ACUSON Maple System fourSight 4D Ultrasound | 1.0

Continue Continue Continue Continue Continue Continue Continue Maple 3D4D Course Master Template HILS2218 | Effective Date: 25-Mar-2022 ? ACUSON Maple™ Ultrasound System | Advanced fourSight™ Technology | 1.0 Software Release In this course contains a series of short videos that will review of the 3D, 4D, volume rendering, real-time 3D and freehand acquisition. The tools, terminology, and image optimization are also included. The objectives are listed here. Outline activation and volume acquisition Review helpful guideline and tips Compare volume storage and editing options Review tools used for volume manipulation 1 4 3 2 Welcome Review site: Password: foresight Statement is only needed on the first slide. Word count: 0 ? 3D/4D Transducers 3D/4D Transducers The 3D/4D transducers available are the mechanical wobblers, which are the 9VC2 and the 9VE4. The non mechanical transducers available are the 10MC3 and only can perform a free hand 3D volume acquisition. We will review the terminology and technology for 3D and 4D. During a 3D acquisition, a single freehand or mechanical automated sweep is performed and produces three orthogonal dimensions or planes, as well as a volume rendering. During a 4D acquisition, the transducer continuously acquires and displays the volume information. This method is also known as real-time 3D ultrasound. The time is considered the fourth dimension. The controls for both transducers are the same, with the exception of the scanning technique that will be covered later in this presentation. ? 3D/4D Terminology 3D/4D Terminology Once entering 3D/4D acquisition, the ROI or region of interest and the VOI or volume of interest graphic box is adjustable in combination only. The ROI size of the box represents the entire area of interest. The VOI rectangular box defines the content of the volume. Once a volume is performed via the Update key, the VOI rectangle box can be resized and optimized. The VOI plane can be curved and will be discussed later in the presentation. Please note when performing a 4D scan, it is possible to readjust the VOI during live scanning or in freeze. Also, when a 3D auto sweep is acquired, it is possible to readjust the VOI size in the frozen 3D volume only. In 3D or 4D mode, when positioning and adjusting the ROI or VOI, the 2D image quality is unchanged. This is the display of an acquired volume with a format of four on one. MPR is the abbreviation of multiplanear reconstruction, also known as multiplanear reformatting. The quadrants are referred to as A,B,C, and D, with quadrants A, B, and C containing the MPRs of the volume and D containing the volume. A is the acquisition plane, B is the elevation plane, C is the coronal plane, and quadrant D contains the surface-rendered volume. The reference orientation indicator in the volume quadrant uses color to indicate the relative location of the data acquired. The first data set is displayed in blue, and the last data acquired in red. The top or apex of the pyramid represents a transducer. The base of the pyramid represents the data at the greatest depth. The reference marker is the intersection point between all three orthogonal planes. Volume manipulation is facilitated by placing the reference point within the volume. This subsequently becomes the pivotal point around which the volume may be rotated along any of the three axes without losing its position. As it remains displayed in all three orthogonal planes. This image using a GYN Phantom is provided as an example. The uterus was acquired to demonstrate an implanted embryo using a 3D auto sweep. Rotations are done via the X, Y, and Z. The embryo remains clearly displayed at all times and in all perpendicular planes as the primary designated structure. If the endometrium becomes the primary point of interest, then the reference marker may be moved from the embryo to the endometrium for navigation within the volume, with the endometrium as a pivotal point. ? 3D/4D Getting Started 3D/4D Getting Started To acquire a volume, press the 3D/4D key on the control panel. Press the Update key to start the 3D/4D acquisition. The default setting for either 3D Auto sweep or 4D Live can be customized for each exam by going to the Configuration page, Exam Type, and then go to 3D/4D Default selection and then make your choice at the 3D/4D Default selection. The Update key starts the volume acquisition using either 3D or 4D, depending on what the user has selected. Before entering a volume acquisition, select the Set key to adjust the ROI toggle between the ROI size and ROI position or panning using the Set key while using the track ball to adjust or move the ROI. VOI resizing can be done on a frozen volume or during live 4D. The ROI outline will change from a solid line to a dotted line during the ROI resizing. The Update key allows a user to toggle through the volume rotations X, Y, and Z on the selected quadrant. When activating 3D imaging, the selected angle size will be displayed in the right upper corner. When in a 3D acquisition, the system updates the incremental data set or slice of the acquired image. The incremental slice is the mid plane perpendicular to the 2D scan plane. On the Touch Screen the 3D method is blue when activated. The major pre-acquisition parameters are Quality and Angle. Details about Quality and Angle settings will be discussed later in this presentation. On the entry page, the volume SubPreset. Details regarding SubPresets will be discussed later in this presentation. Please note 3D Autosweep has a higher volume Quality and detail resolution compared to a 4D acquisition. When activating a 4D image, the 4D function is blue when activated on the Touch Screen. On the soft key control area, the major pre-acquisition parameters are Quality and Angle. On the entry page, the volume SubPreset is also accessible. ? 3D/4D Monitor Layout 3D/4D Monitor Layout The patient banner display at the top of the screen is customizable. Go to System Configuration, General Two, Hide Patient Banner. Depending on the user or site preferences, it can display the patient data as well as information such as hospital name, time, and date of the exam. Volume acquisition imaging parameters such as opacity, Dynamic Range, Brightness, et cetera are displayed in the upper left corner of the image. The image screen area contains the acquired volumes. The format of four on one is predefined. The surface rendered volume on the left and the related view plane in each orthogonal MPR is displayed on the right. A blue and red volume orientation icon is located next to the image display field in the lower left corner to aid the user during manipulation. The cine buffer indicator is located at the bottom of the screen. ? 3D/4D Acquisition 3D/4D Acquisition To acquire a 3D AutoSweep volume, press the 3D/4D control to display the VOI and place it for the desired anatomy. Adjust the VOI size by pressing the Set control and then press Set again to confirm the size. Press the Update control to start the acquisition. The transducer will perform a mechanical sweep of the selected area and when completed, will display the volume and the image format that the user selected. To perform a freehand acquisition with the 9MC3 or 10MC3, first select if the scan will be a Linear or Rocked acquisition. For endovaginal acquisitions, select the Rocked option, move the transducer in a slow, steady sweep, and obtain the desired anatomy. The sweep should start from the patient's right to the patient's left or inferior to superior. The position of the transducer should be as consistent as possible to avoid registration lines in the image. The timer will be displayed indicating how much time is left to acquire the anatomy. The user has the option to stop the acquisition during the scan by pressing the Update key and returning to the acquisition mode. Although the volume will not be saved. To shorten and save the acquisition, the user will need to press the Freeze key and then press the Image key. The default is 90-degrees and may be changed using the Quality and Angle options. ? 3D/4D Volume Manipulation 3D/4D Volume Manipulation Next, we will discuss the tools available for volume manipulation. The control panel of the system contains Rotary Dial keys that allow the user to manipulate the X, Y, and z axis of the acquired volume. The X axis is controlled by the Angle knob. The Y axis is controlled by the PW Doppler knob. The Z axis is controlled by the Color Doppler knob. The MPR slicing function is controlled by the M-mode knob. Please note the Update key can be used to toggle between the X, Y, and Z axis. While in the 3D/4D imaging, the system displays the rotation icons on the selected MPR and volume. When an MPR is selected, the system displays a line and an arrow indicating the axis of rotation on the two corresponding MPRs. X axis rotation is similar to the motion of a rotisserie, Y axis rotation is similar to the motion of a drill. Z axis rotation is similar to a back-and-forth rocking motion. Icons for panning and resizing are also displayed. Once the key is selected, the Touch Screen displays the available functions for manipulating the acquired volume. The Touch Screen layout is grouped for ease of use and contains Advanced Foresight Technology options, MultiSlice, big slice imaging, or TSI, and MPRs are located in the upper right corner. On screen layout options and plane display choices are displayed next. Volume adjustment options are displayed next. Volume optimization soft keys such as Tint, Brightness, or Opacity are at the bottom of the Touch Screen associated with the rotary controls on the keyboard. Touch screen selections are highlighted in blue when on and Gray or dithered went off. Keys that are dithered out are not available in the current active mode but may be available in other modes. Some folders contain additional options or sub settings which are indicated to the user by an arrow or three gray lines on the Touch Screen key. Press the Touch Screen key to open the options or sub settings and select the new option or setting. ? MultiSlice MultiSlice 3D/4D Advanced fourSight Technology contains MultiSlice, thick slice imaging, and Curved MPR options. Press the tab for access to the MultiSlice, TSI, or the Curved MPR feature, and the corresponding imaging folder will open for further adjustments. To initiate MultiSlice, select MultiSlice on the Touch Screen. MultiSlice allows viewing multiple slices of the same plane at the same time. Imagine moving through a volume and displaying each individual slice that you obtained when moving through the volume and spreading them out on a table. This is essentially what Multislics does. Like a CT or MRI, MultiSlice allows selecting the following: Which planes should be displayed A Plane, B Plane, or C Plane. The preferred format three on one, four on one, two on one, or a full screen display. The number of slices displayed at one time or the MultiSlice orientation display with horizontal or vertical lines. Please note once entering MultiSlice, the surface rendered volume is disabled. Once a selection is made, tabs for various page selection appear on the Touch Screen. Previous Page indicates moving through the entire range incrementally. Previous Image allows moving through the slices within the selected range. An advantage selecting via the Touch Screen and target will be that an MPR image stays fixed in the center and the slices will move. Another option is to use the selected plane A, B, or C to move the MPR via the track ball into the MultiSlice. In this case, the slice graphics stay fixed on the MPR. Let's review the two image examples. The left image demonstrates a selection of format four on one with a layout of two by two and chosen vertical lines on the A plane. The right image demonstrates a selection of format of three on one with a layout of three by three and a chosen horizontal line on the A plane. Highlighting the slice in yellow correlates the selected slice within the display and its position within the slice graphics. The ability to rotate the slices in X, Y, and Z axis while in one of the three MPRs is using the mode rotary controls on the control panel. Select the one on one format using the Select knob or click the pointer and Set key on the D quadrant on the Touch Screen. In the full screen mode, the slice spacing, slice number, and total number of slices is shown. Slice spacing is displayed in the image in the left lower corner in millimeters. In this image example, 3.5 millimeters slice spacing was predefined. The current slice number is displayed together with the total number of slices in the right lower corner. A green marked asterisk indicates the center slice of the total number of slices acquired. Please note the green asterisk is already present in combination with the three MPRs layout. The user has the ability to rotate the slices in X, Y, and Z axis while in the full screen display using the mode rotary controls on the control panel. To exit the MultiSlice function, press Exit on the Touch Screen. ? Thick Slice Imaging or TSI Thick Slice Imaging or TSI TSI allows the user to define a view plane or a cut plane and create a certain thick slice in the region of interest. A benefit using TSI is to have access to a predefined thickness of the volume of interest at the acquired region of interest. The result will display in the render mode in a desired slice thickness from two to 40 millimeters. This results in increased detail and contrast resolution in the selected rendered volume. To initialize, select TSI located on the Touch Screen. Select the desired planar display the default is A to C, which is the most used combination for the clinical application. A to C displays the A plane or the MPR with the coronal volume view or D. Select the planar option A to A, which means the display of the A plane of the MPR with the A plane view synchronized to the volume or D. And finally, you'll have the option to choose a slice thickness. If necessary, select another render mode. The surface mode is selected in this example. Volume optimization parameters are accessible use the rotary control to adjust the values. The default is the A to C planar display and with a predefined 20 millimeter slice thickness. Please note that a new icon appears marked in a yellow rectangle and inside the A plane MPR slice as the reference orientation. The MPR A plane is displayed on the left aligned with the reference point. A dotted line appears in advance named as position line or reference line, and this line represents the intersection of the volume rendering or VR. The VR is displayed in association with the C plane and contains the 20 millimeter thickness. To edit the TSI view, before entering TSI function, the user should have adjusted the reference point to the primary designated anatomic structure, and it does not matter if the VOI was on or off or which render mode was utilized. If necessary, adjust the slice thickness setting and observe the effect on the volume. A higher thickness setting will create a thicker slice, and a lower value will create a thinner slice. Activate the A plane by using the pointer and Set key. Move the A plane up or down by using the track ball and please note the effect on the rendered volume. The result image is displayed here. Continue the editing process. The image on the left shows that the reference is fixed. The A plane image was moved up via the track ball until the expected anatomical structure is visible, and in this image example with the GYN Phantom, the focus was to view the embryo. For the image on the right, as long as the A Plane quadrant is still active, the user can access the A Plane rotation. Press the Update key and the track ball will be combined with the rotation line function and a new rotation icon will appear. Move the track ball to adjust the angle and to see the effect on the C volume plane with TSI. Please note be aware that the rotate line does not allow the function as X, Y, and Z. To access the Z axis, rotate the anatomical assessment into a portrait view. Activate the C plane TSI by using the pointer and Set key. A gray outline will be displayed and the Z axis rotation is activated for use via the C mode knob on the control panel. Rotation for X axis and Y axis are disabled, when in the TSI function. Select the A to A folder to initiate the A Plane with a synchronized A view. Please note the reference line has disappeared. The reference dot is still present and promotes the fixed slice center. The TSI icon marked in yellow changes into the reference orientation based on the A Plane view. To exit the TSI function, select Exit on the Touch Screen. ? Curved MPR Curved MPR The function Curved MPR transports the MPR reformatting image into any linear or curved plane. Curved MPR allows a user to set points along a curved object in order to straighten it. The placement of the points tells the software where to put the center of the image. The process is called warping, and the effect is straightening. The selection line defines a curved line structure with two marker positions. The selection trace defines a freeform drawn outline, and the selection spline defines a curved line structure with three or more marker positions. To activate Spline, press Spline on the Touch Screen and a cursor appears. To draw the line, position the crosshair at the top of the endometrium shown in this example and press the Set key. Please note the place you begin the trace affects the orientation of the straightened image. Use the track ball in combination with the Update key to set the spline method points. Once you have finished drawing the line, press the Set key and the straightened image will be displayed to the right. Reposition the line if necessary. Position the pointer over the red dot in the middle of the line and a hand icon appears. Press and hold the Set key and move the track ball to pan the Curved MPR line. Please note if you only press the Set key instead of pressing and holding the Set key, the trace line will disappear, and the trace will need to be repeated. The image on the right has been straightened. The Z axis rotation brings the image in the desired anatomical view. To rotate the line, position the pointer over either end of the line and a circle rotation icon will appear. Press and hold the Set key and move the track ball to rotate the curved MPR line. Please note if you only press the Set key instead of pressing and holding the Set key, the trace line will disappear, and the trace will need to be repeated. To exit the TSI function, select Exit on the Touch Screen. ? 3D/4D Volume Display 3D/4D Volume Display To select Quadrant, select the desired quadrant from the options located on the left side of the Touch Screen, or position the pointer on the required quadrant on the image screen and press the Set key. To select a display format, select the desired format for two on one, four on one, three on one, or one on one, from the options in the center of the Touch Screen. The one on one displays the selected quadrant only. Please note to display the rendered volume, the quadrant D must be highlighted. To select the volume orientation, select the desired angle on the right side of the Touch Screen and this aligns the rendered volume to the selected angle. The small green dot on the side of the volume indicates to the user the displayed degrees of angulation. The choices are zero degrees, 90-degrees, 180-degrees, or 270-degrees. The Select knob allows quick access into the one on one format for the volume display only. The quadrant activated is the one highlighted in green. Press Select again to return to the previous format display. Please note this is the fastest access into the one on one volume display for workflow. The VOI can be resized, repositioned, and curved after acquisition. The VOI will be backlit in blue when active. To position or size the VOI, select the Set keys to toggle between each mode. Position allows a user to pan the image to the desired location. Size allows resizing of the VOI. Select Curved from the touch panel or from the editing tab to access the VOI curve. The two Homebase configuration options are displayed here. Curved VOI allows a user to curve the rendering view line of the VOI box and exclude extraneous information. To access the curved rendered view, select Curved on the touch panel or from the editing tab and move the track ball to the desired curve. A yellow cross appears in the center of the icon at the top of the image. To exit, select Curved again. The Wireframe and CutPlane folders are dithered out as long as the VOI is on. CutPlane enables or disables the CutPlane for the volume data. The acquired volume displays the database on the ROI region size. When enabled, the volume does not display any volume data beyond the cut plane. When the CutPlane for A or B is active, the reference CutPlane slice appears as a solid green rectangle. Use the M-mode key on the control panel to slice through the volume. Each MPR is synchronized when the selected quadrant is highlighted. Typically, the C Plane is aligned. The adjustment sink is under the folder Reset, which will be explained later in this presentation. Please note working with VOI off is often used when performing a fetal head rendering, especially in the corpus callosum area. In Gynecology applications, it is useful to slice through the uterus endometrium and or the ovaries. ? 3D/4D Volume Tools 3D/4D Volume Tools Additional 3D/4D tools are available and will be discussed in detail later in this presentation. Number one Editing, this allows a user the following different tools to edit a volume: Polygon, Large and Small Eraser, Trace, Undo All Edit, Undo Last Edit, turning the VOI on and off and Curved. Number two, reset allows a user to reset or change the orientation of the volume with the following tools. Sync or synchronize aligns the selected plane with the rendered volume. Flip reverses the rendered direction. Reset orientation restores the default orientation for all quadrants. Reset All restores to the default preset options. Number Three, SubPreset, this will be discussed later in this presentation. Number four, Animation this allows the volume to be automatically rotated and also will be discussed later in this presentation. Render direction, Render mode, and LightSource will also be discussed later in this presentation. To edit and remove unnecessary structures, select Editing on the Touch Screen and choose the preferred cutting method. The active method will also be highlighted in blue. The cursor is active only on the selected quadrant. Therefore, select your quadrant first A,B,C or D. Please note rotating the volume assists in determining the type of editing required. Editing features include Polygon this defines an irregular area from a drawn outline. First, position and anchor the starting point for each segment of the Polygon. Roll the track ball to position the ending point and then press the Update key. Press Set to complete the Polygon. Position the cursor where the data will be removed inside or outside the Polygon and then press Set. Trace defines an area from a freeform drawn outline. To start, position and anchor the starting point, roll the track ball to trace the area of interest. Position and then anchor the ending point. Position the cursor where the data will be removed inside or outside the trace shape, and then press Set. For Eraser, a small and large displays a circular shape cursor first position and anchor the starting point. Roll the track ball to erase data, then press Set to complete the edit. To delete all the edits, select Undo All Edit. Sync or synchronize aligns the slice MPR and volume orientation or D. When the selector quadrant is a slice, Sync aligns the orientation of the volume quadrant to that of the slice quadrant. When the selected quadrant is the volume quadrant, Sync aligns the orientation of all slice quadrants to that of the volume quadrant. It is a helpful tool, when VOI is off and using the cut plane A or B functions. Flip reverses the render direction. It is typically used for fetal spine or fetal facial bones. Reset Orientation restores the default orientation for all quadrants. Reset All restores the default orientation and display format for all quadrants. Reset All restores the default or user defined settings of other parameters for all quadrants. User defined settings are those that were in effect when the current volume was first displayed. The system will have predefined SubPresets for each transducer and preset. To enter a SubPreset, select SubPreset on the Touch Screen that will take you to the SubPreset folder. Define creates an optimized configuration of volume parameters for use during 3D or 4D imaging. Please note the SubPresets are independent of the 2D image parameters. Use a quick set User Defined exam preset to customize the 2D settings and use a SubPreset to customize the 3D/4D settings. Select Define to display the SubPreset menu and a dialog box appears. Select New and then add a name and select OK. To enable the new SubPreset as the default exam type for subsequent patient studies, select Set as default. The new SubPreset is displayed next to the SubPreset name, and then select OK. This is an example of a user defined SubPreset list. On the Touch Screen, there are 17 user defined SubPresets. Please note any SubPreset can be selected in the frozen volume image. The exam type contains the measurements, text annotation, body markers, and the default SubPreset. The user can assign a user defined SubPreset with the exam type. Set as default must be selected while in process to create a SubPreset. To activate 4D Cine, select 4D Cine on the Touch Screen. To activate 4D Cine, select the 4D Cine on the Touch Screen. Review Cine Data reviews the data in a continuous loop. Play starts cine playback. Pause stops the Cine playback and the Cine Speed can be selected by rotating the soft key. To activate the animation feature that automatically rotates the volume, select Animation on the Touch Screen. Adjust the settings for Speed, Angle, Axis, and Clip Time by rotating the soft key. To pause the animation, select Pause on the Touch Screen. Please note you can change the automatic rotation settings while the volume is rotating. The Render key allows a user to select the display render method for the volume. Press Render and select a mode. Render method controls how the rendered volume is displayed, except for slice and MPR Only. The render options include Surface Mode. This smooths the image contours, creating a soft sculptured appearance for highlighting surface features. This uses the mode specific selections for surface percentage and threshold. The main application is for fetal face and in gynecology for uterus and ovaries and most internal structures. MaxIP or Maximum Intensity Projection limits the display to maximum value pixels with the highest value along each projection of the volume. This is used for bone structures like spine, long and short bones, or fetal face bones. MPR Only displays the three MPR reconstructed slices without the rendered volume. It is commonly used to identify internal structures. MinIP or Minimum Intensity Projection limits the display to minimum value pixels with the highest value along each projection of the volume. It is a helpful tool when visualizing hypoechoic lesions and large vascular structures. For example, the fetal aorta, fetal Heart and in gynecology for the adnexa area. Mean IP or Mean Intensity Projection limits the display to average value pixels by selecting pixels with the average mean value along each projection of the volume. The Slice mode displays a one voxel thick slice in its 3D context. The displayed slice within the volume corresponds to the most recently selected slice of the MPR quadrant. ? LightSource LightSource LightSource is a movable light source that helps increase the depth perception, reveal surface details, and provides an element of texture and can provide a deeper understanding of relational anatomy. To use LightSource, acquire a volume, then select LightSource from the Touch Screen. Select the Light key from the track ball pad and roll the track ball to move the position of the light source. Select Set to confirm the light direction, and then select Exit to go back to the prior renderer. When acquiring a volume, the format displayed will be a four on one. When LightSource is activated, the one on one format will automatically be displayed. Here is an example of entering the LightSource feature and using the caliper to adjust the light. When in the LightSource mode, the user will have the option of selecting the lighting feature. This will allow the user to access nine separate light directional icons for quick access. Another option is to adjust the brightness of the light levels and it ranges from one to 100%. To change the percentage of light on the volume, rotate the Light rotary control. To exit, select Exit on the Touch Screen. Here is an example of using the different lighting directions. LightSource offers ten different tints to choose from. Here is an example of brightness at zero and at 100%. ? Volume Optimization Volume Optimization The volume angle determines the distance of the volume sweep. A large angle is equivalent to a larger sweep. The maximum field of view angle with the 9VC2 transducer is 69-degrees. The maximum field of view angle with the 9VE4 transducer is 145-degrees. The acquisition angle default setting for the 9VC2 transducer with 4D imaging is 55-degrees and works well in most fetal face scanning. The default setting for the 9VC2 transducer with 3D imaging is 65-degrees. The field of view and acquisition angle default setting for the 9VE4 is 90-degrees. Increasing the sweep angle is recommended in later pregnancy and or if the fetal face is shallow, or nearby the transducer. A lower angle setting will result in a higher volume rate per second in 4D imaging. And a higher angle setting will reduce the volume rate per second in 4D imaging. When scanning the uterus using the 9VE4 transducer, it is highly recommended to use the 3D AutoSweep with the largest acquisition angle of 90-degrees. It is important to display the uterine fundus with the endometrium border on the left and right side. A higher quality setting acquires more slices and typically provides a more detailed reconstructed image. Available values are from one to six ranging from low to high. High scan line density with the highest setting of Quality six enhances the detailed resolution of the rendered volume but will decrease the volumes per second. Medium scan line density a Quality of four to five, enhances the volumes per second and this results in a limited loss of volume resolution. Low scan line Density, a Quality of one to three has the lowest rendered volume quality but the highest volumes per second. The soft key area contains the pre and postprocessing image optimization tools. These parameters improve the display of the MPR planes and the rendered volume. Six controls are located on the control panel with corresponding selections on the Touch Screen. The selections correspond with the location of the rotary keys. On the Touch Screen, select the desired parameter to change or push and rotate the corresponding rotary control clockwise or counterclockwise. Dithered or grayed out fields may be available in a mode and are activated by pushing the rotary control and rotating to change a value. Please note the three MPRs images and volume have some specific parameters when selected. Make sure you have one of the MPRs or the rendered volume prioritized, which will be displayed in a green outline. Low Threshold is when changing the threshold, all echoes below that level are enhanced in a green color for a certain interval and is seen on the three MPR images. Decreasing the value of the Low Threshold will fill in the surface rendered volume with more low level echoes or voxels. Soft tissues like vernix, noise, or umbilical vessels are enhanced. Increasing the value of Low Threshold will remove low level echoes and it may help to clean up the face image. When noise artifacts and or low level echo structures like vernix are present. The Quality depends on the scanning quality of amniotic fluid, maternal abdomen, and how many structures are in front of the fetal face. The default setting starts at 50%. Opacity adjusts the percentage of Opacity level on the overall rendered volume density. The default setting starts with 60%. For fetal face, the values between 60% to 70% are commonly used. To perform 3D, for internal structures such as fetal abdomen or fetal head, a higher Opacity level is necessary mainly between 65 and 85%. 3D imaging and GYN applications, the Opacity setting default is at 65%. Opacity level may be increased up to 85% for cases when you have a myoma, fibroma, endometrium disease, or hemorrhagic cysts. Brightness enhances the voxel saturation. However, it depends how much the 2D gain was adjusted before entering 3D/4D. Increasing the 2D gain slightly prior to entering 3D or 4D imaging may be necessary to achieve an acceptable surface rendered volume compared to conventional 2D. The default setting is at 50%. To get a good surface rendered volume in early OB to early second trimester, the 2D gain must be increased slightly prior to entering 3D/4D. Contrast allows greater visualization of voxels next to each other. A good contrast setting will enhance the depth perception. Available adjustments are from zero to 100% and the default setting is at 50%. Smooth adjustment affects the display of the surface rendered volume. For the fetal face, a range between 40% to 60% is preferred. For early OB to mid-second trimester, use less smoothing for a more detailed look. For the end of the second to mid third trimester, the skin is still developing fatty tissue. At this stage, the skin of the fetus may have a rough looking appearance and increasing the value may result in a smoother fetal face. Please Note To perform 3D data acquisition for internal structures such as fetal abdomen, fetal head, and internal structures in a GYN application, typically zero is used. The maximum adjustment should not be more than ten to 20%. The effect of a higher smooth value in any internal structure decreases the tissue visualization and will blend the voxels next to each other with an adverse result in image quality. The gray map selection affects all three MPR images. Map values are not available for the rendered volume and is dithered out on the soft key menu when the D quadrant is selected. The dynamic range value can be adjusted separately between the three MPRs and the surface rendered volume. To adjust the Dynamic Range using the formats three on one, two on one, or four on one, the volume must be activated, indicated by a green outline. By selecting the quadrant on the Touch Screen or pointer inset key on the control panel. Press the soft key field of Low Threshold and Dynamic Range to the option of Dynamic Range. Rotate the soft key to change a Dynamic Range. This is important in both pre and post processing as it will reduce unnecessary low level echoes and fatty tissue in front of the fetal face. The default setting for the volume is at 45 dB and works for most fetal face imaging. In a technically difficult scan and or a patient with a lot of Vernix, lowering the Dynamic Range to 35 to 40 dB is recommended. If the fetus appears too transparent, increase the Dynamic Range. The Tint selection applies to either the volume or the MPRs. If the selected rendering method is active or the D quadrant, it will apply to the volume only. If one of the MPR images is selected, the Tint will apply to the A, B, and C planes. It is recommended to select the Tint first, and once a volume is optimized, it is not recommended to change the Tint. It may need a re-optimization for Low Threshold, Dynamic Range, Brightness, and or Contrast. Measurements may be performed on the MPR planes, although it is not available on the volume. ? Measure, Edit, and Store Volumes Measure, Edit, and Store Volumes Please note measurements may not be performed on the freehand MPR planes. All measurements are possible using the 9VC2 and 9VE4 transducers, which are the mechanically driven curved arrays. Please note AutoOB measurements are not possible and will be automatically grayed out when the caliper is pressed. Manually labeled measurements are available. No measurements are available with freehand 3D using the conventional 2D transducer. To edit a 3D/4D volume, turn off VOI. Additional editing tools are available and will not be grayed out. To access the Parallel Cut quadrant D volume must be active. To activate Parallel Cut, select Parallel Cut on the Touch Screen. The system displays the wireframe and highlights the first active plane on the left. Parallel Cut selects six planes or layers within the volume and removes all the voxels outside the selected plane. For each plane to be used in an edit, roll the track ball to position the plane and press Update. Press Set to complete the edit. Niche removes data inside a Niche cube shape. You can perform one Niche at a time. Rotate the volume until the area that requires editing is in front. Select Niche on the Touch Screen. To simultaneously adjust the size of all planes of the cube roll the track ball. To resize one plane of the cube, press Update, then press Set to complete the edit. Next we will discuss how to edit and store a volume. When acquiring volume cases, the volume should be stored in order to perform further manipulation in the review state. This will allow the user to reconstruct the volume from another perspective and or perform improved volume optimization. To store the volume, press Clip Store on the control panel. When in 3D, the volume will be saved. When in 4D, the system displays a dialog box allowing the selection of a specific storage mode. Please note the default store volume is 4D Cine. Select 4D Cine to store a sequence of 4D volumes consisting of all 4D imaging volumes in the cine buffer. Select OK to confirm. Select 4D Single Volume to store only one volume and select OK to confirm. The thumbnail panel displays the saved data with the 3D/4D icon for data review. Please note the maximum length of a volume of 4D Cine is three seconds. Pressing Clip Store the 4D Live will continuously store the data to the hard drive and display in the thumbnail panel as a clip. The clip length depends on how the system was configured. The clip length can be adjusted temporarily on the Touch Screen under the folder Clip Settings. The permanent clip length can be programmed under System Configuration, Folder Clip Store, Clip length from one second to 60-second drop-down menu. Additionally, it is possible to configure how a clip should be stored retrospective or prospective, and the default is prospective. Print Store One and Print Store Two are the controls to store the single image frame on the hard disk and print a single image via the printer. The configuration depends how the system is set up. Go to System Configuration, Custom Keys, Key function via drop-down menu, and select the various predefined settings. Example for a system with a printer solution, Clip Store is when scanning live it will save a three second clip. Once the system is in the frozen mode, press Clip Store and the volume can be stored in a 4D Cine or 4D Single. Print Store One will store the single image to the hard drive. Print Store Two will print the actual image. To review the stored volumes, press the Review key on the control panel. Stored volumes are marked with a cube graphic. With the pointer, double click on the volume you would like to review. Select the volume icon at the bottom right side of the image to enter volume editing. If a volume 4D Cine was stored, the cine buffer appears. Lastly, we will discuss guidelines and tips for volume imaging. ? Volume Acquisition Tips Volume Acquisition Tips The greatest potential causes for less than optimal 4D fetal face quality is pushing too hard with the transducer on the maternal abdomen. Lighter pressure on the transducer will produce a better result, when utilizing 3D/4D imaging. The midsagittal view typically does not provide the fetal face view. Use the midsagittal view for orientation, not acquisition. Imagine taking a portrait photo with a camera. The Z axis rotation is priority to use based on the A Plane. Rotating the X axis and the Y axis creates lines. To avoid seeing the lines, rotate the transducer in 4D Live first. When in GYN and acquiring a 3D uterus, it is essential having the largest sweep angle, which is 90-degrees. It is clinically important to see that both uterus cornea and the uterine fungus in the C Plane, these are necessary in case of malformation and performing measurements. Other potential causes for less than optimal 4D fetal face quality is having an ROI that is too small for the selected depth. Adjust the depth of the ROI to include the occipital region. The stage of the fetal face skin development as well as the clarity of amniotic fluid is essential for a good 3D/4D acquisition. A lot of vernix in front of the face and in the amniotic fluid provides clarity, in a fetal face image. The amniotic fluid consistency changes throughout the pregnancy, so it's important to be aware of the timing. For example, a fetus scanned at 28 weeks may have a better result when scanned a week later. In this gestational age, the fetal skin is well developed. The difficulty in obtaining a quality 4D fetal face is due to the hand placed in front of the face and the consistency of amniotic fluid demonstrating a lot of vernix. In the volume image, you can see the fetus sucking on the umbilical cord and holding the umbilical cord. In late pregnancy, the amniotic fluid consistency is clearer. In spite of having a small fluid pocket in front of the fetal face, a surface rendered volume was possible. The head is laying against the placenta in this moment. The fetus appears to be sleeping. The fetal face is relaxed at the mouth and cheek region. ? Volume Acquisition Tips Volume Acquisition Tips A gestational age between 29 weeks to 34 weeks is very exciting because it is when the facial muscle development occurs. A lot of fetal face expression can be seen during this time. Examples include from an angry looking moment to a happy relaxed time clearly visible in this presented comparison. The image on the left shows that the facial muscles demonstrating a lip pucker, inner brow raise, cheek raise, nose wrinkle and the eyes are squeezed shut. The image on the right is showing approximately five minutes later, the fetus started to play with the umbilical cord, feet, and hands. In this gestational age, fetal face entertainment has begun. These images demonstrate fetal face expressions looking through the 4D cine loop based in the upper left image, the following parameters were used. A reduction of VOI size, decrease Low Threshold value to reduce soft tissues, volume Dynamic Range decreased to forty dB, and increased contrast resolution by decreasing the Brightness. ? Course Review Congratulations. You have completed the ACUSON Maple™ Ultrasound System | Advanced fourSight™ Technology | 1.0 Software Release course. Select the numbered buttons below for a high-level review of the material presented in this course. 1 1 1 3 3 3 2 2 2 4 4 4 Outline activation and volume acquisition Review helpful guideline and tips Compare volume storage and editing options Review tools used for volume manipulation Course Review Review helpful guideline and tips This is important in both pre and post processing as it will reduce unnecessary low level echoes and fatty tissue in front of the fetal face. When utilizing 3D/4D imaging, avoid too much pressure on the maternal abdomen.Use the midsagittal view for orientation, not acquisition. Avoid registration lines by rotating the transducer in 4D Live first. When in GYN and acquiring a 3D uterus, it is essential having the largest sweep angle, which is 90-degrees. Other potential causes for less than optimal 4D fetal face quality is having an ROI that is too small for the selected depth. Adjust the depth of the ROI to include the occipital region. The stage of the fetal face skin development as well as the clarity of amniotic fluid is essential for a good 3D/4D acquisition. A lot of vernix in front of the face and in the amniotic fluid provides clarity, in a fetal face image. The amniotic fluid consistency changes throughout the pregnancy, so it's important to be aware of the gestational age. Select the in the upper right corner to return to the Course Review page. Select the in the upper right corner to return to the Course Review page. Compare volume storage and editing options To edit and remove unnecessary structures, select Editing on the touch screen and choose the preferred cutting method. The active method will also be highlighted in blue. The cursor is active only on the selected quadrant. Therefore, select your quadrant first A,B,C or D. Curved VOI allows a user to curve the rendering view line of the VOI box and exclude extraneous information. CutPlane enables or disables the CutPlane for the volume data. Animation allows the volume to be automatically rotated. Polygon defines an irregular area from a drawn outline. Trace defines an area from a freeform drawn outline. Large or Small Eraser displays a circular shape to remove data from the VR. Maximum length of a volume of 4D Cine is three seconds. Clip Store saves the 4D Live data to the hard drive continuously and the clip length is configurable. Stored volumes are marked with a cube graphic. Select the volume icon at the bottom right side of the image to enter volume editing. Select the in the upper right corner to return to the Course Review page. Select the in the upper right corner to return to the Course Review page. Review tools used for volume manipulation The control panel of the system contains rotary dial keys that allow the user to manipulate the X, Y, and z axis of the acquired volume. The X axis is controlled by the Angle knob. The Y axis is controlled by the PW Doppler knob. The Z axis is controlled by the Color Doppler knob.Use the M-mode key on the control panel to slice through the volume. Each MPR is synchronized when the selected quadrant is highlighted. MultiSlice allows viewing multiple slices of the same plane at the same time. once activated, the surface rendered volume is disabled. The preferred format three on one, four on one, two on one, or a full screen display. TSI defines a view plane or a cut plane and creates a certain thick slice in the region of interest. The result will display in the render mode in a desired slice thickness from two to 40 millimeters. This results in increased detail and contrast resolution in the selected rendered volume. Curved MPR transports the MPR reformatting image into any linear or curved plane and allows a user to set points along a curved object in order to straighten it. Select the in the upper right corner to return to the Course Review page. Select the in the upper right corner to return to the Course Review page. Outline activation and volume acquisition 3D/4D transducers available the mechanical wobblers the 9VC2 and the 9VE4 and nonmechanical 10MC3 can only perform a freehand 3D volume acquisition. Select the 3D/4D key on the control panel and press the Update key to start the volume acquisition using either 3D or 4D. VOI resizing can be done on a frozen volume or during live 4D. The ROI outline will change from a solid line to a dotted line during the ROI resizing. The Update key allows a user to toggle through the volume rotations X, Y, and Z on the selected quadrant. When in a 3D acquisition, the system updates the incremental data set or slice of the acquired image. Linear or Rocked options on freehand 3D acquisition. For endovaginal acquisitions, select the Rocked option. The timer will be displayed indicating how much time is left to acquire the anatomy. The user has the option to stop the acquisition during the scan by pressing the Update key and returning to the acquisition mode. Select the in the upper right corner to return to the Course Review page. Disclaimer Please note that the learning material is for training purposes only. For the proper use of the software or hardware, please always use the Operator Manual or Instructions for Use (hereinafter collectively “Operator Manual”) issued by Siemens Healthineers. This material is to be used as training material only and shall by no means substitute the Operator Manual. Any material used in this training will not be updated on a regular basis and does not necessarily reflect the latest version of the software and hardware available at the time of the training. The Operator Manual shall be used as your main reference, in particular for relevant safety information like warnings and cautions. Please note: Some functions shown in this material are optional and might not be part of your system. Certain products, product related claims or functionalities (hereinafter collectively “Functionality”) may not (yet) be commercially available in your country. Due to regulatory requirements, the future availability of said Functionalities in any specific country is not guaranteed. Please contact your local Siemens Healthineers sales representative for the most current information. The reproduction, transmission or distribution of this training or its contents is not permitted without express written authority. Offenders will be liable for damages. All names and data of patients, parameters and configuration dependent designations are fictional and examples only. All rights, including rights created by patent grant or registration of a utility model or design, are reserved. ACUSON Maple and four Sight are trademarks of Siemens Medical Solutions USA, Inc. © Siemens Healthcare GmbH 2023 Siemens Healthineers Headquarters\Siemens Healthcare GmbH\Henkestr. 127 \ 91052 Erlangen, Germany\Telephone: +49 9131 84-0\siemens-healthineers.com ? Disclaimer No audio. Word count: 0 Congratulations! ? You have completed this learning activity. Press Exit to close this training and return to the ACUSON Maple system training area. Exit Congratulations! Audio: xxx.mp4; xxx.vtt Audio script: Time: 00:00:00 Navigation Help Select the icon above to open the table of contents. Click Next to continue. Next Welcome Slide No audio. The timeline displays the slide progression. Slide the orange bar backwards to rewind the timeline. Click Next to continue. Next Timeline No audio. Select the CC icon to display closed captioning (subtitles). Click Next to continue. Next Caption Icon No audio. Select the X to close the pop-up. Click Next to continue. Click the X in the upper right corner to exit the navigation help. Layer Slide No audio. Select Submit to record your response. Click the X in the upper right corner to exit the navigation help. Assessment Slide No audio. Question Bank 1 ACUSON Maple Ultrasound System | Advanced fourSight™ Technology | QR7000000139 3D 4D OB Job Aid 3D 4D GYN Job Aid Adnexa Adjoining organs and soft tissue that is connected to the uterus. Amniotic fluid The fluid surrounding the fetus. Endometrium The tissue that lines the fetus or womb. Endometrium Disease A disorder in which the tissue similar to the inner lining of the uterus (endometrium) grows outside the uterus. Fibroma Benign fibrous tissue of connective tissue that grows around the uterus. Gestational Age This term describes the length of a pregnancy and is measured in weeks. Hemorrhagic Cyst Bleeding within a functional cyst on an ovary. Myoma Noncancerous tumor that grows around the uterus. Ovaries The ovaries produce the eggs that travel through the fallopian tubes. Once the egg has left the ovary it can be fertilized and implant itself in the lining of the uterus. Uterus The uterus is a hollow muscular organ located in the female pelvis between the bladder and rectum. Vernix The vernix caseosa is a waxy coating that is a protective layer on the skin of the fetus. 1.1 Welcome 1.2 3D/4D Transducers 1.3 3D/4D Terminology 1.4 3D/4D Getting Started 1.5 3D/4D Monitor Layout 1.6 3D/4D Acquisition 1.7 3D/4D Volume Manipulation 1.8 MultiSlice 1.9 Thick Slice Imaging or TSI 1.10 Curved MPR 1.11 3D/4D Volume Display 1.12 3D/4D Volume Tools 1.13 LightSource 1.14 Volume Optimization 1.15 Measure, Edit, and Store Volumes 1.16 Volume Acquisition Tips 1.18 Course Review 1.19 Disclaimer 1.20 Congratulations!