NATIVE TrueFISP Scanning Workflow with ECG Triggering

syngo NATIVE TrueFISP Scanning Workflow with ECG Triggering (E-line) syngo E-Line Software NATIVE TrueFISP is a flow-dependent non-contrast enhanced technique for MRA studies of the renal arteries. Because of the challenges of breathing motion, cardiovascular motion, and flow- dependent signal, the NATIVE TrueFISP protocol provides the most optimal results when each of these challenges are compensated for using gating and triggering options. 1. Position the patient on the table preferably in the Head First - Supine position. Feet First positioning will yield more restrictive SAR calculations. TrueFISP pulse sequences are relatively high SAR sequences. 2. Prepare the area and position the ECG leads on the patient according to the instruc- tions in the User Manual 3. Position the coil. Landmark & center the patient at the area of the renal arteries. Be sure that the PERU device box is not immediately over the area being scanned, as it can create image artifacts on the NATIVE TrueFISP images. 4. Run the Transverse and Coronal localizers a. Note: The transverse localizer should have slice coverage from the dome of the liver and all the way down to include at least a portion of the right kidney. The Coronal localizer should include at least one image that shows the right and left renal arteries. 5. Open the “NATIVE_TrueFISP_nav_ECG_tra” sequence Unrestricted 0 Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: XX/XX/XXXX | HOOD/HILS Healthineers Job Aid | syngo NATIVE TrueFISP Scanning Workflow with ECG Triggering (E-line) Effective Date: 06/09/2020 HOOD05162003096950 6. Position the Acquisition slab so the top of the slab is slightly superior to the Renal Ar- teries. Position slab over renal arteries. a. Note: This technique requires “fresh blood” to flow into the Acquisition slab, so the best imaged arteries are those in the superior-most slices of this slab. 13172026 10cm P2 MM/NORM/DIS2DIFMIFI SP BEAS 12_haste_cor_mon FOV 400-400 7. Position the Inversion region so that top of the Inversion band corresponds to the top of the Acquisition slab. a. Note: The Inversion region extends well below the Acquisition slab, so that inflowing venous blood will not be imaged NATIVE, TrueFISP H 20.03.31-21:01:41-DST-1.3. 2 IMA 23 / 35 3/31/2020 ACS ................................................... ....... ............................................................... 10cm p2 M/NORM/DIS2D/FM/FIL TP F45 SP P24.0 12_haste_cor_mbh FOV 400*400 Cor Unrestricted 0 Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: XX/XX/XXXX | HOOD/HILS Healthineers Page 2 of 5 Job Aid | syngo NATIVE TrueFISP Scanning Workflow with ECG Triggering (E-line) Effective Date: 06/09/2020 HOOD05162003096950 8. Position the Navigator so that the intersection of the two Navigator Pulses is located in the dome of the liver a. Scroll through the transverse localizer images to verify that the Navigator Pulses do not bisect any of the renal arteries that you wish to include in the images. Also check that the intersection of the two Navigator Pulses is within the dome of the liver in both the coronal and transverse planes. Do not change the angle at which the two Navigator Pulses intersect unless they are too close to the right artery. On axial image the bands should form a rotated “x”. Make sure coil elements close to Diaphragm are activated. NATIVE, TrueFISP 20.03.31-21:01:41-DST-1.3.12.2.11 NATIVE, TrueFISP 20.03.31-21:01:41-DST-1.3.12.2.11; 3 IMA 4 / 26 3/31/2020 2 IMA 19 /35 3/31/2020 ACS ACS R R 10 cm 10cm ........................................................................................................... ............................................... P2 MINORIBIS2D/FMIFIL 5P.F41 p2 M/NORM/DIS2D/FM/FIL 12_haste je.tra_mbh OV 282 410: TP F45 SP P4.8 2_haste_cor_mbh 400*400 Cor 9. Go to the Physio>PACE tab and deselect Scout mode TA: 2:05 PM: ISO PAT:2 Voxel size: 1.1×1.1×0.9mm Rel. SNR: 1.00 tfi Routine Contrast Resolution Geometry System Physio Inline Sequence Signal1 Cardiac PACE Resp. control Gate Scout mode Tracking factor 0.60 Scout duration 19 . s Chronologic posi Before echo Scout TR 100 - ms RF pulse type Cross .. Accept window + 4.0 - mm Resp. Motion Adaptation Accept position (green) 128.0 mm Search window + 32.0 - mm Concatenations Search position (red) 128.0 mm Unrestricted 0 Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: XX/XX/XXXX | HOOD/HILS Healthineers Page 3 of 5 Job Aid | syngo NATIVE TrueFISP Scanning Workflow with ECG Triggering (E-line) Effective Date: 06/09/2020 HOOD05162003096950 10. Go to the Physio>Signal1 tab > Capture cycle TA: 0:19 PM: ISO PAT: 2 Voxel size: 1.1×1.1×0.9mm Rel. SNR: 1.00 tfi Routine Contrast Resolution Geometry System Physio Inline Sequence Signal1 Cardiac PACE 1st Signal/Mode ECG/Trigger Average cycle 1000 + 3 ms Captured cycle -not set- Acquisition window 730 - ms 0.8 1.6 4[s] Trigger pulse Concatenations Trigger delay 0 : ms Phases TR 729.35 - ms Segments 56 11.Apply the sequence 12. Load 3D NATIVE TrueFISP series to 3D Task Card and MIP 13. Imaging Tips a. In elderly patients or patients with known heart failure, the stroke volume may not be sufficient to fill the complete arterial tree of the kidneys with fresh blood within one heart cycle. In this case, a longer TI value such as 1400 ms may be used. Another option would be to select the Physio Tab>Signal1 and use Trigger Pulse 2 to scan every other heartbeat. b. Imaging renal transplants: In the pelvis region motion artifacts due to breathing are not usually of great significance, so respiratory gating is not needed in this re- gion. Refer to the dedicate protocol in the Siemens Dot Cockpit. c. Respiratory Trigger: If the 1D Navigator impinges on the area of interest, it is pos- sible to use respiratory triggering to synchronize with the respiratory cycle. Use a TI of around 1350 ms to ensure that as many systolic events as possible are included. Unrestricted 0 Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: XX/XX/XXXX | HOOD/HILS Healthineers Page 4 of 5 Job Aid | syngo NATIVE TrueFISP Scanning Workflow with ECG Triggering (E-line) Effective Date: 06/09/2020 HOOD05162003096950 Please note that the learning material is for training purposes only! For the proper use of the software or hardware, please always use the Operator Manual or Instructions for Use (hereinafter collectively “Operator Manual”) issued by Siemens Healthineers. This material is to be used as training material only and shall by no means substitute the Operator Manual. Any material used in this training will not be updated on a regular basis and does not necessarily reflect the latest version of the software and hardware available at the time of the training. The Operator's Manual shall be used as your main reference, in particular for relevant safety information like warnings and cautions. Note: Some functions shown in this material are optional and might not be part of your system. Certain products, product related claims or functionalities (hereinafter collectively “Functionality”) may not (yet) be commercially available in your country. Due to regulatory requirements, the future availability of said Functionalities in any specific country is not guaranteed. Please contact your local Siemens Healthineers sales representative for the most current information. The reproduction, transmission or distribution of this training or its contents is not permitted without express written authority. Offenders will be liable for damages. All names and data of patients, parameters and configuration dependent designations are fictional and examples only. All rights, including rights created by patent grant or registration of a utility model or design, are reserved. Copyright © Siemens Healthcare GmbH 2020 Siemens Healthineers Headquarters Siemens Healthcare GmbH Henkestr. 127 91052 Erlangen, Germany Phone: +49 9131 84-0 siemens-healthineers.com Unrestricted 0 Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: XX/XX/XXXX | HOOD/HILS Healthineers Page 5 of 5