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Baskaran D, Ding B, Chu S, McElhinney P, Allwood‐Spiers S, Williams SN, Muir K, Fullerton NE, Andrew Porter D, Gunamony S. Simultaneous whole-brain and cervical spine imaging at 7 T using a neurovascular head and neck coil with 8-channel transceiver array and 56-channel receiver array. Magn Reson Med 2025; 94:386-400. [PMID: 39887456 PMCID: PMC12021322 DOI: 10.1002/mrm.30450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 12/20/2024] [Accepted: 01/13/2025] [Indexed: 02/01/2025]
Abstract
PURPOSE To develop a 7T neurovascular head and neck (NVHN) coil with an extended longitudinal coverage of the brain and cervical spine, with eight transceiver (TxRx) channels and 56 receive (Rx) channels for dynamic parallel-transmit (pTx) applications. METHODS A dual-row transceiver array with six elements in the upper row and two elements in the lower row was designed using combined electromagnetic and circuit optimization and constructed. A 56Rx array covering the brain and cervical spine was designed and combined with the transceiver array. The performance of the 8TxRx56Rx NVHN coil such asB 1 + $$ {\mathrm{B}}_1^{+} $$ , signal-to-noise ratio, and g-factor were validated in phantom and in vivo studies and compared with an in-house 8Tx64Rx head coil. High-resolution in vivo images were acquired with the NVHN and head coil. RESULTS The averageB 1 + $$ {\mathrm{B}}_1^{+} $$ in phantom while exciting the upper six channels and all eight channels are 43.45 nT/V and 45.80 nT/V, respectively, demonstrating that the availableB 1 + $$ {\mathrm{B}}_1^{+} $$ field is seamlessly distributed in the brain and/or cervical spine, depending on the chosen excitation. The 8TxRx56Rx NVHN coil increases the SNR in the cervical spine and central brain by a factor of 2.18 and 1.16, respectively, compared with the 8Tx64Rx head coil. Furthermore, it demonstrates similar 1/g-factor performance for acceleration factors up to 5 × 5 compared with the head coil and provides diagnostic-quality images of the brain and spinal cord in a single acquisition. CONCLUSION The extended longitudinal coverage of the NVHN coil promises to improve the clinical application of the current generation of pTx 7T MRI systems with 8Tx channels.
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Affiliation(s)
- Divya Baskaran
- Imaging Centre of ExcellenceUniversity of GlasgowGlasgowUK
| | | | - Son Chu
- Imaging Centre of ExcellenceUniversity of GlasgowGlasgowUK
- MR CoilTech LimitedGlasgowUK
| | | | | | | | - Keith Muir
- Imaging Centre of ExcellenceUniversity of GlasgowGlasgowUK
| | - Natasha Eileen Fullerton
- Imaging Centre of ExcellenceUniversity of GlasgowGlasgowUK
- Department of Neuroradiology, Institute of NeuroscienceNHS Greater Glasgow and ClydeGlasgowUK
| | | | - Shajan Gunamony
- Imaging Centre of ExcellenceUniversity of GlasgowGlasgowUK
- MR CoilTech LimitedGlasgowUK
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Budé LMI, Vat K, Voogt IJ, Zivkovic I, Raaijmakers AJE. An evaluation of the coax monopole antenna as a transmit array element for head imaging at 14 T. Magn Reson Med 2025; 93:2667-2679. [PMID: 39963707 PMCID: PMC11971495 DOI: 10.1002/mrm.30464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 12/18/2024] [Accepted: 01/26/2025] [Indexed: 04/06/2025]
Abstract
PURPOSE In comparison to dipole antennas, the coax monopole antenna (CMA) diminishes the possibility of cable-coil coupling. This greatly facilitates cable routing in spatially restricted environments, such as head coil arrays. With the outlook of a 14T MRI system being installed at the Donders Center in Nijmegen, the Netherlands, this study aims to optimize the CMA for an eight-channel head array at 14 T and compare its performance with an array of fractionated dipole antennas. METHODS Both antenna designs were optimized for head imaging at 14 T using single-channel finite-difference time-domain (FDTD) simulations at 596 MHz. Eight-channel simulations were then used on a human model to evaluateB 1 + $$ {\mathrm{B}}_1^{+} $$ and specific absorption rate (SAR) distributions. For both antenna types, prototype arrays were built by placing eight elements on a 26-cm-diameter cylindrical holder. These prototype arrays were used for S11 and S12 evaluation. RESULTS The optimal dimensions of the CMA were a length of 20 cm and a gap position of 4 cm. The fractionated dipole was optimal for a length of 25 cm. Evaluation of 100 000 random shims revealed that the CMA performs with lower SAR efficiency, although the SAR efficiencies are similar in CP mode. Measured S11 and S12 levels were both lower for the CMA. CONCLUSION The coax monopole would be an excellent candidate for head coil arrays at 14T MRI. Although the CMA is expected to perform with lower SAR efficiency than the fractionated dipole, its single-ended design will facilitate elements placement and cable-routing, especially in a spatially restricted environment.
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Affiliation(s)
- Lyanne M. I. Budé
- Department of Electrical EngineeringEindhoven University of TechnologyEindhovenThe Netherlands
| | - Koen Vat
- Department of Biomedical EngineeringEindhoven University of TechnologyEindhovenThe Netherlands
| | | | - Irena Zivkovic
- Department of Electrical EngineeringEindhoven University of TechnologyEindhovenThe Netherlands
| | - Alexander J. E. Raaijmakers
- Department of Biomedical EngineeringEindhoven University of TechnologyEindhovenThe Netherlands
- Division of Imaging and OncologyUMC UtrechtUtrechtThe Netherlands
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Popova KI, Glang F, Bosch D, Scheffler K, Avdievich NI, Glybovski SB, Solomakha GA. An array of paired folded-end dipoles for whole-brain imaging at 9.4 T. JOURNAL OF MAGNETIC RESONANCE (SAN DIEGO, CALIF. : 1997) 2024; 368:107791. [PMID: 39490302 DOI: 10.1016/j.jmr.2024.107791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Revised: 10/14/2024] [Accepted: 10/15/2024] [Indexed: 11/05/2024]
Abstract
PURPOSE To improve transmit B1+ field homogeneity and longitudinal coverage of a human head RF array, we developed a novel eight-element transceiver (TxRx) array using composite elements based on paired folded-end dipoles. METHODS The developed array consisted of eight pairs of coupled folded-end dipoles. Only one dipole in each pair was driven during transmission, while the other was passively coupled with the active one. The distribution of the transmit B1+ field was numerically optimized by changing the overlap between the dipoles and the value of the reactive lumped element placed in the middle of the passive dipole. RESULTS The proposed array of paired folded-end dipoles substantially improved the B1+ homogeneity and longitudinal coverage over the entire brain including the brain stem compared to a single-row folded-end dipole array. The improved whole brain coverage was demonstrated both numerically and experimentally. CONCLUSION As a proof of concept, we developed and characterized both numerically and experimentally a prototype of a single-row eight-element 9.4 T array for human brain imaging consisting of composite array elements based on paired passively-coupled folded-end dipoles. The array improved the transmit magnetic field distribution due to the laterally elongated field pattern created by one active and one passive dipole per channel. As a result, the provided coverage was substantially better than that of an 8-element dipole array consisting of long folded-end dipoles. For the first time, an image of the entire human brain at 9.4 T, covering the brain stem up to the fourth vertebra, was obtained using a simple single row eight-element array.
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Affiliation(s)
- K I Popova
- School of Physics and Engineering, ITMO University, St. Petersburg, Russia
| | - F Glang
- High-Field MR Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany
| | - D Bosch
- High-Field MR Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany; Department for Biomedical Magnetic Resonance, University of Tübingen, Tübingen, Germany
| | - K Scheffler
- High-Field MR Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany; Department for Biomedical Magnetic Resonance, University of Tübingen, Tübingen, Germany
| | - N I Avdievich
- High-Field MR Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany
| | - S B Glybovski
- School of Physics and Engineering, ITMO University, St. Petersburg, Russia
| | - G A Solomakha
- High-Field MR Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany.
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Solomakha GA, Glang F, Bosch D, Steffen T, Scheffler K, Avdievich NI. Dynamic parallel imaging at 9.4 T using reconfigurable receive coaxial dipoles. NMR IN BIOMEDICINE 2024; 37:e5118. [PMID: 38342102 DOI: 10.1002/nbm.5118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 01/09/2024] [Accepted: 01/17/2024] [Indexed: 02/13/2024]
Abstract
Parallel imaging is one of the key MRI technologies that allow reduction of image acquisition time. However, the parallel imaging reconstruction commonly leads to a signal-to-noise ratio (SNR) drop evaluated using a so-called geometrical factor (g-factor). The g-factor is minimized by increasing the number of array elements and their spatial diversity. At the same time, increasing the element count requires a decrease in their size. This may lead to insufficient coil loading, an increase in the relative noise contribution from the RF coil itself, and hence SNR reduction. Previously, instead of increasing the channel number, we introduced the concept of electronically switchable time-varying sensitivities, which was shown to improve parallel imaging performance. In this approach, each reconfigurable receive element supports two spatially distinct sensitivity profiles. In this work, we developed and evaluated a novel eight-element human head receive-only reconfigurable coaxial dipole array for human head imaging at 9.4 T. In contrast to the previously reported reconfigurable dipole array, the new design does not include direct current (DC) control wires connected directly to the dipoles. The coaxial cable itself is used to deliver DC voltage to the PIN diodes located at the ends of the antennas. Thus, the novel reconfigurable coaxial dipole design opens a way to scale the dynamic parallel imaging up to a realistic number of channels, that is, 32 and above. The novel array was optimized and tested experimentally, including in vivo studies. It was found that dynamic sensitivity switching provided an 8% lower mean and 33% lower maximum g-factor (for Ry × Rz = 2 × 2 acceleration) compared with conventional static sensitivities.
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Affiliation(s)
- Georgiy A Solomakha
- Magnetic Resonance Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany
| | - Felix Glang
- Magnetic Resonance Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany
| | - Dario Bosch
- Magnetic Resonance Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany
- Department of Biomedical Magnetic Resonance, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Theodor Steffen
- Magnetic Resonance Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany
| | - Klaus Scheffler
- Magnetic Resonance Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany
- Department of Biomedical Magnetic Resonance, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Nikolai I Avdievich
- Magnetic Resonance Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany
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Solomakha GA, Bosch D, Glang F, Scheffler K, Avdievich NI. Evaluation of coaxial dipole antennas as transceiver elements of human head array for ultra-high field MRI at 9.4T. Magn Reson Med 2024; 91:1268-1280. [PMID: 38009927 DOI: 10.1002/mrm.29941] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 10/29/2023] [Accepted: 11/08/2023] [Indexed: 11/29/2023]
Abstract
PURPOSE The aim of this work is to evaluate a new eight-channel transceiver (TxRx) coaxial dipole array for imaging of the human head at 9.4T developed to improve specific absorption rate (SAR) performance, and provide for a more compact and robust alternative to the state-of-the art dipole arrays. METHODS First, the geometry of a single coaxial element was optimized to minimize peak SAR and sensitivity to the load variation. Next, a multi-tissue voxel model was used to numerically simulate a TxRx array coil that consisted of eight coaxial dipoles with the optimal configuration. Finally, we compared the developed array to other human head dipole arrays. Results of numerical simulations were verified on a bench and in the scanner including in vivo measurements on a healthy volunteer. RESULTS The developed eight-element coaxial dipole TxRx array coil showed up to 1.1times higher SAR-efficiency than a similar in geometry folded-end and fractionated dipole array while maintaining whole brain coverage and low sensitivity of the resonance frequency to variation in the head size. CONCLUSION As a proof of concept, we developed and constructed a prototype of a 9.4T (400 MHz) human head array consisting of eight TxRx coaxial dipoles. The developed array improved SAR-efficiency and provided for a more compact and robust alternative to the folded-end dipole design. To the best of our knowledge, this is the first example of using coaxial dipoles for human head MRI at ultra-high field.
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Affiliation(s)
- G A Solomakha
- High-Field MR Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany
| | - D Bosch
- High-Field MR Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany
- Department for Biomedical Magnetic Resonance, University of Tübingen, Tübingen, Germany
| | - F Glang
- High-Field MR Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany
| | - K Scheffler
- High-Field MR Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany
- Department for Biomedical Magnetic Resonance, University of Tübingen, Tübingen, Germany
| | - N I Avdievich
- High-Field MR Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany
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Rios NL, Gilbert KM, Papp D, Cereza G, Foias A, Rangaprakash D, May MW, Guerin B, Wald LL, Keil B, Stockmann JP, Barry RL, Cohen-Adad J. An 8-channel Tx dipole and 20-channel Rx loop coil array for MRI of the cervical spinal cord at 7 Tesla. NMR IN BIOMEDICINE 2023; 36:e5002. [PMID: 37439129 PMCID: PMC10733907 DOI: 10.1002/nbm.5002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/10/2023] [Accepted: 06/15/2023] [Indexed: 07/14/2023]
Abstract
The quality of cervical spinal cord images can be improved by the use of tailored radiofrequency (RF) coil solutions for ultrahigh field imaging; however, very few commercial and research 7-T RF coils currently exist for the spinal cord, and in particular, those with parallel transmission (pTx) capabilities. This work presents the design, testing, and validation of a pTx/Rx coil for the human neck and cervical/upper thoracic spinal cord. The pTx portion is composed of eight dipoles to ensure high homogeneity over this large region of the spinal cord. The Rx portion is made up of twenty semiadaptable overlapping loops to produce high signal-to-noise ratio (SNR) across the patient population. The coil housing is designed to facilitate patient positioning and comfort, while also being tight fitting to ensure high sensitivity. We demonstrate RF shimming capabilities to optimize B1 + uniformity, power efficiency, and/or specific absorption rate efficiency. B1 + homogeneity, SNR, and g-factor were evaluated in adult volunteers and demonstrated excellent performance from the occipital lobe down to the T4-T5 level. We compared the proposed coil with two state-of-the-art head and head/neck coils, confirming its superiority in the cervical and upper thoracic regions of the spinal cord. This coil solution therefore provides a convincing platform for producing the high image quality necessary for clinical and research scanning of the upper spinal cord.
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Affiliation(s)
- Nibardo Lopez Rios
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montréal, Montréal, QC, Canada
| | - Kyle M. Gilbert
- Centre for Functional and Metabolic Mapping, The University of Western Ontario, London, ON, Canada
| | - Daniel Papp
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montréal, Montréal, QC, Canada
| | - Gaspard Cereza
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montréal, Montréal, QC, Canada
| | - Alexandru Foias
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montréal, Montréal, QC, Canada
| | - D. Rangaprakash
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Markus W. May
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University of Duisburg-Essen, Essen, Germany
- High Field and Hybrid MR Imaging, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Bastien Guerin
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Lawrence L. Wald
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA
- Harvard Medical School, Boston, MA, USA
- Harvard-Massachusetts Institute of Technology Health Sciences & Technology, Cambridge, MA, USA
| | - Boris Keil
- Institute of Medical Physics and Radiation Protection, University of Applied Sciences Mittelhessen, Giessen, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Marburg, Philipps University of Marburg, Marburg, Germany
| | - Jason P. Stockmann
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Robert L. Barry
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA
- Harvard Medical School, Boston, MA, USA
- Harvard-Massachusetts Institute of Technology Health Sciences & Technology, Cambridge, MA, USA
| | - Julien Cohen-Adad
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montréal, Montréal, QC, Canada
- Functional Neuroimaging Unit, CRIUGM, Université de Montréal, Montreal, QC, Canada
- Mila – Quebec AI Institute, Montreal, QC, Canada
- Centre de recherche du CHU Sainte-Justine, Université de Montréal, Montréal, QC, Canada
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Nikulin AV, Bosch D, Solomakha GA, Glang F, Scheffler K, Avdievich NI. Double-row 16-element folded-end dipole transceiver array for 3D RF shimming of the whole human brain at 9.4 T. NMR IN BIOMEDICINE 2023; 36:e4981. [PMID: 37173759 DOI: 10.1002/nbm.4981] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/18/2023] [Accepted: 05/10/2023] [Indexed: 05/15/2023]
Abstract
Homogeneity and longitudinal coverage of transmit (Tx) human head RF coils at ultrahigh field (UHF, ≥7 T) can be improved by 3D RF shimming, which requires using multi-row Tx arrays. Examples of 3D RF shimming using double-row UHF loop transceiver (TxRx) and Tx arrays have been described previously. Dipole antennas provide unique simplicity and robustness while offering comparable Tx efficiency and signal-to-noise ratio to conventional loop designs. Single-row Tx and TxRx human head UHF dipole arrays have been previously described by multiple groups. Recently, we developed a novel type of dipole antenna, a folded-end dipole, and presented single-row eight-element array prototypes for human head imaging at 7 and 9.4 T. These studies have shown that the novel antenna design can improve the longitudinal coverage and minimize peak local specific absorption rate (SAR) as compared with common unfolded dipoles. In this work, we developed, constructed, and evaluated a 16-element double-row TxRx folded-end dipole array for human head imaging at 9.4 T. To minimize cross-talk between neighboring dipoles located in different rows, we used transformer decoupling, which decreased coupling to a level below -20 dB. The developed array design was demonstrated to be capable of 3D static RF shimming and can be potentially used for dynamic shimming using parallel transmission. For optimal phase shifts between the rows, the array provides 11% higher SAR efficiency and 18% higher homogeneity than a folded-end dipole single-row array of the same length. The design also offers a substantially simpler and more robust alternative to the common double-row loop array with about 10% higher SAR efficiency and better longitudinal coverage.
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Affiliation(s)
- Anton V Nikulin
- High-Field MR Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany
- Department for Biomedical Magnetic Resonance, University of Tübingen, Tübingen, Germany
- Center of Photonics and 2D Materials, Moscow Institute of Physics and Technology, Dolgoprudny, Russia
| | - Dario Bosch
- High-Field MR Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany
- Department for Biomedical Magnetic Resonance, University of Tübingen, Tübingen, Germany
| | - Georgiy A Solomakha
- High-Field MR Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany
- Department of Physics and Engineering, ITMO University, St. Petersburg, Russia
| | - Felix Glang
- High-Field MR Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany
| | - Klaus Scheffler
- High-Field MR Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany
- Department for Biomedical Magnetic Resonance, University of Tübingen, Tübingen, Germany
| | - Nikolai I Avdievich
- High-Field MR Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany
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Rios NL, Gilbert KM, Papp D, Cereza G, Foias A, Rangaprakash D, May MW, Guerin B, Wald LL, Keil B, Stockmann JP, Barry RL, Cohen-Adad J. 8-channel Tx dipole and 20-channel Rx loop coil array for MRI of the cervical spinal cord at 7 Tesla. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.02.08.527664. [PMID: 36798276 PMCID: PMC9934596 DOI: 10.1101/2023.02.08.527664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
The quality of cervical spinal cord images can be improved by the use of tailored radiofrequency coil solutions for ultra-high field imaging; however, very few commercial and research 7 Tesla radiofrequency coils currently exist for the spinal cord, and in particular those with parallel transmit capabilities. This work presents the design, testing and validation of a pTx/Rx coil for the human neck and cervical/upper-thoracic spinal cord. The pTx portion is composed of 8 dipoles to ensure high homogeneity over this large region of the spinal cord. The Rx portion is made of 20 semi-adaptable overlapping loops to produce high Signal-to-noise ratio (SNR) across the patient population. The coil housing is designed to facilitate patient positioning and comfort, while being tight fitting to ensure high sensitivity. We demonstrate RF shimming capabilities to optimize B 1 + uniformity, power efficiency and/or specific absorption rate (SAR) efficiency. B 1 + homogeneity, SNR and g-factor was evaluated in adult volunteers and demonstrated excellent performance from the occipital lobe down to the T4-T5 level. We compared the proposed coil with two state-of-the-art head and head/neck coils, confirming its superiority in the cervical and upper-thoracic regions of the spinal cord. This coil solution therefore provides a convincing platform for producing the high image quality necessary for clinical and research scanning of the upper spinal cord.
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Affiliation(s)
- Nibardo Lopez Rios
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montréal, Montreal, QC, Canada
| | - Kyle M. Gilbert
- Centre for Functional and Metabolic Mapping, The University of Western Ontario, London, ON, Canada
| | - Daniel Papp
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montréal, Montreal, QC, Canada
| | - Gaspard Cereza
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montréal, Montreal, QC, Canada
| | - Alexandru Foias
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montréal, Montreal, QC, Canada
| | - D. Rangaprakash
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Markus W. May
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University of Duisburg-Essen, Essen, Germany
- High Field and Hybrid MR Imaging, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Bastien Guerin
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Lawrence L. Wald
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA
- Harvard Medical School, Boston, MA, USA
- Harvard-Massachusetts Institute of Technology Health Sciences & Technology, Cambridge, MA, USA
| | - Boris Keil
- Institute of Medical Physics and Radiation Protection, University of Applied Sciences Mittelhessen, Giessen, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Marburg, Philipps University of Marburg, Marburg, Germany
| | - Jason P. Stockmann
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Robert L. Barry
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA
- Harvard Medical School, Boston, MA, USA
- Harvard-Massachusetts Institute of Technology Health Sciences & Technology, Cambridge, MA, USA
| | - Julien Cohen-Adad
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montréal, Montreal, QC, Canada
- Functional Neuroimaging Unit, CRIUGM, Université de Montréal, Montreal, QC, Canada
- Mila – Quebec AI Institute, Montreal, QC, Canada
- Centre de recherche du CHU Sainte-Justine, Université de Montréal, Montréal, QC, Canada
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Avdievich NI, Nikulin AV, Ruhm L, Magill AW, Henning A, Scheffler K. Double-row dipole/loop combined array for human whole brain imaging at 7 T. NMR IN BIOMEDICINE 2022; 35:e4773. [PMID: 35580922 DOI: 10.1002/nbm.4773] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/29/2022] [Accepted: 05/14/2022] [Indexed: 06/15/2023]
Abstract
Important issues in designing radiofrequency (RF) coils for human head imaging at ultra-high field (UHF; ≥7 T) are the inhomogeneity and longitudinal coverage (along the magnet axis) of the transmit (Tx) RF field. Both the homogeneity and coverage produced by Tx volume coils can be improved by means of three-dimensional (3D) RF shimming, which requires the use of multirow Tx-arrays. In addition, according to recent findings of the ultimate intrinsic signal-to-noise ratio (UISNR) theory, the loop-only receive (Rx) arrays do not provide optimal SNR near the brain center at UHF. The latter can be obtained by combining complementary conductive structures carrying different current patterns (e.g., loops and dipole antennas). In this work, we developed, constructed, and evaluated a novel 32-element hybrid array design for human head imaging at 7 T. The array consists of 16 transceiver loops placed in two rows circumscribing the head and 16 folded-end Rx-only dipoles positioned in the centers of loops. By placing all elements in a single layer, we increased RF power deposition into the tissue and, thus, preserved the Tx-efficiency. Using this hybrid design also simplifies the coil structure by minimizing the total number of array elements. The array demonstrated whole brain coverage, 3D RF shimming capability, and high SNR. It provided ~15% higher SNR near the brain center and, depending on the RF shim mode, from 20% to 40% higher Tx-efficiency than a common commercial head array coil.
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Affiliation(s)
- Nikolai I Avdievich
- High-Field MR Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany
| | - Anton V Nikulin
- High-Field MR Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany
- Department for Biomedical Magnetic Resonance, University of Tübingen, Tübingen, Germany
| | - Loreen Ruhm
- High-Field MR Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany
| | - Arthur W Magill
- Department for Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Anke Henning
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Klaus Scheffler
- High-Field MR Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany
- Department for Biomedical Magnetic Resonance, University of Tübingen, Tübingen, Germany
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10
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Avdievich NI, Nikulin AV, Ruhm L, Magill AW, Glang F, Henning A, Scheffler K. A 32-element loop/dipole hybrid array for human head imaging at 7 T. Magn Reson Med 2022; 88:1912-1926. [PMID: 35766426 DOI: 10.1002/mrm.29347] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/16/2022] [Accepted: 05/16/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE To improve whole-brain SNR at 7 Tesla, a novel 32-element hybrid human head array coil was developed, constructed, and tested. METHODS Our general design strategy is based on 2 major ideas: Firstly, following suggestions of previous works based on the ultimate intrinsic SNR theory, we combined loops and dipoles for improvement of SNR near the head center. Secondly, we minimized the total number of array elements by using a hybrid combination of transceive (TxRx) and receive (Rx) elements. The new hybrid array consisted of 8 folded-end TxRx-dipole antennas and 3 rows of 24 Rx-loops all placed in a single layer on the surface of a tight-fit helmet. RESULTS The developed array significantly improved SNR in vivo both near the center (∼20%) and at the periphery (∼20% to 80%) in comparison to a common commercial array coil with 8 transmit (Tx) and 32 Rx-elements. Whereas 24 loops alone delivered central SNR very similar to that of the commercial coil, the addition of complementary dipole structures provided further improvement. The new array also provided ∼15% higher Tx efficiency and better longitudinal coverage than that of the commercial array. CONCLUSION The developed array coil demonstrated advantages in combining complementary TxRx and Rx resonant structures, that is, TxRx-dipoles and Rx-loops all placed in a single layer at the same distance to the head. This strategy improved both SNR and Tx-performance, as well as simplified the total head coil design, making it more robust.
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Affiliation(s)
- Nikolai I Avdievich
- High-Field MR Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany
| | - Anton V Nikulin
- High-Field MR Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany.,Department for Biomedical Magnetic Resonance, University of Tübingen, Tübingen, Germany
| | - Loreen Ruhm
- High-Field MR Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany
| | - Arthur W Magill
- Department for Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Felix Glang
- High-Field MR Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany
| | - Anke Henning
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, TX
| | - Klaus Scheffler
- High-Field MR Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany.,Department for Biomedical Magnetic Resonance, University of Tübingen, Tübingen, Germany
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11
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Avdievich NI, Solomakha G, Ruhm L, Henning A, Scheffler K. 9.4 T double-tuned 13 C/ 1 H human head array using a combination of surface loops and dipole antennas. NMR IN BIOMEDICINE 2021; 34:e4577. [PMID: 34169590 DOI: 10.1002/nbm.4577] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/17/2021] [Accepted: 06/02/2021] [Indexed: 06/13/2023]
Abstract
MRI at ultra-high field (UHF, ≥7 T) provides a natural strategy for improving the quality of X-nucleus magnetic resonance spectroscopy and imaging due to the intrinsic benefit of increased signal-to-noise ratio. Considering that RF coils require both local transmission and reception at UHF, the designs of double-tuned coils, which often consist of several layers of transmit and receive resonant elements, become quite complex. A few years ago, a new type of RF coil, ie a dipole antenna, was developed and used for human body and head imaging at UHF. Due to the mechanical and electrical simplicity of dipole antennas, combining an X-nucleus surface loop array with 1 H dipoles can substantially simplify the design of a double-tuned UHF human head array coil. Recently, we developed a novel bent folded-end dipole transceiver array for human head imaging at 9.4 T. The new eight-element dipole array demonstrated full brain coverage, and transmit efficiency comparable to that of the substantially more complex 16-element surface loop array. In this work, we developed, constructed and evaluated a double-tuned 13 C/1 H human head 9.4 T array consisting of eight 13 C transceiver surface loops and eight 1 H transceiver bent folded-end dipole antennas all placed in a single layer. We showed that interaction between loops and dipoles can be minimized by placing four 1 H traps into each 13 C loop. The presented double-tuned RF array coil substantially simplifies the design as compared with the common double-tuned surface loop arrays. At the same time, the coil demonstrated an improved 1 H longitudinal coverage and good transmit efficiency.
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Affiliation(s)
- Nikolai I Avdievich
- High-Field MR Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany
| | - Georgiy Solomakha
- Department of Physics and Engineering, ITMO University, St. Petersburg, Russia
| | - Loreen Ruhm
- High-Field MR Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany
| | - Anke Henning
- High-Field MR Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Klaus Scheffler
- High-Field MR Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany
- Department for Biomedical Magnetic Resonance, University of Tübingen, Tübingen, Germany
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12
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Avdievich NI, Solomakha G, Ruhm L, Nikulin AV, Magill AW, Scheffler K. Folded-end dipole transceiver array for human whole-brain imaging at 7 T. NMR IN BIOMEDICINE 2021; 34:e4541. [PMID: 33978270 DOI: 10.1002/nbm.4541] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/07/2021] [Accepted: 04/26/2021] [Indexed: 06/12/2023]
Abstract
The advancement of clinical applications of ultrahigh field (UHF) MRI depends heavily on advances in technology, including the development of new radiofrequency (RF) coil designs. Currently, the number of commercially available 7 T head RF coils is rather limited, implying a need to develop novel RF head coil designs that offer superior transmit and receive performance. RF coils to be used for clinical applications must be robust and reliable. In particular, for transmit arrays, if a transmit channel fails the local specific absorption rate may increase, significantly increasing local tissue heating. Recently, dipole antennas have been proposed and used to design UHF head transmit and receive arrays. The dipole provides a unique simplicity while offering comparable transmit efficiency and signal-to-noise ratio with the conventional loop design. Recently, we developed a novel array design in our laboratory using a folded-end dipole antenna. In this work, we developed, constructed and evaluated an eight-element transceiver bent folded-end dipole array for human head imaging at 7 T. Driven in the quadrature circularly polarized mode, the array demonstrated more than 20% higher transmit efficiency and significantly better whole-brain coverage than that provided by a widely used commercial array. In addition, we evaluated passive dipole antennas for decoupling the proposed array. We demonstrated that in contrast to the common unfolded dipole array, the passive dipoles moved away from the sample not only minimize coupling between the adjacent folded-end active dipoles but also produce practically no destructive interference with the quadrature mode of the array.
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Affiliation(s)
- Nikolai I Avdievich
- High-Field MR Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany
| | - Georgiy Solomakha
- Department of Physics and Engineering, ITMO University, St. Petersburg, Russia
| | - Loreen Ruhm
- High-Field MR Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany
| | - Anton V Nikulin
- High-Field MR Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany
- Department for Biomedical Magnetic Resonance, University of Tübingen, Tübingen, Germany
| | - Arthur W Magill
- Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Klaus Scheffler
- High-Field MR Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany
- Department for Biomedical Magnetic Resonance, University of Tübingen, Tübingen, Germany
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13
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Gilbert KM, Klassen LM, Mashkovtsev A, Zeman P, Menon RS, Gati JS. Radiofrequency coil for routine ultra-high-field imaging with an unobstructed visual field. NMR IN BIOMEDICINE 2021; 34:e4457. [PMID: 33305466 DOI: 10.1002/nbm.4457] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 11/17/2020] [Indexed: 06/12/2023]
Abstract
Many neuroscience applications have adopted functional MRI as a tool to investigate the healthy and diseased brain during the completion of a task. While ultra-high-field MRI has allowed for improved contrast and signal-to-noise ratios during functional MRI studies, it remains a challenge to create local radiofrequency coils that can accommodate an unobstructed visual field and be suitable for routine use, while at the same time not compromise performance. Performance (both during transmission and reception) can be improved by using close-fitting coils; however, maintaining sensitivity over the whole brain often requires the introduction of coil elements proximal to the eyes, thereby partially occluding the subject's visual field. This study presents a 7 T head coil, with eight transmit dipoles and 32 receive loops, that is designed to remove visual obstructions from the subject's line of sight, allowing for an unencumbered view of visual stimuli, the reduction of anxiety induced from small enclosures, and the potential for eye-tracking measurements. The coil provides a practical solution for routine imaging, including a split design (anterior and posterior halves) that facilitates subject positioning, including those with impaired mobility, and the placement of devices required for patient comfort and motion reduction. The transmit and receive coils displayed no degradation of performance due to adaptions to the design topology (both mechanical and electrical) required to create an unobstructed visual field. All computer-aided design files, electromagnetic simulation models, transmit field maps and local specific absorption rate matrices are provided to promote reproduction.
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Affiliation(s)
- Kyle M Gilbert
- Centre for Functional and Metabolic Mapping, The University of Western Ontario, London, Ontario, Canada
- Department of Medical Biophysics, The University of Western Ontario, London, Ontario, Canada
| | - L Martyn Klassen
- Centre for Functional and Metabolic Mapping, The University of Western Ontario, London, Ontario, Canada
| | - Alexander Mashkovtsev
- Centre for Functional and Metabolic Mapping, The University of Western Ontario, London, Ontario, Canada
| | - Peter Zeman
- Centre for Functional and Metabolic Mapping, The University of Western Ontario, London, Ontario, Canada
| | - Ravi S Menon
- Centre for Functional and Metabolic Mapping, The University of Western Ontario, London, Ontario, Canada
- Department of Medical Biophysics, The University of Western Ontario, London, Ontario, Canada
| | - Joseph S Gati
- Centre for Functional and Metabolic Mapping, The University of Western Ontario, London, Ontario, Canada
- Department of Medical Biophysics, The University of Western Ontario, London, Ontario, Canada
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14
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Avdievich NI, Solomakha G, Ruhm L, Henning A, Scheffler K. Unshielded bent folded-end dipole 9.4 T human head transceiver array decoupled using modified passive dipoles. Magn Reson Med 2021; 86:581-597. [PMID: 33629436 DOI: 10.1002/mrm.28711] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 01/14/2021] [Accepted: 01/14/2021] [Indexed: 11/10/2022]
Abstract
PURPOSE To develop an unshielded dipole transceiver array for human head imaging at 9.4 Tesla and to improve decoupling of adjacent dipole elements, a novel array design with modified passive dipole antennas was developed, evaluated, and tested. METHODS The new array consisted of 8 bent folded-end dipole elements placed in a single row and surrounding the head. Adjacent elements of RF transceiver arrays are usually decoupled by introducing circuits electrically connected to elements. These methods are difficult to use for dipole arrays because of the distant location of the adjacent antennas. A recently developed decoupling technique using passive dipoles is simple and does not require any electrical connection. However, common parallel passive dipoles can produce destructive interference with the RF field of the array itself. To minimize this interference, we placed the passive dipoles perpendicularly to the active dipoles and positioned them at the ends of the array. We also evaluated the effect of different passive dipoles on the array transmit performance. Finally, we optimized the array transmit performance by varying the length of the dipole folded portion. RESULTS By rotating the passive dipoles 90º and moving them toward the ends of the array, we minimized the destructive interference to an acceptable level without compromising decoupling and the transmit efficiency. CONCLUSION While keeping the benefits of the passive dipole decoupling method, the new modified dipoles produce substantially less destructive interference with the RF field of the array than the common design. The constructed transceiver array demonstrated good decoupling and whole-brain coverage.
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Affiliation(s)
- Nikolai I Avdievich
- High-Field MR Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany
| | - Georgiy Solomakha
- Department of Physics and Engineering, ITMO University, St. Petersburg, Russia
| | - Loreen Ruhm
- High-Field MR Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany
| | - Anke Henning
- High-Field MR Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany.,Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Klaus Scheffler
- High-Field MR Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany.,Department for Biomedical Magnetic Resonance, University of Tübingen, Tübingen, Germany
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15
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Geldschläger O, Bosch D, Avdievich NI, Henning A. Ultrahigh-resolution quantitative spinal cord MRI at 9.4T. Magn Reson Med 2020; 85:1013-1027. [PMID: 32789980 DOI: 10.1002/mrm.28455] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 07/06/2020] [Accepted: 07/10/2020] [Indexed: 11/08/2022]
Abstract
PURPOSE To present the results of the first human spinal cord in vivo MRI scans at 9.4T. METHODS A human brain coil was used to image the human spinal cord at 9.4T. All anatomical images were acquired with a T2 *-weighted gradient-echo sequence. A comparison of the influence of four different B0 shimming routines on the image quality was performed. Intrinsic signal-to-noise-ratio maps were determined using a pseudo-multiple replica approach. Measurements with different echo times were compared and processed to one multiecho data image combination image. Based on the multiecho acquisitions, T2 *-relaxation time maps were calculated. Algorithmic spinal cord detection and gray matter/white matter segmentation were tested. RESULTS An echo time between 9 and 13.8 ms compromised best between gray matter/white matter contrast and image quality. A maximum in-plane resolution of 0.15 × 0.15 mm2 was achieved for anatomical images. These images offered excellent image quality and made small structures of the spinal cord visible. The scanner vendor implemented B0 shimming routine performed best during this work. Intrinsic signal-to-noise-ratio values of between 6600 and 8060 at the upper cervical spinal cord were achieved. Detection and segmentation worked reliably. An average T2 *-time of 24.88 ms ± 6.68 ms for gray matter and 19.37 ms ± 8.66 ms for white matter was calculated. CONCLUSION The proposed human brain coil can be used to image the spinal cord. The maximum in-plane resolution in this work was higher compared with the 7T results from the literature. The 9.4T acquisitions made the small structures of the spinal cord clearly visible.
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Affiliation(s)
- Ole Geldschläger
- High-Field Magnetic Resonance Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany
| | - Dario Bosch
- High-Field Magnetic Resonance Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany.,Biomedical Magnetic Resonance, University Hospital Tübingen, Tübingen, Germany
| | - Nikolai I Avdievich
- High-Field Magnetic Resonance Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany
| | - Anke Henning
- High-Field Magnetic Resonance Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany.,Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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16
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Avdievich NI, Solomakha G, Ruhm L, Bause J, Scheffler K, Henning A. Bent folded‐end dipole head array for ultrahigh‐field MRI turns “dielectric resonance” from an enemy to a friend. Magn Reson Med 2020; 84:3453-3467. [DOI: 10.1002/mrm.28336] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 04/16/2020] [Accepted: 05/03/2020] [Indexed: 11/05/2022]
Affiliation(s)
- Nikolai I. Avdievich
- High‐Field MR Center Max Planck Institute for Biological Cybernetics Tübingen Germany
| | - Georgiy Solomakha
- Department of Physics and Engineering ITMO University St. Petersburg Russia
| | - Loreen Ruhm
- High‐Field MR Center Max Planck Institute for Biological Cybernetics Tübingen Germany
| | - Jonas Bause
- High‐Field MR Center Max Planck Institute for Biological Cybernetics Tübingen Germany
- Graduate School of Neural and Behavioral Sciences Tübingen Germany
| | - Klaus Scheffler
- High‐Field MR Center Max Planck Institute for Biological Cybernetics Tübingen Germany
- Department for Biomedical Magnetic Resonance University of Tübingen Tübingen Germany
| | - Anke Henning
- High‐Field MR Center Max Planck Institute for Biological Cybernetics Tübingen Germany
- Advanced Imaging Research Center University of Texas Southwestern Medical Center Dallas TX USA
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