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Expanding Capabilities While Enhancing Productivity & Quality in MSK Imaging On SIGNA™ Voyager

Expanding Capabilities While Enhancing Productivity & Quality in MSK Imaging On SIGNA™ Voyager
okay foreign hi everyone my name is steve lawson and my name is ania fufana and welcome to the gemr live demo scanning sessions for rsna 2020. our theme for rsna this year is intelligently efficient and we wanted to show you that through a series of these live demo scan sessions across the portfolio both 1.5 t and 3t products that we have we'll be doing this twice a day here from our headquarters in waukesha wisconsin but we also have another session that's being held out of our headquarters in book france today we are on the

signa

l

voyager

system and we are really very excited to show you finally the

voyager

with aqueous so um we want to start by just showing this coil here into the camera but you can see that the design of the air coils for the

voyager

is pretty much the same as on our other scanners so we have the blanket design we have a really flexible coil where we don't have to worry about twisting and turning the car we have the same rules applied to that coil that means air technology is inside we don't have to worry about decoupling

signa

l by overlapping the coil too much or too less so we really want to show you um how this coil can be used and where we've seen customers using it already and we have an example here on our volunteer where we want to show you to scan um really long bones with just using this coil first uh we want to start off um showing positioning some examples what we've seen really customers do and we switch the uh camera...
expanding capabilities while enhancing productivity quality in msk imaging on signa voyager
setup for that so we have our volunteer here set up on the back and i want to show you now how easy positioning is when we would want to do like a long field of view humorous again so the volunteer can just be comfortably on their back and then i can just easily put the coil underneath their bags i can wrap around the coil and as you can see i can cover the entire length of the shoulders and the um the elbow in one field of view just with one coil so there is no need really to use an additional frame for repositioning just think about the use case where we sometimes have to start in the shoulder and we see that um for example there is a

signa

l further down in the field of view and you will have to reposition the coil and look for a coil which will cover the elbow now all these things are varies about your past because now we have the air coil which you can just wrap around and you can scan wherever you want so another use case where a lot of customers have used that coil for is just think about your patient is coming and it tells you that you have a lot of bacteria so now you have white foreskin as we can ask them oh is that maybe a position for earthquake that may be a position you can tolerate because your back pain is so hard that you cannot be on your back so just see that um we can just put the coil now in the back of the patient and it's perfectly covered for the entire spine work and they can just lay on the table again how they feel comfortable and you can just do...
expanding capabilities while enhancing productivity quality in msk imaging on signa voyager
your scheduling like that so these are cases really which we see frequently um in use by customers by using the airport and uh what we prepared today is really like a long bone scan here for on the leg so that is why i will ask i want you now to just quickly turn around the table and then we are going to set her up for just a long boat yes and as you can see i can just wrap around the corner with no rules i'm applying regarding overlap or so i do have velcro strips um attached at my table so it's easy for me to just like stretch before it a little bit further down on her and as we said at the beginning we don't have to worry about like overlapping too much or too less we can just like put the climate however we want on her um knee and then we can have the entire which is really really nice and then we have a new technology to um recognize our coil elements so no need for me to um land my coil and the field of view anymore so what i do is just landmark the middle of my eye and i just see like the middle of the play so i just do a one finger quick application here press one button and i make sure that my electronics are not on the table that would be a massive failure when so many people are watching me and then i push just one button here to position that back in the middle of the board and that's all we have to do and we can start our scanning session okay i turn up the camera so now you can see our user interface and we are both outside of the magnet room so...
expanding capabilities while enhancing productivity quality in msk imaging on signa voyager
what we do now is we just have our patient data um ready here and we start the exam button and we have a protocol loaded here to scan on the left leg so i will just go ahead and save and start so the first thing you will notify when you're a little bit um familiar with our scanners is that the user interface regarding coils has been updated so what we do see is like really here an image from on the entire coil displayed we get rid of all the coil modes so for you um that means that you don't have to pick really any modes anymore you can just select the entire coil and then the system will do the rest so in that case we have wrapped around the air coil around the legs that is why this coil is only selected and we can just go ahead and start scanning from there so the first localizer was already okay but i want to make sure that i know exactly where i am so i will just place a second one and have a little bit more coverage here on the leg and then we will start scanning with the large of view sequences um and that is really what we can do with having the air coil now um on the patient because the extent of the air coil is uh really 60 centimeters and we can have everything covered in one field of view which is really really nice and huge this is a nice feature from sk it's also great in chest abdomen and pelvis you can a lot of times scan chest abner and pelvis without repositioning the coil at all so here we do our first um sagittal plane we do a stern we do have a...
large field of view as you can see the entire leg will be covered and make sure that the slices are in the middle of the of the leg and then we will scan a stir sequence for three minutes and 34 seconds where we will run on three millimeter slices and um the implant resolution will be around a millimeter so a pretty decent implant resolution here as well so what you see on top of it is here the coverage displayed for the air coil with the blue line so that is uh what is happening because we are using our new our new coil recognition technique which we call air touch the system always generates sensitivity maps of the coil on the patient and it does that because when we launch the three-pen localizer we are creating that map by turning on every single channel element of the scanner and every single element of the coil so we know exactly where the coils are and then the system will take care of the rest and make sure that when we have large field of views it will just use the entire coil and when we have smaller field of views then it will pick them accordingly the next sequence we will run is a sagittal t1 in the same plane direction and um our scanner has been set up with the linking feature so i as a technologist don't have to even like prescribe these slices or have to open that sequence it will be done automatically i can hit here the auto scan button and the system will just run the two sequences um at a time by the way when you have any questions during this scanning...
session feel free to use um the chat window in the corner so we will have an eye on that um and feel free to ask any questions you might have regarding the scanner or in general about software that we can answer

while

we are scanning here can i ask a question is the the blue horizontal line showing the coil location you know not the that top one but the one across the bottom uh go to that image yeah why does it seem like it's more centered in the center of the bore the coil is wrapped around the leg so um i think if it were straightened out you would see that length being traversing the the entire image right but with the coil wrap we're seeing it that way okay so then maybe we can already prescribe the next sequence uh what we do here is we will do um dixon technique um so we will scan a tonal plane here so we'll just prescribe that again um over the leg again with a large field of view and here we have um selected that we want to look at the in and of post-face images at the same time so we will generate a flex technique in a t1 contrast and we will have uh four image impressions and doing one scan so all these flex uh techniques are applied now to all of our contrasts so you can do that in um t2 to pd and t1 contrast and you can do that anywhere in the body so that's really a nice feature too um to use whenever you expect um fat saturations um issues due to like a large full reviews or maybe um you have a lot of different anatomies in one field of view...
thinking about an ankle scan or an entire foot scan then you can use the technique to have a good fat suppressed images okay and then

while

this is running we can have maybe a look at some images we um generated already earlier so here is the example of uh what we just showed when we positioned our volunteer is that we can have a large field of view here bring the shoulder and the elbow in one scan you see that we have a stir contrast here as well and the scan time was only three minutes and three seconds so that is what i mean usually it was always hard to um offer an entire large field of view where you can cover the entire humerus in one field of view because you never had a big coil and if you would have a big coil then you could never like flexible wrap it around it was like a little bit more stiff that um you always would have more

signa

l from other anatomies um as well but now with wrapping around the coil uh around the humerus you you are not afraid of that and uh on the left-hand side you see in our new sequence which we call and zero te scan so it's bone

imaging

so um this has been required um on also on the larger humerus scan um with our zero to e um technique and the scan time was only two minutes here and also here you can cover the entire humerus with only in one field of view this scan is also one one side note i guess it's really a nice thing that that scan is a silent acquisition so it's entirely um ambient room noise during that scan yeah so not...
only patient comfort due to the flexible coil also patient comfort because no noise anymore so and here are just coming up the first um images we just acquired on our volunteer so that was the stir sequence where you can see that we've used the air coil here three minutes and 34 seconds and you can see that you covered easily the knee and then um the entire tibia and fibula in one field of view as well the tt1 images are coming up in 15 seconds and then we will go ahead and scan on the corona images as well how small field of view on the axials can you do get with this coil how small yeah so um that is really something uh which is um so we can challenge the scanner and the coil um a lot we've seen customer using really like small tiny field of views around like uh i would say 12. um for sure uh when we don't use our new um deep learning technique eric on the l you maybe have to invest a little bit more time in order to scan these small field of views but the coil is capable of doing um kind of i would say like 12 14 field of views without issues so here is the example of doing the sagittal t1 which is a higher higher resolution scan here as well so we selected the matrix by 512 and 388 and then the coronal plane i even bumped the metric size higher up so you will see in the coronal t1 sequence um and i think a metric size for 640 by 512 and maybe we can look here in the actual planes so we did select here a field of view of 60. if you wanted challenges let me know...
maybe we can go ahead and just go a little bit smaller if you want to do you want to see a smaller field of view 16 is probably good for a calf so that's good and as we said during positioning the nice thing if you really are going to scan small field of views and you want to maybe don't have the extent in total you can just take the coil and really wrap it around as much and however small your patient is and you don't have to worry about that in any scenario you will decouple your

signa

l because the coil has the air technology that really is a big um idea regarding positioning and helps you a lot um to make it easy on you because you don't have to follow and think about rules when you put your table and your patient on the table and the coils on top of the patient on the patient yeah it gives you a lot of versatility in that way for sure the t1 image we were going to scan we'll be having um yeah here the metric size 640 by 420 so we go really high up in the resolution we still can have a maintain scan time of only one minute and 43 seconds did you do a kemp fatsat on the humerus i was wondering just you know how the uniformity of the fat suppression is with this coil especially in a humerus where it's closer to the sides of the magnet um um so it's easier i'm honest to do a stir and also like just use the flex technique because you don't have to worry um it really depends on your patient size so if you look at patient sizes and look at me...
my status and my co-worker status i think we don't have to worry about doing a spectral fat saturation there but if you have a bigger one then i would highly recommend to just make it easier on you and use some of the um flex techniques we offer so that you can have a true t1 t2 a pd contrast was just using a diction technique so in here we can just maybe split the layout again and i will go ahead and show you all three images we got here so i will show you the water image the fat image in face image and the host face image so now it's a really t1 contrast so in case you need some contrast media you can inject and that for sure always um helps when i'm thinking about fat suppression and otherwise uh really it depends on your patient and about the size and how flexible he is in the board so i always like give the rules if you can make sure that the coil and the patient is positioned on the pillow like on the table pillow then for sure i would try out the spectral fat saturation when you see that you your anatomy is already like on the extended um part of the table then we know it's like off 50 centimeter and so then i would like highly recommend to do use a dixon technique because the field of view of the scanner is uh 50 centimeters we have also seen um customers using this air coil maybe like really um far away for a routine setup but i'm using on the the air coil to wrap it around a head in order to if your patient is having an intubation or something...
like that then you can use that coil really and put it anywhere in the anatomy and still get good images or maybe for cervical spine when they have really uh it is the best rf disease and cannot fit in any of our coils and even the comfort till doesn't help that there would be also a solution just putting this coil in the back of the patient and go over there so now we are having the two one images here and i can display them large and then again the other two one here too see that you can see the knee and almost like all the way down until the ankle and i think maybe if we would have paid more attention that we made sure that the ankle would have been covered then it's easy to cover like in one scan like really both joints so we are really happy that we finally have the air coils also available in

voyager

because um the

voyager

is a nice container but not having the aircoils was always like hard for us to to um to scan with because we are so used to have now easy and just putting points on the patient however we want so we are really excited here in the building that we finally this technology also on on the

voyager

scanner so that we have aircrafts available on our entire portfolio it's kind of changed the way we think a bit about coils having the air coils you know it's so comfortable for the subjects when we scan or even just the image

quality

better parallel

imaging

performance all of that changes with the air coils but uh just really i guess we're...
spoiled we alright and you said the uh the bore diameter is the is the same as like the standard wide bore artist and arc architect yes so the board is a 70 centimeter board right on the voyage what is the what's the length of the bore um compared to the the architect and the artist i think it's a little bit shorter but i cannot give you a a centimeter unfortunately or like a we have to look that up but feel free to like give us a shoot us an email that we can make sure that we can answer your question via email okay but it's not like significantly longer from uh from the front back of the scanner than those than those other ones huh no okay so here um we have uh some serious delay selected which we did um prior also on an angle um again um uh stir on the left hand side and on the right hand side we did again a pd now on a flex technique but just so um there was also always like a challenging exam i would say um to cover the achilles appropriate because when you use that usually doing that with a normal and a foot coil you know that you would always have challenges that sometimes the achilles would like be ripped apart like further up and you would never have coverage but seeing how nice the images turn out when just using um the air coil around wrapped around the ankle you see how much coverage you can get here and if the achilles would be ripped somewhere you don't worry about that anymore as a technologist and then uh here the small field of view 16 fill...
the view with the um coil as well so in that case we did spectral fat saturation we did a four millimeter slices just to make sure that we had a lot of coverage but you can see that we have a lot of

signa

l so i wouldn't worry about going in with like thinner slices here as well and this is not without our air recon this does not have a recon deal on it either so i think we can further reduce scan time or improve resolution with some technique like this yeah so this is very good okay just maybe to summarize what we discussed here today is um just we wanted to show you on the flexibility of the air chlorides and some anatomy so as we demo before you can wrap it around any long bones you can find you can give the patient comfort by like putting the coil and patient on the side and put the coil in the back and scan spine like that and you have the extended field of view when it's getting abdomen and pelvis you don't have to reposition the coils there with the air coils we have a new technology to recognize the coil so we don't have to worry about coil modes at all anymore the system will just pick um the coils needed for that scan and finally we have a solution to scan a large field of views and we are not worried about like uh finding multiple coils or switching the patient in different ways into the board so we can do that all at once please um let me know if you have any questions otherwise so uh these are like i said earlier these are live sessions we'll...
be having every day feel free to join any of the other sessions two a day from here at our global headquarters in uh waukesha but then also uh one session a day also being from our office in boot france okay just double checking if there are more questions otherwise you can also like unmute yourself and ask questions um otherwise besides the air coil uh what uh what other coils are you're thinking are you thinking of having a head coil at least as well do you mean like when you like purchase a system so which coils you would need yeah so for sure i'm the headquarter and on that scanner we have an action coil um for with the uh 19 challenge available and then also you can combine this head coil for example with the air coil thinking about doing plexus images um and you want to like have coverage also through your humerus that's always a nice solution to like combine these quite but these are the coils you definitely would need and then it really depends on what you do on your daily business like if you do um a lot of like high-end wrist images or something like that then i think you would still think about like getting a wristboy but if you do have to scan a wrist like every once in a

while

then i think uh air coil is your way to to do because then you don't need the entire portfolio of the coils anymore i hope that answers your question some of the larger field of view musculoskeletal

imaging

uh does pretty good with the air coil i would say and especially...
having new techniques like every convl can can further improve it even more but if you if you did want some really small field of view

imaging

then maybe dedicated coils might be the way to go for that okay then uh we appreciate you having hey okay do you have any examples side by side of uh um recon dl and your standard

imaging

here with the air coils see what would be in this system hold on one second here let me see what i've got with that i'm not sure exactly if these are with oh here's one here's a hips with ericondo just one second let me pull that up for you okay okay that's it let me know when you can see my screen okay so this is an example with the air coil and air reconditioning so this is a scan that's one minute one minute four for this hip exam um and here's another one this is example two minutes and 46 seconds for this fat suppressed proton density let me know if the window level is not working for you i think it should be okay um so that's a min 2 minutes 46 you can see another one here this is a two minute 49 all with air recon dl these are three millimeter slice thickness 20 centimeter field of view so we're less than one millimeter in plane uh both directions x and y let's see 2 minutes 49 for that and then there's something maybe even higher resolution here it's a nice benefit of error recon dl's you can kind of achieve resolutions you weren't really able to get before so this is very high...
resolution 340 by 280 21 centimeter field of view the air coil and then yeah this one's uh two minutes for this one so a little higher spatial resolution in this example i have a question back from the uh the session i saw the two of you this morning so on the brain acquisition that you show um were you using the um the the the air x brain package yes so here on

voyager

we also have eric's brain available and our deep learning for slice prescription the brain so actually we offer that on all of our scanners and this morning in the live scanning session where we scan the propeller sequence uh we prescribe the slices with eric's brain do you know if ge is coming out with any other uh prescribed um uh like knee or shoulders luckily we can say yes so um the next one which is uh uh like there already is for the knee and uh actually we showed some images um uh during um this week then as well so if you like want to schedule uh uh image demo so feel free we can show you um how an air x in the knee is working and there we achieved that we can have the slice prescription for the knee um no matter which coil you are using so you can use the air coils you can use the dedicated coil you can use the flex coils whatever is there in your portfolio and eric's knee is able to scan and prescribe slices for the knee um with any other coils and then we are working on more and uh hopefully um we will get uh get more to tell you soon too but the knee is already ready the knee is...
very nice you can uh anatomical reference points of acl pcl meniscus patella it finds all of those anatomical reference points and you can build your protocols around that very thin slice acl you can you can use that it's it's really awesome it's great yeah i have a um i have a

voyager

error um going to be installed in about three months four months so um and we did purchase the uh the air x brain but at the time you know none of the others are available yet so i was just curious okay that's great perfect i think we're already a little bit over the time so um as we said so if you want to see like more images feel free to like reach out to us we can happily schedule a one-on-one meeting with any of you guys and do an image review in further detail and otherwise uh we are happy to share more of our technology tomorrow morning again thank you so much thank you bye thank you