Instructions for Use. English. Release 5 - International. Volume 2: Operation in the Magnet Room. Achieva

Transcription

1 Instructions for Use English Release 5 - International Volume 2: Operation in the Magnet Room Achieva

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3 Table of contents Table of contents 1 About these Instructions for Use System Overview MR Scanner Panels Panels Achieva 3.0T TX systems Panels Achieva 1.5T and 3.0T systems Magnet Display Devices and controls essential for system safety ScandiLink Option Examination preparation Preparation of the tabletop Moving patient to isocenter Wireless Physiology Wireless-PPU and Wireless-VCG unit Battery charger Ordering of consumable items and equipment Display of Physiology Signals Respiratory Sensor Peripheral Pulse Sensor VCG (VectorCardioGraphy) Using the trolley Coils and Positioning General coil safety About Coils About Positioning in general Safety Hearing Protection and Nurse Call General Hints Available coils per anatomic region Coil Choice Head / CNS Head / Neck Spine Thorax Abdomen Pelvis Upper Extremities Lower Extremities Achieva 3

4 Table of contents SmartExam and Coils Q-Head coil Positioning SENSE Head coil 6 and Positioning for brain examination SENSE Head coil Patient positioning Removing the anterior coil section SENSE Head/Neck coil Lifting the coil SENSE Head/Neck coil in head/neck and spine examinations Coil elements T/R Head coil Coil positioning on tabletop T/R Head coil for brain examination H Head coil Coil positioning on tabletop H Head coil for brain examination TMJ coil / Coil Holder TMJ coil for TMJ examinations SENSE NeuroVascular coil 8 and Positioning Lifting up the coil Coil elements Operating modes SENSE NV coil Operating modes SENSE NV 16 coil SENSE Head/Spine coil combination SENSE Pediatric Head Spine coil Positioning SENSE Spine coil Coil elements and element selection SENSE Spine coil 1.5T SENSE Spine coil in C-, T- and L-Spine Total Spine workflow in ExamCards SENSE Spine coil in MobiTrak/MobiFlex examinations SENSE Spine coil 3.0T Positioning for C-, T- and L-Spine Total Spine workflow in ExamCards SENSE Spine coil in MobiTrak/MobiFlex examinations Synergy Pediatric coil Coil Assembly of the Synergy Pediatric coil Pediatric spine examinations Achieva

5 Table of contents Q-Body coil SENSE Cardiac coil 1.5T Positioning with the SENSE Cardiac coil 1.5T SENSE Cardiac coil 3.0T Positioning with the SENSE Cardiac coil 3.0T SENSE Torso/Cardiac coil Positioning with the SENSE Torso/Cardiac coil SENSE Breast coil Positioning with the SENSE Breast coil SENSE Breast coil 7 (incl. biopsy) Positioning with the SENSE Breast coil Breast Biopsy MammoTrak Safety MammoTrak Components MammoTrak trolley MammoTrak Breast coil MammoTrak Breast coil Head support Workflow SENSE Breast 3.0T X/TX SENSE Body coil Positioning SENSE XL Torso coil Positioning Coil element combinations SENSE XL Torso T/3.0T Positioning SENSE Torso coil 3.0T Positioning SENSE Torso coil 3.0T Endo-Cavitary coil 1.5T Insertion of the coil Connecting the coil Removing the coil Cleaning / Disinfection Exchangeable coil parts Endo coil with disposable probe Insertion of the coil Positioning and connecting Removing the coil Cleaning / Disinfection Storage Achieva 5

6 Table of contents SENSE Pediatric Body/Cardiac coil Positioning SENSE Shoulder coil Positioning SENSE Shoulder coil Positioning SENSE Wrist coil Positioning SENSE Wrist coil Positioning Hand/Wrist coil Positioning SENSE Small Extremity coil Positioning Knee/Foot coil Positioning Knee/Foot coil 4 (FootAnkleKnee) Positioning SENSE Knee coil T Positioning SENSE T/R Knee coil T Positioning SENSE Knee coil Positioning SENSE Foot-Ankle coil Positioning SENSE PeriphVascular coil MobiTrak or MobiFlex Positioning SENSE GP Flex L 8 coil Positioning for Single Hip Microscopy coils Positioning SENSE Flex coils General SENSE Flex coil spacer SENSE Flex-S coil in head and neck applications SENSE Flex coils in body applications SENSE Flex coils in orthopedic applications Circular coils C1, C3, C Positioning Phosphorous coil Achieva

7 Table of contents 5 Coil combinations Different ways of combining coils Possible Coil Combinations 1.5T Possible Coil Combinations 3.0T SENSE Head/Spine coil combination Positioning SENSE Head/Spine coil combination Total Neuro Examination Allowed Coil Combinations SENSE Spine coil with SENSE Flex-L coil Positioning SENSE Spine coil with SENSE Flex-L coil Total Neuro Examination Allowed Coil Combinations SENSE Flex Coils Combinations Positioning of SENSE Flex-S and -M coil for knee examination Positioning Aids Basic Set Arm Board Pediatric Positioning Aids Pediatric Package Acoustic Hood MobiFlex Feet Immobilizer Index Achieva 7

8 Table of contents 8 Achieva

9 About these Instructions for Use 1 About these Instructions for Use These Instructions for Use consist of three volumes: 1. Your MRI System 2. Operation in the Magnet Room 3. Operation at the MR console This volume 2 of these Instructions for Use, "Operation in the Magnet Room", contains information on how to operate the system in the magnet room, e. g. with respect to coils, patient positioning in the system. This manual may contain descriptions regarding the features and functionalities that are not implemented on the current equipment shipped for Japan and/or the product(s) that is/are not currently sold in Japan due to limitations and restrictions under the applicable local laws and regulations in Japan. Within these Instructions for Use, the most extensive configuration of the system is described, with the maximum number of options and accessories. Not every function described may be available on your system. Achieva 9

10 About these Instructions for Use 10 Achieva

11 System Overview 2 System Overview Your Philips Achieva consists of: MR Scanner For more information, refer to chapter MR Scanner on page 12. Radio Frequency (RF) System RF coils. A transmit coil transmits the RF pulses into the patient. A receive coil receives the MR relaxation signals subsequently emitted by the patient. Available coil types on your MR systems are transmit-/receive-coils and receive-only coils. RF transmitter. The RF transmitter generates the RF pulses. On 3.0T Achieva TX systems the RF transmitter has MultiTransmit capability (with Multi- Transmit capable coils). RF receiver and spectrometer. These analyze the MR signals emitted by the patient. For more information, refer to chapter Coils and Positioning on page 51. Wireless Physiology Wireless Physiology provides synchronization of the MRI sequences with physiology signals. The systems detects respiration, VectorCardioGraphy (VCG) and peripheral pulse (PPU)signals. For more information, refer to chapter Wireless Physiology on page 29. Operator's Console Computer system (Windows operating system and MR system software) and an external DVD recorder. a wide-screen display unit with USB connectors, keyboard and a mouse, patient-operator intercom with nurse call reset, For more information, refer to volume 3 of these Instructions for Use. Achieva 11

12 System Overview MR Scanner MR Scanner Fig. 1: Achieva MR system. Number Description 1 Examination Room Display (ERD) 2 Available only on 3.0T TX: User Interface Module (UIM) 3 Magnet bore with gradient coils and System Body coil 4 Patient support 5 Tabletop 6 User Interface Module (UIM) 7 Magnet, only on 3.0T TX with Ambient ring Magnet and magnet bore Philips MR imaging systems are available with different magnet field strengths. During an examination the patient is positioned in the magnet bore of the system. Gradient coils, the System Body coil and a patient ventilation system are integrated in the magnet bore. Gradient system The gradient coils, which are integrated in the system, provide the relative small magnetic field variations needed for the localization of the weak magnetic resonance relaxation signal emitted by the human body. Philips MR imaging systems are available with different gradient field strengths. Tabletop and patient support During a MR examination, the patient is positioned on a tabletop which is carried by the patient support. 12 Achieva

13 Panels System Overview The tabletop can be moved longitudinally to transport the patient into the magnet. It can also be moved vertically for convenient patient transfer. The tabletop movement can be controlled by means of the UIM (see section below). User Interface Module (UIM) This panel comprises buttons and switches for patient support control, acquisition control and patient comfort. For more information, see chapter Panels on page 13. Examination Room Display (ERD) This optional display is suspended from the ceiling of the examination room. It shows the same view as on the display of the operator s console. It is meant for interventional examinations. Panels Panels Achieva 3.0T TX systems User Interface Module (UIM) There is a UIM located on both sides of the magnet bore. Both panels have the same functionality, but the layout is mirrored. Fig. 2: UIM on Achieva systems at the left side of the magnet bore. The location of the buttons on the right side UIM are mirrored with respect to the left side UIM. Tumble switch The Tumble switch initiates all motorized movements of patient support and tabletop. Achieva 13

14 System Overview Panels Horizontal and vertical movement With the Tumble switch the patient support is moved: up or down when the tabletop is totally moved out of the magnet bore, the vertical speed is fixed. in or out the magnet bore when the patient support is at its highest position, two different speeds are available. Operating the Tumble switch Push the Tumble switch up for the up or in movement of the tabletop and push the switch down for the out or down movement. As long as the Tumble switch is returned gently to the middle position, the horizontal movement will be smooth and comfortable for the patient. If the Tumble switch is released suddenly it will result in an emergency stop of the tabletop movement: it will stop within a distance 15 mm. Light visor By pressing this button a laser light beam is projected onto the patient. This selects the patient reference point, i.e. the plane which will be positioned in the isocenter of the magnet. The laser light will automatically switch off after 15 seconds. Typical use of the Light visor is only once for every patient. Use of the Light visor during the performance of an exam will be ignored: a new patient reference point cannot be defined. WARNING Prevent a patient from looking into the laser beam. Direct laser light damages the eyes. Travel to scanplane (TTS) With this button the TTS mode can be toggled on and off. TTS Mode In TTS mode the tabletop movement will follow the operation of the Tumble switch. When moving the tabletop into the magnet bore it will stop when the patient reference point is in the isocenter. 14 Achieva

15 Panels System Overview The direction of movement to the isocenter is indicated: when tabletop movement is away from the isocenter, the button will flash slowly. Patient reference point After the patient reference point is positioned in the isocenter of the magnet, a survey is performed and all subsequent scans are planned with the information of this patient reference point. All tabletop movements which are required for optimal image quality are deduced from this point. Stop scan Pressing the Stop scan button will stop the currently running scan. Pressing this button will also abort travel to scanplane tabletop movement. It will also stop tabletop movement during a MobiTrak scan. The button has a ridge around it to prevent it from being pressed by accident. Pressing the Stop scan button twice will also stop image reconstruction. If pressed only once, reconstruction will continue if enough data is available. Start scan / Pause scan This button can be used to start a scan in the examination room. When this button is pressed during a scan the scan is stopped immediately. Pressing the button again will resume the scan. In a MobiTrak scan this button will also initiate tabletop movement and start the scan automatically. Bore illumination and Ambient Ring The bore lights can be adjusted to three levels, which are indicated on the LED bar: off, medium and full light. The Ambient Ring is switched on and off simultaneously with the bore lights. Ventilation The amount of ventilation through the magnet bore can be controlled with the Ventilation button. The level of ventilation is indicated on the LED bar. Achieva 15

16 System Overview Panels Ventilation air is not sterile. Music volume This button can be used to adjust the volume of music for the patient. The level is indicated on the LED bar. Talk The Talk button enables communication between the operator in the examination room and the patient wearing a headset. Press the Talk button when the headset is plugged in. This connects the magnet microphone to the patient headset (the button illuminates), and switches off the music speakers in the examination room. This allows easy communication with the patient. Once pressed, it will remain active until pressed again (the LED goes off ). The Talk button on the intercom at the console can temporarily overrule the magnet microphone, but cannot switch it off. Remember to turn on the music after talking to the patient. If the headset is not in use, it should be unplugged. Emergency stop Pressing the Emergency stop button will stop the tabletop movement. This can be reset using the Resume button. The Stop button has a ridge around it to prevent it from being pressed by accident. Resume Pressing this button will reset the tabletop after an emergency stop. Operation is re-enabled. Manual mode Manual mode can be used to toggle between motorized and manual mode. The LED next to the button illuminates when the tabletop is in manual mode. Tabletop position information is available in manual mode. 16 Achieva

17 Panels System Overview When one of the Tabletop release buttons on the patient support is pressed, the manual mode LED will flash. Pressing the same Tabletop release button will re-engage the tabletop. Coil and Sensor Sockets The coil connector sockets are located on the left side of the magnet, see figure below. Fig. 3: Coil sockets. Number Description 1 Spectroscopy and Transmit-/Receive coils 2 Receive coils Coil connector adapter For connecting SENSE and surface coils with a previous type connector a special connector adapter is provided. Connection Panel On the left side of the patient support there is a connection panel. Here are the sockets for the patient headset and the nurse call located. Achieva 17

18 System Overview Panels Fig. 4: Connection panel on Patient support. Number Description 1 Headset 2 Nurse call Panels Achieva 1.5T and 3.0T systems User Interface Module (UIM) The UIM on the front of the magnet can be located either on the left or right side of the magnet bore. Fig. 5: UIM on ACHIEVA systems at the left side of the magnet bore. The location of the buttons on the right side UIM are mirrored with respect to the left side UIM. Tumble switch The Tumble switch initiates all motorized movements of patient support and tabletop. 18 Achieva

19 Panels System Overview Horizontal and vertical movement The Tumble switch moves the patient support up or down when the tabletop is totally moved out of the magnet bore (end stop). In this case, the speed is fixed. The Tumble switch moves the tabletop in or out the magnet bore, when the patient support is at its highest position. Three different speeds are available. Operating the Tumble switch As long as the Tumble switch is returned gently to the middle position, the horizontal movement will be smooth and comfortable for the patient. If the Tumble switch is released suddenly it will result in an emergency stop of the movement of the tabletop: it will stop within 15 mm. Stop Pressing the Stop button will stop the tabletop movement. This can be reset using the Manual button. The Stop button has a ridge around it to prevent it from being pressed by accident. Manual mode Manual mode can be used to toggle between motorized and manual mode. The LED next to the button illuminates when the tabletop is in manual mode. Tabletop position information is available in manual mode. Pressing the Manual mode button will reset the Stop table button. When one of the Tabletop release buttons on the patient support is pressed, the manual mode LED will flash. Pressing the same Tabletop release button will re-engage the tabletop. Light visor A laser cross projected onto the patient selects the patient reference point i.e. the plane which will be positioned in the isocenter of the magnet. The laser cross will automatically switch off after 15 seconds. Typical use of the Light visor is only once for every patient. Use of the Light visor during the performance of an execution list will be ignored: a new patient reference point cannot be defined. Achieva 19

20 System Overview Panels Travel to scanplane (TTS) With the TTS button, TTS mode can be toggled on and off. TTS Mode In TTS mode the patient reference point is moved to the isocenter. The tabletop movement will follow the movement of the Tumble switch, giving the operator the freedom to move the patient reference point to the isocenter and away from the isocenter. TTS Mode - LED In TTS mode the direction of movement to the isocenter is indicated by the LED next to the TTS button which illuminates. When tabletop movement is away from the isocenter in TTS mode, the LED will flash slowly. Patient reference point After the patient reference point is positioned in the isocenter of the magnet, a survey is performed and all subsequent scans are planned with the information of this patient reference point. All tabletop movements which are required for optimal image quality are deduced from this point. Bore illumination The bore lights can be adjusted to three levels: off, low light and full light. 15 minutes after the tabletop is fully out of the magnet, the lights will automatically dim for 45 minutes before they are switched off. Ventilation The amount of ventilation through the magnet bore can be controlled with the Ventilation knob. Ventilation air is not sterile. Talk The Talk button enables communication between the operator in the examination room and the patient wearing a headset. Press the Talk button when the headset is plugged in. This connects the magnet microphone to the patient headset (the LED illuminates), and switches off the music speakers in the examination room. This allows easy communication with the patient. Once pressed, it will remain active until pressed again (the LED goes off ). The Talk button on the intercom at the console can temporarily overrule the magnet microphone, but cannot switch it off. 20 Achieva

21 Panels System Overview Remember to turn on the music after talking to the patient. If the headset is not in use, it should be unplugged from the control panel. Music volume This knob can be used to adjust the volume of music for the patient. Start scan This green button can be used to start a scan in the examination room. In a MobiTrak scan this button will also initiate tabletop movement and start the scan automatically. Stop scan Pressing the Stop scan button will stop the currently running scan. Pressing this button will also abort tabletop movement when initiated by TTS and also during a MobiTrak scan when initiated by pressing the Start scan button or clicking the Proceed button. The button has a ridge around it to prevent it from being pressed by accident. Pressing the Stop scan button twice will also stop reconstruction. If pressed only once, reconstruction will continue if enough data is available. Control Panel at the Rear of the Magnet At the back of the magnet another small control panel is located with a limited number of functions. Achieva 21

22 System Overview Panels Fig. 6: Control panel at the back of the magnet Number Description 1 Manual mode 2 Talk 3 Start scan 4 Stop scan The buttons on this panel have the same function as their equivalent on the Patient Support Control Panel. Coil and Sensor Sockets The coil connection sockets are located on the UIM. Fig. 7: Sockets on the UIM of Achieva systems Number Description 1 Peripheral pulse sensor 2 VCG 3 Respiratory sensor 22 Achieva

23 Panels System Overview Number Description 4 Receive coils 5 Spectroscopy and Transmit/receive coils 6 Receive coils Coil connector adapter For connecting coils with a previous type connector a special connector adapter is provided. Connection Panel Fig. 8: Connection panel on Patient support Number Description 1 Nurse call 2 Headset On the patient support at the same side of the magnet bore as the UIM a connection panel is located. On this connection panel sockets are provided for nurse call and headset. Magnet Display An (optional) LCD display meant for display of physiology signals can be provided on the MR scanner. Achieva 23

24 System Overview Devices and controls essential for system safety Devices and controls essential for system safety The following devices on the system and in the examination room are considered to be essential for system safety and should therefore never be removed, modified, over-ridden or disabled: Quench button Tabletop release button Fingerswitch plate Nurse call Stop buttons on the UIM and the keyboard RF door switch Quench pipe inside and outside the examination room RF examination room configuration Patient ventilation ScandiLink Option In a standard situation the Operator Equipment Cabinet, which includes the host computer, is present in the operator room. With the ScandiLink option the Operator Equipment Cabinet is moved to the technical room of the MRI suite. All input and output devices are available on the operator table and remotely connected to the host computer. These include Monitor, keyboard, computer mouse, intercom, DVD-drive computer and optional printer. 24 Achieva

25 Preparation of the tabletop Examination preparation 3 Examination preparation This chapter provides information about the preparation of an MRI examination. Note that for every new patient the following items must be replaced (if applicable): Mattress paper. Ear plugs. ECG pads. Endo coil probe or cover (condom). Preparation of the tabletop Move the tabletop to the parking position: Under motor control: Press the tumble switch down to the `Out/down' position and hold it there until the tabletop automatically stops in the parking position. Alternatively (manual operation): Press the `Manual' button and move the tabletop out of the magnet manually until the parking position is reached. The tabletop then locks into place automatically. Fig. 9: Achieva UIM with tumble switch. Lower the tabletop to the appropriate height by pressing the tumble switch down to the `Out/down' position and holding it there until the appropriate height is reached. The table should not be at its lowest position when a heavy patient is placed upon it. It should be raised at least 15 cm from its lowest point to ensure ease of vertical movement. To ensure optimum vertical and horizontal table movement, don't exceed the maximum allowed patient weight. Refer to the Technical Description for the maximum allowed patient weight for table and trolley. Prepare the tabletop with coil(s) and mattresses. Position the patient on the tabletop with the appropriate patient positioning aids and, if required, wireless PPU or VCG. Achieva 25

26 Examination preparation Moving patient to isocenter Raise the tumble switch to the `Up/in' position and hold it there until the tabletop stops moving. The tabletop is now at working level and raising the switch again will move the tabletop inward. Moving patient to isocenter This workflow describes how to position the patient in the isocenter. This includes the workflows: Raising the tabletop to working level Centering by means of the light visor, Travelling to scanplane, Return to scanplane after moving the tabletop out of the magnet. Manual operation. Raising the Tabletop to Working Level The patient is positioned on the tabletop with the coils and all required positioning aids. The tabletop is still lowered. Raise the tumble switch (2) to the `Up/in' position and hold it there until the tabletop stops moving. Fig. 10: User Interface Module (UIM) with 'Light visor' button, Tumble switch, 'Travel-to-scanplane' button, 'Manual' button, Indicator for isocenter positioning. The tabletop is now at working level. 26 Achieva

27 Moving patient to isocenter Examination preparation Centering by means of the Light Visor Using the light visor: Instruct the patient not to stare into the beam, Class II (FDA) / Class 2 (IEC) laser. Use the light visor for its intended use only, avoid unnecessary exposure of the patient to laser radiation. For non-responsive patients (babies, anaesthetized patients) provide adequate protection to avoid direct laser light in the eyes. Raise and hold the tumble switch again to the `Up/in' position to horizontally move the tabletop until the area of interest is short before the magnet bore. Press the 'Light visor' button once to switch on the light visor beams. The light visor beams indicate the mid-sagittal and a transverse plane. Raise the tumble switch to the Up/In position and hold it until the area of interest lies within the light visor beams. Coil and area of interest do not have to be in the middle of the beams. The closer the area to be imaged is to the isocenter, the better the image quality. lights green when isocenter positioning is possible with the current light visor position. flashes green when isocenter positioning is not possible with the current light visor position. Reposition the patient feet-first or move him/her closer to the magnet. The indicator for isocenter positioning Travelling to Scanplane Ensure that patients s hands are on the tabletop and arm supports are used before moving the tabletop into the magnet to avoid finger pinching. Fingers can get pinched between tabletop and finger switch plate. The examination/patient data must be entered before the 'Travel-to-scanplane' button can be used. Press and hold the Travel-to-scanplane button for about 2 seconds. Achieva 27

28 Examination preparation Moving patient to isocenter Alternatively, briefly press the 'Travel-to-scanplane' button and raise the tumble switch (2) to the Up/In position and hold it until the isocenter is reached. The tabletop will automatically be moved into the magnet until the isocenter is reached. Care should be taken that cables (coils, VCG) or tubes (IV drip, catheter) do not get caught. Verbal or physical contact is reassuring to a patient. Note that if the travel-to-scanplane tumble switch is released before table motion has ceased, the table will stop before reaching the isocenter. The indicator for isocenter positioning flashes green to indicate that the isocenter has not been reached yet. In this case, raise the switch again and the tabletop will resume its predefined travel. In order to stop automatic table movement, touch the tumble switch or press the 'Travel-toscanplane' button. Return to scanplane after moving the tabletop out of the magnet This function makes it possible to return to the original position after the table has been moved. This feature is especially helpful for studies with contrast agent administration. Use the tumble switch to move the table out of the magnet after the scans have been performed. After administering contrast agent, simply press and hold the Travel-to-scanplane button (3) again for about 2 seconds. The tabletop will stop at the previously indicated isocenter position. Do not move the table right out to the end stop, and do not press the 'Light visor' button. These actions would reset the isocenter position. For manual operation Release the tabletop by pressing the Manual button. Move the tabletop manually towards the magnet until the area of anatomical interest lies within the light visor beams. Press the Manual' button again to lock the tabletop. Press the 'Travel-to-scanplane' button. Raise the tumble switch to the Up/In position and hold it until the isocenter is reached. 28 Achieva

29 Wireless Physiology Examination preparation Wireless Physiology WARNING Do not use the physiology signals for monitoring or diagnostic purposes. The physiology signals are distorted when the patient is inside the magnet. Wireless Physiology provides synchronization of the MRI sequences with the physiological signals. It utilizes wireless sensors for respiration, VCG (VectorCardioGraphy) and plethysmography (Peripheral Pulse Unit PPU). It is compatible with the Invivo Precess patient monitoring system. Wireless Physiology consists of the following components: a wireless basic triggering unit (wbtu) located in the magnet room. two wireless physiology units: wireless-ppu unit (including connection for the respiratory sensor) with SpO 2 grip sensors wireless-vcg unit (including connection for the respiratory sensor) a battery charger. Fig. 11: Left: Wireless physiology units. 1: Respiratory sensor, 2: Connector for PPU, 3: Wireless PPU unit, 4: Wireless VCG unit. Right: PPU SpO2 MRI sensor. 1: Sensor cable, 2: Reusable grip sensor Pediatric (P), 3: Reusable grip sensor Adult (A), 4-7: Single use grip sensors in different sizes where 4 - Neonatal (N), 5 - Adult (A), 6 - Infant (I), 7 - Pediatric (P). Wireless-PPU and Wireless-VCG unit The wireless-ppu and the wireless-vcg unit look identical except for the text in the upper left corner and the connectors on top of the device. The wireless-vcg unit has connectors for VCG and for the respiratory sensor. The wireless-ppu unit has connectors for PPU and for the respiratory sensor. Achieva 29

30 Examination preparation Wireless Physiology The Wireless-VCG unit might only have a connector for VCG and not for the respiratory sensor. Fig. 12: Wireless PPU unit. 1: Connector of respiratory sensor, 2: Connector of Peripheral Pulse Unit (PPU), 3: Text indicating the type of the device: SpO 2 (in case of PPU) or VCG, 4: Indicator of current network, 5: Indicator of battery status Indicator of battery status The table below lists the LED indications for battery and communication status. Color Solid or Blinking Battery Status Communication Status No color Solid No battery inserted or too Not applicable low battery power Green Blinking Battery power is okay No communication with wbtu Green Solid Battery power is okay Good communication with wbtu Red Blinking Battery power is low No communication with wbtu Red Solid Battery power is low Good communication with wbtu Tab. 1: Battery and Communication Status Exchanging battery Press on the battery levers and slide the battery out of the wireless unit. To insert a battery, slide the battery into the battery compartment. 30 Achieva

31 Wireless Physiology Examination preparation Fig. 13: Left: Pressing on battery levers and sliding battery out of wireless unit. Right: Wireless unit from the back with battery removed. When a battery is inserted into the battery compartment, you can select the wireless network A, B, C, D or E as adjusted in the wbtu so that wireless communication is enabled. The procedure is described in the paragraph below. Selecting wireless network The network on the wireless device has to be selected only once by Philips service personnel during device installation. The network selection is persistent. The network has to be selected in the Physiology Properties window on the MR console, chapter Display of Physiology Signals on page 34. Workflow Press on the battery levers to slide the battery a bit out of the wireless unit. Reinsert the battery into the battery compartment. The network LED s start blinking. Press on the text indicating the type of the device to enable the network selection procedure. Achieva 31

32 Examination preparation Wireless Physiology Fig. 14: Left: Reinserting the battery into the battery compartment. Right: Pressing on the text field to go through the networks. Press again on this text field to go through the networks A to E. The current network is indicated by the blinking LED. To confirm the selection of the current network, press on the text field a little bit longer until the LED doesn t blink anymore, but burns constantly. Battery charger The battery charger is used offline to charge the lithium batteries for the wireless-vcg and wireless-ppu units. The battery charger is not MR compatible and should only be used in the control room. Regularly clean the contacts of the battery pack according to the manufacturer's Instructions for Use. Always unplug the charger before cleaning. 32 Achieva

33 Wireless Physiology Examination preparation Parts of the battery charger Fig. 15: Left: Front side of the battery charger. Right: Top side of the battery charger. Nr. Part Description 1 Charger power (green LED) The charger power indicates when +24Vdc input from the AC adapter is present. 2 Battery discharge switch When pushed, the battery in the lower left-hand battery slot will be put in a reconditioning discharge cycle. The associated battery charge LED will illuminate solid blue. 3 Battery charge RBG LEDs These LED s indicate the current status of the batteries inserted in the battery slot(s). 4 Battery slots Each battery slot provides for insertion of a separate lithium battery for recharging purposes. RGB LED display Status Solid green The battery is fully recharged and ready for reuse. Flashing green The battery currently has a medium charge and is successfully recharging. Flashing yellow The battery currently has a low charge and is successfully recharging. Solid red A faulty or dead battery is in the slot. Discard the battery. Solid blue The battery in the lower left-hand battery slot is currently in a reconditioning discharge cycle. Flashing blue The battery requires reconditioning. This battery must be inserted into the lower lefthand battery slot to be reconditioned. Extinguished No battery is inserted in the battery slot. Tab. 2: Status of the Battery Charge RGB LEDs Battery charging time Recharging a complete empty battery takes about 8 hours maximum. It is advised to put the batteries on the charger when not in use. Achieva 33

34 Examination preparation Wireless Physiology Ordering of consumable items and equipment To order consumable items for physiology sensors and/or cables (e.g. for PPU-, respiratory- and VCG-triggering) please contact your Philips Healthcare representative. To order special equipment (e.g. for pediatric examinations), please use the following website: Display of Physiology Signals The physiology signals are displayed on the MR console. For more information on the selection of physiology signals and the adjustment of these signals, refer to volume 3 of these Instructions for Use. Respiratory Sensor Property Purpose Description To detect the patient s breathing through abdominal or chest wall motion Applications Respiratory Compensation: to reduce motion artifacts due to breathing Limitations Positioning of the Respiratory Sensor Visualization of the patient s breathing The respiratory signal cannot be used for monitoring or diagnostic purposes other than determining the respiration wave for MR imaging Place the sensor on the patient s upper abdomen or lower chest (whichever expands most during inspiration - preferably the area to be scanned). Use a velcro strap (hip/shoulder strap) to affix the sensor. The sensor can be placed directly under the coil in longitudinal direction for optimal signal. Connect the flexible tube to the wireless unit. Avoid excessive bending of the flexible tube as this may impair detection of the patient's respiration. Check the respiratory signal (Operator s console: Physiology window) before the patient is placed in the magnet. Position the patient in the magnet. 34 Achieva

35 Wireless Physiology Examination preparation Fig. 16: Left: Respiratory sensor. Right: Physiology signal. If the Respiratory Signal appears to weaken Instruct the patient, between scans, to breathe more deeply during the scan (thus creating more movement at the sensor). Related Parameters Respiratory Compensation For more information, refer to the system's Help Topics. Peripheral Pulse Sensor Property Description Purpose Cardiac Triggering: Acquisition of imaging data at defined moments in the cardiac cycle. The trigger signal is derived from changes in capillary blood flow during the cardiac cycle. It is transmitted via fiber optics. Applications Suppression of artifacts caused by flow of blood or CSF in the spine Pulse rate monitoring Limitations Not advised to use for cardiac imaging or angiography due to an inherent delay from the time of the R-peak until flow change is registered in the finger. SpO 2 and Pulse Rate Accuracy Pulse oximetry measurements are statistically distributed. Achieva 35

36 Examination preparation Wireless Physiology Quick Connect SpO 2 MRI Sensor Fig. 17: PPU SpO 2 MRI sensor. 1: Sensor cable, 2: Reusable grip sensor Pediatric (P), 3: Reusable grip sensor Adult (A), 4-7: Disposable grip sensors in different sizes where 4 - Neonatal (N), 5 - Adult (A), 6 - Infant (I), 7 - Pediatric (P). For instructions on how to clean the sensor and the attachments, refer to the Instructions for Use. The sensor cable has two legs, a receiver side (no light when powered) and an emitter side (illuminates red when powered). Both fiber optic tips of the cable legs are identical in size and can be snapped into either of the two retainers on the attachments. The SpO 2 attachments for PPU are delivered in two different types and in up to four different sizes. Attachment Application Preferred location Alternate locations Reusable Clip A Adult: more than 40 Reusable Clip P kg Pediatric: between 10 kg and 50 kg Disposable Grip A Adult: more than 40 Disposable Grip P Disposable Grip I kg Pediatric: between 10 kg and 50 kg Infant: between 5 kg and 15 kg Any adult finger, preferably index - Any pediatric or small adult finger, preferably index Any adult finger, preferably index Any pediatric or small adult finger, preferably index Any infant or small pediatric s finger, preferably index or thumb - Toe Toe Big toe 36 Achieva

37 Wireless Physiology Examination preparation Attachment Application Preferred location Alternate locations Disposable Grip N Neonate: between 1 kg and 5 kg Any neonate s foot Hand or wrist The patient weights above are given for orientation only. The size of the chosen limb is more important in determining the attachment type to use. Positioning of the Peripheral Pulse sensor Do not place the wireless unit in proximity of the body coil. Push the fiber optic tip into the retainer of the attachment firmly until you hear the click. Assure the sensor cable is snug on the attachment and does not fall off. It may swivel but not wiggle. Repeat for the other cable leg. Attach to limb. Light may shine on top or on bottom of the limb. Failure to insert the tip properly will compromise the measurement accuracy, and may cause error messages to be displayed on the monitor or prevent a reliable measurement. Select the proper attachment for the application. Make sure the sensor windows are completely covered by skin or nail. Always select the attachment that provides a snug fit. Achieva 37

38 Examination preparation Wireless Physiology Avoid placing the sensor on extremities with an arterial catheter, intravascular venous infusion line, or inflated blood pressure cuff. Failure to do so may result in inaccurate readings or false alarm indications. Apply the attachments. Fit the sensor while the patient is outside the magnet. The finger must not be moved during the scan. Reusable Clips Press the clip to open. Push the clip over a finger so either fiber head is on the top over the root of the nail and the other fiber head opposite to it. It does not matter which head is on top. Assure that the finger is touching the stop at the cushion and lays nicely centered in the clip. You may swivel each fiber head into a position that provides most comfort to the patient and bends the cable least. 38 Achieva

39 Wireless Physiology Examination preparation Fig. 18: PPU SpO 2 attaching reusable clip A. Disposable Grips A, P and I Lift off the release liners that protect the adhesive. Put the finger or toe onto either side of the attachment - they are symmetrical - such that the tip covers the window completely and the finger does not protrude over the hinge. Close the grip. If the fit is good, press the attachment firmly on the finger or toe. If the fit is not good, reposition the attachment. Wrap the foam wings around the finger and attachment and stick to the opposing grip side. Do not stretch the foam to apply excessive pressure. You may swivel each fiber head into a position that provides most comfort to the patient and bends the cable least. Achieva 39

40 Examination preparation Wireless Physiology Fig. 19: PPU SpO 2 attaching disposable clip A. Fig. 20: PPU SpO 2 attaching disposable clip I. Disposable Grip N Lift the release liners that protect the adhesive part. Foot application: Align the hinge on the outside facing ridge of the foot. Make sure the attachment is as far as possible toward the small toe but never over it. Hand/wrist application: Align the hinge on the outside facing ridge of the hand or wrist. You may have to swivel the fiber heads to an optimal position to ease the application. If the hinge is in line with the ridge of the foot/hand/wrist, press one side to the skin. Wrap the other side around the limb pulling the long foam piece gently. Press both fiber heads gently to attach the adhesives. Secure the longer foam piece by pressing it firmly to the foam/adhesive of the opposing side. Assure the two fiber heads are opposing and have good skin contact. The angle between the two fiber heads should be as small as possible not exceeding 45 o. If the attachment opens too much, reattach or try another side. You may swivel each fiber head into a position that provides most comfort to the patient and bends the cable least. 40 Achieva

41 Wireless Physiology Examination preparation Fig. 21: PPU SpO 2 attaching disposable clip N. To display the PP sensor signal The PP sensor signal and the trigger pulses are displayed in the physiology window on the Operator's Console and, on request, on the magnet display. If the signal is too weak Excessive pressure on the finger will decrease the blood flow and weaken or suppress the signal. Keeping the finger warm may help. If the PP signal is too weak, fit the sensor to another finger on the same hand or on the other hand. The finger must not be moved during the scan. VCG (VectorCardioGraphy) Property Purpose Description Cardiac Triggering: Acquisition of imaging data at defined moments in the cardiac cycle. Applications Imaging of the heart at various phases of the cardiac cycle Limitations Suppression of artifacts caused by heart motion Suppression of artifacts caused by flow of blood or CSF Imaging arteries with TRANCE The VCG-signal cannot be used for monitoring or diagnostic purposes. With VCG, the electrical activity of the heart is modeled as a vector. During the cardiac cycle this vector changes magnitude and orientation. The vector s projection on to a plane gives a spatial plot of the heart s electrical activity. Achieva 41

42 Examination preparation Wireless Physiology By connecting the tips of the vector at different moments loops are generated describing the different cycles of the electrical activity of the heart: P-, QRS- and T-loop. Thus, using spatial information of the ECG the QRS-loop can be differentiated from the loops of the artifacts. Safety WARNING Only use MR safe ECG electrodes. The use of other types of ECG electrodes may cause heating of the skin. Ask your local application representative about MR safe ECG electrodes. WARNING Do not use ECG electrodes after they have reached their expiration date. Old electrodes can be dried out, which will result in bad electrical contact. WARNING Never reposition or reuse ECG electrodes. Always use new electrodes. Repositioning or reuse may result in a heating effect, as a result of high skin resistance. WARNING Do not use pediatric ECG electrodes on adults or Adult ECG electrodes on pediatric patients. The use of wrong ECG electrodes may result in skin burns. WARNING Only use the appropriate InvivoMDE battery pack with the VCG module. This battery pack may only be charged with the InvivoMDE battery charger. WARNING Do not place the VCG battery module (VCG or PPU unit) directly on the patient s skin. Direct contact may cause heating of the skin. Keep a distance to the patient s skin of at least 1 cm using pads of the standard auxiliary set. 42 Achieva

43 Wireless Physiology Examination preparation WARNING Do not place the VCG battery module (VCG or PPU unit) close to the imaging volume. This may cause image artifacts. WARNING Avoid cable loops and twisted cables. Loops can cause excessive heating of the cables which may result in burns upon (full or partial) contact to patient s skin. Special attention is needed when VCG is used with Transmit-Receive coils. WARNING Avoid placing cable loops and twisted cables (RF coil cables and ECG leads) inside the body coil (RF area). Loops can cause excessive heating of the cables which may result in burns upon contact to patient s skin. The cables must be routed parallel to the axis of the bore. WARNING Avoid routing of the RF coil cable assembly in proximity to the RF transmit coil. Avoid direct contact of the patient s skin with the RF coil cable assembly. This may result in excessive local heating and ultimately in skin burns. Positioning of the RF coil cable assembly must be done with care. Keep a distance to the patient s skin of at least 2 cm. Use the special spacer or pads (of the basic set of positioning aids) where the cable assembly may touch the skin. Patient Preparation WARNING Proper patient preparation is essential for the prevention of skin burns. It is necessary to confirm the use of low resistance electrodes to prevent skin burns. The instructions must be followed carefully. Refer to the electrodes manufacturer's Instructions for Use. Achieva 43

44 Examination preparation Wireless Physiology Positioning of the VCG electrodes The wireless VCG sensor has dual lead VCG monitoring capability based on 4 electrodes. Three leads are measured: {RA-LA}, {LA-LL}, {RA-LL}, but only the first two of these are sent to the scanner. The battery isolated device amplifies and filters the VCG signals and digitizes the signal. The color coding is compliant with international standards. The recommended lead positioning provides proper interoperability with the Precess monitor of Invivo. Workflow Position the first electrode (for green lead) approximately 1 cm left of the xiphoid. Position the second and third electrode in such a way that they form a triangle around the nipple. The distance between the electrodes should be approximately 15 cm. Position the fourth electrode to the left of the top electrode, near the axilla. Connect the green, white, red and black leads to the VCG electrodes. Fig. 22: VCG electrode positioning and wireless VCG unit. Trace VCG1 (V1) corresponds to the signal measured between the WHITE clip and the BLACK clip, trace VCG2 (V2) corresponds to the signal measured between the BLACK clip and the RED clip Color of the Clip white black green red Tab. 3: Color Codings of the ECG/VCG clips Function upper trace common active common ground lower trace 44 Achieva

45 Wireless Physiology Examination preparation Do not position the VCG module under the Anterior coil. The VCG module should be positioned as far out of the bore as possible. Place the VCG module either besides the patient's head or the patient's body. Alternate positioning method In non-monitoring instances, the operator may apply electrode placement in the traditional basic triggering layout: Fig. 23: Alternate method of VCG electrode positioning. Make sure that all of the electrodes are positioned as shown in this figure. (Compared to the non-wireless triggering method, the black and the green electrode are exchanged.) Insufficiently connected leads When leads are not properly connected, an error message "Possible lead failure" is displayed in the Patient Status Area (where the physiology signal is displayed). A "Battery low" indication appears in the Physiology window to notify the user when the battery of the VCG module gets low. The VCG signal may deteriorate when the battery is low. Check the VCG signal Check the VCG signal in the Physiology Display panel. For VCG, two options are available: VCG Calculated VCG signal: A projection of both signals on one axis. Achieva 45

46 Examination preparation Using the trolley This axis is calculated during the calibration phase of the VCG measurement. This trace corresponds best to a conventional ECG signal. VCG1+VCG2 Display of Trace 1 and Trace 2 simultaneously. When using a display that shows the VCG signal together with other signals (e.g. VCG+RESP or VCG+PPU) the calculated VCG signal will be shown. The most important quality criterion is whether you see R-peak markers on the signal, not the strength of the R-peak. Using the trolley The trolley allows patient preparation for an examination while the previous patient is being scanned. Positioning of coils, positioning aids, monitoring and triggering equipment can be done outside the examination room. 46 Achieva

47 Using the trolley Examination preparation Trolley Compatibility WARNING Do not use patient transport systems or trolleys that are not intended for use with your system. The tabletop does not fit on other patient transport systems or trolleys and will fall off. This could lead to serious injury to the patient and damage to the tabletop. Do not use Achieva trolleys on your Ingenia system. For Ingenia systems only use the FlexTrak patient transport system. Do not use Achieva trolleys on your Achieva dstream system. For Achieva dstream systems only use the FlexTrak patient transport system. Do not use the FlexTrak patient transport system on your Achieva and Multiva/Omniva system. For Achieva and Multiva/Omniva systems only use the Achieva trolley. FlexTrak and any Patient Support compatible with FlexTrak are labelled with the following label at the side docking interfaces: Make sure that at docking the labels at the FlexTrak and at the Patient Support match. Achieva 47

48 Examination preparation Using the trolley Fig. 24: Trolleys: 1 - Achieva trolley (suitable for Achieva and Multiva/Omniva systems), 2 - FlexTrak (suitable for Ingenia and Achieva dstream systems). Maximum working Load WARNING The safe working load for the tabletop on the trolley is 150 kg, the safe working load for the tabletop on the MammoTrak trolley is 180 kg. This is the total weight of patient, coils and positioning aids. The maximum total mass is: Trolley: 220 kg. MammoTrak trolley: 330 kg. The safe working load of the trolley shall be distributed over the tabletop as with a patient in lying position when moving the trolley. 48 Achieva

49 Using the trolley Examination preparation Docking Left/Right Trolleys for Intera systems cannot dock at the Patient support control panel side. Every trolley is adjusted for docking to a specific side of the patient support and should never be docked to the opposite side. Lowering patient support Always lower the patient support by means of the tumble switch (motorized) to ensure correct positioning of the tabletop on the trolley. If manual positioning of the tabletop on the trolley is unavoidable, ensure that it is securely locked in position by the endstops and the handle of the trolley. Easy patient transfer from trolley to patient support Position the patient on the trolley using the additional set of positioning aids. Coil(s), VCG electrodes, peripheral pulse finger clip and a respiration sensor can be installed while the patient is still on the trolley. Use the arm supports to ensure that the patient's hands remain close to the body and safe during all patient transfer operations. The arm supports can be slid easily under the mattress. figure 25 on page 50. Ensure that the patient's hands are within the arm supports, next to the body before patient transfer: Remove the current tabletop from the system to allow use of the trolley tabletop. Dock the trolley around the patient support from the side (see figure). Use the brakes to lock the trolley in position when it is correctly docked against the patient support. Both vertical bars on the long side must touch the patient support cover. figure 25 on page 50. Achieva 49

50 Examination preparation Using the trolley Move the patient support up (motorized). The tabletop is automatically unlocked, lifted from the trolley frame and taken over by the patient support. Keep the trolley frame docked around the support while the patient is moved into the magnet. Connect the coil(s) to the scanner. Patient transfer from patient support to trolley Disconnect the coil(s) and move the patient out of the magnet. Move the patient support down (motorized). The tabletop is automatically taken over by the trolley frame and locked when lowered. Ensure that the tabletop is in the correct and secure position on the trolley. Roll the trolley, with tabletop, patient, coils etc. away leaving the scanner free for the next patient. Move the trolley out of the examination room. For safe patient transfer, use the trolley grips to move both trolley frame and tabletop Put the system tabletop back onto the support, figure 25 on page 50. When the tabletop is positioned on the support by hand, make sure the tabletop is in its outmost position. If this is not the case, the support cannot be moved in vertical direction. To restore this, put the support in manual mode and push the tabletop to its outmost mechanical endstop. Return to normal mode and the support can be moved vertical again. Fig. 25: Trolley: 1 - arm supports in use, 2 - using the brakes to lock the trolley, 3 - putting system tabletop back onto the support. 50 Achieva

51 General coil safety Coils and Positioning 4 Coils and Positioning This chapter describes the coils for the Achieva system and how to use them. Before you start using any of the coils, refer to the Instructions for Use for full information on safety aspects. As most of the photographs in this chapter have been taken in a non-clinical environment, it is possible that in some of the photographs the patient s clothing is not suited for a real MR examination. Patients may also be shown without headset and nurse call. For information on coil combinations, refer to the chapter 'Coil combinations. However, in each coil section information is provided if a coil can be used in a Multi coil or Dual coil combination. General coil safety Only coils that have been proven safe and compatible on the Philips MR system shall be used. Coded connectors and software keying are provided to control the use of coils. Refer to the Instructions for Use of the coil for further safety instructions. Safety and performance considerations Receive coils have safely been used to investigate any anatomy. The coil insulation prevents accidental contact with the conductive metal parts. Each coil has been specially designed for prolonged safe and reliable operation. Safety measures WARNING Never use surface coils, coil extension cables and other cables in the magnet bore if the insulation of a cable or connector is damaged. The operator must always visually inspect the coil before use. This also applies to the base of separable coils. The presence of high voltage across the cable shield beneath the insulation, due to RF emission during scanning, is hazardous to patients. Sharp edges may cause injury to patient s skin. Achieva 51

52 Coils and Positioning About Coils Coils must be returned to the manufacturer's Customer Support for replacement if there is any suspected damage to either the external covering or the coil's internal components. The patient must never be allowed to come into contact with the internal coil connections. WARNING Do not simultaneously touch the coil connector contacts and the patient to prevent potential harm for the patient. WARNING Prevent patients from touching the contacts of separable coils. When connected to the system a voltage of 12 volt DC is present at the contacts of the coil base. Under normal conditions this voltage is not hazardous to patients. However for critically ill cardiac patients this low DC voltage may have serious consequences. Always close the coil before connecting it to the system. Always disconnect the coil from the system before opening the coil. Do not leave unused coils or coil parts on the tabletop. WARNING Never scan with the SENSE Head Coil and neurovascular coil positioned more than 5 centimeters offcenter. This may cause local heating of the patient. Always position the SENSE Head coil and neurovascular coil in the isocenter by using the light visor. About Coils Transmit- and Receive-coils The coils work in conjunction with the Quadrature Body coil. The Q-Body coil acts as the RF transmitter and the surface/volume/phased-array coil as the receiver. Type of detection Linear coil Quadrature coil Phased-array coil Receiving elements 1 1 More than 1 SNR Average Higher Highest Connector Surface coil connector Surface coil connector Phased-array coil connector (thick cable) SENSE compatible No No Yes (if name: SENSE) 52 Achieva

53 About Positioning in general Coils and Positioning The term SENSE in the coil name indicates that a coil is SENSE compatible. Use different element combinations for SENSE coils In order to use different channel combinations, perform the SENSE scan and save raw data. Then perform a delayed reconstruction with any other channel combination. Regular inspection The quality of the cable and coil insulation must be inspected regularly. Damaged coils must be replaced. Inspect the connector pins if they are still straight. About Positioning in general Be aware that the first consideration in positioning is comfort, in the patient's interest and to minimize motion artifacts. Use positioning cushions, sandbags and immobilization straps for comfort and stability. Normal X-ray positioning cushions may also be used. Ensure that patients fit easily into the system when positioned off-center or semi-sitting. If positioned semi-obliquely for a shoulder examination, the patient's raised shoulder may impede passage into the system. Use the arm supports to prevent the patient from grabbing around the table sides and pinching the fingers during horizontal table motion. WARNING Verify that patient s hands are on the tabletop before moving the tabletop into the magnet to avoid finger pinching. Fingers can get pinched between tabletop and the system covers. The special arm supports of the accessory set can be used to avoid finger pinching. The arm supports prevent the patient from grabbing around the table sides avoiding finger pinching during tabletop movement. Achieva 53

54 Coils and Positioning About Positioning in general Fig. 26: Left: Arm support. Middle: Incorrect patient positioning. Right: Advised patient positioning with arm support (1) and padding (2). Safety Ensure clearance between body parts and the bore wall, primarily for air flow. Large area contact between body parts and the patient bore needs to be avoided. A small rolled towel can be used to create a clearance of more than 5 mm between body parts and bore. This ensures only a minimum disruption of airflow through the bore. Note that wrapping in sheets is inadequate, because it does not ensure air flow over the body part and traps in heat. WARNING Always avoid current loops formed by touching body parts. A minimum of 2 cm clearance must be secured. Pads from the Positioning Aids Basic Set or towels can be used. Body parts that touch, and limbs that touch the body, can form electrical current loops. The formation of a high-frequency current loop in the patient's body may cause burnings at the point of (full or partial) contact. Current loops are formed when two parts of the human body come into contact (skin to skin) or almost come into contact, e.g.: Both thighs are in contact. Both knees are in contact. Both ankles are in contact. 54 Achieva

55 About Positioning in general Coils and Positioning Arms and hands touching other body parts. Both hands are in contact. This especially is possible for scanning with breast coils when patients are imaged lying prone with both arms extended above the head. Fig. 27: Current loops (curved arrows) and locations where heating can occur (black arrows). Contact between body parts must be prevented as shown in the picture below: Example 1: positioning the patient appropriately. No skin to skin contact. Example 2: padding between arms and body. Example 3: padding between thighs and ankle. A minimum of 2 cm clearance must be secured. Pads from the Positioning Aids Basic Set or towels can be used. Fig. 28: Avoiding current loops. Achieva 55

56 Coils and Positioning About Positioning in general Hearing Protection and Nurse Call Hearing Protection Basic hearing protection must be worn by the patient during scanning. Such hearing protection is provided by appropriately fitted earplugs with sufficient damping (>30 db). Typical damping characteristic of the Philips' headset is 20 db in the 1 khz range. WARNING Always apply hearing protection to the patient and anyone else present in the examination room before start scanning. Without hearing protection, noise levels may be high enough to cause discomfort or result in temporary or even permanent loss of hearing. Fig. 29: Nurse call (left) and headset (right). Fig. 30: Patients with headset and nurse call. 56 Achieva

57 About Positioning in general Coils and Positioning Nurse Call WARNING The Nurse call pinch ball must be given to every patient. This allows for communication between the patient and the operator at all times. Its use should always be demonstrated. If it is pressed quickly twice or once for a longer period, the alarm bell will be heard and the light will be activated on the intercom. Observation of the patient Observation of the patient is reassuring for patient and operator. It may be directly from the console or via a video camera or mirror. Voice contact via the intercom should be demonstrated to each patient. General Hints Cables Cables have to run in a straight line to the connector. Position and secure the cable on the mattress beside or in the groove. Fig. 31: 1: Correct positioning (at the back of the magnet): the cables are straight. 2: 2: Wrong positioning (at the back of the magnet): the cables are not straight. 3: Correct positioning: the cables are straight, a spacer is being used. Flexible coils Use as many fixation bands as required to ensure stability. Attach the coil to the patient in such a way that respiration or normal patient movement does not change its position. Do not place flexible coils perpendicular to the patient's head-feet axis (= axis of the main static field). In this orientation no MR signals can be received. Any other plane of orientation is possible. Achieva 57

58 Coils and Positioning Available coils per anatomic region Electronics box Position the electronics box as far away from the FOV as possible. Extend the cable alongside the patient, avoiding loops, and plug it into one of the connectors. Using flexible coils for head imaging, the Q-Head coil can be used to support or immobilize the patient. Although it is not used, its connector must be plugged into one of the sockets to avoid irreparable damage. During a scan, no coil should ever be placed inside the magnet without connecting it to a control panel socket. Failure to do this will cause RF energy to destroy the preamplifiers inside the coil. Plug the coil connector securely into its socket AFTER the patient has been placed in the magnet (to avoid jamming). Disconnect the coil connector from its socket BEFORE removing the patient from the magnet (to avoid jamming). Available coils per anatomic region Head/CNS and Head/Neck coils Q-Head coil 1.5T SENSE Head coil 6 and 8 1.5T and 3.0T SENSE Head coil 32 SENSE Head/Neck coil 1.5T T/R Head coil 3.0T TMJ coil / Coil Holder 1.5T SENSE NeuroVascular coil 8 and T and 3.0T Total Neuro, Total Spine coils SENSE Head/Spine coil combination 1.5T and 3.0T SENSE Pediatric Head Spine coil 8 1.5T and 3.0T Spine coils SENSE Spine coil T and 3.0T SENSE Spine coil 1.5T 58 Achieva

59 Available coils per anatomic region Coils and Positioning SENSE Spine coil 3.0T Synergy Pediatric coil 1.5T Body coils Q-Body coil 1.5T and 3.0T SENSE Cardiac coil 1.5T SENSE Cardiac coil 3.0T SENSE Torso/Cardiac coil 1.5T and 3.0T SENSE Breast coil 4 1.5T and 3.0T SENSE Breast coil 7 (incl. biopsy) 1.5T and 3.0T MammoTrak MammoTrak Breast coil 16 MammoTrak Breast coil 7 Breast: Stereotactic Localization Device SENSE Body coil 1.5T SENSE XL Torso coil T and 3.0T SENSE Torso coil 3.0T Endo-Cavitary coil 1.5T Endo coil with disposable probe 1.5T and 3.0T SENSE Pediatric Body/Cardiac coil 8 1.5T and 3.0T Orthopedics coils SENSE Shoulder coil 8 1.5T and 3.0T SENSE Shoulder coil 4 1.5T and 3.0T SENSE Wrist coil 4 1.5T and 3.0T SENSE Wrist coil 8 1.5T and 3.0T Hand/Wrist coil 4 1.5T SENSE Small Extremity coil 8 Knee/Foot coil 1.5T Knee/Foot coil 4 (FootAnkleKnee) 1.5T SENSE Knee coil 8 1.5T and 3.0T SENSE Knee coil T SENSE T/R Knee coil T SENSE Foot-Ankle coil 1.5T and 3.0T SENSE PeriphVascular coil 1.5T Achieva 59

60 Coils and Positioning Coil Choice Miscellaneous coils Microscopy coils 1.5T SENSE Flex coils 1.5T and 3.0T Circular coils C1, C3, C4 1.5T Coil Choice This paragraph describes per anatomic region which coil(s) can be used best. Click on a link to go to the corresponding description: Head / CNS Head / Neck Spine Thorax Abdomen Pelvis Upper Extremities Lower Extremities For information on coil combinations, refer to chaptere 6 Coil combinations. However, in each coil section information is provided if a coil can be used in a Multi coil or Dual coil combination. Head / CNS In the table below, the text Any Head coil refers to the following coils: on 1.5T: SENSE Head 6 or 8 coil, SENSE Head/Neck coil, SENSE NeuroVascular 8 or 16 coil, or Q-Head coil on 3.0T: SENSE Head 8 coil, SENSE NeuroVascular 8 or 16 coil or T/R Head coil REGION COIL 1.5T COIL 3.0T Brain / Fast Brain Any Head coil Any Head coil Pituitary Any Head coil Any Head coil Brain stem Any Head coil Any Head coil Hippocampus Any Head coil Any Head coil I.A.C. Any Head coil SENSE Flex-S, -M Any Head coil SENSE Flex-S, -M 60 Achieva

61 Coil Choice Coils and Positioning REGION COIL 1.5T COIL 3.0T Orbit(s) Any Head coil SENSE Flex-S Any Head coil SENSE Flex-S C3 or C4 Microscopy coils Pediatric Any Head coil SENSE Pediatric Head Spine SENSE Knee Knee/Foot Any Head coil SENSE Pediatric Head Spine SENSE Flex-S, -M Combination SENSE Flex coils SENSE Flex-S, -M Combination SENSE Flex coils Brain and C-Spine SENSE NV SENSE NV SENSE Head/Neck Head / Neck REGION COIL 1.5T COIL 3.0T Anterior neck (Thyroid, Larynx) SENSE NV SENSE NV SENSE Head/Neck SENSE Flex-S SENSE Flex-S Combination SENSE Flex coils Combination SENSE Flex coils Angio (Carotid arteries) SENSE NV SENSE NV SENSE Head/Neck SENSE Flex-S, -M SENSE Flex-S, -M Combination SENSE Flex coils Combination SENSE Flex coils Both TMJ SENSE Flex-S SENSE Flex-S TMJ Combination SENSE Flex coils Combination SENSE Flex coils Combination C3, C4 Single TMJ C3 or C4 SENSE Flex-S Achieva 61

62 Coils and Positioning Coil Choice Spine REGION COIL 1.5T COIL 3.0T Cervical spine SENSE Spine SENSE Head/Neck SENSE Spine SENSE NV SENSE NV Thoracic spine SENSE Spine SENSE Spine 15 Lumbar spine SENSE Spine SENSE Spine 15 Total spine SENSE Head Spine SENSE Spine Total neuro SENSE Head Spine Combination SENSE Spine with SENSE Flex-L SENSE Spine SENSE Spine 15 SENSE Spine SENSE Spine 15 SENSE Head Spine SENSE Spine SENSE Head Spine Combination SENSE Spine with SENSE Flex-L Combination SENSE Spine 15 with SENSE Flex-L Pediatric spine SENSE Pediatric Head Spine SENSE Spine SENSE Flex Combination SENSE Flex coils Combination SENSE Spine 15 with SENSE Flex-L SENSE Pediatric Head Spine SENSE Spine SENSE Flex Combination SENSE Flex coils The SENSE Head/Spine coil is a combination of the SENSE NeuroVascular 16 coil and the SENSE Spine 15 coil. Thorax REGION COIL 1.5T COIL 3.0T Heart, Coronary Artery, Mediastinum SENSE Torso/Cardiac SENSE Cardiac Aorta SENSE Torso/Cardiac SENSE Cardiac SENSE Torso/Cardiac SENSE Cardiac SENSE Torso/Cardiac SENSE Cardiac 62 Achieva

63 Coil Choice Coils and Positioning REGION COIL 1.5T COIL 3.0T Lungs SENSE Body SENSE XL Torso Q-Body Breasts SENSE Breast SENSE Body Breast SENSE Flex-L or -M with SENSE breast mattress Pediatric SENSE Pediatric Body/Cardiac Q-Head for small infants C3 for 1 to 6 months SENSE Flex SENSE Cardiac SENSE Torso SENSE XL Torso SENSE Breast SENSE Torso SENSE Flex-L or -M with SENSE breast mattress SENSE Pediatric Body/Cardiac SENSE Cardiac SENSE Flex Combination SENSE Flex coils Combination SENSE Flex coils For examinations of the mediastinum, prone positioning is recommended. Abdomen REGION COIL 1.5T COIL 3.0T Liver/spleen, Angio SENSE Body SENSE Torso SENSE XL Torso SENSE XL Torso Q-Body Q-Body Kidney/adrenals SENSE Body SENSE Torso SENSE XL Torso SENSE XL Torso Pancreas SENSE Body SENSE Torso SENSE XL Torso SENSE XL Torso Pediatric body SENSE Pediatric Body/Cardiac SENSE Pediatric Body/Cardiac SENSE Flex-S, -M, -L depending on SENSE Flex-S, -M, -L depending on patient s size patient s size Combination SENSE Flex coils Combination SENSE Flex coils Achieva 63

64 Coils and Positioning Coil Choice Pelvis REGION COIL 1.5T COIL 3.0T Bladder SENSE Body SENSE XL Torso Angio SENSE Body SENSE XL Torso SENSE XL Torso SENSE Torso SENSE XL Torso SENSE Torso Q-Body Prostate Endo-cavitary 1.5T SENSE Body Endo 3.0T SENSE Torso (3.0T) SENSE Flex (-L) Testes SENSE Flex-S, -M SENSE Flex-S, -M Pediatric body SENSE Pediatric Body/Cardiac SENSE Flex -S, -M, -L depending on patient s size SENSE Pediatric Body/Cardiac SENSE Flex -S, -M, -L depending on patient s size Upper Extremities Combination SENSE Flex coils Combination SENSE Flex coils REGION COIL 1.5T COIL 3.0T Shoulder SENSE Shoulder SENSE Shoulder SENSE Flex-M, -L SENSE Flex-M, -L C3, C1 (larger patients) Elbow SENSE Small Extremity coil 8 SENSE Small Extremity coil 8 SENSE Flex-S SENSE Flex-S Long bones: Upper arm, SENSE Flex-M, -L SENSE Flex-M, -L forearm Combination SENSE Flex coils Combination SENSE Flex coils Wrist SENSE Wrist SENSE Wrist SENSE Small Extremity coil 8 SENSE Small Extremity coil 8 SENSE Flex-S SENSE Flex-S Hand/Wrist 4 Hand SENSE Flex-S SENSE Flex-S Hand/Wrist 4 SENSE Small Extremity coil 8 SENSE Small Extremity coil 8 Microscopy Microscopy 64 Achieva

65 Coil Choice Coils and Positioning REGION COIL 1.5T COIL 3.0T Pediatric applications SENSE Flex-S, -M, -L depending on patient s size SENSE Small Extremity coil 8 SENSE XL Torso SENSE Flex-S, -M, -L depending on patient s size SENSE Small Extremity coil 8 SENSE XL Torso Lower Extremities REGION COIL 1.5T COIL 3.0T Hips (both) SENSE Body SENSE XL Torso Combination SENSE Flex coils SENSE Torso SENSE XL Torso Combination SENSE Flex coils Single hip SENSE Flex-L SENSE Flex-L Upper legs SENSE Body SENSE Body Q-Body SENSE Flex-L Combination SENSE Flex coils Lower legs SENSE XL Torso SENSE Body Combination SENSE Flex coils Knees (both) SENSE Body SENSE XL Torso Combination SENSE Flex coils Single knee SENSE Knee coil T SENSE Knee coil 8 Knee/Foot Knee/Foot 4 SENSE Flex-M, -S Patella SENSE Flex-S C3, C4 Ankles (both) Q-Head Combination SENSE Flex coils Q-Body SENSE Flex-L Combination SENSE Flex coils SENSE Torso SENSE XL Torso Combination SENSE Flex coils SENSE Torso SENSE XL Torso Combination SENSE Flex coils SENSE T/R Knee coil T SENSE Knee coil 8 SENSE Flex-M, -S SENSE Flex-S T/R Head Combination SENSE Flex coils Achieva 65

66 Coils and Positioning SmartExam and Coils REGION COIL 1.5T COIL 3.0T Single ankle SENSE Foot/Ankle SENSE Flex-S, -M SENSE Small Extremity coil 8 SENSE Foot/Ankle SENSE Flex-S, -M SENSE Small Extremity coil 8 Knee/Foot 4 Foot SENSE Foot/Ankle Knee/Foot 4 SENSE Flex-S, -M SENSE Foot/Ankle SENSE Flex-S, -M SENSE Small Extremity coil 8 SENSE Small Extremity coil 8 Q-Head Angio SENSE Body SENSE XL Torso SENSE Torso SENSE XL Torso SENSE PV Pediatric applications SENSE Flex-S, -M, -L depending on patient s size SENSE Small Extremity coil 8 SENSE XL Torso SmartExam and Coils SENSE Flex -S, -M, -L depending on patient s size SENSE Small Extremity coil 8 SENSE XL Torso SmartExam is a tool that automates planning, scanning and processing in brain, knee, shoulder, breast, cervical and lumbar spine examinations. Supported coils for SmartExam For optimum quality of SmartExam, use the supported coils: Anatomic area Supported coils Brain SENSE Head 8 SENSE NeuroVascular 8 SENSE NeuroVascular 16 SENSE Head T Cervical spine SENSE Spine SENSE NeuroVascular 8 SENSE NeuroVascular 16 Lumbar spine SENSE Spine 1.5T and 3.0T SENSE Spine15 66 Achieva

67 Q-Head coil Coils and Positioning Anatomic area Supported coils Breast SENSE Breast 4 SENSE Breast 7 MammoTrak Breast 7 MammoTrak Breast 16 Shoulder SENSE Shoulder 4 SENSE Shoulder 8 SENSE Flex M Knee SENSE Knee 8 SENSE Knee T SENSE T/R Knee T Q-Head coil Type of coil Quadrature detection Receive-only Design Volume coil: It comprises a base, a sliding coil and a head support accessory. The coil may be lifted using one of the horizontal bars and supporting the base. Available for 1.5T SENSE-compatible No CLEAR-compatible No Applications Head Ankle or Feet General remarks This coil may be used in combination with any flexible coil in multi coil mode (see chapter 6, coil combinations). During imaging with a flexible coil, the Q-Head coil must also be plugged into a connector. Multi coil imaging Yes (see section Multi coil imaging ) Dual Coil imaging No User Interface Name Head Achieva 67

68 Coils and Positioning Q-Head coil Fig. 32: Q-Head coil on tabletop. Remember to insert the coil connector into one of the sockets. Starting a scan without it connected will damage the coil. Positioning Brain examinations 1. Place the head coil on the tabletop. 2. Place the mattress on the table top. Make sure the head support is secure. 3. Place the patient on the tabletop with the head 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. 4. 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. 5. Attach the optical mirror to the coil so that the patient can see out of the bore. This can be reassuring for patients. 68 Achieva

69 SENSE Head coil 6 and 8 Coils and Positioning Fig. 33: Patient positioning for brain examinations with Q-Head coil. 1: Q-Head coil open. 2: Q-Head coil closed. 3: Pediatric examination. Ankle and foot examinations 1. Remove the headrest; place some foam cushions on the coil base. 2. Place the feet in the coil. Endorotate the ankle a little to get nice anatomic orthogonal surveys. 3. Place a cushion between the feet and the RF mirror at the back of the coil to improve image quality especially in spectral fat saturation (SPIR, SPAIR) and ProSet sequences. This is not shown in the figure. Fig. 34: Foot/ankle examination with Q-Head coil. SENSE Head coil 6 and 8 Type of coil 6 or 8 element phased-array coil Design Dimensions Receive-only Volume coil consisting of 6 or 8 elements Coil diameter: 24 cm. FH coverage 22 cm Available for 1.5T: SENSE Head coil 6 and 8 3.0T: SENSE Head coil 8 Achieva 69

70 Coils and Positioning SENSE Head coil 6 and 8 SENSE-compatible CLEAR-compatible Yes Yes MultiTransmit-compatible Yes for SENSE Head coil 8 on 3.0T Applications Brain General remarks On systems with a 6-channel acquisition system, this coil is available as a 6- element coil only. This coil should only be used for Head first studies. Always use CLEAR as homogeneity correction for best image quality. Markers on the coil In the middle of the coil (FH direction) for light visor positioning On both sides for image quality verification (phantom) Multi coil imaging Dual coil imaging Yes (see section Multi coil imaging ) No User Interface Name SENSE-Head-8 or SENSE-Head-6 SENSE-Head on 6-channel acquisition systems Fig. 35: Coil on tabletop. Remember to insert the coil connector into one of the sockets. Starting a scan without it connected will damage the coil. Positioning for brain examination 1. Place the head coil on the tabletop. 2. Place the mattress on the table top. Make sure the head support is secure. 3. Place the patient in the head support. Use the head fixation strap for extra immobilization. Use the small wedges to immobilize the head by placing them firmly between the head and the sides of the support. 4. Pull the sliding part gently over the head and face. 70 Achieva

71 SENSE Head coil 32 Coils and Positioning Pull gently on both sides of the coil, close to the base. 5. Attach the mirror to the coil such that the patient can see out of the bore. This can be reassuring for patients. Fig. 36: Patient positioning. SENSE Head coil 32 Type of coil 32 elements phased-array coil Receive-only Design Volume coil consisting of head support and anterior coil section. Two coil connectors. Dimensions Height (AP): 38 cm, width (RL) : 46 cm, length (FH): 59 cm Available for 3.0T SENSE-compatible Yes CLEAR-compatible Yes MultiTransmit- compatible Yes Applications Brain General remarks This coil should only be used for Head first studies. Always use CLEAR as homogeneity correction for best image quality. Markers on the coil In the middle of the coil (FH direction) for light visor positioning Multi coil imaging No Dual coil imaging Yes (Use Dual coil = yes to be able to use both coil halves simultaneously). User Interface Name The anterior and posterior coil part can be combined in Dual coil imaging and be selected separately as: SENSE-Head-32AH SENSE-Head-32P Achieva 71

72 Coils and Positioning SENSE Head coil 32 Fig. 37: 1: Closed coil with pads and cable with connectors. 2: Elements and housing of the SENSE Head coil 32. 3: Open coil. Head support with pads and EEG grove, and anterior section. Remember to insert the coilconnector into both of the sockets. Starting a scan without it connected will damage the coil. Always scan with the anterior section on the head support. Patient positioning 1. Place the head support of the Neuro coil and the long mattress on the tabletop. 2. Place the patient on the tabletop with the head in the head support. Use the small wedges to immobilize the head by placing them firmly between the head and the sides of the support. 3. Optional: place the EEG cable in the EEG groove of the head support. 4. Attach the anterior section to the coil. 72 Achieva

73 SENSE Head/Neck coil Coils and Positioning While closing the coil verify that the patient's skin cannot be pinched between coil parts. Fig. 38: 1: Patient positioning in head support. 2: Closing the coil. 3: Isocenter positioning. Removing the anterior coil section 1. Tilt the lever on the anterior section upwards to unlock the anterior section. 2. Carefully raise the coil at the cranial side and take it off the head support. 3. To attach the anterior coil back to the head support, proceed in the same way in reverse order. Fig. 39: 1: Side view of the closed coil. 2: Upturned pin on anterior section to open the coil. 3: Tilted anterior section. SENSE Head/Neck coil Type of coil 3 elements phased-array coil Design Dimensions Receive-only Volume coil : Combination of Q-Head coil and two quadrature neck elements. 2 neck elements of 16 cm in FH- and 22 cm in LR-direction Achieva 73

74 Coils and Positioning SENSE Head/Neck coil Available for 1.5T SENSE-compatible CLEAR-compatible Yes Yes Applications Brain Imaging including Intracranial MRA Cervical Spine Imaging down to T4 Carotid vessels from aortic arch to Circle of Willis General remarks All combinations of the three coil elements are possible. The coil can be used with or without anterior neck element. Always use CLEAR as homogeneity correction for best image quality. The mirror of the Q-Head coil cannot be used (tilted position). Multi coil imaging Dual coil imaging User Interface Name No No SENSE-Head/Neck Fig. 40: Left: SENSE Head/Neck coil with all components. Right: Patient positioning with anterior neck element. Lifting the coil Always use the dedicated holes at both sides in the base support of the SENSE Head/Neck coil to remove the coil from the patient table. Do not lift the coil by using a bar of the Q-Head coil since base support and combiner box could fall off. SENSE Head/Neck coil in head/neck and spine examinations 1. Position the coil s base support on the patient table. 2. Position the Q-Head coil on the base support. 3. Position the combiner box next to the base support (side of patient support control panel). 74 Achieva

75 SENSE Head/Neck coil Coils and Positioning Fig. 41: 1: Base support. 2: Q-Head coil on base. 3: Combiner box. 4. Connect the short cable of the Q-Head coil to the lowest connector in the combiner box. 5. Replace the head rest of the Q-Head coil with the head rest and posterior element of the SENSE Head/Neck coil. 6. Connect the short cable of the posterior element to the middle connector in the combiner box. Fig. 42: 1: Short cable connection. 2: Posterior element and head rest. 3: Posterior element and short cable. 7. Position the holder for the anterior element on the head coil. 8. Position the patient as close to the top part of the headrest as possible for best coverage in FH-direction. Make sure the patient is comfortable. Move the sliding part of the Q-Head coil down over the patient s head. See section Q-Head coil for more information. 9. Click the anterior element onto its holder on the Q-Head coil. Turn the lock to fixate it. Connect the cable of the anterior element to the upper connector in the combiner box. Achieva 75

76 Coils and Positioning T/R Head coil Fig. 43: 1: Anterior element holder. 2: Mounting of the anterior element:. Coil elements The elements are called: H (head coil), A (anterior), P (posterior), and can be selected in the following way: Recommended element selection Anatomical region Coil elements Notes Anterior neck A or AP It is possible to scan without anterior part Head and neck all three elements: HAP H is optional being connected, e.g. for large patients. Angio AP or HAP C-spine sagittal all thress elements: HAP C-spine axial two neck elements: AP T/R Head coil Type of coil Quadrature detection Transmit/Receive Design Volume coil Coverage Head down to C3 Available for 1.5T and 3.0T SENSE-compatible No CLEAR-compatible No MultiTransmit- compatible No Applications Brain General remarks Coil is shorter than the standard head coil for other field strengths. Make sure the patient is high up in the coil for maximum coverage. 76 Achieva

77 T/R Head coil Coils and Positioning Multi coil imaging Dual coil imaging User Interface Name No No T/R-Head Fig. 44: T/R Head coil. Coil positioning on tabletop Place the plastic bar delivered with the coil in the table groove. A box is located at the back end of the coil which sticks out towards the magnet bore. Placing the plastic bar into the table groove prevents the box from breaking off when the table is lowered. Fig. 45: 1: T/R Head coil on tabletop. 2: Wrong: Plastic bar not in groove, box sticking out. 3: Correct: Plastic bar in groove, box not sticking out. T/R Head coil for brain examination 1. Place the head coil on the tabletop. 2. Place the mattress on the tabletop. Make sure the head support is secure. 3. Place the patient on the tabletop with the head 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. Achieva 77

78 Coils and Positioning H Head coil 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. 4. 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. 5. Attach the optical mirror to the coil so that the patient can look see out of the bore. This can be reassuring for patients. Fig. 46: Left: Head coil closed. Right: open. H Head coil Type of coil Quadrature detection Receive Design Volume coil Coverage Head down to C3 Available for 1.5T SENSE-compatible No CLEAR-compatible No MultiTransmit- compatible No Applications Brain, MR Spectroscopy General remarks Coil is shorter than the standard head coil for other field strengths. Make sure the patient is high up in the coil for maximum coverage. Multi coil imaging No Dual coil imaging No 78 Achieva

79 H Head coil Coils and Positioning User Interface Name H-Head Fig. 47: H Head coil. Coil positioning on tabletop Place the plastic bar delivered with the coil in the table groove. A box is located at the back end of the coil which sticks out towards the magnet bore. Placing the plastic bar into the table groove prevents the box from breaking off when the table is lowered. Fig. 48: 1: T/R Head coil on tabletop. 2: Wrong: Plastic bar not in groove, box sticking out. 3: Correct: Plastic bar in groove, box not sticking out. H Head coil for brain examination 1. Place the head coil on the tabletop. 2. Place the mattress on the tabletop. Make sure the head support is secure. 3. Place the patient on the tabletop with the head 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. Achieva 79

80 Coils and Positioning TMJ coil / Coil Holder Use the head fixation strap for extra immobilization. 4. 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. 5. Attach the optical mirror to the coil so that the patient can look see out of the bore. This can be reassuring for patients. Fig. 49: Left: Head coil open. Right: closed. TMJ coil / Coil Holder Type of coil Linear detection Receive-only Design Two flexible surface coils: circular Dimensions 11 cm, Opening in a coil Ø 8 cm Available for 1.5T SENSE-compatible No CLEAR-compatible No Applications Temporo-Mandibular Joint (TMJ) Eye, Orbit, Ear, Larynx Limitations The penetration depth is only a few centimeters. Multi coil imaging Yes (see section Multi coil imaging ) Dual coil imaging No User Interface Name TMJ-left, TMJ-right 80 Achieva

81 SENSE NeuroVascular coil 8 and 16 Coils and Positioning Fig. 50: Left: TMJ coil. Right: TMJ coil holder with SENSE Flex-S coil. TMJ coil for TMJ examinations Both joints can be imaged simultaneously (in Multi coil mode). 1. Position the patient in the TMJ coil holder rest assembly. 2. Center the patient's head and immobilize it using velcro strap and band. 3. Place your finger through the TMJ coils to locate the head of the mandible (ask the patient to open and close the mouth). 4. Position each coil as close as possible to the patient's cheeks. 5. Use the body coil to make a survey image of both TMJs. SENSE NeuroVascular coil 8 and 16 Type of coil 18 element phased-array coil, available in versions for the 8- and 16-channel Design RF platforms Receive-only Available for 1.5T, 3.0T Rigid volume coil consisting of a posterior and anterior part (cage). Optional: a top-off anterior part (only part of the SENSE Head/Spine coil combination). SENSE-compatible Yes; max. SENSE factor: 8 for SENSE NV coil 8, 16 for SENSE NV coil 16 CLEAR-compatible Yes MultiTransmit- compatible SENSE NV coil 8 and 16: Yes (only applicable for Achieva 3.0T TX) Applications Brain imaging including intracranial MRA Cervical spine imaging down to T4 Carotid vessels from aortic arch to Circle of Willis Markers on the coil In the middle of the coil (FH direction) for light visor positioning. In the middle of the anterior part. Achieva 81

82 Coils and Positioning SENSE NeuroVascular coil 8 and 16 General remarks Always use CLEAR as homogeneity correction for best image quality. Multi coil imaging NV8: No NV16: Yes (see section Multi coil imaging ) Dual coil imaging NV8: No NV16: Yes (see section Multi coil imaging ) User Interface Name Element selection SENSE-NV-16, SENSE-NV-8 See section Coil elements for more information. Fig. 51: 1: Posterior part with pad. 2: Posterior part with anterior part attached. 3: Dedicated headset. Dedicated headset Since this coil is not compatible with the Q-Head coil headset, a dedicated headset is available. The hearing protection provided is lower than with the Q-Head coil headset. The use of earplugs is mandatory on 3.0T and highly recommended on 1.5T. An alternative to the headset are the gray wedge cushions which can be placed between the patient s head and the coil. General Considerations Always close the coil before connecting it to the system. Always disconnect the coil from the system before opening the coil. 82 Achieva

83 SENSE NeuroVascular coil 8 and 16 Coils and Positioning Do not leave unused coils or coil parts on the tabletop. When connected to the system there is a voltage of 12 volt DC present at the contacts of the posterior part. Under normal conditions this voltage is not hazardous to patients. However for critically ill cardiac patients this low DC voltage may have dramatic consequences. Follow the instructions above carefully to prevent that these type of patients can touch the contacts while the coil is connected to the system. Positioning 1. Place the posterior part with the pad on the tabletop. 2. Place the patient on the posterior part so that the shoulders touch the posterior part. 3. Attach the anterior part (either cage or top-off) to the posterior part. 4. Use the two handles to close the coil. While closing the coil verify that the patient's skin cannot be pinched between coil parts. Fig. 52: 1: Attaching of anterior part to posterior part. 2: Anterior part attached to posterior part. 3: Top-off anterior part attached to posterior part. Note that the coil may not be lifted by gripping through the holes (see arrows) between anterior and posterior part. Lifting up the coil 1. Do not lift up the coil in one piece. 2. Remove the anterior part first and then carefully lift up the posterior part. Achieva 83

84 Coils and Positioning SENSE NeuroVascular coil 8 and 16 Never lift the coil by gripping through the holes between anterior and posterior part. This might lead to severe damage of the coil. Coil elements The SENSE NV coil 16 and the SENSE NV coil 8 are different coils which offer a different number of elements for scanning. However, both coils are based on an 18-element design: 8 head elements, 4 neck elements, 6 chest elements. Fig. 53: Coil elements: 8 head (red), 4 neck (green), 6 chest elements (blue). These 18 coil elements are combined in two different ways resulting in the two SENSE Neuro- Vascular coils: the 8-channel SENSE NV coil: SENSE NV 8 the 16-channel SENSE NV coil: SENSE NV 16 Operating modes SENSE NV coil 8 The SENSE NV coil 8 has two operating modes: Head mode The signal from each individual head coil element is directly routed to Freewave. This means that 8 head elements (red in figure) are used as 8 channels. This mode is preferred for head and brain imaging including intracranial MRA. It provides excellent detail for small anatomical structures in the head. NV (NeuroVascular) mode The signals from all elements (red, green and blue in figure) are combined resulting in an 8- channel NV mode. 84 Achieva

85 SENSE Head/Spine coil combination Coils and Positioning This mode is preferred for cervical spine, neck imaging including extracranial MRA. The maximal recommended field of view (FOV) is 44 cm. Operating modes SENSE NV 16 coil The signals from all elements (red, green and blue in figure) are combined resulting in a 16- channel NV coil. These channels can be combined in several ways. The table shows the full range of selection possibilities. Channels Head Neck Ant.Chest Post.Chest Selection HNACPC x x x x x x x x x x x x x x x x H x x x x x x N x x x x AC x x x PC x x x HN x x x x x x x x x x NAC x x x x x x x NPC x x x x x x x HNPC x x x x x x x x x x x x x NACPC x x x x x x x x x x TO-HNPC - x x x x - - x x x x x x TO-NPC x x x x x x The abbreviations stand for H - Head, N - Neck, AC - Anterior Chest, PC - Posterior Chest, TO - Top-off. SENSE Head/Spine coil combination Type of coil 31 elements phased-array coil Design SENSE-compatible CLEAR-compatible Receive-only Coil combination of the SENSE NeuroVascular 16 coil and a rigid 15 element spine coil. The SENSE NV 16 coil offers different coil tops: an anterior coil part (cage) and a U-shaped cover without elements (referred to as top-off ). Yes; max. SENSE factor: 16 (with anterior coil part) Yes Achieva 85

86 Coils and Positioning SENSE Pediatric Head Spine coil MultiTransmit- compatible Yes (only applicable for Achieva 3.0T TX) Fig. 54: SENSE Head/Spine coil combination. 1-3: Set-up for total neuro examination. 4-5: Set-up for total spine examination. The SENSE NeuroVascular 16 coil with top-off can be used stand-alone for the cervical spine in claustrophobic patients. This will result in loss of SNR due to missing anterior elements. Therefore it is not recommended for examinations of the anterior neck, brain or carotid angiography. See chapter Coil Combinations, section SENSE Head/Spine coil combination for more information. SENSE Pediatric Head Spine coil Type of coil 8 element phased-array coil Design Receive-only Rigid volume coil 86 Achieva

87 SENSE Spine coil 15 Coils and Positioning Dimensions Height 26 cm, width 30 cm, length 65 cm Available for 1.5T, 3.0T SENSE-compatible CLEAR-compatible Applications Multi coil imaging Dual coil imaging User Interface name Yes Yes Pediatric head and spine No No SENSE-Ped-HeadS Fig. 55: Left: SENSE Pediatric Head Spine coil. Right: Baby positioned in coil. Positioning 1. Put the yellow mattress on the tabletop. 2. Place the coil on the mattress. 3. Position the child in the coil with the head in the cage-like coil part. SENSE Spine coil 15 Type of coil 15 element phased-array coil Receive-only Design Rigid surface coil. Dimensions 54 cm x 95 cm Available for 1.5T, 3.0T SENSE-compatible Yes CLEAR-compatible Yes MultiTransmit-compatible Yes (only applicable for Achieva 3.0T TX) Achieva 87

88 Coils and Positioning SENSE Spine coil 15 Applications Thoracic and Lumbar spine Screening total spine and total neuro in combination with SENSE NV 16 coil and MobiTrak option. This coil can also be combined with the SENSE Flex-L coil. General remarks Markers on the coil Multi coil imaging Dual coil imaging This coil cannot be used for the cervical spine as a stand-alone coil. There are no inside markers. All elements are indicated by a marker on the outside of the coil. Yes (see section Multi coil imaging ) Yes (see section Dual coil imaging ) User Interface name SENSE-Spine-15 Fig. 56: SENSE Spine coil 15 in use together with the SENSE NV coil 16. Patient positioning. The mattress and the accessories might look different to the figures above. 88 Achieva

89 SENSE Spine coil 1.5T Coils and Positioning Coil elements and element selection Fig. 57: Layout of SENSE Spine coil 15 with element groups A, B, C, D and E. H stands for Head, F stands for Feet. SENSE Spine 15 Element Combination Names A To be used with SENSE NV coil 16 combinations, e.g. NPC, HNPC AB To be used with SENSE NV coil 16 combinations, e.g. NACPC, HNPC ABC To be used with SENSE NV coil 16 combinations, e.g. NPC, TO-NPC BCD To be used for SENSE Spine 15 CDE To be used for SENSE Spine 15 ABCD To be used for SENSE Spine 15 or with NV 16 coil PC BCDE To be used for SENSE Spine 15 ABCDE To be used for SENSE Spine 15 M-ABCDE To be used for SENSE Spine 15 with Flex-L coil See chapter 6 Coil Combinations, section SENSE Head Spine coil combination for more information on the coil combination SENSE Spine 15 and SENSE NV coil 16. SENSE Spine coil 1.5T Type of coil 5 element phased-array coil Design Dimensions Available for 1.5T SENSE-compatible Receive-only Rigid surface coil. Imaging length: 78 cm Yes Achieva 89

90 Coils and Positioning SENSE Spine coil 1.5T CLEAR-compatible Yes Applications Cervical, thoracic and lumbar spine Screening total spine with MobiTrak option Screening total neuro with MobiTrak option and SENSE Flex-L coil Peripheral MRA (lower legs) General remarks Markers on the coil Multi coil imaging Dual coil imaging User Interface name Always use either CLEAR or Homogoneity Correction set to Strong for best image quality. This coil has two built-in MR-markers: in the middle of segment 2 and In the middle of segment 4. All elements are indicated by a marker on the outside of the coil. Yes (see section Multi coil imaging ) Yes (see section Dual coil imaging ) SENSE-Spine Fig. 58: 1: SENSE Spine coil 1.5T. 2: Patient positioned on tabletop. 3: Coil elements 1 to 5 (H - Head, F - Feet). SENSE Spine coil in C-, T- and L-Spine 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. Use the knee cushion to minimize lumbar lordosis and to increase patient comfort. 90 Achieva

91 SENSE Spine coil 1.5T Coils and Positioning Recommended element selection Anatomical region Field of View Coil elements Cervical spine 250 mm 1 (down to T4) CT-spine 400 mm 1,2,3 Thoracic spine 350 mm 1,2,3,4 (C7-L1) TL-spine 530 mm 2,3,4,5 Lumbar spine 300 mm 3,4,5 Total Spine workflow in ExamCards Total Spine examinations can be done with the SENSE Spine coil using the MobiTrak option. Total Spine ExamCards acquire three stacks (cervical, thoracic, lumbar) at different table positions. Table movement is required between acquisition of these stacks. Workflow 1. Position the patient on the SENSE Spine coil. 2. Center on the first element (cervical spine part) of the coil. 3. Start the Total Spine ExamCard. Automatically the sagittal survey will start, followed by the coronal survey. 4. Load both surveys into the MobiView package. 5. Click Smooth fuse. 6. Save the images to the data base. 7. Load the fused surveys into the planning environment. 8. Plan a sagittal Total Spine sequence on the sagittal survey (FH and AP offcenters) and on the coronal survey (RL angulations). 9. Press Proceed to complete planning. 10. All scans and stations are now planned since GeoLinks and ScanAlign are applied within the Total Spine ExamCard. 11. Start the ExamCard. 12. Images can be viewed, fused and saved in MobiView. SENSE Spine coil in MobiTrak/MobiFlex examinations In MobiTrak/MobiFlex examinations, the SENSE Spine coil can be used for improved SNR in the lower legs. Follow the procedure as described below: Achieva 91

92 Coils and Positioning SENSE Spine coil 3.0T The SENSE Spine coil is not compatible with the MobiTrak leg support. Positioning 1. Remove the small mattress from the end of the tabletop closest to the magnet. 2. Place the SENSE Spine coil at the very end of the tabletop. 3. Position the patient supine with feet first. 4. Raise the patient support with the patient sitting on the tabletop. For tall patients only: the SENSE Spine coil neck element (element 1) should stick out in order to obtain as large as possible coverage. 5. Ensure that the middle of the abdominal stack does not lie beyond the markers on the tabletop. 6. Position the patient s feet in a small exo-rotation with a cushion under the achilles tendon. 7. Position a small knee cushion for optimal support of both knees somewhat higher than the knee pit. Both calves must hang freely. 8. Avoid skin-to-skin contact or place insulating material between and outside the patient s legs. 9. Immobilize the patient by means of sandbags and cushions. 10. Position the patient s arms above his/her head on the support cushion or on the abdomen. 11. Use the arm supports to avoid finger pinching. 12. Ensure that the cables don t get trapped: move the tabletop with the patient being positioned from the lower legs up to the abdomen manually. Repeat this tabletop movement until it is for sure that all of the cables are fixed and won t get caught. 13. Move the tabletop to project the light visor on the middle of the lower stack (lower legs). 14. Move the lower legs to the isocenter of the magnet. Check the coil for all stacks (stack A: phased-array coil, stack B and C: Q-Body coil). The parameter Multi Coil has to be set to Yes if a phased-array coil is used for the lower legs. SENSE Spine coil 3.0T Type of coil 12 elements phased-array coil Receive-only 92 Achieva

93 SENSE Spine coil 3.0T Coils and Positioning Design Dimensions Rigid surface coil consisting of 12 elements divided in 6 sections (2 coils per section) Imaging length: 40 cm for each mode Available for 3.0T SENSE-compatible CLEAR-compatible Yes Yes MultiTransmit-compatible Yes (only applicable for Achieva 3.0T TX) Applications Cervical, Thoracic and Lumbar spine Screening total spine with MobiTrak option Screening total neuro with MobiTrak option and SENSE Flex-L coil. Peripheral MRA (lower legs) General remarks The coil is not compatible with the head set. Always use either CLEAR or Homogoneity Correction set to Strong for best image quality. Markers in the coil Multi coil imaging Dual coil imaging User Interface Name This coil has two built-in MR-markers: between element B and C, and between element D and E. Coil sections are indicated at the side of the pad covering the coil. Yes (see section Multi coil imaging ) Yes (see section Dual coil imaging ) SENSE-Spine Fig. 59: Left: SENSE Spine coil. Right: Patient positioned on coil. Coil elements and combinations The SENSE Spine coil consists of twelve coils grouped by two, leading to six sections. Per coil mode (cervical, thoracic, lumbar) different channel combinations can be chosen. Achieva 93

94 Coils and Positioning SENSE Spine coil 3.0T A separate refscan is required for each coil mode. 1 2: A C-Sp B B C C T-Sp D D L-Sp E F 3 Fig. 60: Coil elements of the SENSE Spine coil 3.0T. 1 - Channel combination (C-Spine CSp, T-spine TSp, L-spine LSp), 2 - Coil part (A, B, C, D, E, F), 3 - Each coil section has two elements: a loop and a butterfly. Positioning for C-, T- and L-Spine 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. Use the knee cushion to minimize lumbar lordosis and to increase patient comfort. Recommended element selection Anatomical Region Scan Orientation Coil elements Cervical spine (down to T4) Thoracic spine (C7 - L1) Sagittal AB or 1234 Sagittal (due to different coil element names in different releases) BCD or for maximum coverage (due to different coil element names in different releases) 94 Achieva

95 SENSE Spine coil 3.0T Coils and Positioning Anatomical Region Scan Orientation Coil elements Lumbar spine Sagittal DEF or for maximum coverage (due to different coil element names in different releases) Spine Axial Less elements than listed above Homogeneity Correction and CLEAR Use CLEAR in cervical and lumbar spine in sagittal and axial orientation. Use Homogeneity Correction set to Strong in sagittal total spine examinations. Total Spine workflow in ExamCards Total Spine examinations can be carried out with the SENSE Spine coil using the MobiTrak option. Total Spine ExamCards acquire three stacks (cervical, thoracic, lumbar) at different table positions. Table movement is required between acquisition of these stacks. Workflow 1. Position the patient on the coil (SENSE Spine coil). 2. Center on the first element (cervical spine part) of the coil. 3. Start the Total Spine ExamCard. Automatically the sagittal survey will start, followed by the coronal survey. 4. Load both surveys into the MobiView package. 5. Click Smooth fuse. 6. Save the images to the data base. 7. Load the fused surveys into the planning environment. 8. Plan a sagittal Total Spine sequence on the sagittal survey (FH and AP offcenters) and on the coronal survey (RL angulations). 9. Press Proceed to complete planning. All scans and stations are now planned since GeoLinks and ScanAlign are applied within the Total Spine ExamCard. 10. Start the ExamCard. 11. Images can be viewed, fused and saved in MobiView. SENSE Spine coil in MobiTrak/MobiFlex examinations In MobiTrak/MobiFlex examinations, the SENSE Spine coil can be used for improved SNR in the lower legs. Follow the procedure as described below: Achieva 95

96 Coils and Positioning Synergy Pediatric coil The SENSE Spine coil is not compatible with the MobiTrak leg support. Positioning 1. Remove the small mattress from the end of the tabletop closest to the magnet. 2. Lower the patient support. 3. Place the SENSE Spine coil at the very end of the tabletop. 4. Position the patient supine with feet first. 5. Raise the patient support with the patient sitting on the tabletop. 6. For tall patients only: the SENSE Spine coil neck element (element 1) should stick out in order to obtain as large as possible coverage. 7. Ensure that the middle of the abdominal stack does not lie beyond the markers on the tabletop. 8. Position the patient s feet in a small exo-rotation with a cushion under the achilles tendon. 9. Position a small knee cushion for optimal support of both knees somewhat higher than the knee pit. Both calves must hang freely. 10. Avoid skin-to-skin contact or place insulating material between and outside the patient s legs. 11. Immobilze the patient as good as possible by means of sandbags and cushions. 12. Position the patient s arms above the head on the support cushion or on the abdomen. 13. Use the arm supports to avoid finger pinching. 14. Ensure that the cables don t get trapped beneath the tabletop: move the tabletop with the patient being positioned from the lower legs up to the abdomen manually. Repeat this tabletop movement until it is for sure that all of the cables are fixed and won t get caught. 15. Move the tabletop to project the light visor on the middle of the lower stack (lower legs). 16. Move the lower legs to the isocenter of the magnet. Check the coil for all stacks (stack A: phased-array coil, stack B and C: Q-Body coil). The parameter Multi Coil has to be set to Yes if a phased-array coil is used for the lower legs. Synergy Pediatric coil Type of coil Q-Head coil plus 5 elements phased-array coil Receive-only 96 Achieva

97 Synergy Pediatric coil Coils and Positioning Design Dimensions Volume coil consisting of the Q-Head coil and a dedicated 5 element phased-array pediatric spine coil 40 cm long, 8 cm wide consisting of 5 elements providing a coverage of 58 cm in FH-direction (Q-Head and pediatric spine coil) Available for 1.5T SENSE-compatible CLEAR-compatible Applications No Yes Suitable for patients up to 5 years old Pediatric head and total spine imaging (from Cervical to Sacral spine) in supine as well right-decubitus position Spina Bifida (in the unique vertical coil position) Neonatal examinations Markers spine coil Multi coil imaging There are slots for markers in the middle of the 2nd and the 4th element. No Dual coil imaging User Interface Name No Syn-Pediatric Fig. 61: 1: Synergy Pediatric coil. 2: Supine positioning. 3: Decubitus positioning. Coil Assembly of the Synergy Pediatric coil Put the base support of the Synergy Pediatric coil on the table. Place the spine coil in the base and the special mattress on the base. Remove the headrest holder of the Q-Head coil. Click the holder of the spine coil into the Q-Head coil. Plug the short cable of the Q-Head coil into the connector housed in the holder of the pediatric spine coil. Achieva 97

98 Coils and Positioning Synergy Pediatric coil Connect the large connector of the pediatric spine coil to one of the coil connectors on the front of the magnet. The Q-Head coil and the pediatric spine coil must always be positioned together on the tabletop and be connected to each other. The Q-Head coil is NOT plugged into the connectors on the front of the system but is plugged into the holder of the pediatric spine coil. Always disconnect the Q-Head coil from the pediatric spine coil before removing them from the tabletop. Pediatric spine examinations 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. Spine The Q-Head coil does not need to be moved over the patient s head. The Q-Head coil must always be placed on the tabletop and be connected to the coil base. Do not select the head coil element, but elements 1-5 (the spine coil). 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. 98 Achieva

99 Q-Body coil Coils and Positioning 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. Q-Body coil Type of coil Quadrature detection Transmit/Receive coil Design Built-in volume coil Available for 1.5T, 3.0T SENSE-compatible No CLEAR-compatible No MultiTransmit-compatible Yes (only applicable for Achieva 3.0T TX) Application Imaging large parts of the body Imaging when large fields of view are required (e.g. survey). General remarks All other coils (except for the T/R coils) are passive receive-only coils using the Quadrature Body coil for transmission. Coils with a large effective volume (Q-Body coil) have a lower SNR than coils with a relatively small effective volume. Multi coil imaging No Dual coil imaging No User Interface Name Q-Body Achieva 99

100 Coils and Positioning SENSE Cardiac coil 1.5T Fig. 62: Left: Achieva system. Right: Patient in tunnel (integrated Q-Body coil). SENSE Cardiac coil 1.5T Type of coil 5 element phased-array coil Receive-only Design Volume coil consisting of five separate coil elements: two anterior flexible coils (element 1 and 2) and three posterior coils which are encased in the coil base (elements 3, 4 and 5). Dimensions The top circular coils are 200 mm in diameter. The base is made of three rectangular coils measuring 138 x 200 mm. Available for 1.5T SENSE-compatible Yes CLEAR-compatible Yes Applications Four main cardiac chambers Coronary arteries Aortic and pulmonary root Mediastinum General remarks Always use CLEAR as homogeneity correction for best image quality. Markers on the coil The coil base contains markers to demonstrate the location of elements within the coil. Multi coil imaging Yes (see section Multi coil imaging ) Dual coil imaging Yes (see section Dual coil imaging ) User Interface Name SENSE-Cardiac 100 Achieva

101 SENSE Cardiac coil 1.5T Coils and Positioning Fig. 63: Left: SENSE Cardiac coil - coil base and anterior elements. Right: SENSE cushion besides SENSE Cardiac coil. Positioning with the SENSE Cardiac coil 1.5T The patient lies on the base of the coil and the top section is placed on the anterior chest. There is an adjustable fixation strap which secures the two top coils on to the patient s chest. 1. Lie the patient on the base and use the side markers to align the patient's chest to the center of the coil base. The side markers denote top, middle and bottom of the elements encased in the coil base. 2. Apply electrodes and respiratory belt if necessary. 3. 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. For SENSE scans, the SENSE cushion has to be attached to the top section. See figure. Achieva 101

102 Coils and Positioning SENSE Cardiac coil 3.0T Fig. 64: 1 SENSE Cardiac coil - coil base and anterior elements. 2: Attaching the top section to SENSE cushion. 3: SENSE Cardiac coil in cardiac examination. 4. Attach the top section to the base by using the clips on both sides of the coil base. 5. Adjust the velcro straps to give a secure, but comfortable fit. In case of a PSCP (patient support control panel) on the right side of the system, the cable should be placed underneath the mattress. The coil top may also be positioned more towards center or right side, if the heart is not in the normal location. SENSE Cardiac coil 3.0T Type of coil 6 elements phased-array coil Design Dimensions Available for 3.0T SENSE-compatible CLEAR-compatible MultiTransmit-compatible Receive-only Volume coil consisting of a rigid lower part and flexible upper part. Each part contains three phased-array coil elements. Coil element dimensions: 23 cm left-right by 32 cm feet-head Yes Yes Yes (only applicable for Achieva 3.0T TX) 102 Achieva

103 SENSE Cardiac coil 3.0T Coils and Positioning Applications Four main cardiac chambers Coronary arteries Aortic and pulmonary root Mediastinum General remarks Markers on the coil Multi coil imaging Dual coil imaging User Interface Name Always use CLEAR as homogeneity correction for best image quality. A sticker displaying the element lay-out is positioned on the upper part of the coil. The length of the coil elements is shown by a dotted line. Yes (see section Multi coil imaging ) Yes (see section Dual coil imaging ) SENSE-Cardiac Fig. 65: SENSE Cardiac coil 3.0T: anterior and posterior part with mattress. Positioning with the SENSE Cardiac coil 3.0T 1. Position the posterior coil part on the tabletop. 2. Position the mattress on the coil for patient comfort and to ensure a distance between patient and coil. 3. Position the patient on the posterior coil part. 4. Apply electrodes and respiratory belt if necessary. 5. Place the anterior section on the patient s chest directly above the posterior part. If SENSE is to be used, the SENSE mattress must be attached to the coil to create a small distance between patient and coil. 6. Strap the coil comfortably around the patient, with the respiratory sensor and electrodes in between patient and coil. Achieva 103

104 Coils and Positioning SENSE Torso/Cardiac coil Fig. 66: Patient positioning with SENSE Cardiac coil. SENSE Torso/Cardiac coil Type of coil 32 elements phased-array coil Receive-only Design Volume coil consisting of a flexible posterior part and a flexible anterior part. Each part contains 16 phased-array coil elements. Two types of mattresses are provided: a housing mattress for the posterior coil, a posterior spacer mattress (SENSE pad) for patient comfort and a thick anterior SENSE pad. Dimensions Coil element dimensions: 39.4 cm left-right by 45.7 cm feet-head Available for 1.5T, 3.0T SENSE-compatible Yes CLEAR-compatible Yes MultiTransmit-compatible Yes (only applicable for Achieva 3.0T TX) Applications Abdomen and pelvis, e.g. liver, pancreas, kidneys, bladder, prostate Cardiac applications, e.g. Four main cardiac chambers, Coronary arteries, Aortic and pulmonary root, Mediastinum General remarks Always use CLEAR as homogeneity correction for best image quality. Always use the spacer mattress between patient and anterior coil part for best image quality. Markers on the coil A sticker displaying the element lay-out is positioned on the anterior part of the coil. The length of the coil elements is shown by a dotted line. 104 Achieva

105 SENSE Torso/Cardiac coil Coils and Positioning Multi coil imaging Dual coil imaging User Interface Name Yes Yes (Use Dual coil = yes to be able to use both coil halves simultaneously). The anterior and posterior coil part can be combined in Dual coil imaging and be selected separately as: HR-TorsoCardiac-A HR-TorsoCardiac-P Fig. 67: SENSE Torso/Cardiac coil with its components. 1 - Spacer mattress, 2 - housing mattress with posterior coil part embedded, 3 - anterior coil part. Positioning with the SENSE Torso/Cardiac coil 1. Place the housing mattress with the posterior coil part embedded on the tabletop. 2. Make sure that the cable of the posterior coil passes through the groove of the housing mattress which is on the side of the Patient Support Control Panel so that it can easily be plugged into the connector. 3. Cover with the yellow spacer mattress. 4. Stick the anterior SENSE pad to the anterior coil part by means of the velcro attachment points. Fig. 68: Left: Anterior coil part and anterior SENSE pad. Right: Anterior coil part and anterior SENSE pad sticked together. Achieva 105

106 Coils and Positioning SENSE Breast coil 4 5. Position the patient on the mattress with the anatomical region to be examined above the posterior coil part. 6. Place the anterior coil part on the patient s breast. The posterior and the anterior coil part should be aligned such that they have the same FH (Feet-Head) position. For cardiac examinations, the top of the anterior coil part should almost reach the chin. The arms can be placed inside or outside the coil. 7. Use the standard Philips table Velcro straps to fix the anterior coil. Fig. 69: 1: Tabletop is prepared for patient positioning: housing mattress with posterior coil part embedded and spacer mattress on top, (anterior coil part floating above). 2: Patient is positioned on tabletop, the anterior coil part (with SENSE pad) is being placed. 3: Anterior coil part (with SENSE pad) is fixed to the patient by means of velcro straps. SENSE Breast coil 4 Type of coil 4 element phased-array coil Receive-only Design Volume coil with an aperture in wich the breasts can be positioned. A positioning cushion for the lower part of the body is provided. Available for 1.5T, 3.0T 106 Achieva

107 SENSE Breast coil 4 Coils and Positioning SENSE-compatible CLEAR-compatible MultiTransmit-compatible Applications General remarks Multi coil imaging Dual coil imaging User Interface Name Yes Yes Yes (only applicable for Achieva 3.0T TX) MR Mammography (both breasts simultaneously) Always use CLEAR as homogeneity correction for best image quality. No No SENSE -Breast-4 Fig. 70: SENSE Breast coil 4. Left: Coil. Right: With positioning cushion. Positioning with the SENSE Breast coil 4 Patient preparation 1. Prepare the patient as usual for an MR examination. It is advisable to have the patient strip to the waist and to remove any zip fasteners in the waist area. Imaging is best performed when the breasts can hang freely in the coil aperture. Coil Positioning 1. Place the coil on the tabletop with the coil aperture to the magnet. 2. Place the positioning cushion behind the coil. 3. Route the cable in the groove in the bottom of the cushion. 4. Put a pillow on the tabletop in front of the coil. Achieva 107

108 Coils and Positioning SENSE Breast coil 7 (incl. biopsy) Fig. 71: Left: Coil with positioning cushion. Note the groove in the cushion for the cable. Right: Patient positioning on the coil. Patient Positioning 1. Position the patient prone on the breast coil. 2. Ensure that the breasts are hanging freely in the coil, and that the breasts and the axilla area are free of folds. 3. Ask the patient to place the arms next to the head. 4. Centre the light visor to the middle of the breast, and move the patient into the isocenter. 5. Make sure that the patient s head faces to the pillow. The patient s head should not be turned to the side. This affects the position of the upper part of the body: the breasts and the shoulder may lift up out of the coil. SENSE Breast coil 7 (incl. biopsy) The table below summarizes the most important coil characteristics. For more information, refer to the following sections: Breast Imaging Workflow Breast Biopsy Components Breast Biopsy Methods Breast Biopsy Device Preparation Breast Biopsy Workflow Type of coil 7 element phased-array coil Receive-only 108 Achieva

109 SENSE Breast coil 7 (incl. biopsy) Coils and Positioning Design Volume coil with an aperture in which the breasts can be positioned. A separate head support is provided. Available for 1.5T, 3.0T SENSE-compatible Yes; max. SENSE factor: all elements: AP = 4.0, FH = 1.0 and RL = 7.0 right part: AP = 4.0, FH = 1.0 and RL = 3.0 left part: AP = 4.0, FH = 1.0 and RL = 3.0 CLEAR-compatible MultiTransmit-compatible Applications Yes No MR Mammography (both breasts simultaneously) General remarks Switch off CLEAR as homogeneity correction for all T1-weighted and all fatsuppressed scans. This coil can be used for biopsy with the biopsy starter kit *. Multi coil imaging No Dual coil imaging User Interface Name Fig. 72: SENSE Breast 7 coil. No SENSE-Breast-7 Positioning with the SENSE Breast coil 7 Patient preparation 1. Prepare the patient as usual for an MR examination. It is advisable to have the patient strip to the waist and to remove any zip fasteners in the waist area. Imaging is best performed when the breasts can hang freely in the coil aperture. Achieva 109

110 Coils and Positioning SENSE Breast coil 7 (incl. biopsy) Coil Positioning 1. Place the coil on the tabletop with the coil aperture to the magnet. 2. Place the head support on the table in front of the coil. Patient Positioning 1. Position the patient prone on the breast coil, with the head on the head support. 2. Adjust the height of the head support by means of the lever, see figure. Fig. 73: 1 and 2:Head support for SENSE Breast coil 7. The arrow indicates the lever for height adjustment 3: Positioning on SENSE Breast coil Ask the patient to place the arms either next to the head or alongside their body. 4. Ensure that the breasts are hanging freely in the coil, and that the breasts and the axilla area are free of folds. 5. Center the light visor to the middle of the breast, and move the patient into the isocenter. Breast Biopsy Breast Biopsy Components The coil can be used for biopsy in combination with the corresponding biopsy kit. For information about content and assembly of the biopsy kit, please refer to the user documentation provided with the biopsy kit. Breast Biopsy Methods Immobilization is required when localization or biopsy procedures are intended. Unilateral or bilateral breast immobilization can be performed. There are two different biopsy methods: Grid method (lateral or medial access) Pillar method (lateral or medial access) Both methods can be performed either with lateral or medial access. 110 Achieva

111 SENSE Breast coil 7 (incl. biopsy) Coils and Positioning Fig. 74: Left: Grid method. Right: Pillar method. Breast Biopsy Device Preparation For information about content and assembly of the biopsy kit, please refer to the user documentation provided with the biopsy kit. Breast Biopsy Workflow Make sure that you are familiar with the set up and function of the biopsy device prior to use with a patient. Preparation 1. Prepare the patient as usual for an MR examination. It is advisable to have the patient strip to the waist and to remove any zip fasteners in the waist area. Imaging is best performed when the breasts can hang freely in the coil aperture. 2. Prepare the tabletop in the same way as for Breast imaging. Patient Positioning 1. Position the patient prone on the breast coil, with the head on the head support. Adjust the height of the head support by means of the lever. 2. Place the medial plate in all the way prior to patient positioning. Wait until the patient is lying down to place lateral rail. 3. Ask the patient to place the arms either next to her head or alongside her body. 4. Ensure that the breasts are hanging freely in the coil, and that the breasts and the axillae area are free of folds. 5. Use compression from both medial and lateral sides. Tissue should be slightly pushing through the immobilization system. Do not over-compress since this will constrict arteries. 6. Place a vitamin E capsule (serves as marker) onto the immobilization system, away from suspected lesion location. Achieva 111

112 Coils and Positioning SENSE Breast coil 7 (incl. biopsy) 7. Center the light visor to the middle of the breast, and move the patient into the isocenter. Determine needle entry point - Imaging Protocol and Calculation The determination of the needle entry point requires the acquisition of a number of imaging series. The calculation based on these series can be performed with a DynaCAD system or manually. 1. Acquire a survey scan. 2. Make sure the marker (vitamin E capsule) is included in the FOV. 3. Perform a dynamic e-thrive protocol, containing 3 dynamics. The first dynamic serves as a mask. Proceed as usual with regular dynamic breast imaging. Calculation of FH- and AP-offset and needle depth 1. If a DynaCAD system is available, the needle entry point (relative to the position of the marker) and needle depth needed to target the lesion are calculated automatically. 2. If a DynaCAD system is not available, then manual targeting has to be performed in the following way: 1. Find the lesion on the dynamic e-thrive sequence. Draw a region-of-interest (ROI) over the lesion. Copy the ROI to all slices. Note the slice number of the slice containing the lesion. 2. Find the marker (vitamin E capsule). Draw a region-of-interest (ROI) over the marker. Note the slice number of the slice containing the marker. 3. The FH offset is given by the number of slices between the marker and the lesion multiplied by the slice thickness. 4. Draw straight lines between the ROI of the marker and the ROI of the lesion. There should be a 90 degree angle between both lines. 5. The vertical line length specifies the needle entry point relative to the marker in AP direction. 6. The horizontal line length specifies the required needle depth. Performing Breast Biopsy 1. Place the needle block in the grid. 2. Place the needle block holder in an adjacent grid slot. 3. Lock the needle block holder by depressing the tab. This will prevent the needle block from coming out when the needle is withdrawn. 4. Insert the needle to the required depth and rescan at this location to verify the proper needle placement. 5. Once verified, obtain lesion sample. 112 Achieva

113 MammoTrak Coils and Positioning MammoTrak The MammoTrak enables comprehensive breast examinations including all kinds of diagnostic imaging (such as high resolution scans, dynamic scans, fat-suppressed scans) combined with breast biopsy. It allows for patient preparation outside the MR room. Safety General safety WARNING Verify that the table is at the same position within a set of scans that have the same reference frame. This is facilitated by the iso-center locking features of MammoTrak and the possibility to enforce a new reference frame. WARNING Verify that no magnetic object is present on the tabletop. Magnetic objects are attracted by the magnetic field and may cause severe personal injury when the MammoTrak is moved into to magnet. WARNING To avoid cross-infection always clean and disinfect the tabletop, Abdomen ramp, Breast coil and cables after examination of patients where contamination of these parts may have occurred (biopsy). See the section Cleaning and Disinfection for general cleaning and disinfection instructions. WARNING Do not use the MammoTrak with different MR systems. The MammoTrak only matches with one system. Using the trolley with a different system may cause personal injury while moving the tabletop into the magnet. Achieva 113

114 Coils and Positioning MammoTrak WARNING The safe working load for the tabletop on the trolley is 150 kg, the safe working load for the tabletop on the MammoTrak trolley is 180 kg. This is the total weight of patient, coils and positioning aids. The maximum total mass is: Trolley: 220 kg. MammoTrak trolley: 330 kg. WARNING Verify that no person is sitting on the tabletop at the end of the magnet. The tabletop could tip over causing injury to the patient. WARNING For scanning always move the tabletop to its end stop in the magnet. This is the only position for which correct repositioning is guaranteed. WARNING Do not use the Tumble switch on the patient support control panel when the MammoTrak trolley is docked to the system. Raising the patient support can damage the MammoTrak trolley. Patient positioning WARNING When positioning the patient on the tabletop lock the trolley brakes securely. When the brakes are unlocked the trolley may suddenly move, which may cause the patient to fall off. WARNING Do not to leave the patient unattended on the FlexTrak. The patient may fall off the tabletop, which could lead to serious injury. 114 Achieva

115 MammoTrak Coils and Positioning WARNING Verify that the patient is not using the Breast coil or the Abdomen ramp to hold on to. The coil and ramp are not rigidly connected to the tabletop and may fall off. WARNING Be careful when body parts hang over the tabletop. These parts can scrape over the trolley sides or system bridge and injure the patient. WARNING When patient s feet hang over the MammoTrak end, support the lower legs in such a way that the patient s toes are positioned higher than the tabletop surface. When the patient s length is causing the feet hang over the end of the MammoTrak, the feet can get caught between tabletop and system parts when moving into the magnet. CAUTION Do not use the brakes pedal as a step for the patient. The pedal may get damaged. Patient transport WARNING Verify that tabletop is locked securely to the trolley, do not use the tabletop lock handles to move the trolley. When unlocked the tabletop can be pushed off the trolley, which may lead to the tabletop falling off and personal injury of the patient. WARNING Verify that the patient s extremities remain to be on the tabletop. Patient s extremities can get squashed between the MammoTrak and possible colliding objects. Achieva 115

116 Coils and Positioning MammoTrak WARNING Verify that the patient s extremities remain to be on the tabletop. Patient s extremities can get squash ed between the MammoTrak and possible colliding objects. WARNING Verify that the trolley brake pedal does not collide with people or objects. The brake pedal protrudes from the trolley and may cause injuries or damage to the brake system. Docking the MammoTrak WARNING Do not use the Tumble switch on the patient support control unit when the MammoTrak trolley is docked to the system. Raising the patient support can damage the MammoTrak trolley. WARNING While docking the MammoTrak verify that the patient s arms and hands are on the tabletop. Arms and hands can get caught between trolley and (lowered) patient support when docking. WARNING Lock the brakes after docking the MammoTrak to the system. When the brakes are unlocked the trolley may move while the tabletop is pushed into the magnet. Moving the tabletop into the magnet WARNING Instruct the patient to keep hands and other body parts on the tabletop while it is moving. 116 Achieva

117 MammoTrak Coils and Positioning WARNING Verify that the patient s extremities remain to be on the tabletop. Patient s extremities can brush against the trolley sides and MR system bridge, which may cause personal injury. WARNING Due care must be taken to verify that no part of the patient's body, hair, clothing, cables or infusion lines can get trapped or injured by any part of the equipment. WARNING Before starting a scan which initiates tabletop movement, always check that nothing can get caught or hit during tabletop movement. Check patient, patient extremities, clothing, equipment and accessories. Guide cables and intravenous lines. WARNING With extremely heavy patients, be careful when moving the tabletop into the magnet, such that it sticks out at the magnet end. Due to patient weight and not optimal weight distribution the table top could break. WARNING Verify that no object can fall into the cable slab. Objects in the cable slabs may obstruct table movement. The tabletop can not be moved out of the magnet. Emergency removal of the tabletop is not possible. WARNING Verify that no object can fall into the cable slab. Objects in the cable slabs may obstruct table movement. The tabletop can not be moved out of the magnet. Emergency removal of the tabletop is not possible. WARNING When using drug delivery, Verify that no intravenous lines can get caught during tabletop movement. Achieva 117

118 Coils and Positioning MammoTrak Doing a biopsy WARNING Do not exert unnecessary force on the MamoTrak carrier during a Biopsy. If not required all people must keep clear of the carrier during the intervention. Too much force will move the carrier and may result in injury of the patient or damage to the equipment. MammoTrak Components MammoTrak is delivered with the following components: the MammoTrak trolley (including abdomen ramp) the 16 channel Breast coil (closed design): this coil can be used for diagnosis the 7 channel Breast coil (open design): this coil can be used for diagnosis and biopsy the head support mattresses to cover the trolley, the abdomen ramp and the area below the head support Fig. 75: MammoTrak trolley with head support (2), 16 channel Breast coil (1) and abdomen ramp. Note that the 7 channel breast coil is not shown here. MammoTrak trolley The figure shows the MammoTrak trolley with all its components except for the 7 channel Breast coil. In this figure, the items which are part of the trolley itself are labeled. They are described in detail in the following sections in the order: 118 Achieva

119 MammoTrak Coils and Positioning Fig. 76: MammoTrak trolley. The indicated items are part of the trolley itself. 1 Abdomen ramp 2 Connection panel 3 Tabletop handle 4 Side wing 5 Trolley handle 6 Trolley bars 7 Brake pedal 8 5th wheel Tabletop handle When the MammoTrak trolley is placed at the MR system for examinations, the tabletop has to be moved to the isocenter. With the tabletop handle, the tabletop can be released so that it can easily be moved to the isocenter or back to the initial position. Achieva 119

120 Coils and Positioning MammoTrak Fig. 77: 1 - Tabletop handle left and right from the connection panel. 2 - Handle is not pressed. Tabletop cannot be moved, but is locked. 3 - Handle is pressed. Tabletop can be moved since it is released. To release the tabletop Press the tabletop handle. To move the tabletop Slide the tabletop while keeping the tabletop handle pressed. Whenever the tabletop handles are released, the tabletop is locked. Abdomen ramp The abdomen ramp is part of the trolley. Connection panel The connection panel is located at the end of the trolley close to the trolley handle. It offers connections for the nurse call, the headset and the coil. To access the connection panel 1. Open the lid. When the lid is closed, it can be used to place equipment (e.g. required for biopsy) on it. 120 Achieva

121 MammoTrak Coils and Positioning Fig. 78: Left: Lid of connection panel is closed. Right: Lid of connection panel is open. To connect coil, nurse call or headset 1. Plug the coil connector, the nurse call and the headset into the corresponding connectors. 2. Guide the cables through the dedicated recesses in the lid. Coil connector The coil connector is located at the patient s feet-side of the MammoTrak trolley which is to be placed towards the magnet bore for an examination. Fig. 79: Left: Coil cables and cable routing in the table where: 1 - connection panel, 2 - coil, 3 - magnet, 4 - coil cable, 5 - cable routing in the table, 6 - cable with coil connector. Right: Coil connector. 1 Connection panel 2 Coil 3 Magnet 4 Coil cable 5 Cable routing in the table 6 Cable with coil connector Achieva 121

122 Coils and Positioning MammoTrak 5th Wheel Besides the four standard wheels, the trolley has a fifth wheel which can be used to facilitate trolley movement for straight movement and to turn the corner. This fifth wheel can be lifted up or set to the ground. It can be controlled by means of the brake pedal. Brake pedal The brake pedal can be set to three different positions. Fig. 80: 1 - The trolley is locked and cannot be moved. 2 - The trolley is released and can be moved with the 5th wheel lifted up. 3 - The trolley is released and can be moved with the 5th wheel on the ground. Set the brake pedal to position 1 when the patient is positioned on the trolley, when equipment is positioned on the trolley, when the examination takes place, when the trolley is supposed to be left in a parking position. Set the brake pedal to position 2 when the trolley is to be positioned since position 2 allows small movements, when the trolley is moved towards/around the scanner s tabletop. Set the brake pedal to position 3 when the trolley is to be moved straight forward, when the trolley is to be turned around the corner. To change the brake pedal s position 1. Step on the brake pedal with a foot in one of the positions. Fig. 81: 1 - The trolley is locked and cannot be moved. 2 - The trolley is released and can be moved with the 5th wheel lifted up. 3 - The trolley is released and can be moved with the 5th wheel on the ground. 122 Achieva

123 MammoTrak Coils and Positioning Trolley bars The trolley bars are meant for stability. They can be used by the patient to step up/down the trolley. Fig. 82: The different ways of how to get on the trolley tabletop by means of the trolley bars. Side wings The MammoTrak trolley has two side wings, one on each side of the trolley. They serve as a support for the patient when positioning herself on the coil and the abdomen ramp, as a handle when the trolley has to be removed from the MR system. You can hold on to the grip on top of the side wing or the grip underneath. Fig. 83: Left: Side wing. Right: Side wing serves as support for the patient. Trolley handle Hold on to the trolley handle to move the trolley from its parking position into the magnet room and back. Achieva 123

124 Coils and Positioning MammoTrak Fig. 84: Trolley handle. MammoTrak Breast coil 16 Type of coil 16 element phased-array coil Receive-only Design Volume coil with an aperture in which the breasts can be positioned. Available for 1.5T, 3.0T SENSE-compatible Yes CLEAR-compatible Yes MultiTransmit-compatible Yes (only applicable for Achieva 3.0T TX) Applications MR Mammography (both breasts simultaneously) General remarks Switch off CLEAR as homogeneity correction for all T1-weighted and all fatsuppressed scans. This coil cannot be used for biopsy. Use with feet-first positioning only. Multi coil imaging No Dual coil imaging No User Interface Name SENSE-Breast Achieva

125 MammoTrak Coils and Positioning Fig. 85: Breast 16 coil with abdomen ramp and head support. MammoTrak Breast coil 7 Type of coil 7 element phased-array coil Receive-only Design Open-design volume coil with an aperture in which the breasts can be positioned. Available for 1.5T, 3.0T SENSE-compatible Yes CLEAR-compatible Yes MultiTransmit-compatible Yes (only applicable for Achieva 3.0T TX) Applications MR Mammography (both breasts simultaneously) General remarks Switch off CLEAR as homogeneity correction for all T1-weighted and all fatsuppressed scans. This coil can be used for biopsy. Use with feet-first positioning only. Multi coil imaging No Dual coil imaging No User Interface Name SENSE-Breast-7 Achieva 125

126 Coils and Positioning MammoTrak Fig. 86: Breast 7 coil with abdomen ramp and head support. Head support For maximum patient comfort, the height of the head support can be adjusted. You can also adjust the distance of the head support to the breast coil by simply sliding the head support as shown in figure. This can be done with the mattress around the head support. Fig. 87: 1: Head support on tabletop. Mattress around head support. H = knob for heigth adjustment. 2: Head support is close to coil (mattress removed). 3: Head support is far away from coil (mattress removed). Workflow The workflow can be split into two major parts: the work that has to be done outside the magnet room, the work that has to be done at the MR system. Outside the magnet room Preparation of the MammoTrak trolley 1. Lock the trolley brakes securely. 126 Achieva

127 MammoTrak Coils and Positioning Fig. 88: Left: Locking the brakes. Right: The trolley is locked. Coil positioning The 16 channel breast coil can be used for diagnosis whereas the 7 channel breast coil can be used for diagnosis and biopsy. In some cases, it might be necessary to replace the previously used coil with the other one. Take a coil off the tabletop 1. Remove the mattress around the head support. 2. Remove the head support. 3. Unplug the coil. 4. Take the coil off the tabletop. Fig. 89: 1: Head support with mattress on tabletop. 2: Mattress is removed. 3: Head support is removed and cable is being unplugged. Achieva 127

128 Coils and Positioning MammoTrak Fig. 90: Left: Coil has been taken off the tabletop. Right: Coil is being placed on tabletop. Place a coil on the tabletop 1. Place the coil on the tabletop. Note that the coil is automatically positioned correctly due to the recesses at the side of the tabletop and the two knobs on the tabletop. 2. Plug the coil connector into the connector at the connection panel. 3. Place the head support on the tabletop. 4. Place the mattress around the head support. Patient preparation 1. Prepare the patient as usual for an MR examination. It is advisable to have the patient strip to the waist and to remove any zip fasteners in the waist area. Imaging is best performed when the breasts can hang freely in the coil aperture. Patient positioning 1. Let the patient step on the tabletop by means of the trolley bars. You can also let the patient step up via a staircase. Do not use the brake s pedal as a step for the patient. 128 Achieva

129 MammoTrak Coils and Positioning Fig. 91: Left: Stepping up the table. Right: Side wing serves as support for patient. 2. Tell the patient to lean onto the side wings when positioning herself on the coil and the abdomen ramp. Ensure that the patient is not using the breast coil or the abdomen ramp to hold on to. 3. Position the patient prone on the breast coil, with the head on the head support. 4. Adjust the height of the head support. 5. Ask the patient to place the arms either next to the head or alongside their body. 6. Ensure that the breasts are hanging freely in the coil, and that the breasts and the axillae area are free of folds. Moving MammoTrak trolley to the MR system 1. Release the brake and move the trolley to the MR system. While transporting the patient on the MammoTrak, ensure that the tabletop is locked securely to the trolley. Do not use the tabletop handles to move the trolley. WARNING While transporting the patient on the MammoTrak, ensure that the trolley brake pedal does not collide with people or objects. 2. Lower the MR system s patient support to its lowest position. 3. Position the MammoTrak trolley at the system. Achieva 129

130 Coils and Positioning MammoTrak Fig. 92: MammoTrak trolley at MR system. At the MR system Docking the MammoTrak During installation, the MammoTrak trolley is set up either for docking from the left side (standard situation) or from the right side. If docking from the right side, place all cables (nurse call, coil) on the MammoTrak trolley so that they cannot be damaged while docking. Docking from the right or the left side Ensure that the patient s arms and hands are on the tabletop. Lock the brakes after docking the MammoTrak to the system. 1. Set the patient support to its lowest position before docking the MammoTrak. 130 Achieva

131 MammoTrak Coils and Positioning Do not use the tumble switch on the patient support control panel when the MammoTrak trolley is docked to the system. Raising the patient support can damage the MammoTrak trolley. 2. Set the brake pedal to position 2 (5th wheel off the ground, brake released). Now small trolley movements are possible. 3. Fine-adjust the trolley position: make sure that the trolley s bumpers and the patient support s bumpers are against each other. Hold on to the side wings since this facilitates trolley movement. Fig. 93: Left: setting brake pedal to position 2. Middle: Bumpers at the trolley's end for fine-adjustment. Right: Bumpers at the trolley's side for fine-adjustment. 4. Set the brake pedal to position 1 (trolley is locked and cannot be moved). Fig. 94: Left: Locking the brakes. Right: The trolley is locked. Traveling to isocenter Ensure that the patient s extremitites are on the tabletop. Achieva 131

132 Coils and Positioning MammoTrak To release the tabletop 1. Press the tabletop handle. To move the coil to the isocenter 1. Slide the tabletop slowly towards the magnet while keeping the tabletop handle pressed. 2. Slow down the tabletop movement, when the tabletop handle approaches the markers on the trolley. In this case the breast coil approaches the isocenter position. The coil has reached isocenter when no further tabletop movement is possible. Whenever the tabletop handles are released, the tabletop is locked. Fig. 95: Upper row: Set-up on MammoTrak tabletop. 1: Connection panel with tabletop handle. 2: Head support. 3: Coil. 4: Abdomen ramp. 5: Magnet. Lower row: Moving to isocenter. Trolley tabletop handle approaches marker as breast coil slowly approaches isocenter. Performing scans Perform the survey scan and the required diagnostic scans. Performing biopsy 1. To release the tabletop, press the tabletop handle. 2. To move the coil out of the magnet, slide the tabletop slowly out of the magnet while keeping the tabletop handle pressed. 132 Achieva

133 SENSE Breast 3.0T X/TX 7 Coils and Positioning Fig. 96: Trolley tabletop moved out of the magnet for biopsy. The coil is just outside of the magnet. Undocking MammoTrak When the examination (and/or the biopsy) is finished, MammoTrak has to be undocked again. 1. To release the tabletop, press the tabletop handle. 2. To move the MammoTrak tabletop out of the magnet, slide the tabletop completely out of the magnet while keeping the tabletop handle pressed. 3. To move the MammoTrak trolley away from the magnet, set the brake pedal to position 2 (5th wheel off the ground, brake released). Now small trolley movements are possible. 4. Move the trolley away from the magnet. Hold on to the side wings since this facilitates trolley movement. Moving the MammoTrak trolley to the preparation room 1. Move the trolley to the preparation room. 2. Lock the trolley brakes securely. 3. Let the patient step off the tabletop by means of the trolley bars. SENSE Breast 3.0T X/TX 7 Type of coil 7 element phased-array coil Design Available for SENSE-compatible CLEAR-compatible MultiTransmit-compatible Applications Receive-only Open-design volume coil with an aperture in which the breasts can be positioned. 3.0T TX Yes Yes Yes (only applicable for Achieva 3.0T TX) MR Mammography (both breasts simultaneously) Achieva 133

134 Coils and Positioning SENSE Body coil General remarks Switch off CLEAR as homogeneity correction for all T1-weighted and all fatsuppressed scans. This coil can be used for biopsy. Use with head-first positioning only. Multi coil imaging Dual coil imaging User Interface Name No No SENSE-Breast-7-TX Fig. 97: TX 7 Breast coil with abdomen ramp and head support. SENSE Body coil Type of coil 4 element phased-array coil Receive-only Design Flexible volume coil consisting of an upper (anterior) and lower (posterior) coil part. Each part contains two phased-array coil elements. Dimensions 45 cm left-right by 30 cm feet-head. Available for 1.5T SENSE-compatible Yes CLEAR-compatible Yes Applications Abdomen, Thorax, Pelvis Abdominal Angiography, Peripheral Vascular Angiography. General remarks Always use CLEAR as homogeneity correction for best image quality. Markers on the coil The elements are labelled with coil identification numbers (1, 2, 3 and 4). The odd numbers (1 and 3) are on the cable side. Multi coil imaging No 134 Achieva

135 SENSE Body coil Coils and Positioning Dual coil imaging User Interface Name No SENSE-Body Fig. 98: SENSE Body coil: anterior and posterior coil part, SENSE mattress and SENSE cushion. General considerations Use high SAR only if specifically required in order to perform the scan. Positioning Positioning in general The coil is usually positioned with the largest coverage in RL direction. Use SENSE mattress, SENSE cushion and two shoulder straps in order to have a distance between patient and coil and for higher comfort. Place the posterior coil part with the shoulder straps on the tabletop. Position the SENSE mattress on the coil so that the patient has no discomfort from the electronics part of the coil. Fig. 99: 1: Placing posterior coil part (no straps shown here) and SENSE mattress on the tabletop. 2: Schematic set-up of an examination with the SENSE Body coil. a - anterior coil part, b - SENSE cushion, c - SENSE mattress, d - posterior coil part (no straps shown here). While positioning the patient, the anterior part can hang beside the table (straps are used to connect element 1 and 3). Achieva 135

136 Coils and Positioning SENSE Body coil Place the anterior part directly above the posterior part. The SENSE cushion must be attached to the coil (to create a small distance between patient and coil). Strap the coil tightly around the patient, if necessary with the respiratory sensor in between patient and coil. The arms of the patient are best left outside the coil. Fig. 100: Placing anterior part on patient using straps. Rotated coil When rotating the SENSE Body coil by 90 o for large FH- coverage, a signal intensity drop might be seen between coil loops of anterior and posterior coil part in sagittal images. This effect can be reduced by using CLEAR. Fig. 101: 1: SENSE Body coil on tabletop. 2: Abdomen study. 3: Rotated coil. SENSE Body coil in body applications The coil is usually positioned with the largest coverage in RL-direction. For extra patient comfort, both coil parts have a notch at the top to avoid pressure on the patient s throat. For abdominal angio, the coil is rotated for large FH- coverage. SENSE Body coil for peripheral vascular angio For PV studies (in combination with MobiTrak), this coil can be used for the lower legs to enhance the signal in this area. 136 Achieva

137 SENSE Body coil Coils and Positioning Attention is needed in order to prevent the cables from being caught between the tabletop and bore. Make sure the coil cable can handle the total table travel distance. The coil elements have to be shifted with respect to the posterior elements in order to compensate for signal loss between the elements, see figure. Fig. 102: Peripheral angio: use of SENSE Body coil and MobiTrak leg support. Fig. 103: SENSE Body coil with leg support. Shift the elements with respect to the posterior elements either up- or downwards as illustrated above..d - distance of 5 cm to 10 cm. The white arrow indicates the light visor position for isocenter positioning. SENSE Body coil in hip examinations 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 patient's hands should be on the chest. Position the coil with the largest coverage in RL-direction. SENSE Body coil in MR Mammography 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 Achieva 137

138 Coils and Positioning SENSE Body coil 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 coil in place. Along either side of the top and bottom of the base are grooves into which the cables of the coil should be placed. This gives the required separation between the patient s skin and the cables ensuring both safety and comfort. The flexible cover is designed to sit on the top of the base and cover the coil and cable. It is also fixed to the 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. Fig. 104: Left: Breast mattress. Right: Schematic drawing of the breast mattress. 1 - flexible cover, 2- anterior coil part, 3 - base of the mattress, 4 - posterior coil part, 5 - cables located in groove. 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 tabletop so that the whole device is supported. If the base is off-centred so that part of it is not fully on the tabletop, a risk of the mattress tipping exists which could lead to injury to the patient. 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 the 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. Ensure that the breasts are hanging freely in the coil, and that the breasts and the axilla area are free of folds. Make sure that the patient s head faces to the pillow. 138 Achieva

139 SENSE XL Torso coil 16 Coils and Positioning 8. Centre the light visor to the middle of the patient s breasts, and move the patient into the isocenter. The patient s head should not be turned to the side. This affects the position of the upper part of the body: the breasts and the shoulder may lift up out of the coil. SENSE XL Torso coil 16 Type of coil 16 elements phased-array coil. Receive-only. Design Flexible volume coil consisting of anterior and posterior sections. Each section consists of 8 elements: 4 upper and 4 lower elements. Dimensions On 1.5T: 100 mm x 450 mm x 600 mm (coil half) On 3.0T: 74 mm x 558 mm x 600 mm (coil half), each element has a Z coverage of 22.5 cm. Available for 1.5T, 3.0 T SENSE-compatible Yes; SENSE can be used routinely at reduction factors of 2 (2x2=4 in 3D) and with a theoretical maximum value equal to the number of coil elements. SENSE can be performed in AP, RL, and FH directions. It is advised to perform SENSE mainly in AP and RL directions. CLEAR-compatible Yes CLEAR can be set to Yes, Body Tuned or No MultiTransmit-compatible Yes (only applicable for Achieva 3.0T TX) Applications 2 station acquisition without patient repositioning: Abdomen/Pelvis, Thorax/ Abdomen, or other two-station combinations as well as individual anatomies. Routine anatomical imaging, contrast-enhanced angiography, and spectroscopy. General remarks Do not rotate this coil by 90 o. Use CLEAR for uniform signal intensity across the coil elements. Recommended FOV is for single station coronal or sagittal examinations: on 1.5T systems: 45 cm x 45 cm (FH). on 3.0T systems: 45 cm x 38 cm. (FH) Markers on the coil The coil has markers to indicate the effective edges of the elements as well as the isocenters for the upper, lower and center of both combined groups. Achieva 139

140 Coils and Positioning SENSE XL Torso coil 16 Multi coil imaging No Dual coil imaging No on 1.5T, Yes on 3.0T (see chapter 6, Coil combinations) User Interface Name Element combinations SENSE-XL-Torso All, Upper, Lower, and Central. Fig. 105: SENSE XL Torso coil 16 General considerations Do not rotate the SENSE XL Torso coil by 90 o. Use only the orientation shown in this document. Avoid routing of the RF coil cable assembly in proximity to the RF transmit coil. Avoid direct contact of the patient s skin with the RF coil cable assembly. Disregard for the above listed notes may result in excessive local heating. Positioning of the RF cable and driver box assembly must therefore be done with care. Keep a separation between the patient's skin and the RF cables of at least 2 cm. Use the special spacer or pads of the standard accessory set wherever the cable assembly may touch the skin. If the Q-Body coil is used for acquiring a 3rd station, be sure that it is performed to the superior end of the coil to minimize imaging in areas where the cables and driver box will be in the Field of View. 140 Achieva

141 SENSE XL Torso coil 16 Coils and Positioning On 3.0T systems: Make sure that the posterior section of the coil is the part on the table and the anterior section on top of the patient. Positioning For systems with the UIM (User Interface Module) on the right side, it is necessary to flip the coil. 1. Position the posterior coil section on the tabletop. Attach the four (SENSE XL Torso coil) positioning straps to the Velcro strips at the upper and lower ends of the coil. Fig. 106: SENSE XL Torso coil: anterior and posterior part with straps. 2. Be careful to control the anterior section of the coil by placing it towards the foot end of the tabletop to keep it from falling off of the tabletop while initially positioning the patient. 3. Position the patient head-first on the tabletop with his/her back on the posterior coil section. 4. Place the anterior section directly parallel and above the posterior section in order to reduce artifacts related to mispositioning of coil parts, most noticeable when using SENSE. Position the SENSE cushion between patient and the anterior part of the coil. Improved image quality can be achieved by having at least 1/3 overlap between the lateral upper and lower elements or by keeping them separated. 5. Strap the coil tightly around the patient. If necessary place the respiratory sensor between patient and coil. For optimal results, position the arms of the patient above the head. Achieva 141

142 Coils and Positioning SENSE XL Torso coil 16 Fig. 107: Positioning with the SENSE XL Torso coil Anterior and posterior coil sections, 2 - Prefered patient positioning with arms above the head, 3 - Patient positioning with arms inside of the coil. 6. Be sure that the RF cable and driver box assembly is secured to the tabletop. This can be accomplished by using the arm supports. Fig. 108: 1 - Arm support device used to secure driver box to tabletop. 2 - In head-first positioning: place cushions between patient and coil cable to avoid direct contact. 3 - In any patient position: avoid direct contact with coil cables. Note that pads are placed between patient and cables. Strictly follow the safety directions on cable handling as described in the Instructions for Use. It is crucial that the cables are separated from the patient s body. See figure above. The driver box must be secured to the tabletop and not allowed to contact the façade of the magnet. See figure below. 142 Achieva

143 SENSE XL Torso T/3.0T Coils and Positioning Fig. 109: Incorrect (left) and correct (right) positioning of the driver box. Coil element combinations Fig. 110: Coil elements of SENSE XL Torso coil 16. All: all 16 elements are used. Upper: the 8 upper elements are used. Lower: the 8 lower elements are used. Central: the 8 central elements are used (4 from anterior and 4 from posterior part). This mode is meant for angio studies. SENSE XL Torso T/3.0T Type of coil 16 elements phased-array coil. Receive-only. Design Volume coil consisting of anterior and posterior sections, each with its own connector. Semi-flexible housing. 8 element phased array in anterior section and 8 element phased array in posterior section. Dimensions Height 5cm, Width 55.5cm, Length 48.5cm. Available for 1.5T, 3.0 T Achieva 143

144 Coils and Positioning SENSE XL Torso T/3.0T SENSE-compatible CLEAR-compatible Yes; SENSE can be used routinely at reduction factors of 2 (2x2=4 in 3D) and with a theoretical maximum value equal to the number of coil elements. SENSE can be performed in AP, RL, and FH directions. It is advised to perform SENSE mainly in AP and RL directions. Yes On 1.5 T systems, CLEAR can be set to Yes or No. On 3.0T systems, CLEAR can be set to Yes, Body Tuned or No. MultiTransmit-compatible Yes (only applicable for Achieva 3.0T TX) Applications 2 station acquisition without patient repositioning: Abdomen/Pelvis, Thorax/ Abdomen, or other two-station combinations as well as individual anatomies. Routine anatomical imaging, contrast-enhanced angiography, and spectroscopy. General remarks Do not rotate this coil by 90 o. Use CLEAR for uniform signal intensity across the coil elements. Multi coil imaging No Dual coil imaging No User Interface Name SENSE-XL2A-Torso for the anterior section and SENSE-XL2P-Torso for the posterior section Fig. 111: Components of the SENSE XL Torso T coil. Left: Anterior coil, right: posterior coil. Positioning Place the posterior mattress on the tabletop. Embed the posterior coil section within the recess of the mattress. Route the cable through the cable outlet. 144 Achieva

145 SENSE XL Torso T/3.0T Coils and Positioning Fig. 112: Left: Posterior mattress on the tabletop. Right: Posterior coil section in recess of the mattress. Position the patient with the area of interest centered to the posterior coil section. Position and adjust the anterior coil section to align with the posterior coil section. This will reduce artifacts related to mispositioning of the coil parts and most noticeably when using SENSE. Use Velcro straps to maintain the coil alignment and limit the coil motion during examination. Fig. 113: Left: Patient on the tabletop with the area of interest centered to the posterior coil section. Right: Anterior coil section aligned with posterior coil section and attached with velcro straps. The patient's arms are positioned alongside the body. The patient s arms can be positioned either alongside the body or above the head depending on the patient s preference. Fig. 114: Left: The patient's arems are positioned above the head. Right: Feet-first positioning utilizing a comfort device between cable outlet and patient body. When using the coil set for feet-first positioning, use a comfort device between the cable outlet and the patient body. Achieva 145

146 Coils and Positioning SENSE Torso coil 3.0T SENSE Torso coil 3.0T Type of coil 6 elements phased-array coil Receive-only Design Dimensions Volume coil consisting of a rigid lower part and flexible upper part. Lower part contains two phased-array coil elements, upper part contains four phased-array coil elements. 40 cm left-right by 35 cm feet-head Available for 3.0T SENSE-compatible Yes; max. SENSE factor: 6 CLEAR-compatible MultiTransmit-compatible Yes No Applications Abdomen, Thorax, Pelvis Abdominal Angiography Peripheral Vascular Angiography General remarks Always use CLEAR or Body-Tuned CLEAR as homogeneity correction for best image quality. Markers on the coil A sticker displaying the element lay-out is positioned on the upper part of the coil. The length of the coil elements is shown by a dotted line. Multi coil imaging Yes (see section Multi coil imaging ) Dual coil imaging Yes (see section Dual coil imaging ) User Interface Name SENSE-Torso Fig. 115: SENSE Torso coil 3.0T. General considerations 146 Achieva

147 Endo-Cavitary coil 1.5T Coils and Positioning Use high SAR only if specifically required in order to perform the scan. Positioning SENSE Torso coil 3.0T 1. Position the posterior coil part on the tabletop. 2. Position the mattress on the coil for patient comfort and to ensure a distance between patient and coil. 3. Position the patient on the posterior coil part. 4. Place the anterior section on the patient s chest directly above the posterior part. 5. Strap the coil tightly around the patient, if necessary with the respiratory sensor and electrodes in between patient and coil. Fig. 116: Patient positioned with SENSE Torso coil. Always position the patient's arms above their head for coronal imaging. Endo-Cavitary coil 1.5T Type of coil Linear detection Receive-only Design RF coil which can be positioned inside the rectum.. The RF coil is fixed inside a non-permeable balloon; both are mounted on a plastic rod which extends to a grip. The coil amplifier and decoupling electronics are placed in a small box. Dimensions Regular: cross-section 48 mm fully inflated Small: cross-section 30 mm fully inflated Available for 1.5T in regular and small size SENSE-compatible No Achieva 147

148 Coils and Positioning Endo-Cavitary coil 1.5T CLEAR-compatible Applications No Rectum, prostate Contra-indications Inflammatory bowel disease i.e. ulcerative colitis or Crohn s disease etc. Latex sensitivity Radiation or surgery of the prostate, rectum or surrounding area within the last 8 weeks Rectal fistula Severe hemorrhoids Stricture of the anal canal Any exclusion normally recognized for intrarectal and endorectal devices Gold seed fiducial markers within the last 3 weeks. Please consult your MR safety officer and manufacturer of the gold seed fiducial markers. Brachytherapy seeds within the last 12 weeks. Please consult your MR safety officer and manufacturer of the brachytherapy seeds. Limitations Endo-cavitary coils have a limited lifetime: do not use them more often than 50 times or longer than 3 months, nor after the expire date indicated on the coil and the storage box. The Endo-Cavitary coils are made of material that deteriorates over time. General remarks Before starting an examination, make sure that the coil is connected to the amplifier box. Multi coil imaging No Dual coil imaging No User Interface Name Endo-rectal Fig. 117: Endo-cavitary coil 1.5T. Contraindications 148 Achieva

149 Endo-Cavitary coil 1.5T Coils and Positioning WARNING Do not use the ds Endo coil when any of the following is indicated: Inflammatory bowel disease i.e. ulcerative colitis or Crohn s disease etc. Latex sensitivity. Radiation or surgery of the prostate, rectum or surrounding area within the last 8 weeks. Rectal fistula. Severe hemorrhoids. Rectal obstruction or stricture. Impacted or excessive stool in the rectum. Stricture of the anal canal. Any exclusion normally recognized for intrarectal and endorectal devices. Gold seed fiducial markers within the last 3 weeks. Please consult your MR safety officer and manufacturer of the gold seed fiducial markers. Brachytherapy seeds within the last 12 weeks. Please consult your MR safety officer and manufacturer of the brachytherapy seeds. Safety CAUTION Do not use a Endo-cavitary coil for more than 3 months, more than 50 times nor after the expiration date printed on the coil and its storage box. It is advised to have only one Endo-Cavitary coil in use at any time. This will prevent a coil from being used more often than permissible or from being used after the permissible date. Do not expose Endo-Cavitary coils to UV or direct sunlight. Always store the coils in the storage box at temperatures below 21 C. Deterioration speed will increase highly when exposed to UV light or high temperatures. Achieva 149

150 Coils and Positioning Endo-Cavitary coil 1.5T Only use clinically approved condoms for the Endo-Cavitary coils. Endo-Cavitary coils must always be fitted with a sheath or condom before insertion into the rectum. For USA only: the user should refer to the FDA March 29, 1991 Medical Alert on latex product. This product contains natural rubber. Natural rubber can cause allergic reactions such as itching, fever, dyspnea, urtication, asthma, hypotension, and shock. When these symptoms occur, immediately stop using the coil and take proper action. The disposable probe contains DEHP, which may cause birth defects or other reproductive harm. CAUTION Avoid excessive bending of the coil rod. Excessive bending can lead to leakage of the non-permeable balloon. CAUTION After insertion, do not rotate the coil once the balloon is inflated. CAUTION After the examination, fully deflate the balloon before removing the coil. WARNING Do not scan with the patient in decubitus position when using the Endo coil. Only scan in the supine or prone position with the endo coil in the center of and aligned with the body coil axis. The coil cable must be aligned with the body coil axis. Scanning with the patient in decubitus position could result in excessive coil heating and ultimately causing burns to the patient. Insertion of the coil 1. Pull a 40 mm diameter sheath or condom over the coil up to the grip providing maximum hygiene and serving as protective cover for the coil. 150 Achieva

151 Endo-Cavitary coil 1.5T Coils and Positioning 2. Use a lubricating gel (any lubricating gel used in endorectal ultrasound) on the outside of the condom to ease insertion into the rectum. Fig. 118: Insertion of the coil. 1 - prostate, 2 - rectum, 3 - spinal column. 3. Position the patient in left or right decubitus position, with the knees pulled-up. 4. Squeeze the balloon gently to remove the air and thus ease insertion. 5. Care should be taken when inserting the coil into the rectum; this should be done slowly, according to the patient's tolerance. A centimetre scale has been marked on the rod between grip and balloon to see how far the coil loop has been inserted into the rectum. The distance from the coil s top to the first marker is 100 mm. The plane through the coil loop is perpendicular to the plane through the grip. 6. After positioning the coil, the balloon must be inflated to permit the coil loop to take up its natural form. The balloon is inflated with air using a luer-lock syringe which fits into a valve located close to the grip. The inflated balloon makes it possible not only to position the coil close to the prostate, but also to prevent further movement of the coil in the rectum. Regular size coil: inflation approximately 60 cc Small size coil: inflation approximately 30 cc to 40 cc During inflation one should continuously ask the patient if it is still tolerable. 7. When the balloon is inflated, the patient can turn to a supine position. This is the appropriate position for the examinations. After insertion, do not rotate the coil when the balloon is inflated. Achieva 151

152 Coils and Positioning Endo coil with disposable probe Connecting the coil 1. Connect the cable of the Endo-Cavitary coil to the preamplifier box. 2. Attach the preamplifier cable to one of the coil connectors. Removing the coil 1. To deflate the balloon use the valve close to the grip, place the luer-lock syringe on the valve and withdraw the syringe plunger. 2. Remove the coil. Cleaning / Disinfection See Instructions for Use, Safety chapter. Do not sterilize any part of this coil Exchangeable coil parts The luer-lock syringe The inflate-deflate valve. Endo coil with disposable probe Fig. 119: Endo coil with disposable probe: 1 - luer lock syringe used for inflation, 2 - probe cable, 3 - valve for luer lock syringe, 4 - grip, 5 - migration stop, 6 - plastic rod, 7 - non-permeable balloon. Type of coil Linear detection Receive-only 152 Achieva

153 Endo coil with disposable probe Coils and Positioning Design Dimensions RF coil which can be positioned inside the rectum. The RF coil is fixed inside a non-permeable balloon; both are mounted on a plastic rod which extends to a grip. The coil amplifier and decoupling electronics are placed in a small box. Cross-section 48 mm fully inflated Available for 1.5T 3.0T SENSE-compatible CLEAR-compatible MultiTransmit-compatible Only in combination with specific SENSE coils. More information see SENSE and CLEAR table entry below. The Endo coil can be used as an element of a SENSE coil when combined with some specific SENSE coils. In order to enable this SENSE coil combination, the parameter Dual coil has to be used. Yes (only applicable for Achieva 3.0T TX) Applications 1.5T: rectum, prostate, cervix 3.0T: prostate Contra-indications The Endo coil has several contraindications, e.g. inflammatory bowel disease. Please refer to the section Contraindications below for the complete list. General remarks Before starting an examination, make sure that the coil is connected to the amplifier box. Multi coil imaging Yes (see section Multi coil imaging ) Dual coil imaging Yes (see section Dual coil imaging ) User Interface Name Endo Contraindications WARNING Do not use the ds Endo coil when any of the following is indicated: Inflammatory bowel disease i.e. ulcerative colitis or Crohn s disease etc. Latex sensitivity. Radiation or surgery of the prostate, rectum or surrounding area within the last 8 weeks. Rectal fistula. Severe hemorrhoids. Rectal obstruction or stricture. Impacted or excessive stool in the rectum. Stricture of the anal canal. Any exclusion normally recognized for intrarectal and endorectal devices. Achieva 153

154 Coils and Positioning Endo coil with disposable probe Gold seed fiducial markers within the last 3 weeks. Please consult your MR safety officer and manufacturer of the gold seed fiducial markers. Brachytherapy seeds within the last 12 weeks. Please consult your MR safety officer and manufacturer of the brachytherapy seeds. Safety CAUTION The probe of the coil is intended for single use only. The interface device is reusable. For USA only: the user should refer to the FDA March 29, 1991 Medical Alert on latex product. This product contains natural rubber. Natural rubber can cause allergic reactions such as itching, fever, dyspnea, urtication, asthma, hypotension, and shock. When these symptoms occur, immediately stop using the coil and take proper action. The disposable probe contains DEHP, which may cause birth defects or other reproductive harm. Do not expose Endo-probes to UV or direct sunlight. Always store the probes in the storage box at temperatures below 21 o C. Deterioration speed will increase highly when exposed to UV light or high temperatures. CAUTION Avoid excessive bending of the coil rod. Excessive bending can lead to leakage of the non-permeable balloon. Insertion of the coil 1. Use a lubricating gel on the outside of the probe to ease insertion into the rectum. Too much lubricant may create signal artifacts on the images. 154 Achieva

155 Endo coil with disposable probe Coils and Positioning Fig. 120: 1 - Endo coil where m - migration stop, b - balloon. 2 - Preparation for the examination. 3 - Insertion of the coil where p - prostate, r - rectum, s - spinal column. WARNING Do not scan with the patient in decubitus position when using the Endo coil. Only scan in the supine or prone position with the endo coil in the center of and aligned with the body coil axis. The coil cable must be aligned with the body coil axis. Scanning with the patient in decubitus position could result in excessive coil heating and ultimately causing burns to the patient. 1. Position the patient in left or right decubitus position, with the knees pulled-up. 2. Squeeze the balloon gently to remove the air and thus ease insertion. 3. Maintain alignment and orientation of the blue stripe with the anterior midline of the patient. 4. Care should be taken when inserting the coil into the rectum; this should be done slowly, according to the patient's tolerance. 5. After positioning the coil, the balloon must be inflated to permit the coil loop to take up its natural form. The balloon is inflated with air using the enclosed luer-lock syringe which fits into a valve located close to the grip. The inflated balloon makes it possible not only to position the coil close to the prostate, but also to prevent further movement of the coil in the rectum. 6. Place the migration stop on the shaft. 7. Inflate the balloon to the greatest volume that the patient can tolerate (60 cc to 100 cc). The 1.5 T Endo coil can be filled with air only. Achieva 155

156 Coils and Positioning Endo coil with disposable probe The 3.0 T Endo coil is capable of being filled with fluids approved for use by the manufacturer of the coil, if desired for spectroscopy purposes. During inflation one should continuously ask the patient if it is still tolerable. CAUTION After insertion, do not rotate the coil once the balloon is inflated. Positioning and connecting The following instructions have to be followed strictly to avoid patient injury or damage to the coil: 1. When the balloon is inflated, the patient must turn to a supine position. This is the appropriate position for the examinations. 2. Position the patient head-first supine in the middle of the tabletop, with the cable routed straight away from the patient. 3. Place the preamplifier box on the table and connect the probe cable to it. 4. Route the probe cable and preamplifier box between the patient s legs parallel to the axis of the bore. Make sure that the cable and the amplifier box do not touch the patient or the bore (see figure). 5. Move the patient into the isocenter of the magnet. 6. Route the cable of the amplifier box underneath the leg to the coil socket and connect it to the system. 156 Achieva

157 Endo coil with disposable probe Coils and Positioning Fig. 121: Routing of the Endo coil cable and amplifier box. The cable of the preamplifier box cannot be connect before the patient is positioned in the isocenter. WARNING Do not scan with the patient in decubitus position when using the Endo coil. Only scan in the supine or prone position with the endo coil in the center of and aligned with the body coil axis. The coil cable must be aligned with the body coil axis. Scanning with the patient in decubitus position could result in excessive coil heating and ultimately causing burns to the patient. Removing the coil CAUTION After the examination, fully deflate the balloon before removing the coil. 1. To deflate the balloon use the stopcock close to the grip, place the luer-lock syringe on the valve and withdraw the syringe plunger. 2. Remove the coil. Achieva 157

158 Coils and Positioning SENSE Pediatric Body/Cardiac coil Emergency Patient Removal: Stop the scan, disconnect the probe from the Endo coil interface device, and remove the patient from the examination room. After the patient is removed, deflate the balloon and remove the probe. Cleaning / Disinfection For information about cleaning and disinfection of the Endo coil, refer to the Instructions for Use, volume 1: chapter Maintenance and Quality Assurance. Storage 1. Store the Endo coil in the original shipping container to prevent bending of the shaft. 2. Avoid transporting and storing the Endo coil imaging system at extreme temperatures and humidity as this may cause damage to the system. SENSE Pediatric Body/Cardiac coil Type of coil 8 element phased-array coil Receive-only Design Rigid volume coil consisting of posterior and anterior coil part plus auxiliaries. Dimensions Height 26 cm, width 30 cm, length 26 cm Available for 1.5T, 3.0T SENSE-compatible Yes CLEAR-compatible Yes Applications Pediatric body imaging Multi coil imaging No Dual coil imaging No User Interface Name SENSE-Ped-BodyC 158 Achieva

159 SENSE Shoulder coil 8 Coils and Positioning Fig. 122: SENSE Pediatric Body/Cardiac coil with cradle. Positioning 1. Put the posterior coil part on the tabletop. 2. Place the cradle above the posterior coil part. 3. Position the child on the cradle. 4. Place the anterior coil part on the posterior coil part and close the coil. Fig. 123: Positioning with the SENSE Pediatric Body/Cardiac coil. SENSE Shoulder coil 8 Type of coil 8 element phased-array coil Receive-only Design Rigid volume coil consisting of base plate and an anterior coil plus inferior, anterior and posterior pad. The posterior coil elements are integrated in the base plate. The anterior coil is adjustable in height. Available for 1.5T and 3.0T SENSE-compatible Yes Achieva 159

160 Coils and Positioning SENSE Shoulder coil 8 CLEAR-compatible MultiTransmit-compatible Yes No Applications Shoulder imaging. Multi coil imaging Dual coil imaging User Interface Name No No SENSE-Shoulder-8 Fig. 124: SENSE Shoulder coil coil and cable. 2 - Set-up for right shoulder imaging. 3: Set-up for left shoulder imaging. Positioning 1. Place the base plate on the tabletop. 2. Put the inferior pad on the tabletop so that it fits closely to the base plate. 3. Place the posterior pad on the base plate with the wedge under the shoulder of interest for best image quality and patient comfort. 4. Position the patient on the tabletop with the affected shoulder on the posterior pad. Fig. 125: Preparation for a left shoulder examination. 1 - Base plate on tabletop. 2 - Inferior pad on tabletop and posterior pad on baseplate. 3 - Patient on tabletop. 5. Open the connector on the base plate. 6. Make sure that the cup-shaped anterior pad is securely attached to the anterior coil. 160 Achieva

161 SENSE Shoulder coil 8 Coils and Positioning 7. Insert the anterior coil into the connector. There is a groove in the coil s pillar and the connector which allows inserting in only one way. Do not use the handles on the coil pillar during insertion. 8. Assure that the coil locks in place with an audible noise. Fig. 126: 1 - Opening the connector on the base plate. 2 -Inserting anterior coil into connector. 3 - This picture shows the groove at the coil s pillar and the connector and the pin which snaps against the pillar during insertion 9. Press the handles at the anterior coil s pillar and adjust the height and the angulation of the anterior coil. Make sure that shoulder tissue is not extruded from between the anterior coil and the base plate. Align the lateral portion of the anterior coil with the base plate. To achieve optimal image quality, the lateral edge of the anterior coil part should be parallel to the lateral edge of the base plate. Fig. 127: 1: Handles are pressed to adjust the height of the coil. 2: Positioning for left shoulder imaging. The arrow indicates where to make sure that no tissue is extruded. 3: The lateral portion of the anterior coil is aligned with the base plate. 10. Use the knee cushion to increase comfort. 11. Connect the SENSE Shoulder coil to the connector at the Patient Support Control Panel. Achieva 161

162 Coils and Positioning SENSE Shoulder coil Move the patient into the isocenter and perform the MR examination. 13. After the examination gently pull the anterior coil out of the base plate. SENSE Shoulder coil 4 Type of coil 4 element phased-array coil Receive-only Design Dimensions Rigid volume coil consisting of base plate and a small and a large coil plus auxiliaries. 210 mm x 500 mm x 570 mm (outside dimensions) Available for 1.5T and 3.0T SENSE-compatible CLEAR-compatible MultiTransmit-compatible Yes Yes No Applications Shoulder imaging. General remarks On 1.5T systems, the coil has two slots on each side. On 3.0T systems, the coil has one slot on each side only. Applying CLEAR gives excellent homogeneity throughout the images. In fatsuppressed scans however, image interpretation may sometimes be easier without CLEAR. Multi coil imaging No Dual coil imaging No User Interface Name SENSE-Shoulder-4 Fig. 128: SENSE Shoulder coil. Left: 1.5T version with 2 slots on each side, right: 3.0T version with one slot on each side. 162 Achieva

163 SENSE Wrist coil 4 Coils and Positioning Positioning 1. Place the base plate on the tabletop. 2. Slide the small or large coil into the slot (closest to the center of the bore). Select the small coil if possible. On 1.5T systems only: Do not use the outer slot since image quality might decrease. Only in case of extremely large patients, the outer slot can be used. 3. Position the patient on the tabletop, and place the coil around the shoulder. 4. Let the patient pull up his/her shoulder so that it is as close as possible to the coil. Fig. 129: Patient positioning for the right and left shoulder. Note that the shoulder is pulled up into the coil. SENSE Wrist coil 4 Type of coil 4 element phased-array coil Receive-only Design Rigid volume coil. Ovoid, two-piece, split shell design which conforms closely to the wrist. To reduce patient motion artifacts, this coil includes a base plate to fixate the coil and several pads. Dimensions 360 mm x 460 mm x 260 mm (outside dimensions) Available for 1.5T and 3.0T Achieva 163

164 Coils and Positioning SENSE Wrist coil 4 SENSE-compatible CLEAR-compatible MultiTransmit-compatible Yes Yes No Applications Wrist imaging, middle hand. General remarks The coil can be used overhead (superman position) with the joint horizontally, or at the patient s side, with the joint vertically. Applying CLEAR gives excellent homogeneity throughout the images. In fatsuppressed scans however, image interpretation may sometimes be easier without CLEAR. Multi coil imaging Dual coil imaging User Interface Name No No SENSE-Wrist-4 Fig. 130: SENSE Wrist coil 4. Positioning The wrist coil includes a coil holder for scans performed at the patient's side, and for scans performed over the patient's head. The base plate is equipped with a transverse slot and two lateral slots. 164 Achieva

165 SENSE Wrist coil 4 Coils and Positioning Fig. 131: Positioning with the SENSE Wrist coil 4. Left: Positioning of wrist at patient's side. Right: Positioning overhead (superman positioning). Overhead - Head First 1. Place the base plate on the patient table. 2. To attach the horizontal coil holder, insert the lock down button into the transverse slot and slide into position. 3. Attach the wrist coil by gently applying downward pressure until the support pins click into place in the holder. The coil is correctly positioned when the cable points away from the magnet. Fig. 132: 1 - Lateral (l) and transverse (t) slots. 2 - Coil holder and insert lockdown button (b). 3 - Coil cable pointing away from magnet (m). Left or Right Wrist - At Side - Feet First 1. Place the base plate on the patient table. 2. Slide the vertical coil holder into a lateral slot. 3. Attach the wrist coil by gently applying downward pressure until the support pins click into place in the holder. The coil is correctly positioned when the cable points away from the magnet. Achieva 165

166 Coils and Positioning SENSE Wrist coil 8 Fig. 133: Left: Left wirst - at side - feet first. Right: Right wrist - at side - feet first. SENSE Wrist coil 8 Type of coil 8 element phased-array coil Receive-only Design Rigid volume coil of 8 elements that closely encircles the wrist for high SNR. Onepiece, hinged design for easy patient set-up. To reduce patient motion artifacts, the SENSE Wrist coil includes a rigid base plate to fixate the coil. Dimensions 210 mm x 570 mm x 500 mm (outside dimensions) Available for 1.5T and 3.0T SENSE-compatible Yes CLEAR-compatible Yes Applications Wrist imaging. General remarks The coil can be used overhead (superman position) or at the patient s side, with the joint vertically or horizontally. Applying CLEAR gives excellent homogeneity throughout the images. In fatsuppressed scans however, image interpretation may sometimes be easier without CLEAR. Multi coil imaging No Dual coil imaging No User Interface Name SENSE-Wrist Achieva

167 SENSE Wrist coil 8 Coils and Positioning Fig. 134: SENSE Wrist coil 8. Positioning The base plate is equipped with two central transverse slots and two lateral slots on each side. Fig. 135: 1 - Base plate on tabletop. 2 - Closed coil on base plate for examination right wrist overhead (hotizontally). 3 - Patient positioning right wrist - at side - feet first (vertically). While closing the coil verify that the patient's skin cannot be pinched between coil parts. Overhead - Head First 1. Place the base plate on the tabletop. 2. Slide the coil into the transverse slots. 3. Angulate the coil for right or left wrist examinations. Achieva 167

168 Coils and Positioning SENSE Wrist coil 8 Fig. 136: Left: Coil positioning for left wrist - overhead. Right: Coil positioning for right wrist - overhead. With padding. 4. Make sure that the cable does not stick out over the table. If necessary, shift the coil downwards. 5. Put a pillow on the tabletop below the coil. Position the patient prone with the hand in the coil and the upper body on the pillow. 6. Use cushions so that the patient lies comfortable. 7. Insert padding into the coil for patient comfort. 8. Close the coil. 9. Insert padding into the coil through the opening, underneath the fingers. 10. Place the knee cushion under the lower legs for patient comfort. The cable points towards the magnet and runs down next the coil and patient to the connector. Left or Right Wrist - At Side - Feet First 1. Place the base plate on the tabletop. 2. Slide the coil vertically into the lateral slots of the base plate, either on the left-hand or on the right-hand side. 3. Remove the mount adaptor so that the patient doesn t lie against it. 168 Achieva

169 Hand/Wrist coil 4 Coils and Positioning Fig. 137: Left: Removing the mount adaptor. Right: mount adaptor removed. 4. Position the patient on the tabletop supine and feet-first with his/her hand in the coil (vertically). 5. Insert padding into the coil for patient comfort. 6. Close the coil. 7. Insert padding into the coil through the opening, underneath the fingers. 8. Place thin cushions under the upper arm for patient comfort. Fig. 138: Positioning at side right wrist. Hand/Wrist coil 4 Type of coil 4 element phased-array coil Design Dimensions Available for 1.5T Receive-only Rigid volume coils of 4 elements that closely encircle the wrist for high SNR. Onepiece design for easy patient set-up. To reduce patient motion artifacts, the Hand/Wrist coil includes a rigid base plate to fixate the coil. 170 mm x 480 mm x 360 mm (outside dimensions) FOV: 120 mm to 230 mm Achieva 169

170 Coils and Positioning Hand/Wrist coil 4 SENSE-compatible CLEAR-compatible No Yes Applications Wrist and hand imaging. General remarks The coil can be used overhead (superman position) or at the patient s side, with the joint vertically or horizontally. Applying CLEAR gives excellent homogeneity throughout the images. In fatsuppressed scans however, image interpretation may sometimes be easier without CLEAR. Multi coil imaging Dual coil imaging User Interface Name No No Hand/Wrist Fig. 139: Hand/Wrist coil 4 Fig. 140: Left: Base plate on tabletop. The base plate is equipped with one pair of slots for 'at side' positioning (3), two pairs of slots for 'overhead' positioning (1) and one pair of slots for the phantom holder (2). Right: 2 wedge pads, 2 hand palm supports (small and normal size), 2 flat hand supports (small and normal size). 170 Achieva

171 Hand/Wrist coil 4 Coils and Positioning Positioning Fig. 141: 1 - Coil on base plate. 2 - Examination of left wrist - at side - feet first. 3 - Examination of right wrist overhead. Overhead - Head First 1. Place the base plate on the tabletop. 2. Slide the coil into one of the pair of slots for overhead positioning, either for right or left wrist/hand examination. 3. Fix the coil to the base plate with the strap. Fig. 142: Left: Coil set-up for left wrist - overhead. Right: Coil set-up for right wrist - overhead. 4. Place the hand palm support in the coil, either for a hand examination or for a wrist examination. Achieva 171

172 Coils and Positioning Hand/Wrist coil 4 Fig. 143: These figures show how the hand palm support has to be put in the coil and how the hand has to be placed on this pad for either a hand or a wrist examination. Left: Positioning of pad and hand for wrist examination. Right: Positioning of pad and hand for hand examination. 5. Put a pillow on the tabletop below the coil. Position the patient prone with the hand in the coil and the upper body on the pillow. 6. Use cushions so that the patient lies comfortably. 7. Insert one or more flat hand supports on top of the hand to stabilize the hand. 8. Insert the wedge pad into the coil through the opening above the hand to flatten the hand. Fig. 144: Placement of wedges in the coil: 1 - flat hand support, 2 - wedge pad. 9. Place the knee cushion under the lower legs for patient comfort. Left or Right Wrist - At Side - Feet First 1. Place the base plate on the tabletop such that the slots for at side positioning are at the side of the wrist which has to be examined. 2. Slide the coil vertically into the groove, either on the left-hand or on the right-hand side. 172 Achieva

173 SENSE Small Extremity coil 8 Coils and Positioning Fig. 145: Left: Coil set-up for left wrist examination. Right: Patient positioning for a left wrist examination. The pads are inserted into the coil. 3. Place the hand palm support in the coil, either for a hand examination or for a wrist examination. 4. Position the patient on the tabletop supine and feet-first with his/her hand in the coil (vertically). 5. Insert one or more flat hand supports on top of the hand to stabilize the hand. 6. Insert the wedge pad into the coil through the opening above the hand to flatten the hand. 7. Place thin cushions under the upper arm for patient comfort. SENSE Small Extremity coil 8 Type of coil 8 element phased-array coil Design Receive-only Wrap-around coil on coil base with two dedicated mattresses and dedicated filler pads. Available for 1.5T and 3.0T SENSE-compatible CLEAR-compatible Yes Yes Applications Elbow imaging, Multi coil imaging Dual coil imaging User Interface Name No No Small extremities, Pediatrics SENSE-SmallExt8 Achieva 173

174 Coils and Positioning SENSE Small Extremity coil 8 Fig. 146: SENSE Small Extremity coil Coil in Small Extremity coil mattress. 2 - Small Extremity coil mattress with filler pads. 3 - Cable guide mattress. Positioning This coil can be used for examinations in supine (lateral) or prone (superman) patient position. The procedure for supine examinations is described here. 1. Place the short mattress (mattress provided with all Philips systems) at the bore end. 2. Place the Small Extremity coil mattress on the table. 3. Put the coil into the required side so that the coils lies stable. Place filler pads into the empty spaces. 4. Place the cable guide mattress on the table. 5. Place the cable through an available guide. Fig. 147: Left and right: Three mattresses (short mattress, coil positioning mattress and cable guide mattress) on the tabletop from different views. 6. Position the patient on the mattress with his/her elbow into the coil. 7. Use cushions for patient comfort and stability. 8. Wrap the coil around the patient s elbow. Ensure that the edges of the coil overlap. Snap the coil closed and pull the strap tight. 174 Achieva

175 Knee/Foot coil Coils and Positioning Fig. 148: Left: Open coil on tabletop. Right: Closed coil on tabletop. Fig. 149: Patient's arm in coil supported by sandbag. Knee/Foot coil Type of coil Quadrature detection: 12 elements Receive-only Design Rigid volume coil consisting of a coil base and an upper coil part. Dimensions Internal diameter 18 cm; length 20 cm Coverage: FH 22 cm, LR and AP: 18 cm, AP in foot region: extended to 28 cm due to vertical extension. Available for 1.5T SENSE-compatible No CLEAR-compatible No Achieva 175

176 Coils and Positioning Knee/Foot coil Applications Knee, Ankle, Foot Multi coil imaging Dual coil imaging User Interface Name Yes (see section Multi coil imaging ) No Knee-Foot Fig. 150: Left: Knee/Foot coil. Right: Positioning the coil. Positioning The coil should be placed with the cable coming out on the front. Make sure the coil is properly closed. While closing the coil verify that the patient's skin cannot be pinched between coil parts. Knee Use foam pads to keep the knee securely in place. Use sandbags and cushions to stabilize the knee. Do not place sandbags near or inside the field of view. This will help with shimming. Ankle /Foot Medially rotate the ankle a little to get nice anatomic orthogonal surveys. Use the foot-support coil insert to prevent motion. Use the fixation wedge to prevent motion of the toes/foot. Use the support cushion for the contralateral knee/foot. Support the knees with small wedges. 176 Achieva

177 Knee/Foot coil 4 (FootAnkleKnee) Coils and Positioning Fig. 151: Left: Knee/Foot coil with foot-support coil insert. Right: Knee/Foot coil applying fixation wedge. Knee/Foot coil 4 (FootAnkleKnee) Type of coil 4 elements phased-array coil Receive-only Design Rigid volume coil consisting of base plate, posterior coil part and two different anterior coil parts, one for a knee examination and one for a foot/ankle examination, plus auxiliaries. Dimensions Outer dimensions: height 270mm, width 320mm, length 600mm Available for 1.5T SENSE-compatible No CLEAR-compatible Yes Applications Knee, Foot, Ankle. General remarks Applying CLEAR gives excellent homogeneity throughout the images. In fatsuppressed scans however, image interpretation may sometimes be easier without CLEAR. Markers Landmark on top of anterior coil parts. Multi coil imaging No Dual coil imaging No User Interface Name FootAnkleKnee Achieva 177

178 Coils and Positioning Knee/Foot coil 4 (FootAnkleKnee) Fig. 152: Knee/Foot coil: 1 - base plate, posterior and anterior coil part for foot/ankle examination, 2 - base plate, posterior and anterior coil part for knee examination, 3 - base plate, posterior part with accessories: a - support cushion, b foot support, c - balun cover pad, d - lower leg support. Fig. 153: Auxiliaries: 1 - knee pad for a knee examination, 2 - toe wedge pad and straps for a foot examination, 3 - foot support pads. Positioning General preparation 1. Place the base plate on the tabletop. 2. Slide the coil in the transverse slots, and push it to the left or right side for an examination of the left or right extremity. The coil should be placed with the cable coming out away from the magnet. 178 Achieva

179 Knee/Foot coil 4 (FootAnkleKnee) Coils and Positioning Fig. 154: Base plate on tabletop with posterior coil part. Left: for an examination of the left knee, foot or ankle. Right: for an examination of the right knee, foot or ankle. 3. Place the balun cover pad on the cable trap box. Fig. 155: Placing of balun cover pad on cable trap box. Positioning - Ankle /Foot The following images illustrate the set-up for a left or right foot/ankle examination and where to place the support cushion, the lower leg support and the balun cover pad. 1. Use the support cushion for the contralateral foot. 2. Use the lower leg support for the lower leg to be examined. 3. The balun cover pad can be used to support the contralateral lower leg. Fig. 156: Left: Set-up for left foot/ankle examination. Right: Set-up for right foot/ankle examination. 4. Put the foot support on the posterior coil part. 5. Insert the pads into the foot support, and fix the straps to the coil. Achieva 179

180 Coils and Positioning Knee/Foot coil 4 (FootAnkleKnee) 6. Place the contralateral foot on the support cushion and the lower leg on the balun cover pad. 7. Position the foot in the foot support with the lower leg on the lower leg support. Place the straps around the foot for immobilization. Fig. 157: 1 and 2: inserting pads into foot support. 3 - positioning and immobilizing foot in foot support. 8. Very carefully slide the anterior coil part onto the posterior coil part with both hands. Make sure the coil is properly closed. Special attention is needed in case of patients with damaged feet and toes, e.g. diabetes. 9. Insert the toe wedge pad into the coil through the opening, underneath the toes. This pad can help keep the forefoot immobile. 10. Use the landmark on top of the anterior coil part for isocenter positioning. Fig. 158: 1 and 2: Right foot examination. Contralateral leg on support cushion and balun cover pad. Foot in coil and lower leg on lower leg support. 3 - Insertion of toe wedge pad into the coil. The arrow indicates the landmark for isocenter positioning. 180 Achieva

181 Knee/Foot coil 4 (FootAnkleKnee) Coils and Positioning While closing the coil verify that the patient's skin cannot be pinched between coil parts. Positioning - Knee 1. Put the knee pad on the posterior coil part. Fig. 159: Left: Knee pad. Right: Posterior coil part on base plate for left knee examination. Note that the knee pad is not yet inserted into the knee coil. 2. Place the contralateral knee on the knee support. 3. Position the knee on the knee pad in the coil, and the foot on the lower leg support. Fig. 160: Left: Left knee examination with contralateral (right) knee on knee support. Right: Left knee examination with left foot on lower leg support. 4. Close the coil. 5. Use the landmark on top of the anterior coil part for isocenter positioning. Achieva 181

182 Coils and Positioning SENSE Knee coil T Fig. 161: Left: Closing the coil. Right: Set-up for a right knee examination. Note that the balun cover pad can also be used for patient positioning and comfort. The arrow indicates the landmark for isocenter positioning. SENSE Knee coil T Type of coil 16 element phased-array coil Receive-only Design Rigid volume coil consisting of a coil base (base plate with the posterior coil part attached to it) and an anterior coil part plus auxiliaries. Available for 1.5T SENSE-compatible Yes CLEAR-compatible Yes Applications Knee imaging, feet-first examinations Multi coil imaging No Dual coil imaging No User Interface Name SENSE-Knee-16 Fig. 162: SENSE Knee coil 16. 1: Front view, 2: Rear view, 3: Auxiliaries, upper left: unaffected knee pad; upper right: foot support pad; lower left: thin and thick wedge pad; lower right: knee ramp. 182 Achieva

183 SENSE Knee coil T Coils and Positioning Positioning 1. Place the coil base on the tabletop with the scale towards the magnet. 2. Put the small mattress in front of the coil base. 3. Put the knee ramp on the coil base. Due to its design, the knee ramp can be put on the coil base in one way only. Fig. 163: 1: Coil base with posterior coil part (p) on tabletop with small mattress in front of it. 2: Knee ramp (r) on coil base. 3: Knee ramp can be put on coil base in one way only. s = scale on the coil base. M = arrow points to magnet. 4. Slide the posterior coil part to the left or to the right for a left or right knee examination. 5. Put the thin and/or thick wedge pad in the coil for small knees. 6. Put the unaffected knee pad on the coil base besides the posterior coil part. Fig. 164: Set-up for feet-first knee examinations with unaffected knee pad besides posterior coil part. R: set-up for a right knee examination with posterior coil part slid to the right side. Wedge pads are placed in the coil for a small knee. L: set-up for a left knee examination with posterior coil part slid to the left side. 7. Position the patient on the tabletop with the knee to be examined in the posterior coil part, with the corresponding foot on the foot support pad, with the unaffected knee on the unaffected knee pad. Achieva 183

184 Coils and Positioning SENSE T/R Knee coil T Fig. 165: Right knee examination. Left: right leg with knee in posterior coil part and foot on foot support pad. Right: left leg with knee on unaffected knee pad. 8. Carefully place the anterior coil part on the posterior coil part. 9. Close the coil by moving the U-bolt. Fig. 166: Closing the coil by means of the U-bolt. 10. Use the light visor and move the patient s knee to the isocenter. While closing the coil verify that the patient's skin cannot be pinched between coil parts. SENSE T/R Knee coil T Type of coil 16 element phased-array coil Transmit/Receive Design Rigid volume coil consisting of a coil base (base plate with the posterior coil part attached to it) and an anterior coil part plus auxiliaries. Available for 3.0T 184 Achieva

185 SENSE T/R Knee coil T Coils and Positioning SENSE-compatible CLEAR-compatible Yes Yes Applications Knee imaging, feet-first examinations Multi coil imaging Dual coil imaging User Interface Name No No SENSE-Knee-16 Fig. 167: SENSE Knee coil 16. 1: Front view, 2: Rear view, 3: Auxiliaries, upper left: unaffected knee pad; upper right: foot support pad; lower left: thin and thick wedge pad; lower right: knee ramp. WARNING Do not scan body parts other than the lower limbs with the SENSE T/R Knee 16 coil. Do not scan pediatric patients with the SENSE T/R Knee 16 coil. Positioning Label on the coil: Scanning pediatric patients is not allowed with this coil. 1. Place the coil base on the tabletop with the scale towards the magnet. 2. Put the small mattress in front of the coil base. 3. Put the knee ramp on the coil base. Due to its design, the knee ramp can be put on the coil base in one way only. Achieva 185

186 Coils and Positioning SENSE T/R Knee coil T Fig. 168: 1: Coil base with posterior coil part (p) on tabletop with small mattress in front of it. 2: Knee ramp (r) on coil base. 3: Knee ramp can be put on coil base in one way only. s = scale on the coil base. M = arrow points to magnet. 4. Slide the posterior coil part to the left or to the right for a left or right knee examination. 5. Put the thin and/or thick wedge pad in the coil for small knees. 6. Put the unaffected knee pad on the coil base besides the posterior coil part. Fig. 169: Set-up for feet-first knee examinations with unaffected knee pad besides posterior coil part. R: set-up for a right knee examination with posterior coil part slid to the right side. Wedge pads are placed in the coil for a small knee. L: set-up for a left knee examination with posterior coil part slid to the left side. 7. Position the patient on the tabletop with the knee to be examined in the posterior coil part, with the corresponding foot on the foot support pad, with the unaffected knee on the unaffected knee pad. 186 Achieva

187 SENSE T/R Knee coil T Coils and Positioning Fig. 170: Right knee examination. Left: right leg with knee in posterior coil part and foot on foot support pad. Right: left leg with knee on unaffected knee pad. 8. Carefully place the anterior coil part on the posterior coil part. 9. Close the coil by moving the U-bolt. Fig. 171: Closing the coil by means of the U-bolt. 10. Use the light visor and move the patient s knee to the isocenter. While closing the coil verify that the patient's skin cannot be pinched between coil parts. Connect the coil connectors to the sockets: the T/R connector to the TR socket, the conventional connector to the conventional socket. Achieva 187

188 Coils and Positioning SENSE Knee coil 8 Fig. 172: Connectors of the SENSE T/R Knee coil T in the corresponding sockets on the Achieva TX system. SENSE Knee coil 8 Type of coil 8 elements phased-array coil Receive-only Design Rigid volume coil consisting of 8 elements Dimensions FH: 37 cm, AP: 28 cm, LR (coil): 32 cm, LR (base): 45 cm Available for 1.5T, 3.0T SENSE-compatible Yes CLEAR-compatible Yes MultiTransmit-compatible No Applications Knee Markers on the coil In the middle of the coil (FH direction) for light visor positioning General remarks This coil should only be used for Feet first studies. Applying CLEAR gives excellent homogeneity throughout the images. In fatsuppressed scans however, image interpretation may sometimes be easier without CLEAR. Multi coil imaging Yes (see section Multi coil imaging ) Dual coil imaging No User Interface Name SENSE-Knee Achieva

189 SENSE Foot-Ankle coil Coils and Positioning Fig. 173: SENSE Knee coil 8. Positioning Use foam pads to keep the knee securely in place. Use sandbags and cushions to stabilize the knee. Do not place sandbags near or inside the field of view. This will help with shimming. Fig. 174: Positioning with SENSE Knee coil 8. While closing the coil verify that the patient's skin cannot be pinched between coil parts. SENSE Foot-Ankle coil Type of coil 8 elements phased-array coil Receive-only Design Rigid volume coil consisting of base plate with foot support and the coil plus auxiliaries. Dimensions Inner dimensions: FH: 200 mm, LR: 105 mm, AP: 270 mm. FOV: FH: 220 mm, LR: 120 mm, AP: 280 mm. Achieva 189

190 Coils and Positioning SENSE Foot-Ankle coil Available for 1.5T, 3.0T SENSE-compatible CLEAR-compatible MultiTransmit-compatible Yes Yes No Applications Foot, Ankle. General remarks Applying CLEAR gives excellent homogeneity throughout the images. In fatsuppressed scans however, image interpretation may sometimes be easier without CLEAR. Do not combine this coil with other coils. Markers On the cable to facilitate cable routing into the groove of the base plate. Landmark on top of the handle for isocenter positioning. Multi coil imaging Dual coil imaging User Interface Name No No SENSE-Foot/Ankle Fig. 175: Left: SENSE Foot-Ankle coil: base plate and coil. Right: Schematic drawing of the 8 coil elements. Fig. 176: 1: Base plate with foot support. 2: Toe wedge pad. 3: Foot support pad. 4: Knee support (2x). 5: Unaffected foot pad. 190 Achieva

191 SENSE Foot-Ankle coil Coils and Positioning Positioning 1. Place the base plate on the tabletop towards the magnet so that the patient can be examined supine and feet first. 2. Slide the foot support on the base plate to the left or the right side to accommodate left or right foot and ankle examinations. 3. Insert padding into the foot support for patient comfort and good fixation. The foot support pad is used to center the ankle in the coil. 4. Position the patient on the tabletop. Place the foot to be examined in the foot support. To improve patient comfort, use the knee supports. 5. Place the foot which is not to be imaged in the unaffected foot pad for patient comfort. 6. Use the strap to immobilize the foot to be examined. 7. Very carefully slide the coil onto the foot support with both hands. Special attention is needed in case of patients with damaged feet and toes, e.g. diabetes. There are no latches, the coil is held in place by gravity. 8. Insert the toe wedge pad into the coil through the opening, underneath the toes. This pad can help keep the forefoot immobile. 9. Route the coil cable as illustrated above. Markers on the cable indicate which part of the cable has to be pressed into the groove on the edge of the base plate. Proper placement of the cable simplifies cable management when the table is raised/ lowered or moved in/out of the bore. 10. Use the landmark on top of the handle for isocenter positioning. While closing the coil verify that the patient's skin cannot be pinched between coil parts. Achieva 191

192 Coils and Positioning SENSE PeriphVascular coil Fig. 177: 1: Foot positioning in foot support. 2: Sliding coil onto foot support with both hands. 3: Inserting of toe wedge pad through opening. Fig. 178: 1: Positioning with unaffected foot on dedicated pad. 2: Toe wedge pad in coil, and landmark (arrow) for isocenter positioning. 3: Cable routing: part between markers in groove on coil. SENSE PeriphVascular coil Type of coil 12 element phased-array coil Receive-only Design Bilateral coil which consists of base pad, posterior and anterior coil. The base pad has the shape of an elongated wedge such that one extremity is thicker than the other. The posterior coil is larger than the anterior coil and wraps around the patient s legs. The anterior and posterior coil elements have to be connected to the base pad. Coverage 129 cm; from renal arteries to pedal arch. Available for 1.5T SENSE-compatible Yes CLEAR-compatible Yes 192 Achieva

193 SENSE PeriphVascular coil Coils and Positioning Applications High resolution imaging of abdominal aorta and peripheral vasculature. CE- Angio run off studies. Three-station contrast studies. Ideal in combination with MobiTrak studies. General remarks The complete SENSE PeriphVascular coil consists of three stations: upper, middle and lower station for abdomen, upper and lower legs. Each station is made up of 4 coils which can be selected separately. It can only be scanned with one coil station at any one time. Always use CLEAR as homogeneity correction for best image quality. Multi coil imaging Dual coil imaging User Interface Name Yes (only to combine the stations of this coil) No SENSE-PV Station selection Coil part: middle, upper, lower Ch. combination: 1, 12, 123, 2, 23, 234, 1234, 3, 34 Fig. 179: SENSE PV coil. MobiTrak or MobiFlex Positioning Coil Positioning 1. Move the tabletop completely out of the magnet without lowering it. 2. Place the base pad onto the tabletop with the thick extremity towards the magnet. 3. Place the posterior coil onto the base pad allowing the base to fit into the coil grid. 4. Bend the longest of the two short base pad cables and plug it into the posterior coil. 5. Make sure that the upper station is centered below the mark on the table to ensure that the table can travel to isocenter. 6. The thick end of the base pad will stick out of the tabletop by 4 cm or more. Achieva 193

194 Coils and Positioning SENSE PeriphVascular coil Patient positioning 1. Position the patient feet first with the heels resting on the thick square pads at the end of the base pad. 2. Position the patient s heels within the lower coil element (see orange marked area in figure). 3. Place the two elongated foam cushions under the knee and under the ankles in order to avoid calf compression. 4. Place the supplied foam cube between the patient s legs to provide support to the anterior coil. 5. Support the upper back and the head of the patient with a pillow or other padding material to ensure patient comfort. 6. Position the patient s arms above the head on the support cushion (or on the abdomen outside the coil). 7. 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. 8. Stabilize the patient s legs with sandbags if necessary. 9. Wrap the posterior coil lateral flaps around the patient s legs until they touch the anterior coil. Fig. 180: 1: The orange spots indicate where to position the patient's heels. 2: SENSE PV coil open. 3: SENSE PV coil closed with straps. 10. Wrap the straps attached to the posterior coils around the patient to stabilize the anterior coil as well as the lateral flaps. 11. Plug the base pad connector with the shortest cable into the anterior coil. 12. As the patient s feet are in close proximity to this connector they should be padded medially, then strapped together. 13. Plug the coil into the connector. 14. Use the light visor to position the lower station marker, marked by an engraved cross on the anterior coil surface, into the magnet isocenter. The arms of the patient are best left outside the coil on the abdomen or above the head. 194 Achieva

195 SENSE GP Flex L 8 coil Coils and Positioning The parameter Multi coil has to be set to Yes in order to switch between the different coil parts per stack. Cleaning of the coil is possible with a moist cloth. Avoid cleaning the connector at the feet end of the coil with water. Coil selection It is only possible to scan with one coil station (upper, middle or lower station) at any one time. Select the stations for the stacks as follows: Upper station for the abdominal stack (Stack C); Middle station for the upper legs (Stack B); Lower station for the lower legs (Stack A). SENSE GP Flex L 8 coil Type of coil 8 element phased-array coil Design Dimensions SENSE-compatible CLEAR-compatible Applications Multi coil imaging Dual coil imaging User Interface Name Receive-only Flexible surface coil designed to wrap around the anatomy of interest 65 cm x 24 cm Yes Yes General Purpose (GP) Yes Yes especially designed for hip, pelvis and prostate SENSE-GPFlex8-L Achieva 195

196 Coils and Positioning SENSE GP Flex L 8 coil Fig. 181: SENSE GP Flex L 8 coil. Always store the coil flat. Positioning for Single Hip Position the patient supine. Wrap the coil around the hip to be examined. Use fixation straps to secure the coil. Center the anatomy in the middle of the coil, center the laser to the anatomy. Fig. 182: Single Hip examination with the SENSE GP Flex L 8 coil: The patient is positioned supine, feet-first. The coil is wrapped around the hip and fixed with a strap. Combination of two coils If two coils SENSE GP Flex L coil 8 are available on an Achieva system, these two coils can be combined for optimum image quality. For ease of use, a dedicated GP positioning cushion is provided in this case. A typical application is the examination of the prostate: Prepare the coils as shown in the figure below. 196 Achieva

197 Microscopy coils Coils and Positioning Wrap the coils around the patient and and use fixation straps to secure them. Fig. 183: Left: GP positioning cushion. Right: Preparation of an examination with the two coils utilizing the GP positioning cushion. Coil parameters Enable Dual Coil mode. Select All or Overlap as Element selection. All Overlap should be used if the two coils overlap. should be used if the two coils do not overlap. will deactivate the most outer elements of each coil. will activate all 16 elements: 8 for the anterior coil When overlap is used, this will become a total of 12 and 8 for the posterior coil. channels being used, 6 of the anterior coil and 6 of the posterior coil. Make sure that the Element selection is set to the correct value for both coils. Microscopy coils Type of coil Linear detection Receive-only Design Surface coil Dimensions Large coil: 47 mm; Small coil: 23 mm (coil s inner diameter) Available for 1.5T SENSE-compatible No CLEAR-compatible Yes Applications Applications requiring small FOV with high SNR, e.g. skin, eyes, small joints, superficial vessels, pediatric and nipple imaging. Placed around a finger, against the skin or close to the body surface. Achieva 197

198 Coils and Positioning Microscopy coils General remarks To ensure a flat surface, the coils can be closed with special coil inserts. Limitations Make sure, that the coil is not positioned in the transverse plane. Coils work best when positioned in coronal or sagittal plane. The coil may be combined with the Q-Head coil. The coil may not be used in the mouth. Multi coil imaging Dual coil imaging User Interface Name Yes (see section Multi coil imaging ) No Micro-23, Micro-47 Fig. 184: Microscopy coil. Instead of a cable trap, the Microscopy coils use a driver box. The driver box contains dedicated electronics for the Microscopy coils. This driver box looks very similar to the cable trap and must be plugged directly in the coil connector. Do not try to use the Microscopy coil with the cable trap as it does not fit. Positioning Skin imaging 1. To achieve the best possible image quality, make sure that both the coil and the anatomy are perfectly immobilized. Use sandbags and/or straps. 2. Start with a large FOV (450 mm) to find the location of the coil. 3. Proceed with a multistack small FOV (15 mm) survey. 4. Then perform high resolution scans. 198 Achieva

199 SENSE Flex coils Coils and Positioning Fig. 185: Incorrect (left) and correct (right) positioning of the Microscopy coil. The arrow indicates the axis of the main magnetic field. 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. Positioning examples Fig. 186: Positioning examples with the Microscopy coils: orbit, ear, skin. Fig. 187: Positioning examples with the Microscopy coils: placed against the skin, around a digit and around a thumb. The arrow indicates the axis of the main magnetic field. SENSE Flex coils Type of coil 2 element phased-array coil Receive-only Design Flexible coils consisting of two elements; each element labelled with an identification number Achieva 199

200 Coils and Positioning SENSE Flex coils Available for 1.5T, 3.0T SENSE-compatible CLEAR-compatible MultiTransmit-compatible Application General remarks Multi coil imaging Dual coil imaging User Interface Name Yes Yes No Imaging small Fields of View from 5 cm to 20 cm Always use CLEAR as homogeneity correction for best image quality. Yes (see section Multi coil imaging ) Yes (see section Dual coil imaging ) SENSE Flex-L, SENSE Flex-M, SENSE Flex-S Fig. 188: SENSE Flex coil in three sizes. The SENSE Flex coil is available in three sizes: S-small, M-medium, L-large. Coil Dimensions Applications SENSE Flex-S SENSE Flex-M SENSE Flex-L 2 coil elements Circular, loop size 11 cm, opening 8 cm 2 coil elements Elliptical, loop size 14 cm x 17 cm opening 11 cm x 14 cm 2 coil elements Circular, loop size 20 cm, Opening 17 cm TMJ s, orbits, I.A.C. Small joints (e.g. wrist) Superficial vessels (carotid arteries) Pediatric imaging Shoulder (ABER positioning) Single Hip, Knee, Ankle Pediatric imaging Carotid Arteries Brain and brain intervention Brachial Plexus Pediatric imaging Prostate For more information on how to use the coil in different anatomic areas, refer to the following sections: 200 Achieva

201 SENSE Flex coils Coils and Positioning General Positioning the coil, care must be taken to avoid coupling or cross-talk between the two elements. To avoid coupling: Keep a minimum distance of approximately half the size of an element between the coil elements if they are positioned parallel. Ensure that the coil elements do not touch if they are positioned next to each other. It is better if the coil elements overlap a few centimeters. Ensure that the elements do not touch if they are positioned at an angle. Position one element slightly on the other instead. Do not connect the coil until the patient is positioned in the bore. This makes coil handling easier. Fig. 189: Positioning advices for the SENSE Flex coils to avoid coupling. SENSE Flex coil spacer Use the SENSE Flex coil Spacer in order to keep a distance between coil cables and the patient. With virtually all applications of the SENSE Flex coils, the Spacer can be attached to the cables running between the interface-box and the coil elements. The small cushion can be attached to the interface-box whenever the interface-box cannot be positioned at the tabletop. See examples showing the use of the SENSE Flex coil spacer. Fig. 190: Examples using the SENSE Flex coil spacer. SENSE Flex-S coil in head and neck applications 1. Position the patient in the TMJ coil holder rest assembly, if available. 2. Center the patient s head and immobilize it using strap and band. 3. Place the coil elements on both sides of the patient s head or neck. Achieva 201

202 Coils and Positioning SENSE Flex coils For TMJ examinations 1. Place your finger through the coil elements to locate the head of the mandible (ask the patient to open and close the mouth). Alternatively, the SENSE Flex-M coil could also be used. The SENSE Flex-S coil is not suited for imaging the carotid arteries in their entire length, but it provides excellent image quality if focussed on a specific area, e.g. the bifurcation. Fig. 191: Left: SENSE Flex-S coil with TMJ holder for orbit. Right: SENSE Flex-S coil with TMJ holder for anterior neck. SENSE Flex coils in body applications Do not place the coil elements too close to each other. Keep a minimum distance of 8 cm. Use cushions if necessary. SENSE Flex-L in prostate examinations 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. Pediatric body applications Children may be more comfortable prone. 202 Achieva

203 SENSE Flex coils Coils and Positioning Fig. 192: SENSE Flex-L for pediatric body applications. SENSE Flex-L coil in MR Mammography Use the SENSE breast mattress in conjunction with the SENSE Flex-L coil to provide high quality SENSE imaging of the breast. The SENSE Flex L-coil fits precisely into the mattress. The mattress is available for 1.5T and 3.0T systems. It 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 elements of the SENSE Flex-L coil fit. These recesses also contain velcro attachment points to anchor the coil in place. Along either side of the top and bottom of the base are grooves into which the cables of the coil should be placed. This gives the required separation between the patient s skin and the cables ensuring both safety and comfort. The flexible cover is designed to sit on the top of the base and cover the coil and cable. It is also fixed to the 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. It is allowed to scan with a combination of two SENSE Flex coils in dual mode. The flexible cover is designed to sit on the top of the base and cover the coil and cable. It is also fixed to the 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. Achieva 203

204 Coils and Positioning SENSE Flex coils Fig. 193: Left: Breast mattress. Right: Schematic drawing of the breast mattress. 1 - flexible cover, 2- anterior coil part, 3 - base of the mattress, 4 - posterior coil part, 5 - cables located in groove. For more information on the workflow, refer to the section 'SENSE Body coil'. Fig. 194: SENSE Flex-L coils on dedicated breast mattress. SENSE Flex coils in orthopedic applications SENSE Flex-L or -M coil in shoulder examinations Positioning a patient for the shoulder, one should consider the following: 1. Position the shoulder as much in the isocenter as possible by placing the patient a little semi-oblique. 2. Support the patient s back and legs with cushions. 3. Place the arm next to the patient on the tabletop to minimize motion artifacts due to breathing. Flex coils have to be positioned exactly on the gleno-humural joint. 4. 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 1. Place one coil element such that it encompasses the top of the shoulder and lies approximately in the sagittal plane. 204 Achieva

205 SENSE Flex coils Coils and Positioning 2. 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. Fig. 195: SENSE Flex-M, shoulder. Method 1. Method 2 1. Place one coil element behind the shoulder joint. 2. Place the second coil element anterior. 3. Position the elements parallel to each other. Make sure there is the required distance between the elements and the elements do not touch each other. 4. Use the strap to keep both coil elements in place. 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 oblique the patient towards the to-be-examined side. 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 combiner box 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). SENSE Flex-S or -M coil in wrist examinations 1. Position the patient supine, with the arm along the patient's side. The hand/wrist is as much in the isocenter as possible 2. Use sandbags to immobilize leg and foot. 3. Use positioning cushions to ensure patient comfort. Avoid placing sandbags near or inside the FOV. 4. For the SENSE Flex-M coil, use cushions between hand and coil element to avoid coupling between the coil elements. 5. For the SENSE Flex-S coil, don t use cushions between hand and coil element. Achieva 205

206 Coils and Positioning Circular coils C1, C3, C4 SENSE Flex-S coil in elbow examinations 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. SENSE Flex coils in hip examinations 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 patient's hands should be on the chest. Do not place the coil elements too close to each other. Use cushions if necessary. Circular coils C1, C3, C4 Type of coil Linear detection Receive-only Design Flexible surface coil: Circular Available for 1.5T SENSE-compatible No CLEAR-compatible No Limitations Excess bending may affect the performance of the coil. When using fat suppression, large left-right offcenters (e.g. shoulder imaging) should be avoided (adverse effect on image quality). Multi coil imaging Yes (see section Multi coil imaging ) Dual coil imaging No User Interface Name C1, C3, C4 Coil Dimensions Applications C1 20 cm Opening: Ø 17 cm Facial areas, Sagittal and transverse spine, Shoulder, Foot, Kidney, Lower abdomen C3 14 cm Opening: Ø 11 cm Eye, Orbit, Ear, TMJ, Throat, Shoulder, Wrist, Testes 206 Achieva

207 Circular coils C1, C3, C4 Coils and Positioning Coil Dimensions Applications C4 11 cm Opening: Ø 8 cm High resolution imaging Eye, Orbit, Ear, TMJ, Throat, Wrist, Testes Fig. 196: C1, C3 and C4. When on the tabletop, all coils (if used as positioning aid also the head coil) must always be connected to the system, whether they are being used for imaging or not. Positioning C3 or C4 in head, orbit and IAC examinations 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. 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. C4 coil in anterior neck and carotid angio examinations 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 the straps. Position the C4 as close as possible to the throat. C3 and C4 in TMJ examinations Use the TMJ coil holder if available. Achieva 207

208 Coils and Positioning Circular coils C1, C3, C4 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. C1 coil in thoracic and lumbar spine Position the patient supine on the C1 coil, electronics box to the side. Use the coil cable as a reference to define scan plane. Circular coils in body applications Use the immobilization strap to fix the coil on the patient and minimize respiratory motion. Kidney Position the patient supine with the C1 coil beneath them. Use the coil cable as centering point. 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. Circular coils in orthopedic examinations Shoulder: in general 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 semioblique. 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. Shoulder: C1 in 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. 208 Achieva

209 Phosphorous coil Coils and Positioning 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. Shoulder: 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. Shoulder: C3 in small adults or children Position the C3 coil on top of the shoulder joint. Elbow: C3 coil in elbow examinations Position the C3 coil with the arm placed through the coil Wrist: C3 or C4 in wrist examinations Position the patient supine, with the arm along the patient's side. The hand/wrist is as much in the isocenter as possible Use positioning cushions to ensure patient comfort. Avoid placing sandbags near or inside the FOV. 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. Phosphorous coil Type of coil Linear detection Design Available for 3.0T SENSE-compatible CLEAR-compatible MultiTransmit- compatible Applications All purpose 31 P Transmit/Receive Surface loop coil with a diameter of 14 cm Two long attached rods allow for manual tuning and matching to optimize performance. Slots around the edge of the coil can be used to attach straps to keep the coil positioned properly. A small disk buried at the center of the coil contains both water and methylphosphonic acid (also in Sphere b); it can be used as a marker of coil position. No No No MR Phosphorous Spectroscopy, e.g. leg, muscle, brain, liver, heart. Achieva 209

210 Coils and Positioning Phosphorous coil General remarks The plane of the coil should be kept parallel to the main magnetic field. Proton decoupling and Nuclear Overhauser Enhancement (NOE) irradiation are provided by the Body coil. SAR is calculated on a scan-by-scan basis and takes into account both, the proton and phosphorous pulses. Multi coil imaging Dual coil imaging No No User Interface Name P-140 Fig. 197: Phosphorous coil. 210 Achieva

211 Different ways of combining coils Coil combinations 5 Coil combinations This chapter describes the available coil combinations. For information on the coils, refer to chapter 5 Coils. Before you start using any of the coils, refer to the Instructions for Use for full information on safety aspects. As most of the photographs in this chapter have been taken in a non-clinical environment, it is possible that in some of the photographs the patient s clothing is not suited for a real MR examination. Patients may also be shown without headset and nurse call. Dual coil imaging can be performed on both Achieva and Intera systems with a FreeWave upgrade. Different ways of combining coils It is possible to connect multiple coils simultaneously to the system. Coils can be combined in two different ways: in Multi coil imaging in Dual coil imaging These imaging types can be enabled or disabled by means of the imaging parameters Multi coil or Dual coil. Multi Coil Imaging In Multi coil imaging, multiple coils are used for multistack imaging. The coils are used separately, one coil per stack or scan. Each image contains the information from one coil only. Example A typical application is the examinations of both TMJs simultaneously with two different coils connected. A scan is performed with multiple stacks, one with the TMJ-right coil for the right TMJ and the other stack with the TMJ-left coil for the left TMJ. Related imaging parameter Multi coil (if set to Yes, different coils can be selected per stack) Achieva 211

212 Coil combinations Possible Coil Combinations 1.5T Dual Coil Imaging Dual coil imaging can be performed on Achieva and Intera systems with a FreeWave upgrade. In Dual coil imaging, multiple phased-array coils are combined in such a way that they function as one coil: the signal is added up into one image. This new multi-element coil is CLEAR- and SENSE-compatible. Dual coil imaging opens a wide range of applications. ExampleThe SENSE Head/Spine coil is an example of such a coil combination: the SENSE Neuro- Vascular 16 coil and the SENSE Spine 15 coil are combined to a 31 channel phased-array coil. This coil combination allows total neuro and total spine imaging. Related imaging parameter Dual coil (if set to Yes, two phased-array coils can be used as one coil) Possible Coil Combinations 1.5T In this section the possible coil combinations on 1.5T systems are listed. Recommended coil combinations Recommended coil combinations are the clinically useful combinations. These coil combinations can be used in Dual coil and in Multi coil imaging: Total Neuro / Total Spine SENSE Head/Spine coil combination : SENSE NV 16 with SENSE Spine 15 SENSE Spine coil with SENSE Flex-L coil Miscellaneous applications, e.g. joints and pediatrics SENSE Flex coil combinations SENSE Flex-S with SENSE Flex (-S, -M, -L) SENSE Flex-M with SENSE Flex (-S, -M, -L) SENSE Flex-L with SENSE Flex (-S, -M, -L) Allowed combinations More coil combinations are allowed. These can be used in Multi coil imaging only. The table below gives an overview. 212 Achieva

213 Possible Coil Combinations 3.0T Coil combinations Fig. 198: The R indicates recommended coil combinations (Dual or multi coil imaging can be performed); the checkmark indicates allowed coil combinations (Multi coil imaging can be performed). Possible Coil Combinations 3.0T In this section the possible coil combinations on 3.0T systems are listed. Achieva 213

214 Coil combinations SENSE Head/Spine coil combination Recommended coil combinations Recommended coil combinations are the clinically useful combinations. These coil combinations can be used in Dual coil and in Multi coil imaging: Total Neuro / Total Spine SENSE Head/Spine coil combination: SENSE NV 16 with SENSE Spine 15 SENSE Spine coil with SENSE Flex-L coil Body applications Endo coil 3.0T with SENSE Torso coil Endo coil 3.0T with SENSE Cardiac coil Endo coil 3.0T with SENSE XL Torso coil Endo coil 3.0T with SENSE XL Torso TX coil Miscellaneous applications, e.g. joints and pediatrics SENSE Flex coils with each other SENSE Flex-S with SENSE Flex (-S, -M, -L) SENSE Flex-M with SENSE Flex (-S, -M, -L) SENSE Flex-L with SENSE Flex (-S, -M, -L) SENSE Spine 15 coil with SENSE Flex-L coil Multi coil combinations The following combinations can only be used in Multi coil imaging. SENSE Flex-S coil with SENSE Head 6 coil SENSE Flex-S coil with SENSE Head 8 coil SENSE Flex-S coil with SENSE NV 8 coil SENSE Flex-S coil with SENSE NV 16 coil SENSE Head/Spine coil combination Type of coil 31 elements phased-array coil Design Dimensions Receive-only Available for 1.5T, 3.0T SENSE-compatible Coil combination of the SENSE NeuroVascular 16 coil and a rigid 15 element spine surface coil. In this case, the SENSE NV 16 coil offers different anterior parts: a cage (as usual) and a rigid surface coil (referred to as top-off ). Imaging length (coil combination): 72 cm Yes 214 Achieva

215 SENSE Head/Spine coil combination Coil combinations CLEAR-compatible Yes Applications Cervical, Thoracic and Lumbar spine Screening Total Spine with MobiFlex option Screening Total Neuro with MobiFlex option General remarks The SENSE Spine 15 and the SENSE NV 16 coils can both be used as stand-alone coils. For more information: See section SENSE NeuroVascular coil 8 and 16. See section SENSE Spine coil 15 Positioning SENSE Head/Spine coil combination Place the NV posterior part and the spine coil on the tabletop. Slide the spine coil over posterior part. Move it up maximally. Route the cable of the NV through the groove on the side of the spine coil. Place the mattress on the coil. The mattress helps keeping the cable in place. Position the patient on the coil combination. Let the patient move upwards so that the patient's shoulders touch the NV posterior part. Use the knee cushion to increase patient comfort. Make sure that the patient's hands are on the tabletop and not at the side of the table so that finger pinching cannot occur during table movement. Make use of the arm supports to avoid such a situation. Attach the anterior coil part (either cage or top-off) to the NV posterior part. In case of the cage, move the mirror on the coil to the optimum position. Achieva 215

216 Coil combinations SENSE Head/Spine coil combination Fig. 199: SENSE Head/Spine coil combination. 1-3: Set-up for total neuro examination. 4-5: Set-up for total spine examination. Total Neuro Examination Total Neuro examinations can be done by means of the MobiTrak option and the SENSE Spine 15 coil with the SENSE NV 16 coil. Total Neuro ExamCards acquire three stacks (head/cervical, thoracic, lumbar) at different table positions. Table movement is required between acquisition of these stacks. Stack A (lumbar) is acquired with the SENSE Spine 15 coil. Stack B (thoracic) is acquired in Dual coil mode with both coils (elements ABC and NPC ). Stack C (head/cervical) is acquired with the SENSE NV 16 coil. Total Neuro can also be acquired in 4 stacks. Adapt the ExamCard if necessary. Workflow Position the patient on the coil combination. 216 Achieva

217 SENSE Head/Spine coil combination Coil combinations Center on the middle marker (chin) of the NV 16 coil. Start the Total Neuro ExamCard. Automatically the sagittal survey will start, followed by the coronal survey. Load both surveys into the MobiView package. Click Smooth fuse. Save the images to the data base. Load the fused surveys into the planning environment. Plan a sagittal Total Neuro sequence on the sagittal survey (FH and AP offcenters) and on the coronal survey (RL angulations). Press Proceed to complete planning. All scans and stations are now planned since GeoLinks and ScanAlign are applied within the Total Neuro ExamCard. Start the ExamCard. Images can be viewed, fused and saved in MobiView. Allowed Coil Combinations On 16 channel systems SENSE NV selection AND SENSE Spine 15 selection HNPC TO-HNPC PC NPC TO-NPC PC NPC TO-NPC On 32 channel systems On 32 channel systems, the same coil combinations are allowed as on the 16 channel systems plus those listed in the table below. SENSE NV selection AND SENSE Spine 15 selection HNACPC NACPC HNACPC A A AB AB AB ABC ABC ABC A A AB Achieva 217

218 Coil combinations SENSE Spine coil with SENSE Flex-L coil SENSE NV selection AND SENSE Spine 15 selection HNPC NACPC TO-HNPC NACPC NPC NACPC TO-NPC PC AB AB AB ABC ABCD ABCD ABCD ABCDE SENSE Spine coil with SENSE Flex-L coil Available for 1.5T, 3.0T SENSE-compatible CLEAR-compatible Yes Yes Applications Cervical, Thoracic and Lumbar spine General remarks Screening Total Spine with MobiFlex option Screening Total Neuro with MobiFlex option For more information: See section SENSE Spine coil 1.5T See section SENSE Spine coil 3.0T See section 'SENSE Flex coils'. Positioning SENSE Spine coil with SENSE Flex-L coil Place the spine coil on the tabletop. Position the patient on the coil. Use the knee cushion to increase patient comfort. Make sure that the patient's hands are on the tabletop and not at the side of the table so that finger pinching cannot occur during table movement. Make use of the arm supports to avoid such a situation. Place the elements of the SENSE Flex-L coil at both sides of the patient s head, and fix them with straps. 218 Achieva

219 SENSE Flex Coils Combinations Coil combinations Fig. 200: Positioning with the SENSE Spine and the SENSE Flex-L coil. Total Neuro Examination Total Neuro examinations can be done by means of the MobiTrak option using the SENSE Spine coil with the SENSE Flex-L coil. Change the Total Spine ExamCard in the following way: Add another stack so that you end up with four stacks (head, cervical, thoracic, lumbar) at different table positions. Table movement is required between acquisition of these stacks. Ensure that the stacks A, B, C (lumbar, thoracic, cervical) are acquired with the SENSE Spine coil. Ensure that the stack D (head) is acquired with the SENSE Flex-L coil. Use CLEAR in the head and enable Dual coil imaging. Allowed Coil Combinations On 16 channel systems SENSE Flex selection AND SENSE Spine selection 12 or 1 or 2 A 12 or 1 or 2 AB 12 or 1 or 2 M-ABCDE SENSE Flex Coils Combinations Available for 1.5T, 3.0T SENSE-compatible CLEAR-compatible Yes Yes Achieva 219

220 Coil combinations SENSE Flex Coils Combinations Applications General remarks Miscellaneous, e.g. joints (ankle and knee), pediatrics For more information: See section 'SENSE Flex coils'. It is highly recommended to use the dedicated coils, e.g. knee coils for knee examinations or a foot/ankle coil for ankle examinations. If these dedicated coils are not available or can t be used, SENSE Flex combinations can be used instead. Positioning of SENSE Flex-S and -M coil for knee examination Put one Flex-S element underneath the knee. Place the Flex-M elements at both sides of the knee. Fix them with straps. Place the other Flex-S element on top of the knee. Fix with straps. Put any kind of padding between coil cables and patient. Route the cables so that they are straight and neither touch each other nor the patient. Fig. 201: SENSE Flex-S and -M coil for a knee examination. 220 Achieva

221 Basic Set Positioning Aids 6 Positioning Aids This chapter shows the positioning aids that are delivered with your system: the basic set and the optional positioning aids. For most of them, application examples are given and their purpose is explained. Basic Set The following figures show the basic set of positioning aids: Fig. 202: Mattress yellow long, dimensions: 1800 mm x 560 mm. Mattress yellow short, dimensions: 600 mm x 560 mm. Knee support, dimensions. Fig. 203: Wedge 30 o. Wedge 15 o. Extremity straps: large, medium, small. Fig. 204: Head/orbit strap and immobilization strap (2x velcro strip). Shoulder/hip strap. Elbow support strap (4x velcro strip). Fig. 205: Sandbags (2.8 kg and 3.6 kg). Set of foam wedges. 6 x cable clips. Achieva 221

222 Positioning Aids Arm Board Fig. 206: Body straps: 2xlarge, 2xmedium, 4xsmall. Spacer Flex coils. (4x) wrist strap. Fig. 207: (2x) arm support. Arm support in use. More positioning aids are delivered with the specific coils. Refer to the Coils chapter for more information. Arm Board The use of contrast agent is normally based on first non-contrast images. When applying contrast agent, the arm board can be used as an aid for convenient injection needle insertion. The arm boad can be used: with almost every coil. on every system. in combination with the trolley. Workflow Move the patient partially out of the magnet. Keep the tabletop partly within the bore to maintain the same off-center positioning. Place the arm board with its top corner under the shoulder of the patient. Push the arm board further under the body of the patient. The patient s body weight will fix the arm board and provide stability for insertion of the infusion needle. Insert the infusion needle and connect the infusion lines. Remove the arm board and return the patient to the scan plane. Ensure that no part of the patient's body, hair, clothing, cables or infusion lines can get caught by any part of the equipment while returning the patient into the magnet bore. 222 Achieva

223 Pediatric Positioning Aids Positioning Aids Continue the examination with administration of contrast agent. Fig. 208: Arm board and arm board n use. Pediatric Positioning Aids Pediatric Package The Pediatric package facilitates pediatric examinations. It consists of a cradle, with separate supports; The cradle allows preparation of the child away from the magnet. It is compatible with the SENSE Pediatric Body/Cardiac coil. a soft, thick mattress (elevation mattress); The mattress can be used for easier, more comfortable positioning of the child in the magnet as well as better movement into the isocenter (in AP direction). a PPU with different sensors for premature babies, new borns and pediatric patients (and for adults). a pediatric knee support. Fig. 209: Pediatric Package. From left to right: Baby on the cradle. Pediatric knee support. PPU with different sensors on the cradle. Achieva 223

224 Positioning Aids Pediatric Positioning Aids Fig. 210: Left: Elevation mattress. Right: Pediatric patient on elevation mattress for better isocenter-positioning in AP-direction. Acoustic Hood Fig. 211: Left: Acoustic hood Right: Acoustic hood with SENSE Pediatric Head Spine coil in isocenter The acoustic hood is designed to be used with the SENSE Pediatric Head Spine coil and the SENSE Pediatric Body/Cardiac coil and their mattresses. It will provide good acoustic noise damping for vulnerable neonatal patients requiring MR examinations. Many premature patients are scanned while their acoustic sensory systems are still in development and should be protected. Very small children will not always tolerate a headset. Other positioning aids or auxiliaries, such as Mini-Muffs provide some noise damping (~7dB). The Acoustic Hood will provide noise damping of 12-14dB. The acoustic hood is not designed for use with the SENSE Head Coil. Do not block the flow of air through the bore, around the coil and the patient when the acoustic hood is used. Free convection is necessary in order for the coil to work at the specified ambient temperature. Patient monitoring is advised. 224 Achieva

225 MobiFlex Feet Immobilizer Positioning Aids Use Earplugs - the acoustic hood provides additional protection. Place the hood over the patient and coil before moving the patient into the bore. In this way one will have control over peripheral equipment, cables, tubes and lines. If an adjustment is made to the position of the acoustic hood, always pull it straight watching carefully that cables, tubes and lines are not affected by the movement. Do not sterilize or disinfect the hood. The hood is water resistant but cannot be sterilized or disinfected. If it becomes very dirty we advise that a new one be purchased. MobiFlex Feet Immobilizer A special feet immobilizer is delivered. It has two functions: to ensure patient immobilization (to obtain good subtraction images) to reduce venous enhancement by positioning the lower legs higher than the upper legs and increasing flow to the capillary bed. Fig. 212: MobiFlex feet immobilizer. Achieva 225