MR Elastography - Eline

MR Elastography – E-Line Job Aid MR Elastography – E-line Elastography can be performed at the beginning or end of a routine liver examination, depend- ing on the facilities 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 – back rocker switch, back of unit i. If Active Driver is Turned-On it goes into Sleep Mode after approximately 1 hour of inactivity. ii. Power Cycle – Turn Active Driver Off/On again to ESOUNDANT ... 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 Paddle above level of Xyphoid on Patients Right Lateral Rib Cage i. Secure Paddle using Black Velcro Band • Belt should be as tight as possible without causing discomfort or breathing difficulty • Paddle should have good contact with Upper Abdomen and Flat Against the Body Surface Unrestricted Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 11/15/2021 | HOOD05162003234230 Healthineers Job Aid | MR Elastography – Eline Effective Date: 11/15/2021 | HOOD05162003234230 4. Explain Breathing Instructions to Patient a. Elastography is performed at End of Expiration b. Notify patient they will feel vibration coming from Paddle 5. Position Body Array Coil on Patient 6. Register Patient for MR Abdomen Dot or MR Elastography Exam 7. Run Localizer a. Breath-hold Command > End Expiration b. Select Apply 8. MR Elastography Sequence (greMRE) a. Position Slices – Mid Liver Patient Applications Transfer Edit Queue Protocol View Image Tools Evaluation Scroll System Add-On Options Help H Y YY.V. V.Y XXXXX A 3,WMA 8 / 15 XXXXXX 2 1MA 14 314/201 3/4/2016 0-0-0- -O- R SP410cm SP410cm BO3 BO3 P2 M/NORM/DIS2D TPO haste_localizer v 465-9.9 92 M/NORM/DIS2D SP P6.0 ag> Tra(3.0) haste_localizer FoV 400*400 p2 M/NORM/DIS2D Cor t1_f12d_opp in_tra_p2_bh b. Patient Instructions i. Paddle vibration will be felt again ii. Breath-hold Command > End Expiration c. Select Apply – initates measurement i. Inline Display Opens • Deliver Breath-hold Commands • Click Scan Breath-hold Icon a. Starts Measurement Unrestricted 0 Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 11/15/2021 | HOOD05162003234230 Healthineers Page 2 of 6 Job Aid | MR Elastography – Eline Effective Date: 11/15/2021 | HOOD05162003234230 9. Elastography Post-Processing – Viewing Task Card a. Open Patient Browser i. Select Patient Study > select Load to Viewing Icon b. 4 Series Loaded i. Magnitude Image ii. Relative Stiffness Map (Elastogram) iii. Relative Stiffness 95% Confidence Map (Grid Pattern) overlaid iv. Wave Image Magnitude Image Relative Stiffness Map Relative Stiffness 95% Confidence Map Wave Image Unrestricted 0 Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 11/15/2021 | HOOD05162003234230 Healthineers Page 3 of 6 Job Aid | MR Elastography – Eline Effective Date: 11/15/2021 | HOOD05162003234230 c. Magnitude Images – Check for Image Quality i. Check Breath-hold Quality ii. Check Liver Signal Quality • Is Liver very dark? • Is there a lot of lung, but not much liver tissue? • Note: If image quality is sub-optimal repeat slice with corrections to patient breathing and/or slice positioning b. Wave Images – Loop through images i. Check for clean propagating wavefronts from the body surface inward ii. Correlate disorganized waves with potential artifacts in the Elastogram d. Relative Stiffness 95% Confidence Map – Locate iii. Select Tools Subtask Card • Select Freehand ROI (or) Circle ROI • Free-hand ROI Preferred to include as much of the Liver are as possi- ble • Alternately multiple circular ROI’s can be used • Reported measurement is an average of all ROI’s drawn over all slices acquired • Draw ROI in Liver Tissue Only • Caution: Don’t draw Free-hand ROI or Circle ROI in Grid Area i. e.g., Don’t include any of the Grid as it will corrupt the measurement • ROI should NOT include – non-Hepatic tissue (or) Blood Vessels i. Stiffness in Kilopascals (kPA) = Mean Value divided by 100 • Example: 150.6/100 = 1.5 kPa Tools Image View 1 Min/Max: 0/315 Mean 9 350.6 /37 Pixel: 3095 10cr 1.00 18 TP H10 Unrestricted 0 Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 11/15/2021 | HOOD05162003234230 Healthineers Page 4 of 6 Job Aid | MR Elastography – Eline Effective Date: 11/15/2021 | HOOD05162003234230 10. MR Elastography Protocols a. Abdomen > Library > Elastography (e.g., protocols vary depending on software) i. epiMRE_tra_p2_bh_4slc – Standard EPI MRE sequence for compliant pa- tients • Can acquire multiple slices in a short breath-hold time • Availability depends on software level, but is recommended to use if available ii. greMRE_tra_p2_bh_128 – Standard GRE MRE sequence for compliant pa- tients (Recommend EPI if available) • Can acquire 1 slice per breath-hold iii. greMRE_tra_p2_bh_128_rapid – for noncompliant patients requiring a shorter breath-hold time if GRE only available (Recommend EPI if available) • Reduces acquisition, breath-hold times, and duration • Increases patient comfort and reduces image artifacts due to breath- ing motion • Rapid MRE is activated by reducing the TR time iv. epiMRE_tra_p2_bh_4slc_fract & greMRE_tra_p2_bh_128_fract – Only for patients with short T2* relaxation times whose resulting liver signal is too low (Recommend EPI if available) • Motion-Encoding Gradient (MEG) duration is reduced, reducing en- coding sensitivity • Fractional MRE (fixed 65%) is automatically activated by reducing TE time to a minimum value (range below gray area) SIEMENS SIEMENS > abdomen >> library >> Elastography Q epiMRE_tra_p2_bh_4slc 00:13 abdomen > Abdomen Dot Engine greMRE_tra_p2_bh_128_rapid 00:51 clinical libraries library epiMIRE_tra_p2_bh_4slc_fract 00:13 localizer T1 greMRE_tra_p2_bh_128_fract 01:20 T2 3D greMRE_tra_p2_bh_128 01:20 diffusion BLADE dynamic Maplt Elastography Unrestricted 0 Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 11/15/2021 | HOOD05162003234230 Healthineers Page 5 of 6 Job Aid | MR Elastography – Eline Effective Date: 11/15/2021 | HOOD05162003234230 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: 11/15/2021 | HOOD05162003234230 Healthineers Page 6 of 6