No.

16/June 2005
Stanford Universitys
7th Annual International
Symposium on
Multidetector-Row CT
June 15-18, 2005

www.siemens.com/medical

Highlights
COVER STORY
Think Clinical!
Page 4
NEWS
SOMATOM Sensation
40-Slice Technology
Page 12
BUINESS
SOMATOM Spirit And it
runs, and runs, and runs...
Page 15
CLINICAL OUTCOMES
syngo Body Perfusion CT
Differential Diagnosis of a
Pancreas
Page 20
SOMATOM Emotion 6
High Resolution Orthopedics
Examination
Page 24
SCIENCE
Archaeology High-tech
Meets History
Page 33
CUSTOMER CARE
LIFE Educate
A Win-Win Situation
Page 35

SOMATOM
Sessions
Picture

EDITORS LETTER

Bernd Ohnesorge, PhD,

Vice President CT Marketing and Sales

Dear Reader,
It is Siemens goal to remain the trend-setter in Computed Tomography (CT) technology and
clinical applications, and to provide innovative multislice CT and workflow solutions for all clinical
needs from the cost-optimized SOMATOM Spirit up to the leading edge SOMATOM Sensation
64. More than 100 of our brand-new multislice SOMATOM Spirit CT scanners are in use all over
the world, from the highlands of Tibet to Milwaukee, USA. Within one year, more than 250
SOMATOM Sensation 64-slice CT scanners have been installed in the worlds leading academic
institutions and in busy hospitals and practices. First peer-reviewed reports in leading medical
and scientific journals definitely substantiate the advantages of Siemens' proprietary z-SharpTM
Technology in neuro, chest, vascular and cardiac CT applications. Moreover, the first SOMATOM
Sensation 40 scanners, providing access to z-Sharps benefits at attractive investment levels, are
running successfully in Europe and the USA. And our new SOMATOM Emotion 16, which was
introduced at the ECR 2005 in Vienna, will bring advanced 16-slice CT performance to day-today clinical practice at even lower investment levels. And there is much, much more in the
pipeline
As the amount of data acquired per study is increasing, high-performance workflow and application solutions gain importance. We have devoted most of this issue to discuss the challenges
and solutions for the efficient management of large data sets. Find out about our latest innovations in clinical workflow design for cardio-vascular applications and for highly sensitive early
diagnosis of cancer. Our authors and editors have put together another outstanding collection of
useful information. Join us on a fascinating journey in space and time through the human body.
We are looking forward to your comments, suggestions, and contributions.
Sincerely,

Bernd Ohnesorge, PhD, Vice President CT Marketing and Sales

SOMATOM Sessions 16

CONTENT

COVER STORY
4

Think Clinical!

The Fast Lane to Cardiac Diagnosis

Benefits of Computer-Aided Detection

10

Continuous Software Enhancements

NEWS
11

CT on its Way Beyond Slices?

11

Advanced Performance at Low Cost

12

40-Slice Technology

12

LEONARDO in Anatomy Teaching

BUSINESS
13

Cardiologists and Radiologists Unite Forces

13

Free Trial Clinical Software

14

Driving Initiatives against Colon Cancer

14

Demo Poster

15

And it runs, and runs, and runs...

CLINICAL OUTCOMES
16

SOMATOM Sensation 64: Low Dose Cardiac Scanning of a Neonate in one Second

18

SOMATOM Sensation 40: Peripheral Runoff

20

SOMATOM Sensation 16: Differential Diagnosis of a Pancreas

22

SOMATOM Sensation Open: Paget Sarcoma Disease in the Tibia

24

SOMATOM Emotion: High Resolution Orthopedics Examination

26

SOMATOM Spirit: Pre-operative Neurosurgical Planning

SCIENCE
28

z-Ultra-High Resolution Mode

30

Combining Forces to Improve Patient Care

33

High-tech Meets History

CUSTOMER CARE
35

A Win-Win Situation

36

Cross-country Postprocessing Events

36

CT Imaging and Cherry Blossoms

37

Exploring the Riches of Multislice CT

37

Service: Frequently Asked Questions

38

Service: CT Online

38

Information and Services Available Directly at Your CT Scanner

38

Service: Upcoming Events and Courses

39

Imprint
SOMATOM Sessions 16

COVER STORY

Think Clinical!
Siemens Computed Tomography is setting new trends in clinical workflow.
By Louise A. McKenna, PhD, Global Product and Marketing Manager CT-Workplaces, and Stefan Wnsch, PhD,
Global Product and Marketing Manger Clinical Solutions, Siemens AG, Medical Solutions, CT Division

Think clinical! One of the hottest topics in medical imaging

today is how to deliver a fast, confident diagnosis in an
increasingly demanding clinical environment. Both physicians and patients have high clinical expectations, exam volumes are on the increase, scan times are faster than ever,
datasets are large, plus there is demand for improved patient
safety in terms of dose, without compromising result. Delivering excellent clinical outcomes in medical imaging today is
no longer only about having thinnest slices, the most powerful tube and fastest rotation time. It is about having the
most innovative Computed Tomography (CT) scanner in
combination with well designed clinical workflow solutions.
From the clinicians viewpoint, achieving a fast, confident
diagnosis relies on two key factors: the right CT technology
in combination with the right clinical workflow, says Elliot K.
Fishman, MD, Professor of Radiology and Oncology at Johns

SOMATOM Sessions 16

Hopkins Medical Center, Baltimore, USA. In my opinion,

Siemens is setting the trend in modern diagnostic imaging,
combining the most innovative scanner technologies with
intelligent workflow tools and new intuitive clinical software
applications. Siemens is leading the way in seamlessly integrated CT solutions that help us to be fast in reaching the
right clinical outcomes reliably and efficiently, everyday.

Leadership in Workflow Solutions

The innovation explosion in Multislice CT technology and the
introduction of 64-slice CT has revolutionized medical imaging, paving the way for a wealth of new and exciting clinical
applications: fast cardiac CT in under eight seconds, whole
body vascular CT with exquisite detail in under 20 seconds,
highly sensitive virtual imaging of the colon and perfusion
CT, to name but a few. And true to its tradition as an innova-

COVER STORY

Excellent image quality is only one step towards a confident physicians diagnosis.
Well designed clinical workflow solutions have become equally important.

tion leader, Siemens is setting new trends in clinically orientated diagnostic imaging. The unique portfolio of syngo
based workflow tools and software applications are intuitive
and intelligent, designed to get clinicians to the right diagnosis as quickly and as efficiently as possible. The goal?
Enhanced clinical outcomes for improved patient care.
Improved Efficiency with CARE Solutions
Scanning with speed and efficiency is prerequisite for
improving throughput and enjoying all the clinical benefits
of ultra-fast scan times. This can only be optimally achieved
via more task automation within the scanning workflow.
Dose and contrast management are key areas where
automation can save precious time, improve reliability and
enhance clinical outcomes, especially for interventional procedures. Automated real-time dose modulation and contrast
media management offer two key benefits: they allow
radiologists to offer more patient-friendly exams with no
compromise in diagnostic image quality. Reliably improving
efficiency through task-automation was one of the main
drivers behind the development of Siemens unique portfolio
of CARE solutions.

CARE Dose4D helps us to reduce

complexity The software provides
us with a fully automated, real-time
anatomy based dose regulation,
resulting in a simplified workflow
without the need for individualized
protocol optimization.
Professor Werner Bautz, MD,
University of Erlangen, Germany.

Siemens offers a solution that sets benchmarks for dose

management: CARE Dose4DTM provides a fully automated
dose modulation workflow designed to deliver the lowest
possible dose with the best possible image quality. The automated protocol facilitates a fast workflow, because it is not
necessary to adapt protocols manually for each new patient.
For optimal cardiac studies, Siemens ECG-pulsing modulates
dose so that maximum dose is given during expected
diastole and only 20 percent dose during all other phases.
For contrast media management, CARE Bolus CT and a new,

SOMATOM Sessions 16

COVER STORY

CARE Dose4D

Scan with
constant mA

X-ray
dose

Reduced dose Real-time

level based on angular dose
topogram
modulation

CARE Dose4D

Slice position

500 mA

30 mA
Instead of just taking into account the patients
external dimensions and apparent size, CARE
Dose4D analyzes the cross-sectional anatomy in
real-time and adjusts the emitted X-ray dose
accordingly providing excellent image quality
with minimized exposure.

Siemens exclusive CARE Contrast CT are the right answer to

the increasing demand for fast, contrast enhanced CT scanning. State-of-the-art, 64-slice CT scanners such as the
SOMATOM Sensation 64, image the entire chest, abdomen,
and pelvis in less than ten seconds. These fast scan times
raise unique challenges to the contrast media injector
devices and the use of intravenous contrast media. Todays
Multislice CT scanners are so fast that if the injection parameters are not adjusted, the scan will be completed before the

SOMATOM Sessions 16

entire volume of contrast is injected. These shorter scan

times create an opportunity to reduce the total amount of
intravenous contrast administered, decreasing costs and
improving patient care.
Siemens unique CARE Bolus CT software enables the
improvement of planning procedures and diagnosis due to
an optimized spiral scan start after contrast injection. As
soon as a predefined contrast enhancement threshold is
reached, the diagnostic scan is triggered and begins after a
short, preset delay. In terms of workflow, CARE Bolus
negates the need for a test bolus, facilitates contrast phase
shaping, and the fully automated triggering protocol maximizes efficiency also for emergency exams. With the newest
member of the CARE family, Siemens offers an industry first
CARE Contrast CT. CARE Contrast CT couples the CT with
the injector. The fully automated workflow is initiated by a
single click, which is especially useful for trauma and acute
care patients.
Data Management par Excellence
the WorkStream4D Way
Data management plays a pivotal role in workflow efficiency.
The typical number of images for a CT exam has risen from
around 300 five years ago to well over 2000 with the
SOMATOM Sensation 64. Such large data sets can only be
managed electronically. In addition, the paradigm shift from
2D to volumetric 3D reading is driving medical imaging
departments to adopt an efficient, filmless workflow where
fast reconstruction and 3D volume rendering are essential
for achieving an efficient diagnostic workflow. Siemens has
been a pioneer of this paradigm shift and is the industry
leader in innovative data management solutions.
Managed the traditional way, multiple reconstruction and
re-formatting steps not only reduce workflow efficiency,
they also compromise image quality with a knock-on effect
on diagnostic confidence. Siemens' innovative WorkStream4DTM is specifically designed to efficiently manage
large data sets with fully automated reconstruction and reformatting of raw data assuring the best possible image
quality, which is good news for diagnostic confidence. With
direct 3D reconstruction, all diagnostic information is captured in 3D slices, which economizes on data storage in daily workflow, as data volume can be reduced by up to a factor
of ten. WorkStream4D also offers pre-programmed, multiphase 4D reconstruction protocols, enhancing the advanced
clinical spectrum for dynamic evaluation in cardiac CT, for
example. This deliberate optimization of the 2D, 3D and 4D
workflow is designed to ensure that users can realize the full
clinical benefit of Multislice CT. WorkStream4D is also
designed to make workflow as flexible as possible, uniquely

COVER STORY

WorkStream4D
Conventional Workflow

Scan
Time

Reconstruct & Reformat

Read

WorkStream4D

Scan
Time

Read

WorkStream4D virtually eliminates the need for time-consuming manual

reconstruction steps the software does this automatically.

enabling fully automated reconstruction in parallel to acquisition at both Navigator and Wizard CT-workplaces, offering
users a high degree of workflow synergy.

Leadership in Clinical Applications

Siemens is also setting new standards in clinical CT through
on-going innovation in integrated clinical software applications. The latest enhancements focus on improving speed
and efficiency through simplifying workflow, increasing
automation and integrating clinically orientated tasks into
single software solutions. The current portfolio of syngo
software offers the industrys most comprehensive range of
clinical solutions for cardiovascular CT, preventive care,
oncology, neurology and routine imaging.
The introduction of the SOMATOM Sensation 16 in 2001,
closely followed by the SOMATOM Sensation 64, revolutionized cardiac and vascular CT. For the first time, CT was able to
deliver the exceptional spatial and temporal resolution coupled with the exquisite image quality needed for non-invasive cardiac and vascular imaging. With a focus on automation, speed and simplicity, syngo Circulation* is the newest
addition to the portfolio of advanced cardiac workflow tools
designed to help clinicians realize the full diagnostic potential of cardiac CT imaging. Designed in close collaboration
with Radiologists and Cardiologists, syngo Circulation provides the entire toolset for a comprehensive cardiac CT exam

based on a one-time loaded data-set. This includes an intelligently designed 1-click workflow for robust coronary vessel
segmentation, automated stenosis quantification and optimized stent planning, automated quantification of ejection
fraction, end-diastolic and systolic volume plus stroke volume, and 4D evaluation of up to 24 phases.
Enhancing clinical workflow for vascular CT has been the
focus in the further development of syngo InSpace4DTM.
Concentrating on clinicians requirements for more automated tools, particularly for removal of bony structures for faster
vascular analysis, a fully automated advanced bone removal
application is an integrated feature of the latest syngo
InSpace4D. In combination with syngo Vessel View, users
can really optimize diagnostic workflow for a broad range of
vascular pathologies.
For preventive care and oncology, syngo LungCARE CT and
syngo Colonography are part of the new generation of intelligent clinical software solutions. They incorporate a number
automated features such as measuring tools, synchronization for easy evaluation of follow-up studies or prone/supine
reads and pre-filled reports, all designed to reduce the manual workflow of the clinicians so that they can focus on diagnosis. In combination with Siemens CT technology, a lung or
colon exam, from scan to report, can be completed in less
than 20 minutes the clinician input representing about ten
minutes for diagnosis and reporting.

SOMATOM Sessions 16

COVER STORY

D E D I C AT E D S O L U T I O N S

The Fast Lane to Cardiac Diagnosis

syngo Circulation offers physicians the industrys most comprehensive software solution for cardiac CT,
setting a new benchmark for improving clinical outcomes through innovative software solutions.
Computed Tomography (CT) fulfils many
clinical needs be it in neurology, oncology, angiography, in the emergency
room or, increasingly, also in cardiology
and preventive care. Siemens Medical
Solutions offers specialized solutions for
the specific needs of each of the respective clinical departments. Supplying our
customers with hardware dedicated to
their needs is not enough, says Bernd
Montag, PhD, President of Siemens
Medical Solutions CT division. We also
want to give applications and workflow
tools to them that are explicitly designed to meet the needs of their specific
clinical department from patient registration to reporting.
syngo Circulation* is the first of Siemens
new generation clinical software solutions. syngo Circulation is a dedicated
solution for cardiac evaluation, uniquely
designed to offer fast, robust morphological and functional analysis in one intuitive software application.

An accurate but fast diagnosis is crucial

in cardiovascular imaging in order to
ensure the best quality of care for the
patient. This is why the workflow must
be extremely fast and well organized,
states Lars Hofmann, MD, Global Product and Marketing Manager for Cardiac
CT at Siemens.
syngo Circulation was developed in
close collaboration with leading cardiac
experts. It features a unique user-friendly
workflow that guides the clinician
through cardiac evaluation from automated heart segmentation, through
coronary vessel segmentation and
stenosis quantification, fully automated
functional analysis and reporting, in
under 10 minutes.
A typical workflow begins with fast loading of up to 24 phases, at highest image
resolution. With a single click, the heart
can be isolated from the rib cage facilitating rapid assessment of the overall
cardiac anatomy. Fully automated seg-

mentation and stenosis quantification

tools provide for fast, confident evaluation of the coronary vessels and optimized stent planning. syngo Circulation
also offers tools for full functional analysis
including cine display for evaluation of
wall motion defects, automated left
ventricle segmentation and quantification of ejection fraction, stroke volume,
end systolic and diastolic volumes. All
qualitative and quantitative results are
integrated in a single, customizable report.
The new software helps to facilitate
and increase workflow for physicians
with a busy clinical practice by incorporating intuitive reporting functionality
and integrating many time-saving, accurate and guided procedures for the
rapid examination of cardiac CT studies, says Michael Poon, MD, Director of
Cardiology at the Cabrini Mecial Center
and Associate Professor at the Mount
Sinai School of Medicine, New York, USA.

*syngo Circulation is pending 510(k) review and is not yet commercially available in the U.S.

SOMATOM Sessions 16

COVER STORY

Siemens syngo Neuro Perfusion CT provides a cutting-edge imaging technology that

allows us to speed up patient diagnosis. The method allows us to differentiate definitively
damaged brain tissue from penumbra in less than two minutes.
Bernd Tomandl, MD, Assoc. Professor, Department of Interventional Radiology, Klinikum Sd, Nuremberg, Germany.

Siemens users are also in a unique position to benefit from

state-of-the-art computer-assisted reading tools for lung
nodules and colon lesions. syngo LungCARE CT with NEV
(Nodule Enhanced Viewing) and syngo Colonography with
PEV (Polyp Enhanced Viewing) represent an on-going commitment to development of automated tools that improve
diagnostic confidence through the use of computer-assisted
second readers, which may have real impact on treatment
decisions. Centers that have already been working extensively with syngo LungCARE NEV have realized a significant
improvement in daily workflow. Klinikum Rechts der Isar in

Munich, Germany has been able to reduce the number of

reading physicians since introducing syngo LungCARE NEV:
With this tool, we reduced the need for the second read by
a second physician screening all our chest datasets for lung
nodules, and therefore improved our diagnostic work-up
and follow-up findings, says Christoph Engelke, MD,
Department of Diagnostic Imaging, Technical University
Munich, Germany.
The innovation continues in software solutions for neurology,
particularly for stroke and tumor perfusion. syngo Neuro
Perfusion CT is an established tool for the fast assessment of

S ECO N D R EAD E R TOO L S

Benefits of Computer-Aided Detection

in chest CT examinations

in CT colonography

In my opinion, reliable detection of early stages of lung cancer is a difficult but crucial task. There is no question that
reading screening or diagnostic CT studies is susceptible to
detection errors due to the huge amount of imaging data
that has to be reviewed. In a recently published study, we
demonstrated that the use of second reader technology
considerably increases the radiologists sensitivity for detection of pulmonary nodules.
Therefore, to ensure the highest
possible sensitivity for detection
of early-stage lung cancer in the
screening process, I am strongly
in favor of double-checking the
images with a Computer-Aided
Detection (CAD) system. Preliminary results suggest that application of CAD might even be timeefficient. Finally, CAD is not only
Dag Wormanns, MD,
Department of Diagnos- valuable in lung cancer screentic Radiology, University ing, but also improves detection
of lung metastases when staging
Clinic Muenster,
or re-staging oncology patients.
Muenster, Germany

Computer-Aided Detection (CAD) has been very successful

in mammography and is being used for early detection of
lung cancer. In my opinion, if CAD could accurately detect
colon polyps in CT colonography (CTC), with a relatively low
false positive rate, it might become another very important
clinical application. Currently, most of the radiologists who
are experienced in CTC would not want to interpret more
than 35 studies per day.
Reading CTC is a demanding,
meticulous process, requiring
focused and extremely attentive concentration. Given the
fact that there are not
enough radiologists to interpret the growing number of
CT scans performed in the
United States, any assistance
in interpreting CTC will be
Mark Baker, MD, Section
embraced enthusiastically by
of Abdominal Imaging,
radiologists.
Division of Radiology, The
Cleveland Clinic Foundation, Cleveland, Ohio, USA

SOMATOM Sessions 16

COVER STORY

stroke, with a complete exam requiring less than 15 minutes

[1], which is critical for stroke patients. syngo Neuro Perfusion CT is also designed to be versatile and is ideal for the
analysis of brain tumor perfusion for brain tumor angiogenesis or assessing treatment efficacy in oncology.
Currently, Siemens offers around 30 workflow and clinical
applications, providing solutions to meet a comprehensive

range of clinical needs from cardiac CT to oncology. With a

keen eye on the future, Siemens will continue to set new
trends for the next generation of clinical CT solutions

[1] Tomandl B., et al. Comprehensive imaging of ischemic stroke

with multislice CT. Radiographics 2003; 23: 565-592

syngo C T 2 0 0 6 A / G

Continuous Software Enhancements

In addition to new software developments, Siemens
Medical Solutions continuously enhances existing
clinical applications for Computed Tomography (CT).
The latest developments provide various new features, such as improved workflow solutions, excellent
image quality in the brain due to superior image optimization algorithms, as well as enhanced access to
online information and services directly from the
scanner console. This allows a faster download of
scan protocols and depending on the system configuration facilitates innovative new clinical applications such as
syngo InSpace4D with integrated bone removal
package for enhanced visualization of vascular
structures
syngo Body Perfusion CT for quantitative evaluation
of dynamic CT data of organs and tumors, following
the injection of a compact bolus
CARE Contrast CT for a simplified contrast workflow,
due to synchronized scanning and contrast media
application.
Newly shipped SOMATOM CT systems are pre-installed with the latest complimentary versions and
with the latest optional versions, if ordered. To
increase clinical performance for already installed
SOMATOM CT scanners, complimentary versions are
included in the syngo Evolve contract as part of a
Siemens Service Contract. The optional software
applications can be ordered as upgrade packages, if
desired. More information about the syngo Evolve
Packages can be obtained online. For questions
regarding the individual Evolve status of a CT scanner,
the local Siemens representative should be contacted.

10

SOMATOM Sessions 16

syngo InSpace4D with advanced bone removal facilitates

fast segmentation and removal of bony structures for faster
visualization of vessels.

k Further Information: www.siemens.com/ct-evolve

NEWS

VISION OF THE FUTURE

CT on its Way Beyond Slices?

The number of slices acquired per rotation has doubled every 18 months in the
last few years, and still the innovators at
Siemens Computed Tomography (CT)
Division continue to challenge the future limits of CT technology and applications. To just continue the current slice
race will not be the right path to open up
new clinical possibilities, says Bernd
Ohnesorge, PhD, Vice President Marketing and Sales. Its time to explore totally
new CT concepts, and to move beyond
the simple adding of more detector
rows."
Last years RSNA visitors saw a visionary
CT concept at the Siemens booths Innovation Pavilion that may redefine clinical
CT in the future: a very slim gantry design with a wide gantry opening allowing for easy patient access and higher
patient comfort. A large area detector
with over 15 centimeter z-coverage per
rotation enabling dynamic and volumetric imaging of entire organs and body
regions, such as the heart, liver and
brain. Several X-ray sources generate
separate X-ray fan beams, while raw
data is acquired by an arrangement of

different detectors. A slim tube design

similar to Siemens' STRATON is a key
prerequisite for such a concept. Sources
and detector segments are combined
differently in order to optimally adapt to
the needs of each respective clinical application. Thus, this visionary concept
offers numerous advantages for various
clinical applications:
1. Examination of entire organs in one
rotation, e.g. for brain, organ and tumor perfusion and for dynamic CTA
examinations of the heart and other
organs is made possible by utilizing
the above mentioned area detector.
2.Simultaneously operating several
source-detector subsystems may be a
way to a temporal resolution below
100 milliseconds, eventually even
below 50 milliseconds, independent
of heart rate, with todays rotation
time of 0.33 seconds. Robust cardiac
imaging at high and irregular heart
rate may become feasible, without
b-blockers and without drawbacks of
multi-segment reconstruction algorithms by using data from only one
heart beat.

A future vision of CT, as shown at RSNA 2004

by Siemens Computed Tomography Division
a system combining several X-ray sources
and detector domains
3.In the same way, more X-ray power is
available for high quality imaging of
obese patients at maximum volume
coverage speed. More power is applied within shorter scan times, so
that radiation exposure is not necessarily increased. High diagnostic quality can be achieved in obese patients
where most X-ray energy is absorbed
in the surrounding fat tissue.
4.Totally new opportunities can be explored with multiple source-detector
subsystems operated with different
X-ray energy levels, thus enabling
spectral CT imaging. This may allow
for raw-data based built-in separation of bone, vessel lumen and calcifications, or for characterization of liquids, such as blood and pus, in
emergency diagnostics.

S O M AT O M E m o t i o n 16

Advanced Performance at Low Cost

With the new SOMATOM Emotion 16,
Siemens Medical Solutions again proves
its cost-consciousness and clinical expertise. The SOMATOM Emotion 16 delivers the performance required for advanced clinical applications at low
life-cycle costs. It is based on the successful SOMATOM Emotion product line
with more than 3,500 installations

worldwide. The new system enables

hospitals and private practices with limited budgets and/or space allocations to
install a 16-slice CT.
Being air cooled, the SOMATOM Emotion
16 and all its components require only
18.5 square meter installation space. In
addition to the economical purchase
price, this minimal space requirement
The SOMATOM Emotion 16 unites
modern 16-slice technology with
the cost-efficiency of the SOMATOM
Emotion product line.

and the overall low life cycle costs also

contribute to its cost efficiency.
From a clinical perspective, the new
scanner offers every advantage of a
modern 16-slice system: short breath
hold times alowing image acquisition
without movement artifacts, high diagnostic image quality due to a collimation
of down to 16 x 0.6 millimeters, a minimum gantry rotation time of down to
0.5 seconds, and a comprehensive set
of routine and advanced clinical applications.
SOMATOM Sessions 16

11

NEWS

S O M AT O M S e n s a t i o n P R O D U C T L I N E

40-Slice Technology
Two new Siemens Computed Tomography (CT) systems were recently introduced to the market. The worlds first
SOMATOM Sensation 40 scanner was
installed at the radiology department of
Alamance Regional Medical Center,
Burlington, NC., replacing the clinics
SOMATOM Sensation 10. And Mayo Clinic
in Rochester, MN., was one of the first
clinics to install a SOMATOM Sensation
Open with 40-slice technology. The system features an extra-large, 82 centimeter gantry bore and field of view.
A new, optional high-capacity patient
table, developed as part of the CT Clinical Innovation Center partnership between Mayo and Siemens, was installed
with the system to permit advanced CT
imaging of extremely heavy patients.
The table allows the scanning of patients weighing up to 615 lbs, compared
to 440 lbs for conventional patient tables. With these features, the
SOMATOM Sensation Open is ideally
suited for very heavy patients and our
Bariatric Surgery Program, says Cynthia

McCollough, PhD, Associate Professor of

Radiological Physics at the Mayo Clinic
College of Medicine. In addition, the
STRATON tube provides the X-ray output
needed for high-quality images in very
large patients. These are exactly the
clinical and technical attributes we were
seeking, especially for bariatric care and
image guided interventions.
Both new systems feature Siemens revolutionary z-Sharp Technology, which
utilizes an electron beam that is accurately and rapidly deflected, creating
two alternating and overlapping X-ray
projections reaching each detector element. This doubles the scan information
without a corresponding increase in
dose, and routinely enables acquisition
of 40 slices per rotation with unprecedented image quality and the industrys
highest image resolution of below 0.4
millimeter. z-Sharp Technology firmly
established a new benchmark for diagnostic excellence, as proven with almost
300 installations of z-Sharp powered
systems worldwide.

With the SOMATOM Sensation 40, Siemens

Medical Solutions rounds out its extensive
high-end product portfolio in CT.

The large bore of the SOMATOM Sensation

Open is ideal for examinations of bariatric
and cancer patients.

LERNER COLLEGE OF MEDICINE

LEONARDO in Anatomy Teaching

Students in the anatomy classes at
Cleveland Clinic Lerner College of Medicine at Case Western Reserve University,
Cleveland, OH., are enjoying very special insights into the human body. Each
week starts with a session at the Colleges LEONARDO Workstation. Faculty
members demonstrate with syngo
InSpace and other applications and ex-

12

SOMATOM Sessions 16

plain multiple views of the body regions

they will cover during the coming week.
Students then return several times during the week to review images as they
proceed on their weekly learning matter. New cases to demonstrate specific
examples of anatomy are added onto
the LEONARDO regularly. The use of
this technology has directly enhanced

the students understanding of anatomy

and their ability to visualize structures,
says Richard Drake, PhD, Director of
Anatomy. He is also involved in preparing images on the LEONARDO for a publishing project of Grays Anatomy family
of educational material.
k Further Information:
www.clevelandclinic.org/cclcm

BUSINESS

S O C I ET Y O F C AR D I OVAS C U L AR C T

Cardiologists and Radiologists Unite Forces

By Lars Hofmann, MD, Global Product and Marketing Manager Cardiac CT,
Siemens AG, Medical Solutions, CT Division, Forchheim, Germany

On March 7, 2005, the Society of Cardiovascular Computed Tomography (SCVCT)

and the Society of Cardiac Computed
Tomography (SCCT) merged to form a
new society called Society of Cardiovascular CT (SCCT). Both former societies were relatively new, having just
been formed in January 2005. They
soon realized that they shared common
goals and that a single, strong society
would be more effective.
The SCCT is represented by a 15-member
Board of Directors and five executive officers. Four of them and the vast majority of the Board of Directors are long
term Siemens Computed Tomography
(CT) users. Executive officers of the SCCT are: Stephan Achenbach, MD, President, Erlangen, Germany; Michael

Poon, MD, President-Elect, New York,

NY; Daniel Berman, MD, Vice President,
Los Angeles, CA; Gilbert Raff, MD, Secretary, Royal Oak, MI, and Joao Lima, MD,
Treasurer, Baltimore, MD.
Computed Tomography has gone
through rapid technical development in
the past years, and is increasingly applicable to imaging of the heart, coronary
arteries and vascular system. It is important that researchers and clinicians in
this field work together to create a body
of evidence strong enough to support
recommendations as to which patients
are most likely to benefit from the new
diagnostic modalities and to assure that
CT imaging performed by appropriately
trained physicians will be available to
these patients. I am confident that the

newly formed Society of Cardiovascular

CT will be very helpful in establishing
the appropriate clinical role for cardiovascular CT, said Dr. Achenbach, SCCT
President.
The SCCT is an international organization
committed to the further development
of cardiovascular CT through standards
setting, advocacy, education, training, accreditation, quality control and research.
Its members are physicians, scientists,
technologists, and others who work in
the field of cardiovascular CT. Siemens
CT division strongly supports the new
society and encourages users of cardiac
CT to join the society to support this fascinating technology.
k Further Information: www.scct.org

syn g o LU N G C AR E C T W ITH N EV

Free Trial Clinical Software

Siemens Computed Tomography (CT)
now offers their latest computer assisted detection software syngo LungCARE
CT with NEV (Nodule Enhanced Viewing), on a free, 90-day trial basis. This
software is designed to enhance physicians diagnostic confidence as a second
reader tool, confirming the presence or
absence of lung lesions. Double reading
with a second reader software offers a
significantly increased sensitivity compared to conventional double reading.
Thus, computer assisted detection is a
valuable tool for the detection of pulmonary nodules, and should be used as
second opinion.1

Trial licences are available

via LifeNet: Customers with SRS connectivity can order their trial software
directly from their scanner. The software will then be automatically installed and ready for use.
via the local Siemens Representative:
Customers can contact their local
Siemens Representative. He/she will
discuss the available trial options with
them and schedule an appointment
for the installation of the trial software.
k Further Information:
www.siemens.com/SOMATOMExpand

syngo LungCARE CT with NEV identifies

potential lung lesion that were overlooked
during the radiologists first read.

1 Wormanns D, Beyer F, Diederich S, et al. Diagnostic performance of a commercially available

CAD system for automatic detection of pulmonary
nodules: Comparison with single and double reading. Rfo 2004 Jul; 176(7): 953-958

SOMATOM Sessions 16

13

BUSINESS

INVESTING IN PEOPLE

Driving Initiatives against Colon Cancer

Siemens Medical Solutions, Daimler
Chrysler AG, Henkel KGaA, BASF AG and
E.ON Ruhrgas AG, in cooperation with
their respective occupational health
centers, have all initiated screening programs for colon cancer. Siemens Medical Solutions in Germany invited employees aged 45 plus, together with
those at risk (e.g. familial history) to undergo a Fecal Occult Blood Test (FOBT)
as a primary screening tool. Employees
with a positive test were offered two alternatives for further investigation: a
traditional colonoscopy or true to the
tradition of innovating health care the
opportunity to undergo a CT-Colonography (CTC) on the University of Erlangens SOMATOM Sensation 64. The
hugely successful take-up of this initiative reflects the increased awareness of

the benefits of early detection: 1,110 employees signed up; of the 2.5 percent
with a positive FOBT test, 60 percent
chose to follow-up with a CTC. The success of the project had much to do with
the close collaboration with Siemens
Betriebskrankenkasse (SBK), and also
with the department of radiology at the
University of Erlangen.
This screening initiative represents a
huge opportunity for us to gather more
evidence for the use of virtual colonography as a highly sensitive and specific
screening tool for colon cancer, explains
Rolf Janka, MD, Department of Radiology, University of Erlangen, Germany.
A virtual colonoscopy using CT is noninvasive, patient friendly, and relatively
low cost. These are key pre-requisites
for screening procedures. The more clin-

ical data we can gather, the greater our

chance of getting approval for CTC for
colon cancer screening. In my opinion,
that can only lead to one thing: better
patient care!
The use of CT for early detection of
colon cancer is a hotly debated topic.
Several publications have demonstrated that with Multislice CT, radiologists
can achieve a sensitivity and specificity
to match conventional colonoscopy.
Currently, experts across the globe are
working hard on providing further data
supporting the reliability of CTC for detection of clinically relevant polyps. One
of the largest clinical trials will take place
in the US, where the American College
Imaging Network and the National Cancer Institute aim to accrue over 2,000
patients over the next 2.5 years.

Based on their experience with virtual

colonoscopy, they have designed a
poster demonstrating the spectrum of
CTC findings in colon diseases. All diseases are briefly described and extensively demonstrated on 3D and 2D CT
images, guiding and assisting users in
the reporting of findings in CTC examinations.
The poster has been produced together
with Siemens Medical Solutions, Austria, and is available free of charge in either German or English.
To obtain a free CT Colonography Poster,
please send an e-mail with your postal
address to
med.somatomlife@siemens.com,
subject CTC Poster.

Each disease is briefly described and

demonstrated, based on CT images.

C T C O LO N O G R A P H Y

Demo Poster
CT Colonography (CTC) is emerging as
an attractive alternative to colonoscopy
for the detection and evaluation of lesions of the colon in terms of excellent
diagnostic outcomes, high patient acceptance and lower cost. It is ideally suited for patients who are unable or unfit
to undergo conventional colonoscopy,
as well as for asymptomatic and screening patients. Around 600 Siemens Multislice CT users are currently utilizing
syngo Colonography for efficient evaluation of the colon.
Thomas Mang, MD, and co-workers
from the Medical University of Vienna,
Austria, have performed around 280
CTC exams on their SOMATOM Sensation 16 Scanner over the last two years.

14

SOMATOM Sessions 16

BUSINESS

Interview
S O M AT O M S p i r i t

And it runs, and runs, and runs...

Fudan University Zhongshan Hospital, Shanghai City, China, and WernerWicker-Klinik, Bad Wildungen, Germany, were among the first to install a
SOMATOM Spirit. SOMATOM Sessions
asked Professor Zeng MengShu, MD,
and Carsten Figge, MD, about their
experience with the new system.
What types of examinations are you
using the SOMATOM Spirit for?
Dr. Figge: We use the SOMATOM Spirit
for all exams in daily clinical routine.
With our outpatients, there are more
head, thoracic, and abdominal exams,
while our inpatients mainly need examinations of the spine. We examine
between 15 and 20 patients per day.
Prof. MengShu: We do routine head
and thoracic examinations, high resolution lung scans, abdominal contrast
examinations, spine examinations,
and other routine examinations. On
average, we scan 60 patients per day
with the SOMATOM Spirit.
You have been working with the
SOMATOM Spirit for over six
months. What is your experience,
compared to other CT scanners?
Dr. Figge: Compared to our former
SOMATOM AR.Star, the SOMATOM
Spirit as a dual-slice system broadens our spectrum of examinations, to
CT-Angiographies of the head, or multiphase exams of the abdomen, at
thinner collimation.
What is your opinion about the user
guidance and simplicity of the user
interface?
Prof. MengShu: Our technologists
are very satisfied with the user interface; it is easy to understand and to

operate. Qualified technicians can do

simple examinations after only five
minutes of training.
Dr. Figge: The SOMATOM Spirit is very
easy to operate because of its syngo
user interface. Many workflow steps
can be automated, which reduces the
workload for our technologists and
shortens examination times. Secondary postprocessing like Multi-Planar Reformatting, Maximum Intensity
Projection, or Volume Rendering
Technique (VRT) are readily available
for diagnosis. The ease of use surprises and pleases at the same time.
Where do you use VRT?
Dr. Figge: I use VRT for the visualization of complex diagnosis in meetings
and demonstrations. This way, I can
give surgeons an overview of complex
anatomy; details can then be worked
out in the primary slice images.
Prof. MengShu: We use VRT for many
kinds of examination, such as tracheal
and bronchia examinations. Especially
with CT-Angiography, we can see the
abdominal artery after removing the
bone and other organs. The value of
VRT is well acknowledged, the doctors can see the area of interest directly
in the 3D structure.
What is your overall impression of
the SOMATOM Spirit?
Dr. Figge: And it runs, and runs, and
runs ...
To which customers would you recommend the SOMATOM Spirit?
Dr. Figge: I would recommend it to
any customer who needs an easy to
use system for their daily clinical routine, and, at the same time, wants

Carsten Figge, MD: We experience

up to 30 percent dose reduction,
thanks to the SOMATOM Spirits
CARE Dose functionality.
high cost efficiency. Particularly small,
outlying clinics utilizing teleradiology
can profit from the excellent handling
concept.
Prof. MengShu: The SOMATOM Spirit
is the ideal system for hospitals with
less than 500 beds that buy their first
CT, and for large hospitals that buy an
additional CT for routine examinations.

Werner-Wicker-Klinik specializes in
acute care for spinal marrow injuries,
congenital and acquired spine diseases (German Center for Scoliosis),
neuro-urology, and neuro-surgery.
Its Radiological Institute collaborates
closely with the Radiology Institute
Bad Zwesten, Practice of Drs. Mari/
Aref/Figge. Together, they attend not
only to the outpatients of all hospitals
of the Wicker-Group, but also serve as
a teleradiology center for 14 acute-care
hospitals. As a polyclinic, Zhongshan
Hospital focuses on the diagnosis
and treatment of liver, kidney and lung
cancer. The clinic has 1,272 beds, 1.2
million outpatients and 25 thousand
inpatients per year. There are 2,300
employees working in the hospital, including 360 professors and associate
professors, plus three CAS (Chinese
Academy of Science) and CAE (Chinese Academy of Engineering) academicians.

SOMATOM Sessions 16

15

CLINICAL OUTCOMES

SOMATOM
Sensation

SOMATOM
Emotion

SOMATOM
Spirit

Case 1:
Low Dose Cardiac Scanning of a Neonate in one Second
By Jean-Franois Paul, MD, Anne Sigal-Cinqualbre MD, Department of Radiology, and V. Lambert, MD,
Department of Cardiopediatry, Marie Lannelongue Hospital, Le Plessis-Robinson, France

HISTORY

DIAGNOSIS

An 1 day old infant was referred for cardiac CT for differential

diagnosis prior to surgical intervention for severe aortic
coarctation from total interruption of aortic arch.
Previous foetal echocardiography had revealed asymmetry
of ventricles associated with an enlarged right ventricle, and
there was suspicion of coarctation of the aortic arch. At birth,
echocardiography was not able to assess whether the baby
was suffering from severe aortic coarctation or if the aortic
arch was totally interrupted.

CT revealed atypical coarctation, associated with very large

patent ductus arteriosus, supplying descending aorta with
blood.
On the first acquisition [Fig. 1 and 2], only patent ductus arteriosus, descending aorta and left subclavian artery were opacified, due to the right to left shunt between ductus arteriosus
and descending aorta. The aortic arch was not visualized.
A second acquisition was performed with a longer start delay
to accommodate this unusual anatomical configuration. The
aortic arch was opacified, and MIP images clearly showed

SCANNING PROCEDURE
Due to the high rotation speed (0.33 s) of the SOMATOM Sensation 64 gantry, the entire thorax could be captured in only
1 second and hence it was not necessary to sedate the infant.
Five cc of contrast medium were injected at a flow rate of
0.6 cc/s in a small cubital vein. After the analysis of the first
acquisition data set, an additional acquisition was necessary
to visualize the aortic arch. Indeed, the aortic arch was not
visualized at first-pass because most of the contrast flow was
going from the pulmonary artery directly to the descending
aorta (via patent ductus arteriosus), bypassing the aortic
arch. A second acquisition 10 seconds later was necessary to
get the aortic arch opacified [Fig. 3].
CARE Dose4D was applied, enabling us to perform the exam
with an exposure that was as low as reasonably achievable,
in this case at 80 kV and 20 mAs. Total DLP for 2 acquisitions
was 15, and the estimated exposure for the exam was very
low at 0.6 mSv.
Images were reconstructed at 1 mm using MIP and VRT reconstructions for a complete description of anatomical disorders.

16

SOMATOM Sessions 16

[ 1 ] Left lateral view using

VRT display. First acquisition
showed very large patent
ductus arteriosus in connection with descending aorta.
Left subclavian artery is originating from the junction
of the two vessels. Aortic
arch is not opacified. PDA:
patent ductus arteriosus;
DA: descending aorta;
LSCA: left subclavian artery;
LPA: left pulmonary artery

[ 2 ] Same acquisition
in a more posterior view

CLINICAL OUTCOMES

[ 3 ] Second acquisition (10 seconds after first pass): MIP view

showed opacified aortic arch with
severe coarctation (arrow). AA:
Aortic arch; DA: descending aorta

[ 4 ] VRT display of the aortic arch,

in a left lateral view. Note that the
aortic narrowing is hidden by the
patent ductus arteriosus.PDA: patent
ductus arteriosus; DA: descending
aorta; LSCA: left subclavian artery;
IA: innominate artery; LCA: left carotid
artery; LPA: left pulmonary artery

[ 5 ] VRT display in a posterior

view shows the complex anatomy
associated with the aortic coarctation. PDA: patent ductus arteriosus; DA: descending aorta; LSCA:
left subclavian artery; LCA: left
carotid artery; AA: aortic arch

EXAMINATION PROTOCOL
that the aorta was severely narrowed, but not totally interrupted [Fig. 3]. Additional VRT images depicted this complex
configuration [Fig. 4 and 5].
Surgical intervention by lateral thoracotomy was successful.
The baby was discharged from our institution at day 10, without complication.

COMMENTS
This is an exemplary case for the application of 64-slice CT
scanning for congenital heart disease patients, especially in
newborns. Very short acquisition times, associated with thin
collimation, provide very high quality images in non-interventional procedures, associated with low radiation exposure. These data may be crucial in such critical conditions. In
case of interrupted arch, the surgical approach would have
required sternototomy with bypass circulation instead of lateral thoracotomy. In case of doubt at echocardiography, a
conventional aortography may be indicated, but angiography is a very risky examination, especially in neonates. Multislice CT is the ideal alternative to avoid such an invasive
imaging technique. Here, CT was preferred to MR due to
superior spatial resolution, speed of acquisition (and thus
absence of respiratory artefacts), and no need for sedation.
Radiation dose delivered by CT was below 1 mSv.

Scanner

SOMATOM Sensation Cardiac 64

Scan area

thorax

Scan length

64 mm

Scan time

1s

Scan direction

caudo-cranial

Heart rate

140

ACV

no ECG gating

kV

80 kV

Effective mAs

20 mAs

Rotation time

0.33 s

Slice collimation

0.6 mm

Slice width

1 mm

Table feed

46 mm / s

Reconstruction increment

0.7 mm

CTDI

0.49 mGy

Kernel

B30

Contrast
Volume

5 ml

Flow rate

0.6 ml / s

Start delay

10 s (central venous access)

Postprocessing

MIP, VRT

SOMATOM Sessions 16

17

CLINICAL OUTCOMES

SOMATOM
Sensation

SOMATOM
Emotion

SOMATOM
Spirit

Case 2:
Peripheral Runoff
Geoffrey Browne, MD, Chris DeAngelo RT ( R ), ( CT ), Alamance Regional Medical Center, Burlington, USA

HISTORY
A 56 year old male patient was presented with pain in the
muscle of the left leg after slight exercise. A CTA runoff with
the latest 40-slice CT technology was scheduled to rule out
claudication.

DIAGNOSIS
CTA revealed an occlusion of the left common iliac artery just
distal to its origin. Occlusion of the proximal two thirds of the
left external iliac artery is present. Collateral reconstitution of
the distal left external iliac artery/common femoral artery is noted. Distal vessels are not affected due to collateral blood supply.

COMMENT

[ 1 ] VRT showing occlusion of the left iliac artery after

bone removal performed with syngo InSpace4D

The case demonstrates the clinical impact of CT for non-invasive assessment of vascular structures with the SOMATOM
Sensation 40. Due to the excellent speed and an isotropic
resolution below 0.4 mm, even finest structures can be
resolved without venous overlap.

EXAMINATION PROTOCOL

[ 2 ] MIP image showing occluded femoral artery

from the origin, filling by collateral circulation from
the peripheral part

18

SOMATOM Sessions 16

Scanner

SOMATOM Sensation 40

Scan area

Lower extremity runoff

Scan length

upper leg: 545.5 mm; feet: 238 mm

Scan time

upper leg: 19 s; feet: 8 s

Scan direction

craniocaudal

kV

120 kV

Effective mAs

170 mAs (CARE Dose4D)

Rotation time

0.37 s

Slice collimation

0.6 mm

Slice width

0.75 mm

Pitch

Reconstruction increment

0.5 mm

Contrast

370 Isovue

Volume

100 ml

Flow rate

3 ml / s

Start delay

Care Bolus CT triggered at 100 HU

with the reference ROI on the aorta

Postprocessing

syngo InSpace4D with bone removal

CLINICAL OUTCOMES

[ 3 ] Curved MPR shows calcified and non-calcified

plaques as well as the thrombus responsible for the
occlusion.

[ 4 ] VRT of the collateral vessels

[ 5A and 5B ] VRT images show the normal blood

supply through the collaterals of the tibial vessels
and supply of the feet.

SOMATOM Sessions 16

19

CLINICAL OUTCOMES

SOMATOM
Sensation

SOMATOM
Emotion

SOMATOM
Spirit

NEW: syngo Body Perfusion CT

Functional Diagnosis of Organs and Tumors
The syngo Body Perfusion CT option* allows for the quantitative evaluation of dynamic CT data of organs and tumors,
following the injection of a compact bolus. By providing
images of blood flow, blood volume and permeability from
one set of dynamic CT data, syngo Body Perfusion CT permits

the assessment of irregular perfusion and of perfusion

changes during therapy. Using specific evaluation protocols
for different organs and motion correction for improved
accurate anatomical object alignment, it can be particularly
helpful for differential diagnosis and monitoring of tumors.

Case 3:
Differential Diagnosis of a Pancreas
By Xue Hua Dan, MD, and Jin Zheng Yu, MD, Department of Radiology,
Peking Union Medical College Hospital, Beijing, China

HISTORY
The patient was a 65 year old man, who had suffered from
hypoglycemia for 5 years, aggravated by vertigo and spells
of unconsciousness during the past 2 years. Due to the
severe symptoms, an insulinoma, a tumor of the pancreas,
was suspected. A previous enhanced CT scan (one month
earlier) indicated no abnormalities. The surgeon asked for an
additional CT scan that revealed a pancreatic tumor.

DIAGNOSIS UND COMMENTS

Only a decade ago, the sensitivity of finding insulinomas with
CT was rather low. Today, using high resolution MSCT in the
early arterial phase, we can quite easily detect these small
pancreatic lesions. Arterial spiral CT showed a small, but
strongly enhancing lesion of 1.3 cm at the tail of the
pancreas. Tumor feeding arteries originating from the
splenic artery were also delineated using MIP and MPR.
Additional dynamic scanning confirmed the diagnosis of
insulinoma. With syngo Body Perfusion CT, it was possible to
further characterize the lesion. It showed the typical behavior
of a benign tumor with significantly increased flow and
blood volume, but normal permeability. The patient was
referred for tumor resection. Pathological findings confirmed
the CT results.

*syngo Body Perfusion CT is available for SOMATOM Emotion Duo, 6, and 16,
and SOMATOM Sensation scanners with syngo CT 2006 A/G.

20

SOMATOM Sessions 16

EXAMINATION PROTOCOL
Scanner

SOMATOM Sensation 16
Non-contrast
phase

Arterial phase

Dynamic scan

Scan area

From
diaphragm
to iliac crest

From
horizontal
part of
duodenum
to diaphragm

Pancreas
level

Scan length

25 cm

11.52 cm

2.4 cm

Scan time

11.77 s

3.22 s

35 s

Scan direction

cranial-caudal

caudal-cranial

kV

120 kV

120 kV

80 kV

Effective mAs

160 mAs

160 mAs

140 mAs

Rotation time

0.5 s

0.5 s

1.0 s

Slice
collimation

0.75 mm

1.5 mm

1.5 mm

Slice width

1.0 mm

2.0 mm

3.0 mm

Table feed /
rotation

12.0 mm

24.0 mm

0 mm

Reconstruction
increment

0.7 mm

1.0 mm

Kernel

B10f

B20f

H30f

Contrast

omnipaque
(350 mg
iodine / ml)
+saline

omnipaque
(350 mg
iodine / ml)
+saline

Volume

70 ml + 20 ml

50 ml + 20 ml

Flow rate

5 ml / s

5 ml / s

Start delay/
Bolus tracking

5s

5s

Postprocessing

MPR/MIP/VRT

syngo Body
Perfusion CT

CLINICAL OUTCOMES

[ 1A and 1B ]
MPR and MIP
images show the
small endocrine
tumor as a highly
enhanced nodule
(arrow), located
at the tail of the
pancreas, with the
nutritional artery
visible.

[ 2 ] Functional parameter maps calculated in two adjacent 3 mm slices (upper and lower row) using syngo
Body Perfusion CT. The maps show increased blood flow (left, red color) and blood volume (middle, red color), but
normal permeability (right, green color). Note the excellent spatial delineation of this small tumor made possible
by robust modeling of data from thin slices and acquired in only 35 s (one breath hold).

SOMATOM Sessions 16

21

CLINICAL OUTCOMES

SOMATOM
Sensation

SOMATOM
Emotion

SOMATOM
Spirit

Case 4:
Paget Sarcoma Disease in the Tibia
By J. Dinkel, MD, U. Mende, MD, PhD, Department of Radiation Oncology, and J. Debus, MD, PhD, Director,
Department of Radiation Oncology, University of Heidelberg, Germany

HISTORY
An 80 year old female with monostotic Pagets disease of the
right tibia presents with progressive pain and soft tissue
swelling of the right leg. A biopsy was taken that confirmed the
exact pathologic diagnosis of the lesion arising from Pagets
disease and a sarcomatous transformation to osteosarcoma.

Pagets disease of the bone is a common disorder affecting

approximately 34% of the population over 40 years old.
The pathologic abnormality in Pagets disease is excessive
and abnormal remodeling of the bone. Three phases have
classically been described as discrete and distinctive,
although in reality they represent a continuum: the lytic
phase (incipient-active), in which osteoclasts predominate;
the mixed phase (active), in which osteoblasts begin to

appear superimposed on osteoclastic activity and eventually

predominate; and finally, the blastic phase (late-inactive), in
which osteoblastic activity gradually declines.
Monostotic disease (1035% of cases) is more often seen in
the axial view of the skeleton, although any site can be the
sole region of involvement. Polyostotic disease (6590 %) is
more frequent than monostotic disease. The patient presented
here had monostotic disease localized in the right tibia only.
VRT and MPR images of the tibia show the radiological characteristic manifestations of Pagets disease: a diffuse cortical
and trabecular thickening involving the entire bone.
The combination of progressive osteoclastic and osteoblastic
activity leads to the dichotomy of osseous enlargement but
weakening of the bone. Sequelae of this osseous weakening
are the most common complication of Pagets disease. An
anterior bowing of the tibia is seen in the VRT reconstruction.

1A

1B

DIAGNOSIS

[ 1A and 1B ] Osteoblastic tumor mass (arrow) extending

into the soft tissue with infiltration of the skin and skin metastases

22

SOMATOM Sessions 16

CLINICAL OUTCOMES

Disorganized areas are seen in the cortex of the distal tibia.

The fractured fibula was not affected by Pagets disease.
Since the patient refused the recommended surgical treatment, radiation therapy was performed.

COMMENTS
Neoplastic complications of Pagets disease are relatively
rare. Sarcomatous degeneration is estimated to occur in 1%
of patients with longstanding disease. In case of severe
polyostotic disease, the relative risk of sarcomatous transformation is up to 510%.
A Paget sarcoma can have different appearances depending
on the matrix produced (osteolytic, osteoblastic, mixed). In
this case, the CT scan shows the osteoblastic tumor mass
extending into the soft tissue with infiltration of the skin and
skin metastases. Moreover, the CT scan of the popliteal
region reveals nodular mineralizations of metastatic lymph
nodes.
The high isotropic resolution provided by the SOMATOM
Sensation Open with 40 x 0.6 mm slices produced during
each rotation, allows for the detection of small changes after
the radiation therapy. Spiral artifacts e.g. aliasing artifacts
that manifest as streaks emerging from high contrast
objects, and windmill artifacts, are almost completely eliminated with z-Sharp Technology, even at higher pitch values.
In addition, z-Sharp Technology reduces image noise when
the reconstructed slice width is the same thickness as the
collimation.

[ 2 ] Arteriosclerosis of posterior
tibial artery (thin
arrow); diffuse
cortical and trabecular thickening involving the
entire bone with
anterior bowing
(thick arrow)

[ 3 ] Nodular
mineralizations
of metastatic
lymph nodes
(arrow)

EXAMINATION PROTOCOL
Scanner

SOMATOM Sensation Open, 40 slices

Scan area

extremity

Scan length

451 mm

Scan time

41.5 s

Scan direction

cranio-caudal

kV

120 kV

Effective mAs

66 mAs (CARE Dose4D) 90 mAs ref.

Rotation time

1s

Slice collimation

0.6 mm

Slice width

0.6 mm

Pitch

0.9

Reconstruction increment

0.4 mm

CTDI

7.24 mGy

Kernel

B20 / B60

Postprocessing

syngo InSpace

[ 4 ] Disorganized areas
are seen in the
distal cortex
of the distal tibia

SOMATOM Sessions 16

23

CLINICAL OUTCOMES

SOMATOM
Sensation

SOMATOM
Emotion

SOMATOM
Spirit

Case 5:
High Resolution Orthopedics Examination
Ly Thai Bach, MD, Chief of Radiology Unite, & Eric Devilaine, Chief of X-ray Technician Team,
Centre Hospitalier Robert Morlevat, Semur en Auxois, France

HISTORY
A 75 year old woman was referred for a detailed evaluation
of her left ankle because of degenerative arthropathy, which
also entails mechanical pain. She benefited from a local infiltration of anaesthetics some time ago, with good results.
Prior standard x-rays confirmed a subastragalar arthropathy
of the talus (astragalus) and probably also astragalo-scaphoid
and tibio-tarsal. A high resolution CT scan was requested in
order to examine the different injuries of the region.

DIAGNOSIS
Using the high resolution mode of our SOMATOM Emotion 6
with a collimation of 6 x 0.5 millimeter, we were able to view
the degenerative processes in the tibio-astragalus region
with posterior constriction. We identified the presence of
several subchondral geodes-like formations (sphere shaped
structure which contains a hollow cavity), some 17 mm
diameter, mainly visible at the level of the anterior part of the

heel bone, but also at the level of the anterior-inferior part of

the talus and at the level of the anterior part of the extremity distal of the tibia.
Furthermore, calcifications, probably of cartilagenous origin,
were also visible on both sides of the talus in the frontal view,
confirming the evidence of a chondrocalcinosis (deposition
of multiple small calcified islands of bone within the synovium of the joint). Also, edema of the soft tissue around the
ankle at the subcutaneous level could be observed.

COMMENTS
Especially for examinations of bone joints and the inner ear,
we primarily use the high resolution mode in order to detect
smallest details, such as micro calcification. This feature
allows us to provide an improved differential diagnosis compared to normal scan modes.

The SOMATOM
Emotion scanners from the singleslice SOMATOM
Emotion to the
new, 16-slice
SOMATOM Emotion 16 reliably
perform routine
and advanced
applications.

24

SOMATOM Sessions 16

CLINICAL OUTCOMES

EXAMINATION PROTOCOL
Scanner

SOMATOM Emotion 6, high resolution mode

Rotation time

1.0 s

Scan area

extremity

Slice collimation

6 x 0.5 mm

Scan length

80 mm

Slice width

0.6 mm

Scan time

32 s

Table feed / rotation

2.5 mm

Scan direction

craniocaudal

Reconstruction increment

0.3 mm

kV

130 kV

Kernel

U90s

Effective mAs

90 mAs (CARE Dose4D)

[ 1 ] The axial view shows irregular, roughly spherical,

bodies (arrowhead) in the anterior part of the heel bone
as well as the presence of micro calcifications (arrow).

[ 2 ] Sagital view of degenerative processes of the

tibio-astralagus part of the talus (arrows) with posterior
constriction

[ 3 ] The coronal view shows the presence of micro

calcifications, probably of cartilagenous origin (arrowhead), and edema of the soft tissue (arrow).

[ 4 ] VRT of the tibia shows the geodes-like structures of

the anterior part of extremity distal of the tibia (arrow).

SOMATOM Sessions 16

25

CLINICAL OUTCOMES

SOMATOM
Sensation

SOMATOM
Emotion

SOMATOM
Spirit

New Multisclice CT SOMATOM Spirit

The attractive design of the SOMATOM Spirit helps alleviate patients inhibitions.

The SOMATOM Spirit is a subsecond, dual-slice CT scanner

for day-to-day clinical routine.
It is ideally suited for outlying
satellite clinics utilizing teleradiology as well as medical
fields other than radiology,
such as ENT, dental surgeons,
and general practitioners. By
adding CT to their medical services, virtually any practice or
facility can improve the quality
of patient care and increase
patient volume.

Case 6:
Pre-operative Neurosurgical Planning
By Carsten Figge, MD, Radiology Institute/Practice Drs. Mari/Aref/Figge, Bad Zwesten, Germany

HISTORY
A 36 year old female with a suspected tumor was admitted
for neurosurgical evaluation after increasingly frequent
headaches during the last months, anosmia and emotional
labililty. The patient refused to undergo MR scanning due to
high grade claustrophobia. Pre-operative CT scanning was
requested by the neurosurgeons to provide more information of possible tumor proliferation, infiltration into the
sinuses and dislocations of vessels.

DIAGNOSIS UND COMMENTS

The CT scan showed an inhomogeneous frontobasal
enhancing mass, a suspected meningioma of the olfactory
groove due to related symptoms with heterogeneous rim-

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SOMATOM Sessions 16

like enhancement. A peritumoral edema with compression

of the ventricles was also noted. CTA revealed a dislocation
of the arteriae cerebri anteriores and identified the feeding
arteries of the tumor. Additionally, a hyperosteosis in the
lamina cribrossa can be seen. Tumor growth in the sinuses
can be excluded.
In this specific case, having a patient with claustrophobia, the
combination of CTA, MIP and MPR reconstructions allowed
for successful surgical planning. This case demonstrates the
beneficial value of CT scanning as an alternative to MR scanning in the preparation for surgical interventions.

CLINICAL OUTCOMES

[ 1A ] Axial image showing a subfrontal extra-axial

enhancing mass, with compression of the frontal lobes

[ 2 ] CTA of tumor feeding vessels

[ 3 ] Sagital MPR of the tumor

[ 4 ] VRT of the menigeoma

EXAMINATION PROTOCOL
Scanner

SOMATOM Spirit

Pitch

1.8

Scan area

cerebrum

Reconstruction increment

0.6 mm

Scan length

110 mm

Kernel

H21

Scan time

25 s

Scan direction

caudo-cranial

Contrast

Non ionic contrast media

kV

130 kV

Volume

120 ml

Effective mAs

50 mAs

Flow rate

3 ml / s

Rotation time

0.8 s

Start delay

25 s

Slice collimation

2 x 1 mm

Slice width

1.25 mm

Postprocessing

MIP, MPR, VRT

SOMATOM Sessions 16

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SCIENCE

SOMATOM Sensation 64
z-Ultra-High Resolution Mode
By Thomas Flohr, PhD, Head of Physics and Application Development, and Karl Stierstorfer, PhD,
Physics and Application Development, Siemens AG, Medical Solutions, CT Division
A special ultra-high resolution mode, called z-UHR, providing
considerably enhanced spatial resolution, will be introduced
for new SOMATOM Sensation 64 scanners, starting in summer 2005: up to 0.24 millimeter isotropic resolution can
then be achieved in clinical routine. With z-UHR, the
SOMATOM Sensation 64 has reached a level of resolution
previously known only from non-clinical research CT systems using CsI-aSi flat-panel detectors. The combination of
the revolutionary z-Sharp Technology and the unique z-UHR

Detector set-up

X-ray focus

Scanfield

z-axis

Grid

0.35 mm

[ 1 ] Schematic illustration of the detector set-up

used for z-UHR. A moveable tantalum grid is
positioned in front of the detector elements,
reducing their z-aperture to 0.35 millimeter at
iso-center. z-Sharp technology is used to acquire
readings with a z-shift of 0.3 millimeter at isocenter. Two subsequent readings are interleaved
and result in projection data with 0.3 millimeter
z-sampling distance and 0.35 millimeter detector
z-aperture.

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SOMATOM Sessions 16

functionality offers our users, in daily clinical routine, an

isotropic detail in the range of MicroCT technology, says
Alexander Zimmermann, Global Product and Marketing
Manager SOMATOM Sensation.
The new mode is intended for ultra-high resolution boneimaging, in particular for wrists, joints, and inner ear studies.
Pre-requisite for z-UHR ultra-high resolution mode is the
unique z-Sharp Technology enabled by the Siemens proprietary STRATON X-ray tube. A moveable tantalum comb (grid)
is positioned in front of the detector elements, covering the
outer detector rows and effectively reducing the z-aperture
of the inner six detector rows from 0.6 millimeter to 0.35
millimeter at iso-center [Fig. 1]. Without z-Sharp Technology,
collimated 0.35 millimeter slices would be acquired with this
set-up but unfortunately with a sampling distance of 0.6
millimeter and a corresponding dead zone of 0.25 millimeter, so that the slices would not be adjacent in the z-direction
and volume coverage would be incomplete. However,
z-Sharp Technology provides measurement data in these
dead zones as well. Using z-Sharp Technology, rays of subsequent readings are shifted by 0.3 millimeter at iso-center in
the longitudinal (z-) direction. Two subsequent six-slice readings are interleaved and result in one twelve-slice projection
with 0.3 millimeter z-sampling distance and 0.35 millimeter
detector z-aperture without gaps in the longitudinal direction. The data acquired with z-UHR correspond to those
obtained with a conventional detector with 0.3 millimeter
detector elements. The grid covers six adjacent 0.6 millimeter central detector elements, and thus provides the data of
12 x 0.3 millimeter collimated slices with z-UHR. Well defined
slices with 0.4 millimeter slice-width are reconstructed in a
spiral mode. Both in the scan plane and along the z-axis, an
isotropic resolution of 0.24 millimeter (240 micron) is
achieved. This can be demonstrated using the CATPHAN
(The Phantom Laboratories, Salem, NY). Turning the high
resolution insert by 90, the bar patterns become roughly
oriented along the z-direction. Fig. 2 shows an MPR of this
phantom in the longitudinal direction, proving that 21 lp/cm,
corresponding to 0.24 millimeter object size, can be
resolved. Early clinical experience demonstrates that both
inner ear and wrist studies show significantly improved z-axis
resolution with increased clarity of sub-millimeter anatomic
structures [Fig. 3].

SCIENCE

z-axis (mm)
0.24

0.25

0.26

0.27

[ 2 ] MPR of the high resolution insert of

the CATPHAN, demonstrating 0.24 millimeter isotropic resolution with z-UHR
available for the SOMATOM Sensation 64.
[ 3 ] MPR of a wrist fracture acquired
with 0.24 millimeter isotropic resolution.
The image demonstrates a level of resolution previously known only from research
CT systems with flat-panel detectors.
(Image courtesy of Klinikum Grohadern, Munich,
Germany).

SOMATOM Sessions 16

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SCIENCE

Symbia TruePoint SPECTCT

Combining Forces to Improve Patient Care
Single Photon Emission Computed Tomography (SPECT) and Computed
Tomography (CT) come together to revolutionize medical imaging
By Claudette Yasell, Nuclear Medicine Division,
Siemens Medical Solutions, Hoffmann Estates, IL, USA

The 2004 introduction of Symbia with TruePoint SPECTCT

technology definitely created new momentum in medical
imaging. A breakthrough in healthcare and medical imaging,
it provides a new tool to improve workflow efficiency and
accelerate patient diagnoses. Building on the foundation of
Siemens history of innovation and technology, Symbia is the
perfect merger of two equal modalities, single photon emission computed tomography (SPECT) and computed tomography (CT), into one hybrid imager that will make a difference in the way medical imaging is delivered. SPECT imaging
is predominantly used to reveal a patients functional or vital
processes, such as blood circulation and the metabolism and
vitality of organs and tumors. The addition of CT to this imaging technique provides the anatomical map for pinpointing
the exact location of disease in the body, in order match
metabolic or functional information.

A New Concept
Symbias imaging modalities, SPECT, SPECTCT and Multislice
CT, can be used independently or together. Used in combination, TruePoint SPECTCT provides contemporaneously
acquired, coregistered SPECT and diagnostic CT images, an
advance with immediate benefits for oncology and cardiology,
experts say.
Experience from PET/CT tells us that there is an advantage
to having a diagnostic CT along with the nuclear medicine
study to aid in tumor localization and surgical planning, says
Homer Macapinlac, MD, Deputy Chairman, Department of
Nuclear Medicine, M. D. Anderson Cancer Center, who is
planning for the installation of 5 Symbia TruePoint SPECTCT
imagers in 2005. M. D. Anderson Cancer Centers mission is to
eliminate cancer, and our goal specifically in the Division of
Diagnostic Imaging is to provide the best imaging possible to
empower our physicians to help cancer patients, Macapinlac
said, Because the anatomical detail is essential to have in
combination with the functional information, TruePoint

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SOMATOM Sessions 16

SPECTCT is going to help us in the diagnostic interpretation

of clinical exams. Ultimately, the person who benefits from
this new technology will be the patient.
Experts believe that Symbia will also have a profound effect
on cardiac imaging. Im pretty excited, says Edward Ficaro,
Ph.D., an assistant research scientist in the Department of
Radiology at the University of Michigan Health System, the
very first clinical installation of Symbia. Ficaro has spent
more than a decade working to improve the accuracy of
SPECT imaging, from acquisition through physician review.
He works closely with cardiac specialists and expects that
with Symbia, they will be able to register SPECT and CT
images of the heart with increased precision and accuracy.
Registering these images isnt being done routinely because
it's so difficult, says Ficaro. The problem is that the thorax
isn't a rigid structure. So registration is not just a fixed point
rigid transformation, its often an actual morphing of the
body based upon known landmarks. With TruePoint
SPECTCT technology, Symbia enables the examination of
function and perfusion of the right ventricle of the heart,
that, at just 1 to 4 mm thickness, is usually obscured in traditional SPECT studies.

Thinking Ahead
Innovations in technology have been the backbone of
Siemens' success. Innovations such as TruePoint SPECTCT
were facilitated through an integrated team of engineers
and scientists from nuclear medicine and CT working together to create new possibilities in the care of cardiac and cancer
patients.
After the incredible growth of PET/CT, customers and engineers alike began to imagine the possibilities of SPECT and CT
together. Extensive customer surveys led to an initial concept involving basic CT capabilities added to the powerful
SPECT capabilities of the e.cam Signature Series. The success
of PET/CT systems involving high-end CT technology and the

SCIENCE

SPECT and CT imaging come together

in Symbia TruePoint SPECTCT technology.

explosive growth in Multislice CT studies, however, ultimately led the company to design the current line-up of Symbia
scanners, the T, T2 and T6 systems, involving single-, dual-,
or six-slice CT technology drawn directly from Siemens CT
Division.

Designing a Hybrid Success

Having already designed the best in SPECT, the design team
gave Symbia everything the e.cam has to offer, including HD
detectors, and unparalleled image quality and speed in
nuclear imaging. The team decided early-on to avoid the
washer-dryer approach of simply coupling two existing systems with a common patient bed, in favor of a more tightly
integrated design, using as many existing components as
possible.
The goal was to achieve a 200-cm scan range through both
systems fields of view without requiring an impractically
long patient motion range. An excessively long patient
motion range would have made it difficult to site the system
in standard nuclear medicine and radiology rooms.
Minimizing the patient motion range meant minimizing the
distance between the CT and SPECT fields of view. One possible solution, of course, would have been to mount the CT
and SPECT components on the same rotation gantry so that
they shared a field of view. However, the team rejected this
design because the weight of the SPECT heads would have
severely limited the gantry rotation speed and thus the
imaging speed achievable by the CT components. If state-ofthe-art Multislice CT components were to be used, the system needed to be capable of the sub-second gantry rotation
speeds expected in modern Siemens' CT scanners. So the
team opted for maintaining distinct but closely spaced subsystems.

Fusing the two technologies was not simply a matter of

shoehorning the components of two existing systems into a
slightly larger housing. The system is highly integrated,
mechanically and electronically. While striving to make use
of existing components wherever possible, the team often
had to reconfigure and redesign components from each
technology in the interest of meeting their compactness
goals. The SPECT drive system was pushed to the outside,
which allowed the CT components to be brought closer to
the SPECT heads. The CT gantry was essentially redesigned,
allowing the components to be as close as possible. With the
SPECT and CT components tightly integrated, the resulting
system offers many possible modes of operation.

Meeting the Integration Challenge

The push for tight integration extended to the software as
well. The team aimed at keeping the individual user interfaces the same as those employed in the component systems. The software operation of the Symbia TruePoint
SPECTCT system is based on Siemens' exclusive syngo common medical imaging software platform that provides multimodality connectivity using the DICOM standard.
At the heart of the software lies the Flash 3D SPECT image
reconstruction software, based on an iterative maximumlikelihood algorithm that allows for modeling and correction
of data degradations such as attenuation, collimator blurring, and scatter. Obviously, the CT images can be used to
estimate the attenuation experienced by the SPECT photons,
but not directly. CT X-ray sources produce photons with a
broad range of energies, typically centered around 70 keV,
while SPECT radionuclides most commonly emit photons of
140 keV. To convert a CT image into a SPECT attenuation
map, it is necessary first to determine the effective average
energy of the photons contributing to the CT image, and
then to apply appropriate conversion factors to each pixel.
The conversion has to be accurate for all isotopes and SPECT
acquisition parameters. Moreover, the great difference in
resolution between CT and SPECT images must be bridged in
order for the CT images to be registered with SPECT for
attenuation correction.

Securing Clinical Success

To date, the intuitive interfaces of Symbia have been successful in creating workflow efficiencies since the very first
national and international clinical installations were completed. The very first user, University of Michigan Health System, in Ann Arbor, MI, completed installation prior to the
2004 RSNA and the very first clinical images from Symbia
with TruePoint SPECTCT were presented there. The Symbia

SOMATOM Sessions 16

31

SCIENCE

with TruePoint SPECTCT technology will allow us to take

nuclear cardiac imaging to the next level. We expect that
within the next year, well be doing 80 to 90 percent of our
cardiac studies on these systems, said James Corbett, MD,
professor of Radiology and Internal Medicine, Director of
Cardiovascular Nuclear Medicine, UMMC. As we integrate
this new system into our clinical practice, we expect diagnostic accuracy to be improved significantly, as the amount
of information gathered will be considerably increased. This
should make the Nuclear Medicine SPECT images more accurate, and the information from the spatially registered CT
scan will provide additional correlative data. We expect this
will prove to be important for patient care and significantly
enhance the diagnostic and prognostic value to the combined imaging procedure, compared to conventional SPECT
imaging alone.The University of Erlangen in Germany was
recently the first European recipient of Symbia. Professor

Torsten Kuwert, MD, Chairman of the Department of Nuclear

Medicine is confident that the addition of this hybrid imager
will ultimately achieve the same success as PET/CT. By combining SPECT and CT, it is possible to combine high biochemical resolution with high anatomical resolution to really localize neoplastic lesions, which should be expected to add to
the quality of diagnosis. Hybrid PET/CT systems have already
proven the diagnostic benefit, and most believe its not too
much of a stretch to expect the same from SPECTCT.
Siemens expects the Symbia hybrid imaging system to
appeal to a number of different medical specialists, including
radiologists, cardiologists and, of course, nuclear medicine
specialists. Fittingly for a system born of cooperation and
integration, it may actually realize its full potential when
used in concert across departmental lines, with interpretation of the diagnostic-quality CT scans and SPECT data ultimately improving patient care.

Case Study
Myocardial Perfusion
Using TruePoint SPECTCT
By James Corbett, MD, Professor of Radiology and
Internal Medicine, Director of Cardiovascular Nuclear
Medicine, University of Michigan, Ann Arbor, MI, USA

HISTORY

Images show an apical and

anterior defect thats mostly
reversible and an inferior
and inferior-septal defect
that is significantly reversible.
CT attenuated corrected
(AC) images show greater
reversibility of inferior defect
than uncorrected images.
Also noted is post-stress LV
dilatation.

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SOMATOM Sessions 16

An 82 year old male, 77 kg (169.2 lbs), with known coronary

artery disease, poorly controlled hypertension, insomnia and
other problems, came in for a routine follow-up after experiencing minor bouts of chest pain. His resting EKG was abnormal. During exercise, he experienced greater than 1 to 2 mm
ST depression, but did not experience chest pain at that time.

DIAGNOSIS
A TruePoint SPECTCT study was performed with the Symbia
hybrid imager using standard SPECT protocol in combination
with a 6-slice CT scan. The SPECT portion of the examination
revealed an apical and anterior defect that is mostly
reversible and an inferior and inferior-septal defect that is
significantly reversible. The scan also detected post-stress
LV dilatation.

SCIENCE

Archaeology
High-tech Meets History
Siemens Computed Tomography (CT) scanners help unravel the past:
In January 2005, the ancient Egyptian mummy Tutankhamen was examined
by an Egyptian team utilizing a SOMATOM Emotion 6 to explore how old
he was at death, if he had suffered from any diseases, what he died of, and to
determine the condition of the mummy itself. The following results were
announced in Cairo in March 2005.
Was King Tutankhamen killed? Zahi Hawass, PhD, Secretary
General of Egypts Supreme Council of Antiquities, stated
that there is no evidence that the young king was actually
murdered. This murder theory is based upon an X-ray examination of the pharaohs head in 1968 which revealed a
cloudy area at the back of the skull. The projects scientists
have now agreed that there is no evidence of murder. There
is nothing that indicates a blow to the rear of the skull. There
are two bone fragments loose in the skull, but these cannot
possibly have been from an injury causing death they
would have become stuck in the embalming resin. The scientists have matched these pieces to the fractured cervical
vertebra and foramen magnum, and believe these were broken either during the embalming process or in 1925 by the
mummys discoverers, who were trying to get access to the
gold artifacts wrapped with the mummy.

Careful Mummification
Based on the identification of at least five different types of
resin and the many episodes of its introduction to the body
and cranial cavity, the scientists concluded that great care
was taken in the mummification of the pharaoh. This counters previous arguments that the body was prepared hurriedly and carelessly, perhaps to cover up a crime. However,
the remains of Tutankhamen are in very poor shape, primarily
due to the damage done by the Howard Carter team that discovered the tomb in 1922. The body is in several pieces.
Bones and skin are broken in numerous places. The kings
arms, originally folded across his chest, are now by his sides.
Many parts are missing, although fragments remain loose in
the sand tray where the mummy is resting.
The scientists noted a fracture of the left lower femur, at the
level of the epiphyseal plate. This fracture appears different
from the breaks caused by Carters team: it has ragged

[ 1 ] One of Tutankhamens
wisdom teeth is still impacted.
[ 2 ] The king had a small cleft
in his hard palate.
[ 3 ] Whole body of pharaoh
Tutankhamen
Clinical images courtesy of Supreme
Council of Antiquities

edges, and there are two layers of resin inside. Some scientists believe that the resin indicates that this can only have
occurred during Tutankhamens life or the embalming process. They note that this type of fracture, unlike many others,
is possible in young men. There is no obvious evidence of
healing, but such indications may be masked by the resin.
Since the associated skin wound would still have been open,
this fracture would have had to occur shortly before death.
Carters team had noted that the patella on his left leg was

SOMATOM Sessions 16

33

SCIENCE

[ 4 ] Zahi Hawass, PhD, Secretary General of the

Supreme Council of Antiquities, takes a close look at
the mummy of Tutankhamen.
Photo courtesy of Brando Quilici

loose, possibly suggesting further damage to his body. Now

the patella is completely separated, and has been wrapped
with the left hand. Scientists also noted a fracture of the
right patella and right lower leg. Based on this evidence, they
suggested the king may have suffered an accident in which
he broke his leg, leaving an open wound. Although the break
itself would not have been life-threatening, infection could
have set in. However, it is also possible, although less likely,
that this fracture was caused by the embalmers. Other scientists maintain that the fracture can only have been inflicted by Carters team during extraction of the body from the
coffin. They argue that if such a fracture had been suffered in
life, there would have been evidence of hemorrhage or
hematoma in the CT scan. They believe the resin was pushed
into the fracture by Carters team.
The examination confirmed that Tutankhamen had died at
about the age of 19. The fusion of the epiphyseal plates
matches the development of a young man of 18 or more,
and 20 or less. The wisdom teeth are not completely grown.
One of them [Fig. 1] is impacted, and there is a slight thinning of the sinus cavity above. The king had a small cleft in
his hard palate [Fig. 2], not associated with an external
expression such as a hare-lip. His lower teeth were slightly
misaligned. He had large front incisors and the overbite characteristic of other kings from his family. Tutankhamen had a
dolichocephalic skull. As the cranial sutures are not prematurely fused, this is most likely a normal anthropological variation rather than any pathology. There is a slight bend in his
spine; the scientists agreed that this is not scoliosis, since
there is no rotation and no associated deformation of the
vertebrae. The bend thus most likely reflects the way the
mummy was positioned by the embalmers.
The sternum and a large percentage of the front ribs of the
mummy are missing. Their ends appear to have been cleanly
cut by a sharp instrument. The scientists agree that this cannot mirror extensive trauma to the chest, as such trauma
would have left marks elsewhere in the body. Opinion is

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SOMATOM Sessions 16

divided as to whether the ribs and sternum had been

removed by the embalmers or by Carters team. Archaeological
investigation will continue in an attempt to resolve this issue.
Tutankhamen was approximately 170 centimeters tall [Fig. 4],
as extrapolated from the measurement of the tibia. Judging
from his bones, which indicate a slight build, he had been
well-fed and healthy, and had not suffered major childhood
malnutrition or infectious diseases. His internal organs, as is
usual for Egyptian mummies, are not present in the body,
and thus could not be analyzed.
The Egyptian scientific team, headed by Dr. Hawass, consisted
of radiologists, pathologists, and anatomists from the Faculty
of Medicine at Cairo University. The team later invited three
foreign consultants to work with them.
The examination was part of a research project being conducted by Egypts Supreme Council of Antiquities. The project
also includes meticulous CT scans of a large number of other
Egyptian mummies. To support the project, Siemens Medical
Solutions and the National Geographic Society have provided
a SOMATOM Emotion 6 installed in a trailer making it transportable to wherever it is needed. With this device, the fragile
remains of Egypts ancient people can be studied with a minimum of movement and disturbance with the ultimate view
of prolonging preservation.
k Further Information:
www.ngs.org; www.guardians.net/hawass/

The Great Art Detective

Using CT for ancient relics is not only restricted to
human remains. At RSNA 2004, a group of Belgian
scientists led by Marc Ghysels, MD, illustrated the
spectrum of CT findings in wooden, ivory, pottery and
stone sculptures. Using a SOMATOM Volume Zoom,
these experts are able to disclose manufacturing techniques, natural damage, repairs, restoration and
fakes. When a collector is interested in an art work,
one of his primary concerns is to establish its authenticity. This is based on both subjective factors and
scientific analysis such as stylistic analysis, thermoluminescence or carbon-14 analysis, dendrochronological study, spectroscopic or microscopic analysis etc.
Unlike these tests, which focus mainly on the visible
parts of the work or on a few samples, CT has the
advantage of describing the inner state of the object,
without damaging it in any way.

CUSTOMER CARE

L i f e : E D U C AT E

A Win-Win Situation
With the SOMATOM Sensation Cardiac 64 taking cardiac CT to the next level,
the need for dedicated customer training increases. Siemens Medical Solutions
supports its customers, providing firsthand know-how, and the possibility to
exchange experience with well-versed medical colleagues.
Siemens Life customer care solutions
offer an array of measures to customers
to get the most value out of their
systems by maximizing their clinical
know-how. In addition to a full range of
continuous learning programs from
extensive start-up and technical training
to applications support and web-based
courses customers can attend workshops, fellowships, and symposiums
held in close cooperation with
renowned clinical partners.
Workshops on cardiac computed
tomography (CT) are being held at
Erasmus Medical Center, Rotterdam, The
Netherlands; Friedrich-Alexander University Clinic, Erlangen, Germany; University Hospital Muenster, Germany and
other distinguished institutions. In
co-operation with Siemens, these partners offer regular courses for both
radiologists and cardiologists, combining lectures and hands-on training on
the SOMATOM Sensation Cardiac 64.
Participants have the chance to observe
patient exams, attend lectures and participate in case studies review sessions.
Some physicians just starting with
cardiac CT and with no experience in
radiology, appreciate an even deeper
insight. Frans Santosa, MD, from the
cardiovascular Waringin Medika clinic in
Jakarta, Indonesia, is a German-trained
internist, cardiologist and angiologist,
who was not very familiar with radiology. However, he saw the advantages
of cardiac CT and purchased two

Frans Santosa, MD (2nd from right):

Thanks to Siemens Life Program,
Ive been able to optimally utilize
my new SOMATOM Sensation
Cardiac 64 right from installation.

Stefan Martinoff, MD: "Not only do

our guests profit from us, we also
profit from them. It is a win-win
situation."

SOMATOM Sensation Cardiac 64s in late

2004, one for his clinic, one for a private
practice he started with some colleagues. Just before installation, he
spent quite some time at the FriedrichAlexander University Clinic in a fellowship program. I really appreciate the
chance to learn from my experienced
German colleagues. Everyone has been
very generous sharing their knowledge,
and I now see even more clinical capabilities of the SOMATOM Sensation Cardiac
64 than I thought before, he resumes.
Not only do the trainees profit from the
fellowship program, but the hosting
clinics as well. Says Stefan Martinoff,
MD, Director of the Clinic for Radiology
and Nuclear Medicine at the German
Heart Center in Munich (DHM), We

have made some excellent international

connections during the past years. We
are very proud of our worldwide network of physicians and scientists. Our
joint objective is to steadily increase the
quality of medical care.
Radiologists and cardiologists at the
DHM diagnose CT images together.
Coronary CT is at its best and optimal
patient care is ensured only when both
specialties sit together at the same
table, emphasizes Martinoff. A physician can not be both a radiologist and a
highly trained cardiologist at the same
time, he offers with conviction. This is
why cooperation is a must, although it is
not practiced everywhere due to frequent competition between the two
specialties.

SOMATOM Sessions 16

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CUSTOMER CARE

EDUCATION

E D U C AT E

Cross-country Postprocessing Events

Following last years success, Siemens
Medical Solutions again supported
hands-on training sessions at Professor
Elliot Fishmans popular Advanced Topics in Computed Tomography (CT) Scanning CME accredited courses in Los Angeles (April 13rd, 2005) and Baltimore
(April 810th, 2005). Over 300 radiologists and technologists took advantage
of the opportunity to learn more about
the principles of 3D and virtual imaging
with syngo InSpace4D, CT-Angiography,
cardiac CT, virtual colonography and
lung imaging. Siemens provided 20
LEONARDO workplaces enabling participants to work individually during each
of the clinical hands-on sessions. Sessions, lead by both experienced Hopkins
faculty and Siemens applications spe-

Both, the courses at Advanced Topics in CT Scanning (left), and the Hands-on
Workshop CT-Colonography at ESGAR (right), were met with enthusiasm.
cialists, gave attendees the opportunity
to work through a wealth of specially
selected clinical cases. Everyone walked
away with a firm grasp of the principles
and clinical application of 3D and virtual
post-processing techniques.
ESGARs 3rd CME accredited Hands-on
Workshop, CT-Colonography (April 26
28th, 2005) was hosted by Phillipe Lefere, MD, and Stefaan Gryspeerdt, MD,
from Stedelijk Ziekenhuis, Roeselare, Belgium. Places were limited to 40 for each
of the two concurrent workshops, and a
total of 80 radiologists joined the invited
faculty in the beautiful ancient city of
Bruges, Belgium, for a packed two day
program. The first day of each workshop
was comprehensive with lectures and
hands-on demos on the essentials of CT-

Colonography (CTC) from leading CTC

experts including Johannes Wessling,
MD, (Munster, Germany) and Andrea
Laghi, MD, (Rome, Italy). Day two was
dedicated to tutored hands-on sessions
with faculty members present to guide
the participants through over 100 specially selected cases. Siemens Medical
Solutions supported the workshop with
six LEONARDO workplaces running syngo
Colonography software. The workshop
ideally balanced between lectures and
plenty of time for hands-on training. Having a clinical expert guiding us through
the more challenging test cases was very
helpful. I came away with useful tips that
will certainly enhance my CTC workflow,
says Christian Lauer, MD, O.L.V.V. Lourdes-Ziekenhuis, Belgium.

T E C H N O LO G I S T E D U C AT I O N S Y M P O S I U M

CT Imaging and Cherry Blossoms

During the LEONARDO hands-on

session, participants worked with
the latest applications.

36

SOMATOM Sessions 16

Many customers took advantage of the

outstanding possibility to benefit from
the integrated approach across modalities that Siemens offers for radiology, cardiology, and oncology solutions. This
year's Technologist Education Symposium took place in Washington DC, USA
from April 17th to 19th and offered
sessions related to cardiac and vascular
angiography,
diagnostic
radiology,
computed tomography (CT), magnetic
resonance (MR), nuclear medicine/PET,
oncology, and ultrasound, including
various lectures and hands-on training.
Once again this was a successful event
for everyone who came to learn about
clinical routine and topics encompassing
the cutting edge of medical imaging
technology. The first day, all participants
met for a for a general preview of the

educational symposium, reviewing case

studies and overall topics concerning
the different healthcare sectors. The
evening ended with a welcome reception. During the following two days, all
participants had the chance to attend lectures for cardiac & vascular angiography,
diagnostic radiology, CT, MR, or breakout
sessions, according to their own fields of
interest. For CT, there were speakers from
Siemens as well as from well known institutions, like Andy Trovinger from Radiology Imaging Associates and Williams
Jonathan, MD, from Shands Jacksonville.
Several companies exhibited their filming
products, injector systems and MRI accessories. But even with such an exciting
program, all participants still had enough
time to enjoy Washingtons cherry blossoms and socialize at the dinner buffet.

CUSTOMER CARE

7 T H I N T E R N AT I O N A L S O M AT O M C T U S E R C O N F E R E N C E

Exploring the Riches of Multislice CT

High-end clinical applications were at
the center of the 7th International
SOMATOM Computed Tomography (CT)
User Conference, held in conjunction
with the University Hospital La Sapienza,
in Rome, Italy, in May 2005.
The Eternal City alone, with its impressive art and architecture, the Forum and
Coliseum, the baroque churches and
the Vatican, would have been enough
to fill everybodys senses. But there
have been remarkable achievements in
CT technology and applications since
the last Siemens User Conference in
2002, and all participants were eagerly
awaiting the latest information from
research groups from around the world.
Renowned speakers presented a wealth

of outstanding clinical results in the various fields of CT imaging. The 17th century Teatro Capranica provided beautiful
surroundings for 60 luminary speakers,
lecturing on topics such as Technology
Principles of Multislice CT, Head and
Neck, Chest, Cardiac, Abdominal,
and Vascular CT, and New Frontiers in
CT. The lectures were supplemented by
panel discussions, case demonstrations,
hands-on workstation sessions, and a
poster exhibition.
Professor Roberto Passariello, MD, head
of the Department of Radiologic Sciences,
was chairman of the conference, supported by Carlo Catalano, MD, Associate
Professor at the same department (both
University Hospital La Sapienza, Rome,

The more than 150 participants also

enjoyed the view over Romes ancient
roofs at an exclusive social event.

Italy). Professor Elliot Fishman, MD, Johns

Hopkins Hospital, Baltimore, MD. USA,
and Professor Yutaka Imai, MD, Tokai
University, Tokyo, Japan, were co-chairmen. A CD of the conference will be
available soon.

SERVICE

Frequently Asked Questions

Via the SOMATOM World User Lounges, Siemens applications specialists answer your questions on how to easily
use Siemens Computed Tomography scanners and applications in daily clinical practice. Additionally, SOMATOM Sessions
offers a regular column with frequently asked questions for
offline reference.
Why cant I remove patient protection to delete studies
from the browser?
Reload the study back into the exam card, check for open
recon jobs and delete the open recon jobs, if present. Take
note of the position of the chronicle bars: if any are indented,
patient protection is applied. Once the chronicle bars are all
to the left, the study is no longer protected.
Patient information is incorrect. Can I change it after
scanning is completed?
After reconstructions are complete, select the patient in the
browser. Be sure that the study is not open in any platform,
no open recon jobs exist and the study is not delete protected.

On the browser drop down menu, select Edit and Correct.

A warning box will appear that this is an external document;
select Continue. The correct platform will then open. The
major topics are on the left side of the vertical tabs and the
right side has the details for each section. Make the necessary changes and sign off with your initials (minimum of
3 letters) in the upper right hand corner of the platform and
then click OK in the bottom left corner.
Why are the images that I sent to filming in reverse order?
The order of the images depends on the configuration of
your browser. The sort functions on the browser vary with
each level of the patient study. The selections for the patients
name are alphabetical, chronological, work status or reverse
order. On the series level, multiple and modality specific
selections are also available. Simply select the local database
heading and sort for DB Date and Time, for the study level
select Study Date and Time, and the series level should be
set to Instance Number. Also make sure to deselect any level
with reverse order activated.

SOMATOM Sessions 16

37

CUSTOMER CARE

C T ONLINE

S I E M E N S R E M OTE S E RVI C E

CT on the
World Wide Web

Information and Services Available

Directly at Your CT Scanner

k www.insideinspace.com
Inside InSpace introduces technicians
and physicians to syngo InSpace, the
volume imaging application for interactive display of volume datasets from
Computed Tomography and 3D Angiography. The website offers complete
information on all software features
and specifications. Hints and tips, plus
an 'Ask the Experts' button support
users in getting the most out of syngo
InSpace4D in their daily clinical work. A
selection of feature articles and lectures
is available for reference. The latest
syngo InSpace4D presets are offered for
download. A video and image gallery
introduces interesting cases. The information is supplemented by CME course
dates for syngo InSpace.

Working efficiently in a radiology department becomes more and more dependent

on information. How about finding the latest application guide online? Or easily
receiving information about new software that might simplify daily workflow? Or trying new applications before purchasing? This and much more is possible with
SOMATOM LifeNet, the information
and service portal available free of
charge directly at your Computed
Tomography (CT) scanner consoles.
As a Siemens customer, you can even
download the latest scan protocols to
make sure they are always up to date.
To find out how SOMATOM LifeNet
can help you with your daily work,
simply go to SOMATOM LifeNet under
Options in your syngo menu bar. The
only prerequisite is Siemens Remote
LifeNet offeres easy access to the
Service, a feature provided at no addilatest information directly at the
tional cost in the Siemens service
CT scanner console.
agreement.

Upcoming Events & Courses

Title

Location

Short Description

Date

Contact

6th International
Conference on
Cardiac CT

Boston, USA

International Meeting

July 2123, 2005

cme.med.harvard.edu

ESC

Stockholm,
Sweden

European Society of
Cardiology Congress

Sept. 37, 2005

www.escardio.org

ASTRO

Denver, USA

American Society for

Therapeutic Radiology and
Oncology Congress

Oct. 1620, 2005

www.astro.org

TCT

Washington, USA

Transcatheter Cardiovascular
Therapeutics Sympoisium

Oct. 1721, 2005

www.tct2005.com

ESTRO

Paris, France

European Society for

Therapeutic Radiology and
Oncology Congress

Oct. 30Nov. 3, 2005

www.estroweb.org

AHA

Dallas, USA

American Heart Association

Scientific Sessions

Nov. 1316, 2005

www.americanheart.org
www.scientificsessions.org

RSNA

Chicago, USA

Radiological Society of
North America Congress

Nov. 27Dec. 2, 2005

www.rsna.org

CME Courses

Johns Hopkins University, Focus on multislice CT

University, Baltimore, USA; scanning and
and other US locations
post-processing

Regular events,
please see website

www.CTisus.com

In addition, you can always find the latest CT courses offered by Siemens Medical Solutions at www.siemens.com/SOMATOMEducate.

38

SOMATOM Sessions 16

CUSTOMER CARE

SOMATOM SESSIONS IMPRINT

2005 by Siemens AG, Berlin and Munich, All rights reserved

Publisher
Siemens AG
Medical Solutions
Computed Tomography Division
Siemensstrae 1
D-91301 Forchheim
Responsible for Contents:
Bernd Ohnesorge, PhD
Editors
Doris Pischitz, M.A.
(doris.pischitz@siemens.com)
Stefan Wuensch, PhD
(stefan.wuensch@siemens.com)
Editorial Board
Jessica Amberg
Joachim Buck, PhD
Thomas Flohr, PhD
Chad DeGraaff
Andr Hartung
Sandra Jeleazcov
Matthew Manuel
Louise McKenna, PhD
Axel Lorz
Jens Scharnagl
Authors of this Issue
Geoffrey Browne, MD,
Alamance Regional Medical Center,
Burlington, USA
Chris DeAngelo RT (R), (CT),
Alamance Regional Medical Center,
Burlington, USA
J. Debus, MD, PhD,
Department of Radiation Oncology,
University of Heidelberg, Germany

Eric Devilaine, Chief of X-ray Technician Team,

Centre Hospitalier Robert Morlevat,
Semur en Auxois, France
J. Dinkel, MD,
Department of Radiation Oncology,
University of Heidelberg, Germany
Carsten Figge, MD,
Radiology Institute/Practice Drs. Mari/Aref/Figge,
Bad Zwesten, Germany
V. Lambert, MD,
Department of Cardiopediatry,
Marie Lannelongue Hospital,
Le Plessis-Robinson, France
U. Mende, MD, PhD,
Department of Radiation Oncology,
University of Heidelberg, Germany
Jean-Franois Paul, MD,
Department of Radiology,
Marie Lannelongue Hospital,
Le Plessis-Robinson, France
Jin Zheng Yu, MD,
Department of Radiology,
Peking Union Medical College Hospital,
Beijing, China

Xue Hua Dan, MD,

Department of Radiology
Peking Union Medical College Hospital,
Beijing, China
Tony De Lisa, freelance writer
Jessica Amberg; Chad DeGraaff; Thomas Flohr,
PhD; Lars Hofmann, MD; Louise McKenna, PhD;
Per Anselm Mahr; Bernd Ohnesorge, PhD; Rainer
Raupach, PhD; Gitta Schulz; Karl Stierstorfer, PhD;
Heiko Tuttas; Claudette Yasell; all Siemens Medical
Solutions

Production
Norbert Moser, Siemens Medical Solutions
Layout
independent Medien-Design
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Printers
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Printed in Germany
SOMATOM Sessions is also available on the
internet: www.siemens.com/SOMATOMWorld

Anne Sigal-Cinqualbre MD,

Department of Radiology,
Marie Lannelongue Hospital,
Le Plessis-Robinson, France
Ly Thai Bach, MD, Chief of Radiology Unite,
Centre Hospitalier Robert Morlevat,
Semur en Auxois, France

Note in accordance with 33 Para.1 of the German Federal Data Protection

Law: Despatch is made using an address file which is maintained with the
aid of an automated data processing system.
SOMATOM Sessions with a total circulation of 35,000 copies is sent free of
charge to Siemens Computed Tomography customers, qualified physicians
and radiology departments throughout the world. It includes reports in the
English language on Computed Tomography: diagnostic and therapeutic
methods and their application as well as results and experience gained with
corresponding systems and solutions. It introduces from case to case new
principles and procedures and discusses their clinical potential.
The statements and views of the authors in the individual contributions do
not necessarily reflect the opinion of the publisher.
The information presented in these articles and case reports is for illustration only and is not intended to be relied upon by the reader for instruction
as to the practice of medicine. Any health care practitioner reading this
information is reminded that they must use their own learning, training and
expertise in dealing with their individual patients. This material does not
substitute for that duty and is not intended by Siemens Medical Solutions to
be used for any purpose in that regard. The drugs and doses mentioned
herein are consistent with the approval labeling for uses and/or indications

of the drug. The treating physician bears the sole responsibility for the diagnosis and treatment of patients, including drugs and doses prescribed in
connection with such use. The Operating Instructions must always be strictly
followed when operating the CT System. The sources for the technical data
are the corresponding data sheets. Results may vary.
Partial reproduction in printed form of individual contributions is permitted,
provided the customary bibliographical data such as author's name and title
of the contribution as well as year, issue number and pages of SOMATOM
Sessions are named, but the editors request that two copies be sent to
them. The written consent of the authors and publisher is required for the
complete reprinting of an article.
We welcome your questions and comments about the editorial content of
SOMATOM Sessions. Manuscripts as well as suggestions, proposals and
information are always welcome; they are carefully examined and submitted
to the editorial board for attention. SOMATOM Sessions is not responsible
for loss, damage, or any other injury to unsolicited manuscripts or other
materials. We reserve the right to edit for clarity, accuracy, and space.
Include your name, address, and phone number and send to the editors,
address above.

SOMATOM Sessions 16

39

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No. 16/June 2005

Stanford Universitys
7th Annual International
Symposium on
Multidetector-Row CT
June 15-18, 2005

www.siemens.com/medical

Highlights

SOMATOM
Sessions
Picture

COVER STORY
Think Clinical!
Page 4
NEWS
SOMATOM Sensation
40-Slice Technology
Page 12
BUINESS
SOMATOM Spirit And it
runs, and runs, and runs...
Page 15
CLINICAL OUTCOMES
syngo Body Perfusion CT
Differential Diagnosis of a
Pancreas
Page 20
SOMATOM Emotion 6
High Resolution Orthopedics
Examination
Page 24
SCIENCE
Archaeology High-tech
Meets History
Page 33
CUSTOMER CARE
LIFE Educate
A Win-Win Situation
Page 35

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SOMATOM Sessions
Issue No.16/June 2005

On account of certain regional limitations of sales

rights and service availability, we cannot guarantee
that all products included in this brochure are
available through the Siemens sales organization
worldwide. Availability and packaging may vary
by country and is subject to change without prior
notice. Some/All of the features and products
described herein may not be available in the
United States.
The information in this document contains general
technical descriptions of specifications and options
as well as standard and optional features which do not
always have to be present in individual cases.
Siemens reserves the right to modify the design, packaging, specifications and options described
herein without prior notice. Please contact your local
Siemens sales representative for the most current
information.
Note: Any technical data contained in this document
may vary within defined tolerances. Original images
always lose a certain amount of detail when
reproduced.
Please find fitting accessories:
www.siemens.com/medical-accessories

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Computed Tomography
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06.2005 Siemens SOMATOM Sessions

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