Idea Transcript
20 minuti
La Cardio TC nella Malattia Coronarica Risultati del Progetto di Adozione della Regione Emilia-Romagna e Prospettive Future Parma 15 Gennaio 2010
Dr. Filippo Cademartiri, MD, PhD EMC Rotterdam, NL & AO Parma, IT
Cardiac CT is Team-work Best Technology + Best Human Resources
Coronarografia TC Requisiti hardware • ELEVATA RISOLUZIONE SPAZIALE – Visualizzazione dei piccoli vasi coronarici
• ELEVATA RISOLUZIONE TEMPORALE – Riduzione artefatti da movimento
• ELEVATA RISOLUZIONE DI CONTRASTO – Visualizzazione della parete dei vasi
• ELEVATA VELOCITA’ DI SCANSIONE – Completare l’esame in apnea
• SINCRONIZZAZIONE CON IL CICLO CARDIACO – Fermare il cuore in una fase del ciclo cardiaco
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MSCT 175€ Stress-ECG 33€ Germany
*p20mSv
Coronary CT Dose Stress ECG Stress ECO Cardio-RM
14-18mSv
0 mSv 10-15mSv
8.6mSv 7-9mSv * 4-7mSv 2-5mSv/yr
4.3mSv * 1-3mSv
0.1mSv CXR * ECGECG-Pulsing
Natural background
CT*
CCA
16-CTA
64-CTA
Stress Tc99
Stress Tal
Picano E, BMJ 2003; Jakobs, Eur. Eur. Radiology 2002; ; Hirai, Hirai, Radiology 2008; Shuman, Shuman, Radiology 2008 ;Stolzmann, Radiology 2008
Fazel R. NEJM, 2009
Fazel R. NEJM, 2009
>50%
Fazel R. NEJM, 2009
X-ray Dose in the real world
Chest X-ray
0.06mSv
Screening chest CT (low dose)
0.3-1mSv
Standard chest CT
3-8mSv
Standard abdomen
10-20mSv
3-phase Thoraco-Abdominal CT (staging)
25-35mSv
Cardiac CT (standard)
8-20mSv
Mean = 12 (8-18) mSv
High definition imaging at up to 230 micron resolution Up to 47% improvement in cardiac resolution
Up to 50% dose reduction, with improved image quality Spectral imaging and functional imaging (101 selectable spectral energy images) Gemstone detector to produce sharper and brighter images Up to 500 slices of 4D dynamic coverage Faster scintillator enables higher resolution Produces 2.5 times more views per rotation, improving overall resolution Improved signal with reduced noise from the Volara™ HD digital DAS Featuring a Performix® HD tube which enhances resolution through dynamic control Familiar Xtream™ interface with more power and capabilities to meet increasingly demanding clinical challenges
2.1mSv
Lifecycle benefits •Key performance drivers matched to specific clinical needs now and in the future •Compatible with the Extended Brilliance Workspace and Portal Server •Advanced applications to fuel tomorrow’s research discoveries Essence and Intelligent technologies •Proprietary X-ray tube, detector, and reconstruction advancements •Revolutionary AirGlide Gantry for whisper-quiet performance •NanoPanel 3D spherical detectors with unique ClearRay Collimator for resolution up to 24 lp/cm •Scalable iMRC X-ray tube and generator system improve image quality in patients with higher BMIs and in cardiac imaging •RapidView Reconstruction with quad-core processors and Fast Preview Mode DoseWise •Eclipse DoseRight Collimator •IntelliBeam Filtration •Step & Shoot Cardiac •Dedicated Pediatric Protocols
1-2mSv
Toshiba’s signature Aquilion Series CT Systems All our Aquilion CT systems feature the benefits of Toshiba’s Quantum Advantage, resulting in the industry’s best image quality, whatever the choice, from 4 to 64 to 320 slices. * 0.5mm slice * 350 micron isotropic resolution * 2mm low contrast resolution * 32mm volume coverage Using the same detector platform, Aquilion are the only CT systems on the market that offer the choice between high speed image acquisition (up to 16cm width per rotation) and high resolution with either 4, 8, 16 32, 64 or 320 x 0.5mm per rotation. In addition, by a wide variety of dose control tools enable clinicians to minimise radiation exposure to
both patients and staff up to 80 percent compared to previous scanners.
3-5mSv
Split-second thorax Scanning the thorax incl. the heart needs 0.6 s, taking the burden of breath-holding off the patient and allowing functional imaging for body regions up to 48 cm. Sub-mSv heart Temporal resolution of 75 ms and scan speed of up to 43 cm/s make heart-scanning without beta-blockers possible and for the first time breath-hold optional with dose levels