syngo CT VB30 FAST Bolus Video

Welcome to the Fast Bolus training feature introduced in the Somaris 7VB30 software. In this training, we will discuss the new Fast bolus feature by showing a scenario where this feature would benefit the outcome of a patient study. We will then discuss how fast bolus works and the benefits it provides. Then this video will demonstrate how to use fast Bolus and the requirements for using fast bolus. The VB30 software is an upgrade. That can be purchased for all Somaris 7 scanners. Fast Bolus is an optional license and upgrade that can be included in the VB30 software upgrade. On the screen you can see all the available Somaris 7 scanners that VB30 and Fast Bolus can be installed on. Let's now discuss some real life scenarios where fast bolus can improve the outcome in your exams. In this first scenario, Patient Johnson has arrived at your clinic. He has an order from his physician for a CTA of the aorta for aneurysm. What you do not know is that patient Johnson has a normal cardiac output in the CTA exam. You plan to use bolus tracking to ensure sufficient contrast throughout the aorta during the examination. You place the bolus tracking ROI in the descending aorta and begin the monitoring scan to track the arrival of contrast. Once the Hounsfield units. Cross the threshold. The exam begins with the fixed scan delay for the patient instructions to play and the CTA exam starts. Please breathe in and hold your breath. As you can see in this example with a patient that has a normal cardiac output, this method will work and the scan will happen at the moment that the threshold has been achieved, giving a proper timed examination. After you have finished Patient Johnson's exam, Patient Smith arrives at your clinic. Patient Smith also has an order for a CTA of the aorta for aneurysm. Again, you plan to use bolus tracking in this exam, but what you do not know is that patient Smith has very low cardiac output performing the exam in the same way by using bolus tracking. You can see that the Hounsfield unit measurement has crossed the threshold and the fixed delay for the patient instruction has triggered. This scan is too early and not at the optimal peak of the contrast arrival. Since the contrast is moving more slowly through the patient's body due to this low cardiac output, it can result in a suboptimal examination of the aorta. What if there was a solution to this problem? This can be achieved with the fast bolus feature now introduced with the VB30 software for the Sommeris 7 platform. Fast bolus takes into account various patient specific factors like iodine concentration, cardiac output and injection parameters. As you can see in this example of patient Smith. And utilizing the Fast Bolus algorithm, it now detects a low cardiac output and will automatically adjust the scan delay to ensure scanning at the optimal bolus peak enhancement, giving the best results for this examination. So how does Fast Bolus work? Let's discuss the factors involved with this new feature. Fast Bolus automatically adjusts the post bolus delay by replacing the fixed trigger delay. It considers the variability in the individual blood circulation system of a patient. The algorithm will first look for the information relating to the injection. It looks for the type of contrast used and the iodine concentration. It also looks at the contrast injection rate and amount of contrast injected. Because of this requirement, it is necessary to have care, contrast and injector coupling activated and in use. This way the scanner will pull all the pertinent injection information straight from the injector. Then you must have the checkbox for Fast bolus checked and activated once the injection parameters are known and then confirmed, which happens once you arm the injector. The scanner will use the monitoring scan and the information obtained to determine the speed of the contrast arrival. Depending on this information, the algorithm will predict the proper timing of the bolus peak once the. Peak is determined. The fixed delay will be adapted and changed by the scanner to reflect this new timing shown once again. In this example you can see that for the first patient with normal cardiac output. The scan delay is adjusted minimally and the scan happens at the peak of the curve or the optimal scan delay. In the second example of someone with a slow cardiac output and using the fast bolus feature, the individual scan delay will automatically be extended much further this. Is to ensure that the scan will happen during the peak bolus of the contrast. Having the injection information and monitoring scans, the algorithm can safely predict the peak bolus timing. It is important to know that. For the algorithm to function properly, the monitoring phase needs to have at least four sequence scans performed to obtain the proper timing information. In order to predict the peak within this, at least one of the monitoring scans needs to have no contrast within the monitoring ROI. With these requirements, along with the injection information, Fast Bolus will correctly adjust the delay for the actual contrast peak. If any of these factors are not met, Fast Bolus can't predict the delay accurately and the scanner will revert back to the default fixed delay that is built into the protocol. Fast Bolus is designed in a way that it increases the level of personalization and automation of Bolus tracking scans while providing improved usability and results. With decreased variability, fast bolus can provide you with higher and more homogeneous contrast attenuation. While potentially reducing the number of non diagnostic scans, fast bolus gives you an increased and more homogeneous contrast throughout the entire examination. While potentially reducing the number of non diagnostic scans, Fast Bolus allows you to optimize your use of contrast media by automatically providing optimal timing delay changes. If you would like to read an article on this subject and the findings from patient research studies, please refer to the paper shown here. You now have seen the benefits of fast bolus and how it works. Let's now show you how to activate and use this feature on your scanner. When you would like to use Fast bolus, it needs to be activated from the Contrast tab in the Chronicle. For the algorithm to work properly, all the pertinent contrast injection information must be filled in. To make sure that this is correctly and accurately filled in, injector coupling is required and must be activated in scanstart. You must then check the Fast bolus option. The seconds next to this function will be discussed later in this training. Once Fast Bolus has been checked, a new icon is displayed in the Chronicle. This shows that there is a planned injection with Injector coupling and Fast Bolus activated for this protocol. Keep in mind that the name of the contrast media and iodine concentration must also be filled in. This can be globally inserted from the configuration option. The monitoring ROI must be placed in the aorta. You can place it in any part of the aorta, such as the ascending arch or descending. But it must be in the aorta. Once all of this has been inserted, Fast Bolus is ready to use. You may save all of these settings into a specific protocol. This avoids having to manually turn on these features every time. Fast Bolus is needed. Since the name of the Contrast media and iodine concentration are required for fast bolus, you can insert this information in the configuration. This way it will be easily selectable from the Contrast tab in the Chronicle. To do this, navigate to Options in the menu bar and select Configuration. From the Configuration panel, select Examination. In the Examination configuration, select the Contrast tab. Here you may input. All of the contrast medias that you use at your facility. You may choose a default media to be automatically selected in the Contrast tab in the Chronicle. To change between medias in the contrast tab, there will. Be a drop down list with. All of the media types you inserted here. Let's now watch this process during a simulated scan using actual patient data. Here we have an exam for a chest, abdomen and pelvis CTA. Going to the Contrast tab, you must turn on the Fast Bolus feature and select Injector Coupling in Scanstart. You can now see that the injection parameters have been transferred from the injector to the Contrast tab after checking through the scan parameters of the Monitoring and NGO scans. You load the prescribed exam information, press and hold the. Move button to move the table into the position for the premonitoring. Press the Start button to acquire the premonitoring slice. Once the premonitoring slice has been acquired, you place the ROI in the descending aorta. You then arm the injector for the injection. This is to ensure that the scanner and the injector start together when you press the start button. Once you have. Pressed the start button for the monitoring scans. The injector begins the injection and the 10 second delay starts. Once the monitoring exam begins, it starts acquiring the monitoring slices for fast bolus to work. Properly, it must obtain at least 4 monitoring slices with at least one slice before the contrast has reached the ROI if there. Are not at least 4 slices acquired. And one without contrast, the fast bolus. Feature will just revert to the default delay that is in the scan. This default delay time has to factor in the table movement to the start position and the automated patient instruction if there are at least. 4 slices acquired and one without contrast the fast bolus. Feature will factor in all the information and automatically adjust the delay time to ensure proper timing of the contrast in the exam. In this example, you can see that the delay was automatically adjusted to 19 seconds. After the 19 second fast bolus delay the CTA exam is acquired. As you can see in the real time display images. While reviewing the exam, the contrast is sufficiently dispersed properly throughout the aorta and arterial system. You may then proceed with the reconstructions and finish the exam checking the scan parameters. After the scan, you can see that Fast Bolus automatically added the 19 seconds into the delay. When Fast Bolus has been used, you can find all the delay results in the DICOM Bolus Tracking results graph. This image can be sent to the pack system for storage along with the exam. It can be referred back to any time in the future when fast bolus is used, you may add. Additional delay time to the contrast peak that was determined, in this case 10 seconds has been added. Fast bolus will determine the peak of the contrast and then add the additional 10 seconds. This can be used to properly time a delayed arterial phase in someone with poor cardiac output. In the example above, fast bolus determined that the contrast peak needed a 19 second delay, so in this case, adding an additional 10 seconds, the overall fast bolus delay would have been 29 seconds. You may also use a negative number here to subtract time from the fast bolus peak delay. This could be. Useful when doing an exam of the lungs for embolism where you do not want such a late arterial phase. In the previous example, fast bolus determined that a 19 second delay was needed. For the peak. If you put in a -5 seconds, it would be subtracted from the 19 to give a total of a 14 second delay. Keep in mind that there is a minimum delay time needed for table movement and the automated patient instruction to play. So if the calculated delay including the offset is shorter than the minimum time needed for this, the scanner will apply the shortest delay time possible. If fast bolus is to be used every time in a specific protocol, it can be activated and saved in a scanned protocol. This can save time and speed up the workflow. Avoiding the need to activate this manually, please be sure to activate all the necessary options before saving, let's highlight the main take away points of Fastbolus. Fastbolus is an additional timing tool used in bolus tracking to ensure scanning during the contrast peak. Fast Bolus needs all injection information to be filled out in the contrast tab, such as contrast information, injection amounts and rates. Injector coupling is required to use Fast Bolus. Fast bolus must be checked in order to be. Activated Additional time may be added or subtracted to the fast bolus contrast peak A. Minimum of four monitoring slices must be acquired. With at least one slice with no contrast in the ROI. And lastly the monitoring ROI must be placed in the aorta. Fast bolus cannot be used for timing in the pulmonary artery.

500 400 300 200 100 10 20 30 40 50 700 600 3.0 20= 11 80 80= 12 60 13 1,4 15 25 35 14 [1] 16 17 18 2019;43(4):612-8. 19 3.0= +0 21 654242323 4/11/2023 90 22 3-1 27 23= -917.0 125.0 325 0.0 376 12:49:41.50 120 237 392 129 -1412.5 -769.2 23 125. 23- 113 12:50:46.31 SIEMENS . Healthineers syngo CT VB30 FAST Bolus For Somaris 7 Systems Unrestricted @ Siemens Healthineers, 2023 Table of contents FAST Bolusers · FAST Bolus benefit scenario . How does FAST Bolus work? . How to use FAST Bolus VB30 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. Somaris 7 - VB30 software update Scanner overview: · Optional upgrade for all Somaris 7 scanners SOMATOM Definition AS / AS+ Definition Edge Confidence Edge Plus Confidence - Sliding Gantry Definition Flash Drive Force FAST Bolus usage scenario FAST Bolus scenario Patient Johnson has arrived at your clinic. . He has an order for a CTA of the aorta for aneurysm. Patient Johnson has normal cardiac output. You plan to use bolus tracking in this examin examination. AF CT enhancement [HU] Threshold 60 Time [s] The products/features mentioned herein are not commercially available in all countries. Their future availability cannot be guaranteed. Pr Mc Predicted bolus Monitoring scan Scan delay Scan UniversitätsSpital Hinzpeter R, Eberhard M, Gutjahr R, et al. CT Angiography of the Aorta: Contrast Timing by Using a Fixed versus a Patient-specific Trigger Delay. Radiology 2019;291(2):531-8. Zürich Patient Smith has arrived at your clinic. . She has an order for a CTA of the aorta for Patient Smith has low cardiac output, but you do not know this about patient Smith. Fixed delay 5 10 15 20 25 30 35 40 Time [s] Predicted bolus Duration 5 10 15 20 25 30 35 40 Time [s] 10 15 20 25 30 35 40 Time [s] Pre Ris Risk of missing bolus with fixed delay Hinzpeter R, Eberhard M, Gutjahr R, et al. CT Angiography of the Aorta: Contrast Timing by Using a Fixed versus a Patient-specific Trigger Delay. Radiology 2019;291(2):531-8. 10 15 20 25 30 35 Fixed delay and individualized delay Individual delay Optimal timing with FAST Bolus How does FAST Bolus work? 0 5 10 15 20 25 30 35 FAST Bolus automatically adjusts the post bolus delay (by replacing the fixed trigger delay). It considers the Scan Start -Injector coupled (start button) Saline variability in the individual blood circulation system of a Auto trigger 100 HU Pressure Limit 1000 kPa patient. +0 s Contrast Protocol Name of CM optiray . It does this by first looking at the injection parameters lodine Concentration 300 mg/ml that can be found in the Contrast tab from the delay Monitoring 10 s Flow Volume CM Ratio (s) chronicle. Contrast BodyAngio auto The contrast information is a mandatory requirement for the algorithm to work. CARE Contrast and injector coupling are mandatory prerequisites for using FAST Bolus. Injector 3.0出 patient. ned to determin for the algorithm to work. the scanner to reflect this · Once the injection parameters are known and then confirmed by arming the injector. The scanner will use the monitoring scan and the information obtained to determine the speed of the contrast arrival. Depending on this information, the algorithm will predict the proper timing of the bolus peak." Once the peak is determined, the fixed delay will be adapted and changed by the scanner to reflect this new timing. Once the injectiAm parameters are known a CT enhancement [HU] Time in s . Once the monitoring scans have been O Predicted Bolus performed, this advanced algorithm will - Attenuation Threshold Scan Duration predict where the peak of the bolus will happen. CT-value [HU] It is important to know that, for the algorithm to function properly, the monitoring phase needs to have at least 4 5 10 15 scans to obtain the amount of information genous required in order to predict the peak. Within the this, at least one of the scans needs to have no contrast within the monitoring ROI. Time to peak With these requirements along with the injection information, FAST Bolus will correctly adjust the delay for the actual contrast peak. [1] Hinzpeter R, Eberhard M, Gutjahr R, et al. CT Angiography of the Aorta: Contrast Timing by Using a Fixed versus a Patient-specific Trigger Delay. Radiology 2019;291(2):531-8. 2022. 30 3 30 35 5 10 FAST Bolus is designed in a way that: · It increases the level of personalization and automatization of bolus tracking scans, while providing improved usability and results with [1] Hinzpeter R, Eberhard M, Gutjahr R, et al. CT Angiography of the Aorta: Contrast Timing t Specific Scan Initiation for Pulmonary Embolism CTA: Impact on decreased variability. FAST Bolus provides higher and more homogenous 10 1 30 35 40 Time [s] contrast attenuation and potentially reduces the number of non-diagnostic scans [1]. [1] Schwartz FR, Ramirez-Giraldo JC, Gutjahr R, Boll D, Koweek LM. Poster: Real-Time Patient Specific Scan Initiation for Pulmonary Embolism CTA: Impact on Image Quality. In: Society of Computed Body Tomography and Magnetic Resonance Annual Meeting .; 2022. 20 2 Enabling automated and individualized scan trigger delays Increased and mor Increased and more homogenous contrast Potentially fewe Potentially fewer non-diagnostic scans Courtesy of LMU University Hospital Grosshadern, Munich, Germany 376 HU 363 HU 369 HU 368 HU 74 cm v Optimized use of contrast media Individualized Delay for Abdominal Computed Tomography Angiography Bolus-Tracking Based on Sequential Monitoring: Increased Aortic Contrast Permits Decreased Injection Rate and Lower lodine Dose Bernhard Schmidt, PhD ,* and Cynthia H. McCollough, PhDt Objective: The aim of this study was to determine if computed tomogra- 3 predominate methods used to time the acquisition of computed phy (CT) angiography using an individualized transition delry (CTA-ID) tomography (CT) images so that the intravenous contrast is in the would facilitate reductions in injection rate and iodine dose. arterial tree: fixed timing, bolus tracking, and test bolus. Fixed Methods: The CTA-ID was performed in 20 patients with routine injec- timing relies on a fixed delay between the injection of contrast tion rate and iodine dose; 20 patients with injection rate lowered by 1 mL/s; and image acquisition but will result in suboptimal examinations and 40 patients with injection rate lowered by 1 mL/s with 29% less iodine. in some patients and has largely been replaced with bolus tracking Routine CTAs in the same or size-matched p.tients served as controls. Di- or test bolus due to the widespread availability of this software on modem CT systems.2 Bolus tracking is used in most CT practices Injection rate lowered by 1 ml/S with 29% less iodine. Gutjahr R, Fletcher JG, Lee YS, et al. Individualized Delay for Abdominal Computed Tomography Angiography Bolus-Tracking Based on Sequential Monitoring: Increased Aortic Contrast Permits Decreased Injection Rate and Lower lodine Dose. Journal of Computer Assisted Tomography How to use FAST Bolus FB_BodyAngioRoutine (Adult) 23.04.11-12:37:06-STD-Specials PolyTraun 23.04.11-12:37:06-STC Total mAs: Topogram 80 ml PreMonitoring Scan Start |Injector coupled (start button) 250 ml optiray M Ratio Load Hold Recor · Activate from the Contrast tab. 20 ml · Contrast injection information is required. · Injector coupling is required. . Check the FAST Bolus option. New icon appears in the chronicle. RT Name of CM -Joptiray Name of contrast media and iodine concentration are also required. . The Monitoring ROI must be placed in the Aorta. · Settings can be saved in the protocol. Patient Applications View Options System Since the name of the contrast media and Version .. License. iodine concentration are required, you can Eile Browser .. insert this information in the configuration. This Hide Simulation Taskcard Maintenance way it will be easily selectable from the contrast Auto Expose SY tab in the chronicle. Patient Notes Browser Registration Search Image Text Scan Protocol E-Logbook Examination Bolus Dos Processing Respiratory Heartview Gating Name of CM Filming Layout Layout Editc Set as defeult Help Name of CM Optiray Ca Volume CT CaScoring Catalog name Catalog version Needed for automated billing. Audit Trail Software Distribution OK Defeult Settings Cancel Edtor Optiray . Go to options in the menu bar and select configuration. DIC Transter Select the examination option. In the contrast tab you may insert the contrast information. You may put in multiple contrast medias for easy selection from the contrast tab. Expert-i Test Patient Hospital SOMATOM Confidence CT VB30A1_P01 H-SP 1 IMA 1 TOP 1 SP-750.5 10cm KV 100 mA 20 GT 0.0 1024 0/0 Total mAs: 0 kPa Manual - Monitoring - BodyAngio iemens Healthineers, 2023 7出 Recon Start button 7 s Foot switch Injector coupled (start button) Injector coupled (foot switch) Auto trigger Start button Scan Start - Injector coupled (start button) mAs (32cm): kV SSDE (26.2cm): 37.5 mGy Exam time 44.0 s Slice Range: Craniocaudal Routine SP CE: CTDIvol (32cm): 26.5 mGy Scan time Delay No. of scans No. of images Comments Range: Begin End Table: Position Height Auto Tasking Trigger min FoV: 12.66 s mAS SP 1: -769.2 SP 2: -1412.1 Eff. mAs CARE Dose4D CTDIvol (32cm): 4.64 mGy 5.0 mm Acq. 64 x 0.6 mm 3-2 3 0.5 s 2 s 10.0 mm Acq. 1x 10.0 mm CTDIvol (32cm): 0.88 mGy No of scans No of images Press MOVE STOP No. of No. of in Comm Move Move table and gantry 23 mAs 100 kV 0.5 s 10.0 mm Press START Feed = 0 FOV Delay 1 s KV SSDE (26.5cm) 1.23 mGy Suspend 1 of 1 Accept 2 IMA 1 MON 2 mAs 23 20 m 27卡