CT — Torace: Veran (MCB)

• Now we are ready to scan so please • Take a deep breath in (watch chest to insure a deep breath in) • Let it out (watch chest to insure air is out) • Now breathe all the way IN..IN..IN (watch chest to insure a deep breath in as far as possible – begin scanning) • Keep holding your breath – DO NOT BREATHE! • At end of scan: Breathe and relax

1.3 End Expiration CT Scan

• For the second part of this scan, I am going to ask you to take a couple of deep breaths in and out before we have you hold your breath all the out. • First, let’s practice • Take a deep breath in (watch chest to insure a deep breath in) • Let it out (watch chest to insure air is out)
• Take another deep breath in (watch chest to insure a deep breath in) • Now let it out and hold it (watch chest to insure subject is holding before starting the scan) • Keep holding your breath – DO NOT BREATHE! (count 10 seconds) • Breathe and relax (Give the patient a few relax breath. Talk the patient to insure they understand and will tolerate the breath hold. If they cannot hold their breath instruct them to do the best they can and set scanner to scan base to apex.) • Now we are ready to scan so please • Take a deep breath in (watch chest to insure a deep breath in) • Let it out (watch chest to insure air is out) • Take another deep breath in (watch chest to insure a deep breath in) • Now let it out and hold. (watch chest to insure subject is holding – begin scanning) • Keep holding your breath out – DO NOT BREATHE! • At end of scan: Breathe and relax

1.4 CT Patient Positioning

• Place patient in a supine position, lower legs supported. • Inspiration CT (TLC) scan - the arms should be placed comfortably over the head in a head arm rest. The vPad (patient tracker) should be clearly visible in the scanner field of view. • Expiration CT scan – the arms should be placed comfortably at the patient’s sides. The vPad (patient tracker) should be clearly visible in the scanner field of view. Optimal navigation registration is obtained with the full expiration scan. • Using the laser positioning lights, line up the patient so the chest is iso-center (in the middle) of the CT gantry. • Move the table so the patient is in the correct position for a chest CT scan

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• The scout scan uses default parameters (only one scout AP/PA) • TLC (Inspiration) scan is performed with arms above head. • The expiration scan is performed with arms down at patient’s sides. • To select the proper Display FOV (DFOV) perform the TLC scan first and set the DFOV to be the smallest possible including lungs and vPad. Use the same DFOV set for the inspiration scan on the expiration scan to maintain the same scan resolution for both scans

Table 1: CT Protocol Siemens Definition AS PLUS, Siemens Definition AS, Siemens Sensation64 & GE VCT, Philips Brilliance 64, Philips Brilliance iCT

Scanner make SIEMENS SIEMENS SIEMENS SIEMENS PHILIPS PHILIPS

Definition (AS) Sensation Somotom Brilliance Brilliance Scanner model Definition (AS Plus) 64 slice 64 slice 64 slice iCT 128 slice 64 Slice Dual 64 256 slice Scan Type Spiral Spiral Spiral Spiral Spiral Helix Spiral Helix Scan FOV No Selection No Selection No No No No Selection Selection Selection Selection Rotation Time (s) 0.5 0.5 0.5 0.5 0.5 0.5 Det. Configuration (128) 64 x 0.6 (64)32 x 0.6 64 x 0.6 64 x 0.625 2 x 128 x 64 x 0.6 0.625 mm Pitch 1.0 1.0 1.0 1.0 0.923 0.929 kVp 120 120 120 120 120 120 Siemens = Eff. mAs Effective Effective mAs: Effective Effective mAs: mAs: GE = mA setting mAs: M-105 mAs: mAs: M-130 M-115 Philips = mAs M-110 L-160 M-100 M-105 L-190 L-175

L-170 L-150 L-160 Dose modulation Care Dose Care Dose Care Dose Care Dose OFF OFF OFF OFF Dose Right (ACS) OFF Dose Right (ACS) OFF Beam Hardening

Correction Recon 1 Algorithm B35 B35 B35 B35 B B Additional Filter No selection No Selection No No Do not use Do not use Selection Selection Adaptive Adaptive filters filters Thickness (mm) 0.75 0.75 0.75 0.75 0.67 0.67 Interval (mm) 0.5 0.5 0.5 0.5 0.5 0.5 Iterative recon (noise Do Not use Do Not use No Do Not use Do Not use Do Not use reduction algorithm) IRIS IRIS Selection IRIS iDose iDose Scan Time (Sec) <10 <10 <10 <10 <10 <10 30cm length

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Scanner make TOSHIBA TOSHIBA GE GE GE VCT VCT Select Lightspeed Scanner model Aquilion 64

Aquilion 16 Slice 16 Slice 64 slice 32 Slice Scan Type Helical Helical Helical Helical Helical Scan FOV No No Selection Large Large No Selection Selection Rotation Time (s) 0.5 0.5 0.5 0.5 0.5 Det. Configuration 64 x 0.5 16 x 1.0 64 x 0.625 20 x 0.625 16 x 0.625 Pitch 0.9 < 1.1 0.9 < 1.1 0.984 0.969 1.375 kVp 120 120 120 120 120 Siemens = Eff. mAs mAs: mAs: mA: mA: mA: GE = mA setting M – 140 M-180 M-180 M-180 Philips = mAs L – 210 M-140 L- 210 L-270 L-270 L-270 mA Field: mA Field:

M-280 M-280 L-420 L-420 Auto mA Auto mA Dose modulation OFF OFF Auto mA OFF OFF OFF Beam Hardening Boost On Boost On

Correction Recon 1 Algorithm FC01 FC01 Standard Standard Standard No Additional Filter No No Selection No Selection No Selection Selection Selection Thickness (mm) 1.0 1 0.625 0.625 0.625 Interval (mm) 0.5 0.5 0.5 0.5 0.5 Iterative recon (noise Do Not Do Not Use Do Not Use Do Not use ASIR Do Not use use ASIR reduction algorithm) ASIR Scan Time (Sec) <10 <15 <10 <10 <15 30cm length

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• CT Dose is standardized so each manufacturer and model are matched within ± 3% of the Target CTDIvol.

Table 1.6.1 (CTDIVol selection)

Body Size CTDIvol mGy/cm Large – L 11.4 Medium – M 7.6

1.7 Size Definition (mAs selection)

• Body Mass Index will be used to determine large or medium mAs setting. The technologist will use the chart below to select the mAs setting for a given BMI.

Table 1.4.1 (mAs selection)

BMI range mAs selection >25 Large ≤25 Medium

B. CT Dose Calculation Estimates

• Veran airway segmentation software has the capability to function with a much lesser dose than used on a standard clinical chest CT scan. • Veran functionality will allow this protocol to include an inspiration & expiration scan while only using the dose equal to or below one standard clinical CT scan.

Effective Dose (E) mSv

• Effective dose (E) is used in radiation protection, to compare the stochastic risk of a non-uniform exposure of ionizing radiation, with the risks caused by a uniform exposure of the whole body. The stochastic risks are carcinogenesis and hereditary effects. It is not intended as a measure for acute or threshold effects of radiation exposure such as erythema, radiation sickness or death.

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• The effective dose (E) for a one scan session: Inspiration & Expiration is estimated to be 7mSv. The maximum amount of radiation from the clinical related radiation procedures (E) for subjects having a one scan session of this clinical protocol is equivalent to approximately 14% of the annual radiation limit for a medical worker.

Statement regarding dose estimates

• Although there are no proven harmful effects from this amount of radiation, long- term effects on the patient’s health cannot be ruled out with certainty. This dose estimate takes into account only the exposure to procedures in this clinical procedure. If the patient has experienced other radiation exposure, they should be aware that the risk of effects of radiation exposure is thought to add up across all their exposures(including studies performed as part of your medical care).

Statement regarding breast shields

• It is recommended to have an offset or foam pad between the patient and the breast shield of at least 1 to 2 inches. This allows for optimal sensor recognition and airway segmentation.

C. CT Data Transfer

Data will be transferred via network DICOM or to a CD or USB device depending on each site’s transfer mechanism.

Statement regarding the above Protocol:

Parameters such as slice thickness, slice spacing, rotation speed, pitch, and matrices, should be followed as per the above protocol or significant degradation of the scan airway segmentation will occur. The exposure settings (mA, mAs, or kv) settings in this protocol are only a recommendations based on the goals set forth in this protocol. The final determination and selection of the exposure parameters (mA, mAs, or kv) is the sole responsibility of the imaging institution performing these scans. Although there are no proven harmful effects from this amount of radiation, long-term effects on health cannot be ruled out with certainty.

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