MR LiverLab (AU)

MR LiverLab Job Aid MRI Systems MR LiverLab is saved within the Siemens, Abdomen Dot Engine protocols. The customer can incorporate their own routine liver sequences into the LiverLab protocol within the Abdomen Dot Engine. Requirement: Must be run using a Dot Engine Note: Patient should follow the same breath-hold instructions throughout the exam 1. Position the patient for an Abdominal Examination 2. Register the patient and select the LiverLab Abdomen Dot Engine protocol created 3. Optimize the Dot settings a. Exam Strategy b. Protocol Adaption c. Decisions i. Liver evaluation ii. Contrast agent iii. Evaluation method d. Breath-hold capability e. Automatic breath-hold commands i. Language ii. Before or After scan iii. Pause between breath-holds General Parameters Breath-hold Parameters Exam Strategy Breath-hold Breath-hold capability 20 S Protocol Adaption BH + AutoCo ... Automatic breath-hold commands Decisions Language English (United States) Liver evaluation yes Before scan Hold breath (inhaled). 8.1 contrast agent without contr ... After scan Continue breathing 1.5s Evaluation Method Both Pause between breath-holds 10 4. Run Abdomen Localizers > Select Apply (Green Checkmark) 5. Run Abdominal sequences > Select Apply (Green Checkmark) Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: (AU) 26/10/2020 | HOOD05162003139478 Healthineers Job Aid | MR Liver Lab Effective Date: (AU) 26/10/2020 | HOOD05162003139478 6. Open the T1 VIBE eDIXON sequence a. Plan slice volume to include entire liver, and same breath-hold instructions b. Select Apply (Green Checkmark) Patient Applications Transfer Edit Queue Protocol View Image Tools Evaluation Scroll System Add-On Options Help SP 14 IMA 12 / 30 IMA 11 /60 114/2010 Exam ACS Viewing SP110cm Filming p2 MMNORM/DIS2D Fov 50 00 P2 -NORM/DIS2D SACTO HASTE COR 98 HASTE ABD _1124_opp-in_tra_p2_bh Dot TA: 0:18 PM: ISO PAT: Voxel size: 1.2×1.2×3.0mm Rel. SNR: 1.00 3D X Guidance Parameters AX T2 HASTE TE 180 12+12_haste_tra_mbh Check slice positions and adjust them, if necessary. AX IN OUT COR T2 THICK SLAB AX DWI NEW GRE REF SCAN 10 11_vibe_e-dixon_tra_bh_pre 11 PEL LOC 00:18 12 % COR T2 HASTE PEL 00:56 13 % AX T2 HASTE PEL 13 00:58 20% 11 2 22:11 anning 01-16 Stimu=NM 2/4/2016 11-61 7. System performs Liver Segmentation and Evaluation Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: (AU) 26/10/2020 | HOOD05162003139478 Healthineers Page 2 of 14 Job Aid | MR Liver Lab Effective Date: (AU) 26/10/2020 | HOOD05162003139478 8. Evaluation Step a. Liver segmentation is displayed in the graphic segments i. Evaluate for segmentation quality b. Note: segmentation cannot be adjusted and the same segmentation is used in the T1 VIBE qDIXON sequence ( i.e. segmentation not repeated for qDIXON) c. System provides Pre-Evaluation result i. Normal ii. Fat deposition iii. Iron deposition iv. Both, Fat and Iron Deposition d. System makes a recommendation if further evaluation is required i. Yes ii. No Note: Site should follow the Radiologist recommendation if further evaluation is required am Viewing R Filming MAWATER/NORM/DIS2D TP H17 FoV 300.3.8 P4 M/WATER/NORM/DIS2D SP H18.6 vibe_e-dixon_tra_bh_pr ... 300 a 1_vibe_e-dixon_tra_bh_pt ... SP H24.6 P4 M/WATER/NORM/DIS2D Fov 300-380 t1_vibe_e-dixon_tra_bh_pr ... FoV 309 380 Tra Dot 3D X Guidance Check the liver segmentation as shown 22 AX T1 VIBE FS (CAIPI) POST 20 00:16 in example images. 23 AX T1 VIBE FS (CAIPI) POST 00:16 24 AX T1 VIBE FS (CAIPI) POST 20 00:16 Segmentation volume 1156 ... ml 25 % AX T1 FLASH FS POST 00:45 Voxels sampled 273464 Good segmentation result Bad segmentation result 26 COR T1 FS FLASH POST 01:01 Pre-evaluation result iron deposition 27 AX T1 FLASH FS PEL 02:38 28 Evaluation Run liver evaluation Yes (recommended) yes No vibe a divan tra bb 00:20 Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: (AU) 26/10/2020 | HOOD05162003139478 Healthineers Page 3 of 14 Job Aid | MR Liver Lab Effective Date: (AU) 26/10/2020 | HOOD05162003139478 9. T1 VIBE qDIXON sequence – opens with suggested ROI position a. Plan slice volume to include entire liver and same breath-hold instructions b. ROI can be repositioned by technologists i. Reposition ROI · Left click on ROI and drag to new location (or) · Left click on ROI until cursor changes, next hover over area of liver and left click to drop the ROI to the new location. Note: ROI should not be placed over the gallbladder or a large vessel Patient Applications Transfer Edit Queue Protocol View Image Tools Evaluation Scroll System Add-On Options Help 34/2018 º 12 IMA 10 / 30 344/2016 SPS SP3 ACS ACS P2 /NORM/DIS2D NORM/DIS2D TP H17 SAOTO HASTE 758 |COR TS HASTE ADD cor 11_vibe_e-dicon_ba__B ... FoV 300*300 Dot TA: 0:20 PM: ISO PAT: 4 Voxel size: 1.2×1.2×3.5mm Rel. SNR: 0.69 X Guidance Parameters 22 AX T1 VIBE FS (CAIPI) POST 20 00:16 Check ROI and slice position and adapt if necessary. 23 AX T1 VIBE FS (CAIPI) POST (position the ROI if needed with a left mouse click) 00:16 24 AX T1 VIBE FS (CAIPI) POST 00:16 25 % AX T1 FLASH FS POST 00:45 26 COR T1 FS FLASH POST 01:01 27 AX T1 FLASH FS PEL 02:38 28 Evaluation yes 29 vibe_q-dixon_tra_bh 100% Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: (AU) 26/10/2020 | HOOD05162003139478 Healthineers Page 4 of 14 Job Aid | MR Liver Lab Effective Date: (AU) 26/10/2020 | HOOD05162003139478 10. HISTO Sequence (Breath-hold Spectroscopy) a. Opens with Voxel Placement copied to the Placement of the ROI b. Tips i. Plan (Voxel) off Non-Distortion Correction images ii. Before opening the HISTO sequence make sure VIBE eDIXON sequence is located in the active graphic segment 11. System automatically generates an additional series without Distortion Correction; load eDIXON series into all 3 graphic segments. a. Select 1 graphic segment > Right click > select Series b. Main Menu > Applications > 3D MPR 12. 3D Task Card (MPR’s) a. Create Coronal and Sagittal MPR reformats b. Save Coronal and Sagittal MPR reformats to the Patient Browser c. Tip: Perform MPR’s after loading eDIXON into the graphic segments (Step 11), so MPR’s are created off of the non-distorted images loaded in the graphic segments of the Exam Task Card. 13. Open the Patient Browser a. Select Coronal MPR and drag into Exam Task Card graphic segment b. Select Sagittal MPR and drag into Exam Task Card graphic segment Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: (AU) 26/10/2020 | HOOD05162003139478 Healthineers Page 5 of 14 Job Aid | MR Liver Lab Effective Date: (AU) 26/10/2020 | HOOD05162003139478 14. Exam Task Card a. Plan the HISTO voxel off all 3 planes b. Axial Plane – Check Voxel placement i. Use the tools: Reference Lines, Copy Image Position and Scroll Nearest to check voxel placement on Coronal and Sagittal images. c. Depress Ctrl key and select each segment with the left mouse > Main Menu > Patient > Save As (i.e., records voxel placement for Radiologists) d. Select Apply (Green Checkmark) – run HISTO sequence with same breath-hold instructions am SP3 ACT ACS ACS Viewing R R 802 BO2 SP4 0cm SP4 10cm 10 om Filming MPR/MPR/M/WATER/NORM/ND B03 FoV 388. 38 MPRIMPRIM/WATER/NORMIND Cor .SPR110.4 94 M/WATER/NORMAND Sag t1_vibe_e-dixon_tra_bh_pr .. OV 309-380 Dot TA: 0:15 PM: REF Vol: 30 x30 x30 mm Rel. SNR: 1.00 histo 3D X Guidance Parameters 22 AX T1 VIBE FS (CAIPI) POST 20 00:16 Check voxel position and adapt if necessary. 23 AX T1 VIBE FS (CAIPI) POST 20 00:16 24 AX T1 VIBE FS (CAIPI) POST 20 00:16 25 % AX T1 FLASH FS POST 00: 45 26 COR T1 FS FLASH POST 01:01 27 AX T1 FLASH FS PEL 02:38 O 28 Evaluation yes 29 vibe_q-dixon_tra_bh 00:20 -18% 20 a MICTA Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: (AU) 26/10/2020 | HOOD05162003139478 Healthineers Page 6 of 14 Job Aid | MR Liver Lab Effective Date: (AU) 26/10/2020 | HOOD05162003139478 15. Open the Patient Browser > load the following sequences into the Viewing Task card (i.e. check image quality) a. eDIXON – provides in one series, in-phase and opposed phase, fat and water, segmentation and a report. b. qDIXON – provides both segmentation and ROI Values c. HISTO Report (Histo only creates a report. [23] t1_vibe_e-dixon_tra_bh_pre_opp [30] vibe_q-dixon_tra_bh_W /com/ 1111 PM toom# 187; The [24] t1_vibe_e-dixon_tra_bh_pre_in [31] vite_q-dixon_la_bh_F coomuseus ho /com/ 1111 ma [32] vibe q-dixon tra bh Report [25] t1_vibe_e-dixon_tra_bh_pre_F toom/ 10/1 the /com/ 1111 ma [33] vibe_q dixon_:ra_bh_FP [26] t1_vibe_e-dixon_tra_bh_pre_W [34] Mibe_q-dixon_:ra_bh_GoodnessOfF t (com/ 1111 ma toom/ /t /4 The [27] t1_vibe_e-dixon_tra_bh_pre_W_SEG [35] vibe q-dixon tra bh R2s Ef Toom /17/ /t [36] vibe_q dixon_a_bh_T2s_Eff [28] t1_vibe_e-dixon_tra_bh_pre_Report Joom/ 1111 JA IL [37] vibe_q-dixon_a_bh_WP 16. Viewing Task Card – IQ evaluation a. Evaluate eDIXON first i. Is the Fat image displaying Fat and Water image displaying Water? ii. Was the liver segmentation performed by the system good quality? iii. Does the segmentation include the entire liver or does it include more than liver tissue? Note: The segmentation cannot be altered, but if the segmentation isn’t optimal then the segmentation values in the qDIXON results page will be inaccurate. Patient Applications Transfer Edit View Image Tools Evaluation Options A STUDY 1 3/4/2016 OHARA MARK HELLEN OHARA MARK HEURE 12:59:40 PM 25 IMA 33 /72 MF 1:31 TR 6.7 TE 2.4 D TR 6.7 TE 2.4 TA 14.59 TP F6 BWV 470.0 SP H4.1 TA 14,59 TP F6 BW 470.0 SP H4.1 64 M/FAT/NORM/DIS2D SL 3.01 V 309 380 p4 M/WVATER/NORM/DIS2D SL 3.01 A1/DIXF 176*288 FoV 309 380 301-3;SP3,4 Tra A1/DIXW 176.288 113d2 /10 376 BO1-3;SP3,4 "113d2 /10 O'HARA MARK HENRY Aera STUDY 1 MR E11 28 IMA 1/ Dual-Ratio Dixon Discrimination Recommendations no liver evaluation TA 14.59 TP F6 BW 470.0 SP H4.1 54 MWWVATER/NORM/DIS2D SL 3.01 FoV 309*380 A1/DIV 176 288 MF 1.00 BO1-3;SP3,4 Tra f13d2 /10 389 p4 SC 164 H1_vibe_e-dixon_tra_bh_pre_Report StimLE Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: (AU) 26/10/2020 | HOOD05162003139478 Healthineers Page 7 of 14 Job Aid | MR Liver Lab Effective Date: (AU) 26/10/2020 | HOOD05162003139478 17. Viewing Task Card – IQ evaluation a. Evaluate qDIXON images and results i. Results Page – note Fat Signal percentage and R2* · (R2* is 1/T2*) – displayed in seconds to the inverse of 1 (sec-1 ) · Values displayed for both the segmented volume and the ROI MRET? STUDY 1 Liver Evaluation O'HARA MARK HENRY 32 IMA 1 / 2 voxels mean fit error ROI 1.4% Segmentation Volume 66870 ROI 7 0% Fat signal percentage 60% ROI mean std 0.7% 0.6% Segmentation Volume 61.0% 46.6% Segmentation ROI Os^-1 R2* 400s^-1 mean std ROI 35.35^-1 2.6s^-1 MF 1.00 Segmentation Volume 34.1 s^-1 14.2s^-1 vibe_q-dixon_tra_bh_Report 512*512 18. Poor Liver Segmentation leads to poor results for the segmented volume a. ROI will still have good results with proper placement. A Liver Evaluation MR E11 # 26944020 HFS STUDY 165524443 COHEN JENNIFER # 26944020 mean fit error STUDY 165524443 voxels 3/8/2016 COHEN JENNIFER 21 IMA 1 /2 RO 55 13.9% 9:17:28 AM Segmentation Volume 116299 10.5% 22 IMA 25 / 64 ROI Segmentation 0% Fat signal percentage mean std ROI 0.2% Segmentation Volume 0.7% 10.7% 21.6% Segmentation ROI 4 Os^-1 R2* 400s^-1 mean std MF 1.00 ROI 188.3s^-1 108.0s^-1 VONDIFAT FRACTION Segmentation Volume 138.3s^-1 128.3s^-1 p4 BO2,3,SP3,4 vibe_q-dixon_tra_bh_Report *f13d6 / 4 Gray value 1 equals 0.1% 2 1518 Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: (AU) 26/10/2020 | HOOD05162003139478 Healthineers Page 8 of 14 Job Aid | MR Liver Lab Effective Date: (AU) 26/10/2020 | HOOD05162003139478 19. Goodness of Fitness Map – Evaluation a. Image shows the segmentation and the ROI used b. Image Text, lower portion of the images – States “Gray value = .1%” i. Check Goodness of Fit and get a Mean Value · Draw an ROI over the liver (or) · Place a Pixel Lens ii. Mean Value times .1 = Goodness of fit % · Example: ROI/Pixel lens = 43, then Goodness of Fit = 4.3% · The Goodness of Fit should be 5% or less. Then this is an indication of the fitting residual errors, the fat parentage and the R2* results. · The smaller the value the more reliable the results MR E11 # 26919879 STUDY 165154091 B/4/2016 O'HARA MARK HENRY 12:28:45 PM 55 IMA 25 / 64 Min/Max: 7 /136 Mean/SD: 43.7 /24.8 1 Pixel: 89 10cm MF 1.16 IR 15.6 TE 2.4 TA 18.17 BW 1080.0 SP 64 DIXON/ND FoV 314*380 208*320 | BO1-3;SP3,4 A1 Tra f13d6 / 4 9ml multihance 788 Gray value 1 equals 0.1% 356 Laiting for scan instructions. Stimu=NM SAR=NM Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: (AU) 26/10/2020 | HOOD05162003139478 Healthineers Page 9 of 14 Job Aid | MR Liver Lab Effective Date: (AU) 26/10/2020 | HOOD05162003139478 20. R2* Map – Evaluation a. Evaluate i. If Liver segmentation not performed properly ii. If Radiologist wants to evaluate an area of the liver not included in the ROI b. Image Text, lower portion of the images – ROI Mean Value = Value in sec-1 c. R2* Values are for Iron evaluation i. R2* Values increase – iron deposition increases RE11 STUDY 165154091 O'HARA MARK HENRY 10cm MF 1.16 TR 15.6 TE 2.4 TA 18.17 TP H17 BW 1080.0 SP H50.4 p4 DIXON/ND/R2_STAR_MAP SL 3.5i FoV 314 380 A1 208 320 1 BO1-3;SP3,4 ##3d6 / 4 Gray value mythance, lue 1 equals 1.0 (s^-1) 49 5 21. T2* Map – Evaluation a. Decreasing T2 values – indication of increased iron deposition b. Acquire Mean Value i. Draw ROI on T2* Map ii. Multiple the Mean Value by 0.1 = Value displayed in ms MR E12 STUDY 165154091 HARA MARK H 1 Area: 5.67 sq.cm 84 DIXON/ND/T2_STAR_MAP 8,81-3; SP3,4 Gray value 1 equals 0.1 ms Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: (AU) 26/10/2020 | HOOD05162003139478 Healthineers Page 10 of 14 Job Aid | MR Liver Lab Effective Date: (AU) 26/10/2020 | HOOD05162003139478 22. Fat Fraction and Water Fraction – Evaluation · Mean can also be displayed and evaluated MR E11 STUDY 165154091 O'HARA MARK HENRY 4 IMA 23 / 64 · Mean/SD: 27 / 139.1 Area: 3.15 sq.cm p4 DIXON/ND/FAT_FRACTION FOV 208 320 1 BO1-3;SP3,4 f13d6 /4" 9ml multihance Tra Gray value 1 equals 0.1% W 1421 C 680 Fat Fraction 26919879 PR STUDY 165154091 3/4/2016 O'HARA MARK HENRY 12:28:45 PM 58 IMA 20 / 64 Min/Max, 806 /1000 Area: 11.48 sa. cm 7.5 i Pixel 221 1.16 w 1080.0 PH17 SP H60. 54 DIXON/ND/WATER_FRACTION SL 3.5 FoV 314 38 A1 208 320 BO1-3;SP3,4 f13d6 / 4 9ml multihance Gray value 1 equals 0.1% 1845 Water Fraction Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: (AU) 26/10/2020 | HOOD05162003139478 Healthineers Page 11 of 14 Job Aid | MR Liver Lab Effective Date: (AU) 26/10/2020 | HOOD05162003139478 23. HISTO Results a. Displays i. Fat Percentage ii. R2 Value for Water (for Iron Evaluation) · Shows Fat that was T2 corrected and R2 of Water b. Spin Echo sequence with multiple echoes i. R2 value is displayed, not the R2* c. Color Bar Map i. Fat shown at top in a percent (%) ii. R2 Water = value in seconds inverted over 1 iii. Fit value = rsq fit “R-squared” · Value should be as close to 1 as possible, preferably >0.95 Patient Applications Transfer Edit View Image Tools Scroll Evaluation System Options Help -.-- ---- MR E11 STUDY 1 HISTO O'HARA MARK HENRY 80 IMA 1 / 3 Voxel 0% Fat signal percentage 60% value rsq. fit Voxel 2.2% 0.69 Voxel 10s-1 R2 water 30s-1 35s-1 45s-1 60s-1 value rsq. fit Voxel 27.6s-1 1.00 MF 1.00 512*512 HISTO_reports Colorbar_Report Stimmt-NM SAD- Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: (AU) 26/10/2020 | HOOD05162003139478 Healthineers Page 12 of 14 Job Aid | MR Liver Lab Effective Date: (AU) 26/10/2020 | HOOD05162003139478 24. PACS – Image Archiving Tip – on some PACS systems the eDIXON, qDIXON and HISTO results will need to be saved as RGB (Red, Green, Blue) images a. Save As RGB Workflow · Open the Patient Browser · Select the Series · Main Menu > select Application > DICOM Tools > Save as RGB · New series created with RGB at end of series name (e.g., t1_VIBE_e-DIXON_tra_th_pre_F_RGB) 25. Tips a. When drawing ROI’s on the PACS system, confirm results have the same values as those drawn on the MR system. b. If Fat/Water Swap on the qDIXON the system will note an unusually high fat signal percentage on the qDIXON Report. (e.g., Water image displays fat, and fat image displays water) · Refer to HISTO results in these instances Patient Applications Transfe View Image Tools Scroll Evaluation System Options Help Aera Aera MR E11 MR E11 STUDY 1 HFS 3/4/2016 +LPH STUDY 1 HFS +LPH 1:14:14 PM O'HARA MARK HENRY 3/4/2016 1:14:14 PM O'HARA MARK HENRY 50 IMA 17 / 64 51 IMA 64 / 64 R 16cm MF 1.20 MF 1.20 TR 15.6 TR 15.6 TE 2.4 TA 18.17 TP F2 D TP F2 BW 1080.0 p4 DIXON/VATER/NORM/DIS2D SL 3.51 SP F112.1 p4 DIXON/FAT/NORM/DIS2D SL 3.51 FoV 281 340 A1/DIXW A1/DIXF 208*320 1 BO1-3;SP Tra Tra *113d6 / 4 294 BO1-3;SP 116 *f13d6 / 4 349 ......... ... Aera Liver Evaluation MR E11 STUDY 1 O'HARA MARK HENRY HFS STUDY 1 3/4/2016 52 IMA 1 / 2 voxels mean fit error O'HARA MARK HENR 1:14:14 PM ROI 69 1.7% 53 IMA 64 / 64 Segmentation Volume 69265 2.5% Unusually high fat signal percentage. Check for fat/water swaps. Run HISTO for comparison. Fat signal percentage 50% mean ROI 99.3% Segmentation Volume 0.6% 98.4% 4.5% SegmentationROI MF 1.20 10cm Os^-1 R2ª 400s^-1 TR 156 TE 2.4 mean 36.45^-1 std TA 18.17 MF 1.00 ROI 4.4s^-1 BW 1080.0 Segmentation Volume 36.15^-1 p4 DIXON/ND/FAT_FRACTION 13.5s^-1 208-3201 Ip4 512*512 A1 vibe_q-dixon_tra_bh_Report BO1-3;SP2-4 *f13d6 / 4 Check for fat water swaps. Run THIS .. 2 1829 Waiting for scan instructions. StimIENM SAB=NM Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: (AU) 26/10/2020 | HOOD05162003139478 Healthineers Page 13 of 14 Job Aid | MR Liver Lab Effective Date: (AU) 26/10/2020 | HOOD05162003139478 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 collectively “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 necessarily 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 Healthcare GmbH 2020 Siemens Healthineers Headquarters Siemens Healthcare GmbH Henkestr. 127 91052 Erlangen, Germany Phone: +49 9131 84-0 siemens-healthineers.com Unrestricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: (AU) 26/10/2020 | HOOD05162003139478 Healthineers Page 14 of 14