NAEOTOM Alpha Class - Clinical Case Video: Breast CTA

Today I want to talk about a really interesting case. It's about a 32 year old female patient. She'd breastfed in the past eight years and was suffering from bilateral symptomatic breast hypertrophy with severtosis, which was grade 3. She was scheduled for a reduction mammoplasty before the surgery ACT Angiography was performed using an ultra high resolution scan mode called quantum HD with a dual source photon counting CT neotom alpha. We did this to figure out the dominant blood supply of the nipple areola complex NAC and where its vascular sources were. The CTA images showed a symmetrical pattern of a single source artery on both sides. On the right, the dominant artery branched off the internal thoracic artery at the first intercostal space and on the left it branched off at the second intercostal space, both supplying blood to the NAC region. The virtual mono energetic images shown at 50 KV had better contrast enhancement and let us see the terminal arteries for the NAC more clearly. We used these images to make 3 dimensional images with the cinematic rendering technique. We applied different presets to show the anatomical relationship between the arteries and the bones, muscles and fatty tissues, just like the surgical position of the patient. Then we projected the rendering results for holographic localization and marked the arteries on the patient's body before the operation. The surgery, a reduction mammoplasty and pedicled nipplorella reconstruction was a success and the outcome was satisfactory. The CVRT images also clearly showed that symmetrical pattern of a single source artery on both sides and how they branched off to supply the NAC region. Now let's talk a bit more about the condition. Macromastia or breast hypertrophy is when the breast grows way too big. It causes both physical and psychological problems for patients. There's no long lasting non operative treatment for symptomatic breast hypertrophy and we still don't really know what causes it exactly. Surgical treatment like reduction mammoplasty is considered the best way to relieve the symptoms according to the guidelines and is the most common therapy. But here's the problem. During the operation, because the blood supply is so complex, there can be injuries to the arteries that lead to post operative functional loss or even necrosis of the NAC. Studies have shown that the blood supply pattern of the NAC is really different from person to person and even different between the right and left breast of the same person. The source artery can be single or multiple, and the pattern can be symmetrical or asymmetrical. Sometimes, if the detectable diameter threshold is set above 1.0mm, we might not be able to see the dominant artery. That's why having quantum HDCTA images is so important. It helps us understand the NAC blood supply better and design A successful personalized mammoplasty reduction. This case was done using the dual source photon counting CT Neotom Alpha. This machine gives us energy resolved Connecticut data. It has good spatial resolution and comes with inherent sectral information, and there's no electronic noise. These advanced techniques are great for imaging the small terminal arteries to the NAC in detail. The individual detector pixels of the photon counting detectors are defined by a strong electric field, not like the physical separation in the conventional energy integrating detector CT. So we get small subpixels without losing radiation dose efficiency. The quantum HD mode has a fine collimation of 120 by 0.2mm and high end plane resolution. Also, we can get spectral information at a slice width of 0.4mm and display VM is at a low KV level, like 50KV in this case, which improves contrast enhancement. Since there's no electronic noise, we can potentially reduce the radiation dose. In this case, it was 4.5 milligray while still keeping the image quality top notch. As this case shows, preoperative CTA imaging helps us fully understand the main blood supply in the NAC region. It's a useful tool for surgical planning in reduction mammoplasty. The quantum HD images from the Photon Counting CT show that we can improve the details of the blood vessels while reducing the radiation dose. That's all for this case. Thank you.

123 3/14/2024 201 1.0 1024*1024 0.5 30 1.2 20 120 986 23 10 40 192 195 0.3 216 270 03 NAEOTOM Alpha class Clinical case video: Breast CTA SIEMENS Alpha_Breast_CTA_UHR NAEOTOM Alpha Viewing syngo CT VA50A CTA Thorax_A 0.40 Bv60 Q4 2:36:29.04 PM SP F1046.9 SP A165.5 Favorite Tools MPR SL SPC 10cm KV 120 Series +C ME 50kev ME_50keV Findings SP R2.3 Manip C VRT Printing AC 501 12: 30 2025/04/11 12:30:12 SP A377.8 SP A156.1 SP L36.9 SP SP A170.6 SP L1.9 PC 6 IMA n.a. MPF Healthineers SP F995.8 SP F976.3 kV 120 SP F958.8 SP F990.8 SP F1000.3 6 IMA n.a SP A 165.5 SPA174.1 SP L4.4 SP A210.9 SP R1.1 SP A222.5 SPA212.7 SP A215.2 VRT Gallery Reset Preset Auto Views Cinematic Insight VRT Properties Object Settings Modality CT Body Part Body CR VB60 Tissue Classification General Settings OK Cancel View 2 sbu Bowel 3D Reference Point Windowing Home Position Region Growing Punch Anatomy Visualizer Fit to Segment Remove Table Bone Removal Tools Segmentation Objects Segmentation Tools Neck CR Copy of operties ettings Copy of COVID inting Fine Tune Region SIEMENS . Viewi tings Table Bowe Copy of COVID- atomy Visualizer ntation Objects ntation Tools Viewir assification cation VE Copy of COVID-19 2 sue Classification Jowel Volume Threshold Cance SP F1008.8 SP R3.6 ME 50keV AH HP SP P91.5 ME SP P149.1 SP P170.0 Cinematic VRT VRT MIP Thin MIP MIF SP P161.5 SP P154.7 SP P178.6 MP Hagar MT, Soschynski M, Saffar R, et al. Ultra-high-resolution photon-counting detector CT in evaluating coronary stent patency: a comparison to invasive coronary angiography. Eur Radiol. 2024; doi: 10.1007/s00330-023-10516-3. Thomas Flohr, et al. Photon-counting CT review. Physica Medica 79 (2020) 126-136. SP P173.7 SP R145 2 RPF SP P103.4 HRP SP P145.5 SP R173 7 SP P151.0 SP P148.6 W 1098 C 195 SP P237.0 SP P273.4 SP P269.1 RHA RH 23 9 SP P257.7 W 1168 SP P255.9 W 1360 SP P260.1 RHP SP P303.0 SP P128.6 HPL SP P104.4 RAH SP P99.5 SP P155.6 SP P133.1 SP P120.7 SP P31.0 SP P26.8 AHL SP F1025.9 AHR SP A165 5 SP R116.1 SP P32.7 SP L45.6 SP L54.1 ALH SP P14.0 SP P6.4 V 1360 SP P15.0 IMA n.a. SP P17.2 SP L55.1 HLP SP F999.4 SP L24.4 SP A236.9 SP F991 9 SP F1011.4 LRQ 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 statements by Siemens Healthineers' customers described herein are based on results that were achieved in the customer's unique setting. Because there is no "typical" hospital or laboratory and many variables exist (e.g ., hospital size, samples mix, case mix, level of IT and/or automation adoption) there can be no guarantee that other customers will achieve the same results. Page 1 of 2 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 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 All names and data of patients, parameters, and configuration dependent designations are fictional and examples only. Unrestricted | Published by Siemens Healthineers AG | @ Siemens Healthineers AG, 2025