www.siemens.

com/healthcare

syngo MR E11
Operator Manual – Ortho

Answers for life.

syngo MR E11
Operator Manual – Ortho
 Legend

Indicates a hint
Provides information on how to avoid operating errors or information emphasizing
important details

Indicates the solution to a problem

Provides troubleshooting information or answers to frequently asked questions

Indicates a list item

Indicates a prerequisite
A condition that has to be fulfilled before starting a particular operation

Indicates a single-step operation

Indicates steps within operating sequences

Italic Used for references and for table or figure titles

Used to identify a link to related information as well as previous or next steps

Bold Used to identify window titles, menu items, function names, buttons, and keys, for
example, the Save button

Blue Used to emphasize particularly important sections of the text

Courier Used for on-screen output of the system including code-related elements or
commands

Courier Identifies inputs you need to provide

Menu > Menu Item Used for the navigation to a certain submenu entry

<variable> Identifies variables or parameters, for example, within a string

CAUTION
&$87,21
Used with the safety alert symbol, indicates a hazardous situation which, if not
avoided, could result in minor or moderate injury or material damage.
CAUTION consists of the following elements:
◾ Information about the nature of a hazardous situation

◾ Consequences of not avoiding a hazardous situation

◾ Methods of avoiding a hazardous situation

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 Legend

WARNING
:$51,1*
Indicates a hazardous situation which, if not avoided, could result in death or
serious injury.
WARNING consists of the following elements:
◾ Information about the nature of a hazardous situation

◾ Consequences of not avoiding a hazardous situation

◾ Methods of avoiding a hazardous situation

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6 Ortho | Operator Manual

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 Table of contents

1 Introduction 11
1.1 Layout of the operator manual 11
1.2 The current operator manual 11
1.3 Intended use 12
1.4 Authorized operating personnel 13
1.4.1 Definitions of different persons 13

2 Measurement 15
2.1 Overview of orthopedic imaging concept 16
2.1.1 High throughput—high-resolution
imaging 16
2.1.2 Advanced imaging techniques 16
2.1.3 Dedicated orthopedic phased array coils 16
2.2 Large Joint Dot Engine 17
2.3 Knee Dot Engine 17
2.3.1 Planning the examination and measuring
the localizer 17
Adapting the examination to the
patient 17
Starting the measurement of the scout 18
Changing the examination strategy
subsequently 19
2.3.2 Adjusting the slices and performing the
measurements 20
2.3.3 3D examinations with integrated MPR
planning 21
2.3.4 Configuring MPR views (optional) 22
Assigning 3D measurements to the
integrated MPR post-processing 23
Adding MPR views 23

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 Table of contents

2.4 Hip Dot Engine 25

2.4.1 Planning the examination and measuring
the localizer 25
Adapting the examination to the
patient 25
Starting the measurement of the scout 26
Changing the examination strategy
subsequently 27
2.4.2 Adjusting the slices and performing the
measurements 28
2.4.3 Bilateral 3D hip examinations with
integrated MPR planning 29
2.5 Shoulder Dot Engine 31
2.5.1 Planning the examination and measuring
the localizer 32
Adapting the examination to the
patient 32
Starting the measurement of the scout 33
Changing the examination strategy
subsequently 33
2.5.2 Adjusting the slices and performing the
measurements 34
2.5.3 3D shoulder examinations with
integrated MPR planning 35
2.6 High-resolution fast 2D imaging 37
2.6.1 Optimization with TSE sequence 37
Advantages 38
Optimizing echo time 38
Optimizing echo train length (ETL) 39
Optimizing fat saturation 40
Optimizing fat suppression 40
BLADE technique 41
Reducing examination noise 42
Reducing SAR for hip imaging 42
2.7 syngo WARP: Imaging near orthopedic implants 43
2.7.1 WARP: high bandwidth 44
2.7.2 WARP: View Angle Tilting (VAT) technique 46
2.7.3 WARP: Slice encoding for metal artifact
correction (SEMAC) 47

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 Table of contents

2.8 Isotropic 3D imaging 49

2.8.1 3D SPACE 49
2.8.2 3D TrueFISP 50
2.8.3 3D DESS 51
2.8.4 MEDIC 53
2.8.5 Image examples 54
2.9 Biochemical imaging 58
2.9.1 Biochemical imaging of cartilage 59
2.9.2 T2 or R2 mapping with syngo MapIt 61
2.9.3 T2 or R2 mapping: protocol parameters 62
2.9.4 Examples in cartilage repair therapies
(microfracture therapy vs MACT therapy) 63
2.9.5 T2* or R2* mapping with syngo MapIt 64
2.9.6 T2* or R2* mapping: protocol parameters 65
2.9.7 Clinical use in cartilage repair therapies
(microfracture therapy) 67
2.9.8 Fast T1 mapping with syngo MapIt 68
T1 mapping with B1 correction 68
2.9.9 T1 mapping: protocol parameters 69

3 Post-processing 71
3.1 Fusing biochemical maps and images 72
3.1.1 Loading the data 72
Loading the maps 72
Loading the original images 72
3.1.2 Optimizing the image display 73
3.1.3 Visualizing the cartilage 74
3.1.4 Saving and filming the images 75

Index 77

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 Introduction 1

1 Introduction
In order to operate the MR system accurately and safely, the
operating personnel must have the necessary expertise as well as
knowledge of the complete operator manual. The operator manual
must be read carefully prior to using the MR system.

1.1 Layout of the operator manual

Your complete operator manual is split up into several volumes to
improve readability. Each of these individual operator manuals covers
a specific topic:
◾ Hardware components (system, coils, etc.)
◾ Software (measurement, evaluation, etc.)
Another element of the complete operator manual is the information
provided for the system owner of the MR system.
The extent of the respective operator manual depends on the system
configuration used and may vary.

 All components of the complete operator manual may include

safety information that needs to be adhered to.

The operator manuals for hardware and software address the

authorized user. Basic knowledge in operating PCs and software is a
prerequisite.

1.2 The current operator manual

This manual may include descriptions covering standard as well as
optional hardware and software. Contact your Siemens Sales
Organization with respect to the hardware and software available for
your system. The description of an option does not infer a legal
requirement to provide it.

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 1 Introduction

The graphics, figures, and medical images used in this operator

manual are examples only. The actual display and design of these
may be slightly different on your system.
Male and female patients are referred to as “the patient” for the sake
of simplicity.

1.3 Intended use

Your MAGNETOM MR system is indicated for use as a magnetic
resonance diagnostic device (MRDD) that produces transverse,
sagittal, coronal and oblique cross sectional images, spectroscopic
images and/or spectra, and that displays the internal structure and/or
function of the head, body, or extremities. Other physical parameters
derived from the images and/or spectra may also be produced.
Depending on the region of interest, contrast agents may be used.
These images and/or spectra and the physical parameters derived
from the images and/or spectra when interpreted by a trained
physician yield information that may assist in diagnosis.
Your MAGNETOM MR system may also be used for imaging during
interventional procedures when performed with MR compatible
devices such as in-room displays and MR Safe biopsy needles.

The MAGNETOM MR system is not a device with measuring

 function as defined in the Medical Device Directive (MDD).

Quantitative measured values obtained are for informational
purposes and cannot be used as the only basis for diagnosis.

 For the USA only: Federal law restricts this device to sale,
distribution and use by or on the order of a physician.

 Your MR system is a medical device for human use only!

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 Introduction 1

1.4 Authorized operating personnel

The MAGNETOM MR system must be operated according to the
intended use and only by qualified persons with the necessary
knowledge in accordance with country-specific regulations, e.g.
physicians, trained radiological technicians or technologists,
subsequent to the necessary user training.
This user training must include basics in MR technology as well as
safe handling of MR systems. The user must be familiar with potential
hazard and safety guidelines the same way the user is familiar with
emergency and rescue scenarios. In addition, the user has to have
read and understood the contents of the operator manual.
Please contact Siemens Service for more information on available
training options and suggested duration and frequency of such
training.

1.4.1 Definitions of different persons

Term used Explanation

User/Operator/ Person who operates the system or software,

Operating per- takes care of the patient or reads images
sonnel
Typically physicians, trained radiological techni-
cians, or technologists

System owner Person who is responsible for the MR environ-

ment. This includes legal requirements, emer-
gency plans, employee information and qualifica-
tions, as well as maintenance/repair.

MR worker Person who works within the controlled access

area or MR environment
User/Operator as well as further personnel (for
example, cleaning staff, facility manager, service
personnel)

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Term used Explanation

Siemens Serv- Group of specially trained persons who are

ice/service per- authorized by Siemens to perform certain mainte-
sonnel nance activities
References to “Siemens Service” include service
personnel authorized by Siemens.

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 Measurement 2

2 Measurement
2.1 Overview of orthopedic imaging concept 16
2.2 Large Joint Dot Engine 17
2.3 Knee Dot Engine 17
2.4 Hip Dot Engine 25
2.5 Shoulder Dot Engine 31
2.6 High-resolution fast 2D imaging 37
2.7 syngo WARP: Imaging near orthopedic implants 43
2.8 Isotropic 3D imaging 49
2.9 Biochemical imaging 58

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2.1 Overview of orthopedic imaging concept

Orthopedic imaging is a comprehensive clinical applications package
focusing on the following areas.

2.1.1 High throughput—high-resolution imaging

High-resolution fast 2D imaging: To deliver extremely high in-plane
2D resolution within clinically acceptable examination times.
( Page 37 High-resolution fast 2D imaging)
Isotropic 3D imaging: To deliver enhanced workflow and increased
diagnostic quality. ( Page 49 Isotropic 3D imaging)

2.1.2 Advanced imaging techniques

For helping in early diagnosis of osteoarthritis or monitoring of
cartilage repair therapy.
Biochemical imaging (syngo MapIt): For improved diagnostic
capabilities and therapy planning. ( Page 58 Biochemical imaging)

2.1.3 Dedicated orthopedic phased array coils

The advances in resolution, image quality, workflow, scan speed and
new imaging fields (biochemical) are only possible due to the
dedicated orthopedic phased Array coils and the flexible coils.
Siemens coils:
◾ Flex Large 4 (knee, shoulder, hip, ankle, pediatric MSK imaging)
◾ Flex Small 4 (wrist, elbow, pediatric MSK imaging)
◾ Body 18 (hip)
◾ Hand/Wrist 16 (hand, wrist)
◾ Foot/Ankle 16 (foot, ankle)
◾ Shoulder Large 16 (large shoulders)
◾ Shoulder Small 16 (small shoulders)
◾ CP Extremity Coil (not capable of parallel imaging)
QED coil:
◾ Tx/Rx 15-Channel Knee Coil

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 Measurement 2

2.2 Large Joint Dot Engine

The Large Joint Dot Engine provides a consistent workflow for all
large joints. It consists of three Dot Engines:
◾ Knee Dot Engine ( Page 17 Knee Dot Engine)
◾ Hip Dot Engine ( Page 25 Hip Dot Engine)
◾ Shoulder Dot Engine ( Page 31 Shoulder Dot Engine)

2.3 Knee Dot Engine

The Knee Dot Engine is intended to simplify and speed up the
examination workflow. It provides guidance and easy adaption of the
examination strategy.
For 3D measurements the creation of MPRs is integrated into the
workflow and supported by a guidance step for MPR planning.
( Page 21 3D examinations with integrated MPR planning)


The Dot Engine user interfaces shown in this operator manual are
examples only. The actual guidance texts and the design may be
slightly different on your system.

2.3.1 Planning the examination and measuring the

localizer
✓ Patient has been registered
✓ Knee Dot Engine has been selected
Adapting the examination to the patient
After registration, the Patient View opens automatically. The default
examination parameters are loaded.

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 2 Measurement

Selecting the examination ◆ From the list: Select a suitable Exam Strategy for the patient.
strategy

standard For standard procedures.

Speed focus Provides fast protocols for when the patient cannot stay in the
scanner for a longer period of time.

Motion-insensitive (BLADE) For uncooperative/moving patients. Provides motion-insensitive

protocols.

High Bandwidth (WARP) Provides protocols with reduced sensitivity to susceptibility arti-
facts if the patient has MR Conditional implants.

 Please adhere to all safety instructions regarding implants. (Refer

to Operator Manual – MR System.)

The pending protocols of the measurement queue are updated

upon your selection.
Starting the measurement of the scout
The AAscout is used to determine anatomical structures.
◆ To start the Knee Dot Engine workflow, confirm the settings in the
Patient View.

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 Measurement 2

Results:
◾ The AutoAlign Scout is automatically measured and displayed.
◾ The localizer is the basis for the AutoAlign functionality, which
provides consistent slice positioning of knee protocols without
user interaction. (For a detailed description of the AutoAlign
feature, please refer to: Operator Manual – System and data
management.)
◾ The next protocol opens.
Changing the examination strategy subsequently

Accessing the Patient View You can access the Patient View at any time during the examination.

1 To open the view, click the icon.

2 To confirm the settings and close the view, click the icon.

Modifying parameters of Changes in the Patient View only apply to pending protocols in the
measured protocols measurement queue.
1 To change the status of a protocol from measured to pending,
select the measured protocol.
2 Select Rerun from here from the context menu (right-click with
the mouse).
3 Open the Patient View.
– or –
Select Rerun from here with from the context menu (right-click
with the mouse)
The Patient View opens automatically.
4 Enter the requested modifications.

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 2 Measurement

2.3.2 Adjusting the slices and performing the

measurements
✓ Localizers are displayed
In the GSP segments, the slices for the following protocol are
positioned by AutoAlign Knee. (For a detailed description of the
AutoAlign feature, please refer to: Operator Manual – System and
data management.) Sample images with typical slice positioning are
displayed in the Guidance View.

Example: Guidance View for coronal slice positioning.

1 Check the slice positions for all subsequent measurements and

adjust them, if necessary.

You can also modify several sequence parameters of the current

protocol using the Parameter View. Here you find the most
important sequence parameters, e.g. the number of slices.


To display the complete sequence parameters of the Routine
parameter card, click the icon.

2 Start the measurement.

The measurement is performed. The next protocol opens.

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 Measurement 2

3 Repeat the above steps for all subsequent measurements.

2.3.3 3D examinations with integrated MPR planning

The 3D Knee Dot Engine provides an integrated planning step for
MPR post-processing. MPRs of one or multiple 3D measurements are
calculated immediately after each measurement. The MPR planning
opens after the 3D measurements have been started. You are able to
plan multiple MPR views with different orientations while the 3D
measurements are running.
✓ During registration, the 3D Knee Dot Engine was selected
✓ 3D measurement has been started and the MPR planning step has
opened

Example: Guidance View for sagittal MPR view.

1 Select the desired MPR view from the list on the left side of the
Guidance View.
The corresponding MPR slice positions and orientations are
displayed in the GSP segments.
2 Adapt the slice positioning, if necessary.

 In the Parameter View: You can also modify the view parameters
alpha-numerically, e.g. the FoV.

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3 Repeat the above steps for all MPR views.

4 Save the MPR settings.
As soon as the 3D measurements have been concluded, the
reconstruction of the MPRs is started automatically. For each 3D
measurement, the defined MPR views are generated.
The names of the resulting image series are a combination of the
protocol name and the MPR view. For example:
◾ First 3D measurement: T1_SPC_FS
◾ Planned MPR views:
– transversal
– coronal
– sagittal
◾ Reconstructed MPR image series:
– T1_SPC_FS_MPR_tra
– T1_SPC_FS_MPR_cor
– T1_SPC_FS_MPR_sag

 If you repeat a 3D measurement, a new set of MPRs is calculated.

 You may use the resulting MPR views for the slice planning of
subsequent measurements.

2.3.4 Configuring MPR views (optional)

Dot Engine Step: The Dot Engine Step defines which strategies,
decisions and global parameters are valid for the complete Dot
Engine workflow examination. (For a detailed description, please
refer to: Operator Manual – Dot Cockpit.)
Dot add-ins are predefined add-ins for Dot Engine Steps and
program steps. Depending on the selected Dot add-in, you can
configure different parameters of the Dot Engine Step.

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 Measurement 2

Knee Dot add-ins:

◾ Generic Views
◾ MPR Assignment
◾ MPR Planning
Assigning 3D measurements to the integrated MPR post-
processing
Using the MPR Assignment Dot add-in you can define, for which 3D
protocols the MPR post-processing is performed.
1 In the Dot Cockpit - Explorer: Select a 3D protocol.
2 Select Edit to open the protocol in the Program Editor.
3 Open the Step Properties dialog window by double-clicking the
protocol.
4 Select AddIn Configuration.
5 Select MPR Assignment and activate the desired checkboxes.

Adding MPR views

Using the MPR Planning add-in, you can add new MPR views.
1 In the Queue: Select the MPR planning program step.
2 Open the Step Properties dialog window by double-clicking.

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 2 Measurement

3 Select AddIn Configuration.

4 Select MPR Planning.
5 Add the MPR view by clicking Add MPR range.

A new default MPR view is added to the list of available views.

Renaming views 1 Right-click the added view with the mouse.

2 From the context menu: Select Rename.

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 Measurement 2

3 Enter the new name.

4 Set the Guidance and Parameter Views. (Refer to Operator
Manual – Dot Cockpit.)

Removing views 1 Right-click the view with the mouse.

2 From the context menu: Select Remove.

2.4 Hip Dot Engine

The Hip Dot Engine is intended to simplify and speed up the
examination workflow. It provides guidance and easy adaption of the
examination strategy.
The Hip Dot Engine offers three workflows:
◾ Two standard conventional 2D-workflows (unilateral and bilateral)
and
◾ One bilateral 3D-workflow
For 3D measurements the creation of MPRs is integrated into the
workflow and supported by a guidance step for MPR planning.
( Page 29 Bilateral 3D hip examinations with integrated MPR
planning)


The Dot Engine user interfaces shown in this operator manual are
examples only. The actual guidance texts and the design may be
slightly different on your system.

2.4.1 Planning the examination and measuring the

localizer
✓ Patient has been registered
✓ Hip Dot Engine has been selected
Adapting the examination to the patient
After registration, the Patient View opens automatically. The default
examination parameters are loaded.

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 2 Measurement

Selecting the examination ◆ From the list: Select a suitable Exam Strategy for the patient.
strategy

standard For standard procedures.

Speed focus Provides fast protocols for when the patient cannot stay in the
scanner for a longer period of time.

High Bandwidth (WARP) Provides protocols with reduced sensitivity to susceptibility arti-
facts if the patient has MR Conditional implants.

 Please adhere to all safety instructions regarding implants. (Refer

to Operator Manual – MR System.)

The pending protocols of the measurement queue are updated

upon your selection.
Starting the measurement of the scout
The AAHip_Scout is used to determine anatomical structures.
◆ To start the Hip Dot Engine workflow, confirm the settings in the
Patient View.

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 Measurement 2

Results:
◾ The AutoAlign Scout is automatically measured and displayed.
◾ The localizer is the basis for the AutoAlign functionality, which
provides consistent slice positioning of hip protocols without
user interaction. (For a detailed description of the AutoAlign
feature, please refer to: Operator Manual – System and data
management.)
◾ The next protocol opens.
Changing the examination strategy subsequently

Accessing the Patient View You can access the Patient View at any time during the examination.

1 To open the view, click the icon.

2 To confirm the settings and close the view, click the icon.

Modifying parameters of Changes in the Patient View only apply to pending protocols in the
measured protocols measurement queue.
1 To change the status of a protocol from measured to pending,
select the measured protocol.
2 Select Rerun from here from the context menu (right-click with
the mouse).
3 Open the Patient View.
– or –
Select Rerun from here with from the context menu (right-click
with the mouse)
The Patient View opens automatically.
4 Enter the requested modifications.

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 2 Measurement

2.4.2 Adjusting the slices and performing the

measurements
✓ Localizers are displayed
In the GSP segments, the slices for the following protocol are
positioned by AutoAlign Hip. Sample images with typical slice
positioning are displayed in the Guidance View.

Example: Guidance View for coronal slice positioning.

1 Check the slice positions for all subsequent measurements and

adjust them, if necessary.
2 To modify several sequence parameters of the current protocol,
open the Parameters View.

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 Measurement 2

Here you find the most important sequence parameters, e.g., the
number of slices.

To display the complete sequence parameters of the Routine

parameter card, click the icon.


3 Start the measurement.
The measurement is performed. The next protocol opens.
4 Repeat the above steps for all subsequent measurements.

2.4.3 Bilateral 3D hip examinations with integrated MPR

planning
The 3D workflows of the Hip Dot Engine provide an integrated
planning step for MPR post-processing. MPRs of one or multiple 3D
measurements are calculated immediately after each measurement.
The MPR planning opens after the 3D measurements have been
started. You are able to plan multiple MPR views with different
orientations while the 3D measurements are running. For a detailed
description of configuring MPR views, please refer to:
( Page 22 Configuring MPR views (optional)).

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✓ During registration, a 3D workflow was selected

✓ 3D measurement has been started and the MPR planning step has
opened

Example: Parameters View for sagittal left MPR planning.

1 Select the desired MPR view from the list on the left side of the
Parameters View.
The corresponding MPR slice positions and orientations are
displayed in the GSP segments.
2 Adapt the slice positioning, if necessary.

 In the Parameters View: You can also modify the view

parameters alpha-numerically, e.g. the FoV.

3 Repeat the above steps for all MPR views.

4 Save the MPR settings.
As soon as the 3D measurements have been concluded, the
reconstruction of the MPRs is started automatically. For each 3D
measurement, the defined MPR views are generated.

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 Measurement 2

The names of the resulting image series are a combination of the

protocol name and the MPR view. For example:
◾ First 3D measurement: PD_SPC_FS
◾ Planned MPR views:
– transversal
– coronal
– sagittal
◾ Reconstructed MPR image series:
– PD_SPC_FS_MPR_tra
– PD_SPC_FS_MPR_cor
– PD_SPC_FS_MPR_sag

 If you repeat a 3D measurement, a new set of MPRs is calculated.

 You may use the resulting MPR views for the slice planning of
subsequent measurements.

2.5 Shoulder Dot Engine

The Shoulder Dot Engine is intended to simplify and speed up the
examination workflow. It provides guidance and easy adaption of the
examination strategy.
The Shoulder Dot Engine offers two workflows:
◾ Standard conventional 2D-workflow and
◾ 3D-workflow
For 3D measurements the creation of MPRs is integrated into the
workflow and supported by a guidance step for MPR planning.
( Page 35 3D shoulder examinations with integrated MPR
planning)

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
The Dot Engine user interfaces shown in this operator manual are
examples only. The actual guidance texts and the design may be
slightly different on your system.

2.5.1 Planning the examination and measuring the

localizer
✓ Patient has been registered
✓ Shoulder Dot Engine has been selected
Adapting the examination to the patient
After registration, the Patient View opens automatically. The default
examination parameters are loaded.

Selecting the examination ◆ From the list: Select a suitable Exam Strategy for the patient.
strategy

standard For standard procedures.

Speed focus Provides fast protocols for when the patient cannot stay in the
scanner for a longer period of time.

Motion-insensitive (BLADE) For uncooperative/moving patients. Provides motion-insensitive

protocols.

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 Measurement 2

 Please adhere to all safety instructions regarding implants. (Refer

to Operator Manual – MR System.)

The pending protocols of the measurement queue are updated

upon your selection.
Starting the measurement of the scout
The AAShoulder_Scout is used to determine anatomical structures.
◆ To start the Shoulder Dot Engine workflow, confirm the settings
in the Patient View.
Results:
◾ The AutoAlign Scout is automatically measured and displayed.
◾ The localizer is the basis for the AutoAlign functionality, which
provides consistent slice positioning of shoulder protocols
without user interaction. (For a detailed description of the
AutoAlign feature, please refer to: Operator Manual – System
and data management.)
◾ The next protocol opens.
Changing the examination strategy subsequently

Accessing the Patient View You can access the Patient View at any time during the examination.

1 To open the view, click the icon.

2 To confirm the settings and close the view, click the icon.

Modifying parameters of Changes in the Patient View only apply to pending protocols in the
measured protocols measurement queue.
1 To change the status of a protocol from measured to pending,
select the measured protocol.
2 Select Rerun from here from the context menu (right-click with
the mouse).

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3 Open the Patient View.

– or –
Select Rerun from here with from the context menu (right-click
with the mouse)
The Patient View opens automatically.
4 Enter the requested modifications.

2.5.2 Adjusting the slices and performing the

measurements
✓ Localizers are displayed
In the GSP segments, the slices for the following protocol are
positioned by AutoAlign Shoulder. Sample images with typical slice
positioning are displayed in the Guidance View.

Example: Guidance View for transversal slice positioning.

1 Check the slice positions for all subsequent measurements and

adjust them, if necessary.
2 To modify several sequence parameters of the current protocol,
open the Parameters View.

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Here you find the most important sequence parameters, e.g., the
number of slices.

To display the complete sequence parameters of the Routine

parameter card, click the icon.


3 Start the measurement.
The measurement is performed. The next protocol opens.
4 Repeat the above steps for all subsequent measurements.

2.5.3 3D shoulder examinations with integrated MPR

planning
The 3D workflow of the Shoulder Dot Engine provides an integrated
planning step for MPR post-processing. MPRs of one or multiple 3D
measurements are calculated immediately after each measurement.
The MPR planning opens after the 3D measurements have been
started. You are able to plan multiple MPR views with different
orientations while the 3D measurements are running. For a detailed
description of configuring MPR views, please refer to:
( Page 22 Configuring MPR views (optional)).

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✓ During registration, the 3D workflow was selected

✓ 3D measurement has been started and the MPR planning step has
opened

Example: Parameters View for sagittal MPR planning

1 Select the desired MPR view from the list on the left side of the
Parameters View.
The corresponding MPR slice positions and orientations are
displayed in the GSP segments.
2 Adapt the slice positioning, if necessary.

 In the Parameters View: You can also modify the view

parameters alpha-numerically, e.g. the FoV.

3 Repeat the above steps for all MPR views.

4 Save the MPR settings.
As soon as the 3D measurements have been concluded, the
reconstruction of the MPRs is started automatically. For each 3D
measurement, the defined MPR views are generated.

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The names of the resulting image series are a combination of the

protocol name and the MPR view. For example:
◾ First 3D measurement: PD_SPC_FS
◾ Planned MPR views:
– transversal
– coronal
– sagittal
◾ Reconstructed MPR image series:
– PD_SPC_FS_MPR_tra
– PD_SPC_FS_MPR_cor
– PD_SPC_FS_MPR_sag

 If you repeat a 3D measurement, a new set of MPRs is calculated.

 You may use the resulting MPR views for the slice planning of
subsequent measurements.

2.6 High-resolution fast 2D imaging

Imaging of the musculoskeletal (MSK) system requires high
resolution with the necessary contrast for precise detection of small
and complex structures.

2.6.1 Optimization with TSE sequence

The flexible TSE sequence is optimized for a maximum matrix size and
small FoV. This TSE sequence, together with parallel imaging
techniques, delivers extremely high in-plane 2D resolution within
clinically acceptable examination times, allowing for a more accurate
diagnosis.

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 Alternative protocols with faster scan times are also available in

the Siemens protocol tree.

The concept of high-resolution fast imaging utilizing the TSE sequence. The
high-resolution fat-suppressed PD-weighted TSE image is a tool helping in
accurate diagnosis.

Advantages
By using new reordering techniques, the TSE sequence allows for:
◾ a more flexible choice of TE for better optimization of contrast
◾ a more flexible choice of echo train lengths to maintain image
contrast while optimizing protocols
◾ a flexible choice of fat suppression techniques (WEAK, STRONG,
SPAIR, STIR)
Optimizing echo time
PD-weighted contrast is the “gold standard” in differentiating cartilage
defects. Contrast is optimized by varying the echo time (the preferred
TE varies from physician to physician).

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(1) TE 20 ms
(2) TE 40 ms

Optimizing echo train length (ETL)

Increasing the ETL will reduce the scan time while the contrast is
mostly maintained. The flexible reordering scheme allows greater
flexibility (even and odd ETL, reduced blurring).

(1) TE 24 ms; ETL 5; 4 min

(2) TE 24 ms; ETL 7; 3 min
(3) TE 24 ms; ETL 10; 2 min
(4) TE 24 ms; ETL 15; 1:20 min

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Optimizing fat saturation

Fat saturation is useful when imaging suspected bone trauma or
edema. It allows good differentiation of surface cartilage lesions.
FatSat: Uses a spectrally selective pulse to saturate the fat spins
before the imaging sequence. Has 2 settings: (a) STRONG which
delivers a darker fat than (b) WEAK.
SPAIR: Uses an adiabatic spectrally selective pulse which is insensitive
to dielectric effects. Useful at 3 Tesla in the hip.
STIR: Uses a spatial inversion pulse with a short inversion time to null
fat. Only recommended where fat suppression is difficult due to B0
issues, i.e., with MR Conditional implants.

Example: A cartilage tear can sometimes be better visualized using FatSat

techniques (right) as shown above.

Optimizing fat suppression

For MSK imaging the fat suppression can be optimized for TSE, SE and
SPACE sequences.
The main advantages are:
◾ increased saturation homogeneity
◾ increased saturation strength
◾ decreased sensitivity to B0 inhomogeneities

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The optimized fat suppression region Joints for MSK imaging can

 be selected in the Fat Suppression Optimization dialog window.

To open the dialog window, click the button on the right side of
the Fat suppr. dropdown menu. Prerequisite: Fat sat. is selected.

 Protocols for joints imaging are provided for 3 Tesla only.

 The optimized fat suppression should only be used for foot-ankle,

knee, hand-wrist and elbow imaging.

BLADE technique
The BLADE technique is available for all MSK regions and can be
configured for T1, T2, and PD contrasts. It is compatible with multi-
channel coils, and iPAT can be employed. Any orientation can be used
(sagittal, coronal and axial). BLADE is fully integrated in the TSE
sequence.
For a detailed description, please refer to: Application Brochure “Pulse
Sequences”.

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Advantages of oversampling:
◾ Wrap-around artifacts (streaking) avoided
◾ Good results with respect to movement artifacts
◾ Increased SNR

(1) Knee coronal: FoV 130 × 130, 0.4 mm × 0.4 mm, TE = 47 ms

(2) Wrist: FoV 100 × 100, 0.3 mm × 0.3 mm, TE = 47 ms

Reducing examination noise

The quiet MR sequences increase patient comfort and enable MR
examinations for noise-sensitive patients. The noise reduction mainly
depends on the protocol settings. Compared to conventional
imaging, a reduction of approximately 10 dB(A) can be achieved.
Quiet protocols are available in the Siemens protocol tree.
The protocols for quiet MSK imaging include:
◾ localizer based on GRE sequence
◾ protocols based on TSE and SE sequences with different contrasts
For a detailed description of the quiet MR sequences, please refer to
Operator Manual – Neuro.
Reducing SAR for hip imaging
In particular unilateral hip examinations are limited by SAR. For this
reason, B1 shimming provides an option to reduce the SAR level of a
protocol by optimizing the transmit parameters of the pTx channels.

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In addition, protocols with reduced SAR are provided for unilateral hip
imaging.

 Select Low SAR patient specific from the B1 Shim mode list in
the System pTx Volumes parameter card.

 The SAR reduction depends on the size and position of the FOV
and requires an additional adjustment scan.

2.7 syngo WARP: Imaging near orthopedic

implants
MR imaging in the vicinity of metal implants is challenging, firstly
because of safety concerns and secondly because of image
distortions. In general, an MR examination is contraindicated for
patients with electronic or electronically conductive implants or
metals, especially those containing ferromagnetic foreign matter.


Particularly with regard to magnetic forces and heating of
implants and surrounding tissue, please adhere to all safety
instructions. (Refer to Operator Manual – MR System.)

The main source of artifacts seen when imaging patients with MR

Conditional implants is related to distortions of the local magnetic
field caused by the large difference in magnetic susceptibility
between metal and tissue. The degree of field distortions depends on
the shape, the location and the material properties of the metal
implant.
syngo WARP provides dedicated imaging techniques based on the TSE
sequence in order to reduce susceptibility-related artifacts:

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◾ high bandwidth optimizations to reduce the level of artifacts, for

example geometric distortions and contrast changes are minimized
◾ VAT (View Angle Tilting) technique to correct for in-plane
distortions (geometric distortion of the frequency encoding, for
example image pixels are displaced along the frequency-encoding
direction)
◾ SEMAC (Slice Encoding for Metal Artifact Correction) technique to
correct for through-plane distortions (geometric distortions of the
excited slice profile, for example the excited slices are curved
instead of being plane)

 VAT and SEMAC are available if the WARP checkbox is activated

in the Sequence Part 2 parameter card.

2.7.1 WARP: high bandwidth

By activating the WARP checkbox, the bandwidth of the RF pulses will
be increased. In combination with a high readout bandwidth
selected, the TSE sequence becomes less sensitive to field distortions.
High readout bandwidth:

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◾ reduces in-plane distortions

◾ avoids image blurring when using the VAT technique
◾ reduces the SNR of the image
High RF pulse bandwidth (combined with small slice thickness):
◾ reduces through-plane distortions
◾ depends on the RF pulse type: Fast has a higher bandwidth, but
also a higher SAR
◾ increases the specific absorption rate (SAR)

Practical hints for imaging near MR Conditional implants with the

TSE sequence:
◾ always select the WARP checkbox
◾ select a high readout bandwidth, for most cases 400-500 Hz/

 pixel is an advisable value

◾ select RF pulse type Fast unless the SAR gets too high
◾ SAR can be reduced by selecting a lower refocusing flip angle
◾ replace conventional fat suppression by STIR imaging (Short
Tau Inversion Recovery): select magnetic preparation Slice-sel.
IR with TI approx. 160ms (1.5T) or 200ms (3T)

 If WARP is selected, a “W” is added to the sequence string

displayed in the image (only if VAT and SEMAC are not selected).

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(1) without syngo WARP

(2) with syngo WARP

2.7.2 WARP: View Angle Tilting (VAT) technique

VAT compensates in-plane distortions by adding an additional
readout gradient in the slice direction. The corresponding value in the
Sequence Part 2 parameter card specifies the amplitude of the view
angle tilting gradient:
◾ 0%: VAT is deactivated (no distortion correction)
◾ 100%: VAT has the same amplitude as the slice-selective gradient
(full readout distortion correction)
Performing the measurement with VAT may cause blurring of the
image. Blurring can be reduced by:
◾ using thin slices
◾ using a high readout bandwidth

The result of VAT strongly depends on the type and orientation of

the implant, as well as other imaging parameters. In general, VAT

 can only reduce in-plane distortions. If VAT does not improve the
image quality, this means that other effects are dominating, for
example through-plane distortions. In that case, try to use
thinner slices, RF pulse type Fast or SEMAC.

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 If VAT is selected, a “V” is added to the sequence string displayed

in the image (only if SEMAC is not selected).

(1) without VAT

(2) with VAT

2.7.3 WARP: Slice encoding for metal artifact correction

(SEMAC)
SEMAC provides a through-plane distortion correction by performing
additional phase encoding in the slice direction. SEMAC is most
effective for severe field distortions, for example near large metal
structures such as full joint replacement of the hip or knee.
SEMAC can only be applied in combination with:
◾ VAT set to 100%
◾ slice distance of 0%
A SEMAC value of 0 means that no SEMAC is applied.

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The measurement time will be prolonged by the number of

SEMAC steps. Since SEMAC increases the SNR, try to reduce the
scan time by reducing averages, apply parallel imaging or partial
fourier.
The required number of SEMAC phase-encoding steps depends


on the size, shape and material of the implant and may vary from
patient to patient. For joint arthroplasty 8-12 SEMAC steps is
usually a reasonable value. Metals causing stronger artifacts,
such as stainless steel or cobalt chromium alloys, require higher
SEMAC steps, whereas titanium implants usually require lower
values or even no SEMAC at all.
SEMAC cannot be used in combination with 3D TSE, BLADE,
TimCT, multiple slice groups, and DIXON.

 If SEMAC is selected, a “S” is added to the sequence string

displayed in the image text.

(1) without SEMAC

(2) with SEMAC

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2.8 Isotropic 3D imaging

High-resolution fast isotropic 3D imaging is becoming increasingly
more important as a means of enhancing workflow and providing
more accurate diagnosis. Isotropic 3D imaging allows for fully flexible
examination, i.e. depending on the suspected diagnosis, images can
be reformatted in any plane.
Isotropic sequences: Using an isotropic 3D sequence, the images can
be reformatted with high in-plane and through-plane resolution.
Utilization of such a sequence introduces further improvements in the
workflow by acquiring one 3D series that can be reformatted in the
different planes needed for precise diagnosis.
Siemens provides five different sequences with specified contrasts:
◾ 3D SPACE ( Page 49 3D SPACE)
◾ 3D TrueFISP ( Page 50 3D TrueFISP)
◾ 3D DESS (Dual Echo Steady State) ( Page 51 3D DESS)
◾ 3D MEDIC ( Page 53 MEDIC)
◾ 3D FISP
For a detailed description of the sequences, please refer to:
Application Brochure “Pulse Sequences”.

2.8.1 3D SPACE
Concept: Different planes can be reconstructed from the isotropic
data set for high-resolution diagnosis of cartilage, ligaments, and
meniscus in the knee joint.

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(1) PD-weighted SPACE, isotropic resolution 0.5 mm

(2) PD-weighted SPACE with FatSat, isotropic resolution 0.5 mm

2.8.2 3D TrueFISP
The TrueFISP sequence is used for balanced steady state imaging. On
each of the gradient axes the net gradient moment is zero. It has a
good SNR, but is prone to banding artifacts in regions of
compromised homogeneity, i.e., MR Conditional implants.

(1) RF
(2) Slice selection

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(3) Phase encoding

(4) Frequency encoding
(5) Signal (SS-FID/SS-echo)

 Minimize TR by selecting a high readout bandwidth to avoid

interference streaks in the image.

Ankle, isotropic resolution 0.3 mm, reformatted below in sagittal, coronal, and
axial direction.

2.8.3 3D DESS
In the steady state, two signals are produced—an FID signal and an
echo. With DESS (Dual Echo Steady State) these two signals are
measured and combined to produce a single image.

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(1) RF
(2) Slice selection
(3) Phase encoding
(4) Frequency encoding
(5) Signal (SS-FID/SS-echo)


Use primarily in orthopedic imaging with good contrast between
synovial fluid and cartilage. A non-selective excitation pulse is
activated beforehand for fat suppression at a short TR.

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(1) Shoulder, isotropic resolution 0.7 mm

(2) Knee, isotropic resolution 0.6 mm

2.8.4 MEDIC
The MEDIC sequence is a multi-echo GRE sequence where up to 6
echoes are combined to produce a single image.

(1) RF
(2) Slice selection
(3) Phase encoding

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(4) Frequency encoding

(5) Signal (dashed line: T2* decay)

 Gives very good contrast for meniscus evaluation.

(1) Shoulder coronal

(2) Knee sagittal

2.8.5 Image examples

Example: 10 minute knee exam

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Isotropic data set 0.5 mm.

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Reformat along x diagnosis-based planes:

(1) Meniscus reformat

(2) ACL reformat
(3) Coronal reformat
(4) Patella reformat

Example: Precise localization of anatomy (meniscus)

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Example: Complex geometry—simple reformatting (radial reformats

for hip imaging)

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2.9 Biochemical imaging

Biochemical Imaging is gaining in importance. It improves both the
accuracy of diagnosis and planning and also monitors the
effectiveness of therapy.
At present, the main focus is on:
◾ T2 and T2* mapping,
◾ T1 mapping

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The diagnostic advantages and possible clinical use of these

techniques are still under investigation, but due to syngo MapIt,
the two main limitations involving the clinical use of these
techniques have been solved.

 ◾ Dedicated sequences at the clinical scanner within the protocol

tree.
◾ Inline Mapping for assessment of the relaxation times and data
at the clinical scanner or PACS.
◾ In addition, by using syngo Fusion, the maps can be overlaid
on anatomical images for reading and filming purposes.

The concept of biochemical imaging is illustrated below for patients

with cartilage repair therapy. The different relaxation times can be
used for assessment of the tissue in addition to the morphological
scan (maps fused with syngo Fusion).

2.9.1 Biochemical imaging of cartilage

Several biochemical imaging techniques that map biochemical
changes within the cartilage have been trialed within the scientific
community.
◾ T1 mapping: used in dGEMRIC studies to measure the proteoglycan
content of the cartilage.
◾ T2 mapping: provides information on the collagen orientation and
the water content of the cartilage.
◾ DWI: provides information on the anisotropy and collagen
orientation.
◾ Magnetization transfer: collagen orientation.

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(1) Cell
(2) Collagen
(3) GAG (glycosaminoglycan)
(4) Water/mobile ions

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Courtesy of S. Trattnig, Dept. Radiology, University Vienna.

(1) T2 map
(2) T1 map (dGEMRIC)

2.9.2 T2 or R2 mapping with syngo MapIt

Clinical use to aid in:
◾ Cartilage repair therapies (microfracture therapy vs MACT therapy).
(MACT = Matrix-associated Autologous Chondrocyte
Transplantation).
◾ Cartilage repair therapies (MACT therapy follow up)
◾ Early OA detection (femoral acetabular impingement). (OA =
Osteoarthritis).

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T2 provides information on structural changes in the collagen within

the cartilage. T2 depends on the orientation as a function of the
“magic angle” effect.
T2 provides information on changes in the water content of the
cartilage. Compressed areas show less water content—lower T2. Less
compressed areas show greater water content—higher T2.
T2 has been used to study cartilage repair therapies and to provide
information on cartilage softening.
T2 is measured using a multi-echo spin echo with up to 32 echoes.
Each echo produces an image. The map is produced by a pixel-by-
pixel analysis.
Instead of T2, R2 = 1/T2 can optionally be calculated.

2.9.3 T2 or R2 mapping: protocol parameters

 For T2 or R2 mapping use the “se_mc” sequence. Use the Inline

MapIt parameter card.

MapIt Select T2 or R2 to turn on the Inline tech-

nology.

Measurements Are set to 1.

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Contrasts Up to 32 echoes possible. More echoes

provide a better fit.

TE Set the echo time for each echo. Keep

maximum TE to less than or similar to
expected T2 values.

TR Use TR values > 1000 ms.

Noise threshold Echoes with signals less than this value

will be ignored in the fit. If in doubt, leave
at default value.

Save original images Keeps the morphological base images in

the database.

2.9.4 Examples in cartilage repair therapies (microfracture

therapy vs MACT therapy)
MFX therapy creates microfractures in the bone. Cartilage
regeneration is promoted by the released blood and marrow.
These are the characteristics of this method:
◾ Reduced T2 in the region of MFX therapy.
◾ Matrix-associated autologous chondrocyte transplantation (MACT).
◾ An operative procedure using a cell seeded collagen matrix.
◾ Used for the treatment of localized full thickness cartilage defects.

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Courtesy of S. Trattnig, Dept. Radiology, University Vienna.

2.9.5 T2* or R2* mapping with syngo MapIt

T2* is the apparent transverse relaxation rate and has a T2
component. It can be used as a substitute for T2 mapping.
Instead of T2*, R2* = 1/T2* can be optionally calculated.
T2* also has a component which depends on the field change within
the voxel, resulting from:
◾ Macroscopic field changes, i.e. main field homogeneity, large
susceptibility fields from implants.
◾ Macroscopic field changes due to susceptibility variations, i.e.
bone-cartilage interface.
◾ Microscopic field changes from the microstructure within the
voxel.

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
T2* is measured using a multi-echo gradient-echo sequence.
Each TE gives an image. A pixel-by-pixel analysis produces the
T2* map.

(1) RF
(2) Slice selection
(3) Phase encoding
(4) Frequency encoding
(5) Signal (dashed line: T2* decay)

2.9.6 T2* or R2* mapping: protocol parameters

 For T2* or R2* mapping use the “gre” sequence. Use the Inline
MapIt parameter card.

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MapIt Select T2* or R2* to turn on the Inline

technology.

Measurements Are set to 1.

Contrasts Up to 12 echoes possible.

TE Set the echo time for each echo. Keep

maximum TE to less than or similar to
expected T2 values.

Noise threshold Echoes with signals less than this value

will be ignored in the fit. If in doubt, leave
at default value.

Save original images Keeps the morphological base images in

the database.

In the Sequence Part 1 parameter card:

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Contrasts Up to 12 echoes possible.

Bandwidth Must be entered for each echo. Use the

same bandwidth for all echoes.

Flow comp. Useful in the abdomen

Readout mode Select mono or bi-polar

2.9.7 Clinical use in cartilage repair therapies

(microfracture therapy)
MFX therapy creates microfractures in the bone. Cartilage
regeneration is promoted by the released blood and marrow. T2* is
reduced in the region of MFX therapy. A small patient study suggests
that variability is better with T2*.

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2.9.8 Fast T1 mapping with syngo MapIt

Clinical use to aid in:
◾ dGEMRIC
◾ Pre-operative staging
◾ Prediction of therapy outcome
◾ Therapy follow up
T1 mapping is used in cartilage to track proteoglycans. The gold
standard was multiple IR spin echo measurements. However, the very
long acquisition time of up to 30 minutes makes it clinically difficult.
Fast T1 mapping with syngo uses a 2 angle VIBE measurement. The
acquisition time is significantly reduced to 3 minutes. To calculate T1,
this technique utilizes 2 spoiled GRE measurements, each identical
except for different flip angles.
syngo MapIt calculates T1 on a pixel-by-pixel basis.
T1 mapping with B1 correction
Variable flip angle techniques used by syngo MapIt are intrinsically
sensitive to inhomogeneities of the transmit RF field (B1). syngo
MapIt can perform B1 corrections to improve the spatial homogeneity
and the reproducibility of the acquired T1 maps.

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To enable this feature, run the Siemens B1mapForT1mapping

protocol prior to the T1 mapping protocol. The three-dimensional FoV
of the B1mapForT1mapping protocol should be greater or equal to
the FoV of the T1 mapping protocol. B1 corrections will be performed
automatically. The image series with the corrected T1 maps is marked
as T1_Images_B1corr instead of T1_Images.

Please note: The resulting T1 map values may overestimate the

 absolute T1 values! This behavior is expected due to the

technique used – the variable flip angle method. Thus a relative
comparison of T1 values within tissues should be made.

2.9.9 T1 mapping: protocol parameters

 For fast T1 mapping use the “vibe” sequence. Use the Inline
MapIt parameter card.

MapIt Select T1 map.

Auto angle calcula- Select, if required.

tion

T1 estimate Two optimum angles will be automatically

calculated, based on the estimated T1.

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Flip angle Alternatively, select two flip angles.

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3 Post-processing
3.1 Fusing biochemical maps and images 72

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3.1 Fusing biochemical maps and images

The following example describes how to overlay T2/T2* maps
generated with syngo MapIt with their corresponding anatomical
images. Subsequently, manual cartilage segmentation is performed.


The same procedure applies when using T1 maps. In this case,
two series containing the morphological base images for the two
flip angles are stored together with the T1 map series.

3.1.1 Loading the data

✓ T2/T2* maps have been generated with syngo MapIt
✓ Anatomical base images are available (Save original images
activated during mapping)
Loading the maps
1 Select the mapping series in the Patient Browser.
2 Click the 3D MPR icon to start image processing as MPR.
3 Window the mapping images to optimize their contrast and
brightness.

Loading the original images

The series preceding the T2/T2* maps contains the morphological
base images for all echoes.
1 Select the morphological series in the Patient Browser.
2 Load the data to 3D Fusion with the icon.

3 In the 3D Series List, select the echo images you want to use.

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The Fusion Registration dialog window is displayed. Registration

is not needed in this case.
4 Skip Fusion Registration with OK.

3.1.2 Optimizing the image display

1 Open the Fusion Definition MPR dialog window with Fusion >
Fusion Definition.
2 In order to get access to the mask menu, click Advanced.

3 Hide the background noise in the mapping images by increasing

the L value for Masking to “1” (left spin box).
4 Select suitable Color Lookup Tables for the map and the
morphological images to optimize their view.


Recommended settings: Rainbow for mapping images (left
selection list), Gray Scale for morphological images (right
selection list).

5 Set the T2/T2* baseline map Window Level to a default value by

changing the left C and W values (e.g. “45” each).

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3.1.3 Visualizing the cartilage

It is easier to segment the cartilage if you work on the morphological
images.
1 In the Fusion Definition MPR dialog window, move the Mixing
Ratio slider to the right to display the morphological image only.
2 Activate VOI Punch Mode with the icon in the Settings subtask
card.

The VOI Punch Mode dialog window opens.

VOI drawing is activated automatically.
3 Trace the cartilage in the morphological image. Double-click to
finish.

4 Remove the non-cartilage part of the mapping image with the

Keep Inside icon.
5 In order to provide for good fusion, set a Mixing Ratio of 50% in
the Fusion Definition MPR dialog window.

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3.1.4 Saving and filming the images

1 Select the respective segment for saving or filming.
2 Save the images as a new series with the icon.

3 To film the images selected, click the icon.

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 3 Post-processing

76 Ortho | Operator Manual

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 Index

1,2,3 … TSE sequence 38 MEDIC sequence 53

2D imaging 37 Echo train length MPR views (Dot Engine)
TSE sequence 39 Configuration 22
3D DESS sequence 51
Examination strategy
3D examinations
Dot Engine 17, 19, 25, 27, 32, O
Dot Engine 21, 35
33 Orthopedic coils 16
3D imaging
Image examples 54
F P
Isotropic sequences 49
Fat saturation Protocol parameters
3D SPACE sequence 49
TSE sequence 40 T1 mapping 69
3D TrueFISP sequence 50
Fat suppression T2 mapping 62
TSE sequence 40 T2* mapping 65
B
Fusing biochemical maps and images
Bilateral 3D examinations Refer to MapIt image fusion 72 Q
Dot Engine 29
Quiet TSE
Biochemical imaging 58 H Quiet GRE 42
Cartilage 59
Hip Dot Engine
BLADE technique 41 Refer to Dot Engine 25 S
SAR reduction
C I TSE sequence 42
Cartilage Isotropic sequences 49 Scout
Biochemical imaging 59 3D DESS 51 Dot Engine 18, 26, 33
Coils 16 3D SPACE 49 Shoulder Dot Engine
3D TrueFISP 50 Refer to Dot Engine 31
D MEDIC 53
Strategy
Dot add-in Dot Engine 17, 19, 25, 27, 32,
MPR Assignment 23 K 33
MPR Planning 23 Knee Dot Engine syngo WARP
Dot Engine 17, 17, 25, 31 Refer to Dot Engine 17 SEMAC 43
3D examinations with
integrated MPR planning 21, 35 L T
Adjusting slices 20, 28, 34 Large Joint Dot Engine T1 mapping 68
Bilateral 3D examinations with Refer to Dot Engine 17 Protocol parameters 69
integrated MPR planning 29
Changing the examination T2 mapping 61
M Examples in cartilage repair
strategy 19, 27, 33
Configuring MPR views 22 MapIt therapies 63
Examination strategy 17, 25, 32 T1 mapping 68 Protocol parameters 62
Measuring the scout 18, 26, 33 T2 mapping 61 T2* mapping 64
Performing measurements 20, T2* mapping 64 Examples in cartilage repair
28, 34 MapIt image fusion 72 therapies 67
Cartilage 74 Protocol parameters 65
E Loading images 72 TSE sequence 37
Optimizing image display 73 BLADE technique 41
Echo time
Visualizing the cartilage 74 Optimizing echo time 38

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 Optimizing echo train length 39
Optimizing fat saturation 40
Optimizing fat suppression 40
Quiet Ortho imaging 42

V
VAT
orthopedic implants 43

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 The CE marking applies only to medical devices which have
been put on the market according to the above-mentioned
EC Directives. Unauthorized changes to this product are
not covered by the CE mark and the related Declaration of
Conformity.
Manufacturer’s note:

This device bears a CE mark in accordance with the

provisions of Council Directive 93/42/EEC of June 14, 1993
concerning medical devices and the Council Directive
2011/65/EU of June 08, 2011 on the restriction of the use
of certain hazardous substances in electrical and electronic
equipment.

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