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This issue caused me a lot of heart ache in the past. Having had past problems and suspecting the same for an acceptance test; I called Siemens and went through about 3 tiers of “experts”. I eventually talked to one of their most qualified people</div>
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<p class="MsoNormal"><span style="font-size:12.0pt">This issue caused me a lot of heart ache in the past. Having had past problems and suspecting the same for an acceptance test; I called Siemens and went through about 3 tiers of “experts”. I eventually talked
to one of their most qualified people on this topic. I discussed what I was going to do step-by-step and asked him if the results would comply with the IEC standard. He said yes. I did the test. It failed. Siemens just shrugged and then blew me off by saying
they are compliant and there is nothing that can/should be done.<o:p></o:p></span></p>
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<p class="MsoNormal"><span style="font-size:12.0pt">Siemens claims to be IEC compliant. I think many would disagree.
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<p class="MsoNormal"><span style="font-size:1.0pt"><a href="https://urldefense.com/v3/__https://wearememorial.com/__;!!KGKeukY!1E1kn0dAFHAV6pTHDI00yHPwDj0Gf_84PL5rN32T5oXqgZuf1LKzUiJIbFuiLsKvyooQVkvbaHA-ESyC6uFmCbiaYkpdrwV6b6gN$" target="_blank"><span style="font-size:10.0pt;color:windowtext;text-decoration:none"><!--[if gte vml 1]><v:shapetype id="_x0000_t75" coordsize="21600,21600" o:spt="75" o:preferrelative="t" path="m@4@5l@4@11@9@11@9@5xe" filled="f" stroked="f">
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<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:"Trebuchet MS",sans-serif;color:#00A19C">D. SCOTT WINTER</span></b><b><span style="font-size:12.0pt;font-family:"Trebuchet MS",sans-serif;color:#00A19C"><o:p></o:p></span></b></p>
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<p class="MsoNormal"><b><span style="font-family:"Trebuchet MS",sans-serif;color:#6F767E">CHIEF DIAGNOSTIC MEDICAL PHYSICIST</span></b><b><span style="font-family:"Trebuchet MS",sans-serif;color:#6F767E"><o:p></o:p></span></b></p>
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<p class="MsoNormal"><span style="font-size:9.0pt;font-family:"Trebuchet MS",sans-serif;color:#DBA800">O:</span><span style="font-size:9.0pt;font-family:"Trebuchet MS",sans-serif;color:#DBA800"><o:p></o:p></span></p>
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<p class="MsoNormal"><span style="font-size:9.0pt;font-family:"Trebuchet MS",sans-serif;color:#6F767E"><a href="tel:228-865-3475" target="_blank"><span style="color:#6F767E;text-decoration:none">228-865-3475</span></a><o:p></o:p></span></p>
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<p class="MsoNormal"><b><span style="font-size:11.0pt;font-family:"Calibri",sans-serif">From:</span></b><span style="font-size:11.0pt;font-family:"Calibri",sans-serif"> Intl_dxmedphys_wd_osu_list <intl_dxmedphys_wd_osu_list-bounces@lists.osu.edu>
<b>On Behalf Of </b>Douglas Pfeiffer via Intl_dxmedphys_wd_osu_list<br>
<b>Sent:</b> Thursday, October 8, 2026 8:37 AM<br>
<b>To:</b> Ryan Fisher <rfisher1@metrohealth.org><br>
<b>Cc:</b> DxMedPhys List <intl_dxmedphys_wd_osu_list@lists.osu.edu><br>
<b>Subject:</b> Re: [Intl_DxMedPhys] Older Siemens EI question<o:p></o:p></span></p>
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<p class="MsoNormal" style="mso-line-height-alt:.75pt"><span style="font-size:1.0pt;color:white">Thanks, Ryan. Yes, it’s the physical EXI that I’m looking at. I’m fascinated by the requirement to set the cal factor to one, as that seems to defeat the purpose
of a cal factor! To Mike’s comment, I think the reason that they don’t match is<o:p></o:p></span></p>
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<p class="MsoNormal"><span style="font-size:12.0pt">Thanks, Ryan. Yes, it’s the physical EXI that I’m looking at. I’m fascinated by the requirement to set the cal factor to one, as that seems to defeat the purpose of a cal factor! To Mike’s comment, I think
the reason that they don’t match is because of the assumptions made for clinical EXI, that there’s inherently non-uniformity due to the expected anatomy. I don’t know how the calculation is done, but I think that’s where the delta comes from. This incident
is from my consulting practice. My hospital is almost all Siemens R/F, and I’ve not run into this at the hospital, which is part of why I’m so confused at this response. When the EXI is out of calibration at the hospital, Siemens fixes it with no issue. I’m
thinking that in this case is not OEM service and they just don’t understand in any detail. I have a feeling that I, too, will end up just throwing up my hands. Sigh…<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt"><o:p> </o:p></span></p>
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<p class="MsoNormal"><span style="font-size:12.0pt;color:black">Best regards,<o:p></o:p></span></p>
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<p class="MsoNormal"><span style="font-size:12.0pt;color:black">Doug<o:p></o:p></span></p>
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<p class="MsoNormal"><span style="font-size:12.0pt;color:black">Douglas Pfeiffer, MS, DABR FACR, FAAPM (he/him)<o:p></o:p></span></p>
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<p class="MsoNormal"><span style="font-size:12.0pt;color:black">Medical Physicist, Radiation Safety Officer<o:p></o:p></span></p>
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<p class="MsoNormal"><span style="font-size:12.0pt;color:black">Boulder Community Health<o:p></o:p></span></p>
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<p class="MsoNormal"><span style="font-size:12.0pt;color:black"><a href="mailto:xraydoug@me.com">xraydoug@me.com</a><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:black">303.415.7515<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:black"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:black">+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:black"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:black">The opinions expressed in this message are the product of the gray and white matter loitering in my cranium. I speak for myself and no one else, unless I say otherwise.<o:p></o:p></span></p>
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<p class="MsoNormal"><span style="font-size:12.0pt">On Oct 8, 2026, at 6:24</span><span style="font-size:12.0pt;font-family:"Arial",sans-serif"> </span><span style="font-size:12.0pt">AM, Ryan Fisher <<a href="mailto:rfisher1@metrohealth.org">rfisher1@metrohealth.org</a>>
wrote:<o:p></o:p></span></p>
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<p class="MsoNormal"><span style="font-size:11.0pt">Siemens is weird on this, which makes things messy from our side. They kinda sorta follow the IEC definition and now can report both a “physical EXI” and a “clinical EXI” on their modern systems. I believe
the older systems just report what is now the Physical EXI as “EXI”.</span><span style="font-size:12.0pt"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt"> </span><span style="font-size:12.0pt"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt">Definitions attached, but the physical EXI is the average of the central area of the detector, regardless of what’s there, and with no histogram analysis/pixel rejection. The Clinical EXI considers the pixel
values and is expecting some kind of clinical anatomy and does histogram analysis to try to determine the relevant area, and then is reporting the average of only those pixels. For IEC style verification, the physical EXI is what you want, as the clinical
one gets weird with flat fields sometimes and can pick a weird clump of pixels somewhere skewing results. Naturally there’s no indication of what pixels are going into the calculation. To make things even more fun, on the modern systems there are calibration
factors under the hood to adjust the accuracy of both, but all the Siemens PM procedures require the FSE to set the cal factor for one of them back to 1.</span><span style="font-size:12.0pt"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt"> </span><span style="font-size:12.0pt"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt">It’s been awhile since I dealt with this, but remember basically just throwing up my hands about it because even if we adjusted the cal factor, the next year you’d come back and it would be set back to 1.
Good luck.<span class="apple-converted-space"> </span></span><span style="font-size:12.0pt"><o:p></o:p></span></p>
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<p class="MsoNormal"><span style="font-size:11.0pt"> </span><span style="font-size:12.0pt"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt">Ryan<span class="apple-converted-space"> </span></span><span style="font-size:12.0pt"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt"> </span><span style="font-size:12.0pt"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt"> </span><span style="font-size:12.0pt"><o:p></o:p></span></p>
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<p class="MsoNormal"><b><span style="font-size:11.0pt;font-family:"Calibri",sans-serif">From:</span></b><span class="apple-converted-space"><span style="font-size:11.0pt;font-family:"Calibri",sans-serif"> </span></span><span style="font-size:11.0pt;font-family:"Calibri",sans-serif">Intl_dxmedphys_wd_osu_list
<<a href="mailto:intl_dxmedphys_wd_osu_list-bounces@lists.osu.edu"><span style="color:#467886">intl_dxmedphys_wd_osu_list-bounces@lists.osu.edu</span></a>><span class="apple-converted-space"> </span><b>On Behalf Of<span class="apple-converted-space"> </span></b>Douglas
Pfeiffer via Intl_dxmedphys_wd_osu_list<br>
<b>Sent:</b><span class="apple-converted-space"> </span>Wednesday, October 7, 2026 6:20 PM<br>
<b>To:</b><span class="apple-converted-space"> </span>DxMedPhys List <<a href="mailto:intl_dxmedphys_wd_osu_list@lists.osu.edu"><span style="color:#467886">intl_dxmedphys_wd_osu_list@lists.osu.edu</span></a>><br>
<b>Subject:</b><span class="apple-converted-space"> </span>[Intl_DxMedPhys] Older Siemens EI question</span><span style="font-size:12.0pt"><o:p></o:p></span></p>
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<p class="MsoNormal"><span style="font-size:12.0pt"> <o:p></o:p></span></p>
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<b><span style="font-size:22.5pt;font-family:"Arial",sans-serif;color:white">STOP!</span></b><span style="font-size:12.0pt"><o:p></o:p></span></p>
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<p class="MsoNormal"><b><span style="font-size:11.5pt;font-family:"Arial",sans-serif;color:white">THIS IS AN EXTERNAL EMAIL</span></b><b><span style="font-size:12.0pt;font-family:"Arial",sans-serif;color:white"><br>
</span></b><b><span style="font-size:8.5pt;font-family:"Arial",sans-serif;color:white">This email was originated outside of the MetroHealth System</span></b><span style="font-size:12.0pt"><o:p></o:p></span></p>
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<p class="MsoNormal" style="line-height:12.0pt"><strong><span style="font-size:7.5pt;font-family:"Arial",sans-serif;color:white">Take a 3-second pause and ask yourself the following questions:</span></strong><span style="font-size:12.0pt"><o:p></o:p></span></p>
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<p class="MsoNormal" style="margin-bottom:12.0pt;line-height:9.0pt"><b><span style="font-size:7.5pt;font-family:"Arial",sans-serif;color:white">1. Who is sending me this email? Do I know who this is?</span></b><span style="font-size:7.5pt;font-family:"Arial",sans-serif;color:white"><br>
<b>2. Am I expecting this email? Is this out of the ordinary?</b><br>
<b>3. Why is there a link in the email? Do I trust this link?</b></span><span style="font-size:12.0pt"><o:p></o:p></span></p>
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<b><span style="font-size:14.5pt;font-family:"Arial",sans-serif;color:white">THINK<br>
Before You<span class="apple-converted-space"> </span><br>
Click the Link</span></b><span style="font-size:12.0pt"><o:p></o:p></span></p>
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<p class="MsoNormal"><span style="font-size:1.0pt;color:white">Dear all, I recently tested a 2009 Siemens Axiom Luminos TF and found that the reported EI (or EXI in Siemens parlance) was about 50% of from what it should be. The service engineer replied thusly:
In Siemens we calculate the EXI as the arithmetic</span><span style="font-size:12.0pt"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt">Dear all,<span class="apple-converted-space"> </span><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt"> <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt">I recently tested a 2009 Siemens Axiom Luminos TF and found that the reported EI (or EXI in Siemens parlance) was about 50% of from what it should be. The service engineer replied thusly:<o:p></o:p></span></p>
<blockquote style="margin-left:30.0pt;margin-top:5.0pt;margin-right:0cm;margin-bottom:5.0pt">
<p class="MsoNormal"><span style="font-size:12.0pt">In Siemens we calculate the EXI as the arithmetic mean of gray value of a central area (refer to the example picture below) under consideration of the actual collimation.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt">EXI value is not calculated for dull detector image.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt"> <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt">For the Cannon detector in Luminos TF system, there is no adjustment for the EXI value. The maximum we can do is to calibrate the detector.<o:p></o:p></span></p>
</blockquote>
<p class="MsoNormal"><span style="font-size:12.0pt"> <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt">The IEC standard [62494-1 (2008)] is very specifically calibrated at RQA5 in a uniform field. Has anyone else been told anything like what this person is saying?<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt"> <o:p></o:p></span></p>
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<p class="MsoNormal"><span style="font-size:12.0pt">Best regards,<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt">Doug<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt"> <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt"> <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt"> <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt">Douglas Pfeiffer, MS, DABR FACR, FAAPM (he/him)<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt">Medical Physicist, Radiation Safety Officer<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt">Boulder Community Health<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt"><a href="mailto:xraydoug@me.com"><span style="color:#467886">xraydoug@me.com</span></a><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt">303.415.7515<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt"> <o:p></o:p></span></p>
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<p class="MsoNormal"><span style="font-size:12.0pt"> <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt">The opinions expressed in this message are the product of the gray and white matter loitering in my cranium. I speak for myself and no one else, unless I say otherwise.<o:p></o:p></span></p>
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<p class="MsoNormal"><span style="font-size:12.0pt"> <o:p></o:p></span></p>
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us</span></a></span><span style="font-size:12.0pt"><Siemens EXI Definitions.docx><o:p></o:p></span></p>
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