When a patient is incorrectly positioned for a scan the isocenter may be exposed to a higher level of radiation. This effect is accentuated by an increased distance between the patient and the detector during the acquisition of the Topogram. Here, two Topograms can be compared, scanned with the same parameters but different table heights.

In the Patient Model Dialog it is possible to change the language for the API (Automated Patient Instruction) (marked in red on image 1).
This is how to set the available languages in the best order of importance:
Go to Setup -> API / Comment. Select “Sort” (marked in red on image 2).
Then select a language and use the arrows to place it in the desired position (image 3). Click on “OK” to confirm and save the changes.

Speeding up workflow is important for all medical institutions to achieve diagnostic results as soon as possible. The mouse control options for syngo.via can help fulfil this need. This month’s tips and tricks show you how and for which context they can be applied.

LMB = Left mouse button RMB = Right mouse button MMB= Middle mouse button

An artifact is clearly visible in the VRT image (see red circle, on image 1).
It is a motion artifact, but on the same level no other artifacts can be immediately seen.
The pelvic bone doesn’t show any motion. So, “real” patient motion can be excluded indicating that the motion comes from inside the colon. Check the marked area (see green circle on image 2) of the colon wall where a lack of sharpness can be detected.
Clearly, some motion can be seen there, after adapting the window width and level.
As it is at the same z-position we can say that the motion is caused by flatulation during the examination.

FAST Spine speeds up workflow and aligns spine reconstructions with one click. The “Spine Vertebra” reconstruction, for example, creates paraxial images by default. When sagittal or coronal images are needed, just change the reference segment.

Image 1: Shows the default paraxial reconstruction. The function “Set Reference Segment” (marked in red on the image) changes the reference segment (marked in red on image 1).
Image 2: This results in “coronal” images exactly aligned with the anatomy of the spine. Depending on the selected segment, it is possible to create “coronal” or “sagittal” images. The orientation of the resulting images is clearly marked by the orange arrows.

It is often easier to evaluate the heart valves with various image settings. As is shown on the image, the cusps of the aortic valve are better differentiated. To do this, please use the invert option within syngo.via* (Marked in red on the image). Get access to this option via the right lower corner menu.

* syngo.via can be used as a stand-alone device or together with a variety of syngo.via-based software options which are medical devices on their own rights.

syngo.via makes it possible to navigate fast and easily through image data, customizable to your own workflow evaluation.

The following methods facilitate navigation to the image you are looking for:

• Click and hold on the right mouse button, then use the mouse to navigate.
• Use the mouse wheel for easy scrolling up or down around the region of interest.

On the keyboard, e.g. you can use the following buttons for simultaneous actions
with other mouse functions:

• “Arrow up”– one image per click or continuous scrolling.
• “Arrow down”– one image per click or continuous scrolling.
• “Page Up”– scroll up with bigger steps through the dataset.
• “Page down”– scroll down with bigger steps through the dataset.
• “Home”– go to the first image of the loaded series.
• “End”– go to the last image of the loaded series.

The scan protocol which is used the most can easily be placed at the top of all the scan protocols, for an easy and fast access.

For this example the “AbdomenRoutine” scan protocol is used the most and the user wants to change the position in the list. (See image 1)
In the Scan Protocol Assistant it is possible the place a scan protocol where ever you want.

How to start:
1. Open the Scan Protocol Assistant and select the entry “Manipulate scan protocols (cut/copy/paste/delete)”.
2. In Step 2 select a scan protocol with the left mouse button and drag it to the desired position.
(See image 2)
3. Confirm the changes in Step 3.
From now on the scan protocol will be stored on the preferred position. (See image 3)

For optimal dose distribution within one scan range, use the scan protocol "ThorAbd."* This protocol has a special feature that uses a lower dose for the thorax area than for the abdomen. For the thorax, 60% of the normal radiation is used. The average dose saving can be 30%. The green dashed lines (image 1) indicate the borders between the lowered and the normal dose. This line can be adapted when the third recon job (Abd) is selected.

*(Definition scanners only.)

Choose in a dedicated workflow e.g. "CT Vascular" in a MPR segment "Preset" from the bottom right corner menu.
Immediately the menu is displayed containing all available presets such as "CT Presets". (See image 1)
You can easily modify the user specific windowing presets simply by right click a windowing preset e.g. Soft Tissue.
Choose "Modify Preset" from the context menu. (See image 2)
Now the windowing preset dialog box is displayed. (See image 3)
To adjust the preset values set the following values "c" and "w": "c" (center) defines the brightness
"w" (width) defines the contrast
For PET, NM, or SPECT images set the following values:
B (Bottom) defines the lower window limit
T (top) defines the upper window limit
To change another window preset, select the desired item in the preset name list and adjust the windowing values.
To save all changed windowing presets, click "OK".

TIP: The changed windowing presets are user specific and cannot apply another user presets setting. In the CT Colon workflow it is not possible to modify and save the CT windowing presets in the CT Colon workflow step. Therefore you can do this in the MM Reading workflow step.

For more information check the Help Menu F1 Applying windowing presets.

¹ syngo.via can be used as a standalone device or together with a variety of syngo.via-based software options, which are medical devices in their own rights. The product and the syngo.via based software options are pending in some countries the necessary releases and thus are not yet available for sales in all countries, e.g. Brazil.

Proper placement of the ECG lead is essential to provide a strong and stable signal. A bad ECG signal (see image 1) during the acquisition may result in a non diagnostic study.

Please take these precautions into account to provide stable ECG signals:

Fresh supply of ECG lead.

Skin Area must be shaved and cleaned with alcohol to ensure oil-free surface.

Check the ECG before scan start on the gantry and/or on the Trigger subtaskcard.

Ensure a tidy layout of the ECG cables along the patient side.

It is important to recognize a sub-optimal ECG trace. A good ECG signal has clearly-defined R waves and an identifiable diastolic phase represented by a flat line between the T and P waves. (see images 2) Scanning with a sub-optimal ECG signal necessitates a repeated scan due to motion artifacts and poor image quality. Leading to an avoidable extra exposure for the patient.

On our CT scanners there are several techniques available to scan with the lowest dose. One of them is CARE Dose4D. CARE Dose4D adapts the tube current (mAs) to the patient's size based on the Topogram. The tube current will be automatically lowered for slim patients and will be increased for more obese patients. The advantage is that it is not necessary to adapt the tube current for every patient. The image quality is set by the Quality reference mAs/rot of an average sized patient. The tube current will be adapted if it is necessary to keep the image quality constant. All the Siemens default protocols for cardiac scanning use CARE Dose4D and deliver the correct parameters for an excellent cardiac scan. In customized protocols, check the scan sub-task card to be sure CARE Dose4D is switched on (marked in red on the image).

When a bigeminus pattern exists, the scanner opened up the pulsing window automatically in the past, independent of the given input units (see image 1). The reason was to create the ability to reconstruct in the right phase of the RR interval. This led to unnecessary radiation for the patient. In the latest software version for the SOMATOM Definition Flash and SOMATOM Definition (syngo CT 2010A), this scan mode can be more dose aware! It is now possible to perform an Adaptive Cardio Sequence with absolute positive milliseconds. This allows an optimization of end-systolic acquisition in case of a bigeminus pattern (See image 2).

A positive absolute delay (ms) is used, with the following parameters:
Scan: 300 to 400 ms
Pulsing: manual
Range: 300 to 400 ms

These settings lead to a pulsing window with a fixed width and therefore to a lower dose.

In the latest version of syngo InSpace 4D, there is a new feature called “Perspective” (shown in red on Image 2).

This feature helps you to “look around the corner.” Shown in the example on Image 3, you can see how it works. Place the marker in the pop-up menu and use the slider. The perspective of your view changes and now it is much easier to see what is behind the jaw. Of course, this feature can also help you to improve your readings in other body regions as well.

The HU values don’t change whether CARE Dose 4D is switched on
or not.
A change in the tube voltage can lead to different HU values, but the tube voltage is not affected by using CARE Dose 4D.
It is only the number of quanta (= the mAs value) that will be adapted by CARE Dose 4D.

The newest versions of syngo CT 2010A, syngo CT 2010B and syngo MMWP 2009B now include InSpace 4D. One important advantage of this new feature is that while loading a dataset, the table removal calculation can be done automatically in the background, resulting in a faster workflow, increased productivity and less mouse clicks.

You can activate this feature as follows:
Open syngo InSpace 4D.
Select “InSpace” and then “Settings” in the menu bar. (Marked in red on the image). Place the markers on the same positions as in the example. (Marked in green on the image).
From now on, every time a dataset is loaded, calculation of the table removal will be done automatically in the background.

The following points are important in order to obtain the best results with the lowest dose for your brain perfusion scans.
These parameters are defined for adaptive 4D Spiral perfusion scans:

Use the default protocol that comes with your scanner:
     For example, in the latest syngo CT software for the
     SOMATOM Definition AS we use 80 kV and 200 mAs.

Do not scan longer than 45 seconds. A longer scan time
     does not have any influence on the results and increases
     patient dose.

The maximum cycle time should not exceed 1.5 seconds. Longer cycles times may
      lead to errors.

If possible, position the patient so that the eyes are not in the scan field.

Ensure good contrast enhancement that yields a well-defined bolus by choosing an
      appropriate contrast protocol (consider needle, volume, flow rate, saline chaser).
      We recommend 36ml Iodine (400mg/ml) at a flow rate of 6ml/s followed by a saline
      chaser of 30ml with identical flow rate.¹

¹ Values are recommended by Doctor P. Schramm, Department of Neuroradiology, University Göttingen, Germany.

It is possible to switch off this function. You can use the advantage of monitoring the contrast enhancement during the injection and start the scan when desired manually. On the following screenshot you will see where you can switch the Auto Trigger off. Also on the Trigger Subtask you get a message that the Auto Trigger function is disabled.

Further information about the syngo VPCT Neuro and other clinical applications can be found at www.siemens.com/DiscoverCT

During analysis of the vessels in syngo InSpace 4D AVA (Advanced Vessel Analysis), you can easily edit or delete points on the centerline. Select the "Edit" function (marked in green on image 1) then select the Vessel mode (marked in red on image 1). In the cross-sectional MPR, MPR or VRT, you can select the green handles and then drag them to the desired place or delete them with the delete button on your keyboard. The centerline will then be updated automatically (image 2).

Contrast Volume (ml) = (scan time (s) x flow rate (ml/s)) + 20 ml

After performing a multiphase reconstruction for a cardiac examination, you want to save only one phase.

It is possible within syngo to split your multiphase dataset into different series.

The workflow is described below:

1. Select your multiphase dataset in the patient browser
2. Open the Application: Conversion
3. Mark the checkbox:"Split-up series according to trigger delay (one series holds all slice positions)"
4. Send your desired phase to PACS

SOMATOM Definition scanners deliver 4D datasets while syngo InSpace4D visualizes hemodynamics in excellent quality. Of course it is also important for you to be able to measure the diameter of any vessel and Siemens' AVA (advanced vessel analysis) efficiently provides this capability.
Even after creating your trace, it is still possible to change the time sequence to obtain the best contrast phase.
On the attached image, you can readily see that it is easy to use the 4D dialog window and syngo InSpace AVA at the same time.

When you work with Dual Monitor, syngo 3D lets you select two differents series and load them in the compare mode. To be comparable, the series must be acquired with the same modality type. It is also possible to load series from two different patients.
Make a multi-select of two series in the Patient Browser with the CTRL-key and load them via the dedicated icon into syngo 3D. Zoom and Pan for example will infuence both series, Parallel or Radial Ranges can only be created on one series at the time.

When you create MPR ranges in the syngo 3D card, you can select the icon "Constant Number of Images". The following workflow shows you how to get the same behaviour for the MPR ranges in syngo InSpace4D where there is no dedicated icon available:
1. Open the MPR Ranges menu
2. Define the number of images (20 is used here)
3. Select the first and the last frame, then the spacing will be adjusted to keep the number of steps constant.

On the following image the red-outlined area indicates where you can define the fixed number of images.

When using the Kidney Stone Application class in syngo Dual Energy, small kidney stones (< 3 mm) may not be color coded. To depict these stones in color, you can perform a recalculation using a lower Range value (minimum should not be less than 2). You can change the Range value in the Advanced Parameter Definition menu. The Range value indicates the typical range of smoothing filter in units of pixel size.The use of a smaller value will improve the detection of small kidney stones as can be seen in the following images.

In syngo InSpace 4D, it is possible load up to three different datasets of different patients. After loading the first patient you select "CTRL+O". The patient browser will open and you can select another series and load it with "Enter." The previous dataset will move to the background but remains available. In the main menu you find all loaded datasets under "Volumes" and can easily switch between them.

With "Center Click" in syngo Oncology, you can easily define how a vessel adjacent to a tumor is situated. When you use the function "Center Click" you have the ability to rotate the MPR views 360 degrees in all directions. When the icon (marked in red on the image) is activated, use the SHIFT-Key + one left mouse click in one of the MPR segments on the vessel. This point will be placed in the center of the segment and stay there. The pointer of the mouse will change automatically into the rotate function and you can rotate the image in all directions. The workflow is displayed on the following images.

For example, when you create an image and want to use it in a presentation, you do a right mouse click on the "Save As" icon (indicated in red on the image), and select the desired format. Alternately, if you are using a USB-device that is supported by our software, you can save the image directly to it.

When you have loaded thin slices in the viewing card to do your reading or to do other manipulations on the images, you can easily send them into the 3D card and continue your post-processing process by clicking on the icon in the right lower corner "3D MPR" (the red marked icon on the image). Then the same series will be loaded automatically into the 3D card.

To load images of different patients into the same folder of the Viewing task card, please activate the Multi View icon.
Immediately the layout of the Viewing task card changes to the special Multi View layout, the image segments of different studies or patients are now divided by a triple line. To load the data of the patients, please use the "Multiple Selection " or the "Drag and Drop " Technique.
The Multi View mode lets you easily and simultaneously compare, scroll
and manipulate images of different series, studies or patients.