protocols for more options. Add or Select Protocols audf_cont_media_con_man_add_69.mp3 You can add a new protocol or select an existing one. Move the right mouse button over one of the existing protocols for more options.   Define Contrast Protocols contrast_protocols1 Select a phase (e.g. Contrast) to define the parameters. Select another phase (e.g. Saline) to define the parameters. Tip: Deselect all other phases Define Contrast Protocols audf_cont_media_con_man_define_70.mp3 You can define contrast protocols as desired.   Select a phase (for example, Contrast) to define the parameters.   Select another phase (for example, Saline) to define the parameters. Please note that all other phases shall be deselected. contrast_protocols4 Define Contrast Protocols Insert or delete phases via the right mouse button context menu. (Available phases are: Contrast, Saline, Dualflow, Delay) Define Contrast Protols - Insert and Delete Phases audf_cont_media_con_man_insert_71.mp3 You can insert or delete phases by means of the right mouse button context menu.   The phases available here are: Contrast, Saline, Dualflow, and Delay.   ProtocolDefinition Define Contrast Protocols Changing parameters The changed parameters will be highlighted in green. Define Contrast Protocols - Changing Parameters audf_cont_media_con_man_change_72.mp3 Change of parameters is possible as well.   The parameters that have been changed will be highlighted in green. Confirm and Save Changes to Contrast Protocols contrast_protocols5 contrast_protocols6 Confirm and Save Changes to Contrast Protocols audf_cont_media_con_man_confirm_73.mp3 Any changes to the contrast protocols need to be confirmed and saved. Change Parameters link_contrast_protocols1 Linking contrast protocols with scan protocols in the SPA. Select Change parameters. Change Parameters audf_cont_media_con_man_ch_par_74.mp3 You can link the contrast protocols with the scan protocols in the Scan Protocol Assistant.   To do so, select Change parameters. Select Protocol link_contrast_protocols2 Linking contrast protocols with scan protocols in the SPA. Select one or several scan protocols required. Select Protocols audf_cont_media_con_man_sel_prot_75.mp3 Then select one or several required scan protocols. Select Contrast link_contrast_protocols3 Linking contrast protocols with scan protocols in the SPA. Select the Contrast options. Select Contrast audf_cont_media_con_man_sel_contr_76.mp3 Select the Contrast options. Insert a Contrast Entry link_contrast_protocols3 InsertBT Linking contrast protocols with scan protocols in the SPA. Insert a contrast entry (Contrast, Bolus Tracking or Test Bolus). Insert a Contrast Entry audf_cont_media_con_man_insert_77.mp3 Insert a contrast entry (Contrast, Bolus Tracking or Test Bolus). Coupled Mode link_contrast_protocols5 Linking contrast protocols with scan protocols in the SPA. Choose the Scan start coupled mode. Tip: Activate the Spin button with a double click, or deselect other phases. Coupled Mode audf_cont_media_con_man_coup_mode_78.mp3 Choose the Scan start coupled mode.   You should activate the Spin button with a double click, or deselect other phases.   Choose a Saved Contrast Protocol Link KM Linking contrast protocols with scan protocols in the SPA. Choose a saved contrast protocol from the list. Tip: Activate the Spin button with a double click, or deselect other phases. Choose a Saved Contrast Protocol audf_cont_media_con_man_choose_79.mp3 Choose a saved contrast protocol from the list.   Save the Changed Scan Protocol link_contrast_protocols7 Linking contrast protocols with scan protocols in the SPA. Save the changed scan protocol. Save the Changes Scan Protocol audf_cont_media_con_man_save_80.mp3 Save the changed scan protocol. Confirm the Result link_contrast_protocols9 Linking contrast protocols with scan protocols in the SPA. The scan protocol will now be loaded including the linked contrast protocol. Confirm the Result audf_cont_media_con_man_confirm_res_81.mp3 The scan protocol will now be loaded including the linked contrast protocol. Confirm the Saved Scan Protocol link_contrast_protocols14 Changes can be saved as a new contrast protocol, or an existing contrast protocol can be overwritten. The current scan protocol will not be overwritten. To link the new contrast protocol, the scan protocol shall be saved as explained before. Confirm the Saved Scan Protocol audf_cont_media_con_man_confirm_prot_82.mp3 Changes can be saved as a new contrast protocol, or an existing contrast protocol can be overwritten.   The current scan protocol will not be overwritten.   To link the new contrast protocol, the scan protocol shall be saved as explained before. Invalid Parameters InvalidCMprotocol Invalid parameters will be highlighted in yellow. Invalid Parameters audf_cont_media_con_man_invalid_83.mp3 If there are any invalid parameters, they will be highlighted in yellow.   Import, Export or List Contrast Protocols CMSPRAPage4 CMSPRAPage1 The contrast protocols can be exported, imported, and listed. Select List / import / export contrast protocols. Import, Export or List Contrast Protocols audf_cont_media_con_man_import_84.mp3 Contrast protocols can be exported, imported, and listed. To do so, please select List / import / export contrast protocols.   CARE Contrast Summary CARE Contrast I (CANopen standard, class I) Synchronization of scan and contrast media injection using a single button either at the scanner console or at the injector. CARE Contrast II (CANopen standard, class III) Automatic transfer of injection parameters to the patient protocol, MPPS Download of injection parameters from the injector to the scanner. CARE Contrast III (CANopen standard, class IV) Defining and management of contrast protocols on the scanner console, and transfer to the injector. Combining scan and injector protocols to integrated examination protocols, and exporting them to other scanners. CARE Contrast Summary audf_cont_media_con_man_summary_85.mp3 The functionality of the CARE Contrast feature can be summarized as follows:   CARE Contrast I, which stands for CANopen standard class one, offers synchronization of scan and contrast media injection using a single button either at the scanner console or at the injector.   CARE Contrast II, or CANopen standard class three, ensures automatic transfer of injection parameters to the patient protocol, MPPS, or the like. It can also be used for the download of injection parameters from the injector to the scanner.   CARE Contrast III, or CANopen standard class four, is used to define and manage contrast protocols on the scanner console, and to transfer these to the injector. It also combines scan and injector protocols to integrated examination protocols, and exports them to other scanners.   ? Course Review Congratulations. You have completed the Management of Scan and Contrast Media Injection Online Training. Select the objectives listed below to review the material before proceeding to the final assessment. Learn about Contrast Management Identify CARE Contrast I-III Summarize CARE Bolus, Test Bolus and Dynamic Evaluation (DynEva) Define Different Types of Contrast Media and Applications 1 1 2 2 2 3 3 3 4 4 4 Course Review Congratulations. You have completed the Contrast Media Online Training. Select the objectives listed below to review the material before proceeding to the final assessment. Additionally, a full course review is available in the Resources tab. Learn about Contrast Management The Syringe symbol displayed at the screens bottom shows connection status between scanner and injector Adjustable/Selectable Features of the Scan Protocol Assistant (SPA) = main tool for contrast management Select Define contrast protocols Add new protocol or select existing one Define contrast protocols Insert or delete phases via RMB context menu (available: Contrast, Saline, Dualflow, Delay) Change parameters Confirm and save changes Link contrast protocols with scan protocols in SPA: Select change parameters, select one or several scan protocols required, select contrast options, insert contrast entry, choose scan start coupled mode, choose contrast protocol from list, save changed scan protocol Scan protocol will be loaded including linked contrast protocol The contrast protocols can be exported, imported, and listed Identify CARE Contrast I - III Challenge: Synchronizing CT scan and contrast media injection, even with one technician only, standardized and pre-defined scan protocols with bolus injector coupling, separated and decoupled documented injector information  Solution: Simplified bolus injector coupling via CARE Contrast (CARE Contrast I), definition and management of contrast protocols on the scanner console (CARE Contrast II), combined scan and contrast protocols (CARE Contrast III) + Benefits: Single button control from either the scanner or the injector, standardized communication between scanner and injector CARE Contrast I CARE Contrast II CARE Contrast III Kontroller Summarize CARE Bolus, Test Bolus and DynEva Table with 2 columns and 4 rows Methods Explanation CARE Bolus Bolus-triggered contrast agent analysis Optional Workflow: Load examination –> Scan topogram –> Insert bolus tracking scan –> Select position of slice to perform bolus tracking on –> Set ROI in dedicated vessel –> Auto trigger threshold can be adjusted in Contrast (Som 7) / IV Bolus (Som 5) row (Auto trigger threshold HU is relative) –> delay & cycle times can be adjusted from monitoring row --> Apply contrast media and start scan Scan will not start if there is extravasation, contrast pump is not working correctly, saline is in wrong syringe The shorter the cycle time, the more precise the bolus curve (but: more scans --> higher dose) Manual scan start is possible at any time Test Bolus Available on every scanner as standard feature Workflow: Load examination –> Scan topogram –> Insert test bolus –> Select level where test bolus scan should be performed –> Apply test bolus of contrast media (do not terminate test bolus scan until contrast has started to fade out in ROI) DynEva DynEva = Dynamic evaluation For perfusion evaluation and better timing of contrast media examinations Uses the time-density curve Workflow: Select relevant series in patient browser –> Load into DynEva application –> Segment 1 loads all images, segment 2 loads results, segment 3 loads baseline-image (DynEva requires at least 4 images/time points to work) –> Draw and set ROI in vessel –> Insert the delay of the test bolus –> curve shifts to correct point in time TTP (Time To Peak) = time needed to reach peak of contrast in the ROI for the test bolus scan Define different Types of Contrast Media and Applications What are contrast media: Substances to enhance the contrast of the tissue structures or fluids. Why contrast media: Inherent contrast of some human tissues not sufficient to make images with high contrast and consequently good diagnoses. Examples of contrast media applications: Parenchymal contrast, Angiography, Cardiac diagnostics, Gastro-intestinal-tract, Perfusion, Interstitial contrast Types of contrast media: Positive contrast media (absorb more X-rays), e.g. Gastrografin, Imeron Negative contrast media (absorb fewer X-rays), e.g. Mannitol, Air Saline flush: The use of a saline chaser pushes the contrast bolus forward, hastens the arrival of the contrast bolus by 4 seconds and increases peak enhancement by 30%. Check before injection: Patient allergies, Metformin prescription, blood values of the kidneys (Creatinine, eGFR), Thyroid function test levels (TSH, fT3, fT4, venous catheter) Case of emergency: Call the emergency unit! Medication in case of emergency: Cortisone / H1, H2, Oxygen, IV fluids (NaCl) Day 0 - perfusion CT perfusion demonstrates a large defect involving the superior division of the right MCA territory. A 3D image of the heart from the Philips Brilliance iCT scanner Please note that the 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 Healthineers sales representative for the most current information. The reproduction, transmission or distribution of this training or its contents is not permitted without express 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 Healthcare GmbH 2023 Siemens Healthineers Headquarters\Siemens Healthcare GmbH\Henkestr. 127\ 91052 Erlangen, Germany\Telephone: +49 9131 84-0\siemens-healthineers.com Disclaimer Disclaimer Assessment Welcome to the assessment. For each question, select your answer and then select Submit. You will have 3 attempts to take this assessment and to successfully pass this course. You must receive a score of 80% or higher. You will receive your score when you have completed the assessment. Start Assessment Select the correct answer. ? Question 1 of 5 Which functionality is available ONLY with CARE Contrast III? Synchronized scanning and contrast injection One button control from the CT console or from the injector Automatic transfer of injection parameters from the CT scanner to the injector Automatic transfer of injection parameters from the CT scanner to the injector Automatic transfer of injection parameters from the CT scanner to the injector Display of injection parameters on contrast card Display of injection parameters on contrast card Display of injection parameters on contrast card Multiple Choice Select the applicable image. ? Which of the following is an example of an examination with negative contrast media? Question 2 of 5 CT brain perfusion CT angiography of the abdomen Virtual colonography Pick One Select the correct answer. ? Question 3 of 5 Which statement about CARE Contrast is correct? CARE Contrast defines and manages patient dose on the scanner console. CARE Contrast is a special scan mode for the examination with contrast media. CARE Contrast is a calculation method to minimize the volume of contrast media. CARE Contrast is a calculation method to minimize the volume of contrast media. CARE Contrast is a calculation method to minimize the volume of contrast media. CARE Contrast combines scan and contrast protocols into integrated examination protocols. CARE Contrast combines scan and contrast protocols into integrated examination protocols. Multiple Choice Select the correct answer. ? Question 4 of 5 Which of the following clinical examination does NOT require application of contrast media? Cardiac Angiography Carotid Angiography Lung Perfusion Lung Perfusion Lung Perfusion Cardiac calcium scoring Cardiac calcium scoring Cardiac calcium scoring Multiple Choice Select the correct answer. ? Question 5 of 5 Which patient history are commonly vetted prior to contrast administration? Patient allergies (iodine, preservative agent), Metformin prescription (to prevent CIN lactic acidosis), Blood values of the kidneys and Thyroid function. There is no common examination prior to contrast administration. Metformin prescription (to prevent CIN lactic acidosis), Pulmonary capacity, Blood component and arrhythmia. Metformin prescription (to prevent CIN lactic acidosis), Pulmonary capacity, Blood component and arrhythmia. Metformin prescription (to prevent CIN lactic acidosis), Pulmonary capacity, Blood component and arrhythmia. Metformin prescription (to prevent CIN lactic acidosis), Patient allergies (iodine, preservative agent), Claustrophobia and Blood pressure. Metformin prescription (to prevent CIN lactic acidosis), Patient allergies (iodine, preservative agent), Claustrophobia and Blood pressure. Metformin prescription (to prevent CIN lactic acidosis), Patient allergies (iodine, preservative agent), Claustrophobia and Blood pressure. Multiple Choice Retry Assessment Results %Quiz2.ScorePercent%% %Quiz2.PassPercent%% Continue YOUR SCORE: PASSING SCORE: Assessment Results You have exceeded your number of assessment attempts. Exit You did not pass the course. Select Retry to continue. Congratulations. You passed the course. Exit To access your Certificate of Completion, select the Launch button drop down on the course overview page. You can also access the certificate from your PEPconnect transcript. ? You have completed the Management of Scan and Contrast Media Injection Online Training. Completion Question Bank 1 management_scan_contrast_media_injection_usa 2.1 Welcome 2.2 Define Different Types of Contrast Media and Applications 2.3 Overview 2.4 Contrast Media 2.5 What are Contrast Media? 2.6 Why do We need Contrast Media 2.7 Types of Contrast Media 2.8 Examples of Cases with Contrast Media 2.9 Examples of Cases with Contrast Media 2.10 Saline Flush 2.11 Checklist before Injection 2.12 Emergency 2.13 Summarize CARE Bolus, Test Bolus and DynEva 2.14 Overview 2.15 CARE Bolus / Test Bolus / DynEva 2.16 CARE Bolus 2.17 SOMATOM Somaris 5 Systems 2.18 SOMATOM Somaris 7 Systems 2.19 CARE Bolus - Steps 2.20 Step 2 2.21 Step 3 2.22 Step 4.1 2.23 4.2 2.24 Step 5.1 2.25 Step 5.2 2.26 How to deactivate Auto trigger - Somaris 7 2.27 How to deactive Auto trigger - Somaris 5 2.28 Step 5.3 2.29 Step 6 2.30 Procedure? 2.31 The scan will not start, if ... 2.32 Defining Contrast Media 2.33 Tips 2.34 Test Bolus - Steps 2.35 Step 1 2.36 Step 2 2.37 Step 3 2.38 Step 4 2.39 Step 5.1 2.40 Step 5.2 2.41 DynEva 2.42 Calculation of the Delay 2.43 Multi-Slice CT 2.44 Images 2.45 Image Selection 2.46 Insert Delay of Test bolus 2.47 Identify CARE Contrast I-III 2.48 Overview 2.49 CARE Contrast 2.50 CARE Contrast - Why do we need it? 2.51 Synchronization and Management of Scan and Contrast Media Injection 2.52 CARE Contrast I - Synchronization of Scan and Contrast Media Injection 2.53 Key Features, Benefits and Supported Scan Types 2.54 Start in Control and Scan Room 2.55 Prerequisites 2.56 Start Injector Coupling 2.57 Start Injector Coupling - Message 2.58 Loading the Scan 2.59 Arming the Injector 2.60 Starting the Scan and the Injection 2.61 Error Handling I 2.62 Error Handling II 2.63 CARE Contrast II 2.64 Overview 2.65 Contrast Protocols in CARE Contrast III 2.66 Contrast Protocols in CARE Contrast III 2.67 Learn about Contrast Management 2.68 Overview 2.69 Indications of the Injector Status 2.70 Scan Protocol Assistant 2.71 Add or Select Protocols 2.72 Define Contrast Protocols 2.73 Define Contrast Protols - Insert and Delete Phases 2.74 Define Contrast Protocols - Changing Parameters 2.75 Confirm and Save Changes to Contrast Protocols 2.76 Change Parameters 2.77 Select Protocols 2.78 Select Contrast 2.79 Insert a Contrast Entry 2.80 Coupled Mode 2.81 Choose a Saved Contrast Protocol 2.82 Save the Changes Scan Protocol 2.83 Confirm the Result 2.84 Confirm the Saved Scan Protocol 2.85 Invalid Parameters 2.86 Import, Export or List Contrast Protocols 2.87 CARE Contrast Summary Course Review and Disclaimer 2.88 Course Review 2.89 Disclaimer 2.90 Assessment