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MR LiverLab - Numaris X

This Job Aid provides workflow steps for an abdominal examination using the MR LiverLab Dot Engine on an MAGNETOM MR System with Numaris X software.

MR LiverLab: Numaris X Job Aid MR LiverLab for MR MAGNETOM Systems with Numaris X Software MR LiverLab is saved within the Siemens Tree under the LiverLab Dot Engine protocol. Routine abdomen sequences can be incorporated within the LiverLab Dot Engine protocol. Requirement – LiverLab must be placed within a Dot Engine in order for it to run properly. Note: Patient should follow the same breath-hold instructions throughout the examination. 1. Position the patient for an Abdominal Examination 2. Register Patient a. Select LiverLab Abdomen Dot Engine Protocol All Programs SIEMENS › head c-spine + t-spine ... >> Abdomen > Abdomen Dot Engine >> LiverLab Dot Engine I-spine Dot LiverLab ( Basic Patient View > whole-spine V LiverLab neck soft tissue localizer_bh 00:19 > Thorax Onco Auto Coverage Scout t1_vibe_e-dixon_tra_bh_pre 00:14 › heart Generic Views › breas Evaluation yes O Liver Segmentation Abdomen Evaluation Abdomen Dot Engine yes Abdomen Dot Engine Liver Eval CB Evaluation Method multi-echo Dixon HISTO Both Abdomen Dot Engine CB vibe_q-dixon tra bh 00:13 HISTO_bh 00:15 vibe_q-dixon tra bh 00:13 Liver Quantification Liver Quantification Liver Quantification Abdomen Dot Engine TB HISTO bh 00:15 LiverLab Dot Engine Liver Quantification · Angio Dot Engine › clinical libraries library SIEMENS Unrestricted 0 Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Healthineers Job Aid Effective Date: 10/07/2020 | HOOD05162003128291 Job Aid | MR LiverLab – Numaris X Effective Date: 10/07/2020 | HOOD05162003128291 3. Optimize Dot Settings within Patient View before starting Localizer a. Exam Strategy – LiverLab b. Evaluation Method – Both LiverLab ISO ℮ › ›Y + localizer_bh 00:19 2 t1_vibe_e-dixon_tra_bh_pre 00:14 3 % Evaluation yes 4 vibe_q-dixon_tra bh 00:13 5 % HISTO_bh 00:15 01:01 Delete II Skip KI Stop Pause Go Cancel Exam Strategy LiverLab Evaluation Method Both 4. Run Abdomen Localizers  Select GO a. Accepts Patient View Settings and Localizer Auto Starts 5. Run additional Abdomen sequences that are needed prior to LiverLab exam for localization purposes. Unrestricted 0 Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 10/07/2020 | HOOD05162003128291 Healthineers Page 2 of 15 Job Aid | MR LiverLab – Numaris X Effective Date: 10/07/2020 | HOOD05162003128291 6. Open T1_vibe_e-dixon_pre sequence Note: This is an evaluation step so the system can automatically perform liver segmentation. This must be performed or the segmentation will not be done. a. Plan Slice Volume to include Entire Liver i. Auto Coverage is used so it should position very close to anatomy needed. b. Select GO Guidance Parameters XX 7. System performs Liver Sementation and Evaluation 8. Evaluation Step  Open a. Liver segmentation displayed in graphic segments i. Page through images to evaluate segmentation quality ii. Note: Segmentation cannot be adjusted for now. The same segmentation from e-dixon is also used for q-dixon.  If results are poor select e-dixon sequence and repeat and open  Original segmentation is replaced with 2nd result. e-Dixon_W_seg series [showing segmentation) is loaded to GSP Unrestricted 0 Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 10/07/2020 | HOOD05162003128291 Healthineers Page 3 of 15 Job Aid | MR LiverLab – Numaris X Effective Date: 10/07/2020 | HOOD05162003128291 b. System provides Pre-Evaluation Result in Guidance step i. Normal ii. Fat deposition iii. Iron deposition iv. Combined deposition- Both Fat and Iron deposition v. Unclear c. System makes recommendation if futher evaluation is required i. Run Liver Evaluation – Yes ii. Run Liver Evaluation – No Note: The recommendation is to select “Yes“ for a complete evaluaton. Site should follow Radiologist recommendation to determine if further evaluation is required. Guidance Check the liver segmentation as shown in example images. Good segmentation result Bad segmentation result Segmentation Volume 0 4 ml Voxels Sampled Pre-evaluation Result No segmentation data found. Run Liver Evaluation Yes No Unrestricted 0 Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 10/07/2020 | HOOD05162003128291 Healthineers Page 4 of 15 Job Aid | MR LiverLab – Numaris X Effective Date: 10/07/2020 | HOOD05162003128291 9. Open T1 vibe_q-dixon sequence a. Plan Slice Volume – include entire liver and same breath-hold instructions b. Red Region of Interest (ROI) – automatically displayed but can be repositioned i. Reposition ROI:  Left click on ROI and Drag to new location -----------------------(or)--------------------------  Left click on ROI until Curser changes to bullseye a. Next page through images and find area and left click to drop ROI to new location  Note: ROI should not be placed over the gallbladder or a large vessel Check ROI and slice position and adapt if necessary. (position the ROI if needed with a left mouse click) c. Select GO to apply sequence i. Note: Before applying sequence, ensure e-dixon axial image is in an active GSP segment for the HISTO sequence run next Unrestricted 0 Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 10/07/2020 | HOOD05162003128291 Healthineers Page 5 of 15 Job Aid | MR LiverLab – Numaris X Effective Date: 10/07/2020 | HOOD05162003128291 10. HISTO Sequence (Breath-hold Spectroscopy) a. Note: If an e-dixon image is in an active GSP segment, system generates an axial, Sagittal and Coronal non distortion corrected images for planning. Spectroscopy cannot be planned off Distortion Corrected images. b. Open Sequence  voxel placement copied over from q-dixon step. If multiple areas are needed repeat with new voxel placement c. Plan HISTO Voxel Off All 3 Planes i. Axial images – check voxel placement. Location should match what was used for q-dixon ii. Coronal images – page through until VOI box becomes solid so image displayed is inside voxel iii. Sagittal images – page through until VOI box becomes solid so image displayed is inside voxel Guidance Parameters Check voxel position and adapt if necessary. ang Clear All Segments + Shift to Image Plane d. Save images showing voxel placement Group Graphics i. Hold Control Key > select 3 GSP Perpendicular segments Orthogonal ii. Right Click > select “Create Align Parallel Align Fou Snapshot.” Copy Image Position  Creates an MR and PR image ] Find Localizer that can be sent to PACS Ropeat Stop FOV 36 3 Repeat & Open Step Tra>Sa(-41)- MAGNIL Resuts :54 Copy Pammeters- more7 heartbeats Create Snapshot Unrestricted 0 Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 10/07/2020 | HOOD05162003128291 Healthineers Page 6 of 15 Job Aid | MR LiverLab – Numaris X Effective Date: 10/07/2020 | HOOD05162003128291 11. Open Patient Browser  Load sequences into MR View&GO a. e-dixon i. Provides in-phase, opposed phase, fat, and water images ii. Provides Segmentation results for liver and an Evaluation Report 11_vibe_e-dixon tra_bh_pre_opp 11 vibe_e-dixon tra_bh_pre in 11_vibe_e-dixon tra bh_pre_F 11_vibe_e-dixon_tra_bh_pre_W 11_vibe_e-dixon_tra_bh_pre_W_SEG t1_vibe e-dixon tra_bh pre_Report b. q-dixon i. Provides fat and water images ii. Provides Quantitative Report iii. Provides FF, Goodness of Fit, R2s_Eff, T2s_Eff and WF vibe_q-dixon_tra_bh_W vibe_q-dixon_tra_bh_F vibe_q-dixon_tra_bh_Report vibe_q-dixon_tra_bh_FF vibe_q-dixon_tra_bh_GoodnessOfFit vibe_q-dixon_tra_bh_R2s_Eff vibe_q-dixon_tra_bh_T2s_Eff vibe_q-dixon_tra_bh_WF c. HISTO i. Provides a Quantitative Report only HISTO reports Unrestricted 0 Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 10/07/2020 | HOOD05162003128291 Healthineers Page 7 of 15 Job Aid | MR LiverLab – Numaris X Effective Date: 10/07/2020 | HOOD05162003128291 12. View&GO – IQ evaluation a. Evaluate e-dixon 1st i. Evaluate that Dixon images did not swap between water and fat images ii. Did the liver segmentation performed by the system have good quality? iii. Does the segmentation include the entire liver, or does it include more than liver tissues?  Note #1: the segmentation cannot be altered, but if the segmenta- tion is not optimal then the q-dixon results will be inaccurate.  Note #2: If the results are not good repeat and open e-dixon to see if it improves "Fat" Segmentation Error - Different breath hold states than e-Dixon "Water" Global Fat/Water Swap Unrestricted 0 Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 10/07/2020 | HOOD05162003128291 Healthineers Page 8 of 15 Job Aid | MR LiverLab – Numaris X Effective Date: 10/07/2020 | HOOD05162003128291 b. Evaluate q-dixon 2nd i. Evaluate that dixon images did not swap between water and fat images. ii. Is the segmentation value close to the ROI value?  Note: If the segmentation is not good ROI results will still be valid iii. Report Evaluation  Top Color Bar – represents Fat Signal Percentage  Bottom Color Bar – represents R2* (iron value)  Each Color Bar – has an ROI value % and Segmentation Volume s^-1 32 IMA 1 / 2 voxels mean fit error ROI 58 4% Segmentation Volume 66870 2.4% ROI A 0% Fat signal percentage 80% m mean sto ROI 0.7% 0.6% Segmentation Volume 61.0% 16.6% Segmentation ROI R2 4005^-1 mean ROI 35.35^-1 2.65^-1 MF 1.00 Sanmentation Volume 34.1s^-1 14.25^-1 512 512 Note: R2* = 1/T2* and is in units of seconds to the inverse of 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: 10/07/2020 | HOOD05162003128291 Healthineers Page 9 of 15 Job Aid | MR LiverLab – Numaris X Effective Date: 10/07/2020 | HOOD05162003128291 13. Poor Liver Segmentation leads to poor results for segmented volume a. ROI will still have good results with proper placement ROI 0% Fat sinent percentage 60% mean std ROI 0.7% 0.6% Segmentation Volume 61.0% 46.6% Segmentation ROI OS^-1 R2* 400$^- mean std ROI 35.35^-1 2.65-1 1.00 Segmentation Volume 34.15^-1 14.254-1 14.Dixon Fat Water Swaps can create invalid results Unusually high fat signal percentage. Check for fat/water swaps. Run HISTO for comparison. 0% Fat signal percentage 60% mean std ROI 99.3% 0.6% Segmentation Volume 98.4% 4.5% F 1.20 MF 1.20 R 15.6 TR 158 E 2.4 TP F2 TE 2.4 A:10.17 TA 18.17 EVV 1080 0 SP H52.4 SL 3.5 BWV 1080.0 64 DIXON WATER/NORM/DIS2D oY 281:340 p4 DIXON FAT/NICRM.DIS2D 2084320 | FOY 2012 FO1-3,5 Tra 241 /DIXF 113:16 / 4 W 294 BO1-3; '1346 /4 Water Image that is swapped Fat Image that is swapped Unrestricted 0 Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 10/07/2020 | HOOD05162003128291 Healthineers Page 10 of 15 Job Aid | MR LiverLab – Numaris X Effective Date: 10/07/2020 | HOOD05162003128291 15. Goodness of Fit Map – Evaluation a. Image shows segmentation and ROI used b. Image Text Comment lower part of image – “Gray value 1 equals 0.1%” i. Draw ROI over liver to get Mean Value ii. Mean Value multiplied by 0.1= Goodness of Fit  Example: ROI Mean Value 31.07 multiplied by factor 0.1= 3.1% Goodness of Fit iii. Goodness of Fit should be 5 % or less  Note: smaller value, more precise result. Isan indication of the fit- ting residual errors. 16. R2* Map – Evaluation a. Image Text Comment lower part of image – “Gray value 1 equal 1.0(s^-1)” i. Draw ROI over liver to get Mean Value ii. Mean Value multiplied by 1= R2* in units sec^-1  Example: ROI Mean value 39 multiplied by factor of 1= 39 sec^-1 R2* KO MIN/ Max 25 00 53 458, 36.00 10 Unrestricted 0 Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 10/07/2020 | HOOD05162003128291 Healthineers Page 11 of 15 Job Aid | MR LiverLab – Numaris X Effective Date: 10/07/2020 | HOOD05162003128291 17. T2* Map – Evaluation a. Image Text Comment lower part of image – “Gray value 1 equal 0.1ms” i. Draw ROI over liver to get Mean Value ii. Mean Value multiplied by 0.1 = T2* in units ms  Example: ROI Mean value 244.71 multiplied by factor of .1= 24.471 ms T2* Mes7/50 344 71 /21 69 LAres 1 15 cm2 18. Fat Fraction and Water Fraction Map – Evaluation a. Image Text Comment lower part of image – “Gray value 1 equal 0.1%” i. Draw ROI over liver to get Mean Value ii. Mean Value multiplied by 0.1= either FF or WF in a percent  Example: ROI Mean value 27.7 multiplied by factor of 0.1= 2.7% Fat Fraction Min/Max: 0 /153 Mean/SD: 27.7 /39.1 3.15 sq.cm Pixel: 61 16 80.0 CONIND/FAT_FRACTION FoV 31 ;SP3,4 9ml multihance Gray value 1 equals 0.1% Unrestricted 0 Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 10/07/2020 | HOOD05162003128291 Healthineers Page 12 of 15 Job Aid | MR LiverLab – Numaris X Effective Date: 10/07/2020 | HOOD05162003128291  Example: ROI Mean value 116.2 multiplied by factor of 0.1= 11.6% Water Fraction  Hint: Example shows that multiple ROI’s can be drawn for different areas Min / Max 121 00 /195.00 Area 2 52 cm2 Min / Max 78:00 /148:00 Nean/SD. 118:20 /17 80 Area 1:22 cm2 Gray value 1 equals 0.1% 19. HISTO Results a. Displays: i. Top Color Bar – represents Fat Percentage ii. Bottom Color Bar – represents R2 value for Water (Iron Evaluation) iii. Both Fat and Water on ppm scale are T2 corrected b. Sequence – Spin Echo based Single Voxel Spectroscopy using 5 different echoes c. Color Bar Map i. Fat shown at top in a unit of percent (%) ii. R2 Water (for Iron) shown at bottom in a unit of sec^-1 (seconds inverted over 1) iii. Fit Value= rsq fit “R-Squared”  Note: Value should be as close to 1 as possible preferably >.95  Example: Fat has a 2.2% value and R2 water has a 27.6 s^-1 value Voxel 0% Fat signal percentage 60% value Voxel rsq. fit 2.2% 0.69 Voxel 10s-1 R2 water 30s-1 35s-1 45 60s-1 value rsq. fit Voxel 27.6s-1 1.00 Unrestricted 0 Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 10/07/2020 | HOOD05162003128291 Healthineers Page 13 of 15 Job Aid | MR LiverLab – Numaris X Effective Date: 10/07/2020 | HOOD05162003128291 20. Quality Step for HISTO sequence a. Top shows Fat Peak at 1.3ppm and Water peak at 4.7ppm on the x axis. Both Water and Fat Peaks should be easily resolved. b. Bottom shows Curves for both Fat and Water with T2 correction TE - 12 ms Aera MREI Water 5.0 4.7 ppm 0.0 Fat 5.0 1.3ppm 10.0 Crem Shirt(pon Si.ta.u.) -0.0 14.1 5.0 - 0.0- 5.0 - 0.0 TE (me) 0.0 25.0 50.0 75.0 100.0 21. PACS – Image Archiving a. Send e-dixon, q-dixon and HISTO results to PACS i. Note: With Numaris X Software there is no need to do an RGB conversion b. When drawing ROI’s on the PACS system, confirm results have the same values as those drawn on the MR system i. Note: If the Dixon has a fat/water swap the q-dixon results will note an unusually high fat signal percentage. If this happens, refer to the HISTO sequence for best results for fat quantification 22. Study Complete – select “Save and Pause” to save any user results Save and Pause Unrestricted 0 Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 10/07/2020 | HOOD05162003128291 Healthineers Page 14 of 15 Job Aid | MR LiverLab – Numaris X Effective Date: 10/07/2020 | HOOD05162003128291 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: 10/07/2020 | HOOD05162003128291 Healthineers Page 15 of 15