Magnetic Resonance Imaging Workflow

Transcription

1 WHITEPAPER Magnetic Resonance Imaging Workflow Workflow is critical to the efficient operation of an MRI. It impacts patient satisfaction, image quality and cost effectiveness. This whitepaper discusses how to maximize the functionality available with Hitachi s Echelon Oval MRI.

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3 Introduction The Radiological Society of North America reports that 30% of data is incorrectly entered and needs to be manually fixed. (Droukas, 2015) Time is valuable. Wasted time in a healthcare setting impacts patient care and adds unnecessary costs to a system that is already stressed. By enabling efficient workflow, medical imaging departments can minimize the waiting times that patients experience and maximize the patient throughput. All of this ultimately impacts patient satisfaction, healthcare delivery costs and potentially revenues. Efficient workflow encompasses many aspects of patient and modality interaction. From the moment the patient arrives to be registered, through to sharing the resulting images, Hitachi has enabled workflow processes to ensure that patients spend minimal amount of time on the table, while technologists can focus on the patient care needed for a successful exam. Automating workflow simplifies the technologists tasks and creates a consistent image acquisition for radiologists. This report walks you through the flow of a patient study from registration to image acquisition to image sharing post acquisition. Patient Registration Scanning/ Acquisition Clinical Efficiencies Post Processing Introducing the SynergyDrive Workflow Solution Hitachi s SynergyDrive is the latest in complete efficiency and workflow engines to ensure the fastest patient throughput, best patient comfort and highest quality imaging. SynergyDrive benefits technologists, radiologists, department administrators and most of all, patients. 3

4 Operational Benefits Decrease operator entry errors Faster patient registration Standards based integration Patient Registration & Setup In today s world of increasing throughput and patient volume, it becomes key to maintain efficiency, not waste time getting patients entered into the system. Data entry errors, incorrect patient names and the time consuming task of data entry all impact efficiencies. Integration with existing information systems simplifies the tasks of registering patients. The Echelon Oval provides a simplified patient registration process: HIS/RIS Integration enables the technologist to select the chosen patient from a list of scheduled patients with the information already entered, reducing the possibility of data entry errors DICOM Modality Worklist appears in the patient registration window, pulling data from the information systems and presenting the technologists with the patient list utilizing the DICOM standard Once selected, the patient demographics auto-populate the information associated with the scan A A. DICOM Modality worklist (MWL) B. Prioritized protocols C. Large icons for quick setup D. Auto populated patient demographics E. Patient orientation setting D C B E 4 Magnetic Resonance Imaging Workflow

5 Protocol Prioritization Standardizing protocols is an important aspect of scanning patients to provide a consistent environment for radiologists to report. With Hitachi s protocol prioritization, the system automatically loads the default scanning protocol associated with the modality worklist classification. This saves time for technologists selecting the protocols that can be customized by body region. The user interface is color optimized for better visualization with large icons. Technologists can start scanning in as few as two mouse clicks. Operational Benefits Reduced data entry errors and faster patient registration Less administrative effort of correcting incorrectly entered data Included with the integration of DICOM Modality Worklist (MWL) is the IHE profile, Modality Performed Procedure Step. When a patient is selected from the MWL, a message is created indicating the exam is In Progress. After the exam is completed an updated status is sent and the scheduling system is updated. This allows physicians and administrators to determine the status of any exam and know when to look for the resulting reports. Increased consistency in scanning protocols Short learning curve Consistency of images through protocol prioritization Increased throughput Notification of patient study status Room Preparation & Scanner Setup An important part of any MRI exam is the patient and room preparation. With Workflow Integrated Coils (WIT) embedded into the table, technologists can quickly position the patient for a variety of scans without the time consuming effort of repeatedly changing coils. When the call for additional coils is needed, a simple one click attachment speeds things along. The WIT Monitor verifies all coils are connected and ready to acquire, saving time and energy right at the gantry. Workflow Integrated Coils (WIT) One Click Coil Attachment 5

6 WIT Mobile Table The detachable table is the first step in ensuring patient comfort and can be a key contributor to time savings when getting the patient ready for the exam. With all of the tools incorporated into the scanning table, no time is wasted looking for MR safe IV poles, changing coils or repositioning the patient. 63cm wide table aids patient comfort Fully powered table simplifies technologist movement A A. MR friendly IV pole with table B. 63cm wide table accommodates the largest patients C. WIT integrated coils D. Battery powered table enables quick movement, smoother ride E. Lowers to 20 for easy access F. Three-way retractable arm boards E B C D F WIT Mobile Table Wrists at side enable quick, comfortable positioning Feet first positioning including brain studies Wrist at side positioning Feet first positioning 6 Magnetic Resonance Imaging Workflow

7 Patient Positioning and Set Up Dual side gantry controls enables flexibility in working with patients and helps reduce anxiety by being at their side throughout the setup. Operational Benefits Time savings in preparation for each patient Maintain contact with the patient to ensure patient is comfortable Comfort features provide patients with the best experience possible facilitating compliance during the scan Patient compliance means minimal movement during the scan, resulting in better image quality, eliminating repeat scans and callbacks Dual side gantry controls Ensuring the optimal imaging location is critical to generating the best image quality and the SynergyDrive Auto Set feature positions the area of interest at iso-center with the push of a button. Auto set positioning Greater patient satisfaction scores WIT Monitoring While at the gantry, the technologist can start, pause and restart scanning without the need to go back to the main console, ensuring patients are ready to begin the exam, are less anxious and know someone is with them from the beginning. Ensure reliable gating before exams start Check patient orientation Verify coil connectivity 7

8 Scanning/Acquisition Selecting the most appropriate scan protocols and setting up the acquisition for high quality diagnostic exams can deeply impact productivity. Automating as much of this work as possible is key to providing efficient, consistent quality scans. Echelon Oval s unique coil solutions allow the machine to perform like several scanners in one. Slice Positioning Echelon Oval intuitively recognizes the coils, patient landmarks and orientation and loads sequences automatically. Users can select Autopose for automatic slice positioning for consistent results from patient to patient. Cheryl Rawlings Manager St. Joseph s/candler Hospital Imaging Services 3 Plane Scanogram Scanograms are acquired in 3 planes with user defined multi-plane offsets for better slice positioning from the start. Scan Setup SynergyDrive Intelligent Parameter Guidance provides real time parameter suggestions to meet the clinical requirements and maintain efficiency. The Image Quality Indicator provides feedback on SNR, CNR and resolution to ensure a higher quality image. Parameter guidance Quality indicator 8 Magnetic Resonance Imaging Workflow

9 Operational Benefits Automated processes simplify setup and generate time savings Intuitive user interface facilitates reproducibility and reduces variability between technologists Consistent image acquisition provides high quality images between patients Faster scanning protocols allows for increased throughput without sacrificing image quality Reliable uniform fat suppression Scan Optimization Workflow is more than just physical aspects and automation. Hitachi offers a variety of sequences that facilitate faster scanning, motion compensation and noise reduction that means reducing the number of repeat series/exams due to factors beyond the technologists control. VIVID image quality adjustment parameter reduces noise while enhancing edge sharpness and image contrast, allowing for faster scan times with SynergyDrive Quick Scan protocols opfse provides better definition, increased sharpness and reduced image noise isofse A single 3D acquisition provides multiplanar reformats RAPID Hitachi s parallel imaging solution that shortens acquisition time All Around RADAR comprehensive whole body motion compensation Copy Drive Acquisition Plan 9

10 Reliable Uniform Fat Suppression Acquisition setup wouldn t be complete without Higher Order Active Shim Technology (HOAST). SynergyDrive s integrated 6 axis shim calibration ensures a homogeneous field throughout the imaging volume. By applying 2 levels of shimming, a larger, homogeneous, magnetic field can be created that enhances the off-isocenter imaging that is performed with exams such as wrists. Patients are comfortably positioned with their arms at their side, instead of in the Superman position, and high quality images can be acquired with less likelihood of patient motion. Setting up protocols for each patient can be time consuming and may introduce variables between image series, making diagnosis more difficult. By automating as much of the setup as possible patient studies can be more consistently scanned between series with better reproducibility. Higher Order Active Shim Technology (HOAST) Patient s body disrupts magnetic field Unique compensation applied for each patient Automated setup and acquisition includes: CopyDrive copies slice positioning for consistency from sequence to sequence Acquisition Plan multiple sequences grouped into one scan task with one click start Auto image load quickly loads preset images for the next scan Simultaneous Scan and Reconstruction with automatic image preview 10 Magnetic Resonance Imaging Workflow

11 QuickScan Ultra fast acquisitions realized through VIVID integrated image algorithms. Sequence Conventional Brain QuickScan Brain % Improvement T1 Sagittal 3:47 1:15 67% T2 FSE Axial 2:31 1:09 54% FLAIR 3:37 1:49 48% Gradient Echo 3:14 0:07 96% DWI 1:35 0:46 52% Total Scan Time 14:44 5:20 62% QuickScan Brain - 5:20 QuickScan Spine - 9:13 QuickScan Shoulder - 13:48 QuickScan Knee - 8:04 11

12 Clinical Efficiencies NeuroDrive Neurological scans present a challenge when imaging, as patients are most likely to be anxious with the coil arrangements being so close. Efficiency and speed will help improve patient compliance and minimize movement resulting in quality images. Hitachi s NeuroDrive provides a number of automated features to improve efficient scanning. Autopose automatically positions slices for efficiency and consistency from patient to patient and among operators All Around RADAR to apply motion compensation as part of the scan protocol, available in FSE, IR, SE, GE, TOF isofse Isotropic 3D imaging with one acquisition and unlimited reformats of a selected image contrast including one click MPR, available with T1, T2, PD, IR, T2/T1 FLAIR Automatic map generation for DWI and DTI imaging Autopose 12 Magnetic Resonance Imaging Workflow

13 SpineDrive Patients come in different sizes and imaging the spine can be a challenge when trying to capture the entire anatomy. Hitachi s SpineDrive accounts for the natural shape of the spine and intuitively selects the appropriate WIT coil elements based on anatomical landmarks and imaging field of view for the best image quality and faster scan set up using the SynergyDrive Auto Element Selection. Additional time saving features include: isofse one 3D acquisition with unlimited orthogonal and oblique reformats Complete spine coverage with two acquisitions that can be seamlessly stitched With Echelon Oval s HOAST high field uniformity, a larger field of view is possible isofse 13

14 BreastDrive MR breast imaging is becoming increasingly important, requiring high spatial and temporal resolution dynamic sequences to improve diagnostic accuracy. Hitachi s BreastDrive provides efficient workflow capabilities: Feet first positioning alleviates anxious feelings to streamline patient cooperation Hitachi designed protocols meet ACR requirements TIGRE provides high resolution, dynamic acquisition with consistent fat saturation Auto-dynamic series subtraction and separation for each post contrast acquisition simplifies the complex timing of dynamic imaging Dynamic intensity curves at the MR console Compatibility with leading CAD systems Easily accessible biopsy capability Feet First Breast Imaging TIGRE Dynamic 14 Magnetic Resonance Imaging Workflow

15 Retrospective Gating: Captures the entire cardiac cycle to minimize artifacts CardiacDrive Dynamic gated imaging for cardiac studies, in combination with the wide variety of views, means cardiac imaging can be time consuming. Losing time on inefficient processes reduces the effectiveness of many departments. Hitachi s CardiacDrive minimizes many of the constraints traditional imaging poses. Wireless gating enables faster scan preparation and At the gantry cardiac gating vector selection ensures the strongest signal is used for gating Interactive Scan Control (iscan) facilitates accuracy and reproducibility for quick simplified slice positioning TI survey allows easy determination of the correct TI time Navigator echo enables cine acquisitions for non-compliant patients Navi Slice adjusts slice position with diaphragm movement to minimize mis-registration iscan 15

16 ProstateDrive Imaging of the prostate requires multi-sequence, multi-parameter fast scanning and efficient protocols to get the most out of the images. Hitachi s ProstateDrive accommodates for motion and facilitates dynamic imaging with key functionality: RADAR motion compensation TIGRE and RF Spoiled Gradient Echo sequences acquired in less than 10 seconds Multiple b-value DWI with adjustable NSA in a single acquisition eliminating multiple sequences Pi-RADS compliant Multiple b-values in a Single Acquisition 16 Magnetic Resonance Imaging Workflow

17 With the way the integrated coils are configured there s leeway to have some creative thinking. Jonathan Nelson MR/CT Technologist St. Joseph s/candler Hospital Imaging Services BodyDrive Body imaging is subject to motion and patient compliance, as breath hold acquisitions are not easy when patients are in discomfort. Fast imaging with anatomical coverage is paramount for quality body imaging. Hitachi s BodyDrive provides: Auto voice automated patient instructions and synchronized scanning Free breathing abdominal scanning for non-compliant patients utilizing RADAR Automatic centering of patient anatomy for multiple region scanning Fast, reliable single breath holds for ssfse, TIGRE and FatSep TIGRE provides high temporal resolution dynamic imaging of abdominal and pelvic regions FatSep acquires 4 image contrasts in one short breath hold Fat Separation (FatSep) Out-of-Phase In-Phase Water Image Fat Image 17

18 FatSep provides the benefit of uniform fat suppression and 4 image sets acquired in one acquisition with a 40% reduction in scan time. OrthoDrive Positioning is always a challenge for patients with orthopedic issues, and traditional imaging puts patients in unnatural positions. Hitachi s OrthoDrive takes advantage of the 63cm wide table and 74cm wide bore to make patients as comfortable as possible, leading to more compliant patients and better images. Wide bore allows easy off-set imaging and all extremities can be positioned at the patient s side Precise graphical angulation positioning for complex joints isofse enables high resolution 3D acquisitions HOAST and regional shim for consistent RF fat saturation FatSep provides multiple contrasts in one acquisition including with and without fat suppression Comprehensive suite of fat suppression capabilities: RF Fat Saturation, FatSep, Water Excitation and Inversion Recovery T2 Relax Map for quantitative cartilage visualization Off Centered Imaging Positioning 18 Magnetic Resonance Imaging Workflow

19 RADAR TOF: Hitachi s unique motion compensating vascular sequence highlights cranial vasculature VascularDrive Contrast enhanced imaging poses challenges while patient physiological conditions make vascular imaging one of the most challenging and time consuming regions. Hitachi s VascularDrive simplifies non-contrast and contrast enhanced imaging. Non-contrast MRA sequences TOF, VASC-ASL, VASCFSE and Blood Sensitive Imaging consistently depict vascular structures eliminating contrast timing errors Time resolved TRAQ ensures diagnostic quality for compromised circulatory patients FLUTE: fluoro-triggered timing for optimal arterial enhancement Auto-table and auto-voice support multi-station MRA by simplifying technologist actions Auto generated MIP tool Auto-subtraction for simplified contrast enhanced MRA RADAR TOF VASC-ASL Non-contrast MRA VASC-FSE 19

20 Post Processing Operational Benefits Simple user interface speeds post processing times Automated data routing ensures studies are safe and secure Minimized technologist time spent processing means more time for patients which translates into improved patient satisfaction and higher throughput Uniform processing and presentation assists diagnostic confidence Once the acquisition is complete the final stage of the workflow is post processing. SynergyDrive offers several post processing tasks that have been automated and require minimal user interaction. Intuitive post processing tasks for MRA, perfusion and other applications, allow users to quickly and efficiently generate additional images for diagnosis all from a single screen Being able to see the entire flow of blood through the lower body enables physicians to better diagnose blockages and stenosis, and stitching anatomical landmarks together with a single click speeds the post processing for spine, whole body and vascular imaging Annotations, measurements and contrast levels are all saved as a Gray Scale Softcopy Presentation State (GSPS) in accordance with the Consistent Presentation of Images (CPI) profile of the IHE framework. Images will appear on PACS or enterprise viewers with the same parameters as they were saved on the MR console, ensuring physicians see the same thing as the technologists The DICOM images can be routed automatically to multiple destinations such as PACS, enterprise viewers and long term archives using the DICOM standard One-Click Image Stitching 20 Magnetic Resonance Imaging Workflow

21 Processing Tasks Include: Max/Min Intensity Projection (Mip/minIP) Multi-Planar Reconstruction (MPR) Vascular Volume Rendering Addition/Subtraction T1 & T2 Calculated Images T2/T2* Relax Map Dynamic Analysis Perfusion Analysis Diffusion Analysis (ADC, DWI Trace) Tensor/Kurtosis Analysis (FA and MD Map) Spectroscopy Analysis (Single, Dual, Multi Voxel, Breast) Breast Dynamic Intensity Curves 21

22 Conclusion Workflow is critical to providing efficient MR studies and Hitachi s SynergyDrive workflow solution ensures that time is spent with the patient, without losing the high quality images needed for accurate diagnoses. From registration through to post processing, SynergyDrive has the tools and flow needed to efficiently scan patients in a comfortable and effective manner. Automation, consistency and speed combine to generate high quality images with high patient throughput to meet the needs of any busy department. 22 Magnetic Resonance Imaging Workflow

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