Procedure

What steps should the radiologist take?

A 3D TOF MOTSA should be performed, either on a 1,5 or 3 Tesla MRI, according to the protocols that we have made for all major manufacturers of MRI scans (GE, Philips, Siemens or Toshiba/Canon).

This guide will take you through the necessary steps to successfully complete the exam. Please do follow these instructions carefully, it is paramount to apply the right parameters to obtain an optimized image of the arterial anatomy.

Some parameters can vary slightly according to the type of MRI system that is used, but this should eventually be adapted by the radiologist.

Step 1: Infrared lamp and protocol

When an HCP wants to work with your radiology department, you will be contacted by Augmented Anatomy. Augmented Anatomy will take care of the delivery of an IR lamp and the protocol for your type of MRI system will be sent by e-mail. There are no costs involved for you in the delivery of the IR lamp.

You will however have to provide us with a delivery address, contact person, contact details and type of MRI scanner (Brand and Tesla).

Step 2: Appointment

A referring Health Care Practitioner is chosen to do beta testing of the ARtery 3D application; this HCP will send the patient with a specific MRI request form. (An example will be uploaded to this page very soon.) The patient makes an appointment at the assigned radiology department. You will receive the MRI Prescription form of the patient.
The title of the exam is: Infrared enhanced 3D-TOF MOTSA of the face.

Step 3: Patient preparation

After your standard MRI screening for medical contraindications, the patient should remove all metallic materials on his/her body (including all cellphones, keys, wallet, jewelry, piercings...), and also any make-up or dental (removable) prosthesis.

Place the patient in front of the IR-lamp. The patient should be placed at a distance of 30 cm with the face parallel to the lamp (so that there is an equal distribution of heat on the entire face). The heat will improve the arterial flow and therefore enhance the image quality of the 3D TOF MOTSA.

The patient should sit in front of the lamp for 10 minutes, with the eyes closed, while performing all kinds of different facial expressions (smiling, frowning, blowing up the cheeks, …). This will activate the facial muscles and further improve the arterial blood flow and image quality.

During these 10 minutes, the scan parameters can be implemented into the MRI system. These settings will be saved, so you will only have to enter these parameters once for all MRI’s that will be done in your department.

Step 4: Patient positioning

As soon as the preparation time in front of the IR-lamp is finished, the MRI should be performed immediately to profit as much as possible from the vasodilation effect on the arteries.

Place the patient in the following stable position:
  • - Supine
  • - Head first, in neutral position (face parallel to the table)
  • - Mouth closed without pressing the lips
  • - Eyes closed
  • - Arms alongside the body
  • - Legs next to each other

Place the head coil, and if available, a flexible wrap-around surface coil should be mounted on top of the head coil (see image 4). Ask the patient not to move nor make any facial movements; for the success of the MRI it is mandatory that the patient remains completely still during the entire procedure.

Step 5: Setting up the MRI

Enter all necessary parameters, based on the protocol suitable for the hospital MRI. Some parameters can vary slightly according to the type of MRI system that is used, but this should eventually be adapted by the radiologist. If available, activate Hypersense on a GE MRI or any parallel imaging technique on another MRI brand.

Step 6: Performing the MRI

Obtain a lateral (or 3D) scout view of the head. Position the multi slab zone so that the caudal border includes the chin and the cranial border should be 3cm above the supra-orbital rim. The 3D-TOF MOTSA MRA sequence is obtained in an oblique coronal plane (tilting of 25° cranially backwards versus the line between the glabella and the chin). Use a multislab technique to reduce the saturation effect of the inflowing blood signal. Place a saturation block cranially from the multi slab zone.

Step 7: MIP Reconstructions

Start by removing the intracranial vessels to avoid superposition. MIP images should be made every two degrees over 180° in a sagittal plane, from Profile-right to Profile-left.

Step 8: DICOM and MIP upload

Go to https://radiology.augmented-anatomy.com. Log in to the upload portal using the `upload code` and `patient date of birth`.
Select the folder containing the DICOM files to upload. The upload will start automatically.
Please do not forget to upload the MIP reconstructions!