Siemens Healthcare Headquarters

Siemens Healthcare GmbH

Henkestraße 127
91052 Erlangen
Germany
Phone: +49 9131 84-0
siemens.com/healthcare

Printed in Germany | CG CT 2336 06152.3 | © Siemens Healthcare GmbH 2015

siemens.com/medhistory
The History of
Computed Tomography at Siemens
A retrospective
MedHistory Milestones

Answers for life.

The History of
Computed Tomography at Siemens
A retrospective
 Contents
03 Foreword 20 Changing times 50 40 years of experience in a single unit
04 “Röntgen must be crazy” 22 A seemingly very peculiar idea 52 From small factory to global player
06 What is computed tomography, 30 A paradigm shift in computed tomography 55 CEOs of the Computed
and what are its strengths? Tomography Business Unit
32 Small dose, big progress
08 From idea to SIRETOM
40 Twice the scanning power
12 New insights into the brain
42 Improved detail for big impact
14 From head to toe

2
Foreword
Walter Märzendorfer
CEO of the Computed Tomography &
Radiation Oncology Business Unit

Viewed in evolutionary terms, humanity’s most of grainy black-and-white images to today’s high- life,” Hounsfield said. We are excited to see what
important trait is curiosity. The curiosity to learn how resolution 3D and 4D data sets, which are navigable in else we will be able to discover and bring to life in the
the world works. The curiosity to experience what infinite degrees. As far back as 1975 – just three years decades to come, since we firmly believe that we at
happens when new things are combined together. after Hounsfield had brought the EMI Mark 1 up to Siemens Healthcare, driven by our passion for medical
The curiosity to see what lies beyond the horizon. market readiness – Siemens launched the SIRETOM, innovation, will continue to make history in the field
Without curiosity, Wilhelm Conrad Röntgen might the first CT head scanner. Together with our many of computed tomography for a long and dynamic time
have simply shrugged and moved on in 1895, when longstanding medical cooperation partners, we have to come. With this in mind, we hope you will view this
he discovered X-rays more or less by accident and worked ceaselessly since then to advance computed publication as a kind of serial novel. It is a chance to
X-rayed first a thick book and then his wife’s hand. tomography into an ever-broader range of fields. pause for a moment and look back on what has been
Luckily, he didn’t do that, but instead pressed on to The curiosity to see how we can improve diagnosis achieved so far. I invite you to share this moment
find out more, with his curiosity about these extra­ and treatment guidance, boost patient comfort, with us, and would also like to take this opportunity
ordinary insights into the human body laying the and reduce radiation doses has spurred us onward to thank all of our cooperation partners, users, and
cornerstone for many of the most important medical throughout the past 40 years. Year after year, employees for the trust they have placed in us and
imaging methods of our time. In the late 1960s and innovation after innovation. Right up to the present their contributions to our CT innovations, both for
early 1970s, Sir Godfrey Hounsfield worked based day, and our versatile portfolio encompassing myself personally and on behalf of the entire Siemens
on Röntgen’s discoveries, developing a method of made-to-measure solutions for any issue, from the Healthcare team. Our shared passion for advances in
producing axial images of “slices” of the human body. SOMATOM Force, the current most powerful CT medical technology and our close working relation­
Today’s computed tomography systems still work on scanner in the world, to the extremely robust systems ships – all of them geared toward the long term –
the same general principle – although there is a world used for basic care, the SOMATOM Scope and have been one of the key factors in the tremendous
of difference between today’s technology and the SOMATOM Spirit. success of Siemens CT over the past 40 years.
technology available back then. Siemens Healthcare
But our curiosity is not yet satisfied – far from it.
has been a major influence throughout the develop­ Enjoy reading!
“There are probably many discoveries right around the
ment of this technology, from its infancy in the form
corner, just waiting for someone to bring them to Walter Märzendorfer

3
 “Röntgen must be crazy”

Modern medical technology unlocks fascinating views couldn’t be ordinary light. He placed a thick book and everything
of the inside of the human body. Medical imaging between the tube and the paper, but the rays simply was X-rayed: coin
makes it possible for physicians to visualize both the passed through it. Röntgen then held his hand up to purses, doors,
morphology and the function of the human body in the strange rays and made the most exciting discovery furniture – and
detail. The clear images of pathological changes or of his life: The coated paper showed the shadowy most of all, human
injuries that this makes possible represent a huge outline of the bones in his hand! bodies. Unlike in Bertha Röntgen’s
contribution to diagnosis and treatment guidance conventional photography – hand, 1895
Röntgen was not the first scientist to observe
today. Depending on the requirements in the specific from the Greek photos, for “light,” and
these rays – but he was the first to recognize their
case, high-resolution images of any part of the body – graphos, for “drawing” – early X-ray images were
importance and study the phenomenon scientifically.
from the crown of the head to the soles of the feet – more like shadow images. Röntgen’s name became a
But at the very start, he kept his observations to
are available. These images can then be used to filter household word, and the rays he had discovered
himself, spending several weeks on further research
out the information that is of medical interest and even came to be called after him in German. Particular
on his own. “I didn’t tell anyone anything about my
present it optimally using sophisticated data processing acclaim came from Sweden: Röntgen was awarded
work; I told my wife that I was doing something that,
algorithms. But 120 years ago, physicians still had to the first Nobel Prize in Physics in 1901.
if people heard about it, would make them say,
rely on external signs and symptoms – or on a surgical
‘Röntgen must be crazy.’” X-rays had already become an integral part of modern
scalpel – to identify injuries and certain diseases.
medicine by then. Around 1900, X-ray technology
That changed on November 8, 1895, with what is Röntgen’s wife was named Bertha, and part of her
had advanced beyond merely providing images of the
still the most important discovery ever in the history body has become world-famous. To be able to offer
skeleton; it could also be used to see inflammations,
of medical technology: Wilhelm Conrad Röntgen, a proof of his discovery, Röntgen X-rayed her hand
gallstones, and foreign bodies. For the first time ever,
physicist, discovered X-rays. and captured the image on a photographic plate. On
doctors had a way to detect the early stages of what
January 1, 1896, he published his work with a few
Late that evening, Röntgen was working at his lab in was then the most common cause of death in the
photos as evidence in an insert in the report on the
the city of Würzburg, experimenting with a vacuum Western world: pulmonary tuberculosis. At the same
meeting of the Würzburg Physikalisch-Medizinische
tube made of glass, which he was using to generate time, numerous X-ray pioneers were at work on new
Gesellschaft. The title of his treatise: “On a New
beams of electrons. He wrapped the tube with black examination methods and improved equipment. Over
Kind of Rays.” Not long afterward, as he himself
paper so that he would not be disturbed by the the years, X-ray images have become so clear that
had expected, “chaos broke out.” The news of his
light generated by the electric discharge occurring they also show soft tissue. Special contrast agents
sensational discovery spread around the world in
in the gas inside it. But when Röntgen started his injected into a patient’s bloodstream ultimately even
just a few days.
experiment in the darkened lab, a coated paper that made it possible to visualize the vascular system.
happened to be lying near the tube began to glow Scientists were thrilled, and even laypeople celebrated
Right from the start, the predecessors of Siemens
brightly. Röntgen was astonished – it definitely the discovery. As “X-ray fever” caught on, anything
Healthcare played a major role in these ongoing

4
 Wilhelm Conrad Röntgen, 1900

developments and improvements. For example,

Siemens & Halske, which was based in Berlin,
launched the first complete X-ray system on the
market already in March 1896. Max Gebbert, the
owner of the Erlangen-based firm Reiniger, Gebbert &
Schall, also recognized the potential of X-ray tech­
nology right away. Just three days after hearing of
Röntgen’s discovery, he sent an engineer to Würzburg
to learn more about the new rays.
Just under 80 years later, a new technology sparked
great fascination in the medical community, much
as the first X-ray images had done before. Computed
tomography (CT) is also based on X-ray technology,
but it visualizes the inside of the body onscreen, one
slice at a time. This method can be used to locate
tumors, hematomas, and internal injuries with great
accuracy. In conventional X-ray images, different
structures are superimposed on top of each other;
images of the lungs, for example, are affected by the
structures of the bones. This means that X-ray images
depict minor differences in density between different
kinds of tissue poorly, if at all. The “slice images”
produced by computed tomography, by contrast,
present slices of the body without superimposition,
as if individual sections had been taken out of the
body. In advanced systems, these slices are just 0.5 to
1 millimeter thick, allowing doctors to see even the
tiniest changes in tissue.
Siemens launched its first CT system on the market
in 1975. The SIRETOM cranium scanner generated
tomographic images of the brain, taking just under
five minutes per scan. Development advanced rapidly.
Just two years later, a head scan using the Siemens
SOMATOM whole-body scanner took only five
seconds. Today’s high-performance systems are even
faster, and they also offer incomparably better image
quality. A lot has happened over the 40-year history
of computed tomography at Siemens. It is a history
packed with discoveries, inventions, and innovations.

5
 What is computed tomography,
and what are its strengths?

6
 Rotation of the
Conventional X-ray systems X-ray unit and
beam rays through the body, detector
visualizing bones and tissue
X-ray unit =
on special X-ray film. In the tube
process, structures in the
path of radiation are shown Gantry
superimposed. Computed
tomography, by contrast, Patient table
measures the weakening of
Detector
X-rays within the tissue,
visualizing the inside of the
body as tomograms – slice
images – on a screen. The CT
scanner “slices” the body into
thin sections. In principle, this
is much like slicing a marble
cake, which provides a detailed picture of just
where the dark and light batter are distributed
inside the cake. The medical images offer a A brief introduction to present-day CT technology
detailed, high-contrast view of the tissue inside
the body, with significant advantages for many
medical issues: they are free of superimpositions, The ring-shaped opening of the CT scanner, which computer for analysis. The computer translates the
so the image is not affected by other bodily laypeople often call the “donut,” is known in the measurements into individual section images or even
structures; the body is shown with spatial depth medical community as the gantry. The gantry houses a three-dimensional model of the entire body, all
and can be viewed as a 3D model on the monitor; the measurement system, consisting of the X-ray tube without a noticeable delay. The physician can turn
and the very high image resolution makes it and the opposite detector. The measurement system, the body on the monitor, zoom in and out, and even
possible to see even tiny blood vessels, such as which typically weighs between 400 and 1,600 do a virtual “fly-through” to examine structures such
those in and around the heart muscle or in the kilograms, circles the patient several times per as the intestine.
brain. Computed tomography is especially suitable second. During this process, the tube transmits a
Today’s CT systems analyze the individual physical
for visualizing hairline fractures, changes in the fan-shaped X-ray beam, which is weakened less by
anatomy and calculate the optimum dose of radiation
organs, tumor search and heart examinations. soft tissue than by firmer tissue as it passes through
for each scan. Radiation exposure is measured in
It is also used in emergency rooms to rapidly the body. When they reach the detector, the rays hit
millisieverts (mSv). Annual exposure to naturally
diagnose internal injuries, to plan surgical a “scintillator” – Siemens uses a highly specialized
occurring X-ray radiation for a person in Germany
interventions, and to check the progress of ceramic mixture – that converts the detected X-rays
averages 2.4 millisieverts. The minimum dose for
treatments. A CT scan is completely painless and into light. Photodiodes then convert the light into
a lung scan with a present-day CT scanner can be
generally takes less than ten minutes from electricity, and a converter produces digital data
0.1 mSv, and typical doses range from 2 to 3 mSv.
preparation to the final image. from the analog signals and transmits them to the

7
Before 1975
From idea
to SIRETOM

The discovery of X-rays was a dream come true for

many doctors. Being able to see inside the body
facilitates diagnosis of certain diseases, injuries, and
medical conditions – and, in many cases, makes a
detailed and reliable examination possible in the first
place. Technological progress in the years after the
discovery unlocked a steady stream of new uses, as
sharper images made even softer tissue within the
body visible. But conventional X-ray images did not
offer conclusive findings for many medical questions,
since all of the structures in the area of the body that
had been scanned appeared superimposed one over
the other in the final picture. And so physicians soon
had a new dream – the dream of slice images, free of
superimposition, that could be localized accurately in
all three dimensions.
One of the first ideas that scientists came up with
toward this aim was stereoscopy. This technology is
similar to the 3D glasses you might find in a movie
theater today, giving a film spatial depth. Both eyes
see the same image, but from different perspectives.
The brain merges these images, thereby perceiving
the image as having depth. Physicians can use this
trick with X-ray images to do things such as identify
the site and extent of inflammations. Stereoscopic
images are fuzzy, however, and they require a lot of

8 Pre-production model, 1975

 A Siemens-Introskop conventional tomograph, 1934 SIRETOM prototype, 1974 A head scan using the prototype, 1974

practice to interpret. In addition, stereoscopy is not without knowing about the work being done by the The impressive results brought an outbreak of “CT
truly a tomography-based method; here, as others. Allan M. Cormack, an American physicist, and fever.” More than 15 other companies joined EMI in
elsewhere, the structures of the body are British engineer Godfrey Hounsfield made particularly developing CT scanners. The head of development in
superimposed in the images. noteworthy contributions. Between 1957 and 1963, the medical technology arm at Siemens, Oskar
Cormack developed a method to calculate the Dünisch, and the head of Siemens X-ray development,
Conventional tomography was developed in the early
behavior of X-ray radiation in the human body. He Friedrich Gudden, visited EMI in London. The visit
1930s, producing the first slice images of the human
suspected that even the tiniest differences in soft “was highly informative,” Gudden wrote in his
body to be free of superimposition. The Siemens-
tissue could be depicted using X-ray technology, but memoirs. “Excellent food and Godfrey Hounsfield, the
Introskop, for example, worked according to the
he did not have the opportunity to put his ideas into inventor of computed tomography, joined in. He
following principle: The X-ray film and tube moved
practice. The first functional computed tomography made an excellent impression on me, calm and
around the part of the body that was to be scanned.
unit, a system used for soft tissue diagnosis of the unpretentious, a real British gentleman. And what he
At the center of the rotation, where the rays were
head, was built in London some years later. It was a explained was fascinating – for example, that
focused, a sharp picture of the structures of the body
surprise in two ways: First, the medical community collecting the measurements for an image took nine
emerged, but outside this area, the image was fuzzy
was astonished by the images it produced, and days at the start.”
and blurred. The results were impressive at the time,
second, it came from a surprising source – EMI, a
with images depicting individual slices of the body, A development department dedicated specifically to
record company. Hounsfield, viewed today as the
just a few millimeters thick. This enabled findings that CT was established in the fundamental research unit
father of computed tomography, worked in the
were not possible with conventional X-ray images. at Siemens in Erlangen not long afterward, in 1972.
research department there. Together with his
The goal was to come up with a powerful prototype
The first steps had been taken, but tomography still colleagues, he made it possible for the first patient
optimized for workflows in hospitals and medical
had a long way to go before making a breakthrough. to undergo a scan using the new method, which took
practices. The pioneering figures were Friedrich
Two prerequisites were especially important in terms place on October 1, 1971. Computed tomography
Gudden, Gerhard Linke, Karlheinz Pauli, Benedikt
of achieving accurate, fast tomography methods: received an enthusiastic response from medical
Steinle, and Reiner Liebetruth. Steinle, for example,
computers with sufficient processing speed, and the professionals, and many people called it the most
developed a method of reconstructing images that
mathematical bases for calculating the images. important invention since the discovery of X-rays.
was later used by all other companies as well;
Computer technology had advanced to this point in Cormack and Hounsfield became famous and were
Liebetruth introduced flicker-free image display on
the 1960s; as for the math, various researchers jointly awarded the Nobel Prize in Medicine in 1979
TV screens. The team grew and received support from
were at work independently of each other, and even for their pioneering work in this field.

9
 displayed them on a 44-centi­ The system was put to heavy use right away, scanning
meter monitor. A second screen 1,750 patients until mid-February 1975. At an average
built into the control console of four scans per patient, that works out to about
made it possible to take Polaroid 7,000 scans in all, delivering about 14,000 images.
pictures with a built-in camera. The trial run was followed with great interest by a
Scan results could also be large number of medical professionals and engineers.
recorded on tape if desired. “Legions of visitors were brought to Frankfurt,
Alongside the fundamental including competitors, who admired the processing
technology for taking measure­ time, convenient use, and image reproduction alike,”
ments and producing images, the Gudden explained some years later. He also pointed
engineers also paid attention to out that the unit was far superior to all others on
The SIRETOM measurement The SIRETOM control center at seemingly minor details. The the market at the time. But it was still the only proto-
system, 1974 Frankfurt University Hospital, 1974 scanning table, for example, was type of its kind, and it was a long way from series
designed with patient comfort in production. “If we had been able to deliver at the
other Siemens teams as well. “Unforgettable” is how mind. This pleased patients and doctors alike, since if time, any number of them would have been sold.
Gudden describes “the tremendous enthusiasm of our the patient does not lie still during the scan, the When American doctors asked about the delivery time
[…] significantly larger development team.” Work image will contain visual artifacts, and the results will and heard our answer, they either laughed or cried,
continued until late night every day. Gudden often be fuzzy and difficult to interpret. The team also depending on their nature.”
drove employees who relied on public transit home aimed to make using the system as simple and secure
Hans Hacker was another firm believer in the new
personally after midnight. The excitement even for personnel as possible. With this in mind, all of the
technology. In a report, he wrote in summary that
caught on among employees of DEC, an American controls needed during a scan were built into a single
computed tomography would be “one of the most
computer manufacturer that provided the computer control console. A safety system with automatic
important methods used to investigate diseases and
used for the SIRETOM. Specialists from the service locking mechanisms made it practically impossible
disorders of the brain in the future, and the SIRETOM
team helped Siemens technicians eliminate artifacts for operators to make mistakes.
can be viewed as a reliable and easy-to-operate
and errors in the images and “were pleased with us at
In the first half of 1974, the preliminary work was system for this kind of scan.” With the experience
the ongoing improvement in the images.”
completed, initial trial runs were possible, and the gained in Frankfurt and the findings generated by
When they first started work, the technicians and prototype had been given a name: The first computed other trial runs, the engineers at Siemens went to
engineers at Siemens were able to build on their tomography system from Siemens was named work on the finishing touches, getting the SIRETOM
experiences with X-ray technology. Many components SIRETOM. Even back then, the head scanner was ready for series production. They also boosted the
had already been developed and merely needed to already able to produce images of double slices of resolution from 80 x 80 to 128 x 128 pixels. In 1975,
be adapted to their new purpose. For example, a the brain by using two detectors placed side by side. Siemens presented the scanner to the medical
therapeutic X-ray tube turned out to be especially After initial test images were produced at the Siemens community at the European Congress of Radiology
suitable for use as a radiation source in computed research lab, trial runs were to take place in clinical (ECR), in Edinburgh, and at the annual meeting of
tomography. The technicians modified the tube and settings as soon as possible. To this end, Siemens the Radiological Society of North America (RSNA),
designed a high-voltage generator that kept the formed a close partnership with Professor Hans in Chicago – and then, on December 1, the time
power supply especially stable in order to prevent Hacker and his team at the neuroradiology depart­ had finally come: Professor Hacker’s prototype was
measurement errors. There were also aspects that ment at the Goethe University medical center in dismantled, and he was the first to receive a series-
were newly developed from scratch, including the Frankfurt. The SIRETOM prototype arrived in Frankfurt produced model of the Siemens SIRETOM cranium
detector and a new system that converted the on June 19, 1974, and was commissioned exactly eight scanner.
computer’s calculations into digital images and days later, when the first patient scan was performed.

10
 SIRETOM 1974
SIRETOM at the European Congress
of Radiology, Edinburgh, 1975

11
12
1975
 Series-produced model of the SIRETOM, A head scan using a series-
the first Siemens CT scanner, 1975 produced model, 1975

New insights into the brain

The SIRETOM cranium scanner passed the clinical vessels of the brain using the methods commonly double slice itself was completed in just four to five
validation tests performed in 1975. The system was available back then was using contrast agents, and minutes. During the examination, a fine X-ray beam
already being used at several university medical visualizing the chambers of the brain required the scanned the brain, point by point. The detector
centers to perform neurological scans, for example displacement of cerebrospinal fluid with air. Patients located opposite the beam registered several hundred
where there was a suspicion of brain disease or to generally needed to spend several days in the hospital values and forwarded them to the computer. After
plan an operation. SIRETOM proved especially useful following the lengthy procedure. every scan, the SIRETOM unit turned the X-ray tube
in the field of trauma care, allowing physicians to and detector by one degree. After an additional 179
Computed tomography was significantly simpler,
identify and locate possible brain injuries in just a turns, the system had measured two neighboring
faster, and less invasive even as far back as 1975,
short time without placing additional strain on the slices, each one centimeter thick. If necessary, four
and it was considerably more accurate than any other
patient. That represented a major step forward at the double slices could be scanned, providing a picture
method previously used to examine the brain. With
time: Conventional X-ray images of the head showed of the entire brain. The computer processed the
the SIRETOM, the patient could be scanned on an
bleeding or tumors barely, if at all, since the bones of measurements so quickly that the doctor could call up
outpatient basis and completely without pain. The
the skull overlay the soft tissue of the brain, causing the resulting image just two seconds after the final
system depicted tumors, cysts, hemorrhages, and
an overshadowing effect. The process required measurement was taken. A life-size image of the brain
even tiny areas of calcification without contrast
laborious, time-consuming preparations that were was then shown onscreen and could be printed as a
media. A SIRETOM scan took 30 minutes at most,
uncomfortable for patients. The only way to see the Polaroid picture or stored on tape as desired.
including positioning the patient, and scanning a

13
 From head to toe
The technology was ready to be launched on the mar- was to reduce the time from just under five minutes After a three-year development period, Siemens
ket, and the medical community was impressed by the to 20 seconds instead. In many cases, this would presented its SOMATOM whole-body CT system in
new possibilities – within just a short time, computed make it possible to produce images during a pause in September 1977. The system was even faster than the
tomography became the preferred method for exam- the patient’s breathing. requisite 20 seconds per section: In normal operation,
ining the tissue of the brain. The high-contrast images the SOMATOM could scan a slice either eight or four
The SIRETOM scanning method had mechanical limi­
it produced sparked a logical desire among many millimeters thick in just four seconds. In quick scan
tations that meant that the scan time could not be
physicians: They wanted overlay-free CT images of the mode, in which only the data from two-thirds of a
shortened to any meaningful degree. A new tech­
entire body to enable them to examine other areas, revolution were collected and used to reconstruct an
nology had to be developed to accelerate the entire
such as the liver, intestines, and joints. Even before image, the unit needed just two and a half seconds
measurement system. The time-consuming, detailed
work on the SIRETOM unit was completed, Siemens per section. The detector system consisted of 256
process of scanning used for the SIRETOM, with the
began studying the technical fundamentals that discrete measurement elements. On each rotation,
measurement system turning by one degree after
would be needed for whole-body CT scans. The engi- the SOMATOM collected more than 92,000 measure-
every step and then performing another scan, was
neers faced two problems in particular: The gantry ments, which were converted by a computer and
replaced by a system that rotated 360 degrees around
needed to be much larger, and the scan time had to presented on a monitor as a grayscale image without
the patient in a single pass. This was made possible
be shorter. The latter point was a necessity because any delay. For archiving purposes, scan results
by a special tube and a new configuration: A fan beam
patient movements, such as breathing, would lead could be photographed or stored on videotape or
X-ray tube generated a broad fan of X-rays covering
to artifacts – images that were blurry and difficult to magnetic disks.
the entire patient. Instead of a single detector ele-
interpret – if the scan time was too long. This meant
ment, the opposite side of the unit now housed a The gantry opening of the SIRETOM was 23.5 centi-
that image quality depended on scanning time, and so
larger arc-shaped detection device with numerous in- meters across, while that of the SOMATOM measured
the stated goal of the CT developers in the mid-1970s
dividual detectors to capture the entire fan-shaped 54 centimeters. The patient was positioned on a
beam. This structure remote-controlled conveyor and moved into the
was a major challenge opening for the scan. A light-beam localizer helped
to the engineers, position the patient optimally. Before the scan, the
since the components doctor selected from among specific measurement
weighed several programs for the various types of tissue in the body in
hundred kilograms order to adjust settings such as the power of the X-ray
and built up a huge beam accordingly. With these adjustments, the first
amount of centrifugal SOMATOM unit was already able to visualize various
force during the rapid parts of the body, including the kidneys, abdominal
rotation, and yet the aorta, and numerous details of the musculature with-
system also had to out the need to administer a contrast medium to the
be designed to run patient. However, the system was still much too slow
extremely quietly and to produce sharp images of the beating heart.
evenly.
SIRETOM 2000 head scanner, 1977 SOMATOM abdominal scan image produced
without contrast media, 1977

14
SOMATOM whole-body scanner, 1977

1976–1987
15
1974 1983

16
But computed tomography was advancing rapidly. refined the detector system, an especially important 1974, the one on the right is an image taken with the
Shortly after the SOMATOM was introduced, Siemens element in terms of image quality. With 512 detectors current SOMATOM model in 1983. While a doctor can
presented an improved version of its SIRETOM head instead of the previous 256, the SOMATOM 2 system already identify and localize tumors or hemorrhages
scanner. The SIRETOM 2000 delivered significantly im- now offered twice the spatial resolution. During a in the older image, even details of the brain and the
proved performance and greater convenience than its scan, there were now twice as many measurements to optic nerves are clearly visible ten years later. Such
predecessor. Instead of an image matrix of 128 x 128, be processed – 368,640 instead of 184,230. To keep detailed images are made up of a huge volume of
the SIRETOM 2000 now had 256 x 256 pixels, so it the scan time from doubling, too, the engineers data, meaning the measurements that need to be
offered four times higher resolution per image. And developed a faster processor. The duration increased calculated and converted by the computer. To be
even with the considerable gains that had been made slightly, from four to five seconds in normal operation able to deliver an immediate image even before the
in image quality, the engineers had also markedly and from two and a half to three seconds in quick scan is complete, the SOMATOM was equipped with
reduced the scanning time. What had taken five scan mode, but the advantages of the new configura- what was then the fastest mass-produced image pro-
minutes with the previous model now took just 60 tion more than made up for the difference. For exam- cessor in the world. It was able to complete about
seconds with the new one – a long time compared to ple, it was now possible, for the first time, to visualize 25,000,000 calculations per second. In 2015, any
the SOMATOM, but it made no difference for scans the beating heart using a cardio CT addition. This smartphone is a lot faster than that, but back in 1983,
of the brain and neck, since these areas of the body was achieved by a method called “triggering”: An ECG this processing speed was highly impressive.
are not subject to fuzzy images as a result of patient measured the heart function and synchronized the
Also impressive were the weight and dimensions
movements. Patients and medical staff benefited from SOMATOM 2 with the patient’s heartbeat. The unit
of a new CT unit introduced by Siemens in 1984:
the revised configuration of the SIRETOM 2000. Low then emitted an X-ray pulse only at certain points in
It weighed approximately 25 tons and was about
gantry depth and free access from the back made the cardiac cycle, meaning that it did not measure the
15 meters long. The new unit was a semi-trailer truck
preparations easier and more convenient, and the heart when it was pumping, but instead during the
housing an entire CT department, with a radiation-
29-centimeter opening made it more comfortable for brief resting phases in between. This kept the CT im-
protected, air-conditioned examining room, interpre-
patients to undergo a scan, since they had more room age largely free of disruptions due to the movement
tation room and technical section. This computed
and a clearer view. This made the system a much of the heart.
tomography unit on wheels offered numerous advan-
better fit than the previous model for small children
The two images of the brain on page 16 show how tages. In rural areas, where patient density is lower,
and in emergencies in particular.
quickly computed tomography developed within operating a stationary CT unit can often be prohibi-
For the new SOMATOM produced in 1979, Siemens a decade. The image on the left was produced in tively costly. With the SOMATOM trucks, several small
hospitals or medical practices
could share the investment
costs and allow their patients to
undergo CT scans. The mobile CT
technology could also help large
medical centers that faced a
temporary need to perform more
scans than usual. Operating these
kinds of systems is more expen-
sive and laborious, and they do
face challenges such as inclement
weather and poor transportation
routes.
Preparing for a scan with the SOMATOM 2, Lung cancer image, 1980 A full CT system in a semi-trailer truck, 1984
1979

17
 A scan performed with the SOMATOM DR, 1984 SOMATOM DR with accessories, 1984 Osteoporosis check, 1986 Functionality check of the SOMATOM DR, 1986

But the SOMATOM unit in a trailer or bus met the institution Midwest Radiation Consultants, Inc., in St. and see signs of operations performed during lifetime
same quality standards as a stationary system. More Paul, Minnesota, presented the results of his tests of and possible causes of death. Until not long before
than 15 SOMATOM systems literally hit the road in the state-of-the-art CT systems from various then, this kind of CT scan would have been impossible
spring of 1984, with plans to boost that number to manufacturers. In the process, Payne used special because the gantry was too small, but the
around 30 by the end of the year. The engineers also measurement phantoms to compare detail resolution 70-centimeter gantry of most of the new SOMATOM
had smaller hospitals and radiologists in private and artifacts in the CT image. The Siemens SOMATOM models from 1984 onward could fit even a large,
practice in mind when making the plans for the DRH, a high-end model with 704 detector elements, bulky sarcophagus. This large opening not only made
SOMATOM DR 1 entry-level model. As a result, the performed the best in all the measurements. The it possible to scan 4,000-year-old mummies, but in
major goals for the development of this system were images from the Siemens system offered the highest radiological practice it also meant added comfort and
to achieve low purchase and operating costs and geometric resolution, displayed the least image convenience for doctors – and above all, for
limited space needs without having to compromise on artifacts, and were also superior to those produced by overweight and obese patients.
quality and comfort. This was achieved by heavily competing devices in the posterior cranial fossa, an
Another of the many interesting examples of the use
revising the system components. For example, a new area especially prone to artifacts.
of computed tomography in research concerns an
and significantly smaller X-ray generator made it
By the mid-1980s, CT images had already become so animal even older than any mummy. The field of
possible to install an entire CT unit in less than 40
detailed and expressive that they not only helped paleo-ornithology, the study of fossilized birds, faced
square meters of space. The high-performance X-ray
physicians make diagnoses; scientists from other a hotly debated question at the time: Could an
tube could absorb more heat and cooled off faster, so
fields had begun to use the technology for their archaeopteryx fly, or not? About 145 million years
it could be operated with a less extensive cooling
research as well. Egyptologists, cultural historians, after the pigeon-sized archosaur died out, CT images
system. The SOMATOM DR 1 was part of the new
and anthropologists were interested in ancient taken with a Siemens SOMATOM system provided
SOMATOM DR family and could easily be retooled or
Egyptian mummies, a rich trove of information on new impetus for the debate without damaging the
expanded as needed, using components from other
their living conditions and other aspects of their few fossilized specimens that had been found.
models to adjust it to different tasks.
times. Computed tomography was able to bring the
In 1987, computed tomography had reached the
Another “family member” underwent a detailed insides of these mummies to light without damaging
point where scanner performance could hardly be
comparison at the same time. At the 1984 RSNA, their valuable exteriors. This allowed researchers to
enhanced at all anymore – at least not with the basic
American physicist Thomas Payne, of the independent identify things like changes in the skeleton and teeth

18
 A cast of Archaeopteryx siemensii, donated
to the Berlin Museum für Naturkunde
by Werner von Siemens in 1880

CT scan of an archaeopteryx, 1986

technical framework that had been used so far. The

main limiting factors were the supply of energy to the
gantry and the transmission of measurement data
from the gantry to the image processor. Up until then,
X-ray tube and detector system had been connected
to the power supply via cords. This meant that the
gantry could not rotate continuously, but instead had
to be accelerated in one direction, stopped after a
360-degree rotation, and then accelerated in the
opposite direction. To further reduce scan times and
thus improve image quality, engineers went to work
on a wide range of different solutions in the 1980s.
The technology that would ultimately catch on is still
used for the power supply in most CT scanners today:
Instead of cords, the rotating components get their
electricity via slip rings. It is no longer necessary to
stop the system after every rotation, so it can rotate
continuously and collect data without interruption.
Slip ring technology accelerates the entire scanning
process while at the same time laying the foundation
for one of the most important innovations in the
history of computed tomography. But we’ll come
back to that later. First, let’s take a look at what
was then the fastest CT scanner ever: the Siemens
SOMATOM Plus.

19
20
1987
 The measurement system of the Abdominal scan, 1988 Rendering of space requirements
SOMATOM Plus, ca. 1988 for the SOMATOM Plus, 1988

Changing times
In the first ten years after the launch of the SOMATOM, In late 1987, Siemens shortened the time needed for the electronic data from the measurement system
there had been no changes in the fundamental a 360-degree scan with the world’s first fully rotating into light and transmitting it in that form. The other
technology used for CT scanners. Engineers expanded – and thus fastest – CT system to just one second. components of the SOMATOM Plus had also been
the possible applications, improved the components, The SOMATOM Plus was the first unit in a new CT adapted to the potential offered by the higher system
and thus pushed the existing technical framework to generation. Continuous rotation was made possible speed. The DURA X-ray tube had twice the power of
its limit. One key aspect of that limit was the way the in particular by a new kind of energy supply. Up until previous tubes and cooled down considerably faster.
measurement system, which weighed several hundred then, the gantry had received its electricity via cords, This made it possible to take more than 100 individual
kilograms, worked: acceleration, 360-degree rotation, but now the energy was transmitted using slip rings. images in a twelve-second scan, all without pausing.
deceleration, stop, rotation in the other direction, The entire measurement system ran on a newly A technology known as MULTIFAN scanned the
stop – with umpteen repetitions per scan, an extreme developed bearing designed for ongoing high-speed patient’s tissue from different angles, making it
level of mechanical strain with no further room for rotation. Alongside the higher system speed, this possible to visualize the most detailed structures of
improvement. Shortening scan times further, a crucial technology had the advantage that operation was the bones and soft parts in a single image.
point in achieving better image quality, would significantly quieter and involved less wear than with
With the SOMATOM Plus, Siemens solidified its
only be possible if the measurement system could the previous start-stop method.
leadership in the CT market, securing a technological
rotate continuously.
Significantly higher speed also meant significantly lead over competitors for several years and at the
larger data volumes. To transmit the information, same time laying the cornerstone for the next
Siemens used an optoelectronic system, converting revolution to come in high-power systems: spiral CT.

21
 A seemingly very
peculiar idea
How much can power and quality in computed At first, the idea used to do this sounded quite concepts and conducted experiments. Many of them
tomography still be improved? Is there a fixed limit? peculiar indeed, since spiral CT does exactly what scrapped the idea at first, though, or saw it as merely
And if so, can that limit be transcended with a new engineers and designers had been supposed to avoid a theory without practical benefit. At Siemens, a
approach? These and similar questions were in computed tomography until then: It moves the team headed by physicist Willi A. Kalender started
increasingly making the rounds among specialists in patient inside the scanner. Conventional CT systems researching spiral CT in 1988, and about a year later
the mid-1980s. In fact, computed tomography was work sequentially, meaning that the tube and the group presented physical tests and clinical studies
reaching the point at which major gains were no detector circle the patient while the table stays in a of the method’s performance. The solution to the
longer possible with the existing technology. With fixed position and produce a scan of one slice of the problem of motion artifacts lay in mathematics.
slip rings, and the continuous rotation they enabled patient’s body. After each scan sequence, the table Complicated algorithms needed to be added to the
in the SOMATOM Plus, Siemens overcame this barrier moves a few millimeters along the body’s longitudinal software used to reconstruct the images in order to
and laid the groundwork for one of the biggest axis, and then the scan of the next section is factor the movement of the table into the measure­
innovations in the history of computed tomography: produced. If the patient moves during the scan, the ments. The other components were largely similar
spiral CT. measurement data are no longer consistent. This to those of conventional systems, but they needed to
leads to motion artifacts, which can even render the be adapted to the specific requirements of spiral CT.
image unusable for diagnostic purposes in extreme Some of them needed significantly more power, and
cases. The basic idea behind spiral CT is to move the controlling the processes within the system was much
table holding the patient through the measurement more complicated.
Direction of continuous field continuously in order to leverage the benefits
Later that year, Kalender and his team built the first
patient transport of even faster scanning. The X-rays then scan the
spiral CT prototype, but the technical limitations
body in a spiral path. The medical community’s
Path of the rotating gantry that applied in 1989 were still too extensive for the
(tube and detector) response to this suggestion was skeptical at first.
system to be used in clinical settings. A year later,
Critics even called spiral CT “a method of producing
after extensive experimentation and clinical tests, the
artifacts in CT.”
time had finally come, and Siemens launched the
But spiral CT promised to bring a huge leap in SOMATOM Plus-S on the market as the world’s first
performance if the issue of blurring caused by spiral volume scanner. A “volume scan” is an image of
movement could be resolved. Various researchers an entire area of the body, such as a whole organ.
working independently of each other and – as is often With sequential scans, offset images can be the result:
the case with new scientific methods – without Movements between the individual sectional scans,
knowing of each other’s work developed the initial such as the natural contraction of the intestines or

22
 1989–1998
The SOMATOM Plus-S, the world’s first spiral CT system, 1991 23
 breathing, lead to individual slices being positioned on the right, the operator controls the scan using
differently. If these individual images are then lined special commands. One command, such as
up with each other, they can be so far out of “TOMO/2/20/120/50,” sets parameters such as the
alignment in extreme cases that the final result shows slice thickness, X-ray power, and number of slices.
double slices or even incomplete ones. Through spiral From today’s standpoint, this method of operation
scanning, the SOMATOM Plus-S set new standards in seems very old-fashioned, but it did not take long
volume imaging, scanning a volume of as much as 30 to learn, so customers accepted it for a long time,
centimeters within 30 seconds in a single pass, especially since the entry options were expanded to
without any gaps. With spiral CT, the movements include an electric pen that converted writing into
taking place inside the patient’s body were no longer graphics – truly state-of-the-art technology at the
an issue. time.
The 3000th SOMATOM leaves the test facility, 1991
The level of detail in the images produced by the Other features of the CT systems from around 1990
SOMATOM Plus-S was already so high that it was even also seem antiquated today. Installing the systems
possible to determine the mineral content of a was much more labor-intensive back then, so it was
patient’s bones. This meant that the system could be also more time-consuming. Merely setting up the
used together with the OSTEO CT software to mechanical parts of the gantry took a technician
diagnose and monitor the progression of several days. Replacing parts was also complicated
osteoporosis. The SOMATOM Plus-S automatically and sometimes required two service technicians.
located the contours of the vertebrae, determined the Computed tomography units needed much more
slices to be scanned, and then presented the results in energy and more space, at least 36 square meters.
a clearly laid out, easy-to-understand diagram. The They were also very sensitive to electromagnetic
crucial factor in this process was that the scans could pulses. If an error occurred in the system, the screen
be reproduced accurately in order to see the progress would merely show a cryptic number without further
of the disease during regular-check-ups. explanation.
It was already clear in 1990 that the future belonged Siemens launched its “Project 47” with the goal of
Control and analysis console, 1989 to spiral CT. Still, for more than two years the significantly improving these and other points. A
SOMATOM Plus-S remained the only system on the team composed of former ultrasound engineers and
market to use this scanning technique. The other “old” CT engineers was tasked with developing an
major CT manufacturers announced their own unprecedented CT system: a system that could be
systems using slip ring and spiral technology at the installed within two days and took up a maximum of
RSNA in the fall of 1992. At that time, many experts 20 square meters of space, was operated by a user
assumed that spiral CT would only be used in high- interface like that of a PC and a computer mouse,
end systems also in the future. This forecast later cost just one-third of the price of previous entry-level
turned out to be mistaken, but a few more years models, and required significantly less energy. The
would pass before the first spiral CT system for the final product of Project 47 was an extremely unusual
lower segments of the market was presented. CT system: the SOMATOM AR. In technical terms,
quite a few major new developments had been
If you look closely at the pictures of the control and
realized for the first time in this entry-level unit. The
analysis console, you can see the user interface.
unusual thing about it was that new developments
The monitor on the left shows a result image, and
Bone mineral content determination via spiral CT, 1991

24
 SOMATOM AR, 1994

are normally introduced from the top down, meaning

that they are developed for high-end systems and
end up moving down to the systems in lower price
segments over time. The project goals that had
been achieved were joined by additional new system
components that had been developed from the
ground up. The communication interface between
the six microprocessors was so powerful, for example,
that it became the standard for medical technology
from Siemens. Today, interfaces like this one can be
found in any CT system, but also in many other
electronic devices and in all cars. The SOMATOM AR
was also the first system with pre-produced wiring
instead of the wire harnesses that had been
customary until then. This dramatically reduced
the possible sources of error.
At about 170 centimeters in height and width, the
SOMATOM AR seems very small when compared to
other CT systems. The compact design was made
possible by various factors, including what developer
Andres Sommer called a “fairly ingenious design of
the tilt bases.” For the first time, the entire tilt
mechanism was contained within the unit casing.
But it almost didn’t come to that, as a funny story
from the development department shows: “When we
had set up the unit for the first time and used the tilt,
a very heavy colleague, about 160 kilograms, was
lying on the table,” Sommer recalls. “As the tilt
increased, he was squeezed more and more in the
60-centimeter opening. We were all stumped as to
whether we should build the system that way.” The
team set to work on other tasks for a time, and after
a while, the subject of tilting was back on the agenda
and the heavy colleague was back in the gantry as a
test subject. The engineers were astonished to see
that there were suddenly “no problems at all with the
tilt. Everything was fine, and everyone was happy.
What we hadn’t noticed was that our colleague had
lost 30 kilograms in the meantime, so he met the
requirements for the table.”

25
SOMATOM Plus4, 1994

26
The SOMATOM AR came out in 1991. It was aimed at automatically. Even in 1995, the SOMATOM Plus4 converts it without losses. UFCs (ultra fast ceramics)
customers who wanted to shift from a conventional had numerous options, but over its five-year lifespan, replaced xenon gas as the material used in the
X-ray system to CT. To ensure that it was also another 51 were added, including perfusion CT, which detector. The ceramic absorbs the rays and converts
available to customers in more remote areas, such as visualizes the circulation in the organs, and tracking them directly into photons – visible light. UFCs are not
in Africa or India, the entire system was designed to programs that automatically position the patient only significantly more efficient than xenon, but also
be transported with just one truck, and, even more correctly and then perform the scan. offer a much shorter afterglow period. A shorter
importantly, the SOMATOM AR needed so little energy afterglow means that the material becomes “dark”
With the SOMATOM Plus4, the engineers found that
that a standard electrical outlet was enough to supply again faster and can absorb new X-rays, meaning new
they had a “luxury problem”: The high-performance
it with power. The system was a complete success. information. This represented a huge step in X-ray
components delivered 300 images or more per slice
Siemens produced almost three times more technology, since from then on, radiation doses
scan when used with spiral CT. That was too many to
SOMATOM AR units than had been planned. Over the could be reduced by as much as 30 percent without
use diagnostically with the methods then available.
years, new models of the AR family were launched affecting image quality. Today, UFCs from Siemens
New ways had to be developed in order to evaluate
after being upgraded with new technologies and Healthcare are also used by other industries, including
and visualize datasets faster. These efforts had various
adapted to the various markets. In 1994, Siemens automotive manufacturers, which utilize them to
results, including the possibility of displaying scan
presented the SOMATOM AR.SP with spiral CT. Two examine materials non-invasively, and the furniture
images in three dimensions – also a function unique
years later, the AR family was reissued in a fresh, industry, which employs this technology to determine
to the SOMATOM Plus4 at the time.
contemporary design. The technology inside stayed the quality of wood.
the same, since it had proven to be highly reliable; In 1997, another innovation made its premiere in
One thing that is especially important to the field
nearly a quarter-century later, in 2014, Siemens the SOMATOM Plus4: a “solid-state detector” with a
of medicine – and thus also for medical imaging –
employees discovered a SOMATOM AR built in 1992 in special material used to convert X-rays. But first,
is accurate, dependable scans of the heart, since
China, still running perfectly and scanning 15 to 20 let’s take a look at how the detectors used until then
the root causes of many physical problems lie in the
patients per day. worked. The xenon detector, the first generation of CT
heart. Siemens had long been working on various
detectors, worked using xenon, a noble gas. The gas
On October 22, 1993, the CT engineers at Siemens approaches to further improve cardiac imaging.
was located under high pressure inside a measuring
were looking forward to a bottle of sparkling wine. One unusual
chamber. When X-rays struck the detector, they
It was initially scanned as the first test image to be approach was
changed the state of the gas molecules, exciting them
produced with the SOMATOM Plus4 and then drunk to a tomography
and causing them to lose electrons through the
celebrate the success. When the system was launched system that
energy transmitted by the X-rays, in a process known
on the market, in 1995, it was the fastest CT scanner featured unique
as ionization. This generated electrical impulses that
in the world – which, oddly enough, no one noticed at technology:
were registered in the chamber by measuring
first. The gantry of the SOMATOM Plus4 completed a Electron beam
electrodes and then forwarded for data processing.
rotation in 0.75 seconds, while all other scanners at tomography
However, a xenon detector only absorbs 60 to 90
the time needed at least a second to do so. Siemens (EBT) was
percent of the incoming X-rays and converts them
built on the insights gleaned through Project 47 when originally
into usable signals.
developing the new unit. By that time, the software developed by
was so advanced that all the doctor had to do was At the detector center in the Franconia city of Imatron, a
select the desired examination and the system would Forchheim, Siemens developed a special ceramic company in San
perform all of the necessary scans and sequences mixture that absorbs almost all X-ray radiation and Francisco with

A bottle of sparkling wine

as a test image, 1993

27
SOMATOM Plus4, 1994

which Siemens worked in the 1990s. Unlike in perfect for cardiac CT. But the method also had diagnostic quality and user and patient friendliness
conventional CT systems, in which the X-ray tube serious disadvantages, especially when it came to offered by the new units. Along with the SOMATOM
assembly and detector system rotated around the visualizing other areas of the body. The quality of Plus and SOMATOM AR product families, Siemens
patient, the gantry of an EBT scanner did not contain the images was not even close to that of images offered numerous other systems tailored to the
any moving mechanical parts. The X-rays were produced by conventional CT scanners, and further various needs of its customers, such as the Miyabi
generated in a three-meter-long vacuum tube behind development activities also did not promise any Angio-CT system, a combination of a full angiography
the gantry. Electrons moving at high speed struck significant improvements. With this in mind, Siemens workstation and a CT system that slides on a track.
anode ring segments arranged in a semicircle in the decided in the mid-1990s to halt development of Many limits had been overcome, but in the mid-
lower part of the gantry, where they generated the electron beam tomography and focus its resources 1990s, the engineers were faced with a new one:
X-rays that struck the detector semicircle in the upper on other approaches – about which the rest of this The power of X-ray tubes could not be further
part of the gantry. section will tell more. increased at will without affecting the tube lifespan.
But there was a way to put the existing power to
The advantage of EBT technology is its extremely After the innovations of the previous ten years, there
better use while at the same time making a huge leap
rapid scanning time, at just 50 milliseconds per slice – was no comparison between early systems and the
in cardiac CT: multislice CT.

An image of the lungs produced with the SOMATOM Plus4, 1997 Miyabi Angio-CT, 1998

28
The UFC detector for the SOMATOM Plus4, 1997

29
30
1998
Single-slice spiral CT Multislice spiral CT Presentation at the RSNA, 1998 Image of coronary arteries at Klinikum
Grosshadern, Munich, 1999

A paradigm shift in computed tomography

Up until this point, physicians had to decide between the body. Siemens achieved this high resolution by meant that it became less and less common to
volume size and sharp detail: Was it necessary to arranging the individual slices in a certain way. In an visualize individual slices, and the grand era of three-
visualize the entire organ, or would it be enough to “adaptive array detector,” the slices are very narrow, dimensional imaging began. The SOMATOM Volume
produce images of thin slices, but at a higher widening toward the outer edges. Because variable Zoom was also the first unit to have an automatic
resolution? With the SOMATOM Volume Zoom, the settings are available for the X-ray tube collimator, operating concept. Before then, users had to think
question became moot. This was due to two factors. resolutions of between 0.5 and 5 millimeters per slice about the right scan parameters before every scan,
First, the rotation time was just 0.5 seconds per can be selected, producing much thinner slices than but now the SureView software handled this aspect,
rotation, and second – and more importantly – the previously. determining the optimum settings for the scanner.
machine featured the new multislice technology. The SOMATOM Volume Zoom marked an especially
To Siemens, the main goal of developing multislice
Conventional detectors scan one slice per revolution. important point in the history of cardiac CT. The first
CT technology was to further reduce scan times and
In multislice technology, the photodiode is spread CT image of the coronary vessels was produced at the
further enlarge the possible scan volume. But the
among the detector elements on separate rows that Klinikum Grosshadern facility, in Munich, in 1999.
SOMATOM Volume Zoom was a milestone in many
process the signals transmitted by the X-ray tube It took about 40 seconds, but Siemens recognized
ways, representing a paradigm shift in computed
independently of each other, thereby recording that there was further potential and began devoting
tomography. Up until then, vascular examinations had
several slices per rotation – in the SOMATOM Volume great efforts to pushing development forward, in
been performed invasively, generally using catheters.
Zoom, four at once. This multiple-row detector utilizes cooperation with clinical partners. Over the next few
Multislice technology ushered in the era of routine
the X-ray output significantly more efficiently, enables years, this would turn out to be a major contribution
vascular imaging using CT scanners. It also brought a
image resolution that is as much as eight times higher to the field of cardiac imaging – without Siemens,
fundamental shift in how scan results were viewed:
in a longitudinal direction relative to the patient, and there would probably be no such thing as routine
Because the slices were much thinner, significantly
considerably reduces scanning time for large areas of cardiac CT today.
larger volume data sets were now available. This
31
1998–2005 Three-dimensional image of the interior walls of the intestine in syngo, 2003

32
Small dose, big progress
In the 1970s, computed tomography was a revolution. image quality for each patient individually. Depending functions that have been optimized for workflows in
In the 1980s, there was still something special, on the patient’s anatomy, CARE was able to reduce clinical settings and medical practices. For example,
something exclusive, about it. By the early 1990s, the dose of radiation by as much as 56 percent. all of the data on a patient can be compiled in the
it had become a matter of course, an established electronic patient file, so the physician can always
Siemens unveiled another groundbreaking software
technology and a crucial part of everyday clinical keep track of past scans and tests, including CT
innovation in 1999. With syngo, the company became
practice. Entry-level models put CT within reach even findings, lab results, and operative reports. Cross-
the first manufacturer of medical technology to craft
for hospitals and radiology practices with smaller department networking speeds workflows, allowing
a standardized user interface for all of its systems.
budgets. Several major innovative leaps, especially doctors to focus more on patients. Siemens, too,
CT scanners, magnetic resonance imaging (MRI)
continuous rotation and spiral CT, improved image benefits directly from syngo. The interface makes
systems and other imaging systems from the same
quality and significantly expanded the range of integrating new developments into the existing
manufacturer had previously had different software
applications. On the eve of the new millennium, the system much easier. In February 2000, the company
interfaces – and operators had to learn how to
dose per scan was just a fraction of the X-ray power received the iF Interaction Design Award from the
use each and every one of them separately. syngo
that was needed in older CT scanners. This was due international judging panel of Industrie Forum Design
allowed Siemens to standardize the operation of its
to two factors: significantly more efficient hardware, Hannover for syngo. The jury’s statement: “In short,
equipment. When a hospital or medical practice
such as the UFC detector, and software specially the epitome of a user interface, which is already clear
purchases a new system from Siemens, the learning
developed for this purpose, such as Combined from the fact that work steps and connections were
curve for staff is much shorter. The graphical user
Applications to Reduce Exposure (CARE). Among readily apparent even to us as laypeople without
interface consists entirely of simple, self-explanatory
other things, CARE technology calculated the smallest background knowledge of the subject.”
symbols. Behind the syngo interface are numerous
possible dose that would deliver the best possible
Ultra-fast, smooth-running medical care is a must in
hospital emergency rooms. Trauma rooms are where
initial care for patients with serious injuries or trauma
starts. Doctors there maintain the patient’s vital
functions and diagnose the injuries or the physical
cause of the emergency. CT is excellently suited to
providing rapid diagnoses. But at this point, it was still
necessary for patients who were to undergo a CT scan
to be moved, first from the operating table to the
CT table and then, at most hospitals, also from the
trauma room to the scanner room. The optimum
solution for emergency rooms would be if the patient
could lie motionless on a freestanding operating table
and the CT scanner could be moved to the patient for
diagnoses instead of the other way around. With this
SOMATOM Plus 4 CARE ad, 1994 Preparing for a scan in a trauma room, 2001

33
 in mind, Siemens developed the Sliding Gantry – a slightly differently during different treatment In addition to significantly greater accuracy, the
SOMATOM on rails – in 1998. In the new system, the sessions. A simple detector was used to check the PRIMATOM also brought other advantages to radiation
first of its kind in the world, the patient lay completely location of the bones, but it was usually not possible therapy, including this one: “Integrating imaging into
still on the table and received all of the necessary care to see the tumor in the process. On top of that, therapy unlocks a new dimension for us in treating
from medical staff without any space restrictions. If organs do move inside the body. These factors meant cancer patients, namely the ability to consider how
necessary, a fully functional SOMATOM Plus4 could be that radiation fields were expanded, in some cases the tumor changes over time during the course
moved into the scanning position in less than one significantly, in order to be sure that all of the cells of of treatment,” as Dr. Jürgen Debus, a professor
minute. The system could also be combined optionally the tumor would be covered. What Wong wanted to and Medical Director of Clinical Radiology at the
with the Siemens MULTISTAR Plus angiography C-arm do was check the tumor’s position with a combination Heidelberg University Hospital, said in 2004. At the
and various ultrasound diagnostic systems. of a linear accelerator and CT scanner before every time, more than 500 patients had been treated
radiation treatment. with the first PRIMATOM in Europe, which was
being operated at the German Cancer Research
Center (DKFZ) in cooperation with the University of
The team headed Heidelberg. The PRIMATOM with syngo and the
by engineer Andres additional software function represented a milestone
Sommer at Siemens in in radiation therapy, and it is still recognized as the
Erlangen began looking gold standard for image-guided systems to this day.
for solutions to the
mechanical issues and In the fall of 1999, the field of CT at Siemens
concluded that „this kind entered uncharted territory. The UK National Maritime
of solution was easy to Museum in London, the Royal London Hospital,
build“. They relied on the and the medical technology arm at Siemens teamed
principle of the Sliding up to learn more about the craftsmanship of
Gantry to develop the British shipbuilders in the 17th and 18th centuries.
PRIMATOM, the world’s Endoscopic scans performed in the past had yielded
first 3D image-guided only modest insight, and so the plan now was to use a
PRIMATOM, 1999 Image of model ships, 1999
radiation therapy system. CT scanner to generate cross-sectional images of the
The team installed this cross between a CT scanner ships. Since the 70-centimeter gantry of a SOMATOM
Not long after the development of the SOMATOM and a linear accelerator in Morristown in April 1999. Plus4 was a bit too small to fit a life-size sailing
Plus4 Sliding Gantry, Siemens received an inquiry Several months later, Sommer visited the site for a ship, the researchers scanned historical model ships,
from James Wong, Chair of the Department of closer look at the workflows involved. He discovered which had been built at the time by British carpenters
Radiation Oncology at Morristown Memorial Hospital that analyzing and interpreting the images and to serve as exact prototypes for shipbuilding.
in Morristown, New Jersey. Wong was using linear resetting the system for the next patient took The engineers at Siemens adjusted the image
accelerators to fight cancer. A linear accelerator is a a very long time. Conveniently, the team was processing algorithms to accommodate the particular
radiation treatment device that accelerates electrons working on developing the first version of an image characteristics of the materials used in the ships.
almost to the speed of light and beams them at cancer reconstruction software program based on syngo at Naturally, the research took place in the evening so
cells. Up until 1999 radiation therapy had involved the time. Specifically for the PRIMATOM, they added that it would not impede routine operations at the
“flying blind.” This meant that when treatment plans a new software function that showed the necessary hospital.
were drawn up, the tumor’s position was determined shifting of the patient in 3D images. The visit had The length of the gantry is irrelevant when scanning
one time and it was assumed that it was always in the been worthwhile. The system now worked ten times model ships – but when dealing with patients, it’s a
same location, even if the patient was positioned faster than before. different story. Some people feel cramped inside the

34
“tube,” and some get an uneasy feeling just
looking at it. This means that one important
goal of any development in this area of
medical technology is to boost patient
comfort and make the scan as pleasant as
possible. As a result, the new SOMATOM
models launched in 1999, Emotion and
Balance, featured a gantry that was just 56
centimeters long – at that time, the shortest
on the market. The compact design not only
made undergoing the scan easier for many
patients, but also benefited operators,
who had better access to the patient. For
these and other aspects of their design,
such as improved service and maintenance
friendliness, the SOMATOM Emotion and
SOMATOM Balance received the iF Product
Design Award for the year 2000.

SOMATOM Emotion, 2001

35
 SPECT-CT Symbia, 2004

A few weeks after the that was four times faster in July 2002. The package procedure required two separate scans, one with a
awards ceremony, included the syngo VA40 software upgrade, which PET or SPECT scanner and one by CT, and then the
Siemens launched the brought various features with it, including new result images were superimposed over each other.
SOMATOM Esprit. The applications for pediatrics and cardiology. Customers This method was time-consuming and meant a lot of
new model also had a also had the option to add new functions to their work for medical staff, and it was also cumbersome
gantry just 56 centi- systems, such as the ability to do a virtual “fly- for patients.
meters long, but it through” of a patient’s intestine. Users were able
Hybrid systems could combine the particular strengths
was also even more to adjust the scope of the service package on an
of these methods of nuclear medicine with those of
compact overall. The individual basis to suit their needs. More than 75
CT in order to detect certain diseases and disorders
entry-level SOMATOM percent of all customers purchasing a new SOMATOM
even faster, earlier, and with greater reliability. The
Esprit did not have in 2002 chose to receive this service.
same idea had also occurred to David Townsend, of
an additional cooling
Each of the established imaging methods has its own the University of Pittsburgh, and Ron Nutt, of CTI PET
system, which meant that it needed just 17 square
major strengths, meaning that it is especially suitable Systems, in Knoxville, Tennessee, a joint venture
meters of space. At the same time, the system came
for certain types of scans. Ultrasound diagnosis is between Siemens and CTI. They applied for a patent
equipped with features otherwise found only in larger
the first choice for many routine examinations, such on the idea of combining PET and CT technology, with
CT scanners. The standard features included a UFC
as for preventive care during pregnancy; magnetic plans to build the first hybrid system with support
detector and spiral CT, and functions such as CT
resonance imaging (MRI) delivers extremely sharp, from the CT team at Siemens. To this end, Siemens
angiography or CARE Bolus, a program to reduce the
detailed images of areas of soft tissue, such as delivered a SOMATOM AR with spiral CT capability
amount of contrast agents, could also be added upon
the brain; and computed tomography offers high- from Forchheim to Pittsburgh in 1997. Thomas Beyer,
request. The system could be installed and ready for
resolution images of the skeleton and precision results then a research associate at the university, built a
the first scan in just one day.
when time is of the essence, such as when a stroke is prototype there by combining the SOMATOM AR
The computer used for CT systems is based on suspected. Two other important methods used for with a PET system from Knoxville. The first scans,
microprocessors, just like in a cell phone or PC. In clinical imaging are positron emission tomography performed on more than 300 cancer patients, already
1965, Gordon Moore, one of the co-founders of Intel, (PET) and single-photon emission computed tomo- showed impressive results. Building on this, a Siemens
observed a correlation in the development of graphy, or SPECT. These nuclear medicine methods team was tasked with getting the combination system
electronic components that, in a slightly modified can be used to obtain a detailed picture of bodily ready for the market. They produced a special CT
form, still applies to microprocessors to this day: functions and metabolic processes. They are used scanner based on the SOMATOM Emotion, sent it to
“Moore’s law” holds that the power of microprocessors primarily in diagnosis and treatment of cancer, heart Knoxville, and built a combined PET/CT scanner there,
doubles every 24 months. This means that if a disease and neurological disorders. But because they launching it on the market in 2001 as the Siemens
hospital buys a CT scanner today, that same system, are geared specifically toward biochemical processes, Biograph. The path they had taken – opening up the
equipped with a new microprocessor, would work PET and SPECT are of limited utility in visualizing possibility of producing simultaneous CT and PET
even faster in a few years, and it would even be the anatomical details of the body. In many scans, images – soon turned out to be the right one. By
possible to add new functions and applications. however, simultaneously visualizing metabolic about five years later, individual PET scanners were
For customers who wanted to keep their system up- processes and anatomical structures with accuracy no longer being sold. The Biograph was built in nine
to-date, Siemens began offering its Evolve service down to the sub-millimeter level is crucial in terms of versions, with multislice technology and numerous
package, later marketed under the name syngo Evolve optimum treatment planning – for example, being new functions and improvements.
Package, for all imaging systems. The SOMATOM able to determine quickly and accurately where and to
In the early 2000s, Siemens began considering
Volume Zoom and Volume Access systems installed what extent a patient’s heart muscle has sustained
whether a hybrid of SPECT and CT was also possible
between August 1999 and October 2000 were the damage due to an inadequate supply of blood after a
without lowering quality standards, and if so, how.
first to benefit from this program, receiving hardware heart attack. Up until then, this kind of diagnostic
A team of engineers working in nuclear medicine and

36
 Presenting the first PET/CT combination scanner at the RSNA, 2000

computed tomography planned the unusual

architecture, decided on the SOMATOM Emotion as
the CT component of the system, and combined it
with the latest SPECT technology, the e.cam. Siemens
presented the results of this development, the
TruePoint SPECT-CT, in mid-2004, giving the new
product family the name Symbia. The system was
extremely versatile. In addition to combined SPECT-CT
scans, Symbia systems could also be used for purely
SPECT or CT scanning, depending on the doctor’s
needs. The engineers’ decision to use the SOMATOM
Emotion turned out to be just right. The SOMATOM
Emotion is still on the market to this day, and
upgrades and improvements for this scanner can be
imported seamlessly into the Symbia family.
In December 2001, a scant three years after com­puted
tomography had first been used to visualize the
coronary arteries, Siemens took the next step by
introducing the world’s first 16-slice multislice CT
scanner. The SOMATOM Sensation 16 now made even
the surrounding segments of the coronary arteries
and their delicate side branches visible. The leap from
four to 16 slices and the even faster rotation time –
just 0.4 seconds – brought numerous advantages.
For example, it now took only about ten seconds to
perform a lung scan. But there was one area where
the SOMATOM Sensation 16 really excelled: cardiac
imaging in conjunction with the “HeartView CT”
software. This program even allowed doctors to see
areas of narrowing and deposits in the coronary
arteries, a hugely important factor in terms of early
detection in particular. For their work on HeartView
CT, the development team headed by Bernd
Ohnesorge and Thomas Flohr was nominated for
the Deutscher Zukunftspreis, the highest award for
innovation in science and technology given in
Germany, in 2002. That same year, the Design Award
of the Federal Republic of Germany went to the CT
development unit at Siemens in recognition of a very
special system: the SOMATOM Smile.

37
 An entry-level model, the SOMATOM Smile was Computed tomography places an immense strain Siemens presented this unique development to the
designed for the needs of private radiology practices on the X-ray tube, especially since the introduction public under the name STRATON X-ray tube – an
and smaller medical facilities in China, Southeast Asia, of spiral CT and the high speeds that come with it. innovation that brought the team headed by Peter
and Brazil. The system was simply plugged into a Up until then, tubes had worked according to the Schardt and Erich Hell a nomination for the Deutscher
normal electrical outlet and was ready to go in just following principle: The airless X-ray tube contained Zukunftspreis award for innovation in science and
three hours. If technical problems cropped up, an a cathode and a rotating anode that were linked to technology in 2005.
intelligent self-test function helped to identify the each other through the application of high voltage.
The ability to bring CT systems fully up to date
malfunctioning or The cathode was heated up, causing it to discharge
SOMATOM Smile, 2000 without completely redesigning the underlying
defective parts electrons. The electrons were accelerated and collided
framework was a major goal for the engineers
and then with the anode. This generated X-ray radiation, which
with each development. The SOMATOM Sensation
displayed the was then beamed out of the tube. The weak points
family offers a good example of the benefits of this
correct order of this design are the development of heat and the
approach. In 2001, the SOMATOM Sensation 16 was
number onscreen. position of the rotating anode. The longer a CT
the first system in the world with a 16-slice detector.
Customers could scan lasts, the hotter the anode gets. It is cooled by
With z-spring focus technology, the engineers at
order the replace- discharging the heat through the vacuum to the
Siemens quadrupled the number of slices that
ment component cooling oil surrounding the tube. This cooling process
could be scanned at once, making the latest model
from Siemens and is not very efficient, necessitating longer pauses to
introduced in 2003, the SOMATOM Sensation 64, the
replace it them- cool down between scans. Two major design changes
world’s first 64-slice CT system. Special optimizations
selves based on significantly boosted X-ray tube performance: pivot
for specific requirements could also be realized within
convenient color- bearings outside the tube, for greater stability, and
a system family. Siemens launched the SOMATOM
coding. The direct cooling of the anode.
Sensation Cardiac 64, a system specifically optimized
concept used to
Back in 1993, Willi A. Kalender and Wolfgang Knüpfer for cardiovascular imaging, in 2004. The rotation time
operate the
started working at Siemens on what they called a was faster than the base system, at 0.37 seconds to
system was also
rotating envelope tube, an approach later continued the base system’s 0.33, and additional hardware and
revolutionary:
by a team of developers headed by Peter Schardt software designed specifically for cardiac scans came
The unit came
and Erich Hell. In this design, it is not the anode that pre-installed. At the same time, the SOMATOM
with a CD-ROM
rotates, but the entire vacuum tube instead. This Sensation Open made it easier to scan overweight and
con­taining
makes the mechanical construct significantly more obese patients. This scanner built on the SOMATOM
training software
robust and compact, yielding further benefits. The Sensation 16, but with upgrades including an 82-
that taught users
most important factor is the direct cooling of the centimeter gantry and a STRATON tube. This shows
– step by step and
anode: Compared with conventional CT tubes, the that technological evolution, with all the innovations,
in clear, easily
rotating envelope tube discharges about ten times improvements, and new application options that
understood terms
A conventional CT tube more heat. The rapid cooling meant that the come with it, increasingly boosts performance across
– how to use all
versus STRATON, 2005 engineers could install anodes that were significantly a system family over the years. A technological
of the system’s
smaller, and thus also weighed less, which further revolution generally depends on fully redesigning
functions, from turning on the scanner to patient
enhanced mechanical stability and made it possible the basic framework and then introducing the new
positioning and preparing images that could be used for
to achieve even greater rotation speeds. Another design in a new system family – just like with the
diagnosis. For its ease of use, appealing design, and
prominent new development lay in the details: next groundbreaking CT system from Siemens: the
intelligent overall concept, the SOMATOM Smile not
The “z-spring focus” recorded every projection from SOMATOM Definition, the first dual-source CT
only won the Design Award of the Federal Republic of
two to four different perspectives during the scan, scanner.
Germany, but also brought Siemens the red dot award
significantly improving image clarity. In 2003,
for 2001 and the iF Design Award for 2002.

38
 SOMATOM Sensation 16, 2002

Heart scan with

SOMATOM Sensation
Cardiac 64, 2004

39
2005

Trial run with test body, 2006

40
 Rotation of
the X-ray unit
and detector

X-ray unit 1
and 2

Rotation of
the X-ray unit
and detector

Patient table

Gantry

Detector 1
Detector 2

Gantry production, 2006 The skull and cervical spine Image of different levels of the Operating principle of dual source CT
of a 59-year-old man, 2006 body in the same man, 2006

Twice the scanning power

With spiral CT, the UFC multiple-row detector, the temporal resolution of images, an especially important significantly lower than with one, but there is a simple
STRATON tube and all the other hardware and factor in cardiac CT. Before then, patients with a high explanation: With two tubes, completing a scan takes
software innovations, computed tomography in the heart rate had to take beta blockers before under­ half as much time. Whether the patient is large or
mid-2000s made it possible to produce images of the going a scan to lower their resting heart rate for the small, thick or thin, is unimportant. With the two
inside of the body at levels of quality that would have procedure. With dual source CT, the scanner was now, STRATON tubes, the SOMATOM Definition had more
been unimaginable not long before then. Siemens for the first time, fast enough to eliminate the need than enough power reserves to scan even very obese
took the next major step by coming up with a simple for these drugs. The reason for this lay in the scanning patients without any ill effects on image quality. For
but ingenious idea that doubled the power of scans procedure: A CT scanner with one X-ray tube and one certain scans, the two tubes could also be operated
in the high-end segment while at the same time detector collects data during a 180-degree path around with “dual energy,” meaning at different tube
cutting radiation doses nearly in half: The SOMATOM the gantry, but the SOMATOM Definition with dual voltages. With low energy, the radiation is attenuated
Definition was the first system in the world to have source technology only needs to rotate 90 degrees to differently in the body than with high energy. This
two X-ray tubes and two detectors rotating around do the same. Combined with a gantry rotation time technique can be used to produce two data sets
the patient. of just 0.33 seconds, this brought the time needed to containing different information in a single scan. The
perform a full scan of the beating heart down to only benefits of this approach are readily apparent for a
The main reason for the development of this tech­
0.083 seconds – twice as fast as before. field like emergency diagnostics, for example: One
nology, known as dual source CT, was cardiac imaging.
tube can be optimized for visualization of bones,
The SOMATOM Definition set completely new It might seem paradoxical at first glance that the
while the other can be set specifically for images of
standards for scan speed, image resolution, and the radiation dose that is required with two X-ray tubes is
soft tissue or fluids.

41
Since 2005

42 SOMATOM Emotion 16, 2005

Improved detail for big impact

The long chain of individual technical improvements 10 seconds by 1980 and 1 to 2 seconds ten years later the way that the electronics were arranged in the
that scientists and engineers all over the world have on. The fastest scanners in 2005 needed just 0.33 gantry. It was just this task – developing even more
worked on has made computed tomography into an seconds to do the same. Advances in CT technology powerful, more efficient components – that would
essential tool for everyday clinical use over the years. are similarly apparent if we look at the volume of data keep the engineers busy over the years to come
Comparing older images with those produced today collected for each 360-degree rotation, which rose as well.
paints an especially vivid picture of how far this from less than 0.06 megabytes (MB) in a prototype
It all started with the optimization of the SOMATOM
technology has come, but the figures are also from 1972 to 1 MB in the early 1980s, 2 MB in 1990,
Emotion, which had become one of the most
impressive in their own right: Back in the 1970s, and finally as much as 100 MB in 2005. Each spiral
commercially successful CT scanners in the world
the first CT systems took about five minutes to scan scan produced in 1990 generated between 24 and
since the first model was launched. The new model
one slice, a time that had been reduced to just 4 to 48 megabytes of data, while a scanner from 2005
introduced in 2005 turned the system from a low-cost
collected up to 4000 MB in just a few seconds. Over
entry-level model with a single-slice detector to a
the years, innovations from Siemens have brought
low-cost entry-level model with a 16-slice detector.
fresh drive to the field of computed tomography time
The fully overhauled system retained all of the
and again, even spurring advances in whole new
strengths of the predecessor model, including the
directions and setting trends in many cases.
small installation space of just 18 square meters, and
The latest Siemens development in 2005, dual source low power consumption, but it also offered numerous
CT, sounds like an easily implemented idea: Just new functions. The new unit had an Internet
integrate a second tube, put in a second detector, and connection, adding flexibility for operators. Optional
there you have it – a dual source scanner. In reality, syngo WebSpace software allowed doctors to access
the technical side of implementing this idea was a and work with scan results in encrypted form via the
huge challenge for the engineers, because the gantry internet. The Guardian service program was installed
was already very tightly packed in conventional to monitor the scanner’s functions online and flag
systems with single source CT. Without the compact any abnormalities before disruptions could arise.
STRATON X-ray tube, dual source CT would not have
A similar system from the SOMATOM Emotion family
been, at least not without changing the structure and
helped clear up a suspected murder. The question
making the scanner significantly larger. But the new
of whether famed pharaoh Tutankhamen had
tube technology alone was not enough to make the
been killed by a blow to the head more than 3,000
leap. The engineers had to optimize almost all of
years before was a source of considerable debate
the other components as well and make them more
among Egyptologists. In January 2005, Egyptian
compact. This included the entire cooling system and
syngo WebSpace, 2006

43
The 3,300-year-old mummy of the pharaoh
Tutankhamen before the CT scan, 2005

44
researchers cracked the
case with help from a
SOMATOM Emotion 6.
The 1,700 tomographic
images taken of the
mummy showed no signs
of murder; instead, the
results pointed to the
effects of a hunting
accident. At the same
time, the CT images also
showed that Tutankhamen
was between the ages of
18 and 20 at the time of The bust of Nefertiti, 2007 The hidden portrait becomes visible, 2007
his death, not between 23
and 27, as some Egyptologists had estimated. As part less characteristic. The researchers suspect that the flexibility by combining components such as a
of the research project, the Egyptian Council of limestone core inside the bust is closer to the queen’s 78-centimeter gantry and a scan length of up to 200
Antiquities scanned numerous other mummies and real image than the plaster exterior. centimeters for the first time in this system. This made
historical finds, some of them about 5,000 years old. the SOMATOM Definition AS suitable for a wide range
Solving archaeological mysteries was an exciting and
The SOMATOM Emotion 6 was loaded on a tractor- of different patient groups, from overweight people
interesting sideline, but computed tomography was
trailer and driven to wherever it was needed. This to those with claustrophobia or children, and at the
naturally geared mainly toward use in medicine. In
meant that the delicate ancient Egyptian remains same time, it could perform complex neurology or
the mid-2000s, the technology was so accurate and
were hardly moved at all, treating them as carefully cardiology scans with no restrictions, along with fast
advanced that it was hard to imagine that there was
as possible. scans in emergency situations, such as trauma, stroke,
any further room for improvement. But work on
or heart attack patients. These kinds of emergency
A bust of the Egyptian ruler Nefertiti had already been technical details, patient comfort and user friendliness
examinations were also the main area of use for the
scanned using CT technology back in 1992, a process would continue over the next few years and bring
first SOMATOM Definition AS ever delivered, which
that yielded a startling secret: Inside the sculpture, astonishing further progress and new developments.
was installed at the trauma center at the Erlangen
there was a second portrait of Nefertiti in limestone At that time, Siemens started development of various
University Hospital in late 2007.
that looked different from the outer depiction. CT had features, including a new generation of detectors, and
made such tremendous advances since the time of optimized the hardware and software used for the The CT systems from Siemens did not start being
this first scan that the hidden portrait could now be product families. adaptable only once they were in clinical use; their
shown in full detail. With this in mind, the National flexibility started even before the purchase. All of the
Siemens introduced a number of single source
Geographic Channel decided to re-scan the queen in current systems offered by the company at the time
systems with flexible configuration options to join its
2007 for a TV documentary, with help from Siemens. could be configured by customers according to their
top-of-the-line SOMATOM Definition model with dual
The new scan image, produced with a SOMATOM requirements. From the number of detector rows to
source CT technology. In 2007, the high-end system
Sensation 64 and showing structures as tiny as 0.3 software and service packages, there were numerous
with one X-ray tube was the SOMATOM Definition AS.
millimeters, even reveales clear lines around the options available. The systems could be upgraded
The “AS” stands for “adaptive scanner,” meaning that
mouth. The nose is less harmonious, the shoulders with new hardware and software innovations as
the system adjusted to all patients and medical
stocky and asymmetrical. Nefertiti seems older and needed in the years to come. This was true of both
requirements. The Siemens engineers achieved this

45
 pure CT systems in the SOMATOM family and hybrid tomography. Siemens built on this success and on its To further reduce the radiation dose, Siemens
systems like the Miyabi, Symbia, and Biograph mCT experiences with dual source technology, and in 2009 developed an innovative mathematical method of
families. In 2008, all of these systems were equipped launched a new model that was once again the fastest processing images. The IRIS (Iterative Reconstruction
with multislice detectors, and the Biograph mCT and CT scanner in the world at the time: the SOMATOM in Image Space) algorithm ran much faster than
many SOMATOM systems could even offer as many Definition Flash. previous methods, despite the additional calculations
as 128 slices upon request. involved, and made it possible to reduce the dose by
An example from cardiac imaging provides a vivid
a further 60 percent. The first systems were equipped
In 2005, when Siemens became the only CT picture of the advances that had been made with the
with the new method starting in the spring of 2010.
manufacturer to turn its back on the race for ever- SOMATOM Definition Flash. Previously, producing
A year later, Fast Care software helped clinical
greater numbers of detector rows and instead focus detailed images of the heart with as few artifacts as
personnel optimize the dose while also streamlining
on the completely new dual source technology, the possible had required doses averaging between 8
workflows. Reducing the dose any more would
move was viewed as a risky one. But it soon became and 30 millisieverts. The SOMATOM Definition Flash
lead to “noise” in the image, meaning artifacts and
apparent that the venture had been worthwhile: needed less than one millisievert to do the job. This
diminished image
quality – unless an
even more efficient
detector was
developed, that is.
The leap from xenon
to solid-state detectors
had already yielded
significant improve-
ments in converting
X-ray signals. But this
second generation of
detectors had a weak
point that affected
A foot scan with dual energy, Grosshadern Biograph mCT, 2008 syngo.CT Cardiac Function software, 2013 image quality: After
University Hospital, Munich, 2007 the X-rays were
converted to light
A few weeks after the first SOMATOM Definition was was made possible by a number of factors, including signals, the photodiode transmitted them to a
installed, experts estimated that a large portion of further improved and specialized syngo programs and, converter that transformed the analog electrical
the approximately 600,000 catheter examinations most especially, the premium scanner’s outstanding impulses into digital ones. This took place via several
performed each year could be replaced by cardiac CT. speed. The gantry rotated around the patient in 0.28 hundred wires. The longer these wires were, the
Clinical studies documented this technique’s benefits, seconds, almost four times per second. At the same greater the electronic noise – and the greater the
especially for cardiac imaging, the place where time, the patient was moved through the scanner electronic noise, the worse the image quality.
computed tomography really excelled. Among other twice as fast as in conventional systems in use at the Siemens launched the first detector that eliminated
findings, researchers from Zurich University Hospital time. This meant that a person two meters tall could nearly all of these wires in 2012: In the Stellar
showed that with the SOMATOM Definition, it was be scanned from head to toe in less than 5 seconds, detector, all of the electronics used for signal
possible to significantly lower the dose used for a while a chest scan took 0.6 seconds and a cardiac conversion are combined in a single chip located
cardiac scan in comparison to conventional computed scan just 0.25 seconds – less than half a heartbeat. directly under the photodiode.

46
Dual Source CT SOMATOM Definition Flash, 2009

47
 During the early stages of the six-year process of Stellar, the system made structures as small as Spiral CT, multislice, UFC, the Straton and Vectron
developing the Stellar detector, it was not yet clear 0.30 millimeters visible. This system also marked tube, Sliding Gantry, dual source, dual energy, the
whether it would even be possible to combine the the introduction of a new dual energy technology Stellar detector – these and many other hardware and
photodiode and converter in the first place. To replace in single source CT that needed significantly less software developments over the last 40 years have
the wiring, about 90 contacts per square centimeter, radiation than was customary for scans performed made Siemens the leading innovator in the field of
each just 0.1 millimeters in diameter, had to be etched with this method using one X-ray tube. computed tomography. The current system families
through a silicon plate. There were also several layers for the year 2015 are the product of years of ex­
Reducing the radiation dose also played an important
of oxide isolating the tiny contact holes from the perience and cooperation with scientists, researchers,
role in the development of the Vectron X-ray tube,
silicon. In cooperation with semiconductor manu­ and medical professionals all over the world. The
in 2013. The operating voltage of X-ray tubes can be
facturer ams, the engineers at Siemens were able to portfolio today ranges from energy-efficient entry-
set to between 70 and 150 kilovolts (kV). To keep the
realize this completely new electronic design. The level models to high-end scanners with two X-ray
radiation dose low, especially for CT scans performed
extremely short transmission routes significantly tubes and from systems for routine clinical appli­
using contrast media, many radiologists prefer 70 kV
boosted signal quality. Stellar reduced electronic cations to highly specialized trauma room CT units on
or 80 kV as the voltage. Until then, however, only
noise by as much as 30 percent, which brought a rails. Scanner families that have stood the test of time
children and slender people could be examined using
comparable dose reduction – with improved image for many years, like the Biograph and Symbia, are
this method, known as “low-kV” scanning, since the
quality at the same time. always at the forefront of advances in technology,
X-ray tubes simply did not have enough power at low
and they are joined by new product classes such as
The outer structure of the Stellar detector was the voltage. The Vectron tube eliminated this technical
the SOMATOM Perspective or the SOMATOM Scope,
same as in conventional Siemens detectors. The rest limitation. It had more than enough power reserves –
introduced in mid-2014, an all-around CT for routine
of the system architecture remained unchanged, and over twice the amount of other CT tubes – to scan
clinical use with ultra-low operating costs that needs
current scanners such as the SOMATOM Definition even people with thicker bodies using the low-kV
just eight square meters of space. And the develop­
Flash could easily be upgraded with Stellar. The method. In addition, the contrast-to-noise ratio was
ment process is far from over – as shown by the
Siemens SOMATOM Definition Edge, the new high- so high that it was even possible to reduce the
current highlight in the history of computed tomo­
end model with single source CT in 2012, came amount of contrast medium used in CT angiography.
graphy at Siemens, the SOMATOM Force.
standard with the new detector technology. With

A conventional detector element (top) The SOMATOM Scope, which needs just A dual energy scan with the SOMATOM Definition Edge,
and Stellar (bottom), 2012 eight square meters of space, 2014 University of Erlangen-Nuremberg, 2014

48
 SOMATOM on rails, Frankfurt University Hospital, 2014

SOMATOM Perspective with up to 128 slices, 2014

49
50
2013
SOMATOM Force, 2013 Upper body scan, Mannheim University SOMATOM Force in Mannheim, 2013
Medical Centre, 2013

40 years of experience in a single unit

The prototype of what was once again the fastest CT technological feasibility. The system took a 600-person the SOMATOM Force scans a lung at a dose of just
scanner in the world was set up at the University team five years to develop. It brings together all of the 0.1 millisieverts – about the same as the natural level
Medical Centre Mannheim in late 2013. The gantry of high-end components from Siemens and pushes them of radiation exposure occurring on a flight from
the SOMATOM Force held a child carrier with a small, even further. The 1.6-ton gantry rotates around the Germany to Argentina.
wiggly patient – a one-year-old boy who had been patient four times a second. That’s like a Mercedes
Over the last 40 years, new areas of application for CT
admitted to the hospital with a suspected case of E-Class vehicle tracing a circular path on a small round
have been unlocked on an ongoing basis. The tech­
pneumonia. An X-ray image had been taken, but the coffee table with five times the accelerative force of a
nology is now essential in many disciplines, such as
results were inconclusive. But then things moved very fighter jet. At the same time, the two Stellar detectors
cardiac imaging. Current systems have changed
quickly. The SOMATOM Force scanned the infant’s and the Vectron X-ray tubes have to be kept in
clinical practice: The necessary dose is now so low
chest in just 0.3 seconds – without any artifacts from position with the utmost accuracy, down to not only
that CT scanners are used for regular checks such as
his movements or breathing getting in the way of the millimeter, but even the micrometer. Together
to monitor the progress of treatment and for early
the final image. The image showed tiny areas of with the table speed, which has been increased from
detection of diseases, such as for lung scans in
inflammation in the lung tissue, and it did so at a dose 45 to 73.7 centimeters per second – the fastest on
smokers. On average, eight people are scanned in
of radiation no higher than with a conventional X-ray. the market – this means the system can now scan an
Siemens CT systems worldwide every second, and CT
This finding allowed the doctors to initiate suitable adult’s entire upper body in under one second. The
is growing ever more important as it is developing
treatment for the little patient right away. achievable resolution is 0.24 millimeters, as compared
more and more into a comfortable, convenient, and
with the 0.33 millimeters possible with the previous
The SOMATOM Force is the world’s most powerful uncomplicated procedure – in short, CT scans will
model. Without any compromises in image quality,
CT scanner, pushing the limits of present-day become the new X-rays.

51
Locations

52 Detector production at the main plant in Erlangen, 1981

From small
factory to
global player
Production in Forchheim, 2015 Production in Shanghai, 2014

In 1975, Siemens built the first SIRETOM in a Forchheim, Germany Shanghai, China
relatively small production hall in Erlangen and
Siemens Healthcare opened a small branch location The history of Siemens in China starts back in the era
delivered it to Munich. Today, the company
in Forchheim, about 20 kilometers away from the of the Qing dynasty. In 1872, the company supplied
produces more than one thousand systems a year
company’s headquarters in Erlangen, in 1986. At first, China’s first dial telegraph, and seven years later,
at three sites spread around the globe and ships
about 280 employees worked here, producing sheet Siemens installed a lighting system, including power
them all over the world. The Siemens plant in
metal housings for medical equipment, but now, the plant, at the Shanghai harbor. The bustling city in
Forchheim is home to the largest and most
site has become one of the most important locations eastern China also became the headquarters of
advanced computed tomography production
for medical technology at Siemens, with a staff of Siemens Shanghai Medical Equipment Ltd. (SSME),
facility worldwide. Siemens produces CT scanners
about 1,800. Siemens began expanding the site at the first Chinese production site for Siemens medical
for the Asian market in Shanghai, and in August
regular intervals right from the very start, and finally technology, which was founded in 1992. In two
2012, a 6,000-square-meter Siemens factory in
moved the company’s growing CT manufacturing decades, the plant has grown from a simple assembly
Joinville, Brazil, began supporting worldwide sales
activities from Erlangen to Forchheim. In November factory to a major site with activities spanning
activities involving the SOMATOM family. The sites
1994, after 13 months of construction, the company development, production, customer service and
are seamlessly connected with each other. In close
began operating one of the world’s most advanced training for engineers and specialized workers in the
cooperation with other business units at Siemens,
factories for medical technology: the only CT produc- Asia-Pacific area. The computed tomography business
teams work on hardware innovations and develop
tion site in Europe and an expanded plant for angio­ unit alone has about 420 employees here. Alongside
new software applications. All of the X-ray tubes
graphy systems. The two units were closely inter­ CT scanners, SSME also produces ultrasound systems,
used in Siemens CT scanners come from the
connected in terms of development, manu­facturing, X-ray units, and medical components. The plant,
company’s own X-ray plants, which are located in
quality management, international logistics, and which is located in the heart of the Shanghai
Rudolstadt, Erlangen, and the Chinese city of Wuxi.
marketing. The site has received numerous awards International Medical Zone, grew by more than
and distinctions over the years, including the title of 32,000 square meters in 2013 and now occupies
“Factory of the Year” in 1998. The plant is still growing over 100,000 square meters in all.
today. A 25,000-square-meter office and development
building is scheduled to be dedicated in early 2016,
offering space for 750 employees.
53
54 Forchheim, 2015
CEOs of the Computed
Tomography Business Unit

1972–1984 Friedrich Gudden (CT development)

1985–1986 Walter Schwarze
1986–1990 Wolfgang Feindor
1991–1995 Peter Bertsch
1996–2000 Klaus Hambüchen
2000–2004 Richard Hausmann
2004–2008 Bernd Montag
2008–2011 Sami Atiya
Seit 2011 Walter Märzendorfer

55
Publishing details

Publisher Print run

Siemens Healthcare GmbH 2.300
Henkestraße 127
Sources
91052 Erlangen
This publication is based primarily on sources held
Germany
in the collections of the Siemens MedArchiv (SMA),
Author in Erlangen, and contemporary reports.
Ingo Zenger
Images
Editorial cooperation © page 4: Deutsches Röntgen-Museum
Siemens MedArchiv Erlangen
© All other images:
Siemens Computed Tomography &
Siemens MedArchiv, Erlangen
Radiation Oncology
Siemens Computed Tomography & Radiation Oncology
Layout
Andrea tom Felde, Siemens Healthcare GmbH,
Henkestr. 127, 91052 Erlangen, Germany
Production
Norbert Moser, Siemens Healthcare GmbH,
Henkestr. 127, 91052 Erlangen, Germany
© Siemens Healthcare GmbH, 2015
All rights reserved.