CT scans were performed using a 16 or 128 multi-detector CT scanner (Somatom Sensation 16, Siemens Medical Solution, Erlangen, Germany or Somatom Definition AS Plus, Siemens Medical Solution, Forchheim, Germany, respectively) at end-inspiration in the supine position. Scanning parameters for each scanner were as follows. For the 16-detector row scanner, the detector collimation was 0.75 mm; beam pitch, 1.5; reconstruction thickness, 1.0 mm; reconstruction interval, 10.0 mm; rotation time, 0.75 second; tube voltage, 120 kVp; tube current, 200 effective mAs; and reconstruction kernel, the very sharp algorithm (B70f). For the 64-detector row scanner, the detector collimation was 0.6 mm; beam pitch, 1.0; reconstruction thickness, 1.0 mm; reconstruction interval, 10.0 mm; rotation time, 0.5 second; tube voltage, 120 kVp; tube current, 200 effective mAs; and reconstruction kernel, the very sharp algorithm (B70f). Scanned images were displayed in the lung window setting (window level, –600 to –700 HU; window width, 1200–1500 HU) and were interfaced directly to our Picture Archiving and Communication System (PACS, m-view TM; Marotech, Seoul, Korea).
Somatom definition as plus
Manufactured by Siemens
Sourced in Germany, United States
The Somatom Definition AS Plus is a computed tomography (CT) imaging system produced by Siemens. It is designed to perform high-quality scans of the human body. The system utilizes advanced technology to capture detailed images for diagnostic and analytical purposes.
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7 protocols using somatom definition as plus
1
Standardized CT Scanning Protocol
2
Breast Cancer Radiotherapy Simulation Protocol
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All patients underwent CT using a Siemens Somatom definition AS plus (Siemens Medical Solutions, Erlangen, Germany) for treatment planning. In the TPS (Eclipse version 10.0.28 and 13.6.23, Varian medical systems; CA Varian), the surface structure set (BODY), treatment fields and isocenter position were exported to the CatalystTM in the industry standard DICOM format. The patients were treated in supine position on a breast board (PosiboardTM‐2 Breastboard, CIVCO Medical Solutions) with their arms raised over the head and positioned on an arm support. For tangential and locoregional treatment, a breastboard pitch of 7.5° and 0° was used as standard, respectively. An immobilization wedge was placed under the patients’ knees for support. One patient receiving locoregional treatment was positioned in a WingStepTM (Elekta AB, Stockholm, Sweden) and body vacuum bag with the contralateral arm by the side of her body.
3
Retrospective Study on Orbital Wall Fractures
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This was a retrospective case–control study. A retrospective chart review was undertaken for 1378 patients with a diagnosis of OWF at the emergency department (ED) at our hospital between 1 January 2004 and 31 March 2014. Our hospital is a university hospital located in an urban area that treats ∼100 000 patients per year in the ED.
In this study, patients who underwent facial bone CT scans at our hospital with a specific International Classification of Diseases, 10th revision (ICD-10) code at the ED were included. All orbital fractures were confirmed using CT scans. There are five major bones of the skull that form the orbit—the frontal bone, sphenoid bone, zygoma, maxillary bone and ethmoid bone. Fractures of the orbit can involve one or more walls of the orbit, the orbital rim or both. Axial and coronal CT scans of the facial bone were obtained with a 1.0 mm slice thickness using a 128-channel multidetector CT scanner (Somatom Definition AS Plus; Siemens Medical Solutions, Cary, North Carolina, USA). Patients who were 65 years or older were categorised as the elderly group and patients younger than 65 years were included in the non-elderly group. Exclusion criteria included patients younger than 18 years at the time of injury and patients who were referred to our hospital after a diagnosis of OWF was made at another hospital. The patients were of Asian (Korean) ethnicity.
In this study, patients who underwent facial bone CT scans at our hospital with a specific International Classification of Diseases, 10th revision (ICD-10) code at the ED were included. All orbital fractures were confirmed using CT scans. There are five major bones of the skull that form the orbit—the frontal bone, sphenoid bone, zygoma, maxillary bone and ethmoid bone. Fractures of the orbit can involve one or more walls of the orbit, the orbital rim or both. Axial and coronal CT scans of the facial bone were obtained with a 1.0 mm slice thickness using a 128-channel multidetector CT scanner (Somatom Definition AS Plus; Siemens Medical Solutions, Cary, North Carolina, USA). Patients who were 65 years or older were categorised as the elderly group and patients younger than 65 years were included in the non-elderly group. Exclusion criteria included patients younger than 18 years at the time of injury and patients who were referred to our hospital after a diagnosis of OWF was made at another hospital. The patients were of Asian (Korean) ethnicity.
4
Pelvic Bone CT Analysis for Body Composition
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Pelvic bone CT was performed using a 128‐channel multi‐detector CT scanner (Somatom Definition AS Plus; Siemens Healthineers, Erlangen, Germany) with the following protocols: tube voltage, 120–130 kVp; effective tube current, 120–150 mAs; matrix, 512 × 512; and slice thickness, 3 mm. The pelvic bone CT was performed by scanning from the mid‐abdomen to the upper thigh without injection of a contrast agent.
The overall procedure of the body morphometry analysis is summarized in Figure1 . An experienced radiologist (K. W. K) analysed the CT images using the AsanJ‐Morphometry™ software, which was developed for the measurement of body composition based on ImageJ (NIH, Bethesda, MD, USA).14 We selected the CT slice at the upper thigh level, which was defined as the inferior tip of the ischial tuberosity, that is, the lowest CT slice where the ischial bone was visible on a pelvic bone CT image. The boundary between the subcutaneous fat and skeletal muscle was demarcated. Within the boundary, the cross‐sectional area of the skeletal muscle area (SMA) was segmented using predetermined thresholds (−29 to +150 Hounsfield units). Outside the boundary, the subcutaneous fat area (SFA) was segmented using thresholds ranging from −190 to −30 HU. The muscle density within the muscle boundary was assessed as the mean radiodensity in HU.
The overall procedure of the body morphometry analysis is summarized in Figure
5
Quantitative Chest CT Lung Analysis
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A chest X-ray (posteroanterior view) was taken in full inspiration. A non-contrast-enhanced HRCT of the thorax was performed on a 128 slice multi-dimensional CT scanner (Somatom Definition AS plus; Siemens Healthcare, Germany). The tube voltage was kept at 120 kV, and the tube current was 100–200 mAs depending on the patient’s body habitus. High-resolution CT lung images were reconstructed with 0.6 mm slice thickness. The total radiation dose was approximately 7 mSv. Image analysis was done by a trained radiologist for the presence of any abnormality. Any additional neck or upper abdomen findings were also recorded. Anteroposterior and transverse diameters of the trachea at the level of the thoracic inlet were recorded. Quantitative analysis of inspiratory lung volume was done by tracing the lung margins on volume software (Syngo, Siemens). The total volume of the lung was calculated using the threshold value of −500 to −1024 HU. For control subjects, tracheal diameter and lung volume were calculated from age-matched cases where CT chest was done as part of disease work-up.
6
Coronary CT Angiography with Multidetector CT
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Subjects underwent coronary CT angiography with five different 64 or 128-channel multidetector CT (MDCT) scanners: a 64-channel dual-source CT scanner (SOMATOM Definition; Siemens Medical Solutions, Forchheim, Germany), a 128-channel dual-source CT scanner (SOMATOM Definition Flash; Siemens Medical Solutions), two 64-channel MDCT scanners (Brilliance 64, Philips Medical Systems, Best, the Netherlands; GE LightSpeed VCTXT, General Electric Medical Systems, Milwaukee, WI, USA), and a 128-channel MDCT scanner (SOMATOM Definition AS Plus; Siemens Medical Solutions). Each institute followed a standardized protocol for the CT examination: craniocaudal direction; retrospective gating; bolus tracking in the descending aorta with a 100 Hounsfield units (HU) trigger and 8 second delay; tube voltage, 120 kVp; tube current-time product, adjustable; detector configuration, 64 x 0.6–0.625 mm, 32 x 0.6 or 64 x 0.6 mm in scanners; table speed, 0.2 pitch; gantry rotation time, 0.28–0.42 msec; matrix, 512 x 512; reconstruction slice thickness, 1 mm; reconstruction interval, 0.5–1 mm; and a standard algorithm reconstruction. Prospective sequential scanning was not allowed.
7
CT Urography Protocols Across Institutions
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CT urography was performed using two 128-MDCT scanners (Somatom Definition Edge and Somatom Definition AS Plus; Siemens Healthcare, Erlangen, Germany). CT scans were obtained with the following parameters: tube voltage, 100 kVp with automatic tube current modulation; beam collimation, 0.6 mm; and rotation time, 0.5 seconds. The scan protocols in the two institutions were not identical. The reference tube current was 150 mAs in the unenhanced scan and 245 mAs in the enhanced scan at institution A and 289 mAs in all scans at institution B. After an unenhanced scan was obtained, 1.5 mL/kg of non-ionic contrast material was administered through a 20- or 22-gauge antecubital venous catheter at a rate of 3.5 mL/s. At institution A, corticomedullary- and excretory-phase images were acquired 60 seconds and 5 minutes after contrast medium injection for all patients, respectively. At institution B, corticomedullary- and excretory-phase images were acquired 40 seconds and 5 minutes after contrast medium injection, respectively. The definition of corticomedullary-phase is images acquired 25-70 seconds after contrast injection (10 (link)11 (link)). The image data were reconstructed at slice thicknesses and intervals of 5 mm (institution A) and 3 mm (institution B).
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