Breast Imaging Protocol

Greg Brown
Royal Adelaide Hospital MRI Unit
23 May 1998
 
Protocol Purpose Contrast Dose Data Handling  Subtractions Evaluation
Protocol Rationale Preparation Filming
Coil Instructions for injecting radiologist Full Sequence Details
Injection Equipment Tray Sequences Back to the Adelaide MRI Website
 

PURPOSE


RATIONALE


COIL

CP Breast coil and light grey breast coil pads.
See VISION System Guide D.3-16. for coil handling information


INJECTION EQUIPMENT

CONTRAST DOSE

The correct dose is critical to allow standard levels of lesion detection.


PREPARATION

Preparation of the patient, injection equipment, scanner and staff is essential to avoid timing errors.   We only get one shot at acquiring the early post contrast data.

Patient Preparation

Undress completely.   Put on two gowns, the first opening to the front, the second opening to the back.
Explain the procedure to the patient. Stress the need to be comfortable and very still throughout.  Instruct them to breath gently.

Patient Positioning

Instruction for Radiologist


SEQUENCES

The MR sequences are based on those suggested by Siemens.   Viewing teh full listing of these sequences, you will see the required modifications.  Click on the sequence names to jump to the sequence listing.

Coil: Breast coil or CP Breast Array
Group: Dynamic
Protocols:
 

SCOUT
CORONAL_3D-FLASH_Contrast_run_14297 Water_Excitation_MPRAGE
Optional Sequence for new lesions only. The images can be used for rough MPR's in other planes, and to locate late enhancing lesions.  malignancies will not be distinguishable from benign mass lesions on this sequence.


IMAGE HANDLING

SUBTRACTIONS

Read NUMARIS Reference guide part 2 F.15-1 to 15-3 and 15-11
 
 
  • Use Evaluate Dynamic Analysis to subtract the precontrast coronal study form the 1st, 2nd, and last post contrast coronal studies. 
  • The post contrast images are selected as the first operand and the pre-contrast images should be selected as the second operand.  It is easiest to use Select function. 
  • Set operation to Subtract 

  • Enter an appropriate Study name (eg. 90 sec post contrast sub) before pressing Go
     

    FINDING THE LESIONS

    ENHANCEMENT CURVES

    Read NUMARIS Reference Guide part 2  F.13
    The aim is to make enhancement curves for each enhancing mass identifiable of the post contrast images
     
  • Put a contrasted image that best shows the lesion in segment 1. 
  • Select Evaluate Mean/Curve 
  • Type in the slice numbers of the slices for the pre and post contrast images at the location you are evaluating. 
  • Select parameters as shown in the adjacent window. 
  • Click on Draw 
  • Click and drag the circle tool over the lesion.
    •  Click Select and click on the circle.
    • Adjust circle size to only include enhanced lesion. 
  • Copy the circle and drag the second circle to a region of non-enhanced breast tissue (not fat) 
  • Click GO 
  • The time curve will appear in segment 2 
  • Move the vertical sampling line to the second data point 

  • Click Copy Segment for the graph and the image with ROIs and note the image number 
     

    Full Sequence Listings

    Scout
    Date: Tue Mar  9 18:55:10 1999  Royal Adelaide Hospital               Page:  551
    +------------------------------------------------------------------------------+
    |                           SIEMENS MAGNETOM VISION                            |
    +------------------------------------------------------------------------------+
    |                          Measurement Protocol Data                           |
    +------------------------------------------------------------------------------+
    | CUSTOMER protocol                       | NUMARIS/3 VB31D                    |
    | Coil     : breast                       | Print Date : Tue Mar  9            |
    | Group    : MASS_STUDY                                                        |
    | Protocol : Scout                                                             |
    +------------------------------------------------------------------------------+
    | Sequence : scout.wkc                                                         |
    | No. Meas.        : 1                    No. Acq.         : 1                 |
    | Bodyscout        : No                   Pixel Size       : 3.13 X 1.56 mm    |
    |                                         Scan Time        : 26 sec            |
    +------------------------------------------------------------------------------+
    | TR               : 40   ms                                                   |
    | TE               : 6    ms                                                   |
    | Flip angle       : 40.00 deg                                                 |
    +------------------------------------------------------------------------------+
    | No Slices        : 4                    Matrix Size      : (50%) 128*256,o   |
    | Slice Thickn.    : 10.00 mm             Ph-OS            : 0 %               |
    |                                         FOV              : 400.00 mm         |
    |                                         Rect. FoV        : 8/8               |
    |                                         Half Fourier     : No                |
    | Shift-mean       : Various                                                   |
    | Orientation      : Various                                                   |
    | Dist. Factor     : Various              Fat Sat.         : No                |
    | Excit. Order     : Interleaved          MT-Sat.          : No                |
    | Trigger/Gate     : Off                                                       |
    | Filter           : Hanning (W)                                               |
    | Interpolation    : Off                  Inline adj.      : Yes               |
    | Phase Images     : No                   Shim Adj.        : No                |
    |                                         Swap Phase Enc.  : No (Various)      |
    +------------------------------------------------------------------------------+
    |                               MSMA Slice Data                                |
    +------------------------------------------------------------------------------+
    | Nr  Thick    FOV   Base Orient.    Rotated to      Rotated to      Shift     |
    +------------------------------------------------------------------------------+
    |  1   10.0  400.0   Sag             -               -                70.0     |
    |  2   10.0  400.0   Sag             -               -               -70.0     |
    |  3   10.0  400.0   Cor             -               -                 0.0     |
    |  4   10.0  400.0   Tra             -               -                 0.0     |
    +------------------------------------------------------------------------------+


    Coronal 3D T1 FLASH Series
    Date: Tue Mar  9 18:55:10 1999  Royal Adelaide Hospital              Page:  553
    +------------------------------------------------------------------------------+
    |                           SIEMENS MAGNETOM VISION                            |
    +------------------------------------------------------------------------------+
    |                          Measurement Protocol Data                           |
    +------------------------------------------------------------------------------+
    | CUSTOMER protocol                       | NUMARIS/3 VB31D                    |
    | Coil     : breast                       | Print Date : Tue Mar  9            |
    | Group    : MASS_STUDY                                                        |
    | Protocol : CORONAL_3D-FLASH_Contrast_run_14297                               |
    +------------------------------------------------------------------------------+
    | Sequence : fl3d_4b244.ykc                                                    |
    | No. Meas.        : 7                    No. Acq.         : 1                 |
    | Repetit. delay   : 0 - 10 sec                                                |
    | Bodyscout        : No                   Pixel Size       : 1.52 X 1.25 mm    |
    |                                         Scan Time        : 1 min, 0 sec      |
    +------------------------------------------------------------------------------+
    | TR               : 8.1  ms                                                   |
    | TE               : 4    ms                                                   |
    | Flip angle       : 20.00 deg                                                 |
    +------------------------------------------------------------------------------+
    | No Slabs         : 1                    Matrix Size      : (82%) 105*256,o   |
    | Slab Thickn.     : 160.00 mm            Ph-OS            : 0 %               |
    | Eff. slice thick.: 2.50 mm              FOV              : 320.00 mm         |
    | No. Partitions   : 64                   Rect. FoV        : 4/8               |
    | 3D-OS            : 6 %                  Half Fourier     : No                |
    | Shift-mean       : 0.00 mm                                                   |
    | Orientation      : Cor                                                       |
    | Dist. Factor     : Undefined            Fat Sat.         : No                |
    | Excit. Order     : Undefined            MT-Sat.          : No                |
    | Trigger/Gate     : Off                                                       |
    | Filter           : Off                                                       |
    | Interpolation    : Off                  Inline adj.      : Yes               |
    | Phase Images     : No                   Shim Adj.        : No                |
    |                                         Swap Phase Enc.  : Yes (H->F)        |
    +------------------------------------------------------------------------------+


    Water Excitation MP-RAGE
    +------------------------------------------------------------------------------+
    |                           SIEMENS MAGNETOM VISION                            |
    +------------------------------------------------------------------------------+
    |                          Measurement Protocol Data                           |
    +------------------------------------------------------------------------------+
    | CUSTOMER protocol                       | NUMARIS/3 VB31D                    |
    | Coil     : breast                       | Print Date : Tue Mar  9            |
    | Group    : MASS_STUDY                                                        |
    | Protocol : Water_Excitation_MP-RAGE_30996                                    |
    +------------------------------------------------------------------------------+
    | Sequence : mpr_we_ns_t1_4b195.wkc                                            |
    | No. Meas.        : 1                    No. Acq.         : 1                 |
    | Bodyscout        : No                   Pixel Size       : 1.25 X 1.25 mm    |
    |                                         Scan Time        : 4 min, 49 sec     |
    +------------------------------------------------------------------------------+
    | TR               : 10.3 ms                                                   |
    | TE               : 4    ms                                                   |
    | TI               : 300  ms                                                   |
    | TD               : 300  ms                                                   |
    | Flip angle       : 15.00 deg                                                 |
    +------------------------------------------------------------------------------+
    | No Slabs         : 1 (fixed)            Matrix Size      : (100%) 128*256,o  |
    | Slab Thickn.     : 256.00 mm            Ph-OS            : 0 %               |
    | Eff. slice thick.: 1.60 mm              FOV              : 320.00 mm         |
    | No. Partitions   : 160                  Rect. FoV        : 4/8               |
    | 3D-OS            : 0 %                  Half Fourier     : No                |
    | Shift-mean       : 0.00 mm                                                   |
    | Orientation      : Cor                                                       |
    | Dist. Factor     : Undefined            Fat Sat.         : No                |
    | Excit. Order     : Undefined            MT-Sat.          : No                |
    | Trigger/Gate     : Off                                                       |
    | Filter           : Off                                                       |
    | Interpolation    : Off                  Inline adj.      : Yes               |
    | Phase Images     : No                   Shim Adj.        : Yes               |
    |                                         Swap Phase Enc.  : Yes (H->F)        |
    +------------------------------------------------------------------------------+
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