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MAGNETOM Skyra
Operator Manual – MR System
syngo MR E11
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MAGNETOM Skyra
Operator Manual – MR System
syngo MR E11
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&$87,21
Legend
Indicates a hint
Provides information on how to avoid operating errors or information emphasizing
important details
Indicates the solution to a problem
Provides troubleshooting information or answers to frequently asked questions
Indicates a list item
Indicates a prerequisite
A condition that has to be fulfilled before starting a particular operation
Indicates a single-step operation
Indicates steps within operating sequences
Italic
Bold
Blue
Courier
Courier
Menu > Menu Item
<variable>
Used for references and for table or figure titles
Used to identify a link to related information as well as previous or next steps
Used to identify window titles, menu items, function names, buttons, and keys, for
example, the Save button
Used to emphasize particularly important sections of the text
Used for on-screen output of the system including code-related elements or
commands
Identifies inputs you need to provide
Used for the navigation to a certain submenu entry
Identifies variables or parameters, for example, within a string
CAUTION
Used with the safety alert symbol, indicates a hazardous situation which, if not
avoided, could result in minor or moderate injury or material damage.
CAUTION consists of the following elements:
◾ Information about the nature of a hazardous situation
◾ Consequences of not avoiding a hazardous situation
◾ Methods of avoiding a hazardous situation
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WARNING
:$51,1*
Indicates a hazardous situation which, if not avoided, could result in death or
serious injury.
WARNING consists of the following elements:
◾ Information about the nature of a hazardous situation
◾ Consequences of not avoiding a hazardous situation
◾ Methods of avoiding a hazardous situation
Legend
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Legend
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Table of contents
1 Introduction
1.1 Layout of the operator manual 11
1.2 The current operator manual 11
1.3 Intended use 12
1.4 Authorized operating personnel 13
1.4.1 Definitions of different persons 13
2 Safety
2.1 Preface about safety 15
2.1.1 Hazards and risks 15
2.1.2 Common causes of accidents 15
2.1.3 Responsibility 15
2.1.4 Configuration of hazard hints 16
2.2 Common/permanently existing hazards 16
2.2.1 Electromagnetic fields 16
2.2.2 Safety instructions on the static magnetic
field 18
2.2.3 Safety instructions on RF and gradient
fields 20
2.2.4 Contraindications 23
2.2.5 Mechanical hazards 25
2.2.6 Compatibility 28
2.3 What else must be observed? 30
2.3.1 Ambient conditions 30
2.3.2 Access to the examination room 30
2.3.3 Noise development 31
2.3.4 Patient care 32
2.3.5 Artifacts and imaging errors 33
2.3.6 Maintenance/repair 38
2.3.7 Signs and symbols 38
2.3.8 System owner-related advices 41
2.3.9 Coils/quality assurance 41
2.4 In case of emergency 41
2.4.1 Emergency switches 41
2.4.2 Medical emergency 44
2.4.3 Coolant accidents 45
2.4.4 Fire/Fire fighting 46
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Table of contents
3 MR system components
3.1 Overview MR system 47
3.1.1 About function 47
3.1.2 Super-conducting magnet 47
3.1.3 Electronics cabinets 47
3.1.4 RF coils 49
3.2 syngo Acquisition Workplace 49
3.2.1 Host 50
3.2.2 Data recording 50
3.2.3 Monitor 50
3.2.4 Keyboard 51
3.2.5 Mouse 52
3.2.6 syngo MR Workplace (optional) 53
3.3 System control 53
3.3.1 Description 53
3.3.2 Operating the Dot display 57
3.4 Patient table 57
3.4.1 Description 57
3.4.2 Operating the patient table 59
3.5 Dockable patient table 64
3.5.1 Description 64
3.5.2 Operating the dockable patient table 65
3.6 Laser light localizer 70
3.6.1 Using the laser light localizer 70
3.7 Alarm box 72
3.7.1 Description 72
3.7.2 Checks 72
3.8 Intercom 74
3.8.1 Description 74
3.8.2 Operating the intercom 75
3.9 In-Room syngo Acquisition Workplace 76
3.9.1 Description 76
3.9.2 Operating the In-Room syngo Acquisition
Workplace 77
3.10 Other components and accessories 80
3.10.1 Gradient supervision 80
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Table of contents
4 Physiological imaging
4.1 Triggering methods 83
4.1.1 Prospective triggering 83
4.1.2 Retrospective gating 84
4.2 Physiological Measurement Unit (PMU) 84
4.2.1 Description 84
4.2.2 Preparing the measurement 89
4.3 ECG triggering 91
4.3.1 Description 91
4.3.2 Performing 92
4.4 Pulse triggering 95
4.4.1 Description 95
4.4.2 Performing 95
4.5 Respiratory triggering 96
4.5.1 Description 96
4.5.2 Performing 96
4.6 External triggering 97
4.6.1 Input for external trigger signal 97
4.6.2 Performing 98
5 MR system operation
5.1 Daily functionality checks 99
5.1.1 Checking the functionality and
cleanliness 99
5.2 Starting up and shutting down the MR system 100
5.2.1 Starting the system (System On) 101
5.2.2 Shutting down the system (System Off) 103
5.2.3 Shutting down the syngo MR Workplace 104
5.2.4 Starting/ending Standby 105
5.3 Preparing the MR system 105
5.3.1 Connecting the squeeze bulb 106
5.3.2 Setting tunnel conditions 106
5.4 Preparing the patient 106
5.4.1 Informing the patient 107
5.5 Physiological effects 108
5.5.1 Operating modes 108
5.5.2 Exposure to low frequency
electromagnetic fields 110
5.5.3 Exposure to RF electromagnetic fields 112
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Table of contents
5.6 Starting/Stopping the measurement 115
5.6.1 Starting the measurement 115
5.6.2 Stopping the measurement 115
6 Maintenance
6.1 Cleaning 117
6.1.1 Cleaning the LCD monitor/video display 117
6.1.2 Cleaning the camera lens 118
6.1.3 Cleaning the data carrier 118
6.1.4 Cleaning the plugs and connectors 118
6.1.5 Cleaning the patient table and the straps 118
6.1.6 Cleaning and disinfecting the receptors 118
6.1.7 Disinfecting system components 119
6.1.8 Care and cleaning of floors 119
6.2 Return and disposal 120
6.2.1 MR System 120
6.2.2 Packaging 120
6.2.3 Batteries and accumulators 120
7 Appendix: regulatory information
7.1 Medical devices of other manufacturers 123
7.2 CE for Physiological Measurement Unit (PMU) 124
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Introduction 1
Introduction
1
In order to operate the MR system accurately and safely, the
operating personnel must have the necessary expertise as well as
knowledge of the complete operator manual. The operator manual
must be read carefully prior to using the MR system.
1.1
1.2
Layout of the operator manual
Your complete operator manual is split up into several volumes to
improve readability. Each of these individual operator manuals covers
a specific topic:
◾ Hardware components (system, coils, etc.)
◾ Software (measurement, evaluation, etc.)
Another element of the complete operator manual is the information
provided for the system owner of the MR system.
The extent of the respective operator manual depends on the system
configuration used and may vary.
All components of the complete operator manual may include
safety information that needs to be adhered to.
The operator manuals for hardware and software address the
authorized user. Basic knowledge in operating PCs and software is a
prerequisite.
The current operator manual
This manual may include descriptions covering standard as well as
optional hardware and software. Contact your Siemens Sales
Organization with respect to the hardware and software available for
your system. The description of an option does not infer a legal
requirement to provide it.
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1 Introduction
The graphics, figures, and medical images used in this operator
manual are examples only. The actual display and design of these
may be slightly different on your system.
Male and female patients are referred to as “the patient” for the sake
of simplicity.
1.3
Intended use
Your MAGNETOM MR system is indicated for use as a magnetic
resonance diagnostic device (MRDD) that produces transverse,
sagittal, coronal and oblique cross sectional images, spectroscopic
images and/or spectra, and that displays the internal structure and/or
function of the head, body, or extremities. Other physical parameters
derived from the images and/or spectra may also be produced.
Depending on the region of interest, contrast agents may be used.
These images and/or spectra and the physical parameters derived
from the images and/or spectra when interpreted by a trained
physician yield information that may assist in diagnosis.
Your MAGNETOM MR system may also be used for imaging during
interventional procedures when performed with MR compatible
devices such as in-room displays and MR Safe biopsy needles.
The MAGNETOM MR system is not a device with measuring
function as defined in the Medical Device Directive (MDD).
Quantitative measured values obtained are for informational
purposes and cannot be used as the only basis for diagnosis.
For the USA only: Federal law restricts this device to sale,
distribution and use by or on the order of a physician.
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Your MR system is a medical device for human use only!
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Introduction 1
1.4
1.4.1
Authorized operating personnel
The MAGNETOM MR system must be operated according to the
intended use and only by qualified persons with the necessary
knowledge in accordance with country-specific regulations, e.g.
physicians, trained radiological technicians or technologists,
subsequent to the necessary user training.
This user training must include basics in MR technology as well as
safe handling of MR systems. The user must be familiar with potential
hazard and safety guidelines the same way the user is familiar with
emergency and rescue scenarios. In addition, the user has to have
read and understood the contents of the operator manual.
Please contact Siemens Service for more information on available
training options and suggested duration and frequency of such
training.
Definitions of different persons
Term used Explanation
User/Operator/
Operating personnel
Person who operates the system or software,
takes care of the patient or reads images
Typically physicians, trained radiological technicians, or technologists
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System owner Person who is responsible for the MR environ-
ment. This includes legal requirements, emergency plans, employee information and qualifications, as well as maintenance/repair.
MR worker Person who works within the controlled access
area or MR environment
User/Operator as well as further personnel (for
example, cleaning staff, facility manager, service
personnel)
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1 Introduction
Term used Explanation
Siemens Service/service personnel
Group of specially trained persons who are
authorized by Siemens to perform certain maintenance activities
References to “Siemens Service” include service
personnel authorized by Siemens.
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Safety
2
Safety 2
2.1
2.1.1
2.1.2
2.1.3
Preface about safety
Hazards and risks
An MR system may present various hazards. Some occur only during
the examination, while others exist permanently and thus are also
relevant to non-users (e.g. cleaning personnel).
The various hazards and the corresponding safety instructions are
explained in the safety chapter of this operator manual.
Common causes of accidents
Despite safety instructions, some hazards lead to accidents time and
again. In particular, this includes magnet accidents and RF burns/loop
formation, as well as the use of incompatible devices and the wearing
of clothing with electrically conductive materials. A detailed patient
screening ensures that the patient is free of metallic objects and
clothing with metallic yarns or appliqués.
The following sections provide information on how to avoid the most
common mistakes and the resulting safety risks. These sections were
prepared based on the long-time experience of Siemens.
Responsibility
Siemens accepts no responsibility for the safety, reliability, and
performance of the MR system, if the MR system is not used in
accordance with the instructions for use (Operator Manual, System
Owner Manual). Siemens is also not responsible for any direct or
indirect damages caused by incorrect operation. This includes, but is
not limited to, accidents with ferromagnetic objects. This applies
even if the consequences only become obvious at a later point in
time.
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2 Safety
2.1.4
2.2
Configuration of hazard hints
All hazard hints are identified in a special way. The following
keywords signal the level of hazard involved:
WARNING Warning regarding risks that may result in
death or serious physical injury.
CAUTION Warning regarding risks that may result in
minor physical injury or material damage.
Example:
WARNING
Source of danger!
Consequences
◆ Countermeasure.
Common/permanently existing hazards
The frequency at which the potential hazards mentioned in this
section lead to accidents is still too high. Therefore, it is especially
important to observe the instructions on how to avoid these
dangerous situations.
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2.2.1
The most significant hazards include:
◾ Electromagnetic fields
◾ Contraindications
◾ Mechanical hazards
◾ Incompatible devices
Electromagnetic fields
In the examination room, there are different kinds of electromagnetic fields and the resulting risks.
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Fields Most serious hazards
Static magnetic field Movement by implants and prostheses in the body
Attraction, alignment, and projectile-like acceleration of magnetizable
objects
( Page 18 Safety instructions on the static magnetic field)
Gradient fields Peripheral nerve stimulation
( Page 20 Safety instructions on RF and gradient fields)
RF fields Warming of body tissue
( Page 20 Safety instructions on RF and gradient fields)
All persons (e.g. patients, physicians, operating and cleaning
personnel, accompanying persons, and rescue personnel/fire
fighters) are exposed to these fields in the examination room.
Therefore, all limits and safety measures regarding
electromagnetic fields equally apply to patients and MR workers.
Safety 2
Static magnetic field/controlled
access area
Gradient fields
RF fields
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◆ Observe prohibition signs in the area near the entrances to the MR
system and the controlled access area.
The static basic field is generated by a superconductive magnet and
may extend beyond the examination room (walls, ceilings).
In order to minimize the hazards mentioned, the controlled access
area of the basic field is identified on the floor (
the controlled access area, the magnetic flux density is less than
0.5 mT. See: System owner manual
Linearly rising additional fields of variable strength - gradient fields are superimposed on the static main magnetic field in three different
orientations. They may cause shifts in charge in the patient's tissue
and lead to peripheral nerve stimulation.
The nuclear spins of the body tissue are stimulated via pulsed
electromagnetic RF fields. These RF pulses are generated by an RF
transmit amplifier and transferred via RF coils to the object to be
measured.
0.5 mT line). Outside
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2 Safety
RF fields lead to warming of the body tissue. In this context, an
important value per body weight is the specific absorption rate or
SAR. ( Page 108 Physiological effects)
Side effects
2.2.2
Possible undesirable side effects for MR are dizziness, heating,
claustrophobia and nerve stimulation.
Safety instructions on the static magnetic field
The list of objects in this chapter is not exhaustive. It only serves as an
illustration of objects that present hazards in the presence of
magnetic forces.
◆ Only use equipment specified or recommended for use in the
controlled access area.
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Safety 2
WARNING
Movement and/or alignment of implants and prostheses in the
body, as well as attraction, alignment, and projectile-like
acceleration of magnetizable objects may result in very serious
hazards!
Injury to patient and operating personnel
◆ Do not use resuscitation devices - for example, defibrillators
or oxygen bottles - in the examination room.
◆ Do not use transport trolleys, movable beds, stretchers, etc.
that consist of magnetizable parts.
◆ Do not wear or carry any magnetizable objects on your person
- for example, watches, pens, scissors, etc..
◆ Use only proven MR Safe or MR Conditional accessories, parts
subject to wear and tear, and disposable articles with the MR
system.
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◆ Use only MR Safe or MR Conditional tools and devices.
◆ Service work on the MR system may only be performed by
Siemens Service.
◆ Ensure that only authorized personnel enter the controlled
access area (0.5 mT
or cleaning personnel trained in MR safety.
◆ Keep the door to the examination room closed.
WARNING
Magnetizable objects introduced into the magnetic field become
projectiles!
Injury to patient and operating personnel
◆ Inform the operating personnel about the effect of forces on
ferromagnetic parts or implants, especially on systems with a
higher field strength (for example, 3T). Explain that the forces
increase with the field strength of the magnet!
exclusion zone), for example, electricians
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2 Safety
For China only: In 3-T systems medical supervision is required for
all patients according to IEC 60601-2-33 (2nd edition).
Dizziness during exposure
Device malfunctions
When persons (e.g. MR workers or patients) are exposed to the static
magnetic field, possible effects are dizziness, light-headedness, or
metallic taste, especially in 3-Tesla magnetic fields.
1 Ask the patient to lie still during the measurement.
2 Keep a sufficient distance to the magnet and avoid rapid
movements of the head.
CAUTION
Dizziness, light-headedness or metallic taste in the patient‘s
mouth during measurements and/or table movements in a 3Tesla magnetic field!
Reaction of fear by the patient
◆ Prior to the examination, inform the patient about the
possible occurrence of these symptoms.
Magnetic flux densities exceeding 0.5 mT can interfere with
electronic implants or other devices. The main magnetic field may
either affect or destroy electronic data carriers such as check or credit
cards, hard disks, ID cards with magnetic strips and/or magnetic
tapes, diskettes or pocket calculators, as well as RFID chips (Radio
Frequency Identification).
Patients at risk
Current loops and bore wall
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2.2.3
contact
Safety instructions on RF and gradient fields
◆ Do not examine patients unable to communicate potential
overheating effects (e.g. small children, seriously ill, paralyzed,
unconscious, sedated, or handicapped patients).
Dangerous current loops may be generated when parts of the
patient's body touch. These loops may lead to burns or increase the
probability of stimulation.
Current loops are also generated when the patient's skin contacts the
tunnel lining or RF coil cables.
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Safety 2
Ensure to prevent potential current loops as shown in the red
labeled illustration.
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Ensure the patient is positioned with proper distance (
magnet tunnel as well as proper distance between parts of the
body as shown in the green labeled illustration.
◆ To lower the effects of gradient fields or RF fields, keep a sufficient
distance from the RF coils and the magnet tunnel (gradient coils),
and reduce the time of exposure during measurements.
5 mm) to
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2 Safety
CAUTION
The patient is wearing electrically conductive material! Incorrect
patient positioning!
Formation of electric current loops
Peripheral nerve stimulation of the patient
◆ Ensure that the patient does not wear clothing that is wet or
dampened by perspiration.
◆ Ensure that the patient is free of metallic rings, chains, or
electrically conductive materials worked into items of clothing
(for example, brassiere support wires, metallic appliqués or
woven metallic yarns).
◆ Always position the patient so that the patient's arms are
aligned with the torso and ensure that hands, arms, and legs
do not touch (minimum distance: 5 mm).
◆ Ensure that the minimum distance of 5 mm is maintained
between patient and tunnel covering.
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◆ To ensure this distance, use positioning aids, e.g. blankets
made of linen, cotton, or paper, or dry material that is
permeable to air.
◆ Ensure sufficient ventilation.
CAUTION
Heating up/ignition of synthetic blankets via the RF field during
the measurement!
Patient burns
◆ Use only covers made of paper, cotton or linen.
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Safety 2
CAUTION
Heating up of RF blankets or shields used to avoid aliasing
artifacts!
Patient burns
◆ Never use RF blankets or other conductive sheets within the
MR system.
2.2.4
Contraindications
This chapter contains very important information about MR
safety: In principle, a qualified physician must evaluate the risk/
benefit ratio of the MR examination for every patient.
To date, there is no scientific proof that MR examinations are
harmless for pregnant women, the unborn (embryos or fetuses)
and children under two years of age.
In general, an MR examination is contraindicated for patients with
electronic or electronically conductive implants or metals, especially
those containing ferromagnetic foreign matter.
Typical contraindications for MR examinations are:
◾ Electronic implants: e.g. pacemakers, stimulators, insulin pumps
◾ Artificial heart valves, aneurysm clips
◾ Metal splinters in the eye (danger of retinal detachment)
◾ Artificial anus (anus praeter) with magnetic closure
◾ Transdermal drug patches with metallic backings
◾ Electrically conductive implants and prostheses
◾ Metallic spirals for contraception (IUDs = Intrauterine Devices)
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◾ Transdermal or other similar implants (for example, body piercings
as well as magnetic piercings)
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2 Safety
WARNING
Electronic and/or electrically conductive implants and
magnetizable inclusions in static and low-frequency magnetic
fields and RF fields!
Risk of patient death/patient injury
◆ Ask the patient about implants and inclusions.
◆ Do not perform MR examinations on patients with electronic
or electrically conductive implants and magnetizable
inclusions.
◆ Ensure that patients wearing such implants and/or inclusions
remain outside the exclusion zone (
Exceptions: Certain implantable medical devices have been cleared,
approved and/or licensed by the Competent Governmental
Authorities and/or labeled by the device manufacturer as “MR
Conditional”. For such implantable medical devices, the previously
mentioned list of general contraindications and the warning may not
be applicable in its entirety.
0.5 mT line).
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It is the responsibility of the device manufacturer to declare an
implantable medical device as MR Conditional if appropriate and to
define the conditions (constraints) for safe MR scanning. The MR
operator must be aware of any such conditions for MR scanning. It is
the obligation of the MR operator to assure that these conditions are
strictly adhered to. To obtain these specific conditions the MR
operator may refer to the labeling of the implantable medical device
or contact the device manufacturer. Siemens MR does not assume
responsibility or liability for the operation of the MR system with any
implantable medical device. Especially, Siemens MR is not responsible
for controlling technical parameters of the MR system other than
those defined by the normal operating mode, the first level controlled
operating mode and the data provided in the system owner manual,
such as spatial gradient field plots.
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Safety 2
CAUTION
Eddy currents induced by low-frequency magnetic fields!
Patient burns
◆ Do not examine patients with electrically conducting implants
or prostheses.
CAUTION
Electrically conducting objects!
Injury to patient due to warming
Incorrect diagnosis due to artifacts
◆ Request that the patient removes all electrically conducting
objects, e.g. necklaces, rings, braces, rubber bands for long
hair, piercings as well as jewelry.
2.2.5
Collision and points of injury
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◆ Request that the patient removes all clothing including
electrically conducting material, for example, bras, metallic
appliqués or woven metallic yarns.
◆ Inform patients that eyeliners and tattoos may contain
ingredients causing artifacts or skin irritations during MR
examinations. In some cases, patients have been burned.
◆ To prevent injuries, instruct patients to remove makeup prior
to the examination.
◆ Instruct patients to seek medical attention in case of
discomfort during or following the MR examination.
Mechanical hazards
Collisions and injuries are more prevalent when using the
exchangeable tabletop, the patient table or when performing
maintenance activities.
◆ Observe the warning and prohibition signs as well as the safety
information.
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2 Safety
CAUTION
Accidental patient table movement!
Injury to the patient
◆ If you plan an intervention outside the magnet, activate the
Table Lock function at the Dot display with the control unit to
avoid accidental patient table movement, or injury to the
patient. After completing the intervention, the table can be
unlocked.
WARNING
Cover of the table lifting column is defective; access to moving
parts is possible!
Risk of severe contusion during vertical movement
◆ Complete the current examination and then shut down the
system.
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◆ Notify Siemens Service.
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Safety 2
CAUTION
Vertical and horizontal movement of the patient table!
Injury to patient and other persons
Damage to the patient table
◆ Ensure that there are no obstacles (e.g. extending or
overhanging body parts, hair, clothing, straps) between table
and the magnet, or that the additional equipment (e.g. IV
tube, respirator or ECG) does not get caught and remains in
and on the patient when moving the tabletop.
◆ Secure the patient’s arms and legs with straps so that the
patient is not caught between the tabletop and the magnet
cover. Remain in the MR examination room with helpless
patients (e.g. children and patients who are either seriously
ill, paralyzed, unconscious, sedated, handicapped or
medicated), even if the patients are secured during the
examination.
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◆ Ensure that the sensor for height detection is not obstructed
by clothing, sheets, or accessories, etc.
◆ Keep the patient under visual or acoustic control.
◆ In case of hazardous conditions, press the Table Stop button.
◆ Explain the significance of protocol-controlled table
movements to the patient.
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2 Safety
WARNING
Improper patient transport with the dockable patient table,
improper use of the side rails!
Injury to the patient
Damage to the patient table
◆ Carefully transport the patient on the dockable patient table.
Secure the patient if necessary.
◆ Do not pull/push the tabletop or use the emergency release to
avoid any unintended horizontal movement.
◆ Use the side rails as intended (as an arm rest or in the vertical
position e.g. for securing the patient). Always make sure that
the side rails are completely engaged after moving them and
consider possible pinching parts on the side rails.
◆ Fold the side rails down to move the tabletop.
Risk of stumbling
Combinations with other
systems, accessories
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2.2.6
The risk of stumbling is related in particular to the unfavorable
routing of cables/hoses of interventional components.
CAUTION
Cable/hoses of interventional components!
Injury to patient and operating personnel
◆ Route cables/hoses of interventional components so that it is
not possible to trip over them.
Compatibility
Among other things, the following hazards or complications may
occur through the use of third-party products during MR
examinations:
◾ Heating of system cables or connection cables
◾ Interference with MR image quality
◾ Malfunctioning of third-party products
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Safety 2
Auxiliary equipment, which has not been specifically tested and
approved for use in the environment of the MR equipment, may
result in burns or other injuries to the patient.
If the MR system is combined with other systems or components, it
must be ensured that the planned combination and cable routing do
not affect the safety of patients, personnel, or the environment.
Ensure that the devices used in the examination room are
compatible with the field strength of the MR system. For
example, devices compatible with 1.5 T systems may be
unsuitable for 3 T systems, and vice versa. See also MR
Conditional: ( Page 29 Labeling)
◆ Contact Siemens Service prior to combining the MR system with
other devices.
Interferences
Labeling
MR Safe An item that poses no known hazards in all MR environments. MR Safe items
include nonconducting, nonmagnetic items such as a plastic petri dish. An
item may be determined to be MR Safe by providing a scientifically based
rationale rather than test data.
Peripheral equipment (e.g. patient monitoring, life support or
emergency care equipment) which is not specified or recommended
for use in the MRI environment, including the controlled access area,
may be disturbed by the RF field or the magnetic fringe field of the
MR system. This equipment may also disturb the proper function of
the MR system.
ASTM International developed a new classification system for
implants and ancillary clinical devices. The following definitions
apply:
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MR Conditional An item that has been demonstrated to pose no known hazards in a specified
MR environment with specified conditions of use. Field conditions that define
the specified MR environment include field strength, spatial gradient, dB/dt
(time rate of change of the magnetic field), RF fields, and SAR. Additional
conditions, including specific configurations of the item, may be required.
MR Conditional devices (for example, RF communications equipment) may
present hazards as well. Observe the manufacturer's operator manual to
avoid potential hazards and injuries.
MR Unsafe An item that is known to pose hazards in all MR environments. MR Unsafe
items include magnetic items such as a pair of ferromagnetic scissors.
Technical data
2.3
2.3.1
Regulating the room
temperature
2.3.2
Detailed information on B0 values, gradient and RF data, as well as
graphic representations of the spatial distributions are included in the
MR compatibility data sheet. See: System Owner Manual
What else must be observed?
Ambient conditions
As the ambient conditions and SAR have a considerable effect on the
patient’s body temperature, you must regularly check the ambient
conditions.
The patient’s ability to dissipate surplus heat is increasingly affected
as the room temperature and relative humidity increase.
◆ Ensure that the room temperature is at or below
relative humidity does not exceed 60%.
Access to the examination room
Free access to and exit from the examination room must be ensured
at all times.
1 Regularly check the correct functioning of the door to the
examination room.
22°C and the
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Safety 2
2 Ensure that the door to the examination room opens and closes
correctly.
2.3.3
Noise development
By switching the currents in the gradient coils for imaging purposes,
the mechanical forces lead to noise development (humming,
knocking noises) during the MR examination which can exceed
99 dB(A) in the bore.
CAUTION
Noise development during the MR examination!
Injury to patient and people in the examination room
(hearing impairment)
◆ Provide the patient with appropriate hearing protection that
lowers noise to at least
◆ Mandatory provide anesthetized or unconscious patients with
hearing protection. Ear protection for these patients should
not be omitted even at moderate sound levels.
◆ Ensure that personnel and accompanying persons in the
examination room wear hearing protection during the
examination that lowers noise to at least 85 dB(A).
◆ For required level of hearing protection, see: System Owner
Manual, Technical data: Hearing protection data. All hearing
protection devices must provide the required level of sound
attenuation.
99 dB(A).
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Adequate attenuation levels can be achieved by using, for example,
ear plugs. Ear plugs offering sufficient hearing protection can be
found in the Siemens Accessories catalog.
The standard Siemens headphones are intended for communication
with the patient and can be used in combination with ear plugs.
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◾ For appropriate sound attenuation, the proper use of hearing
protection is important. All personnel should be trained to correctly
apply the hearing protection.
◾ Special attention and training of the operator is required for proper
positioning of the hearing protection for neonates and infants. In
addition this applies to any other condition where an alternative
form of hearing protection might be necessary.
◾ For MR examinations of infants special hearing protection may be
required.
◾ Due to increased anxiety the permissible sound pressure level may
be a reason for concern for pregnant women and their unborn, for
newborns, infants and small children as well as older persons.
2.3.4
Patient information
Patient care
Patients must be informed about the hazards and safety measures
during MR examinations. Before doing so, it must be confirmed that
an MR examination is permissible and/or checked if increased
precautions are necessary.
CAUTION
Patient received insufficient clarification of facts!
Injury to patient
◆ Explain to the patient the conduct expected and possible risks
involved.
◆ Inform the patient about the monitoring and communication
equipment e.g. squeeze ball, intercom.
◆ Instruct the patient regarding possible heat development
during the MR examination.
◆ Inform the patient about noise developing during the MR
examination.
◆ Prior to the MR examination, instruct patients of possible
stimulations during the examination i.e. twitching muscles,
tingling sensation.
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Patient monitoring
Patients may be acoustically as well as visually and physiologically
monitored in the MR system.
◾ The viewing window or a video system is used for visual
monitoring.
◾ The intercom can be used to acoustically contact the patient.
( Page 74 Description)
◾ Medical supervision: MR Conditional monitoring devices are used
to monitor the patient's vital parameters, provided the conditions
for safe operation are observed.
Medical supervision means adequate medical management of
patients who can be at risk from some parameters of exposure to the
MR equipment, either because of the medical condition of the
patient, the levels of exposure or a combination.
All patients should receive at least routine monitoring. For some
(e.g. sedated, physically unstable) patients, monitoring of the
vital parameters is mandatory. In the First Level Controlled
Operating Mode medical supervision is also mandatory.
CAUTION
Incompatible monitoring devices!
2.3.5
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Patient burns
◆ Use only monitoring devices, for example, ECG electrodes and
pulse sensor, that meet the conditions for safe use (MR Safe
or MR Conditional).
Artifacts and imaging errors
Due to their magnetizability, foreign objects in the area of the
magnet bore cause strong local distortions of the basic field and lead
to considerable image artifacts. Depending on the level of distortion,
diagnosis may be difficult, impaired or completely impossible.
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Causes: Artifacts and imaging errors are listed according to their
source for error:
◾ System-related artifacts/imaging errors
◾ Patient-related artifacts/imaging errors
◾ User-related artifacts/imaging errors, see: Software operator
manual
User-related and patient-related artifacts/imaging errors can be
largely avoided through patient instructions and proper conduct of
patient and personnel.
System-related artifacts/
imaging errors
Stripe artifacts
Incorrect slice positioning
The MR image may show system-related artifacts/imaging errors
despite careful preparation.
◆ If the same artifact/imaging error appears repeatedly, document
and submit it to Siemens Service.
CAUTION
RF-signal interference caused by incompatible accessories e.g.
patient monitoring devices!
Streaks and bright spots in the MR image
◆ Use only accessories tested and approved for the MR system.
◆ Keep the door to the examination room closed.
◆ Vary the bandwidth of the MR sequence.
◆ Whenever possible, use local coils for the MR examination.
CAUTION
Phasing of MR signal is not set correctly!
Structure is shown in the wrong position
◆ Repeat the measurement for the structure in question by
using a second orthogonal slice and check whether the
position of the structure is reproducible nor not.
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Variations in brightness
CAUTION
Local variation in the sensitivity of local coils!
Continuous fluctuations in MR image brightness
◆ Whenever possible, use a local coil with transmit
characteristics that are more suitable for the field of view
desired.
◆ Use the normalization filter.
CAUTION
Static and/or stationary brightness errors on the LCD monitor
due to aging!
Incorrect diagnosis
◆ Scroll through the images to ensure that the MR image does
not show differences in brightness, spots, or cloudiness and
check bright objects for afterglow.
◆ Keep your eyes always in central monitor position with a
vertical view angle towards the screen surface for best image
quality.
Variations in signal and
contrast
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CAUTION
Inhomogeneous RF field!
Asymmetry of contrast in the MR image
◆ Whenever possible, use a local coil with transmit
characteristics that are more suitable for the desired field of
view.
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Distortions/signal obliteration
along the edges
Localization errors due to
distortion
Potato chip artifact
CAUTION
Spatial non-linearity of the gradient field and inhomogeneity of
the static magnetic field!
Pin-cushion and barrel-shaped distortions and/or loss of
signal in the margins of the MR image
◆ Go through a distortion correction.
◆ Position the region to be examined as close to the magnet
isocenter as possible.
◆ Use phantoms for the control measurements.
CAUTION
Incorrect localization data due to spatial non-linearity of the
gradient field and inhomogeneity of the static magnetic field!
Incorrect stereotactic planning or breast biopsy
◆ Take localization errors into account while planning
stereotactic interventions or breast biopsies.
CAUTION
36
Distorted slice edges in the margin due to spatial non-linearity of
the gradient field and inhomogeneity of the static magnetic
field!
Incorrect stereotactic planning
◆ When planning stereotactic interventions, take into account
slice distortion at the margins of the MR image. This applies in
particular to graphic slice positioning (GSP) as well as other
graphic slice displays and slice positioning data independent
of the possible use of distortion correction.
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DIXON swapping
Patient-related artifacts/
imaging errors
WARNING
When using the DIXON method, water and fat swaps might
occur!
Incorrect diagnosis
◆ Diagnosis should be confirmed by a second contrast and/or a
different orientation.
CAUTION
Poor image quality! Wrong image position!
Incorrect diagnosis
◆ Prior to the examination, inform patients about movements
and their negative effects on the measurement.
◆ Ensure that the patient does not move during the
measurement.
◆ Monitor the patient during the MR examination.
CAUTION
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Imprecise localization due to patient movement during
functional MR imaging (fMRI)!
Incorrect stereotactic planning and injury of the patient
Incorrect assignment of active brain areas
◆ Prior to the examination, inform patients about movements
and their negative effects on the measurement.
◆ Use Siemens scan protocols with motion correction.
◆ Monitor the patient to ensure that the task is performed
correctly.
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2 Safety
2.3.6
Daily checks
Safety-relevant accessories
Maintenance
Serious malfunctions
Maintenance/repair
WARNING
High voltage and currents inside the electronics cabinets!
Risk of death by electrocution
◆ Electronics cabinets should only be opened by Siemens
Service.
Windows, doors, and emergency flaps must not be blocked.
The following safety-relevant accessories should be checked:
◾ All RF coils for the transmitting and receiving system
◾ ECG and respiratory sensor
◾ Disposable electrodes
◾ Pulse sensor
For detailed information about maintenance of the MR system, see:
System owner manual
In case of serious malfunctions, shut down the MR system
immediately and notify Siemens Service.
Magnetic field
38
2.3.7
Warning signs
Signs and symbols
RF field
Observe operator manual
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Potential injury to persons
Risk of breaking
Laser
Risk of injury
Maximum load side rails
Laser (for the US only)
Laser radiation
Refilling with liquid nitrogen and helium
Prohibition signs
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The following objects are prohibited in the examination room:
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2 Safety
Implants susceptible to
electromagnetic effects
Fire extinguishers with
magnetizable metal
housing
Unauthorized access
Further symbols
Open flames, no smoking
Metal parts, e.g. tools
Metallic implants and
other metallic objects
inside the body
Electronic data carriers
Implants susceptible to electromagnetic effects
Mechanical watches
and electronic data carriers
40
Sign requiring mandatory hearing protection
Non-ionizing radiation
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Safety 2
2.3.8
2.3.9
2.4
Protective class symbol B for
application parts
Protective class symbol BF for
application parts
System owner-related advices
Some safety instructions address the system owner. They are
included as “Safety information” in a separate operator manual, see:
System owner manual. This manual also contains the technical
description of the system.
Coils/quality assurance
Safety instructions covering the intended use of coils and
measurement phantoms are included in a separate operator manual.
See: Coil operator manual.
In case of emergency
1 Before working with the system, familiarize yourself with the
location and functionality of the emergency switches installed.
2 Report all accidents resulting in personal injury immediately to the
appropriate authorities.
3 Observe the established emergency plans (e.g. emergency plan in
case of coolant accidents, emergency plan for fire fighting).
2.4.1
Switch Effect Emergency
Magnet Stop Shutting down the static magnetic
field (quenching)
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Emergency switches
The MR system has different types of emergency switches.
E.g. in case of accidents with attracted
metal parts or in case of fire
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2 Safety
Switch Effect Emergency
Emergency Shutdown
Table Stop Motorized table movement is stopped In case of accidents or injury due to
Electric power of the entire MR system
is switched off, but magnet remains at
field
In case of emergency, the relevant switch should be pressed.
E.g. in case of fire
table movement
42
Magnet Stop switch
(1) Magnet Stop switch
(2) Emergency Shut-down switch
(3) Table Stop button
The Magnet Stop switch triggers a controlled magnet quench
(shutting down the magnetic field). The MR system is not
disconnected from the power.
There are two different versions of the Magnet Stop switch on the
MR system: as an individual switch or as an integral part of the alarm
box. The switches may also be installed in other places of the MR
system.
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Safety 2
After the Magnet Stop switch has been pressed, an alarm is triggered
at the alarm box. The WARNING LED will light up and an alarm signal
will sound.
As a rule, Siemens Service must be called following a quench.
The magnet must only be put back into operation by Siemens
Service personnel.
WARNING
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Formation of droplets due to condensation during quenching!
Personal injury
Risk of fire
◆ Do not touch the exhaust line.
◆ Do not stand under the exhaust line.
◆ Avoid open flames and do not smoke.
WARNING
System indicates Magnet Stop error!
Hazardous conditions because the magnet cannot be
quenched in case of emergency
◆ Immediately remove the patient from the magnet.
◆ Restrict the access to the examination room.
◆ Notify Siemens Service.
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2 Safety
Emergency Shut-down switch
Table Stop button
Typically there are two Emergency Shut-down switches installed:
one near the alarmbox and another one in the examination room.
The switch is used to switch off the electric power of the entire MR
system.
WARNING
Fire or electrical accidents!
Personal injury
◆ Press the Emergency Shut-down switch immediately.
◆ Contact your fire department.
It is located on the intercom and on the patient table.
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2.4.2
Medical emergency
WARNING
Medical emergency during MR measurements!
Risk of death to patients
◆ Terminate the measurement immediately.
◆ Remove patients from the examination room for treatment
unless it is certain that the medical equipment required is
appropriate for use inside an MR room.
◆ Do not store or operate oxygen bottles, defibrillators, or other
auxiliary tools for resuscitation in the examination room.
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CAUTION
Squeeze bulb is defective!
Risk of injury to patient because emergencies cannot be
communicated
◆ Check the functionality of the squeeze bulb daily.
2.4.3
First aid in case of shortness of
breath
First aid in case of frostbite
Coolant accidents
During a quench, a person might become unconscious due to severe
shortness of breath:
1 Remove unconscious persons immediately from the examination
room.
2 Start adequate first aid measures and contact a physician
immediately.
Direct contact with subzero liquids, gases, and surfaces (e.g. pipes)
may lead to frostbite. The eyes and mucous membranes are
especially vulnerable.
CAUTION
Improper handling of liquid helium!
Skin damage caused by frostbite
◆ Do not rub frostbitten skin areas.
1 Remove clothing carefully from the locations involved.
2 Rinse frostbitten skin with lukewarm water.
3 Cover frostbitten skin with sterile bandages.
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4 Do not apply powder or creams.
5 Contact a physician immediately.
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2.4.4
Fire/Fire fighting
The following devices/materials may be used for fire fighting:
◾ Non-magnetic CO2 extinguisher
◾ Self-contained, anti-magnetic compressed-air breathing apparatus
(or hose connection)
◾ Airtight chemical protective suit
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MR system components 3
MR system components
3
3.1
3.1.1
3.1.2
Magnetic field
Cooling system
Shielding
Gradient system
Overview MR system
About function
A detailed specification of the systems hardware and software is
available in the Info dialog box (main menu Help > Info).
Super-conducting magnet
The super-conducting magnet generates a strong homogeneous
magnetic field with a field strength of
The magnet is filled with liquid helium as a coolant. Following
installation, it is adjusted to the desired operating field strength. The
ramped-up magnet does not require additional electric power to
maintain the magnetic field. Under normal operating conditions,
there is no helium boil-off.
To minimize the effects of the magnetic fringe field on the
environment, the magnet of the MR system is equipped with active
super-conducting shielding.
The gradient system provides precise localizing slice positions.
For details on the gradient system, please refer to the System owner
manual.
3 T.
3.1.3
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Electronics cabinets
The electronics cabinets are located in the engineering room or the
operating room.
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(1) Gradient cabinet
(2) Control cabinet
48
Gradient cabinet
Control cabinet
(3) System separator
The gradient cabinet contains the power electronics for generating
the magnetic field gradients.
The control cabinet includes different electronics components to
operate the MR system.
The control cabinet includes a sequence-programmable, optical
trigger signal output which can be made externally accessible by
Siemens Service via installation of a fiber optic cable.
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Please note that Siemens provides customers with the optical
trigger signal output for research purposes only. No devices
connected to this output have been tested by Siemens. Before
connecting devices to the MR suite using the optical trigger
signal output, they must be tested for safety by trained
personnel.
Before using devices in the proximity of the magnet, their nonmagnetic properties and clinical operation in the magnetic field
have to be confirmed.
The use of devices connected to the optical trigger signal output
has to comply with any applicable governmental or local hospital
Institutional Review Boards (IRBS).
Siemens will not be held responsible for the use of any device
and resulting consequences in connection with the optical trigger
signal output.
System separator
3.1.4
3.2
The system separator contains electronics components and coolingequipment to deliver an adequate cooling power for the system. If a
special cooling system (chiller) is installed, the system separator is not
necessary.
RF coils
The description, handling and quality measurements for RF coils are
included in a separate operator manual. See: Coil operator manual
syngo Acquisition Workplace
The workplace in the control room is known as syngo Acquisition
Workplace (syngo Acq WP). It includes the host processor with the
operating elements monitor, keyboard, and mouse.
An additional component of the syngo Acquisition Workplace is the
intercom. ( Page 74 Description)
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3.2.1
3.2.2
Host
Among other things, the host processor includes the following
functions:
◾ Patient management
◾ Image selection and storage
◾ Measurement sequence management
Measured MR images may be transferred to other systems or
computers via the network connection (e.g. PACS or RIS
systems). MR images from other systems or computers can be
received via the network as well.
Information about network connections is displayed in the Info...
dialog window.
Data recording
The MR system provides the following modules for data recording:
◾ CD/DVD burner
◾ DVD drive
An interface (e.g. USB connection) for a paper printer is also
available.
50
Data carrier
3.2.3
The burn and read process is started via the software. See: Software
operator manual
Only CD-Rs/DVD-Rs (Recordable) labeled “Medical Grade” and having a
gold-colored layer are suitable for documenting data for medical
purposes. Siemens Service will provide you with CD-Rs/DVD-Rs.
Please take into account the handling, care, storage of CDs/DVDs
and CD-Rs/DVD-Rs as specified by the respective manufacturers.
Monitor
The monitor is used for displaying MR images as well as user dialogs.
It is switched on or off as part of the overall MR system.
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All other adjustments are blocked since the monitor is already
optimally configured by Siemens Service.
Do not touch the surface of the screen using sharp, pointed
objects.
Do not position containers holding fluids, e.g. cups or glasses, on
top of the monitor.
In addition, general cleaning instructions must be observed.
The monitor may only be opened by authorized Siemens Service
personnel.
3.2.4
Function Original Siemens key Windows key
Increase/decrease image brightness (set window
position)
Increase/decrease contrast (set the window width)
Automatically set contrast and brightness 9
Page forth/back in the examination
Keyboard
The syngo Acquisition Workplace
Siemens keyboard. This keyboard is a modified Windows keyboard
where the numeric keys have been replaced with symbol keys.
The symbol keys are used to access frequently used functions. The
F4, F5, F6, F7, and F8 function keys enable you to access the
individual task cards. The F1 function key lets you access the Online
help.
/
/
/
is equipped with an original
NUM / /
* / -
8 / 7
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Function Original Siemens key Windows key
Page forth/back in the series
/
Page forth/back image by image
/
Open patient registration
Selecting the Patient Browser Del
Copy to film sheet Enter
Highlight
Send to node 1 +
5 / 4
2 / 1
Ins
3
52
3.2.5
If the computer system is connected to a clinic-wide processor
network (HIS/RIS), use the Examination task card to send images to
other network addresses via node 1.
Mouse
The system is equipped with a wheel mouse.
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◾ Left mouse button:
– Selecting or moving objects
– Starting applications
– Executing commands
◾ Center mouse button/wheel:
– Changing the window values of patient images
– Scrolling (for example, through the Patient list)
◾ Right mouse button:
– Opening the context menu (depending on the position of the
mouse pointer)
3.2.6
3.3
3.3.1
syngo MR Workplace (optional)
The syngo MR Workplace allows for evaluation, documentation and
post-processing of previously measured images while acquiring
images at the syngo Acquisition Workplace. It accesses the database
of the host processor.
It is not possible to perform measurements at the syngo MR
Workplace. It is not connected to the MR scanner or the image
reconstruction system.
System control
Description
The system control is used to operate the system and the patient
table. It comprises control units and the Dot display.
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Control units
The control units are located at the right and the left side of the
patient table at the front of the magnet cover. Optionally, additional
control units are located at the back of the magnet.
Each control unit consists of a jogwheel and several additional
buttons.
(1) Control unit for positioning the table
(2) Control unit for menu navigation and for adjusting settings for
patient comfort
( Page 59 Operating the patient table)
( Page 57 Operating the Dot display)
54
( Page 105 Preparing the MR system)
For better user guidance, the jogwheels and buttons are backlit.
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Depending on the situation, the small jogwheel can have different
functions:
◾ Rotate: e.g. for navigating through the display menu or for
changing settings of, for example, ventilation
◾ Push: e.g. for resetting the patient alert or for starting a
measurement
Alternatively, use the intercom to reset the patient alert or to
change the volume settings of the headphones and
loudspeakers.
The optional control units at the back of the magnet additionally
comprise a Table Stop button.
Dot display
Information service
The Dot (Day Optimized Throughput) display provides status
information as well as several tools.
The display is located above the magnet bore opening at the front of
the magnet cover. Optionally, at the back of the magnet, a second
display can be installed for the additional control unit.
The display shows several pieces of information:
◾ Information concerning patient positioning (e.g. patient
orientation, current table position, auto-positioning)
◾ Information about the connected coils
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◾ Guidance for attaching ECG electrodes, docking the table and
emergency evacuation
◾ General patient information submitted from the software
◾ Information concerning troubleshooting
Tool bar
You can navigate between the depicted icons by using the small
jogwheel. The selected icon is highlighted.
Confirm patient data
Displays the patient data of the registered patient
Table overview
Displays the current table position as well as the
patient orientation
Physio data
Displays the physiological data of the patient
Table lock/Table unlock
Activates/Deactivates the table lock function for interventional examination (toggle icon)
Start
Starts a prepared measurement, during the measurements, the display will be shut off
Info
56
Displays further information (e.g. undocking of the
dockable patient table)
Close patient comfort
Confirms the patient comfort settings
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3.3.2
Operating the Dot display
To operate the Dot display, use the jogwheel of the smaller control
unit. ( Page 54 Control units)
1 Turn the jogwheel to navigate through the icons.
2 Press the jogwheel to confirm the selection.
3 If necessary, adjust your settings by turning and pressing the
jogwheel.
3.4.1
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3.4
Patient table
Description
The patient table is used for positioning the patient and the coils. The
table comprises several sockets and connections.
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(1) Tabletop
(2) Head end
(3) Table Stop button
58
(4) Handle to pull out the table top in case of emergency
(5) Emergency release
The tabletop can be moved horizontally into the magnet bore. When
moved completely out of the magnet, the tabletop may be moved
vertically as well.
Coil sockets
The coil sockets are located at the head end and the foot end of the
patient table. For more information concerning the occupation of the
coil sockets, see: Coil operator manual
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MR system components 3
Make sure that no liquids such as contrast medium, blood, or
cleaning agents get into the table connections.
Connections
Paper roll holder
3.4.2
The following connections are located at the foot end of the patient
table:
(1) Headphones
(2) Vacuum cushion
(3) Squeeze bulb
(4) Placeholder [Intended for future use]
The paper roll holder can be mounted at the foot end of the table
below the handle. It includes a holder to reposit the headphones and
can be removed if required. To replace the paper roll (disposable),
you need to detach the headphone holder. If you remove the stick on
the paper roll, you can pull out the right mounting bracket. Then you
can replace the roll and let the bracket again lock into place.
Operating the patient table
The patient table can be controlled via the movement buttons and
the jogwheel on the larger control unit.
( Page 54 Control units)
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Please note that this section only describes the operation of the
patient table. For details on positioning the patient, see: Operator
Manual Coils
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(1) Table Up/Inward button
(2) Jogwheel, Center Position button
(3) Home Position button
(4) Table Down/Outward button
To operate the patient table safely and efficiently, operating
personnel must be familiar with its most important positions.
Home Position Table is at the height of moving into the magnet bore, tabletop is
moved completely out of the magnet
Last Scan Position If the tabletop was moved only in the horizontal direction, the tab-
letop can be returned into the position of the last measurement
Default Position The center of the Head/Neck 20 is in the magnet isocenter
Center Position The body region to be measured is in the magnet isocenter
Relative Position Distance between the slice marked with the light localizer and the
magnet isocenter
For interventional examinations, a table lock function is available via
the Dot display.
For some measurements, the tabletop is moved automatically.
( Page 55 Dot display)
60
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Using the jogwheel
MR system components 3
1 Keep the jogwheel turned to move the patient table up/into or
down/out of the magnet bore.
Depending on how far the jogwheel is turned, the speed increases.
The table movement stops immediately once you release the
jogwheel.
2 Press the jogwheel for one second to move the patient table into
the Center Position.
Depending on the situation, you can also move the table
horizontally into the Last Scan Position or the Default Position by
pressing this jogwheel.
Using the buttons
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Pressing the jogwheel during an automatic table movement
(e.g., to the Home Position) stops the table immediately. Turning
the jogwheel in this case adjusts the speed and movement
direction according to the jogwheel position.
◆ Press the corresponding button to move the patient table into the
required position.
The Table Up/Inward and the Table Down/Outward button can
be pressed in two stages for horizontal movements. Pressing the
button softly moves the table slowly. Pressing the button
forcefully moves the table more quickly.
Pressing one of these buttons during an automatic table
movement (e.g., to the Home Position) stops the table
immediately.
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Stopping table movement
1 Press the Table Stop button to stop the table movement.
2 To reset the table stop, turn the Table Stop button clockwise until
it releases mechanically. Then simultaneously press the Table Up/
Inward and the Table Down/Outward button fully.
Rescuing the patient in an
emergency
Rescuing the patient manually
In case of accidents, e.g. patient emergency situation (e.g. heart
attack), the tabletop and patient must be moved out of the magnet
bore.
The fastest method for moving the tabletop out of the magnet
bore is to press the Home Position button. Select this method
whenever the power supply and/or motorized drive are intact.
1 Press the Home Position button.
The tabletop moves completely out of the magnet.
2 Rescue the patient.
In case of power failure and/or defective motorized drive, pull the
tabletop manually out of the magnet bore.
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WARNING
Patient rescue during emergency situations, e.g. quench with
failing quench pipe, fire with strong smoke development,
emergency situation involving patient (e.g. heart attack) and
simultaneous power failure!
Personal injury
◆ After releasing the emergency release, pull the tabletop with
the patient manually out of the magnet.
1 Pull the Emergency release (location is indicated by a label)
outward up to the end stop.
The MR measurement is terminated and the table loses the
referenced position.
2 Turn up the pull-out handle and pull the tabletop out of the
magnet.
Resetting the Emergency
release
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3 Rescue the patient.
The error regarding the power supply and/or the motorized drive
✓
has been removed.
1 Press the Emergency release back into its original position while
shifting the tabletop slightly in any direction until it audibly locks
into position.
2 To reset the table, simultaneously press the Table Up/Inward
button and the Table Down/Outward button fully.
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3 Press the Home Position button.
After reaching the Home Position, the patient table is ready for
operation again.
3.5
3.5.1
Dockable patient table
Description
The dockable patient table is an optional table that can be completely
removed from the magnet system. This enables the transport of
immobile patients.
The configuration of the dockable patient table is similar to the
standard table. This section only mentions the differences. For the
standard patient table, please refer to:
( Page 57 Description)
64
(1) Side rails
(2) Docking station
(3) Lateral pedal
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(4) Emergency undocking handle
(5) Pedals
(6) Handle at the foot end
Pedals
Side rails
Guiding wheel
Identification label
3.5.2
If the table is removed from the system, you can use the pedals to lift
and lower the table manually.
The side rails can be folded out to secure patients during transport, or
as a arm rest for patients with infusions.
For better maneuverability, a fifth wheel is positioned in the middle,
underneath the dockable patient table. This fifth wheel functions as
center of rotation - the table can rotate around this center.
The label at the foot end of the dockable table indicates that your
table can only be operated on the
respectively.
1.5 T system or the 3 T system,
Operating the dockable patient table
To avoid injuries during vertical table movement, a safety shut-down
is available at the carriage of the dockable patient table and a safety
switch is available at the docking station. If the table is docked, table
movement stops automatically if obstacles constrict vertical table
movement.
Undock the table only if the tabletop is in the Home position.
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◆ Position the side rails as required: e.g. in a vertical position to
secure the patient, or in a horizontal position as arm supports.
Undocking the table
Moving the dockable patient
table
The tabletop is in Home Position.
✓
Brake for the castors is released.
✓
◆ Step completely on the left pedal to undock the table.
The table is removed from the system and can be moved in any
direction.
You can use the side rails to steer the table.
The guiding wheel (5th wheel underneath the table) allows for better
directional stability and easier steering.
(1) Guiding wheel is lifted/deactivated
(2) Guiding wheel is lowered/activated
(3) Table is braked
1 For turning the table in place, navigating in curves and moving the
table straight ahead, set the lateral pedal to the middle position (2)
to lower/activate the guiding wheel.
2 For moving the patient table laterally, lift the lateral pedal (position
1) to lift/deactivate the guiding wheel.
66
3 Lower the pedal to the lowest position (3) to brake the table.
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CAUTION
Dockable patient table may move against the wall or the
door!
Possible injuries (for example, squashed fingers)
◆ To move the table, always grasp the middle area of the
handle (not the outside edges).
4 Move the table with the handle at the foot end of the table.
If the dockable patient table is not in use, make sure not to move
it to the back of the magnet.
Docking the table
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Guiding wheel is activated.
✓
Side rails are lowered.
✓
CAUTION
Points of injury during docking of the table!
Damage to the system, injury to the patient
◆ Ensure that the patient’s hair, parts of the body, or items of
clothing do not get caught between the table and the system.
1 Use the table‘s momentum (to save strength) and move the table
into the docking station.
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2 Position the table so that the docking nose is positioned in the
docking station and the table is positioned at the end stop of the
docking station.
The display shows if the table is positioned correctly and
completely in the docking station.
3 Check the display if the table is ready for docking. If the table is not
ready for docking, reposition the table in the docking nose.
4 Press the right pedal down fully with your foot to lock the table to
the MR system - in doubt press the pedal twice.
5 Wait for the table to get ready after docking.
The “Wait” message at the display disappears and the tabletop
moves into the reference position.
Do not undock the table again, before the tabletop is in the
reference position.
Table cannot be docked to the system?
Troubleshooting: Problems
during docking
68
◆ Position the table again so that the docking nose is positioned
correctly and completely in the docking station. Try again to
press the right pedal.
Pedal cannot be pressed
Check that the tabletop is completely in Home position and the
emergency undocking handle is not activated/pulled (reset with
left pedal).
Control units flash
Make sure that the Table Stop buttons are not pressed (at the
table and at the intercom) and that the intercom is powered on.
Table cannot be lowered
Remove any weight from the docking station and the table carriage
cover.
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Table moves downwards despite you want to lift the table
In certain cases (for example, after docking), the table must find
the reference position and moves slightly down. This is normal
behavior.
Table does not move horizontally
Check that the side rails are fully stored in the carrying frame - otherwise no table movement is possible.
Troubleshooting: Problems
during undocking
Undocking in case of
emergency
Pedal cannot be pressed and the table is not pushed away from
the MR System
Set the lateral pedal to the middle position to deactivate the brake
and make sure that the tabletop is completely in Home position.
If undocking via the pedals does not work, the table can be undocked
by using the emergency undocking handle at the foot end (between
the pedals).
WARNING
Wrong tabletop position for emergency undocking!
Uncontrolled table movement, tabletop crashes
◆ Use the emergency undocking handle only when the tabletop
is in the outermost position (Home position).
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Tabletop is in Home position.
✓
Brake for the castors is released.
✓
◆ Pull the emergency undocking handle to undock table.
The table can be removed from the system.
Resetting the emergency
undocking handle
3.6
1 Press the emergency undocking handle back into its original
position.
2 Position the table with the docking nose in the docking station up
to the end stop. Then press the left pedal down fully with your
foot.
Laser light localizer
The laser light localizer facilitates correct patient positioning. The
laser light localizer is located on top at the entrance to the magnet
bore.
All laser-relevant locations at the MR system are identified by warning
labels affixed directly next to the laser opening.
For some examinations, a manual alignment of the laser light
localizer to the coil is not necessary. If all relevant data (e.g. patient
orientation, body height, examination) are registered, autopositioning is indicated on the Dot display at the magnet cover.
70
3.6.1
Using the laser light localizer
Anesthetized patients or patients who do not have an eye blink reflex
must be protected against the effects of the laser beam.
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The patient is positioned on the tabletop.
✓
The patient table has been moved to measurement height.
✓
WARNING
Laser beam of the laser light localizer!
Eye injury caused by laser beam
◆ Ensure that the operating and adjustment devices as well as
methods given are used as described.
◆ Inform the patient about the laser and request that he keeps
his eyes closed during positioning.
◆ Ensure that helpless patients keep their eyes closed during
the positioning procedure.
1 Press the Laser Light Localizer button on the control unit.
The laser light localizer is switched on. A crosshair is visible directly
below the area.
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2 Move the tabletop so that the crosshairs point precisely to the
region of interest.
The slice for measurement is marked. The display shows the
relative tabletop position of the marked slice.
3 If the laser is correctly positioned, press the Center Position button
for one second to move the table into the magnet isocenter.
The tabletop moves to the selected position and the laser shuts off
automatically.
When the table is not moving, the laser light localizer shuts off
automatically after 60 seconds.
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3.7
3.7.1
3.7.2
Alarm box
Description
The alarm box has the following functions:
◾ Displays alarm signals
◾ Switches the MR system on and off
◾ Magnet Stop / Magnet Quench
The alarm box is installed near the syngo Acquisition Workplace.
Checks
WARNING
MR system malfunction!
Hazardous conditions for patients
◆ Note the sounding alarm and signal.
72
◆ Do not perform MR examinations.
◆ Notify Siemens Service.
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Checking the LEDs
MR system components 3
(1) WARNING LED
(2) POWER LED
(3) SYSTEM ON LED
LED LEDs light up to indicate
WARNING Error message, e.g. helium fill level is too
low
POWER Voltage supply of MR system is satisfactory
SYSTEM ON The MR system is switched on
1 Check the WARNING LED for alarm messages.
An alarm is present when a yellow LED lights up and/or an alarm
sounds.
Remote monitoring
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2 In case of an alarm: Check the host computer for error messages.
Press the Audio Alarm Off button to silence the alarm, and notify
Siemens Service.
3 Verify that the POWER LED is green.
4 If the POWER LED is not on: Check the power supply of the MR
system.
The POWER LED is off, even though the power supply is
functioning properly?
◆ Notify Siemens Service.
After a power failure, the battery powers the circuit of the
magnet emergency shutdown for another 14 days. During this
time, the magnet can still be quenched i.e. the magnetic field
can be shut down by pressing the Magnet Stop switch in case of
emergency.
After installing remote monitoring, various error messages can be
output centrally (e.g. to the front door or gate):
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◆ Please contact Siemens Service regarding questions about remote
monitoring.
3.8
3.8.1
Intercom
Description
The intercom allows personnel and patients to communicate during
the examination. In addition, some important operations like
stopping the patient table can be managed from the intercom.
Optionally, music or automatic voice outputs can be played in the
examination room via the loudspeaker or the headphones.
The operating unit of the intercom is located at the syngo Acquisition
Workplace
(1) Stop button
(2) Talk button
(3) Reset Patient Alert button
.
74
(4) Listen button
(5) Physio Signal button
(6) Audio connection
(7) Reset Stop button
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Patient alert
3.8.2
Patients may use the squeeze bulb to alert the operating personnel
(patient alert):
◾ Acoustically:
– Continuous tone over the intercom
– Brief feedback signal via the patient’s headphones and
loudspeaker in the examination room
◾ Visually:
– Blinking button on the intercom
– Message on the Dot display in the examination room
The alert can be reset by pressing the Reset Patient Alert or the Talk
button on the intercom. Alternatively, the alert reset is possible at the
control unit in the examination room.
Patients, for example, sedated patients, who may not be able to
alert the personnel must be monitored by a person present in the
examination room.
Operating the intercom
The intercom operation is partially software-based. The Patient
Comfort Configuration dialog box allows for several settings, for
example, Active Noise Cancellation to reduce background noise
from the system, can be activated. For detailed information regarding
the operation of the software, see: Software operator manual
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Button Function
Listen Enables listening to the patient in the exami-
nation room
Talk Allows speaking to the patient (as long as the
button is pressed)
Reset Patient
Alert
Physio Signal Switches the transmission of physiological sig-
Resets the patient alert
nals on/off
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Button Function
Stop Stops the table movement and the measure-
Reset Stop Resets the table Stop
1 Press the corresponding button.
2 If necessary, adjust the volume using the +/- buttons. Press and
hold the buttons to adjust the volume.
If you hold the button for about one second, the volume increases/
decreases until you release the button.
ment immediately
Transmitting automatic voice
output
Transmitting music
3.9
3.9.1
Automatic voice output can be used for transmission of commands
e.g. breath hold commands.
1 Use the Patient Comfort Configuration dialog box in the software
to initiate automatic voice output: Software Operator Manual
2 On request, adjust the volume in the Patient Comfort
Configuration dialog box to the desired level in the examination
room.
To play music in the examination room, an audio device can be
connected at the intercom.
1 Connect a suitable cable to the audio device and to the connection
at the intercom.
2 Adjust the final volume to the desired level using the control unit
at the magnet or the Patient Comfort Configuration dialog box.
3 Start the music at the audio device.
In-Room syngo Acquisition Workplace
Description
The In-Room syngo Acquisition Workplace (
an additional operating console in the examination room. It is used
for image viewing and MR system operation.
In-Room syngo Acq WP) is
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The In-Room syngo Acq WP
facilitates the examination process by allowing the operating
personnel to remain inside the examination room between
procedures.
The In-Room syngo Acq WP is used as follows:
◾ Displaying MR guided procedures
◾ Quickly adjusting patient positioning for survey measurements
◾ Immediately starting the measurement after administering
contrast medium
The constant presence of operating personnel inside the examination
room allows uninterrupted patient care and quick intervention in case
of complications.
The In-Room syngo Acq WP comprises the following components:
(1) LCD monitor
(2) Tray with trackball and keys
(3) Foot switch (optional)
As an alternative, the monitor can be suspended from the ceiling. For
this option, the tray with trackball and keys is not available.
is connected with the host processor and
3.9.2
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Operating the
The In-Room syngo Acquisition Workplace (In-Room syngo Acq WP) is
operated via the trackball and three keys. The same software
functions are available as with the syngo Acquisition Workplace.
In-Room syngo Acquisition Workplace
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Diagnosis at the In-Room syngo Acquisition Workplace or use for
interventional procedures!
Risk of patient injury; incorrect diagnosis
◆ Always plan appropriate emergency measures prior to
starting an MR-guided or MR-monitored interventional
procedure.
◆ Do not use the In-Room syngo Acquisition Workplace for
diagnostic purposes.
Operating the trackball and the
keys
CAUTION
Adjusting the monitor tilt
78
(1) Keys
(2) Trackball
(3) Handle
The keys have the same functions as those of the mouse.
1 Roll the trackball to move the pointer on the program interface.
2 Press the keys to execute a specific application.
The monitor height and tilt can be adjusted for easy and comfortable
operation.
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Adjusting the monitor height
Operating the footswitch
1 Release the locking lever by turning it counter-clockwise by 90
°.
2 Press lightly against the upper or lower edge of the display to move
the monitor into the desired tilt position.
1 Turn the wheel clockwise to raise the monitor.
2 Turn the wheel counter-clockwise to lower the monitor.
The footswitch is used to start and stop the MR measurement in the
examination room.
(1) Hose
(2) Hose connector
(3) Pushbutton unit
(4) Footswitch Start/Stop
For additional support, labels can be affixed to the footswitches.
Start label
Stop label
Performing the measurement
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MR measurements with the footswitch are only possible for protocols
that were configured for manual start-up. This is the case e.g. for
protocols with MR measurements after administering contrast
medium.
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If the protocol is configured for repeated measurements, the next
measurement can be started with the footswitch after completing the
preceding measurement. For more information regarding the
configuration of protocols, see: Software operator manual
1 Push the hose plug into the retaining rings of the pushbutton unit.
2 Load a suitable protocol and start it at the syngo Acq WP or the In-
Room syngo Acq WP.
The MR system is waiting for the manual start of the protocol.
3 Press the Start footswitch to begin the measurement.
As an alternative, you can start and end the measurement via the
In-Room syngo Acq WP
4 Press the Stop footswitch to end the measurement.
or the syngo Acq WP.
80
3.10
3.10.1
Other components and accessories
Gradient supervision
To prevent damage to the MR system by a malfunction of the
gradient system, a specially designed supervision is installed at your
MAGNETOM system.
This supervision monitors that cables, connections, or other
components of the gradient system do not show excessive heating. In
case of a malfunction, the measurement is stopped and an alarm
message is issued.
After 1 minute the system will be automatically switched to
Standby.
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Acting in case of an alarm
Gradient malfunction is detected.
✓
An alarm message appears at the syngo Acquisition Workplace
✓
Dialog box at the syngo Acquisition Workplace
(1) Scanner hardware error
Automatic shutdown! Evacuate patient immediately from the
examination room! To prevent further damage, the system will
be switched to Standby within 1 minute! Call Siemens Service
immediately.
1 Immediately move the patient out of the magnet bore by pressing
the Home Position button.
Within the next 60 seconds, the system will be switched to
Standby automatically. Then, the patient table motors can not be
operated any longer.
.
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2 Call Siemens Service.
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Acting in case of a supervision
malfunction
A malfunction within the supervision system is detected.
✓
A corresponding error message appears at the syngo Acquisition
✓
Workplace.
Dialog box at the syngo Acquisition Workplace
(1) Scanner hardware malfunction
Functional problem within automatic shutdown mechanism.
Please restart software of MeasRecon. If the problem persists,
please call Siemens Service immediately.
◆ Call Siemens Service.
The supervision sensitivity is potentially affected, but the
operation of your MR scanner is still possible.
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Physiological imaging 4
Physiological imaging
4
4.1
4.1.1
Triggering methods
MR imaging procedures are sensitive to patient movement. Images
may exhibit artifacts in the form of smears when motion times - for
instance, during respiration or heartbeat - are short compared to
measurement times. In particular, this problem occurs as a result of
the patient's heartbeat during cardiac examinations or as a result of
the patient's breathing during abdominal examinations.
Two different procedures are used to avoid motion artifacts in
images: prospective triggering and retrospective gating. Both
procedures are based on the correlation between measurement and
physiological signal (ECG signal, respiratory signal, pulse signal).
Prospective triggering
During prospective triggering (or antegrade triggering), a
measurement is triggered by using a so-called trigger signal derived
from the patient's physiological signal. This signal is usually defined
based on the time period during which organ movement is as low as
possible. The trigger delay is, for example, set to the end of the
systole for certain cardiac examinations so that the measurement is
running during the akinetic diastole. For respiratory triggering during
abdominal examinations, it is recommended to start the
measurement at the end of the respiratory period.
To determine the start time for the measurement, an acquisition
window is defined based on the signal form (e.g. R-wave in ECG,
minimum of respiratory curve). For example, the size of the
acquisition window is approx. 80 % of the RR interval for ECG
measurements. The acquisition window defines the range in which
the measurement can be triggered. The trigger time is defined by the
trigger delay.
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Prospective triggering can be used for ECG, pulse, or respiratory
signal curves as well as for external trigger signal curves.
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4 Physiological imaging
4.1.2
4.2
4.2.1
Retrospective gating
Retrospective gating fundamentally differs from prospective
triggering. No actual triggering is taking place. The physiological
signal and data acquisition times are recorded simultaneously. The
measurement is performed completely independently of the patient’s
heartbeat or pulse. A temporal assignment of images to the
corresponding phase (e.g. heart stimulation) is performed after the
measurement (retrospectively).
In particular, retrospective gating is used to acquire images of the
beating heart. As compared to measurements using prospective
triggering, this technique is especially useful for displaying the late
diastole. Temporal resolution is freely selectable and may be higher
or lower than selected for the measurement.
Retrospective gating can be used for ECG, pulse, or external trigger
signal curves.
Physiological Measurement Unit (PMU)
Description
The Physiological Measurement Unit (PMU)
measurement sequences using a patient's physiological signals (ECG,
respiration and pulse).
lets you control MR
84
The PMU consists of the following components:
◾ PERU (Physiologic ECG and Respiratory Unit): ECG and respiratory
sensor
◾ PPU (Peripheral Pulse Unit): Pulse sensor
◾ External trigger input
The physiological signals are acquired with receptors - ECG
electrodes, respiratory cushion and pulse sensor - directly at the
patient via the PERU (ECG, respiration) and PPU (pulse). The
measured data can be viewed at the Dot display in the examination
room and in the Physiological Display dialog window at the syngo
Acquisition Workplace.
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Physiological imaging 4
Only one PERU or PPU can be located in the examination room!
ECG and respiratory sensor
(PERU)
Two ECG and respiratory sensors in the examination room
interfere with one another in signal transmission. It is not
possible to determine the results.
Patient monitoring systems are optional accessories and are not part
of the PMU.
The Physiological Measurement Unit may be used only for
controlling MR measurement sequences. The unit does not
replace a patient monitoring system.
The wireless PERU simultaneously acquires three ECG channels as
well as the respiratory channel of the patient.
(1) ECG leads with clips
(2) Plug for respiration cushion
(3) Transmitter unit
(4) Control LEDs
The ECG electrodes and respiratory cushion are connected to the
PERU.
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To prevent skin irritations, the PERU has to be located in the
application cushion during the examination.
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4 Physiological imaging
(1) Application cushion
(2) Respiratory cushion with pressure hose
(3) Respiratory belt
The respiratory cushion is attached to the patient using the
respiratory belt.
Wireless pulse sensor (PPU)
The PPU acquires the patient's peripheral pulse. It consists of a
transmitter unit, a fiber-optic sensor and a removable finger adapter
(available in different sizes).
(1) Finger adapter
(2) Fiber optic cable
(3) Transmitter unit
(4) Control LEDs
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External trigger input
Charging station
Physiological imaging 4
External trigger sources (e.g. patient monitoring system) may be
connected with the help of the trigger input to drive MR sequences.
The connection for the trigger input is located on the cover of the MR
system. Trigger input is galvanically isolated with respect to the MR
system.
Both the PERU and the PPU are supplied with power via accumulators.
All other components of the PMU are supplied by system-internal
voltage sources. The charging station is installed separately near the
syngo Acquisition Workplace and is used for storing both units.
Accumulators should not be fully discharged before recharging them.
If only one green LED flashes, you should charge the accumulator for
the next patient. The maximum charging time is approx. 3 hours.
After being fully charged, the operating hours for the units cover
approximately 24 hours.
LEDs during charging
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To charge a unit, it has to be placed firmly in the charging station.
The PERU and PPU can be charged together or separately in the
charging station. ( Page 88 Control LEDs)
Use only the charger included with delivery. Charging the units
with non-Siemens equipment may destroy the PERU and PPU.
If proper charging of the accumulators is not possible anymore,
please contact Siemens Service, as the PMU accumulators cannot be
exchanged.
The red LED goes out when the unit is positioned correctly in the
charging station. While charging, the green LEDs flash alternately as
moving light. If the accumulator is nearly discharged, only one LED
flashes at the beginning. With increasing charging status, a second
green LED flashes and then also the third LED. If the accumulators are
fully charged, the 3 green LEDs are on and stop flashing.
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Control LEDs
3 Green LEDs flash Fully or nearly fully (2/3) charged accumulator
2 Green LEDs flash 1/3 to 2/3 fully charged accumulator
1 Green LED flashes Nearly discharged accumulator; remaining operating duration is 1 hour
Red LED flashes (as regular as
the green LEDs)
Red LED is off Transmit function activated; unit is positioned on the patient table in
The transmitter unit includes three green LEDs for signaling the
battery status and one red LED as fault indicator (for example,
insufficient skin contact of the ECG electrodes).
(1) 3 Green LEDs (battery status)
(2) 1 Red LED (fault)
(3) Transmitter unit
Battery status and faults are also indicated on the Dot display and the
Physiological Display dialog window.
If the accumulator is not in the charging station, the green LEDs flash
regularly and simultaneously.
Transmit function deactivated, unit is positioned outside the static magnetic field; no electrode/application fault detected
the static magnetic field; no electrode/application fault detected
Red LED flashes rapidly PERU: electrode fault - one or more ECG electrodes are not applied cor-
rectly or fell off
PPU: application fault - pulse sensor is not applied correctly at the finger
A second set of sensors with charging station may be useful in
hospitals or radiology facilities because one PPU and PERU can be
Data display
88
permanently ready for operation, while a second PPU and PERU
are being charged.
The physiological signals are shown on the Dot display.
( Page 55 Dot display)
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Physiological Display
Physiological imaging 4
Additionally, battery status and electrode/application fault are
indicated on the display.
The Physiological Display lets you view the patient's physiological
signals at the syngo Acquisition Workplace. See: Software operator
manual
4.2.2
Informing the patient
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Preparing the measurement
WARNING
Monitoring vital parameters via the Dot display!
Anomalies of the vital parameters are not recognized or
recognized too late
◆ Never use the Dot display to monitor the vital parameters of a
patient.
◆ Use only suitable patient monitoring systems for monitoring
vital parameters.
1 Ask the patient to lie still during the measurement.
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2 Inform the patient that the knocking sounds during the
measurement are caused by switching the gradients on and off.
The PERU may also vibrate slightly.
Knocking sounds may affect the heart rate of patients, either
consciously or subconsciously. The resulting irregular cardiac
cycles adversely affect image quality.
Attaching the PERU
The PERU is used together with ECG and respiratory triggering.
ECG electrodes are attached.
✓
The patient table is in the Home position.
✓
CAUTION
Hot ECG cables!
Patient burns
◆ Place absorbent natural material between the ECG cables/
leads of the PERU and the patient’s skin.
1 Position the patient on the patient table with the head toward the
magnet bore.
2 Position the PERU in the application cushion.
Especially with respect to whole-body examinations, it should be
noted that artifacts (homogeneity distortions) may occur in the
direct vicinity of the PERU transmitter unit.
3 Use the application cushion and position it together with the PERU
on the patient.
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Physiological imaging 4
4 Align the PERU on the patient in the direction of the patient’s feet.
5 For the special case of triggered flow measurements/flow
quantification in the head region, please position the PERU next to
the patient's head (as shown in the picture) to reduce gradient
interference.
Position and connect the PERU and electrodes as usual. Then use
the electrodes as a pivot point and turn the PERU with the
application cushion counterclockwise until the cushion is lying next
to the patient's head.
4.3.1
ECG leads
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4.3
ECG triggering
Description
ECG triggering is a method for measuring heart sequences including
dynamic studies. It is also suitable for studies where pulse flow causes
artifacts. Provided that special sequences are in use, ECG triggering
can be applied in combination with respiratory-controlled methods.
A number of special sequences support retrospective gating.
The ECG leads are selected according to the potential difference
between the connected electrodes.
The three leads I, II and III are used and acquired in parallel via the
ECG channels. All curves display a prominent R wave when the ECG
electrodes and leads are correctly attached.
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The characteristic QRS complex of the ECG signal is used as a trigger
signal. Simultaneous acquisition and overlaying of the orthogonal
leads (vector cardiography) is used to minimize triggering errors due
to gradient switching and the magneto-hydrodynamic effect (i.e.
excess T-wave amplitude).
Trigger methods
Disposable electrodes
4.3.2
Image quality
In the dialog box of the Physiological Display several trigger
methods are available:
◾ VCG standard: VCG activated
◾ ECG I: VCG inactive
◾ ECG II: VCG inactive
◾ ECG III: VCG inactive
◾ Auto: Improved trigger algorithm; VCG activated; default trigger
method
If Auto is used, the signal characteristics can be relearned by
selecting Relearn in the context menu of the Physiological Display.
If triggering with Auto fails, preferably VCG standard should be used.
For ECG triggering, special MR Conditional and disposable electrodes
are used (the recommended ones are available through the
Accessories catalog).
Performing
The quality of the ECG signal for triggered measurements is enhanced
by:
◾ Proper placement of the electrodes
92
◾ Good skin contact of the electrodes
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Physiological imaging 4
◾ Reduction of interference signals caused by electromagnetic
induction.
– Due to cable loops
– Interferences from electrical potentials caused by muscle
movement
Attach the electrodes so that interferences from electrical
potentials caused by muscle movement and baseline drifts are
minimized. Suitable contact points are therefore areas that show
very little muscle or fatty tissue.
Preparing the patient
Applying ECG electrodes
1 Prepare the patient for the examination as early as outside the
examination room.
2 On the chest of the patient, select locations with minimal muscle
and fat tissue for attaching the electrodes.
3 In case of hairy skin: shave the points where you intend to attach
the electrodes.
Shave the patient outside the examination room to prevent
accidents.
4 Thoroughly clean the patient's skin at the locations involved.
However, do not use solutions containing alcohol.
5 Then dry the skin with a paper towel.
6 Use a suitable gel to prepare the skin for better signal transmission.
Finding the best position for the electrodes is a matter of trial and
error. ( Page 91 ECG leads)
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Patients with an offset heart axis (e.g. dilatative cardiomyopathy)
may require a different orientation than parallel to the spine.
1 Check the expiration date of disposable electrodes and order new
ones if necessary.
2 Pull the protective foil off the electrodes and attach them.
3 Use the application cushion and position it together with the PERU
on the patient. ( Page
4 Connect the electrode clips of PERU to the ECG electrodes.
89 Preparing the measurement)
Performing the examination
Evaluating the signal quality
◆ Perform the examination. See: Software operator manual
1 Check to see if the leads show a preferably pronounced R-wave on
the Dot display. Information about the ECG signal quality is also
available at the display.
2 In case you are using the Body 18 coil, position it over the heart.
Connect the coil and secure it with the belts. See: Coil operator
manual
The display shows the following message: Initial Learningphase
active. Don´t move table.
3 Wait at least 10 heart beats (learning phase for triggering) before
you move the patient table into the magnet.
The patient must not move during this learning phase. The
patient table is in the Home position.
The red LED (fault) at the PERU is flashing rapidly?
No analyzable signal is available.
◆ Ensure that the ECG electrodes are attached correctly.
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Physiological imaging 4
4.4
4.4.1
4.4.2
Attaching the pulse sensor
Pulse triggering
Description
Pulse triggering uses the patient's pulse to trigger the measurement.
A pulse sensor is connected to the patient's toe or finger. The first
pulse wave (“premature pulse wave”) is used for triggering. This wave
corresponds to the systolic blood pressure.
A number of special sequences support retrospective gating.
Performing
Suitable finger adapter is attached.
✓
1 Ensure that the cable is not bent.
2 Attach the pulse sensor to a finger or on a toe.
3 Ensure that the pulse sensor is attached properly.
The red LED (fault) at the PPU is flashing rapidly?
No analyzable signal is available.
◆ Ensure that the pulse sensor is attached correctly.
Performing the examination
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The pulse sensor is attached.
✓
◆ Perform the examination. See: Software operator manual
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4 Physiological imaging
4.5
4.5.1
4.5.2
Informing the patient
Respiratory triggering
Description
To keep respiratory artifacts to a minimum, respiratory triggering is
primarily used in abdominal imaging. Data acquisition for respiratory
triggering begins when the respiratory signal reaches a predefined
level (approx. 20 % of the maximum value). Respiratory movement is
minimal in this range.
(1) Expiration
(2) Inspiration
The respiratory signal is acquired using a respiratory cushion
connected via a pressure hose to the ECG and respiratory sensor
(PERU). The respiratory cushion is attached to the patient via the
respiratory belt.
Retrospective gating cannot be applied.
Performing
1 Ask the patient to lie still during the measurement.
2 Inform the patient that the knocking sounds during the
measurement are caused by switching the gradients on and off.
The PERU may also vibrate slightly.
Attaching the respiratory
cushion and belt
96
The plug of the respiration cushion is NOT connected.
✓
CAUTION
Incorrect MR image due to disconnected respiratory cushion!
Incorrect diagnosis
◆ As a last step, plug the connector of the respiratory cushion
into the allocated jack.
1 Determine whether the patient is a thoracic or abdominal breather.
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Physiological imaging 4
Women and athletes are usually thoracic breathers.
Men and obese patients are usually abdominal breathers.
2 If the patient is an abdominal breather, place the respiration belt
around his abdomen.
– or –
If the patient is a thoracic breather, place the respiration belt
around his chest.
As an alternative, the respiratory cushion and belt can be used in
combination with the Body 18.
3 Slide the respiratory cushion underneath the respiratory belt.
Connecting the respiratory
cushion
Performing the examination
4.6
4.6.1
The respiratory cushion is attached.
✓
1 Use the application cushion and position it on the patient together
with the PERU. ( Page
2 For respiratory triggering alone, position the electrode leads
loosely on the respiratory belt.
3 Connect the plug for the respiratory cushion to the appropriate
socket on the PERU.
4 Ensure that the pressure hose of the respiration cushion is not
crimped or bent. Make sure the respiration cushion is not unduly
compressed.
With quiet patients, a periodic signal will appear on-screen.
◆ Perform the examination. See: Software operator manual
89 Preparing the measurement)
External triggering
Input for external trigger signal
The external trigger signal has to meet the following specifications:
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4 Physiological imaging
Voltage-tim diagram for external triggering of the PMU
Name Value
4.6.2
U
L
U
H
0 V ... 0.8 V
2.5 V ... 5 V
tL(min.) 10 ms
tH(min.) 10 ms
Input current min. 5 mA
Input voltage max. ± 5 V
Internal contact +
External contact -
The measurement sequence is triggered by the rising edge of the
external signal.
The external trigger signal can be supplied via the connections in the
magnet cover.
Performing
1 Connect the source of the external trigger signal to the cinch jack
trigger input (magnet cover, left).
2 Perform external triggering. See: Software operator manual
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MR system operation 5
MR system operation
5
5.1
5.1.1
Daily functionality checks
Before using the MR system, the functionality and/or cleanliness of
the following parts and areas must be checked:
◾ Alarm box
◾ Warning signs
◾ Floor
◾ Magnetizable materials
◾ Exhaust vent
◾ Patient table
◾ Squeeze bulb
Checking the functionality and cleanliness
WARNING
Large amount of liquid (for example, phantom fluid) spilled onto
patient table and seeping into electrical connections!
System malfunction due to electrical hazards
◆ Immediately stop the running examination.
◆ Shut down the computer system and power off the MR
system (SYSTEM OFF).
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◆ Notify Siemens Service.
1 Check the LEDs on the alarm box.
2 Check if all warning symbols and signs are present inside and
outside the examination room.
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5 MR system operation
Leaking hydraulic system!
Slipping hazard
◆ Check the area around the patient table for hydraulic fluids
on the floor.
3 Check the examination room, control room, and electronics room
for liquid spills and puddles on the floor.
4 Ensure that no magnetizable materials or objects such as vacuum
cleaners, carts, ladders, and tools are present in the examination
room.
5 Ensure that the outlet of the exhaust vent line is not obstructed.
6 Ensure that any contrast medium residue has been cleaned off the
patient table.
CAUTION
5.2
7 Check the functionality of the squeeze bulb. The patient must be
able to trigger the patient alert using the squeeze bulb.
Starting up and shutting down the MR system
There are three operating modes:
◾ System On (full operation)
All MR system components are switched on. Examinations may be
performed.
◾ System Off (system is not working)
All MR system components except cooling are switched off.
◾ Standby (standby operation)
Only the host computer is switched on. Standby is useful for
patient evaluations on the computer after performing an
examination.
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