Key Questions to Ask When Ordering neusoft computed tomography

Statement of Purpose

The American Association of Physicists in Medicine (AAPM) is a professional organization whose members include board-certified medical physicists who specialize in the safe and effective use of radiation in medicine. Medical physicists partner with radiologists, technologists, regulators, manufacturers, administrators and others to ensure that CT scans are performed using the minimum amount of radiation required to obtain the diagnostic information for which the CT scan was ordered, or to guide the therapeutic procedure for which the CT is used.

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In , the Alliance for Quality Computed Tomography Working Group was formed to provide information to CT users that enhances the quality of their CT practice. The membership includes academic and consulting medical physicists who specialize in CT imaging, representatives of each of the major CT scanner manufacturers, and liaisons to the American College of Radiology, American Society of Radiology Technologists, and the Food and Drug Administration.

The Working Group was initially charged with the development of reference CT protocols, which are defined by the Working Group to be reasonable and appropriate protocols for specified diagnostic tasks. The published protocols provide typical clinical values for a sampling of currently available scanner models, and may not always match manufacturer-supplied reference protocols.

In addition to the development of reference protocols, the Working Group developed a lexicon to assist users in navigating the different nomenclature used by different manufacturers.

Since , the Working Group has taken on a number of additional projects, including the development of recommendations and default values for CT Dose Alert and Notification Values, and the preparation of a number of teaching slide sets. Slides are available that describe the parameters on a CT scanner that affect the delivered dose; these include manufacturer-specific slide sets that show images of each manufacturer’s user interface. Additionally, slides have been developed that teach users about the Dose Check feature, and how to avoid potential problems that may occur in long interventional examinations.

To better represent the scope of the activities of the Working Group, which is dedicated to promoting the highest level of quality in CT imaging, we have adopted a new name: The Alliance for Quality Computed Tomography (AQCT).

It is our hope that you find the resources provided here to be helpful in achieving the highest level of quality in your CT practice.

American Association of Physicists in Medicine (AAPM) Working Group Recognized by the FDA

On June 10, , the Director of the Center for Devices and Radiological Health (CDRH) of the Federal Drug Administration (FDA), Jeffrey Shuren, M.D., J.D., awarded the AAPM Working Group on Standardization of CT Nomenclature and Protocols the CDRH Director’s Special Citation Award.  This award was presented “For developing CT imaging radiation safety instructional materials through a collaboration of end-users, CT manufacturers, and the Food and Drug Administration.”

The FDA award stated:

In , FDA released an "Initiative to Reduce Unnecessary Radiation Exposure from Medical Imaging", which targets high dose imaging modalities, including CT. A key partner in following through on the goals of this Initiative has been the American Association of Physicists in Medicine (AAPM) Working Group on Standardization of CT Nomenclature and Protocols. Meeting bi-weekly since , the group has worked tirelessly to advance CT radiation safety through publication of publicly available resources on the AAPM website (http://www.aapm.org/pubs/CTProtocols/).

The effect of these efforts has been to improve public health by optimizing the dose of ionizing radiation during CT scans and by helping to eliminate accidental radiation overdoses during CT scanning.

The group is an outstanding example of what can be accomplished through collaboration of key stakeholders. The group includes medical physicists, radiologists, radiologic technologists, industry representatives, and regulators, from AAPM, the American College of Radiology (ACR), the American Society of Radiologic Technologists (ASRT), the Society for Pediatric Radiology (SPR), the Image Gently Alliance, the Medical Imaging and Technology Alliance, from all 7 U.S. CT manufacturers, and from the FDA.

Additional Scanner Model Questions

Users with questions specific to a certain manufacturer or scanner model should contact the applications support line for that product. AAPM cannot respond to requests for specific customer support.

How to reach Applications Support for:

• GE Healthcare:

  • GE TiP Answerline - CT: 800-682-, option 1, option 3
  • GE Support

• Hitachi:

  • CT Help Desk: 877-228-

• NeuroLogica Corporation:

  • 1-888-564-

• Neusoft:

  • 281-453
  • Website

• Philips Healthcare:

  • Customer Care Solutions Center: 800-722-
  • Support Website

• Siemens Healthcare:

  • UPTIME Applications Support: 800-888- (Option 3)
  • Website

• Toshiba Medical Systems:

  • Learning Center

Equipment Performance Questions

Users experiencing problems in performing an exam, or that have questions on the operation or performance of their systems, should contact their service provider. The AAPM cannot respond to requests for specific customer support.

How to reach Technical Support for:

• GE Healthcare:

  • GE TiP Answerline - CT: 800-682-, option 1, option 3
  • GE Support

• Hitachi:

  • CT Help Desk: 877-228-

• NeuroLogica Corporation:

  • 1-888-564-

• Neusoft:

  • 281-453
  • Website

• Philips Healthcare:

  • Customer Care Solutions Center: 800-722-
  • Support Website

• Siemens Healthcare:

  • UPTIME Technical Support: 800-888- (Option 2)

• Toshiba Medical Systems:

  • Learning Center

Role of Qualified Medical Physicist (QMP)

Diagnostic medical physicists play an essential role in the delivery of high quality and safe CT examinations. For example, accreditation by the American College of Radiology in CT imaging requires the services of a qualified medical physicist, stating that the qualified medical physicist:

• Must be familiar with the principles of imaging physics and of radiation protection; the guidelines of the National Council on Radiation Protection and Measurements; laws and regulations pertaining to the performance of the equipment being tested; the function, clinical uses, and performance specifications of the imaging equipment; and calibration processes and limitations of the instruments used for performance testing.
• The qualified medical physicist should be available for consultation regarding patient dosimetry issues.
• The qualified medical physicist is responsible for the conduct of all surveys of the CT equipment.

A primary motivation of this working group is to support and equip AAPM members in the performance of these important duties. These materials are therefore being developed specifically for the medical physics community. Although many radiologists and technologists are well educated in the technical aspects of protocol development, there are some users who may have a difficult time in understanding and correctly implementing the provided information. We fundamentally believe that patients are best served when radiologists, technologists and medical physicists work together, each bringing their unique skill set and perspective to the task of protocol optimization. Radiologists and technologists desiring access to these protocols should contact the qualified medical physicist who supports their practice. Many practices have initiated protocol review teams to individually review each protocol in their practice. A qualified medical physicist is a necessary member of this team and can facilitate comparison of a site's existing protocols with those recommended here.

QMP Involvement in Planning for and Accepting a New CT scanner

The QMP plays a vital role not just in accepting a new CT scanner after it has been purchased and installed, but also in identifying key equipment specifications, equipment configuration, staff and radiologist training needs, and protocol configuration. The CT Install – Physicist Perspectives document reviews how a QMP may interact with a site, vendor and staff to facilitate a smooth installation process.

• CT Install - Physicist Perspectives (added 04/07/)

Computed Tomography Dose Check (NEMA XR-25) Education Slides

This section contains documents with information about CT Dose Notification and Alert values and how they can work in clinical practice. Dose Notification and Alert Values can be configured as part of a Dose Check feature described in NEMA XR-25. These documents also contain key points to ensure successful implementation of these features. These slides are intended for educational purposes and may be distributed freely with proper acknowledgement ("Courtesy of the AAPM Working Group on CT Nomenclature and Protocols").

Guidelines for the CT Dose-Check Standard

• AAPM Recommendations Regarding Notification and Alert Values for CT Scanners: Guidelines for Use of the NEMA XR 25 CT Dose-Check Standard
• CT Dose Notifications and Alerts Educational Slides

Vendor Dose Check Education Slides

• GE Healthcare (updated 06/02/) [Give Feedback]
• Hitachi (updated 06/02/) [Give Feedback]
• NeuroLogica (updated 06/02/) [Give Feedback]
• Neusoft (updated 06/02/) [Give Feedback]
• Philips (updated 06/02/) [Give Feedback]
• Siemens (added 05/22/) [Give Feedback]
• Toshiba (updated 06/02/) [Give Feedback]

Available Protocols

Adult Protocols

• CT Colonography (added 11/30/) [Give Feedback]
• Lung Cancer Screening CT (updated 11/09/) [Give Feedback]
• Routine Adult Chest-Abdomen-Pelvis CT (added 02/20/) [Give Feedback]
• Routine Adult Chest CT (updated 05/04/) [Give Feedback]
• Routine Adult Abdomen/Pelvis CT (updated 08/07/) [Give Feedback]
• Routine Adult Head CT (updated 03/01/) [Give Feedback]
• Routine Adult Brain Perfusion (updated 03/01/) [Give Feedback]

Pediatric Protocols

Your feedback regarding the content of this website is welcome. Feedback regarding this website will not be monitored daily. Users experiencing problems in performing an exam should contact their service provider.

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CT scan parameters: Translation of terms for different manufacturers

AAPM CT Lexicon v2.0 (03/08/)

Introduction

Updates for the 2.0 version include Dual Energy CT Terms and additional vendors.

For the CT technologist who operates multiple scanner models, perhaps from multiple manufacturers, the variability in names for important scan acquisition and reconstruction parameters can lead to confusion, reduced comfort and an increased potential for error. The intent of this CT terminology lexicon is to allow users to translate important CT acquisition and reconstruction terms between different manufacturers' systems.

This represents a first step in the terminology standardization effort undertaken by this working group. Phase 2 of our work will:

1. Identify relevant terms from established standard lexicons (e.g. RadLex and DICOM) and other relevant literature and publish an expanded lexicon including these terms.
2. Form consensus recommendations on preferred terms.

This website will be updated as the terminology standardization work progresses.

The generic descriptions or terms in the first column are intended to orient the user to the relevant concepts; they are not consensus "preferred terms." The generic descriptions are not based on any single existing or pending terminology standard; however the references in the pdf attachment were consulted in developing the generic descriptions. Future efforts of this Working Group include making recommendations for standardized terminology.

A number of individuals and groups have advocated for terminology standardization in CT, including at a March 30-31, FDA public meeting entitled "Device Improvements to Reduce Unnecessary Radiation Exposure from Medical Imaging" (transcripts available here; see p. 153-155). Participants proposed a cooperative effort among professional organizations (AAPM, ASRT, ACR, etc.), industry, FDA, and standards organizations to accomplish this task, as is now being undertaken by this Working Group.

AAPM CT Lexicon v2.0 (03/08/)

Computed Tomography Radiation Dose Education Slides

This section contains documents with information on how CT acquisition parameters and CT scanner features affect the radiation dose used for a given study and how the dose is reported and tracked. These slides are intended for educational purposes and may be distributed freely with proper acknowledgement (“Courtesy of the AAPM Alliance for Quality CT”).

The "General Dose Education Slides" are available as a PowerPoint or PDF file and contains vendor-independent information on CT acquisition parameters, dose modulation and reduction and dose display. The entire slide set or pieces of it may be incorporated into any educational presentation as the user sees fit.

The Power Point slides that are accessible through the following link deal with factors that affect radiation dose in CT studies. They may be used as a resource for developing presentations on this topic.

General Dose Education Slides

• CT Dose Notifications and Alerts - PPT | PDF (added 04/17/) [Give Feedback]
• CT Radiation Dose Education - PPT | PDF (updated 11/18/) [Give Feedback]

The "Vendor Dose Education Slides" are available as PDF files only and individual slides may not be modified by the user. Each slide set follows the same outline as the General Dose Education Slides but includes vendor-specific screen shots and information on vendor specific parameters and features. The vendor specific slides were generated with the assistance of the vendor and screen shots of the scanner console/interface and descriptions of the vendor specific acquisition parameters are not representative of all scanners and software versions produced by the vendor. The slides are for instructional purposes only.

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Vendor Dose Education Slides

• GE Healthcare (added 11/18/) [Give Feedback]
• Hitachi (added 11/18/) [Give Feedback]
• NeuroLogica (added 12/20/) [Give Feedback]
• Neusoft (added 11/18/) [Give Feedback]
• Philips (added 11/18/) [Give Feedback]
• Siemens (added 01/05/) [Give Feedback]
• Toshiba (added 11/18/) [Give Feedback]

Computed Tomography Automatic Exposure Control (AEC) Education Slides

This section contains documents with information on how Automatic Exposure Control functions on CT systems. These slides are intended for educational purposes and may be distributed freely with proper acknowledgement (“Courtesy of the AAPM Alliance for Quality CT”).

The "General AEC Education Slides" are available as a PowerPoint or PDF file and contains vendor-independent information on various AEC features and how they may be implemented and affect radiation dose/image quality. The entire slide set or pieces of it may be incorporated into any educational presentation as the user sees fit. They may be used as a resource for developing presentations on this topic.

General AEC Education Slides

• CT AEC Education - PPT | PDF (added 01/20/) [Give Feedback]

The "Vendor AEC Education Slides" are available as PDF files only and individual slides may not be modified by the user. Each slide set follows the same outline as the General AEC Education Slides but includes vendor-specific screen shots and information on vendor specific parameters and features. The vendor specific slides were generated with the assistance of the vendor and screen shots of the scanner console/interface and descriptions of the vendor specific acquisition parameters are not representative of all scanners and software versions produced by the vendor. The slides are for instructional purposes only.

Vendor Dose Education Slides

• Canon (added 04/07/) [Give Feedback]
• GE Healthcare (added 04/07/) [Give Feedback]
• Hitachi (added 04/07/) [Give Feedback]
• Neusoft (added 04/07/) [Give Feedback]
• Philips (added 04/07/) [Give Feedback]
• Siemens (added 04/07/) [Give Feedback]

Do NOT uninstall QCT Pro.

This error may occur immediately after installing QCT Pro. If this is your situation, insert the QCT Pro installation CD, start the AutoRun application on the CD if it does not start automatically, and click on the option to "Upgrade" QCT Pro. The upgrade process detects and installs missing components.

If QCT Pro has been operating in a normal manner, but now this error occurs when starting QCT Pro, then it is likely that the QCT Pro database is locked by another QCT Pro application. The QCT Pro Database Dump utility is often the culprit since it locks the QCT Pro database when the application is opened. To resolve this issue, make sure that all other QCT Pro applications that make use of the QCT Pro database are closed before starting the main QCT Pro application.

DICOM licenses are licenses to allow receipt of DICOM images from different CT scanners. Images can be transferred from a CT scanner, PACS, or other media. CliniQCT licenses are linked to the CT scanner and enable processing CT images acquired without a patient phantom from CT scanners with an assigned CliniQCT license. If you wish to perform QCT analyses on images from more CT scanners, you can purchases additional CliniQCT licenses.

First ensure that you still have the images on your CT scanner. Then click on the "bridge" icon (left-most icon) on the QCT Pro toolbar. Click on the "Select" button in the lower-left cornter of the file translation dialog. This displays a file-open dialog. Find the folder or folders with names matching the patient name. Right-click on such a folder and select the option to "delete" the folder. Confirm deletion of the folder. This action deletes the DIOCM images previously sent to QCT Pro for the patient. Now resend from your CT scanner just the series of interest for the patient.

You can find the Port number for transferring images to QCT Pro by opening the "QCT Pro Server Monitor" in the system tray. A port number is listed in the top left hand corner under QCT PRO DICOM Server.

The default AE Title for QCT Pro is "QCTPRO" The AE Title changed by opening Tools → PACS Configuration… within QCT Pro. View/change the AE title. Save any changes you make to the AE title.

The IP address of the computer you are using to run QCT Pro can be found by opening a Command Window (Windows button, search for "cmd") and typing "ipconfig" on the command line followed by hitting the enter key.

The IP address of the computer you are using to run QCT Pro can be found by opening a Command Window (Windows button, search for "cmd") and typing "ipconfig" on the command line followed by hitting the enter key.

Open QCT Pro and then click on Tools → PACS Configuration… to open the PACS configuration dialog. The AE Title for QCT Pro can be viewed and changed from this dialog. Additionally, the AE Title, IP address and port number for one or more PACS destinations can be defined through this configuration dialog.

There are three primary purposes behind the Mindways quality assurance process. First, the QA process is used to establish the operational integrity of a QCT Pro or CliniQCT system. The QA process involves CT scanning, image transfer, data processing and reporting. If all of these steps can be completed in the intended manner, then the system should be ready for patient scanning. Second, the QA process is used to monitor the long-term stability (calibration) of your CT scanner. Third, and specifically in the context of CliniQCT, the QA process is the source of calibration information used to measure bone mineral density from CT scans acquired without a calibration phantom imaged with the patient.

QA analyses should be performed monthly

For CliniQCT, when the system is first used with a new CT scanner a QA should be done for every kVp and SFOV pair used to acquire patient images. After this initial calibration analysis, a monthly QA need only be done at one kVp and SFOV in order to monitor CT scanner performance. If significant performance change is found, new QAs should be done for all kVp and SFOV pairs.

For example, if you scan all patients at an SFOV of 500 mm and with a kVp of 120 for normal patients and 140 for obese patients, your QA schedule should look like this:

kVp and SFOV affect the calibration, and as such must match between patient scans and the QA scan. In routine clinical use with a set protocol, changes to kVp or SFOV should be avoided if possible. If the settings must be changed (e.g., increasing kVp for an obese patient), a QA scan should be done at the new settings.

When using CliniQCT to measure bone mineral density from CT scans acquired for other reasons, it is necessary to perform a QA scan on the same scanner at the same kVp and SFOV used to acquire the patient images.

Ideally for the hip exam, yes. Rotating the feet inwards helps prevent the acetabulum from obscuring the femoral neck. In practice, however, some patients will be uncomfortable or unable to inwardly rotate their feet. In such cases, have the patient maintain a comfomfortable foot position, inwardly rotated as much as possible, and be prepared to use a 10 mm femoral neck ROI height when analyzing the hip case to avoid overlap for the femoral neck ROI with acetabulum and/or ischium.

Clothing or hospital gowns without metal are acceptable. Patients should not have any metal items in their pockets, and clothing with metal zippers, buttons or rivets between the patient and calibration phantom should be removed. Small amounts of metal generally is not a problem if located external to the patient and anterior to the spine. Bra clips are generally not an issue.

When imaging the spine, avoid imaging vertebrae with implanted hardware. Up to three levels between T11 and L4 can be used for a QCT spine study. If all six of these levels are affected by hardware, it is likely best to forgo spine imaging.

When imaging the hip, it may be possible to get a good BMD measurement of the contralateral hip (without implanted hardware). Rocking the hips to move the prosthesis more out of the axial planes with the organic hip can help reduce beam-hardening induced errors.

For the spine, L1 and L2 are the preferred measurement sites when neither L1 nor L2 is fractured or otherwise significantly deformed structurally. If L1 and/or L2 are not suitable for measurement, then any two, and up to three, vertebral levels between T11 and L4 is a suitable alternative. In general, the scan range should cover the entire vertebral body for each vertebra intended for analysis.

For the hip, the left hip is typically analyzed unless hardware or other factors suggest analyzing the right hip is preferred. The CT scan should extend from the top of the femoral head to just below (approximately 1 cm) the lesser trochanter of the hip to be analyzed.

The scan extent should be from the top of the femoral head to approximately 1 cm below the bottom edge of the lesser trochanter. Excessive coverage of the femoral shaft and/or ilium may cause the software to lose anatomical landmarks and return an access violation error. Use the SlicePick module to select the appropriate range. If this does not solve the problem, Contact Us.

Open QCT Pro and click on Tools → Backup Database… → Backup. The drive letter associated with the desired backup location can be selected before clicking Backup. Note that Windows Explorer can be used to map a backup destination on the local or a remote computer to a drive letter than can be selected in the QCT Pro backup tool.

Both the clinical and technical reports (without the hip image) for the hip, but only the clinical report for the spine can be printed again from the database. To do so, use the database review tool to find the patient of interest in the database, highlight the exam, click "Select Exam", in the new window click the "Results" tab, and then click "Print Report".

Spine interpretation guidelines are available from the American College of Radiology.

CTXA Hip BMD measurements are intended to be interpreted exactly the same way as DXA hip BMD measurements. This includes application of WHO T-score guidelines as well as the University of Sheffield FRAX® fracture risk calculator.

QCT Spine T-scores provide an accurate reflection of spine fracture risk. Clinical practice guidelines, however, emphasize hip fracture risk mitigation. Most individuals are at significantly increased risk of spine fracture some ten to fifteen years before they are at significant risk of hip fracture. Applying WHO T-score guideslines, intended for use identifying individuals at at significant risk of hip fracture from hip BMD measurements, to QCT Spine T-scores thus results in overcalling osteoporosis relative to commonly used practice guidelines.

The serial comparison section calculates BMD based on the vertebral levels in common for all exams in the comparison, whereas the results section displays values from all levels analyzed in that exam. For example, consider the case: exam from two years ago covered L1+L2, new exam covers L2+L3: results displays (L2+L3) while serial comparison shows only L2.

QCT uses common CT scan protocols, and as such the scan will be very similar to what you have experienced before. The primary difference between QCT and conventional CT studies occurs with how your CT images will be processed after they are acquired.

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