Chapter 3-1 Imaging - hca.fujifilm.com

DM# 65225v3 Copyright 2013 by Hitachi Medical Systems America, Inc. All rights reserved. 3-1

Chapter 3-1 Imaging

Open the Exam window from the Patient Registration window. The selected protocol will be displayed.

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Click a task to select it to be performed. Tasks can be added, moved, or deleted.

Tasks included in the selected protocol are listed in the Protocol Properties window on the Exam window.

How to start your scanning:

For detailed safety information, please refer to Chapter 1, Safety, in the Echelon Reference Manual.

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Chapter 3-1 Imaging

3 Click . The STARTbutton will change states to become the PAUSE button. Green circles indicate the scan is running.

The completed scans will be displayed under the Output Series window.

Completed scans Green circles

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Chapter 3-1 Imaging

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Click the next task to be run.

Click all 3 planes of scanograms in the Output Series window to select them. Drag and drop them into the Source box.

Series selected to be set up

3 planes of scanos, displayed in viewports

6 Set up slices and FOV based on three-plane scanograms; check scan parameters.

Click

Source box

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Chapter 3-1 Imaging

7 While the task is running, select next task to be performed.

Set up next scan based on three -plane scanograms, or wait and use output images from a scan that is currently running.

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9 Drag the scanograms / series into the Source box. Check scan parameters and FOV.

Click

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Chapter 3-1 Imaging

10 Use thumbnail images below Output Series window to check results of each series.

Use the icon found under the thumbnail image area to enlarge thumbnail window for easier viewing.

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Chapter 3-1 Imaging

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How to review images from multiple series:Click Review Task in the Protocol Properties window.

NOTE: You can review images from multiple series, but only series performed in this Exam window.

Drag a series into the appropriate viewport on the Review Task window.

Double-click a series in the Output Series window to load it into a viewport

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Chapter 3-1 Imaging

15 Continue the previous steps until all required tasks from the protocol have been completed.

Protocol

Output Series

Thumbnail Images


Chapter 3-1 Imaging

1How To Image a 3D TOF Exam: For demonstration purposes, a 3D TOF MRA of the Brain is used. Open the Exam window from

the Patient Registration window; the selected protocol will be displayed.

Tasks included in the selected protocol are listed in the Protocol Properties area of the Exam window.

Left-click on the Scanogram SCA task to select it to be performed. Green circles indicate the scan is running.

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Chapter 3-1 Imaging

3 Click the MRA Brain 3D TOF task.

Click all 3 planes of scanograms in the Output Series window to select them. Drag them into the source box.

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Source Box

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Chapter 3-1 Imaging

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Click anywhere in the sagittal viewport. Position the 3D slab crosshairs so that the 3D slab covers from mid corpus callosum to the base of the skull.

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3D Slab

SuperiorPresat

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Click to run the 3D TOF sequence. After the scan is completed, load the source images into a MIP task.

Refer to Chapter 5, Post Processing, for MIP task loading details.

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The walking presat will move along with the 3D slab. Make sure the presat is 15mm above the top of the 3D slab.

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Presat

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Chapter 3-1 Imaging

1How To Image a 2D TOF Exam: For demonstration purposes, a 2D TOF MRA of the Carotids is used. Open the Exam window from

the Patient Registration window. The selected protocol is displayed.

2 Click the Scanogram SCA task to select it to be performed.

Tasks can be added, moved, or deleted.

1 Tasks included in the selected protocol are listed in the Protocol Properties window of the Exam window.

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Chapter 3-1 Imaging

3 Click . The START button changes states to become the PAUSE button.

The completed scans will be displayed in the Output Series window.

3Completed scans


Chapter 3-1 Imaging

4 Click the S-Map task.

Click all 3 planes of scanograms in the Output Series window to select them. Drag them into the Source box.

Position the slice slab as displayed at left.

Click to run the S-Map sequence.

Note: When the S-Map sequence is completed, no image data will be generated or displayed in the Output Series window.

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Chapter 3-1 Imaging

7 Click the MRA Carotids 2D TOF task.

Click all 3 planes of scanograms in the Output Series window to select them. Drag them into the Source box.

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Source Box

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Chapter 3-1 Imaging

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Click anywhere in the Sagittal viewport. For proper coverage, position the 2D slab crosshairs between C3-C5. If more coverage is needed, add slices.

The walking presat will move along with the 2D slab. Make sure that the presat is 10mm above the top of the 2D slices.

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2D TOF Slices

Superior Presat

Click to run the 2D TOF sequence. After the scan is completed, load the source images into a MIP task.

Refer to Chapter 5, Post Processing, for MIP task loading details.

Presat

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Chapter 3-2 Imaging: Presats

1How To Place Presats for Imaging: Why do we need presaturation pulses?

Why we use presaturation pulses for clinical scanning.

2 Types of presaturation pulses.

a. Reduce flow artifacts

b. Specific Vessel flow

c. Anatomy aliasing

d. Breathing motion

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2 a. Normal (Spatial)

b. Intermittent

c. Walking



3How To Place Presats for Imaging: Tips for placing presaturation pulses above and below the heart. Placement of presats when

imaging above the heart.

4 Placement of presats when imaging below the heart.

Placement of the presats: Imaging above the heart

• To suppress venous flow, the presatshould be placed above the slice stack

• To suppress arterial flow, the presatshould be placed below the slice stack

Placement of the presats: Imaging below the heart

• To suppress venous flow, the presatshould be placed below the slice stack

• To suppress arterial flow, the presat should be placed above the slice stack

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5How To Place Presats for Imaging: Flow Artifacts

Left-click the blue (spatial) presat pulse.

6 Using a sagittal image, place the presat inferior to the slice acquisition, as demonstrated in the example.

Presat 5

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7How To Place Presats for Imaging: Specific Vessel Flow Click on the green (walking) presat pulse.

8 Using a sagittal image, center the slab as desired. The presat will move with the 3D slab. The presat should be 15mm above the top of the slab.

Presat 78



9How To Place Presats for Imaging: Flow Artifacts

Three presat pulses will display for setup. They are used to prevent flow in the cord.

10 Using the sagittal image, place one presat superior, one anterior, and one inferior to the spine, as demonstrated in the example.

Presat #1

Presat #3

Presat #2

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11How To Place Presats for Imaging: Specific Vessel Flow, Venous Click and select the green (walking) presat pulse.

12 Using the sagittal image, move the 2D slices as desired. The presat will move along with the slices. The presat must be 10mm away from the slice group.

Presat 11

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13How To Place Presats for Imaging: Axial or Coronal with R-L phase- Anatomy Aliasing

Using the coronal viewport, click on the blue (spatial) presat.

14 Drag the presat over to cover the opposite leg. This prevents the shim from obtaining data from the opposite leg.

Presat

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15How To Place Presats for Imaging: Coronal Shoulder-Breathing motion Using the Axial viewport, click

on the blue (spatial) presat.

16 Place the presat so that it covers the posterior chest wall and lung field, as demonstrated in the example.

Presat 15

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17How To Place Presats for Imaging: Axial Shim of the Wrist (Down by the Side)

Using the Axial viewport, click on the blue (spatial) presat.

18 Position both the presats so that they cover the body, as demonstrated in the example.

Presat 1

Presat 2

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Chapter 3-3 Imaging: Breath Holding

In the Wait mode list, under the Scan Control area in the ScanParameterList window, click ON.

Confirm the scan time of the sequence is within the patient’s breath-holding capabilities.

Breathing instructions can be given manually, or by using the Auto Voice parameter.

How to use Breathholds during imaging:

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Note: If you are using the Magnacoustics Stereo system, the patient will hear your voice or the auto voice directly through the headphones.

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Auto Voice patterns can be set up in the Auto Voice Settingwindow, which can be accessed from the System Settings launcher button.

In the Auto Voice list, click the desired breathing instruction.

How to use Breathholds during imaging:

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Default and created auto voice patterns are listed in the Auto Voice list on the Scan Parameters List window.

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Multi acquisitions are useful when trying to acquire a large number of slices, while maintaining a low TR (for T1 weighted and/or short scan times for breathholds).

When 24 is entered / selected from the Multi slice box, the value in the TR box remains low. At 530ms, scan time is approximately 21 seconds.

If the Multi slice value is increased to 36, minimum TR becomes 792ms (too high for T1 weighted), and scan time becomes 31 sec. (too long for patient breath hold).

How to set up multi acquisitions when more slices are needed:

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ON is selected in the Wait mode list (under the Scan Control area in the ScanParameterList window), so the system will pause after the prescan for breath hold instructions.

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If Multi Acquisition is changed to 2, scan time goes to 59 sec. The user can then decrease the TR to ~500ms so T1 weighting can be maintained, and scan time decreases to ~21 sec.

In the Scan Control area, the usermust change the Wait# to 1. The Wait# setting tells the system how many acquisitions to perform before pausing. In this example, the system will pause after performing 1 acquisition. (This is in addition to the pause after prescan).

The system is now set to perform 2 acquisitions of 18 slices each, with a pause after the prescan and a pause between the acquisitions. Each acquisition takes ~21 sec., which is a reasonable breathhold time.

How to perform multi acquisitions when more slices are needed:

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The system is now set to perform 2 acquisitions of 12 slices each, with a pause after the prescan and a pause between the acquisitions. Each acquisition takes ~16 sec., which is a reasonable breathhold time.

How to perform multi acquisitions when a lower scan time is needed:

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1 When 24 is entered / selected in the Multi slice box, the value in the TR box remains low. At 228ms, scan time is approximately 23 seconds.

If the value in the Multi Acquisition box is changed to 2, scan time goes to 45 sec. The user can then decrease the value in the TR box to ~120ms, so T1 weighting can be maintained, and scan time decreases to ~25 sec.In the Wait# box, under the Scan Control area on the ScanParameterList window, the user must enter / select 1.

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Chapter 3-4 Imaging: DynamicHow to perform dynamic studies: For demonstration purposes, a dynamic breast study is used. 1 Set up the slice / slab location

for the dynamic task utilizing three planes. The example shown here is an Axial TIGRE 3D Dynamic set-up.


Chapter 3-4 Imaging: DynamicParameters for dynamic studies are selected in the Scan Control area of the Scan Parameter List window.

In the Wait mode list, click ON. This will pause the system prior to starting the Pre-Cont. (mask).

In the Early Post Cont. box, enter or select 4 to acquire four “runs” or acquisitions. In the wait mode list, click Once, which means the system will pause only once before the first of the four Early Post Cont. scans.

How to perform dynamic studies: 2

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5 In the No. of scan set box, enter 2, indicating that you are performing two sets or groups of scans: Pre-Cont.(mask) and Early Post Cont.

6 In the Pre-Cont. box, enter or select 1 to run one acquisition, which will be the mask images.

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In the Multi scan mode list, click Dynamic.

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Chapter 3-4 Imaging: Dynamic

For a graphical display of the Scan Control area, left-click on the button, found under the Overview icon on the far right side of Scan Parameters window. The Dynamic scan time table window appears.

This window offers a “visual” picture of the dynamic scan process.

How to perform dynamic studies:

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Changes made to the parameters in the lower left of this window are reflected in the graphical display.

Currently, the graphical display shows that the system will wait before the Pre-Contrast scan, and will wait again before the Early Post Contrast scan. There will be a total of four Early Post Contrast acquisitions.

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The Scan Remaining Timewindow displays the progression of dynamic scans (the example shown here is four dynamic breast scans).

The gray box indicates that the first acquisition (Pre-Cont.) is complete.

The green box indicates that the second acquisition (first of 4 Early Post Cont.) is in progress.

How to perform dynamic studies:

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4 The 3 white boxes indicate that there are 3 more Early Post Cont. acquisitions to be acquired.

5 Indicates that the second of five total scans is currently running.

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Parameters for dynamic studies are selected in the Scan Controlarea of the Scan Parameter List window.

How to perform a dynamic liver study: For demonstration purposes, a liver study with imaging at 30 sec., 1 min., 3 min., 5 min., and 10 min.will be used.

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In the Wait mode list ON.

In the No. of scan set box, enter or select 2 indicating that you are performing two sets or groups of scans: Pre-Cont.(mask) and Early Post Cont.

In the Pre-Cont. box, enter or select 1 to run one acquisition, which will be the mask images. In the wait mode list, click Oncewhich means the system will pause before the Pre-Cont. scan.

In the Early Post Cont. box enter or select 5 to acquire five “runs” or acquisitions. In the wait modelist, click Every, which means the system will pause before each of the five Early Post Cont. scans

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In the Sync. StopWatch list, click ON. The stop watch feature will then be synchronized to start counting when the scan is started.

Click the button on the Launcher toolbar to open the StopWatch window.

The system is set to pause between each of the Post Cont. scans; the stop watch will continue counting; the usermust check the stop watch, then click the to start the Post Cont. scans at the appropriate times (1 min., 3 min., etc.).

How to perform a dynamic liver study:

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In this example, Auto Voicehas been activated to give Inspiration instructions.

A delay time of five seconds has been added to both the Pre-Cont.and the Early Post Cont. text boxes. This is the amount of time needed for Auto Voice to give breathing instructions, and allow the patient time to respond to the instructions.

With the addition of the five second delay time, the user will now click five seconds before the appropriate start time for the scan (i.e. 2:55, 4:55, etc.).

How to perform a dynamic liver study:

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Chapter 3-5 Imaging: Gating - RespiratoryHow to perform respiratory gating with large respiratory belt:

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While the patient is sitting or standing, instruct the patient to take a deep breath. Position the respiratory bellows over the area that rises as the patient breathes. The cushioned side of the bellows should be against the patient.

Adjust the attached white straps so that the belt is tight, but does not constrict the patient’s normal breathing. The bellows must be able to respond to the patient’s breathing. If the patient is standing, have them lie down on the table, and re-check the fit of the respiratory belt.

Connect the hose from the respiratory belt to the RESPconnector on the PMM module, located on the left side of the gantry.

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Chapter 3-5 Imaging: Gating - RespiratoryHow to perform respiratory gating with respiratory sensor pad:

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Your site may have respiratory gating equipment that includes a respiratory belt, respiratory sensor pad with blue tubing (see A), and a joint hose made of clear tubing (see B).

While the patient is sitting or standing, fasten the respiratory sensor belt just under the patient’s rib cage, fitting the belt comfortably against the abdomen. The solid white side of the belt should be against the patient.

Have the patient lie down on the table. Insert the respiratory sensor pad into the pocket on the belt; attach the blue tubing of the respiratory sensor to the clear tubing of the joint hose, using the end of the joint hose that does not have a metal fitting.

Re-check the fit of the respiratory belt.

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Chapter 3-5 Imaging: Gating - RespiratoryHow to perform respiratory gating:

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Connect the hose from the respiratory belt to the RESPconnector on the PMM module, located on the left side of the gantry.

At the Echelon console, click the Waveform button on the Launcher toolbar. The WaveForm window will open.

Click on the RESP tab to activate the respiratory gating. The tab highlights yellow.

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Chapter 3-5 Imaging: Gating - Respiratory

Monitor the waveform for approximately one minute to ensure a strong, steady signal. The system calculates the patient’s respiratory rate and displays it in the WaveFormwindow. If the waveform is erratic or otherwise unstable, reposition the respiratory belt on the patient, then check the waveform again.

The patient’s respiratory rate is displayed in the upper right corner of the WaveFormwindow. Enter this number in the Beat Rate box.

How to perform respiratory gating:

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Respiratory gating parameters are located in the Gating area of the Scan Parameter List window. In the Gating list, click Resp.

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Chapter 3-5 Imaging: Gating - Respiratory

The Gating Source list defaults to Resp.

The Resp Mode list defaults to Trigger.

In the Delay Mode list click Rate. The list of choices are Time, Rate, or Min.

How to perform respiratory gating:

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10 In the Delay (%) box, enter or select 20.

11 Check scan parameters in all areas, and click .

Gating Source

Resp Mode

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Chapter 3-6 Imaging: Gating - PulseHow to perform pulse gating:

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Warning: Verify that only the peripheral gating sensor touches the patient and that the cables do not come in contact with the patient. Contact with cables can lead to thermal injury.

For additional safety information, please refer to Chapter 1, Safety, in the Echelon Reference Manual.

Attach the pulse wave sensor to the patient’s middle or index finger so it fits snugly. The sensor must be positioned so that the arrow is on top of the fingernail.

Place the patient’s hand by his side. Advise the patient that any movement of their hand will interfere with the pulse signal.

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Connect the fiber optic cable from the pulse wave sensor to the PULSE connector on the PMM module, located on the left side of the gantry.

At the Echelon console, click on the Waveform button on the Launcher toolbar. The WaveForm window will appear.

Click on the PULSE tab to activate the pulse gating. The tab highlights yellow.

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Monitor the waveform for approximately one minute to ensure a strong, steady signal. The system calculates the patient’s pulse rate and displays it in the WaveForm window. If the waveform is erratic or otherwise unstable, reposition the pulse wave sensor on the patient’s finger, then check the waveform again.

Pulse gating parameters are located in the Gating area of Scan Parameter List window. In the Gating list, click MS-ECG or Cine.

The patient’s pulse rate is displayed in the upper right corner of the WaveFormwindow. Enter this number in the Beat Rate box.

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Chapter 3-6 Imaging: Gating - Pulse

a. Other options available in the Gating area depend on the selection made in the Sequencelist of the Scan Parameter List window.

b. The Gate Mode list options include Gate or Trigger.

c. The Echo Alloc list options include Sequential or Centric.

How to perform pulse gating:Check scan parameters in all areas and click .

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Gate Mode

Echo Alloc.

Scan Parameter list


Chapter 3-7 Imaging: Gating - CardiacHow to perform cardiac gating:

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ECG gating requires that ECG electrodes be placed on the patient. Before placing the ECG electrodes on the patient, wipe the skin on the chest where the electrodes will be placed with skin preparation gel. Follow the application instructions on the bottle.

Wipe off excess skin preparation gel with clean gauze.

Peel the backing from the electrodes.3

For detailed safety information, please refer to Chapter 1, Safety, in the Echelon Reference Manual.


Chapter 3-7 Imaging: Gating - Cardiac

How to perform cardiac gating: 4

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Warning: Do not use ECG patches that have exceeded their expiration date or appear to be damaged.

Note: If you do not receive a usable ECG waveform, the ECG leads can be rearranged until the waveform is acceptable.

Warning: Never use electrodes other than those supplied by Hitachi Medical Corporation in order to prevent burns to the person the ECG electrodes are affixed to.

Place the electrodes on the patient’s chest in the shape of a diamond, slightly left of midline and centered approximately halfway between the sternal notch and the xiphoid process. Make sure that the center points of the electrodes are not placed directly over the patient’s ribs.

Attach the ECG leads from the induction cord to the appropriate electrodes. Each lead is labeled and color-coded for correct placement around the heart: towards the right side of the diamond (RA, White), towards the bottom of the diamond (RL, Green), towards the top of the diamond (LA, Black), and towards the left side of the diamond (LL, Red). Do not press on the electrodes, as the electrode gel may escape and adversely affect the MR signal.

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For additional safety information, please refer to Chapter 1, Safety in the Echelon Reference Manual.

LA

RL

RA

LL

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Arrange the induction cord to be as straight as possible. 6

Warning: Do not allow gating cables to come in contact with a surface coil or surface coil cable.

Prevent the EGC lead wires and cable from coming in contact with the patients skin. Use padding or other materials to separate the ECG lead wires and the ECG cable from the patient. Contact with wires/cables can lead to thermal injury.

For additional safety information, please refer to Chapter 1, Safety, in the Echelon Reference Manual.

Connect the induction cord to the ECG connector on the PMM module, located on the lower left front of the gantry.

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8 At the Echelon console, click the Waveform button on the Launcher toolbar. The WaveForm window will display.

Monitor the waveform for approximately one minute to ensure a strong, steady signal. The system calculates the patient’s heart rate and displays it in the WaveForm window. If the waveform is erratic or otherwise unstable, reposition the electrodes on the patient, then check the waveform again.

Click on the ECG tab to activate the ECG gating. The tab highlights yellow.

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Select MS-ECG or Cine in the Gating field located in the Gating section of Scan Parameters.

Enter the patient’s heart rate in the Beat Rate field located below the Gating type. The patient’s heart rate is located in the upper right corner of the Waveform window.

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13 Select ECG in the Gating Source field.

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14 Other options available in the Gating area depend on the selection made in the Gating list. (Cine or MS-ECG).

In Cine gating, various Gate Modes are available.

Cine gating has fields for the user to select Multi Phase and Segment parameters, to determine the number of images to be acquired at different heart phases. The user can also enter or select the Delay (ms) time.

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Chapter 3-7 Imaging: Gating - Cardiac

MS-ECG gating uses multiple slices, rather than multiple phases of the cardiac cycle.

To perform cardiac gating:

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In MS-ECG gating, the Gate Mode list defaults to Trigger.

The user can enter or select values for Count and Interval (these fields cannot be adjusted in Cine gating), in addition to the Delay (ms) field.

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