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EBT CLINICAL UPDATE
November 2000
EBT Clinical Applications
CARDIAC IMAGING
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Coronary Artery Calcium Scanning
Coronary Electron Beam Angiography (EBA)
Functional Cardiac Imaging
BODY IMAGING
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Pulmonary Embolism
Low-Dose Lung Scanning
Abdominal Scanning
Colonography
Peripheral EBA (Carotid, Aorta, Renal, Femoral)
Head Scan
EBT Radiation Dose
Radiation dose from EBT scans compared to other sources of radiation
Radiation Source
Millirems
Millisieverts
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
300 mrem
3.0 mSv
2 mrem
0.02 mSv
8 to 10 mrem
0.08 to 0.1 mSv
48 mrem
4.8 mSv
300 mrem
3.o mSv
500 to 600 mrem
5.0 to 6.0 mSv
600 mrem
6.0 mSv
Background radiation in 1year
Cross country airplane trip
Chest X-ray
Abdominal X-ray
Lumbar Spine X-ray series
Coronary Angiogram
Lower G.I. X-ray series
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).
Functional Cardiac Imaging
Multi-Slice Mode
Cine and Flow Acquisitions
Cardiac Imaging
Prospective ECG-Triggering
Cine Mode – Functional Cardiac Imaging
Flow Mode – Perfusion Imaging
80% RR1
40% RR2
Volume Mode – Coronary Imaging (Calcium & EBA)
Functional Cardiac Imaging
Pre Dobutamine Stress
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Myocardial Perfusion
Scanning Protocol
Flow Mode
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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
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Post Dobutamine Stress
Functional Cardiac Imaging
Diastole
Systole
Pre Dobutamine Stress
Pre Dobutamine Stress
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Ejection Fraction
Scanning Protocol
Cine Mode
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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
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Post Dobutamine Stress
Post Dobutamine Stress
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Coronary Artery Calcium
Scanning
Step Volume Mode
ECG Triggered Acquisitions
Coronary Calcium Scanning
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Coronary Artery
Scanning Protocol
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Patient Preparation: None
ECG Triggered to 60-70% of
the R to R interval
3mm contiguous scans
From carina to the apex
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Calcium Report Generation
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Coronary Artery
Calcium Report
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Agatston Calcium Score
Volume Calcium Score
Example Images
Clinical Findings
Clinical Recommendations
Further Cardiac testing
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Coronary Calcium Progression
Progression of Right coronary artery calcium score over 5 years
1993
Calcium Score: 56
Volume Score: 45
1995
Calcium Score: 90
Volume Score: 78
1997
Calcium Score: 128
Volume Score: 113
Coronary Calcium Scanning
Visualization of Non-obstructive Plaque Formation - EBT
LAD
LM
LAD
LCX
Soft Plaque
G.O. Kerkhoff, Alfried Krupp Hospital Essen (2000)
Coronary EBA
Step Volume Mode
ECG Triggered Acquisition
Coronary EBA
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CLINICAL INDICATIONS
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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
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Coronary EBA
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Coronary EBA
Scanning Protocol
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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
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Coronary EBA Report Generation
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Coronary Artery EBA
Report
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Clinical Indication
Procedure
Example Images
Clinical Findings
Clinical Recommendations
Further Cardiac testing
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Coronary EBA
Posterior 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.
Coronary EBA
G.O. Kerkhoff, Alfried Krupp Hospital Essen (2000)
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Follow Up PTCA
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This 3 Dimensional Volume Rendered
image demonstrates a re-stenosis in
the mid LAD coronary artery in a
patient post PTCA
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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 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.
Coronary EBA
Coronary Stent
Courtesy of Milwaukee Heart Scan, Milwaukee, WI
Volume rendering technique
VRT
Virtual Angioscopy
FLY THROUGH
Maximum intensity projection
MIP
Coronary EBA
Right Coronary Artery Stent
G.O. Kerkhoff, Alfried Krupp Hospital Essen (2000)
Stent - Ave gfxTM
3,0/30mm
Coronary EBA
Right Coronary Artery Bypass Graft – Distal anastomoisis
G.O. Kerkhoff, Alfried Krupp Hospital Essen (2000)
Coronary EBA
Right Coronary Artery Bypass Graft
G.O. Kerkhoff, Alfried Krupp Hospital Essen (2000)
Coronary EBA
Central occluded Right Coronary Artery Graft
G.O. Kerkhoff, Alfried Krupp Hospital Essen (2000)
Coronary 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.
Coronary EBA Sensitivity & Specificity
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%
125
25%
92%
94%
Budoff et al,
Am J Cardiol 1999
52
11%
78%
91%
Achenbach et al,
Heart 2000
36
20%
92%
91%
118
24%
90%
82%
Achenbach et al,
NEJM 1998
Ropers et al,
Z Kardiol 2000
Coronary and Thoracic EBA
76.94mm
77.99mm
Large Thoracic Aneurysm
G.O. Kerkhoff, Alfried Krupp Hospital Essen (2000)
Coronary and Thoracic EBA
Thoracic aortic stent (Talent MedtronicTM) in dissection of the aorta
True
Lumen
False
Lumen
G.O. Kerkhoff, Alfried Krupp Hospital Essen (2000)
Lung Scanning
Continuous Volume Scan
Lung Scanning
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Lung Scan Protocol
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Patient Preparation: None
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This Continuous Volume
acquisition consisted of forty
seven, 6 mm images, each
taken at 300 milliseconds. The
total acquisition time was 18
seconds.
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Findings: Asbestosis
Lung Scanning
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Lung Scan Protocol
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Patient Preparation: None
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This Continuous Volume
acquisition consisted of forty
seven, 6 mm images, each
taken at 300 milliseconds. The
total acquisition time was 18
seconds.
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Findings: Lung Nodule Right
Upper Lobe
Pulmonary Embolism
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Pulmonary Embolism
Acute Scan Protocol
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Patient Preparation: None
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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.
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Findings: Large embolism in right
and left main pulmonary arteries.
Pulmonary Embolism
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Pulmonary Embolism
Chronic Scan Protocol
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Patient Preparation: NPO 4 hour
prior to scanning.
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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.
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Maximum Intensity Projections
Abdominal Scanning
Continuous Volume Scan
Abdominal Scan
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Abdomen screen
Protocol
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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.
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This Continuous Volume
acquisition consisted of, 6mm
images, each taken at 400
milliseconds. The total
acquisition time was 24
seconds.
Abdominal Scan
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Abdomen Diagnostic
Protocol
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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.
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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 Colonography
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EBT Colonography
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Patient Preparation: 24 to 48
hour colon preparation. NPO
after midnight the night prior to
the exam.
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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 EBA
Continuous Volume Scan
Renal 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 EBA
 Abdominal Aortic
EBA Scan Protocol
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This 3D Volume Rendered
image loop demonstrates arterial
flow through a post operative
abdominal aortic graft.
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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.
Abdominal Aortic EBA
Post operative Abdominal Aortic Graft
G.O. Kerkhoff, Alfried Krupp Hospital Essen (2000)
Maximum intensity projection
MIP
Shaded surface display
SSD
Volume rendering technique
VRT
Femoral and Iliac EBA
Femoral and iliac
EBA Scanning Protocol
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coronal Maximum Intensity
Projection image demonstrates
arterial flow through a post operative
abdomenoiliac graft.
G.O. Kerkhoff, Alfried Krupp Hospital Essen (2000)
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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 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 Scanning
Continuous Volume Scan
Cerebral EBA
Internal Carotid
This axial Maximum
Intensity Projection image
demonstrates the Left
internal carotid artery with
limited flow to the Right.
G.O. Kerkhoff, Alfried Krupp Hospital Essen (2000)
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.
Cerebral 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 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
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Head Scanning
Protocol
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Patient Preparation: NPO 4
hours before the scan.
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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.