MR VE11 Software Features

Welcome to this web-based training for customers receiving the new MR VE11 software on the MAGNETOMTM MR Systems.   This training focuses on DotGO and the new features of the Dot Cockpit for protocol management. Additionally, new features of the Exam Task Card, new and modified sequences, new applications, and hardware components will be discussed.         The newest generation of Dot – DotGO – will set new standards in protocol configuration.  DotGo is Siemens’ unique MRI exam software that combines intuitive protocol management (Dot Cockpit) with quality results for each exam (Dot engines).    The Dot Cockpit is a central interface for all protocol management. This replaces the Exam Explorer and enables you to configure all your MRI protocols, whether it is a Dot or a non-Dot protocol. Benefits AutoSearch Drag and Drop Create Exam Strategies with one mouse click Create as many Strategies as needed for a protocol Create and add Decisions Edit protocols instantly Changes made in one sequence can be applied to all protocols                                                      To open the Dot Cockpit - from the Exam Task Card click on the Dot Cockpit icon (1) located on the lower right. If the Program Card icon (2) is shown instead of the Dot Cockpit icon, click the arrow on the left side of the icon. A "split button" (3) appears showing both the Dot Cockpit (4) and Program Card (5) icons. Click the Dot Cockpit icon to open the interface or click the Program Card icon to see the program details. Dot Cockpit offers two main functions: Explorer and Program Editor. 1. Explorer Configure multiple User Trees. Manage customer Regions, Exams and Programs. ​Enables browsing, organization, selection and the drag & drop feature to move a protocol to a new destination. Print the table of contents as well as individual protocols including an overview of parameter settings. Search for measurement programs or protocols during an examination and transfer them directly to the measurement queue. 2. Program Editor Create new measurement programs or modify existing ones. Review complete programs in Simulation Mode (Simulation mode is used to verify new exam programs). NOTE: you cannot perform edit functions in the Explorer.   The structure view (Structogram) displays on one screen all protocols including Strategies, Decisions, Branches, Sequences and Addins so that all steps are visible at once. The structogram is part of the Explorer as well as the Program Editor.   Explorer Browse feature  Type full or partial word search query in search field Highlighted results will display Use  Program Editor to Create new or modify existing measurement programs Review complete programs in simulation mode To access the Program Editor, select the Edit button in the Explorer   Program Editor Tabs: Edit and Simulate   Edit: modify programs and protocols   Simulate: Verify new exam programs; preview the examination to show the program flow with selected strategies and decisions                              To add a new strategy to a program: Drag and drop the strategy from Program Editor side bar New Dot engine created automatically  To rename the strategy: Right mouse click to select Rename from context menu   Organize the protocol tree and directories Open and save programs Delete, Copy, Paste, Undo, and Redo Select the areas of the toolbar to see the location and description of these features There are many new applications and sequences for the VE11 software upgrade. The following pages highlight these features. Provides sequence options to reduce sound pressure for routine neurological and orthopedic examinations with no compromises in image quality. Includes QuietX and PETRA optimized protocols for neurological and orthopedic exams Caution: Always wear adequate hearing protection, even with noise reduced measurements. Performing a noise reduced measurement without adequate hearing protection may temporarily damage hearing. An algorithm for optimizing gradient switching Provides best possible gradient trajectory through intelligent summation of gradients reduction of the slew rate, while maintaining timing parameters in the same range Results include: Significant reduction in acoustic noise Smoother, more pleasant sounds with no impact on image quality and scan time   Pointwise Encoding Time Reduction (PETRA) 3D T1 weighted half-radial pulse sequence Only available for head imaging Protocols based on the Quiet PETRA sequence provide T1 weighted contrast similar to MPRAGE (Magnetization Prepared Rapid Acquisition Gradient Echo) protocol Pulse sequence can barely be heard over ambient background noise when running Protocols location: Siemens tree under Region > Library > QUIET > PETRA Protocols provided for Neurology - Head imaging region only Licenses or Dot Engines that offer SEMAC: Advanced WARP - WARP-SEMAC with TSE Sequences Large Joint Dot Engine Large Joint Dot Engine Upgrade Package  Without SEMAC  With SEMAC Disclaimer: MR imaging of patients with metallic implants brings specific risks. However, certain implants are approved by the governing regulatory bodies to be MR conditionally safe. For such implants, the previously mentioned warning may not be applicable. Please contact the implant manufacturer for the specific conditional information. The conditions for MR safety are the responsibility of the implant manufacturer, not of Siemens. SEMAC is available when the WARP checkbox is activated in the Sequence/Part 2 Parameter Card. Disclaimer: MR imaging of patients with metallic implants brings specific risks. However, certain implants are approved by the governing regulatory bodies to be MR conditionally safe. For such implants, the previously mentioned warning may not be applicable. Please contact the implant manufacturer for the specific conditional information. The conditions for MR safety are the responsibility of the implant manufacturer, not of Siemens. Results of LiverLab – Fat/Iron Evaluation     LiverLab is incorporated into the “Abdomen Dot Engine”  Stages Guided workflow with fully automated processing steps Fully automated segmentation of the liver and estimation of liver volumes Automated calculation of Fat Fraction and R2* color maps Quantification of local fat and iron concentration with HISTO Intuitive visualization of results in a histogram Benefits Detects Liver Deposition Disease (Fat, iron, combined) Monitor early stages of disorders like non-alcoholic fatty liver disease Noninvasive examination     Myocardial Mapping (Cardiac Muscle) Promise of quantitative assessment of tissue parameters Based on system-guided HeartFreeze Inline Motion Correction Generates Comprehensive Pixel-Based Maps T1 Map T2 Map T2* Map The VE11 update provides modification and enhancements of several areas.    Define customized diffusion directions or Diffusion Vector Sets (DVS) Multiple direction sets can be provided in a text file Must comply with a specific syntax each containing at least 6 linearly independent directions Required: careful direction selection to ensure a reliable tensor estimation Recommended: an isotropic distribution of the diffusion directions       Tim Coil Designed to image children up to age 18 months High channel density coil with smaller diameter Increased SNR and Resolution Small FOV for Head and Neck Imaging ​DirectConnect Tim 4G Coil Technology Comfortable cradle for safe transport and preparation for children <5 months old or up to 10 kilograms in weight ​Other Features  Recess in the lower end of the anterior head coil for easier management of respiratory tubes Aperture in upper portion for improved ventilation Head coil = 13 elements Neck coil = 3 elements Head Imaging only – neck elements can be turned off Coil can also be combined with Spine and other Tim 4G coils (e.g., Body, Flex) for whole spine and whole body imaging Disclaimer: MR scanning has not been established as safe for imaging fetuses and infants less than two years of age. The responsible physician must evaluate the benefits of the MR examination compared to those of other imaging procedures.  ​   Value for the accumulated whole body SAR throughout examination Monitored continuously At SED limit, imaging is no longer possible Expressed in Joules per kilogram [units = Joules/kg] SED limits and thresholds SED limit - 14,400 J/kg. Equivalent to a continuous SAR level of 2 W/kg for 2 hours or 4 W/kg for 1 hour. Siemens risk management warning threshold: 6000 J/kg Equivalent to a continuous SAR level of 2 W/kg for 50 minutes or 4 W/kg for 25 minutes Below warning threshold, patients with normal thermal regulation are considered safe Above warning threshold, patient may suffer physiological stress or tissue damage     E  f fects depend on applied SAR and patient's condition Adapt examination duration to the described times for normal and first level modes SED level: reset to zero when new patient registration is initialized   Pop-up message appears if SED limit is exceeded Read message to determine if examination should continue or be aborted                                                                                                         Warning: it is recommended that you stop the examination.  If a decision is made to continue with the exam, the patient must be closely monitored to avoid unacceptable thermal stress.                                    Displays a message when the protocol exceeds Stimulation threshold Validate that patient’s arms and legs are not crossed to minimize peripheral nerve stimulation To start the measurement, select OK Tim TX True Shape with ZOOMit Reveals important anatomical and pathological details Small selective FOV”s – high resolution and/or fast imaging Available with: T2 SPACE for Fast 3D Anatomical imaging EPI BOLD – high resolution fMRI EPI Diffusion – high resolution DWI/DTI with less distortions and blurring artifacts pTX Accelerated Pulse Shorter duration – ability to obtain minimal echo times with increased SNR for zoomed imaging Available on Sequence > pTX Pulses Parameter Card TX Acceleration – activated when Biopolar Diffusion is selected Available on 3T MAGNETOM Skyra with TimTX TrueShape and the 3T MAGNETOM Prisma        Use Drag & Drop from sidebar to add Strategies, Decisions, Interactions Pauses, and Dot Add-ins to sequences Use search tool to add a sequence to a program     Specific Absorption Rate (SAR) – Radio-Frequency (RF) output absorbed per kilo-gram body weight Expressed in Watts per kilogram [W/kg] SAR limits exceeded – system automatically sends a pop-up message indicating the SAR limit is reached VE11 software – SAR information window provides additional information Note: The system no longer automatically selects the “reduce slices” option in the Protocol Parameters area. The user must select one of the options in order for the “OK” button to become active. Protocol Parameters: Reduces slices, Increases TR, Reduces Flip angle. Values displayed are for the current parameters and the system recommended changes   Pulse sequences are available for neurological and orthopedic exams and are located in Exam Database program folders   QuietX Spin Echo (SE) and Turbo Spin Echo (TSE) sequences provide T1 weighted, T2 weighted, and Dark-Fluid contrast.  Enable or disable acoustic noise reduction in Sequence/Part 2 parameter card to toggle between quiet and regular imaging.   QuietX Gradient Echo (GRE): standard sequence provides additional acoustic noise reduction parameter in Sequence/Part 2 parameter card. Protocols based on Quiet Gradient Echo (GRE) sequence; provide T1 weighted   Susceptibility Weighted Imaging (SWI) contrast   Protocols location: Siemens tree under Region > Library > QUIET > PETRA. Available region protocols: Neurology: Head, C-spine, T-spine, L-spine Orthopedic: Shoulder, Hip, Knee and Ankle         Sequence > Part 2 Parameter Card Acoustic noise reduction Always active – triggers quiet adjustments Resolution > Common Parameter Card Phase Partial Fourier – selectable for shorter TE Acoustic noise reduction—always active (triggers quiet adjustments)    Phase Partial Fourier—selectable for a shorter TE     Dot Cockpit > Head >  Library > Quiet > qDWI qDWI                                                                                       EPI Single-Shot Balanced Steady-State Free Precession Acquisition 2D ECG gated –  One axial slice per heartbeat Image contrast is generated using in-plane saturation to suppress background tissue Tracking saturation pulse to suppress venous signal prior to quiescent inflow period                  QISS - 3T                                  CE MRA - 3T           Table Results: myocardial mass available Average Myocardial Mass: calculated over all cardiac phases Standard Deviation Myocardial Mass: standard deviation of the average Myocardial Mass at ED: mass at end-diastole             Segmentation algorithm improved Automatic aortic value detection during image processing using long-axis images Improved endocardial contour detection in the end-systolic phase Improved estimation of end systolic volume, ejection fraction and stroke volumes Improved segmentation for CINE acquisitions post-contrast   Five-minute diagnostic brain exam* MAGNETOM Aera and Skyra systems with 48 Channel or higher Neuro Applications Stroke Hemorrhage Neoplasm Infection Demyelination Post-operative findings *Disclaimer: Achieved on a MAGNETOM Skyra with the Head 32 coil. Total examination time can take up to six minutes depending on system field strength and coil density.         Synonyms SMS = Multi-Band (MB) Slice acceleration factor = SMS = MB Factor Functionality Excitation of multiple slices simultaneously Separation of slices with different coil sensitivities along the slice direction (like PAT) Benefits Faster imaging More slices Shorter TR Improved temporal resolution Higher Spatial Resolution              Simultaneous Multi-Slice (SMS) EPI SMS speeds up imaging Simultaneous excitation and readout of multiple imaging slices Blipped CAIPIRINHA Creates Field-of-View (FoV) shifts of parallel slices in phase encoding direction Minimizes g-factor related to Signal-to-Noise Ratio (SNR) losses during reconstruction of individual imaging slices Sequence options SMS EPI DWI SMS EPI BOLD Note: Optional sequence Accel Mode Accel factor slice SMS only Pat Mode called Acceleration Mode Total Acceleration Factor = iPAT factor x SMS Factor Accel. Factor slice = # of simultaneously measured slices (also called SMS factor) Reduces imaging time High Resolution Diffusion Tensor Imaging (DTI) Routine Diffusion-weighted imaging Benefits Higher spatial resolution Higher diffusion resolution Increased diffusion directions Increased b-values Conventional, p2 TA 34:38 min SMS 4, p2, TA 11:10 min Conventional, b0, b1000, ADC, TA 2:20 SMS 2, b0, b1000, ADC TA 1:21 Increased slice coverage Higher spatial resolution Higher temporal resolution (sampling rate) Improved sensitivity to BOLD signal Better mapping of functional cortices Increased temporal sampling of BOLD signal Detect and correct for physiological signals (respiration) also improved Conventional TR 3000 ms* 90 measurements SMS 4 TR 1000 ms 270 measurements SMS 8* TR 500 ms 540 measurements TE 30, 2 mm iso, 48 slices, TA 4:30 mins * Identical significance thresholds, MAGNETOM Prisma Head/Neck 64 Sequences – se_17rb130 T1 Weighted Head imaging (pre/post) 1.5T and 3T Systems Modified UI - improved SAR control 2 Flip Angles 1st excitation – initial RF pulse 2nd excitation – new refocusing pulse 150° recommended Better control of RF energy Dot Cockpit > Head > Library > T1 > t1_se_17rb130_tra   Recommendations for ZOOMit 2.0 using TX Acceleration: Neuro Imaging: TX acceleration use Bipolar (standard) Decrease TE Body Imaging: TX acceleration is not recommended due to Fat Saturations issues when combining Monopolar with TX acceleration. Body Imaging syngo BLADE – Fast TSE SPAIR @ 3T syngo SPACE – SPAIR improvements 3D HASTE– SPAIR improvements DIXON Contrast > Common Parameter Card  Fat Suppression – SPAIR SPAIR Region Options Default – equivalent to SPAIR on previous software Abdomen & Pelvis Thorax Note: Available at 3T only Available sequences TSE, syngo BLADE, syngo SPACE, HASTE, VIBE, epi_diff         New Region Options for 3T Only—Abdomen & Pelvis and Thorax 1.5T & 3T Systems Frequency of the excitation pulse is shifted in the middle between fat and water Improves residual fat signal (band) bottom of slab To activate Select Geometry > Common > Series > Ascending     Fat Sat Modes Strong – fats signal completely suppressed (black) Weak – residual fat signal visible Improved Fat Suppression   VE11 New Software Weak Strong   PACE; TR = 1600 ms Redesigned pulse sequence for faster, sharper and streak free BLADE imaging, especially in the abdomen Advantages Higher Turbo Factors possible with constant TE Reduced T2-decay effects in neighboring k-space lines Results in broader BLADES Better coverage of k-space (less blur) Reduces star-like artifacts Acquisition time reduced: Fewer blades acquired   TSE Acquisition Pattern                   Fast_TSE Acquisition Pattern Improved reconstruction   Optimized seed-growing algorithms Connect high confidence areas of water or fat signal with neighboring areas Reduces risk of local fat/water swaps                    VE11A               New Software Same (customer) dataset used for both recons  swapping in the kidney removed Water New SPAIR pulse is about 220 Hz broader SPAIR pulse: Default mode SPAIR pulse: Thorax mode SPAIR pulse: Default mode SPAIR pulse: Abdomen and Pelvis mode Water New SPAIR pulse for Abdomen & Pelvis mode is about 120 Hz closer to the water peak New SPAIR pulse is about 220 Hz broader VIBE with Default VIBE with Abdomen & Pelvis   VIBE with Default VIBE with Abdomen & Pelvis   Default Thorax Abdomen & Pelvis Note: The Abdomen & Pelvis mode can lead to water saturation if used in other body regions (especially in the Thorax). Series Mode – Interleaved Series Mode – Ascending Primarily same acquisition parameters Reduced acquisition times fast_tse TF = 43 1:52 minutes Conventional TSE TF = 33 3:00 minutes      Conventional TSE Fast TSE                    syngo BLADE with fast_tse     syngo BLADE - Conventional Siemens > Abdomen > Library > BLADE Image labeling – fBLADE Siemens > Thorax > library > T2 Image labeling – ftse Drawbacks Higher SAR than TSE Different slice profile Don’t use for Neuro, and MSK Narrow slice imaging Not available for QuietX, WARP, 3D and reduced EC sensitivity   Security Levels & Features User Login Security License & SECURITY_USER Password Lockout Policy & Requirements User Protocol Tree User Trees Password Protection Locking and Unlocking User Trees Lock and unlocking User tree locations Locked User Tree Changing and removing password Protection syngo Security: Three Levels   1. Hardened syngo MR Software VE11: All customers   2. Enhanced: Optional security package (purchasable option) Flexible configuration Assign different user roles to person (e.g., Technologists, Radiologists, administrator) Role: assigned to a user, allows access to specific execution rights or privileges (e.g., only lead tech can send, correct, delete patient data and modify protocols) 3. Department of Defense: Security features Special installation steps for US military only   syngo Security – Customer Protocol Protection Write protection of protocol trees: all customers and security levels Now available for user login and user protocol trees User Login Password Requirements User Protocol Tree Locking and Unlocking User Trees Locking and Unlocking User Trees - Multiple Locations Changing or Removing Password Protection   syngo Security license – SECURITY_USER  Required to change password complexity rules Password Lockout Policy After three incorrect logon attempts, user account is locked Rule also applies to administrative account All Users are locked, syngo software must be restored by service      Enhanced syngo Security Login   Two uppercase letters  Minimum: 14 characters Maximum: 20 characters ​Cannot contain username User can only change new password after 24 hours System remembers up to 24 passwords     Two lowercase letters                                                                   Two numerals NOTE: users' and security administrators' accounts are  locked after three incorrect login attempts. If all users are locked, the syngo software must be restored!     Two special characters User Trees Multiple customer trees can be created Each user tree can be password protected Protected user trees can only be modified after entering correct password Unprotected trees can be modified without restrictions         Activate Password Protection Select Dot Cockpit > New Tree Check box: Protect tree against unauthorized changes Enter Password twice (minimum of 4 characters required) Select OK   Big un-lock icon – Upper right Locks all Customer User trees Similar to lock screen when leaving scanner Small lock icon – Left side Unlocks or locks selected Customer User trees Explorer Program Editor "Save As" dialog window Locked User Tree Menu Entries are disabled Rename Tree, Delete Tree Toolbar buttons are disabled Paste, Delete, Save Undo, Redo Keyboard shortcuts are ignored Ctrl-X, Ctrl-V, Del At the end of this web-based training, you will be able to: Identify the new features of DotGO and the Dot Cockpit for protocol building List the new applications for the MR VE11 software upgrade Identify new VE11 sequences and sequence modifications Identify advantages and uses for the Pediatric 16 Coil and the Contour 24/28 Coils List the new features of the Exam Task Card Discuss syngo Security features and password protection options Identify the features of the new Dot Engines Discuss the features of Access-i Remote Control List the features of Implant Suite for the MAGNETOM Aera MPRAGE: GRAPPA 2, 0.952x1 mm3 TA ~ 6 min  95 dB(A) PETRA: 0.953 mm3 TA ~ 6 min 64.9 dB(A) 1. Select DIffusion > Neuro Parameter Card 2. Select import button next to Diffusion Mode dropdown box (1) 3. A dialog window opens displaying available DVS files 4. Select one DVS file (2)  5. Confirm with Open (3) 6. Use correct syntax to import contained diffusion vector sets 7. Choose corresponding number of diffusion directions in Diffusion Neuro Parameter Card Sequences TWIST-VIBE StarVIBE Abdominal imaging Benefits Exact Contrast Timing Reduces Motion Artifacts Applications Head Head/Neck Abdomen Pelvis/Chest If the Stimulation limit is exceeded, a window will pop up automatically .                                                           Open Protocol: Opens parameter card to make modification Calculate: Opens the Stimulation Monitor-Recommendations dialog window Cancel: Skips current step                                                                     Enhancements Measurement Queue: new look Additional icons for use during imaging New Features Direct action mouse click for Working Man Step name Inline editing Recycle bin Multi-Selection Optimized Context Menus New Program Card New Conversion Service Stimulation Proposals Color assignments when scanning Green - Running Sequence Gray - Open Sequence The image on the next page, which contains no audio, offers more details about the newly redesigned Measurement Queue.   Blue - Selected Sequence Significant improvements Opening protocols Applying changes Loading sequences into measurement queue Parameter Cards: located at the top of the Measurement Parameters Subtask Card Tabs: located directly below Parameter Cards   Advanced WARP includes Slice Encoding for Metal Artifact Correction (SEMAC) Performs additional phase encoding step in slice direction to provide through-plane distortion correction Most effective for severe field distortions Example: near large metal structures such as full joint replacement of the hip or knee SEMAC can only be applied in combination with:   View Angle Tilting (VAT) set to 100% Slice Distance of 0% SEMAC increases Signal-to-Noise Decrease averages to reduce scan time Use Parallel Imaging Measurement time may be prolonged by number of SEMAC steps Use Partial Fourier Implant factors that determine required number of SEMAC phase-encoding steps Size Shape Material NOTE: Factors may vary from patient to patient Joint arthroplasty Typical recommendation: 8-12 SEMAC steps Metals causing stronger artifacts require higher SEMAC steps Examples: stainless steel or cobalt chromium alloys Titanium implants require lower SEMAC values or no SEMAC at all  SEMAC cannot be used in combination with 3D TSE Multiple slice groups BLADE DIXON TimCT Contrast Parameter Card with Fast T2 TSE DIXON Fast T2 TSE Dixon, a Dual Echo Dixon technique Enables consecutive acquisition of in- and opposed-phase echoes in one echo train Measurement Times: cut in half with reduced motion sensitivity Fat signal independent from TR and Trigger mode PACE Fat Sat Mode = Strong TR = 3000 ms TR = 1600 ms TR = 800 ms New Software VE11A Fat signal independent from TR and Trigger mode Breath-hold Fat Sat Mode = Strong TR = 3000 ms TR = 1600 ms TR = 800 ms New Software VE11A Move your mouse over each highlighted area of the popup screen to learn more about its function. Patient Confirmation with Updated Fields Patient Confirmation Screen Base ImageHotspotsText BlocksImage FileSAR: switches to First Level ModePatient Safety: safety-relevant patient informationStimulation: increases dB/ddt toleranceMEDICAL INFORMATION: general medical informationSTUDY: defiines the measurement program (e.g., Protocol)All Programs: shows the entire examination treeFrequent: shows a list of examinations used frequentlyLoad Program to Queue: automatically loads measurement program to wait queue after registration confirmationRequested Procedure: study-specific informationStudy Description: names study in Patient BrowserAdd Study Comment: places comments on all patient imagesBody Part and Laterality: assigns the Body Part Examined and Laterality (right, left, both) informaton to the program stepsSelect Confirm (1) to confirm and register each patient in Exam Task Card. Select  Calculate in the Stimulation LImit Exceeded Warning window to open the Stimulation Monitor - Recommendations window. Move your mouse over each highlighted area of the popup screen to learn more about its function. Simulation Monitor Recommendations Stimulation Monitor Screen Base ImageHotspotsText BlocksImage FileOpen Protocol: opens parameter cards to make modificationsProtocol Parameters: current parameters and suggested changes to reduce stimulationChange Gradient Mode: changes the Gradient Mode.  As a result, changes are made to TE, TR, and measurement time.  Changes are active if the Change Gradient Mode checkbox is activatedSkip: Closes the window; no modifications were acceptedOK: accepts changes made Stimulation Limit Exceeded Warning window: another way to access the Stimulation Monitor Information window Move your mouse over each highlighted area of the popup screen to learn more about its function. Two ways to select:  1. Calculate  2. Main Menu > Options > Stimulation Info Stimulation Monitor—Information Stimulation Monitor - Information Screen Base ImageHotspotsText BlocksImage FileStimulation level: shows maximal approximation of the stimulation limit in a percentageLookahead safety factor: shows safety factors for th estimulation predictionStimulation threshold and Stimulation limit exceeded: displays "yes" or "no" to indicate if these values were exceeded Move your mouse over each highlighted area of the popup screen to learn more about its function. Patient Registration Patient Registration Screen Base ImageHotspotsText BlocksImage FileHospital: Enter additional data for physicians (This information is optional)Patient: Enter patient data (BOLD fields are mandatory)Procedure: Enter data concerning the examination (BOLD fields are mandatory)Institution:  Additional data for hospital (This information is optional)Select Exam (1) to save information entered on this screen.  Move your mouse over each highlighted area of the popup screen to learn more about its function.  Note: this page contains no audio. Measurement Queue Screen Measurement Queue Screen Base ImageHotspotsText BlocksImage FileSkip: cancelled or skipped measurementProtocol Marker: toggle and switch view to Standard, Image Comment, Body Part, or Study PartSyringe: opens contrast agent administration window to enter amount and type of contrast mediaDot:  opens Patient View to switch strategies and/or add/remove decisionsGreen checkmark: applies measurementSeries Icon: images from a series were reconstructedReconstruction icon: series reconstruction startedGreen: running sequenceGraphical display: remaining measurement time shown graphically for current protocol in queueWorking man: planning protocol toggle on/off with left mouse clickBlue: selected sequenceGray: Open sequenceDisplay of the measurement time of the protocolDisplay of the remaining overall measurement timeStop: aborts measurementRecycle bin: delete a sequence or program step via drag & dropSequences not executed in queue Thorax Abdomen & Pelvis Default Chemical Shift (ppm) Available sequences TSE syngo BLADE syngo SPACE HASTE epi_diff VIBE Water Password Protection Admin Dialog Change password Remove password protection Workflow: three steps...         Enter old password Uncheck Protect tree against unauthorized changes to remove protection” Enter new password twice to modify Special readout segmented EPI sequence   Stretched gradients to minmize the slew rate   Reduced Acoustic noise during scanning   Provides image quality comparable to single shot EPI   Noise reduction Results from slowdown of gradients Increases acquisition time (Comparable to rs-EPI) Lower image quality (Comparable to ss-EPI) Single Shot EPI RESOLVE Segmented k-Space Reduced ESP Readout Partial Fourier QUIET DWI Similiar ESP as ss-EPI (longer than resolve) Phase Partial Fourier for shorter TE TE TE TE Imaging echo Navigator echo T1 Map Amyloidosis with MyoMaps Courtesy: Peter Kellman, national Institutes of Health, Bethesda, USA Inversion Recovery Sequence SingleShot TrueFISP – Different  Inversion Times (TI) following an inversion pulse ECG Triggered – acquisition gated to same cardiac phase Enables a pixelbased T1 value myocardial estimation Estimated T1 values with a single breathhold Motion Correction – fast and fully automatic nonrigid registration algorithm Compensates for inplane motion between images Used to reduce motion artifacts for Breast, Female Pelvis, and especially Orthopedic examinations Dual-echo DIXON technique acquires in-phase and opposed-phase echoes consecutively within one echo train This sequence diagram depicts a Single Echo Train for a Fast DIXON sequence with a Turbo Factor of 3 opposed phase ADC in phase ADC Consistent Spine Imaging for Cervical, Thoracic, Lumbar Guided and Automated workflow Wide range of patients and conditions Exam Strategies – create different  protocols   Standard – for fast routine spine examinations   Post-Surgery – for a detailed evaluation of the spine including fat saturation and DIXON techniques.   High Bandwidth (WARP) – optimized for reduction of susceptibility artifacts1. Disclaimer1 The MRI restrictions (if any) of the metal implant must be considered prior to patient undergoing MRI exam. MR imaging of patients with metallic implants brings specific risks. However, certain implants are approved by the governing regulatory bodies to be MR conditionally safe. For such implants, the previously mentioned warning may not be applicable. Please contact the implant manufacturer for the specific conditional information. The conditions for MR safety are the responsibility of the implant manufacturer, not of Siemens Healthineers.   Additional Features:   AutoAlign Spine LS – automated positioning and alignment of slice groups to spine anatomy   Inline Curved Reconstruction – automatic curved reconstruction of 3D acquisitions   AutoLabeling – automatic vertebrae labeling   Interactive Snapping – drag the slice groups over the sagittal image and the Auto-Align Spine L-S automatically positions the double oblique axial slice groups to intervertebral disk spaces   AutoCoverage – automatically sets number of slices and FoV to fully cover Cervical, Thoracic, or Lumbar spine.   syngo WARP – reduction of susceptibility artifacts (e.g., MR conditional metal implants1) Consistent Imaging for Knee, Hip, Shoulder Guided and Automated workflow Wide range of patients and conditions Exam Strategies – create different  protocols   Standard – maximum image quality in a reasonable scan time 2D and 3D sequence   Speed Focus – examine patients shortest time possible iPAT integrated   Motion Insensitive (BLADE) – compensate for patient motion artifacts   High Bandwidth (WARP) – optimized for reduction of susceptibility artifacts1. Disclaimer1 The MRI restrictions (if any) of the metal implant must be considered prior to patient undergoing MRI exam. MR imaging of patients with metallic implants brings specific risks. However, certain implants are approved by the governing regulatory bodies to be MR conditionally safe. For such implants, the previously mentioned warning may not be applicable. Please contact the implant manufacturer for the specific conditional information. The conditions for MR safety are the responsibility of the implant manufacturer, not of Siemens Healthineers.   Additional Features: AutoAlign – automatic positioning and alignment of slice groups to anatomy   AutoCoverage – automatically sets number of slices and FoV to fully cover knee, hip, or shoulder anatomy   Inline MPR’s – automatic multi-planar reconstruction of 3D datasets   WARP and Advanced WARP (SEMAC) – optimized for reduction of susceptibility artifacts1 Consistent Breast Imaging Tissue Depiction Implant Visualization Breast Biopsy Exam Strategies – create different  protocols   FatSat Standard Fat Sat InterVIEWS Non-FatSat Standard Non Fat Sat InterVIEWS Additional Features:   Implant Situation – implant type identification scan   Select or modify exam based on implant type and laterality System automatically modifies scan queue Frequency adjustment – assumes either “Dominant Fat” or “Silicone”   Auto-Coverage – automatic segmentation performed Estimates optimal FoV and adapts Adjust Volume to patients anatomy   MPR Planning – user-selected protocols, Multi-Planar reformats are automatically calculated   Biopsy Support   Single Frequency Adjust – preselect to show frequency adjustments Consistent Cardiac Imaging Guided and Automated workflow Wide range of patients and conditions Exam Strategies – create different  protocols   Standard – segmented acquisition Limited Patient Capability – switch to realtime and single shot imaging if breath-holds are not possible or arrhythmias occur Additional Features:   AutoFOV – automatically estimates optimal Field-of-View   Automated Parameter Adaption – scan parameters automatically adapted to patient condition (e.g., heart rate)   AutoAlign Heart– based on localizer images Automatic detection of 5 cardiac landmarks Fully automated planning results 2, 3, and 4 Chamber Views Stack of Short Axis Views   Automated Localization – automated localization of short-axis views   Guided Slice Positioning – match slice positions (short-axis) between cine, dynamic imaging, tissue characterization   Cardiac Views – selection of cardiac views during exam planning (e.g., 3 chamber view) Additional Features:   Inline Ventricular-Function Evaluation – Cardiac CINE Volumetric Data Evaluation performed automatically after image reconstruction Load into 4D Ventricular Function Analysis for review and processing   Inline Time Course Evaluation – automatic, real-time, motion corrected calculation of parametric maps   Adaptive Triggering – Acquisition adapts in realtime to heart rate variations for non-CINE applications   Automated Naming – series automatically named depending on cardiac view and image contrast   AutoVoiceCommands – Voice commands integrated into scanning workflow Supports features for interactive Realtime sequence (BEAT_IRTTT) Set additional parameters interactively Interactive Functionality is activated for the following parameters: Slice Thickness – up to 5 times larger than the thickness at beginning of the sequence Previously chosen preparation pulse can be switch off (switch on again later) Imaging part of the sequence can be switched of interactively to increase performance of sequence (switch on again later) Please note: sequence only available in the Siemens Sequence Default Protocol Subtree Compressed Sensing Cardiac CINE Adaptive Triggering   Acquire a complete stack of short-axis slices in a single breath-hold   Temporal and Spatial Resolution – comparable to conventional segmented technique   Real-time approach – robust for arrhythmia and breathing artifacts   Use to: Reduce Number of breath-holds (or) Shorten breath-hold duration   2D TrueFISP sequence High myocardial-blood contrast   Single-slice acquisition – acquires 2 heart-beats One dummy heartbeat for steady-state preparation One heartbeat for acquisition Adaptive Triggering Cover the complete Cardiac Cycle Include late diastole Reacts in real-time to detected triggers   Acquisition window – doesn’t need adjusting, define the number of calculated phases instead Physio/Signal 1 Parameter card – Adaptive Triggering (default setting) Set number of Calculated Phases (Tooltip) Two Series are generated Original Series – contains a varying number of phases per acquired slice, dependent on R-R interval Interpolated Series – fixed number of phases   Image Processing Applications – Inline Ventricular Function and syngo-via MR Cardiac Function Require all slices in a Short-Axis stack covering the left ventricle have the same number of phases Without Adaptive Triggering CINE performed using Prospective Triggering   Acquisition window – adjust to the patients R-R interval Physio/Signal 1 Parameter card – deselect Adaptive Triggering Select “Captured Cycle” button – adjusts the “Acquisition Window” to patient R-R interval   Strong Arrhythmia Set “Acquisition Window” to a few seconds to cover several heartbeats     Determines if further “Evaluation” needed     Segmented Liver Images displayed ROI or HISTO-voxel position Recommendation for more detailed tissue characterization Fat and Iron Deposition Normal Unclear  Based on dual-ratio discrimination of Fat/Water and In-phase/Opposed-phase signal ratios Guidance View – Run Liver Evaluation Yes or No Clinically Validated Push button highresolution 3D Knee exam in 10 minutes CAIPIRINHA SPACE Acceleration (iPAT) in two directions High Signal to Noise (SNR) All essential clinical contrast and imaging planes Diagnostic imaging contrasts for knee examinations Intermediate/Proton Density (PD) weighted Intermediate/T2weighted with fat saturation High resolution isotropic imaging in any plane Improved patient throughput and reduced cost per examination Push button exam with the Large Joint Dot Engine – reduces scan time High consistency in imaging reduces need for repeat sequences Reconstruct in all 3 planes – eliminates need to acquire 2D thin slices for individual planes Left Monitor Examination Only Right Monitor syngo Classic Postprocessing & Viewing only Note: Purchasable option for 2nd monitor   Operate a MAGNETOM system from another computer Control and edit MR System examination programs from a non-Siemens device Platform independent (tablet, PC, smartphone, etc.) Programming language and operating system independent   Using Access-i Switch on “Accessi” from syngo Acquisition Workplace Passive – view and receive acquired MR Images on the clientAll interactions are performed on the syngo Acquisition workplace or by another active client Active – control measurements from clientInteractions at the syngo acquisition Workplace are not possible Note: Software feature is not available for MAGNETOM Skyra fit and Avanto Fit Accessi Remote Control (Option) Prepare measurement programs for remote control access  creating template Programs can only be controlled that are “Enabled” for remote access Two Preparation Steps are needed   Enter [Remote] in Description field of Directory Properties of program in question Add “AccessI” Dot addin to relevant program step [Template] localizer [Template] BEAT_IRT   Note: Software  feature is not available for MAGNETOM Skyra fit and Avanto Fit Entering [Remote] in Description Field of Directory Properties Enable a measurement program for remote access, adjust directory properties Open Dot Cockpit > Explorer task > Browser subtask Select Measurement Program (Directory) in tree view Right click > Choose Edit Properties from context menu Directory Properties dialog window opens Description field of Directory Properties dialog window Enter [Remote] – (Note: square brackets must be included) Click OK – confirms entry Adding Accessi Dot Addin Open Dot Cockpit Select Program Editor Select Edit subtask card Select Program Step Select Default Addins Select Accessi Dot Addin > drag to program step Repeat process for each program step to control from the client Configure Accessi Dot addin for Interactive Sequences Open Dot Cockpit Select Program Editor > Edit subtask card > select program step Right click > select Edit Properties Lower left of Step Properties Click AddIn Configuration Select Access-i card > select Enable Interactivity Click Close – confirms entry Access-i Remote Control (Option)  Establish Active Remote Control Register a Patient Measurement Queue – no sequences (program step) is open No sequences are running No Popup dialog boxes are open Window indicating “AccessI Remote Control Active” is displayed Cancel Active Remote Control Select “STOP” – cancels remote operation on the syngo Acquisition workplace Both “Active” and “Passive” control are cancelled Implant Suite MAGNETOM Aera Siemens Healthcare GmbH does not assume responsibility or liability for the operation of the MR system with any implantable medical device.   Siemens Healthcare GmbH is not responsible for controlling technical parameters of the MR system other than those defined by the normal operating mode, the first level controlled operating mode, the Implant Suite modes (Scan Limits 1, Scan Limits 2, or Scan Limits 3), and the data provided in the system owner manual, such as spatial gradient field plots.   The MRI restrictions (if any) of the metal implant must be considered prior to patient undergoing MRI exam. MR imaging of patients with metallic implants brings specific risks. However, certain implants are approved by the governing regulatory bodies to be MR conditionally safe. For such implants, the previously mentioned warning may not be applicable. Please contact the implant manufacturer for the specific conditional information. The conditions for MR safety are the responsibility of the implant manufacturer, not of Siemens.   A fetus is especially sensitive to potential thermal events during the first three months of pregnancy. Therefore, avoid scanning pregnant patients in the first three months of pregnancy and avoid scanning patients with unknown pregnancy status.   MR scanning has not been established as safe for imaging fetuses and infants less than two years of age. The responsible physician must evaluate the benefits of the MR examination compared to those of other imaging procedures. Simplify scanning with implants Offer patients with “MR Conditional” implants access to MR Imaging Extra protection limits and ensures implantspecific scan limits cannot be exceeded Simple user interface, avoid manual data entry Addresses different implant requirements Fulfills implant specific scan requirements  Requirements and Restrictions Only available for the MAGNETOM Aera IEC Requirements – enforcement of “CP Mode” only No FastView No TimCT protocols Acoustic noise reduction (Quiet) must be turned on explicitly Shim Mode – must use “Standard Shim” or “Tuneup” Interactive Shim – cannot be used Only used in conjunction with: Built-in Transmit (Tx) Body Coil Non-transmitting local coils Note: Local Tx/Rx (Transmit/Receive) coils are not supported  Note: Only available for the MAGNETOM Aera MR Safe Implants which pose no known hazards in all MR environments   MR Conditional Implants are safe in MR examinations under certain conditions, which have been tested and documented by the implant manufacturer   MR Unsafe Implants of this category pose hazards in all MR environments   Disclaimer: Siemens Healthcare GmbH does not assume responsibility or liability for the operation of the MR system with any implantable medical device Scan Limits 1 Main Parameters limited Body SAR Head SAR Most “MR Conditional Implants” are covered by “Scan Limits 1” Scan Limits 2 Limit of B1 + RMS as main parameter Body and Head SAR values also limited Implant Suite – Scan Limits Scan Limits 3 Most restrictive Mode Offers additional GradientRelated limits dB/dt peak and dB/dt Max B1 + rms limits For exact parameter value limits and any additional information regarding “Implant Suite” refer to the “Operator Manual - Implant Suite". Permitted Coils Body Coil Head/Neck 16 Spine 32 Spine 24 Body 18 Body 18 Long Peripheral Angio 36 Shoulder 16 Large/Small Hand/Wrist 16 Foot/Ankle 16 Breast 18 Pediatric 16 Flex Coil Interface – Permitted Coil requirement Special Purpose 4 Flex Small /Large 4 Loop 4/7/11 Tim Coil Interface – Permitted Coil requirement 4-Channel BI Breast 16-Channel AI Breast 2/4/8 Channel Breast Coil 2/10/16 Channel Breast Coil Specified Revision Level Requirement Head/Neck 20 Body 6 and Body 6 Long Body 30 and Body 60 Note: contact your local sales representative for additional information   Patient completes “MR Screening Form” – determines and “Contraindications” and if implant present   Request “Implant ID” information from patient if implant present Implant ID – Implant Classification – read info and proceed depending on classification and label. Implant ID “Without” Classification Implant is “Not Classified” as: “MR Safe”, “MR Conditional” “MR Unsafe” Warning – DO NOT proceed with examination Contact implant manufacturer for details whether MR imaging is possible under specific conditions If implant classification isn't possible – MR imaging is a contraindication. Implant Suite – “MR Safe” Classification Implant ID – Classification “MR Safe” Implant – Classified “MR Safe” MR Safe Symbol – also indicates classification  Registration – indicate patient has an “MR Safe Implant” in “Patient Confirmation > Implant” Pre-measurement includes Automatic Liver Registration Pre-evaluation – first overview of possible iron overload entire liver Sequence Recommendations Contrast > Common Parameter Card TE1 and TE2 – in and Opposed Phase TE Dixon Evaluation button – check Report Pre-Evaluation Report Determines Segmented Liver Images displayed ROI or HISTO-voxel position Multi-Echo Gradient Echo (VIBE Dixon) sequence Number of Echoes enabled = 6 Dixon Evaluation Options Fat Fraction Water Fraction T2* (effective) R2* (effective) Report ROI or HISTO – voxel position Benefits Spatially resolved whole liver coverage Correction for transverse relaxation effects Simultaneous estimation of fat signal fraction, and R2* Adapt ROI and Slice Position Check ROI and Slice Position Move ROI and Slices as needed   Recommendations for Evaluation of Fat and Iron Deposition Fat Fraction R2* Report Evaluation Parameter maps calculated Multi-echo Dixon Results Color Bar Report Fat signal fraction R2* Fit Error Color Bar Report Liver segmentation volume and ROI are displayed Mean Value Standard Deviation Number of Voxels Histogram Report Distribution of parameter values for voxels of segmentation volume Multi-echo VIBE Dixon Color Bar Report Multi-echo VIBE Dixon Histogram HISTO Color Bar Report HISTO Spectra Single Voxel Spectroscopy (SVS) Breath-hold Voxel Location HISTO Results Report contains Average fat signal fraction within a voxel R2* of water as text and color bar Spectrum with Shortest TE Table containing fat signal% and R2 of water Quality of Fit Individual echo values for water and lipid signal Prostate: TWIST-VIBE Dixon Water Transverse, CAIPIRINHA 4, SL =3 mm, Slices = 28, TA 13.4 s + 6.4 s. Images courtesy of Hospital St. Elisabeth, Zottegem, Belgium   T1-weighted Fast 4D imaging with VIBE Dixon – Robust fat suppression with fat/water separation CAIPIRINHA – improved SNR and higher iPAT factors TWIST – view-sharing for ultra-high temporal resolution Benefits Accurate contrast timing in dynamic liver MRI examinations Multi-arterial phase imaging in a single breath-hold with higher temporal and spatial resolution Excellent images to plan surgical intervention Increased confidence in lesion detection Hepatic Cellular Carcinoma – may show progressive enhancement capturing the optimal phase for detection 3D TWIST-VIBE : Contrast Enhanced Slices = 72, Matrix = 288x216; Dynamic Sub phases = 5 Temporal Resolution: 2.6 seconds per breath-hold Images courtesy University Hospital Grosshadern, LMU, Munich, Germany   3D TWIST-VIBE Dynamic - Rectum Carcinoma: Dixon Water, Transverse, CAIPIRINHA 4, SL = 4 mm, TA 9.4-39 + 4.5 seconds Images courtesy of Knappscharftkrankenhaus Botrop, Germany 3D StarVIBE – Head/Neck FatSat, Slice Thickness  = 3 mm Ospedale Regionale Civico Lugano, Switzerland   3D T1-weighted Gradient Echo (GRE) sequence Combines VIBE Contrast with in-plane, radial acquisition scheme (3D "Stack of Stars”)   Benefits Reduced motion artifacts Free-breathing measurement with high spatial resolution Entire (radial) scan is contrast-sensitive, and contrast enhancement cannot be missed Improved image quality, ghosting, and image sharpness Improved contrast timing Provides lesion conspicuity and edge sharpness   Applications Head Head/Neck Chest Abdomen & Pelvis Conventional VIBE Abdomen Free breathing StarVIBE Abdomen Free breathing 3D StarVIBE Chest SPAIR, Slice Thickness = 1.2 mm Matrix = 320x320; Time 5:33 minutes T2 Map Myocardial Edema with MyoMaps Courtesy: Christoph Tillmanns, Diagnostikum, Berlin, Germany T2 Prepared sequence Combined with either TrueFISP (or) GradientEcho readout Produces singleshot T2weighted images Each with a different T2 preparation time Sequence waits several recovery heartbeats between each preparation for full T1 regrowth ECG Triggered Motion Correction – fast and fully automatic nonrigid registration algorithm Compensates for inplane motion between images Clinical Indications Assess pathologic conditions that alter myocardial water content and prolong T2 relaxation times Edema Acute Myocarditis Heart Transplant Rejection Acute Ischemia Cardiac Allograft Rejection T2* Map Iron Overload with MyoMaps Courtesy: Dudley Pennell, Royal Brompton Hospital, London, UK Blackblood preparation with a Segmented GradientEcho Readout Enables a pixelwise T2* estimation using a robust fitting technique Signal at each TE iteratively weighted to reflect fidelity to a monoexponential decay curve   Inline-Curve Fitting and Map Generation   Motion Correction – fast and fully automatic nonrigid registration algorithm Compensates for inplane motion between images Clinical Indications Noninvasive Assessment of Iron Overload   Plan and monitor ironchelating treatments for transfused thalassemia major patients   Hemochromatosis Note: T2* maps are only available for 1.5 Tesla MR Systems. Contour Coil – 24 Contour Coil – 48 “MR Conditional” Classification Implant ID – Classification “MR Conditional” Implant – Classified “MR Conditional” MR Safe Symbol – also indicates classification Implant ID – Follow instructions on where to find detailed instructions from the implant manufacturer. Follow preparatory steps for an MR exam Scan Parameters and Scan Limits – Highlight or make a note of this information Registration > Patient Confirmation > Implant  Indicate patient has an “MR Conditional Implant”   Implant Suite – MR Unsafe Classification Implant ID – Classification “MR Unsafe” Implant – Classified “MR Unsafe” MR Safe Symbol – also indicated   DO NOT Proceed with examination – implant labeled “MR Unsafe” is a “Contraindication for MR Imaging”. Select “Confirm”    “MR Conditional Implant” selected in “Patient Confirmation” dialog box "Select MR Conditional Implant Scan Mode” dialog window opens Refer to “Patient Implant ID” or “Implant Manufacturer’s Instructions” for this implant   “MR Conditional Implant Scan Mode” dialog window Refer to “Scan Limit Information” by manufacturer to identify for appropriate safety level Scan Limits 1 Scan Limits 2 Scan Limits 3 Click “Select” below “Scan Limits” column chosen “Control Key” for selected “Mode” shown Enter “Control Key” in selected field Click “Continue” – starts examination Select Patient Registration Complete fields with “BOLD” type Select “Exam” “Patient Confirmation” dialog box opens Under “Implant” select one of the following: No Implant MR Safe Implant MR Conditional Implant Study – select a “Protocol” Check any other information, complete or correct as needed Select Confirm   Note: when “MR Conditional Implant” is combined with “First Level Mode”Strictest Limits defined by either of these modes will be applied for each of the critical parameters 1 - MR Conditional Implant Mode Symbol 2 - Scan Limits Indicator Exam Task Card MR Conditional Implant Mode – selected scan limits show directly above queue MR Conditional Implant Mode Scan Limits Indicator Point to “MR Conditional Implant Mode Symbol” or the “Scan Limits indicator” or show the specific measurement parameters that this level entails Asymmetric echo is selectable with Fast DIXON on 3T Systems   Asymmetric echo location: Sequence > Part 1 Parameter Card Increases distance between inphase and opposed phase echoes when activated on 3T systems Important recommendations, especially at 3 Tesla Increase Bandwidth Increase FOV Decrease Base Resolution Set Gradient Mode to Fast   Parameters have been moved to a separate window: Contrast > Common Parameter Card.         Click button to the right of the Dixon checkbox (1)  Window launches with access to the additional selections      Original Echoes – turns on or off in-phase and opposed phase images Water – turns on or off Dixon images reconstructed with water signal only, and Fat – turns on or off Dixon images reconstructed with fat signal only     Turns on or off in-phase & opposed phase images DIXON image reconstructed contains water signal only  DIXON image reconstructed contains fat signal only. You should now be able to: Identify the new features of DotGO and the Dot Cockpit for protocol building List the new applications for the MR VE11 software upgrade Identify new VE11 sequences and sequence modifications Identify advantages and uses for the Pediatric 16 Coil and the Contour 24/28 Coils List the new features of the Exam Task Card Discuss syngo Security features and password protection options Identify the features of the new Dot Engines Discuss the features of Access-i Remote Control List the features of Implant Suite for the MAGNETOM Aera