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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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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
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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
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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.
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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
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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
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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.
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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.
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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
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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
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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
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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
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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.
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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).
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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.
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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.
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“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.
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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.
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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
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A B C
Figure3.Athickeningoftheterminalileum(redarrows)isconsistentwithCrohn’sdisease.(A)CoronalT2SSFSE;(B)CoronalT1LAVAASPIR;and(C)MIPfromDISCO,arterialphase.
Figure4.SamepatientasFigure3.(A)CoronalT2FIESTAand(B)AxialT1LAVAASPIR.
A
B
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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
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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.
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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.
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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
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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
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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
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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.
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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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©2019GeneralElectricCompany–Allrightsreserved.
GEHealthcarereservestherighttomakechangesinspecificationsandfeaturesshownherein,ordiscontinuetheproductdescribedatanytimewithoutnoticeorobligation.ContactyourGEHealthcarerepresentativeforthe most current information.
GE,theGEMonogram,SIGNAandAIRTechnologyaretrademarksofGeneralElectricCompany.GEHealthcare,adivisionofGeneralElectricCompany.GEMedicalSystems,Inc.,doingbusinessasGEHealthcare.
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