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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</div>
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<meta http-equiv="content-type" content="text/html; charset=utf-8"></head><body style="overflow-wrap: break-word; -webkit-nbsp-mode: space; line-break: after-white-space;">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…<div><br id="lineBreakAtBeginningOfMessage"><div>
<div dir="auto" style="caret-color: rgb(0, 0, 0); color: rgb(0, 0, 0); letter-spacing: normal; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px; -webkit-text-stroke-width: 0px; text-decoration: none; overflow-wrap: break-word; -webkit-nbsp-mode: space; line-break: after-white-space;"><div id="signature"><div style="color: rgb(0, 0, 0); letter-spacing: normal; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px; -webkit-text-stroke-width: 0px; overflow-wrap: break-word; -webkit-nbsp-mode: space; line-break: after-white-space;"><div style="color: rgb(0, 0, 0); letter-spacing: normal; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px; -webkit-text-stroke-width: 0px; overflow-wrap: break-word; -webkit-nbsp-mode: space; line-break: after-white-space;"><div><div style="orphans: 2; widows: 2;">Best regards,</div><div style="orphans: 2; widows: 2;">Doug</div><div style="orphans: 2; widows: 2;"><br></div><div style="orphans: 2; widows: 2;"><br></div><div style="orphans: 2; widows: 2;"><br></div><div style="orphans: 2; widows: 2;">Douglas Pfeiffer, MS, DABR FACR, FAAPM (he/him)</div><div style="orphans: 2; widows: 2;">Medical Physicist, Radiation Safety Officer</div><div style="orphans: 2; widows: 2;">Boulder Community Health</div><span class="Apple-style-span" style="border-collapse: separate; border-spacing: 0px;"><span class="Apple-style-span" style="border-collapse: separate; border-spacing: 0px;"><span class="Apple-style-span" style="border-collapse: separate; border-spacing: 0px;"><div style="overflow-wrap: break-word; -webkit-nbsp-mode: space; line-break: after-white-space;"><div style="overflow-wrap: break-word; -webkit-nbsp-mode: space; line-break: after-white-space;"><div>xraydoug@me.com</div><div>303.415.7515</div><div><br class="webkit-block-placeholder"></div><div>+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-</div><div><br class="webkit-block-placeholder"></div><div>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.</div></div></div></span></span></span></div></div></div></div></div>
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<div><br><blockquote type="cite"><div>On Oct 8, 2026, at 6:24 AM, Ryan Fisher <rfisher1@metrohealth.org> wrote:</div><br class="Apple-interchange-newline"><div><meta charset="UTF-8"><div class="WordSection1" style="page: WordSection1; caret-color: rgb(0, 0, 0); font-family: Helvetica; font-size: 12px; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; text-decoration-line: none; text-decoration-thickness: auto; text-decoration-style: solid;"><div style="margin: 0in; font-size: 12pt; font-family: Aptos, sans-serif;"><span style="font-size: 11pt;">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”.<o:p></o:p></span></div><div style="margin: 0in; font-size: 12pt; font-family: Aptos, sans-serif;"><span style="font-size: 11pt;"><o:p> </o:p></span></div><div style="margin: 0in; font-size: 12pt; font-family: Aptos, sans-serif;"><span style="font-size: 11pt;">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.<o:p></o:p></span></div><div style="margin: 0in; font-size: 12pt; font-family: Aptos, sans-serif;"><span style="font-size: 11pt;"><o:p> </o:p></span></div><div style="margin: 0in; font-size: 12pt; font-family: Aptos, sans-serif;"><span style="font-size: 11pt;">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><o:p></o:p></span></div><div style="margin: 0in; font-size: 12pt; font-family: Aptos, sans-serif;"><span style="font-size: 11pt;"><o:p> </o:p></span></div><div style="margin: 0in; font-size: 12pt; font-family: Aptos, sans-serif;"><span style="font-size: 11pt;"><o:p> </o:p></span></div><div style="margin: 0in; font-size: 12pt; font-family: Aptos, sans-serif;"><span style="font-size: 11pt;">Ryan<span class="Apple-converted-space"> </span><o:p></o:p></span></div><div style="margin: 0in; font-size: 12pt; font-family: Aptos, sans-serif;"><span style="font-size: 11pt;"><o:p> </o:p></span></div><div style="margin: 0in; font-size: 12pt; font-family: Aptos, sans-serif;"><span style="font-size: 11pt;"><o:p> </o:p></span></div><div><div style="border-width: 1pt medium medium; border-style: solid none none; border-color: rgb(225, 225, 225) currentcolor currentcolor; border-image: none; padding: 3pt 0in 0in;"><div style="margin: 0in; font-size: 12pt; font-family: Aptos, sans-serif;"><b><span style="font-size: 11pt; font-family: Calibri, sans-serif;">From:</span></b><span style="font-size: 11pt; font-family: Calibri, sans-serif;"><span class="Apple-converted-space"> </span>Intl_dxmedphys_wd_osu_list <<a href="mailto:intl_dxmedphys_wd_osu_list-bounces@lists.osu.edu" style="color: rgb(70, 120, 134); text-decoration: underline;">intl_dxmedphys_wd_osu_list-bounces@lists.osu.edu</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" style="color: rgb(70, 120, 134); text-decoration: underline;">intl_dxmedphys_wd_osu_list@lists.osu.edu</a>><br><b>Subject:</b><span class="Apple-converted-space"> </span>[Intl_DxMedPhys] Older Siemens EI question<o:p></o:p></span></div></div></div><div style="margin: 0in; font-size: 12pt; font-family: Aptos, sans-serif;"><o:p> </o:p></div><div align="center"><table class="MsoNormalTable" border="0" cellspacing="0" cellpadding="0" style="max-width: 6.25in; background: rgb(238, 39, 56);"><tbody><tr><td width="20%" style="width: 117px; border-width: medium 2.25pt medium medium; border-style: none solid none none; border-color: currentcolor white currentcolor currentcolor; border-image: none; padding: 7.5pt 0in 0in;"><div align="center"><table class="MsoNormalTable" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td style="padding: 0in;"><div style="margin: 0in; font-size: 12pt; font-family: Aptos, sans-serif; text-align: center; line-height: 23.25pt;"><b><span style="font-size: 22.5pt; font-family: Arial, sans-serif; color: white;">STOP!<o:p></o:p></span></b></div></td></tr></tbody></table></div></td><td width="60%" valign="top" style="width: 360px; padding: 7.5pt 0in 0in;"><table class="MsoNormalTable" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td valign="top" style="padding: 0in;"><table class="MsoNormalTable" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td style="padding: 0in 0in 0in 11.25pt;"><div style="margin: 0in; font-size: 12pt; font-family: Aptos, sans-serif;"><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-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><b><span style="font-family: Arial, sans-serif; color: white;"><o:p></o:p></span></b></div></td></tr></tbody></table></td></tr><tr><td valign="top" style="padding: 0in 0in 0in 11.25pt;"><div style="margin: 0in; font-size: 12pt; font-family: Aptos, sans-serif; line-height: 12pt;"><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: 7.5pt; font-family: Arial, sans-serif; color: white;"><o:p></o:p></span></div></td></tr><tr><td valign="top" style="padding: 0in 0in 0in 11.25pt;"><p class="MsoNormal" style="margin: 0in 0in 12pt; font-size: 12pt; font-family: Aptos, sans-serif; line-height: 9pt;"><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><o:p></o:p></span></p></td></tr></tbody></table></td><td width="20%" style="width: 117px; border-width: medium medium medium 2.25pt; border-style: none none none solid; border-color: currentcolor currentcolor currentcolor white; border-image: none; padding: 7.5pt 0in 0in;"><div align="center"><table class="MsoNormalTable" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td style="padding: 0in;"><div style="margin: 0in; font-size: 12pt; font-family: Aptos, sans-serif; text-align: center; line-height: 15pt;"><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<o:p></o:p></span></b></div></td></tr></tbody></table></div></td></tr></tbody></table></div><div><div style="margin: 0in; font-size: 12pt; font-family: Aptos, sans-serif;"><span style="font-size: 1pt; 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<o:p></o:p></span></div></div><div style="margin: 0in; font-size: 12pt; font-family: Aptos, sans-serif;">Dear all,<span class="Apple-converted-space"> </span><o:p></o:p></div><div style="margin: 0in; font-size: 12pt; font-family: Aptos, sans-serif;"><o:p> </o:p></div><div style="margin: 0in; font-size: 12pt; font-family: Aptos, sans-serif;">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></div><blockquote style="margin-left: 30pt; margin-right: 0in;"><div style="margin: 0in; font-size: 12pt; font-family: Aptos, sans-serif;">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></div><div style="margin: 0in; font-size: 12pt; font-family: Aptos, sans-serif;">EXI value is not calculated for dull detector image.<o:p></o:p></div><div style="margin: 0in; font-size: 12pt; font-family: Aptos, sans-serif;"> <o:p></o:p></div><div style="margin: 0in; font-size: 12pt; font-family: Aptos, sans-serif;">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></div></blockquote><div style="margin: 0in; font-size: 12pt; font-family: Aptos, sans-serif;"><o:p> </o:p></div><div style="margin: 0in; font-size: 12pt; font-family: Aptos, sans-serif;">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></div><div style="margin: 0in; font-size: 12pt; font-family: Aptos, sans-serif;"><o:p> </o:p></div><div><div id="signature"><div><div><div><div style="margin: 0in; font-size: 12pt; font-family: Aptos, sans-serif;"><span style="">Best regards,<o:p></o:p></span></div></div><div><div style="margin: 0in; font-size: 12pt; font-family: Aptos, sans-serif;"><span style="">Doug<o:p></o:p></span></div></div><div><div style="margin: 0in; font-size: 12pt; font-family: Aptos, sans-serif;"><span style=""><o:p> </o:p></span></div></div><div><div style="margin: 0in; font-size: 12pt; font-family: Aptos, sans-serif;"><span style=""><o:p> </o:p></span></div></div><div><div style="margin: 0in; font-size: 12pt; font-family: Aptos, sans-serif;"><span style=""><o:p> </o:p></span></div></div><div><div style="margin: 0in; font-size: 12pt; font-family: Aptos, sans-serif;"><span style="">Douglas Pfeiffer, MS, DABR FACR, FAAPM (he/him)<o:p></o:p></span></div></div><div><div style="margin: 0in; font-size: 12pt; font-family: Aptos, sans-serif;"><span style="">Medical Physicist, Radiation Safety Officer<o:p></o:p></span></div></div><div><div style="margin: 0in; font-size: 12pt; font-family: Aptos, sans-serif;"><span style="">Boulder Community Health<o:p></o:p></span></div></div><div><div><div style="margin: 0in; font-size: 12pt; font-family: Aptos, sans-serif;"><span style=""><a href="mailto:xraydoug@me.com" style="color: rgb(70, 120, 134); text-decoration: underline;">xraydoug@me.com</a><o:p></o:p></span></div><div style="margin: 0in; font-size: 12pt; font-family: Aptos, sans-serif;"><span style="">303.415.7515<o:p></o:p></span></div><div style="margin: 0in; font-size: 12pt; font-family: Aptos, sans-serif;"><span style=""><o:p> </o:p></span></div><div style="margin: 0in; font-size: 12pt; font-family: Aptos, sans-serif;"><span style="">+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-<o:p></o:p></span></div><div style="margin: 0in; font-size: 12pt; font-family: Aptos, sans-serif;"><span style=""><o:p> </o:p></span></div><div style="margin: 0in; font-size: 12pt; font-family: Aptos, sans-serif;"><span style="">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></div></div></div></div></div></div></div><div style="margin: 0in; font-size: 12pt; font-family: Aptos, sans-serif;"><o:p> </o:p></div></div><br style="caret-color: rgb(0, 0, 0); font-family: Helvetica; font-size: 12px; font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; text-decoration-line: none; text-decoration-thickness: auto; text-decoration-style: solid;"><font size="2" face="Tahoma" color="#0069aa" style="font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; text-decoration-line: none; text-decoration-thickness: auto; text-decoration-style: solid;"><b>MetroHealth’s Mission: Leading the way to a healthier you and a healthier community through service, teaching, discovery, and teamwork.</b></font><font face="Tahoma" size="2" style="caret-color: rgb(0, 0, 0); font-style: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; text-decoration-line: none; text-decoration-thickness: auto; text-decoration-style: solid;"><span class="Apple-converted-space"> </span>This email and all attachments that may have been included are intended only for the use of the party to whom/which the email is addressed and may contain information that is privileged, confidential, or exempt from disclosure under applicable law. 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