low Dose, Lightning Speed

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1 CXL edition low Dose, Lightning Speed

Maximize the potential of today s clinical resources. In today s demanding healthcare environment, you need a CT system that satisfies all your requirements on a day-to-day basis.

2 Maximize the potential of today s clinical resources. In today s demanding healthcare environment, you need a CT system that satisfies all your requirements on a day-to-day basis. Aquilion TM /CXL meets your needs like no other system on the market. Keeping pace with advances in medicine with one of the most cost-effective and versatile diagnostic solutions ever developed, Aquilion has continuously evolved to meet the needs of patients, clinicians and facilities worldwide. Based on a sophisticated platform featuring proven technology, Aquilion /CXL now gives all the advantages you need to optimize workflow, improve image quality, enhance dose management, and elevate the level of care you provide both now and in the future. 2

3 LOW DOSE TECHNOLOGY Aquilion /CXL incorporates Toshiba s latest technologies to reduce exposure dose, while maintaining high image quality. AIDR 3D (Adaptive Iterative Dose Reduction 3D) Exposure TM 3D Adaptive (automatic exposure control) Active Collimator Dose Management Functions Dose Check/Dose Report LIGHTNING SPEED The new console enables significant improvements in workflow with faster reconstruction speed, greater flexibility with remote access, and improved efficiency with Technologies software*. New Console Architecture Xtension (Remote Access)* 0.5 mm x 64 Quantum Detector phasexact (Automated Optimal Cardiac Phase Reconstruction)* Automated Bone Removal 64-SLICE CONFIGURATION AIDR 3D, adaptive iterative dose reduction technology, for ultra low dose and full isotropic imaging through Toshiba s unique 0.5mm detector technology. 128-SLICE CONFIGURATION Best in class low contrast resolution combined with double slice technology for superior imaging of small structures e.g. Internal Auditory Canal. *Option 3

Our commitment to dose reduction. The ability to rapidly deliver high resolution diagnostic information has made CT a core imaging modality across healthcare today.

4 Our commitment to dose reduction. The ability to rapidly deliver high resolution diagnostic information has made CT a core imaging modality across healthcare today. However, with its greater use and growing breadth of applications, there has been a corresponding increase in concerns regarding patient safety due to radiation exposure. Toshiba has always shared these concerns and has been actively involved in developing tools to reduce CT dose for decades, based on the ALARA principle. When applied to medical imaging, the ALARA principle states that only the minimum amount of radiation necessary to accomplish the diagnostic task at hand should be used in order to keep patient risk As Low As Reasonably Achievable (ALARA). With ALARA at the heart of its CT design process, Toshiba s engineering department is focused on developing technologies to minimize the amount of radiation needed to obtain diagnostic images of the highest quality. 4

Low dose Lightning speed Toshiba s On-Going Commitment to Dose Reduction TOSHIBA S CT SYSTEMS - DESIGNED FOR LOW DOSE EXAMS Toshiba offers a full suite of dose reduction technologies to improve

5 Low dose Lightning speed Toshiba s On-Going Commitment to Dose Reduction TOSHIBA S CT SYSTEMS - DESIGNED FOR LOW DOSE EXAMS Toshiba offers a full suite of dose reduction technologies to improve patient safety while providing high quality diagnostic CT examinations. Dose reduction technology is considered in every step of the system design, as Toshiba engineers recognize that every small dose saving will add up. For example, the gantry geometry is designed with the x-ray tube located further from the patient reducing skin entrance dose. In addition, innovative dose reduction technologies have been developed negating the need for larger capacity generators which can result in higher patient dose. These technologies such as Exposure 3D, Active Collimator, and AIDR 3D are all included in the standard configuration. Aquilion /CXL also features the highly efficient Quantum detector featuring the Multiplex Sequential Sampling. 5

Exposure 3D Adaptive and Active Collimator. Aquilion /CXL achieves consistent image quality with industry-leading low-contrast resolution of 2 mm at 0.3% in low-dose scanning.

6 Maximum image quality at minimum dose. Aquilion /CXL incorporates a variety of functions based on technologies that were developed for Aquilion ONE with the aim of significantly reducing the patient exposure dose, including AIDR 3D, Exposure 3D Adaptive and Active Collimator. Aquilion /CXL achieves consistent image quality with industry-leading low-contrast resolution of 2 mm at 0.3% in low-dose scanning. AIDR 3D (Adaptive Iterative Dose Reduction) AIDR 3D is a sophisticated algorithm that has been designed to work in both the raw data and reconstruction domains. The collective AIDR 3D process results in robust noise reduction, which is essential for achieving ultra low dose examinations in routine clinical imaging. This iterative algorithm is superior in removing background noise while preserving diagnostic information compared to non-iterative approaches. AIDR 3D can be applied to all acquisition modes for routine clinical use and is able to remove up to 50% of image noise resulting in dose reduction of up to 75%. Original Reconstruction AIDR 3D Reconstruction 6

Low dose Lightning speed Exposure 3D Adaptive (Integrated with AIDR 3D) The integration of dose reduction features is essential for optimal dose management, so AIDR 3D has been

Exposure 3D Adaptive is a powerful dose reduction tool that modulates the exposure for each patient based on a preset target level of image quality.

7 Low dose Lightning speed Exposure 3D Adaptive (Integrated with AIDR 3D) The integration of dose reduction features is essential for optimal dose management, so AIDR 3D has been seamlessly integrated with Exposure 3D Adaptive, Toshiba s automatic tube current modulation software. Exposure 3D Adaptive is a powerful dose reduction tool that modulates the exposure for each patient based on a preset target level of image quality. When it is combined with AIDR 3D, X-ray exposure is automatically reduced before the scan to maintain the preprogrammed image quality adjusted for the expected level of noise reduction. AIDR 3D off AIDR 3D on 74.3% Dose Reduction Integrated dose reduction of 74.3% with AIDR 3D and Exposure 3D Adaptive 7

8 Experience the Quantum Advantage. QUANTUM DETECTOR Featuring Toshiba s exclusive, industry-leading Quantum Detector technology, Aquilion /CXL incorporates 0.5 mm detector technology for acquiring true isotropic voxels. This very small detector aperture (the smallest in current CT technology) provides razor-sharp images, ensuring fast and accurate diagnosis in all parts of the body with a lower exposure dose. Regardless of the procedure, you are always assured of superior diagnostic imaging with no compromise in the image quality or patient safety. 0.5 mm detector elements are the thinnest in the industry The industry s best low contrast resolution creates consistent soft tissue imaging at the lowest possible dose Uniform image quality is achieved by ultra high 310 micron* isotropic resolution Dose vs. Low Contrast Detectability Aquilion 25 Manufacturer A Manufacturer B 350 micron Dose (mgy) micron 350 micron 0 2 mm 3 mm 5 mm Optimal voxel size for any region of the body View axial image quality in all imaging planes Low Contrast 0.3% Comparison of LCD specifications for Aquilion and systems from other manufacturers. 8 *350 micron for 64-slice configuration

Low dose Lightning speed TCOT+ RECONSTRUCTION Toshiba s patented helical cone beam

It uses a modified Feldkamp algorithm, employing data from multiple projections in

reconstructed axial image are constant for field of view, ensuring high quality

Carotid stent: A stent across the bifurcation of the left common carotid artery is

9 Low dose Lightning speed TCOT+ RECONSTRUCTION Toshiba s patented helical cone beam reconstruction technique has advanced to TCOT+. It uses a modified Feldkamp algorithm, employing data from multiple projections in the z-direction to correct for the cone beam effect resulting in a uniform slice profile. Unlike more approximate reconstruction techniques, the properties of the reconstructed axial image are constant for field of view, ensuring high quality images. TCOT+ The nearest group of detector rows are used for each pixel. Carotid stent: A stent across the bifurcation of the left common carotid artery is depicted in this 3D image. The curved MPR view shows some in-stent restenosis in the internal carotid artery. The 350 micron spatial resolution provides excellent images that clearly demonstrate the struts of the stent. 9

High definition 128 slices in a single rotation. Aquilion /CXL presents the latest state of technological innovation in Multi Slice CT technology.

No additional exposure is necessary as this breakthrough technology is entirely reconstruction based.

As a result, partial volume effects are minimized and leading to more detailed images while maintaining superior low contrast detectability.

10 High definition 128 slices in a single rotation. Aquilion /CXL presents the latest state of technological innovation in Multi Slice CT technology. With the new conexact algorithm the Aquilion /CXL is able to generate 128 unique slices per rotation* with more detail than ever before. No additional exposure is necessary as this breakthrough technology is entirely reconstruction based. conexact RECONSTRUCTION Developed for Aquilion ONE dynamic volume CT, new proprietary algorithms using the conexact technology are now available for Aquilion /CXL. As a result, partial volume effects are minimized and leading to more detailed images while maintaining superior low contrast detectability. DOUBLE-SLICE TECHNOLOGY Taking full advantage of the conexact technology, acquired volume data can be reconstructed in double density, resulting in a more true-to-original reconstruction in MPR and 3D rendered images. Conventional Scan slices Without Double-Slice Technology With Double-Slice Technology 0.5 mm x 128 slices slices 10 *for 128-slice configuration

Low dose Lightning speed Double-Slice Technology High Fidelity Advanced Technology Innovative Solution Double-slice reconstruction technology provides full fidelity images with superior resolution.

11 Low dose Lightning speed Double-Slice Technology High Fidelity Advanced Technology Innovative Solution Double-slice reconstruction technology provides full fidelity images with superior resolution. Details of the most intricate structures are sharply depicted in any imaging plane. The advanced conexact reconstruction technology originally developed for Aquilion ONE has been reengineered for Aquilion /CXL to provide the same high-quality image reconstruction. Toshiba s unique double-slice solution both increases image resolution and reduces cone beam artifacts with absolutely no exposure dose penalty. Temporal Bone: Double-slice reconstruction using conexact technology provides exceptional spatial resolution, as demonstrated in these axial images of the inner ear. 11

12 Fast and flexible workflow. Aquilion /CXL incorporates the latest generation hardware to optimize productivity and enhance diagnosis. NEW CONSOLE ARCHITECTURE From performing exams to distributing data, Aquilion /CXL accelerates the process of providing the information you need to make the best treatment decisions. With a reconstruction speed of up to 30 images per second (with a Fast Reconstruction System *1 up to 60 images per second), all images are available in a flash, even when scanned with Toshiba s unique 0.5 mm slice thickness. 60 fps SINGLE CONSOLE WITH DOUBLE PRODUCTIVITY The space saving single console environment provides multitasking productivity, helping technologists keep up with increasing patient loads. Single Console ONE Xtension Network DUAL CONSOLE *2 FOR GREATER EXPANDABILITY The console configuration is highly flexible to match the needs of any user. In addition to the standard single console, optional dual console is supplied with two hybrid keyboards, two-mice, and two 19-inch display monitors. Ideal for two-operator environment. One concurrent Xtension remote user can be added to further enhance the workflow. Dual Console TWO Xtensions Network Two concurrent Xtension remote users can be added. 12

Low dose Lightning speed MultiView MultiView automation saves time by reconstructing MPR images as a part of the exam

AUTOMATED BONE REMOVAL Aquilion /CXL incorporates automated bone removal algorithms to quickly and accurately segment bone

SINGLE CLICK Xtension *3 Healthcare providers increasingly need to make information resources available outside the

Xtension provides remote access to Toshiba s powerful post processing applications from the client PC *4 in the hospital.

13 Low dose Lightning speed MultiView MultiView automation saves time by reconstructing MPR images as a part of the exam protocol, reducing the number of images for initial review and / or printing. AUTOMATED BONE REMOVAL Aquilion /CXL incorporates automated bone removal algorithms to quickly and accurately segment bone in CT angiography examinations. In just a few seconds, high quality angiographic images are available for diagnosis. SINGLE CLICK Xtension *3 Healthcare providers increasingly need to make information resources available outside the traditional workplace. Xtension provides remote access to Toshiba s powerful post processing applications from the client PC *4 in the hospital. Supports two concurrent users (operator plus one remote user) per console with no compromise in performance. *5 *1, 2 & 3: Option *4: For the system requirements, please refer to the product data sheet Not included in the standard configuration *5: Subject to the network environment 13

14 Golden standard high performance. Every aspect of clinical performance has been considered in creating Aquilion /CXL. As a result, you can count on Toshiba to improve patient comfort and clinician access, reduce radiation exposure and contrast media, boost productivity while providing the ultimate platform for treating a broader patient base and perform a wider range of procedures. HIGH Performance Aquilion /CXL provides new standards in performance that allow clinicians to do more with fewer resources in less time. 72 kw* generator with 350 ms* rotation acquires data quickly and reduces exam duration The enhanced DICOM protocol allows an ultrafast data transfer speed of up to 60 images per second. Stores up to 500,000 images for immediate access 2D, 3D, and 4D imaging Ergonomic DESIGN A host of exclusive, ergonomic features increase patient comfort and operator convenience while making procedures safer and more efficient. Gantry and couch return to home position automatically with the push of a button Carbon fiber couch top with 1500, 1800 mm, or even 2000 mm scan range Convenient foot switches are available for hands-free patient positioning *Option 14

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16 Cardiac scanning made easy. High performance in image quality and speed must go hand in hand with efficient workflow. The Aquilion /CXL has specifically addressed workflow integration to optimize productivity and enhance diagnosis. Cardio with phasexact* Delivers clear, accurate cardiac images and enhances patient throughput and workflow by automatically selecting optimum scan parameters. Automated, clinically validated protocols provide the best temporal resolution regardless of patient heart rate or condition Achieve consistent Cardiac CTA with adaptive, multi-segment reconstruction Decrease patient scan time through protocol automation Reduce view time and storage space with phasexact, which automatically selects the cardiac phase with the least motion phasexact Reconstruction Cardiac Motion 0% 20% 40% Cardiac Phase 60% 80% 100% Coronary Artery Bypass Graft (CABG) acquired using Cardio with phasexact. 16

Low dose Lightning speed Cardio Prospective (automated ultra-low dose coronary artery CTA)* Reduce the exposure dose during ECG-gated helical scanning by changing the helical pitch according to the

Developed to perform low dose cardiac CTA in a volumetric helical scan Use a pulsed (ON / OFF) exposure control with higher helical pitch settings Pitch selection and exposure window are chosen

Calculates Ca scores using the Agaston method and the volume mass method A report and the representative images showing calcium are automatically generated Cardio Scoring for fast volumetric coronary

17 Low dose Lightning speed Cardio Prospective (automated ultra-low dose coronary artery CTA)* Reduce the exposure dose during ECG-gated helical scanning by changing the helical pitch according to the heart rate and restricting X-ray exposure to the required cardiac phases in synchronization with the ECG signal. Developed to perform low dose cardiac CTA in a volumetric helical scan Use a pulsed (ON / OFF) exposure control with higher helical pitch settings Pitch selection and exposure window are chosen automatically to match the patient s heart rate Cardio Scoring* Provides fast and easy evaluation of calcium based on non-contrasted, ECG-gated data directly from the Aquilion console. Calculates Ca scores using the Agaston method and the volume mass method A report and the representative images showing calcium are automatically generated Cardio Scoring for fast volumetric coronary calcium evaluation. Plaque * A comprehensive advanced visualization tool to assist clinicians in evaluating the characteristics inside the blood vessel. Visualize coronary vessel anatomy and disease with ease using defined HU ranges Quantify plaque burden and coronary remodeling non-invasively Characterize lesions in the vessel wall as either calcified or non-calcified Plaque permits both classification and quantification of coronary artery plaques. *Option 17

tools to improve image quality, lower dose requirements and deliver the industry s fastest data to

Continuous development of optional field upgradable software enhancements means that when it comes

Cardiac Neuro Cardio Prospective* Automated ultra-low dose coronary artery CTA Plaque* Automated

analyzed from dynamic scan images and the results are displayed as map images Cardio Scoring* Fast

18 Maximizing clinical capabilities. Aquilion /CXL supports Toshiba s sophisticated suite of Technologies and other advanced software tools to improve image quality, lower dose requirements and deliver the industry s fastest data to diagnosis. Continuous development of optional field upgradable software enhancements means that when it comes to maintaining state-of-the-art capabilities, your investment is always protected. Cardiac Neuro Cardio Prospective* Automated ultra-low dose coronary artery CTA Plaque* Automated plaque visualization and characterization software CBP Study* Blood flow characteristics are analyzed from dynamic scan images and the results are displayed as map images Cardio Scoring* Fast and easy evaluation of calcium based on non-contrast ECG-gated data Cardiac Function Analysis* Calculate the various functional parameters, such as ejection fraction, wall motion, cardiac output, etc Subtraction * Automated digital subtraction of intra-cranial vessels from bone 18

Body vhp* Acquire a gated and non-gated scan in a

Vessel View* Generate and displays CPR and cross-cut

Quantifies low attenuation areas in lung tissue.

reconstruction and display of fluoroscopic images for

Advanced and reporting tools for CT Colonoscopy.

tagging Fat Index View* Automatically calculates the

19 Body vhp* Acquire a gated and non-gated scan in a single examination using a single contrast bolus Vessel View* Generate and displays CPR and cross-cut images of blood vessels Lung Volume Analysis* Quantifies low attenuation areas in lung tissue. (Regions of pulmonary emphysema) Fluoro * Real-time reconstruction and display of fluoroscopic images for faster and safer interventional procedures Colon View* Advanced and reporting tools for CT Colonoscopy. Display includes fillet view, fly through and polyp tagging Fat Index View* Automatically calculates the ratio of visceral to subcutaneous fat as a prognostic indicator of metabolic syndrome *Option 19

20 Aquilion /CXL Performance you can see. Tilted helical brain scan showing a large AVM. Metal artifact free image. 20 Cardiac CTA using Sure Cardio Prospective. Fused MPR/3D image created on CT console.

21 Low dose abdominal study showing liver metastases. Runoff CTA showing bilateral femoral occlusions. Wrist with fixation reconstructed with super resolution. 21

22 Continuously advancing the state-of-the-art. As part of its mission to enhance quality of life by supplying patients and practitioners with superior imaging technology, Toshiba conducts ongoing product validation and provides product education for those involved in delivering patient care. Clinical Trials Toshiba is the first in the industry to conduct international, multiinstitution clinical studies in the use of multidetector CT as the primary diagnostic tool for detecting cardiovascular diseases. Validating 64 detector row Coronary CT Angiography with cardiac catheterization, CorE64 (Coronary Evaluation on 64) participants represent nine of the world s premiere medical education and research centers. factor64, a randomized, outcomesbased trial of over 1,000 diabetic patients with obstructive coronary artery disease, is also being conducted in cooperation with Intermountain Healthcare. Other clinical trials include ilead, an international multi-center trial evaluating Aquilion 64 CT low dose lung nodule detection, conducted at: Beth Israel Deaconess, USA Kobe University, Japan DKFZ, Germany Brazil University of Sao Paulo - INCOR Heart Institute Canada Toronto General Hospital Germany Humboldt University - Campus Charité Mitte Japan Iwate Medical University Netherlands Leiden University Medical Center Singapore Mount Elizabeth Hospital USA Johns Hopkins University Johns Hopkins Bayview Medical Center Beth Israel Deaconess Medical Center USA Intermountain Healthcare 22

Delivering high-quality, cost-effective patient care Aquilion /CXL provides more ways to help you better manage the cost of providing healthcare without compromising the quality of physician and

Make more efficient use of limited resources with flexible financing options Increase utilization with faster throughput and access to a wider range of applications Quality Management In 1915 Toshiba

23 Delivering high-quality, cost-effective patient care Aquilion /CXL provides more ways to help you better manage the cost of providing healthcare without compromising the quality of physician and patient services. Make more efficient use of limited resources with flexible financing options Increase utilization with faster throughput and access to a wider range of applications Quality Management In 1915 Toshiba developed the first X-ray tube in Japan. Since that time we have continuously pursued product quality, while developing and producing many products with superior safety, durability, flexibility, economy, and serviceability. Toshiba s fundamental principles are based on respect for people. In addition to strict compliance with the law, our goal is to provide products and services that improve our customer s lives, and contribute to society. Toshiba Learning Centers To ensure consistent scanning and a faster diagnosis with Aquilion CT scanners, Toshiba s global training facilities provide courses for clinicians and technologists. Global Network With a network of local corporations and representatives in more than 120 countries across the globe, we are proud of our record of service and support to the leading medical institutions throughout the world. Customer Support & Training Center at the Nasu Headquarters. 23

24 technology history For over 130 years, Toshiba has been a world leader in developing technology to improve the quality of life. Our 50,000 global patents demonstrate a long, rich history of leading innovation. It might surprise you to learn about some of the things we ve invented Japan s first X-ray tube 1990 First helical CT scanner 2002 First 400 ms CT scanner 1954 First digital computer 1993 First real-time CT fluoro 2004 First Quantum Denoising Software 1977 First cardiac ultrasound scanner 1995 First DVD 2007 First dynamic volume CT scanner 1985 First slip-ring CT scanner 1999 First quiet MRI 2009 First 160-row Helical 1986 First laptop computer 1999 First 0.5 mm multidetector CT 2010 First iterative recon technique for 320 Detector Row CT Please check with your local Toshiba representative as this product might not be available in your country/region. Toshiba Medical Systems Corporation meets internationally recognized standards for Quality Management System ISO 9001, ISO Toshiba Medical Systems Europe BV 2011 all rights reserved. Design and specifications subject to change without notice. MCACT0221EC Toshiba Medical Systems Corporation Nasu Operations meets the Environmental Management System standard, ISO Made for Life, Aquilion ONE, Aquilion, Exposure, Boost3D, Technologies, Xtension, conexact, Cardio, Plaque, Subtraction and Fluoro are trademarks of Toshiba Medical Systems Corporation.

Low Dose, Lightning Speed, Latest Applications

RXL EDITION Low Dose, Lightning Speed, Latest Applications The New Standard for Radiology Toshiba Medical Systems is committed to the development of new technologies to minimize radiation dose while maintaining