Unveiling Real3D Imaging with Robotic Advanced X-Ray - Introduction and Physics

So the title of our webinar is revolutionising trauma diagnosis unveiling Wheel 3D imaging with robotic advanced X-ray. First, I would like to show you One Financial disclosure and two important regulatory disclaimers for good integrity purpose. We will show you T spec a couple of times later. Let's start with the learning objectives for the webinar. So we identify 3 objectives. The first one is to understand the clinical and physics principles of Wheel 3D for lower and upper extremity imaging. The second objective is to understand clinical image interpretation along with the limitations and the strengths. And the last objective is to understand the clinical application of Wheel 3D for the emergency department. At this stage you may be wondering what wheel 3D is and this is what I'm going to talk about right now. So wheel 3D is a three-dimensional imaging functionality that come with the multi term racks X-ray system from Siemens Helsini. The system uses robotics so that X-ray can be taken with very comfortable positioning for the patient, which is particularly important in the context of Ed imaging. As you can see, the X-ray source and the detector are attached to telescopic arms themselves attached to the ceiling, enabling lateral and transverse translation. So I'm going to show you how we can do hand, wrist or elbow imaging first. So it starts with the patient lying down on the table and the arms stretch out on the lateral extension. The detector comes with the X-ray source into the posterior anterior positioning. We can verify that the hand is properly positioned. Then we rotate the system by 90° and we can verify that we have satisfactory lateral positioning and then the system is moved towards the initial position of the scan. At this stage your patient is informed that the scan will proceed and the patient should stay still for about 8 second and the other scan is proceeding. Now the scan has been completed and we are going to bring the source detector back into the initial position and lower the table and then the X-ray tech can verify that. Quality. What we do with them is that we computationally process them to create multiplanar reconstruction that we can do in the actual sagittal and coronal direction. And so here that's an example of coronal and PR covering the wrist and the meta carpals. If the arm of the patient is a little bit stretched out further, then we can also image the elbow. And here I'm showing you a resulting sagittal MPR for the elbow. Now we'll show you how we can perform foot and ankle imaging. In this case, we don't use a lateral, but rather a longitudinal extension of the table. This is the black form that you see here. So let's say that the left foot is of interest. So we place the foot as shown. The detector arrives in the posterior interior position. We verify that the foot is within the field of view we altered by 90° and verify that laterally speaking, the foot is also inside the field of view. If this were not the case, we could do some adjustment, but this is where we needed. And then we go towards the initial positioning of the system for the scan. Then we tell the patient that the scan is going to proceed and so tell the patient to be still and the other scan is proceeding at this stage. And now the scan has been completed, you can see compared to the hand that we applied some tape to the foot here and this can make it much easier for the patient to stay still. And here is a resulting actual MPR covering the ankle. And so now I'm going to show you how we perform knee imaging. So we also use the longitudinal extension of the table. Let's say here that the knee of interest is the right knee. So we verify that we have good posterior anterior positioning. We rotate by 90° to verify that we have good lateral positioning. Adjustments could be made if we wanted to, but it's rarely needed again. Then we move the system towards the initial positioning for the scan. At this stage, we tell the patient to stay still during 8 seconds or so while the scan is proceeding. And all the scan has been completed. 2 important comment. The first one is that in this demo the right knee, which is the knee of interest is centred on the middle of the field of view. This is not a requirement. As long as the knee of interest is within the field of view, the image quality will be good. And so we use that feature very much particularly when the patient have wider legs. A second important comment is that the scan is taking place at a higher position along the table where the width of the table is a little bit larger. And because of that, compared to the foot, we cannot rotate by as large an arc as we did for the foot. This spring issue in terms of artifacts that I will discuss shortly. But first, let me show you the raw projection data that we get. They're absolutely not of diagnostic quality, but we can use the principles of image reconstruction to digitally remove the leg of no interest, and thereby we obtain this type of sagittal MPR for the knee. Volume by essentially following the physics principle of cone beam CT imaging. That is to say using a cone beam scan which consists of low dose XR obtained while the source detector assembly rotates around the body part of interest. The low dose XRS are not of diagnostic quality. What we do with them is that we computationally process them using filter back projection to create ACT like volume. Some important aspects about the detector of physics is that we have a much larger number of detector rows compared to CT 1200 instead of 64 to 2:56 and we have a much smaller detector pixel size 150 instead of 600 microns. On the counterpart, we have a lower dynamic range and this can create limitations for detecting small contrast, small low contrast lesions. And we also have a longer detector readout and there's a longer data acquisition of about 8 seconds per half rotation as you saw. But the preferred data acquisition show me tree is the actual scan because given the large number of detector rows, we don't need to do patient translation. So we don't need to lose time with that type of translation as we do in CT. Now mathematician, they will tell you that artifact free con beam city imaging requires non planar source detector motion around the anatomy of interest and non truncated projection data. But these conditions are too demanding for practical utilization typically, and so most system including wheel CD only use a circular arc. When the length of the arc is at least of 180° plus the fan angle that I'm showing you here, we say that we have a short scan. If the length is less than that but still more than 130° minus the fan angle, we say that we have a super short scan. When we image the knee, we deal with a super short scan. When we image the OZO extremity, we deal with the short scan. So sensitive. We have to deal with the fact that there will be some artifacts that we call con beam artifacts. With a short scan or a super short scan, there will always be con beam artifacts out of the plane of the source trajectory. If you have a super short scan, there will also be limited angle artifacts in the plane of the source detector trajectory. Whether we're talking about cold beam artifacts or limited angle artifacts, they all look very similar. Essentially slight distortion in shape and some variations in shape that I like to call combat like artifacts. I'm illustrating this here on the right side using a very simple phantom that has spheres embedded in a water cylinder. So in the plane of the short scan, the image quality is great, but if the scan is a super short scan, then you may have some limited angular artifacts. So because of the difference between knee versus all the other extremities, we felt it's important to first look at the knees apparently. And this is what my colleague Doctor Don will now be talking about.

Revolutionizing Trauma Diagnosis Unveiling Real3D Imaging with Robotic Advanced X-Ray Introduction and Physics Revolutionizing Trauma Diagnosis: Unveiling Real3D Imaging with Robotic Advanced X-Ray Frederic Noo Frederic Noo, PhD; Maryam Soltanolkotabi, MD; Dell Dunn, MD; HEALTH Maryam Soltanolkotabi Christopher Kelly, MD UNIVERSITY OF UTAH SIEMENS Clara Lee; Sebastian Vogt, Ph.D. Healthineers Lee, Clara DELL P DUNN Disclosures/Disclaimers The product/feature and/or service offerings mentioned herein are not commercially available in all countries and/or for all modalities. Their future availability cannot be guaranteed. Dr. Noo, Dr. Soltanolkotabi, Dr. Dunn and Dr. Kelly are all employed by an institution that receives financial support from Siemens Healthineers for collaborations. The statements by customers of Siemens Healthineers 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. Webinar Outline Learning objectives Introduction to Real3D imaging technology Physics aspects Clinical experience with knee imaging Clinical experience over all extremities Panel discussion Understand the clinical and physics principles of Real3D for lower and upper extremity imaging Understand clinical image interpretation, limitations and strengths Understand the clinical application of Real3D for the Emergency Department · Clinical experience over all extremities Multitom RAX X-ray system Disclaimer: The product/feature and/or service offerings mentioned herein are not commercially available in all countries and/or for all modalities. Their future availability cannot be guaranteed. Hand/Wrist/Elbow Imaging Raw data Resulting coronal MPR (wrist & metacarpals) sagittal MPR (elbow) Foot/Ankle Imaging DOWN axial MPR (ankle & metatarsals) Knee Imaging (knee) of Veterans Alfair Outline Real3D creates 3D volume imaging following the physics principles of cone-beam CT imaging. A cone-beam scan consists of low dose XRs obtained with a source- detector assembly that rotates around the body part of interest The low dose XRs are computationally processed (filtered backprojection) to create a CT-like volume Physics aspects (cont'd) Detector physics, compared to CT Much larger number of detector rows (1200 vs 64-256 rows) Much smaller detector pixel (150 vs 600 microns) Less dynamic range, creating limitation for detection of small low-contrast lesion (< 30 HU, < 5mm) Longer detector read-out, yielding fewer views per scan (300 vs 600 per half rotation) and longer data acquisition time (8 seconds per half rotation vs 175 ms) Given the large number of detector rows, the preferred data acquisition geometry is the axial scan (circular rotation; no patient translation, i.e ., no helix) · Artifact-free cone-beam CT imaging requires non-planar source- detector motion around the anatomy of interest and non-truncated projection data, but these are practically challenging Most systems including MRAX use a circular arc · Any arc of >1800 + fan angle is termed a "short-scan" · Shorter arcs are called "super short scans" Short Scan Super Short Scan Scan Arc > 180º+fan angle 180º- fan angle · Scanning arcs of 1800 + fan angle come with out- of-plane cone-beam artifacts BUT no in-plane artifacts Super short-scans come with out-of-plane cone- C/W:0/1000HU beam artifacts as well as with in-plane limited angle artifacts Cone-beam artifacts and limited angle artifacts appear as distorted shapes and shade variations (comet-like artifacts) Stay tuned. Clinical experiences with knee imaging will follow. Siemens Healthineers AG, 2024 Multitom Rax is not commercially available in all countries. Due to regulatory reasons its future availability cannot be guaranteed. Please contact your local Siemens Healthineers organization for further details. True2scale Body Scan and Real3D are options. The statements by customers of Siemens Healthineers described herein are based on results that were achieved in the customer's unique setting. Because there is no "typical" hospital and many variables exist (e.g ., hospital size, case mix, level of IT and/or automation adoption) there can be no guarantee that other customers will achieve the same results. Speakers are employed by an institution that receives financial support from Siemens Healthineers for collaborations. Heal