MR Breast Silicone Implant - Numaris X

MR Breast Silicone Implant Job Aid MR breast silicone implant – Numaris X This job aid reviews the sequences, suppression techniques, and workflow to determine the implant type and how to perform manual frequency adjustments. If the patient is unaware of the type of implant that was surgically implanted, run the Siemens Healthineers Tree Implant Type Scan. • Hypointense (dark) implant, then the implant is silicone. • Hyperintense (grey) then the implant is saline. Sequences: the most common sequences used for silicone breast implant assessment include: • Turbo Spin Echo T2-weighted • STIR + WS Silicone (e.g., silicone hyperintense, water suppressed) • STIR + WS Silicone Sat (e.g., water hyperintense, silicone suppressed) for 1.5T • SPAIR Breast (e.g., water hyperintense, silicone suppressed) for 3T. Note: Breast MR sequences acquired are at the radiologist's discretion. Implant Imaging Techniques: 1. Inversion Recovery (STIR): a. Enter the TI to suppress Fat. b. Both Water and Silicone are Bright. Axial STIR Fluid Unrestricted | Published by Siemens Healthineers AG, 2025 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 04/11/2025 | QR700021027 Healthineers 2. STIR with Water Saturation (Silicone Bright): a. Enter the TI to suppress Fat. b. Water saturation pulse suppresses water signals from breast tissue and blood vessels. c. Set the Center Frequency to Water (farthest to right). [i.e., suitable for identifying ruptures but not always optimal for evaluating breast tissue]. d. Hint: this sequence is extremely sensitive for free silicone that may have leaked outside the implant. Axial STIR + WS 3. STIR with Water Saturation (Silicone Dark): a. Enter the TI to suppress Fat. b. Water saturation pulse suppresses silicone signal. c. Set the Center Frequency to Silicone (farthest to the left). [i.e., suitable for identifying ruptures but not always optimal for evaluating breast tissue]. d. Hint: This sequence is the radiologists' preference. Unrestricted | Published by Siemens Healthineers AG, 2025 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 04/11/2025 | QR700021027 Healthineers Page 2 of 8 4. SPAIR Breast a. Available sequences: Turbo Spin Echo (TSE), VIBE, HASTE, EPI Diffusion, Resolve. b. Suppresses fat and silicone simultaneously. c. Various levels of tissue suppression depending on the SPAIR mode (Strong, Weak). T2 TSE SPAIR Breast Strong T2 TSE SPAIR Breast Weak 5. T2 Turbo Spin Echo (TSE): a. Use to evaluate the anatomy and integrity of the implant lumen and differentiate between Saline and Silicone implants. b. Saline appears brighter (hyperintense) relative to surrounding tissue. (i.e., a good indicator that a Saline implant is present is the fill valve). c. Silicone appears darker (hypointense) relative to surrounding tissue. 1/20 Silicone_ T2 Sagittal Silicone Sat T2 Sagittal Silicone Sat T2 Sagittal Double Lumen (saturated silicone & (Water Saturation) Centered on silicone bright saline) Unrestricted | Published by Siemens Healthineers AG, 2025 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 04/11/2025 | QR700021027 Healthineers Page 3 of 8 6. T2 TSE with Fat Sat: a. This technique can yield differing results due to the relative closeness of frequency peaks that silicone and fat share. b. Fat suppression is not needed to evaluate implant leaks versus folds. However, it can help assess the integrity of the implant shell and capsule and visualize cysts and other breast lesions. 7. STIR BLADE or TSE BLADE: a. Use to reduce artifacts in sagittal images caused by the inherent motion of the implant itself. (i.e., more ghosting from saline than silicone). b. Note: The fill valve is only visible in saline implants. Silicone implant Saline implant Fill Valve 8. STIR TI (gray silicone): a. Use for uniform silicone suppression (fat not suppressed). Identifies implant rupture/linguine sign. STIR TI = 450 @1.5T TI = 660 @3T Gray silicone with bright fluid and bright fat Unrestricted | Published by Siemens Healthineers AG, 2025 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 04/11/2025 | QR700021027 Healthineers Page 4 of 8 Display of the MR Breast – Frequency Spectrum: The frequency spectrum for breast implants runs from left to right (silicone, fat, and water). Usually, the fat line in the spectrum overlays the silicone line since the peaks are so close to- gether. 1 Display of MR Spectra 1) Amplitude 3 2) Silicone 3) Fat 4 4) Water 5) Frequency 5 Spectral difference between fat, silicone, and water: the peak behavior for patients with silicone implants may differ depending on the implant size and if the implant is in one or both breasts. Hint: Only the position of the Peak (not Amplitude) determines the center resonant frequency. 1. Silicone frequency separation from water: a. 600 Hz from water @3T. b. 300 Hz from water @1.5T. 2. Fat frequency separation from water: a. 440 Hz from water @3T. b. 220 Hz from water @1.5T. Routine Contrast Resolution Geometr System Physio Inline Sequence Activating System Adjustments: Coils Miscellaneous Adjustments Adjust Volume | TX/RX 1. Open the Sequence Adjustment Strategy Standard Adjustment Tolerance Auto (Maxi ... 2. Select the System>Adjustments BO Shim Tune up Adjust with Body Coil V parameter card. Confirm Frequency Never Assume Silicone Never 3. Click the Confirm Frequency Always pulldown: When Changed a. For most Breast protocols, choose Confirm Frequency Manual Adjustments Always. - b. When enabling Assume Silicone, use either Always or When Changed. Unrestricted | Published by Siemens Healthineers AG, 2025 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 04/11/2025 | QR700021027 Healthineers Page 5 of 8 MR breast implants – Assume Silicone: 1. Assume Silicone optimizes measurement for patients with silicone is. a. It enables a 3-peak model to calculate the resonance frequency. b. Results are more dependable for adipose conditions; no user interaction is necessary. 2. When the Assume Silicone box is checked, the system automatically adjusts the frequency to the water peak. a. Hint: use only for patients with known silicone implants; Only change the resonance frequency if the system frequency is not set correctly to the water peak. Mag Fat Silicone 3.5ppm Water 4.85ppm Frequency >> implant >> stir_ws_tra_silicone_bilateral ? X Ò 3:20 min | Auto @ 2 0.9x0.9×4.0 mm3 1.00 Routine Contrast Resolution Geometry System Physic Inline Sequence Miscellaneous Adjustments Adjust Volume TX/Rx Adjustment Strategy Standard Adjustment Tolerance Auto BO Shim Standard Adjust with Body Coil B1 Shim TrueForm Confirm Frequency Alway Assume Silicone V CoilShim Off Unrestricted | Published by Siemens Healthineers AG, 2025 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 04/11/2025 | QR700021027 Healthineers Page 6 of 8 Confirm Frequency – Confirming the resonance frequency adjustments: It may be necessary to change the center resonance frequency if the system frequency is not set correctly. The white triangle and the dotted line indicate the system frequency. By default, peaks are arranged from left to right. (i.e., silicone, fat, and water). 1. Select Always (or) When Changed in the Confirm Frequency pulldown. 2. Select GO to start the measurement and adjust the resonance frequency. 3. To Enlarge the Spectrum, right-click in the spectral display and select the preferred zoom factor. (e.g., better visualization of smaller peaks). 4. Center the frequency on the water peak by left-clicking on the Water peak. (or silicone if needed) 5. The new transmit frequency is copied to the Frequency (temp) field. 6. Accept the new frequency with Apply. 7. Start the measurement with Continue, which is performed without additional adjustments. Confirm Frequency Adjustment ? Fat peak (left) Water peak (right) Right-click in Spec- JMax] 42,568 tral display FWHM [Hz] 190.6 Ma Low resolution --- - High resolution f [HZ] 63,640,591 X orientation > 53,645,699 X orientation Coil Combined ADC - Zoom x1 Zoom x2 Zoom x5 Frequency (sys) 63643106 Hz] Zoom x10 Frequency (temp) 63643106 [Hz] Zoom x20 Apply Continue Cancel Unrestricted | Published by Siemens Healthineers AG, 2025 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 04/11/2025 | QR700021027 Healthineers Page 7 of 8 Please note that the learning material is for training purposes only! For the proper use of the software or hardware, please always use the Operator Manual or Instructions for Use (hereinafter collec- tively “Operator Manual”) issued by Siemens Healthineers. This material is to be used as training material only and shall by no means substitute the Operator Manual. Any material used in this training will not be updated on a regular basis and does not neces- sarily reflect the latest version of the software and hardware available at the time of the training. The Operator's Manual shall be used as your main reference, in particular for relevant safety information like warnings and cautions. Note: Some functions shown in this material are optional and might not be part of your system. Certain products, product related claims or functionalities (hereinafter collectively “Functionality”) may not (yet) be commercially available in your country. Due to regulatory requirements, the future availability of said Functionalities in any specific country is not guaranteed. Please contact your local Siemens Healthineers sales representative for the most current information. The reproduction, transmission or distribution of this training or its contents is not permitted without express written authority. Offenders will be liable for damages. All names and data of patients, parameters and configuration dependent designations are fictional and examples only. All rights, including rights created by patent grant or registration of a utility model or design, are reserved. Copyright © Siemens Healthineers AG 2025 Siemens Healthineers Headquarters Local Contact Information Legal Manufacturer Siemens Healthineers AG Siemens Medical Solutions USA, Inc. Imaging & Therapy Systems Siemensstraße 3 40 Liberty Blvd. Magnetic Resonance 91301 Forcheim, Germany Malvern, PA 19355-9998 USA Henkestr. 127 Phone: +49 9191 18-0 Telephone: +1-888-826-9702 DE-91052 Erlangen siemens-healthineers.com Customer Care Telephone: Germany +1-800-888-7436 Telephone: +49 9191 18-0 Unrestricted | Published by Siemens Healthineers AG, 2025 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 04/11/2025 | QR700021027 Healthineers Page 8 of 8