Diagnostic Radiology

Diagnostic Radiology

MR Bilateral Breasts WWO Protocol

  • Saline Implants: No extra sequences required. Call the rad to see if they want to proceed. 
  • Silicone implants: (will be bright on the STIR images). Run additional SAG STIR and AX STIR sequences
  • Philips Breast Implants Guide
MR Breast STIR Silicone Implant

If the patient has silicone implants, run the SAG and AX Stir sequences. The silicone will be bright, and the breast tissue will be very dark.

  • IV 22 g or larger. Labs if needed per department protocol. 
  • Patient will have filled out the screening form, as well as a breast questionnaire. 
  • If they are coming from having a mammo, ask them to remove any nipple markers that may have been left on the skin. 
  • If the patient has implants, make sure to ask them what kind if they didn’t indicate so on the screening form.
  • Breast Patient Care Article
  • Position patient prone on the coil, head first (MR1) and feet first (MR2 and MR4). 
  • Make sure to gently pull as much breast tissue into the FOV as possible without hurting the patient. 
  • Manually create a subtraction if needed.
  • MIP Bilateral and Left and Right breasts. Rotate Only.

DYNACAD: Send ONLY the following sequences:

  • LOCALIZER
  • AX T2 SPAIR
  • AX T1
  • DYNAMIC POST 
    *VIP*: Do not send any “bad” images you repeated to Dynacad.

PACS:  

  • Send everything including subtractions and MIPs

Last updated: 4/12/19
Charge as: Breast Bilateral WWO
Scanner preference: 1.5T or MR4
Coil: Breast coil 
Page Dr. Oh for protocols. Page Alina Tudorica pgr 11496 for sequence questions.

Plane FAT-SAT FOV Notes
3 plane loc - FOV to cover both breasts Check positioning. Reposition if necessary.
AX T2 SPAIR SPAIR FOV to cover both breasts Center on both breasts, FOV to cover entire breast tissue and lymph nodes. If fat sat fails, run the repeat sequence (it has the prep turned to “auto” instead of “full)
(Silicone Implants) SAG STIR with water saturation STIR (water saturation) FOV to cover both breasts Run if patient has silicone implants. Center on both breasts, FOV to cover entire breast tissue and lymph nodes. Implants will be bright, tissue will be very dark.
(Silicone Implants) AX STIR STIR (water saturation) FOV to cover both breasts Run if patient has silicone implants. Center on both breasts, FOV to cover entire breast tissue and lymph nodes. Implants will be bright, tissue will be very dark.
AX T1 NONE FOV to cover both breasts Center on both breasts, FOV to cover entire breast tissue and lymph nodes.
AX eTHRIVE_HR NO FS NONE FOV to cover both breasts Center on both breasts, FOV to cover entire breast tissue and lymph nodes.
AX DWI FOV to cover both breasts Center on both breasts, FOV to cover entire breast tissue and lymph nodes.
PRE AX eTHRIVE_HR THRIVE FOV to cover both breasts OK to add slices but each dynamic time must remain below 90 seconds. Make sure the shim volume is centered on the Sag view for both breasts. IF FAT SAT FAILS: Turn off Fat Sat and repeat. You must also turn off Fat Sat on the POST!! Refer to the below image to see an example of when fat sat fails. This sequence pictured would need to be repeated again without fat sat, and the post Thrive would also need to be run WITHOUT fat sat

Power Inject Contrast

  • Start the scan. Scan will pause after the first dynamic.
  • Scan will remain paused until you press “Scan”.
  • During this pause, inject contrast @ 2.0ml/s followed by 20ml Saline flush @ 2.0ml/s. 
  • Resume the scan once the injector has counted 50 seconds.
Plane FAT-SAT FOV Notes
POST AX eTHRIVE_HR SAME AS PRE SAME AS PRE SAME AS PRE. Sequence should propagate from PRE. Do not change any parameters, sequence should be built in.
MR Breast AX T2 SPAIR
MR Breast STIR Silicone Implant
MR Breast AX T1
MR Breast AX eTHRIVE NO FS
MR Breast PRE AX eTHRIVE FS
MR Breast Pre AX eTHRIVE FS - example of failed FS
MR Breast Post AX eTHRIVE FS