ACUSON Origin 4D Fundamentals Presentation Part 1

SIEMENS Healthineers SIEMENS Healthineers® ACUSON Origin ultrasound system Fundamentals of 4D cardiac imaging; part I 2.0 software version Unrestricted © Siemens Healthineers, Unrestricted © Siemens Healthineers 2025 Notes No. 1 SIEMENS Healthineers Objectives SIEMENS . Healthineers • Discuss basic principles, benefits and clinical applications of 4D cardiac ultrasound • Recognize 4D cardiac transducers and image optimization parameters • Understand 4D echocardiography imaging modalities and acquisition techniques 2 Unrestricted © Siemens Healthineers, 2025 Notes No. 2 SIEMENS Healthineers SIEMENS . Healthineers eeeee 4D Cardiac ultrasound Basic principles, benefits and clinical applications Click to add footnote 3 second line Unrestricted © Siemens Healthineers, 2025 SIEMENS Healthineers What is 3D ultrasound? SIEMENS . Healthineers' ... ASMxe-Z -axis/axial plane y-axis/axial plane x-axis/lateral plane x-axis/lateral plane 2D ultrasound: Two dimensions, axes or planes 3D ultrasound: Three dimensions, axes or planes • x- and y-axis • Lateral and axial planes X-, y-, and z-axis • • Lateral, axial and elevation planes 4 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • Tradition 2D ultrasound images have two dimensions, the x- and y-axes or lateral and axial planes. • 3D ultrasound adds the third dimension or z-axis, to give depth to the image. This is called the elevation plane. Notes No. 4 SIEMENS Healthineers What is 4D ultrasound? SIEMENS . Healthineers 3D ultrasound: 4D ultrasound: Technique to acquire, visualize and display volumetric data at Provides continuous acquisition or moving 3D datasets, a single point in time enabling visualization of motion in real-time • For imaging stable or motionless structures • 3D ultrasound + time = 4D ultrasound • For imaging dynamic or moving structures 5 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • 3D ultrasound is a technique of acquiring static or motionless, volumetric ultrasound data, which can subsequently be manipulated to generate multiplanar images. • It is the sequential stacking of B-mode (and color) slices to form a volume of data, giving spatial height, width and depth perception to ultrasound data. • The image of a baby foot acquired during a fetal ultrasound exam is an example of 3D ultrasound. • Unlike a static 3D image, 4D imaging provides a live video feed, enabling observation of movement and dynamic changes within the body. • Continuous acquisition or moving datasets are 4D ultrasound. • 4D signifies the three spatial dimensions plus the dimension of time, enabling visualization of motion in real-time. • 3D ultrasound + time = 4D ultrasound. The 4th dimension is time. • • Echocardiography images moving, dynamic structures, utilizing 4D cardiac ultrasound. Notes No. 5 SIEMENS Healthineers Data processing SIEMENS . Healthineers • 3D ultrasound image data reconstruction is the process of converting raw ultrasound data into a structured 3D representation of anatomical structures • This process enhances spatial understanding, allowing for improved visualization of complex structures like the heart, vessels, and organs in clinical applications 1 2 3 CB Three key stages1,2: Acquisition Reconstruction Rendering and visualization 1. Acquisition Capturing multiple 2D Algorithm generates a Technique used to 2. Reconstruction slices or volumetric 3D image from a series visualize the 3. Visualization data from different of 2D/B-mode reconstructed data1 angles1,2 ultrasound slices1 1. Mohamed, F., and Vei Siang, C. (2019). A Survey on 3D Ultrasound Reconstruction Techniques. IntechOpen. doi: 10.5772/intechopen.81628 2. Huang, Qinghua, Zeng, Zhaozheng, A Review on Real-Time 3D Ultrasound Imaging Technology, BioMed Research International, 2017, 6 6027029, 20 pages, 2017. https://doi.org/10.1155/2017/6027029 Unrestricted © Siemens Healthineers, 2025 Speaker notes: • Data reconstruction in 3D ultrasound imaging is the process of converting raw ultrasound data into a structured 3D representation of anatomical structures. • This process enhances spatial understanding, allowing for improved visualization of complex structures like the heart, vessels, and organs in clinical applications. • Data processing involves three key stages: acquisition, reconstruction and visualization. 1. Acquisition is the capture of multiple 2D slices or volumetric data from different angles. 2. Reconstruction is a mathematical process used to generate a 3D image from 2D slices. 3. A rendering technique is then used to visualize the reconstructed data. • This is where data can be viewed for analysis, diagnosis, or intraprocedural guidance. Notes No. 6 SIEMENS Healthineers Data processing SIEMENS . Healthineers Acquisition Freehand Mechanical Matrix array ................................................................................................................... ........ 7 3. JDMS 21:392–399 September/October 2005 Unrestricted © Siemens Healthineers, 2025 Speaker notes: • Volume acquisition can be achieved through mechanical, freehand or matrix array scanning. • Freehand, or manual sweep acquisition is performed with conventional 2D ultrasound transducer. • The imager places the transducer over the region of interest and acquires a series of 2D images using a fan-like motion to collect the 3D data.3 • A mechanical transducer is a dedicated 3D/4D probe with a built-in motor used to systematically move across the region of interest, capturing multiple 2D slices at different angles.3 • Matrix array use one single sweep to acquire a considerable amount of data. • This incorporates a whole series of 2D frames taken in succession, followed by data processing to provide a 3D image. Any view or plane of interest, can then be extracted from the dataset, helping to visualize structure size, morphology and spatial relationships. • Cardiac volume imaging is acquired with a matrix array transducer. Notes No. 7 SIEMENS Healthineers 4D Matrix transducer SIEMENS . Healthineers ... 4D matrix transducer features a grid of tiny elements, enabling simultaneous data capture from multiple angles and live volume - image construction • Multiple tiny piezoelectric elements enable precise beam steering and focusing ensuring high-quality 4D imaging • Matrix array transducers deliver high- resolution 4D imaging, enabling live motion visualization, and enhanced diagnostics for complex anatomy 8 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • 4D matrix transducers feature a grid of tiny piezoelectric elements, enabling simultaneous data capture from multiple angles and live volume image construction. • Visualization of dynamic structures is crucial for cardiac imaging. • Multiple tiny piezoelectric elements enable precise beam steering and focusing ensuring high-quality 4D imaging • Matrix array transducers deliver high-resolution 4D imaging, enabling live motion visualization and enhanced diagnostics for complex anatomy. Notes No. 8 SIEMENS Healthineers Rendering and visualization SIEMENS . Healthineers ... Tomographic Multiplanar Surface Photorealistic Volume 01 02 03 04 05 9 Unrestricted © Siemens Healthineers, 2025 Speaker notes: • Data visualization and rendering techniques include tomographic, multiplanar, surface, photorealistic and volume. • Tomographic rendering shows multiple parallel cross-sections, or slices, extracted automatically from a single pyramidal data set. This is particularly useful for evaluating wall motion at different levels in the heart. • Multiplanar format allows for evaluation of multiple 2D planes at the same time. • The point of intersection of the three orthogonal planes (X, Y, and Z) is represented by a reference dot. That dot can freely be moved to obtain an image at any plane within the volume. • Surface rendering depicts the surfaces of structures identified by manual or semi- or fully-automated border tracing. • Automated algorithms utilize pattern recognition and other forms of artificial intelligence to identify fixed anatomic landmarks. • Software allows either manual or semi-, or fully-automated tracking of the structures of interest on 2D MPRs providing relevant quantitative parameters, such as volume, length, area, strain. • The model can be presented as a wireframe, where the surface is segmented into a fixed number of small geometric elements, or as a solid object. Output of the advanced analyses can also be color-coded and mapped onto the model's surface for easier interpretation, such as highlighting regions of high or low strain on a ventricle or identifying areas of AV valve prolapse. • Surface rendering is currently most applicable in the quantitative assessment of diameters, areas and/or volumes of various cardiac structures. • Photorealistic technique is a post-processing method using advanced algorithms to create highly realistic images by incorporating features like shadows, virtual lighting, and detailed skin rendering. Images appear more photographic vs traditional ultrasound. • LightSource is a feature on the ACUSON Sequoia system that simulates direction and intensity of light to create shadows and depth perception, to reveal surface details and enhancing the realism of the image. • Photorealistic rendering can be beneficial in visualizing potential abnormalities or providing parents with a more detailed view of their developing baby during a 4D ultrasound. • The most common visualization and rendering technique in 4D echo is probably volume. • Volume rendering utilizes various levels of shading and transparency to provide the impression of depth and to visualize internal and external details of the volume dataset. Notes No. 9 SIEMENS Healthineers • This method enhances depth perception and provides detailed insights into complex structures and spatial relationships structures, making it valuable for diagnostic imaging and surgical planning, particularly in evaluating cardiac valves and adjacent anatomical structures. Notes No. 9 SIEMENS Healthineers Volume rendered visualization and display SIEMENS . Healthineers ... Image projection Opacity Shading Pixel = unit of display in 2D imaging The intensity of a displayed voxel is Shading defines surface orientation and • opacity assigns colors based on an illumination • Voxel = volumetricc pixel; 3D equivalent to a pixel • ↑ intensities creates more opaque model images • Depth perception in 3D imaging is • ↓ intensities can make structures enhanced by adjusting shading and translucent or near invisible color intensity • Opacity is primarily controlled by the • Typically using blue and bronze hues gain and map settings 10 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • For effective visualization, the displayed image must convey depth within the volume dataset. • Ray casting is a volume rendering technique used to generate 3D images from volumetric ultrasound data. It works by projecting imaginary rays from the viewer's perspective into the 3D dataset, tracing their path through the volume, and sampling voxel values along the way. • The unit of display in 2D imaging is called a pixel. The 3D equivalent to a pixel is a voxel, or a volumetric pixel. A voxel is a unit of graphic information that represents a value on a regular grid to define the x, y, z points in a three-dimensional space. • Ray casting converts raw image data into a volumetric representation by assigning color, transparency and shading information to each voxel. This process enhances visualization by identifying, classifying, and mapping image properties for display. • Opacity is the intensity of a displayed voxel. It plays a fundamental role in visualizing internal structures. Higher opacity highlights structures of interest, while lower opacity minimizes background visibility. However, foreground objects can obscure deeper regions, affecting visualization of the target area. • Opacity is primarily controlled by the gain and map settings. • High intensity = opaque • Low intensity = translucent/near invisible • Shading, managed by the display software, defines surface orientation and assigns colors based on an illumination model. • Depth perception in 3D imaging is enhanced by adjusting shading and color intensity, typically using blue and bronze hues. • The default settings on the Origin system use a sepia hue to designate structures that are closer to the observer and a bluish tone to depict deeper structures. Notes No. 10 SIEMENS Healthineers Anatomical planes SIEMENS . Healthineers Sagittal: left/right Coronal: anterior/posterior A B The EAE/ASE Recommendations for Image Acquisition and Display Using Three- Dimensional Echocardiography Guidelines and Standards define three anatomical planes for cardiac volume image orientation • Anatomical planes are in reference to the heart itself, versus orientation of the heart to the body axis From front • Sagittal plane: vertical plane dividing From top heart into right and left segments • Coronal plane: vertical plane dividing From left heart into anterior and posterior segments • Transverse plane: horizontal plane From right running parallel to the ground dividing C the heart into superior and inferior Transverse: inferior/superior segments From back From bottom 4. Lang et al. J Am Soc Echocardiogr 2012. 11 5. C. Mitchell et al. J Am Soc Echocardiography 2018. https://doi.org/10.1016/j.echo.2018.06.004 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • The EAE/ASE Recommendations for Image Acquisition and Display Using Three-Dimensional Echocardiography Guidelines and Standards define three planes for cardiac volume image orientation • These anatomical planes are in reference to the heart itself, versus orientation of the heart to the body axis. • The three anatomical planes for 3D echocardiography are: • The sagittal plan is a vertical plane that divides the heart into right and left segments. • The coronal plane, a vertical plane that divides the heart into anterior and posterior segments. • The transverse plane is a horizontal plane that runs parallel to the ground dividing the heart into superior and inferior segments. Notes No. 11 SIEMENS Healthineers 3D Axes SIEMENS . Healthineers A -A X-axis: lateral (horizontal) Y-axis: axial (vertical) Z-axis: elevation (depth) When volume rendered image is rotated When volume rendered image is rotated When volume rendered image is rotated around the lateral axis, image rotates similar around the axial axis, image rotates similar to around the elevation axis, image rotates to a rotisserie split or a gymnast performing a a revolving door or merry-go-round similar to a clockface or steering wheel somersault 12 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • In addition to three anatomical planes, there are also three (3) axes: x-, y-, and z-axis in 3D ultrasound . • An axis is a single line representing a direction in 3D space. • Rotation of the plane occurs around an axis. • The x-axis represents the horizontal axis. The volume rotates around the x-axis similar to rotisserie split or a gymnast performing a somersault. • The y-axis represents the vertical axis. The volume rotates around the y-axis a revolving door or merry-go-round. • The z-axis represents the depth axis. The volume rotates around the z-axis similar to a clockface or a steering wheel. Notes No. 12 SIEMENS Healthineers 3D Planes SIEMENS . Healthineers Multiplanar reconstructions From back Sagittal = x-axis = lateral plane Sagittal = x-axis = lateral plane Sagittal = x-axis = lateral plane Coronal = z-axis = elevation plane A B From top From right From left From front From front Transverse = y-axis = axial plane Transverse = y-axis = axial plane Coronal = z-axis = elevation plane Coronal = z-axis = elevation plane Y: Axial Z: Elevation X: Lateral From bottom Planes C Axes Transverse = y-axis = axial plane 13 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • The 3D imaging planes that correspond with each axis and anatomical plane are: • Sagittal plane corresponds with the x-axis, or lateral plane (red), which is represented by MPR A. • The coronal plane corresponds with the z-axis or elevation plane (green) and is represented by MPR B. • Transverse plane corresponds with y-axis or axial plane (blue) and is represented by MPR C. SIEMENS Healthineers Advantages of 4D echocardiography SIEMENS . Healthineers 06 Improved proceducral guidance and 01 outcomes: Manipulation of 4D images Accurate volume measurements: during the procedure provides a more Cardiac volumes can be precisely intuitive understanding of the anatomy calculated without relying on geometric and enables informed decisions regarding assumptions, which can be inaccurate in device selection and deployment.7 2D imaging.6 05 Dynamic blood flow assessment: Real- 02 time visualization of blood flow Detailed motion analysis: Dynamic 4D dynamics provides valuable imaging provides a more accurate hemodynamic information during assessment of cardiac function and wall evaluation of shunts and valve motion, including subtle abnormalities 6 function.6,7 that might be missed in 2D imaging. 04 Better visualization of complex 03 Enhanced valve assessment: Ability to anatomy: Able to assess structural visualize valve from muliptle angles abnormalities, like congenital defects, allows for better evaluation of in more detail, providing clearer morphology and dynamics, including understanding of spatial relationships assessment of regurgitation and and anatomic orientation.6,7 stenosis.6,7 6. J Am Soc Echocardiogr 2012;25:3-46. doi: 10.1016/j.echo.2011.11.010. 14 7. EuroIntervention 2022;17:1205-1226. Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • Compared to 2D, 4D echocardiographic imaging captures a full volumetric view of the heart, providing a more accurate representation of cardiac structures and allows for detailed analysis of complex anatomy, unlike 2D which only provides a planar view. • Key advantages of 4D echo over 2D include: 1. Accurate volume measurements: Cardiac volumes can be precisely calculated without relying on geometric assumptions, which can be inaccurate in 2D imaging, especially in complex cases. 2. Detailed motion analysis: By capturing the full three-dimensional movement of the heart, 4D provides a more detailed assessment of wall motion and function, including subtle abnormalities that might be missed in 2D imaging alone. 3. Enhanced valve assessment: 4D echo allows for better evaluation of valve morphology and dynamics, including the assessment of regurgitation and stenosis, due to the ability to visualize the valve from multiple angles. 4. Better visualization of complex anatomy: Volumetric imaging is particularly beneficial for visualizing complex cardiac anatomy, like congenital defects, and can more accurately assess spatial relationships and anatomic orientation compared to 2D imaging, providing a clearer understanding of structural abnormalities. 5. Dynamic blood flow assessment: The 4D aspect allows for real-time visualization of blood flow dynamics within the heart, which is crucial for evaluating shunts, valve function and identifying potential areas of turbulence or obstruction. 6. Improved procedural guidance and outcomes: The ability to manipulate the 4D image in real-time during the procedure provides a more intuitive understanding of the anatomy, allowing the interventional cardiologist to make informed decisions regarding device selection and deployment. Multiplanar views enables precise positioning of transcatheter devices, minimizing the risk of mispositioning and complications. Optimized 4D views with excellent spatial resolution, anatomic Notes No. 14 SIEMENS Healthineers orientation, visualization of soft tissue onto fluoroscopic view, allows for better procedural navigation with fluoroscopy and with less use of contrast medium. Notes No. 14 SIEMENS Healthineers SIEMENS . Healthineers eeeee 4D Cardiac ultrasound Transducers and image optimization Click to add footnote 15 second line Unrestricted © Siemens Healthineers, 2025 SIEMENS Healthineers 4D Cardiac transducers Transthoracic: 5Z1 Transesophageal: Z6T Intracardiac: AcuNav Lumos Freq HMid Freq Mid Freq Mid AutoTEQ Active AutoTEQ Inactive AutoTEQ Inactive Line Density Mid Line Density Mid Line Density Mid UltraArt 2 UltraArt 2 UltraArt 2 DR 60 DR 60 DR 60 Maps MPR: D/Vol: E Maps MPR: D/Vol: A Maps MPR: B/Vol: C Tint MPR: 5/Vol: 7 Tint MPR: 5/Vol: 8 Tint MPR: 5/Vol: 8 Volume Enhance 2 Volume Enhance 1 Volume Enhance 3 Size Vol Size Vol Size Vol Position Lat Position Lat Position Lat Default 4D Settings Default 4D Settings Default 4D Settings Unrestricted © Siemens Healthineers, 2025 SIEMENS Healthineers 4D Cardiac transducers Transthoracic: 5Z1 Transesophageal: Z6T Intracardiac: AcuNav Lumos Freq Mid Freq Mid AutoTEQ Inactive AutoTEQ Inactive Line Density Mid Line Density Mid UltraArt 2 UltraArt 2 DR 60 DR 60 Maps MPR: D/Vol: A Maps MPR: B/Vol: C Freq HMid Tint MPR: 5/Vol: 8 Tint MPR: 5/Vol: 8 AutoTEQ Active Volume Enhance 1 Volume Enhance 3 Line Density Mid Size Vol Size Vol UltraArt 2 Position Lat Position Lat Default 4D Settings Default 4D Settings DR 60 Maps MPR: D/Vol: E Tint MPR: 5/Vol: 7 Volume Enhance 2 Size Vol Position Lat Default 4D Settings Unrestricted © Siemens Healthineers, 2025 SIEMENS Healthineers 4D Cardiac transducers Transesophageal: Z6T Transthoracic: 5Z1 Intracardiac: AcuNav Lumos Freq HMid Freq Mid AutoTEQ Active AutoTEQ Inactive Line Density Mid Line Density Mid UltraArt 2 UltraArt 2 DR 60 DR 60 Maps MPR: D/Vol: E Maps MPR: B/Vol: C Tint MPR: 5/Vol: 7 Mid Tint MPR: 5/Vol: 8 Volume Enhance Freq 2 AutoTEQ Inactive Volume Enhance 3 Size Vol Line Density Mid Size Vol Position Lat UltraArt 2 Position Lat Default 4D Settings Default 4D Settings DR 60 Maps MPR: D/Vol: A Tint MPR: 5/Vol: 8 Volume Enhance 1 Size Vol Position ....... Lat Default 4D Settings Unrestricted © Siemens Healthineers, 2025 SIEMENS Healthineers 4D Cardiac transducers Intracardiac: AcuNav Lumos Transthoracic: 5Z1 Transesophageal: Z6T Freq HMid Freq Mid AutoTEQ Active AutoTEQ Inactive Line Density Mid Line Density Mid UltraArt 2 UltraArt 2 DR 60 DR 60 Maps MPR: D/Vol: E Maps MPR: D/Vol: A Tint MPR: 5/Vol: 7 Tint MPR: 5/Vol: 8 Volume Enhance Volume Enhance Freq Mid 2 1 Size Vol Size Vol AutoTEQ Inactive Position Mid Lat Position Lat Line Density UltraArt 2 Default 4D Settings Default 4D Settings DR 60 Maps MPR: B/Vol: C Tint MPR: 5/Vol: 8 Volume Enhance 3 Size Vol Position Lat Default 4D Settings Unrestricted © Siemens Healthineers, 2025 SIEMENS Healthineers 4D Image acquisition SIEMENS . Healthineers • 4D echocardiographic image acquisition can be divided into four areas: 1 2 3 4 88 Optimization Mode selection Cropping Display and analysis • 2D • 4D • Color Doppler 20 Unrestricted © Siemens Healthineers, 2025 Speaker notes: • 4D cardiac echo acquisition can be divided into four areas or stages: 1. Image optimization: 2D, 4D and color Doppler modes should all be optimized to acquire high-quality 4D images. 2. Acquisition mode selection 3. Cropping of the dataset 4. Display and analysis • The first, and arguably most important stage, is image optimization. Notes No. 20 SIEMENS Healthineers SIEMENS . Healthineers 4D Image optimization B-mode 21 Unrestricted © Siemens Healthineers, 2025 Notes No. 21 SIEMENS Healthineers Image optimization SIEMENS . Healthineers Optimal 2D imaging is essential to a quality volume acquisition • Prior to activating or acquiring 4D, always optimize 2D image parameters • Poor 2D image quality = poor 4D image quality To obtain high-quality 3D/4D images: • Align structure of interest perpendicular with ultrasound beam for highest resolution • Ensure heart is centered • Adjust 4D/color Doppler ROIs to ensure structure(s) of interest are within the field of view • Enhance image quality by removing artifacts and adjusting gain and map settings 22 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • It is essential to begin with the highest quality 2D image prior to acquiring a volume dataset. • 2D images should always be optimized prior to performing 4D. 4D image quality is a reflection of the two-dimensional (2D) image quality. • Poor 2D images = poor 4D images. When 2D images are not appropriately optimized, 4D imaging could be clinically non-diagnostic. • To obtain high-quality 3D/4D images: • Align structure of interest perpendicular with the ultrasound beam for highest resolution. • Ensure heart is centered when acquiring 4D datasets. • Adjust dataset to ensure structure of interest is within the field of view. • Enhance image quality by removing artifacts and adjusting gain and map settings. Notes No. 22 SIEMENS Healthineers Touch screen layout SIEMENS . Healthineers ... Image optimization Image layout functions/volume orientation and formats MPR tools/additional settings Transducer and exam type Additional selections Cardiac ap Lumos Workflow tabs (based on operating mode Operating mode and workflow) tabs Patient Physio maging Main navigation Multislic Show MPR Lines MPR Lock Review Lock Bi-Plane selections Report Reset Orientation Reset Cropping A MPRA MPR B Sync MPR C End Exam Bi-Planc+ 4D Lines Auto TEQ Cut Plane 3D Caliper User-defined buttons Harmonics Single V 4D Zoom Capture Type Number of pages Prospective Additional Frequency Line Density DR Size osition Clip Capture selections menu H Mid Mid Vol Lat Flex Lat Eley Beats Sec Additional page selections Rotary dial controls 23 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • The touch screen has selections for use during each 4D imaging mode and during review. • Understanding the general layout of the touch screen can help identify where to locate certain controls or features more readily. • Orange indicates the selection is active. • Dark orange indicates a tap on the selection. • Gray indicates the selection is available. • Dark gray indicates the selection is unavailable. 23 SIEMENS Healthineers 4D Touch screens SIEMENS . Healthineers ... B-mode 5Z1 Workflow ap lumes Workflow Patient Physio Patient Physio Imaging Show MPR Lines MPR Lock Imaging Multislice Lock Bi-Plane L/R Flip UID FEp Review Review Report Reset Orientation Reset Cropping MPRA MARC Report Reset Orientation Leset Cropping End Exam End Exam Bi-Plane+ 4D Lines Auto TEQ Cut Plane 30 Caliper Free Plane Volume Enhance Harmonics Single V 4D Zoom Capture Type Prospective Cut Mane Line Des DR Size Cip Capture Page 1 Page 2 24 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • Most 4D optimization controls can be found on the touch screen. • Here are the default page one and two 4D touch screens for the 5Z1 transducer. • The 4D and default capture settings are identical with the following exceptions: maximum acquisition clip length for 4D volumes is 10 seconds. Beats setting is also limited to number of heart beats completed within the 10 second maximum acquisition length, regardless of the selected Beats setting. • For example, Clip Capture is set to 8 Beats, and patient has a heart rate of 60 bpm. The system would only capture 6 beats, as the 10 second maximum acquisition length would be reached at that time. • Press the 6 th rotary dial control on page one of the 4D touch screen to select a Clip Capture setting. • Beats indicates the duration of the clip, in cardiac cycles, Sec indicates the duration of the clip, in seconds. • Rotate Clip Capture dial to select clip duration. • 1 to 8 Beat or 1 to 10 seconds. SIEMENS Healthineers 4D Touch screens SIEMENS . Healthineers B-mode Z6T ap Lumos Workflow 22 Lumet 2 521 Workflow Patient Physio Patient Physio Imaging Mitral Valve Multislice Show MPR Lines MPR Lock Imaging LUAR Flip UID Flip Cool Down Review Lock Bi-Plane Review Report leset Orientation Reset Cropping KMPRA MAR B MARC Report Reset Orientation Reset Cropping End Exam End Exam Bi-Planet 4D Lines Auto TEQ Cut Plane 30 Caliper Free Plane Volume Enhance Single V 4D Zoom Capture Type Prospective Frequency Line Density DR Size APR Thickness Page 1 Page 2 25 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • On the default Z6T 4D touch screens, there is no Harmonics button and there is a new Mitral Valve button on page one. Page two (2) has a Cool Down button. • Note the placement of controls and features is remains consistent between transducers for ease of use. SIEMENS Healthineers 4D Touch screens SIEMENS . Healthineers B-mode Lumos 0 0 0 9 tratardie 26 Workflow Workflow Patient Physio Patient Physio Imaging MPR Lock Imaging En Face Multislice how MPR Lines Review Lock Bi-Plane UR Flip UID Flip Report Reset Orientation Reset Cropping NMPARC Report Reset Orientation Reset Cropping and Exam End Exam Bi-Plane 4D Lines Auto TEQ Cut Plane 30 Caliper Free Plane Volume Enhance Harmonics Single V 4D Zoom Capture Type Prospective Cut Mane Mid DR Position Clip Capture APR Thickness Page 1 Page 2 26 Unrestricted © Siemens Healthineers, 2025 SIEMENS Healthineers 4D Volume region of interest size SIEMENS . Healthineers ... B-mode Cardiac TIS.0.42 MI.O.88 Workflow Portiere Physio H Mid dB/DR60 Q Mid V 645 Lock Bi Phare Th15 Reset Oriermarie Reset Cropping Br-8 Con50 Erd Exam MPR Bi-Plane+ 40 Lines MapD/T4 Vol MapE/T7 30 Caliper Harmonics Size Capture Type Frequency Vol Lat Elev • 4D ROI size and position determine what structures To adjust 4D sector size, press 4th rotary dial to select • are contained within the volume rendered image Vol, Lat, or Elev plane (default is Vol) • Adjusting 4D ROI size for volume rendered image • Rotate Size dial to adjust the width of selected plane(s) removes unnecessary anatomy or artifacts from the • It is important to always keep an anatomical landmark volume dataset (usually the aorta) within the 4D sector to maintain Reducing ROI size in any plane increases volume rates spatial orientation • 27 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • ROI box size and position determine what structures are contained within the volume rendered image. • Adjusting the size of the 4D sector size for the volume rendered image removes unnecessary anatomy or artifacts from the volume dataset. • Reducing the region of interest size in any plane increases volume rates. Adjust the 4D sector size using the 4th rotary dial on page one of the 4D touch screen. • • Press the rotary dial to select Vol, Lat, or Elev, then rotate the control to adjust the size of volume in the selected plane. • It is important to always keep an anatomical landmark (usually the aorta) within the 4D sector to maintain spatial orientation. 27 SIEMENS Healthineers 4D Volume ROI size SIEMENS . Healthineers ... B-mode 4D Size: Volume 4D Size: Lateral 4D Size: Elevation • Vol adjusts width of 4D sector for lateral and • Lat adjusts 4D sector width of the lateral plane • Elev adjusts 4D sector width/depth of the elevation planes simultaneously • MPR A (red) elevation plane • MPRs A (red) and B (green) • Adjustments visualized in lateral and axial • MPR B (green) • Adjustments visualized in lateral, elevation, MPRs • Adjustments visualized in elevation and axial and axial MPRs MPRs • Check all MPRs when resizing 4D sector to confirm structure(s) of interest are present within volume before acquiring 28 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • Vol adjusts the width of the 4D sector for the lateral and elevation planes simultaneously. • MPRs A (red) and B (green) • Lat adjusts 4D sector width of the lateral plane. • MPR A (red) • Elev adjusts 4D sector width/depth of the elevation plane. • MPR C (green) • Check all MPRs when resizing the region of interest to confirm structure(s) of interest are present within volume before acquiring. 28 SIEMENS Healthineers 4D Volume VOI position SIEMENS . Healthineers ... B-mode Position Lat Eley Position: Lateral Position: Elevation • 4D Position determines what structures are • Lat repositions the 4D sector within the lateral • Elev repositions the 4D sector within the contained within the volume image based on plane elevation plane the location of the 4D sector • MPR A (red) • MPR B (green) • Adjust 4D sector position using the 5 th rotary • Adjustments visualized in lateral and axial • Adjustments visualized in elevation and dial on page one (1) of the 4D touch screen MPRs axial MPRs • Press dial to select Lat or Elev • Check all MPRs when adjusting 4D sector • Rotate to adjust 4D sector position within position to confirm structures/anatomy of selected plane interest remain within volume at the updated location 29 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • 4D Position determines what structures are contained within the volume image, based on the location of the 4D sector. Adjust the 4D sector position for the 4D volume using the 5th rotary dial on page one (1) of • the 4D touch screen. • Press the rotary dial to select Lat or Elev, then rotate the dial to adjust the position in the selected plane. • Lat repositions the 4D sector within the lateral plane. • In the clip of the PLAX, if structure of interest to acquire in 4D is the aortic valve, repositioning the Lat plane to the far left would no longer contain the structure within the volume. In this example, the red and green MPRs show what structures will be in the region of interest based upon the Lat position. • Elev repositions the 4D sector within the elevation plane. • Check all MPRs when adjusting 4D sector position to confirm structures/anatomy of interest remain within volume at the updated location. 29 SIEMENS Healthineers Selectable 4D frequencies SIEMENS . Healthineers ... B-mode To adjust balance between penetration and CP ZGT resolution Cardiac @ Lumos Workflow Rotate Frequency rotary dial on page one Patient Physio • 4D (1) of the 4D touch screen while real-time Imaging Multislice Show imaging Review PR Lines MPR Lock Lock Bi-Plane Harmonics enhances visualization, improves Report Reset Orientation Reset Cropping B MPR A MPR B MPR C image contrast and spatial resolution and Enkwam reduces noise Bi-Plane+ 4D Lines • Select Harmonics button to activate Cut Plane 3D Caliper harmonic frequency Harmonics Single V 4D Zoom Capture Type Prospective Frequency H Mid Size Harmonics only available DR Position Clip Capture 60 d fol Lat Elev Lat Eley C on 5Z1 and Lumosfor volume imaging .......................................... 30 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • The 4D B-mode operating frequencies covers a wide range of use cases, such as near field enhancement and far field penetration. • Penetration and spatial resolution are inversely affected by changes in Frequency. Increasing to a higher frequency will result in better resolution, but less penetration. A lower frequency will increase penetration; however, some spatial resolution will be lost. • Select a higher frequency if you need more spatial resolution and lower frequency if the ROI requires more penetration. • To select a Fundamental Frequency, adjust the 1st rotary dial control on page 1 of the 4D touch screen. • Harmonics improves contrast and spatial resolution of an image, as well as reduces noise. When active, the Harmonics button will be orange on the touch screen and an “H” will be displayed before the frequency range on the Frequency control button. Notes No. 30 SIEMENS Healthineers A u t h o r | D e Selectable 4D frequencies SIEMENS . p a r t m B-mode Healthineers ... e n t 5Z1 5Z1 Cardiac Cardiac TIS:0.65 MI:0.55 45.5Vps 31.2vps 95% 95% 4D 4D Mid H Mid 0dB/DR60 2dB/DR60 Q Mid Q Mid S2 S2 MPR: MPR. MapD/T4 MapD/T4 Vol: Vol: MapE/T7 MapE/T7 4D frequency: Mid 4D frequency: HMid 31 Unrestricted © Siemens Healthineers, 2025 Notes No. 31 SIEMENS Healthineers Auto TEQ SIEMENS . Healthineers ... Auto TEQ optimizes image Werthon Potest brightness uniformity within the field of view by adjusting overall gain and DGCs Auto TEQ Cat Rate 30 Calper D DGC controls must be set to midline PRIOR to • • activation Select Auto TEQ button on the touch screen System displays icon on image screen to activate when feature is active ++++++ 32 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • When active, Auto Tissue Equalization optimization will continuously adjust overall gain and DGC levels based on what is being imaged and continues to adjust as new information is scanned. • It is important to have DGCs set to the exact midline of the controls BEFORE activating Auto TEQ, or prior to selecting a preset if the default setting for that preset is active Auto TEQ. • Upon activation, Auto TEQ assumes the current position of DGCs is midline and uses this as the midline setting while active. • If DGCs have been turned up or down before Auto TEQ is activated, the amount of adjustment you can make will be reduced and may result in an inability to increase/decrease DGCs as needed to optimize the image. Simply deactivate Auto TEQ, return DGCs to midline and re-activate to reset available range. • To activate or deactivate the Auto TEQ, select the Auto TEQ button on the touch screen. The feature is active when the button is orange and inactive if the button is gray. • Auto TEQ icon will be displayed on the image screen when feature is active. Notes No. 32 SIEMENS Healthineers 4D Line Density SIEMENS . Healthineers ... B-mode 1 45.1vps Cardiac TIS:0.42 MIO.88 2 31.2vps Cardiac TIS:0.42 45.1vps 31.2vps 95 Q Low Q Mid 40 H Mid 24B/DR60 208 OR60 @ Low Q Md MPR: MapD/T4 MapE/T7 2 Lumes Workflow Patient Physio Imaging Multislice Show MPR Lines MPR Lock ock Bi-Plane Reset Orientatie Reset Cropping MIRA 4D Line Density: Low 4D Line Density: Mid (default) Bi-Plane+ 40 Lines 3 22.9vps Auto TEQ Court Plane 30 Calpe Q High Line Density 0 Zoom Capture Type Mid JaporT4 Cip Capture MAPEXPt 4D Line Density: High 33 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • There is separate control for 4D Line Density independent of 2D Line Density settings. • 4D Line Density adjusts the balance between spatial resolution and the volume rate (speed) for 4D volume acquisitions. • There are three (3) 4D Line Density options: Low, Mid and High. The default 4D Line Density setting for 5Z1, Z6T, and Lumos catheter is Mid. • Resolution and volume rates are inversely affected by changes in Line Density setting. • If higher volume rates are needed, adjust Line Density to Low. However, recognize this will also result in slightly lower image resolution. Low has highest volume rate, but lowest spatial resolution. Similarly, to improve image detail, adjust Line Density to High, but be aware volume rates will slightly decrease with this change. High has highest image detail, but lowest volume rates. • Use the 2 nd rotary dial control on page one of the 4D touch screen to adjust 4D Line Density setting. • Image 1 (Line Density Low) provides less detail but has the best temporal resolution (volume rate) (45.1 VPS). • Image 2 (Line Density Mid) provides better spatial resolution with a slightly lower volume rate (31.2 VPS). • Image 3 (Line Density High) provides the overall best spatial resolution and image detail but lowest temporal resolution (22.9 VPS); ~ ½ that of Line Density Low. 33 SIEMENS Healthineers 4D Gain SIEMENS . Healthineers ... B-mode 4D gain controls overall SIEMENS O) brightness of volume rendered and MPR images 4D It also affects the opacity of the volume rendered image 4D gain: 0dB (default) • 4D gain should be set at a value to eliminate static noises while preserving SECRET Healthingers› • Rotate 4D dial on control panel to anatomic structures adjust overall 4D gain • • Too much gain increases To determine optimal setting, begin reducing 4D gain until image noise and can obscure dropout occurs, then slowly structures of interest increase until structures are again • Too little gain creates visible tissue dropout 4D gain: 10dB 4D gain: -10dB 34 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • 4D gain controls overall brightness of the volume rendered and 2D MPR images. It also affects the opacity of the volume rendered image. • An appropriate gain setting is of even greater importance in 4D imaging compared to 2D imaging, because over-gaining can obscure structures of interest. • Too high gain setting produces static noises that resemble dense spontaneous echo contrast. Too low a gain setting creates dropout artifacts in the tissues. • A certain gain setting may be ideal for a given structure, but too high or too low for an adjacent structure within the same volume. • 4D gain should be set at a value to eliminate the static noises while preserving anatomic structures. • To determine the optimal setting, begin by reducing the 4D gain until image dropout occurs, then slowly increase until structures are again visible. • Rotate the 4D dial on the control panel to adjust overall gain in one decibel increments. • Gain range: -20 dB – 20 dB Notes No. 34 SIEMENS Healthineers 4D Dynamic range SIEMENS . Healthineers 1 2 267 e Lumos Workflow Patient Physio Imaging Multislice Show MPR Lines MPR Lock Review Lock Bi-Man Reset Orientation eset Cropping End Exam 4D Dynamic range: 40 dB 4D Dynamic range: 60 dB (default) Bi-Plane+ 40 Lines 3 Auto TEQ Cut Mare 3D Caliper 4D Zoom Capture Type DR Prospective Frequency 50 dB Posion 4D Dynamic range: 80 dB 35 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • Dynamic range (DR) setting determines the number shades of gray displayed within an image. Endocardial definition is essential for accurate 4D analysis of chamber quantification and valvular assessment. • Decreasing or increasing the number of gray shades will further enhance the blood-tissue interface. • Increasing dynamic range results in more shades of gray displayed and generates a smoother, softer image. A higher DR value can increase tissue detail vs over-gaining an image. • Low dynamic range produces a high-contrast image which better shows fine details. Dynamic range should be adjusted once the gain and TGCs settings are optimized. Dynamic range is displayed as DR under the 3rd rotary dial on page one of the 4D touch • screen. Rotating the control clockwise will increase the Dynamic Range value or increase number of grays displayed and rotating the control counterclockwise will lower the Dynamic Range value, displaying fewer gray shades in the image. Setting ranges from 10 – 80 dB. The 4D default setting is 60 dB. • Dynamic Range setting can be adjusted on live or frozen images. 35 SIEMENS Healthineers UltraArt universal image processing SIEMENS . Healthineers ... 4D Smoothing Lumos Z6T Off 1 Off 1 Speckle reduction Ridge enhancement/ edge sharpening 2 3 2 3 Contrast enhancement Gain and dynamic range control 36 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • UltraArt universal image processing reduces speckle and enhances contrast to provide a realistic tissue presentation and patient-specific processing that adapts to differences in tissue. • It better delineates contours of a structure, improving continuity and creating more defined borders to improve image detail and contrast resolution. • 4D smoothing gives a rough surface a more uniform appearance. • UltraArt technology further enhances the overall image quality of the 4D transducers and Lumos catheter. • The major components of image enhancement for UltraArt include speckle reduction, ridge enhancement/edge sharpening, contrast resolution and gain and dynamic range control. • There are four (4) 4D UltraArt or Smoothing settings, giving users the control to adjust the amount of smoothing and edge enhancement applied to the image based on personal preference. Notes No. 36 SIEMENS Healthineers UltraArt SIEMENS . Healthineers ... 4D Smoothing 5Z1 Off 1 Workflow Patient Physio imaging Multiplica Show MPR Lines MPR Lock Lock Bi-Plane Off 2 MPR A NMPAR C 40 Lines Dw Auto TEQ 3D Caliper 2 3 Dw Harmonics Single V 4D Zoom Capture Type Prospective DR Position Cip Capture 37 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • Tap the UltraArt button on page one of the 4D tab of the touch screen to display to modal fly out menu and select preferred setting. SIEMENS Healthineers 4D volume and 2D MPR Maps SIEMENS . Healthineers ... B-mode Maps determine the how light or dark each shade of gray is displayed, based on ultrasound signal strength ap Lumos 8 521 Workflow • Volume maps determine how the perception of Patient Physio depth is displayed for 4D images Imaging • Can increase image resolution and make it Review L/R Flip UID Flip Cool Down easier to identify abnormalities Report Reset Orientation Reset Cropping • 2D MPR and volume rendered image Maps can End Exam be adjusted independently • MPR Maps adjust 2D MPR grayscale and Vol Free Plane volume Enhance Maps adjust 4D grayscale of the volume Cut Plane X = rendered image Wireframe Maps Use 5 th rotary dial control on page two of 4D • MPR Thickness A MPR Vall touch screen to adjust Mapssetting • Press dial to select either MPR or Vol, then rotate control to select Mapssetting 38 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • Whereas dynamic range adjusts the overall number of shades of gray, a gray Map decides how light or dark each shade of gray is displayed based on the strength of the ultrasound signal. • Maps determine how the perception of depth is displayed on the 4D images. They are used to make clearer, brighter and more detailed images. Maps can increase image resolution and make it easier to identify abnormalities. • Volume Maps represent the 4D grayscale image created from the volume data and are used to differentiate tissue types and densities. • The gray Maps indicate how different tissue densities are displayed as varying shades of gray on the image, with brighter areas representing denser tissues and darker areas representing less dense tissues. • Maps can be adjusted for the 2D MPRs and volume rendered image independently of each other. • Use the 5 th rotary dial control on page two of the touch screen to adjust the 4D MPR or Volume Maps settings. • Press the rotary dial to select either MPR or Vol, then rotate the control to select a Map setting. • On the Z6T transducer: • There are seven (7) 2D MPR and seven (7) 4D Volume Maps setting options. The default 2D MPR Maps setting is Map D and default 4D Volume Maps setting is Map A. • Maps can be adjusted during Live imaging or in Review. Notes No. 38 SIEMENS Healthineers 4D volume and 2D MPR Maps SIEMENS . Healthineers ... B-mode 5Z1 5Z1 Who.ft. siffle MPR maps Volume maps 39 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • The 5Z1 has seven (7) 2D MPR and six (6) 4D Volume Maps setting options. The default 2D MPR Maps setting is Map D and default 4D Volume Maps setting is Map E. 39 SIEMENS Healthineers 4D Volume and 2D MPR Maps SIEMENS . Healthineers ... B-mode ZGT Z6T MPR maps Volume maps 40 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • There are seven (7) 2D MPR and seven (7) 4D Volume Maps setting options on the Z6T transducer. The default 2D MPR Maps setting is Map D and default 4D Volume Maps setting is Map A. 40 SIEMENS Healthineers 4D Volume and 2D MPR Maps SIEMENS . Healthineers ... B-mode Lumos Lumos x MPR maps Volume maps 41 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • The Lumos catheter has transducer have seven (7) 2D MPR and five (5) 4D Volume Maps setting options. • The default Lumos 4D MPR Maps setting is Map B and 4D Volume Maps setting is Map C. 41 SIEMENS Healthineers 4D Volume and 2D MPR Tint SIEMENS . Healthineers B-mode Tints are pre-defined chroma maps that aid in visualizing subtle tissue characteristics to ap Lumos 8 521 Workflow highlight data Patient Physio • Adds blue, red, yellow or green to gray in gray Imaging map to change color of MPR and/or volume Review L/R Flip UID Flip Cool Down • 2D MPR and volume tints can be adjusted Report Reset Orientation Reset Cropping independently End Exam th rotary dial on page two (2) of 4D • Use 6 touch screen to adjust Tint setting Free Plane Volume Enhance • Press dial to select either MPR or Vol, then X = rotate control to select Tint setting Tint MPR Thickness 8 MPR Voll 42 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • Tints are pre-defined chroma maps, this post-processing setting adds a hue to the 4D volume or 2D MPR B-mode maps to aid in visualization of subtle tissue characteristics to highlight data. Changes the color of the MPR and/or volume by adding blue, red, yellow, or green to the gray in a gray map. Use the 6 th rotary dial control on page two of the touch screen to adjust the 4D MPR Tint • setting. • Press the rotary dial to select either MPR or Vol, then rotate the control to select a Tint setting. • Tints can be adjusted on live and frozen images. Notes No. 42 SIEMENS Healthineers 2D MPR tints SIEMENS . Healthineers ... B-mode 5Z1 Z6T Lumos MPR tints settings 43 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • There are eleven (11) Tint settings for the 2D MPRs. • The default 2D MPR Tint setting is 5 for all the 4D transducers and catheter. th rotary dial control on page two of the touch screen to adjust the 4D MPR Tint • Use the 6 setting. • Press the rotary dial to select either MPR or Vol, then rotate the control to select a Tint setting. • Tint can be adjusted on live and frozen images. 43 SIEMENS Healthineers 4D Volume tints SIEMENS . Healthineers ... B-mode 5Z1 ZGT Lumos Volume tints settings 44 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • There are ten (10) volume Tint settings on the 5Z1 and Z6T transducers and nine (9) volume Tint settings on Lumos. • The default 5Z1 Volume Tint setting is 7. • The default Volume Tint setting on the Z6T transducer and Lumos catheter is 8. 44 SIEMENS Healthineers Volume Enhance SIEMENS . Healthineers ... B-mode 529 Patient Physio Z6T Cool Down 0 1 2 Free Phase Volume Enhance 3 4 5 • Volume Enhance changes the transparency of the volume rendered image • System exclude low-level signal data and adjusts opacity and transparency of the volume • To adjust transparency of the volume rendered image, select the Volume Enhance button on page two (2) of 4D touch screen to display the modal fly out menu and select preferred setting 45 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • Volume Enhance changes the transparency of the volume rendered image. The system excludes low-level signal data and adjusts opacity and transparency of the volume image. • There are six (6) 4D B-mode Volume Enhance settings. • To change the transparency of the volume rendered image, tap the Volume Enhance button on page two of the 4D tab on the touch screen to display the modal fly out menu and select preferred setting. • The default settings are: • 5Z1: 2 • Z6T: 1 • Lumos: 3 45 SIEMENS Healthineers MPR Thickness SIEMENS . Healthineers ... Just Chipping MPR Thickness 20 • MPR Thickness changes thickness of 2D MPR slices, creating 3D effect on 2D MPRs • Measurements cannot be made on MPRs with MPR Thickness > 0 mm due to parallax artifact rd rotary dial on page two (2) of 4D touch • Use 3 screen to adjust MPR Thickness MPR Thickness: 0 default MPR Thickness: 10 MPR Thickness: 20 46 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • MPR Thickness changes the thickness of the 2D MPR slices. It creates a 3D effect on the 2D MPRs. • Default setting is MPR Thickness 0, indicating a thickness of 0mm, for all 4D transducer and catheter. Thickness settings range from 0mm – 20mm and can be adjusted in increments of 1mm. • NOTE: Once MPR Thickness is increased > 0 mm, measurements can no longer be made on the MPRs due to parallax artifact. • Use the 3 rd rotary dial control on page two of the 4D touch screen to adjust the MPR Thickness. 46 SIEMENS Healthineers SIEMENS . Healthineers 4D Image optimization Color Doppler 47 Unrestricted © Siemens Healthineers, 2025 Notes No. 47 SIEMENS Healthineers 4D Touch screens SIEMENS . Healthineers ... Color Doppler 5Z1 26T Workflow 26 PP Lume Workflow Patient Color (40) Physio Patient Color (AD) Physio Imaging Reduce FOV Show MPR Lines MPR Lock Imaging Review Lock Bi-Plane Review Report eset Orientation Reset Cropping MPRA MAR B MARC Report Reset Orientation Leset Cropping End Exam End Exam 2D + Color 2D Only Color Only Bi-Planet Color Crop 4D Lines Cut Plane Free Plane C Vol Enhance Single V 4D Zoom Scale Baseline ROI Size ROI Position Filter Smooth Line Densit Priority Page 1 Page 2 48 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • Most 4D color optimization controls are located on the touch screen. • Here are the default page one and two Color (4D) touch screens for the 5Z1 transducer. SIEMENS Healthineers 4D Touch screens SIEMENS . Healthineers Color Doppler Z6T 0 00 7 cardiac 22 Lumes Workflow ap Lumo Workflow Patient Color (40) Physio Patient Color (40) Physio Imaging Mitral Valve Reduce FOV Show MPR Lines MPR Lock Imaging Review Lock Bi-Plane Review Report Reset Orientation Reset Cropping MPRA MAR B MARC Report Reset Orientation Leset Cropping End Exam End Exam 2D . Color 2D Only Color Only Bi-Planet Color Crop 4D Lines Cut Plane Free Plane C Vol Enhance Single V 4D Zoom Scale Baseline ROI Size ROI Position Filter Smooth Line Density Priority Maps Page 1 Page 2 49 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • There is a new Mitral Valve button on page one of the default Z6T Color (4D) touch screen. • For ease of use, the placement of color imaging optimization controls and features is remains consistent between transducers. SIEMENS Healthineers 4D Touch screens SIEMENS . Healthineers Color Doppler Lumos 0 0 0 9 tratarding 26 Workflow Workflow Patient Color (40) Physio Patient Color (AD) Physio Imaging En Face Reduce FOV Show MPR Lines WAR Lock Imaging Lock Bi-Plane UR FIP WO Flip Review Review Report aset Orientation Reset Cropping A NOPRA Report Reset Orientation leset Cropping End Exam End Exam 20 + Calce 20 Only Calor Only B-Plane Calor Crop Cut Plane Free Plane C Vol Enhance Single V 4D Zoom Scale Baseline ROI Size ROI Position Filter Smooth Line Density Priority CROI Size Maps Page 1 Page 2 50 Unrestricted © Siemens Healthineers, 2025 SIEMENS Healthineers 4D Volume ROI size and position SIEMENS . Healthineers ... Color Doppler 4D color ROI box size and position determine what structures are interrogated with color @ Lumos SZ1 Workflow Doppler within the volume rendered image Patient color (4D Physio • Adjusting the color ROI box size keeps color Doppler contained to specific structure(s) BurBewn Mitral Valve Reduce FOV Show MPR Lines MPR Lock Review Lock Bi-Plane within the volume Report Reset Orientation Reset Cropping MPRA MAR B MARC Reducing color ROI size increases volume End Exar • 20 + Color 2D Only Color Only Bi-Plane Color Crop 40 Lines rates • Press 4 th rotary dial to select the Lat, Cut Plane Elev, or Axial plane 4D Zoom • Rotate C ROI Size dial to adjust the color CROI Size Scale Lat Elev Axial Filter ROI box size within the selected plane • Check all MPRs when resizing color ROI box to confirm structure(s) of interest will be adequately interrogated before acquiring 51 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • 4D color ROI box size and position determine what structures within the volume rendered image are interrogated with color Doppler. • Adjusting the size of the color ROI for the volume rendered image keeps the color Doppler contained to specific structure(s) within the volume. • Keep color ROI box size to that of the structures of interest. Reducing the color ROI size increases volume rates. • Lat adjusts the lateral width of the color ROI box in the lateral/red plane (MPR A). • Elev adjusts the elevation depth of the color ROI box in the elevation/green plane (MPR B). • Axial adjusts the height of the color ROI box in the axial/blue plane (MPR C). Adjust the 4D color ROI box size using the 4th rotary dial on page one of the Color (4D) touch • screen. • Press the rotary dial to select Lat, Elev or Axial, then rotate the dial to adjust the size of the color ROI box within the selected plane • Check all MPRs when resizing the color ROI box to confirm structure(s) of interest within volume rendered image will be adequately interrogated before acquiring. 51 SIEMENS Healthineers 4D Volume ROI size SIEMENS . Healthineers Color Doppler Size: Lateral Size: Elevation Size: Axial • Lat adjusts color ROI box width within • Elev adjusts color ROI box width/depth • Axial adjusts color ROI box height in lateral plane in elevation plane axial plane • MPR A (red) • MPR B (green) • MPR C (blue) • Adjustments visualized in lateral and • Adjustments visualized in elevation • Adjustments visualized in lateral, axial MPRs and axial MPRs elevation, and axial MPRs • Default plane for color ROI box size is Lat 52 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: Adjust the 4D color ROI box size using the 4th rotary dial on page one of the Color (4D) touch • screen. • Press the rotary dial to select Lat, Elev or Axial, then rotate the dial to adjust the size of the color ROI box within the selected plane. • Lat adjusts the lateral width of the color ROI box in the lateral/red plane (MPR A). • Elev adjusts color ROI box width/depth in elevation plane (MPR B/green box) • Axial adjusts color ROI box height in the axial plane (MPR C/blue box) • Check all MPRs when resizing the color ROI box to confirm structure(s) of interest within volume rendered image are adequately interrogated before acquiring. 52 SIEMENS Healthineers 4D Volume ROI position SIEMENS . Healthineers ... Color Doppler Color ROI Position determines what structures are interrogated with color @ Lumos SZ1 Workflow Doppler within the volume rendered image Patient color (4D Physio based on location of color ROI box Imaging To reposition 4D color ROI box, press 5th Mitral Valve Reduce FOV Show MPR Lines MPR Lock Lock Bi-Plane • Review rotary dial to select the Lat, Elev, or Axial Report Reset Orientation Reset Cropping MPRA MAR B MARC plane End Exar 20+ Color 2D Only Color Only Bi-Plane Color Crop 40 Lines • Rotate C ROI Position dial to adjust the position of 4D color ROI box within the Cut Plane selected plane Single V Check all MPRs when repositioning color C ROI Position • Scale Baseline FROIS Lat Eley Avisi ROI box to confirm structure(s) of interest will be adequately interrogated before acquiring 53 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • Color ROI Position determines what structures within the volume rendered image are interrogated with color Doppler based on location of the color ROI box. To reposition 4D color ROI box, press 5th rotary dial on page one (1) of the Color 4D touch • screen to select the Lat, Elev or Axial plane. • Rotate dial to adjust the position of the 4D color ROI box within the selected plane. • Check all MPRs when repositioning color ROI box to confirm structure(s) of interest within volume rendered image will be adequately interrogated before acquiring. 53 SIEMENS Healthineers 4D Volume ROI position SIEMENS . Healthineers ... Color Doppler Position: Lateral Position: Elevation Position: Axial • Lat adjusts color ROI box position in • Elev adjusts color ROI box position in • Axial adjusts color ROI box position in lateral plane elevation plane axial plane • MPR A (red) • MPR B (green) • MPR C (blue) • Adjustments visualized in lateral and • Adjustments visualized in elevation • Adjustments visualized in lateral, axial MPRs and axial MPRs elevation, and axial MPRs 54 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • 4D color ROI Position determines what structures are contained within the volume image, based on the location of the color ROI box. Adjust the ROI position for the 4D volume using the 5th rotary dial on page one of the Color • (4D) touch screen. • Press the rotary dial to select Lat, Elev, or Axial, then rotate the dial to adjust the position in the selected plane. • Lat moves the color ROI box position within the lateral plane/MPR A (red). • Elev moves the color ROI box position within the elevation plane/MPR B (green). • Axial moves the color ROI box position within the axial plane/MPR C (blue). • Check all MPRs when repositioning the color ROI box to confirm structure(s) of interest within volume rendered image are adequately interrogated before acquiring. 54 SIEMENS Healthineers Selectable 4D frequencies SIEMENS . Healthineers ... Color Doppler 4D Color Doppler frequency adjusts the 521 Cardiac 26T ap Lumos Workflow balance between penetration and resolution • To optimize 4D color Doppler: Patient Color (4D) Physio Select an appropriate frequency for the Imaging • MPpack Reduce FOV Show MPR Lines structure being evaluated Review Lock Bi-Plane • Minimize the color box ROI to increase Report Reset Orientation Reset Cropping A MPR A MPR C volume rates End Exam Adjust Nyquist limit to avoid aliasing 2D + Color Color Only Bi-Plane+ Color Crop 4D Lines • • Use 1st rotary dial on page one (1) of Color Cut Plane (4D) touch screen while real-time imaging to adjust 4D color frequency Single V +D Zoom Frequency Mid Baseline ROI Size ROI Position Lat Elev Axial Lat Elev Axial Filter 55 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • Optimizing 4D color Doppler frequency is a balance between achieving good spatial resolution (higher frequency) and sufficient penetration depth (lower frequency. Penetration and spatial resolution are inversely affected by changes in Frequency. • Select an appropriate frequency for the structure being evaluated, minimize the color box ROI to increase volume rates, and adjust the Nyquist limit to avoid aliasing. • A lower frequency may be preferred for deeper structures while a higher frequency can be used for superficial structures with high resolution. • To adjust the Color (4D) Frequency, adjust the 1 st rotary dial control on page one (1) of the Color (4D) touch screen. Notes No. 55 SIEMENS Healthineers Gain SIEMENS . Healthineers 4D Color Doppler 4D color Doppler gain adjusts overall strength of echoes processed in the color ROI • Rotate color dial on control panel to adjust overall 4D color gain in one decibel increments Update 56 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • 4D color Doppler gain adjusts the overall strength of echoes processed in the color ROI of MPR and volume images. • 4D color Gain is controlled by the color rotary dial on the control panel. Notes No. 56 SIEMENS Healthineers Scale SIEMENS . Healthineers ... 56 Z6T : 39.0ºC Cardiac TIS:0.71 26T ap Lumen MI:1.37 Workflow 17.0vps 95% Patient Color (4D) Physio 4D Mid Imaging -9dB/DR60 Reduce FOV Show MPR Lin MPR Lock S2 Review Lock Bi-Plane Bro Con50 MPR Reset Orientation leset Cropping SOPRA MARC MapD/T5 Vol: End Exam MapA/T8 D . Color 20 Only Color Orly Bi-Plane+ Color Crop 40 Lines C Low OdB Cut Plane P1/LD2 RF 4808 Pr2 ngle v 4D Zoom MPR: MapD/F3 Scale 2D + Color Vol: ROI Size MapA 2D + Color 56 cms 57 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • When blood flow velocity surpasses the Nyquist limit, indicated by the value on the velocity bar, aliasing may occur. • When lower velocity blood flow may not be displayed when a Nyquist limit is set too high. • The maximum velocity scale, or Nyquist limit, is displayed at the top of the velocity bar. • Adjust the 4D color Doppler scale based on the ROI. Use the 2nd rotary dial on page one (1) of the Color (4D) touchscreen to adjust the 4D color • Doppler scale. 57 SIEMENS Healthineers Filter SIEMENS . Healthineers Filter adjusts the level of motion or low flow 0 0 0 / Cardia @ Lumos Workflow sensitivity Patient 4D Color (4D) Physio • Allows for clearer visualization of blood flow Imaging by filtering out unwanted "clutter" or noise educe FOV Review Show MPR Lines MPR LOCK Lock Bi-Plane from surrounding tissues Report Reset Orientation Reset Cropping A MPRA MPR B MPRC • Higher wall filter reduces the level of End Exam 2D + Color D Only Color Only Bi-Plane+ Color Crop sensitivity 4D Lines Use 6 th rotary dial on page one of Color 4D • Cut Plane touch screen to adjust Filter setting Single V Filter Scale Baseline ROI Size ROI PO 3 Lat Elev Axial 58 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • Filter adjust the level of motion or low flow sensitivity. It eliminates low-frequency Doppler shifts that originate from the movement of vessel walls and nearby tissues, which can interfere with the interpretation of blood flow signals. This allows for clearer visualization of blood flow by filtering out unwanted clutter or noise from surrounding issues; it essentially isolates Doppler signals from the blood flow itself. • A higher wall filter reduces the level of sensitivity. • There are four (4) 4D Color Filter settings 1, 2, 3 and 4. Adjust the 4D Color Filter setting using the 6 th rotary dial on page one of the Color (4D) • touch screen. • The default settings are: • 5Z1: 2 • Z6T: 3 • Lumos: 3 Notes No. 58 SIEMENS Healthineers Smooth SIEMENS . Healthineers ** Smoothing creates uniformity and consistency in color flow displayed ap Lumos ZET 9 521 Workflow • Helps reduce appearance of overly pixelated or noisy color variations in blood flow in Patient 4D Color (4D) Physio image, particularly in slow or turbulent flow Imaging L/R Flip UID Flip • Increasing color Smooth can make blood flow Review appear smoother but can also potentially Report Reset Orientation Reset Cropping mask subtle details or small changes in End Exam velocity As spatial averaging (smoothing) increases, Free Plane C Vol Enhance • flow sensitivity increases and spatial Cut Plane resolution decreases Smooth ireframe Use 1 st rotary dial on page two (2) of Color 2 Priority CROI Size Maps • (4D) touch screen to adjust Smooth setting 59 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • Smooth refers to the level of uniformity and consistency in color displayed. This setting helps reduce the appearance of overly pixelated or noisy color variations in blood flow represented in the image displayed, particularly in slow or turbulent flow. • Increasing the color smooth setting can make the blood flow appear smoother but can also potentially mask subtle details or small changes in velocity. As the spatial averaging (smoothing) increases, the flow sensitivity increases and spatial resolution decreases. • There are four (4) 4D Color Smooth settings 0, 1, 2, and 3. • Adjust the 4D Color Smooth setting using the 1 st rotary dial on page two of the Color (4D) touch screen. • The default settings are: • 5Z1: 3 • Z6T: 2 • Lumos: 2 Notes No. 59 SIEMENS Healthineers Priority SIEMENS . Healthineers ... Priority determines the amount Lumos of color pixel information to 1 2 overlay on the B-mode information of the image display • Higher setting provides more color information and lower 3 4 setting displays more B-mode Priority 2 information Use 3rd rotary dial control on page • two (2) of Color (4D) touch screen to adjust Priority setting 60 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • Priority determines the amount of color pixel information to overlay the B-mode information on the image display. • There are four (4) available Priority settings: 1, 2, 3, and 4. • A higher numbered setting will provide more color information displayed on-screen, and a lower number setting will display more B-mode information on-screen. Use the 3 rd rotary dial control on page two of the touch screen to adjust the Priority setting. • • The default settings are: • 5Z1: 1 • Z6T: 2 • Lumos: 2 Notes No. 60 SIEMENS Healthineers 4D Volume and MPR Maps SIEMENS . Healthineers ... Color Doppler Color maps select a processing curve for assigning velocity ranges to color ranges in the Lumos ZET 521 Workflow MPR and volume rendered images Patient 4D Color (4D) Physio • MPR and volume rendered images can be Imaging adjusted independently Review L/R Flip UID Flip • MPR maps adjust color map displayed in Report Reset Orientation Reset Cropping the 2D MPRs and Vol Maps adjust color End Exam map displayed in volume rendered image • Use 5 th rotary dial on page two of Color (4D) Free Plane C Vol Enhance touch screen to adjust Mapssetting Cut Plane Press dial to select either MPR or Vol, then Wireframe • Maps rotate dial to select a color Map setting Smooth Line Densit Priority ROLLS B MPR Vol 61 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • 4D color Doppler maps select a processing curve for assigning velocity ranges to color ranges in the multiplanar reconstructions and volume rendered images. • Color Maps can be adjusted for the 2D MPRs and volume rendered image independently of each other. Use the 5 th rotary dial control on page two of the Color (4D) touch screen to adjust the 4D • MPR or Volume Maps settings. • Press the rotary dial to select either MPR or Vol, then rotate the control to select a Map setting. • Color (4D) Maps can be adjusted during Live imaging or in Review. Notes No. 61 SIEMENS Healthineers 4D Volume and MPR Maps SIEMENS . Healthineers ... Color Doppler 5Z1 5Z1 MPR color Doppler maps Volume color Doppler maps 62 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • There are ten (10) 2D MPR and ten (10) 4D Volume Color Map options on the 5Z1 transducer. The default 2D MPR and 4D Volume Color Map setting is Map B. 62 SIEMENS Healthineers 4D Volume and MPR Maps SIEMENS . Healthineers ... Color Doppler Z6T Z6T 3 D MPR color Doppler maps Volume color Doppler maps 63 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • There are ten (10) 2D MPR and ten (10) 4D Volume Color Map options on the Z6T transducer. The default 2D MPR Color Map setting is Map D and default 4D Volume Color Map setting is Map A. 63 SIEMENS Healthineers 4D Volume and MPR Maps SIEMENS . Healthineers ... Color Doppler Lumos Lumos 300 11 301 0 02 CLI ond Fel MPR color Doppler maps Volume color Doppler maps 64 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • There are seven (7) 2D MPR and seven (7) 4D Volume Color Map options on the Lumos catheter. The default 2D MPR and 4D Volume Color Map setting is Map B. 64 SIEMENS Healthineers Color Volume Enhance SIEMENS . Healthineers ... Color Volume Enhance changes the transparency of the color Z6T Doppler overlay on volume 267:38.7"C 0 1 Cardiac TIS:0.76 ME: 1 37 rendered image • System excludes low-level signal Color (60) Physio data and adjusts color opacity MARE/TS Mapa/T and transparency on volume rendered image • To change transparency of color C Vol Enhance overlay on volume rendered 287:38.7'C image, select C Vol Enhance 2 3 Priority button on page two (2) on Color (4D) touch screen to display the modal fly out menu and select preferred setting 65 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • Color Volume Enhance changes the transparency of the color Doppler overlay on the volume rendered image. The system excludes low-level signal data and adjusts color opacity and transparency on the volume rendered image. • There are four (4) 4D Color Volume Enhance settings on the 5Z1 and Z6T transducers and five (5) settings on the Lumos catheter. • To change the transparency of the color overlay on the volume rendered image, tap the C Vol Enhance button on page two on the Color (4D) tab of the touch screen to display to modal fly out menu and select preferred setting. • The default settings are: • 5Z1: 1 • Z6T: 0 • Lumos: 0 65 SIEMENS Healthineers SIEMENS . Healthineers 4D Cardiac imaging Modalities and acquisition 66 Unrestricted © Siemens Healthineers, 2025 Notes No. 66 SIEMENS Healthineers 4D Image acquisition SIEMENS . Healthineers • 4D echocardiographic image acquisition can be divided into four areas: 1 2 Optimization Mode selection • 2D • Bi-plane • 4D • Live 4D • Color Doppler • Live 4D wide sector • 4D Zoom • 4D+Color 67 Unrestricted © Siemens Healthineers, 2025 Speaker notes: • The next area of focus is mode selection. It is important to always begin with end in mind when performing 4D cardiac imaging. • Understanding how the data is to be utilized helps plan which modality is most applicable based on the clinical need, as well as determine where to obtain images to ensure optimal acquisition of structures. Image resolution is best when structure is perpendicular to the beam. • Based on the structure of interest to be evaluated, a decision should be made with respect to acquisition modality, including 4D color Doppler, Bi-Plane, and volume size. This also guides how volume rates can be optimization, such as 4D zoom vs full sector size. For example, if a 4D study is needed to evaluate congenital abnormalities and a virtual dissection is to be performed, 4D zoom would not be the modality of choice for this procedure. • Understanding the capabilities, strengths and limitations of each modality will help guide decision making and practical applications for 4D cardiac imaging. Notes No. 67 SIEMENS Healthineers 4D Acquisition SIEMENS . Healthineers Modalities Bi-Plane+ Live 4D Live 4D Wide sector 4D Zoom 4D + Color • Two (2) simultaneous anatomical planes of valves/chambers • Align structures within ROI for Live 4D/4D Zoom imaging • Intra-procedural guidance 68 Unrestricted © Siemens Healthineers, 2025 Unrestricted © Siemens Healthineers 2025 Speaker Notes: • 4D matrix transducers offer imaging technologies not available on traditional 2D transducers beyond just 4D imaging. • 2D biplane is one of the most commonly used image acquisitions, allowing obtaining two simultaneous cross- section views of the same heartbeat • Electronic beam steering allows rotation of the scan angle without having to move the placement of the transducer while in 2D imaging. • It provides two (2) two-dimensional orthogonal imaging planes, that can be individually adjusted using the Bi-Plane+ feature. • This technique has proven particularly useful for guidance of advanced interventional or hybrid cardiac procedures where maneuvering and deployment of intracardiac devices require both accurate spatial resolution and high frame rates. Notes No. 68 SIEMENS Healthineers 5Z1 and Z6T Single plane SIEMENS . Healthineers .: Scan plane rotation Electronic beam steering allows images to be viewed and captured from various angles without physically manipulating or rotating the transducer • Increases workflow efficiency • Minimizes transducer manipulation • Beneficial for: • Evaluating complex anatomies • Scanning difficult imaging windows Scan plane rotation Apical four-, three-, and two- Reducing risk of foreshortening • Dot on angle indicator designates chamber views • anatomical structures starting point for image acquisition • AP4: 0° • • • Evaluating and aligning with color 0° is default/starting angle AP3: 245°* • 90° is equivalent to rotating scan • Doppler jets AP2: 310°* plane/transducer 90° clockwise • 180° provides mirror image of scan plane ..................................................................................................................... 69 *Angles are approximate and will vary slightly based on patient anatomy Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • Matrix transducers are able to electronically steer the orientation of the ultrasound beam by activating different combinations of transducer elements within the array. • Using scan angle rotation, imager can view structures and acquire images from multiple scanning planes at different angles without physically rotating or manipulate the probe itself. • This feature is particularly useful for complex anatomies, on patients with difficult imaging windows, it reduces the risk of foreshortening the left ventricle or atria for volume measurements and when evaluating the extent of color Doppler jets or trying to align with an eccentric spectral Doppler signal. • Single plane imaging displays a scan plane indicator on the image screen with the rotation angle and orientation of the scan direction. • The dot on the angle indicator designates the starting point for image acquisition. • The starting angle of a single plane is 0° or 270°, depending on transducer configuration. Notes No. 69 SIEMENS Healthineers 5Z1 and Z6T Single plane SIEMENS . Healthineers ... Scan plane rotation GI 245 Reset Angle Angle 1º 309 To adjust scan plane rotation: • To return to default angle of 0°: • Press 4th rotary dial to select either 1° or 30° • Select Reset Angle • • Rotate dial to change Angle by increments of 1° or 30° • Clockwise increases Angle and counterclockwise decreases Angle 70 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • When single plane imaging with a 4D matrix transducer a scan plane indicator is displayed on the image screen providing orientation of scan plane direction and the rotation angle. • The starting or default angle of a single plane is 0°. • The dot on the scan plane indicator designates the starting point for image acquisition. • As the scan plane rotates, the system updates the rotation angle and angle indicator on the scan plane indicator. Using the 4 th rotary dial control on page one of the 2D or Color touch screen, the scan plane • Angle can be steered by increments of 1° or 30° and rotates 359°. • Press the rotary dial to select either 1° or 30°, then rotate dial to electronically steer the beam, clockwise to increase the Angle or counterclockwise to decrease the Angle. • To instantly return to the default angle of 0°, select the Reset Angle button on page one of 2D touch screen. Notes No. 70 SIEMENS Healthineers 5Z1 and Z6T Bi-Plane+ SIEMENS . Healthineers ... Bi-Plane+ imaging scans two (2) imaging planes with different rotation and tilt angles in a side- by-side format • Increases workflow efficiency for imager • Simultaneously image structures in two (2) 90 different anatomical planes • Minimizes manipulation of transducer • Provides more information to diagnose and Use with or without color Doppler enable treatment faster • Adjust planes individually or simultaneously • FOV, 2D/color Doppler gain • Rotation • Tilt 60º 120º Individually control scan plane rotation and tilt angle for each plane 71 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • Bi-Plane+ is a 2D imaging mode which offers the ability to simultaneously image structures in two (2) different anatomical planes with or without color Doppler in a side-by-side format. • BiPlane+ imaging improves workflow efficiency for the imager. • It minimizes manipulation of the transducer, making imaging more streamlined. • It offers the ability to image a structure of interest in two different planes simultaneously in both 2D and 2D with color Doppler. • This provides imagers with more information to diagnose and enable treatment for patients even faster. • The Bi-Plane+ feature images two (2) scan planes from different rotation and tilt angles. • The two planes can be adjusted individually or simultaneously. • Individual adjustments include field of view, 2D and color Doppler gain, adjustment of the tilt angle, and scan plane rotation • Bi-Plane+ is available on the 5Z1 and Z6T matrix transducers. Notes No. 71 SIEMENS Healthineers 5Z1 and Z6T Bi-Plane+ SIEMENS . Healthineers Scan plane indicator 90º 0 90º 0 90º O Left Right Planes are perpendicular. Right plane Reference plane selected; red indicator is Planes are perpendicular. Both planes are Reference plane (left) is red selected; green indicator is bold. No bold. Right plane tilted relative to selected; both indicators are bold. Right Right plane is green elevation tilt applied to right plane. reference plane as indicated by tilt angle plane tilts relative to reference plane. on right plane as indicated by the tilt angle on the right plane. 90º 60º 60º 60º 120º 60º 120º O Default Bi-Plane+ angles are 0° (reference Both planes are parallel. No elevation tilt Planes are neither parallel nor Planes are neither parallel nor plane) and 90° (right plane). Both planes applied to right plane. perpendicular. Right plane selected. No perpendicular. Reference plane selected. selected. No elevation tilt applied to right elevation tilt applied to right plane. Right plane tilted relative to reference plane. plane. 72 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • Similar to single plane, the scan plane indicator includes the rotation angle and angle indicator for each plane, designated by color. • The reference plane is depicted by the color red on the indicator. Green identifies the right plane. • The default scan planes are the left reference plane at 0° (angle in red) with the red dot on the indicator designating the starting point for image acquisition at 3:00, and the right plane is at 90° (angle in green), orthogonal to the reference plane and the green dot on the indicator designating the starting point for image acquisition at 6:00. Note: Default scan angles can also be red 0° and green 270°, based on transducer configuration. • The image on the left is the reference plane. The reference plane displays the tilt line and tilt indicator in turquoise • The angle indicator also identifies the active, or selected plane(s). The angle indicator of the selected plane(s) is bold. If both planes are active, both angle indicators are bold. • The indicator also shows the tilt angle, in green (the same color as the right plane), relative to the reference plane. When the right plane is selected, the tilt angle will also be bold. Notes No. 72 SIEMENS Healthineers 5Z1 and Z6T Bi-Plane+ SIEMENS . Healthineers ... ap Luma Workflow Workflow Patient Physio Patient Physio Imaging Imaging Mitral Valee Show Mit Lines MPf Lock lock & Mare LI Flip Review Reset Orientation Rupert Ful FOV Bi-Plane+ End Exam 40 Lines Right invert D AUAS TED Cut Mane 30 Calper Auto TEQ Reset Angle 4D Zoom 0 Zoom Capture Type Prospecthe Harmonics Left Both Line Derait Frequency dip Capture 50 da • To activate biplane imaging, select the Bi-Plane+ button on • The touch screen menu will automatically change to a 2D page one (1) of the touchscreen imaging tab upon activation • 4D functions are accessible and can be selected from the Bi-Plane+ touch screen menu 73 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • To activate biplane imaging, select the Bi-Plane+ button on page one of the 2D, Color, or 4D tab of the touch screen. • The touch screen menu will automatically change to a 2D imaging tab upon activation, as Biplane+ images in 2D. • 4D functions are accessible and can be selected from the Bi-Plane+ touch screen menu. Notes No. 73 SIEMENS Healthineers Bi-Plane and Bi-Plane+ SIEMENS . Healthineers ... Image optimization Left Both Right Go to Right • To adjust image optimization settings, select • Or use the Update key on control panel to • In this image, only the right plane was Left, Both, or Right button from touch screen select Go to Right/Go to Left on trackball selected, depicted by bold green angle to choose image(s) to adjust display graphic, if needed indicator • 2D gain only increased in selected/active plane Author | Department 74 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • Image optimization settings can be applied to scan planes independently or together. • Adjustments will apply to the currently selected plane(s). • Select Left, Both, or Right from page one of the 2D or Color touch screen or press the Update key on the control panel trackball arbitration controls until Go to Right or Go to Left is displayed on the trackball display graphic. • In this image, just the Right plane was selected, depicted by the bold green angle indicator. 2D gain was increased only in the selected or active plane. Notes No. 74 SIEMENS Healthineers Bi-Plane and Bi-Plane+ SIEMENS . Healthineers ... Field of view 105. Left Both Right Go to Right Size Position • To adjust 2D or color ROI sector size/position, • To reduce sector size, press left/right trackball • In this image, the reference plane was select Left, Both, or Right button from touch arbitration control to activate Size (function will selected, depicted by bold red angle indicator screen to select sector for adjustment be highlighted on trackball display graphic) and red dotted outline on image • Or press Update key on control panel to select • Roll trackball adjust sector size and press a • Available for both 2D and color Doppler Go to Right/Go to Left on image screen trackball key to set trackball display graphic, if needed • Press left/right trackball arbitration control to activate Position to reposition the sector using trackball 75 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • Image optimization settings can be applied to scan planes independently or together. • Adjustments will apply to the currently selected plane(s). • Select Left, Both, or Right from page one of the 2D or Color touch screen or press the Update key on the control panel trackball arbitration controls until Go to Right or Go to Left is displayed on the trackball display graphic. • Adjust the sector size and position either the 2D or color field of view using the trackball arbitration control set keys and track ball. • This can increase frame rate and remove unnecessary anatomy or artifacts from the image. • To reduce the sector size, press left/right trackball arbitration control to activate Size on the trackball icon control on the image screen. • Roll the trackball adjust sector size. • Press a trackball arbitration control key to set the new sector size. • Press left/right trackball arbitration control to activate Position (function will be highlighted on the image screen trackball icon) and reposition the sector using trackball. Notes No. 75 SIEMENS Healthineers 5Z1 and Z6T Bi-Plane+ SIEMENS . Healthineers ... Scan plane rotation Both Angle L60º R150 1ª 30º Clp Capte To rotate scan planes simultaneously: Press 4th rotary dial control to select either • • • Right plane remains at 90° orthogonal view to • Select Both button from touch screen 1° or 30° reference plane when angles are rotated • This keeps the relationship of the two scan • Rotate dial change Angle of both planes together from default orientation plane angles locked in the current together by increments of 1° or 30° orientation simultaneously • Clockwise increases Angle and counterclockwise decreases Angle Author | Department 76 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • To rotate the reference and right scan planes together while imaging in BiPlane+, select the Both button on page one of the 2D or Color touch screen. • This maintains the perpendicular relationship of the two scan planes while rotating the beam angle. th rotary dial control on page one of the 2D or Color touch screen, the scan plane • Using the 4 Angle can be steered by increments of 1° or 30° to rotate the scan planes together. • Press the rotary dial to select either 1° or 30°, then rotate dial clockwise to increase both scan Angles, or counterclockwise to decrease both scan Angles simultaneously. Notes No. 76 SIEMENS Healthineers 5Z1 and Z6T Bi-Plane+ SIEMENS . Healthineers ... Scan plane rotation Right Angle 1º 300 Go to Right • To rotate the right or reference plane Press 4th rotary dial to select either 1° or 30° • • In this image, just the right plane was selected, independently, select Left or Right button • Rotate dial to change Angle of selected depicted by bold green angle indicator from touch screen individual plane by increments of 1° or 30° • Or use the Update key on the control panel to • Clockwise increases Angle and select Go to Right/Go to Left on trackball counterclockwise decreases Angle display graphic, if needed 77 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • To rotate only the left or right scan plane, select the Left or Right button on page one of the 2D or Color touch screen, or press the Update key on the control panel trackball arbitration controls until Go to Right/Go to Left is displayed on the trackball image screen graphic. th rotary dial control on page one of the 2D or Color touch screen, the scan plane • Using the 4 Angle can be steered by increments of 1° or 30° to rotate the Right scan plane. • Press the rotary dial to select either 1° or 30°, then rotate dial to electronically steer the beam, clockwise to increase the Angle or counterclockwise to decrease the Angle. Notes No. 77 SIEMENS Healthineers 5Z1 and Z6T Bi-Plane+ SIEMENS . Healthineers ... Scan plane rotation 26T:38.7"C Z6T:39.2"C TIS 0 58 Cardiac TIS 0.58 MIO.68 95% 11fps 95% 2D H Mid OdB DR63 Right Invert Low OdB General PRF 2907 Perpendicular Canorary Goreral • To obtain a 180° view from the current angle in • Right Invert instantly changes the angle of • If imaging at 90° and 327°, selecting the right scan plane, select Right Invert button right scan plane by 180° Perpendicular would instantly rotate right on touch screen scan plane from 327° to 180° • To instantly move the right scan plane to a 90° • Scan planes must be rotated ≥ 1° away from orthogonal plane, perpendicular to the 90° orientation to one another for feature to reference plane, select Perpendicular button be available • Feature would not be available at angles of 0° and 90° or 180° and 270°; it would become enabled at 1° and 90° or 0° and 91° Author | Department 78 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • Right Invert instantly provides a mirrored-image or 180° view from the current position in the right scan plane. • To rotate the right scan plane 180° from the current angle, select the Right Invert button on page one of the 2D or Color touch screen. • To instantly move the right scan plane to a 90° orthogonal plane, perpendicular to the reference plane, select the Perpendicular button on page one of the 2D or Color touch screen. • If imaging at 90° and 327°, selecting Perpendicular would instantly rotate the right scan plane from 327° to 180°. • Scan planes must be rotated ≥ 1° from 90° orientation to each other for feature to be available. For example, feature is not available at angles of 0° and 90° or 180° and 270° but would become enabled at 1° and 90° or 0° and 91°. Notes No. 78 SIEMENS Healthineers 5Z1 and Z6T Bi-Plane+ SIEMENS . Healthineers' ... Reset Angle ZGT: 39.0ºC Cardiac TIS:0.58 3140 MI:0.68 y Cardia ap Lumes Workflow 11fps 95% 2D Patient Physio H Mid OdB Imaging LUR Flip UND Flip C Review Low Report OdB Full FOV eral 907 End Exam Reset Angle Auto TER Harmonics Right 4D Zoom Capture Type Prospective Frequency Mid Cip Capture 84bpm Mead 11 79 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • Scan planes can quickly be reset to the default orthogonal positions (0° and 90° or 0° and 270°, depending on transducer configuration). • Select the Reset Angle button on page one of 2D or color touch screen. Notes No. 79 SIEMENS Healthineers 5Z1 and Z6T Bi-Plane+ SIEMENS . Healthineers ... Scan plane tilt Tilt digitally steers the ultrasound 90 beam to view structures from a Right plane slightly different angle • Displays the reference plane and Reference plane second tilted view simultaneously • The tilted view is angled relative Right plane Reference plane to original reference plane • Lateral tilt: side-to-side or left/right • Elevation tilt: up and down or Lateral tilt Elevation tilt superior/inferior I Sweeps scan plane side-to-side Sweeps scan plane up and down • • • Provides better understanding of across the reference plane relative to the reference plane spatial relationships Right plane image updates in real- • Right plane image updates in real- • time relative to the position of tilt time relative to the position of tilt • Allows imaging of scan planes not line/single caret tilt icon line/double caret tilt icon visualized with standard views ....................................................................................................................... 80 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • Scan plane tilt electronically steers the ultrasound beam to view structures from a slightly different angle. • It displays one standard anatomical, or initial plane, and a tilted view simultaneously. One image is initial plane, and the other is at a tilted angle relative to the initial plane. • This provides better understanding of spatial relationships and allows imaging of scan planes not visualized with standard views. • There is lateral and elevation tilt. Both are used to gain a more comprehensive view of the anatomy by manipulating the imaging plane electronically without physically moving the transducer. • With lateral tilt, the scan plane sweeps along a side-to-side axis across the reference plane. • Lateral tilt is useful for visualizing structures partially obscured by overlapping anatomy when viewed directly from the front. • Right plane image updates in real-time relative to the position of the tilt line/single caret tilt icon on the image screen. • In elevation tilt, the scan plane sweeps up and down along the axis of the reference plane, essentially looking superior/inferior to the original plane. • Elevation tilt helps examine structures located at different depths within the body; for example, sweeping with 2D and color from the RVOT to tricuspid valve in the parasternal long axis view and the coronary sinus to the LVOT in an apical window to evaluate for a perimembranous VSD. • To activate elevation tilt, the reference image and right scan plane angles must be parallel. A double tilt caret icon will appear on the image screen. The right plane image will then update in real-time relative to the position of tilt line/double caret tilt icon. Notes No. 80 SIEMENS Healthineers 5Z1 and Z6T Bi-Plane+ SIEMENS . Healthineers ... Lateral tilt 630 Cardos 333º TIS 0 87 Tilt Angle -10º Reset Tilt • To adjust lateral tilt, press left/right trackball Or rotate 5th rotary dial to change Tilt Angle • • Turquoise tilt line cursor will move in arbitration control key to select Tilt on • Clockwise sweeps tilt line cursor to the right reference plane/left image, and right plane trackball display graphic, if needed and counterclockwise sweeps cursor to the image will update to align scan plane with Roll trackball to move tilt line cursor to view angle of tilt line cursor • left structure of interest in right image • Scan indicator icon will also update the tilt angle of the right plane to reflect e tilt line position relative to the reference plane 81 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • To adjust the lateral tilt, use left/right trackball arbitration control keys on the control panel to select Tilt on the trackball display graphic, if needed. • Roll the trackball on the control panel to position the tilt line cursor at the desired angle to view structure of interest in the right image. • The tilt line cursor will move on reference plane/left image screen and image in the right plane will update to align scan plane position with the angle of the tilt line cursor. Turquoise tilt line will disappear after 1.5 seconds of inactivity. The turquoise caret at the bottom of the reference image will remain on screen for orientation. • The scan indicator icon will also update the right plane scan angle to reflect the lateral tilt line position along the reference plane. Notes No. 81 SIEMENS Healthineers 5Z1 and Z6T Bi-Plane+ SIEMENS . Healthineers Elevation tilt Tilt Angle 10º Reset Tilt • To change elevation tilt: • Roll trackball to move tilt line cursor to view Adjusting 5th rotary dial also changes Tilt • • Align reference and right scan plane angles structure of interest in right image Angle parallel to each other at matching angles • As tilt line cursor moves on reference • Scan indicator icon will update the tilt angle • Orientation dots in the same direction plane/left image, right plane will update to of the right plane to reflect the tilt line Both images should be identical prior to align with scan plane of elevation tilt angle position relative to the reference plane • moving double caret tilt line cursor • Moving tilt line →, sweeps right image scan • Turquoise tilt line cursor has a double caret to plane superior, or ↑ and moving cursor ←, indicate planes are parallel sweeps right image scan plane inferior, or ↓ 82 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • To change the elevation tilt, first align reference scan plane and right scan plane angles parallel to each other at the same angle, including orientation. Angles should be identical, and dots aligned in the same direction. • Turquoise tilt line cursor will have a double caret to indicated planes are parallel and both images should be identical prior to moving double-tilt line cursor. • Roll the trackball on the control panel to position the tilt line cursor at the desired angle to view structure of interest in the right image. • As tilt line cursor moves on reference plane/left image, and right plane will update to align with scan plane of elevation tilt angle. As the tilt line cursor moves right, the right image scan plane sweeps superiorly and as the tilt line cursor moves left, the right image scan plane sweeps inferiorly. • For example, when reference and right plane are oriented in the PLAX view at the aortic and mitral valve level, moving tilt line to the right would bring in the RVOT/pulmonary valve in the right image, similar to physically angling the transducer to visualize these structures. Moving the tilt line to the left would bring in the tricuspid valve, similar to physically angling the transducer inferiorly to obtain this view. • The tilt line cursor will move on reference plane/left image screen and image in the right plane will update to align scan plane position with the angle of the tilt line cursor. Turquoise tilt line will disappear after 1.5 seconds of inactivity. The double turquoise caret along the bottom of the reference image will remain on screen for orientation. • Scan indicator icon will also update the tilt angle of the right plane to reflect the tilt line position relative to the reference plane. Notes No. 82 SIEMENS Healthineers 4D Acquisition SIEMENS . Healthineers ... Modalities 4D Zoom 60° x 60° 90° x 90° 83 8. Adapted from JACC Vol. 48, No. 10 2006:2053–69 doi:10.1016/j.jacc.2006.07.047 Unrestricted © Siemens Healthineers, 2025 Unrestricted © Siemens Healthineers 2025 Speaker Notes: The default Live 4D imaging sector is ~ 60°x 60°. • From the default size, the Live 4D the sector can be enlarged up to 90°x 90° (90°x5 4°on • Lumos) to encompass the entire cardiac structure, or performed to targeted structures of interest with higher lateral and elevation resolution using 4D Zoom. Notes No. 83 SIEMENS Healthineers 4D Acquisition SIEMENS . Healthineers Modalities Bi-Plane+ Live 4D Live 4D Wide sector 4D Zoom 4D + Color 60° x 60° volume sector • ~ • Two (2) simultaneous Resolution: Moderate • • Acquisition time: Single cycle anatomical planes of • FOV: Small – moderate valves/chambers • Strengths: Visualization of ROI • Align anatomy for Live and adjacent anatomy • Limitations: Insufficient FOV to 4D/4D Zoom cover entire structure • Ideal for intra-procedural • Intra-procedural guidance guidance • Best for intraoperative use, transcatheter interventions 84 Unrestricted © Siemens Healthineers, 2025 Unrestricted © Siemens Healthineers 2025 Speaker Notes: The default Live 4D volume sector is ~ 60°x 60°. • • While the sector size may be insufficient to visualize all structures in their entirety from a single plane, this modality has superior spatial and temporal resolution for complex pathologies with moderate to high resolution. • It is ideal for intraprocedural guidance and transcatheter interventions. Notes No. 84 SIEMENS Healthineers 4D Acquisition SIEMENS . Healthineers Live 4D Mic OdB/DR51 52 MPR: MapD/T5 Vol: MapA/TS 20 Comper Playback KN C Might Virgin s Beats Loft Maigin • Press 4D dial on control panel to activate live • Or press Freeze on the control panel and use • Live 4D full volume imaging of a catheter tip at 4D imaging Playback, 4th rotary dial on touch screen, to 51 vps • 4D volume and MPRs are continuously review clip in CINE buffer • Press 2D or 4D dial on control panel to exit 4D acquired and displayed in real-time • Select specific frames/beats using Cine control imaging • Press Capture key on control panel to acquire and then press Capture 4D clip • Pressing Freeze while in cine review will clear the cine buffer and exit to live 4D imaging 85 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • Each 4D acquisition produces a volume rendering and multiplanar reconstructions. • Settings can be adjusted during 4D acquisition to enhance visualization of anatomy within the volume rendering. • Temporarily pause to play back and review CINE data at any time during 4D acquisition. • Press the 4D dial on the control panel to activate live 4D imaging. • The ultrasound system continuously acquires and displays the volume and multiplanar reconstructions on the image screen. • Review and optimize the volume during acquisition. • Perform necessary adjustments to imaging parameters, orientation of the volume, layout or magnification. • Press the Capture key on the control pane to acquire a clip of the 4D image Or press Freeze and use 4th rotary dial on the touch screen to Playback and review CINE • data. Rotate the Cine dial (5 th rotary control) to select specific frames/beats or leave margins in • place to select all. • Press the Capture key to acquire selected data within the CINE buffer. • Pressing Freeze while in CINE review will clear the buffer and exit to live 4D imaging. • Press the 2D or 4D dial on the control panel to exit 4D imaging. Notes No. 85 SIEMENS Healthineers 4D Acquisition SIEMENS . Healthineers Modalities Bi-Plane+ Live 4D Live 4D Wide sector 4D Zoom 4D + Color 60° x 60° volume sector • 90° x 90° volume sector • ~ • • • Two (2) simultaneous Resolution: Moderate Resolution: Moderate Acquisition time: Single cycle • Acquisition time: Single cycle • anatomical planes of • FOV: Wide • FOV: Small – moderate valves/chambers Strengths: Visualization of ROI • Strengths: Complete • and adjacent anatomy visualization of entire cardiac • Align anatomy for Live structures/adjacent anatomy • 4D/4D Zoom Limitations: Insufficient FOV • to cover entire structure Limitations: ↓ volume rates Ideal for: Intra-procedural • • Intra-procedural guidance Ideal for: Volumetric analysis, • guidance detailed structural assessment • Best for: intraoperative use, • Best for: Ventricular function, transcatheter interventions valve quantification, pre- procedural planning 86 Unrestricted © Siemens Healthineers, 2025 Unrestricted © Siemens Healthineers 2025 Speaker Notes: • Wide sector live 4D imaging is the same acquisition modality as live 4D, but with an adjusted sector to obtain up to a 90° x 90° volume rendered image. • Its main advantage for acquiring this type of 4D image is the ability to acquire the entire pyramidal volume with cropping and analyses able to be performed both during the acquisition and in post-processing. • This dataset can be cropped or multiplane transected to perform virtual dissections within the volume or to visualize 2D multiplanar reconstructions. • This performs the largest sector acquisition; ideal for volumetric analysis and detailed diagnosis of complex pathologies and structural assessments for pre-procedural planning. Notes No. 86 SIEMENS Healthineers 4D Acquisition SIEMENS . Healthineers ... Live 4D wide sector Cardiac TIS:0.42 ML:0.88 50.7vps 95% 4D H Mid 4dB/DR60 Q Mid V 64" Th15 Op70 S2 Br-8 Con50 Peset Orientation MPR MapD/T4 Vol: El Phares MapE/T7 Auto TEQ Size Capture Type Une Burity Vol Lat Elev LA 4D pyramidal sector can be increased up to 90° x 90° To adjust 4D ROI size, press 4th rotary dial to select • • from the default 60° x 60° Vol, Lat or Elev plane (default is Vol) • Useful for performing chamber quantification or • Rotate Size dial to adjust the width of selected virtual dissection for pre-procedural planning plane(s) up to 90° 87 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: Use the 4th rotary dial (Size) on page one of the 4D touch screen to increase the sector size • of the volume rendered image to up to 90° x 90° • Press the rotary dial to select Vol, Lat, or Elev, then rotate the control to adjust the size of volume in the selected plane. 87 SIEMENS Healthineers 4D Acquisition SIEMENS . Healthineers ... Modalities Bi-Plane+ Live 4D Live 4D Wide sector 4D Zoom 4D + Color 60° x 60° sector volume • 90° x 90° sector volume • Variable size truncated sector • ~ Resolution: Moderate • Resolution: Moderate volume (default ~ 50° x 50°) • • Two (2) simultaneous • Acquisition time: Single cycle • Acquisition time: Single cycle • Resolution: High anatomical planes of • FOV: Wide • Acquisition time: Single cycle • FOV: Small – moderate valves/chambers Strengths: Visualization of ROI • Strengths: Complete • FOV: Focused • • • Align anatomy for Live and adjacent anatomy visualization of entire cardiac Strengths: ↑ lateral, elevation and temporal resolution • Limitations: Insufficient FOV to structures/adjacent anatomy 4D/4D Zoom cover entire structure • Limitations:↓ volume rates • Limitations: Loss of spatial Ideal for intra-procedural • Intra-procedural guidance Ideal for: volumetric analysis, orientation • • guidance detailed structural assessment • Ideal for: High resolution Best for intraoperative use, • Best for: Ventricular function, assessment of specific • transcatheter interventions valve quantification, pre- structures procedural planning • Best for: Valves, IAS, IVS 88 Unrestricted © Siemens Healthineers, 2025 Unrestricted © Siemens Healthineers 2025 Speaker Notes: • 4D Zoom displays a truncated and magnified pyramidal dataset of the region of interest (ROI). • Pre-cropped imaging • Pre-processing re-write HD zoom of Live 4D • With 4D Zoom, the operator selects size and position the sample box, smaller than the full volume, to encompass only a targeted ROI or specific structures. • It is important to always ensure an anatomical landmark, for example, the aortic valve, remain present within the ROI box as to not lose spatial orientation should too much data be cropped away from the volume. • One major benefit of this technique is its ability to quickly assess a targeted area, eliminating the need for extensive cropping and reorientation. Additionally, by capturing a smaller volume, it achieves higher volume rates and enhanced resolution compared to full-volume acquisitions. • 4D Zoom is ideal for high-resolution assessment of specific structures of interest and valvular interrogation. Notes No. 88 SIEMENS Healthineers 4D Zoom SIEMENS . Healthineers ... Setup H Md 3dB/DR68 LD 3 UA 2 MapE/T4 4D Zoom o Icca 4D Zoom 111 Position _ Size _ Elev Size, Schpm [med 11 • To enhance lateral and elevation resolution in • To re-position/size ROI, press trackball arbitration • Elev Size resizes width/height of the ROI in the volume rendered image, select the 4D key to highlight selection elevation plane/right image Zoom button on page one (1) of the • Roll trackball to adjust ROI and press trackball • It is important to always keep an anatomical touchscreen arbitration key to set landmark (usually the aorta) within the 4D Gear icon on 4D Zoom button displays • Position only moves ROI location in the Zoom ROI box to maintain spatial orientation • orange to indicate 4D Zoom setup is active reference/left image • Select 4D Zoom button or press Update to set 2D bi-plane preview displays a reference plane • To adjust to ROI position in elevation/right ROI boxes and display 4D Zoom volume image • and its orthogonal view with trapezoid-shaped image, rotate Elev Position dial • 4D Zoom button will display orange and gear icon boxes defining default ROI position and size • Size resizes width/height of ROI in the will change to white to indicate 4D Zoom is active reference/left image 89 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • 4D enhanced resolution imaging, also known as 4D Zoom improves the lateral and elevational resolution of the volume rendered image. • To enhance the volume: • Select 4D Zoom button on page one (1) of the touchscreen. • The gear icon on the touch screen button will display orange to indicate an active 4D Zoom setup mode and 4D Z indicator displays below the image when 4D Zoom setup or 4D Zoom is active. • The 2D bi-plane preview will display the reference plane and its orthogonal view with two (2) trapezoid-shaped boxes defining the default position and size of the ROI. • To re-position or -size the 4D Zoom ROI: • Press a trackball arbitration key, if necessary, to choose a selection. • Roll the trackball to adjust the ROI and then press a trackball arbitration control key. • Position repositions the ROI within the displayed reference view/left image. • To adjust the ROI box position in the elevation plane/right image, rotate the Elev Position dial, 5 th rotary control on the touch screen. • Size resizes width of the ROI in the reference plane/left image. • Elev Size resizes the width of the ROI in the elevation plane/right image. • Select 4D Zoom button or press Update to finalize ROI boxes and display the 4D HD Zoom volume image. • The 4D Zoom button will display orange and the gear icon will change to white to indicate 4D Zoom is active. • To return to 4D Zoom setup to re-size or position the ROI, select the 4D Zoom button. 89 SIEMENS Healthineers 4D Zoom SIEMENS . Healthineers' ... Cardiac TI5:0.42 ME0.88 14.7vps 95% MPR Vol 4D Zoom Setup 4D Z 4D Zoom Accepted em Lead Il • Press the Zoom dial on control panel while • 2D bi-plane preview displays a reference plane • 4D Z indicator is displayed in lower-left corner imaging in 4D to activate 4D Zoom and its orthogonal view with trapezoid-shaped of image screen when 4D Zoom setup or 4D boxes defining default ROI position and size Zoom is active • It is important to always keep an anatomical • Press 4D dial to exit 4D Zoom landmark (usually the aorta) within the 4D Zoom ROI box to maintain spatial orientation • Press Zoom dial or Update key on the control panel to display high-resolution 4D Zoom volume 90 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • 4D Zoom can also be activated while live 4D imaging directly from the control panel. • Press the Zoom dial on the control panel while performing 4D imaging, to display the 2D bi-plane images. • The 2D bi-plane preview will display the reference plane and its orthogonal view with two (2) trapezoid-shaped boxes defining the default position and size of the ROI. • A consecutive press of Zoom dial or Update key on the control panel will display the high- resolution volume image. • To exit 4D Zoom, press the 4D dial on the control panel. 90 SIEMENS Healthineers 4D Acquisition SIEMENS . Healthineers Modalities Bi-Plane+ Live 4D Live 4D Wide angle 4D Zoom 4D + Color 60° x 60° volume sector • 90° x 90° volume sector • Variable size truncated sector • Variable volume sector • ~ Resolution: Moderate volume (default ~ 50° x 50°) • • • Resolution: Moderate • Two (2) simultaneous Resolution: Moderate • Acquisition Time: Single cycle • Resolution: High • FOV: Variable • Acquisition Time: Single cycle anatomical planes of FOV: Small – moderate • FOV: Wide • Acquisition Time: Single cycle • Strengths: Clinically relevant • valves/chambers Strengths: Visualization of ROI • Strengths: Complete • FOV: Focused volume rates; can be applied • and adjacent anatomy visualization of entire cardiac • Strengths: ↑ lateral, elevation to all listed 4D modalities • Align anatomy for Live Limitations: Insufficient FOV to structure/adjacent anatomy and temporal resolution Limitations: ROI size to • • 4D/4D Zoom cover entire structure • Limitations:↓ volume rates • Limitations: Loss of spatial maintain adequate rates Ideal for intra-procedural • Ideal for: Volumetric analysis, orientation • • Procedural guidance Ideal for: Eccentric Doppler • guidance detailed structural assessment • Ideal for: High resolution jets, non-circular orifices Best for intraoperative use, • Best for: Ventricular function, assessment of specific • Best for: Valves, device • transcatheter interventions valve quantification, pre- structures evaluation procedural planning • Best for: Valves, IAS, IVS 91 Unrestricted © Siemens Healthineers, 2025 Unrestricted © Siemens Healthineers 2025 Speaker Notes: • Similar to 2D imaging, a color Doppler region of interest (ROI) can be overlaid on Bi-Plane or 4D volume images, including live imaging and 4D Zoom. • By visualizing the spatial relationship between blood flow and cardiac structures, it provides detailed insights into the extent, direction, origin, and severity of intracardiac flows, such as regurgitant lesions, shunts, and overall cardiac output. • This technique helps address limitations of 2D color Doppler, particularly in measuring flow through non-circular orifices or eccentric jets. • When integrated with 4D structural imaging, it enhances the understanding of complex blood flow patterns and helps detect valvular and paravalvular leaks, as well as intricate structures that may not be visible in traditional 2D imaging. • The primary limitation of 4D + color imaging is its lower volume rates, which can impact temporal resolution. Notes No. 91 SIEMENS Healthineers 4D + Color SIEMENS . Healthineers ... 26T:40.5ºC Cardiac TIS:0.77 MI:1.34 14.1vps 95% 3GB DR60 MPR PRF 5102 600pm Lead IN Press Color dial to activate color Doppler while performing 4D • Press Color or 4D dial to exit color Doppler imaging • imaging • Color Doppler can be applied to all 4D modalities 92 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • Press the Color dial on control panel to activate color Doppler while performing 4D imaging. • Color Doppler can be applied to all 4D modalities. • Press the Color or 4D dial to exit color Doppler imaging. Notes No. 92 SIEMENS Healthineers Live 4D and 4D Zoom + Color SIEMENS . Healthineers ... 15 76T:39.1"C ZUT:40.5ºC ZGT:39.0'C Cardiac Cardiac Cardiac TIS:0.76 TIS 0.77 TIS 0,71 ME:1.36 ME1.34 MI:1.37 15.5vps 14.1vps 17.0vps 955 95% 95% 40 4D Mid Mid GB DREO -13dB/DR60 MPR TS Vot TE C Low General PRE 5102 20 . CADA Lead Il Live 4D color Doppler imaging the mitral 4D Zoom + color Doppler imaging of 4D Zoom + color Doppler imaging of the valve at 15 vps prosthetic mitral valve paravalvular leak at aortic valve at 17 vps 14 vps 93 Unrestricted © Siemens Healthineers, 2025 Speaker Notes: • Even with larger color ROI boxes, 4D+color on the Origin system maintains clinically relevant volume rates, providing clinically relevant and physiologically accurate detail. • Real-time 4D volume color Doppler with a superior volume rate provides the clinician with valuable information about the leak for diagnosis and/or intervention. Notes No. 93 SIEMENS Healthineers To learn about cropping, display and analysis, continue to the SIEMENS . Healthineers ACUSON Origin Fundamentals of 4D cardiac imaging, part II presentation! 1 2 3 4 ET Optimization Mode selection Cropping Display and analysis • 2D • Bi-plane • 4D • Live 4D • Color Doppler • 4D Zoom • 4D+Color 94 Unrestricted © Siemens Healthineers, 2025 Notes No. 94 SIEMENS Healthineers Thank you for your enthusiasm! SIEMENS . Healthineers Questions? 95 Unrestricted © Siemens Healthineers, 2025 Notes No. 95 SIEMENS Healthineers References SIEMENS . Healthineers 1. Mohamed, F., and Vei Siang, C. (2019). A Survey on 3D Ultrasound Reconstruction Techniques. IntechOpen. doi: 10.5772/intechopen.81628 2. Huang, Qinghua, Zeng, Zhaozheng, A Review on Real-Time 3D Ultrasound Imaging Technology, BioMed Research International, 2017, 6027029, 20 pages, 2017. https://doi.org/10.1155/2017/6027029 3. JDMS 21:392–399 September/October 2005. 4. Lang et al. J Am Soc Echocardiogr 2012. 5. C. Mitchell et al. J Am Soc Echocardiography 2018. https://doi.org/10.1016/j.echo.2018.06.004 6. J Am Soc Echocardiogr 2012;25:3-46. doi: 10.1016/j.echo.2011.11.010. 7. EuroIntervention 2022;17:1205-1226. 8. JACC Vol. 48, No. 10 2006:2053–69 doi:10.1016/j.jacc.2006.07.047. 96 Unrestricted © Siemens Healthineers, 2025 Notes No. 96 SIEMENS Healthineers Trademarks and disclaimers The products/features mentioned in this document may not be commercially available in all countries. Due to regulatory reasons their future availability cannot be guaranteed. Please contact your local Siemens Healthineers organization for further details. 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 trademarks are the property of their respective owners. Siemens Healthineers owns the rights to all images. At Siemens Healthineers, we pioneer breakthroughs in healthcare. For everyone. Everywhere. Sustainably. As a leader in medical technology, we want to advance a world in which breakthroughs in healthcare create new possibilities with a minimal impact on our planet. By consistently bringing innovations to the market, we enable healthcare professionals to innovate personalized care, achieve operational excellence, and transform the system Origin of care. Our portfolio, spanning in vitro and in vivo diagnostics to image-guided therapy and cancer care, is crucial for clinical decision making and treatment pathways. With the unique combination of our strengths in patient twinning1, precision therapy, as well as digital, data, and artificial intelligence (AI), we are well positioned to take on the greatest challenges in healthcare. We will continue to build on these strengths to help overcome the world's most threatening diseases, enable efficient operations, and expand access to care. We are a team of more than 71,000 Healthineers in over 70 countries passionately pushing the boundaries of what is possible in healthcare to help improve the lives of people around the world. Siemens Healthineers Headquarters Manufacturer Siemens Healthineers AG Siemens Medical Solutions USA, Inc. Siemensstr. 3 Ultrasound 91301 Forchheim, Germany 22010 S.E. 51st Street Phone: +49 9191 18-0 Issaquah, WA 98029, USA siemens-healthineers.com Phone: 1-888-826-9702 siemens-heathineers.com/ultrasound Unrestricted © Siemens Healthineers, 2025