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MR Elastography - Numaris XA31 Job Aid

This Job Aid reviews workflow to perform Elastography at the beginning or end of a routine Liver examination.

MR Elastography – Numaris X Job Aid MR Elastography – Numaris X Elastography can be performed at the beginning or end of a routine liver examination, depend- ing on the facility’s preference. The patient should be NPO 4-6 hours prior to the exam. 1. Active Driver (Located in Equipment Room) a. Active Driver > Turn On – black rocker switch, back of unit i. Numaris XA30-XA31 MR Systems– if Active Driver is Turned-On it Wakes-up automatically as soon as an MRE Exam is started • Access-i Router (Optional Purchase) must be installed for Auto Wakeup to occur. If ... not purchased it behaves like Numaris XA20 RESOUNDANT Systems ii. Numaris XA20 MR Systems – if Active Driver is Turned-On it goes into Sleep Mode after approxi- mately 1 hour of inactivity • Power Cycle – Turn Active Driver Off/On again to Wake-up 2. Position Patient for Abdomen Examination a. Position Patient > Head-First > Supine b. Place Black Velcro Band on Patient Table > Position Middle of Liver 3. Position Paddle (Passive Driver) on Patients Upper-Right Abdomen a. Passive Driver Paddle Tubing – position tubing through back of magnet along mag- net tunnel (or front, depends on scan room configuration) b. Attach Tubing to Passive Driver Paddle c. Position 1/3 of Paddle above level of Xyphoid on Patients Right Lateral Rib Cage d. Secure Paddle using Black Velcro Band (e.g., Belt should be as tight as possible without causing discomfort or breathing difficulty) Unrestricted 0 Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 09/24/2021 | HOOD05162003226717 Healthineers Job Aid | MR Elastography – Numaris X Job Aid Effective Date: 09/24/2021 | HOOD05162003226717 4. Explain Breathing Instructions to Patient a. Elastography is performed End Expiration b. Notify patient they will feel vibration coming from the paddle. 5. Position Coil (e.g., Body Array/Body Matrix Body 12 or 18) on patient 6. Register Patient for Exam (e.g., MR Abdomen Dot, MR Elastography) 7. Dot Cockpit a. Default > Default Add-ins > Elastography i. New Add-in was added to Elastography protocols (≥XA30 software) with the purchase of the Access-i Router • Access-i Router (Optional Purchase) must be installed for access to the Add-in and Auto Wakeup to occur. If not purchased the Add-in isn’t available. 8. MR Elastography Protocols (e.g., XA30 and XA31) a. Abdomen > Library > Elastography (e.g., protocols vary depending on software level). i. greMRE – Original standard MRE ii. ep2d_se_MRE – based on Single-shot SE Echo Planar Imaging (EPI) • Multiple slices in a single breath-hold • More robust against signal dephasing effects, especially at 3T iii. Rapid MRE (greMRE only) • Reduces acquisition and breath-hold times • Rapid MRE is activated by reducing TR time iv. Fractional MRE (greMRE and ep2d_se_mre) • Only for patients with short T2* relaxation times whose resulting liver signal is too low • Fractional MRE (fixed 65%) is automatically activated by reducing TE time to a minimum value (range below gray area, as shown below) SIEMENS epiMRE_tra_p2_bh_4slc 00:13 16.58 Elastography TE 16.58 45.00 ms @ elasto epiMRE_tra_p2_bh_4slc_fract 00:13 Elastography breast greMRE_tra_p2_mbh_128_4slc_rapid 02:19 abdomen [5] Elastography Abdomen Dot Engine greMRE_tra_p2_mbh_128_4slc fract 02:58 O Angio Dot Engine Elastography greMRE_tra_p2_mbh_128_4slc 02:52 clinical libraries Elastography library [5] localizer T1 T2 3D diffusion BLADE dynamic Maplt LiverLab Elastography [5] Unrestricted 0 Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 09/24/2021 | HOOD05162003226717 Healthineers Page 2 of 7 Job Aid | MR Elastography – Numaris X Job Aid Effective Date: 09/24/2021 | HOOD05162003226717 9. Exam UI> Patient View > Elastography a. Amplitude – Adjust Driver Amplitude depending on patient’s size (default value of 40-50% should work in most circumstances) i. Systems with Access-i Router (Optional Purchase) – with Elastography Add-in, when Amplitude is adjusted the Driver is also updated • Important Note – Access-i Router option is only available for XA30/XA31 systems • Important Note – Resoundant Profile Amplitude adjustment is only available if network access to the driver can be enabled ii. Systems without Access-i Router – when the Amplitude needs adjusted the Driver must be adjusted on the Resoundant Active Driver page. • Important Note – Resoundant Profile Amplitude adjustment is only available if network access to the driver can be enabled Elastography RESOUNDANT Guidance Profiles Amplitude 50 % Select Profile: 0 Profile 0 Edit Frequency 60.1 Hz Profile Name Profile 0 Frequency HZ 60.00 Amplitude % 20.00 Duration cycles 420 Bias V 0.00 Phase Shift deg 0.00 Inverted Waveform Not Inverted Waveform Type Sine The Last Profile Sent was 0 The Sine Wave has been downloaded to the system. Trigger 10. Exam UI > Patient View > Guidance – Passive Driver and Slice positioning Guidance a. Passive Driver Position i. Typically placed along right midclavicular line at the level of the xiphoid b. Slice Position i. Plan Slices through center of liver at end expiration lastography Guidance (1) The passive driver is typically placed along the right midclavicular line at the level of the xiphoid. (2) Plan slices through center of liver. (1) passive driver position (2) slice position Unrestricted 0 Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 09/24/2021 | HOOD05162003226717 Healthineers Page 3 of 7 Job Aid | MR Elastography – Numaris X Job Aid Effective Date: 09/24/2021 | HOOD05162003226717 11. Run Localizer a. Breath hold Command > End Expiration 12. MR Elastography Sequence a. Position Slices – Mid Liver b. Patient Instructions i. Paddle vibration will be felt again ii. Breath-hold Command > End Expiration c. Select GO – runs sequence H Abdomen Test Abdomen Test Abdomen Test 2021.05.10-19:34 :58-DST-1.3.12.2.1107.5.99.3 2021.05.10-19:34:58-DST-1.3.12.2.1107.5.99.3 2021:05:10-19:34:58-DST-1.3.12.2.1107:5:99:3 1 IMA 1 FRM 2/18 1 IMA 1 FRM 12/18 1 IMA 2 FRM 4/5 R 10cm 10cm 10cm L A TP 0 TP 0 TP O SP R28.0 SP A33.0 SP H32.5 FoV 430*430 FoV 430*430 FoV 430*430 p2 MAGNINORM/DIS2D Sag>Tra(3) P2 MAGN/NORM/DIS2D Cor Tra localizer_6h 336 336 p2 MAGN/NORM/DIS2D 336 156 localizer_bh W 156 localizer_bh 156 nE nE 13. Elastography Post-Processing a. Open Patient Browser i. Select Patient Study > select View&GO Icon b. MR View&GO i. Locate Stiffness 95% Map • Displayed as “ _StiffC95” Upper-Left Corner • Hint: Series consists of Stiffness Map with a Grid Pattern overlaid ELASTOGRAPHY 0 +1/1/1980, M, 32Y CURRENT 3/8/2012 06/greMRE_tra_p2_bh_128__StiffC95 latest STUDY ID 1 2:40:52 PM 18 IMA 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: 09/24/2021 | HOOD05162003226717 Healthineers Page 4 of 7 Job Aid | MR Elastography – Numaris X Job Aid Effective Date: 09/24/2021 | HOOD05162003226717 c. Select Free-hand ROI or Circle ROI – Upper-Right-Corner i. Free-hand ROI Preferred to include as much of the Liver area as possible • Alternately multiple circular ROIs can be used ii. Reported measurement is an average of all ROIs drawn over all slices ac- quired Edit Comment Distance Line RC7 /DEF091084 Rol Circle O ROI Circle ROI Freehand ROI Auto Contour Angle Text T d. Draw ROI in Liver Tissue Only i. Caution: Don’t draw Free-hand ROI or Circle ROI in Grid Area e.g., don’t include any of the Grid as it will corrupt the measurement • Min / Max: 522.00 /879.00 Mean/SD: 684.28 /91.59 Area: 5.10 cm2 8 Unrestricted 0 Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 09/24/2021 | HOOD05162003226717 Healthineers Page 5 of 7 Job Aid | MR Elastography – Numaris X Job Aid Effective Date: 09/24/2021 | HOOD05162003226717 e. Stiffness in Kilopascals (kPa) = Mean Value divided by 100 i. Example: 684.28/100 = 6.84 kPa Min / Max: 522.00 /879.00 Mean/SD: 684.28 /91.59 Area: 5.10 cm2 Unrestricted 0 Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 09/24/2021 | HOOD05162003226717 Healthineers Page 6 of 7 Job Aid | MR Elastography – Numaris X Job Aid Effective Date: 09/24/2021 | HOOD05162003226717 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: 09/24/2021 | HOOD05162003226717 Healthineers Page 7 of 7