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Opening the door to quick lesion characterization

Thanks to Gemstone Spectral Imaging, clinicians enter the realm
of more definitive diagnoses

Delivering on the
Promise of Dual Energy
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Breaking Barriers with

Gemstone Spectral Imaging
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Plus…Gemstone Spectral
Imaging Photo Gallery
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 Step Into the Future
of Dual-energy CT
Clinical images on the Discovery CT750 HD
with Gemstone Spectral Imaging

70 keV with iodine color map shows head Non-enhancing lung granuloma is confirmed Low-contrast visibility is optimized using
of pancreas enhancing more than tail. using 65 keV with iodine material overlay. 70 keV spectral image.

70 keV nicely demonstrates a right renal lesion. MD iodine image demonstrates no iodine MD water (iodine) demonstrates hyperdensity
enhancement in the right renal lesion. vs. the background tissue. Combining the
information from these three images suggest
a right hemorrhagic renal cyst.

2
Optimized low-contrast visualization 140 kVp 75 keV spectral image
at 65 keV to better differentiate the Conventional CT using 140 kVp is typically handicapped with beam-hardening artifacts in the posterior
grey/white matter in the brain. fossa. Using GSI and a spectral setting of 75 keV the artifacts are removed and anatomical detail
is revealed.

140 kVp 75 KeV spectral image

Using conventional CT 140 kVp imaging, artifact spray from metal hardware inside the body
can obstruct critical anatomy from being assessed. Using GSI the artifacts are removed and
anatomical detail is revealed.

3
 TA B L E O F CONTENTS

GE Healthcare News: Technical Innovation:

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Taking Post-processing to New Places. . . . . . . . . . . . . . . . . . . . . .8
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 TA B L E O F C O N T E N T S

Clinical Value: Breaking Barriers Beyond the Scan:

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Clinical Educational Opportunities for Europe . . . . . . . . . . . . 71

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 G E H E A LT H C A R E N E W S WELCOME
Welcome
This year has seen unprecedented challenges in healthcare.
Those reading this have undoubtedly felt the impact of the
economy, DRA and the challenges of trying to do more with less.
Amidst this tough healthcare climate, we at GE Healthcare
have introduced several new technologies, first unveiled
at RSNA in 2007, that have provided a fresh direction for
using computed tomography in diagnosing some of the
most pressing clinical issues in healthcare today. With t hat,
I welcome you to this issue of CT Clarity: Seventy-two pages
devoted entirely to stories that illustrate how GE Healthcare
delivers on its promises made to transform the future of CT.
In our inaugural issue of CT Clarity, we told you about
Gemstone™ Spectral Imaging (GSI) and its tremendous potential
to redefine CT imaging. In this issue, we are pleased to be
able to provide the clinical images and data that demonstrate
how GSI provides more anatomical information than ever
before so that clinicians can more accurately and confidently
interpret CT exams.
Found exclusively on the Discovery™ CT750 HD scanner,
GSI includes a viewing console like no other. In this issue of
CT Clarity, we explain how GSI Viewer allows clinicians to
visualize and differentiate multiple material density attributes
in a single view with image overlay capabilities. We also
share how GSI and the viewing system deliver value for
leading healthcare providers, including an example from
Massachusetts General Hospital.
Since the views of practitioners speak volumes, leading
clinicians also take this opportunity to present their
findings on the use of Discovery CT750 HD with ASiR™
Steve Gray, Vice President and General Manager,
Computed Tomography, GE Healthcare
(Adaptive Iterative Statistical Reconstruction). Included are
numerous ways in which the new scanner and ASiR greatly
improve image quality – while at the same time – dramatically
lower dose in a variety of clinical applications. Meanwhile,
others discuss how they put ASiR to work on the LightSpeed™
VCT XTe configuration with very positive results.
Also in this issue, physicians share their impressions of
AW Server:™ an incredibly exciting technology that eliminates
the need to work at a dedicated post-processing workstation.
In other words, it frees up the clinician for greatly improved
collaboration and workflow.
To top off 2009, GE has also kicked off healthymagination.
This initiative represents an unprecedented commitment
to develop innovative technologies that enable doctors
to help more people everywhere live longer, healthier lives.
In the process, healthymagination also helps healthcare
providers reduce costs and overcome a host of industry
issues that stand in the way of success.
What I like most about healthymagination, and all the
innovations covered in this issue of CT Clarity, is that they
all align perfectly with our customers’ values and priorities.
It sends a very strong message that we are trying our
best to listen to our customers and answer their needs. And
whether it’s about seeing more, knowing more, lowering
dose, or providing technology solutions in our portfolio for all
segments – it means one thing: We are moving in the right
direction if we always start with our customer’s point of view.
Thanks for your support. n
 EVENTS G E H E A LT H C A R E N E W S

Calendar of Events
GE looks forward to seeing you at the following events.
Date Conference Site City/State Country Web Link
Dubai International
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 G E H E A LT H C A R E N E W S
The AW Server™ lets clinicians review,
process and share diagnostic
images without being tethered to a
dedicated workstation. Using the latest
advancement in thin-client technology,
virtually any standard PC* now
transforms into a 3D post-processing
workstation that provides clinicians
secure, instant access to patient
images from anywhere.
Current users have experienced:
Better collaboration. Physicians
now can easily share information
with colleagues. From their office
PCs, specialists can consult on cases
in real time, and radiologists can
review images with referring
physicians beyond facility walls.
Get Creative!
Marketing low-dose scanners
Customized tools are available for the BrightSpeed,™
Discovery™ CT750 HD, LightSpeed™ VCT XT and
LightSpeed VCT XTe configurations. Announce and
market your advanced GE Healthcare technology to
referring physicians and patients to help your hospital
or imaging center grow! Jump start your creativity with
easy-to-download public relations and marketing tools,
system photos, clinical images and more at:
www.getcreative.gehealthcare.com. n
8 0
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ANNOUNCEMENTS
Taking Post-processing
to New Places
AW Server enhances radiology
workflow, improves collaboration
Enhanced workflow. Radiologists across the AW Server and workstations.
can access advanced multi-modality The learning curve is minimal because
images, quickly access prior cases the server shares its applications’
for comparison and instantly switch user interface with the well-known
between multiple application sessions Advantage Workstation® architecture.
to maximize workflow. GE-exclusive
A suite of cardiovascular applications
“Smart Compression” lets users
is now available for the AW Server.
manipulate images quickly, without
GE Healthcare’s robust oncology
compromising image detail. The DICOM
applications will be available soon.
data sets are automatically compressed
Turn to page 60 to find out more
when the user interacts with them, and
and hear what users are saying
then restored to full fidelity for reading,
about this latest innovation. n
even at low bandwidths.
Seamless integration. AW Server
*Subject to minimum specifications for
lets facilities leverage current technology
PC and network connection.
and maximize their investment by
integrating with existing IT infrastructure.
Users can share application licenses
 GEMSTONE SPECTRAL IMAGING T E C H N I C A L I N N O VAT I O N

Spectral
Imaging Takes Flight
By Steve Gray, Vice President and General Manager,
Computed Tomography

It wasn’t until very recently when the diagnostic-imaging

community considered whether dual-energy computed
tomography would ever be ready for prime time. Would there
be a way to make it work? Would it add clinical value beyond
volume CT? Could it redefine the field of computed tomography?
With Gemstone™ Spectral Imaging (GSI), the answers to those
questions are clear: Dual energy has arrived and its value is
quickly becoming immeasurable. Naturally, that’s not just my
opinion. It’s what experts from across the industry are saying
about this truly radical breakthrough in imaging technology.
It’s luminaries in the field like Dr. Sahani of Massachusetts
General Hospital and others’ perspectives who firmly believe
GSI propels CT beyond previous limitations. (Learn about
Dr. Sahani’s views on GSI on page 22).
On many levels, GSI exemplifies GE Healthcare’s devotion to
change healthcare and the health of millions for the better.
It’s something we firmly believe needed to happen, no matter
how massive the challenge, no matter the large number of
obstacles to conquer. We simply took the philosophy that
significant milestones in imaging require equally significant
commitments in R&D – and a passion for turning the best
ideas into reality.
The development of our spectral-imaging solution took
a willingness to turn conventional thinking upside down.
In other words, we realized we had to break down the imaging
chain and essentially re-create it from the ground up. And that’s
exactly what we did with the introduction of the Gemstone™
detector – the fastest scintillator in the industry and the first
major breakthrough in detector materials in 20 years. Along
with a new X-ray tube, redesigned data acquisition system,
and the debut of ASiR™ (Adaptive Statistical Iterative
Reconstruction), CT technology has reached new heights.
The following pages offer insight into GSI and how it helps
clinicians see and know more in new clinical ways that are
nothing short of inspirational. As the clinical direction of
spectral imaging continues to progress, GE will take the lead
and re-imagine the possibilities of computed tomography. n

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Gemstone Spectral Imaging:
Delivering on the Promise of Dual Energy
By Bob Beckett, Global Product Manager, Premium CT, GE Healthcare
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T E C H N I C A L I N N O VAT I O N

Sometimes, technology reaches a plateau

in the value it can deliver. And then there
are other times when breakthroughs
open up a whole new realm of possibilities.
That time is now with Gemstone™ Spectral
Imaging (GSI) – GE Healthcare’s dual-energy Bob Beckett, Global Product Manager,
solution, which further evolves CT as a Premium CT, GE Healthcare

powerful diagnostic tool.

Gemstone Spectral Imaging, which is found on the Discovery™
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to help them better “problem solve” clinical findings. In other
words, it tells a more complete story so that physicians can
easily and confidently interpret exams.
That is not to say there haven’t been significant strides in CT
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where added clinical value only benefits a
small percentage of CT procedures. The
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offers imaging advancements that benefit
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perspective is that it represents a major achievement on
the part of GE engineers who overcame limitations of early
dual-energy imaging methods, including sequential axial/
cine scans and dual-source (two X-ray tube) systems.
The major hurdle virtually all industry researchers ran into
was the inability to temporally register high- and low-energy
data accurately. If the temporal sampling is not fast enough,
mis-registration will occur and the ability to distinguish
between two materials will be compromised.
Fortunately, I have the luxury of working with the finest team
of engineers in the industry that overcame this, and other
previous limitations, by designing a dual-energy solution
unlike any other previously researched.
The effort involved re-inventing the CT imaging chain and
breaking down conventional thinking about dual energy
and how it’s created. The effort led to the introduction of the
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CT components and sub-systems. At the heart of the scanner
is the exclusive Gemstone detector. The highly advanced
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per rotation at the same speed of previous detectors. In short,
it enables extremely high sampling rates for outstanding
high/low dual-energy registration. The new Performix® HD
X-ray tube operated in the GSI mode can rapidly switch
between the required energy levels. Just as important,
we redesigned the Data Acquisition System (DAS)
in order to take full advantage of the additional
sampled information.
Great effort also went into the new
reconstruction algorithms, which output
new types of images with added diagnostic
information. Finally, the team created an
image display viewer that effectively packages
all of the GSI information into a seamless reading
environment (See story on GSI Viewer on page 18).
The bold thinking, combined with technical innovations,
culminates in GSI: a dual-energy solution unlike any other.
And it’s done with a single-source architecture, meaning one
very efficient X-ray tube and one very fast Gemstone detector.
What GSI does and how
There’s only one way to truly appreciate any new technology
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GSI is an exclusive single tube dual-energy scan mode that
acquires data of an object by alternating quickly between
low kVp and high kVp X-ray spectrums through a particular
material density. By so doing, it generates data with different
attenuation values based on the corresponding energy levels
in terms of water and iodine, water and calcium, and iodine
and calcium basis-pair images. This results in axial, helical or
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80 kVp 140 kVp

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GE Healthcare

Balance image quality

and dose like never before.
Today, with breakthrough ASiR™* technology from GE, you can lower patient dose in CT
imaging without sacrificing image quality. So while leading-edge clarity lets you diagnose
with confidence, a reduced dose enables better patient care. That’s our kind of balance —
and thanks to ASiR, only GE delivers it.
Learn more at gehealthcare.com/lowdoseCT

ASiR is available LightSpeed VCT XTe**: Low-dose

in both the scanning on an established platform.
Discovery™ CT750 HD
and the
LightSpeed™ VCT XTe.

Discovery CT750 HD: Unmatched image

clarity at up to 50% less dose.

©2009 General Electric Company – All rights reserved. *Adaptive Statistical Iterative Reconstruction, a proprietary dose-reducing
approach that subtracts noise without degrading anatomical integrity.
**A premium LightSpeed VCT configuration.
 T E C H N I C A L I N N O VAT I O N 0 3 E0 = C0 6 4
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 Breaking Barriers
with Gemstone
Spectral Imaging
Making differential diagnoses
with Gemstone Spectral Imaging
on the Discovery CT750 HD scanner

An interview with Dushyant Sahani, MD,

Director of CT, Department of Radiology,
Massachusetts General Hospital

Massachusetts General Hospital operates a Discovery™ CT750 HD scanner

using Gemstone™ Spectral Imaging (GSI), a novel dual-energy application that
uses rapid kV switching to acquire dual-energy samples almost simultaneously
to generate material density and monochromatic image data. GSI is specifically
designed to enhance the ability to characterize lesions through the separation
of materials and better overall image quality, both of which lead to more
confident diagnoses and improved workflow. (See GSI article on page 10).
Dushyant Sahani, MD, Director of CT, Department of Radiology, spoke with
GE about his experiences with the scanner and GSI.

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 Non-enhancing hemorrhagic cyst

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 Non-enhancing right renal cyst

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 Setting New Standards
for Cardiovascular and
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DiscovTah
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By Jean-Louis Sablayrolles, MD, Chief of the CT and MRI Department;
and V. Barrau, MD, Centre Cardiologique du Nord (CCN)

Case 1
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to severe stenosis of the right coronary artery. The patient
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 CLINICAL VALUE 38B2>E4AH
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F8C7
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Case 1
Findings
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to quantify.
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Dr. J.L. Sablayrolles
Case 2

Case 2
Patient history
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the LAD artery but the coronary angiography was negative.
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 38B2>E4AH
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Conclusion Findings
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 CLINICAL VALUE 3 8 B 2 > E 4 A H
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 P E D I AT R I C C T & L O W D O S E CLINICAL VALUE

Driving Down Dose

in Pediatric CT
By Sarabjeet Singh, MBBS, MMST, and Mannudeep K. Kalra, MD , Massachusetts General Hospital

Minimizing dose in CT exams is always a priority at Low-dose technology

Massachusetts General Hospital (MGH) – and especially
More recent dose-reduction measures include the use of
so for pediatric patients. MGH achieves lower pediatric
ASiR™ (Adaptive Statistical Iterative Reconstruction) on the
patient dose without compromising diagnostic image
new Discovery™ CT750 HD scanner. ASiR is an image
quality through a comprehensive program that includes:
reconstruction algorithm that allows significant dose
~
Observing industry-accepted, dose-reduction principles. reductions while maintaining or increasing image quality
(measured as image standard deviation).
~
Applying the latest CT imaging technologies.
Since the technology was installed in January 2009, pediatric
~
Developing customized exam protocols that
radiologists at MGH have expressed a preference for scanning
further reduce dose.
all children using ASiR. Those patients receive priority on the
~
Using a decision support system to guide selection Discovery CT750 HD scanner, even if non-urgent adult exams
of optimum exam protocols and prevent unnecessary must be delayed. In general, radiologists were immediately
or duplicate exams. comfortable with the ASiR technology. Some concern
over mild pixilation in images was resolved as radiologists
found they did not miss lesions or other findings
Pediatric dose management
as a result of lowering their technique to minimize
Dose-reduction initiatives are not new at MGH. The hospital radiation dose.
staff has long understood that children are more radiation-
sensitive than adults and that radiation risks are cumulative
over a patient’s lifetime. In addition, parents of the hospital’s
young patients tend to be well educated and dose-conscious.
Hospital physicians observe FeatherLight imaging dose
optimization principles as advocated by
GE Healthcare. The MGH team of radiologists
developed the foundation for FeatherLight
procedure-based protocols (as seen in CT Clarity magazine,
Spring 2009). These include using color-coded zone protocols
for patients from newborns to age 21 (Figure 1). The protocols
follow ALARA (As Low As Reasonably Achievable) principles and
provide a unified, collaborative approach to dose reduction.
The protocols help radiologists manage dose efficiently based
on the clinical indication, the scanning region of interest,
the patient’s weight, and whether the exam is a routine
initial study or follow-up CT. At MGH, compliance with the
FeatherLight imaging protocols have reduced dose by as
much as 62 to 83% in the abdomen and chest, respectively.1

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 CLINICAL VALUE P E D I AT R I C C T & L O W D O S E

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Weight Noise Index Minimum mA Maximum mA kV
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46 0
64
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 P E D I AT R I C C T & L O W D O S E CLINICAL VALUE

Case 1
Testicular tumor metastasis
Contrast protocols
Patient history
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!( 47
 Case 2

Conclusion
Radiation dose reduction
of up to 50% is possible
with the use of ASiR.

FBP ASiR

Case 2
Invasive Cushing disease

Patient history Contrast protocols

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scans showed ground glass opacities. C^cP[
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48 0
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Case 3
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Patient history
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Case 3

Conclusion
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0
64
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!( 49
 CLINICAL VALUE P E D I AT R I C C T & L O W D O S E

Contrast protocols
Brand/type of contrast .................................6Pbca^
P]S
8b^edT
"&
Contrast injection rate ...............................................................
\[bTR
Mannudeep K. Kalra, MD, is director of the Center
C^cP[
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\[ U^a
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at Massachusetts General Hospital, Boston.
Saline injection rate .....................................................................
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C^cP[
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\[

Discussion
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at Massachusetts General Hospital, Boston.
in prior FBP scan. n

About the facility

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in virtually every specialty and subspecialty
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BrightSpeed –
More of a Workhorse
than a Show Pony

One sort looks impressive, attracts admiring glances Dr. Cohen notes an important truth that can often be forgotten
and can do remarkable things. On the other side, there in the technological arms race of medical imaging – the most
are machines that will just get on with the job that they vital piece of equipment in a radiology department sits
have been designed to do, quietly and without fuss. between the ears of the doctor on duty. “The factor that is
most important in limiting the number of cases we see each
Dr. Yves Cohen knew which sort of machine he wanted to
day is the ability of the radiologist to analyze the images
provide the CT services for C.H.P. Claude Galien, a 270-bed
before them and to report on their findings. The only way
general hospital in Quincy-sous-Sénart, about 35 km south of
that we could significantly increase the throughput in our
Paris. So in August 2008, the radiology department was equipped
department would be to employ another radiologist.”
with GE Healthcare’s BrightSpeed™ Elite 16-slice scanner.
Nor should anyone forget the equally essential role of the
His department wanted a machine that would produce
department’s radiography staff, whose preferences were a key
high-quality images at a speed which would satisfy the
element in the decision to choose post-processing equipment.
demands of its professional staff, but was also robust
Senior technologists were given the opportunity to try the
and reliable enough to cope with an extremely heavy
equipment from different vendors. “Their requirements
workload. The department is responsible for performing
are obviously slightly different from those of the radiologists;
an average of 65 CT scans a day, or 13,000 cases a year.
they want an easy-to-use system for manipulating the images.
This covers a wide range of clinical disciplines, mainly
The one they liked best was the Advantage Workstation.® We
emergency trauma cases, oncology, orthopedics
chose this system because it is very important, particularly
and peripheral vascular scanning.
in trauma cases, to be able to instantaneously reconstruct
The one significant absentee on that list is cardiology cases. and display the image that you have taken so that you can
So when the radiology team wanted to upgrade from its respond quickly.”
previous 8-slice scanner, they decided to acquire a 16-slice
Meanwhile, the BrightSpeed system has a number
machine. “Higher speed machines are necessary if you want
of other features that make it easy for the radiographers
to capture the details of a beating heart, but for our purposes,
to use. “They like the protocols that are available with
16-slice technology is more than enough to show what we
this system, and the SmartPrep or bolus timing to optimize
need in our practice. In more than 95% of our scans there
contrast-enhanced studies. They also appreciate the easy
is no evidence of motion artifacts – these are only likely to
access to the different functions on the gantry, or on the
occur in unconscious patients being scanned postoperatively
operator console.”
when we cannot ask them to hold their breath.”

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Dr. William P. Shuman

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 C T I M A G I N G W I T H U LT R A S O U N D BEYOND THE SCAN

Designed by users for users

Keeping work-related issues in mind, LOGIQ E9 was designed with direct input
from sonographers and radiologists. It features a customizable program, called Bill Kyle, Marketing Manager,
“Scan Assistant,” which helps to greatly streamline the scanning process. General Imaging Ultrasound
Additionally, a host of innovations help improve ergonomic comfort.
Scan Assistant allows users to take control over the most important elements
of an exam as it automatically manages less critical functions. Taking it to
the next level, Scan Assistant automatically steers color Doppler – and sets
up image controls and modes. It also initiates and automatically completes
required measurements, as well as automatically inserts comments.
The result is the ability to focus less on keystrokes and more on patient care.
Ergonomic features range from a motorized system that adjusts the
height of the keyboard at the touch of a button to a monitor that tilts
down so that nothing obstructs the technologist’s view during transport. Kirstin LaConte, LOGIQ Leadership
LOGIQ E9’s single, compact system is on average 20% smaller and Global Product Manager
up to 100 pounds (45.36 kilograms) lighter than other comparable
systems. Additional ergonomic features include:
~
A full-sized, floating keyboard that adjusts to the user and
eliminates the strain of a far reach.
~
A touch screen panel, customizable to each user’s exacting
mode of operation.
~
A highly intuitive control layout that clusters 95%
of the most-used keys around the trackball.
~
Both front and rear handles to aid in transporting
and maneuvering the system.
~
E-Series transducers with lighter plastics, ridges for improved
handling and proper grip, and flexible, lightweight cables.

It’s all there

The ability to fuse CT, PET and MR images on the
spot; extraordinary ultrasound image quality on
all body types; GPS-like tool for marking and
tracking anatomy; customizable protocols
that automatically manage the busywork; an
unparalleled level of ergonomic design; and volume
imaging. Clinicians can enjoy all of these features
with LOGIQ E9. n

*Based on an internal study performed by a third-party sonographer.

69
 BEYOND THE SCAN E D U C AT I O N

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With Mannudeep K. Kalra, MD
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For more information and to register for a CT Masters Course please go to:
www.gehealthcare.com/gectmasters

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 Future issues
To receive future issues of
CT Clarity, please subscribe at:
www.gehealthcare.com/CTclarity

GE Healthcare

A healthy dose
of freedom.
Today, thanks to breakthrough ASiR™ * technology
from GE, clinicians have the freedom to lower patient
dose dramatically without compromising image quality.
ASiR delivers the high-quality images they need
to diagnose with confidence — and only GE has it.
Learn more at gehealthcare.com/lowdoseCT

*Adaptive Statistical Iterative Reconstruction, a proprietary dose-reducing

approach that subtracts noise without degrading anatomical integrity.

©2009 General Electric Company – All rights reserved. CT-0419-11.09-EN-US