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  6. Redefine musculoskeletal CT
NAEOTOM Alpha photon-counting CT scanner, musculoskeletal imaging next to the abstract visualization of a photon-counting detector combined with a clinical image.

Redefine musculoskeletal CT
with NAEOTOM Alpha®Clear differentiation at lower dose

Compelling advancements in MSK CT

Conventional CT imaging has limited ability to differentiate between soft tissues, such as muscles, tendons, and ligaments, compared to other modalities like MRI. Detecting subtle soft tissue abnormalities or early-stage pathologies can be challenging. And metal implant artifacts that distort the surrounding anatomy make it difficult to accurately assess the area. Additionally, a choice between using comb-filter-based UHR imaging or dual energy capabilities had to be made. Many of these challenges have been overcome with photon-counting CT.

NAEOTOM Alpha with Quantum Technology® achieves twice the spatial resolution1 that delivers enhanced image quality for musculoskeletal CT imaging. Its high image quality, reduced radiation dose, and inherently available spectral information provide radiologists with valuable information that help them in their clinical decisions.

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    Quantum HD05
    Quantum Spectral Imaging06
    Metal artifact reduction04

    Revealing fine details with Quantum HD images for the assessment of tibia osteomyelitis.
    Courtesy of Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands

    Clinical images of an osteochondritis dissecans of the capitellum, elbow of a 13-year-old patient
    Clinical images of a foot fracture from an ultra-high-resolution Quantum HD scan with 0.2mm slice thickness and high in-plane resolution
    Pediatric photon-counting CT scan of a wrist
    Quantum HD image of an elbow-caput radii fracture
    Clinical images of a gout spectral analysis
    Clinical images of a fracture evaluation with Quantum HD imaging
    Clinical images of an evaluation of bone marrow, part 1
    Clinical images of an evaluation of bone marrow, part 2
    Photon-counting CT scan of a knee bone marrow evaluation with Quantum HD and Quantum Spectral Imaging
    Photon-counting CT scan of an ankle with Quantum HD and Quantum Spectral Imaging
    Photon-counting CT scan of a screw fixation of a wrist showing fine anatomical details such as the trabecular bone structure and metal artifact reduction surrounding the screw
    Photon-counting CT scan of a foot with metal object with Quantum HD imaging and iMAR, showing metal artifact reduction
    Photon-counting CT scan of a jaw reconstruction with Quantum HD imaging and metal artifacts reduction
    Photon-counting CT scan of a hip prosthesis with Quantum HD imaging and metal artifacts reduction
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    Ultra-high resolution for surgery planning

    NAEOTOM Alpha with Quantum Technology can generate images for soft tissue imaging with lower doses than conventional CT scanners. In bone imaging, high spatial resolution is important for imaging fractures, bone healing, malignancies, and the visualization of tiny osseous structures. With NAEOTOM Alpha, Quantum HD images and spectral information can be combined. This plays an important role in the diagnosis of acute trauma, detection of fractures, and metal artifact reduction for surgical follow up.
    Photon-counting Quantum HD image of a capitellum showing fine details, acquired at Erasmus Medical Center, Rotterdam, The Netherlands
    Courtesy of Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands

    Improved image quality with high-spatial resolution

    Quantum HD imaging with 0.2 mm slice thickness provides highly-detailed trabecular bone imaging. Recent peer-reviewed papers have shown that “The effective spatial resolution of photon-counting CT in trabecular bone imaging was comparable with that of high-resolution peripheral quantitative CT (HR-pQCT) and more than five times higher compared with conventional CT.”3 

    Another paper showed that “Photon-counting CT offers improved image quality for visualization of scaphoid fractures and for healing assessment compared with EID-CT” and “radiologists found primary fracture visibility and overall image quality superior with photon-counting CT.”4

    Quantum HD and Quantum Spectral Imaging of an ankle, acquired at University Hospital of North Norway, Tromso
    Courtesy of University Hospital of North Norway, Tromso, Norway

    Quantum Spectral Imaging at full radiation dose efficiency

    Spectral information is always included in scans made with Quantum Technology. This enables image reconstruction with multi-energy post processing, including virtual monoenergetic imaging and bone marrow edema.2 Spectral information can also be combined with 0.2 mm Quantum HD images to further improve image quality without dose penalty. 

    Latest review paper from Quintiens et al. states the dose reduction potential while using Quantum HD mode: “When using the UHR mode, comparisons between noise-matched images from UHR-EID-CT and PCCT significantly favour PCCT in terms of SNR and image quality, and this for a reduction in radiation dose ranging between 31% and 49%.5 These advantages are particularly useful in multiple myeloma imaging.6 The impact of photon-counting CT on whole-body imaging in patients with multiple myeloma has demonstrated “significantly better subjective and objective image quality and increased diagnostic confidence at a lower radiation dose (54%) compared to current standard clinical protocols for EID-CT imaging.”7

    Photon-counting CT image of a wrist with metal implant, showing metal artifact reduction surrounding the screw, acquired at Erasmus Medical Center, Rotterdam, The Netherlands
    Courtesy of Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands

    Improvements in metal artifact reduction

    Metal artifacts can obscure or mimic pathological findings, leading to potential misdiagnosis or incomplete assessment. Current metal artifact reduction algorithms and dual energy CT imaging still have limitations, such as high electronic noise and limited spatial resolution.

    Virtual monoenergetic imaging with NAEOTOM Alpha can be used with the combination of Tin Filter and/or iMAR8 to reduce metal artifacts, increase dose efficiency, and improve visualization of fine bone anatomy around metal implants in the spine, shoulder, or extremities. 

    Pallasch et al., from University Medical Center Freiburg has shown that photon-counting CT “allows for effective metal artifact reduction in patients with orthopedic implants, resulting in superior image quality and diagnostic confidence with the potential to improve patient management and clinical decision making.”9

    NAEOTOM Alpha’s ultra-high resolution mode with 0.2 mm slice thickness allows for sharp visualization of metal objects, fine structures like trabecular bone or small fractures.10
    Prof. Edwin Oei, MD, Chief of MSK Radiology in the Department of Radiology & Nuclear Medicine
    Ronald Booij, PhD, PCCT Expert and Radiographer
    Erasmus Medical Center Rotterdam,
    Rotterdam, The Netherlands

    What photon-counting means for the future of your department

    The NAEOTOM Alpha with Quantum Technology will redefine CT imaging. Based on the revolutionary direct signal-conversion of its QuantaMax detector, NAEOTOM Alpha offers high-resolution images at minimal dose, improved contrast at lower noise, and breakthrough consistency you’ve never seen before.

    NAEOTOM Alpha Hero Image 4x3

    Scan previously excluded patients

    The NAEOTOM Alpha may redefine which patient populations can be addressed with CT. It unlocks patient groups, like those with heavy calcifications, stents, pacemakers, or artificial valves, by offering intrinsic spectral imaging independent of scan speed, and of temporal or spatial resolution.

    Impact treatment outcomes

    Benefit from confident clinical decision-making in cardiology, oncology, and pulmonology, with answers that are meaningful, precise, and reproducible.

    1
    Compared to current high-end systems like SOMATOM Force.
    2
    Bone marrow spectral analysis functionality is pending 510(k) clearance and is not yet commercially available in the United States.
    3
    Thomsen et al. https://doi.org/10.1097/RLI.0000000000000873
    4
    Kämmerling et al. https://doi.org/10.1016/j.ejrad.2024.111383
    5
    Quintiens et al. https://doi.org/10.1007/s11914-024-00876-0
    6
    Cook et al. https://doi.org/10.1159/000531461
    7
    Rau et al : https://doi.org/10.3348/kjr.2023.0211
    8
    iMAR is designed to yield images with a reduced level of metal artifacts compared to conventional reconstruction if the underlying CT data is distorted by metal being present in the scanned object. The exact amount of metal artifact reduction and the corresponding improvement in image quality achievable depends on a number of factors, including composition and size of the metal part within the object, the patient size, anatomical location and clinical practice. iMAR reconstructions have to be performed and evaluated in combination with standard reconstructions.
    9
    Pallasch et al. https://doi.org/10.1007/s11547-024-01822-x
    10
    The statements by Siemens Healthineers’ customers described herein are based on results that were achieved in the customers’ unique setting. Because there is no “typical” hospital and many variables exist (e.g., hospital size, samples mix, case mix, level of IT and/or automation adoption) there can be no guarantee that other customers will achieve the same results.
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