Needle intervention add-in: Real-time workflow

This demonstration video has the. Purpose to show. You the steps and interactions commonly used an interventional MRI. In this example we focus on the needle intervention add in functionality. In this setup you can find an additional screen next to the patient table which enables the operator in the room to follow the progress of the user interface. To control the interactive real time imaging steps of the. Protocol. The operator. Has an in room foot switch. For demonstration purposes we use a phantom on the table which is positioned as described in the operator manual. For the needle intervention, add in. The patient has been registered, the measurement program for the needle intervention is loaded, and the localizer measurement has been performed. To create a program with the protocol suitable for your needs, please refer to the user manual. First, acquire images for planning the needle path. Then verify that the images are suitable for planning the needle path. Setting entry point and target point. The GSP. Segments show the images that you should use to mark the needle path. If preferred. You can also. Use GSP auto load. Click on the Needle Intervention planning card. In the GSP segments, scroll to a suitable slice and position the entry point marker as shown in the next steps. Click on the entry point marker icon, move the mouse pointer to across the image to position the entry point, then Click to set the marker. The corresponding coordinates are shown on the planning card. Check the. Position of the entry point marker and reposition if necessary. Next, click on the target point marker icon. Please note that you can scroll through the image slices to localize the position for setting the target point. Move the mouse pointer to across the image to position the target point, then Click to set the marker. Corresponding coordinates are shown on the planning card. Check the position of the target point marker and reposition if necessary. When you scroll through the slices, the target and entry point will remain in their set location if preferred. You can also first set the target point and afterwards set the entry point. You can maximize the image view by double clicking to find position the marker position, double Click to go back to the default. View. Open the marking tab. Inform the patient that the table will move. Please note that you must not use the jog wheel for table positioning. Use the left Move table to button, which is the Move table to laser light localizer position to position the entry point under the laser light localizer. You can see in the infographic whether the table has reached the correct position or if you have to continue to press the Move table to Laser Light Localizer position button. Turn the laser light on. Do not turn the. Laser light off or press the center position button at the scanner as this would cause a loss of the table reference. The table is now in the calculated Z position below the laser. Light Localizer. The lateral distance is shown on the scanner user interface and the Select and Go display on the patient. Measure the determined lateral distance from the crosshair and mark the entry point on the patient. Place a marker on the patient at the marked entry point. Ensure markers are Mr. Safe. Use the markers only to verify the entry point position. Markers are not allowed in diagnostic imaging. Remove. The marker before you perform any diagnostic measurement in the. Console user interface Click on the Move table into Bore icon to move the table and the patient to the ISO center of the magnet. In the console user interface, click the Go button to start the verification measurement. Verify the. Correct position of the marked entry point in the images. Setting the center position. Open the table position strategy step. Choose fixed positioning mode to prevent unintended table movements. Click the Confirm and Proceed button in the reference images. Drag the yellow triangle up or down until it points to the planned entry point. Click the Go button to confirm the positioning strategy and move on to the needle intervention interactive real time imaging sequence. You can adjust the image windowing parameters with the middle mouse button to meet your individual needs. Click the details. Button to display all interactive sequence parameters. Here you can adjust detailed settings if necessary. For the real time imaging, you can choose between different slice alignment modes, parallel mode or orthogonal mode. If needed, you can also turn on the line box mode to get a different view. Or orthogonal mode. If using the orthogonal slice alignment mode, at least two slice groups must be selected. All slice groups are aligned orthogonally to each other along the planned needle path, the slice. Groups are aligned as close as possible to the main orientation. Sagittal, coronal, and transverse. The two slice groups are aligned orthogonally to each other so that they intersect in the planned needle path. The third slice group, if present, is aligned orthogonally to the first two slice groups at the target point. Select a minimum of two slice. Groups Click the. Orthogonal alignment icon. Choose the center of the slice groups from the list. The slice groups can be centered at the following positions. No. Centering entry point Midpoint slice groups are centered between the entry point and the target point. Target point is the default selection. Click the orthogonal alignment again to apply the centering option. Parallel mode. If you select parallel slice alignment mode, you can align 3 slice groups parallel to a reference slice if you are using the parallel. Slice alignment mode. Three slice groups must be selected. The selected slice or planned needle trajectory will be used as the center slice. The middle layer. Other layers are boundary layers. The middle layer is loaded into the middle graphic slice positioning segment to use. Parallel slice alignment mode. First select the slice group to which the other two slice groups are. To be aligned parallel. Click the parallel icon. Now all three slice groups are aligned parallel to each other with the currently selected slice group as the middle slice. Positioning of the needle during real time imaging. Click copy and go to start the needle positioning measurement. Please remain in a constant communication with the patient during the sequence you now. Start real time imaging and the advancement of the needle will be visible in real time. You can stop, pause, or continue real time imaging. Use the foot switch if available, or the toolbar. You can use the parallel mode as well as the orthogonal mode. During the needle placement you. Can zoom in or out if needed. Double Click to go back to the default view you can. Change the entry point during the scan if needed and. Readjust the images. By clicking the orthogonal mode button. You can. Also switch to the parallel mode during the scan. Here you can also zoom in or out as well. As readjust the views, use the interactive adjustments to help with needle positioning during real time imaging. Ensure you perform continuous communication between the in room operator and the acquisition workplace. Operator.

00:14 01:27 44:22 06:17 29:34 150 23 25 00:11 00:10 104 20 00:00 165 106 296 4.13 266 121 294 120 84 432 220 340 01:24 37 376 154 443,49 44:03 779 44:02 774 44:01 44:00 43:59 43:58 771 43:57 43:56 43:55 43:54 827 43:53 43:51 704 06:1 43:50 29:22 29:20 29:19 624 29:18 29:17 29:16 242 29:15 29:13 29:12 29:11 29:10 29:09 29:08 29:07 29:06 29:04 29:03 29:02 29:01 728 43:49 43:48 43:47 43:46 43:45 43:44 43:43 43:42 43:41 43:40 43:39 43:38 43:37 43:36 43:35 43:34 43:33 43:32 43:30 43:29 43:28 43:27 44:06 762 756 44:05 43:31 43:26 43:25 44:11 44:10 766 44:09 44:08 44:07 772 44:04 13:54 717 381 361 770 Needle inter Needle intervention add-in: Real-time workflow Presentation of the technical implementation SIEMENS MAGNETOM Sola Foot CIRS AGNETOM Sola New patient registered Table Position Home Coils T-Spine Flex Loop Large BM Spine 48 Physio Doe, John 01.01.2000 M Training Abdomen Cance SAR Stimu Mode EN Add Program / Steps IMRI localizer 3D_Verification Needle Intervention Example (2 IRT slices) Table Positioning Strategy Example (3 IRT slices) App Training Step 1 - localizer Protocol Parameters Volce Commands Execution Image Management Auto Load Copy References Close 14 sec Routine Contrast Resolution System Inline Sequence FOV Read Slice Group Slices FOV Phase Distance Factor TR Position TE Transversal Averages Phase Encoding Dir. A>> P Concatenations AutoAlign Phase Oversampling Cancel Loading ... Scanning 00:00:10 Geometry Physlo Slab Group 380 mm Slabs Slices per Slab Slice Thickness R4.3 P19.1 H4.0 Orientation Phase Encoding Dir. Slice Oversampling HL Training 1 IMA 1 FRM 6/23 1 IMA 1 FRM 15/23 1 IMA 1 FRM 21/23 10cm SP P30,0 SP H50,0 Tra ms Setting Entry Point and Target Point Healthineers 4 IMA 1 FRM 23/23 4 Table Positioning Strategy TP FOV 430*430 3D_Planning GO Cor Adjusting (3D Shim Fieldma 5 IMA 1 FRM 51/104 TP F4 SP F12,3 FOV 238'380 Planning Marking Mark the entry point and the target point on the GSP by clicking the corresponding symbol. Entry Point Coordinates: Target Point Waiting for slice positioning. Normal SP H10,0 SP F6,9 R 39 mm A 61 mm F 7 mm R 39 mm A 61 mm L 2 mm A 3 mm SP F10,5 R. p2-MAGN/M/NORM/DIS3D 4 IMA 1 FRM 15/23 R 38 mm F7 mm L 1 mm A 2 mm Place the marker on the patient based on the lateral distance, as displayed below: Move Table to: Lateral Distance: Inform the patlent about remote table 38 mm to left of laser center movement. Monitor the patient during remote table movement. Once you have switched on the laser-light localizer, do not switch it off and do not press Table is not at correct position. Use the table move buttons to position the entry point the Center Position button on the scanner. under the laser-light localizer. Service QA Show Overlay 5 IMA1 FRM 51/104 FoV 238'380 Sola Place the marker on the patient based on the latera Moves table into bore 42 mm to left of laser center 3D Verification Select Table Positioning Strategy Previous steps must be finished before proceeding. Apply Opened Step Iso Center Local Range 6 IMA1 FRM 52/104 SP F5,1 Setting the Center Position SIEMENS . 3D Planning TP 0 Go FIX Define the Fixed Table Position by dragging the triangle In the planning segment(s) to the body part of Interest. The Fixed Table Positioning Strategy allows for imaging outside of the homogeneity sphere, beyond the isocenter of the scanner. Selecting this strategy can result in poor quality images, use only if needed. Check the operator manual for further Information. Alternatively select one of the previously used positions or enter a Confirm and Proceed mm Fixed E 50:39 Real-Time Imaging Click on Copy&Go to start the interactive real-time imaging sequensiice Thickness Markers Slice alignment Center on Midpoint Image Acquisition Select slice groups to acquire Images from: Slice Group 1 Create Mosaic 6 IMA1 FRM 51/104 ER Inplane Rotation Angle: 0.0 deg Click on Copy&Go to start the interactive real-time imaging sequence Select slice groups to acquire images from: Add Slice mage Ref. Lines Table Line Volum EX Group Display Slice Groups in Package TH MENS Orthogonal Mode Align all slices along planned trajectory. SP P No Centering Midpoint enter on Center on Parallel Mode HAR AF 19 IMA 14 FRM 1/1 AL RIA TP H3 FOV 300 300 20 IMA 14 FRM 1/1 Center on Target Point Step 7 - BEAT_Multislice_3SL scanning 00:44:03 (14/2000) Save RFP E 06:17 HLA AR Positioning of the needle during Real Time Imaging 6 IMA 1 FRM 51/104 Markers + Slice Group 2 TEN Duplicates Opened Step and Inserts it Before Opened Step Patient table moving. Continue Cument 9 IMA 14 FRM 1/1 9 IMA 13 FRM 1/1 SP P12,0 10 IMA 14 FRM 1/1 Step 5 - BEAT_Multislice_2SL Scanning 00:29:22 (14/2000) Control Sag HPL FoV 300 300 RHA RP P H3 AH SP A3,0 HPR MA MAGNETOM A BioMatrix System 16 IMA 24 FRM 1/1 Pause the Measurement Step 5 - BEAT_Multislice_35L scanning 00:43:43 (29/2000) 16 IMA 39 FRM 1/1 Stop the Measurement Delete Copy 19 IMA 16 FRM 1./1 SP F11,8 SP L2 SP F1,8 Scanning 00:44:06 (12/2000) Current scanning 00:44:08 (10/2000) center on center on Target Point 19 IMA 25 FRM 1/1 Siemens Healthineers AG, 2025 Please note this 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 Manual shall be used as your main reference, in particular for relevant safety information like warnings and cautions. Please 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. Siemens Healthineers HQ | Siemens Healthineers AG Siemensstr. 3 91301 Forchheim Germany Phone: +49 9191 18-0 siemens-healthineers.com