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MR Breast Positioning for Best Image Quality

This Job Aid, provides information and techniques to position a patient for a MR Breast examination to obtain optimal image quality.

MR Breast Positioning for Best Image Quality Introduction: Improper positioning of the breasts in a dedicated breast coil causes inhomogeneous fat saturation as well as other artifacts. Checking the localizer images and repositioning as necessary, before any diagnostic imaging is key. Use the presented positioning techniques and suggestions, as well as strict attention to detail before imaging. By doing this, it will improve image quality and limit the need for repeat imaging studies. Goals of proper positioning include imaging the maximum area of breast tissue, minimizing skin folds, and achieving homogeneous fat suppression and nondeformed breast tissue. Positioning: 1. Coil Setup: a. Each coil has specific instructions for proper use, see below for examples of design differences SEMENS ... Unrestricted 0 Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 04/29/2020 | HOOD05162003086671 Healthineers Job Aid | MR Breast Positioning Effective Date: 04/29/2020 |HOOD05162003086671 2. Patient Prep: a. Give the patient all instructions prior to beginning positioning b. Provide earplugs, hair-tie or bonnet, etc. c. Trying to get the patient as comfortable as possible now will prevent any added need for repositioning later 3. Patient position on the coil: a. Guide the patient into the coil and center the breasts over the medial coil or center bar b. Adjust headrest for comfort c. Make sure the patient is not rotated on the coil, shoulders are even d. Elevate the hips with additional support as needed to provide a flat back – this will aleveate some pressure from the sternum e. Arms down is typically preferred for comfort and to relax more breast tissue down into the coil i. If the patient will not fit into the bore with arms down, they can go above their head to provide more clearance ii. This in turn will stretch out the upper portion of the breast tissue, additional coverage may need to be added f. Give headphones if they are provided – ask the patient to try not to help or move for the rest of the exam 4. Breast Position in the coil: a. Reaching in with your hands, pull the breast away from the middle to seperate any breast tissue that could be folded in the sternal area b. Clear any abdominal tissue. This can be done with diffrent techniques i. Reach under the patients chest until you can touch the middle coil, then with a “swooping“ motion pull downwards towards the feet ii. If the patient has a sheet under them that could also be used to pull downward Unrestricted 0 Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 04/29/2020 | HOOD05162003086671 Healthineers Page 2 of 6 Job Aid | MR Breast Positioning Effective Date: 04/29/2020 |HOOD05162003086671 iii. By starting with the patient aiming towards the bottom of the coil initialy and pushing themselves upwards into the coil helps to smooth out tissue. (This technique may be difficult for some) c. The bottom of the breast should be about an inch in front of the bottom side of the medial coil / base plate depending on coil design Head End Here in a different coil design, you see poor superior positioning. Lateral view shows the breast positioned too far superiorly in the coil with too much inferior abdominal tissue (arrow). This will result in inhomogeneous fat saturation and a lack of signal in the region of the upper intramammary lymph nodes. Unrestricted 0 Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 04/29/2020 | HOOD05162003086671 Healthineers Page 3 of 6 Job Aid | MR Breast Positioning Effective Date: 04/29/2020 |HOOD05162003086671 d. Check breast position from the lateral, medial, and top-down positions e. Nipple should be in profile if possible f. Ensure no folds g. Repeat the positioning check with the other breast 5. Lateral coil element placement (depending on coil manufacture): a. The height of the coil should be adjusted so that the top is at where breast tissue falls away from the chest wall, start on the larger breast first b. Match the coil height on the other side to ensure even signal and alignment of elements c. Holding the breast with nipple at profile – move the coil in just until the coil touches the fullest portion of the breast. Do Not compress. Acq. 1 Unrestricted 0 Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 04/29/2020 | HOOD05162003086671 Healthineers Page 4 of 6 Job Aid | MR Breast Positioning Effective Date: 04/29/2020 |HOOD05162003086671  Additional hints: For Large Breast, there can be anterior puddling (compression of the anterior breast tissue and flattening of the nipples against the coil). This causes contrast agent flow to be nonuniform. Depending on the radiologist preference you could try:  Placing a pad on the coil underneath the patient’s sternum and lifting the patient up so that the breasts hang freely  Using a sheet sling technique Unrestricted 0 Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 04/29/2020 | HOOD05162003086671 Healthineers Page 5 of 6 Job Aid | MR Breast Positioning Effective Date: 04/29/2020 |HOOD05162003086671 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 Unrestricted 0 Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 04/29/2020 | HOOD05162003086671 Healthineers Page 6 of 6