6 Coil Choice and Positioning

Transcription

1 6 Coil Choice and Positioning 6.1 Head / CNS Coil Choice REGION COIL 1.5 T COIL 3.0 T Brain / Fast Brain Q-Head 3.0 T Head SENSE Head-8 SENSE Head-8 SENSE Flex-L, SENSE Flex-M SENSE NV Pituitary Q-Head 3.0 T Head SENSE Head-8 SENSE Head-8 Brain stem Q-Head 3.0 T Head SENSE Head-8 SENSE Head-8 Hippocampus Q-Head 3.0 T Head SENSE Head-8 SENSE Head-8 I.A.C. SENSE Flex-S SENSE Flex-M SENSE Head T Head Q-Head SENSE Head-8 Orbit(s) Q-Head 3.0 T Head SENSE Head-8 SENSE Head-8 SENSE Flex-S C3 or C4 Pediatric Q-Head (also see Synergy 3.0 T Head Pediatric Coil ) SENSE Head-8 Q-Knee for prematures Brain and C-Spine SENSE NV SENSE NV Synergy Head/Neck 6 ACHIEVA/INTERA Release 1.2/11 6-1

2 Figure 6.1 Q-Head coil for pediatric examination Brain - Positioning Q-Head Coil and 3.0 T Head Coil Place the head coil on the tabletop. Place the mattress on the table top. Make sure the head support is secure. Place the patient in the head support. - If the patient has a short neck, it is advisable to place some padding over the lower part of the support under the shoulders. - Use the small wedges to immobilize the head by placing them firmly between the head and the sides of the support. - Use the head fixation strap for extra immobilization. Pull the sliding part gently over the head and face. - Pull gently on both sides of the coil, close to the base. - It is not necessary to pull the coil all the way so that it 'clicks' into position: this may not be possible with patients with large shoulders or a short neck. In this case, the coil will function normally, although the head appears lower in the survey image. Attach the optical mirror to the coil or use the comfort zone so that the patient can look outside the bore. This can be reassuring to patients. WARNING Remember to insert the coil connector into one of the sockets. Starting a scan without it connected will damage the coil. Figure 6.2 Q-Head coil. Figure 6.3 Q-Head coil closed. Figure 6.4 Coil and comfort zone. 6-2 ACHIEVA/INTERA Release 1.2/11

3 SENSE Head-8 Coil Place the head coil on the tabletop. Place the mattress on the table top. Make sure the head support is secure. Place the patient in the head support. - Use the head fixation strap for extra immobilization. Pull the sliding part gently over the head and face. - Pull gently on both sides of the coil, close to the base. Attach the mirror to the coil such that the patient can look outside the bore. This can be reassuring to patients. WARNING Remember to insert the coil connector into one of the sockets. Starting a scan without it connected will damage the coil. 6 Figure 6.5 Coil on tabletop. Figure 6.6 Patient positioning. Figure 6.7 Patient positioning SENSE Flex-L Coil Use the SENSE Flex-L coil, alternatively also the SENSE Flex-M coil. Place the coil elements on both sides of the patient s head. - Use the TMJ holder if available. Figure 6.8 SENSE Flex-L coil for brain examination. ACHIEVA/INTERA Release 1.2/11 6-3

4 SENSE NV (NeuroVascular) Coil Place the coil base on the tabletop. Place the mattress on the table top. Make sure the head support is secure. Place the patient in the head support. - Use the head fixation strap for extra immobilization. Attach the head portion to the coil base. Figure 6.9 SENSE NV-16 coil Orbit and I.A.C. - Positioning SENSE Flex-S coil Position the patient in the TMJ coil holder rest assembly, if available. Center the patient s head and immobilize it using strap and band. Position each coil as close as possible to the patient s eyes rsp. ears. Figure 6.10 C4 in Q-head coil. Figure 6.11 SENSE Flex-L coil with comfort zone for brain examination. Figure 6.12 SENSE Flex-S coil with TMJ holder for orbit. C3 or C4 It is easier to position the surface coil when the patient is sitting. Use fixation straps to secure the coil. If used in combination with the head coil, the head band may be used for immobilization. 6-4 ACHIEVA/INTERA Release 1.2/11

5 - Use the optical mirror on the head coil in combination with a marker on the wall behind the MR system to avoid eye motion. Let the patient look at this marker during acquisition to fixate the eyes in one position. 6.2 Head / Neck Coil choice REGION COIL 1.5 T COIL 3.0 T Anterior neck (Thyroid, Larynx) Angio (Carotid arteries) SENSE NV Synergy Head/Neck SENSE Flex-S Synergy Head/Neck SENSE Flex-S Both TMJ SENSE Flex-S TMJ Combination C3, C4 SENSE NV SENSE Flex-M SENSE NV SENSE Flex-M SENSE Flex-M Single TMJ C4 or C3 SENSE Flex-M Anterior Neck and Angio - Positioning SENSE NV (NeuroVascular) Coil Place the coil base on the tabletop. Place the mattress on the table top. Make sure the head support is secure. Place the patient in the head support. - Use the head fixation strap for extra immobilization. Attach the head portion to the coil base. Figure 6.13 SENSE NV coil. ACHIEVA/INTERA Release 1.2/11 6-5

6 Synergy Head/Neck Coil Figure 6.14 Syn. Head/Neck coil. Area of interest Recommended coil elements Notes Anterior neck Head and neck A or AP all three elements: HAP A is optional Angio A For best SNR. * H: Head coil, A: anterior element, P: posterior element For best SNR. If A is used, apply REST slab over anterior thorax. C4 coil Use the TMJ coil holder if available. Position the patient in the TMJ coil holder rest assembly. Center the patient s head and immobilize it using strap and band. Position the C4 as close as possible to the throat. SENSE Flex-S Coil Use the TMJ coil holder if available. Position the patient in the TMJ coil holder rest assembly. Center the patient s head and immobilize it using strap and band. Position one element on the left hand side and the other one on the right hand side of the patient s neck. The SENSE Flex-S coil is not suited to image the carotid arteries in their entire length, but it provides excellent image quality if focussed on a specific area, e.g. the bifurcation. The SENSE Flex-M coil could also be used. Figure 6.15 C4 with TMJ holder: Anterior neck. Figure 6.16 SENSE Flex-S with TMJ holder: Angio. 6-6 ACHIEVA/INTERA Release 1.2/11

7 6.2.3 TMJ - Positioning SENSE Flex-S Coil Use the TMJ coil holder if available. Position the patient in the TMJ coil holder rest assembly. Center the patient s head and immobilize it using strap and band. Place your finger through the coil elements to locate the head of the mandible (ask the patient to open and close the mouth). Position each coil as close as possible to the patient s cheeks. Figure 6.17 SENSE Flex-S coil: TMJ. Circular Coils C3 and C4 Use the TMJ coil holder if available. Avoid positioning the coils so that the electronics box moves with patient respiration. The connector number in use must be specified in the preset procedure Figure 6.18 C4 in Q-head coil: TMJ. TMJ Coil Both joints can be imaged simultaneously. Position the patient in the TMJ coil holder rest assembly. Center the patient's head and immobilize it using velcro strap and band. Place your finger through the TMJ coils to locate the head of the mandible (ask the patient to open and close the mouth). Position each coil as close as possible to the patient's cheeks. Use the body coil to make a survey image of both TMJs. Figure 6.19 TMJ coil: TMJ study. ACHIEVA/INTERA Release 1.2/11 6-7

8 6.3 Spine Coil Choice REGION COIL 1.5 T COIL 3.0 T Cervical spine Synergy Spine coil 3.0 T CTL Spine Synergy Head/Neck coil C1 Thoracic spine Synergy Spine coil 3.0 T CTL Spine Q-T/L Spine coil R1 Lumbar spine Synergy Spine coil 3.0 T CTL Spine Q-T/L Spine coil R1 Total spine Synergy Spine coil 3.0 CTL Spine Pediatric spine REGION COIL 1.5 T COIL 3.0 T Total spine Q-Head coil and Synergy Pediatric coil 3.0 CTL Spine General positioning Use the knee cushion to minimize lumbar lordosis and the amount of motion due to breathing in the cervical spine. 6-8 ACHIEVA/INTERA Release 1.2/11

9 6.3.3 Cervical Spine - Positioning Figure 6.20 Synergy Spine Coil. Figure 6.21 Synergy Head/Neck coil. Figure T CTL Spine coil. Synergy Spine Coil Position the special mattress on the coil. Position the patient s neck as close to the coil as possible and avoid hyperextension of the neck. Coil element selection suggestions 6 Anatomy Field of View Elements C-spine (down to T4) 275 mm 1 or 1,2 CT-spine 400 mm 1,2, Synergy Head/Neck Coil Use all three elements for sagittal scans, but only the two neck elements for axial scans. 3.0 T CTL Spine Coil Position the special mattress on the coil. Position the patient s neck as close to the coil as possible and avoid hyperextension of the neck. ACHIEVA/INTERA Release 1.2/11 6-9

10 6.3.4 Thoracic Spine - Positioning Synergy Spine Coil Position the special mattress on the coil. Position the patient s neck as close to the coil as possible and avoid hyperextension of the neck. Coil element selection suggestions Anatomy Field of View Elements CT-spine 400 mm 1,2,3 T-spine (C7-L1) 350 mm 1,2,3 or 2,3 TL-spine 450 mm 2,3,4 Figure 6.23 Synergy Spine coil. Q-T/L Spine Coil Place a pillow under the top part of the T-spine coil. Position the special T/L spine coil mattress on the coil. Make sure that the L-segment is pulled down to the lowest position. Position the patient on the T-segment. C1 coil Position the patient supine on the C1 coil, electronics box to the side. Use the coil cable as a reference to define scan plane. Figure 6.24 Figure 6.25 Q-T/L coil: Adjusting. 3.0 T CTL Spine coil. R1 coil Position the coil at the required level with the patient supine. The positioning strip indicates the center of the coil. Position the electronics box towards the front opening of the bore, so that the cable does not loop and run parallel to the coil. Take care that the box does not cause patient discomfort. Using R1 and C1, the R1 should be placed between patient and C1 due to the limited penetration of the R1. Do not place the electronics boxes on top of each other, as this may cause artifacts. 3.0 T CTL Spine Coil Position the special mattress on the coil. Position the patient s neck as close to the coil as possible and avoid hyperextension of the neck ACHIEVA/INTERA Release 1.2/11

11 6.3.5 Lumbar Spine - Positioning Synergy Spine Coil Position the special mattress on the coil. Position the patient s neck as close to the coil as possible and avoid hyperextension of the neck. Coil element selection suggestions Anatomy Field of View Elements TL-spine 450 mm 2,3,4 L-spine 320 mm 2,3,4 or 3,4 or 4,5 S-spine 275 mm 4 or 4,5 Figure 6.26 Synergy Spine coil. Q-T/L Spine Coil Place a pillow under the top part of the T-spine coil. Position the special coil mattress on the coil. Pull the L-segment down to the lowest position. Position the patient so that the L-segment marker is in the middle of the patient's lumbar spine. C1 coil Position the patient supine on the C1 coil, electronics box to the side. Use the coil cable as a reference to define scan plane Figure 6.27 Q-T/L coil: Adjusting. R1 coil Position the coil at the required level with the patient supine. The positioning strip indicates the center of the coil. Position the electronics box towards the front opening of the bore, so that the cable does not loop and run parallel to the coil. Take care that the box does not cause patient discomfort. Using R1 and C1, the R1 should be placed between patient and C1 due to the limited penetration of the R1. Do not place the electronics boxes on top of each other, as this may cause artifacts. Figure T CTL Spine coil. 3.0 T CTL Spine Coil Position the special mattress on the coil. Position the patient s neck as close to the coil as possible and avoid hyperextension of the neck. ACHIEVA/INTERA Release 1.2/

12 6.3.6 Total spine - Positioning Synergy Spine coil Total spine studies can be performed in one scan with a maximum FOV of 530 mm. Use elements 1-4 or 2-5 for a full (overlapping) coverage. A table movement of approximately 30 cm is required for normal adults. For total spine imaging, the MobiTrak option can be used. Refer to the Total Spine preset procedures. Figure 6.29 Spine study setup. 3.0 T CTL Spine Coil Position the special mattress on the coil. Position the patient s neck as close to the coil as possible and avoid hyperextension of the neck Pediatric spine - Positioning Synergy Pediatric Coil Place the pediatric patient on the coil. Slide the Q-Head coil over the patient s head. Use fixation straps. Fasten them at the head fixation device. Head and Spine For neonates, the Q-head coil and the first 3 elements of the spine coil will cover brain and spine. If the anatomy of interest exceeds the maximum FOV, use two scans or stacks. Use elements H-4 for the first one and elements 1-5 (the spine coil) for the second one. Use free or perpendicular REST to reduce artifacts caused by the heart. Figure 6.30 Synergy Pediatric coil - position the patient Spine The Q-head coil does not need to be slid over the patient s head. Do not select the head coil element, but elements 1-5 (the spine coil). The Q-Head coil must always be used and be connected to the coil base ACHIEVA/INTERA Release 1.2/11

13 Figure 6.31 Decubitus positioning Using the vertical holder for decubitus examinations Position and lock the Q-Head coil on the base support. Put the base support of the pediatric spine coil on the table. Place the special vertical coil holder in the base. Slide the spine coil into the vertical holder with the cable on the top. Put the special mattress on the base. Connect the Q-Head coil cable to the base of the pediatric spine coil. Decubitus positioning Place the pediatric patient on their right side against the coil with the patient s head in the headrest. Minimize the distance between the patient s spine and the coil. Slide the Q-Head coil gently totally over the patient s head. For neonates (spina bifida), 4 elements (head coil and first 3 elements of spine coil) will cover brain and spine. Parameter settings FOV should be chosen according to the size of the child. Homogeneity correction should be set to none Homogeneity correction (HC) Homogeneity Correction (HC) should be set to different values with the different coils, see table. setting is automatically taken over to every next scan Coil Synergy Spine Coil (SSpC) Synergy Head/neck coil (SHNC) Q-Neck coil (QNC) C1 coil Q-Body coil Q-T/L Spine coil R1 coil Default setting HC Strong None None Weak None Strong Weak CLEAR is automatically taken over to every next scan. requires a reference scan to be made before it can be used. The reference scans can be found in the subanatomy refscans of the anatomy spine. ACHIEVA/INTERA Release 1.2/

14 can be used in combination with the Synergy Spine coil. In the survey protocol, homogeneity correction is chosen and set to strong. Activating CLEAR will give a conflict. Change homogeneity correction to none to solve the conflict. should always be used in combination with the Synergy Head/Neck coil and thus CLEAR is set to Yes in the protocol SURVEY/SHNC Total spine The subanatomy Total spine contains 3 sagittal protocols with a maximum FOV of 530 mm and 3 sagittal protocols using MobiTrak (only if the Synergy Spine coil and the MobiTrak option are available). Remarks Total Spine examinations can be done by means of the Synergy Spine-coil and the MobiTrak option. Three stacks (cervical, thoracic, lumbar) are acquired at different table positions. Table movement is required between acquisition of these stacks. Total Neuro Examination To perform a total neuro examination (head and spine imaging): Position the SENSE Flex-L or SENSE Flex-M coil at both sides of the patient s head. Add another stack to the MobiTrak protocols. Change the coil for stack D to SENSE Flex-L or Flex-M. To view the total neuro scans as 5 adjacent slices, choose screen layout 5rx4c (descending slice order) ACHIEVA/INTERA Release 1.2/11

15 6.4 Thorax Coil choice REGION COIL 1.5 T COIL 3.0 T Heart, Coronary Artery, Mediastinum SENSE Cardiac C1 3.0 T SENSE Cardiac Aorta SENSE Body SENSE Cardiac Lungs SENSE Body Q-Body Breast Bilateral Breast SENSE Body SENSE Flex-L C1 for one breast Pediatric Q-Head for small infants C3 for 1 to 6 months E1 for 6 months to 5 years SENSE Flex coils 3.0 T SENSE Cardiac 3.0 T SENSE Cardiac 3.0 T SENSE Torso SENSE Flex-L 3.0 T SENSE Cardiac SENSE Flex coils Positioning SENSE Cardiac Coil Electrodes and respiratory belt should be applied before putting on the top coil elements. Place the top section on the patient s chest. The top section is freely movable for positioning over the patient s left (normal heart location) or right side (congenital abnormality). - The center of the two top elements should be placed just to the left of the sternum. - Element number 1 of the top circular coil should be curved to wrap down, and over the patient s side. This will ensure that the lateral wall of the heart is properly covered by the surface coil. 6 Figure 6.32 Cardiac examination. NOTE For information on the element combination examples, refer to Application Guide, volume 3 on Cardiac imaging. The coil top may also be positioned more towards center or right side, if the heart is not in the normal location. ACHIEVA/INTERA Release 1.2/

16 3.0 T SENSE Cardiac coil Electrodes and respiratory belt should be applied before putting on the top coil elements. Position the patient on the coil base. Place the top section on the patient s chest. Wrap the straps around the patient to stabilize the coil. Figure 6.33 coil. 3.0 T SENSE Cardiac SENSE Flex-L coil (pediatric applications) Children may be more comfortable prone with the leads on the back. For more details on how to position the SENSE Flex-L coil, refer to the chapter on coils. Breast coil Figure 6.34 SENSE Flex-L for Pediatric study Patient preparation Prepare the patient as usual for an MR examination. It is advisable to have the patient strip to the waist, to remove any zip fasteners in the waist area, and that the patient wears an open fronted gown (imaging is best performed when the breasts can hang freely in the coil aperture). If a patient objects to lying semi-naked, an oversized T-Shirt could be worn, providing the breasts are not inhibited by the material and can be manipulated if necessary. Coil Positioning Place the coil part on the tabletop with the coil aperture to the magnet and the cable placed in one of the cable grooves in the side of the table. Place the head support on the table in front of the coil. Fold the table mattress double and place it at the back of the coil to support the rest of the body ACHIEVA/INTERA Release 1.2/11

17 Figure 6.35 in position Breast coil with patient Patient Positioning Let the patient kneel on to the tabletop, facing the magnet, then lean forward (with assistance) and firmly grasp both sides of the patient support. Let the patient slowly lower her breasts into the coil aperture. Assistance should always be given to the patient, especially elderly or weak patients. If possible, the operator should ensure that the breasts are hanging freely in the coil. This may be difficult to achieve with very large breasts. It is advisable that the patient's arms are placed alongside her body, as this allows the shoulders to drop forwards onto the support, which in turn ensures better contact of the auxiliary region with the coil. Moreover, having (at least) one arm alongside the body facilitates the administration of intravenous contrast, if necessary. A separate head support is supplied. A cushion may also be used in combination with this support. The head should be kept as low as possible: if it is raised, the auxiliary region may no longer be close to the coil. If a large cushion is used, care should be taken that the patient is able to breathe freely. Centre the light visor to the marks on the side of the coil, and move the patient into the isocentre in the same way as with any other surface coil. With larger patients it may be difficult to align the light visor with the marks on the coil, a marker on the table top can be useful. NOTE Please note that if the cable is long enough the additional cable trap should not be used Figure 6.36 SENSE Breast mattress SENSE Body coil for breast imaging Use the SENSE breast mattress in conjunction with the SENSE Body coil to provide high quality SENSE imaging of the breast. The mattress comprises of two parts: a solid foam base a flexible cover with fits onto the top side of the base The base of the mattress has recesses on the top and bottom into which the anterior and posterior elements of the SENSE Body coil fit. These recesses also contain velcro attachment points to anchor the SENSE Body coil in place. Along either side of the top and bottom of the base are grooves into which the cables of the SENSE Body coil should be placed. This gives the required separation between the patient s skin and the cables ensuring both safety and comfort. ACHIEVA/INTERA Release 1.2/

18 The flexible cover is designed to sit on the top of the base and cover the SENSE Body coil and cable. It is also fixed to the SENSE Body coil and the base by use of velcro attachment. Both the base and cover are designed for ease of cleaning for the prevention of cross-infection. Workflow 1 Put the posterior elements of the SENSE Body coil in the recesses of the base. 2 Place the cables of the SENSE Body coil in the groove on the bottom of the mattress. 3 Put the base centrally on the table top so that the whole device is supported. NOTE If the base if off-centred so that part of it is not fully on the table top, a risk of the mattress tipping exists which could lead to injury to the patient. Flexible cover SENSE Body coil Base Cables located in groove Figure 6.37 Diagram of the SENSE Breast mattress. 4 Place the cables of the SENSE Body coil in the grooves on the top of the mattress. 5 Put the anterior part of the coil in the top recess of the base. 6 Put the flexible cover on the top of the base, covering both the base and the SENSE Body coil. 7 Position the patient so that their breasts are centrally located within the holes provided. The patient s arms can be positioned either alongside the body or above the head depending on the patient s preference. 8 Centre the light visor to the patient s breasts, and move the patient into the isocentre in the normal way. Labelling Because there are no labels on the product, this information is stated in this document. Figure 6.38 Labels 6-18 ACHIEVA/INTERA Release 1.2/11

19 6.5 Abdomen Coil choice REGION COIL 1.5 T COIL 3.0 T Liver/spleen, Angio SENSE Body 3.0 T SENSE Torso Q-Body Q-Body Kidney/adrenals SENSE Body 3.0 T SENSE Torso C1 Pancreas SENSE Body 3.0 T SENSE Torso SENSE Cardiac 3.0 T SENSE Cardiac C1 Pediatric body SENSE Flex-S, -M, -L SENSE Flex-S, -M, -L depending on patient s size depending on patient s size Positioning SENSE Body Coil For abdomen, the coil is usually positioned with the largest coverage in RL-direction. For abdominal angio, the coil is rotated for large FH-coverage (45 cm) Figure 6.39 Abdomen study. Figure 6.40 Coil rotated. NOTE The reference scan has to be performed in inspiration and the SENSE-scan itself in expiration. This is crucial for best image quality. ACHIEVA/INTERA Release 1.2/

20 SENSE Cardiac Coil Use all five coil elements for abdomen examinations. NOTE The reference scan has to be performed in inspiration and the SENSE-scan itself in expiration. This is crucial for best image quality. C1 Coil Use the immobilization strap to fix the coil at the patient and minimize respiratory motion. Kidney Position the patient supine with the C1 coil underneath. Use the coil cable as centering point. SENSE Flex coils Do not place the coil elements too close to each other. Keep a minimum distance of 8 cm. Use cushions if necessary. Figure 6.41 SENSE Cardiac: Patient positioning abdomen. Figure 6.42 application. SENSE Flex-L: Pediatric Figure T SENSE Torso coil. 3.0 T SENSE Torso Coil Position the patient on the coil base. Place the top section on the patient s chest. Wrap the straps around the patient to stabilize the coil ACHIEVA/INTERA Release 1.2/11

21 6.6 Pelvis Coil choice REGION COIL 1.5 T COIL 3.0 T Bladder SENSE Body 3.0 T SENSE Torso SENSE Cardiac 3.0 T SENSE Cardiac C1 Angio SENSE Body 3.0 T SENSE Torso Q-Body 3.0 T SENSE Cardiac Prostate Endo-cavitary 3.0 T SENSE Torso SENSE Body 3.0 T SENSE Cardiac SENSE Flex-L SENSE Cardiac Testes C3 or C1 3.0 T SENSE Torso 3.0 T SENSE Cardiac Pediatric body SENSE Flex-S, -M, -L SENSE Flex-S, -M, -L depending on patient s size depending on patient s size Positioning SENSE Body Coil The coil is usually positioned with the largest coverage in RL-direction. 6 SENSE Cardiac Coil Use all five coil elements for abdomen examinations SENSE Flex coils Prostate Use the SENSE Flex-L coil. Use the imobilization strap to fix the upper element in position and minimize respiratory motion. The patient can also be positioned prone, in which case extra attention should be paid to patient comfort. Figure 6.44 Prostate study ACHIEVA/INTERA Release 1.2/

22 Figure 6.45 Pediatric study Pediatric body applications Do not place the coil elements too close to each other. Keep a minimum distance of 8 cm. Use cushions if necessary. Endo-cavitary coil This coil can be used for prostate and rectum imaging. Refer to the safety guidelines in chapter 2. Circular Coils C1, C3 and C4 Testes Use the C3 or C4 coil. For easier positioning and imaging, support the genitalia on a cushion or a strap spanned across the thighs. The genitalia may be passed through (and rest on) the surface coil. Use fixation straps to secure the coil. Bladder Use the immobilization strap to fix the C1 coil position and minimize respiratory motion. The patient can also be positioned prone, in which case extra attention should be paid to patient comfort. 3.0 T SENSE Torso Coil Position the patient on the coil base. Place the top section on the patient s chest. Wrap the straps around the patient to stabilize the coil. Figure T Torso Coil ACHIEVA/INTERA Release 1.2/11

23 6.7 Upper Extremities Coil choice REGION COIL 1.5 T COIL 3.0 T Shoulder SENSE Flex-M, SENSE Flex-L C3, E1, C1 (larger patients) Elbow SENSE Flex-S Long bones: Upper arm, forearm C3, E1, C1 Q-Body E1, R1, SENSE Flex-L Wrist SENSE Flex-S C4, C3 Hand SENSE Flex-S C1, C3 Microscopy Microscopy coils Pediatric applications SENSE Flex-S, -M, -L depending on patient s size SENSE Flex-M, SENSE Flex-L SENSE Flex-M SENSE Flex-M SENSE Flex-M SENSE Flex-M SENSE Flex-M, -L depending on patient s size Homogeneity Correction (HC) should be set to different values with the different coils, see table. setting is automatically taken over to every next scan Coil Flexible surface coils C1, C3, C4, E1 SENSE Flex coils Quadrature coils Default setting HC Weak None None CLEAR is automatically taken over to every next scan. requires a reference scan to be made before it can be used. The reference scans can be found in the subanatomy refscans. should be used with all SENSE coils. ACHIEVA/INTERA Release 1.2/

24 6.7.2 Shoulder - Positioning Positioning a patient for the shoulder, one should note: The shoulder is as much in the isocenter as possible by positioning the patient a little semi-oblique. Support the patient s back and legs with cushions. The arm is placed next to the patient on the tabletop to minimize motion artifacts due to breathing. SENSE Flex-M or SENSE Flex-L coil Flex-coils have to be positioned exactly on the gleno-humural joint. Figure 6.47 SENSE Flex-M: Shoulder, method 1. Figure 6.48 SENSE Flex-M: Shoulder, method 2. Place a strap on the table. Position the patient slightly off-center so that the shoulder of interest is positioned close to the iso-center. Method 1 - Place one coil element such that it encompasses the top of the shoulder (if possible with arm through the coil element) and lies approximately in the sagittal plane. - Place the second coil element on top of the first one approximately in the coronal plane. It should have a 20% overlap parallel to the clavicle. Method 2 - Place one coil element behind the shoulder joint. - Place the second coil element anterior. - Position the elements parallel to each other. Make sure that they do not touch each other. Use the strap to keep both coil elements in place ACHIEVA/INTERA Release 1.2/11

25 Do not put a sandbag on the shoulder, because this can generate movement artifacts or artifacts that result from small ferrous particles in the sandbag. In order to avoid breathing artifacts, try to turn the patient on the to-beexamined side if possible. Do not place the patient s arm on the abdomen. Shoulder at opposite side of Patient Support Control Panel Cables between coil elements and the combinerbox should be parallel to the bore s long axis. The rest of the coil (outside the magnet) should run in a curved route to the control panel. Make sure there is a distance between cable and patient and between patient and combiner box (can be placed underneath the leg support). Figure 6.49 Cable positioning C1 coil (e.g. for adults) Position the C1 coil - either with the arm placed through the coil - or with the coil folded over the shoulder. Be careful that the coil will not be abnormally folded as this could decrease image quality. Fixate with a strap, and use positioning cushions if necessary. Do not place the electronic box on the patient s chest as this causes artifacts in the images. If fat suppression is required, avoid scanning through the electronic box and make sure that the electronic box is not touching the patient s skin Figure 6.50 C1: Shoulder. Arm placed through coil. For semi-oblique position Place cushions under the side not being imaged so that the shoulder of interest is moved closer to the isocenter. Use straps to hold the coil in place. Ensure that the raised shoulder travels unhindered into the centre of the system during travel-to-scanplane. C3 coil (e.g. small adults or children) Position the C3 coil on top of the shoulder joint. ACHIEVA/INTERA Release 1.2/

26 E1 coil Wrap the E1 coil around the humerus to examine the shoulder joint. Do not place the coil too low, make sure that the AC-joint is covered by the coil. Fixation straps are used to keep the coil in the proper position. For a semi-oblique position: place cushions under the side not being imaged so that the shoulder of interest is moved closer to the isocenter. Use straps to hold the coil in place. Ensure that the raised shoulder travels unhindered into the centre of the system during travel-to-scanplane. Figure 6.51 E1: Shoulder Long bones - Positioning Position the patient supine, with the arm along the patient's side. The arm is preferably in exo-rotation which means that the thumb is pointing towards the magnet bore). With the R1, the arm lies on top of the coil. Position the electronics box towards the front opening of the bore, so that the cable does not loop and run parallel to the coil. Take care that the box does not cause patient discomfort. Use positioning cushions to ensure patient comfort. Avoid placing sandbags near or inside the FOV Elbow - Positioning Position the patient supine, with the arm along the patient's side. - The elbow is as much in the isocenter as possible. The arm is preferably in exo-rotation which means that the thumb is pointing towards the magnet bore). Use positioning cushions to ensure patient comfort. Avoid placing sandbags near or inside the FOV. Figure 6.52 SENSE Flex-S: Elbow. C3 coil Position the C3 coil with the arm placed through the coil 6-26 ACHIEVA/INTERA Release 1.2/11

27 6.7.5 Hand / Wrist - Positioning Position the patient supine, with the arm along the patient's side. - The hand/wrist is as much in the isocenter as possible Strap the arm to the patient s body. Use sandbags to immobilize leg and foot. Use positioning cushions to ensure patient comfort. Avoid placing sandbags near or inside the FOV. Figure 6.53 SENSE Flex-S coil: Hand / wrist. C3 coil or C4 coil Use the C3 or the C4 coil dependent on the size of the wrist. Insert the wrist through the coil or position the wrist on the coil. SENSE Flex-S/-M coil For the SENSE Flex-M coil, use cushions between hand and coil element to avoid coupling between the coil elements. For the SENSE Flex-S coil, don t use cushions between hand and coil element Microscopy - Positioning bore Figure 6.54 Correct positioning. bore Figure 6.55 Wrong positioning. Skin imaging To achieve the best possible image quality, make sure that both the coil and the anatomy are perfectly immobilized. Use sandbags and/or straps. Start with a large FOV (450 mm) to find the location of the coil. Proceed with a multistack small FOV (15 mm) survey. Then perform high resolution scans. Eye studies To avoid eye movement, ask the patient to close the eyes or to focus on a specific point in the bore or via a mirror on the wall behind the scanner. 6 ACHIEVA/INTERA Release 1.2/

28 Figure 6.56 Figure 6.57 Figure 6.58 Figure 6.59 Figure 6.60 Figure Preset procedures in general Always add Left or Right to the scan name to prevent errors with the scanned anatomical area. Image resolution can be improved using a 512 reconstruction matrix. In case of large offcenters it is advisable to start up with a survey with a very large FOV. Plan a MST survey with a smaller FOV on this one ACHIEVA/INTERA Release 1.2/11

29 6.8 Lower Extremities Coil choice REGION COIL 1.5 T COIL 3.0 T Hips (both) SENSE Body 3.0 T SENSE Torso Single hip SENSE Flex-L, C1 SENSE Flex-L Upper legs Q-Body, SENSE Flex-L Q-Body, SENSE Flex-L Lower legs R1, C1 3.0 T SENSE Torso Knees (both) SENSE Body, SENSE Cardiac 3.0 T SENSE Torso Q-Knee/Foot and E1 Single knee Q-Knee/Foot, E1 SENSE Flex-M SENSE Flex-M, SENSE Flex-S Patella SENSE Flex-S, C3, C4 SENSE Flex-M Ankles (both) Q-Head 3.0 T Head Single ankle Q-Knee/Foot, E1, SENSE Flex-S SENSE Flex-M Foot Q-Knee/Foot, Q-Head, C1 SENSE Flex-M SENSE Flex-S Angio SENSE Body 3.0 T SENSE Torso Synergy P/V Q-Knee/Foot Pediatric applications SENSE Flex-S, -M, -L SENSE Flex-M, -L depending on patient s size depending on patient s size Homogeneity Correction (HC) should be set to different values with the different coils, see table. setting is automatically taken over to every next scan. Coil Synergy coils; SENSE coils; Quadrature coils Flexible surface coils R1, C1, E1 Default setting HC None Weak CLEAR is automatically taken over to every next scan. requires a reference scan to be made before it can be used. The reference scans can be found in the subanatomy refscans. should be used with all SENSE coils. ACHIEVA/INTERA Release 1.2/

30 6.8.2 Hips - Positioning Do not position the patient too low on the tabletop. Position the patient between the markers on the table top. Tall patients can be positioned feet first. The preset procedures assume a head first positioning. The patient's hands should be on the chest. SENSE Body Coil The coil is positioned with the largest coverage in RL-direction. SENSE Flex coils Do not place the coil elements too close to each other. Keep a minimum distance of 8 cm. Use cushions if necessary. Figure 6.62 single hip. SENSE Flex-M: Pediatric Figure 6.63 study. R1 coil for lower leg Long Bones - Positioning If available, use the MobiTrak extremity device to immobilize the legs and to get them aligned as well as possible. In other cases, use straps and cushions to uplift and immobilize the legs ACHIEVA/INTERA Release 1.2/11

31 6.8.4 Knee - Positioning Use foam pads to keep the knee securely in place. Use sandbags and cushions to stabilize the knee. Prevent that sandbags are placed near or inside the field of view to avoid shimming problems. Figure 6.64 SENSE Knee coil. Figure 6.65 Q-Knee/Foot coil: single Knee. Figure 6.66 both knees. SENSE Cardiac coil: Ankle / Foot - Positioning Endorotate the ankle a little to get nice anatomic orthogonal surveys Figure 6.67 single ankle. Q-Knee/Foot coil: Figure 6.68 Q-Knee/Foot coil: single ankle. Figure 6.69 ankles / feet. Q-Head coil: both Q-Head coil Remove the headrest; place some foam cushions on the coil base. Place a cushion between the feet and the RF mirror of the coil to improve image quality especially in SPIR, SPAIR and ProSet sequences. ACHIEVA/INTERA Release 1.2/

32 6.8.6 Angio - Positioning Synergy P/V coil Figure 6.70 Coil Positioning Move the table top completely out of the magnet without lowering it. Place the base pad onto the table top with the thick extremity towards the magnet. Place the posterior coil onto the base pad allowing the base soft square pads to fit into the coil grid. Bend the longest of the two short base pad cables and plug it into the posterior coil. Figure 6.71 Figure 6.72 Syn. PV coil open. Syn. PV coil closed. Slide the base pad towards the magnet until the center of the upper station coil - marked with a black cross - lies ahead, in the magnet direction, of the marker on the table top, which indicates the farthest point that can reach the isocenter. The thick end of the base pad will stick out of the table top by 4 cm or more. Patient positioning Position the patient feet first with the heels leaning on the thick square pads at the end of the base pad. Place the two elongated foam cushions under the knee and under the ankles in order to avoid calf compression. Place the supplied foam cube between the patient s legs to provide support to the anterior coil. Support the upper back and the head of the patient with a pillow or other padding material to ensure patient comfort. Place the anterior coil on top of the patient s legs and abdomen while making sure that the three stations coil centers coincide to the ones of the posterior coil. The patient s feet cam be placed through or underneath the coil part dependent on the patient s length and coverage needed. Stabilize the patient s legs with sandbags if necessary. Wrap the posterior coil lateral flaps around the patient s legs until they touch the anterior coil. Wrap the straps attached to the posterior coils around the patient to stabilize the anterior coil as well as the lateral flaps. Plug the base pad connector with the shortest cable into the anterior coil. As the patient s feet are in close proximity to this connector they should be padded medially then strapped together. Plug the coil into one of the scanner contral panel synergy connectors ACHIEVA/INTERA Release 1.2/11

33 Use the light visor to position the lower station marker, marked by an engraved cross on the anterior coil surface, into the magnet isocenter. NOTE The arms of the patient are best left outside the coil. Cleaning of the coil is possible with a moist cloth. Avoid cleaning the connector at the feet end of the coil with water. SENSE Body Coil Peripheral Vascular Angiography For PV studies (in combination with MobiTrak) the coil can be positioned to enhance the signal in the lower legs. Attention is needed in order to prevent the cables from being caught in between table top and table. Make sure the cable of the coil can handle the total table travel distance. The upper coil elements have to be shifted with respect to the lower elements in order to compensate for signal loss between the elements. Figure 6.73 Syn. PV coil closed Preset Procedures - In General Always add Left or Right to the scan name to prevent errors with the scanned anatomical area. Image resolution can be improved using a 512 reconstruction matrix ACHIEVA/INTERA Release 1.2/

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