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Acknowledgments
In addition to the reviewers listed separately, the authors would Cindy R, Comeau, BS, RT(N)(MR)
like to thank the following individuals for their contributions: Advanced Cardiovascular Imaging, NY, NY
Provided images for the cardiac section
Robert DeLaPaz, MD
Professor of Radiology Cover image courtesy of Mitsue Miyazaki from Toshiba
Director of Neuroradiology, Medical Systems Corp.
NYP Columbia Medical Center Caption: The entire arterial vasculature is depicted with
Foreword “MD-Technologist interaction” and ƒMRI section exquisite clarity using noncontrast angiography techniques.
images and context. The fresh blood imaging (FBI) technique was used to depict
the pulmonary system, subclavian arteries, and runoff vessels,
Martin R. Prince, MD, PhD, FACR from the abdominal aorta to the pedal arteries. The time-spa-
Professor of Radiology at Cornell & Columbia Universities tial labeling inversion pulse (Time-SLIP) technique was used to
Foreword and review of the contrast section depict the carotid arteries through the Circle of Willis.
vii
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Contents
Preface Soft Tissue Neck
Patient Preparation Magnetic Resonance Angiography of Carotid Arteries and
Safety Guidelines Carotid Bifurcation
CHAPTER 1 MRI of the Head and Neck CHAPTER 2 MRI of the Spine and Bony Pelvis
Important Considerations for Scan Acquisition MRI of the Spine and Bony Pelvis—Considerations
Routine Brain Scan Routine Cervical Spine
Brain for Pituitary Cervical Spine for Multiple Sclerosis
Brain for Internal Auditory Canals (IACs) Routine Thoracic Spine
Brain for Orbits—Optic Nerves Lumbar Spine
Brain for MS Sacroiliac Joints—Sacrum and Coccyx
Brain for Epilepsy—Temporal Lobe MRI of the Bony Pelvis
Brain for TMJs
MRA—Circle of Willis CHAPTER 3 MRI of the Upper Extremities
MRV—Superior Sagittal Sinus MRI of the Upper Extremities—Considerations
Brain for CSF MRI of the Shoulder
Brain for Stroke MRI of the Humerus
fMRI—Functional MRI MRI of the Elbow
ix
CONTENTS
CHAPTER 4 MRI of the Lower Extremities CHAPTER 6 MRI of the Abdomen and Pelvis
MRI of the Lower Extremities—Considerations MRI of the Abdomen and Pelvis—Considerations
MRI of the Hips MRI of the Abdomen—Kidneys
MRI of the Femur MRI of the Abdomen—Portal Vein
MRI of the Knee Magnetic Resonance Cholangiographic Pancreatography
MRI of the Lower Leg MRI of the Adrenal Glands
MRI of the Ankle MRI of the Female Pelvis—Uterus
MRI of the Foot and Digits MRI of the Male Pelvis—Prostate
MRA of the Renal Arteries
CHAPTER 5 MRI of the Thorax MRA Runoff—Abdomen, Pelvis, and Lower Extremities
MRI of the Breast
Bilateral Breast
Preface
As both technologists and educators, we strongly believe there line of defense against MR related accidents. Included in this
is a need for a comprehensive reference for MR scanning. This text is an overview of MR safety including issues related to
includes not only the accurate and consistently standardized administration of contrast agents .We urge all MR personnel to
acquisition of images, but also a place to reference standard adhere to all safety protocols to avoid accidents that can injure
and advanced protocols for imaging the vast range of medical patients, staff and equipment.
conditions and body habitus presented.
We feel this book is both basic and broad enough to meet
Organization and Content
the needs of students and experienced technologists. It is
intended to provide not only a baseline for MR image acquisi- • A safety section, including MR suite configuration, patient
tion but also a standard of quality that should be consistently screening and personnel classifications, provides a solid
duplicated to provide the health care team with quality diag- foundation for secure operating parameters within the
nostic images. highly volatile MR environment.
In our tables we have suggested scan protocols with techni- • A section on Gadolinium Based Contrast Agents (GBCAs)
cal parameters for both 1.5T and the more advanced 3T mag- provides background on safety considerations as outlined
nets. In addition we have provided blank tables to modify your by the ACR, pharmaceutical vendors, including appropriate
site protocols to accommodate the capabilities of your specific dosing and off label use.
equipment. We suggest you enter all data on your site tables in • Each section is logically divided into protocols for acquisi-
pencil to modify as protocols and software change. tion in the axial, coronal and sagittal planes, with suggestions
Of utmost importance, regardless of the field strength of for scan parameters and sequences for both 1.5T and 3T.
your specific equipment, is MR safety. MR safety guidelines, • Tables suggesting protocols and sequences for both 1.5T and
as set forth by your facility and the MR technologist, is the first 3T magnets.
xi
preface
• Each pilot, or scan plan, is followed by a relevant midline Each chapter has
image from the sequence and a detailed anatomical refer- • Scan Considerations
ence of the pertinent anatomy. • Coils
• The parameters for coil type, proper patient position- • Pulse Sequences
ing, consistent and accurate slice placement and ana- • Options
tomical coverage are detailed for each sequence. In • Scanning Tips
addition, a “Tips” section will assist with techniques • Scan Planning
designed to perfect each scan and ensure patient safety • Anatomic Midline Image
and comfort. • Anatomic Drawing
• The fMRI section at the end of Chapter 1 gives insight to
some of the most current techniques and applications of
Ancillaries
MRI.
• The cross-vendor reference acronym chart allows replica- • The images from the book are available online on Evolve at
tion of sequences from one vendor to another. http://evolve.elsevier.com/BurghartFinn/MRI
Patient Preparation
• The patient should be “properly identified” by name, date of • Many patients are anxious when having an MRI. Make sure
birth and facility medical record number (when appropri- you explain the examination to the patient. A conversation
ate), which should be compared to the patient's requisition with the patient prior to scanning usually puts the patient's
and schedule. fears to rest.
• Have the patient fill out a MRI questionnaire while in • Explain the importance of holding still.
zone 2. • Explain that the scanner makes a loud knocking sound and
• The MRI questionnaire should be reviewed by the MRI they should try to relax.
staff, particularly nurse and the technologist who are the • Explain that you will be talking to them between scans.
“gatekeepers”. Give patient a call bell and instructions to use only when
• The MRI questionnaire should be discussed with the patient necessary.
making sure they understand the questions. • When they speak to you, make sure you listen to what they
• The patient should be screened for implanted devices, such say so you can address their needs if necessary.
as a pacemaker, defibrillator, neuro-stimulator, aneurysm • Make sure ear plugs are securely fitted into the patient's ears.
clip, hearing aid and prosthetic devices. • Secure the head with side sponges, and tape with gauze
• Patient should be screened for the possibility of renal disease across the forehead.
when contrast is ordered. • Secure the patient in a comfortable position, with cushions
• Have the patient go to the bathroom prior to coming into under their knees to relieve back pressure.
the MRI suite. • Put sponges or sheets along the side of the patient to pre-
• All patients should undress and put on a gown or scrubs. vent their arms and torso from touching the sides of the
Make sure all metal is removed. magnet.
xiii
Safety Guidelines
MR environments can pose a wide array of potential risks for 3T MR vendors provide SAR monitors with their 3T magnets.
patients, health care workers, and ancillary personnel who These monitors should be observed while scanning.
enter the magnetic field. Strict policy and procedures should As practitioners and educators, we strongly suggest the
be in place and adhered to, to ensure safe operation. Areas to American College of Radiology (ACR) Guidance Document
be considered are zoning of the MR suite, identification and for MR Practices: 2007 (listed in the references to these Safety
education of qualified MR personnel, guidelines for screening Guidelines) be referenced and adhered to for implementation
patients and accompanying family members, administration of of safety guidelines in all MRI departments. Further informa-
contrast, implant, and device screening and cryogens. tion for safe practice can be accessed at the Joint Commission
The inherent risks for accidents caused by the magnetic field Sentinel Event Alert on MRI Safety and at NIH.gov/mri (both
continue to be similar at 1.5T and 3T. However, as the static links are found in the references to these Safety Guidelines). A
magnetic field strength increases, the probability for move- brief overview of ACR guidelines are discussed below.
ment of ferromagnetic material, metallic implants and the pro-
jectile effect become increasingly problematic. To avoid tissue
ZONING OF THE MR SUITE
heating, which is caused by the time-varying magnetic field,
the FDA provides guidance on the rate of energy that may be The architectural plan for the MR suite should support safety
deposited in tissue, which is termed specific absorption rate and be designed with barriers to prevent harm to patients
(SAR). In addition, the time-varying magnetic field can affect and personnel. The four-zone plan suggested by the ACR is
acoustic noise and induce voltage. At 3T, SAR can becomes a described below. Whatever system is adopted, it should be
greater concern, particularly with fast spin echo sequences, strictly adhered to. The entrance to each zone should be clearly
especially as the echo train length increases. For this reason, all marked.
Zone I—All areas that are outside the MR environment and MR personnel and are typically divided into two categories—
are accessible to the general public. In this area, no risk is posed level 1 and level 2 MR personnel.
to the general public. Level 1 personnel—Anyone who has completed basic MR
Zone II—This is the area that bridges the contact between training and will be permitted in Zones I–III.
Zone I and the more strictly supervised areas of Zone III and Level 2 personnel—It should be the responsibility of the MR
IV. This is the area where patients are typically screened and safety officer to identify the personnel who qualify as level 2
history is taken. personnel. They should possess comprehensive MR training
Zone III—This is a restricted area for all who are not MR and understand the potential for hazardous situations that may
personnel. Because the magnetic field is three-dimensional and arise from a wide variety of risks associated with Zones III and
may project through walls and floors, this area should be clearly IV. Level 2 personnel will primarily consist of the MR technolo-
marked as potentially hazardous. The five-gauss line, which is gist and the MR nurse.
the exclusionary zone, should be clearly delineated. Signage MR Technologist—As stated by the ACR, all MR technolo-
should be posted to ensure that all patients or staff with pace- gists should be American Registry of Radiologic Technologists–
makers or defibrillators do not enter this area. certified radiologic technologists (RTs). All MR technologists
Zone IV—This is the room in which the MR scanner is should maintain current certification by the American Heart
housed and is the area that poses the most potential risk. It Association in basic life support at the health care provider
should be clearly marked with proper signage stating: “The level.
Magnet is Always On,” and that you are entering Zone IV.
GUIDELINES FOR SCREENING PATIENTS
MR PERSONNEL AND NON-MR PERSONNEL
Considering the potential dangers that can occur in the MR Several components of patient screening can and should take
suite, all individuals working within this environment should place during the scheduling process. Typically at this time, it
be annually certified in the completion of safe practice edu- is determined whether the patient has any contraindicated
cational training. These practitioners should be designated as implants such as a pacemaker or internal cardiac defibrillator,
xv
safety guidelines
or whether there is a medical condition such as renal disease Determination to scan a patient with an implanted medi-
or pregnancy that may need special considerations before cal device or foreign body should be made by the attending
scanning. MR radiologist via plain x-ray films or computed tomog-
All patients and personnel who attempt to enter Zone raphy. For other implantable devices, further investigation
III must be formally screened and documented in writing. for compatibility should be made and documented by MR
Only MR personnel are qualified to perform the screen- personnel.
ing process before permitting non-MR personnel into
Zone III. MR screening should be performed by at least two
PEDIATRIC CONCERNS
separate individuals, one of whom should be a level 2 MR
personnel. Because children and teens are often unreliable sources of med-
Screening should typically take place in Zone II, where the ical history, they should be questioned both in the presence of
patients should remove all outer clothing, jewelry, and prosthet- a parent or guardian, as well as alone to ensure that a complete
ics, and change into a gown. The formal institutional screen- history is disclosed.
ing questionnaire should include confidential information and Children comprise the largest group of patients for whom
a MR hazard checklist, which would be reviewed along with sedation is necessary. Although protocols will vary, strict adher-
comprehensive discussion of the patient's medical history. The ence to guidelines and constant monitoring is mandatory. For
screening forms for patients and non- MR personnel who may infants, special attention must be paid to monitoring body
accompany the patient, or enter the scan room, should essen- temperature for both hypo- and hyperthermia.
tially be the same.
Everyone entering Zone III must be physically screened for
PREGNANCY AND MR
the presence of ferromagnetic materials, which, regardless of
size, can become hazardous projectiles to the patient and the Pregnant MR personnel are permitted to work within the
MR scanner. The use of a ferromagnetic detector and wand confines of Zone IV during all stages of pregnancy but it is
that differentiates between ferrous and nonferrous material is recommended that they not enter the MR room when the
recommended. radiofrequency (RF) is on during the scanning process.
Because no detrimental effect of MR has been conclusively Materials International, all metallic material must conform
documented to the developing fetus, no special consideration to the following standard.
is suggested for any stage of a patient's pregnancy. However,
screening for pregnancy is recommended before MR, particu-
MR
larly when the study may require contrast. MR contrast should
not be routinely injected during pregnancy unless risk versus
benefit has been assessed. MR MR
MR Safe MR Conditional Not MR Safe
DEVICE SCREENING
As part of Zone III safety protocol, the availability of a hand- MR SCANNING SAFETY
held magnet (≥ 1000 gauss) or target scanner (wand) is recom-
mended to clear and test equipment. Both patients and accompanying family members must be
Before MR personnel enter Zone III, all metallic or par- completely screened before entering Zone IV—the scan room.
tially metallic objects must be identified in writing as fer- Both patients and those remaining in the room during the scan
romagnetic or nonferromagnetic and safe or conditionally must wear ear protection to limit the noise from the magnet.
safe before entering this area. Never assume MR compatibil- Acoustic noise can reach 90 dB; the pain threshold is approxi-
ity unless documented in writing and tested with a hand- mately 120 dB.
held magnet. Every object entering Zone III must be tested Patients with implanted wires or leads are at a higher risk
and the results, including the date and the method of test- when sequences such as echo-planar imaging in DWI, fMRI,
ing, documented in writing. In accordance with FDA label- or gradient intense sequences are used. Many factors can affect
ing criteria, developed by American Society for Testing and the potential for tissue heating. The strength of the magnetic
xvii
safety guidelines
field and type of sequences should be taken into consideration. In the event of a code, the patient should be removed
Time-varying gradient fields can influence nerves, blood ves- from Zone IV and brought directly into Zone II. Code
sels, and muscles, which can act as conductors. responders should be aware of safety implications within
Thermal heating is of great concern during the scanning the MR suite.
process. Heat generated by electrical voltages and currents In the event of a quench, when cryogens are released and
within the magnet is sufficient to cause thermal injury or burns sometimes form a white cloud in the scan room, it is impera-
to the patient. RF energy transmits easily through open space tive to quickly remove all patients and personnel and close
from the RF transmit coil to the patient. To avoid excessive heat- the door to the scan room until the vendor engineers are
ing or damage to a patient's tissue, avoid placing any conductive present.
material within the RF field. Only MR-compatible wires or leads In the event of a fire, it is important to note that responding
may be used during the scanning process to prevent RF-induced police and fire personnel must be prevented from entering the
burns. If electrically conductive materials must be used, posi- scan room with ferromagnetic objects. All MR suites should
tion them to prevent “cross points” (cables that touch, loop over have MR-compatible, nonferrous fire extinguishers readily
themselves, or come in contact with the RF coil). available.
During the scan process, it is imperative that the patient's Follow all manufacturer specifications for safe operation
tissue does not come into contact with the walls of the bore. and maintenance of all patient monitoring equipment used
Most vendors provide pads for this purpose. Caution should during MR procedures.
be taken that the patient's anatomy does not form conductive All MR facilities should have a MR safety officer and com-
loops. Instruct patients not to cross their legs or clasp their mittee who oversee and enforce the written MR safety policies
hands on their torso during the scan process. These risks are of for their institution.
special concern at higher field and gradient strengths. There are many factors to consider for ensuring that a MR
Drug patches that deliver medications may have metallic facility is properly prepared to serve patients and support MR
backing and are therefore at risk for delivering burns during personnel. Adaptation to the ACR Guidelines and strict adher-
the scan process. Consult with the patient's physician before ence to the policies and procedures put into place by your insti-
removing the patch so the dose is not miscalculated. tution will maximize a safe and secure environment.
References SecondaryMainMenuCategories/quality_safety/MRSafety/
Kanal E, Barkovich AJ, Bell C, et al: ACR Guidance Document JointCommissionIssuesMRISentinelEventAlert.aspx.
for Safe MR Practices: 2007. Available at: http://www.acr.org/ Mednovus: SAFESCAN Target Scanner. Available at: http://www.
SecondaryMainMenuCategories/quality_safety/MRSafety/safe_ mednovus.com/targetscanner.html.
mr07.aspx http://koppdevelopment.com
American College of Radiology. Joint Commission Issues
MRI Sentinel Event Alert. Available at: http://www.acr.org/
xix
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Chapter
MRI of the Head and Neck
1
Chapter Outline
IMPORTANT CONSIDERATIONS FOR SCAN MRA—CIRCLE OF WILLIS
ACQUISITION Magnetic Resonance Venography—Superior
ROUTINE BRAIN SCAN SAGITTAL SINUS
BRAIN FOR PITUITARY BRAIN FOR CEREBROSPINAL FLUID
BRAIN FOR INTERNAL AUDITORY CANALS (IACS) BRAIN FOR STROKE
BRAIN FOR ORBITS—OPTIC NERVES fMRI—FUNCTIONAL MRI
BRAIN FOR MULTIPLE SCLEROSIS soft tissue neck
BRAIN FOR EPILEPSY—TEMPORAL LOBE MRA—carotid arteries and carotid
BRAIN FOR TEMPOROMANDIBULAR JOINTS bifurcation
1
Chapter 1 MRI of the Head and Neck
3
Chapter 1 MRI of the Head and Neck
Vessels are always flowing so they are bright on phase con- a flow void (appear dark) on T1 and T2 pulse sequences.
trast scans. Veins flow slower then arteries at approximately Saturation bands can be used on all pulse sequences.
15-20 cm/sec, whereas arteries flow at approx 50-70 cm/sec. • Flow compensation (FC) or gradient nulling should be used
• Enhanced MRA and MRV are high-resolution PC sequences on T2 images to help compensate for CSF flow and vascular
that can be used to replace TOF imaging. It has the ability to motion. FC should never be used on T1 pre-contrast because
eliminate vascular susceptibility issues that occur with TOF it can cause vessels to appear bright and mimic pathology.
sequences, because it uses the velocity of the flow instead of It is often used post gadolinium (GAD) on T1 sequences to
flow-related enhancement. compensate for flow artefacts.
• Fat saturation (FS) options and terminology are vendor spe-
Options cific. For GE systems, use “fat classic” for fat saturation of the
• Inferior (I) saturation (sat) band can help to compensate for orbits and internal auditory canals.
CSF and vascular pulsation. Vascular structures should have
ROUTINE BRAIN SCAN
Acquire three-plane pilot per site specifications.
Figure 1-1 Sagittal brain Figure 1-2 Axial brain Figure 1-3 Coronal brain
5
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this crest, and descending get between us and the captured but now
abandoned Heights in the rear?
The dawn of Monday proved how well grounded had been these
fears. At eight o’clock a heavy rebel column was observed streaming
down the mountain side, and pushing rapidly for Marye’s Heights.
Not a picket had been thrown out to give warning of their approach,
or a single gun to sweep the gully through which they had to pass. A
scene of utmost confusion now ensued. The road leading from the
city out to the army was crowded with straggling soldiers, going on to
rejoin their Regiments, supply wagons, ammunition trains and
ambulances filled with wounded from the previous evening’s fight.
The soldiers scattered through the fields in all directions. The
teamsters and ambulance drivers dashed furiously into the city, or
turned back to the army, thereby escaping. A few, losing presence of
mind, cut their horses loose from the wagons, and, mounting them,
rode away, in hot haste. Gen. Gibbon, in charge of the city, sent up
one or two Regiments left with him as a patrol, to check the enemy.
But it was useless for them to attempt doing so, and after firing three
or four rounds, they fled out to the army. The rebels now pressed
forward and re-occupied the Heights, delivering as they did so, one
of their characteristic yells, so much resembling a wolf howl.
After resting for a moment they were deployed out to the right of
the Heights, and forming an extended line, swept rapidly up after the
Sixth Corps. A Union battery, planted on a bluff up the river, one mile
from the city, immediately opened a hot fire on their backs, and so
interfered with his plans that the commanding officer was content to
draw in his forces and mass them around the Heights.
Fredericksburg, as well as Falmouth, was now perfectly
defenceless, all the troops not with Sedgwick having been sent up to
the support of Hooker, and a few siege guns planted on Stafford
Heights, comprising almost our only artillery. The enemy, had they
known it, could have passed down into the city with impunity, paroled
our fifteen hundred wounded, and then, seizing our pontoon-boats,
pushed over the river and captured Gen. Hooker’s headquarters and
the immense supplies at the Falmouth depot. Why they did not at
least descend to the city still remains a mystery. Perhaps they were
intimidated by the show of resistance made by a few stragglers,
whom some wounded officers collected about the streets and posted
along the edge of the city. Capts. Root and Cole, and other officers
in the hospital, sent their swords and equipments over the river,
expecting to be made prisoners. As the day advanced, however, and
the enemy did not come down, preparations were made for
transferring the wounded to the opposite bank, and before night they
were all taken over, together with the materiel of war, which had
collected there.
The Sixth Corps was now placed in a most critical position by this
coup-de-main of Gen. Lee, having the enemy in front, left and rear,
and an unfordable river on the right. No wonder that Gen. Butterfield,
Chief-of-Staff, when he rode down to the Falmouth side of the river
and comprehended the situation, remarked to Gen. Fogliardi, the
Swiss General who accompanied him, “Sedgwick has gone up.” That
indomitable hero, however, had no idea of “going up,” but
immediately set about rescuing his command from the dilemma in
which Hooker and his Chief-of-Staff had placed it. Hooker and his
Chief-of-Staff, we say, for it was in accordance with their orders that
the Sixth Corps had been pushed on, regardless of the higher ridge
at the left.
The diagram on the opposite page represents the positions of the
different forces of both armies as they then were.
First on the west our main army, then Lee’s main army, then the
Sixth Corps, then a rebel Corps, and then our siege guns, planted on
the east side of the river—a most extraordinary sandwiching of
opposing forces together.
Instead of attempting to cut his way through to Hooker in front, or
Fredericksburg in the rear, Gen. Sedgwick drew back Brook’s
Division, still in the advance, and arranging his army in the form of
an arc, fronting towards the enemy, gradually contracted the lines
until the wings extended nearly to the river. By this movement the
rebels were thrown out of the rear to his left front. The lines
continued to stretch out towards the river, until they enclosed Banks’
Ford, six miles above the city, over which communication was
immediately established with Falmouth, and Gen. Sedgwick sent for
supplies. The announcement of this fact dispelled much of the gloom
prevailing at headquarters, for it was then known that if the Corps
could hold out until night it would be able to draw back to the ford,
under cover of darkness, and escape.
At daybreak, the Thirty-third, together with three other Regiments
of Gen. Neill’s Brigade, had been sent out to attack a body of rebels
who appeared on the higher ridge, some distance further on from the
point where they finally descended. After a spirited fight, the enemy
were put to flight. The Regiment had now returned, and was posted
on the left curvature of the arc formed by Sedgwick, about one mile
from the Heights, and near the road leading from the city. Occupying
a commanding position, and being so near, they could perceive all
the operations of the flanking force, which numbered twenty-five
thousand. The reader can imagine their feelings at seeing the
Heights which they had so gallantly stormed on the day previous,
now reöccupied by the enemy. After being arranged in line of battle,
the men amused themselves by firing at the rebel skirmishers, who
crept up behind the trees and fences to reconnoitre our position.
Several were killed in this manner. Lieutenant Carter, seizing a
musket from the hands of one of his men, brought down a general
officer, who persisted in recklessly riding out in front of the line.
As the morning advanced, members of the Regiment proceeded
out on the road, and brought in one of the wagons abandoned by the
teamsters, which proved to be well stocked with delicacies for a
General and his Staff. This was a rich prize for the men, who, now
having subsisted for six days on the scanty contents of their
haversacks, were as eager for food as the famished Arab in the
desert, who, discovering a bag of gold, mourned that it did not
contain dates.
Towards noon a Brigade of rebels charged upon the earthworks
thrown up in front of the Brigade, but were handsomely repulsed,
and two hundred of them made prisoners, by a counter charge.
Our forces remained in two lines of battle, expecting every
moment a fierce onslaught from various points. But the day wore
away without an attack, and the men were beginning to think that
none would be made, when suddenly, about four o’clock, a heavy
column of reinforcements for the enemy were observed descending
the upper ridge. This meant battle. Imagine a semi-circle within a
semi-circle, and you have the relative positions of the opposing
forces at that time.
An hour later, the rebel hordes rose quickly from the Heights
where they had lain all day, and rushing forward with cheers and
yells, precipitated themselves upon our line. At the same moment
the siege guns at Falmouth opened a fire on their rear. Gen. Neill’s
Brigade, being the nearest to them, bore the brunt of the attack, and
though assaulted by overpowering numbers, maintained its position
and repulsed the enemy. One Regiment, the same which broke at
White-Oak Swamp, gave way, thereby bringing a destructive cross
fire upon the Thirty-third. As the rebels fell back in disorder through
the fields, it was only by the greatest exertions that Col. Taylor could
restrain his men from following. A few squads did rush forward and
secured several prisoners.
But unmindful of the havoc made in their ranks, the enemy again
pressed on, determined to crush the Brigade. At the same time they
attacked other points in the extended arc, and Gen. Neill, seeing that
there was imminent danger of his position being turned, fell back,
not, however, before having incurred a loss of one thousand men.
Gen. Sedgwick now gave instructions for the entire lines to recede,
in accordance with the plan which he had previously decided upon,
viz: to slowly fall back fighting to the river, until darkness should
come on. As the lines drew back, the enemy steadily pursued, a
vigorous fire of musketry and artillery being kept up on both sides.
Our batteries literally mowed the pursuers down, as they repeatedly
charged upon them in solid columns. The gunners reserved their fire
until the charging forces came within a few rods, and then poured
the grape and cannister into them at a fearful rate. Having broken
the columns, they would fall back to new positions, and again resist
their approach.
In this manner the retreat was conducted most successfully,
though not without great loss. The Thirty-third, which suffered
severely at the outset, likewise lost many men in falling back,
including Lieuts. Porter and Rossiter. While scaling a fence at one
time, which through some culpable negligence had been left
standing, several were killed and wounded. Gen. Neill being stunned
by the falling of his wounded horse, Col. Taylor temporarily took
command of the Brigade.
To assume command of a Brigade in the confusion of a retreat,
when the enemy was pressing on all sides, was a most hazardous
undertaking. Col. Taylor, however, did not shrink from the
responsibility, and with the assistance of the Major of the Seventh
Maine, who stepped forward when he called for volunteer Aids, soon
arranged the Regiments in proper line.
SALEM HEIGHTS.