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Metal Artifact MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X Reduction: Numaris X SIEMEON Healthineers .. MAGNETOM Sola i alotMatrix System Module Workbook Education & Workforce Solutions SIEMENS Your potential is calling. Healthineers MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X I. Welcome A Message from Nanci Wozniak Welcome to your training experience with Education & Workforce Solutions. I want to personally thank you for choosing Siemens Healthineers. We are honored to have you as our partner and hope you will enjoy this course. Our teams strive to ensure your priorities and needs are met. We sincerely appreciate your hard work around what really matters - the human side of health care. You are our heroes. Thank you for being part of the Siemens Healthineers family and we look forward to our partnership with you. Nani ligh Nanci Wozniak Vice President, Education & Workforce Solutions CX SV USA – Customer Service Organization Siemens Healthineers Clinical Training and Continuing Education Contact Information Customer Care Center - Clinical Application Support: Call 1-800-888-7436 PEPconnect https://pep.siemens-info.com/en-us 2 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X II. Save Workbook with Notes In order to save this document with your digital notes included, you must use the print to pdf functionality. Clicking the button below will initiate that function. Print to PDF 3 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X III. Contents I. Welcome ....................................................................................................................................................................2 II. Save Workbook with Notes .................................................................................................................................3 III. Contents ..................................................................................................................................................................4 IV. Course Description ...............................................................................................................................................5 1. Course Overview................................................................................................................................................... 6 2. Magnetic Susceptibilty Artifacts ....................................................................................................................12 3. Reducing Susceptibility Artifacts ...................................................................................................................18 4. syngo WARP & VAT............................................................................................................................................ 26 5. Advanced WARP - SEMAC............................................................................................................................... 42 6. Metal Consideration .........................................................................................................................................60 7. Protocol Recommendations .............................................................................................................................76 4 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X IV. Course Description Course Overview: This educational module reviews the causes of magnetic susceptibility artifacts from metal, past and current techniques/sequences available (WARP/VAT/SEMAC), and protocol recommendations to reduce susceptibility artifact on MAGNETOM MR Systems with Numaris X software. Upon completion of this course, you will be able to: Understand the causes of magnetic susceptibility artifacts in the presence of metal • Identify the past and current techniques for metal artifact reduction • Define WARP & View Angle Tilting • Identify the pros and cons of using WARP & VAT • Understand the system parameters related to WARP/VAT • Define SEMAC • Understand the system parameters related to SEMAC • Identify types of metal and the resulting challenges with scanning in an MR environment • Discuss protocol recommendations for reducing magnetic sucseptibility artifacts • 5 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X 1. Course Overview SIEMENS Healthineers Metal Artifact Reduction Techniques Numaris X Unrestricted © Siemens Healthineers, 2020 Notes 6 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X SIEMENS Healthineers .. Introductions SIEMENS . Healthineers • Instructor Introduction • Name • Job Role • Location • Experience MAGNETOM Vida A B- Matrix System • Participant Introductions • Name • Facility Name and Location • Experience • Job Role Click to add footnote 2 second line Unrestricted © Siemens Healthineers, 2020 Notes 7 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X Overview SIEMENS Healthineers .. Teams Tools & Features • Explain Desktop View (e.g., panels) • Content Area • List of Participants • Chat Explain/Demo Features • • Raise your hand • Show conversation • Show participants 3 Unrestricted © Siemens Healthineers, 2020 Notes 8 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X Overview SIEMENS Healthineers .. Teams Tools & Features • Virtual Training Suggestions • Phone should have sufficient battery power • Stay on mute unless you need to speak • Raise “hand” to get instructors attention • Use “Show Conversation” to ask questions and see responses • Limit office interruptions 4 Unrestricted © Siemens Healthineers, 2020 Notes 9 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X SIEMENS Agenda Healthineers .. • Magnetic Susceptibility Artifacts – Metal • Protocol Recommendations • What Causes Image Degradation from Metal? • Localizer • Geometrical Image Distortion • WARP & VAT • Inhomogeneous Tissue Suppression • SEMAC • Reducing Susceptibility Artifacts – The Past & Now • Metal Types • The Past • Contrast Studies • Now • syngo WARP & View Angle Tilting (VAT) • What is WARP? • What is VAT? • VAT Blurring • VAT Scaling • STIR • SEMAC • What is SEMAC? • Case Examples • Compressed Sensing • Metal Considerations • Common Types of Metal • Titanium • Stainless Steel • Cobalt Chromium Molybdenum Alloy 5 Unrestricted © Siemens Healthineers, 2020 Notes 10 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X Implant Disclaimer SIEMENS Healthineers .. Implant Disclaimer ‐ The MRI restrictions (if any) of any implant must be considered prior to patient undergoing MRI exam. MR imaging of patients with implants brings specific risks. However, certain implants are approved by the governing regulatory bodies to be MR conditionally safe. For such implants, the previously mentioned warning may not be applicable. Please contact the implant manufacturer for the specific conditional information. The conditions for MR safety are the responsibility of the implant manufacturer and user, not of Siemens Healthineers. 6 Unrestricted © Siemens Healthineers, 2020 Notes 11 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X 2. Magnetic Susceptibilty Artifacts Magnetic Susceptibility Artifacts ‐ Metal 7 Unrestricted © Siemens Healthineers, 2020 Notes 12 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X What Causes Image Degradation from Metal? SIEMENS Healthineers .. • Regardless of the metal material, they all have the potential to cause artifacts on images • Metal contains no hydrogen, so will therefore present a signal loss in the area • Any metal is a potential conductor of electricity, and it can lead to distortion in the local magnetic field and result in geometric distortions • When the field changes rapidly, the frequency of the spins will be outside the range of the imaging system and result in signal loss • Frequency variations caused by dephasing near the metal can result in displacement of signal in the readout and slice selection directions resulting in signal voids or accumulation in one region (pile‐up artifact) • Frequency variations will also prevent successful tissue suppression techniques that are based on the frequency of the tissue (e.g. spectral fat saturation) Implant Disclaimer ‐ The MRI restrictions (if any) of any implant must be considered prior to patient undergoing MRI exam. MR imaging of patients with implants brings specific risks. However, certain implants are approved by the governing regulatory bodies to be MR conditionally safe. For such implants, the previously mentioned warning may not be applicable. Please contact the implant manufacturer for the specific conditional 8 information. The conditions for MR safety are the responsibility of the implant manufacturer and user, not of Siemens Healthineers. Unrestricted © Siemens Healthineers, 2020 Notes 13 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X Geometrical Image Distortion SIEMENS Healthineers .. Distorted Readout Gradient  • Pixel Dislocation in Readout Direction void metal pileup void pileup Phase axis Phantom Clinical Example Readout axis Implant Disclaimer ‐ The MRI restrictions (if any) of any implant must be considered prior to patient undergoing MRI exam. MR imaging of patients with implants brings specific risks. However, certain implants are approved by the governing regulatory bodies to be MR conditionally safe. For such implants, the previously mentioned warning may not be applicable. Please contact the implant manufacturer for the specific conditional 9 information. The conditions for MR safety are the responsibility of the implant manufacturer and user, not of Siemens Healthineers. Unrestricted © Siemens Healthineers, 2020 Notes 14 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X Geometrical Image Distortion SIEMENS Healthineers ... Distorted Readout Gradient  Pixel • • Distorted Slice Selection Gradient Dislocation in Readout Direction Distorted Slice Profile metal void pileup metal Phase axis Phantom Readout axis Excited Slice Profile Implant Disclaimer ‐ The MRI restrictions (if any) of any implant must be considered prior to patient undergoing MRI exam. MR imaging of patients with implants brings specific risks. However, certain implants are approved by the governing regulatory bodies to be MR conditionally safe. For such implants, the previously mentioned warning may not be applicable. Please contact the implant manufacturer for the specific conditional 10 information. The conditions for MR safety are the responsibility of the implant manufacturer and user, not of Siemens Healthineers. Unrestricted © Siemens Healthineers, 2020 Notes 15 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X Geometrical Image Distortion SIEMENS Healthineers .. • Origin of Artifacts • Distortion reduction and Correction Methods 3. [KHz] 20 15 10 5 -5 -10 15 Implant Disclaimer ‐ The MRI restrictions (if any) of any implant must be considered prior to patient undergoing MRI exam. MR imaging of patients with implants brings specific risks. However, certain implants are approved by the governing regulatory bodies to be MR conditionally safe. For such implants, the previously mentioned warning may not be applicable. Please contact the implant manufacturer for the specific conditional 11 information. The conditions for MR safety are the responsibility of the implant manufacturer and user, not of Siemens Healthineers. Unrestricted © Siemens Healthineers, 2020 Notes 16 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X Knowledge Check SIEMENS Healthineers .. 1. Signal accumulation in the readout or slice direction into one region that causes a white artifact is called what? a. Void Artifact b. Accumulate Artifact c. Pileup Artifact d. Spectral Artifact Author | Department 12 Unrestricted © Siemens Healthineers, 2020 Notes 17 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X 3. Reducing Susceptibility Artifacts Reducing Susceptibility Artifacts – The Past & Now 13 Unrestricted © Siemens Healthineers, 2020 Notes 18 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X Reducing Susceptibility Artifacts – The Past & Now SIEMENS Healthineers .. The Past • In MRI, there are several optimizations that have been used for years to improve on image quality • Success was determined by technical know how and the type of metal • Here are some of the application tips usually recommended for optimization: ↑ Readout (RO) Bandwidth (Increase above 500 Hz/pixel) • • ↓ Slice Thickness ↑ Matrix • • ↓ TE ↓ Echo Spacing (e.g. Fast RF, Fast Gradients, ↑ RO Bandwidth, iPAT) • • ↓ Field Strength (1.5T vs 3T) Implant Disclaimer ‐ The MRI restrictions (if any) of any implant must be considered prior to patient undergoing MRI exam. MR imaging of patients with implants brings specific risks. However, certain implants are approved by the governing regulatory bodies to be MR conditionally safe. For such implants, the previously mentioned warning may not be applicable. Please contact the implant manufacturer for the specific conditional 14 information. The conditions for MR safety are the responsibility of the implant manufacturer and user, not of Siemens Healthineers. Unrestricted © Siemens Healthineers, 2020 Notes 19 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X Reducing Susceptibility Artifacts – The Past & Now SIEMENS Healthineers .. The Past Distorted Readout Gradient  Distorted Slice Selection Gradient  • • Pixel Dislocation in Readout Direction Distorted Slice Profile Example 5 kHz Field Distortion Example Slices = 5 mm 5 kHz Field Distortion Bandwidth = 500 Hz/Pixel FOV = 250 mm Geometric Distortion = 50 mm metal Matrix 256 void pileup Bandwidth = 150 Hz/Pixel metal Geometric Distortion = 33 mm Phase axis Phantom Readout axis Excited Slice Profile Implant Disclaimer ‐ The MRI restrictions (if any) of any implant must be considered prior to patient undergoing MRI exam. MR imaging of patients with implants brings specific risks. However, certain implants are approved by the governing regulatory bodies to be MR conditionally safe. For such implants, the previously mentioned warning may not be applicable. Please contact the implant manufacturer for the specific conditional 15 information. The conditions for MR safety are the responsibility of the implant manufacturer and user, not of Siemens Healthineers. Unrestricted © Siemens Healthineers, 2020 Notes 20 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X Reducing Susceptibility Artifacts – The Past & Now SIEMENS Healthineers .. The Past Distorted Readout Gradient  Distorted Slice Selection  • • Pixel Dislocation in Readout Direction Gradient Distorted Slice Profile Example Example 5 kHz Field Distortion 5 kHz Field Distortion FOV = 250 mm Slices = 5 mm Matrix 256 Bandwidth = 500 Hz/Pixel Bandwidth = 150 Hz/Pixel Geometric Distortion = 50 mm metal Geometric Distortion = 33 mm metal Optimized Sequence Optimized Sequence Phase axis FOV = 250 mm Slice Thickness = 3 mm Phantom Matrix = 512 Bandwidth = 1500 Hz/Pixel Bandwidth = 800 Hz/Pixel Geometric Distortion = 10 mm Geometric Distortion = 3 mm Readout axis Excited Slice Profile Implant Disclaimer ‐ The MRI restrictions (if any) of any implant must be considered prior to patient undergoing MRI exam. MR imaging of patients with implants brings specific risks. However, certain implants are approved by the governing regulatory bodies to be MR conditionally safe. For such implants, the previously mentioned warning may not be applicable. Please contact the implant manufacturer for the specific conditional 16 information. The conditions for MR safety are the responsibility of the implant manufacturer and user, not of Siemens Healthineers. Unrestricted © Siemens Healthineers, 2020 Notes 21 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X Reducing Susceptibility Artifacts – The Past & Now SIEMENS Healthineers .. Now The past techniques are still utilized today, but now Siemens offers other techniques to assist the user in the reduction of artifacts associated with metal. Siemens offers 3 different techniques: • syngo WARP • View Angle Tilting (VAT) • Slice Encoding for Metal Artifact Correction (SEMAC) – Now available with Compressed Sensing (license required) Implant Disclaimer ‐ The MRI restrictions (if any) of any implant must be considered prior to patient undergoing MRI exam. MR imaging of patients with implants brings specific risks. However, certain implants are approved by the governing regulatory bodies to be MR conditionally safe. For such implants, the previously mentioned warning may not be applicable. Please contact the implant manufacturer for the specific conditional 17 information. The conditions for MR safety are the responsibility of the implant manufacturer and user, not of Siemens Healthineers. Unrestricted © Siemens Healthineers, 2020 Notes 22 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X Reducing Susceptibility Artifacts – The Past & Now SIEMENS Healthineers .. Now Artifact Method Signal Voids Spin‐Echo based sequences (SE, TSE, etc.) High Resolution High Readout Bandwidth High RF Bandwidth (WARP) Fat Sat STIR (with high RF Bandwidth ‐ WARP) In‐plane Geometric Distortions High Readout Bandwidth (Readout Direction) High Resolution View Ange Tilting (VAT) Through‐plane Distortions High RF Bandwidth (WARP) (Slice Direction) Thin Slices SEMAC (Advanced WARP) Implant Disclaimer ‐ The MRI restrictions (if any) of any implant must be considered prior to patient undergoing MRI exam. MR imaging of patients with implants brings specific risks. However, certain implants are approved by the governing regulatory bodies to be MR conditionally safe. For such implants, the previously mentioned warning may not be applicable. Please contact the implant manufacturer for the specific conditional 18 information. The conditions for MR safety are the responsibility of the implant manufacturer and user, not of Siemens Healthineers. Unrestricted © Siemens Healthineers, 2020 Notes 23 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X Reducing Susceptibility Artifacts – The Past & Now SIEMENS Healthineers .. Now Standard VAT SEMAC orerte Arra Fins 0015: 001 99741 80 STUDY 1 360 472 300012 RA MF 1.00 ENE 1.30 ៛ 1.00 14 0358 TE HO TE 43 SL80 AZSATI LEFT 1120 1821 12/150 LEFT Prof. White, Mt. Sinai Hospital, Toronto Metal Disclaimer ‐ The MRI restrictions (if any) of the metal implant must be considered prior to patient undergoing MRI exam. MR imaging of patients with metallic implants brings specific risks. However, certain implants are approved by the governing regulatory bodies to be MR conditionally safe. For such implants, the previously mentioned warning may not be applicable. Please contact the implant manufacturer for the specific conditional information. The conditions for MR safety are the responsibility of the implant manufacturer, not of Siemens. 19 Unrestricted © Siemens Healthineers, 2020 Notes 24 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X Knowledge Check SIEMENS Healthineers .. 2. If all other parameters are the same, which of the following sequences would produce the least amount of artifact from metal? a. Matrix 256x256, Bandwidth 250Hz b. Matrix 256x256, Bandwidth 500Hz c. Matrix 512x512, Bandwidth 250Hz d. Matrix 512x512, Bandwidth 500Hz Author | Department 20 Unrestricted © Siemens Healthineers, 2020 Notes 25 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X 4. syngo WARP & VAT syngo WARP & View Angle Tilting (VAT) 21 Unrestricted © Siemens Healthineers, 2020 Notes 26 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X syngo WARP – What is WARP? SIEMENS Healthineers .. syngo WARP – incorporates different susceptibility artifact reduction Routine Contrast Resolution Geometry System Physio Inline Sequence techniques Part 1 Part 2 Assistant 2D TSE sequence Introduction v WARP V • High Bandwidth VAT 50 + % • RF Pulses – Optimized SEMAC O • Reduced susceptibility artifacts originating from Phase Correction Automatic Red. EC Sensitivity MR conditional implants Compensate T2 Decay Not an acronym; it is a synonym for Acoustic noise reduction Off “bending’, distorted Hyperecho Reduce Motion Sens. WARP mode • High bandwidth mode VAT 50 0 100 % • Optimized high bandwidth RF pulses Implant Disclaimer ‐ The MRI restrictions (if any) of any implant must be considered prior to patient undergoing MRI exam. MR imaging of patients with implants brings specific risks. However, certain implants are approved by the governing regulatory bodies to be MR conditionally safe. For such implants, the previously mentioned warning may not be applicable. Please contact the implant manufacturer for the specific conditional 22 information. The conditions for MR safety are the responsibility of the implant manufacturer and user, not of Siemens Healthineers. Unrestricted © Siemens Healthineers, 2020 Notes 27 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X syngo WARP – What is WARP? SIEMENS Healthineers .. WARP + VAT* 15 Similar to MARS** Sequence Standard on all Numaris X systems WARP - Off WARP Implant Disclaimer ‐ The MRI restrictions (if any) of any implant must be considered prior to patient undergoing MRI exam. MR imaging of patients with implants brings specific risks. However, certain implants are approved by the governing regulatory bodies to be MR conditionally safe. For such implants, the previously mentioned warning may not be applicable. Please contact the implant manufacturer for the specific conditional information. The conditions for MR safety are the responsibility of the implant manufacturer and user, not of Siemens Healthineers. **Competitor Information Disclaimer: Competition product descriptions, comparison and specifications contained in this document are based on interpretation of available data at the time this material was being prepared and may require independent verification. Specifications have been obtained 23 from competition brochures, websites and other independent published sources. Unrestricted © Siemens Healthineers, 2020 Notes 28 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X syngo WARP – What is WARP? SIEMENS Healthineers .. Based on TSE sequence • Most robust in terms of signal dephasing Reduced Geometrical Image Distortions • Reduction and correction of displaced signal RF Af X slic phase encoding Robust STIR Contrast VAT gradient • Enables fat suppressed imaging GSS GPE GRO SS Implant Disclaimer ‐ The MRI restrictions (if any) of any implant must be considered prior to patient undergoing MRI exam. MR imaging of patients with implants brings specific risks. However, certain implants are approved by the governing regulatory bodies to be MR conditionally safe. For such implants, the previously mentioned warning may not be applicable. Please contact the implant manufacturer for the specific conditional 24 information. The conditions for MR safety are the responsibility of the implant manufacturer and user, not of Siemens Healthineers. Unrestricted © Siemens Healthineers, 2020 Notes 29 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X View Angle Tilting (VAT) – What is VAT? SIEMENS Healthineers .. View Angle Tilting (VAT) • VAT is an acronym for View Angle Routine Contrast Resolution Geometry System Physio Inline Sequence Tilting Part 1 Part 2 Assistant • VAT is standard and is utilized in Introduction v WARP V conjunction with WARP VAT 50 % • VAT applies an additional gradient in SEMAC slice‐encoding direction during signal readout Phase Correction Automatic Red. EC Sensitivity • Helps to reduce in‐plane distortions Compensate T2 Decay in the readout direction Acoustic noise reduction Off Hyperecho Reduce Motion Sens. VAT 50 0 100 % Implant Disclaimer ‐ The MRI restrictions (if any) of any implant must be considered prior to patient undergoing MRI exam. MR imaging of patients with implants brings specific risks. However, certain implants are approved by the governing regulatory bodies to be MR conditionally safe. For such implants, the previously mentioned warning may not be applicable. Please contact the implant manufacturer for the specific conditional 25 information. The conditions for MR safety are the responsibility of the implant manufacturer and user, not of Siemens Healthineers. Unrestricted © Siemens Healthineers, 2020 Notes 30 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X View Angle Tilting (VAT) – What is VAT? SIEMENS Healthineers .. VAT z z slice encoding! VAT gradient x encoding frequency Dfoff f DfVAT f Implant Disclaimer ‐ The MRI restrictions (if any) of any implant must be considered prior to patient undergoing MRI exam. MR imaging of patients with implants brings specific risks. However, certain implants are approved by the governing regulatory bodies to be MR conditionally safe. For such implants, the previously mentioned warning may not be applicable. Please contact the implant manufacturer for the specific conditional 26 information. The conditions for MR safety are the responsibility of the implant manufacturer and user, not of Siemens Healthineers. Unrestricted © Siemens Healthineers, 2020 Notes 31 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X View Angle Tilting (VAT) – What is VAT? SIEMENS Healthineers ... 20111107 KJ15ETP HRP 20111107 HRP 20111107 knee TP HRP 1:54:55 PM 4 IM2ºP 10 IMA 17 12 AR AR AR 5cm Scm MF 1.00 MF 1.00 1F 1.00 TR 4000.0 TE 18.0 DE TR 4000.0 TE 15.0 DE TR 4000.0 TA 02:40 TP F7 TA 02:40 TP F7 TE 15.0 BV 385.0 SP R92.9 SL 3.5/0.35 BVV 531.0 SP R92.9 TA 02:40 M.NORM DIS2D FoV 180*180 M NORM DIS2D SL 3.5/0.35 BV 531.0 FoV 180*180 M/NORM DIS2D A1 297*448 Sag>Cor(7.7)>Tra(-0.0) 41 296*448 C:KN *tse2d1_11 /150 W 1088 C:KN Sag>Cor(7.7)>Tra(-0.0) 41 502 tse2d1_11 /150 ₩ 1088 C:KN 502 tseV2d1_11 /150 Standard High Bandwidth VAT Images courtesy of Prof. Pfirrmann, Balgrist Univ. Hospital, Switzerland Implant Disclaimer ‐ The MRI restrictions (if any) of any implant must be considered prior to patient undergoing MRI exam. MR imaging of patients with implants brings specific risks. However, certain implants are approved by the governing regulatory bodies to be MR conditionally safe. For such implants, the previously mentioned warning may not be applicable. Please contact the implant manufacturer for the specific conditional 27 information. The conditions for MR safety are the responsibility of the implant manufacturer and user, not of Siemens Healthineers. Unrestricted © Siemens Healthineers, 2020 Notes 32 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X View Angle Tilting (VAT) – Blurring SIEMENS Healthineers .. • VAT can commonly present blurring on the image in two forms: • Geometric Blurring – (Slice Shearing) • Signal Filter Blurring – (ADC low pass filter) Literature • Jung et al, Effect of Slice Angle on Inhomogeneity Artifact and Its Correction in Slice‐Selective MR Imaging, Concepts Magn. Res., Vol34A, 2009 • Butts et al, Reduction of blurring in View Angle Tilting MRI, ISMRM 2002 Implant Disclaimer ‐ The MRI restrictions (if any) of any implant must be considered prior to patient undergoing MRI exam. MR imaging of patients with implants brings specific risks. However, certain implants are approved by the governing regulatory bodies to be MR conditionally safe. For such implants, the previously mentioned warning may not be applicable. Please contact the implant manufacturer for the specific conditional 28 information. The conditions for MR safety are the responsibility of the implant manufacturer and user, not of Siemens Healthineers. Unrestricted © Siemens Healthineers, 2020 Notes 33 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X VAT – Blurring SIEMENS Healthineers .. Geometric Blurring RF slice‐sel. slice‐sel. VAT Gz readout Gx x signal z = (- ) 𝐺𝐺𝐺𝐺𝐺𝐺𝐺𝐺 𝛼𝛼 tilting arctan 𝐺𝐺𝐺𝐺𝐺𝐺𝐺𝐺𝐺𝐺𝐺𝐺𝐺𝐺𝐺𝐺 x Slice Shearing 29 Unrestricted © Siemens Healthineers, 2020 Notes 34 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X VAT – Blurring SIEMENS Healthineers .. Signal Filter Blurring RF RF slice‐sel. VAT Gz slice‐sel. VAT Gz readout readout Gx Gx signal signal Low pass filter! Shorter readout ‐ 12.01.26-17:46:29-STD-1 718 23-310-1.3.12 ... (red. res. or higher bw) *26/01/1992, 0,20Y STUDY 1 26/01/2012 17:59:18 Broader filter 10 IMA 1/1 ‐ (red. RF bandwidth) Smaller view angle ‐ RF RF 5cm IF 1 55 Ir 1.55 TR 700.0 TR 700.0 TE 47.0 TE 48.0 TA 14.85 TP O TP O EY 300.0 SP F16.6 TA 14.84 SP F16.6 SL 3.0 EVV 558.0 FoV 250*250 SL 3.0 FoV 250*250 320*320 320*320 C:HEA HEP 2.1 kHz, 300 Hz/px Tra>Sag(19.8) C:HEA HEP 1.8 kHz, 550 Hz/px Tra>Sag(19.8) tseV2d1_15 / 150 ₩ 3303 tseV2d1_15/150 ₩ 3314 1859 30 Unrestricted © Siemens Healthineers, 2020 Notes 35 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X VAT – Blurring SIEMENS Healthineers . Correction System Physio Inline Sequence • Increasing Bandwidth will help with VAT blurring Bandwidth 501 - Hz/Px • Reduces echo spacing which improves slice profile Echo Spacing 8.64 ms • Balance increase in bandwidth with other parameters to maintain SNR and optimize time Define Turbo Factor actor 3 + Slice 144 RA 5cm MF 1.00 MF 1.00 TI 195.0 TR 5000.0 TI 195.0 D TR 5000.0 TE 30.0 TE 31.0 TA 05:46 O TA 06:56 EV 260.0 60.9 BVV 781.0 MIND MIND A2/R/SAT1 C:K15 23/4R/SATI tirV2d1_7 / 180 @| tirV2d1 _7 / 180 Courtesy of UTMB – Dr. Val Runge Implant Disclaimer ‐ The MRI restrictions (if any) of any implant must be considered prior to patient undergoing MRI exam. MR imaging of patients with implants brings specific risks. However, certain implants are approved by the governing regulatory bodies to be MR conditionally safe. For such implants, the previously mentioned warning may not be applicable. Please contact the implant manufacturer for the specific conditional 31 information. The conditions for MR safety are the responsibility of the implant manufacturer and user, not of Siemens Healthineers. Unrestricted © Siemens Healthineers, 2020 Notes 36 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X VAT – Scaling SIEMENS Healthineers .. • No improvement by VAT • Severely blurred‐out joint space • Explanation: Metal artifacts dominated by through‐plane distortion High Bandwidth VAT Images courtesy of Prof. Pfirrmann, Balgrist Univ. Hospital, Switzerland Implant Disclaimer ‐ The MRI restrictions (if any) of any implant must be considered prior to patient undergoing MRI exam. MR imaging of patients with implants brings specific risks. However, certain implants are approved by the governing regulatory bodies to be MR conditionally safe. For such implants, the previously mentioned warning may not be applicable. Please contact the implant manufacturer for the specific conditional 32 information. The conditions for MR safety are the responsibility of the implant manufacturer and user, not of Siemens Healthineers. Unrestricted © Siemens Healthineers, 2020 Notes 37 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X VAT – Scaling SIEMENS Healthineers ... • Scales the amplitude of VAT gradient VAT 50% • Allows trade‐off between VAT blurring RF and distortion correction slice‐sel. VAT Gz readout Gx System hysio Inline Sequence signal WARP V VAT 50 % VAT 100% SEMAC RF VAT Red. EC Sensitivity slice‐sel. Gz readout Gx Acoustic noise reduction Off Reduce Motion Sens. signal 50 100 % 33 Unrestricted © Siemens Healthineers, 2020 Notes 38 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X STIR – WARP & VAT SIEMENS Healthineers .. IR RF slice select gradient amplitude Gslice Gphase ES Greadout metal metal metal metal Inverted slice profile Excited slice profile Inverted slice profile Excited slice profile Regular STIR WARP STIR ‐ matched high bandwidth IR Implant Disclaimer ‐ The MRI restrictions (if any) of any implant must be considered prior to patient undergoing MRI exam. MR imaging of patients with implants brings specific risks. However, certain implants are approved by the governing regulatory bodies to be MR conditionally safe. For such implants, the previously mentioned warning may not be applicable. Please contact the implant manufacturer for the specific conditional 34 information. The conditions for MR safety are the responsibility of the implant manufacturer and user, not of Siemens Healthineers. Unrestricted © Siemens Healthineers, 2020 Notes 39 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X STIR – WARP & VAT SIEMENS Healthineers ... • Using VAT and Modified TI pulse for STIR imaging for better evaluation of marrow Images Courtesy of UTMB – Dr. Val Runge Implant Disclaimer ‐ The MRI restrictions (if any) of any implant must be considered prior to patient undergoing MRI exam. MR imaging of patients with implants brings specific risks. However, certain implants are approved by the governing regulatory bodies to be MR conditionally safe. For such implants, the previously mentioned warning may not be applicable. Please contact the implant manufacturer for the specific conditional 35 information. The conditions for MR safety are the responsibility of the implant manufacturer and user, not of Siemens Healthineers. Unrestricted © Siemens Healthineers, 2020 Notes 40 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X Knowledge Check SIEMENS Healthineers .. 3. What is are the two ways to reduce VAT blurring? a. Increase Bandwidth, Decrease VAT Scaling % b. Decrease Bandwidth, Decrease VAT Scaling % c. Increase Bandwidth, Increase VAT Scaling % d. Decrease Bandwidth, Increase VAT Scaling % Author | Department 36 Unrestricted © Siemens Healthineers, 2020 Notes 41 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X 5. Advanced WARP - SEMAC Advanced WARP ‐ SEMAC Slice Encoding for Metal Artifact Correction 37 Unrestricted © Siemens Healthineers, 2020 Notes 42 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X SEMAC – What is SEMAC? SIEMENS Healthineers ... Advanced WARP (SEMAC) Routine Contrast Resolution Geometry System Physio Inline Sequence • SEMAC is an acronym for Slice Encoding Part 1 Part 2 Assistant for Metal Artifact Correction Introduction v WARP • Performs additional encoding step VAT 100 % through slice‐plane to reduce through‐ plane distortions SEMAC 15 • syngo WARP and Advanced WARP (SEMAC) now come standard on Numaris Phase Correction Automatic Red. EC Sensitivity X systems (previously licensed option) Compensate T2 Decay • Compressed Sensing (CS) SEMAC is new Acoustic noise reduction Off to Numaris XA20 software and available Hyperecho Reduce Motion Sens. for purchase as an individual license or part of the Turbo Suite Excelerate option Implant Disclaimer ‐ The MRI restrictions (if any) of any implant must be considered prior to patient undergoing MRI exam. MR imaging of patients with implants brings specific risks. However, certain implants are approved by the governing regulatory bodies to be MR conditionally safe. For such implants, the previously mentioned warning may not be applicable. Please contact the implant manufacturer for the specific conditional 38 information. The conditions for MR safety are the responsibility of the implant manufacturer and user, not of Siemens Healthineers. Unrestricted © Siemens Healthineers, 2020 Notes 43 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X SEMAC – What is SEMAC? SIEMENS Healthineers .. knee [13] t2_tse_warp_stir_tra • Preconfigured Protocols > Knee Dot Engine [4] 04:18 hip [13] pd_tse_warp_sag_unilat library [9] 04:18 • High Bandwidth protocols > Hip Dot Engine [4] localizer t2_tse_stir_warp_cor library [9] t2_tse_warp_sag_unilat t2_tse_stir_warp_sag 04:00 • VAT with SEMAC localizer t2_tse_stir_warp_cor_unila T2 T1 t2_tse_stir_warp_tra_unilat PD SEMAC • Advanced User T2 3D PD t2_tse_stir_warp_sag_unila BLADE t1_tse_semac_sag 06:34 • Adjustable protocols and 3D Maplt BLADE _SEMAC_ pd_tse_semac_cor ₪07:05 free to use in other body WARP [9 Maplt t1_tse_semac_sag_unilat 10:06 regions WARP [9] QUIET t2_tse_stir_semac_sag pd_tse_semac_cor_unilat >clinical libraries QUIET t1_tse_semac_cor_cs8 clinical libraries >ankle 06:58 t2_tse_stir_semac_cor_uni knee [13] foot pd_tse_semac_cor_cs8 07:14 ankle body 12 whole body oncology foot whole body diffusion t2_tse_stir_semac_cor_cs8 05:44 t1_tse_semac_cor_cs8_un > whole body oncology peripheral angiography whole body diffusion pd_tse_semac_cor_cs8_un spectroscopy pd_tse_semac_tra_cs8 07:02 peripheral angiography t2_tse_stir_semac_cor_cs8 intervention t2_tse_stir_semac_tra_cs8 06:46 spectroscopy System > intervention pd_tse_semac_tra_cs8_un System 12_tse_stir_semac_tra_cs8_unilat 05:40 radiotherapy Implant Disclaimer ‐ The MRI restrictions (if any) of any implant must be considered prior to patient undergoing MRI exam. MR imaging of patients with implants brings specific risks. However, certain implants are approved by the governing regulatory bodies to be MR conditionally safe. For such implants, the previously mentioned warning may not be applicable. Please contact the implant manufacturer for the specific conditional 39 information. The conditions for MR safety are the responsibility of the implant manufacturer and user, not of Siemens Healthineers. Unrestricted © Siemens Healthineers, 2020 Notes 44 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X SEMAC – What is SEMAC? SIEMENS Healthineers ... Image Acquisition (e) Distorted Slab Profiles (b) Excited Slabs with Phase-encoded Imaging Phase-encoded FOV Phase-oncoded sactions Image Reconstruction (c) Phase-encoded sections combined from Excited Slabs (d) 3D Distortion- Corrected Image Figure 1: SEMAC uses additional through-slice phase encoding to resolve the shape of each slice (a, b). At reconstruction, data are from different slices are resampled to correct through-plane distortion (c,d). Reference: Accelerated Slice-Encoding for Metal Artifact Correction B. A. Hargreaves1, W. Lu2, W. Chen3, G. E. Gold1, A. C. Brau2, J. M. Pauly4, and K. Butts Pauly Radiology, Stanford University, Stanford, CA, United States, Electrical & Electronic Engineering, Nanyang Technological University, Singapore, Singapor Applied Science Lab, GE Healthcare, Menlo Park, CA, United States, Electrical Engineering, Stanford University, Stanford, CA, United States Implant Disclaimer ‐ The MRI restrictions (if any) of any implant must be considered prior to patient undergoing MRI exam. MR imaging of patients with implants brings specific risks. However, certain implants are approved by the governing regulatory bodies to be MR conditionally safe. For such implants, the previously mentioned warning may not be applicable. Please contact the implant manufacturer for the specific conditional 40 information. The conditions for MR safety are the responsibility of the implant manufacturer and user, not of Siemens Healthineers. Unrestricted © Siemens Healthineers, 2020 Notes 45 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X SEMAC – What is SEMAC? SIEMENS Healthineers . Conventional TSE High BW SEMAC-VAT Cobalt Chromium Conventional TSE High BW SEMAC-VAT Titanium Tibial Courtesy of Prof. V.M. Runge, UTMB, USA conv. High BW SEMAC Implant Disclaimer ‐ The MRI restrictions (if any) of any implant must be considered prior to patient undergoing MRI exam. MR imaging of patients with implants brings specific risks. However, certain implants are approved by the governing regulatory bodies to be MR conditionally safe. For such implants, the previously mentioned warning may not be applicable. Please contact the implant manufacturer for the specific conditional 41 information. The conditions for MR safety are the responsibility of the implant manufacturer and user, not of Siemens Healthineers. Unrestricted © Siemens Healthineers, 2020 Notes 46 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X SEMAC – What is SEMAC? SIEMENS Healthineers .. 46, M, 63Y • “Pseudo‐3D”acquisition 723 • Large 3D phase encoded slab • Thin 2D slice excitation F 3D‐encoding Slice excitation DIS2D For 150 Se-Cor:12.6). Implant Disclaimer ‐ The MRI restrictions (if any) of any implant must be considered prior to patient undergoing MRI exam. MR imaging of patients with implants brings specific risks. However, certain implants are approved by the governing regulatory bodies to be MR conditionally safe. For such implants, the previously mentioned warning may not be applicable. Please contact the implant manufacturer for the specific conditional 42 information. The conditions for MR safety are the responsibility of the implant manufacturer and user, not of Siemens Healthineers. Unrestricted © Siemens Healthineers, 2020 Notes 47 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X SEMAC – What is SEMAC? SIEMENS Healthineers .. • “Pseudo‐3D”acquisition 6. M. 63Y MR • Large 3D phase encoded slab 23 • Thin 2D slice excitation Slice #n 3D‐encoding slice excitation RF PIS2 slice phase encoding VAT gradient M 15 • 3D‐encoding determined by GSS • Partition Thickness – (2D‐slice thickness) GPE & GRO • Coverage – (Extend of distortion) Implant Disclaimer ‐ The MRI restrictions (if any) of any implant must be considered prior to patient undergoing MRI exam. MR imaging of patients with implants brings specific risks. However, certain implants are approved by the governing regulatory bodies to be MR conditionally safe. For such implants, the previously mentioned warning may not be applicable. Please contact the implant manufacturer for the specific conditional 43 information. The conditions for MR safety are the responsibility of the implant manufacturer and user, not of Siemens Healthineers. Unrestricted © Siemens Healthineers, 2020 Notes 48 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X SEMAC SIEMENS Healthineers .. Case Example Standard SEMAC 09:04 PM 15 MA 10 /19 1 53 33 PM 14 MA 156 / 25 AR 5 cm MF 1.00 MF 1 00 TI 160 0 n 145.0 TR 7000.0 TR 6000.0 TE 50.0 TE 35.0 DE TA 02:13 IP F9 BWV 256.0 TA 07:07 EW 781 0 SP R68.3 INORM/DISZD p2 M.NCRM.OIS2D SL 2.5 FoV 200 200 ALAR A1.IR/PFP 205p 255 CKN Sag Cor(9 0) tir2d1_13 /180 C:KN tirVS2ch_21 /135 196 Images courtesy of Prof. Pfimrmann, Balgrist Univ. Hospital, Switzerland Implant Disclaimer ‐ The MRI restrictions (if any) of any implant must be considered prior to patient undergoing MRI exam. MR imaging of patients with implants brings specific risks. However, certain implants are approved by the governing regulatory bodies to be MR conditionally safe. For such implants, the previously mentioned warning may not be applicable. Please contact the implant manufacturer for the specific conditional 44 information. The conditions for MR safety are the responsibility of the implant manufacturer and user, not of Siemens Healthineers. Unrestricted © Siemens Healthineers, 2020 Notes 49 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X SEMAC SIEMENS Healthineers ... Case Example NYU_20120314_Skyra_knee NYU Langone Met 12.03.14-20:46:45-DST-1.3.12 NYU_20120314_Skyra_knee 12.03.14-20:46:45-DST-1.3.12. NYU Langone Met NYU_20120314_Skyra_knee NYU Langone Mer *3/14/1992, 0,20Y *3/14/1992, 0, 20Y 12.03.14-20:46:45-DST-1.3.12 *3/14/1992, 0,20Y STUDY 1 STUDY 1 3/14/2012 STUDY 1 9:52:24 PM 3/14/2012 13 IMA 25 / 40 9:58:33 PM 3/1 4/2012 14 IMA 25 / 40 10:02:59 PM 15 IMA 400 / 40 AR AR AR MF 1.00 MF 1.00 MF 1.00 TR 4220.0 TR 4000.0 TE 33.0 TR 4030.0 TA 04:30 TE 31.0 TA 04:16 TE 31.0 BV 505.0 TA 10:40 MIND BV 505.0 MIND BV 505.0 p4 MIND A1 K15 A1 *tse2d1_12/150 K15 A1 tseV2d1_12 / 150 K15 tseVS2d1_12 / 150 Standard TSE High Bandwidth TSE with VAT TSE SEMAC Images courtesy of Prof. M. Recht, NYU Langone Medical Center, USA Implant Disclaimer ‐ The MRI restrictions (if any) of any implant must be considered prior to patient undergoing MRI exam. MR imaging of patients with implants brings specific risks. However, certain implants are approved by the governing regulatory bodies to be MR conditionally safe. For such implants, the previously mentioned warning may not be applicable. Please contact the implant manufacturer for the specific conditional 45 information. The conditions for MR safety are the responsibility of the implant manufacturer and user, not of Siemens Healthineers. Unrestricted © Siemens Healthineers, 2020 Notes 50 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X SEMAC SIEMENS Healthineers . Case Example NYU_20120314_Skyra_knee NYU Langone Men NYU Langone Met 12.03.14-20:46:45-DST-1.3.12. NYU_20120314_Skyra_knee *3/14/1992, 0, 20Y 12.03.14-20:46:45-DST-1.3.12 .... NYU_20120314_Skyra_knee *3/14/1992, 0,20Y 12.03.14-20:46:45-DST-1.3.12 *3/14/1992, 0,20Y STUDY 1 STUDY 1 3/14/2012 9:52:24 PM 3/14/2012 STUDY 1 13 IMA 25 / 40 9:58:33 PM 3/1 4/2012 14 IMA 25 / 40 10:02:59 PM 15 IMA 400 / 40 AR MF 1.00 TR 4220.0 TE 33.0 TA 04:30 BW 505.0 MIND A1 K15 *tse2d1_12/150 Standard TSE high bandwidth TSE with VAT TSE SEMAC Images courtesy of Prof. M. Recht, NYU Langone Medical Center, USA MPR MPR High Bandwidth TSE with VAT TSE SEMAC Implant Disclaimer ‐ The MRI restrictions (if any) of any implant must be considered prior to patient undergoing MRI exam. MR imaging of patients with implants brings specific risks. However, certain implants are approved by the governing regulatory bodies to be MR conditionally safe. For such implants, the previously mentioned warning may not be applicable. Please contact the implant manufacturer for the specific conditional 46 information. The conditions for MR safety are the responsibility of the implant manufacturer and user, not of Siemens Healthineers. Unrestricted © Siemens Healthineers, 2020 Notes 51 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X SEMAC SIEMENS Healthineers .. Case Example High Bandwidth with VAT ‐ SEMAC Routine T2 Suppressed MF 1.00 TR 3000.0 Central Canal TE 105.0 E IR $550.0 TE 103.0 TA 51.49*2 BWV 289.0 TA 06:24 p2 M/NORMDIS2D 3.01 BWV 930.0 p2 M/NORM/DIS2D not seen A2/SAT1 T:HEP; NE1,2;SP1 sag A7 ^tseR2dirr31 / 160 T:HEP; NE1,2;SP1 tseV2d1_28/120 without metal *10/14/1956, F, 55Y *10/14/1956, F, 55Y STUDY 1 1/10/2012 STUDY 1 1/10/2012 suppression 9:44:22 AM 7 IMA 10 /36 10:19:52 AM 11 IMA 7 /36 at L2-3 TR 3510.0 TE 86.0 TR 6240.0 TA 01:14*2 TP H9 TE 103.0 BVV 199,0 SP F27.6 TA 02:49*2 p2 M/NORM/DIS2D SL 3.010.99 EV 930.0 FoV 200*200 p2 M/NORM/DIS2D A2/SAT1 230-256 T:HEP: NE1,2;SP1 Tra-Cor(16.0)-Sag(-0.8) AZ *tscR2d1rs13 /130 W 646 T:NE1,2;SP1 369 tscV2d1_28 /120 Dr. Safriel, Radiology Associates of Clearwater/ University of South Florida Implant Disclaimer ‐ The MRI restrictions (if any) of any implant must be considered prior to patient undergoing MRI exam. MR imaging of patients with implants brings specific risks. However, certain implants are approved by the governing regulatory bodies to be MR conditionally safe. For such implants, the previously mentioned warning may not be applicable. Please contact the implant manufacturer for the specific conditional 47 information. The conditions for MR safety are the responsibility of the implant manufacturer and user, not of Siemens Healthineers. Unrestricted © Siemens Healthineers, 2020 Notes 52 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X Knowledge Check SIEMENS Healthineers .. 4. SEMAC performs an additional phase encoding step in which direction? a. Phase b. Slice c. Readout/Frequency d. None of the Above Author | Department 48 Unrestricted © Siemens Healthineers, 2020 Notes 53 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X SEMAC – Compressed Sensing SIEMENS Healthineers .. Compressed Sensing – SEMAC • Pseudo‐3D Acquisition • Heavy slice distortion due to metal • Thin 2D slice excitation • Large 3D phase encoded slab Final SEMAC recon Retro Recon MR Retro Patient ID 1 M1/1/1960, 0 STUDY 1 6/11/2014 2:14:51 PM 289 IMA 177 /52 Intrinsically sparse! Implant Disclaimer ‐ The MRI restrictions (if any) of any implant must be considered prior to patient undergoing MRI exam. MR imaging of patients with implants brings specific risks. However, certain implants are approved by the governing regulatory bodies to be MR conditionally safe. For such implants, the previously mentioned warning may not be applicable. Please contact the implant manufacturer for the specific conditional 49 information. The conditions for MR safety are the responsibility of the implant manufacturer and user, not of Siemens Healthineers. Unrestricted © Siemens Healthineers, 2020 Notes 54 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X SEMAC – Compressed Sensing SIEMENS Healthineers .. Compressed Sensing – SEMAC • SEMAC – stand alone pulse sequences • TSE with SEMAC • CS SEMAC TSE with SEMAC CS SEMAC Routine Contrast Resolution Geor Routine Contrast Resolutio Part 1 Part 2 Assistant Part 1 Part 2 Assistant Sequence Name tseS Sequence Name tseS Sequence File Name: Routine Contrast Resolution Sequence Variant: tseS2d1 15 tse Sequence File Name: Routine Contrast Resolu semac Immon Acceleration Filter Sequence Variant: tseS2d1_11 mmon Acceleration Filter Acceleration mode GRAPPA Acceleration mode CS ... None RF Pulse Type Fast GRAPPA RF Pulse Type Fast Total Factor CS Reference Scans Integrated Reference Scans Integrated Gradient Mode Fast Acceleration Factor PE Gradient Mode Fast Flow Compensation No Reference Lines PE 31 + Reference Lines PE 24 + Reference Lines 3D 25 Implant Disclaimer ‐ The MRI restrictions (if any) of any implant must be considered prior to patient undergoing MRI exam. MR imaging of patients with implants brings specific risks. However, certain implants are approved by the governing regulatory bodies to be MR conditionally safe. For such implants, the previously mentioned warning may not be applicable. Please contact the implant manufacturer for the specific conditional 50 information. The conditions for MR safety are the responsibility of the implant manufacturer and user, not of Siemens Healthineers. Unrestricted © Siemens Healthineers, 2020 Notes 55 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X SEMAC – Compressed Sensing SIEMENS Healthineers .. CS SEMAC – SAR Optimization Routine Contrast Resolution Geometr System Sequence Part 1 Part 2 Assistant • Reduce applied RF pulse energy Introduction WARP V • Varies flip angle in 3D k‐space (SEMAC Steps) VAT 100 % • Outer SEMAC steps acquired with 60° flip angle SEMAC 15 • Flip angle increase up to protocol value for SAR Optimization Automatic center step (blue line) Phase Correction Automatic Off On • Modes: Off, On, Automatic (on for 3T systems) Automatic 60° 150° Flip Angle 150 + deg SEMAC steps 60° Implant Disclaimer ‐ The MRI restrictions (if any) of any implant must be considered prior to patient undergoing MRI exam. MR imaging of patients with implants brings specific risks. However, certain implants are approved by the governing regulatory bodies to be MR conditionally safe. For 51 such implants, the previously mentioned warning may not be applicable. Please contact the implant manufacturer for the specific conditional Unrestricted © Siemens Healthineers, 2020 information. The conditions for MR safety are the responsibility of the implant manufacturer and user, not of Siemens Healthineers. Notes 56 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X SEMAC – Compressed Sensing SIEMENS Healthineers .. Conventional 3:00 SEMAC 9:45 CS SEMAC 4:10, SEMAC=15 Images courtesy: Dr. Jan Fritz, Johns Hopkins, Baltimore Implant Disclaimer ‐ The MRI restrictions (if any) of any implant must be considered prior to patient undergoing MRI exam. MR imaging of patients with implants brings specific risks. However, certain implants are approved by the governing regulatory bodies to be MR conditionally safe. For such implants, the previously mentioned warning may not be applicable. Please contact the implant manufacturer for the specific conditional 52 information. The conditions for MR safety are the responsibility of the implant manufacturer and user, not of Siemens Healthineers. Unrestricted © Siemens Healthineers, 2020 Notes 57 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X SEMAC – Compressed Sensing SIEMENS Healthineers . Compressed Sensing – SEMAC • Pre‐built Siemens protocols currently available in Dot Cockpit for Knee & Hip knee [5] SEMAC_ hip [5] SEMAC > Knee Dot Engine TxRx Knee 18 library [5] t1_tse_semac_sag 06:34 Hip Dot Engine t1_tse_semac_sag_unilat 09:43 general 2D bilateral localizer pd_tse_semac_cor 07:05 general 2D unilateral pd_tse_semac_cor_unilat 07:05 T1 general 3D T2 t2 tse_stir_semac_sag 10:06 library [5] t2_tse_stir_semac_cor_unilat 11:22 PD ocalizer 3D t1_tse_semac_cor_cs8 06:58 body 12 BLADE T1 pd_tse_semac_cor_cs8 07:14 t1_tse_semac_cor_cs8_unilat 05:50 Maplt T2 WARP [5] PD t2_tse_stir_semac_cor_cs8 05:44 3D pd tse_semac_cor_cs8_unilat 05:25 QUIET ª pd_tse_semac_tra_cs8 07:02 BLADE Flex Large 4 library t2_tse_stir_semac_cor_cs8_unilat 05:29 Maplt clinical libraries t2_tse_stir_semac_tra_cs8 06:46 WARP [5] pd_tse_semac_tra_cs8_unilat 05:17 >ankle QUIET foot clinical libraries t2_tse_stir_semac_tra_cs8_unilat 05:40 > whole body oncology Implant Disclaimer ‐ The MRI restrictions (if any) of any implant must be considered prior to patient undergoing MRI exam. MR imaging of patients with implants brings specific risks. However, certain implants are approved by the governing regulatory bodies to be MR conditionally safe. For 53 such implants, the previously mentioned warning may not be applicable. Please contact the implant manufacturer for the specific conditional information. The conditions for MR safety are the responsibility of the implant manufacturer and user, not of Siemens Healthineers. Unrestricted © Siemens Healthineers, 2020 Notes 58 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X Knowledge Check SIEMENS Healthineers .. 5. Pre‐built CS‐SEMAC protocols are available in the Siemens Tree for which body parts? a. Shoulder b. Ankle c. Hip d. Knee e. a & b f. c & d Author | Department 54 Unrestricted © Siemens Healthineers, 2020 Notes 59 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X 6. Metal Consideration Metal Consideration Using WARP/VAT/SEMAC 55 Unrestricted © Siemens Healthineers, 2020 Notes 60 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X Common Types of Metal SIEMENS Healthineers .. In some cases, WARP & VAT are sufficient to reduce distortions caused by metal… However, the type of metal can also play a major role in what techniques should be utilized. 3 Types of Metal Commonly Encountered • Titanium – Can easily be compensated with truly optimized protocols using • High Bandwidth • Shorter TE • Smaller Voxel with product • VAT alone can be very helpful with the least amount of scan time • Stainless Steel – poses the greatest challenge due to the geometric distortion in a 3 dimensional field • Difficult to optimize due to through plane geometric distortions • In‐plane is easily improved slightly with Readout Bandwidth increases • 2D TSE with SEMAC & VAT provide best results • Cobalt – Chromium‐Molybdenum Alloy ‐ is the next challenging of all • WARP with increases in Slice Oversampling (SEMAC) is a must at the cost of increased acquisition time Implant Disclaimer ‐ The MRI restrictions (if any) of any implant must be considered prior to patient undergoing MRI exam. MR imaging of patients with implants brings specific risks. However, certain implants are approved by the governing regulatory bodies to be MR conditionally safe. For such implants, the previously mentioned warning may not be applicable. Please contact the implant manufacturer for the specific conditional 56 information. The conditions for MR safety are the responsibility of the implant manufacturer and user, not of Siemens Healthineers. Unrestricted © Siemens Healthineers, 2020 Notes 61 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X Titanium SIEMENS Healthineers .. Case Example Implant Disclaimer ‐ The MRI restrictions (if any) of any implant must be considered prior to patient undergoing MRI exam. MR imaging of patients with implants brings specific risks. However, certain implants are approved by the governing regulatory bodies to be MR conditionally safe. For such implants, the previously mentioned warning may not be applicable. Please contact the implant manufacturer for the specific conditional 57 information. The conditions for MR safety are the responsibility of the implant manufacturer and user, not of Siemens Healthineers. Unrestricted © Siemens Healthineers, 2020 Notes 62 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X Titanium SIEMENS Healthineers ... Case Example • 1.5 Tesla Comparison SEMAC and VAT with product STIR Titanium Plate and Screws HRA HRA 41:03 AM R 317 STUDY 1 5/27/2011 8 IMA 225 / 22 8:28:57 AM 7 IMA 15 / 22 AL AL MF 1.23 5cm 5cm TI 150.0 TR 3500.0 11150.0 TR 3500.0 TE 36.0 TA 03:27*4 TP O TE 34.0 SP L135.1 TA 01:07*6 TP O BVV 930.0 BV 781.0 SP L135.1 p2 M/NORM DIS2D SL 2.5 SL 2.5 FoV 170*170 M.NORM DIS2D FoV 170*170 EFS 166*256 Sag>Tra(-6.2)>Cor(-0.0) A2/R 410*5121 Sag>Tra(-6.2)>Cor(-0.0) tirVS2d1_26 / 150 SEMAC C:FS Standard TSE *tir2d1_22 /150 144 60 Images Courtesy of Dr. Val Runge Implant Disclaimer ‐ The MRI restrictions (if any) of any implant must be considered prior to patient undergoing MRI exam. MR imaging of patients with implants brings specific risks. However, certain implants are approved by the governing regulatory bodies to be MR conditionally safe. For such implants, the previously mentioned warning may not be applicable. Please contact the implant manufacturer for the specific conditional 58 information. The conditions for MR safety are the responsibility of the implant manufacturer and user, not of Siemens Healthineers. Unrestricted © Siemens Healthineers, 2020 Notes 63 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X Titanium SIEMENS Healthineers ... Case Example • 3 Tesla Comparison SEMAC and VAT with product STIR Titanium Plate and Screws HPR 5/27/2011 Verio HPR $27.2011 8 IMA 195 / 25 7IMÃ 13,25 AHR AHR 5cm 5 cm MF 1.00 MF 1.00 T1 200.0 TI 200.0 TE 4500.0 TR 4500.0 TA 07:49+2 TE 35.0 SP L120.1 TA 58.83*4 BWV 930.0 BW 781.0 SP L120.1 p2 M/NORM DIS2D FoV 170*170 M.NORM DIS2D SL 2.5 FoV 170*170 A1/R/PFP 166p*256 Sag>Tra(-2.3)>Cor(0.6) A1/R 410*5121 C:FS C:FS Sag>Tra(-2.3)>Cor(0.6) tirVS2d1_15 / 120 SEMAC 21 *tir2d1 15/150 Standard TSE 302 117 Images Courtesy of Dr. Val Runge Implant Disclaimer ‐ The MRI restrictions (if any) of any implant must be considered prior to patient undergoing MRI exam. MR imaging of patients with implants brings specific risks. However, certain implants are approved by the governing regulatory bodies to be MR conditionally safe. For such implants, the previously mentioned warning may not be applicable. Please contact the implant manufacturer for the specific conditional 59 information. The conditions for MR safety are the responsibility of the implant manufacturer and user, not of Siemens Healthineers. Unrestricted © Siemens Healthineers, 2020 Notes 64 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X Stainless Steel SIEMENS Healthineers .. WARP & VAT candle test 13.05.28-17:20:49-DST-1.3.12. 17501:57/20:49-DST-1.3.12 .... *1/30/1954, M. 59Y STUDY 1 5/28/2013 • WARP and VAT alone do not help as much 7:55:14 PM 24 IMA 0 / 5 with stainless steel (displayed here) Cor>Tra 3 • Here we can see the through‐plane distortion artifacts on the sag recon and on the transverse recon MF 1.00 MF 1.00 TR 3500.0 TE 27.0 TR 3500.0 BW 781.0 L TE 27.0 TP O BW 781.0 LA • The actual slice signals have been p2 MPR/MPR SP L14,3 p2 MPR/MPR A6 SL 2.5 C:K15 Sag>Tra(-2.1)>Cor(-0.1) A6 geometrically distorted outside the volume tscV2d1_25 /122 W 1166 C:K15 tscV2d1_25 /122 candle test AH Victory Lakes 3.1 13.05.28-17:20:49-DST-1.3.12. *1/30/1954, M. 59Y STUDY 1 SEMAC is essential for improvements on 5/28/2013 • 7:55:14 PM 24 IMA 0 /5 patient exams when this metal is anatomically in place RFA • With Stainless Steel we will need to compromise on acquisition time to make it MF 1.00 clinically feasible TR 3500.0 TE 27.0 F BW 781.0 p2 MPR/MPR TP O SP H25.2 A6 SL 2.5 C:K15 Tra-Cor(-3.4)-Sag(1.9) tseV2d1_25 /122 ₩ 1166 507 Implant Disclaimer ‐ The MRI restrictions (if any) of any implant must be considered prior to patient undergoing MRI exam. MR imaging of patients with implants brings specific risks. However, certain implants are approved by the governing regulatory bodies to be MR conditionally safe. For such implants, the previously mentioned warning may not be applicable. Please contact the implant manufacturer for the specific conditional 60 information. The conditions for MR safety are the responsibility of the implant manufacturer and user, not of Siemens Healthineers. Unrestricted © Siemens Healthineers, 2020 Notes 65 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X Stainless Steel SIEMENS Healthineers .. SEMAC candle test Victory Lakey ?! Victory Lakes 3 T 13.05.28-17:20:49-DST-1.3.12 ... *1/30/1 954, M. 59Y MR 817 H/Son954, M.Soy0ST-1.3.12. STUDY 1 5/28/2013 • Here you can see how SEMAC corrected 8:42:31 PM 8:42:31 PM 27 IMA 0 /5 Cor>Tra much of the geometric distortion in the ----------- slice direction. Now the slices are kept AH within the volume measured. At 40 SEMAC steps the metal cut out is MF 1.00 actually seen and measurable on the L TR 4700.0 TE 33.0 TP O BW 587.0 A SP L15.0 p4 MPR/MPR SL 2.0 transverse recon. A1 C:K15 Sag-Tra(-1.9)>Cor(-0.1) A1 tseVS2d1_40 / 122 480 C:K15 209 tseVS2d1_40 condie test AH 13.05.28-17:20:49-DST-1.3.12 .. Victory Lak ^1/30/1 954, M, 59Y STUDY 1 • Keep in mind that the SS piece is exactly 5/28/2013 8:42:31 PM 27 IMA 0 / 5 the same dimension and size with same measured cuts and the reference plastic seen next to the metal for comparison. MF 1.00 TR 4700.0 TE 33.0 F BW 587.0 p4 MPR/MPR A1 C:K15 tseVS2d1_40 /122 Implant Disclaimer ‐ The MRI restrictions (if any) of any implant must be considered prior to patient undergoing MRI exam. MR imaging of patients with implants brings specific risks. However, certain implants are approved by the governing regulatory bodies to be MR conditionally safe. For such implants, the previously mentioned warning may not be applicable. Please contact the implant manufacturer for the specific conditional 61 information. The conditions for MR safety are the responsibility of the implant manufacturer and user, not of Siemens Healthineers. Unrestricted © Siemens Healthineers, 2020 Notes 66 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X Stainless Steel SIEMENS Healthineers ... Case Example 3TUB4 52. F. 48Y 7/31 /1962. F. 48Y 83.93 PM STUDY 1 3 IRMA 165 / 29 15:29 PM29 • SEMAC and VAT used on 1.5 Tesla • Stainless Steel Plate and Screws MF 1.00 MF 1.00 TI 150.0 TI 150.0 This screw not used on the TR 3500.0 TE 35.0 TR 3500.0 TA 03:27*3 TE 34.0 TA 01:07*5 BVV 930.0 Patient images shown p2 MIND BV 781.0 FoV 180 180 MIND A1AR 166*256 C:FA Cor>Sag(-2.6) A2AR tirVS2d1_26 / 150 C.FA "tir 2d1_22 / 150 *7/31/1962, F, 48Y *7/31/1962, F, 48Y STUDY 1 5/6/2011 STUDY 1 2:20:24 PM 5/6/2011 6 IMA 300 / 29 2:24:15 PM 7 IMA 20 / 29 System Physio Inline Sequence WARP V MF 1.00 VAT 100 % MF 1.00 TR 3000.0 TE 28.0 TR 3140.0 TE 31.0 TA 03:42 2 TP O TA 03:43 SEMAC 15 + BVV 930.0 SP L92.7 p2 M/ND/NORM SL 3.0. BV 781.0 FoV 180*180 M/ND/NORM A1/PFP 192p*256 C:FA Sag A3 tseVS2d1_22 / 154 CFA 398 *tse2d1 8/1 Example of Hardware used Images Courtesy of Dr. Val Runge Implant Disclaimer ‐ The MRI restrictions (if any) of any implant must be considered prior to patient undergoing MRI exam. MR imaging of patients with implants brings specific risks. However, certain implants are approved by the governing regulatory bodies to be MR conditionally safe. For such implants, the previously mentioned warning may not be applicable. Please contact the implant manufacturer for the specific conditional 62 information. The conditions for MR safety are the responsibility of the implant manufacturer and user, not of Siemens Healthineers. Unrestricted © Siemens Healthineers, 2020 Notes 67 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X Stainless Steel SIEMENS Healthineers ... Case Example MA 100 / 25 MA 10 / 25 • SEMAC and VAT used on 3 Tesla • Stainless Steel Plate and Screws MF 1.00 MF 1.00 This screw not used on the TI 200.0 TR 5500.0 TI 200.0 TE 42.0 TR 6290.0 TA 03:35*3 TE 36.0 TA 01:22*4 Patient images shown BW 930.0 P2 M/ND BV 781.0 FoV 180*180 M/NORM/DIS2D A1/R C.FA A1AR tir VS2d1_26 / 120 C:FA ^tir 2d1_15 /150 *7/31/1962, F, 48Y *7/31/1962, F. 48Y STUDY A5717258 5/6/2011 STUDY A5717258 4:54:11 PM FFS 5/6/2011 7 IMA 345 / 32 +LPH 5:00:07 PM System Physio Inline Sequence WARP V VAT 100 % 2500.0 SEMAC 15 + 5.0 TR 3610.0 04:21 2 TP O TE 33.0 TA 01:19 3 930.0 SP L81.4 UND SL 3.0 BW 781.0 oV 180 180 M/DIS2D PEP Sag 41 /S2d1_21 / 100 632 C:FA *tse2d1_14 /120 Example of Hardware used Images Courtesy of Dr. Val Runge Implant Disclaimer ‐ The MRI restrictions (if any) of any implant must be considered prior to patient undergoing MRI exam. MR imaging of patients with implants brings specific risks. However, certain implants are approved by the governing regulatory bodies to be MR conditionally safe. For such implants, the previously mentioned warning may not be applicable. Please contact the implant manufacturer for the specific conditional 63 information. The conditions for MR safety are the responsibility of the implant manufacturer and user, not of Siemens Healthineers. Unrestricted © Siemens Healthineers, 2020 Notes 68 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X Cobalt Chromium Molybdenum Alloy SIEMENS Healthineers .. The Science of Increased Motion" High flexion knee system designed for mobility with stability through 150 degrees of motion. Flared Posterior Condyles Open design accommodate: 20 degrees of internal/external cotation throughout the range of motion Rotary Arc Insert + Precision machined warface facilitate Internalexternal eutation Anatomic Radius (10"- 110") . Designed to maintain collateral Sgument stability throughout the range of motion Centered at the transepicondy lar axis the optimal flexion asis of the knee." Anatomic Patellofemoral Track- The Triathlon" Knee patellofemoral track shares the came dexign as perceding Stryker@ total knee systems, bringing over a decade of excellent clinical performance and the industry's lowest revision rate (0.35s )" to date to this knee system. Implant Disclaimer ‐ The MRI restrictions (if any) of any implant must be considered prior to patient undergoing MRI exam. MR imaging of patients with implants brings specific risks. However, certain implants are approved by the governing regulatory bodies to be MR conditionally safe. For such implants, the previously mentioned warning may not be applicable. Please contact the implant manufacturer for the specific conditional 64 information. The conditions for MR safety are the responsibility of the implant manufacturer and user, not of Siemens Healthineers. Unrestricted © Siemens Healthineers, 2020 Notes 69 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X Cobalt Chromium Molybdenum Alloy SIEMENS Healthineers .. Case Example 3T MAGNETOM Skyra Standard PD TSE PD TSE high bandwidth and VAT‐SEMAC Images Courtesy of University of Texas Medical Branch, Galveston, USA Implant Disclaimer ‐ The MRI restrictions (if any) of any implant must be considered prior to patient undergoing MRI exam. MR imaging of patients with implants brings specific risks. However, certain implants are approved by the governing regulatory bodies to be MR conditionally safe. For such implants, the previously mentioned warning may not be applicable. Please contact the implant manufacturer for the specific conditional 65 information. The conditions for MR safety are the responsibility of the implant manufacturer and user, not of Siemens Healthineers. Unrestricted © Siemens Healthineers, 2020 Notes 70 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X Cobalt Chromium Molybdenum Alloy SIEMENS Healthineers .. Case Example HAR HAR STUDY 1 14/1 4/2011 1/14/2011 55:55 PM IMA 315 / 38 14 IMA 315 / 38 • SEMAC and VAT used on 1.5T • Total Knee • CCM Alloy RP RP present • Same 5cm Volunteer for MF 1.00 MF 1.00 TI 150.0 TR 4390.0 TE 35.0 TR 671.0 consistency TA 04:2043 TP O TE 14.0 TP O JVV 930.0 SP A64.9 TA 01:2048 SP A64,9 52 MIND SL 3.0 BVV 930.0 FoV 180*180 p2 M/ND/NORM SL 3.0 166*256 FoV 180*180 Cor>Sag(-11.7)>Tra(-7.4) A1 251*256 irVS2d1_26 / 150 56 C:KN Cor>Sag(-11.7)>Tra(-7,4) tseVS2d1_18 / 133 80 Images Courtesy of Dr. Val Runge Implant Disclaimer ‐ The MRI restrictions (if any) of any implant must be considered prior to patient undergoing MRI exam. MR imaging of patients with implants brings specific risks. However, certain implants are approved by the governing regulatory bodies to be MR conditionally safe. For such implants, the previously mentioned warning may not be applicable. Please contact the implant manufacturer for the specific conditional 66 information. The conditions for MR safety are the responsibility of the implant manufacturer and user, not of Siemens Healthineers. Unrestricted © Siemens Healthineers, 2020 Notes 71 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X Cobalt Chromium Molybdenum Alloy SIEMENS Healthineers .. Case Example HLP HLP 10:23.20 AM 5/18/2011 • SEMAC and VAT used on 3T • Total Knee • CCM Alloy RPH RPH present Sem Scm • Same MF 1,00 MF 1,00 Volunteer for TI 200.0 TR 6290.0 TE 42.0 DE TR 886.0 TA 10:56*2 TP O TE 7.0 TA 01:45 8 consistency BVV 930.0 SP A53.8 SL 2.5 BVV 930.0 p2 M/NORM DIS2D FoV 180*180 p2 M/NORM DIS2D A1/R 166*256 C:KN Cor>Sag(-4.5)>Tra(0.3) 21 Cor-Sag(-4.5)- Tra 30 tirVS2d1_15 /120 180 C:KN tscVS2d1_18 /92 Images Courtesy of Dr. Val Runge Implant Disclaimer ‐ The MRI restrictions (if any) of any implant must be considered prior to patient undergoing MRI exam. MR imaging of patients with implants brings specific risks. However, certain implants are approved by the governing regulatory bodies to be MR conditionally safe. For such implants, the previously mentioned warning may not be applicable. Please contact the implant manufacturer for the specific conditional 67 information. The conditions for MR safety are the responsibility of the implant manufacturer and user, not of Siemens Healthineers. Unrestricted © Siemens Healthineers, 2020 Notes 72 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X Cobalt Chromium Molybdenum Alloy SIEMENS Healthineers .. Case Example • Oxford Partial Replacement • Metal Alloy – Cobalt Chromium Molybdenum • Plastic Insert – Ultra‐High Molecular Weight Polyethylene ^5/31/1955, F.36Y STUDY 1 3/30/2011 8:15:23 PM 7 IMA 225 / 29 RP MF 1.00 TE TA 01:23 6 TP BWV 930.0 SP A32. p2 M/NORM/DIS2D SL 3.0 FoV 180 180 A1 251 C:KN Cor>Sag(-3.7 tseVS2d1_18 / 139 Implant Disclaimer ‐ The MRI restrictions (if any) of any implant must be considered prior to patient undergoing MRI exam. MR imaging of patients with implants brings specific risks. However, certain implants are approved by the governing regulatory bodies to be MR conditionally safe. For such implants, the previously mentioned warning may not be applicable. Please contact the implant manufacturer for the specific conditional 68 information. The conditions for MR safety are the responsibility of the implant manufacturer and user, not of Siemens Healthineers. Unrestricted © Siemens Healthineers, 2020 Notes 73 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X Cobalt Chromium Molybdenum Alloy SIEMENS Healthineers .. Case Example • PD and T2 Sag were acquired with equal results • ACL can be evaluated due to improved through‐plan correction 5/31/1955, F. 557 Eppreg H STUDY 1 FFS 3/30/2011 +LPH STUDY 1 8:35:13 PM 3/30/2011 10 IMA 286 / 35 8:38:39 PM 11 IMA 286 / 35 IA MIF 1.00 IF 1.00 TR 2500.0 TE 28.0 TR 6000.0 TA 03:05*2 TE 77.0 EV 930.0 TA 07:25 p2 M/NORM/DIS2D EV 930.0 p2 M/NORM/DIS2D A1/PFP C:KN A1/PFP tseVS2d1_22 / 154 C:KN tseVS2d1_25 / 136 Images Courtesy of Dr. Val Runge Implant Disclaimer ‐ The MRI restrictions (if any) of any implant must be considered prior to patient undergoing MRI exam. MR imaging of patients with implants brings specific risks. However, certain implants are approved by the governing regulatory bodies to be MR conditionally safe. For such implants, the previously mentioned warning may not be applicable. Please contact the implant manufacturer for the specific conditional 69 information. The conditions for MR safety are the responsibility of the implant manufacturer and user, not of Siemens Healthineers. Unrestricted © Siemens Healthineers, 2020 Notes 74 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X Knowledge Check SIEMENS Healthineers .. 6. Which of these metals produce the most artifact on an MR image? a. Titanium b. Cobalt Chromium Molybdenum Alloy c. Stainless Steel d. All are the Same Author | Department 70 Unrestricted © Siemens Healthineers, 2020 Notes 75 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X 7. Protocol Recommendations Protocol Recommendations 71 Unrestricted © Siemens Healthineers, 2020 Notes 76 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X Protocol Recommendations SIEMENS Healthineers .. Localizer • Petra for Metal Localizer and why WARP SCOUT TEST METHODIST WILLOWBROOK HOE WARP SCOUT TEST H METHODIST WILLOWBROOK Hora 15 CH KNEE $1/30/1954, 0, 61Y 15 CH KNEE *1/30/1 954, 0, 61Y STUDY 1 6/19/2015 STUDY 1 6/1 9/2015 8:07:15 PM 5 IMA 0 /5 8:07:15 PM 5 IMA 0 /5 CursSay -4 Say-Cur 2 MF 1.00 TI 1100.0 TR 3,6 TI 1300.0 BWV 415.0 TE 0.1 A TR 3.3 MPRAMPR TP O DW 415.0 TE 0.1 BW 405.0 SP R47.9 MPR/MPR SP A25.5 MPR/MPR/M/ND/NORM/FS/FIL ALAR SL 1.15 SL 1.56 15K Sag ALAR Cor>Sog(-4.0): Petra3d1 / 6 W 15K Petra3d1 /6 "Petra3d1_8000 / 6 WARP SCOUT TEST 15 CH KNEE METHODIST WILLOWBROOK HO .. *1/30/1954, 0, 61Y Aera MR D13 STUDY 1 FFS 6/19/2015 LPH 8:07:15 PM 5 IMA 0 /5 Implant Disclaimer ‐ The MRI restrictions (if any) of any implant must be considered prior to patient undergoing MRI exam. MR imaging of patients with implants brings specific risks. However, certain implants are approved by the governing regulatory bodies to be MR conditionally safe. For such implants, the previously mentioned warning may not be applicable. Please contact the implant manufacturer for the specific conditional 72 information. The conditions for MR safety are the responsibility of the implant manufacturer and user, not of Siemens Healthineers. Unrestricted © Siemens Healthineers, 2020 Notes 77 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X Protocol Recommendations SIEMENS Healthineers .. WARP & VAT WARP + VAT Protocol Set up Routine Contrast Resolution Geometry System Physio Inline Sequence Part 1 Part 2 Assistant • Thin slices – reduces in‐plane distortions and VAT blurring Introduction v WARP V • Bandwidth > 500 Hz/Pixel to reduce VAT 50 % distortions and to avoid VAT blurring SEMAC • RF Mode Fast – preferred to reduce distortions (higher SAR) Phase Correction Automatic Red. EC Sensitivity For general metal a VAT scaling of Compensate T2 Decay • 40‐60% recommended, but can Acoustic noise reduction Off increase and decrease as necessary Hyperecho Reduce Motion Sens. • Higher matrix can also reduce dephasing, but should be balanced VAT 50 0 100 % with SNR/Time Implant Disclaimer ‐ The MRI restrictions (if any) of any implant must be considered prior to patient undergoing MRI exam. MR imaging of patients with implants brings specific risks. However, certain implants are approved by the governing regulatory bodies to be MR conditionally safe. For such implants, the previously mentioned warning may not be applicable. Please contact the implant manufacturer for the specific conditional 73 information. The conditions for MR safety are the responsibility of the implant manufacturer and user, not of Siemens Healthineers. Unrestricted © Siemens Healthineers, 2020 Notes 78 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X Protocol Recommendations SIEMENS Healthineers .. SEMAC knee [13] • Same recommendations for WARP/VAT apply to SEMAC Knee Dot Engine [4] t2_tse_warp_stir_tra 04:18 library [9] as well localizer t2_tse_stir_warp_cor 04:18 • WARP & VAT of 100% will be applied automatically if T1 t2_tse_stir_warp_sag 04:00 utilizing SEMAC T2 PD SEMAC • Recommended to begin with Siemens protocols and 3D BLADE t1_tse_semac_sag 06:34 optimize Maplt pd_tse_semac_cor 07:05 Utilize Compressed Sensing (CS) if available to reduce WARP [9] • t2_tse_stir_semac_sag scan time – Balance Time/Artifact Reduction/IQ QUIET 10:06 clinical libraries ankle t1_tse_semac_cor_cs8 06:58 System Physio Inline Sequence foot pd_tse_semac_cor_cs8 07:14 whole body oncology > whole body diffusion t2_tse_stir_semac_cor_cs8 05:44 WARP peripheral angiography spectroscopy pd_tse_semac_tra_cs8 07:02 VAT 100 % intervention t2_tse_stir_semac_tra_cs8 06:46 SEMAC 15 + System Implant Disclaimer ‐ The MRI restrictions (if any) of any implant must be considered prior to patient undergoing MRI exam. MR imaging of patients with implants brings specific risks. However, certain implants are approved by the governing regulatory bodies to be MR conditionally safe. For such implants, the previously mentioned warning may not be applicable. Please contact the implant manufacturer for the specific conditional 74 information. The conditions for MR safety are the responsibility of the implant manufacturer and user, not of Siemens Healthineers. Unrestricted © Siemens Healthineers, 2020 Notes 79 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X Protocol Recommendations SIEMENS Healthineers .. SEMAC • Practical considerations • Scan time is multiplied by SEMAC encoding steps! Acceptable scan times usually require trade‐offs, like reduced resolution. However, SEMAC steps also increase SNR, which allows for high iPAT acceleration (if supported by coil) SEMAC • #SEMAC steps determined by distortion level. encoding Unfortunately, currently no fast and robust method steps exists how to quantify this value. Usually the effective improvement beyond ~15 steps is rather low (depends on various factors including field strength and implant type). • SEMAC requires a certain slice coverage Unfortunately, currently no fast and robust method exists how to quantify this value. The slice coverage always should x V range well beyond the implant size on both sides Implant Disclaimer ‐ The MRI restrictions (if any) of any implant must be considered prior to patient undergoing MRI exam. MR imaging of patients with implants brings specific risks. However, certain implants are approved by the governing regulatory bodies to be MR conditionally safe. For such implants, the previously mentioned warning may not be applicable. Please contact the implant manufacturer for the specific conditional 75 information. The conditions for MR safety are the responsibility of the implant manufacturer and user, not of Siemens Healthineers. Unrestricted © Siemens Healthineers, 2020 Notes 80 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X Protocol Recommendations SIEMENS Healthineers .. Metal Types • Titanium – Can easily be compensated with truly optimized protocols using • High Bandwidth • Shorter TE • Smaller Voxel with product • WARP/VAT alone can be very helpful with the least amount of scan time • Stainless Steel – posses a greatest challenge due to the geometric distortion in a 3 dimensional field • Difficult to optimize due to through plane geometric distortions • In‐plane is easily improved slightly with Readout Bandwidth increases • 2D TSE with SEMAC & VAT provide best results • Cobalt – Chromium‐Molybdenum Alloy ‐ is the next challenging of all • WARP with increases in Slice Oversampling (SEMAC) is a must at the cost of increased acquisition time Implant Disclaimer ‐ The MRI restrictions (if any) of any implant must be considered prior to patient undergoing MRI exam. MR imaging of patients with implants brings specific risks. However, certain implants are approved by the governing regulatory bodies to be MR conditionally safe. For such implants, the previously mentioned warning may not be applicable. Please contact the implant manufacturer for the specific conditional 76 information. The conditions for MR safety are the responsibility of the implant manufacturer and user, not of Siemens Healthineers. Unrestricted © Siemens Healthineers, 2020 Notes 81 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X Protocol Recommendations SIEMENS Healthineers .. Contrast Studies T1 TSE VAT ‐ Pre‐ contrast T1 TSE VAT with Contrast T1 TSE VAT For contrasted studies, running pre/post non‐fat saturated T1 Subtraction • imaging with WARP/VAT and performing subtraction can assist in absence of T1 Fat Saturated imaging Images Courtesy of Skane University Hospital, Malmö, Sweden Implant Disclaimer ‐ The MRI restrictions (if any) of any implant must be considered prior to patient undergoing MRI exam. MR imaging of patients with implants brings specific risks. However, certain implants are approved by the governing regulatory bodies to be MR conditionally safe. For such implants, the previously mentioned warning may not be applicable. Please contact the implant manufacturer for the specific conditional 77 information. The conditions for MR safety are the responsibility of the implant manufacturer and user, not of Siemens Healthineers. Unrestricted © Siemens Healthineers, 2020 Notes 82 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X Protocol Recommendations SIEMENS Healthineers .. Contrast Studies R R T1w TSE pre T1w TSE post Subtraction Images Courtesy of Dr. IR WARP IW TSE Fritz at Johns Hopkins Implant Disclaimer ‐ The MRI restrictions (if any) of any implant must be considered prior to patient undergoing MRI exam. MR imaging of patients with implants brings specific risks. However, certain implants are approved by the governing regulatory bodies to be MR conditionally safe. For such implants, the previously mentioned warning may not be applicable. Please contact the implant manufacturer for the specific conditional 78 information. The conditions for MR safety are the responsibility of the implant manufacturer and user, not of Siemens Healthineers. Unrestricted © Siemens Healthineers, 2020 Notes 83 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X Knowledge Check SIEMENS Healthineers .. 7. What sequence is recommended as a localizer in the presence of metal? a. TWIST b. Blade c. StarVibe d. PETRA Implant Disclaimer ‐ The MRI restrictions (if any) of any implant must be considered prior to patient undergoing MRI exam. MR imaging of patients with implants brings specific risks. However, certain implants are approved by the governing regulatory bodies to be MR conditionally safe. For such implants, the previously mentioned warning may not be applicable. Please contact the implant manufacturer for the specific conditional Author | Department 79 information. The conditions for MR safety are the responsibility of the implant manufacturer and user, not of Siemens Healthineers. Unrestricted © Siemens Healthineers, 2020 Notes 84 MODULE WORKBOOK | METAL ARTIFACT REDUCTION: NUMARIS X On account of certain regional limitations of sales rights and service availability, we cannot guarantee that all products included in this brochure are available through the Siemens sales organization worldwide. Availability and packaging may vary by country and is subject to change without prior notice. Some/All of the features and products described herein may not be available in the United States. The information in this document contains general technical descriptions of specifications and options as well as standard and optional features which do not always have to be present in individual cases. Local Contact Information Siemens Medical Solutions USA, Inc. 40 Liberty Blvd. Siemens reserves the right to modify the Malvern, PA 19355-9998 design, packaging, specifications and USA options described herein without prior Telephone: +1-888-826-9702 notice. Please contact your local siemens-healthineers.com Siemens sales representative for the most current information. Legal Manufacturer Imaging & Therapy Systems Magnetic Resonance Note: Any technical data contained in Henkestr. 127 this document may vary within defined DE-91052 Erlangen tolerances. Original images always lose Germany a certain amount of detail when Telephone: +49 9191 18-0 reproduced. siemens-healthineers.com Siemens Healthcare Headquarters Siemens Healthcare GmbH Healthcare Sector Henkestr. 127 91052 Erlangen Germany Phone: +49 9131 84-0 siemens-healthineers.com Published by Siemens Healthcare GmbH · HOOD05162003118186 · Printed in USA · ©Siemens Healthcare GmbH, 2020 85