The difference between images and answersDual Energy spectral imaging

Dual Energy Heart PBV — COURTESY: Courtesy of Hospital Calmette Lille, Lille, France

Make Dual Energy spectral imaging an integral part of your daily clinical routine. Dual Energy can make the difference between images and answers, as you can get a greater depth of information compared to a traditional single energy scan. Our scanners offer a seamless solution with optimized scanning technologies and automated results. This lets you visualize, characterize and quantify various materials in a personalized and consistent way for virtually all patients and a wide range of clinical questions.

Dual Energy spectral imaging supports you in making confident diagnostic and treatment decisions based on answers only available with Dual Energy. This helps you to impact clinical outcome and deliver optimal care for your patients.

Features & Benefits

Move from morphological to functional imaging

Dual Energy spectral imaging provides clinical answers that let you move to functional imaging by offering clinical information beyond morphology. Dedicated applications fine‐tuned for your specific clinical questions support you in all clinical fields. These range e.g. from quantifying iodine concentrations of oncological lesions, assessing lung perfusion defects, differentiating brain hemorrhages to visualizing bone marrow edemas and quantifying gout.

syngo.CT DE Monoenergetic Plus

syngo.CT DE Monoenergetic Plus simulates images that are equivalent to images scanned with a single photon energy beam, depending on the energy (keV). By changing the energy (keV), you can enhance the contrast between different materials. syngo.CT DE Monoergetic Plus provides a range of keV values from 40-190 keV.

_{COURTESY:
Courtesy of Peking Union Medical College, Beijing, China}

syngo.CT DE Virtual Unenhanced

syngo.CT DE Virtual Unenhanced allows you to visualize the contrast agent concentration in soft body tissue. The application generates virtual non-contrast (VNC) images by subtracting iodine from the Dual Energy data sets. The VNC images can be used for baseline density measurements.

_{COURTESY:
Courtesy of Peking Union Medical College, Beijing, China}

syngo.CT DE Lung Analysis

syngo.CT DE Lung Analysis combines Lung Vessels and Lung PBV. Lung Vessels is designed to visualize the iodine enhancement in pulmonary vessels. Different colors are assigned to differentiate between perfused and non-perfused pulmonary arteries. Lung PBV (Perfused Blood Volume) is designed to visualize and quantify the iodine uptake in the lung parenchyma.

_{COURTESY:
Courtesy of Hospital Calmette Lille, Lille, France}

Personalize your Dual Energy acquisition to your patient’s needs

Expanding precision medicine requires us to adapt technology to diverse patients, by adjusting to their size and age levels which involves a huge variety of challenging clinical questions.

With powerful Dual Energy solutions from Siemens Healthineers patients benefit from personalized protocols without extra dose for reliable clinical answers.

At the same time, you benefit from the automatic selection and the right combination of the scan settings. Multiple kV levels let you adapt to the patient size. A large spectral separation means even the most demanding exams, like visualizing bone marrow edemas, are possible. Always available dose modulation offers equal or even lower dose than a conventional 120 kV CT scan resulting in a dose neutral acquisition.

Dual Energy spectral imaging is available across the portfolio of Siemens Healthineers CT scanners:

Dual Source Dual Energy

During a Dual Source Dual Energy scan, two CT datasets are acquired simultaneously with different kV and mA levels, allowing you to visualize differences in the energy-dependence of the attenuation coefficients of different materials. These images are combined and analyzed to visualize information about anatomical and pathological structures.

Available for Dual Source CT (SOMATOM Drive and SOMATOM Force).

TwinBeam Dual Energy

TwinBeam Dual Energy (TBDE) allows simultaneous acquisition of high and low kV datasets in a single spectral CT scan by splitting the X-ray beam with two filters before it reaches the patient, enabling high-contrast dynamic applications.

Available for SOMATOM X.cite, SOMATOM go.Top, SOMATOM Edge Plus and SOMATOM Definition Edge.

TwinSpiral & Dual Spiral Dual Energy

The Twin Spiral Dual Energy scan mode acquires two consecutive spiral data sets at different kV and mA levels in one easy to understand UI timeline. The additional tin filter brings improved material separation to the Dual Energy applications. CARE kV complements existing dose reduction technologies for dose neutral Dual Energy acquisitions. The Dual Spiral Dual Energy scan mode consists of two successive spiral scans at different kV and mA levels.

Available for SOMATOM X.cite, SOMATOM Edge Plus, SOMATOM Definition Edge and SOMATOM go.platform

Siemens Healthineers focuses on optimizing relevant quality criteria for spectral imaging

Image quality is crucial for reliable DECT imaging since dual energy data processing is sensitive to small changes of the Hounsfield units. Relevant criteria comprise the spectral separation and temporal coherence of the low and high energy data, as well as the temporal and spatial resolution of the CT images, but of course also the dose efficiency or the workflow aspects play an important role in enabling efficient DECT imaging in daily routine.

Spectral Separation

The tin filter enables dose neutrality by minimizing spectral overlap

The single energy gray-scale image (left) does not allow for differentiation of the two materials. Spectral imaging with inferior spectral separation (middle) allows material differentiation but with limited differentiation (noise in the green/orange material space). With excellent spectral separation, the differentiation is clear (right; i.e., Dual Source Dual Energy, TwinSpiral Dual Energy).

The spectral separation refers to the amount of overlap between the detected low and high energy X-ray spectrum. Greater spectral separation results in more reliable and quantitative material decomposition—relevant for better image quality, as illustrated in the figure.

Acquisition methods have unique levels of spectral separation. Techniques that can incorporate additional dedicated beam filtration (e.g., Dual Source Dual Energy or TwinSpiral Dual Energy) have considerably improved spectral separation necessary for challenging spectral imaging tasks such as differentiation of bone marrow edema. This is also directly related to radiation dose: with better spectral separation, less dose is required to obtain the same image quality^1,2

Dose Neutrality

Dual Energy spectral imaging can provide additional diagnostic information, however, this should not come at the expense of an increased patient dose compared to a conventional single energy examination. Siemens Healthineers Dual Energy solutions incorporate all state-of-the-art dose reduction features like tube current modulation or iterative reconstruction to allow dose neutral spectral imaging acquisitions. Spectral separation also plays an important role since systems with dedicated filtration achieve the highest spectral separation without a dose comprise^1,2

Get exactly what you need whenever and wherever you need it

Dual Energy is available across the portfolio of Siemens Healthineers CT scanners, helping you to provide better outcomes for your entire patient population – regardless of operational, financial, or clinical constraints. Dual Energy spectral imaging offers you automation, control and choice. Your selected combination of spectral series is processed and transferred to your PACS completely automatically. The results are therefore available where you need them and when you need them, even for retrospective analysis.

Rapid Results Technology for direct to PACS results

Rapid Results enables direct communication between syngo.via and SOMATOM CT scanners, triggering zero-click postprocessing within the selected scan protocol. In that way, syngo.via automatically creates and sends ready-to read results to the PACS. Rapid Results will automatically generate standard visualizations of different anatomies in any required orientation and thickness for all Dual Energy applications.

SPP – Spectral Post Processing dataformat

By fusing low- and high-kV data into the DICOM conformant spectral imaging data format, SPP (Spectral Post-Processing), data and transfer times to PACS are reduced. In your PACS, the SPP dataset shows a single DICOM dataset either as Mixed or Monoenergetic Plus images while maintaining intact the low and high Dual Energy information. SPP enables Interactive Spectral Imaging and gives the user retrospective access to the encapsulated spectral data at any time.

Courtesy of Peking Union Medical College, Beijing, China

Interactive Spectral Imaging – as easy as windowing

Switch between spectral imaging views on the fly. Use additional diagnostic information at a glance based on spectral image data in MM Reading and CT View&GO. Toggle between your Iodine maps and VNCs datasets and change keV levels of Monoenergetic Plus images as easy as windowing. Enabled by new Spectral Post Processing (SPP) data format to reduce complexity and storage needs.

myExam Companion for Spectral Imaging

myExam Companion smoothly navigates users through spectral CT examinations – by sharing built-in expertise, characterizing real-time patient input, and adjusting key parameters to each patient. It also guides them to Dual Energy reconstructions, such as Iodine Maps or Virtual Non-Contrast, that are generated PACS-ready. For radiologists, this means they have additional information to work with.

Recon&GO Inline Results

Recon&GO standardizes results by automatically generating the most appropriate DE inline results in any required orientation and thickness. Just define your workflow once and let Recon&GO produce the decision basis.

Available for Mixed, Monoenergetic Plus, VNC, Iodine Maps, Liver VNC, Lung Analysis (incl. Lung PBV), Brain hemorrhage, Direct Angio, Bone Marrow, Gout, Calculi Characterization and Rho/Z.

Recon&GO Spectral Recon

Benefit from the speed of Dual Energy reconstructions calculated directly on the IRS based on the spectral information available in the raw data, while reducing data and transfer times to PACS.

It offers full freedom of recon parameters (e.g., kernels, recon options such as different orientations, including oblique). Full freedom for further multiplanar reconstructions and quantification of DE-related parameters.

Available for Mixed, Monoenergetic Plus, VNC (Virtual Non-Contrast) and Iodine Maps.

FAST DE Results

FAST DE Results directly sends the spectral results from the scanner to the PACS. Up to 3 Dual Energy reconstructions can be sent within one recon job.

Available for Iodine Maps, Monoenergetic Plus, VNC, Lung PBV, Liver VNC and Rho/Z.

syngo.CT Dual Energy

syngo.CT Dual Energy allows for retrospective interaction of Dual Energy data and enables customization of the Dual Energy analysis to the clinical question. This empowers the user to customize their reading based on the clinical questions by e.g. changing keV levels or the display of Fat Maps. syngo.CT Dual Energy allows the user to create their own application classes for even more advanced research questions.

Clinical Use

Abdominal CT with suspicious lesions in the liver

SOMATOM Force

Scan time: 6.85 s
Scan length: 315 mm
80/Sn150 kV
CTDI_vol: 4.58 mGy
DLP: 130.23 mGy*cm

Uncompromised, precise Dual Energy with tissue differentiation.

_{Courtesy of Peking University Medical College, Beijing, PR China}

Dual Energy Lung Imaging

SOMATOM Force

Collimation: 128 × 0.6 mm
Scan time: 4.12 s
Scan length: 355 mm
Rotation time: 0.25 s
Tube setting: 80/Sn 150 kV, 115/70 mAs
CTDI_vol: 7.78 mGy
DLP: 298.7 mGy*cm
Eff. dose: 4.18 mSv

Fast Dual Source Dual Energy technology helped visualize the degree of perfusion defects after resection of the left lung to treat suspicious lesion

_{Courtesy of University Hospital Calmette, Lille, France}

Trauma follow-up – TwinSpiral DE CT of the knee

TwinSpiral Dual Energy

SOMATOM X.cite

90 kV / Sn150 kV
CTDI_vol: 16.65 mGy
DLP: 417 mGy*cm
Exposure time: 12 s
Pitch: 0.6 (each)
Rotation time: 0.5 s (each)

Spectral assessment of bone marrow

TwinSpiral Dual Energy helps distinguish blood bruises within the bone marrow
By filtering out the high energies with Tin Filter, TwinSpiral Dual Energy provides optimal spectral separation in bone marrow and no dose penalty

_{Courtesy of University Hospital Erlangen, Erlangen, Germany}

Dual Energy thorax and abdomen incl. spine for post trauma evaluation

Collimation: 128 x 0.6 mm
Pitch: 0.6
Scan time: 12.08 s
Scan length: 555 mm
Rotation time: 0.5 s
Tube setting: 100/Sn 150 kV, 89/47 mAs
CTDI_vol: 5.28 mGy
DLP: 276.5 mGy*cm
Eff. dose: 4.15 mSv

High power reserves
Fast DE acquisition in clinical routine
Advanced DE applications such as syngo.CT DE Bone Marrow
High-resolution imaging

_{Courtesy of University of Tuebingen, Tuebingen, Germany}

Dual Energy evaluation of pulmonary embolism and lung perfusion

SOMATOM Force

Collimation: 128 × 0.6 mm
Scan time: 4.12 s
Scan length: 355 mm
Rotation time: 0.25 s
Tube setting: 80/Sn 150 kV, 115/70 mAs
CTDI_vol: 7.78 mGy
DLP: 298.7 mGy*cm
Eff. dose: 4.18 mSv

Fast Dual Source Dual Energy technology helped visualize the degree of perfusion defects after resection of the left lung to treat suspicious lesion

_{Courtesy of University Hospital Calmette, Lille, France}

Dual Energy Cardiac Imaging

Collimation: 2 x 128 x 0.6 mm
Scan time: 10.9 s
Scan length: 208.4 mm
Rotation time: 0.25 s
Tube setting: 90/Sn150 kV, 128/108 mAs
CTDI_vol: 10.99 mGy
DLP: 230.9 mGy*cm
Eff. dose: 3.23 mSv
HR: 53-58 bpm

Cardiac CT scans exceeding 16 cm with 66 ms temproal resolution, low dose and Dual Energy information.
With a single scan, both CTA and myocardium PBV information are acquired without any dose penalty for DE aquisition

_{Courtesy of MUSC Medical Center, Charleston, USA}

Find out how Dr. Moritz Albrecht and his team from the University Hospital Frankfurt use Dual Energy CT in their daily clinical routine. Watch the videos on PEP-Connect:

Watch the video here.

CT-Dual Energy – Pulmonary Angiography – Color Coding and Monoenergetic Plus Tutorial

Watch the video here.

Watch the video here.

Scientific Corner

Find out about the latest research and clinical trends in Dual Energy CT. Watch the recordings of the scientific sessions from the SOMATOM World Summit 2019:

Role of Dual Energy CT in abdominal imaging

Jeong Min Lee, Seoul National University Hospital

TwinBeam Dual Energy – Benefits in daily clinical routine

Harald Seifarth, Esslingen Hospital

The role of Dual Energy CT in Pulmonary Vascular Diseases

Martine Rémy-Jardin, University Centre of Lille

Value of Dual Energy CT in MSK Imaging

Moritz Albrecht, University Hospital Frankfurt

Role of Dual Energy CT for pancreatic imaging

Lorenz Biggemann, University Medical Center Göttingen

Dual Energy CT response evaluation in GIST - Beyond RECIST and Choi

Mathias Meyer
University Medical Center Mannheim

Services & Support Education & Training

Krauss B, Grand KL, Schmidt BT, Flohr TG. The importance of spectral separation : an assessment of dual energy spectral seperation for quantitative ability and dose efficiency. Invest Radiol. 2015;50(2):114-118.

Faby et al. Performance of today's dual energy CT and future multi energy CT in virtual noncontrast imaging and in iodine quantification: A simulation study. Med. Phys. 2015;42(7):4349-4366.

Available on syngo.via

* Not all modules maybe available for all systems. Please contact us for further information.

The difference between images and answersDual Energy spectral imaging

Features & Benefits

Move from morphological to functional imaging

syngo.CT DE Monoenergetic Plus

syngo.CT DE Virtual Unenhanced

syngo.CT DE Lung Analysis

Personalize your Dual Energy acquisition to your patient’s needs

Dual Energy spectral imaging is available across the portfolio of Siemens Healthineers CT scanners:

Dual Source Dual Energy

TwinBeam Dual Energy

TwinSpiral & Dual Spiral Dual Energy

Siemens Healthineers focuses on optimizing relevant quality criteria for spectral imaging

Spectral Separation

Dose Neutrality

Get exactly what you need whenever and wherever you need it

Rapid Results Technology for direct to PACS results

SPP – Spectral Post Processing dataformat

Interactive Spectral Imaging – as easy as windowing

myExam Companion for Spectral Imaging

Recon&GO Inline Results

Recon&GO Spectral Recon

FAST DE Results

syngo.CT Dual Energy

Clinical Use

Abdominal CT with suspicious lesions in the liver

Scientific Corner

Role of Dual Energy CT in abdominal imaging

TwinBeam Dual Energy – Benefits in daily clinical routine

The role of Dual Energy CT in Pulmonary Vascular Diseases

Value of Dual Energy CT in MSK Imaging

Role of Dual Energy CT for pancreatic imaging

Dual Energy CT response evaluation in GIST - Beyond RECIST and Choi

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