Siemens MAGNETOM Skyra fit Operator's Manual
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Siemens MAGNETOM Skyra fit Operator's Manual

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MAGNETOM Skyra
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Operator Manual – MR System
syngo MR E11
Answers for life.
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  • Page 1 MAGNETOM Skyra Operator Manual – MR System syngo MR E11 Answers for life.
  • Page 3 MAGNETOM Skyra Operator Manual – MR System syngo MR E11...
  • Page 4 Legend Indicates a hint Provides information on how to avoid operating errors or information emphasizing important details Indicates the solution to a problem Provides troubleshooting information or answers to frequently asked questions Indicates a list item Indicates a prerequisite A condition that has to be fulfilled before starting a particular operation Indicates a single-step operation Indicates steps within operating sequences Italic...
  • Page 5 Legend WARNING Indicates a hazardous situation which, if not avoided, could result in death or serious injury. WARNING consists of the following elements: ◾ Information about the nature of a hazardous situation ◾ Consequences of not avoiding a hazardous situation ◾...
  • Page 6 Legend MR System | Operator Manual Print No. M6-04401.621.02.02.02...

  • Page 7: Table Of Contents

    Table of contents 1 Introduction Layout of the operator manual The current operator manual Intended use Authorized operating personnel 1.4.1 Definitions of different persons 2 Safety Preface about safety 2.1.1 Hazards and risks 2.1.2 Common causes of accidents 2.1.3 Responsibility 2.1.4 Configuration of hazard hints Common/permanently existing hazards...
  • Page 8 Table of contents 3 MR system components Overview MR system 3.1.1 About function 3.1.2 Super-conducting magnet 3.1.3 Electronics cabinets 3.1.4 RF coils syngo Acquisition Workplace 3.2.1 Host 3.2.2 Data recording 3.2.3 Monitor 3.2.4 Keyboard 3.2.5 Mouse 3.2.6 syngo MR Workplace (optional) System control 3.3.1 Description...
  • Page 9 Table of contents 4 Physiological imaging Triggering methods 4.1.1 Prospective triggering 4.1.2 Retrospective gating Physiological Measurement Unit (PMU) 4.2.1 Description 4.2.2 Preparing the measurement ECG triggering 4.3.1 Description 4.3.2 Performing Pulse triggering 4.4.1 Description 4.4.2 Performing Respiratory triggering 4.5.1 Description 4.5.2 Performing External triggering...
  • Page 10 Table of contents Starting/Stopping the measurement 5.6.1 Starting the measurement 5.6.2 Stopping the measurement 6 Maintenance Cleaning 6.1.1 Cleaning the LCD monitor/video display 6.1.2 Cleaning the camera lens 6.1.3 Cleaning the data carrier 6.1.4 Cleaning the plugs and connectors 6.1.5 Cleaning the patient table and the straps 6.1.6 Cleaning and disinfecting the receptors...

  • Page 11: Introduction

    The current operator manual This manual may include descriptions covering standard as well as optional hardware and software. Contact your Siemens Sales Organization with respect to the hardware and software available for your system. The description of an option does not infer a legal requirement to provide it.

  • Page 12: Intended Use

    Introduction The graphics, figures, and medical images used in this operator manual are examples only. The actual display and design of these may be slightly different on your system. Male and female patients are referred to as “the patient” for the sake of simplicity.

  • Page 13: Authorized Operating Personnel

    In addition, the user has to have read and understood the contents of the operator manual. Please contact Siemens Service for more information on available training options and suggested duration and frequency of such training.
  • Page 14 Introduction Term used Explanation Siemens Serv- Group of specially trained persons who are ice/service per- authorized by Siemens to perform certain mainte- sonnel nance activities References to “Siemens Service” include service personnel authorized by Siemens. MR System | Operator Manual...

  • Page 15: Safety

    MR system, if the MR system is not used in accordance with the instructions for use (Operator Manual, System Owner Manual). Siemens is also not responsible for any direct or indirect damages caused by incorrect operation. This includes, but is not limited to, accidents with ferromagnetic objects.

  • Page 16: Configuration Of Hazard Hints

    Safety Configuration of hazard hints 2.1.4 All hazard hints are identified in a special way. The following keywords signal the level of hazard involved: WARNING Warning regarding risks that may result in death or serious physical injury. CAUTION Warning regarding risks that may result in minor physical injury or material damage.
  • Page 17 Safety Fields Most serious hazards Static magnetic field Movement by implants and prostheses in the body Attraction, alignment, and projectile-like acceleration of magnetizable objects ( Page 18 Safety instructions on the static magnetic field) Gradient fields Peripheral nerve stimulation ( Page 20 Safety instructions on RF and gradient fields) RF fields Warming of body tissue...

  • Page 18: Safety Instructions On The Static Magnetic Field

    Safety RF fields lead to warming of the body tissue. In this context, an important value per body weight is the specific absorption rate or SAR. ( Page 108 Physiological effects) Side effects Possible undesirable side effects for MR are dizziness, heating, claustrophobia and nerve stimulation.
  • Page 19 Use only MR Safe or MR Conditional tools and devices. ◆ Service work on the MR system may only be performed by Siemens Service. ◆ Ensure that only authorized personnel enter the controlled access area (0.5 mT exclusion zone), for example, electricians or cleaning personnel trained in MR safety.

  • Page 20: Safety Instructions On Rf And Gradient Fields

    Safety For China only: In 3-T systems medical supervision is required for all patients according to IEC 60601-2-33 (2nd edition). Dizziness during exposure When persons (e.g. MR workers or patients) are exposed to the static magnetic field, possible effects are dizziness, light-headedness, or metallic taste, especially in 3-Tesla magnetic fields.
  • Page 21 Safety Ensure to prevent potential current loops as shown in the red  labeled illustration. Ensure the patient is positioned with proper distance (5 mm) to magnet tunnel as well as proper distance between parts of the body as shown in the green labeled illustration. ◆...
  • Page 22 Safety  CAUTION The patient is wearing electrically conductive material! Incorrect patient positioning! Formation of electric current loops Peripheral nerve stimulation of the patient ◆ Ensure that the patient does not wear clothing that is wet or dampened by perspiration. ◆...

  • Page 23: Contraindications

    Safety  CAUTION Heating up of RF blankets or shields used to avoid aliasing artifacts! Patient burns ◆ Never use RF blankets or other conductive sheets within the MR system. 2.2.4 Contraindications This chapter contains very important information about MR safety: In principle, a qualified physician must evaluate the risk/ ...
  • Page 24 To obtain these specific conditions the MR operator may refer to the labeling of the implantable medical device or contact the device manufacturer. Siemens MR does not assume responsibility or liability for the operation of the MR system with any implantable medical device.

  • Page 25: Mechanical Hazards

    Safety  CAUTION Eddy currents induced by low-frequency magnetic fields! Patient burns ◆ Do not examine patients with electrically conducting implants or prostheses.  CAUTION Electrically conducting objects! Injury to patient due to warming Incorrect diagnosis due to artifacts ◆ Request that the patient removes all electrically conducting objects, e.g.
  • Page 26 Cover of the table lifting column is defective; access to moving parts is possible! Risk of severe contusion during vertical movement ◆ Complete the current examination and then shut down the system. ◆ Notify Siemens Service. MR System | Operator Manual Print No. M6-04401.621.02.02.02...
  • Page 27 Safety  CAUTION Vertical and horizontal movement of the patient table! Injury to patient and other persons Damage to the patient table ◆ Ensure that there are no obstacles (e.g. extending or overhanging body parts, hair, clothing, straps) between table and the magnet, or that the additional equipment (e.g.

  • Page 28: Compatibility

    Safety  WARNING Improper patient transport with the dockable patient table, improper use of the side rails! Injury to the patient Damage to the patient table ◆ Carefully transport the patient on the dockable patient table. Secure the patient if necessary. ◆...
  • Page 29 3 T systems, and vice versa. See also MR Conditional: ( Page 29 Labeling) ◆ Contact Siemens Service prior to combining the MR system with other devices. Interferences Peripheral equipment (e.g. patient monitoring, life support or emergency care equipment) which is not specified or recommended...

  • Page 30: What Else Must Be Observed

    Safety MR Conditional An item that has been demonstrated to pose no known hazards in a specified MR environment with specified conditions of use. Field conditions that define the specified MR environment include field strength, spatial gradient, dB/dt (time rate of change of the magnetic field), RF fields, and SAR. Additional conditions, including specific configurations of the item, may be required.

  • Page 31: Noise Development

    Adequate attenuation levels can be achieved by using, for example, ear plugs. Ear plugs offering sufficient hearing protection can be found in the Siemens Accessories catalog. The standard Siemens headphones are intended for communication with the patient and can be used in combination with ear plugs. MAGNETOM Skyra | syngo MR E11 Print No.

  • Page 32: Patient Care

    Safety ◾ For appropriate sound attenuation, the proper use of hearing protection is important. All personnel should be trained to correctly apply the hearing protection. ◾ Special attention and training of the operator is required for proper positioning of the hearing protection for neonates and infants. In addition this applies to any other condition where an alternative form of hearing protection might be necessary.

  • Page 33: Artifacts And Imaging Errors

    Safety Patient monitoring Patients may be acoustically as well as visually and physiologically monitored in the MR system. ◾ The viewing window or a video system is used for visual monitoring. ◾ The intercom can be used to acoustically contact the patient. (...
  • Page 34 The MR image may show system-related artifacts/imaging errors imaging errors despite careful preparation. ◆ If the same artifact/imaging error appears repeatedly, document and submit it to Siemens Service. Stripe artifacts  CAUTION RF-signal interference caused by incompatible accessories e.g. patient monitoring devices! Streaks and bright spots in the MR image ◆...
  • Page 35 Safety Variations in brightness  CAUTION Local variation in the sensitivity of local coils! Continuous fluctuations in MR image brightness ◆ Whenever possible, use a local coil with transmit characteristics that are more suitable for the field of view desired. ◆...
  • Page 36 Safety Distortions/signal obliteration  CAUTION along the edges Spatial non-linearity of the gradient field and inhomogeneity of the static magnetic field! Pin-cushion and barrel-shaped distortions and/or loss of signal in the margins of the MR image ◆ Go through a distortion correction. ◆...
  • Page 37 Incorrect assignment of active brain areas ◆ Prior to the examination, inform patients about movements and their negative effects on the measurement. ◆ Use Siemens scan protocols with motion correction. ◆ Monitor the patient to ensure that the task is performed correctly. MAGNETOM Skyra | syngo MR E11 Print No.

  • Page 38: Maintenance/Repair

    2.3.6  WARNING High voltage and currents inside the electronics cabinets! Risk of death by electrocution ◆ Electronics cabinets should only be opened by Siemens Service. Daily checks Windows, doors, and emergency flaps must not be blocked. Safety-relevant accessories The following safety-relevant accessories should be checked: ◾...
  • Page 39 Safety Potential injury to persons Laser radiation Risk of injury Maximum load side rails Risk of breaking Laser (for the US only) Laser Refilling with liquid nitrogen and helium Prohibition signs The following objects are prohibited in the examination room: MAGNETOM Skyra | syngo MR E11 Print No.
  • Page 40 Safety Open flames, no smok- Implants susceptible to Metallic implants and Mechanical watches electromagnetic effects other metallic objects and electronic data car- inside the body riers Fire extinguishers with Metal parts, e.g. tools Electronic data carriers magnetizable metal housing Implants susceptible to electromagnetic effects Unauthorized access Further symbols Non-ionizing radiation...

  • Page 41: System Owner-Related Advices

    Safety Protective class symbol B for Protective class symbol BF for application parts application parts System owner-related advices 2.3.8 Some safety instructions address the system owner. They are included as “Safety information” in a separate operator manual, see: System owner manual.
  • Page 42 Safety Switch Effect Emergency Emergency Shut- Electric power of the entire MR system E.g. in case of fire down is switched off, but magnet remains at field Table Stop Motorized table movement is stopped In case of accidents or injury due to table movement In case of emergency, the relevant switch should be pressed.
  • Page 43 The WARNING LED will light up and an alarm signal will sound.  As a rule, Siemens Service must be called following a quench. The magnet must only be put back into operation by Siemens Service personnel.

  • Page 44: Medical Emergency

    Safety Emergency Shut-down switch Typically there are two Emergency Shut-down switches installed: one near the alarmbox and another one in the examination room. The switch is used to switch off the electric power of the entire MR system.  WARNING Fire or electrical accidents! Personal injury ◆...

  • Page 45: Coolant Accidents

    Safety  CAUTION Squeeze bulb is defective! Risk of injury to patient because emergencies cannot be communicated ◆ Check the functionality of the squeeze bulb daily. 2.4.3 Coolant accidents First aid in case of shortness of During a quench, a person might become unconscious due to severe breath shortness of breath: Remove unconscious persons immediately from the examination...

  • Page 46: Fire/Fire Fighting

    Safety Fire/Fire fighting 2.4.4 The following devices/materials may be used for fire fighting: ◾ Non-magnetic CO extinguisher ◾ Self-contained, anti-magnetic compressed-air breathing apparatus (or hose connection) ◾ Airtight chemical protective suit MR System | Operator Manual Print No. M6-04401.621.02.02.02...

  • Page 47: Mr System Components

    MR system components MR system components Overview MR system 3.1.1 About function A detailed specification of the systems hardware and software is available in the Info dialog box (main menu Help > Info). 3.1.2 Super-conducting magnet Magnetic field The super-conducting magnet generates a strong homogeneous magnetic field with a field strength of 3 T.
  • Page 48 The control cabinet includes different electronics components to operate the MR system. The control cabinet includes a sequence-programmable, optical trigger signal output which can be made externally accessible by Siemens Service via installation of a fiber optic cable. MR System | Operator Manual Print No. M6-04401.621.02.02.02...

  • Page 49: Rf Coils

    The use of devices connected to the optical trigger signal output has to comply with any applicable governmental or local hospital Institutional Review Boards (IRBS). Siemens will not be held responsible for the use of any device and resulting consequences in connection with the optical trigger signal output.

  • Page 50: Host

    Data carrier Only CD-Rs/DVD-Rs (Recordable) labeled “Medical Grade” and having a gold-colored layer are suitable for documenting data for medical purposes. Siemens Service will provide you with CD-Rs/DVD-Rs.  Please take into account the handling, care, storage of CDs/DVDs and CD-Rs/DVD-Rs as specified by the respective manufacturers.

  • Page 51: Keyboard

     Do not position containers holding fluids, e.g. cups or glasses, on top of the monitor. In addition, general cleaning instructions must be observed. The monitor may only be opened by authorized Siemens Service personnel. Keyboard 3.2.4 The syngo Acquisition Workplace is equipped with an original Siemens keyboard.

  • Page 52: Mouse

    MR system components Function Original Siemens key Windows key Page forth/back in the series 5 / 4 Page forth/back image by image 2 / 1 Open patient registration Selecting the Patient Browser Copy to film sheet Enter Highlight Send to node 1...

  • Page 53: Syngo Mr Workplace (Optional)

    MR system components ◾ Left mouse button: – Selecting or moving objects – Starting applications – Executing commands ◾ Center mouse button/wheel: – Changing the window values of patient images – Scrolling (for example, through the Patient list) ◾ Right mouse button: –...
  • Page 54 MR system components Control units The control units are located at the right and the left side of the patient table at the front of the magnet cover. Optionally, additional control units are located at the back of the magnet. Each control unit consists of a jogwheel and several additional buttons.
  • Page 55 MR system components Depending on the situation, the small jogwheel can have different functions: ◾ Rotate: e.g. for navigating through the display menu or for changing settings of, for example, ventilation ◾ Push: e.g. for resetting the patient alert or for starting a measurement ...
  • Page 56 MR system components ◾ Guidance for attaching ECG electrodes, docking the table and emergency evacuation ◾ General patient information submitted from the software ◾ Information concerning troubleshooting Tool bar You can navigate between the depicted icons by using the small jogwheel.

  • Page 57: Operating The Dot Display

    MR system components Operating the Dot display 3.3.2 To operate the Dot display, use the jogwheel of the smaller control unit. ( Page 54 Control units) Turn the jogwheel to navigate through the icons. Press the jogwheel to confirm the selection. If necessary, adjust your settings by turning and pressing the jogwheel.
  • Page 58 MR system components (1) Tabletop (2) Head end (3) Table Stop button (4) Handle to pull out the table top in case of emergency (5) Emergency release The tabletop can be moved horizontally into the magnet bore. When moved completely out of the magnet, the tabletop may be moved vertically as well.

  • Page 59: Operating The Patient Table

    MR system components  Make sure that no liquids such as contrast medium, blood, or cleaning agents get into the table connections. Connections The following connections are located at the foot end of the patient table: (1) Headphones (2) Vacuum cushion (3) Squeeze bulb (4) Placeholder [Intended for future use] Paper roll holder...
  • Page 60 MR system components (1) Table Up/Inward button (2) Jogwheel, Center Position button (3) Home Position button (4) Table Down/Outward button To operate the patient table safely and efficiently, operating personnel must be familiar with its most important positions. Home Position Table is at the height of moving into the magnet bore, tabletop is moved completely out of the magnet Last Scan Position...
  • Page 61 MR system components Using the jogwheel Keep the jogwheel turned to move the patient table up/into or down/out of the magnet bore. Depending on how far the jogwheel is turned, the speed increases. The table movement stops immediately once you release the jogwheel.
  • Page 62 MR system components Stopping table movement Press the Table Stop button to stop the table movement. To reset the table stop, turn the Table Stop button clockwise until it releases mechanically. Then simultaneously press the Table Up/ Inward and the Table Down/Outward button fully. Rescuing the patient in an In case of accidents, e.g.
  • Page 63 MR system components  WARNING Patient rescue during emergency situations, e.g. quench with failing quench pipe, fire with strong smoke development, emergency situation involving patient (e.g. heart attack) and simultaneous power failure! Personal injury ◆ After releasing the emergency release, pull the tabletop with the patient manually out of the magnet.

  • Page 64: Dockable Patient Table

    MR system components Press the Home Position button. After reaching the Home Position, the patient table is ready for operation again. Dockable patient table Description 3.5.1 The dockable patient table is an optional table that can be completely removed from the magnet system. This enables the transport of immobile patients.

  • Page 65: Operating The Dockable Patient Table

    MR system components (4) Emergency undocking handle (5) Pedals (6) Handle at the foot end Pedals If the table is removed from the system, you can use the pedals to lift and lower the table manually. Side rails The side rails can be folded out to secure patients during transport, or as a arm rest for patients with infusions.
  • Page 66 MR system components ◆ Position the side rails as required: e.g. in a vertical position to secure the patient, or in a horizontal position as arm supports. Undocking the table ✓ The tabletop is in Home Position. ✓ Brake for the castors is released. ◆...
  • Page 67 MR system components  CAUTION Dockable patient table may move against the wall or the door! Possible injuries (for example, squashed fingers) ◆ To move the table, always grasp the middle area of the handle (not the outside edges). Move the table with the handle at the foot end of the table. ...
  • Page 68 MR system components Position the table so that the docking nose is positioned in the docking station and the table is positioned at the end stop of the docking station. The display shows if the table is positioned correctly and completely in the docking station.
  • Page 69 MR system components Table moves downwards despite you want to lift the table In certain cases (for example, after docking), the table must find the reference position and moves slightly down. This is normal behavior. Table does not move horizontally Check that the side rails are fully stored in the carrying frame - oth- erwise no table movement is possible.

  • Page 70: Laser Light Localizer

    MR system components ✓ Tabletop is in Home position. ✓ Brake for the castors is released. ◆ Pull the emergency undocking handle to undock table. The table can be removed from the system. Resetting the emergency Press the emergency undocking handle back into its original undocking handle position.
  • Page 71 MR system components ✓ The patient is positioned on the tabletop. ✓ The patient table has been moved to measurement height.  WARNING Laser beam of the laser light localizer! Eye injury caused by laser beam ◆ Ensure that the operating and adjustment devices as well as methods given are used as described.

  • Page 72: Alarm Box

    The alarm box is installed near the syngo Acquisition Workplace. 3.7.2 Checks  WARNING MR system malfunction! Hazardous conditions for patients ◆ Note the sounding alarm and signal. ◆ Do not perform MR examinations. ◆ Notify Siemens Service. MR System | Operator Manual Print No. M6-04401.621.02.02.02...
  • Page 73  The POWER LED is off, even though the power supply is functioning properly? ◆ Notify Siemens Service. After a power failure, the battery powers the circuit of the  magnet emergency shutdown for another 14 days. During this time, the magnet can still be quenched i.e. the magnetic field can be shut down by pressing the Magnet Stop switch in case of emergency.

  • Page 74: Intercom

    MR system components ◆ Please contact Siemens Service regarding questions about remote monitoring. Intercom 3.8.1 Description The intercom allows personnel and patients to communicate during the examination. In addition, some important operations like stopping the patient table can be managed from the intercom.

  • Page 75: Operating The Intercom

    MR system components Patient alert Patients may use the squeeze bulb to alert the operating personnel (patient alert): ◾ Acoustically: – Continuous tone over the intercom – Brief feedback signal via the patient’s headphones and loudspeaker in the examination room ◾...

  • Page 76: In-Room Syngo Acquisition Workplace

    MR system components Button Function Stop Stops the table movement and the measure- ment immediately Reset Stop Resets the table Stop Press the corresponding button. If necessary, adjust the volume using the +/- buttons. Press and hold the buttons to adjust the volume. If you hold the button for about one second, the volume increases/ decreases until you release the button.

  • Page 77: Operating The In-Room Syngo Acquisition Workplace

    MR system components The In-Room syngo Acq WP is connected with the host processor and facilitates the examination process by allowing the operating personnel to remain inside the examination room between procedures. The In-Room syngo Acq WP is used as follows: ◾...
  • Page 78 MR system components  CAUTION Diagnosis at the In-Room syngo Acquisition Workplace or use for interventional procedures! Risk of patient injury; incorrect diagnosis ◆ Always plan appropriate emergency measures prior to starting an MR-guided or MR-monitored interventional procedure. ◆ Do not use the In-Room syngo Acquisition Workplace for diagnostic purposes.
  • Page 79 MR system components Release the locking lever by turning it counter-clockwise by 90°. Press lightly against the upper or lower edge of the display to move the monitor into the desired tilt position. Adjusting the monitor height Turn the wheel clockwise to raise the monitor. Turn the wheel counter-clockwise to lower the monitor.

  • Page 80: Other Components And Accessories

    MR system components If the protocol is configured for repeated measurements, the next measurement can be started with the footswitch after completing the preceding measurement. For more information regarding the configuration of protocols, see: Software operator manual Push the hose plug into the retaining rings of the pushbutton unit. Load a suitable protocol and start it at the syngo Acq WP or the In- Room syngo Acq WP.
  • Page 81 (1) Scanner hardware error Automatic shutdown! Evacuate patient immediately from the examination room! To prevent further damage, the system will be switched to Standby within 1 minute! Call Siemens Service immediately. Immediately move the patient out of the magnet bore by pressing the Home Position button.
  • Page 82 Dialog box at the syngo Acquisition Workplace (1) Scanner hardware malfunction Functional problem within automatic shutdown mechanism. Please restart software of MeasRecon. If the problem persists, please call Siemens Service immediately. ◆ Call Siemens Service.  The supervision sensitivity is potentially affected, but the operation of your MR scanner is still possible.

  • Page 83: Physiological Imaging

    Physiological imaging Physiological imaging Triggering methods MR imaging procedures are sensitive to patient movement. Images may exhibit artifacts in the form of smears when motion times - for instance, during respiration or heartbeat - are short compared to measurement times. In particular, this problem occurs as a result of the patient's heartbeat during cardiac examinations or as a result of the patient's breathing during abdominal examinations.

  • Page 84: Retrospective Gating

    Physiological imaging Retrospective gating 4.1.2 Retrospective gating fundamentally differs from prospective triggering. No actual triggering is taking place. The physiological signal and data acquisition times are recorded simultaneously. The measurement is performed completely independently of the patient’s heartbeat or pulse. A temporal assignment of images to the corresponding phase (e.g.
  • Page 85 Physiological imaging Only one PERU or PPU can be located in the examination room!  Two ECG and respiratory sensors in the examination room interfere with one another in signal transmission. It is not possible to determine the results. Patient monitoring systems are optional accessories and are not part of the PMU.
  • Page 86 Physiological imaging (1) Application cushion (2) Respiratory cushion with pressure hose (3) Respiratory belt The respiratory cushion is attached to the patient using the respiratory belt. Wireless pulse sensor (PPU) The PPU acquires the patient's peripheral pulse. It consists of a transmitter unit, a fiber-optic sensor and a removable finger adapter (available in different sizes).
  • Page 87 Use only the charger included with delivery. Charging the units with non-Siemens equipment may destroy the PERU and PPU. If proper charging of the accumulators is not possible anymore, please contact Siemens Service, as the PMU accumulators cannot be exchanged. LEDs during charging The red LED goes out when the unit is positioned correctly in the charging station.
  • Page 88 Physiological imaging Control LEDs The transmitter unit includes three green LEDs for signaling the battery status and one red LED as fault indicator (for example, insufficient skin contact of the ECG electrodes). (1) 3 Green LEDs (battery status) (2) 1 Red LED (fault) (3) Transmitter unit Battery status and faults are also indicated on the Dot display and the Physiological Display dialog window.

  • Page 89: Preparing The Measurement

    Physiological imaging Additionally, battery status and electrode/application fault are indicated on the display. Physiological Display The Physiological Display lets you view the patient's physiological signals at the syngo Acquisition Workplace. See: Software operator manual 4.2.2 Preparing the measurement  WARNING Monitoring vital parameters via the Dot display! Anomalies of the vital parameters are not recognized or recognized too late...
  • Page 90 Physiological imaging Inform the patient that the knocking sounds during the measurement are caused by switching the gradients on and off. The PERU may also vibrate slightly.  Knocking sounds may affect the heart rate of patients, either consciously or subconsciously. The resulting irregular cardiac cycles adversely affect image quality.

  • Page 91: Ecg Triggering

    Physiological imaging Align the PERU on the patient in the direction of the patient’s feet. For the special case of triggered flow measurements/flow quantification in the head region, please position the PERU next to the patient's head (as shown in the picture) to reduce gradient interference.

  • Page 92: Performing

    Physiological imaging The characteristic QRS complex of the ECG signal is used as a trigger signal. Simultaneous acquisition and overlaying of the orthogonal leads (vector cardiography) is used to minimize triggering errors due to gradient switching and the magneto-hydrodynamic effect (i.e. excess T-wave amplitude).
  • Page 93 Physiological imaging ◾ Reduction of interference signals caused by electromagnetic induction. – Due to cable loops – Interferences from electrical potentials caused by muscle movement Attach the electrodes so that interferences from electrical  potentials caused by muscle movement and baseline drifts are minimized.
  • Page 94 Physiological imaging  Patients with an offset heart axis (e.g. dilatative cardiomyopathy) may require a different orientation than parallel to the spine. Check the expiration date of disposable electrodes and order new ones if necessary. Pull the protective foil off the electrodes and attach them. Use the application cushion and position it together with the PERU on the patient.

  • Page 95: Pulse Triggering

    Physiological imaging Pulse triggering 4.4.1 Description Pulse triggering uses the patient's pulse to trigger the measurement. A pulse sensor is connected to the patient's toe or finger. The first pulse wave (“premature pulse wave”) is used for triggering. This wave corresponds to the systolic blood pressure.

  • Page 96: Respiratory Triggering

    Physiological imaging Respiratory triggering 4.5.1 Description To keep respiratory artifacts to a minimum, respiratory triggering is primarily used in abdominal imaging. Data acquisition for respiratory triggering begins when the respiratory signal reaches a predefined level (approx. 20 % of the maximum value). Respiratory movement is minimal in this range.

  • Page 97: External Triggering

    Physiological imaging  Women and athletes are usually thoracic breathers. Men and obese patients are usually abdominal breathers. If the patient is an abdominal breather, place the respiration belt around his abdomen. – or – If the patient is a thoracic breather, place the respiration belt around his chest.

  • Page 98: Performing

    Physiological imaging Voltage-tim diagram for external triggering of the PMU Name Value 0 V ... 0.8 V 2.5 V ... 5 V (min.) 10 ms (min.) 10 ms Input current min. 5 mA Input voltage max. ± 5 V Internal contact External contact The measurement sequence is triggered by the rising edge of the external signal.

  • Page 99: Mr System Operation

    ◆ Shut down the computer system and power off the MR system (SYSTEM OFF). ◆ Notify Siemens Service. Check the LEDs on the alarm box. Check if all warning symbols and signs are present inside and outside the examination room.

  • Page 100: Starting Up And Shutting Down The Mr System

    MR system operation  CAUTION Leaking hydraulic system! Slipping hazard ◆ Check the area around the patient table for hydraulic fluids on the floor. Check the examination room, control room, and electronics room for liquid spills and puddles on the floor. Ensure that no magnetizable materials or objects such as vacuum cleaners, carts, ladders, and tools are present in the examination room.

  • Page 101: Starting The System (System On)

    MR system operation The operating modes can be selected by pressing the corresponding button on the alarm box or by using the System Manager in the syngo MR software. See: Software operator manual Additionally a main circuit breaker is located in the control room which should NOT be used during proper functioning of the MR system.
  • Page 102 Close the window and notify Siemens Service or have the magnet refilled. Check all Table Stop buttons (at the intercom and at the patient table). Ensure that these buttons function properly and stop the table immediately.

  • Page 103: Shutting Down The System (System Off)

    MR system operation Check if the contact spring connectors at the door frame and the door to the examination room are free of residues, such as cleaning agents, oil, grease, paint splatters, blood drops, etc. 5.2.2 Shutting down the system (System Off) Shutting down the system includes the following steps: ◾...

  • Page 104: Shutting Down The Syngo Mr Workplace

    MR system operation Select the Shutdown System option. The computer system shuts down.  The software does not respond? ◆ Simultaneously press the Ctrl, Alt, and S keys on the keyboard and shut down the system with the System Manager. The System Manager cannot be opened? ...

  • Page 105: Starting/Ending Standby

    MR system operation Select the Shutdown System option. The computer system shuts down.  In case of problems during shutting down, see troubleshooting information: ( Page 103 Shutting down the computer system) Starting/ending Standby 5.2.4 Standby can be switched on by using the System Manager in the syngo MR software.

  • Page 106: Connecting The Squeeze Bulb

    MR system operation Connecting the squeeze bulb 5.3.1 (1) Connection for headphones (2) Connection for squeeze bulb Connect the hose connector of the squeeze bulb to the corresponding connector at the foot end of the patient table. Connect the headphone to the corresponding connector at the foot end of the patient table.

  • Page 107: Informing The Patient

    MR system operation  CAUTION Heat development during the examination! Patient burns ◆ Instruct patients to press the squeeze bulb in case of strong heat sensations.  WARNING Use of unapproved fMRI stimulation devices for the given magnetic field strength! Injury to patient and operating personnel ◆...

  • Page 108: Physiological Effects

    MR system operation Physiological effects Due to the presence of alternating electromagnetic fields, patients may experience various physiological effects during MR measurements: ◾ Peripheral nerve stimulation through low-frequency fields of the gradient coils ( Page 110 Exposure to low frequency electromagnetic fields) ◾...
  • Page 109 MR system operation First Level Controlled In the First Level Controlled Operating Mode, patients may Operating Mode experience noticeable stress levels depending on the measurement programs selected. The decision to change to the First Level Controlled Operating Mode must be based on a medical consideration of the potential risks and benefits for the patient.

  • Page 110: Exposure To Low Frequency Electromagnetic Fields

    MR system operation  CAUTION Stereotactic frames and similar devices: tips of screws may heat up considerably, especially if MR examinations are performed in the First Level Controlled Operating Mode! Localized burns of the patient ◆ Please observe the recommendations and notes of the manufacturer of the stereotactic frame.
  • Page 111 MR system operation Peripheral nerve stimulation Stimulation threshold: The electrical field affects the patient. If the strength of the electrical field exceeds a certain threshold (stimulation threshold), the patient experiences peripheral nerve stimulation. Nerve stimulation manifests itself as e.g. tingling sensations or slight muscle spasms in the ribs, side, abdomen, hip, buttock, or thoracic regions, along the upper arms or the back muscles in the shoulder region.

  • Page 112: Exposure To Rf Electromagnetic Fields

    MR system operation First Level Controlled Operating Mode: In the First Level Controlled Operating Mode, the performance limits are determined directly from the statistically determined stimulation limits. Accordingly, at the maximum performance allowed in this operating mode, up to 50 % of all patients may experience stimulations.
  • Page 113 MR system operation Noticeable effects on the During the MR measurement, patients may experience heat patient sensations on the skin and, as a consequence of the RF energy absorption, patients may begin to perspire during the course of the MR examination. Their pulse rate may increase as well. The individual effects vary from patient to patient.
  • Page 114 MR system operation Look Ahead monitoring: Prior to each measurement, the values of the SAR quantities to be observed are calculated (always as worst- case values) and compared with the corresponding limit values. If one of the calculated SAR values exceeds the corresponding limit, the measurement cannot be started.

  • Page 115: Starting/Stopping The Measurement

    MR system operation Online monitoring: The system constantly measures the transmit power and ensures that the appropriate limit values are observed. Examinations in progress will be aborted if the limit is exceeded. Limit values: The SAR limits used by the Look Ahead monitoring function are set according to country-specific approval guidelines at the time of the syngo MR installation.
  • Page 116 MR system operation The measurement is stopped. The display is activated. MR System | Operator Manual Print No. M6-04401.621.02.02.02...

  • Page 117: Maintenance

    Maintenance Maintenance Cleaning All instructions in the operator manual regarding cleaning and, when applicable, regarding disinfecting and sterilization must be always observed.  WARNING Improper cleaning of the MR system! Risk of electric shock ◆ Only clean the MR system with a damp cloth. For information regarding cleaning of RF coils, see: Operator Manual Coils...

  • Page 118: Cleaning The Camera Lens

    Maintenance  The LCD monitor/video display are highly sensitive to mechanical damage. Cleaning the camera lens 6.1.2 ◆ Carefully clean the camera lens with a lint-free cloth and lens cleaner. 6.1.3 Cleaning the data carrier Clean contaminated data carriers with a clean cloth (cotton or microfiber).

  • Page 119: Disinfecting System Components

    However, do not use solutions with alcohol or acetone. Follow manufacturer’s instructions.  Siemens does not test alcohol-containing, phenol-alkaline and alkaline-based disinfectants for harmful effects on surfaces. Avoid disinfecting system components with these materials. Care and cleaning of floors 6.1.8...

  • Page 120: Return And Disposal

    Observe national regulations. 6.2.3 Batteries and accumulators  Siemens AG is obligated to accept the return of batteries and accumulators and to dispose of them. MR System | Operator Manual Print No. M6-04401.621.02.02.02...
  • Page 121 Maintenance Contact Siemens Service with respect to questions regarding the return and disposal of batteries and accumulators. Observe national regulations. MAGNETOM Skyra | syngo MR E11 Print No. M6-04401.621.02.02.02...
  • Page 122 Maintenance MR System | Operator Manual Print No. M6-04401.621.02.02.02...

  • Page 123: Appendix: Regulatory Information

    Please note that this manual may also contain information about  medical devices that are NOT legally manufactured by Siemens. These medical devices are either only distributed by Siemens, or only mentioned for additional information. In the following table you will find information about the medical device, the corresponding legal manufacturer and, if applicable, the authorized representative.

  • Page 124: Ce For Physiological Measurement Unit (Pmu)

    Appendix: regulatory information CE for Physiological Measurement Unit (PMU) The PMU (PPU, PERU) bears a CE marking in accordance with the provisions of regulation 1999/5/EC of March 9, 1999 for radio and telecommunications terminal equipment. Changes or modifications not expressly approved by the party responsible for compliance could void the user's authority to operate the equipment.
  • Page 125 Index Cleaning 118 Emergency Emergency switches 41 Contraindications Accessories Rescuing the patient in an Implants 23 Safety instructions 38 emergency 62 Safety information 23 Accidents Emergency buttons Control cabinet Burns 20 Magnet Stop 42 Description 48 Coils 41 Table Stop 44 Coolant accidents 45 Control units 54 Emergency Shut-down...
  • Page 126 Index Noise development 31 Start/Stop 115 Performance limits 111 Potential hazards 16 Starting and ending; with Standby 105 RF and gradient fields 20 footswitch 79, 79 Switching operating modes 110 Static magnetic field 18 Measurement phantoms Operation Headphone Accidents 41 Dot display 57 Connection 106 Mechanical hazards...
  • Page 127 PPU 86 Connection 106 Warning and prohibition signs 38 Pulse triggering Standby Description 95 Starting/ending Standby 105 Performing 95 Static magnetic field Device malfunctions 20 Safety instructions 18 Quality Assurance Super-conducting magnet Coils 41 Description 47 syngo Acquisition Workplace Description 49 Host processor 50 Repair Keyboard 51...
  • Page 128 This page has been intentionally left blank. MR System | Operator Manual Print No. M6-04401.621.02.02.02...
  • Page 129 This page has been intentionally left blank. MAGNETOM Skyra | syngo MR E11 Print No. M6-04401.621.02.02.02...
  • Page 130 This page has been intentionally left blank. MR System | Operator Manual Print No. M6-04401.621.02.02.02...
  • Page 131 Please note: For products that are not legally manufactured This device bears a CE mark in accordance with the by Siemens but distributed, please refer to the Appendix of provisions of Council Directive 93/42/EEC of June 14, 1993 this manual!

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