Transcript quic k referenc e guide mri

Elegance Through Simplicity
And Versatility
Q U I C K
R E F E R E N C E
M R I
I N N O V A T I V E
3 Morgan
Irvine, CA 92618
877-210-1300 Customer Service
949-362-3519 Fax
[email protected]
www.senorx.com
B R E A S T
G U I D E
C A R
E
A T
E V E R Y
S T E P
Table of Contents
Grid-Based Approach
Positioning the Breast
Fiducial Placement
Target Correlation
Depth Registration
1
2
3
4
The Biopsy: Localization and Sampling
Prepping the Breast surface
Trocar Preparation
Locking the Block
Securing the Cannula
Verifying VisiLoc™ Position
Attaching the Probe
Sampling Program
5
6
7
8
9
10
11-12
Marker Placement and Procedure Completion
Applicator Placement
Marker Deployment
Cavity Verification
Introducer Specifications
13
14
15
16
Positioning The Breast
Fiducial Placement
Target Correlation
Depth Registration
Positioning the Breast
Position breast within the well of the
coil to ensure optimal access to the
lesion from the surface of the grid.
1
Advance the grids and/or
stabilization plates uniformly until a
“pillowing” of the tissue is visible
between the fenestrations of the
grids.
2
3
1
Fiducial Placement
1
Place an external fiducial marker within a free
fenestration of the grid as an external
reference point for targeting—ideally away
from the suspected ROI but near the breast
tissue.
Post
Pre
Scan the patient pre and post contrast and
identify the target ROI seen on the
diagnostic MRI.
2
3
2
Target Correlation
Correlate the position of the ROI within the breast
relative to the fiducial on the surface of the breast
contained within the grid.
1
2
3
4
1
2
Using the MRI Grid Worksheet,
determine and note the block location
as well as the aperture position within
the block that correlates to the ROI.
3
Depth Registration
=10mm
+102.0
+92.0
Calculate the depth of the targeted ROI by
subtracting the actual position of the sagittal slice
on which the lesion is identified from the slice in
which the surface of the breast is seen.
Advance the depth stop to the proper
location on the cannula and be sure to add
2cm to the calculated depth to account for
the thickness of the block.
4
Prepping The Breast Su
Trocar Preparation
Locking The Block
Securing The Cannula
Verifying VisiLoc Posi
Attaching The Probe
Sampling
™
Prepping the Breast Surface
Anesthetize along the entire
projected approach pathway
and ~2cm beyond the ROI.
Sterilize the appropriate area
of the breast in and around
the fenestration of the
projected approach.
Utilize an MRI approved
scalpel to make a skin nick at
the appropriate location (as
noted on the MRI Grid
Worksheet).
5
Trocar Preparation
Slide the trocar and cannula through
the appropriate aperture of the block.
Insert the trocar through the cannula.
6
Locking the Block
Lock the block into the grid
fenestration by rotating the lever into
the locked position, denoted by the “L”
on the block.
L
Orient the block to the
appropriate position as defined
by your MRI Grid Worksheet or
CAD software. Insert the tip of
the trocar into the skin nick
and seat the block firmly into
place in the grid without
advancing the trocar.
7
Securing the Cannula
Lock the cannula into place by rotating
the depth stop clockwise until it seats
firmly into position.
While holding the cannula hub, gently twist
the trocar and cannula together while
inserting to the desired depth.
8
Verifying VisiLoc Position
Remove the trocar and insert the VisiLoc
obturator into the cannula and fully advance until
the handle is flush against the cannula hub. Reimage the patient. The VisiLoc obturator will
provide a bright disc in the sagittal plane image
and a bright line in the axial plane image.
Sagittal
Axial
9
Attaching the Probe
NOTE: Prior to loading an EnCor MRI Probe,
rotate collection chamber 180°.
Upon confirmation of targeting, attach the
EnCor MRI probe onto the EnCor MRI Driver by sliding the front
of the probe beneath both of the leading edge guides and
snapping the rear of the probe into place. Press the sample
button on either the foot-pedal or the driver to calibrate the
probe prior to sampling.
10
Sampling
Remove the obturator and insert the
probe into the cannula, advancing until it
rests flush against the hub.
Pre-programmed sampling options
available in the EnCor Control Module
allow for selecting a sampling pattern to
best suit each study.
11
Sampling
While the collection chamber remains
sealed at all times during tissue
acquisition, the tray can be removed for
close inspection of samples.
Samples accumulate within the
collection chamber at the back of
the probe. With the tray in place,
this provides a truly closed system.
12
Applicator Placement
Marker Deployment
Position Verification
Introducer Specifications
Applicator Placement
Upon completion of sampling, carefully
remove the probe from the cannula.
Outside of the MRI suite, prepare samples
for pathology. Insert the SenoMark™
UltraCor® MRI marker applicator into the
cannula and advance until the adapter seats
firmly into place within the hub.
13
Marker Deployment
SenoMark UltraCor markers are designed
to deploy pellets to help ensure that the
metal marker remains centered within the
biopsy cavity.
Unlock the plunger by rotating 90°. Fully
advance the plunger in a uniform motion
to deploy the marker within the biopsy
cavity.
14
Position Verification
~1cm
SenoMark UltraCor markers initially
provide visibility for all modalities – MRI,
stereotactic and ultrasound.
Remove the marker applicator and re-insert the
obturator into the cannula leaving about 1 cm
extending from the hub to prevent disturbance
of the marker in the cavity. Re-image.
15
Introducer Specifications
Depth Beyond
Obturator Tip
Item Description
VisiLoc Obturator
Trocar
Block Depth
Sampling Notch
Blunt Tip Probe
Half Sample
Depth Beyond Obturator Tip
Trocar
18mm
Blunt Tip Probe
N/A
Trocar Tip Probe
21mm
Sampling Notch Length
Full Sample
19mm
Half Sample
9.5mm
10G
7G
17mm
15mm
20mm
19mm
9.5mm
Trocar Tip Probe
Block Depth
2cm
2 cm
16
Rx Only
Please consult product labels and inserts for any indications, contraindications, hazards, warnings, cautions and directions for use.
SenoMark and VisiLoc are trademarks of SenoRx. EnCor and UltraCor are a registered trademarks of SenoRx.
©Copyright 2009 SenoRx®, Inc. All rights reserved.
3 Morgan
Irvine, CA 92618
877-210-1300 Customer Service
949-362-3519 Fax
[email protected]
www.senorx.com
IU01
35A