Object ID: 00000018WIA308C4970GYZ
Topic ID: id_40024255 Version: 1.6
Date: May 19, 2022 11:43:29 AM

VIBRANT with Flex Imaging Option: acquire a scan

Before you begin

Important: VIBRANT with Flex is not recommended to be used with women who have silicone implants because it may result in a fat/water signal swap. Use a VIBRANT protocol for patients with silicone implants. Select a VIBRANT protocol from the Protocol Selection screen, GE library, Chest > Breast Routine. Select any of the VIBRANT protocols.

About this task

Use these steps to acquire fat and water bilateral breast images.

Step-by-step instructions

Enter your patient into the Worklist Manager.
1. From the Protocol screen, in the GE library, select the chest anatomical area and the VIBRANT with Flex Breast protocol.
2. Match the position and entry selections to the patient orientation.
3. From the Coil tab, confirm that a phased array breast coil is selected.
  - VIBRANT with Flex is only compatible with phased array breast coils.

Prepare the patient.

Position the patient prone, feet first in the breast coil. Make sure that the breast is centered in the middle of the coil.

Warning

IEC 60601-2-33: 201.7.9.2.101 (j) RF can cause localized heating at contact points between adjacent body parts when a loop is formed. Such localized heating can result in discomfort, or burns. This could occur when a patient’s hands are touching or when a female patient’s breasts are compressed to her chest. Use pads between body parts to avoid creating a loop with adjacent body parts.

Figure 1. Patient Positioned in 8-channel VIBRANT Breast Array Coil. Make sure hands do not touch one another.

Pull the breasts downward to insure that as much breast tissue as possible is included in the coil. Make sure that the breast is hanging free and that there are no breast skin wrinkles. The nipple should be the most anterior anatomy in the coil.
Landmark to the center of the breast.
Advance the patient into the scanner.

Acquire the localizer.
Prescribe the VIBRANT with Flex multi-phase acquisition. Either axial or sagittal bilateral scans can be acquired.
1. Do not copy the FOV, slice thickness, or spacing from a VIBRANT protocol into a VIBRANT with Flex protocol. VIBRANT with Flex has specific parameters saved in the protocol that if changed can affect parameter compatibility issues. All the scan parameters in the VIBRANT with Flex protocol are compatible and if you change a parameter you may get a compatibility error message.
  Important: VIBRANT with Flex relies on out-of-phase and in-phase echo collection for robust water/fat image synthesis.
  - For 1.5T systems, in-phase and out-of-phase values have twice the separation in comparison to a 3.0T system; thus TE limits are not as critical.
2. Navigate to the Protocol screen and select a VIBRANT with Flex multi-phase protocol. Check the multi-phase tab parameters:
  - Check Variable Delays. If it is not selected, the Mask phase cannot be enabled.
  - When Mask Phase is selected, Pause After Mask is automatically turned on. This allows time for getting the patient ready for the next phase of the exam.
  - If you want each phase to be reconstructed into a separate series, then select Series per Phase.
  - If no out-put series are defined, in-phase images are reconstructed as the default series.
3. Click the Advanced tab and select User CV values, if needed.
  - Apodization Level
  - Image Acquisition Delay
  - K-Space: Select a Viewing Order option: Elliptical Centric or Centric.
  - Multiple TR Acquisitions: set image acquisition to a single (CV off) or multiple TRs (CV on). Turning Multiple TR On allows higher Frequency matrix values to be prescribed within the allowed TE limits, at the expense of increased scan time.
  - Slice Partial Fourier
  - Turbo Mode: Select 1 (turbo) to have a shorter scan time with the trade-off of potentially lower SNR. When turbo mode is selected, Elliptic Centric ordering and Turbo ARC user CVs are not available.
  - Turbo ARC which only appears if Turbo mode is off
4. Graphically prescribe the 3D volume.
  Figure 2. VIBRANT Graphic Rx
  - Position the cursor over the breast area and click to deposit the volume.
  - Adjust the slice thickness and Slices per Slab to cover the anatomy of interest. FOV and Slices per Slab vary depending on the patient size.
  - Prescribe the 3D volume to include all breast and axillary tissue.
  - Confirm that the coil extent lines cover the anatomy of interest.
If desired, Add post-process task.
Click Save Rx.
From the Scan menu, click Prep Scan > Scan.
The mask scan begins and the Scan Time area begins the count-down.
Figure 3. Count down begins
- There are occasions when a “memory not enough, please reduce the scan size” message appears. This most frequently occurs with bilateral multi-phase scans. If this occurs, reduce scan parameter values that affect image size and, therefore, affect the memory required for acquisition (number of phases, slices, matrix size, or Zero-fill Interpolation Processing factor). Alternatively, the Phase FOV > 1 scan parameter can be modified to reduce matrix size without sacrificing resolution but reducing memory consumption. For example, both of the following scan parameters result in a 1 mm² resolution:
  - Freq= 360 and Phase=360 with FOV=36 cm and Phase FOV=1.0
    Figure 4. VIBRANT with Phase FOV = 1
  - Freq= 240 and Phase=240 with FOV=24 cm and Phase FOV=1.5
    Figure 5. VIBRANT with Phase FOV = 1.5
Acquire the remaining phases.
- After the Mask phase is completed, the scan stops.
- Prepare the patient for the remainder of the phases. Make in-phase and out-of-phase selections from the scan prescription Details screen.
- Start the remaining phases by clicking Scan or pressing Start on the keyboard.
- The Scan Time area counts down the phase time and updates the Total scan time as each phase is completed.
  Figure 6. Scan time count down

Display or post process the images.

The annotated TE of the fat and water images is the average of the two echoes, due to the fat and water images being synthesized from in-phase and out-of-phase echoes.
The subtracted images are stored in the series number 100 times the Multi-Phase series number of the same examination. The subtracted images have a “PROC” series type. It is annotated in the Patient List and on the image. The subtracted images are annotated with “+C” if contrast was enabled for the series.
Launch READY View from one of the following locations:
- The Viewer by Add post-process task.
- The Image Management work area. From the patient list, press Ctrl and simultaneously click the pre-contrast series and the post-contrast series to select them both and then click READY View from the Session Management list.
- From the READY View protocol screen, click Ser and follow the instructions detailed in the READY View section.
VIBRANT images can be post-processed using the purchasable CADstream option. For details, see the CADstream operator manual.

Warning

It is possible that a spatial distortion can be seen on 3D data sets, especially in the lateral-most VIBRANT images. The distortion can be demonstrated in sagittal versus axial data sets. There is a potential risk for lesion localization misregistration during biopsy procedures, which could result in a re-biopsy of the patient.

CAUTION

Images labeled as water may include signal from fatty tissue, and images labeled as fat may include signal from water. This error may occur in regions of high magnetic field variation, in spatially isolated tissue, due to patient or tissue motion, due to phase wrap artifacts, due to similar water and fat intensity in T2-weighted Flex scans, due to TE values beyond recommended limits, and/or in images with low signal-to-noise ratios. The presence of fat tissue in images labeled as water, or vice versa, may occur within single images or throughout an in entire stack of slices. By default, both sets of images (labeled fat and labeled water) will be reconstructed and inserted into the database for review. Proper calibration and center frequency selection will reduce the occurrence of this error. Complete elimination of this error may not be possible and thus interpretation of MR images must be completed by trained personnel.

Results

Image annotation

M3D/VIBRANT/flip angle

Water and Fat images are synthesized from collected in-phase and out-of-phase images; thus TE values for Water and Fat images are the average of IN-phase and Out-of-Phase TEs. In-phase and out-of-phase gets annotated according to the TE and TE2 values on screen.