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Improving image quality of the brain by using IRIS and X-Care

SOMATOM Definition Flash Scanning

Author: By Dominik Augart, Barbara Wieser, Christoph Becker, MD
Department of Radiology Ludwig-Maximilians-University Munich, Germany

History

A 76-year-old female patient with a chronic dural hematoma following a fall presented at our department. The first scan was performed 24 hours after the fall with a SOMATOM Sensation, 64-slice scanner utilizing CARE Dose4D. To check progress of the wound, a follow-up scan of the skull was requested. An additional exam was taken 7 days later with a SOMATOM Definition Flash utilizing IRIS and X-CARE, and Neuro BestContrast.

 

Diagnosis
The first scan revealed a chronic subdural hematoma with old as well as fresh blood. There was no indication of intra-cerebral, subarachnoid or intra-ventricular bleeding. Additionally, there was no indication of an ischemic event.
A significantly better judgment of the spread and differentiation between old and new blood as well as the chronic subdural hematoma was first possible with the second examination one week later. This clearly showed additional hypodense structure indicating fresh bleeding that could not be detected in the previous examination.

 

Comments
Due to the newest scan and reconstruction technologies, a significantly better image quality resulted making possible a better delineation of bleeding possible. The differentiation between old and new blood was also substantially improved. A further significant advantage of these new procedures is not only better image quality but also dose reduction. In our follow-up study, we were able to determine, in addition to an overall dose reduction, close to 40% less dose applied to the eye lens. This is particularly important in order to minimize the possibility of long-term damage to the eye lens for young patients who must undergo repeated scans.
 

Significantly improved image quality to delineate the bleeding (arrow)
Chronic dural hematoma (arrow)
Fresh bleeding could be outlined by the hypodense structure (arrow) that couldn’t be clearly seen in the initial examination (Fig 2B arrow).
Fresh bleeding could be outlined by the hypodense structure (arrow) that couldn’t be clearly seen in the initial examination (Fig 2B arrow).

Examination Protocol

Scanner SOMATOM Definition Flash SOMATOM Sensation 64
Scan area Head Head
Scan length 150 mm 150 mm
Scan direction Cranio-Caudal Cranio-Caudal
Scan time 9 s 30 s
Tube voltage 120 kV 120 kV
Tube current 320 mAs 306 mAs
Rotation time 1.0 s 1.0 s
Dose modulation CARE Dose4D, X-CARE CARE Dose4D
CTDIvol 42.21 mGy 49.80 mGy
DLP 661mGy*cm 761.88 mGy*cm
Eff. Dose 1.4 mSv 1.6 mSv
Slice collimation 128 x 0.6 40 x 0.6
Slice width 5 mm 5 mm
Reconstruction kernel J37s H37

The information presented in this case study 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 Systems to be used for any purpose in that regard.


The drugs and doses mentioned herein are consistent with the approval labeling for uses and/or indications of the drug. The treating physician bears the sole responsibility for the diagnosis and treatment of patients, including drugs and doses prescribed in connection with such use. The Operating Instructions must always be strictly followed when operating the CT System. The source for the technical data is the corresponding data sheets. Results may vary.

Date: 2011-02-17


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