CARE Right

Committed to ALARA
CARE Right

In medical imaging it is essential to provide sound and sustainable clinical results with highest patient safety. When it comes to applying radiation, ALARA - as low as reasonably achievable - is the overarching principle.
 

For years, Siemens Healthineers has been at the forefront of radiation reduction. Continuous dedication and unique technological advances have made Siemens CT the low dose leader to catch. Thanks to these efforts, scans at sub-mSv doses found their way into clinical routine.


But as such low doses become achievable, one has to verify whether 1 mSv actually is the right dose for every patient. Obviously, there isn’t one dose level that fits everyone. Every clinical question and every single patient demands an individual and specific dose level. Therefore, while everybody is only talking about low dose, Siemens Healthineers is convinced that what really matters is the right dose.

 


The right dose is the reasonable balance between applied radiation, image quality and patient care. In order to help customers achieve this balance, Siemens Healthineers has introduced CARE Right.


This holistic approach is based on the belief that after the recent innovations in radiation reduction, a singular focus on low dose only is not sufficient anymore. Consequently, efforts must now be targeted towards a comprehensive understanding of the right dose. Thus, CARE Right encompasses three key areas:

Right Dose Technology

Right Dose Technology

In order to reduce radiation to the right dose, of course, the first prerequisite is still the appropriate hardware: healthcare institutions need the right technology. Siemens Healthineers has a long tradition of being an innovation leader in CT technology: whether it was the introduction of CARE (Combined Applications to Reduce Exposure) in the 1990s, Dual Source CT in the 2000s, or the Stellar detector in the 2010s, Siemens Healthineers has continuously been one step ahead. Therefore, it was a logical consequence that Siemens Healthineers was named “the low dose leader to catch” when its SOMATOM® Definition Flash won the 2011 Best in KLAS award.1 Overall, this was due to the fact that Siemens Healthineers offers a comprehensive and innovative portfolio of unique dose reduction features.

 


In order to achieve the right dose for a patient, there are three important factors to consider: the size and stature of the patient, the type of examination, and the applied radiation dose. With Siemens Healthineers’ technology, all of these aspects can be addressed:

Siemens Healthineers - CT - Tin Filter

The Tin Filter cuts out lower energies to reduce dose and optimize image quality at the interface between soft tissue and air. This has direct benefits in lung and colon imaging, for example.

CT – Technologies – ADMIRE – Advanced Modeled Iterative Reconstruction

ADMIRE  (Advanced Modeled Iterative Reconstruction) is an advanced iterative image reconstruction algorithm that achieves higher resolution at organ borders and improved delineation of edges.² One advantage of this is that it may potentially allow clinicians to better localize lesions. Fast reconstruction times also mean that ADMIRE can smoothly integrate into daily clinical routines.

SAFIRE

SAFIRE (Sinogram Affirmed Iterative Reconstruction) is a unique image reconstruction algorithm that reduces noise³ without affecting image quality or detail visualization. It does this by introducing multiple iteration steps into the raw data during the reconstruction process.

CARE Dose4D

CARE Dose4D achieves significant dose reductions with automated dose modulation for individual patient size and shape while producing optimal image quality.

CARE kV automated dose-optimized selection

CARE kV offers an automated dose-optimized selection of the X-ray tube voltage (kV) depending on the selected type of examination. It is the industry’s first tool that automatically determines the appropriate kV and scan parameter settings to help deliver the right dose for a particular scan and the user defined image quality.

Low kV

Low kV
One of the main parameters of a scan protocol is the tube voltage, kV. The SOMATOM scanners offers different kV values from 70 to 150 kV depending on the scanner type. The tube voltage is an important parameter that has an impact on radiation dose and image impression.

Dose Shield

Adaptive Dose Shield
In spiral CT, it is routine to do an extra half-rotation of the gantry before and after each scan, even though only part of the acquired data is necessary for the image reconstruction. ​The Adaptive Dose Shield, a technology based on precise, fast, and independent movement of both collimator blades asymmetrically opens and closes at the beginning and end of each spiral scan, temporarily blocking those parts of the X-ray beam that are not used for image reconstruction. As a result, only the targeted tissue is irradiated.

Right Dose Levels

Right Dose Levels

Next to having access to the right technology, it is essential to know the right dose levels to perform an examination according to ALARA (as low as reasonably achievable). The right dose level is the best possible balance between image quality and required amount of radiation.


Absolute Dose Values in Computed Tomography

A prerequisite for users to know whether they apply the right dose levels is an understanding of absolute dose values. This is why Siemens Healthineers provides them along with their protocols. Users can then use these values as a reference to compare their current dose level with regional recommendations and guidelines, scientific publications, or the dose levels delivered by Siemens Healthineers CT standard scan protocols.

 


CT Scan Protocols

These scan protocols apply these recommendations to each examination. Along with international guidelines and reference values, Siemens Healthineers’ dedicated protocol development team continuously incorporates the feedback from panels into a sophisticated library of scan protocols.

Right Dose Management

Right dose management

In order to establish consistent dose levels, organizations need to be able to sustainably manage dose across their institutions. They may also be required to document and report dose applied to patients due to regional regulations.

 


All of these requirements rely on the availability of dose data and adequately educated personal. These two aspects are at the core of Right Dose Management, which further optimizes dose reduction.

DoseMAP - Siemens Healthineers CT Dose Management Program - creates transparency in dose values and makes it possible to assess the dose situation. It provides functionalities like CARE Analytics to report, document and analyze dose. It lets the user access dose values per case, per examination type, or per patient.
DoseMAP may also help to protect our patients from over radiation - thanks to its alert function that warms the operator in case set dose thresholds are exceeded.
Additionally, to protect the set dose levels, access to scan protocols can be restricted to prevent unauthorized changes to the scan parameters.

EduCARE bundles dedicated trainings from Siemens Healthineers that focus on key technologies and their application in clinical practice. Exclusive tutorials, webinars, e-trainings, and brochures cover a wide range of topics related to achieving the right dose.
Clinical Webinars
“How to guides”

Optimize CARE CT is a consultancy program offered by Siemens Healthineers Customer Service. Over the course of the program, Siemens Healthineers professionals guide users towards optimizing the use of radiation in order to reduce dose. Through onsite and offsite support and trainings, users learn how to use the right dose technology to deliver the right dose levels for every patient.1

CRADLE - This comprehensive consultancy program advances and optimizes medication safety and dose management.1

Cases

CARE Right aims at finding the right dose for every individual patient. What matters is the right balance between image quality and radiation dose. All of CARE Right’s individual areas – Right Dose Technology, Right Dose Levels, and Right Dose Management – come together in the following examples.



SOMATOM Drive

CT Chest Angiography Pediatrics

Diagnosis: Coarctation of the aorta
(Image: Shandong Medical Imaging Research Institute / Shandong, P. R. China)


Used iterative reconstruction method: SAFIRE

Collimation: 128 x 0.6 mm

70 kV, 130 mAs

Flash scan mode

CTDIvol: 0.37 mGy

Scan time: 0.32 s

DLP: 8 mGy cm

Scan length: 144 mm

Eff. dose: 0.35 mSv

Rotation time: 0.28 s

 


SOMATOM Force

CT Chest Abdomen Pelvis Angiography

Diagnosis: A re-evaluation CTA using only 20 mL of contrast media confirmed a Stanford B aortic dissection, beginning behind the junction of the left subclavian artery and stretching to just below the diaphragm, with a new partially thrombotic occlusion of the false lumen.
(Image: University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University)

Used iterative reconstruction method: ADMIRE
 

Collimation: 192 x 0.6 mm

80 kV, 140 mAs

Flash scan mode

CTDIvol: 2.09 mGy

Scan time: 0.91 s

DLP: 154.6 mGy cm

Scan length: 673.6 mm

Eff. dose: 2.3 mSv

Rotation time: 0.25 s

 


SOMATOM Perspective

CT Abdomen Pelvis

Diagnosis: The radiologists found the right balance between applied radiation and image quality. As the habitus of the patient is larger than the reference patient, 5.6 mSv was the right effective dose to achieve this balance. CT images showed a cauliflower-like, broad-based soft tissue mass located on the left-posterior wall of the rectum. It measured 25 x 22 mm and was causing luminal narrowing.
(Image: Department of Radiology, Panshi City Hospital, Lilin, P. R. China)

Used Iterative Reconstruction Method: SAFIRE

Collimation: 64 x 0.6 mm

110 kV, 86 mAs

Scan time: 13 s

CTDIvol: 6.36 mGy

Scan length: 518 mm

DLP: 374.27 mGy cm

Rotation time: 0.6 s

Eff. dose: 5.6 mSv


SOMATOM Definition Flash with Stellar detector

Pediatric

Diagnosis: Septum defect with impact on lung perfusion?
(Image: Erasmus MC - University Medical Center Rotterdam / Rotterdam, the Netherlands)

   

 

Scan method: thorax Dual Energy scan and Flash Spiral scan

Thorax Dual Energy scan:

Collimation: 64 x 0.6 mm

80/140 Sn kV, 26/16 mAs

Spatial resolution: 0.30 mm

DLP: 18 mGy cm

Scan time: 2 s

CTDIvol: 1.28 mGy

Scan length: 118 mm

Eff. dose: 1.58 mSv

TI: 0.28 s

 

Flash Spiral scan:

Collimation: 128 x 0.6 mm

70 kV, 14 mAs

Spatial resolution: 0.30 mm

DLP: 3 mGy cm

Scan time: 0.29 s

CTDIvol: 0.15 mGy

Scan length: 118 mm

Eff. dose: 0.26 mSv

TI: 0.28 s

 


SOMATOM Definition Edge

CT Abdomen

Diagnosis: EVAR with persistent aortic endoleak
(Image: Clinique CIMOP Bizet / Paris, France)

Collimation: 128 x 0.6 mm

100 kV, 83 mAs

Spatial resolution: 0.30 mm

DLP: 190 mGy cm

Scan time: 3 s

CTDIvol: 3.29 mGy

Scan length: 543 mm

Eff. dose: 2.85 mSv

TI: 0.28 s

 


SOMATOM Definition AS

CT Abdomen

Diagnosis: obese patient after cholecystectomy
(Image: C.I.M. Laennec / Cesson Sevigne, France)

Collimation: 64 x 0.6 mm

100 kV, 300 mAs

Spatial resolution: 0.30 mm

DLP: 529 mGy cm

Scan time: 10 s

CTDIvol: 13.55 mGy

Scan length: 373 mm

Eff. dose: 7.9 mSv

TI: 0.5 s