A collection of articles from SIGNA™ Pulse of MR

AIR Technology™

gehealthcare.com/air

T O M O R R O W T O D AY

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3

Table of contents3 Introduction

In Practice

5 Transforming the MR imaging experience for one of Sweden’s largest pediatric hospitals

10 Ultra-flexibleAIRTechnologySuitemakingadifferenceinthetechnologist’sworkflow

14 An upgrade that meets the expectation for higher resolution, SNR and productivity

18 New deep learning tool streamlines MR slice prescription

19 AIRTechnology:abrilliantimprovementinhigh-qualityimagingand patient comfort

24 Alighter,moreflexibleandcomfortablewaytoscan

Case Studies

29 Body imaging with AIR Technology Anterior Array and Posterior Array

33 Neuro imaging with 48-channel Head Coil

37 DiffusionimagingwithAIRTechnologySuite

MRCP Protocol Enhancement: Auto-tracker Prescription and 3D MRCP with HyperCube and HyperSenseBy Dominik Weishaupt, MD, PhD, Chief Physician, Institute of Radiology

and Nuclear Medicine, Triemli Spital, Switzerland

Product name

MRCP Parameters

TR, ms: 5000

TE, ms: 706

ETL: 140

FOV, cm: 35

Slice thickness, mm: 1.4

Phase: 352

Frequency: 352

Scan time, min: 4:16

Name MD, PhD Need..Institute of Radiology Nuclear Medicine in Triemli Spital, Switzerland

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AIR Technology™ Coils set to drive thefuture of MR imaging“Flexibilityornothing”wastheinspirationthatguidedGEHealthcareengineersastheysetouttocompletelyrethinktraditionalMRcoils.Therewasnodoubttherewerelimitationswiththeexistingtechnology.Elementshadtobeplacedacertainwaywithinthecoils,andcoilsweretypicallyheavy,inflexibleandbulky.Thegoalwas to develop coils that were light, versatile and more pleasing to patients and technologists.

Rethinkingcoilswasnoeasytask.Aftertwodedicated

research projects, engineers created the innovative

technologiesattheheartofGEHealthcare’srevolutionary

AIR Technology™‡ Coil Suite. Incorporating a miniaturized

moduleofelectronicsandaflexibleloopoflinkedresonators,

these coils are at least 38% lighter than traditional coils plus

the anterior array coil has the industry’s highest channel

count.They’realsoflexibleandwrapcloselyaroundthe

patientlikeablanketforincrediblecomfortandimagequality.

Theresultwassimplybetter.

AIRTechnology™isalsodesignedtoworkwithotherGE

innovationslikeAIRTouch™andAIRx™.AIRTouch™,an

intelligentcoillocalizationandselectiontool,worksasabridge

betweenthecoilandthescanner.Thisallowsthetechnologist

tolandmarkthepatientwithasingletouch,andeven

optimizestheelementconfigurationbasedonthepatient’s

sizeandshape.AIRx™,anAI-based,automatedworkflowtool

forMRbrainscanning,canbeusedwithAIRTechnology™Coils

tospeedworkflowbyautomaticallyprescribingslicestohelp

reduce redundant manual steps.

To illustrate just how revolutionary AIR Technology™ is for

patients, technologists and physicians, we’ve compiled

aseriesofarticlesforyou.You’llreadabouthowthese

comfortingandcomfortablecoilsarebeingusedtoelevate

the imaging experience for patients, improve image

qualityinalltypesofscansandtransformtechnologist

workflow.Afterreading,you’llbeaskingyourselfwhatelse

canAIRTechnology™do?Quitefrankly,wecan’tthinkof

anything it can’t do.

‡Notavailableforsaleinallregions.

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HåkanBoström,MDThe Queen Silvia Children’s Hospital Gothenburg,Sweden

Pär-Arne SvenssonThe Queen Silvia Children’s Hospital Gothenburg,Sweden

According to Pär-Arne Svensson, MR

researchradiographer,akeymotivation

behindtheSIGNA™ Architect upgrade

wastheabilitytoacquirethenew

AIR Technology™ Suite, including the

48-channel Head Coil, along with new

MRsequencesavailableinSIGNA™Works,

specificallyMUSE,PROPELLERMB

(multi-blade),MPRAGEanddistortion

correctionwithdiffusion-weighted

imaging(DWI)likePROGRES.

Theradiologydepartmenthasbeen

evaluatingMUSEasareplacement

sequenceforsingle-shotdiffusion

imaginginneonates.WithMUSE,Dr.

Boströmcanobtainhigherresolution

andthedistortioncorrectionisbetter

with less distortion artifacts. In addition

As one of the largest pediatric hospitals

in Sweden, The Queen Silvia Children’s

HospitalatSahlgrenskaUniversity

HospitalinGothenburgprovidescare

tochildrenfromnewbornsuptoage18.

The Department of Pediatric Radiology

performs around 45,000 exams each

year. Named for the country’s current

Queen, the hospital has undergone

a modernization project to improve

workflowandenhanceclinicalservicesas

well as create a safe and secure healing

environment for its young patients.

The pediatric radiology department

recently upgraded its Discovery™ MR750w

3.0Twide-boresystemtoSIGNA™

Architect. With new gradients and Total

DigitalImaging(TDI),thecutting-edge

platformisdesignedtohelpfacilitieslike

The Queen Silvia Children’s Hospital adapt

to existing and future advancements

in MR imaging technologies, such as

AIR Technology™ and the SIGNA™Works

productivity platform.

“Wewanttobeonthefrontlineof

new technology and prepare for the

future,”saysHåkanBoström,MD,

pediatric radiologist at The Queen

Silvia Children’s Hospital.

In addition to the recently upgraded

SIGNA™ Architect, the hospital also has

anOptima™MR450w1.5T.Combined,

thesetwoMRsystemsenablethe

hospital to perform more than 2,000

MR exams each year.

Transforming the MR imaging experience for one of Sweden’s largest pediatric hospitals

As part of a modernization project, The Queen Silvia Children’s Hospital upgraded to the SIGNA™ Architect with AIR Technology™‡. An initial evaluationbytheDepartmentofPediatricRadiologyfoundthenewAIRTechnology™ AnteriorArray(AA)deliversgoodSNRandhomogeneityforhigh-resolutionimaging.Thecoilalsoenablesflexibilityandeaseof positioning patients, and when used with AIR Touch™makescoilselectioneasierandhelpswithworkflow.

‡Notavailableforsaleinallregions.

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Figure1.Longbone/softtissueassessmentin10-year-oldpatient,bothlegsimagedsimultaneously with AIR Technology™AA.(A,B)CoronalT2FSEFlex,0.9x1.2x5mm, 2:54min.;(B)Waterimage;(C)AxialT2FSEFlex(Water),1.2x0.8x5mm,2:31min.; and(D,E)AxialDWIwithADCMap.

A

C

D

E

B

toDr.BoströmfindingthatMUSEdelivers

high resolution and excellent image

quality,PROPELLERMBisalsohelpfulin

avoidingmetalartifacts.PROPELLERMB

isparticularlybeneficialwhenimaging

thecervicalspineandtemporalbone

withdiffusionsequences.Svensson

andDr.Boströmarestillevaluating

MPRAGE,however,theyareobtaining

bettercontrastbetweenwhiteandgray

matterinthebraincomparedtoother

conventional3DFSPGRsequences.This

sequencewouldbeparticularlyhelpful

whenimagingepilepsypatientsbefore

and after surgery.

Inadditiontothenewsequences,the

department received the AIR Technology™

AA and 48-channel Head Coil in early

2019. The AIR Technology™ AA has the

highest channel count and coverage in

the industry.

“Ourinitialexperienceisverygood,”says

Dr.Boström.“We’veusedtheAAfor

severalexams,suchastheabdomen,

pelvic, lower extremities, shoulder and

fetal imaging. The main advantages with

the AIR Technology™AAaretheflexibility

andeaseofpositioningonthepatient.”

It is lightweight—60 percent lighter

than conventional, hard-shell coils—and

children in pain may not tolerate a

heavycoilontheirbody,Dr.Boström

explains. This includes children who had

open heart surgery at The Queen Silvia

Children’s Hospital, one of only two

pediatric cardiac surgery centers

in Sweden.

“Fetal imaging is another area where we

see an advantage with the AIR Technology™

AA,”addsSvensson.“Itcanbedifficult

to put a conventional, hard-shell coil

aroundapregnantwoman’sabdomen

andgetagood,homogeneoussignal.”

For women in the late stage of

pregnancy,lyingontheirbackcanbe

uncomfortable.Svenssonwantstotry

imaging them on their side with the AIR

Technology™ AA wrapped around them

and see what the impact is on patient

comfortandimagequality.

Inmusculoskeletalimagingofthe

shoulder and arm, lower extremities or

imagingbothlegs,Svenssoncanwrap

thecoilaroundlargerfield-of-views

(FOVs)andobtainahomogenoussignal

7

A

B

C D E

Figure 3. Fetal imaging with AIR Technology™ AAimprovedcomfortforthewomanbyimagingherinthedecubitusposition.(A-B)AxialT2SSFSE;and(C-E)ObliqueT2SSFSE.

A B

C

Figure 2. Same patient as Figure 1. (A)SagittalInhance3DVelocityNCEMRA;(B)Sagittal3DMERGE;and(C)Volumerendered3DMERGEfused withNCEMRAandFSEFlex.

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Figure4.Free-breathingkidneyexamwith Auto Navigator in a six-year-old patientusingacombinationofthe AIR Technology™ AA and the PA embeddedintheSIGNA™Architecttable.(A)SSFSE,0.9x1.3x6mm, 17sec.;(B)T2PROPELLERwithrespiratory trigger, 0.9 x 0.9 x 4 mm, 4min.;(C)SSFSE,0.9x1.0x5mm, 49sec.;(D)LAVAFlexwithAutoNavigator, 1 x 0.9 x 3 mm, 3:56 min.; and(E)T2frFSEFatSatwithAutoNavigator, 0.8 x 0.9 x 3 mm, 4 min.

A

C D E

B

A B C D

Figure5.Neuroimagingwiththe48-channelHeadCoilinathree-year-oldpatient.NotethesameresolutionwithlessblurringintheMUSEDWIsequence.(A-B)Traditionalsingle-shotDWI,1.8x1.4x3.6mm,2shots,accelerationfactorof2,1:58min.;and(C,D)MUSEDWI,1.8x1.4x3.6mm,2 shots, acceleration factor of 2, 2:16 min.

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A B C

Figure 6. Neuro imaging with the 48-channel Head Coil in a three-day-old patient.(A-B)MUSEDWIwith ADC Map, 1.2 x 1 x 3 mm,3:09min.;and(C)AxialASLCBFMap.

Multi-Purpose(MP)Coil‡‡, a smaller

version of the AIR Technology™ AA.

Therehavebeenafewpatientswhohad

MRexamswithboththeconventional

coil and the AIR Technology™ AA.

Svenssonsayswhenasked,these

patients preferred the new coil,

especiallybecauseitwasnotsoheavy

andconfiningontheirbodies.

“Themostimportantbenefitof

AIR Technology™isthepatientcomfort,”

saysDr.Boström.“Itislightweight

andcanlayonthepatientlikea

blanket.Webelievethisalsoimpacts

patientcompliance.”

Overall,Dr.BoströmandSvensson

are impressed with SIGNA™

Architect, SIGNA™Worksandespecially

AIR Technology™.

“ThisisastableMRsystemwithvery

goodimagequality,”saysSvensson.“We

aresatisfiedwiththeupgradeandour

initial experience with AIR Technology™.”

forgoodimagequality.Forexample,

patients with multifocal chronic

osteomyelitis or muscular dystrophy/

myositiswilloftenrequireimagingof

bothlegssimultaneously.

“With the AIR Technology™ AA, we can

coverlargeareasbutwealsogetgood

SNR, so we can provide detailed images

ofspecificjointswithhighresolution,”

he says.

Positioning these precious patients is also

easier now with AIR Technology™. There

are many factors that can impact the

overall time a child is in the MR scanner

and any time saved in positioning means

thesoonerthepatientcangetbacktohis

or her parents.

Another patient-centric feature of

AIR Touch™ is that it assists with patient

positioning. It automatically selects

thebestelementstouseanduniquely

optimizes uniformity, SNR, artifacts

and parallel imaging.

“AIR Touch™makescoilselectionmuch easier and I don’t have tocheckwhatelementsareactivatedbecausethesystemdoesit.Ithelpswithworkflow,butthemostimportantfactoristhat it helps me focus more on thechild.”

Pär-Arne Svensson

AIR Touch™ even helps when using more

thanonecoil.EmbeddedintheSIGNA

Architect™tableisthePosteriorArray

(PA).Withsmallchildren,Dr.Boström

andSvenssonareusingGE’sFlex

CoilincombinationwiththePA.They

have seen excellent results using the

combinationofbothcoilsincardiac

andabdominalexams.

After using the impressive AIR

Technology™ AA for just two months

SvenssonandDr.Boströmnolongeruse

theconventionalAA.Theylookforward

to receiving the new AIR Technology™

‡‡NotCEmarked.Notavailableforsaleinallregions.

10

TakafumiNaka,RT(R)(MR)KawasakiSaiwaiHospital Kawasaki,Kanagawa,Japan

KawasakiSaiwaiHospitalinKanagawa,Japan,installedtheSIGNA™ Architect 3.0TMRsysteminlate2017.InFebruary2019, the hospital upgraded to the latest version of the SIGNA™WorksproductivityplatformandacquiredtheAIR Technology™ Suite. As one of the main healthcare providers for the region, especially for acutely ill patients, the hospitalembracestheconceptofpatient-centered healthcare. The AIR Technology™ AnteriorArray(AA)conformstothehumanbody,isflexibletofitallshapesand sizes and has a 60 percent lighter design compared to previous generations ofconventionalcoiltechnology—makingittheidealcoiltodeliverbothpatientcomfortandhighimagequalityatKawasakiSaiwaiHospital.

TakafumiNaka,RT(R)(MR),Chief Technologist, evaluated the new system and coils and the impact on the technologist’sworkflowandpatientexperience. He was most impressed that the AIR Technology™AAisultra-flexible

Ultra-flexible AIR Technology Suite making a difference in the technologist’s workflow

The AIR Technology™‡Suitesimplifiespatientpositioningandsetupwith AIR Touch™ automatic coil and element selection, a 60 percent lighter designthanpriorgenerationsofcoiltechnologyandaflexibledesign thatfitspatientsofvarioussizesandshapes.

andcanbewrappedaroundthepatienttofacilitatepositioningandfitsavarietyofpatientbodysizes.

Inmusculoskeletal(MSK)extremityimaging, coil selection for MR exams ofthehumerusandantebrachialbonewouldrequiretwocoilstoimagefromtheshouldertotheelbow.TheAIRTechnology™ AA, however, covers a largerregionofinterest(ROI)withacomfortablewrap-aroundfitandahigherSNR.Nakaexpectsthesameresults in lower extremity imaging, particularly for patients with cellulitis andmusclecontusionswherelargeROIsneedtobeacquired.

A conventional heavy, hard-shell coil on a patient’s chest could impact the respiratorydetectiondevice,soNakawouldplaceaspacerbetweenthecoiland the patient.

“However, with the AIR Technology™ AA, wenolongerhavetodothat,”Nakasays.

“Wenowhavebetterpatientpositioning

workflowandalsogetanimprovementinSNRbecausethecoilisclosertothepatient’schest.”

In addition, he does not have to worry aboutsettingthecoilcenterbecauseAIRTouch™ automatically detects it, providing additionalworkflowimprovementsandremoving the chance for human error.

Nakaisalsothrilledthathecanusehigher parallel imaging acceleration factors with the AIR Technology™ AA. In one case, he applied a factor of 4x forabodyCoronalDWIandhadlessdistortionandblurringthanwithaconventionalcoil(Figure1).

“Itwasasingle-shotEPIDWI,however,the anatomy detail and information was reallyamazing,”headds.

NakahasalsousedhigherparallelimagingaccelerationfactorsinbodyPROPELLERexams.Heleveragedthiscapabilityforbetterimagequality,suchasrefocusingtheflipangleforhigherT2 contrast. He sees the same impact

‡Notavailableforsaleinallregions.

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Figure 1. High-resolution MR Urography with reduced scantimeispossibleusingHyperSenseandHyperCube.Aurethral tumor was visualized on the Coronal DWI using long axis.EvenwithanASSETfactorof 4.0, there was low distortion inthediffusion-weightedimages.Allimagesacquiredwith the AIR Technology™ AA. (A)AxialT2wSSFSE,1.3x1.4x4mm,1:28min.;(B)AxialDWIb1000,2.7x2.7x4mm,3:57min.;(C)MRurography,0.7x1.2x1.4mm,2:40min.(RTr);and(D)CoronalDWIb800,3.1x1.6x4.5mm,ASSETfactor4,4:27min.(RTr).

Figure2.MAGiCisroutinelyusedatKawasakiSaiwaiforneuroMRexams.The48-channelHeadCoilwasusedforthisexam.(A)AxialDW-EPIin45sec.and(B)AxialT2FLAIRin3:07min.UsingMAGiC,from(A)and(B),thetechnologistcangeneratemultiplecontrasts,including(C)AxialT2w,(D)AxialT1w,(E)AxialDIRand(F)AxialPDw.

A

A C

E

B D

F

C

B

D

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in neuro imaging with the 48-channel Head Coil.

“We already use MAGiC in clinical routine neuroexaminationstoacquireexcellentT1contrast,whichbyprincipleisdifficulttoobtainat3.0T,”Nakasays.“However,withthe 48-channel Head Coil, we can reduce the scan time from six to three minutes becauseofthehigherSNR,”(Figure2).

Plus, the 48-channel Head Coil allows NakatouseahigherHyperSensefactorbecauseofthehighSNRandspatial resolution. As a result, he can

nowacquireahigh-resolutionMRangiography exam in six minutes—somethingthatpreviouslytookapproximately20minutes(Figure3).

He has noticed that patients are more relaxed with the AIR Technology™ AA thanwithconventionalcoils.Evenlarge-sizedpatientsweighingover200lbs.canfitcomfortablyinsidetheMR,withspacebetweenthecoilandthebore(Figure4).

KawasakiSaiwaiHospitalalsoinstalledthe latest version of the SIGNA™Worksproductivity platform with SIGNA™

Architect.Nakalovestheimprovementsin DWI, especially MUlti-plexed Sensitivity Encodingtechnique(MUSE)andPROGRES.

“The most impressive application is MUSE,amulti-shotDWIthatallowsustoachievequitehighspatialresolutioncomparedtoconventionalDWI,”heexplains.“IfindthatMUSEDWIprovidesuscompletelydifferentimagequalityversustheconventionalsequence.”

In particular, the improvement in female pelvisimagingisnotable.MUSEDWIclearly depicts details of cervix and

Figure3.(A-C)TOFMRAwithHyperSensefactorof2.5andARCfactorof2,0.4x0.5x0.8mm,6:06min.

A

B C

Figure4.Patientweighedover200lbs.(120kg).AbdominalkidneyexamusingtheAIRTechnology™AArequiredawideFOV,however, highlyuniformimageswereacquired.(A)AxialT2wPROPELLERMB,0.8x0.8x5mm,ASSET4.0,5:39min.;(B-D)AxialLAVAFlex;(B)water; (C)in-phase;(D)out-of-phase:1.6x1.6x4mm,14sec.;and(E)CoronalDWIb900,3.1x1.6x5mm,ASSET4.0,4:20min.

A

C

B

D E

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Figure5.MUSEacquireshighresolutionDWIevenathighb-values(b1000)andbyusing4shotswithARCaccelerationof1,distortioncanbe reduced.FusingSagittalT2wPROPELLERMBwiththeADCmapdoesnotleadtodistortioneveninthepresenceofrectalgas.(A)SagittalMUSE b1000,1.5x0.9x6mm,4shotswithARCaccelerationof1,5NEX,4:39min.;(B)SagittalT2wPROPELLERMB,0.8x0.8x6mm,4:12min.;and(C)FusedADCmapwithSagittalT2wPROPELLERMB.

A B C

thedifferencethatAIRTechnology™ has on the patient experience. For his department,theabilitytousehigher acceleration factors and save time in patient set-up will positively impact the technologist’sworkflow,furtherimproving staffsatisfaction.And,withthenewsequencesavailableinSIGNA™Works,he and his team can deliver the excellent imagequalitycliniciansneedforamoreconfidentdiagnosis.

endometriallesionswhenNakasetstheacquisitionplane(slices)alongtheuterineaxis(Figure5).

“We could see almost no distortion even in the Sagittal plane and there was less artifactfromrectalgas,”explainsNaka.

“Surprisingly,whenwefuseMUSEDWIwith T2-weighted images, we could not findmisregistrationcausedbydistortion.So,wethinkhigh-resolutionMUSEDWIwill have an advantage in detecting smalllesionsinthepancreas.”

Afterinvestigatingseveralsequences,NakaandhiscolleaguesfoundPROGRESprovidedthebestDWIimagewiththeleastdistortion.Susceptibilityartifacts around the eye and inner ear were decreased with no major impact onscantimewhenusingPROGRES.Asaresult,PROGRESisbeingfrequentlyusedforneuroDWIatKawasakiSaiwaiHospital(Figure6).

From streamlined patient positioning togreaterpatientcomfort,Nakasees

Figure6.(A-C)DWIwithPROGRES;and(D-F)conventionalDWI.PROGRESprovideslessdistortion than conventional DWIsequences,includingfewersusceptibilityartifacts(arrows)around the eye and inner ear.

A

D

C

F

B

E

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Masatoshi Hori, MD, PhDOsakaUniversityHospital Suita,Osaka,Japan

Fornearly150years,OsakaUniversity

Hospital(originallyOsakaMedical

School,circa1869)hasservedthe

residentsofOsakaandfosteredthe

education of medical professionals

throughout the region. The hospital’s

dedicationtoprovidinghigh-quality

medicalcareiscenteredonthebelief

that adopting new and advanced

technologies further promotes patient-

centered,safeandreliableholisticcare

thatcontributestothesociety.

“AtOsakaUniversityHospital,wealways

seekthelatestinnovativetechnology

toprovidethebestclinicalperformance

andpatientcare,”saysMasatoshi

Hori, MD, PhD, Associate Professor,

DepartmentofRadiologyatOsaka

University Hospital. With this philosophy,

An upgrade that meets the expectation for higher resolution, SNR and productivity

After upgrading its SIGNA™ Architect to the latest SIGNA™WorksproductivityplatformandacquiringtheAIRTechnology™‡AnteriorArray(AA),OsakaUni-versity Hospital is delivering exceptional MR imaging that also promotes patient-centered care—two tenets of the hospital’s core philosophy. The combinationofthesethreeadvancedtechnologiesisdeliveringexcellentim-age uniformity across a wide range of patients and clinical exams.

the department recently upgraded its

existing Discovery™ MR750w 3.0T to

SIGNA™Architectandalsoacquiredthe

AIR Technology™ AA.

“OurkeyexpectationforMRishigher

resolution, higher signal-to-noise

ratioandhighertemporalresolution,”

Professor Hori says. “This upgrade

completelymeetsourexpectations.”

He found the AIR Technology™ AAtobe

lighter than expected and anticipates it

willprovideabetterpatientexperience

during an MR exam. Technologists have

also shared with him that patient and

coil set-up is much easier and that SNR

gainsarebeingrealizedbecause,in

mostcases,thecoilfitsthemanyshapes

andsizesofpatientsmuchbetterthan

conventional arrays.

“The AIR Technology™ AA is one of the

biggestinnovationsIhaveseenin

thelastdecade,”addsProfessorHori.

Hebelievesitwillbecomeafuture

standard technology and is excited to

beanearlyadopter.

AnimportantbenefitofAIRTechnology™

istheabilitytoutilizehigherparallel

imaging acceleration factors with the

coilelementconfigurationandlower

g-factorofthenewcoils.Specifically,

in a 640 x 640 matrix T2-weighted

PROPELLERMulti-shotBlade(MB)FatSat

pancreas exam, high-resolution images

wereobtainedwithanARCfactorof4in

4:24minutes(Figure1).

PROPELLERMBisonekeyenhancement

that Professor Hori is routinely using.

Itcombinesmultiplebladestogether

toachieveshorterTEsandimproved‡Notavailableforsaleinallregions.

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Figure 1. AIR Technology™enablestheuseofhigherparallelimagingfactorswithimprovedSNRforhigh-resolutionimagingandreducedscantimes.(A)AxialT2wFatSatacquisitionwithPROPELLERMB,0.6x0.6x4mm,ARCfactorof4,4:24min.;(B)ROIin(A)magnified.

Figure 2. A female weighing 287lbs.(130kg)referredforMRimagingofthepelvis.(A)SagittalT2wfrFSE,0.8x0.9x4mm,6:08min.;(B)SagittalT2wPROPELLERMB,0.9x0.9x 4 mm, 3:02 min.

A

A B

B

motioncorrection.PROPELLERMBis

alsocompatiblewithAutoNavigator,

afree-breathingapproachtocombat

respiratorymotioninthebody,cardiac

and chest imaging with automatic

trackerplacement.

“WearenowusingPROPELLERMBfor

allabdominalcases,suchaspelvis,

liverandpancreas,”hesays.“There

isalsotheadditionalbigadvantage

of motion correction without any

criticaldisadvantage.”

Forexample,heobtainedgoodcontrast

of the endometrium and junctional zone

in a patient without motion artifact.

Intheupperabdomen,heacquiredgood

images that were also not compromised

duetomotion(Figure2).

It’s not just the coil that is leading to

excellentimagingresultsatOsaka

University. Professor Hori found the

combinationoftheSIGNA™ Architect,

advancedsequencesandAIRTechnology™

togetherdeliverrobustimagingwith

excellent image uniformity.

“SometimesweneededdifferentWW/WL

adjustments so we could clearly see the

anatomybetweenthecenterandthe

edgeoftheFOVtomakeadiagnosis.Now,

wenolongerneedtomakethischangein

mostpatients,”hesays(Figure3).

Professor Hori evaluated the AIR

Technology™ AA and a conventional AA in

a patient exam. He discovered that with

the latest uniform correction application,

reFINE,hecouldacquirehigherimage

qualityandbetteruniformityinmany

clinical cases and contrasts.

“Also, I found the AIR Technology™ AA

providesbettersignalpenetration,so

imagequalityandSNRarebetterthan

a conventional coil, especially in large

patients,”headds.

UsingHyperCubewiththeAIR

Technology™ AA in prostate imaging,

Professor Hori can perform thin-slice

imaging.Heacquires1-2mmslice3D

imageswithHyperCubeandobtains

goodqualitycomparedtoconventional

2D 5 mm Axial imaging. The advantage

is that the thin slices provide him with

abetterunderstandingofcapsular

16

invasion, which can impact patient

management and treatment options

(Figures4and5).

Multi-plexedSensitivityEncoding(MUSE)

DWI is another impressive application,

especiallyintheprostate.Itprovidesboth

high SNR and high spatial resolution.

“Currently,weacquirebothconventional

EPIDWIforthewholepelvisandFOCUS

DWIfortargetedsmallFOVwithhigh

resolution,”ProfessorHoriexplains.

“However,MUSEcanprovidehigh-quality

imaginginbothlargerandsmallerFOVfor

theprostate,”(Figure6).InMRCPimaging,

HyperSenseisshorteningscantimesby

30percentatOsakaUniversity.Hehas

also increased matrix size, from 512 x 320

to 512 x 416. With this protocol, he can

more clearly see the small intrahepatic

bileductwithlessmotionduetothe

shortenedscantime(Figure7).

Lookingforward,ProfessorHoriwants

to evaluate the use of AIR Technology™ in

examsthatrequirewidescancoverage,

fromtheuppertothelowerabdomen.

This coil has the highest channel count

and coverage in the industry today.

“With the AIR Technology™ AA, 65 cm

widecoveragemightbeverybeneficial

forthesetypesofstudies,”headds.

Figure3.Patientwithanadrenalmass.(A)AxialT2wSSFSE,1.1x1.8x5mm,18sec.;(B)AxialDW-EPI,2.8x2.8x5mm,3:49min.(RTr); (C-E)CoronalLAVAFlex,1.4x1.6x3mm,16sec.;(C)water,(D)in-phaseand(E)out-of-phase.

A

C

B

D E

Figure4.Prostatecancerpatient(A)AxialT2wPROPELLERMB,0.6x0.7x4mm,3:25min;(B)EPIDWIb1000,2.3x2.3x4mm,2:08min.; and(C)FOCUSDWI,b1000,1.5x1.5x4mm,4:10min.

A CB

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Figure 7. Comparison of MRCP exam with and without HyperSense. Scan time was reduced 30% with HyperSense.(A)ConventionalMRCPRTr, 0.7 x 1.1 x 1.6 mm, 3:51 sec. and (B)MRCPRTrwithHyperSense,0.7x0.9 x 1.6 mm, 2:45 min.

Figure 5. Prostate exam usingHyperCube.(A-C)Conventional 2D T2w in 3planes.(D-F)T2wwithHyperCubeenables(E-F) thin-sliceimaging.(A)AxialT2w, 0.6 x 0.8 x 4 mm, 3:42 min.;(B)CoronalT2w,0.6x0.8x4mm,3:25min.;(C)Sagittal T2w, 0.6 x 0.8 x 4 mm, 2:36min.;and(D-F)T2wwithHyperCubeacquiredintheAxial plane and reformatted to(E)Coronaland(F)Sagittal,0.9 x 0.9 x 2 mm, 3:54 min.

A

D

C

F

B

E

Figure 6. Patient referred for prostate exam. (A)DWIb1000,2.3x2.3x4mm,2:08min.; (B)FOCUSb1000,1.5x1.8x4mm,4:10min.;and (C)MUSE3shotb1000,1.6x1.6x4mm,4:15min.

A

B C

A B

18

TomSchrack,ARMRIT,MRSOFairfax Radiological Consultants Fairfax,Virginia

time. A study showed average prescription timesavingscanbeupto62%.‡‡

It precisely places slices on the smallest and most challenging neurological anatomy, such as optic nerves.

“Everythingthatitsaysitcanfind,itfindsitwithamazingaccuracy,”saysSchrack.

“For example, if I tell AIRx™ that I want an obliquesagittaloftheleftopticnerve,it puts a slice right down the center of that left optic nerve. AIRx™ does that immediately and perfectly, every time. It can save me some eye strain, save time fromtweakingparameters,andgetmegoingalittlebitfaster.”

SchracksaysAIRx™ is one step in the rightdirectionoffulfillingthepromiseof AI, with the potential to use it on complicated anatomy such as the heart and joints, while continuing to simplify thetechnologist’sjob.

“You'll never hear a technologist say, ‘I wish this was harder to use,’ or ‘I wish the machine would stop automating tasksforme’,”saysSchrack.“Theywantthemachinetomakedecisionsforthemsothatit'seasier,andIthinktheonlyway that’s going to happen is with deep learningandartificialintelligence.Forthe technologist, anything that reduces thenumberofdecisionsinanMRexamwillmaketheirjobbetter.”

New deep learning tool streamlines MR slice prescription

earlyNovember2018,conducting about15casesontheirfacility’s 3.0T SIGNA™ Architect MR scanner.

Deep learning for faster imagingAIRx™isbuiltonEdison,anewplatformthat helps accelerate the development and adoption of AI technology and empower providers to deliver faster, moreprecisecare.Edisonisaholistic,integrated digital platform for healthcare, combininggloballydiversedatasetsfromacross modalities, vendors, healthcare networksandlifesciencessettings.

ItenablesGEHealthcaretointegrateand assimilate data from disparate sources, apply advanced analytics and AI to transform the data, and generate insightstosupportclinical,financialandoperationaldecision-making.Edisonincludesdeployment-agnosticintelligent applications and smart devices, designed to help achieve greater efficiency,increaseaccesstocare,andimprove patient outcomes.

By leveraging this platform, AIRx™ features apre-trainedneuralnetworkmodelthatleverages deep learning algorithms and anatomyrecognitionbasedonadatabaseof over 36,000 images sourced from clinical studies and reference sites.

AIRx™helpsincreaseproductivitybysimplifyingworkflowsteps,thussignificantlyreducinguserprescription

A new deep learning software from GEHealthcareishelpingstreamline MR scan prescription that may help reduce inconsistencies in imaging across patients and technologists. AIRx™‡isanAI-based,automatedworkflowtoolforMRbrainscanningthatautomatically“prescribes”slicesto help reduce redundant, manual steps. ItusesdeeplearningalgorithmsbuiltrightintotheMRtechnologist’sworkflowtoautomaticallydetectandprescribeslicesforneurologicalexams,deliveringconsistentandquantifiableresults. AIRx™ also helps produce images thathavelessvariabilitybetweentechnologistsandbetweenscans,helping to lower the chances a patient willberecalledduetoincorrectsliceplacement. An increase in consistency is particularly important when doing longitudinal assessments on patients with diseases that progress over time.

“EverytimeIselectalandmarkfortheprescription, the slice placement is dead on,”saysTomSchrack,ARMRIT,MRSO,ManagerofMREducationandTechnicalDevelopment at Fairfax Radiological ConsultantsinFairfax,Virginia.

Schrackandtwootherseniortechnologists at Fairfax Radiological Consultants have used a prototype of AIRx™—whichstandsforArtificialIntelligenceprescription(AIRx)—since ‡Notavailableforsaleinallregions..

‡‡AccordingtoaninternalstudyconductedbyGEHealthcare.

19

Alexander Hirsch, MDErasmusMedicalCenter Rotterdam, Netherlands

EdwinOei,MD,PhDErasmusMedicalCenter Rotterdam, Netherlands

ErasmusMedicalCenterinRotterdam,

Netherlands, is a leading university

medicalcenterinEuropeandhas

longbeenrecognizedforitsadoption

of cutting-edge technologies and

advanced medical solutions. For the last

fewyears,Erasmushascollaborated

withGEHealthcaretoevaluatethe

introduction of new technologies into

theclinicalenvironment.Oneofthese

is AIR Technology™.

AIR Technology™ Coils are designed

tofitallpatients,allowflexibilityinany

direction and closely wrap around

the patient’s anatomy for greater

visibilityofhard-to-scanareaswith

excellentimagequality.Byconforming

tothepatienthabitusandbringingthe

AIR Technology: a brilliant improvement in high-quality imaging and patient comfort

AsoneofthefirstsitesintheworldtoinstallSIGNA™ Premier and AIR Technology™‡,ErasmusMedicalCenterisaleaderinadopting cutting-edgetechnologies.Thesenewsolutionsareprovidingabetterpatientexperiencewhiledeliveringhigh-qualityimagingandadvancedapplications,furtherenhancingtheexcellentcareprovidedbyclinicians atErasmus.

coil elements closer to the patient, AIR

Technology™improvessignalqualityand

signal-to-noiseratio(SNR)andreduces

imaging artifacts when compared to

previous generations of conventional

coil technology.

Recently,severalcliniciansfromErasmus

shared their initial impression of AIR

Technology™ on the SIGNA™ Premier 3.0T

MR system, including the AIR Technology™

AnteriorArray(AA),the48-channelHead

Coil and AIR Touch™.

Cardiac imaging

Alexander Hirsch, MD, cardiologist,

specializes in non-invasive cardiac

imaging. In cardiac patients, Dr. Hirsch

scans cardiomyopathy and ischemic

heart disease patients on SIGNA™

Premier.Typically,the2DFIESTA,first-

passperfusionandMDEimagesare

themostcommonsequencesforthese

patients. Imagequalityisimportant,

particularly in the late enhancement

(MDE)sequencewhereDr.Hirsch

evaluatesmyocardialviability.Withthe

2DFIESTAsequence,heislookingat

cardiacfunction.However,2DFIESTA

sequenceshavehistoricallybeen

problematicat3.0T.

“The new SIGNA™ Premier system is

especially good for late enhancement

imagesandalsoforperfusion,”Dr.Hirsch

says.“Iwasabletoseetheanatomy

andthefunction,aswellasdifferentiate

thecontrastbetweenthebloodandthe

‡Notavailableforsaleinallregions.

20

JuanHernandezTamames,PhDErasmusMedicalCenter Rotterdam, Netherlands

myocardium. Previously in a 3.0T system,

thatwasaproblem,however,withthe

SIGNA™Premierthishasimprovedalot.”

Akeyfactorintheimprovedimage

qualityisAIRTechnology™. Dr. Hirsch

says he gets a more homogeneous signal

andbettercontrastbetweentheblood

and the myocardium.

“Because of the specialized nature of

our facility, with referrals from all over

the Netherlands, it is important to

havethelatesttechnology,”hesays.

“WiththenewGESIGNA™ Premier and

AIR Technology™, we can provide high-

qualitycareforourpatients.”

“The new AIR Technology™ AA has a

major advantage in that it helps provide

highimagequality,”Dr.Hirschadds.

Plus, with SIGNA™Premierhehasbeen

abletoachievehighSNR,whichis

veryimportantforthesequenceshe

is using. Dr. Hirsch also expects to see

improvementsin4DFlow(ViosWorks),

aswellasthenew3DMDEsequence.

“WhenwestartedworkingwithSIGNA™

Premier, I was pleasantly surprised to

seetheimagequality,especiallyforthe

2DFIESTAsequence,”hesays.

BrendanBakker,MRradiographer,has

developedcardiacMR(CMR)protocolsat

ErasmuswithDr.Hirsch.While1.5Twas

typicallypreferredforCMR,heworked

with Dr. Hirsch to evaluate CMR exams

on the SIGNA™ Premier 3.0T MR system

with AIR Technology™.

“The AIR Technology™AAisbrilliantand

it’s an improvement for the patient. It

is very easy to handle, very lightweight

andthequalityisverygoodforcardiac

imaging, especially on the SIGNA™

Premiersystem,”Bakkersays.

“AIR Technology™isveryflexible,youcan

putitaroundthechestorstomachbut

alsouseitaroundthekneeorshoulders,”

Bakkersays.“Withothercoilsthatare

morerigid,thisisnotpossible.”

In pediatric imaging, the AIR Technology™

Coilsfitalmostlikeablanketonthechild,

he adds.

MSK imaging

EdwinOei,MD,PhD,isanAssociate

ProfessorofMusculoskeletalImaging

andSectionChiefofMusculoskeletal

RadiologyatErasmusMedicalCenter.

He dedicates half his time to research

andworkingwithMRphysicistsand

PhD students to improve technologies

Figure1.Shortaxis2DFIESTA.Thecombinationof SIGNA™ Premier and AIR Technology™ delivers highSNRandhighimagequalityforexcellentcardiac MR imaging results at 3.0T.

Watch Dr. Hirsch’s 2019 SCMR presentation, “Getting consistent and quantifiableresultsincardiacimaging:”https://youtu.be/dQ3-sU-kPv0

21

48-channelHeadCoilbecausethefront

part of the coil is slightly smaller and

doesn’t cover the patient’s entire face.

“You can immediately see the high-

qualityimagesthattheAIRTechnology™

Coilcaptures,”Laarhovenexplains.“Of

course, we also have the AIR Technology™

PosteriorArray(PA)inthetablesowe

only have to position the AIR Technology™

AAontopofthepatient.”

Improving the patient experience

SitaRammanhasbeenanMR

radiographer for nearly 28 years at

Erasmus.Often,shehashadtocomfort

and reassure patients who are nervous

abouttheirMRexams.Shewillexplain

that they have to remain very still and

mayhavetoholdtheirbreathwhilethe

systemacquirestheimages.

Since the introduction of AIR Technology™,

shehasseenanoticeabledifference.

“ThepatientsliketheAIRTechnology™

Coilsbecausetheyareverylightweight

andflexible,andmoldtothepatient’s

anatomy,”Rammansays.“Forus,itis

very easy to position. You just put it on

the patient and that’s it. That’s all you

havetodo.”

She has also used AIR Touch™, an

intelligent coil localization and selection

toolthatenablesautomaticcoilelement

selectionanduniquelyoptimizes

uniformity and SNR. AIR Touch™ informs

the system when the coil is connected,

and apply MR imaging in population

health studies.

“SIGNA™Premieroffersadvantagesin

musculoskeletalimagingbecauseofits

higher gradient performance, especially

when it is used with the AIR Technology™

Coil,”ProfessorOeisays.

AccordingtoProfessorOei,

musculoskeletal(MSK)MRimaging

tendstosufferfromartifactsand

movementmorethaninotherbody

parts.Often,therearedifficulties

with positioning patients due to their

injury or ailment, as well as using the

right coil. While coil selection is not

asproblematicinthekneeorankle,

itcanbemoredifficultwhenimagingthe

shoulder,wristsorribs.

“With AIR Technology™, we are moreflexibleinchoosingthecoil, which allows for imaging specificbodypartswithgreateraccuracy. For patients with chronic diseases such as arthri-tis,itmaynotbeeasyforthemto lie still in the scanner for a long time with a rigid coil. AIR Technology™ is lighter and more comfortableforthepatientso,indirectly,Ithinkitwillalsoreducemovementartifacts.”

Professor Edwin Oei

AIR Technology™ also assists with patient

positioning. When using traditional rigid

coils,thebodypartbeingimagedhadto

bepositionedpreciselyinthecoil.With

AIR Technology™, this is less of an issue.

“Wemainlynowusetheblanket-type

AA Coil and have achieved great

imaging results in the chest wall and in

joints,”addsProfessorOei.“IthinkAIR

Technology™isbeneficialfordiverse

patient groups, including pediatric and

elderlypatients.”

ProfessorOeibelievesthereisa

movement in MR imaging toward whole-

bodyimaging,particularlyforoncology.

He anticipates that AIR Technology™ will

provide excellent results over existing

coil technology due to its wide coverage.

“Since the introduction of SIGNA™ Premier

and AIR Technology™atErasmus,I’ve

seenimagequalityimproveover

previousscansandIbelievethatAIR

Technology™ can greatly improve patient

throughput,”ProfessorOeisays.

The AIR Technology™ Suite also

includesa48-channelHeadCoil.Jean

PaulLaarhoven,MRradiographer,

hasscannedpatientswithboththe

48-channel Head Coil and the AIR

Technology™ AA on SIGNA™ Premier.

Withtheabilitytoadjustthecoilfor

larger-sizedheadsandnecks,hecan

accommodate more patients. He has

found that patients with anxiety or

claustrophobiacanbettertoleratethe

JeanPaulLaarhovenErasmusMedicalCenter Rotterdam, Netherlands

BrendanBakkerErasmusMedicalCenter Rotterdam, Netherlands

22

allowsthetechnologisttolandmarkthe

patient with a single touch and even

optimizestheelementconfiguration.

Coil coverage, uniformity and parallel

imaging acceleration are generated

dynamicallytooptimizeimagequality.

Asimplifieduserinterfaceallowsthe

technologist to focus on the patient and

alsomaximizesexaminationefficiency.

“We just put the AIR Technology™ Coil

on the patient, localize using the

AIR Touch™buttononthetableand

move the patient inside the SIGNA™

Premier,”Rammanexplains.“WithAIR

Technology™ and AIR Touch™, we don’t

needtodoanycalibrationasitisdone

automatically.Thismakesadifference

inourdailyroutinebecauseittakesless

timetopositionapatient.”

A remarkable advance

JuanHernandezTamames,PhD,

AssociateProfessor(MR)andHeadof

the MR Physics group in the radiology

departmentatErasmus,facilitates

the introduction of new technology

inMRimagingforbothclinicaland

research purposes.

“SIGNA™ Premier incorporates several

newapproachesandbreakthroughs

intechnology,”ProfessorTamames

says. “For example, the AIR Technology™

Coilsareoneofthemostremarkable

innovationsI’veseenbecausethey

increaseSNR.”

He also discovered that the HyperBand

capabilityonSIGNA™Premierenablesthe

possibilitytosimultaneouslyscanseveral

slices,acceleratingacquisitionwiththe

potential to shorten scan times when

using DWI. With the parallel transmission,

hecantailortheRFforspecifictissuesin

a more appropriate way.

“Compressed sensing is another

remarkableadvanceonSIGNA™Premier,”

Professor Tamames adds. “When used

with AIR Technology™, which improves

signal due to the closer proximity to

the patient anatomy and tissue, we

can increase the acceleration with

compressed sensing and parallel

imagingtoreducescantimes.”

Forexample,sincethelungsarefilled

withair,itisoftendifficulttoobtaingood

SNR. Because the AIR Technology™ AA

lays on the patient’s chest, it is as close

tothebodyaspossible.Thisenablesa

high SNR.

Sita RammanErasmusMedicalCenter Rotterdam, Netherlands

Figure 2. AIR Technology™Suiteisflexibleandassistswithpatientpositioninginareaswherecoilselectionmaybemoredifficult,suchasthewrist.(A)Coronal3DMERGE;(B)CoronalPDFatSat;and(C)CoronalT2Flex.

A B C

23

withEEGsystems,cliniciansatErasmus

cansimultaneouslyrecordEEGand

capture MR images. Professor Tamames

also sees the potential for continued

innovationintechnologyandsequences

to shorten MR scan times, in some cases

toasquickasfiveor10minutes.

“IthinkSIGNA™ Premier and AIR Technology™

arepavingthewaytoachievethisgoal,”

Professor Tamames adds.

Another advantage is in pediatric

imaging.ProfessorTamamessaysababy

canbewrappedinthecoil,whichmakes

themmorecomfortableandenablesthe

coil to get closer to the anatomy.

“In general, AIR Technology™ is more

convenientanditcanfitalmostanysized

anatomy,”addsProfessorTamames.

Professor Tamames is interested in

testing the AIR Technology™ AA with

a conventional head coil and also with

the 48-channel Head Coil.

“With 48-channels we can accelerate

morebecausewehaveareallygood,

high-qualitysignal,”ProfessorTamames

explains. “By accelerating, we reduce

the echo time, which means less

distortioninanEPIsequence.Andthat

isimportantforexploringthebasal

ganglia and frontal or temporal areas.

Notonlyisthesignalbetter,butthe

anatomy and morphology of the tissue

ismorerealistic.”

And,becausetheheadsetforthe

48-channelHeadCoiliscompatible

Figure 3. The 48-channel Head Coil delivers moresignalfromthecortical,basalgangliaanddeepbrain.(A)Axial3DT1FSPGR;(B)AxialT2;(C)AxialDWIb1000;(D)AxialT2PROPELLER;and(E)CoronalT2PROPELLERFatSat.

A

D

B

E

C

WatchtheteamatErasmusdiscuss their experience with AIR Technology™.https://youtu.be/MeGebBSjUNQ

24

also increases patient comfort during

scanning,”Dr.Motosugisays.“Wefound

SIGNA™Premiertobethebestproduct

forthispurpose.”

Inthefirstthreemonthsofoperation,

the facility had performed over 400

clinical exams with SIGNA™ Premier,

including284head/neck,71abdomen

and57musculoskeletal(MSK)exams.

“AIR Technology™isthebiggest

technologybreakthroughinMRimaging

inthelasttwodecades,”Dr.Motosugi

adds.“It’sakeyreasontochoosea

GEMRsystem.”

He cites the advantage of patient comfort

withtheflexiblecoilbutalsothehigh

At the University of Yamanashi Hospital

inJapan,UtarohMotosugi,MD,PhD,

Associate Professor, Department of

Radiology, is focused on research in

abdominalMRimaging.Dr.Motosugi

hascollaboratedwithGEHealthcare,

RichardL.Ehman,MD,MayoClinic

and Scott Reeder, MD, PhD, University

of Wisconsin-Madison using MR

elastographyandIDEALIQ.

The importance of this research is

underscoredbytheclinicalneedsofan

agingJapanesesociety.Cancer,which

accounts for nearly one-third of all

deathsinJapan,alongwithAlzheimer’s

and heart disease, are top concerns

for the country’s health ministry.1,2

Locally,GEresearchersoftenactively

workwithDr.Motosugiandhiscolleagues

to explore new technologies and

sequencesforMRimaging,including

SIGNA™ Premier and AIR Technology™‡.

In March 2018, SIGNA™ Premier and

the 48-channel Head Coil were installed,

followedbyAIRTechnology™ Anterior and

Posterior Arrays. The hospital already had

a good experience with the Discovery™

MR750inbothclinicalandresearchuse.

According to Dr. Motosugi, the university

chose SIGNA™Premierbecauseofthe

SuperGgradientcapabilitiesandthenew

AIR Technology™ Suite.

“We wanted to add a higher performance

systemthatisresearchcapablebut

Utaroh Motosugi, MD, PhDUniversity of Yamanashi Hospital, Yamanashi,Japan

A lighter,more

flexible and

way to scancomfortable

‡Notavailableforsaleinallregions.

25

signal penetration and uniformity when

imagingdeepareasofthebodyaswellas

the lower g-factor for faster imaging.

The AIR Technology™ Suite of coils are 60% lighter than conventional hard-shell coils andareflexibletofitallbodyshapes, sizes and ages. In these instances, they deliver consistent,high-qualityimageswith higher signal-to-noise ratios(SNR)andfreedomin coilpositioningbyfitting99.9%of the population.

Inbrainimaging,the48-channelHead

Coil and SIGNA™ Premier are now the

preferred choice at the University of

Yamanashi Hospital. Routine MSK

imaging with the AIR Technology™

AnteriorArrayforshoulder,longbone

and femoral imaging has delivered very

good, uniform images with larger Z

coveragethanpreviouslyattainable.

“WhilewewouldliketouseSIGNA™

Premierforallofourbodywork,we

have several ongoing liver research

studies on the Discovery™ MR750 that

includecollaborationfromothersites

throughouttheworld,”heexplains.

“However,asabodyradiologist,I’meager

to run more research on SIGNA™ Premier

with AIR Technology™.”

Dr.Motosugiappreciatesthequalityof

thefacility’sexisting3.0Tscannerbutis

excitedbythepotentialfromthehigher

performanceandwiderboreofSIGNA™

Premier.Healsolikesthesleek,modern

look.Withthenewcoiltechnology,his

firstimpressionisthataconventional

MSKcoilcouldbereplacedwithAIR

Technology™ for routine clinical exams.

Inabdominalimaging,deepsignal

penetration with AIR Technology™ Coils

in pancreatic imaging has delivered

betterimageuniformityandlarger

coverage.Whenimagingspecificbody

areas for lesions, such as the liver or

kidneys,itisnotuncommontofind

a lesion in another area. Prior to AIR

Technology™Coils,thisrequiredthe

repositioning of the coil and/or patient,

takingupvaluableimagingtime.Thisis

no longer the case with AIR Technology™,

leadingtohigherefficiencyandmore

productive exams.

Oneareaofexplorationistheuseof

AIR Technology™ Coils with 3D dynamic

imagingandareductioninbreath-

holdtime.“Weoftenwanttoacquire

A

B C

Figure 1. Using the same AIR Technology™ Anterior Array setting, thetechnologistcanacquirethetargetregionofinterest(FOV13cm)andwidecoveragedepictingthepatient’schest,abdomenandpelvis(FOV34cmx2stations).

26

of AIR Technology™. Now, the technologist

can position the patient in the center

of the magnet for these exams, which

furtherenhancesimagequality.

AIR Touch™ has also helped the

technologists with reducing coil selection

errors. It helps technologists determine

thebestconfigurationforeachpatient

with an intelligent patient recognition

algorithm and system intelligence to

automatically optimize every scan, even

theelementconfiguration.

Reducingscantimesisakeyinitiative

at the University of Yamanashi, as it

will free up SIGNA™ Premier for more

research-related scanning.

multiple arterial phases for dynamic

liversequenceswithhighimagequality.

IbelieveAIRTechnology™ will help

accelerate higher reduction factors due

tothelowerg-factor,”Dr.Motosugisays.

He also expects to see faster and higher

spatial resolution volumetric imaging

with the AIR Technology™ Suite. In

particular, he anticipates high-resolution

volumetric T2-weighted imaging in the

abdomenwillhelphimdetectsmallcysts

inthepancreasandfindtherelationship

to the pancreatic duct, all in one scan.

In the shoulder, arm and femoral

regions, AIR Technology™ Coils have

replaced conventional coils for most

clinical exams, especially in cases of

suspectedinflammatorydisease.In

these types of cases, the clinician needs

to visualize a wide area to determine

theextentofinflammation.

“Conventional rigid MSK coils cannot provide the coverage we need in cases of inflamma-tion.ThisisaclearbenefitofAIR Technology™.”

Dr. Utaroh Motosugi

Patient positioning in upper extremity

exams has also changed with the addition

A

A

B

B

C

C

Figure2.ImagesacquiredonapatientwithabladdertumorusingAIRTechnology™AnteriorandPosteriorArrays.(A)AxialT2wPROPELLER,FOV20cm,Th/Sp5mm/0.5mm,288x288inascantimeof2:15min.(B)AxialMUSEwithab1000,FOV28cm,Th/Sp4mm/-2mm,128x256inascantimeof2:30min.(C)ADCMap.

Figure 3. A 35-year-old female with suspected trophoblasticdisease.(A)Pre-contrastand(B)Dynamic1stPhaseofaSagittalDCELAVA,FOV28cm,Th/Sp5mm/-2.5mm,288x224,14sec.x2phases.(C)AxialT2w,FOV28cm,Th/Sp 5 mm/1 mm, 384 x 256 in a scan time of 2:13 min.

27

The 48-channel Head Coil has helped

immensely in this regard, reducing total

exam time for a comprehensive neuro

exam that includes T1-weighted, T2-

weighted,FLAIR,T2*-weighted,DWIand

MRA with HyperBand and HyperSense to

fiveminutes.Dr.Motosugibelievesthis

is 50 percent less than conventional 3.0T

neuro exam times.

AqualityMRsystemismorethanjust

hardware.Severalnewsequences

forbodyimaginghavealsoimpressed

Dr. Motosugi.

“AclearbenefitofMUSEDWIisless

distortion,”hesays.Inabdominal

imaging,MUSEDWIwasimpressive.

WhenthepriorDWIsequencewas

comparedtoMUSEDWI,Dr.Motosugi

and his colleagues found the older

images were more distorted than they

perceived at the time, even to the point

ofimpactingaconfidentdiagnosis.

WithliverMUSEDWI,thereisa

reduction in the signal drop that occurs

nearthestomach.ForMUSEDWIrenal

and adrenal gland imaging, the image

qualityisexcellentintheCoronalplane

without distortion. The pancreas is

another area with great potential for

high-resolution DWI.

“MUSEDWIisalsopromisingin

extremity imaging for detecting tumors.

Wewereabletoobtainexcellentimage

A

A

C

B

B

D

Figure 4. Image of a hip-joint depicting femoral head necrosis. (A)T2wFSEFlexCoronal(WaterImage),FOV36cm,Th/Sp4mm/ 1 mm, 384 x 288 in a scan time of1:17min.(B)T2wFSEFlexCoronal(In-phase),FOV36cm, Th/Sp 4 mm/1 mm, 384 x 288 in a scan time of 1:17 min.

Figure5.Liverimagingstudyusing AIR Technology™ Anterior and Posterior Arrays to assess ahemangioma.(A)AxialT2wPROPELLER,FOV30cm,Th/Sp 5 mm/0 mm, 384 x 384 in scan timeof5:04min.(B)Pre-contrast,(C)Dynamic1stPhaseand(D)Dynamic 2nd Phase.

28

“Surprisingly, the first patient we scanned with an AIR Technology™ Coil said, ‘Why is itsocomfortabletoday?’AcomfortableexaminationforthepatientisobviouslyakeybenefitoftheAIRTechnology™.”

Dr. Utaroh Motosugi References

1. http://www.healthdata.org/japan

2. https://www.nippon.com/en/features/h00211/

qualityinthekneeandshoulder,”Dr.

Motosugi adds.

The University of Yamanashi is

implementingfree-breathingabdominal

scansthankstotheadditionof

PROPELLERMB.Sofar,theimaginghas

beenrobustwithgreatimagequality.

Yet, the real test of implementing

the new AIR Technology™ Coils is the

impact it has on the patient experience.

Thefirsttimetheywereused,theAIR

Technology™ Coils passed the test.

A

A

B

B

C

Figure6.LowdistortionDWIisachievedwithMUSE.(A)AxialT2wFSE,FOV30cm,Th/Sp5mm/1mm,320x320inascantimeof2:49min. (B)AxialMUSEwithb1000,FOV36cm,Th/Sp4mm/1mm,128x160,shot2,ASSET2inascantimeof3:30min.(C)AxialDWIEPIwithb1000,FOV36 cm, Th/Sp 4 mm/1 mm, 128 x 160,ASSET2 in a scan time of 2:30 min.

Figure7.(A)MUSEwasutilized for a DWI study of a patient with a suspected bonetumorinthefourth rib.(B)AxialT2wPROPELLER, FOV24cm,Th/Sp5mm/ 1 mm 256 x 256 in a scan time of 3:22 min.

29

VicenteMartinezdeVega,MDQuirónsalud Madrid University Hospital Madrid, Spain

Manuel Recio Rodríguez, MDQuirónsalud Madrid University Hospital Madrid, Spain

Body imaging with AIR Technology Anterior Array and Posterior ArraySubmitted by Quirónsalud Madrid University Hospital

Fetal imaging

By Manuel Recio Rodríguez, MD, Associate Chief of Diagnostic Imaging Department

With the AIR Technology™‡AnteriorArray(AA),wecanachievegoodsignalpenetrationforfetalimaging.

Thisenablesustoobtainhigh-qualityimagesofthefetalbrainwithshortacquisitiontimesusingT2and

DWIsequences.

A B C D

Figure 1. AIR Technology™AAprovidesexcellentsignalpenetrationforhigh-qualityimages.(A)SagittalT2SSFSE;(B)CoronalT2SSFSE; (C)AxialT2SSFSE;and(D)AxialDWIb800.

38-year-old pregnant woman; fetus with hydrocephalus.

Coil: AIR Technology™ AA

Parameters:

T2 SSFSE in three planes:

- Sagittal: 0.7 x 0.7 x 3 mm, 1:00 min.

- Coronal/Axial: 0.7 x 0.7 x 2.5 mm, 1:22 min.

DWI, b800: - Axial: 2.8 x 2.8 x 2.5 mm, 0:50 sec.

‡Notavailableforsaleinallregions.

30

Abdominalimaging

By Vicente Martinez de Vega, MD, Chief of Diagnostic Imaging Department

AbdominalimagingwiththeAIRTechnology™Coilsisbetterthanweexpected,particularlythecoverage,signal

homogeneity,highspatialresolutionandscanningspeed.Wewerealsoabletoachieveshortacquisitiontimes

andhomogenousfatsuppression.Inthisparticularcase,athickeningoftheterminalileumcanbenoticedina

very short segment, which is consistent with Crohn’s disease.

A D

EB

Figure 2. AIR Technology™AAandPACoilsforabdominalimagingdeliverbetterthanexpectedcoverage,signalhomogeneity,highspatialresolutionandhomogeneousfatsuppression.Athickeningoftheterminalileum(redarrows)isconsistentwithCrohn’sdisease.(A)AxialT2SSFSE;(B)AxialDWIb1000;(C)CoronalT2SSFSE;(D)AxialT2SSFSEFatSat;and(E)AxialT1LAVAASPIR.

48-year-old male with Crohn’s disease.

Coils: AIR Technology™AAandPosteriorArray(PA)

Parameters:

T2 SSFSE in two planes with and without FatSat:

- Axial: 0.8 x 1 x 4 mm, 0:52 sec.

- Axial w/FatSat: 0.9 x 0.9 x 4 mm, 0:54 sec.

- Coronal: 1 x 1.25 x 4 mm, 0:38 sec.

Axial DWI: b1000,2.9x1.2x5mm

T1 LAVA ASPIR in two planes:

- Axial 1 x 1.25 x 2.4 mm, 0:24 sec.

- Coronal: 1 x 1.25 x 3 mm, 0:19 sec.

Coronal T1 DISCO: 1 x 1.6 x 2 mm, 7 sec./phase

Coronal T2 FIESTA dynamic:

1 x 1 x 3 mm, 0:54 sec.

C

31

A B C

Figure3.Athickeningoftheterminalileum(redarrows)isconsistentwithCrohn’sdisease.(A)CoronalT2SSFSE;(B)CoronalT1LAVAASPIR;and(C)MIPfromDISCO,arterialphase.

Figure4.SamepatientasFigure3.(A)CoronalT2FIESTAand(B)AxialT1LAVAASPIR.

A

B

32

Prostate imaging

By Manuel Recio Rodríguez, MD, Associate Chief of Diagnostic Imaging Department

Prostate MR is growing in use and referrals in our institution. However, in order to clearly depict the cancer to determine

theextentofdisease,itisnecessarytoobtainT2sequenceswithhighspatialresolution.Also,T2Cubeimagescanbe

usedtomergewithultrasoundtoassistinperformingtargetedbiopsies.Inthisparticularcase,alesionwithhighsignal

intheT2-weightedsequenceinthecentralprostatecanbeseen.Thereisnoenhancementinthedynamicsequenceand

restricteddiffusionisconsistentwithaprostateabscess.DynamicacquisitionwithDISCOLAVAprovideshighspatialand

temporalresolution(4.5secondsperphase)andthediffusionimagingisveryhighquality.

A

A B

B

C D E

Figure 6. There is no enhancement in the dynamicsequenceandrestricteddiffusionisconsistentwithaprostateabscess.(A)AxialDISCOLAVA;(B)enhancementintegralmap;(C)AxialDWIFOCUSb800;(D)ADCmap;and(E)MAGiCDWIb1500.

Figure 5. AIR Technology™ AA and PA provide high spatial resolutioninT2sequences,which improves visualization of the cancerous lesion for staging. Note the lesion with a high signal in the central prostate. (A)AxialT2and(B)AxialT2Cube.

71-year-old male with prostate cystic adenoma.

Coils: AIR Technology™ AA and PA

Parameters:

Axial T2 FSE: 3 x 0.4 x 0.7 mm, 4:47 min.

Axial T2 Cube: 0.5 x 0.8 x 0.8 mm, 5:31 min.

FOCUS DWI: b800,3x2x2mm

MAGiCDWI:b1500

Axial DISCO LAVA: 1.5 x 1 x 1 mm, 4.5 sec./phase

33

BrigitteTrudel,RT(R)(MR)RNR Institute of Radiology and Neuroradiology Glattzentrum, Wallisellen, Switzerland

Krisztina Baráth, MDRNR Institute of Radiology and Neuroradiology Glattzentrum, Wallisellen, Switzerland

Neuro imaging with 48-channel Head CoilBy Krisztina Baráth, MD, neuroradiologist, and Brigitte Trudel, RT(R)(MR), MRI Chief Technologist,

RNR Institute of Radiology and Neuroradiology at Glattzentrum

When scanning with the new 48-channel

Head Coil on the SIGNA™ Pioneer 3.0T MR

system,routineneuroacquisitionsshow

significantlyhighersignal-to-noiseratio

(SNR)comparedtoprioracquisitions

withtheconventionalHeadNeckUnit

(HNU)coil.

WiththeembeddedAIRTechnology™

elementdesign,wecanobserveavery

homogenoussignaldistributionoverthe

wholefield-of-viewwithoutanysignal

dropinthecenterofthebrain.Inour

experience,weknowthisisnotthecase

foreverydedicatedneurocoilavailable

onthemarket.

Additionally, the coverage of the coil in

the z-direction gives us the versatility to

easilyscanthebrainandcervicalspine

for multiple sclerosis as well as carotid

MRA studies.

The 48-channel Head Coil has an

adaptabledesignwithanadditional

3 cm expansion to gain more room for

verylarge-sizedheadsandnecks.Italso

helpsreducethepatientfeelingconfined

or having their nose in contact with the

frontofthecoil.Thecoiliscompatible

with the comfort tilt device, which is

very important when scanning elderly

patientssufferingfromkyphosisbecause

ithelpsthemliecomfortablyonthe

table.Itisessentialforourdementia

protocols that the patient not move

during scanning due to discomfort.

Bycombiningtheadvantageofextra

SNR with high ARC factors and new

accelerationtechniques,suchas

HyperSense and HyperBand, we are

abletodecreasesignificantlyourtotal

examinationtimeforneuroprotocolsby

25% while maintaining or even increasing

imagequalityandspatialresolution.

The 48-channel Head Coil is a real asset

for us as a neuroradiological institute

and it further extends the clinical

benefitsofapowerful3.0TMRsystem

such as the SIGNA™ Pioneer.

34

A B

Figure 1. Cervical spine and carotid CE-MRA.(A)SagittalT2FSEFlex, 0.9x0.9x3mm,3:45min.;(B)Sagittal T1 optimized, 0.8 x 1 x 3 mm, 2:47min.;(C)Coronalcarotid CE-MRA,0.9x0.9x1.2mm,0:40sec.; and(D)AxialT2HyperCube,0.7x0.7x 1.8 mm, 2:24 min.

C

D

A

D

C

F

B

E

Figure 2. Patient with multiple sclerosis. Higher SNR with the 48-channelHeadCoilenables bettergraymatterdelineation(greenarrows)andenhancedlesiondepiction(redarrows). (A-C)48-channelHeadCoil, SagittalCubeFLAIRHyperSense, 1 x 1.1 x 1.2 mm, 3:30 min.; and (D-F)conventionalHNU,SagittalCubeFLAIRHyperSense, 1 x 1.1 x 1.2 mm, 3:45 min.

35

A B

Figure 4. Patient with low-grade glioma.(A,B)DTIHyperBandwith 32 directions, 2.2 x 1.8 x 4 mm, 3:43 min.

A

D F

B

E

Figure 3. Patient with low-grade glioma.HigherSNRwiththe(A-C)48-channelHeadCoilenablesbetterin-planeresolution(greenarrow)and enhanced lesion depiction (red arrow)than(D-F)imagesacquiredwithconventionalHNU.(A,D)CubeFLAIRwithHyperSense,1x1.1x 1.2 mm, 3:38 min. with 48-channel Head Coil and 3:45 min. with conventionalHNU;(B,C,E,F)AxialT2PROPELLER,0.5x0.5x3mm,2:10 min. with 48-channel Head Coil and 0.6 x 0.6 x 3 mm, 2:23 min. with conventional HNU.

C

36

Figure6.Standardbrainandorbitsprotocolsacquiredwiththe48-channelHeadCoil.(A)TOFwithHyperSense,0.7x0.7x1mm,3:21min.;with(C)Sagittaland(D)Coronalreformats;and(B)AxialT2HyperCubewithFlexandHyperSense,3:53min.

A C

D

B

A

Figure5.Patientwithmeningiomascannedwiththe48-channelHeadCoil.(A)CoronalT2,0.5x0.6x3mm,2:15min.;(B)AxialLAVAASPIRpostcontrast,0.8x0.8x1mm,3:50min.with(C)Coronalreformat.

B C

37

Diffusion imaging with AIR Technology SuiteSubmitted by Kawasaki Saiwai Hospital

Case 1

A59-year-oldfemalewithlossofconsciousness.Priorhistoryincludesgallbladderstoneandcholecystitis.

MR findings

Patienthasmultipleinfarction.MicroinfarctionwasnotclearlyvisualizedinconventionalDWIsequence.

However,MUSEenabledhigh-resolutionDWIthatenableddepictionofmicroinfarctioninthegraymatter.

A

D

B

E

C

F

Figure1.WiththeimprovementinresolutionusingMUSE,thereiscleardepictionoftheinfarctinthegraymattercomparedtotheconventionalsequence.(A-C)ConventionalDWI,b1000;(D-F)MUSE,b1000.

59-year-old female.

Coil: 48-channel Head Coil

Parameters:

DWI, b1000: 0.9 x 1.9 x 5 mm

MUSE, b1000: 0.8 x 0.9 x 5 mm

38

Case 2A46-year-oldmalepresentingwithfeverofunknownoriginandsuspectedinfectionafteraorticstentreplacementsurgery.

MR findings

T2SSFSEandT2STIRPROPELLERMBconfirmedabscessformationintheleftupperlunglobewithouthavingtorepositionthecoil.

HighsignalDWIconfirmedlocation.Whole-bodyCoronalDWIwasacquiredintwostations.TheAIRTechnology™‡ Anterior Array

(AA)allowshigherparallelimagingfactors,enablinglow-distortionDWIevenincaseswithalargefield-of-view.‡Notavailableforsaleinallregions.

Figure2.(A)CoronalT2wSTIRPROPELLERMB; (B)CoronalLAVA;(C)CoronalDW-EPI,2stations; (D)whole-bodyDWI,radialMIP;(E)whole-bodyCoronal DWI radial MIP, 2 stations.A B

C D E

46-year-old male.

Coil: AIR Technology™ AA

Parameters:

T2 STIR PROPELLER MB:

1.6 x 1.6 x 5 mm ARC factor of 3 3:49 min.

T2-weighted SSFSE:

1.3 x 2.1 x 5 mm 1:10 min.

Whole-body DWI, b800:

2 station Coronal DWI, 1.8 x 4.2 x 5 mm Acc 2.0/4.0 4:00 min.

gehealthcare.com/mr

Simply better compared to conventional technology.

AIR Technology™ transforms the MR experience. Its flexible and versatile coil design conforms to almost any part of the human body, so you can get closer to the anatomy you need to see. When paired with intelligent applications that automate and personalize your workflow, you’ll be able to achieve industry-leading productivity and image quality. Imagine the possibilities with an MR experience that’s simply better.

To learn more, visit us online at gehealthcare.com/AIR.

Simply better

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