ACUSON Juniper™ Ultrasound System | 2.0 Software Release | Pediatric Hip Job Aid

ACUSON Juniper™ Ultrasound System 2.0 SW release Pediatric Hip Job Aid siemens-healthineers.com/ultrasound Two-dimensional (2D) ultrasound evaluation of the neonatal hip utilizing sonographic landmarks and measurement workflow. Sonographic Anatomy Coronal View Neutral 1. Cartilaginous part of the femoral C L head (yellow) 2. Triradiate cartilage and bony il- ium junction (green) 3. Bony acetabulum or acetabular * roof (red) 4. Labral fibrocartilaginous tip (open arrow) 5. Greater trochanter (asterisk) 6. Synovial fold (double arrow- head) 7. Femoral metaphysis (blue) This image of the right hip demonstrates normal anatomy of the pediatric hip. C = cephalad; L = lateral. Acquire 2D images demonstrating all anatomic landmarks to ensure measurement accuracy.1 SIEMENS Restricted | Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2022 Healthineers Master Template Effective Date: 10 Aug 2021 | HILS 2224 Job Aid Effective Date: 22 July 2022 | HOOD05162003284307 Job Aid | ACUSON Juniper Pediatric Hip | 2.0 SW Release Effective Date: 22 July 2022 | HOOD05162003284307 Beginning the Pediatric Hip Examination Step 1 Select an appropriate linear transducer and applicable musculoskeletal or Ped Hip preset Step 2 Obtain the desired hip image and Freeze (circled in orange) Step 3 Caliper Press the Caliper key (circled in yellow) on the control panel to activate the measurement * Step 4 From the Exam tab, located on the bottom right-hand side of the touch screen, select Pediatrics Exam Pediatrics Note: When using the Ped Hip preset, skip this step Step 5 Select a measurement label indicating laterality Right, Left, Right Left None or None Rt Hip Angle Rt Flexed FHC Rt Stressed FHC Step 6 Select the labeled Hip Angle and desired tool to start the measurement Ped Hip Exam and Workflow Tips • All linear transducers support the Ped Hip measurement. • The Ped Hip preset automatically activates the measurement package. • Move intersecting lines with the trackball and freely align the intersecting lines to the ultrasound anatomy with the Rotate knob. • Edit the circle tool with the Size knob. • During measurement, the trackball keys appear at the bottom center of the monitor. • Advance through the Ped Hip measurement with the Set keys (highlighted in teal). Rotate Size Edit Set Set Rotate and Size On-screen trackball keys Set SIEMENS Healthineers Job Aid | ACUSON Juniper Pediatric Hip | 2.0 SW Release Effective Date: 22 July 2022 | HOOD05162003284307 Hip α Measurement Step 1 Obtain the desired hip image in Ped Hip preset and press Freeze (circled in orange) Caliper Step 2 Press the Caliper key (circled in yellow) on the Control Panel to activate the Ped Hip measurements Right Left None Step 3 Select a measurement label indicating laterality Right, Rt Hip Angle Rt Flexed FHC Rt Stressed FHC Left, or None Step 4 Select the labeled Hip Angle and then Hip α tool and the α line appears Hip (a) Step 5 Rotate Use the Rotate knob to align the baseline parallel to the ilium and crossing into the femoral head (line one), press the Set key (highlighted in teal) to anchor the baseline Step 6 Align the α line to the acetabulum roof (line two) using 2 the Rotate knob, press the Set key (highlighted in teal) ........ to anchor the α line Step 7 1 a Press the Set key (highlighted in teal) to place in the alpha angle into the Patient Report SIEMENS Healthineers Job Aid | ACUSON Juniper Pediatric Hip | 2.0 SW Release Effective Date: 22 July 2022 | HOOD05162003284307 Hip α + β Measurement Step 1 Obtain the desired hip image in Ped Hip preset and press Freeze (circled in orange) x ... x Caliper Step 2 Press the Caliper key (circled in yellow) on the Control Panel ** to activate the Ped Hip measurements Step 3 Right Left None Select a measurement label indicating laterality Right, Left, or None Rt Hip Angle Rt Flexed FHC Rt Stressed FHC Step 4 Select the labeled Hip Angle Hip (a+B) Step 5 To activate, tap the Hip α+β tool from the touch screen and the α line appears Rotate Step 6 Use the Rotate the knob to align the baseline parallel to the iliac (line one), press the Set key (highlighted in teal) to anchor the baseline Step 7 3 Orient the α line to the acetabular roof (line two) using 2 *.. ....... the Rotate knob, press the Set key (highlighted in teal) to anchor the α line Step 8 1 B ... Align the β line to the bony acetabulum (line three) using the Rotate knob, press the Set key (highlighted in teal) to anchor the β line Step 9 Press Set key (highlighted in teal) to place the alpha and beta angles into the Patient Report SIEMENS Healthineers Job Aid | ACUSON Juniper Pediatric Hip | 2.0 SW Release Effective Date: 22 July 2022 | HOOD05162003284307 Hip β + α Measurement Step 1 Obtain the desired hip image in Ped Hip preset and press Freeze (circled in orange) Caliper Step 2 ** Press the Caliper key (circled in yellow) on the Control Panel to activate the Ped Hip measurements Step 3 Right Left None Select a measurement label indicating laterality Right, Left, Rt Hip Angle Rt Flexed FHC Rt Stressed FHC or None Step 4 Select the labeled Hip Angle and then Hip β+α tool from the touch screen and the β line appears Hip (B+a) Step 5 align the baseline parallel to the iliac (line one) with Rotate the Rotate knob, press the Set key (highlighted in teal) to anchor the baseline Step 6 Align the β line to the bony acetabulum (line two) with the Rotate knob, press the Set key (highlighted in teal) to anchor the β line 2 3 Step 7 Orient the α line to the acetabular roof (line three) with the Rotate knob, press the Set key (highlighted in teal) 1 1 + ........................................................................................................... to anchor the α line Step 8 Press the Set key (highlighted in teal) to place the beta and alpha angles into the Patient Report SIEMENS Healthineers Job Aid | ACUSON Juniper Pediatric Hip | 2.0 SW Release Effective Date: 22 July 2022 | HOOD05162003284307 Percent Femoral Head Coverage (% FHC) Step 1 Obtain the desired hip image in Ped Hip preset and press Freeze (circled in orange) Caliper Step 2 Press the Caliper key (circled in yellow) on the Control Panel to activate the Ped Hip measurements Ped Abd Step 3 Ped Hip Select a measurement label indicating laterality Right, Left, Right Left None or None Rt Hip Angle Rt Flexed FHC Rt Stressed FHC Step 4 Choose either labeled Flexed FHC or Stressed FHC on the touch screen Step 5 d:D Tap to activate the d:D % FHC tool on the touch screen %FHC Step 6 Align the baseline parallel to the iliac (yellow one) using Rotate Size the Rotate knob, press the Set key (highlighted in teal) to anchor the baseline Step 7 Position and size the circle to fit the femoral head (dotted circle); edit using the Size soft key, press the Set key (highlighted in teal) to anchor the circle Step 8 Press the Set key (highlighted in teal) to place the % FHC into the Patient Report Ped Hip Ped Abd Flexed FHC or Stressed FHC automatically de- Right Left None faults to the % FHC tool. Rt Hip Angle Rt Flexed FHC Rt Stressed FHC SIEMENS Healthineers Job Aid | ACUSON Juniper Pediatric Hip | 2.0 SW Release Effective Date: 22 July 2022 | HOOD05162003284307 Femoral Head Coverage (FHC) – Ratio Step 1 Obtain the desired hip image in Ped Hip preset and press Freeze (circled in orange) Caliper Step 2 Press the Caliper key (circled in yellow) to activate the meas- urement package Ped Hip Ped Abd Step 3 Select a measurement label indicating laterality Right, Left, Right Left None or None Rt Hip Angle Rt Flexed FHC Rt Stressed FHC Step 4 Choose either Flexed FHC or Stressed FHC on the touch d:D screen Ratio Step 5 Tap to activate the d:D Ratio tool from the touch screen 2 Step 6 Place the first caliper at the posterior femoral head (caliper 4 one), press the Set key (highlighted in teal) to anchor and the second caliper appears 1 3 Step 7 Position the second caliper at the anterior femoral head (caliper two), press the Set key (highlighted in teal) to anchor and the third caliper appears Step 8 Position the third caliper at the posterior femoral head (caliper three), press the Set key (highlighted in teal) to anchor and the fourth caliper appears Step 9 Position the fourth caliper at the femoral head and femoral neck axis, press the Set key (highlighted in teal) to anchor, completing the FHC Ratio Step 10 Select the Set key (highlighted in teal) to place the FHC Ratio of d:D into the Patient Report SIEMENS Healthineers Job Aid | ACUSON Juniper Pediatric Hip | 2.0 SW Release Effective Date: 22 July 2022 | HOOD05162003284307 Image Rotation Step 1 Activate the Rotate Image control from the touch screen or the soft keys. Image Rotation from the touch screen is the default setting. Image Rotation may also be assigned to a soft key rotary knob under System Configuration, then Soft Keys Step 2 Choose 90°, 0°, or -90° -90 90 . Step 3 Rotate Image 90 0 Select the desired hip measurement and complete as previously described Rotate 90° Depth indicator along the top of the image with the nearfield on the right-hand side of the field of view (FOV) Pod Hlp Ix Porver 1012 Rotate 0° 1 0.99 TID 0.2 ASC 7 DICE Med Standard orientation with the nearfield at the top and the Dyn 3 67 dF IHI 14.0 16- 20 ch 45 ps depth indicators along the right-hand side of the FOV 1414 Pod Hip Rotate -90° 1IS 09.2 TID 0.2 ASC 2 Depth indicator along the top of the image with the nearfield DTCC Med Dyr 8 67 JE TINI 14.0 M LE 45 jo on the left-hand side of the FOV Ped Hip measurement tools rotate with the 2D image. Image Rotation is active on all linear transducers. Image Rotation is available during live imaging and is not available in Trapezoid, Dual mode, or while magnified using Zoom. SIEMENS Healthineers Job Aid | ACUSON Juniper Pediatric Hip | 2.0 SW Release Effective Date: 22 July 2022 | HOOD05162003284307 Pediatric Hip Definitions and Values The Graf method Well established ultrasound method for evaluating 2D measurements on infants aged less than six months and at an increased risk of developmen- tal hip dysplasia 1-4 Hip α Angle The intersection of the baseline placed parallel to the ilium, and the sec- ond line, positioned along the acetabular labrum creates the alpha or α angle. The resulting value reflects the depth of the bony acetabular roof. Hip α + β Workflow measuring the alpha followed by the beta angle. The alpha an- gle value reflects the depth of the bony acetabular roof. The angle formed by the baseline and the bony acetabulum (roof) is the beta angle or β an- gle. This helps determine femoral head coverage by the acetabulum. Hip β + α Workflow measuring the beta followed by the alpha angle. The β angle helps determine femoral head coverage by the acetabulum and the alpha angle reflects the depth of the bony acetabular roof. % Femoral Head Coverage The percentage of the femoral head which lies within the acetabulum. (%FHC) Femoral Head Coverage The percentage of femoral head to the posterior offset from the femoral (FHC) – Ratio neck axis. 90° or -90° Image Rotation Rotating the 2D ultrasound image allows for matching to the hanging pro- tocol for hip radiographs. Graphing α and β Values The Sonometer displays on the bottom right side of the im- Sonometer GRAF 3 6 12 WEEKS age monitor and in the Patient Report once the hip meas- 35 45 50 55 60 65 urement is complete. The top horizontal line on the Sono- Ill a/b --------- meter represents the alpha angle, and the bottom horizontal CRITICAL ZONE 55 50 45 B line represents the beta angle. a angle 60º Bangle 55 As an example, the solid yellow line on this Sonometer de- notes a measurement within the healthy range for both alpha and beta angles. Type I values indicate a healthy alpha angle which is 60° or greater and a healthy beta angle is 55° or less. Review the chart shown below for more information about Type II and Type III alpha and beta values. 3,4 α β Type I ≥ 60° ≤ 55° * Type II * Includes Type IIa, Type IIb, and Type IIc 43 - 50° < 70° Type III # # Includes Type IIIa and Type IIIb ≤ 42° > 77° SIEMENS Healthineers Job Aid | ACUSON Juniper Pediatric Hip | 2.0 SW Release Effective Date: 22 July 2022 | HOOD05162003284307 References 1. Kang YR, Koo J. Ultrasonography of the pediatric hip and spine. Ultrasonography. 2017;36(3):239-251. doi:10.14366/usg.16051 2. Matrawy K, Nouh M. Ultrasound screening for developmental dysplasia of the hip and its socioeconomic impact: Experience of tertiary care health level. Alexandria Journal of Medicine. 01/01 2013;50doi:10.1016/j.ajme.2013.04.006 3. Graf R. Classification of hip joint dysplasia by means of sonography. Arch Orthop Trauma Surg (1978). 1984;102(4):248- 55. doi:10.1007/bf00436138 4. Graf R, Mohajer M, Plattner F. Hip sonography update. Quality-management, catastrophes - tips and tricks. Med Ultrason. Dec 2013;15(4):299-303. doi:10.11152/mu.2013.2066.154.rg2 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 (herein- after 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. 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