CT — Torace: Pulmonx Zephyr (MCB)

Updated 06/08/24 CT Chest Pulmonx Zephyr (Endobronchial Valve) Reviewed 05/14/25 Indications - pre procedural imaging prior to endobronchial valve placement and should be ordered as Pulmonx Zephyr protocol by Pulmonology. Use CT Chest without Contrast charge. GENERAL SCAN NOTES The patient's arms must be over his/her head. Remove any metal from the imaging field of view. Have the patient cough a few times to clear secretions. This reduces incidence of small lung nodules. Topogram - lung apices through diaphragm (obtained during end inspiration). Craniocaudal scan coverage - lung apices through adrenal glands (obtained during maximum end inspiration). Adjust FOV (field of view) on topogram to smallest without cropping anatomy. Scan parameters are the same as routine chest protocol. IV Contrast: not given for this protocol. For GE scanners, it is essential for the 1st recon thickness on the scanner to match the 1st recon thickness in this protocol book for the prescribed Noise Index to be valid. The 1st recon should generally be the thickest recon in the protocol. SIEMENS PARAMETERS & RECONS Scan
Care
Scan
Coll Rot Mode kV mAs Care
Dose kV & Lvl Pitch Acq Time Time Can't scan this protocol on Sensation 16 due to thin slice limitations. Sensation 16 Go Up 32 spiral 130 51 on on 80 1.50 32 0.7 0.8 7.1 Sensation 64 spiral 120 100 on NA 1.40 64 0.6 0.5 5.6 Definition 64 spiral 120 110 on on 1.20 64 0.6 0.5 6.5 Go Top 64 spiral 120 62 on on 80 1.20 64 0.6 0.33 2.1 Drive 128 spiral 120 66 on on 1.20 128 0.6 0.5 3.3 Force 192 spiral 110 51 on on 1.20 192 0.5 0.5 2.6 IR
Recon
Name of Series Thick Interval Kernel Window Lvl Direction AX LUNG 3.0 3.0 Br57 / B70f lung 3 head/feet AX SOFT 3.0 3.0 Br40 / B41f mediastinum 3 head/feet COR SOFT 3.0 3.0 Br40 / B41f mediastinum 3 front/back SAG SOFT 3.0 3.0 Br40 / B41f mediastinum 3 left/right Pulmonx specific recon. TLC INSP ≤0.625 ≤0.625 Br38f / B30f mediastinum 3 head/feet 3 head/feet AX MIPS 8.0 3.0 Br40 / B41f lung

CT Chest Pulmonx Zephyr (Endobronchial Valve) GE PARAMETERS & RECONS Scan
Smart
Slice
Beam
Dose
Scan
Type SFOV kV mA
Range Noise
Index mA Thick Coll Pitch Speed Rot
Time Red ASIR Time LS 16 helical large 120 100-440 16.36 on 2.5 10 1.375 13.75 0.5 NA NA 10.9 Opt 540 helical large 120 100-440 16.36 on 2.5 10 1.375 13.75 0.5 NA NA 10.9 LS VCT 64 helical large body 120 100-650 18.38 on 2.5 40 1.375 55.00 0.4 50 50 2.2 Disc VCT 64 helical large body 120 100-650 1.375 55.00 0.4 NA NA 18.38 on 2.5 40 2.2 Window
Recon
Name of Series Thickness Interval Recon
Algorithm Width/Level Direction AX LUNG 2.5 2.5 lung 1600/-600 head/feet Must be first recon. AX SOFT 2.5 2.5 std full 400/40 head/feet COR SOFT 2.5 2.5 std full 400/40 front/back SAG SOFT 2.5 2.5 std full 400/40 left/right head/feet Pulmonx specific recon. TLC INSP ≤0.625 ≤0.625 standard 400/40 std full 1600/-600 head/feet AX MIPS 8.0 3.0 PHILIPS PARAMETERS & RECONS Scan
Dose
3D
Rot Scan
Mode kV Avg
mAs Index Dose Pitch Detect Colli Time Time Incisive 128 helical 120 92 19 5.6 on 1.00 64 0.625 0.75 Name of Series Thick Interval Filter Window iDose Recon
Direction AX LUNG 3.0 3.0 YA lung 3 head/feet AX SOFT 3.0 3.0 B mediastinum 3 head/feet COR SOFT 3.0 3.0 B mediastinum 3 front/back SAG SOFT 3.0 3.0 B mediastinum 3 left/right Pulmonx specific recon. TLC INSP ≤0.625 ≤0.625 B mediastinum 3 head/feet 3 head/feet AX MIPS 8.0 2.0 B lung

CT Parameters General Information 1. Ensure all files are in standard .DICOM format 2. Only SUPINE position chest CT scans with arms positioned above the head are supported. Scans obtained in PRONE position can NOT be analyzed. 3. The CT scans must have a slice thickness of 1.5mm or less (smaller slices provide more information for fissure completeness). The following CT scan radiographic parameters have been optimized in order to provide appropriate inputs to the StratX® Lung Analysis Platform. 4. The input image should NOT be reconstructed with a slice spacing larger than the slice thickness (slice spacing should be less than or equal to slice thickness, no gaps in the 3D volume are allowed). 5. The complete lung must be present on the CT scan. If parts of the lung are missing, the output parameters will be compromised. 6. Only non-contrast TLC (inspiration) scans are accepted for analysis. 7. Technologist should instruct the patient to take a full inspiration breath and hold. The scan should start once the patient has reached breath hold and relaxed their body. 8. Ensure the CT scan is not of poor quality (e.g., movement artifacts, artifacts In order to produce quality output parameters displayed in the StratX Report, it is recommended to adhere as closely as possible to the ideal parameters detailed on page 2. If a scan can’t be obtained with the ideal parameters, we have specified acceptable scan parameters on pages 3 and 4. Significant deviation from these parameters may result in reduced accuracy or an inability to analyze the CT scan. due to metal, high noise levels due to dose level, etc.). 9. Please ensure the CT scan does NOT suffer from image artifacts such as streak artifacts from implants. 10. Scans taken from CT scanners with less than 16 detector rows are not recommended. For more specific information
related to scan parameters or if
your CT scanner manufacturer is
not listed below, please contact us directly for support at
[email protected]. 11. Any series containing less than 120 images will be automatically
removed by the system. Please note that CT scanners with less than
16 detector rows are not recommended.

Ideal Scan Parameters Following these parameters will achieve the highest quality report possible Highest Quality Report Parameters PARAMETERS SIEMENS PHILIPS TOSHIBA GE Kernel Standard B30 B FC08 Standard Regular Patient (<30 BMI): 80 mAs Large Patient (>30 BMI): 100 mAs Tube Current *No tube current modulation KV 120 Slice Thickness 0.625mm Reconstruction Interval
(Slice Spacing) ≤0.625mm Pitch Range: 0.5-1.2 Range: 0.5-1.2 Range: 0.5-1.0 Range: 0.5-1.375 Rotation or Gantry Speed (sec) ≤0.5 Iterative Reconstruction None Contrast None

Acceptable Scan Parameters CT Scan Parameters WITHOUT Iterative Reconstruction No iterative reconstruction preferred 3-4mSv Dose PARAMETERS SIEMENS PHILIPS TOSHIBA GE 30mA – 770mA 20mA – 600mA 20mA - 450 mA 0mA - 900 mA Tube Current No tube current modulation preferred No tube current modulation preferred No tube current modulation preferred No tube current modulation preferred KV 120 Dose Modulation CareDose ON CarekV OFF Z-Dom ON SURE Exposure ON Smart mA ON Pitch Range: 0.5-1.2 Range: 0.5-1.2 Range: 0.5-1.0 Range: 0.5-1.375 Rotation or Gantry Speed (sec) ≤0.5 Kernel Standard ≤B45f B, C ≤FC45 Bone, Standard ≤1.5mm Slice Thickness Thinnest slice possible preferred Slice Spacing ≤slice thickness Average mSv <4.0 Contrast None

Acceptable Scan Parameters CT Scan Parameters WITH Iterative Reconstruction No iterative reconstruction preferred 1-2mSv Dose PARAMETERS SIEMENS PHILIPS TOSHIBA GE 30mA – 770mA 20mA – 600mA 20mA - 450 mA 0mA - 900 mA
Tube Current No tube current modulation preferred No tube current modulation preferred No tube current modulation preferred No tube current modulation preferred KV 120 Dose Modulation CareDose ON CarekV OFF V-Dom ON SURE Exposure ON Smart mA ON Pitch Range: 0.5-1.2 Range: 0.5-1.2 Range: 0.5-1.0 Range: 0.5-1.375 Rotation or Gantry Speed (sec) ≤0.5 Iterative Reconstruction Use SAFIRE, ADMIRE Use IMR Use ADIR 3D standard Use VEO, ASiR Iterative Strength 3 Routine 2 Standard 30-50 Kernel Standard ≤B45f B, C ≤FC45 Bone, Standard ≤1.5mm Slice Thickness Thinnest slice possible preferred Slice Spacing ≤slice thickness Average mSv <2.0 Contrast None Pulmonx Corporation 700 Chesapeake Drive Redwood City, CA 94063 © 2020 Pulmonx Corporation or its affiliates. All rights reserved. All trademarks are property of their respective owners.

D1005EN_A – April 2020 4-page CT Parameters