MR Cardiac Lead Placement (B-Line) Job Aid

MR Cardiac Lead Placement (B-Line) syngo MR Systems with B-Line Software 1. Electrode Placement and Preparation: Option 1 Option 2 Option 3 A. Positioning of electrodes can vary depending on the position of the heart B. If necessary shave the location where you want to attach the electrode C. Thoroughly clean the patient’s skin with NUPREP ECG & EEG Abrasive Skin Prepping Gel WEAVER i. Note: Do NOT use alcohol to clean skin as it will Nuprep reduce conductivity D. Dry the skin carefully E. Electrodes should be MRI safe and not expired i. Siemens-Approved electrodes includes the Conmed 2700 Cleartrace only F. ALWAYS place a new electrode if repositioning, and DO NOT reuse after placing on skin 2. Physiologic ECG & Respiratory Unit (PERU) A. Position the PERU in the appropriate support or add absorbent material between the ECG cables, PERU and skin i. Can direct PERU above shoulder our down depending on image area to be scanned as PERU can artifact if in area of interest 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 Lead Placement (B-Line) Effective Date: 05/04/2020 | HOOD05162003086704 B. If the red LED Electrode fault on the PERU flashes, the ECG electrodes are not attached correctly i. Check to ensure that the electrodes are well attached (3) (1) (4) ii. Optional: To help ensure stable skin contact, place a short strip of medical tape over each electrode C. Units are always on and should be placed in charging station when not in use D. A fully charged PERU can usually last for 8 hours of use 3. Checking the Signal A. The ECG signal can be checked via the display 10 on the magnet bore 0586M mm B. To ensure reliable triggering: i. Channel I should show a minimum of 3 stars (asterisk) ii. Channel AVF should show a minimum of at least 2 stars iii. More Stars = Better Signal C. Learning Phase: i. When the patient is in Home position, a learning phase will be conducted so the system can learn and save the ECG I ***** 10 **** A 3 signal pattern identified from a run of 0065 mm 3(10) consecutive heartbeats ii. Make sure patient lies perfectly still during this time iii. After learning phase is complete, drive the patient 300mm beyond Home position to end learning phase cycle. iv. If still between Home and 300mm a new learning phase will be run continuously until patient is moved into bore. 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 5 Job Aid | MR Cardiac Lead Placement (B-Line) Effective Date: 05/04/2020 | HOOD05162003086704 4. Physiological Display A. The Physiological Display dialog window is a window on the GSP B. Each signal track displays one of the physiological signals as a continuous curve, i.e., the ECG I signal, ECG aVF signal, the pulse signal, the respiratory signal, and the external signal C. The trigger information delivered by the PERU is shown as triangles above the signal curve i. Large triangle: Channel is used for triggering ii. Small triangle: Channel is not used for triggering ECGI HF : 60 / min HP : 997 ms D. If you can see good ECG waveforms but there are no trigger pulses: i. Try using a different triggering algorithm or try using the RELEARN VCG function with the patient at isocenter and triggering mode set to VCG Advanced Physiological Display ECG HF 60 / min HP 997 ms ECG aVF HP : 60 / min 997 ms 2nd Track VCG/advanced Statistics Reset Stat No Signal from PPU VCG/standard channel I only channel aVF only MCG/advanced 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 5 Job Aid | MR Cardiac Lead Placement (B-Line) Effective Date: 05/04/2020 | HOOD05162003086704 E. Note: Description of Algorithms i. VCG/Advanced1 (default): This should be used for most exams. Pattern recognition is used to compare the shape and amplitude of the R-wave and T-wave of the 2 ECG signals to similar features obtained during the Learning Phase. If the R-wave and T-wave patterns match closely enough, a trigger pulse is issued. This algorithm features a reduced sensitivity against gradient interference and signal variations caused by the patient’s respiration and elevated T-waves. ii. VCG/Standard (optional): This should be used only if the default algorithm is not working well. Slope detection is used to compare the slopes of the R-waves to those obtained during the Learning Phase. If the R-wave slopes match closely enough, a trigger event is issued. This should optionally be used if the VCG/Advanced1 algorithm is not working. iii. Channel I Only (optional): This should be used only if the default algorithm is not working well. If the R-wave slope of Lead 1 exceeds a preset threshold, a trigger event is issued. Since this is based on a single signal, no information from the Learning Phase is used. This should optionally be used if both VCG algorithms are not working and Lead 1 is the best signal. iv. Channel AVF Only (optional): This should be used only if the default algorithm is not working well. If the R-wave slope of AVF exceeds a preset threshold, a trigger event is issued. Since this is based on a single signal, no information from the Learning Phase is used. This should optionally be used if both VCG algorithms are not working and AVF is the best signal. v. Relearn VCG: This option should only be used if all other options fail. Must reset the triggering algorithm back to the default (VCG/Advanced1) and apply Relearn VCG while the patient is still at isocenter. Although this may resume the missing trigger pulses for the vector-based algorithms (Advanced or Standard), it will have no effect on the single-lead algorithms (Lead 1 or AVF) because no information from the Learning Phase is used on them. Relearn VCG will not work during a scan, so either wait until it finishes or abort the scan before relearning. 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 5 Job Aid | MR Cardiac Lead Placement (B-Line) Effective Date: 05/04/2020 | HOOD05162003086704 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 5 of 5