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    “In all relevant imaging procedures, such as computed tomography, angiography and molecular imaging, Siemens has pioneered the development of dose reduction technologies for many years,” said Dr. Bernd Montag, CEO, Imaging & Therapy Systems Division, Siemens Healthcare. “Now, we’re planning to launch a comprehensive education program which will support clinical staff in protecting themselves and patients better against avoidable radiation exposure. In this context, we’ll be offering new training seminars, and we will provide a Guide to Low Dose, among other initiatives.”
    For radiological and nuclear medicine examinations that involve the use of ionizing radiation with X-ray fluoroscopy or radiodiagnostics, the medical profession generally applies the ALARA (As Low As Reasonably Achievable) principle – aimed to strike an ideal balance between the required image quality and the radiation dose. Generally, medical imaging scans require an increased dose of radiation to enhance the image quality. For its radiological devices that work with X-rays or radioactive tracers, Siemens has developed an entire range of technologies – Combined Applications to Reduce Exposure (CARE) – that enable the dose to be reduced significantly, without compromising the image quality. These technologies include, for example, IRIS (Iterative Reconstruction in Image Space), a new method for the reconstruction of CT images, High Definition PET (HD-PET), a high-resolution Positron Emission Tomography technology for molecular imaging, and a comprehensive package of dose-reduction features for interventional imaging, which are now available free of charge for our customers.
    Alongside dose reduction, dose control is an important measure for avoiding unnecessary radiation. In the future, radiological devices from Siemens will issue a warning message to the user if a certain dose threshold is exceeded in critical applications. Reports are generated for examinations; these contain the patient data, the relevant protocol and the dose values. Clinics can then analyze this information, according to specific criteria, such as the dose administered, and optimize their protocols and processes accordingly.
    Examples of dose reduction innovations from Siemens
    Siemens was one of the pioneers of dose reduction in CT. As early as 1994, scientists and engineers from Siemens had developed CARE Dose4D™, the first fully automatic radiation exposure control technique. This was followed by ECG-synchronized dose modulation (ECG pulsing) and the Adaptive Dose Shield. ECG pulsing automatically reduces the dose during cardiograms, while the Adaptive Dose Shield is the first collimator capable of eliminating unnecessary radiation that cannot be used for image reconstruction.
    In 2008, Siemens expanded its portfolio in the premium segment with the SOMATOM® Definition Flash, a dual-source CT scanner that produces an image of the entire heart in less than a quarter of a second. The radiation dose that occurs during scanning is less than one millisievert (mSv) – a value that corresponds to less than half the annual natural background radiation in Germany.
    The latest innovation is FAST CARE, a hardware and software platform for CT scanners. The FAST CARE applications offer new functions and protocols for dose reduction. They also simplify time-consuming, complex procedures, such as patient scanning or preparation for image reconstruction.
    Earlier this year, Siemens launched the SIERRA (Siemens Radiation Reduction Alliance) Dose Panel to advance the cause of dose reduction in computed tomography. This expert panel is comprised of 15 specialists in the fields of radiology, cardiology and physics, who are internationally recognized for their publications on the subject of dose in CT. The panel is working on generating proposals for how manufacturers can improve their technology and how users can help to bring about further dose reduction.
    Since 1994, Siemens has been continuously helping to reduce dose during interventional procedures in radiology and cardiology. Siemens is not only enhancing its CARE applications with new functionality at this year’s RSNA but also offering all Artis zee® customers – both existing and new – these CARE applications free of charge. This underlines Siemens’ commitment to dose reduction and the optimization of treatment results in hospitals.
    CARE includes new applications that reduce radiation not only for patients but also for clinical staff, as well as simplifying the post-examination documentation of the dose values. With special applications, such as radiation-free collimation and patient positioning or pulsed fluoroscopy, both the patient and the examiner are exposed to as much as 75 percent less radiation. For 3D imaging with syngo® DynaCT, there are new, particularly low-dose image acquisition protocols that enable 3D imaging for neurology from as low as 0.3 mSv, reducing the dose by up to 72 percent, compared to conventional 3D protocols.
    Also new is CAREguard, which supports dose monitoring during complex interventional procedures. To help minimize applied skin dose and align with established or future regulatory requirements, physicians can use CAREguard to predefine up to three different skin dose thresholds. Once these values have been reached, physicians will receive acoustical and visual warnings so that he or she can adapt the procedure accordingly. At the end of the examination, a structured dose report documents all patient dose values, making it easier for hospitals to manage their dose reporting.
    Siemens’ molecular imaging technologies – SPECT (Single Photon Emission Computed Tomography), SPECT/CT and PET/CT – are designed to reduce the radiation dose for all exams, simplifying the scanning process considerably and yielding high image quality at the lowest possible dose level, even for obese and pediatric patient examinations.
    Technologies, such as IRIS, TrueV and ultraHD-PET, improve the image quality and can provide for additional dose savings. The Biograph™ mCT system includes ultraHD-PET technology and ensures increased image sharpness and precision, and allows physicians to pinpoint small lesions with a smaller amount of injected radiopharmaceutical. In addition, the Symbia® S and T series systems utilize IQ-SPECT technology to reduce injected dose for cardiac studies by up to 50 percent, while also imaging patients in half the time, thereby, setting this family of systems apart from other general purpose SPECT and SPECT/CT systems on the market.
    All mobile X-ray devices from Siemens ARCADIS® family are equipped with the latest dose reduction functions as standard. They include EASY (Enhanced Acquisition System), which can be used to analyze the images during acquisition to optimize dose, brightness and contrast. Even objects outside the focus are displayed with high precision. Additional copper filters, radiation-free collimation and multilevel dose control also help to ensure that the minimum necessary dose is applied. For pediatric surgery, where dose levels are most critical, the ARCADIS Avantic features a detachable grid. The devices of the ARCADIS family can also be equipped with a highly sensitive DAP (Dose Area Product) measurement chamber.
    Physicians using a surgical navigation system can reduce the dose even further. NaviLink is an open interface from Siemens that enables the acquired patient dataset to be sent automatically from the mobile C-arm to the navigation system. The physician can then navigate within the patient’s anatomy without the need for any further radiographs during the operation. NaviLink is optionally available for the ARCADIS Varic and for 3D imaging with the Orbic.
    The mammography platform MAMMOMAT® Inspiration features a wide range of functions and technical details to minimize the radiation dose, including a special X-ray tube with a tungsten anode and new AEC algorithms that optimize the dose individually according to breast size and tissue type.
    The multifunctional urology workstation UROSKOP® Omnia is also equipped with CARE programs. Pulsed fluoroscopy and radiation-free collimation and patient positioning enable the radiation dose to be reduced. In addition, the physician can adjust the dose required for acquisition and fluoroscopy to exactly the right level by selecting an organ program specially tailored to the examination being conducted.
    The Siemens Healthcare Sector is one of the world’s largest suppliers to the healthcare industry and a trendsetter in medical imaging, laboratory diagnostics, medical information technology and hearing aids. Siemens offers its customers products and solutions for the entire range of patient care from a single source – from prevention and early detection to diagnosis, and on to treatment and aftercare. By optimizing clinical workflows for the most common diseases, Siemens also makes healthcare faster, better and more cost-effective. Siemens Healthcare employs some 48,000 employees worldwide and operates around the world. In fiscal year 2010 (to September 30), the Sector posted revenue of 12.4 billion euros and profit of around 750 million euros. For further information please visit: www.healthcare.siemens.com.
    Not all of the products/features mentioned here are already commercially available. Some of the products/functions mentioned here already are available for purchase in some countries. Due to the legal specifications pertaining to medical devices, their future availability cannot be promised in any country. More detailed information can be obtained from the relevant local Siemens organization.
    SOURCE Siemens Healthcare

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