64 Slice CT Scanners Evaluation PDF

t
64-Slice
Computed Tomography Systems
Computed tomography systems offering 64 slices are highly popular

because of their fast acquisition time. Any of the four systems cov-
ered in this article is likely to meet your basic CT needs. But each of-
fers differing features and capabilitiesfor example, theyre not all
equally effective at cardiac imaging. Our Evaluation will help you de-
cide which product is best for your facility.
We tested and rated the following products:
u GE LightSpeed VCT
u Philips Brilliance 64
u Siemens Sensation 64
u Toshiba Aquilion 64 w
2007 ECRI Institute. Duplication of this page by any means for any purpose is prohibited. www.ecri.org HEALTH DEVICES December 2007 377
S ixty-four slice computed tomography (CT) systems per-
form fast acquisition of radiographic images. They are
used to obtain accurate diagnoses for a wide range of in-
your basic requirements for a 64-slice CT system. But
each has specific features and capabilities that will be ad-
vantageous to particular users. Because any CT system
dications, to track disease progression, and to plan therapy. must be able to support a wide range of applications, we
If youre purchasing one of these systems, your princi- have not rated the systems for specific environments but
pal concern should, of course, be whether it can provide have applied a single rating to each unit.
the highest image quality and diagnostic effectiveness. But
you need to be sure that it can do so while delivering the Preferred
lowest possible radiation dose to the patient. As we dis-
cussed in our February 2007 Guidance Article, Radiation Toshiba Medical Systems Aquilion 64
Dose in Computed Tomography, the full radiation risks u Offers superior image quality, most significantly for
of CT are only now being recognized. Given CTs poten- cardiac imaging, as well as tools to help technologists
tial to cause cancer, a systems ability to modulate dose is achieve reproducible, consistent results.
an important purchasing consideration. The Aquilion 64 exceeds many of our test criteria. The
Another key factor for 64-slice systems is dynamic reason we rate it Preferred is that it offers superior image
image quality. One of the main reasons for purchasing a quality over the other systemsmost notably in low-
64-slice system is to perform cardiac imaging, since the contrast and cardiac (dynamic) imaging, which is a key
faster acquisition time possible with 64 slices provides the reason for purchasing a 64-slice system. Our user survey
ability to image coronary arteries in the beating heart. found that the MegaCool x-ray tube is consistently the
Consequently, the quality of cardiac images a scanner can longest-life 64-slice CT tube, and third-party servicing is
produce needs to be carefully examined. possible without annual licensing fees. In addition, the
And for all systems, its important to consider elements Aquilion provides some unique and useful tools, such as
such as workflow integration and manufacturer support. SureCardio and PhaseXact, that help make cardiac imag-
ing more reliable. Workflow is aided by having two inde-
pendent workstations, so that image acquisition and
In this Evaluation, we look at four suppliers 64-slice sys- processing do not interfere with each other. The user inter-
tems, examining their image quality, dose, workflow, reli- face is intuitive and easy to use.
ability, and service.
u Our ratings and test methods are summarized in this Acceptable
section; in addition, the table on page 379 provides a The remaining systems do not have the same cardiac im-
quick look at the products performance. age quality and maintenance advantages as our Preferred
u Our detailed observations about the systems overall per- system and are rated Acceptable. However, we believe
formance are described beginning on page 383. each system has some advantages that may be more valu-
u Our product profiles describing the evaluated scanners able in specific applications and scenarios.
and our specific test results begin on page 388.
MORE DESIRABLE
u A guide for selecting a 64-slice systemnot just the ACCEPTABLE PRODUCTS
ones we evaluate herecan be found on page 401.
Products are listed alphabetically by supplier.
GE Healthcare LightSpeed VCT

u Offers high-quality imaging and is very easy to use.
ECRI Institute Ratings
The LightSpeed VCT is very easy to use, provides
high-quality images with a straightforward user interface,
In general, all the systems we tested meet or exceed our and makes full use of its standard dual-monitor display.
criteria. So it is likely that any of these systems will meet Image quality is good, particularly for cardiac images.
Dose-control mechanisms are implemented, including the
recording of the dose efficiency, and the study dose is
UMDNS term.
(continued on page 380)
378 HEALTH DEVICES December 2007 www.ecri.org 2007 ECRI Institute. Duplication of this page by any means for any purpose is prohibited.
Evaluation at a Glance: 64-Slice CT Systems
GE LightSpeed VCT Philips Brilliance 64 Siemens Sensation 64 Toshiba Aquilion 64
PRODUCT RATING
but somewhat less desirable
than the other systems
IMAGE QUALITY Good Good Good Excellent
Noise characteristics Good Good Good Good
Slice thickness and Good Good ExcellentUltrahigh- ExcellentNarrow-
spatial resolution resolution mode is avail- est slices
able (0.3 mm slices)
Uniformity Excellent interslice Good ExcellentBest uni- ExcellentGood
uniformity formity performance scores
Temporal resolution ExcellentBest scores ExcellentHigh scores Good ExcellentBest scores
overall for phantom images for narrowest slices
Artifacts Good Good Good Good
DOSE MANAGEMENT Excellent Excellent Excellent Excellent
Dose ExcellentCardiac ExcellentCardiac Excellent ExcellentAuto-
SnapShot Pulse reduces Step & Shoot image ac- matic selection of filters
dose by 80%; Color Cod- quisition reduces dose based on image size
ing Kids used for pediatric
doses; 3 filters automati-
cally match image size
Dose modulation ExcellentDose is Excellent ExcellentUses non- ExcellentDose is
recorded for all exams as linear exposure model so recorded within DICOM
DICOM image larger patients receive data
less dose
WORKFLOW Excellent Excellent Good Good
INTEGRATION
Clinical experience ExcellentHigh-power ExcellentSmall Good Good
x-ray source for obese pa- focal spot (high resolu-
tients; descriptive names tion) available at high mA
for reconstruction filters settings
Image acquisition Good ExcellentWide- Good Good
performance coverage stroke detection
and real-time image
display
Postprocessing ExcellentWide range ExcellentRemote ExcellentAutomated ExcellentVitrea
of applications, including users can reprocess im- postprocessing workflow; workstation includes ac-
wide-coverage stroke de- ages; full range of appli- wide range of clinical appli- cess to lung nodule
tection and computer- cations, including ability to cations, including true CAD CAD software
assisted reading export data to cath lab for lung nodule detection
Ease of use Good Good ExcellentIntelligent ExcellentSeveral
help for setting parameters features make image
acquisition more consis-
tent regardless of user
experience
Connectivity Good Good Good Good
SERVICE AND Good Good Good Good
SUPPORT
User feedback Excellent Excellent Excellent Excellent
Training ExcellentRemote Good ExcellentRemote Excellent
users can control acquisi- service and access to ap-
tion parameters plications specialists
Reliability and Good Good Good Good
maintenance
Planning Good ExcellentUnique in- Good Good
stallation planning and ar-
chitectural services help
reduce patient anxiety
(continued from page 378) The Brilliance 64 provides consistent, high-quality images
saved with the images. In addition, GEs cardiac dose-sav- in both cardiac and noncardiac applications. Its Extended
ing feature, Cardiac SnapShot Pulse, demonstrated an 80% Brilliance Workspace feature enables multiple users to ac-
dose saving during our tests, although it has limitations cess and reconstruct raw data remotely, a unique capability
such as only being usable for heart rates up to 65 bpm and that is likely to benefit radiologists who are not physically
producing an image of only one part of the cardiac phase. close to the scanner. In departments with Philips cardiol-
Extended-coverage brain perfusion imaging is available. ogy imaging equipment, the Brilliance can be closely inte-
For advanced 3-D processing, GE depends on the Advan- grated with Philipss TrueView technology, which allows
tage Workstation, which has some unique applications CT cardiac images to be displayed in the cath lab. Philips
(e.g., stent planning, pacemaker planning, body perfusion offers a function called Step & Shoot that provides ad-
calculation, colonography, densitometry). For large pa- vanced dose saving in cardiac CT, although it has limita-
tients, the standard configuration has the most powerful tionsfor example, it cannot be used with higher heart
specified x-ray generator. GE also provides a wide range rates and produces an image of only one part of the cardiac
of training and business-optimization services. phase. In stroke imaging, the Jog Mode has been used for
a few years to provide reliable and accurate brain perfu-
Philips Medical Systems Brilliance 64 sion images.
u Provides high-quality images and includes some useful For imaging obese patients, Philips has an optional ta-
and unique applications, such as remote access to raw ble with a weight limit of 295 kg (650 lb), which is the
data and large-coverage stroke detection. highest capacity available, and the x-ray tube can be used
at maximum power on the small focal spot for short peri-
ods, so high-resolution imaging is possible with larger pa-
A Comment on Slices tients. In addition, Philips offers good tube warranty terms
Why Test 64? and upgrade options, improving the predictability of the
overall cost of ownership. And the company provides all
the information required for installation planning and of-
Each supplier covered in this Evaluation offers a fers architectural design featuresincluding lighting
range of systems, providing varying numbers of designed to reduce patient anxiety.
slices. In our April 2007 Guidance Article Com-
puted TomographyHow Many Ways Should You LESS DESIRABLE ACCEPTABLE PRODUCT
Slice It? we concluded that 16-slice systems are ad- The remaining system is also rated Acceptable but is not
equate for most applications. So why did we concen- quite as desirable as the others because its cardiac image
trate on 64-slice products for this Evaluation? qualitya vital factor when choosing a 64-slice system
One reason is that 64-slice systems represent the doesnt quite measure up to that of the other systems.
latest available technology* and are heavily pro-
moted by suppliers, so there is considerable pressure Siemens Medical Solutions Sensation 64
on facilities to offer them. Another is that in most u Offers excellent performance for noncardiac applica-
cases, suppliers 16- and 64-slice systems have tions, including computer-aided detection.
many similarities. This means that facilities looking The Sensation 64 is a good choice for noncardiac applica-
at 16-slice systems can use our findings to judge tions, as well as for facilities standardizing on the Siemens
many of those products capabilities, particularly in multimodality platform (Syngo) for workflow and eco-
areas such as x-ray detection, image reconstruction, nomic considerations. It provides high-quality images with
and applications software. (However, our actual a straightforward user interface. It offers the highest spa-
product ratings apply only to the specific 64-slice tial resolution and narrowest slice thickness of the systems
systems we tested.) we evaluated; this is useful in some limited applications,
such as inner-ear exams. Also, the image uniformity is ex-
* Systems offering 256 slices are in the late stages of development ceptional, and the default dose settings are the lowest of
but are still several months from being commercially available. We
profiled this technology in our November 2007 Technology Timeline
the systems we tested. However, a disadvantage is the sys-
article, 256-Slice Wide-Detector Computed Tomography. tems narrower coverage, which is only half of that
provided in other systems.
The Syngo multimodality platform has now been used cases, all images were anonymized to ensure an unbiased
for a number of years and has proved popular. The image result.
display workstation uses the same database as the acquisi- A particularly important feature of 64-slice CT systems
tion computer, so there are no data transfer penalties, and is the ability to acquire clear images of coronary arteries in
data can be reprocessed without interfering with acquisi- the beating heart. To test this, we designed and built a dy-
tion. Users can access some of the 3-D image visualization namic test phantom that emulated the motion of the coro-
tools on remote computers over the Internet. Siemens is nary arteries at various heart rates. The phantom can be
the only CT manufacturer to offer computer-aided detec- connected to the ECG input of a CT system so that it can
tion for lung nodules. Users of Siemens cardiology imag- be imaged in exactly the same way that a patient would be.
ing equipment can display CT cardiac images within the For more details, see the discussion of ECRI Institutes
cath lab. cardiac phantom, below.
Siemens also offers some potentially useful service
and monitoring tools. These depend on a CT system being Dose Management
electronically accessible by Siemens (via a virtual private Suppliers have made considerable efforts to reduce the
network [VPN], usually through a facilitys firewall). dose of CT scans, in particular controlling the dose based
Siemens provides proactive system monitoring, as well as on the patients size. Using phantoms, we evaluated the ef-
good tube warranty coverage and unique utilization and fectiveness of dose-reduction technologies and the effect
management data.
Tests Performed
Desirable Features and How
We Tested For Them Image Quality
Noise Characteristics
Slice Thickness and Spatial Resolution
Multislice CT is used for a wide variety of diagnostic and
Uniformity
screening exams. Not only must the image quality be ade-
quate with minimum x-ray dose, but the systems must al- Temporal Resolution
low efficient patient throughput and have high reliability. Artifacts
Our specific tests are listed on this page. In broad outline,
they consisted of the following: Dose Management
Dose
Image Quality Dose Modulation
Image quality determines diagnostic accuracy. You need a
scanner that offers the highest-quality images without sig- Workflow Integration
nificantly increasing dose. We used standard CT image Clinical Experience
quality measurement techniques (noise, uniformity, slice
thickness, spatial resolution, and low-contrast detectability)
Image Acquisition Performance
to assess the image quality across the full range of clini- Postprocessing
cally relevant imaging parameters. We used either our own Ease of Use
phantom or industry-standard phantoms to ensure compa- Connectivity
rability of the results.
Our measurement methods are widely used, and most Service and Support
are objective; for example, our criteria are based on indus- User Feedback
try standards such as the International Electrotechnical Training
Commissions IEC 61223-3-5 (Acceptance TestsImag-
Reliability and Maintenance
ing Performance of Computed Tomography X-Ray
Equipment). However, other measurements, such as low- Planning
contrast detectability, are necessarily subjective; in such
on dose when using different beam collimations. We also motion at various heart rates (65 bpm, 75 bpm, 85 bpm,
looked at dose-control mechanisms for pediatric patients. and irregular). The phantom had an ECG output that con-
nected to a CT scanner in the same way that a patient
Workflow Integration would be. Images were acquired and reconstructed using
CT systems must reliably and consistently perform many the manufacturers recommended protocols.
different scans on a wide range of patients, and the resulting The images from our phantom (about 200 for each
data must be processed and interpreted. Efficient workflow heart rate) were processed using a maximum intensity pro-
requires adequate equipment and good integration with jection to create composites, some of which can be found
other systems. in the product profiles for the individual systems. The im-
We ascertained how well systems fit into the workflow ages of the catheters were assessed using the following
by exploring the application tools available, surveying us- scale:
ers, and examining the compliance to relevant standards 5. Clear and sharp throughout
applicable to CT (e.g., DICOM, IHE).
4. Slight blurring and irregularities
3. Majority of sectors usable
Service and Support 2. Minority of sectors usable
CT systems are complex and will require both routine and 1. Unusable
emergency service, making good manufacturer servicing
important. We surveyed users regarding their experiences
with the manufacturers. In addition, we looked at each
manufacturers policies regarding service, particularly
x-ray tube reliability and warranty options.
ECRI Institutes
Cardiac Phantom
To assess the dynamic image quality of the evaluated sys-

tems, we designed and built a dynamic phantom that con-
tained three contrast-filled catheters (diameters 1.3 mm,
Schematic of our cardiac phantom, showing mechan-
1.9 mm, and 2.5 mm). The catheters were moved by a ical motion.
microprocessor-controlled mechanism to simulate cardiac
Evaluation Findings
Overall Performance between 13% and 20%, which represent comparable effec-
The evaluated systems are all able to consistently provide tiveness. Even so, cardiac CT remains a high-dose exam.
images of suitable quality. All of the users we interviewed GE, Philips, and Siemens have techniques using axial ac-
said that they would choose the same system again.* Even quisition that can reduce the dose by 80%. However, there
customers who reported some problems answered posi- are limitations to these techniques, and other more signifi-
tively. At the same time, we found that each manufacturer cant technological innovations may prove to be more ef-
had some unique features and technologies, which we de- fective at reducing dose without limiting the diagnostic
tail in this and the following sections. informationfor example, dual-source CT from Siemens
and 256-slice CT from Toshiba. ECRI Institute believes
IMAGE QUALITY that dose is becoming a key decision issue when choosing
General findings. The tables on pages 384 through 386 CT systems for cardiac imaging. It is vital that users
summarize our image quality measurements. As our re- understand the benefits and limitations of any new
sults show, the image quality provided by all the systems techniques being proposed.
is within acceptable limits. However, there are some dif-
ferences among the systems that are discussed in the indi- WORKFLOW INTEGRATION
vidual product profiles. It is clear from our study that all the manufacturers have
Dynamic imaging. Perhaps the hardest aspect of modern made considerable efforts to develop intuitive user inter-
CT scanning to evaluate objectively is the quality of an faces; all of them define clear steps through which the user
image captured from a beating heart. Our assessment using progresses. However, differences emerge when consider-
simulated coronary arteries showed clear differences being how image acquisition and image reconstruction
tween the systems (see ECRI Institutes Cardiac Phan- coexist. Some manufacturers put scan planning and recon-
tom on page 382), particularly at higher and irregular struction into one console, while others use separate
heart rates: GEs and Toshibas images were clear and consoles. One console is sufficient if it is unlikely that
sharp, the other systems slightly less so. The images also physicians will ask for additional reconstructions and if
demonstrated that manufacturers use significantly different workspace is limited. But in situations with more demand-
reprocessing parameters (e.g., reconstruction filters, slice ing physicians who are likely to request additional pro-
width). It is possible that these will affect the accuracy of cessing, two separate workstations are preferred so that
the cardiac images. Therefore, we believe that more re- scanning is not interrupted. One manufacturer, Philips, has
search into those factors is needed. introduced technology that enables any user to access raw
data remotely; this technology enables radiologists to re-
DOSE MANAGEMENT process images without interrupting workflow and to do so
Dose modulation based on information retrieved from from different locations.
scout views is now standard on CT systems. While there The huge amount of data produced by CT means that
are subtle differences between the approaches used, the 3-D processing is now indispensable. Picture archiving
techniques achieve comparable dose savings of 40% to and communication system (PACS) workstations are gen-
60%. Absolute dose savings will depend not only on the erally not adequate for this purpose, but few facilities can
technology, but also on how the user configures and uses afford to purchase sufficient 3-D workstations to handle
the tools provided. their workloads. So the trend today is to use thin-client
Dose control is a major issue in cardiac imaging. ECG technology so that users can access advanced 3-D func-
gating of the x-ray exposurethat is, using the ECG sig- tionality from personal computers or PACS workstations.
nal to trigger the beginning and end of a scanis now Different pricing models are used for licensing the number
standard, and each manufacturer achieves dose reductions of concurrent users, so overall costs will be variable.
* Note that we did not restrict our user survey to names provided by the
manufacturers. (continued on page 386)
Table 1. Noise Comparison
Spatial frequency,
line pairs/cm Noise, %
GE Philips Siemens Toshiba
3 (standard) 0.36 0.38 0.35 NA

5 (chest) 1.7 1.7 1.8 0.9
6 (lung) 2.3 2.3 2.5 3.2
9 (bone) 4.2 4.2 4.7 10.6
Noise limits the visibility of details, so it is widely used as an indicator of image qualitythe lower the
noise, the better the image quality. However, noise is strongly affected by the sharpness of the image,
which is determined by the reconstruction kernel. In fact, there is a linear relationship between them.
Therefore, to compare systems, we can interpolate the noise produced by each at specific spatial fre-
quencies. These values show comparable performance for three of the systems; the exception is
Toshiba. In soft-tissue imaging, Toshiba uses a higher spatial resolution and has lower noise. But in bone
imaging (which is a high-resolution technique), Toshiba has higher noise. Keep in mind, however, that
minimizing noise is more important during soft-tissue imaging than during high-resolution imaging.
In addition to the standard reconstruction kernels, manufacturers also include high-resolution kernels
with reduced noise levels, sometimes referred to as adaptive filters. Our results confirm that adaptive fil-
ters allow the dose to be reduced in high-resolution imaging. The main disadvantage with these filters is
that they require a slightly longer reprocessing time.
Table 2. Uniformity Comparison

Results in italics represent the best uniformity. Numbers in parentheses indicate the slice thickness used.
Intraslice axial uniformity, HU 3.7 (5 mm) 3.6 (5 mm) 0.3 (4.8 mm) 0.4 (8 mm)
Interslice axial uniformity, HU
Broad slices 1.0 (5 mm) 3.8 (5 mm) 0.8 (4.8 mm) 0.83 (8 mm)
Narrow slices 2.68 (0.625 mm) 8 (0.6 mm) 2.25 (1 mm) 1.53 (0.5 mm)
Interslice uniformity for 5 mm 1.0 1.0 0.3 1.1
spiral slices, HU
In CT images, voxel values are directly related to the attenuation characteristics of the subject. The voxel
values in a uniform phantom image should be uniform regardless of the position of the phantom. Unifor-
mity depends on good calibration for all the detectors. Low values indicate good uniformity.
For all four systems, the measurements were within acceptable limits. Overall, the Siemens and
Toshiba results demonstrated better performance.
Table 3. Sharpness Comparison
Higher values indicate sharper images. Results in italics represent the best performance.
Soft-tissue imaging Standard kernel UB kernel B31s kernel FC22 kernel
50% 3.6 lp/cm 3.0 lp/cm 3.3 lp/cm 4.4 lp/cm
Lung imaging Lung kernel E kernel B70s kernel FC50 kernel
Bone imaging Edge kernel D kernel B75h kernel FC80 kernel
The sharpness of any imaging device can be measured using the modulation transfer function (MTF). Put
simply, the MTF is a plot of contrast against spatial resolution. In general, MTF decreases with spatial
resolutionin other words, fine detail (high spatial resolution) is more difficult to see. CT manufacturers
typically report the spatial frequencies at specific points along the MTF curve for comparison (e.g., 50%,
10%, and 2%). The 10% values are probably the most indicative of the image sharpness. However, the
MTF is dependent on the reconstruction kernel. This table reports the spatial frequency, in line pairs
(lp)/cm for specific points on the MTF response for three kernels for each manufacturer.
Table 4. Nominal versus Measured Slice Thickness

Results in italics indicate closest agreement between nominal and measured values.
Nominal, mm 0.625 0.625 0.6 0.5
FWHM 0.72 0.83 0.69 0.60
FWTM 1.3 1.7 1.5 1.0
Nominal, mm 5 5 5 5
FWHM 5.3 5.0 5.1 5.0
FWTM 8.2 8.6 8.0 5.7
The thickness of helical slices is measured by assessing a profile of a thin object through multiple slices.
The full width half maximum (FWHM) of the profile defines slice thickness and should match the set value,
while the full width tenth maximum (FWTM) shows the spread of the slice profilea narrower spread is
preferred. Toshiba images show smaller spreads than those of the other systems.
Table 5. Low-Contrast Detectability
Results in italics represent best performance.
GE Standard Philips UB Siemens B31s Toshiba FC13
kernel kernel kernel kernel
Dose CTDIvol, mGy* 53 41 43 35
Minimum visible
diameter, mm
At 1% contrast 2 2 2 2
At 0.5% contrast 2 3 3 2
At 0.3% contrast 3 5 4 2
* Dose calculated using the head phantom CTDIw values and mAs.
The detectability of low-contrast objects of various sizes is often used to visually confirm the other mea-
surements. In CT, the minimum visible diameter is reported at three contrasts. A smaller diameter indicates
better image quality. However, manufacturers differ in how dose is determined, so comparing systems re-
quires close analysis of specifications. The results for the evaluated systems are comparable; Toshiba
shows the best performance overall.
(continued from page 383) Instead, manufacturers maintain distributed parts depots,
which can entail a longer delivery time. However, facili-
The range of clinical applications available on different ties that allow manufacturers to remotely troubleshoot
suppliers 3-D workstations is broadly similar. The main their CT systems should benefit from earlier parts
differences can be found in the quantitative and automated delivery.
tools they provide, such as computer-aided detection and
The most significant service issue with CT is the x-ray
computer-assisted reading. It is important to keep in mind
tube life. A replacement tube can cost $200,000. There is
that buyers are not limited to choosing a 3-D workstation
no standard method used to determine tube use, so com-
from the same manufacturer as the CT system, so they
paring manufacturers warranties can be challenging. Our
should carefully consider their options and what is best for
calculations showed a wide variation in warranted tube life
their specific situation.
from 120,000 to 250,000 scan seconds. Also, our survey
showed that x-ray tube life span tends to be random: Some
INSTALLATION AND MAINTENANCE
tubes lasted four months, while identical tubes lasted two
All the manufacturers have made considerable efforts to years. Based on our pooled data, users should budget to re-
provide installation, training, and maintenance services to place their tubes at least once per year. However, our sur-
their customers. For example, they all have training vey found that one manufacturer, Toshiba, showed
schools and normally include training for two hospital cli- consistently more reliable x-ray longevity, with most cus-
nicians with the purchase of new equipment. In addition, tomers still using their first tube after more than a year of
the companies applications specialists will spend some operation.
time on-site after installation.
For a fee, all the manufacturers will train hospital or
The users we surveyed were satisfied with the overall third-party service technicians in the same way as their
level of service they received. However, one common com- own technicians; most also require substantial additional
plaint with CT is the time involved in waiting for replace- annual licensing fees to allow these technicians to service
ment parts. This is unavoidable to some extent, since the their equipment. The bottom line is that, for facilities
high cost of most parts means that it is not feasible to main- wanting to service their own equipment, the full costs
tain spare-parts inventories within healthcare facilities. must be considered.
About the Product Profiles Fair. The system either does not perform satisfactorily
Starting on the next page, we describe each evaluated or has a noteworthy deficiency or limitation. However,
product and note the test results that contributed to our rat- the failure, deficiency, or limitation is not likely to (1)
ings. We present only those results from our testing that cause an adverse clinical outcome, (2) significantly af-
we determined to be significant; we dont discuss results fect the overall performance of the system, or (3) place
for tests in which a unit simply met our criteria or had no an excessive burden on those who purchase, use, or
remarkable features. However, for all tests or test catego- service the system.
ries, we present an ECRI Institute judgment of the units Poor. The system does not perform satisfactorily, and
performance according to the following scheme: its deficiencies or limitations are likely to (1) adversely
Excellent. The system possesses a feature or performs affect the clinical outcome, (2) significantly affect the
at a level that would likely be considered favorable dur- overall performance of the system, or (3) place an ex-
ing the selection process. cessive burden on those who purchase, use, or service
the system.
Good. The system performs satisfactorily. In general,
any advantages of the system balance or outweigh any Note that, in future updates of this study, our judgments
disadvantages. may change as we obtain new information.
Health Devices Ratings System

Health Devices Evaluations rate products based on their clinical less suitable for a specific application. A product that we rate
and technical acceptability and desirability. Ratings are based on Not Recommended is safe to use and does not have to be
standard commercial products. Suppliers often modify their prod- withdrawn from service. However, we recommend against
ucts in response to our findings, sometimes before we publish purchasing the product unless overriding considerations
our Evaluations. If the modified product is not available in time for warrant it.
us to verify the significance of the change, we may include a
statement of the suppliers intentions. In future issues of Health Ratings Category: Unacceptable
Devices, we may update the information provided for the evalu-
ated products and may revise our ratings. The product fails to meet significant criteria
We recommend that you use our ratings as a guide for se- for performance or poses significant safety risks. A healthcare
lecting the best products for your healthcare facility. Actual facility that does not own such a product should not purchase
purchasing decisions should be based on a thorough under- it. If you have a product that we have rated Unacceptable, re-
standing of the article, as well as on your specific clinical view the disadvantages of continuing to use it, and plan to
applications, users opinions, standardization policies, direct replace it. If you decide to purchase or continue to use the
experience with the supplier, and price. product, carefully document the basis for your actions.
Ratings Category: Acceptable for Use Conditional Ratings
The product meets all major performance Occasionally, our rating for a product depends on whether a
and safety criteria. It has no serious shortcomings and offers healthcare facility is willing and able to take corrective mea-
significant advantages over other alternatives. sures to overcome a basic performance or safety shortcoming.
Corrective measures range from special training (e.g., stress-
The product meets all major performance
ing the importance of certain operating instructions) to order-
and safety criteria and has no serious shortcomings.
ing an upgrade or modifying a product. If the facility meets the
The product does what it is intended to conditions stated, the product is rated in the category speci-
do, but not at the desired level of performance, or it has sig- fiedthat is, Preferred, Acceptable, or Not Recommended.
nificant disadvantages compared with other alternatives. For However, if the facility does not or cannot meet the conditions,
example, it may be more difficult to use or clean, or it may be the product is Unacceptable.
GE Healthcare LightSpeed VCT
Supplier. GE Healthcare [439946], Waukesha, Wisconsin

(USA); +1 (800) 643-6439, +1 (262) 544-3011; www.
gehealthcare.com
Product availability. Introduced in 2005, this product is
marketed worldwide.
The system we tested. We performed our testing on a
LightSpeed VCT with software release 06MW29.7 and
07MW18.4. The system was located in the manufacturers
testing and manufacturing facility.
Product Description
The LightSpeed VCT family of CT systems includes sys-
tems with either 32 or 64 slices. In addition, the 16-slice or
4-slice LightSpeed RT and Xtra wide-bore (80 cm) config-
urations are available for oncology and general radiology
applications (e.g., trauma, bariatrics). GE has recently in-
troduced the BrightSpeed family of systems, which are
available with 4 to 16 slices and have a more compact gan-
try so they can be installed in smaller rooms.
The standard scanner configuration includes a dual-
monitor acquisition console to control scanning and im- Acceptable. The GE LightSpeed VCT offers high-quality
age reconstruction. A majority of clinical applications imaging and is very easy to use.
can be accessed from the console. However, in most sce-
narios a specialized 3-D platform is more appropriate.
65 bpm, 4 at 75 bpm, 4 at 85 bpm, and 4 for the irregular
GE uses the Advantage Workstation (AW), which can be
heart rate. The larger catheters were easily visible regard-
directly connected to GE CT scanners. In addition, the
less of heart rate. (Some of the phantom images are shown
AW RemoteAccess option allows users to remotely ac-
on the next page.)
cess and use an AW.
Artifacts. GoodNo significant findings to report.
Significant Test Results Dose managementExcellent

Image qualityGood Dose. ExcellentWe were able to test a feature that
Noise characteristics. GoodNo significant findings to GE recently introduced commercially, Cardiac SnapShot
report. Pulse. We found that this feature reduced the dose length
product to 102 mGy cm compared to 561 mGy cm for

Slice thickness and spatial resolution. GoodNo sig-
an ECG-modulated scan, which is an 80% reduction in
nificant findings to report.
dose. Whats more, the breathhold time was reduced from
Uniformity. ExcellentThe uniformity across a 250 mm 8 seconds to less than 5 seconds. The technique is limited
diameter phantom was within 3.7 HU, which is within our to heart rates no greater than 65 bpm, so beta blockers are
criterion of 5 HU. The uniformity between contiguous ax- normally needed to reduce the heart rate. We interviewed an
ial slices was 1 HU for 5 mm slices and less than 3 HU for early user of this technology to determine the drawbacks.
0.625 mm slices. These values are well within our criteria. The main drawback is that only one phase of cardiac data
Temporal resolution. ExcellentWhen using our dy- is acquired. Therefore, the images can only be used to
namic cardiac phantom, the scores (5 = clear and sharp to determine the patency of the coronaries and cannot be
1 = unusable) for the 1.3 mm simulated catheter were 5 at used for functional measurements. Also, the quality of the
works just for the z-axis, while SmartmA works in all
three dimensions. The settings are based on the scout im-
age. A dose saving of 42% was demonstrated.
When using dose modulation, each facility specifies the
target standard deviation and the range of acceptable mA
values. Once specified, these settings are built into all
standard protocols, making dose modulation easy to use.
A dose record is made with all studies as an additional
text image within the DICOM data. This report includes
both the dose length product and CT dose index (CTDI vol).
Therefore, dose data can be retrospectively reviewed.
During cardiac exams, the dose is modulated based on
the ECG. Measurements with our cardiac phantom showed
dose savings of about 20% at a heart rate of 65 bpm com-
pared to a non-ECG-modulated exam.
Workflow integrationExcellent
Clinical experience. ExcellentAll users surveyed re-
ported that they would choose GE again for a CT system.
The system is equipped with either an 85 kW or 100
kW generator; these are the highest powers available for
any CT system. Higher power means that most obese pa-
tients can be scanned without the need to adjust standard
protocols. Several users commented that this aids
workflow.
The acquisition console uses a standard dual-monitor
configuration. While other manufacturers also offer
GE phantom images. 1.3 mm catheter imaged at simu-
lated 85 bpm (top) and irregular heart rate (middle). The dual-monitor configurations, we found that the GE console
stationary image (bottom) serves as a baseline. makes the most efficient use of the additional space avail-
able. For example, one monitor is used to display text,
while the second monitor is used just to display images.
images produced by the first versions of this technique is
susceptible to variations in heart rate. GE informed us that GE uses descriptive names for the reconstruction filters.
the full commercial version will be modified to better cope Whats more, the choices offered to the user are limited to
with varying heart rates. In our opinion, this technique is a those that are clinically useful. So while users must usually
significant step forward in the reduction of dose when CT choose between multiple coded options (e.g., UB, B31s,
is being used to diagnose coronary disease. FC22) that often have only subtle differences, GE makes it
easy for the user to select the most appropriate option
Dose in pediatric body imaging is set using the Broselow-
(e.g., soft, standard, lung, chest, detail, bone, edge,
Luten Color Coding Kids system, which is commonly
boneplus).
used in emergency rooms to determine appropriate drug
doses. The system is applicable for weights up to 36 kg Image acquisition performance. GoodNo significant
(80 lb). In head imaging, three age ranges are used. findings to report.
The system uses three bow-tie filters to shape the x-ray Postprocessing. ExcellentWhile no second console is
beam before it is incident on the patient. The bow-tie filter available for postprocessing, it is possible to access a prior
is automatically selected to match the field of view. These patient without interfering with the present exam.
filters help optimize the dose to the clinical requirements. A comprehensive range of clinical applications is avail-
Dose modulation. ExcellentTwo dose-modulation able on the AW and the acquisition console. These include
techniques are used, AutomA and SmartmA. AutomA full cardiac analysis (including pacemaker planning), brain
perfusion (GE is developing a shuttle technique that will Service and supportGood
double the coverage possible in stroke detection), vessel User feedback. ExcellentAll users reported a generally
analysis (including thrombus assessment), computer- positive experience regarding service.
assisted lung measurement (not available on the acquisi- Training. ExcellentIn addition to the standard training
tion console), and virtual colonography (including a dis- offerings, GE provides Training in Partnership (TiP) Vir-
section view). tual Assist, in which a GE specialist can remotely control
A standard feature on the LightSpeed systems is exam an AW workstation through a VPN connection. This al-
split, which enables studies of contiguous body parts to be lows users to access expert help at almost any time. In ad-
split prospectively and given new accession numbers. This dition, GE provides various business analysis services,
has advantages for billing. such as Imaging Roadmap and Realize VCT, that are de-
signed to optimize the training and clinical services.
Ease of use. GoodNo significant findings to report. Reliability and maintenance. GoodThe x-ray tube is
Connectivity. GoodIn addition to meeting all our warranted to last for 6,000 patients, which equates to a
DICOM requirements, the LightSpeed meets most of the year under normal use. Standard warranty conditions re-
appropriate IHE profiles, including Scheduled Workflow, flect this. Assuming 20 seconds per patient, this equates to
Patient Information Reconciliation, Consistent Presenta- 120,000 scan seconds.
tion of Images, and Presentation of Grouped Procedures. Planning. GoodNo significant findings to report.
Specifications for GE CT Systems

Description LightSpeed VCT BrightSpeed Elite BrightSpeed Select
Number of slices 64, 32 16, 8, 4 16, 8, 6

Detector coverage (z-axis), mm 40 20 20
Number of detectors (z-axis) 64 24 24
Minimum slice width, mm 0.625 0.625 0.625
Minimum rotation time, sec 0.4; 0.35 optional 0.5 0.8
Generator power, kW 85; 100 optional 53 42
Large focal spot, mm 0.9 0.9 0.9 0.7 0.9 0.7
Small focal spot, mm 0.6 0.7 0.6 0.7 0.6 0.7
X-ray tube heat storage, MHU 8 6.3 3.5
X-ray tube cooling rate, kHU/min 1,782 840 820
Standard patient table
Weight limit, kg (lb) 227 (500) 180 (400) 205 (451)
Precision of table movement, mm 0.25 0.25 1
Optional patient table
Weight limit, kg (lb) NA 205 (451) NA
Precision of table movement, mm NA 1 NA
Minimum height of patient table, 43 (17) 52 (20) 44 (17)
cm (in)
Philips Medical Systems Brilliance 64
Supplier. Philips Medical Systems International [415450],

Best (The Netherlands); 31 (40) 2763051 n Philips Medi-
cal Systems North America [102120], Bothell, Washing-
ton (USA); +1 (800) 722-7900, +1 (425) 487-7000 n
www.medical.philips.com
marketed worldwide.
Brilliance 64 with software release 2.2.1. The system was
located in the manufacturers testing and manufacturing
facility.
Product Description
The Brilliance family of CT systems includes systems of- Acceptable. The Philips Brilliance 64 provides high-
fering 6 to 64 slices. In addition, the 16-slice Brilliance quality images and includes some useful and unique
Big Bore (85 cm) configuration is available, primarily for applications, such as remote access to raw data and
large-coverage stroke detection.
oncology applications.
The standard Brilliance 64 scanner configuration in-
regardless of heart rate. (Some of the phantom images are
cludes a dual-monitor acquisition console to control scan-
shown on the next page.)
ning, image reconstruction, and postprocessing. All
clinical applications can be accessed from the console. In The cardiac images are reconstructed with a 0.9 mm
addition, the Extended Brilliance Workspace is an image slice width and a smooth reconstruction filter (XCB). This
analysis workstation and has full access to both the raw means that the images appear to have low noise. However,
data and processed images, so images can be reprocessed the smooth reconstruction filter will also tend to reduce the
remotely. In addition, a thin client-server product, known resolution. This may explain why the diameter of the sim-
as the Brilliance Workspace Portal, is available. The portal ulated contrast-filled vessel appeared to be too wide (2.4
enables almost any networked computer to run a suite of mm compared to 1.3 mm).
advanced applications. Artifacts. GoodNo significant findings to report.
Significant Test Results Dose managementExcellent

Dose. ExcellentInfant and pediatric protocols are auto-
Image qualityGood
matically applied when appropriate, based on the patients
Noise characteristics. GoodNo significant findings to age.
report.
Philips has just commercially introduced a cardiac
Slice thickness and spatial resolution. GoodNo sig-
dose-reduction technique called Step & Shoot. While it
nificant findings to report.
was not available during our testing, its technical details
Uniformity. GoodThe uniformity across a 250 mm di- are similar to those of GEs Cardiac SnapShot Pulse tech-
ameter phantom was within 3.6 HU, which is within our nique, which will be commercially introduced soon; we
criterion of 5 HU. did test the SnapShot Pulse, finding that it shows signifi-
Temporal resolution. ExcellentWhen using our dy- cant dose savings. Therefore, ECRI Institute expects that
namic cardiac phantom, the scores (5 = clear and sharp the Philips approach will demonstrate similar resultsin-
to 1 = unusable) for the 1.3 mm simulated catheter were cluding limitations such as not being usable with higher
5 at 65 bpm, 4 at 75 bpm, 3 at 85 bpm, and 2 for the ir- heart rates and producing an image of only one part of the
regular heart rate. The larger catheters were easily visible cardiac phase.
Dose modulation. ExcellentThe dose modulation time) was an advantage, since it enables high-resolution
function (called DOM) operates in both the 2-D and 3-D imaging even with large patients.
modes based on the Surview (scout) image. A dose saving Image acquisition performance. ExcellentThe sys-
up to 60% was demonstrated. The operation of the DOM tems Jog Mode (used for brain perfusion imaging) is
is dependent on the automatic current selection (ACS), useful and well accepted by patients. According to a
which aims for constant noise (standard deviation) long-term user, the images are of similar quality to those
throughout the image. Once ACS is calibrated, the user from magnetic resonance.
simply selects the required noise level.
During acquisition, a subset of the images is displayed
Dose modulation based on the ECG is standard in car-
to the operator as they are reconstructed (using an optional
diac exams. Measurement with our phantom showed dose
feature called Evolve), so the user has feedback and can
savings of about 15% at a heart rate of 65 bpm.
terminate and rescan the exam if necessary.
Workflow integrationExcellent Postprocessing. ExcellentAny user of the Philips 3-D
Clinical experience. ExcellentAll users surveyed re- workstation (Extended Brilliance Workspace) can repro-
ported that they would choose Philips again for a CT sys- cess raw data remotely. In addition, via the Workspace
tem. Users commented that being able to use the small Portal option, remote users can view and process 3-D CT
focal spot at maximum power (for a limited exposure data using any networked computer.
A comprehensive range of clinical applications is avail-
able on any Brilliance Workspace, including the acquisition
console. These applications include full cardiac analysis,
brain perfusion (Philips has the Jog Mode technique, which
will double the brain volume covered in stroke detection),
vessel analysis, computer-assisted lung measurement
(computer-aided detection is under development), and
colonography (including a dissection view). In addition,
Philips offers its TrueView technology, which exports car-
diac data to a Philips cath lab and shows the cardiologist
how to obtain the projections obtained from CT.
A standard feature on the Brilliance 64 and 40 systems
is split study. This enables studies of contiguous body
parts to be split prospectively and given new accession
numbers. This has advantages for billing.
Ease of use. GoodNo significant findings to report.
Connectivity. GoodIn addition to meeting all our
DICOM requirements, the Brilliance meets some of the
IHE profiles we specified, including Scheduled Workflow
and Patient Information Reconciliation.
Service and supportGood

User feedback. ExcellentAll users reported a generally
positive experience regarding service.
Training. GoodPhilips has a Web-based NetForum
community for users to ask questions and access instruc-
tional materials (e.g., lectures).
Reliability and maintenance. GoodThe x-ray tube is
Philips phantom images. 1.3 mm catheter imaged at warranted for 12 months and is not prorated; if the tube
simulated 85 bpm (top) and irregular heart rate (middle).
fails at any time during the warranty period, a replacement
The stationary image (bottom) serves as a baseline.
will be installed at no cost. The expected life of the tube is
250,000 scan seconds, which is the longest of the evalu- Planning. ExcellentPhilips provides complete installa-
ated systems. tion planning, physicist information, and site surveys (in-
Philips offers a co-op agreement for non-Philips techni- cluding power quality) to the purchaser. Planning includes
cians to access the same service support as that available provisions for the predictable requirements for future CT
to Philips technicians. technology upgrades.
Philips also offers a technology update program to Unique to Philips is the availability of Ambient Experi-
all service customers, in which all applicable software ence, which is an integrated room design that is intended
options are migrated when new versions (including up- to reduce patient anxiety using lighting and curved spaces
grades) are released, and computer hardware is swapped that are meant to be less threatening. Users of Ambient
after 3 years. The program is available to all Philips ser- Experience have reported reduced use of sedation in pedi-
vice customers. atric patients.
Specifications for Philips Brilliance CT Systems

Description Brilliance 64 Brilliance 16
Number of slices 64, 40 16, 6
Detector coverage (z-axis), mm 40 24
Number of detectors (z-axis) 64 24
Minimum slice width, mm 0.625 (2 0.5) 0.75 (2 0.6)
Minimum rotation time, sec 0.5; 0.4 optional 0.5; 0.4 optional
Generator power, kW 60 60
Large focal spot, mm 1 1 1 1
Small focal spot, mm 0.5 1 0.5 1
X-ray tube heat storage, MHU 8 8
X-ray tube cooling rate, kHU/min 1,608 1,608
Weight limit, kg (lb) 204 (450) 204 (450)
Precision of table movement, mm 0.25 0.25
Weight limit, kg (lb) 295 (650) 295 (650)
Precision of table movement, mm 0.25 0.25
Minimum height of patient table, cm (in) 53 (21) 53 (21)
Siemens Medical Solutions Sensation 64
Supplier. AG Siemens Medical Solutions [401832],

Erlangen (Germany); 49 (9131) 840 n Siemens Medical
Solutions USA Inc. [399199], Malvern, Pennsylvania
(USA); +1 (888) 826-9702, +1 (610) 219-6300 n www.
siemensmedical.com
marketed worldwide.
Sensation 64 with software release Syngo CT 2006A. The
system was located in the manufacturers testing and man-
ufacturing facility. (Note that Siemens also produces a
dual-source x-ray system, the Definition. The Definition is
specifically designed for cardiac and dual-energy CT scan- Acceptable. The Siemens Sensation 64 offers excellent
performance for noncardiac applications, including com-
ning. We will compare the Definition to the Sensation 64
puter-aided detection. Its not quite as desirable as the
in a future issue of Health Devices.) other systems because its cardiac image quality doesnt
match theirs.
Product Description
The Sensation family of CT systems includes 40- and reconstruction kernels are used to increase the sharpness
64-slice options. In addition, Siemens markets the Defini- within the scan plane (i.e., the x/y plane). In addition, a
tion dual-source CT, the Emotion (2 or 16 slices), and the collimator can be inserted in front of the detector to de-
Spirit (2 slices), as well as the 40- or 24-slice Sensation crease the slice width from 0.6 to 0.3 mm across the full
Open wide-bore (82 cm) system for bariatric and oncology detector coverage. Both techniques require a high dose.
applications. However, in some limited situations (e.g., the inner ear),
the additional resolution will be beneficial.
The standard scanner configuration includes a Syngo
Acquisition Workplace for 3-D processing. The Acquisi- Uniformity. ExcellentThe uniformity across a 250 mm
tion Workplace controls all scanning and reconstruction diameter phantom was less than 1 HU, which is well in-
and is available with either single- or dual-monitor config- side our criterion of 5 HU. The uniformity between contig-
urations. Advanced clinical applications and 3-D tools can uous spiral slices was less than 0.5 HU for pitches of 0.5
be accessed using one of three Syngo Workplaces: CT, to 1.5. This value is better than that found for other sys-
MultiModality, or WebSpace. The CT Workplace shares tems and is well within our criteria. The uniformity be-
the scanner database, so there is no delay in transferring tween contiguous axial slices was less than 1 HU for all
images. The MultiModailty is a thick client that can be dis- slice widths. This value is also well within our criteria.
tributed around the department. The WebSpace enables
Temporal resolution. GoodThe dynamic phantom
any Internet-connected PC, including PACS workstations,
to access the Syngo applications, including the InSpace 4D scores met our baseline criteria. Further analysis of the im-
package (an interactive 3-D image-processing package). ages showed that, of all the evaluated systems, the catheter
diameters measured by the Sensation most accurately
matched the real diameters, which is an advantage. The
Significant Test Results cardiac images are reconstructed with a sharp reconstruc-
tion filter (B46f); as a result, any flaw in the image is also
Image qualityGood
very visible, which would not be the case if a smoother fil-
Noise characteristics. GoodNo significant findings ter were used. This is why the Sensations scores (5 =
to report. clear and sharp to 1 = unusable) were lower overall than
Slice thickness and spatial resolution. Excellent for the other systems: 4 at 65 bpm, 3 at 75 bpm, 2 at
Two ultrahigh-resolution modes are available. Specialized 85 bpm, and 3 for the irregular heart rate. The larger
catheters were easily visible regardless of heart rate. with the Sensation 64 compared to other 64-slice systems,
(Some of the phantom images are shown on this page.) since the Sensation will require twice as many steps as the
Artifacts. GoodNo significant findings to report. others to cover the same anatomy, making dose reduction
more difficult.
Dose managementExcellent Dose modulation. ExcellentThe built-in protocols are
Dose. ExcellentThe Sensations CareDose 4D dose- initially set up with the lowest dose. Whats more, the dose
modulation application includes provisions for pediatric modulation feature, CareDose 4D, operates in both the
patients based on weight. 2-D and 3-D modes based on the topogram (scout) image
Siemens is making its forthcoming cardiac step-and- and real-time feedback during the scan. A dose saving up
shoot feature available free of charge to its customers. It is to 40% was demonstrated.
similar to other axial cardiac dose-reduction techniques, The operation of the CareDose 4D is dependent on the
and Siemens predicts that a 80% dose reduction will be configured reference point. Unlike other dose-modulation
possible. However, the Sensations smaller z-axis cover- techniques, CareDose does not aim for constant noise. In-
age will likely limit the clinical utility of the technique stead, the dose for smaller patients is not reduced as much,
and the dose for larger patients is not increased as much.
Siemens believes that this approach is more beneficial in
terms of matching the image quality to the clinical need. It
also reduces the mA required for very large patients, so
you are less likely to have problems when scanning obese
subjects.
Dose modulation based on ECG is standard in cardiac
exams. At the time of our testing, Siemens was in the pro-
cess of introducing a revised ECG modulation technique
that is designed to more accurately predict the R-R interval
rather than simply average the previous three intervals.
Results presented by Siemens show that the new approach
achieves an average dose reduction of 39%, which is dou-
ble that normally found. The higher dose reduction is a re-
sult of being able to more reliably set narrower pulses
based on the ECG.
Workflow integrationGood
Clinical experience. GoodAll users surveyed reported
that they would choose Siemens again for a CT system.
Image acquisition performance. GoodDuring acquisi-
tion, a subset of the images is displayed to the operator as
they are reconstructed, so the user has feedback and can
stop the exam if necessary.
Postprocessing. ExcellentWorkStream 4D automates
most of the routine postprocessing steps so that technolo-
gists do not have to manually process the images into the
required projections and views, as would be normally re-
quested by the radiologist. If used properly, this saves time
Siemens phantom images. 1.3 mm catheter imaged at
and should enhance workflow.
The stationary image (bottom) serves as a baseline. The Full reprocessing is possible at the Syngo Acquisition
gaps visible in the top two images were caused by air Workplace, which can be fitted with dual monitors as an
bubbles that could not be completely purged from the
option (Syngo is the Siemens interface for all imaging mo-
contrast media; these can be disregarded.
dalities). In addition, a separate Syngo CT Workplace,
which shares the same database as the main Acquisition Therefore, the user can quickly find suitable alternative
Workplace, can be used for raw data reprocessing and settings with minimum compromise.
clinical applications. Since the database is shared, there is
Connectivity. GoodThe Sensation meets all our
no delay in transferring data. Distributed reading can be
DICOM requirements, plus three of the IHE profiles we
achieved with Syngo MultiModality Workplaces or via the
specified: Scheduled Workflow, Patient Information Rec-
Syngo WebSpace.
onciliation, and Consistent Presentation of Images.
A comprehensive range of clinical applications is avail-
able on any Syngo Workplace, including the acquisition Service and supportGood
console. These applications include full cardiac analysis,
User feedback. ExcellentAll users reported a generally
brain perfusion, vessel analysis, computer-aided lung-nod-
positive experience regarding service.
ule detection (computer-aided detection has premarket ap-
proval from the U.S. Food and Drug Administration Training. ExcellentSiemens runs three training centers
[FDA]), and colonography. In addition, Siemens has re- within the United States as part of the Siemens Remote
cently introduced technology that exports cardiac data to a Services, which are offered at no cost to customers; it re-
Siemens cath lab and shows the cardiologist how to obtain quires a VPN connection. Users can contact applications
the projections obtained in CT. specialists via the Acquisition Workplace.
Ease of use. ExcellentIf the user sets nonviable study Reliability and maintenance. GoodThe x-ray tube has
parameters, the Scan Assist feature displays a window that an unlimited 12-month warranty. After 12 months, the
shows the interdependence of all the settings. In addition, coverage is prorated with a minimum coverage of 160,000
the scan parameters (e.g., pitch) are freely selectable. scan seconds. Additional coverage (scan seconds) can be
Specifications for Selected

Siemens Single-Source CT Systems
Description Sensation 64 Emotion 16 Spirit
Number of slices 64 16, 2 2

Detector coverage (z-axis), mm 28.8 24 10
Number of detectors (z-axis) 40* 16 2
Minimum slice width, mm 0.6; 0.3 optional 0.6 1
Minimum rotation time, sec 0.37; 0.33 optional 0.6; 0.5 optional 0.8
Generator power, kW 80 50 24
Large focal spot, mm 0.8 x 1.1 0.8 x 0.7 0.8 x 0.7
Small focal spot, mm 0.6 x 0.7 0.8 x 0.5 NA
X-ray tube heat storage, MHU 0** 6 2
X-ray tube cooling rate, kHU/min 5,000 810 700
Weight limit, kg (lb) 205 (450) 200 (440) 220 (480)
Precision of table movement, mm 0.25 0.25 0.25
Weight limit, kg (lb) 280 (615) NA NA
Precision of table movement, mm Not specified NA NA
Minimum height of patient table, cm (in) 53 (21) 45 (18) 45 (18)
* Siemens uses a technology it calls z-Sharp to produce 64 slices; 64-slice acquisition is only possible during spiral acquisition.
** Siemens specifies the equivalent heat storage to be 30 MHU based on the tubes rapid cooling (see next line).
purchased. Customers without tube coverage automatically Users of Siemens Remote Services are proactively
have a prorated 160,000-scan-second warranty. monitored from Cary, North Carolina. If a problem is
identified, the service center will contact the customer.
Another warranty-related feature offered by Siemens is Siemens estimates that 50% of problems can be fixed re-
the optional Syngo Evolve Package. Purchasers of this motely. In addition, Siemens can now provide utilization
package receive a computer hardware and software up- management and service data direct to users via e-mail.
grade after three years. The Syngo Evolve Package is in-
cluded in Gold level service contracts. Planning. GoodNo significant findings to report.
Toshiba Medical Systems Aquilion 64
Supplier. Toshiba Corp. Medical Systems Co. Ltd.

[140664], Otawara-shi Tochigi Pref., (Japan); 81 (287)
266301; www.toshiba-medical.co.jp n Toshiba America
Medical Systems Inc. [101894], Tustin, California (USA);
+1 (800) 621-1968, +1 (714) 730-5000; www.medical.
toshiba.com
Product availability. Introduced in 2005; marketed
worldwide
The system we tested. We performed our testing on an
Aquilion 64 with software release V3.00ER003. The sys-
tem was located in the manufacturers testing facility.
Product Description
The Aquilion family of CT systems includes systems with 4
Preferred. Offers superior image quality, most signifi-
to 64 slices; apart from the number of slices, the standard
cantly for cardiac imaging, as well as tools to help technol-
Aquilion systems have identical specifications. Also avail- ogists achieve reproducible, consistent results.
able is the 16-slice Aquilion Large Bore (90 cm) configura-
tion, which is intended primarily for oncology and general
radiography applications (e.g., trauma and bariatrics). within our criterion of 5 HU. Also, the uniformity between
contiguous axial slices was 0.8 HU for 8 mm slices and
The standard scanner configuration includes two inde-
1.5 HU for 0.5 mm slices. These values are also well
pendent consoles. Both consoles can be used for study man-
within our criteria.
agement and raw data processing. In addition, the scan
console is used for scanning, while the display console can be
Temporal resolution. ExcellentWhen using our dy-
used for some 3-D processing. Additional 3-D applications
namic cardiac phantom, the scores (5 = clear and sharp to
are available on the Vitrea workstation (supplied by Vital
1 = unusable) for the 1.3 mm simulated catheter were 5 at
Images Inc. [331069], Minnetonka, Minnesota, www.
65 bpm, 4 at 75 bpm, 4 at 85 bpm, and 4 for the irregular
vitalimages.com), which is generally sold with the Aquilion.
heart rate. The larger catheters were easily visible regard-
The Aquilion and Vitrea both support the enhanced DICOM
less of heart rate. These were the best scores of the sys-
CT standard, which enables much faster image transfer com-
tems evaluated. (Some of the phantom images are shown
pared to the normal DICOM CT standard.
on the next page.)
Significant Test Results Toshiba has two applications that are designed to aid
cardiac image acquisition. SureCardio is used before the
Image qualityExcellent
acquisition to record the effects of breathholding on the
Noise characteristics. GoodNo significant findings
patients ECG, providing a more accurate ECG record
to report. for gating. Following the exam, the PhaseXact technique
Slice thickness and spatial resolution. ExcellentThe is used to automatically select the phase with the least
actual slice thickness used for routine imaging is the nar- coronary movement. For most patients, the optimal phase
rowest we measured (0.6 mm; nominal = 0.5 mm). Whats will be predictable; however, it is well established that in
more, we found that the slice width profiles had the least some cases (e.g., higher heart rates), different cardiac
spreadthat is, were overall the narrowestof all the phases are better for imaging. All manufacturers offer the
evaluated systems. Therefore, the actual slice width most ability to manually select different phases to reconstruct,
closely matches the resolution set during scan planning. but PhaseXact automates this process. If the results are
Uniformity. ExcellentThe uniformity across a 250 mm not satisfactory, the user can always revert to the manual
diameter phantom was less than 1 HU, which is well technique.
measured x-ray composition, operating on the principle of
keeping the noise level constant. In addition, pediatric pro-
tocols are automatically triggered by the patients date
of birth.
The system uses two bow-tie filters to shape the x-ray
beam before it is incident on the patient. The bow-tie filter
is automatically selected to match the field of view. These
filters help optimize the dose to the clinical requirements.
Dose modulation. ExcellentSureExposure demon-
strated a dose saving up to 40%.
Users define the target standard deviation and the range
of acceptable mA values. These settings are built into all
standard protocols, making dose modulation easy to use.
A dose record is recorded with all studies as an addi-
tional image within the DICOM data. This report includes
both the dose length product and CTDI vol.
Dose modulation based on ECG is standard in cardiac
exams. Measurements with our cardiac phantom showed
dose savings of about 13% at a heart rate of 65 bpm.
Workflow integrationGood
Clinical experience. GoodAll users surveyed reported
that they would choose Toshiba again for a CT system.
Two independent workstations are provided as standard.
Both workstations can process raw data. Therefore, a cur-
rent study should not need to be interrupted if any repro-
Toshiba phantom images. 1.3 mm catheter imaged at cessing is required.
The stationary image (bottom) serves as a baseline. The Image acquisition performance. GoodDuring image
gaps visible in the top two images were caused by air acquisition, the SureScan feature displays a subset of the
bubbles that could not be completely purged from the images to the operator at 12 fps, so the user has feedback
contrast media; these can be disregarded. and can stop the exam if necessary.
The SureFluoro feature is used in biopsy cases and dis-
We found that the cardiac images are reconstructed plays three slices in real time instead of the normal single
with a 0.5 mm slice width and a sharp reconstruction filter slice. Therefore, the physician can have more images to
(FC43), with the result that the simulated coronaries ap- guide the biopsy needle.
peared to be sharp and well defined. As a result, measure-
Postprocessing. ExcellentFull reprocessing is possible
ment of the diameter closely matched the actual diameter,
which is an advantage. However, any flaw in the image is at the acquisition and display consoles so long as the raw
also very visible, which is not the case if a smoother filter data remains.
is used. Toshiba relies on Vital Images Vitrea workstation for
most applications and develops applications in close part-
Artifacts. GoodNo significant findings to report.
nership with Vital Images. The Vitrea offers a comprehen-
sive range of clinical 3-D applications. These include
Dose managementExcellent
full cardiac analysis, brain perfusion, vessel analysis,
Dose. ExcellentThe Aquilion offers the SureExposure computer-aided lung nodule detection (using the R2 CAD
3-D dose-modulation technique, which automatically algorithm, which has FDA premarket approval), and
adjusts the exposure parameters based on the patients virtual colonography.
Ease of use. ExcellentA number of Sure techniques training offerings, Toshiba has started an e-mail service
are available that automate acquisition and processing. allowing users to directly contact applications specialists.
Unique to Toshiba is SureCardio, which automatically re- Reliability and maintenance. GoodThe MegaCool
cords the patients ECG during a rehearsal scan while pre- x-ray tube is warranted to last for 200,000 rotations, which
paring for a cardiac scan. The system can then better equates to approximately 100,000 scan seconds. Standard
predict the ECG during the real scan. Also, SureExposure warranty conditions reflect this. Our survey found that us-
shows the user what the image would look like based on ers were consistently achieving more than 12 months use
the parameters selected. from their tubes. While other manufacturers also often
Connectivity. GoodIn addition to meeting all our achieve more than 12 months use, the record is far from
DICOM requirements, the Aquilion meets most of the IHE consistent. We believe there are a number of reasons for
profiles we specified, including Scheduled Workflow, Pa- the high consistency, including the moderate power speci-
tient Information Reconciliation, Consistent Presentations fication, which means that high mA is not used routinely;
of Images, and Presentation of Grouped Procedures. use of a grounded anode (it is usually at +75 kV), which
allows the anode to be directly cooled; and the larger focal
Service and supportGood spot size used. This longer life may translate into consider-
User feedback. ExcellentAll users reported a generally able cost savings over the life of the equipment.
positive experience regarding service. Access to service tools does not require the payment of
Training. ExcellentToshiba has recently expanded its licensing fees. Therefore, there are no recurring annual
user training academy in Tustin, California, for both fees for in-house service.
technologists and radiologists. In addition to the standard Planning. GoodNo significant findings to report.
Specifications for Toshiba Aquilion CT Systems

Description Aquilion Systems
Number of slices 64, 32, 16, 4

Detector coverage (z-axis), mm 32
Number of detectors (z-axis) 64
Minimum slice width, mm 0.5
Minimum rotation time, sec 0.5; 0.4, 0.35 optional
Generator power, kW 60; 72 optional
Large focal spot, mm 1.6 1.6
Small focal spot, mm 0.9 0.8
X-ray tube heat storage, MHU 7.5
X-ray tube cooling rate, kHU/min 1,386
Weight limit, kg (lb) 200 (440)
Precision of table movement, mm 0.25
Weight limit, kg (lb) 280 (615)
Precision of table movement, mm 0.25
Minimum height of patient table, cm (in) 30 (12)
Choosing a System
What You Need to Know When Interpreting CT Product Specifications
As a supplement to the findings from this months Evalua- lowest CTDIvol. Therefore, CTDIvol cannot be used to
tion of CT scanners, we provide this guide for readers who compare devices. Instead, potential buyers should seek the
desire a more general discussion of the factors that should typical mAs values employed by existing users.
be considered when purchasing a CT scanner. By examin- The next technological step in dose reduction is to fur-
ing and considering the following discussion in addition to ther reduce the dose during specific studiescardiac ex-
reviewing our Evaluation findings, you can gain the per- ams, for example. Some manufacturers are now installing
spectives necessary to select a unit that we did not evaluate systems that incorporate these more task-specific tech-
to ensure that it meets the needs of the clinical environ- niques. Early experience with these systems has demon-
ment(s) for which it is intended. strated that further dose savings are possible. However,
A significant challenge for buyers is the fact thateven there is usually some degree of tradeoff between dose re-
though manufacturers follow international standards when duction and the diagnostic efficacy of the images. So com-
specifying CT performancedifferent companies specifi- paring the dose savings possible on different systems will
cations are not necessarily stated in the same terms. There- require an in-depth understanding of the technologies
fore, buyers often need to obtain further information and involved.
conduct additional analysis.
The following factors are relevant regardless of the X-ray Production
number of slices chosen. The power of a systems x-ray generation (the output of
the x-ray tube and generator, measured in kW) seems to be
X-ray Dose an easy specification to compare and is often used as such.
The power directly affects the maximum tube current that
The radiation hazards of CT have only recently been fully
is available (greater tube currents enable larger patients to
recognized. Dose-modulation techniques are now standard
be scanned with shorter rotation times). Nevertheless, a
and are of comparable effectiveness among the evaluated
100 kW system is not twice as effective as a 50 kW sys-
systems. However, the dose required for suitable image
tem. One reason is that, because of noise considerations,
quality may not be comparable among the systems.
doubling the tube current increases the image quality by
An example of the complexity of comparing doses is only a factor of 1.4. A second reason is that the dose per
the question of how dose is reported. All manufacturers mAs is not a fixed quantity. As the CTDI values in the ta-
routinely report volume CT dose index (CTDI vol) values in ble below demonstrate, some systems output 1.7 times the
their specifications. These values are normalized with re- dose for the same mAs. In some cases, therefore, the same
spect to mAs. Yet there is no reason to expect that the image quality can be achieved with less mAs. So generator
same mAs will be used by different CT systems for the power specifications should not be compared in isolation.
same exam, so directly comparing the CTDIvol values will Other factorsin particular, the typical power and mAs
not yield meaningful information. needed for obese patientsshould also be compared.
To illustrate this point, the CTDIvol values taken from
manufacturers specifications are reported in the table on
this page. Comparing the dose requires that we also know Comparison of Manufacturer
typical mAs values used by each system. (Unfortunately, CTDI Data
now that automatic dose control is standard, typical values GE Philips Siemens Toshiba
are hard to establish. The values we report here are esti- CTDIvol, body, 8.5 5.6 6.7 9.4
mGy
mated from manufacturer literature and discussions we
Typical body 140 250 150 150
have had with the manufacturers.) Multiplying the CTDI vol
mAs
by the typical effective mAs, then dividing by 100, yields Comparative 11.9 14.0 10.05 14.1
comparative CTDI values (bottom row of the table); ob- CTDI, mGy
serve that the lowest-dose system is not the one with the
Image Processing workstations connected to the CT scanner via a Web-based
application, and using a third-party workstation.
Image reconstruction takes considerably longer than image
acquisition. While the fastest scanner can generate almost Each CT and workstation manufacturer has a different
200 images per second, the fastest reconstruction rate is 20 approach to how to fit the CT data into the workflow. It is
images per second. So even with the fastest computers, a not yet clear whether there is an optimum approach. The
10-second scan can take almost two minutes to reconstruct. use of remote general-purpose computers (thin client) ac-
cessing a central processing computer (server) is becoming
Our measurements showed that a systems overall scan more common. This provides a more cost-effective way to
timethat is, the acquisition and processing times com- share expensive resources and also allows physicians to
binedhas little correlation with the specified reconstruc- more easily access the advanced tools.
tion rate. Some systems start to process while the scan is
Each of the available solutions offers similar 3-D re-
continuing, while others wait until the scan is complete.
construction and viewing functionality. Features such as
Whats more, the maximum specified reconstruction rate
bone removal, vessel analysis, lung nodule measurement,
is highly dependent on the scan and reconstruction param-
brain perfusion measurement, and colonography are avail-
eters (e.g., pitch, slice thickness, increment, reconstruction
able as options from every vendor. Differences among
filter). So it is very difficult to compare reconstruction rate
systems include more specific features such as com-
specifications. Buyers should ask to time typical clinical
puter-aided detection, stent planning, bone densitometry,
cases.
body perfusion measurement, pacemaker planning, and
dental imaging. Therefore, you should select the appropri-
Workflow and ate 3-D processing based on your specific technical and
Clinical Applications clinical needs.
All the images produced by a CT scanner must be viewed Make sure you clearly understand the strengths and
and interpreted by a physician, so physicians must have the limitations of each manufacturers approach and how it
tools to manage and display large data volumes. General- fits your situation and requirements. Factors that will af-
purpose PACS workstations do not provide such tools, fect your selection include your physicians preferences,
however, meaning that more specialized workstations are diagnostic workstations you already have, your network
necessary. The possible choices include using a networked bandwidth, the specialized software tools available from
workstation from the CT manufacturer, using standard the manufacturers, and the layout of your facility.
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t

Computed tomography systems offering 64 slices are highly popular

We tested and rated the following products:

GE Healthcare LightSpeed VCT

(continued on page 380)

To assess the dynamic image quality of the evaluated sys-

3 (standard) 0.36 0.38 0.35 NA

Table 2. Uniformity Comparison

Table 4. Nominal versus Measured Slice Thickness

Health Devices Ratings System

Ratings Category: Acceptable for Use Conditional Ratings

Supplier. GE Healthcare [439946], Waukesha, Wisconsin

Significant Test Results Dose managementExcellent

Specifications for GE CT Systems

Number of slices 64, 32 16, 8, 4 16, 8, 6

Supplier. Philips Medical Systems International [415450],

Significant Test Results Dose managementExcellent

Service and supportGood

Specifications for Philips Brilliance CT Systems

Supplier. AG Siemens Medical Solutions [401832],

Specifications for Selected

Number of slices 64 16, 2 2

Supplier. Toshiba Corp. Medical Systems Co. Ltd.

Specifications for Toshiba Aquilion CT Systems

Number of slices 64, 32, 16, 4

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