Copyright 2014 by Hitachi Medical Systems America, Inc. All rights reserved. 9-1 QS4-86806v2 Chapter 9 Breast: Setup Echelon Oval 7-channel RAPID Breast Coil The following items are included with the Echelon Oval 7-channel RAPID Breast Coil: A. Head Rest B. 7-channel RAPID breast coil C. Torso transition piece D. Head rest pad E. Breast coil pad F. Torso transition piece pad G. Breast coil mediastinum pad H. Breast coil strap I. Coil cup cover for medial biopsy J. Coil biopsy immobilization arms: Lateral (2), Medial (2) K. Solid immobilization plates (4) L. Biopsy plate: Grid design (1) * Pillar-post biopsy plates can be ordered through HMSA sales administration. Note: Biopsy plates are single use only and must be ordered separately to perform breast biopsies. Additional biopsy plates can be ordered from HMSA sales administration.
Transcript
Copyright 2014 by Hitachi Medical Systems America, Inc. All rights reserved. 9-1
QS4-86806v2
Chapter 9 Breast: Setup
Echelon Oval 7-channel RAPID Breast Coil
The following items are included with the Echelon Oval 7-channel RAPID Breast Coil:
A. Head RestB. 7-channel RAPID breast coilC. Torso transition pieceD. Head rest padE. Breast coil padF. Torso transition piece padG. Breast coil mediastinum padH. Breast coil strapI. Coil cup cover for medial biopsyJ. Coil biopsy immobilization arms:
* Pillar-post biopsy plates can be ordered through HMSA sales administration.
Note: Biopsy plates are single use only and must be ordered separately to perform breast biopsies. Additional biopsy plates can be ordered from HMSA sales administration.
Copyright 2014 by Hitachi Medical Systems America, Inc. All rights reserved. 9-2
QS4-86806v2
Chapter 9 Breast: SetupFor feet first breast exams, place the 12 channel WIT spine coil nearest the magnet end of the table.
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Place the torso support into the voids in the WIT 8 channel spine coil with the low end toward the gantry.
Note: Breast exams can be performed either feet first or head first on the Echelon OVAL system.
For detailed safety information, refer to the Echelon OVAL Equipment Description and Safety Manual.
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QS4-86806v2
Chapter 9 Breast: Setup
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Place the head holder on the patient table, close to the top of the coil.
Place the Breast coil on the table next to the torso support.
5 Plug the coil into either table connector at the foot end of the table.
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Copyright 2014 by Hitachi Medical Systems America, Inc. All rights reserved. 9-4
QS4-86806v2
Chapter 9 Breast: SetupPosition the patient lying prone on the coil.
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Center the patient’s sternum on the bridge that separates the two halves of the coil. The patient’s breasts must be positioned within each open cavity, with the central part of each breast (from the head-to-foot direction) centered on the transaxial positioning mark on the coil. Using a Velcro strap, adjust the side wings so they are firmly against the sides of the patient.
Adjust the head holder to support the patient’s head.
Place accessory pads under the patient’s arms for support.
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CautionAvoid loops in the cable. Place any excess cable between the patient table and the pads. Prevent the cable from touching the patient or any part of the magnet bore.
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Copyright 2014 by Hitachi Medical Systems America, Inc. All rights reserved. 9-5
QS4-86806v2
Chapter 9 Breast: Setup
Center the laser light to the center of the coil. Press Auto then Set to advance the patient into the magnet.
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Copyright 2014 by Hitachi Medical Systems America, Inc. All rights reserved. 9-6
QS4-86806v2
Chapter 9 Breast: Imaging
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Select the button.
Adjust the presat so that it covers the posterior chest wall.
Select the Shim task. Load the Scanogram SCA images. Adjust the slice number and position to cover both breasts.
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Select the S-Map task. Load the Scanogram SCA images. Adjust the slice number and position to cover the breasts and chest.
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Load your site’s Breast protocol into the exam window. If your site does not have one, select a protocol from the System library.
In the Protocol Properties area, select the Scanogram SCA task, then select the button.
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Select the button. 7
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Copyright 2014 by Hitachi Medical Systems America, Inc. All rights reserved. 9-7
QS4-86806v2
Chapter 9 Breast: Imaging
8 To perform axial breast imaging, select an Axial scan task. Adjust the slice number and position to assure all tissue from both breasts is covered.
Select the button.
When performing axial breast FatSat imaging, adjust the Regional Shim (purple box) to cover both breasts, as displayed.
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11 To perform sagittal breast imaging, select an sagittal scan task. Adjust the slice number and position to assure all tissue from both breasts is covered.
Select the button.
When performing sagital breast FatSat imaging, adjust the Regional Shim (purple box) to cover both breasts, as displayed.
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Copyright 2014 by Hitachi Medical Systems America, Inc. All rights reserved. 9-8
QS4-86806v2
Chapter 9 Breast: Imaging
Navigating the Frequency Graph
Pay close attention to the Frequency Graph every time it is displayed. Sometimes the center frequency line is shifted to center on fat instead of water.
This is common when imaging patients with fatty breasts, or silicone implants, which may not result in a prominent water peak, causing the system to center on the dominant fat peak, or silicone peak, instead of water.
In such cases, you must move the blue line over so that it is centered correctly on water before clicking Continue.
NOTE: When performing breast imaging, always keep in mind what types of tissues, and type of implants, the patient may have as you look at the Frequency Graph.
Frequency graph before adjustment Frequency graph after adjustment
Examples of breast imaging frequency graphs
Fat
Water
Copyright 2014 by Hitachi Medical Systems America, Inc. All rights reserved. 9-9
QS4-86806v2
Chapter 9 Breast: Silicone Implants
Silicone Only ImagingSilicone only imaging utilizes a STIR pulse for Fat Saturation and the RF “FatSat” pulse for water saturation. When both fat and water saturation are applied, only signal from silicone is seen.
At 1.5T, the offset resonance frequency of fat is -224 Hz, and the offset resonance frequency of silicone is -300 Hz. Because of this, up to three peaks may be visualized on the Frequency Graph: siliconefatwater (as displayed left-to-right on the Frequency Graph.
Depending on the amounts of silicone, adipose tissue, and glandular tissue, 3 peaks may not always be visualized. In some cases, there may be a large amount of fat and silicone, and the two peaks can combine. In some cases there is little glandular tissue and a water peak may not be visualized.
Silicone only imaging displayed in the Axial, Coronal and Sagittal views
Frequency Graph demonstration silicone, fat and water peaks
Silicone
Fat
Water
Copyright 2014 by Hitachi Medical Systems America, Inc. All rights reserved. 9-10
QS4-86806v2
Chapter 9 Breast: Silicone Implants
Silicone Only Imaging
3 Peaks Visualized
Water
1 Identify the peaks.
Confirm the Center Frequency (blue line) is centered on the water peak.
Note: The RF “FatSat” pulse (green line) should be centered on the fat peak, as displayed.
SiliconeFat
Water
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2 In the Offset Frequency field, enter the positive value of 224 and press enter.
Note: The RF “FatSat” pulse will shift to the right of the Center Frequency on the Frequency Graph, as displayed.
Select the button.3
Copyright 2014 by Hitachi Medical Systems America, Inc. All rights reserved. 9-11
QS4-86806v2
Chapter 9 Breast: Silicone Implants
Silicone Only Imaging
2 Peaks Visualized
Water
1 Identify the peaks.
Confirm the Center Frequency (blue line) is centered on the water peak.
Note: The RF “FatSat” pulse (green line) may not be centered on the silicone/fat peak, as displayed, due to a larger amount of silicone than fat.
Silicone/Fat
Water
1 2
2 In the Offset Frequency field, enter the positive value of 224 and press ENTER.
Note: The RF “FatSat” pulse will shift to the right of the Center Frequency on the Frequency Graph, as displayed.
Select the button.3
Copyright 2014 by Hitachi Medical Systems America, Inc. All rights reserved. 9-12
QS4-86806v2
Chapter 9 Breast: Silicone Implants
Silicone Only Imaging
1 Peak Visualized
Water
1 Identify the peak.
Adjust the Center Frequency (blue line) to place the RF “FatSat” pulse (green line) over the silicone/fat peak.
Silicone/Fat
1 2
2 In the Offset Frequency field, enter the positive value of 300 and press ENTER.
Note: An Offset Frequency of 300Hz applied because the RF “FatSat” pulse is centered over the silicone/fat peak, which resonates -300Hz from water.
Note: The RF “FatSat” pulse will shift to the right of the Center Frequency on the Frequency Graph, as displayed.
Select the button.3
Copyright 2014 by Hitachi Medical Systems America, Inc. All rights reserved. 9-13
QS4-86806v2
Chapter 9 Breast: Silicone Implants
Fat Saturation Imaging
2 or 3 Peaks Visualized
Water
Identify the peaks.
Adjust the Center Frequency (blue line) to be placed over the water peak.
1 Peak Visualized
Identify the peak.
In the Offset Frequency field, enter the negative value of -300 and press ENTER.
Note: An Offset Frequency of -300Hz applied because the FatSat pulse is centered over the silicone/fat peak, which resonates -300Hz from water.
Adjust the RF “FatSat” pulse (green line) to be placed over the silicone/fat peak.
Silicone/Fat
SiliconeFat
Water
Silicone/Fat
Water
3 peaks 2 peaks
1 peak
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QS4-86806v2
Chapter 9 Breast: Silicone Implants
Silicone Suppression Imaging
Different levels of silicone suppression can be achieved by adjusting the TI time of the silicone suppression task.
Recommended TI Times:550ms = Light suppression650 ms = Medium suppression750 ms = Heavy suppression
The silicone suppression System scan tasks are saved with the TI set to 750 ms.
Note: Changing the TR is not recommended, as TR and TI are directly related. Changing the TR will impact optimal TI time and result in poor silicone suppression.
Light SuppressionTI=550
Medium SuppressionTI=650
Heavy SuppressionTI=750
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QS4-86806v2
Chapter 9 Breast: Saline Implants
Saline Suppression Imaging
The saline suppression scans are FIR sequences with the TI set to null the signal from saline, while fat signal remains bright.
Note: Changing the TR and/or TI are not recommended, as TR and TI are directly related. Changing the TR and/or TI will impact optimal saline suppression.
No Suppression Saline Suppression
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QS4-86806v2
Chapter 9 Breast: Silicone/Saline Implants
Silicone/Saline Combination Implant Imaging
For patients who have implants that are composed of both silicone and saline, it is recommended to perform both silicone and saline implant imaging techniques.
Remember to identify the proper peaks and adjust the Frequency graph as needed.
