Open Recon SubtleMR Integration Job Aid - USA

SIEMENS Healthineers Open Recon | SubtleMR Integration Job Aid Template Effective Date: 10 Aug 2021| HILS 2223 Effective Date 20 Dec 2022 | HOOD05162003323428 Unrestricted © Siemens Healthineers, 2022 Open Recon | SubtleMR Integration SIEMENS Healthineers Table of Contents Benefits 3 SubtleMR Workflow 5 -- SubtleMR Supported Sequences 6 ¡¡¡' Recommended SubtleMR Jobs 7 Siemens Protocol Managing 8 Clinical Examples 14 Sample Processing 10 Result Information 14 Printing Results 16 Daily Maintenance 18 Weekly Maintenance 19 Monthly Maintenance 20 As-Needed Maintenance 23 2 Effective Date 20 Dec 2022 | HOOD05162003323428 Unrestricted © Siemens Healthineers, 2022 Benefits SIEMENS Healthineers SubtleMR is an AI-powered software solution used to enhance the quality of up to 60% faster MRI scans by increasing image sharpness and denoising. SubtleMRT™ Benefits: • Improved image quality Faster scan times Original Scan Accelerated Scan Enhanced • by SubtleMRT™ • Increased throughput • Better patient experience • More flexibility between patients Acquisition Time: 1:46 min Acquisition Time: 42 sec 3 Effective Date 20 Dec 2022 | HOOD05162003323428 Unrestricted © Siemens Healthineers, 2022 Benefits for all Stakeholders SIEMENS Healthineers rio Patients Radiologists Facility  Scan time reduction  Better patient care  Increase operational efficiency  Improve patient comfort  Fewer motion artifacts, reducing need for rescans  More flexibility in  Increase patient between patients satisfaction  Increase referrals  Less overtime  Fewer rescans 4 Effective Date 20 Dec 2022 | HOOD05162003323428 Unrestricted © Siemens Healthineers, 2022 Open Recon | SubtleMR Workflow SIEMENS Healthineers 1 From the Siemens console, select the tab Open 2 Under Algorithm, use the drop-down menu to Recon. select the desired job. SIEMENS .. Healthineers 918/1986 F df596017-adca-4541 .- X X MR View&GO E 00:00 Brain + Delete Stop K Stop Pause Go Cancel 4.7x4.7x8.0 mm Continue Copy&Go 4 sec | Auto @ None Routine Contrast Resolution Geometr System Physio Inline Subtraction MIP Composing Maplt Open Recon Algorithm None None 12i_notsigned_mirroring V1 SubtleMR V2 E 00:00 O SAR Stimu Go Cancel 4 sec 1 Auto @ None @ 4.7x4.7x8.0 mm3 @ 1.00 Settings Display Display myExam Normal Normal Delete Skip Pause Continue Copy&Go Mode Mode Stop Routine Contrast Resolu Geometry System Physio Inline Sequence Subtraction Mip Composing Open Recon Waiting for slice positioning Algorithm None 3 Once the appropriate algorithm is selected, the scan can be performed. SAR Stimu Settings Settings 2jector 5 Normal Normal Mode Mode Effective Date 20 Dec 2022 | HOOD05162003323428 Waiting for slice positioning. Unrestricted © Siemens Healthineers, 2022 SubtleMR Supported Sequences SIEMENS Healthineers SubtleMR has been trained and tested using a diverse DICOM image dataset Hints Hints collected from different MR imaging applications primarily at 1.5T/3T, including: 1. Data Processing and Sequences Not • T1 weighted imaging for neuro, spine, breast, body (e.g., abdomen/pelvis/prostate), MSK (e.g., Supported: shoulder/knee) applications: 1) gradient echo (GRE) based 2D/3D sequences (e.g., FLASH) • Diffusion Weighted Imaging (DWI) with/without contrast, using Cartesian/Radial readout trajectories, without/with inversion • Diffusion Tensor Imaging (DWI) preparation (e.g., MPRAGE); 2) spin echo (SE) based 2D sequences including fast SE (FSE) • Functional (fMRI) with/without variable refocusing flip angle pulse train. • MR Spectroscopy (MRS) • MR Perfusion Imaging* • T2 weighted imaging for neuro, spine, breast, body (e.g., abdomen/pelvis/prostate), MSK (e.g., • Multi Planar Reformats (MPR) shoulder/ knee) applications: SE based 2D/ 3D sequences, 2D/3D Dark Fluid TIRM with/without contrast and with/without fat suppression. 2. Any imaging sequences/applications outside the above list may result in • Proton density weighted imaging for spine, MSK (e.g., shoulder/knee/ankle) applications: 2D SE prolonged processing time and/or sequences with/without fat suppression. unreasonable results. • Susceptibility weighted imaging for neuro and abdomen applications: T2* weighted GRE. *Perfusion imaging was not included in the training and testing data. • STIR sequence for spine imaging. US Contrast Disclaimer – A licensed physician may choose to use FDA-approved contrast agents in conjunction with an MRI exam, based on 6 his/her medical opinion and discretion and in accordance with the instructions for use and indications for use supplied by the pharmaceutical Effective Date 20 Dec 2022 | HOOD05162003323428 manufacturer for the contrast agents. Unrestricted © Siemens Healthineers, 2022 SubtleMR Supported Sequences SIEMENS Healthineers SubtleMR has been trained and tested using a diverse DICOM image dataset collected from different MR imaging applications primarily at 1.5T/3T, including: 1 Any imaging sequences/applications • T1 weighted imaging for neuro, spine, breast, body (e.g., abdomen/pelvis/prostate), MSK (e.g., outside the above list may result in shoulder/knee) applications: 1) gradient echo (GRE) based 2D/3D sequences (e.g., FLASH) with/without prolonged processing time (e.g., high- contrast, using Cartesian/Radial readout trajectories, without/with inversion preparation (e.g., dimensional MR imaging) and/or MPRAGE); 2) spin echo (SE) based 2D sequences including fast SE (FSE) with/without variable refocusing unreasonable results. flip angle pulse train. Note that DWI and MPR sequences are • T2 weighted imaging for neuro, spine, breast, body (e.g., abdomen/pelvis/prostate), MSK (e.g., not supported when executing with shoulder/ knee) applications: SE based 2D/ 3D sequences, 2D/3D Dark Fluid TIRM with/without contrast ISMRMRD images. and with/without fat suppression. In addition, Diffusion Tensor Imaging • Proton density weighted imaging for spine, MSK (e.g., shoulder/knee/ankle) applications: 2D SE (DTI), functional MRI (fMRI) and MR sequences with/without fat suppression. spectroscopy (MRS) data processing are out of the scope of SubtleMR. • Susceptibility weighted imaging for neuro and abdomen applications: T2* weighted GRE. Perfusion imaging sequences were not • STIR sequence for spine imaging. included in the training and testing dataset. US Contrast Disclaimer – A licensed physician may choose to use FDA-approved contrast agents in conjunction with an MRI exam, based on his/her 7 medical opinion and discretion and in accordance with the instructions for use and indications for use supplied by the pharmaceutical manufacturer Effective Date 20 Dec 2022 | HOOD05162003323428 for the contrast agents. Unrestricted © Siemens Healthineers, 2022 Recommended SubtleMR Jobs SIEMENS Healthineers • For denoising jobs, the recommended job is @ 3:07 min Auto 0.7x0.7x5.0 mm3 ~ 1.00 denoise-enhanced-level1. If less denoising is Routine Contrast Resolution Geometry System Physio Inline Sequence required, use denoise. Similarly, if the images Subtraction MIP Composing Open Recon are not denoised enough, denoise- Algorithm SubtleMR V2 enhanced-level2 is recommended. • For super-resolution jobs (BRAIN), the recommended default is super-resolution. Preset denoise Free Text denoise The job edge-super-resolution will produce denoise-enhanced-level1 ... results with sharper boundaries. Conversely, denoise-enhanced-level2 super-resolution smooth-super-resolution will produce smooth-super-resolution smoother results. edge-super-resolution • SubtleMR does not support diffusion weighted images (DWI) or multiplanar reformat (MPR) jobs. 8 Effective Date 20 Dec 2022 | HOOD05162003323428 Unrestricted © Siemens Healthineers, 2022 Siemens Protocol Managing SIEMENS Healthineers 1 Locate Protocol Folders/Exam Cards. Protocols are located in myExam Cockpit: During the examination the protocols can be added into the Queue at any time. myExam Cockpit - Explorer ? O X Brain Assist LOC + Add Program / Steps Explorer Program Editor Browse Import Export Edit Simulate 1 AAhead_scout SIEMENS Brain Assist SIEMENS head 2 t1_se_sag Brain Autopilot c-spine t-spine 3 %% 12_tse_tra 512 clinical libraries advanced applications libraries head I-spine whole-spine 4 t2_tse_dark-fluid_tra 04:50 head Cc-spine GOBrain neck soft tissue % ep2d_diff_3scan_trace_p2 c-spine Cat-spine [ l-spine thorax 5 01:47 t-spine library heart >whole-spine 6 t1_se_tra 3 02:25 angiography breast I-spine >[ whole-spine angiography ce > neck soft tissue abdomen 7 Inject contrast agent. [ thorax pelvis female [ heart pelvis male t1_se_tra 02:25 neck soft tissue breast tmj thorax abdomen shoulder 9 t1_se_cor 02:27 pelvis female elbow heart [ pelvis male wrist > [] breast myExam Cockpit 0 tmj hand hip abdomen shoulder elbow knee > pelvis female wrist ankle foot E 13:54 pelvis male hand Chip lower extremity [ tmj whole body oncology >knee whole body diffusion L(Go Delete Go Cancel shoulder 0 ankle peripheral angiography Skip Stop Pause Continue Copy&Go foot elbow spectroscopy lower extremity intervention whole body oncology radiotherapy > whole body diffusion System [ peripheral angiography [] spectroscopy 9 Effective Date 20 Dec 2022 | HOOD05162003323428 Unrestricted © Siemens Healthineers, 2022 Siemens Protocol Managing SIEMENS Healthineers (Brain) 3 Edit sequences: There are two options: (A) Denoising (DNE) and (B) Super-resolution (SRE). A. Denoising (DNE) If multiple Averages  Adjust Averages USER >> head >> clinical libraries >> general >> S-t2 tse tra 512-DNE ? X USER > head >> clinical libraries > general >> S-t2_tse_tra_512-DNE ? X General 3:37 min 4 Auto @ None 0.4x0.4x5.0 mm3 1.00 General @ 3:37 min Auto @ None 0.4x0.4x5.0 mm3 1.00 Protocol Parameters 2  1 Routine Contrast Resolution Geometry System Physio Inline Sequence Protocol Parameters Routine Contrast Resolution Geometry System Physio Inline Sequence • Voice Commands FoV Read Voice Commands 230 - mm e.g., 4  2 Execution Slice Group Execution Slice Group FoV Read 230 mm • Image Management Slices 25 + FoV Phase 90.6 ¢ % Image Management Slices 25 FOV Phase 90.6 % Auto Load Slice Thickness Auto Load Copy References 5.0 - mm Copy References Slice Thickness 5.0 + m Distance Factor 30 ¢ % TR 5000.0 ms Distance Factor 30 TR 5000.0 + m Position Isocenter TE 89.00 - ms Position Isocenter TE 89.00 + ms Orientation Transversal Averages 2 + Orientation Transversal Averages 1 ... Phase Encoding Dir. R>>L ... Concatenations Phase Encoding Dir. R>>L ... Concatenations Phase Oversampling 0 4 % AutoAlign --- ... Phase Oversampling % AutoAlign --- ... Averages 2 1- 32 Averages. 1 32 OK Cancel #8 2 Identical OK Cancel EB 2 Identical CI 10 Effective Date 20 Dec 2022 | HOOD05162003323428 Unrestricted © Siemens Healthineers, 2022 Siemens Protocol Managing SIEMENS Healthineers (Brain) 3 Edit sequences: B. Super-resolution (SRE) If multiple Averages  Adjust USER >> head >> clinical libraries >> general >> S-t2_tse_tra_512-DNE ? X General 8 1:52 min 4 Auto @ None @ 0.4x0.4x5.0 mm3 9 0.71 Phase Resolution in Resolution Protocol Parameters Routine Contrast Resolution Geometry System Physio Inline Sequenc Voice Commands Acceleration Filter tab Execution Common Image Management FoV Read 230 - mm Auto Load FoV Phase 90.6 ¢ % Copy References Slice Thickness 5.0 - mm • Adjust resolution to 60% of Base Resolution 512 USER > head >> clinical libraries » general »> S-t2_tse tra_512-DNE General Phase Resolution 75 ¢ % ¿ 57 sec Auto @ None @ 0.4x0.4x5.0 mm3 9 1.08 original resolution Protocol Parameters Routine Contrast Resolution Geometry System Physio Inline Acq. Matrix: 348x512 Sequence Voice Commands Execution Common Acceleration Filter 348 => 158 Image Management FoV Read 230 - mm nterpolation Auto Load FoV Phase 90.6 + Copy References Slice Thickness 5.0 - mm • Or to 128 at the very Base Resolution 512 + minimum resolution Phase Resolution 34 = % OK Cancel B 2 Identical Acq. Matrix: 158×512 158 => 128 Interpolation • If the resolution is higher than 256, adjust to 50% resolution OK Cancel 2 Identical CI e.g., 384 -> 192 C. If neither resolution or averages can be decreased (Already 1 Average and below 128) leave as routine. 11 Effective Date 20 Dec 2022 | HOOD05162003323428 Unrestricted © Siemens Healthineers, 2022 Siemens Protocol Managing SIEMENS Healthineers 2 There are two methods to add compatible SubtleMR, USER >> head >> clinical libraries » general MR sequences to your routine* Brain, Spine, and t1_se_r_sag 03:25 MSK protocols. t1_se_cor 02:25 A. Copy all sequences routine protocols t2 tse tra 512 03:37 In an existing protocol, copy all sequences and add them underneath for editing. Add a break or pause with Subtle to t2_tse_dark-fluid_tra 04:50 distinguish [Preferred approach]. SUBTLE ----- add a Pause B. Create a new protocol S-t1_se_r_sag-DNE 03:25 Create a new protocol which is a copy of your routine protocols but with SubtleMR as protocol name and then start editing. S-t1_se_cor-DNE 02:25 copy of routine protocols S-t2_tse_tra_512-DNE 03:37 S-t2 tse dark-fluid_tra-DNE 04:50 12 Effective Date 20 Dec 2022 | HOOD05162003323428 *Routine protocols may include Diffusion Weighted Imaging (DWI) which is not a supported sequence for SubtleMR. Unrestricted © Siemens Healthineers, 2022 Siemens Protocol Managing SIEMENS Healthineers (Spine & MSK) USER >> c-spine >> clinical libraries >> general >> S-t2 tse_stir_sag_DNE ? X 3 Edit sequences: General 3:53 min 4 Auto @ 2 @ 0.9x0.9×3.0 mm3 9 1.22 Protocol Parameters Routine Contrast Resolution Geometry System Physio Inline Sequence Voice Commands For Spine and MSK: all will be Denoising (DNE) or Execution Slice Group 1 FOV Read 220 - mm Image Management Slices 15 FoV Phase 100.0 reduction in average. Auto Load Slice Thickness Copy References 3.0 mn Distance Factor 104 TR 3800.0 ms Position Isocenter TE 37.00 + ms • Adjust Averages (Avgs) Orientation Sagittal Averages 3 ... 2  1 Phase Encoding Dir. H>> F Concatenations • Phase Oversampling 80 % AutoAlign --- e.g., 4  2 • Averages [3] 32 • If the sequence is a STIR or FS, ensure sufficient SNR is present. Be less aggressive: OK Cancel BB 3 Identical CI • (ex: If Avgs = 2, don’t change it. If Avgs = 3, USER > c-spine » clinical libraries » general »> S-t2_tse_stir_sag-DNE ? X General @ 2:37 min 4Auto 2 2 @ 0.9x0.9x3.0 mm3 1.00 reduce it to 2) Protocol Parameters Routine Contrast Resolution Geometry System Physio Inline Sequence Voice Commands Execution Slice Group 1 FOV Read 220 - mm Image Management Slices 15 FoV Phase 100.0 % Auto Load • If Average = 1, then leave the sequence as routine Copy References Slice Thickness 3.0 - mm Distance Factor 10 % TR 3800.0 ¢ m n Isocenter TE 37.00 + ms Orientation Sagittal Averages 2- ... Phase Encoding Dir. H>> F ... Concatenations Phase Oversampling 80 % AutoAlign ... Averages OK Cancel 8 3 Identical 13 Effective Date 20 Dec 2022 | HOOD05162003323428 Unrestricted © Siemens Healthineers, 2022 Siemens Protocol Managing SIEMENS Healthineers USER > head >> clinical libraries » general t1_se_r_sag 03:25 t1_se_cor 02:25 t2_tse_tra 512 03:37 regular protocol t2_tse_dark-fluid_tra 04:50 H. • If making copies of protocols rather than adding to current protocols: Adjust protocol name to: Subtle-Routine Brain. SUBTLE ------ • It is very important to save all your work before moving to edit S-t1_se_r_sag-DNE 03:25 the next protocol. S-t1_se_cor-DNE 02:25 5-t2_tse_tra_512-DNE 03:40 DNE example S-t2_tse_tra_512-SRE 00:57 SRE example S-t2_tse_dark-fluid_tra-DNE 04:50 14 Effective Date 20 Dec 2022 | HOOD05162003323428 Unrestricted © Siemens Healthineers, 2022 Clinical Examples SIEMENS Healthineers 1.5 T MAGNETOM Systems – Brain – Sag T1 (DNE) Accelerated scan enhanced by SubtleMR Original scan Time Acq Time: Savings: 0:54 min. 28% Acq Time: Fast Acq Matrix: 1:15 320x320 Acq Matrix: Enhanced 320x320 Matrix: 320x320 NEX/Avgs: 2 NEX/Avgs: 1 15 The statements by the Siemens’ customer described herein are based on results that were achieved in the customer's unique setting. Since there is no "typical" hospital and Effective Date 20 Dec 2022 | HOOD05162003323428 many variables exist (e.g., hospital size, case mix, level of IT adoption) there can be no guarantee that other customers will achieve the same results. Unrestricted © Siemens Healthineers, 2022 Clinical Examples SIEMENS Healthineers 1.5 T MAGNETOM Systems – Knee – Cor T2 (DNE) Accelerated scan enhanced by SubtleMR Original scan Time Savings: 51% Acq Time: Acq Time: 1:50 min. 3:46 Acq Matrix: 320x224 Acq Matrix: 320x224 NEX/Avgs: 2 NEX/Avgs: 1 16 The statements by the Siemens’ customer described herein are based on results that were achieved in the customer's unique setting. Since there is no "typical" hospital and Effective Date 20 Dec 2022 | HOOD05162003323428 many variables exist (e.g., hospital size, case mix, level of IT adoption) there can be no guarantee that other customers will achieve the same results. Unrestricted © Siemens Healthineers, 2022 Clinical Examples SIEMENS Healthineers 1.5 T MAGNETOM Systems – Hip – Cor STIR (DNE) Accelerated scan enhanced by SubtleMR Original scan Time Savings: 49% Acq Time: Acq Time: 2:24 min. 4:42 Acq Matrix: 320x240 Acq Matrix: 320x240 NEX/Avgs: 2 NEX/Avgs: 1 17 The statements by the Siemens’ customer described herein are based on results that were achieved in the customer's unique setting. Since there is no "typical" hospital Effective Date 20 Dec 2022 | HOOD05162003323428 and many variables exist (e.g., hospital size, case mix, level of IT adoption) there can be no guarantee that other customers will achieve the same results. Unrestricted © Siemens Healthineers, 2022 SIEMENS Healthineers 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 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 Healthcare GmbH 2022 Siemens Healthineers Headquarters Siemens Healthcare GmbH Henkestr. 127 91052 Erlangen, Germany Telephone: +49 9131 84-0 siemens-healthineers.com 18 Effective Date 20 Dec 2022 | HOOD05162003323428 Unrestricted © Siemens Healthineers, 2022