Off-center imaging in elbow, hand/wrist, and shoulder (USA)

SIEMENS Healthineers Off-center imaging Job Aid Elbow, hand/wrist, and shoulder Template Effective Date: 10 Aug 2021 | HILS 2223 Job Aid Effective Date: 02 Sep 2024 | QR700011950 Unrestricted I Published by Siemens Healthineers AG I © Siemens Healthineers, 2024 Off-center imaging SIEMENS Healthineers Table of contents Challenge – Fat suppression 3 Adjustment strategy – Sequence 4 Challenge – Distortion 5 Adjustment strategy – Parameter 6 Guidance for elbow 8 Hints for elbow and wrist positioning 9 Adjustment strategy for hand/wrist 10 Hints for hand and wrist positioning 11 Support for shoulder 12 Hints for shoulder positioning 13 2 Effective Date: 02 Sep 2024 | QR700011950 Unrestricted I Published by Siemens Healthineers AG | © Siemens Healthineers AG, 2024 Off-center imaging SIEMENS Healthineers Challenge - Fat suppression To obtain optimal image quality and homogeneous fat saturation, HLA ARH Lumina Elbow Ref.: DemoCongress Lumina_Elbow Ref.: DemoCongress Lumina_Elbow position the patient's extremity to be examined as close to the Siemens_MAC_2aaaa2331 MAGNETOM Lumina Siemens_MAC_2aaaa2331 MAGNETOM Lumina Siemens_MAC_2aaaa2331 Ref.: DemoCongress *16.11.1981, F, 40Y MR XA50 *16.11.1981, F, 40Y MR XA50 *16.11.1981, F, 40Y MAGNETOM Lumina isocenter as possible. 16.11.2021 MR XA50 HFS 16.11.2021 HFS 16.11.2021 +LPH +LPH LPA pd_tse_fs_cor_DRB_DRS pd_tse_fs_sag_DRB_DRS pd_tse_fs_tra_DRB_DRS latest latest latest # XA50A # XA50A # XA50A STUDY ID 2aaaa2331 STUDY ID 2aaaa2331 STUDY ID 2aaaa2331 Especially when imaging areas with strong B1 variations across the 13:27:13 13:33:25 13:37:02 7001 IMA 9 6001 IMA 11 8001 IMA 12 shoulder, elbow, hand, or wrist. T2-STIR techniques provide robust fat suppression, especially when compared to spectral fat saturation. • Challenge: Inhomogeneous fat saturation O RPH ARF RPH 2D SL 2D 20 SL SL SPC Ocm 10cm 10cm IF TR 2170,0 TP F10 TR 2590,0 TP F9 TR 3770,0 TP F13 TE 33,0 SP P43,4 TE 33,0 SP R117,1 TE 34,0 SP F18,3 TA 03:00 FoV 120*120 TA 02:43 FoV 120*120 TA 02:34 FoV 120*120 BW 303,0 768*768 1 BW 250,0 576*768s | BW 289,0 576*768s | /DRS/DIS2D/DRB/MFSPLIT Cor>Sag(-15)>Tra(1) JDRS/DIS2D/DRB/MF SPLIT Sag>Cor(17)>Tra(7) /DRS/DIS2D/DRB/MF SPLIT Tra>Sag(-7)>Cor(2) A1/FS Zoom 0,55 A1/FS Zoom 0,55 Zoom 0,55 UFS W 690 W 708 A1/SAT2/FS W 573 *tseR2d1_7/ 137 C Not for diagnostic use 334 UFS UFS *tseR2d1rr7 / 133 321 *tseR2d1rr7 / 120 C 249 3 Effective Date: 02 Sep 2024 | QR700011950 Unrestricted I Published by Siemens Healthineers AG | © Siemens Healthineers AG, 2024 Off-center imaging SIEMENS Healthineers Adjustment strategy - Sequence Select STIR/DIXON-based sequences for better fat suppression. [ wrist library off-center E localizer 8 T1 high-channel coils E T2 t2_tse_stir_cor_256 03:35 E PD 8 3D t2_tse_dixon_tra_304_p2_s2 02:14 E BLADE library Deep Resolve t2_tse_dixon_cor_304_p2_s2 02:19 clinical libraries t2_tse_dixon_sag_304_p2_s2 02:24 › hand 4 Effective Date: 02 Sep 2024 | QR700011950 Unrestricted I Published by Siemens Healthineers AG | © Siemens Healthineers AG, 2024 Off-center imaging SIEMENS Healthineers Challenge – Distortion Off-center imaging may lead to distortions due to non-linearity of the AF ... A HA IMP_Elbow IMP_Elbow IMP_Elbow gradients. SP7 5 IMA 1 FRM 20/20 11 IMA 1 FRM 9/10 4 IMA 1 FRM 4/9 When distortion correction is applied the anatomy that was initially included in the Field of View (FOV) is cropped. This is a well-known historical issue on all MR scanners and is called the potato chip artifact. RFP 1cm 5 cm 5cm Challenge: Cropping and distortion off-center F F A • TP 0 TP 0 TP O SP F41.7 SP F31.5 SP P46.4 Fo¥ 120*120 FoV 200*200 FoV 200*200 MAGN/NORM/DIS2D Tra>Sag(3)>Cor(3) p2 MAGN/NORM/DIS2D Tra p2 MAGN/NORM/DIS2D Cor>Tra(-3) pd_tse_fs_tra_320 306 30 localizer_sag+cor+tra 364 localizer_sag+cor+tra W 207 166 150 C 61 CAUTION Distorted slice edges in the margin due to spatial non-linearity of the gradient field and inhomogeneity of the static magnetic field! Incorrect diagnosis Take into account slice distortion at the margins of the MR image. This applies in particular to graphic slice positioning (GSP) as well as other graphic slice displays and slice positioning data independent of the possible use of distortion correction. 5 Effective Date: 02 Sep 2024 | QR700011950 Unrestricted I Published by Siemens Healthineers AG | © Siemens Healthineers AG, 2024 Off-center imaging SIEMENS Healthineers Adjustment strategy – Parameter (1/2) Please note: The adjustment strategy parameter offcenter and the additional adjustment to the flip angle can only be selected on MAGNETOM 3T systems from syngo MR XA31A and upwards. Address the challenge of distortion with the adjustment strategy parameter offcenter, which is only available for TSE, TSE_DIXON, BLADE, and SE sequences. You are required to activate offcenter manually in all sequences by selecting Protocol Parameters > System > Adjustments > Offcenter. If you have selected Offcenter as the adjustment strategy, the measurement is performed in a central transversal slice at isocenter. General 3:35 min 1 Auto@ 2 @ 0.2x0.2x2.5 mm3 1.00 Protocol Parameters Routine Contrast Resolution Geometry System Physio Inline Sequence Voice Commands Execution Miscellaneous Adjustments Adjust Volume TX/RX Image Management Adjustment Strategy Offcenter Adjustment Tolerance Auto Auto Load BO Shim Standard SliceAdjust Adjust with Body Coil Copy References B1 Shim FastView Confirm Frequency Never Offcenter Assume Silicone CoilShim Off syngo MR > XA31A; MAGNETOM 3T systems 6 Effective Date: 02 Sep 2024 | QR700011950 Unrestricted I Published by Siemens Healthineers AG | © Siemens Healthineers AG, 2024 Off-center imaging SIEMENS Healthineers Adjustment strategy – Parameter (2/2) The B1 evaluation and flip angle determination are performed within this transversal slice using the current FOV. This provides a well-suited transmitter reference amplitude for the current FOV and is also robust against FOV changes. Open the Contrast > Common tab for further optimization after you set Offcenter: You can manually adapt the flip angle for the excitation and refocusing pulse. A flip angle reduction (by e.g., 15%) can further enhance the signal uniformity (see the image comparison for the elbow). General @ 4:35 min 4 Auto @ None @ 0.5x0.5x3.0 mm3 1.00 AH AH Protocol Parameters Routine Contrast Resolution Geometry System Physio Inline 2020031235 2020031245 Sequence 2020 03 12-12:11:57 STD 1 312 2.1107 5993 2070 03:1 2-12-11-57-5TD-1-3 12 2-1107 5 99 3 Voice Commands "1MM952 M ERY "1/1/1 952. M.68Y Execution Common Dynamic CURRENT CURRENT NFS $/12/2820 W/12/2020 LPH Image Management TR 3500.0 ms Fat-Water Contrast Standard pd1st_Is tra 320 Auto Load TE 37.00 03 ms Copy References STUDY ID baelt Ja6 5890 STUDY 10 bac30336 myExam Analyzer 12.31.02 PM 12.36 41 PM 5001 MA.6 7003 INAB MTC Dark Blood Magn. Preparation Slice-sel. IR RFA RFA 1cm TI 160 ms Contrasts Freeze Suppr. Tissue Wrap-up Magn. None Reconstruction Magnitude TR 3940.0 TP O TE 29 0 BP F23.5 TIR 1900 0 TP O 52 1235 TA0350 EL: 2 5/0.25 TE 29 0 EL 25/0.25 Flip Angle 1 150 + deg BWW 300.0 FOV 120-120 TA03:50 FOV 120-120 90 deg D2 MAIORMADISON SPUIT 256+320 BW 300 0 255-320 Flip Angle for Excitation: P2 MONORMDIS20/MFOFL T Flip Angie 1 110 Flip Angle for Refocussing: 150 deg 180 deg A219AT1 /F'S Zoom 1:34 Zoom 1.35 UFS W 24 ES UFS "HeR2d1 17/141 IsCR20117 /141 Fatist strong joint FOY based 2=0, FAQ. 05. FatSal strong joind syngo MR > XA31A; MAGNETOM 3T system 7 Effective Date: 02 Sep 2024 | QR700011950 Unrestricted I Published by Siemens Healthineers AG | © Siemens Healthineers AG, 2024 Off-center imaging SIEMENS Healthineers Guidance for elbow For off-center elbow imaging, guidance was added to the 2nd localizer_sag+cor+tra from syngo MR XA70A and upwards. This guidance informs you that the elbow must be adequately covered in the axial localizer. This helps to ensure diagnostic image quality. If you can’t achieve this coverage in the axial localizer, reposition the patient closer to the isocenter. Alternatively, position the patient in the superman position (see notes on positioning the elbow and wrist). SIEMENS >> elbow >> clinical libraries »> general localizer_tra 00:06 Guidance Parameters localizer_sag+cor+tra 00:10 Generic Views Please ensure the elbow is covered sufficiently in "localizer_tra", otherwise, please reposition the patient. Table Positioning Strategy Table Positioning Strategy localizer_sag+cor+tra 00:10 pd_tse fs tra 320 04:31 pd_tse cor 320 03:58 t1 se cor 320 03:57 pd_tse_fs_cor 320 04:22 t2 tse stir cor 256 04:35 pd_tse_sag_384 03:29 2 localizer_tra pd_tse_fs_sag_320 04:26 2 t1_vibe_we_cor_iso 05:34 syngo MR XA70A; MAGNETOM Flow syngo MR XA70A; MAGNETOM Flow 8 Effective Date: 02 Sep 2024 | QR700011950 Unrestricted I Published by Siemens Healthineers AG | © Siemens Healthineers AG, 2024 Off-center imaging SIEMENS Healthineers Hints for elbow and wrist positioning • Position the patient in head-first (supine position). • Use a flexible coil (e.g., BioMatrix Contour S/M Coil) to wrap the coil around the patient`s elbow or wrist. • Make sure that there’s no gap when wrapping the coil. Alternatively, use the next larger coil. • Secure the coil with straps and/or sandbags to stabilize the coil. Ensure the coil cable doesn’t touch the patient or hang over either side of the patient table. • To help mitigate image quality issues, always position the region of interest as close to the isocenter as possible with the help of positioning aids (e.g., sandbags, cushions). • Please note: If the position depicted in the localizer_sag+cor+tra guidance can’t be achieved, position the patient in the superman position (prone/head-first). 9 Effective Date: 02 Sep 2024 | QR700011950 Unrestricted I Published by Siemens Healthineers AG | © Siemens Healthineers AG, 2024 Off-center imaging SIEMENS Healthineers Adjustment strategy for hand and wrist SIEMENS SIEMENS > wrist > library >> T1 Please note: The adjustment strategy parameter offcenter can only be selected on MAGNETOM 3T t1 tse cor 320 03:51 a off-center X systems. t1 se tra 320 03:52 [ pelvis female > [ pelvis male t1_tse_fs_cor_256 04:24 Based on your software version and coil configuration (e.g., Hand/Wrist 16) you can find different off- › 0tmj t1 tse fs tra 240 05:08 center protocols. Search for "off center" in the Siemens tree to display all protocols in yellow that are shoulder elbow t1 tse fs tra s2 256 04:11 verified for an offcenter adjustment. [ wrist [32] [ library [21] t1_f12d_fs_cor_256 03:23 All sequences require a manual setting of offcenter under Protocol Parameters > System > El localizer t1 tse cor 02:02 El T1 [7] Adjustments > Adjustment Strategy > Offcenter. ET2 [7] t1 tse_tra 02:01 E PD [7] General 8 2:53 min Auto @ None 0.3x0.3x3.0 mm3 1.00 EJ 3D t1_tse fs tra 02:37 Protocol Parameters Routine Contrast Resolution Geometry System Physio Inline Sequence Voice Commands E| BLADE off-center_ Execution Miscellaneous Adjustments Adjust Volume Tx/Rx [ library Deep Resolve [11] Image Management Adjustment Strategy Standard Adjustment Tolerance Auto clinical libraries Hand/Wrist 16 Auto Load BO Shim Standard hand [26] SliceAdjust Adjust with Body Coil [ library [26] t1_tse cor 320 Copy References 02:53 myExam Analyzer Confirm Frequency Never Offcenter El localizer Assume Silicone t1 tse dixon_sag 05:10 E| T1 [7] E| T2 [7] t1_tse_dixon_sag_s2 04:14 El PD [8] El 3D [4] t1_tse dixon_cor 04:47 0 hip t1 tse dixon tra 05:34 knee ankle t1 tse dixon tra s2 04:33 foot syngo MR > XA31A; MAGNETOM 3T systems 10 Effective Date: 02 Sep 2024 | QR700011950 Unrestricted I Published by Siemens Healthineers AG | © Siemens Healthineers AG, 2024 Off-center imaging SIEMENS Healthineers Hints for hand and wrist positioning • The hand and/or wrist examination can also be performed using the Hand/Wrist 16 Coil. K • Position the patient in feet-first (supine position). • Position the base plate on the table. If required, press on the fixation knob and slide the base plate toward the center of the patient table. • Slide the coil vertically into the recesses on the base plate until it locks into place. • Place the elbow pad in front of the coil opening. cio) . • Please note: If the position depicted in the localizer_sag+cor+tra guidance can’t be achieved, position the patient in superman pose (prone/head-first). The coil is located in the horizontal direction on the patient table. 11 Effective Date: 02 Sep 2024 | QR700011950 Unrestricted I Published by Siemens Healthineers AG | © Siemens Healthineers AG, 2024 Off-center imaging SIEMENS Healthineers Support for shoulder For off-center shoulder imaging, a second localizer in the shoulder library is available since syngo MR XA50A. To harmonize the protocols in the Siemens tree, a renaming took place on MAGNETOM 1.5T systems from syngo MR XA61A and upwards. You can find the second localizer without additional guidance under localizer_sag+cor+tra. If this coverage can’t be achieved in the axial localizer, reposition the patient closer to the isocenter. Alternatively, place the patient in the superman pose (see hints for elbow and wrist positioning). SIEMENS » shoulder » library » localizer SIEMENS » shoulder »> library »> localizer AAshoulder_scout 00:23 AAshoulder_scout 00:31 AutoAlign Scout AutoAlign Scout localizer 00:07 localizer 00:07 3 plane localizer 00:12 localizer_sag+cor+tra 00:12 localizer_sag 00:06 syngo MR XA50A; MAGNETOM Sola syngo MR XA70A; MAGNETOM Flow 12 Effective Date: 02 Sep 2024 | QR700011950 Unrestricted I Published by Siemens Healthineers AG | © Siemens Healthineers AG, 2024 Off-center imaging SIEMENS Healthineers Hints for shoulder positioning • Insert the head support on the patient table. • If available, position the L-shaped holder in the groove of the table to border the coil in the x direction. • Position the patient in head-first (supine position). • Position the Shoulder Shape 16 Coil on the patient against the L- shaped holder. • Stabilize and fixate the coil´s position with cushions, wedges, sandbags, and/or straps. • Please note: The L-shaped holder shown may not be available on your MAGNETOM MR system. In this case, use alternative positioning aids to stabilize the coil. L-shaped holder 13 Effective Date: 02 Sep 2024 | QR700011950 Unrestricted I Published by Siemens Healthineers AG | © Siemens Healthineers AG, 2024 SIEMENS Healthineers 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 I Siemens Healthineers AG Siemensstr. 3 91301 Forchheim Germany Phone: +49 9191 18-0 siemens-healthineers.com 14 Effective Date: 02 Sep 2024 | QR700011950 Unrestricted I Published by Siemens Healthineers AG | © Siemens Healthineers AG, 2024