D-Wave vs. MEP

Information box
The main purpose of this site is to extend the intraoperative monitoring to include the neurophysiologic parameters with intraoperative navigation guided with Skyra 3 tesla MRI and other radiologic facilities to merge the morphologic and histochemical data in concordance with the functional data.
CNS Clinic
Located in Jordan Amman near Al-Shmaisani hospital, where all ambulatory activity is going on.
Contact: Tel: +96265677695, +96265677694.

Skyra running
A magnetom Skyra 3 tesla MRI with all clinical applications started to run in our hospital in 28-October-2013.
Shmaisani hospital
The hospital where the project is located and running diagnostic and surgical activity.

Tim Planning Suites

Easy planning of extended Field of View examinations in an efficient way using Set-n-Go protocols. It allows planning of several stations at once e.g. on composed localizer images. The overlap of slice groups can be adjusted. All stations can have independent parameter settings although they are displayed together. A special coupling mode allows easy positioning of all stations at once according to the patient’s anatomy. Fully supports scan@center and Phoenix functionality.
• Tim Planning UI with optimized layout for slice positioning
• Ready to use Set-n-Go protocols for different clinical questions
• Integrated toolbar for fast advanced slice planning: FoV-Plus, FoV-Minus, AlignParallel, AlignFieldOfViews.


Tim Application Suites

The Tim Application Suite offers a complete range of clinically optimized sequences, protocols and workflow functionalities for all body regions. Excellent head-to-toe imaging can be accomplished with the sequences and features included in this application suite. To enable this comprehensive application range, nine dedicated application packages have been included.
Neuro Suite
Angio Suite
Cardiac Suite
Body Suite
Whole Body Suite
Onco Suite
Breast Suite
Ortho Suite
Pediatric Suite
Scientific Suite

Neuro Suite

Comprehensive head and spine examinations can be performed with dedicated programs. High resolution protocols and fast protocols for uncooperative patients are provided. The Neuro Suite also includes protocols for diffusion imaging, perfusion imaging, and fMRI. It includes for example:
-       EPI sequences and protocols for diffusion, perfusion and fMRI for advanced neurological applications.
Diffusion weighted imaging is possible with up to 16 b-values in the orthogonal directions. Dynamic Analysis software (included in standard configuration) enables calculation of:
-       ADC maps
-       t-test maps from the EPI images for fMRI
-       Time-to-Peak maps for perfusion analysis.
-       Whole spine protocols acquire in multiple steps via software controlled table movement in a single click.
-       3D isotropic resolution volume imaging using T1 3D MPRAGE / 3D FLASH, SPACE DarkFluid, T2 SPACE and 3D TSE
-       T2-weighted high resolution 3D Restore protocols optimized for inner ear examinations
-       Whole-spine protocols in multiple steps with software controlled table movement
-       2D and 3D MEDIC protocols for T2-weighted imaging, particularly for C-spine examinations in axial orientation where reproducibility is difficult due to CSF pulsations and blood flow artifacts
-       3D Myelograms with 3D HASTE and 3D True-FISP for anatomical details
-       Dynamic sacro-iliac joint imaging after contrast administration using a fast T1-weighted FLASH 2D sequence
-       Spine diffusion protocols to differentiate osteoporosis versus tumor infiltration and post-radiotherapy changes versus residual tumor with PSIF sequence
-       Precision filter for high spatial accuracy e.g. for neuro intra-operative imaging and stereotactic planning
-       3D CISS (Constructive Interference in Steady State) for excellent visualization of fine structures such as cranial nerves. High resolution imaging of inner ear and spine
-       AutoAlign Head LS providing a fast, easy, standardized, and reproducible patient scanning supporting reading by delivering a higher and more standardized image quality.

Angio Suite

Excellent MR Angiography can be performed to visualize arteries and veins with or without contrast agent.
Contrast-enhanced MRA
-       3D contrast-enhanced MRA protocols for e.g. single step, dynamic, peripheral, whole body MRA with the shortest TR and TE. The strong gradients make it possible to separate the arterial phase from the venous phase.
-       TestBolus workflow for optimized bolus timing and superb image quality.
-       CareBolus functionality for accurate determination of the bolus arrival time and the "Stop and Continue" of the 3D ce-MRA protocol after the 2D bolus control scan.
-       Dynamic ce-MRA for 3D imaging over time.
Non-contrast-MRA and venography
-       2D and 3D Time-of-Flight (ToF) protocols for MRA for the Circle of Willis, carotids, neck vessels, and breath-hold protocols for abdominal vessels
-       Triggered 2D ToF sequences for non-contrast MRA, particularly of the abdomen and the extremities
-       2D/3D Phase-Contrast
-       MR venography with 2D/3D Time-of-Flight (ToF) and Phase-Contrast
-       TONE (Tilted Optimized Non-saturation Excitation) and MTC (Magnetization Transfer Contrast) techniques for improved Contrast-to-Noise Ratio (CNR)
Image processing tools
-       MPR, MIP, MinIP, and 3D SSD
-       Inline MIP for immediate results
-       Inline subtraction of pre- and post-contrast measurements
-       Inline standard deviation maps of Phase-Contrast measurements for delineation of arteries and veins

Cardiac Suite

The cardiac suite covers comprehensive 2D routine cardiac applications, ranging from morphology and ventricular function to tissue characterization. Featuring syngo BEAT 2D in conjunction with iPAT and T-PAT techniques.
Cardiac views
-       Fast acquisition of the basic cardiac orientations for further examination planning
-       Cardiac scouting provides users with a step-by-step procedure for the visualization and planning of typical cardiac views, e.g. based on TrueFISP or Dark Blood TurboFLASH: short axis, 4-chamber and 2-chamber views.
syngo BEAT
-       Unique tool for fast and easy cardiovascular MR imaging
-       E.g. 1 click change from FLASH to TrueFISP for easy contrast optimization
-       1-click to switch arrhythmia rejection on / off
-       1-click change from Cartesian to radial sampling to increase effective image resolution (e.g. in pediatric patients) and avoid folding artifacts in large patients
Visualization of structural cardiovascular pathologies with CMR – syngo BEAT
-       Breath-hold and free breathing techniques for strong contrast between the blood and vascular structures. Dark Blood TSE and HASTE imaging are available for the structural evaluation of the cardiothoracic anatomy, including vessels or heart valves. Cine techniques (FLASH & TrueFISP) for high-resolution valve evaluation
-       Multiple contrasts such as T1- and T2-weighted imaging for use in diseases such as myocarditis (inflammation / hyperaemia), ARVD (fibrous-fatty degeneration) or acute myocardial infarction (edema)
-       Dark-blood TSE with motion compensation for high-quality vessel wall imaging in small or large vessels
Tools for rapid evaluation of left or right ventricular function
-       Acquisition of a stack of short-axis slices (standard segmented FLASH, or advanced segmented TrueFISP)
-       Automatic adjustment of the acquisition window to the current heart rate
-       Use of the Inline ECG for graphical ECG triggering setup
-       Retrospective gating with cine sequences (TrueFISP, FLASH)
-       Protocols for whole-heart coverage
-       iPAT integration for highest temporal and spatial resolution
-       Real-time imaging in case the patient is not able to hold his breath
Dynamic imaging and tissue characterization with syngo BEAT
-       Protocols for high-contrast and high-resolution tissue characterization
-       Protocols for stress and rest imaging with TrueFISP or TurboFLASH contrast support the acquisition of multiple slices with high resolution and arbitrarily adjustable slice orientation for each slice
-       T-PAT with mSENSE and GRAPPA for advanced parallel imaging provides fast high-resolution dynamic imaging
-       Segmented IR TrueFISP / FLASH with TI scout for optimization of tissue contrast
-       Advanced tissue characterization with 2D phase-sensitive IR (PSIR) sequences TrueFISP and FLASH contrast. Magnitude and phase-sensitive images with one acquisition
-       Simple: no adjustment of inversion time (TI) necessary with PSIR technique
-       Ungated single-shot PSIR imaging for tissue characterization under difficult conditions: free-breathing technique that can be applied even in case of arrhythmia
Physiological Measurement Unit (PMU) - Wireless Physio Control
-       Synchronizes the measurement with the physiological cycles (triggering to minimize motion artifacts caused by cardiac and respiratory movements)
-       Wireless Sensors
-       Wireless Vector ECG / respiration and pulse sensors for physiologically synchronized imaging, rechargeable battery-powered - for optimized patient handling
-       Physiological Signals Display
-       ECG (3 channels)
-       Pulse
-       Respiration
-       External Trigger Input Display
ECG Triggering:
-       Acquisition of multiple slices, e.g. of the heart, at different phases of the cardiac cycle
-       Excellent image quality by synchronizing data acquisition with cardiac motion
-       Peripheral Pulse Triggering:
-       Reduces flow artifacts caused by pulsatile blood flow
-       Excellent image quality by synchronizing data acquisition to the pulsatile blood flow
-       Respiratory Triggering:
-       Excellent image quality by synchronizing data acquisition with the respiratory motion
-       External Triggering:
-       Interface for trigger input from external sources (e.g. Patient Monitoring System) inside the examination room
-       Interface for trigger input from external sources (e.g. pulse generator, trigger sources for fMRI) outside the examination room
-       Optical trigger output for fMRI
-       Retrospective gating for ECG, peripheral pulse, and external trigger input

Breast Suite

MR imaging has proven a very high sensitivity for breast lesions and is the gold standard for the examination of silicone implants. Extremely high spatial and temporal resolution can be achieved in very short measuring times by using iPAT with GRAPPA.
Excellent soft tissue differentiation, customized protocols (e.g. with fat saturation or water excitation or silicone excitation), as well as flexible multiplanar visualization allow for fast, simple and reproducible evaluation of MR breast examinations.
This package includes:
-       Quantitative evaluation and fast analysis of the data with colorized Wash-in, Wash-out, Time-To-Peak, Positive-Enhancement-Integral, MIPtime and combination maps with Inline technology or for offline calculation
-       High-resolution 2D protocols for morphology evaluation
-       High-resolution 3D protocols covering both breasts simultaneously
-       Protocols to support interventions (fine needle and vacuum biopsies, wire localization)
-       Protocols for evaluating breasts with silicone implants
-       Automatic and manual frequency adjustment, taking into account the silicone signal
-       Detection of the silicone signal either to suppress the silicone signal, if the surrounding tissue is to be evaluated, or to suppress the tissue signal in order to detect an implant leakage
-       SPAIR - robust fat sat (robust fat suppression using an adiabatic frequency selective inversion pulse)
-       DIXON - 2-point Dixon with 3D VIBE, the following contrasts can be obtained: in-phase, opposed phase, fat and water image.
-       iPAT with GRAPPA for maximum resolution in short time
-       Inline subtraction and MIP display
-       Offline subtraction, MPR and MIP display
-       syngo REVEAL: diffusion imaging for breast exams
-       iPAT Extension that allows state-of-the-art sagittal breast imaging
-       iPAT Extension allows bilateral 3D sagittal breast imaging with Fat Sat or Water excitation
The Breast Suite also includes:
syngo VIEWS (Volume Imaging with Enhanced Water Signal)
-       bilateral - both breasts are examined simultaneously
-       axial - the milk ducts are directly displayed
-       fat-saturated or water-excited - fat complicates clinical evaluation and is suppressed
-       near-isotropic 3D measurement - the same voxel size in all three directions for reconstruction in any slice direction
-       submillimeter voxel - highest resolution for precise evaluation


Body Suite

Body Suite covers your needs for clinical body applications. Ultrafast high resolution 2D and 3D protocols are provided for abdomen, pelvis, MR Colonography, MRCP, dynamic kidney, and MR Urography applications. Siemens unique 2D PACE technique makes body imaging easy allowing for multi-breath hold examinations as well as free breathing during the scans. Motion artifacts are greatly reduced with 2D PACE Inline technology.
This package includes:
-       Free breathing 2D PACE applications with 2D/3D HASTE (RESTORE) and 2D/3D TSE (RESTORE)
-       Optimized fast single shot HASTE protocols and high-resolution 3D RESTORE protocols based on SPACE and TSE for MRCP and MR Urography examinations
-       T1w (FLASH) breath-hold scans +/- Fat Sat (SPAIR, Q-FatSat, in-/opp-phase)
-       T2w (HASTE, TSE/BLADE, EPI ) breath-hold scans +/- Fat Sat (SPAIR, FatSat, STIR)
-       T1w (TFL) triggered scans (2D PACE free breathing) in-/opp-phase
-       T2w (HASTE, TSE/BLADE, EPI) triggered scans (2D PACE free breathing) +/- Fat Sat (SPAIR,FatSat, STIR) as well as HASTE- and TSE-multi-echo
-       Optimized fast single shot HASTE protocols and high-resolution 3D RESTORE protocols based on SPACE and TSE for MRCP and MR urography examinations
-       Dixon (VIBE 2pt-Dixon) breath-hold scans, following contrasts can be obtained: in-phase, opposed phase, fat and water image.
-       Dynamic (VIBE + Q-FatSat) protocols for best visualization of focal lesions with high spatial and temporal resolution
-       Colonography dark lumen with T1-weighted VIBE
-       High-resolution T1w, T2w pelvic imaging (prostate, cervix)
-       Isotropic T2w SPACE 3D protocols for tumor search in the pelvis
-       Dynamic volume examinations with 3D VIBE
-       syngo REVEAL: diffusion imaging for liver and whole body exams

Tim Whole Body Suite

Features a full effective Field of View of 205 cm. Table movement to its full extent can be controlled from the syngo Acquisition Workplace. The large FoV helps in imaging metastases with sequences such as TIRM (Turbo Inversion Recovery Magnitude). Whole body MR Angiography is possible on the entire volume with iPAT.
• Max. scan range of 205 cm
• Protocols and programs for whole body MR Angiography and metastases detection

Onco Suite

MR imaging has an excellent advantage of soft tissue contrast, multi-planar capabilities and the possibility of selectively suppressing specific tissue e.g. fat or water. This helps visualize pathologies, particularly metastases. The Onco Suite features a collection of sequences as well as protocols and evaluation tools that guide through a detailed screening of clinical indications, such as in hepatic neoplasms.
This package includes:
-       STIR TSE and HASTE, FLASH in-phase and opposed-phase protocols with a high sensitivity to metastases visualization
-       Dynamic imaging protocols for assessment of the kinetic behavior for lesion visualization and characterization
-       Quantitative evaluation and fast analysis of the data with colorized Wash-in, Wash-out, Time-To-Peak, Positive-Enhancement-Integral, MIPtime and combination maps with Inline technology or for offline calculation
-       Display and analysis of the temporal behavior in selected regions of interest with the included MeanCurve postprocessing application. This includes the capability of using additional datasets as a guide for defining regions of interest even faster and easier than before.
-       syngo REVEAL: diffusion imaging for liver and whole body exams
Dedicated prostate protocols for detection, localization, and staging of tumors and recurrences
-       syngo REVEAL (diffusion-weighted imaging)
-       Protocols with high temporal resolution allow time course evaluation based on pharmacokinetic modeling

Ortho Suite

Ortho Suite is a comprehensive collection of protocols for joint and spine imaging. MR imaging is especially suitable for avascular necrosis and internal derangements. The protocols included in this Suite can also be applied for imaging of tumors and infections.
This package includes:
-       2D TSE protocols for PD, T1 and T2-weighted contrast with high in-plane resolution and thin slices
-       3D MEDIC, 3D TrueFISP protocols with water excitation for T2-weighted imaging with high in-plane resolution and thin slices
-       High resolution 3D VIBE protocol for MR arthrography (knee, shoulder and hip)
-       3D MEDIC, 3D TrueFISP, 3D VIBE protocols with water excitation having high isotropic resolution, optimized for 3D post-processing
-       PD SPACE with fat saturation and T2 SPACE with high isotropic resolution optimized for 3D post-processing
-       Whole spine single-step or multi-step protocols
-       Excellent fat suppression in off-center positions, e.g. in the shoulder due to high magnet homogeneity
-       Dynamic TMJ and ilio-sacral joint protocol
-       Susceptibility-insensitive protocols for imaging in the presence of a prosthesis
-       Multi-Echo SE sequence with up to 32 echoes for the calculation of T2 time maps (calculation included in the Scientific Suite)
-       High resolution 3D DESS (Double Echo Steady State): T2 / T1-weighted imaging for excellent fluid-cartilage differentiation

Pediatric Suite

The parameters for pediatric imaging vary significantly in comparison to the parameters for adults. The reasons are developing tissues, body size, faster heart rates and restricted compliance with breath-hold commands. Protocols can be adapted for imaging infants.

Scientific Suite

Scientific Suite supports the scientifically oriented user with an easy access to application-specific data for further processing and advanced image computation methods.
-       Support of USB memory sticks
-       Access to the file system by means of a secure and convenient browser
-       Anonymization of patient data
-       Easy generation of AVIs and screenshots for integration into presentations and training videos
-       Export function for tables, statistics and signal-time-courses in a communal format (MeanCurve, Spectroscopy, DTI evaluation)
Advanced image computation methods such as T2 and T1 time calculation, addition, subtraction, multiplication, division, and integration of images

This is a neurosurgical site dedicated to intraoperative monitoring to catch in time the early signs of possible functional complications before they evolve to morphologic ones.

Complications in neurosurgery

So as to have a digital data, the best ever made Inomed Highline ISIS system was put in service to provide documented information about the complications.

Directed by Prof. Munir Elias

Team in action.

Starting from July-2007 all the surgical activities of Prof. Munir Elias will be guided under the electrophysiologic control of ISIS- IOM

ISIS-IOM Inomed Highline



Copyright [2014] [CNS Clinic - Jordan - Munir Elias]. All rights reserved