CLINICAL EXPERIENCES WITH THE X-TEND TABLE ON PHILIPS ACHIEVA 1.5T AND 3.0T

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1 CLINICAL EXPERIENCES WITH THE X-TEND TABLE ON PHILIPS ACHIEVA 1.5T AND 3.0T August 2009 November 2010 SCANDINAVIAN MR FORUM OSLO 9-10 th JUNE 2011 X-tend ApS

2 the standard Philips table with the coil on top. Written by Erik Morre Pedersen, Radiologist, MD, PhD, DMSc Assoc. Prof. Aarhus University Hospital Clinical experiences from Aarhus University Hospital, Denmark The first presentation of the X-tend table for the Philips Achieva systems was at the Philips Scandinavian User meeting 2 years ago in Copenhagen 2009 where we presented the results with the first clumsy prototype that added 7cm to the height of the table. The aim was simple: we wanted to use surface coils for whole body scanning! But we soon realized that the added height was a real problem. Only relatively slim patients could be scanned, and the patients were lying out of isocenter in the top of the scanner giving reduced image quality on our 3T system. No problem said the people from X-tend: we can replace the entire tabletop with a X-tend table and it will not be higher than The X-tend Table is nearly same height as the standard Philips table with the XL-torso coil on top. And to make a long story short numerous working hours, weeks and months later a new X-tend table was developed without adding height but still with the possibility to use the XL-torso coil for scanning the whole body. And X-tend decided to go ahead and make a commercial solution that could be sold to other sites as well. Then the next part of the process started: Patient safety, optimizations of work flows, ease of use, finding every cm for increasing scanning length to now 210 cm of XL-torso coil covered scanning. I have personally learned that such a process takes a looong time. Every detail has to be thought out, constructed, modified, tested by real radiographers in real patients etc.

3 Other important improvements were release mechanisms for patient safety, improving patient comfort by dedicated armholders, making the table fit in the Philips Trolley and many more workflow and patient comfort related issues. Creative developing meeting between Philips, Aarhus University Hospital and X-tend ApS. The biggest improvements beside the lowering of the table has definitely been when Philips allowed the pad system : Fixation pads taped on the scanner, for holding the electronics box and most importantly for holding the upper coil in the center without straps between the upper and lower coil. Now the patients can not get their hands stuck in the straps when moving through the coil. Small pads, big evolution. X-tend Table on the trolley Philips helped by implementing an X-tend table parameter in the release, so that extended key stroke can now be used with the X-tend table, allowing a full 210 cm XL-torso covered stroke. Along the way came other potential uses for the X-tend table. Initially it was only meant for whole body scanning, and we now have a number of fast and high image quality protocols for that on our 3T system. But we soon realized that in daily practise other applications would be just as relevant. The main attraction was increasing coverage for abdomen-pelvis-thorax scanning. So a simple solution was made.

4 Instead of mounting the entire whole body setup with fixing the coil in the center we just place the coil as normal with straps and then we just go in and manually move the coil once or twice during scanning. Then you can scan on the same scouts without moving the patients and stitch images together etc. A few weeks ago we also used the X-tend table as backup for our spine coil that was broken down and we scanned total spines and pelvis with the X-tend table (fig. 1) just using the same protocols as normally. The implementation of the X-tend table function with extended keystroke in the release software made it possible to make full whole body scans with the x-tend table. An example of speeding up a standard whole body STIR sequence using the X- tend table at 1.5 T is seen in fig. 2. Fig.2 Fast 5 station STIR (36cm, 36 sec pr station). Respiration triggering was used with 3.6 sec scan time pr respiration. 0.8 x 1.7 x 6 mm resolution, SENSE 4. Total scan time appr. 3:00 min (1.5 T) Fig.1. T1-TSE columna with X-tend table and XL-Torso coil.

5 Another example is shown (fig. 3) using the new mdixon technique, where seven stations of 20 sec scans gives you T1-fatsat, T1-water image, T1 in-phase and T1 outphase with 1,7cm isotropic resolution. Fig. 3 : mdixon with 1.7 mm isotropic resolution. 7 station with 20 sec scans = total scan time 2:10 min (3T). In summary the X-tend table has come a long way over the last two years. Starting out only as a research tool for improved whole body imaging the company X-tend has taken it through a long number of patient safety, patient comfort and workflow optimizations so it now makes sense to use it in daily clinical practice. When the table returns from Oslo we will keep our XL-torso coil on the X-tend table in a Philips trolley as our standard XL-torso table. Then we have full flexibility in coverage whenever using the XL-torso coil without having to change it to and from the X-tend table. By Erik Morre Pedersen

6 Nils Paaske and Anne-Lise Schierup, X-tend ApS NEWS For the moment we are in contact with Kolding Hospital in Denmark, where we last week, used the X-tend table for lower extremity angio at the vascular surgery center at Kolding. They are in a need of finding a substitute for their PV coil, which cannot be repaired and neither replaced by a new. Therefore they have tried the solution of an X-tend table and the XL-Torso coil. The image beside is from the first exam with this alternative solution. The image quality was that good, that Kolding consider this as a potential permanent solution. In the near future we will hopefully see a lot of other possible uses for the flexible combination of the XL-Torso coil with the X-tend Table. By X-tend ApS Fig 4. MobiTrak UE angio with X-tend table and XL-torso coil (1.5 T)