How can intelligent and personalized CT scanning ease radiology workflow?

Manuel Meyer
Published on December 3, 2019

As a specialized clinic with a clear mandate for training and research, the University Hospital Erlangen is always seeking out the latest CT technology. Now, it has made the first step into a new era of computed tomography.

<p><a href="" target="_blank" rel="noindex nofollow" class="">Download your PDF here</a><br><br>Laura Schwarzfaerber calls the next patient into the treatment room. Today, she will conduct a computed tomography (CT) scan of the thorax. This used to require up to seven different protocols. But with the new intelligent support from myExam Companion, the technical radiology assistant at University Hospital Erlangen in Germany now only needs to select one. The scanning process is not only personalized for each patient, but is even tailored to their specific requirements. On the tablet, Schwarzfaerber clicks through the decision tree for the thoracoabdominal CT scan. Should the scan be restricted to the epigastric region or the abdomen? Is the patient able to hold their breath for more than 12 seconds, or not? Does the patient have any metal implants? Should the scan be done with dual or single energy?<br> </p>
<p>Automated algorithms read the patient’s ECG and feed it directly into the system, which calculates the appropriate protocols and doses of radiation adjusted for ECG data, weight, size, and age.<br></p>
Automating CT scanning not only supports the staff, but also leads to more relaxed patients.
Tablet in hand, Schwarzfaerber stands beside the patient, who is already lying on the scanner table. The fully automated positioning program, supported by a 3D camera, places the patient in the optimal position. “We save loads of time at this stage, since all of these steps had to be done manually before,” says Schwarzfaerber. With the advanced tablet functionalities, she can now remain even longer at the patient’s side – “and that makes them much more calm and relaxed, which also assists our scanning process.” For the scan itself, Schwarzfaerber returns to the control room. With the scanner’s 2D camera, she can continue to monitor the patient carefully. “Looking at his face, I can see immediately whether he is uncomfortable, in pain, or nervous, and can react quickly.”

Matthias May, MD, Assistant Professor at the radiology department of the University Hospital Erlangen, Germany

<p>While one radiology technologist is already busy with automated reconstruction and archiving in the diagnostic room, another can get to work in the treatment room with the tablet, position the next patient, and prepare the scan. “The mobile environment means that work processes can be carried out in parallel, more flexibly, and with optimal use of time,” says Matthias May, MD, Assistant Professor at the radiology department of the University Hospital Erlangen, Germany.</p><p>The time savings also benefit the university hospital as a whole: As a referral and specialist hospital for a catchment area including about one million potential patients, it has a considerable scanning workload of 40 CT scans per day. “Now, consider that we are also a training hospital. This means that we senior physicians always have to re-check the findings of our younger colleagues and doctors in training before they are passed on to the attending specialist.”</p>
<p>But the time saved is certainly not the only reason why Matthias May participated in the pilot study of the new <a href="" class="">SOMATOM X.cite</a>, which has been undergoing worldwide tests in five clinics since last summer.</p>
Intelligent imaging is made possible with the SOMATOM X.cite and the intelligent user concept myExam Companion.
His assessment is clear: “The scanner is definitely the first step towards personalized radiology.” May and his clinic have been working closely for years with Siemens Healthineers on the development of new scan protocols and procedures at the Imaging Science Institute. “As a university hospital, we have a clear mandate for training and research in addition to medical care, which we can only fulfill if we also have the latest technologies at our disposal.” In order to research new treatments or to introduce the next generation of radiologists to future technologies, May explains, it is necessary to have state-of-the-art in technology. Moreover, he notes that the university hospital at Erlangen is a specialized hospital. “We also need the latest technology in order to be able to treat cases that exceed the capabilities of regular communal hospitals.”
<p>The SOMATOM X.cite, he says, is a “good all-rounder”, incorporating the technical innovations of the past decade. However, as he explains, scanning time and image quality are no longer the main issues in radiology today. Rather, the goal is now to make scanning easier, thus making the experience more pleasant for patients, while relieving staff members from additional tasks and allowing them to use more of their time to deal with the patient on the human level. After all, he notes, the focus here is on individuals who are worried about their health.</p><p>“And where can we save time or relieve the burden on staff? On the periphery, when it comes to preparing the patient, the scan, or the reconstruction,” says May. It is here that the new intelligent user concept myExam Companion really comes into play. Currently, the concept offers up to 20 examination protocols that can be called up by way of decision trees.</p>
<p>“By using these predefined decision-making criteria, and assisted by automated capture and reconstruction settings, even less experienced staff are able to scan rapidly and flawlessly with the optimal image quality, X-ray dose, and contrast medium dose,” says the radiologist.<br></p>
Personalized scanning protocols help easing the scanning workflow.
This, he believes, is the upcoming trend in CT imaging. “We envision a future where you won’t need to be an expert to operate a CT scanner. This will be crucial not only in regions lacking a radiologist, but even here in our hospital: For instance, if less experienced personnel find themselves in stressful emergency situations or alone during their night shift.” On the other hand, this very aspect is also of particular importance for a German university hospital with a training mandate as affects not only students, interns from other hospitals, or staff in training. “Many of my colleagues spend most of their working hours operating MRI scanners or X-ray machines, and they often feel out of their depth when working with the CT. But with this user interface, nearly all of them find it easy to switch to the CT imaging,” says radiology technologist Laura Schwarzfaerber. She believes that the system is highly intuitive, self-explanatory, and easy to learn. Users are no longer required to familiarize themselves with as many technical details. Schwarzfaerber explains: “Really, all you need to do is answer a series of questions, and then – based on your responses – click through the system, which will generate the appropriate scanning protocol.”

By Manuel Meyer

Manuel Meyer reports from Spain and Portugal for Ärzte Zeitung (a German newspaper for physicians and other medical professionals) and other media outlets. He is based in Madrid.