State-of-the-Art Technology in Cardiac CT

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CT 2s 1s 0.75s Rotation Time CT in 2000 Multislice CT 4 16 64 Slice-Number? Body Regions Time 3 4 Technical Progress of MSCT From Slices to Applications Moore s Law Valid for CT? 1.5 Doubling of Slices/Rotation every 2.

1 1 2 Next Step Evolution or Revolution? State-of-the-Art Technology in Cardiac CT Stefan Ulzheimer, PhD Global Director of Collaborations CT Siemens Medical Solutions Major Innovations in CT Head The 80 s Axial CT Lung Body The 90 s Spiral CT 2s 1s 0.75s Rotation Time CT in 2000 Multislice CT Slice-Number? Body Regions Time 3 4 Technical Progress of MSCT From Slices to Applications Moore s Law Valid for CT? 1.5 Doubling of Slices/Rotation every 2.5 Years Diagnostic Oncology Neuro Cardio- Vascular Acute Care syngo 5 6 Our Vision for the Future of CT Sensation 64-slice config. with z-sharp 9 sec for 479 mm 64 x 0.6 mm Resolution < 0.4 mm 200 effective mas Make CT the first imaging test in management of CAD patients Establish CT as the first line test choice in acute care Exploring ways to add new contrasts to CT

Energy Beyond Visualization with Dual Energy Full Cardiac Detail at Half the Dose Full Cardiac Detail at Half the Dose Already 14 Installations in Leading Institutions 9 150 installations by the end

2 7 8 More and More Slices? The World s First Faster than Every Beating Heart Faster than Every Beating Heart One-Stop Diagnosis in Acute Care One-Stop Diagnosis in Acute Care Beyond Visualization with Dual Energy Beyond Visualization with Dual Energy Full Cardiac Detail at Half the Dose Full Cardiac Detail at Half the Dose Already 14 Installations in Leading Institutions installations by the end of the year 10 William Beaumont Hospital UCLA Mayo Clinic Rochester NYU Medical Center Cleveland Clinic Foundation University of Aachen University of Tübingen University of Münster University of Zurich Erasmus MC Rotterdam University Medical Center Groningen - University of Munich, Grosshadern University of Erlangen Nagoya City University Hospital June 2006 Scientific Evaluation Thomas Flohr, Phd. First performance evaluation of a Dualsource CT system 11 Excellence in CT 12 Stephan Achenbach, M.D. Contrast-enhanced coronary artery visualization by dual-source CT Thorsten Johnson, M.D. DSCT cardiac imaging, initial experience The idea behind is as simple as ingenious. It uses two X-ray sources and two detectors at the same time.

3 seconds rotation speed of 1.6 tons Faster than Every Beating Heart The World s first DSCT 15 Temporal resolution of maximum 165 ms 16 Technical challenge with high heart rates 100 bpm 60 bpm Temporal Resolution = Rotation Time 2 = 165 ms 17 with Multisegment Recon. Software attempt to increase temporal resolution 1 18 Heart rate independent temp. resolution of 83 ms 2 Coronary arteries change position between beats = limited image quality Temporal Resolution = (2 Segment Recon) varies between = 83 and 165 ms Temporal Resolution = Rotation Time 4 = 83 ms 3

rates 100 bpm 60 bpm Temporal Resolution = Rotation Time 2 = 165 ms 17 with Multisegment Recon.

19 20 Reliable imaging of all heart rates 100 bpm 60 bpm Accurate visualization of valve motion, enabling exact surgery planning of valve replacement 8 sec for 150 mm HR 65 bpm 21 Excellent

7 sec for 140 mm 380 ma/rot HR 72 bpm End Systolic 5 sec for 103 mm 400 mas/rot HR 73 bpm End Diastolic Courtesy of Erasmus MC - University Medical Center Rotterdam / Rotterdam, the Netherlands

4 19 20 Reliable imaging of all heart rates 100 bpm 60 bpm Accurate visualization of valve motion, enabling exact surgery planning of valve replacement 8 sec for 150 mm HR 65 bpm 21 Excellent visualization in both, end systolic and end diastolic phase. 22 Precise RCA and LAD in-stent visualization with dramatically reduced blooming and without any motion artifacts. 7 sec for 140 mm 380 ma/rot HR 72 bpm End Systolic 5 sec for 103 mm 400 mas/rot HR 73 bpm End Diastolic Courtesy of Erasmus MC - University Medical Center Rotterdam / Rotterdam, the Netherlands Courtesy of Friedrich-Alexander University Erlangen-Nuermberg - Institute of Medical Physics / Erlangen, Germany 23 Excellent image quality of arrhythmic, lima bypass patient with a rapidly changing heart rate between 48 and 90 bpm At higher or varying heart rates, the diastolic phase is too short for a single source CT scanner, resulting in poor image quality. DSCT delivers sharp and detailed cardiac images even at high HR sec for 137 mm HR bpm 43% End-Systolic HR 101 bpm 90 Courtesy of Friedrich-Alexander University Erlangen-Nuermberg - Institute of Medical Physics / Erlangen, Germany Courtesy of The CT Clinical Innovation Center, Mayo Clinic / Rochester USA 4

67% End-Disatolic HR 101 bpm 6 sec for 125 mm HR 122 bpm Courtesy of The CT Clinical Innovation Center, Mayo Clinic / Rochester USA Courtesy of University Hospital of Munich - Grosshadern / Munich,

5 25 26 At higher or varying heart rates, the diastolic phase is too short for a single source CT scanner, resulting in poor image quality. DSCT delivers sharp and detailed cardiac images even at high HR. Despite high heart rate of 122 bmp, motion free visualization of all coronary arteries and accurate display of right atrium dilatation. 67% End-Disatolic HR 101 bpm 6 sec for 125 mm HR 122 bpm Courtesy of The CT Clinical Innovation Center, Mayo Clinic / Rochester USA Courtesy of University Hospital of Munich - Grosshadern / Munich, Germany Scan of a 4 month old baby with high heart rate of 144 bpm and blandwhite-garland-syndroma shows excellent, motion free visualization of anastomoses of LAD to aorta. 5 sec for 109 mm 120 mas/rot HR 144 bpm Full Cardiac The World s first DSCT Detail at Half the Dose * compared with today's most doseefficient single x-ray tube CT scanners at heart rates above 75 bpm Step 1: images the heart 2 x fast, reducing the pulsing window by more than 1/2 Step 2: maintains slow acquisition even with higher heart rates 60 bpm single source CT 100 bpm single source CT Slow Acquisition Speed Slow Acquisition Speed

6 31 Step 2: increases the table speed and reduces the exposure at higher heart rates 60 bpm 100 bpm 32 Full Cardiac Detail at Half the Dose = 1/2 x Dose 100% * compared with today's most doseefficient single x-ray tube CT scanners at heart rates above 75 bpm Single Source without ECG Pulsing with ECG Pulsing 50% x Relative Dose Normal Acquisition Speed x Fast Acquisition Speed x with Pitch Adaptation and Adaptive ECG Pulsing Heart rate in bpm Source: Cynthia McCollough PhD, Mayo Clinic Rochester, USA RSNA 2005 talk: SSE16-06 / Physics (CT: Cardiac Imaging I) / Monday, Nov , 03:50 PM - 04:00 PM, S401AB sec for 118 mm Exposure ~ 5mSv HR 78 bpm Single Source 100% Dual Source One-Stop Diagnosis in Acute Care The World s first DSCT 50% < >90 bpm Courtesy of University of Erlangen/ Erlangen, Germany 35 accumulates the power of 2 sources resulting in unprecedented 160 kw Single source CT 1 x Power Low Speed + Good IQ Insufficient power for high-speed scanning of obese patients 36 accumulates the power of 2 sources resulting in unprecedented 160 kw Single source CT 2 x 80 kw High Speed + Good IQ Sufficient power for sharp and detailed images at any scan speed High Speed + Low IQ Insufficient power for high-speed scanning of obese patients High Speed + Good IQ Sufficient power for sharp and detailed images at any scan speed 6

Adaptation and Adaptive ECG Pulsing 60 70 80 90 100 110 120 Heart rate in bpm Source: Cynthia McCollough PhD, Mayo Clinic Rochester, USA RSNA 2005 talk: SSE16-06 / Physics (CT: Cardiac Imaging I) /

7 37 38 Patient was scanned to obtain a vascular status. Calcifications along the whole aorta were found as well as a horse shoe kidney. One-Stop Diagnosis in Acute Care 9 sec for 490 mm 2 x 150 effective mas Hear rate independent temporal resolution of 83 msec 87 mm/sec scan speed with 0.33 mm isotropic resolution 78 cm gantry opening and Field of View 200 cm scan range 160 kw power Courtesy of Friedrich-Alexander University Erlangen-Nuermberg - Institute of Medical Physics / Erlangen, Germany sec for 433 mm Rotation 0.5 sec 320 effective mas 22 sec for 445 mm Rotation 0.5 sec 2 x 250 effective mas Weight: 287 lbs / 130 kg A non-gated scan was performed showing excellent visualization of the whole aorta without motion artifacts. The LAD showed severe calcifications in the proximal segment. Excellent display of obese patient staging post status rectum carcinoma. Courtesy of University Hospital of Munich - Grosshadern / Munich, Germany 41 Excellent visualization of the complete peripheral artery tree with 0.33 mm isotropic resolution, showing a occlusion of the left iliac artery Fast visualization of the complete human anatomy in only 42 sec. with 0.33 mm isotropic resolution. Courtesy of University Hospital of Munich - Grosshadern / Munich, Germany sec for 1889 mm Rotation 0.5 sec 120 effective mas 31 sec for 1389 mm Rotation 0.5 sec 200 effective mas 7

33 mm isotropic resolution 78 cm gantry opening and Field of View 200 cm scan range 160 kw power Courtesy of Friedrich-Alexander University Erlangen-Nuermberg - Institute of Medical Physics /

43 44 Beyond The World s first DSCT Visualization with Dual Energy Beyond Visualization with Dual Energy 80kV Bone 670 HU Iodine 296 HU Bone 450 HU Iodine 144 HU 140kV 45 46 Potential clinical

Simultaneous operation of two X-ray sources at different energies Sources A: 80 kv Sources B: Simultaneous operation of two X-ray sources at different energies Sources A: 80 kv Sources B: Single

8 43 44 Beyond The World s first DSCT Visualization with Dual Energy Beyond Visualization with Dual Energy 80kV Bone 670 HU Iodine 296 HU Bone 450 HU Iodine 144 HU 140kV Potential clinical application and research area: Direct subtraction of either vessels or bone during scanning. Potential Clinical Application and Research Area: Improved identification of cartilage and ligaments. Simultaneous operation of two X-ray sources at different energies Sources A: 80 kv Sources B: Simultaneous operation of two X-ray sources at different energies Sources A: 80 kv Sources B: Single X-ray source image Two X-ray sources at different kv "WIP-The information about this product is preliminary. The product is under development and not commercially available in the U.S., and its future availability cannot be ensured." "WIP-The information about this product is preliminary. The product is under development and not commercially available in the U.S., and its future availability cannot be ensured." Potential Clinical Application and Research Area: Iodine removal from liver/ kidney images with contrast medium to generate a virtual unenhanced image. initial scan contrast image Simultaneous operation of two X-ray sources at different energies Sources A: 140 kv Sources B: 80 kv From Slices to Applications Diagnostic Oncology Neuro Cardio- Vascular Acute Care virtual non-contrast image contrast image (red) Dual Energy "WIP-The information about this product is preliminary. The product is under development and not commercially available in the U.S., and its future availability cannot be ensured." syngo Courtesy of Friedrich-Alexander University Erlangen-Nuermberg / Erlangen, Germany

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Master s Program in Medical Physics. Physics of Imaging Systems Basic Principles of Computer Tomography (CT) III. Prof. Dr. Lothar Schad.

1 12/9/2008 Page 1 Master s Program in Medical Physics Physics of Imaging Systems Basic Principles of Computer Tomography (CT) III Chair in Faculty of Medicine Mannheim University of Heidelberg Theodor-Kutzer-Ufer