8 Breast Biopsy. 8.1 SENSE Breast 7 coil. Breast biopsy can be performed using the SENSE Breast 7 coil.

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Avice Leonard
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1 8 Breast Biopsy Breast biopsy can be performed using the SENSE Breast 7 coil. This chapter of the Addendum describes the following issues: SENSE Breast 7 coil Breast Biopsy Components Breast Biopsy Methods Breast Biopsy Device Preparation Breast Biopsy Workflow 8.1 SENSE Breast 7 coil Type of coil 7 element phased-array coil Receive-only 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: 4 CLEAR-compatible Yes Applications MR breast imaging (both breasts simultaneously) General remarks Switch off CLEAR as homogeneity correction for all T1- weighted and all fat-suppressed scans. This coil can be used for biopsy with the biopsy starter kit. Multi coil imaging No Dual coil imaging No User Interface Name SENSE-Breast-7 PHILIPS MR 8-1

Figure 8.1 Left: SENSE Breast 7 coil. Right: Positioning on SENSE Breast 7 coil. 8.2 Breast Biopsy Components This coil can be used for biopsy in combination with the starter and/or practice kit.

Lateral immobilization system Immobilization plate Medial immobilization system Bottle phantom Bottle phantom holder Breast blocker

2 Figure 8.1 Left: SENSE Breast 7 coil. Right: Positioning on SENSE Breast 7 coil. 8.2 Breast Biopsy Components This coil can be used for biopsy in combination with the starter and/or practice kit. The following figures show the coil with the accessories, the starter and the practice kit. Lateral immobilization system Immobilization plate Medial immobilization system Bottle phantom Bottle phantom holder Breast blocker tray Fluid tray Head support device Figure 8.2 Breast coil with accessories (delivered with coil). 8-2 PHILIPS MR

Item Description Quantity 1 Grid immobilization plate 10 2 Pillar immobilization plate 10 3 Needle block 12 g Needle block 18 g 5 8 4 Needle block holder 10 5 Needle sleeve 12 g Needle sleeve 18 g 5

10 ClipLoc (18 g, 100 mm / 130 mm / 150 mm) 1 each Figure 8.3 Starter kit.

3 Item Description Quantity 1 Grid immobilization plate 10 2 Pillar immobilization plate 10 3 Needle block 12 g Needle block 18 g Needle block holder 10 5 Needle sleeve 12 g Needle sleeve 18 g Needle hub 10 7 Fully-Automatic biopsy kit (12 g /14 g 115 mm) 3 8 Semi-Automatic biopsy kit (12 g /14 g 130 mm) 2 9 Wire localization needle 18 GA 100 mm Wire localization needle 18 GA 80 mm ClipLoc (18 g, 100 mm / 130 mm / 150 mm) 1 each Figure 8.3 Starter kit. Item Description Quantity 1 Grid immobilization plate 1 2 Pillar immobilization plate 1 3 Needle block (12 g and 18 g) 1 each 4 Needle block holder 1 5 Needle sleeve (12 g and 18 g) 1 each 6 Needle hub 1 7 Semi-Automatic biopsy kit (12 g /14 g 130 mm) 1 8 Wire localization needle 18 GA (100 mm) 1 9 ClipLoc (18 g, 130 mm) 1 10 Coaxial needle (12 g, 126 mm) 1 11 Breast biopsy phantom 1 Figure 8.4 Practice kit. PHILIPS MR 8-3

5): Grid method (lateral or medial access) Pillar method (lateral access or medial access) Both methods can be performed either with lateral or medial access Figure 8.

4 8.3 Breast Biopsy Methods The SENSE Breast coil 7 provides means for unilateral or bilateral breast immobilization. Immobilization is required when localization or biopsy procedures are intended. There are two different biopsy methods (see Figure 8.5): Grid method (lateral or medial access) Pillar method (lateral access or medial access) Both methods can be performed either with lateral or medial access Figure 8.5 Left: Grid method. Right: Pillar method. 8.4 Breast Biopsy Device Preparation This chapter describes the preparation of the biopsy device and contains the following items: 1 Setting up the grid immobilization system 2 Setting up the pillar immobilization system 8-4 PHILIPS MR

8.4.1 Setting up the grid immobilization system 1 Position the SENSE Breast 7 coil on the tabletop. Affected side 2 Place the fluid tray in the affected side lower aperture.

Unaffected side (for medial access only) 3 Place the breast blocker in the unaffected side upper aperture, with the single tab to the outside. Figure 8.6 Left: Placing fluid tray.

5 8.4.1 Setting up the grid immobilization system 1 Position the SENSE Breast 7 coil on the tabletop. Affected side 2 Place the fluid tray in the affected side lower aperture. NOTE For bilateral procedures, place a fluid tray on each side. Unaffected side (for medial access only) 3 Place the breast blocker in the unaffected side upper aperture, with the single tab to the outside. Figure 8.6 Left: Placing fluid tray. Right: Placing breast blocker. 4 Slide the grid immobilization plate into the immobilization system of the affected side, either on medial or lateral aspect of the breast. 5 Slide a solid immobilization plate into the other side. The convex side of the solid plate must face towards the phantom. See Figure 8.7. NOTES The arrows on both sides of the immobilization plates indicate the sliding direction. Ensure both lock latches on the immobilization system are in the unlocked (raised) position when sliding the immobilization plates into it. 6 Depress both lock latches to lock the immobilization plate. Figure 8.7 Left and middle: Arrow on side of immobilization plate Right: Depressing the lock latches to lock the immobilization plate. PHILIPS MR 8-5

6 7 Slide the immobilization system into the rails of the coil aperture on the affected side breast. See Figure 8.8. Use the outer set of rails for the medial immobilization system and the inner set of rails for the lateral immobilization system. Depress the release button to adjust the immobilization system. Figure 8.8 Sliding the immobilization system into the rails of the coil aperture Setting up the pillar immobilization system 1 Position the SENSE Breast 7 coil on the tabletop. Affected side 2 Place the fluid tray in the affected side lower aperture. NOTE For bilateral procedures, place a fluid tray on each side. Unaffected side (for medial access only) 3 Place the breast blocker in the unaffected side upper aperture, with the single tab to the outside. Figure 8.9 Left: Placing fluid tray. Right: Placing breast blocker. 8-6 PHILIPS MR

4 Connect the sterile needle hub to the pillar. See Figure 8.10.

The hub can be used on either side of the pillar.

Figure 8.10 Left: Lining up the tab on the needle hub with the slot on the pillar.

Snap pillar onto immobilization plate. See Figure 8.11.

7 4 Connect the sterile needle hub to the pillar. See Figure Line up the tab on the needle hub with the slot on the pillar. Insert until fully engaged. To lock the hub in place, rotate the lock lever up or down. The hub can be used on either side of the pillar. Rotate the tab 180 degrees for insertion in the opposite side of the pillar. Figure 8.10 Left: Lining up the tab on the needle hub with the slot on the pillar. Middle: Insert until fully engaged. Right: Locking the hub in place by rotating the lock lever up or down 5 Snap pillar onto immobilization plate. See Figure Ensure base of pillar (lock lever end) is snapped onto bottom of immobilization plate. Figure 8.11 Left: Snapping base of pillar onto immobilization plate. Right: Snapping top of pillar onto immobilization plate. PHILIPS MR 8-7

6 Slide the pillar assembly into the immobilization system of the affected side, either on medial or lateral aspect of the breast, see Figure 8.12.

Ensure both lock latches on the immobilization system are in the unlocked (raised) position when sliding the pillar assembly into it. 8 Depress both lock latches to lock the pillar assembly. Figure 8.

8 6 Slide the pillar assembly into the immobilization system of the affected side, either on medial or lateral aspect of the breast, see Figure Slide a solid immobilization plate into the other side. The convex side of the solid plate must face towards the phantom. See Figure 8.7. NOTES The arrows on both sides of the pillar assembly indicate the sliding direction. Ensure both lock latches on the immobilization system are in the unlocked (raised) position when sliding the pillar assembly into it. 8 Depress both lock latches to lock the pillar assembly. Figure 8.12 Left: Sliding the pillar assembly into the immobilization system. Right: Depressing the lock latches to lock the pillar assembly. 9 Slide the immobilization system into the rails of the coil aperture on the affected side breast. Use the outer set of rails for the medial immobilization system and the inner set of rails for the lateral immobilization system. Depress the release button to adjust the immobilization system. 10 Position the pillar assembly at the zero marks by releasing the lock latch. Depress the lock latch to secure the pillar and needle guide. See Figure Insert the fiducial marker into the needle guide. Secure by turning it clockwise. 8-8 PHILIPS MR

Figure 8.13 Left: Positioning the pillar assembly at the zero marks. Right: Fiducial marker inserted into the needle guide. 8.5 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.

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.

9 Figure 8.13 Left: Positioning the pillar assembly at the zero marks. Right: Fiducial marker inserted into the needle guide. 8.5 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. It is recommended that you practice on a phantom. 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 2 Place the coil on the tabletop with the coil aperture to the magnet. 3 Place the head support on the table in front of the coil. Patient Positioning 4 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. See Figure PHILIPS MR 8-9

10 5 Place the medial plate in all the way prior to patient positioning. Wait until the patient is lying down to place lateral rail. 6 Ask the patient to place the arms either next to the head or downwards next to the body. 7 Ensure that the breasts are "hanging freely" in the coil, and that the breasts and the axillae area are free of folds. 8 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 and contrast flow cannot be seen. 9 Place a vitamin E capsule (serves as marker) onto the immobilization system, away from suspected lesion location. 10 Center the light visor to the middle of the breast, and move the patient into the isocenter. Figure 8.14 Left: Positioning on SENSE Breast 7 coil. Right: Head support for SENSE Breast 7 coil. The arrow indicates the lever for height adjustment. Imaging protocol - Determine needle entry point 11 Acquire a survey scan. 12 Make sure the marker (vitamin E capsule) is included in the FOV. 13 Perform a refscan and a dynamic THRIVE protocol, containing 3 dynamics. The first dynamic serves as a mask. Proceed as usual with regular dynamic breast imaging PHILIPS MR

11 Calculate FH- and AP-offset and needle depth DynaCAD automatic calculation The needle entry point (relative to the position of the marker) and needle depth needed to target the lesion are calculated automatically when a DynaCAD system is available. Manual targeting If a DynaCAD system is not available, then manual targeting has to be performed in the following way: Find the lesion on the dynamic 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. 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. The FH offset is given by the number of slices between the marker and the lesion multiplied by the slice thickness. 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. The vertical line length specifies the needle entry point relative to the marker in AP direction. The horizontal line length specifies the required needle depth. Performing breast biopsy 14 Place the needle block in the grid. 15 Place the needle block holder in an adjacent grid slot. 16 Lock the needle block holder by depressing the tab, see Figure This will prevent the needle block from coming out when the needle is withdrawn. PHILIPS MR 8-11

rescan at this location to verify the proper needle

12 Figure 8.15 Left: Placing the needle block in the grid. Right: Locking the needle block holder. 17 Insert the needle to the required depth and rescan at this location to verify the proper needle placement. See Figure Once verified, obtain lesion sample. Figure 8.16 Inserting the needle PHILIPS MR

6 Coil Choice and Positioning

6 Coil Choice and Positioning 6.1 Head / CNS 6.1.1 Coil Choice 4522 132 30761 REGION COIL 1.5 T COIL 3.0 T Brain / Fast Brain Q-Head 3.0 T Head SENSE Head-8 SENSE Head-8 SENSE Flex-L, SENSE Flex-M SENSE