Introduction to Ultrasonography

SIEMENS Basics and Funcitional Description of Healthineers Ultrasonography Workshop on Imaging for Future Neyaz Ahmad March 2018 HOOD05162002873707 Effective date: 05/06/2018 BME_USG Education Page 1 | © Siemens Healthcare GmbH, 2017 Ultrasound SIEMENS Healthineers What is ultrasound? Prostate Dortsi Rotator Cutt HOOD05162002873707 Effective date: 05/06/2018 BME_USG Education Page 2 | © Siemens Healthcare GmbH, 2017 What is ultrasound SIEMENS Healthineers Diagnostic ultrasound is a medical imaging procedure that generates cross-sectional images of internal structures. These structures may be static (such as organ tissue) or moving (such as blood flow). Images are formed from returning echoes of low-intensity ultrasound beams transmitted into the patient through a transducer. Two-dimensional images are composed of many beams side by side, and are displayed real-time on an image monitor. HOOD05162002873707 Effective date: 05/06/2018 BME_USG Education Page 3 | © Siemens Healthcare GmbH, 2017 What is ultrasound in brief SIEMENS Healthineers Ultrasound is a medical imaging technique that uses high frequency sound waves and their echoes. The technique is similar to the echo location used by bats, whales and dolphins, as well as SONAR used by submarines. The ultrasound machine transmits high-frequency (1 to 18 megahertz) sound pulses into your body using a probe. The sound waves travel into your body and hit a boundary between tissues (e.g. between fluid and soft tissue, soft tissue and bone). Some of the sound waves get reflected back to the probe, while some travel on further until they reach another boundary and get reflected. The reflected waves are picked up by the probe and relayed to the machine. The machine calculates the distance from the probe to the tissue or organ (boundaries) using the speed of sound in tissue (5,005 ft/s or1,540 m/s) and the time of the each echo's return (usually on the order of millionths of a second). The machine displays the distances and intensities of the echoes on the screen, forming a two dimensional image HOOD05162002873707 Effective date: 05/06/2018 BME_USG Education Page 5 | © Siemens Healthcare GmbH, 2017 Echo Hello Hello Hello Hello Hello Hello Hello® Hello Hello HOOD05162002873707 Effective date: 05/06/2018 6 BME_USG Education Page 6 | © Siemens Healthcare GmbH, 2017 HOOD05162002873707 Effective date: 05/06/2018 BME_USG Education Page 7 | © Siemens Healthcare GmbH, 2017 SONAR SIEMENS Healthineers Another example of the use of ultrasound would be with the SONAR. SONAR is being used by the submarine to detect the ship on the oceans surface. SONAR is also used to map the ocean floor to guide the submarine to avoid collisions. SONAR may also used for recreational activities such as boating and fishing. SONAR is used by boats to determine the depth of the water they are traveling in and may be used to located schools of fish for fishermen HOOD05162002873707 Effective date: 05/06/2018 BME_USG Education Page 8 | © Siemens Healthcare GmbH, 2017 Innovation SIEMENS Healthineers First Real – time Ultrasound scanner Richard Soldner The innovation which had completely changed the practice of ultrasound scanning was the advent of the Real-time scanners. The first real-time scanner, better known as fast B-scanners at that time, was developed by Walter Krause and Richard Soldner (with J Paetzold and and Otto Kresse) and manufactured as the Vidoson® by Siemens Medical Systems of Germany in 1965. HOOD05162002873707 Effective date: 05/06/2018 BME_USG Education Page 9 | © Siemens Healthcare GmbH, 2017 Frequency SIEMENS Healthineers Sound Waves with Frequency above the range of human hearing May be used in medicine for ACUSON NX2 • Diagnosis • Therapy • Audible: 20-20,000 Hz • Ultrasound: above 20,000 Hz • Infrasound: below 20 Hz 1 MHz = 1,000,000 Hz Medical diagnostic ultrasound frequencies: 1-22 MHz HOOD05162002873707 Effective date: 05/06/2018 BME_USG Education Page 10 | © Siemens Healthcare GmbH, 2017 Travel Speed SIEMENS Healthineers Propagation Speed is the speed at which sound moves through a medium. This speed is determined by the characteristics of the medium: • Density • Stiffness HOOD05162002873707 Effective date: 05/06/2018 BME_USG Education Page 11 | © Siemens Healthcare GmbH, 2017 Velocities SIEMENS Healthineers Material Velocity m/s Air 330 Lung 650 Water (20ºC 1480 Avg. soft tissue 1540 Liver 1550 Fat 1459 Muscle 1580 Blood 1575 Bone 4080 HOOD05162002873707 Effective date: 05/06/2018 BME_USG Education Page 12 | © Siemens Healthcare GmbH, 2017 Sound reflection SIEMENS Healthineers incident Specular Reflection reflected incident Scattering backscattered HOOD05162002873707 Effective date: 05/06/2018 BME_USG Education Page 13 | © Siemens Healthcare GmbH, 2017 Applications SIEMENS Healthineers Applications Ultrasound is used in a growing number of diagnostic applications in hospitals, clinics, and doctors' offices. As ultrasound technology advances and image resolution increases, potential applications for an ultrasound exam continue to expand. One area of the human anatomy that is not imaged by ultrasound is the respiratory system, due to the presence of air. The most common exam types are listed below. Internal Medicine This exam type is generally referred to as Abdominal, since the main structures examined are the organs of the abdominal cavity: Liver Gall bladder Kidneys Pancreas Spleen HOOD05162002873707 Effective date: 05/06/2018 BME_USG Education Page 14 | © Siemens Healthcare GmbH, 2017 Applications- Cntd. SIEMENS Healthineers Cardiovascular System Obstetrics and Gynecology Ultrasound is used to evaluate blood flow Commonly known as OB/GYN, this application is characteristics of arteries, veins, and the heart. familiar to many patients. Expectant mothers Exam types are usually grouped as follows: undergo routine ultrasound exams during Cardiac pregnancy. OB exams are used not only to An examination of valve action and blood flow in determine the sex of the fetus but also to make the heart. measurements for predicting birth date and birth Cerebrovascular weight. GYN exams are used for fertility studies An examination of blood vessels in the head, and for other images of the female reproductive especially the carotid arteries. organs. Peripheral vascular Prostate An examination of blood vessels in the arms, This application is an exam type specific for adult legs, and extremities. males. Using special transducers, the prostate can be imaged in two planes for diagnosis and Blood flow can also be evaluated in other exam types such as Abdominal, OB/GYN, etc. treatment of prostate cancer. HOOD05162002873707 Effective date: 05/06/2018 BME_USG Education Page 15 | © Siemens Healthcare GmbH, 2017 Applications- Ctd. SIEMENS Healthineers Pediatrics and Small Parts Exam Presets These two exam types are often grouped Ultrasound systems are optimized for various together because they use higher-frequency exam types. These optimizations are known as transducers and the structures imaged are exam (or, study) presets. By selecting an relatively small and superficial, such as: appropriate preset, the sonographer can more Thyroid exam easily acquire a clinically acceptable image. In Penile and scrotal studies addition to the general categories listed above, ultrasound systems may have exam presets that Breast exam are specific for certain organs or tissue types. Musculoskeletal Available presets may vary according to system Muscles, tendons and other structures of the type. For example, some ultrasound systems are arms, legs, and shoulders are examined with specialized for cardiac imaging, others for diagnostic ultrasound. This application is often urology, womens health, general radiology, etc. used for sports injuries. The Imaging Systems lesson provides further details HOOD05162002873707 Effective date: 05/06/2018 BME_USG Education Page 16 | © Siemens Healthcare GmbH, 2017 Different types of imaging modes. SIEMENS Healthineers Imaging Modes There are six ultrasound imaging modes, some of which can be displayed simultaneously. The modes are identified by the initial letter of the mode name: A Mode = Amplitude B Mode = Brightness C Mode = Color D Mode = Doppler M Mode = Motion P Mode = Power HOOD05162002873707 Effective date: 05/06/2018 BME_USG Education Page 17 | © Siemens Healthcare GmbH, 2017 Different types of imaging modes SIEMENS Healthineers A Mode : MEDISON 255 16.0cm Fatinet. 134 96542-5 Abdomen CN2-8 HGen. M [2D] G50 / P90 /125dB 0- FA6 / FSI1 / PGCO MIO.8 / Tls0.2 Figure 2. Ultrasonographic image of right eye of a dog with immature cataracts. Lens diameter is B mode: 7.6mm. B mode is the most common imaging mode and usually is the system default. B-mode images are black-and-white cross sections. Because B Mode produces a two-dimensional cross-section image, it is also known as 2D Mode. HOOD05162002873707 Effective date: 05/06/2018 BME_USG Education . Page 18 | © Siemens Healthcare GmbH, 2017 Different types of imaging modes SIEMENS Healthineers C Mode C mode is used in conjunction with B mode to display blood flow as color within grayscale vessels and tissues. C mode is referred to also as color Doppler, as distinct from spectral Doppler, which is D mode. Both C mode and D mode use the Doppler technique to detect flow. In C mode, flow velocities are assigned a color value, with higher velocities usually displayed as a lighter color. Flow towards and away from the transducer is represented by different hues. In a real- time display, C mode can clearly depict vessel patholgy and hemodynamics. Some ultrasound systems can display B, D, and M mode in color. Such displays are not to be confused with C mode, which uses special scanning and processing techniques to depict blood flow as color motion. Where B, D, and M mode displays are represented in color, the display may simply be a grayscale value that has been mapped to color HOOD05162002873707 Effective date: 05/06/2018 BME_USG Education Page 19 | © Siemens Healthcare GmbH, 2017 Color Imaging SIEMENS Healthineers In color Doppler mode blood flow in real Transducer time is displayed as a color overlay over the Multiple 2D image. Gates C mode is used in conjunction with B mode to display blood flow as color within grayscale vessels and tissues. d1 d2d3d4 ... Scanning Doppler Lines In C mode, flow velocities are assigned a color value, with higher velocities usually displayed as a lighter color. Flow towards and away from the transducer is represented by different hues. In a real-time display HOOD05162002873707 Effective date: 05/06/2018 BME_USG Education Page 20 | © Siemens Healthcare GmbH, 2017 25 SFA 2- -25 SFV cm s-1 3- 4- HOOD05162002873707 Effective date: 05/06/2018 BME_USG Education Page 21 | © Siemens Healthcare GmbH, 2017 SIEMENS Color Doppler Velocity Healthineers The Color Doppler Bar • Color represents mean velocity at the sample area Yellow Flow towards Increasing the transducer • Toward the transducer is one color (i.e., red) Velocities • Away from the transducer is another (i.e., blue) Red • Shade indicates the velocity of blood flow O Blue • Deep shades indicate low velocities • Lighter shades or a change in color indicate higher Flow away from Increasing velocities the transducer Velocities Green • Baseline indicator or “0” velocity • Velocity scale indicators appear at each end HOOD05162002873707 Effective date: 05/06/2018 BME_USG Education Page 22 | © Siemens Healthcare GmbH, 2017 Different types of imaging modes. SIEMENS Healthineers D Mode D mode (spectral Doppler) depicts flow velocities as a scrolling display of frequencies. Blood particle echoes from a selected ultrasound beam are transformed to the frequency domain through an FFT (Fast Fourier Transform) processor. Vascular pathology is indicated by abnormal spectral envelope and content. In addition to the scrolling display, D mode has an audio output that represents flow velocities. Doppler audio is output through system loudspeakers or headphone jack. Continuous-wave Doppler (CW) and steered continuous-wave Doppler (SCW) are special modes designed for the higher flow velocities of cardiac imaging. M Mode M mode is used for evaluating heart wall and valve motion, including fetal heart examination. In M mode, the B-mode echoes of a selected beam are displayed side-by-side in a scrolling window. Any motion irregularities are seen over time in the M-mode display. The motion display may be evaluated in relation to an ECG trace HOOD05162002873707 Effective date: 05/06/2018 BME_USG Education Page 23 | © Siemens Healthcare GmbH, 2017 M-Mode SIEMENS Healthineers M mode is used for evaluating heart wall and valve motion, including fetal heart examination. In M mode, the B-mode echoes of a selected beam are displayed side-by-side in a scrolling window. Any motion irregularities are seen over time in the M-mode display. The motion display may be evaluated in relation to an ECG trace HOOD05162002873707 Effective date: 05/06/2018 BME_USG Education Page 24 | © Siemens Healthcare GmbH, 2017 Different types of imaging modes. SIEMENS Healthineers Power Mode Power mode is similar to C mode. Blood flow is depicted in color but the flow direction is ignored. The main purpose of Power mode is to evaluate perfusion, or the presence of flow, without respect to its direction. For example, Power mode may be used to evaluate renal perfusion after a kidney transplant. Power mode is effective in imaging flow states where increased sensitivity is required, such as where vascular pathology restricts normal flow. Power mode is also known as energy mode. Power mode is an imaging mode and should not be confused with ultrasound output power, which is the transmit voltage applied to the transducer. HOOD05162002873707 Effective date: 05/06/2018 BME_USG Education Page 25 | © Siemens Healthcare GmbH, 2017 Color Doppler Energy SIEMENS Healthineers Power mode is similar to C mode. Blood flow is depicted in color but the flow direction is ignored. SIEMENS The main purpose of Power mode is to evaluate TIS 0.6 (TIB 0.6) CX5-2/4.2 perfusion, or the presence of flow, without respect to Abdomen 100% its direction. For example, Power mode may be used 2 2 dB RS3 11.0cm 9fps to evaluate renal perfusion after a kidney transplant. PF2.8MHZ PRF868Hz Power mode is effective in imaging flow states where F-Low 64dB RS7 increased sensitivity is required, such as where vascular pathology restricts normal flow HOOD05162002873707 Effective date: 05/06/2018 BME_USG Education Page 26 | © Siemens Healthcare GmbH, 2017 SIEMENS Healthineers 10:36:42 am 15L8 55mm NeoHead S2/-1/ 4/E:5+1 2/1 CD:10.0MHZ CD Gain = 54 CDE 25dB 008 Neonatal Brain Circulation CDE HOOD05162002873707 Effective date: 05/06/2018 27 BME_USG Education Page 27 | © Siemens Healthcare GmbH, 2017 Doppler SIEMENS Healthineers The phenomenon of the Doppler effect is experienced in everyday life: the pitch of the ambulance siren, police siren, or train whistle increases as the vehicle approaches and decreases as the vehicle departs. The Doppler effect is a change in frequency caused by motion of the sound source, receiver, or reflector. In the case of ultrasound, the source and receiver (the transducer) are stationary, and the reflectors (blood cells) are moving. Simply stated, the Doppler shift frequency equals the received frequency minus the transmitted frequency. A positive number indicates motion towards the transducer; a negative number indicates motion away. Ultrasound imaging systems use a quadrature phase detect circuit in order to detect motion HOOD05162002873707 Effective date: 05/06/2018 BME_USG Education Page 28 | © Siemens Healthcare GmbH, 2017 This presentation uses the preinstalled Office font Calibri. If you send it to someone internally or externally, please convert it into a pdf to ensure that the content stays as intended. SIEMENS Healthineers Doppler Effect Our template contains layout guidelines. Their purpose is to indicate key margins and mandatory areas on slides. Copy and paste Copy only full slides when they use the same new design. Otherwise the file size will be very large. Use the function Insert > Insert Content > Unformatted Text to paste a copied text. The text will now use the same existing format. Placeholder for the eye-catcher Each presentation needs to Change in reflected frequency caused by the motion of blood cells or tissue for notes and third-party be categorized, with the logos: placement can vary in author being responsible for terms of height. If this choosing the right category: element is not required, Unrestricted please delete it. – Restricted – Confidential – Strictly confidential – The preset default category HOOD05162002873707 Edit “Author | Department” for presentations is “restricted”. Effective date: 05/06/2018 Unrestricted © Siemens Healthcare GmbH, 2017 in the “Header and footer” for all pages. “Restricted ©” and “the Start > Replace > insert new category ©” Doppler Principles SIEMENS Healthineers Effect of the Doppler angle in the sonogram. (A) higher-frequency shift Doppler signal is obtained if the beam is A B C D aligned more to the direction of flow. In the diagram, beam (A) is more aligned skin than (B) and produces higher-frequency beam shift Doppler signals. The beam/flow direction vessel angle at (C) is almost 90° and there is a flow A B C very poor Doppler signal. The flow at (D) D is away from the beam and there is a Sonogram negative signal. HOOD05162002873707 Effective date: 05/06/2018 BME_USG Education Page 31 | © Siemens Healthcare GmbH, 2017 Doppler Principles SIEMENS Healthineers Doppler Shift The Doppler Effect • A shift in frequency caused by the relative movement of either the sound wave source, the sound wave reflector or the sound wave receiver CCCCCCCCCB - • The transducer is the sound wave source and receiver wwwwww • The Red Blood Cells are the sound wave reflectors • For any given transmitted ultrasound RBC’s moving toward the transducer compress frequency, the returned frequency will (increase) the frequency be higher after encountering red blood • RBC’s moving away from the transducer expand cells moving toward the transducer and (decrease) the frequency lower after encountering red cells moving away from the transducer. HOOD05162002873707 Effective date: 05/06/2018 BME_USG Education Page 32 | © Siemens Healthcare GmbH, 2017 Pulse (PW) Doppler SIEMENS Healthineers One element SIEMENS or group of elements 75L401/8.00 transmit and receive. The elements 000 100% 2008 transmit and the system waits to receive 14fps RS 3 Ocm DR65 dB 1/00/0/2 returning echoes. The time delay CFS . 53MHZ PRF4000Hz INVERTED RS122 5 5 dB 2000 F100Hz between transmit and receive relates Hz 3/12/2 CHAPO 464B =100- 5 . 14MHZ directly to the depth of the targeted PRES 257Hz DR60GB FZSHz GD24 CS1.0 reflectors. The shift in the frequency of the reflected echoes is converted to velocity and displayed as a strip. HOOD05162002873707 Effective date: 05/06/2018 BME_USG Education Page 33 | © Siemens Healthcare GmbH, 2017 Continuous Wave (CW) Doppler SIEMENS Healthineers One element or a group of elements transmits continuously and another set of elements continuously receive. Velocities from all points along the line are detected. It is used to measure high flow velocities as in Cardiology. 4V1c Works-in-Progress .80 12:50:08 pm 40dB 3 ./+1/2/ 2 4V1c-S 16sec CW Focus=106mm H4.25MHZ 160mm CW Gain= - 6dB ECHO General /V Pwr= Mlcd=1.9 OdB TIS=1.1 .80 Store in progress CW:2.0MHZ HR=105bpm Sweep=100mm/s. 2.0 m/s + 6.0 - 6-AQUA Grey Scale HOOD05162002873707 Effective date: 05/06/2018 BME_USG Education Page 34 | © Siemens Healthcare GmbH, 2017 Color Doppler imaging SIEMENS Healthineers • CDV--- Color Doppler Velocity • CDE--- Color Doppler Energy. ( Power Mode) • DTI--- Doppler Tissue Imaging HOOD05162002873707 Effective date: 05/06/2018 BME_USG Education Page 35 | © Siemens Healthcare GmbH, 2017 CDV Vs PW . SIEMENS Healthineers Color Doppler Spectral Doppler • Imaging Technique • Graphic Technique • Displays mean velocity and variance • Displays peak, mean and range of velocities within an area of the image at a single point along the Doppler beam (PW) or along the entire beam (CW) .59 + Flow 20 0 Flow m/s Flow - .20 59 HOOD05162002873707 Effective date: 05/06/2018 BME_USG Education Page 36 | © Siemens Healthcare GmbH, 2017 Color Doppler Velocity 8 6mm 69º Invert cm/s -- 100 -- 50 cm/s 1-50 1.5cm 14fps HOOD05162002873707 Effective date: 05/06/2018 37 BME_USG Education Page 37 | © Siemens Healthcare GmbH, 2017 Color Doppler Energy (CDE) SIEMENS Healthineers Utilizes the amplitude/energy component CDE • Has virtually no angle dependence • Has no aliasing • Does not display velocity • Does not display direction of flow • Power Doppler / Directional power CDV HOOD05162002873707 Effective date: 05/06/2018 BME_USG Education Page 38 | © Siemens Healthcare GmbH, 2017 DTI™ Doppler Tissue Imaging SIEMENS Healthineers Reflects low velocity high amplitude Doppler signals Doppler shift information from myocardium instead of flow 13 35dB - / -/-/B 1.5mm/1 DT PW D= 81mm 13 INVERTER CAL- . 10m/s 2 . 0MHZ 10 m / s 10 HOOD05162002873707 Effective date: 05/06/2018 BME_USG Education Page 39 | © Siemens Healthcare GmbH, 2017 Transducers SIEMENS Healthineers HOOD05162002873707 Effective date: 05/06/2018 BME_USG Education Page 40 | © Siemens Healthcare GmbH, 2017 SIEMENS Healthineers What is a transducer? A device which converts one form of energy into another form. HOOD05162002873707 Effective date: 05/06/2018 BME_USG Education Page 41 | © Siemens Healthcare GmbH, 2017 Transducer SIEMENS Healthineers The transducer is the main part of the ultrasound machine. The transducer probe makes the sound waves and receives the echoes. The transducer probe generates and receives sound waves using a principle called the piezoelectric (pressure electricity) effect, which was discovered by Pierre and Jacques Curie in 1880. In the probe, there are one or more quartz crystals called piezoelectric crystals. When an electric current is applied to these crystals, they change shape rapidly. The rapid shape changes, or vibrations, of the crystals produce sound waves that travel outward. Conversely, when sound or pressure waves hit the crystals, they emit electrical currents. Therefore, the same crystals can be used to send and receive sound waves. The probe also has a sound absorbing substance to eliminate back reflections from the probe itself, and an acoustic lens to help focus the emitted sound waves. HOOD05162002873707 Effective date: 05/06/2018 BME_USG Education Page 42 | © Siemens Healthcare GmbH, 2017 Transducer- Physics SIEMENS Healthineers Acoustic matching layer Backing material Piezoelectric element Acoustic lens (transducer) Convex type probe HOOD05162002873707 43 BME_USG Education Effective date: 05/06/2018 Page 43 | © Siemens Healthcare GmbH, 2017 A emit B wait reflection transmission C return HOOD05162002873707 Effective date: 05/06/2018 BME_USG Education 44Page 44 | © Siemens Healthcare GmbH, 2017 Transducer SIEMENS Healthineers Transducer probes come in many shapes and sizes. The shape of the probe determines its field of view, and the frequency of emitted sound waves determines how deep the sound waves penetrate and the resolution of the image. Transducer probes may contain one or more crystal elements; in multiple-element probes, each crystal has its own circuit. Multiple-element probes have the advantage that the ultrasound beam can be "steered" by changing the timing in which each element gets pulsed; steering the beam is especially important for cardiac ultrasound HOOD05162002873707 Effective date: 05/06/2018 BME_USG Education Page 45 | © Siemens Healthcare GmbH, 2017 SIEMENS Attenuation vs. Resolution Healthineers Transducer frequency is directly related to resolution • High frequency = high resolution • Low frequency = decreased resolution High frequency  increased attenuation  decreased penetration with increased resolution Low frequency  less attenuation  better penetration with decreased resolution So higher the frequency lower the penetration and lower the frequency higher penetration. HOOD05162002873707 Effective date: 05/06/2018 BME_USG Education Page 46 | © Siemens Healthcare GmbH, 2017 Transducer Frequency SIEMENS Healthineers Transducer frequency is directly related to Therefore we use high frequency transducers for: image resolution. • Small parts The higher the frequency, the better the • MSK resolution. However due to attenuation, high • Vascular frequency will demonstrate less penetration. • Pediatrics Using a lower frequency will provide • intraoperative penetration for deeper organ. • Lower frequency for: In medical ultrasound we strive to use the • Abdominal imaging highest frequency possible for the depth of the • organ to be imaged. Cardiac imaging • Technically difficult patients HOOD05162002873707 Effective date: 05/06/2018 BME_USG Education Page 47 | © Siemens Healthcare GmbH, 2017 High Frequency Transducers SIEMENS Healthineers Highest frequency transducers have the best resolution but are limited in how a deep a structure/organ they can image. High Frequencies: VFI3.5 Superficial Structures Better Resolution, Less Penetration HOOD05162002873707 Effective date: 05/06/2018 BME_USG Education Page 48 | © Siemens Healthcare GmbH, 2017 Lower Frequency Transducers SIEMENS Healthineers Low Frequency transducers are used to image deeper organs/structures Low Frequency: Less Resolution for better penetration Deep structures HOOD05162002873707 Effective date: 05/06/2018 BME_USG Education Page 49 | © Siemens Healthcare GmbH, 2017 SIEMENS Ultrasound Transducer Healthineers Crystals are sliced to create multiple small elements Each element is connected as an individual transducer Group of elements form an active aperture HOOD05162002873707 Effective date: 05/06/2018 BME_USG Education Page 50 | © Siemens Healthcare GmbH, 2017 SIEMENS Role of Transducer Healthineers Transducer sends ultrasound pulses Between pulses transducer receives echoes System converts echoes to an image HOOD05162002873707 Effective date: 05/06/2018 BME_USG Education Page 51 | © Siemens Healthcare GmbH, 2017 Types of Transducers SIEMENS Healthineers Mechanical • Sector Electronic • Linear Arrays • Curved Array (Curved Linear Array) • Phased Array HOOD05162002873707 Effective date: 05/06/2018 BME_USG Education Page 52 | © Siemens Healthcare GmbH, 2017 SIEMENS Healthineers Mechanical Sector Linear Array Phased Arrays • Multiple Transducer • • One Or More Crystals. Multiple Elements Produce Elements In Line • In Housing Wedge Shaped Field Of View (FOV) • Elements Sequentially Pulsed • Mechanic • Can Be Electronically Focused • Electronic Delay Techniques • Arc-Shaped • Generally Rectangular Used To Focus And Steer Beam • Small Transducer Face Shaped Image • Small Footprint • Application which require Applications Small parts , • Sector/Vector FOV • wide field of view like Vascular… • Endocavity Color / Doppler • Echocardiography Choice • Intercostal Imaging HOOD05162002873707 Effective date: 05/06/2018 BME_USG Education Page 53 | © Siemens Healthcare GmbH, 2017 SIEMENS Curved Arrays Endocavity Transducers Healthineers • Elements arranged in an arc • Endorectal • Multiple Elements Pulsed Sequentially • Rectal And Prostate Evaluation • Offer Wider Field Of View • Endovaginal • Easier Access In Specific Exams • High Frequency Transducers • Abdomen • Defined Evaluation Of Pelvic • Pelvis Structures • Obstetrics HOOD05162002873707 Effective date: 05/06/2018 BME_USG Education Page 54 | © Siemens Healthcare GmbH, 2017 Transesophageal multiplane Transducer SIEMENS Healthineers Visualization of cardiac structures which are difficult to visualize Transthoracically such as Atrial thrombus, shunts, vegetations … HOOD05162002873707 Effective date: 05/06/2018 BME_USG Education Page 55 | © Siemens Healthcare GmbH, 2017 Intracardiac Transducer SIEMENS Healthineers Intra cardiac applications such as visualization of ASD, VSD closure. Electrophysiology Visualization. AcuNac HOOD05162002873707 Effective date: 05/06/2018 BME_USG Education Page 56 | © Siemens Healthcare GmbH, 2017 SIEMENS LA-3 Freeze Clip Save Gain Depth Color TGC Tools Exams Needle V ACUSON Freestyle HOOD05162002873707 Effective date: 05/06/2018 BME_USG Education Page 57 | © Siemens Healthcare GmbH, 2017 18L6 HD Transducer SIEMENS Healthineers Unique Ergonomic Design Palmar grip design improves ergonomics  Grip force in palmar is 4 times greater than in pinch (fingers) grip HO 978L  Operator fatigue is greatly reduced Textured elastomeric coating allows improved control with less force HOOD05162002873707 Effective date: 05/06/2018 BME_USG Education Page 58 | © Siemens Healthcare GmbH, 2017 Image Processing SIEMENS Healthineers scanner console and computer processor convex Transducer array monitor screen Scan lines HOOD05162002873707 Effective date: 05/06/2018 BME_USG Education Page 59 | © Siemens Healthcare GmbH, 2017 System Architecture SIEMENS Healthineers PHYSIO FPD KBD ARRAY TRANSDUCERS RGB CONTROL TR2 USB PANEL TR1 H TRO USB CB D DVD TI E MODULE IO RC S-VHS DVR BE VI RM USB PRINTER CW TRANSDUCER PSD PSA AC TO RM PS 48 VDC PSAC AC AC BATTERY XFMR AC TO FPD HOOD05162002873707 Effective date: 05/06/2018 BME_USG Education Page 60 | © Siemens Healthcare GmbH, 2017 Board-to-Segment Allocation SIEMENS Healthineers Segment Boards/Modules Frontend Segment Transducer Interface Board (TI) Transmit/Receive Boards (TR) Receive Beamformer , CW and Controller Board (RC) Backend Segment Backend Board (BE) Video/Audio Interface(BE) RM board(RM) System Input/Output Board (IO and IO sub) Interconnect Backplane (BP) Segment Other system cabling HOOD05162002873707 Effective date: 05/06/2018 BME_USG Education Page 61 | © Siemens Healthcare GmbH, 2017 Structure switch Probe RTC CO VGA Pulser Real Time Control Ci AR A/D BF DR EP / SP / + SC / VP `~ Monitor TGC FP C2 Analg Receiver Analog to Echo processing connector Digital Beam forming Digital Flow processing Scan conversion converter re ceiver Spectral processing Video processing TR RC BE Transducer Interface Tx/Rx Receive control Back End HOOD05162002873707 FE Effective date: 05/06/2018 BME_USG Education Front End Page 62 | © Siemens Healthcare GmbH, 2017 Signal flow SIEMENS Healthineers TR Network RC FE RM USB CP/KBD Bus Overlay PCI EXP Bus USB 3 Array Xducers PCI Bus TI CW SCW CB CW SCW BE VI 10 CW Xducer ECG FPD Physio OEMs Aux HOOD05162002873707 Effective date: 05/06/2018 BME_USG Education Page 63 | © Siemens Healthcare GmbH, 2017 Recent Trends in Ultrasound SIEMENS Healthineers Elastography (breast and liver). wireless transducer technology. Pin less Transducer--- 3D TEE Elastography is a medical imaging modality that maps the elastic properties of soft tissue. The main idea is that whether the tissue is hard or soft will give diagnostic information about the presence or status of disease. HOOD05162002873707 Effective date: 05/06/2018 BME_USG Education Page 64 | © Siemens Healthcare GmbH, 2017 eSie Touch- Elasticity Imaging SIEMENS Healthineers MI.1.0 SF SIEMENS 14L5 / Breast Detail 2D - 100% THI / H14.00 MHZ -8 dB / DR 70 SC 2 Map A / ST 3 QF: 95 FTI 16fps 2.5cm eSie Touch™ elasticity imaging Solid Breast Mass HOOD05162002873707 Effective date: 05/06/2018 BME_USG Education Page 65 | © Siemens Healthcare GmbH, 2017 eSie Touch Elasticity Imaging SIEMENS Healthineers ME10 9 SF SIEMENS 9L4 / Breast Detail 2D 100% THI / H9.00 MHZ 1 dB / DR 80 SC 2 Map B / ST 3 HD QF: 70 eSie Touch™ elasticity imaging 14fps 4cm Biopsy Proven Breast Carcinoma Courtesy of Dr. Dirk Clevert - Munich HOOD05162002873707 Effective date: 05/06/2018 BME_USG Education Page 66 | © Siemens Healthcare GmbH, 2017 eSie Touch Elasticity Imaging SIEMENS Healthineers MI: 1.2 SF SIEMENS 6C2 / Abdomen Detail 2D THI / H5.00 MHZ 100% 0 dB / DR 70 SC 2 Map D / ST 3 QF: 35 eSie Touch™ elasticity imaging 9fps 10cm Liver Hemangioma HOOD05162002873707 Effective date: 05/06/2018 BME_USG Education Page 67 | © Siemens Healthcare GmbH, 2017 eSie Touch Elasticity Imaging SIEMENS Healthineers MI: SF SIEMENS 14L5 / Thyroid Detail 2D 100% THI / H14.00 MHZ 0 dB / DR 70 SC 2 Map A / ST 3 +D=16.8 mm HD QF: 75 Shadow Measurements Complex Thyroid Mass 16fps 3cm HOOD05162002873707 Effective date: 05/06/2018 BME_USG Education Page 68 | © Siemens Healthcare GmbH, 2017 SIEMENS 6C1 HD Abdomen General SF TIS: 0.6 TIB: 0.6 MI: 1.5 10fps 2D- 100% THI H4.00 MHZ 7dB/DR70 SC Off DTCE M MapD/ ST2 HD HOOD05162002873707 Cooling 3 Effective date: 05/06/2018 BME_USG Education 69Page 69 | © Siemens Healthcare GmbH, 2017 11cm 08/14/2014 6:19 PM Z6Ms 15 vps / 120 mm 0.61 m/s 0.61 m/s Ann AP Diam 34.1 mm Ann AL-PM Diam 39.9 mm HOOD05162002873707 Effective date: 05/06/2018 BME_USG Education 70Page 70 | © Siemens Healthcare GmbH, 2017 ACUSON- P500 SIEMENS Healthineers ACUSON P500 FROsx HOOD05162002873707 Effective date: 05/06/2018 BME_USG Education Page 71 | © Siemens Healthcare GmbH, 2017 ACUSON S Family Premium segment SIEMENS Healthineers HOOD05162002873707 Effective date: 05/06/2018 BME_USG Education Page 72 | © Siemens Healthcare GmbH, 2017 ACUSON- SC2000 SIEMENS Healthineers ACLISON SC2000PRIME SIEMENS The thustound Points PRIME 1111 C. 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