Cardiac Scanning Online Training

Continue Button Navigation Help Select the icon above to open the table of contents. Click Next to continue. Next Welcome Slide The timeline displays the slide progression. Slide the orange bar backwards to rewind the timeline. Click Next to continue. Next Timeline Select the X to close the pop-up. Click Next to continue. Next Layer Slide Select Submit to record your response. Click the X in the upper right corner to exit the navigation help. Assessment Slide Cardiac Scanning – Online Training This online training will give you an overview of relevant units, scan techniques and reconstruction, and will cover the following four learning objectives: 1 2 3 4 Know Temporal Resolution Learn about ECG Understand Phases and Units Specify Scan Techniques Master Template HOOD05162003052540 | Effective Date: 26-Nov-2019 ? Cardiac Scanning – Online Training Welcome audf_card_scan_title_page_01.mp3 Welcome to the Cardiac Scanning Online Training.   This online training will give you an overview of relevant units, scan techniques and reconstruction, and will cover the following four learning objectives: Know Temporal Resolution Cardiac Scanning – Online Training Know Temporal Resolution Temporal Resolution of SH CT Scanner Models Temporal resolution controls the reconstruction angle and corresponds to the number of projections considered for the reconstruction of a cardiac image. A higher resolution (the value itself becomes lower) leads to a reduction in motion artifacts but may also result in decreased image quality. The temporal resolution is fixed for the cardiac spiral ranges. Therefore, you cannot edit the temporal resolution parameter. Table with 3 columns and 7 rows Scanner Rotation Time Temporal Resolution Definition AS/go.All/go.Top 0.33 TR = 330 ms = 165 ms 2 Definition AS+/X.cite 0.30 TR = 300 ms = 150 ms 2 Definition Edge 0.28 TR = 280 ms = 140 ms 2 DS 1st Generation 0.33 TR = 330 ms = 83 ms 4 Definition Flash, Drive 0.28 TR = 280 ms = 75 ms 3.75 SOMATOM Force 0.25 TR = 250 ms = 66 ms 3.75 ? Temporal Resolution of SH CT Scanner Models audf_card_scan_temp_resol_sh_ct_03.mp3 The temporal resolution of the Siemens Healthineers CT scanner models controls the reconstruction angle and corresponds to the number of projections considered for the reconstruction of a cardiac image. A higher resolution (where the value itself becomes lower) leads to a reduction in motion artifacts but may also result in decreased image quality. The temporal resolution is fixed for the cardiac spiral ranges. Therefore, you cannot edit the temporal resolution parameter. Single-Source CT (Definition AS+) Temporal resolution of maximum 150 ms (perfect for low and stable heart rates). When the heart rate gets higher, the temporal resolution is no longer appropriate for the diastolic phase of the cardiac cycle. HerzOK Herzschlecht = 150 ms Rotation Time 300 ms 2 Temporal Resolution = ? Temporal Resolution | Single-Source CT 60bpm 100bpm Temporal Resolution | Single-Source CT audf_card_scan_temp_resol_defin_04.mp3 Let us take single-source CT scanners such as Definition AS  plus as an example. Here we have the temporal resolution of maximum 150 milliseconds. This works perfectly for low and stable heart rates. Yet, as soon as the heart rate gets higher, the temporal resolution is no longer appropriate for the diastolic phase of the cardiac cycle. (2 Segment Recon) varies between = 83 and 150 ms Temporal Resolution = Single-Source CT with BiSegment Recon Software attempt to increase temporal resolution. Required reconstruction data will be obtained from two cardiac cycles. ? Temporal Resolution | BiSegment Recon Temporal Resolution | BiSegment Recon audf_card_scan_temp_resol_biseg_05.mp3 BiSegment is a reconstruction method in the single-source CT. This is a software attempt to increase the temporal resolution of a CT scanner. With BiSegment reconstruction, the data required will be obtained from two cardiac cycles. Rotation Time 330 ms 4 Temporal Resolution = SOMATOM Definition Dual Source CT Scanner (DSCT) Heart rate-independent temporal resolution of 83 ms. Two tubes are active at the same time, and the data can therefore be simultaneously acquired from two detectors. DualTube_05 Mitte ? Temporal Resolution | SOMATOM Definition DSCT = 83 ms Temporal Resolution | SOMATOM Definition DSCT audf_card_scan_temp_resol_dsct_06.mp3 With dual-source CT scanners such as those of the first-generation Definition, we can achieve temporal resolution of 83 milliseconds. Two tubes are active at the same time, and the data can therefore be simultaneously acquired from two detectors. Learn about ECG Cardiac Scanning – Online Training Learn about ECG Patient Preparation | ECG For motion artifact-free CT images in the heart region, an ECG triggering and gating function (HeartView option) is available. The HeartView option requires the Siemens ECG monitor. The ECG monitor signal is shown on the gantry display or the tablet. Please note: The ECG monitor must not be used to establish a diagnosis! The ECG electrodes are connected to the interface at the PMM (Physiological Measurement Module) at the patient table. ECG gating is required for all cardiac examinations! ? (1) Europe (2) USA (1) Channel (2) Heart Rate (3) ECG Signal (4) R-Peaks (5) Signal Strength Patient Preparation | ECG audf_card_scan_pat_prep_ecg_08.mp3 To obtain motion artifact-free CT images in the heart region, an ECG  triggering and gating function (the so-called HeartView option) is available.   If you wish to use the HeartView option, you will need the Siemens ECG monitor. The ECG monitor signal is shown on the gantry display or the tablet.   Please note that the ECG monitor must not be used to establish a diagnosis!   The ECG electrodes are connected to the interface at the Physiological Measurement Module (or PMM  for short) at the patient table.   ECG gating is required for all cardiac examinations! The red numbers indicate the heart rate; this information is required to select an appropriate scan mode. The light blue boxes show where the data is acquired (this display may vary in different scan modes). The dark blue box shows where the data will be reconstructed. This example represents spiral acquisition. ? Patient Preparation | ECG | SOMARIS 7* Real-time display and recording of the patient’s ECG tracing * SOMATOM Definition AS, SOMATOM Confidence, SOMATOM Definition AS+, SOMATOM Definition Edge, SOMATOM Edge Plus, SOMATOM Definition Flash, SOMATOM Drive, SOMATOM Force Heart rate (bpm) Min: 78 Max: 84 Avg: 78 Var: 1.1 Patient Preparation | ECG | SOMARIS 7 audf_card_scan_pat_prep_ecg_som_7_09.mp3 In this slide, you can gain additional insight into the ECG display.   The picture depicts the real-time display and recording of the patient’s ECG tracing.   The red numbers indicate the heart rate; this information is required to select an appropriate scan mode.   The light blue boxes show where the data is acquired (this display may vary in different scan modes).   The dark blue box shows where the data will be reconstructed. This example represents spiral acquisition. The white numbers indicate the heart rate; this information is required to select an appropriate scan mode. The green boxes show where the data is acquired (this display may vary in different scan modes). This example shows sequential acquisition. Ein Bild, das Objekt, Uhr, Licht enthält. Mit sehr hoher Zuverlässigkeit generierte Beschreibung ? Patient Preparation | ECG | SOMARIS 10* Real-time display and recording of the patient’s ECG tracing * SOMATOM go.Now, SOMATOM go.UP, SOMATOM go.All, SOMATOM go.Sim, SOMATOM go.Top, SOMATOM go.Open Pro, SOMATOM X.cite Patient Preparation | ECG | SOMARIS 10 audf_card_scan_pat_prep_ecg_som_10_10.mp3 Now, let us take a look at the ECG patient preparation in Somaris 10.   The image depicts the real-time display and recording of the patient’s ECG tracing.   The white numbers indicate the heart rate; this information is required to select an appropriate scan mode.   The green boxes show where the data is acquired (this display may vary in different scan modes). This example represents sequential acquisition. Detailed Description | SOMARIS 7 Pulsing window: Defines the area where the entered dose is applied Low dose level Magenta colored line: Indicates that the radiation is on during and after scanning Scan/recon window: the width corresponds to the temporal resolution of the images Heart symbol (with channel number) Heart rate (in beats per minute): Displays minimum, maximum, average, and variability R-peaks (syncs try to match R-peaks) Syncs: Set by the R-peak detection algorithm, retrospectively editable Phase start: Delay for starting the scan window (sequence, prospective triggering), delay for positioning the recon window (spiral, retrospective gating) ? Heart rate (bpm) Min: 60 Max: 60 Avg: 60 Var: 0.0 Detailed Description | SOMARIS 7 audf_card_scan_det_descr_som_7_11.mp3 Here you can see a detailed description of the ECG tracing in Somaris 7. Please refer to the items 1 to 9 for more detail information. Ein Bild, das Uhr enthält. Mit sehr hoher Zuverlässigkeit generierte Beschreibung Low dose level Pulsing window: Defines the area where the entered dose is applied. The color in recon boxes indicates the dose corresponding to the dose profile. Phase start: Delay for starting the scan window (sequence, prospective triggering), delay for positioning the recon window (spiral, retrospective gating) Green line: Indicates that the radiation is on during and after scanning R-peaks: Syncs try to match R-peaks Scan/recon window: The width corresponds to the temporal resolution of the images Syncs: Set by the R-peak detection algorithm, restrospectively editable. Dots above the trace indicate the detected R-peaks. The corresponding heart rate in bpm is displayed between the R-peaks. Display of the offline tracing to edit syncs Heart rate (in beats per minute) ? Detailed Description | SOMARIS 10 Detailed Description | SOMARIS 10 audf_card_scan_det_descr_som_10_12.mp3 This slide offers you a detailed explanation of the ECG tracing in Somaris 10. Take a close look at the items 1 to 9 to find out more. Understand Phases and Units Cardiac Scanning – Online Training Understand Phases and Units Single-Phase | Multiphase | SOMARIS 7* Cardiac examinations usually result in a single-phase reconstruction. There is one dark blue reconstruction bar at a single pre-defined time point in the ECG tracing, one image per heart cycle, and no information about any other phases. ? If needed, multiphase reconstructions are available. With the multiphase feature (multiple dark blue recon boxes), up to 24 different heart phases within one recon job are possible. It is useful if we want to obtain additional information from other cardiac phases (functional evaluation, left ventricle analysis). * SOMATOM Definition AS, SOMATOM Confidence, SOMATOM Definition AS+, SOMATOM Definition Edge, SOMATOM Edge Plus, SOMATOM Definition Flash, SOMATOM Drive, SOMATOM Force Single-Phase | Multiphase | SOMARIS 7 audf_card_scan_sing_ph_multiph_som_7_14.mp3 The next issue we are going to address is that of single-phase and multiphase reconstruction. Let us start with Somaris 7.   Cardiac examinations usually result in a single-phase reconstruction. There is one dark blue reconstruction bar at a single pre-defined time point in the ECG tracing, one image per heart cycle, and no information about any other phases.   If needed, multiphase reconstructions are also available. By means of the multiphase feature (with multiple dark blue recon boxes), up to 24 different heart phases within one recon job are possible. This option is useful if we want to obtain additional information from other cardiac phases (for instance, functional evaluation or left ventricle analysis). If needed, multiphase reconstructions are available. It is useful if we want to obtain additional information from other cardiac phases (functional evaluation, left ventricle analysis). Cardiac examinations usually result in a single-phase reconstruction. There is one reconstruction bar at a single pre-defined time point in the ECG tracing, one image per heart cycle, and no information about any other phases.  Ein Bild, das Zeichnung, Uhr, Anzeige enthält. Mit sehr hoher Zuverlässigkeit generierte Beschreibung Ein Bild, das Computer enthält. Mit sehr hoher Zuverlässigkeit generierte Beschreibung ? Single-Phase | Multiphase | SOMARIS 10* * SOMATOM go.Now, SOMATOM go.UP, SOMATOM go.All, SOMATOM go.Sim, SOMATOM go.Top, SOMATOM go.Open Pro, SOMATOM X.cite Single-Phase | Multiphase | SOMARIS 10 audf_card_scan_sing_ph_multiph_som_10_15.mp3 This slide offers you an insight into this functionality in Somaris 10.   As is the case with Somaris 7, cardiac examinations usually result in a single-phase reconstruction. There is again one reconstruction bar at a single pre-defined time point in the ECG tracing, one image per heart cycle, and no information about any other phases.   Multiphase reconstructions are available here as well. This useful option allows you to obtain additional information (such as functional evaluation or left ventricle analysis) from other cardiac phases. Phase Units % and ms | SOMARIS 7 & 10 % or ms values shall be used as a trigger unit for reconstruction. One unit has to be selected depending on the heart rate of the patient.  % is a relative value. Each heart cycle starts at 0% and ends at 100% (R to R). This is also termed the filling phase of the left ventricle. The size of the heart changes. The end point of a phase is at the same time the starting point of the next cardiac cycle. This unit is often used for the scans of patients with low and stable heart rates. ms % Ein Bild, das Anzeige enthält. Mit sehr hoher Zuverlässigkeit generierte Beschreibung SOMARIS 7 SOMARIS 10 ECG tracing example from SOMARIS 7 ? Phase Units % and ms | SOMARIS 7 and 10 audf_card_scan_phase_units_som_7_10_16.mp3 In Somaris 7 and Somaris 10, percentage values or milliseconds can be used as phase units.   The trigger unit for reconstruction can be specified in percent or milliseconds. One of the units shall be selected depending on the heart rate of the patient.   Percentage is a relative value. Each heart cycle starts at zero percent, and ends at one hundred percent (R to R). This is also termed the filling phase of the left ventricle. The size of the heart changes. So, the end point of a phase is at the same time the starting point for the next cardiac cycle. This unit is often used for the scans of patients with low and stable heart rates. % or ms values shall be used as a trigger unit for reconstruction. One unit has to be selected depending on the heart rate of the patient.  ms is an absolute value. With every R-peak, we start counting a certain delay time until the launch of the pre-defined cardiac data acquisition. This unit is often used for the scans of patients with high and unstable heart rates. ? Phase Units % and ms | SOMARIS 7 & 10 SOMARIS 7 SOMARIS 10 ms ECG tracing example from SOMARIS 7 Phase Units % and ms | SOMARIS 7 and 10 audf_card_scan_phase_units_som_7_10_17.mp3 When we opt for milliseconds as a phase unit, we need to observe the following: Milliseconds constitute an absolute value. With every R-peak, we start counting a certain delay time until the launch of the pre-defined cardiac data acquisition (just like with a stopwatch). This unit is often used for the scans of patients with high and unstable heart rates. End-diastolic phase Cardiac Phases Bildergebnis für systole diastole Bildergebnis für ekg welle ? End-systolic phase In general, we differentiate between two cardiac phases where we can acquire cardiac data without much motion: Systole and Diastole. The size of the left ventricle strongly depends on the cardiac phase. Diastole = large left ventricle, smaller myocardium Systole = small left ventricle, thicker myocardium Therefore, the user has to know how to define the correct phases for the examination. The phase start value of 70% R-R (diastolic phase) is set as a default value in the standard protocols for SOMARIS 7 scanners. The phase start value of 75% R-R (diastolic phase) is set as a default value in the standard protocols for SOMARIS 10 scanners. The phase start value of 30% (35%) R-R or ~250 ms (or higher) (systolic phase) might be useful for patients with higher unstable heart rates. Cardiac Phases audf_card_scan_card_phases_18.mp3 In general, we differentiate between two phases in the cardiac cycle where we can acquire cardiac data without much motion. These phases are referred to as systole and diastole. The size of the left ventricle strongly depends on the cardiac phase. Diastole is characterized by a large left ventricle and a smaller myocardium. Systole has a small left ventricle and a thicker myocardium. Therefore, the user has to know how to define the correct phases for the examination.   The phase start value of 70 percent R-R (for the diastolic phase) is set as a default value in the standard protocols for Somaris 7 scanners. The phase start value of 75 percent R-R (for the diastolic phase) is set as a default value in the standard protocols for Somaris 10 scanners. The phase start value of 30 or respectively 35 percent R-R , which approximately corresponds to 250 milliseconds or higher (for the systolic phase) might be useful for patients with higher unstable heart rates. Specify Scan Techniques Cardiac Scanning – Online Training Specify Scan Techniques Scan Modes | Overview The following cardiac CT modes are available: ECG-triggered sequence – prospective ECG-gated spiral – retrospective BiSegment spiral – retrospective ? Please note : These are recommendations only. The actual selection depends on the user’s preference. Table with 2 columns and 4 rows Initial Situation Recommended Scan Mode Regular sinus rhythm Moderate heart rate Limited to increased variance Several ectopic beats ECG-triggered sequence High to very high heart rate Very irregular heart rate, which needs a high flexibility in reconstruction up to editing the ECG ECG-gated spiral Very high heart rate BiSegment spiral Scan Modes | Overview audf_card_scan_scan_modes_overview_20.mp3 The following scan modes are available in cardiac CT: ECG-triggered sequence – prospective, ECG-gated spiral – retrospective, and BiSegment spiral – retrospective.   Generally speaking, the ECG-triggered sequence mode is recommended for patients with a regular sinus rhythm and moderate heart rate. This mode is limited to the increased variance or several ectopic beats.   The ECG-gated spiral mode is recommended for patients with a high to very high, or a very irregular heart rate, which requires a high degree of flexibility in reconstruction up to editing the ECG.   The BiSegment spiral mode is recommended for patients with a very high heart rate.   Please note that these are recommendations only. The actual selection depends on the user’s preference. Prospective Scanning | Sequence | SOMARIS 7* & 10** | Prospective Triggering Prospective ECG triggering combined with Step-and-Shoot acquisition of axial slices acquires the appropriate amount of scan data needed for image reconstruction during the previously selected heart phase. The ECG signal of the patient is monitored during examination, axial scans start with pre-defined time offset relative to the R-waves. In the ECG-triggered sequence mode, the patient table moves to first z-position. The scan is ECG triggered. Then the patient is moved to the next z-position. The procedure repeats until scan range is complete. The reconstruction is done prospectively based on timestamps from the recorded ECG. ? * SOMATOM Definition AS, SOMATOM Confidence, SOMATOM Definition AS+, SOMATOM Definition Edge, SOMATOM Edge Plus, SOMATOM Definition Flash, SOMATOM Drive, SOMATOM Force ** SOMATOM go.Now, SOMATOM go.UP, SOMATOM go.All, SOMATOM go.Sim, SOMATOM go.Top, SOMATOM go.Open Pro, SOMATOM X.cite Prospective Scanning | Sequence | Somaris 7 and 10 audf_card_scan_prosp_scan_seq_som_7_10_21.mp3 Let us address the issue of prospective scanning with the sequence mode in Somaris 7 and Somaris 10. Prospective ECG triggering combined with the so-called “step-and-shoot” acquisition of axial slices acquires the appropriate amount of scan data needed for image reconstruction during the previously selected heart phase. The ECG signal of the patient is monitored during the examination, and the axial scans are started with a pre-defined time offset relative to the R-waves.   In the ECG-triggered sequence mode, the patient table moves the patient to the first z-position. The scan is triggered depending on the ECG. Then the patient is moved to the next z-position. The procedure is repeated until the range to be scanned is completed. The reconstruction is done prospectively based on the timestamps from the recorded ECG. How does the classic cardio sequence work? (all default Calcium Scoring Sequence examinations) The scan start is determined prospectively based on the last three heart cycles. Good results for patients with stable heart rates. Ectopic heartbeats lead to scanning in the wrong phase – decrease in image quality! ? Prospective Scanning | Sequence Prospective Scanning | Sequence audf_card_scan_prosp_scan_seq_22.mp3 In order to understand the principle of Prospective Scanning and its sequence, we need to understand how the “classic” cardio sequence works. (Please note that all default Calcium Scoring Sequence examinations are scanned with this mode.) The scan start is determined prospectively based on the last three heart cycles. This scan mode shows good results for patients with stable heart rates.   Ectopic heartbeats though lead to scanning in the wrong phase, which results in the decrease in image quality! Adaptive Cardio Sequence | Only SOMARIS 7* The Adaptive Cardio Sequence ACS is a special scan mode that monitors the ECG of the patient while the scan is being performed. It can detect irregular heartbeats and repeat scans at a certain table position, if necessary. It also allows more than one phase of the heart cycle to be scanned. The scan start is determined prospectively based on the last three heart cycles. The scan is omitted if extra systole has been detected before the scan. The scan is repeated if extra systole occurs during or shortly after the scan. ? * SOMATOM Definition AS, SOMATOM Confidence, SOMATOM Definition AS+, SOMATOM Definition Edge, SOMATOM Edge Plus, SOMATOM Definition Flash, SOMATOM Drive, SOMATOM Force Adaptive Cardio Sequence | Only SOMARIS 7 audf_card_scan_adapt_card_seq_som_7_23.mp3 The Adaptive Cardio Sequence – also referred to as ACS  – is available with Somaris 7 only.   The Adaptive Cardio Sequence is a special scan mode that monitors the ECG of the patient while the scan is being performed. It can detect irregular heartbeats and repeat scans at a certain table position, if necessary. It also allows more than one phase of the heart cycle to be scanned.   With this mode The scan start is determined prospectively based on the last three heart cycles; The scan is omitted if extra systole has been detected before the scan; The scan is repeated if extra systole occurs during or shortly after the scan. FlexPadding used a fixed acquisition window Adjustable acquisition window (scan from X to Y) Automatic adaptation of the acquisition window depending on the variance of the heart rate ECG pulsing – used for the assessment of the cardiac function to reduce overall radiation exposure ? ACS | Only SOMARIS 7 ACS | Only SOMARIS 7 audf_card_scan_adapt_card_seq_som_7_24.mp3 The FlexPadding feature used a fixed acquisition window. With the Adaptive Cardio Sequence, an adjustable acquisition window for scanning from X to Y is used. The acquisition window is adapted automatically depending on the variance of the heart rate. ECG pulsing is used for the assessment of the cardiac function in order to reduce overall radiation exposure. Free selection of the acquisition window Not limited to fixed acquisition Selectable pulsing window like in the spiral mode: Manual; Auto: Off High dose plateau only for coronary assessment! Can be used with % or ms values. Suitable for a lot of heart rates. ? ECG Pulsing for ACS | Only SOMARIS 7 (1/2) ECG Pulsing for ACS | Only SOMARIS 7 (1/2) audf_card_scan_adapt_card_seq_som_7_25.mp3 The feature of ECG pulsing for the Adaptive Cardio Sequence allows free selection of the acquisition window. It is not limited to fixed acquisition. This feature offers a selectable pulsing window like in the spiral mode. The options we can choose from are Manual and Auto Off . Free phase shifting after the scan for reconstruction The ACS can be used for single- and multiphase reconstructions depending on the amount of cardiac data available J:\Cardiac\ACS 03.jpg ? ECG Pulsing for ACS | Only SOMARIS 7 (2/2) ECG Pulsing for ACS | Only SOMARIS 7 (2/2) audf_card_scan_adapt_card_seq_som_7_26.mp3 The ECG pulsing function also allows free phase shifting after the scan for reconstruction.   The ACS can be used for single- and multiphase reconstructions, depending on the amount of cardiac data available. Cardiac Sequence Adult Angio Flex | Only SOMARIS 10* | ECG Pulsing for Flex Sequence (1/2) Free selection of the acquisition window Not limited to fixed acquisition As compared to the ACS: no repetition of the same position if extra systolic beats appear Adjustable acquisition window (scan from X to Y) Automatic adaptation of the acquisition window depending on the variance of the heart rate ? * SOMATOM go.Now, SOMATOM go.UP, SOMATOM go.All, SOMATOM go.Sim, SOMATOM go.Top, SOMATOM go.Open Pro, SOMATOM X.cite ECG Pulsing for Flex Sequence (1/2) audf_card_scan_card_seq_aaf_som_10_27.mp3 The Cardiac Sequence Adult Angio Flex function is only available with Somaris 10.   The ECG pulsing feature for the Flex Sequence offers the following advantages: Free selection of the acquisition window is possible. It is not limited to fixed acquisition. As compared to the ACS, it is not necessary to repeat the scan of the same position  if extra systolic beats appear. An adjustable acquisition window for scanning from X to Y is used. The acquisition window is adapted automatically depending on the variance of the heart rate. Free phase shifting after the scan for reconstruction possible Flex sequence can be used for single- and multiphase reconstructions depending on the amount of cardiac data available Cardiac Sequence Adult Angio Flex | Only SOMARIS 10 | ECG Pulsing for Flex Sequence (2/2) ? ECG Pulsing for Flex Sequence (2/2) audf_card_scan_card_seq_aaf_som_10_28.mp3 Due to the ECG pulsing feature for the Flex Sequence, free phase shifting after the scan for reconstruction is possible.   The Flex Sequence can be used for single- and multiphase reconstructions depending on the amount of cardiac data available. Difference in Phase Definition SOMARIS 7: Phase start is at the beginning of the box. SOMARIS 10: Phase start is in the middle of the box. 65% 75% ? Difference in Phase Definition audf_card_scan_differ_phase_def_29.mp3 Please note that there is some difference in phase definition between the two systems:   In Somaris 7, the phase start is positioned at the beginning of the box.   In Somaris 10, however, the phase start is now in the middle of the box! Retrospective Scanning | Spiral | SOMARIS 7 & 10 In cardiac spiral CT, data acquisition proceeds continuously while the patient table is moving forward with a constant pitch. The ECG and the CT raw data are recorded simultaneously throughout the entire heart cycle. Due to the continuous data acquisition, the spiral mode allows maximum flexibility for data reconstruction. If necessary, you can also edit the ECG in this mode for challenging patients. J:\Cardiac\ECG Pulsing01.jpg SOMARIS 7 25% dose pulsing SOMARIS 10 10% dose pulsing ? Retrospective Scanning | Spiral | SOMARIS 7 and 10 audf_card_scan_retro_scan_spir_som_7_10_30.mp3 The next function we are going to address is that of Retrospective Scanning for cardiac spiral CT available with both Somaris 7 and Somaris 10.   In cardiac spiral CT, data acquisition proceeds continuously while the patient table is moving forward with a constant pitch. The ECG and the CT raw data are recorded simultaneously throughout the entire heart cycle.   Due to the continuous data acquisition, the spiral mode allows maximum flexibility for data reconstruction. If necessary, you can also edit the ECG in this mode if you are dealing with more challenging patients. Retrospective Scanning | MinDose Spiral | SOMARIS 7 Scanning with the MinDose option allows you to activate an enforced dose modulation mechanism. In this way, you can reduce the dose beyond the high dose plateau down to a minimum of 4%. syngo.via can load and post-process images with a reduced quality. The quality of images obtained beyond the high dose plateau is lower. If MinDose is activated, the following message will appear: J:\Cardiac\ECG Pulsing01.jpg MessageMinDose MinDose – auto MinDose – manual ? Retrospective Scanning | MinDose Spiral | SOMARIS 7 audf_card_scan_retro_scan_min_spir_som_7_31.mp3 Retrospective Scanning in Somaris 7 spiral CT also offers you a so-called MinDose option.   Scanning with the MinDose option allows you to activate an enforced dose modulation mechanism. In this way, you can reduce the dose beyond the high dose plateau down to a minimum of 4 percent.   syngo.via can load and post-process images with a reduced quality. The quality of images obtained beyond the high dose plateau is lower. If MinDose is activated, the message shown in the slide will appear. (Turbo)Flash Mode | SOMARIS 7 For ultra-fast scanning of the heart ((Turbo)Flash Spiral Cardiac), a special ECG-triggered spiral technique is employed. The ECG signal is used prospectively to acquire images of the whole heart within one cardiac cycle. It uses the motionless phase of the myocardium to avoid motion artifacts. This scan mode is available on all dual-source scanners. The scan phases cannot be changed: the default is a starting phase of 60%! ? (1) Single Source CT (2) Dual Source CT (3) Tube A (4) Tube B (Turbo)Flash Mode | SOMARIS 7 audf_card_scan_turbo_flash_som_7_32.mp3 Another mode available with Somaris 7 is termed TurboFlash.   For ultra-fast scanning of the heart, the so-called Turbo Flash Spiral Cardiac, a special ECG-triggered spiral technique is employed. The ECG signal is used prospectively to acquire images of the whole heart within one cardiac cycle. It uses the motionless phase of the myocardium to avoid motion artifacts. This scan mode is available on all dual-source scanners.   Please not that the scan phases cannot be changed: the default is a starting phase of 60 percent. The Flash Check result is displayed in the Chronicle and on the Trigger card. The result is valid for all Flash Cardio ranges with the same scan parameters. Result interpretation: Green: Start timing can be reached. Red: Start timing cannot be reliably reached. To reach the start timing and to ensure very fast table acceleration, a 30 cm distance is necessary to speed up the table! (Turbo)Flash Mode | SOMARIS 7 | Result ? (Turbo)Flash Mode | SOMARIS 7 | Result audf_card_scan_turbo_flash_som_7_33.mp3 When we use the Turbo Flash mode, the Flash Check result is displayed in the Chronicle and on the Trigger card. The result is valid for all Flash Cardio ranges with the same scan parameters.   The results are interpreted as follows: Green indicates that the start timing can be reached. Red means that the start timing cannot be reliably reached.   In order to reach the start timing and to ensure very fast table acceleration, a 30-centimeter distance is necessary to speed up the table! BestPhase Reconstruction | SOMARIS 7 & 10 Cardio BestPhase enables you to minimize the heart motion effects and to choose the most appropriate heart phase for post-processing. The determined best phase provides optimum image quality in the systolic phase or in the diastolic phase. Cardio BestPhase is used to reconstruct the images automatically irrespective of the heart motion. The software defines the phase start for the Cardio BestPhase reconstruction automatically; the free selection of Phase Start settings will be dimmed. SOMARIS 7 SOMARIS 10 Best Phase Systole: 38%, Diastole: 76% ? BestPhase Reconstruction | SOMARIS 7 & 10 audf_card_scan_bestphase_som_7_10_34.mp3 Both Somaris 7 and Somaris 10 also feature the BestPhase Reconstruction option.   The Cardio BestPhase option enables you to minimize the heart motion effects and to choose the most appropriate heart phase for post-processing. The determined best phase provides optimum image quality in the systolic or diastolic phase.   Cardio BestPhase is used to reconstruct the images automatically irrespective of the heart motion. The software defines the phase start for the Cardio BestPhase reconstruction automatically; the free selection of Phase Start settings will be dimmed. ? Course Review Congratulations. You have completed the CT Cardiac Scanning course. Select the numbered buttons below to review the material before proceeding to the final assessment. Specify Scan Techniques Understand Phases and Units Learn about ECG Know Temporal Resolution 1 1 2 2 2 3 3 3 4 4 4 Course Review Scan Techniques 3 cardiac CT modes: ECG-triggered sequence, ECG-gated spiral, BiSegment spiral Prospective Scanning: classic cardio sequence – for stable heart rates (based on last 3 heart cycles) Prospective ECG triggering: combined with step-and-shoot acquisition ECG-triggered sequence mode: patient table moves and scans triggered by ECG Adaptive Cardio Sequence (SOM 7) Monitors ECG while scanning (Allows scanning of more than one phase of heart cycle) Detects irregular heartbeats and repeats scan if necessary Cardiac Sequence Adult Angio Flex (SOM 10) - ECG Pulsing for Flex Sequence No repetition of the same position if extra systolic beats appear For single- and multiphase reconstruction Retrospective Scanning – Cardiac spiral CT Continuously data acquisition while table movement with constant pitch Recording of ECG and CT raw data for entire heart cycle à maximum reconstruction flexibility MinDose reduces dose to minimum of 4% (Turbo)Flash mode for ultra-fast whole heart scanning with ECG-triggered spiral technique within 1 cycle BestPhase for optimum image quality by minimizing motion effects and choosing optimum phase for post-processing Phases and Units Usually single-phase reconstruction for cardiac examinations - one image per heart cycle Multiphase reconstructions available when additional information from other phases needed % or ms = trigger unit for reconstruction % is a relative value: filling phase 0-100%; for low and stable heart rates ms is a absolute value: counting delay time with R-peaks; for high and unstable heart rates Cardiac data without motion measurable in systolic and diastolic phase ECG HeartView option: ECG triggering and gating function for motion artifact-free CT images in heart region Siemens ECG monitor required ECG gating required for all cardiac examinations ECG monitor not for diagnosis Real-time display and recording of the patient’s ECG tracing SOMARIS 7 SOMARIS 10 Temporal Resolution Controls reconstruction angle Corresponds to number of projections (reconstruction of cardiac image) Higher Resolution → reduction in motion artifacts & possibly decreased image quality Temporal resolution fix for cardiac spiral ranges → temporal resolution parameter not editable Disclaimer 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 2022 Siemens Healthineers Headquarters\Siemens Healthcare GmbH\Henkestr. 127\ 91052 Erlangen, Germany\Telephone: +49 9131 84-0\siemens-healthineers.com ? Disclaimer Assessment This assessment will test your retention of the presented content. A passing score of 80% or higher is required to complete the course and earn your certificate. You may repeat the assessment as many times as needed. Start ? Assessment Select the best answer. ? Question 1 of 5 Which is the most suitable phase start value in the image reconstruction for patients with higher or unstable heart rates?  The phase start value does not affect image quality. Therefore, it is not necessary to consider the phase start value for image reconstruction 70% R-R (diastolic phase)  30% (35%) R-R or ~250 ms (or higher) (systolic phase)  75% R-R (diastolic phase) Multiple Choice Incorrect Incorrect Incorrect Incorrect Select the best answer. ? Question 2 of 5 Which patient shall not be scanned with the ECG-triggered sequence mode?  Regular sinus rhythm Moderate heart rate Several ectopic beats Very high heart rate Multiple Choice Correct Incorrect Incorrect Incorrect Select the best answer. ? Question 3 of 5 What does BestPhase do?  It minimizes the heart motion effects by choosing the most appropriate heart phase for post-processing. It optimizes the tube voltage. It determines the best phase for cardiac scanning. It configures the reconstruction phase in the configuration panel. Multiple Choice Incorrect Incorrect Incorrect Incorrect Select the best answer. ? Question 4 of 5 Which statement about temporal resolution is correct?  It can be edited in the cardiac sequence mode but not in the cardiac spiral mode.  Users can adjust it with CARE kV. Higher temporal resolution results in fewer motion artifacts in the images.  A higher dose is required for higher temporal resolution. Multiple Choice Incorrect Incorrect Incorrect Incorrect Select the best answer. ? Question 5 of 5 Which statement about the units available in the image reconstruction is correct?  It can be set in % only. It can be set in ms only. It can be set in bpm. It can be set in % and ms. Multiple Choice Correct Incorrect Incorrect Incorrect Assessment Results YOUR SCORE: PASSING SCORE: Review Retry Retry Continue Continue Continue %Results.ScorePercent%% %Results.PassPercent%% ? Assessment Results You did not pass the course. Take time to review the assessment then select Retry to continue. Congratulations. You passed the course.. 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 CT Cardiac Scanning Online Training. Exit Completion Question Bank 1 HOOD05162003185747 | EffectiveDate: 20 May 2021 2.1 Welcome 2.2 Know Temporal Resolution 2.3 Temporal Resolution of SH CT Scanner Models 2.4 Temporal Resolution | Single-Source CT 2.5 Temporal Resolution | BiSegment Recon 2.6 Temporal Resolution | SOMATOM Definition DSCT 2.7 Learn about ECG 2.8 Patient Preparation | ECG 2.9 Patient Preparation | ECG | SOMARIS 7 2.10 Patient Preparation | ECG | SOMARIS 10 2.11 Detailed Description | SOMARIS 7 2.12 Detailed Description | SOMARIS 10 2.13 Understand Phases and Units 2.14 Single-Phase | Multiphase | SOMARIS 7 2.15 Single-Phase | Multiphase | SOMARIS 10 2.16 Phase Units % and ms | SOMARIS 7 and 10 2.17 Phase Units % and ms | SOMARIS 7 and 10 2.18 Cardiac Phases 2.19 Specify Scan Techniques 2.20 Scan Modes | Overview 2.21 Prospective Scanning | Sequence | Somaris 7 and 10 2.22 Prospective Scanning | Sequence 2.23 Adaptive Cardio Sequence | Only SOMARIS 7 2.24 ACS | Only SOMARIS 7 2.25 ECG Pulsing for ACS | Only SOMARIS 7 (1/2) 2.26 ECG Pulsing for ACS | Only SOMARIS 7 (2/2) 2.27 ECG Pulsing for Flex Sequence (1/2) 2.29 Cardiac Sequence Adult Angio Flex – only Somaris 10 2.29 Difference in Phase Definition 2.30 Retrospective Scanning | Spiral | SOMARIS 7 and 10 2.31 Retrospective Scanning | MinDose Spiral | SOMARIS 7 2.32 (Turbo)Flash Mode | SOMARIS 7 2.33 (Turbo)Flash Mode | SOMARIS 7 | Result 2.34 BestPhase Reconstruction | SOMARIS 7 & 10 Course Review, Disclaimer & Assessment 2.35 Course Review 2.36 Disclaimer 2.37 Assessment