7/21/2014 - AMOS Online

1 7/21/ 2014 1 Philips Research - Hamburg Confidential 1 Partners in Solution session Philips CT Dose Optimization tools and Advanced Reconstruction Tsvi Katchalski Philips July 24, 2014 Philips Research - Hamburg Confidential 2 Content (I) Dose Reduction and Dose Optimization Technologies Dose Right and Tube Current Modulation (Dose Right, Z-DOM, 3D-DOM) Special Acquisition Modes (Cardiac Dose Right, Prospective gating) Beam Filtration and Beam Shapers Eclipse Collimator and Clear Ray Collimator NanoPanel Elite Detector NEMA XR-25 Dose check Dose structured reporting (II) Advanced Reconstruction Technology iDose4 IMR (Iterative Model) Philips Research - Hamburg Confidential 3 PART (I) (I) Dose Reduction and Dose Optimization Technologies Dose Right and Tube Current Modulation (Dose Right, Z-DOM, 3D-DOM Special Modulation Modes (Cardiac Dose Right, Prospective gating) Beam Filtration and Beam Shapers Eclipse Collimator and Clear Ray Collimator NanoPanel Elite Detector NEMA XR-25 Dose check Dose structured reporting (II) Advanced Reconstruction Technology iDose4 IMR (Iterative Model))

2 7/21/ 2014 2 Philips Research - Hamburg Confidential 4 Dose Right and Tube Current Modulation Dose Right Index Consistent IQ for Different Patient Size Dose Right Index + Current Modulation Consistent IQ for Different Patients and at Different Z-Locations DoseRight recommendation: 389mAs DoseRight recommendation: 240mAs Philips Research - Hamburg Confidential 5 Dose Right Index Definition (by Reference) Dose Right How Does it Work Averages patient size is calculated from the surview Patient size is compared to the EC Reference size Avg. mAs for the patient is calculated according to the DRI DRI=24 200 mAs @120 kV @ average patient size (29 cm) 0100200300400500600700800900100001020304 050 Current x Time [mAs] Average Size [cm] Exponential Adaptation to Patient size Philips Research - Hamburg Confidential 6 Increase and Decrease in DRI (Dose Right Index) - Adults DRI 25cm 29cm 35cm.

3 18 71 102 202 19 80 114 226 20 90 128 254 21 101 143 284 22 113 160 317 23 127 179 355 24 142 200 400 25 159 224 443 26 178 250 497 .. 1 DRI: +12% mAs 6 cm: +100% (doubled) mAs 6 DRI: +100% mAs 6 7/21/ 2014 3 Philips Research - Hamburg Confidential 7 Z- Dose Modulation (Z-DOM) Consistent IQ Along Patient Liver Detection Head Detection 01002003004005000510152025mAs Z-position Philips Research - Hamburg Confidential 8 3D- Dose Modulation (3D-DOM) Reduction of Streak Artifacts Improve Noise Uniformity Philips Research - Hamburg Confidential 9 3D- Dose Modulation vs. Z-DOM - Reduction of Streak Artifacts - Improve Noise Uniformity 7/21/ 2014 4 Philips Research - Hamburg Confidential 10 Automatic Pitch/Rotation Time Algorithm Basic equations: = = = Bed speed Pitch / rotation time mAs Tube current Philips Research - Hamburg Confidential 11 Special Modulation Modes - Cardiac Heart Cycle The Heart is in Constant Motion General motion profile: Relaxation: Heart is filled with blood.

4 Contraction: Heart pushes blood to the body/Lungs Quiet phases : Phases with relatively less motion End systolic ( 40% ): Relaxation Expansion End diastolic ( 75% ): Relaxation Contraction Systole Diastole 40% 75% 0% 100% Philips Research - Hamburg Confidential 12 Cardiac Cycles Reconstructing at Different Phases ECG Gated 20 35 75 Cardiac Phase 7/21/ 2014 5 Philips Research - Hamburg Confidential 13 Special Modulation Modes Cardiac Retrospective ECG triggered dose modulation in Helical/Spiral scans 57 34 Z 20 % Cardiac DoseRight - Prospective 100 % Philips Research - Hamburg Confidential 14 Special Modulation Modes Cardiac Step and Shoot Prospective Gating Low dose (3 5 mSv)

5 Diagnostic scan Dose reduction up to 80% compared to standard retrospectively-gated spiral scans Image quality comparable to that of standard retrospectively-gated spiral scans 3D axial cone beam reconstruction algorithm Real-time arrhythmia handling algorithms Philips Research - Hamburg Confidential 15 Special Modulation Modes Dose Reduction from ECG Dose Modulation Dependency on HR Compared to ECG-gated spiral scans without dose modulation 010203040506070809060 bpm70 bpm80 bpm90 bpm100 bpmS&SCDose Reduction (%) Klass O, Walker MJ, et al, Eur Rad 2008 7/21/ 2014 6 Philips Research - Hamburg Confidential 16 Beam Filtration and Beam Shapers InteliBeam Filters SmartShape Wedge (Bowtie) Filters -Filtration is optimized to increase Low Contrast and reduce Skin Dose and is done per protocol -Three filtration modes.

6 Half / Full / Off-center enabled Philips Research - Hamburg Confidential 17 Eclipse Collimator and Clear Ray Collimator Helical Dynamic Collimation to Reduce Over Scanning Walker MJ, Olszewski ME, Desai MY, et al, Intl Journal of Cardiovasc Imaging, 2009 Philips Research - Hamburg Confidential 18 Eclipse Collimator and Clear Ray Collimator 2D Anti Scatter Grid 7/21/ 2014 7 Philips Research - Hamburg Confidential 19 Clear Ray Scatter and Beam Hardening Correction -Monte Carlo based scatter estimation -Analytical Beam Hardening Correction -Scatter correction is proportional to patient size Philips Research - Hamburg Confidential 20 NanoPanel Elite New Tile Detector Scintillator IGOS (Gd2O2S) High Quality Ceramic Scintillator Fast Response High Light Output Low Cross-Talk ASIC Very Low Noise Improved linearity over all the dynamic range Front End Electronics with 256 Channels PDA (Photo Diode Array)

7 Back Illuminated Using Thin and High purity Silicon High Quantum efficiency. High Shunt Resistance Low Cross-talk Philips Research - Hamburg Confidential 21 PART (II) (I) Dose Reduction and Dose Optimization Technologies Dose Right and Tube Current Modulation (Dose Right, Z-DOM, 3D-DOM Special Acquisition Modes (Cardiac Dose Right, Prospective gating) Beam Filtration and Beam Shapers Eclipse Collimator and Clear Ray Collimator NanoPanel Elite Detector (II) Advanced Reconstruction Technology iDose4 IMR (Iterative Model) 7/21/ 2014 8 Philips Research - Hamburg Confidential 22 iDose advanced reconstruction How it works iterative reconstruction technique: How does it work? iDose uses the raw data output from the NanoPanel detector to determine and remove noise while keeping structure intact Philips Research - Hamburg Confidential 23 iDose Mode of Operation Noise Reduction Reduce noise according to iDose Level selection For each protocol the achievable iDose Level were determined No degradation in Resolution and Low Contrast (Tolerance.))

8 10% in MTF10% and 1mm in Low Contrast) High mA IQ Improvements Keep the Dose Level the same and improve spatial resolution and Low Contrast Hardware Enabler RapidView IR, Next Generation Intel Multi-Core Processors Up to 20 Images/sec Compensating increase in noise (noise reduction %) 11 % 16 % 23 % 29 % 37 % 45 % 55 % Philips Research - Hamburg Confidential 24 Philips Healthcare / Clinical Science & Application CT EMEA, June 6, 2008 24 50% Dose (125mAs) FBP 50% Dose (125mAs) iDose Courtesy TU Munich, Germany Follow up with 50% Dose Reduction Comparison Full Dose / 50% Dose Reduction + iDose Full Dose (250mAs) FBP 7/21/ 2014 9 Philips Research - Hamburg Confidential 25 Philips Healthcare / Clinical Science & Application CT EMEA, June 6, 2008 25 120 kV, 100 mAs ( mGy)/ 80 kV, 100 mAs ( mGy) 70% Dose Reduction 70% Dose Reduction ( ) - iDose Courtesy TU Munich, Germany Full Dose ( ) - FBP Comparison Full Dose / 70% Dose Reduction + iDose Philips Research - Hamburg Confidential 26 Philips Healthcare / Clinical Science & Application CT EMEA, June 6, 2008 26 120kV, 70mAs, , Prospective Gated Aortic CTA (Step & Shoot Complete) iDose FBP Courtesy Cleveland Clinic, USA Improving Image Quality.

9 Artifact Reduction Philips Research - Hamburg Confidential 27 Philips Healthcare / Clinical Science & Application CT EMEA, June 6, 2008 27 Courtesy OHSU, USA 120kV, 280 mAs, , Prospective Gated Cardiac CTA (Step & Shoot Cardiac) iDose FBP Improving image quality in inherently noisy acquisitions 7/21/ 2014 10 Philips Research - Hamburg Confidential 28 Knowledge-Based Iterative Reconstruction Technique Name Philips Research - Hamburg Confidential 29 Knowledge-Based Iterative Reconstruction What makes this possible Fast and compact next-gen computing devices using GPU (under 3min for most protocols) Integrated Workflow User has flexibility as to the final result. Body Soft Tissue Routine Sharp Plus Philips Research - Hamburg Confidential 30 Performance Evaluation Low Contrast Detectability A measure of a person s ability to perform a particular task.

10 The determination of a Low Contrast object Is influenced by all Physics IQ metrics (Noise, Resolution, Uniformity and CT number) A statistical approach is needed Human observer study, 4 Alternative Forced Choice (4 AFC) Study was used Test 42 out of 100 Test 57 out of 100 Test 73 out of 100 Test 77 out of 100 Test 94 out of 100 Test 57 out of 100 Test 42 out of 100 Test 94 out of 100 Test 77 out of 100 Test 73 out of 1007/21/ 2014 11 31 Low-contrast Detectability Index - Low-contrast Detectability Index* Standard Reconstruction * Low-contrast detectability was assessed using 4-AFC test on a reference abdomen protocol, tested on the MITA CT IQ phantom. Data on file.