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Cardiac MR Free Breathing and Arrhythmias Scanning Tips (E-line & Numaris X) Step by Step

Cardiac MR Free Breathing and Arrhythmias Scanning Tips (E-line & Numaris X) Step by Step

Cardiac MR(CMR) Free Breathing & Arrhythmias Scanning Tips (E-Line & Numaris X) Dark Blood: The goal is to visualize anatomy and characterize tissue of cardiac muscle and surrounding vessels.  Non-ideal condition for cardiac imaging are arrhythmia and breathing (seriously degrade image quality) 1. Arrhythmia - single shot techniques like HASTE is a good choice for cases with variable heart beats. All data is acquired in one heartbeat. a. For HASTE T1W like effect, increase bandwidth and use minimum TE (20-40) b. For HASTE T2W like effect, increase TE (70-80) by changing RF Pulse Type (Sequence Tab) 2. Free Breathing - using navigator techniques. a. HASTE free breathing protocol can be found under Siemens tree > heart > morphology > HASTE > HASTE fb b. T2W TSE Blade can be use for high resolution imaging, found under Siemens tree > heart > morphology > tse > t2w blade i. This is a segmented technique, does not work well for arrhythmia patients. 3. Fat Suppression can be used with any of these sequences for arrhythmias and/or free breathing. a. Best fat suppression for the heart is SPAIR (Contrast Tab) Cumiust Flaschniun Quomistry System Physio Inine TE 49 - 10 MIC Magri Preparation Contrusts Wrap-up Magn. Fig Angle 125 = dug Unrestricted 0 Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: XX/XX/XXXX | HOOD/HILS Healthineers Job Aid | Cardiac MR Free Breathing & Arrhythmias Scanning Tips (E-Line & Numaris X) Effective Date: 05/01/2020 | HOOD05162003083161 Cine (Function): The goal is to visualize wall motion abnormalities, valve dysfunction and quantitative functional values of the ventricles.  Non-ideal condition for cardiac imaging are arrhythmia and breathing (seriously degrade image quality) 1. Arrhythmia - depending on the type of arrhythmia different strategies are available. Compress Sensing Cine with adaptive triggering and real time imaging are the best option for arrhythmia (purchasable option). If this option is not available, see below for different strategies in arrhythmia cases. a. Minor Arrhythmia – Use retrospective cine(red square) with arrhythmia rejection(red circle),select Arrtythmia Detection > By Time (Trigger Window 200-300ms) i. Increase segments(red arrow) to decrease breath hold. ii. After selecting captured cycle, evaluate the Target RR value which should be the average of highest and lowest value of the variable R-R period. Routine Contrast Resolution Geometry System Physic Inline Sequence Signal Cardiac PACE 1st Signal/Mode ECG/Retro Average Cycle 1000 + 3 ms Captured Cycle 1000 + 3 Target RR 1000 ¢ ms 1.6 Concatenations Calculated Phases 25 TR 40.80 - ms Arrhythmia Detection By Time Segments 12 4 Trigger Window 200 Unrestricted 0 Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: XX/XX/XXXX | HOOD/HILS Healthineers Page 2 of 9 Job Aid | Cardiac MR Free Breathing & Arrhythmias Scanning Tips (E-Line & Numaris X) Effective Date: 05/01/2020 | HOOD05162003083161 b. Extreme Arrhythmia – Use prospective/ecg trigger cine(red square), set window shorter than the shortest r-r interval(capture cycle). Usually not entire cardiac cycle image but sufficient for Ejection Fraction (EF) calculation. & 11 sec Memory @1.4x1.4x6.0 mm 9 1.22 Routine Contrast Resolution Geometry System Physio Inline Sequence Signal Cardiac PACE ist SignalMode ECG/Trigger Average Cycle 1000 + 3 ms Captured Cycle 1000 + 3 Acquisition Window 940 ms p.8 6 Trigger Pulse Concatenations 1 . Trigger Delay 0 - ms Phases 23 TR 40.80 = ms Segments 12 c. Fibrilation/Bigeminy/PVC (worst case scenario) – Use real time cine ecg gated (red square). m > heart > function > cine buti SIEMENS cine trufi_retro 00 10 q cine_trufi_retro_reduced_fov 00:14 , head cine truii_retro arryth 00:08 >t-spine ventricular volume I-spine > whole spine cine_trufi_retro_10st_invf 01:10 neck soft tissue cine_truli_retro_10sl_invi_reduced. 01:40 thorax Theart radial > Gardiar Dot Engine › localizer cine_trufi_radial_retro 00:08 › morphology realtime - function cine trufi cine truff_rt_10sl trig 00:18 frequency scout cine flash cine_trufi_it_non_trig 00:04 tagging Unrestricted 0 Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 prospective triggered SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: XX/XX/XXXX | HOOD/HILS Healthineers Page 3 of 9 Job Aid | Cardiac MR Free Breathing & Arrhythmias Scanning Tips (E-Line & Numaris X) Effective Date: 05/01/2020 | HOOD05162003083161 2. Free Breathing - Best option is Compress Sensing Cine (purchasable option) for free breathing cine. If this option is not available, see below for different free breathing techniques. a. Select cine trufi retro, found under the Siemens Tree > heart > function > cine trufi > cine trufi retro and make the following modifications. i. Increase averages to 6, select the box with three dots > select long term (red circle) ii. Reduce spatial resolution (matrix) 8 55 sec / Manual 2 @ 1.8x1.8×6.0 mm 2.45 Routine Contras Resolution Geometry System Physio Inline Sequence Averaging Details Slice Group FoV Read 400 mm Slices FoV Phase 80.4 % Averaging Mode Long Term Slice Thickness 6.0 mm Distance Factor 20.00 ¢ % TR 38.64 - ms Position L44.9 A2.7 F0.7 TE 1.36 + ms Orientation T > C14.6 > S-11.3 ... Averages Phase Encoding Dir. A>> P Concatenations Close Phase Oversampling O % AutoAlign Coil Elements BY1-3;SP1-4 iii. Increase segments (red square), temporal resolution needs to stay below 50ms (red arrow) Routine Contrast Resolution Geometry System Physio Inline Sequence Cardiac PACE 1st Signal/Mode ECG/Retro Average Cycle No Signal ms 0.8 1.6 4[s] Concatenations Calculated Phases 25 + TR 38.64 ¢ ms Arrhythmia Detection None Segments 16 Segments. 12 16 51 iv. This is a segmented technique, does not work well for arrhythmia patients. v. Select Apply/Go to start sequence (around 40-50 secs per slice, free breathing). Unrestricted 0 Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: XX/XX/XXXX | HOOD/HILS Healthineers Page 4 of 9 Job Aid | Cardiac MR Free Breathing & Arrhythmias Scanning Tips (E-Line & Numaris X) Effective Date: 05/01/2020 | HOOD05162003083161 Flow (Phase Contrast): The goal is to measure blood flow velocity and provide quantification of blood flow. 1. Arrhythmia- depending on the type of arrhythmia different strategies are available, see below for different strategies. Use through plane flow sequences for quantification. heart + Cardiac Dot Engine localizer + morphology kifunction + dynamic + tissue characterzation + MyoMaps TOW Throughplane Inplane a. Minor Arrhythmia – Use retrospective flow (red square) with arrhythmia rejection, select Arrhythmia Detection (Physio Tab) > By Time (Trigger Window 200ms) flow_150_tp_retro_bh flow_150_tp_prosp_bh % flow_150_tp_retro_fb i. Increase segments (Physio Tab) to decrease breath hold. ii. After selecting captured cycle, evaluate the Target RR value which should be the average of highest and lowest value of the variable R-R period. Unrestricted 0 Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: XX/XX/XXXX | HOOD/HILS Healthineers Page 5 of 9 Job Aid | Cardiac MR Free Breathing & Arrhythmias Scanning Tips (E-Line & Numaris X) Effective Date: 05/01/2020 | HOOD05162003083161 b. Extreme Arrhythmia – Use prospective flow (red square), set window shorter than the shortest r-r interval (capture cycle). Usually not entire cardiac cycle image. flow_150_tp_retro_bh flow_150_tp_prosp_bh flow_150_tp_retro_fb 2. Free Breathing - Use Retro_fb sequence which uses multi averaging to average out motion from breathing a. Select Siemens Tree > heart > flow > throu plane > Flow retro fb (fb + free breathing) flow_150_tp_retro_bh flow_150_tp_prosp_bh flow_150_tp_retro_fb Unrestricted 0 Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: XX/XX/XXXX | HOOD/HILS Healthineers Page 6 of 9 Job Aid | Cardiac MR Free Breathing & Arrhythmias Scanning Tips (E-Line & Numaris X) Effective Date: 05/01/2020 | HOOD05162003083161 Dynamic: The goal is visualization of first pass of contrast agent contrast. It uses a gradient echo single shot technique.** 1. Arrhythmia - Single shot techniques are great choice for variable heart beats. Usually arrhythmias not an issue for dynamic imaging. a. Found under Siemens > heart > dynamic > tfl sr dynamic dynamic_(l_sr_epal 01:00 tfl si dynamic_Url_sr_tpat 00:32 > tissue characterization >MyoMaps mr-interval < 600 ms > flow dynamic_tfl_sr_epal_6sl_2concats 00:53 2. Free Breathing - Single shot techniques are great choice for free breathing. Dynamic scan available in E line and Numaris X with motion correction a. Found under Siemens > heart > dynamic > tfl sr i. Motion correction available , Inline Tab > Subtraction > Motion Correction (red circle) Revise Convasa Resolvien System Playsio hice Sequence Subtractos Cardic MP Composing Measurements 50 Medion Conection Advanced Sere Original lnuages v ** A licensed physician may choose to use FDA-approved contrast agents in conjunction with an MRI exam, based on his/her medical opinion and discretion and in accordance with the instructions for use and indications for use supplied by the pharmaceutical manufacturer for the contrast agents Unrestricted 0 Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: XX/XX/XXXX | HOOD/HILS Healthineers Page 7 of 9 Job Aid | Cardiac MR Free Breathing & Arrhythmias Scanning Tips (E-Line & Numaris X) Effective Date: 05/01/2020 | HOOD05162003083161 Delayed Enhancement (Viability): The goal is to evaluate ischemic and non-ischemic heart diseases after contrast injection. ** 1. Arrhythmia - Single shot techniques are great choice for variable heart beats. a. Found under Siemens > heart > tissue characterization > trufi ir i. Two options available PSIR or Magnitude only ii. This option can be performed as a breath hold or free breathing 2d single-shot bh de_trufi_overview_10sl_psir 00:31 de trufi overview_10sl_mag 00:31 2d single-shot moco tb de_trufi_high-res_psir_fb 00:20 de_trufi_overview_8sl_psir_fb 01:31 2. Free Breathing - Single shot techniques are great choice for free breathing. b. Found under Siemens > heart > tissue characterization > trufi ir i. New single shot sequence available with motion correction (only in Numaris x)  Note: Does not work well with arrhythmia, due to multiple averages ii. For E Line/Numaris X software free breathing, use 2d single shot trufi (red arrow) 2d single-shot bh de_trufi overview 10sl_psir 00:31 de trufi overview 10sl mag 00:31 2d single-shot moco fb de trufi_high-res_psir tb 00:20 de trufi overview 8sl psir fb 01:31 ** A licensed physician may choose to use FDA-approved contrast agents in conjunction with an MRI exam, based on his/her medical opinion and discretion and in accordance with the instructions for use and indications for use supplied by the pharmaceutical manufacturer for the contrast agents Unrestricted 0 Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: XX/XX/XXXX | HOOD/HILS Healthineers Page 8 of 9 Job Aid | Cardiac MR Free Breathing & Arrhythmias Scanning Tips (E-Line & Numaris X) Effective Date: 05/01/2020 | HOOD05162003083161 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 0 Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: XX/XX/XXXX | HOOD/HILS Healthineers Page 9 of 9