Siemens SOMATOM Emotion 6 User guide

SOMATOM Emotion 6
Application Guide
Routine Protocols
Software Version A70

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The information presented in this application guide
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 Inc , to
be used for any purpose in that regard The drugs and
doses mentioned herein were specified to the best
of our knowledge We assume no responsibility whats-
oever for the accuracy of this information
Variations may prove necessary for individual patients
The treating physician bears the sole responsibility
for all of the parameters selected The pertaining oper-
ating instructions must always be strictly followed
when operating the SOMATOM Emotion 6
The statutory sources for the technical data are the
corresponding data sheets
We express our sincere gratitude to the many customers
who contributed valuable input
Special thanks to Christiane Bredenhoeller, Christoph
Süß, Thomas Flohr and the CT-Application Team for their
valuable assistance
To improve future versions of this application guide,
we would highly appreciate your questions, suggestions
and comments
Please contact us:
USC-Hotline:
Tel no [phone]
email ct-application hotline@med siemens de
Editor: Ute Feuerlein

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3
Overview
General 8
Children 24
Head 76
Neck 92
Shoulder 102
Thorax 106
Abdomen 134
Pelvis 164
Spine 172
Extremities 182

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Content
General 8
· Concept 8
· Scan Set Up 9
· Scan and Reconstruction 9
– Slice Collimation and Slice Width 9
– Pitch 11
– Recon Job 11
– Kernels 12
– Image Filter 12
· Effective mAs 14
· Dose Information 15
– CTDIWand CTDIVol 15
– CARE Dose 17
– How Does it Work 17
· Workflow 19
– Auto Load in 3D and
Postprocessing Presets 19
· Contrast Medium IV Injection 20
· How to Create your own Scan Protocols 21

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Content
Children 24
· Overview 24
· Hints in General 26
– Head kernels 29
– Body kernels 30
· HeadAngio 32
· HeadAngio06s 34
· Head 36
· HeadSeq 37
· Sinus 38
· InnerEar 40
· NeckRoutine 42
· CarotidCTA 44
· CarotidCTA06s 46
· NeonateBody 48
· NeonateBody06s 49
· ThoraxRoutine 50
· ThoraxRoutine06s 52
· ThoraxCombi 54
· ThoraxCombi06s 56
· ThoraxSeqHR 58
· AbdPelRoutine 60
· AbdPelRoutine06s 62
· AbdCTA 64
· AbdCTA06s 66
· Spine 68
· SpineSagittal 70
· Extremity 72
· ExtrHR 74

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Content
Head 76
· Overview 76
· Hints in General 77
· AngioHead 78
· AngioHead06s 80
· HeadSeq 82
· Head 84
· InnerEarSeq 86
· InnerEar 88
· OrbiSinus 90
Neck 92
· Overview 92
· Hints in General 93
· AngioCarotid 94
· AngioCarotid06s 96
· NeckRoutine 98
· NeckThinSlice 100
Shoulder 102
· Overview 102
· Hints in General 103
· Shoulder 104
Thorax 106
· Overview 106
· Hints in General 108
· LungLowDose 110
· LungLowDose06s 112
· Embolism 114
· Embolism06s 116
· ThoraxCombi 118
· ThoraxCombi06s 120
· ThoraxRoutine 122
· ThoraxRoutine06s 124
· ThoraxFast 126
· ThoraxFast06s 128
· ThoraxHR 130
· ThoraxSeqHR 132

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Content
Pelvis 164
· Overview 164
· Hints in General 165
· Hip 168
· PelvisRoutine 170
Spine 172
· Overview 172
· Hints in General 173
· SpineRoutineSeq 176
· SpineObeseSeq 177
· Spine 178
· C-Spine 180
Extremities 182
· Overview 182
· Hints in General 183
· AngioRunOff 186
· AngioRunOff06s 188
· ExtrCombi 190
· ExtrHR 192
Abdomen 134
· Overview 134
· Hints in General 136
· AbdRoutine 140
· AbdRoutine06s 142
· AbdomenCombi 144
· AbdomenCombi06s 146
· AbdMultiPhase 148
· AbdMultiPhase06s 150
· AbdFast 152
· AbdFast06s 154
· AngioFast 156
· AngioFast06s 158
· AngioRoutine 160
· AngioRoutine06s 162

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General
Concept
The scan protocols for adult are defined according
to body regions – Head, Neck, Shoulder, Thorax,
Abdomen, elvis, Spine, Extremities.
The pediatric scan protocols are defined under the
folder “Children“.
The protocols for special applications are defined
under “Special“ (please refer to the Application Guide
for Special applications)
The general concept is as follows:
All not specially marked protocols are standard spiral
modes E g “Head” means the spiral mode for the head
“Fast“: uses 2 0 or 3 0 mm slice collimation and
a higher pitch for fast acquisition for CT Angios or
trauma cases
“Routine“: uses either 1 0 mm or 2 0 mm slice colli-
mation depending on the region of interest for routine
studies
“ThinSlice“: uses 1 0 mm slice collimation for thin
slice studies
“HR“: uses 0 5 mm (optional) or 1 0 mm slice colli-
mation and rotation time of 1 0 s for High-resolution
studies
“Combi“: uses 1 0 mm as slice collimation and by
default, has 2 reconstruction jobs: one thin slice width
for HiRes or CTA, and one thicker slice width for soft
tissue studies
“Seq“: stands for Sequence E g “HeadSeq“ means
the sequence mode for the head
The existence of scan protocols depend on the system
configuration Protocols with the 0 6 sec rotation time
are only available on systems configured with the Power
Package, also 0 5 mm slice collimation is available only
on systems with High Resolution option

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General
Scan Set Up
Scans can be simply set up by selecting a predefined
examination protocol To repeat any mode, just click
the chronicle with the right mouse button for “repeat”.
To delete it, select “cut“. Each chronicle is rewriteable
before “load“.
Multiple ranges can be run either automatically with
“auto range“, which is denoted by a bracket connecting
the two ranges, or separately with a “pause” in between
Scan and Reconstruction
Slice Collimation and Slice Width
Slice collimation is the slice thickness resulting from
the effect of the tube-side collimator and the adaptive
detector array design In Multislice CT, the Z-coverage
per rotation is given by the product of the number of
active detector slices and the collimation
(e g 6 x 1 0 mm)
Slice width is the true thickness of the reconstructed
image
With the SOMATOM Emotion 6, you select the slice
collimation together with the slice width desired The
slice width is independent of pitch and algorithm, i e
what you select is always what you get Actually, you
do not need to care about the algorithm any more; the
software does it for you

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General
If Metrorecon is not selected you will get routinely
“Real Time” reconstructed images in full image quality
The Recon icon on the chronicle will be labeled with
“RT” After the scan the Real Time displayed image series
has to be reconstructed
The following tables show you the possibilities of image
reconstruction in spiral and sequential scanning
Slice Collimation and Slice Width for Spiral Mode
0 5 mm 0 63, 0 75, 1, 1 25, 2, 2 5, 3, 4, 5 mm
(optional)
1 mm 1 25, 2, 2 5, 3, 4, 5, 6, 8, 10 mm
2 mm 2 5, 3, 4, 5, 6, 8, 10 mm
3 mm 4, 5, 6, 8, 10 mm
Cardio Spiral Modes
1 mm 1 25, 2, 3 mm
2 mm 2 5, 3, 5 mm
Slice Collimation and Slice Width for Sequence Mode
1 0 mm 1 0, 2 0, 3 0 mm
2 0 mm 2, 4, 6, 12 mm
3 0 mm 3, 6, 9, 18 mm
5 0 mm 5, 10 mm
erfusion Multiscan Modes
1 mm 1, 2, 3 mm
2 mm 2, 4, 6, 12 mm
3 mm 3, 6, 9, 18 mm
5 mm 5, 10 mm
ECG triggered Modes
1 mm 1 25, 2, 3 mm
2 mm 2 5, 3, 5 mm
HR Spiral Mode
0 5 mm 0 63, 0 75, 1, 1 25, 2, 2 5, 3, 4, 5 mm
(optional)
1 mm 1 mm
HR Sequence Mode
1 mm 1 mm

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General
itch
In single slice CT:
Pitch = table movement per rotation/slice collimation
E g : slice collimation = 5 mm,
table moves 5 mm per rotation, then pitch = 1
With the SOMATOM Emotion 6, in Siemens Multislice
CT, we differentiate between:
Feed/Rotation, the table movement per rotation
Volume itch, the table movement per rotation/
single slice collimation
E g : single slice collimation = 1 0 mm, table moves
6 mm per rotation, then the Volume Pitch = 6
itch Factor, the table movement per rotation/
collimation
E g : slice collimation = 6 x 1 0 mm, table moves
6 mm per rotation, then the Pitch Factor = 1
With the SOMATOM Emotion 6, you do not need to
select pitch Once the scan range, scan time, slice
collimation, and rotation time is defined, the software
will adapt the table feed per rotation accordingly
The Pitch Factor can be freely adapted from 0 5 – 1 8
Recon Job
In the Recon card, you can define up to 3 reconstruction
jobs with different parameters either before or after
you acquire the data When you click on “Recon“, they
will all be done automatically In case you want to add
another recon job, simply click the little icon on the
chronicle with the right mouse button and select “delete
recon job“ to delete the one which has been completed,
and then one more recon job will be available in the
Recon card (Note: what you delete is just the job from
the display, not the images that have been reconstructed
Once reconstructed, these completed recon jobs stay
in the browser, until deleted from the hard drive) You
can also reconstruct images for all scans performed by
not selecting any range in the chronicle, prior to clicking
“Recon”

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General
Kernels
There are 5 different types of kernels: “H“ stands for
Head, “B“ stands for Body, “U“ stands for High Reso-
lution, “C“ stands for ChildHead, and “S“ stands for
Special Application, e g , Osteo CT
The image sharpness is defined by the numbers –
the higher the number, the sharper the image; the
lower the number, the smoother the image
A set of 32 kernels is supplied with the Emotion 6 Soft-
ware, consisting of 13 body kernels B10s, B20s, B30s,
B31s, B35s, B40s, B41s, B46s, B50s, B60s, B70s, B80s,
B90s, 12 head kernels H10s, H20s, H21s, H30s, H31s,
H40s, H41s, H50s, H60s, H70s, H80s, H90s, 3 child
head kernels C20s, C30s, C60s, 4 special kernels S30s,
S80s, S90s, U90s
Note: Do not use different kernels for other body parts
other than what they are designed for
For further information regarding the kernels, please
refer to the “Hints in General” of the corresponding
body region
Image Filter
There are 4 different filters available:
PFO: To reduce beam-hardening artifacts in head
images, particularly in the base of the skull, use the
Posterior Fossa Optimization (PFO) filter It is highly
recommended to use the PFO filter for all soft tissue
reconstruction

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General
ASA: The Advanced Smoothing Algorithm (ASA) filter
reduces noise in soft tissue while edges with high con-
trast are preserved
LCE: The Low-contrast enhancement (LCE) filter
enhances low-contrast detectability It reduces the
image noise
HCE: The High-contrast enhancement (HCE) filter
enhances high-contrast detectability It increases the
image sharpness
Reconstruction
with PFO filter.
Reconstruction
without PFO filter.

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General
Effective mAs
In sequential scanning, the dose (Dseq) applied to the
patient is the product of the tube current-time (mAs)
and the CTDIwper mAs:
Dseq = DCTDIwx mAs
In spiral scanning, however, the applied dose (Dspiral)
is influenced by the “classical” mAs (mA x Rot Time) and
in addition by the Pitch Factor For example, if a Multi-
slice CT scanner is used, the actual dose applied to the
patient in spiral scanning will be decreased when the
Pitch Factor is larger than 1, and increased when the
Pitch Factor is smaller than 1 Therefore, the dose in
spiral scanning has to be corrected by the Pitch Factor:
Dspiral = (DCTDIwx mA x Rot Time)/Pitch Factor
To make it easier for the users, the concept of the
“effective” mAs was introduced with the SOMATOM
Multislice scanners
The effective mAs takes into account the influence of
pitch on both the image quality and dose:
Effective mAs = mAs/Pitch Factor
To calculate the dose on the SOMATOM Emotion 6,
you simply have to multiply the CTDIWper mAs with
the effective mAs of the scan:
Dspiral = DCTDIwx effective mAs
For spiral scan protocols, the indicated mAs is the effec-
tive mAs per image The correlation between tube
current mA and effective mAs of spiral scans on a Multi-
slice CT scanner is given by the following formula:
Effective mAs = mA x RotTime/Pitch Factor
Pitch Factor = Feed/Rot
nrow x Slice collimation
mA = effective mAs x Pitch Factor
RotTime
where collimated Slice refers to the collimation of one
detector row, and nrow is the number of used detector
rows

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General
Dose Information
CTDIWand CTDIVol
The average dose in the scan plane is best described by
the CTDIWfor the selected scan parameters The CTDIW
is measured in the dedicated plastic phantoms – 16 cm
diameter for head and 32 cm diameter for body (as
defined in IEC 60601-2 -44) This dose number gives a
good estimate for the average dose applied in the
scanned volume as long as the patient size is similar to
the size of the respective dose phantoms
Since the body size can be smaller or larger than
32 cm, the CTDIWvalue displayed can deviate from the
dose in the scanned volume
The CTDIWdefinition and measurement is based on
single axial scan modes For clinical scanning, i e scan-
ning of entire volumes in patients, the average dose
will also depend on the table feed in between axial scans
or the feed per rotation in spiral scanning The dose,
expressed as the CTDIW, must therefore be corrected by
the pitch-factor of the spiral scan or an axial scan series
to describe the average dose in the scanned volume
For this purpose the IEC defined the term “CTDIVol“ in
September 2002:
CTDIVol = CTDIW/pitch-factor
This dose number is displayed on the user interface for
the selected scan parameters
Please note: Up to now the dose display on the
Somaris\5 user interface was labeled “CTDIW“
This displayed CTDIWwas also corrected for the pitch

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The CTDIVol value does not provide the entire information
of the radiation risk associated with CT examination
For this purpose, the concept of the “Effective Dose“ was
introduced by ICRP (International Commission on
Radiation Protection) The effective dose is expressed
as a weighted sum of the dose applied not only to the
organs in the scanned range, but also to the rest of the
body It could be measured in whole body phantoms
(Alderson phantom) or simulated with Monte Carlo
techniques
The calculation of the effective dose is rather compli-
cated and has to be done by sophisticated programs
These have to take into account the scan parameters,
the system design of individual scanner, such as x-ray
filtration and gantry geometry, the scan range, the
organs involved in the scanned range and the organs
affected by scattered radiation For each organ, the
respective dose delivered during the CT scanning has
to be calculated and then multiplied by its radiation
risk factor Finally the weighted organ dose numbers
are added up to get the effective dose
The concept of effective dose would allow the com-
parison of radiation risk associated with different CT or
x-ray exams, i e different exams associated with the
same effective dose would have the same radiation risk
for the patient It also allows comparing the applied
x-ray exposure to the natural background radiation,
e g 2 – 3 mSv per year in Germany
General

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General
CARE Dose
CARE Dose is a clinical application package that pro-
vides real-time tube current modulation for Spiral and
Sequential Scanning
CARE Dose reduces patient dose significantly, espe-
cially in the regions of shoulder and pelvis It decreases
tube load, which extends the capacity for volume scan-
ning with thinner slices, larger volumes or Multi-phase
studies
It can also improve image quality by increasing mA
thus reducing image noise on the lateral views
How Does it Work
It reduces the mA for low attenuation views up to 90%
and keeps the nominal higher mA for high attenuation
views, e g in the lateral projection (Fig 4) This is done
“on-the-fly”, i e the scanner adapts the mA in real-time,
according to the patient’s attenuation profile (Fig 5)

Fig. 4: Example of scanning in the shoulder region.
High
attenuation,
high mA
Low attenuation,
low mA
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General
Fig. : Principle of CARE Dose tube current adaptation.
• CARE Dose is pre-selected by default for most standard
protocols It can be switched on/off in the scan card
• For the average patients examination, CARE Dose
does not require any manual changes to the scan
protocol However, the mAs must be adapted manu-
ally for obese and pediatric patients
• The mean value of the mAs applied will be lower
than what you have selected Although the average
mA for the entire scan will be lower than selected, we
allow the scanner to apply increased mA levels for
the high attenuation views This may cause different
results of the tube load controller when switching
on and off CARE Dose
• The mean value of the effective mAs applied is shown
in the image text
lateral
1 00
0 75
0 50
0 25
rel units
a p
time
Object attenuation
Modulated tube current

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General
Workflow
Auto Load in 3D and ostprocessing resets
You can activate the “Auto load in 3D” function on the
Examination Card/Auto Tasking and link it to a recon
job For example, the 2nd recon job with thinner slice
width in some of the examination protocols If the post-
processing type is chosen from the pull down menu,
the reconstructed images will be loaded automatically
into the 3D Card on the Navigator with the correspond-
ing postprocessing type
On the 3D Card you have the possibility to create MPR,
MIPthin Range Parallel and Radial protocols which can
be linked to a special series
For example, if you always do sagittal Multiplanar
Reconstructions for a Spine examination, you load once
a Spine examination into the 3D Card Select the image
type (MPR, MIPthin), select the orientation and open
the Range Parallel function Adapt the range settings
(Image thickness, Distance between the images etc )
and hit the link button From that point on, you have a
predefined postprocessing protocol, linked to the series
description of a Spine examination
Exactly the same can be done for VRT presets In the
main menu, under Type/VRT Definition, you can link
VRT presets with a series description

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General
Some of the Scan protocols, primarily for Angio exami-
nations, are already preset in the protocol with Auto load
in 3D If you prefer not to use this preset, please de-
select the Auto load in 3D and save your scan protocol
Some of the Scan protocols are preset in the protocol
with links to a postprocessing protocol If you prefer
not to have this preset, please delete the Range Parallel
preset or overwrite them with your own settings
Contrast Medium IV Injection*
The administration of a contrast medium depends on
the indication and on the delay times to be used during
the examination The patient’s weight and circulatory
system condition also play a role In general, no more
than 3 ml per kg of body weight for adults and 2 ml per
kg of body weight for children should be applied
As a rule of thumb, the contrast medium injection
should be stopped when the scan (or acquisition)
is finished Keep this in mind, as you may save contrast
medium on your routine studies since the Multislice
spiral scan can be up to 10 times faster than a 1 second,
single slice spiral scan
For CTA studies (arterial phase), the principle is to keep
contrast injection for the whole scan Thus, the total
amount of contrast medium needed should be calcu-
lated with the following formula:
CM = (start delay time + scan time) x flow rate
CARE Bolus or Test Bolus may be used for optimal
contrast bolus timing Please refer to the Application
Guide for special protocols
* For more information regarding the general use
of drugs and doses mentioned in this guide, please
refer to page 2.