MR Cardiac Coronary Arteries Imaging (E-line and Numaris X) Step by Step

MR Cardiac Coronary Arteries Imaging (E-line and Numaris X) syngo MR Systems with E-line or Numaris X Software 1. Localizer images acquired in all three planes 2. Perform a 4 Chamber Cine free breathing a. Increase to 3 Averages (Routine Tab) and use 40-60 Phases (Physio Tab) 3. Select whole heart angiography sequence a. Found under the Siemens Tree > heart > angiography > free breathing 3d b. Select whole heart > fl3d t2prep nav whole heart or whole heart > trufi_3d_nav_fs_whole heart i. Note: Depending on 1.5T or 3T sequence choice will vary whole heart_ angiography whole heart free breathing 00.19 trufi 3d nav fs fb ipat2 00:19 113:3 1prep nr whole heart trufi_3d_nav_is_whole heart 113d 12prep nav whole heart por 00:19 trufi_3d_nav_is_whole heart ipat2 - 00 19 4. Position slices for whole heart 3d coronary sequence. Be sure to cover entire anatomy (heart), check coverage/position in all three planes (orange box). a. Adjust shim volume (green box) as needed (cover heart) b. Position navigator pulse (blue lines) at the level of the diaphragm (Coronal) and away from anatomy of interest (heart). Check position also in axial plane. 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 | MR Cardiac Coronary Arteries Imaging Effective Date: 05/13/2020 | HOOD 05162003087212 Navigator Positioning Raphragm right left lung lung right left lung diaphragm lung 5. Prior to starting the whole heart 3d coronary sequence, go to Physio Tab and select PACE. Confirm Scout Mode is selected (red circle) a. Select Go/Apply b. Scan time around 20 seconds (only provides a navigator diagram) @ 19 sec Memory O2 0.7x0.7x1.0 mm @ 1.18 Routine Contrast Resolution Geometry System Physio Inline Sequence Signal Cardiac PACE Resp. Control Gate & Follow Scout Mode Tracking Factor 0.60 Scout Duration 19 Chronologic Position Before Echo Scout TR 100 ms RF Pulse Type Crossed Pair Accept Window + 2.5 mm Resp. Motion Adaptation Accept Position (green) 128.0 mm Search Window + 45.0 mm Concatenations Search Position (red) 128.0 - mm 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 8 Job Aid | MR Cardiac Coronary Arteries Imaging Effective Date: 05/13/2020 | HOOD 05162003087212 6. In the MR View&Go (or Viewing Tab), review navigator diagram for diaphragm position. a. Mode (red circle) provides the position of the diaphragm at max expiration (no motion). Navigator Diagram Mode 134 Ima 240 :220 -200 180 160 134 140 £120 £100 -80 -60 40 8 12 O 7. Review free breathing 4 Chamber Cine images in the MR View&Go (or Viewing Tab). Ideally data acquisition of coronaries should be during resting period of coronary arteries. a. Page thru the 4 chamber cine images to find heart resting period. b. The goal is to find the time when the heart stops moving (rest) and then the time when the heart starts to move again. This is the true diastole time during the cardiac rhythm. c. Find the image at REST (heart) and record the TT Time (e.g. 472 – red box) d. Find the image when the heart STARTS to contract (look for the arterial wall kick next to the RCA) and record the TT Time (e.g. 567 – red box) 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 3 of 8 Job Aid | MR Cardiac Coronary Arteries Imaging Effective Date: 05/13/2020 | HOOD 05162003087212 REST START Cine_Segmented LA Cine Hi Res_4CHtitest 2:53:25 PM 48 IMA 1 FRM 36/50 48 IMA 1 FRM 4369 RF RP TT 472.5 TR 17.9 TE 1.0 TA 29,71 SW 12025 BW 1202 0 P2 MAGN/CINE/REFRONNORM/FM4 2/EIL/DI52D e. Subtract the two times 567 – 472 = 95 (data window duration needs to be less than 95ms = Readout time) 8. Repeat and Open sequence (whole heart 3d coronary). a. Go to Physio > PACE and remove Scout Mode b. Under search position (red box), enter diaphragm position number (from whole heart 3d Coronary Scout Navigator Diagram – Example 134) i. Once 134 is entered under search position, accept position (red arrow) will update with the same number. @ 3:10 min Memory 22 2 @0.7x0.7x1.0 mm @ 1.18 Routine Contrast Resolution Geometry System Physio Infine Sequence Signal Cardiac PACE Resp Control Gate & Follow Scout ModeII Tracking Factor 0.60 ¢ Scout Duration 19 Chronologie Position Before Echo Scout TR 100 - ms RF Pulse Type Crossed Pali Accept Window 1 2.5 % mm Resp. Motion Adaptation Accept Position (green) 140.0 - mm Search Window + 45.0 - mm Concatenations Search Position (red) 140.0 - mm The desired center position of the navigator search window, inside of which the edge of the moving object can be found. 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 8 Job Aid | MR Cardiac Coronary Arteries Imaging Effective Date: 05/13/2020 | HOOD 05162003087212 9. Go to the Physio Tab > Signal and select Capture Cycle (Red circle) & 4:16 min Auto 02 @0.7x0,7x1.2 mm 1,00 Routine Contrast Resolution Geometry System Physio Inline Sequence Signal Cardiac PACE 1st Signal/Mode: ECG/Trigger Average Cuclo- 87042 ms Captured Cycle -not set- Acquis TUDU ms 0.8 16 4[s] Trigger Pulse Concatenations Trigger Delay 330 - ms Phases TR 229.50 + ms Segments 23 10. Place mouse over trigger delay, a tool tip box (red arrow) will open showing data window duration and data window start. a. Adjust segments in order to get data window duration under 95ms (example given using 4 chamber cine resting period). i. Data Window Duration is the acquisition time of the readout. This number will need to be less than the resting period time based on 4 chamber cine free breathing (rest/start times) b. Adjust Trigger Delay in order for data window start time to be at the time when the heart is at rest or after (example given 472). c. Data Window Start (472ms) plus the Data Window Duration (81ms) needs to be less than the time when the heart starts to move again (567ms). In this example 472(window start time) + 81 (Window duration time) = 553. Acquisition/Readout finishes before heart start to move again (eliminating cardiac motion) d. After adjustment to data window start/duration, do not select capture cycle 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 8 Job Aid | MR Cardiac Coronary Arteries Imaging Effective Date: 05/13/2020 | HOOD 05162003087212 Routine Contrast Resolution Geometry System Physio Inline Sequence Signal Cardiac PACE 1st Signal/Mode ECG/Trigger Average Cycle 670 + 2 ms Captured Cycle -not set- Acquisition Window 1050 + ms 0.8 6 4[s] Trigger Pulse 1 Concatenations Trigger Delay 330 + ms Data window duration: 81 ms Data window start: 472 ms Phases TR 229.50 ¢ ms Segments 23 + 11. Advise patient not to move or fall sleep, as this will change the breathing pattern. a. Sequence (whole heart 3d Coronary) actual scanning time should be around 8-14 minutes depending on coverage and spatial resolution. 12. Select Go/Apply to start sequence a. Inline display will provide the acceptance percentage in real time. i. Goal is to have accept percentage (red circle) between 30-45% ii. Too high acceptance percentage images will have motion iii. Too low acceptance percentage increases scanning time. Mode 134 Ima Accept 46% :240 98. =200 ៛180 F160 1341 E140 E120 E100 -80 -40 O 4 8 12 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 8 Job Aid | MR Cardiac Coronary Arteries Imaging Effective Date: 05/13/2020 | HOOD 05162003087212 13. Load images into 3D to create MIP/ThinMIP and/or MPR/Curve MPR From: McNeal GR. Whole Heart MRI - Adopting the CT Approach, Magnetom Flash 1, 2006 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 8 Job Aid | MR Cardiac Coronary Arteries Imaging Effective Date: 05/13/2020 | HOOD 05162003087212 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. 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