MR Applications Fundamentals Part 2 - STEP Workbook

MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Welcome A Message from Nanci Wozniak Welcome to your training experience with Education & Workforce Solutions. I want to personally thank you for choosing Siemens Healthineers. We are honored to have you as our partner and hope you will enjoy this course. Our teams strive to ensure your priorities and needs are met. We sincerely appreciate your hard work around what really matters - the human side of health care. You are our heroes. Thank you for being part of the Siemens Healthineers family and we look forward to our partnership with you. Nanci Wozniak Vice President, Education & Workforce Solutions CX SV USA – Customer Service Organization Siemens Healthineers Clinical Training and Continuing Education Contact Information Customer Care Center - Clinical Application Support: Call 1-800-888-7436 PEPconnect https://pep.siemens-info.com/en-us 2MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Save Workbook with Notes In order to save this document with your digital notes included, you must use the print to pdf functionality. Clicking the button below will initiate that function. 3MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Contents Welcome........................................................................................................................................................................2 Save Workbook with Notes.......................................................................................................................................3 Contents.........................................................................................................................................................................4 Course Description..................................................................................................................................................... 6 Contrast - Enhanced MRA........................................................................................................................................7 Introduction.........................................................................................................................................................11 Contrast - Enhanced MRA Techniques..........................................................................................................21 Motion Management............................................................................................................................................... 45 Breath-hold Measurements............................................................................................................................ 48 Free-breathing Measurements....................................................................................................................... 53 BLADE....................................................................................................................................................................71 StarVIBE................................................................................................................................................................78 Body Diffusion...........................................................................................................................................................90 Protocols in Different Body Regions............................................................................................................. 93 Diffusion Parameter Card Setup................................................................................................................... 98 Clinical Image Examples................................................................................................................................112 Special Considerations...................................................................................................................................115 Body Imaging........................................................................................................................................................... 128 Thorax..................................................................................................................................................................131 Liver Imaging.................................................................................................................................................... 142 Liver Mapping....................................................................................................................................................181 MRCP.................................................................................................................................................................. 189 Whole-Body MRI.............................................................................................................................................. 201 Set-n-GO............................................................................................................................................................209 FastView Localizer........................................................................................................................................... 214 Compressed Sensing (CS) GRASP-VIBE............................................................................................................222 Review of Golden Rules for Compressed Sensing (CS)..........................................................................226 Challenges with Conventional Liver Imaging..........................................................................................229 Review of GRASP-VIBE Principles...............................................................................................................234 GRASP-VIBE Liver............................................................................................................................................238 Parameter Card................................................................................................................................................246 Hints & Tips....................................................................................................................................................... 257 Pelvic Imaging......................................................................................................................................................... 265 Prostate Imaging..............................................................................................................................................269 Cervix Imaging..................................................................................................................................................289 4MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Bowel Imaging..................................................................................................................................................298 Kidney Imaging................................................................................................................................................. 312 MR Breast Imaging................................................................................................................................................326 Breast Cancer...................................................................................................................................................330 Breast Imaging.................................................................................................................................................339 Coils and Planning..........................................................................................................................................346 Morphology....................................................................................................................................................... 355 Dynamic Imaging.............................................................................................................................................362 Diffusion.............................................................................................................................................................380 Breast Silicone Implant Imaging................................................................................................................. 385 Special Considerations..................................................................................................................................392 MR Protocols Module...........................................................................................................................................402 Fleet....................................................................................................................................................................405 Publish & Update............................................................................................................................................ 414 System Types & Groups in Fleet................................................................................................................... 421 Fleet Tree Structure......................................................................................................................................... 427 Fleet Management..........................................................................................................................................434 Adding New Systems to an Existing Fleet.................................................................................................439 FAQs & General Recommendations...........................................................................................................444 Concurrent Work & Conflicts.......................................................................................................................452 Metal Artifact Reduction.....................................................................................................................................456 Introduction......................................................................................................................................................460 WARP..................................................................................................................................................................465 WARP: View Angle Tilting (VAT)................................................................................................................... 475 Advanced WARP - SEMAC............................................................................................................................. 487 Compressed Sensing SEMAC........................................................................................................................498 Physiological Measurement Unit....................................................................................................................... 507 Physiological Measurement Unit (PMU) Overview................................................................................. 510 Hardware........................................................................................................................................................... 513 Software............................................................................................................................................................. 525 Application........................................................................................................................................................ 532 Limits of ECG Triggering................................................................................................................................. 537 MR Cardiac Imaging..............................................................................................................................................546 Introduction......................................................................................................................................................549 Planning............................................................................................................................................................. 557 5MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Morphology....................................................................................................................................................... 572 Function............................................................................................................................................................. 581 Flow..................................................................................................................................................................... 598 Coronary Arteries............................................................................................................................................603 Patient’s Physiology........................................................................................................................................607 Additional Techniques.................................................................................................................................... 612 ZOOMit......................................................................................................................................................................624 Introduction...................................................................................................................................................... 627 Inner Volume Imaging....................................................................................................................................632 2D RF Pulses.....................................................................................................................................................638 ZOOMitPRO..........................................................................................................................................................................................................................................................................................647 6MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Course Description Course Overview: The MR Applications Fundamentals Part 2 is a four and one-half day course that will focus on contrast MR Angiography, MR Oncology, and MR Cardiology. This course will have lecture and hands-on training. Upon completion of this course, you will be able to: • Identify CE MRA Protocols • Explain Test Bolus & Care Bolus Technique • Understand the causes of magnetic susceptibility artifacts in the presence of metal • Define WARP & View Angle Tilting (VAT) • Explain the sequences to be used for bowel imaging • Identify protocols to be used for kidney imaging • Explain Planning for Cardiac Imaging • Identify Morphology sequences • Describe Cine Function sequences • Identify protocols for body imaging • Explain the benefits of whole-body imaging 7MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. • Y:\MR\ILT\STEP\MR Applications Fundamentals Part 2 - DEV\PPT MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Contrast - Enhanced MRA Contrast‐ enhanced MRA MR Applications Fundamentals – Part Two Presenter, Calibri 16 pt English, Month 2019 Unrestricted © Siemens Healthineers, 2020 Unrestricted Notes 8MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Agenda • Introduction • Contrast Enhanced MRA Techniques • Care Bolus • Test Bolus • TWIST 2 Unrestricted © Siemens Healthineers, 2020 Notes 9MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Objectives • Identify CE MRA Protocols • Explain Test Bolus Technique • Describe workflow of Care Bolus Technique • Identify TWIST Protocol 3 Unrestricted © Siemens Healthineers, 2020 Notes 10MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Contrast Disclaimer Contrast Disclaimer –A licensed physician may choose to use FDA‐approved contrast agents  in conjunction with an MRI exam, based on his/her medical opinion and discretion and in  accordance with the instructions for use and indications for use supplied by the  pharmaceutical manufacturer for the contrast agents 4 Unrestricted © Siemens Healthineers, 2020 Notes 11MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Introduction Introduction 5 Unrestricted © Siemens Healthineers, 2020 Notes 12MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Introduction MR contrast agent To shorten the T1 or T2 relaxation time of the tissue  and improve the visibility of internal body structures  It could help to differentiate between: • benign and malignant lesions • different malignant lesions • malignity of lesions In order to change the relaxation time of the tissue,  contrast agents usually consist of paramagnetic  materials  Without contrast agent With contrast agent 6 Unrestricted © Siemens Healthineers, 2020 Notes 13MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Introduction Classification of the MR contrast agents They could be classified in several different ways, e.g. magnetic properties, chemical composition,  biodistribution, and so on Elements used for MR contrast agents • Gadolinium (Gd): the most popular one • Iron • Manganese  O O O O O O O O O N N O N 3+ N N Gd 3+ O O N N O Gd O O O O O Magnevist Dotarem 7 Unrestricted © Siemens Healthineers, 2020 Notes 14MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Introduction Contrast‐enhanced MRA Usually we could take extracellular fluid agents for CE‐MRA scans  After the intravenous injection, contrast agent runs through the whole body via the circulation system • T1 relaxation time of blood is changed  • Acquiring pre‐ and post‐contrast images, calculating the subtraction results, and displaying the information  from vessels  Timing of acquiring post‐contrast image is very important 8 Unrestricted © Siemens Healthineers, 2020 Notes 15MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Introduction CE‐MRA: first‐pass CE‐MRA: steady‐state Courtesy: Dr. med. A. Halbsguth, Gem.Prax. Radiologie, Frankfurt Unrestricted Siemens Healthineers, 2020 Notes 16MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Introduction  Spatial resolution • Higher spatial resolution could help reduce the  partial volume effects   Unrestricted Siemens Healthineers, 2020 Notes 17MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Introduction K‐space, image contrast and resolution  Full k‐space reconstruction  Reconstruction without central k‐space Unrestricted Siemens Healthineers, 2020 Notes 18MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Introduction Bolus timing • Arterial peak should match the central k‐space ~6-10 s acquisition +2 s • Estimation of the timing is very important • Different techniques:  Care Bolus, Test Bolus Acquisition time +2-3 s +4 s Venous 0 s Time to center enhancement Contrast injection Arterial +2-3 s enhancement +2-3 s +3-4 s Time (sec) Scan delay +3-4 s 12 Unrestricted © Siemens Healthineers, 2020 Notes 19MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Introduction Bolus timing: not optimal results pathology No enhancement „Maki“-artefact Venous overlap inhomogen Much too early Too early Too late Unrestricted Siemens Healthineers, 2020 Notes 20MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP CE‐MRA Examples Carotis occlusion High resolution High resolution arterial phase VRT @3T venous phase VRT GRAPPA=4 GRAPPA=6 (3x2) 0.8 x 0.7 x 0.8 mm3 no add. contrast TA=22 sec, MIP 1.0 x 1.0 x 1.0 mm3 TA=28 sec Courtesy of Dr. Paul Finn, UCLA Unrestricted Siemens Healthineers, 2020 Notes 21MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Contrast - Enhanced MRA Techniques Contrast‐Enhanced  MRA techniques 15 Unrestricted © Siemens Healthineers, 2020 Notes 22MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Protocols CE‐MRA protocols are available in different body  regions Different techniques are configured  • Care Bolus • Test Bolus  • TWIST  Vessel Scout is used for planning  For Care Bolus and Test Bolus, we acquire pre‐ and  post‐contrast images (in separate protocols) and  generate inline subtraction results  16 Unrestricted © Siemens Healthineers, 2020 Notes 23MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Protocols Post‐contrast Pre‐contrast Subtraction 17 UnrestrictedUnrestricted © Siemens Healthineers, 2020 Notes 24MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Vessel Scouts  Single step Multi‐steps • Sequence: pc • Sequence: fl_rd (rephased‐dephased) • Image results: magnitude sum and MIP  • Set‐n‐go, inline composing and MIP • Use MIP images for planning • Guidance images are available • Use MIP images for planning 18 Unrestricted © Siemens Healthineers, 2020 Notes 25MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Vessel Scouts  Vessel Scouts based on BEAT_FQ (from XA20) Vessel Scout fl_pc Vessel Scout BEAT_FQ Unrestricted Siemens Healthineers, 2020 Notes 26MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Care Bolus Use Care Bolus measurement to know when the  contrast arrives  • Start the Care Bolus measurement and then inject  Acquisition time the contrast agent  • Observe the inline images Venous Time to center enhancement • When signal enhanced, stop the care bolus  Contrast masurement. The post contrast scan should start  injection Arterial enhancement immediately Time (sec) 20 Unrestricted © Siemens Healthineers, 2020 Notes 27MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Care Bolus Planning the care bolus measurement • The orientation of this single‐slice protocol  should be easy to observe the signal  enhancement from the vessels  • It might be a sagittal or coronal view planning  • Copy reference: table position • Execution> Wait for user to start  Unrestricted Siemens Healthineers, 2020 Notes 28MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Care Bolus Care Bolus measurement • The post‐contrast scan should start immediately To catch the bolus, use a shorter TTC  when the contrast arrives Note: shortest TTC= 1 sec Unrestricted Siemens Healthineers, 2020 Notes 29MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Care Bolus Pre‐ and post‐contrast measurement • Copy reference: everything • Enable inline subtraction and motion correction  Unrestricted Siemens Healthineers, 2020 Notes 30MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Care Bolus Peripheral angiography: possible to use care bolus  with BH in the pelvic region (first station) • Note the timing!!  Unrestricted Siemens Healthineers, 2020 Notes 31MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Test Bolus  Use small amount injection to estimate the contrast arrival time  • The measured test bolus dataset loaded to  Acquisition time TimeCurve Time to center Arterial • Draw the ROI on arteries and veins  enhancement from • Use the curve to calculate the scan delay Contrast full injection Arterial Injection enhancement from Venous enhancement Test Bolus (1-2ml) from TB Transit time Time (sec) Scan delay Expected offset Scan delay = Transit Time + expected offset - TTC 25 Unrestricted © Siemens Healthineers, 2020 Notes 32MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Test Bolus  • Don´t check the contrast agent in Test Bolus step • Start the contrast injection and scan  simultaneously  • After the test bolus scan, use TimeCurve to  calculate the scan delay  Unrestricted Siemens Healthineers, 2020 Notes 33MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Test Bolus  Transit time=19.85s Use the dynamic information to know the location of arteries and veins ROI from artery ROI from vein Unrestricted Siemens Healthineers, 2020 Notes 34MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Test Bolus  Under „prepare injector“ step, the contrast information should be checked Unrestricted Siemens Healthineers, 2020 Notes 35MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Test Bolus  Input the Countdown time in post‐contrast scan Scan Delay = Transit Time + Offset – TTC • Transit time = 20sec (the previous example) • Expected offset = 3sec(assumed value) • TTC = 8sec (protocol settings) →  Scan delay = 20 + 3 –8 = 15 sec Enable “Auto Continue” and Start Countdown • Voice command duration would be considered  Unrestricted Siemens Healthineers, 2020 Notes 36MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP TWIST Time‐resolved angiography WIth Stochastic  Trajectories  • Try to find a balance between temporal  Full k‐space resolution (dynamic contrast) and spatial  resolution (details) • Contrast: defined in central k‐space  • Details: defined in peripheral k‐space • The full k‐space is divided into two regions • Central region • Peripheral region • Scan central region more frequently than  Central region Peripheral region peripheral region to get a higher temporal  resolution series  30 Unrestricted © Siemens Healthineers, 2020 Notes 37MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP TWIST Definition of A and B • Central region A: fraction of full k‐space points • Available values from 4% to 100%  • 100% = no peripheral region 4% 50% 100% • Sampling density B: dividing peripheral k‐space regions into several subsets • Available values from 0% to 50% • 0% = Keyhole technique B=50% →                    + peripheral B1 B2 k-space 31 Unrestricted © Siemens Healthineers, 2020 Notes 38MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP TWIST During data acquisition, central A is updated more  frequently for higher temporal resolution Example: A=20%, B=50% (i.e. peripheral k=B1+B2) • A‐B1‐A‐B2‐A‐B1‐A‐B2‐… • Full k‐space would be acquired in the beginning or  the end of the dynamic depending on different  reconstruction schemes  Central k- space Full k-space A B1 A B2 … Time (sec) Temporal resolution TWIST with sampling density B=50% 32 Unrestricted © Siemens Healthineers, 2020 Notes 39MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP TWIST Data reconstruction takes the concept of „view‐ sharing“  Forward share • Full k‐space is needed • 3 schemes to obtain the full k B1 B2 B3A B4 A B1 A B2 A B3 A B4 A Time Backward share B1 A B2 A B3 A B4 A A B2 A B3 A B1 Time Symmetric share B1 B2 B3A B4 A B1 A B2 A B3 A B4 A Time 33 Unrestricted © Siemens Healthineers, 2020 Notes 40MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP TWIST Temporal resolution could be manipulated by  changing A and B • Temporal resolution: the interval of acquiring two  neighboring central k‐spaces (A) A=15%, B=20% • A‐B1‐A‐B2‐A‐B3‐A‐B4‐A‐B5‐A‐B1‐A‐B2‐… A=15%, B=50% • A‐ B1 ‐A‐ B2 ‐A‐ B1 ‐A‐ B2 ‐…  A=50%, B=20% • A ‐B1‐ A ‐B2‐ A ‐B3‐ A ‐B4‐ A ‐B5‐ A ‐B1‐… 34 Unrestricted © Siemens Healthineers, 2020 Notes 41MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP TWIST Time to Center  Available protocols • Preparation time is included • For CE‐MRA or some dynamic studies (e.g.  breast) Burn Time to Center • Coded the Time to Center value to DICOM  images Unrestricted Siemens Healthineers, 2020 Notes 42MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP TWIST iPAT vs. ePAT Unrestricted Siemens Healthineers, 2020 Notes 43MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP TWIST: Image Examples Carotids stenosis TWIST High resolution GRAPPA=3, 4 ml of contrast GRAPPA=4 + 20 ml of contrast (same session) 50 cm FoV 50 cm FoV 1.2 x 1.0 x 3.0 mm3 0.8 x 0.7 x 0.8 mm3 1.8 sec / frame TA=22 sec Courtesy of Dr. Paul Finn, UCLA;  Unrestricted Siemens Healthineers, 2020 MAGNETOM Trio Tim Notes 44MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Knowledge Check 1. __________is a time resolved MRA  2.  After the ___________scan, use  technique that increases the temporal  TimeCurve to calculate the scan delay . resolution by repeated measurements  a. Care Bolus of the central k‐space region. b. Test Bolus a. Care Bolus c. Mean Curve b. Test Bolus d. PC Scout c. TWIST d. PC Scout Author | Department 38 Unrestricted © Siemens Healthineers, 2020 Notes 45MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Motion Management Motion  Management MR Applications Fundamentals‐ Part Two Presenter, Calibri 16 pt English, Month 2019 Unrestricted © Siemens Healthineers, 2020 Unrestricted Notes 46MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Agenda • Breath‐hold Measurements • Free breathing Measurements • BLADE • StarVIBE 2 Unrestricted © Siemens Healthineers, 2020 Notes 47MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Objectives • Identify different sequences that may  decrease patient motion • Explain different type of breathing  measurements to decrease patient motion • Utilize StarVIBE and BLADE sequences in  their protocols 3 Unrestricted © Siemens Healthineers, 2020 Notes 48MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Breath-hold Measurements Breath‐hold Measurements 4 Unrestricted © Siemens Healthineers, 2020 Notes 49MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Breath‐hold Measurements Single breath‐hold • First choice of the measurement, fast and easy • Protocol names with “…._bh” Multiple breath‐hold  • If the required slice number is not possible in one  breath‐hold • Protocol names with “…._mbh” Available sequences in gre, tse, haste, trufi… • Parameter setup: Physio> PACE> Breath‐hold • Multiple breath‐hold defines in Concatenations • Check breath‐hold duration via Scan Time  tooltip 5 Unrestricted © Siemens Healthineers, 2020 Notes 50MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Breath‐hold Measurements Voice command configuration  • RMB> Edit Properties> Voice Commands • Use local settings: only apply to the current  protocol • Use Dot settings: take the voice command  setup in the current Dot engine (if any) • In multi breath‐hold scans, pause would be  configured for patient comfort   6 Unrestricted © Siemens Healthineers, 2020 Notes 51MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Breath‐hold Measurements Localizer in Inspiration vs. Expiration • The locations of diaphragm and liver have some  shifts in two different states • Use the same voice command for the whole  program • Apply more slices on free‐breathing without‐ trigger (e.g. diffusion imaging) scans  BH in expiration BH in inspiration 7 Unrestricted © Siemens Healthineers, 2020 Notes 52MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Breath‐hold Measurements For MBH protocols Geometry> Common> Series= Interl. In B.h.  Conc.=2 1st BH Interleaved 2nd BH Conc.=2 1st BH Interl. in BH  2nd BH 8 Unrestricted © Siemens Healthineers, 2020 Notes 53MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Free-breathing Measurements Free breathing Measurements 9 Unrestricted © Siemens Healthineers, 2020 Notes 54MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Free Breathing Measurements • Respiratory motion is a problem when scanning the heart and abdomen regions • If the breath‐hold measurement is not  applicable, triggered strategies should be  considered  • Respiratory trigger  • Use respiratory cushion  • Use respiratory sensor (BioMatrix system  only) • PACE (Prospective Acquisition CorrEction)  trigger • 1D PACE: usually for cardiac exams • 2D PACE: usually for abdomen exams  10 Unrestricted © Siemens Healthineers, 2020 Notes 55MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Free Breathing Measurements Respiratory trigger  • Use respiratory cushion • The cushion plugs into PERU • Use respiratory belt to hold the cushion  Plug for cushion • Using respiratory sensor  • Available in BioMatrix systems  • The sensor embedded in BM Spine coil  Resp. cushion Resp. belt (Vida/Sola) or BM Body13 coil (Amira) PERU Cushion support with labels for  the respiratory sensors 11 Unrestricted © Siemens Healthineers, 2020 Notes 56MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Free Breathing Measurements Respiratory trigger  • Respiratory sensor in BM Spine coil • Two sensors for head first and feet first position • A magnetic loop antenna is located beneath  patient‘s torso  • Reflected energy Pr is observed while breathing • Respiratory sensor in BM Body13 coil • A Tx element embedded in the coil  • Continuously transmits low energy RF pulses  with a slightly shifted resonance frequency • Signal is received by all receive coil elements  and separated from imaging signals  Resp. sensor in BM  Body13 coil 12 Unrestricted © Siemens Healthineers, 2020 Notes 57MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Resp. Sensors Application Hints In BM Spine Coils • Only use spine cushion support on the back • Feet‐first position for patient height < 160cm • Before registration, combined signal from both  sensors are displayed. Patient registration (HF or  FF) defines which sensor is used.  • Instruct patients to lie calm and avoid leg motion  to avoid glitches in respiratory signal • Use/Judge the respiratory signal when table is not  moving, because table movement induces signal  drift.  • If the respiratory cushion is plugged, the cushion  signal is displayed in any case (can be used as  fallback) 13 Unrestricted © Siemens Healthineers, 2020 Notes 58MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Resp. Sensors Application Hints In BM Body13 Coil • The respiratory curve is displayed as a straight  • Patient should keep still and breathe regularly  line in the Physio Display during the following  during the learning phase cases • After the BM Body Array coil is plugged (7s) • A distorted respiratory curve is observed →  • After the patient table stops at the ISO center  restart the measurement to initiate a new  position (7s) learning phase • During the Adjustment phase of a  measurement Learning phase:  • After the Adjustment phase ends (12s) • The first 12s of the measurement after the  • After a measurement ends (11s) adjustment phase of a triggered scan • If no trigger is observed within 30s, the system  • BM Body Array coil elements should be selected  will initiate a new learning phase. (no trigger  in order to see the resp. signal during the scan ~60s, the measurement will be aborted) 14 Unrestricted © Siemens Healthineers, 2020 Notes 59MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Free Breathing Measurements Respiratory trigger  It is enabled under Physio>Signal>1st Signal/Mode 100% Acquisition window In order to avoid/suppress motion artifacts Threshold • Acquisition window ~30% resp. cycle 0% • Resp. phase = Expiration Data window • Set a reasonable threshold value to acquire the  time data in the expiration 100% Acquisition window Threshold 0% Data window time Note: too high threshold would lead to the data acquisition in the inspiration period 15 Unrestricted © Siemens Healthineers, 2020 Notes 60MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Free Breathing Measurements Respiratory trigger Supported sequences • TSE/BLADE • HASTE • TFL • ep2d_diff  • SPACE Hint: depending on the MR system, configuration  and SW version supported protocols may vary 16 Unrestricted © Siemens Healthineers, 2020 Notes 61MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Free Breathing Measurements 1D PACE*  • Available for GRE or TrueFISP sequence (CV_nav),  to acquire free‐breathing images  • Procedures • Select Resp. Control=Gate (or Gate&Follow)  • Enable Scout Mode to detect the search and  accept position  • Uncheck Scout Mode and start the scan • More applications on cardiac imaging * More details would be discussed in  17 Unrestricted © Siemens Healthineers, 2020 Native TrueFISP technique Notes 62MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Free Breathing Measurements 2D PACE allows for all relevant scanning techniques  Liver Dome Scout to acquire free breathing images  • 2D image based prospective gating  • Body and (some) cardiac applications  • Avoiding the additional planning of the  respiratory cushion  Two types of 2D PACE • Liver Dome Scout • Manually planning the navigator Phase Scout • Phase Scout  • Manual or automatic  18 Unrestricted © Siemens Healthineers, 2020 Notes 63MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Free Breathing Measurements 2D PACE Learning phase happens before the imaging  acquisition, it takes 4 to 5 respiratory cycles • Learning phase: only providing navigator pulses to  define the accept position  • Acquisition phase: when signal from navigators  within the accept window, the data acquisition  starts  Accept window • Accept window could be defined in mm (liver  Accept position dome scout) or % (phase scout) time Imaging scan (acquisition duration) Learning phase navigator Scout TR 19 Unrestricted © Siemens Healthineers, 2020 Notes 64MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Free Breathing Measurements 2D PACE Acquisition window should not be too long because  it might introduce motion artifacts  • Acquisition window ~30% of resp. cycle • Acquisition window > acquisition duration Select Acquisition Window: Automatic  • Available for TSE, BLADE sequences  • Automatically adjust the concats number  according to the resp. cycle and the acquisition  window Respiratory Cycles: 5 + X • 5: learning phase • X: acquisition phase  20 Unrestricted © Siemens Healthineers, 2020 Notes 65MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Free Breathing Measurements 2D PACE: Liver Dome Scout  Position the navigator on diaphragm (or liver dome)  to detect the respiratory motion  • The blue curve follows diaphragm movement Learning phase navigator Signal from lung Signal from liver Unrestricted Siemens Healthineers,2020,  Notes 66MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Free Breathing Measurements 2D PACE: Phase Scout Position the navigator within the liver • Automatic: navigator box is not displayed  • Manual: navigator box is displayed in the default  position. Adjustment might be needed.  Position Navigator: Manual Position Navigator: Automatic Unrestricted Siemens Healthineers,2020,  Notes 67MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Free Breathing Measurements 2D PACE: Phase Scout The gray scale plot shows the phase information  along left‐right direction  • The blue curve displays the accumulated phase  information to detect the respiratory motion  navigator Learning phase Unrestricted Siemens Healthineers,2020,  Notes 68MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Free Breathing Measurements 2D PACE: Please check the accept window locating  in a reasonable region  Unrestricted Siemens Healthineers,2020,  Notes 69MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Free Breathing Measurements Protocols with 2D PACE  Available for different sequences • tfl, tse, haste, blade, ep2d_diff and space • Protocol names showing with “trig” • Liver Dome scout ↔ Phase scout 25 Unrestricted © Siemens Healthineers, 2020 Notes 70MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Free Breathing Measurements T1 protocols with 2D PACE • Conventional T1 contrast is created by short TR  and short TE • Since TR is limited by the trigger, the T1 contrast should be controlled by the TI  26 Unrestricted © Siemens Healthineers, 2020 Notes 71MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP BLADE BLADE 27 Unrestricted © Siemens Healthineers, 2020 Notes 72MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP BLADE  • BLADE continuously acquires low resolution  images during motion • Retrospectively registers patient motion in the  image plane during the exam, and corrects for  this motion during the reconstruction process • In abdomen imaging, the motion artifacts could  be even reduced with the combination of trigger  and BLADE 28 Unrestricted © Siemens Healthineers, 2020 Notes 73MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP BLADE  Liver imaging in free breathing  Standard TSE with PACE (GRAPPA=2) BLADE with PACE (GRAPPA=2, w/o MoCo) Unrestricted Siemens Healthineers, 2020 Notes 74MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP BLADE  The true FOV of BLADE is a circular shape • Use the FOV (yellow box) for the scan • Blue circle is the true FOV • Aliasing artifacts might occur • Add phase oversampling (dashed yellow box) • Green circle is the true FOV • Aliasing artifacts could be reduced/removed Unrestricted Siemens Healthineers, 2020 Notes 75MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP BLADE  Fast BLADE (from VE11C) Advantages  Drawbacks of fast BLADE • fast_tse allows higher turbo factors (with same TE  • Higher SAR compared to conventional TSE � not  as conv. TSE): applicable to all patients • Blades get broader and cover larger regions of k‐ • Different slice profile, so it should not be used for  space “narrow slice” imaging (Neuro, MSK, …) • T2 decay is reduced for neighboring lines • Reduced artifacts in final images • Shorter acquisition time in most cases, since less  blades are needed 31 Unrestricted © Siemens Healthineers, 2020 Notes 76MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP BLADE  Conventional BLADE Fast BLADE Unrestricted Siemens Healthineers, 2020 Notes 77MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP BLADE  Conventional BLADE Fast BLADE Unrestricted Siemens Healthineers, 2020 Notes 78MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP StarVIBE StarVIBE 34 Unrestricted © Siemens Healthineers, 2020 Notes 79MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP StarVIBE Sequence features • A 3D‐spoiled GRE sequence available with various  fat saturation techniques  • Stack of stars trajectory (radial scan) • Regridding reconstruction  kz kz= 3 kz= 2 kz= 1 kz= 0 ky kz=-1 kz=-2 kz=-3 kx 35 Unrestricted © Siemens Healthineers, 2020 Notes 80MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP StarVIBE Advantages More robust to motion, which would support free  breathing measurements  • Oversampling of k‐space center → averaging  effect • Varying readout direction → no vulnerable phase‐ encoding axis Cartesian Radial Note: iPAT not available Unrestricted Siemens Healthineers,2020,  Notes 81MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP StarVIBE Radial views The radial view should be at least 2 times of the  base resolution • In cartesian sampling, 2 times oversampling  applied to readout direction by default  • In radial sampling, 2 times oversampling still  exists, but readout direction rotates  • The peripheral k‐space might be under‐sampled,  lost information for regridding 760 radial views 360 radial views Unrestricted Siemens Healthineers,2020,  Notes 82MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP StarVIBE Conventional cartesian sampling StarVIBE 2x oversampling in  2x oversampling in RO direction rotating RO direction • Infomation lost  for regridding 2x FOV in RO  Radial view =  direction 2x base resolution  38 Unrestricted © Siemens Healthineers, 2020 Notes 83MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP StarVIBE: Image Examples Pediatric applications 2yr‐old patient with hepatoblastoma 9yr‐old patient Cartesian Radial Cartesian Radial 10yr‐old patient with enhancing spinal mass 14yr‐old patient with tuberous sclerosis Cartesian Radial Cartesian Radial 8th MAGNETOM World Summit, Paris  Unrestricted Siemens Healthineers, 2020 France Notes 84MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP StarVIBE: Image Examples Pelvic applications: Case of rectal cancer staging Infiltration of rectum wall? ? T2 pre contrast  Coronal oblique StarVIBE confirms invasion Image courtesy M. Bridges MD, Mayo  Unrestricted Siemens Healthineers, 2020 Clinic Notes 85MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP StarVIBE 4D MRI: Respiratory self‐gating for RT image suite Purpose • Using MR instead of CT to derive information  about moving lesions for RT planning Clinical use • Free‐breathing non‐contrast abdomen and thorax  examinations.  • Special focus: qualification of patients for mid‐ ventilation approach in RT Image Suite Self-gating signal Claims • Acquisition of 4D MR data in free breathing in the  Bin 1 abdomen and thorax Bin 2 • Generate respiratory gated 3D MR image series  and support of MR based radiotherapy planning  Bin 3 of moving targets in the thorax and abdomen  without need for a respiratory gating device Amplitude [a.u.] Bin 4 41 Unrestricted © Siemens Healthineers, 2020 Notes 86MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP StarVIBE 4D MRI User selectable parameters • Radial Views: user defined number of radial  spokes acquired in total (upper limit dependent  on MaRS memory, # coil elements, acquisition  matrix etc.) • Number of Bins (only available if Motion Scan is  checked): user defined number of distinct  respiratory motion states (2‐10) • Find a balance between Number of Bins and  Radial Views (temporal resolution vs. radial  undersampling)  • Use fat suppression, keep arms out of FOV if  possible 42 Unrestricted © Siemens Healthineers, 2020 Notes 87MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP StarVIBE: 4D MRI Examples Abdomen  StarVIBE: full reconstruction 4D MRI: Bin1 reconstruction Unrestricted Siemens Healthineers,2020,  Notes 88MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP StarVIBE: 4D MRI Examples Thorax StarVIBE: full reconstruction 4D MRI: Bin1 reconstruction Unrestricted Siemens Healthineers,2020,  Notes 89MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Knowledge Check 1. The _____________ is a 3D‐spoiled GRE  2. One of the drawbacks to fast BLADE is  sequence available with various fat  _____________. saturation techniques, which is a stack of  a. More Motion stars trajectory (radial scan).  b. Higher SAR a. BLADE c. Long Scan Time b. PACE c. StarVIBE d. FLASH Author | Department 45 Unrestricted © Siemens Healthineers, 2020 Notes 90MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Body Diffusion Body Diffusion MR Applications Fundamentals – Part Two Presenter, Calibri 16 pt English, Month 2019 Unrestricted © Siemens Healthineers, 2020 Unrestricted Notes 91MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Agenda • Protocols in different body regions • Diffusion Parameter Card • Clinical Example • Special Considerations 2 Unrestricted © Siemens Healthineers, 2020 Notes 92MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Objectives • Identify Diffusion Protocols for body imaging • Explain b values • Utilize Diffusion protocols for body imaging • Identify whole body diffusion protocols • Explain Diffusion Parameters 3 Unrestricted © Siemens Healthineers, 2020 Notes 93MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Protocols in Different Body Regions Protocols in  Different Body Regions  4 Unrestricted © Siemens Healthineers, 2020 Notes 94MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Protocols and Sequences Available protocols • In various body regions: neck soft tissue, thorax,  abdomen, male/female pelvis, whole body  diffusion, and breast  • Sequences:  • Single‐shot EPI (+ ZOOMit) • RESOLVE  • Accelerations:  • GRAPPA (+ SMS) 5 Unrestricted © Siemens Healthineers, 2020 Notes 95MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Protocols and Sequences Available protocols • In various body regions: neck soft tissue, thorax,  abdomen, male/female pelvis, whole body  diffusion, and breast  • Triggers in abdomen diffusion • Multi breath‐hold (short TA, single average) • Free breathing (more averages) • 2D PACE + free breathing • Fat saturation in whole body diffusion • STIR 6 Unrestricted © Siemens Healthineers, 2020 Notes 96MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Protocols and Sequences RESOLVE diffusion • In Neuro protocols  • Reacquisition mode=ON • TA increases about 20% • In other protocols/regions • Reacquisition mode=OFF • No default protocols in abdomen and thorax  regions due to the respiratory motion 7 Unrestricted © Siemens Healthineers, 2020 Notes 97MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Protocols and Sequences Whole body diffusion • Two IR schemes for STIR fat saturation • Automatic • Sequential: available since E11, TR could be reduced to shorten the TA Sequential IR scheme Ref: Alto Stemmer, Proc. Intl. Soc. Mag. Reson. Med. 21 (2013) 2059 8 Unrestricted © Siemens Healthineers, 2020 Notes 98MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Diffusion Parameter Card Setup Diffusion Parameter Card Setup 9 Unrestricted © Siemens Healthineers, 2020 Notes 99MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Diffusion Parameter Card Diffusion mode • 3D Diagonal vs. 3‐ or 4‐scan TRACE 10 Unrestricted © Siemens Healthineers, 2020 Notes 100MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Diffusion Parameter Card Diffusion Scheme • Bipolar • Double refocused SE diffusion encoding • Better eddy current compensation and  therefore less spatial distortions • Monopolar • Single refocused SE diffusion encoding • Allows ↓TE  ↑SNR • Suggestion: in body diffusion using Monopolar bipolar monopolar 11 Unrestricted © Siemens Healthineers, 2020 Notes 101MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Diffusion Parameter Card B‐value • The measure of diffusion weightings, unit: s/mm2 • Since E11C‐SP01: The increment step in 10 when  b≤200, only for Monopolar diffusion scheme  mode • For IVIM application, but no dedicated post‐ processing tools in our product • b50_400_800 or b50_800?  • Mathematically no differences*  • Numaris X changes many of the protocols to  b50_800, and more averages in b800 • But additional b‐values are still valuable if they  are not centered between the lowest and  highest b‐value (e.g. b50, b250 and b800) * Ref: Park MY et al., AJR2012, DOI:10.2214/AJR.12.923  12 Unrestricted © Siemens Healthineers, 2020 Notes 102MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Diffusion Parameter Card Exponential ADC Maps: DWI without T2 shine  through effect (Arbitrary Units) • Motivation: signal‐intensity in DWI‐EPI influenced  by two factors • Diffusion • Strong T2‐weighting due to long TR and TE • In case of hyperintensity: is it T2‐related,  diffusion‐related or both? • Exponential ADC Map could eliminated T2  related effect  • Exp ADC is calculated from ADC map using b=200 1 𝑆𝑆 𝑏𝑏 ��·��� 𝑆𝑆�𝑏𝑏� 𝐴𝐴𝐴𝐴𝐴𝐴 � · ln 𝐸𝐸𝐸𝐸𝐸𝐸 𝐴𝐴𝐴𝐴𝐴𝐴: 𝑒𝑒 � 13 𝑏𝑏 𝑆𝑆 𝑏𝑏� Unrestricted © Siemens Healthineers,𝑆𝑆�𝑏𝑏 2020�� Notes 103MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Diff Card Exp ADC maps • In both maps, the T2 shine through  effect is eliminated • The ADC Map gives the Apparent  Diffusion Coefficient information • Exponential ADC Map gives the  DW contrast  (arbitrary units) ADC Map Exponential ADC Map 14 Unrestricted SiemensUnrestricted Healthineers © Siemens Training Healthineers, Center, 2020 Notes 104MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Diffusion Parameter Card Inverted Gray Scale • Trace Weighted Images are displayed with an  inverted gray scale 15 Unrestricted © Siemens Healthineers, 2020 Notes 105MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Diffusion Parameter Card Calculated b‐value • Generate artificial Trace weighted images (or Diff.  weighted images) with the b‐value specified  under this field • Since E11C‐SP01, calculated b is up to b=5000 16 Unrestricted © Siemens Healthineers, 2020 Notes 106MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Diffusion Parameter Card Calculated b‐value • Reducing signal from certain tissues • The contrast in the computed image (Calculated  b = 1500s/mm2) is improved compared to the  acquired image as signal from tissues such as  the kidneys, testes and salivary glands (teal,  plum and orange arrows respectively) has been  reduced Patient with  multiple  metastases along  the spine from a  b = 900 s/mm²  b = 1500 s/mm²  Calculated Image primary prostate  17 tumor Unrestricted © Siemens Healthineers, 2020 Notes 107MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Diffusion Parameter Card Calculated b‐value • Extrapolating images to b=2000 s/mm2 reveals the  presence of water restriction within a peri‐ tumoral margin in liver metastases (orange arrow) • Furthermore, it is observed that the contrast  between metastases and background tissue is  improved (teal arrows) b = 0 s/mm²  b = 750 s/mm²  b = 2000 s/mm²  b = 800 s/mm² b = 1400 s/mm²  Calculated Image Calculated Image Courtesy Royal Marsden Hospital / UK Unrestricted  Siemens Healthineers, 2020 Notes 108MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Diffusion Parameter Card B‐value >= • Only b‐values higher than the specified value are  used in the ADC calculation • Eliminate perfusion effects by excluding lower b‐ values  (organ specific e.g. < 150 s/mm2… ) from  ADC calculation 19 Unrestricted © Siemens Healthineers, 2020 Notes 109MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Diffusion Parameter Card ADC from b = 0, 100, 600 s/mm²  ADC from b = 100, 600 s/mm²  Unrestricted Siemens Healthineers, 2020 Notes 110MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Diffusion Parameter Card Dynamic Field Correction Direct mode • Registration of individual diffusion encoded  images to undistorted reference image (image  b=0) • An additional b0 image will be always acquired  independently of the protocol settings Adjustment mode  • Dedicated, additional adjustment scans to  estimate dynamic field errors • Applicable to low SNR images (high b‐values) • Additional scan time longer than Direct mode “series_MIX“: there are some non‐corrected images  in series not matching quality criteria 21 Unrestricted © Siemens Healthineers, 2020 Notes 111MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Diffusion Parameter Card Dynamic Field Correction: Direct mode Reference image  Distorted image  Corrected image  Additional b0 image b = 1000 s/mm2 b = 1000 s/mm2 22 Unrestricted SiemensUnrestricted Healthineers © Siemens Training Healthineers, Center, 2020 Notes 112MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Clinical Image Examples Clinical Image Examples 23 Unrestricted © Siemens Healthineers, 2020 Notes 113MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Clinical Image Examples  4‐years‐old female with suspicion of Wilms tumor T2 TSE, detection of lung metastasis and detailed  evaluation of primary tumor DWI, 5 steps composed,  b=800 s/mm2 Image courtesy: University of Homburg/Saar, Germany Unrestricted Siemens Healthineers, 2020 Notes 114MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Clinical Image Examples  9‐years‐old female with suspicion of Non‐Hodgkin’s  Disease Image courtesy: University of Homburg/Saar, Germany Unrestricted Siemens Healthineers, 2020 Notes 115MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Special Considerations Special  Considerations 26 Unrestricted © Siemens Healthineers, 2020 Notes 116MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Special Considerations Slice Adjustment • Supported Sequence • ep2d_diff • Supported Adjustments • frequency, 1st order B0‐shim, transmitter  scaling, B1 shim (for pTX systems) • Adjustment focus • any relevant sub volume, including imaging  slices, saturation volumes • Achievable Improvements • more SNR, better spatial fidelity, improved Fat  suppression & image contrast 27 Unrestricted © Siemens Healthineers, 2020 Notes 117MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Special Considerations Slice Adjustment with different B0 options • Tune up → SliceAdjust uses its „own“ B0 Shim (only 1st order shim)  • fast option • Whole Body → optimized AdjVol for whole body imaging • Uses tune up with modified adjust volume, fast option • Recommended for multi‐station measurements of the torso • Might fail in the neck region in rare cases st nd • Standard → 1 and 2 static order shim is used first, SliceAdjust B0 shim on top • requires additional adjustment time • prerequisite for combination with CoilShim (recommended for  neck) 28 Unrestricted © Siemens Healthineers, 2020 Notes 118MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Special Considerations Adjustment Durations Standard Shim (1st & 2nd) SliceAdjust Shim (1st) 29 Unrestricted © Siemens Healthineers, 2020 Notes 119MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Special Considerations IQ improvements from slice adjustment Whole Body‐DWI 1st shim volume 2nd shim volume Volume shim 3rd shim volume Slice adjustment Volume shim Slice adjustment Unrestricted Siemens Healthineers, 2020 Notes 120MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Special Considerations IQ improvements from slice adjustment Slice adjustment Whole Body ‐tra‐DWI; sagittal reformation, Slice adjustment 4 stations Unrestricted Siemens Healthineers, 2020 Notes 121MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Special Considerations IQ improvements from slice adjustment Without slice adjustment Slice adjustment Without slice adjustment Slice adjustment + Coil shim Unrestricted Siemens Healthineers, 2020 Notes 122MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Special Considerations Planning of the whole‐body diffusion Sporadic image quality issues could be: • Breathing motion causing broken spine in  diaphragm area • Avoid planning the step‐border in diaphragm area X O Unrestricted Siemens Healthineers, 2020 Notes 123MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Special Considerations Composing function „Diffusion“ Broken spine artifact may appear due to: • Different adjustment frequencies cause a shift in  PE direction • B0 may vary locally which causes distortions at the  extremities • If patient moves between steps a shift can occur It helps reduce the broken spine artifacts 34 Unrestricted © Siemens Healthineers, 2020 Notes 124MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Special Considerations Broken spine artifacts  Apply composing function „Diffusion“ Unrestricted Siemens Healthineers, 2020 Notes 125MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Special Considerations Normalize filter • It is an signal intensity homogeneity filter, to  minimize the signal intensity variations in whole  body images  • 4 options: • OFF • Strong • Medium • Weak  36 Unrestricted © Siemens Healthineers, 2020 Notes 126MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Special Considerations Breast diffusion • Fat saturation should be activated in “Strong”  mode and use the PA phase encoding direction • Use enough b‐values to get an accurate ADC Map  (even more important in dense breast) • In RESOLVE protocols, it is important to ensure  sufficient SNR Use 2 saturation bands Use PA phase encoding direction Note: in N4 platform, we also suggest to activate „Assume dominant fat“ and “Confirm freq. adjustment“ 37 Unrestricted © Siemens Healthineers, 2020 Notes 127MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Knowledge Check 1. The  _________diffusion scheme is  2. The ___________ eliminates the T2  used in body Diffusion. shine through effect. a. Bipolar a. b‐value b. Monopolar b. Monopolar c. Tripolar c. ADC Map d. Shift d. Bipolar Author | Department 38 Unrestricted © Siemens Healthineers, 2020 Notes 128MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Body Imaging Body Imaging  MR Applications Fundamentals – Part Two Presenter, Calibri 16 pt English, Month 2019 Unrestricted © Siemens Healthineers, 2020 Unrestricted Notes 129MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Agenda • Thorax • Liver Imaging • Liver Mapping • MRCP • Whole Body • Set‐n‐GO • FastView Localizer 2 Unrestricted © Siemens Healthineers, 2020 Notes 130MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Objectives • Identify protocols for body imaging • Explain the benefits of whole body imaging • Describe the workflow of Set‐n‐Go Protocols • Utilize liver imaging protocols in your user  protocols • Identify MRCP protocols 3 Unrestricted © Siemens Healthineers, 2020 Notes 131MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Thorax Thorax 4 Unrestricted © Siemens Healthineers, 2020 Notes 132MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Thorax Introduction • The value of MRI in imaging cardiac and large vessel disease is widely accepted, but the largest organ of the thorax,  the lung, has some well known technological challenges • These include low lung proton content, susceptibility artifacts at air‐tissue interfaces and cardio‐respiratory  motions • Therefore chest CT has become the gold standard in clinical practice as both a diagnostic and a monitoring tool • However, technological advances have made it possible to perform MRI imaging of the chest with reasonable  image quality in acceptable scan time • This has allowed lung MRI to become a valuable method for imaging children, pregnant patients and those who  require frequent follow up examinations thus reducing exposure to radiation J Biederer et.al, MRI of the Lung, MAGNETOM Flash 1/2011  Giovanni Morana, Chest MRI: Morphological Imaging and Beyond, MAGNETOM Flash (68) 2/2017  5 Unrestricted © Siemens Healthineers, 2020 Notes 133MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Thorax Imaging J Biederer et.al, MRI of the Lung, MAGNETOM Flash 1/2011  6 Unrestricted © Siemens Healthineers, 2020 Notes 134MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Thorax Protocols in Dot Cockpit • Programs already prepared according to   specific pathologies are available in the  Dot Cockpit • These cover different aspects of lung  pathology: • General purpose • Lesions/tumours • Functional imaging with dynamic first  pass perfusion • High resolution angiography 7 Unrestricted © Siemens Healthineers, 2020 Notes 135MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Thorax Protocols ‐ General 8 Unrestricted © Siemens Healthineers, 2020 Notes 136MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Thorax ‐ Mass • Coronal multi‐breathhold T2 BLADE in a patient with a larger lung cancer in the upper left lobe 9 J Biederer et.al, MRI of the Lung, MAGNETOM Flash 1/2011  Unrestricted © Siemens Healthineers, 2020 Notes 137MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Thorax ‐ Granuloma • Contrast enhanced VIBE of a lung granuloma in Wegener’s disease. Note central necrosis with air‐filled defect  inside the large mass  J Biederer et.al, MRI of the Lung, MAGNETOM Flash 1/2011  Contrast Disclaimer –A licensed physician may choose to use FDA‐approved contrast agents in conjunction with an MRI  10 exam, based on his/her medical opinion and discretion and in accordance with the instructions for use and indications for  Unrestricted © Siemens Healthineers, 2020 use supplied by the pharmaceutical manufacturer for the contrast agents Notes 138MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Thorax Protocols – Vessels / Perfusion • The protocols in this Vessels / Perfusion branch are  very similar to the Thoracic Mass protocols: • Central Mass program includes the T2 FS Tra BLADE  sequence as well as additional angiography  sequences • Perfusion program excludes the T2 FS Tra BLADE and  DWI sequences but also has the angiography  protocols • Vessel Structure program has the angiography  protocols and only the T2 Cor TrueFISP protocol  Contrast Disclaimer –A licensed physician may choose to use FDA‐approved contrast agents in conjunction  with an MRI exam, based on his/her medical opinion and discretion and in accordance with the instructions for  11 use and indications for use supplied by the pharmaceutical manufacturer for the contrast agents Unrestricted © Siemens Healthineers, 2020 Notes 139MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Thorax ‐ Embolism Patient with acute pulmonary embolism • In the Cor TrueFISP series (a & b) we see  the embolus inside the right lower lobe  artery (circled).  • (c) Series of subtracted images from first  pass perfusion study, perfusion deficits  marked with open arrows  12 J Biederer et.al, MRI of the lung (3/3) current applications and  Unrestricted © Siemens Healthineers, 2020 future perspectives, Insights Imaging (2012) 3:373–386 Notes 140MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Thorax – Additional Protocols • The Angiography protocol branch contains an isotropic  TWIST sequence for high spatial and temporal resolution  • Additional protocols can be found in the Library protocol  branch including:  • T1 StarVIBE protocols which provide high spatial  resolution and reduced motion artifacts during free  breathing • Respiratory triggered T2 SPACE sequences  Contrast Disclaimer –A licensed physician may choose to use FDA‐approved contrast agents in conjunction with an MRI  exam, based on his/her medical opinion and discretion and in accordance with the instructions for use and indications for  13 use supplied by the pharmaceutical manufacturer for the contrast agents Unrestricted © Siemens Healthineers, 2020 Notes 141MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Thorax – Additional Protocols Coronal respiratory triggered SPACE STIR acquisition 14 J. Biederer et.al, MRI of the Lung, MAGNETOM Flash 1/2011  Unrestricted © Siemens Healthineers, 2020 Notes 142MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Liver Imaging Liver Imaging 15 Unrestricted © Siemens Healthineers, 2020 Notes 143MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP VIBE Volume Interpolated Breath‐hold Examination (Volume) Interpolation • Omitting data collection of signal outside the raw data causes  truncation artifacts (Gibbs ringing) • Filling these data lines with zeros improves the image  appearance: Gp • Equivalent to an interpolation, i.e. voxel‐shifted images are  Gs calculated • The zero filling approach improves the partial volume effect • it does not improve spatial or volume resolution • it does reduce artifacts caused by the shape and size of pixels in  GR the image Zero-filling 16 Unrestricted © Siemens Healthineers, 2020 Notes 144MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP VIBE  Image Examples VIBE Coronal contrast enhanced liver imaging   Dynamic Intern © Siemens Healthineers Training Center, 2019 Notes 145MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP VIBE Special Options: Excitation Slab‐sel. PE Slab selective: • Slab selection is usually performed in slice  encoding direction (i.e. through plane) • For coronal imaging, the whole volume in “head  Slab‐selective – feet” and “left – right” direction will be excited • Requires large FOV and/or phase oversampling to  avoid wrap‐around from the arms Slab selective PE: • Excitation is performed in phase encoding  direction • Allows smaller FOV in phase encoding direction  (i.e. less phase encoding steps!) • Needs full coverage through‐plane to avoid wrap‐ Slab‐selective PE around in slice direction 18 Unrestricted © Siemens Healthineers, 2020 Notes 146MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP VIBE Special Options: Increased Gradient spoiling “Increased Gradient spoiling” • Especially within a 3D sequence, high  number of excitations to acquire the 3D  k‐space • Contributions of undesired echo  pathways get reduced by RF and  gradient spoiling • However, for certain protocols, some  residual signal from undesired pathways  might remain • “Incr. Gradient spoiling” will use longer  and stronger gradient spoilers to further  reduce contributions of undesired echo  pathways 19 Unrestricted © Siemens Healthineers, 2020 Notes 147MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP VIBE – Special Options:  Increased Gradient spoiling & Excitation Slab‐sel. PE slab selective slab selective PE  slab selective slab selective PE  weak spoiling  weak spoiling strong spoiling strong spoiling  Intern © Siemens Healthineers Training Center, 2019 Notes 148MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP StarVIBE Stack of stars trajectory Features inherited from Cartesian VIBE: • 3D spoiled GRE with Volume Interpolation  • Quick fat sat or SPAIR • Dixon Non Cartesian features: • Stack of stars trajectory (radial) • Regridding reconstruction z x 21 Unrestricted © Siemens Healthineers, 2020 Notes 149MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP StarVIBE Advantages of radial  trajectory: • Significantly higher  robustness to motion • Supports free breathing  measurements Reason: • Oversampling of k‐space  center   Averaging effect Cartesian Radial • Varying readout direction    no vulnerable phase‐ encoding axis  Intern © Siemens Healthineers Training Center, 2019 Notes 150MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP StarVIBE Required settings: • Trajectory: Radial • Radial views  recommended to  have 2‐3x more views than base  resolution • FoV Phase = 100% (since readout  is rotated, i.e. no PE) • no iPAT or CE acceleration • no TWIST‐sharing available  (but GRASP is based on the  StarVIBE principle) • Motion Scan  Respiratory Self  Gating 4D MRI (for RT planning) 23 Unrestricted © Siemens Healthineers, 2020 Notes 151MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP StarVIBE  Number of radial views Matrix size: 320x320 760 radial views 360 radial views 180 radial views 80 radial views Reducing the number of radials will increase streaking artifacts and will reduce the SNR! Intern © Siemens Healthineers Training Center, 2019 Notes 152MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Liver Imaging Contrast Disclaimer: A licensed physician may choose to use FDA‐approved contrast agents in  conjunction with an MRI exam based on his/her medical opinion and discretion and in accordance  with the instructions for use and indications for use supplied by the pharmaceutical manufacturer  for the contrast agents. 25 Unrestricted © Siemens Healthineers, 2020 Notes 153MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Dynamic Liver Imaging  Motivation • Contrast enhanced dynamic T1 weighted imaging  is crucial for a complete evaluation of liver  diseases  • CE Liver MRI helps to detect and characterize  many hepatic lesions and to differentiate between  benign and malignant lesions Hepatic artery • The value of this dynamic imaging relies heavily  on the appropriate timing of the contrast injection Gallbladder • For accurate interpretation of liver diseases, good  Pancreas understanding of the newer imaging techniques  and familiarity with typical imaging features of  liver diseases are essential Portal vein 26 Unrestricted © Siemens Healthineers, 2020 Notes 154MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Dynamic Liver Imaging  Dynamic phases Pre phase Early Arterial phase Late Arterial phase Portal Venous phase Delayed phase Portal veins Hepatic arteries Hepatic veins 27 Unrestricted © Siemens Healthineers, 2020 Notes 155MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Dynamic Liver Imaging  Dynamic phases Pre phase Early Arterial phase Late Arterial phase Portal Venous phase Delayed phase Portal veins Hepatic arteries Hepatic veins early mid late A A A 28 Unrestricted © Siemens Healthineers, 2020 Notes 156MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Dynamic Liver Imaging  Protocols Dynamic contrast‐enhanced images are acquired  with 3D T1‐weighted fat suppressed GRE sequences • VIBE with DIXON, SPAIR or spectral fat sat • Short scan time within a breath‐hold for each  phase  • Conventional setup with 4 phases: pre contrast,  arterial, venous, and delayed phases  • All the four phases are acquired with the same  parameters Configuration of the conventional liver dynamics • DynaVIBE • Care Bolus • Test Bolus 29 Unrestricted © Siemens Healthineers, 2020 Notes 157MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Dynamic Liver Imaging  Image example with VIBE‐DIXON Four contrasts are generated • Opposed phase • In phase • Fat  • Water Fat image In phase Opp phase Water image Unrestricted Siemens Healthineers, 2020 Notes 158MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Dynamic Liver Imaging  W F 2pt-FF Protocols DIXON‐VIBE: Fat Fraction (2pt) • After DIXON measurements, fat and water images  are reconstructed  • Fat fraction could be (roughly) calculated:  F FF= 100 (%)= S.I. ROI/10 F+W _tra_bh ൈ FF2pt t1_vibe_dixon_ Unrestricted Siemens Healthineers, 2020 Notes 159MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Dynamic Liver Imaging  Dynamic phase: Timing Pre phase Early Arterial phase Late Arterial phase Portal Venous phase Delayed phase Portal veins Hepatic arteries Hepatic veins Before Contrast Because of the temporal Center of k-space ~30 to Center of k-space ~30 Center of k-space ~180 agent injection resolution usually no early 35 seconds after seconds after center of k- seconds after center of k- arterial phase is acquired. contrast injection. space of the arterial space of portal venous Most important phase in phase, i.e. ~60 to 65 phase (i.e. ~240 to 245 liver dynamics is the Late seconds after contrast seconds after contrast arterial phase! injection. injection). 32 Unrestricted © Siemens Healthineers, 2020 Notes 160MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Dynamic Liver Imaging  Dynamic phase: Timing Pre phase Late Arterial phase Portal Venous phase Delayed phase B VIBE B B VIBE B B VIBE B B VIBE B H (~15 sec.) H H (~15 sec.) H H (~15 sec.) H H (~15 sec.) H ~30-35 sec. ~30 sec. ~180 sec. 33 Unrestricted © Siemens Healthineers, 2020 Notes 161MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Dynamic Liver Imaging  DynaVIBE One protocol with multiple measurements  • All four phases are acquired with the predefined  pause duration between the measurements  • Contrast is injected after the 1st measurement • Liver registration and inline subtraction could be  applied  34 Unrestricted © Siemens Healthineers, 2020 Notes 162MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Dynamic Liver Imaging  Inline Liver Registration The second measurement is the reference image  and we perform the elastic image registration  • Correcting different breath‐hold positions  between dynamics  • The inline subtraction results more reliable  • If liver registration fails, the original images are  Registered images saved automatically and no registered images are  saved  Original images 35 Unrestricted © Siemens Healthineers, 2020 Notes 163MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Dynamic Liver Imaging  Liver Registration Subtraction of original images (w/o contrast)  Subtraction of registered images (w/o contrast) Unrestricted Siemens Healthineers, 2020 Notes 164MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Dynamic Liver Imaging  Individual protocol setups Each dynamic phase has its own protocol  • Create Copy Reference = Everything  Test Bolus or  • All scan parameters are the same for the whole  Care Bolus here dynamic measurements • Timing should be controlled manually or configure  voice commands pause  • Liver registration is not applicable • In order to handle the timing more precisely, Care  Bolus or Test Bolus step could be inserted into the  workflow  37 Unrestricted © Siemens Healthineers, 2020 Notes 165MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Dynamic Liver Imaging  Care Bolus The Care Bolus measurement is inserted before the  arterial phase scan • Inject the contrast in Care Bolus measurement  • When seeing the signal enhancement in Inline  Display, click “Stop/Continue” to start the arterial  phase scan*  • “Create Copy Reference = Table Position” for Care  Bolus protocol to avoid the table movement  during the dynamic scan  * With „CareBolus“ addin, the care bolus scan would stop automatically when signal intensity exceeds the  threshold and proceed to the arterial phase scan. See details in Abdomen Dot Engine  38 Unrestricted © Siemens Healthineers, 2020 Notes 166MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Dynamic Liver Imaging  Care Bolus Configure the contrast information in prepare step Start the Care Bolus measurement  Unrestricted Siemens Healthineers, 2020 Notes 167MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Dynamic Liver Imaging  Test Bolus delay time=18 s The small amount contrast injection is applied  before the arterial phase scan • Injection and start the measurement  Estimated curve for simultaneously full‐dose injection • Plot the dynamic curve from Test Bolus to  evaluate the contrast arrival time  • Estimate the timing offset  • Calculate the starting time for the arterial phase  measurement. This time is used for Countdown:  Delay time + Timing offset – TTC Timing offset ~10s Test Bolus image 40 Unrestricted © Siemens Healthineers, 2020 Notes 168MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Dynamic Liver Imaging  Test Bolus • Suggestion: Transverse view image to select  descending aorta more easily  • Don´t assign contrast in Test Bolus step Click „Continue“ and start  injection together!! Unrestricted Siemens Healthineers, 2020 Notes 169MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Dynamic Liver Imaging  Test Bolus Configure the contrast information in prepare step Input Countdown time → Auto Continue → Start  Unrestricted Siemens Healthineers, 2020 Notes 170MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Dynamic Liver Imaging  StarVIBE for free‐breathing dynamic scans • Default protocols only available in Whole‐Body  Dot Engine*  • Low motion artifacts and comparable image quality • An alternative solution in patients unable to  suspend respiration for dynamic liver imaging  43 Unrestricted © Siemens Healthineers, 2020 Notes 171MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Dynamic Liver Imaging  StarVIBE for free‐breathing dynamic scans • The information lost through the motion is  expressed as overall softer image appearance and  streaking  • However, streaking artifacts might have less  Arterial impact on diagnostic images than periodic motion  phase artifacts  Venous  phase Motion artifacts from VIBE VIBE StarVIBE Ref: B. Kaltenbach et al., European  Unrestricted Siemens Healthineers, 2020 Journal of Radiology 86 (2017) 26–32 Notes 172MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Dynamic Liver Imaging  From the MIP in arterial and venous phase could  show the feeding vessels and portal venous system 3D slab 44 slices with fatsat Arterial phase Venous phase Slice thickness=2mm MIP in Coronal view MIP in Coronal view Matrix size=256, TA=21s Unrestricted Siemens Healthineers, 2020 Notes 173MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Dynamic Liver Imaging  TWIST view sharing scheme =+++ From the conventional VIBE sequence, the  A B1 B2 B3 temporal resolution is the limitation to acquire  k-space A=central region B-region = periphery more dynamic data for arterial phase  time measured: B1 B2 A B3 A B1 A B2 A B3 A … We should not miss the late arterial phase, so the  reconstructed: M1 M2 M3 M4 M5 … timing is important • Do we miss any information from the early  Parallel imaging with CAIPIRINHA Acc.factor PE=2 , = acquired = not acquired arterial phase?  • Could we obtain more clinical information from  the early arterial phase?  Reordering shift 3D=1 TWIST‐VIBE (since VE11A) is introduced • Higher temporal resolution with the view‐sharing  Acc.fact.3D=2 technique, TWIST F/W separation with Dixon • CAIPIRIHNA acceleration  TE1 TE2 RF Coils • DIXON for fat saturation  RO ADC 46 Unrestricted © Siemens Healthineers, 2020 Notes 174MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Dynamic Liver Imaging  TWIST‐VIBE Benefits  Attentions • View sharing → better temporal resolution • Sensitivity to view‐sharing and motion • Dixon in combination with view sharing • Careful parameterization for CAIPIRINHA • View sharing supports undersampling (CAIPI) • Longer reconstruction time • More Dixon‐flexibility: no strict opp/in condition  • Temporal footprint: duration over which any data  necessary portions used for a single image are acquired. 47 Unrestricted © Siemens Healthineers, 2020 Notes 175MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Dynamic Liver Imaging  TWIST‐VIBE Case of hepatocellular carcinoma • shows progressive enhancement & captures optimal phase for detection Image Courtesy: M. Bridges MD, Unrestricted Siemens Healthineers, 2020 Mayo Clinic, USA Notes 176MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Dynamic Liver Imaging  TWIST‐VIBE Possible to have multi‐arterial phase imaging in a  single breath‐hold with • high temporal resolution (<2.5s), and  • high spatial resolution (~1.3x1.3x3 mm3) Studies from UK Mannheim • 14 arterial phases with TA=28s  • From 47 patients, with added diagnostic value in  10 patients (~20%) Ref: Michaely HJ et al., CDT‐VIBE. Invest Radiol 2013;48: 590Y597 49 Unrestricted © Siemens Healthineers, 2020 Notes 177MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Dynamic Liver Imaging  TWIST‐VIBE Liver metastasis Liver metastasis • Avascular metastases (arrowhead) • Left: metastasis seen in both • Subcapsular metastasis (arrow) • Right: metastasis only seen in 7th phase 1/14 7/14 8/14 14/14 Ref: Michaely HJ et al., CDT‐VIBE. Invest Radiol 2013;48: 590Y597 Unrestricted Siemens Healthineers, 2020 Notes 178MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Dynamic Liver Imaging  TWIST‐VIBE Liver metastasis (patient already had major liver  Early arterial phase resection) • One new metastasis seen on all sequences (yellow  arrow) • Second new metastasis only clearly visible on  early arterial phase (orange arrow) DWI Mid‐arterial phase hepatobiliary phase Image Courtesy: M. Bridges MD, Mayo Clinic, USA Unrestricted Siemens Healthineers, 2020 Notes 179MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Dynamic Liver Imaging  TWIST‐VIBE: Protocol and timing  Fix Timing 1 2 3 4 5 Start 1st phase at:  15 s  (< 65 y)  20 s  (> 65 y) time Test Bolus 1 2 3 4 5 Start 1st phase at 2 sec after the beginning of the signal upslope time 2 s 52 Unrestricted © Siemens Healthineers, 2020 Notes 180MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Knowledge Check 1.  All of the following are contrasts that  2.    The Care Bolus Measurement is  are generated in the VIBE‐DIXON except  inserted before the ______________phase  __________. scan. a. Opposed phase a. Pre‐Phase (no contrast) b. In phase b. Arterial c. Fat c. Venous d. STIR d. Delayed  Author | Department 53 Unrestricted © Siemens Healthineers, 2020 Notes 181MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Liver Mapping Liver Mapping 54 Unrestricted © Siemens Healthineers, 2020 Notes 182MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Liver Mapping  T2* (or R2*) measurement  To evaluate the hemochromatosis (iron load) • It might affect on liver, pancreas, heart and  endocrine glands  T1 measurement  The iron load also shortens the T1 relaxation time • Correlation between T1 and iron concentration  was shown in several studies • T1 measurements could be used for iron  quantification  55 Unrestricted © Siemens Healthineers, 2020 Notes 183MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Liver Mapping  Two different techniques for T2* or R2* mapping MapIt LiverLab • 2D FLASH sequence with multi‐echo readout and  • Multi‐Echo Dixon (q‐Dixon, 6 TEs) subsequent T2*/R2* calculation • 3D VIBE with multi‐echo readout, fat/water  Separation and subsequent calculation of the  effective R2* (plus fat fraction and others) 56 Unrestricted © Siemens Healthineers, 2020 Notes 184MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Liver Mapping  T2* and R2* mapping with MapIt R2* mapping and fat fraction from LiverLab Results from a normal volunteer Results from a normal volunteer R2* in ROI = 77.2/s T2* in ROI = 12.6ms effective R2* in ROI = 43.2/s Inline statistics (mean, std)  of FP and effective R2* Unrestricted Siemens Healthineers, 2020 Notes 185MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Liver Mapping  Normal range of the T2* and R2* values Depending on different sequence techniques, field  strengths, the values are variant  • Conventional multi‐echo 2D FLASH • Q‐DIXON Iron loaded liver Healthy liver 58 MAGNETOM FLASH 1/2015 Unrestricted © Siemens Healthineers, 2020 Notes 186MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Liver Mapping  T1 mapping Using VIBE to acquire images from (at least) two FAs  and calculating the T1 map via MapIt  • B1Map protocol could be scanned before the  T1Map protocol and enable the B1 corrected  T1Map calculation results  T1 Map B1 corrected T1 Map 59 Unrestricted © Siemens Healthineers, 2020 Notes 187MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Liver Mapping  T1 mapping Using VIBE to acquire images from (at least) two FAs  and calculating the T1 map via MapIt  • Fat in the liver could cause bias to the T1  measurements • DIXON could be enabled for the scan and we  calculate T1 Map using water images B1 corrected T1 Map B1 corrected T1 Map Water Only ROI=704.3ms ROI=663.6ms 60 Unrestricted © Siemens Healthineers, 2020 Notes 188MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Liver: T2+T2 The multiple T2‐contrast measurement could  distinguish some cases, e.g. hemangioma or  metastasis  • Some other images (DWI or ADC map) could be  also helpful TE=74ms TE=503ms B=50 B=800 ADC Unrestricted Siemens Healthineers, 2020 Notes 189MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP MRCP MRCP 62 Unrestricted © Siemens Healthineers, 2020 Notes 190MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP MRCP  MR Cholangiopancreatography : using MRI to  visualize the biliary and pancreatic ducts  It can show gallstones, narrowing or blockages in  the bile duct or the pancreatic duct, tumors, and  evidence of inflammation Images are strong T2 contrast and possible  sequences could be: • HASTE single thick slab • HASTE thin slab  • SPACE or TSE3D (with trigger) 63 Unrestricted © Siemens Healthineers, 2020 Notes 191MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP MRCP HASTE thick slab measurement Long TR to avoid cross‐talk (if multi‐slices) Single slice Create radial slices Keep the necessary slices Unrestricted Siemens Healthineers, 2020 Notes 192MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP MRCP HASTE thick slab measurement Pineapple juice is used as an oral  negative contrast  • Drink before the scan ~15mins • Suppress the high signal of  gastrointestinal tract  Thick slab MRCP Thick slab MRCP  (prepared with pineapple juice) 65 UnrestrictedUnRestricted ©  Siemens Healthineers, 2020 Notes 193MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP MRCP  3D imaging techniques  SPACE or TSE3D sequences with strong T2 contrast • Long TE, long echo train  • Trigger is necessary • The trigger algorithm is changed from box mode  to level mode to avoid the acquisition during the  inspiration (since VE11E)  Box mode Level mode Unrestricted Siemens Healthineers, 2020 Notes 194MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP MRCP  3D imaging: Other improvements for MRCP Adaptation of the acquisition window • Original design: acquisition window is  automatically set symmetrically in breathing cycle  • New (since XA11): longer acquisition window is  Acquisition window calculated to acquire the data during stable  Sequence timing period  • Hint: Take care during protocol conversion! In  some cases, acquisition window is not long  enough to convert protocol! Must be adapted  manually 67 Unrestricted © Siemens Healthineers, 2020 Notes 195MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP MRCP  Protocol conversion issue  Problems: • „Acquisition Window“ must be longer than  „Acquisition Duration“.  • In case of „Acquisition Window“ is too short,  protocol conversion adapts TE (e.g. reduced from  700ms to 400ms) in order to fulfill protocol  settings. Protocol is underlined afterwards. Manual solution: • Increase „Acquisition Window“ again to ~2000ms  and adapt TE to original value 68 Unrestricted © Siemens Healthineers, 2020 Notes 196MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP MRCP  3D imaging: Other improvements for MRCP Short cycle mode • When respiration period ~ Tim  Planning Suite task card • Enable Inline Composing • Select Composing Function • Remember Group Graphics to move all steps  simultaneously • Step parameter defines the number of sub‐ protocols, and which sub‐protocol is actually  active • A new sub‐protocol is initially an exact copy of  the previous active sub‐protocol 85 Unrestricted © Siemens Healthineers, 2020 Notes 213MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Set‐n‐Go • Steps in a Set‐n‐Go protocol are scanned one after the  other, in the pre‐defined order • Set‐n‐Go protocol continues to ‘run’ until the last sub‐ protocol is completed • Each ‘completed’ sub‐step is visualized as a step in the  queue • Steps in queue are labelled 1.1, 1.2, … • ‘Sub‐step indicator’ indicates how many steps remain • To repeat a single step, phoenix from GSP, stamp  segment, or from MR View&GO into the queue • To repeat all steps, phoenix composed step into queue  (or use context menu to repeat step) • Phoenix of a Set‐n‐Go step from Patient Browser into  queue will repeat all steps 86 Unrestricted © Siemens Healthineers, 2020 Notes 214MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP FastView Localizer FastView Localizer 87 Unrestricted © Siemens Healthineers, 2020 Notes 215MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP FastView Localizer • TimCT FastView is the “one go” localizer for the whole body or  large body regions such as the whole spine etc. • It acquires the complete extended Field of View in one volume  with isotropic resolution • Transverse, coronal and sagittal reformats of the volume are  calculated in‐line and displayed for planning subsequent exams  Inline reconstruction of the localizer images during the scan   Localizer images in three planes over the maximum Field of  View available for subsequent planning in all orientations  88 Unrestricted © Siemens Healthineers, 2020 Notes 216MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP TimCT FastView Localizer • Gradient‐echo sequence • Used for localizer images of large body  3 T regions with transverse slices and continuous  table movement 1.5 T 89 Unrestricted © Siemens Healthineers, 2020 Notes 217MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP TimCT FastView Localizer 90 Unrestricted © Siemens Healthineers, 2020 Notes 218MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP TimCT FastView Localizer 91 Unrestricted © Siemens Healthineers, 2020 Notes 219MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP TimCT FastView Localizer • FastView Adjustments acquire the frequency adjustments at every table position which can be used for subsequent  measurements, which in turn reduces time • If this is checked then the B0 Shim field is displayed where  Tune up or Standard can be selected • With Tune up, only freq adjustments are calculated, the shim  settings are defined by Siemens Service • If Standard is selected the table will drive through the magnet one more time to acquire a TimCT based shim and  adjustment for each table position • In subsequent measurements, if FastView  is selected in the “Adjustment Strategy” field, then the frequency  adjustments acquired with the FastView localizer will be used  92 Unrestricted © Siemens Healthineers, 2020 Notes 220MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP TimCT FastView Localizer Summary  • The FastView sequence is based on a fast 2D gradient echo sequence with fixed sequence parameters and runs  without further sequence adjustments.  • The acquisition scan plane is transversal. The scanning range extends from the head region down to the feet  with almost whole‐body coverage. • Subsequent to data acquisition, large field‐of‐view (FoV) coronal and sagittal slices are automatically  reformatted and displayed online. These reformats provide a gross overview of the patient’s anatomy and  serve as localizers to plan further examination steps. • Since the FastView sequence uses only low flip angles for spin excitation, this sequence is noncritical with  regards to the specific absorption rate (SAR).  • While the FastView is being acquired, the MRI system automatically detects and displays individual RF coil  positions of the Tim Matrix coils with regard to their location on the patient’s body.  • FastView provides all relevant scanner adjustment parameters with feedback to the system while the scan is  being acquired. H H. Quick et al, MRI on the Move: syngo TimCT, MAGNETOM Flash 3/2006 93 Unrestricted © Siemens Healthineers, 2020 Notes 221MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Knowledge Check 1.  Sub‐protocols are the same sequence,  2.    _____________________is an  but may have the same parameters (e.g.  effective method for early diagnosis,  table position, FoV, matrix, coil selection,  staging, and assessment of therapeutic  TR, TE, etc.) response in oncology.  It uses the  a. True combination of morphologic MRI and DWI  b. False sequences. a. FastView Localizer b. Whole Body MRI c. Thorax Author | Department 94 Unrestricted © Siemens Healthineers, 2020 Notes 222MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Compressed Sensing (CS) GRASP-VIBE Compressed  Sensing (CS) GRASP‐VIBE MR Applications Fundamentals – Part Two Presenter, Calibri 16 pt English, Month 2019 Unrestricted © Siemens Healthineers, 2020 Unrestricted Notes 223MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Agenda • Review of Golden Rules for Compressed  Sensing (CS) • Challenges with Conventional Liver Imaging  • Review of GRASP‐VIBE Principles • GRASP‐VIBE Liver • Parameter Card • Hints & Tips 2 Unrestricted © Siemens Healthineers, 2020 Notes 224MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Objectives • Explain Golden Rules for CS • Define the benefits of GRASP‐VIBE • Identify GRASP‐VIBE Protocols • Identify parameters for GRASP‐VIBE 3 Unrestricted © Siemens Healthineers, 2020 Notes 225MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Contrast Disclaimer Contrast Disclaimer –A licensed physician may choose to use FDA‐approved contrast agents  in conjunction with an MRI exam, based on his/her medical opinion and discretion and in  accordance with the instructions for use and indications for use supplied by the  pharmaceutical manufacturer for the contrast agents 4 Unrestricted © Siemens Healthineers, 2020 Notes 226MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Review of Golden Rules for Compressed Sensing (CS) Review of Golden Rules for  Compressed Sensing (CS) 5 Unrestricted © Siemens Healthineers, 2020 Notes 227MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Compressed Sensing 6 Unrestricted © Siemens Healthineers, 2020 Notes 228MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Golden Rules for CS 1) Incoherent ("random") subsampling "Noise‐like" aliasing artifacts, faster imaging 2) Transform Sparsity Compressibility of image (in a certain domain) 3) Non‐linear iterative reconstruction Balancing of data consistency vs. sparsity 1 2 3 Unrestricted Siemens Healthineers, 2020 Notes 229MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Challenges with Conventional Liver Imaging Challenges with  Conventional Liver Imaging 8 Unrestricted © Siemens Healthineers, 2020 Notes 230MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Liver MRI is the best abdominal imaging test, but quality is often insufficient due to motion 9% 7% of patients  of patients were  undergoing  unable to suspend  abdominal MRI are  respiration unable to hold their  breath for 15s or  more Lee V, et al., Radiology 2000:365-372; Krinski G, et al., Radiology 2001:219:445-454 Unrestricted Siemens Healthineers, 2020 9 Notes 231MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Acute transient dyspnea during application of contrast agent  is unpredictably leading to severe artifacts in 16‐36% of cases1 Image Acquisition 16-36% Breath‐hold failure due to involuntary breathing  in the arterial phase during contrast application 1 Motosugi U etl al., An Investigation of Transient Severe Motion Related to Gadoxetic Acid‐enhanced MR Imaging. Radiology. 2016;279:93‐102. Unrestricted Siemens Healthineers, 2020 1 0 Notes 232MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Expand patient population suitable for liver MRI   with Compressed Sensing GRASP‐VIBE Push‐button,  4 breath‐holds, free‐breathing  critical timing with  liver dynamics contrast administration with CS GRASP‐VIBE 11 NYU, Lagone Medical Center, USA Unrestricted © Siemens Healthineers, 2020 Notes 233MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Push‐button scan instead of several breath‐hold scans  with complex timing Conventional Contrast 1st breath‐hold 2nd breath‐ 3rd breath‐ 4th breath‐hold hold hold         your your your your       Pre‐contrast    Arterial‐phase  Venous‐phase  Delayed phase  scan scan scan scan breath!” breath!” breath!” Hold Hold Hold Continue” breath!” Continue” Continue” Hold Continue” “ “ “ “ “ “ “ “ ~ 20 s ~ 60 s ~ 120 s Compressed Sensing                          GRASP‐VIBE Continuous radial scan Free breathing time Pre‐contrast  Arterial-phase Venous‐phase  Delayed phase  scan Arterial-phasescan scan scan Arterialscan ‐phase  scan 12 Unrestricted © Siemens Healthineers, 2020 Notes 234MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Review of GRASP-VIBE Principles Review of GRASP‐VIBE Principles 13 Unrestricted © Siemens Healthineers, 2020 Notes 235MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Compressed Sensing Grasp Golden‐Angle Acquisition Scheme • Angle continuously increased by 111.25° • Never acquires same spoke twice • Next spoke fills largest angular gap • Spokes always cover k‐space uniformly if #spokes is a  Fibonacci number  Winkelmann et al, IEEE T Med Imaging 2007: 26 14 Unrestricted © Siemens Healthineers, 2020 Notes 236MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Compressed Sensing GRASP – retrospective gating Inhaled Exhaled Retrospective gating • From the entire Signal  intensity of the 3D volume  within the temporal sub‐ samples, we are able to  Low mean intensity High mean intensity distinguish between  different breathing states Self‐gating signal • 2 Phases in actual product  implementation (inhaled =  lower 50%  [a.u.] exhaled = upper 50%)    Amplitude 0 s 5 s 10 s 15 s 15 Unrestricted © Siemens Healthineers, 2020 Notes 237MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Compressed Sensing GRASP – Automatic (intrinsic) bolus  detection Automatic bolus detection Automatic bolus detection Variable temporal resolution GRASP • From the entire Signal intensity of  the 3D volume within the  temporal sub‐samples,  we are able to automatically  detect the arrival of the contrast  agent bolus Variable temporal resolution • For different time points we can  Conventional GRASP define variable temporal  resolutions VTR‐GRASP  Efficient bolus signal analysis  Faster reconstruction Grimm et al., #0696, Proc. ISMRM 2013.                      Grimm et al., #4366, Proc. ISMRM 2014. 16 Unrestricted © Siemens Healthineers, 2020 Notes 238MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP GRASP-VIBE Liver GRASP‐VIBE Liver 17 Unrestricted © Siemens Healthineers, 2020 Notes 239MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Compressed Sensing DCE Liver imaging with GRASP Continuous radial scan Free breathing time Portal Venous Pre‐Contrast Phase Arterial  Phase 1,  2,  3 Delayed  18 Unrestricted © Siemens Healthineers, 2020 Notes 240MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP GRASP Liver Protocols in Dot Cockpit  19 Unrestricted © Siemens Healthineers, 2020 Notes 241MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP GRASP AddIn for Liver Workflow: Alternative 1 • User specifies bolus transit time • Test Bolus is optional Phases Duration of the phases Temporal resolution of phases Bolus transit time Reconstructed volumes  Reconstruction mode Preview images 20 Unrestricted © Siemens Healthineers, 2020 Notes 242MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP GRASP AddIn for Liver Workflow: Alternative 2 With Auto Bolus detection. Phases Duration of the phases Temporal resolution of phases Delay after bolus Reconstructed volumes  detection Note: If bolus is not detected, all  Reconstruction mode measurements will be  Auto Bolus Detection  reconstructed with the highest  user defined temporal resolution  Preview images e.g. here: ~8.2s 21 Unrestricted © Siemens Healthineers, 2020 Notes 243MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP GRASP Dynamic Parameter Card Liver Workflow 22 Unrestricted © Siemens Healthineers, 2020 Notes 244MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP GRASP Liver Gating vs Non Gating gatinggating no gatingno gating more undersampling artifacts less sharp more undersampling artifacts less sharpness courtesy Univ. Basel Unrestricted Siemens Healthineers, 2020 Notes 245MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP GRASP Liver Gating vs Non Gating gating no gating more undersampling artifacts less sharp Unrestricted Siemens Healthineers, 2020 Notes 246MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Parameter Card Parameter Card 25 Unrestricted © Siemens Healthineers, 2020 Notes 247MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP GRASP Dynamic Parameter Card (example from Liver Workflow) 1. Dynamic Mode: Standard or GRASP  dynamic methods can be selected 2. Reconstruction: select whether all  1 phases, reduced phases or whether both  2 should be reconstructed –more details in  later slides 3 3. Phases: these can be defined by the user.  The default liver protocols have multiple  phases to evaluate the pre‐contrast,  arterial, portal venous and delayed  enhancement. The protocols in the pelvis  by default have 2 phases defined for pre  and post contrast 26 Unrestricted © Siemens Healthineers, 2020 Notes 248MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP GRASP Dynamic Parameter Card (example from Liver Workflow) 4. Duration: this is similar to pause between  measurements in conventional dynamic  scans: • 22s ‐ duration of pre contrast scan • 30s ‐ acquisition duration for arterial  scans and time delay between arterial  and portal venous 4 • 180s ‐ acquisition duration for portal  venous scans and time delay between  portal venous and delayed phase • 45s ‐ acquisition duration for delayed  scans and time between delayed  phase and end of scan 27 Unrestricted © Siemens Healthineers, 2020 Notes 249MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP GRASP Dynamic Parameter Card (example from Liver Workflow) 5. Temporal Resolution: defines the  acquisition time of each reconstructed  volume 6. Reconstructed Volumes: defines the  number of measurements that will be  labelled when the contrast agent box is  ticked in the injection pause 5 7. Workflow: Liver or General can be  6 selected. If Liver is selected then Liver  7 Gating and Auto Bolus Detection features  become available for the user. In the  pelvis protocols the General Workflow is  used 28 Unrestricted © Siemens Healthineers, 2020 Notes 250MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP GRASP Dynamic Parameter Card (example from Liver Workflow) 8. Liver Gating: if checked, all data from  inspiration phases are excluded and only  data from expiration is used for  reconstruction 9. Auto Bolus Detection: If checked, the  contrast arrival is automatically detected  10. Delay After Bolus: is the time delay before  start of arterial phase after contrast  injection. Can be used in conjunction with  Test Bolus  8 9 11. Preview: if checked, 4 images from the  11 10 middle of every measurement are  reconstructed  29 Unrestricted © Siemens Healthineers, 2020 Notes 251MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP GRASP Dynamic Parameter Card When hovering over the Temp Res we see the  radial views per slice per time point. 30 Unrestricted © Siemens Healthineers, 2020 Notes 252MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP GRASP Resolution Parameter Card In the Resolution > Common parameter card we see  the radial views per slice for entire measurement. 31 Unrestricted © Siemens Healthineers, 2020 Notes 253MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP CS GRASP – reconstruction modes Complete Series:  • One series with all time points with the  specified temporal resolution is  generated • User can specify (with parameter:  reconstructed volumes) how many  volumes will be labeled (starting from  beginning of the respective phase). This is  needed for viewing and post‐processing.  Labeled  volumes will be sent to PACS • If Auto Bolus Detection fails, volumes  with the highest temporal resolution will  be reconstructed. Labeling will be  according to the defined duration of the  phases 32 Unrestricted © Siemens Healthineers, 2020 Notes 254MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP CS GRASP – reconstruction modes Reduced Series:  • One series with reduced  volumes/timepoints is generated • All timepoints are labeled  and will be  sent to PACS Complete and Reduced Series: • Complete Series (as on previous slide)  for Tissue4D • Reduced Series (as above) for PACS 33 Unrestricted © Siemens Healthineers, 2020 Notes 255MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP GRASP Automatic Countdown for Liver Workflow) Automatic Countdown: • A countdown will begin after the start of the measurement • It is the time needed to acquire the pre‐contrast measurement • Contrast should be administered when the time runs out 34 Unrestricted © Siemens Healthineers, 2020 Notes 256MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP GRASP Automatic Countdown for Prostate/General Workflow Automatic Countdown: Also available in pelvis / general protocol 35 Unrestricted © Siemens Healthineers, 2020 Notes 257MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Hints & Tips Hints & Tips 36 Unrestricted © Siemens Healthineers, 2020 Notes 258MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP GRASP‐VIBE Hints and Tips • Good patient instructions  • Encourage shallow breathing (automatic voice  commands available) • Use sat bands over arms and keep arms close to the  patients sides (or above head) • For bigger patients (arms exceed spine coil  dimension/side rails L_R), arms should be positioned  above the head • Can also raise one arm (on the side of liver) to help  reduce artifacts • Limit coil selection to imaging volume 37 Unrestricted © Siemens Healthineers, 2020 Notes 259MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP GRASP‐VIBE Hints and Tips: Arms & Sat's Positioning Arms close Arms far from body Arms above the head,  no SatBands 38 Unrestricted © Siemens Healthineers, 2020 Notes 260MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP GRASP‐VIBE Hints and Tips: Arms & Sat's Positioning Gated  with arms far Non‐gated with arms far Gated with arms closer Gated with arms closer (or up!) sats closer 39 Unrestricted © Siemens Healthineers, 2020 Notes 261MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP GRASP‐VIBE Hints and Tips • Grasp data not visible in exam queue‐ no head icon. Will be loaded to MR View&Go after reconstruction • Retro recon can be used to recon images with different settings but there will always be a comment in  the images informing user that these are not for diagnostic use • Recommended scan time should never be less than 5mins (especially for liver) • Minimum radial views for Liver  • 27 radials for gated • 21 radials for non‐gated • If contrast is not detected in protocol with Auto Bolus Detection, then all reconstructed volumes will be  calculated with highest defined temporal resolution 40 Unrestricted © Siemens Healthineers, 2020 Notes 262MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP GRASP‐VIBE Hints and Tips Labels in Series Navigator: • The reconstructed volumes will not be labelled if the  contrast agent check box is not ticked • This means no labels will be visible in the Series Navigator • These labels will also not be visible in the segment next to  the phase information or on the navigation axis of the 4D  Navigation tool (movie tool) • The DICOM standard attribute Contrast/Bolus Agent Phase  (0018,9344) of the Contrast/Bolus Usage Macro is used to  define the labels • The labels will still be displayed as an image comment in the  bottom of the segment  41 Unrestricted © Siemens Healthineers, 2020 Notes 263MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP GRASP‐VIBE Hints and Tips Contrast agent check box ticked  Labels available in Series Navigator, in segment next to phase information  and on movie navigation axis  42 Unrestricted © Siemens Healthineers, 2020 Notes 264MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Knowledge Check 4. ____________is similar to pause  2. If you hoover your mouse over the  between measurements in conventional  temporal resolution, you see the  dynamic scans. number of __________. a. Phases a. Phases b. Duration b. Duration c. Radial views per slice c. Radial views per slice d. slices d. slices Author | Department 43 Unrestricted © Siemens Healthineers, 2020 Notes 265MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Pelvic Imaging Pelvic Imaging MR Applications Fundamentals – Part Two Presenter, Calibri 16 pt English, Month 2019 Unrestricted © Siemens Healthineers, 2020 Unrestricted Notes 266MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Agenda • Prostate Imaging • Cervix Imaging • Bowel Imaging • Kidney Imaging 2 Unrestricted © Siemens Healthineers, 2020 Notes 267MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Objectives • Identify Prostate Protocols • Describe Female Pelvis Protocols to be used  for cervix imaging • Explain the sequences to be used for bowel  imaging • Identify protocols to be used for kidney  imaging 3 Unrestricted © Siemens Healthineers, 2020 Notes 268MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Pelvic Imaging Contrast Disclaimer: A licensed physician may choose to use FDA‐approved contrast agents in  conjunction with an MRI exam based on his/her medical opinion and discretion and in accordance  with the instructions for use and indications for use supplied by the pharmaceutical manufacturer  for the contrast agents. 4 Unrestricted © Siemens Healthineers, 2020 Notes 269MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Prostate Imaging Prostate Imaging 5 Unrestricted © Siemens Healthineers, 2020 Notes 270MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Prostate Imaging  Motivation Multi Parametric Prostate MRI • The role of MRI has evolved over the past decade  Prostate Cancer … with the development of newer techniques to  • is the most common non‐cutaneous malignancy  localize, stage, and obtain functional information in the western world • the most common cancer and the second most  common cause of cancer deaths among men • Management of prostate cancer is complex  because of the difficulty in accurate staging and in  predicting the speed of progression Prostate cancer detection include: • digital rectal examination (DRE) • serum prostate‐specific antigen (PSA) level • transrectal ultrasound with sextant biopsy 6 Unrestricted © Siemens Healthineers, 2020 Notes 271MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Prostate Imaging  Peripheral Zone Transition Zone Anatomy of the prostate gland Central Zone • The three main glandular zones and their  respective gland volume (in young men) are: • The peripheral zone (PZ) with ~70% • The central zone (CZ) with ~25% • The transition zone (TZ) with ~5% • Additionally, one stromal zone (anterior  fibromuscular stroma, blue area in images) 7 Unrestricted © Siemens Healthineers, 2020 Notes 272MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Prostate Imaging  Endorectal Coil – Basic Information 1.5T 3T Disposable coil Endorectal adapter • 1 channel coil  • Single use only • Combine with body coils  • Only feet first   Endorectal interface 8 Unrestricted © Siemens Healthineers, 2020 Notes 273MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Prostate Imaging  Endorectal Coil • Positioning: the coil cable is routed through the  tunnel of the endo cushion 9 Unrestricted © Siemens Healthineers, 2020 Notes 274MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Prostate Imaging  Prostate 2 Coil* ‐Basic Information • 2 channel coil • Re‐usable • Combine with body coils • Head or feet first possible Feet‐first position:  support with Body  18 Prostate 2 coil Head‐first position:  support with the  Mounting clip  spine coil Stabilization arm Patient support  * This coil from the MAGNETOM Aera or MAGNETOM Skyra  system can still be used with the new MAGNETOM Sola Fit and  10 MAGNETOM Vida Fit systems. Unrestricted © Siemens Healthineers, 2020 Notes 275MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Prostate Imaging  Body30/Body60 Coil  • A flexible body‐array coil(s) for different body  regions, e.g. abdomen, thorax, liver, pelvis The use of Body30 coil • Combined with second anterior Body 30 and/or  Spine Coil • Can be rotated by 90° • Dedicated Pre‐Scan Normalize scans for different  combinations of the Coil(s) Body30 Coil layout • 6 elements in L‐R direction, 5 elements in H‐F • Coil element diameter: 10 cm • Coil dimensions: 56x44 cm2 11 Unrestricted © Siemens Healthineers, 2020 Notes 276MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Prostate Imaging  Two Body30 coils could form a Body60 coil • Remove the spine coil, put one Body30 in  anterior and the other one in posterior position • Can be positioned for different body parts,  supported by different cushion combinations • Anterior and Posterior Position must match in  H‐F direction 12 Unrestricted © Siemens Healthineers, 2020 Notes 277MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Prostate Imaging  PI‐RADS (Prostate Imaging Reporting and Data  System) provides guidelines for interpreting  prostate multiparametric MR imaging  Two main contrasts are used : • T2 weighted imaging: dominant for TZ • T2 TSE in 3 orientations  • 3D SPACE with (almost) isotropic resolution  • DWI : dominant for PZ • Typical b‐value= 50, 800 • Additional high b‐value (b≥1400) could be  acquired or calculated  Dynamic contrast enhanced (DCE) image is only  used to distinguish in PZ between score 3 and 4  13 Unrestricted © Siemens Healthineers, 2020 Notes 278MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP PI‐RADS v.2 Our imaging protocol setups are also adapted to PI‐RADS v.2 14 Unrestricted © Siemens Healthineers, 2020 Notes 279MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP PI‐RADS v.2 Ref: Purysko AS et al., PI‐RADS v.2 update. RadioGraphics 2016; 36:1354–1372 15 Unrestricted © Siemens Healthineers, 2020 Notes 280MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Prostate Image Examples Images acquired @3T • T2 TSE in tra, cor, and sag views Unrestricted Siemens Healthineers, 2020 Notes 281MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Prostate Image Examples Images acquired @3T • Diffsuion in single‐shot EPI and RESOLVE Unrestricted Siemens Healthineers, 2020 Notes 282MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Prostate Image Examples Images acquired @3T • DCE in TWIST, VIBE and GRASP Unrestricted Siemens Healthineers, 2020 Notes 283MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Prostate Imaging  Morphological imaging  • T2 weighted image suggestions from PI‐RADS  • Slice thickness 3mm, no gap. Location should  be the same as those for DWI and DCE • FOV 120 to 200mm to include the entire  prostate and seminal vesicles  • In‐plane resolution ≤ 0.7mm(PE) x 0.4mm(RO) • T1 weighted image is used to distinguish  hemorrhage from tumors • Hemorrhage shows high signal intensity in T1 T1W‐images determine the presence of post‐biopsy hemorrhage Ref: https://radiologyassistant.nl/abdomen/prostate/prostate‐cancer‐pi‐rads‐v2 19 Unrestricted © Siemens Healthineers, 2020 Notes 284MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Prostate Imaging  Diffusion weighted imaging  • It is dominant for the evaluation of lesions in the  PZ • T2 is dominant for the evaluation in the TZ, but  DWI may have additional value  • At least two b‐values for ADC calculation (1) 50‐100, and  (2) 800‐1000 • Inclusion of an additional high‐b value image  (b=1400‐2000) is recommended Ref: Purysko AS et al., PI‐RADS v.2 update. RadioGraphics 2016; 36:1354–1372 20 Unrestricted © Siemens Healthineers, 2020 Notes 285MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Prostate Imaging  Image examples: T2, single‐shot DWI DWI examples: single shot vs. RESOLVE TSE T2 b=800 RESOLVE b=800 Single Shot, b=800 ADC calc. b=1400 RESOLVE, ADC Single Shot, ADC Unrestricted Siemens Healthineers, 2020 Notes 286MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Prostate Imaging  ZOOMit with Endorectal coil for DWI b100 b400 ADC ZOOMit DWI, matrix T2 TSE, matrix 384, 58 x 98, SL 3 mm, FoV GRAPPA 2, TA 3:36 min 71 x 120, TA 4:21 b800 b1200 Kantonsspital Aarau, Aarau,  Unrestricted Siemens Healthineers, 2020 Switzerland Notes 287MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Prostate Imaging  DCE imaging • Check if the dynamic images show focal and  In PI‐RADS v.1 includes three types of dynamic  earlier enhancement corresponding to a finding  curves for scoring on T2 or DWI images DWI  T2 Calc. b=1500 DCE ADC Ref: Purysko AS et al., PI‐RADS v.2 update. RadioGraphics 2016; 36:1354–1372 23 Unrestricted © Siemens Healthineers, 2020 Notes 288MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Prostate Imaging: Examples Gleason 8 tumor (PSA=117ng/ml) Low‐grade Gleason 6 tumor (PSA=10ng/ml) T2 ADC T2 ADC DCE Ref: Murphy G et al., AJR 2013;  Unrestricted Siemens Healthineers, 2020 201:1229–1238 Notes 289MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Cervix Imaging Cervix Imaging 25 Unrestricted © Siemens Healthineers, 2020 Notes 290MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Cervix Imaging  MRI can be used for detecting and staging  endometrial and cervical cancers • Good for preoperatively assessing myometrial  invasion depth and cervical involvement for  endometrial cancer • Good for assessing primary tumors over 10mm in  size for cervical cancer  https://www.britannica.com/science/cervix Protocols would include T1, T2, DCE and DWI  measurements   Planning for  Planning for  endometrial cancer cervical cancer 26 Otero‐García et al. Insights into Imaging (2019) 10:19  Unrestricted © Siemens Healthineers, 2020 https://doi.org/10.1186/s13244‐019‐0696‐8 Notes 291MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Cervix Imaging  Protocol examples  Protocol in Siemens Tree Ref: Otero‐García et al. Insights into Imaging (2019) 10:19 https://doi.org/10.1186/s13244‐019‐0696‐8 27 Unrestricted © Siemens Healthineers, 2020 Notes 292MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Cervix Imaging  T2 weighted imaging • High resolution T2 is the mainstay for tumor  detection  • Oblique axial T2W images planned perpendicular  to the cervical long axis provide more accurate  assessment of stromal involvement and  parametrial invasion  • Fat‐suppressed sequences can be useful for the  Normal cervix images in T2 contrast1 evaluation of parametrial involvement cervical cancer with  bladder invasion2 Ref: 1. Patel‐Lippmann K, et al., J. MR Imaging of Cervical Cancer. Magn Reson Imaging Clin N Am. 2017;25(3):635‐649. 2. Otero‐García et al. Insights into Imaging (2019) 10:19 https://doi.org/10.1186/s13244‐019‐0696‐8 28 Unrestricted © Siemens Healthineers, 2020 Notes 293MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Cervix Imaging  Diffusion weighted imaging  • DWI can be applied to the detection of cervical  cancer: increased signal intensity and low ADC  Transitional bladder cancer invading the cervix values on tumor  • It is complimentary to T2WI in recognizing early‐ stage disease.   • ADC values can be a useful tool in monitoring  response to therapy T2 Sag T2 Tra (oblique) T2 + DWI Ref: Otero‐García et al. Insights into Imaging (2019) 10:19 https://doi.org/10.1186/s13244‐019‐0696‐8 29 Unrestricted © Siemens Healthineers, 2020 Notes 294MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Cervix Imaging  ZOOMit for Uterus  Conventional DWI Matrix 140x140  FOV 200x200 B=50 B=400 B=800 ADC T2 TSE, GRAPPA=2  Matrix 310x320  Zoomit FOV 200x200 Matrix 54x90 FOV 89x149 Unrestricted Siemens Healthineers, 2020 Notes 295MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Cervix Imaging  Dynamic contrast enhanced (DCE) images  • Small tumor detection may be improved due to  • Small cell neuroendocrine tumor with  the early enhancement relative to the adjacent  myometrium and cervical invasion normal cervix  • Improves accuracy of diagnosing bladder and  rectal invasion.  • Useful in the post‐treatment setting to  differentiate residual or recurrent tumor from  radiation fibrosis. T2 Sag T1 DCE Sag Ref: Otero‐García et al. Insights into Imaging (2019) 10:19 https://doi.org/10.1186/s13244‐019‐0696‐8 31 Unrestricted © Siemens Healthineers, 2020 Notes 296MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Cervix Imaging  Dynamic contrast enhanced (DCE) images  Malignant lymphoma T2 Sag T1 Sag Pre-contrast T1 Sag Post-contrast Ref: Okamoto Y et al., RadioGraphics 2003; 23:425– Unrestricted Siemens Healthineers, 2020 445 Notes 297MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Knowledge Check 1. PI‐RADS recommends using two main  2. The ______________ T2 weighted  contrasts, which are T2 weighted  images should be planned  imaging and ____________. perpendicular to the cervical long axis  A. T1 VIBE to provide a more accurate assessment  B. T1 FLASH of stromal involvement.  C. DWI A. Axial D. DTI B. Oblique Axial C. Coronal D. Sagittal Author | Department 33 Unrestricted © Siemens Healthineers, 2020 Notes 298MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Bowel Imaging Bowel Imaging 34 Unrestricted © Siemens Healthineers, 2020 Notes 299MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP MR Small Bowel Imaging  • The main clinical application of MR small bowel  imaging is for Crohn disease due to the needs of  multiple follow‐up exams  • MR imaging can demonstrate complications of  Crohn disease, including penetrating disease,  bowel obstructions, and perianal fistulation  Two Techniques: • MR enterography  • Large volumes of fluid are ingested   • MR enteroclysis  • Enteric contrast medium is administered  T2 Cor TrueFISP* through a nasoenteric tube  T1 VIBE with Gd * Ref images from Fidler JL et al., RadioGraphics 2009; 29:1811–1825 35 Unrestricted © Siemens Healthineers, 2020 Notes 300MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP MR Bowel Imaging Anatomy – Intestines • Small Intestine (Small Bowel) • Duodenum, jejunum, and ileum • Large Intestine (Large Bowel) or Colon • Rectum and ends at the anus 36 Unrestricted © Siemens Healthineers, 2020 Images from Wikipedia website Notes 301MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP MR Small Bowel Imaging  MR Enterography  • Patient Prep (Radiologists Discretion) • Bowel Prep ‐ Day before examination • NPO –4 to 6 hours prior to exam 1 2 • Oral Contrast and Intravenous Contrast • Glucagon is administered after drinking all the  enteric contrast medium  • Reducing bowel peristalsis and motion  3 4 artifacts • T2 and T1 post‐contrast images are helpful  5 Active Crohn disease* progressive rapid bowel wall enhancement  within the first 70 seconds after IV • Ref images from Fidler JL et al., RadioGraphics 2009; 29:1811–1825 37 Unrestricted © Siemens Healthineers, 2020 Notes 302MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP MR Small Bowel Imaging  Before Glucagon After Glucagon Unrestricted Siemens Healthineers, 2020 Notes 303MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP MR Small Bowel Imaging  MR Enteroclysis  • A nasoenteric tube is placed during fluoroscopy  before MR enteroclysis T1 2D‐FLASH  • Enteric contrast medium is manually injected   with Gd when patients in the scanner • Use T2 images to monitor the small bowel  filling  • Other preparations and imaging protocols are  similar to MR enterography T2 fat‐sat  TrueFISP Active inflammation  or fibrosis  Unrestricted Siemens Healthineers, 2020 Notes 304MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP MR Small Bowel Imaging  Pseudosacculations  Acute chronic Crohn’s inflammation T2 TrueFISP T1 post‐contrast T1 post‐contrast Ref: Melamud K et al., Applied Radiology June 2016 Unrestricted Siemens Healthineers, 2020 Notes 305MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP MR Colonography Bowel preparation and colonic distension maybe  not necessary, however  • Rectal distension is considered for assessment of  smaller or polypoid lesions, or in post‐operative  recurrence • Infusion of warm water or warm ultrasound gel  into the rectum before the scan The use of rectal gel is not recommended for low  rectal tumors • Distention of the rectum can efface the small  amount of perirectal fat around the lower rectum  and obscure nodes in the lower mesorectum T1 post‐contrast for a distended colon  Unrestricted Siemens Healthineers, 2020 Notes 306MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP MR Colonography Imaging protocols T2 contrast image is the most important information normal • Sagittal and transverse T2 for overviews  • Small FOV T2 through tumors to obtain details Diffusion weighted imaging would be optional Post‐contrast T1 image • To visualize polyps, masses and inflammation   T1 post‐contrast  T1 post‐contrast  Pedunculated polyp Ulcerative colitis Ref: Thornton E et al., RadioGraphics 2010; 30:201–218 42 Unrestricted © Siemens Healthineers, 2020 Notes 307MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP MR Colonography Rectal adenocarcinoma ‐ metastatic T2 Sag T2 Tra DWI Ref: https://radiopaedia.org/cases/rectal‐ Unrestricted Siemens Healthineers, 2020 adenocarcinoma‐metastatic?lang=us Notes 308MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Proctogram for Pelvic Floor Clinical Indications • Proctogram – Clinical Indications • Pelvic floor abnormalities • Stress Urinary Incontinence (SUI) • Pelvic Organ Prolapse (POP) • Anal Incontinence • Fecal Incontinence • Obstructed Defecation 44 Unrestricted © Siemens Healthineers, 2020 Notes 309MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Proctogram for Pelvic Floor Patient Preparation • Protogram – Patient Preparation • Bowel Prep – 24 hours prior to procedure (e.g.,optional) • NPO –2 to 4 hours • Lidocaine Gel – Place on tubing for insertion into rectum • Per Radiologist discretion • Ultrasound Gel – Short flexible tube inserted in rectum • Ultrasound gel introduced into rectum with patient outside of bore • Don’t Void Bladder –1 hour prior to examination • Anterior and middle compartment dysfunction (e.g. , vaginal valut eversion and prolapse)  better assessed when bladder distended 45 Unrestricted © Siemens Healthineers, 2020 Notes 310MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Proctogram for Pelvic Floor Patient Preparation • Portogram ‐ Patient Preparation • Plastic drape placed on table • Lateral decubitus for tubing and ultrasound gel insertion • Supine for imaging • Coils • Body 18 and BioMatrix Spine 32 • Endorectal Coil (optional) • Complete survey of pelvic area multiple orientations • Sagittal slices for dynamic imaging • Note: Endorectal coil used, it is removed before insertion of the tubing and ultrasound gel 46 Unrestricted © Siemens Healthineers, 2020 Notes 311MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP MR Defecating Proctography Preparation 100‐150ml ultrasound gel is instilled per rectum Imaging sequences Dynamic T2 weigthed imaging (e.g. TrueFISP) Image Courtesy of Dr. W. Judmaier, Unrestricted Siemens Healthineers, 2020 innsbruck Uni-Klinik Notes 312MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Kidney Imaging Kidney Imaging 48 Unrestricted © Siemens Healthineers, 2020 Notes 313MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Kidney MRI Due to the nice soft‐tissue contrast, it is helpful to  detect and characterize the renal lesions • Normal T1, T2 contrast images and T1 post‐ contrast scan would be used  MR urography could visualize the genitourinary  system  • Very strong T2 contrast and/or T1 dynamic scans  would be used  49 Unrestricted © Siemens Healthineers, 2020 Notes 314MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Kidney MRI Conventional protocols may include: T1 VIBE pre‐ & post‐contrast T2 TSE Tra (with fat suppression) • Post‐contrast images could be used for renal  • Characterizing cysts and intraparenchymal  venous anatomy, the analysis of thrombus and  abscesses evaluation of extent of the tumor in the  • Evaluating hydronephrosis perinephric fat • Detecting solid lesions  T1 FL Tra in/opp phase • Many solid renal lesions are hypointense  compared to renal parenchyma  • Lesions with hemorrhage, macroscopic fat, cysts  with hugh protein content may show  hyperintense signal  • Opp‐phase used to prove the presence of small  amounts of fat  Ref: Nikken JJ et al., MRI of the kidney. Eur Radiol (2007) 17: 2780–2793 50 Unrestricted © Siemens Healthineers, 2020 Notes 315MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Kidney MRI Pathologic exam: cystic renal cell  carcinoma T2 TSE T1 Pre‐contrast T1 Post‐contrast Cystic multiloculated lesion Ref: Nikken JJ et al., MRI of the kidney. Eur Radiol (2007) 17: 2780–2793 51 UnrestrictedUnrestricted © Siemens Healthineers, 2020 Notes 316MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Kidney MRI MRI renal mass protocol from Society of Abdominal Radiology*  * https://cdn.ymaws.com/www.abdominalradiology.org/resource/resmgr/education_dfp/RCC/RCC.MRIprotocolfinal‐7‐15‐17.pdf 52 Unrestricted © Siemens Healthineers, 2020 Notes 317MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP MR Urography Applications • Early diagnosis for the management of congenital  malformations and other urogenital anomalies in  children • Assessing renal obstruction  Protocols  • Heavy T2‐weighted image (2D or 3D) • T1‐weighted images with contrast, acquired in  excretory phase (5‐8mins after CM) Reasons of signal loss in MRU • Calculus, blood clots, gas, tumors • If a signal void is not clearly detached from the  wall of the pelvis or ureter, additional T1 contrast‐ enhanced images are necessary 53 Unrestricted © Siemens Healthineers, 2020 Notes 318MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP MR Urography • MR Urography – Protocol • Siemens > Abdomen > Clinical Libraries >  Kidneys • Patient Prep • Void prior to Exam 54 Unrestricted © Siemens Healthineers, 2020 Notes 319MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP MR Urography T2 Cor  CINE MR Urography Obstruction @ right distal ureter T2 Thick‐slab Ref: Leyendecker JR et al., MR Urography RadioGraphics 2008;  55 UnrestrictedUnrestricted © Siemens Healthineers, 2020 28:23– 48 Notes 320MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP MR Urography Normal MR Urogram in 5‐year‐old boy T2 Cor pre‐contrast MIP in arterial phase MIP during excretion Ref: Hadjidekov G et al., Assessing renal function in children with hydronephrosis. Radiol Oncol 2011; 45(4): 248‐ 258 Unrestricted Siemens Healthineers, 2020 Notes 321MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Renal Dynamic Imaging Assessment of renal perfusion is helpful in several  renal diseases  • Renal artery stenosis (RAS) • Renal transplant dysfunction  Reduced renal perfusion is associated with  increased morbidity and mortality Measurement protocols Sequences: T1‐2D‐FLASH or T1‐VIBE Acquisition time: • Estimates of renal perfusion about 20‐30s • Longer acquisition time is used for assessment of  the filtration an tubular properties (2‐5mins) 57 Unrestricted © Siemens Healthineers, 2020 Notes 322MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Renal Perfusion Healthy Volunteer turboFLASH + PAT turboFLASH trueFISP Signal-time curves from different sequences Unenhanced phase Early arterial phase Medullary phase Ref: Michaely HJ et al., AJR 2007;  Unrestricted Siemens Healthineers, 2020 188:919–926 Notes 323MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Diffusion in Kidney • DWI shows good correlation with renal function  decline and with cortical fibrosis in chronic  kidney disease  • In diffuse renal diseases, DWI could support the  decisions to perform renal biopsy and avoid  unnecessary interventions  DWI measurements • Slice orientation could be transverse or coronal  • Coronal view: easier for full coverage but more  prone to respiratory motion  • Two b‐value between 0 and 800  Normal kidney CKD patients with 60% fibrosis • Note: no default protocols configured in Siemens  tree Ref: Caroli A et al., Nephrol Dial Transplant (2018) 33: ii29–ii40 59 Unrestricted © Siemens Healthineers, 2020 Notes 324MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Diffusion in Kidney Renal allograft function assessment  b0 ADC b0 ADC Recipient with  Recipient with good  moderately impaired  impaired allograft  FA allograft function FA function Ref: Fan W et al., MAGNETOM Flash   Unrestricted Siemens Healthineers, 2020 3/2014 Notes 325MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Knowledge Check 1. MR ____________ is an exam where  2. For DWI imaging of the kidney, the two  large volumes of fluid are ingested and  b‐values are between 0 and  the small bowel is imaged. ___________. A. Urography A. 800 B. Enterography B. 1000 C. Enteroclysis C. 1500 Author | Department 61 Unrestricted © Siemens Healthineers, 2020 Notes 326MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP MR Breast Imaging MR Breast Imaging MR Applications Fundamentals‐ Part Two Presenter, Calibri 16 pt English, Month 2019 Unrestricted © Siemens Healthineers, 2020 Unrestricted Notes 327MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Agenda • Breast Cancer • Breast Imaging • Coils and Planning • Morphology • Dynamic Imaging • Diffusion • Breast Silicone Implant Imaging • Special Considerations 2 Unrestricted © Siemens Healthineers, 2020 Notes 328MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Objectives • Objectives • Review Breast Cancer and Screening  Recommendations • Explain Breast Coils available on Siemens  MAGNETOM MR Systems • Discuss Patient Preparation and  Positioning  • Identify Siemens MR Breast Protocols • Explain  Implant Imaging techniques 3 Unrestricted © Siemens Healthineers, 2020 Notes 329MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Breast Imaging ‐ Disclaimer Contrast Disclaimer: A licensed physician may choose to use FDA‐approved contrast agents in  conjunction with an MRI exam based on his/her medical opinion and discretion and in accordance  with the instructions for use and indications for use supplied by the pharmaceutical manufacturer  for the contrast agents. 4 Unrestricted © Siemens Healthineers, 2020 Notes 330MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Breast Cancer Breast Cancer 5 Unrestricted © Siemens Healthineers, 2020 Notes 331MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP MR Breast Imaging Breast Cancer  • Breast Cancer1 • Most common cancer in women.  • On a global scale, every tenth woman is affected, and  numbers continue to rise.  • MR Breast Imaging can help provide: • Early and reliable diagnosis especially in difficult  cases.  • Can provide accurate preoperative staging and  differential diagnosis, resulting in faster and more  cost‐effective patient management. 1Reference: https://intranet.for.healthineers.siemens.com/cms/di‐ 6 Unrestricted © Siemens Healthineers, 2020 mr/en/business/clinicalspecialties/Pages/breast‐mri.aspx Notes 332MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP MR Breast Imaging Role of Breast MRI in Managing Breast Disease “Screening MRI is  recommended for women with  an approximately 20‐25% or  greater lifetime risk of  breast cancer.” American Cancer Society’s new screening guidelines will impact up  to 1.4 million women. A high percentage of these women will  benefit from breast MRI. CA Cancer J Clin 2007;57:75‐89. 7 Unrestricted © Siemens Healthineers, 2020 The information provided here is of general nature and not related to the  Notes 333MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Breast Cancer Types of breast carcinoma • Ductal • Carcinoma originating in the ducts of the  mammary gland • Lobular • Carcinoma originating in the lobules of the  mammary gland 1. Chest wall 2. Pectoralis muscles 3. Lobules 4. Nipple 5. Areola 6. Milk duct 7. Fatty tissue 8. Skin Image from https://en.wikipedia.org/wiki/Breast 8 Unrestricted © Siemens Healthineers, 2020 Notes 334MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Breast Cancer In situ carcinomas • Preliminary stages of breast carcinoma, limited to  the mammary ducts or glandular lobules • The most common (90%) is DCIS ‐ ductal  carcinoma in situ • Low‐grade DCIS: behaves relatively benignly  and in some cases never leaves the milk duct • High‐grade DCIS: always becomes invasive  breast cancer • LCIS (lobular carcinoma in situ) is rarer 9 Image from https://breast‐cancer.canceraustralia.gov.au/types/ductal‐carcinoma‐situ Unrestricted © Siemens Healthineers, 2020 Notes 335MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Breast Cancer Invasive breast cancer • The tumor penetrates the adjoining layers of  tissue, such as the connective tissue of the breast • If the tumor finds its way into the lymph and  blood systems, it may lead to the formation of  metastases • Besides the regional lymph nodes, the skeleton,  lungs, liver and brain are often affected by  metastases in women suffering breast cancer 10 Image from https://breast‐cancer.canceraustralia.gov.au/types/ductal‐carcinoma‐situ Unrestricted © Siemens Healthineers, 2020 Notes 336MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Breast Cancer Diagnosis using mammography • Mammography is the current gold standard for  But breast cancer screening • Clinical benefits are limited in case of dense  • High level of sensitivity breast tissue • High level of specificity • Aggressive high‐grade DCIS is usually not  • Fast associated with microcalcifications • Easy • Women with an increased risk of breast cancer,  • Cost‐effective the disease often starts with this type of DCIS • Only imaging exam that can visualize  microcalcifications 11 Unrestricted © Siemens Healthineers, 2020 Notes 337MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Breast Cancer Diagnosis using breast MRI • It is highly sensitive and enables precise  • Helpful to look for additional tumor foci (i.e.  differentiation of soft tissue contralateral breast) in women who have been  diagnosed with a presumably malignant tumor  • Kinetic characterization via mammography • Malignant tissue up‐takes contrast very fast  (fast wash‐in) • Stage of the tumor can be assessed more  • Malignant tissue often displays a clear wash‐out precisely • Better assessment of whether it is an individual  lesion or a multicentric carcinoma • Helpful to clarify unclear mammography or  ultrasound examinations 12 Unrestricted © Siemens Healthineers, 2020 Notes 338MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Breast Cancer Diagnosis using breast MRI (Cont) • Chest wall and the axillary lymph nodes are  • It can also be used for planning and performing  depicted very well on the images biopsies, specially when the lesion cannot be  visualized by ultrasound and/or mammography • If the lymph nodes are affected, an additional  whole‐body measurement can be taken straight  away to ascertain whether remote metastases  have already formed • Helpful in operation planning before surgery • When monitoring the results of non‐surgical  therapy (e.g. chemotherapy), MRI can indicate at  an early stage whether there has been a  response to the therapy 13 Unrestricted © Siemens Healthineers, 2020 Notes 339MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Breast Imaging Breast Imaging 14 Unrestricted © Siemens Healthineers, 2020 Notes 340MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Breast Imaging  Scoring system for breast MRI diagnosis Contrast‐enhanced image / T2 Dynamic information T2 (+fat sat) Ref: Marino MA et al., Eur Radiol DOI 10.1007/s00330‐015‐ 15 4075‐7 Unrestricted © Siemens Healthineers, 2020 Notes 341MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Breast Imaging  MRI reconstructions to identify ductal carcinoma vs. fibroadenoma Unrestricted Siemens Healthineers, 2020 Notes 342MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Breast Imaging  Breast MRI protocol example (or T2-STIR) Ref: Mann RM et al., Breast MRI:state of the art. Radiology 2019; 292:520– 17 536 Unrestricted © Siemens Healthineers, 2020 Notes 343MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Breast Imaging: Examples Carcinoma left breast, axillary lymph node metastases, 37‐year‐old female  T2 TIRM, matrix 448, TA 4:36 min T1 3D FLASH, GRAPPA 2, T2 TSE, GRAPPA 2, matrix 512, TA 1:07 min matrix 512, TA 5:24 min Radprax Wuppertal/Solingen, Wuppertal, Germany Unrestricted Siemens Healthineers, 2020 Notes 344MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Breast Imaging: Examples Follow‐up after implant rupture, 46‐year‐old female T2 TSE tra MX=448 T2 TIRM, MX=448 ep2d diff tra SPAIR ZOOMit b1000 T1_3D_FLASH tra dynVIEWS, MX=512 T1_3D_FLASH tra_dynVIEWS SUB, MX =512 ep2d diff tra SPAIR ZOOMit ADC Radprax Wuppertal/Solingen,  19 UnrestrictedUnrestricted ©   Siemens Healthineers, 2020 Wuppertal, Germany Notes 345MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Breast Imaging: Examples T1 VIBE 3D T2 SPAIR  RESOLVE b=50, 400 ADC map Universitätsklinikum Erlangen, Germany 20 UnrestrictedUnrestricted ©   Siemens Healthineers, 2020 Notes 346MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Coils and Planning Coils and Planning 21 Unrestricted © Siemens Healthineers, 2020 Notes 347MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP MR Breast Imaging Patient Preparation • Patient Preparation • Patients should remove all metallic objects • Snaps & Zippers • Jewelry • Copper Mesh Clothing • etc. • Patients should change into gown or scrubs  provided by facility • Screening form may want to include • History of Surgery • Hormone Therapy • Menstrual Cycle  • Explain procedure before positioning patient on  table 22 Unrestricted © Siemens Healthineers, 2020 Notes 348MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Coils  Available breast coils Breast 18 16-ch AI Breast Coil Breast Matrix 2/4/8-ch Sentinelle Breast Coil 2/10/16-ch Sentinelle Breast Coil 2/4-ch Sentinelle Breast Coil, Breast BI 7 4-ch BI Breast Coil 2/4-ch Sentinelle Breast Coil biopsy set-up 23 Unrestricted © Siemens Healthineers, 2020 Notes 349MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Coils and Planning The general use of the breast coils*  • Bore size 60cm systems (e.g. Prisma, Avantofit) • Remove the spine coil • Head first orientation only • Bore size 70cm systems (e.g. Vida, Sola ) • Place the coil on top of the spine coil base plate  • Use base plate or the attached frame fixture to  stabilize the coil on the table • Head first and feet first possible  Frame fixture * For the individual breast coil use, please see the corresponding user manuals 24 Unrestricted © Siemens Healthineers, 2020 Notes 350MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP MR Breast Imaging Patient Positioning – Choose Feet‐First (or) Head‐First • Patient Positioning  • Choose between Feet‐First (or) Head‐First Positioning 25 Reference:  Unrestricted © Siemens Healthineers, 2020 MR syngo Women's Health HOOD051620029 Notes 351MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Coils and Planning Arms above head vs. arms by side Arms Above Head Arms By Side Breasts lifted out of coil More breast in the coil Shoulders may get tired New coils generally have  better shoulder support Bend in arm may occlude IV  Reduced risk of vessel  line occlusion No phase aliasing from arms May get phase aliasing from  arms or IV line Reduced lesion access for  Access to more posterior  biopsy lesions for biopsy Use of straps / padding to  support arms 26 Unrestricted © Siemens Healthineers, 2020 Notes 352MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP MR Breast Imaging Patient Positioning • Patient Positioning • Position Coil Elements (or) Coil Grids only to touch • NO compression • Reduces chance of compressing of blood vessels 27 Unrestricted © Siemens Healthineers, 2020 Notes 353MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP MR Breast Imaging Patient Positioning • Patient Positioning • Position Breasts symmetrically • Nipples straight down in 12 o’clock position • Smooth out and remove any skin folds • 3‐Plane Localizer • Validates breasts are in 12 o’clock position and there are no skin folds 28 Unrestricted © Siemens Healthineers, 2020 Notes 354MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP MR Breast Imaging Patient Positioning – Skin Folds  • Patient Positioning • Skin Folds • Uneven fat saturation results and  may mask pathology 29 https://pubs.rsna.org/doi/full/10.1148/rg.341125193 Unrestricted © Siemens Healthineers, 2020 Notes 355MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Morphology Morphology 30 Unrestricted © Siemens Healthineers, 2020 Notes 356MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Morphology Protocols  • T2 weighted images with or without fat sat • 2D or 3D imaging  • SPACE with CS available (from XA20) • Rec: rectangular FoV protocols for less  visualization of heart and chest Applications  • T2 with fat‐sat  • Easy visualization of cysts  • Depiction of perifocal or prepectoral edema  • T2 w/o fat‐sat: better for lesion morphology  • High signal intensity: more benign  • Cancers do not show high signal intensity  relative to parenchyma 31 Unrestricted © Siemens Healthineers, 2020 Notes 357MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Morphology: Image Examples Mass lesions • Check the signal intensity • Check the margins  • Compare with the dynamic information Fibroadenoma Invasive  carcinoma T2 Early enhancement Late enhancement Ref: Marino MA et al., Eur Radiol DOI 10.1007/s00330‐015‐ 4075‐7 Unrestricted Siemens Healthineers, 2020 Notes 358MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Morphology: Image Examples 69‐year‐old woman with an invasive ductal carcinoma Pre‐chemotherapy After six cycles of chemotherapy Peritumoral edema T1 contrast enhanced T2 fat sat T1 contrast enhanced T2 fat sat 20Ref: Mann RM et al., Breast MRI:state of the art. Radiology  19; 292:520–536 Unrestricted Siemens Healthineers, 2020 Notes 359MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Morphology: CS SPACE Image Examples Sola fit 1.5T isotropic isotropic T2_spc_tra_p3 T2_spc_tra_cs_7.0_iso MPR to sagittal view TR 1000 ms/ TE 174 ms TR 1000 ms/ TE 177 ms 0.8 x 0.8 x 1.5 mm 0.8 x 0.8 x 0.8 mm 104 slices, TA 04:03 192 slices, TA 03:52 Unrestricted Siemens Healthineers, 2020 Notes 360MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Morphology: CS SPACE Image Examples Vida fit 3T T2_spc_tra_spair_p3 T2_spc_tra_spair_cs_5.0 T2_spc_tra_spair_cs_8.0 TR 1500 ms / TE 135 ms TR 1500 ms / TE 132 ms TR 1500 ms / TE 133 ms 0.8 x 0.8 x 1.5 mm, 112 slices 0.8 x 0.8 x 1.5 mm, 112 slices 0.8 x 0.8 x 1.5 mm, 112 slices Phase OS 15%, TA 05:04 Phase OS 25%, TA 05:04 Phase OS 50%, TA 03:43 35 Note: Increased motion‐and 3rd arm artifacts are compensated by more phase oversampling and higher acceleration factor  UnrestrictedUnrestricted ©   Siemens Healthineers, 2020 Notes 361MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Knowledge Check 1. The Screening form may want to  2. Skin folds can cause uneven fat  include for breast imaging, all of the  saturation results and may mask  following except_______________. pathology. a. True a. History of Surgery b. False b. Hormone Therapy c. Bra size d. Menstrual Cycle Author | Department 36 Unrestricted © Siemens Healthineers, 2020 Notes 362MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Dynamic Imaging Dynamic Imaging 37 Unrestricted © Siemens Healthineers, 2020 Notes 363MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Breast Dynamic Imaging Motivations: The analysis of the dynamic curve  would be used for tumor characterization  Signal enhancement Initial phase (~2mins after contrast injection): signal  enhancement is calculated   High: >120% > 10% increase = Persistent Delayed phase: divided to 3 conditions ≤ 10% change = Plateau • Persistent: >10% increase  • Plateau: within 10% change • Wash‐out : >10% decrease Medium > 10% decrease = Wash‐out Low: <50% Initial phase Delayed phase Time * More research oriented, no available post‐processing tools for calculating the results 38 Unrestricted © Siemens Healthineers, 2020 Notes 364MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Breast Dynamics  Color‐coded results could be  displayed  Initial phase:  • Calculate the enhancement  percentage • Default criteria: 50% and 120%  212% Delayed phase: • Classified to wash‐out, plateau, and  167% persistent • Default criteria: ‐10% and +10% 39 UnrestrictedUnrestricted ©   Siemens Healthineers, 2020 Notes 365MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Breast Dynamics  Protocols: • T1 3D imaging  • Temporal resolution about 60‐90 secs  • Slice thickness <2.5mm • Post‐contrast scans take 5 to 7 mins (i.e. 4 to 5  measurements) • Non fat sat acquisitions: the subtraction images  are required → Inline subtraction  • Strategies • DynaVIEWS: all dynamics in a single protocol  • InterVIEWS: a high resolution image inserted  between the dynamics after contrast injection 40 Unrestricted © Siemens Healthineers, 2020 Notes 366MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Breast Dynamics  DynaVIEWS • All dynamic scans configure in a single protocol • 1 pre‐contrast scan  • Pause after the 1st scan ~25sec • 4 to 5 post‐contrast scan  Signal enhancement • Calculation inline maps (Inline> Soft tissue) are  possible  • After dynamics, a high resolution image is  Pause~25sec acquired for a better lesion delineation Pre‐contrast Post‐contrast High resolution Time 41 Unrestricted © Siemens Healthineers, 2020 Notes 367MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Breast Dynamics  InterVIEWS • Dynamic scans are separated, and a high‐res scan  is inserted  • 1 pre‐contrast scan • Pause after the 1st scan ~25sec • 2 post‐contrast scans  Signal enhancement • 1 high resolution scan • 1 post‐contrast scan (end of dynamics) • Calculation inline maps (Inline> Soft tissue) are  Pause~25sec NOT possible  • It is used for a better lesion delineation  Pre-contrast Post High resolution Post Time 42 Unrestricted © Siemens Healthineers, 2020 Notes 368MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Breast Dynamics: Image Examples DynaVIEWS 1+5 Unrestricted Siemens Healthineers, 2020 Notes 369MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Breast Dynamics: Inline Results Wash‐in map • It defines the signal increase after the  injection of contrast agent • First measurement: • Determines which measurement is used as  the first measurement of the wash‐in • Last measurement: • Determines which measurement is used as  the last measurement of the wash‐in • Highest value: • The highest value between the first and last  measurement is used for reconstructing the  Wash‐in Map 44 Unrestricted © Siemens Healthineers, 2020 Notes 370MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Breast Dynamics: Inline Results Wash‐out map • Signal behavior (increase, plateau, decrease)  after the wash‐in • First measurement: • Determines which measurement is used as  the first measurement of the wash‐out • Last measurement: • Determines which measurement is used as  the last measurement of the wash‐out 45 Unrestricted © Siemens Healthineers, 2020 Notes 371MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Breast Dynamics: Inline Results Wash‐in map Wash‐out map Signal enhancement Wash‐out Wash‐in Post‐contrast High resolution Pre‐contrast Time 46 Unrestricted © Siemens Healthineers, 2020 Notes 372MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Breast Dynamics: Inline Results TTP (time to peak) map • The pixel intensity value in the image shows the  time that expired until the signal peak was  reached PEI (positive enhancement integral) map • Area under the signal intensity time curve MIP‐time • In the calculation, the highest pixel value along  the time axis is taken into account 47 Unrestricted © Siemens Healthineers, 2020 Notes 373MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Breast Dynamics: Inline Results TTP MIP‐time Signal enhancement MIP‐time TTP PEI  PEI Post‐contrast High resolution Pre‐contrast Time 48 Unrestricted © Siemens Healthineers, 2020 Notes 374MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Breast Dynamics: Inline Subtraction DynaVIEWS • An multiple measurement protocol • Subtraend=1, the first scan is the native series Injection 1 2 3 4 5 DynaVIEWS + CareBolus • Subtraction of series from different protocols • Subtraend=‐1, the first matching series is the native one Care   Bolus 49 Unrestricted © Siemens Healthineers, 2020 Notes 375MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Breast Dynamics: Offline Motion Correction Available in MR Breast and MR BreVis  Unrestricted Siemens Healthineers, 2020 Notes 376MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Breast Dynamics   TWIST protocols are available for high channel  coils, more for research orientations  • t1_twist_tra_1+9+3_15sec = t1 with 1 pre‐ contrast phase, 9 x 15 seconds wash‐in phases,  and 3 x 60 seconds wash‐out phases • t1_twist_fs_tra_1+6+3_20sec = t1 fat sat with 1  pre‐contrast phase, 6 x 20 seconds wash‐in  phases, and 3 x 60 seconds wash‐out phases • Pauses are inserted in wash‐out phases 51 Unrestricted © Siemens Healthineers, 2020 Notes 377MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Breast Dynamics  twist_tra_dyn_1+9+3_15sec twist_fs_tra_dyn_1+6+3_20sec TE in phase TE opposed phase, water excitation   Unrestricted Siemens Healthineers, 2020 Notes 378MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Breast Dynamics  TWIST‐VIBE technique: improvement of the  temporal resolution for dynamic studies  • Malignant lesions tend to enhance earlier and  show steeper slopes • Time to Enhancement seems to be a strong  discriminator between benign and malignant  breast disease and improves specificity whilst  maintaining sensitivity  Conv. Dynamic, TA 1 min/series 3D TWIST‐VIBE, TA 4.97 s/series University Hospital, Institut für Diagnostische  Unrestricted Siemens Healthineers, 2020 Radiologie, Erlangen, Germany Notes 379MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Breast Dynamics  TWIST‐VIBE technique: improvement of the  temporal resolution for dynamic studies  The high temporal resolution of TWIST enables the  visualization of very early enhancement of contrast  in the breast. TWIST may help improve specificity  whilst maintaining sensitivity 1) 1) R. Mus et al, UMC Nijmegen, RSNA 2012 Unrestricted Siemens Healthineers, 2020 Right: Ritse Mann, Radboud University, Nijmegen, Netherlands  Notes 380MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Diffusion Diffusion  55 Unrestricted © Siemens Healthineers, 2020 Notes 381MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Breast Diffusion Protocols: • Available sequences:  • ep2d_diff (+ ZOOMit), RESOLVE • Acceleration techniques:  • GRAPPA, SMS  • Fat saturation:   • SPAIR in “Strong” mode  • Additional considerations:  • Phase encoding direction in P>A • Two saturation bands for signal suppression  from chest and back  Use 2 saturation  bands Use PA phase encoding  direction 56 Unrestricted © Siemens Healthineers, 2020 Notes 382MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Breast Diffusion Examples ZOOMit Ep2d_diff_p2_s2 RESOLVE_p2_s2 TA=3:20mins, Res=80x180 TA=2:20mins, Res=96x180 TA=3:58mins, Res=86x170 TR/TE=5400/60ms, Slice=4mm x30 TR/TE=3500/64ms, Slice=4mm x34 TR/TE=3500/55ms, Slice=4mm x34 57 Breast protocols at 1.5T Sola fit XQ system UnrestrictedUnrestricted ©   Siemens Healthineers, 2020 Notes 383MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Breast Diffusion Examples External phase correction is enabled to reduce the Ep2d_diff with internal phase correction artifacts Ep2d_diff with external phase correction Unrestricted Siemens Healthineers, 2020 Notes 384MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Breast Diffusion Examples A DWI example of a 36‐year‐old breast cancer  patient with grade 3 invasive ductal carcinoma  (RESOLVE @ 7 Tesla MRI) Post T1w b = 0 s/mm² b =850 s/mm² ADC Map Unrestricted Siemens Healthineers, 2020 Notes 385MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Breast Silicone Implant Imaging Breast Silicone  Implant Imaging 60 Unrestricted © Siemens Healthineers, 2020 Notes 386MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP MR Breast Implant Imaging FDA Approval & FDA Rupture Screening Recommendations • FDA Approval • FDA Rupture Screening Recommendations1 • Saline implants (May 2000) • MR Screening • Silicone implants (November 2006) • Between 5 and 6 years post‐surgery • Every 2 years thereafter • Asymptomatic Patients • Ultrasound acceptable alternative to MRI for  asymptomatic patients. • Symptomatic Patients (or) Patients with equivocal  Ultrasound Results for Rupture • MRI recommended *Reference: 2https://www.fda.gov/media/131885/download#:~:text=Even%20if%20you%20have%20no,rupture%2C%20an%20MRI%20is%20recommended;  61 1https://www.jdsupra.com/legalnews/fda‐announces‐updates‐to‐two‐guidance‐85447/ Unrestricted © Siemens Healthineers, 2020 Notes 387MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP MR Breast Implant Imaging Implant Types • Implant Types1 • Silicone Implant1 • Saline Implant • Cohesive Gel Implant • Elastic Silicone Shell and Saline (Salt Water) Fill • Comes pre‐filled • Implant placed in breast pocket then filled • Softest and most natural‐feeling • Smooth or Textured Implant available  • Options for level of cohesion and softness of  • Ranges in: Thickness, Shape and Profile silicone gel • Silicone Implant1 • Round or Smooth texture  • Soft durable Silicone Shells with Cohesive  • Gummy Bear Implant Silicone Gel inside • Soft, natural‐feeling, and firmer than Cohesive  • Two Categories Silicone Gel Implants  • Cohesive Silicone Gel  • Form‐stable Gel (Gummy Bear) • Silicone‐Saline Blend Implant (Double Lumen) 1 • Implant Inner Shell – filled with Saline • Outer Saline Shell – holds additional saline filler • Between Two Shells – three baffle shells designed to  eliminate sloshing movement of saline filler • FDA approved 2014 62 *Reference: Everything You Need to Know About Breast Implant Types (justbreastimplants.com) 1 Unrestricted © Siemens Healthineers, 2020 Notes 388MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Breast Implant Images  Chemical shifts Mag Fat • Silicone to water ~ 4.85ppm • @1.5T ~310Hz, @3T ~620Hz Silicone • Fat to water ~ 3.5ppm Water • @1.5T ~220Hz, @3T ~440Hz 3.5ppm Assume Silicone 4.85ppm frequency • Enable it when silicone exists in the images • It enables 3‐peak model to calculate the  resonance frequency • The results are more reliable*. For adipose  conditions no user interaction necessary * Comparing with N4 system. Assume dominant fat is  not available anymore in NX platforms.  63 Unrestricted © Siemens Healthineers, 2020 Notes 389MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Breast Implant Images  Protocol setups focus on the silicone implants Define the type of the implant: implant_type_scan • TI~600ms (@3T), TI~500ms (@1.5T) • Silicone: dark signal; saline: bright signal  • Confirm Frequency= Never Stir_ws_tra/sag_silicone:  • Fat sat: TI~230ms (@3T), TI~140ms (@1.5T)  • Apply the water suppression pulse  • Silicone implants are bright and it is helpful to  define the boundaries of the implants  64 Unrestricted © Siemens Healthineers, 2020 Notes 390MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Breast Implant Images  Protocol setups focus on the silicone implants Stir_tra/sag_siliconeSat: • Fat sat: TI~230ms (@3T), TI~140ms (@1.5T) • Water suppression pulse is used for silicone  suppression → Silicone implant: dark • Confirm Frequency= Always • Resonance frequency is set to silicone peak!! Stir660_tra_siliconeIR • TI~600ms (@3T), TI~500ms (@1.5T) • Only silicone signal is suppressed  65 Unrestricted © Siemens Healthineers, 2020 Notes 391MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP MR Breast Implant Imaging Breast Implant – Types • Implant Types • Saline  • Fill Valve seen on images • Silicone Saline Silicone 66 Unrestricted © Siemens Healthineers, 2020 Notes 392MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Special Considerations Special Considerations 67 Unrestricted © Siemens Healthineers, 2020 Notes 393MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Special Considerations Women´s Cycle WHEN TO SCAN? : Some recommendations, but customer must have their own policy • Pre‐menopausal day 10‐15 of menstrual cycle • Increased parenchymal enhancement normally observed during secretory phase of menstrual  cycle may give rise to false positive • 6 months after surgery • 12 months after radiotherapy • Consider discontinuing HRT (Hormone Replacement Therapy) for 4‐6 weeks prior (may have an  effect on enhancement pattern) 68 Unrestricted © Siemens Healthineers, 2020 Notes 394MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Special Considerations Confirm Frequency • Never: the pop‐up window would not display  before the scan starts • Always: the pop‐up window would show before  the scan, to let the user confirm the frequency • When Changed: the pop‐up window would  appear only when the detected central frequency  changes  For most of the breast protocols, Confirm  Frequency = Never  When enabling “Assume Silicone”, we might use  “Always” or “When Changed”  69 Unrestricted © Siemens Healthineers, 2020 Notes 395MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Special Considerations Reduce Motion Sens. In flash3D • Parameter available in the flash 3D protocols  when selecting “Breast Application” • Radial reordering to reduce motion artifacts • “3D Reordering = Min. TTC” is not available if  Reduce Motion Sens. is ON Start End With Q‐FatSat or SPAIR Without Q‐FatSat or SPAIR Radial reordering Radial reordering 70 Unrestricted © Siemens Healthineers, 2020 Notes 396MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Special Considerations Bific Filter Breast @ 3T • When breast coil is selected, a breast specific  Bific Filter will be used • Intensity Weak is recommended. Please use  Prescan Normalize as well (new with XA11A: both  are possible) • Not seen in the image text, but can be found in  the DICOM header 71 Unrestricted © Siemens Healthineers, 2020 Notes 397MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Special Considerations Bific Filter Breast @ 3T Do not use in combination with fat sat  Without Bific With Bific weak Unrestricted Siemens Healthineers, 2020 Notes 398MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Special Considerations SPAIR Breast Mode @3T Mag Fat • The adiabatic inversion pulse covers fat and  silicone peaks Silicone Water • TSE, SPACE, HASTE, VIBE, EPI  Available for:  Breast (BW5.0ppm) diffusion and RESOLVE sequences  • Limitation: silicone could not be completely Default (BW2.8ppm) suppressed due to different T1 times -2.1 -0.2 1.3 2.9 4.7 Frequency (ppm) 73 Unrestricted © Siemens Healthineers, 2020 Notes 399MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Special Considerations SPAIR Breast Mode @3T: Examples from Vida  TSE with SPAIR Breast TSE with SPAIR Default VIBE with SPAIR Breast VIBE with SPAIR Default Unrestricted Siemens Healthineers, 2020 Notes 400MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Special Considerations SPAIR Breast Mode @3T: Examples from Vida  TSE with SPAIR Breast VIBE with SPAIR Default Unrestricted Siemens Healthineers, 2020 Notes 401MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Knowledge Check 1. For Implant imaging, when using the  2. On Numaris X software, the Assume  STIR with Water sat sequence, the TI  Dominant fat is not available. should be ___________at 3T. a. True a. 140 b. False b. 160 c. 200 d. 230 Author | Department 76 Unrestricted © Siemens Healthineers, 2020 Notes 402MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP MR Protocols Module MR Protocols  Module MR Applications Fundamentals – Part Two Presenter, Calibri 16 pt English, Month 2019 Unrestricted © Siemens Healthineers, 2020 Unrestricted Notes 403MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Agenda • Fleet • Publish & Update • Systems types and groups in fleet • Fleet tree Structure • Fleet management • Adding new systems to an existing fleet • FAQ’s & general recommendations • Concurrent work and conflicts • Installation & Configuration 2 Unrestricted © Siemens Healthineers, 2020 Notes 404MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Objectives • Explain what a fleet is • Identify Fleet Tree Structure • Describe how to publish and update • Explain how to add a new system to an  existing fleet 3 Unrestricted © Siemens Healthineers, 2020 Notes 405MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fleet Fleet 4 Unrestricted © Siemens Healthineers, 2020 Notes 406MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Protocol & Fleet Management today System 1 System 4 System 7 System 6 System 2 System 8 System 3 System 5 5 Unrestricted © Siemens Healthineers, 2020 Notes 407MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Protocol & Fleet Management today • Costly protocol configuration • Due to blocking system for a period of time • Time‐consuming protocol distribution • Manual distribution via USB stick or Expert –i • Efforts increase with the number of scanners • No standard scan protocols  across enterprise lead to diverse results • Dot Cockpit One central exam user interface for protocol configuration and management 6 Unrestricted © Siemens Healthineers, 2020 Notes 408MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Protocol Management with XA20 MR Protocols Module NX VA20, VA30… Neither blocked systems nor blocked patient examination  Dot Cockpit user interface to be installed on any customer PC/virt. PC connect licenses Efficiently distribute protocols across your fleet Modify your scan parameters only once & save valuable working hours Achieve reproducible results across your entire MR system fleet Automatic distribution of changes to your scanner fleet min. 32 GB RAM 7 Unrestricted © Siemens Healthineers, 2020 Notes 409MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fleet More than just the sum of its parts…. Scanner 1 Scanner 2 Scanner 3 8 Unrestricted © Siemens Healthineers, 2020 Notes 410MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fleet More than just the sum of its parts…. Fleet Db Fleet Db Scanner Fleet MR Protocols Module ‐ a member of the fleet 9 Unrestricted © Siemens Healthineers, 2020 Notes 411MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fleet More than just the sum of its parts…. Fleet Db Fleet Db Fleet Db Scanner Fleet Share MR Protocols  ‐ interface between  Module(MRPM) fleet members ‐ a member of the fleet 10 Unrestricted © Siemens Healthineers, 2020 Notes 412MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fleet Cloud on Dot Cockpit icon indicates system is part of fleet 11 Unrestricted © Siemens Healthineers, 2020 Notes 413MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fleet Databases and Trees Scanners use different exam databases (ExamDbs) to store trees with protocols 1. ExamDb “Default” [Read‐Only] Contains “DEFAULT” Tree with all default sequences 2. ExamDb “SIEMENS” [Read‐Only]:  Contains “SIEMENS” Tree with all SIEMENS Dot Engines, clinical programs and libraries 3. ExamDb “Customer” Contains “USER” Tree which can be modified by the customer Multiple User trees can be created 4. Exam Db “Fleet” (if fleet is configured) Contains “FLEET” Tree which can be modified by the customer and will be distributed across the fleet Multiple Fleet trees can be created 12 Unrestricted © Siemens Healthineers, 2020 Notes 414MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Publish & Update Publish & Update 13 Unrestricted © Siemens Healthineers, 2020 Notes 415MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Distribute Fleet Changes Publish/Update Fleet Db Publish: distributes local changes to the central  Fleet ExamDb Share Fleet Db Fleet Db Update: distributes central changes to the local  Fleet ExamDb 14 Unrestricted © Siemens Healthineers, 2020 Notes 416MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Distribute Fleet Changes Publish/Update Publishing progress Publish Create local change Pending local changes  (E.g. create new region) (Publish) Publish complete 15 Unrestricted © Siemens Healthineers, 2020 Notes 417MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Distribute Fleet Changes Publish/Update Update • Publish must be triggered manually Pending remote changes Automatic Update  (Update) complete • Update is automatically performed (as soon as possible) 16 Unrestricted © Siemens Healthineers, 2020 Notes 418MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Distribute Fleet Changes Publish/Update Share Publish changes Distributes local  (manual) changes to central  Fleet ExamDb Make change(s) in  Fleet ExamDb @ MR  Protocol Manager Central changes distributed to  local FLEET ExamDb via Update  (automatic) 17 Unrestricted © Siemens Healthineers, 2020 Notes 419MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Distribute Fleet Changes Publish/Update Share Publish changes Distributes local  (manual) changes to central  Central changes distributed to  Fleet ExamDb Make change(s) to  local Fleet ExamDb via Update  local Fleet ExamDb @  (automatic) scanner 18 Unrestricted © Siemens Healthineers, 2020 Notes 420MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Distribute Fleet Changes Publish/Update Pending Local Changes (Publish): must be triggered manually  Pending Remote Changes (Update): performed automatically Pending Local and Remote Changes: first update then publish 19 Unrestricted © Siemens Healthineers, 2020 Notes 421MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP System Types & Groups in Fleet System Types &  Groups in Fleet 20 Unrestricted © Siemens Healthineers, 2020 Notes 422MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP MR Protocols Module Systems Types and Groups Current System type (only Sola‐XJ programs  are displayed) Current System (with license and  hardware options) Structure is shared across  System types (Fleet Trees,  Programs, Steps, Protocols, Sequences  Regions, Exams) are specific for one system type (e.g.  Sola‐XJ) 21 Unrestricted © Siemens Healthineers, 2020 Notes 423MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP MR Protocols Module Systems Types and Groups • The MR Protocols Module simulates the systems connected to the Fleet • Hardware options and licenses of the systems are used • To perform consistency and license checks • To provide limits during editing of protocols (e.g. due to gradients) • Selecting a system type controls which programs are displayed (WHAT) • Selecting a system from the group controls which hardware options and licenses are used (HOW) 22 Unrestricted © Siemens Healthineers, 2020 Notes 424MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP MR Protocols Module Systems Types and Groups Example: System Types System Group: Sola XJ System Group: Sola XQ System Group: Vida XT 3 system types within FLEET:  4 systems within FLEET: 1 system in Sola XJ group, 2 systems in Sola XQ group, 1 system in  Sola XJ, Sola XQ and Vida XT Vida XT group • Structure is shared across all systems in Fleet:  Fleet Trees, Regions, Exams • Programs, Steps, Protocols, Sequences are specific for system type  23 Unrestricted © Siemens Healthineers, 2020 Notes 425MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP MR Protocols Module Systems Types and Groups 1.5T @ XA20 1.5T XJ  Group Name 1.5T XQ 1.5T XJ low Rx Sola XQ 48 Sola XJ 48 Altea XJ 32 Sola XQ 64 Sola fit XJ 48 Sola XJ 32 Sola fit XQ 48 24 Unrestricted © Siemens Healthineers, 2020 Notes 426MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP MR Protocols Module Systems Types and Groups 3T @ XA20 3T XQ Group Name 3T XK 3T XQ   3T XT low Rx Lumina 3T Vida XQ 32 Vida fit XQ 64 Vida XT 128 XK Vida XQ 48 Vida XT 64 25 Unrestricted © Siemens Healthineers, 2020 Notes 427MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fleet Tree Structure Fleet Tree Structure 26 Unrestricted © Siemens Healthineers, 2020 Notes 428MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fleet Tree Structure • Fleet Tree structure (Region and Exam) is consistent across members of Fleet  • Example: If I create a Region and Exam for my Sola XJ system and publish, the same Region and Exam structure  will be available for all systems across Fleet Sola XJ Sola XQ Vida XT 27 Unrestricted © Siemens Healthineers, 2020 Notes 429MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fleet Tree Structure Creating New Trees • When creating a new tree, you can choose between Fleet Tree or  Customer Tree (local) • New Fleet Trees can be created with password protection to avoid  unwanted changes (at MRPM and scanner) • Existing Fleet Trees can be password protected at scanner (using  Dot Cockpit Administrator) 28 Unrestricted © Siemens Healthineers, 2020 Notes 430MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fleet Tree Structure • Fleet Tree structure (Fleet Trees) is consistent across members of Fleet • Example: If I create a 2nd Fleet Tree and publish, this FleetTree will be available for all systems across Fleet Vida XT Sola XJ Sola XQ 29 Unrestricted © Siemens Healthineers, 2020 Notes 431MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fleet Tree Structure • Programs are specific to System Type • Example: If I create a program in my Sola XJ system, it will only be available for Sola XJ group members Sola XJ Sola XQ Sola XT 30 Unrestricted © Siemens Healthineers, 2020 Notes 432MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fleet Tree Structure • Programs are specific to System Type • Example: If I create a program in my Sola XQ system, it will only be available for Sola XQ group members Sola XQ‐1 Sola XQ‐2 31 Unrestricted © Siemens Healthineers, 2020 Notes 433MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Knowledge Check 1. New Fleet Trees can not be created  2. _____________distributes central  with password protection. changes to the local Fleet ExamDb.  a. True a. Publish b. False b. Update c. Export Author | Department 32 Unrestricted © Siemens Healthineers, 2020 Notes 434MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fleet Management Fleet Management 33 Unrestricted © Siemens Healthineers, 2020 Notes 435MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fleet Management Example: MRPM + 1 system Sola XQ 64_1 MR Protocol Manager • After initial configuration, there will be an  empty Fleet Tree  • We need to start building the Fleet Tree 34 Unrestricted © Siemens Healthineers, 2020 Notes 436MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fleet Management Example: MRPM + 1 system OPTION 1: Configure Fleet Tree @ Scanner (Sola XQ 64_1) • Copy & paste User Tree to Fleet Tree & Publish => Fleet Tree update at MR Protocol Manager (MRPM) will occur  automatically Sola XQ 64_1 MRPM 35 Unrestricted © Siemens Healthineers, 2020 Notes 437MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fleet Management Example: MRPM + 1 system OPTION 2: Export exar files at scanner and import to MRPM • To avoid blocking the system you can export User exar files at the scanner, then import them into the Fleet Tree at  MRPM • Once imported, publish: Fleet Tree update at system will occur automatically Sola XQ 64_1 36 Import at MRPM Unrestricted © Siemens Healthineers, 2020 Notes 438MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fleet Management Example: MRPM + 2 systems (same type) • The Fleet Tree structure will be the same for both systems within group • License and hardware options are checked and unlicensed program steps will be dimmed • Use as an opportunity to get rid of redundant programs Sola XQ‐1 Sola XQ‐2 37 Unrestricted © Siemens Healthineers, 2020 Notes 439MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Adding New Systems to an Existing Fleet Adding New Systems to  an Existing Fleet 38 Unrestricted © Siemens Healthineers, 2020 Notes 440MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Adding new systems to an existing Fleet Another system to a group E.g. Sola XQ system type already exists and you add another Sola XQ system to the group • The Fleet does already contain programs and protocols for the system type of the new scanner (programs  are shared across same system types) • The new system automatically uses these programs and protocols (licenses and hardware options are  checked – actual usefulness of programs depends on outcome of check); unlicensed program steps will be  dimmed • If the new system does contain some programs and protocols which are missing in the fleet, they can be  easily added at the system via copy/paste into the Fleet 1. Select one or more programs and Copy 2. Switch to the desired FLEET Tree 3. Select the desired target exam 4. Paste 5. Publish 39 Unrestricted © Siemens Healthineers, 2020 Notes 441MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Adding new systems to an existing Fleet The first system of a system type (1/3) E.g. Adding a Sola XJ to the Fleet (first Sola XJ system to be added to the group) • The Fleet does not already contain programs and protocols for the system type of the new scanner • The Fleet does already contain the desired structure (Fleet Trees, Regions and Exams are shared across all  system types)  Which source should be used to add all required programs and protocols into the existing Tree structure? a) Existing programs/protocols of the actual system (e.g. Sola XJ User Tree) b) Existing programs/protocols of a different system type (e.g. Sola XQ) 40 Unrestricted © Siemens Healthineers, 2020 Notes 442MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Adding new systems to an existing Fleet The first system of a system type (2/3)  Which source should be used to add all required programs and protocols into the existing Tree structure? a) Existing programs/protocols of the actual system (e.g. Sola XJ User Tree) b) Existing programs/protocols of a different system type (e.g. Sola XQ) • Copy & Paste programs from User Tree to FLEET Tree @ new system OR Export exar files from new system and import to FLEET Tree • In case many programs should be copied (with directories): • To avoid “Copy of xxx” directory naming issues, the following workflow is suggested: • Export relevant Regions/Exams into an exar file (via Explorer/Export) • Use Import to copy all programs of a single Exam to the corresponding Exam in the Fleet Tree  (must be done one Exam at a time) 41 Unrestricted © Siemens Healthineers, 2020 Notes 443MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Adding new systems to an existing Fleet The first system of a system type (3/3)  Which source should be used to add all required programs and protocols into the existing Tree structure? a) Existing programs/protocols of the actual system (e.g. Sola XJ User Tree) b) Existing programs/protocols of a different system type (e.g. Sola XQ) • Copy & Paste programs from different system type to new system  • In order to avoid conversion delays: • Create temporary tree for the conversion of the customer database (e.g. new local ‘Convert Tree’) • Switch to the source scanner type (e.g. Sola XQ) • Select relevant regions and Copy • Switch to target scanner type (e.g. Sola XJ) • Switch to the Convert Tree • Paste: during copying all programs are automatically converted (Warning: this takes a very long time) • Check and correct conversion results • Then follow the steps in scenario a) “Existing programs/protocols of the actual system (e.g. Sola XJ User  Tree)”; Copy and Paste from the Sola SJ Convert Tree to Sola XJ FLEET Tree 42 • The temporary tree can be deleted after completion Unrestricted © Siemens Healthineers, 2020 Notes 444MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP FAQs & General Recommendations FAQ’s &  General Recommendations 43 Unrestricted © Siemens Healthineers, 2020 Notes 445MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Managing Fleet Database FAQ’s Question: What happens if there is a network problem and the automatic update can’t be performed?  Answer:  • A warning or error message will be displayed over the cloud icon on the Home Screen and FLEET Tree in Dot Cockpit • Because there is a local copy of the Fleet database at each scanner, the system will work as usual • The update will be performed when the network is reestablished 44 Unrestricted © Siemens Healthineers, 2020 Notes 446MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Managing Fleet Database FAQ’s Question: What happens if a license is only available on one system within group? (e.g. Sola XQ‐1 has CS license, Sola XQ‐ 2 doesn’t) Answer: If a license is not available on one system in group, protocol step will be dimmed at that system Consider having 2 programs – one with licensed step and one without; appropriate program can be selected at scanner Sola XQ with CS license Sola XQ without CS license  45 (protocol step dimmed) Unrestricted © Siemens Healthineers, 2020 Notes 447MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Managing Fleet Database FAQ’s Question: What happens if one system within  group has the TxRx Knee 18 coil and the other  has the UltraFlex 18 coil? (e.g. Sola XQ‐1 has  TxRx Knee 18 coil and Sola XQ‐2 has UltraFlex  18 coil) Answer: Consider having 2 programs ‐ one for  each coil; appropriate program can be selected  at scanner. 46 Unrestricted © Siemens Healthineers, 2020 Notes 448MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Managing Fleet Database FAQ’s Question: What happens if one system within group does breast examinations, and the others do not?  (e.g. Sola XQ‐1 has breast coil, Sola XQ‐2 does not) Answer: Breast program will be visible for all group members 47 Unrestricted © Siemens Healthineers, 2020 Notes 449MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Managing Fleet Database FAQ’s Question:  What happens if one system type within Fleet has a breast coil, and the others do not? (e.g. the Fleet consists of a Sola XJ, Sola XQ and Vida XT; only the Vida XT has a breast coil) Answer: configure breast program on Vida XT; it will only be available for Vida XT system; Region and Exam will be visible  at other FLEET systems, but not program 48 Unrestricted © Siemens Healthineers, 2020 Notes 450MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Managing Fleet Database FAQ’s Question (continued): what happens if I try to delete  Breast Region or Exam from a system where no Breast  program is configured? (e.g. Breast program is configured  on Vida XT, but not Sola XJ or Sola XQ, and I try to delete  Breast Region from Sola XQ) Answer: User is asked if they want to delete program from  current system configuration or from all system  configurations Warning: if user selects “Delete from all system  configurations” the Breast program will be deleted from  Vida XT system (FLEET Tree) 49 Unrestricted © Siemens Healthineers, 2020 Notes 451MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP General Recommendations 1. If there are significant differences (eg. hardware, licenses) between systems, we suggest separate fleet trees 2. In the case of minor differences, we suggest separate programs in one fleet tree (e.g. program with GRASP Vibe,  program without GRASP Vibe) 3. If there are several Customer and Fleet trees, a common prefix for all fleet trees (e.g. FLEET) is suggested to help  differentiate 4. We suggest to activate password protection for fleet trees to avoid undesired changes 5. Define naming conventions for fleet trees 6. Click publish only once the current task has been completed 7. Communicate and document modifications 8. Make use of both the local and fleet database for program maintenance in the MRPM 9. Coordinate fleet changes to avoid conflicts 50 Unrestricted © Siemens Healthineers, 2020 Notes 452MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Concurrent Work & Conflicts Concurrent Work  & Conflicts 51 Unrestricted © Siemens Healthineers, 2020 Notes 453MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Concurrent Work and Conflicts • Simultaneous changes to a fleet tree should be avoided • If you are not careful, contradictory changes may occur, and such conflicts must be resolved during update. • There are 3 types of conflicts: 1. Structure Conflicts: e.g. moving / adding / deleting programs or directories; these conflicts will be resolved  automatically 2. Program Conflicts: e.g. moving steps, renaming program; these conflicts must be resolved manually (Take  Server Version, Keep Local Version, Both) 3. Directory Conflicts: e.g. renaming directories, changing directory properties; these conflicts must be resolved  manually (Take Server Version, Keep Local Version) • Fleet changes should be coordinated in order to avoid conflicts 52 Unrestricted © Siemens Healthineers, 2020 Notes 454MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Concurrent Work and Conflicts E.g. Program has been  Two pending changes: modified at scanner and at  1. Local program change MRPM, causing a Merge  2. Conflict resolution (“Take  Conflict Server Version”)  First Update, then Publish 53 Unrestricted © Siemens Healthineers, 2020 Notes 455MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Concurrent Work and Conflicts Directory Conflict E.g. Region has been renamed  Two pending changes: at scanner and at MRPM,  1. Local rename (“Region  causing a Merge Conflict Name @ MRPM”) 2. Conflict resolution (“Take   First Update, then Publish Server Version”) 54 Unrestricted © Siemens Healthineers, 2020 Notes 456MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Metal Artifact Reduction Metal Artifact  Reduction Software Presenter, Calibri 16 pt English, Month 2019 Unrestricted © Siemens Healthineers, 2020 Unrestricted Notes 457MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Agenda • Introduction • WARP • View Angle Tilting (VAT) • SLice Encoding for Metal Artifact Correction  (SEMAC) • Compressed Sensing SEMAC 2 Unrestricted © Siemens Healthineers, 2020 Notes 458MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Objectives • Objectives • Understand the causes of magnetic  susceptibility artifacts in the presence of  metal • Define WARP & View Angle Tilting (VAT) • Identify the benefits of using WARP & VAT • Define SEMAC 3 Unrestricted © Siemens Healthineers, 2020 Notes 459MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Implant Disclaimer Implant Disclaimer ‐ The MRI restrictions (if any) of any implant must be considered prior to patient undergoing MRI  exam. MR imaging of patients with implants brings specific risks. However, certain implants are approved by the  governing regulatory bodies to be MR conditionally safe. For such implants, the previously mentioned warning may not  be applicable. Please contact the implant manufacturer for the specific conditional information. The conditions for MR  safety are the responsibility of the implant manufacturer and user, not of Siemens Healthineers. 4 Unrestricted © Siemens Healthineers, 2020 Notes 460MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Introduction Introduction 5 Unrestricted © Siemens Healthineers, 2020 Notes 461MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP WARP: Introduction By 2050: Significant increase in adults > 60 years 6 Unrestricted © Siemens Healthineers, 2020 Notes 462MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP What Causes Image Degradation from Metal? • Regardless of the metal material, they all have the potential to cause artifacts on images • Metal contains no hydrogen, so will therefore present a signal loss in the area • Any metal is a potential conductor of electricity, and it can lead to distortion in the local magnetic field  and result in geometric distortions • When the field changes rapidly, the frequency of the spins will be outside the range of the imaging  system and result in signal loss • Frequency variations caused by dephasing near the metal can result in displacement of signal in the  readout and slice selection directions resulting in signal voids or accumulation in one region (pile‐up  artifact) • Frequency variations will also prevent successful tissue suppression techniques that are based on the  frequency of the tissue (e.g. spectral fat saturation) Implant Disclaimer ‐ The MRI restrictions (if any) of any implant must be considered prior to patient undergoing MRI exam. MR imaging of  patients with implants brings specific risks. However, certain implants are approved by the governing regulatory bodies to be MR conditionally  safe. For such implants, the previously mentioned warning may not be applicable. Please contact the implant manufacturer for the specific  7 conditional information. The conditions for MR safety are the responsibility of the implant manufacturer and user, not of Siemens Healthineers. Unrestricted © Siemens Healthineers, 2020 Notes 463MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Ways to Minimize Susceptibility Artifacts in the Past • In MRI, there are several optimizations that have been used for years to improve on  image quality • Success was determined by technical know how and the type of metal • Here are the application tips used for optimization:  • Readout Bandwidth – Increase above 500 Hz/pixel • Slice Thickness – Decrease  • Matrix – Increase • TE – Decrease  • Fast RF  • Fast Gradients 8 Unrestricted © Siemens Healthineers, 2020 Notes 464MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Reducing Susceptibility Artifacts – The Past & Now • The past techniques are still utilized today, but now Siemens offers other techniques to assist  the user in the reduction of artifacts associated with metal. • Siemens offers 3 different techniques: • syngo WARP • View Angle Tilting (VAT) • Slice Encoding for Metal Artifact Correction (SEMAC) – Now available with Compressed  Sensing (license required) 9 Unrestricted © Siemens Healthineers, 2020 Notes 465MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP WARP WARP 10 Unrestricted © Siemens Healthineers, 2020 Notes 466MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP syngo WARP – What is WARP? syngo WARP – incorporates different  susceptibility artifact reduction  techniques • 2D TSE Sequence • High Bandwidth • RF Pulses – optimized • Reduced susceptibility  artifacts originating from MR  Conditional implants • Not an acronym; it is a  synonym for “bending”  distorted WARP mode • High Bandwidth mode • Optimized high bandwidth RF  Pulses 11 Unrestricted © Siemens Healthineers, 2020 Notes 467MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP WARP: Introduction  • Due to the implant, the homogeneous magnetic  field would be distorted • All distortion can be classified as: • In‐plane distortions  • Shift in frequency encoding direction  • Through‐plane distortions  • Tilted slice is excited or acquired  • Spatial encoding does not work properly 12 Unrestricted © Siemens Healthineers, 2020 Notes 468MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP WARP: Introduction  Signal voids Geometric distortions Fat suppression artifacts All typical problems due to the field distortions/inhomogeneities Images courtesy of Prof. Pfirrmann, Balgrist Univ. Hospital,  13 UnrestrictedUnrestricted © Siemens Healthineers, 2020 Switzerland Notes 469MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP WARP: Introduction  Without field distortions, the reconstructed image  Pixel dislocation in the readout direction due to  is free of distortion  field distortions object axis   phase phase axis metal readout axis readout axis 14 Unrestricted © Siemens Healthineers, 2020 Notes 470MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP WARP: Introduction To reduce the distortion: High receiving BW; high  spatial resolution  Example: 5 kHz field distortion FOV 250 mm, Matrix 256 axis   150 Hz/Px  bandwidth geom. distortion: 33 mm phase metal Optimized sequence FOV 250mm, Matrix 512 800 Hz/Px  bandwidth geom. distortion: 3 mm readout axis 15 Unrestricted © Siemens Healthineers, 2020 Notes 471MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP WARP: Introduction  Without field distortions, the excited slice profile is  The distorted slice selection gradient results in the  as expected  distorted slice profile  metal Excited slice profile Excited slice profile 16 Unrestricted © Siemens Healthineers, 2020 Notes 472MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP WARP: Introduction  To improve the slice excitation profile: High  excitation BW; thin slice thickness  Example: 5 kHz field distortion 5mm slice thickness 500Hz pulse  bandwidth geom. distortion: 50 mm Optimized sequence metal 3mm slice thickness 1500Hz pulse  bandwidth geom. distortion: 10 mm Excited slice profile 17 Unrestricted © Siemens Healthineers, 2020 Notes 473MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP WARP: Introduction  Overview of different methods Artifacts Reduction Methods ARTIFACT METHOD Signal voids Spin‐Echo based sequences (SE, TSE, etc) Fat saturation STIR (with high RF bandwidth) high RO bandwidth “In‐plane” distortions high resolution View Angle Tilting (VAT) high RF bandwidth “Through‐plane” distortions thin slices SEMAC (Advanced WARP) 18 Unrestricted © Siemens Healthineers, 2020 Notes 474MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP WARP: High Bandwidth Protocols  Example: conventional protocol WARP protocol Note: In default WARP protocols, VAT is also enabled.   19 Unrestricted © Siemens Healthineers, 2020 Notes 475MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP WARP: View Angle Tilting (VAT) WARP: View Angle Tilting (VAT) 20 Unrestricted © Siemens Healthineers, 2020 Notes 476MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP View Angle Tilting (VAT) View Angle Tilting (VAT) • VAT is an acronym for View Angle Tilting • VAT is standard and is utilized in conjunction with WARP • VAT applies an additional gradient in slice‐encoding direction during signal readout • Helps to reduce in‐plane distortions in the readout direction   21 Unrestricted © Siemens Healthineers, 2020 Notes 477MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP WARP: VAT  View Angle Tilting Original object Distorted image Undistorted image View Angle Tilting 22 Unrestricted © Siemens Healthineers, 2020 Notes 478MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP WARP: VAT  23 Unrestricted © Siemens Healthineers, 2020 Notes 479MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP WARP: VAT  • VAT applies an additional gradient along  the slice selective direction with the same  amplitude as that employed during RF  Geometric blurring (slice shearing) excitation pulse RF slice-sel. VAT G • It is applied simultaneously with  z readout conventional readout gradient x Gx • It rephases spins in the x‐axis z signal G VAT • It corrects in‐plane distortion tilting = arctan G readout • VAT%: value determines how long gradient  α is applied for during readout • 0%: no VAT gradient The longer the VAT gradient is  • 100%: VAT gradient is on for entire  Slice shearing x applied during readout (i.e. higher  duration of readout VAT%), the more severe the image  blurring Ref: Cho ZH et al., Med Phys 15(1), 1998  24 Unrestricted © Siemens Healthineers, 2020 Notes 480MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP WARP: VAT   Image without VAT  Blurred image with VAT Image with VAT Vertical structure cuts slice plane at the VAT angle 25 UnrestrictedUnrestricted © Siemens Healthineers, 2020 Notes 481MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP WARP: VAT  • Slice A: Blurring of anatomic edges that are  cutting the slice plane perpendicularly  Slice  A  Slice VAT-slice readout axis No VAT With VAT • Slice B: Anatomical structures that are cutting  the slice plane at the VAT‐angle are better  defined, than on the non‐VAT image Slice  B  Slice VAT-slice readout axis No VAT With VAT Image courtesy: Prof. Pfirrmann, Balgrist Univ. Hospital,  Unrestricted Siemens Healthineers, 2020 Switzerland Notes 482MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP VAT – Blurring Correction • Increasing Bandwidth will help with VAT blurring • Reduces echo spacing which improves slice profile • Balance increase in bandwidth with other parameters to maintain  SNR and optimize time Courtesy of UTMB – Dr. Val Runge  Implant Disclaimer ‐ The MRI restrictions (if any) of any implant must be considered prior to patient undergoing MRI exam. MR imaging of  patients with implants brings specific risks. However, certain implants are approved by the governing regulatory bodies to be MR conditionally  safe. For such implants, the previously mentioned warning may not be applicable. Please contact the implant manufacturer for the specific  27 conditional information. The conditions for MR safety are the responsibility of the implant manufacturer and user, not of Siemens Healthineers. Unrestricted © Siemens Healthineers, 2020 Notes 483MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP VAT – Scaling • No improvement by VAT • Severely blurred‐out joint space • Explanation:  Metal artifacts dominated by through‐plane distortion High Bandwidth VAT Images courtesy of Prof. Pfirrmann, Balgrist Univ. Hospital, Switzerland Implant Disclaimer ‐ The MRI restrictions (if any) of any implant must be considered prior to patient undergoing MRI exam. MR imaging of  patients with implants brings specific risks. However, certain implants are approved by the governing regulatory bodies to be MR conditionally  safe. For such implants, the previously mentioned warning may not be applicable. Please contact the implant manufacturer for the specific  28 conditional information. The conditions for MR safety are the responsibility of the implant manufacturer and user, not of Siemens Healthineers. Unrestricted © Siemens Healthineers, 2020 Notes 484MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP VAT – Scaling • Scales the amplitude of VAT gradient VAT 50% • Allows trade‐off between VAT blurring RF slice‐sel. and distortion correction VAT Gz readout Gx signal VAT 100% RF slice‐sel. VAT Gz readout Gx signal 29 Unrestricted © Siemens Healthineers, 2020 Notes 485MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP WARP: High Bandwidth + VAT  Standard High Bandwidth: WARP High Bandwidth + VAT Image courtesy: Prof. Pfirrmann, Balgrist Univ. Hospital, Switzerland 30 UnrestrictedUnrestricted © Siemens Healthineers, 2020 Notes 486MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP WARP: High Bandwidth + VAT  Standard  High Bandwidth + VAT Unrestricted  Siemens Healthineers, 2020 Notes 487MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Advanced WARP - SEMAC Advanced WARP ‐ SEMAC Slice Encoding for Metal Artifact Correction 32 Unrestricted © Siemens Healthineers, 2020 Notes 488MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Advanced WARP: SEMAC  • SEMAC (Slice Encoding for Metal Artifact  Correction), also Advanced WARP in product  • Data acquisition: • A conventional 2D slice‐selective TSE sequence  is used • A single 2D slice is excited • Additional phase encoding is performed in  SLICE direction  encoding • SEMAC encoding: distortions only seen by RF‐   Pulses, but not for encoding gradients SEMAC Standard SEMAC Images taken from: Wenmiao Lu, MRM 2009 33 Unrestricted © Siemens Healthineers, 2020 Notes 489MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Advanced WARP: SEMAC  . Image reconstruction . . • Separated images are reconstructed for every  Slice 4 Slice 4 SEMAC encoding step (only internally!) (Slice 5) (Slice 6) • Slice 6 contains signal excited while Slice 5 is  acquired, but belongs to Slice 5 . . . • All SEMAC encoded slices are combined to  original slice position (“added together”) Slice 5 SEMAC encoding SEMAC . . The theoretical excited slice Slice 6 Slice 6 Slice 6 Slice 6 Slice 6 Slice 6 SEMAC (Slice 5) (Slice 4) (Slice 3) (Slice 2) (Slice 1) (Slice 3) . . The real signal of the slice coming from  . Images taken from: Wenmiao Lu, MRM 2009 34 Unrestricted © Siemens Healthineers, 2020 Notes 490MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Advanced WARP: SEMAC  Note: SEMAC can be turned on only when  VAT=100% Slice 5 ‐ SEMAC Slice 5 ‐ No SEMAC (Corrected) (Uncorrected) Unrestricted  Siemens Healthineers, 2020 Notes 491MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Advanced WARP: SEMAC  Standard  SEMAC Images courtesy of Prof. Pfirrmann Balgrist Univ. Hospital  Unrestricted  Siemens Healthineers, 2020 Switzerland Notes 492MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Advanced WARP: SEMAC  Standard  SEMAC Images courtesy of Prof. Pfirrmann Balgrist Univ. Hospital  Unrestricted  Siemens Healthineers, 2020 Switzerland Notes 493MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Advanced WARP: SEMAC  Standard   High bandwidth ‐ WARP SEMAC Courtesy of Prof. V.M. Runge, UTMB,  Unrestricted  Siemens Healthineers, 2020 USA Notes 494MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Advanced WARP: SEMAC  Standard  High Bandwidth + VAT High Bandwidth + VAT + SEMAC 39 UnrestrictedUnrestricted © Siemens Healthineers, 2020 Notes 495MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Advanced WARP: SEMAC  MAGNETOM Spectra T1 TSE ‐ SEMAC MAGNETOM Avanto fit PD TSE ‐ SEMAC Unrestricted  Siemens Healthineers, 2020 Notes 496MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Advanced WARP: SEMAC  Default protocols available in Hip and Knee regions High Bandwidth ‐ WARP High BW + VAT High BW + VAT + SEMAC 41 Unrestricted © Siemens Healthineers, 2020 Notes 497MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Advanced WARP: SEMAC  Summary  SEMAC resolves through‐plane distortions • If possible, go to lower field strength (1.5T) • SEMAC will always use WARP + VAT=100% • At 3T artifacts will be stronger because of the  • The required SEMAC factor depends on the size,  higher field shape and material of the implant and may vary  • In addition, at 3T SAR might be more of an  from patient to patient issue, prolonging the scan time  • For joint arthroplasty 8‐12 SEMAC steps is usually  a reasonable value • If SEMAC is not necessary, please use the  • SEMAC factor between 1 and 6 makes no sense  protocols under ‘High Bandwidth’ (not allowed in the parameter card) • Metals causing stronger artifacts, such as stainless  • Limitation: Restore can not be combined with  steel or cobalt chromium alloys, require higher  VAT and SEMAC SEMAC steps • Titanium implants usually require lower values or  even no SEMAC at all 42 Unrestricted © Siemens Healthineers, 2020 Notes 498MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Compressed Sensing SEMAC Compressed Sensing (CS) SEMAC 43 Unrestricted © Siemens Healthineers, 2020 Notes 499MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP CS SEMAC  Why Compressed Sensing? • SEMAC is a pseudo‐3D acquisition technique to  deal with heavy slice distortions  • Thin 2D slice excitation   • Large 3D phase encoded slab  • The information is intrinsically sparse, which is  advantageous for compressed sensing  Final SEMAC recon 44 Unrestricted © Siemens Healthineers, 2020 Notes 500MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP CS SEMAC  Implementation Variable density Poisson Disc  • 3D incoherent undersampling (Poisson disc  sampling algorithm) • L1 wavelet regularization in three spatial  dimensions kz =k • Non‐linear iterative reconstruction using  SEMAC ky sensitivity encoding and FISTA (8‐fold acceleration with Poisson disc approach) • Multi‐GPU implementation for faster  reconstruction CS‐SEMAC Reconstruction Unrestricted Siemens Healthineers, 2020 Notes 501MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP CS SEMAC  The stand‐alone SEMAC sequence enables CS  TSE with SEMAC acceleration: CS=8 is fixed Unrestricted  Siemens Healthineers, 2020 Notes 502MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP CS SEMAC  Elliptical scanning is available for further scan time  Denoising mode for CS reconstruction: in CS SEMAC  reduction  default is 4 Unrestricted  Siemens Healthineers, 2020 Notes 503MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP CS SEMAC  SAR optimization is used to reduce SAR during the  measurement  When Flip angle=150° and SAR optimization=ON • Variable flip angle mode will be used • SAR Optimization= Automatic @3T → ON  60° teps s 150° SEMAC 60° Unrestricted  Siemens Healthineers, 2020 Notes 504MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP CS SEMAC  Conventional 3:00 min SEMAC 9:45 min CS SEMAC 4:10 min, SEMAC=15 Images courtesy: Dr. Jan Fritz, Johns  49 UnrestrictedUnrestricted © Siemens Healthineers, 2020 Hopkins, Baltimore Notes 505MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP CS SEMAC  Protocols for hip and knee  „cs8“ Unrestricted  Siemens Healthineers, 2020 Notes 506MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Knowledge Check 1.  If you VAT % set to _____, then there is  2.  SEMAC performs an additional phase  no VAT Gradient. encoding step in which direction? a. 0% a. Phase b. 20% b. Slice c. 50% c. Readout/Frequency d. 100% d. None of the Above Author | Department 51 Unrestricted © Siemens Healthineers, 2020 Notes 507MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Physiological Measurement Unit Physiological  Measurement Unit MR Applications Fundamentals – Part Two Presenter, Calibri 16 pt English, Month 2019 Unrestricted © Siemens Healthineers, 2020 Unrestricted Notes 508MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Agenda • Physiological Measurement Unit (PMU)  Overview • Hardware • Software • Application • Limits of ECG Triggering 2 Unrestricted © Siemens Healthineers, 2020 Notes 509MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Objectives • Identify challenges of ECG Triggering • Explain the learning phase of ECG Triggering • Identify flashing LED Codes • Explain how to charge the PERU 3 Unrestricted © Siemens Healthineers, 2020 Notes 510MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Physiological Measurement Unit (PMU) Overview Physiological Measurement Unit  (PMU) Overview 4 Unrestricted © Siemens Healthineers, 2020 Notes 511MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Physiological Measurement Unit (PMU) Cardiac examinations • MR imaging ↔ heart in movement  • Placement of electrodes on the chest • Acquisition of ECG • Triggering on R‐Peak of ECG • Synchronization of MR imaging on trigger • Cardiovascular MR imaging Challenges  • Gradient switching = interference on ECG • Magneto‐hydrodynamic effect = induced voltage due to  blood flow in magnetic field (i.e. enhancement of T‐wave) =  distortion of ECG 5 Unrestricted © Siemens Healthineers, 2020 Notes 512MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Physiological Measurement Unit (PMU) • It´s crucial to detect the R‐peak • Irregular heatbeats is also a problem  • Characteristic ECG Waveform: • P – atria contract • R wave – the time point of the R‐wave  corresponds to the end diastole • QRS – atria relax & ventricles contract • T wave – ventricles relax 6 Unrestricted © Siemens Healthineers, 2020 Notes 513MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Hardware Hardware 7 Unrestricted © Siemens Healthineers, 2020 Notes 514MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP PMU: Hardware and Software Components TIM Systems  Physiological ECG and  PMU display Host Respiratory Unit (PERU) Physiological display PMU-SW AMC/MARS Peripheral Pulse Unit  Physiological Data Acquisition  (PPU) Unit (PDAU) 8 Unrestricted © Siemens Healthineers, 2020 Notes 515MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP PMU: Hardware and Software Components Aera/Skyra and later systems Physiological ECG and  Host Patient data display (PDD) Respiratory Unit (PERU) Physiological display PMU‐Server PMU‐SW MARS Physiological Data Acquisition  Peripheral Pulse Unit  Unit (PDAU) on RFCEL_COM (PPU) 9 Unrestricted © Siemens Healthineers, 2020 Notes 516MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Receiver Antenna • Red arrows: Minimum required position: Edge  light green – dark green of receive antenna board  over metal edge of magnet. • Blue arrows: It is recommended to position the  receive antenna board some millimeters (4 to  5mm?) below the minimum required position.  Avoid too much tension due to the black tube. 10 Unrestricted © Siemens Healthineers, 2020 Notes 517MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP PERU (Physiological ECG and Respiratory Unit)  PPU (Peripheral Pulse Unit) • With new design indicated by the silver edge, the new radio protocol is used by TIM  systems and Area/Skyra ex factory PERU and PPU TIM Systems  PERU TIM Systems  PPU TIM Systems with old PERU and PPU Aera / Skyra (old design)  (since 2014) finger clip No silver edge Silver edge 11 Unrestricted © Siemens Healthineers, 2020 Notes 518MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP PERU  • The wireless PERU simultaneously acquires  three ECG channels as well as the respiratory  channel of the patient Control LEDs • The ECG electrodes and respiratory cushion are  connected to the PERU ECG leads with clips Transmitter unit • Use the application cushion and position it  Plug for respiration together with the PERU on the patient • Align the PERU on the patient in the direction of  the foot end of the patient table (also for ‘feet  first’) Radio data transmission is only enabled if  PERU is in magnetic field 12 Unrestricted © Siemens Healthineers, 2020 Notes 519MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP PPU • The wireless PPU acquires the patients  peripheral pulse • Consists of a transmitter unit, a fiber optic  Fiber optic cable sensor and a removable finger adapter  Transmitter unit (available in different sizes) Control LEDs • Induced eddy currents in the transmitter box  can cause a small magnetic field which interacts  with the magnet and gradients • This can cause vibrations of the sensor and can  slightly change the portion of finger whose  Finger Adapter light absorption is evaluated. Radio data transmission is only  • If pulse signal is sensitive to gradients: Put PPU  enabled if PPU is in magnetic field! partly under leg, but take care of antenna (→ at  LEDs) 13 Unrestricted © Siemens Healthineers, 2020 Notes 520MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP PPU Attaching PPU • Suitable finger adapter is attached • Ensure that the cable is not bend • Attach the pulse sensor to a finger or a toe • Ensure that the pulse sensor is attached properly Attention • Insert sensor into the adapter as shown on the  picture Reciever • Make sure that the sensor is inserted all way to  the stop and that the transmitter points at the  finger nail Emitter 14 Unrestricted © Siemens Healthineers, 2020 Notes 521MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP LED Flashing Codes for PERU and PPU 3 green LEDs (battery status) • The transmitter unit includes three LEDs for  signaling the battery status and one red LED as  fault indicator (for example, insufficient skin  contact of the ECG electrodes) 1 red LED (fault) • Battery status and faults are also indicated on  Transmitter unit the Dot display and the Physiological Display  dialog window • If the accumulator is not in the charging station,  the green LEDs flash regularly and  simultaneously PDD in Aera/Skyra Touch panel in Vida/Sola 15 Unrestricted © Siemens Healthineers, 2020 Notes 522MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP LED Flashing Codes for PERU and PPU LED Codes 3 Green LEDS flash Fully or nearly fully (2/3) charged  2 Green LEDs flash 1/3 to 2/3 fully charged  1 Green LED flash Nearly discharged; remaining operating duration is  1 hour RED LED flashes (as regular as the green LEDs) Transmit function deactivated, unit is positioned  outside the static magnetic field; no  electrode/application fault detected RED LED is out Transmit function activated; unit is positioned on  the patient table in the static magnetic field; no  electrode/application fault detected RED LED flashes rapidly PERU:  electrode fault – one or more ECG  electrodes are not applied correctly or fell off PPU:  application fault – pulse sensor is not applied  correctly at the finger 16 Unrestricted © Siemens Healthineers, 2020 Notes 523MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Charging Station • Accumulators should not be fully discharged before recharging them. If only one green LED  flashes, you should charge the accumulator for the next patient. The maximum charging time  is ~3 hours. After being fully charged, the operating hours for the units cover approx. 24 hours. • To charge a unit, it has to be placed firmly in the charging station. The PERU & PPU can be  charged together or separately in the charging station. • The red LED goes out when the unit is positioned correctly in the charging station. While  charging, the green LEDs flash alternatively as moving light. If the accumulator is nearly  charged, only one LED is flashing in the beginning. With increasing charging status, a second  green LED flashes and also the third LED. If the accumulators are fully charged, the green LEDs  are on and stop flashing. • The charging stations are connected to two USB ports of the host computer. If the MR system  is shut down overnight, PERU and PPU can not be charged! 17 Unrestricted © Siemens Healthineers, 2020 Notes 524MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Accessories  To prevent skin irritations, the PERU has to be  located in the application cushion during  examination Application Cushion Respiratory Cushion with pressure hose Respiratory Belt The respiratory cushion is attached to the patient using the respiratory belt. 18 Unrestricted © Siemens Healthineers, 2020 Notes 525MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Software Software 19 Unrestricted © Siemens Healthineers, 2020 Notes 526MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Vector Cardiogram (VCG) The VCG records from two pairs of electrodes the  magnitude and direction (phase) of the electrical  forces. • Resulting graph is spatial representation of  aVF electrical activity in the heart Lead I • Magnitude and Phase of cardiac vector can be  determined An elaborate algorithm can then separate noise  from the R‐wave aVF • Reduced sensitivity to gradients and RF‐related  artifacts Flow artifacts, • 2D direction (Magnitude) of R‐waves is  R- Wave gradient noise determined during learning phase, while patient  is outside magnet bore • Phase information is used to differentiate R‐waves  Lead I from artifacts 20 Unrestricted © Siemens Healthineers, 2020 Notes 527MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP ECG Trigger Algorithm New trigger algorithm (Auto, VCG/advanced_1) • No erroneous triggers • Very small jitter R‐peak • Old: Detection of learned limits • New: Detection of learned wave shapes 21 Unrestricted © Siemens Healthineers, 2020 Notes 528MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP ECG Trigger Algorithm Learning phase of ECG trigger algorithm • The learning phase of the ECG trigger algorithm is  running when the patient table is within 30 cm of  its “Home” position • Recommendation: After patient is completely  prepared, additionally wait at least ten heart  beats before the patient table is moved into  magnet = optimum learning phase  • Relearn in magnet available since VD11A and  VB17A SP4 Note:  • If reboot scanner with patient table & patient  inside magnet ‐> no learnphase ‐> no triggers • If PMU signal simulation is active during  preparation of patient and subsequent  deactivation of PMU signal simulation in magnet ‐ > no learnphase ‐> no triggers 22 Unrestricted © Siemens Healthineers, 2020 Notes 529MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Trigger Algorithms (XA Software) • The PERU uses three different ECG leads, each  showing the voltage difference between two of  the electrodes (ECG I, II, III) • Auto (VCG) uses a VCG derived from the two  best ECG leads and uses the ‘new’ learning  algorithm. • VCG standard uses a VCG generated by two  fixed pairs of electrodes and uses the ‚old‘  learning algorithm (may generate more fail‐ triggers but might be useful in case of strong  arrhythmia, where Auto might detect less ‘true’  R waves) • “Relearn” is only available for trigger algorithm  “Auto”  23 Unrestricted © Siemens Healthineers, 2020 Notes 530MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Trigger Algorithms (VD/VE Software) The PERU uses three different ECG leads, each  showing the voltage difference between two of the  electrodes (ECG I, II, III) Auto uses a VCG derived from the two best ECG  leads and uses the ‘new’ learning algorithm. • VCG standard uses a VCG generated by two fixed  pairs of electrodes and uses the ‚old‘ learning  algorithm (may generate more fail‐triggers but  might be useful in case of strong arrhythmia,  where Auto might detect less ‘true’ R waves) “Relearn” is only available for trigger algorithm  “Auto”  24 Unrestricted © Siemens Healthineers, 2020 Notes 531MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Trigger Algorithms (since VB17 SP4) “Relearn” is only available for trigger algorithm  “VCG/advanced_1”  Activate Frame to see PMU status  messages! E.g. notification on  electrode fault … 2nd option to relearn 1st option to relearn Available only with Available only with VCG/Advanced_1 VCG/Advanced_1 25 Unrestricted © Siemens Healthineers, 2020 Notes 532MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Application Application 26 Unrestricted © Siemens Healthineers, 2020 Notes 533MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP ECG Signal Strength • ECG is always scaled to fill the displays.  • ECG will look good even with a low amplitude • If ECG signal is weak: Inside the magnet the ECG  may be wiped out by gradient / RF and magneto  hydrodynamic effects • Always check signal strength of ECG signal at  table display/PDD: Range is from one to five  stars/bars • If needed, optimize signal strength (shave hairy  skin, Nuprep, Conmed 2700, electrode position)  27 Unrestricted © Siemens Healthineers, 2020 Notes 534MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Patient Preparation for PERU To minimize the effects from gradient switching on  ECG, the signal strength of the ECG must be  maximized as best as possible • In case of hairy chest:  Shave the points where  you intend to attach the electrodes • Use Nuprep gel to prepare the skin for better  signal transmission. Wipe any excess gel after it  has been rubbed on the skin. • Use only the recommended electrodes:  Conmed 2700 28 Unrestricted © Siemens Healthineers, 2020 Notes 535MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Wireless VCG Triggering Multi‐channel ECG System 2‐channel system has 3 electrodes 3‐channel system has 4 electrodes: • 1 vertical signal (AVF) • 1 vertical signal (Lead 1) • 1 horizontal signal (Lead I) • 2 horizontal signals (Leads 2,3) 29 Unrestricted © Siemens Healthineers, 2020 Notes 536MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP PERU (Physiologic ECG and Respiratory Unit) Wireless VCG Triggering • The ECG sensor in the PERU ensures transfer of the ECG  signal • The PERU is aligned longitudinally toward the foot end of  the patient table even though the patient may be  positioned feet first  • Position the PERU in the sponge or add absorbent material  between the ECG cables, PERU, and skin • Distance between the PERU and the patient should be at  least 2 cm 30 Unrestricted © Siemens Healthineers, 2020 Notes 537MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Limits of ECG Triggering Limits of ECG Triggering 31 Unrestricted © Siemens Healthineers, 2020 Notes 538MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Magneto‐Hydrodynamic Effect Magneto‐hydrodynamic effect: induced voltage  due to blood flow in magnetic field (e.g.  enhancement of T‐wave) → distortion of ECG • Blood is a conductive medium. When moving  blood is exposed to a magnetic field and the  vessel is oriented perpendicular to B0, charge  separation occurs, inducing a time‐varying  𝒗𝒗𝒗𝒗 electrical dipole signal.  • This dipole is detected as a time‐varying electrical  signal superimposed onto the ECG waveform. B0 32 Unrestricted © Siemens Healthineers, 2020 Notes 539MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Magneto‐Hydrodynamic Effect Theoretical example Practical example at 3T 33 Unrestricted © Siemens Healthineers, 2020 Notes 540MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Gradient Switching • The electrode cables and the body form loops  which are sensitive to changes of the magnetic  field, especially gradient switching (dynamo  Recommended use of PERU to  Technical view: principle…) gather the ECG: • Interference on ECG due to gradient switching • Interference the stronger the more PERU is off‐ center • For triggered head/neck scans turn PERU that it  is aligned beside the head  Loop! 34 Unrestricted © Siemens Healthineers, 2020 Notes 541MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Gradient Switching & Magneto‐Hydrodynamic Effect Gradient interference practical example Magneto‐hydrodynamic effect & gradient  interference example @ Verio 3T 35 Unrestricted © Siemens Healthineers, 2020 Notes 542MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Time‐Variant R‐Peak The waveform to be detected is time‐variant → Avoid deep breath‐hold! Before breath‐hold During deep breath‐hold 36 Unrestricted © Siemens Healthineers, 2020 Notes 543MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Summary Boundary conditions • R‐peak‐trigger already in maximum ‐> only rising  Gradient interference Magneto‐hydrodynamic effect edge for detection  • Magneto‐hydrodynamic effect & artefacts (with  rising edge like R‐peak?) Trigger algorithm Detection of R‐peak in ECG • Gradient interference superimposed to R‐peak • Time‐variant R‐peak Time‐variant R‐Peak Suboptimum patient preparation: Conclusions for ECG trigger algorithms • Skin not shaved • If the number of wrong triggers should be near  • No Nuprep gel applied • Wrong electrodes zero (small tolerance accepted from learned R‐ • Electrode position peak), then missing triggers are very likely • If the number of missing triggers should be near  Severe problems  100% trigger reliability is not  zero (notable tolerance accepted from learned R‐ expected for 7T possible with ECG! peak), then wrong triggers are very likely Other techniques for synchronization with  heart movement? 37 Unrestricted © Siemens Healthineers, 2020 Notes 544MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Case: Customer uses PMU to monitor vital parameters  • Advice: If you gain knowledge of such a misuse  then immediately advise the customer and  clarify that PMU may not be used as a  monitoring system • Otherwise, in case a patient got hurt, Siemens  might be taken into responsibility 38 Unrestricted © Siemens Healthineers, 2020 Notes 545MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Knowledge Check 1. ECG is always scaled to fill the displays,  2. The learning phase of the ECG trigger  therefore ECG will look good even with  algorithm is running when the patient  a low amplitude. table is within ______cm of its Home  a. True position. b. False a. 10 b. 20 c. 30 d. 40 Author | Department 39 Unrestricted © Siemens Healthineers, 2020 Notes 546MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP MR Cardiac Imaging MR Cardiac  Imaging MR Applications Fundamentals – Part Two Presenter, Calibri 16 pt English, Month 2019 Unrestricted © Siemens Healthineers, 2020 Unrestricted Notes 547MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Agenda • Introduction • Planning • Morphology • Function • Flow • Coronary Arteries • Patient Physiology • Additional Techniques 2 Unrestricted © Siemens Healthineers, 2020 Notes 548MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Objectives • Explain Planning for Cardiac Imaging • Identify Morphology sequences • Describe Cine Function sequences • Explain Flow Imaging  • Identify Coronary Artery Imaging sequences • Describe other cardiac imaging techniques to   use due to the patients physiology • Identify MyoMaps sequences 3 Unrestricted © Siemens Healthineers, 2020 Notes 549MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Introduction Introduction 4 Unrestricted © Siemens Healthineers, 2020 Notes 550MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Introduction • Cardiavascular diseases (CVDs ) (a group of disorders of the heart and blood vessels) are the number 1 cause of  death globally: more people die annually from CVDs than from any other cause (1) • An estimated 17.9 million people died from CVDs in 2016, representing 31% of all global deaths. Of these  deaths, 85% are due to heart attack and stroke (1) • Diagnostics, especially MR imaging important • CMR has become gold standard for evaluating myocardial function, volumes and scarring (2) • Additionally CMR is unique in its comprehensive tissue characterization and has become indispensable in  evaluation of congenital heart disease, heart failure, cardiac masses, pericardial diseases etc. (2) (1) https://www.who.int/en/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds) 5 (2) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5777859/ Unrestricted © Siemens Healthineers, 2020 Notes 551MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Introduction  6 Unrestricted © Siemens Healthineers, 2020 Notes 552MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Basic Observations: Challenges Location: breathing Cardiac motion: continuous contraction and dilation  Unrestricted Siemens Healthineers, 2020 Notes 553MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Basic Observations: Challenges Anatomy: non standard imaging plane Unrestricted Siemens Healthineers, 2020 Notes 554MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Basic Observations: Cardiac MR & ECG • (More or less) periodic motion of the heart is  accompanied by a periodic electric signal = ECG • ECG‐gating = synchronization of data acquisition  with ECG i.e. acquiring data at the “same state of motion“ R wave of ECG  used as trigger Data acquisition at fixed position in cardiac (RR) interval https://www.msdmanuals.com/home/heart-and-blood-vessel-disorders/diagnosis-of-heart-and-blood-vessel- disorders/electrocardiography 9 Unrestricted © Siemens Healthineers, 2020 Notes 555MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Basic Observations: Cardiac MR & ECG Cardiac MR typically uses fast ECG gated  breathhold protocols TD TD • Short imaging time • Fast sequences/protocols (and “fast  hardware”) Continuous contraction and dilatation:  Breathhold: Limited  Short period of data acquisition in each number of heart beats. RR‐interval. (~ 10 ‐ 20 hb) (~ 40 ‐ 200 ms) 10 Unrestricted © Siemens Healthineers, 2020 Notes 556MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Basic Observations: Cardiac MR & ECG https://www.msdmanuals.com/home/heart-and-blood-vessel-disorders/diagnosis-of-heart-and-blood-vessel- disorders/electrocardiography 11 Unrestricted © Siemens Healthineers, 2020 Notes 557MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Planning Planning 12 Unrestricted © Siemens Healthineers, 2020 Notes 558MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Cardiac MR Protocols Dot Cockpit 13 Unrestricted © Siemens Healthineers, 2020 Notes 559MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Cardiac MR Imaging Planes –A Remark Sagittal • Imaging of heart is typically performed along cardiac oriented planes 2‐ Chamber  Short axis • Makes structures and  Coronal Transverse function comparable but  also suitable planning necessary 4‐ Chamber Unrestricted Siemens Healthineers, 2020 Notes 560MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Planning 1. Localizers  • 3‐plane loc • 3‐plane loc with heart in isocenter • Axial Stack Dark Blood HASTE • Pseudo 2‐chamber, 4‐chamber and short axis 2. Cine Imaging Left heart • 4‐chamber, 2‐chamber, 3‐chamber, LVOT (Left Ventricular Outflow Tract), short axis (SAX) 3. Cine Imaging Right Heart • 2ch RV (Right Ventricle), RVOT (Right Ventricular Outflow Tract) 15 Unrestricted © Siemens Healthineers, 2020 Notes 561MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Planning ‐ Localizers 16 Unrestricted © Siemens Healthineers, 2020 Notes 562MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Localizers ‐ Axial Stack‐ Haste Dark Blood  17 Unrestricted © Siemens Healthineers, 2020 Notes 563MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Localizers – Pseudo 2Ch / 4Ch / SAX Transverse localizer Pseudo 2‐Chamber Pseudo 4‐Chamber Plan pseudo 2ch through  Plan pseudo 4ch through  Plan pseudo SAX perpendicular  middle of left ventricle, parallel  middle of ventricle to cut apex  to septum and parallel to mitral  to septum  and mitral valve valves. Include aortic root and  atrium 18 Unrestricted © Siemens Healthineers, 2020 Notes 564MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Localizers ‐ Pseudo Short‐Axis Resulting pseudo SAX views 19 Unrestricted © Siemens Healthineers, 2020 Notes 565MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP 4‐Chamber  Pseudo 2Ch Pseudo SAX – mid ventricle Pseudo SAX‐ basal Pseudo 4Ch * Right Ventricle Septum Tricuspid Valve Right Atrium * Left Ventricle Left Atrium Mitral Valve 20 Unrestricted © Siemens Healthineers, 2020 Notes 566MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP 2‐Chamber 4Ch Pseudo SAX Pseudo 2Ch Mitral Valve Left Atrium Left Ventricle 21 Unrestricted © Siemens Healthineers, 2020 Notes 567MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP 3‐Chamber Pseudo SAX‐ basal 2Ch 4Ch Aorta Aortic Valve Left Atrium Mitral Valve Right Ventricle Left Ventricle 22 Unrestricted © Siemens Healthineers, 2020 Notes 568MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP LVOT (Left Ventricular Outflow Tract) 3Ch Coronal Localizer Pulmonary Aorta Artery Aortic Valve Right Ventricle Left Ventricle 23 Unrestricted © Siemens Healthineers, 2020 Notes 569MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP RV 2Ch Short axis 4Ch Aorta Right Ventricle Pulmonary Right Atrium Valve Tricuspid Valve Right Ventricle 24 Unrestricted © Siemens Healthineers, 2020 Notes 570MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP RVOT (Right Ventricular Outflow Tract) 2Ch RV Transverse Localizer Pulmonary Right Ventricle Valve Left Atrium Right Ventricle Left Ventricle 25 Unrestricted © Siemens Healthineers, 2020 Notes 571MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Knowledge Check 1. This image is a _______________view. 2. The ___________is also know as the  a. 2 Chamber View inflow and outflow tract. b. 3 Chamber View a. 2 Chamber View c. 4 Chamber View b. 3 Chamber View d. RVOT c. 4 Chamber View d. RVOT Author | Department 26 Unrestricted © Siemens Healthineers, 2020 Notes 572MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Morphology Morphology 27 Unrestricted © Siemens Healthineers, 2020 Notes 573MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Morphology Aim: Visualize anatomy and characterize tissue of cardiac muscle and surrounding vessels • Typical use of turbo spin echo (TSE) sequence with high turbo factors to be fast enough • Blood appears dark in TSE images • But: TSE inflow effect must be supplemented by dark blood preparation (double inversion recovery technique) 28 Unrestricted © Siemens Healthineers, 2020 Notes 574MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Morphology “normal“ TSE TSE with dark blood preparation 29 Unrestricted © Siemens Healthineers, 2020 Notes 575MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Morphology Fat infiltration in LV  myocardium Myocarditis T1 weighting: TR = 1 HB, TE & echo train short Myocarditis  (bright signal in myocardium not seen in T1 image‐ above right) Prep pulses TSE data (dark blood + eg fat saturation) acquisition T2 weighting: TR = 2 HB, TE & echo train long 30 Unrestricted © Siemens Healthineers, 2020 Notes 576MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Morphology After the trigger is detected a non‐selective IR pulse followed by a selective IR pulse is delivered 31 Unrestricted © Siemens Healthineers, 2020 Notes 577MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Morphology The non‐selective IR pulse inverts all the spins in the field including blood 32 Unrestricted © Siemens Healthineers, 2020 Notes 578MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Morphology The selective IR pulse re‐inverts only the spins in the slice plane 33 Unrestricted © Siemens Healthineers, 2020 Notes 579MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Morphology The re‐inverted blood washes out of the slice plane and the inverted blood washes into the slice plane 34 Unrestricted © Siemens Healthineers, 2020 Notes 580MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Morphology Fluid (cyst) Both T1 and T2 are helpful for tissue  of unclear composition as for cardiac  masses (tumor, cyst, thrombus) and  pericardial diseases. T1  T2  T2 Fat Sat  Fatty (lipoma) 35 Unrestricted © Siemens Healthineers, 2020 Notes 581MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Function Function 36 Unrestricted © Siemens Healthineers, 2020 Notes 582MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Function • The heart is a pump and imaging of its dynamics (function) is very  important • Cine imaging is performed in all MR cardiac exams & allows study of: • Wall motion • Function of valves • Quantitative analysis of cardiac function Idea: Data is acquired at different phases throughout the cardiac cycle From: MR Herzbildgebung Interaktiv. Thieme, 2009. 1 2 3 4 5 6 7 89 10 123 ... Cardiac Phases 37 Unrestricted © Siemens Healthineers, 2020 Notes 583MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Function • Two common sequences are used (bright blood techniques): TrueFISP • TrueFISP (preferred technique) better • FLASH SNR, CNR; better • Two different ECG gating methods are used: blood‐tissue • Prospective Triggering borders • Retrospective Triggering FLASH 38 Unrestricted © Siemens Healthineers, 2020 Notes 584MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Function Prospective ECG gating: “Acquisition window” has to be determined before acquisition Acquisition Window 1 2 3 4 5 6 7 89 10 123 ... Cardiac Phases Measures less than entire cardiac cycle (Due to variability of heart beats) 39 Unrestricted © Siemens Healthineers, 2020 Notes 585MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Function Retrospective ECG gating: Measures throughout the entire cardiac cycle. No acquisition window to fix. User defined  number of calculated cardiac phases 1 2 3 4 5 6 7 89 10 11 12 1 2 3 4 Average RR Interval 1 2 3 4 5 6 7 89 10 11 12 Measured Data 1 2 3 4 5 678 9 ... Calculated Phases 40 Unrestricted © Siemens Healthineers, 2020 Notes 586MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Function Prospective                             vs                            Retrospective 41 Unrestricted © Siemens Healthineers, 2020 Notes 587MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Function 2‐chamber view                              4‐chamber view                         LV outflow tract short axis view                             3‐chamber view                        RV 2‐chamber view Unrestricted Siemens Healthineers, 2020 Notes 588MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Function The cine images can be assessed quantitatively and qualitatively • Quantitatively by calculating certain volume parameters: • End Systolic Volume • End Diastolic Volume • Stroke Volume • Ejection Fraction • Qualitatively by visual assessment of the: • Wall motion • Blood flow • Valve function 43 Unrestricted © Siemens Healthineers, 2020 Notes 589MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Function The cine images can be assessed quantitatively and qualitatively.  Quantitatively by calculating certain volume parameters: • End Systolic Volume • End Diastolic Volume • Stroke Volume • Ejection Fraction Qualitatively by visual assessment of the: • Wall motion • Blood flow • Valve function 44 Unrestricted © Siemens Healthineers, 2020 Notes 590MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Function: Quantitative Assessment End Diastolic Volume  End Systolic Volume  Left ventricular muscle (EDV, largest volume) (ESV, smallest volume) mass correct Functional parameters can be quantified Stroke Volume (SV)  EDV ESV (e.g. of the left ventricle). From: MR Herzbildgebung interaktiv. Thieme, 2009. = - SV EDV Ejection Fraction (EF) = 45 Unrestricted © Siemens Healthineers, 2020 Notes 591MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Functional Quantitative Assessment of Cine Images Functional parameters can be quantified (e.g. of the left  ventricle) • Cine series acquired throughout (e.g. left ventricle) • Volumes calculated slice by slice and added up (Simpson approach)  Contouring of endo‐ and epicardial borders allows determination of left ventricular blood volume and  muscle in each slice   Summed up at a cardiac phase gives left ventricular volume and mass (volume x density) at that phase 46 Unrestricted © Siemens Healthineers, 2020 Notes 592MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Function The cine images can be assessed quantitatively and qualitatively.  Quantitatively by calculating certain volume parameters: • End Systolic Volume • End Diastolic Volume • Stroke Volume • Ejection Fraction Qualitatively by visual assessment of the: • Wall motion • Valve function • Blood flow 47 Unrestricted © Siemens Healthineers, 2020 Notes 593MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Function: Qualitative Assessment of Wall Motion Global reduced contractility Atypical septal motion (dilatative cardiomyopathy) (pulmonary hypertension) 48 Unrestricted © Siemens Healthineers, 2020 Notes 594MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Function: Qualitative Assessment of Valves Cardiac valves often do not open fully (stenosis) or do not close completely (insufficiency) Normal Aortic Valve Bicuspid Aortic Valve Stenotic Aortic Valve 49 Unrestricted © Siemens Healthineers, 2020 Notes 595MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Function: Qualitative Assessment of Blood Flow Vortical blood flow in an aneurysm Blood flow from left to right atrium through a shunt (atrial septal defect, ASD) 50 Unrestricted © Siemens Healthineers, 2020 Notes 596MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Function: Qualitative Assessment of Valves & Blood Flow  Aortic Stenosis  Aortic Insufficiency Turbulent jet‐like blood flow is visible in cine  series as signal voids Tricuspid Insufficiency Mitral Insufficiency 51 Unrestricted © Siemens Healthineers, 2020 Notes 597MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Knowledge Check 1. A T1 weighted TSE cardiac sequence  2. Two common sequences that are used  would have a long echo train. for bright blood imaging techniques are  a. True TrueFISP and _________.  b. False a. TSE b. FLASH c. TSE Dark blood d. SE Author | Department 52 Unrestricted © Siemens Healthineers, 2020 Notes 598MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Flow Flow 53 Unrestricted © Siemens Healthineers, 2020 Notes 599MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Flow Pumping of heart causes complex blood flow patterns in ventricles, atria and surrounding vessels, which may be  pathological in many respects • In Cine imaging we can qualitatively assess these flow effects • However, with Phase Contrast imaging blood flow velocities can be quantified: • Phase of MR signal depends on velocity • Phase contrast “extracts” velocity dependence via subtraction B0 Phase depends on velocity Transverse magnetization -= Velocity “compensated“ Velocity “sensitive“ Phase image Gray value ~ phase ~ velocity (encoding) in 1 direction 54 Unrestricted © Siemens Healthineers, 2020 Notes 600MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Flow Both in‐plane and through‐plane phase contrast imaging useful  In‐plane Through‐plane Shunt  Stenosis (atrial septal defect) 55 Unrestricted © Siemens Healthineers, 2020 Notes 601MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Flow Both in‐plane and through‐plane phase contrast imaging useful In‐plane: qualitative assessment Through‐plane: quantitative assessment Shunt  Stenosis (atrial septal defect) 56 Unrestricted © Siemens Healthineers, 2020 Notes 602MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Flow Through‐plane phase contrast measurements may show blood flow through whole cross‐sectional area (e.g. a vessel) • Flow = Area  Velocity • Summing up in cardiac cycle: Passing blood volume • Aorta Ascending & Main Pulmonary Artery: Stroke volume 57 Unrestricted © Siemens Healthineers, 2020 Notes 603MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Coronary Arteries Coronary Arteries 58 Unrestricted © Siemens Healthineers, 2020 Notes 604MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Coronary Arteries • Coronary arteries originate just above the Aortic  valve • We have 3 coronary arteries: • Left Coronary (Left Main) which splits into: • Left Anterior Descending  (LAD) • Circumflex  (Cx) • Right Coronary Artery (RCA) • Coronary arteries small (~3‐4 mm at origin) such that  high resolution necessary • ECG‐gated high resolution 3D sequences Unrestricted Siemens Healthineers, 2020 Notes 605MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Coronary Arteries • Due to long imaging times of 3D sequences compared with 2D, only thin slabs with limited resolution possible • Coronary arteries can be acquired as a breathhold or by using navigators to detect and correct breathing  movement • With breathhold acquisition , the  coronary arteries can be visualized quite well (e.g. with fat saturated TrueFisp),  but coverage is difficult and resolution limits stenoses evaluation • Therefore imaging the coronaries is usually performed using respiratory gating which employs navigators.  However, the quality depends largely on the regularity of the breathing patterns Navigators (“1‐dimensional images“) used for breathing/diaphragm motion detection. From: MR Herzbildgebung interaktiv. Thieme, 2009. Unrestricted Siemens Healthineers, 2020 Notes 606MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Coronary Arteries There are  2 approaches to cover the coronary arteries: • Whole heart approach‐ cover whole coronary artery tree with one  (typically transversal) thick 3D imaging slab From: McNeal GR. Whole Heart MRI – Adopting the CT Approach,  Magnetom Flash 1, 2006 • Targeted approach‐ cover (part of) coronary artery of interest by a  thin 3D imaging slab RCA Unrestricted Siemens Healthineers, 2020 Notes 607MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Patient’s Physiology Patient’s Physiology 62 Unrestricted © Siemens Healthineers, 2020 Notes 608MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Patient’s Physiology When performing cardiac MR, all techniques have to be adapted to patient’s physiology. Some things to consider: • Firstly breathhold capabilities vary and the quality of the breathhold is not always the same • Also heart frequencies of patients vary across broad range. Without any change in data acquisition this leads to  corresponding change in breathhold time    High Frequency Low Frequency Measurement time  e.g. 100 beats/min e.g. 50 beats/min  increases (doubles) RR = 600 ms RR = 1200 ms • In addition, the motion of the varies during the cardiac cycle, there are phases with more motion and phases with less motion • Therefore, data acquisition has to be adapted for each patient and protocol 63 Unrestricted © Siemens Healthineers, 2020 Notes 609MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Patient’s Physiology Data acquisition has to be adapted for each  Data  patient and protocol: acquisition To early • Imaging results usually vary depending on  amout of motion during data acquisition • But “resting periods“ of the heart depend on  heart frequency Here an example from DB TSE sequences: • The heart is moving slower so data acquisition is too early‐ needs to be moved to later in cardiac cycle Data  acquisition Good timing 64 Unrestricted © Siemens Healthineers, 2020 Notes 610MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Patient’s Physiology • The situation becomes even more challenging when the patient suffers from  arrhythmia , which means they have irregular heart beats • Irregular heart beats in the case of arrhythmia lead to acquisition of image  data at different positions From: MR Herzbildgebung interaktiv. Thieme, 2009. • Possible result • Alternative methods required 65 Unrestricted © Siemens Healthineers, 2020 Notes 611MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Patient’s Physiology So, cardiac MR is no press a button technique ... Cardiac sequences and protocols have to be adapted  to patient‘s physiology Unrestricted Siemens Healthineers, 2020 Notes 612MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Additional Techniques Additional Techniques 67 Unrestricted © Siemens Healthineers, 2020 Notes 613MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Additional Techniques – Compressed Sensing Cine For patients … Acquire free‐breathing, high‐resolution cardiac cine  images • Facilitates exams and enhances patient comfort and  outcomes • Opens up CMR where it could not be done before, or was  inconclusive … that can‘t easily … or those with hold their breath arrhythmia 68 Unrestricted © Siemens Healthineers, 2020 Notes 614MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Case Study: 50‐year‐old with atrial fibrillation Reliable ventricular function quantification not feasible Needs: • Fast acquisition covering the  whole ventricle  • Fewer breath‐holds to improve  patient compliance  • High spatial resolution  to delineate ventricular borders  for analysis • High temporal resolution  for accurate determination of  end‐diastole and end‐systole  at high heart rates Segmented poor image quality Real‐time poor resolution Unrestricted Siemens Healthineers, 2020 6 9 Notes 615MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Case Study: 50‐year‐old with atrial fibrillation Reliable ventricular function quantification not feasible Standard segmented Standard real‐time Compressed Sensing Cardiac Cine (iPAT 3), 8 heart beats (TPAT 3), 1 heart beat (Acc. 11.5), 1 heart beat Peking Union Medical College Hospital, Peking,  China; MAGNETOM Skyra Unrestricted Siemens Healthineers, 2020 7 0 Notes 616MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Additional Techniques – Compressed Sensing Cine • Whole heart: 10 slices • Acceleration factor 10 • 1 breathhold: 2  heartbeats per slice  (prep + scan) • Temporal resolution <  50 ms • Adaptive triggering:  full cardiac cycle Courtesy MR PI TIO Card Unrestricted Siemens Healthineers, 2020 Notes 617MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Challenge:  Accurate scar burden assessment, even  in patients who cannot hold their breath • Solution: PSIR HeartFreeze  Breath‐hold • Motion Corrected Phase‐Sensitive  Inversion Recovery  • We can now do high resolution  late enhancement imaging under  free breathing conditions. Free breathing Images obtained courtesy of Peking Union Medical College Hospital MAGNETOM Skyra, syngo MR D13, with WIP 826 Unrestricted Siemens Healthineers, 2020 Notes 618MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Additional Techniques – PSIR HeartFreeze Repeat the same acquisition multiple times…. These are the “original images” Unrestricted Siemens Healthineers, 2020 Notes 619MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Additional Techniques – PSIR HeartFreeze Then perform Motion correction …. These are the “MoCo images” Unrestricted Siemens Healthineers, 2020 Notes 620MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Additional Techniques – PSIR HeartFreeze Repeat the same acquisition multiple times, then motion correct and average the images These are the “Averaged images” Unrestricted Siemens Healthineers, 2020 Notes 621MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP And one can do even more… Cardiac Mapping Acute apical infarct‐ T2  map indicates  • MyoMaps = automated T1, T2 and T2* relaxation  edema around apex  time mapping (color coded in orange) • Focus = tissue characterization of left ventricular  myocardium • T1 Mapping – can be acquired to evaluate e.g. scar  tissue • T2 Mapping can be used to evaluate e.g. oedema • T2* Mapping used to assess iron overload  Wassmuth et al. Journal of cardiovascular Magnetic Resonance,  2013, 15:27 Unrestricted Siemens Healthineers, 2020 Notes 622MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP And one can do even more… 4D Flow Measurement to study complex cardiovascular flow  patterns 4D Flow = 3D Flow x time Unrestricted Siemens Healthineers, 2020 Notes 623MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Knowledge Check 1. The whole heart approach covers the  2. MyoMaps provides  whole coronary artery tree with  _________________________mapping  ______________. of the heart at 1.5T. a. 2D Imaging a. T1 b. Thick 3D Imaging Slab b. T2  c. Thin 3D Imaging Slab c. T2 and T2* d. T1, T2, and T2* Author | Department 78 Unrestricted © Siemens Healthineers, 2020 Notes 624MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP ZOOMit ZOOMit MR Applications Fundamentals – Part 2 Presenter, Calibri 16 pt English, Month 2019 Unrestricted © Siemens Healthineers, 2020 Unrestricted Notes 625MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Agenda • Introduction • Inner Volume Imaging • 2D RF Pulses • ZOOMitPRO 2 Unrestricted © Siemens Healthineers, 2020 Notes 626MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Objectives • Describe the benefits of using ZOOMit • Explain the supported sequences for ZOOMit • Identify the protocols used for inner volume  imaging • Explain the benefits of ZOOMitPRO 3 Unrestricted © Siemens Healthineers, 2020 Notes 627MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Introduction Introduction 4 Unrestricted © Siemens Healthineers, 2020 Notes 628MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Introduction ‐ ZOOMit • When ZOOMit was first introduced it was based  on TimTX TrueSHAPE Siemens parallel transmit  technology • Creates a zoom effect during MR Imaging • This unique application uses selective excitation  to allow you to shape your image • Use ZOOMit to highlight regions, organs, or even  features of an organ Unrestricted Siemens Healthineers, 2020 Notes 629MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Introduction ‐ ZOOMitPRO • With XA20 software, ZOOMitPRO was introduced  • PRO:  Partially Rotated • RF excitation trajectory is modified to rotate side excitations (and therefore potential aliasing artifacts)  out of FOV • Additional Benefits: • Available for all systems (1.5T,3T, non‐pTx, pTx) • Improved fat saturation • Reduced RF pulse length          reduced echo time (dependent on protocol)      SNR increase 6 Unrestricted © Siemens Healthineers, 2020 Notes 630MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Introduction ZOOMit Overview < XA20  ≥ XA20 ≥ XA20 Supported system pTx systems Non‐pTx systems pTx systems Supported sequences SPACE  ep2d_diff*  SPACE  ep2d_bold  ep2d_bold  ep2d_fid ep2d_fid ep2d_diff  ep2d_diff* pTx volume No: SPACE No: ep2d_diff No: SPACE, ep2d_diff Yes: ep2d Yes: ep2d_bold, ep2d_fid * ZOOMit PRO from XA20 7 Unrestricted © Siemens Healthineers, 2020 Notes 631MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Introduction • ZOOMit: In Siemens MR systems to acquired the  images with reduced FOV in phase‐encoding  directions • It is implemented via inner volume excitation  (2D slab selective) or selective excitation (2D RF  pulses) technique • It could be helpful to reduce the scan time or  Conventional  SPACE ZOOMit SPACE SAR due to the reduction of PE steps • However, SNR would decrease  Conventional DWI ZOOMit DWI 8 Unrestricted © Siemens Healthineers, 2020 Notes 632MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Inner Volume Imaging ZOOMit: Inner Volume Imaging 9 Unrestricted © Siemens Healthineers, 2020 Notes 633MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP ZOOMit: Inner Volume Imaging  180° 180° 90° • Excite only volume of interest to reduce PE steps  and save the scan time  RF time • SNR would decrease G • SNR ~ √(Scan time) r acquisition acquisition Gp • Spin echo sequences are suitable to implement  the technique  Gs • Two orthogonal slices for excitation and  refocusing RF pulses • The spin echo comes from the intersection of  Excitation slice both slices based on conventional slice  selection  Inner volume • Excitation on orthogonal planes prevents  Refocusing slice interleaved multi‐slice imaging  • Only available for 3D imaging, i.e. SPACE 10 Unrestricted © Siemens Healthineers, 2020 Notes 634MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP ZOOMit: Inner Volume Imaging  ZOOMit SPACE is a slab‐selective SPACE sequence in both PE directions  11 Unrestricted © Siemens Healthineers, 2020 Notes 635MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP ZOOMit: Inner Volume Imaging  • Indication of phase encoding direction in  conventional and Zoomed SPACE displaying in  the GSP segments 12 Unrestricted © Siemens Healthineers, 2020 Notes 636MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP ZOOMit: Inner Volume Imaging  • Protocols are available in head, spine, pelvis and  hip for T2 or PD contrast SPACE  • Benefits: • Shorter scan times • Longer TR within the same scan time • Shorter echo train lengths 13 Unrestricted © Siemens Healthineers, 2020 Notes 637MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP ZOOMit: Inner Volume Imaging  Challenges:  Zoomed SPACE w/o saturation bands • Excitation displacements due to chemical shift  and/ or B0 variations may lead to aliasing  artefacts or signal drops at FOV boundary  • Use additional saturation bands outside FOV to  saturate fat signal • Use smaller FOV along PE direction • (Automatic) phase oversampling • Improve B0 shim With anterior and posterior saturation bands • Increased flow sensitivity along the PE direction • SNR 14 Unrestricted © Siemens Healthineers, 2020 Notes 638MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP 2D RF Pulses ZOOMit: 2D RF Pulses 15 Unrestricted © Siemens Healthineers, 2020 Notes 639MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP ZOOMit: 2D RF Pulses  Idea: 1D slice selective excitation  • Excitation k‐space analogue to imaging k‐space B1 • EPI trajectory: for each run 1D slice excitation but  PE modulated with different RF amplitude and PE  blips in between Fourier  Transform • In‐plane but outside the FOV spins may be excited  time during the RF pulse transmission but flipped back  slice GS by the end of the pulse 2D selective excitation  Properties: • Interleaved multi slice possible • Low Bandwidth along PE (sensitive to B0  K-y variations) PE • Long pulses (~20ms) Fourier  Transform • Moderately SAR intense K-z slice 16 Unrestricted © Siemens Healthineers, 2020 Notes 640MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP ZOOMit: 2D RF Pulses  2D selective excitation • slice excitation on each EPI trapezoid + RF pulse  2D RF excitation pulse and gradients • ~50 „PE“ lines = composite pulses RF • 18ms long (depending on pTX volume) Implemented in • ZOOMit – BOLD EPI RO • ZOOMit – DWI EPI 18 ms Rational • EPI benefits most from shorter echo train PE • EPI provides high SNR  • Pulse properties (2D, long RF, SAR intense) limit  pulse application SL 17 Unrestricted © Siemens Healthineers, 2020 Notes 641MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP ZOOMit: 2D RF Pulses  In GSP shows two boxes for the planning  • Gray box: pTx volume for 2D RF pulse definition. It  has to cover all anatomy • Yellow box: zoomed FOV along the phase  encoding direction pTx volume contains area of excitation and non‐ excitation  • Only 1 pTx volume available  • Vol. visibility=ON: display pTx volume in GSP Unrestricted Siemens Healthineers, 2020 Notes 642MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP ZOOMit: 2D RF Pulses  Couple to Acquisition Volume Couple to pTx Volume Unrestricted Siemens Healthineers, 2020 Notes 643MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP ZOOMit: 2D RF Pulses  Acceleration of the 2D RF pulses • Available since VE11 software  • Available in ep2d_bold, ep2d_fid  • Available in ep2d_diff when using bipolar  diffusion scheme (for the software version before  XA20)  20 Unrestricted © Siemens Healthineers, 2020 Notes 644MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP ZOOMit: 2D RF Pulses  Benefits:  • Allows imaging a selective volume of interest by  exciting only a small, reduced FOV • Reduced susceptibility artifacts and distortions • Supported sequences: ep2d_diff, ep2d_fid,  ep2d_bold Limitations: • Image quality especially in body applications not  robust • Only available for pTx systems: MAGNETOM  Prisma, Skyra, Vida 21 Unrestricted © Siemens Healthineers, 2020 Notes 645MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP ZOOMit: 2D RF Pulses  Artifacts  • Fold‐over artifacts from outside the FOV may  occur, especially problematic for body regions and  bigger patients Prostate Female pelvis Unrestricted Siemens Healthineers, 2020 Notes 646MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP ZOOMit: 2D RF Pulses  Side excitation Excited region / FOV Side excitation Origin of fold‐over artifacts • ZOOMit is based on a 2D excitation pulse, for  which excitation k‐space is sampled with EPI  trajectory • Due to this discretized EPI sampling, side  excitations outside of region of interest occur  • Aliasing along phase encoding direction leads to  fold‐over artifacts phase encoding direction Unrestricted Siemens Healthineers, 2020 Notes 647MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP ZOOMitPRO ZOOMitPRO 24 Unrestricted © Siemens Healthineers, 2020 Notes 648MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP ZOOMitPRO The sequence improvement solves the fold‐over  artifacts from XA20 • Spin echo based sequence (with refocusing pulse,  i.e. diffusion) • Shift the side excitations in slice direction! (PRO:  Partially ROtated) • Refocusing pulse slice selective → does not  refocus the side excitations Refocusing • Side excitations not refocused → no signal from  Excitation them Unrestricted Siemens Healthineers, 2020 Notes 649MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP ZOOMitPRO Additional benefits  Conventional ZOOMit                     ZOOMitPRO • Available for all systems. No matter at 1.5T, 3T,  non‐pTx or pTx systems • Improved fat saturation • Reduced RF pulse length → reduced echo time  (dependent on protocol) → SNR increase Side  Side excitations excitations Phase Reduced FOV Reduced FOV Slice Side  Side excitations excitations Read Refocusing plane Unrestricted Siemens Healthineers, 2020 Notes 650MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP ZOOMitPRO: Image Example Conventional ZOOMit ZOOMitPRO Fold‐over artifacts Robust image quality Unrestricted Siemens Healthineers, 2020 Notes 651MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP ZOOMitPRO: Protocols  • ZOOMitPRO only available for zoomed diffusion  weighted imaging (ep2d_diff) • Protocols ar provided for: • Head • Spine • Prostate • Abdomen (kidney, pancreas) • Breast 28 Unrestricted © Siemens Healthineers, 2020 Notes 652MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP ZOOMitPRO: Protocols  • The protocol name is labeled with ZOOMit • To enable ZOOMitPRO, switch Excitation from  Standard to ZOOMit 29 Unrestricted © Siemens Healthineers, 2020 Notes 653MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP ZOOMitPRO: Protocols  • It is also possible to enable ZOOMit in pTx tab  card (only available in pTx systems) • pTx volume (relevant for conventional ZOOMit)  chosen automatically • No additional user interaction required • pTx volume not displayed in GSP 30 Unrestricted © Siemens Healthineers, 2020 Notes 654MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP ZOOMitPRO: Image Examples Male/female pelvis Spine Pancreas Kidney Brain Breast Unrestricted Siemens Healthineers, 2020 Notes 655MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP ZOOMitPRO vs. ZOOMit Conventional ZOOMit  ZOOMitPRO Available only for pTx systems Available for all systems Enabled for ep2d_fid, ep2d_bold, SPACE Enabled for ep2d_diff pTx volume has to be chosen manually No additional operator input required Sensitive to fold‐over artifacts Robust image quality 32 Unrestricted © Siemens Healthineers, 2020 Notes 656MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Summary ZOOMit allows exciting a reduced FOV, which is  Properties EPI smaller than the anatomical region in phase  • Less distortions due to shorter EPI read out train.  encoding direction and leads to less phase  • Enables increased resolution (at same echo train  encoding steps length/ distortions) • SPACE: avoids fold‐over artifact by a 2D slab  • Reduces SNR according to acceleration selective spin echo experiment • Increased minimum TE (DWI) • EPI (BOLD and DWI): avoids fold‐over artifact by  using a 2D spatially selective excitation RF pulse. Properties SPACE • Shorter scan times due to less phase encoding  lines • Longer TR within the same scan time • Shorter echo train lengths • Slab selective along the PE direction with  potentially increased motion sensitivity along the  PE direction 33 Unrestricted © Siemens Healthineers, 2020 Notes 657MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Knowledge Check 1. The ep2d_BOLD sequence has the  2. ZOOMitPRO  solves the  capability to use ZOOMit on a non – ____________artifacts from XA20. PTX system. a. Chemical Shift a. True b. Ringing b. False c. Fold‐over Author | Department 34 Unrestricted © Siemens Healthineers, 2020 Notes 658MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling. MODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP On account of certain regional limitations of sales rights and service availability, we cannot guarantee that all products included in this brochure are available through the Siemens sales organization worldwide. Availability and packaging may vary by country and is subject to change without prior notice. Some/All of the features and products described herein may not be available in the United States. The information in this document contains general technical descriptions of specifications and options as well as standard and optional features which do not always have to be present in individual cases. Local Contact Information Siemens Medical Solutions USA, Inc. 40 Liberty Blvd. Siemens reserves the right to modify the Malvern, PA 19355-9998 design, packaging, specifications and USA options described herein without prior Telephone: +1-888-826-9702 notice. Please contact your local siemens-healthineers.com Siemens sales representative for the most current information. Legal Manufacturer Imaging & Therapy Systems Magnetic Resonance Note: Any technical data contained in Henkestr. 127 this document may vary within defined DE-91052 Erlangen tolerances. Original images always lose Germany a certain amount of detail when Telephone: +49 9191 18-0 siemens-healthineers.com reproduced. Siemens Healthcare ­Headquarters Siemens Healthcare GmbH Healthcare Sector Henkestr. 127 91052 Erlangen Germany Phone: +49 9131 84-0 siemens-healthineers.com Published by Siemens Healthcare GmbH · HOOD05162003173376 · Printed in USA · © Siemens Healthcare GmbH, 2020 659MR ApplicationsMODULE WORKBOOK | MR APPLICATIONS FUNDAMENTALS PART 2 - STEP Fundamentals - Part 2 STEP Module Workbook Education & Workforce Solutions Your potential is calling.