EBT CLINICAL UPDATEEBT CLINICAL UPDATENovember 2000November 2000
EBT Clinical ApplicationsEBT Clinical Applications
CARDIAC IMAGING Coronary Artery Calcium Scanning Coronary Electron Beam Angiography (EBA) Functional Cardiac ImagingBODY IMAGING Pulmonary Embolism Low-Dose Lung Scanning Abdominal Scanning Colonography Peripheral EBA (Carotid, Aorta, Renal, Femoral) Head Scan
EBT Radiation DoseEBT Radiation Dose
EBT Coronary calcium scan 50 to 63 mrem 0.5 to 0.63 mSv
EBT Coronary EBA scan 70 to 90 mrem 0.7 to 0.9 mSv
EBT Low-dose Lung scan 100 to 150 mrem 1.0 to 1.5 mSv
Background radiation in 1year 300 mrem 3.0 mSv
Cross country airplane trip 2 mrem 0.02 mSv
Chest X-ray 8 to 10 mrem 0.08 to 0.1 mSv
Abdominal X-ray 48 mrem 4.8 mSv
Lumbar Spine X-ray series 300 mrem 3.o mSv
Coronary Angiogram 500 to 600 mrem 5.0 to 6.0 mSv
Lower G.I. X-ray series 600 mrem 6.0 mSv
Radiation dose from EBT scans compared to other sources of radiation
Millirems Millisieverts
The advantage of the EBT over conventional scanners is that, instead of exposing the entire circumference of the body to the X-ray beam, the EBT X-ray beam enters from the back. Thus, anterior structures such as the breast and thyroid are subjected to a lesser dose of radiation (17% of the entrance skin dose).
Radiation Source
Functional Cardiac ImagingFunctional Cardiac Imaging
Multi-Slice ModeCine and Flow Acquisitions
Cine Mode – Functional Cardiac ImagingCine Mode – Functional Cardiac Imaging
Prospective ECG-Triggering
80% RR80% RR11 40% RR40% RR22
Flow Mode – Perfusion ImagingFlow Mode – Perfusion Imaging
Volume Mode – Coronary Imaging (Calcium & EBA)Volume Mode – Coronary Imaging (Calcium & EBA)
Cardiac ImagingCardiac Imaging
Myocardial Perfusion Scanning Protocol Flow Mode
Table is slewed for Long Axis ECG Triggered to 40% of the
R to R interval MSM 8 mm 15 to 20 images per level Injection of 35ml IV contrast @ 4ml per
second. Repeat scan post stress
Pre Dobutamine StressPre Dobutamine Stress
Post Dobutamine StressPost Dobutamine Stress
Functional Cardiac ImagingFunctional Cardiac Imaging
SystoleDiastolePre Dobutamine Stress
Post Dobutamine Stress Post Dobutamine Stress
Pre Dobutamine Stress Ejection Fraction Scanning Protocol Cine Mode
Table is slewed for Short Axis ECG Triggered to 0% of the
R to R interval MSM CINE mode 8 mm 15 to
20 images per level Injection of 35ml IV contrast
@ 4ml per second Repeat scan post stress
Functional Cardiac ImagingFunctional Cardiac Imaging
Coronary Artery Calcium Coronary Artery Calcium ScanningScanning
Step Volume ModeECG Triggered Acquisitions
Coronary Calcium ScanningCoronary Calcium Scanning
Coronary Artery Scanning Protocol
Patient Preparation: None ECG Triggered to 60-70% of
the R to R interval 3mm contiguous scans From carina to the apex
Calcium Report GenerationCalcium Report Generation Coronary Artery
Calcium Report
Agatston Calcium Score Volume Calcium Score Example Images Clinical Findings Clinical Recommendations Further Cardiac testing
Coronary Calcium ProgressionCoronary Calcium Progression
Calcium Score: 56 Calcium Score: 90 Calcium Score: 128 Volume Score: 45 Volume Score: 78 Volume Score: 113
1993 1995 1997Progression of Right coronary artery calcium score over 5 years
LAD
LCX
LM
LAD
Soft Plaque
Coronary Calcium ScanningCoronary Calcium Scanning
G.O. Kerkhoff, Alfried Krupp Hospital Essen (2000)
Visualization of Non-obstructive Plaque Formation - EBT
Coronary EBACoronary EBA
Step Volume ModeECG Triggered Acquisition
Coronary EBACoronary EBA CLINICAL INDICATIONS
Follow-up PTCA and Stents Follow-up Bypass grafts Equivocal results following stress
testing (or stress imaging) Congenital anomalies Symptomatic patients with Coronary
Calcium score Asymptomatic patients with
Coronary Calcium score greater than 400 or in the 75 percentile
Pre and post operative Heart transplant patients
People who are not willing to have an elective conventional angiogram
Coronary EBACoronary EBA Coronary EBA
Scanning Protocol
Patient Preparation: Start IV ECG Triggered to 40% of the
R to R interval 3mm x 2mm scans Injection of 150ml IV contrast
@ 4ml per second Normal algorithm, 18 cm FOV
Coronary EBA Report GenerationCoronary EBA Report Generation
Coronary Artery EBA Report
Clinical Indication Procedure Example Images Clinical Findings Clinical Recommendations Further Cardiac testing
Coronary EBACoronary EBAPosterior Descending
Coronary artery
This 3 Dimensional Volume Rendered image demonstrates normal coronary
arterial flow in the Posterior Descending Coronary artery to the
apex of the heart as well as the coronary sinus and cardiac vein.
This ECG triggered acquisition consisted of sixty, 3 mm images, each taken at 100 milliseconds. The total acquisition time was 45 seconds with an intravenous injection of 150 ml of
contrast media.
G.O. Kerkhoff, Alfried Krupp Hospital Essen (2000)
Follow Up PTCA
This 3 Dimensional Volume Rendered image demonstrates a re-stenosis in the mid LAD coronary artery in a patient post PTCA
This ECG triggered acquisition consisted of sixty, 3 mm images, each taken at 100 milliseconds. The total acquisition time was 45 seconds with an intravenous injection of 150 ml of contrast media.
Coronary EBACoronary EBA
Coronary EBACoronary EBA
Coronary Artery Stent Scanning Protocol
This 3 Dimensional Volume Rendered image demonstrates a 50% stenosis just proximal to the stent in the left anterior descending coronary artery .
This ECG triggered acquisition consisted of sixty, 1.5 mm images, each taken at 100 milliseconds. The total acquisition time was 45 seconds with an intravenous injection of 150 ml of contrast media.
Maximum intensity projection
MIPVolume rendering technique
VRT
Coronary Stent
Virtual AngioscopyFLY THROUGH
Courtesy of Milwaukee Heart Scan, Milwaukee, WI
Coronary EBACoronary EBA
Stent - Ave gfxTM 3,0/30mm
G.O. Kerkhoff, Alfried Krupp Hospital Essen (2000)
Coronary EBACoronary EBARight Coronary Artery Stent
G.O. Kerkhoff, Alfried Krupp Hospital Essen (2000)
Coronary EBACoronary EBARight Coronary Artery Bypass Graft – Distal anastomoisis
G.O. Kerkhoff, Alfried Krupp Hospital Essen (2000)
Coronary EBACoronary EBARight Coronary Artery Bypass Graft
Central occluded Right Coronary Artery Graft
Coronary EBACoronary EBA
G.O. Kerkhoff, Alfried Krupp Hospital Essen (2000)
Coronary EBACoronary EBA
Congenital Anomalies
This 3 Dimensional Volume Rendered image demonstrates an aberrant
circumflex coronary artery that arises from the Right coronary artery.
This ECG triggered acquisition consisted of fifty, 3 mm images, each taken at 100 milliseconds. The total acquisition time was 35 seconds with an intravenous injection of 120 ml of contrast media.
Number of Patients
Non-Evaluated Segments
Sensitivity Specifity
Moshage et al, Radiology 1995
20 ? 74% 100%
Schmermund et al, JACC 1998*
28 12% 83% 91%
Reddy et al, Radiology 1998
23 10% 88% 79%
Rensing et al, Circulation 1998**
37 18% 77% 94%
Achenbach et al, NEJM 1998
125 25% 92% 94%
Budoff et al, Am J Cardiol 1999
52 11% 78% 91%
Achenbach et al, Heart 2000
36 20% 92% 91%
Ropers et al, Z Kardiol 2000
118 24% 90% 82%
Coronary EBA Sensitivity & SpecificityCoronary EBA Sensitivity & Specificity
77.99mm76.94mm
Large Thoracic Aneurysm
G.O. Kerkhoff, Alfried Krupp Hospital Essen (2000)
Coronary and Thoracic EBACoronary and Thoracic EBA
True Lumen
False Lumen
G.O. Kerkhoff, Alfried Krupp Hospital Essen (2000)
Thoracic aortic stent (Talent MedtronicTM) in dissection of the aorta
Coronary and Thoracic EBACoronary and Thoracic EBA
Lung ScanningLung Scanning
Continuous Volume Scan
Lung ScanningLung Scanning
Lung Scan Protocol
Patient Preparation: None
This Continuous Volume acquisition consisted of forty seven, 6 mm images, each taken at 300 milliseconds. The total acquisition time was 18 seconds.
Findings: Asbestosis
Lung ScanningLung Scanning
Lung Scan Protocol
Patient Preparation: None
This Continuous Volume acquisition consisted of forty seven, 6 mm images, each taken at 300 milliseconds. The total acquisition time was 18 seconds.
Findings: Lung Nodule Right Upper Lobe
Pulmonary EmbolismPulmonary Embolism Pulmonary Embolism
Acute Scan Protocol
Patient Preparation: None
This Continuous Volume acquisition consisted of 42, 6 mm images, each taken at 100 milliseconds. The total acquisition time was 5 seconds with an intravenous injection of 50 ml of contrast media @ 3 ml per second.
Findings: Large embolism in right and left main pulmonary arteries.
Pulmonary EmbolismPulmonary Embolism Pulmonary Embolism
Chronic Scan Protocol
Patient Preparation: NPO 4 hour prior to scanning.
This Continuous Volume acquisition consisted of 120, 3 mm images, each taken at 100 milliseconds. The total acquisition time was 5 seconds with an intravenous injection of 50 ml of contrast media @ 3 ml per second.
Maximum Intensity Projections
Abdominal ScanningAbdominal Scanning
Continuous Volume Scan
Abdominal ScanAbdominal Scan Abdomen screen
Protocol
Patient Preparation: Optional NPO after midnight the night prior to the exam. Drink 24 oz of gastrographin and H2o mix 2 hour prior and 12 oz before scanning.
This Continuous Volume acquisition consisted of, 6mm images, each taken at 400 milliseconds. The total acquisition time was 24 seconds.
Abdominal ScanAbdominal Scan Abdomen Diagnostic
Protocol
Patient Preparation: NPO after Midnight the night prior to the exam. Drink 24 oz of gastrographin and H2o mix 2 hour prior and 12 oz before scanning.
This Continuous Volume acquisition consisted of sixty one, 10 mm images, each taken at 600 milliseconds. The total acquisition time was 22 seconds with an intravenous injection of 90 ml of contrast media @ 2.0 ml per second.
EBT ColonographyEBT Colonography
EBT Colonography
Patient Preparation: 24 to 48 hour colon preparation. NPO after midnight the night prior to the exam.
This Continuous Volume acquisition consisted of 140, 3mm images, each taken at 200 milliseconds. The total acquisition time was 28 seconds with and air contrast enema.
Peripheral EBAPeripheral EBA
Continuous Volume Scan
Renal EBARenal EBA
Renal Arteries
This coronal Maximum Intensity Projection image demonstrates
normal renal arterial flow.
This Continuous Volume acquisition consisted of seventy, 3
mm images, each taken at 400 milliseconds. The total acquisition
time was 28 seconds with an intravenous injection of 100 ml of
contrast media.
Abdominal Aortic EBAAbdominal Aortic EBA Abdominal Aortic EBA Scan Protocol
This 3D Volume Rendered image loop demonstrates arterial flow through a post operative abdominal aortic graft.
This Continuous Volume acquisition consisted of one hundred and forty, 3 mm images, each taken at 200 milliseconds. The total acquisition time was 28 seconds with an intravenous injection of 120 ml of contrast media.
Maximum intensity projection
MIPShaded surface display
SSDVolume rendering technique
VRT
G.O. Kerkhoff, Alfried Krupp Hospital Essen (2000)
Abdominal Aortic EBAAbdominal Aortic EBAPost operative Abdominal Aortic Graft
Femoral and Iliac EBAFemoral and Iliac EBA
G.O. Kerkhoff, Alfried Krupp Hospital Essen (2000)
Femoral and iliac EBA Scanning Protocol
This coronal Maximum Intensity Projection image demonstrates arterial flow through a post operative abdomenoiliac graft.
This Continuous Volume acquisition consisted of one hundred and forty, 3 mm images, each taken at 200 milliseconds. The total acquisition time was 28 seconds with an intravenous injection of 120 ml of contrast media.
Carotid EBACarotid EBA
Carotid Arteries
This 3 Dimensional Volume Rendered image demonstrate the
the carotid arteries (RED) and venous circulation (BLUE).
This Continuous Volume acquisition consisted of forty, 3 mm images, each taken at 300
milliseconds. The total acquisition time was 12 seconds with an
intravenous injection of 60 ml of contrast media.
Head ScanningHead Scanning
Continuous Volume Scan
Cerebral EBACerebral EBA
Internal Carotid
This axial Maximum Intensity Projection image
demonstrates the Left internal carotid artery with limited flow to the Right.
This Continuous Volume acquisition consisted of
forty, 3 mm images, each taken at 600 milliseconds. The total acquisition time was 24 seconds with an
intravenous injection of 80 ml of contrast media. G.O. Kerkhoff, Alfried Krupp Hospital Essen (2000)
Cerebral EBACerebral EBA
Cerebral AVM
This 3 Dimensional Volume Rendered image demonstrate the
Circle of Willis with an Arterial Vascular Malformation (AVM).
This Continuous Volume acquisition consisted of forty, 3 mm images, each taken at 600
milliseconds. The total acquisition time was 24 seconds with an
intravenous injection of 100 ml of contrast media.
Cerebral EBACerebral EBA
Cerebral EBA
This axial Maximum Intensity Projection image demonstrates
cerebral arterial flow.
This Continuous Volume acquisition consisted of forty-five, 6
mm images, each taken at 600 milliseconds. The total acquisition
time was 27 seconds with an intravenous injection of 100 ml of
contrast media.
Head Scan Head Scan
Head Scanning Protocol
Patient Preparation: NPO 4 hours before the scan.
This Continuous Volume acquisition consisted of forty one, 6 mm images, each taken at 600 milliseconds. The total acquisition time was 25 seconds with an intravenous injection of 90 ml of contrast media @ 2.0 ml per second.